Conceptual foundations of organizational structure: re-structuring of women's health services.

PURPOSE: Researchers often debate health service structure. Understanding of the practical implications of this debate is often limited by researchers' neglect to integrate participants' views on structural options with discourses those views represent. As a case study, this paper aims to discern the extent to which and how conceptual underpinnings of stakeholder views on women's health contextualize different positions in the debate over the ideal structure of health services. DESIGN/METHODOLOGY/APPROACH: The researchers chose a self-standing, comprehensive women's health service facing the prospect of being dispersed into "mainstream" health services. The researchers gathered perspectives of 53 professional and consumer stakeholders in ten focus groups and seven semi-structured interviews, analyzed through inductive thematic analysis. FINDINGS: "Women's marginalization" was the core theme of the debate over structure. The authors found clear patterns between views on the function of women's health services, women's health needs, ideal client group, ideal health service structure and particular feminist discourses. The desire to re-organize services into separate mainstream units reflected a liberal feminist discourse, conceiving marginalization as explicit demonstration of its effects, such as domestic abuse. The desire to maintain a comprehensive women's health service variously reflected post-structural feminism's emphasis on plurality of identities, and a radical feminist discourse, holding that womanhood itself constituted a category of marginalization - that is, merely being at risk of unmet health needs. ORIGINALITY/VALUE: As a contribution to health organizational theory, the paper shows that the discernment of discursive underpinnings of particular stakeholder views can clarify options for the structure of health services.

Improving the effectiveness of interpreted consultations: Australian interpreter, general practitioner and patient perspectives.

Healthcare consultations with patients lacking English proficiency are challenging for all parties, even in Australian primary care where the engagement of interpreters is encouraged and fully subsidised. Our objective was to understand these challenges from the perspectives of interpreters, patients and general practitioners in order to improve the effectiveness of interpreted consultations. Our investigator team approached the interpreted consultation as an interprofessional collaboration. A convenience sample of seven general practitioners, eight health interpreters and six representatives from culturally and linguistically diverse communities (representing the patient perspective) participated in three separate focus group discussions, lasting 60-90 min each, exploring participant experiences with healthcare consultations in which interpreters were present. Two semistructured interviews were undertaken subsequently with three additional community representatives purposively recruited to increase participant diversity. Data were collected in 2016 and analysed inductively using a method of constant comparison to identify, and reach consensus on, key emerging themes. All participant groups emphasised the importance of working with trained interpreters, rather than relying on family interpreters or a doctor's own second language skills. Although participants reported experiences of effective interpreted consultations, other reports suggested that some doctors are unaware of, or have difficulty following, accepted guidelines about speech, gaze and turn-taking. Challenges identified in relation to interpreted consultations fell into the five themes of contextual constraints, consultation complexity, communication difficulties, the interpreter role and collaboration. Some general practitioner participants appeared to be unsure and anxious about the etiquette of interpreted consultations, and there was some confusion between and within participant groups about interpreter roles and professional codes. A briefing session prior to the consultation, clarifying the roles of all parties, including any family or bicultural workers present, may help to establish respectful, flexible and effective interprofessional collaborations and to encourage participants to directly address any problems during the consultation.

Diarrhoea and Suboptimal Feeding Practices in Nigeria: Evidence from the National Household Surveys.

BACKGROUND: Globally, Nigeria has the largest burden of infectious diseases (including diarrhoea). Optimal feeding practices have been well-documented to protect against diarrhoea in other contexts; but this benefit has not been broadly studied in Nigeria. The study aimed to examine the association between diarrhoea and childhood feeding practices to provide country-specific evidence. METHOD: Data from the Nigeria Demographic and Health Survey for the period spanning 1999-2013 were used. Prevalence of diarrhoea by infant and young child feeding indicators was estimated, and the association between diarrhoea and childhood feeding indicators was examined using multilevel regression analyses. RESULTS: Prevalence of diarrhoea was higher among children whose mothers did not initiate breast feeding within the first hour of birth, infants who were not exclusively breastfed, and infants who were prematurely introduced to complementary foods. Early initiation of breast feeding was significantly associated with lower risk of diarrhoea (RR 0.68, 95% confidence interval (CI) 0.63, 0.74). Exclusively breastfed infants were less likely to develop diarrhoea compared to non-exclusively breastfed infants (RR 0.61, 95% CI 0.44, 0.86). Predominant breast feeding was significantly associated with a lower risk of diarrhoea (RR 0.66, 95% CI 0.54, 0.80). Bottle feeding and introduction of complementary foods were associated with a higher risk of diarrhoea. CONCLUSION: Early initiation of breast feeding as well as exclusive and predominant breast feeding protect against diarrhoea in Nigeria, while bottle feeding and introduction of complementary foods were risk factors for diarrhoea. Community- and facility-based initiatives are needed to improve feeding practices, and to reduce diarrhoea prevalence in Nigeria.

Have policy responses in Nigeria resulted in improvements in infant and young child feeding practices in Nigeria?

BACKGROUND: Nigeria initiated a range of programs and policies (from 1992 to 2005) to improve infant and young child feeding (IYCF) practices. However, the prevalence of children fed in accordance with IYCF recommendations in Nigeria remains low. This paper presents time trends in IYCF practices in Nigeria for the period (1999-2013), and considers trends in the context of key national policy responses and initiatives. METHODS: Prevalence and percentage change (including 95% confidence intervals) of IYCF indicators were investigated over the period 1999-2013 based on a total of 88,152 maternal responses from the Nigeria Demographic and Health Surveys, (n = 8,199 in 1999; n = 7,620 in 2003; n = 33,385 in 2008 and n = 38,948 in 2013). RESULTS: Early or timely initiation of breastfeeding decreased significantly by 4.3% (95% Confidence Interval [CI]: -8.1, -0.5; p = 0.0280 for the period (1999-2013); while exclusive breastfeeding remained unchanged 1.6% (95% CI: -2.7, 5.9; p = 0.478). From 2003 to 2013, minimum meal frequency increased significantly by 13.8% (95% CI: 9.9, 17.8; p < 0.001), but minimum dietary diversity and minimum acceptable decreased significantly by 9.7% (95% CI: -9.2, -6.3; p < 0.001) and 3.5% (95% CI: -5.7, -1.3; p = 0.002), respectively. Predominant breastfeeding increased significantly by 13.1% (p < 0.001), and children ever breastfed declined by 16.4% (p < 0.001) over time. CONCLUSION: Despite considerable improvements in national legislation, health system responses and community level development, IYCF practices in Nigeria are still below expected levels. Strengthening community and facility based participation, and broader stand-alone/integrated IYCF policy implementations are needed to improve the current feeding practices of Nigerian mothers.

Trends in complementary feeding indicators in Nigeria, 2003-2013.

OBJECTIVE: The study aimed to examine secular trends and determinants of changes in complementary feeding indicators in Nigeria. DESIGN, SETTING AND PARTICIPANTS: Data on 79 953 children aged 6-23 months were obtained from the Nigeria Demographic and Health Surveys (NDHS) for the period spanning 2003-2013. The surveys used a stratified two-stage cluster sample of eligible mothers aged 15-49 years from the six geopolitical zones of Nigeria. Trends in complementary feeding indicators and socioeconomic, health service and individual characteristics including factors associated with complementary feeding indicators were examined using multilevel logistic regression analyses. RESULTS: Minimum dietary diversity for children aged 6-23 months worsened from 26% in 2003 to 16% in 2013. Minimum meal frequency improved from 43% in 2003 to 56% in 2013 and minimum acceptable diet worsened from 11% to 9%. Among educated mothers, there was a decreasing prevalence of the introduction of solid, semisolid and soft foods in infants aged 6-8 months (67% in 2003 to 57% in 2013); minimum dietary diversity (33% in 2003 to 24% in 2013) and minimum acceptable diet (13% in 2003 to 8% in 2013). Mothers with a higher education level and mothers who reported more health service contacts were more likely to meet the minimum dietary diversity. Similarly, the odds for minimum acceptable diet were higher among mothers from higher socioeconomic status groups and mothers who reported frequent health services use. CONCLUSIONS: Complementary feeding practices in Nigeria declined over the study period and are below the expected levels required to ensure adequate growth and development of Nigerian children. National policies and programmes that ensure sustainability of projects post-MDGs and higher health service coverage for mothers, including community-based education initiatives, are proposed to improve complementary feeding practices among Nigerian mothers.

Determinants of trends in breast-feeding indicators in Nigeria, 1999-2013.

OBJECTIVE: The present study aimed to examine the trends and differentials in key breast-feeding indicators in Nigeria for the period 1999-2013. DESIGN: Longitudinal study of trends (1999-2013) in optimal feeding practices using a series of population-based Nigerian Demographic and Health Surveys. Trends in socio-economic, health service and individual characteristics associated with key breast-feeding indicators were examined using multilevel regression analyses. SETTING: Nigeria. SUBJECTS: Children (n 88 152) aged under 24 months (n 8199 in 1999; n 7620 in 2003; n 33 385 in 2008; n 38 948 in 2013). RESULTS: Among educated mothers, there was an increase in prevalence of exclusive breast-feeding (26% in 1999 to 30% in 2013) and predominant breast-feeding (27% in 1999 to 39% in 2013) compared with mothers with no schooling. A similar increasing trend was evident for mothers from wealthier households and mothers who had a higher frequency of health service access compared with mothers from poorer households and women who reported no health service access, respectively. Mothers with no schooling predominantly breast-fed, but the odds for bottle-feeding were higher among educated mothers and women from wealthier households. The odds for early initiation of breast-feeding were lower for mothers who reported no health service contacts and mothers of lower socio-economic status. CONCLUSIONS: Significant increasing trends in key breast-feeding indicators were evident among mothers with higher socio-economic status and mothers who had more health service access in Nigeria. Broader national and sub-national policies that underpin nursing mothers in work environments and a comprehensive community-based approach are proposed to improve feeding practices in Nigeria.

Beyond reintegration: a framework for understanding ex-prisoner health.

PURPOSE: This paper proposes a framework to better understand ex-prisoner health, and pilot-tests the framework using qualitative interviews with ten people who have been out of prison for two years or more. The proposed framework considers different stages of re-entry (from pre-incarceration through to post-release), individual and structural factors influencing health, and health outcomes. DESIGN/METHODOLOGY/APPROACH: The authors conducted qualitative, open-ended interviews with ex-prisoners released from prison two or more years ago, who could be considered to have transitioned "successfully" out of prison. The aim of the interviews was to generate insights into the strategies that ex-prisoners use to negotiate the post-release period. FINDINGS: Most of the themes that emerged from interviews were consistent with the proposed framework. Structural factors are important concerns for ex-prisoners that may have to be resolved before other issues, such as drug addiction, can be addressed. However, these findings suggest that it is inappropriate to view health-related experiences during re-entry as homogenous, given the diversity of individual characteristics and backgrounds among ex-prisoners, notably including pre-incarceration social status. ORIGINALITY/VALUE: To explain the health-related experiences of people following their release from prison, we need to think beyond reintegration and move beyond homogenous notions of the ex-prisoner population. Addressing sociocultural, demographic and incarceration-specific factors that ameliorate or intensify the challenges faced by ex-prisoners is of critical importance.