Levels of Leadership: Effects of District and School Leaders on the Quality of School Programs of Family and Community Involvement

ERIC Educational Resources Information Center

Epstein, Joyce L.; Galindo, Claudia L.; Sheldon, Steven B.

2011-01-01

Purpose: This study tests key constructs of sociocultural and organizational learning theories with quantitative methods to better understand the nature and impact of district and school leadership and actions on the quality of programs of family and community involvement. Research Design: Survey data from a "nested" sample of 24 districts and 407…

Linking data sources for measurement of effective coverage in maternal and newborn health: what do we learn from individual- vs ecological-linking methods?

PubMed

Willey, Barbara; Waiswa, Peter; Kajjo, Darious; Munos, Melinda; Akuze, Joseph; Allen, Elizabeth; Marchant, Tanya

2018-06-01

Improving maternal and newborn health requires improvements in the quality of facility-based care. This is challenging to measure: routine data may be unreliable; respondents in population surveys may be unable to accurately report on quality indicators; and facility assessments lack population level denominators. We explored methods for linking access to skilled birth attendance (SBA) from household surveys to data on provision of care from facility surveys with the aim of estimating population level effective coverage reflecting access to quality care. We used data from Mayuge District, Uganda. Data from household surveys on access to SBA were linked to health facility assessment census data on readiness to provide basic emergency obstetric and newborn care (BEmONC) in the same district. One individual- and two ecological-linking methods were applied. All methods used household survey reports on where care at birth was accessed. The individual-linking method linked this to data about facility readiness from the specific facility where each woman delivered. The first ecological-linking approach used a district-wide mean estimate of facility readiness. The second used an estimate of facility readiness adjusted by level of health facility accessed. Absolute differences between estimates derived from the different linking methods were calculated, and agreement examined using Lin's concordance correlation coefficient. A total of 1177 women resident in Mayuge reported a birth during 2012-13. Of these, 664 took place in facilities within Mayuge, and were eligible for linking to the census of the district's 38 facilities. 55% were assisted by a SBA in a facility. Using the individual-linking method, effective coverage of births that took place with an SBA in a facility ready to provide BEmONC was just 10% (95% confidence interval CI 3-17). The absolute difference between the individual- and ecological-level linking method adjusting for facility level was one percentage point (11%), and tests suggested good agreement. The ecological method using the district-wide estimate demonstrated poor agreement. The proportion of women accessing appropriately equipped facilities for care at birth is far lower than the coverage of facility delivery. To realise the life-saving potential of health services, countries need evidence to inform actions that address gaps in the provision of quality care. Linking household and facility-based information provides a simple but innovative method for estimating quality of care at the population level. These encouraging findings suggest that linking data sets can result in meaningful evidence even when the exact location of care seeking is not known.

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

Disaster mitigation at drainage basin of Kuranji Padang City

NASA Astrophysics Data System (ADS)

Utama, L.; Yamin, M.

2017-06-01

Floods is flooding of effect of exit water groove river because big river debit sudden its accomodation energy, happened swiftly knock over areas which is debasement, in river basin and hollow. Flow debris or which is recognized with galodo have knock over river of Kuranji year 2012 in Padang city. Area is floods disaster are: 19 Sub-District in 7 district, and hard that is district of Pauh and district of Nanggalo. Governmental claim tired loss of Rp 263,9 Billion while Government of Provinsi West Sumatera appraise loss estimated by Fourty Billion Rupiah (Padang Ekspress 28 July 2012), with detail of damage house counted 878 unit, damage religious service house 15 unit, damage irrigation 12 unit, damage bridge 6 unit, damage school 2 unit, damage health post 1 unit. Result of calculation, by using rainfall of year 2003 until year 2015 with method Gumbel, Hasper and Wedwen, got high rainfall plan is 310,00 mm, and method Melchior and Hasper floods is 1125,86 m³ / second. From result of study analyse at Citra map of correlation and image to parameters cause of floods, and use software Watershed Modelling System (WMS) this region have two class that is middle susceptance and low susceptance. Middle susceptance area is there are in middle river and downstream river, with inclination level off. Low susceptance area there is middle river. Area which have potency result the happening of floods is headwaters, because having keen ramp storey level ( 45 - 55%) and is hilly. For the mitigasi of floods disaster determined by three area evacuate that are: Sub-District Of Kelurahan Limau Manis District Of Pauh, Sub-District Of Surau Gadang District Of Nanggalo, and Sub-District Of Lambung Bukik District of Pauh, in the form of map.

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

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.

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.

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

Determinants of modern family planning use among women of reproductive age in the Nkwanta district of Ghana: a case–control study

PubMed Central

2014-01-01

Background Average contraceptive prevalence rate in the Nkwanta district of Ghana was estimated to be 6.2% relative to the national average at the time, of 19%. While several efforts had been made to improve family planning in the country, the district still had very low use of modern family planning methods. This study sought to determine the factors that influenced modern family planning use in general and specifically, the factors that determined the consistently low use of modern family planning methods in the district. Methods A case–control study was conducted in the Nkwanta district of Ghana to determine socio-economic, socio-cultural and service delivery factors influencing family planning usage. One hundred and thirty cases and 260 controls made up of women aged 15–49 years were interviewed using structured questionnaires. A logistic regression was fitted. Results Awareness and knowledge of modern family planning methods were high among cases and controls (over 90%). Lack of formal education among women, socio-cultural beliefs and spousal communication were found to influence modern family planning use. Furthermore, favourable opening hours of the facilities and distance to health facilities influenced the use of modern contraceptives. Conclusion While modern family planning seemed to be common knowledge among these women, actual use of such contraceptives was limited. There is need to improve use of modern family planning methods in the district. In addition to providing health facilities and consolidating close-to-client service initiatives in the district, policies directed towards improving modern family planning method use need to consider the influence of formal education. Promoting basic education, especially among females, will be a crucial step as the district is faced with high levels of school dropout and illiteracy rates. PMID:25117887

Using Synthetic Controls to Evaluate the Effect of Unique Interventions: The Case of Say Yes to Education.

PubMed

Bifulco, Robert; Rubenstein, Ross; Sohn, Hosung

2017-12-01

"Place-based" scholarships seek to improve student outcomes in urban school districts and promote urban revitalization in economically challenged cities. Say Yes to Education is a unique district-wide school reform effort adopted in Syracuse, NY, in 2008. It includes full-tuition scholarships for public and private universities, coupled with extensive wraparound support services in schools. This study uses synthetic control methods to evaluate the effect of Say Yes on district enrollment and graduation rates. It also introduces the synthetic control method and provides guidance for its use in evaluating single-site interventions. Combining school district-level data from the National Center for Education Statistics' Common Core of Data and New York State School Report Cards, this article uses synthetic control methods to construct a synthetic comparison district to estimate counterfactual enrollment and graduation trends for Syracuse. We find that Say Yes to Education was associated with enrollment increases in the Syracuse City School District, a district that had previously experienced decades of sustained enrollment declines. We do not find consistent evidence of changes in graduation rates following adoption of the program. Graduation rate analyses demonstrate that estimates of treatment effects can be sensitive to choices that the researcher has to make in applying synthetic control methods, particularly when pretreatment outcome measures appear to have considerable amounts of noise.

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

Impact of a decision-support tool on decision making at the district level in Kenya

PubMed Central

2013-01-01

Background In many countries, the responsibility for planning and delivery of health services is devolved to the subnational level. Health programs, however, often fall short of efficient use of data to inform decisions. As a result, programs are not as effective as they can be at meeting the health needs of the populations they serve. In Kenya, a decision-support tool, the District Health Profile (DHP) tool was developed to integrate data from health programs, primarily HIV, at the district level and to enable district health management teams to review and monitor program progress for specific health issues to make informed service delivery decisions. Methods Thirteen in-depth interviews were conducted with ten tool users and three non-users in six districts to qualitatively assess the process of implementing the tool and its effect on data-informed decision making at the district level. The factors that affected use or non-use of the tool were also investigated. Respondents were selected via convenience sample from among those that had been trained to use the DHP tool except for one user who was self-taught to use the tool. Selection criteria also included respondents from urban districts with significant resources as well as respondents from more remote, under-resourced districts. Results Findings from the in-depth interviews suggest that among those who used it, the DHP tool had a positive effect on data analysis, review, interpretation, and sharing at the district level. The automated function of the tool allowed for faster data sharing and immediate observation of trends that facilitated data-informed decision making. All respondents stated that the DHP tool assisted them to better target existing services in need of improvement and to plan future services, thus positively influencing program improvement. Conclusions This paper stresses the central role that a targeted decision-support tool can play in making data aggregation, analysis, and presentation easier and faster. The visual synthesis of data facilitates the use of information in health decision making at the district level of a health system and promotes program improvement. The experience in Kenya can be applied to other countries that face challenges making district-level, data-informed decisions with data from fragmented information systems. PMID:24011028

Increased fairness in priority setting processes within the health sector: the case of Kapiri-Mposhi District, Zambia

PubMed Central

2014-01-01

Background The challenge of priority setting (PS) in health care within contexts of severe resource limitations has continued to receive attention. Accountability for Reasonableness (AFR) has emerged as a useful framework to guide the implementation of PS processes. In 2006, the AFR approach to enhance legitimate and fair PS was introduced by researchers and decision makers within the health sector in the EU funded research project entitled ‘Response to Accountable priority setting for Trust in health systems’ (REACT). The project aimed to strengthen fairness and accountability in the PS processes of health systems at district level in Zambia, Tanzania and Kenya. This paper focuses on local perceptions and practices of fair PS (baseline study) as well as at the evolution of such perceptions and practices in PS following an AFR based intervention (evaluation study), carried out at district level in Kapiri-Mposhi District in Zambia. Methods Data was collected using in depth interviews (IDIs), focus group discussions (FGDs) and review of documents from national to district level. The study population for this paper consisted of health related stakeholders employed in the district administration, in non-governmental organizations (NGO) and in health facilities. Results During the baseline study, concepts of legitimacy and fairness in PS processes were found to be grounded in local values of equity and impartiality. Government and other organizational strategies strongly supported devolution of PS and decision making procedures. However, important gaps were identified in terms of experiences of stakeholder involvement and fairness in PS processes in practice. The evaluation study revealed that a transformation of the views and methods regarding fairness in PS processes was ongoing in the study district, which was partly attributed to the AFR based intervention. Conclusions The study findings suggest that increased attention was given to fairness in PS processes at district level. The changes were linked to a number of simultaneous factors among them the concepts introduced by the present project with its emphasis on fairness and enhanced participation. A responsive leadership that was increasingly accountable to its operational staff and communities emerged as one of the key elements in driving the processes forward. PMID:24548767

Determinants of modern family planning use among women of reproductive age in the Nkwanta district of Ghana: a case-control study.

PubMed

Eliason, Sebastian; Awoonor-Williams, John K; Eliason, Cecilia; Novignon, Jacob; Nonvignon, Justice; Aikins, Moses

2014-08-13

Average contraceptive prevalence rate in the Nkwanta district of Ghana was estimated to be 6.2% relative to the national average at the time, of 19%. While several efforts had been made to improve family planning in the country, the district still had very low use of modern family planning methods. This study sought to determine the factors that influenced modern family planning use in general and specifically, the factors that determined the consistently low use of modern family planning methods in the district. A case-control study was conducted in the Nkwanta district of Ghana to determine socio-economic, socio-cultural and service delivery factors influencing family planning usage. One hundred and thirty cases and 260 controls made up of women aged 15-49 years were interviewed using structured questionnaires. A logistic regression was fitted. Awareness and knowledge of modern family planning methods were high among cases and controls (over 90%). Lack of formal education among women, socio-cultural beliefs and spousal communication were found to influence modern family planning use. Furthermore, favourable opening hours of the facilities and distance to health facilities influenced the use of modern contraceptives. While modern family planning seemed to be common knowledge among these women, actual use of such contraceptives was limited. There is need to improve use of modern family planning methods in the district. In addition to providing health facilities and consolidating close-to-client service initiatives in the district, policies directed towards improving modern family planning method use need to consider the influence of formal education. Promoting basic education, especially among females, will be a crucial step as the district is faced with high levels of school dropout and illiteracy rates.

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.

Health Services: Results from the School Health Policies and Programs Study 2006

ERIC Educational Resources Information Center

Brener, Nancy D.; Wheeler, Lani; Wolfe, Linda C.; Vernon-Smiley, Mary; Caldart-Olson, Linda

2007-01-01

Background: The specific health services provided to students at school and the model for delivering these services vary across districts and schools. This article describes the characteristics of school health services in the United States, including state- and district-level policies and school practices. Methods: The Centers for Disease Control…

Factors Associated with the Performance and Cost-Effectiveness of Using Lymphatic Filariasis Transmission Assessment Surveys for Monitoring Soil-Transmitted Helminths: A Case Study in Kenya

PubMed Central

Smith, Jennifer L.; Sturrock, Hugh J. W.; Assefa, Liya; Nikolay, Birgit; Njenga, Sammy M.; Kihara, Jimmy; Mwandawiro, Charles S.; Brooker, Simon J.

2015-01-01

Transmission assessment surveys (TAS) for lymphatic filariasis have been proposed as a platform to assess the impact of mass drug administration (MDA) on soil-transmitted helminths (STHs). This study used computer simulation and field data from pre- and post-MDA settings across Kenya to evaluate the performance and cost-effectiveness of the TAS design for STH assessment compared with alternative survey designs. Variations in the TAS design and different sample sizes and diagnostic methods were also evaluated. The district-level TAS design correctly classified more districts compared with standard STH designs in pre-MDA settings. Aggregating districts into larger evaluation units in a TAS design decreased performance, whereas age group sampled and sample size had minimal impact. The low diagnostic sensitivity of Kato-Katz and mini-FLOTAC methods was found to increase misclassification. We recommend using a district-level TAS among children 8–10 years of age to assess STH but suggest that key consideration is given to evaluation unit size. PMID:25487730

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

Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study.

PubMed

Wendt, Amanda S; Stephenson, Rob; Young, Melissa F; Verma, Pankaj; Srikantiah, Sridhar; Webb-Girard, Amy; Hogue, Carol J; Ramakrishnan, Usha; Martorell, Reynaldo

2018-04-12

Maternal anaemia prevalence in Bihar, India remains high despite government mandated iron supplementation targeting pregnant women. Inadequate supply has been identified as a potential barrier to iron and folic acid (IFA) receipt. Our study objective was to examine the government health system's IFA supply and distribution system and identify bottlenecks contributing to insufficient IFA supply. Primary data collection was conducted in November 2011 and July 2012 across 8 districts in Bihar, India. A cross-sectional, observational, mixed methods approach was utilized. Auxiliary Nurse Midwives were surveyed on current IFA supply and practices. In-depth interviews (n = 59) were conducted with health workers at state, district, block, health sub-centre, and village levels. Overall, 44% of Auxiliary Nurse Midwives were out of IFA stock. Stock levels and supply chain practices varied greatly across districts. Qualitative data revealed specific bottlenecks impacting IFA forecasting, procurement, storage, disposal, lack of personnel, and few training opportunities for key players in the supply chain. Inadequate IFA supply is a major constraint to the IFA supplementation program, the extent of which varies widely across districts. Improvements at all levels of infrastructure, practices, and effective monitoring will be critical to strengthen the IFA supply chain in Bihar.

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

Trends in Disparities in School District Level Expenditures per Pupil.

ERIC Educational Resources Information Center

Hussar, William; Sonnenberg, William

2000-01-01

Examines trends in disparities between districts in education expenditures from 1979-1980 to 1993-1994. Uses seven measures of educational disparity to present a cross-section of the different methods available. A majority of disparity measures indicate a decline in disparity in most states, but an increase in disparity for the United States as a…

Teacher Job Satisfaction and Retention in a Suburban Georgia School District

ERIC Educational Resources Information Center

Thompson, Denise G.

2008-01-01

An investigation of the relationship between job satisfaction and retention among elementary, middle, and high school teachers in a suburban school district in Georgia was addressed in this mixed-methods study. The focus of the study was to determine the level of job satisfaction among the nine subscales of the Teacher Job Satisfaction…

Optimization model using Markowitz model approach for reducing the number of dengue cases in Bandung

NASA Astrophysics Data System (ADS)

Yong, Benny; Chin, Liem

2017-05-01

Dengue fever is one of the most serious diseases and this disease can cause death. Currently, Indonesia is a country with the highest cases of dengue disease in Southeast Asia. Bandung is one of the cities in Indonesia that is vulnerable to dengue disease. The sub-districts in Bandung had different levels of relative risk of dengue disease. Dengue disease is transmitted to people by the bite of an Aedesaegypti mosquito that is infected with a dengue virus. Prevention of dengue disease is by controlling the vector mosquito. It can be done by various methods, one of the methods is fogging. The efforts made by the Health Department of Bandung through fogging had constraints in terms of limited funds. This problem causes Health Department selective in fogging, which is only done for certain locations. As a result, many sub-districts are not handled properly by the Health Department because of the unequal distribution of activities to prevent the spread of dengue disease. Thus, it needs the proper allocation of funds to each sub-district in Bandung for preventing dengue transmission optimally. In this research, the optimization model using Markowitz model approach will be applied to determine the allocation of funds should be given to each sub-district in Bandung. Some constraints will be added to this model and the numerical solution will be solved with generalized reduced gradient method using Solver software. The expected result of this research is the proportion of funds given to each sub-district in Bandung correspond to the level of risk of dengue disease in each sub-district in Bandung so that the number of dengue cases in this city can be reduced significantly.

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.

Population genetic analysis and sub-structuring of Theileria parva in the northern and eastern parts of Zambia

PubMed Central

2012-01-01

Background Theileriosis, caused by Theileria parva, is an economically important disease in Africa. It is a major constraint to the development of the livestock industry in some parts of eastern, central and southern Africa. In Zambia, theileriosis causes losses of up to 10,000 cattle annually. Methods Cattle blood samples were collected for genetic analysis of Theileria parva from Isoka and Petauke districts in Zambia. Microsatellite analysis was then performed on all Theileria parva positive samples for PCR using a panel of 9 microsatellite markers. Microsatellite data was analyzed using microsatellite toolkit, GenAlEx ver. 6, Fstat ver. 2.9.3.2, and LIAN computer softwares. Results The combined percentage of positive samples in both districts determined by PCR using the p104 gene primers was 54.9% (95% CI: 46.7 – 63.1%, 78/142), while in each district, it was 44.8% (95% CI: 34.8 – 54.8%) and 76.1% (95% CI = 63.9 – 88.4%) for Isoka and Petauke districts, respectively. We analyzed the population genetic structure of Theileria parva from a total of 61 samples (33 from Isoka and 28 from Petauke) using a panel of 9 microsatellite markers encompassing the 4 chromosomes of Theileria parva. Wright’s F index (FST = 0.178) showed significant differentiation between the Isoka and Petauke populations. Linkage disequilibrium was observed when populations from both districts were treated as a single population. When analyzed separately, linkage disequilibrium was observed in Kanyelele and Kalembe areas in Isoka district, Isoka district overall and in Petauke district. Petauke district had a higher multiplicity of infection than Isoka district. Conclusion Population genetic analyses of Theileria parva from Isoka and Petauke districts showed a low level of genotype exchange between the districts, but a high level of genetic diversity within each district population, implying genetic and geographic sub-structuring between the districts. The sub-structuring observed, along with the lack of panmixia in the populations, could have been due to low transmission levels at the time of sampling. However, the Isoka population was less diverse than the Petauke population. PMID:23146577

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.

A Comparison between the Effect of Cooperative Learning Teaching Method and Lecture Teaching Method on Students' Learning and Satisfaction Level

ERIC Educational Resources Information Center

Mohammadjani, Farzad; Tonkaboni, Forouzan

2015-01-01

The aim of the present research is to investigate a comparison between the effect of cooperative learning teaching method and lecture teaching method on students' learning and satisfaction level. The research population consisted of all the fourth grade elementary school students of educational district 4 in Shiraz. The statistical population…

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

IgG responses to the gSG6-P1 salivary peptide for evaluating human exposure to Anopheles bites in urban areas of Dakar region, Sénégal

PubMed Central

2012-01-01

Background Urban malaria can be a serious public health problem in Africa. Human-landing catches of mosquitoes, a standard entomological method to assess human exposure to malaria vector bites, can lack sensitivity in areas where exposure is low. A simple and highly sensitive tool could be a complementary indicator for evaluating malaria exposure in such epidemiological contexts. The human antibody response to the specific Anopheles gSG6-P1 salivary peptide have been described as an adequate tool biomarker for a reliable assessment of human exposure level to Anopheles bites. The aim of this study was to use this biomarker to evaluate the human exposure to Anopheles mosquito bites in urban settings of Dakar (Senegal), one of the largest cities in West Africa, where Anopheles biting rates and malaria transmission are supposed to be low. Methods One cross-sectional study concerning 1,010 (505 households) children (n = 505) and adults (n = 505) living in 16 districts of downtown Dakar and its suburbs was performed from October to December 2008. The IgG responses to gSG6-P1 peptide have been assessed and compared to entomological data obtained in or near the same district. Results Considerable individual variations in anti-gSG6-P1 IgG levels were observed between and within districts. In spite of this individual heterogeneity, the median level of specific IgG and the percentage of immune responders differed significantly between districts. A positive and significant association was observed between the exposure levels to Anopheles gambiae bites, estimated by classical entomological methods, and the median IgG levels or the percentage of immune responders measuring the contact between human populations and Anopheles mosquitoes. Interestingly, immunological parameters seemed to better discriminate the exposure level to Anopheles bites between different exposure groups of districts. Conclusions Specific human IgG responses to gSG6-P1 peptide biomarker represent, at the population and individual levels, a credible new alternative tool to assess accurately the heterogeneity of exposure level to Anopheles bites and malaria risk in low urban transmission areas. The development of such biomarker tool would be particularly relevant for mapping and monitoring malaria risk and for measuring the efficiency of vector control strategies in these specific settings. PMID:22424570

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.

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.

Auditing the Immunization Data Quality from Routine Reports in Shangyu District, East China

PubMed Central

Hu, Yu; Zhang, Xinpei; Li, Qian; Chen, Yaping

2016-01-01

Objective: To evaluate the immunization data quality in Shangyu District, East China. Methods: An audit for immunization data for the year 2014 was conducted in 20 vaccination clinics of Shangyu District. The consistency of immunization data was estimated by verification factors (VFs), which was the proportion of vaccine doses reported as being administered that could be verified by written documentation at vaccination clinics. The quality of monitoring systems was evaluated using the quality index (QI). Results: The VFs of 20 vaccine doses ranged from 0.94 to 1.04 at the district level. The VFs for the 20 vaccination clinics ranged from 0.57 to 1.07. The VFs for Shangyu District was 0.98. The mean of total QI score of the 20 vaccination clinics was 80.32%. A significant correlation between the VFs of the 3rd dose of the diphtheria–tetanus–pertussis combined vaccine (DTP) and QI scores was observed at the vaccination clinic level. Conclusions: Deficiencies in data consistency and immunization reporting practice in Shangyu District were observed. Targeted measures are suggested to improve the quality of the immunization reporting system in vaccination clinics with poor data consistency. PMID:27869729

Auditing the Immunization Data Quality from Routine Reports in Shangyu District, East China.

PubMed

Hu, Yu; Zhang, Xinpei; Li, Qian; Chen, Yaping

2016-11-18

Objective: To evaluate the immunization data quality in Shangyu District, East China. Methods: An audit for immunization data for the year 2014 was conducted in 20 vaccination clinics of Shangyu District. The consistency of immunization data was estimated by verification factors (VFs), which was the proportion of vaccine doses reported as being administered that could be verified by written documentation at vaccination clinics. The quality of monitoring systems was evaluated using the quality index (QI). Results: The VFs of 20 vaccine doses ranged from 0.94 to 1.04 at the district level. The VFs for the 20 vaccination clinics ranged from 0.57 to 1.07. The VFs for Shangyu District was 0.98. The mean of total QI score of the 20 vaccination clinics was 80.32%. A significant correlation between the VFs of the 3rd dose of the diphtheria-tetanus-pertussis combined vaccine (DTP) and QI scores was observed at the vaccination clinic level. Conclusions: Deficiencies in data consistency and immunization reporting practice in Shangyu District were observed. Targeted measures are suggested to improve the quality of the immunization reporting system in vaccination clinics with poor data consistency.

Linking U.S. School District Test Score Distributions to a Common Scale. CEPA Working Paper No. 16-09

ERIC Educational Resources Information Center

Reardon, Sean F.; Kalogrides, Demetra; Ho, Andrew D.

2017-01-01

There is no comprehensive database of U.S. district-level test scores that is comparable across states. We describe and evaluate a method for constructing such a database. First, we estimate linear, reliability-adjusted linking transformations from state test score scales to the scale of the National Assessment of Educational Progress (NAEP). We…

Systems of Continuing Education: Priority to District Health Personnel. Report of a WHO Expert Committee. Technical Report Series 803.

ERIC Educational Resources Information Center

World Health Organization, Geneva (Switzerland).

Continuing education systems can improve the performance of health workers in countries around the world and support the functioning of district health systems. Continuing education guides health personnel toward the principles and methods of primary health care and improves their work with the community and family to attain an adequate level of…

A Phenomenological Study on the Lived Experience of First and Second Year Teachers in Standards-Based Grading Districts

ERIC Educational Resources Information Center

Battistone, William A., Jr.

2017-01-01

Problem: There is an existing cycle of questionable grading practices at the K-12 level. As a result, districts continue to search for innovative methods of evaluating and reporting student progress. One result of this effort has been the adoption of a standards-based grading approach. Research concerning standards-based grading implementation has…

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…

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.

School District Resources and Identification of Children With Autistic Disorder

PubMed Central

Palmer, Raymond F.; Blanchard, Stephen; Jean, Carlos R.; Mandell, David S.

2005-01-01

Objectives. We estimated the effect of community and school district resources on the identification of children with autistic disorder. Methods. Latent growth curve regression models were applied to school district–level data from one large state. Results. The rate of identification of autistic disorder increased on average by 1.0 child per 10000 per year (P<.001), with statistically significant district variation. After adjustment for district and community characteristics, each increase in decile of school revenue was associated with an increase of 0.16 per 10000 children identified with autistic disorder. The proportion of economically disadvantaged children per district was inversely associated with autistic disorder cases. Conclusions. District revenue was associated with higher proportions of children identified with autistic disorder at baseline and increasing rates of identification when measured longitudinally. Economically disadvantaged communities may need assistance to identify children with autistic spectrum disorders and other developmental delays that require attention. PMID:15623872

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

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

Development of a scalable mental healthcare plan for a rural district in Ethiopia

PubMed Central

Fekadu, Abebaw; Hanlon, Charlotte; Medhin, Girmay; Alem, Atalay; Selamu, Medhin; Giorgis, Tedla W.; Shibre, Teshome; Teferra, Solomon; Tegegn, Teketel; Breuer, Erica; Patel, Vikram; Tomlinson, Mark; Thornicroft, Graham; Prince, Martin; Lund, Crick

2016-01-01

Background Developing evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority. Aims To outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia. Method A mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation). Results The community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability. Conclusions The MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC. PMID:26447174

Performance Indicators Workbook: Edition I, for Calculating School District Performance in Elementary School Reading and Arithmetic.

ERIC Educational Resources Information Center

New York State Education Dept., Albany. Bureau of School Programs Evaluation.

The Performance Indicators in Education program is designed to develop methods of measuring the performance in reading and arithmetic achievement at the elementary school level of the schools of New York State. From data on file at the State Education Department, a set of profiles was developed for each of 628 school districts indicating how the…

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-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

State and district policy influences on district-wide elementary and middle school physical education practices.

PubMed

Chriqui, Jamie F; Eyler, Amy; Carnoske, Cheryl; Slater, Sandy

2013-01-01

To examine the influence of state laws and district policies on district-wide elementary school and middle school practices related to physical education (PE) time and the percentage of moderate-to-vigorous physical activity (MVPA) time during PE. Multivariate, cross-sectional analysis of state laws, district wellness and PE policies, and district PE practices for school year 2010-2011 controlling for district-level urbanicity, region, size, race/ethnicity of students, and socioeconomic status and clustered on state. One hundred ninety-five public school districts located in 42 states. District-level PE coordinators for the included districts who responded to an online survey. Minutes and days of PE per week and percent time spent in MVPA during PE time. District PE coordinators reported significantly less PE time than national standards-82.9 and 189.6 minutes at the elementary school and middle school levels, respectively. Physical education was provided an average of 2.5 and 3.7 days per week, respectively; and the percentage of MVPA time in PE was 64.4% and 65.7%, respectively. At the elementary school level, districts in either states with laws governing PE time or in a state and district with a law/policy reported significantly more days of PE (0.63 and 0.67 additional days, respectively), and districts in states with PE time laws reported 18 more minutes of PE per week. At the middle school level, state laws were associated with 0.73 more days of PE per week. Neither state laws nor district policies were positively associated with percent MVPA time in PE. State laws and district policies can influence district-level PE practices-particularly those governing the frequency and duration of PE-although opportunities exist to strengthen PE-related laws, policies, and practices.

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

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.

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.

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.

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

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

Perceptions of Supervision Processes and Practices in Initial Contract, Tenured, and Distinguished-Rated Teachers as They Relate to Self-Learning and Growth in One Large Suburban School District

ERIC Educational Resources Information Center

Watters, Chad M.

2017-01-01

The purpose of this mixed methods study is to examine the perceptions of supervision practices in initial contract, tenured, and distinguished-rated teachers at the elementary level in one large, suburban school district. This study described teacher perceptions of clinical and alternative supervision practices. Six research questions guided this…

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

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

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.

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

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

Community-directed interventions for priority health problems in Africa: results of a multicountry study

PubMed Central

2010-01-01

Abstract Objective To determine the extent to which the community-directed approach used in onchocerciasis control in Africa could effectively and efficiently provide integrated delivery of other health interventions. Methods A three-year experimental study was undertaken in 35 health districts from 2005 to 2007 in seven research sites in Cameroon, Nigeria and Uganda. Four trial districts and one comparison district were randomly selected in each site. All districts had established ivermectin treatment programmes, and in the trial districts four other established interventions – vitamin A supplementation, use of insecticide-treated nets, home management of malaria and short-course, directly-observed treatment for tuberculosis patients – were progressively incorporated into a community-directed intervention (CDI) process. At the end of each of the three study years, we performed quantitative evaluations of intervention coverage and provider costs, as well as qualitative assessments of the CDI process. Findings With the CDI strategy, significantly higher coverage was achieved than with other delivery approaches for all interventions except for short-course, directly-observed treatment. The coverage of malaria interventions more than doubled. The district-level costs of delivering all five interventions were lower in the CDI districts, but no cost difference was found at the first-line health facility level. Process evaluation showed that: (i) participatory processes were important; (ii) recurrent problems with the supply of intervention materials were a major constraint to implementation; (iii) the communities and community implementers were deeply committed to the CDI process; (iv) community implementers were more motivated by intangible incentives than by external financial incentives. Conclusion The CDI strategy, which builds upon the core principles of primary health care, is an effective and efficient model for integrated delivery of appropriate health interventions at the community level in Africa. PMID:20616970

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.

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

Validating a High Performance Liquid Chromatography-Ion Chromatography (HPLC-IC) Method with Conductivity Detection After Chemical Suppression for Water Fluoride Estimation.

PubMed

Bondu, Joseph Dian; Selvakumar, R; Fleming, Jude Joseph

2018-01-01

A variety of methods, including the Ion Selective Electrode (ISE), have been used for estimation of fluoride levels in drinking water. But as these methods suffer many drawbacks, the newer method of IC has replaced many of these methods. The study aimed at (1) validating IC for estimation of fluoride levels in drinking water and (2) to assess drinking water fluoride levels of villages in and around Vellore district using IC. Forty nine paired drinking water samples were measured using ISE and IC method (Metrohm). Water samples from 165 randomly selected villages in and around Vellore district were collected for fluoride estimation over 1 year. Standardization of IC method showed good within run precision, linearity and coefficient of variance with correlation coefficient R 2  = 0.998. The limit of detection was 0.027 ppm and limit of quantification was 0.083 ppm. Among 165 villages, 46.1% of the villages recorded water fluoride levels >1.00 ppm from which 19.4% had levels ranging from 1 to 1.5 ppm, 10.9% had recorded levels 1.5-2 ppm and about 12.7% had levels of 2.0-3.0 ppm. Three percent of villages had more than 3.0 ppm fluoride in the water tested. Most (44.42%) of these villages belonged to Jolarpet taluk with moderate to high (0.86-3.56 ppm) water fluoride levels. Ion Chromatography method has been validated and is therefore a reliable method in assessment of fluoride levels in the drinking water. While the residents of Jolarpet taluk (Vellore distict) are found to be at a high risk of developing dental and skeletal fluorosis.

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.

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…

Home modification to reduce falls at a health district level: Modeling health gain, health inequalities and health costs

PubMed Central

Wilson, Nick; Kvizhinadze, Giorgi; Pega, Frank; Nair, Nisha; Blakely, Tony

2017-01-01

Background There is some evidence that home safety assessment and modification (HSAM) is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level. Methods and findings A previously established Markov macro-simulation model built for the whole New Zealand (NZ) population (Pega et al 2016, Injury Prevention) was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial. In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280). The net health system cost was estimated at NZ$8.44 million (95% UI: $663 to $14.3 million). The incremental cost-effectiveness ratio (ICER) was estimated at NZ$5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ$15,300 [equivalent to US$10,300]). Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: $700 and $832, respectively) with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: Māori (Indigenous population) vs non-Māori. Conclusions This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases. PMID:28910342

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.

Malaria Control and Elimination in Sri Lanka: Documenting Progress and Success Factors in a Conflict Setting

PubMed Central

Abeyasinghe, Rabindra R.; Galappaththy, Gawrie N. L.; Smith Gueye, Cara; Kahn, James G.; Feachem, Richard G. A.

2012-01-01

Background Sri Lanka has a long history of malaria control, and over the past decade has had dramatic declines in cases amid a national conflict. A case study of Sri Lanka's malaria programme was conducted to characterize the programme and explain recent progress. Methods The case study employed qualitative and quantitative methods. Data were collected from published and grey literature, district-level and national records, and thirty-three key informant interviews. Expenditures in two districts for two years – 2004 and 2009 – were compiled. Findings Malaria incidence in Sri Lanka has declined by 99.9% since 1999. During this time, there were increases in the proportion of malaria infections due to Plasmodium vivax, and the proportion of infections occurring in adult males. Indoor residual spraying and distribution of long-lasting insecticide-treated nets have likely contributed to the low transmission. Entomological surveillance was maintained. A strong passive case detection system captures infections and active case detection was introduced. When comparing conflict and non-conflict districts, vector control and surveillance measures were maintained in conflict areas, often with higher coverage reported in conflict districts. One of two districts in the study reported a 48% decline in malaria programme expenditure per person at risk from 2004 to 2009. The other district had stable malaria spending. Conclusions/Significance Malaria is now at low levels in Sri Lanka – 124 indigenous cases were found in 2011. The majority of infections occur in adult males and are due to P. vivax. Evidence-driven policy and an ability to adapt to new circumstances contributed to this decline. Malaria interventions were maintained in the conflict districts despite an ongoing war. Sri Lanka has set a goal of eliminating malaria by the end of 2014. Early identification and treatment of infections, especially imported ones, together with effective surveillance and response, will be critical to achieving this goal. PMID:22952642

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

A game theory approach for assessing risk value and deploying search-and-rescue resources after devastating tsunamis.

PubMed

Wu, Cheng-Kuang

2018-04-01

The current early-warning system and tsunami protection measures tend to fall short because they always underestimate the level of destruction, and it is difficult to predict the level of damage by a devastating tsunami on uncertain targets. As we know, the key to minimizing the total number of fatalities after a disaster is the deployment of search and rescue efforts in the first few hours. However, the resources available to the affected districts for emergency response may be limited. This study proposes two game theoretic models that are designed for search-and-rescue resource allocation. First, the interactions between a compounded disaster and a response agent in the affected district are modelled as a non-cooperative game, after which the risk value is derived for each district from the Nash equilibrium. The risk value represents the threat, vulnerability, and consequence of a specific disaster for the affected district. Second, the risk values for fifteen districts are collected for calculation of each district's Shapley value. Then an acceptable plan for resource deployment among all districts is made based on their expected marginal contribution. The model is verified in a simulation based upon 2011 tsunami data. The experimental results show the proposed approach to be more efficient than the proportional division of rescue resources, for dealing with compounded disaster, and is feasible as a method for planning the mobilization of resources and to improve relief efforts against devastating tsunamis. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessment of district health system within inter-sectoral context in Nepal.

PubMed

Bhusal, C L; Singh, S P; Aryal, K K; Jha, B K; Ghimire, N; Shah, N; Khatiwada, D; Magar, A

2013-05-01

Inter-sectoral coordination has been one of the different factors in the district health system that produces efficient output which has been identified by the Alma Ata declaration as an essential component to achieve notion of 'Health for All'. This study was therefore aimed to describe the major four key functions of the health systems and to find out the situation of inter-sectoral coordination in Nepal. A mixed method with Focus Group Discussion (FGD) and In-Depth Interview with relevant personnel to collect the majority of the data was carried out from June 2012 to November 2012 from six districts selected purposively based on the health performance indicators. The major findings in relation to the key functions of district health systems showed that the overall management of the district health system happens under the leadership of chief of District Health Office of Public health office with the cooperation of all the personnel in different sections in a predetermined pattern and inter-sectoral coordination and collaboration exist only to a very limited extent. The major constraints for inter-sectoral coordination to be effective is lack of its planning and enforcement where inter-sectoral coordination could be important for both preventive and promotive health care, waste management, water supply and sanitation, health service utilization, pesticides and human health, agriculture and nutrition, air pollution. The main components in the district health system needs an immediate attention and inter-sectoral effort should be initiated from the central level and implemented in all the levels.

[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.

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

Coastal women empowerment in improving enterprise of fish product processing in Sanga-Sanga Districts

NASA Astrophysics Data System (ADS)

Haqiqiansyah, G.; Sugiharto, E.

2018-04-01

This research was conducted to identify and scrutinize women empowerment of fish product processing group in the District of Sanga-Sanga on 2017. The method used was survey method, which is direct observation and interview to respondent. Data were collected in the form of primary and secondary data. Collected data then processed, tabulated, and displayed in the table and graph. The measurement of women empowerment degree was measured by Likert Scale on 3 level, that are score 1 = low, score 2 = less, and score 3 = high. The result of research demonstrated that the rate of empowerment women group of fish product processor was high (score 42,75). Partially, awareness level or willingness to change of processing enterprise group which indicate empowerment indicator categorized as high (91,67%). The level of capability to increase the chance of acquiring access was high (66,67%), the level of capability to overcome an obstacle tend to categorized as less (50%) and the level of capability to collaborate was high (66,67%). It means that the level of coastal women empowerment could be reliable to do a reformation.

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).

Increased fairness in priority setting processes within the health sector: the case of Kapiri-Mposhi District, Zambia.

PubMed

Zulu, Joseph M; Michelo, Charles; Msoni, Carol; Hurtig, Anna-Karin; Byskov, Jens; Blystad, Astrid

2014-02-18

The challenge of priority setting (PS) in health care within contexts of severe resource limitations has continued to receive attention. Accountability for Reasonableness (AFR) has emerged as a useful framework to guide the implementation of PS processes. In 2006, the AFR approach to enhance legitimate and fair PS was introduced by researchers and decision makers within the health sector in the EU funded research project entitled 'Response to Accountable priority setting for Trust in health systems' (REACT). The project aimed to strengthen fairness and accountability in the PS processes of health systems at district level in Zambia, Tanzania and Kenya. This paper focuses on local perceptions and practices of fair PS (baseline study) as well as at the evolution of such perceptions and practices in PS following an AFR based intervention (evaluation study), carried out at district level in Kapiri-Mposhi District in Zambia. Data was collected using in depth interviews (IDIs), focus group discussions (FGDs) and review of documents from national to district level. The study population for this paper consisted of health related stakeholders employed in the district administration, in non-governmental organizations (NGO) and in health facilities. During the baseline study, concepts of legitimacy and fairness in PS processes were found to be grounded in local values of equity and impartiality. Government and other organizational strategies strongly supported devolution of PS and decision making procedures. However, important gaps were identified in terms of experiences of stakeholder involvement and fairness in PS processes in practice. The evaluation study revealed that a transformation of the views and methods regarding fairness in PS processes was ongoing in the study district, which was partly attributed to the AFR based intervention. The study findings suggest that increased attention was given to fairness in PS processes at district level. The changes were linked to a number of simultaneous factors among them the concepts introduced by the present project with its emphasis on fairness and enhanced participation. A responsive leadership that was increasingly accountable to its operational staff and communities emerged as one of the key elements in driving the processes forward.

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

The development of mental health services within primary care in India: learning from oral history

PubMed Central

2014-01-01

Background In India very few of those who need mental health care receive it, despite efforts of the 1982 National Mental Health Programme and its district-level component the District Mental Health Programme (DMHP) to improve mental health care coverage. Aims To explore and unpack the political, cultural and other historical reasons for the DMHP’s failures and successes since 1947 (post-independence era), which may highlight issues for today’s current primary mental health care policy and programme. Methods Oral history interviews and documentary sourcing were conducted in 2010–11 with policy makers, programme managers and observers who had been active in the creation of the NMHP and DMHP. Results The results suggest that the widely held perception that the DMHP has failed is not entirely justified, insofar that major hurdles to the implementation of the plan have impacted on mental health coverage in primary care, rather than faults with the plan itself. These hurdles have been political neglect, inadequate leadership at central, state and district levels, inaccessible funding and improperly implemented delivery of services (including poor training, motivation and retention of staff) at district and community levels. Conclusion At this important juncture as the 12th Five Year Plan is in preparation, this historical paper suggests that though the model may be improved, the most important changes would be to encourage central and state governments to implement better technical support, access to funds and to rethink the programme leadership at national, state and district levels. PMID:25089154

The Relationship between Reading Response Journals as an Intervention and Reading Achievement of Fourth and Fifth Graders in a Suburban School District

ERIC Educational Resources Information Center

Hume, Julie M.

2013-01-01

Many of today's students are reading below grade level and schools are investigating methods for increasing student achievement in the area of reading. This mixed method research study investigated the achievement of students who were reading below grade level. The purpose of this study was to investigate the relationship between reading response…

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.

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.

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.

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

Factors contributing to men’s reluctance to seek HIV counselling and testing at Primary Health Care facilities in Vhembe District of South Africa

PubMed Central

Sirwali, Robert N.; Tshitangano, Takalani

2016-01-01

Background Voluntary HIV antibody Counselling and Testing (HCT) is a cornerstone of HIV prevention in South Africa because it has the potential to prevent HIV transmission. The government of South Africa has for a long time been investing heavily in fighting the spread of HIV and/or AIDS. However, men rarely utilise this service. Aim The aim of this study was to explore the factors contributing to the reluctance of men to seek HCT in the primary health facilities in Vhembe District. Setting The study was conducted at Vhembe District health offices in Limpopo, South Africa. Methods A qualitative research design, anchored on semi-structured interviews as a method of data collection, was used. Fifteen men working at Vhembe health offices were purposively sampled. Data were analysed using the TECHS’s 8 steps method. The approval from Polokwane Provincial offices was guaranteed with participants being protected and respected throughout the study. Results The response rate per question was 100% with all 15 participants willing to answer all the raised questions, though with different views and opinions. The majority of the interviewees indicated that they were aware of HCT services. Stigma as a societal reaction to disease, governmental policies, and attitudinal factors made men refrain from seeking counselling and testing from public health facilities. Conclusion There was a high level of HCT awareness among men in Vhembe District. However, attitudinal and political barriers, stigma, and cultural practices such as circumcision were cited as the reasons for the low level utilisation of HCT services. PMID:27380851

Does similarity in educational level between health promotion volunteers and local residents affect activity involvement of the volunteers?

PubMed

Murayama, Hiroshi; Taguchi, Atsuko; Murashima, Sachiyo

2012-01-01

This study examined whether similarity in educational level, as a socioeconomic background factor, between health promotion volunteers (HPVs) and residents in the district where HPVs work encourages the volunteers' involvement in providing activities. Cross-sectional questionnaire survey. A total of 512 HPVs in a Japanese city with 5 districts. We focused on the number of activities related to working as an HPV as an aspect of involvement in the HPV role. HPV individual educational level was collected from a questionnaire. District educational level was obtained from the Japanese census database. Of 512 questionnaires, 363 were returned and used for the analysis. Multiple regression analysis stratified by district educational level indicated that a higher educational level in HPVs was significantly associated with a greater number of self-motivated activities in the districts with a higher educational level, although the association between a lower HPV educational level and more activity involvement was not found in districts with a lower educational level. It is important to consider similarity in educational level, as a socioeconomic status factor, between HPVs and the districts in which they will work when recruiting new members and when allocating HPVs to work areas. © 2011 Wiley Periodicals, Inc.

[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.

Modelling of land use change in Indramayu District, West Java Province

NASA Astrophysics Data System (ADS)

Handayani, L. D. W.; Tejaningrum, M. A.; Damrah, F.

2017-01-01

Indramayu District into a strategic area for a stopover and overseas from East Java area because Indramayu District passed the north coast main lane, which is the first as the economic lifeblood of the Java Island. Indramayu District is part of mainstream economic Java pathways so that physical development of the area and population density as well as community activities grew by leaps and bounds. Growth acceleration raised the level of land use change. Land use change and population activities in coastal area would reduce the carrying capacity and impact on environmental quality. This research aim to analyse landuse change of years 2000 and 2011 in Indramayu District. Using this land use change map, we can predict the condition of landuse change of year 2022 in Indramayu District. Cellular Automata Markov (Markov CA) Method is used to create a spatial model of land use changes. The results of this study are predictive of land use in 2022 and the suitability with Spatial Plan (RTRW). A settlement increase predicted to continue in the future the designation of the land according to the spatial plan should be maintained.

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.

An Innovative Method of Measuring Changes in Access to Healthful Foods in School Lunch Programs: Findings from a Pilot Evaluation

PubMed Central

Hawkes, Allison P.; Weinberg, Stacy L.; Janusz, Ruth; Demont-Heinrich, Christine; Vogt, Richard L.

2016-01-01

Introduction A large local health department in Colorado partnered with 15 school districts to develop an approach to evaluate changes in access to healthy foods in reimbursable school lunches and a la carte offerings. Materials and Methods School district nutrition managers were engaged at the start of this project. Health department dietitians developed criteria to classify food items as “Lower Fat and less added Sugar” (LFS) and “Higher Fat and more added Sugar” (HFS) based on the percentage of calories from fat and grams of added sugar. Lunch production sheets were obtained for two time periods, food items and the number of planned servings recorded. LFS and HFS planned servings were summed for each time period, and a LFS to HFS ratio calculated by dividing LFS planned servings by HFS planned servings. Additional analyses included calculating LFS: HFS ratios by school district, and for a la carte offerings. Results In 2009, the LFS: HFS ratio was 2.08, in 2011, 3.71 (P<0.0001). The method also detected changes in ratios at the school district level. For a la carte items, in 2009 the ratio of LFS: HFS was 0.53, and in 2011, 0.61 (not statistically significant). Conclusions This method detected an increase in the LFS: HFS ratio over time and demonstrated that the school districts improved access to healthful food/drink by changing the contents of reimbursable school lunches. The evaluation method discussed here can generate information that districts can use in helping sustain and expand their efforts to create healthier environments for children and adults. Although federal regulations now cover all food and beverages served during the school day, there are still opportunities to improve and measure changes in food served in other settings such as child care centers, youth correction facilities, or in schools not participating in the National School Lunch Program. PMID:26800523

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

Perceptions on diabetes care provision among health providers in rural Tanzania: a qualitative study

PubMed Central

Geubbels, Eveline; Klatser, Paul; Dieleman, Marjolein

2017-01-01

Abstract Diabetes prevalence in Tanzania was estimated at 9.1% in 2012 among adults aged 24–65 years — higher than the HIV prevalence in the general population at that time. Health systems in lower- and middle-income countries are not designed for chronic health care, yet the rising burden of non-communicable diseases such as diabetes demands chronic care services. To inform policies on diabetes care, we conducted a study on the health services in place to diagnose, treat and care for diabetes patients in rural Tanzania. The study was an exploratory and descriptive study involving qualitative methods (in-depth interviews, observations and document reviews) and was conducted in a rural district in Tanzania. Fifteen health providers in four health facilities at different levels of the health care system were interviewed. The health care organization elements of the Innovative Care for Chronic Conditions (ICCC) framework were used to guide assessment of the diabetes services in the district. We found that diabetes care in this district was centralized at the referral and district facilities, with unreliable supply of necessary commodities for diabetes care and health providers who had some knowledge of what was expected of them but felt ill-prepared for diabetes care. Facility and district level guidance was lacking and the continuity of care was broken within and between facilities. The HMIS could not produce reliable data on diabetes. Support for self-management to patients and their families was weak at all levels. In conclusion, the rural district we studied did not provide diabetes care close to the patients. Guidance on diabetes service provision and human resource management need strengthening and policies related to task-shifting need adjustment to improve quality of service provision for diabetes patients in rural settings. PMID:27935802

Principal Selection: A National Study of Selection Criteria and Procedures

ERIC Educational Resources Information Center

Palmer, Brandon

2017-01-01

Despite empirical evidence correlating the role of the principal with student achievement, researchers have seldom scrutinized principal selection methods over the past 60 years. This mixed methods study investigated the processes by which school principals are selected. A national sample of top-level school district administrators was used to…

Principal Selection: A National Study of Selection Criteria and Procedures

ERIC Educational Resources Information Center

Palmer, Brandon

2016-01-01

Despite empirical evidence correlating the role of the principal with student achievement, researchers have seldom scrutinized principal selection methods over the past 60 years. This mixed methods study investigated the processes by which school principals are selected. A national sample of top-level school district administrators was used to…

[Atomic absorption in mercury determination by "Julia-2" analyzer and urine mercury level in children of Moscow suburbs].

PubMed

Pavlovskaia, N A; Vagina, E N; Stepanova, E V

2000-01-01

The authors report on atomic absorption method determining mercury in urine. Being sensitive, with lower determination threshold of 10 nmole/l and correctness of 95.5%, the method was tested on children living in two districts of Moscow suburb.

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

RANGE RAM: a long-term planning method for managing grazing lands

Treesearch

Henricus C. Jansen

1976-01-01

Range RAM (Resource Allocation Method) is a computerized planning method designed to assist range managers in developing and selecting alternatives in spatial and temporal allocation of resources. The technique is applicable at the frest or district management levels, or their equivalents. Range RAM can help formulate plans that maximize the production of range outputs...

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.

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...

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

Cost of delivering secondary-level health care services through public sector district hospitals in India

PubMed Central

Prinja, Shankar; Balasubramanian, Deepak; Jeet, Gursimer; Verma, Ramesh; Kumar, Dinesh; Bahuguna, Pankaj; Kaur, Manmeet; Kumar, Rajesh

2017-01-01

Background & objectives: Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Methods: Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. Results: The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was 844 (USD 15.5), i; 3481 (USD 64) and 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was 139 (USD 2.5). Interpretation & conclusions: The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India. PMID:29355142

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 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

Development and Usefulness of a District Health Systems Tool for Performance Improvement in Essential Public Health Functions in Botswana and Mozambique

PubMed Central

Bishai, David; Sherry, Melissa; Pereira, Claudia C.; Chicumbe, Sergio; Mbofana, Francisco; Boore, Amy; Smith, Monica; Nhambi, Leonel; Borse, Nagesh N.

2018-01-01

Introduction This study describes the development of a self-audit tool for public health and the associated methodology for implementing a district health system self-audit tool that can provide quantitative data on how district governments perceive their own performance of the essential public health functions. Methods Development began with a consensus building process to engage Ministry of Health and provincial health officers in Mozambique and Botswana. We then worked with lists of relevant public health functions as determined by these stakeholders to adapt a self-audit tool describing essential public health functions to each country’s health system. We then piloted the tool across districts in both countries and conducted interviews with district health personnel to determine health workers’ perception of the usefulness of the approach. Results Country stakeholders were able to develop consensus around eleven essential public health functions that were relevant in each country. Pilots of the self-audit tool enabled the tool to be effectively shortened. Pilots also disclosed a tendency to up code during self-audits that was checked by group deliberation. Convening sessions at the district enabled better attendance and representative deliberation. Instant feedback from the audit was a feature that 100% of pilot respondents found most useful. Conclusions The development of metrics that provide feedback on public health performance can be used as an aid in the self-assessment of health system performance at the district level. Measurements of practice can open the door to future applications for practice improvement and research into the determinants and consequences of better public health practice. The current tool can be assessed for its usefulness to district health managers in improving their public health practice. The tool can also be used by ministry of health or external donors in the African region for monitoring the district level performance of the essential public health functions. PMID:27682727

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.

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

Introducing the Social Presence Model to Explore Online and Blended Learning Experiences

ERIC Educational Resources Information Center

Whiteside, Aimee L.

2015-01-01

This study explores the level of "social presence" or connectedness, in two iterations of a 13-month, graduate-level certificate program designed to help K-12 school leaders integrate technology in their districts. Vygotsky's Social Development Theory serves as the theoretical lens for this programmatic research. The methods include a…

Intestinal helminths in Luweero district, Uganda.

PubMed

Dumba, Robinah; Kaddu, John B; Wabwire Mangen, Fred

2008-06-01

Intestinal helminthiasis is a debilitating parasitic disease found in many parts of Uganda including Luweero district. In the district, the disease causes as high as 9% morbidity in children below five years. There was very scanty district information on the disease based mainly on hospital records despite this figure. The current study was carried out to provide data to plan for its effective control. To investigate risk factors that promote helminth infections among children under five years of age in Luweero district. Stool samples from 727 children were examined for presence of helminth ova using Kato-Katz technique. The subjects' parents or guardians were interviewed using a semi-structured questionnaire to establish their demographic, social-cultural characteristics; information on water accessibility and usage; child toileting practices and knowledge about helminthiasis. Risk factors strongly associated with helminth infections included methods of anal cleaning, how compounds and latrines were maintained, keeping of pigs and age of the subjects, (P <0.001). In addition, methods of hand washing after latrine visits, the respondents' education level, type of house floor and household compound as well as accessibility to water were associated with worm infection. The hygiene practices of the parents/guardians and environmental surroundings in which the child grows play a big part in determining his or her helminth status. The District Health workers, community leaders and extension staff should educate the community on the importance of personal hygiene and environmental sanitation to minimize the risks of helminth infections.

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

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

Assessment of Entrepreneurial Territorial Attractiveness by the Ranking Method

ERIC Educational Resources Information Center

Gavrilova, Marina A.; Shepelev, Victor M.; Kosyakova, Inessa V.; Belikova, Lyudmila F.; Chistik, Olga F.

2016-01-01

The relevance of the researched problem is caused by existence of differentiation in development of separate regional units (urban districts and municipalities) within the region. The aim of this article is to offer a method, which determines the level of differentiation in development of various components of the region, and also in producing a…

Are health interventions implemented where they are most needed? District uptake of the integrated management of childhood illness strategy in Brazil, Peru and the United Republic of Tanzania.

PubMed Central

Victora, C. G.; Huicho, L.; Amaral, J. J.; Armstrong-Schellenberg, J.; Manzi, F.; Mason, E.; Scherpbier, R.

2006-01-01

OBJECTIVE: To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs. METHODS: We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United Republic of Tanzania, and an ecological study of factors associated with health worker training in IMCI. Explanatory factors included district population, distance from the capital, human development index, other socioeconomic indicators and baseline mortality rates in children younger than five years. FINDINGS: In line with recommendations by WHO, early implementation districts were characterized by proximity to the capital and suitable training sites, presence of motivated health managers and a functioning health system. In the expansion phase, IMCI tended to be adopted by other districts with similar characteristics. In Brazil, uptake by poor and small municipalities and those further away from the state capital was significantly lower. In Peru, there was no association with distance from Lima, and a non-significant trend for IMCI adoption by small and poor departments. In the United Republic of Tanzania, the only statistically significant finding was a lower uptake by remote districts. Implementation was not associated with baseline mortality levels in any country studied. CONCLUSION: Whereas clear and reasonable guidelines are provided for selection of early use districts, no criteria for promoting IMCI expansion had been issued, and areas of greatest need were not prioritized. Equity analyses based on the geographical deployment of new programmes and strategies can contribute to assessing whether they are reaching those who need them most. PMID:17128359

Applying stochastic small-scale damage functions to German winter storms

NASA Astrophysics Data System (ADS)

Prahl, B. F.; Rybski, D.; Kropp, J. P.; Burghoff, O.; Held, H.

2012-03-01

Analyzing insurance-loss data we derive stochastic storm-damage functions for residential buildings. On district level we fit power-law relations between daily loss and maximum wind speed, typically spanning more than 4 orders of magnitude. The estimated exponents for 439 German districts roughly range from 8 to 12. In addition, we find correlations among the parameters and socio-demographic data, which we employ in a simplified parametrization of the damage function with just 3 independent parameters for each district. A Monte Carlo method is used to generate loss estimates and confidence bounds of daily and annual storm damages in Germany. Our approach reproduces the annual progression of winter storm losses and enables to estimate daily losses over a wide range of magnitudes.

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

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)…

[Relationships between urbanization and water resource utilization in Dongting Lake District of South-central China].

PubMed

Li, Jing-Zhi; Zhu, Xiang; Li, Jing-Bao; Xu, Mei

2013-06-01

By using analytic hierarchy process and entropy method, the evaluation index system and the response relationship model of comprehensive development level of urbanization and comprehensive development and utilization potential of water resources in Dongting Lake District were constructed, with the key affecting factors, their change characteristics, and response characteristics from 2001 to 2010 analyzed. During the study period, the Dongting Lake District was undergoing a rapid development of urbanization, and at a scale expansion stage. The economic and social development level was lagged behind the population and area increase, and the quality and efficiency of urbanization were still needed to be improved. With the advance of urbanization, the water consumption increased yearly, and the water resources utilization efficiency and management level improved steadily. However, the background condition of water resources and their development and utilization level were more affected by hydrological environment rather than urbanization. To a certain extent, the development of urbanization in 2001, 2002, 2005, 2006, 2007, 2009 was slowed down by the shortage of water resources. At present, Dongting Lake region was confronted with the dual task of improving the level and quality of urbanization, and hence, it would be necessary to reform the traditional epitaxial expansion of urbanization and to enhance the water resource support capability.

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

Health system productivity change in Zambia: A focus on the child health services.

PubMed

Achoki, Tom; Kinfu, Yohannes; Masiye, Felix; Frederix, Geert W J; Hovels, Anke; Leufkens, Hubert G

2017-02-01

Efficiency and productivity improvement have become central in global health debates. In this study, we explored productivity change, particularly the contribution of technological progress and efficiency gains associated with improvements in child survival in Zambia (population 15 million). Productivity was measured by applying the Malmquist productivity index on district-level panel data. The effect of socioeconomic factors was further analyzed by applying an ordinary least squares regression technique. During 2004-2009, overall productivity in Zambia increased by 5.0 per cent, a change largely attributed to technological progress rather than efficiency gains. Within-country productivity comparisons revealed wide heterogeneity in favor of more urbanized and densely populated districts. Improved cooking methods, improved sanitation, and better educated populations tended to improve productive gains, whereas larger household size had an adverse effect. Addressing such district-level factors and ensuring efficient delivery and optimal application of existing health technologies offer a practical pathway for further improving population health.

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)

Equity and geography: the case of child mortality in Papua New Guinea.

PubMed

Bauze, Anna E; Tran, Linda N; Nguyen, Kim-Huong; Firth, Sonja; Jimenez-Soto, Eliana; Dwyer-Lindgren, Laura; Hodge, Andrew; Lopez, Alan D

2012-01-01

Recent assessments show continued decline in child mortality in Papua New Guinea (PNG), yet complete subnational analyses remain rare. This study aims to estimate under-five mortality in PNG at national and subnational levels to examine the importance of geographical inequities in health outcomes and track progress towards Millennium Development Goal (MDG) 4. We performed retrospective data validation of the Demographic and Health Survey (DHS) 2006 using 2000 Census data, then applied advanced indirect methods to estimate under-five mortality rates between 1976 and 2000. The DHS 2006 was found to be unreliable. Hence we used the 2000 Census to estimate under-five mortality rates at national and subnational levels. During the period under study, PNG experienced a slow reduction in national under-five mortality from approximately 103 to 78 deaths per 1,000 live births. Subnational analyses revealed significant disparities between rural and urban populations as well as inter- and intra-regional variations. Some of the provinces that performed the best (worst) in terms of under-five mortality included the districts that performed worst (best), with district-level under-five mortality rates correlating strongly with poverty levels and access to services. The evidence from PNG demonstrates substantial within-province heterogeneity, suggesting that under-five mortality needs to be addressed at subnational levels. This is especially relevant in countries, like PNG, where responsibility for health services is devolved to provinces and districts. This study presents the first comprehensive estimates of under-five mortality at the district level for PNG. The results demonstrate that for countries that rely on few data sources even greater importance must be given to the quality of future population surveys and to the exploration of alternative options of birth and death surveillance.

Optimal allocation model of construction land based on two-level system optimization theory

NASA Astrophysics Data System (ADS)

Liu, Min; Liu, Yanfang; Xia, Yuping; Lei, Qihong

2007-06-01

The allocation of construction land is an important task in land-use planning. Whether implementation of planning decisions is a success or not, usually depends on a reasonable and scientific distribution method. Considering the constitution of land-use planning system and planning process in China, multiple levels and multiple objective decision problems is its essence. Also, planning quantity decomposition is a two-level system optimization problem and an optimal resource allocation decision problem between a decision-maker in the topper and a number of parallel decision-makers in the lower. According the characteristics of the decision-making process of two-level decision-making system, this paper develops an optimal allocation model of construction land based on two-level linear planning. In order to verify the rationality and the validity of our model, Baoan district of Shenzhen City has been taken as a test case. Under the assistance of the allocation model, construction land is allocated to ten townships of Baoan district. The result obtained from our model is compared to that of traditional method, and results show that our model is reasonable and usable. In the end, the paper points out the shortcomings of the model and further research directions.

Defining river types in a Mediterranean area: a methodology for the implementation of the EU Water Framework Directive.

PubMed

Munné, Antoni; Prat, Narcís

2004-11-01

The Water Framework Directive (WFD), approved at the end of 2000 by the European Union, proposes the characterization of river types through two classification systems (A and B) (Annex II of the WFD), thereby obtaining comparable reference sites and improving the management of aquatic systems. System A uses fixed categories of three parameters to classify rivers: three altitude ranges, four basin size ranges, and three geological categories. In the other hand, System B proposes to establish river types analyzing different factors considered as obligatory and optional. Here, we tested Systems A and B in the Catalan River Basin District (NE Spain). The application of System A results in 26 river types: 8 in the Pyrenees and 18 in the Iberic-Macaronesian ecoregions. This number would require the establishment of a complex management system and control of the ecological status in a relatively small river basin district. We propose a multivariant system to synthesize the environmental descriptors and to define river types using System B. We use five hydrological, seven morphological, five geological, and two climatic variables to discriminate among river types. This method results in fewer river type categories than System A but is expected to achieve the same degree of differentiation because of the large number of descriptors considered. Two levels are defined in our classification method using System B. Five "river types," defined at large scale (1:1,000,000), are mainly discriminated by annual runoff coefficient, air temperature, and discharge. This level is useful and could facilitate comparisons of results among European river basin districts. The second level defines 10 "subtypes of river management," mainly discriminated by geology in the basin and flow regime. This level is more adequate at local scale (1:250,000) and provides a useful tool for management purposes in relatively small and heterogeneous river basin districts.

Impact of life expectancy, literacy rate, opened unemployment rate and gross domestic regional income per capita on poverty in the districts/city in Central Sulawesi Province

NASA Astrophysics Data System (ADS)

Tombolotutu, A. D.; Djirimu, M. A.; Lutfi, M.; Anggadini, F.

2018-05-01

Research was conducted in several districts/city in Central Sulawesi Province in order to determine the effect of life expectancy, literacy rate, opened unemployment rate, and gross domestic regional income per capita on poverty at the districts/city in the province. The analysis used is Panel Data Regression. The results show that first, life expectancy and gross domestic regional income have a negative and significant impact on the poverty level in the districts/city in the Province. Second, the opened unemployment rate has a positive and significant effect on the poverty level in the districts/city in the province. Third, literacy rates show a positive effect and insignificant effect on the poverty level in the districts/city in the Province of Central Sulawesi. Fourth, these four variables simultaneously affect the poverty in the districts/city in Central Sulawesi

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.

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…

Implementation of a health management mentoring program: year-1 evaluation of its impact on health system strengthening in Zambézia Province, Mozambique

PubMed Central

Edwards, Laura J.; Moisés, Abú; Nzaramba, Mathias; Cassimo, Aboobacar; Silva, Laura; Mauricio, Joaquim; Wester, C. William; Vermund, Sten H.; Moon, Troy D.

2015-01-01

Background: Avante Zambézia is an initiative of a Non-Governmental Organization (NGO), Friends in Global Health, LLC (FGH) and the Vanderbilt Institute for Global Health (VIGH) to provide technical assistance to the Mozambican Ministry of Health (MoH) in rural Zambézia Province. Avante Zambézia developed a district level Health Management Mentorship (HMM) program to strengthen health systems in ten of Zambézia’s 17 districts. Our objective was to preliminarily analyze changes in four domains of health system capacity after the HMM’s first year: accounting, Human Resources (HRs), Monitoring and Evaluation (M&E), and transportation management. Methods: Quantitative metrics were developed in each domain. During district visits for weeklong, on-site mentoring, the health management mentoring teams documented each indicator as a success ratio percentage. We analyzed data using linear regressions of each indicator’s mean success ratio across all districts submitting a report over time. Results: Of the four domains, district performance in the accounting domain was the strongest and most sustained. Linear regressions of mean monthly compliance for HR objectives indicated improvement in three of six mean success ratios. The M&E capacity domain showed the least overall improvement. The one indicator analyzed for transportation management suggested progress. Conclusion: Our outcome evaluation demonstrates improvement in health system performance during a HMM initiative. Evaluating which elements of our mentoring program are succeeding in strengthening district level health systems is vital in preparing to transition fiscal and managerial responsibility to local authorities. PMID:26029894

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.

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…

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…

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

Middle School Science Curriculum Design and 8th Grade Student Achievement in Massachusetts Public Schools

ERIC Educational Resources Information Center

Clifford, Betsey A.

2016-01-01

The Massachusetts Department of Elementary and Secondary Education (DESE) released proposed Science and Technology/Engineering standards in 2013 outlining the concepts that should be taught at each grade level. Previously, standards were in grade spans and each district determined the method of implementation. There are two different methods used…

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…

Identifying factors associated with the uptake of prevention of mother to child HIV transmission programme in Tigray region, Ethiopia: a multilevel modeling approach.

PubMed

Lerebo, Wondwossen; Callens, Steven; Jackson, Debra; Zarowsky, Christina; Temmerman, Marleen

2014-04-23

Prevention of mother to child HIV transmission (PMTCT) remains a challenge in low and middle-income countries. Determinants of utilization occur--and often interact--at both individual and community levels, but most studies do not address how determinants interact across levels. Multilevel models allow for the importance of both groups and individuals in understanding health outcomes and provide one way to link the traditionally distinct ecological- and individual-level studies. This study examined individual and community level determinants of mother and child receiving PMTCT services in Tigray region, Ethiopia. A multistage probability sampling method was used for this 2011 cross-sectional study of 220 HIV positive post-partum women attending child immunization services at 50 health facilities in 46 districts. In view of the nested nature of the data, we used multilevel modeling methods and assessed macro level random effects. Seventy nine percent of mothers and 55.7% of their children had received PMTCT services. Multivariate multilevel modeling found that mothers who delivered at a health facility were 18 times (AOR = 18.21; 95% CI 4.37,75.91) and children born at a health facility were 5 times (AOR = 4.77; 95% CI 1.21,18.83) more likely to receive PMTCT services, compared to mothers delivering at home. For every addition of one nurse per 1500 people, the likelihood of getting PMTCT services for a mother increases by 7.22 fold (AOR = 7.22; 95% CI 1.02,51.26), when other individual and community level factors were controlled simultaneously. In addition, district-level variation was low for mothers receiving PMTCT services (0.6% between districts) but higher for children (27.2% variation between districts). This study, using a multilevel modeling approach, was able to identify factors operating at both individual and community levels that affect mothers and children getting PMTCT services. This may allow differentiating and accentuating approaches for different settings in Ethiopia. Increasing health facility delivery and HCT coverage could increase mother-child pairs who are getting PMTCT. Reducing the distance to health facility and increasing the number of nurses and laboratory technicians are also important variables to be considered by the government.

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…

Beyond the Biomedical: Community Resources for Mental Health Care in Rural Ethiopia

PubMed Central

Selamu, Medhin; Asher, Laura; Hanlon, Charlotte; Medhin, Girmay; Hailemariam, Maji; Patel, Vikram; Thornicroft, Graham; Fekadu, Abebaw

2015-01-01

Background The focus of discussion in addressing the treatment gap is often on biomedical services. However, community resources can benefit health service scale-up in resource-constrained settings. These assets can be captured systematically through resource mapping, a method used in social action research. Resource mapping can be informative in developing complex mental health interventions, particularly in settings with limited formal mental health resources. Method We employed resource mapping within the Programme for Improving Mental Health Care (PRIME), to systematically gather information on community assets that can support integration of mental healthcare into primary care in rural Ethiopia. A semi-structured instrument was administered to key informants. Community resources were identified for all 58 sub-districts of the study district. The potential utility of these resources for the provision of mental healthcare in the district was considered. Results The district is rich in community resources: There are over 150 traditional healers, 164 churches and mosques, and 401 religious groups. There were on average 5 eddir groups (traditional funeral associations) per sub-district. Social associations and 51 micro-finance institutions were also identified. On average, two traditional bars were found in each sub-district. The eight health centres and 58 satellite clinics staffed by Health Extension Workers (HEWs) represented all the biomedical health services in the district. In addition the Health Development Army (HDA) are community volunteers who support health promotion and prevention activities. Discussion The plan for mental healthcare integration in this district was informed by the resource mapping. Community and religious leaders, HEWs, and HDA may have roles in awareness-raising, detection and referral of people with mental illness, improving access to medical care, supporting treatment adherence, and protecting human rights. The diversity of community structures will be used to support rehabilitation and social reintegration. Alcohol use was identified as a target disorder for community-level intervention. PMID:25962075

Access to syringes for HIV prevention for injection drug users in St. Petersburg, Russia: syringe purchase test study

PubMed Central

2013-01-01

Background The HIV epidemic in Russia is concentrated among injection drug users (IDUs). This is especially true for St. Petersburg where high HIV incidence persists among the city’s estimated 80,000 IDUs. Although sterile syringes are legally available, access for IDUs may be hampered. To explore the feasibility of using pharmacies to expand syringe access and provide other prevention services to IDUs, we investigated the current access to sterile syringes at the pharmacies and the correlation between pharmacy density and HIV prevalence in St. Petersburg. Methods 965 pharmacies citywide were mapped, classified by ownership type, and the association between pharmacy density and HIV prevalence at the district level was tested. We selected two districts among the 18 districts – one central and one peripheral – that represented two major types of city districts and contacted all operating pharmacies by phone to inquire if they stocked syringes and obtained details about their stock. Qualitative interviews with 26 IDUs provided data regarding syringe access in pharmacies and were used to formulate hypotheses for the pharmacy syringe purchase test wherein research staff attempted to purchase syringes in all pharmacies in the two districts. Results No correlation was found between the density of pharmacies and HIV prevalence at the district level. Of 108 operating pharmacies, 38 (35%) did not sell syringes of the types used by IDUs; of these, half stocked but refused to sell syringes to research staff, and the other half did not stock syringes at all. Overall 70 (65%) of the pharmacies did sell syringes; of these, 49 pharmacies sold single syringes without any restrictions and 21 offered packages of ten. Conclusions Trainings for pharmacists need to be conducted to reduce negative attitudes towards IDUs and increase pharmacists’ willingness to sell syringes. At a structural level, access to safe injection supplies for IDUs could be increased by including syringes in the federal list of mandatory medical products sold by pharmacies. PMID:23452390

Web-based decision support system to predict risk level of long term rice production

NASA Astrophysics Data System (ADS)

Mukhlash, Imam; Maulidiyah, Ratna; Sutikno; Setiyono, Budi

2017-09-01

Appropriate decision making in risk management of rice production is very important in agricultural planning, especially for Indonesia which is an agricultural country. Good decision would be obtained if the supporting data required are satisfied and using appropriate methods. This study aims to develop a Decision Support System that can be used to predict the risk level of rice production in some districts which are central of rice production in East Java. Web-based decision support system is constructed so that the information can be easily accessed and understood. Components of the system are data management, model management, and user interface. This research uses regression models of OLS and Copula. OLS model used to predict rainfall while Copula model used to predict harvested area. Experimental results show that the models used are successfully predict the harvested area of rice production in some districts which are central of rice production in East Java at any given time based on the conditions and climate of a region. Furthermore, it can predict the amount of rice production with the level of risk. System generates prediction of production risk level in the long term for some districts that can be used as a decision support for the authorities.

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.

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.

Self-rated health: small area large area comparisons amongst older adults at the state, district and sub-district level in India.

PubMed

Hirve, Siddhivinayak; Vounatsou, Penelope; Juvekar, Sanjay; Blomstedt, Yulia; Wall, Stig; Chatterji, Somnath; Ng, Nawi

2014-03-01

We compared prevalence estimates of self-rated health (SRH) derived indirectly using four different small area estimation methods for the Vadu (small) area from the national Study on Global AGEing (SAGE) survey with estimates derived directly from the Vadu SAGE survey. The indirect synthetic estimate for Vadu was 24% whereas the model based estimates were 45.6% and 45.7% with smaller prediction errors and comparable to the direct survey estimate of 50%. The model based techniques were better suited to estimate the prevalence of SRH than the indirect synthetic method. We conclude that a simplified mixed effects regression model can produce valid small area estimates of SRH. © 2013 Published by Elsevier Ltd.

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

Determinants of exclusive breastfeeding: a study of two sub-districts in the Atwima Nwabiagya District of Ghana

PubMed Central

Ayawine, Alice; Ae-Ngibise, Kenneth Ayuurebobi

2015-01-01

Introduction Optimal breastfeeding rates have not been encouraging globally with sub-optimal feeding being customized in Sub-Saharan Africa. However, in the Atwima Nwabiagya district of Ghana, the message of Exclusive Breastfeeding (EBF) has caught up well with many nursing mothers. we examined the determinants of EBF vis-à-vis performance of a community based growth promotion strategy in the Atwima Nwabiagya district of the Ashanti region of Ghana. Methods The study employed a cross-sectional comparative study design to analyze the impact of a community based growth promotion strategy on exclusive breast feeding in Abuakwa and Barekese, both in the Atwima Nwabiagya district of Ghana. Simple random sampling was used to select three communities each from the two sub-districts. Data collection tool employed was a standard questionnaire consisting of closed-ended questions. The variables were EBF knowledge level of mothers, cultural practices affecting EBF practice, occupational hindrances and the level of community participation in EBF activities. Results In all three hundred (300) nursing mothers of babies (0-12 months) were purposively interviewed. Results showed that mother's level of knowledge about EBF was good as such the practice was high. In addition, cultural practices in the area did not deter mothers from practicing exclusive breastfeeding. Two factors were associated with EBF in the univariate logistic model. Unmarried mothers were less likely to practice EB compared with mothers who were married (OR = 0.46, 95% 0.28, 0.77). Also the duration of breast feeding was associated wit EBF. The adjusted odds ratio was 0.41(95% CI: 0.32, 0.54) in favor of three months compared with six months. Conclusion The Community Based Growth Promotion strategy has had a positive impact on the practice of EBF in the district. It is recommended that the collapsed initiative be reawaken if the stakes are to be maintained. There is also the need to address mothers’ occupational needs and effective breastfeeding practices as this emerged as a major set-back to the practice of EBF among the participants. PMID:26958111

Finding parasites and finding challenges: improved diagnostic access and trends in reported malaria and anti-malarial drug use in Livingstone district, Zambia

PubMed Central

2012-01-01

Background Understanding the impact of malaria rapid diagnostic test (RDT) use on management of acute febrile disease at a community level, and on the consumption of anti-malarial medicines, is critical to the planning and success of scale-up to universal parasite-based diagnosis by health systems in malaria-endemic countries. Methods A retrospective study of district-wide community-level RDT introduction was conducted in Livingstone District, Zambia, to assess the impact of this programmed on malaria reporting, incidence of mortality and on district anti-malarial consumption. Results Reported malaria declined from 12,186 cases in the quarter prior to RDT introduction in 2007 to an average of 12.25 confirmed and 294 unconfirmed malaria cases per quarter over the year to September 2009. Reported malaria-like fever also declined, with only 4,381 RDTs being consumed per quarter over the same year. Reported malaria mortality declined to zero in the year to September 2009, and all-cause mortality declined. Consumption of artemisinin-based combination therapy (ACT) dropped dramatically, but remained above reported malaria, declining from 12,550 courses dispensed by the district office in the quarter prior to RDT implementation to an average of 822 per quarter over the last year. Quinine consumption in health centres also declined, with the district office ceasing to supply due to low usage, but requests for sulphadoxine-pyrimethamine (SP) rose to well above previous levels, suggesting substitution of ACT with this drug in RDT-negative cases. Conclusions RDT introduction led to a large decline in reported malaria cases and in ACT consumption in Livingstone district. Reported malaria mortality declined to zero, indicating safety of the new diagnostic regime, although adherence and/or use of RDTs was still incomplete. However, a deficiency is apparent in management of non-malarial fever, with inappropriate use of a low-cost single dose drug, SP, replacing ACT. While large gains have been achieved, the full potential of RDTs will only be realized when strategies can be put in place to better manage RDT-negative cases. PMID:23043557

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.

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 Effects of Math Acceleration in Middle School at the High School Level

ERIC Educational Resources Information Center

Dossenbach, Chris Payton

2017-01-01

The purpose of this mixed-methods capstone is to investigate the effectiveness of the math acceleration initiative that began in the studied school district in 2009 and the impact the initiative has had on mathematics enrollment at the high school level. This research project followed cohorts of students during the 2012-2013 and 2013-2014 school…

Female married illiteracy as the most important continual determinant of total fertility rate among districts of Empowered Action Group States of India: Evidence from Annual Health Survey 2011–12

PubMed Central

Kumar, Rajesh; Dogra, Vishal; Rani, Khushbu; Sahu, Kanti

2017-01-01

Background: District level determinants of total fertility rate in Empowered Action Group states of India can help in ongoing population stabilization programs in India. Objective: Present study intends to assess the role of district level determinants in predicting total fertility rate among districts of the Empowered Action Group states of India. Material and Methods: Data from Annual Health Survey (2011-12) was analysed using STATA and R software packages. Multiple linear regression models were built and evaluated using Akaike Information Criterion. For further understanding, recursive partitioning was used to prepare a regression tree. Results: Female married illiteracy positively associated with total fertility rate and explained more than half (53%) of variance. Under multiple linear regression model, married illiteracy, infant mortality rate, Ante natal care registration, household size, median age of live birth and sex ratio explained 70% of total variance in total fertility rate. In regression tree, female married illiteracy was the root node and splits at 42% determined TFR <= 2.7. The next left side branch was again married illiteracy with splits at 23% to determine TFR <= 2.1. Conclusion: We conclude that female married illiteracy is one of the most important determinants explaining total fertility rate among the districts of an Empowered Action Group states. Focus on female literacy is required to stabilize the population growth in long run. PMID:29416999

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

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

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.

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.

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…

The Primacy of Superintendent Leadership

ERIC Educational Resources Information Center

Waters, J. Timothy; Marzano, Robert J.

2007-01-01

In this article, the authors take a quick comparative look at two superintendents and their districts to better understand how both of them, considered strong leaders, can have very different effects on mean district-level student achievement. Their recent meta-analysis of the effects of district-level leadership on student achievement, summarized…

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

PubMed Central

2014-01-01

Background Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. Methods In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. Discussion EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. Trial registration PACTR201311000681314 PMID:24690284

Fruit and Vegetable Plate Waste among Students in a Suburban School District Participating in the National School Lunch Program

ERIC Educational Resources Information Center

Handforth, Kellyn M.; Gilboy, Mary Beth; Harris, Jeffrey; Melia, Nicole

2016-01-01

Purpose/Objectives: The purpose of this project was to assess fruit and vegetable plate waste, examine patterns of selection and consumption of specific fruit and vegetable subgroups, and analyze for differences across gender, grade level, and school. Methods: A previously-validated digital photography method was used to collect plate waste data…

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.

Location priority for non-formal early childhood education school based on promethee method and map visualization

NASA Astrophysics Data System (ADS)

Ayu Nurul Handayani, Hemas; Waspada, Indra

2018-05-01

Non-formal Early Childhood Education (non-formal ECE) is an education that is held for children under 4 years old. The implementation in District of Banyumas, Non-formal ECE is monitored by The District Government of Banyumas and helped by Sanggar Kegiatan Belajar (SKB) Purwokerto as one of the organizer of Non-formal Education. The government itself has a program for distributing ECE to all villages in Indonesia. However, The location to construct the ECE school in several years ahead is not arranged yet. Therefore, for supporting that program, a decision support system is made to give some recommendation villages for constructing The ECE building. The data are projected based on Brown’s Double Exponential Smoothing Method and utilizing Preference Ranking Organization Method for Enrichment Evaluation (Promethee) to generate priority order. As the recommendations system, it generates map visualization which is colored according to the priority level of sub-district and village area. The system was tested with black box testing, Promethee testing, and usability testing. The results showed that the system functionality and Promethee algorithm were working properly, and the user was satisfied.

Evaluation of introduction of the Haemophilus influenzae vaccine in Côte d’Ivoire

PubMed

Yohou, Kévin Sylvestre; Aka, Nicaise Lepri; Noufe, Soualihou; Douba, Alfred; Assi Assi, Bernard; Dagnan, Simplice N Cho

2016-11-25

Introduction: Côte d’Ivoire introduced the Haemophilus influenzae type b vaccine into the EPI in March 2009. Following this introduction, an evaluation was conducted in 2012 in order to evaluate the vaccine introduction process. Methods: Data collection methods consisted of document review, structured interviews and direct observation. This study collected information from six health region officials, 12 health districts and 36 healthcare institutions. Seventy-two mothers or child carers were also interviewed. Collected data were processed and analysed by Excel, Epi Info and SPSS. Results: A vaccine introduction plan was developed, but was not communicated at the operational level. The planned training for district health care providers was conducted eighteen months after introduction of the vaccine. None of the vaccinating centres had communication support about the new vaccine. Temperature recording was regularly performed in 92% of district deposits and 68% of vaccinating centres. Deteriorated vaccines were observed in 6% of vaccinating centres. Only 3.5% of parents had been informed about introduction of the vaccine. Increased immunization coverage for the third dose of pentavalent vaccine was observed in one half of health districts. Conclusion: Evaluation of the introduction of Haemophilus influenzae type b vaccine highlightsthe strengths and weaknesses of the health system and provides lessons for the introduction of other vaccines into the expanded programme on immunization.

Meeting the community halfway to reduce maternal deaths? Evidence from a community-based maternal death review in Uttar Pradesh, India

PubMed Central

Raj, Sunil Saksena; Maine, Deborah; Sahoo, Pratap Kumar; Manthri, Suneedh; Chauhan, Kavita

2013-01-01

ABSTRACT Background: Uttar Pradesh (UP) is the most populous state in India with the second highest reported maternal mortality ratio in the country. In an effort to analyze the reasons for maternal deaths and implement appropriate interventions, the Government of India introduced Maternal Death Review guidelines in 2010. Methods: We assessed causes of and factors leading to maternal deaths in Unnao District, UP, through 2 methods. First, we conducted a facility gap assessment in 15 of the 16 block-level and district health facilities to collect information on the performance of the facilities in terms of treating obstetric complications. Second, teams of trained physicians conducted community-based maternal death reviews (verbal autopsies) in a sample of maternal deaths occurring between June 1, 2009, and May 31, 2010. Results: Of the 248 maternal deaths that would be expected in this district in a year, we identified 153 (62%) through community workers and conducted verbal autopsies with families of 57 of them. Verbal autopsies indicated that 23% and 30% of these maternal deaths occurred at home and on the way to a health facility, respectively. Most of the women who died had been taken to at least 2 health facilities. The facility assessment revealed that only the district hospital met the recommended criteria for either basic or comprehensive emergency obstetric and neonatal care. Conclusions: Life-saving treatment of obstetric complications was not offered at the appropriate level of government facilities in a representative district in UP, and an inadequate referral system provided fatal delays. Expensive transportation costs to get pregnant women to a functioning medical facility also contributed to maternal death. The maternal death review, coupled with the facility gap assessment, is a useful tool to address the adequacy of emergency obstetric and neonatal care services to prevent further maternal deaths. PMID:25276519

A novel stochastic modeling method to simulate cooling loads in residential districts

DOE PAGES

An, Jingjing; Yan, Da; Hong, Tianzhen; ...

2017-09-04

District cooling systems are widely used in urban residential communities in China. Most of such systems are oversized, which leads to wasted investment, low operational efficiency and, thus, waste of energy. The accurate prediction of district cooling loads that can support the rightsizing of cooling plant equipment remains a challenge. This study develops a novel stochastic modeling method that consists of (1) six prototype house models representing most apartments in a district, (2) occupant behavior models of residential buildings reflecting their spatial and temporal diversity as well as their complexity based on a large-scale residential survey in China, and (3)more » a stochastic sampling process to represent all apartments and occupants in the district. The stochastic method was applied to a case study using the Designer's Simulation Toolkit (DeST) to simulate the cooling loads of a residential district in Wuhan, China. The simulation results agreed well with the measured data based on five performance metrics representing the aggregated cooling consumption, the peak cooling loads, the spatial load distribution, the temporal load distribution and the load profiles. Two prevalent simulation methods were also employed to simulate the district cooling loads. Here, the results showed that oversimplified assumptions about occupant behavior could lead to significant overestimation of the peak cooling load and the total cooling loads in the district. Future work will aim to simplify the workflow and data requirements of the stochastic method for its application, and to explore its use in predicting district heating loads and in commercial or mixed-use districts.« less

A novel stochastic modeling method to simulate cooling loads in residential districts

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

An, Jingjing; Yan, Da; Hong, Tianzhen

District cooling systems are widely used in urban residential communities in China. Most of such systems are oversized, which leads to wasted investment, low operational efficiency and, thus, waste of energy. The accurate prediction of district cooling loads that can support the rightsizing of cooling plant equipment remains a challenge. This study develops a novel stochastic modeling method that consists of (1) six prototype house models representing most apartments in a district, (2) occupant behavior models of residential buildings reflecting their spatial and temporal diversity as well as their complexity based on a large-scale residential survey in China, and (3)more » a stochastic sampling process to represent all apartments and occupants in the district. The stochastic method was applied to a case study using the Designer's Simulation Toolkit (DeST) to simulate the cooling loads of a residential district in Wuhan, China. The simulation results agreed well with the measured data based on five performance metrics representing the aggregated cooling consumption, the peak cooling loads, the spatial load distribution, the temporal load distribution and the load profiles. Two prevalent simulation methods were also employed to simulate the district cooling loads. Here, the results showed that oversimplified assumptions about occupant behavior could lead to significant overestimation of the peak cooling load and the total cooling loads in the district. Future work will aim to simplify the workflow and data requirements of the stochastic method for its application, and to explore its use in predicting district heating loads and in commercial or mixed-use districts.« less

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.

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.

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…

Minimum Flows and Levels Method of the St. Johns River Water Management District, Florida, USA

NASA Astrophysics Data System (ADS)

Neubauer, Clifford P.; Hall, Greeneville B.; Lowe, Edgar F.; Robison, C. Price; Hupalo, Richard B.; Keenan, Lawrence W.

2008-12-01

The St. Johns River Water Management District (SJRWMD) has developed a minimum flows and levels (MFLs) method that has been applied to rivers, lakes, wetlands, and springs. The method is primarily focused on ecological protection to ensure systems meet or exceed minimum eco-hydrologic requirements. MFLs are not calculated from past hydrology. Information from elevation transects is typically used to determine MFLs. Multiple MFLs define a minimum hydrologic regime to ensure that high, intermediate, and low hydrologic conditions are protected. MFLs are often expressed as statistics of long-term hydrology incorporating magnitude (flow and/or level), duration (days), and return interval (years). Timing and rates of change, the two other critical hydrologic components, should be sufficiently natural. The method is an event-based, non-equilibrium approach. The method is used in a regulatory water management framework to ensure that surface and groundwater withdrawals do not cause significant harm to the water resources and ecology of the above referenced system types. MFLs are implemented with hydrologic water budget models that simulate long-term system hydrology. The method enables a priori hydrologic assessments that include the cumulative effects of water withdrawals. Additionally, the method can be used to evaluate management options for systems that may be over-allocated or for eco-hydrologic restoration projects. The method can be used outside of the SJRWMD. However, the goals, criteria, and indicators of protection used to establish MFLs are system-dependent. Development of regionally important criteria and indicators of protection may be required prior to use elsewhere.

Seroprevalence of bovine herpesvirus-1 antibodies in bovines in five districts of Uttarakhand

PubMed Central

Thakur, Vipul; Kumar, Mahesh; Rathish, R. L.

2017-01-01

Aim: This study was conducted to know the status of bovine herpesvirus-1 (BHV-1) antibodies in the bovines of the selected area of Uttarakhand. Materials and Methods: A total of 489 serum samples, 392 of cattle and 97 of buffaloes were randomly collected from the unvaccinated bovine population of five districts viz., Dehradun, Haridwar, Nainital, Pithoragarh, and Udham Singh Nagar and were tested by avidin biotin enzyme-linked immunosorbent assay for BHV-1 antibodies. Results: The overall prevalence was observed to be 29.03%. At district level, the highest prevalence was recorded in Pithoragarh district (40.00%) while it was lowest in district Udham Singh Nagar (16.00%). The prevalence of BHV-1 antibodies was found to be higher in unorganized dairy units (31.02%) compared to organized farms (26.51%) in Uttarakhand. Buffaloes were found to have greater prevalence (38.14%) than cattle (26.78%) while on sex-wise basis; it was found that more females (30.08%) were harboring antibodies to the virus than males (16.21%). Conclusion: The study revealed that the population in the area under study has been exposed to BHV-1 and hence prevention and control strategies must be implemented. PMID:28344394

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.

A Randomized Controlled Trial of a Response-to-Intervention (RTI) Tier 2 Literacy Program: Leveled Literacy Intervention (LLI)

ERIC Educational Resources Information Center

Ransford-Kaldon, Carolyn; Flynt, E. Sutton; Ross, Cristin

2011-01-01

The purpose of this study was twofold: (1) to determine the efficacy of the Leveled Literacy Intervention program (LLI) in increasing reading achievement for K-2 students and (2) to examine LLI program implementation fidelity. This study evaluated LLI in two U.S. school districts and used a mixed-method design to address the following key research…

The Relationship between the Styles of Coping with Stress and the Levels of Hopelessness of Preschool Teachers

ERIC Educational Resources Information Center

Ekici, Fatma Yasar

2017-01-01

The main aim of this research is to examine the relationship between the styles of coping with stress and the levels of hopelessness of preschool teachers. Relational survey method was used in this research. The research sample consists of 108 preschool teachers working in preschool education institutions in Küçükçekmece district of Istanbul in…

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.

Handwriting Instruction in Elementary Schools: Revisited!

ERIC Educational Resources Information Center

Asher, Asha; Estes, Joanne

2016-01-01

Handwriting is an essential literacy and communication skill developed through a variety of instructional methods in elementary school. This study explored the consistency in handwriting instruction across grade levels in a Midwest public school district 15 years after the school initially implemented a uniform handwriting program. Additionally,…

Communicating Effectively to Obtain Supervision of Professional Practice

ERIC Educational Resources Information Center

Fischetti, Barbara A.; Petry, Bradley; Munch, Jessica Kouvel

2012-01-01

School psychologists are expected by parents, students, and their profession to maintain their competency to ensure the appropriate delivery of psychological services. Supervision by a school psychologist is a prime method for maintaining skill levels and updating professional services. Unfortunately, many school districts do not understand the…

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.

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.

Understanding the organisational culture of district health services: Mahalapye and Ngamiland health districts of Botswana

PubMed Central

Mash, Robert; Phaladze, Nthabiseng

2015-01-01

Background Botswana has a shortage of health care workers, especially in primary health care. Retention and high performance of employees are closely linked to job satisfaction and motivation, which are both highest where employees’ personal values and goals are realised. Aim The aim of the study was to evaluate employees’ personal values, and the current and desired organisational culture of the district health services as experienced by the primary health care workers. Setting The study was conducted in the Ngamiland and Mahalapye health districts. Method This was a cross sectional survey. The participants were asked to select 10 values that best described their personal, current organisational and desired organisational values from a predetermined list. Results Sixty and 67 health care workers completed the survey in Mahalapye and Ngamiland districts, respectively. The top 10 prevalent organisational values experienced in both districts were: teamwork, patient satisfaction, blame, confusion, job insecurity, not sharing information and manipulation. When all the current values were assessed, 32% (Mahalapye) and 36% (Ngamiland) selected by health care workers were potentially limiting organisational effectiveness. The organisational values desired by health care workers in both districts were: transparency, professional growth, staff recognition, shared decision-making, accountability, productivity, leadership development and teamwork. Conclusions The experience of the primary health care workers in the two health districts were overwhelmingly negative, which is likely to contribute to low levels of motivation, job satisfaction, productivity and high attrition rates. There is therefore urgent need for organisational transformation with a focus on staff experience and leadership development. PMID:26842516

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

Identifying Pathways for Improving Household Food Self-Sufficiency Outcomes in the Hills of Nepal

PubMed Central

Karki, Tika B.; Sah, Shrawan K.; Thapa, Resam B.; McDonald, Andrew J.; Davis, Adam S.

2015-01-01

Maintaining and improving household food self-sufficiency (FSS) in mountain regions is an ongoing challenge. There are many facets to the issue, including comparatively high levels of land fragmentation, challenging terrain and transportation bottlenecks, declining labor availability due to out-migration, and low technical knowledge, among others. Using a nonparametric multivariate approach, we quantified primary associations underlying current levels of FSS in the mid-hills of Nepal. A needs assessment survey was administered to 77 households in Lungaun (Baglung District), Pang (Parbat District), and Pathlekhet (Myagdi District), with a total of 80 variables covering five performance areas; resulting data were analyzed using Classification and Regression Trees. The most parsimonious statistical model for household FSS highlighted associations with agronomic management, including yields of maize and fingermillet within a relay cropping system and adoption of improved crop cultivars. Secondary analyses of the variables retained in the first model again focused primarily on crop and livestock management. It thus appears that continued emphasis on technical agricultural improvements is warranted, independent of factors such as land holding size that, in any case, are very difficult to change through development interventions. Initiatives to increase household FSS in the mid-hills of Nepal will benefit from placing a primary focus on methods of agricultural intensification to improve crop yields and effective technology transfer to increase adoption of these methods. PMID:26047508

Institutionalizing and sustaining social change in health systems: the case of Uganda.

PubMed

Hage, Jerald; Valadez, Joseph J

2017-11-01

The key to high impact health services is institutionalizing and sustaining programme evaluation. Uganda represents a success story in the use of a specific programme evaluation method: Lot Quality Assurance Sampling (LQAS). Institutionalization is defined by two C's: competent programme evaluators and control mechanisms that effectively use evaluation data to improve health services. Sustainability means continued training and funding for the evaluation approach. Social science literature that researches institutionalization has emphasized 'stability', whereas in global health, the issue is determining how to improve the impact of services by 'changing' programmes. In Uganda, we measured the extent of the institutionalization and sustainability of evaluating programmes that produce change in nine districts sampled to represent three largely rural regions and varying levels of effective health programmes. We used the proportion of mothers with children aged 0-11 months who delivered in a health facility as the principal indicator to measure programme effectiveness. Interviews and focus groups were conducted among directors, evaluation supervisors, data collectors in the district health offices, and informant interviews conducted individually at the central government level. Seven of the nine districts demonstrated a high level of institutionalization of evaluation. The two others had only conducted one round of programme evaluation. When we control for the availability of health facilities, we find that the degree of institutionalization is moderately related to the prevalence of the delivery of a baby in a health facility. Evaluation was institutionalized at the central government level. Sustainability existed at both levels. Several measures indicate that lessons from the nine district case studies may be relevant to the 74 districts that had at least two rounds of programme evaluation. We note that there is an association between the evaluation data being used to change health services, and the four separate indicators being used to measure women's health and child survival services. We conclude that the two C's (competent evaluators and control mechanisms) have been critical for sustaining programme evaluation in Uganda. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Institutionalizing and sustaining social change in health systems: the case of Uganda

PubMed Central

Hage, Jerald; Valadez, Joseph J

2017-01-01

Abstract The key to high impact health services is institutionalizing and sustaining programme evaluation. Uganda represents a success story in the use of a specific programme evaluation method: Lot Quality Assurance Sampling (LQAS). Institutionalization is defined by two C’s: competent programme evaluators and control mechanisms that effectively use evaluation data to improve health services. Sustainability means continued training and funding for the evaluation approach. Social science literature that researches institutionalization has emphasized ‘stability’, whereas in global health, the issue is determining how to improve the impact of services by ‘changing’ programmes. In Uganda, we measured the extent of the institutionalization and sustainability of evaluating programmes that produce change in nine districts sampled to represent three largely rural regions and varying levels of effective health programmes. We used the proportion of mothers with children aged 0–11 months who delivered in a health facility as the principal indicator to measure programme effectiveness. Interviews and focus groups were conducted among directors, evaluation supervisors, data collectors in the district health offices, and informant interviews conducted individually at the central government level. Seven of the nine districts demonstrated a high level of institutionalization of evaluation. The two others had only conducted one round of programme evaluation. When we control for the availability of health facilities, we find that the degree of institutionalization is moderately related to the prevalence of the delivery of a baby in a health facility. Evaluation was institutionalized at the central government level. Sustainability existed at both levels. Several measures indicate that lessons from the nine district case studies may be relevant to the 74 districts that had at least two rounds of programme evaluation. We note that there is an association between the evaluation data being used to change health services, and the four separate indicators being used to measure women's health and child survival services. We conclude that the two C’s (competent evaluators and control mechanisms) have been critical for sustaining programme evaluation in Uganda. PMID:28981663

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…

Lot quality assurance sampling (LQAS) for monitoring a leprosy elimination program.

PubMed

Gupte, M D; Narasimhamurthy, B

1999-06-01

In a statistical sense, prevalences of leprosy in different geographical areas can be called very low or rare. Conventional survey methods to monitor leprosy control programs, therefore, need large sample sizes, are expensive, and are time-consuming. Further, with the lowering of prevalence to the near-desired target level, 1 case per 10,000 population at national or subnational levels, the program administrator's concern will be shifted to smaller areas, e.g., districts, for assessment and, if needed, for necessary interventions. In this paper, Lot Quality Assurance Sampling (LQAS), a quality control tool in industry, is proposed to identify districts/regions having a prevalence of leprosy at or above a certain target level, e.g., 1 in 10,000. This technique can also be considered for identifying districts/regions at or below the target level of 1 per 10,000, i.e., areas where the elimination level is attained. For simulating various situations and strategies, a hypothetical computerized population of 10 million persons was created. This population mimics the actual population in terms of the empirical information on rural/urban distributions and the distribution of households by size for the state of Tamil Nadu, India. Various levels with respect to leprosy prevalence are created using this population. The distribution of the number of cases in the population was expected to follow the Poisson process, and this was also confirmed by examination. Sample sizes and corresponding critical values were computed using Poisson approximation. Initially, villages/towns are selected from the population and from each selected village/town households are selected using systematic sampling. Households instead of individuals are used as sampling units. This sampling procedure was simulated 1000 times in the computer from the base population. The results in four different prevalence situations meet the required limits of Type I error of 5% and 90% Power. It is concluded that after validation under field conditions, this method can be considered for a rapid assessment of the leprosy situation.

AhR transcriptional activity in serum of Inuits across Greenlandic districts

PubMed Central

Long, Manhai; Deutch, Bente; Bonefeld-Jorgensen, Eva C

2007-01-01

Background Human exposure to lipophilic persistent organic pollutants (POPs) including polychlorinated dibenzo-p-dioxins/furans (PCDDs/PCDFs), polychlorinated biphenyls (PCBs) and organochlorine pesticide is ubiquitous. The individual is exposed to a complex mixture of POPs being life-long beginning during critical developmental windows. Exposure to POPs elicits a number of species- and tissue-specific toxic responses, many of which involve the aryl hydrocarbon receptor (AhR). The aim of this study was to compare the actual level of integrated AhR transcriptional activity in the lipophilic serum fraction containing the actual POP mixture among Inuits from different districts in Greenland, and to evaluate whether the AhR transactivity is correlated to the bio-accumulated POPs and/or lifestyle factors. Methods The study included 357 serum samples from the Greenlandic districts: Nuuk and Sisimiut (South West Coast), Qaanaaq (North Coast) and Tasiilaq (East Coast). The bio-accumulated serum POPs were extracted by ethanol: hexane and clean-up on Florisil columns. Effects of the serum extract on the AhR transactivity was determined using the Hepa 1.12cR mouse hepatoma cell line carrying an AhR-luciferase reporter gene, and the data was evaluated for possible association to the serum levels of 14 PCB congeners, 10 organochlorine pesticide residues and/or lifestyle factors. Results In total 85% of the Inuit samples elicited agonistic AhR transactivity in a district dependent pattern. The median level of the AhR-TCDD equivalent (AhR-TEQ) of the separate genders was similar in the different districts. For the combined data the order of the median AhR-TEQ was Tasiilaq > Nuuk ≥ Sisimiut > Qaanaaq possibly being related to the different composition of POPs. In overall, the AhR transactivity was inversely correlated to the levels of sum POPs, age and/or intake of marine food. Conclusion i) We observed that the proportion of dioxin like (DL) compounds in the POP mixture was the dominating factor affecting the level of serum AhR transcriptional activity even at very high level of non DL-PCBs; ii) The inverse association between the integrated serum AhR transactivity and sum of POPs might be explained by the higher level of compounds antagonizing the AhR function probably due to selective POP bioaccumulation in the food chain. PMID:17956617

Exploring multi-level system factors facilitating educator training and implementation of evidence-based practices (EBP): a study protocol.

PubMed

Stahmer, Aubyn C; Suhrheinrich, Jessica; Schetter, Patricia L; McGee Hassrick, Elizabeth

2018-01-08

This study examines how system-wide (i.e., region, district, and school) mechanisms such as leadership support, training requirements, structure, collaboration, and education affect the use of evidence-based practices (EBPs) in schools and how this affects the outcomes for students with autism spectrum disorder (ASD). Despite growing evidence for the positive effects of EBPs for ASD, these practices are not consistently or effectively used in schools. Although special education programs are mandated to use EBPs, there are very few evidence-based methods for selecting, implementing, and sustaining EBPs. Research focuses primarily on teacher training, without attention to contextual factors (e.g., implementation climate, attitudes toward EBPs, resource allocation, and social networks) that may impact outcomes. Using an implementation science framework, this project will prospectively examine relations between system-wide factors and teachers' use of EBPs and student education outcomes. Survey data will be collected from approximately 85 regional special education directors, 170 regional program specialists, 265 district special education directors, 265 behavior specialists, 925 school principals, 3538 special education teachers, and 2700 paraprofessionals. Administrative data for the students with ASD served by participating teachers will be examined. A total of 79 regional-, district-, and school-level personnel will also participate in social network interviews. Mixed methods, including surveys, administrative data, and observational checklists, will be used to gather in-depth information about system-wide malleable factors that relate to positive teacher implementation of EBPs and student outcomes. Multi-level modeling will be used to assess system-wide malleable factors related to EBP implementation which will be linked to the trainer, teacher, and student outcomes and examined based on moderators (e.g., district size, Special Education Local Plan Area structure, teachers' ASD experience). Finally, a dynamic social network approach will be used to map EBP-related connectivity across all levels of the system for selected regions. Dynamic network analysis will be used to gauge the degree to which and ways that EBP trainings, resources, and interventions are shared (or not shared) among school staff. Results are expected to inform the development of system-wide interventions to improve the school-based implementation of EBPs for students with ASD.

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.

2014-15 Integrated Postsecondary Education Data System (IPEDS) Methodology Report

ERIC Educational Resources Information Center

Ginder, Scott A.; Kelly-Reid, Janice E.; Mann, Farrah B.

2015-01-01

The Integrated Postsecondary Education Data System (IPEDS) collects institution-level data from postsecondary institutions in the United States (50 states and the District of Columbia) and other U.S. jurisdictions. This report describes the universe, methods, and editing procedures used in the 2014-15 Integrated Postsecondary Education Data System…

Perceptions of Elementary Teachers from an Urban School District in Southern California Regarding Their Inquiry-Based Science Instructional Practices, Assessment Methods, and Professional Development

ERIC Educational Resources Information Center

Ugwu, Romanus Iroabuchi

2012-01-01

The purpose of this mixed-methods study was to describe the perceptions of elementary teachers from an urban school district in Southern California regarding their inquiry-based science instructional practices, assessment methods and professional development. The district's inquiry professional development called the California Mathematics and…

Exploring multi-scale forest above ground biomass estimation with optical remote sensing imageries

NASA Astrophysics Data System (ADS)

Koju, U.; Zhang, J.; Gilani, H.

2017-02-01

Forest shares 80% of total exchange of carbon between the atmosphere and the terrestrial ecosystem. Due to this monitoring of forest above ground biomass (as carbon can be calculated as 0.47 part of total biomass) has become very important. Forest above ground biomass as being the major portion of total forest biomass should be given a very careful consideration in its estimation. It is hoped to be useful in addressing the ongoing problems of deforestation and degradation and to gain carbon mitigation benefits through mechanisms like Reducing Emissions from Deforestation and Forest Degradation (REDD+). Many methods of above ground biomass estimation are in used ranging from use of optical remote sensing imageries of very high to very low resolution to SAR data and LIDAR. This paper describes a multi-scale approach for assessing forest above ground biomass, and ultimately carbon stocks, using very high imageries, open source medium resolution and medium resolution satellite datasets with a very limited number of field plots. We found this method is one of the most promising method for forest above ground biomass estimation with higher accuracy and low cost budget. Pilot study was conducted in Chitwan district of Nepal on the estimation of biomass using this technique. The GeoEye-1 (0.5m), Landsat (30m) and Google Earth (GE) images were used remote sensing imageries. Object-based image analysis (OBIA) classification technique was done on Geo-eye imagery for the tree crown delineation at the watershed level. After then, crown projection area (CPA) vs. biomass model was developed and validated at the watershed level. Open source GE imageries were used to calculate the CPA and biomass from virtual plots at district level. Using data mining technique, different parameters from Landsat imageries along with the virtual sample biomass were used for upscaling biomass estimation at district level. We found, this approach can considerably reduce field data requirements for estimation of biomass and carbon in comparison with inventory methods based on enumeration of all trees in a plot. The proposed methodology is very cost effective and can be replicated with limited resources and time.

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.

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.

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.…

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.

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…

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…

Community resources and reproductive behaviour in rural Bangladesh.

PubMed

Saha, T D

1994-03-01

Local community impact on contraceptive usage is illustrated in this logistic model of contraceptive behavior in 1986 in rural Bangladesh. Variables include an index of accessibility and availability of family planning (FP) at the "thana" level, age of respondent, respondent's educational level, desire to have a child, distance from the district, rural electrification, an index of agricultural wages and percentage of small farm households, and presence of a mosque. Community-level variables are found to be significant in separate equations and in equations with individual level variables. Contraceptive use is more likely to occur in a rural situation where there are commercial places such as market places and post offices. Contraceptive use is enhanced by "thana" closeness to district headquarters. Reduced contraceptive use is related to rural areas with many small farm households and a high agricultural wage rate. Access to FP provides a positive environment for improving motivation to use contraception and for improving use of modern methods. The degree of rural isolation negatively impacts on contraceptive use. Bangladesh is one of the few countries with a comprehensive development program at the sub-district level or "thana." Health centers and family welfare centers are established but are unevenly distributed spatially. Data for this study were obtained from the 1985 Bangladesh Contraceptive Prevalence Survey of 7681 rural women aged under 50 years, from the 1983 Agricultural Census on farm land, and from other statistical publications. Information was obtained on 120 "thanas." Contraceptive use status is measured as use, nonuse, modern use, traditional use, intention to use, and nonintention to use. The religious variable is negative, as expected, but not significant for contraceptive use and intention to use. The sign is positive for modern contraceptive use. Closer examination reveals that respondents with no education and with no household land are more frequent users of modern methods, including sterilization which incurs a religious moral and social stigma. Other data support the notion that religious beliefs are not an important factor in nonuse of contraceptives in Bangladesh. The FP index has a significant impact on use and intention to use but has a positive and insignificant effect on modern methods, which may indicate measurement error.

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

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

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.

Lymphatic filariasis in Papua New Guinea: distribution at district level and impact of mass drug administration, 1980 to 2011

PubMed Central

2013-01-01

Background Lymphatic filariasis (LF) caused by Wuchereria bancrofti is present at high prevalence in some parts of Papua New Guinea. However, there has been no rigorous data-based representative assessment of nationwide prevalence of LF. The LF programme has been daunted by the scope of the problem, and progress on mass drug administration (MDA) has been slow and lacking in resources. Methods A systematic literature review identified LF surveys in Papua New Guinea between 1980 and 2011. Results were extracted by location, time period and test used (blood slide, immunochromatographic test (ICT) or Og4C3 ELISA) and combined by district. Three criteria schemes based on the Global Programme to Eliminate Lymphatic Filariasis guidelines, with modifications, were developed to classify and prioritize districts by prevalence level. Results of repeated surveys in the same sites were used to investigate the impact of MDA on LF prevalence over the time period. Results There were 312 distinct survey sites identified in 80 of the 89 districts over the 31-year period. The overall LF prevalence in the sites tested was estimated at 18.5 to 27.5% by blood slide for microfilariae (Mf), 10.1% to 12.9% by ICT and 45.4% to 48.8% by Og4C3. Biases in site selection towards areas with LF, and change in type of assay used, affected the prevalence estimates, but overall decline in prevalence over the time period was observed. Depending on the criteria used, 34 to 36 districts (population 2.7 to 2.9 million) were classed as high endemic (≥5% prevalence), 15 to 25 districts (1.7 to 1.9 million) as low endemic (<5%) and 20 to 31 (1.3 to 2.2 million) as non-endemic. Nine districts (0.7 million) had no information. The strong impact of MDA, especially on microfilaria (Mf) prevalence, was noted in sites with repeat surveys. Conclusions This analytical review of past surveys of LF in Papua New Guinea enables better estimation of the national burden, identifies gaps in knowledge, quantifies and locates the population at risk, and can be used to predict the likely impact of MDA and/or vector control. Better targeting of districts by level of prevalence will strengthen the control programme, facilitate monitoring of the disease trend and increase the likelihood of reaching the target of LF elimination by 2020. PMID:23311302

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…

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.

Investigating the criteria and processes used in the selection, implementation, and evaluation of STEM within K-12 education

NASA Astrophysics Data System (ADS)

Delp, Matthew J.

This study utilized survey research to investigate how school districts within K-12 education select, implement, and evaluate Science, Technology, Engineering, and Mathematics (STEM) programs. Thirty school districts within the Math and Science Collaborative located in Western Pennsylvania participated in this research. In addition to characterizing the STEM programs of the participating school districts, this study also analyzed the alignment of these programs to the components of comprehensive STEM programs and critical approaches to substantiate STEM program implementation as stated in the literature (Augustine, 2005; Bybee, 2010a, 2010b; Carnevale et al., 2011; DeJarnette, 2010; Epstein & Miller, 2011b; Gardner et al., 1983; Hossain & Robinson, 2011, 2012; Kuenzi, 2008). Findings suggest that the primary goal for school districts, as it relates to STEM program implementation, is to influence students' interest and pursuit of STEM-related careers and degrees. In order to achieve this goal, results of this study indicate the focus of STEM program implementation occurs with the greatest frequency at the middle school (grades seven and eight) level, are developed as an adaptation to the curriculum, and are very diverse from one school district to the next. In addition, findings suggest that although school districts maintain they aim to promote careers and degrees in STEM, districts rely on traditional methods of evaluating STEM program implementation (i.e. standardized test scores) and do not track the longitudinal impact their STEM programs as they related to degrees and careers in STEM. Furthermore, results indicate district STEM programs are not aligned to the characteristics of comprehensive STEM programs as defined by the literature. In order to address the misalignment of school district goals and evaluation processes involved in STEM program implementation and the absence of the characteristics commensurate with comprehensive STEM programs, this study has created a framework to guide school districts in STEM program selection, implementation, and evaluation.

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…

Use of traditional contraceptive methods in India & its socio-demographic determinants.

PubMed

Ram, Faujdar; Shekhar, Chander; Chowdhury, Biswabandita

2014-11-01

The high use of traditional contraceptive methods may have health repercussions on both partners. High failure rate, lack of protection from sexually transmitted diseases are some of the examples of these repercussions. The aim of this study was to understand the level, trends, pattern, volume and socio-demographic determinants of using traditional contraceptive methods in the Indian context. Percentages, per cent distribution, cross-tabulation and multinomial logistic regression analyses were carried out. The data from the three rounds of National Family Health survey (NFHS) were used. The unit level District Level Household Survey (2007-2008) were mainly used to carry out the analysis in this paper. Marriage rates for States and Union Territories (UTs) were projected for the period of 2001-2011 to estimate the volume of traditional contraceptive users. These rates are required to get the number of eligible couples as on 2011 in the respective State/UT. The latest round of the District Level Household Survey (2007-2008) revealed that 6.7 per cent currently married women were using traditional contraceptive methods in India. More than half of the currently married women (56%) have ever used these methods. In terms of socio-demographic determinants, the odds ratios of using these methods were significantly higher for women aged 35 years and above, rural, Hindu, other than Scheduled Castes/Tribes (SCs/STs), secondary and above educated, non-poor, having two plus living children, and at least one surviving son in most of the states as well as at the national level. The northeastern region showed higher odds ratios (5 times) of women using traditional contraceptive methods than the southern region. A large number of currently married women have ever used the traditional contraceptive methods in India. On the basis of the findings from this study, the total size of those women who were using traditional methods and those who were having unmet need, and are required to use modern spacing methods of family planning in achieving the reproductive goals, is around 53 million. Women from a set of specific socio-demographic backgrounds are more likely to use these methods. A regional pattern has also emerged in use of tradition contraceptive methods in India.

When are solar refrigerators less costly than on-grid refrigerators: A simulation modeling study☆

PubMed Central

Haidari, Leila A.; Brown, Shawn T.; Wedlock, Patrick; Connor, Diana L.; Spiker, Marie; Lee, Bruce Y.

2017-01-01

Background Gavi recommends solar refrigerators for vaccine storage in areas with less than eight hours of electricity per day, and WHO guidelines are more conservative. The question remains: Can solar refrigerators provide value where electrical outages are less frequent? Methods Using a HERMES-generated computational model of the Mozambique routine immunization supply chain, we simulated the use of solar versus electric mains-powered refrigerators (hereafter referred to as “electric refrigerators”) at different locations in the supply chain under various circumstances. Results At their current price premium, the annual cost of each solar refrigerator is 132% more than each electric refrigerator at the district level and 241% more at health facilities. Solar refrigerators provided savings over electric refrigerators when one-day electrical outages occurred more than five times per year at either the district level or the health facilities, even when the electric refrigerator holdover time exceeded the duration of the outage. Two-day outages occurring more than three times per year at the district level or more than twice per year at the health facilities also caused solar refrigerators to be cost saving. Lowering the annual cost of a solar refrigerator to 75% more than an electric refrigerator allowed solar refrigerators to be cost saving at either level when one-day outages occurred more than once per year, or when two-day outages occurred more than once per year at the district level or even once per year at the health facilities. Conclusion Our study supports WHO and Gavi guidelines. In fact, solar refrigerators may provide savings in total cost per dose administered over electrical refrigerators when electrical outages are less frequent. Our study identified the frequency and duration at which electrical outages need to occur for solar refrigerators to provide savings in total cost per dose administered over electric refrigerators at different solar refrigerator prices. PMID:28364935

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.

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

Spin systems and Political Districting Problem

NASA Astrophysics Data System (ADS)

Chou, Chung-I.; Li, Sai-Ping

2007-03-01

The aim of the Political Districting Problem is to partition a territory into electoral districts subject to some constraints such as contiguity, population equality, etc. In this paper, we apply statistical physics methods to Political Districting Problem. We will show how to transform the political problem to a spin system, and how to write down a q-state Potts model-like energy function in which the political constraints can be written as interactions between sites or external fields acting on the system. Districting into q voter districts is equivalent to finding the ground state of this q-state Potts model. Searching for the ground state becomes an optimization problem, where optimization algorithms such as the simulated annealing method and Genetic Algorithm can be employed here.

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…

The School Health Policies and Programs Study (SHPPS): Context, Methods, General Findings, and Future Efforts.

ERIC Educational Resources Information Center

Kolbe, Lloyd J.; And Others

1995-01-01

The School Health Policies and Programs Study assessed health education, physical education, health services, food service, and policies prohibiting violence, tobacco use, and alcohol and other drug use at state, district, school, and classroom levels. State questionnaires found several common themes across the components of school health…

Transition Strategies at the School Level: Reforming Middle Grades' Organization and Programs.

ERIC Educational Resources Information Center

Bentley, Ernest L., Jr.; Campbell, Beverly

This paper presents organizational strategies and implementation methods for conversion to middle school organization (scheduled to take place in 1988) in the Johnson City, Tennessee, school system. Carried out by the district in partnership with local institutions of higher education, the study focuses on what is educationally best for the child…

High-Stakes Testing and Teacher Stress

ERIC Educational Resources Information Center

Hoyt, Joshua Paul

2017-01-01

The purpose of this mixed-methods research study was to examine how stress levels of middle school mathematics teachers who taught Algebra I in school districts in the state of Pennsylvania relate to high-stakes testing and to explore the experiences of middle school mathematics Algebra I teachers. The researcher collected and compared it to…

Supporting Learner-Centered ICT Integration: The Influence of Collaborative and Needs-Based Professional Development

ERIC Educational Resources Information Center

MacDonald, Ronald

2009-01-01

A mixed-method study was carried out to investigate how teacher attitude and professional development influence learner-centered Information Communication Technology (ICT) integration. A questionnaire, interviews and observations were used to gather data in a school district in Nova Scotia, Canada. Teacher data were categorized by grade level,…

Integration of Academic and Behavioral MTSS at the District Level Using Implementation Science

ERIC Educational Resources Information Center

Freeman, Rachel; Miller, Dawn; Newcomer, Lori

2015-01-01

The evolution of multi-tier systems of support (MTSS) for both academics and behavior has reflected the diverse interests of those leading implementation efforts, the influence of various state and local regulatory requirements, and differing funding methods and priorities. These variations have naturally led to many different pathways for…

National Assessment of Data Quality and Associated Systems-Level Factors in Malawi

PubMed Central

O'Hagan, Richael; Marx, Melissa A; Finnegan, Karen E; Naphini, Patrick; Ng'ambi, Kumbukani; Laija, Kingsley; Wilson, Emily; Park, Lois; Wachepa, Sautso; Smith, Joseph; Gombwa, Lewis; Misomali, Amos; Mleme, Tiope; Yosefe, Simeon

2017-01-01

ABSTRACT Background: Routine health data can guide health systems improvements, but poor quality of these data hinders use. To address concerns about data quality in Malawi, the Ministry of Health and National Statistical Office conducted a data quality assessment (DQA) in July 2016 to identify systems-level factors that could be improved. Methods: We used 2-stage stratified random sampling methods to select health centers and hospitals under Ministry of Health auspices, included those managed by faith-based entities, for this DQA. Dispensaries, village clinics, police and military facilities, tertiary-level hospitals, and private facilities were excluded. We reviewed client registers and monthly reports to verify availability, completeness, and accuracy of data in 4 service areas: antenatal care (ANC), family planning, HIV testing and counseling, and acute respiratory infection (ARI). We also conducted interviews with facility and district personnel to assess health management information system (HMIS) functioning and systems-level factors that may be associated with data quality. We compared systems and quality factors by facility characteristics using 2-sample t tests with Welch's approximation, and calculated verification ratios comparing total entries in registers to totals from summarized reports. Results: We selected 16 hospitals (of 113 total in Malawi), 90 health centers (of 466), and 16 district health offices (of 28) in 16 of Malawi's 28 districts. Nearly all registers were available and complete in health centers and district hospitals, but data quality varied across service areas; median verification ratios comparing register and report totals at health centers ranged from 0.78 (interquartile range [IQR]: 0.25, 1.07) for ARI and 0.99 (IQR: 0.82, 1.36) for family planning to 1.00 (IQR: 0.96, 1.00) for HIV testing and counseling and 1.00 (IQR: 0.80, 1.23) for ANC. More than half (60%) of facilities reported receiving a documented supervisory visit for HMIS in the prior 6 months. A recent supervision visit was associated with better availability of data (P=.05), but regular district- or central-level supervision was not. Use of data by the facility to track performance toward targets was associated with both improved availability (P=.04) and completeness of data (P=.02). Half of facilities had a full-time statistical clerk, but their presence did not improve the availability or completeness of data (P=.39 and P=.69, respectively). Conclusion: Findings indicate both strengths and weaknesses in Malawi's HMIS performance, with key weaknesses including infrequent data quality checks and unreliable supervision. Efforts to strengthen HMIS in low- and middle-income countries should be informed by similar assessments. PMID:28963173

[Pollution characteristics and health risk assessment of heavy metals in PM(2.5) in Lanzhou].

PubMed

Wei, Q Z; Li, S; Jia, Q; Luo, B; Su, L M; Liu, Q; Yuan, X R; Wang, Y H; Ruan, Y; Niu, J P

2018-06-06

Objective: To understand the pollution characteristics and assess the pollution health risks of heavy metals in atmospheric PM(2.5) in Lanzhou. Methods: According to the regional characteristics of air pollution and industrial distribution characteristics in Lanzhou, atmospheric PM(2.5) was sampled monthly in Chengguan and Xigu Districts from January, 2015 to December, 2016. Detected the concentration of PM(2.5) and 12 kinds of elements (Sb, Al, As, Be, Cd, Cr, Hg, Pb, Mn, Ni, Se and Tl) by weighing method and inductively coupled plasma mass spectrometry. Enrichment factor and geo-accumulation index were used to describe the pollution characteristics, while health risk assessment was conducted using the recommended United States Environmental Protection Agency (USA EPA) model. The health risks of non-carcinogens were evaluated by non-cancer hazard quotient (HQ), the non-carcinogenic risk was considered to be negligible when HQ<1, HQ>1 meant a health risk. With a single contaminant cancer Risk value to evaluate the health risks of carcinogens, when the Risk value between 10(-6) to10(-4) as an acceptable level. Results: The daily average concentrations of PM(2.5) was 83.0 μg/m(3), 77.0 μg/m(3) in Chengguan and Xigu Districts, respectively, during the sampling periods, and the concentration of PM(2.5) in winter/spring was higher than summer/fall in both districts. The concentration of Al in PM(2.5) was the highest and other elements in descending order: Pb, Mn, As, Sb/Cd, Tl in both districts. Enrichment factor results showed that Al and Mn were mainly affected by natural factors, the rest of five elements were all typical man-made pollution elements and according to geo-accumulation index pollution level of Cd was the strongest in the winter. The results of health risk assessment showed that Mn had the highest non-cancer risks (HQ>1) and affected the health of the children seriously. HQ reached up to 2.44 and 1.79 in Chengguan and Xigu Districts, respectively. Pb, As, Sb, Cd had slight health impact (HQ<1), could be negligible. The cancer risks range of As, Cr were 6.33×10(-6) to 6.46×10(-5) between the acceptable level of risk (10(-6) to 10(-4)), which indicated that As and Cd had potential cancer-risks. Conclusions: The pollution level of atmospheric PM(2.5) and the heavy metals in it was still grim;the non-cancer risks caused by multiple metals on children deserved attention. Although the cancer risks of As and Cd were between the acceptable level of risk, the potential cancer risk still shall not be ignored.

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

The Interrelationship of School District Expenditures and Student Academic Achievement in Oklahoma Public Elementary School Districts

ERIC Educational Resources Information Center

Moore, Glenn M.

2012-01-01

Purpose and Method of Study. The primary purpose of this quantitative study was to analyze the relationship between school district expenditures and student academic achievement in 102 public elementary school districts in the state of Oklahoma. The secondary purpose was to investigate the relationship between school district expenditures and…

Mycotoxin contamination of home-grown maize in rural northern South Africa (Limpopo and Mpumalanga Provinces).

PubMed

Mngqawa, P; Shephard, G S; Green, I R; Ngobeni, S H; de Rijk, T C; Katerere, D R

2016-01-01

The aim of this study was to assess mycotoxin contamination of crops grown by rural subsistence farmers over two seasons (2011 and 2012) in two districts, Vhembe District Municipality (VDM, Limpopo Province) and Gert Sibande District Municiality (GSDM, Mpumalanga Province), in northern South Africa and to evaluate its impact on farmers' productivity and human and animal health. A total of 114 maize samples were collected from 39 households over the two seasons and were analysed using a validated liquid chromatography-tandem mass spectrometry mycotoxins method. Aflatoxin B1 (AFB1) occurrence ranged from 1 to 133 µg kg(-1) in VDM while AFB1 levels in GSDM were less than 1.0 µg kg(-1) in all maize samples. Fumonisin B1 levels ranged from 12 to 8514 µg kg(-1) (VDM) and 11-18924 µg kg(-1) (GSDM) in 92% and 47% positive samples, respectively, over both seasons. Natural occurrence and contamination with both fumonisins and aflatoxins in stored home-grown maize from VDM was significantly (p < 0.0001) higher than from GSDM over both seasons.

SMS for Life: a pilot project to improve anti-malarial drug supply management in rural Tanzania using standard technology

PubMed Central

2010-01-01

Background Maintaining adequate supplies of anti-malarial medicines at the health facility level in rural sub-Saharan Africa is a major barrier to effective management of the disease. Lack of visibility of anti-malarial stock levels at the health facility level is an important contributor to this problem. Methods A 21-week pilot study, 'SMS for Life', was undertaken during 2009-2010 in three districts of rural Tanzania, involving 129 health facilities. Undertaken through a collaborative partnership of public and private institutions, SMS for Life used mobile telephones, SMS messages and electronic mapping technology to facilitate provision of comprehensive and accurate stock counts from all health facilities to each district management team on a weekly basis. The system covered stocks of the four different dosage packs of artemether-lumefantrine (AL) and quinine injectable. Results Stock count data was provided in 95% of cases, on average. A high response rate (≥ 93%) was maintained throughout the pilot. The error rate for composition of SMS responses averaged 7.5% throughout the study; almost all errors were corrected and messages re-sent. Data accuracy, based on surveillance visits to health facilities, was 94%. District stock reports were accessed on average once a day. The proportion of health facilities with no stock of one or more anti-malarial medicine (i.e. any of the four dosages of AL or quinine injectable) fell from 78% at week 1 to 26% at week 21. In Lindi Rural district, stock-outs were eliminated by week 8 with virtually no stock-outs thereafter. During the study, AL stocks increased by 64% and quinine stock increased 36% across the three districts. Conclusions The SMS for Life pilot provided visibility of anti-malarial stock levels to support more efficient stock management using simple and widely available SMS technology, via a public-private partnership model that worked highly effectively. The SMS for Life system has the potential to alleviate restricted availability of anti-malarial drugs or other medicines in rural or under-resourced areas. PMID:20979633

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.

Residential environments, alcohol advertising, and initiation and continuation of alcohol consumption among adolescents in urban Taiwan: A prospective multilevel study.

PubMed

Chen, Yen-Tyng; Cooper, Hannah L F; Windle, Michael; Haardörfer, Regine; Crawford, Natalie D; Chen, Wei J; Chen, Chuan-Yu

2016-12-01

Research indicates that place characteristics and the media environment are important contextual determinants of underage drinking behaviors in Western countries, but it is unknown whether these exposures influence adolescent alcohol consumption outside Western contexts, including in Asia׳s emerging global alcohol markets. Guided by the social ecological framework, we prospectively investigated the influences of place characteristics and alcohol advertising on initiation and continuation of alcohol consumption among adolescents in Taipei, Taiwan. Data on individual-level characteristics, including alcohol use behaviors and perceived exposure to alcohol advertising, were obtained from two waves of a longitudinal school-based study through a stratified probability sampling method in 2010 (Grade 7/Grade 8, aged 13-14 years old) and 2011-2012 (Grade 9, aged 15 years old) from 1795 adolescents residing in 22 of 41 districts in Taipei. Data on district-level characteristics were drawn from administrative sources and Google Street View virtual audit to describe districts where adolescents lived at baseline. Hierarchical generalized linear models tested hypotheses about the associations of place characteristics and perceived alcohol advertising with underage drinking, with stratification by baseline lifetime alcohol consumption. Among alcohol-naïve adolescents, lower district-level economic disadvantage, a higher proportion of betel nut kiosks (a relatively unregulated alcohol source) compared to off-premises alcohol outlets, and exposure to television-based alcohol advertising predicted increased likelihood of alcohol initiation at one-year follow-up. Among alcohol-experienced adolescents, greater spatial access to off-premises alcohol outlets, and lower access to metro rapid transportation (MRT) and to temples were found to predict a subsequent increased likelihood of continued alcohol use. Parental drinking moderated the relationship between district-level violent crime and initiation of alcohol consumption. These findings suggest that local social economic status, alcohol access, and institutional resource and individual media exposure affect underage drinking behaviors in Taiwan. We discuss potential public health implications for place-based interventions. Future research on place, media, and adolescent alcohol consumption in Asian contexts is warranted.

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.

Mapping and modelling the impact of mass drug adminstration on filariasis prevalence in Myanmar.

PubMed

Aye, Ni Ni; Lin, Zaw; Lon, Khin Nan; Linn, Nay Yi Yi; Nwe, Thet Wai; Mon, Khin Mon; Ramaiah, Kapa; Betts, Hannah; Kelly-Hope, Louise A

2018-05-31

Lymphatic filariasis (LF) is endemic in Myanmar and targeted for elimination. To highlight the National Programme to Eliminate Lymphatic Filariasis (NPELF) progress between 2000 and 2014, this paper describes the geographical distribution of LF, the scale-up and impact of mass drug administration (MDA) implementation, and the first evidence of the decline in transmission in five districts. The LF distribution was determined by mapping historical and baseline prevalence data collected by NPELF. Data on the MDA implementation, reported coverage rates and sentinel site surveillance were summarized. A statistical model was developed from the available prevalence data to predict prevalence at township level by year of measurement. Transmission assessment survey (TAS) methods, measuring antigenemia (Ag) prevalence in children, were used to determine whether prevalence was below a level where recrudescence is unlikely to occur. The highest baseline LF prevalence was found in the Central Valley region. The MDA implementation activities scaled up to cover 45 districts, representing the majority of the endemic population, with drug coverage rates ranging from 60.0% to 98.5%. Challenges related to drug supply and local conflict were reported, and interrupted MDA in some districts. Overall, significant reductions in LF prevalence were found, especially after the first 2 to 3 rounds of MDA, which was supported by the corresponding model. The TAS activities in five districts found only two Ag positive children, resulting in all districts passing the critical threshold. Overall, the Myanmar NPELF has made positive steps forward in the elimination of LF despite several challenges, however, it needs to maintain momentum, drawing on international stakeholder support, to aim towards the national and global goals of elimination.

Seasonal prevalence of malaria in West Sumba district, Indonesia

PubMed Central

Syafruddin, Din; Krisin; Asih, Puji; Sekartuti; Dewi, Rita M; Coutrier, Farah; Rozy, Ismail E; Susanti, Augustina I; Elyazar, Iqbal RF; Sutamihardja, Awalludin; Rahmat, Agus; Kinzer, Michael; Rogers, William O

2009-01-01

Background Accurate information about the burden of malaria infection at the district or provincial level is required both to plan and assess local malaria control efforts. Although many studies of malaria epidemiology, immunology, and drug resistance have been conducted at many sites in Indonesia, there is little published literature describing malaria prevalence at the district, provincial, or national level. Methods Two stage cluster sampling malaria prevalence surveys were conducted in the wet season and dry season across West Sumba, Nusa Tenggara Province, Indonesia. Results Eight thousand eight hundred seventy samples were collected from 45 sub-villages in the surveys. The overall prevalence of malaria infection in the West Sumba District was 6.83% (95% CI, 4.40, 9.26) in the wet season and 4.95% (95% CI, 3.01, 6.90) in the dry. In the wet season Plasmodium falciparum accounted for 70% of infections; in the dry season P. falciparum and Plasmodium vivax were present in equal proportion. Malaria prevalence varied substantially across the district; prevalences in individual sub-villages ranged from 0–34%. The greatest malaria prevalence was in children and teenagers; the geometric mean parasitaemia in infected individuals decreased with age. Malaria infection was clearly associated with decreased haemoglobin concentration in children under 10 years of age, but it is not clear whether this association is causal. Conclusion Malaria is hypoendemic to mesoendemic in West Sumba, Indonesia. The age distribution of parasitaemia suggests that transmission has been stable enough to induce some clinical immunity. These prevalence data will aid the design of future malaria control efforts and will serve as a baseline against which the results of current and future control efforts can be assessed. PMID:19134197

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

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.

Cost & efficiency evaluation of a publicly financed & publicly delivered referral transport service model in three districts of Haryana State, India

PubMed Central

Prinja, Shankar; Manchanda, Neha; Aggarwal, Arun Kumar; Kaur, Manmeet; Jeet, Gursimer; Kumar, Rajesh

2013-01-01

Background & objectives: Various models of referral transport services have been introduced in different States in India with an aim to reduce maternal and infant mortality. Most of the research on referral transport has focussed on coverage, quality and timeliness of the service with not much information on cost and efficiency. This study was undertaken to analyze the cost of a publicly financed and managed referral transport service model in three districts of Haryana State, and to assess its cost and technical efficiency. Methods: Data on all resources spent for delivering referral transport service, during 2010, were collected from three districts of Haryana State. Costs incurred at State level were apportioned using appropriate methods. Data Envelopment Analysis (DEA) technique was used to assess the technical efficiency of ambulances. To estimate the efficient scale of operation for ambulance service, the average cost was regressed on kilometres travelled for each ambulance station using a quadratic regression equation. Results: The cost of referral transport per year varied from ₹5.2 million in Narnaul to ₹9.8 million in Ambala. Salaries (36-50%) constituted the major cost. Referral transport was found to be operating at an average efficiency level of 76.8 per cent. Operating an ambulance with a patient load of 137 per month was found to reduce unit costs from an average ₹ 15.5 per km to ₹ 9.57 per km. Interpretation & conclusions: Our results showed that the publicly delivered referral transport services in Haryana were operating at an efficient level. Increasing the demand for referral transport services among the target population represents an opportunity for further improving the efficiency of the underutilized ambulances. PMID:24521648

Estimating Scale Economies and the Optimal Size of School Districts: A Flexible Form Approach

ERIC Educational Resources Information Center

Schiltz, Fritz; De Witte, Kristof

2017-01-01

This paper investigates estimation methods to model the relationship between school district size, costs per student and the organisation of school districts. We show that the assumptions on the functional form strongly affect the estimated scale economies and offer two possible solutions to allow for more flexibility in the estimation method.…

Perspectives and Challenges of HMIS Officials in the Implementation of Health Management Information System (HMIS) with Reference to Maternal Health Services in Assam

PubMed Central

Dehury, Ranjit Kumar

2016-01-01

Introduction Health Management Information System (HMIS) is one of the important components of National Rural Health Mission (NRHM). The web portal of HMIS was launched by the Ministry of Health and Family Welfare (MOHFW), Govt. of India (GOI) in 21st Oct. 2008 to enable capturing of public health data from both public and private institutions in rural and urban areas across the country. Aim The aim of the study was to assess the quality perspectives and challenges among HMIS officials in implementing HMIS at their respective levels, i.e. district and block level. Materials and Methods We conducted a pilot qualitative study in two districts of Assam. HMIS officials working at district and block level were interviewed in-depth with the help of a semi-structured interview schedule which lasted from May to July 2014. Results Both HMIS and MCTS (Mother and Child Tracking System) formats were considered useful, by the HMIS officials, for data collection, planning at various levels, tracking maternal and neonatal deaths, institutional deliveries. HMIS officials reported that MCTS is useful for monitoring individual health status especially the status of the mother and child and HMIS being helpful as a health facility monitoring tool. Conclusion The study used a small sample size, hence similar type of studies are required with large sample size to understand the perspectives and challenges of HMIS officials in the implementation of HMIS. PMID:27504314

Factors Which Influence The Fish Purchasing Decision: A study on Traditional Market in Riau Mainland

NASA Astrophysics Data System (ADS)

Siswati, Latifa; Putri, Asgami

2018-05-01

The purposes of the research are to analyze and assess the factors which influence fish purchasing by the community at Tenayan Raya district Pekanbaru.Research methodology which used is survey method, especially interview and observation technique or direct supervision on the market which located at Tenayan Raya district. Determination technique of sampling location/region is done by purposive sampling. The sampling method is done by accidental sampling. Technique analysis of factors which used using the data that derived from the respondent opinion to various fish variable. The result of this research are the factors which influence fish purchasing decision done in a traditional market which located at Tenayan Raya district are product factor, price factors, social factor and individual factor. Product factor which influences fish purchasing decision as follows: the eyelets condition, the nutrition of fresh fish, the diversity of sold fish. Price factors influence the fish purchasing decision, such as: the price of fresh fish, the convincing price and the suitability price and benefits of the fresh fish. Individual factors which influence a fish purchasing decision, such as education and income levels. Social factors which influence a fish purchasing decision, such as family, colleagues and feeding habits of fish.

Automated detection of case clusters of waterborne acute gastroenteritis from health insurance data - pilot study in three French districts.

PubMed

Rambaud, Loïc; Galey, Catherine; Beaudeau, Pascal

2016-04-01

This pilot study was conducted to assess the utility of using a health insurance database for the automated detection of waterborne outbreaks of acute gastroenteritis (AGE). The weekly number of AGE cases for which the patient consulted a doctor (cAGE) was derived from this database for 1,543 towns in three French districts during the 2009-2012 period. The method we used is based on a spatial comparison of incidence rates and of their time trends between the target town and the district. Each municipality was tested, week by week, for the entire study period. Overall, 193 clusters were identified, 10% of the municipalities were involved in at least one cluster and less than 2% in several. We can infer that nationwide more than 1,000 clusters involving 30,000 cases of cAGE each year may be linked to tap water. The clusters discovered with this automated detection system will be reported to local operators for investigation of the situations at highest risk. This method will be compared with others before automated detection is implemented on a national level.

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.

A Systems Theory Approach to the District Central Office's Role in School-Level Improvement

ERIC Educational Resources Information Center

Mania-Singer, Jackie

2017-01-01

This qualitative case study used General Systems Theory and social network analysis to explore the relationships between the members of a district central office and principals of elementary schools within an urban school district in the Midwest. Findings revealed sparse relationships between members of the district central office and principals,…

School District Revenues for Elementary and Secondary Education: 1997-98. Statistical Analysis Report.

ERIC Educational Resources Information Center

Sherman, Joel D.; Gregory, Barbra; Poirier, Jeffrey M.

This report is an annual collection of school district financial data. Specifically, this report presents analyses of school district revenues from the 1997-98 school year. The report is designed to address the following questions about the financing of public elementary and secondary education at the state and district levels: How much money per…

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…

The Determinants of School District Salary Incentives: An Empirical Analysis of, Where and Why

ERIC Educational Resources Information Center

Martin, Stephanie M.

2010-01-01

Most public school districts in the United States use a salary schedule to determine compensation for teachers within the district. However, some school districts have implemented incentive pay schemes that allow flexibility at the school or even individual teacher level. These compensation schemes in some ways may more closely approximate a…

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…

Analysing child mortality in Nigeria with geoadditive discrete-time survival models.

PubMed

Adebayo, Samson B; Fahrmeir, Ludwig

2005-03-15

Child mortality reflects a country's level of socio-economic development and quality of life. In developing countries, mortality rates are not only influenced by socio-economic, demographic and health variables but they also vary considerably across regions and districts. In this paper, we analysed child mortality in Nigeria with flexible geoadditive discrete-time survival models. This class of models allows us to measure small-area district-specific spatial effects simultaneously with possibly non-linear or time-varying effects of other factors. Inference is fully Bayesian and uses computationally efficient Markov chain Monte Carlo (MCMC) simulation techniques. The application is based on the 1999 Nigeria Demographic and Health Survey. Our method assesses effects at a high level of temporal and spatial resolution not available with traditional parametric models, and the results provide some evidence on how to reduce child mortality by improving socio-economic and public health conditions. Copyright (c) 2004 John Wiley & Sons, Ltd.

Evaluation of a communication campaign to improve continuation among first-time injectable contraceptive users in Nyando District, Kenya.

PubMed

McClain Burke, Holly; Ambasa-Shisanya, Constance

2014-06-01

Communication campaigns might be a viable means of improving contraceptive continuation; however, few such interventions aimed at reducing contraceptive discontinuation have been evaluated. Data were collected from independent samples of new injectable users in Nyando District, Kenya-site of a communication campaign to increase contraceptive continuation-and in a comparison district, nine months before and nine months after intervention implementation. Survival analysis was used to compare the intervention and comparison groups with respect to the distribution of time until first discontinuation of modern method use among women still in need of family planning. Exposure to family planning information was high in both the treatment and the comparison district before (97% and 85%, respectively) and after the intervention (99% and 78%). Postintervention, 5% of women in the comparison district discontinued by 98 days, 8% by 196 days and 23% by 294 days; the proportions in the treatment district were 4%, 6% and 16%, respectively. No significant difference between the districts was found in the ninemonth postintervention contraceptive continuation rates. Having method-related side effects or health concerns was the reason most consistently associated with discontinuation. Other factors associated with discontinuation differed between the districts. Addressing method-related side effects and health concerns will be critical in improving continuation of the injectable.

An assessment of priority setting process and its implication on availability of emergency obstetric care services in Malindi District, Kenya.

PubMed

Nyandieka, Lilian Nyamusi; Kombe, Yeri; Ng'ang'a, Zipporah; Byskov, Jens; Njeru, Mercy Karimi

2015-01-01

In spite of the critical role of Emergency Obstetric Care in treating complications arising from pregnancy and childbirth, very few facilities are equipped in Kenya to offer this service. In Malindi, availability of EmOC services does not meet the UN recommended levels of at least one comprehensive and four basic EmOC facilities per 500,000 populations. This study was conducted to assess priority setting process and its implication on availability, access and use of EmOC services at the district level. A qualitative study was conducted both at health facility and community levels. Triangulation of data sources and methods was employed, where document reviews, in-depth interviews and focus group discussions were conducted with health personnel, facility committee members, stakeholders who offer and/ or support maternal health services and programmes; and the community members as end users. Data was thematically analysed. Limitations in the extent to which priorities in regard to maternal health services can be set at the district level were observed. The priority setting process was greatly restricted by guidelines and limited resources from the national level. Relevant stakeholders including community members are not involved in the priority setting process, thereby denying them the opportunity to contribute in the process. The findings illuminate that consideration of all local plans in national planning and budgeting as well as the involvement of all relevant stakeholders in the priority setting exercise is essential in order to achieve a consensus on the provision of emergency obstetric care services among other health service priorities.

Some insights into the relationship between urban air pollution and noise levels.

PubMed

Kim, Ki-Hyun; Ho, Duy Xuan; Brown, Richard J C; Oh, J-M; Park, Chan Goo; Ryu, In Cheol

2012-05-01

The relationship between noise and air pollution was investigated in eight different districts across Seoul, Korea, between September and November 2010. The noise levels in each district were measured at both roadside and non-roadside locations. It was found that the maximum levels of noise were generally at frequencies of around 1000 Hz. The equivalent noise levels (L(eq)), over all districts, averaged 61.4 ± 7.36 dB which is slightly lower than the noise guidelines set by the World Health Organization (WHO) of 70 dB for industrial, commercial, traffic, and outdoor areas. Comparison of L(eq) levels in each district consistently indicates that noise levels are higher at roadside sites than non-roadside sites. In addition the relative dominance of noise during daytime as compared to nighttime was also apparent. Moreover, the results of an analysis relating sound levels with air pollutant levels indicate strongly that the correlation between these two parameters is the strongest at roadside sites (relative to non-roadside sites) and during nighttime (relative to daytime). The results of our data analysis point to a positive, but complex, correlation between noise levels and air pollution. Copyright © 2012 Elsevier B.V. All rights reserved.

Comparison of practice based research network based quality improvement technical assistance and evaluation to other ongoing quality improvement efforts for changes in agency culture.

PubMed

Livingood, William C; Peden, Angela H; Shah, Gulzar H; Marshall, Nandi A; Gonzalez, Ketty M; Toal, Russell B; Alexander, Dayna S; Wright, Alesha R; Woodhouse, Lynn D

2015-07-31

Public health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. Many of the functional and structural barriers to effective use of QI can be found in the organizational culture of public health agencies. The purpose of this study was to assess the impact of public health practice based research network (PBRN) evaluation and technical assistance for QI interventions on the organizational culture of public health agencies in Georgia, USA. An online survey of key informants in Georgia's districts and county health departments was used to compare perceptions of characteristics of organizational QI culture between PBRN supported QI districts and non-PBRN supported districts before and after the QI interventions. The primary outcomes of concern were number and percentage of reported increases in characteristics of QI culture as measured by key informant responses to items assessing organizational QI practices from a validated instrument on QI Collaboratives. Survey results were analyzed using Multi-level Mixed Effects Logistic Model, which accounts for clustering/nesting. Increases in QI organizational culture were consistent for all 10- items on a QI organizational culture survey related to: leadership support, use of data, on-going QI, and team collaboration. Statistically significant odds ratios were calculated for differences in increased QI organizational culture between PBRN-QI supported districts compared to Non-PBRN supported districts for 5 of the 10 items, after adjusting for District clustering of county health departments. Agency culture, considered by many QI experts as the main goal of QI, is different than use of specific QI methods, such as Plan-Do-Study-Act (PDSA) cycles or root-cause analyses. The specific use of a QI method does not necessarily reflect culture change. Attempts to measure QI culture are newly emerging. This study documented significant improvements in characteristics of organizational culture and demonstrated the potential of PBRNs to support agency QI activities.

[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.

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.

[Work-related stress in nursery school educators in the Venice and Marghera districts].

PubMed

Camerino, Donatella; Fichera, G P; Punzi, Silvia; Campanini, P; Conway, P M; Prevedello, Laura; Costa, G

2011-01-01

Based on an investigation on organizational well-being in the Municipality of Venice (2009), we examined 110 public nursery school and preschool teachers working in the Venice and Marghera districts. The aim of this study was to develop and implement a procedure for work-related stress assessment and management in Municipality of Venice, in the light of Law 81/2008. Occupational stress and its impact on teachers' well-being and health were assessed by means of self-administered questionnaires and semi-structured interviews. Descriptive analyses were conducted to compare teachers' data with those concerning employees operating in other services in the Venice and Marghera districts. According to the results, while nursery school and preschool teachers work with considerable commitment, vigor, dedication and involvement, problems were observed related to: assignment of administrative tasks without appropriate support from the district offices; difficult access to support services; shortage of temporary teachers and auxiliary personnel and, limited to some facilities, lack of adequate physical space devoted to teaching activities. Such adverse conditions result in an increase in vigilance levels required to ensure children's safety. Personnel also suffer from a lack of career prospects, with scarce opportunities for contact with other facilities in the area and inadequate involvement in the decisional processes at Municipality level. Improving such adverse conditions could solve the current marginalization of public nursery school and preschool teachers and encourage mutual exchange of information, which would in turn favour more appropriate methods of managing each single facility.

Forecasting Japanese encephalitis incidence from historical morbidity patterns: Statistical analysis with 27 years of observation in Assam, India.

PubMed

Handique, Bijoy K; Khan, Siraj A; Mahanta, J; Sudhakar, S

2014-09-01

Japanese encephalitis (JE) is one of the dreaded mosquito-borne viral diseases mostly prevalent in south Asian countries including India. Early warning of the disease in terms of disease intensity is crucial for taking adequate and appropriate intervention measures. The present study was carried out in Dibrugarh district in the state of Assam located in the northeastern region of India to assess the accuracy of selected forecasting methods based on historical morbidity patterns of JE incidence during the past 22 years (1985-2006). Four selected forecasting methods, viz. seasonal average (SA), seasonal adjustment with last three observations (SAT), modified method adjusting long-term and cyclic trend (MSAT), and autoregressive integrated moving average (ARIMA) have been employed to assess the accuracy of each of the forecasting methods. The forecasting methods were validated for five consecutive years from 2007-2012 and accuracy of each method has been assessed. The forecasting method utilising seasonal adjustment with long-term and cyclic trend emerged as best forecasting method among the four selected forecasting methods and outperformed the even statistically more advanced ARIMA method. Peak of the disease incidence could effectively be predicted with all the methods, but there are significant variations in magnitude of forecast errors among the selected methods. As expected, variation in forecasts at primary health centre (PHC) level is wide as compared to that of district level forecasts. The study showed that adopted forecasting techniques could reasonably forecast the intensity of JE cases at PHC level without considering the external variables. The results indicate that the understanding of long-term and cyclic trend of the disease intensity will improve the accuracy of the forecasts, but there is a need for making the forecast models more robust to explain sudden variation in the disease intensity with detail analysis of parasite and host population dynamics.

Estimation of annual agricultural pesticide use for counties of the conterminous United States, 1992-2009

USGS Publications Warehouse

Thelin, Gail P.; Stone, Wesley W.

2013-01-01

A method was developed to calculate annual county level pesticide use for selected herbicides, insecticides, and fungicides applied to agricultural crops grown in the conterminous United States from 1992 through 2009. Pesticide-use data compiled by proprietary surveys of farm operations located within Crop Reporting Districts were used in conjunction with annual harvested-crop acreage reported by the U.S. Department of Agriculture National Agricultural Statistics Service (NASS) to calculate use rates per harvested crop acre, or an 'estimated pesticide use' (EPest) rate, for each crop by year. Pesticide-use data were not available for all Crop Reporting Districts and years. When data were unavailable for a Crop Reporting District in a particular year, EPest extrapolated rates were calculated from adjoining or nearby Crop Reporting Districts to ensure that pesticide use was estimated for all counties that reported harvested-crop acreage. EPest rates were applied to county harvested-crop acreage differently to obtain EPest-low and EPest-high estimates of pesticide-use for counties and states, with the exception of use estimates for California, which were taken from annual Department of Pesticide Regulation Pesticide Use Reports. Annual EPest-low and EPest-high use totals were compared with other published pesticide-use reports for selected pesticides, crops, and years. EPest-low and EPest-high national totals for five of seven herbicides were in close agreement with U.S. Environmental Protection Agency and National Pesticide Use Data estimates, but greater than most NASS national totals. A second set of analyses compared EPest and NASS annual state totals and state-by-crop totals for selected crops. Overall, EPest and NASS use totals were not significantly different for the majority of crop-stateyear combinations evaluated. Furthermore, comparisons of EPest and NASS use estimates for most pesticides had rank correlation coefficients greater than 0.75 and median relative errors of less than 15 percent. Of the 48 pesticide-by-crop combinations with 10 or more state-year combinations, 12 of the EPest-low and 17 of the EPest-high totals showed significant differences (p < 0.05) from NASS use estimates. The differences between EPest and NASS estimates did not follow consistent patterns related to particular crops, years, or states, and most correlation coefficients were greater than 0.75. EPest values from this study are suitable for making national, regional, and watershed assessments of annual pesticide use from 1992 to 2009. Although estimates are provided by county to facilitate estimation of watershed pesticide use for a wide variety of watersheds, there is a greater degree of uncertainty in individual county-level estimates when compared to Crop Reporting District or state-level estimates because (1) EPest crop-use rates were developed on the basis of pesticide use on harvested acres in multi-county areas (Crop Reporting Districts) and then allocated to county harvested cropland; (2) pesticide-by-crop use rates were not available for all Crop Reporting Districts in the conterminous United States, and extrapolation methods were used to estimate pesticide use for some counties; and (3) it is possible that surveyed pesticide-by-crop use rates do not reflect all agricultural use on all crops grown. The methods developed in this study also are applicable to other agricultural pesticides and years.

Feasibility and coverage of implementing intermittent preventive treatment of malaria in pregnant women contacting private or public clinics in Tanzania: experience-based viewpoints of health managers in Mkuranga and Mufindi districts

PubMed Central

2013-01-01

Background Evidence on healthcare managers’ experience on operational feasibility of malaria intermittent preventive treatment for malaria during pregnancy (IPTp) using sulphadoxine-pyrimethamine (SP) in Africa is systematically inadequate. This paper elucidates the perspectives of District Council Health Management Team (CHMT)s regarding the feasibility of IPTp with SP strategy, including its acceptability and ability of district health care systems to cope with the contemporary and potential challenges. Methods The study was conducted in Mkuranga and Mufindi districts. Data were collected between November 2005 and December 2007, involving focus group discussion (FGD) with Mufindi CHMT and in-depth interviews were conducted with few CHMT members in Mkuranga where it was difficult to summon all members for FGD. Results Participants in both districts acknowledged the IPTp strategy, considering the seriousness of malaria in pregnancy problem; government allocation of funds to support healthcare staff training programmes in focused antenatal care (fANC) issues, procuring essential drugs distributed to districts, staff remuneration, distribution of fANC guidelines, and administrative activities performed by CHMTs. The identified weaknesses include late arrival of funds from central level weakening CHMT’s performance in health supervision, organising outreach clinics, distributing essential supplies, and delivery of IPTp services. Participants anticipated the public losing confidence in SP for IPTp after government announced artemither-lumefantrine (ALu) as the new first-line drug for uncomplicated malaria replacing SP. Role of private healthcare staff in IPTp services was acknowledged cautiously because CHMTs rarely supplied private clinics with SP for free delivery in fear that clients would be required to pay for the SP contrary to government policy. In Mufindi, the District Council showed a strong political support by supplementing ANC clinics with bottled water; in Mkuranga such support was not experienced. A combination of health facility understaffing, water scarcity and staff non-adherence to directly observed therapy instructions forced healthcare staff to allow clients to take SP at home. Need for investigating in improving adherence to IPTp administration was emphasised. Conclusion High acceptability of the IPTp strategy at district level is meaningless unless necessary support is assured in terms of number, skills and motivation of caregivers and availability of essential supplies. PMID:24079911

Wisconsin K-12 Career Education Consortium. Final Project Performance Report. Volume I of Two Volumes.

ERIC Educational Resources Information Center

Wisconsin State Dept. of Public Instruction, Madison.

To demonstrate career education methods and procedures, seven Wisconsin school districts were chosen to participate in an incremental improvement project. Project activities were conducted district-wide and by individual districts. District-wide dissemination activities involved promoting demonstration packets and assessment/evaluation (AE)…

Using the Fusion Proximal Area Method and Gravity Method to Identify Areas with Physician Shortages

PubMed Central

Xiong, Xuechen; Jin, Chao; Chen, Haile; Luo, Li

2016-01-01

Objectives This paper presents a geographic information system (GIS)-based proximal area method and gravity method for identifying areas with physician shortages. The innovation of this paper is that it uses the appropriate methods to discover each type of health resource and then integrates all these methods to assess spatial access to health resources using population distribution data. In this way, spatial access to health resources for an entire city can be visualized in one neat package, which can help health policy makers quickly comprehend realistic distributions of health resources at a macro level. Methods First, classify health resources according to the trade areas of the patients they serve. Second, apply an appropriate method to each different type of health resource to measure spatial access to those resources. Third, integrate all types of access using population distribution data. Results In case study of Shanghai with the fusion method, areas with physician shortages are located primarily in suburban districts, especially in district junction areas. The result suggests that the government of Shanghai should pay more attention to these areas by investing in new or relocating existing health resources. Conclusion The fusion method is demonstrated to be more accurate and practicable than using a single method to assess spatial access to health resources. PMID:27695105

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.

Modern contraceptive use among women in the Asuogyaman district of Ghana: is reliability more important than health concerns?

PubMed

Teye, Joseph Kofi

2013-06-01

This study examines the socio-demographic determinants of modern contraceptive use among women in the Asuogyaman district of Ghana. The results reveal that although 97% of the survey respondents knew of at least one modern method of contraception, only 16% of them were using modern contraceptives. Statistical tests show that level of education, place of residence, and work status significantly influence modern contraceptive use among women in the study area. Fear of side effects, desire for more children, and partner's disapproval were the main barriers to modern contraceptive use in the study area. The use of traditional methods of contraception was very high because of the perception that they are safer. Based on these findings, it has been suggested that in addition to making family planning services available and accessible, health workers must address attitudinal factors such as fear of side effects and high fertility preferences.

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…

Caseload management methods for use within district nursing teams: a literature review.

PubMed

Roberson, Carole

2016-05-01

Effective and efficient caseload management requires extensive skills to ensure that patients receive the right care by the right person at the right time. District nursing caseloads are continually increasing in size and complexity, which requires specialist district nursing knowledge and skills. This article reviews the literature related to caseload management with the aim of identifying the most effective method for district nursing teams. The findings from this review are that there are different styles and methods of caseload management. The literature review was unable to identify a single validated tool or method, but identified themes for implementing effective caseload management, specifically caseload analysis; workload measurement; work allocation; service and practice development and workforce planning. This review also identified some areas for further research.

Physical Activity Intensity, Lesson Context, and Teacher Interactions during an Unstructured Afterschool Physical Activity Program

ERIC Educational Resources Information Center

Behrens, Timothy K.; Miller, Daniel J.; Schuna, John M.; Liebert, Mina L.

2015-01-01

Background: Afterschool programs are promising arenas to improve youth physical activity (PA) levels. During the school year for 2012-2013, 5 elementary schools from a low-socioeconomic status (SES) school district in southern Colorado participated in evaluation of the afterschool program entitled Keep It Moving! (KIM). Methods: In this…

Faculty and Staff Health Promotion: Results from the School Health Policies and Programs Study 2006

ERIC Educational Resources Information Center

Eaton, Danice K.; Marx, Eva; Bowie, Sara E.

2007-01-01

Background: US schools employ an estimated 6.7 million workers and are thus an ideal setting for employee wellness programs. This article describes the characteristics of school employee wellness programs in the United States, including state-, district-, and school-level policies and programs. Methods: The Centers for Disease Control and…

Measuring School Performance To Improve Student Achievement and To Reward Effective Programs.

ERIC Educational Resources Information Center

Heistad, Dave; Spicuzza, Rick

This paper describes the method that the Minneapolis Public School system (MPS), Minnesota, uses to measure school and student performance. MPS uses a multifaceted system that both captures and accounts for the complexity of a large urban school district. The system incorporates: (1) a hybrid model of critical indicators that report on level of…

An economic-research-based approach to calculate community health-staffing requirements in Xicheng District, Beijing.

PubMed

Yin, Delu; Yin, Tao; Yang, Huiming; Xin, Qianqian; Wang, Lihong; Li, Ninyan; Ding, Xiaoyan; Chen, Bowen

2016-12-07

A shortage of community health professionals has been a crucial issue hindering the development of CHS. Various methods have been established to calculate health workforce requirements. This study aimed to use an economic-research-based approach to calculate the number of community health professionals required to provide community health services in the Xicheng District of Beijing and then assess current staffing levels against this ideal. Using questionnaires, we collected relevant data from 14 community health centers in the Xicheng District, including resident population, number of different health services provided, and service volumes. Through 36 interviews with family doctors, nurses, and public health workers, and six focus groups, we were able to calculate the person-time (equivalent value) required for each community health service. Field observations were conducted to verify the duration. In the 14 community health centers in Xicheng District, 1752 health workers were found in our four categories, serving a population of 1.278 million. Total demand for the community health service outstripped supply for doctors, nurses, and public health workers, but not other professionals. The method suggested that to properly serve the study population an additional 64 family doctors, 40 nurses, and 753 public health workers would be required. Our calculations indicate that significant numbers of new health professionals are required to deliver community health services. We established time standards in minutes (equivalent value) for each community health service activity, which could be applied elsewhere in China by government planners and civil society advocates.

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

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.

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.

Studying Drinking Water Quality and its Change During Transportation through Samara Water-Supply Facilities

NASA Astrophysics Data System (ADS)

Kichigin, V. I.; Egorova, Y. A.; Nesterenko, O. I.

2017-11-01

The paper investigates changes in water physico-chemical composition and its physical indicators through ζ-potential in residential buildings in eight administrative districts of Samara. The results are processed by the methods of mathematical statistics and presented at the 0.05 level of importance. The sampling points for water in the city districts were chosen with the aid of random numbers tables. It was determined that the quality of drinking water was stable and consistent with the existing standards in Zheleznodorozhniy, Samarskiy, Leninskiy, Octyabrskiy, Kirovsliy, Sovetskiy and Promyshlenniy districts of Samara. The following indicators were taken into account: pH, colour, turbidity, alkalinity, general rigidity, content of ions Ca2 +, Mg2 +. It was also established that drinking water in Kuibyshevskiy district (with all other excellent indicators) had increased mineralization due to the natural hydrological conditions of the water inlet. Some change in the size of zeta-potential of the water was detected during its transportation through the existing water-supplying networks of the city. It was shown that the link between zeta-potential and various kinds of contamination in drinking water is underexplored and requires further detailed study.

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)

Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data

PubMed Central

Saxena, Deepak; Vangani, Ruchi; Mavalankar, Dileep V.; Thomsen, Sarah

2013-01-01

Background Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Methods Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3) carried out during 2007–2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes – Institutional delivery, antenatal care (ANC), and use of modern contraception – and selected intermediary and structural determinants of health using multiple logistic regression. Results Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Discussion and conclusions Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste) has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic education and infrastructural development to begin to remove the structural causes of non-use of maternal health services. PMID:23469890

Indoor Residual Spraying Delivery Models to Prevent Malaria: Comparison of Community- and District-Based Approaches in Ethiopia

PubMed Central

Johns, Benjamin; Yihdego, Yemane Yeebiyo; Kolyada, Lena; Dengela, Dereje; Chibsa, Sheleme; Dissanayake, Gunawardena; George, Kristen; Taffese, Hiwot Solomon; Lucas, Bradford

2016-01-01

ABSTRACT Background: Indoor residual spraying (IRS) for malaria prevention has traditionally been implemented in Ethiopia by the district health office with technical and operational inputs from regional, zonal, and central health offices. The United States President's Malaria Initiative (PMI) in collaboration with the Government of Ethiopia tested the effectiveness and efficiency of integrating IRS into the government-funded community-based rural health services program. Methods: Between 2012 and 2014, PMI conducted a mixed-methods study in 11 districts of Oromia region to compare district-based IRS (DB IRS) and community-based IRS (CB IRS) models. In the DB IRS model, each district included 2 centrally located operational sites where spray teams camped during the IRS campaign and from which they traveled to the villages to conduct spraying. In the CB IRS model, spray team members were hired from the communities in which they operated, thus eliminating the need for transport and camping facilities. The study team evaluated spray coverage, the quality of spraying, compliance with environmental and safety standards, and cost and performance efficiency. Results: The average number of eligible structures found and sprayed in the CB IRS districts increased by 19.6% and 20.3%, respectively, between 2012 (before CB IRS) and 2013 (during CB IRS). Between 2013 and 2014, the numbers increased by about 14%. In contrast, in the DB IRS districts the number of eligible structures found increased by only 8.1% between 2012 and 2013 and by 0.4% between 2013 and 2014. The quality of CB IRS operations was good and comparable to that in the DB IRS model, according to wall bioassay tests. Some compliance issues in the first year of CB IRS implementation were corrected in the second year, bringing compliance up to the level of the DB IRS model. The CB IRS model had, on average, higher amortized costs per district than the DB IRS model but lower unit costs per structure sprayed and per person protected because the community-based model found and sprayed more structures. Conclusion: Established community-based service delivery systems can be adapted to include a seasonal IRS campaign alongside the community-based health workers' routine activities to improve performance efficiency. Further modifications of the community-based IRS model may reduce the total cost of the intervention and increase its financial sustainability. PMID:27965266

Condom availability in high risk places and condom use: a study at district level in Kenya, Tanzania and Zambia

PubMed Central

2012-01-01

Background A number of studies from countries with severe HIV epidemics have found gaps in condom availability, even in places where there is a substantial potential for HIV transmission. Although reported condom use has increased in many African countries, there are often big differences by socioeconomic background. The aim of this study was to assess equity aspects of condom availability and uptake in three African districts to evaluate whether condom programmes are given sufficient priority. Methods Data on condom availability and use was examined in one district in Kenya, one in Tanzania and one in Zambia. The study was based on a triangulation of data collection methods in the three study districts: surveys in venues where people meet new sexual partners, population-based surveys and focus group discussions. The data was collected within an overall study on priority setting in health systems. Results At the time of the survey, condoms were observed in less than half of the high risk venues in two of the three districts and in 60% in the third district. Rural respondents in the population-based surveys perceived condoms to be less available and tended to be less likely to report condom use than urban respondents. Although focus group participants reported that condoms were largely available in their district, they expressed concerns related to the accessibility of free condoms. Conclusion As late as thirty years into the HIV epidemic there are still important gaps in the availability of condoms in places where people meet new sexual partners in these three African districts. Considering that previous studies have found that improved condom availability and accessibility in high risk places have a potential to increase condom use among people with multiple partners, the present study findings indicate that substantial further efforts should be made to secure that condoms are easily accessible in places where sexual relationships are initiated. Although condom distribution in drinking places has been pinpointed in the HIV/AIDS prevention strategies of all the three countries, its priority relative to other HIV/AIDS measures must be reassessed locally, nationally and regionally. In practical terms very clear supply chains of condoms to both formal and informal drinking places could make condom provision better and more reliable. PMID:23181969

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.

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.

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.

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

Projecting Enrollment in Rural Schools: A Study of Three Vermont School Districts

ERIC Educational Resources Information Center

Grip, Richard S.

2004-01-01

Large numbers of rural districts have experienced sharp declines in enrollment, unlike their suburban counterparts. Accurate enrollment projections are required, whether a district needs to build new schools or consolidate existing ones. For school districts having more than 600 students, a quantitative method such as the Cohort-Survival Ratio…

Anaemia and associated factors among under-fives and their mothers in Bushenyi district, Western Uganda.

PubMed

Kikafunda, Joyce K; Lukwago, Fred B; Turyashemererwa, Florence

2009-12-01

To determine the prevalence of anaemia and associated factors among under-fives and their mothers in a rural area of Western Uganda. A cross-sectional investigation using both qualitative and quantitative methods of data collection. Stratified multistage sampling methods were used to select the study sample. A haemoglobinometer was used to assess Hb levels in the blood. A rural district in Western Uganda. Children aged 6-59 months and their mothers aged 15-49 years. The overall prevalence of Fe-deficiency anaemia among children and their mothers was 26.2 % and 17.9 %, respectively. There was a significant correlation (r = 0.5, P = 0.008) between the Hb levels of the mothers and their children. Place of birth, age of the child, factors related to complementary foods, and formal education and nutrition knowledge of the mother were major factors that were significantly associated (r = 0.05, P = 0.05) with low Hb levels among the children. The most important factors that were associated with low Hb levels of the mothers were their formal education, nutrition knowledge and health status. Fe-deficiency anaemia was found to be a major problem in this cohort of children and their mothers. Dietary factors and sociodemographic factors were the major factors associated with high levels of anaemia among the children and their mothers. It is therefore recommended that rural mothers should be sensitized on best practices for prevention of anaemia among both women and children.

Schistosoma mansoni Infections, Undernutrition and Anaemia among Primary Schoolchildren in Two Onshore Villages in Rorya District, North-Western Tanzania.

PubMed

Munisi, David Zadock; Buza, Joram; Mpolya, Emmanuel A; Kinung'hi, Safari M

2016-01-01

Undernutrition and anaemia remains to be a major public health problem in many developing countries, where they mostly affect children. Intestinal parasitic infections are known to affect both growth and haemoglobin levels. Much has been reported on the impact of geohelminths on anaemia and undernutrition, leaving that of Schistosoma mansoni not well studied. Therefore this study intended to determine the association between S.mansoni infections, anaemia and undernutrition among schoolchildren in Rorya district, Northwestern Tanzania. A cross-sectional study was carried among schoolchildren in two onshore villages namely Busanga and Kibuyi in Rorya district. Single stool specimens were collected from 513 randomly selected schoolchildren and processed for microscopic examination using the Kato-Katz method. Nutritional status was determined by anthropometry. Blood samples were also collected and examined for malaria parasites and haemoglobin levels using the Giemsa stain and HaemoCue methods, respectively. A pretested questionnaire was used to collect socio-demographic data and associated factors. The prevalence of S. mansoni infection and malaria was 84.02% and 9.16%, respectively. Other parasites found were Ascaris lumbricoides (1.36%) and Hookworm (1.36%). The prevalence of stunting and wasting was 38.21% and 14.42%, respectively. The prevalence of anaemia was 29.43%, whereby 0.58% had severe anaemia. S. mansoni infection was not found to be associated with undernutrition or anaemia (p>0.05). The risk of stunting and wasting increased with increasing age (p<0.001). Anaemia was associated with age, sex and village of residence (p<0.05). S.mansoni, undernutrition and anaemia are highly prevalent in the study area. The observed rates of undernutrition and anaemia were seen not to be associated with S.mansoni infection suggesting possibly being a result of poor dietary nutrients. This study suggests that policy makers should consider Rorya district for inclusion into national schistosomiasis control and school feeding programmes.

Indigenous knowledge of zootherapeutic use among the Biate tribe of Dima Hasao District, Assam, Northeastern India

PubMed Central

2013-01-01

Background The present study addresses the use of zootherapy in the traditional healthcare system of the Biate tribe of Dima Hasao district, Assam, India. It sought to identify the different species used for zootherapeutic use with the detailed methods of usages to create awareness and contribute to the conservation and sustainable utilization of the resources. Method 15 Biate villages within the district of Dima Hasao were surveyed through semi-structured questionnaires and informal interviews. Detailed information on the uses of each animal was recorded. Species were identified using standard literature. Fidelity level (FL) was calculated to demonstrate the percentage of respondents claiming the use of a certain animal for the same major purposes. Result The study documents 34 species for the treatment of about 34 different ailments. The largest number of species reported was mammals with17 species. Maximum number of species has been reported for the treatment of diabetes and its high fidelity levels warrants in-depth studies to establish its pharmacological activity. The usages documented herein are unique to the Biate tribe. Very often, these animals are hunted and sold openly at the local markets in the lure of quick money. A 300 gm live Gekko gecko may fetch a sum of 2,50,000 Indian Rupees (INR), and smoked meat of Hoolock hoolock cost approximately 250–300 INR per kg. Animals are also hunted for its hide. The unrestricted hunting of species like Capricornis sumatraensis has almost wiped out the population within the district. Some species are also reared as pets while some are used for display as a sign of expertise in hunting. The present study has documented the usage of at least 15 animals listed in the IUCN Red List. Conclusion The study illustrates the in-depth knowledge of the Biate tribe on zootherapy. Systematic investigation to identify the active ingredient may lead to the development of new drugs, which would prompt protection of these valuable resources. PMID:23938109

Community case management of malaria using ACT and RDT in two districts in Zambia: achieving high adherence to test results using community health workers

PubMed Central

2011-01-01

Background Access to prompt and effective treatment is a cornerstone of the current malaria control strategy. Delays in starting appropriate treatment is a major contributor to malaria mortality. WHO recommends home management of malaria using artemisininbased combination therapy (ACT) and Rapid Diagnostic tests (RDTs) as one of the strategies for improving access to prompt and efective malaria case management. Methods A prospective evaluation of the effectiveness of using community health workers (CHWs) as delivery points for ACT and RDTs in the home management of malaria in two districts in Zambia. Results CHWs were able to manage malaria fevers by correctly interpreting RDT results and appropriately prescribing antimalarials. All severe malaria cases and febrile non-malaria fevers were referred to a health facility for further management. There were variations in malaria prevalence between the two districts and among the villages in each district. 100% and 99.4% of the patients with a negative RDT result were not prescribed an antimalarial in the two districts respectively. No cases progressed to severe malaria and no deaths were recorded during the study period. Community perceptions were positive. Conclusion CHWs are effective delivery points for prompt and effective malaria case management at community level. Adherence to test results is the best ever reported in Zambia. Further areas of implementation research are discussed. PMID:21651827

District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study.

PubMed

Ng'ang'a, Njoki; Byrne, Mary Woods; Kruk, Margaret E; Shemdoe, Aloisia; de Pinho, Helen

2016-08-08

In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

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…

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.

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.

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.

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…

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.

Decentralization in Zambia: resource allocation and district performance.

PubMed

Bossert, Thomas; Chitah, Mukosha Bona; Bowser, Diana

2003-12-01

Zambia implemented an ambitious process of health sector decentralization in the mid 1990s. This article presents an assessment of the degree of decentralization, called 'decision space', that was allowed to districts in Zambia, and an analysis of data on districts available at the national level to assess allocation choices made by local authorities and some indicators of the performance of the health systems under decentralization. The Zambian officials in health districts had a moderate range of choice over expenditures, user fees, contracting, targeting and governance. Their choices were quite limited over salaries and allowances and they did not have control over additional major sources of revenue, like local taxes. The study found that the formula for allocation of government funding which was based on population size and hospital beds resulted in relatively equal per capita expenditures among districts. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. General guidelines for the allocation of resources established a maximum and minimum percentage to be allocated to district offices, hospitals, health centres and communities. Districts tended to exceed the maximum for district offices, but the large urban districts and those without public district hospitals were not even reaching the minimum for hospital allocations. Wealthier and urban districts were more successful in raising revenue through user fees, although the proportion of total expenditures that came from user fees was low. An analysis of available indicators of performance, such as the utilization of health services, immunization coverage and family planning activities, found little variation during the period 1995-98 except for a decline in immunization coverage, which may have also been affected by changes in donor funding. These findings suggest that decentralization may not have had either a positive or negative impact on services.

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…

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

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…

Effective Strategies for District Leadership to Create Successful Inclusion Models: Special Education Directors and School Reform in Context of Least Restrictive Environment

ERIC Educational Resources Information Center

Bublitz, Gregory

2016-01-01

This qualitative mixed methods study explored how Special Education Directors transformed and maintained a successful inclusion model throughout their district. The study identified leadership strategies and inclusive behaviors utilized by Special Education Directors who have successfully transformed their district into inclusive school districts.…

Inventory Control of Fixed Assets by School District Personnel.

ERIC Educational Resources Information Center

Jensen, Paul E.

By July 1, 1966, each school district in New York State was required to install a system of property accounting. This pamphlet provides a suggested method of property accounting to assist school districts in meeting this requirement. In addition, suggestions are made to help the districts record the information needed for fire insurance purposes.…

Smoking Patterns in Oregon Youth: Effects of Funding and Defunding of a Comprehensive State Tobacco Control Program

PubMed Central

Pizacani, Barbara A.; Dent, Clyde W.; Maher, Julie E.; Rohde, Kristen; Stark, Michael J.; Biglan, Anthony; Thompson, Jill

2014-01-01

Purpose Comprehensive tobacco control programs have included school-based prevention programs as a key strategy to reach adolescents. Unfortunately, these programs have undergone extensive budget reductions in recent years. In 2003, funding for the Oregon Tobacco Prevention and Education Program was reduced by about 70%, and the school component was entirely defunded. To assess the effects of program funding and subsequent defunding on smoking prevalence within targeted Oregon schools, we compared the change in 30-day smoking prevalence between grades 8 and 11 in school districts in two periods: namely, during funding and after funding was eliminated. Methods We used annual school-based survey data for grades 8 and 11 to describe district-level changes in smoking prevalence in five age cohorts: two during the funding period and three after defunding. Each cohort was comprised of districts whose 8th-graders completed the survey and participated again 3 years later. Using mixed models, we compared the change in 30-day adjusted smoking prevalence among cohorts in funded districts, defunded districts, and districts that never received funding. Results Smoking prevalence growth was significantly higher among cohorts from the defunded period than for cohorts from the funded period (p = .04) and was not significantly different from schools that were never-funded (p = .79). Conclusions In Oregon, funding a school component of a comprehensive tobacco control strategy was associated with depressed uptake of smoking. Gains were quickly lost upon program defunding. School programs are an important strategy if they are long term, comprehensive, and reinforced in the larger environment. PMID:19237108

Investigation of hepatitis A outbreak in district of Manjung, Perak, Malaysia, October 2012

PubMed Central

Rahman, Rusdi Abdul; May, Ling He; Budart, Suzana Binti; Sulaiman, Lokman Hakim

2015-01-01

Background In September 2012, 10 cases suspected to be hepatitis A were notified to the Manjung District Health Department. An investigation was conducted to identify the possible mode of transmission, source of the outbreak and to recommend prevention and control measures. Methods A case was a person with acute illness with discrete onset of symptoms and jaundice or elevated serum aminotransferase levels in September 2012 in the Manjung District. We conducted a case-control study and environmental assessments of processing plants and food premises. Results There were 78 confirmed cases of hepatitis A; an attack rate of 3.1 per 10 000 population. Multiple logistic regression showed that being male (odds ratio [OR]: 18.4 [5.13–65.9]; P < 0.001) and drinking toddy at processing place A (Adjusted OR: 2.70 [1.17–6.25]; P < 0.05) were associated with being a case. Environmental investigations of this and one other processing place found them to be unhygienic, and the pH of the toddy was at levels that encouraged growth of hepatitis A virus. Conclusion Toddy was possibly the primary source of this outbreak based on both epidemiological and environmental results. Both toddy preparation places and several food premises were closed as a result of this investigation. PMID:26306213

Fecal contamination of drinking water in Kericho District, Western Kenya: role of source and household water handling and hygiene practices.

PubMed

Too, Johana Kiplagat; Kipkemboi Sang, Willy; Ng'ang'a, Zipporah; Ngayo, Musa Otieno

2016-08-01

Inadequate protection of water sources, and poor household hygienic and handling practices have exacerbated fecal water contamination in Kenya. This study evaluated the rate and correlates of thermotolerant coliform (TTC) household water contamination in Kericho District, Western Kenya. Culture and multiplex polymerase chain reaction (PCR) techniques were used to characterize TTCs. The disk diffusion method was used for antibiotic susceptibility profiling of pathogenic Escherichia coli. Out of the 103 households surveyed, 48 (46.6%) had TTC contaminated drinking water (TTC levels of >10 cfu/100 mL). Five of these households were contaminated with pathogenic E. coli, including 40% enteroaggregative E. coli, 40% enterotoxigenic E. coli, and 20% enteropathogenic E. coli. All these pathogenic E. coli strains were multidrug resistant to sulfamethoxazole/trimethoprim, ampicillin, tetracycline and ampicillin/sulbactam. Rural household locality, drinking water hand contact, water storage container cleaning practice, hand washing before water withdrawal, water source total coliforms <10 cfu/100 mL, temperature, and free chlorine levels were associated with TTC contamination of household drinking water. Significant proportions of household drinking water in Kericho District are contaminated with TTCs including with pathogenic multidrug-resistant E. coli. Source and household hygiene and practices contribute significantly to drinking water contamination.

Health facility-based data on women receiving sulphadoxine-pyrimethamine during pregnancy in Tanzania: lessons to learn from a cross-sectional survey in Mkuranga and Mufindi districts and other national survey reports

PubMed Central

2014-01-01

Background A study of health facility (HF) data on women receiving sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy (IPTp) was carried out at antenatal care clinics in Mkuranga and Mufindi districts. Methods A review of health management information system (HMIS) registers, interviews with health-care workers (HWs) and district and national level malaria control program managers corroborated by inter-temporal assessment through observations at HF levels. Statistical data were analyzed in Excel and interpreted in triangulation with qualitative data from interviews and observations. Results Data indicated that IPTp doses administered to women were inadequate and partly inconsistent. HMIS registers lacked space for IPT records, forcing HWs to manipulate their record-keeping. The proportion/number of IPTp recipients in related to the supply of SP for free delivery, to women’s attendance behaviours, showed variation by quarter and year of reporting. Conclusion It is impossible to achieve rational health service planning when the HMIS is weak. Whilst it is acknowledged that the HMIS is already overloaded, concerted measures are urgently needed to accommodate data on new interventions and other vertical programs if malaria programs are to achieve their goals. PMID:24433529

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...

Cardiovascular Risk Factors and Physical Activity Behavior among Elementary School Personnel: Baseline Results from the ACTION! Worksite Wellness Program

ERIC Educational Resources Information Center

Webber, Larry S.; Rice, Janet C.; Johnson, Carolyn C.; Rose, Donald; Srinivasan, Sathanur R.; Berenson, Gerald S.

2012-01-01

Background: Although the prevalence of obesity is increasing during adulthood, there have been few assessments of obesity, cardiovascular risk factors, and levels of physical activity among adult elementary school staff. Methods: Data were collected from 745 African-American and White female school personnel in a suburban school district in…

Views of Students in the Department of Recreation and Sport Management on Distance Education

ERIC Educational Resources Information Center

Herguner, Gulten

2012-01-01

This study aims to investigate viewpoints of students in recreation and sport management department on distance education, and the effects of sex, having computers and internet access at home, family's monthly income, district of the family, and students' level of class on these viewpoints. Survey method was used to carry out the study. The sample…

Healthy and Safe School Environment, Part I: Results from the School Health Policies and Programs Study 2006

ERIC Educational Resources Information Center

Jones, Sherry Everett; Fisher, Carolyn J.; Greene, Brenda Z.; Hertz, Marci F.; Pritzl, Jane

2007-01-01

Background: Policies set at the state, district, and school levels can support and enhance a healthy and safe school environment. Methods: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were…

Developing Proactive Methods for General Aviation Data Collection

DTIC Science & Technology

2010-11-01

standard weather package that all pilots would review before flying. 17. Key Words 18. Distribution Statement General Aviation...completed page authorized iii ACKNOWLEDGMENTS We are indebted to the many Flight Standards District Office employees that provided assistance beyond...Directive / Level of Effort Agree- ment between the Human Factors Research and Engineering Group (AJP-61), Flight Standards Service – General Aviation

The Success of Urban Schools in Oxnard, California: An In-Depth Look at Developmental and Relational Assets

ERIC Educational Resources Information Center

Akhavan, Nancy; Emery, Ryan; Shea, Ginger; Taha-Resnick, Adria

2017-01-01

The study is a mixed-methods investigation of how urban schools are succeeding. The study surveyed 28 former students from urban schools in Oxnard, California. The qualitative responses represent themes that align to a high level of school connectedness and social-emotional learning (SEL) as key indicators of a successful urban school district.…

Beyond the biomedical: community resources for mental health care in rural Ethiopia.

PubMed

Selamu, Medhin; Asher, Laura; Hanlon, Charlotte; Medhin, Girmay; Hailemariam, Maji; Patel, Vikram; Thornicroft, Graham; Fekadu, Abebaw

2015-01-01

The focus of discussion in addressing the treatment gap is often on biomedical services. However, community resources can benefit health service scale-up in resource-constrained settings. These assets can be captured systematically through resource mapping, a method used in social action research. Resource mapping can be informative in developing complex mental health interventions, particularly in settings with limited formal mental health resources. We employed resource mapping within the Programme for Improving Mental Health Care (PRIME), to systematically gather information on community assets that can support integration of mental healthcare into primary care in rural Ethiopia. A semi-structured instrument was administered to key informants. Community resources were identified for all 58 sub-districts of the study district. The potential utility of these resources for the provision of mental healthcare in the district was considered. The district is rich in community resources: There are over 150 traditional healers, 164 churches and mosques, and 401 religious groups. There were on average 5 eddir groups (traditional funeral associations) per sub-district. Social associations and 51 micro-finance institutions were also identified. On average, two traditional bars were found in each sub-district. The eight health centres and 58 satellite clinics staffed by Health Extension Workers (HEWs) represented all the biomedical health services in the district. In addition the Health Development Army (HDA) are community volunteers who support health promotion and prevention activities. The plan for mental healthcare integration in this district was informed by the resource mapping. Community and religious leaders, HEWs, and HDA may have roles in awareness-raising, detection and referral of people with mental illness, improving access to medical care, supporting treatment adherence, and protecting human rights. The diversity of community structures will be used to support rehabilitation and social reintegration. Alcohol use was identified as a target disorder for community-level intervention.

Level of Fluoride in Soil, Grain and Water in Jalgaon District, Maharashtra, India.

PubMed

Naik, Rahul Gaybarao; Dodamani, Arun Suresh; Vishwakarma, Prashanth; Jadhav, Harish Chaitram; Khairnar, Mahesh Ravindra; Deshmukh, Manjiri Abhay; Wadgave, Umesh

2017-02-01

Fluoride has an influence on both oral as well as systemic health. The major source of fluoride to body is through drinking water as well as through diet. Staple diet mainly depends on local environmental factors, food grains grown locally, its availability etc. Determination of fluoride level in these food grains is important. So, estimation of the amount of fluoride in grains and its relation to the sources of fluoride used for their cultivation viz., soil and water is important. To estimate the relation of fluoride concentration in grains (Jowar) with respect to that of soil and water used for their cultivation. Fifteen samples each of soil, water and grains were collected using standardized method from the same farm fields of randomly selected villages of Jalgaon district. Fluoride ion concentration was determined in laboratory using SPADNS technique. Mean difference in fluoride levels in between the groups were analyzed using ANOVA and Post-Hoc Tukey test. Linear regression method was applied to analyse the association of the fluoride content of grain with water and soil. There was a significant difference in between mean fluoride levels of soil and water (p<0.001) and in between soil and grain (p<0.001); however, difference in between mean fluoride levels of water and grain was found to be non significant (p=0.591). Also fluoride levels in all the three groups showed significant association with each other. Fluoride level of soil, grains and water should be adjusted to an optimum level. Soil has positive correlation with respect to uptake of fluoride by Jowar grains. So, Jowar grains with optimum fluoride content should be made available in the commercial markets so that oral and general health can be benefitted.

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…

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.

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.

Ethnomedicinal study of plants used for human ailments in Ankober District, North Shewa Zone, Amhara Region, Ethiopia

PubMed Central

2013-01-01

Background Ankober District has long been inhabited by people who have a long tradition of using medicinal plants to treat human ailments. Overexploitation of medicinal plants coupled with an ever-increasing population growth, deforestation and agricultural land expansion threatens plants in the area. Hence, this study aimed at documenting and analyzing the plant-based ethnomedicinal knowledge of the people in order to preserve the dwindling indigenous knowledge. Methods Ethnobotanical data were collected using semi-structured interviews, focus group discussions, participant observation and walk-in-the-woods. Quantitative approaches were used to determine Informant Consensus Factor (ICF) and Fidelity level (FL) values. Statistical tests were used to compare the indigenous knowledge on medicinal plants among different informant categories. Results A total of 135 medicinal plant species belonging to 128 genera and 71 botanical families were reported to treat human diseases in the District. Families Asteraceae (12 species, 9%) and Fabaceae (10, 7.4%) were found to be best represented in the area. About 44% of preparations were reported to be obtained from roots. Significant difference (P < 0.05) was observed on the mean number of medicinal plants reported by groups of respondents compared within age, literacy level and experience parameters. Highest ICF values were recorded for gastro-intestinal & parasitic and dermatological disease categories (0.70 each) indicating best agreement among informants knowledge on medicinal plants used to treat aliments in these categories. Highest fidelity level values were recorded for Zehneria scabra (95%) and Hagenia abyssinica (93.75%) showing conformity of knowledge on species of best healing potential. Podocarpus falcatus was ranked first in a direct matrix ranking exercise of multipurpose medicinal plants. The output of preference ranking exercise indicated that Olea europaea subsp. cuspidata was the most preferred species to treat atopic eczema. Conclusion The study revealed that Ankober District is rich in medicinal plant diversity and associated indigenous knowledge. However, anthropogenic factors coupled with acculturation and very poor conservation efforts threaten medicinal plant survival in the area. Promoting a complementary in situ and ex situ conservation strategy for medicinal plants of the District is highly recommended. PMID:23984919

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.

Goiter prevalence in school-going children: A cross-sectional study in two border districts of sub-Himalayan Jammu and Kashmir

PubMed Central

Gupta, Rajiv Kumar; Langer, Bhavna; Raina, Sunil Kumar; Kumari, Rashmi; Jan, Reyaz; Rani, Renu

2016-01-01

Introduction: Iodine deficiency disorder remains one of the major public health problems, despite it being easily preventable. Initially thought as the disorder of Himalayan goiter belt, the disorder has been found to have a pan-India presence. The study was planned with the aim to assess the prevalence of goiter among 6–12 years school-going children and to identify levels of iodine in salt consumed at the household level in the study area. Materials and Methods: The study was conducted among 3955 school-going (2162 children from Rajouri and 1793 children from Poonch) children age 6–12 years in Rajouri and Poonch districts of Jammu Province. The children were examined clinically to detect and grade the goiter. Salt samples were collected from subsample (n = 400) to estimate iodine content in the salt. Results: The prevalence of goiter in the study population was found to be 18.87% and 9.70% in Rajouri and Poonch districts, respectively. Goiter prevalence was higher in 9–12 years age group as compared to 6–9 years age group and the difference in goiter prevalence in males of these two age groups was statistically significant (P = 0.02). Estimation of iodine content of the salt samples revealed that all of them (100%) had adequate iodine content. Conclusion: Despite the implementation of Universal Iodization Program and adequate content of iodine in salt consumed by the families, the goiter prevalence in both the districts is high. The future research should focus on identifying the reasons for this high prevalence. PMID:28348999

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.

‘M-TRACK’ (mobile phone reminders and electronic tracking tool) cuts the risk of pre-treatment loss to follow-up by 80% among people living with HIV under programme settings: a mixed-methods study from Gujarat, India

PubMed Central

Mehta, Kedar; Kumar, Ajay M. V.; Chawla, Sudhir; Chavda, Paragkumar; Selvaraj, Kalaiselvi; Shringarpure, Kalpita S.; Solanki, Dipak M.; Verma, Pramod B.; Rewari, B. B.

2018-01-01

ABSTRACT Background: In 2016, the National AIDS Control Programme (NACP) in Gujarat, India implemented an innovative intervention called ‘M-TRACK’ (mobile phone reminders once every week for four weeks after diagnosis and electronic patient tracking tool) to reduce pre-treatment loss to follow-up (LFU) among people living with HIV (PLHIV) in Vadodara district while other districts received standard of care. Objectives: To assess the effectiveness of M-TRACK in reducing pre-treatment LFU (proportion of diagnosed PLHIV not registering for HIV care by four weeks after diagnosis) and to explore the implementation enablers and challenges from health care providers’ and PLHIV perspective. Methods: An explanatory mixed-methods study design was used wherein the quantitative phase (cohort study with two groups: Vadodara district exposed to M-TRACK and Rajkot district as unexposed) was followed by a qualitative phase (descriptive study involving group interview with 16 health care providers, personal interviews with two programme managers and telephonic interviews with 16 PLHIV). Data were collected during October 2016 to February 2017. Results: During the pre-M-TRACK period (July–September 2016), the LFU proportion was similar [13% (25/191) in Vadodara; 15% (21/141) in Rajkot (p = 0.8)]. During the M-TRACK period (October–December 2016), LFU decreased to 4% (9/209) in Vadodara (exposed), whereas it remained similar at 16% (18/113) in Rajkot (unexposed) district (p = 0.02). PLHIV exposed to M-TRACK had an 80% lower risk of LFU (aRR 0.2; 95% CI: 0.1–0.5) compared with standard care, after adjusting for socio-demographics, time and clustering at district level. During interviews, M-TRACK was welcomed by both PLHIV and the counsellors. The latter felt it saved time by obviating the need for home visits and helped in documentation. Inconvenience of using landline phone available at the health facility, lack of budgets for reimbursement of mobile call expenses and internet connectivity problems were the key implementation challenges. Conclusion: M-TRACK was highly effective in reducing the gap between diagnosis and treatment. It may be considered for scale-up after addressing the challenges noted. PMID:29482468

Dementia care mapping: an approach to quality audit of services for people with dementia in two health districts.

PubMed

Younger, D; Martin, G W

2000-11-01

The audit reported in this paper and submitted to the Psychiatry of Old Age Management group, assessed six units within each of two health districts in the UK. Using a nonparticipatory observation method in the units selected, the aim was to measure quality and the environment of care. Dependency levels of the clients/residents were also estimated to give a clearer picture of the setting and the care requirements. This was intended to establish a baseline for the units mapped and to enable care developments to be focussed upon intended outcomes. Results led to a number of observations related to the levels of interaction between staff and clients/residents, the need for a wider range of activities to promote person-centred care, and a suggested route to the improvement in quality of life for this vulnerable group of people. Assessment of dependency levels linked to the results of the mapping showed that high dependency does not lead automatically to a lower quality of person centred care.

[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 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.

Middle school science curriculum design and 8th grade student achievement in Massachusetts public schools

NASA Astrophysics Data System (ADS)

Clifford, Betsey A.

The Massachusetts Department of Elementary and Secondary Education (DESE) released proposed Science and Technology/Engineering standards in 2013 outlining the concepts that should be taught at each grade level. Previously, standards were in grade spans and each district determined the method of implementation. There are two different methods used teaching middle school science: integrated and discipline-based. In the proposed standards, the Massachusetts DESE uses grade-by-grade standards using an integrated approach. It was not known if there is a statistically significant difference in student achievement on the 8th grade science MCAS assessment for students taught with an integrated or discipline-based approach. The results on the 8th grade science MCAS test from six public school districts from 2010 -- 2013 were collected and analyzed. The methodology used was quantitative. Results of an ANOVA showed that there was no statistically significant difference in overall student achievement between the two curriculum models. Furthermore, there was no statistically significant difference for the various domains: Earth and Space Science, Life Science, Physical Science, and Technology/Engineering. This information is useful for districts hesitant to make the change from a discipline-based approach to an integrated approach. More research should be conducted on this topic with a larger sample size to better support the results.

An Alternative Approach for Supportive Supervision and Skill Measurements of Health Workers for Integrated Management of Neonatal and Childhood Illnesses Program in 10 Districts of Haryana.

PubMed

Aggarwal, Arun K; Gupta, Rakesh; Das, Dhritiman; Dhakar, Anar S; Sharma, Gourav; Anand, Himani; Kaur, Kamalpreet; Sheoran, Kiran; Dalpath, Suresh; Khatri, Jaidev; Gupta, Madhu

2018-01-01

"Integrated Management of Neonatal and Childhood Illnesses" (IMNCI) needs regular supportive supervision (SS). The aim of this study was to find suitable SS model for implementing IMNCI. This was a prospective interventional study in 10 high-focus districts of Haryana. Two methods of SS were used: (a) visit to subcenters and home visits (model 1) and (b) organization of IMNCI clinics/camps at primary health center (PHC) and community health center (CHC) (model 2). Skill scores were measured at different time points. Routine IMNCI data from study block and randomly selected control block of each district were retrieved for 4 months before and after the training and supervision. Change in percentage mean skill score difference and percentage difference in median number of children were assessed in two areas. Mean skill scores increased significantly from 2.1 (pretest) to 7.0 (posttest 1). Supportive supervisory visits sustained and improved skill scores. While model 2 of SS could positively involve health system officials, model 1 was not well received. Outcome indicator in terms of number of children assessed showed a significant improvement in intervention areas. SS in IMNCI clinics/camps at PHC/CHC level and innovative skill scoring method is a promising approach.

The role of nurses and midwives in polio eradication and measles control activities: a survey in Sudan and Zambia

PubMed Central

Nkowane, Annette Mwansa; Boualam, Liliane; Haithami, Salah; El Sayed, El Tayeb Ahmed; Mutambo, Helen

2009-01-01

Background Nurses and midwives are the key providers of nursing and midwifery services; in many countries, they form the major category of frontline workers who provide both preventive and curative services in the community. When the skills and experience of nursing and midwifery personnel are maximized, they can contribute significantly to positive health outcomes. We conducted a survey among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes. Methods Nurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunization campaigns for polio and measles. Results Nurses and midwives were found to play significant roles in implementing immunization programme activities. The level of responsibilities of nurses and midwives in their routine work related more to existing opportunities than to their job descriptions. In Zambia, where nurses reported constraints in performing their tasks, the reasons cited were an increase in the burden of disease and the shortage of health personnel. Factors identified as key to improving work performance included written job descriptions, opportunities for staff and career development and opportunities to earn extra income through activities associated with their jobs. Other non-monetary incentives mentioned included reliable transport, resources and logistics to support routine work in the district. However, in both countries, during supplementary immunization activities or mass campaigns for polio eradication and measles control, nurses and midwives took on more management responsibilities. Conclusion This study shows that nurses and midwives play an important role in implementing immunization activities at the district level and that their roles can be maximized by creating opportunities that lead to their having more responsibilities in their work and in particular, their involvement in early phases of planning of priority health activities. This should be accompanied by written job descriptions, tasks and clear lines of authority as well as good supportive supervision. The lessons from supplementary immunization activities, where the roles of nurses and midwives are maximized, can be easily adopted to benefit the rest of the health services provided at district level. PMID:19737379

Smart Money

ERIC Educational Resources Information Center

Ullman, Ellen

2009-01-01

From using virtualization technology to accepting lunch payments online, school districts are seeking money-saving methods. In this article, the author discusses some methods used by school districts that allow them to save money from using virtualization technology to accepting lunch payments online.

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.

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.

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).

Organizing Districts for Better Schools: A Summary of School District Reorganization Policies and Procedures. Bulletin, 1958, No. 9

ERIC Educational Resources Information Center

Fitzwater, C. O.

1958-01-01

The establishment of soundly organized local districts for administering the schools has long been a major problem in American education. Methods of dealing with this problem have varied greatly ranging from compulsory reorganization of districts by legislative decree to dependence upon highly permissive laws to be used or ignored as local people…

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…

Report card on school snack food policies among the United States' largest school districts in 2004–2005: Room for improvement

PubMed Central

Greves, H Mollie; Rivara, Frederick P

2006-01-01

Background Federal nutritional guidelines apply to school foods provided through the national school lunch and breakfast programs, but few federal regulations apply to other foods and drinks sold in schools (labeled "competitive foods"), which are often high in calories, fat and sugar. Competitive food policies among school districts are increasingly viewed as an important modifiable factor in the school nutrition environment, particularly to address rising rates of childhood overweight. Congress passed legislation in 2004 requiring all school districts to develop a Wellness Policy that includes nutrition guidelines for competitive foods starting in 2006–2007. In addition, the Institute of Medicine (IOM) recently published recommendations for schools to address childhood obesity. Methods Representatives of school districts with the largest student enrollment in each state and D.C. (N = 51) were interviewed in October-November 2004 about each school district's nutrition policies on "competitive foods." District policies were examined and compared to the Institute of Medicine's recommendations for schools to address childhood obesity. Information about state competitive food policies was accessed via the Internet, and through state and district contacts. Results The 51 districts accounted for 5.9 million students, representing 11% of US students. Nineteen of the 51 districts (39%) had competitive food policies beyond state or federal requirements. The majority of these district policies (79%) were adopted since 2002. School district policies varied in scope and requirements. Ten districts (53%) set different standards by grade level. Most district policies had criteria for food and beverage content (74%) and prohibited the sale of soda in all schools (63%); fewer policies restricted portion size of foods (53%) or beverages (47%). Restrictions more often applied to vending machines (95%), cafeteria à la carte (79%), and student stores (79%) than fundraising activities (47%). Most of the policies did not address more comprehensive approaches to the school nutrition environment, such as nutrition education (32%) or advertising to students (26%), nor did they include guidelines on physical education (11%). In addition, few policies addressed monitoring (32%) or consequences for non-compliance (11%). No policy restricted foods sold for after-school fundraising or required monitoring physical health indicators (e.g. BMI). Conclusion When compared to the Institute of Medicine's recommendations for schools' role in preventing obesity, none of the nutrition policies among each state's largest school district had addressed all the recommendations by 2004–2005. Nutritionists, nurses, pediatricians, parents, and others concerned about child health have an unprecedented opportunity to help shape and implement more comprehensive school district nutrition policies as part of the Congressional requirement for a "Wellness Policy" by 2006–2007. PMID:16390544

Views of teenagers on termination of pregnancy at Muyexe high school in Mopani District, Limpopo Province, South Africa

PubMed Central

Lebese, Tsakani R.; Maputle, Sonto M.; Mulaudzi, Lindiwe

2016-01-01

Background Teenage pregnancy is a global social health concern especially because of the HIV and AIDS pandemic, sexually transmitted infections, high rate of termination of pregnancy (TOP), adolescents’ parenthood and decreased level of contraceptives. Aim To explore the views of teenagers on the TOP at Muyexe high school in a rural village of Mopani District, Limpopo Province. Setting Muyexe high school in a rural village of Mopani District, Limpopo Province, in South Africa. Methodology A qualitative method using explorative and descriptive designs was used to find in-depth description and understanding of teenagers’ views on TOP. The target population was girls aged 15–19 years at Muyexe high school in Mopani District. Non-probability, convenient sampling was used to select high school teenage girls who had undergone TOP for the study. Data were collected using individual self-report technique (interview). Tesch’s eight steps of qualitative data analysis were used. Measures to ensure trustworthiness and ethical considerations were observed. Results Two major themes were revealed: (1) Views of teenagers regarding TOP (poverty, relationship problems and single parenthood, negative impact on the teen’s life while attending school) and (2) teenager’s fears regarding pregnancy (stigma, fear of parents and friends, rape and incest and fear of giving birth). Conclusion Majority of participants had knowledge about TOP; some had experiences about TOP while others held inadequate knowledge. Recommendations were based on the findings by teaching dangers of TOP and various contraceptive methods to prevent unwanted pregnancies and TOP. PMID:27380849

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

Retention of health workers in Malawi: perspectives of health workers and district management

PubMed Central

Manafa, Ogenna; McAuliffe, Eilish; Maseko, Fresier; Bowie, Cameron; MacLachlan, Malcolm; Normand, Charles

2009-01-01

Background Shortage of human resources is a major problem facing Malawi, where more than 50% of the population lives in rural areas. Most of the district health services are provided by clinical health officers specially trained to provide services that would normally be provided by fully qualified doctors or specialists. As this cadre and the cadre of enrolled nurses are the mainstay of the Malawian health service at the district level, it is important that they are supported and motivated to deliver a good standard of service to the population. This study explores how these cadres are managed and motivated and the impact this has on their performance. Methods A quantitative survey measured health workers' job satisfaction, perceptions of the work environment and sense of justice in the workplace, and was reported elsewhere. It emerged that health workers were particularly dissatisfied with what they perceived as unfair access to continuous education and career advancement opportunities, as well as inadequate supervision. These issues and their contribution to demotivation, from the perspective of both management and health workers, were further explored by means of qualitative techniques. Focus group discussions were held with health workers, and key-informant interviews were conducted with members of district health management teams and human resource officers in the Ministry of Health. The focus groups used convenience sampling that included all the different cadres of health workers available and willing to participate on the day the research team visited the health facility. The interviews targeted district health management teams in three districts and the human resources personnel in the Ministry of Health, also sampling those who were available and agreed to participate. Results The results showed that health workers consider continuous education and career progression strategies to be inadequate. Standard human resource management practices such as performance appraisal and the provision of job descriptions were not present in many cases. Health workers felt that they were inadequately supervised, with no feedback on performance. In contrast to health workers, managers did not perceive these human resources management deficiencies in the system as having an impact on motivation. Conclusion A strong human resource management function operating at the district level is likely to improve worker motivation and performance. PMID:19638222

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.

Health facilities at the district level in Indonesia

PubMed Central

Heywood, Peter; Harahap, Nida P

2009-01-01

Background At Independence the Government of Indonesia inherited a weak and unevenly distributed health system to which much of the population had only limited access. In response, the government decided to increase the number of facilities and to locate them closer to the people. To staff these health facilities the government introduced obligatory government service for all new graduates in medicine, nursing and midwifery. Most of these staff also established private practices in the areas in which they were located. The health information system contains little information on the health care facilities established for private practice by these staff. This article reports on the results of enumerating all health facilities in 15 districts in Java. Methods We enumerated all healthcare facilities, public and private, by type in each of 15 districts in Java. Results The enumeration showed a much higher number of healthcare facilities in each district than is shown in most reports and in the health information system which concentrates on public, multi-provider facilities. Across the 15 districts: 86% of facilities were solo-provider facilities for outpatient services; 13% were multi-provider facilities for outpatient services; and 1% were multi-provider facilities offering both outpatient and inpatient services. Conclusion The relatively good distribution of health facilities in Indonesia was achieved through establishing public health centers at the sub-district level and staffing them through a system of compulsory service for doctors, nurses and midwives. Subsequently, these public sector staff also established solo-provider facilities for their own private practice; these solo-provider facilities, of which those for nurses are almost half, comprise the largest category of outpatient care facilities, most are not included in official statistics. Now that Indonesia no longer has mandatory service for newly graduated doctors, nurses and midwives, it will have difficulty maintaining the distribution of facilities and providers established through the 1980s. The current challenge is to envision a new health system that responds to the changing disease patterns as well as the changes in distribution of health facilities. PMID:19445728

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

The dependency on central government funding of decentralised health systems: experiences of the challenges and coping strategies in the Kongwa District, Tanzania

PubMed Central

2014-01-01

Background Decentralised health systems in Tanzania depend largely on funding from the central government to run health services. Experience has shown that central funding in a decentralised system is not an appropriate approach to ensure the effective and efficient performance of local authorities due to several limitations. One of the limitations is that funds from the central government are not disbursed on a timely basis, which in turn, leads to the serious problem of shortage of financial resources for Council Health Management Teams (CHMT). This paper examines how dependency on central government funding in Tanzania affects health activities in Kongwa district council and the strategies used by the CHMT cope with the situation. Methods The study adopted a qualitative approach and data were collected using semi-structured interviews and focus group discussions. One district in the central region of Tanzania was strategically selected. Ten key informants involved in the management of health service delivery at the district level were interviewed and one focus group discussion was held, which consisted of members of the council health management team. The data generated were analysed for themes and patterns. Results The results showed that late disbursement of funds interrupts the implementation of health activities in the district health system. This situation delays the implementation of some activities, while a few activities may not be implemented at all. However, based on their prior knowledge of the anticipated delays in financial disbursements, the council health management team has adopted three main strategies to cope with this situation. These include obtaining supplies and other services on credit, borrowing money from other projects in the council, and using money generated from cost sharing. Conclusion Local government authorities (LGAs) face delays in the disbursement of funds from the central government. This has necessitated introduction of informal coping strategies to deal with the situation. National-level policy and decision makers should minimise the bureaucracy involved in allocating funds to the district health systems to reduce delays. PMID:24460781

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)

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.

Spatial distribution and health risk assessment of toxic metals associated with receptor population density in street dust: a case study of Xiandao District, Changsha, Middle China.

PubMed

Li, Fei; Huang, Jinhui; Zeng, Guangming; Huang, Xiaolong; Liu, Wenchu; Wu, Haipeng; Yuan, Yujie; He, Xiaoxiao; Lai, Mingyong

2015-05-01

Spatial characteristics of the properties (dust organic material and pH), concentrations, and enrichment levels of toxic metals (Ni, Hg, Mn and As) in street dust from Xiandao District (Middle China) were investigated. Method of incorporating receptor population density into noncarcinogenic health risk assessment based on local land use map and geostatistics was developed to identify their priority pollutants/regions of concern. Mean enrichment factors of studied metals decreased in the order of Hg ≈ As > Mn > Ni. For noncarcinogenic effects, the exposure pathway which resulted in the highest levels of exposure risk for children and adults was ingestion except Hg (inhalation of vapors), followed by dermal contact and inhalation. Hazard indexes (HIs) for As, Hg, Mn, and Ni to children and adults revealed the following order: As > Hg > Mn > Ni. Mean HI for As exceeded safe level (1) for children, and the maximum HI (0.99) for Hg was most approached the safe level. Priority regions of concern were indentified in A region at each residential population density and the areas of B at high and moderate residential population density for As and the high residential density area within A region for Hg, respectively. The developed method was proved useful due to its improvement on previous study for making the priority areas of environmental management spatially hierarchical and thus reducing the probability of excessive environmental management.

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…

Reorganizing a Countywide School District: A Critical Analysis of Politics and Policy Development toward Decentralization

ERIC Educational Resources Information Center

Diem, Sarah; Sampson, Carrie; Browning, Laura Gavornik

2018-01-01

Policymakers and educational leaders continue to use school district decentralization as a reform effort that attempts to shift power and authority from central office administration to school-level leadership. In 2015, the Nevada Legislature passed legislation to restructure the Clark County School District (CCSD), the state's largest school…

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,…

Doing More with Less: A Preliminary Study of the School District Investment.

ERIC Educational Resources Information Center

MacPhail-Wilcox, Bettye

1983-01-01

Changes in cash management practices from 1978 to 1981 were investigated in a random sample of 145 North Carolina school districts, stratified by attendance size. Analysis using chi-square tests indicated the level of investment sophistication (as measured by the proportion of cash invested) has increased, especially for large districts. (RW)

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…

Site Selection in School District Research: A Measure of Effectiveness Using Hierarchical Longitudinal Growth Models of Performance

ERIC Educational Resources Information Center

Bowers, Alex J.

2015-01-01

School districts in the USA are an active area of study in education research as findings have shown that some districts find success in certain contexts while others struggle. However, the research domain has had few actionable methods for site selection for in-depth qualitative studies. This study analyses all districts in the state of Ohio (n =…

Stakeholders’ participation in planning and priority setting in the context of a decentralised health care system: the case of prevention of mother to child transmission of HIV programme in Tanzania

PubMed Central

2013-01-01

Background In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania. Methods This qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied in-depth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers. Results Two plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector. Conclusion The challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery. PMID:23849730

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".

Implementation research to improve quality of maternal and newborn health care, Malawi

PubMed Central

Wilhelm, Danielle; Lohmann, Julia; Kambala, Christabel; Chinkhumba, Jobiba; Muula, Adamson S; De Allegri, Manuela

2017-01-01

Abstract Objective To evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi. Methods We conducted a non-randomized controlled before and after study to evaluate the effects of district- and facility-level performance incentives for health workers and management teams. We assessed changes in the facilities’ essential drug stocks, equipment maintenance and clinical obstetric care processes. Difference-in-difference regression models were used to analyse effects of the scheme on adherence to obstetric care treatment protocols and provision of essential drugs, supplies and equipment. Findings We observed 33 health facilities, 23 intervention facilities and 10 control facilities and 401 pregnant women across four districts. The scheme improved the availability of both functional equipment and essential drug stocks in the intervention facilities. We observed positive effects in respect to drug procurement and clinical care activities at non-intervention facilities, likely in response to improved district management performance. Birth assistants’ adherence to clinical protocols improved across all studied facilities as district health managers supervised and coached clinical staff more actively. Conclusion Despite nation-wide stock-outs and extreme health worker shortages, facilities in the study districts managed to improve maternal and neonatal health service quality by overcoming bottlenecks related to supply procurement, equipment maintenance and clinical performance. To strengthen and reform health management structures, performance-based financing may be a promising approach to sustainable improvements in quality of health care. PMID:28670014

Tackling the workforce crisis in district nursing: can the Dutch Buurtzorg model offer a solution and a better patient experience? A mixed methods case study.

PubMed

Drennan, Vari M; Calestani, Melania; Ross, Fiona; Saunders, Mary; West, Peter

2018-06-06

Despite policy intentions for more healthcare out of hospital, district nursing services face multiple funding and staffing challenges, which compromise the care delivered and policy objectives. What is the impact of the adapted Buurtzorg model on feasibility, acceptability and effective outcomes in an English district nursing service? Mixed methods case study. Primary care. Neighbourhood nursing team (Buurtzorg model), patients and carers, general practitioners (GPs), other health professionals, managers and conventional district nurses. The adapted Buurtzorg model of community nursing demonstrated feasibility and acceptability to patients, carers, GPs and other health professionals. For many patients, it was preferable to previous experiences of district nursing in terms of continuity in care, improved support of multiple long-term conditions (encompassing physical, mental and social factors) and proactive care. For the neighbourhood nurses, the ability to make operational and clinical decisions at team level meant adopting practices that made the service more responsive, accessible and efficient and offered a more attractive working environment. Challenges were reported by nurses and managers in relation to the recognition and support of the concept of self-managing teams within a large bureaucratic healthcare organisation. While there were some reports of clinical effectiveness and efficiency, this was not possible to quantify, cost or compare with the standard district nursing service. The adapted Buurtzorg model of neighbourhood nursing holds potential for addressing issues of concern to patients, carers and staff in the community. The two interacting innovations, that is, a renewed focus on patient and carer-centred care and the self-managing team, were implemented in ways that patients, carers, other health professionals and nurses could identify difference for both the nursing care and also the nurses' working lives. It now requires longer term investigation to understand both the mechanism for change and also the sustainability. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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.

Relationship between Instructional Strategies and Students' Performance in the New York State Regents Examination in Integrated Algebra in High Performing Suburban Districts

ERIC Educational Resources Information Center

Quintana, Elizabeth Ruiz

2015-01-01

This mixed method study explored and analyzed instructional strategies utilized by algebra teachers whose students' coursework culminated in the New York State Regents Examination in Integrated Algebra and for whom 50% of the tested cohort earned mastery level (85 or higher) on the examination. The targeted populations were eighth or ninth grade…

Online Course Use in New York High Schools: Results from a Survey in the Greater Capital Region. REL 2015-075

ERIC Educational Resources Information Center

Clements, Margaret; Pazzaglia, Angela M.; Zweig, Jacqueline

2015-01-01

As in most states, New York does not currently have a state-level protocol for collecting data about schools' objectives or methods for offering online courses. The goals of the study conducted by the Regional Educational Laboratory Northeast and Islands' Northeast Rural Districts Research Alliance (NRDRA) were (1) to create a survey tool capable…

Emphasizing Public Health Within a Health Information Exchange: An Evaluation of the District of Columbia’s Health Information Exchange Program

PubMed Central

Goldwater, Jason; Jardim, Juliette; Khan, Tasnuva; Chan, Karen

2014-01-01

Introduction: Clinovations Government Solutions (CGS) was contracted in 2013 to conduct a mixed-methods evaluation of the District of Columbia (D.C.) Health Information Exchange (HIE) program as part of their Cooperative Agreement Grant funded by the Office of the National Coordinator in 2010. The evaluation was to focus on the progress of the HIE, how many providers and hospitals were participating in the program, and what benefits were being realized through the use of the HIE. During the course of the evaluation, the CGS team found that the use of the HIE to support public health reporting was one of its core elements. Background: The D.C. HIE is one of 56 HIE that were funded out of the Cooperative Agreement program. The HIE program was managed by the District of Columbia Department of Health Care Finance (DHCF), which also manages the District of Columbia Medicaid Program. The program was initially designed to accomplish the following: developing state-level directories and enabling technical services for HIE within and across states; ensuring an effective model for governance and accountability; coordinating an integrated approach with Medicaid and public health; and developing or updating privacy and security requirements for HIE within and across state borders. As the evaluation progressed, the CGS team discovered that the relationship between the DHCF and the District of Columbia Department of Health (DOH) had become a cornerstone of the D.C. HIE program. Methods: The CGS team used a mixed-methods approach for the evaluation, including a review of documents developed by the DHCF in its HIE program, including its original application. We also conducted 10 key informant interviews and moderated two small-group discussions using a semistructured protocol; and we developed a survey that measured the use, satisfaction, and future sustainability of the HIE for over 200 providers within the District of Columbia. Findings: While the evaluation focused on the D.C. HIE program in its entirety, the results indicated the value of utilizing the HIE for public health reporting to enhance the surveillance activities of the DOH. Specifically, the DHCF and DOH collaboration resulted in using the HIE to electronically capture and report immunization data; and in requiring electronic lab reporting and results as part of the Meaningful Use Requirement—which can assist in detecting HIV/AIDS and providing better care for the district’s high population of individuals with HIV/AIDS. Electronic lab reporting and electronic prescribing within the HIE can assist the DOH and providers in identifying specific diseases, such as tuberculosis and viral hepatitis, before they affect a significant part of the population. Discussion: Given the severe health disparities in the district, the ability of the D.C. HIE program to collect public health information on affected populations will be instrumental in better understanding and identifying methods of supporting these populations through improved surveillance and identification of the appropriate treatments. The D.C. HIE program is uniquely positioned to support these populations due to the partnership of DHCF with the D.C. DOH. Conclusion and Next Steps: The District of Columbia has made significant strides in expanding its public health infrastructure and activities. Three key areas of growth were identified that have the potential to transform the District of Columbia’s public health approach: establishing sufficient feedback loops, collection of environmental data, integration, and interoperability. PMID:25848617

Mixing methodology, nursing theory and research design for a practice model of district nursing advocacy.

PubMed

Reed, Frances M; Fitzgerald, Les; Rae, Melanie

2016-01-01

To highlight philosophical and theoretical considerations for planning a mixed methods research design that can inform a practice model to guide rural district nursing end of life care. Conceptual models of nursing in the community are general and lack guidance for rural district nursing care. A combination of pragmatism and nurse agency theory can provide a framework for ethical considerations in mixed methods research in the private world of rural district end of life care. Reflection on experience gathered in a two-stage qualitative research phase, involving rural district nurses who use advocacy successfully, can inform a quantitative phase for testing and complementing the data. Ongoing data analysis and integration result in generalisable inferences to achieve the research objective. Mixed methods research that creatively combines philosophical and theoretical elements to guide design in the particular ethical situation of community end of life care can be used to explore an emerging field of interest and test the findings for evidence to guide quality nursing practice. Combining philosophy and nursing theory to guide mixed methods research design increases the opportunity for sound research outcomes that can inform a nursing model of care.

Dental caries prevalence and its association with fluoride level in drinking water in Sana'a, Yemen

PubMed Central

Al-Akwa, Ameen Abdullah; Al-Maweri, Sadeq Ali

2018-01-01

Objectives: Dental caries is the most prevalent chronic condition affecting schoolchildren worldwide. This study is aimed to assess the prevalence of dental caries among schoolchildren in urban and rural districts of Sana'a governorate, Yemen, and to investigate the correlation between caries experience and level of fluoride in drinking water, age, gender, and residence. Materials and Methods: This school-based survey involved 17,599 schoolchildren (aged 6–12 years), of whom 9623 were boys and 7976 were girls. We used decay-missing-filled teeth/decay-filled teeth (DMFT/dft) indices to evaluate dental caries experience. In addition, fluoride concentration in drinking water was investigated. Results: Around 67.6% of children had dental caries. Children residing in urban districts had significantly higher mean scores of DMFT/dft than those in rural areas (P < 0.05). A significant negative correlation between caries experience and fluoride level was found (P < 0.05), with the lowest dft/DMFT scores at the optimum fluoride level of 0.61–2 ppm and the highest at two extremes, 0.0–0.4 ppm and >2 ppm. Conclusion: This survey found a very high prevalence of caries among schoolchildren in Yemen. There was also an inverse relation between dental caries experience and fluoride levels. PMID:29657520

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…

A Case Analysis of a Suburban North Carolina Public School System's Elementary School Level Redistricting Outcomes

ERIC Educational Resources Information Center

LoFrese, Christopher Todd

2014-01-01

This case study explored the socioeconomic integration outcomes of a central North Carolina Public School District's recent elementary level redistricting process. The district's student assignment policy seeks to balance schools in part by the socioeconomic status of students. Previous redistricting efforts used free and reduced price lunch…

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

Evaluation of a monitoring program for assessing the effects of management practices on the quantity and quality of drainwater from the Panoche Water District, western San Joaquin Valley, California

USGS Publications Warehouse

Leighton, David A.; Fio, John L.

1995-01-01

An evaluation was made of an existing monitoring program in the Panoche Water District for 1986-93. The Panoche Water District is an agricultural area located in the western San Joaquin Valley of California. Because irrigation drainage from this area has high concentrations of dissolved solids and selenium, management strategies have been developed to improve the quality of drainwater discharge. The purpose of the Panoche Water District's monitoring program is to assess the effects of water- and land-use practices on local ground water and drain flow from the district. Drainflow from the district consists of the discharge from 50 separate on-farm underground tile-drainage systems. The Panoche Water District maintains information on water deliveries, planned and actual crop types, and planned and actual acreages planted each year. In addition, the water district monitors ground-water and drainage-system discharges using a variety of data-collection methods. A total of 62 observation well sites are used to monitor ground-water level and quality. A total of 42 sites were monitored for drainflow quantity, and drain flow quality samples were collected from the outlets of each of the 50 drainage systems. However, these data were collected inconsistently and (or) intermittently during the period studied. All data obtained from the water district were compiled and stored in a geographic information system database. Water delivered for irrigation by the Panoche Water District is a mix of imported water and local ground water pumped directly into delivery canals. Although delivered water is a mix, information on the proportion of water from the two sources is not reported. Also, individual growers pump directly to their crops unknown quantities of ground water, the total of which could be greater than 60 percent of total applications during years when water district deliveries are greatly reduced (for example, the years during and following a drought). To evaluate the effects of irrigation on ground-water and drainflow quality, data on the combined chemical characteristics and the volume of water applied to crops are needed as part of the district's monitoring program. For example, without these data, this study could estimate only the effects of irrigation on ground-water recharge for 1986 (60.4 106 m3/y), 1987 (74.2 106 m3/y), and 1988 (56.0 106 m3/y) in the Panoche Water District water years when the amount of ground water pumped by individual growers was probably small. Water-level data show a significant decline of the water table in the upslope, undrained parts of the study area, and little or no significant change in the down slope, drained parts of the study area. Pumping from productions wells, most of which are located in the upslope part of the study area, may have contributed to the decline of the water table in the upslope area. The quantities of drainflow, dissolved solids, and selenium discharged from the study area decreased during the study period. However, drainflow, dissolved solids, and selenium discharged from individual on-farm drainage systems did not decrease. These data also illustrate the need for consistent and regular monitoring of the factors that affect drainage in the western San Joaquin Valley.

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.

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.

An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh

PubMed Central

2012-01-01

Background Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh. Methods Using adapted World Health Organization (WHO) hospital assessment tools and standards, an assessment of 18 randomly selected district (n=6) and sub-district (n=12) hospitals was undertaken. Teams of trained assessors used direct case observation, record review, interviews, and Management Information System (MIS) data to assess the quality of clinical case management and monitoring; infrastructure, processes and hospital administration; essential hospital and laboratory supports, drugs and equipment. Results Findings demonstrate that the overall quality of care provided in these hospitals was poor. No hospital had a functioning triage system to prioritise those children most in need of immediate care. Laboratory supports and essential equipment were deficient. Only one hospital had all of the essential drugs for paediatric care. Less than a third of hospitals had a back-up power supply, and just under half had functioning arrangements for safe-drinking water. Clinical case management was found to be sub-optimal for prevalent illnesses, as was the quality of neonatal care. Conclusion Action is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care. PMID:23268650

RISK CHARACTERIZATION OF MATERNAL AND NEONATAL TETANUS IN VIEW OF TETANUS VACCINATION CAMPAIGNS IN PAKISTAN.

PubMed

Khan, Ejaz A; Khan, Rownak; Iqbal, Muhammad Tariq; Hasan, Quamrul; Farrukh, Saadia; Rana, Muhammad Safdar; Khan, Wasiq Mehmood

2015-01-01

Pakistan is one of the remaining 24 countries which have not yet achieved Maternal and Neonatal Tetanus Elimination (MNTE), The country adopted high-risk approach for 56 out of 119 districts with country-wide Tetanus Toxoid (TT) provision in Routine Immunization (RI) during early 2000-2003. The TT's mass campaigns could only cover 13% of high risk districts for 2009- 2011, and mostly for the Punjab province. To achieve MNT elimination, the country needs risk mapping for cost-effective intervention. We used both the quantitative and qualitative methods to conduct risk characterization. All the three available data sets (Reported EPI coverage data, PDHS 2012-13, and PSLM 2010-11) were assessed. A mix of core and surrogate indicators-for risk categorization was used through ranking and scoring the aggregated data and considering the past tetanus campaigns' coverage. Tetanus Toxoid (TT2+)-coverage of pregnant women and delivery in health facility, both received more weightage in scoring. We based the higher and lower cuts off points for each indicator on data ranges. The districts with higher scores, i.e., 10.5 and above were ranked good followed by medium (5.5-10.4) and low performing (less than 5.5). Consultations with the national and provincial field officers were utilized to understand the local context. In Pakistan, there are 139 districts out of which, 60 are the high risk districts for tetanus. Highest percentage is for Baluchistan (83%) followed by Sindh (52%), and Khyber Pakhtunkhwa (40%). Most of the Punjab is at medium risk (55%), followed by KP (52%), and Sindh (39%). Pakistan is at medium to high risk of MNT with a great variation at the sub-national level. Campaigns aiming to these districts may bring the country closer to MNT elimination target.

Income gaps in self-rated poor health and its association with life expectancy in 245 districts of Korea

PubMed Central

2017-01-01

OBJECTIVES To examine the income gaps associated with self-rated poor health at the district level in Korea and to identify the geographical correlations between self-rated poor health, life expectancy, and the associated income gaps. METHODS We analyzed data for 1,578,189 participants from the Community Health Survey of Korea collected between 2008 and 2014. The age-standardized prevalence of self-rated poor health and the associated income gaps were calculated. Previously released data on life expectancy and the associated income gaps were also used. We performed correlation and regression analyses for self-rated poor health, life expectancy, and associated income gaps. RESULTS Across 245 districts, the median prevalence of self-rated poor health was 15.7% (95% confidence interval [CI], 14.6 to 16.8%), with interquartile range (IQR) of 3.1 percentage points (%p). The median interquintile gaps in the prevalence of self-rated poor health was 11.1%p (95% CI, 8.1 to 14.5%p), with IQR of 3.6%p. Pro-rich inequalities in self-rated health were observed across all 245 districts of Korea. The correlation coefficients for the association between self-rated poor health and the associated income gaps, self-rated poor health and life expectancy, and income gaps associated with self-rated poor health and life expectancy were 0.59, 0.78 and 0.55 respectively. CONCLUSIONS Income gaps associated with self-rated poor health were evident across all districts in Korea. The magnitude of income gaps associated with self-rated poor health was larger in the districts with greater prevalence of self-rated poor health. A strong correlation between self-rated poor health and life expectancy was also observed. PMID:28330335

Evaluation of the district health management fellowship training programme: a case study in Iran

PubMed Central

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

2018-01-01

Objective To evaluate the district health management fellowship training programme in the north-west of Iran. Data sources/study setting The programme was introduced to build the managerial capacity of district health managers in Iran. Eighty-nine heads of units in the province’s health centre, district health managers and the health deputies of the district health centres in the north-west provinces of Iran had registered for the district health management fellowship training programme in Tabriz in 2015–2016. Study design This was an educational evaluation study to evaluate training courses to measure participants' reactions and learning and, to a lesser extent, application of training to their job and the organisational impact. Data collection/extraction methods Valid and reliable questionnaires were used to assess learning techniques and views towards the fellowship, and self-assessment of health managers’ knowledge and skills. Also, pretest and post-test examinations were conducted in each course and a portfolio was provided to the trainees to be completed in their work settings. Principal findings About 63% of the participants were medical doctors and 42.3% of them had over 20 years of experience. Learning by practice (scored 18.37 out of 20) and access to publications (17.27) were the most useful methods of training in health planning and management from the participants’ perspective. Moreover, meeting peers from other districts and the academic credibility of teachers were the most important features of the current programme. Based on the managers’ self-assessment, they were most skilful in quality improvement, managing, planning and evaluation of the district. The results of the post-test analysis on data collected from district health managers showed the highest scores in managing the district (77 out of 100) and planning and evaluation (69) of the courses. Conclusion The results of this study indicated that training courses, methods and improvement in managers' knowledge about the health system and the skills necessary to manage their organisation were acceptable. PMID:29525773

Profile of suicide in rural Cameroon: are health systems doing enough?

PubMed

Keugoung, Basile; Kongnyu, Emmanuel Tabah; Meli, Jean; Criel, Bart

2013-08-01

To describe the characteristics of suicide and assess the capacity of health services at the district level in Cameroon to deliver quality mental health care. The study covered the period between 1999 and 2008 and was carried out in Guidiguis health district which had a population of 145 700 inhabitants in 2008. Data collection was based on psychological autopsy methods. To collect data, we used documentary review of medical archives, semi-structured interviews of relatives of suicide completers, a focus group discussion of health committee members and a survey to consulting nurses working at the primary health care level. Forty-seven suicides were recorded from 1999 to 2008: 37 (78.7%) males and 10 (21.3%) females, yielding rates of reported suicides that ranged from 0.89 to 6.54 per 100 000 inhabitants. The most frequently used suicide method was the ingestion of toxic agricultural chemicals (in 76.6% of cases). According to the relatives, the suicides were due to an ongoing chronic illness (31.9%), sexual and marital conflicts (25.5%), witchcraft (14.9%), financial problems (8.5%) or unknown cause (25.5%). In 25 (53.2%) cases, suicide victims exhibited symptoms suggestive of a mental disorder but only six of the suicide committers who presented behavioural symptoms sought health care. Only two of the 15 consulting nurses were able to cite at least three symptoms of depression and were aware that depression can lead to suicide. All of the nurses acknowledged that they had never received any specific training or supervision in mental health care. Suicides are not a rare event in rural settings in Cameroon. The health district capacity to provide quality mental care is almost insignificant. The integration of minimal mental health care services at the community and primary health care levels should be considered a priority in sub-Saharan Africa. © 2013 John Wiley & Sons Ltd.

District Leaders' Framing of Educator Evaluation Policy

ERIC Educational Resources Information Center

Woulfin, Sarah L.; Donaldson, Morgaen L.; Gonzales, Richard

2016-01-01

Purpose: Educator evaluation systems have recently undergone scrutiny and reform, and district and school leaders play a key role in interpreting and enacting these systems. This article uses framing theory to understand district leaders' interpretation and advancement of a state's new educator evaluation policy. Research Methods: The article…

Try a Videotape for Communicating with District Patrons.

ERIC Educational Resources Information Center

DiazGrandox, Frederick

1991-01-01

A small Idaho school district gained public support for a school levy by producing and distributing a videotape of school activities and district needs. The videotape provided a clear, concise presentation of information while avoiding confrontations that often occur with other methods of communication. (Author/SV)

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.

People Participation Towards Opisthorchis viverrini Prevention and Control in Chaiyaphum Province, Northeastern Thailand.

PubMed

Phongsiripapat, Rutjirapat; Chimplee, Kanokporn; Rujirakul, Ratana; Kaewpitoon, Soraya; Keawpitoon, Natthawut

2016-01-01

This cross-sectional descriptive and qualitative study was aimed to study the people participation and their approaches toward the human carcinogenic liver fluke, Opisthorchis viverrini, prevention and control in Ban Chaun sub-district administrative organization (BCSAO) and Bamnet Narong sub-district municipality (BNSM), Bamnet Narong district, Chaiyaphum Province, Thailand between June 2013 and February 2014. Participants were purposive selected, included chiefs of sub-district administrative organizations, sub-district municipalities, sub-district health promotion hospitals (SHPHs), heads of village, and a further sample was selected with a multi- stage random sampling for public health volunteers, and villagers. The pre-designed questionnaire contained items for individualized status and the participatory steps of sharing ideas, decision-making, and planning, procession, evaluation, and mutual benefit, for the project O. viverrini prevention and control (POPC). In-depth interviews were used for collection of need approaches to POPC. With 375 participants who completed the questionnaire, it was found that people had a high level regarding to participate in the POPC, particularly in the process stage (X_ =3.78, S.D. = 0.56), but the lowest level was found in sharing ideas, decision making, and planning step (X_ =3.65, S.D. = 0.63). By comparison, participant status and organization did not significantly differ with people participation. In each step, Ban Chaun sub-district had a high level of participation in the step of sharing ideas, decision making, and planning toward POPC, more than Bamnet Narong sub-district municipality (t=2.20, p=0.028). Approaches for POPC in Ban Chaun sub-district and Bamnet Narong sub-district municipality included requirements for budget support, annual campaigns for liver fluke prevention and control, campaign promotion, risk group observation, home visiting, community rules regarding reducing raw fish consumption in their communities, and a professional public health officer for working in their communities, BCSAO, BNSM, and SHPH, for O. viverrini prevention and control. This study indicates that people realize that eradication of the liver fluke needs a continuous people participation for O. viverrini prevention and control in their communities.

School Safety: Safer Schools with Different Kinds of Safety Personnel

ERIC Educational Resources Information Center

Herreras, Henry

2013-01-01

The purpose of this study was to investigate the difference between the total number of education code violations and the security personnel assigned by the school district. This study also proposed to examine factors such as socio-economic level of the district, the size of the district, and its location. Due to the increase in violence in…

Perceptions of Relationships between District and School Level Administrators on Student Achievement

ERIC Educational Resources Information Center

Brookins, Tyrone

2010-01-01

The purpose of this qualitative study was to assess the extent to which perceived Using a case study of an urban school district, serving 40,000 students in the Midwest region of the United States, this study investigated district and school administrative leaders' perceptions of how their interactions influenced the achievement of black students.…

An Analysis of Community Use Policies in Missouri School Districts

ERIC Educational Resources Information Center

Eyler, Amy A.; Swaller, Erin M.

2012-01-01

Background: Joint use or community use policies are state-, district-, or school-level policies that allow for shared use of space or facilities between a school and a city or private organization. For this study, we (1) created an inventory of community use policies within Missouri school districts; (2) analyzed the policies for content, and (3)…

Goal Setting to Achieve Results

ERIC Educational Resources Information Center

Newman, Rich

2012-01-01

Both districts and individual schools have a very clear set of goals and skills for their students to achieve and master. In fact, except in rare cases, districts and schools develop very detailed goals they wish to pursue. In most cases, unfortunately, only the teachers and staff at a particular school or district-level office are aware of the…

Impact of the Basic Education Program on Educational Spending and Equity in Tennessee.

ERIC Educational Resources Information Center

Goldhaber, Dan; Callahan, Karen

2001-01-01

Examines state- and district-level spending patterns in Tennessee to assess the extent to which the Basic Education Program (BEP) funding formula has affected spending in the state and spending in districts with varying characteristics, for example, poverty status of students, school district size. Suggests that BEP led to greater education…

The ReDistricting Game: Teaching Congressional Gerrymandering through an Online Simulation Game

ERIC Educational Resources Information Center

Juckett, Emily; Feinberg, Joseph R.

2010-01-01

The ReDistricting Game is an online simulation game that engages learners in the redistricting process and spotlights the problem of gerrymandering districts in the United States. Hands-on simulation games such as this one can motivate students to think at higher levels and master key concepts. The concept of redistricting does not automatically…

The Relationship between Student Transfers and District Academic Performance: Accounting for Feedback Effects

ERIC Educational Resources Information Center

Welsch, David M.; Zimmer, David M.

2015-01-01

This paper draws attention to a subtle, but concerning, empirical challenge common in panel data models that seek to estimate the relationship between student transfers and district academic performance. Specifically, if such models have a dynamic element, and if the estimator controls for unobserved traits by including district-level effects,…

Educational Renegades: Dissatisfied Teachers as Drivers of Charter School Formation

ERIC Educational Resources Information Center

Milliman, Scott; Maranto, Robert

2009-01-01

The U.S. charter school movement has expanded rapidly, but this growth is geographically uneven at the school district level. Focusing on Arizona--which has the least restrictive charter school law in the United States--we use district variables to determine the factors driving charter market share in 41 districts. Included in our analysis is an…

Association and Diffusion of Nutrition and Physical Activity Policies on the State and District Level

ERIC Educational Resources Information Center

Taber, Daniel R.; Chriqui, Jamie F.; Chaloupka, Frank J.

2012-01-01

Background: School district wellness policies designed to reduce obesity and promote student health and well-being often lack specific requirements or any mandate that schools comply with the policy. Researchers, educators, and policymakers have called for states to take an active role in shaping district policies. The objective of this study was…

Serving Students Who Are Homeless: A Resource Guide for Schools, Districts, and Educational Leaders

ERIC Educational Resources Information Center

Hallett, Ronald E.; Skrla, Linda

2016-01-01

Schools and districts are seeing unprecedented numbers of students and families living without residential stability. Although the McKinney-Vento Act has been around for over 2 decades, many district- and site-level practitioners have a difficult time interpreting and implementing the Act's mandates within their local contexts. This book provides…

Factors Influencing the Demand and Supply of Public School Teachers in Indiana: An Exploratory Analysis

ERIC Educational Resources Information Center

Debertin, David L.; Huie, John M.

1975-01-01

Describes a conceptual model representing the demand and supply of public school teachers and the relationship between the assessed valuation of property within a school district and the training, experience, and salary levels of teachers in the district, based on an analysis of data from 269 Indiana school districts. (Author/JG)

Leadership Development Institute: A California Community College Multi-College District Case Study

ERIC Educational Resources Information Center

Leon, Bianca R.

2016-01-01

The purpose of this study is to examine a community college district Grow Your Own (GYO) leadership program in the Western United States, the Multi College Leadership Development Institute (MCLDI). The MCLDI was developed in-house for a multi-campus community college district and offered to interested employees at all position levels with the…

Cancer incidence in urban, rural, and densely populated districts close to core cities in Bavaria, Germany.

PubMed

Radespiel-Tröger, M; Geiss, K; Twardella, D; Maier, W; Meyer, M

2018-02-01

An ecologic study on the level of districts was performed to evaluate the possible association between district type and risk of cancer in Bavaria, Southern Germany. Cancer incidence data for the years 2003-2012 were obtained from the population-based cancer registry Bavaria according to sex and cancer site. Data on district type, socio-economic area deprivation, particulate matter exposure, tobacco consumption, and alcohol consumption were obtained from publicly available sources. The possible association between district type and cancer risk adjusted for age, socio-economic area deprivation, particulate matter exposure, tobacco consumption, and alcohol consumption was evaluated using multivariable multi-level negative binomial regression. We found a significantly reduced cancer risk in densely populated districts close to core cities and/or rural districts compared to core cities with respect to the cancer sites mouth and pharynx (women only), liver (both sexes), larynx (both sexes), lung (both sexes), melanoma of the skin (both sexes), mesothelioma (men only), connective and soft tissue (both sexes), corpus uteri, other urinary tract (men only), urinary bladder (both sexes), and non-Hodgkin lymphoma (both sexes). Our findings require further monitoring. Since the apparently increased cancer risk in core cities may be related to lifestyle factors, preventive measures against lifestyle-related cancer could be specifically targeted at populations in deprived core cities.

Analyzing Impact Area of Osym Offices in Istanbul by Idw Method

NASA Astrophysics Data System (ADS)

Kalkan, Y.; Ozturk, O.; Gülnerman, A. G.; Bilgi, S.

2016-12-01

OSYM is the main institute for organizing the national level large scale exams in Turkey. According to the Ministry of National Education of Turkey data, there are 17.588.958 students in the country. Therefore, OSYM has a significant role for everyone from every level of education. More than 15% of the total students are studying in Istanbul. These students have various exams throughout a year, which brings some procedures for each exam to be applied. OSYM Coordination Offices were founded to meet the demands and procedures of these exams and applicants. There are 9 Coordination Offices in Istanbul. Moreover, OSYM Application Centers were founded as support units to OSYM Coordination Offices. These units are under the high schools. There are 67 OSYM Application Centers in Istanbul. In the study, spatial distribution of OSYM Coordination Offices and OSYM Application Centers in Istanbul have been studied related to the transportation network of each district of Istanbul city. Origin Destination Cost Matrix (ODCM) and Invers Distance Weighting (IDW) Method were used to visualize the distribution of OSYM Coordination Offices and Application Centers accessibilities. ODCM measures the nearest paths along the transportation network from origins to destinations. IDW is one of the several interpolation methods allocating values to unknown points. ODCM Method was used to calculate the distances over the transportation network. The results obtained from ODCM Method were used in IDW Method to interpolate the weightings of the OSYM offices and centers. Accessibility of the OSYM Coordination Offices and Application Centers has been detected according to surrounding transportation network. Spatial distribution of existing offices and application centers were evaluated by districts of Istanbul city in conclusion of the study by the ODCM and IDW Methods.

District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries.

PubMed

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

2016-01-01

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. Consensus on trauma care audit filters was built between twenty panellists 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 to 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. Panellists 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 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation--a large bore IV was placed within 15 min of patient arrival; referral--if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. 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 towards improving care for the injured at district-level hospitals in LMICs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prevalence of dental fluorosis & dental caries in association with high levels of drinking water fluoride content in a district of Gujarat, India

PubMed Central

Kotecha, P.V.; Patel, S.V.; Bhalani, K.D.; Shah, D.; Shah, V.S.; Mehta, K.G.

2012-01-01

Background & objectives: Endemic fluorosis resulting from high fluoride concentration in groundwater is a major public health problem in India. This study was carried out to measure and compare the prevalence of dental fluorosis and dental caries in the population residing in high and normal level of fluoride in their drinking water in Vadodara district, Gujarat, India. Methods: A cross-sectional study was conducted in Vadodara district, six of the 261 villages with high fluoride level and five of 1490 with normal fluoride level in drinking water were selected. The data collection was made by house-to-house visits twice during the study period. Results: The dental fluorosis prevalence in high fluoride area was 59.31 per cent while in normal fluoride area it was 39.21 per cent. The prevalence of dental caries in high fluoride area was 39.53 per cent and in normal fluoride area was 48.21 per cent with CI 6.16 to 11.18. Dental fluorosis prevalence was more among males as compared to females. Highest prevalence of dental fluorosis was seen in 12-24 yr age group. Interpretation & conclusions: The risk of dental fluorosis was higher in the areas showing more fluoride content in drinking water and to a lesser degree of dental caries in the same area. High fluoride content is a risk factor for dental fluorosis and problem of dental fluorosis increased with passage of time suggesting that the fluoride content in the water has perhaps increased over time. Longitudinal studies should be conducted to confirm the findings. PMID:22825606

Long-run relative importance of temperature as the main driver to malaria transmission in Limpopo Province, South Africa: a simple econometric approach.

PubMed

Komen, Kibii; Olwoch, Jane; Rautenbach, Hannes; Botai, Joel; Adebayo, Adetunji

2015-03-01

Malaria in Limpopo Province of South Africa is shifting and now observed in originally non-malaria districts, and it is unclear whether climate change drives this shift. This study examines the distribution of malaria at district level in the province, determines direction and strength of the linear relationship and causality between malaria with the meteorological variables (rainfall and temperature) and ascertains their short- and long-run variations. Spatio-temporal method, Correlation analysis and econometric methods are applied. Time series monthly meteorological data (1998-2007) were obtained from South Africa Weather Services, while clinical malaria data came from Malaria Control Centre in Tzaneen (Limpopo Province) and South African Department of Health. We find that malaria changes and pressures vary in different districts with a strong positive correlation between temperature with malaria, r = 0.5212, and a weak positive relationship for rainfall, r = 0.2810. Strong unidirectional causality runs from rainfall and temperature to malaria cases (and not vice versa): F (1, 117) = 3.89, ρ = 0.0232 and F (1, 117) = 20.08, P < 0.001 and between rainfall and temperature, a bi-directional causality exists: F (1, 117) = 19.80; F (1,117) = 17.14, P < 0.001, respectively, meaning that rainfall affects temperature and vice versa. Results show evidence of strong existence of a long-run relationship between climate variables and malaria, with temperature maintaining very high level of significance than rainfall. Temperature, therefore, is more important in influencing malaria transmission in Limpopo Province.

Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso.

PubMed

Ridde, Valéry; Turcotte-Tremblay, Anne-Marie; Souares, Aurélia; Lohmann, Julia; Zombré, David; Koulidiati, Jean Louis; Yaogo, Maurice; Hien, Hervé; Hunt, Matthew; Zongo, Sylvie; De Allegri, Manuela

2014-10-12

The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications. The study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods. Performance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.

Forest-dweller demographics in West Kalimantan, Indonesia.

PubMed

Fox, J; Atok, K

1997-03-01

This study sought to ascertain, from census and other data, the number of people living on state-claimed forest land (SCFL) in West Kalimantan in the outer islands of Indonesia. One aim was to determine why data collection is problematic. In 1990 the outer islands accounted for 38% of total population, 93% of its land mass, and 98% of its forests. 72% of the land mass of the outer islands was designated SCFL. Kalimantan has 38.5 million hectares of SCFL, while West Kalimantan has 9.2 million hectares, or 63% of the land area of the province. In 1990, 3.2 million people lived in West Kalimantan. Two sets of forest cover maps and census statistics at the village level were integrated into the geographic information system (GIS) technology by district and regency boundaries and the location of villages. The fieldwork was conducted in Sengah Temila District in Pontianak Regency and Simpang Hulu District in Ketapang Regency. Four methods were used to estimate forest populations: 1) estimating gross population density, 2) mapping forest villages, 3) adjusting density to account for uneven population distribution, and 4) estimating population densities for specific villages and generalizing to the province level. Methods 3 and 4 gave the most reasonable estimates. Population varied from 650,000 to 1 million. Government census statistics proved to be accurate representations of human population. The 1:50,000 scale of topological maps of West Kalimantan correctly identified the location of villages listed in the census. The Indonesian Ministry of Forestry's forest-planning maps and the RePPProT maps both reported similar SCFL. The GIS technology was useful in integrating data from several sources. The lack of knowledge was not due to political or institutional interests.

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.

Knowledge and practices of general practitioners at district hospitals towards cervical cancer prevention in Burundi, 2015: a cross-sectional study.

PubMed

Ndizeye, Zacharie; Vanden Broeck, Davy; Vermandere, Heleen; Bogers, John Paul; Van Geertruyden, Jean-Pierre

2018-01-16

Well-organized screening and treatment programmes are effective to prevent Invasive Cervical Cancer (ICC) in LMICs. To achieve this, the World Health Organization (WHO) recommends the involvement of existing health personnel in casu doctors, nurses, midwives in ICC prevention. A necessary precondition is that health personnel have appropriate knowledge about ICC. Therefore, to inform policy makers and training institutions in Burundi, we documented the knowledge and practices of general practitioners (GPs) at district hospital level towards ICC control. A descriptive cross-sectional survey was conducted from February to April, 2015 among all GPs working in government district hospitals. A structured questionnaire and a scoring system were used to assess knowledge and practices of GPs. The participation rate was 58.2%. Majority of GPs (76.3%) had appropriate knowledge (score > 70%) on cervical cancer disease; but some risk factors were less well known as smoking and the 2 most important oncogenic HPV. Only 8.4% of the participants had appropriate knowledge on ICC prevention: 55% of the participants were aware that HPV vaccination exists and 48.1% knew cryotherapy as a treatment method for CIN. Further, 15.3% was aware of VIA as a screening method. The majority of the participants (87%) never or rarely propose screening tests to their clients. Only 2 participants (1.5%) have already performed VIA/VILI. Wrong thoughts were also reported: 39.7% thought that CIN could be treated with radiotherapy; 3.1% thought that X-ray is a screening method. In this comprehensive assessment, we observed that Burundian GPs have a very low knowledge level about ICC prevention, screening and treatment. Suboptimal practices and wrong thoughts related to ICC screening and treatments have also been documented. We therefore recommend an adequate pre- and in-service training of GPs and most probably nurses on ICC control before setting up any public health intervention on ICC control.

Estimating the prevalence of 26 health-related indicators at neighbourhood level in the Netherlands using structured additive regression.

PubMed

van de Kassteele, Jan; Zwakhals, Laurens; Breugelmans, Oscar; Ameling, Caroline; van den Brink, Carolien

2017-07-01

Local policy makers increasingly need information on health-related indicators at smaller geographic levels like districts or neighbourhoods. Although more large data sources have become available, direct estimates of the prevalence of a health-related indicator cannot be produced for neighbourhoods for which only small samples or no samples are available. Small area estimation provides a solution, but unit-level models for binary-valued outcomes that can handle both non-linear effects of the predictors and spatially correlated random effects in a unified framework are rarely encountered. We used data on 26 binary-valued health-related indicators collected on 387,195 persons in the Netherlands. We associated the health-related indicators at the individual level with a set of 12 predictors obtained from national registry data. We formulated a structured additive regression model for small area estimation. The model captured potential non-linear relations between the predictors and the outcome through additive terms in a functional form using penalized splines and included a term that accounted for spatially correlated heterogeneity between neighbourhoods. The registry data were used to predict individual outcomes which in turn are aggregated into higher geographical levels, i.e. neighbourhoods. We validated our method by comparing the estimated prevalences with observed prevalences at the individual level and by comparing the estimated prevalences with direct estimates obtained by weighting methods at municipality level. We estimated the prevalence of the 26 health-related indicators for 415 municipalities, 2599 districts and 11,432 neighbourhoods in the Netherlands. We illustrate our method on overweight data and show that there are distinct geographic patterns in the overweight prevalence. Calibration plots show that the estimated prevalences agree very well with observed prevalences at the individual level. The estimated prevalences agree reasonably well with the direct estimates at the municipal level. Structured additive regression is a useful tool to provide small area estimates in a unified framework. We are able to produce valid nationwide small area estimates of 26 health-related indicators at neighbourhood level in the Netherlands. The results can be used for local policy makers to make appropriate health policy decisions.

Nation's Capital to cover low-income women's abortions.

PubMed

1994-04-15

Sharon Pratt Kelly, the mayor of the District of Columbia, has announced that, effective May 1, 1994, the city will use its Medical Charities Fund to pay for "medically appropriate" abortions for women with annual incomes of US$13,200 who do not have health insurance that covers abortions. This income level represents 185% of the federal poverty level for single women. The determination as to whether an abortion is "appropriate" will be made by the woman's physician. From 1989-93, there was a ban on the use of District of Columbia tax monies to cover abortions for local women. In 1988, however, approximately 4000 District women received funding for their abortions. The US$1 million Medical Charities Fund was originally set up to cover emergency room bills for low-income District residents who did not qualify for Medicaid. $650,000 is expected to be added to the fund; in addition, the District's 1995 budget will allocate funding earmarked for abortion coverage for low-income women.

Granite School District First Grade Reading Study.

ERIC Educational Resources Information Center

Castner, Myra H.; And Others

A comparative study of first-grade reading instructional methods was undertaken with the support of the Granite School District Exemplary Center for Reading Instruction. This study was conducted in 19 schools of the district and involved approximately 1,295 students. Nine hypotheses concerning the various approaches used in reading instruction…

Michigan School Privatization Survey 2010

ERIC Educational Resources Information Center

Hohman, James M.; Anderson, Dustin D.

2010-01-01

Privatization of support services has been a method that Michigan school districts have used for several years to lower costs. More than ever before, Michigan school districts are privatizing the three main support services they offer--food, custodial and transportation. The annual survey finds that 48.8 percent of Michigan school districts are…

Everybody Leads: A Model for Collaborative Leadership

ERIC Educational Resources Information Center

Maxfield, C. Robert; Klocko, Barbara A.

2010-01-01

This mixed-methods case study analyzes the perceptions of participants in a year-long collaborative leadership initiative conducted at a small school district situated between larger urban districts and multiple suburban districts in a midwestern state. The initiative was facilitated by the Galileo Institute for Teacher Leadership in cooperation…

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.

Application of lot quality assurance sampling for leprosy elimination monitoring--examination of some critical factors.

PubMed

Gupte, M D; Murthy, B N; Mahmood, K; Meeralakshmi, S; Nagaraju, B; Prabhakaran, R

2004-04-01

The concept of elimination of an infectious disease is different from eradication and in a way from control as well. In disease elimination programmes the desired reduced level of prevalence is set up as the target to be achieved in a practical time frame. Elimination can be considered in the context of national or regional levels. Prevalence levels depend on occurrence of new cases and thus could remain fluctuating. There are no ready pragmatic methods to monitor the progress of leprosy elimination programmes. We therefore tried to explore newer methods to answer these demands. With the lowering of prevalence of leprosy to the desired level of 1 case per 10000 population at the global level, the programme administrators' concern will be shifted to smaller areas e.g. national and sub-national levels. For monitoring this situation, we earlier observed that lot quality assurance sampling (LQAS), a quality control tool in industry was useful in the initially high endemic areas. However, critical factors such as geographical distribution of cases and adoption of cluster sampling design instead of simple random sampling design deserve attention before LQAS could generally be recommended. The present exercise was aimed at validating applicability of LQAS, and adopting these modifications for monitoring leprosy elimination in Tamil Nadu state, which was highly endemic for leprosy. A representative sample of 64000 people drawn from eight districts of Tamil Nadu state, India, with maximum allowable number of 25 cases was considered, using LQAS methodology to test whether leprosy prevalence was at or below 7 per 10000 population. Expected number of cases for each district was obtained assuming Poisson distribution. Goodness of fit for the observed and expected cases (closeness of the expected number of cases to those observed) was tested through chi(2). Enhancing factor (design effect) for sample size was obtained by computing the intraclass correlation. The survey actually covered a population of 62157 individuals, of whom 56469 (90.8%) were examined. Ninety-six cases were detected and this number far exceeded the critical value of 25. The number of cases for each district and the number of cases in the entire surveyed area both followed Poisson distribution. The intraclass correlation coefficients were close to zero and the design effect was observed to be close to one. Based on the LQAS exercises leprosy prevalence in the state of Tamil Nadu in India was above 7 per 10000. LQAS method using clusters was validated for monitoring leprosy elimination in high endemic areas. Use of cluster sampling makes this method further useful as a rapid assessment procedure. This method needs to be tested for its applicability in moderate and low endemic areas, where the sample size may need increasing. It is further possible to consider LQAS as a monitoring tool for elimination programmes with respect to other disease conditions.

Kenya’s emergency-hire nursing programme: a pilot evaluation of health service delivery in two districts

PubMed Central

2014-01-01

Objective To assess the feasibility of utilizing a small-scale, low-cost, pilot evaluation in assessing the short-term impact of Kenya’s emergency-hire nursing programme (EHP) on the delivery of health services (outpatient visits and maternal-child health indicators) in two underserved health districts with high HIV/AIDS prevalence. Methods Six primary outcomes were assessed through the collection of data from facility-level health management forms—total general outpatient visits, vaginal deliveries, caesarean sections, antenatal care (ANC) attendance, ANC clients tested for HIV, and deliveries to HIV-positive women. Data on outcome measures were assessed both pre-and post-emergency-hire nurse placement. Informal discussions were also conducted to obtain supporting qualitative data. Findings The majority of EHP nurses were placed in Suba (15.5%) and Siaya (13%) districts. At the time of the intervention, we describe an increase in total general outpatient visits, vaginal deliveries and caesarean sections within both districts. Similar significant increases were seen with ANC attendance and deliveries to HIV-positive women. Despite increases in the quantity of health services immediately following nurse placement, these levels were often not sustained. We identify several factors that challenge the long-term sustainability of these staffing enhancements. Conclusions There are multiple factors beyond increasing the supply of nurses that affect the delivery of health services. We believe this pilot evaluation sets the foundation for future, larger and more comprehensive studies further elaborating on the interface between interventions to alleviate nursing shortages and promote enhanced health service delivery. We also stress the importance of strong national and local relationships in conducting future studies. PMID:24636052

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.

Hemoglobin status of non-school going adolescent girls in three districts of Orissa, India.

PubMed

Bulliyy, Gandham; Mallick, Gitanjali; Sethy, Girija Sankar; Kar, Santanu Kumar

2007-01-01

Anemia is a major public health problem in young children and pregnant women in SouthEast Asia, but a paucity of data on anemia in adolescent girls in India. Studies are lacking on the entire non-school going adolescent population. To determine the prevalence of anemia in non-school going adolescent girls and the association between hemoglobin (Hb) concentration and socioeconomic and nutritional factors. A cross-sectional community study conducted on a sample of 1937 healthy adolescent girls aged 11-19 years from three districts of Orissa, India. Sample size was determined using a probability proportionate to size cluster sampling. The adolescent girls were interviewed and anthropometric measurements were collected. The Hb estimation was carried out in capillary blood samples using the cyanmethemoglobin method. Anemia and nutritional status were evaluated according to standard procedures. The mean Hb concentration was 9.7 +/- 1.4 g/dL (range, 4.5-13.4 g/dL). Of the total adolescent girls, 1869 (96.5%) were anemic (Hb < 12.0 g/dL), of which, 45.2%, 46.9% and 4.4% had mild, moderate, and severe anemia, respectively. A significant curvilinear relation was found between Hb concentration and age, with the nadir of the curve occurring in the 12-14 years age group. Girls from Bargarh district had significantly lower mean Hb levels than those from the Jajpur and Khurda districts. Significant positive associations were found between Hb concentration and pre-menarche, community, education levels of girls and their parents' family income, body mass index, and mid-upper arm circumference. This study revealed that prevalence of anemia was extremely high in non-school going adolescent girls (most were moderately anemic) and stressed the need for more research and public health interventions.

From their own perspective - constraints in the Polio Eradication Initiative: perceptions of health workers and managers in a district of Pakistan's Punjab province

PubMed Central

2010-01-01

Background The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. This paper describes the perceptions of health workers and managers regarding constraints in the Polio Eradication Initiative (PEI) to ultimately provide evidence for designing future interventions. Methods A qualitative cross-sectional study using focus group discussions and in-depth interviews was conducted in the Nankana Sahib District of Pakistan's Punjab province. Study subjects included staff at all levels in the PEI at district headquarters, in all 4 tehsils (sub-districts) and at 20 randomly selected primary health centers. In total, 4 FGD and 7 interview sessions were conducted and individual session summary notes were prepared and later synthesized, consolidated and subjected to conceptual analysis. Results The main constraints identified in the study were the poor condition of the cold chain in all aspects, poor skills and a lack of authority in resource allocation and human resource management, limited advocacy and communication resources, a lack of skills and training among staff at all levels in the PEI/EPI in almost all aspects of the program, a deficiency of public health professionals, poor health services structure, administrative issues (including ineffective means of performance evaluation, bureaucratic and political influences, problems in vaccination areas and field programs, no birth records at health facilities, and poor linkage between different preventive programs), unreliable reporting and poor monitoring and supervision systems, limited use of local data for interventions, and unclear roles and responsibilities after decentralization. Conclusion The study highlights various shortcomings and bottlenecks in the PEI, and the barriers identified should be considered in prioritizing future strategies. PMID:20731832

Effects of a Data-Driven District-Level Reform Model

ERIC Educational Resources Information Center

Slavin, Robert E.; Holmes, GwenCarol; Madden, Nancy A.; Chamberlain, Anne; Cheung, Alan

2010-01-01

Despite a quarter-century of reform, US schools serving students in poverty continue to lag far behind other schools. There are proven programs, but these are not widely used. This large-scale experiment evaluated a district-level reform model created by the Center for DataDriven Reform in Education (CDDRE). The CDDRE model provided consultation…

Different Types of Leadership Styles Found in School Districts, Both at the Building Level and District Level

ERIC Educational Resources Information Center

Fournier, John

2012-01-01

In American public education today, a school can become successful or unsuccessful based on leadership. In this age of school reform, it is only appropriate to determine common leadership characteristics among successful educational leaders so that appropriate leadership training and development can be part of school improvement. This dissertation…

Collaboration to Achieve Whole School SEL across a Large, Urban District

ERIC Educational Resources Information Center

Porche, Michelle; Grossman, Jenny; Biro, Nova; MacKay, Nancy; Rivers, Sojourner

2014-01-01

Research on social and emotional learning (SEL) has largely focused on classroom interventions and student-­ and classroom­-level outcomes. Few studies have examined whole­-school and district-­level SEL implementations, or how to ensure that SEL programs are implemented effectively and sustained over time. This study examines both process…

Including All Families in Education: School District-Level Efforts to Promote Parent Engagement in Ontario, Canada

ERIC Educational Resources Information Center

Hands, Catherine

2013-01-01

Parent engagement plays an essential role in student achievement and well-being, but not all families are able to participate in their children's education. This article focuses on strategies for reaching and supporting parents who face challenges to engagement such as poverty and cultural diversity. Five district-level parent engagement projects…

A Case Study of Secondary District-Level Literacy Coaches' Beliefs about How to Teach Reading

ERIC Educational Resources Information Center

Crawford, Pamela Sharp

2012-01-01

This was a qualitative case study that compared data across six district-level literacy coaches' epistemological and ontological beliefs about how to teach reading. All six coaches were working as a cohort of literacy coaches on the development and implementation of a secondary reading intervention program for seventh-grade struggling readers.…

An Ethnographic Study of Haitian Administrators in New York and Florida Public Schools

ERIC Educational Resources Information Center

Leveque, Yanique

2012-01-01

The purpose of this study was to cast some light on the current level of participation of Haitians in the educational system transformation at the school district level. This study will increase our understanding and appreciation of the unique characteristics and the rich cultural resources that administrators bring to the school district where…

A Distributional Difference-in-Difference Evaluation of the Response of School Expenditures to Reforms and Tax Limits

ERIC Educational Resources Information Center

McMillen, Daniel P.; Singell, Larry D., Jr.

2010-01-01

Prior work uses a parametric approach to study the distributional effects of school finance reform and finds evidence that reform yields greater equality of school expenditures by lowering spending in high-spending districts (leveling down) or increasing spending in low-spending districts (leveling up). We develop a kernel density…

The Lilead Survey: A National Study of District-Level Library Supervisors: Roles, Responsibilities, Challenges, and Professional Development Needs

ERIC Educational Resources Information Center

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

2017-01-01

The school district library supervisor plays a pivotal role in supporting, advising, and providing professional development to building-level librarians; advocating for the program; providing leadership; and representing school library programs to stakeholders in the school system and the larger community. To gain a better understanding of…

Potentiometric surface map of the Floridan Aquifer in the St Johns River Water Management District and vicinity, Florida, September, 1977

USGS Publications Warehouse

Watkins, F.A.; Laughlin, C.P.; Hayes, E.C.

1977-01-01

This map presents the potentiometric surface of the Floridan aquifer in the St. Johns River Water Management District and vicinity for September 1977. The Floridan aquifer is the principal source of potable water in the area. Water-level measurements were made on approximately 900 wells and springs. The potentiometric surface is shown by 5-foot contours except in the Fernandina Beach area where 10- and 20-foot contours are used to show the deep cone of depression. This is the first map covering the entire St. Johns River Water Management District and vicinity for September, a high water-level period. The potentiometric surface ranged from 130 feet above mean sea level in Polk County to 131 feet below sea level in Nassau County. (Woodard-USGS)

Open access tools for quality-assured and efficient data entry in a large, state-wide tobacco survey in India

PubMed Central

Shewade, Hemant Deepak; Vidhubala, E; Subramani, Divyaraj Prabhakar; Lal, Pranay; Bhatt, Neelam; Sundaramoorthi, C.; Singh, Rana J.; Kumar, Ajay M. V.

2017-01-01

ABSTRACT Background: A large state-wide tobacco survey was conducted using modified version of pretested, globally validated Global Adult Tobacco Survey (GATS) questionnaire in 2015–22016 in Tamil Nadu, India. Due to resource constrains, data collection was carrid out using paper-based questionnaires (unlike the GATS-India, 2009–2010, which used hand-held computer devices) while data entry was done using open access tools. The objective of this paper is to describe the process of data entry and assess its quality assurance and efficiency. Methods: In EpiData language, a variable is referred to as ‘field’ and a questionnaire (set of fields) as ‘record’. EpiData software was used for double data entry with adequate checks followed by validation. Teamviewer was used for remote training and trouble shooting. The EpiData databases (one each for each district and each zone in Chennai city) were housed in shared Dropbox folders, which enabled secure sharing of files and automatic back-up. Each database for a district/zone had separate file for data entry of household level and individual level questionnaire. Results: Of 32,945 households, there were 111,363 individuals aged ≥15 years. The average proportion of records with data entry errors for a district/zone in household level and individual level file was 4% and 24%, respectively. These are the errors that would have gone unnoticed if single entry was used. The median (inter-quartile range) time taken for double data entry for a single household level and individual level questionnaire was 30 (24, 40) s and 86 (64, 126) s, respectively. Conclusion: Efficient and quality-assured near-real-time data entry in a large sub-national tobacco survey was performed using innovative, resource-efficient use of open access tools. PMID:29092673

The Professional Development Needs of School-Based Leadership in Preparation for a District-Wide One-to-One Initiative in a Large Urban School District

ERIC Educational Resources Information Center

Simmons, Brandon Dean

2015-01-01

The purpose of this study was to determine the professional development needs of school-based leadership in preparation for a district-wide one-to-one initiative in a large urban school district. This study used an explanatory sequential mixed methods design to answer the three research questions that drove the study. Research for this study was…

Spatial autocorrelation in uptake of antenatal care and relationship to individual, household and village-level factors: results from a community-based survey of pregnant women in six districts in western Kenya.

PubMed

Prudhomme O'Meara, Wendy; Platt, Alyssa; Naanyu, Violet; Cole, Donald; Ndege, Samson

2013-12-07

The majority of maternal deaths, stillbirths, and neonatal deaths are concentrated in a few countries, many of which have weak health systems, poor access to health services, and low coverage of key health interventions. Early and consistent antenatal care (ANC) attendance could significantly reduce maternal and neonatal morbidity and mortality. Despite this, most Kenyan mothers initiate ANC care late in pregnancy and attend fewer than the recommended visits. We used survey data from 6,200 pregnant women across six districts in western Kenya to understand demand-side factors related to use of ANC. Bayesian multi-level models were developed to explore the relative importance of individual, household and village-level factors in relation to ANC use. There is significant spatial autocorrelation of ANC attendance in three of the six districts and considerable heterogeneity in factors related to ANC use between districts. Working outside the home limited ANC attendance. Maternal age, the number of small children in the household, and ownership of livestock were important in some districts, but not all. Village proportions of pregnancy in women of child-bearing age was significantly correlated to ANC use in three of the six districts. Geographic distance to health facilities and the type of nearest facility was not correlated with ANC use. After incorporating individual, household and village-level covariates, no residual spatial autocorrelation remained in the outcome. ANC attendance was consistently low across all the districts, but factors related to poor attendance varied. This heterogeneity is expected for an outcome that is highly influenced by socio-cultural values and local context. Interventions to improve use of ANC must be tailored to local context and should include explicit approaches to reach women who work outside the home.

Home modification to reduce falls at a health district level: Modeling health gain, health inequalities and health costs.

PubMed

Wilson, Nick; Kvizhinadze, Giorgi; Pega, Frank; Nair, Nisha; Blakely, Tony

2017-01-01

There is some evidence that home safety assessment and modification (HSAM) is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level. A previously established Markov macro-simulation model built for the whole New Zealand (NZ) population (Pega et al 2016, Injury Prevention) was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial. In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280). The net health system cost was estimated at NZ$8.44 million (95% UI: $663 to $14.3 million). The incremental cost-effectiveness ratio (ICER) was estimated at NZ$5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ$15,300 [equivalent to US$10,300]). Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: $700 and $832, respectively) with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: Māori (Indigenous population) vs non-Māori. This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases.

Differential Impacts of Intensive District-Level Technical Assistance on Student Achievement: A Study of California's District Assistance and Intervention Teams

ERIC Educational Resources Information Center

Strunk, Katharine O.; McEachin, Andrew

2012-01-01

Building on Strunk, McEachin, and Westover (2011), the authors examine whether or not District Assistance and Intervention Teams (DAITs) have a differential impact on student performance across school and student characteristics. They use a quasi-experimental design to examine the impacts of DAITs on student achievement on math and English…

The Nation's Report Card Mathematics 2011 Trial Urban District Snapshot Report. School District of Philadelphia. Grade 8, Public Schools

ERIC Educational Resources Information Center

National Center for Education Statistics, 2011

2011-01-01

This one-page report presents overall results, achievement level percentages and average score results, scores at selected percentiles, average scores for district and large cities, results for student groups (school race, gender, and eligibility for National School Lunch Program) in 2011, and score gaps for student groups. In 2011, the average…

Gifted and at Risk: A Cross-District Comparison of Gifted Student Growth and Solutions for Urban Schools

ERIC Educational Resources Information Center

Kurt, Layla J.; Chenault, Krystel H.

2017-01-01

In this study, the researchers highlight differences in district level value-added growth data of gifted students in urban and suburban districts, as categorized by the Ohio Department of Education. In addition to analyzing the difference between the academic growth of urban and suburban gifted students, the researchers sought to synthesize…

Evaluation of Social and Academic Effects of School-Wide Positive Behaviour Support in a Canadian School District

ERIC Educational Resources Information Center

McIntosh, Kent; Bennett, Joanna L.; Price, Kathy

2011-01-01

This article discusses School-wide Positive Behaviour Support (SWPBS), an evidence-based approach to teaching social competencies and enhancing the school social environment. The focus of this article is on the value of evaluation and evaluation plans at a district level for maintaining and increasing the effectiveness of SWPBS in a district. We…

Experiences of Leaders in One Texas School District Integrating Social Media as a Communication Medium: Bounded Phenomenological Case Study

ERIC Educational Resources Information Center

Lewis, Bradley D.

2017-01-01

The purpose of this bounded phenomenological case study was to investigate the experiences of leaders in one Texas school district integrating social media into communication practices. The participants in this study were twelve campus leaders, four district level leaders, and the superintendent of schools. The focus groups consisted of three…

States Train Sights on School Districts for Interventions

ERIC Educational Resources Information Center

Olson, Lynn

2004-01-01

After years of trying to fix trouble schools one at a time, a number of states are weighing stronger measures for intervening in low-performing school districts. The shift is seen as a response to the federal No Child Left Behind Act. States are turning in a bigger way to district-level strategies, in part because as their own accountability…

Deregulation of the Electric Industry and Its Potential Benefits for School Districts.

ERIC Educational Resources Information Center

Watkiss, Jeffrey D.

1997-01-01

The electric utility industry is the last bastion of regulated monopolies in the United States. An overview of recent competition in the electric-power industry at both the federal and state levels and how this may affect school districts is offered in this article. The text identifies and evaluates how school districts can obtain cheaper power…

The Nation's Report Card Mathematics 2011 Trial Urban District Snapshot Report. Cleveland Metropolitan School District. Grade 4, Public Schools

ERIC Educational Resources Information Center

National Center for Education Statistics, 2011

2011-01-01

This one-page report presents overall results, achievement level percentages and average score results, scores at selected percentiles, average scores for district and large cities, results for student groups (school race, gender, and eligibility for National School Lunch Program) in 2011, and score gaps for student groups. In 2011, the average…

Metamorphosis: Texas District Opts for Learner-Centered Professional Learning

ERIC Educational Resources Information Center

Ellinger, Alan; Launius, Keri; Scott, Annette

2017-01-01

Like many districts across the United States, Galveston, Texas, is focused on building a culture of excellence. The district is a study in contrasts. On one hand, it is laced with opulent vacation homes and resort hotels used by out-of-town owners. On the other, the median household income level is $28,895, with 22% of the population living below…

The Student Voice Collaborative: An Effort to Systematize Student Participation in School and District Improvement

ERIC Educational Resources Information Center

Sussman, Ari

2015-01-01

This chapter recounts the first 3 years of the Student Voice Collaborative (SVC) in New York City, a district supported student leadership initiative that engages high school aged youth in school reform work at school and district levels. Based on his experiences developing and running the SVC, the author identifies nine design and implementation…

Can a District-Level Teacher Salary Incentive Policy Improve Teacher Recruitment and Retention? Policy Brief 13-4

ERIC Educational Resources Information Center

Hough, Heather J.; Loeb, Susanna

2013-01-01

In this policy brief, Heather Hough and Susanna Loeb examine the effect of the Quality Teacher and Education Act of 2008 (QTEA) on teacher recruitment, retention, and overall teacher quality in the San Francisco Unified School District (SFUSD). They provide evidence that a salary increase can improve a school district's attractiveness within their…

The Nation's Report Card Reading 2011 Trial Urban District Snapshot Report. San Diego Unified School District. Grade 8, Public Schools

ERIC Educational Resources Information Center

National Center for Education Statistics, 2011

2011-01-01

This one-page report presents overall results, achievement level percentages and average score results, scores at selected percentiles, average scores for district and large cities, results for student groups (school race, gender, and eligibility for National School Lunch Program) in 2011, and score gaps for student groups. In 2011, the average…

The Nation's Report Card Mathematics 2011 Trial Urban District Snapshot Report. San Diego Unified School District. Grade 8, Public Schools

ERIC Educational Resources Information Center

National Center for Education Statistics, 2011

2011-01-01

This one-page report presents overall results, achievement level percentages and average score results, scores at selected percentiles, average scores for district and large cities, results for student groups (school race, gender, and eligibility for National School Lunch Program) in 2011, and score gaps for student groups. In 2011, the average…

The Nation's Report Card Mathematics 2011 Trial Urban District Snapshot Report. San Diego Unified School District. Grade 4, Public Schools

ERIC Educational Resources Information Center

National Center for Education Statistics, 2011

2011-01-01

This one-page report presents overall results, achievement level percentages and average score results, scores at selected percentiles, average scores for district and large cities, results for student groups (school race, gender, and eligibility for National School Lunch Program) in 2011, and score gaps for student groups. In 2011, the average…

The Nation's Report Card Reading 2011 Trial Urban District Snapshot Report. San Diego Unified School District. Grade 4, Public Schools

ERIC Educational Resources Information Center

National Center for Education Statistics, 2011

2011-01-01

This one-page report presents overall results, achievement level percentages and average score results, scores at selected percentiles, average scores for district and large cities, results for student groups (school race, gender, and eligibility for National School Lunch Program) in 2011, and score gaps for student groups. In 2011, the average…

Improving Literacy for Diverse, Low Socioeconomic Status, Middle School Students in an Urban District

ERIC Educational Resources Information Center

Means, Vivian Fowler

2017-01-01

In an urban district, Surfside School personnel were concerned that student literacy proficiency levels were low during 2011-2014 and teachers had not been able to close the achievement gap despite a focus on literacy practices and literacy professional development (PD) provided by the district. The purpose of this case study was to explore the…

The Nation's Report Card Reading 2011 Trial Urban District Snapshot Report. Austin Independent School District. Grade 4, Public Schools

ERIC Educational Resources Information Center

National Center for Education Statistics, 2011

2011-01-01

This one-page report presents overall results, achievement level percentages and average score results, scores at selected percentiles, average scores for district and large cities, results for student groups (school race, gender, and eligibility for National School Lunch Program) in 2011, and score gaps for student groups. In 2011, the average…

The Nation's Report Card Reading 2011 Trial Urban District Snapshot Report. Austin Independent School District. Grade 8, Public Schools

ERIC Educational Resources Information Center

National Center for Education Statistics, 2011

2011-01-01

This one-page report presents overall results, achievement level percentages and average score results, scores at selected percentiles, average scores for district and large cities, results for student groups (school race, gender, and eligibility for National School Lunch Program) in 2011, and score gaps for student groups. In 2011, the average…

The Nation's Report Card Mathematics 2011 Trial Urban District Snapshot Report. Austin Independent School District. Grade 8, Public Schools

ERIC Educational Resources Information Center

National Center for Education Statistics, 2011

2011-01-01

This one-page report presents overall results, achievement level percentages and average score results, scores at selected percentiles, average scores for district and large cities, results for student groups (school race, gender, and eligibility for National School Lunch Program) in 2011, and score gaps for student groups. In 2011, the average…

The Nation's Report Card Mathematics 2011 Trial Urban District Snapshot Report. Austin Independent School District. Grade 4, Public Schools

ERIC Educational Resources Information Center

National Center for Education Statistics, 2011

2011-01-01

This one-page report presents overall results, achievement level percentages and average score results, scores at selected percentiles, average scores for district and large cities, results for student groups (school race, gender, and eligibility for National School Lunch Program) in 2011, and score gaps for student groups. In 2011, the average…

THE MARY KATHLEEN URANIUM PROJECT

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

Nelson, A.

1960-02-01

A description is given of uranium mining and milling methods at the Mary Kathleen Mine in the Cloncurry-Mt. Isa district of Queensland, Australia. The discovery of this property and its development are outlined. The deposit cecurs in highly altered meta-sediments in the corella beds of lower proterozoic age. Because of the considerable internal waste in the deposit, it was necessary to devise a selective mining method which would keep dilution to the lowest possible level. The mining, haulage and handling, premilling program, drilling, and blasting are discussed. (M.C.G.)