Browsing by Author "Broverman, Sherryl"

Now showing 1 - 4 of 4
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    Analyzing the Connections Among Water Access, Sanitation, Malaria and Diarrhea Outcomes in Rural Central Uganda
    (2016-04-22) Hu, Michael
    Access to safe water and sanitation around the world has increased significantly in the past few decades. The United Nations claims that 91% of the world’s population has access to safe water, exceeding the Millennium Development Goal for water access. Yet, some evidence in the literature suggests that safe water and sanitation access is overestimated, as the common indicator used to estimate safe water is infrastructural. The usage of water, behaviors surrounding water acquisition and storage, and possible contamination along the source to point-of-use continuum is poorly understood. This cross-sectional epidemiological study used a combination of surveying, mapping and bacteriological water testing to identify some of the possible factors in water contamination, and relationships with malaria and diarrhea burden, in a parish in Central Uganda. Secondary goals included assessing the burden of malaria and diarrhea in the parish, and assessing the use of mapping and water testing as field research tools. The survey included questions on water acquisition and usage behavior, sanitary conditions, knowledge of diarrhea, and malaria and diarrhea burden. In this parish, 126 households across 9 villages were randomly chosen to be surveyed, mapped and water tested. All water sources in the parish were additionally mapped and water tested. Across all water sources, including piped water, the water quality at the household point-of-use level was drastically worse than quality measured at the source. In fact, among all water sources, piped water recipients showed the highest average bacterial loads, despite the clean quality of the source itself. Possible factors in lowering or raising contamination, as displayed by regression results, include the frequency of obtaining water and distance from the water source respectively. The malaria and diarrhea case sample size proved smaller than expected, and challenges remain in using mapping and water testing in the field. These results support the theories that the amount of people with access to safe water is overestimated, and that contamination exists along the source to point-of-use continuum. More research is needed to investigate the exact points of contamination in the spectrum and possible contaminating factors.
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    Determinants of Secondary School Attrition and Related Health Factors among Female Youth in Rural Kenya
    (2016-04-28) Fowler, Zack
    This paper investigates the determinants of secondary school attrition and related health factors among female students in rural Kenya. To explore the relationship between attrition determinants and negative health outcomes, a mixed-methods approach was taken to collect both qualitative and quantitative data. Semi-structured interviews were conducted with 35 female youth that had terminated their enrollment in a Muhuru Bay secondary school between 2011 and 2015. Using grounded theory and thematic analysis, dominant themes were identified pertaining to determinants of attrition and implications for attrition-related health outcomes. Participants reported three primary causes of attrition: adolescent pregnancy (65.7% n=23), poverty and school fees (45.7% n=16) and early marriage (5.7% n-2). Health-related themes emerged in three major themes: in-school factors, out-of-school factors, and new-situation factors. Emergent health-related subthemes vary per temporal category and include forming relationships for favors, pride from enrollment status, intimate partner violence in early marriage, familial violence in response to situation changes, and abortion in response to early pregnancy. Numerical attrition data collected for the graduating classes of 2014 and 2015 in Muhuru Bay revealed no significant difference between male and female rates of attrition in the community. This may suggest that the burden of poverty in Muhuru Bay is so elevated that confounding factors of attrition, such as gender, are masked. Further research is necessary to determine health factors of male attrition and potential points of intervention for both male and female students.
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    Labor Attrition between South Africa’s Public and Private Health Sectors: A Mixed-Methods Case Study of KwaZulu-Natal Dietitians
    (2018-04-25) Perper, Raichel
    The South African health care system has a highly inequitable distribution of human and financial resources. The private sector only serves 28-38% of the population but has 59% of medical specialists. Applying the concept of job satisfaction as a mediator of labor attrition, the study aims included (1) evaluating the factors influencing choice of workplace amongst clinical dietitians, and (2) analyzing the policy implications for improving labor retention. This cross-sectional study employed a mixed-methods design, including job satisfaction surveys (N=66) and semi-structured interviews (N=7). The sample included public and private clinical dietitians in KwaZulu-Natal, South Africa. Data were analyzed using regression modeling and thematic content analysis. The regression analysis revealed private dietitians to be 12.43 points happier than public dietitians on a 12-question job satisfaction survey (95% CI: 6.74, 18.13), after controlling for salary level, degree, job setting, time in current job, university, and specialty. The private sector offers perceived advantages in physical workplace, workday flexibility, and salary level. Government dietitians expressed more favorable professional relationships with dietetic and non-dietetic colleagues, feelings of value, and salary stability. Private dietitians were dissatisfied with income insecurity, colleague competitiveness, and marketing one’s dietetic services. Public dietitians noted poor physical working conditions and limited promotion opportunities. These findings suggest that retention strategies should target public sector staffing shortages, career pathing, and contract flexibility regarding working hours. Further research is needed to evaluate these findings on a national scale and assess the comparative feasibility, favorability, and impact of private contracting models across other allied health professions.
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    The Effect of Commercial Sanitary Pad Use on School Attendance and Health of Adolescents in Western Kenya
    (2011) Stopford, Amy Louise

    This mixed-method cross-sectional study evaluated the effect of commercial sanitary pads on school attendance and symptoms of vaginal infections in rural Kenyan adolescents aged 11-18. It also provides contextual information that situates the data gathered on school attendance and vaginal infections in the broader experience of girls managing their menstruation. A sequential design was used for this study with a total of 8 qualitative focus groups and a quantitative survey. A total of 482 girls were surveyed, with 321 who were currently attending school and 151 who had dropped out of school. Qualitative data from focus groups was analyzed using applied thematic analysis, while the effect of commercial sanitary pads as well as the effect of using other items on school attendance and symptoms of vaginal infections was estimated using logistic regression analysis. Overall, girls reported that menstruation negatively affects their experience at school and in the classroom and causes an array of negative emotions. Girls also conveyed having to often leave school to change or bathe due to menstrual leaks and missing class lessons as a result. Poor concentration in class attributed to menstrual pain and worry over potential leaks was also mentioned. Lastly, the practice of transactional sex to obtain money to purchase pads was a theme within the data. It was found through the quantitative data that the prevalence odds of missing one or more days of school over a two-month period when using commercial sanitary pads is 1.6 times as high as the odds of missing one or more days of school over a two-month period when using other items (p = 0.02, 95% C.I. = 1.03-2.07). There was no statistically significant difference found in the number of school days missed when comparing those who used reusable pads, many underwear, homemade items, and nothing each to those using commercial sanitary pads. The overall prevalence of symptoms of vaginal infections among all girls in this study was found to be 9.4%. There is no statistically significant difference between the odds of having symptoms of a vaginal infection when using commercial sanitary pads as compared to using any other item to control menstruation.