This report presents further analysis of the 2015 Nepal Health Facility Survey. Data analysis is based on the Donabedian framework for assessing quality of care in health services, which divides the
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indicators into three groups: structure, process, and outcome. The World Health Organization Service Availability and Readiness Assessment (SARA) indicator guideline was used to assess facility service readiness, service quality and client satisfaction with maternal health services. The study performed both bivariate and multivariate regression analysis to examine the association of maternal health service readiness and quality indicators with client satisfaction.
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Infant Psychiatry
Chapter B.1
Early Maltreatment and exposure to violence
Alcohol misuses
Substance use disorders
Chapter G.1
Externalizing disorders
Chapter D.1
Attention deficit hyperactivity disorder
DHS Working Papers No. 98.
Submitted to the US Agency for International Development by the
Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program.
This manual provides a framework to identify problems and
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design interventions to improve access to and use of medicines for children. It is a resource for both health policy makers and health system managers and presents a structured approach to the steps introduced in the framework in the context of child health.
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DHS Working Papers No. 106
Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of
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a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
Methods: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.
Findings: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
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The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD)
DHS Further Analysis Reports No. 97
What We Know, What We Don’t Know, and What We Need to Do
Model Chapter for textbooks for medical students and allied health professionals
DHS Further Analysis Reports No. 103