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Proposal Paper: Outline Instructions
You will write a 10-page proposal paper in current AMA format that focuses on the design of a primary health program to meet the maternal and child primary health care needs of a hypothetical village in an underdeveloped country in either sub-Sahara Africa, Southeast Asia, or Latin America (student’s choice). Infrastructure within the village is essentially non-existent. Both infant and maternal mortality are high. Diarrhea, malaria, childhood malnutrition, HIV/AIDS, and measles are fairly prevalent. For this exercise, assume the project will be managed by culturally proficient individuals capable of deploying a scientifically valid programming without worry of violating community mores and standards. In reality, programming to meet the health care needs of a community can be challenging and can often raise controversy even under the best of circumstances. The early chapters of the Lankester text delineate many of the issues which must be addressed by a successful program. The debate generated in the discussion boards must provide ample framework for student proposals. You will assess the country you have chosen using country data provided by the WHO (see http://www.who.int/countries/en/). The proposal will address the maternal and child health care needs of the village; determine the level of intervention; and target population, program design, and the program personnel and financing needs. The thrust of this project is direct services for maternal and child health care. This exercise will not be concerned with providing village infrastructure (water, sewerage, electric, building codes, etc.). The development of the final document for this assignment is divided into 3 stages.
An outline will be submitted as the second stage of the proposal. The outline will give structure to the final proposal. It will be created using a hierarchical bulleted format. It must provide only sufficient detail to give the instructor a sense of direction for the project. Lengthy explanations must be avoided before or within the outline. The instructor will be looking for short, one-line bullets arranged in a matrix as follows:
- First topic — Roman numerals are broad ideas. The Roman numeral level in the outline will be sections in the paper
- Next sub-point
- Yet another subdivision
- This outline level might give some details
- This is not the numbering default from Microsoft Word
- The number/letter arrangement is important
- If you have one sub-point, include a second
- Each detail must be brief
- And a third sub-point if necessary
- Second topic
- Third topic
- Sub-point – typically a capital letter sub point will be a paragraph theme statement
- This might be point-by-point list
- The sections of a paper may have 3 or 4 paragraphs
- The Arabic numeral level provides the details of the paragraph
- You may need 3–5 details within a paragraph
- Each detail must fit with the theme
The Proposal Paper: Outline is due by 11:59 p.m. (ET) on Sunday of Module/Week 6.
- Oloruntoba EO, Folarin TB, Ayede AI. Hygiene and sanitation risk factors of diarrhoeal disease among under-five children in Ibadan, Nigeria. African Health Sciences. 2014;14(4):1001-1011. doi:10.4314/ahs. v14i4.32.
This study was to decrease the leading cause of mortality and death in children under five in Nigeria. Unsafe water, poor hygiene, and inadequate sanitation were determined to be the primary cause behind these deaths. 440 children children were paired by age, questionnaire and observation checklists were administered to the caregivers of these children as well as, sanitation conditions of 30% of these caregivers were observed for further analysis. With the help of descriptive and inferential statistics it was uncovered that children with caregivers that did not wash their hands with soap before preparing food had higher risk of contracting diarrheal disease. Other factors that were also associated with children contracting diarrheal disease was poor hand washing, clogged drains near the house, presence of flies, and improperly handling water.
- Idowu A, Olowookere SA, Abiola OO, Akinwumi AF, Adegbenro C. Determinants of Skilled Care Utilization among Pregnant Women Residents in an Urban Community in Kwara State, North Central Nigeria. Ethiopian Journal of Health Sciences. 2017;27(3):291-298.
This study was to determine the progress of maternal health. 400 people took place in this survey in North central Nigeria. They took a pre-test questionnaire that was used to collect data and analyze the statistics. The skilled attendant at delivery or SBA watches 74% of the births this resulted in the need for improvement and implementation of reproductive health policies needing change in Nigeria.
- Early results of an integrated maternal, newborn, and child health program, Northern Nigeria, 2009 to 2011.Findley SE, Uwemedimo OT, Doctor HV, Green C, Adamu F, Afenyadu GY. BMC Public Health. 2013 Oct 31; 13:1034. Epub 2013 Oct 31
This paper describes early results of an integrated maternal, newborn, and child health (MNCH) program in Northern Nigeria where child mortality rates are two to three times higher than in the southern states. The intervention model integrated critical health systems changes needed to reinvigorate MNCH health services, together with community-based activities aimed at mobilizing and enabling women to make changes in their MNCH practices. Control Local Government Areas received less-intense statewide policy changes.
- Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review.Gilmore B, McAuliffe E. BMC Public Health. 2013 Sep 13; 13:847. Epub 2013 Sep 13.
Evidence from this review suggests several strategies that should be further explored, including combining hygiene education with breastfeeding interventions with the prospect of reducing diarrhea rates in infants, using visual aids, which can be left with the mother as educational tools, and specifically targeting health messages. Variations in interventions, training and outcomes make it difficult to compare all included studies, however some important findings emerged from this research. Community health workers are effective at increasing acceptability of mother-performed practices, such as skin-to-skin care and exclusive breastfeeding.
- Kana, M. A., Doctor, H. V., Peleteiro, B., Lunet, N., & Barros, H. (2015). Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014. BMC public health, 15, 334. doi:10.1186/s12889-015-1688-3
This systematic review has provided important lessons for operational research and the application of epidemiological reasoning to the understanding of MNCH problems and institution of relevant interventions. Firstly, the prolonged intervention-publication interval may contribute to delayed management awareness, mobilization of resources and response. We also observed a lack of coordination of policies and interventions either as source of evidence for initiating intervention or its evaluation. Furthermore, the scale and duration of many of the interventions was insufficient to have demonstrable impact on maternal and child health outcomes. A fewthe MNCH interventions were implemented as pilots or within the framework of vertical programmes thereby raising concerns for scaling-up for wider coverage, integration into the health system and sustainability.
- An assessment of maternal, newborn and child health implementation studies in Nigeria: implications for evidence informed policymaking and practice.Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P.Health Promote Perspect. 2016; 6(3):119-27. Epub 2016 Aug 10.
Nigeria, with a population of over 160 million and weak health systems, health outcomes especially those related to maternal and child health remains poor. With approximately 2.5% of the world’s population, the country is reportedly having more than 10% of all under-5 and maternal deaths – more than 1 million newborn, infant, and child deaths and more than 50 000 maternal deaths every year.However, there has been some level of reduction in maternal and child mortality with the last few years. The national maternal mortality rate (MMR) reduced from 800/100 000 in 2005 to 545/100 000 in 2008 and to 110/100 000 according to the recent Nigeria Demographic and Health Survey (NDHS) 2013. The 2008 NDHS reported an under five mortality rate (U5MR) of 157 deaths per 1000 live births, suggesting a 22% decline from the NDHS report of 2003 which had shown an U5MR of 201 per 1000 live births. According to the World Bank recent report, the Nigeria U5MR further declined to 117 per 1000 live births in 2013.
- Abimbola S, Okoli U, Olubajo O, Abdullahi MJ, Pate MA (2012) The Midwives Service Scheme in Nigeria. PLoS Med 9(5): e1001
These variations in health indices are influenced by the presence of tertiary hospitals, social amenities, and a population that can afford to pay for health services that in turn attract highly skilled health workers. Therefore, in much of rural Nigeria, beyond issues of access, there are inadequate human resources for providing 24-hour health services in primary health care (PHC) facilities. Nigeria faces a crisis in human resources for health (HRH) in the form of health worker shortages, requiring an immediate and significant increase in the number of health workers, or in the meantime a strategic redistribution of health workers to grossly underserved rural areas
- The influence of the social and cultural environment on maternal mortality in Nigeria: Evidence from the 2013 demographic and health survey
Oluwatosin Ariyo, Ifeoma D. Ozodiegwu, Henry V. Doctor and Imelda K. Moise
Journal: PLOS ONE, 2017, Volume 12, Number 12, Page e0190285DOI: 10.1371/journal.pone.0190285
Efforts to reduce maternal mortality should implement tailored programs that address barriers to health-seeking behavior influenced by cultural beliefs and attitudes, and low educational attainment. Strategies to improve women’s agency should be at the core of these programs; they are essential for reducing maternal mortality and achieving sustainable development goals towards gender equality. Future studies should develop empirically evaluated measures which assess, and further investigate the association between women’s empowerment and maternal health status and outcomes.
- A Rapid Assessment of the Availability and Use of Obstetric Care in Nigerian Healthcare Facilities. Daniel O. Erim, Usman M. Kolapo,Stephen C. Resch. Published: June 22, 2012
Most of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC) services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home
- Support for breastfeeding mothers: a systematic review. Jim Sikorski Mary J. Renfrew Sima Pindoria Angela Wade. First published: 17 October 2003
Although the benefits of breastfeeding are widely accepted, the effectiveness of different strategies to promote the continuation of breastfeeding once initiated are less clear. The objective of this systematic review was to describe studies comparing standard care with the provision of extra breastfeeding support and to measure its effectiveness. Outcome measures used were rates of cessation of any breastfeeding or exclusive breastfeeding at chosen points in time. Measures of child morbidity and maternal satisfaction were also used when these were reported.