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Dickinson A, Gates L, Metcalf C, Owen C, Kheng S, Harte C, Bunthoeun S, Simpson S, Worsley P, Ostler C, Donovan-Hall M, Channon A. Learning about the changing needs for prosthetics service provision from routinely collected digital centre management data: An exemplar study across three clinics in Cambodia. J Glob Health 2022; 12:04083. [PMID: 36259231 PMCID: PMC9579830 DOI: 10.7189/jogh.12.04083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Prosthetic service development and delivery rely on data describing population needs. These needs are context-specific, but most existing data come from high-income countries or small geographic areas, which are often not comparable. This study analysed routinely collected digital patient record data at multiple time points to provide insights into characteristics of people accessing Cambodian prosthetic services. Methods We investigated trends in birth year, sex, year and reason for limb absence, and prosthesis type, over three decades. Then, we observed data from 2005 and 2019 indicating how the population actively accessing prosthetics services has changed. Results Temporal trends in prosthetics service user demographics corresponded with events in Cambodia’s socio-political history. The predominant historical reason for limb absence prior to 2000 was weapon trauma during and following conflict. Since 2000, this was replaced by non-communicable disease and road accidents. Transtibial remained the most prevalent amputation level but transfemoral amputation had higher incidence for people with limb loss from road accidents, and people with limb loss due to disease were older. These observations are important as both transfemoral and older-aged groups experience particular rehabilitation challenges compared to the young, transtibial group. Conclusions The study shows how standardised, routinely collected data across multiple clinics within a country can be used to characterise prosthetics service user populations and shows significant changes over time. This indicates the need to track client characteristics and provides evidence for adapting services according to population dynamics and changes in patient need.
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Affiliation(s)
- Alex Dickinson
- Faculty of Engineering & Physical Sciences, University of Southampton, UK.,Institute for Life Sciences, University of Southampton, UK.,Exceed Research Network, Lisburn, UK
| | - Lucy Gates
- Institute for Life Sciences, University of Southampton, UK.,Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Cheryl Metcalf
- Institute for Life Sciences, University of Southampton, UK.,Exceed Research Network, Lisburn, UK.,Faculty of Environmental and Life Sciences, University of Southampton, UK.,Faculty of Medicine, University of Southampton, UK
| | - Charlotte Owen
- Centre for Global Health and Policy (GHAP), University of Southampton, UK
| | - Sisary Kheng
- Exceed Research Network, Lisburn, UK.,Exceed Worldwide, Phnom Penh, Cambodia
| | - Carson Harte
- Exceed Research Network, Lisburn, UK.,Exceed Worldwide, Lisburn, UK
| | | | - Sam Simpson
- Exceed Research Network, Lisburn, UK.,Exceed Worldwide, Lisburn, UK
| | - Peter Worsley
- Institute for Life Sciences, University of Southampton, UK.,Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Chantel Ostler
- Institute for Life Sciences, University of Southampton, UK.,Exceed Research Network, Lisburn, UK.,Faculty of Environmental and Life Sciences, University of Southampton, UK.,Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Maggie Donovan-Hall
- Institute for Life Sciences, University of Southampton, UK.,Exceed Research Network, Lisburn, UK.,Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Amos Channon
- Exceed Research Network, Lisburn, UK.,Centre for Global Health and Policy (GHAP), University of Southampton, UK
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Channon MD, Puri M, Gietel-Basten S, Stone LW, Channon A. Prevalence and correlates of sex-selective abortions and missing girls in Nepal: evidence from the 2011 Population Census and 2016 Demographic and Health Survey. BMJ Open 2021; 11:e042542. [PMID: 33727264 PMCID: PMC7970271 DOI: 10.1136/bmjopen-2020-042542] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES These were to: (1) produce national and subnational estimates of the sex ratio at birth (SRB) and number of missing girl births in Nepal and (2) understand the socioeconomic correlates of these phenomena. DESIGN Observational secondary data analysis of (1) the 2011 population census of Nepal and (2) the Nepal Demographic and Health Survey (DHS) 2006, 2011 and 2016. SETTING Nepal. PARTICIPANTS (1) 2 567 963 children age 0-4 in the 2011 population census and (2) 27 329 births recorded in DHSs. PRIMARY AND SECONDARY OUTCOMES We estimate the SRB, and number and proportion of missing girls in the year and 5 years before the census by district. We also calculate conditional sex ratios (the SRB dependant on parity and sex of previous children) by province, time, education and wealth. RESULTS We find that 11 districts have significantly skewed sex ratios at birth in the 2011 population census, with the highest SRBs observed in Arghakhanchi (SRB=127) and Bhaktapur (SRB=123). 22 540 girl births were missing in the 5 years before the 2011 population census. Sex-selective abortion is geographically concentrated, especially in the Kathmandu Valley and Lumbini Province, with 53% of missing girls found in only 11 out of 75 districts.DHS data confirm this, with elevated conditional sex ratios observed in Bagmati and Lumbini Provinces; conditional sex ratios where previous births were all female also became more skewed over time. Skewed sex ratios are concentrated among wealthier more educated groups. CONCLUSIONS It is clear that sex selection will persist and develop in Nepal unless a coordinated effort is made to address both the demand for and supply of this service. Policies should be holistic and encompass economic and legal gender equity, and strengthen monitoring mechanisms to prevent technology misuse, without jeopardising the right to safe, free and legal abortion.
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Affiliation(s)
| | - Mahesh Puri
- Center for Research on Environment, Health and Population Activities (CREHPA), Lalitpur, Nepal
| | - Stuart Gietel-Basten
- Humanities and Social Science, Hong Kong University of Science and Technology, Kowloon, China
| | | | - A Channon
- Social Statistics & Demography, University of Southampton, Southampton, UK
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Carter S, Channon A, Berrington A. Socioeconomic risk factors for labour induction in the United Kingdom. BMC Pregnancy Childbirth 2020; 20:146. [PMID: 32143597 PMCID: PMC7059288 DOI: 10.1186/s12884-020-2840-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/25/2020] [Indexed: 12/29/2022] Open
Abstract
Background Labour induction is a childbirth intervention experienced by a growing number of women globally each year. While the maternal and socioeconomic indicators of labour induction are well documented in countries like the United States, considerably less research has been done into which women have a higher likelihood of labour induction in the United Kingdom. This paper explores the relationship between labour induction and maternal demographic, socioeconomic, and health indicators by parity in the United Kingdom. Method Logistic regression analyses were conducted using the first sweep of the Millennium Cohort Study, including a wide range of socioeconomic factors such as maternal educational attainment, marital status, and electoral ward deprivation, in addition to maternal and infant health indicators. Results In fully adjusted models, nulliparous and multiparous women with fewer educational qualifications and those living in disadvantaged places had a greater likelihood of labour induction than women with higher qualifications and women in advantaged electoral wards. Conclusions This paper highlights which UK women are at higher risk of labour induction and how this risk varies by socioeconomic status, demonstrating that less advantaged women are more likely to experience labour induction. This evidence could help health care professionals identify which patients may be at higher risk of childbirth intervention.
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Affiliation(s)
- Sarah Carter
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
| | - Amos Channon
- Social Statistics & Demography, Economic, Social & Political Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Ann Berrington
- Social Statistics & Demography, Economic, Social & Political Sciences, University of Southampton, Southampton, SO17 1BJ, UK
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Carter S, Channon A, Berrington A, Carter S. Variations in the Risk of Labour Induction Across Hospitals and NHS Trusts in the United Kingdom. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Channon
- University of Southampton, Southampton, UK
| | | | - S Carter
- University of Southampton, Southampton, UK
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Luff R, Channon A. PATTERNS OF MISSING DATA AT THE END-OF-LIFE: USING LINKED MORTALITY DATA TO EXAMINE BIAS IN PANEL DATA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R. Luff
- National Centre for Research Methods, University of Southampton, Southampton, United Kingdom
| | - A. Channon
- National Centre for Research Methods, University of Southampton, Southampton, United Kingdom
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Mackintosh M, Channon A, Karan A, Selvaraj S, Cavagnero E, Zhao H. What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries. Lancet 2016; 388:596-605. [PMID: 27358253 DOI: 10.1016/s0140-6736(16)00342-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners-both unlicensed and licensed-to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa.
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Affiliation(s)
- Maureen Mackintosh
- Faculty of Social Sciences, Economics Department, The Open University, Walton Hall, Milton Keynes, UK.
| | - Amos Channon
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Anup Karan
- Public Health Foundation of India, New Delhi, India
| | | | - Eleonora Cavagnero
- World Bank, Health Nutrition and Population Global Practice, Washington, DC, USA
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7
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Van Lerberghe W, Matthews Z, Achadi E, Ancona C, Campbell J, Channon A, de Bernis L, De Brouwere V, Fauveau V, Fogstad H, Koblinsky M, Liljestrand J, Mechbal A, Murray SF, Rathavay T, Rehr H, Richard F, ten Hoope-Bender P, Turkmani S. Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality. Lancet 2014; 384:1215-25. [PMID: 24965819 DOI: 10.1016/s0140-6736(14)60919-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention.
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Affiliation(s)
| | - Zoe Matthews
- Evidence for Action, University of Southampton, Southampton UK
| | - Endang Achadi
- Center for Family Welfare, Faculty of Public Health University of Indonesia, Depok, West Java, Indonesia
| | | | - James Campbell
- Instituto de Cooperación Social Integrare, Barcelona, Spain
| | - Amos Channon
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | | | - Vincent De Brouwere
- Woman & Child Health Research Centre, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | | | - Susan F Murray
- International Development Institute, King's College London, London, UK
| | - Tung Rathavay
- National Reproductive Health Program, Phnom Penh, Cambodia
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Abstract
Andrew Channon and colleagues outline the complexities of urban advantage in maternal health where the urban poor often have worse access to health care than women in rural areas.
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Affiliation(s)
- Zoë Matthews
- Division of Social Statistics and Centre for Global Health, Population, Poverty, and Policy, University of Southampton, Southampton, United Kingdom
| | - Amos Channon
- Division of Social Statistics and Centre for Global Health, Population, Poverty, and Policy, University of Southampton, Southampton, United Kingdom
| | - Sarah Neal
- Division of Social Statistics and Centre for Global Health, Population, Poverty, and Policy, University of Southampton, Southampton, United Kingdom
| | - David Osrin
- UCL Centre for International Health and Development, Institute of Child Health, London, United Kingdom
| | - Nyovani Madise
- Division of Social Statistics and Centre for Global Health, Population, Poverty, and Policy, University of Southampton, Southampton, United Kingdom
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9
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Walker A, Pfau T, Channon A, Wilson A. Assessment of dairy cow locomotion in a commercial farm setting: The effects of walking speed on ground reaction forces and temporal and linear stride characteristics. Res Vet Sci 2010; 88:179-87. [DOI: 10.1016/j.rvsc.2009.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 04/16/2009] [Accepted: 05/12/2009] [Indexed: 10/20/2022]
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Kanyighe C, Channon A, Tadesse E, Madise N, Changole J, Bakuwa E, Malunga E, Stones RW. Determinants of post-partum maternal mortality at Queen Elizabeth Central Hospital, Blantyre, Malawi: a case-control study 2001-2002. Afr J Reprod Health 2008; 12:35-48. [PMID: 19435011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of this research is to identify the clinical, demographic and service-based determinants of postpartum maternal mortality within Queen Elizabeth Central Hospital, Blantyre, Malawi, during 2001 and 2002. The study uses a case-control design using all postpartum maternal deaths in 2001 and 2002 as cases, with analysis conducted using conditional logistic regression. The results indicate that the mothers' reason for admission into hospital and the outcome of the birth were significantly related to maternal death when analysing all potential explanatory variables in one model. A group of high-risk mothers can be identified using these factors. If these criteria were applied as a predictive tool in the clinical setting the resulting sensitivity and specificity would be over 85%. Identification within the hospital setting of a group of very high-risk mothers in whom serious complications are aggressively managed in a coordinated way across the medical specialties may reduce maternal mortality.
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Affiliation(s)
- C Kanyighe
- Queen Elizabeth Central Hospital, Blantyre, Malawi
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Channon A, Gunther M, Vereecke E. Morphological adaptations for jumping in the gibbon hind limb. Comp Biochem Physiol A Mol Integr Physiol 2008. [DOI: 10.1016/j.cbpa.2008.04.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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