Strengthening uptake of adolescent-friendly health services in Blantyre, Malawi.

The importance of teacher performance in improving achievement to determine the quality of education and school performance, This study is an Exploratory Sequential mixed method design study. aims to influence leadership, work motivation, and organizational culture on teacher performance and achievement, both partially and simultaneously with Exploratory Sequential Design . This approach combines qualitative and quantitative methods, starting with an in-depth exploration of the factors that influence the effectiveness of teacher work performance, followed by testing the quantitative model. This research was conducted at SMP Negeri 3 Numfor Barat in a remote area. To achieve the objectives of this study, the researcher applied Exploratory Sequential mixed method design research with a case study approach . In the qualitative stage, the research data was collected through observation, in-depth interviews with 1 head of educational unit and 10 subject teachers, and document analysis to identify needs, challenges, and best practices in management. The research data was processed through the stages of data collection, data presentation, data reduction, and data conclusion drawing. To ensure the validity of the research data, the researcher conducted data confirmation and credibility by involving the Education Office for the development of educational resources and school supervisors. The results of the study indicate that: (1) the teacher training management model in improving work performance that has been implemented in remote areas consists of the planning, organizing, implementing and evaluating stages. (2) The function of the teacher training management model in improving work performance that has been implemented in remote areas runs effectively and efficiently. The results of this study provide important information for the government, school supervisors, principals and teachers. leadership, work motivation, and organizational culture simultaneously have a positive and significant effect on teacher work performance.

Context: Despite a high number of unwanted pregnancies in Kenya, contraceptive use among adolescents is very low. Establishing the nature of sexuality discussions is critical to determine perceptions and barriers affecting contraceptive use among adolescents. Methods: The study used systematic random sampling to collect data to examine sexuality information and knowledge that affect perception and barriers on contra-ceptive use among 1119 adolescents aged 15 - 19 years in Nairobi. The survey was conducted using the 2009 Kenya Demographic and Health Survey enumeration areas and projections based on the 1999 population census. Data were collected using structured interviews, focus group discussions (FGDs) and in-depth interviews (IDIs) among adolescents, parents and teachers. Quantitative data were analyzed using Statistical Package for Social Sciences (SPSS) software while qualitative information was analyzed using iT Atlas. Results: Although teachers were identified as a primary source of sexuality information, they were poorly prepared to teach the subject. While the study found negative perceptions on sexuality education, most FGDs and IDIs supported the need for its integration in the school curriculum. Most adolescents who used con- traceptives had perceptions that their parents approved. Source of sexuality information, living arrangement and perceptions on contraceptives for unmarried adolescents were statistically associated with contraceptive use. Conclusion: The study showed that sexuality information from parents and teachers was biased against adolescents using contraceptives. There is need to address attitudes in discussing contraceptive use for adolescents by parents and teachers to enhance positive perceptions and increase contraceptive use by adolescents.

In 2018, Ethiopia's government digitized its Community Health Information System (eCHIS) to enhance Health Extension Program service delivery. However, the impact of eCHIS on health outcomes remains unclear. This study, therefore, examined the effects of eCHIS on the uptake of maternal and child health services. A post-test-only, non-equivalent group household survey design was used, collecting data from July to August 2024 in rural communities with and without eCHIS. A stratified multistage sampling technique was employed to recruit respondents. A sample of 1,728 women of reproductive age (271 in eCHIS and 1,457 in non-eCHIS woredas), 1,118 women with children ages 0-11 months (188 in eCHIS and 930 in non-eCHIS), and 569 women with children ages 12-23 months (301 in eCHIS and 268 in non-eCHIS) were included in this study. Propensity scores were used to match intervention and comparison communities based on women's age, religion, parity, education, household wealth, distance to health facilities, and autonomy. A modified Poisson regression analysis, adjusting for covariates, was conducted to estimate the adjusted prevalence ratios (PR) for maternal and child health outcomes. Modern contraceptive use was 66% in intervention areas versus 56% in comparison areas. Institutional delivery rates were 95% in intervention and 79% in comparison areas. In intervention areas, 94% of children received the first dose of the Pentavalent vaccine compared to 83% in comparison areas, while 85% and 68%, respectively, received the third dose. Adjusted analyses showed that eCHIS intervention areas had statistically significant increases in contraceptive use (13.0 percentage points; PR: 1.25; p-value < 0.01) and institutional deliveries (8.9 percentage points; PR: 1.18; p-value < 0.01) compared to comparison areas. Similarly, the average treatment effect of eCHIS on Pentavalent 1, Pentavalent 3, and full vaccination coverage showed significant increases of 10.3 (PR: 1.13; p-value < 0.01), 13.6 (PR: 1.26; p-value < 0.01), and 14.6 (PR: 1.36; p-value < 0.01) percentage points, respectively. This study underscores the transformative potential of eCHIS in improving maternal and child health outcomes in Ethiopia. Sustained investment in digital health systems can help scale effective health care services to rural and underserved communities.

Health service delivery is a key pillar of the health system management .The World Health Organization recently emphasized the need to develop adolescent -friendly health services to improve the care provided to young people throughout the world. However, there is limited peer reviewed literature on this subject therefore necessitating assessment of whether the existing health facilities are prepared to implement the adolescent friendly health services. Adolescent friendly health services remains a relatively new and sensitive area mainly due to restrictive norms and policies guiding the services. After International Conference on Population and Development in 1994, countries started implementing adolescent friendly health services. The Government of Kenya together with partners in an attempt to address the health challenges came up with the Adolescent package of care (APOC) in 2013 whose guidelines were finalized in November 2014 and released for use by service providers . Despite this package of care, there is still ineffective staff capacity in relation to skills and knowledge gap of health professionals, training needs, health resources as well as health system factors that can affect implementation of AFHS. The study explored ways of mitigating or addressing the barriers to implementation of these services. The study used both quantitative and qualitative approaches to collect data. The study utilized survey research adapting descriptive cross sectional design and semi-structured questionnaire to interview 348 health care providers and 472 adolescents in Mam Lucy Kibaki Hospital from 3rd May 2014 to 16 June 2014 .The key informants were mainly nurses, clinical officers and Medical doctors who were working at the health service delivery area at the time of study and were interviewed using an interview guide. The managers at the hospital were interviewed using an in-depth interview guide while the adolescents were interviewed through interview guide and focused group discussion. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) Version 18.0. Descriptive statistics and chi-square tests were performed to determine significant associations. The study established that sex, age, level of education and adolescent awareness about existence of friendly health services offered were significantly associated with utilization at p<0.05. Long queues, unfavorable working hours and lack of money negatively affected consumption of AFHS.The study concluded that the utilization of health services among the adolescents was low largely due to unfriendliness of the health care providers at health facilities and lack of awareness of AFHS services. In view of the findings, this study recommends need for the Government through the Ministry of Health and partners in health service provision to increase the number of AFHS and ensure that the recommendations of Adolescent Package of care is implemented fully with good evaluation strategies in place. Laborious awareness drives to sensitize the adolescents about the available services through rigorous health education and increased involvement of both parents/guardians and teachers to scale up implementation are also recommended.

This study seeks to explore and understand the Bhutanese secondary school teacher's perception of increased Continuous Formative Assessment (CFA) weightings and the associated opportunities and challenges. Grounded on pragmatism, this study employed an explanatory sequential mixed methods design. The quantitative and qualitative data were collected through a survey of 370 randomly sampled secondary teachers and 16 participants for 4 FGDs. The descriptive statistics were conducted using Statistical Package for Social Science (SPSS) version 25 to determine the perception of teachers on new CFA weightings, opportunities of CFA, and challenges of CFA. The qualitative data were analyzed by coding and identifying emerging themes. The qualitative and quantitative data findings were triangulated. The result of this study revealed that teachers have a positive perception of the increased CFA weightings.

Quality education is anchored on how skilled and motivated teachers are to improve their professional knowledge and skill throughout their careers to ensure effective curriculum development. There has been growing thirst and continuous demand for teachers to enhance their professional knowledge and skills on pedagogy through continued teacher professional development strategies. However, demands for continued teacher professional development are a worldwide issue. There is growing need therefore of teachers professional development beyond their initial training. The thrust of this study therefore was to assess the influence of continued teacher development on the implementation of early childhood education curriculum. The study employed explanatory sequential mixed methods design. From a target population, 236 head teachers, 313 ECDE teachers and 56 County ECDE officers were randomly sampled yielding 588 participants. Data was collected using questionnaire and interview schedules. Quantitative data for the first phase were analyzed with the assistance of Statistical Package for Social Sciences (SPSS) to generate descriptive and inferential statistic Qualitative data during the second phase were analyzed thematically. Mixed results were obtained indicating that head teachers and ECDE teachers held contrary views regarding teacher’s recruitment and deployment. While the head teachers’ results indicated that there was a significant and positive correlation (p=.001, &lt; .05), the ECDE teachers revealed a non-statistically correlation (p=.456,&gt;.05), between professional development of teachers and curriculum implementation. The conclusion reached was that there was inadequate teacher professional development and the understaffing was negatively influencing curriculum implementation. It was recommended that national and county government should put in place a harmonized teacher professional development policy and employ adequate teachers to effectively implement the curriculum.

ObjectiveThe study aims to assess quality of obstetric and newborn care including respectfulness of the maternity care.DesignThe study used explanatory sequential mixed methods design .SettingThis study was conducted in 50 health centres in Addis Ababa city administration January 25 to April 31, 2021.MethodsDuring the quantitative phase 500 women in postpartum period were interviewed using structured questionnaire. In the second phase in-depth interview was conducted with 20 midwives and 13 health centre managers. The quantitative data was analysed using Statistical Package for Social Sciences (SPSS). The qualitative data was analysed using Colaizzi’s seven step process.ResultsOnly 24.6% of women had respectful maternity care (RMC). Only 46% of women had effective communication during child birth. Only 9.6% of women had emotional support during child birth. Majority of women were encouraged to mobilize, take food and be on labor position of their choice. However, only 22.4 and 18.8% of women respectively had a companion of choice and any pharmacologic pain relief during child birth. One in seven women (15%) had one form of disrespect and abuse during child birth.ConclusionEnsuring respectful maternity care needs strong policy direction to health facilities, public education on their right to respectful maternity care, training of care givers and monitoring care through engagement of frontline staff and clients.

The thrust of this study was to assess the influence of teacher recruitment on the implementation of pre-school curriculum. The study employed explanatory sequential mixed methods design. From a target population, 236 head teachers, 313 ECDE teachers and 56 County ECDE officers were randomly sampled yielding 588 participants. Data was collected using questionnaire and interview schedules. Quantitative data for the first phase were analyzed with the assistance of Statistical Package for Social Sciences (SPSS) to generate descriptive and inferential statistic Qualitative data during the second phase were analyzed thematically. Mixed results were obtained indicating that head teachers and ECDE teachers held contrary views regarding teacher’s recruitment and deployment. While the head teachers’ results indicated that there was a significant and positive correlation (p=.001, &lt; .05), the ECDE teachers revealed a non-statistically correlation (p=.456,&gt;.05), between the recruitment of teachers and curriculum implementation. The conclusion reached was that there was inadequate teacher recruitment and the understaffing was negatively influencing curriculum implementation. It was recommended that national and county government should put in placed a harmonized teacher recruitment policy and employ adequate teachers to effectively implement the curriculum. Keywords: Recruitment, Head teachers, Pre-school teachers, Curriculum implementation. DOI: 10.7176/RHSS/12-4-04 Publication date: February 28 th 2022

Sequential explanatory mixed method design is the most frequently applied in both health and social sciences literature. It is denoted by ‘QUAN → qual’ which represents the quantitative study occurs first and has greater weight in addressing the study’s aims, and the qualitative study follows to explain quantitative results. Despite the extensive use of sequential explanatory design, there are limited references to this design. Therefore, this methodological paper attempts to fill the gap by providing an illustration in developing a sequential explanatory interview schedule based on complementary-alternative medicine (CAM) study among clinical psychologists in Indonesia. The most important step to develop sequential explanatory interview schedule was the construction of aspects and questions that were immensely grounded on the most notable quantitative results. In this study, eight aspects of interview schedule were constructed after analyses of the nationwide survey. The interview schedule then piloted among participants with fairly similar characteristics to the participants in the main interviews. This process enhanced the quality of questions through feedback from participants and improved the interviewer’s skills through familiarization with questions. It is expected that this reflection report could be adopted as a practical guideline in developing interview schedule for sequential explanatory mixed method design, particularly in the field of psychology.

Pre-service accounting teachers perform a variety of calculations in accounting courses, for example, they calculate and compare company financial ratios, calculate dividends, interests, and variances. Mathematics is thus a crucial tool for performing accounting calculations. This paper reports on a study designed in order to investigate pre-service accounting teachers’ mathematics anxiety with respect to accounting. The Fennema-Sherman Mathematics Anxiety Scale (F-SMAS), with established reliability and validity, was applied. A cross-sectional data set containing demographic details and attitudes towards mathematics anxiety was collected and quantitative responses of 255 first-, second-, and third-year pre-service teachers were analysed. In addition, semi-structured interviews with 18 pre-service accounting teachers, 6 from each level, were conducted. A sequential explanatory mixed methods design was employed. Data was analysed using the Statistical Package for Social Sciences for quantitative data, and semi-structured interviews were transcribed and analysed qualitatively. The study revealed that the Fennema-Sherman Mathematics Anxiety Scale score is slightly above neutral. Qualitative results reveal that even mathematically competent students are not free from mathematics anxiety. Based on these findings it was concluded that mathematics anxiety affects and influences the way students learn and perform accounting calculations. Keywords: accounting; accounting calculations; mathematics anxiety; pre-service accounting teachers

Because rates of unintended pregnancy, abortion and unintended birth are very high among adult women in the United States, it is important to identify interventions that can increase contraceptive use in this population. PubMed, PsycINFO and POPLINE were searched for experimental or quasi-experimental studies published between 1990 and 2005 that evaluated policies or programs designed to increase contraceptive use or reduce pregnancy among adult women in the United States. In addition, relevant journals were searched, experts were asked to provide further citations and several subsequently published articles were included. Only 11 studies that assessed programs, and none that assessed policies, were found. The evaluated interventions offered pregnancy and STD prevention counseling (one study); provided contraceptives in settings other than family planning clinics (two studies); had women initiate contraceptive use during the medical visit (two studies); provided advance supplies of emergency contraception (four studies); or implemented systems to remind injectable contraceptive users about their next injection (two studies). The interventions generally had positive, albeit short-term, effects on contraceptive use; none reduced pregnancy rates. Programs that gave women a contraceptive during the visit were the most effective at increasing method use. Advance provision of emergency contraception increased the likelihood of its use and did not affect regular contraceptive use. Very few studies have evaluated interventions to increase contraceptive use among adult women. A research plan that rigorously assesses the impact of different approaches to increasing contraceptive use among adult women should be an integral part of any long-term effort to prevent unintended pregnancy in the United States.

Despite the harmful effects of burnout among many nursing students, academic burnout is poorly understood. This study was conducted to better explain the concept of burnout in nursing students. An explanatory sequential mixed-method design was used. In the quantitative phase, the Maslach Burnout Inventory-Student Survey was completed by 91 nursing students in eastern Iran. In the qualitative phase, individual interviews were conducted with 13 undergraduate nursing students, one nurse and one instructor. Data were analysed using the directed content analysis method. Results from an ANOVA test showed differences in burnout scores in different semesters (p=.02) that were confirmed by the qualitative data. In addition to the three dimensions of the Maslach burnout model (exhaustion, cynicism and inadequacy feeling), qualitative data from the present study indicated the presence of a fourth dimension (incompatible learning style).

BackgroundFollowing the armed conflict in Tigray, the health system collapsed and routine health services were interrupted. However, after the Pretoria peace agreement, various health -related interventions aimed at recovery were implemented. Despite these efforts, little is known about the current status of child health services, including immunization and healthcare seeking for childhood illnesses. Therefore, this study aimed to evaluate child health services in post-war Tigray.MethodsA community and facility-based cross-sectional study was conducted from January to February 2024 to assess the uptake of child health services and service readiness among mothers of children aged 0–59 months (N = 2340). A multistage sampling technique was used, with a random selection of 24 districts and 78 sub-districts, and 30 households were considered per Tabia based on the assumption of Ethiopian Demographic Health Survey, 2019. A representative sample of health facilities (30%) including primary hospitals, health centers and health posts, was also considered. Data were collected using Open Data Kit (ODK), which was pretested, modified, and translated into the local language. The collected data were cleaned, coded, and analyzed using SPSS version 25.ResultsThe response rate of this study was 99.9%. The proportion of children who received full vaccination was 58.8%, with a significant disparity between urban and rural areas. A significant difference was noted in the full vaccine uptake among contraceptive users (65.7%) (p-value < 0.007) and by residence urban (66.8%) versus rural (56.3%) (p-value < 0.006). Cough was the leading cause of childhood illnesses, followed by fever in the rural settings accompanied by the healthcare seeking of 58.6%, 48.4%, 59.3% for diarrhea, cough and fever respectively. The overall readiness score for child health and specific EPI service were 46.4% and 37.4% respectively.ConclusionIn the post- war period, immunization coverage in Tigray was relatively low, with a notable urban–rural disparity. Utilization of healthcare for childhood illness was also low in rural communities despite the high burden of diseases. Overall, readiness score for child health and immunization services were low. Concerted efforts are needed to improve the uptake of childhood vaccines and the readiness score for child health services.

BackgroundMalaria continues to be a significant global health challenge, particularly in sub-Saharan African regions. Effective prevention and control strategies are crucial in mitigating its impact. Therefore, assessing the use of malaria preventive measures, treatment-seeking behaviours, and understanding the motivating factors behind positive behaviours/practices and barriers to using malaria preventive and control measures is essential for designing successful intervention programs.MethodsUsing a sequential explanatory mixed methods design, a descriptive cross-sectional study was conducted among 382 heads of households in the Mareba sector, Bugesera district, Rwanda. A qualitative study followed with 30 in-depth interviews among the top performers and other community members to explore the motivations and barriers to performing positive behaviours. Descriptive statistics for quantitative data and thematic analysis for qualitative data were used.ResultsThis study revealed that among those who own insecticide-treated nets, 234(89.3%) reported that they slept under the bed net the night preceding the survey; 256(67%) had fever cases in the last 24 months preceding the survey; and 214(87%) reported seeking care within 24 h. While almost all 243(98.8%) of participants who had fever case reported that they have taken all medicines as prescribed, however, a large number 263(68.8%) and 148(38.7%) still think that there are people in the community who do not take all malaria medications as prescribed and there are people who share malaria medications in the community, respectively. 82(65.1%) of those who never had a fever case believe that they have been using malaria preventive measures correctly and consistently. This study found that knowledge about malaria, family support, and community mobilization are the top motivating factors to practice positive behaviours while, lack of bet nets, poverty, and lack of time were reported as main barriers.ConclusionInterventions that target key motivating factors for adopting positive behaviours in malaria prevention and control should be prioritized. This, in turn, will reduce the disease burden on affected populations. Efforts to overcome barriers in malaria prevention and control should also be participatory. Community involvement should be at the centre of these interventions.

As a continent with 54 independent states Africa’s diversity is often highlighted but frequently forgotten when fertility is discussed. Fifty and more years ago to consider that all African countries and societies had a single fertility pattern (large numbers of children) and single trend (unchanging over time) was a valid characterization. Since the 1960s however that uniformity has disappeared replaced by substantial inter- and intra-country differences in fertility patterns and trends that render previous perceptions of continent-wide homogeneity obsolete. In this chapter we consider two African countries—Ghana and Kenya—whose fertility patterns and trends and their determinants have been well documented (Bongaarts 2008; Garenne 2008; Machiyama 2010; Shapiro and Gebreselassie 2008; Sneeringer 2009). Both countries have benefited from regularWorld Fertility Surveys (WFS) and Demographic and Health Surveys (DHS) that record trends in fertility family planning (FP) and other relevant indicators. The recently introduced Performance Monitoring and Accountability 2020 (PMA2020) surveys monitor progress since 2012 for the FP2020 initiative and occasional Situation Analysis and Service Provision Assessment surveys have also detailed the readiness of the health system in both countries to make quality FP services available. Ghana and Kenya share some common history: both have relatively strong health system legacies from the period of British colonialization; both were among the earliest countries to achieve independence; they were the first two African countries that developed policies to address population growth in the 1960s; and both have received substantial and sustained resources over several decades from many external donors and technical assistance organizations explicitly intended to increase the availability and quality of family planning services. However they are composed of cultures that are both diverse within each country and markedly different in many ways between the two countries. The two countries demonstrate remarkably different pathways in fertility and family planning patterns and trends from the 1970s to the present. We highlight some of the key differences and similarities explain why they have occurred and identify insights that could inform a wider understanding of fertility transitions and the role of family planning in other African countries. (excerpt)