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PubMed1989

Use of ethnographic research for instrument development in a case-control study of immunization use in Haiti.

A rapid ethnographic assessment of barriers to health service utilization was conducted to identify maternal factors predicting use of child immunizations in Haiti. Methods included four focus group interviews, four natural group interviews, individual interviews with 14 health care providers and participant observation at vaccination posts. Analysis of qualitative data identified five categories of maternal factors associated with immunization use: competing priorities, low motivation, socioeconomic constraints, perceived accessibility of services, fears about health or social consequences and knowledge and folk beliefs related to vaccines. Selected variables among these factors were incorporated into a survey instrument designed to compare mothers of completely vaccinated children (cases) with mothers of incompletely vaccinated children (controls). The questionnaire was administered to 299 randomly selected mothers (217 cases, 82 controls). Bivariate and multivariate analyses found that of the factors identified through ethnographic research, only vaccine-related knowledge was significantly associated with immunization status. The utility and constraints of using ethnographic research for instrument development in epidemiological studies are discussed.

Case-Control Studies↗
PubMed1992

Illegal induced abortion: a study of 74 cases in Ile-Ife, Nigeria.

Seventy-four women with complications of induced abortion were studied prospectively at the Obafemi Awolowo University, Nigeria. Twenty of the women were interviewed privately to elicit confidential information and also to determine their attitudes to contraception and to the Nigerian national abortion law. The results showed that abortion is prevalent in all classes of women and in married as well as unmarried women. There were 13 maternal deaths, accounting for 35% of the maternal mortality in the hospital during the period. Sepsis was the most common cause of death, and most of the abortions complicated by sepsis had been performed by medical practitioners. Interviews with the women revealed that most of them had knowledge of contraception but were unwilling to use it because of wrong information. Most women did not know that abortion is illegal in Nigeria, but felt that it should be. Measures that could be of value in reducing abortion-associated maternal mortality in Nigeria include training and retraining of physicians in the management of abortion and of abortion complications, family planning education of all fertile women, provision of confidential family planning services and liberalization of the abortion law.

Abortion, Illegal↗
PubMed2006

Can we talk? Importance of random-digit-dial surveys for injury prevention research.

Prevention research in public health requires quality data. In injury prevention research, "official" data sources, such as medical or law enforcement data, often do not possess the required depth or completeness. Self-reported data can fill this gap. Such data allow us to understand knowledge, attitudes, exposures, and behaviors associated with injury risk. Self-reported data are also needed to understand outcomes that are often missing from official sources, such as victimization by an intimate partner that is not reported because of concerns about legal consequences and less severe injuries from suicide attempts that go untreated. Data on risk and protective factors and specific types of violence exposures can often only be obtained by directly asking those affected. In addition, "official" data sources are rarely representative. Random-digit-dialing (RDD) surveys are a method of obtaining representative self-reported data. The RDD approach is relatively cost effective, handles non-English-speaking households with relative ease, and possesses a well-developed theory for constructing sample weights. However, there are significant challenges to using RDD surveys. These include declining participation rates; possible self-selection bias, since potential respondents can choose to opt out of the survey; and, with sensitive topics such as intimate partner violence, the need to anticipate potential risks for participants. This theme issue provides suggestions for how we can improve the design and implementation of RDD surveys in a manner that is both practical and ethical.

Behavioral Risk Factor Surveillance System↗
PubMed2000

Patient satisfaction and research-related problems (Part 2). Is triangulation the answer?

AIM: The article consists of two parts, the first of which examined the description of patient satisfaction by means of a questionnaire and the problems related to it. The aim of this second part is to complement the topic by explicating patient satisfaction research using a triangulative approach. BACKGROUND: Patient satisfaction has been the object of interest in health care for some time, and is now increasingly used as the basis for quality management and improvement. At the same time, the methods used have been criticised. As it was shown in the first part of this article, traditional questionnaires contain many problems which are difficult to solve in a satisfactory way, for example, by using different methods of analysis. METHODS: The data were collected from the patients of three different hospital wards using an interview (n = 30). The interview themes corresponded to the classification of a questionnaire employed at the same time. The interview material was analysed using content analysis, whereas satisfaction is investigated using a triangulative approach. FINDINGS: The findings confirm that the interview supplements the questionnaire as a data collection method, but that is also produces overlapping information. The interviews gave deeper information on the patients' experiences and feelings. Triangulative examination made it possible to show factors influencing the reliability of the study. CONCLUSIONS: The advantage of a triangulative approach seems to be that it provides a fairly accurate description of patient satisfaction. However, the problem of this method is that it doubles the amount of work needed and is slow to use which is worth considering as patient satisfaction should be followed on a regular basis and the results reported without delay. In spite of these problems, patient satisfaction surveys are important, since information provided by them is needed as basis for quality management, quality improvement and clinical supervision.

Adult↗
PubMed1990

Validation of postmortem interviews to ascertain selected causes of death in children.

In developing countries, diagnoses of diseases associated with deaths in children are frequently derived from retrospective maternal interviews. To determine the validity of this methodology, and to define sensitive and specific diagnostic algorithms, we compared symptoms and signs reported by mothers using structured questionnaires, with selected physician diagnoses for 164 deaths among hospitalized children on the Philippine island of Cebu. The 164 decreased children had 256 physician diagnoses of acute lower respiratory infections (ALRI) (100), diarrhoeas (92), measles (48), and neonatal tetanus cases (16). Forty-three per cent of children had multiple illnesses. An algorithm for tetanus (age at death less than or equal to 30 days with convulsion or spasm) was 100% sensitive, but specificity could not be estimated due to the small number of comparison neonatal deaths. An algorithm for measles (age greater than or equal to 120 days, with rash and fever for at least three days) had 98% sensitivity and 90% specificity. Diagnosis of ALRI was more difficult, cough and dyspnoea alone yielding 86% sensitivity but low specificity, whereas prolonged cough and dyspnoea provided 93% specificity but low sensitivity (41%). Diarrhoea diagnoses based on frequent loose or liquid stools had high sensitivity (78-84%) and specificity (79%), irrespective of whether the child died with diarrhoea alone or in combination with other illnesses. However, maternal reports of moderate/severe dehydration had low specificity. We conclude that, in this setting, verbal autopsies can diagnose major illnesses contributing to death in children with acceptable sensitivity and specificity.

Algorithms↗
PubMed1993

Contraception and abortion in Romania.

After the downfall of the Ceausescu regime in December, 1989, the new Government of Romania abolished the law that prohibited abortions on request. Subsequently, the rate of legally induced abortions increased significantly while the rate of maternal mortality declined dramatically. Despite the large number of women who request induced abortions, most women and gynaecologists say that they would prefer to prevent unwanted pregnancies through the use of modern contraception. In this paper we examine factors that contribute to the disparity between women's desire to use modern contraception to prevent unwanted pregnancies and their practice of having induced abortions to prevent unwanted births. The results show that women (and suggest that men) need a wide choice of dependably available high-quality contraceptives; they need to be able to obtain information, counselling, and methods from a wide range of sources/health-care providers; both women's and men's perceptions about, and use of, modern contraception could be positively affected through sexual education started in secondary school; and, to reduce repeat abortions, women's post-abortion family-planning needs must not be neglected.

Abortion, Legal↗
PubMed1991

Validation of the diagnosis of childhood morbidity using maternal health interviews.

The diagnosis of childhood illness by maternal health interview surveys is widely used to estimate the prevalence of childhood morbidity in developing countries. To determine the validity of interview-based diagnoses, and to define simple, sensitive and specific diagnostic algorithms, we compared symptoms and signs reported by mothers during structured interviews with physicians' diagnoses for 271 children on the Philippine island of Cebu. The 271 children had 318 physician diagnosed illnesses: 105 acute lower respiratory infections (ALRI), 121 diarrhoeas, 36 measles, 50 upper respiratory infections (URTI), 5 roseola infantums and one milaria rubria. An algorithm for measles (age greater than or equal to 120 days, rash and fever greater than or equal to 3 days and fading of rash) had a sensitivity and specificity of 94%. For ALRI an algorithm of cough, dysponea and fever had a sensitivity of 82%, but specificity was lower in comparison with URTI (58%) than with children who had no respiratory illness (79%). Inclusion of signs of respiratory distress (flaring of nostrils, intercostal retraction) raised the specificity to 83-84%, but reduced sensitivity to 68%. Diagnosis of diarrhoea based on frequent loose or liquid stools had a sensitivity of 95-97% and specificity of 80% in children with or without concomitant non-diarrhoeal illnesses. Addition of questions on numbers of stools (greater than or equal to 6 per day), and no signs of dehydration increased specificity to 95% but reduced the sensitivity to 84-86%. However, specific signs of dehydration were not well reported by the mothers.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗