Factors associated with maternal healthcare services utilization in nine high focus states in India: a multilevel analysis based on 14 385 communities in 292 districts.

PubMed

Singh, Prashant Kumar; Kumar, Chandan; Rai, Rajesh Kumar; Singh, Lucky

2014-08-01

Studies have often ignored examining the role of community- and district-level factors in the utilization of maternity healthcare services, particularly in Indian contexts. The Social Determinants of Health framework emphasizes the role of governance and government policies, the measures for which are rarely incorporated in single-level individual analysis. This study examines factors associated with maternal healthcare utilization in nine high focus states in India, which shares more than half of the total maternal deaths in the country; accounting for individual-, household-, community- and district-level characteristics. The required data are extracted from the third round of the nationally representative District Level Household and Facility Survey conducted during 2007-08. Multilevel analyses were applied to three maternity outcomes, namely, four or more antenatal care visits, skilled birth attendance and post-natal care after birth. Results show that along with individual-/household-level factors, community and district-level factors influence the pattern of utilization of maternal healthcare services significantly. At the community level, the odds of maternal healthcare utilization were lower in rural areas and in communities with a high concentration of poor and illiterate women. Moreover, the average population coverage of primary health centres (PHCs), availability of labour room in PHC and percentage of registered pregnancies were significant factors at the district level that influenced the use of maternity care services. The study also found a strong association between the extent of previous use of maternal healthcare and its effect on subsequent usage patterns. This study highlights the role of strengthening public health infrastructure at district level in the study area, and promoting awareness about available healthcare services and subsidized schemes in the community. To reach out to rural and underprivileged communities and to apply a participatory approach from the programme officials are issues to delve into. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

From papers to practices: district level priority setting processes and criteria for family planning, maternal, newborn and child health interventions in Tanzania.

PubMed

Chitama, Dereck; Baltussen, Rob; Ketting, Evert; Kamazima, Switbert; Nswilla, Anna; Mujinja, Phares G M

2011-10-21

Successful priority setting is increasingly known to be an important aspect in achieving better family planning, maternal, newborn and child health (FMNCH) outcomes in developing countries. However, far too little attention has been paid to capturing and analysing the priority setting processes and criteria for FMNCH at district level. This paper seeks to capture and analyse the priority setting processes and criteria for FMNCH at district level in Tanzania. Specifically, we assess the FMNCH actor's engagement and understanding, the criteria used in decision making and the way criteria are identified, the information or evidence and tools used to prioritize FMNCH interventions at district level in Tanzania. We conducted an exploratory study mixing both qualitative and quantitative methods to capture and analyse the priority setting for FMNCH at district level, and identify the criteria for priority setting. We purposively sampled the participants to be included in the study. We collected the data using the nominal group technique (NGT), in-depth interviews (IDIs) with key informants and documentary review. We analysed the collected data using both content analysis for qualitative data and correlation analysis for quantitative data. We found a number of shortfalls in the district's priority setting processes and criteria which may lead to inefficient and unfair priority setting decisions in FMNCH. In addition, participants identified the priority setting criteria and established the perceived relative importance of the identified criteria. However, we noted differences exist in judging the relative importance attached to the criteria by different stakeholders in the districts. In Tanzania, FMNCH contents in both general development policies and sector policies are well articulated. However, the current priority setting process for FMNCH at district levels are wanting in several aspects rendering the priority setting process for FMNCH inefficient and unfair (or unsuccessful). To improve district level priority setting process for the FMNCH interventions, we recommend a fundamental revision of the current FMNCH interventions priority setting process. The improvement strategy should utilize rigorous research methods combining both normative and empirical methods to further analyze and correct past problems at the same time use the good practices to improve the current priority setting process for FMNCH interventions. The suggested improvements might give room for efficient and fair (or successful) priority setting process for FMNCH interventions.

Decision-Making, Information Communication Technology, and Data Analysis by School Leaders about Student Achievement

ERIC Educational Resources Information Center

Akoma, Ahunna Margaux

2012-01-01

This case study of one school district examined how school leaders use student performance data and technology-based data analysis tools to engage in data-informed decision-making for continuous improvement. School leaders in this context included leaders at the district, school, and classroom levels. An extensive literature review provided the…

Variation in cervical and breast cancer screening coverage in England: a cross-sectional analysis to characterise districts with atypical behaviour

PubMed Central

Massat, Nathalie J; Douglas, Elaine; Waller, Jo; Wardle, Jane; Duffy, Stephen W

2015-01-01

Objectives Reducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions where coverage is low. This study aimed to characterise districts with atypical coverage levels for cervical or breast screening. Design Observational study of district-level coverage in the English Cervical and Breast screening programmes in 2012. Setting England, UK. Participants All English women invited to participate in the cervical (age group 25–49 and 50–64) and breast (age group 50–64) screening programmes. Outcomes Risk adjustment models for coverage were developed based on district-level characteristics. Funnel plots of adjusted coverage were constructed, and atypical districts examined by correlation analysis. Results Variability in coverage was primarily explained by population factors, whereas general practice characteristics had little independent effect. Deprivation and ethnicity other than white, Asian, black or mixed were independently associated with poorer coverage in both screening programmes, with ethnicity having the strongest effect; by comparison, the influence of Asian, black or mixed ethnic minority was limited. Deprivation, ethnicity and urbanisation largely accounted for the lower cervical screening coverage in London. However, for breast screening, being located in London remained a strong negative predictor. A subset of districts was identified as having atypical coverage across programmes. Correlates of deprivation in districts with relatively low adjusted coverage were substantially different from overall correlates of deprivation. Discussion These results inform the continuing drive to reduce avoidable cancer deaths in England, and encourage implementation of targeted interventions in communities residing in districts identified as having atypically low coverage. Sequential implementation to monitor the impact of local interventions would help accrue evidence on ‘what works’. PMID:26209119

WWC Quick Review of the Report "Charter School Performance in Los Angeles Unified School District: A District and Neighborhood Matched Comparison Analysis"

ERIC Educational Resources Information Center

What Works Clearinghouse, 2008

2008-01-01

The study examined whether charter schools have higher growth in student achievement than traditional public schools. The study analyzed data on 79 charter schools and 593 traditional public elementary, middle, and high schools in the Los Angeles Unified School District from 2005-06 to 2006-07. School-level academic achievement was measured using…

Arsenic contamination in the Kanker district of central-east India: geology and health effects.

PubMed

Pandey, P K; Sharma, R; Roy, M; Roy, S; Pandey, M

2006-10-01

This paper identifies newer areas of arsenic contamination in the District Kanker, which adjoins the District Rajnandgaon where high contamination has been reported earlier. A correlation with the mobile phase episodes of arsenic contamination has been identified, which further hinges on the complex geology of the area. Arsenic concentrations in both surface and groundwater, aquatic organisms (snail and water weeds) soil and vegetation of Kanker district and its adjoining area have been reported here. The region has been found to contain an elevated level of arsenic. All segments of the ecoysystem are contaminated with arsenic at varying degrees. The levels of arsenic vary constantly depending on the season and location. An analysis of groundwater from 89 locations in the Kanker district has shown high values of arsenic, iron and manganese (mean: 144, 914 and 371 microg L(-1), respectively). The surface water of the region shows elevated levels of arsenic, which is influenced by the geological mineralised zonation. The most prevalent species in the groundwater is As(III), whereas the surface water of the rivers shows a significant contamination with the As(V) species. The analysis shows a bio-concentration of the toxic metals arsenic, nickel, copper and chromium. Higher arsenic concentrations (groundwater concentrations greater than 50 microg L(-1)) are associated with sedimentary deposits derived from volcanic rocks, hence mineral leaching appears to be the source of arsenic contamination. Higher levels of arsenic and manganese in the Kanker district have been found to cause impacts on the flora and fauna. A case study of episodic arsenical diarrhoea is presented.

Healthier Fundraising in U. S. Elementary Schools: Associations between Policies at the State, District, and School Levels

PubMed Central

Turner, Lindsey; Chriqui, Jamie F.; Chaloupka, Frank J.

2012-01-01

Objectives We examined whether state laws and district policies pertaining to nutritional restrictions on school fundraisers were associated with school policies as reported by administrators in a nationally-representative sample of United States public elementary schools. Methods We gathered data on school-level fundraising policies via a mail-back survey during the 2009–10 and 2010–11 school years. Surveys were received from 1,278 public elementary schools (response rate = 60.9%). Data were also gathered on corresponding school district policies and state laws. After removing cases with missing data, the sample size for analysis was 1,215 schools. Results After controlling for school characteristics, school policies were consistently associated with state laws and district policies, both those pertaining to fundraising generally, as well as specific restrictions on the sale of candy and soda in fundraisers (all Odds Ratios >2.0 and Ps<.05). However, even where district policies and state laws required fundraising restrictions, school policies were not uniformly present; school policies were also in place at only 55.8% of these schools, but were more common at schools in the West (77.1%) and at majority-Latino schools (71.4%), indicating uneven school-level implementation of district policy and state law. Conclusions District policies and state laws were associated with a higher prevalence of elementary school-level fundraising policies, but many schools that were subject to district policies and state laws did not have school-level restrictions in place, suggesting the need for further attention to factors hindering policy implementation in schools. PMID:23166788

Healthier fundraising in U. S. elementary schools: associations between policies at the state, district, and school levels.

PubMed

Turner, Lindsey; Chriqui, Jamie F; Chaloupka, Frank J

2012-01-01

We examined whether state laws and district policies pertaining to nutritional restrictions on school fundraisers were associated with school policies as reported by administrators in a nationally-representative sample of United States public elementary schools. We gathered data on school-level fundraising policies via a mail-back survey during the 2009-10 and 2010-11 school years. Surveys were received from 1,278 public elementary schools (response rate = 60.9%). Data were also gathered on corresponding school district policies and state laws. After removing cases with missing data, the sample size for analysis was 1,215 schools. After controlling for school characteristics, school policies were consistently associated with state laws and district policies, both those pertaining to fundraising generally, as well as specific restrictions on the sale of candy and soda in fundraisers (all Odds Ratios >2.0 and Ps<.05). However, even where district policies and state laws required fundraising restrictions, school policies were not uniformly present; school policies were also in place at only 55.8% of these schools, but were more common at schools in the West (77.1%) and at majority-Latino schools (71.4%), indicating uneven school-level implementation of district policy and state law. District policies and state laws were associated with a higher prevalence of elementary school-level fundraising policies, but many schools that were subject to district policies and state laws did not have school-level restrictions in place, suggesting the need for further attention to factors hindering policy implementation in schools.

Prevalence and correlates of hypertension in Maharashtra, India: A multilevel analysis

PubMed Central

Bhise, Mahadev D.

2018-01-01

Background and aim In the last few decades, the prevalence of hypertension has been drastically increased in India. The present study estimates the current prevalence of hypertension and its correlates in the state of Maharashtra. The variation in the prevalence of hypertension associated with individual-level characteristics is explained at the community and district level. Methods Data is used from the recent round of District Level Household & Facility Survey (DLHS-4), 2012–13. The DLHS-4 has used the nationally representative sample, collected through multistage stratified sampling procedure. A similar sampling frame, used in NSSO-2007-08, has been followed. The chi-square test is used to show the significance level of the association between the estimated prevalence of hypertension and its correlates. Multilevel regression analysis is carried out to investigate the effects of individual and community level factors on the prevalence of hypertension. Results The overall prevalence of hypertension is 25% in Maharashtra, and a huge variation in the prevalence of hypertension is found across the districts. Dhule, Gadchiroli (with a low HDI rank), Mumbai and Satara (with higher HDI rank) are the districts with the higher (above 30%) prevalence of high blood pressure. The prevalence also significantly varies according to different correlates. The prevalence of high blood pressure is higher among elderly population (40%), among males (28%), in the urban areas (27%) and in the richest wealth quintile (28%). The prevalence is also higher among cigarette smokers (31%), alcohol consumers (30%) and people with obesity (38%) as compared to their counterparts. The results of the multilevel analysis show that the older and obese persons are at four-time higher risk of hypertension. Again, age, sex, marital status, place of residence, wealth status, unhealthy habits (i.e. smoking and alcohol consumption) and BMI are significantly associated with hypertension. The results of VPC statistics show that 14% of hypertension prevalence could be attributed to differences at the community level. Conclusion The prevalence of hypertension largely varies in the districts of Maharashtra irrespective of their level of socio-economic development (i.e. HDI rank). The variation in the rate of prevalence of hypertension is higher in the community (PSU) level as compared to the variation in the prevalence rate at the district level. Hypertension is attributable to the modifiable factors like risky lifestyle practices. PMID:29401464

Prevalence and correlates of hypertension in Maharashtra, India: A multilevel analysis.

PubMed

Bhise, Mahadev D; Patra, Shraboni

2018-01-01

In the last few decades, the prevalence of hypertension has been drastically increased in India. The present study estimates the current prevalence of hypertension and its correlates in the state of Maharashtra. The variation in the prevalence of hypertension associated with individual-level characteristics is explained at the community and district level. Data is used from the recent round of District Level Household & Facility Survey (DLHS-4), 2012-13. The DLHS-4 has used the nationally representative sample, collected through multistage stratified sampling procedure. A similar sampling frame, used in NSSO-2007-08, has been followed. The chi-square test is used to show the significance level of the association between the estimated prevalence of hypertension and its correlates. Multilevel regression analysis is carried out to investigate the effects of individual and community level factors on the prevalence of hypertension. The overall prevalence of hypertension is 25% in Maharashtra, and a huge variation in the prevalence of hypertension is found across the districts. Dhule, Gadchiroli (with a low HDI rank), Mumbai and Satara (with higher HDI rank) are the districts with the higher (above 30%) prevalence of high blood pressure. The prevalence also significantly varies according to different correlates. The prevalence of high blood pressure is higher among elderly population (40%), among males (28%), in the urban areas (27%) and in the richest wealth quintile (28%). The prevalence is also higher among cigarette smokers (31%), alcohol consumers (30%) and people with obesity (38%) as compared to their counterparts. The results of the multilevel analysis show that the older and obese persons are at four-time higher risk of hypertension. Again, age, sex, marital status, place of residence, wealth status, unhealthy habits (i.e. smoking and alcohol consumption) and BMI are significantly associated with hypertension. The results of VPC statistics show that 14% of hypertension prevalence could be attributed to differences at the community level. The prevalence of hypertension largely varies in the districts of Maharashtra irrespective of their level of socio-economic development (i.e. HDI rank). The variation in the rate of prevalence of hypertension is higher in the community (PSU) level as compared to the variation in the prevalence rate at the district level. Hypertension is attributable to the modifiable factors like risky lifestyle practices.

An Analysis on Dropout Levels of Public Secondary Schools in Kericho District in Relation to Selected School Characteristics

ERIC Educational Resources Information Center

Sang, Anthony K. A.; Koros, Peter K. A.; Bosire, Joseph N.

2013-01-01

The Education Sector in Kenya and other parts of the world has faced many challenges particularly dropouts, which is an indicator of low internal efficiency during the past two decades. This study sought to determine and analyze the dropout levels of Public Secondary Schools in Kericho District of Kenya for the period between 2004 and 2007. The…

Flood Disaster Analysis Using Landsat-8 and SPOT-6 Imagery for Determination of Flooded Areas in Sampang, Madura

NASA Astrophysics Data System (ADS)

Sukojo, B. M.; Alfiansyah, F.

2017-12-01

Based on data of disaster which is defaced by Badan Penanggulangan Bencana Daerah (BPBD) of Sampang that in the period of 2015 - 2017 as many as 25 cases from 31 cases of disaster caused by flood disaster or 80.65% from total disaster. Therefore, the purpose of this research is to create a map of flood vulnerability in Sampang. From the vulnerability map, we can know the area with the impacted flood level in Sampang so that from the map of flood affected areas can be known the extent of the affected area in each class. In this study, two Landsat-8 and SPOT 6 data were used. For Landsat-8 imagery used for land cover on district level disaster level vulnerability maps, while high-resolution SPOT-6 images were used for land cover making maps of flood affected areas Sampang district. With the flood affected areas in this study, it is expected to be used as a determinant of flood affected areas in Sampang district. Based on data processing and analysis it is found that the highest impacted area is located in Sampang district with 12 cases of 17 cases of total flood disaster in Sampang district based on data from BPBD Kabupaten Sampang in 2016. There are 4 classes of flood affected areas in Sampang district i.e. not affected by 9039,540 ha, low impact 46262.881 ha, medium impact 43012.431 ha and high impact of 14009,760 ha.

Spatial Patterns of Heat-Related Cardiovascular Mortality in the Czech Republic

PubMed Central

Urban, Aleš; Burkart, Katrin; Kyselý, Jan; Schuster, Christian; Plavcová, Eva; Hanzlíková, Hana; Štěpánek, Petr; Lakes, Tobia

2016-01-01

The study examines spatial patterns of effects of high temperature extremes on cardiovascular mortality in the Czech Republic at a district level during 1994–2009. Daily baseline mortality for each district was determined using a single location-stratified generalized additive model. Mean relative deviations of mortality from the baseline were calculated on days exceeding the 90th percentile of mean daily temperature in summer, and they were correlated with selected demographic, socioeconomic, and physical-environmental variables for the districts. Groups of districts with similar characteristics were identified according to socioeconomic status and urbanization level in order to provide a more general picture than possible on the district level. We evaluated lagged patterns of excess mortality after hot spell occurrences in: (i) urban areas vs. predominantly rural areas; and (ii) regions with different overall socioeconomic level. Our findings suggest that climatic conditions, altitude, and urbanization generally affect the spatial distribution of districts with the highest excess cardiovascular mortality, while socioeconomic status did not show a significant effect in the analysis across the Czech Republic as a whole. Only within deprived populations, socioeconomic status played a relevant role as well. After taking into account lagged effects of temperature on excess mortality, we found that the effect of hot spells was significant in highly urbanized regions, while most excess deaths in rural districts may be attributed to harvesting effects. PMID:26959044

Operation Pied Piper: a geographical reappraisal of the impact of wartime evacuation on scarlet fever and diphtheria rates in England and Wales, 1939-1945.

PubMed

Smallman-Raynor, M R; Cliff, A D

2015-10-01

This paper examines the geographical impact of the British Government's wartime evacuation scheme on notified rates of two common acute childhood diseases (scarlet fever and diphtheria) in the 1470 local government districts of England and Wales, 1939-1945. Drawing on the notifications of communicable diseases collated by the General Register Office (GRO), we establish pre-war (baseline) disease rates for the 1470 districts. For the war years, techniques of binary logistic regression analysis are used to assess the associations between (a) above-baseline ('raised') disease rates in evacuation, neutral and reception districts and (b) the major phases of the evacuation scheme. The analysis demonstrates that the evacuation was temporally associated with distinct national and regional effects on notified levels of disease activity. These effects were most pronounced in the early years of the dispersal (1939-1941) and corresponded with initial levels of evacuation-related population change at the regional and district scales.

Heat Wave Vulnerability Mapping for India.

PubMed

Azhar, Gulrez; Saha, Shubhayu; Ganguly, Partha; Mavalankar, Dileep; Madrigano, Jaime

2017-03-30

Assessing geographic variability in heat wave vulnerability forms the basis for planning appropriate targeted adaptation strategies. Given several recent deadly heatwaves in India, heat is increasingly being recognized as a public health problem. However, to date there has not been a country-wide assessment of heat vulnerability in India. We evaluated demographic, socioeconomic, and environmental vulnerability factors and combined district level data from several sources including the most recent census, health reports, and satellite remote sensing data. We then applied principal component analysis (PCA) on 17 normalized variables for each of the 640 districts to create a composite Heat Vulnerability Index (HVI) for India. Of the total 640 districts, our analysis identified 10 and 97 districts in the very high and high risk categories (> 2SD and 2-1SD HVI) respectively. Mapping showed that the districts with higher heat vulnerability are located in the central parts of the country. On examination, these are less urbanized and have low rates of literacy, access to water and sanitation, and presence of household amenities. Therefore, we concluded that creating and mapping a heat vulnerability index is a useful first step in protecting the public from the health burden of heat. Future work should incorporate heat exposure and health outcome data to validate the index, as well as examine sub-district levels of vulnerability.

Variations in the prevalence of antibody to brucella infection in cattle by farm, area and district in Kenya.

PubMed Central

Kadohira, M.; McDermott, J. J.; Shoukri, M. M.; Kyule, M. N.

1997-01-01

Variations in the sero-prevalence of antibody to brucella infection by cow, farm and area factors were investigated for three contrasting districts in Kenya: Samburu, an arid and pastoral area: Kiambu, a tropical highland area; and Kilifi, a typical tropical coastal area. Cattle were selected by a two-stage cluster sampling procedure and visited once between August 1991 and 1992. Schall's algorithm, a statistical model suitable for multi-level analysis was used. Using this model, older age, free grazing and large herd size (> or = 31) were associated with higher seroprevalence. Also, significant farm-to-farm, area-to-area and district-to-district variations were estimated. The patterns of high risk districts and areas seen were consistent with known animal husbandry and movement risk factors, but the larger than expected farm-to-farm variation within high risk areas and districts could not be explained. Thus, a multi-level method provided additional information beyond conventional analyses of sero-prevalence data. PMID:9042033

Health financing at district level in Malawi: an analysis of the distribution of funds at two points in time.

PubMed

Borghi, Josephine; Munthali, Spy; Million, Lameck B; Martinez-Alvarez, Melisa

2018-01-01

There is growing attention to tracking country level resource flows to health, but limited evidence on the sub-national allocation of funds. We examined district health financing in Malawi in 2006 and 2011, and equity in the allocation of funding, together with the association between financing and under five and neonatal mortality. We explored the process for receiving and allocating different funding sources at district level. We obtained domestic and external financing data from the Integrated Financial Management Information System (2006-11) and AidData (2000-12) databases. Out-of-pocket payment data came from two rounds of integrated household budget surveys (2005; 2010). Mortality data came from the Multiple Indicator Cluster Survey (2006) and Demographic and Health Survey (2010). We described district level health funding by source, ran correlations between funding and outcomes and generated concentration curves and indices. 41 semi-structured interviews were conducted at the national level and in 10 districts with finance and health managers. Per capita spending from all sources varied substantially across districts and doubled between 2006 and 2011 from 7181 Kwacha to 15 312 Kwacha. In 2011, external funding accounted for 74% of funds, with domestic funding accounting for 19% of expenditure, and out of pocket (OOP) funding accounting for 7%. All funding sources were concentrated among wealthier districts, with OOP being the most pro-rich, followed by domestic expenditure and external funding. Districts with higher levels of domestic and external funding had lower levels of post-neonatal mortality, and those with higher levels of out-of-pocket payments had higher levels of 1-59 month mortality in 2006. There was no association between changes in financing and outcomes. Districts reported delayed receipt of lower-than-budgeted funds, forcing them to scale-down activities and rely on external funding. Governments need to track how resources are allocated sub-nationally to maximize equity and ensure allocations are commensurate to health need. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Health financing at district level in Malawi: an analysis of the distribution of funds at two points in time

PubMed Central

Borghi, Josephine; Munthali, Spy; Million, Lameck B; Martinez-Alvarez, Melisa

2018-01-01

Abstract There is growing attention to tracking country level resource flows to health, but limited evidence on the sub-national allocation of funds. We examined district health financing in Malawi in 2006 and 2011, and equity in the allocation of funding, together with the association between financing and under five and neonatal mortality. We explored the process for receiving and allocating different funding sources at district level. We obtained domestic and external financing data from the Integrated Financial Management Information System (2006–11) and AidData (2000–12) databases. Out-of-pocket payment data came from two rounds of integrated household budget surveys (2005; 2010). Mortality data came from the Multiple Indicator Cluster Survey (2006) and Demographic and Health Survey (2010). We described district level health funding by source, ran correlations between funding and outcomes and generated concentration curves and indices. 41 semi-structured interviews were conducted at the national level and in 10 districts with finance and health managers. Per capita spending from all sources varied substantially across districts and doubled between 2006 and 2011 from 7181 Kwacha to 15 312 Kwacha. In 2011, external funding accounted for 74% of funds, with domestic funding accounting for 19% of expenditure, and out of pocket (OOP) funding accounting for 7%. All funding sources were concentrated among wealthier districts, with OOP being the most pro-rich, followed by domestic expenditure and external funding. Districts with higher levels of domestic and external funding had lower levels of post-neonatal mortality, and those with higher levels of out-of-pocket payments had higher levels of 1–59 month mortality in 2006. There was no association between changes in financing and outcomes. Districts reported delayed receipt of lower-than-budgeted funds, forcing them to scale-down activities and rely on external funding. Governments need to track how resources are allocated sub-nationally to maximize equity and ensure allocations are commensurate to health need. PMID:29088357

Benchmarking health system performance across districts in Zambia: a systematic analysis of levels and trends in key maternal and child health interventions from 1990 to 2010.

PubMed

Colson, Katherine Ellicott; Dwyer-Lindgren, Laura; Achoki, Tom; Fullman, Nancy; Schneider, Matthew; Mulenga, Peter; Hangoma, Peter; Ng, Marie; Masiye, Felix; Gakidou, Emmanuela

2015-04-02

Achieving universal health coverage and reducing health inequalities are primary goals for an increasing number of health systems worldwide. Timely and accurate measurements of levels and trends in key health indicators at local levels are crucial to assess progress and identify drivers of success and areas that may be lagging behind. We generated estimates of 17 key maternal and child health indicators for Zambia's 72 districts from 1990 to 2010 using surveys, censuses, and administrative data. We used a three-step statistical model involving spatial-temporal smoothing and Gaussian process regression. We generated estimates at the national level for each indicator by calculating the population-weighted mean of the district values and calculated composite coverage as the average of 10 priority interventions. National estimates masked substantial variation across districts in the levels and trends of all indicators. Overall, composite coverage increased from 46% in 1990 to 73% in 2010, and most of this gain was attributable to the scale-up of malaria control interventions, pentavalent immunization, and exclusive breastfeeding. The scale-up of these interventions was relatively equitable across districts. In contrast, progress in routine services, including polio immunization, antenatal care, and skilled birth attendance, stagnated or declined and exhibited large disparities across districts. The absolute difference in composite coverage between the highest-performing and lowest-performing districts declined from 37 to 26 percentage points between 1990 and 2010, although considerable variation in composite coverage across districts persisted. Zambia has made marked progress in delivering maternal and child health interventions between 1990 and 2010; nevertheless, substantial variations across districts and interventions remained. Subnational benchmarking is important to identify these disparities, allowing policymakers to prioritize areas of greatest need. Analyses such as this one should be conducted regularly and feed directly into policy decisions in order to increase accountability at the local, regional, and national levels.

Analyzing spatial clustering and the spatiotemporal nature and trends of HIV/AIDS prevalence using GIS: the case of Malawi, 1994-2010.

PubMed

Zulu, Leo C; Kalipeni, Ezekiel; Johannes, Eliza

2014-05-23

Although local spatiotemporal analysis can improve understanding of geographic variation of the HIV epidemic, its drivers, and the search for targeted interventions, it is limited in sub-Saharan Africa. Despite recent declines, Malawi's estimated 10.0% HIV prevalence (2011) remained among the highest globally. Using data on pregnant women in Malawi, this study 1) examines spatiotemporal trends in HIV prevalence 1994-2010, and 2) for 2010, identifies and maps the spatial variation/clustering of factors associated with HIV prevalence at district level. Inverse distance weighting was used within ArcGIS Geographic Information Systems (GIS) software to generate continuous surfaces of HIV prevalence from point data (1994, 1996, 1999, 2001, 2003, 2005, 2007, and 2010) obtained from surveillance antenatal clinics. From the surfaces prevalence estimates were extracted at district level and the results mapped nationally. Spatial dependency (autocorrelation) and clustering of HIV prevalence were also analyzed. Correlation and multiple regression analyses were used to identify factors associated with HIV prevalence for 2010 and their spatial variation/clustering mapped and compared to HIV clustering. Analysis revealed wide spatial variation in HIV prevalence at regional, urban/rural, district and sub-district levels. However, prevalence was spatially leveling out within and across 'sub-epidemics' while declining significantly after 1999. Prevalence exhibited statistically significant spatial dependence nationally following initial (1995-1999) localized, patchy low/high patterns as the epidemic spread rapidly. Locally, HIV "hotspots" clustered among eleven southern districts/cities while a "coldspot" captured configurations of six central region districts. Preliminary multiple regression of 2010 HIV prevalence produced a model with four significant explanatory factors (adjusted R2 = 0.688): mean distance to main roads, mean travel time to nearest transport, percentage that had taken an HIV test ever, and percentage attaining a senior primary education. Spatial clustering linked some factors to particular subsets of high HIV-prevalence districts. Spatial analysis enhanced understanding of local spatiotemporal variation in HIV prevalence, possible underlying factors, and potential for differentiated spatial targeting of interventions. Findings suggest that intervention strategies should also emphasize improved access to health/HIV services, basic education, and syphilis management, particularly in rural hotspot districts, as further research is done on drivers at finer scale.

Analyzing spatial clustering and the spatiotemporal nature and trends of HIV/AIDS prevalence using GIS: the case of Malawi, 1994-2010

PubMed Central

2014-01-01

Background Although local spatiotemporal analysis can improve understanding of geographic variation of the HIV epidemic, its drivers, and the search for targeted interventions, it is limited in sub-Saharan Africa. Despite recent declines, Malawi’s estimated 10.0% HIV prevalence (2011) remained among the highest globally. Using data on pregnant women in Malawi, this study 1) examines spatiotemporal trends in HIV prevalence 1994-2010, and 2) for 2010, identifies and maps the spatial variation/clustering of factors associated with HIV prevalence at district level. Methods Inverse distance weighting was used within ArcGIS Geographic Information Systems (GIS) software to generate continuous surfaces of HIV prevalence from point data (1994, 1996, 1999, 2001, 2003, 2005, 2007, and 2010) obtained from surveillance antenatal clinics. From the surfaces prevalence estimates were extracted at district level and the results mapped nationally. Spatial dependency (autocorrelation) and clustering of HIV prevalence were also analyzed. Correlation and multiple regression analyses were used to identify factors associated with HIV prevalence for 2010 and their spatial variation/clustering mapped and compared to HIV clustering. Results Analysis revealed wide spatial variation in HIV prevalence at regional, urban/rural, district and sub-district levels. However, prevalence was spatially leveling out within and across ‘sub-epidemics’ while declining significantly after 1999. Prevalence exhibited statistically significant spatial dependence nationally following initial (1995-1999) localized, patchy low/high patterns as the epidemic spread rapidly. Locally, HIV “hotspots” clustered among eleven southern districts/cities while a “coldspot” captured configurations of six central region districts. Preliminary multiple regression of 2010 HIV prevalence produced a model with four significant explanatory factors (adjusted R2 = 0.688): mean distance to main roads, mean travel time to nearest transport, percentage that had taken an HIV test ever, and percentage attaining a senior primary education. Spatial clustering linked some factors to particular subsets of high HIV-prevalence districts. Conclusions Spatial analysis enhanced understanding of local spatiotemporal variation in HIV prevalence, possible underlying factors, and potential for differentiated spatial targeting of interventions. Findings suggest that intervention strategies should also emphasize improved access to health/HIV services, basic education, and syphilis management, particularly in rural hotspot districts, as further research is done on drivers at finer scale. PMID:24886573

Is wealthier always healthier in poor countries? The health implications of income, inequality, poverty, and literacy in India.

PubMed

Rajan, Keertichandra; Kennedy, Jonathan; King, Lawrence

2013-07-01

Standard policy prescriptions for improving public health in less developed countries (LDCs) prioritise raising average income levels over redistributive policies since it is widely accepted that 'wealthier is healthier'. It is argued that income inequality becomes a significant predictor of public health only after the 'epidemiological transition'. This paper tests this theory in India, where rising income levels have not been matched by improvements in public health. We use state-, district-, and individual-level data to investigate the relationship between infant and under-five mortality, and average income, poverty, income inequality, and literacy. Our analysis shows that at both state- and district-level public health is negatively associated with average income and positively associated with poverty. But, at both levels, controlling for poverty and literacy renders average income statistically insignificant. At state-level, only literacy remains a significant and negative predictor. At the less aggregated district-level, both poverty and literacy predict public health but literacy has a stronger effect than poverty. Inequality does not predict public health at state- or district-levels. At the individual-level, however, it is a strong predictor of self-reported ailment, even after we control for district average income, individual income, and individual education. Our analysis suggests that wealthier is indeed healthier in India - but only to the extent that high average incomes reflect low poverty and high literacy. Furthermore, inequality has a strong effect on self-reported health. Standard policy prescriptions, then, need revision: first, alleviating poverty may be more effective than raising average income levels; second, non-income goods like literacy may make an important contribution to public health; and third, policy should be based on a broader understanding of societal well-being and the factors that promote it. Copyright © 2013 Elsevier Ltd. All rights reserved.

Assessment of Yellow Fever Epidemic Risk: An Original Multi-criteria Modeling Approach

PubMed Central

Briand, Sylvie; Beresniak, Ariel; Nguyen, Tim; Yonli, Tajoua; Duru, Gerard; Kambire, Chantal; Perea, William

2009-01-01

Background Yellow fever (YF) virtually disappeared in francophone West African countries as a result of YF mass vaccination campaigns carried out between 1940 and 1953. However, because of the failure to continue mass vaccination campaigns, a resurgence of the deadly disease in many African countries began in the early 1980s. We developed an original modeling approach to assess YF epidemic risk (vulnerability) and to prioritize the populations to be vaccinated. Methods and Findings We chose a two-step assessment of vulnerability at district level consisting of a quantitative and qualitative assessment per country. Quantitative assessment starts with data collection on six risk factors: five risk factors associated with “exposure” to virus/vector and one with “susceptibility” of a district to YF epidemics. The multiple correspondence analysis (MCA) modeling method was specifically adapted to reduce the five exposure variables to one aggregated exposure indicator. Health districts were then projected onto a two-dimensional graph to define different levels of vulnerability. Districts are presented on risk maps for qualitative analysis in consensus groups, allowing the addition of factors, such as population migrations or vector density, that could not be included in MCA. The example of rural districts in Burkina Faso show five distinct clusters of risk profiles. Based on this assessment, 32 of 55 districts comprising over 7 million people were prioritized for preventive vaccination campaigns. Conclusion This assessment of yellow fever epidemic risk at the district level includes MCA modeling and consensus group modification. MCA provides a standardized way to reduce complexity. It supports an informed public health decision-making process that empowers local stakeholders through the consensus group. This original approach can be applied to any disease with documented risk factors. PMID:19597548

Assessment of yellow fever epidemic risk: an original multi-criteria modeling approach.

PubMed

Briand, Sylvie; Beresniak, Ariel; Nguyen, Tim; Yonli, Tajoua; Duru, Gerard; Kambire, Chantal; Perea, William

2009-07-14

Yellow fever (YF) virtually disappeared in francophone West African countries as a result of YF mass vaccination campaigns carried out between 1940 and 1953. However, because of the failure to continue mass vaccination campaigns, a resurgence of the deadly disease in many African countries began in the early 1980s. We developed an original modeling approach to assess YF epidemic risk (vulnerability) and to prioritize the populations to be vaccinated. We chose a two-step assessment of vulnerability at district level consisting of a quantitative and qualitative assessment per country. Quantitative assessment starts with data collection on six risk factors: five risk factors associated with "exposure" to virus/vector and one with "susceptibility" of a district to YF epidemics. The multiple correspondence analysis (MCA) modeling method was specifically adapted to reduce the five exposure variables to one aggregated exposure indicator. Health districts were then projected onto a two-dimensional graph to define different levels of vulnerability. Districts are presented on risk maps for qualitative analysis in consensus groups, allowing the addition of factors, such as population migrations or vector density, that could not be included in MCA. The example of rural districts in Burkina Faso show five distinct clusters of risk profiles. Based on this assessment, 32 of 55 districts comprising over 7 million people were prioritized for preventive vaccination campaigns. This assessment of yellow fever epidemic risk at the district level includes MCA modeling and consensus group modification. MCA provides a standardized way to reduce complexity. It supports an informed public health decision-making process that empowers local stakeholders through the consensus group. This original approach can be applied to any disease with documented risk factors.

Under-Five Mortality in High Focus States in India: A District Level Geospatial Analysis

PubMed Central

Kumar, Chandan; Singh, Prashant Kumar; Rai, Rajesh Kumar

2012-01-01

Background This paper examines if, when controlling for biophysical and geographical variables (including rainfall, productivity of agricultural lands, topography/temperature, and market access through road networks), socioeconomic and health care indicators help to explain variations in the under-five mortality rate across districts from nine high focus states in India. The literature on this subject is inconclusive because the survey data, upon which most studies of child mortality rely, rarely include variables that measure these factors. This paper introduces these variables into an analysis of 284 districts from nine high focus states in India. Methodology/Principal Findings Information on the mortality indicator was accessed from the recently conducted Annual Health Survey of 2011 and other socioeconomic and geographic variables from Census 2011, District Level Household and Facility Survey (2007–08), Department of Economics and Statistics Divisions of the concerned states. Displaying high spatial dependence (spatial autocorrelation) in the mortality indicator (outcome variable) and its possible predictors used in the analysis, the paper uses the Spatial-Error Model in an effort to negate or reduce the spatial dependence in model parameters. The results evince that the coverage gap index (a mixed indicator of district wise coverage of reproductive and child health services), female literacy, urbanization, economic status, the number of newborn care provided in Primary Health Centers in the district transpired as significant correlates of under-five mortality in the nine high focus states in India. The study identifies three clusters with high under-five mortality rate including 30 districts, and advocates urgent attention. Conclusion Even after controlling the possible biophysical and geographical variables, the study reveals that the health program initiatives have a major role to play in reducing under-five mortality rate in the high focus states in India. PMID:22629412

The Influence of Local Politics on Educational Decisions

ERIC Educational Resources Information Center

Bigham, Gary; Ray, Jan

2012-01-01

This ex post facto, causal-comparative research study examined student reading performance data within a school district before and after a school district-wide decision to alter the reading curriculum in response to local political pressure from parents. Data analysis revealed that test scores dropped to a significantly lower level, especially…

Monitoring and Controlling Engineering and Construction Management Cost Performance Within the Corps of Engineers

DTIC Science & Technology

1988-12-01

COST MANAGEMENT The CMIF approach addresses total costs but does not permit the analysis of indirect costs. We found that indirect costs vary...responsibility USACE/divisions Increasing CMIF Districts/divisions level of by fund type detail G&A, technical indirect, burden Districts by fund type

Looking within to Improve Office Organization

ERIC Educational Resources Information Center

Malinowski, Matthew J.

2009-01-01

When tough economic times set in, school business administrators heighten their normal zeal in finding ways to reduce costs and improve efficiency. The author's school district recently underwent a yearlong internal self-analysis to examine and determine the proper staffing levels for the administrative functions within the school district's…

Regional approach to building operational level capacity for disaster planning: the case of the Eastern Africa region.

PubMed

Bazeyo, W; Mayega, R W; Orach, G C; Kiguli, J; Mamuya, S; Tabu, J S; Sena, L; Rugigana, E; Mapatano, M; Lewy, D; Mock, N; Burnham, G; Keim, M; Killewo, J

2013-06-01

The Eastern Africa region is regularly affected by a variety of disasters ranging from drought, to human conflict and population displacement. The magnitude of emergencies and response capacities is similar across the region. In order to strengthen public health disaster management capacities at the operational level in six countries of the Eastern Africa region, the USAID-funded leadership project worked through the HEALTH Alliance, a network of seven schools of public health from six countries in the region to train district-level teams. To develop a sustainable regional approach to building operational level capacity for disaster planning. This project was implemented through a higher education leadership initiative. Project activities were spear-headed by a network of Deans and Directors of public health schools within local universities in the Eastern Africa region. The leadership team envisioned a district-oriented systems change strategy. Pre-service and in-service curricula were developed regionally and district teams were formed to attend short training courses. Project activities began with a situational analysis of the disaster management capacity at national and operational levels. The next steps were chronologically the formation of country training teams and training of trainers, the development of a regional disaster management training curriculum and training materials, the cascading of training activities in the region, and the incorporation of emerging issues into the training curriculum. An evaluation model included the analysis of preparedness impact of the training program. The output from the district teams was the creation of individual district-level disaster plans and their implementation. This 4-year project focused on building operational level public health emergency response capacity, which had not previously been part of any national program. Use of the all-hazard approach rather than a scenario-based contingency planning led to the development of a standardized curriculum for training both in-service and pre-service personnel. Materials developed during the implementation phases of the project have been incorporated into public health graduate curricula in the seven schools. This systems-based strategy resulted in demonstrable outcomes related to district preparedness and university engagement in disaster management. University partnerships are an effective method to build district-level disaster planning capacity. Use of a regional network created a standardized approach across six countries.

Exploring the use of social network analysis to measure communication between disease programme and district managers at sub-national level in South Africa.

PubMed

Kawonga, Mary; Blaauw, Duane; Fonn, Sharon

2015-06-01

With increasing interest in maximising synergies between disease control programmes (DCP) and general health services (GHS), methods are needed to measure interactions between DCP and GHS actors. In South Africa, administrative integration reforms make GHS managers at decentralised level (district managers) responsible for the oversight of DCP operations within districts, with DCP managers (programme managers) providing specialist support. The reforms necessitate interdependence, but these actors work together ineffectively. Communication is crucial for joint working, but no research to assess communication between these actors has been done. This study explores the use of social network analysis (SNA) to measure the extent to which programme and district managers in South Africa communicate, using HIV monitoring and evaluation (M&E) as an exemplar. Data were collected from fifty one managers in two provinces during 2010-2011, to measure: a) one-on-one task-related communication - talking about the collation (verification, reporting) and use of HIV data for monitoring HIV interventions; and b) group communication through co-participating in management committees where HIV data are used for monitoring HIV interventions in districts. SNA measures were computed to describe actor centrality, network density (cohesion), and communication within and between respective manager groups. Block modelling was applied to identify management committees that connect respective manager groups. Results show HIV programme managers located at higher level communicated largely amongst themselves as a group (homophily), seldom talked to the district managers to whom they are supposed to provide specialist HIV M&E support, and rarely participated with them in management committees. This research demonstrates the utility of SNA as a tool for measuring the extent of communication between DCP and GHS actors at sub-national level. Actions are needed to bridge observed communication gaps in order to promote collaborative monitoring of HIV programme interventions within districts. Copyright © 2015 Elsevier Ltd. All rights reserved.

The path dependence of district manager decision-space in Ghana

PubMed Central

Kwamie, Aku; van Dijk, Han; Ansah, Evelyn K; Agyepong, Irene Akua

2016-01-01

The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive literature review of democratic governance in Ghana, and key informant interviews with high-level health system officials integral to the development of the district health system. Through our analysis we identified four periods of district health system progression: (1) development of the district health system (1970–85); (2) Strengthening District Health Systems Initiative (1986–93); (3) health sector reform planning and creation of the Ghana Health Service (1994–96) and (4) health sector reform implementation (1997–2007). It was observed that district manager decision-space steadily widened during periods (1) and (2), due to increases in managerial profile, and concerted efforts at managerial capacity strengthening. Periods (3) and (4) saw initial augmentation of district health system financing, further widening managerial decision-space. However, the latter half of period 4 witnessed district manager decision-space contraction. Formalization of Ghana Health Service structures influenced by self-reinforcing tendencies towards centralized decision-making, national and donor shifts in health sector financing, and changes in key policy actors all worked to the detriment of the district health system, reversing early gains from bottom-up development of the district health system. Policy feedback mechanisms have been influenced by historical and contemporary sequencing of local government and health sector decentralization. An initial act of administrative decentralization, followed by incomplete political and fiscal decentralization has ensured that the balance of power has remained at national level, with strong vertical accountabilities and dependence of the district on national level. This study demonstrates that the rhetoric of decentralization does not always mirror actual implementation, nor always result in empowered local actors. PMID:26318537

Contamination characteristics and possible sources of PM10 and PM2.5 in different functional areas of Shanghai, China

NASA Astrophysics Data System (ADS)

Wang, Jun; Hu, Zimei; Chen, Yuanyuan; Chen, Zhenlou; Xu, Shiyuan

2013-04-01

From July 2009 through September 2010, PM10 and PM2.5 were collected at two different functional areas in Shanghai (Baoshan district, an industrial area, and Putuo district, a mixed-use area of residential, commercial, and educational compounds). In our analysis, 15 elements were determined using a 710-ES Inductively Coupled Plasma-Emission Spectrometer (ICP-AES). The contents of PM2.5, PM10, and metal elements at the two different sites were comparatively analyzed. The results show that the mean annual concentrations of PM10 and PM2.5 (149.22 μg m-3 and 103.07 μg m-3, respectively) in Baoshan district were significantly higher than those in Putuo district (97.44 μg m-3 and 62.25 μg m-3 respectively). The concentrations of PM10 and PM2.5 were both greatest in winter and lowest in summer, with the two different sites exhibiting the same seasonal variation. It was found that the proportions of 15 metal elements in PM10 and PM2.5 in Baoshan district were 20.49% and 20.56%, respectively, while the proportions in Putuo district were higher (25.98% and 25.93%, respectively). In addition, the proportions of eight heavy metals in PM10 and PM2.5 were 5.50% and 3.07%, respectively, for Baoshan district, while these proportions in Putuo district were 3.18% and 2.77%, respectively, indicating that heavy metal pollution is more pronounced in Baoshan district. Compared with cities in developed countries, the total levels of PM10, PM2.5 and heavy metals in Shanghai were slightly higher. Scanning electron microscopy (SEM) and principal component analysis (PCA) suggested that the possible sources of PM10 in Baoshan district were ground level fugitive dust, traffic sources, and industrial activities, whereas PM2.5 mainly originated from industrial activities, coal combustion, and traffic sources. The sources are same for PM10 and PM2.5 in Putuo region, which originate from traffic sources and ground level fugitive dust.

Heat demand mapping and district heating grid expansion analysis: Case study of Velika Gorica

NASA Astrophysics Data System (ADS)

Dorotić, Hrvoje; Novosel, Tomislav; Duić, Neven; Pukšec, Tomislav

2017-10-01

Highly efficient cogeneration and district heating systems have a significant potential for primary energy savings and the reduction of greenhouse gas emissions through the utilization of a waste heat and renewable energy sources. These potentials are still highly underutilized in most European countries. They also play a key role in the planning of future energy systems due to their positive impact on the increase of integration of intermittent renewable energy sources, for example wind and solar in a combination with power to heat technologies. In order to ensure optimal levels of district heating penetration into an energy system, a comprehensive analysis is necessary to determine the actual demands and the potential energy supply. Economical analysis of the grid expansion by using the GIS based mapping methods hasn't been demonstrated so far. This paper presents a heat demand mapping methodology and the use of its output for the district heating network expansion analysis. The result are showing that more than 59% of the heat demand could be covered by the district heating in the city of Velika Gorica, which is two times more than the present share. The most important reason of the district heating's unfulfilled potential is already existing natural gas infrastructure.

Variation in cervical and breast cancer screening coverage in England: a cross-sectional analysis to characterise districts with atypical behaviour.

PubMed

Massat, Nathalie J; Douglas, Elaine; Waller, Jo; Wardle, Jane; Duffy, Stephen W

2015-07-24

Reducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions where coverage is low. This study aimed to characterise districts with atypical coverage levels for cervical or breast screening. Observational study of district-level coverage in the English Cervical and Breast screening programmes in 2012. England, UK. All English women invited to participate in the cervical (age group 25-49 and 50-64) and breast (age group 50-64) screening programmes. Risk adjustment models for coverage were developed based on district-level characteristics. Funnel plots of adjusted coverage were constructed, and atypical districts examined by correlation analysis. Variability in coverage was primarily explained by population factors, whereas general practice characteristics had little independent effect. Deprivation and ethnicity other than white, Asian, black or mixed were independently associated with poorer coverage in both screening programmes, with ethnicity having the strongest effect; by comparison, the influence of Asian, black or mixed ethnic minority was limited. Deprivation, ethnicity and urbanisation largely accounted for the lower cervical screening coverage in London. However, for breast screening, being located in London remained a strong negative predictor. A subset of districts was identified as having atypical coverage across programmes. Correlates of deprivation in districts with relatively low adjusted coverage were substantially different from overall correlates of deprivation. These results inform the continuing drive to reduce avoidable cancer deaths in England, and encourage implementation of targeted interventions in communities residing in districts identified as having atypically low coverage. Sequential implementation to monitor the impact of local interventions would help accrue evidence on 'what works'. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Planning and Budgeting for Nutrition Programs in Tanzania: Lessons Learned From the National Vitamin A Supplementation Program.

PubMed

Lyatuu, Margaret Benjamin; Mkumbwa, Temina; Stevenson, Raz; Isidro, Marissa; Modaha, Francis; Katcher, Heather; Dhillon, Christina Nyhus

2016-05-03

Micronutrient deficiency in Tanzania is a significant public health problem, with vitamin A deficiency (VAD) affecting 34% of children aged 6 to 59 months. Since 2007, development partners have worked closely to advocate for the inclusion of twice-yearly vitamin A supplementation and deworming (VASD) activities with budgets at the subnational level, where funding and implementation occur. As part of the advocacy work, a VASD planning and budgeting tool (PBT) was developed and is used by district officials to justify allocation of funds. Helen Keller International (HKI) and the Tanzania Food and Nutrition Centre (TFNC) conduct reviews of VASD funds and health budgets annually in all districts to monitor the impact of advocacy efforts. This paper presents the findings of the fiscal year (FY) 2010 district budget annual review. The review was intended to answer the following questions regarding district-level funding: (1) how many funds were allocated to nutrition-specific activities in FY 2010? (2) how many funds were allocated specifically to twice-yearly VASD activities in FY 2010? and (3) how have VASD funding allocations changed over time? Budgets from all 133 districts in Tanzania were accessed, reviewed and documented to identify line item funds allocated for VASD and other nutrition activities in FY 2010. Retrospective data from prior annual reviews for VASD were used to track trends in funding. The data were collected using specific data forms and then transcribed into an excel spreadsheet for analysis. The total funds allocated in Tanzania's districts in FY 2010 amounted to US$1.4 million of which 92% were for VASD. Allocations for VASD increased from US$0.387 million to US$1.3 million between FY 2005 and FY 2010. Twelve different nutrition activities were identified in budgets across the 133 districts. Despite the increased trend, the percentage of districts allocating sufficient funds to implement VAS (as defined by cost per child) was just 21%. District-driven VAS funding in Tanzania continues to be allocated by districts consistently, although adequacy of funding is a concern. However, regular administrative data point to fairly high and consistent coverage rates for VAS across the country (over 80% over the last 10 years). Although this analysis may have omitted some nutrition-specific funding not identified in district budget data, it represents a reliable reflection of the nutrition funding landscape in FY 2010. For this year, total district nutrition allocations add up to only 2% of the amount needed to implement nutrition services at scale according to Tanzania's National Nutrition Strategy Implementation Plan. VASD advocacy and planning support at the district level has succeeded in ensuring district allocations for the program. To promote sustainable implementation of other nutrition interventions in Tanzania, more funds must be allocated and guidance must be accompanied by tools that enable planning and budgeting at the district level. © 2016 by Kerman University of Medical Sciences

Planning and Budgeting for Nutrition Programs in Tanzania: Lessons Learned From the National Vitamin A Supplementation Program

PubMed Central

Lyatuu, Margaret Benjamin; Mkumbwa, Temina; Stevenson, Raz; Isidro, Marissa; Modaha, Francis; Katcher, Heather; Dhillon, Christina Nyhus

2016-01-01

Background: Micronutrient deficiency in Tanzania is a significant public health problem, with vitamin A deficiency (VAD) affecting 34% of children aged 6 to 59 months. Since 2007, development partners have worked closely to advocate for the inclusion of twice-yearly vitamin A supplementation and deworming (VASD) activities with budgets at the subnational level, where funding and implementation occur. As part of the advocacy work, a VASD planning and budgeting tool (PBT) was developed and is used by district officials to justify allocation of funds. Helen Keller International (HKI) and the Tanzania Food and Nutrition Centre (TFNC) conduct reviews of VASD funds and health budgets annually in all districts to monitor the impact of advocacy efforts. This paper presents the findings of the fiscal year (FY) 2010 district budget annual review. The review was intended to answer the following questions regarding district-level funding: (1) how many funds were allocated to nutrition-specific activities in FY 2010? (2) how many funds were allocated specifically to twice-yearly VASD activities in FY 2010? and (3) how have VASD funding allocations changed over time? Methods: Budgets from all 133 districts in Tanzania were accessed, reviewed and documented to identify line item funds allocated for VASD and other nutrition activities in FY 2010. Retrospective data from prior annual reviews for VASD were used to track trends in funding. The data were collected using specific data forms and then transcribed into an excel spreadsheet for analysis. Results: The total funds allocated in Tanzania’s districts in FY 2010 amounted to US$1.4 million of which 92% were for VASD. Allocations for VASD increased from US$0.387 million to US$1.3 million between FY 2005 and FY 2010. Twelve different nutrition activities were identified in budgets across the 133 districts. Despite the increased trend, the percentage of districts allocating sufficient funds to implement VAS (as defined by cost per child) was just 21%. Discussion: District-driven VAS funding in Tanzania continues to be allocated by districts consistently, although adequacy of funding is a concern. However, regular administrative data point to fairly high and consistent coverage rates for VAS across the country (over 80% over the last 10 years). Although this analysis may have omitted some nutrition-specific funding not identified in district budget data, it represents a reliable reflection of the nutrition funding landscape in FY 2010. For this year, total district nutrition allocations add up to only 2% of the amount needed to implement nutrition services at scale according to Tanzania’s National Nutrition Strategy Implementation Plan. Conclusion: VASD advocacy and planning support at the district level has succeeded in ensuring district allocations for the program. To promote sustainable implementation of other nutrition interventions in Tanzania, more funds must be allocated and guidance must be accompanied by tools that enable planning and budgeting at the district level. PMID:27694649

Health effects of 'Juntos', a conditional cash transfer programme in Peru.

PubMed

Pérez-Lu, José E; Cárcamo, Cesar; Nandi, Arijit; Kaufman, Jay S

2017-07-01

In some countries, conditional cash transfer (CCT) programmes show an impact on maternal and child health. Juntos, the CCT programme in Peru, has been evaluated several times operationally, but seldom for maternal and child health outcomes. The objective of this study is to evaluate the impact of Juntos on children under 6 years, pregnant women and mothers of children under 17 years. Outcomes evaluated included (1) anaemia in women and children; (2) acute malnutrition in children; (3) post-partum complications in mothers; and (4) underweight and overweight in mothers. We identified Juntos eligible respondents from the Demographic and Health Surveys of Peru for years 2007 to 2013. Propensity score matching was used to identify comparable treatment and control groups, including eligible respondents enrolled in Juntos vs. those not enrolled in Juntos (individual-level analysis), as well as eligible respondents living in Juntos districts vs. those not residing in Juntos districts (district-level analysis). We then used generalized linear models to estimate prevalence ratios. Individual level analysis showed that Juntos reduced underweight in women (PR:0.39, 95%CI:0.18 - 0.85) and anaemia in children (PR:0.93, 95%CI:0.86 - 1.00). In the district level analysis, the programme was associated with a reduction of overweight in women (PR:0.94, 95%CI:0.90 - 0.98) and acute malnutrition in children (PR:0.49, 95%CI:0.32 - 0.73), but an increase in the prevalence of anaemia in children (PR:1.09, 95%CI:1.01 - 1.17). We found that Juntos had an effect on maternal and child health indicators, but further studies are required to overcome some limitations encountered here. © 2016 John Wiley & Sons Ltd.

An Analysis of State Policies Connected with Alternative School Programs

ERIC Educational Resources Information Center

Bielefeld, William C.; Stubblefield, Anna; Templeton, Zach

2009-01-01

Many school districts offer alternative education programs for their students who do not succeed in the regular classroom. At the high school level, many of these programs are separated from the regular schools. It seemed that many districts were establishing alternative education programs, but there were differences in the types of programs that…

Section 504 Compliance in Missouri School Districts: A Problem-Based Discrepancy Analysis

ERIC Educational Resources Information Center

Spurgin, Armand; Steffes, Terri; Wilson, Suzanne

2013-01-01

This report describes a problem based learning project focusing on Section 504 Compliance in the State of Missouri. Additionally it provides information about Superintendent's perceptions and levels of knowledge about Section 504 compliance in their districts. The project team sought to learn and understand the historical timeline of legislation…

Impact of Insecticide-Treated Net Ownership on All-Cause Child Mortality in Malawi, 2006-2010.

PubMed

Florey, Lia S; Bennett, Adam; Hershey, Christine L; Bhattarai, Achuyt; Nielsen, Carrie F; Ali, Doreen; Luhanga, Misheck; Taylor, Cameron; Eisele, Thomas P; Yé, Yazoume

2017-09-01

Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis. To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62-90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60-0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006-2010 in Malawi and represent a novel use of district-level data from nationally representative surveys.

Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods.

PubMed

Odaga, John; Henriksson, Dorcus K; Nkolo, Charles; Tibeihaho, Hector; Musabe, Richard; Katusiime, Margaret; Sinabulya, Zaccheus; Mucunguzi, Stephen; Mbonye, Anthony K; Valadez, Joseph J

2016-01-01

Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions. Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project. All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans. In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival.

Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods

PubMed Central

Odaga, John; Henriksson, Dorcus K.; Nkolo, Charles; Tibeihaho, Hector; Musabe, Richard; Katusiime, Margaret; Sinabulya, Zaccheus; Mucunguzi, Stephen; Mbonye, Anthony K.; Valadez, Joseph J.

2016-01-01

Background Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions. Design Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project. Results All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans. Conclusions In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival. PMID:27225791

Excess under-5 female mortality across India: a spatial analysis using 2011 census data.

PubMed

Guilmoto, Christophe Z; Saikia, Nandita; Tamrakar, Vandana; Bora, Jayanta Kumar

2018-06-01

Excess female mortality causes half of the missing women (estimated deficit of women in countries with suspiciously low proportion of females in their population) today. Globally, most of these avoidable deaths of women occur during childhood in China and India. We aimed to estimate excess female under-5 mortality rate (U5MR) for India's 35 states and union territories and 640 districts. Using the summary birth history method (or Brass method), we derived district-level estimates of U5MR by sex from 2011 census data. We used data from 46 countries with no evidence of gender bias for mortality to estimate the effects and intensity of excess female mortality at district level. We used a detailed spatial and statistical analysis to highlight the correlates of excess mortality at district level. Excess female U5MR was 18·5 per 1000 livebirths (95% CI 13·1-22·6) in India 2000-2005, which corresponds to an estimated 239 000 excess deaths (169 000-293 000) per year. More than 90% of districts had excess female mortality, but the four largest states in northern India (Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh) accounted for two-thirds of India's total number. Low economic development, gender inequity, and high fertility were the main predictors of excess female mortality. Spatial analysis confirmed the strong spatial clustering of postnatal discrimination against girls in India. The considerable effect of gender bias on mortality in India highlights the need for more proactive engagement with the issue of postnatal sex discrimination and a focus on the northern districts. Notably, these regions are not the same as those most affected by skewed sex ratio at birth. None. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Determinants of HIV prevalence among female sex workers in four south Indian states: analysis of cross-sectional surveys in twenty-three districts.

PubMed

Ramesh, Banadakoppa M; Moses, Stephen; Washington, Reynold; Isac, Shajy; Mohapatra, Bidhubhushan; Mahagaonkar, Sangameshwar B; Adhikary, Rajatashuvra; Brahmam, Ginnela N V; Paranjape, Ramesh S; Subramanian, Thilakavathi; Blanchard, James F

2008-12-01

In four states in southern India we explored the determinants of HIV prevalence among female sex workers (FSW), as well as factors associated with district-level variations in HIV prevalence among FSW. Data from cross-sectional surveys in 23 districts were analysed, with HIV prevalence as the outcome variable, and sociodemographic and sex work characteristics as predictor variables. Multilevel logistic regression was applied to identify factors that could explain variations in HIV prevalence among districts. HIV prevalence among the 10 096 FSW surveyed was 14.5% (95% confidence interval 14.0-15.4), with a large interdistrict variation, ranging from 2% to 38%. Current marital status and the usual place of solicitation emerged as important factors that determine individual probability of being HIV positive, as well as the HIV prevalence within districts. In multivariate analysis, compared with home-based FSW, the odds of being HIV positive was greater for brothel-based FSW [adjusted odds ratio (AOR) 2.17, P

Epidemiological Perspective of National Leprosy Eradication Programme in Maharashtra: Focusing on "Tribal Hot-spot" of Tribal District.

PubMed

Katkar, Dhananjay; Mote, Balu Natha; Adhav, Ambadas; Muthuvel, Thirumugam; Kadam, Suhas

2017-01-01

Leprosy or Hansen's disease, a chronic infectious disease caused by Mycobacterium leprae is a serious public health concern because of associated case load, morbidity and stigma attached to it. India achieved elimination of leprosy as a public health problem (prevalence rate [PR]<1 case/10,000 population) at the national level on January 1, 2006, still 19% districts in the country report PR more than one. In Maharashtra, it is found that very few districts within the state or very few pockets within the district are actually having leprosy burden. (1) Identification of region-wise actual "hot-spot" districts/pockets within state of Maharashtra.(2) Further drop-down below the district and block to tribal belt for understanding the actual high risk area/belt within the tribal districts. Secondary data analysis of leprosy patients registered in the State during the period 2008-2015. PR per 10,000 was found more in Vidharbha region followed by rest of Maharashtra and then Marathwada. Analysis showed that, there are tribal districts and tribal area within tribal districts which are having higher leprosy burden as compared to the all other districts indicating need of allocation of programme funds and facilities to these tribal belts for the effective control and elimination of leprosy. National Leprosy Eradication Programme should focus on tribal belt for effective control. Without giving extra attention to these tribal areas within high risk district/pockets efforts of eradication of leprosy by 2018 would be unrealistic and impractical.

Planning for district mental health services in South Africa: a situational analysis of a rural district site.

PubMed

Petersen, Inge; Bhana, Arvin; Campbell-Hall, Victoria; Mjadu, Sithembile; Lund, Crick; Kleintjies, Sharon; Hosegood, Victoria; Flisher, Alan J

2009-03-01

The shift in emphasis to universal primary health care in post-apartheid South Africa has been accompanied by a process of decentralization of mental health services to district level, as set out in the new Mental Health Care Act, no. 17, of 2002 and the 1997 White Paper on the Transformation of the Health System. This study sought to assess progress in South Africa with respect to deinstitutionalization and the integration of mental health into primary health care, with a view to understanding the resource implications of these processes at district level. A situational analysis in one district site, typical of rural areas in South Africa, was conducted, based on qualitative interviews with key stakeholders and the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). The findings suggest that the decentralization process remains largely limited to emergency management of psychiatric patients and ongoing psychopharmacological care of patients with stabilized chronic conditions. We suggest that, in a similar vein to other low- to middle-income countries, deinstitutionalization and comprehensive integrated mental health care in South Africa is hampered by a lack of resources for mental health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.

Assessment of the core and support functions of the Integrated Disease Surveillance system in Maharashtra, India

PubMed Central

2013-01-01

Background Monitoring the progress of the Integrated Disease Surveillance (IDS) strategy is an important component to ensure its sustainability in the state of Maharashtra in India. The purpose of the study was to document the baseline performance of the system on its core and support functions and to understand the challenges for its transition from an externally funded “project” to a state owned surveillance “program”. Methods Multi-centre, retrospective cross-sectional evaluation study to assess the structure, core and support surveillance functions using modified WHO generic questionnaires. All 34 districts in the state and randomly identified 46 facilities and 25 labs were included in the study. Results Case definitions were rarely used at the periphery. Limited laboratory capacity at all levels compromised case and outbreak confirmation. Only 53% districts could confirm all priority diseases. Stool sample processing was the weakest at the periphery. Availability of transport media, trained staff, and rapid diagnostic tests were main challenges at the periphery. Data analysis was weak at both district and facility levels. Outbreak thresholds were better understood at facility level (59%) than at the district (18%). None of the outbreak indicator targets were met and submission of final outbreak report was the weakest. Feedback and training was significantly better (p < 0.0001) at district level (65%; 76%) than at facility level (15%; 37%). Supervision was better at the facility level (37%) than at district (18%) and so were coordination, communication and logistic resources. Contractual part time positions, administrative delays in recruitment, and vacancies (30%) were main human resource issues that hampered system performance. Conclusions Significant progress has been made in the core and support surveillance functions in Maharashtra, however some challenges exist. Support functions (laboratory, transport and communication equipment, training, supervision, human and other resources) are particularly weak at the district level. Structural integration and establishing permanent state and district surveillance officer positions will ensure leadership; improve performance; support continuity; and offer sustainability to the program. Institutionalizing the integrated disease surveillance strategy through skills based personnel development and infrastructure strengthening at district levels is the only way to avoid it from ending up isolated! Improving surveillance quality should be the next on agenda for the state. PMID:23764137

Comparison of indoor air quality management strategies between the school and district levels in New York State.

PubMed

Lin, Shao; Kielb, Christine L; Reddy, Amanda L; Chapman, Bonnie R; Hwang, Syni-An

2012-03-01

Good school indoor air quality (IAQ) can affect the health and functioning of school occupants. Thus, it is important to assess the degree to which schools and districts employ strategies to ensure good IAQ management. We examined and compared the patterns of IAQ management strategies between public elementary schools and their school districts in New York State. District-level information obtained from surveys of district facilities managers in 326 districts was described and stratified by district size and socioeconomic status. School-level information obtained from surveys of head custodians in 770 elementary schools was then compared with the district-level information in 241 districts. About 47% of participating school districts reported having a district-wide IAQ program, with a large range in the prevalence of specific IAQ management strategies. Airing out newly painted areas was the most commonly reported (92%) and having a classroom animal policy was the least commonly reported (29%). Larger districts and districts with a district-wide IAQ program were more likely to report certain IAQ strategies than other districts. Elementary schools and their districts were most likely to report airing out newly painted areas (76%). The most common area of disagreement was construction after hours (50%). The top strategy not reported at either level was having an IAQ coordinator (53%). Many school districts lack key IAQ management strategies, and differences exist between district-level policy and school-level practice. Districts and schools should work together to formalize and expand existing IAQ policies and inform stakeholders about these strategies. © 2012, American School Health Association.

Subjective wellbeing, suicide and socioeconomic factors: an ecological analysis in Hong Kong.

PubMed

Hsu, C-Y; Chang, S-S; Yip, P S F

2018-04-10

There has recently been an increased interest in mental health indicators for the monitoring of population wellbeing, which is among the targets of Sustainable Development Goals adopted by the United Nations. Levels of subjective wellbeing and suicide rates have been proposed as indicators of population mental health, but prior research is limited. Data on individual happiness and life satisfaction were sourced from a population-based survey in Hong Kong (2011). Suicide data were extracted from Coroner's Court files (2005-2013). Area characteristic variables included local poverty rate and four factors derived from a factor analysis of 21 variables extracted from the 2011 census. The associations between mean happiness and life satisfaction scores and suicide rates were assessed using Pearson correlation coefficient at two area levels: 18 districts and 30 quantiles of large street blocks (LSBs; n = 1620). LSB is a small area unit with a higher level of within-unit homogeneity compared with districts. Partial correlations were used to control for area characteristics. Happiness and life satisfaction demonstrated weak inverse associations with suicide rate at the district level (r = -0.32 and -0.36, respectively) but very strong associations at the LSB quantile level (r = -0.83 and -0.84, respectively). There were generally very weak or weak negative correlations across sex/age groups at the district level but generally moderate to strong correlations at the LSB quantile level. The associations were markedly attenuated or became null after controlling for area characteristics. Subjective wellbeing is strongly associated with suicide at a small area level; socioeconomic factors can largely explain this association. Socioeconomic factors could play an important role in determining the wellbeing of the population, and this could inform policies aimed at enhancing population wellbeing.

Shifting the Role: School-District Superintendents' Experiences as They Build a Learning Community

ERIC Educational Resources Information Center

Dickson, John; Mitchell, Coral

2014-01-01

This paper presents the findings of a qualitative action-research study that explored how one group of district-level school superintendents conceptualized their role as they built their own learning community. Data analysis yielded four elements that supported the participants' efforts: (a) using a process as an entry point, (b) aligning various…

Assessing School Council Contribution to the Enabling Conditions for Instructional Capacity Building: "An Urban District in Kentucky"

ERIC Educational Resources Information Center

Talley, Wade Kenneth; Keedy, John L.

2006-01-01

This study identified the enabling conditions related to building instructional capacity created by the councils in three high-performance schools in an urban district. The authors collected the data through observation, interview, and document mining. School-level data were sorted inductively into themes through constant comparative analysis.…

Prevalence of trachoma at sub-district level in ethiopia: determining when to stop mass azithromycin distribution.

PubMed

King, Jonathan D; Teferi, Tesfaye; Cromwell, Elizabeth A; Zerihun, Mulat; Ngondi, Jeremiah M; Damte, Mesele; Ayalew, Frew; Tadesse, Zerihun; Gebre, Teshome; Mulualem, Ayelign; Karie, Alemu; Melak, Berhanu; Adugna, Mitku; Gessesse, Demelash; Worku, Abebe; Endashaw, Tekola; Admassu Ayele, Fisseha; Stoller, Nicole E; King, Mary Rose A; Mosher, Aryc W; Gebregzabher, Tesfaye; Haileysus, Geremew; Odermatt, Peter; Utzinger, Jürg; Emerson, Paul M

2014-03-01

To eliminate blinding trachoma, the World Health Organization emphasizes implementing the SAFE strategy, which includes annual mass drug administration (MDA) with azithromycin to the whole population of endemic districts. Prevalence surveys to assess impact at the district level are recommended after at least 3 years of intervention. The decision to stop MDA is based on a prevalence of trachomatous inflammation follicular (TF) among children aged 1-9 years below 5% at the sub-district level, as determined by an additional round of surveys limited within districts where TF prevalence is below 10%. We conducted impact surveys powered to estimate prevalence simultaneously at the sub-district and district in two zones of Amhara, Ethiopia to determine whether MDA could be stopped. Seventy-two separate population-based, sub-district surveys were conducted in 25 districts. In each survey all residents from 10 randomly selected clusters were screened for clinical signs of trachoma. Data were weighted according to selection probabilities and adjusted for correlation due to clustering. Overall, 89,735 residents were registered from 21,327 households of whom 72,452 people (80.7%) were examined. The prevalence of TF in children aged 1-9 years was below 5% in six sub-districts and two districts. Sub-district level prevalence of TF in children aged 1-9 years ranged from 0.9-76.9% and district-level from 0.9-67.0%. In only one district was the prevalence of trichiasis below 0.1%. The experience from these zones in Ethiopia demonstrates that impact assessments designed to give a prevalence estimate of TF at sub-district level are possible, although the scale of the work was challenging. Given the assessed district-level prevalence of TF, sub-district-level surveys would have been warranted in only five districts. Interpretation was not as simple as stopping MDA in sub-districts below 5% given programmatic challenges of exempting sub-districts from a highly regarded program and the proximity of hyper-endemic sub-districts.

The path dependence of district manager decision-space in Ghana.

PubMed

Kwamie, Aku; van Dijk, Han; Ansah, Evelyn K; Agyepong, Irene Akua

2016-04-01

The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive literature review of democratic governance in Ghana, and key informant interviews with high-level health system officials integral to the development of the district health system. Through our analysis we identified four periods of district health system progression: (1) development of the district health system (1970-85); (2) Strengthening District Health Systems Initiative (1986-93); (3) health sector reform planning and creation of the Ghana Health Service (1994-96) and (4) health sector reform implementation (1997-2007). It was observed that district manager decision-space steadily widened during periods (1) and (2), due to increases in managerial profile, and concerted efforts at managerial capacity strengthening. Periods (3) and (4) saw initial augmentation of district health system financing, further widening managerial decision-space. However, the latter half of period 4 witnessed district manager decision-space contraction. Formalization of Ghana Health Service structures influenced by self-reinforcing tendencies towards centralized decision-making, national and donor shifts in health sector financing, and changes in key policy actors all worked to the detriment of the district health system, reversing early gains from bottom-up development of the district health system. Policy feedback mechanisms have been influenced by historical and contemporary sequencing of local government and health sector decentralization. An initial act of administrative decentralization, followed by incomplete political and fiscal decentralization has ensured that the balance of power has remained at national level, with strong vertical accountabilities and dependence of the district on national level. This study demonstrates that the rhetoric of decentralization does not always mirror actual implementation, nor always result in empowered local actors. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Site Management. An Analysis of the Concepts and Fundamental Operational Components Associated with the Delegation of Decision-Making Authority and Control of Resources to the School-Site Level in the California Public School System.

ERIC Educational Resources Information Center

Decker, Erwin A.; And Others

The pros and cons of decentralization of decision-making authority to the school-site level as a public school management technique are intended to serve as an informational summary for the members of the California State Board of Education, and as a resource for school district governing boards and district administrators to use to determine the…

Enhancement of the FDOT's project level and network level bridge management analysis tools

DOT National Transportation Integrated Search

2011-02-01

Over several years, the Florida Department of Transportation (FDOT) has been implementing the AASHTO Pontis Bridge Management System to support network-level and project-level decision making in the headquarters and district offices. Pontis is an int...

Epidemiology of Foot and Mouth Disease in Ethiopia: a Retrospective Analysis of District Level Outbreaks, 2007-2012.

PubMed

Jemberu, W T; Mourits, M C M; Sahle, M; Siraw, B; Vernooij, J C M; Hogeveen, H

2016-12-01

This study aimed at determining the incidence, distribution, risk factors, and causal serotypes of foot and mouth disease (FMD) outbreaks in Ethiopia based on 5 years of retrospective outbreak data (September 2007 until August 2012). District level outbreak data were collected from 115 randomly selected districts using a questionnaire administered to district animal health officers. The national incidence of FMD outbreaks during the study period was 1.45 outbreaks per five district years. Outbreaks were geographically widespread affecting all major regional states in the country and were more frequent in the central, southern, and southeastern parts of the country. Neither long-term nor seasonal trends were observed in the incidence of outbreaks. A mixed effects logistic regression analysis revealed that the type of production system (market oriented system versus subsistence systems), presence of a major livestock market and/or route, and adjacency to a national parks or wildlife sanctuary were found to be associated with increased risk of outbreaks in the districts. FMD virus serotypes O, A, SAT 2, and SAT 1 were identified as the causal serotypes of the outbreaks during the study period. Whereas O was the dominant serotype, SAT 2 was the serotype that showed increase in relative frequency of occurrence. The estimated incidence of outbreaks is useful in assessing the economic impacts of the disease, and the identified risk factors provide important knowledge to target a progressive FMD control policy for Ethiopia. © 2015 Blackwell Verlag GmbH.

Measurement of health system performance at district level: A study protocol.

PubMed

Sharma, Atul; Prinja, Shankar; Aggarwal, Arun Kumar

2017-12-13

Limited efforts have been observed in low and middle income countries to undertake health system performance assessment at district level. Absence of a comprehensive data collection tool and lack of a standardised single summary measure defining overall performance are some of the main problems. Present study has been undertaken to develop a summary composite health system performance index at district level. A broad range of indicators covering all six domains as per building block framework were finalized by an expert panel. The domains were classified into twenty sub-domains, with 70 input and process indicators to measure performance. Seven sub-domains for assessing health system outputs and outcomes were identified, with a total of 28 indicators. Districts in Haryana state from north India were selected for the study. Primary and secondary data will be collected from 378 health facilities, district and state health directorate headquarters. Indicators will be normalized, aggregated to generate composite performance index at district level. Domain specific scores will present the quality of individual building block domains in the public health system. Robustness of the results will be checked using sensitivity analysis. The study presents a methodology for comprehensive assessment of all health system domains on basis of input, process, output and outcome indicators which has never been reported from India. Generation of this index will help identify policy and implementation areas of concern and point towards potential solutions. Results may also help understand relationships between individual building blocks and their sub-components.

Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries

PubMed Central

Hanlon, Charlotte; Luitel, Nagendra P.; Kathree, Tasneem; Murhar, Vaibhav; Shrivasta, Sanjay; Medhin, Girmay; Ssebunnya, Joshua; Fekadu, Abebaw; Shidhaye, Rahul; Petersen, Inge; Jordans, Mark; Kigozi, Fred; Thornicroft, Graham; Patel, Vikram; Tomlinson, Mark; Lund, Crick; Breuer, Erica; De Silva, Mary; Prince, Martin

2014-01-01

Background Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. Methods A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. Results The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. Conclusions The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care. PMID:24558389

Impact of Insecticide-Treated Net Ownership on All-Cause Child Mortality in Malawi, 2006–2010

PubMed Central

Florey, Lia S.; Bennett, Adam; Hershey, Christine L.; Bhattarai, Achuyt; Nielsen, Carrie F.; Ali, Doreen; Luhanga, Misheck; Taylor, Cameron; Eisele, Thomas P.; Yé, Yazoume

2017-01-01

Abstract. Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis. To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62–90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60–0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006–2010 in Malawi and represent a novel use of district-level data from nationally representative surveys. PMID:28990922

Expanding school-district/university partnerships to advance health promoting schools implementation and efficacy in Taiwan.

PubMed

Liu, Chieh-Hsing; Chang, Fong-Ching; Liao, Li-Ling; Niu, Yu-Zhen; Cheng, Chi-Chia; Shih, Shu-Fang; Chang, Tzu-Chau; Chou, Hsin-Pei

2015-08-01

In 2011, the Taiwan government expanded its support of school-district/university partnership programs that promote the implementation of the evidenced-based Health Promoting Schools (HPS) program. This study examined whether expanding the support for this initiative was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011 and 2013, a total of 647 and 1195 schools, respectively, complemented the questionnaire. Univariate analysis results indicated that the HPS implementation levels for six components were significantly increased from 2011 to 2013. These components included school health policies, physical environment, social environment, teaching activities and school-community relationships. Participant teachers also reported significantly greater levels of perceived HPS impact and HPS efficacy after the expansion of support for school-district/university partnership programs. Multivariate analysis results indicated that after controlling for school level, HPS funding and HPS action research approach variables, the expansion had a positive impact on increasing the levels of HPS implementation, perceived HPS impact and perceived HPS efficacy. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Comparisons of Student Achievement Levels by District Performance and Poverty. ACT Research Report Series 2016-11

ERIC Educational Resources Information Center

Dougherty, Chrys; Shaw, Teresa

2016-01-01

This report looks at student achievement levels in Arkansas school districts disaggregated by district poverty and by the district's performance relative to other districts. We estimated district performance statistics by subject and grade level (4, 8, and 11-12) for longitudinal student cohorts, using statistical models that adjusted for district…

The cost of the district hospital: a case study in Malawi.

PubMed

Mills, A J; Kapalamula, J; Chisimbi, S

1993-01-01

Described in an analysis of the cost to the Ministry of Health of providing district health services in Malawi, with particular emphasis on the district hospital. District resource allocation patterns were assessed by carefully disaggregating district costs by level of care and hospital department. A strikingly low proportion of district recurrent costs was absorbed by salaries and wages (27-39%, depending on the district) and a surprisingly high proportion by medical supplies (24-37%). The most expensive cost centre in the hospital was the pharmacy. A total of 27-39% of total recurrent costs were spent outside the hospital and 61-73% on hospital services. The secondary care services absorbed 40-58% of district recurrent costs. Unit costs by hospital department varied considerably by district, with one hospital being consistently the most expensive and another the cheapest. A total of 3-10 new outpatients could be treated for the average cost of 1 inpatient-day, while 34-55 could be treated for the average cost of 1 inpatient. The efficiency of hospital operations, the scope for redistributing resources districtwide, and the costing methodology are discussed.

The cost of the district hospital: a case study in Malawi.

PubMed Central

Mills, A. J.; Kapalamula, J.; Chisimbi, S.

1993-01-01

Described in an analysis of the cost to the Ministry of Health of providing district health services in Malawi, with particular emphasis on the district hospital. District resource allocation patterns were assessed by carefully disaggregating district costs by level of care and hospital department. A strikingly low proportion of district recurrent costs was absorbed by salaries and wages (27-39%, depending on the district) and a surprisingly high proportion by medical supplies (24-37%). The most expensive cost centre in the hospital was the pharmacy. A total of 27-39% of total recurrent costs were spent outside the hospital and 61-73% on hospital services. The secondary care services absorbed 40-58% of district recurrent costs. Unit costs by hospital department varied considerably by district, with one hospital being consistently the most expensive and another the cheapest. A total of 3-10 new outpatients could be treated for the average cost of 1 inpatient-day, while 34-55 could be treated for the average cost of 1 inpatient. The efficiency of hospital operations, the scope for redistributing resources districtwide, and the costing methodology are discussed. PMID:8324852

Barriers to Uptake of Conservation Agriculture in southern Africa: Multi-level Analyses from Malawi

NASA Astrophysics Data System (ADS)

Dougill, Andrew; Stringer, Lindsay; Whitfield, Stephen; Wood, Ben; Chinseu, Edna

2015-04-01

Conservation agriculture is a key set of actions within the growing body of climate-smart agriculture activities being advocated and rolled out across much of the developing world. Conservation agriculture has purported benefits for environmental quality, food security and the sustained delivery of ecosystem services. In this paper, new multi-level analyses are presented, assessing the current barriers to adoption of conservation agriculture practices in Malawi. Despite significant donor initiatives that have targeted conservation agriculture projects, uptake rates remain low. This paper synthesises studies from across 3 levels in Malawi: i.) national level- drawing on policy analysis, interviews and a multi-stakeholder workshop; ii.) district level - via assessments of development plans and District Office and extension service support, and; iii) local level - through data gained during community / household level studies in Dedza District that have gained significant donor support for conservation agriculture as a component of climate smart agriculture initiatives. The national level multi-stakeholder Conservation Agriculture workshop identified three areas requiring collaborative research and outlined routes for the empowerment of the National Conservation Agriculture Task Force to advance uptake of conservation agriculture and deliver associated benefits in terms of agricultural development, climate adaptation and mitigation. District level analyses highlight that whilst District Development Plans are now checked against climate change adaptation and mitigation criteria, capacity and knowledge limitations exist at the District level, preventing project interventions from being successfully up-scaled. Community level assessments highlight the need for increased community participation at the project-design phase and identify a pressing requirement for conservation agriculture planning processes (in particular those driven by investments in climate-smart agriculture) to better accommodate, and respond to, the differentiated needs of marginalised groups (e.g. poor, elderly, carers). We identify good practices that can be used to design, plan and implement conservation agriculture projects such that the multiple benefits can be realised. We further outline changes to multi-level policy and institutional arrangements to facilitate greater adoption of conservation agriculture in Malawi, noting the vital importance of District-level institutions and amendments and capacity building required within agricultural extension services. We highlight the need for capacity building and support to ensure conservation agriculture's multiple benefits are realised more widely as a route towards sustainable land management.

An Analysis of Programs and Implementation of Professional Learning Communities in the Red Clay Consolidated School District with Recommendations for Future Implementation

ERIC Educational Resources Information Center

Goodwin, Kenneth L., Jr.

2012-01-01

During the 2010-2011 school year, schools throughout the Red Clay Consolidated School District were expected to implement Professional Learning Communities (PLCs); however, little to no guidance was provided to school-level administrators and teacher teams. Not surprisingly, many schools implemented team meetings that were not aligned with…

A Case Analysis of an Elementary School's Implementation of Response to Intervention

ERIC Educational Resources Information Center

White, Richard B.; Polly, Drew; Audette, Robert H.

2012-01-01

The study provides an illustration of an elementary school's implementation of a model of Response to Intervention (RTI). The school was selected to be the pilot for RTI implementation within the district. The study employed interviews of all members of the school RTI Leadership Team and select members of the district-level RTI Leadership Team. An…

Implementation at the School Building Level: The Development and Analysis of Nine Mini-Case Studies.

ERIC Educational Resources Information Center

Hall, Gene; And Others

As part of a district-wide longitudinal study of the implementation of a science curriculum innovation, researchers developed case studies of a sample of nine elementary schools in the Jefferson County School District, a large suburban system in Colorado. The study applied the Concerns-Based Adoption Model, which assumes that change is carried out…

Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia.

PubMed

Zulu, Joseph Mumba; Hurtig, Anna-Karin; Kinsman, John; Michelo, Charles

2015-01-28

To address the huge human resources for health gap in Zambia, the Ministry of Health launched the National Community Health Assistant Strategy in 2010. The strategy aims to integrate community-based health workers into the health system by creating a new group of workers, called community health assistants (CHAs). However, literature suggests that the integration process of national community-based health worker programmes into health systems has not been optimal. Conceptually informed by the diffusion of innovations theory, this paper qualitatively aimed to explore the factors that shaped the acceptability and adoption of CHAs into the health system at district level in Zambia during the pilot phase. Data gathered through review of documents, 6 focus group discussions with community leaders, and 12 key informant interviews with CHA trainers, supervisors and members of the District Health Management Team were analysed using thematic analysis. The perceived relative advantage of CHAs over existing community-based health workers in terms of their quality of training and scope of responsibilities, and the perceived compatibility of CHAs with existing groups of health workers and community healthcare expectations positively facilitated the integration process. However, limited integration of CHAs in the district health governance system hindered effective programme trialability, simplicity and observability at district level. Specific challenges at this level included a limited information flow and sense of programme ownership, and insufficient documentation of outcomes. The district also had difficulties in responding to emergent challenges such as delayed or non-payment of CHA incentives, as well as inadequate supervision and involvement of CHAs in the health posts where they are supposed to be working. Furthermore, failure of the health system to secure regular drug supplies affected health service delivery and acceptability of CHA services at community level. The study has demonstrated that implementation of policy guidelines for integrating community-based health workers in the health system may not automatically guarantee successful integration at the local or district level, at least at the start of the process. The study reiterates the need for fully integrating such innovations into the district health governance system if they are to be effective.

Income inequality and depressive symptoms in South Africa: A longitudinal analysis of the National Income Dynamics Study.

PubMed

Adjaye-Gbewonyo, Kafui; Avendano, Mauricio; Subramanian, S V; Kawachi, Ichiro

2016-11-01

Research suggests that income inequality may detrimentally affect mental health. We examined the relationship between district-level income inequality and depressive symptoms among individuals in South Africa-one of the most unequal countries in the world-using longitudinal data from Wave 1 (2008) and Wave 3 (2012) of the National Income Dynamics Study. Depressive symptoms were measured using the Center for Epidemiological Studies of Depression Short Form while district Gini coefficients were estimated from census and survey sources. Age, African population group, being single, being female, and having lower household income were independently associated with higher depressive symptoms. However, in longitudinal, fixed-effects regression models controlling for several factors, district-level Gini coefficients were not significantly associated with depressive symptoms scores. Our results do not support the hypothesis of a causal link between income inequality and depressive symptoms in the short-run. Possible explanations include the high underlying levels of inequality in all districts, or potential lags in the effect of inequality on depression. Copyright © 2016 Elsevier Ltd. All rights reserved.

Design and evaluation of a web-based decision support tool for district-level disease surveillance in a low-resource setting

PubMed Central

Pore, Meenal; Sengeh, David M.; Mugambi, Purity; Purswani, Nuri V.; Sesay, Tom; Arnold, Anna Lena; Tran, Anh-Minh A.; Myers, Ralph

2017-01-01

During the 2014 West African Ebola Virus outbreak it became apparent that the initial response to the outbreak was hampered by limitations in the collection, aggregation, analysis and use of data for intervention planning. As part of the post-Ebola recovery phase, IBM Research Africa partnered with the Port Loko District Health Management Team (DHMT) in Sierra Leone and GOAL Global, to design, implement and deploy a web-based decision support tool for district-level disease surveillance. This paper discusses the design process and the functionality of the first version of the system. The paper presents evaluation results prior to a pilot deployment and identifies features for future iterations. A qualitative assessment of the tool prior to pilot deployment indicates that it improves the timeliness and ease of using data for making decisions at the DHMT level. PMID:29854209

Spatiotemporal analysis of dengue fever in Nepal from 2010 to 2014.

PubMed

Acharya, Bipin Kumar; Cao, ChunXiang; Lakes, Tobia; Chen, Wei; Naeem, Shahid

2016-08-22

Due to recent emergence, dengue is becoming one of the major public health problems in Nepal. The numbers of reported dengue cases in general and the area with reported dengue cases are both continuously increasing in recent years. However, spatiotemporal patterns and clusters of dengue have not been investigated yet. This study aims to fill this gap by analyzing spatiotemporal patterns based on monthly surveillance data aggregated at district. Dengue cases from 2010 to 2014 at district level were collected from the Nepal government's health and mapping agencies respectively. GeoDa software was used to map crude incidence, excess hazard and spatially smoothed incidence. Cluster analysis was performed in SaTScan software to explore spatiotemporal clusters of dengue during the above-mentioned time period. Spatiotemporal distribution of dengue fever in Nepal from 2010 to 2014 was mapped at district level in terms of crude incidence, excess risk and spatially smoothed incidence. Results show that the distribution of dengue fever was not random but clustered in space and time. Chitwan district was identified as the most likely cluster and Jhapa district was the first secondary cluster in both spatial and spatiotemporal scan. July to September of 2010 was identified as a significant temporal cluster. This study assessed and mapped for the first time the spatiotemporal pattern of dengue fever in Nepal. Two districts namely Chitwan and Jhapa were found highly affected by dengue fever. The current study also demonstrated the importance of geospatial approach in epidemiological research. The initial result on dengue patterns and risk of this study may assist institutions and policy makers to develop better preventive strategies.

From the battlefield to the bedroom: a multilevel analysis of the links between political conflict and intimate partner violence in Liberia.

PubMed

Kelly, Jocelyn T D; Colantuoni, Elizabeth; Robinson, Courtland; Decker, Michele R

2018-01-01

Assess the link between levels of armed conflict and postconflict intimate partner violence (IPV) experienced by women in Liberia. Armed Conflict Location and Event Data Project data were used to measure conflict-related fatalities in districts in Liberia during the country's civil war from 1999 to 2003. These data were linked to individual-level data from the 2007 Demographic and Health Survey, including past-year IPV. Multilevel logistic models accounting for the clustering of women within districts evaluated the relationship of conflict fatalities with postconflict past-year IPV. Additional conflict measures, including conflict events and cumulative years of conflict, were assessed. After adjusting for individual-level characteristics correlated with IPV, residence in a conflict fatality-affected district was associated with a 50% increase in risk of IPV (adjusted OR (aOR): 1.55, 95% CI 1.26 to 1.92). Women living in a district that experienced 4-5 cumulative years of conflict were also more likely to experience IPV (aOR 1.88, 95% CI 1.29 to 2.75). Residing in a conflict-affected district even 5 years after conflict was associated with postconflict IPV. Recognising and preventing postconflict IPV violence is important to support long-term recovery in postconflict settings.

Farmer readiness for adopting stevia cultivation (a case study at District of Pasir Jambu, Regency of Bandung)

NASA Astrophysics Data System (ADS)

Supyandi, D.; Sukayat, Y.; Hapsari, H.

2018-03-01

Recognized as a complementary for conventional sugars made from cane, coconut, corn, and palm, as well as a substitute for synthetic sweetener, recently stevia has accepted significant attention in order to fulfill increasing demand for sweeteners in Indonesia. Stevia has several advantages, among other is having 200-300 times sweetness level compared to cane sugar with low-calorie level. In Indonesia, stevia was introduced from Japan, Korea and China, and has been cultivated in several areas, among other is in West Java, particularly at District of Cikajang (Garut), District of Pangalengan (Bandung) and District of Ciwidey/Pasir Jambu (Bandung). Introducing new commodity and/or technology has usually faced constraints and sometimes rejection. However, considering the potentials and increasing demand for it, stevia cultivation widespread need to be stimulated. This paper describes several conditions of farmer community at District of Pasir Jambu in terms of their readiness to adopt stevia cultivation in their land. Community readiness model was used to guide the structure of thinking in data collection process at farmer level in order to compose possible best intervention based on farmer aspiration and condition. In addition, several references from previous research reports, journal articles as well as government reports were used to sharpen analysis of data and information collected from the field.

A Preliminary Tsunami vulnerability analysis for Bakirkoy district in Istanbul

NASA Astrophysics Data System (ADS)

Tufekci, Duygu; Lutfi Suzen, M.; Cevdet Yalciner, Ahmet; Zaytsev, Andrey

2016-04-01

Resilience of coastal utilities after earthquakes and tsunamis has major importance for efficient and proper rescue and recovery operations soon after the disasters. Vulnerability assessment of coastal areas under extreme events has major importance for preparedness and development of mitigation strategies. The Sea of Marmara has experienced numerous earthquakes as well as associated tsunamis. There are variety of coastal facilities such as ports, small craft harbors, and terminals for maritime transportation, water front roads and business centers mainly at North Coast of Marmara Sea in megacity Istanbul. A detailed vulnerability analysis for Yenikapi region and a detailed resilience analysis for Haydarpasa port in Istanbul have been studied in previously by Cankaya et al., (2015) and Aytore et al., (2015) in SATREPS project. In this study, the methodology of vulnerability analysis under tsunami attack given in Cankaya et al., (2015) is modified and applied to Bakirkoy district of Istanbul. Bakirkoy district is located at western part of Istanbul and faces to the North Coast of Marmara Sea from 28.77oE to 28.89oE. High resolution spatial dataset of Istanbul Metropolitan Municipality (IMM) is used and analyzed. The bathymetry and topography database and the spatial dataset containing all buildings/structures/infrastructures in the district are collated and utilized for tsunami numerical modeling and following vulnerability analysis. The tsunami parameters from deterministically defined worst case scenarios are computed from the simulations using tsunami numerical model NAMI DANCE. The vulnerability assessment parameters in the district according to vulnerability and resilience are defined; and scored by implementation of a GIS based TVA with appropriate MCDA methods. The risk level is computed using tsunami intensity (level of flow depth from simulations) and TVA results at every location in Bakirkoy district. The preliminary results are presented and discussed. Acknowledgements: Partial support by Japan-Turkey Joint Research Project by JICA on earthquakes and tsunamis in Marmara Region in (JICA SATREPS - MarDiM Project), 603839 ASTARTE Project of EU, UDAP-C-12-14 project of AFAD, Turkey, 108Y227, 113M556, 213M534 projects of TUBITAK Turkey, RAPSODI (CONCERT_Dis-021) of CONCERT-Japan Joint Call and Istanbul Metropolitan Municipality are acknowledged.

A Homegrown Design for Data Warehousing: A District Customizes Its Own Process for Generating Detailed Information about Students in Real Time

ERIC Educational Resources Information Center

Thompson, Terry J.; Gould, Karen J.

2005-01-01

In recent years the Metropolitan School District of Wayne Township in Indianapolis has been awash in data. In attempts to improve levels of student achievement, the authors collected all manner of statistical details about students and schools and attempted to perform data analysis as part of the school improvement process. The authors were never…

Geographical Inequalities and Social and Environmental Risk Factors for Under-Five Mortality in Ghana in 2000 and 2010: Bayesian Spatial Analysis of Census Data.

PubMed

Arku, Raphael E; Bennett, James E; Castro, Marcia C; Agyeman-Duah, Kofi; Mintah, Samilia E; Ware, James H; Nyarko, Philomena; Spengler, John D; Agyei-Mensah, Samuel; Ezzati, Majid

2016-06-01

Under-five mortality is declining in Ghana and many other countries. Very few studies have measured under-five mortality-and its social and environmental risk factors-at fine spatial resolutions, which is relevant for policy purposes. Our aim was to estimate under-five mortality and its social and environmental risk factors at the district level in Ghana. We used 10% random samples of Ghana's 2000 and 2010 National Population and Housing Censuses. We applied indirect demographic methods and a Bayesian spatial model to the information on total number of children ever born and children surviving to estimate under-five mortality (probability of dying by 5 y of age, 5q0) for each of Ghana's 110 districts. We also used the census data to estimate the distributions of households or persons in each district in terms of fuel used for cooking, sanitation facility, drinking water source, and parental education. Median district 5q0 declined from 99 deaths per 1,000 live births in 2000 to 70 in 2010. The decline ranged from <5% in some northern districts, where 5q0 had been higher in 2000, to >40% in southern districts, where it had been lower in 2000, exacerbating existing inequalities. Primary education increased in men and women, and more households had access to improved water and sanitation and cleaner cooking fuels. Higher use of liquefied petroleum gas for cooking was associated with lower 5q0 in multivariate analysis. Under-five mortality has declined in all of Ghana's districts, but the cross-district inequality in mortality has increased. There is a need for additional data, including on healthcare, and additional environmental and socioeconomic measurements, to understand the reasons for the variations in mortality levels and trends.

Geographical Inequalities and Social and Environmental Risk Factors for Under-Five Mortality in Ghana in 2000 and 2010: Bayesian Spatial Analysis of Census Data

PubMed Central

Arku, Raphael E.; Bennett, James E.; Agyeman-Duah, Kofi; Mintah, Samilia E.; Spengler, John D.; Agyei-Mensah, Samuel

2016-01-01

Background Under-five mortality is declining in Ghana and many other countries. Very few studies have measured under-five mortality—and its social and environmental risk factors—at fine spatial resolutions, which is relevant for policy purposes. Our aim was to estimate under-five mortality and its social and environmental risk factors at the district level in Ghana. Methods and Findings We used 10% random samples of Ghana’s 2000 and 2010 National Population and Housing Censuses. We applied indirect demographic methods and a Bayesian spatial model to the information on total number of children ever born and children surviving to estimate under-five mortality (probability of dying by 5 y of age, 5q0) for each of Ghana’s 110 districts. We also used the census data to estimate the distributions of households or persons in each district in terms of fuel used for cooking, sanitation facility, drinking water source, and parental education. Median district 5q0 declined from 99 deaths per 1,000 live births in 2000 to 70 in 2010. The decline ranged from <5% in some northern districts, where 5q0 had been higher in 2000, to >40% in southern districts, where it had been lower in 2000, exacerbating existing inequalities. Primary education increased in men and women, and more households had access to improved water and sanitation and cleaner cooking fuels. Higher use of liquefied petroleum gas for cooking was associated with lower 5q0 in multivariate analysis. Conclusions Under-five mortality has declined in all of Ghana’s districts, but the cross-district inequality in mortality has increased. There is a need for additional data, including on healthcare, and additional environmental and socioeconomic measurements, to understand the reasons for the variations in mortality levels and trends. PMID:27327774

District health information system assessment: a case study in iran.

PubMed

Raeisi, Ahmad Reza; Saghaeiannejad, Sakineh; Karimi, Saeed; Ehteshami, Asghar; Kasaei, Mahtab

2013-03-01

Health care managers and personnel should be aware and literate of health information system in order to increase the efficiency and effectiveness in their organization. Since accurate, appropriate, precise, timely, valid information and interpretation of information is required and is the basis for policy planning and decision making in various levels of the organization. This study was conducted to assess the district health information system evolution in Iran according to WHO framework. This research is an applied, descriptive cross sectional study, in which a total of twelve urban and eight rural facilities, and the district health center at Falavarjan region were surveyed by using a questionnaire with 334 items. Content and constructive validity and reliability of the questionnaire were confirmed with correlation coefficient of 0.99. Obtained data were analyzed with SPSS 16 software and descriptive statistics were used to examine measures of WHO compliance. The analysis of data revealed that the mean score of compliance of district health information system framework was 35.75 percent. The maximum score of compliance with district health information system belonged to the data collection process (70 percent). The minimum score of compliance with district health information system belonged to information based decision making process with a score of 10 percent. District Health Information System Criteria in Isfahan province do not completely comply with WHO framework. Consequently, it seems that health system managers engaged with underlying policy and decision making processes at district health level should try to restructure and decentralize district health information system and develop training management programs for their managers.

[Chronic Malnutrition among Children under Five in Peru: A Spatial Analysis of Nutritional Data, 2010-2016].

PubMed

Hernández-Vásquez, Akram; Tapia-López, Elena

2017-05-19

Peru has implemented various strategies seeking to improve nutritional indicators in children under five years old. However, high prevalence of malnutrition in some regions still remains. The aim of this study was to assess changes in regional prevalence and to determine the presence of district conglomerates with a high prevalence of chronic childhood malnutrition (CCM) in 2010 and 2016. A comparative descriptive analysis by regions and a district-level spatial analysis were conducted employing indicators reported by the Nutritional Status Information System. 23.9% (561.090/2.343.806) children under five years evaluated in Peru during 2010 and 18.0% (394.049/2.193.268) evaluated during 2016 were chronic malnutrition (reduction of 5.9 percentage points). We identified a decline of 7.6 percent points in rural areas and the persistence of prevalence above 30% in only one region (Huancavelica). The spatial analysis identified clusters of districts with high prevalence in 20% (379/1834) of Peruvian districts in 2010, and 17.2% (316/1834) of those in 2016, which are mainly spread across the sierra and jungle regions. . Peru has made significant progress in reducing stunting in children. Nevertheless, it still represents a health problem due to high prevalence in the sierra region, as well as expansion to jungle districts in 2016. Licencia Creative Commons Atribución-NoComercial-SinDerivadas 3.0 Unported Licencia Creative Commons

Factors influencing the work efficiency of district health managers in low-resource settings: a qualitative study in Ghana.

PubMed

Bonenberger, Marc; Aikins, Moses; Akweongo, Patricia; Wyss, Kaspar

2016-01-14

There is increasing evidence that good district management practices can improve health system performance and conversely, that poor and inefficient management practices have detrimental effects. The aim of the present study was to identify factors contributing to inefficient management practices of district health managers and ways to improve their overall efficiency. Nineteen semi-structured interviews were conducted with district health managers in three districts of the Eastern Region in Ghana. The 19 interviews conducted comprised 90% of the managerial workforce in these districts in 2013. A thematic analysis was carried out using the WHO's leadership and management strengthening framework to structure the results. Key factors for inefficient district health management practices were identified to be: human resource shortages, inadequate planning and communication skills, financial constraints, and a narrow decision space that constrains the authority of district health managers and their ability to influence decision-making. Strategies that may improve managerial efficiency at both an individual and organizational level included improvements to planning, communication, and time management skills, and ensuring the timely release of district funds. Filling District Health Management Team vacancies, developing leadership and management skills of district health managers, ensuring a better flow of district funds, and delegating more authority to the districts seems to be a promising intervention package, which may result in better and more efficient management practices and stronger health system performance.

Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India.

PubMed

Thamattoor, Usha; Thomas, Tinku; Banandur, Pradeep; Rajaram, S; Duchesne, Thierry; Abdous, Belkacem; Washington, Reynold; Ramesh, B M; Moses, Stephen; Alary, Michel

2015-01-01

Heterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively. Data on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity. The average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age ≥ 25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age<25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04). Illiteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India.

Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India

PubMed Central

Thamattoor, Usha; Thomas, Tinku; Banandur, Pradeep; S, Rajaram; Duchesne, Thierry; Abdous, Belkacem; Washington, Reynold; B M, Ramesh; Moses, Stephen; Alary, Michel

2015-01-01

Background Heterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively. Methods Data on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity. Results The average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age≥25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age<25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04). Conclusion Illiteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India. PMID:26147208

[Effect of fluoride on human hypothalamus-hypophysis-testis axis hormones].

PubMed

Hao, Pengfei; Ma, Xiaoying; Cheng, Xuemin; Ba, Yue; Zhu, Jingyuan; Cui, Liuxin

2010-01-01

To study of endocrine disturbing effect of fluoride on human hypothalamus-hypophysis-testis axis hormones. Sunying County, Kaifeng City was selected as polluted district which the fluoride in drinking water was 3.89 mg/L, and Shenlilou county was selected as control district which the fluoride was less than 1.0 mg/L. 150 individual lived there more than 5 years were srlected randomly. And investigated by medical examination, then blood and urine sample were collected, and the serum level of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), testosterone (T) and estradiol (E2) were measured by RIA method, and the urine level of fluoride were measured. Other than that, the concentration of fluoride in the water, food, soil and air were detected by the standard methods. The concentrations of fluoride in the water, food and soil of the fluoride polluted district were significantly higher than those of control district (P < 0.05), and the concentration fluoride in the air of two district were not found. There was no significant difference of serum level of GnRH between fluoride polluted district and control district (P > 0.05). The serum level of LH in men of fluoride polluted district was significantly higher than that of control group (P < 0.05), and the serum level of T in men of fluoride polluted district was significantly less than that of control group (P < 0.05). There was no significant difference of serum level of LH between fluoride polluted district and control district (P > 0.05), and the serum level of T in women of fluoride polluted district was significantly higher than that of control group (P < 0.05). There was no significant difference of serum level of E2 between fluoride polluted district and control district (P > 0.05). Fluoride could effect hormone levels of each layer of the hypothalamus-hypophysis-testis axis, and show the reproductive endocrine disturbing effects. The reproductive endocrine disturbing effects of male maybe more severe than those of female.

Community and District Empowerment for Scale-up (CODES): a complex district-level management intervention to improve child survival in Uganda: study protocol for a randomized controlled trial.

PubMed

Waiswa, Peter; O'Connell, Thomas; Bagenda, Danstan; Mullachery, Pricila; Mpanga, Flavia; Henriksson, Dorcus Kiwanuka; Katahoire, Anne Ruhweza; Ssegujja, Eric; Mbonye, Anthony K; Peterson, Stefan Swartling

2016-03-11

Innovative and sustainable strategies to strengthen districts and other sub-national health systems and management are urgently required to reduce child mortality. Although highly effective evidence-based and affordable child survival interventions are well-known, at the district level, lack of data, motivation, analytic and planning capacity often impedes prioritization and management weaknesses impede implementation. The Community and District Empowerment for Scale-up (CODES) project is a complex management intervention designed to test whether districts when empowered with data and management tools can prioritize and implement evidence-based child survival interventions equitably. The CODES strategy combines management, diagnostic, and evaluation tools to identify and analyze the causes of bottlenecks to implementation, build capacity of district management teams to implement context-specific solutions, and to foster community monitoring and social accountability to increase demand for services. CODES combines UNICEF tools designed to systematize priority setting, allocation of resources and problem solving with Community dialogues based on Citizen Report Cards and U-Reports used to engage and empower communities in monitoring health service provision and to demand for quality services. Implementation and all data collection will be by the districts teams or local Community-based Organizations who will be supported by two local implementing partners. The study will be evaluated as a cluster randomized trial with eight intervention and eight comparison districts over a period of 3 years. Evaluation will focus on differences in uptake of child survival interventions and will follow an intention-to-treat analysis. We will also document and analyze experiences in implementation including changes in management practices. By increasing the District Health Management Teams' capacity to prioritize and implement context-specific solutions, and empowering communities to become active partners in service delivery, coverage of child survival interventions will increase. Lessons learned on strengthening district-level managerial capacities and mechanisms for community monitoring may have implications, not only in Uganda but also in other similar settings, especially with regard to accelerating effective coverage of key child survival interventions using locally available resources. ISRCTN15705788 , Date of registration; 24 July 2015.

District wellness policies and school-level practices in Minnesota, USA.

PubMed

Larson, Nicole; Davey, Cynthia; Hoffman, Pamela; Kubik, Martha Y; Nanney, Marilyn S

2016-01-01

To compare the strength of district wellness policies with corresponding school-level practices reported by principals and teachers. District-level wellness policy data were collected from school district websites and, if not available online, by requests made to district administrators in the autumn of 2013. The strength of district policies was scored using the Wellness School Assessment Tool. School-level data were drawn from the 2012 Minnesota School Health Profiles principal and teacher surveys and the National Center for Education Statistics Common Core Data. Generalized estimating equations which accounted for school-level demographics and the nesting of up to two schools within some districts were used to examine ten district policy items and fourteen school-level practices of relevance to nutrition standards, nutrition education and wellness promotion, and physical activity promotion. State-wide sample of 180 districts and 212 public schools in Minnesota, USA. The mean number of energy-dense, nutrient-poor snack foods and beverages available for students to purchase at school was inversely related to the strength of district wellness policies regulating vending machines and school stores (P=0·01). The proportion of schools having a joint use agreement for shared use of physical activity facilities was inversely related to the strength of district policies addressing community use of school facilities (P=0·03). No associations were found between the strength of other district policies and school-level practices. Nutrition educators and other health professionals should assist schools in periodically assessing their wellness practices to ensure compliance with district wellness policies and environments supportive of healthy behaviours.

District wellness policies and school-level practices in Minnesota

PubMed Central

Larson, Nicole; Davey, Cynthia; Hoffman, Pamela; Kubik, Martha Y.; Nanney, Marilyn S.

2015-01-01

Objective To compare the strength of district wellness policies with corresponding school-level practices reported by principals and teachers. Design District-level wellness policy data was collected from school district websites and, if not available online, by requests made to district administrators in the fall of 2013. The strength of district policies was scored using the Wellness School Assessment Tool. School-level data were drawn from the 2012 Minnesota School Health Profiles principal and teacher surveys and National Center for Education Statistics Common Core Data. Generalized estimating equations which accounted for school-level demographics and the nesting of up to two schools within some districts were used to examine 10 district policy items and 14 school-level practices of relevance to nutrition standards, nutrition education and wellness promotion, and physical activity promotion. Setting/Subjects Statewide sample of 180 districts and 212 public schools in Minnesota. Results The mean number of energy-dense, nutrient-poor snack foods and beverages available for students to purchase at school was inversely related to the strength of district wellness policies regulating vending machines and school stores (p=0.01). The proportion of schools having a joint use agreement for shared use of physical activity facilities was inversely related to the strength of district policies addressing community use of school facilities (p=0.03). No associations were found between the strength of other district policies and school-level practices. Conclusions Nutrition educators and other health professionals should assist schools in periodically assessing their wellness practices to ensure compliance with district wellness policies and environments supportive of healthy behaviors. PMID:25990324

Governing the implementation of Emergency Obstetric Care: experiences of Rural District Health Managers, Tanzania

PubMed Central

2014-01-01

Background Many health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects. Methods The study used a qualitative approach in which data was obtained from thirteen individual interviews and one focus group discussion (FGD). Interviews were conducted with members of the district health management team, district health service boards and NGO representatives. The FGD included key informants who were directly involved in the work of implementing EmOC services in the district. Documentary reviews and observation were done to supplement the data. All the materials were analysed using a qualitative content analysis approach. Results Implementation of EmOC was considered to be a process accompanied by achievements and challenges. Achievements included increased institutional delivery, increased number of ambulances, training service providers in emergency obstetric care and building a new rural health centre that provides comprehensive emergency obstetric care. These achievements were associated with good leadership skills of the team together with partnerships that existed between different actors such as the Non-Governmental Organization (NGO), development partners, local politicians and Traditional Birth Attendants (TBAs). Most challenges faced during the implementation of EmOC were related to governance issues at different levels and included delays in disbursement of funds from the central government, shortages of health workers, unclear mechanisms for accountability, lack of incentives to motivate overburdened staffs and lack of guidelines for partnership development. Conclusion The study revealed that implementing EmOC is a process accompanied by challenges that require an approach with multiple partners to address them and that, for effective partnership, the roles and responsibilities of each partner should be well stipulated in a clear working framework within the district health system. Partnerships strengthen health system governance and therefore ensure effective implementation of health policies at a local level. PMID:25086597

Governing the implementation of emergency obstetric care: experiences of rural district health managers, Tanzania.

PubMed

Mkoka, Dickson Ally; Kiwara, Angwara; Goicolea, Isabel; Hurtig, Anna-Karin

2014-08-03

Many health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects. The study used a qualitative approach in which data was obtained from thirteen individual interviews and one focus group discussion (FGD). Interviews were conducted with members of the district health management team, district health service boards and NGO representatives. The FGD included key informants who were directly involved in the work of implementing EmOC services in the district. Documentary reviews and observation were done to supplement the data. All the materials were analysed using a qualitative content analysis approach. Implementation of EmOC was considered to be a process accompanied by achievements and challenges. Achievements included increased institutional delivery, increased number of ambulances, training service providers in emergency obstetric care and building a new rural health centre that provides comprehensive emergency obstetric care. These achievements were associated with good leadership skills of the team together with partnerships that existed between different actors such as the Non-Governmental Organization (NGO), development partners, local politicians and Traditional Birth Attendants (TBAs). Most challenges faced during the implementation of EmOC were related to governance issues at different levels and included delays in disbursement of funds from the central government, shortages of health workers, unclear mechanisms for accountability, lack of incentives to motivate overburdened staffs and lack of guidelines for partnership development. The study revealed that implementing EmOC is a process accompanied by challenges that require an approach with multiple partners to address them and that, for effective partnership, the roles and responsibilities of each partner should be well stipulated in a clear working framework within the district health system. Partnerships strengthen health system governance and therefore ensure effective implementation of health policies at a local level.

Developing Vulnerability Analysis Method for Climate Change Adaptation on Agropolitan Region in Malang District

NASA Astrophysics Data System (ADS)

Sugiarto, Y.; Perdinan; Atmaja, T.; Wibowo, A.

2017-03-01

Agriculture plays a strategic role in strengthening sustainable development. Based on agropolitan concept, the village becomes the center of economic activities by combining agriculture, agro-industry, agribusiness and tourism that able to create high value-added economy. The impact of climate change on agriculture and water resources may increase the pressure on agropolitan development. The assessment method is required to measure the vulnerability of area-based communities in the agropolitan to climate change impact. An analysis of agropolitan vulnerability was conducted in Malang district based on four aspects and considering the availability and distribution of water as the problem. The indicators used to measure was vulnerability component which consisted of sensitivity and adaptive capacity and exposure component. The studies earned 21 indicators derived from the 115 village-based data. The results of vulnerability assessments showed that most of the villages were categorised at a moderate level. Around 20% of 388 villages were categorized at high to very high level of vulnerability due to low level of agricultural economic. In agropolitan region within the sub-district of Poncokusumo, the vulnerability of the villages varies between very low to very high. The most villages were vulnerable due to lower adaptive capacity, eventhough the level of sensitivity and exposure of all villages were relatively similar. The existence of water resources was the biggest contributor to the high exposure of the villages in Malang district, while the reception of credit facilities and source of family income were among the indicators that lead to high sensitivity component.

Assessing chronic and climate-induced water risk through spatially distributed cumulative deficit measures: A new picture of water sustainability in India

NASA Astrophysics Data System (ADS)

Devineni, Naresh; Perveen, Shama; Lall, Upmanu

2013-04-01

India is a poster child for groundwater depletion and chronic water stress. Often, water sustainability is measured through an estimate of the difference between the average supply and demand in a region. However, water supply and demand are highly variable in time and space. Hence, measures of scarcity need to reflect temporal imbalances even for a fixed location. We introduce spatially distributed indices of water stress that integrate over time variations in water supply and demand. The indices reflect the maximum cumulative deficit in a regional water balance within year and across years. This can be interpreted as the amount that needs to be drawn from external storage (either aquifers or surface reservoirs or interarea transfers) to meet the current demand pattern given a variable climate and renewable water supply. A simulation over a long period of record (historical or projected) provides the ability to quantify risk. We present an application at a district level in India considering more than a 100 year data set of rainfall as the renewable supply, and the recent water use pattern for each district. Consumption data are available through surveys at the district level, and consequently, we use this rather than river basins as the unit of analysis. The rainfall endogenous to each district is used as a potentially renewable water supply to reflect the supply-demand imbalances directly at the district level, independent of potential transfers due to upstream-induced runoff or canals. The index is useful for indicating whether small or large surface storage will suffice, or whether the extent of groundwater storage or external transfers, or changes in demand are needed to achieve a sustainable solution. Implications of the analysis for India and for other applications are discussed.

An Examination of Tri-Level Collaboration around Student Achievement Using the Gap Analysis Approach: School Site Leadership Factors

ERIC Educational Resources Information Center

Salinas, Esther Charlotte

2013-01-01

Using the Gap Analysis problem-solving framework (Clark & Estes, 2008), this project examined collaboration around student achievement at the school site leadership level in the Pasadena Unified School District (PUSD). This project is one of three concurrent studies focused on collaboration around student achievement in the PUSD that include…

An Examination of Tri-Level Collaboration around Student Achievement Using the Gap Analysis Approach: Central Office Leadership Factors

ERIC Educational Resources Information Center

Llamas, Sonia Rodarte

2013-01-01

Using the Gap Analysis problem-solving framework (Clark & Estes, 2008), this study examined collaboration around student achievement at the central office leadership level in the Pasadena Unified School District (PUSD). This study is one of three concurrent studies focused on collaboration around student achievement in the PUSD that include…

An Examination of Tri-Level Collaboration around Student Achievement Using the Gap Analysis Approach: Teacher Factors

ERIC Educational Resources Information Center

Carruthers, Anthony Steven

2013-01-01

Using the Gap Analysis problem-solving framework (Clark & Estes, 2008), this project examined collaboration around student achievement in the Pasadena Unified School District (PUSD) from the teacher perspective. As part of a tri-level study, two other projects examined collaboration around student achievement in PUSD from the perspectives of…

Socioeconomic deprivation and cancer survival in Germany: an ecological analysis in 200 districts in Germany.

PubMed

Jansen, Lina; Eberle, Andrea; Emrich, Katharina; Gondos, Adam; Holleczek, Bernd; Kajüter, Hiltraud; Maier, Werner; Nennecke, Alice; Pritzkuleit, Ron; Brenner, Hermann

2014-06-15

Although socioeconomic inequalities in cancer survival have been demonstrated both within and between countries, evidence on the variation of the inequalities over time past diagnosis is sparse. Furthermore, no comprehensive analysis of socioeconomic differences in cancer survival in Germany has been conducted. Therefore, we analyzed variations in cancer survival for patients diagnosed with one of the 25 most common cancer sites in 1997-2006 in ten population-based cancer registries in Germany (covering 32 million inhabitants). Patients were assigned a socioeconomic status according to the district of residence at diagnosis. Period analysis was used to derive 3-month, 5-year and conditional 1-year and 5-year age-standardized relative survival for 2002-2006 for each deprivation quintile in Germany. Relative survival of patients living in the most deprived district was compared to survival of patients living in all other districts by model-based period analysis. For 21 of 25 cancer sites, 5-year relative survival was lower in the most deprived districts than in all other districts combined. The median relative excess risk of death over the 25 cancer sites decreased from 1.24 in the first 3 months to 1.16 in the following 9 months to 1.08 in the following 4 years. Inequalities persisted after adjustment for stage. These major regional socioeconomic inequalities indicate a potential for improving cancer care and survival in Germany. Studies on individual-level patient data with access to treatment information should be conducted to examine the reasons for these socioeconomic inequalities in cancer survival in more detail. © 2013 UICC.

"Why Are the Black Kids Being Suspended?" An Examination of a School District's Efforts to Reform a Faulty Suspension Policy through Community Conversations

ERIC Educational Resources Information Center

Davis, Cassandra R.

2017-01-01

This article will explore a district's attempt to revise their suspension policy with the collaborative effort of community members and school-level educators. In this article, I will present my analysis of data from six forums where participants expressed their concerns and made recommendations on how to improve the policy. I will also use…

Poor Knowledge and Nonuse of Long-Acting/Permanent Methods of Contraceptives in Six Districts in Indonesia.

PubMed

Titaley, Christiana R; Ariawan, Iwan; Damayanti, Rita; Ismail, Amry; Saputri, A Y; Yelda, Fitra; Soeharno, Nugroho; Subarkah; Harlan, Sarah; Wahyuningrum, Yunita; Storey, Douglas

2017-11-01

This analysis aimed at examining the association between the level of knowledge about long-acting/permanent methods of contraceptives (LAPM) and nonuse of LAPM among currently married, nonpregnant, and fecund women aged 15 to 49 years intending to limit childbearing. Data were derived from a cross-sectional study in Tuban, Kediri, and Lumajang District (East Java Province) and Lombok Barat, Lombok Timur, and Sumbawa District (Nusa Tenggara Barat Province) in June 2012. Information was obtained from 4323 respondents. Using multivariate logistic regression, we found that women with moderate levels of LAPM knowledge were less likely to use LAPM than women with high levels of knowledge (adjusted odds ratio [aOR] = 2.01, 95% CI = 1.51-2.68). Women with low level of LAPM knowledge were less likely to use LAPM than women with high levels of knowledge (aOR = 4.25, 95% CI = 3.37-5.36). Efforts to strengthen counseling services and increased provider knowledge and counselling skills are important to improve women's knowledge about and use of LAPM.

Association between income inequality and dental status in Japanese older adults: Analysis of data from JAGES2013.

PubMed

Tashiro, Atsushi; Aida, Jun; Shobugawa, Yugo; Fujiyama, Yuki; Yamamoto, Tatsuo; Saito, Reiko; Kondo, Katsunori

2017-01-01

Objectives　Personal income affects dental status in older people. However, the impact of income inequality on dental status at the community level (junior high school district) is unclear. The purpose of this study was to examine the association between dental status and community level income inequity after adjust for individual socio-economic status in Japanese older adults, and to verify the relative income hypothesis, also known as the Wilkinson hypothesis.Methods　We used data from the Japan Gerontological Evaluation Study (JAGES) conducted in Niigata city. JAGES is a postal survey of functionally independent adults aged 65 years or older. We enrolled 4,983 respondents (response rate 62.3%) and used data on 3,980 of them after excluding incomplete data. We evaluated health condition and socio-economic status using questionnaires. The Gini coefficient, as an indicator of income inequality, was calculated by junior high school district (57 districts) based on the data from the questionnaire. Additionally, the Pearson's coefficient of correlation was calculated to evaluate the association between the mean number of remaining teeth and the community level Gini coefficient. Then we evaluated the mean number of remaining teeth among the groups stratified by the Gini coefficient conditions. Next, we conducted a multilevel analysis using an ordinal logistic regression model. The number of remaining teeth was set as the dependent variable, while sex, age, household size, education, smoking status, diabetes treatment, current living conditions, and equivalent income were used as independent variables at the individual level. The Gini coefficient and average equivalent income in the junior high school district were used as independent variables at the community level.Results　The Pearson's correlation coefficient for the relationship between the Gini coefficient and the mean number of remaining teeth in the junior high school district was -0.44 (P<0.01). Wider income disparity area (Gini coefficient≧0.35) revealed a significantly small number of remaining teeth (P<0.001). The multilevel analysis showed that a higher Gini coefficient and a lower average equivalent income at the community level were significantly associated with a lower number of remaining teeth, and with educational attainment, smoking status, current living conditions, and equivalent income at the individual level, after adjusting for sex and age. On the other hand, educational attainment at the individual level, and average equivalent income at the community level were not significant factors after adjusting for all individual level variables.Conclusion　This study showed that, in addition to individual socio-economic status, income inequality at the community level was significantly associated with number of remaining teeth in Japanese older adults. Although the precise mechanism of this association is still unclear, our result supports the relative income hypothesis.

Mapping agroecosystem zone using remote sensing for food security analysis in Bantul district Daerah Istimewa Yogyakarta

NASA Astrophysics Data System (ADS)

Murti, Sigit Heru

2017-10-01

Food security is one of the most important issue for Indonesia. The huge population number and high population growing rate has made the food security a critical issue. This paper describe the application of remote sensing data to (1) map agroecosystem zones in Bantul District, Special Region of Yogyakarta, Indonesia in 2012 and (2) analyze the food security in the study area based on the resulting agro-ecosystem map. Bantul District is selected as the pilot area because this area is among the highest food crop production area in the Province. ALOS AVNIR-2 image accquired on 15 June 2010 was integrated with Indonesian Surface map (RBI map), soil types map, and slope steepness map. Population statistics data was also used to calculate the food needs. Field survey was conducted to obtain the crop field productivity information on each agro-ecosystem zone and assess the accuracy of the model. This research indicates that (1) Bantul District can be divided into three agroecosystem zones, where each zone has unique topograhic configuration and soil types composition, and (2) Bantul Distict is categorized as food secure area since the rice production in 2012 managed to cover the food needs of the people with the surplus of 33,208.6 tonnes of rice. However, when the analysis was conducted at sub-district level, there are four subdistrict with food insecurity where the food needs surpass the rice production. These sub-district are Kasihan Sub-district (-5,598.4 t), Banguntapan Sub-district (-2,483.4 t), Pajangan Sub-district (-1,039.6 t) and Dlingo Sub-district (-798.7 t).

Urban water metabolism efficiency assessment: integrated analysis of available and virtual water.

PubMed

Huang, Chu-Long; Vause, Jonathan; Ma, Hwong-Wen; Yu, Chang-Ping

2013-05-01

Resolving the complex environmental problems of water pollution and shortage which occur during urbanization requires the systematic assessment of urban water metabolism efficiency (WME). While previous research has tended to focus on either available or virtual water metabolism, here we argue that the systematic problems arising during urbanization require an integrated assessment of available and virtual WME, using an indicator system based on material flow analysis (MFA) results. Future research should focus on the following areas: 1) analysis of available and virtual water flow patterns and processes through urban districts in different urbanization phases in years with varying amounts of rainfall, and their environmental effects; 2) based on the optimization of social, economic and environmental benefits, establishment of an indicator system for urban WME assessment using MFA results; 3) integrated assessment of available and virtual WME in districts with different urbanization levels, to facilitate study of the interactions between the natural and social water cycles; 4) analysis of mechanisms driving differences in WME between districts with different urbanization levels, and the selection of dominant social and economic driving indicators, especially those impacting water resource consumption. Combinations of these driving indicators could then be used to design efficient water resource metabolism solutions, and integrated management policies for reduced water consumption. Copyright © 2013 Elsevier B.V. All rights reserved.

The experiences of districts in implementing a national incentive programme to promote safe delivery in Nepal

PubMed Central

Powell-Jackson, Timothy; Morrison, Joanna; Tiwari, Suresh; Neupane, Basu Dev; Costello, Anthony M

2009-01-01

Background Nepal's Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the intention of increasing utilisation of professional care at childbirth. It provided cash to women giving birth in a health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We explored early implementation of the programme at the district-level to understand the factors that have contributed to its low uptake. Methods We conducted in ten study districts a series of key informant interviews and focus group discussions with staff from health facilities and the district health office and other stakeholders involved in implementation. Manual content analysis was used to categorise data under emerging themes. Results Problems at the central level imposed severe constraints on the ability of district-level actors to implement the programme. These included bureaucratic delays in the disbursement of funds, difficulties in communicating the policy, both to implementers and the wider public and the complexity of the programme's design. However, some district implementers were able to cope with these problems, providing reasons for why uptake of the programme varied considerably between districts. Actions appeared to be influenced by the pressure to meet local needs, as well individual perceptions and acceptance of the programme. The experience also sheds light on some of the adverse effects of the programme on the wider health system. Conclusion The success of conditional cash transfer programmes in Latin America has led to a wave of enthusiasm for their adoption in other parts of the world. However, context matters and proponents of similar programmes in south Asia should give due attention to the challenges to implementation when capacity is weak and health services inadequate. PMID:19508710

Barriers to District-Level Educational Reform: A Statewide Study of Minnesota School Superintendents

ERIC Educational Resources Information Center

Stewart, Courtney; Raskin, Candace; Zielaski, Daniel

2012-01-01

This study attempts to identify and describe Minnesota superintendents' perceptions of barriers to district-level reform as well as compare superintendents' perceptions of district reform related characteristics. This research also strives to identify factors preventing Minnesota's district-level leadership from implementing national reform…

[Experience in using cluster analysis and the prognosis of the stages of epizootic risk for Newcastle disease in poultry].

PubMed

Elitsina, P; Parannzhilova, M; Vukov, M

1985-01-01

An attempt was made to use clastic analysis and projection of the steps of the epizootic hazard with regard to Newcastle disease. There were no records of the disease after 1982 but still it is the object of consideration on the part of specialists. A clastic analysis was made on the base of a factorial model of Newcastle disease in this country for the 1970-1979. Used was a programme already worked out and practised at the Pilot Computor Center of the Medical Academy, Sofia. The districts in the country were grouped in a dendogramme, 16 groups being distinguished out of a total of 27 districts. This showed that regardless of the small territory of the country the districts are sufficiently differing between each other (due to the various degrees of integration) so that they could not be grouped together by similar values of intensity of poultry breeding and epizootic conjuncture with regard to Newcastle disease. Districts of epizootic hazard ranging from 1st to 5th degree substantiate the use of a differential approach in building up the tactics of prophylaxis and control of the disease, while measures concerning the poultry dressing combines should be at a high level regardless of the category of the respective district. The grouping of neighboring districts on a territorial principle disclosed the existence of reasons of climatic-and-geographic nature that could predispose equal degrees of intensity of poultry breeding and epizootic hazard.

Ecological context of infant mortality in high-focus states of India

PubMed Central

2016-01-01

OBJECTIVES: This goal of this study was to shed light on the ecological context as a potential determinant of the infant mortality rate in nine high-focus states in India. METHODS: Data from the Annual Health Survey (2010-2011), the Census of India (2011), and the District Level Household and Facility Survey 3 (2007-08) were used in this study. In multiple regression analysis explanatory variable such as underdevelopment is measured by the non-working population, and income inequality, quantified as the proportion of households in the bottom wealth quintile. While, the trickle-down effect of education is measured by female literacy, and investment in health, as reflected by neonatal care facilities in primary health centres. RESULTS: A high spatial autocorrelation of district infant mortality rates was observed, and ecological factors were found to have a significant impact on district infant mortality rates. The result also revealed that non-working population and income inequality were found to have a negative effect on the district infant mortality rate. Additionally, female literacy and new-born care facilities were found to have an inverse association with the infant mortality rate. CONCLUSIONS: Interventions at the community level can reduce district infant mortality rates. PMID:26971696

Ecological context of infant mortality in high-focus states of India.

PubMed

Ladusingh, Laishram; Gupta, Ashish Kumar; Yadav, Awdhesh

2016-01-01

This goal of this study was to shed light on the ecological context as a potential determinant of the infant mortality rate in nine high-focus states in India. Data from the Annual Health Survey (2010-2011), the Census of India (2011), and the District Level Household and Facility Survey 3 (2007-08) were used in this study. In multiple regression analysis explanatory variable such as underdevelopment is measured by the non-working population, and income inequality, quantified as the proportion of households in the bottom wealth quintile. While, the trickle-down effect of education is measured by female literacy, and investment in health, as reflected by neonatal care facilities in primary health centres. A high spatial autocorrelation of district infant mortality rates was observed, and ecological factors were found to have a significant impact on district infant mortality rates. The result also revealed that non-working population and income inequality were found to have a negative effect on the district infant mortality rate. Additionally, female literacy and new-born care facilities were found to have an inverse association with the infant mortality rate. Interventions at the community level can reduce district infant mortality rates.

Correlations and contrasts in structural history and style between an Archaean greenstone belt and adjacent gneiss belt, NE Minnesota

NASA Technical Reports Server (NTRS)

Bauer, R. L.; Hudleston, P. J.; Southwick, D. L.

1986-01-01

An analysis of the deformation along the boundary between the Vermilion Granitic Complex (VGC) and the Vermilion district indicates that the two terranes have seen a similar deformation history since the earliest stages of folding in the area. Despite this common history, variations in structural style occur between the two terranes, such as the relative development of D sub 1 fabrics and D sub 2 shear zones, and these can be attributed to differences in the crustal levels of the two terranes during the deformation. Similarly, the local development of F sub 3 folds in the VGC, but not in the Vermilion district, is interpreted to be a result of later-D sub 2 pluton emplacement which was not significant at the level of exposure of ther Vermilion district.

Survey of Emergency and Essential Surgical, Obstetric and Anaesthetic Services Available in Bangladeshi Government Health Facilities.

PubMed

Loveday, Jonathan; Sachdev, Sonal P; Cherian, Meena N; Katayama, Francisco; Akhtaruzzaman, A K M; Thomas, Joe; Huda, N; Faragher, E Brian; Johnson, Walter D

2017-07-01

Evaluate the capacity of government-run hospitals in Bangladesh to provide emergency and essential surgical, obstetric and anaesthetic services. Cross-sectional survey of 240 Bangladeshi Government healthcare facilities using the World Health Organisation Situational Analysis Tool to Assess Emergency and Essential Surgical Care (SAT). This tool evaluates the ability of a healthcare facility to provide basic surgical, obstetric and anaesthetic care based on 108 queries that detail the infrastructure and population demographics, human resources, surgical interventions and reason for referral, and available surgical equipment and supplies. For this survey, the Bangladeshi Ministry of Health sent the SAT to sub-district, district/general and teaching hospitals throughout the country in April 2013. Responses were received from 240 healthcare facilities (49.5% response rate): 218 sub-district and 22 district/general hospitals. At the sub-district level, caesarean section was offered by 55% of facilities, laparotomy by 7% and open fracture repair by 8%. At the district/general hospital level, 95% offered caesarean section, 86% offered laparotomy and 77% offered open fracture treatment. Availability of anaesthesia services, general equipment and supplies reflected this trend, where district/general hospitals were better equipped than sub-district hospitals, though equipment and infrastructure shortages persist. There has been overall impressive progress by the Bangladeshi Government in providing essential surgical services. Areas for improvement remain across all key areas, including infrastructure, human resources, surgical interventions offered and available equipment. Investment in surgical services offers a cost-effective opportunity to continue to improve the health of the Bangladeshi population and move the country towards universal healthcare coverage.

Quality-Assurance/Quality-Control Manual for Collection and Analysis of Water-Quality Data in the Ohio District, US Geological Survey

USGS Publications Warehouse

Francy, D.S.; Jones, A.L.; Myers, Donna N.; Rowe, G.L.; Eberle, Michael; Sarver, K.M.

1998-01-01

The U.S. Geological Survey (USGS), Water Resources Division (WRD), requires that quality-assurance/quality-control (QA/QC) activities be included in any sampling and analysis program. Operational QA/QC procedures address local needs while incorporating national policies. Therefore, specific technical policies were established for all activities associated with water-quality project being done by the Ohio District. The policies described in this report provide Ohio District personnel, cooperating agencies, and others with a reference manual on QA/QC procedures that are followed in collecitng and analyzing water-quality samples and reporting water-quality information in the Ohio District. The project chief, project support staff, District Water-Quality Specialist, and District Laboratory Coordinator are all involved in planning and implementing QA/QC activities at the district level. The District Chief and other district-level managers provide oversight, and the Regional Water-Quality Specialist, Office of Water Quality (USGS headquarters), and the Branch of Quality Systems within the Office of Water Quality create national QA/QC polices and provide assistance to District personnel. In the literature, the quality of all measurement data is expressed in terms of precision, variability, bias, accuracy, completeness, representativeness, and comparability. In the Ohio District, bias and variability will be used to describe quality-control data generated from samples in the field and laboratory. Each project chief must plan for implementation and financing of QA/QC activities necessary to achieve data-quality objectives. At least 15 percent of the total project effort must be directed toward QA/QC activities. Of this total, 5-10 percent will be used for collection and analysis of quality-control samples. This is an absolute minimum, and more may be required based on project objectives. Proper techniques must be followed in the collection and processing of surface-water, ground-water, biological, precipitation, bed-sediment, bedload, suspended-sediment, and solid-phase samples. These techniques are briefly described in this report and are extensively documented. The reference documents listed in this report will be kept by the District librarian and District Water-Quality Specialist and updated regularly so that they are available to all District staff. Proper handling and documentation before, during, and after field activities are essential to ensure the integrity of the sample and to correct erroneous reporting of data results. Field sites are to be properly identified and entered into the data base before field data-collection activities begin. During field activities, field notes are to be completed and sample bottles appropriately labeled a nd stored. After field activities, all paperwork is to be completed promptly and samples transferred to the laboratory within allowable holding times. All equipment used by District personnel for the collection and processing of water-quality samples is to be properly operated, maintained, and calibrated by project personnel. This includes equipment for onsite measurement of water-quality characteristics (temperature, specific conductance, pH, dissolved oxygen, alkalinity, acidity, and turbidity) and equipment and instruments used for biological sampling. The District Water-Quality Specialist and District Laboratory Coordinator are responsible for preventive maintenance and calibration of equipment in the Ohio District laboratory. The USGS National Water Quality Laboratory in Arvada, Colo., is the primary source of analytical services for most project work done by the Ohio District. Analyses done at the Ohio District laboratory are usually those that must be completed within a few hours of sample collection. Contract laboratories or other USGS laboratories are sometimes used instead of the NWQL or the Ohio District laboratory. When a contract laboratory is used, the projec

Spatial Random Effects Survival Models to Assess Geographical Inequalities in Dengue Fever Using Bayesian Approach: a Case Study

NASA Astrophysics Data System (ADS)

Astuti Thamrin, Sri; Taufik, Irfan

2018-03-01

Dengue haemorrhagic fever (DHF) is an infectious disease caused by dengue virus. The increasing number of people with DHF disease correlates with the neighbourhood, for example sub-districts, and the characteristics of the sub-districts are formed from individuals who are domiciled in the sub-districts. Data containing individuals and sub-districts is a hierarchical data structure, called multilevel analysis. Frequently encountered response variable of the data is the time until an event occurs. Multilevel and spatial models are being increasingly used to obtain substantive information on area-level inequalities in DHF survival. Using a case study approach, we report on the implications of using multilevel with spatial survival models to study geographical inequalities in all cause survival.

[Stakeholder representations of the role of the intermediate level of the DRC health system].

PubMed

Mbeva, Jean Bosco Kahindo; Karemere, Hermès; Schirvel, Carole; Porignon, Denis

2014-01-01

Intermediate health care structures in the DRC were designed during the setting-up of primary health care in a perspective of health district support. This study was designed to describe stakeholder representations of the intermediate level of the DRC health system during the first 30 years of the primary health care system. This case study was based on inductive analysis of data from 27 key informant interviews.. The intermediate level of the health system, lacking sufficient expertise and funding during the 1980s, was confined to inspection and control functions, answering to the central level of the Ministry of health and provincial authorities. Since the 1990s, faced with the pressing demand for support from health district teams, whose self-management had to deal with humanitarian emergencies, the need to integrate vertical programmes, and cope with the logistics of many different actors, the intermediate heath system developed methods and tools to support heath districts. This resulted in a subsidiary model of the intermediate level, the perceived efficacy of which varies according to the province over recent years. The "subsidiary" model of the intermediary health system level seems a good alternative to the "control" model in DRC.

Stakeholder analysis for a maternal and newborn health project in Eastern Uganda.

PubMed

Namazzi, Gertrude; N, Kiwanuka Suzanne; Peter, Waiswa; John, Bua; Olico, Okui; A, Allen Katharine; A, Hyder Adnan; Elizabeth, Ekirapa Kiracho

2013-03-04

Based on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders' interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country. A stakeholder analysis was carried out in March 2011 at national level and in four districts of Eastern Uganda where the proposed interventions would be conducted. At the national level, four key informant interviews were conducted with the ministry of health representative, Member of Parliament, and development partners. District health team members were interviewed and also engaged in a workshop; and at community level, twelve focus group discussions were conducted among women, men and motorcycle transporters. This analysis revealed that district and community level stakeholders were high level supporters of the proposed interventions but not drivers. At community level the mothers, their spouses and transporters were of low influence due to the limited funds they possessed. National level and district stakeholders believed that the intervention is costly and cannot be affordably scaled up. They advised the study team to mobilize and sensitize the communities to contribute financially from the start in order to enhance sustainability beyond the study period. Stakeholders believed that the proposed interventions will influence policy through modeling on how to improve the quality of maternal/newborn health services, male involvement, and improved accessibility of services. Most of the stakeholders interviewed were supporters of the proposed maternal and newborn care intervention because of the positive benefits of the intervention. The analysis highlighted stakeholder concerns that will be included in the final project design and that could also be useful in countries of similar setting that are planning to set up programmes geared at increasing access to maternal and new born interventions. Key among these concerns was the need to use both human and financial resources that are locally available in the community, to address supply side barriers that influence access to maternal and child healthcare. Research to policy translation, therefore, will require mutual trust, continued dialogue and engagement of the researchers, implementers and policy makers to enable scale up.

Stakeholder analysis for a maternal and newborn health project in Eastern Uganda

PubMed Central

2013-01-01

Background Based on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders’ interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country. Methods A stakeholder analysis was carried out in March 2011 at national level and in four districts of Eastern Uganda where the proposed interventions would be conducted. At the national level, four key informant interviews were conducted with the ministry of health representative, Member of Parliament, and development partners. District health team members were interviewed and also engaged in a workshop; and at community level, twelve focus group discussions were conducted among women, men and motorcycle transporters. Results This analysis revealed that district and community level stakeholders were high level supporters of the proposed interventions but not drivers. At community level the mothers, their spouses and transporters were of low influence due to the limited funds they possessed. National level and district stakeholders believed that the intervention is costly and cannot be affordably scaled up. They advised the study team to mobilize and sensitize the communities to contribute financially from the start in order to enhance sustainability beyond the study period. Stakeholders believed that the proposed interventions will influence policy through modeling on how to improve the quality of maternal/newborn health services, male involvement, and improved accessibility of services. Conclusion Most of the stakeholders interviewed were supporters of the proposed maternal and newborn care intervention because of the positive benefits of the intervention. The analysis highlighted stakeholder concerns that will be included in the final project design and that could also be useful in countries of similar setting that are planning to set up programmes geared at increasing access to maternal and new born interventions. Key among these concerns was the need to use both human and financial resources that are locally available in the community, to address supply side barriers that influence access to maternal and child healthcare. Research to policy translation, therefore, will require mutual trust, continued dialogue and engagement of the researchers, implementers and policy makers to enable scale up. PMID:23497057

County Variation in Children's and Adolescent's Health Status and School District Performance in California

PubMed Central

Jung, Sunyoung

2008-01-01

Objectives. We examined the association between county-level estimates of children's health status and school district performance in California. Methods. We used 3 data sources: the California Health Interview Survey, district archives from the California Department of Education, and census-based estimates of county demographic characteristics. We used logistic regression to estimate whether a school district's failure to meet adequate yearly progress goals in 2004 to 2005 was a function of child and adolescent's health status. Models included district- and county-level fixed effects and were adjusted for the clustering of districts within counties. Results. County-level changes in children's and adolescent's health status decreased the likelihood that a school district would fail to meet adequate yearly progress goals during the investigation period. Health status did not moderate the relatively poor performance of predominantly minority districts. Conclusions. We found empirical support that area variation in children's and adolescent's health status exerts a contextual effect on school district performance. Future research should explore the specific mechanisms through which area-level child health influences school and district achievement. PMID:18309137

Impact and economic evaluation of a novel HIV service delivery model in rural Malawi.

PubMed

McBain, Ryan K; Petersen, Elizabeth; Tophof, Nora; Dunbar, Elizabeth L; Kalanga, Noel; Nazimera, Lawrence; Mganga, Andrew; Dullie, Luckson; Mukherjee, Joia; Wroe, Emily B

2017-09-10

We performed an impact and cost-effectiveness analysis of a novel HIV service delivery model in a high prevalence, remote district of Malawi with a population of 143 800 people. A population-based retrospective analysis of 1-year survival rates among newly enrolled HIV-positive patients at 682 health facilities throughout Malawi, comparing facilities implementing the service delivery model (n = 13) and those implementing care-as-usual (n = 669). Through district-level health surveillance data, we evaluated 1-year survival rates among HIV patients newly enrolled between July 2013 and June 2014 - representing 129 938 patients in care across 682 health facilities - using a multilevel modeling framework. The model, focused on social determinants of health, was implemented throughout Neno District at 13 facilities and compared with facilities in all other districts. Activity-based costing was used to annualize financial and economic costs from a societal perspective. Incremental cost-effectiveness ratios were expressed as quality-adjusted life-years gained. The national average 1-year survival rate for newly enrolled antiretroviral therapy clients was 78.9%: this rate was 87.9% in Neno District, compared with 78.8% across all other districts in Malawi (P < 0.001; 95% confidence interval: 0.079-0.104). The economic cost of receiving care in Neno district (n = 6541 patients) was $317/patient/year, compared with an estimated $219/patient in other districts. This translated to $906 per quality-adjusted life-year gained. Neno District's comprehensive model of care, featuring a strong focus on the community, is $98 more expensive per capita per annum but demonstrates superior 1-year survival rates, despite its remote location. Moreover, it should be considered cost-effective by traditional international standards.

Multilevel poisson regression modelling for determining factors of dengue fever cases in bandung

NASA Astrophysics Data System (ADS)

Arundina, Davila Rubianti; Tantular, Bertho; Pontoh, Resa Septiani

2017-03-01

Scralatina or Dengue Fever is a kind of fever caused by serotype virus which Flavivirus genus and be known as Dengue Virus. Dengue Fever caused by Aedes Aegipty Mosquito bites who infected by a dengue virus. The study was conducted in 151 villages in Bandung. Health Analysts believes that there are two factors that affect the dengue cases, Internal factor (individual) and external factor (environment). The data who used in this research is hierarchical data. The method is used for hierarchical data modelling is multilevel method. Which is, the level 1 is village and level 2 is sub-district. According exploration data analysis, the suitable Multilevel Method is Random Intercept Model. Penalized Quasi Likelihood (PQL) approach on multilevel Poisson is a proper analysis to determine factors that affecting dengue cases in the city of Bandung. Clean and Healthy Behavior factor from the village level have an effect on the number of cases of dengue fever in the city of Bandung. Factor from the sub-district level has no effect.

Achieving universal health coverage through voluntary insurance: what can we learn from the experience of Lao PDR?

PubMed Central

2013-01-01

Background The Government of Lao Peoples’ Democratic Republic (Lao PDR) has embarked on a path to achieve universal health coverage (UHC) through implementation of four risk-protection schemes. One of these schemes is community-based health insurance (CBHI) – a voluntary scheme that targets roughly half the population. However, after 12 years of implementation, coverage through CBHI remains very low. Increasing coverage of the scheme would require expansion to households in both villages where CBHI is currently operating, and new geographic areas. In this study we explore the prospects of both types of expansion by examining household and district level data. Methods Using a household survey based on a case-comparison design of 3000 households, we examine the determinants of enrolment at the household level in areas where the scheme is currently operating. We model the determinants of enrolment using a probit model and predicted probabilities. Findings from focus group discussions are used to explain the quantitative findings. To examine the prospects for geographic scale-up, we use secondary data to compare characteristics of districts with and without insurance, using a combination of univariate and multivariate analyses. The multivariate analysis is a probit model, which models the factors associated with roll-out of CBHI to the districts. Results The household findings show that enrolment is concentrated among the better off and that adverse selection is present in the scheme. The district level findings show that to date, the scheme has been implemented in the most affluent areas, in closest proximity to the district hospitals, and in areas where quality of care is relatively good. Conclusions The household-level findings indicate that the scheme suffers from poor risk-pooling, which threatens financial sustainability. The district-level findings call into question whether or not the Government of Laos can successfully expand to more remote, less affluent districts, with lower population density. We discuss the policy implications of the findings and specifically address whether CBHI can serve as a foundation for a national scheme, while exploring alternative approaches to reaching the informal sector in Laos and other countries attempting to achieve UHC. PMID:24344925

Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators.

PubMed

Von Pressentin, Klaus B; Mash, Bob J; Esterhuizen, Tonya M

2017-04-28

The supply of appropriate health workers is a key building block in the World Health Organization's model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011. This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators. All 52 South African health districts were included as units of analysis. An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015. Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district. The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician's circle of control may be better positioned to demonstrate a measurable impact in the short term.

District-level variations in childhood immunizations in India: The role of socio-economic factors and health infrastructure.

PubMed

Rammohan, Anu; Awofeso, Niyi

2015-11-01

Routine childhood immunizations against measles and DPT are part of the World Health Organization's (WHO) Expanded Program on Immunization (EPI) set up in 1974, with the aim of reducing childhood morbidity and mortality. Despite this, immunization rates are sub-optimal in developing countries such as India, with wide heterogeneity observed across districts and socio-economic characteristics. The aim of this paper is to examine district-level variations in the propensity to vaccinate a child in India for measles and DPT3, and analyse the extent to which these immunizations are given age-inappropriately, either prematurely or delayed. The present study uses data from the Indian District Level Household Survey (DLHS-3) collected in 2008, and the final sample contains detailed information on 42157 children aged between 12 and 60 months, across 549 Indian districts for whom we have complete information on immunization history. Our empirical study analyses: (i) the district-level average immunization rates for measles and DPT3, and (ii) the extent to which these immunizations have been given age-appropriately. A key contribution of this paper is that we link the household-level data at the district level to data on availability and proximity to health infrastructure and district-level socio-economic factors. Our results show that after controlling for an array of socio-economic characteristics, across all our models, the district's income per capita is a strong predictor of better immunization outcomes for children. Mother's education level at the district-level has a statistically significant and positive influence on immunization outcomes across all our models. Copyright © 2015 Elsevier Ltd. All rights reserved.

Task sharing in Zambia: HIV service scale-up compounds the human resource crisis.

PubMed

Walsh, Aisling; Ndubani, Phillimon; Simbaya, Joseph; Dicker, Patrick; Brugha, Ruairí

2010-09-17

Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. The findings are based on an analysis of routine data that are available to district and national managers. Mixed methods research is needed, combining quantitative analyses of routine health information with follow-up qualitative interviews, to explore and explain workload changes, and to identify and measure where problems are most acute, so that decision makers can respond appropriately. This study provides quantitative evidence of a human resource crisis in health facilities in Zambia, which may be more acute in rural areas.

Public funding of health at the district level in Indonesia after decentralization – sources, flows and contradictions

PubMed Central

Heywood, Peter; Harahap, Nida P

2009-01-01

Background During the Suharto era public funding of health in Indonesia was low and the health services were tightly controlled by the central government; district health staff had practically no discretion over expenditure. Following the downfall of President Suharto there was a radical political, administrative and fiscal decentralization with delivery of services becoming the responsibility of district governments. In addition, public funding for health services more than doubled between 2001 and 2006. It was widely expected that services would improve as district governments now had both more adequate funds and the responsibility for services. To date there has been little improvement in services. Understanding why services have not improved requires careful study of what is happening at the district level. Methods We collected information on public expenditure on health services for the fiscal year 2006 in 15 districts in Java, Indonesia from the district health offices and district hospitals. Data obtained in the districts were collected by three teams, one for each province. Information on district government revenues were obtained from district public expenditure databases maintained by the World Bank using data from the Ministry of Finance. Results The public expenditure information collected in 15 districts as part of this study indicates district governments are reliant on the central government for as much as 90% of their revenue; that approximately half public expenditure on health is at the district level; that at least 40% of district level public expenditure on health is for personnel, almost all of them permanent civil servants; and that districts may have discretion over less than one-third of district public expenditure on health; the extent of discretion over spending is much higher in district hospitals than in the district health office and health centers. There is considerable variation between districts. Conclusion In contrast to the promise of decentralization there has been little increase in the potential for discretion at the district level in managing public funds for health – this is likely to be an important reason for the lack of improvement in publicly funded health services. Key decisions about money are still made by the central government, and no one is held accountable for the performance of the sector – the district blames the center and the central ministries (and their ministers) are not accountable to district populations. PMID:19371410

Public funding of health at the district level in Indonesia after decentralization-sources, flows and contradictions.

PubMed

Heywood, Peter; Harahap, Nida P

2009-04-16

During the Suharto era public funding of health in Indonesia was low and the health services were tightly controlled by the central government; district health staff had practically no discretion over expenditure. Following the downfall of President Suharto there was a radical political, administrative and fiscal decentralization with delivery of services becoming the responsibility of district governments. In addition, public funding for health services more than doubled between 2001 and 2006. It was widely expected that services would improve as district governments now had both more adequate funds and the responsibility for services. To date there has been little improvement in services. Understanding why services have not improved requires careful study of what is happening at the district level. We collected information on public expenditure on health services for the fiscal year 2006 in 15 districts in Java, Indonesia from the district health offices and district hospitals. Data obtained in the districts were collected by three teams, one for each province. Information on district government revenues were obtained from district public expenditure databases maintained by the World Bank using data from the Ministry of Finance. The public expenditure information collected in 15 districts as part of this study indicates district governments are reliant on the central government for as much as 90% of their revenue; that approximately half public expenditure on health is at the district level; that at least 40% of district level public expenditure on health is for personnel, almost all of them permanent civil servants; and that districts may have discretion over less than one-third of district public expenditure on health; the extent of discretion over spending is much higher in district hospitals than in the district health office and health centers. There is considerable variation between districts. In contrast to the promise of decentralization there has been little increase in the potential for discretion at the district level in managing public funds for health - this is likely to be an important reason for the lack of improvement in publicly funded health services. Key decisions about money are still made by the central government, and no one is held accountable for the performance of the sector - the district blames the center and the central ministries (and their ministers) are not accountable to district populations.

State-Level Guidance and District-Level Policies and Practices for Food Marketing in US School Districts.

PubMed

Merlo, Caitlin L; Michael, Shannon; Brener, Nancy D; Blanck, Heidi

2018-06-07

State agencies play a critical role in providing school districts with guidance and technical assistance on school nutrition issues, including food and beverage marketing practices. We examined associations between state-level guidance and the policies and practices in school districts regarding food and beverage marketing and promotion. State policy guidance was positively associated with districts prohibiting advertisements for junk food or fast food restaurants on school property. Technical assistance from states was negatively associated with 2 district practices to restrict marketing of unhealthy foods and beverages, but positively associated with 1 practice to promote healthy options. These findings may help inform the guidance that states provide to school districts and help identify which districts may need additional assistance to address marketing and promotion practices.

Development Of Index To Assess Drought Conditions Using Geospatial Data A Case Study Of Jaisalmer District, Rajasthan, India

NASA Astrophysics Data System (ADS)

Chhajer, Vaidehi; Prabhakar, Sumati; Rama Chandra Prasad, P.

2015-12-01

The Jaisalmer district of Rajasthan province of India was known to suffer with frequent drought due to poor and delayed monsoon, abnormally high summer-temperature and insufficient water resources. However flood-like situation prevails in the drought prone Jaisalmer district of Rajasthan as torrential rains are seen to affect the region in the recent years. In the present study, detailed analysis of meteorological, hydrological and satellite data of the Jaisalmer district has been carried out for the years 2006-2008. Standardized Precipitation Index (SPI), Consecutive Dry Days (CDD) and Effective Drought Index (EDI) have been used to quantify the precipitation deficit. Standardized Water-Level Index (SWI) has been developed to assess ground-water recharge-deficit. Vegetative drought indices like Vegetation Condition Index (VCI), Temperature Condition Index (TCI), Vegetation Health Index (VHI), Normalized Difference Vegetation Index (NDVI) and Modified Soil-Adjusted Vegetation Index 2 have been calculated. We also introduce two new indices Soil based Vegetation Condition Index (SVCI) and Composite Drought Index (CDI) specifically for regions like Jaisalmer where aridity in soil and affects vegetation and water-level.

STRUCTURING EDUCATION FOR BUSINESS MANAGEMENT.

ERIC Educational Resources Information Center

WHITT, ROBERT L.

IN TERMS OF SERVICES RECEIVED, LOCAL SCHOOLS BENEFIT SUBSTANTIALLY FROM EDUCATIONAL BUSINESS MANAGEMENT. IN ORDER TO ISOLATE BUSINESS ADMINISTRATIVE PROBLEMS OF THE SCHOOL SYSTEM, AN ANALYSIS WAS CONDUCTED AT EACH OF 6 ADMINISTRATIVE SERVICE LEVELS--LOCAL (ATTENDANCE LEVEL), DISTRICT, AREA, REGIONAL, STATE, AND MULTI-STATE. AS A RESULT OF MERGED…

A locally initiated and executed measles outbreak response immunization campaign in the nylon health district, Douala Cameroon 2011.

PubMed

Sume, Gerald Etapelong; Fouda, André Arsène Bita; Kobela, Marie; Nguelé, Salomé; Emah, Irène; Atem, Peter

2013-03-16

The Cameroon health system is divided into central, intermediate and peripheral levels. Of the 43 health districts with a measles outbreak in Cameroon in 2011, only the Nylon Health District organized a documented outbreak response immunization. We present the methods and results of the response campaign solely shouldered by the district and intermediate level. The risk group, targets and neighborhoods to be vaccinated were identified after a detailed analysis of initial cases. The intermediate level defined strategies, provided logistics, capacity building and 41% of the operational budget while 59% was completed by the peripheral level. Microsoft Office Excel 2007 was used to estimate coverage rates and to draw an epidemic curve. The response immunization campaign was organized on the 14th epidemiological week, 10 weeks after the onset of the outbreak which ended 11 weeks thereafter. A total of 15867(108.5%) children aged 9-59 months were vaccinated in five health areas at a direct cost (vaccines excluded) of 71.34FCFA ($0.143) per vaccinated child. An additional 824 children aged 9-59 months were vaccinated around the residence of notified cases in neighborhoods which were not involved in the response campaign. The number of cases after the response campaign was lower than before. Once vaccines are available, prompt outbreak response campaigns can be organized at operational level to obtain commendable results instead of depending solely on international organizations or central levels. Decision makers at the intermediate and operational levels should redeploy available funds during emergencies to prevent the development of extreme public health conditions.

Evidence of Self-correction of Child Sex Ratios in India: A District-Level Analysis of Child Sex Ratios From 1981 to 2011.

PubMed

Diamond-Smith, Nadia; Bishai, David

2015-04-01

Sex ratios in India have become increasingly imbalanced over the past decades. We hypothesize that when sex ratios become very uneven, the shortage of girls will increase girls' future value, leading sex ratios to self-correct. Using data on children under 5 from the last four Indian censuses, we examine the relationship between the sex ratio at one point in time and the change in sex ratio over the next 10 years by district. Fixed-effects models show that when accounting for unobserved district-level characteristics--including total fertility rate, infant mortality rate, percentage literate, percentage rural, percentage scheduled caste, percentage scheduled tribe, and a time trend variable--sex ratios are significantly negatively correlated with the change in sex ratio in the successive 10-year period. This suggests that self-corrective forces are at work on imbalanced sex ratios in India.

Regional agricultural susceptibility to climate variability: A district level analysis of Maharashtra, India

NASA Astrophysics Data System (ADS)

Swami, D.; Parthasarathy, D.; Dave, P.

2016-12-01

Climate variability (CV) has adverse impact on crop production and inadequate research carried out to assess the impact of CV on crop production has aggravated the ability of farmers to adapt (Jones et al., 2000). A better understanding of CV is required to reduce the vulnerability of farmers towards existing and future CV. Further, a wide variation in policies related to climate change exists at global level and considering the state/nation as a single unit for policy formulations may lead to under-representation of regional problems. Hence, the present work chooses to focus on CVassessment at the regional/district level of Maharashtra state in India. Here, interannual variability of wet and dry spells from year 1951-2013, are used as a measure of CV. Statistical declining trend of wet spells for (12/34) districts was observed across all the districts of Maharashtra. Districts showing highest change in wet spell pre and post 1976/77 are Beed, Latur and Osmanabad belong to Central Maharashtra Plateau zone and Western Maharashtra scarcity zone. Dry spells for (8/34) districts were found to statistically increase across all the districts of Maharashtra. Washim, Yavatmal of Vidarbha zone; and Latur, Parbhani of Amravati division belonging to Central Maharashtra Plateau zone and Central Vidarbha zone are found to reflect the large variation in their behavior pre and post 1976/77. Findings reveal that districts from the same agro-climate zones respond differently to CV, indicating significant spatial heterogeneity within the region. Trend in monsoon variability was found to be prominent after 1976/77, suggesting an enhanced role of climate change on climate variability after 1977. It necessitates separate policy formulation related to CV and agriculture for each district to bring out the solution for regional issues (socio-political, farmers, agriculturalists, economical) more clearly. Further we have attempted to link agriculture vulnerability and crop sensitivity to CV. Results signify spatial and temporal variability of different agro-ecological and climate parameters; suitable adaptation measures to famers and policy makers need to address this change. The findings can be utilized by farmers and policy makers while formulating agricultural policies and adaptation measures related to climate change.

Views of collaboration among administrators and teachers involved in science education reform

NASA Astrophysics Data System (ADS)

Trax, Mark Francis

The purposes of this study were to investigate the perceptions of collaboration among administrators and teachers involved in science education reform, determine similarities and difference in perception among administrators and teachers, and examine the progress of district reform efforts in terms of reform recommendations advanced in the research literature. Naturalistic constructivist theory guided the generation of the instruments and the analysis of data. Instruments for this investigation included a questionnaire and structured surveys. Audio-taped responses to the surveys were transcribed and analyzed for patterns of interaction. Support for science teacher collaboration and science education reform depended on the district's overall organizational style (classified as top-down, bottom-up, or a combination of these two styles), was connected to the level of commitment of the sciences teachers and administrators interviewed, and was linked to the level of solidarity for that support among teachers and administrators in the district. Reform-oriented districts addressed resource allocation in ways that supported science education reform. Science teachers, identified as the agents for educational reform, facilitated the overall process by providing specific evidence in support of reform, recruiting teachers and administrators to a reform-oriented agenda, and creating close-knit cadres engaged in the reform process. District activities in support of science education reforms which reflect the overall school reform recommendations maintained their focus provided that such activities were monitored and adjusted to furnish opportunities to include all the district science teachers, utilized a committed cadre of science teachers that supported the overall recommendations, and facilitated the inclusion of all district staff in the overall process. For success, it is important for the staff in each district to identify a clear need and establish a high level of commitment to the reform before embarking on it. Involvement of the entire district staff in the processes of reform is vital if long-term educational reform and development is to occur. Strategies to develop a process of professional development need to be in concert with the recommendations of reform and applicable to the policies and philosophies of the particular school system.

Heavy metal and other residues in feathers of laggar falcon Falco biarmicus jugger from six districts of Pakistan.

PubMed

Movalli, P A

2000-08-01

This paper presents the levels of metals and other trace elements measured in feathers of laggar falcons, Falco biarmicus jugger, in Pakistan. The laggar falcon is resident or locally migrant throughout the Indian Subcontinent where it is a rare and declining species. Breast feathers from 57 live, recently trapped, adult and juvenile laggar falcons and from five dead birds were collected from Bahawalpur, Bahawalnagar, Mithi, Chachcro, Jacobabad and Karachi districts. Cadmium (Cd), lead (Pb) and mercury (Hg) were analysed by atomic absorption spectrophotometry (AAS), cobalt (Co), selenium (Se), zinc (Zn), scandium (Sc), chromium (Cr), cesium (Cs), lanthanum (La) and bromine (Br) by neutron activation analysis (NAA). Hg levels were below those found in other raptors with reduced reproductive success. No correlation was found between Hg and Se levels. For some metals and elements interpretation of results is difficult as no data exist in the literature. Concentrations did not differ significantly between males and females nor between juveniles and adults, but differed among districts for Pb, Hg, Co, Sc, Cr, La and Br. A significant correlation was found between Pb concentration and occurrence of louse eggs. As the laggar is resident or a partial local migrant, it is probable that the metal burden in adult and juvenile feathers reflects the level of contamination in these particular districts.

[A study on dental manpower distribution in Shanghai Pudong new district].

PubMed

Gu, Qin; Feng, Xi-ping

2006-02-01

A study of dental manpower distribution was made in Shanghai Pudong new district in order to analyze the needs and demands for dental services in Shanghai Pudong new district, to forecast the developmental trends of dental demand in the future and to provide basis for regional programs of dental manpower in the urban areas of China. An analysis was made in 601 subjects taken from all age groups in Shanghai Pudong new district by stratified and cluster random sampling and in 83 medical institutions of stomatology in Shanghai Pudong new district by mass examination. The amount of dental manpower need and demand was computed and forecasted by means of health care need and demand and proportional analogy methods. The total amounts needed were 755-834 dentists. The total amounts demanded were 285-314 dentists. It was forecasted that the figures would be 392-1041 in the year of 2010. The prevalence of oral disease was 90.18%, but only 37.66% of subjects visited dentist in a year. The ratio of dentists to the population was 1:9375. The unbalance between demand for and supply of dental manpower was mainly due to negative awareness of people, the irrationalness of demand levels, problems from service provider and the irrationalness of dental manpower levels.

A Analysis of Saudi Arabian High School Students' Misconceptions about Physics Concepts.

NASA Astrophysics Data System (ADS)

Al-Rubayea, Abdullah A. M.

This study was conducted to explore Saudi high students' misconceptions in selected physics concepts. It also detected the effects of gender, grade level and location of school on Saudi high school students' misconceptions. In addition, a further analysis of students' misconceptions in each question was investigated and a correlation between students' responses, confidence in answers and sensibleness was conducted. There was an investigation of sources of students' answers in this study. Finally, this study included an analysis of students' selection of reasons only in the instrument. The instrument used to detect the students' misconceptions was a modified form of the Misconception Identification in Science Questionnaire (MISQ). This instrument was developed by Franklin (1992) to detected students' misconceptions in selected physics concepts. This test is a two-tier multiple choice test that examines four areas of physics: Force and motion, heat and temperature, light and color and electricity and magnetism. This study included a sample of 1080 Saudi high school students who were randomly selected from six Saudi educational districts. This study also included both genders, the three grade levels of Saudi high schools, six different educational districts, and a city and a town in each educational district. The sample was equally divided between genders, grade levels, and educational districts. The result of this study revealed that Saudi Arabian high school students hold numerous misconceptions about selected physics concepts. It also showed that tenth grade students were significantly different than the other grades. The result also showed that different misconceptions are held by the students for each concept in the MISQ. A positive correlation between students' responses, confidence in answers and sensibleness in many questions was shown. In addition, it showed that guessing was the most dominant source of misconceptions. The result revealed that gender and grade level had an affect on students' choice of decision on the MISQ items. A positive change in the means of gender and grade levels in the multiple choice test and gender differences in selection of reason may be associated with specific concepts. No significant difference in frequencies of the reasons chosen by the student to justify their answers were found in most of the items (10 items).

Cholera in Cameroon, 2000-2012: Spatial and Temporal Analysis at the Operational (Health District) and Sub Climate Levels.

PubMed

Ngwa, Moise C; Liang, Song; Kracalik, Ian T; Morris, Lillian; Blackburn, Jason K; Mbam, Leonard M; Ba Pouth, Simon Franky Baonga; Teboh, Andrew; Yang, Yang; Arabi, Mouhaman; Sugimoto, Jonathan D; Morris, John Glenn

2016-11-01

Recurrent cholera outbreaks have been reported in Cameroon since 1971. However, case fatality ratios remain high, and we do not have an optimal understanding of the epidemiology of the disease, due in part to the diversity of Cameroon's climate subzones and a lack of comprehensive data at the health district level. A unique health district level dataset of reported cholera case numbers and related deaths from 2000-2012, obtained from the Ministry of Public Health of Cameroon and World Health Organization (WHO) country office, served as the basis for the analysis. During this time period, 43,474 cholera cases were reported: 1748 were fatal (mean annual case fatality ratio of 7.9%), with an attack rate of 17.9 reported cases per 100,000 inhabitants per year. Outbreaks occurred in three waves during the 13-year time period, with the highest case fatality ratios at the beginning of each wave. Seasonal patterns of illness differed strikingly between climate subzones (Sudano-Sahelian, Tropical Humid, Guinea Equatorial, and Equatorial Monsoon). In the northern Sudano-Sahelian subzone, highest number of cases tended to occur during the rainy season (July-September). The southern Equatorial Monsoon subzone reported cases year-round, with the lowest numbers during peak rainfall (July-September). A spatial clustering analysis identified multiple clusters of high incidence health districts during 2010 and 2011, which were the 2 years with the highest annual attack rates. A spatiotemporal autoregressive Poisson regression model fit to the 2010-2011 data identified significant associations between the risk of transmission and several factors, including the presence of major waterbody or highway, as well as the average daily maximum temperature and the precipitation levels over the preceding two weeks. The direction and/or magnitude of these associations differed between climate subzones, which, in turn, differed from national estimates that ignored subzones differences in climate variables. The epidemiology of cholera in Cameroon differs substantially between climate subzones. Development of an optimal comprehensive country-wide control strategy for cholera requires an understanding of the impact of the natural and built environment on transmission patterns at the local level, particularly in the setting of ongoing climate change.

[Counseling role of district nurses and district assistant nurses. A descriptive and evaluative study of the extent and intensity of counseling].

PubMed

Tiesinga, L J; Halfens, R J

1993-11-01

In nursing literature no consensus exists on the phenomenon 'counseling'. A literature search of the concept 'counseling' makes clear that it is possible to distinguish two dimensions of the concept 'counseling', namely 'range' and 'intensity' of counseling. These two dimensions are the starting point of this study. The main purpose of this study is to gain insight in the range and intensity of the counseling given by district nurses and district assistant nurses. This article aims to discover how often psychosocial nursing problems are recognized and how often nursing interventions are executed by nurses, and with how many patients this was done. The research is designed as a secondary analysis. We used data collected by Wiersma et al. (1991). The results confirm earlier research but also offer new points of view. The study confirms that counseling is an essential aspect of district nursing. Some (significant) differences were discovered between district nurses and district assistant nurses in the psychosocial care that was given. Factors like level of education, patient population and organization will probably explain the differences between the two professional groups. This aspect of the study needs further inquiry.

A framework to assess management performance in district health systems: a qualitative and quantitative case study in Iran.

PubMed

Tabrizi, Jafar Sadegh; Gholipour, Kamal; Iezadi, Shabnam; Farahbakhsh, Mostafa; Ghiasi, Akbar

2018-01-01

The aim was to design a district health management performance framework for Iran's healthcare system. The mixed-method study was conducted between September 2015 and May 2016 in Tabriz, Iran. In this study, the indicators of district health management performance were obtained by analyzing the 45 semi-structured surveys of experts in the public health system. Content validity of performance indicators which were generated in qualitative part were reviewed and confirmed based on content validity index (CVI). Also content validity ratio (CVR) was calculated using data acquired from a survey of 21 experts in quantitative part. The result of this study indicated that, initially, 81 indicators were considered in framework of district health management performance and, at the end, 53 indicators were validated and confirmed. These indicators were classified in 11 categories which include: human resources and organizational creativity, management and leadership, rules and ethics, planning and evaluation, district managing, health resources management and economics, community participation, quality improvement, research in health system, health information management, epidemiology and situation analysis. The designed framework model can be used to assess the district health management and facilitates performance improvement at the district level.

Analysis of repeated network-level testing by the falling weight deflectometer on I-81 in the Virginia Department of Transportation's Bristol District.

DOT National Transportation Integrated Search

2016-11-01

This study was undertaken in an effort to determine the required time between subsequent rounds of network-level pavement deflection testing using a falling weight deflectometer (FWD) on the Virginia Department of Transportations (VDOTs) inters...

Introducing quality management into primary health care services in Uganda.

PubMed Central

Omaswa, F.; Burnham, G.; Baingana, G.; Mwebesa, H.; Morrow, R.

1997-01-01

In 1994, a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting times and increased patient satisfaction at Masaka District Hospital, and a marked reduction in reported cases of measles in Arua District. Beyond these quantitative improvements, increased morale of district health team members, improved satisfaction among patients, and greater involvement of local government in the decisions of district health committees have been observed. At the central level, the increased coordination of activities has led to new guidelines for financial management and the procurement of supplies. District quality management workshops followed up by regular support visits from the Ministry of Health headquarters have led to a greater understanding by central staff of the issues faced at the district level. The quality assurance programme has also fostered improved coordination among national disease-control programmes. Difficulties encountered at the central level have included delays in carrying out district support visits and the failure to provide appropriate support. At the district level, some health teams tackled problems over which they had little control or which were overly complex; others lacked the management capacity for problem solving. PMID:9185368

[Comparative analysis of malaria detection ability of laboratories in Shanghai City from 2012 to 2015].

PubMed

Zhen-Yu, Wang; Li, Jiang; Yao-Guang, Zhang; Min, Zhu; Xiao-Ping, Zhang; Xiao-Jiang, Ma; Qian, Zhu; Yan-Yan, He; Shou-Fu, Jiang; Li, Cai

2017-02-27

To compare the application effects of three methods, namely microscopic examination, antigen detection (RDT) and nucleic acid test (PCR) in malaria detection between municipal and districts/counties centers for disease control and prevention in Shanghai, and analyze the malaria detection ability of the laboratories in Shanghai. The blood smears, whole blood samples, case review confirmation records and case data of malaria cases and suspected cases in Shanghai from 2012 to 2015 were collected by Shanghai Municipal Center for Disease Control and Prevention, and the detection results were analyzed and compared. A total of 212 samples with complete data were submitted by all districts (counties) in Shanghai from 2012 to 2015, the samples submitted by Jinshan Districts were the most (41.98%), and among the first diagnosis hospitals, those submitted by the tertiary hospitals were the most (82.07%). The submitted samples in the whole year were increased gradually from January to October. All the 212 samples were detected by three methods (the microscopic examination, RDT and PCR) in the laboratory of Shanghai Municipal Center for Disease Control and Prevention, and 167 were tested and confirmed comprehensively as positives, accounting for 78.77%, and 45 were confirmed as negatives, accounting for 21.23%. The samples were detected by the method of microscopy and domestic RDT in the laboratories of the centers for disease control and prevention at district/county level, totally 153 were tested as positives, accounting for 72.17%, 41 were unclassified, accounting for 19.34%, 53 were negative, accounting for 25.00%, and 6 were undetected, accounting for 2.83%. The coincidence of microscopic examination between the report hospitals and the centers for disease control and prevention at district/county level was 78.16%, and the coincidence between centers for disease control and prevention at district/county level and municipal level was 93.20%. The utilization rate of RDT in the laboratory of district/county level was 73.58%. The coincidence of RDT tests between those domestic and imported was 93.59%. Compared with the detection results by municipal center for disease control and prevention, 37 samples were misjudged by the laboratories of district/county level. Almost all (99.37%) of the confirmed malaria cases were imported overseas, including Africa (85.44%), Asia (13.92%) and America (0.63%). The surveillance after malaria elimination in Shanghai should be carried out by combining with different detection methods and resource integration.

Child mortality inequalities across Rwanda districts: a geoadditive continuous-time survival analysis.

PubMed

Niragire, François; Achia, Thomas N O; Lyambabaje, Alexandre; Ntaganira, Joseph

2017-05-11

Child survival programmes are efficient when they target the most significant and area-specific factors. This study aimed to assess the key determinants and spatial variation of child mortality at the district level in Rwanda. Data from the 2010 Rwanda Demographic and Health Survey were analysed for 8817 live births that occurred during five years preceding the survey. Out of the children born, 433 had died before survey interviews were carried out. A full Bayesian geo-additive continuous-time hazard model enabled us to maximise data utilisation and hence improve the accuracy of our estimates. The results showed substantial district- level spatial variation in childhood mortality in Rwanda. District-specific spatial characteristics were particularly associated with higher death hazards in two districts: Musanze and Nyabihu. The model estimates showed that there were lower death rates among children from households of medium and high economic status compared to those from low-economic status households. Factors, such as four antenatal care visits, delivery at a health facility, prolonged breastfeeding and mothers younger than 31 years were associated with lower child death rates. Long preceding birth intervals were also associated with fewer hazards. For these reasons, programmes aimed at reducing child mortality gaps between districts in Rwanda should target maternal factors and take into consideration district-specific spatial characteristics. Further, child survival gains require strengthening or scaling-up of existing programmes pertaining to access to, and utilisation of maternal and child health care services as well as reduction of the household gap in the economic status.

Healthcare Work and Organizational Interventions to Prevent Work-related Stress in Brindisi, Italy.

PubMed

d'Ettorre, Gabriele; Greco, Mariarita

2015-03-01

Organizational changes that involve healthcare hospital departments and care services of health districts, and ongoing technological innovations and developments in society increasingly expose healthcare workers (HCWs) to work-related stress (WRS). Minimizing occupational exposure to stress requires effective risk stress assessment and management programs. The authors conducted an integrated analysis of stress sentinel indicators, an integrated analysis of objective stress factors of occupational context and content areas, and an integrated analysis between nurses and physicians of hospital departments and care services of health districts in accordance with a multidimensional validated tool developed in Italy by the National Network for the Prevention of Work-Related Psychosocial Disorders. The purpose of this retrospective observational study was to detect and analyze in different work settings the level of WRS resulting from organizational changes implemented by hospital healthcare departments and care services of health districts in a sample of their employees. The findings of the study showed that hospital HCWs seemed to incur a medium level risk of WRS that was principally the result of work context factors. The implementation of improvement interventions focused on team development, safety training programs, and adopting an ethics code for HCWs, and it effectively and significantly reduced the level of WRS risk in the workplace. In this study HCW resulted to be exposed to occupational stress factors susceptible to reduction. Stress management programs aimed to improve work context factors associated with occupational stress are required to minimize the impact of WRS on workers.

Physical education policy compliance and Latino children’s fitness: Does the association vary by school neighborhood socioeconomic advantage?

PubMed Central

Sanchez-Vaznaugh, Emma V.; Goldman Rosas, Lisa; Fernández-Peña, José Ramón; Baek, Jonggyu; Egerter, Susan; Sánchez, Brisa N.

2017-01-01

Objectives To investigate the contribution of school neighborhood socioeconomic advantage to the association between school-district physical education policy compliance in California public schools and Latino students’ physical fitness. Methods Cross-sectional Fitnessgram data for public-school students were linked with school- and district-level information, district-level physical education policy compliance from 2004–2005 and 2005–2006, and 2000 United States Census data. Multilevel logistic regression models examined whether income and education levels in school neighborhoods moderated the effects of district-level physical education policy compliance on Latino fifth-graders’ fitness levels. Results Physical education compliance data were available for 48 California school districts, which included 64,073 Latino fifth-graders. Fewer than half (23, or 46%) of these districts were found to be in compliance, and only 16% of Latino fifth-graders attended schools in compliant districts. Overall, there was a positive association between district compliance with physical education policy and fitness (OR, 95%CI: 1.38, 1.07, 1.78) adjusted for covariates. There was no significant interaction between school neighborhood socioeconomic advantage and physical education policy compliance (p>.05): there was a positive pattern in the association between school district compliance with physical education policy and student fitness levels across levels of socioeconomic advantage, though the association was not always significant. Conclusions Across neighborhoods with varying levels of socioeconomic advantage, increasing physical education policy compliance in elementary schools may be an effective strategy for improving fitness among Latino children. PMID:28591139

The Role of School District Science Coordinators in the District-Wide Appropriation of an Online Resource Discovery and Sharing Tool for Teachers

NASA Astrophysics Data System (ADS)

Lee, Victor R.; Leary, Heather M.; Sellers, Linda; Recker, Mimi

2014-06-01

When introducing and implementing a new technology for science teachers within a school district, we must consider not only the end users but also the roles and influence district personnel have on the eventual appropriation of that technology. School districts are, by their nature, complex systems with multiple individuals at different levels in the organization who are involved in supporting and providing instruction. Varying levels of support for new technologies between district coordinators and teachers can sometimes lead to counterintuitive outcomes. In this article, we examine the role of the district science coordinator in five school districts that participated in the implementation of an online resource discovery and sharing tool for Earth science teachers. Using a qualitative approach, we conducted and coded interviews with district coordinators and teachers to examine the varied responsibilities associated with the district coordinator and to infer the relationships that were developed and perceived by teachers. We then examine and discuss two cases that illustrate how those relationships could have influenced how the tool was adopted and used to differing degrees in the two districts. Specifically, the district that had high support for online resource use from its coordinator appeared to have the lowest level of tool use, and the district with much less visible support from its coordinator had the highest level of tool use. We explain this difference in terms of how the coordinator's promotion of teacher autonomy took distinctly different forms at those two districts.

Spatiotemporal Clustering Analysis of Malaria Infection in Pakistan.

PubMed

Umer, Muhammad Farooq; Zofeen, Shumaila; Majeed, Abdul; Hu, Wenbiao; Qi, Xin; Zhuang, Guihua

2018-06-07

Despite tremendous progress, malaria remains a serious public health problem in Pakistan. Very few studies have been done on spatiotemporal evaluation of malaria infection in Pakistan. The study aimed to detect the spatiotemporal pattern of malaria infection at the district level in Pakistan, and to identify the clusters of high-risk disease areas in the country. Annual data on malaria for two dominant species ( Plasmodium falciparum , Plasmodium vivax ) and mixed infections from 2011 to 2016 were obtained from the Directorate of Malaria Control Program, Pakistan. Population data were collected from the Pakistan Bureau of Statistics. A geographical information system was used to display the spatial distribution of malaria at the district level throughout Pakistan. Purely spatiotemporal clustering analysis was performed to identify the high-risk areas of malaria infection in Pakistan. A total of 1,593,409 positive cases were included in this study over a period of 6 years (2011⁻2016). The maximum number of P . vivax cases (474,478) were reported in Khyber Pakhtunkhwa (KPK). The highest burden of P . falciparum (145,445) was in Balochistan, while the highest counts of mixed Plasmodium cases were reported in Sindh (22,421) and Balochistan (22,229), respectively. In Balochistan, incidence of all three types of malaria was very high. Cluster analysis showed that primary clusters of P . vivax malaria were in the same districts in 2014, 2015 and 2016 (total 24 districts, 12 in Federally Administered Tribal Areas (FATA), 9 in KPK, 2 in Punjab and 1 in Balochistan); those of P . falciparum malaria were unchanged in 2012 and 2013 (total 18 districts, all in Balochistan), and mixed infections remained the same in 2014 and 2015 (total 7 districts, 6 in Balochistan and 1 in FATA). This study indicated that the transmission cycles of malaria infection vary in different spatiotemporal settings in Pakistan. Efforts in controlling P . vivax malaria in particular need to be enhanced in high-risk areas. Based on these findings, further research is needed to investigate the impact of risk factors on transmission of malaria in Pakistan.

Right Game, Wrong Field? The Pursuit of School Funding Equity.

ERIC Educational Resources Information Center

Hertert, Linda

1995-01-01

District-level fiscal equity, when achieved, will not necessarily result in a fairer distribution of educational resources. School-level inequities generally exceed those found at the district level in most states. If districts were required to distribute funds to schools on a per-pupil basis, school-level equalization could be accomplished…

7 CFR 1940.308 - Environmental responsibilities at the District and County Office levels.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Environmental Program § 1940.308 Environmental responsibilities at the District and County Office levels. (a... County Office levels. 1940.308 Section 1940.308 Agriculture Regulations of the Department of Agriculture... completed at the District Office level. (b) The County Supervisor will be responsible for carrying out the...

Strength and Comprehensiveness of District School Wellness Policies Predict Policy Implementation at the School Level

PubMed Central

Henderson, Kathryn E; Falbe, Jennifer; Novak, Sarah A.; Wharton, Christopher; Long, Michael; O'Connell, Meghan L.; Fiore, Susan S.

2013-01-01

Background In 2006, all local education agencies in the United States participating in federal school meal programs were required to establish school wellness policies. The aim of this study was to document the strength and comprehensiveness of one state's written district policies using a quantitative coding tool, and test whether the strength and comprehensiveness of the written policy predicted school level implementation and practices. Methods School wellness policies from 151 Connecticut districts were evaluated using a quantitative coding system. In each district, school principal surveys were collected before and after the writing and expected implementation of wellness policies. Socio-demographic variables were assessed for each district, including enrollment, population density, political climate, racial composition and socio-economic status. Changes in school-level policy implementation before and after the federal wellness policy requirement were compared across districts by wellness policy strength, and policies were compared based on district-level demographic factors. Results Statewide, fuller implementation of nutrition and physical activity policies at the school level was reported after adoption of written policies in 2006. Districts with stronger, more comprehensive policies were more successful in implementing those policies at the school level. Some socio-demographic characteristics predicted the strength of wellness policies; larger, urban districts and districts with a greater ratio of registered Democrats to Republicans wrote stronger policies. Conclusions Written school wellness policies have the potential to promote significant improvements in the school environment. Future regulation of school wellness policies should focus on the importance of writing strong and comprehensive policies. PMID:22568461

Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators

PubMed Central

Mash, Robert J.

2017-01-01

Background The supply of appropriate health workers is a key building block in the World Health Organization’s model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011. Aim This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators. Setting All 52 South African health districts were included as units of analysis. Methods An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015. Results Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district. Conclusion The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician’s circle of control may be better positioned to demonstrate a measurable impact in the short term. PMID:28470076

Technical efficiency of public district hospitals in Madhya Pradesh, India: a data envelopment analysis.

PubMed

Jat, Tej Ram; Sebastian, Miguel San

2013-09-24

Scarcity of resources for healthcare is a well-acknowledged problem. In this context, efficient utilization of existing financial and human resources becomes crucial for strengthening the healthcare delivery. The assessment of efficiency of health facilities can guide decision makers in ensuring the optimum utilization of available resources. The objective of this study was to evaluate the technical efficiency (TE) of the public district hospitals in Madhya Pradesh, India, with special emphasis on maternal healthcare services, using data envelopment analysis (DEA). Data from 40 district hospitals from January to December 2010 were collected from the health management information system and other records of the department of health and family welfare of the state. DEA was performed with input orientation and variable returns to scale assumption. TE and scale efficiency scores of the district hospitals were 0.90 (SD = 0.14) and 0.88 (SD = 0.15), respectively. Of the total district hospitals in the study, 20 (50%) were technically efficient constituting the 'best practice frontier'. The other half were technically inefficient, with an average TE score of 0.79 (SD = 0.12) meaning that these hospitals could produce the same outputs by using 21% less inputs from current input levels. Twenty-six (65%) district hospitals were found to be scale inefficient, manifesting a mean score of 0.81 (SD = 0.16). Half of the district hospitals in the study were operating inefficiently. Decision makers and administrators in the state should identify the causes of the observed inefficiencies and take appropriate measures to increase efficiency of these hospitals.

Health system's barriers hindering implementation of public-private partnership at the district level: a case study of partnership for improved reproductive and child health services provision in Tanzania.

PubMed

Kamugumya, Denice; Olivier, Jill

2016-10-21

Public-private partnership (PPP) has been suggested as a tool to assist governments in lower to middle income countries fulfil their responsibilities in the efficient delivery of health services. In Tanzania, although the idea of PPP has existed for many years in the health sector, there has been limited coordination, especially at a district level - which has contributed to limited health gains or systems strengthening obviously seen as a result of PPP. This case study was conducted in the Bagamoyo district of Tanzania, and employed in-depth interviews, document reviews, and observations methods. A stakeholder analysis was conducted to understand power distribution and the interests of local actors to engage non-state actors. In total 30 in-depth interviews were conducted with key informants that were identified from a stakeholder mapping activity. The initial data analysis guided further data collection in an iterative process. The provision of Reproductive and Child Health Services was used as a context. This study draws on the decision-space framework. Study findings reveal several forms of informal partnerships, and the untapped potential of non-state actors. Lack of formal contractual agreements with private providers including facilities that receive subsidies from the government is argued to contribute to inappropriate distribution of risk and reward leading to moral hazards. Furthermore, findings highlight weak capacity of governing bodies to exercise oversight and sanctions, which is acerbated by weak accountability linkages and power differences. Disempowered Council Health Services Board, in relation to engaging non-state actors, is shown to impede PPP initiatives. Effective PPP policy implementation at a local level depends on the capacity of local government officials to make choices that would embrace relational elements dynamics in strategic plans. Orientation towards collaborative efforts that create value and enable its distribution is argued to facilitate healthy partnership, and in return, strengthen a district health system. This study highlights a need for new social contracts that will support integrative collaboration at the local level and bring all non-state actors to the centre of the district health system.

Quantifying the impact of rising food prices on child mortality in India: a cross-district statistical analysis of the District Level Household Survey.

PubMed

Fledderjohann, Jasmine; Vellakkal, Sukumar; Khan, Zaky; Ebrahim, Shah; Stuckler, David

2016-04-01

Rates of child malnutrition and mortality in India remain high. We tested the hypothesis that rising food prices are contributing to India's slow progress in improving childhood survival. Using rounds 2 and 3 (2002-08) of the Indian District Level Household Survey, we calculated neonatal, infant and under-five mortality rates in 364 districts, and merged these with district-level food price data from the National Sample Survey Office. Multivariate models were estimated, stratified into 27 less deprived states and territories and 8 deprived states ('Empowered Action Groups'). Between 2002 and 2008, the real price of food in India rose by 11.7%. A 1% increase in total food prices was associated with a 0.49% increase in neonatal (95% confidence interval (CI): 0.13% to 0.85%), but not infant or under-five mortality rates. Disaggregating by type of food and level of deprivation, in the eight deprived states, we found an elevation in neonatal mortality rates of 0.33% for each 1% increase in the price of meat (95% CI: 0.06% to 0.60%) and 0.10% for a 1% increase in dairy (95% CI: 0.01% to 0.20%). We also detected an adverse association of the price of dairy with infant (b = 0.09%; 95% CI: 0.01% to 0.16%) and under-five mortality rates (b = 0.10%; 95% CI: 0.03% to 0.17%). These associations were not detected in less deprived states and territories. Rising food prices, particularly of high-protein meat and dairy products, were associated with worse child mortality outcomes. These adverse associations were concentrated in the most deprived states. © The Author 2016. Published by Oxford University Press on behalf of the International Epidemiological Association.

Quantifying the impact of rising food prices on child mortality in India: a cross-district statistical analysis of the District Level Household Survey

PubMed Central

Fledderjohann, Jasmine; Vellakkal, Sukumar; Khan, Zaky; Ebrahim, Shah; Stuckler, David

2016-01-01

Abstract Background: Rates of child malnutrition and mortality in India remain high. We tested the hypothesis that rising food prices are contributing to India’s slow progress in improving childhood survival. Methods : Using rounds 2 and 3 (2002—08) of the Indian District Level Household Survey, we calculated neonatal, infant and under-five mortality rates in 364 districts, and merged these with district-level food price data from the National Sample Survey Office. Multivariate models were estimated, stratified into 27 less deprived states and territories and 8 deprived states (‘Empowered Action Groups’). Results : Between 2002 and 2008, the real price of food in India rose by 11.7%. A 1% increase in total food prices was associated with a 0.49% increase in neonatal (95% confidence interval (CI): 0.13% to 0.85%), but not infant or under-five mortality rates. Disaggregating by type of food and level of deprivation, in the eight deprived states, we found an elevation in neonatal mortality rates of 0.33% for each 1% increase in the price of meat (95% CI: 0.06% to 0.60%) and 0.10% for a 1% increase in dairy (95% CI: 0.01% to 0.20%). We also detected an adverse association of the price of dairy with infant (b = 0.09%; 95% CI: 0.01% to 0.16%) and under-five mortality rates (b = 0.10%; 95% CI: 0.03% to 0.17%). These associations were not detected in less deprived states and territories. Conclusions: Rising food prices, particularly of high-protein meat and dairy products, were associated with worse child mortality outcomes. These adverse associations were concentrated in the most deprived states. PMID:27063607

The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study.

PubMed

Bonenberger, Marc; Aikins, Moses; Akweongo, Patricia; Wyss, Kaspar

2014-08-09

Motivation and job satisfaction have been identified as key factors for health worker retention and turnover in low- and middle-income countries. District health managers in decentralized health systems usually have a broadened 'decision space' that enables them to positively influence health worker motivation and job satisfaction, which in turn impacts on retention and performance at district-level. The study explored the effects of motivation and job satisfaction on turnover intention and how motivation and satisfaction can be improved by district health managers in order to increase retention of health workers. We conducted a cross-sectional survey in three districts of the Eastern Region in Ghana and interviewed 256 health workers from several staff categories (doctors, nursing professionals, allied health workers and pharmacists) on their intentions to leave their current health facilities as well as their perceptions on various aspects of motivation and job satisfaction. The effects of motivation and job satisfaction on turnover intention were explored through logistic regression analysis. Overall, 69% of the respondents reported to have turnover intentions. Motivation (OR = 0.74, 95% CI: 0.60 to 0.92) and job satisfaction (OR = 0.74, 95% CI: 0.57 to 0.96) were significantly associated with turnover intention and higher levels of both reduced the risk of health workers having this intention. The dimensions of motivation and job satisfaction significantly associated with turnover intention included career development (OR = 0.56, 95% CI: 0.36 to 0.86), workload (OR = 0.58, 95% CI: 0.34 to 0.99), management (OR = 0.51. 95% CI: 0.30 to 0.84), organizational commitment (OR = 0.36, 95% CI: 0.19 to 0.66), and burnout (OR = 0.59, 95% CI: 0.39 to 0.91). Our findings indicate that effective human resource management practices at district level influence health worker motivation and job satisfaction, thereby reducing the likelihood for turnover. Therefore, it is worth strengthening human resource management skills at district level and supporting district health managers to implement retention strategies.

The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study

PubMed Central

2014-01-01

Background Motivation and job satisfaction have been identified as key factors for health worker retention and turnover in low- and middle-income countries. District health managers in decentralized health systems usually have a broadened ‘decision space’ that enables them to positively influence health worker motivation and job satisfaction, which in turn impacts on retention and performance at district-level. The study explored the effects of motivation and job satisfaction on turnover intention and how motivation and satisfaction can be improved by district health managers in order to increase retention of health workers. Methods We conducted a cross-sectional survey in three districts of the Eastern Region in Ghana and interviewed 256 health workers from several staff categories (doctors, nursing professionals, allied health workers and pharmacists) on their intentions to leave their current health facilities as well as their perceptions on various aspects of motivation and job satisfaction. The effects of motivation and job satisfaction on turnover intention were explored through logistic regression analysis. Results Overall, 69% of the respondents reported to have turnover intentions. Motivation (OR = 0.74, 95% CI: 0.60 to 0.92) and job satisfaction (OR = 0.74, 95% CI: 0.57 to 0.96) were significantly associated with turnover intention and higher levels of both reduced the risk of health workers having this intention. The dimensions of motivation and job satisfaction significantly associated with turnover intention included career development (OR = 0.56, 95% CI: 0.36 to 0.86), workload (OR = 0.58, 95% CI: 0.34 to 0.99), management (OR = 0.51. 95% CI: 0.30 to 0.84), organizational commitment (OR = 0.36, 95% CI: 0.19 to 0.66), and burnout (OR = 0.59, 95% CI: 0.39 to 0.91). Conclusions Our findings indicate that effective human resource management practices at district level influence health worker motivation and job satisfaction, thereby reducing the likelihood for turnover. Therefore, it is worth strengthening human resource management skills at district level and supporting district health managers to implement retention strategies. PMID:25106497

A DESIGN METHOD FOR RETAINING WALL BASED ON RETURN PERIOD OF RAINFALL AND SNOWMELT

NASA Astrophysics Data System (ADS)

Ebana, Ryo; Uehira, Kenichiro; Yamada, Tadashi

The main purpose of this study is to develop a new design method for the retaining wall in a cold district. In the cold district, snowfall and snowmelt is one of the main factors in sediment related disaster. However, the effect of the snowmelt is not being taken account of sediment disasters precaution and evacuation system. In this study, we target at past slope failure disaster and quantitatively evaluate that the effect of rainfall and snowmelt on groundwater level and then verify the stability of slope. Water supplied on the slope was determined from the probabilistic approach of the snowmelt using DegreeDay method in this study. Furthermore, a slope stability analysis was carried out based on the ground water level that was obtained from the unsaturated infiltration flow with the saturated seepage flow simulations. From the result of the slope stability analysis, it was found that the effect of ground water level on the stability of slope is much bigger than that of other factors.

Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation.

PubMed

Langston, Anne; Weiss, Jennifer; Landegger, Justine; Pullum, Thomas; Morrow, Melanie; Kabadege, Melene; Mugeni, Catherine; Sarriot, Eric

2014-08-01

The Kabeho Mwana project (2006-2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes. While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital. The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates.

Demand and supply factors affecting the rising overmedicalization of birth in India.

PubMed

Leone, Tiziana

2014-11-01

To understand the interaction between health systems and individual factors in determining the probability of a cesarean delivery in India. In a retrospective study, data from the 2007-2008 District Level Household and Facility Survey was used to determine the risk of cesarean delivery in six states (Punjab, Delhi, Maharashtra, Andhra Pradesh, Kerala, and Tamil Nadu). Multilevel modeling was used to account for district and community effects. After controlling for key risk factors, the analysis showed that cesareans were more likely at private than public institutions (P<0.001). In terms of demand, higher education levels rather than wealth seemed to increase the likelihood of a cesarean delivery. District-level effects were significant in almost all states (P<0.001), demonstrating the need to control for health system factors. Supply factors might contribute more to the rise in cesarean delivery than does demand. Further research is needed to understand whether the quest for increased institutional deliveries in a country with high maternal mortality might be compromised by pressures for overmedicalization. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

A locally initiated and executed measles outbreak response immunization campaign in the nylon health district, Douala Cameroon 2011

PubMed Central

2013-01-01

The Cameroon health system is divided into central, intermediate and peripheral levels. Of the 43 health districts with a measles outbreak in Cameroon in 2011, only the Nylon Health District organized a documented outbreak response immunization. We present the methods and results of the response campaign solely shouldered by the district and intermediate level. The risk group, targets and neighborhoods to be vaccinated were identified after a detailed analysis of initial cases. The intermediate level defined strategies, provided logistics, capacity building and 41% of the operational budget while 59% was completed by the peripheral level. Microsoft Office Excel 2007 was used to estimate coverage rates and to draw an epidemic curve. The response immunization campaign was organized on the 14th epidemiological week, 10 weeks after the onset of the outbreak which ended 11 weeks thereafter. A total of 15867(108.5%) children aged 9-59 months were vaccinated in five health areas at a direct cost (vaccines excluded) of 71.34FCFA ($0.143) per vaccinated child. An additional 824 children aged 9-59 months were vaccinated around the residence of notified cases in neighborhoods which were not involved in the response campaign. The number of cases after the response campaign was lower than before. Once vaccines are available, prompt outbreak response campaigns can be organized at operational level to obtain commendable results instead of depending solely on international organizations or central levels. Decision makers at the intermediate and operational levels should redeploy available funds during emergencies to prevent the development of extreme public health conditions. PMID:23497712

Distribution of metal and metalloid elements in human scalp hair in Taiyuan, China.

PubMed

Zhu, Yuen; Wang, Yuzhe; Meng, Fanjian; Li, Lifen; Wu, Shan; Mei, Xiaohui; Li, Hua; Zhang, Guixiang; Wu, Daishe

2018-02-01

This study investigated the levels of metal and metalloid elements (As, Ca, Cd, Cr, Cu, Fe, Hg, Mg, Ni, Pb, and Zn) in scalp hair samples collected from 161 people of different age and gender groups living in the six districts of Taiyuan, an industrial city with rich coal reserve in Shanxi province in China. Levels of most elements in the hair were high in the 26-40 age groups and increased with the length of residence. Calcium, Cr, Mg, Ni and Zn levels in the females' hair were significantly higher than those in the males' (p < 0.05). Element levels in the hair didn't have significantly differences between industrial and non-industrial districts because most of industry factories are in the upper wind position in Taiyuan, and contamination is prone to spread to non-industrial districts. The principal component analysis indicates that the main sources of these elements are mining activities, the neighboring stainless steel industry, and coal combustion. These results indicate that the industrial activities primarily contribute to the metal and metalloid pollution in Taiyuan, whereas numerous factors caused the metals accumulation in hair. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessing the gap between the acute trauma workload and the capacity of a single rural health district in South Africa. What are the implications for systems planning?

PubMed

Clarke, D L; Aldous, C; Thomson, S R

2014-06-01

This study focuses on a single rural health district in South Africa, and attempts to establish the burden of disease and to review the capacity of the district hospitals to deal with this load. Ethical approval to undertake this study was obtained from both the University of Kwa-Zulu Natal and the Department of Health. The audit was performed over a 6-month period in the four district hospitals of rural Sisonke District. There were four components to this audit. 1. Information on the hospital incidence of acute trauma in Sisonke was also sourced from the epidemiology unit of the Department of Health in Pietermaritzburg 2. Each of the district hospitals was visited and the medical manager was interviewed. The medical manager was asked to complete the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. (SAT). 3. The operative registers were reviewed to determine the number of index cases for trauma. This information was used to determine the unmet need of acute trauma in the district. 4. Each hospital was classified according to the Trauma Society of South Africa (TSSA) guidelines for levels of trauma care. The annual incidence of trauma in the Sisonke District is estimated to be 1,590 per 100,000 population. Although there appeared to be adequate infrastructure in the district hospitals, the SAT revealed significant deficits in terms of capacity of staff to adequately treat and triage acute trauma patients. There is a significant unmet need for trauma care in Sisonke. The four district hospitals can best be classified as Level IV centers of trauma care. There is a significant burden of trauma in the Sisonke District, yet the capacity to deal with this burden is inadequate. Although the physical infrastructure is adequate, the deficits relate to human resources. The strategic choices are between enhancing the district hospitals' capacity to deal with acute trauma, or deciding to bypass them completely and deliver all acute trauma patients to large regional trauma centers. If the first option is chosen, urgent intervention is required to build up the human resource capacity of district hospitals.

Analysis of Superintendent Longevity in Large School Districts: A Qualitative Study

ERIC Educational Resources Information Center

Mouton, Nikki Golar

2013-01-01

School district leadership matters, as evidenced by a meta-analysis of 27 reports and 1,210 districts conducted by Waters and Marzano (2006) which highlights a statistically significant correlation between district leadership and student achievement. Because this relationship is significant, it is important for school districts to have effective…

[Frequency of chromosome aberrations in residents of the Semipalatinsk Oblast].

PubMed

Gubitskaia, E G; Akhmatullina, N B; Vsevolodov, E B; Bishnevskaia, S S; Sharipov, I K; Cherednichenko, O G

1999-06-01

Cytogenetic analysis of the population of the Beskaragai district of the Semipalatinsk oblast adjacent to the territory of the nuclear test site was conducted by means of an ecological genetic questionnaire and cytogenetic examination of metaphase chromosomes. An increase in the total mutation level in the region was observed. The frequency of chromosome aberrations among the population of the Beskaragai district (3.2%) was statistically significantly (about 1.5 times) higher than the background levels in the clear regions (from 1 to 2%). Furthermore, the frequency of aberrations in adolescents was comparable with that in the adults. The spectrum of chromosome aberrations pointed to a significant contribution of radiation component to the mutagenesis.

Toward Addressing the Issues of Site Selection in District Effectiveness Research: A Two-Level Hierarchical Linear Growth Model

ERIC Educational Resources Information Center

Bowers, Alex J.

2010-01-01

Purpose: District effectiveness research (DER) is an emerging field concerned with identifying the organizational structures, administration, and leadership practices at the school district level that help districts find success with all of their students across the schools within the system. This work has mirrored much of the early school…

Changing Past Student Discipline Practices to Create a District-Wide Discipline Plan

ERIC Educational Resources Information Center

Green, Judith A.

2009-01-01

Improving student discipline is a constant challenge in the field of P-12 education. The challenge is especially great for district-level administrators who must address the educational and social needs of all students. As a district-level administrator, the author participates in a study of a midwestern district of elementary (preschool-8)…

Measurement of health system performance at district level: A study protocol

PubMed Central

Sharma, Atul; Prinja, Shankar; Aggarwal, Arun Kumar

2018-01-01

Background Limited efforts have been observed in low and middle income countries to undertake health system performance assessment at district level. Absence of a comprehensive data collection tool and lack of a standardised single summary measure defining overall performance are some of the main problems. Present study has been undertaken to develop a summary composite health system performance index at district level. Methods A broad range of indicators covering all six domains as per building block framework were finalized by an expert panel. The domains were classified into twenty sub-domains, with 70 input and process indicators to measure performance. Seven sub-domains for assessing health system outputs and outcomes were identified, with a total of 28 indicators. Districts in Haryana state from north India were selected for the study. Primary and secondary data will be collected from 378 health facilities, district and state health directorate headquarters. Indicators will be normalized, aggregated to generate composite performance index at district level. Domain specific scores will present the quality of individual building block domains in the public health system. Robustness of the results will be checked using sensitivity analysis. Expected impact for public health: The study presents a methodology for comprehensive assessment of all health system domains on basis of input, process, output and outcome indicators which has never been reported from India. Generation of this index will help identify policy and implementation areas of concern and point towards potential solutions. Results may also help understand relationships between individual building blocks and their sub-components. Significance for public health Measuring performance of health system is important to understand progress and challenges, and create systems that are efficient, equitable and patient-focused. However, very few assessments of such nature have been observed in low and middle income countries, especially at district level, mainly because of methodological challenges. This study presents a methodology for comprehensive assessment of all domains of health system and generation of a composite Health System Performance Index on the basis of input, process, output and outcome indicators. It will help identify policy and implementation problems worthy of attention and point towards potential solutions to health system bottlenecks resulting in poor performance. The results may also help better understand the relationships between individual building blocks and their sub-components and the overall performance of the health system. PMID:29441330

Development of Indonesia-Papua New Guinea border, Muara Tami District, Jayapura City through agropolitan concept

NASA Astrophysics Data System (ADS)

Subagiyo, A.; Dwiproborini, F.; Sari, N.

2017-06-01

The border of RI-PNG Muara Tami district is located on the eastern part of Jayapura city, which has agricultural potential. The past paradigm put the border as the backyard caused underdevelopment in border RI-PNG Muara Tami district, so that needed acceleration development through agropolitan concept. The purpose of the research is to define the aspect of physical, social, economic and border security to support agropolitan concept in border RI-PNG Muara Tami district. The analytical research method are border interactionan analysis, border security analysis, land capability analysis, land availability analysis, schallogram analysis, institutional analysis, leading comodity analysis (LQ and Growth Share), agribusiness linkage system analysis, accessibility analysis and A’WOT analysis. The result shown that mobilization from PNG to Muara Tami district could increase the economic opportunities with agricultural based. Border security of RI-PNG Muara Tami district is vulnerable, yet still condusive to mobilization. There is 12.977,94 Ha potensial land for agricultural (20,93%). There are six leading commodities to developed are rice, watermelon, banana, coconut, areca nut and cocoa. The border of RI-PNG Muara Tami district is ready enough to support agropolitan concept, but still have problems in social and economy aspect.

Multi scale modelling of landslide hazard and risk assessment in data scarce area - a case study on Dhalai District, Tripura, India

NASA Astrophysics Data System (ADS)

Ghosh, Kapil; De, Sunil Kumar

2017-04-01

Successful landslide management plans and policy depends on in-depth knowledge about the hazard and associated risk. Thus, the present research is intended to present an integrated approach involving uses of geospatial technologies for landslide hazard and risk assessment at different scales (site specific to regional level). The landslide hazard map at regional scale (district level) is prepared by using weight-rating based method. To analyze landslide manifestation in the Dhalai district of Tripura different causative factor maps (lithology, road buffer, slope, relative relief, rainfall, fault buffer, landuse/landcover and drainage density) are derived. The analysis revealed that the geological structure and human interference have more influence than other considered factors on the landslide occurrences. The landslide susceptibility zonation map shows that about 1.64 and 16.68% of the total study area is falling under very high and high susceptibility zones respectively. The landslide risk assessment at district level is generated by integrating hazard scouring and resource damage potential scouring (fuzzy membership values) maps. The values of landslide risk matrix are varying within the range of 0.001 to 0.18 and the risk assessment map shows that only 0.45% (10.80 km2) of the district is under very high risk zone, whereas, about 50% pixels of existing road section are under very high to high level of landslide risk. The major part (94.06%) of the district is under very low to low risk zone. Landslide hazard and risk assessment at site specific level have been carried out through intensive field investigation in which it is found that the Ambassa landslide is located within 150 m buffer zone of fault line. Variation of geo-electrical resistivity (2.2Ωm to 31.4Ωm) indicates the complex geological character in this area. Based on the obtained geo-technical result which helps to identify the degree of risk to the existing resource, it is appropriate to implement the management plans such as construction of sub-surface drainage, extension of retaining walls, cutting/filling of slope in scientific manner. Keywords: landslide, hazard, risk, fuzzy set theory

Thai district Leaders' perceptions of managing the direct observation treatment program in Trang Province, Thailand.

PubMed

Choowong, Jiraporn; Tillgren, Per; Söderbäck, Maja

2016-07-28

Thailand is 18th out of the 22 countries with the highest tuberculosis (TB) burden. It will be a challenge for Thailand to achieve the UN Millennium Development target for TB, as well as the new WHO targets for eliminating TB by 2035. More knowledge and a new approach are needed to tackle the complex challenges of managing the DOT program in Thailand. Contextual factors strongly influence the local implementation of evidence in practice. Using the PARIHS model, the aim has been to explore district leaders' perceptions of the management of the DOT program in Trang province, Thailand. A phenomenographic approach was used to explore the perceptions among district DOT program leaders in Trang province. We conducted semi-structured interviews with district leaders responsible for managing the DOT program in five districts. The analysis of the data transcriptions was done by grouping similarities and differences of perceptions, which were constructed in a hierarchical outcome space that shows a set of descriptive categories. The first descriptive category revealed a common perception of the leaders' duty and wish to comply with the NTP guidelines when managing and implementing the DOT program in their districts. More varied perceptions among the leaders concerned how to achieve successful treatment. Other perceptions concerned practical dilemmas, which included fear of infection, mutual distrust, and inadequate knowledge about TB. Further, the leaders perceived a need for improved management practices in implementing the TB guidelines. Using the PARIHS framework to gain a retrospective perspective on the district-level policy implementation of the DOT program and studying the leadership's perceptions about applying the guidelines to practice, has brought new knowledge about management practices. Additional support and resources from the regional level are needed to manage the challenges.

Identification of burden hotspots and risk factors for cholera in India: An observational study

PubMed Central

Sen Gupta, Sanjukta; Arora, Nisha; Khasnobis, Pradeep; Venkatesh, Srinivas; Sur, Dipika; Nair, Gopinath B.; Sack, David A.; Ganguly, Nirmal K.

2017-01-01

Background Even though cholera has existed for centuries and many parts of the country have sporadic, endemic and epidemic cholera, it is still an under-recognized health problem in India. A Cholera Expert Group in the country was established to gather evidence and to prepare a road map for control of cholera in India. This paper identifies cholera burden hotspots and factors associated with an increased risk of the disease. Methodology/Principle findings We acquired district level data on cholera case reports of 2010–2015 from the Integrated Disease Surveillance Program. Socioeconomic characteristics and coverage of water and sanitation was obtained from the 2011 census. Spatial analysis was performed to identify cholera hotspots, and a zero-inflated Poisson regression was employed to identify the factors associated with cholera and predicted case count in the district. 27,615 cholera cases were reported during the 6-year period. Twenty-four of 36 states of India reported cholera during these years, and 13 states were classified as endemic. Of 641 districts, 78 districts in 15 states were identified as “hotspots” based on the reported cases. On the other hand, 111 districts in nine states were identified as “hotspots” from model-based predicted number of cases. The risk for cholera in a district was negatively associated with the coverage of literate persons, households using treated water source and owning mobile telephone, and positively associated with the coverage of poor sanitation and drainage conditions and urbanization level in the district. Conclusions/Significance The study reaffirms that cholera continues to occur throughout a large part of India and identifies the burden hotspots and risk factors. Policymakers may use the findings of the article to develop a roadmap for prevention and control of cholera in India. PMID:28837645

Identification of burden hotspots and risk factors for cholera in India: An observational study.

PubMed

Ali, Mohammad; Sen Gupta, Sanjukta; Arora, Nisha; Khasnobis, Pradeep; Venkatesh, Srinivas; Sur, Dipika; Nair, Gopinath B; Sack, David A; Ganguly, Nirmal K

2017-01-01

Even though cholera has existed for centuries and many parts of the country have sporadic, endemic and epidemic cholera, it is still an under-recognized health problem in India. A Cholera Expert Group in the country was established to gather evidence and to prepare a road map for control of cholera in India. This paper identifies cholera burden hotspots and factors associated with an increased risk of the disease. We acquired district level data on cholera case reports of 2010-2015 from the Integrated Disease Surveillance Program. Socioeconomic characteristics and coverage of water and sanitation was obtained from the 2011 census. Spatial analysis was performed to identify cholera hotspots, and a zero-inflated Poisson regression was employed to identify the factors associated with cholera and predicted case count in the district. 27,615 cholera cases were reported during the 6-year period. Twenty-four of 36 states of India reported cholera during these years, and 13 states were classified as endemic. Of 641 districts, 78 districts in 15 states were identified as "hotspots" based on the reported cases. On the other hand, 111 districts in nine states were identified as "hotspots" from model-based predicted number of cases. The risk for cholera in a district was negatively associated with the coverage of literate persons, households using treated water source and owning mobile telephone, and positively associated with the coverage of poor sanitation and drainage conditions and urbanization level in the district. The study reaffirms that cholera continues to occur throughout a large part of India and identifies the burden hotspots and risk factors. Policymakers may use the findings of the article to develop a roadmap for prevention and control of cholera in India.

Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects.

PubMed

Chowdhury, Chitta R; Shahnawaz, Khijmatgar; Kumari, Divya; Chowdhury, Avidyuti; Bedi, Raman; Lynch, Edward; Harding, Stewart; Grootveld, Martin

2016-11-01

(1) To estimate the concentrations of fluoride in drinking water throughout different zones and districts of the state of Karnataka. (2) To investigate the variation of fluoride concentration in drinking water from different sources, and its relationships to daily temperature and rainfall status in the regional districts. (3) To develop an updated fluoride concentration intensity map of the state of Karnataka, and to evaluate these data in the context of fluoride-related health effects such as fluorosis and their prevalence. Aqueous standard solutions of 10, 100 and 1,000 ppm fluoride (F - ) were prepared with analytical grade Na + /F - and a buffer; TISAB II was incorporated in both calibration standard and analysis solutions in order to remove the potentially interfering effects of trace metal ions. This analysis was performed using an ion-selective electrode (ISE), and mean determination readings for n = 5 samples collected at each Karnataka water source were recorded. The F - concentration in drinking water in Karnataka state was found to vary substantially, with the highest mean values recorded being in the north-eastern zone (1.61 ppm), and the lowest in the south-western one (only 0.41 ppm). Analysis of variance (ANOVA) demonstrated that there were very highly significant 'between-zone' and 'between-districts-within-zones' sources of variation (p < 10 -5 -10 -9 ), results consistent with a substantial spatial variance of water source F - levels within this state. The southern part of Karnataka has low levels of F - in its drinking water, and may require fluoridation treatment in order to mitigate for dental caries and further ailments related to fluoride deficiency. However, districts within the north-eastern region have contrastingly high levels of fluoride, an observation which has been linked to dental and skeletal fluorosis. This highlights a major requirement for interventional actions in order to ensure maintenance of the recommended range of fluoride concentrations (0.8-1.5 ppm) in Karnataka's drinking water sources. © Royal Society for Public Health 2016.

NAEP Reporting Practices: Investigating District-Level and Market-Basket Reporting. The Compass Series.

ERIC Educational Resources Information Center

DeVito, Pasquale J., Ed.; Koenig, Judith A., Ed.

A committee of the National Research Council studied the desirability, feasibility, and potential impact of two reporting practices for National Assessment of Educational Progress (NAEP) results: district-level reporting and market-basket reporting. NAEP's sponsors believe that reporting district-level NAEP results would support state and local…

Reducing Lead in School Drinking Water: A Case Study.

ERIC Educational Resources Information Center

Odell, Lee

1991-01-01

The Seattle School District began a program in 1990 to identify lead levels in the district's drinking water and to implement measures to lower any high lead levels. Recounts each of the seven steps of the program, discusses what the district found, and explains how it lowered lead levels in the drinking water. (MLF)

The Politics of School-Based Management: Understanding the Process of Devolving Authority in Urban School Districts.

ERIC Educational Resources Information Center

Walker, Elaine M.

2002-01-01

Studied the implementation of school-based management in 30 of the poorest school districts in New Jersey (the Abbott districts). Findings show that genuine autonomy has been usurped by increased state power and authority, and that state elites allow little opportunity for capacity building at the district level. The level of democratization has…

Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan

PubMed Central

Petersen, Inge; Fairall, Lara; Bhana, Arvin; Kathree, Tasneem; Selohilwe, One; Brooke-Sumner, Carrie; Faris, Gill; Breuer, Erica; Sibanyoni, Nomvula; Lund, Crick; Patel, Vikram

2016-01-01

Background In South Africa, the escalating prevalence of chronic illness and its high comorbidity with mental disorders bring to the fore the need for integrating mental health into chronic care at district level. Aims To develop a district mental healthcare plan (MHCP) in South Africa that integrates mental healthcare for depression, alcohol use disorders and schizophrenia into chronic care. Method Mixed methods using a situation analysis, qualitative key informant interviews, theory of change workshops and piloting of the plan in one health facility informed the development of the MHCP. Results Collaborative care packages for the three conditions were developed to enable integration at the organisational, facility and community levels, supported by a human resource mix and implementation tools. Potential barriers to the feasibility of implementation at scale were identified. Conclusions The plan leverages resources and systems availed by the emerging chronic care service delivery platform for the integration of mental health. This strengthens the potential for future scale up. PMID:26447176

Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015

PubMed Central

Ogbuanu, Ikechukwu U.; Adegoke, Oluwasegun J.; Scobie, Heather M.; Uba, Belinda V.; Wannemuehler, Kathleen A.; Ruiz, Alicia; Elmousaad, Hashim; Ohuabunwo, Chima J.; Mustafa, Mahmud; Nguku, Patrick; Waziri, Ndadilnasiya Endie; Vertefeuille, John F.

2016-01-01

Background Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria. Methods Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014–2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12–23 months was documented based on vaccination card or caretaker’s recall. District-level coverage estimates were calculated using survey methods. Results Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1–63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%–139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%). Conclusions Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria. PMID:27936077

Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015.

PubMed

Gunnala, Rajni; Ogbuanu, Ikechukwu U; Adegoke, Oluwasegun J; Scobie, Heather M; Uba, Belinda V; Wannemuehler, Kathleen A; Ruiz, Alicia; Elmousaad, Hashim; Ohuabunwo, Chima J; Mustafa, Mahmud; Nguku, Patrick; Waziri, Ndadilnasiya Endie; Vertefeuille, John F

2016-01-01

Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria. Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014-2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12-23 months was documented based on vaccination card or caretaker's recall. District-level coverage estimates were calculated using survey methods. Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1-63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%-139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%). Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria.

Utility of check dams in dilution of fluoride concentration in ground water and the resultant analysis of blood serum and urine of villagers, Anantapur District, Andhra Pradesh, India.

PubMed

Bhagavan, S V B K; Raghu, V

2005-02-01

High levels of fluoride (beyond 1.5 ppm) in ground water as source of drinking water are common in many parts of Andhra Pradesh, India, causing fluorosis. The study carried out in endemic Nalgonda District, Andhra Pradesh, has indicated that the fluoride-rich ground water present in the wells located down stream and close to the surface water bodies is getting diluted by the low-fluoride surface water. Encouraged by this result, check dams were constructed upstream of the identified marginally high fluoride bearing ground water zones in Anantapur District to reduce fluoride levels as an alternate solution for safe drinking water. In this paper, an attempt is made to study the utility and effect of these check dams in dilution of fluoride concentration in drinking water and its resultant impact on the health aspects of certain villagers of Anantapur District through the analysis of their blood serum and urine. Ground water samples from three fluoride-affected villages, blood and urine of males and females from the same villages were collected and analyzed for fluoride using ion selective electrode method. The results indicated that the fluoride levels in blood serum and urine of males in the age group of 5-11 years are found to be the highest. The concentration of fluoride in ground water is directly proportional to the concentration of fluoride in blood serum and urine. The concentration of fluoride in ground water with depth of the aquifer is a function of lithology, amount and duration of rainfall, rate of infiltration, level of ground water exploitation in the area etc. The construction of check dams upstream of the identified marginally high fluoride waters will not only cause additional recharge of ground water but also reduces the fluoride concentration eventually improving the health of the villagers.

Effect of School Electrification on Learning Outcomes: A Subnational Level Analysis of Students' Pass Rate in English and Mathematics in Ghana

ERIC Educational Resources Information Center

Adamba, Clement

2018-01-01

The paper used district level students' pass rate in a nationally conducted basic education certification examination to assess the effect of school electrification on learning outcomes. The results show that school electrification in addition to the traditional school-level inputs, such as class size, pupil-teacher ratio, ratio of core textbook…

A quantitative analysis of factors influencing the professional longevity of high school science teachers in Florida

NASA Astrophysics Data System (ADS)

Ridgley, James Alexander, Jr.

This dissertation is an exploratory quantitative analysis of various independent variables to determine their effect on the professional longevity (years of service) of high school science teachers in the state of Florida for the academic years 2011-2012 to 2013-2014. Data are collected from the Florida Department of Education, National Center for Education Statistics, and the National Assessment of Educational Progress databases. The following research hypotheses are examined: H1 - There are statistically significant differences in Level 1 (teacher variables) that influence the professional longevity of a high school science teacher in Florida. H2 - There are statistically significant differences in Level 2 (school variables) that influence the professional longevity of a high school science teacher in Florida. H3 - There are statistically significant differences in Level 3 (district variables) that influence the professional longevity of a high school science teacher in Florida. H4 - When tested in a hierarchical multiple regression, there are statistically significant differences in Level 1, Level 2, or Level 3 that influence the professional longevity of a high school science teacher in Florida. The professional longevity of a Floridian high school science teacher is the dependent variable. The independent variables are: (Level 1) a teacher's sex, age, ethnicity, earned degree, salary, number of schools taught in, migration count, and various years of service in different areas of education; (Level 2) a school's geographic location, residential population density, average class size, charter status, and SES; and (Level 3) a school district's average SES and average spending per pupil. Statistical analyses of exploratory MLRs and a HMR are used to support the research hypotheses. The final results of the HMR analysis show a teacher's age, salary, earned degree (unknown, associate, and doctorate), and ethnicity (Hispanic and Native Hawaiian/Pacific Islander); a school's charter status; and a school district's average SES are all significant predictors of a Florida high school science teacher's professional longevity. Although statistically significant in the initial exploratory MLR analyses, a teacher's ethnicity (Asian and Black), a school's geographic location (city and rural), and a school's SES are not statistically significant in the final HMR model.

Decentralization and health resource allocation: a case study at the district level in Indonesia.

PubMed

Abdullah, Asnawi; Stoelwinder, Johannes

2008-01-01

Health resource allocation has been an issue of political debate in many health systems. However, the debate has tended to concentrate on vertical allocation from the national to regional level. Allocation within regions or institutions has been largely ignored. This study was conducted to contribute analysis to this gap. The objective was to investigate health resource allocation within District Health Offices (DHOs) and to compare the trends and patterns of several budget categories before and after decentralization. The study was conducted in three districts in the Province of Nanggroe Aceh Darussalam. Six fiscal year budgets, two before decentralization and four after, were studied. Data was collected from the Local Government Planning Office and DHOs. Results indicated that in the first year of implementing a decentralization policy, the local government budget rose sharply, particularly in the wealthiest district. In contrast, in relatively poor districts the budget was only boosted slightly. Increasing total local government budgets had a positive impact on increasing the health budget. The absolute amount of health budgets increased significantly, but by percentage did not change very much. Budgets for several projects and budget items increased significantly, but others, such as health promotion, monitoring and evaluation, and public-goods-related activities, decreased. This study concluded that decentralization in Indonesia had made a positive impact on district government fiscal capacity and had affected DHO budgets positively. However, an imbalanced budget allocation between projects and budget items was obvious, and this needs serious attention from policy makers. Otherwise, decentralization will not significantly improve the health system in Indonesia.

Exploring Factors Affecting Girls' Education at Secondary Level: A Case of Karak District, Pakistan

ERIC Educational Resources Information Center

Suleman, Qaiser; Aslam, Hassan Danial; Habib, Muhammad Badar; Yasmeen, Kausar; Jalalian, Mehrdad; Akhtar, Zaitoon; Akhtar, Basreen

2015-01-01

The study examined the factors that affect girls' education at secondary school level in Karak District, Khyber Pakhtunkhwa (Pakistan). All the female heads, teachers and students serving and studying at secondary school level in Karak District constituted the population of the study. The study was delimited to only 30 girls' secondary schools in…

Policy Matters: An Analysis of District-Level Efforts to Increase the Identification of Underrepresented Learners

ERIC Educational Resources Information Center

McBee, Matthew T.; Shaunessy, Elizabeth; Matthews, Michael S.

2012-01-01

Policies delegating control of educational policy to the local level are widespread, yet there has been little examination of the effects of such distributed decision making in the area of advanced education programming. We used propensity score matching to examine the effectiveness of locally developed policies for identifying intellectually…

Association between State Assistance on the Topic of Indoor Air Quality and School District-Level Policies That Promote Indoor Air Quality in Schools

ERIC Educational Resources Information Center

Everett Jones, Sherry; Doroski, Brenda; Glick, Sherry

2015-01-01

Nationally representative data from the 2012 School Health Policies and Practices Study examined whether state assistance on indoor air quality (IAQ) was associated with district-level policies and practices related to IAQ and integrated pest management (IPM). Districts in states that provided assistance on IAQ were more likely than districts not…

Particle-bound polychlorinated dibenzo- p-dioxins and dibenzofurans in the atmosphere of Guangzhou, China

NASA Astrophysics Data System (ADS)

Yu, Liping; Mai, Bixian; Meng, Xiangzhou; Bi, Xinhui; Sheng, Guoying; Fu, Jiamo; Peng, Ping'an

A short-term sampling scheme was devised to determine the levels of particle-bound polychlorinated dibenzo- p-dioxins and dibenzofurans (PCDD/Fs) in Guangzhou atmosphere and to evaluate the impact of PCDD/Fs on the lives of the inhabitants in Guangzhou. Samples were collected from four different districts of Guangzhou City, and the results indicated that industrial activities had tremendous influence on the levels of atmospheric PCDD/Fs in these districts. The mean PCDD/Fs concentrations (mean I-TEQ values) for Huadu, Liwan, Tianhe and Huangpu districts were 3815 fg m -3 (104.6 fg I-TEQ m -3), 12 777 fg m -3 (430.5 fg I-TEQ m -3), 6963 fg m -3 (163.7 fg I-TEQ m -3) and 10 953 fg m -3 (769.3 fg I-TEQ m -3), respectively, which were higher than the concentration ranges for other cities in the world. The mean concentrations of particulate organic carbon (OC) and elemental carbon (EC) were 17.61±0.94 and 3.17±0.21 μg m -3 for Huadu district, 44.18±2.29 and 13.32±0.75 μg m -3 for Liwan district, 33.53±1.72 and 9.89±0.56 μg m -3 for Tianhe district, and 29.52±1.53 and 8.87±0.53 μg m -3 for Huangpu district, respectively. The relationship between PCDD/Fs concentrations and OC and EC concentrations demonstrated that EC could be a better predictor for the concentration of PCDD/Fs. Detailed source analysis indicated that the PCDD/Fs in Guangzhou were derived from small diffuse combustion sources, e.g., traffic sources, domestic burning of fossil fuels, non-industrial combustion sources and industrial combustion sources. Results of daily intake of PCDD/Fs by inhaling air suggested that the inhalation exposure of PCDD/Fs by the inhabitants in Liwan district is relatively high.

Hazard, Vulnerability and Capacity Mapping for Landslides Risk Analysis using Geographic Information System (GIS)

NASA Astrophysics Data System (ADS)

Sari, D. A. P.; Innaqa, S.; Safrilah

2017-06-01

This research analyzed the levels of disaster risk in the Citeureup sub-District, Bogor Regency, West Java, based on its potential hazard, vulnerability and capacity, using map to represent the results, then Miles and Huberman analytical techniques was used to analyze the qualitative interviews. The analysis conducted in this study is based on the concept of disaster risk by Wisner. The result shows that the Citeureup sub-District has medium-low risk of landslides. Of the 14 villages, three villages have a moderate risk level, namely Hambalang, Tajur, and Tangkil, or 49.58% of the total land area. Eleven villages have a low level of risk, namely Pasir Mukti, Sanja, Tarikolot, Gunung Sari, Puspasari, East Karang Asem, Citeureup, Leuwinutug, Sukahati, West Karang Asem West and Puspanegara, or 48.68% of the total land area, for high-risk areas only around 1.74%, which is part of Hambalang village. The analysis using Geographic Information System (GIS) prove that areas with a high risk potential does not necessarily have a high level of risk. The capacity of the community plays an important role to minimize the risk of a region. Disaster risk reduction strategy is done by creating a safe condition, which intensified the movement of disaster risk reduction.

Simple versus composite indicators of socioeconomic status in resource allocation formulae: the case of the district resource allocation formula in Malawi

PubMed Central

2010-01-01

Background The district resource allocation formula in Malawi was recently reviewed to include stunting as a proxy measure of socioeconomic status. In many countries where the concept of need has been incorporated in resource allocation, composite indicators of socioeconomic status have been used. In the Malawi case, it is important to ascertain whether there are differences between using single variable or composite indicators of socioeconomic status in allocations made to districts, holding all other factors in the resource allocation formula constant. Methods Principal components analysis was used to calculate asset indices for all districts from variables that capture living standards using data from the Malawi Multiple Indicator Cluster Survey 2006. These were normalized and used to weight district populations. District proportions of national population weighted by both the simple and composite indicators were then calculated for all districts and compared. District allocations were also calculated using the two approaches and compared. Results The two types of indicators are highly correlated, with a spearman rank correlation coefficient of 0.97 at the 1% level of significance. For 21 out of the 26 districts included in the study, proportions of national population weighted by the simple indicator are higher by an average of 0.6 percentage points. For the remaining 5 districts, district proportions of national population weighted by the composite indicator are higher by an average of 2 percentage points. Though the average percentage point differences are low and the actual allocations using both approaches highly correlated (ρ of 0.96), differences in actual allocations exceed 10% for 8 districts and have an average of 4.2% for the remaining 17. For 21 districts allocations based on the single variable indicator are higher. Conclusions Variations in district allocations made using either the simple or composite indicators of socioeconomic status are not statistically different to recommend one over the other. However, the single variable indicator is favourable for its ease of computation. PMID:20053274

Cholera in Cameroon, 2000-2012: Spatial and Temporal Analysis at the Operational (Health District) and Sub Climate Levels

PubMed Central

Liang, Song; Kracalik, Ian T.; Morris, Lillian; Blackburn, Jason K.; Mbam, Leonard M.; Ba Pouth, Simon Franky Baonga; Teboh, Andrew; Yang, Yang; Arabi, Mouhaman; Sugimoto, Jonathan D.; Morris, John Glenn

2016-01-01

Introduction Recurrent cholera outbreaks have been reported in Cameroon since 1971. However, case fatality ratios remain high, and we do not have an optimal understanding of the epidemiology of the disease, due in part to the diversity of Cameroon’s climate subzones and a lack of comprehensive data at the health district level. Methods/Findings A unique health district level dataset of reported cholera case numbers and related deaths from 2000–2012, obtained from the Ministry of Public Health of Cameroon and World Health Organization (WHO) country office, served as the basis for the analysis. During this time period, 43,474 cholera cases were reported: 1748 were fatal (mean annual case fatality ratio of 7.9%), with an attack rate of 17.9 reported cases per 100,000 inhabitants per year. Outbreaks occurred in three waves during the 13-year time period, with the highest case fatality ratios at the beginning of each wave. Seasonal patterns of illness differed strikingly between climate subzones (Sudano-Sahelian, Tropical Humid, Guinea Equatorial, and Equatorial Monsoon). In the northern Sudano-Sahelian subzone, highest number of cases tended to occur during the rainy season (July-September). The southern Equatorial Monsoon subzone reported cases year-round, with the lowest numbers during peak rainfall (July-September). A spatial clustering analysis identified multiple clusters of high incidence health districts during 2010 and 2011, which were the 2 years with the highest annual attack rates. A spatiotemporal autoregressive Poisson regression model fit to the 2010–2011 data identified significant associations between the risk of transmission and several factors, including the presence of major waterbody or highway, as well as the average daily maximum temperature and the precipitation levels over the preceding two weeks. The direction and/or magnitude of these associations differed between climate subzones, which, in turn, differed from national estimates that ignored subzones differences in climate variables. Conclusions/Significance The epidemiology of cholera in Cameroon differs substantially between climate subzones. Development of an optimal comprehensive country-wide control strategy for cholera requires an understanding of the impact of the natural and built environment on transmission patterns at the local level, particularly in the setting of ongoing climate change. PMID:27855171

The Paris Declaration in practice: challenges of health sector aid coordination at the district level in Zambia

PubMed Central

Sundewall, Jesper; Forsberg, Birger C; Jönsson, Kristina; Chansa, Collins; Tomson, Göran

2009-01-01

Background The increasing resources available for and number of partners providing health sector aid have stimulated innovations, notably, the Paris Declaration on Aid Effectiveness, which aim to improve aid coordination. In this, one of the first studies to analyse implementation of aid coordination below national level, the aim was to investigate the effect of the Paris Declaration on coordination of health sector aid at the district level in Zambia. Methods The study was carried out in three districts of Zambia. Data were collected via interviews with health centre staff, district managers and officials from the Ministry of Health, and from district action plans, financial reports and accounts, and health centre ledger cards. Four indicators of coordination related to external-partner activity, common arrangements used by external partners and predictability of funding were analysed and assessed in relation to the 2010 targets set by the Paris Declaration. Findings While the activity of external partners at the district level has increased, funding and activities provided by these partners are often not included in local plans. HIV/AIDS support show better integration in planning and implementation at the district level than other support. Regarding common arrangements used for fund disbursement, the share of resources provided as programme-based support is not increasing. The predictability of funds coming from outside the government financing mechanism is low. Conclusion Greater efforts to integrate partners in district level planning and implementation are needed. External partners must improve the predictability of their support and be more proactive in informing the districts about their intended contributions. With the deadline for achieving the targets set by the Paris Declaration fast approaching, it is time for the signatories to accelerate its implementation. PMID:19505300

Leadership Academies: A District Office Perspective

ERIC Educational Resources Information Center

Doll, Rick

2016-01-01

This article investigates district-level administrators' perceptions regarding the value of the partnership academies. The article uses input from seven district administrators who provided feedback regarding the value of the district and university partnership, specific benefits to the district, the differences between participants who envision…

Do Management and Leadership Practices in the Context of Decentralisation Influence Performance of Community Health Fund? Evidence From Iramba and Iringa Districts in Tanzania.

PubMed

Joseph, Chakupewa; Maluka, Stephen Oswald

2016-09-26

In early 1990s, Tanzania like other African countries, adopted health sector reform (HSR). The most strongly held centralisation system that informed the nature of services provision including health was, thus, disintegrated giving rise to decentralisation system. It was within the realm of HSR process, user fees were introduced in the health sector. Along with user fees, various types of health insurances, including the Community Health Fund (CHF), were introduced. While the country's level of enrolment in the CHF is low, there are marked variations among districts. This paper highlights the role of decentralised health management and leadership practices in the uptake of the CHF in Tanzania. A comparative exploratory case study of high and low performing districts was carried out. In-depth interviews were conducted with the members of the Council Health Service Board (CHSB), Council Health Management Team (CHMT), Health Facility Committees (HFCs), in-charges of health facilities, healthcare providers, and Community Development Officers (CDOs). Minutes of the meetings of the committees and district annual health plans and district annual implementation reports were also used to verify and triangulate the data. Thematic analysis was adopted to analyse the collected data. We employed both inductive and deductive (mixed coding) to arrive to the themes. There were no differences in the level of education and experience of the district health managers in the two study districts. Almost all district health managers responsible for the management of the CHF had attended some training on management and leadership. However, there were variations in the personal initiatives of the top-district health leaders, particularly the district health managers, the council health services board and local government officials. Similarly, there were differences in the supervision mechanisms, and incentives available for the health providers, HFCs and board members in the two study districts. This paper adds to the stock of knowledge on CHFs functioning in Tanzania. By comparing the best practices with the worst practices, the paper contributes valuable insights on how CHF can be scaled up and maintained. The study clearly indicates that the performance of the community-based health financing largely depends on the personal initiatives of the top-district health leaders, particularly the district health managers and local government officials. This implies that the regional health management team (RHMT) and the Ministry of Health and Social Welfare (MoHSW) should strengthen supportive supervision mechanisms to the district health managers and health facilities. More important, there is need for the MoHSW to provide opportunities for the well performing districts to share good practices to other districts in order to increase uptake of the community-based health insurance.

Cost Analysis at the Local Level: Applications and Attitudes. Paper and Report Series No. 103.

ERIC Educational Resources Information Center

Smith, Jana Kay

This study reports the results of a survey sent to 67 metropolitan school district evaluators. The survey assessed past and anticipated conduct of cost analysis methods, as well as attitudes toward the use of these methods. The instrument used contained many items taken from a survey instrument used in a previous study of cost analysis methods at…

Burden of psychiatric morbidity among attendees of a secondary level hospital in Northern India: Implications for integration of mental health care at subdistrict level.

PubMed

Haldar, Partha; Sagar, Rajesh; Malhotra, Sumit; Kant, Shashi

2017-01-01

There is little information available on the type, pattern, trend, and demographic differentials of psychiatric cases attending a subdistrict level facility in India. Our objectives were to describe the sociodemographic profile of the patients availing the psychiatric outpatient department services and document the diagnosis. This study is based on a retrospective analysis of routinely recorded administrative data collected during psychiatry consultations that took place between January 2010 and June 2014, at the subdistrict level hospital, Ballabgarh, Faridabad district, Haryana, Northern India. The data were abstracted in Microsoft Excel, scrutinized for duplicates, and cleaned in terms of the International Classification of Diseases 10 th Revision coding. Descriptive analysis was done for dependent variables and continuous variables were compared using independent t -test. A total of 2806 people (new registrations) were provided psychiatric consultations between January 2010 and June 2014. The mean age of males was 33.7 years (95% confidence interval [CI], 32.9, 34.5) and of females was 35.6 years (95% CI, 34.9, 36.3). Neurotic, stress-related, and somatoform disorders (F40-F48) comprised the major category of diagnoses with 661 cases (24%), followed by unspecified mental disorders (F99) with 528 cases (19%), mood (affective) disorders (F30-F39) with 448 cases (16%), and episodic and paroxysmal disorders (G40-G47) with 334 cases (12%). We reported an increase in level and trend in the monthly attendance of patients who required psychiatric at a secondary care hospital in Northern India. We suggest that setting up of mental health units only at district hospital might not be a sufficient health system's approach as has been envisaged under the District Mental Health Program.

Bottleneck analysis and strategic planning using Tanahashi model for childhood diarrhea management in Gujarat, Western India.

PubMed

Rupani, Mihir Prafulbhai; Gaonkar, Narayan T; Bhatt, Gneyaa S

2016-10-01

In spite of continued efforts, India is still lagging behind in achieving its MDG goals. The objectives of this study were to identify stake-holders who have a role to play in childhood diarrhea management, to identify gaps in childhood diarrhea management and to propose strategic options for relieving these gaps. Bottleneck analysis exercise was carried out based on the Tanahashi model in six High Priority Districts (HPDs) of Gujarat in period between July-November 2013. The major bottlenecks identified for Childhood Diarrhea management were poor demand generation, unsafe drinking water, poor access to improved sanitation facility and lack of equitable distribution and replenishment mechanisms for Oral Rehydration Solution (ORS) packets and Zinc tablets till the front-line worker level. The main strategic options that were suggested for relieving these bottlenecks were Zinc-ORS roll out in scale-up districts, develop Information Education Communication/Behaviour Change Communication (IEC/BCC) plan for childhood diarrhea management at state/district level, use of Drug Logistics Information Management System (DLIMS) software for supply chain management of Zinc-ORS, strengthening of chlorination activity at household level, monitoring implementation of Nirmal Bharat Abhiyaan (NBA) for constructing improved sanitation facilities at household level and to develop an IEC/BCC plan for hygiene promotion and usage of sanitary latrines. Use of Zinc tablets need to be intensified through an effective scale-up. Adequate demand generation activity is needed. There is need to address safe drinking water and improved sanitation measures at household levels. Multi-sectoral engagements and ownership of Zinc-ORS program is the need of the hour. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessment of social vulnerability to natural hazards in Nepal

NASA Astrophysics Data System (ADS)

Gautam, Dipendra

2017-12-01

This paper investigates district-wide social vulnerability to natural hazards in Nepal. Disasters such as earthquakes, floods, landslides, epidemics, and droughts are common in Nepal. Every year thousands of people are killed and huge economic and environmental losses occur in Nepal due to various natural hazards. Although natural hazards are well recognized, quantitative and qualitative social vulnerability mapping has not existed until now in Nepal. This study aims to quantify the social vulnerability on a local scale, considering all 75 districts using the available census. To perform district-level vulnerability mapping, 13 variables were selected and aggregated indexes were plotted in an ArcGIS environment. The sum of results shows that only 4 districts in Nepal have a very low social vulnerability index whereas 46 districts (61 %) are at moderate to high social vulnerability levels. Vulnerability mapping highlights the immediate need for decentralized frameworks to tackle natural hazards in district level; additionally, the results of this study can contribute to preparedness, planning and resource management, inter-district coordination, contingency planning, and public awareness efforts.

De-adoption of an evidence-based trauma intervention in schools: A retrospective report from an urban school district

PubMed Central

Nadeem, Erum; Ringle, Vanesa

2017-01-01

The de-adoption of evidence-based practices (EBPs) is a largely understudied topic. The present study examined factors related to the de-adoption of an EBP for students exposed to traumatic events in a large urban school district. Qualitative interviews conducted with school clinicians and district administrators two years after the district embarked on a large-scale roll-out of the EBP distinguished between factors that impacted partial de-adoption after one year (phase 1) and complete de-adoption by the district after two years (phase 2). Phase 1 factors included organizational consistency, workforce stability, prior success, positive student outcomes, school- and district- level supports, innovation-setting fit, and innovation-related issues. Phase 2 factors included district-level leadership changes, financial and workforce instability, and shifting priorities. Study results suggest that sustainment-enhancing strategies should be included in the early stages of program implementation to most effectively adapt to school- and system- level changes. PMID:28775793

Do Schools in Rural and Nonrural Districts Allocate Resources Differently? An Analysis of Spending and Staffing Patterns in the West Region States. Summary. Issues & Answers. REL 2011-No. 099

ERIC Educational Resources Information Center

Levin, Jesse; Manship, Karen; Chambers, Jay; Johnson, Jerry; Blankenship, Charles

2011-01-01

This report presents the first detailed comparison of resource allocation between rural and nonrural districts in the West Region. Three regional characteristics often associated with rural districts were chosen for the analysis: district enrollment, student population density within a district (students per square mile), and drive time from the…

Evidence from district level inputs to improve quality of care for maternal and newborn health: interventions and findings.

PubMed

Salam, Rehana A; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar A

2014-09-04

District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews. Evidence suggests that supervision positively influenced provider's practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes. There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries.

Association of child health and household amenities in high focus states in India: a district-level analysis

PubMed Central

Gouda, Jitendra; Gupta, Ashish Kumar; Yadav, Ajit Kumar

2015-01-01

Objectives To assess household amenities in districts of high focus states and their association with child health in India. Design The data for the study are extracted from Annual Health Survey (AHS) and Census 2011. Settings Districts in high focus states in India. Participants Information regarding children below 5 years of age and women aged 15–49 has been extracted from the AHS (2010–2011), and household amenities information has been obtained from the Census (2011). Measures Household amenities were assessed from the census at the district level in the high focus states. Child health indicators and wealth index were borrowed from AHS and used in this study to check their linkage with household amenities. Results Absence of drinking water from a treated source, improved sanitation, usage of clean cooking fuel and drainage facility in the household were adversely associated with the incidence of acute respiratory infection, diarrhoea, infant mortality rate (IMR) and under 5 mortality rate (U5MR). The mean IMR declined from 64 to 54 for districts where a high proportion of household have improved sanitation. The result of ordinary least square regression shows that improved sanitation has a negative and statistically significant association (β=−0.0067, p<0.01) with U5MR. Conclusions Although child healthcare services are important in addressing child health issues, they barely touch on the root of the problem. Building toilets and providing safe drinking water, clean cooking fuel and drainage facilities at the household level, may prevent a number of adverse child health issues and may reduce the burden on the healthcare system in India. PMID:25968003

The health management information system of Pakistan under devolution: health managers' perceptions.

PubMed

Qazi, Muhammad Suleman; Ali, Moazzam; Kuroiwa, Chushi

2008-04-01

Devolution implies that use of data for decision making starts at the level of data generation. However under a newly decentralized system, managers may face different hurdles in utilizing the preexisting Health Management Information System (HMIS). This qualitative research explores the perceptions of health managers regarding HMIS under the devolution reforms enacted in 2001 in Pakistan. The study was carried out by interviewing 26 managers at various levels in seven selected districts in all provinces. There was general dissatisfaction and confusion over roles and responsibility: respondents reported that the overall atmosphere was characterized by the reluctance of provincial managers to release data under their authority, the absence of prerequisite human resources, and conflicts of interests between political and administrative leadership. The devolution didn't bring immediate good effects for the HMIS. Treated as a least priority area, staff was distributed from provincial HMIS cells, causing overburdening of remaining staff and jeopardizing data analysis. Reporting regularity from the districts was also compromised secondary to political interference and loss of provincial control. The present HMIS is in need of redesigning so that it may keep pace with the devolved system. The HMIS reforms are needed to improve information systems at the district level, capacity building of district managers, political commitment, and administrative ownership of the system and to earmark and make available resource and promote evidence-based decision making. Change in the public administration culture towards encouraging initiative taking at lower levels, introduction of performance incentives, inculcating work ethics, encouraging local accountability, and good governance are all essential.

A needs index for mental health care.

PubMed

Glover, G R; Robin, E; Emami, J; Arabscheibani, G R

1998-02-01

The study aimed to develop a mental illness needs index to help local managers, district purchasers and national policy makers in allocating resources. Formulae were developed by regression analysis using 1991 census data to predict the period prevalence of acute psychiatric admission from electoral wards. Census variables used were chosen on the basis of an established association with mental illness rates. Data from one English Health Service region were analysed for patterns common to wards at hospital catchment area level and patterns common to district health authorities at regional level. The North East Thames region was chosen as the setting for the study, with 7096 patients being admitted during 1991. In most, but not all, catchment areas reasonable prediction of the pattern of admission prevalence was possible using the variables chosen. However, different population characteristics predicted admission prevalence in rural and urban areas. Prediction methods based on one or two variables are thus unlikely to work in both settings. A Mental Illness Needs Index (MINI) based on social isolation, poverty, unemployment, permanent sickness and temporary and insecure housing predicted differences in admission prevalence between wards at catchment area level better than Jarman's Underprivileged Area (UPA) score [1] and between districts at regional level better than the UPA score and comparably to the York Psychiatric Index [2] (adjusted r2 at regional level (MINI 0.82, UPA 0.53, York index 0.70). District admission prevalence rates vary by a factor of three between rural and inner city areas; this difference may not fully reflect the variation in the cost of providing care. It did not prove possible to incorporate factors related to bed availability in the models used; reasons for this are discussed. Data covering other aspects of mental health care in addition to hospital admission are needed for more satisfactory modelling.

Land quality, sustainable development and environmental degradation in agricultural districts: A computational approach based on entropy indexes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zambon, Ilaria, E-mail: ilaria.zambon@unitus.it; Colantoni, Andrea; Carlucci, Margherita

Land Degradation (LD) in socio-environmental systems negatively impacts sustainable development paths. This study proposes a framework to LD evaluation based on indicators of diversification in the spatial distribution of sensitive land. We hypothesize that conditions for spatial heterogeneity in a composite index of land sensitivity are more frequently associated to areas prone to LD than spatial homogeneity. Spatial heterogeneity is supposed to be associated with degraded areas that act as hotspots for future degradation processes. A diachronic analysis (1960–2010) was performed at the Italian agricultural district scale to identify environmental factors associated with spatial heterogeneity in the degree of landmore » sensitivity to degradation based on the Environmentally Sensitive Area Index (ESAI). In 1960, diversification in the level of land sensitivity measured using two common indexes of entropy (Shannon's diversity and Pielou's evenness) increased significantly with the ESAI, indicating a high level of land sensitivity to degradation. In 2010, surface area classified as “critical” to LD was the highest in districts with diversification in the spatial distribution of ESAI values, confirming the hypothesis formulated above. Entropy indexes, based on observed alignment with the concept of LD, constitute a valuable base to inform mitigation strategies against desertification. - Highlights: • Spatial heterogeneity is supposed to be associated with degraded areas. • Entropy indexes can inform mitigation strategies against desertification. • Assessing spatial diversification in the degree of land sensitivity to degradation. • Mediterranean rural areas have an evident diversity in agricultural systems. • A diachronic analysis carried out at the Italian agricultural district scale.« less

A simple simulation model as a tool to assess alternative health care provider payment reform options in Vietnam.

PubMed

Cashin, Cheryl; Phuong, Nguyen Khanh; Shain, Ryan; Oanh, Tran Thi Mai; Thuy, Nguyen Thi

2015-01-01

Vietnam is currently considering a revision of its 2008 Health Insurance Law, including the regulation of provider payment methods. This study uses a simple spreadsheet-based, micro-simulation model to analyse the potential impacts of different provider payment reform scenarios on resource allocation across health care providers in three provinces in Vietnam, as well as on the total expenditure of the provincial branches of the public health insurance agency (Provincial Social Security [PSS]). The results show that currently more than 50% of PSS spending is concentrated at the provincial level with less than half at the district level. There is also a high degree of financial risk on district hospitals with the current fund-holding arrangement. Results of the simulation model show that several alternative scenarios for provider payment reform could improve the current payment system by reducing the high financial risk currently borne by district hospitals without dramatically shifting the current level and distribution of PSS expenditure. The results of the simulation analysis provided an empirical basis for health policy-makers in Vietnam to assess different provider payment reform options and make decisions about new models to support health system objectives.

[Analysis of the Association between Regional Deprivation and Utilization: An Assessment of Need for Physicians in Germany].

PubMed

Kopetsch, T; Maier, W

2018-01-01

A new strategy for planning outpatient medical care needs to be developed. The social and morbidity structure of the population should be considered in the planning of needs-based provision of medical care. This paper aims to examine the extent to which the degree of regional deprivation can be incorporated in the calculation of the regional requirements for specialists in Germany. To measure regional deprivation status at district level, we used the "German Index of Multiple Deprivation" (GIMD) developed in the Helmholtz Zentrum München - German Research Center for Environmental Health. Scores were calculated for the deprivation status of each rural and urban district in Germany. The methods used to compute the deprivation-adjusted medical need are linear regression analyses. The analyses were based on regionalized data for the number of office-based physicians and their billing data. The analyses were carried out with the SPSS software package, version 20. The analyses showed a clear positive correlation between regional deprivation and the utilisation of medical services both for outpatients and in-patients, on the one hand, and mortality and morbidity, as measured by the risk adjustment factor (RSA), on the other. At the district level, the analyses also revealed varying associations between the degree of deprivation and the utilisation of the 12 groups of specialists included in the needs assessment. On this basis, an algorithm was developed by which deprivation at district level can be used to calculate an increase or a decrease in the relative number of specialists needed. Using the GIMD and various determinants of medical utilisation, the model showed that medical need increased with the level of regional deprivation. However, regarding SHI medical specialist groups, the associations found in this analysis were statistically (R 2 ) insufficient to suggest a needs assessment planning system based only on the factors analysed, thereby restricting physicians' constitutional right of professional freedom. In particular cases, i. e. licenses to meet special needs, the developed instruments may be suitable for indicating a greater or lesser need for doctors at a regional level due to their relative ease of use and practicability. © Georg Thieme Verlag KG Stuttgart · New York.

The Cost of War on Public Health: An Exploratory Method for Understanding the Impact of Conflict on Public Health in Sri Lanka.

PubMed

Johnson, Sandy A

2017-01-01

The direct impact of protracted conflict on population health and development is well understood. However, the extent of a war's impact on long-term health, and the opportunity costs, are less well understood. This research sought to overcome this gap by asking whether or not health outcomes in Sri Lanka would have been better in the absence of a 26-year war than they were in the presence of war. A counterfactual model of national and district-level health outcomes was created for Sri Lanka for the period 1982 to 2002. At the national level, the model examined life expectancy, infant mortality rate (IMR), and maternal mortality ratios (MMR). At the district level, it looked at IMR and MMR. The model compared outcomes generated by the counterfactual model to actual obtained health outcomes. It looked at the rate of change and absolute values. The analysis demonstrated that war altered both rate of change and absolute health outcomes for the worse. The impact was most clearly evident at the district level. IMR was poorer than predicted in 10 districts; of these 8 were outside of the conflict zone. The MMR was worse than expected in 11 districts of which 9 were not in the conflict zone. Additionally, the rate of improvement in IMR slowed as a result of war in 16 districts whereas the rate of improvement in MMR slowed in 9. This project showed that protracted conflict degraded the trajectory of public health in Sri Lanka and hurt population health outside of the conflict zone. It further provided a novel methodology with which to better understand the indirect impact of conflict on population health by comparing what is to what could have been achieved in the absence of war. In so doing, this research responded to two public health challenges by providing a tool through which to better understand the human and opportunity costs of war and by answering a call for new methodologies.

The Cost of War on Public Health: An Exploratory Method for Understanding the Impact of Conflict on Public Health in Sri Lanka

PubMed Central

2017-01-01

Purpose The direct impact of protracted conflict on population health and development is well understood. However, the extent of a war's impact on long-term health, and the opportunity costs, are less well understood. This research sought to overcome this gap by asking whether or not health outcomes in Sri Lanka would have been better in the absence of a 26-year war than they were in the presence of war. Methods A counterfactual model of national and district-level health outcomes was created for Sri Lanka for the period 1982 to 2002. At the national level, the model examined life expectancy, infant mortality rate (IMR), and maternal mortality ratios (MMR). At the district level, it looked at IMR and MMR. The model compared outcomes generated by the counterfactual model to actual obtained health outcomes. It looked at the rate of change and absolute values. Results The analysis demonstrated that war altered both rate of change and absolute health outcomes for the worse. The impact was most clearly evident at the district level. IMR was poorer than predicted in 10 districts; of these 8 were outside of the conflict zone. The MMR was worse than expected in 11 districts of which 9 were not in the conflict zone. Additionally, the rate of improvement in IMR slowed as a result of war in 16 districts whereas the rate of improvement in MMR slowed in 9. Conclusion This project showed that protracted conflict degraded the trajectory of public health in Sri Lanka and hurt population health outside of the conflict zone. It further provided a novel methodology with which to better understand the indirect impact of conflict on population health by comparing what is to what could have been achieved in the absence of war. In so doing, this research responded to two public health challenges by providing a tool through which to better understand the human and opportunity costs of war and by answering a call for new methodologies. PMID:28081118

An ecological study of food desert prevalence and 4th grade academic achievement in new york state school districts.

PubMed

Frndak, Seth E

2014-12-02

This ecological study examines the relationship between food desert prevalence and academic achievement at the school district level. Sample included 232 suburban and urban school districts in New York State. Multiple open-source databases were merged to obtain: 4(th) grade science, English and math scores, school district demographic composition (NYS Report Card), regional socioeconomic indicators (American Community Survey), school district quality (US Common Core of Data), and food desert data (USDA Food Desert Atlas). Multiple regression models assessed the percentage of variation in achievement scores explained by food desert variables, after controlling for additional predictors. The proportion of individuals living in food deserts significantly explained 4th grade achievement scores, after accounting for additional predictors. School districts with higher proportions of individuals living in food desert regions demonstrated lower 4th grade achievement across science, English and math. Food deserts appear to be related to academic achievement at the school district level among urban and suburban regions. Further research is needed to better understand how food access is associated with academic achievement at the individual level. Significance for public healthThe prevalence of food deserts in the United States is of national concern. As poor nutrition in United States children continues to spark debate, food deserts are being evaluated as potential sources of low fruit and vegetable intake and high obesity rates. Cognitive development and IQ have been linked to nutrition patterns, suggesting that children in food desert regions may have a disadvantage academically. This research evaluates if an ecological relationship between food desert prevalence and academic achievement at the school district level can be demonstrated. Results suggest that food desert prevalence may relate to poor academic performance at the school district level. Significant variation in academic achievement among urban and suburban school districts is explained by food desert prevalence, above additional predictors. This research lays the groundwork for future studies at the individual level, with possible implications for community interventions in school districts containing food desert regions.

Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation

PubMed Central

Langston, Anne; Weiss, Jennifer; Landegger, Justine; Pullum, Thomas; Morrow, Melanie; Kabadege, Melene; Mugeni, Catherine; Sarriot, Eric

2014-01-01

ABSTRACT Background: The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. Methods: The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes. Results: While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital. Conclusions: The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates. PMID:25276593

Teacher Hiring Practices and Educational Efficiency

ERIC Educational Resources Information Center

Naper, Linn Renee

2010-01-01

This paper analyses the relationship between teacher hiring practices and educational efficiency in Norwegian school districts. The hiring decision is made at the school level by the principal or at the school district level. According to the data, efficiency is the highest in districts where hiring is decentralized. Hiring practices are decided…

Assessing the Primary Schools--A Multi-Dimensional Approach: A School Level Analysis Based on Indian Data

ERIC Educational Resources Information Center

Sengupta, Atanu; Pal, Naibedya Prasun

2012-01-01

Primary education is essential for the economic development in any country. Most studies give more emphasis to the final output (such as literacy, enrolment etc.) rather than the delivery of the entire primary education system. In this paper, we study the school level data from an Indian district, collected under the official DISE statistics. We…

Creating a System for Data-Driven Decision-Making: Applying the Principal-Agent Framework

ERIC Educational Resources Information Center

Wohlstetter, Priscilla; Datnow, Amanda; Park, Vicki

2008-01-01

The purpose of this article is to improve our understanding of data-driven decision-making strategies that are initiated at the district or system level. We apply principal-agent theory to the analysis of qualitative data gathered in a case study of 4 urban school systems. Our findings suggest educators at the school level need not only systemic…

Exploring the socio-ecological levels for prevention of sexual risk behaviours of the youth in uMgungundlovu District Municipality, KwaZulu-Natal

PubMed Central

2018-01-01

Background Prevention of youth sexual risk behaviour among the youth in uMgungundlovu District Municipality continues to be a primary challenge for public health and health promotion. Current prevention interventions are targeted at an individual level, whilst youth behaviour is influenced by many social and environmental factors. Aim The aim of the study was to explore the factors influencing sexual risk behaviours of the youth at different socio-ecological levels in uMgungundlovu District Municipality. Methods An explorative and descriptive qualitative study design was used, using in-depth interviews and focus group discussions for data collection. A framework analysis was used to develop themes derived from the socio-ecological theory. Results Four themes were identified that influence youth to engage in sexual risk behaviours: (1) individual factors, related to role modelling behaviour, gender and negative stereotypes towards females; (2) the microsystem in which youth function including the influence of family and peers; (3) the exo-system comprising the disadvantaged socio-economic status of the communities where the youth live; and (4) the macrosystem where negative social norms were reported to influence youth health outcomes. Conclusion Sexual risk behaviour among youth in uMgungundlovu is influenced by many factors at multiple social levels. Interventions directed at these multiple levels are needed urgently. PMID:29781679

Use of a Balanced Scorecard in strengthening health systems in developing countries: an analysis based on nationally representative Bangladesh Health Facility Survey.

PubMed

Khan, M Mahmud; Hotchkiss, David R; Dmytraczenko, Tania; Zunaid Ahsan, Karar

2013-01-01

This paper illustrates the importance of collecting facility-based data through regular surveys to supplement the administrative data, especially for developing countries of the world. In Bangladesh, measures based on facility survey indicate that only 70% of very basic medical instruments and 35% of essential drugs were available in health facilities. Less than 2% of officially designated obstetric care facilities actually had required drugs, injections and personnel on-site. Majority of (80%) referral hospitals at the district level were not ready to provide comprehensive emergency obstetric care. Even though the Management Information System reports availability of diagnostic machines in all district-level and sub-district-level facilities, it fails to indicate that 50% of these machines are not functional. In terms of human resources, both physicians and nurses are in short supply at all levels of the healthcare system. The physician-nurse ratio also remains lower than the desirable level of 3.0. Overall job satisfaction index was less than 50 for physicians and 66 for nurses. Patient satisfaction score, however, was high (86) despite the fact that process indicators of service quality were poor. Facility surveys can help strengthen not only the management decision-making process but also the quality of administrative data. Copyright © 2012 John Wiley & Sons, Ltd.

A geographic analysis of population density thresholds in the influenza pandemic of 1918-19.

PubMed

Chandra, Siddharth; Kassens-Noor, Eva; Kuljanin, Goran; Vertalka, Joshua

2013-02-20

Geographic variables play an important role in the study of epidemics. The role of one such variable, population density, in the spread of influenza is controversial. Prior studies have tested for such a role using arbitrary thresholds for population density above or below which places are hypothesized to have higher or lower mortality. The results of such studies are mixed. The objective of this study is to estimate, rather than assume, a threshold level of population density that separates low-density regions from high-density regions on the basis of population loss during an influenza pandemic. We study the case of the influenza pandemic of 1918-19 in India, where over 15 million people died in the short span of less than one year. Using data from six censuses for 199 districts of India (n=1194), the country with the largest number of deaths from the influenza of 1918-19, we use a sample-splitting method embedded within a population growth model that explicitly quantifies population loss from the pandemic to estimate a threshold level of population density that separates low-density districts from high-density districts. The results demonstrate a threshold level of population density of 175 people per square mile. A concurrent finding is that districts on the low side of the threshold experienced rates of population loss (3.72%) that were lower than districts on the high side of the threshold (4.69%). This paper introduces a useful analytic tool to the health geographic literature. It illustrates an application of the tool to demonstrate that it can be useful for pandemic awareness and preparedness efforts. Specifically, it estimates a level of population density above which policies to socially distance, redistribute or quarantine populations are likely to be more effective than they are for areas with population densities that lie below the threshold.

Multi-scalar interactions between infrastructure, smallholder water management, and coastal dynamics in the Bengal Delta, Bangladesh

NASA Astrophysics Data System (ADS)

Rogers, K. G.; Brondizio, E.; Roy, K.; Syvitski, J. P.

2016-12-01

Because of their low-lying elevations and large number of inhabitants and infrastructure, river deltas are ground zero for climate change impacts, particularly from sea-level rise and storm surges. The increased vulnerability of downstream delta communities to coastal flooding as a result of upstream engineering has been acknowledged for decades. What has received less attention is the sensitivity of deltas to the interactions of these processes and increasing intensity of cultivation and irrigation in their coastal regions. Beyond basin-scale damming, regional infrastructure affects the movement of sediment and water on deltas, and combined with upstream modifications may exacerbate the risk of expanded tidal flooding, erosion of arable land, and salinization of soils and groundwater associated with sea level rise. To examine the social-biophysical feedbacks associated with regional-scale infrastructure, smallholder water management practices and coastal dynamics, a nested framework was applied to two districts of the coastal southwest region of Bangladesh. The two districts vary in tidal range, salinity, freshwater availability and socioeconomic structures, and are spatially varied in farmer's adaptations. Both districts contain numerous large embankment systems initially designed to protect cropland from tidal flooding, but that have been poorly maintained since their construction in the 1960's. The framework was co-produced using local-level stakeholder input collected during group interviews with rural farmers in 8 villages within the two districts, and explicitly accounts for engineered and natural biophysical variables as well as governance and institutional structures at 3 levels of analysis. Household survey results indicate that the presence or absence of embankments as a result of poor management and dynamic coastal processes is the primary control on freshwater availability and thus influences farming strategies, socioeconomic conditions and social positions in both districts. Local-scale interactions with the embankments are spatially heterogeneous, but geospatial analyses show the potential for these to collectively impact physical and social stability across a region already vulnerable to coastal flooding.

A geographic analysis of population density thresholds in the influenza pandemic of 1918–19

PubMed Central

2013-01-01

Background Geographic variables play an important role in the study of epidemics. The role of one such variable, population density, in the spread of influenza is controversial. Prior studies have tested for such a role using arbitrary thresholds for population density above or below which places are hypothesized to have higher or lower mortality. The results of such studies are mixed. The objective of this study is to estimate, rather than assume, a threshold level of population density that separates low-density regions from high-density regions on the basis of population loss during an influenza pandemic. We study the case of the influenza pandemic of 1918–19 in India, where over 15 million people died in the short span of less than one year. Methods Using data from six censuses for 199 districts of India (n=1194), the country with the largest number of deaths from the influenza of 1918–19, we use a sample-splitting method embedded within a population growth model that explicitly quantifies population loss from the pandemic to estimate a threshold level of population density that separates low-density districts from high-density districts. Results The results demonstrate a threshold level of population density of 175 people per square mile. A concurrent finding is that districts on the low side of the threshold experienced rates of population loss (3.72%) that were lower than districts on the high side of the threshold (4.69%). Conclusions This paper introduces a useful analytic tool to the health geographic literature. It illustrates an application of the tool to demonstrate that it can be useful for pandemic awareness and preparedness efforts. Specifically, it estimates a level of population density above which policies to socially distance, redistribute or quarantine populations are likely to be more effective than they are for areas with population densities that lie below the threshold. PMID:23425498

Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework.

PubMed

Maluka, Stephen; Kamuzora, Peter; San Sebastiån, Miguel; Byskov, Jens; Olsen, Øystein E; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin

2010-08-01

Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process. (c) 2010 Elsevier Ltd. All rights reserved.

Fertility transition and adverse child sex ratio in districts of India.

PubMed

Mohanty, Sanjay K; Rajbhar, Mamta

2014-11-01

Demographic research in India over the last two decades has focused extensively on fertility change and gender bias at the micro-level, and less has been done at the district level. Using data from the Census of India 1991-2011 and other sources, this paper shows the broad pattern of fertility transition and trends in the child sex ratio in India, and examines the determinants of the child sex ratio at the district level. During 1991-2011, while the Total Fertility Rate (TFR) declined by 1.2 children per woman, the child sex ratio fell by 30 points in the districts of India. However, the reduction in fertility was slower in the high-fertility compared with the low-fertility districts. The gender differential in under-five mortality increased in many districts of India over the study period. The decline in the child sex ratio was higher in the transitional compared with the low-fertility districts. The transitional districts are at higher risk of a low child sex ratio due to an increased gender differential in mortality and increase in the practice of sex-selective abortions. The sex ratio at birth and gender differential in mortality explains one-third of the variation, while region alone explains a quarter of the variation in the child sex ratio in the districts of India.

A Comparative Analysis of the Perceptions of Special Education Teachers regarding Educative Activities to Further Develop Teaching Skills

ERIC Educational Resources Information Center

Arocha-Gill, Theresa

2010-01-01

A comparative analysis of the perceptions of special education teachers in the San Antonio Independent School District (SAISD) regarding the importance, comfort, and frequency levels of educative activities to further develop their teaching skills was conducted by the researcher in order to apply findings to the development of future professional…

An Analysis of the Social Impact of the Stipend Program for Secondary School Girls of Khyber Pakhtunkhwa

ERIC Educational Resources Information Center

Ahmed, Vaqar; Zeshan, Muhammad

2014-01-01

The present study carries out an impact analysis of a conditional cash transfer (CCT) program for secondary-school girls in seven districts of Khyber Pakhtunkhwa province in Pakistan, including Battagram, Bonair, Hangu, Kohistan, Shangla, Tank, and Upper Dir. In 2012 we collected household-level primary data and used a probit model for…

School District Crisis Preparedness, Response, and Recovery Plans - United States, 2012.

PubMed

Silverman, Brenda; Chen, Brenda; Brener, Nancy; Kruger, Judy; Krishna, Nevin; Renard, Paul; Romero-Steiner, Sandra; Avchen, Rachel Nonkin

2016-09-16

The unique characteristics of children dictate the need for school-based all-hazards response plans during natural disasters, emerging infectious diseases, and terrorism (1-3). Schools are a critical community institution serving a vulnerable population that must be accounted for in public health preparedness plans; prepared schools are adopting policies and plans for crisis preparedness, response, and recovery (2-4). The importance of having such plans in place is underscored by the development of a new Healthy People 2020 objective (PREP-5) to "increase the percentage of school districts that require schools to include specific topics in their crisis preparedness, response, and recovery plans" (5). Because decisions about such plans are usually made at the school district level, it is important to examine district-level policies and practices. Although previous reports have provided national estimates of the percentage of districts with policies and practices in place (6), these estimates have not been analyzed by U.S. Census region* and urbanicity.(†) Using data from the 2012 School Health Policies and Practices Study (SHPPS), this report examines policies and practices related to school district preparedness, response, and recovery. In general, districts in the Midwest were less likely to require schools to include specific topics in their crisis preparedness plans than districts in the Northeast and South. Urban districts tended to be more likely than nonurban districts to require specific topics in school preparedness plans. Southern districts tended to be more likely than districts in other regions to engage with partners when developing plans. No differences in district collaboration (with the exception of local fire department engagement) were observed by level of urbanicity. School-based preparedness planning needs to be coordinated with interdisciplinary community partners to achieve Healthy People 2020 PREP-5 objectives for this vulnerable population.

Gaps and gains from engaging districts stakeholders for community-based health professions education in Uganda: a qualitative study.

PubMed

Okello, Elialilia S; Nankumbi, Joyce; Ruzaaza, Gad Ndaruhutse; Bakengesa, Evelyn; Gumikiriza, Joy; Arubaku, Wilfred; Acio, Christine; Samantha, Mary; Matte, Michael

2015-12-01

Community-based education research and service (COBERS) is a brand of community-based education that has been adopted by the Medical Education and Service for All Ugandans consortium. The COBERS programme is aimed at equipping students in health professional education with the knowledge, attitudes and skills required to provide appropriate health care services. For sustainability purposes, the health professional training institutions have made efforts to involve various stakeholders in the implementation of the programme. However, the actual engagement process and outcome of such efforts have not been documented. This paper documents gaps and gains made in engaging district stakeholders for community-based education. Key informant interviews, focus group discussions and document review were used to collect data. Atlas.ti, computer software for qualitative data was used to aid analysis. The analysis revealed that the adopted engagement model has registered some gains including increased awareness among district leaders about potential opportunities offered by COBERS such as boosting of human resources at health facilities, opportunities for professional development for health care workers at health facilities, and establishment of linkages between prospective employees and employers. However, the engagement model left some gaps in terms of knowledge, awareness and ownership of the programme among some sections of stakeholders. The apparent information gap about the programme among district stakeholders, especially the political leadership, may hinder concerted partnership. The findings highlight the need for health professional education institutions to broaden the scope of actively engaged stakeholders with the district level.

[The medical organizational aspects of decreasing of preventable mortality in the case of traffic accident in municipal district].

PubMed

Voloshina, L V; Plutnitskiĭ, A N

2010-01-01

The article deals with the results of the study of such actual issue as decreasing of preventable mortality in the case of traffic accident in municipal district. The analysis was based on the mortality statistical data and the expertise of causes of lethal outcomes of traffic accidents. The results are used to develop the measures of improving the organization and quality of medical care of victims of road accident on the pre-hospital and hospital stages on the level of municipal health care to decrease the human losses caused by traffic accident.

Public opinion about smoking and smoke free legislation in a district of North India.

PubMed

Goel, S; Singh, R J; D, Sharma; A, Singh

2014-01-01

Context: A growing number of cities, districts, counties and states across the globe are going smoke-free. While an Indian national law namely Cigarettes and Other Tobacco Products Act (COTPA) exists since 2003 and aims at protecting all the people in our country; people still smoke in public places. Aim: This study assessed knowledge and perceptions about smoking, SHS and their support for Smoke-free laws among people residing in Mohali district, Punjab. Materials and Methods: This cross-sectional study was conducted in Mohali district of Punjab, India. A sample size of 1600 people was obtained. Probability Proportional to Size technique was used for selecting the number of individuals to be interviewed from each block and also from urban and rural population. Statistical Analysis Used: We estimated proportions and tested for significant differences by residence, smoking status, literacy level and employment level by means of the chi-square statistics. Statistical software SPSS for Windows version 20 was used for analysing data . Results: The overall prevalence of current smoking among study participants was 25%. Around 96% were aware of the fact that smoking is harmful to health, 45% viewed second-hand smoke to be equally harmful as active smoking, 84.2% knew that smoking is prohibited in public places and 88.3% wanted the government to take strict actions to control the menace of public smoking. Multivariate logistic regression analysis showed that people aged 20 years and above, unemployed, urban, literate and non-smokers had significantly better perception towards harms of smoking. The knowledge about smoke free provisions of COTPA was significantly better among males, employed individuals, urban residents, and literate people. Conclusions: There was high knowledge about deleterious multi-dimensional effects of smoking among residents and a high support for implementation of COTPA. Efforts should be taken to make Mohali a "smoke-free district".

Teachers Must Push Technology's Tidal Wave: District Technology Initiatives Must Put the Teacher in Charge.

ERIC Educational Resources Information Center

Guhlin, Miguel

2002-01-01

For technology to impact student achievement, teachers must be empowered via extensive staff development. This paper presents building-level technology initiatives (e.g., peer training, super substitutes, and computer clubs) and district- level initiatives (e.g., establish a district technology committee, allow teachers to take computers home over…

Concept of Supervision and Supervisory Practices at Primary Level in Pakistan

ERIC Educational Resources Information Center

Behlol, Malik Ghulam; Yousuf, Muhammad Imran; Parveen, Qaisara; Kayani, Muhammad Munir

2011-01-01

The study was conducted to find out the practices and problems of supervisors working at primary school level in Pakistan. The teachers, Headmasters, Area Education Officers, District Education Officers, Deputy District Education officers working in primary schools of Rawalpindi District were the population of the study. The questionnaire was…

Controlling Special Education Costs at the School District Level.

ERIC Educational Resources Information Center

Morgan, W. Daniel

1992-01-01

Describes the financing of a New York school district for emotionally disturbed children. Summarizes suggestions for controlling special education costs at the district level obtained from a nationwide sample of school business officials. Among the suggestions offered are to include a review of private placements and an annual caseload review,…

The Lilead Survey: A National Study of District-Level Library Supervisors: The Position, Office, and Characteristics of the Supervisor

ERIC Educational Resources Information Center

Weeks, Ann Carlson; DiScala, Jeffrey; Barlow, Diane L.; Massey, Sheri A.; Kodama, Christie; Jarrell, Kelsey; Jacobs, Leah; Moses, Alexandra; Follman, Rebecca; Hall, Rosemary

2016-01-01

The school district library supervisor occupies a pivotal position in library and information services programs that support and enhance the instructional efforts of a school district: providing leadership; advocating for the programs; supporting, advising, and providing professional development to building-level librarians; and representing…

Drought disaster vulnerability mapping of agricultural sector in Bringin District, Semarang Regency

NASA Astrophysics Data System (ADS)

Lestari, D. R.; Pigawati, B.

2018-02-01

Agriculture sector is a sector that is directly affected by drought. The phenomenon of drought disaster on agriculture sector has occurred in Semarang regency. One of districts in Semarang which is affected by drought is Bringin district. Bringin district is a productive agricultural area. However, the district experienced the most severe drought in 2015. The question research of this study is, “How is the spatial distribution of drought vulnerability on agriculture sector in Bringin district, Semarang regency?” The purpose of this study is to determine the spatial distribution of drought vulnerability on agriculture sector to village units in Bringin district. This study investigated drought vulnerability based on Intergovernmental Panel on Climate Change (IPCC) by analyzing exposure, sensitivity, and adaptive capacity through mapping process. This study used quantitative approach. There were formulation analysis, scoring analysis, and overlay analysis. Drought vulnerability on agriculture sector in Bringin district was divided into three categories: low, medium, and high.

Mundane? Demographic characteristics as predictors of enrolment onto the National Health Insurance Scheme in two districts of Ghana.

PubMed

Seddoh, Anthony; Sataru, Fuseini

2018-05-04

In 2003, Ghana passed a law to establish a National Health Insurance Scheme (NHIS) to serve as the main vehicle for achieving universal health coverage. Over 60% of the population had registered by 2009. Current active membership is however 40%. The stagnation in growth has been recorded across all the membership categories. Clearly, the Scheme is falling short of its core objective. This analysis is a critical thematic contextual examination of the effects of demographic factors on enrolment onto the Scheme. Demographic secondary data for 625 respondents collected (using a structured questionnaire) during a cross-sectional household survey in an urban, Ashaiman, and rural, Adaklu, districts was analyzed in univariate and multivariate logistic regression models using Statistical Package for Social Scientists (SPSS). Statistical significance was set at P-value < 0.05. Variables included in the analysis were age, gender, education, occupation and knowledge about the NHIS. Seventy-nine percent of the survey respondents have ever enrolled onto the NHIS with three-fifths being females. Of the ever enrolled, 63% had valid cards. Age, gender and educational level were significant predictors of enrolment in the multivariate analysis. Respondents between the ages 41-60 years were twice (p = 0.05) more likely to be enrolled onto a district Scheme compared with respondents between the ages 21-40 years. Females were thrice (p = 0.00) more likely to enroll compared with males. Respondents educated to the tertiary, five times (p = 0.02), and post-graduate, four times (p = 0.05), levels were more likely to enroll compared with non-educated respondents. No significant association was observed between occupation and enrolment. Uptake of the scheme is declining despite high awareness and knowledge. Leadership, innovation and collaboration are required at the district Scheme level to curtail issues of low self-enrolment and to grow membership. Otherwise, the goal of universal coverage under the NHIS will become merely a slogan and equity in financial access to health care for all Ghanaians will remain elusive.

Identifying cholera "hotspots" in Uganda: An analysis of cholera surveillance data from 2011 to 2016

PubMed Central

Bwire, Godfrey; Sack, David A.; Nakinsige, Anne; Naigaga, Martha; Debes, Amanda K.; Ngwa, Moise C.; Brooks, W. Abdullah; Garimoi Orach, Christopher

2017-01-01

Background Despite advance in science and technology for prevention, detection and treatment of cholera, this infectious disease remains a major public health problem in many countries in sub-Saharan Africa, Uganda inclusive. The aim of this study was to identify cholera hotspots in Uganda to guide the development of a roadmap for prevention, control and elimination of cholera in the country. Methodology/Principle findings We obtained district level confirmed cholera outbreak data from 2011 to 2016 from the Ministry of Health, Uganda. Population and rainfall data were obtained from the Uganda Bureau of Statistics, and water, sanitation and hygiene data from the Ministry of Water and Environment. A spatial scan test was performed to identify the significantly high risk clusters. Cholera hotspots were defined as districts whose center fell within a significantly high risk cluster or where a significantly high risk cluster was completely superimposed onto a district. A zero-inflated negative binomial regression model was employed to identify the district level risk factors for cholera. In total 11,030 cases of cholera were reported during the 6-year period. 37(33%) of 112 districts reported cholera outbreaks in one of the six years, and 20 (18%) districts experienced cholera at least twice in those years. We identified 22 districts as high risk for cholera, of which 13 were near a border of Democratic Republic of Congo (DRC), while 9 districts were near a border of Kenya. The relative risk of having cholera inside the high-risk districts (hotspots) were 2 to 22 times higher than elsewhere in the country. In total, 7 million people were within cholera hotspots. The negative binomial component of the ZINB model shows people living near a lake or the Nile river were at increased risk for cholera (incidence rate ratio, IRR = 0.98, 95% CI: 0.97 to 0.99, p < .01); people living near the border of DRC/Kenya or higher incidence rate in the neighboring districts were increased risk for cholera in a district (IRR = 0.99, 95% CI: 0.98 to 1.00, p = .02 and IRR = 1.02, 95% CI: 1.01 to 1.03, p < .01, respectively). The zero inflated component of the ZINB model yielded shorter distance to Kenya or DRC border, higher incidence rate in the neighboring districts, and higher annual rainfall in the district were associated with the risk of having cholera in the district. Conclusions/significance The study identified cholera hotspots during the period 2011–2016. The people located near the international borders, internationally shared lakes and river Nile were at higher risk for cholera outbreaks than elsewhere in the country. Targeting cholera interventions to these locations could prevent and ultimately eliminate cholera in Uganda. PMID:29284003

Identifying cholera "hotspots" in Uganda: An analysis of cholera surveillance data from 2011 to 2016.

PubMed

Bwire, Godfrey; Ali, Mohammad; Sack, David A; Nakinsige, Anne; Naigaga, Martha; Debes, Amanda K; Ngwa, Moise C; Brooks, W Abdullah; Garimoi Orach, Christopher

2017-12-01

Despite advance in science and technology for prevention, detection and treatment of cholera, this infectious disease remains a major public health problem in many countries in sub-Saharan Africa, Uganda inclusive. The aim of this study was to identify cholera hotspots in Uganda to guide the development of a roadmap for prevention, control and elimination of cholera in the country. We obtained district level confirmed cholera outbreak data from 2011 to 2016 from the Ministry of Health, Uganda. Population and rainfall data were obtained from the Uganda Bureau of Statistics, and water, sanitation and hygiene data from the Ministry of Water and Environment. A spatial scan test was performed to identify the significantly high risk clusters. Cholera hotspots were defined as districts whose center fell within a significantly high risk cluster or where a significantly high risk cluster was completely superimposed onto a district. A zero-inflated negative binomial regression model was employed to identify the district level risk factors for cholera. In total 11,030 cases of cholera were reported during the 6-year period. 37(33%) of 112 districts reported cholera outbreaks in one of the six years, and 20 (18%) districts experienced cholera at least twice in those years. We identified 22 districts as high risk for cholera, of which 13 were near a border of Democratic Republic of Congo (DRC), while 9 districts were near a border of Kenya. The relative risk of having cholera inside the high-risk districts (hotspots) were 2 to 22 times higher than elsewhere in the country. In total, 7 million people were within cholera hotspots. The negative binomial component of the ZINB model shows people living near a lake or the Nile river were at increased risk for cholera (incidence rate ratio, IRR = 0.98, 95% CI: 0.97 to 0.99, p < .01); people living near the border of DRC/Kenya or higher incidence rate in the neighboring districts were increased risk for cholera in a district (IRR = 0.99, 95% CI: 0.98 to 1.00, p = .02 and IRR = 1.02, 95% CI: 1.01 to 1.03, p < .01, respectively). The zero inflated component of the ZINB model yielded shorter distance to Kenya or DRC border, higher incidence rate in the neighboring districts, and higher annual rainfall in the district were associated with the risk of having cholera in the district. The study identified cholera hotspots during the period 2011-2016. The people located near the international borders, internationally shared lakes and river Nile were at higher risk for cholera outbreaks than elsewhere in the country. Targeting cholera interventions to these locations could prevent and ultimately eliminate cholera in Uganda.

Social capital and neo-materialist contextual determinants of sense of insecurity in the neighbourhood: a multilevel analysis in Southern Sweden.

PubMed

Lindström, Martin; Lindström, Christine; Moghaddassi, Mahnaz; Merlo, Juan

2006-12-01

The aim of this study was to investigate the influence of contextual (social capital and neo-materialist) and individual factors on sense of insecurity in the neighbourhood. The 2000 public health survey in Scania is a cross-sectional study. A total of 13,715 persons answered a postal questionnaire, which is 59% of the random sample. A multilevel logistic regression model, with individuals at the first level and municipalities at the second, was performed. The effect (median odds ratios, intra-class correlation, cross-level modification and odds ratios) of individual and municipality/city quarter (social capital and police district) factors on sense of insecurity was analysed. The crude variance between municipalities/city quarters was not affected by individual factors. The introduction of administrative police district in the model reduced the municipality variance, although some of the significant variance between municipalities remained. The introduction of social capital did not affect the municipality variance. This study suggests that the neo-materialist factor administrative police district may partly explain the individual's sense of insecurity in the neighbourhood.

Spatial modeling of households' knowledge about arsenic pollution in Bangladesh.

PubMed

Sarker, M Mizanur Rahman

2012-04-01

Arsenic in drinking water is an important public health issue in Bangladesh, which is affected by households' knowledge about arsenic threats from their drinking water. In this study, spatial statistical models were used to investigate the determinants and spatial dependence of households' knowledge about arsenic risk. The binary join matrix/binary contiguity matrix and inverse distance spatial weight matrix techniques are used to capture spatial dependence in the data. This analysis extends the spatial model by allowing spatial dependence to vary across divisions and regions. A positive spatial correlation was found in households' knowledge across neighboring districts at district, divisional and regional levels, but the strength of this spatial correlation varies considerably by spatial weight. Literacy rate, daily wage rate of agricultural labor, arsenic status, and percentage of red mark tube well usage in districts were found to contribute positively and significantly to households' knowledge. These findings have policy implications both at regional and national levels in mitigating the present arsenic crisis and to ensure arsenic-free water in Bangladesh. Copyright © 2012 Elsevier Ltd. All rights reserved.

Significance of informal (on-the-job) learning and leadership development in health systems: lessons from a district finance team in South Africa

PubMed Central

Choonara, S; Goudge, J; Nxumalo, N; Eyles, J

2017-01-01

Background The district health system (DHS) has a critical role to play in the delivery of primary healthcare (PHC). Effective district management, particularly leadership is considered to be crucial element of the DHS. Internationally, the debate around developing leadership competencies such as motivation or empowerment of staff, managing relationships, being solution driven as well as fostering teamwork are argued to be possible through approaches such as formal and informal training. Despite growing multidisciplinary evidence in fields such as engineering, computer sciences and health sciences there remains little empirical evidence of these approaches, especially the informal approach. Findings are based on a broader doctoral thesis which explored district financial management; although the core focus of this paper draws attention to the significance of informal learning and its practical value in developing leadership competencies. Methods A qualitative case study was conducted in one district in the Gauteng province, South Africa. Purposive and snowballing techniques yielded a sample of 18 participants, primarily based at a district level. Primary data collected through in-depth interviews and observations (participant and non-participant) were analysed using thematic analysis. Findings Results indicate the sorts of complexities, particularly financial management challenges which staff face and draws attention to the use of two informal learning strategies—learning from others (how to communicate, delegate) and fostering team-based learning. Such strategies played a role in developing a cadre of leaders at a district level who displayed essential competencies such as motivating staff, and problem solving. Conclusions It is crucial for health systems, especially those in financially constrained settings to find cost-effective ways to develop leadership competencies such as being solution driven or motivating and empowering staff. This study illustrates that it is possible to develop such competencies through creating and nurturing a learning environment (on-the-job training) which could be incorporated into everyday practice. PMID:28588998

Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance.

PubMed

Martineau, Tim; Raven, Joanna; Aikins, Moses; Alonso-Garbayo, Alvaro; Baine, Sebastian; Huss, Reinhard; Maluka, Stephen; Wyss, Kaspar

2018-01-01

To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects. Documentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick's evaluation framework to identify effects at different levels. The MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI. The MSI is appropriate to the contexts where tested and can improve staff performance. However, for significant impact on service delivery and UHC, a method of scaling up and sustaining the MSI is required.

Significance of informal (on-the-job) learning and leadership development in health systems: lessons from a district finance team in South Africa.

PubMed

Choonara, S; Goudge, J; Nxumalo, N; Eyles, J

2017-01-01

The district health system (DHS) has a critical role to play in the delivery of primary healthcare (PHC). Effective district management, particularly leadership is considered to be crucial element of the DHS. Internationally, the debate around developing leadership competencies such as motivation or empowerment of staff, managing relationships, being solution driven as well as fostering teamwork are argued to be possible through approaches such as formal and informal training. Despite growing multidisciplinary evidence in fields such as engineering, computer sciences and health sciences there remains little empirical evidence of these approaches, especially the informal approach. Findings are based on a broader doctoral thesis which explored district financial management; although the core focus of this paper draws attention to the significance of informal learning and its practical value in developing leadership competencies. A qualitative case study was conducted in one district in the Gauteng province, South Africa. Purposive and snowballing techniques yielded a sample of 18 participants, primarily based at a district level. Primary data collected through in-depth interviews and observations (participant and non-participant) were analysed using thematic analysis. Results indicate the sorts of complexities, particularly financial management challenges which staff face and draws attention to the use of two informal learning strategies-learning from others (how to communicate, delegate) and fostering team-based learning. Such strategies played a role in developing a cadre of leaders at a district level who displayed essential competencies such as motivating staff, and problem solving. It is crucial for health systems, especially those in financially constrained settings to find cost-effective ways to develop leadership competencies such as being solution driven or motivating and empowering staff. This study illustrates that it is possible to develop such competencies through creating and nurturing a learning environment (on-the-job training) which could be incorporated into everyday practice.

Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance

PubMed Central

Martineau, Tim; Raven, Joanna; Aikins, Moses; Alonso-Garbayo, Alvaro; Baine, Sebastian; Huss, Reinhard; Maluka, Stephen; Wyss, Kaspar

2018-01-01

Background To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects. Methods Documentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick’s evaluation framework to identify effects at different levels. Findings The MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI. Conclusions The MSI is appropriate to the contexts where tested and can improve staff performance. However, for significant impact on service delivery and UHC, a method of scaling up and sustaining the MSI is required. PMID:29662692

Examination of the food and nutrient content of school lunch menus of two school districts in Mississippi.

PubMed

Addison, Clifton C; Jenkins, Brenda W; White, Monique S; Young, Lavon

2006-09-01

This study examined the diet quality of the school meals in two Mississippi school districts and compared them to the national guidelines. We examined the lunch menus of the two school districts that participated in the National School Lunch Program and School Breakfast Program focusing on food quality and assessing both healthy and unhealthy foods and eating behaviors. This analysis was completed through a computerized review used to accurately determine the nutrient content. Both the standard and the alternative meals provided by the cafeterias in the two school districts exceeded the minimum requirement for calories for all grade levels. The meals from the urban schools cafeteria provide more calories than meals from the cafeteria in the rural school district. Although schools believe that they are making positive changes to children's diets, the programs are falling short of the nutrient recommendations. Poor nutrition and improper dietary practices are now regarded as important risk factors in the emerging problems of obesity, diabetes mellitus, hypertension and other chronic diseases, with excessive energy intake listed as a possible reason. Dieticians, school professionals and other health care practitioners need to accurately assess energy intake and adequately promote a dietary responsible lifestyle among children.

Moving data off the shelf and into action: an intervention to improve data-informed decision making in Côte d'Ivoire.

PubMed

Nutley, Tara; Gnassou, Léontine; Traore, Moussa; Bosso, Abitche Edwige; Mullen, Stephanie

2014-01-01

Improving a health system requires data, but too often they are unused or under-used by decision makers. Without interventions to improve the use of data in decision making, health systems cannot meet the needs of the populations they serve. In 2008, in Côte d'Ivoire, data were largely unused in health decision-making processes. To implement and evaluate an intervention to improve the use of data in decision making in Cote d'Ivoire. From 2008 to 2012, Cote d'Ivoire sought to improve the use of national health data through an intervention that broadens participation in and builds links between data collection and decision-making processes; identifies information needs; improves data quality; builds capacity to analyze, synthesize, and interpret data; and develops policies to support data use. To assess the results, a Performance of Routine Information System Management Assessment was conducted before and after the intervention using a combination of purposeful and random sampling. In 2008, the sample consisted of the central level, 12 districts, and 119 facilities, and in 2012, the sample consisted of the central level, 20 districts, and 190 health facilities. To assess data use, we developed dichotomous indicators: discussions of analysis findings, decisions taken based on the analysis, and decisions referred to upper management for action. We aggregated the indicators to generate a composite, continuous index of data use. From 2008 to 2012, the district data-use score increased from 40 to 70%; the facility score remained the same - 38%. The central score is not reported, because of a methodological difference in the two assessments. The intervention improved the use of data in decision making at the district level in Côte d'Ivoire. This study provides an example of, and guidance for, implementing a large-scale intervention to improve data-informed decision making.

Are characteristics of the school district associated with active transportation to school in Danish adolescents?

PubMed

Stock, Christiane; Bloomfield, Kim; Ejstrud, Bo; Vinther-Larsen, Mathilde; Meijer, Mathias; Grønbæk, Morten; Grittner, Ulrike

2012-06-01

This study sought to determine the influence of individual factors on active transportation to school among Danish seventh graders and whether school district factors are associated with such behaviour independently of individual factors. Mixed effects logistic regression models determined the effects of individual (gender, family affluence, enjoyment of school and academic performance) and school district factors (educational level, household savings, land use and size) on active transportation to school (by foot, bicycle or other active means) among 10 380 pupils aged 13-15 years nested in 407 school districts. Of all students, 64.4% used active transportation to school daily. Boys, those with perceived higher school performance and those with lower family affluence were more likely to use active transportation to school. After adjustment for all individual factors listed above, high household savings at the school district level was associated with higher odds of active transportation to school. As factors of land use, low level of farming land use and high proportion of single houses were associated with active transportation to school. Policies aiming at reducing social inequalities at the school district level may enhance active transportation to school. School districts with farming land use face barriers for active transportation to school, requiring special policy attention.

[System construction of early warning for ecological security at cultural and natural heritage mixed sites and its application: a case study of Wuyishan Scenery District].

PubMed

You, Wei-Bin; He, Dong-Jin; Qin, De-Hua; Ji, Zhi-Rong; Wu, Li-Yun; Yu, Jian-An; Chen, Bing-Rong; Tan, Yong

2014-05-01

This paper proposed a new concept of ecological security for protection by a comprehensive analysis of the contents and standards of world heritage sites. A frame concept model named "Pressure-State-Control" for early warning of ecological security at world heritage mixed sites was constructed and evaluation indicators of this frame were also selected. Wuyishan Scenery District was chosen for a case study, which has been severely disturbed by natural and artificial factors. Based on the frame model of "Pressure-State-Control" and by employing extension analysis, the matter-element model was established to assess the ecological security status of this cultural and natural world heritage mixed site. The results showed that the accuracy of ecological security early warning reached 84%. Early warning rank was I level (no alert status) in 1997 and 2009, but that in 2009 had a higher possibility to convert into II level. Likewise, the early-warning indices of sensitive ranks were different between 1997 and 2009. Population density, population growth rate, area index for tea garden, cultivated land owned per capita, level of drought, and investment for ecological and environmental construction were the main limiting factors to hinder the development of ecological security from 2009 to future. In general, the status of Wuyishan Scenery District ecological security was relatively good and considered as no alert level, while risk conditions also existed in terms of a few early-warning indicators. We still need to pay more attention to serious alert indicators and adopt effective prevention and control measures to maintain a good ecological security status of this heritage site.

Analysis of County School Districts in Arkansas.

ERIC Educational Resources Information Center

Budd, Karol B.; Charlton, J.L.

The 1948, Arkansas School District Reorganization Act was passed in an effort to reduce the 1589 small school districts to a smaller number. Those districts not consolidated would form county districts. As of the 1967-68 school year, 26 of these county districts remained. The purpose of this study was to provide information drawing attention to…

Staffing Levels in the Dallas Independent School District

ERIC Educational Resources Information Center

Council of the Great City Schools, 2009

2009-01-01

The Board of Trustees of the Dallas Independent School District (DISD) asked the Council of the Great City Schools, the nation's primary coalition of large urban school systems, to examine the staffing levels of the school system and determine whether the numbers of staff members employed were appropriate for a district serving as many students as…

Demographic Differences in District-Level Policies Related to School Mental Health and Social Services--United States, 2012

ERIC Educational Resources Information Center

Demissie, Zewditu; Brener, Nancy

2017-01-01

Background: Mental health conditions among youth are a major concern. Schools can play an important role in supporting students affected by these conditions. This study examined district-level school health policies related to mental health and social services to determine if they varied by district demographic characteristics. Methods: The School…

Regional health accounts for Pakistan--expenditure disparities on provincial and district level.

PubMed

Lorenz, Christian; Khalid, Muhammad

2011-05-01

Since May 2009 the first National Health Accounts (NHA) for Pakistan have been finalised and published by Federal Bureau of Statistics (FBS) in cooperation with German Technical Cooperation (GTZ). This paper goes one step ahead of the report and analyses in more detail the regional differences in health expenditure structures in Pakistan. The further analyses can be divided into four parts: health expenditures in provinces (Provincial Health Accounts, PHA), Punjab provincial and district governments health expenditures and its comparison with ADB figures, all districts of Pakistan and comparison between total district government and provincial government expenditure for each province; the latter calculation is applied as indication for the degree of fiscal autonomy of the districts in each province. Consequently, first the provincial health expenditures by Financial Agents is analysed and compared between the provinces which leads to very heterogeneous results (section 2); the per capita health expenditures differ from 16 to 23 USD. Secondly, NHA results on Punjab district government are compared with available ADB results and differences in methods as possible reasons for different results are presented (section 3). Third, district data of all district governments in all four Pakistani provinces are analysed on the level of detailed function codes in section 4; the aim is to discover regional differences between districts of the same as well as of different provinces. Fourth, in section 5 the degree of fiscal autonomy on health of the districts in each province is analysed; therefore the ordinance description is reviewed and total district government with total provincial government expenditures are compared per province. Finally recommendations for future rounds of NHA in Pakistan are given regarding formats and necessities of detailed health expenditure data collection to ensure evidence based decision making not only on federal, but also on provincial and district level.

Iodine deficiency in children: A comparative study in two districts of south-interior Karnataka, India.

PubMed

Ahmed, Mansoor; Zama, Syed Y; Nagarajarao, Vadiraja; Khan, Mudassir A

2014-01-01

Iodine is an essential component of the hormones produced by the thyroid gland that are essential for mammalian life. Although goiter is the most visible sequelae of iodine deficiency, the major impact of hypothyroidism as a result of iodine deficiency is impaired neurodevelopment, particularly early in life. According to the World Health Organization, it is the single most preventable cause of mental retardation and brain damage. The simplest, most effective and inexpensive preventive method is the consumption of iodized salt. The objective of the following study is to estimate the prevalence of goiter in children in the rural areas of Mysore and Coorg districts in India and estimate iodine levels in salt samples. A cross-sectional study in the age group of 6-12 years, using population proportionate to size systematic sampling method. The total sample size was 10,082: out of which 5337 was from Mysore and the rest from Coorg district. Clinical examination of the thyroid gland was done and salt samples collected for the estimation of Iodine. The total prevalence of goiter was 19.01% in children of 6-12 years in Coorg district and 8.77% in Mysore district and it was more in females than in males. It was observed that iodine deficiency disorders is endemic in both districts, with a prevalence of 19.01% in children aged 6-12 years in Coorg district and 8.77% in Mysore district. Analysis of salt samples suggested that most of the samples were inadequately iodised (73.92% in Coorg and 45.92% in Mysore).

Relationship Between Drinking Water Fluoride Levels, Dental Fluorosis, Dental Caries and Associated Risk Factors in 9-12 Years Old School Children of Nelakondapally Mandal of Khammam District, Andhra Pradesh, India: A Cross-sectional Survey

PubMed Central

Shanthi, M; Reddy, B Vishnuvardhan; Venkataramana, V; Gowrisankar, S; Reddy, B V Thimma; Chennupati, Sireesha

2014-01-01

Background: The present study was conducted to assess the relationship between drinking water fluoride (F) levels, dental fluorosis and dental caries among 9-12 years old school children of Nelakondapally Mandal, Khammam district, Andhra Pradesh. Materials and Methods: A cross-sectional analytical study was conducted on 1500 school children aged 9-12 years, selected by stratified random sampling from different areas with different levels of naturally occurring F in drinking water. The children were assessed for dental fluorosis according to WHO basic survey guidelines. The overall oral health status of the child was assessed by decayed missing filled teeth (DMFT)/dmft index. Statistical analysis was done using mean, standard deviation, standard error, Z-test, ANOVA test, and Chi-square test. Results: The results of the present study revealed that the prevalence of fluorosis was 74.9%. Number of children having dental fluorosis was highest in children who consume water from bore wells. Caries prevalence in the study population was about 56.5%. Caries prevalence and mean DMFT/dmft scores were least in children with optimal F areas and highest in children with below optimal F areas. Conclusion: There was moderate prevalence of fluorosis in Nelakondapally Mandal of Khammam district, and caries prevalence is high in areas below optimal F areas. How to cite the article: Shanthi M, Reddy BV, Venkataramana V, Gowrisankar S, Reddy BV, Chennupati S. Relationship between drinking water fluoride levels, dental fluorosis, dental caries and associated risk factors in 9-12 year old school children of Nelakondapally Mandal of Khammam district, Andhra Pradesh, India: A cross-sectional survey. J Int Oral Health 2014;6(3):106-10. PMID:25083044

Open defecation and childhood stunting in India: an ecological analysis of new data from 112 districts.

PubMed

Spears, Dean; Ghosh, Arabinda; Cumming, Oliver

2013-01-01

Poor sanitation remains a major public health concern linked to several important health outcomes; emerging evidence indicates a link to childhood stunting. In India over half of the population defecates in the open; the prevalence of stunting remains very high. Recently published data on levels of stunting in 112 districts of India provide an opportunity to explore the relationship between levels of open defecation and stunting within this population. We conducted an ecological regression analysis to assess the association between the prevalence of open defecation and stunting after adjustment for potential confounding factors. Data from the 2011 HUNGaMA survey was used for the outcome of interest, stunting; data from the 2011 Indian Census for the same districts was used for the exposure of interest, open defecation. After adjustment for various potential confounding factors--including socio-economic status, maternal education and calorie availability--a 10 percent increase in open defecation was associated with a 0.7 percentage point increase in both stunting and severe stunting. Differences in open defecation can statistically account for 35 to 55 percent of the average difference in stunting between districts identified as low-performing and high-performing in the HUNGaMA data. In addition, using a Monte Carlo simulation, we explored the effect on statistical power of the common practice of dichotomizing continuous height data into binary stunting indicators. Our simulation showed that dichotomization of height sacrifices statistical power, suggesting that our estimate of the association between open defecation and stunting may be a lower bound. Whilst our analysis is ecological and therefore vulnerable to residual confounding, these findings use the most recently collected large-scale data from India to add to a growing body of suggestive evidence for an effect of poor sanitation on human growth. New intervention studies, currently underway, may shed more light on this important issue.

Spatiotemporal Evolution of Ebola Virus Disease at Sub-National Level during the 2014 West Africa Epidemic: Model Scrutiny and Data Meagreness.

PubMed

Santermans, Eva; Robesyn, Emmanuel; Ganyani, Tapiwa; Sudre, Bertrand; Faes, Christel; Quinten, Chantal; Van Bortel, Wim; Haber, Tom; Kovac, Thomas; Van Reeth, Frank; Testa, Marco; Hens, Niel; Plachouras, Diamantis

2016-01-01

The Ebola outbreak in West Africa has infected at least 27,443 individuals and killed 11,207, based on data until 24 June, 2015, released by the World Health Organization (WHO). This outbreak has been characterised by extensive geographic spread across the affected countries Guinea, Liberia and Sierra Leone, and by localized hotspots within these countries. The rapid recognition and quantitative assessment of localised areas of higher transmission can inform the optimal deployment of public health resources. A variety of mathematical models have been used to estimate the evolution of this epidemic, and some have pointed out the importance of the spatial heterogeneity apparent from incidence maps. However, little is known about the district-level transmission. Given that many response decisions are taken at sub-national level, the current study aimed to investigate the spatial heterogeneity by using a different modelling framework, built on publicly available data at district level. Furthermore, we assessed whether this model could quantify the effect of intervention measures and provide predictions at a local level to guide public health action. We used a two-stage modelling approach: a) a flexible spatiotemporal growth model across all affected districts and b) a deterministic SEIR compartmental model per district whenever deemed appropriate. Our estimates show substantial differences in the evolution of the outbreak in the various regions of Guinea, Liberia and Sierra Leone, illustrating the importance of monitoring the outbreak at district level. We also provide an estimate of the time-dependent district-specific effective reproduction number, as a quantitative measure to compare transmission between different districts and give input for informed decisions on control measures and resource allocation. Prediction and assessing the impact of control measures proved to be difficult without more accurate data. In conclusion, this study provides us a useful tool at district level for public health, and illustrates the importance of collecting and sharing data.

Multi-site time series analysis of acute effects of multiple air pollutants on respiratory mortality: a population-based study in Beijing, China.

PubMed

Yang, Yang; Cao, Yang; Li, Wenjing; Li, Runkui; Wang, Meng; Wu, Zhenglai; Xu, Qun

2015-03-01

In large cities in China, the traffic-related air pollution has become the focus of attention, and its adverse effects on health have raised public concerns. We conducted a study to quantify the association between exposure to three major traffic-related pollutants - particulate matter < 10 μm in aerodynamic diameter (PM10), carbon monoxide (CO) and nitrogen dioxide (NO2) and the risk of respiratory mortality in Beijing, China at a daily spatiotemporal resolution. We used the generalized additive models (GAM) with natural splines and principal component regression method to associate air pollutants with daily respiratory mortality, covariates and confounders. The GAM analysis adjusting for the collinearity among pollutants indicated that PM10, CO and NO2 had significant effects on daily respiratory mortality in Beijing. An interquartile range increase in 2-day moving averages concentrations of day 0 and day 1 of PM10, CO and NO2 corresponded to 0.99 [95% confidence interval (CI): 0.30, 1.67], 0.89 (95% CI: 0.27, 1.51) and 0.95 (95% CI: 0.29, 1.61) percent increase in daily respiratory mortality, respectively. The effects were varied across the districts. The strongest effects were found in two rural districts and one suburban district but significant in only one district. In conclusion, high level of several traffic-related air pollutants is associated with an increased risk of respiratory mortality in Beijing over a short-time period. The high risk found in rural areas suggests a potential susceptible sub-population with undiagnosed respiratory diseases in these areas. Although the rural areas have relatively lower air pollution levels, they deserve more attention to respiratory disease prevention and air pollution reduction. Copyright © 2014 Elsevier B.V. All rights reserved.

From environmental noise abatement to soundscape creation through strategic noise mapping in medium urban agglomerations in South Europe.

PubMed

Vogiatzis, Konstantinos; Remy, Nicolas

2014-06-01

In the framework of the European Directive 2002-49-EU, the medium sized cities of Volos and Larissa in central Greece recently completed (2012) their strategic noise maps and relevant action plans that define the main strategies to reduce noise exposure of residents and introduce and preserve "quite zones". For the first time in this framework, it has been decided to introduce, as well, a general study for five specific urban districts covering not only the measurement and modeling of environmental noise levels but also qualitative surveys on the sound perception by the residents and several analyses of the urban and architectural tissue. The districts (respectively four in Volos and one in Larissa with the two of them in the center of both agglomerations) were chosen as representatives of urban situations due to their proximity to transportation infrastructures (main road network, industrial harbor facilities and both regional and intercity train network) and also because they represent different urban typologies (residential district, downtown area with or without shops, more or less densely populated neighborhood, etc.…). Sociological surveys on sound and noise perception have been implemented on some 15% of the residents per district using opened questionnaires. Soundscape analysis was also conducted through qualitative criteria. A cross-analysis of these data explains in detail the physical reasons for the existence of sound qualities that contribute to the identity of each distinct neighborhood. This paper, in a strategic plan level, has introduced valuable recommendations in order not only to preserve the sound quality on the existing sites but also to authorize developers and decision makers (mayors, architects, town planners) to evolve them positively over time. © 2013 Elsevier B.V. All rights reserved.

Toxoplasmosis in camels (Camelus dromedarius) of Borana zone, Oromia region, Ethiopia: seroprevalence and risk factors.

PubMed

Gebremedhin, Endrias Zewdu; Dima, Nura; Beyi, Ashenafi Feyisa; Dawo, Fufa; Feyissa, Negassa; Jorga, Edilu; Di Marco, Vincenzo; Vitale, Maria

2016-12-01

Toxoplasmosis is one of the most prevalent parasitic infections of medical and veterinary importance. A cross-sectional study was conducted from November 2013 to January 2014 to estimate the seroprevalence of Toxoplasma gondii infection in camels from four districts of Borana zone, Southern Oromia, Ethiopia. In addition, a questionnaire survey was administered to 124 pastoralists to identify possible risk factors and to assess the awareness level of pastoral communities about toxoplasmosis. A total of 396 serum samples were examined for anti-Toxoplasma IgG antibodies using the direct agglutination test (DAT). Fisher's exact test and logistic regression were used for data analysis. An overall seroprevalence of 8.33 % (95 % confidence interval [CI] 5.60 %, 11.07 %) at animal-level and 37.5 % (95 % CI: 20.1 %, 57.4 %) at herd-level was found. The seroprevalence was significantly high in Moyale district (23.07 %) followed by Yabello (7.20 %), Dirre (3.77 %), and Arero (0.0 %) districts (P < 0.001). Multivariable logistic regression analysis revealed that the likelihood of acquiring T. gondii infection was significantly higher in camels of Moyale district (adjusted OR = 5.89, 95 % CI 2.15, 16.12; P = 0.001) than Dirre district, in camels of >8 years old (adjusted odds ratio [OR] = 4.95, 95 % CI 1.68, 14.55; P = 0.004) than camels of ≤4 years old. There was no significant association between herd-level seroprevalence of T. gondii infection and abortion history, herd size, and presence of domestic cats and wild felids (P > 0.05). The majority of interviewees were uneducated (82.25 %), and all had no knowledge of toxoplasmosis. All camel herders drink raw camel milk but consume cooked meat (90.32 %). Of the interviewees, 93.06 % are aware about soil-eating habit of camels and provide salt supplement for their camels. Majority of the respondents practice improper disposal of aborted materials (throw along the way) (88.70 %), and 73 % of the study participants do not wash their hands after handling aborted fetus. The results of the present study confirm relatively lower prevalence of T. gondii infection in camels reared in Borana zone. Age and study district are significant predictors of T. gondii seropositivity. The vast majorities of interviewed pastoralists were uneducated and practice poor biosecurity measures to prevent diseases. Education of pastoralists about biosecurity measures to prevent toxoplasmosis and further studies are warranted to unravel the economic and public health consequences of T. gondii infection.

Analysis of cattle movements in Argentina, 2005.

PubMed

Aznar, M N; Stevenson, M A; Zarich, L; León, E A

2011-02-01

We describe the movement of cattle throughout Argentina in 2005. Details of farm-to-farm and farm-to-slaughter movements of cattle were obtained from the Sanitary Management System database (Sistema de Gestión Sanitaria, SGS), maintained by the National Service for Agrifood Health and Quality (SENASA). Movements were described at the regional and district level in terms of frequency, the number of stock transported, the district of origin and destination and Euclidean distance traveled. Social network analysis was used to characterize the connections made between regions and districts as a result of cattle movement transactions, and to show how these characteristics might influence disease spread. Throughout 2005 a total of 1.3 million movement events involving 32 million head of cattle (equivalent to approximately 57% of the national herd) were recorded in the SGS database. The greatest number of farm-to-farm movements occurred from April to June whereas numbers of farm-to-slaughter movement events were relatively constant throughout the year. Throughout 2005 there was a 1.1-1.6-fold increase in the number of farm-to-farm movements of cattle during April-June, compared with other times of the year. District in-degree and out-degree scores varied by season, with higher maximum scores during the autumn and winter compared with summer and spring. Districts with high in-degree scores were concentrated in the Finishing region of the country whereas districts with high out-degree scores were concentrated not only in the Finishing region but also in Mesopotamia, eastern Border and southern Central regions. Although movements of cattle from the Border region tended not to be mediated via markets, the small number of districts in this area with relatively high out-degree scores is a cause for concern as they have the potential to distribute infectious disease widely, in the event of an incursion. Published by Elsevier B.V.

Awareness regarding eye donation among stakeholders in Srikakulam district in South India.

PubMed

Ronanki, Venkata Ramana; Sheeladevi, Sethu; Ramachandran, Brinda P; Jalbert, Isabelle

2014-03-06

There is a huge need for the availability of transplantable donor corneas worldwide to reduce the burden of corneal blindness due to corneal opacity. Voluntary eye donation depends on the awareness levels of various stakeholders in the community. This study aimed to assess the awareness level regarding eye donation among various stakeholders in Srikakulam district in the state of Andhra Pradesh, India. 355 subjects were selected from the district using multi stage random sampling. A pre tested semi structured questionnaire was used to collect information regarding each individual's awareness, knowledge, and perception regarding eye donation. Each response was scored individually and a total score was calculated. Univariate and multivariate regression analysis was used to determine the factors associated with willingness towards eye donation and increased awareness levels. Of the 355 subjects interviewed, 192 (54%) were male and 163 (46%) were female. The mean age of the stakeholders was 35.9 years (SD ±16.1) and all the study subjects were literate. Ninety-three percent of subjects were aware of the concept of eye donation. Knowledge levels were similar among the teaching community and persons engaged in social service, but lower among students (p < 0.05). Among the stakeholders, there was considerable ambiguity regarding whether persons currently wearing spectacles or suffering from a chronic illnesses could donate their eyes. Older age group (p < 0.001), female gender (p < 0.001) and education (p < 0.001) were associated with increased knowledge levels. 82% of the subjects were willing to donate their eyes and this was unaffected by gender or geographical location (rural vs urban). Awareness levels and willingness to donate eyes are high among the stakeholders in Srikakulam district in India. The services of stakeholders could be utilized, in conjunction with other community based eye donation counselors, to promote awareness regarding eye donation among the general population.

Decentralisation and health services delivery in Tanzania: Analysis of decision space in planning, allocation, and use of financial resources.

PubMed

Kigume, Ramadhani; Maluka, Stephen; Kamuzora, Peter

2018-04-01

While decentralisation of health systems has been on the policy agenda in low-income and middle-income countries since the 1970s, many studies have focused on understanding who has more decision-making powers but less attention is paid to understand what those powers encompass. Using the decision space approach, this study aimed to understand the amount of decision-making space transferred from the central government to institutions at the periphery in the decentralised health system in Tanzania. The findings of this study indicated that the decentralisation process in Tanzania has provided authorities with a range of decision-making space. In the areas of priority setting and planning, district health authorities had moderate decision space. However, in the financial resource allocation and expenditure of funds from the central government, the districts had narrow decision-making space. The districts, nevertheless, had wider decision-making space in mobilising and using locally generated financial resources. However, the ability of the districts to allocate and use locally generated resources was constrained by bureaucratic procedures of the central government. The study concludes that decentralisation by devolution which is being promoted in the policy documents in Tanzania is yet to be realised at the district and local levels. The study recommends that the central government should provide more space to the decentralised district health systems to incorporate locally defined priorities in the district health plans. Copyright © 2018 John Wiley & Sons, Ltd.

Health and quality of life among older rural people in Purworejo District, Indonesia

PubMed Central

Ng, Nawi; Hakimi, Mohammad; Byass, Peter; Wilopo, Siswanto; Wall, Stig

2010-01-01

Introduction Increasing life expectancy and longevity for people in many highly populated low- and middle-income countries has led to an increase in the number of older people. The population aged 60 years and over in Indonesia is projected to increase from 8.4% in 2005 to 25% in 2050. Understanding the determinants of healthy ageing is essential in targeting health-promotion programmes for older people in Indonesia. Objective To describe patterns of socio-economic and demographic factors associated with health status, and to identify any spatial clustering of poor health among older people in Indonesia. Methods In 2007, the WHO Study on global AGEing and adult health (SAGE) was conducted among 14,958 people aged 50 years and over in Purworejo District, Central Java, Indonesia. Three outcome measures were used in this analysis: self-reported quality of life (QoL), self-reported functioning and disability, and overall health score calculated from self-reported health over eight health domains. The factors associated with each health outcome were identified using multivariable logistic regression. Purely spatial analysis using Poisson regression was conducted to identify clusters of households with poor health outcomes. Results Women, older age groups, people not in any marital relationship and low educational and socio-economic levels were associated with poor health outcomes, regardless of the health indices used. Older people with low educational and socio-economic status (SES) had 3.4 times higher odds of being in the worst QoL quintile (OR = 3.35; 95% CI = 2.73–4.11) as compared to people with high education and high SES. This disadvantaged group also had higher odds of being in the worst functioning and most disabled quintile (OR = 1.67; 95% CI = 1.35–2.06) and the lowest overall health score quintile (OR = 1.66; 95% CI = 1.36–2.03). Poor health and QoL are not randomly distributed among the population over 50 years old in Purworejo District, Indonesia. Spatial analysis showed that clusters of households with at least one member being in the worst quintiles of QoL, functioning and health score intersected in the central part of Purworejo District, which is a semi-urban area with more developed economic activities compared with other areas in the district. Conclusion Being female, old, unmarried and having low educational and socio-economic levels were significantly associated with poor self-reported QoL, health status and disability among older people in Purworejo District. This study showed the existence of geographical pockets of vulnerable older people in Purworejo District, and emphasized the need to take immediate action to address issues of older people's health and QoL. PMID:20959875

Removing the regional level from the Niger vaccine supply chain.

PubMed

Assi, Tina-Marie; Brown, Shawn T; Kone, Souleymane; Norman, Bryan A; Djibo, Ali; Connor, Diana L; Wateska, Angela R; Rajgopal, Jayant; Slayton, Rachel B; Lee, Bruce Y

2013-06-10

Since many of the world's vaccine supply chains contain multiple levels, the question remains of whether removing a level could bring efficiencies. We utilized HERMES to generate a detailed discrete-event simulation model of Niger's vaccine supply chain and compared the current four-tier (central, regional, district, and integrated health center levels) with a modified three-tier structure (removing the regional level). Different scenarios explored various accompanying shipping policies and frequencies. Removing the regional level and implementing a collection-based shipping policy from the district stores increases vaccine availability from a mean of 70-100% when districts could collect vaccines at least weekly. Alternatively, implementing a delivery-based shipping policy from the central store monthly in three-route and eight-route scenarios only increases vaccine availability to 87%. Restricting central-to district vaccine shipments to a quarterly schedule for three-route and eight-route scenarios reduces vaccine availability to 49%. The collection-based shipping policy from district stores reduces supply chain logistics cost per dose administered from US$0.14 at baseline to US$0.13 after removing the regional level. Removing the regional level from Niger's vaccine supply chain can substantially improve vaccine availability as long as certain concomitant adjustments to shipping policies and frequencies are implemented. Copyright © 2013 Elsevier Ltd. All rights reserved.

Removing the Regional Level from the Niger Vaccine Supply Chain

PubMed Central

Assi, Tina-Marie; Brown, Shawn T.; Kone, Souleymane; Norman, Bryan A.; Djibo, Ali; Connor, Diana L.; Wateska, Angela R.; Rajgopal, Jayant; Slayton, Rachel B.; Lee, Bruce Y.

2013-01-01

Objective Since many of the world’s vaccine supply chains contain multiple levels, the question remains of whether removing a level could bring efficiencies. Methods We utilized HERMES to generate a detailed discrete-event simulation model of Niger’s vaccine supply chain and compare the current four-tier (central, regional, district and integrated health center levels) with a modified three-tier structure (removing the regional level). Different scenarios explored various accompanying shipping policies and frequencies. Findings Removing the regional level and implementing a collection-based shipping policy from the district stores increases vaccine availability from a mean of 70% to 100% when districts could collect vaccines at least weekly. Alternatively, implementing a delivery-based shipping policy from the central store monthly in three-route and eight-route scenarios only increases vaccine availability to 87%. Restricting central-to district vaccine shipments to a quarterly schedule for three-route and eight-route scenarios reduces vaccine availability to 49%. The collection-based shipping policy from district stores reduces supply chain logistics cost per dose administered from US$0.14 at baseline to US$0.13 after removing the regional level. Conclusion Removing the regional level from Niger’s vaccine supply chain can substantially improve vaccine availability as long as certain concomitant adjustments to shipping policies and frequencies are implemented. PMID:23602666

Hazard analysis of Arid and semi-Arid (ASAL) regions of Kenya.

PubMed

Tabu, J S; Otwelo, J A; Koskei, P; Makokha, P

2013-06-01

This paper describes a situationanalysis on hazards in the Arid and semi-Arid lands of Kenya. The leading hazards affecting the Arid and semi-arid lands are mainly natural and include among others drought, floods, and landslides. Other hazards of importance were found to be war and conflict, HIV/AIDS and fires. Over 80% of these are weather related. The overall objective of this study was to prioritize hazards in the ASAL region. Specifically, the study identified the top ten hazards in the ASAL Districts of Kenya, determined Probability of occurrence; Analyzed the potential impact of the hazard and utilizing multiplier effect prioritized the Hazards using a hypothetical model. This was a descriptive study conducted in over half of the Kenya's ASAL Districts in four regions of Lower and Upper Eastern, North Eastern and part of the Coast region. Six Districts were purposively selected per region with six officers from each District all totaling one hundred and forty four. The sectors where respondents were sourced from were Agriculture, Health, local Government, and Provincial Administration, Environment and NGO. The members through a consensus process analyzed hazards in groups of their respective districts using a tool that had been developed and respondents trained on its use. One hundred and forty four (144) officers from Twenty four Districts in the four regions were recruited. One hundred twenty seven (81%) were male and only 27 (19% ) were female The representation of participants per sector was Governance 25% followed by Civil society organizations 21%, Health 16%, Agriculture and arid lands 15%, Research and scientific institutions 13%. The top Priority Hazards identified using the mean score were Drought and famine (5.4) Epidemics and epizootics (3.8), HIV/AIDS (3.6), War and conflict (2.5), Floods (2.5) CONCLUSIONS: The exercise confirmed the priority hazards in the Arid and semi-arid regions of Kenya and described vulnerability factors that included water scarcity, poverty and low educational levels. The region suffers from a variety of hazards in particular Drought and famine, Epidemics including HIV/AIDS and War and conflict. Environmental degradation though given a low score may be more of a perception. There is need to undertake a comprehensive hazard and Vulnerability analysis at regional and country level to inform interventions and other developmental activities. Women should be targeted at the community and leadership level, and efforts to empower them should be stepped up.

A District Level Planning Model.

ERIC Educational Resources Information Center

McHenry, W. E.; Achilles, C. M.

This report examines school district planning models in South Carolina. It focuses on three questions: (1) Of those school districts conducting some type of systematic planning, how many are producing strategic plans? Long-range plans? Accountability reports? (2) In those same districts, how many are preparing adequate program-management…

An Explanation of Pupil Transportation Costs, Seattle School District No. 1. Report No. 78-29.

ERIC Educational Resources Information Center

Collister, Larry

The state of Washington is moving towards the assumption of the full costs of public school student transportation. This move has increased interest at the state level in transportation costs originating at the local district level. These costs have been relatively high in the Seattle school district, complicated by the city's geographic and…

Parental Experiences Related to an Intra-District Boundary Adjustment Transition at the Elementary School Level

ERIC Educational Resources Information Center

Schockaert, Frederik

2014-01-01

School districts at times need to implement structural and programmatic changes requiring students to attend a different school, which tends to elicit strong parental emotions. This qualitative study analyzes how parents in one suburban Rhode Island district responded to a large-scale redistricting at the elementary level in order to (a) attain a…

Who, What, Where, When, and Why: Demographic and Ecological Factors Contributing to Hostile School Climate for Lesbian, Gay, Bisexual, and Transgender Youth

ERIC Educational Resources Information Center

Kosciw, Joseph G.; Greytak, Emily A.; Diaz, Elizabeth M.

2009-01-01

This study examines how locational (region and locale), community-level (school district poverty and adult educational attainment), and school district-level (district size and ratios of students to key school personnel) variables are related to indicators of hostile school climate for lesbian, gay, bisexual, and transgender (LGBT) youth.…

Programs That Work

ERIC Educational Resources Information Center

Hyslop, Alisha; Hemmelman, Chris

2012-01-01

According to the National Research Center for Career and Technical Education, a "promising practice is any technique used that has a positive impact on students and has some data to support the claims made." Sources of this data range from experimental research to district- or state-level data analysis, but they must provide…

Internal Communication Study. 1974-75 Evaluation Report.

ERIC Educational Resources Information Center

Austin Independent School District, TX. Office of Research and Evaluation.

This report attempts to identify some communication problem areas in the Austin Independent School District, based on an open-ended interview questionnaire and a network analysis. Guidelines based on a review of the literature are included for communicators at all levels of the organizational structure. Backup summaries of that review are also…

English Learners' Time to Reclassification: An Analysis

ERIC Educational Resources Information Center

Thompson, Karen D.

2017-01-01

This study uses 9 years of longitudinal, student-level data from the Los Angeles Unified School District to provide updated, empirically-based estimates of the time necessary for English learners (ELs) to become reclassified as proficient in English, as well as factors associated with variation in time to reclassification. To illustrate how…

State Limitations, Self-Help Secondary Schooling, and Development in Kenya.

ERIC Educational Resources Information Center

Bradshaw, York W.

1993-01-01

Over 60% of Kenya's secondary schools are nongovernment community-run schools. Analysis of district-level data on adult literacy, secondary enrollment, child health and mortality, malaria prevalence, and rural development indicates that government schooling has few effects. Nongovernment schooling is associated with lower child mortality and other…

The Program Evaluation Guide: A Preliminary Review of Special Education Instruction

ERIC Educational Resources Information Center

Nulty, Elizabeth C.

2017-01-01

Special education programs vary in the quality of services provided across states, cities, and school districts. There are three major components necessary for a quality special education program for children with complex learning needs. These components include systems level analysis, capacity building for staff, and strong individual student…

Moving beyond the mother-child dyad: women's education, child immunization, and the importance of context in rural India.

PubMed

Parashar, Sangeeta

2005-09-01

The argument that maternal education is critical for child health is commonplace in academic and policy discourse, although significant facets of the relationship remain empirically and theoretically challenged. While individual-level analyses consistently suggest that maternal education enhances child health outcomes, another body of literature argues that the observed causality at the individual-level may, in fact, be spurious. This study contributes to the debate by examining the contextual effects of women's education on children's immunization in rural districts of India. Multilevel analyses of data from the 1994 Human Development Profile Index and the 1991 district-level Indian Census demonstrate that a positive and significant relationship exists between the proportion of literate females in a district and a child's complete immunization status within that district, above and beyond the child's own mother's education as well as district-level socioeconomic development and healthcare amenities. However, results also indicate that the effect of maternal education cannot be downplayed. Thus, increasing women's literacy at the community level, in addition to mother's access to higher education-such as matriculation and beyond-at the individual-level, emerge as effective developmental tools.

Development of regionalized SPFs for two-lane rural roads in Pennsylvania.

PubMed

Li, Lingyu; Gayah, Vikash V; Donnell, Eric T

2017-11-01

The American Association of State Highway and Transportation Officials' Highway Safety Manual (HSM) contains safety performance functions (SPFs) to predict annual crash frequencies for several roadway types. When applying these SPFs in a jurisdiction whose data were not used to develop the SPF, a calibration factor can be applied to adjust the expected crash frequency estimate to statewide or local conditions. Alternatively, the HSM suggests that transportation agencies may develop their own SPFs in lieu of applying the calibration factor to the HSM SPFs. However, the HSM does not provide guidance on the appropriate level of regionalization that should be adopted for either method, even though safety performance may vary considerably within a state. In light of this, the present study considers the development of local or regionalized SPFs for two-lane rural highways within the Commonwealth of Pennsylvania. Three regionalization levels were considered: statewide, engineering district and individual counties. The expected crash frequency for each level of regionalization was compared to the reported crash frequency over an eight-year analysis period. The results indicate that district-level SPFs with county-level adjustment factors provide better predictive accuracy than the development of a statewide SPF or application of the HSM-calibrated SPF. The findings suggest that there are significant differences in safety performance across engineering districts within Pennsylvania. As such, other state transportation agencies developing SPFs or using calibration factors may also consider how variations across jurisdictions will affect predicted crash frequencies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Polycyclic aromatic hydrocarbons (PAHs) in multimedia environment of Heshan coal district, Guangxi: distribution, source diagnosis and health risk assessment.

PubMed

Huang, Huan-Fang; Xing, Xin-Li; Zhang, Ze-Zhou; Qi, Shi-Hua; Yang, Dan; Yuen, Dave A; Sandy, Edward H; Zhou, Ai-Guo; Li, Xiao-Qian

2016-10-01

Mining activities are among the major culprits of the wide occurrences of soil and water pollution by PAHs in coal district, which have resulted in ecological fragilities and health risk for local residents. Sixteen PAHs in multimedia environment from the Heshan coal district of Guangxi, South China, were measured, aiming to investigate the contamination level, distribution and possible sources and to estimate the potential health risks of PAHs. The average concentrations of 16 PAHs in the coal, coal gangue, soil, surface water and groundwater were 5114.56, 4551.10, 1280.12 ng g(-1), 426.98 and 381.20 ng L(-1), respectively. Additionally, higher soil and water PAH concentrations were detected in the vicinities of coal or coal gangue dump. Composition analysis, isomeric ratio, Pearson correlation analysis and principal component analysis were performed to diagnose the potential sources of PAHs in different environmental matrices, suggesting the dominant inputs of PAHs from coal/coal combustion and coal gangue in the soil and water. Soil and water guidelines and the incremental lifetime risk (ICLR) were used to assess the health risk, showing that soil and water were heavily contaminated by PAHs, and mean ICLRcoal/coal-gangue and mean ICLRsoil were both significantly higher than the acceptable levels (1 × 10(-4)), posing high potential carcinogenic risk to residents, especially coal workers. This study highlights the environmental pollution problems and public health concerns of coal mining, particularly the potential occupational health hazards of coal miners exposed in Heshan.

Groundwater quality in Ghaziabad district, Uttar Pradesh, India: Multivariate and health risk assessment.

PubMed

Chabukdhara, Mayuri; Gupta, Sanjay Kumar; Kotecha, Yatharth; Nema, Arvind K

2017-07-01

This study aimed to assess the quality of groundwater and potential health risk due to ingestion of heavy metals in the peri-urban and urban-industrial clusters of Ghaziabad district, Uttar Pradesh, India. Furthermore, the study aimed to evaluate heavy metals sources and their pollution level using multivariate analysis and fuzzy comprehensive assessment (FCA), respectively. Multivariate analysis using principle component analysis (PCA) showed mixed origin for Pb, Cd, Zn, Fe, and Ni, natural source for Cu and Mn and anthropogenic source for Cr. Among all the metals, Pb, Cd, Fe and Ni were above the safe limits of Bureau of Indian Standards (BIS) and World Health Organization (WHO) except Ni. Health risk in terms of hazard quotient (HQ) showed that the HQ values for children were higher than the safe level (HQ = 1) for Pb (2.4) and Cd (2.1) in pre-monsoon while in post-monsoon the value exceeded only for Pb (HQ = 1.23). The health risks of heavy metals for the adults were well within safe limits. The finding of this study indicates potential health risks to the children due to chronic exposure to contaminated groundwater in the region. Based on FCA, groundwater pollution could be categorized as quite high in the peri-urban region, and absolutely high in the urban region of Ghaziabad district. This study showed that different approaches are required for the integrated assessment of the groundwater pollution, and provides a scientific basis for the strategic future planning and comprehensive management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Levels of Trust in Districts with Exemplary Superintendents

ERIC Educational Resources Information Center

Weiss, Jeffrey

2017-01-01

Students from schools with greater levels of trust have higher levels of academic achievement. This study specifically examined the levels of trust that teachers have in each other, their principals, their students, and their students' families. Teachers from four school districts in which the superintendent won the state superintendent of the…

A comparison of hierarchical cluster analysis and league table rankings as methods for analysis and presentation of district health system performance data in Uganda.

PubMed

Tashobya, Christine K; Dubourg, Dominique; Ssengooba, Freddie; Speybroeck, Niko; Macq, Jean; Criel, Bart

2016-03-01

In 2003, the Uganda Ministry of Health introduced the district league table for district health system performance assessment. The league table presents district performance against a number of input, process and output indicators and a composite index to rank districts. This study explores the use of hierarchical cluster analysis for analysing and presenting district health systems performance data and compares this approach with the use of the league table in Uganda. Ministry of Health and district plans and reports, and published documents were used to provide information on the development and utilization of the Uganda district league table. Quantitative data were accessed from the Ministry of Health databases. Statistical analysis using SPSS version 20 and hierarchical cluster analysis, utilizing Wards' method was used. The hierarchical cluster analysis was conducted on the basis of seven clusters determined for each year from 2003 to 2010, ranging from a cluster of good through moderate-to-poor performers. The characteristics and membership of clusters varied from year to year and were determined by the identity and magnitude of performance of the individual variables. Criticisms of the league table include: perceived unfairness, as it did not take into consideration district peculiarities; and being oversummarized and not adequately informative. Clustering organizes the many data points into clusters of similar entities according to an agreed set of indicators and can provide the beginning point for identifying factors behind the observed performance of districts. Although league table ranking emphasize summation and external control, clustering has the potential to encourage a formative, learning approach. More research is required to shed more light on factors behind observed performance of the different clusters. Other countries especially low-income countries that share many similarities with Uganda can learn from these experiences. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

A comparison of hierarchical cluster analysis and league table rankings as methods for analysis and presentation of district health system performance data in Uganda†

PubMed Central

Tashobya, Christine K; Dubourg, Dominique; Ssengooba, Freddie; Speybroeck, Niko; Macq, Jean; Criel, Bart

2016-01-01

In 2003, the Uganda Ministry of Health introduced the district league table for district health system performance assessment. The league table presents district performance against a number of input, process and output indicators and a composite index to rank districts. This study explores the use of hierarchical cluster analysis for analysing and presenting district health systems performance data and compares this approach with the use of the league table in Uganda. Ministry of Health and district plans and reports, and published documents were used to provide information on the development and utilization of the Uganda district league table. Quantitative data were accessed from the Ministry of Health databases. Statistical analysis using SPSS version 20 and hierarchical cluster analysis, utilizing Wards’ method was used. The hierarchical cluster analysis was conducted on the basis of seven clusters determined for each year from 2003 to 2010, ranging from a cluster of good through moderate-to-poor performers. The characteristics and membership of clusters varied from year to year and were determined by the identity and magnitude of performance of the individual variables. Criticisms of the league table include: perceived unfairness, as it did not take into consideration district peculiarities; and being oversummarized and not adequately informative. Clustering organizes the many data points into clusters of similar entities according to an agreed set of indicators and can provide the beginning point for identifying factors behind the observed performance of districts. Although league table ranking emphasize summation and external control, clustering has the potential to encourage a formative, learning approach. More research is required to shed more light on factors behind observed performance of the different clusters. Other countries especially low-income countries that share many similarities with Uganda can learn from these experiences. PMID:26024882

An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone.

PubMed

Bertone, Maria Paola; Witter, Sophie

2015-09-01

The need for evidence-based practice calls for research focussing not only on the effectiveness of interventions and their translation into policies, but also on implementation processes and the factors influencing them, in particular for complex health system policies. In this paper, we use the lens of one of the health system's 'building blocks', human resources for health (HRH), to examine the implementation of official policies on HRH incentives and the emergence of informal practices in three districts of Sierra Leone. Our mixed-methods research draws mostly from 18 key informant interviews at district level. Data are organised using a political economy framework which focuses on the dynamic interactions between structure (context, historical legacies, institutions) and agency (actors, agendas, power relations) to show how these elements affect the HRH incentive practices in each district. It appears that the official policies are re-shaped both by implementation challenges and by informal practices emerging at local level as the result of the district-level dynamics and negotiations between District Health Management Teams (DHMTs) and nongovernmental organisations (NGOs). Emerging informal practices take the form of selective supervision, salary supplementations and per diems paid to health workers, and aim to ensure a better fit between the actors' agendas and the incentive package. Importantly, the negotiations which shape such practices are characterised by a substantial asymmetry of power between DHMTs and NGOs. In conclusion, our findings reveal the influence of NGOs on the HRH incentive package and highlight the need to empower DHMTs to limit the discrepancy between policies defined at central level and practices in the districts, and to reduce inequalities in health worker remuneration across districts. For Sierra Leone, these findings are now more relevant than ever as new players enter the stage at district level, as part of the Ebola response and post-Ebola reconstruction. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Microbial Load of Hard Red Winter Wheat Produced at Three Growing Environments across Nebraska, USA.

PubMed

Sabillón, Luis; Stratton, Jayne; Rose, Devin J; Regassa, Teshome H; Bianchini, Andréia

2016-04-01

Post-flowering weather variables in farm fields may influence the microbial loads of wheat grain. In this study, the effects of weather variables following wheat flowering on the microbiological quality of wheat were evaluated over two consecutive growing seasons (2011 to 2012 and 2012 to 2013) in the state of Nebraska, USA. Three hard red winter wheat lines, including two commercial cultivars (Overland and McGill) and one experimental line (NW07505), were planted in three regions with contrasting key weather variables (Southeast, South Central, and Panhandle district) to ensure that developing seeds were exposed to different weather conditions. The natural microbial flora and deoxynivalenol concentrations of 54 freshly harvested wheat samples (three samples per wheat line, with a total of 9 samples per district) were analyzed to evaluate the impacts of the weather conditions prevailing from flowering to harvesting in each growing location (district) and season on the microbiological quality and safety of wheat grain. In 2012, the values for aerobic plate counts, Enterobacteriaceae, yeasts, molds, and internal mold infection levels were significantly lower in grain samples collected from the Panhandle district than in grain harvested from the South Central and Southeastern districts. No significant differences in the yeast counts were found in grain collected from all districts in 2013, but the levels of internal mold infection and mold counts were significantly higher in grain from the Southeastern district than in grain from the Panhandle district. Deoxynivalenol was detected in all districts; however, the concentrations were below the advisory level of 1 mg/kg for processed wheat. Microbial growth during grain development seems to be dependent on the existence of a threshold level of weather variables during the season. In general, the microbial loads in wheat grain tended to be lower in those areas with lower relative humidity levels (below 55%) and with temperatures lower than 13.7°C and higher than 31.5°C.

Estimating the Efficiency of Michigan's Rural and Urban Public School Districts

ERIC Educational Resources Information Center

Maranowski, Rita

2012-01-01

This study examined student achievement in Michigan public school districts to determine if rural school districts are demonstrating greater financial efficiency by producing higher levels of student achievement than school districts in other geographic locations with similar socioeconomics. Three models were developed using multiple regression…

Developing, Managing, and Gaining Public Support for the School District Budget.

ERIC Educational Resources Information Center

Holly, William J.

1987-01-01

This bulletin focuses on four aspects of budget development and management in local school districts. Chapter 1 describes the general budget development process, highlighting variations some Oregon districts have found useful. The chapter outlines the responsibilities of educational agencies and district staff members at various levels and reviews…

An Analysis of a High Performing School District's Culture

ERIC Educational Resources Information Center

Corum, Kenneth D.; Schuetz, Todd B.

2012-01-01

This report describes a problem based learning project focusing on the cultural elements of a high performing school district. Current literature on school district culture provides numerous cultural elements that are present in high performing school districts. With the current climate in education placing pressure on school districts to perform…

Lessons Learned: A Strategic Alliance to Improve Elementary Physical Education in an Urban School District.

PubMed

Thompson, Hannah R; Haguewood, Robin; Tantoco, Nicole; Madsen, Kristine A

2015-01-01

Physical education (PE) can help to achieve important public health goals, but is often under-prioritized and lacking in schools. To detail the actions, impact, and successes of a strategic alliance formed by three collaborating organizations to improve PE in a large California school district. Semistructured interviews with alliance members, principals, and teachers in 20 elementary schools, 3 years after the alliance formation. Interviewees reported district-level increases in priority and funding for PE and attributed improvements to the alliance's collection and dissemination of local data on the status of PE. Common goals, trust, and open communication within the alliance were seen as critical to the alliance's success. However, changes in district- or school-level accountability measures for PE were not reported. This strategic alliance succeeded in promoting district-level priority and funding for PE. Ongoing alliance work will focus on increasing accountability measures for PE, which may take longer to implement.

Analysis on the Bullying Tendencies and Value Preferences of High School Students According to Level of Receiving Physical Education and Sports Course

ERIC Educational Resources Information Center

Savucu, Yüksel; Kanat, Metin; Karadag, Mustafa; Sezer, Süreyya. Y.; Yücel, Ali S.

2017-01-01

The aim of this study was to investigate the bullying tendencies and value preferences of high school students according to the level of taking physical education and sports course. The research population of the study was composed of high school students studying in Yesilyurt and Battalgazi districts of Malatya province during 2013-2014 academic…

Spatial variation of natural radiation and childhood leukaemia incidence in Great Britain.

PubMed

Richardson, S; Monfort, C; Green, M; Draper, G; Muirhead, C

This paper describes an analysis of the geographical variation of childhood leukaemia incidence in Great Britain over a 15 year period in relation to natural radiation (gamma and radon). Data at the level of the 459 district level local authorities in England, Wales and regional districts in Scotland are analysed in two complementary ways: first, by Poisson regressions with the inclusion of environmental covariates and a smooth spatial structure; secondly, by a hierarchical Bayesian model in which extra-Poisson variability is modelled explicitly in terms of spatial and non-spatial components. From this analysis, we deduce a strong indication that a main part of the variability is accounted for by a local neighbourhood 'clustering' structure. This structure is furthermore relatively stable over the 15 year period for the lymphocytic leukaemias which make up the majority of observed cases. We found no evidence of a positive association of childhood leukaemia incidence with outdoor or indoor gamma radiation levels. There is no consistent evidence of any association with radon levels. Indeed, in the Poisson regressions, a significant positive association was only observed for one 5-year period, a result which is not compatible with a stable environmental effect. Moreover, this positive association became clearly non-significant when over-dispersion relative to the Poisson distribution was taken into account.

Regional variations in mortality rates in England and Wales: an analysis using multi-level modelling.

PubMed

Langford, I H; Bentham, G

1996-03-01

Mortality rates in England and Wales display a persistent regional pattern indicating generally poorer health in the North and West. Some of this is simply a reflection of regional differences in the extent of social deprivation which is known to exert a profound influence on health. Part of the pattern may also be the result of regional differences in urbanization which also affect mortality rates. However, there may be important regional differences over and above these compositional effects. This study attempts to establish the magnitude of such independent regional differences in mortality rates by using the techniques of multi-level modelling. Standardized mortality rates (SMRs) for males and females under 65 for 1989-91 in local authority districts are grouped into categories using the ACORN classification scheme. The Townsend Index is included as a measure of social deprivation. Using a cross-classified multi-level model, it is shown that region accounts for approximately four times more variation in SMRs than is explained by the ACORN classification. Analysis of diagnostic residuals show a clear North-South divide in excess mortality when both regional and socio-economic classification of districts are modelled simultaneously, a possibility allowed for by the use of a multi-level model.

The Role of School District Science Coordinators in the District-Wide Appropriation of an Online Resource Discovery and Sharing Tool for Teachers

ERIC Educational Resources Information Center

Lee, Victor R.; Leary, Heather M.; Sellers, Linda; Recker, Mimi

2014-01-01

When introducing and implementing a new technology for science teachers within a school district, we must consider not only the end users but also the roles and influence district personnel have on the eventual appropriation of that technology. School districts are, by their nature, complex systems with multiple individuals at different levels in…

'Busyness' and the preclusion of quality palliative district nursing care.

PubMed

Nagington, Maurice; Luker, Karen; Walshe, Catherine

2013-12-01

Ethical care is beginning to be recognised as care that accounts for the views of those at the receiving end of care. However, in the context of palliative and supportive district nursing care, the patients' and their carers' views are seldom heard. This qualitative research study explores these views. Data were collected through semi-structured interviews with 26 patients with palliative and supportive care needs receiving district nursing care, and 13 of their carers. Participants were recruited via community nurses and hospices between September 2010 and October 2011. Post-structural discourse analysis is used to examine how discourses operate on a moral level. One discourse, 'busyness', is argued to preclude a moral form of nursing care. The discourse of friendship is presented to contrast this. Discussion explores Gallagher's 'slow ethics' and challenges the currently accepted ways of measuring to improve quality of care concluding that quality cannot be measured.

The role of the pharmacy technician in the skill-mixed district nursing team.

PubMed

McGraw, Caroline; Coleman, Bridget; Ashman, Lea; Hayes, Sarah

2012-09-01

Registered nurses in the district nursing service delegate a broad range of medication administration activities to healthcare assistants. Although healthcare assistants have provided extra capacity, not all activities are suitable for delegation to unregulated practitioners. At the same time, their competency assessment is often patient-specific and demands significant registered nursing input. The purpose of this 6-month pilot programme was to test the premise that the employment of a pharmacy technician in the district nursing service would enhance productivity levels and deliver cost savings. Activities delegated included the administration of oral tablets and subcutaneous insulin and low molecular weight heparin injections. The evaluation found that the introduction of the pharmacy technician was associated with neither enhanced productivity nor more than modest cost savings. However, role redesign is a long-term activity and their role could be built on with further competency analysis.

Geographical and socioeconomic inequalities in women and children's nutritional status in Pakistan in 2011: an analysis of data from a nationally representative survey

PubMed Central

Cesare, Mariachiara Di; Bhatti, Zaid; Soofi, Sajid B; Fortunato, Lea; Ezzati, Majid; Bhutta, Zulfiqar A

2015-01-01

Summary Background Pakistan has one of the highest levels of child and maternal undernutrition worldwide, but little information about geographical and socioeconomic inequalities is available. We aimed to analyse anthropometric indicators for childhood and maternal nutrition at a district level in Pakistan and assess the association of nutritional status with food security and maternal and household socioeconomic factors. Methods We used data from the 2011 Pakistan National Nutrition Survey, which included anthropometric measurements for 33 638 children younger than 5 years and 24 826 women of childbearing age. We estimated the prevalences of stunting, wasting, and underweight among children and of underweight, overweight, and obesity in women for all 143 districts of Pakistan using a Bayesian spatial technique. We used a mixed-effect linear model to analyse the association of nutritional status with individual and household sociodemographic factors and food security. Findings Stunting prevalence in Pakistan's districts ranged between 22% (95% credible interval 19–26) and 76% (69–83); the lowest figures for wasting and underweight were both less than 2·5% and the highest were 42% (34–50) for wasting and 54% (49–59) for underweight. In 106 districts, more women were overweight than were underweight; in 49 of these districts more women were obese than were underweight. Children were better nourished if their mothers were taller or had higher weight, if they lived in wealthier households, and if their mothers had 10 or more years of education. Severe food insecurity was associated with worse nutritional outcomes for both children and women. Interpretation We noted large social and geographical inequalities in child and maternal nutrition in Pakistan, masked by national and provincial averages. Pakistan is also beginning to face the concurrent challenge of high burden of childhood undernutrition and overweight and obesity among women of reproductive age. Planning, implementation, and evaluation of programmes for food and nutrition should be based on district-level needs and outcomes. Funding Bill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council. PMID:25794676

Geographical and socioeconomic inequalities in women and children's nutritional status in Pakistan in 2011: an analysis of data from a nationally representative survey.

PubMed

Di Cesare, Mariachiara; Bhatti, Zaid; Soofi, Sajid B; Fortunato, Lea; Ezzati, Majid; Bhutta, Zulfiqar A

2015-04-01

Pakistan has one of the highest levels of child and maternal undernutrition worldwide, but little information about geographical and socioeconomic inequalities is available. We aimed to analyse anthropometric indicators for childhood and maternal nutrition at a district level in Pakistan and assess the association of nutritional status with food security and maternal and household socioeconomic factors. We used data from the 2011 Pakistan National Nutrition Survey, which included anthropometric measurements for 33 638 children younger than 5 years and 24 826 women of childbearing age. We estimated the prevalences of stunting, wasting, and underweight among children and of underweight, overweight, and obesity in women for all 143 districts of Pakistan using a Bayesian spatial technique. We used a mixed-effect linear model to analyse the association of nutritional status with individual and household sociodemographic factors and food security. Stunting prevalence in Pakistan's districts ranged between 22% (95% credible interval 19-26) and 76% (69-83); the lowest figures for wasting and underweight were both less than 2·5% and the highest were 42% (34-50) for wasting and 54% (49-59) for underweight. In 106 districts, more women were overweight than were underweight; in 49 of these districts more women were obese than were underweight. Children were better nourished if their mothers were taller or had higher weight, if they lived in wealthier households, and if their mothers had 10 or more years of education. Severe food insecurity was associated with worse nutritional outcomes for both children and women. We noted large social and geographical inequalities in child and maternal nutrition in Pakistan, masked by national and provincial averages. Pakistan is also beginning to face the concurrent challenge of high burden of childhood undernutrition and overweight and obesity among women of reproductive age. Planning, implementation, and evaluation of programmes for food and nutrition should be based on district-level needs and outcomes. Bill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council. Copyright © 2015 Di Cesare et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.

The challenges of achieving high training coverage for IMCI: case studies from Kenya and Tanzania

PubMed Central

Mushi, Hildegalda P; Mullei, Kethi; Macha, Janet; Wafula, Frank; Borghi, Josephine; Goodman, Catherine; Gilson, Lucy

2011-01-01

Health worker training is a key component of the integrated management of childhood illness (IMCI). However, training coverage remains low in many countries. We conducted in-depth case studies in two East African countries to examine the factors underlying low training coverage 10 years after IMCI had been adopted as policy. A document review and in-depth semi-structured interviews with stakeholders at facility, district, regional/provincial and national levels in two districts in Kenya (Homa Bay and Malindi) and Tanzania (Bunda and Tarime) were carried out in 2007–08. Bunda and Malindi achieved higher levels of training coverage (44% and 25%) compared with Tarime and Homa Bay (5% and 13%). Key factors allowing the first two districts to perform better were: strong district leadership and personal commitment to IMCI, which facilitated access to external funding and encouraged local-level policy adaptation; sensitization and training of district health managers; and lower staff turnover. However, IMCI training coverage remained well below target levels across all sites. The main barrier to expanding coverage was the cost of training due to its duration, the number of facilitators and its residential nature. Mechanisms for financing IMCI also restricted district capacity to raise funds. In Tanzania, districts could not spend more than 10% of their budgets on training. In Kenya, limited financial decentralization meant that district managers had to rely on donors for financial support. Critically, the low priority given to IMCI at national and international levels also limited the expansion of training. Levels of domestic and donor support for IMCI have diminished over time in favour of vertical programmes, partly due to the difficulty in monitoring and measuring the impact of an integrated intervention like IMCI. Alternative, lower cost methods of IMCI training need to be promoted, and greater advocacy for IMCI is needed both nationally and internationally. PMID:21047808

The Value of NJ School District Demographic Data in Explaining School District NJ ASK Grade 3 Language Arts and Mathematics Scores

ERIC Educational Resources Information Center

Turnamian, Peter G.

2012-01-01

This study examined the strength and direction of the relationship between 2009 NJ ASK 3 Language Arts and Mathematics scores and district social and demographic data (i.e., lone-parent household, level of parental education, and household income levels) found in the extant literature to influence student achievement on high-stakes standardized…

Spatio-temporal analysis of small-area intestinal parasites infections in Ghana.

PubMed

Osei, F B; Stein, A

2017-09-22

Intestinal parasites infection is a major public health burden in low and middle-income countries. In Ghana, it is amongst the top five morbidities. In order to optimize scarce resources, reliable information on its geographical distribution is needed to guide periodic mass drug administration to populations of high risk. We analyzed district level morbidities of intestinal parasites between 2010 and 2014 using exploratory spatial analysis and geostatistics. We found a significantly positive Moran's Index of spatial autocorrelation for each year, suggesting that adjoining districts have similar risk levels. Using local Moran's Index, we found high-high clusters extending towards the Guinea and Sudan Savannah ecological zones, whereas low-low clusters extended within the semi-deciduous forest and transitional ecological zones. Variograms indicated that local and regional scale risk factors modulate the variation of intestinal parasites. Poisson kriging maps showed smoothed spatially varied distribution of intestinal parasites risk. These emphasize the need for a follow-up investigation into the exact determining factors modulating the observed patterns. The findings also underscored the potential of exploratory spatial analysis and geostatistics as tools for visualizing the spatial distribution of small area intestinal worms infections.

Source of atmospheric heavy metals in winter in Foshan, China.

PubMed

Tan, Ji-Hua; Duan, Jing-Chun; Ma, Yong-Liang; Yang, Fu-Mo; Cheng, Yuan; He, Ke-Bin; Yu, Yong-Chang; Wang, Jie-Wen

2014-09-15

Foshan is a ceramics manufacturing center in the world and the most polluted city in the Pearl River Delta (PRD) in southern China measured by the levels of atmospheric heavy metals. PM2.5 samples were collected in Foshan in winter 2008. Among the 22 elements and ions analyzed, 7 heavy metals (Zn, V, Mn, Cu, As, Cd and Pb) were studied in depth for their levels, spatiotemporal variations and sources. The ambient concentrations of the heavy metals were much higher than the reported average concentrations in China. The levels of Pb (675.7 ± 378.5 ng/m(3)), As (76.6 ± 49.1 ng/m(3)) and Cd (42.6 ± 45.2 ng/m(3)) exceeded the reference values of NAAQS (GB3095-2012) and the health guidelines of the World Health Organization. Generally, the levels of atmospheric heavy metals showed spatial distribution as: downtown site (CC, Chancheng District)>urban sites (NH and SD, Nanhai and Shunde Districts)>rural site (SS, Shanshui District). Two sources of heavy metals, the ceramic and aluminum industries, were identified during the sampling period. The large number of ceramic manufactures was responsible for the high levels of atmospheric Zn, Pb and As in Chancheng District. Transport from an aluminum industry park under light north-west winds contributed high levels of Cd to the SS site (Shanshui District). The average concentration of Cd under north-west wind was 220 ng/m(3), 20.5 times higher than those under other wind directions. The high daily maximum enrichment factors (EFs) of Cd, Pb, Zn, As and Cu at all four sites indicated extremely high contamination by local emissions. Back trajectory analysis showed that the heavy metals were also closely associated with the pathway of air mass. A positive matrix factorization (PMF) method was applied to determine the source apportionment of these heavy metals. Five factors (industry including the ceramic industry and coal combustion, vehicle emissions, dust, transportation and sea salt) were identified and industry was the most important source of atmospheric heavy metals. The present paper suggests a control policy on the four heavy metals Cd, Pb, Zn, and Cu, and suggests the inclusion of As in the ceramic industry emission standard in the future. Copyright © 2014 Elsevier B.V. All rights reserved.

Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation.

PubMed

Maluka, Stephen; Kamuzora, Peter; Sansebastián, Miguel; Byskov, Jens; Ndawi, Benedict; Olsen, Øystein E; Hurtig, Anna-Karin

2011-02-10

Despite the growing importance of the Accountability for Reasonableness (A4R) framework in priority setting worldwide, there is still an inadequate understanding of the processes and mechanisms underlying its influence on legitimacy and fairness, as conceived and reflected in service management processes and outcomes. As a result, the ability to draw scientifically sound lessons for the application of the framework to services and interventions is limited. This paper evaluates the experiences of implementing the A4R approach in Mbarali District, Tanzania, in order to find out how the innovation was shaped, enabled, and constrained by the interaction between contexts, mechanisms and outcomes. This study draws on the principles of realist evaluation -- a largely qualitative approach, chiefly concerned with testing and refining programme theories by exploring the complex interactions of contexts, mechanisms, and outcomes. Mixed methods were used in data collection, including individual interviews, non-participant observation, and document reviews. A thematic framework approach was adopted for the data analysis. The study found that while the A4R approach to priority setting was helpful in strengthening transparency, accountability, stakeholder engagement, and fairness, the efforts at integrating it into the current district health system were challenging. Participatory structures under the decentralisation framework, central government's call for partnership in district-level planning and priority setting, perceived needs of stakeholders, as well as active engagement between researchers and decision makers all facilitated the adoption and implementation of the innovation. In contrast, however, limited local autonomy, low level of public awareness, unreliable and untimely funding, inadequate accountability mechanisms, and limited local resources were the major contextual factors that hampered the full implementation. This study documents an important first step in the effort to introduce the ethical framework A4R into district planning processes. This study supports the idea that a greater involvement and accountability among local actors through the A4R process may increase the legitimacy and fairness of priority-setting decisions. Support from researchers in providing a broader and more detailed analysis of health system elements, and the socio-cultural context, could lead to better prediction of the effects of the innovation and pinpoint stakeholders' concerns, thereby illuminating areas that require special attention to promote sustainability.

Does a geographical context of deprivation affect differences in injury mortality? A multilevel analysis in South Korean adults residing in metropolitan cities.

PubMed

Lee, JeSuk; Lee, Weon-Young; Noh, Maengseok; Khang, Young-Ho

2014-05-01

This study aimed to examine whether the socioeconomic context of urban areas affects differences in adult mortality from injuries in the districts of all seven South Korean metropolitan cities, after adjusting for individual demographic and socioeconomic indicators. Two different sets of data were used in this study: (1) the National Death Registration data from 2003 to 2008; and (2) the National Census in 2005. Variables for individual characteristics were gender, age, residential area and educational level. A geographic deprivation index was calculated based on the Carstairs Index. Multilevel Poisson regression models were used to analyse the relationship between area deprivation levels and injury mortality. Greater mortality risks of traffic accidents, falls, suicide and all injuries were found in the elderly, the less educated and men, compared with their counterparts. The most deprived districts were at greater risks of death due to traffic accidents (risk ratio (RR)=1.34; 95% CI 1.05 to 1.73), falls (RR=1.63; 95% CI 1.20 to 2.20), suicide (RR=1.09; 95% CI 1.01 to 1.17) and all injuries (RR=1.14; 95% CI 1.07 to 1.22) compared with the least deprived districts, even after individual level socioeconomic variables were controlled for. However, area level deprivation did not show cross level interactions with the individual level education in estimating fatal injury risks. Both contextual and compositional effects of socioeconomic status on injury mortality among urban areas in South Korea should be considered in allocating resources for injury prevention.

A cross-sectional study to assess the intelligence quotient (IQ) of school going children aged 10-12 years in villages of Mysore district, India with different fluoride levels.

PubMed

Sebastian, Shibu Thomas; Sunitha, S

2015-01-01

Besides dental and skeletal fluorosis, excessive fluoride intake can also affect the central nervous system without first causing the physical deformities associated with skeletal fluorosis. With the existence of widespread endemic fluorosis in India, the possible adverse effect of elevated fluoride in drinking water on the Intelligence Quotient (IQ) level of children is a potentially serious public health problem. This study assessed the Intelligence Quotient (IQ) of school going children aged 10-12 years in villages of Mysore district with different fluoride levels. In this cross-sectional study, 405 school children aged 10-12 years were selected from three villages in Mysore district with normal fluoride (1.20 mg F/l), low fluoride (0.40 mg F/l) and high fluoride (2.20 mg F/l) in their water supplies. A pre designed questionnaire was used to collect the required data for the survey which included socio demographic details, oral hygiene practices, diet history, body mass index and dental fluorosis. Intelligence Quotient was assessed using Raven's colored Progressive Matrices Test. In bivariate analysis, significant relationships were found between water fluoride levels and Intelligence Quotient of school children (P < 0.05). In the high fluoride village, the proportion of children with IQ below 90, i.e. below average IQ was larger compared to normal and low fluoride village. Age, gender, parent education level and family income had no significant association with IQ. School children residing in area with higher than normal water fluoride level demonstrated more impaired development of intelligence when compared to school children residing in areas with normal and low water fluoride levels. Thus, children's intelligence can be affected by high water fluoride levels.

Quality-assurance plan for water-resources activities of the U.S. Geological Survey in Idaho

USGS Publications Warehouse

Packard, F.A.

1996-01-01

To ensure continued confidence in its products, the Water Resources Division of the U.S. Geological Survey implemented a policy that all its scientific work be performed in accordance with a centrally managed quality-assurance program. This report establishes and documents a formal policy for current (1995) quality assurance within the Idaho District of the U.S. Geological Survey. Quality assurance is formalized by describing district organization and operational responsibilities, documenting the district quality-assurance policies, and describing district functions. The districts conducts its work through offices in Boise, Idaho Falls, Twin Falls, Sandpoint, and at the Idaho National Engineering Laboratory. Data-collection programs and interpretive studies are conducted by two operating units, and operational and technical assistance is provided by three support units: (1) Administrative Services advisors provide guidance on various personnel issues and budget functions, (2) computer and reports advisors provide guidance in their fields, and (3) discipline specialists provide technical advice and assistance to the district and to chiefs of various projects. The district's quality-assurance plan is based on an overall policy that provides a framework for defining the precision and accuracy of collected data. The plan is supported by a series of quality-assurance policy statements that describe responsibilities for specific operations in the district's program. The operations are program planning; project planning; project implementation; review and remediation; data collection; equipment calibration and maintenance; data processing and storage; data analysis, synthesis, and interpretation; report preparation and processing; and training. Activities of the district are systematically conducted under a hierarchy of supervision an management that is designed to ensure conformance with Water Resources Division goals quality assurance. The district quality-assurance plan does not describe detailed technical activities that are commonly termed "quality-control procedures." Instead, it focuses on current policies, operations, and responsibilities that are implemented at the management level. Contents of the plan will be reviewed annually and updated as programs and operations change.

The Socioeconomic and Institutional Determinants of Participation in India’s Health Insurance Scheme for the Poor

PubMed Central

Nandi, Arindam; Ashok, Ashvin; Laxminarayan, Ramanan

2013-01-01

The Rashtriya Swasthya Bima Yojana (RSBY), which was introduced in 2008 in India, is a social health insurance scheme that aims to improve healthcare access and provide financial risk protection to the poor. In this study, we analyse the determinants of participation and enrolment in the scheme at the level of districts. We used official data on RSBY enrolment, socioeconomic data from the District Level Household Survey 2007–2008, and additional state-level information on fiscal health, political affiliation, and quality of governance. Results from multivariate probit and OLS analyses suggest that political and institutional factors are among the strongest determinants explaining the variation in participation and enrolment in RSBY. In particular, districts in state governments that are politically affiliated with the opposition or neutral parties at the centre are more likely to participate in RSBY, and have higher levels of enrolment. Districts in states with a lower quality of governance, a pre-existing state-level health insurance scheme, or with a lower level of fiscal deficit as compared to GDP, are significantly less likely to participate, or have lower enrolment rates. Among socioeconomic factors, we find some evidence of weak or imprecise targeting. Districts with a higher share of socioeconomically backward castes are less likely to participate, and their enrolment rates are also lower. Finally, districts with more non-poor households may be more likely to participate, although with lower enrolment rates. PMID:23805211

Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda.

PubMed

Iyer, Hari S; Kamanzi, Emmanuel; Mugunga, Jean Claude; Finnegan, Karen; Uwingabiye, Alice; Shyaka, Edward; Niyonzima, Saleh; Hirschhorn, Lisa R; Drobac, Peter C

2015-01-01

While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline. Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use of limited resources, improve facility readiness, and ensure consistency of facility capacity to provide quality care at the district level.

Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda

PubMed Central

Iyer, Hari S.; Kamanzi, Emmanuel; Mugunga, Jean Claude; Finnegan, Karen; Uwingabiye, Alice; Shyaka, Edward; Niyonzima, Saleh; Hirschhorn, Lisa R.; Drobac, Peter C.

2015-01-01

Background While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. Design The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. Results We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline. Conclusions Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use of limited resources, improve facility readiness, and ensure consistency of facility capacity to provide quality care at the district level. PMID:26140729

From reaching every district to reaching every community: analysis and response to the challenge of equity in immunization in Cambodia.

PubMed

Chan Soeung, Sann; Grundy, John; Duncan, Richard; Thor, Rasoka; Bilous, Julian B

2013-08-01

BACKGROUND An international review of the Cambodian Expanded Programme on Immunization (EPI) in 2010 and other data show that despite immunization coverage increases and vaccine preventable diseases incidence reductions, inequities in access to immunization services exist. Utilizing immunization and health systems literature, analysis of global health databases and the EPI review findings, this paper examines the characteristics of immunization access and outcome inequities, and describes proposed longer-term strategic and operational responses to these problems. Findings The national programme has evolved from earlier central and provincial level planning to strengthening routine immunization coverage through the District level 'Reaching Every District Strategy'. However, despite remarkable improvements, the review found over 20% of children surveyed were not fully immunized, primarily from communities where inequities of both access and impact persist. These inequities relate mainly to socio-economic exposures including wealth and education level, population mobility and ethnicity. To address these problems, a shift in strategic and operational response is proposed that will include (a) a re-focus of planning on facility level to detect disadvantaged communities, (b) establishment of monitoring systems to provide detailed information on community access and utilization, (c) development of communication strategies and health networks that enable providers to adjust service delivery according to the needs of vulnerable populations, and (d) securing financial, management and political commitment for 'reaching every community'. CONCLUSIONS For Cambodia to achieve its immunization equity objectives and disease reduction goals, a shift of emphasis to health centre and community is needed. This approach will maximize the benefits of new vaccine introduction in the coming 'Decade of Vaccines', plus potentially extend the reach of other life-saving maternal and child health interventions to the socially disadvantaged, both in Cambodia and in other countries with a similar level of development.

Integrating socio-economic and infrastructural dimension to reveal hazard vulnerability of coastal districts

NASA Astrophysics Data System (ADS)

Mazumdar, Jublee; Paul, Saikat

2015-04-01

Losses of life and property due to natural hazards have intensified in the past decade, motivating an alteration of disaster management away from simple post event resettlement and rehabilitation. The degree of exposure to hazard for a homogeneous population is not entirely reliant upon nearness to the source of hazard event. Socio-economic factors and infrastructural capability play an important role in determining the vulnerability of a place. This study investigates the vulnerability of eastern coastal states of India from tropical cyclones. The record of past hundred years shows that the physical vulnerability of eastern coastal states is four times as compared to the western coastal states in terms of frequency and intensity of tropical cyclones. Nevertheless, these physical factors played an imperative role in determining the vulnerability of eastern coast. However, the socio-economic and infrastructural factors influence the risk of exposure exponentially. Inclusion of these indicators would provide better insight regarding the preparedness and resilience of settlements to hazard events. In this regard, the present study is an effort to develop an Integrated Vulnerability Model (IVM) based on socio-economic and infrastructural factors for the districts of eastern coastal states of India. A method is proposed for quantifying the socio-economic and infrastructural vulnerability to tropical cyclone in these districts. The variables included in the study are extracted from Census of India, 2011 at district level administrative unit. In the analysis, a large number of variables are reduced to a smaller number of factors by using principal component analysis that represents the socio-economic and infrastructure vulnerability to tropical cyclone. Subsequently, the factor scores in socio-economic Vulnerability Index (SeVI) and Infrastructure Vulnerability Index (InVI) are standardized from 0 to 1, indicating the range from low to high vulnerability. The factor scores are then mapped for spatial analysis. Utilizing SeVI and InVI, the highly vulnerable districts are demonstrated that are likely to face significant challenges in coping with tropical cyclone and require strategies to address the various aspects of socio-economic and infrastructural vulnerability. Moreover, this model can be incorporated not only for multi-level governance but also to integrate it with the real-time weather forecasts to identify the predictive areas of vulnerability.

Examination of the Food and Nutrient Content of School Lunch Menus of Two School Districts in Mississippi

PubMed Central

Addison, Clifton C.; Jenkins, Brenda W.; White, Monique S.; Young, Lavon

2006-01-01

This study examined the diet quality of the school meals in two Mississippi school districts and compared them to the national guidelines. We examined the lunch menus of the two school districts that participated in the National School Lunch Program and School Breakfast Program focusing on food quality and assessing both healthy and unhealthy foods and eating behaviors. This analysis was completed through a computerized review used to accurately determine the nutrient content. Both the standard and the alternative meals provided by the cafeterias in the two school districts exceeded the minimum requirement for calories for all grade levels. The meals from the urban schools cafeteria provide more calories than meals from the cafeteria in the rural school district. Although schools believe that they are making positive changes to children’s diets, the programs are falling short of the nutrient recommendations. Poor nutrition and improper dietary practices are now regarded as important risk factors in the emerging problems of obesity, diabetes mellitus, hypertension and other chronic diseases, with excessive energy intake listed as a possible reason. Dieticians, school professionals and other health care practitioners need to accurately assess energy intake and adequately promote a dietary responsible lifestyle among children. PMID:16968975

Seismic-sequence stratigraphy and geologic structure of the Floridan aquifer system near "Boulder Zone" deep wells in Miami-Dade County, Florida

USGS Publications Warehouse

Cunningham, Kevin J.

2015-01-01

In addition to the preceding seismic-reflection analysis, interpretation of geophysical well log data from four effluent injection wells at the North District “Boulder Zone” Well Field delineated a narrow karst collapse structure beneath the injection facility that extends upward about 900 ft from the top of the Boulder Zone to about 125 ft above the top of the uppermost major permeable zone of the Lower Floridan aquifer. No karst collapse structures were identified in the seismic-reflection profiles acquired near the North District “Boulder Zone” Well Field. However, karst collapse structures at the level of the lowermost major permeable zone of the Lower Floridan aquifer at the South District “Boulder Zone” Well Field are present at three locations, as indicated by seismic-reflection data acquired in the C–1 Canal bordering the south side of the injection facility. Results from the North District “Boulder Zone” Well Field well data indicate that a plausible hydraulic connection between faults and stratiform permeability zones may contribute to the upward transport of effluent, terminating above the base of the deepest U.S. Environmental Protection Agency designated underground source of drinking water at the North District “Boulder Zone” Well Field.

Analysis of variables affecting unemployment rate and detecting for cluster in West Java, Central Java, and East Java in 2012

NASA Astrophysics Data System (ADS)

Samuel, Putra A.; Widyaningsih, Yekti; Lestari, Dian

2016-02-01

The objective of this study is modeling the Unemployment Rate (UR) in West Java, Central Java, and East Java, with rate of disease, infant mortality rate, educational level, population size, proportion of married people, and GDRP as the explanatory variables. Spatial factors are also considered in the modeling since the closer the distance, the higher the correlation. This study uses the secondary data from BPS (Badan Pusat Statistik). The data will be analyzed using Moran I test, to obtain the information about spatial dependence, and using Spatial Autoregressive modeling to obtain the information, which variables are significant affecting UR and how great the influence of the spatial factors. The result is, variables proportion of married people, rate of disease, and population size are related significantly to UR. In all three regions, the Hotspot of unemployed will also be detected districts/cities using Spatial Scan Statistics Method. The results are 22 districts/cities as a regional group with the highest unemployed (Most likely cluster) in the study area; 2 districts/cities as a regional group with the highest unemployed in West Java; 1 district/city as a regional groups with the highest unemployed in Central Java; 15 districts/cities as a regional group with the highest unemployed in East Java.

Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.

PubMed

Luitel, Nagendra P; Jordans, Mark Jd; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H

2015-01-01

Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry of Health and Population (MoHP). Strategies to overcome these challenges included involvement of MoHP in the process, especially by providing psychotropic medicines and appointing a senior level officer to facilitate project activities, and collaboration with National Health Training Centers (NHTC) in training programs. This study describes many challenges facing mental health care in Nepal. Most of these challenges are not new, yet this study contributes to our understanding of these difficulties by outlining the national and district level factors that have a direct influence on the development of a district level mental health care plan.

Detection of anthelmintic resistance in sheep and goat against fenbendazole by faecal egg count reduction test.

PubMed

Singh, Ramandeep; Bal, M S; Singla, L D; Kaur, Paramjit

2017-06-01

Anthelmintic resistance against commonly used anthelmintic fenbendazole was evaluated by employing faecal egg count reduction test (FECRT) in naturally occurring gastrointestinal (GI) nematodes in the semi organized sheep and goat farms of Ludhiana and Amritsar districts. A total of 80 animals (20 each for sheep and goat in both districts) were randomly selected and their faecal samples were examined by qualitative and quantitative parasitological techniques. Results indicate presence of high level of resistance against fenbendazole in both sheep and goat population of Ludhiana and Amritsar districts. More resistance was observed in the GI nematodes from animals reared in Amritsar district as compared to Ludhiana district. The level of anthelmintic resistance observed was apparently more in sheep than goats.

A comparison of dental hygienists' salaries to state dental supervision levels.

PubMed

Catlett, April

2014-12-01

The purpose of this study is to evaluate the effect of dental supervision on registered dental hygienists' salaries in the 50 states and District of Columbia by comparing the average dental hygiene salaries from the largest metropolitan city within each state from May 2011, the most recent valid data, in relation to the required level of dental supervision. A retrospective contrasted-group quasi-experimental design analysis was conducted using the most current mean dental hygiene salaries for the largest metropolitan city within each state and the District of Columbia which was matched to the appropriate dental supervision level. In addition, a dental assisting salary control group was utilized and correlated to the appropriate dental hygienist salary in the same metropolitan city and state. Samples were obtained from the U.S. Department of Labor. A multivariate analysis of variance (MANOVA) statistical analysis was utilized to assess the relationship of the 5 levels of dentist supervision, with the registered dental hygienist salaries. The MANOVA analysis was also utilized to assess the control group, dental assistant salaries. No statistically significant results were found among the dental supervision levels on the measures of dental hygiene salaries and dental assistant salaries. Wilks's Λ=0.81, F (8, 90)=1.29, p=0.26. Analyses of variances (ANOVA) on the dependent variables were also conducted as follow-up tests to the MANOVA. Study results suggest dental hygienists who are required to have a dentist on the premises to complete any dental treatment obtain similar salaries to those dental hygienists who are allowed to work in some settings unsupervised by a dentist. Therefore, dental supervision does not seem to have an impact on dental hygienists' salaries. Copyright © 2014 The American Dental Hygienists’ Association.

Promoting Children's and Adolescents' Social and Emotional Development: District Adaptations of a Theory of Action.

PubMed

Kendziora, Kimberly; Osher, David

2016-01-01

This article contributes to the broader discussion of promotion, prevention, and intervention in child and adolescent mental health by describing implementation and early outcomes of an 8-school district demonstration project aimed at making the promotion of social and emotional learning a systemic part of school districts' practice. Eight districts are 2-3 years in to their participation in the 6-year project. The districts are large, are predominantly urban, and serve many students who are at disadvantage. The evaluation involved collection of qualitative data to measure the degree to which the districts realized the goals established in the initiative's theory of action, as well as school climate data, extant student records, and surveys of students' social and emotional competence. To date, results show that districts have followed highly individual pathways toward integrating social and emotional learning systemically, and all have made progress over time. Although school-level implementation remains at moderate levels, 2 districts in which we could examine school climate showed gains from preinitiative years. Four of 6 measured districts showed improvement in social and emotional competence for students in Grade 3, and achievement and discipline showed overall improvements across all districts. Overall findings show that implementation of the initiative's theory of action by school districts is feasible, even in times of budgetary stress and leadership turnover. This establishes the potential for school districts to serve as a lever of change in the promotion of students' social and emotional development and mental wellness.

The Intended Curriculum in Co-operative Education in Ontario Secondary Schools: An Analysis of School District Documents.

ERIC Educational Resources Information Center

Hutchinson, Nancy L.; Munby, Hugh; Chin, Peter; Edwards, Karol Lyn; Steiner-Bell, Karin; Chapman, Christine; Ho, Katherine; de Espana, Wendy Mills

2001-01-01

Analysis of cooperative education policy documents from nine Ontario school districts indicated that statements about evaluation, remediation, equity, and teacher qualifications were inconsistent. Although the Ministry of Education and Training prescribes co-op for delivery of academic subjects. districts focus exclusively on career preparation…

High School Administrative Staffing in Washington State: Principal Perspectives on Resource Needs and Utilization

ERIC Educational Resources Information Center

Steach, John C.

2011-01-01

This mixed methods study explored how high school principals prioritize their work and utilize available human resources to adjust to inadequate administrative staffing. Analysis of staffing levels across the state of Washington and specifically inside two eastern Washington districts framed interview questions for central office administration…

Analysis of Special Education Mediations in Texas, 2006-08

ERIC Educational Resources Information Center

Davison, Diana Lane

2012-01-01

The purpose of this study was to explore variables which might influence the frequency of Texas special education mediations used for dispute resolution. Variables such as district size, location, economic level, and the State Accountability Rating were investigated and evaluated. In order to determine if there were any relationships between the…

Public School Choice in the District of Columbia: A Descriptive Analysis. Brief 13

ERIC Educational Resources Information Center

Ozek, Umut

2011-01-01

Increasing parental choice has been a leading theme of recent education policy intended to enhance the academic achievement of low-performing students in the United States. These policies aim to "level the playing field" in access to high-quality education for disadvantaged students who cannot otherwise afford higher-quality schooling…

State Teacher Salary Schedules. Policy Analysis

ERIC Educational Resources Information Center

Griffith, Michael

2016-01-01

In the United States most teacher compensation issues are decided at the school district level. However, a group of states have chosen to play a role in teacher pay decisions by instituting statewide teacher salary schedules. Education Commission of the States has found that 17 states currently make use of teacher salary schedules. This education…

Race to Top Buy-In Level Examined

ERIC Educational Resources Information Center

McNeil, Michele

2010-01-01

States significantly increased buy-in from local teachers' unions in round two of the Race to the Top competition, but made far less progress in enlisting districts or expanding the number of students affected by the states' education reform plans. Those patterns emerged from an "Education Week" analysis of applications from 29 states…

An Analysis of Rural Unemployment Using a Human Resources Development Perspective.

ERIC Educational Resources Information Center

Napier, Ted L.; Jarrett, Charles W.

Investigation indicated factors other than human resource variables must be used to understand unemployment status. Based on a 1979 survey of a random sample (N=640) of rural adult California residents from a multi-county development district, 15 human resource development factors (including educational level, job training, match of work skills…

[Prevalence and risk factors of Enterobius vermicularis among preschool children in kindergartens in Luohu District, Shenzhen City].

PubMed

Kuang, Cui-ping; Wu, Xiao-liang; Chen, Wu-shen; Wu, Fei-fei; Zhuo, Fei

2015-02-01

To understand the prevalence and risk factors of Enterobius vermicularis among preschool children in kindergartens in Luohu District, Shenzhen City. A total of 489 children in 6 kindergartens were selected by the stratified sampling method and investigated for E. vermicularis infection by the cellophane anal swab technique. The information of sanitary condition of the kindergartens, personal hygiene, and family hygiene were investigated by questionnaire. The infection rate of E. vermicularis was 10.2% (50/489). The single factor analysis indicated that the following factors might related to the infection: the different classes of kindergartens, grades, ground of bed ioom, private toilet, types of taps and beds, bed management, education levels of parents, frequency of shower and washing anus, and washing hands before meal and after WC. The multivariate Logistic analysis indicated that the bed management, education level of mothers, frequency of washing anus, and private toilet were independent risk factors for E. vermicularis infection. To control the infection of E. vermicularis, the circumstance and management of kindergartens, parents' knowledge of E. vernicularis infection, and children's healthy habit need improve.

The Distribution of Climate Change Public Opinion in Canada.

PubMed

Mildenberger, Matto; Howe, Peter; Lachapelle, Erick; Stokes, Leah; Marlon, Jennifer; Gravelle, Timothy

2016-01-01

While climate scientists have developed high resolution data sets on the distribution of climate risks, we still lack comparable data on the local distribution of public climate change opinions. This paper provides the first effort to estimate local climate and energy opinion variability outside the United States. Using a multi-level regression and post-stratification (MRP) approach, we estimate opinion in federal electoral districts and provinces. We demonstrate that a majority of the Canadian public consistently believes that climate change is happening. Belief in climate change's causes varies geographically, with more people attributing it to human activity in urban as opposed to rural areas. Most prominently, we find majority support for carbon cap and trade policy in every province and district. By contrast, support for carbon taxation is more heterogeneous. Compared to the distribution of US climate opinions, Canadians believe climate change is happening at higher levels. This new opinion data set will support climate policy analysis and climate policy decision making at national, provincial and local levels.

The Distribution of Climate Change Public Opinion in Canada

PubMed Central

Gravelle, Timothy

2016-01-01

While climate scientists have developed high resolution data sets on the distribution of climate risks, we still lack comparable data on the local distribution of public climate change opinions. This paper provides the first effort to estimate local climate and energy opinion variability outside the United States. Using a multi-level regression and post-stratification (MRP) approach, we estimate opinion in federal electoral districts and provinces. We demonstrate that a majority of the Canadian public consistently believes that climate change is happening. Belief in climate change’s causes varies geographically, with more people attributing it to human activity in urban as opposed to rural areas. Most prominently, we find majority support for carbon cap and trade policy in every province and district. By contrast, support for carbon taxation is more heterogeneous. Compared to the distribution of US climate opinions, Canadians believe climate change is happening at higher levels. This new opinion data set will support climate policy analysis and climate policy decision making at national, provincial and local levels. PMID:27486659

Sexual Harassment Policies in Florida School Districts.

ERIC Educational Resources Information Center

Rienzo, Barbara A.; Moore, Michele Johnson

1998-01-01

Investigated the extent to which Florida's school districts complied with the Florida Department of Education's (FDOE) recommendations for addressing sexual harassment in schools. Surveys of district equity coordinators and analysis of policies indicated that most districts approved sexual harassment policies incorporating many FDOE…

District decision-making for health in low-income settings: a feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia.

PubMed

Avan, Bilal Iqbal; Berhanu, Della; Umar, Nasir; Wickremasinghe, Deepthi; Schellenberg, Joanna

2016-09-01

Low-resource settings often have limited use of local data for health system planning and decision-making. To promote local data use for decision-making and priority setting, we propose an adapted framework: a data-informed platform for health (DIPH) aimed at guiding coordination, bringing together key data from the public and private sectors on inputs and processes. In working to transform this framework from a concept to a health systems initiative, we undertook a series of implementation research activities including background assessment, testing and scaling up of the intervention. This first paper of four reports the feasibility of the approach in a district health systems context in five districts of India, Nigeria and Ethiopia. We selected five districts using predefined criteria and in collaboration with governments. After scoping visits, an in-depth field visit included interviews with key health stakeholders, focus group discussions with service-delivery staff and record review. For analysis, we used five dimensions of feasibility research based on the TELOS framework: technology and systems, economic, legal and political, operational and scheduling feasibility. We found no standardized process for data-based district level decision-making, and substantial obstacles in all three countries. Compared with study areas in Ethiopia and Nigeria, the health system in Uttar Pradesh is relatively amenable to the DIPH, having relative strengths in infrastructure, technological and technical expertise, and financial resources, as well as a district-level stakeholder forum. However, a key challenge is the absence of an effective legal framework for engagement with India's extensive private health sector. While priority-setting may depend on factors beyond better use of local data, we conclude that a formative phase of intervention development and pilot-testing is warranted as a next step. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Prioritizing health system and disease burden factors: an evaluation of the net benefit of transferring health technology interventions to different districts in Zimbabwe.

PubMed

Shamu, Shepherd; Rusakaniko, Simbarashe; Hongoro, Charles

2016-01-01

Health-care technologies (HCTs) play an important role in any country's health-care system. Zimbabwe's health-care system uses a lot of HCTs developed in other countries. However, a number of local factors have affected the absorption and use of these technologies. We therefore set out to test the hypothesis that the net benefit regression framework (NBRF) could be a helpful benefit testing model that enables assessment of intra-national variables in HCT transfer. We used an NBRF model to assess the benefits of transferring cost-effective technologies to different jurisdictions. We used the country's 57 administrative districts to proxy different jurisdictions. For the dependent variable, we combined the cost and effectiveness ratios with the districts' per capita health expenditure. The cost and effectiveness ratios were obtained from HIV/AIDS and malaria randomized controlled trials, which did either a prospective or retrospective cost-effectiveness analysis. The independent variables were district demographic and socioeconomic determinants of health. The study showed that intra-national variation resulted in different net benefits of the same health technology intervention if implemented in different districts in Zimbabwe. The study showed that population data, health data, infrastructure, demographic and health-seeking behavior had significant effects on the net margin benefit for the different districts. The net benefits also differed in terms of magnitude as a result of the local factors. Net benefit testing using local data is a very useful tool for assessing the transferability and further adoption of HCTs developed elsewhere. However, adopting interventions with a positive net benefit should also not be an end in itself. Information on positive or negative net benefit could also be used to ascertain either the level of future savings that a technology can realize or the level of investment needed for the particular technology to become beneficial.

District decision-making for health in low-income settings: a feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia

PubMed Central

Avan, Bilal Iqbal; Berhanu, Della; Umar, Nasir; Wickremasinghe, Deepthi; Schellenberg, Joanna

2016-01-01

Low-resource settings often have limited use of local data for health system planning and decision-making. To promote local data use for decision-making and priority setting, we propose an adapted framework: a data-informed platform for health (DIPH) aimed at guiding coordination, bringing together key data from the public and private sectors on inputs and processes. In working to transform this framework from a concept to a health systems initiative, we undertook a series of implementation research activities including background assessment, testing and scaling up of the intervention. This first paper of four reports the feasibility of the approach in a district health systems context in five districts of India, Nigeria and Ethiopia. We selected five districts using predefined criteria and in collaboration with governments. After scoping visits, an in-depth field visit included interviews with key health stakeholders, focus group discussions with service-delivery staff and record review. For analysis, we used five dimensions of feasibility research based on the TELOS framework: technology and systems, economic, legal and political, operational and scheduling feasibility. We found no standardized process for data-based district level decision-making, and substantial obstacles in all three countries. Compared with study areas in Ethiopia and Nigeria, the health system in Uttar Pradesh is relatively amenable to the DIPH, having relative strengths in infrastructure, technological and technical expertise, and financial resources, as well as a district-level stakeholder forum. However, a key challenge is the absence of an effective legal framework for engagement with India’s extensive private health sector. While priority-setting may depend on factors beyond better use of local data, we conclude that a formative phase of intervention development and pilot-testing is warranted as a next step. PMID:27591204

The Burden of Leprosy in Cameroon: Fifteen Years into the Post-elimination Era.

PubMed

Tabah, Earnest Njih; Nsagha, Dickson Shey; Bissek, Anne-Cecile Zoung-Kanyi; Bratschi, Martin W; Njamnshi, Theophilus Ngeh; Plushke, Gerd; Njamnshi, Alfred Kongnyu

2016-10-01

Cameroon achieved the elimination target of leprosy in 2000, and has maintained this status ever since. However, a number of health districts in the country continue to report significant numbers of leprosy cases. The aim of this study was to assess the burden of leprosy in Cameroon from 2000 to 2014. We obtained and analysed using the new leprosy burden concept of analysis, leprosy surveillance data collected between 2000 and 2014 from the National Leprosy Control Programme. Cameroon achieved leprosy elimination in 2000, registering a prevalence rate of 0.94/10,000 population. The prevalence rate dropped further to reach 0.20/10,000 population (78% reduction) in 2014. Similarly, the new case detection rate dropped from 4.88/100,000 population in 2000 to 1.46/100,000 population (85.3% reduction) in 2014. All 10 regions of the country achieved leprosy elimination between 2000 and 2014; however, 10 health districts were still to do so by 2014. The number of high-leprosy-burden regions decreased from 8 in 2000 to 1 in 2014. Seven and two regions were respectively medium and low-burdened at the end of 2014. At the health districts level, 18 remained at the high-leprosy-burdened level in 2014. The leprosy prevalence and detection rates as well as the overall leprosy burden in Cameroon have dropped significantly between 2000 and 2014. However, a good number of health districts remain high-leprosy-burdened. The National Leprosy Control Programme should focus efforts on these health districts in the next coming years in order to further reduce the burden of leprosy in the country.

The Burden of Leprosy in Cameroon: Fifteen Years into the Post-elimination Era

PubMed Central

Tabah, Earnest Njih; Nsagha, Dickson Shey; Bissek, Anne-Cecile Zoung-Kanyi; Bratschi, Martin W.; Njamnshi, Theophilus Ngeh; Plushke, Gerd; Njamnshi, Alfred Kongnyu

2016-01-01

Background Cameroon achieved the elimination target of leprosy in 2000, and has maintained this status ever since. However, a number of health districts in the country continue to report significant numbers of leprosy cases. The aim of this study was to assess the burden of leprosy in Cameroon from 2000 to 2014. Methods We obtained and analysed using the new leprosy burden concept of analysis, leprosy surveillance data collected between 2000 and 2014 from the National Leprosy Control Programme. Principal findings Cameroon achieved leprosy elimination in 2000, registering a prevalence rate of 0.94/10,000 population. The prevalence rate dropped further to reach 0.20/10,000 population (78% reduction) in 2014. Similarly, the new case detection rate dropped from 4.88/100,000 population in 2000 to 1.46/100,000 population (85.3% reduction) in 2014. All 10 regions of the country achieved leprosy elimination between 2000 and 2014; however, 10 health districts were still to do so by 2014. The number of high-leprosy-burden regions decreased from 8 in 2000 to 1 in 2014. Seven and two regions were respectively medium and low-burdened at the end of 2014. At the health districts level, 18 remained at the high-leprosy-burdened level in 2014. Conclusion The leprosy prevalence and detection rates as well as the overall leprosy burden in Cameroon have dropped significantly between 2000 and 2014. However, a good number of health districts remain high-leprosy-burdened. The National Leprosy Control Programme should focus efforts on these health districts in the next coming years in order to further reduce the burden of leprosy in the country. PMID:27732603

An Environmental Scan of the Greater Sacramento Area and of Area Students Served by Los Rios Community College District.

ERIC Educational Resources Information Center

Glyer-Culver, Betty

Prepared by California's Los Rios Community College District, this environmental scan summarizes social, economic, and political changes at the national, state, and district levels, focusing on trends in the district's three colleges: American River College, Cosumnes River College, and Sacramento City College. The first section reviews demographic…

Background Variables, Levels of Aggregation, and Standardized Test Scores

ERIC Educational Resources Information Center

Paulson, Sharon E.; Marchant, Gregory J.

2009-01-01

This article examines the role of student demographic characteristics in standardized achievement test scores at both the individual level and aggregated at the state, district, school levels. For several data sets, the majority of the variance among states, districts, and schools was related to demographic characteristics. Where these background…

Comparative Evaluation of Dental and Skeletal Fluorosis in an Endemic Fluorosed District, Salem, Tamil Nadu.

PubMed

Ramesh, Maya; Malathi, N; Ramesh, K; Aruna, Rita Mary; Kuruvilla, Sarah

2017-11-01

High levels of fluoride in the drinking water, especially ground water, results in skeletal fluorosis which involves the bone and major joints. This study was conducted to assess the prevalence of skeletal fluorosis to compare with dental fluorosis in an endemically fluorosed population in the District of Salem, Tamil Nadu. Institutional ethical clearance was obtained. A total of 206 patients who reported to the Department of Hematology for blood investigations were the participants in this study. Age, sex, place, weight, height, dental fluorosis, and skeletal complaints were noted down. Body mass index was calculated, and statistical analysis was performed. Dental fluorosis was present in 63.1% and absent in 36.9% of the samples reported. Skeletal fluorosis was present in 24.8% and was absent in 75.2%. A large number of the patients had knee pain and difficulty in bending. Chi-square test was used for statistical analysis. Skeletal fluorosis and age were compared and P value was 0.00 and was significant. Dental fluorosis and skeletal fluorosis were compared and P value was found to be 0.000 and significant. There is a need to take measures to prevent dental and skeletal fluorosis among the residents of Salem district. Calcium balance should be maintained, and fluoride intake should be minimized to reduce the symptoms. The government should provide water with low fluoride level for drinking and cooking. Once the symptoms develop, treatment largely remains symptomatic, using analgesics and physiotherapy.

Knowledge of free delivery policy among women who delivered at health facilities in Oudomxay Province, Lao PDR.

PubMed

Chankham, Tengbriacheu; Yamamoto, Eiko; Reyer, Joshua A; Arafat, Rahman; Khonemany, Innoukham; Panome, Sayamoungkhoun; Hongkham, Dalavong; Bounfeng, Phommalaysith; Anonh, Xeuthvongsa; Hamajima, Nobuyuki

2017-02-01

To promote the utilization of maternal health services and reduce financial barriers, the Laos government introduced its "Free Maternal Health Services Policy" in 2012. This policy provides free maternal health services for pregnant women, which includes costs related to treatment, transportation, food fees, referral and an incentive for four antenatal care appointments. This study aims to ascertain the knowledge level regarding this policy among Lao women and determine their level of satisfaction with the maternal service provision. This is a cross-sectional study conducted in Xay district, La district, and Namore district of Oudomxay province, in August 2015. Three hundred and sixty women who delivered their children at the health facilities from July 2014 to June 2015 were randomly selected from the list of mothers who lived in each area. The majority of women had heard about the free delivery policy and knew that the main health services related to delivery and pregnancy were free of charge. Logistic regression analysis showed that education level (P=0.026), length of stay (P<0.0001) and receiving transportation support (P=0.005) had significant associations with the knowledge level. The women were highly satisfied with the quality of the services, health care providers, and health facilities. However, most mothers were not satisfied with accessibility to health facilities. To increase utilization of health facilities and reduce the maternal mortality ratio in rural areas, the government needs to improve people's education status and health care accessibility.

Risk Factors of Porcine Cysticercosis in the Eastern Cape Province, South Africa

PubMed Central

Krecek, Rosina Claudia; Mohammed, Hamish; Michael, Lynne Margaret; Schantz, Peter Mullineaux; Ntanjana, Lulama; Morey, Liesl; Werre, Stephen Rakem; Willingham, Arve Lee

2012-01-01

There is a high prevalence of Taenia solium taeniosis/cysticercosis in humans and pigs in the Eastern Cape Province (ECP) of South Africa. The objective of this study was to identify risk factors of porcine cysticercosis in select districts of the ECP. Data were collected in 2003 by interviewing 217 pig producers from the area. Blood samples were collected from 261 of their pigs, which were tested using two enzyme-linked immunosorbent assays (ELISA) for the presence of antibodies to cysticercosis. Frequencies of both owner- and pig-level characteristics were determined. For pig-level analysis, all bivariable and multivariable associations were determined using the surveylogistic procedure of the SAS/STAT® software to accommodate for the intraclass correlation that exists for clusters of pigs within one owner and for clusters of owners within a district. All tests for significance were performed at the α = 0.05 level, and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were determined. Among the respondents, 48% of their households lacked a latrine, 98% slaughtered pigs at home, and 99% indicated that meat inspection services were not available. On bivariable analysis, there was a significant association between porcine infection and district (p = 0.003), breed (p = 0.041) and the absence of a latrine (p = 0.006). On multivariable analysis, the absence of a latrine was the only variable significantly associated with porcine infection (aOR = 1.89; 95% CI = 1.07, 3.35) (p = 0.028). The increased odds of porcine infection with households lacking a latrine contributes to our understanding of the transmission of this parasite in the ECP. Determining and addressing the risk factors for T. solium infection can potentially lower the very high prevalence in humans and pigs in this endemic area. PMID:22655065

Spatial Dependency and Contextual Effects on Academic Achievement

ERIC Educational Resources Information Center

Matlock, Ki; Song, Joon Jin; Goering, Christian Z.

2014-01-01

This study investigated the influences of district-related variables on a district's academic performance. Arkansas augmented benchmark examination scores were used to measure a district's scholastic achievement. Spatial analysis fit each district's performance to its geographical location; spatial autocorrelation measured the amount of influence…

Geographic information systems for mapping the National Exam Result of Junior High School in 2014 at West Java Province

NASA Astrophysics Data System (ADS)

Setiawan Abdullah, Atje; Nurani Ruchjana, Budi; Rejito, Juli; Rosadi, Rudi; Candra Permana, Fahmi

2017-10-01

National Exam level of schooling is implemented by the Ministry of Education and Culture for the development of education in Indonesia. The national examinations are centrally evaluated by the National Education Standards Agency, and the expected implementation of the national exams can describe the successful implementation of education at the district, municipal, provincial, or national level. In this study, we evaluate, analyze, and explore the implementation of the national exam database of the results of the Junior High School in 2014, with the Junior High School (SMP/MTs) as the smallest unit of analysis at the district level. The method used in this study is a data mining approach using the methodology of Knowledge Discovery in Databases (KDD) using descriptive analysis and spatial mapping of national examinations. The results of the classification of the data mining process to national exams of Junior High School in 2014 using data 6,878 SMP/MTs in West Java showed that 81.01 % were at moderate levels. While the results of the spatial mapping for SMP/MTs in West Java can be explained 36,99 % at the unfavorable level. The evaluation results visualization in graphic is done using ArcGIS to provide position information quality of education in municipal, provincial or national level. The results of this study can be used by management to make decision to improve educational services based on the national exam database in West Java. Keywords: KDD, spatial mapping, national exam.

Human health risk assessment, congener specific analysis and spatial distribution pattern of organochlorine pesticides (OCPs) through rice crop from selected districts of Punjab Province, Pakistan.

PubMed

Mumtaz, Mehvish; Qadir, Abdul; Mahmood, Adeel; Mehmood, Andleeb; Malik, Riffat Naseem; Li, Jun; Yousaf, Zubaida; Jamil, Nadia; Shaikh, Irfan Ahmed; Ali, Habib; Zhang, Gan

2015-04-01

To evaluate the screening level risk assessment of OCPs in rice (Oryza sativa L.) straw (n=20) and rice grains (n=20), samples were collected from different districts of Punjab Province, Pakistan. ∑OCPs' levels (ng g(-1)) in rice straw and grains ranged from 3.63 to 39.40, 2.72 to 49.89, respectively. DDTs were found predominant over the other detected OCP isomers followed by HCH and heptachlor. Results of one way ANOVA reflected no significant difference for OCPs' levels among sampling sites, except heptachlor for rice grains. ∑OCPs' concentration in rice straw samples was exceeding the minimal residual levels (MRLs) (Australian and Japanese). Results of dietary intake and risk assessment suggested that rice straw is not safe for animals to consume as fodder. Human health was suggested to have some carcinogenic risks by consumption of rice grains, however, no considerable hazardous risk (non-carcinogenic) to human health was found. Copyright © 2014 Elsevier B.V. All rights reserved.

District Administrator Perspectives on Student Learning in an Era of Standards and Accountability: A Collective Frame Analysis

ERIC Educational Resources Information Center

Anderson, Stephen E.; Macri, Joelle Rodway

2009-01-01

Our analysis explores the agenda for student learning communicated in interviews with school district officials from four Ontario districts. Using research methods drawn from collective action framing theory, we identified six core frames and one broader frame in the discourse on student learning: (a) measureable academic achievement, (b)…

Teacher Hiring, Transfer and Evaluation in Los Angeles Unified School District. Executive Summary

ERIC Educational Resources Information Center

New Teacher Project, 2009

2009-01-01

In the spring and summer of 2008, The New Teacher Project (TNTP) partnered with Los Angeles Unified School District (LAUSD) to investigate the impact of the school district's policies and practices on the ability of schools to build and maintain strong instructional teams. TNTP's analysis included the following components: (1) Analysis of teacher…

Cattle mortality in the Thane district, India: a study of cause/effect relationships.

PubMed

Dogra, R K; Murthy, R C; Srivastava, A K; Gaur, J S; Shukla, L J; Varmani, B M

1996-02-01

An unexpected mortality of more than 300 cattle was investigated near a metal recovery factory located in a rural area of the Thane district of India. The factory was engaged in reclaiming lead, aluminum, tin, and zinc from discarded lead storage batteries and soft drink cans. The environmental samples (soil, leaves, grass, slag, water, and sediment), human blood and hair and animal samples (blood, urine, peritoneal fluid, liver, kidney, cow dung, ribs, and femur), collected for analysis revealed toxic levels of lead, cadmium, and chromium. Clinical examination of factory workers and school children revealed cough, fever, gastric problems, abdominal pain, skin lesions (scabies), and blue line on gums. Histopathological examination of animal tissues revealed chronic pathology with lead inclusion bodies in hepatocytes and renal tubules. Based on environmental, clinical, analytical, and histopathological observations, the mortality has been attributed to toxic levels of metals in the body and the malnourished status of the animals.

Lessons Learned in Systemic District Reform: A Cross-District Analysis from the Comprehensive Aligned Instructional System (CAIS) Benchmarking Study

ERIC Educational Resources Information Center

Waters, Louise Bay; Vargo, Merrill

2008-01-01

Urban district reform has been hampered by the challenge of understanding and supporting the tremendous complexity of district change. Improving this understanding through actionable, practice-based research is the purpose of this study. The authors began the study with the hypothesis that achieving districts both align their instructional systems…

Small Rural School District Consolidation in Texas: An Analysis of Its Impact on Cost and Student Achievement

ERIC Educational Resources Information Center

Cooley, Dwight A.; Floyd, Koy A.

2013-01-01

Historically, the number of public school districts in the United States has decreased despite a dramatic increase in the number of students enrolled. Although public school district consolidation has impacted districts of all sizes, since the late 1930's smaller rural districts facing dwindling community resources have merged or consolidated with…

[Association analysis between urbanization and non-communicable diseases and health-related behavior].

PubMed

Liu, G F; Sun, M P; Wang, Z Y; Jian, W Y

2016-06-18

To explore the association between different urbanization levels and non-communicable diseases (NCDs) in China and provide suggestions on designing relevant health policies in the urbanization process. We obtained health-related data from China Health and Retirement Longitudinal Study (CHARLS) 2011. This study used multistage sampling in design stage and covered 150 districts/counties, representative at the levels of the country. Geo-information system (GIS) method was used to get district areas data, and in combination with the Sixth National Census population data, we computed the population density which was regarded as the proxy variable of urbanization level in every city. The Logistic model was used to explore the effect of urbanization level on hypertension, diabetes, smoking, drinking, overweight and obesity. Compared with other cities in China, Shanghai and Shenzhen, with the population density of more than 3 000 people per km(2), were the cities with highest urbanization level. From the map of urbanization distribution across China, it was found that the urbanization levels of the northwestern districts were lower than those of the southeastern and coastal districts. The hypertension rate increased with the development of urbanization but there was no statistical significance. The proportion of patients with diabetes went up first and then saw a decrease trend in the process of urbanization. Drinking rate, overweight rate and obesity rate had similar trends, falling to their lowest point when urbanization level equaled 737,1 186 and 1 353 people per km(2) respectively and then experienced upward trends. By contrast, smoking rate declined first and then went up (the turning point was 1 029 people per km(2)). Different urbanization levels have different effects on NCDs, health-related behavior, overweight and obesity. Low urbanization level may create negative impact on health while high level can pose positive effect and increase people's health condition possibly due to the improvement of health care accessibility and the quality of living environment. Policy-makers should specially focus on different residents'health problems in different periods of urbanization, such as the impact of environmental pollution, health resources' allocation and accessibility of health services. It is necessary to reduce or avoid the negative effect of urbanization on NCDs during the local development process to face the NCDs' threat.

[Analysis of cataract surgical rate and its influencing factors in Shanghai, China].

PubMed

Zhu, Ming-ming; Zhu, Jian-feng; Zou, Hai-dong; He, Xian-gui; Zhao, Rong; Lu, Li-na

2013-12-17

To explore the cataract surgical rate (CSR) of Shanghai from 2006 to 2012 and examine its influencing factors. As of 2003, a cataract surgery registration form had been filled by physicians after every cataract surgery in Shanghai. The local eye disease prevention team then entered the relevant information into the Shanghai Cataract Operations Database. Based upon this database, CSR of Shanghai was calculated. And the number of cataract surgeries was compared between Shanghai urban and suburban districts as well as among different medical institutions. The overall CSR in Shanghai increased from 1741 in 2006 to 2313 in 2012. In 2012, CSR in urban districts reached 6013 while it stood at 460 and 584 in inner and outer suburb districts respectively. The number of hospitals performing cataract surgery in urban districts was much more than that in suburbs. And the average number of cataract surgeries per hospital per year in suburbs was only one third of that (748 cases) in urban areas. The number of cataract surgeries at in private hospitals increased rapidly during the past 7 years. The number of 1921 cases was nearly twice as many as that at tertiary hospitals in 2012. Phacoemulsification surgery was the most popular surgical choice for cataract removal, accounting for 98.40% of total cataract surgeries in 2012. Until 2012, CSR in Shanghai dropped below the target of World Health Organization (WHO). A low level of CSR in suburbs is a major influencing factor for the overall level of CSR in Shanghai.

District of Columbia Public Schools: Student Enrollment Count Remains Vulnerable to Errors. Report to the Chairman, Subcommittee on the District of Columbia, Committee on Government Reform and Oversight. House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

The District of Columbia Public Schools (DCPS) is one of the largest public school districts in the United States. Since 1989-90, there have been questions about several aspects of DCPS's enrollment-count process. A valid enrollment-count process and an accurate count are critical to DCPS's district- and school-level planning, staffing, funding,…

Population-Based Study of Trachoma in Guatemala.

PubMed

Silva, Juan Carlos; Diaz, Marco Antonio; Maul, Eugenio; Munoz, Beatriz E; West, Sheila K

2015-01-01

A prevalence survey for active trachoma in children aged under 10 years and trichiasis in women aged 40 years and older was carried out in four districts in the Sololá region in Guatemala, which is suspected of still having a trachoma problem. Population-based surveys were undertaken in three districts, within 15 randomly selected communities in each district. In addition, in a fourth district that borders the third district chosen, we surveyed the small northern sub-district, by randomly selecting three communities in each community, 100 children aged under 10 years were randomly selected, and all females over 40 years. Five survey teams were trained and standardized. Trachoma was graded using the World Health Organization simplified grading scheme and ocular swabs were taken in cases of clinical follicular or inflammatory trachoma. Prevalence estimates were calculated at district and sub-district level. Trachoma rates at district level varied from 0-5.1%. There were only two sub-districts where active trachoma approached 10% (Nahualá Costa, 8.1%, and Santa Catarina Costa, 7.3%). Trichiasis rates in females aged 40 years and older varied from 0-3%. Trachoma was likely a problem in the past. Trachoma is disappearing in the Sololá region in Guatemala. Health leadership may consider further mapping of villages around the areas with an especially high rate of trachoma and infection, and instituting trichiasis surgery and active trachoma intervention where needed.

Counseling, Psychological, and Social Services Staffing: Policies in U.S. School Districts.

PubMed

Brener, Nancy; Demissie, Zewditu

2018-06-01

Schools are in a unique position to meet the mental and behavioral health needs of children and adolescents because approximately 95% of young people aged 7-17 years attend school. Little is known, however, about policies related to counseling, psychological, and social services staffing in school districts. This study analyzed the prevalence of such policies in public school districts in the U.S. Data from four cycles (2000, 2006, 2012, and 2016) of the School Health Policies and Practices Study, a national survey periodically conducted to assess policies and practices for ten components of school health, were analyzed in 2017. The survey collected data related to counseling, psychological, and social services among nationally representative samples of school districts using online or mailed questionnaires. Sampled districts identified respondents responsible for or most knowledgeable about the content of each questionnaire. The percentage of districts with a district-level counseling, psychological, and social services coordinator increased significantly from 62.6% in 2000 to 79.5% in 2016. In 2016, 56.3% of districts required each school to have someone to coordinate counseling, psychological, and social services at the school. Fewer districts required schools at each level to have a specified ratio of counselors to students (16.2% for elementary schools, 16.8% for middle schools, and 19.8% for high schools), and the percentage of districts with these requirements has decreased significantly since 2012. Increases in the prevalence of district-level staffing policies could help increase the quantity and quality of counseling, psychological, and social services staff in schools nationwide, which in turn could improve mental and behavioral health outcomes for students. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services. Published by Elsevier Inc.

Costs of early detection systems for epidemic malaria in highland areas of Kenya and Uganda

PubMed Central

Mueller, Dirk H; Abeku, Tarekegn A; Okia, Michael; Rapuoda, Beth; Cox, Jonathan

2009-01-01

Background Malaria epidemics cause substantial morbidity and mortality in highland areas of Africa. The costs of detecting and controlling these epidemics have not been explored adequately in the past. This study presents the costs of establishing and running an early detection system (EDS) for epidemic malaria in four districts in the highlands of Kenya and Uganda. Methods An economic costing was carried out from the health service provider's perspective in both countries. Staff time for data entry and processing, as well as supervising and coordinating EDS activities at district and national levels was recorded and associated opportunity costs estimated. A threshold analysis was carried out to determine the number of DALYs or deaths that would need to be averted in order for the EDS to be considered cost-effective. Results The total costs of the EDS per district per year ranged between US$ 14,439 and 15,512. Salaries were identified as major cost-drivers, although their relative contribution to overall costs varied by country. Costs of relaying surveillance data between facilities and district offices (typically by hand) were also substantial. Data from Uganda indicated that 4% or more of overall costs could potentially be saved by switching to data transfer via mobile phones. Based on commonly used thresholds, 96 DALYs in Uganda and 103 DALYs in Kenya would need to be averted annually in each district for the EDS to be considered cost-effective. Conclusion Results from this analysis suggest that EDS are likely to be cost-effective. Further studies that include the costs and effects of the health systems' reaction prompted by EDS will need to be undertaken in order to obtain comprehensive cost-effectiveness estimates. PMID:19149878

Costs of early detection systems for epidemic malaria in highland areas of Kenya and Uganda.

PubMed

Mueller, Dirk H; Abeku, Tarekegn A; Okia, Michael; Rapuoda, Beth; Cox, Jonathan

2009-01-16

Malaria epidemics cause substantial morbidity and mortality in highland areas of Africa. The costs of detecting and controlling these epidemics have not been explored adequately in the past. This study presents the costs of establishing and running an early detection system (EDS) for epidemic malaria in four districts in the highlands of Kenya and Uganda. An economic costing was carried out from the health service provider's perspective in both countries. Staff time for data entry and processing, as well as supervising and coordinating EDS activities at district and national levels was recorded and associated opportunity costs estimated. A threshold analysis was carried out to determine the number of DALYs or deaths that would need to be averted in order for the EDS to be considered cost-effective. The total costs of the EDS per district per year ranged between US$ 14,439 and 15,512. Salaries were identified as major cost-drivers, although their relative contribution to overall costs varied by country. Costs of relaying surveillance data between facilities and district offices (typically by hand) were also substantial. Data from Uganda indicated that 4% or more of overall costs could potentially be saved by switching to data transfer via mobile phones. Based on commonly used thresholds, 96 DALYs in Uganda and 103 DALYs in Kenya would need to be averted annually in each district for the EDS to be considered cost-effective. Results from this analysis suggest that EDS are likely to be cost-effective. Further studies that include the costs and effects of the health systems' reaction prompted by EDS will need to be undertaken in order to obtain comprehensive cost-effectiveness estimates.

A Political Analysis of Community Influence over School Closure

ERIC Educational Resources Information Center

Finnigan, Kara S.; Lavner, Mark

2012-01-01

This study seeks to understand community member participation in and influence over an urban school district's school closure process. Data from interviews with School Board members, district administrators, and community members, as well as district documents and newspaper articles suggest that district administrators limited participation…

State but not District Nutrition Policies Are Associated with Less Junk Food in Vending Machines and School Stores in US Public Schools

PubMed Central

KUBIK, MARTHA Y.; WALL, MELANIE; SHEN, LIJUAN; NANNEY, MARILYN S.; NELSON, TOBEN F.; LASKA, MELISSA N.; STORY, MARY

2012-01-01

Background Policy that targets the school food environment has been advanced as one way to increase the availability of healthy food at schools and healthy food choice by students. Although both state- and district-level policy initiatives have focused on school nutrition standards, it remains to be seen whether these policies translate into healthy food practices at the school level, where student behavior will be impacted. Objective To examine whether state- and district-level nutrition policies addressing junk food in school vending machines and school stores were associated with less junk food in school vending machines and school stores. Junk food was defined as foods and beverages with low nutrient density that provide calories primarily through fats and added sugars. Design A cross-sectional study design was used to assess self-report data collected by computer-assisted telephone interviews or self-administered mail questionnaires from state-, district-, and school-level respondents participating in the School Health Policies and Programs Study 2006. The School Health Policies and Programs Study, administered every 6 years since 1994 by the Centers for Disease Control and Prevention, is considered the largest, most comprehensive assessment of school health policies and programs in the United States. Subjects/setting A nationally representative sample (n = 563) of public elementary, middle, and high schools was studied. Statistical analysis Logistic regression adjusted for school characteristics, sampling weights, and clustering was used to analyze data. Policies were assessed for strength (required, recommended, neither required nor recommended prohibiting junk food) and whether strength was similar for school vending machines and school stores. Results School vending machines and school stores were more prevalent in high schools (93%) than middle (84%) and elementary (30%) schools. For state policies, elementary schools that required prohibiting junk food in school vending machines and school stores offered less junk food than elementary schools that neither required nor recommended prohibiting junk food (13% vs 37%; P = 0.006). Middle schools that required prohibiting junk food in vending machines and school stores offered less junk food than middle schools that recommended prohibiting junk food (71% vs 87%; P = 0.07). Similar associations were not evident for district-level polices or high schools. Conclusions Policy may be an effective tool to decrease junk food in schools, particularly in elementary and middle schools. PMID:20630161

A Strategy for Chapter I Planning and Evaluation in School-Based vs. District-Based Projects: Spinoffs from the School Effectiveness Research.

ERIC Educational Resources Information Center

Slaughter, Helen B.; And Others

Although many large districts have centrally organized their Chapter 1 (Education Consolidation and Improvement Act) compensatory programs at the district and project levels, elementary school improvement efforts are strongly tied to local school autonomy and principal leadership. This paper analyzes the Tucson (Arizona) Unified School District's…

Educational Technology in Public School Districts: Fall 2008. First Look. NCES 2010-003

ERIC Educational Resources Information Center

Gray, Lucinda; Lewis, Laurie

2009-01-01

This report provides national data on the availability and use of educational technology in public school districts during fall 2008. The data are the results of a national district-level survey that is one of a set that includes district, school, and teacher surveys on educational technology. Every year between 1994 and 2005 (with the exception…

School Leaders' Perceptions of School Counselors as Leaders as Part of the District Leadership Team and Impact on the District Wide Change Process

ERIC Educational Resources Information Center

Davis, James S., Jr.

2013-01-01

This exploration focuses on school leaders' perceptions of school counselors as leaders and their involvement with district wide change. This study explores school counselor leadership, school counselors' role in district level change, and barriers to school counselor leadership. This is a qualitative study utilizing grounded theory design.…

Educational Resource Allocation at the Elementary Level: A Case Study of One Elementary School District in California

ERIC Educational Resources Information Center

Nguyen, Dominic

2013-01-01

The purpose of this study was to examine the dispersion of human capital resources within one school district in southern California and compare the use of personnel at each school to the desired allocation informed by the district's strategies and staffing formula. The district's resource distribution was also compared to that of the Evidence…

Feasibility and Supply Analysis of U.S. Geothermal District Heating and Cooling System

NASA Astrophysics Data System (ADS)

He, Xiaoning

Geothermal energy is a globally distributed sustainable energy with the advantages of a stable base load energy production with a high capacity factor and zero SOx, CO, and particulates emissions. It can provide a potential solution to the depletion of fossil fuels and air pollution problems. The geothermal district heating and cooling system is one of the most common applications of geothermal energy, and consists of geothermal wells to provide hot water from a fractured geothermal reservoir, a surface energy distribution system for hot water transmission, and heating/cooling facilities to provide water and space heating as well as air conditioning for residential and commercial buildings. To gain wider recognition for the geothermal district heating and cooling (GDHC) system, the potential to develop such a system was evaluated in the western United States, and in the state of West Virginia. The geothermal resources were categorized into identified hydrothermal resources, undiscovered hydrothermal resources, near hydrothermal enhanced geothermal system (EGS), and deep EGS. Reservoir characteristics of the first three categories were estimated individually, and their thermal potential calculated. A cost model for such a system was developed for technical performance and economic analysis at each geothermally active location. A supply curve for the system was then developed, establishing the quantity and the cost of potential geothermal energy which can be used for the GDHC system. A West Virginia University (WVU) case study was performed to compare the competiveness of a geothermal energy system to the current steam based system. An Aspen Plus model was created to simulate the year-round campus heating and cooling scenario. Five cases of varying water flow rates and temperatures were simulated to find the lowest levelized cost of heat (LCOH) for the WVU case study. The model was then used to derive a levelized cost of heat as a function of the population density at a constant geothermal gradient. By use of such functions in West Virginia at a census tract level, the most promising census tracts in WV for the development of geothermal district heating and cooling systems were mapped. This study is unique in that its purpose was to utilize supply analyses for the GDHC systems and determine an appropriate economic assessment of the viability and sustainability of the systems. It was found that the market energy demand, production temperature, and project lifetime have negative effects on the levelized cost, while the drilling cost, discount rate, and capital cost have positive effects on the levelized cost by sensitivity analysis. Moreover, increasing the energy demand is the most effective way to decrease the levelized cost. The derived levelized cost function shows that for EGS based systems, the population density has a strong negative effect on the LCOH at any geothermal gradient, while the gradient only has a negative effect on the LCOH at a low population density.

Disparity in maternal, newborn and child health services in high focus states in India: a district-level cross-sectional analysis.

PubMed

Awasthi, Ashish; Pandey, C M; Chauhan, Rajesh K; Singh, Uttam

2016-08-05

To examine the level and trend in the coverage gap of a set of interventions of maternal and child health services using a summary index and to assess the disparity in usage of maternal and child health services in the districts of high focus states of India. Data for the present study are taken from the Annual Health Survey (AHS), 2010-2013 and Census of India, 2011. This study used secondary data from states having higher mortality and fertility rates, termed as high focus states in India. District-level information regarding children aged 12-23 months and ever married women aged 15-49 years has been extracted from the AHS (2010-2013), and household amenities, female literacy and main workforce information has been obtained from the Census of India 2011. 2 summary indexes were calculated first for maternal and child health services and another for socioeconomic and development status, using data from AHS and Census. Cronbach's α was used to assess the internal consistency of the items used in the index. The result shows that the coverage gap is highest in Uttar Pradesh (37%) and lowest in Madhya Pradesh (21%). Converge gap and socioeconomic development are negatively correlated (r=-0.49, p=0.01). The average coverage gap was highest in the lowest quintile of socioeconomic development. There was an absolute change of 1.5% per year in coverage gap during 2009-2013. In regression analysis, the coefficient of determination was 0.24, β=-30.05, p=0.01 for a negative relationship between socioeconomic development and coverage gap. There is a significant disparity in the usage of maternal and child healthcare services in the districts of India. Resource-rich people (urban residents and richest quintile) are way ahead of marginalised people (rural residents and poorest quintile) in the usage of healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Examining statewide capacity for school health and mental health promotion: a post hoc application of a district capacity-building framework.

PubMed

Maras, Melissa A; Weston, Karen J; Blacksmith, Jennifer; Brophy, Chelsey

2015-03-01

Schools must possess a variety of capacities to effectively support comprehensive and coordinated school health promotion activities, and researchers have developed a district-level capacity-building framework specific to school health promotion. State-level school health coalitions often support such capacity-building efforts and should embed this work within a data-based, decision-making model. However, there is a lack of guidance for state school health coalitions on how they should collect and use data. This article uses a district-level capacity-building framework to interpret findings from a statewide coordinated school health needs/resource assessment in order to examine statewide capacity for school health promotion. Participants included school personnel (N = 643) from one state. Descriptive statistics were calculated for survey items, with further examination of subgroup differences among school administrators and nurses. Results were then interpreted via a post hoc application of a district-level capacity-building framework. Findings across districts revealed statewide strengths and gaps with regard to leadership and management capacities, internal and external supports, and an indicator of global capacity. Findings support the utility of using a common framework across local and state levels to align efforts and embed capacity-building activities within a data-driven, continuous improvement model. © 2014 Society for Public Health Education.

Potentiometric surface of the Floridan Aquifer, Southwest Florida Water Management District, May 1981

USGS Publications Warehouse

Yobbi, D.K.; Woodham, W.M.; Schiner, George R.

1981-01-01

A May 1981 potentiometric-surface map of the Southwest Florida Water Management District depicts the annual low water-level period. Potentiometric levels decreased 10 to 45 feet between September 1980 and May 1981 in the citrus and farming sections of southern Hillsborough, northern Hardee, southwestern Polk, northwestern DeSoto, and Manatee Counties. Water levels in these areas are widely affected by pumping for irrigation and have the greatest range in fluctuations. Water-level decreases ranged from 0 to 1 feet in coastal, northern, and southern areas of the Water Management District. Water levels in all of the approximate 700 wells measured in May 1981 are lower than May 1980 because of the virtual absence of rainfall in April and May. (USGS)

District health managers' perceptions of supervision in Malawi and Tanzania.

PubMed

Bradley, Susan; Kamwendo, Francis; Masanja, Honorati; de Pinho, Helen; Waxman, Rachel; Boostrom, Camille; McAuliffe, Eilish

2013-09-05

Mid-level cadres are being used to address human resource shortages in many African contexts, but insufficient and ineffective human resource management is compromising their performance. Supervision plays a key role in performance and motivation, but is frequently characterised by periodic inspection and control, rather than support and feedback to improve performance. This paper explores the perceptions of district health management teams in Tanzania and Malawi on their role as supervisors and on the challenges to effective supervision at the district level. This qualitative study took place as part of a broader project, "Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers". Semi-structured interviews were conducted with 20 district health management team personnel in Malawi and 37 council health team members in Tanzania. The interviews covered a range of human resource management issues, including supervision and performance assessment, staff job descriptions and roles, motivation and working conditions. Participants displayed varying attitudes to the nature and purpose of the supervision process. Much of the discourse in Malawi centred on inspection and control, while interviewees in Tanzania were more likely to articulate a paradigm characterised by support and improvement. In both countries, facility level performance metrics dominated. The lack of competency-based indicators or clear standards to assess individual health worker performance were considered problematic. Shortages of staff, at both district and facility level, were described as a major impediment to carrying out regular supervisory visits. Other challenges included conflicting and multiple responsibilities of district health team staff and financial constraints. Supervision is a central component of effective human resource management. Policy level attention is crucial to ensure a systematic, structured process that is based on common understandings of the role and purpose of supervision. This is particularly important in a context where the majority of staff are mid-level cadres for whom regulation and guidelines may not be as formalised or well-developed as for traditional cadres, such as registered nurses and medical doctors. Supervision needs to be adequately resourced and supported in order to improve performance and retention at the district level.

District health managers’ perceptions of supervision in Malawi and Tanzania

PubMed Central

2013-01-01

Background Mid-level cadres are being used to address human resource shortages in many African contexts, but insufficient and ineffective human resource management is compromising their performance. Supervision plays a key role in performance and motivation, but is frequently characterised by periodic inspection and control, rather than support and feedback to improve performance. This paper explores the perceptions of district health management teams in Tanzania and Malawi on their role as supervisors and on the challenges to effective supervision at the district level. Methods This qualitative study took place as part of a broader project, “Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers”. Semi-structured interviews were conducted with 20 district health management team personnel in Malawi and 37 council health team members in Tanzania. The interviews covered a range of human resource management issues, including supervision and performance assessment, staff job descriptions and roles, motivation and working conditions. Results Participants displayed varying attitudes to the nature and purpose of the supervision process. Much of the discourse in Malawi centred on inspection and control, while interviewees in Tanzania were more likely to articulate a paradigm characterised by support and improvement. In both countries, facility level performance metrics dominated. The lack of competency-based indicators or clear standards to assess individual health worker performance were considered problematic. Shortages of staff, at both district and facility level, were described as a major impediment to carrying out regular supervisory visits. Other challenges included conflicting and multiple responsibilities of district health team staff and financial constraints. Conclusion Supervision is a central component of effective human resource management. Policy level attention is crucial to ensure a systematic, structured process that is based on common understandings of the role and purpose of supervision. This is particularly important in a context where the majority of staff are mid-level cadres for whom regulation and guidelines may not be as formalised or well-developed as for traditional cadres, such as registered nurses and medical doctors. Supervision needs to be adequately resourced and supported in order to improve performance and retention at the district level. PMID:24007354

Physical Education Curriculum Analysis Tool (PECAT)

ERIC Educational Resources Information Center

Lee, Sarah M.; Wechsler, Howell

2006-01-01

The Physical Education Curriculum Analysis Tool (PECAT) will help school districts conduct a clear, complete, and consistent analysis of written physical education curricula, based upon national physical education standards. The PECAT is customizable to include local standards. The results from the analysis can help school districts enhance…

Serum PCBs and organochlorine pesticides in Slovakia: age, gender, and residence as determinants of organochlorine concentrations.

PubMed

Petrik, Jan; Drobna, Beata; Pavuk, Marian; Jursa, Stanislav; Wimmerova, Sona; Chovancova, Jana

2006-10-01

We measured organochlorine concentrations of 15 polychlorinated biphenyl congeners and six organochlorine pesticides (PCB28, 52, 101, 123(+149), 118, 114, 153, 105, 138(+163), 167, 156(+171), 157, 180, 170, 189, alpha-, beta-, gamma-HCH, HCB, p,p'-DDT and p,p'-DDE) in 2047 subjects from contaminated and background areas of eastern Slovakia. Data were collected in 2001 and analyzed by high-resolution gas chromatography with electron capture detection in 2002-2003. Elevated levels persist in subjects from Michalovce district, site of former production facility, after almost 20-years since the end of the PCB manufacturing. Sum of 15 PCB congeners was 3105 ng/g of lipid in the Michalovce district versus 871 ng/g of lipid for subjects from the background districts of Svidnik and Stropkov. Relatively high concentration in children from the Michalovce district, sum PCB = 766 ng/g of lipid versus 372 ng/g of lipid in children from background area suggest ongoing exposure from environmental reservoirs and contaminated food. Consistent differences between genders in both contaminated and background areas are reported here. Levels in males are about 20% higher in both districts. Levels of organochlorine pesticides, particularly of DDT metabolite DDE and hexachlorobenzene are also elevated in the Michalovce district, reflecting intensive use of pesticides in agriculture in the past. About 30% decrease in serum organochlorine levels was observed in comparison with our earlier samples collected in 1998. These results suggest that contamination with PCBs still remains a source of relatively high environmental exposure for subjects in the Michalovce district.

Cost-Efficacy Analysis of Out-of-District Special Education Placements: An Evaluative Measure of Behavior Support Intervention in Public Schools.

ERIC Educational Resources Information Center

Putnam, Robert F.; Luiselli, James K.; Sennett, Kenneth; Malonson, Joanne

2002-01-01

Evaluation of out-of-district special education placement costs in the 15 largest Massachusetts public school districts found the criterion school district (which had developed a system-wide approach to behavioral intervention) had the lowest per capita cost, lowest percentage of total school budget consumed by out-of-district placements, and the…

Capturing district nursing through a knowledge-based electronic caseload analysis tool (eCAT).

PubMed

Kane, Kay

2014-03-01

The Electronic Caseload Analysis Tool (eCAT) is a knowledge-based software tool to assist the caseload analysis process. The tool provides a wide range of graphical reports, along with an integrated clinical advisor, to assist district nurses, team leaders, operational and strategic managers with caseload analysis by describing, comparing and benchmarking district nursing practice in the context of population need, staff resources, and service structure. District nurses and clinical lead nurses in Northern Ireland developed the tool, along with academic colleagues from the University of Ulster, working in partnership with a leading software company. The aim was to use the eCAT tool to identify the nursing need of local populations, along with the variances in district nursing practice, and match the workforce accordingly. This article reviews the literature, describes the eCAT solution and discusses the impact of eCAT on nursing practice, staff allocation, service delivery and workforce planning, using fictitious exemplars and a post-implementation evaluation from the trusts.

Education And Gender Bias in the Sex Ratio At Birth: Evidence From India

PubMed Central

ECHÁVARRI, REBECA A.; EZCURRA, ROBERTO

2010-01-01

This article investigates the possible existence of a nonlinear link between female disadvantage in natality and education. To this end, we devise a theoretical model based on the key role of social interaction in explaining people’s acquisition of preferences, which justifies the existence of a nonmonotonic relationship between female disadvantage in natality and education. The empirical validity of the proposed model is examined for the case of India, using district-level data. In this context, our econometric analysis pays particular attention to the role of spatial dependence to avoid any potential problems of misspecification. The results confirm that the relationship between the sex ratio at birth and education in India follows an inverted U-shape. This finding is robust to the inclusion of additional explanatory variables in the analysis, and to the choice of the spatial weight matrix used to quantify the spatial interdependence between the sample districts. PMID:20355693

Education and gender bias in the sex ratio at birth: evidence from India.

PubMed

Echávarri, Rebeca A; Ezcurra, Roberto

2010-02-01

This article investigates the possible existence of a nonlinear link between female disadvantage in natality and education. To this end, we devise a theoretical model based on the key role of social interaction in explaining people's acquisition of preferences, which justifies the existence of a nonmonotonic relationship between female disadvantage in natality and education. The empirical validity of the proposed model is examined for the case of India, using district-level data. In this context, our econometric analysis pays particular attention to the role of spatial dependence to avoid any potential problems of misspecification. The results confirm that the relationship between the sex ratio at birth and education in India follows an inverted U-shape. This finding is robust to the inclusion of additional explanatory variables in the analysis, and to the choice of the spatial weight matrix used to quantify the spatial interdependence between the sample districts.

Comparative Analysis of Fluoride Concentrations in Groundwaters in Northern and Southern Ghana: Implications for the Contaminant Sources

NASA Astrophysics Data System (ADS)

Sunkari, Emmanuel Daanoba; Zango, Musah Saeed; Korboe, Harriet Mateko

2018-04-01

Bongo and Sekyere South districts, both in the northern and southern parts of Ghana, respectively, have high populations living in rural areas and most of them use groundwater for drinking purposes. The groundwater in these areas is prone to contamination from natural and/or artificial sources. Therefore this study aims; (1) to present a comparative analysis of the fluoride concentration in groundwater samples from Bongo and Sekyere South districts and the associated groundwater-rock interaction that may be the cause for the varied fluoride concentrations, (2) to determine the leaching potential of fluoride from the host rocks as the possible mechanism for groundwater contamination. Sixty (60) groundwater samples from active pumping wells and twelve (12) rock samples from outcrops were collected from various communities in the two districts for fluoride concentration and mineralogical analysis. Based on the variations in fluoride concentration, fluoride spatial distribution maps were prepared using empirical Bayesian kriging interpolation method and analysed by means of hierarchical cluster analysis. The fluoride concentration in Bongo district varies between 1.71 and 4.0 mg/L, whereas that in Sekyere South district changes from 0.3 to 0.8 mg/L. From the mineralogical studies, biotite has the highest percentage in the Bongo district and has positive correlation with fluoride concentration in the analysed water samples than in the Sekyere South district. The elevated fluoride concentration in the Bongo district relative to the Sekyere South district is due to the dissolution of biotite in the groundwater and the sufficient groundwater-rock interaction since the water samples are mainly sourced from deeper boreholes. This high fluoride concentration has resulted in a plethora of reported cases of dental fluorosis and other health-related issues in Bongo.

Comparative Analysis of Fluoride Concentrations in Groundwaters in Northern and Southern Ghana: Implications for the Contaminant Sources

NASA Astrophysics Data System (ADS)

Sunkari, Emmanuel Daanoba; Zango, Musah Saeed; Korboe, Harriet Mateko

2018-05-01

Bongo and Sekyere South districts, both in the northern and southern parts of Ghana, respectively, have high populations living in rural areas and most of them use groundwater for drinking purposes. The groundwater in these areas is prone to contamination from natural and/or artificial sources. Therefore this study aims; (1) to present a comparative analysis of the fluoride concentration in groundwater samples from Bongo and Sekyere South districts and the associated groundwater-rock interaction that may be the cause for the varied fluoride concentrations, (2) to determine the leaching potential of fluoride from the host rocks as the possible mechanism for groundwater contamination. Sixty (60) groundwater samples from active pumping wells and twelve (12) rock samples from outcrops were collected from various communities in the two districts for fluoride concentration and mineralogical analysis. Based on the variations in fluoride concentration, fluoride spatial distribution maps were prepared using empirical Bayesian kriging interpolation method and analysed by means of hierarchical cluster analysis. The fluoride concentration in Bongo district varies between 1.71 and 4.0 mg/L, whereas that in Sekyere South district changes from 0.3 to 0.8 mg/L. From the mineralogical studies, biotite has the highest percentage in the Bongo district and has positive correlation with fluoride concentration in the analysed water samples than in the Sekyere South district. The elevated fluoride concentration in the Bongo district relative to the Sekyere South district is due to the dissolution of biotite in the groundwater and the sufficient groundwater-rock interaction since the water samples are mainly sourced from deeper boreholes. This high fluoride concentration has resulted in a plethora of reported cases of dental fluorosis and other health-related issues in Bongo.

District nursing workforce planning: a review of the methods.

PubMed

Reid, Bernie; Kane, Kay; Curran, Carol

2008-11-01

District nursing services in Northern Ireland face increasing demands and challenges which may be responded to by effective and efficient workforce planning and development. The aim of this paper is to critically analyse district nursing workforce planning and development methods, in an attempt to find a suitable method for Northern Ireland. A systematic analysis of the literature reveals four methods: professional judgement; population-based health needs; caseload analysis and dependency-acuity. Each method has strengths and weaknesses. Professional judgement offers a 'belt and braces' approach but lacks sensitivity to fluctuating patient numbers. Population-based health needs methods develop staffing algorithms that reflect deprivation and geographical spread, but are poorly understood by district nurses. Caseload analysis promotes equitable workloads but poorly performing district nursing localities may continue if benchmarking processes only consider local data. Dependency-acuity methods provide a means of equalizing and prioritizing workload but are prone to district nurses overstating factors in patient dependency or understating carers' capability. In summary a mixed method approach is advocated to evaluate and adjust the size and mix of district nursing teams using empirically determined patient dependency and activity-based variables based on the population's health needs.

Planning and Budgeting for School Media Programs at the Building, District, and Regional Levels: O.R. in the Little Red Schoolhouse.

ERIC Educational Resources Information Center

Kraft, Donald H.; Liesener, James W.

1979-01-01

Presents an analysis of problems of resource allocation in the school library and a practical operations research approach toward accountability. Four planning instruments are included in the solution procedure: inventory of services; preference form; data collection guide; and program costing matrix. (Author/MBR)

Effects of Livestock Herd Migration on Child Schooling in Marsabit District, Kenya

ERIC Educational Resources Information Center

Mburu, Samuel

2017-01-01

To throw light on the challenge of providing education to pastoral households in the context of social and economic change, this study investigates the effects of herd migration on child schooling in Northern Kenya. Specifically, the analysis uses both household panel data and community-level focus-group data to identify the barriers to schooling,…

U.S. congressional district cancer death rates.

PubMed

Hao, Yongping; Ward, Elizabeth M; Jemal, Ahmedin; Pickle, Linda W; Thun, Michael J

2006-06-23

Geographic patterns of cancer death rates in the U.S. have customarily been presented by county or aggregated into state economic or health service areas. Herein, we present the geographic patterns of cancer death rates in the U.S. by congressional district. Many congressional districts do not follow state or county boundaries. However, counties are the smallest geographical units for which death rates are available. Thus, a method based on the hierarchical relationship of census geographic units was developed to estimate age-adjusted death rates for congressional districts using data obtained at county level. These rates may be useful in communicating to legislators and policy makers about the cancer burden and potential impact of cancer control in their jurisdictions. Mortality data were obtained from the National Center for Health Statistics (NCHS) for 1990-2001 for 50 states, the District of Columbia, and all counties. We computed annual average age-adjusted death rates for all cancer sites combined, the four major cancers (lung and bronchus, prostate, female breast, and colorectal cancer) and cervical cancer. Cancer death rates varied widely across congressional districts for all cancer sites combined, for the four major cancers, and for cervical cancer. When examined at the national level, broad patterns of mortality by sex, race and region were generally similar with those previously observed based on county and state economic area. We developed a method to generate cancer death rates by congressional district using county-level mortality data. Characterizing the cancer burden by congressional district may be useful in promoting cancer control and prevention programs, and persuading legislators to enact new cancer control programs and/or strengthening existing ones. The method can be applied to state legislative districts and other analyses that involve data aggregation from different geographic units.

U.S. congressional district cancer death rates

PubMed Central

Hao, Yongping; Ward, Elizabeth M; Jemal, Ahmedin; Pickle, Linda W; Thun, Michael J

2006-01-01

Background Geographic patterns of cancer death rates in the U.S. have customarily been presented by county or aggregated into state economic or health service areas. Herein, we present the geographic patterns of cancer death rates in the U.S. by congressional district. Many congressional districts do not follow state or county boundaries. However, counties are the smallest geographical units for which death rates are available. Thus, a method based on the hierarchical relationship of census geographic units was developed to estimate age-adjusted death rates for congressional districts using data obtained at county level. These rates may be useful in communicating to legislators and policy makers about the cancer burden and potential impact of cancer control in their jurisdictions. Results Mortality data were obtained from the National Center for Health Statistics (NCHS) for 1990–2001 for 50 states, the District of Columbia, and all counties. We computed annual average age-adjusted death rates for all cancer sites combined, the four major cancers (lung and bronchus, prostate, female breast, and colorectal cancer) and cervical cancer. Cancer death rates varied widely across congressional districts for all cancer sites combined, for the four major cancers, and for cervical cancer. When examined at the national level, broad patterns of mortality by sex, race and region were generally similar with those previously observed based on county and state economic area. Conclusion We developed a method to generate cancer death rates by congressional district using county-level mortality data. Characterizing the cancer burden by congressional district may be useful in promoting cancer control and prevention programs, and persuading legislators to enact new cancer control programs and/or strengthening existing ones. The method can be applied to state legislative districts and other analyses that involve data aggregation from different geographic units. PMID:16796732

Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies

PubMed Central

LaFond, Anne; Kanagat, Natasha; Steinglass, Robert; Fields, Rebecca; Sequeira, Jenny; Mookherji, Sangeeta

2015-01-01

There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria–tetanus–pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement—four direct drivers and two enabling drivers—that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance. PMID:24615431

Factors Associated with the Competencies of Public Health Workers in Township Hospitals: A Cross-Sectional Survey in Chongqing Municipality, China

PubMed Central

He, Zhifei; Cheng, Zhaohui; Fu, Hang; Tang, Shangfeng; Fu, Qian; Fang, Haiqing; Xian, Yue; Ming, Hui; Feng, Zhanchun

2015-01-01

Purpose: This study aimed to explore the competencies of public health workers (PHWs) of township hospitals in Chongqing Municipality (China), and determine the related impact factors of the competencies of PHWs; Methods: A cross-sectional research was conducted on 314 PHWs from 27 township hospitals in three districts in Chongqing Municipality (China), from June to August 2014. A self-assessment questionnaire was established on the basis of literature reviews and a competency dictionary. The differences in competencies among the three districts were determined by adopting the chi-square test, t-test, analysis of variance (ANOVA) method, and the impact factors of the competencies of PHWs were determined by adopting stepwise regression analysis. Results: (1) Results of the demographic characteristics of PHWs in three sample districts of Chongqing Municipality showed that a significant difference in age of PHWs (p = 0.021 < 0.05) and the majors of PHWs (p = 0.045 < 0.05); (2) In terms of the self-evaluation competency results of PHWs in township hospitals, seven among the 11 aspects were found to have significant differences in the three districts by the ANOVA test; (3) By adopting the t-test and ANOVA method, results of the relationship between the characteristics of PHWs and their competency scores showed that significant differences were found in the economic level (p = 0.000 < 0.05), age (p = 0.000 < 0.05), years of working (p = 0.000 < 0.05) and title of PHWs (p = 0.000 < 0.05); (4) Stepwise regression analysis was used to determine the impact factors of the competencies of PHWs in township hospitals, including the economic level (p = 0.000 < 0.001), years of working (p = 0.000 < 0.001), title (p = 0.001 < 0.005), and public health major (p = 0.007 < 0.01). Conclusions: The competencies of the township hospital staff in Chongqing Municipality (China), are generally insufficient, therefore, regulating the medical education and training skills of PHWs is crucial to improve the competencies of PHWs in the township hospitals of Chongqing Municipality. The results of this study can be mirrored in other areas of China. PMID:26569273

Factors Associated with the Competencies of Public Health Workers in Township Hospitals: A Cross-Sectional Survey in Chongqing Municipality, China.

PubMed

He, Zhifei; Cheng, Zhaohui; Fu, Hang; Tang, Shangfeng; Fu, Qian; Fang, Haiqing; Xian, Yue; Ming, Hui; Feng, Zhanchun

2015-11-09

This study aimed to explore the competencies of public health workers (PHWs) of township hospitals in Chongqing Municipality (China), and determine the related impact factors of the competencies of PHWs; A cross-sectional research was conducted on 314 PHWs from 27 township hospitals in three districts in Chongqing Municipality (China), from June to August 2014. A self-assessment questionnaire was established on the basis of literature reviews and a competency dictionary. The differences in competencies among the three districts were determined by adopting the chi-square test, t-test, analysis of variance (ANOVA) method, and the impact factors of the competencies of PHWs were determined by adopting stepwise regression analysis. (1) RESULTS of the demographic characteristics of PHWs in three sample districts of Chongqing Municipality showed that a significant difference in age of PHWs (p = 0.021 < 0.05) and the majors of PHWs (p = 0.045 < 0.05); (2) In terms of the self-evaluation competency results of PHWs in township hospitals, seven among the 11 aspects were found to have significant differences in the three districts by the ANOVA test; (3) By adopting the t-test and ANOVA method, results of the relationship between the characteristics of PHWs and their competency scores showed that significant differences were found in the economic level (p = 0.000 < 0.05), age (p = 0.000 < 0.05), years of working (p = 0.000 < 0.05) and title of PHWs (p = 0.000 < 0.05); (4) Stepwise regression analysis was used to determine the impact factors of the competencies of PHWs in township hospitals, including the economic level (p = 0.000 < 0.001), years of working (p = 0.000 < 0.001), title (p = 0.001 < 0.005), and public health major (p = 0.007 < 0.01). The competencies of the township hospital staff in Chongqing Municipality (China), are generally insufficient, therefore, regulating the medical education and training skills of PHWs is crucial to improve the competencies of PHWs in the township hospitals of Chongqing Municipality. The results of this study can be mirrored in other areas of China.

Exploring the use of routinely-available, retrospective data to study the association between malaria control scale-up and micro-economic outcomes in Zambia.

PubMed

Comfort, Alison; Leegwater, Anthony; Nakhimovsky, Sharon; Kansembe, Henry; Hamainza, Busiku; Bwalya, Benson; Alilio, Martin; Johns, Ben; Olsho, Lauren

2017-01-04

Country-level evidence on the impact of malaria control on micro-economic outcomes is vital for mobilizing domestic and donor resources for malaria control. Using routinely available survey data could facilitate this investigation in a cost-efficient way. The authors used Malaria Indicator Surveys (MIS) and Living Conditions Monitoring Survey (LCMS) data from 2006 to 2010 for all 72 districts in Zambia to relate malaria control scale-up with household food spending (proxy for household well-being), educational attainment and agricultural production. The authors used two quasi-experimental designs: (1) a generalized propensity score for a continuous treatment variable (defined as coverage from owning insecticide-treated bed nets and/or receipt of indoor residual spraying); and, (2) a district fixed effects model to assess changes in the outcome relative to changes in treatment pre-post scale-up. The unit of analysis was at district level. The authors also conducted simulations post-analysis to assess statistical power. Micro-economic outcomes increased (33% increase in food spending) concurrently with malaria control coverage (62% increase) from 2006 to 2010. Despite using data from all 72 districts, both analytic methods yielded wide confidence intervals that do not conclusively link outcomes and malaria control coverage increases. The authors cannot rule out positive, null or negative effects. The upper bound estimates of the results show that if malaria control coverage increases from 60 to 70%, food spending could increase up to 14%, maize production could increase up to 57%, and years of schooling could increase up to 0.5 years. Simulations indicated that the generalized propensity score model did not have good statistical power. While it is technically possible to use routinely available survey data to relate malaria control scale-up and micro-economic outcomes, it is not clear from this analysis that meaningful results can be obtained when survey data are highly aggregated. Researchers in similar settings should assess the feasibility of disaggregating existing survey data. Additionally, large surveys, such as LCMS and MIS, could incorporate data on both malaria coverage and household expenditures, respectively.

Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso.

PubMed Central

Su, Tin Tin; Kouyaté, Bocar; Flessa, Steffen

2006-01-01

OBJECTIVE: To quantify the extent of catastrophic household health care expenditure and determine the factors responsible for it in Nouna District, Burkina Faso. METHODS: We used the Nouna Health District Household Survey to collect data on 800 households during 2000-01 for our analysis. The determinants of household catastrophic expenditure were identified by multivariate logistic regression method. FINDINGS: Even at very low levels of health care utilization and modest amount of health expenditure, 6-15% of total households in Nouna District incurred catastrophic health expenditure. The key determinants of catastrophic health expenditure were economic status, household health care utilization especially for modern medical care, illness episodes in an adult household member and presence of a member with chronic illness. CONCLUSION: We conclude that the poorest members of the community incurred catastrophic health expenses. Setting only one threshold/cut-off value to determine catastrophic health expenses may result in inaccurate estimation leading to misinterpretation of important factors. Our findings have important policy implications and can be used to ensure better access to health services and a higher degree of financial protection for low-income groups against the economic impact of illness. PMID:16501711

New Zealand evidence for the impact of primary healthcare investment in Capital and Coast District Health Board.

PubMed

Tan, Lee; Carr, Julia; Reidy, Johanna

2012-03-30

This paper provides New Zealand evidence on the effectiveness of primary care investment, measured through the Capital and Coast District Health Board's (DHB) Primary Health Care Framework. The Framework was developed in 2002/2003 to guide funding decisions at a DHB level, and to provide a transparent basis for evaluation of the implementation of the Primary Health Care Strategy in this district. The Framework used a mixed method approach; analysis was based on quantitative and qualitative data. This article demonstrates the link between investment in primary health care, increased access to primary care for high-need populations, workforce redistribution, and improved health outcomes. Over the study period, ambulatory sensitive hospitalisations and emergency department use reduced for enrolled populations and the District's immunisation coverage improved markedly. Funding and contracting which enhanced both 'mainstream' and 'niche' providers combined with community-based health initiatives resulted in a measurable impact on a range of health indicators and inequalities. Maori primary care providers improved access for Maori but also for their enrolled populations of Pacific and Other ethnicity. Growth and redistribution of primary care workforce was observed, improving the availability of general practitioners, nurses, and community workers in poorer communities.

Complex Adaptive Systems, soil degradation and land sensitivity to desertification: A multivariate assessment of Italian agro-forest landscape.

PubMed

Salvati, Luca; Mavrakis, Anastasios; Colantoni, Andrea; Mancino, Giuseppe; Ferrara, Agostino

2015-07-15

Degradation of soils and sensitivity of land to desertification are intensified in last decades in the Mediterranean region producing heterogeneous spatial patterns determined by the interplay of factors such as climate, land-use changes, and human pressure. The present study hypothesizes that rising levels of soil degradation and land sensitivity to desertification are reflected into increasingly complex (and non-linear) relationships between environmental and socioeconomic variables. To verify this hypothesis, the Complex Adaptive Systems (CAS) framework was used to explore the spatiotemporal dynamics of eleven indicators derived from a standard assessment of soil degradation and land sensitivity to desertification in Italy. Indicators were made available on a detailed spatial scale (773 agricultural districts) for various years (1960, 1990, 2000 and 2010) and analyzed through a multi-dimensional exploratory data analysis. Our results indicate that the number of significant pair-wise correlations observed between indicators increased with the level of soil and land degradation, although with marked differences between northern and southern Italy. 'Fast' and 'slow' factors underlying soil and land degradation, and 'rapidly-evolving' or 'locked' agricultural districts were identified according to the rapidity of change estimated for each of the indicators studied. In southern Italy, 'rapidly-evolving' districts show a high level of soil degradation and land sensitivity to desertification during the whole period of investigation. On the contrary, those districts in northern Italy are those experiencing a moderate soil degradation and land sensitivity to desertification with the highest increase in the level of sensitivity over time. The study framework contributes to the assessment of complex local systems' dynamics in affluent but divided countries. Results may inform thematic strategies for the mitigation of land and soil degradation in the framework of action plans to combat desertification. Copyright © 2015 Elsevier B.V. All rights reserved.

20 CFR 658.601 - State agency responsibility.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Cost Accounting Reports shall be compared to planned levels. Variances between achievement and plan... district office, a report describing local office performance within the area or district jurisdiction... System (ESARS) tables and Cost Accounting Reports shall be compared to planned levels. Variances between...

20 CFR 658.601 - State agency responsibility.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Cost Accounting Reports shall be compared to planned levels. Variances between achievement and plan... district office, a report describing local office performance within the area or district jurisdiction... System (ESARS) tables and Cost Accounting Reports shall be compared to planned levels. Variances between...

20 CFR 658.601 - State agency responsibility.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Cost Accounting Reports shall be compared to planned levels. Variances between achievement and plan... district office, a report describing local office performance within the area or district jurisdiction... System (ESARS) tables and Cost Accounting Reports shall be compared to planned levels. Variances between...

Examining Variability in Superintendent Community Involvement

ERIC Educational Resources Information Center

Kowalski, Theodore J.; Young, I. Phillip; Petersen, George J.

2013-01-01

This study examined the extent to which four independent variables (age, gender, education level, and district type) accounted for variability in superintendent community involvement. Two covariates associated with levels of community involvement (disposition toward community involvement and district enrollment) were infused to assess the impact…

How District Communities Do and Do Not Foster Teacher Pride.

ERIC Educational Resources Information Center

McLaughlin, Milbrey Wallin

1992-01-01

As one survey shows, although collegiality within academic departments determined secondary teachers' innovation norms, conceptions of students, sense of subject area, and enthusiasm, teacher commitment and pride are primarily products of district-level influences. Teacher autonomy without strong district professional community, with its…

Inefficiency, heterogeneity and spillover effects in maternal care in India: a spatial stochastic frontier analysis.

PubMed

Kinfu, Yohannes; Sawhney, Monika

2015-03-25

Institutional delivery is one of the key and proven strategies to reduce maternal deaths. Since the 1990s, the government of India has made substantial investment on maternal care to reduce the huge burden of maternal deaths in the country. However, despite the effort access to institutional delivery in India remains below the global average. In addition, even in places where health investments have been comparable, inter- and intra-state difference in access to maternal care services remain wide and substantial. This raises a fundamental question on whether the sub-national units themselves differ in terms of the efficiency with which they use available resources, and if so, why? Data obtained from round 3 of the country's District Level Health and Facility Survey was analyzed to measure the level and determinants of inefficiency of institutional delivery in the country. Analysis was conducted using spatial stochastic frontier models that correct for heterogeneity and spatial interactions between sub-national units. Inefficiency differences in maternal care services between and within states are substantial. The top one third of districts in the country has a mean efficiency score of 90 per cent or more, while the bottom 10 per cent of districts exhibit mean inefficiency score of as high as over 75 per cent or more. Overall mean inefficiency is about 30 per cent. The result also reveals the existence of both heterogeneity and spatial correlation in institutional delivery in the country. Given the high level of inefficiency in the system, further progress in improving coverage of institutional delivery in the country should focus both on improving the efficiency of resource utilization--especially where inefficiency levels are extremely high--and on bringing new resources in to the system. The additional investment should specifically focus on those parts of the country where coverage rates are still low but efficiency levels are already at a high level. In addition, given that inefficiency was also associated inversely with literacy and urbanization and positively related with proportion of households belonging to poor households, investment in these areas can also improve coverage of institutional delivery in the country.

Taking kangaroo mother care forward in South Africa: The role of district clinical specialist teams.

PubMed

Feucht, Ute Dagmar; van Rooyen, Elise; Skhosana, Rinah; Bergh, Anne-Marie

2015-11-20

The global agenda for improved neonatal care includes the scale-up of kangaroo mother care (KMC) services. The establishment of district clinical specialist teams (DCSTs) in South Africa (SA) provides an excellent opportunity to enhance neonatal care at district level and ensure translation of policies, including the requirement for KMC implementation, into everyday clinical practice. Tshwane District in Gauteng Province, SA, has been experiencing an increasing strain on obstetric and neonatal services at central, tertiary and regional hospitals in recent years as a result of growing population numbers and rapid up-referral of patients, with limited down-referral of low-risk patients to district-level services. We describe a successful multidisciplinary quality improvement initiative under the leadership of the Tshwane DCST, in conjunction with experienced local KMC implementers, aimed at expanding the district's KMC services. The project subsequently served as a platform for improvement of other areas of neonatal care by means of a systematic approach.

Barriers and Facilitators to Career Advancement by Top-Level, Entry-Level and Non-Administrative Women in Public School Districts: A Mixed Methods Study

ERIC Educational Resources Information Center

Ahmed, Eman Ibrahim El-Desouki

2011-01-01

The purpose of this study was to investigate the barriers and facilitators to career advancement among women administrators occupying top-level positions, those occupying entry-level positions and those in non-administrative positions in both rural and urban public school districts in central Pennsylvania. The need to increase the awareness of the…

Stock-outs of essential health products in Mozambique - longitudinal analyses from 2011 to 2013.

PubMed

Wagenaar, Bradley H; Gimbel, Sarah; Hoek, Roxanne; Pfeiffer, James; Michel, Cathy; Manuel, João Luis; Cuembelo, Fatima; Quembo, Titos; Afonso, Pires; Gloyd, Stephen; Sherr, Kenneth

2014-07-01

To assess the relationship between health system factors and facility-level EHP stock-outs in Mozambique. Service provisions were assessed in 26 health facilities and 13 district warehouses in Sofala Province, Mozambique, from July to August in 2011-2013. Generalised estimating equations were used to model factors associated with facility-level availability of essential drugs, supplies and equipment. Stock-out rates for drugs ranged from 1.3% for oral rehydration solution to 20.5% for Depo-Provera and condoms, with a mean stock-out rate of 9.1%; mean stock-out rates were 15.4% for supplies and 4.1% for equipment. Stock-outs at the district level accounted for 27.1% (29/107) of facility-level drug stock-outs and 44.0% (37/84) of supply stock-outs. Each 10-km increase in the distance from district distribution warehouses was associated with a 31% (CI: 22-42%), 28% (CI: 17-40%) or 27% (CI: 7-50%) increase in rates of drug, supply or equipment stock-outs, respectively. The number of heath facility staff was consistently negatively associated with the occurrence of stock-outs. Facility-level stock-outs of EHPs in Mozambique are common and appear to disproportionately affect those living far from district capitals and near facilities with few health staff. The majority of facility-level EHP stock-outs in Mozambique occur when stock exists at the district distribution centre. Innovative methods are urgently needed to improve EHP supply chains, requesting and ordering of drugs, facility and district communication, and forecasting of future EHP needs in Mozambique. Increased investments in public-sector human resources for health could potentially decrease the occurrence of EHP stock-outs. © 2014 John Wiley & Sons Ltd.

Stock-outs of essential health products in Mozambique-longitudinal analyses from 2011 to 2013

PubMed Central

Wagenaar, Bradley H.; Gimbel, Sarah; Hoek, Roxanne; Pfeiffer, James; Michel, Cathy; Manuel, João Luis; Cuembelo, Fatima; Quembo, Titos; Afonso, Pires; Gloyd, Stephen; Sherr, Kenneth

2015-01-01

objectives To assess the relationship between health system factors and facility-level EHP stock-outs in Mozambique. methods Service provisions were assessed in 26 health facilities and 13 district warehouses in Sofala Province, Mozambique, from July to August in 2011–2013. Generalised estimating equations were used to model factors associated with facility-level availability of essential drugs, supplies and equipment. results Stock-out rates for drugs ranged from 1.3% for oral rehydration solution to 20.5% for Depo-Provera and condoms, with a mean stock-out rate of 9.1%; mean stock-out rates were 15.4% for supplies and 4.1% for equipment. Stock-outs at the district level accounted for 27.1% (29/107) of facility-level drug stock-outs and 44.0% (37/84) of supply stock-outs. Each 10-km increase in the distance from district distribution warehouses was associated with a 31% (CI: 22–42%), 28% (CI: 17–40%) or 27% (CI: 7–50%) increase in rates of drug, supply or equipment stock-outs, respectively. The number of heath facility staff was consistently negatively associated with the occurrence of stock-outs. conclusions Facility-level stock-outs of EHPs in Mozambique are common and appear to disproportionately affect those living far from district capitals and near facilities with few health staff. The majority of facility-level EHP stock-outs in Mozambique occur when stock exists at the district distribution centre. Innovative methods are urgently needed to improve EHP supply chains, requesting and ordering of drugs, facility and district communication, and forecasting of future EHP needs in Mozambique. Increased investments in public-sector human resources for health could potentially decrease the occurrence of EHP stock-outs. PMID:24724617

Understanding the impact of area-based interventions on area safety in deprived areas: realist evaluation of a neighbour nuisance intervention in Arnhem, the Netherlands.

PubMed

Kramer, Daniëlle; Harting, Janneke; Kunst, Anton E

2016-03-31

Area-based health inequalities may partly be explained by higher levels of area disorder in deprived areas. Area disorder may cause safety concerns and hence impair health. This study assessed how, for whom and in what conditions the intervention Meeting for Care and Nuisance (MCN) had an impact on neighbour nuisance and area safety in four deprived districts in Arnhem, the Netherlands. Realist evaluation methodology was applied to uncover how, for whom, and under what conditions MCN was expected to and actually produced change. Expected change was based on action plans and scientific theories. Actual change was based on progress reports, media articles, interviews with district managers, and quantitative surveys. Three levels of impact were distinguished. At the organisational level, partly as expected, MCN's coordinated partnership strategy enabled role alignment, communication, and leadership. This resulted in a more efficient approach of nuisance households. At the level of nuisance households, as expected, MCN's joint assistance and enforcement strategy removed many of the underlying reasons for nuisance. This resulted in less neighbour nuisance. At the district level, perceptions of social control and area safety improved only in one district. Key conditions for change included a wider safety approach, dense population, and central location of the district within the city. This realist evaluation provided insight into the mechanisms by which a complex area-based intervention was able to reduce neighbour nuisance in deprived areas. Depending on wider conditions, such a reduction in neighbour nuisance may or may not lead to improved perceptions of area safety at the district level.

Comparison of Student-Level and School-Level Data in a National Impact Evaluation

ERIC Educational Resources Information Center

Velez, Melissa; Sahni, Sarah; Rulf-Fountain, Alyssa; Gamse, Beth

2014-01-01

One of the primary obstacles facing education researchers today is the struggle to obtain student-level data from states, districts, and schools. Researchers typically face one of two scenarios; they must either (1) work with contractors hired by the state or district to handle data requests who can be prohibitively expensive or (2) invest…

How school climate relates to chronic absence: A multi-level latent profile analysis.

PubMed

Van Eck, Kathryn; Johnson, Stacy R; Bettencourt, Amie; Johnson, Sarah Lindstrom

2017-04-01

Chronic absence is a significant problem in schools. School climate may play an important role in influencing chronic absence rates among schools, yet little research has evaluated how school climate constructs relate to chronic absence. Using multilevel latent profile analysis, we evaluated how profiles of student perceptions of school climate at both the student and school level differentiated school-level rates of chronic absence. Participants included 25,776 middle and high school students from 106 schools who completed a district administered school climate survey. Students attended schools in a large urban school district where 89% of 6th through 12th grade students were African-American and 61% were eligible for the federally subsidized school meals program. Three student-level profiles of perceptions of school climate emerged that corresponded to "positive," "moderate," and "negative" climate. Two predominant patterns regarding the distribution of these profiles within schools emerged that corresponded to the two school-level profiles of "marginal climate" and "climate challenged" schools. Students reporting "moderate" and "negative" climate in their schools were more likely to attend schools with higher chronic absence rates than students reporting that their school had "positive" climate. Likewise, "climate challenged" schools had significantly higher chronic absence rates than "marginal climate" schools. These results suggest that school climate shares an important relation with chronic absence among adolescent students attending urban schools. Implications for prevention and intervention programs are discussed. Copyright © 2016 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

An Analysis of Local Education Foundations as Alternative Revenue Streams for Public School Districts

ERIC Educational Resources Information Center

Busch, Douglas M.

2012-01-01

As school district revenues are reduced by state allocating agencies, local school district administrators and school boards frequently evaluate alternative sources of possible revenue. One emerging source of revenue that many school districts explore is a local education foundation. Local education foundations are 501(c)(3) nonprofit…

No One Way: Differentiating School District Leadership and Support for School Improvement

ERIC Educational Resources Information Center

Anderson, Stephen E.; Mascall, Blair; Stiegelbauer, Suzanne; Park, Jaddon

2012-01-01

This article examines findings from a qualitative investigation of how school district administrators in four mid to large sized urban school districts (10,000-50,000) identify and address differences in school performance. The analysis explores the interaction between district policies and actions that centralize and standardize expectations for…

Intra-class correlation estimates for assessment of vitamin A intake in children.

PubMed

Agarwal, Girdhar G; Awasthi, Shally; Walter, Stephen D

2005-03-01

In many community-based surveys, multi-level sampling is inherent in the design. In the design of these studies, especially to calculate the appropriate sample size, investigators need good estimates of intra-class correlation coefficient (ICC), along with the cluster size, to adjust for variation inflation due to clustering at each level. The present study used data on the assessment of clinical vitamin A deficiency and intake of vitamin A-rich food in children in a district in India. For the survey, 16 households were sampled from 200 villages nested within eight randomly-selected blocks of the district. ICCs and components of variances were estimated from a three-level hierarchical random effects analysis of variance model. Estimates of ICCs and variance components were obtained at village and block levels. Between-cluster variation was evident at each level of clustering. In these estimates, ICCs were inversely related to cluster size, but the design effect could be substantial for large clusters. At the block level, most ICC estimates were below 0.07. At the village level, many ICC estimates ranged from 0.014 to 0.45. These estimates may provide useful information for the design of epidemiological studies in which the sampled (or allocated) units range in size from households to large administrative zones.

The levels of polycyclic aromatic hydrocarbons (PAHs) in human milk and exposure risk to breastfed infants in petrochemical industrialized Lanzhou Valley, Northwest China.

PubMed

Wang, Li; Liu, Aiping; Zhao, Yuan; Mu, Xi; Huang, Tao; Gao, Hong; Ma, Jianmin

2018-06-01

We investigated in this paper the presence of PAHs in human milk from lactating women residing in Lanzhou, a petrochemical industrialized valley city in Northwest China. The PAH concentration levels in human milk samples from 98 healthy women were determined by gas chromatography/mass spectrometry (GC/MS). The associations between the lifestyle factors and the PAHs levels of human milk were analyzed. Moreover, we applied principal component analysis (PCA) method to gain a better insight into the similarities or dissimilarities of the human milk PAH loads and different pathways of source exposure. In addition, the exposure risks of breastfed infants due to PAH ingestion via breast milk were assessed and the relative breast-feeding risk to the total intake dose of infants was addressed. The results showed that the average fat-normalized human milk ∑ 15 PAHs concentrations for the lactating women residing in four districts of Lanzhou, namely, Xigu, Anning, Qilihe, and Chengguan were 320.40, 270.36, 374.04, and 259.84 ng/g of fat, respectively. The ∑ 15 PAHs of human milk from the lactating women of Qilihe District exhibited the highest concentration level, while the concentration level for women from Xigu District is the second highest for the observed human milk ∑ 15 PAHs. And the corresponding BaPeq concentrations for women in Xigu, Anning, Qilihe, and Chengguan districts were 58.29, 47.95, 65.13, and 45.60 ng/g of fat, respectively. A significant correlation was only found between human milk and living district environment (p < 0.05). Although the Spearman correlation analysis showed that there were no significant correlation existing between other lifestyle and human milk PAHs, we confirmed that consuming barbecue food could elevate PAHs levels in human milk: the barbecue intake frequency caused 10% fluctuation of ∑ 15 PAHs concentration between high frequency and low frequency group in our study. Furthermore, the exposure to second-hand smoke can also increase the ∑ 15 PAHs levels in human milk by 4 to 11% here. Ingestion doses of PAHs by infants (19.37-77.75 ng kg -1  day -1 ) were much higher than the inhalation doses (2.83-16.48 ng kg -1  day -1 ), which indicated that the ingestion is the main exposure risk pathway for infants. Since there are limited guidelines and standards for PAHs ingestion dose in human milk by infant, we compared the ingestion dose of BaP with the upper bound estimates of BaP dietary exposure of 108 ng kg -1  day -1 for toddlers of ages between 1.5 and 2.5 years of age in the UK reported by Committee on Toxicity of Chemicals in Food (COT) and the data we obtained were lower than this upper bound. However, the estimated margin of exposure (MOE) values of BaP-MOE, PAH2-MOE, PAH4-MOE, and PAH8-MOE were smaller than 10,000 which indicated that there are potential hazard for breastfed infants consuming these human milk samples.

School District Policies and Adolescents’ Soda Consumption

PubMed Central

Miller, Gabrielle F.; Sliwa, Sarah; Brener, Nancy D.; Park, Sohyun; Merlo, Caitlin L.

2016-01-01

Purpose Sugar-sweetened beverages (SSBs) are a significant source of calories and added sugars for youth ages 14–18 years in the United States. This study examined the relationship between district-level policies and practices and students’ consumption of regular soda, one type of SSB, in 12 large urban school districts. Methods Data from the 2012 School Health Policies and Practices Study and 2013 Youth Risk Behavior Surveillance System were linked by district. The outcome variable was soda consumption and exposure variables were district policies. We used multivariable logistic regression analyses to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) after controlling for student characteristics and district free/reduced-price meal eligibility. Results About 18% of students reported consuming regular soda at least once per day. Most districts required high schools to have nutrition education, maintain closed campuses, and required/recommended that schools restrict promotional products and sale of beverages. Fewer districts required/recommended that schools offer healthful alternative beverages. Students in districts that restricted promotional products had lower odds of regular soda consumption (AOR = .84, 95% CI = .71–1.00), as did students in districts that restricted access to SSBs and offered healthful beverages when other beverages were available (AOR = .72, 95% CI = .54–.93, AOR = .76, 95% CI = .63–.91). Conclusions This study demonstrates that certain district-level policies are associated with student consumption of regular soda. These findings add to a growing consensus that policies and practices that influence the availability of healthier foods and beverages are needed across multiple settings. PMID:27021401

School District Policies and Adolescents' Soda Consumption.

PubMed

Miller, Gabrielle F; Sliwa, Sarah; Brener, Nancy D; Park, Sohyun; Merlo, Caitlin L

2016-07-01

Sugar-sweetened beverages (SSBs) are a significant source of calories and added sugars for youth ages 14-18 years in the United States. This study examined the relationship between district-level policies and practices and students' consumption of regular soda, one type of SSB, in 12 large urban school districts. Data from the 2012 School Health Policies and Practices Study and 2013 Youth Risk Behavior Surveillance System were linked by district. The outcome variable was soda consumption and exposure variables were district policies. We used multivariable logistic regression analyses to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) after controlling for student characteristics and district free/reduced-price meal eligibility. About 18% of students reported consuming regular soda at least once per day. Most districts required high schools to have nutrition education, maintain closed campuses, and required/recommended that schools restrict promotional products and sale of beverages. Fewer districts required/recommended that schools offer healthful alternative beverages. Students in districts that restricted promotional products had lower odds of regular soda consumption (AOR = .84, 95% CI = .71-1.00), as did students in districts that restricted access to SSBs and offered healthful beverages when other beverages were available (AOR = .72, 95% CI = .54-.93, AOR = .76, 95% CI = .63-.91). This study demonstrates that certain district-level policies are associated with student consumption of regular soda. These findings add to a growing consensus that policies and practices that influence the availability of healthier foods and beverages are needed across multiple settings. Published by Elsevier Inc.

Negotiating in School Districts when Times Are Tough

ERIC Educational Resources Information Center

Dolph, David

2012-01-01

When the economy is depressed, resources are limited, mandates are overwhelming, and the organizational climate in the district is souring, education leaders and teachers union officials often brace themselves for contentious negotiations. Poor economic conditions affect the district's ability to offer raises, maintain current benefit levels, and…

District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries

PubMed Central

Stewart, Barclay T; Gyedu, Adam; Quansah, Robert; Addo, Wilfred Larbi; Afoko, Akis; Agbenorku, Pius; Amponsah-Manu, Forster; Ankomah, James; Appiah-Denkyira, Ebenezer; Baffoe, Peter; Debrah, Sam; Donkor, Peter; Dorvlo, Theodor; Japiong, Kennedy; Kushner, Adam L; Morna, Martin; Ofosu, Anthony; Oppong-Nketia, Victor; Tabiri, Stephen; Mock, Charles

2015-01-01

Introduction Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. Methods Consensus on trauma care audit filters was built between twenty panelists using a Delphi technique with four anonymous, iterative surveys designed to elicit: i) trauma care processes to be measured; ii) important features of audit filters for the district-level hospital setting; and iii) potentially useful filters. Filters were ranked on a scale from 0 – 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. Results Panelists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1 - 0.58; Round 2 - 0.66; Round 3 - 0.76; and Round 4 - 0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage - vital signs are recorded within 15 minutes of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation - a large bore IV was placed within 15 minutes of patient arrival; referral - if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. Conclusion This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs, the collection and reporting of prospective trauma care audit filters may be an important step toward improving care for the injured at district-level hospitals in LMICs. PMID:26492882

Mountain bikes and metropolitan park districts: issues and trends identified by state parks and state park districts in Ohio

Treesearch

Eric L. Longsdorf; Ruthie Kucharewski

2007-01-01

This study explored selected issues and trends related to mountain biking within Ohio State Parks and Park Districts. A convenience sample of 21 State Parks and 26 Park Districts completed a 24-item survey assessing mountain bike: (a) access, (b) activity levels, (c) planning, and (d) management. Results indicated that 86 percent of State Parks participating in the...

Infant mortality in South Africa - distribution, associations and policy implications, 2007: an ecological spatial analysis

PubMed Central

2011-01-01

Background Many sub-Saharan countries are confronted with persistently high levels of infant mortality because of the impact of a range of biological and social determinants. In particular, infant mortality has increased in sub-Saharan Africa in recent decades due to the HIV/AIDS epidemic. The geographic distribution of health problems and their relationship to potential risk factors can be invaluable for cost effective intervention planning. The objective of this paper is to determine and map the spatial nature of infant mortality in South Africa at a sub district level in order to inform policy intervention. In particular, the paper identifies and maps high risk clusters of infant mortality, as well as examines the impact of a range of determinants on infant mortality. A Bayesian approach is used to quantify the spatial risk of infant mortality, as well as significant associations (given spatial correlation between neighbouring areas) between infant mortality and a range of determinants. The most attributable determinants in each sub-district are calculated based on a combination of prevalence and model risk factor coefficient estimates. This integrated small area approach can be adapted and applied in other high burden settings to assist intervention planning and targeting. Results Infant mortality remains high in South Africa with seemingly little reduction since previous estimates in the early 2000's. Results showed marked geographical differences in infant mortality risk between provinces as well as within provinces as well as significantly higher risk in specific sub-districts and provinces. A number of determinants were found to have a significant adverse influence on infant mortality at the sub-district level. Following multivariable adjustment increasing maternal mortality, antenatal HIV prevalence, previous sibling mortality and male infant gender remained significantly associated with increased infant mortality risk. Of these antenatal HIV sero-prevalence, previous sibling mortality and maternal mortality were found to be the most attributable respectively. Conclusions This study demonstrates the usefulness of advanced spatial analysis to both quantify excess infant mortality risk at the lowest administrative unit, as well as the use of Bayesian modelling to quantify determinant significance given spatial correlation. The "novel" integration of determinant prevalence at the sub-district and coefficient estimates to estimate attributable fractions further elucidates the "high impact" factors in particular areas and has considerable potential to be applied in other locations. The usefulness of the paper, therefore, not only suggests where to intervene geographically, but also what specific interventions policy makers should prioritize in order to reduce the infant mortality burden in specific administration areas. PMID:22093084

Regional Inequalities in Lung Cancer Mortality in Belgium at the Beginning of the 21st Century: The Contribution of Individual and Area-Level Socioeconomic Status and Industrial Exposure.

PubMed

Hagedoorn, Paulien; Vandenheede, Hadewijch; Willaert, Didier; Vanthomme, Katrien; Gadeyne, Sylvie

2016-01-01

Being a highly industrialized country with one of the highest male lung cancer mortality rates in Europe, Belgium is an interesting study area for lung cancer research. This study investigates geographical patterns in lung cancer mortality in Belgium. More specifically it probes into the contribution of individual as well as area-level characteristics to (sub-district patterns in) lung cancer mortality. Data from the 2001 census linked to register data from 2001-2011 are used, selecting all Belgian inhabitants aged 65+ at time of the census. Individual characteristics include education, housing status and home ownership. Urbanicity, unemployment rate, the percentage employed in mining and the percentage employed in other high-risk industries are included as sub-district characteristics. Regional variation in lung cancer mortality at sub-district level is estimated using directly age-standardized mortality rates. The association between lung cancer mortality and individual and area characteristics, and their impact on the variation of sub-district level is estimated using multilevel Poisson models. Significant sub-district variations in lung cancer mortality are observed. Individual characteristics explain a small share of this variation, while a large share is explained by sub-district characteristics. Individuals with a low socioeconomic status experience a higher lung cancer mortality risk. Among women, an association with lung cancer mortality is found for the sub-district characteristics urbanicity and unemployment rate, while for men lung cancer mortality was associated with the percentage employed in mining. Not just individual characteristics, but also area characteristics are thus important determinants of (regional differences in) lung cancer mortality.

Mentoring and Coaching Rural School Leaders: What Do They Need?

ERIC Educational Resources Information Center

Duncan, Heather E.; Stock, Mark J.

2010-01-01

This study explores the types of principal mentoring/coaching programs delivered in Wyoming school districts, USA, and the areas of need perceived by principals at different levels of experience. Some formalized district principal mentorship programs existed in larger school districts but these mainly targeted beginning principals. Most of the…

Brevard District Plan for Career Education Development.

ERIC Educational Resources Information Center

Thomas, Olive W.

The Brevard County Plan was written to include goals and objectives for the years 1974-77. Goals for 1974-75 include promoting the career education concept in all district schools (emphasizing the various career education elements at appropriate grade levels), setting up placement services, coordinating county and district goals, program…

Evidence, Interpretation, and Persuasion: Instructional Decision Making at the District Central Office

ERIC Educational Resources Information Center

Coburn, Cynthia E.; Toure, Judith; Yamashita, Mika

2009-01-01

Background/Context: Calls for evidence-based decision making have become increasingly prominent on the educational landscape. School district central offices increasingly experience these demands. Yet there are few empirical studies of evidence use at the district level. Furthermore, research on evidence use among policy makers in noneducation…

Perceptions of Secondary School Teachers and Administrators on Effective Professional Development Programs

ERIC Educational Resources Information Center

Sherrod, Ginnie

2014-01-01

Effective professional development programs have been linked with rigorous state standards and district school improvement goals. Despite efforts of local districts to meet state standards and district school improvement goals, there has been limited research at the local level that has compared administrators' and teachers' perceptions of…

Classification of andisol soil on robusta coffee plantation in Silima Pungga - Pungga District

NASA Astrophysics Data System (ADS)

Marbun, P.; Nasution, Z.; Hanum, H.; Karim, A.

2018-02-01

The survey study aims to classify the Inceptisol soil on Robusta coffee plantation in Silima Pugga-Pungga District, from Order level to Sub Group level. The study was conducted on location of sample soil profiles which were determined based on Soil Map Unit (SMU) with the main Andisol Order, i.e. SMU 12, SMU 15 and SMU 17 of 18 existing SMU. The soil profiles were described to determine the morphological characteristics of the soil, while the physical and chemical properties were done by laboratory analysis. The soil samples were taken from each horizon in each profile and analyzed in the laboratory in the form of soil texture, bulk density, pH H2O, pH KCl, pH NaF, C-organic, exchangeable bases (Ca2+, Mg2+, K+, Na+), ZPC (zero point charge), base saturation, cation exchange capasity (CEC), P-retention, Al-Oxalate (Al-O) and Si-Oxalate (Si-O). The results showed that the classification of Andisol soil based on Soil Taxonomy only has one Sub Group namely Typic Hapludand. It is expected that the results of this study can provide information for more appropriate land management in order to increase the production of Robusta coffee plant in Silima Pungga-Pungga Sub district.

Financial management systems under decentralization and their effect on malaria control in Uganda.

PubMed

Kivumbi, George W; Nangendo, Florence; Ndyabahika, Boniface Rutagira

2004-01-01

A descriptive case study with multiple sites and a single level of analysis was carried out in four purposefully selected administrative districts of Uganda to investigate the effect of financial management systems under decentralization on malaria control. Data were primarily collected from 36 interviews with district managers, staff at health units and local leaders. A review of records and documents related to decentralization at the central and district level was also used to generate data for the study. We found that a long, tedious, and bureaucratic process combined with lack of knowledge in working with new financial systems by several actors characterized financial flow under decentralization. This affected the timely use of financial resources for malaria control in that there were funds in the system that could not be accessed for use. We were also told that sometimes these funds were returned to the central government because of non-use due to difficulties in accessing them and/or stringent conditions not to divert them to other uses. Our data showed that a cocktail of bureaucratic control systems, corruption and incompetence make the financial management system under decentralization counter-productive for malaria control. The main conclusion is that good governance through appropriate and efficient financial management systems is very important for effective malaria control under decentralization.

District Level Leadership: Core Leadership Practices for Sustainable Change

ERIC Educational Resources Information Center

Feagan, Roger W.; Kupka, Cynthia J.; Laubenstein, Michelle M.; Miller, Dana L.

2009-01-01

This report describes the findings of a doctoral team project regarding core leadership practices that support sustainable academic change. The project team reviewed literature related to sustainable change, reform models, and leadership. The empirical research regarding the relationship between district level leadership practices that contribute…

Implementing Metrics at a District Level. Administrative Guide. Revised Edition.

ERIC Educational Resources Information Center

Borelli, Michael L.; Morelli, Sandra Z.

Administrative concerns in implementing metrics at a district level are discussed and specific recommendations are made regarding them. The paper considers the extent and manner of staff training necessary, the curricular changes associated with metrics, and the distinctions between elementary and secondary programs. Appropriate instructional…

[Supporting the intermediate level of health care in urban health areas in Kinshasa (1995-2005), DR Congo].

PubMed

Mbeva, Jean-Bosco Kahindo; Schirvel, Carole; Karemere, Hermès; Porignon, Denis

2012-06-08

As a result of the decentralization of health systems, some countries have introduced intermediate (provincial) levels in their public health system. This paper presents the results of a case study conducted in Kinshasa on health system decentralization. The study identified a shift from a focus on regulation compliance assessment to an emphasis on health system coordination and health district support. It also highlighted the emergence of a?managerial (as opposed to a bureaucratic) approach to health district support. The performance of health districts in terms of health care coverage and health service use were also found to have improved. The results highlight the importance of intermediate levels in?the health care system and the value of a more organic and managerial rationality in supporting health districts faced with the complexity of urban environments and the integration of specialized multi-partner programs and interventions.

Characteristics of Illinois School Districts That Employ School Nurses.

PubMed

Searing, Lisabeth M; Guenette, Molly

2016-08-01

Research indicates that school nursing services are cost-effective, but the National Association of School Nurses estimates that 25% of schools do not have a school nurse (SN). The purpose of this study was to identify the characteristics of Illinois school districts that employed SNs. This was a secondary data analysis of Illinois School Report Card system data as well as data obtained from district websites regarding SNs. Employment of an SN was determined for 95% of the 862 existing districts. Binary logistic regression analysis found that district size was the largest significant predictor of employment of an SN. Other factors included the type of district and diversity of the teaching staff as well as the percentage of students receiving special education services or with limited English proficiency. These findings indicate where to focus advocacy and policy efforts to encourage employment of SNs. © The Author(s) 2015.

Preparedness of Finnish Emergency Medical Services for Chemical Emergencies.

PubMed

Jama, Timo J; Kuisma, Markku J

2016-08-01

Introduction The preparedness level of Finnish Emergency Medical Services (EMS) for treating chemical emergencies is unknown. The aim of this study was to survey the preparedness level of EMS systems for managing and handling mass-casualty chemical incidents in the prehospital phase in Finland. Hypothesis The study hypothesis was that university hospital districts would have better clinical capability to treat patients than would central hospital districts in terms of the number of patients treated in the field within one hour after dispatching as well as patients transported to hospital within one hour or two hours after dispatching. This cross-sectional study was conducted as a Webropol (Wuppertal, Germany) survey. All hospital districts (n=20) in continental Finland were asked about their EMS preparedness level in terms of capability of treating and transporting chemically affected patients in the field. Their capability for decontamination of affected patients in the field was also inquired. University hospital district-based EMS systems had at least 20% better absolute clinical capacity than central hospital-based EMS systems for treating chemically affected patients concerning all treatments inquired about, except the capacity for non-invasive ventilation (NIV)/continuous positive airway pressure (CPAP) treatment in the field. Overall, there was a good level of preparedness for treating chemical accident patients with supplemental oxygen, bronchodilators, and inhaled corticosteroids. Preparedness for providing antidote therapy in cases of cyanide gas exposure was, in general, low. The variation among the hospital districts was remarkable. Only nine of 15 central hospital district EMS had a mobile decontamination unit available, whereas four of five university hospital districts had one. Emergency Medical Services capacity in Finland for treating chemically affected patients in the field needs to be improved, especially in terms of antidote therapy. Mobile decontamination units should be available in all hospital districts. Jama TJ , Kuisma MJ . Preparedness of Finnish Emergency Medical Services for chemical emergencies. Prehosp Disaster Med. 2016;31(4):392-396.

Classroom Questioning Tendencies from the Perspective of Big Data

ERIC Educational Resources Information Center

Lu, Wang; Rongxiao, Cai

2016-01-01

We are now living in an era of big data. From the perspective of data analysis of classroom questioning, the paper chooses three districts in City B that have significant differences. These are educationally developed District D, less developed District F, and developing District M. The study uses the stratified sampling method to choose from…

An Analysis of Staff Development Programs and Their Costs in Three Urban School Districts.

ERIC Educational Resources Information Center

Moore, Donald R.; Hyde, Arthur A.

This report analyzes teacher staff development programs and their costs in three large urban school districts, and discusses research and policy implications of the research results. The districts were selected through a survey of school districts serving the 75 largest U.S. cities, and were chosen because of their respectively high, medium, and…

School District Labour Conflict and Frame Analysis: A Field Study of Contentious Negotiations

ERIC Educational Resources Information Center

Gates, Gordon S.; Vesneske, Staci S.

2012-01-01

Labour conflict in school districts is a largely neglected area of educational research. This study examines the perceptions, actions, and decisions of union and district leaders using social movement theory to describe, analyze, and interpret contentious contract negotiations in three school districts in the Pacific Northwest region of the US.…

A Model for Determining School District Cash Flow Needs.

ERIC Educational Resources Information Center

Dembowski, Frederick L.

This paper discusses a model to optimize cash management in school districts. A brief discussion of the cash flow pattern of school districts is followed by an analysis of the constraints faced by the school districts in their investment planning process. A linear programming model used to optimize net interest earnings on investments is developed…

Prevalence of arsenic exposure in population of Ballia district from drinking water and its correlation with blood arsenic level.

PubMed

Katiyar, Shashwat; Singh, Dharam

2014-05-01

An investigation was carried out to ascertain the effect of arsenic in the blocks of Ballia district in Uttar Pradesh in the upper and middle Ganga plain, India. Analysis of 100 drinking water samples revealed that arsenic concentration was below 10 μg l⁻¹ in 60% samples, 10-50 μg l⁻¹ in 6%, 100 μg l⁻¹ in 24% and 200 μg l⁻¹ in 10% samples, respectively. The arsenic concentration in drinking water ranged from 12.8 to 132.2 μg l⁻¹. The depth of source of drinking water (10-60 m) was also found with a mean of 36.12 ± 13.61 μg l⁻¹ arsenic concentration. Observations revealed that at depth ranging from 10 to 20 m, the mean level of arsenic concentration was 17.398 ± 21.796 μg l⁻¹, while at 21 to 40 m depth As level was 39.685 ± 40.832 μg l⁻¹ and at 41 to 60 m As level was 46.89 ± 52.80 μg l⁻¹, respectively. These observations revealed a significant positive correlation (r = 0.716, t = 4.215, P < 0.05) between depth and arsenic concentration in drinking water. The age of water sources were ranged from zero to 30 years. The study indicates that the older sources of drinking water showed higher chance of contamination. Results showed that group 21-30 years having maximum arsenic concentration with mean value of 52.57 ± 53.79 μg l⁻¹. Correlation analysis also showed a significant positive correlation (r = 0.801, t = 5.66, P < 0.05) between age of drinking water sources and their respective arsenic concentration (μg l⁻¹). Arsenic concentration in blood with mean value 0.226 ± 0.177 μg dl⁻¹ significantly increased as compared to control. The blood arsenic content correlated significantly (r = 0.6823, t = 3.93, P < 0.05) with drinking water arsenic level and exposure time (r = 0.545, t = 3.101 & *P < 0.05) for populations residing in Ballia districts. Observations and correlation analysis revealed that individuals having depth of drinking water sources 20-30 m were less affected with arsenic exposure.

The relationship between qualified personnel and self-reported implementation of recommended physical education practices and programs in U.S. schools.

PubMed

Davis, Kristen S; Burgeson, Charlene R; Brener, Nancy D; McManus, Tim; Wechsler, Howell

2005-06-01

The authors analyzed data from the School Health Policies and Programs Study 2000 to assess the associations between the presence of a district physical education coordinator and district-level physical education policies and practices recommended by federal government agencies and national organizations. The authors also examined the relationship between teacher qualifications and staff development related to physical education and self-reported implementation of recommended teachingpractices. District-level data were collected by self-administered mail questionnaires from a nationally representative sample of school districts. Classroom-level data were collected by computer-assisted personal interviews with teachers of randomly selected classes in elementary schools and randomly selected required physical education courses in middle/junior high and senior high schools. Nearly two thirds (62.2%) of districts had a physical education coordinator, and those were generally more likely than other districts to report having policies and practices that corresponded with national recommendations for high-quality physical education programs. More than two thirds of teachers (66.9%) met the criteria for teacher qualifications based on their education and certification. These teachers were more likely than others to report use of certain recommended physical education teaching practices. Teachers who participated in staff development also were more likely to use recommended teaching practices in their classrooms. Using a district physical education coordinator and teachers with appropriate qualifications as well as offering staff development opportunities on physical education may enhance school physical education programs.

Geographic distribution of suicide and railway suicide in Belgium, 2008-2013: a principal component analysis.

PubMed

Strale, Mathieu; Krysinska, Karolina; Overmeiren, Gaëtan Van; Andriessen, Karl

2017-06-01

This study investigated the geographic distribution of suicide and railway suicide in Belgium over 2008--2013 on local (i.e., district or arrondissement) level. There were differences in the regional distribution of suicide and railway suicides in Belgium over the study period. Principal component analysis identified three groups of correlations among population variables and socio-economic indicators, such as population density, unemployment, and age group distribution, on two components that helped explaining the variance of railway suicide at a local (arrondissement) level. This information is of particular importance to prevent suicides in high-risk areas on the Belgian railway network.

Assessment of the population-level effectiveness of the Avahan HIV-prevention programme in South India: a preplanned, causal-pathway-based modelling analysis.

PubMed

Pickles, Michael; Boily, Marie-Claude; Vickerman, Peter; Lowndes, Catherine M; Moses, Stephen; Blanchard, James F; Deering, Kathleen N; Bradley, Janet; Ramesh, Banadakoppa M; Washington, Reynold; Adhikary, Rajatashuvra; Mainkar, Mandar; Paranjape, Ramesh S; Alary, Michel

2013-11-01

Avahan, the India AIDS initiative of the Bill & Melinda Gates Foundation, was a large-scale, targeted HIV prevention intervention. We aimed to assess its overall effectiveness by estimating the number and proportion of HIV infections averted across Avahan districts, following the causal pathway of the intervention. We created a mathematical model of HIV transmission in high-risk groups and the general population using data from serial cross-sectional surveys (integrated behavioural and biological assessments, IBBAs) within a Bayesian framework, which we used to reproduce HIV prevalence trends in female sex workers and their clients, men who have sex with men, and the general population in 24 South Indian districts over the first 4 years (2004-07 or 2005-08 dependent on the district) and the full 10 years (2004-13) of the Avahan programme. We tested whether these prevalence trends were more consistent with self-reported increases in consistent condom use after the implementation of Avahan or with a counterfactual (assuming consistent condom use increased at slower, pre-Avahan rates) using a Bayes factor, which gave a measure of the strength of evidence for the effectiveness estimates. Using regression analysis, we extrapolated the prevention effect in the districts covered by IBBAs to all 69 Avahan districts. In 13 of 24 IBBA districts, modelling suggested medium to strong evidence for the large self-reported increase in consistent condom use since Avahan implementation. In the remaining 11 IBBA districts, the evidence was weaker, with consistent condom use generally already high before Avahan began. Roughly 32700 HIV infections (95% credibility interval 17900-61600) were averted over the first 4 years of the programme in the IBBA districts with moderate to strong evidence. Addition of the districts with weaker evidence increased this total to 62800 (32000-118000) averted infections, and extrapolation suggested that 202000 (98300-407000) infections were averted across all 69 Avahan districts in South India, increasing to 606000 (290000-1 193000) over 10 years. Over the first 4 years of the programme 42% of HIV infections were averted, and over 10 years 57% were averted. This is the first assessment of Avahan to account for the causal pathway of the intervention, that of changing risk behaviours in female sex workers and high-risk men who have sex with men to avert HIV infections in these groups and the general population. The findings suggest that substantial preventive effects can be achieved by targeted behavioural HIV prevention initiatives. Bill & Melinda Gates Foundation. Copyright © 2013 Pickles et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.

The successful implementation of STEM initiatives in lower income schools

NASA Astrophysics Data System (ADS)

Bakshi, Leena

The purpose of this study was to examine the leadership strategies utilized by superintendents, district administrators and school principals and the impact of these identified strategies on implementing STEM initiatives specifically for lower-income students. This study set out to determine (a) What role does district leadership play in the implementation of STEM initiatives in lower income secondary schools; (b) What internal systems of accountability exist in successful lower income secondary schools' STEM programs; (c) What leadership strategies are used to implement STEM curriculum initiatives; (d) How do school and district leadership support staff in order to achieve student engagement in STEM Initiative curriculum. This study used a mixed-methods approach to determine the impact of leadership strategies utilized by superintendents, district administrators and school principals on implementing STEM initiatives. Quantitative data analyzed survey questionnaires to determine the degree of correlation between the school districts that have demonstrated the successful implementation of STEM initiatives at the school and district levels. Qualitative data was collected using highly structured participant interviews and purposeful sampling of four district superintendents, one district-level administrator and five school leaders to capture the key strategies in implementing STEM initiatives in lower income secondary schools. Through the process of triangulation, the results of the study revealed that superintendents and principals should consider the characteristics of effective STEM initiatives that have shown a considerable degree of correlation with positive outcomes for lower income students. These included the leadership strategies of personnel's making decisions about the district's and school's instructional direction and an emphasis on the conceptual development of scientific principles using the Next Generation Science Standards coupled with the Common Core State Standards across the grade levels. It also emphasized the importance of establishing community partnerships as a primary resource. This study highlighted the criteria district and school leadership should include in implementing STEM initiatives and designing professional development models that result in meaningful instructional practices of STEM curriculum for secondary lower income students. Overall, this study provides insight for superintendents, district leaders and school administrators that can play an integral role in implementing STEM initiatives with access for socioeconomically disadvantaged students.

School Finance Reform in the Seventies: Achievements and Failures. Technical Analysis Paper.

ERIC Educational Resources Information Center

Brown, Lawrence L., III; And Others

As a base for evaluating the need for further federal involvement in school finance, this study examines changes that have taken place in the distribution of resources within the states. It examines the effectiveness of school finance reform solely in terms of results--the resource levels made available in the school districts of a state and the…

Money for Music Education: A District Analysis of the How, What, and Where of Spending for Music Education

ERIC Educational Resources Information Center

Fermanich, Mark L.

2011-01-01

Evidence suggests that accountability and financial pressures are causing schools across the country to reduce investments in subject areas that are not assessed for accountability purposes. However, due to the design of financial reporting systems in most states, inadequate data are available to analyze spending levels and patterns for specific…

Making an Educational Innovation Stick: Building State Networks to Support Experience-Based Career Education.

ERIC Educational Resources Information Center

Bridgeford, Nancy; Douglas, Marcia

A study assessed the activities of five state networks that were designed to transfer experience-based career education (EBCE) ownership to appropriate state and local institutions and to develop a state-level support system for continued implementation of EBCE in local districts. Focus of the analysis was on factors contributing to EBCE entry,…

Implementation of a Proficiency-Based Diploma System in Maine: Phase II--District Level Analysis

ERIC Educational Resources Information Center

Silvernail, David L.; Stump, Erika K.; McCafferty, Anita Stewart; Hawes, Kathryn M.

2014-01-01

This report describes the findings from Phase II of a study of Maine's implementation of a proficiency-based diploma system. At the request of the Joint Standing Committee on Education and Cultural Affairs of the Maine Legislature, the Maine Policy Research Institute (MEPRI) has conducted a two-phased study of the implementation of Maine law…

Who Chooses, Who Uses? Initial Evidence from the D.C. Opportunity Scholarship Program

ERIC Educational Resources Information Center

Wolf, Patrick; Eissa, Nada; Gutmann, Babette

2006-01-01

The federal government recently enacted its first school voucher program as a pilot project in the District of Columbia. To be eligible, students need to be entering grades K-12 and have a family income at or below 185 percent of the poverty level. Although a rigorous analysis of the Opportunity Scholarship Program's impact on student achievement…

Selective screening for inborn errors of metabolism and secondary methylmalonic aciduria in pregnancy at high risk district of neural tube defects: a human metabolome study by GC-MS in China.

PubMed

Song, Yuan-Zong; Li, Bing-Xiao; Hao, Hu; Xin, Ruo-Lei; Zhang, Ting; Zhang, Chun-Hua; Kobayashi, Keiko; Wang, Zi-Neng; Zheng, Xiao-Ying

2008-05-01

Urease pretreatment-gas chromatography-mass spectrometry (UP-GC-MS) has become a valuable tool in the field of metabolome research, including analysis of inborn errors of metabolism (IEMs) and acquired metabolic disturbances secondary to nutrition or drugs. This research aims to screen IEMs in Chinese patients and to explore the cause of neural tube defects (NTDs), a congenital malformation very common in North China. Urine samples from 618 patients at high risk of IEMs in China were collected, and UP-GC-MS was performed in the selective screening. Urinary methylmalonate (MMA) levels in pregnancy with and without NTDs fetus, respectively, at Luliang district, a countryside region with NTDs incidence 227/10,000, Shanxi Province, North China, were analyzed by GC-MS-selective ion monitoring, and compared with that from control region. Among the 618 patients, 22 kinds and 59 cases of IEM were found. Methylmalonic aciduria (MMAuria) is on top of the list, followed by neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD), phenylketonuria (PKU), multiple carboxylase deficiency (MCD), etc. Satisfactory therapeutic effects have been achieved in patients such as NICCD, MCD, and galactosemia. At Luliang district, urinary MMA levels in pregnancy, no matter NTDs-affected or unaffected, are both significantly (P<0.01) higher than that in normal control, while serum B(12) levels in NTDs-affected pregnancy are significantly lower than that both in NTDs-unaffected group (P<0.01) and in normal control (P<0.01). Furthermore, B(12) <52.5 pmol/L is associated with a 7.78-fold increased NTDs risk (P<0.01) at Luliang district. Selective screening for IEMs by UP-GC-MS provides valuable evidences for the diagnosis of IEMs. MMAuria secondary to B(12) deficiency is quite common at Luliang district, suggesting B(12) deficiency is involved in the development of NTDs in the specific population. This metabolome research by UP-GC-MS provides valuable epidemiological information that helps to understand the prevalence and the possible intervention strategy of NTDs and IEMs, especially in Chinese population.

Resource Needs for the Trivalent Oral Polio to Bivalent Oral Polio Vaccine Switch in Indonesia.

PubMed

Holmes, Marionette; Abimbola, Taiwo; Lusiana, Merry; Pallas, Sarah; Hampton, Lee M; Widyastuti, Retno; Muas, Idawati; Karlina, Karlina; Kosen, Soewarta

2017-07-01

We present an empirical economic cost analysis of the April 2016 switch from trivalent (tOPV) to bivalent (bOPV) oral polio vaccine at the national-level and 3 provinces (Bali, West Sumatera and Nusa Tenggara) for Indonesia's Expanded Program on Immunization. Data on the quantity and prices of resources used in the 4 World Health Organization guideline phases of the switch were collected at the national-level and in each of the sampled provinces, cities/districts, and health facilities. Costs were calculated as the sum of the value of resources reportedly used in each sampled unit by switch phase. Estimated national-level costs were $46 791. Costs by health system level varied from $9062 to $34 256 at the province-level, from $4576 to $11 936 at the district-level , and from $3488 to $29 175 at the city-level. Estimated national costs ranged from $4 076 446 (Bali, minimum cost scenario) to $28 120 700 (West Sumatera, maximum cost scenario). Our findings suggest that the majority of tPOV to bOPV switch costs were borne at the subnational level. Considerable variation in reported costs among health system levels surveyed indicates a need for flexibility in budgeting for globally synchronized public health activities. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Income inequality and cardiovascular disease risk factors in a highly unequal country: a fixed-effects analysis from South Africa.

PubMed

Adjaye-Gbewonyo, Kafui; Kawachi, Ichiro; Subramanian, S V; Avendano, Mauricio

2018-03-06

Chronic stress associated with high income inequality has been hypothesized to increase CVD risk and other adverse health outcomes. However, most evidence comes from high-income countries, and there is limited evidence on the link between income inequality and biomarkers of chronic stress and risk for CVD. This study examines how changes in income inequality over recent years relate to changes in CVD risk factors in South Africa, home to some of the highest levels of income inequality globally. We linked longitudinal data from 9356 individuals interviewed in the 2008 and 2012 National Income Dynamics Study to district-level Gini coefficients estimated from census and survey data. We investigated whether subnational district income inequality was associated with several modifiable risk factors for cardiovascular disease (CVD) in South Africa, including body mass index (BMI), waist circumference, blood pressure, physical inactivity, smoking, and high alcohol consumption. We ran individual fixed-effects models to examine the association between changes in income inequality and changes in CVD risk factors over time. Linear models were used for continuous metabolic outcomes while conditional Poisson models were used to estimate risk ratios for dichotomous behavioral outcomes. Both income inequality and prevalence of most CVD risk factors increased over the period of study. In longitudinal fixed-effects models, changes in district Gini coefficients were not significantly associated with changes in CVD risk factors. Our findings do not support the hypothesis that subnational district income inequality is associated with CVD risk factors within the high-inequality setting of South Africa.

Population pressure and human carrying capacity in selected locations of Machakos and Kitui districts.

PubMed

Bernard, F E; Thom, D J

1981-04-01

The nature and magnitude of population pressure in Machakos and Kitui Districts of Kenya were investigated. Specific study objectives were: 1) to examine the roots and evolution of the problem; 2) to compute carrying capacity for a sample of locations and ecozones in the 2 districts; and 3) to consider agricultural and demographic implications of the findings. Carrying capacity is defined as the number of people and the level of their activities which a region is able to sustain in perpetuity at an acceptable quality of life and without land deterioration. A methodology for calculating human carrying capacity utilizing crude soil, ecological, crop yield, and land use data for 41 locations in Machakos and Kitui Districts is demonstrated. Analysis and a comparison of population carrying capacities within the study area reveals that Machakos has reached a critical level of population pressure. To the north in Mbere and eastward in Kitui there are areas that are not currently experiencing population pressure, but it is likely that as the pressure in western Machakos becomes more acute, movement into these adjacent lands of relatively sparse settlement will increase. Signs of environmental stress resulting from overpopulation are evident throughout Machakos. The methodology used for estimating population pressure provided reasonably accurate carrying capacity estimates, but the methodology could be refined. Vigorous efforts to rejuvenate the land through soil and water conservation have been undertaken, but these have been insufficient and must be increased. Such efforts will fail unless the basic problem of population pressure in the marginal lands is resolved.

Trip generation and data analysis study.

DOT National Transportation Integrated Search

2015-09-01

Through the Trip Generation and Data Analysis Study, the District of Columbia Department of : Transportation (DDOT) is undertaking research to better understand multimodal urban trip generation : at mixed-use sites in the District. The study is helpi...

Geospatial Analysis on the Distributions of Tobacco Smoking and Alcohol Drinking in India

PubMed Central

Fu, Sze Hang; Jha, Prabhat; Gupta, Prakash C.; Kumar, Rajesh; Dikshit, Rajesh; Sinha, Dhirendra

2014-01-01

Background Tobacco smoking and binge alcohol drinking are two of the leading risk factors for premature mortality worldwide. In India, studies have examined the geographic distributions of tobacco smoking and alcohol drinking only at the state-level; sub-state variations and the spatial association between the two consumptions are poorly understood. Methodology We used data from the Special Fertility and Mortality Survey conducted in 1998 to examine the geographic distributions of tobacco smoking and alcohol drinking at the district and postal code levels. We used kriging interpolation to generate smoking and drinking distributions at the postal code level. We also examined spatial autocorrelations and identified spatial clusters of high and low prevalence of smoking and drinking. Finally, we used bivariate analyses to examine the spatial correlations between smoking and drinking, and between cigarette and bidi smoking. Results There was a high prevalence of any smoking in the central and northeastern states, and a high prevalence of any drinking in Himachal Pradesh, Arunachal Pradesh, and eastern Madhya Pradesh. Spatial clusters of early smoking (started smoking before age 20) were identified in the central states. Cigarette and bidi smoking showed distinctly different geographic patterns, with high levels of cigarette smoking in the northeastern states and high levels of bidi smoking in the central states. The geographic pattern of bidi smoking was similar to early smoking. Cigarette smoking was spatially associated with any drinking. Smoking prevalences in 1998 were correlated with prevalences in 2004 at the district level and 2010 at the state level. Conclusion These results along with earlier evidence on the complementarities between tobacco smoking and alcohol drinking suggest that local public health action on smoking might also help to reduce alcohol consumption, and vice versa. Surveys that properly represent tobacco and alcohol consumptions at the district level are recommended. PMID:25025379

Effective U.S. Aid and Assistance to Pakistan’s Federally Administered Tribal Area and Northwest Frontier Province

DTIC Science & Technology

2010-03-16

federal, provincial and district level. They created the National Disaster Management Authority ( NDMA ) to serve as that agency. In 2009, the Pakistan...Government created two subordinate levels to the NDMA : the Provincial Disaster Management Authority (PDMA) and the District Disaster Management

Influencing Change for Teacher Leader Professional Learning: A Phenomenological Study

ERIC Educational Resources Information Center

Reichert, Emily C.

2010-01-01

Implementing district level change to an established teacher leader professional development model calls for an understanding of the power and influence structures within the school district. Levels of power and influence are impacted by four main factors in the change process: roles in the organization, ability to communicate, personal…

Introducing Technology Education at the Elementary Level

ERIC Educational Resources Information Center

McKnight, Sean

2012-01-01

Many school districts are seeing a need to introduce technology education to students at the elementary level. Pennsylvania's Penn Manor School District is one of them. Pennsylvania has updated science and technology standards for grades 3-8, and after several conversations the author had with elementary principals and the assistant superintendent…

Factors Affecting Teacher Satisfaction in an Urban School District

ERIC Educational Resources Information Center

Halpert, Michael A.

2011-01-01

The purpose of this study was to distinguish factors that influence the satisfaction levels of teachers in urban school districts. This work also distinguished factors that directly impacted teachers' level of satisfaction towards their work and their attitude towards the administration of their schools. Forty-one teachers from two kindergarten…

Understanding Policy Implementation: District-Level Leaders' Perceptions of Reading Policy Implementation Efforts

ERIC Educational Resources Information Center

Hall, Charles Dana

2013-01-01

Research investigating the complex, multi-directional relationships inherent to public education has become a focal point of reform research. This study investigated the perceptions held by district-level leaders regarding the Colorado Department of Education's efforts to facilitate the successful implementation of reading policy. In addition, it…

Prioritization of disasters and their management in Rwanda.

PubMed

Rugigana, E; Nyirazinyoye, L; Umubyeyi, A; Nsengiyumva, J B; Kanyandekwe, C; Ntahobakulira, I

2013-06-01

Rwanda has been experiencing quite a significant number of disastrous events of both natural and man-made origin in the last 2 decades. Many cases of disasters are particularly linked to the geographic, historical and socio-cultural aspects of the country. The overall objective of the present article is to perform a situation analysis of disasters in Rwanda and to highlight the institutional and legal framework of disaster management. An assessment questionnaire focused on the current capacity, institutional frameworks and on-going initiatives for disaster management at country level and operational level was administered. The assessment was descriptive and used mainly qualitative methods. These included review of records (country policies and policy briefs, programme documents), interviews with key informants from line ministries, and interviews with key informants from stakeholder agencies. The Rwandan hazard profile, its vulnerability and capacity assessment shows top seven disasters which are related to epidemics, hails storms/floods; roads accidents; environmental degradation and earthquakes/volcanic eruption. Currently, the Institutional framework for disaster management and response is coordinated by Ministry of Disaster Management and Refugee Affairs through the Rwanda National Disasters Operation Center. Although disaster risk reduction has been integrated into sustainable policies and plans, most districts do not have adequate capacity to plan for disasters and the majority of districts disaster committees have not yet been trained. Rwanda has established a legal and institutional framework for disasters management. There is a need to build capacity in disaster management at operational level (District).

Association between Urinary Aflatoxin (AFM₁) and Dietary Intake among Adults in Hulu Langat District, Selangor, Malaysia.

PubMed

Sulaiman, Siti Husna; Jamaluddin, Rosita; Sabran, Mohd Redzwan

2018-04-07

Aflatoxin is a food contaminant and its exposure through the diet is frequent and ubiquitous. A long-term dietary aflatoxin exposure has been linked to the development of liver cancer in populations with high prevalence of aflatoxin contamination in foods. Therefore, this study was conducted to identify the association between urinary aflatoxin M₁ (AFM₁), a biomarker of aflatoxin exposure, with the dietary intake among adults in Hulu Langat district, Selangor, Malaysia. Certain food products have higher potential for aflatoxin contamination and these were listed in a Food Frequency Questionnaire, which was given to all study participants. This allowed us to record consumption rates for each food product listed. Concomitantly, urine samples were collected, from adults in selected areas in Hulu Langat district, for the measurement of AFM₁ levels using an ELISA kit. Of the 444 urine samples collected and tested, 199 were positive for AFM₁, with 37 of them exceeding the limit of detection (LOD) of 0.64 ng/mL. Cereal products showed the highest consumption level among all food groups, with an average intake of 512.54 g per day. Chi-square analysis showed that consumption of eggs ( X ² = 4.77, p = 0.03) and dairy products ( X ² = 19.36, p < 0.01) had significant associations with urinary AFM₁ but both food groups were having a phi and Cramer's V value that less than 0.3, which indicated that the association between these food groups' consumption and AFM₁ level in urine was weak.

Relationship between regional population and healthcare delivery in Japan.

PubMed

Niga, Takeo; Mori, Maiko; Kawahara, Kazuo

2016-01-01

In order to address regional inequality in healthcare delivery in Japan, healthcare districts were established in 1985. However, regional healthcare delivery has now become a national issue because of population migration and the aging population. In this study, the state of healthcare delivery at the district level is examined by analyzing population, the number of physicians, and the number of hospital beds. The results indicate a continuing disparity in healthcare delivery among districts. We find that the rate of change in population has a strong positive correlation with that in the number of physicians and a weak positive correlation with that in the number of hospital beds. In addition, principal component analysis is performed on three variables: the rate of change in population, the number of physicians per capita, and the number of hospital beds per capita. This analysis suggests that the two principal components contribute 90.1% of the information. The first principal component is thought to show the effect of the regulations on hospital beds. The second principal component is thought to show the capacity to recruit physicians. This study indicates that an adjustment to the regulations on hospital beds as well as physician allocation by public funds may be key to resolving the impending issue of regionally disproportionate healthcare delivery.

Environmental justice implications of industrial hazardous waste generation in India: a national scale analysis

NASA Astrophysics Data System (ADS)

Basu, Pratyusha; Chakraborty, Jayajit

2016-12-01

While rising air and water pollution have become issues of widespread public concern in India, the relationship between spatial distribution of environmental pollution and social disadvantage has received less attention. This lack of attention becomes particularly relevant in the context of industrial pollution, as India continues to pursue industrial development policies without sufficient regard to its adverse social impacts. This letter examines industrial pollution in India from an environmental justice (EJ) perspective by presenting a national scale study of social inequities in the distribution of industrial hazardous waste generation. Our analysis connects district-level data from the 2009 National Inventory of Hazardous Waste Generating Industries with variables representing urbanization, social disadvantage, and socioeconomic status from the 2011 Census of India. Our results indicate that more urbanized and densely populated districts with a higher proportion of socially and economically disadvantaged residents are significantly more likely to generate hazardous waste. The quantity of hazardous waste generated is significantly higher in more urbanized but sparsely populated districts with a higher proportion of economically disadvantaged households, after accounting for other relevant explanatory factors such as literacy and social disadvantage. These findings underscore the growing need to incorporate EJ considerations in future industrial development and waste management in India.

Potentiometric surface of the upper Floridan Aquifer in the St. Johns Water Management District and vicinity, Florida, May 1984

USGS Publications Warehouse

Schiner, George R.; Hayes, Eugene C.

1984-01-01

This map shows the potentiometric surface of the Upper Floridan aquifer in the St. Johns River Water Management District and vicinity for May 1984. The Upper Floridan aquifer is the principal source of potable water in the area. Water-level measurements were made on approximately 1,000 wells and on several springs. The potentiometric surface is shown mostly by 5-foot contour intervals. In the Fernandina Beach area a 40-foot interval is used to show a deep cone of depression. The potentiometric surface ranged from 126 feet above sea level in Polk County to 84 feet below sea level in Nassau County. Water levels in key wells were mostly above, or less frequently, slightly below averages for May in response to diverse area rainfall patterns. Most levels in the district were about the same, or more commonly, 1 to 2 feet lower than May 1983 levels. (USGS)

[Assessment and early warning of land ecological security in rapidly urbanizing coastal area: A case study of Caofeidian new district, Hebei, China].

PubMed

Zhang, Li; Chen, Ying; Wang, Shu-tao; Men, Ming-xin; Xu, Hao

2015-08-01

Assessment and early warning of land ecological security (LES) in rapidly urbanizing coastal area is an important issue to ensure sustainable land use and effective maintenance of land ecological security. In this study, an index system for the land ecological security of Caofeidian new district was established based on the Pressure-State-Response (P-S-R) model. Initial assessment units of 1 km x 1 km created with the remote sensing data and GIS methods were spatially interpolated to a fine pixel size of 30 m x 30 m, which were combined with the early warning method (using classification tree method) to evaluate the land ecological security of Caofeidian in 2005 and 2013. The early warning level was classed into four categories: security with degradation potential, sub-security with slow degradation, sub-security with rapid degradation, and insecurity. Result indicated that, from 2005 to 2013, the average LES of Caofeidian dropped from 0.55 to 0.52, indicating a degradation of land ecological security from medium security level to medium-low security level. The areas at the levels of insecurity with rapid degradation were mainly located in the rapid urbanization areas, illustrating that rapid expansion of urban construction land was the key factor to the deterioration of the regional land ecological security. Industrial District, Shilihai town and Nanpu saltern, in which the lands at the levels of insecurity and sub-security with rapid degradation or slow degradation accounted for 58.3%, 98.9% and 81.2% of their respective districts, were at the stage of high early warning. Thus, land ecological security regulation for these districts should be strengthened in near future. The study could provide a reference for land use planning and ecological protection of Caofeidian new district.

Influence of GSTM1 and NAT2 genotypes on placental DNA adducts in an environmentally exposed population.

PubMed

Topinka, J; Binková, B; Mracková, G; Stávková, Z; Peterka, V; Benes, I; Dejmek, J; Lenícek, J; Pilcík, T; Srám, R J

1997-01-01

The placenta bulky DNA adducts have been studied in relation to metabolic genotypes for glutathione S-transferase M1 (GSTM1) and N-acetyl transferase 2 (NAT2) in 158 mothers (113 nonsmokers and 45 smokers) living in two regions with different annual average air pollution levels of sulphur dioxide, nitrogen oxides, particulate matter < 10 microns, and polycyclic aromatic hydrocarbons. One region was the district of Teplice as the polluted industrial region with mines and brown coal power plants, and the other was the district of Prachatice, an agricultural region without heavy industry. DNA adduct levels were determined by using a butanol extraction enrichment procedure of 32P-postlabeling. GSTM1 and NAT2 genotypes were studied by using polymerase chain reaction. The total DNA adduct levels included a diagonal radioactive zone (DRZ) and one distinct spot outside DRZ (termed X), which was detected in almost all placenta samples and correlated with DRZ (r = .682; P < .001). We found the total DNA adduct levels 2.12 +/- 1.46 (0.04-7.70) and 1.48 +/- 1.09 (0.11-4.98) adducts per 10(8) nucleotides for Teplice and Prachatice districts, respectively, indicating significant differences between both regions studied (P = .004). Elevated DNA adduct levels were found in smoking mothers (10 or more cigarettes per day) by comparison with nonsmoking mothers (3.21 +/- 1.39 versus 1.32 +/- 0.88 adducts per 10(8) nucleotides; P < .001). Placental DNA adduct levels in smokers correlated with cotinine measured in plasma (r = .432; P = .003). This relation indicates that cigarette smoking could be predominantly responsible for DNA adduct formation in placentas of smoking mothers. DNA adduct levels were evaluated separately for non-smokers (1.50 +/- 1.00 vs. 1.09 +/- 0.66 adducts/10(8) nucleotides for the Teplice and Prachatice districts, respectively; P = .046) and smokers (3.35 +/- 1.47 vs. 2.91 +/- 1.20 adducts/10(8) nucleotides for Teplice and Prachatice districts, respectively; P = .384) to exclude the effect of active cigarette smoking on the district variation. These findings indicate that the effect of the environmental pollution in cigarette smokers is practically overlapped by tobacco exposure. No seasonal variation was observed for DNA adduct levels in the overall population studied and no relation between total DNA adduct levels in placenta and levels of vitamins A, C, and E in venous and cord blood was found. A positive GSTM1 genotype was detected in 78 subjects, while negative GSTM1 genotype was found in 80 subjects. Higher DNA adduct levels were detected in the group with GSTM1-negative genotype by comparison with GSTM1-positive genotype (2.05 +/- 1.30 vs. 1.66 +/- 1.39 adducts/10(8) nucleotides; P = .018). This finding is more pronounced in the Teplice district (2.33 +/- 1.36 vs. 1.88 +/- 1.56 adducts/10(8) nucleotides; P = .053) than for the Prachatice district (1.61 +/- 1.09 vs. 1.36 +/- 1.10 adducts/10(8) nucleotides; P = .248) and for nonsmokers (1.45 +/- 0.82 vs. 1.18 +/- 0.93 adducts/10(8) nucleotides; P = .029) more than for smokers (3.45 +/- 1.14 vs. 2.95 +/- 1.62 adducts/10(8) nucleotides; P = .085). Significant district and seasonal differences were found in subgroups with GSTM1-negative genotype. DNA adduct levels in placentas of the GSTM1-negative subgroup were higher in mothers living in the polluted district of Teplice than in Prachatice (P = .012). The adduct levels in placentas sampled in the summer period were higher than in the winter period in the GSTM1-negative population (P = .006). No effect of the NAT2 genotype on DNA adduct levels was observed.

Home-Town Values and High Accountability: A Texas Recipe for Districtwide Success in an Urban School District

ERIC Educational Resources Information Center

Skrla, Linda; McKenzie, Kathryn Bell; Scheurich, James Joseph; Dickerson, Kimberly L.

2011-01-01

This article reports the findings from a case study of urban school district effectiveness taken from a larger, multistate study. The case study district, Galena Park Independent School District in Galena Park, Texas, was chosen for inclusion in the study based on quantitative analysis of student achievement data in Texas. An education production…

An Analysis of Florida's School Districts' Attendance Policies and their Relationship to High School Attendance Rates

ERIC Educational Resources Information Center

Reardon, Ryan Turner

2008-01-01

The purpose of this non-experimental correlational study was to determine the relationship between the type of attendance policies in the high schools of the 67 Florida school districts, the size of the school district (number of high school students), the socioeconomic status SES) of the school district, and the average daily attendance rate of…

Mississippi School Districts: Factors in the Disestablishment of Dual Systems. Final Report.

ERIC Educational Resources Information Center

Palmer, James M.

This research is basically a search for a model to explain why some districts achieved a higher degree of desegregation than others in their efforts to disestablish the dual system. The population studied consists of all of the school districts in Mississippi, and the unit of analysis was the local school district. Three types of variables were…

The Case for District-Based Reform: Leading, Building, and Sustaining School Improvement

ERIC Educational Resources Information Center

Supovitz, Jonathan A.

2006-01-01

In 1999, the Duval County (Fla.) school system set out to improve every school in the district. Over the next five years, the district achieved stunning results that have drawn nationwide attention. Jonathan A. Supovitz uses the unfolding story of Duval County to develop a sophisticated and thoughtful analysis of the role of the school district in…

Cross-District Collaboration: Curriculum and Professional Development

ERIC Educational Resources Information Center

Short, Deborah J.; Cloud, Nancy; Morris, Patricia; Motta, Julie

2012-01-01

Secondary English as a second language (ESL) curricula that address four levels of ESL proficiency and prepare students for the English language arts (ELA) curricula and state-mandated ELA tests are not common. A curriculum jointly developed by two districts is even rarer. Yet two urban districts in Rhode Island undertook such a curriculum…

Examination of Resource Allocation in Education: Connecting Spending to Student Performance. Research Report.

ERIC Educational Resources Information Center

Pan, Diane; Rudo, Zena H.; Schneider, Cynthia L.; Smith-Hansen, Lotte

This document reports on a study on the relationship between resources and student performance. The study examined district-level patterns of resource allocation, district and school resource practices implemented to improve student performance, and barriers and challenges to efficient resource allocation faced by districts and schools. The study…

District-Level Black--White Funding Disparities in the United States, 1987?2002

ERIC Educational Resources Information Center

Bifulco, Robert

2005-01-01

A large body of literature examines disparities in school funding across districts. Berne and Stiefel (1984) developed the standard framework for measuring school finance equity, and the measures catalogued there have been applied extensively to assess funding disparities across districts. Much of this literature has focused on measures of…

Early Implementation of the Class Size Reduction Initiative.

ERIC Educational Resources Information Center

Illig, David C.

A survey of school districts was conducted to determine the initial progress and problems associated with the 1997 Class Size Reduction (CSR) Initiative. Data reveal that most school districts had enough space for smaller classes for at least two grade levels; small school districts were much less likely to report space constraints. The CSR did…

Integrating Districts in Comprehensive School Reform in the Middle-Grades: Lessons from Middle Start CSR

ERIC Educational Resources Information Center

Gopalan, Pritha

2004-01-01

This report compares district leaders' perspectives on changes in school capacity, student outcomes and district policy over three years of implementation of Middle Start (MS), a comprehensive school reform program to demonstrate the potential for improving the effectiveness and sustainability of CSR at the school level through integrating…

Making Sense, Making Do: Local District Implementation of a New State Induction Policy

ERIC Educational Resources Information Center

Ellis, Chad D.

2016-01-01

Connecticut's Teacher Education and Mentoring (TEAM) program is in its early stages of implementation. This study examined how local school districts implemented TEAM and identified factors that affected implementation. It was based on interviews with twenty-two participants at the state, district, and local school levels. The intentions of the…

Character Education by Design: A Blueprint for Successful District and School Initiatives

ERIC Educational Resources Information Center

Maryland State Department of Education, 2007

2007-01-01

Designed for district- and school-level character education committees, "Character Education by Design: A Blueprint for Successful District and School Initiatives" is a how-to guide for developing an effective character education initiative, one that will not only enhance the climate of the school and social behavior of the students, but…

An Empirical Validation of a Management Construct for District Level Supervisors.

ERIC Educational Resources Information Center

Snyder, Karolyn J.; And Others

Findings of a study that examined the effects of a management/leadership program on school district work culture are presented in this paper. The Pasco County (Florida) school district under study was involved in school restructuring, part of which included participation in a management training program, Managing Productive Programs (MPP). MPP…

Differences in Spending in School Districts across Geographic Locales in Minnesota. Issues & Answers. REL 2012-No. 124

ERIC Educational Resources Information Center

Wan, Yinmei; Norbury, Heather; Molefe, Ayrin C.; Gerdeman, R. Dean; Meyers, Coby V.; Burke, Matthew

2012-01-01

This study examines the relationship between school district expenditures and district characteristics, including regional features (enrollment size, student population density, labor costs, and geographic remoteness) and level of student need (percentages of students eligible for free or reduced-price lunch, of special education students, and of…

Accelerated Districts--The Next Step. A Summary of Research and Design.

ERIC Educational Resources Information Center

Driver, Cyrus; And Others

The National Center for the Accelerated Schools Project at Stanford University has recognized that district-level change is necessary if changes at accelerated schools are to gain permanence and become widespread. The Center has therefore initiated a research and development project to design a set of models on which districts can reconstitute…

Intervention in Deficient School Districts: Re-Establishing Effective Local Control.

ERIC Educational Resources Information Center

Cooperman, Saul

In the wake of January 1988 takeover legislation to improve education in the State of New Jersey, this paper describes and justifies the strict state three-tier monitoring system of school district educational standards. School districts that need improvement after the first level of monitoring must develop an improvement plan to overcome their…

Examining Charter School Policy and Public School District Resource Allocation in Ohio

ERIC Educational Resources Information Center

Linick, Matthew A.

2016-01-01

This project focuses on the competitive pressure, or the threat of competitive pressure, generated by charter school policy. This paper uses longitudinal district-level data and multiple quasi-experimental designs to examine the relationship between two Ohio charter school policies and changes in public school district instructional resource…

Supporting Solo at the District Level

ERIC Educational Resources Information Center

Woodard, Mary

2011-01-01

School librarians in the Mesquite Independent School District (ISD) have been operating solo on their campuses since the 1970s. Campus clerical assistance in the school libraries was a luxury that they couldn't afford. Since the district's vision was of a teaching librarian, a Library Processing Department was established in 1972. As years passed,…

From Zero Energy Buildings to Zero Energy Districts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Polly, Ben; Kutscher, Chuck; Macumber, Dan

Some U.S. cities are planning advanced districts that have goals for zero energy, water, waste, and/or greenhouse gas emissions. From an energy perspective, zero energy districts present unique opportunities to cost-effectively achieve high levels of energy efficiency and renewable energy penetration across a collection of buildings that may be infeasible at the individual building scale. These high levels of performance are accomplished through district energy systems that harness renewable and wasted energy at large scales and flexible building loads that coordinate with variable renewable energy supply. Unfortunately, stakeholders face a lack of documented processes, tools, and best practices to assistmore » them in achieving zero energy districts. The National Renewable Energy Laboratory (NREL) is partnering on two new district projects in Denver: the National Western Center and the Sun Valley Neighborhood. We are working closely with project stakeholders in their zero energy master planning efforts to develop the resources needed to resolve barriers and create replicable processes to support future zero energy district efforts across the United States. Initial results of these efforts include the identification and description of key zero energy district design principles (maximizing building efficiency, solar potential, renewable thermal energy, and load control), economic drivers, and master planning principles. The work has also resulted in NREL making initial enhancements to the U.S. Department of Energy's open source building energy modeling platform (OpenStudio and EnergyPlus) with the long-term goal of supporting the design and optimization of energy districts.« less

The Impact of a Multi-Year, Multi-School District K-6 Professional Development Programme Designed to Integrate Science Inquiry and Language Arts on Students' High-Stakes Test Scores

NASA Astrophysics Data System (ADS)

Shymansky, James A.; Wang, Tzu-Ling; Annetta, Leonard A.; Yore, Larry D.; Everett, Susan A.

2013-04-01

This paper is a report of a quasi-experimental study on the impact of a systemic 5-year, K-6 professional development (PD) project on the 'high stakes' achievement test scores of different student groups in rural mid-west school districts in the USA. The PD programme utilized regional summer workshops, district-based leadership teams and distance delivery technologies to help teachers learn science concepts and inquiry teaching strategies associated with a selection of popular science inquiry kits and how to adapt inquiry science lessons in the kits to teach and reinforce skills in the language arts-i.e. to teach more than science when doing inquiry science. Analyses of the school district-level pre-post high-stakes achievement scores of 33 school districts participating in the adaptation of inquiry PD and a comparative group of 23 school districts revealed that both the Grade 3 and Grade 6 student-cohorts in the school districts utilizing adapted science inquiry lessons significantly outscored their student-cohort counterparts in the comparative school districts. The positive school district-level high-stakes test results, which serve as the basis for state and local decision making, suggest that an inquiry adaptation strategy and a combination of regional live workshop and distance delivery technologies with ongoing local leadership and support can serve as a viable PD option for K-6 science.

The Relationship between per Pupil Expenditure in Maricopa County K-12 Public School Districts and Student Preparedness at the Post-Secondary Level

ERIC Educational Resources Information Center

Lamperez, Edmond Allen, Jr.; Dereshiwsky, Mary

2016-01-01

Student under preparedness is one of the major challenges facing community colleges in the United States. A contributing factor of student under preparedness at the postsecondary level is an inequitable and inadequate distribution of resources at the K-12 level. Students residing in socio-economically disadvantaged school districts that often…

Early malaria resurgence in pre-elimination areas in Kokap Subdistrict, Kulon Progo, Indonesia

PubMed Central

2014-01-01

Background Indonesia is among those countries committed to malaria eradication, with a continuously decreasing incidence of malaria. However, at district level the situation is different. This study presents a case of malaria resurgence Kokap Subdistrict of the Kulon Progo District in Yogyakarta Province, Java after five years of low endemicity. This study also aims to describe the community perceptions and health services delivery situation that contribute to this case. Methods All malaria cases (2007–2011) in Kulon Progo District were stratified to annual parasite incidence (API). Two-hundred and twenty-six cases during an outbreak (May 2011 to April 2012) were geocoded by household addresses using a geographic information system (GIS) technique and clusters were identified by SaTScan software analysis (Arc GIS 10.1). Purposive random sampling was conducted on respondents living inside the clusters to identify community perceptions and behaviour related to malaria. Interviews were conducted with malaria health officers to understand the challenges of malaria surveillance and control. Results After experiencing three consecutive years with API less than 1 per thousand, malaria in Kokap subdistrict increased almost ten times higher than API in the district level and five times higher than national API. Malaria cases were found in all five villages in 2012. One primary and two secondary malaria clusters in Hargotirto and Kalirejo villages were identified during the 2011–2012 outbreak. Most of the respondents were positively aware with malaria signs and activities of health workers to prevent malaria, although some social economic activities could not be hindered. Return transmigrants or migrant workers entering to their villages, reduced numbers of village malaria workers and a surge in malaria cases in the neighbouring district contributed to the resurgence. Conclusion Community perception, awareness and participation could constitute a solid foundation for malaria elimination in Kokap. However, decreasing number of village malaria workers and ineffective communication between primary health centres (PHCs) within boundary areas with similar malaria problems needs attention. Decentralization policy was allegedly the reason for the less integrated malaria control between districts, especially in the cross border areas. Malaria resurgence needs attention particularly when it occurs in an area that is entering the elimination phase. PMID:24684702

Cluster Analysis of Minnesota School Districts. A Research Report.

ERIC Educational Resources Information Center

Cleary, James

The term "cluster analysis" refers to a set of statistical methods that classify entities with similar profiles of scores on a number of measured dimensions, in order to create empirically based typologies. A 1980 Minnesota House Research Report employed cluster analysis to categorize school districts according to their relative mixtures…

Health system decentralisation in Nepal: identifying the issues.

PubMed

Collins, Charles; Omar, Mayeh; Adhikari, Damodar; Dhakal, Ramji; Emmel, Nick; Dhakal, Megha Raj; Chand, Padam; Thapa, Druba; Singh, Arjun B

2007-01-01

The purpose of this paper is to describe and discuss policy analysis in Nepal and review the wide range of choices feasible in decentralisation decision making. In this paper an iterative qualitative method was developed and used in the research, which consisted of focus group interviews, key informant interviews, document analysis, including descriptive statistics, and analysis of the policy context. Participants in the research reflected the urban/rural mix of districts and the geography of Nepal. Analysis combined transcribed interviews with findings from document searches and analysis of the policy context. Coding was pre-determined during the training workshop and further codes were generated during and after the fieldwork. The paper finds that Nepal is in the process of decentralising public services from the central level to the local level, particularly to local bodies: District Development Committees (DDCs), Village Development Committees (VDCs) and Municipalities. Key contextual factors referred to are the overall structure of decentralisation, the social context of poverty and the political instability leading to a fluid political situation characterised by political tension, armed conflict, controversies and agreements while carrying out the research. The key issues identified and discussed in the paper are the policy process leading to decentralisation, the organisational structure and tension in the proposed system, the systems of resource generation, allocation, planning and management and lastly the forms of accountability, participation, public-private relations and collaborative strategies. The paper discusses the challenges faced in conducting such a policy analysis, the broad ranging and unremitting nature of the decentralisation process, and the contextual setting of the process of change.

Public accountability needs to be enforced -a case study of the governance arrangements and accountability practices in a rural health district in Ghana.

PubMed

Van Belle, Sara; Mayhew, Susannah H

2016-10-12

Improving public accountability is currently high on the global agenda. At the same time, the organisation of health services in low- and middle-income countries is taking place in fragmented institutional landscapes. State and non-state actors are involved in increasingly complex governance arrangements. This often leads to coordination problems, confusion of roles and responsibilities and possibly accountability gaps. This study aimed at assessing the governance arrangements and the accountability practices of key health actors at the level of a Ghanaian health district with the aim to understand how far public accountability is achieved. We adopted the case study design as it allows for in-depth analysis of the governance arrangements and accountability relations between actors, their formal policies and actual accountability practices towards the public and towards stakeholders. Data were collected at a rural health district using in-depth interviews, observation and document review. In the analysis, we used a four-step sequence: identification of the key actors and their relationships, description of the multi-level governance arrangements, identification of the actual accountability relations and practices between all actors and finally appraisal of the public accountability practices, which we define as those practices that ensure direct accountability towards the public. In this rural health district with few (international) non-governmental organisations and private sector providers, accountability linkages towards management and partners in health programmes were found to be strong. Direct accountability towards the public, however, was woefully underdeveloped. This study shows that in settings where there is a small number of actors involved in organising health care, and where the state actors are underfunded, the intense interaction can lead to a web of relations that favours collaboration between partners in health service delivery, but fails public accountability. It is clear that new formal channels need to be created by all actors involved in health service delivery to address the demand of the public for accountability. If the public does not find an adequate response to its genuine concerns, distrust between communities and service users on one hand, and providers, international non-governmental organisations and District Health Management Teams on the other is likely to increase to the detriment of all parties' interests.

Rural district hospitals - essential cogs in the district health system - and primary healthcare re-engineering.

PubMed

le Roux, K W D P; Couper, I

2015-06-01

The re-engineering of primary healthcare (PHC) is regarded as an essential precursor to the implementation of National Health Insurance in South Africa, but improvements in the provision of PHC services have been patchy. The authors contend that the role of well- functioning rural district hospitals as a hub from which PHC services can be most efficiently managed has been underestimated, and that the management of district hospitals and PHC clinics need to be co-located at the level of the rural district hospital, to allow for proper integration of care and effective healthcare provision.

Spatial distribution of mumps in South Korea, 2001-2015: identifying clusters and population risk factors.

PubMed

Choe, Y-J; Min, K; Cho, S-I

2017-07-01

In South Korea, the resurgence of mumps was noted primarily among school-aged children and adolescents since 2000. We analyzed spatial patterns in mumps incidence to give an indication to the geographical risk. We used National Notifiable Disease Surveillance System data from 2001 to 2015, classifying into three periods according to the level of endemicity. A geographic-weighted regression analysis was performed to find demographic predictors of mumps incidence according to district level. We assessed the association between the total population size, population density, percentage of children (age 0-19 years), timely vaccination rate of measles-mumps-rubella vaccines and the higher incidence rate of mumps. During low endemic periods, there were sporadic regional distributions of outbreak in the central and northern part of the country. During intermediate endemic periods, the increase of incidence was noted across the country. During high endemic period, a nationwide high incidence of mumps was noted especially concentrated in southwestern regions. A clear pattern for the mumps cluster shown through global spatial autocorrelation analysis from 2004 to 2015. The 'non-timely vaccination coverage' (P = 0·002), and 'proportion of children population' (P < 0·001) were the predictors for high mumps incidence in district levels. Our study indicates that the rate of mumps incidence according to geographic regions vary by population proportion and neighboring regions, and timeliness of vaccination, suggesting the importance of community-level surveillance and improving of timely vaccination.

More than a Message of Hope: A District-Level Policymaker's Guide to Understanding Resiliency.

ERIC Educational Resources Information Center

Berliner, BethAnn; Benard, Bonnie

One of the greatest challenges facing today's district-level policymakers and educational leaders is helping America's youth avoid adverse outcomes such as school failure, substance abuse, teen pregnancy, and delinquency. This document describes an alternative policy approach to address these problems--the building of resiliency in youth. Rather…

Inconvenient Truth? Do Collective Bargaining Agreements Help Explain the Mobility of Teachers within School Districts?

ERIC Educational Resources Information Center

Goldhaber, Dan; Lavery, Lesley; Theobald, Roddy

2016-01-01

We utilize detailed teacher-level longitudinal data from Washington State to investigate patterns of teacher mobility in districts with different collective bargaining agreement (CBA) transfer provisions. Specifically, we estimate the log odds that teachers of varying experience and effectiveness levels transfer out of their schools to other…

Bully Proofing: What One District Learned about Improving School Climate.

ERIC Educational Resources Information Center

Berkey, Leonard G.; Keyes, Barbara J.; Longhurst, James E.

2001-01-01

Collaborating with school officials, a group of concerned parents implemented a bully-proofing program throughout their school district. After two years, the results are encouraging; it was received with enthusiasm at the elementary level. Further study will be needed to determine how these principles might be applied at the secondary level. (MKA)

Assessment of arsenic, fluoride, bacteria, and other contaminants in drinking water sources for rural communities of Kasur and other districts in Punjab, Pakistan.

PubMed

Arshad, Nasima; Imran, Saiqa

2017-01-01

High levels of arsenic contamination in drinking water of two villages, Badarpur and Ibrahimabad of district Kasur, central Punjab, Pakistan is reported first time in present studies. Groundwater quality situation was found to be impaired when samples of different rural areas of district Kasur were monitored according to Pakistan Standards and Quality Control Authority (PSQCA) for all significant water quality constituents and analyzed for trace elements, physico-chemical, and microbiological parameters. Out of 35water sources, 97 % were found unsafe and only 3 % of the sources were within safe limits. High concentrations of arsenic, fluoride, and bacteria were found in 91, 74, and 77 % sources of drinking water, respectively. Very high concentrations of arsenic ranging 58-3800 μg/L were found in the water samples obtained from Badarpur and Ibrahimabad. A decrease in water contamination was observed with increase in source depth. The health issues like arsenicosis and skeletal/dental flourosis were observed in the residents of the monitored areas. Drinking water quality conditions of some rural areas of northen and southern districts of Punjab was also analyzed and compared with Kasur district. High levels of nitrates were found in the samples of Islamabad and Rawalpindi, while high levels of arsenic, iron, fluoride, and TDS were found in Bahawalpur district. Graphical abstract ᅟ.

Expansion of antiretroviral treatment to rural health centre level by a mobile service in Mumbwa district, Zambia

PubMed Central

Dube, Christopher; Hayakawa, Tadao; Kakimoto, Kazuhiro; Yamada, Norio; Simpungwe, James B

2010-01-01

Abstract Problem Despite the Government’s effort to expand services to district level, it is still hard for people living with HIV to access antiretroviral treatment (ART) in rural Zambia. Strong demands for expanding ART services at the rural health centre level face challenges of resource shortages. Approach The Mumbwa district health management team introduced mobile ART services using human resources and technical support from district hospitals, and community involvement at four rural health centres in the first quarter of 2007. This paper discusses the uptake of the mobile ART services in rural Mumbwa. Local setting Mumbwa is a rural district with an area of 23 000 km2 and a population of 167 000. Before the introduction of mobile services, ART services were provided only at Mumbwa District Hospital. Relevant changes The mobile services improved accessibility to ART, especially for clients in better functional status, i.e. still able to work. In addition, these mobile services may reduce the number of cases “lost to follow-up”. This might be due to the closer involvement of the community and the better support offered by these services to rural clients. Lessons learnt These mobile ART services helped expand services to rural health facilities where resources are limited, bringing them as close as possible to where clients live. PMID:20931065

District decision-making for health in low-income settings: a case study of the potential of public and private sector data in India and Ethiopia

PubMed Central

Bhattacharyya, Sanghita; Berhanu, Della; Taddesse, Nolawi; Srivastava, Aradhana; Wickremasinghe, Deepthi; Schellenberg, Joanna

2016-01-01

Many low- and middle-income countries have pluralistic health systems where private for-profit and not-for-profit sectors complement the public sector: data shared across sectors can provide information for local decision-making. The third article in a series of four on district decision-making for health in low-income settings, this study shows the untapped potential of existing data through documenting the nature and type of data collected by the public and private health systems, data flow and sharing, use and inter-sectoral linkages in India and Ethiopia. In two districts in each country, semi-structured interviews were conducted with administrators and data managers to understand the type of data maintained and linkages with other sectors in terms of data sharing, flow and use. We created a database of all data elements maintained at district level, categorized by form and according to the six World Health Organization health system blocks. We used content analysis to capture the type of data available for different health system levels. Data flow in the public health sectors of both counties is sequential, formal and systematic. Although multiple sources of data exist outside the public health system, there is little formal sharing of data between sectors. Though not fully operational, Ethiopia has better developed formal structures for data sharing than India. In the private and public sectors, health data in both countries are collected in all six health system categories, with greatest focus on service delivery data and limited focus on supplies, health workforce, governance and contextual information. In the Indian private sector, there is a better balance than in the public sector of data across the six categories. In both India and Ethiopia the majority of data collected relate to maternal and child health. Both countries have huge potential for increased use of health data to guide district decision-making. PMID:27591203

New Mexico district work-effort analysis computer program

USGS Publications Warehouse

Hiss, W.L.; Trantolo, A.P.; Sparks, J.L.

1972-01-01

The computer program (CAN 2) described in this report is one of several related programs used in the New Mexico District cost-analysis system. The work-effort information used in these programs is accumulated and entered to the nearest hour on forms completed by each employee. Tabulating cards are punched directly from these forms after visual examinations for errors are made. Reports containing detailed work-effort data itemized by employee within each project and account and by account and project for each employee are prepared for both current-month and year-to-date periods by the CAN 2 computer program. An option allowing preparation of reports for a specified 3-month period is provided. The total number of hours worked on each account and project and a grand total of hours worked in the New Mexico District is computed and presented in a summary report for each period. Work effort not chargeable directly to individual projects or accounts is considered as overhead and can be apportioned to the individual accounts and projects on the basis of the ratio of the total hours of work effort for the individual accounts or projects to the total New Mexico District work effort at the option of the user. The hours of work performed by a particular section, such as General Investigations or Surface Water, are prorated and charged to the projects or accounts within the particular section. A number of surveillance or buffer accounts are employed to account for the hours worked on special events or on those parts of large projects or accounts that require a more detailed analysis. Any part of the New Mexico District operation can be separated and analyzed in detail by establishing an appropriate buffer account. With the exception of statements associated with word size, the computer program is written in FORTRAN IV in a relatively low and standard language level to facilitate its use on different digital computers. The program has been run only on a Control Data Corporation 6600 computer system. Central processing computer time has seldom exceeded 5 minutes on the longest year-to-date runs.

Intelligent community management system based on the devicenet fieldbus

NASA Astrophysics Data System (ADS)

Wang, Yulan; Wang, Jianxiong; Liu, Jiwen

2013-03-01

With the rapid development of the national economy and the improvement of people's living standards, people are making higher demands on the living environment. And the estate management content, management efficiency and service quality have been higher required. This paper in-depth analyzes about the intelligent community of the structure and composition. According to the users' requirements and related specifications, it achieves the district management systems, which includes Basic Information Management: the management level of housing, household information management, administrator-level management, password management, etc. Service Management: standard property costs, property charges collecting, the history of arrears and other property expenses. Security Management: household gas, water, electricity and security and other security management, security management district and other public places. Systems Management: backup database, restore database, log management. This article also carries out on the Intelligent Community System analysis, proposes an architecture which is based on B / S technology system. And it has achieved a global network device management with friendly, easy to use, unified human - machine interface.

Trends and spatial distribution of deaths of children aged 12-60 months in São Paulo, Brazil, 1980-98.

PubMed Central

Antunes, José Leopoldo Ferreira; Waldman, Eliseu Alves

2002-01-01

OBJECTIVE: To describe trends in the mortality of children aged 12-60 months and to perform spatial data analysis of its distribution at the inner city district level in São Paulo from 1980 to 1998. METHODS: Official mortality data were analysed in relation to the underlying causes of death. The population of children aged 12-60 months, disaggregated by sex and age, was estimated for each year. Educational levels, income, employment status, and other socioeconomic indices were also assessed. Statistical Package for Social Sciences software was used for the statistical processing of time series. The Cochrane-Orcutt procedure of generalized least squares regression analysis was used to estimate the regression parameters with control of first-order autocorrelation. Spatial data analysis employed the discrimination of death rates and socioeconomic indices at the inner city district level. For classifying area-level death rates the method of K-means cluster analysis was used. Spatial correlation between variables was analysed by the simultaneous autoregressive regression method. FINDINGS: There was a steady decline in death rates during the 1980s at an average rate of 3.08% per year, followed by a levelling off. Infectious diseases remained the major cause of mortality, accounting for 43.1% of deaths during the last three years of the study. Injuries accounted for 16.5% of deaths. Mortality rates at the area level clearly demonstrated inequity in the city's health profile: there was an increasing difference between the rich and the underprivileged social strata in this respect. CONCLUSION: The overall mortality rate among children aged 12-60 months dropped by almost 30% during the study period. Most of the decline happened during the 1980s. Many people still live in a state of deprivation in underserved areas. Time-series and spatial data analysis provided indications of potential value in the planning of social policies promoting well-being, through the identification of factors affecting child survival and the regions with the worst health profiles, to which programmes and resources should be preferentially directed. PMID:12077615

Regional density of private dentists: empirical evidence from Austria.

PubMed

Gächter, Martin; Schwazer, Peter; Theurl, Engelbert; Winner, Hannes

2014-02-01

We investigated the determinants of disparities in the regional density of private dentists in Austria. Specifically, we focused on the relationship between the density of private dentists and their public counterparts, thereby controlling for other possible covariates of dentist density. Dentist density was measured at the district level. We used panel data of dentist density from 121 Austrian districts over the years 2001-2008. We applied a Hausman-Taylor framework to cope with possible endogeneity and to control for cross-district effects in the dentist density. A significant negative relationship was found between the density of private and public dentists, indicating a substitution effect between the two dentist groups. A significant positive spatial relationship also existed for private and public dentists in the neighboring regions. Dental capacities in public and private hospitals and dental laboratories run by the public health insurance system did not have a significant effect on private dentist density. Although a strong negative relationship existed between private and public dentists within the districts, one should not draw the conclusion that private dentists in Austria are close substitutes for public dentists. Such a conclusion would require further empirical analysis on the utilization patterns of dental services and their relationships with financing mechanisms. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The administrative costs of community-based health insurance: a case study of the community health fund in Tanzania

PubMed Central

Borghi, Josephine; Makawia, Suzan; Kuwawenaruwa, August

2015-01-01

Community-based health insurance expansion has been proposed as a financing solution for the sizable informal sector in low-income settings. However, there is limited evidence of the administrative costs of such schemes. We assessed annual facility and district-level costs of running the Community Health Fund (CHF), a voluntary health insurance scheme for the informal sector in a rural and an urban district from the same region in Tanzania. Information on resource use, CHF membership and revenue was obtained from district managers and health workers from two facilities in each district. The administrative cost per CHF member household and the cost to revenue ratio were estimated. Revenue collection was the most costly activity at facility level (78% of total costs), followed by stewardship and management (13%) and pooling of funds (10%). Stewardship and management was the main activity at district level. The administration cost per CHF member household ranged from USD 3.33 to USD 12.12 per year. The cost to revenue ratio ranged from 50% to 364%. The cost of administering the CHF was high relative to revenue generated. Similar studies from other settings should be encouraged. PMID:24334331

Intranet and village community: optimization of public service based on electronic government at the local level

NASA Astrophysics Data System (ADS)

Pradana, G. W.; Fanida, E. H.; Niswah, F.

2018-01-01

The demand for good governance is directed towards the realization of efficiency, effectiveness, and clean government. The move is demonstrated through national and regional levels to develop and implement electronic government concepts. Through the development of electronic government is done structuring management systems and work processes in the government environment by optimizing the utilization of information technology. One of the real forms of electronic government (e-Gov) implementation at the local level is the Intranet Sub-District program in Sukodono Sub-District, Sidoarjo. Intranet Sub-District is an innovation whose purpose is to realize the availability of information on the utilization of management, distribution, and storage of official scripts, and also the optimal delivery of information and communication in the implementation of guidance and supervision of local administration. The type of this paper is descriptive with a qualitative approach and focus on the implementation of the Intranet District Program in Sukodono District, Sidoarjo. The findings of the study are the limited number of human resources who have mastered ICT, the uneven network, the adequacy of institutional needs and the existence of budget support from the authorized institution and the information system has not accommodated all the service needs.