DHS Further Analysis Reports No. 108 - This report examines levels, trends, and inequalities in maternal health in Rwanda from 2010 to 2014-15 among women age 15-49 with a recent birth. The analysis uses Demographic and Health Survey (DHS) data for 15 key indicators of maternal health: 6 for antenat...al care, 3 for delivery, 1 for postnatal care, and 5 for barriers to accessing medical care. Levels and trends in these indicators were analyzed overall and by three background characteristics: women’s education, household wealth quintile, and region.
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DHS Working Papers No. 105 - Rwanda has developed and implemented many strategies at the national level to reduce the incidence of HIV in the general population. One of the main objectives of such interventions is to improve the general level of knowledge of HIV, with the hypothesis that increasing... HIV knowledge will reduce risky sexual behavior. However, there has been a concern that HIV knowledge may not necessarily reduce risky sexual behavior. Only a limited number of population-based studies describe the results of these interventions in terms of how HIV knowledge affects risky sexual behavior. Therefore, the aim of this paper is to fill in this gap, by exploring HIV knowledge and its effect on risky sexual behavior among men in Rwanda.
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This report investigates the impact of potential misclassification of samples on HIV prevalence estimates for 23 surveys conducted from 2010-2014. In addition to visual inspection of laboratory results, we examined how accounting for potential misclassification of HIV status through Bayesian latent ...class models affected the prevalence estimates. Two types of Bayesian models were specified: a model that only uses the individual dichotomous test results and a continuous model that uses the quantitative information of the EIA (i.e., the signal-to-cutoff values). Overall, we found that adjusted prevalence estimates matched the surveys’ original results, with overlapping uncertainty intervals. This suggested that misclassification of HIV status should not affect the prevalence estimates in most surveys. However, our analyses suggested that two surveys may be problematic. The prevalence could have been overestimated in the Uganda AIDS Indicator Survey 2011 and the Zambia Demographic and Health Survey 2013-14, although the magnitude of overestimation remains difficult to ascertain. Interpreting results from the Uganda survey is difficult because of the lack of internal quality control and potential violation of the multivariate normality assumption of the continuous Bayesian latent class model. In conclusion, despite the limitations of our latent class models, our analyses suggest that prevalence estimates from most of the surveys reviewed are not affected by sample misclassification.
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DHS Further Analysis Reports No. 111
This study is a theory-driven analysis of the socio-demographic determinants of maternal care seeking in Kenya. Specifically, it examines predisposing, enabling, and need factors potentially associated with use of antenatal care (ANC), health facility delive...ry, and timely postnatal care (PNC).
This study uses data from the 2014 Kenya Demographic and Health Survey (KDHS) conducted among women age 15-49 with a live birth in the five years preceding the survey. It includes data from all 47 counties of Kenya, grouped contiguously into 12 regions. We apply Andersen’s Behavioral Model of Health Services Use to examine socio-demographic predictors of health service use. We estimate logistic regression models for adequate use of ANC (defined as attending at least four ANC visits, starting in the first three months of pregnancy), delivery in a health facility, and PNC within 48 hours of delivery.
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DHS Methodological Report No. 20
This study used Service Provision Assessment (SPA) and Demographic and Health Survey (DHS) data from Haiti, Malawi, and Tanzania to compare traditionally used additive methods with a data reduction method—principal component analysis (PCA).
We scored ...the quality of health facilities with three approaches (simple additive, weighted additive, and PCA) for two constructs: quality of services, with only facilities-level data, and quality of care, which incorporates observation and client data. We ranked facilities as high, medium, or low quality based on their scores. Our results indicated that the rankings change with the scoring methodology. There was more consistency in the rankings of facilities by the simple additive and PCA methods than the weighted additive and PCA-based rankings. This may be due to the low factor loadings and little variance explained by the first component in the PCA. We aggregated facility scores to their respective DHS clusters (Haiti, Malawi) or regions (Tanzania) and geographically linked them to women interviewed in DHS surveys to test associations between the use of family planning services and the quality environment, as measured with each index.
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A discussion paper on the scope of the problem, its drivers, and strategies for moving forward for policy, practice, and research
In many protracted emergencies, the prevalence rates of global acute malnutrition (GAM) regularly exceed the emergency threshold of > 15% of children with acute malnutri...tion (< -2 weight-for-height z-scores (WHZ) or with nutritional edema), despite ongoing humanitarian interventions. The widespread scale and long-lasting nature of “persistent GAM” means that it is a policy and programming priority.
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The objective of the evaluation is to understand whether the CHW program has achieved its intended objectives, thus contributing to the overarching objectives defined in the HSSP III of improving the health status of the population by “Ensuring universal accessibility of quality health services fo...r all Rwandans”.
This evaluation has focused on CHWs, who are selected, trained and deployed by the MoH to deliver a defined set of tasks at community level. CHWs are the central element of the Community Health Policy and of the community health strategy plan (CHSP) of the MoH.
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The purpose of this report is to provide an overview of the issues in regulating and managing international emergency in a selection of large and small-scale sudden onset disasters (SODs). In doing so, it aims to contribute to several key international commitments as well as its objective in disaste...rs and emergencies to “reduce the consequences the event may have on world health and its social and economic implications”.
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Ethiopia met the MDG target for drinking water access with a unique and high degree of success. The magnitude of the country’s success in providing improved drinking water to nearly half of its population in 25 years despite its diversity, size, and challenges cannot be overstated. This case study... documents the progress of the Ethiopian WASH sector from 1990 to 2015, and analyzes the impact of local systems created in Ethiopia to respond to water and sanitation challenges.
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Democratic dispensation in 1994 created a political and social platform that reshaped life in South Africa. There was a surge in common belief that the inequity and wrong of Apartheid should and could be rectified. Equity of access to water and sanitation were obvious targets for improvement. In 199...4, an estimated 14–15 million South Africans were without access to an improved water supply, while close to 21 million - more than half of the population at that time - did not have access to improved sanitation facilities. These problems were most severe in poorer rural areas. The water and sanitation sector became unified by the vision of universal access for all South Africans. This case study documents the progression of the sector between 1994 and 2016, and analyzes the impact of local systems created in South Africa to respond to the water and sanitation challenge.
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In April 2018, Refugees International (RI) conducted a mission to Bangladesh, to research the GBV (gender-based violence) response for Rohingya women and girls. RI found that the entire humanitarian system is struggling under tremendous constraints in Bangladesh, and protection and health actors do ...deliver lifesaving services to survivors in an incredibly challenging environment. This report, however, focuses on key gaps and challenges in GBV programming, as communicated by practitioners deployed to Bangladesh at various stages of the emergency, by local organizations, and by the affected women and girls themselves.
In the analyses and recommendations provided in this report, RI draws in part from the framework of the international initiative to safeguard women and girls in emergencies — the Call to Action on Protection from Gender-Based Violence in Emergencies — and urges the donors and humanitarian organizations that are Call to Action partners to implement it more effectively and with urgency during this emergency.
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The USAID | DELIVER PROJECT, Task Order 4, developed this guide for quantifying health commodities; it will assist technical advisors, program managers, warehouse managers, procurement officers, and service providers in (1) estimating the total commodity needs and costs for successful implementation... of national health program strategies and goals, (2) identifying the funding needs and gaps for procuring the required commodities, and (3) planning procurements and shipment delivery schedules to ensure a sustained and effective supply of health commodities.
The step-by-step approach to quantification presented in this guide is complemented by a set of product-specific companion pieces that include detailed instructions for forecasting consumption of antiretroviral drugs, HIV test kits, antimalarial drugs, and laboratory supplies.
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No publication year indicated
This manual is intended to enable WASH practitioners
who work in Mozambique to contribute to the
reduction of WASH-preventable NTDs.
As part of an ongoing effort to promote disability-inclusive humanitarian action in Pacific countries, this policy brief identifies priority actions for disaster readiness, response and recovery. It has been prepared through a collaborative approach and should be a key reference in the future, promo...ting coordination across all levels and stages of the humanitarian cycle in the Region.
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User satisfaction with assistive devices is a predictor of use and an important outcome measure. This study evaluated client satisfaction with prosthetic and orthotic assistive devices and services in three provinces in the Lao People’s Democratic Republic. Clients were quite satisfied with the as...sistive device and services provided, yet many reported barriers to optimal device use and difficulties in accessing follow-up services. There is a need to examine how prosthetic and orthotic devices can be improved further for better comfort and ambulation on uneven ground in low-resource contexts and to address access barriers.
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