Correction to: Patient-level factors are more salient than a legislation prohibiting minors in bars in predicting unintentional injury hospitalizations.

It was highlighted that in the original article [1] Fig. 1 and Fig. 2 were interchanged.

Patient-level factors are more salient than a legislation prohibiting minors in bars in predicting unintentional injury hospitalizations.

BACKGROUND: Alcohol related homicide, suicide and aggravated assault represent the largest costs for the state of Illinois. Previous research has examined the impact of some alcohol-related policies on youth alcohol use and alcohol-related harm in the United States but findings have been mixed. To our knowledge, no study has provided a detailed epidemiology of the relationship between the impacts of alcohol policies on unintentional injury in Illinois. Therefore, the purpose of this study is to determine whether a legislation that prohibit minors under 21 years old in establishments that serve alcohol is more salient than individual level factors in predicting hospitalization for traumatic unintentional injuries. METHODS: A retrospective observational study of data abstracted from 6,139 patients aged 10 to 19 hospitalized in Illinois Level I and Level II trauma centers. Patient data from 2006 to 2015 was linked with the city-level alcohol-related legislation (n = 514 cities). The response variable was whether a patient tested positive or negative for blood alcohol concentration (BAC) at the time of admission. Mixed-effects logistic regression analyses were conducted to model the patient and city level legislation effect of having a positive BAC test result on hospitalizations after adjusting for the legislation and patient factors. RESULTS: After adjustment, patients aged 15 to 19 and white patients who tested positive for BAC at the time of admission had the greater odds of hospitalization for traumatic alcohol-related unintentional injuries compared to patients who had a negative BAC test result. However, odds of hospitalization decreased for female patients and for those with private insurance, and over time, but a significant decrease in such hospitalizations occurred during 2010, 2014 and 2015. The alcohol-related legislation of interest was not a significant predictor of traumatic alcohol-related unintentional injury hospitalization. CONCLUSIONS: Patient-level covariates were significant predictors of traumatic alcohol-related unintentional injury hospitalization; an alcohol-related legislation may not reduce hospitalizations for young patients aged 10 to 19. Therefore, to prevent underage drinking and consequences, interventions should target sex/gender, race/ethnicity and focus on both individual and environmental strategies.

Impact of a health system strengthening intervention on maternal and child health outputs and outcomes in rural Rwanda 2005-2010.

INTRODUCTION: Although Rwanda's health system underwent major reforms and improvements after the 1994 Genocide, the health system and population health in the southeast lagged behind other areas. In 2005, Partners In Health and the Rwandan Ministry of Health began a health system strengthening intervention in this region. We evaluate potential impacts of the intervention on maternal and child health indicators. METHODS: Combining results from the 2005 and 2010 Demographic and Health Surveys with those from a supplemental 2010 survey, we compared changes in health system output indicators and population health outcomes between 2005 and 2010 as reported by women living in the intervention area with those reported by the pooled population of women from all other rural areas of the country, controlling for potential confounding by economic and demographic variables. RESULTS: Overall health system coverage improved similarly in the comparison groups between 2005 and 2010, with an indicator of composite coverage of child health interventions increasing from 57.9% to 75.0% in the intervention area and from 58.7% to 73.8% in the other rural areas. Under-five mortality declined by an annual rate of 12.8% in the intervention area, from 229.8 to 83.2 deaths per 1000 live births, and by 8.9% in other rural areas, from 157.7 to 75.8 deaths per 1000 live births. Improvements were most marked among the poorest households. CONCLUSION: We observed dramatic improvements in population health outcomes including under-five mortality between 2005 and 2010 in rural Rwanda generally and in the intervention area specifically.

Motivations and Constraints to Family Planning: A Qualitative Study in Rwanda's Southern Kayonza District.

BACKGROUND: While Rwanda has achieved impressive gains in contraceptive coverage, unmet need for family planning is high, and barriers to accessing quality reproductive health services remain. Few studies in Rwanda have qualitatively investigated factors that contribute to family planning use, barriers to care, and quality of services from the community perspective. METHODS: We undertook a qualitative study of community perceptions of reproductive health and family planning in Rwanda's southern Kayonza district, which has the country's highest total fertility rate. From October 2011 to December 2012, we conducted interviews with randomly selected male and female community members (n = 96), community health workers (n = 48), and health facility nurses (n = 15), representing all 8 health centers' catchment areas in the overall catchment area of the district's Rwinkwavu Hospital. We then carried out a directed content analysis to identify key themes and triangulate findings across methods and informant groups. RESULTS: Key themes emerged across interviews surrounding: (1) fertility beliefs: participants recognized the benefits of family planning but often desired larger families for cultural and historical reasons; (2) social pressures and gender roles: young and unmarried women faced significant stigma and husbands exerted decision-making power, but many husbands did not have a good understanding of family planning because they perceived it as a woman's matter; (3) barriers to accessing high-quality services: out-of-pocket costs, stock-outs, limited method choice, and long waiting times but short consultations at facilities were common complaints; (4) side effects: poor management and rumors and fears of side effects affected contraceptive use. These themes recurred throughout many participant narratives and influenced reproductive health decision making, including enrollment and retention in family planning programs. CONCLUSIONS: As Rwanda continues to refine its family planning policies and programs, it will be critical to address community perceptions around fertility and desired family size, health worker shortages, and stock-outs, as well as to engage men and boys, improve training and mentorship of health workers to provide quality services, and clarify and enforce national policies about payment for services at the local level.

Data for Program Management: An Accuracy Assessment of Data Collected in Household Registers by Community Health Workers in Southern Kayonza, Rwanda.

Community health workers (CHWs) collect data for routine services, surveys and research in their communities. However, quality of these data is largely unknown. Utilizing poor quality data can result in inefficient resource use, misinformation about system gaps, and poor program management and effectiveness. This study aims to measure CHW data accuracy, defined as agreement between household registers compared to household member interview and client records in one district in Eastern province, Rwanda. We used cluster-lot quality assurance sampling to randomly sample six CHWs per cell and six households per CHW. We classified cells as having 'poor' or 'good' accuracy for household registers for five indicators, calculating point estimates of percent of households with accurate data by health center. We evaluated 204 CHW registers and 1,224 households for accuracy across 34 cells in southern Kayonza. Point estimates across health centers ranged from 79 to 100% for individual indicators and 61 to 72% for the composite indicator. Recording error appeared random for all but the widely under-reported number of women on modern family planning method. Overall, accuracy was largely 'good' across cells, with varying results by indicator. Program managers should identify optimum thresholds for 'good' data quality and interventions to reach them according to data use. Decreasing variability and improving quality will facilitate potential of these routinely-collected data to be more meaningful for community health program management. We encourage further studies assessing CHW data quality and the impact training, supervision and other strategies have on improving it.

5-SPICE: the application of an original framework for community health worker program design, quality improvement and research agenda setting.

INTRODUCTION: Despite decades of experience with community health workers (CHWs) in a wide variety of global health projects, there is no established conceptual framework that structures how implementers and researchers can understand, study and improve their respective programs based on lessons learned by other CHW programs. OBJECTIVE: To apply an original, non-linear framework and case study method, 5-SPICE, to multiple sister projects of a large, international non-governmental organization (NGO), and other CHW projects. DESIGN: Engaging a large group of implementers, researchers and the best available literature, the 5-SPICE framework was refined and then applied to a selection of CHW programs. Insights gleaned from the case study method were summarized in a tabular format named the '5×5-SPICE charts'. This format graphically lists the ways in which essential CHW program elements interact, both positively and negatively, in the implementation field. RESULTS: The 5×5-SPICE charts reveal a variety of insights that come from a more complex understanding of how essential CHW projects interact and influence each other in their unique context. Some have been well described in the literature previously, while others are exclusive to this article. An analysis of how best to compensate CHWs is also offered as an example of the type of insights that this method may yield. CONCLUSIONS: The 5-SPICE framework is a novel instrument that can be used to guide discussions about CHW projects. Insights from this process can help guide quality improvement efforts, or be used as hypothesis that will form the basis of a program's research agenda. Recent experience with research protocols embedded into successfully implemented projects demonstrates how such hypothesis can be rigorously tested.

Utilizing community health worker data for program management and evaluation: systems for data quality assessments and baseline results from Rwanda.

Community health workers (CHWs) have and continue to play a pivotal role in health services delivery in many resource-constrained environments. The data routinely generated through these programs are increasingly relied upon for providing information for program management, evaluation and quality assurance. However, there are few published results on the quality of CHW-generated data, and what information exists suggests quality is low. An ongoing challenge is the lack of routine systems for CHW data quality assessments (DQAs). In this paper, we describe a system developed for CHW DQAs and results of the first formal assessment in southern Kayonza, Rwanda, May-June 2011. We discuss considerations for other programs interested in adopting such systems. While the results identified gaps in the current data quality, the assessment also identified opportunities for strengthening the data to ensure suitable levels of quality for use in management and evaluation.