Higher Decision-making Power Research Articles

Using Multilevel Modeling to Understand Individual and Community-level Determinants of Anemia in Ethiopia (P11-030-19)

ObjectivesAnemia is a public health problem in Ethiopia. There is strong evidence to show that both individual and community level factors play an important role in the prevalence of anemia and should be considered while designing effective programs to reduce anemia. The study aims to explore the determinants of anemia at both individual and community levels and to analyze any differential effect of a predictor at the two levels. MethodsMultilevel random intercept model was estimated using Ethiopia DHS 2016 with group mean centered variables at the individual level and grand mean level centering for cluster-level variables. The analysis was conducted in Stata/SE 15.1 using “melogit”. The final sample included 14,489 women of reproductive age group (WRA) belonging to 25 strata with an average cluster size of 580. ResultsThe variation between strata accounted for almost 11 percentage of the variability in the outcome. Woman’s age and number of children at the individual level as well as at the cluster level, and religion and education at the individual level are significant predictors. In addition, significant cross-level interactions include mean number of children in cluster versus woman’s age and household wealth; religion versus cluster means of household wealth and prevalence of high decision-making power and child marriage; and number of children versus mean age in cluster.Results suggest that women who are younger than the average cluster age and reside in relatively younger clusters have a higher probability of being anemic as compared to women who are older than the average cluster age. On the other hand, the probability of being anemic is the lowest across ages for younger women if they reside in clusters with highest mean age. Similarly, the association of poverty at the individual level reduces with increasing average wealth at cluster level while the opposite is true for number of children. Cluster average of number of children has a differential association with the probability of being anemic across religions. Cluster prevalence of high decision-making power among women and child marriage have a negative association with the probability of being anemic though the association varies by religion. ConclusionsResults showed the importance of variation between strata and clusters; and the importance of these when interacting with some individual level characteristics, that are not modifiable. These results have important implications for anemia program and policy Funding SourcesFHI 360, Bill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs▪▪

Relationship Between Emotional Intelligence and Locus of Control With Decision-making Styles among Corporate Managers in Iran

Emotional intelligence is defined as the facilitator of the perception, expression, attraction, understanding, and regulation of relationships that stimulates intellectual and emotional growth. Those who are more conscious about their emotions have more skills in managing emotional problems. They also have higher decision-making power. The purpose of this study is to investigate the relationship between emotional intelligence and locus of control with decision-making styles in corporate executives. The research method is descriptive and in terms of nature, it is a correlative study. The statistical population of the research is all managers and supervisors of Iran Khodro Company. The results of this study indicate that there is a strong relationship between emotional intelligence and styles of decision making in managers and supervisors of this company, but there is not a significant relationship between locus of control and decision making styles.

Using Software’s and Technology in Solving Mathematics Problem to Motivate and Accelerate the Learning Process

The purpose of this study was to investigate the use of software and technology in solving mathematics problem for speed-up the learning process. In this research, as a case study we investigated the dynamic properties that lead to transformations into chaos, where the point of resistance and the points of proximity was studied. We discussed the solving of the problem by applying the Matlab software for the case study. It demonstrated the areas of contraction and expansion of the map as well as the points of attracting and repelling. The results showed that the use of information and communication technology in student’s mathematical reasoning skill is effective. The goal of education is to transform a student into a person with high decision-making power and creative solving problems and has the power of reasoning. Citizenship education that can adapt to the complexity of the 21st century.

Inside a Multinational Corporation Combining Commercial and Social Objectives

This qualitative study explores whether, and if so how, a multinational corporation can organize itself to develop internal ventures that pursue blended, commercial and social, value at the base of the pyramid (BoP). Comparing four such BoP ventures combining commercial and social objectives inside a multinational corporation, we find that structural origins (differentiated or integrated) and operational relatedness (higher or lower) did not determine whether BoP ventures could develop internally. We find that BoP ventures with different structural origins and degrees of relatedness developed internally, instead of spinning out from the corporation, by extricating from standard corporate rules primarily centered on short-term profit maximization and corresponding uncertainty avoidance. They did so with the support of top and senior managers from organizational units with high decision-making power, who could thereby play the role of extricator. This rule extrication involved three components: permission, which authorized departure from standard activities; fluid metrics, which provided a rationale for high risk and uncertainty; and an expedient process, which provided space for experimentation over time. Overall, this study contributes to emergent theory of how large corporations can fulfill the growing external demands and their own internal commitments to deliver social value alongside profit.

Women\u2019s autonomy and maternal healthcare service utilization in Ethiopia

BackgroundMost previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women’s autonomy. We assessed whether women’s autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia.MethodsWe analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women’s decision-making power and permissive gender norms associated with wife beating. We used Spearman’s correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women’s autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics.ResultsOur multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics.ConclusionsOur study shows that women’s autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution.

Needs and concerns of transgender individuals regarding interdisciplinary transgender healthcare: A non-clinical online survey.

This study investigates the needs and concerns transgender (short: trans) individuals have concerning trans healthcare (THC) in interdisciplinary THC centres. Trans individuals’ gender does not (fully/constantly) match their sex assigned at birth. To be able to live in their gender role and to prevent or minimise gender dysphoria, they might require a multidisciplinary set of transition related healthcare services. The current shift from the traditionally highly regulated, hierarchical and pathologising approach to THC towards a more patient-centred approach has highlighted the importance of trans patients’ satisfaction with treatment processes and results. As the still influential regulations have a negative effect on patient satisfaction, and might also keep trans individuals from seeking transition related treatment, it is crucial to investigate what trans individuals, whether patients or not, need and fear regarding transition related healthcare. Against the backdrop of mixed reactions received from the local trans community regarding the foundation of the Interdisciplinary Transgender Healthcare Centre Hamburg (ITHCCH), Germany, this study seeks to determine what trans individuals need with respect to THC in order to guarantee for high quality service provision at the ITHCCH. To this end, an online questionnaire was developed. The researchers employed a participatory approach to questionnaire development by involving a working group consisting of local trans support group representatives and (THC) specialists (N = 4). The sample consisted of N = 415 trans-identified individuals aged between 16 and 76. Most of them were based in Germany. 85.2% (n = 382) reported experience with transition related healthcare and 72.5% (n = 301) had (additional) treatments planned. Analysis revealed a need for communication and feedback opportunities. Furthermore, during the treatment process, addressing individual needs was considered crucial by participants. They agreed moderately with concerns towards THC centres. 96.5% of participants would like high decision-making power concerning treatment-associated decisions. The results demonstrate the importance of patient-centred THC that takes patients' individual needs and realities into consideration and involves patients in decision-making processes.

Household decision-making power and the mental health and well-being of women initiating antiretroviral treatment in Oromia, Ethiopia

ABSTRACTLow decision-making power (DMP) has been associated with HIV seropositivity among women in sub-Saharan Africa. As treatment accessibility and life expectancy for HIV-positive individuals increase, greater attention to the mental health and well-being of HIV-positive women is needed. This study examined whether low DMP was associated with psychological distress, social support or health-related quality of life (HRQoL) among women initiating ART. The sample included 722 women aged 18 or older initiating ART during 2012–2013 at six HIV clinics in Oromia, Ethiopia. DMP was assessed with five questions about household resource control and decision-making. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10). HRQoL was assessed with the overall subscale of the HIV/AIDS-Targeted Quality of Life instrument. Multivariable logistic regression analyses controlled for age, education, and location (urban/rural). Most respondents (63%) reported high DMP, followed by medium (27%) and low (10%) DMP. More than half (57%) reported psychological distress. Compared to medium DMP, low DMP among married or cohabitating women was associated with greater odds of low social support (aOR: 1.9 [1.3, 2.9]; high DMP among women not in a relationship was associated with greater odds of low social support (aOR: 4.4 [2.4, 8.1]) and psychological distress (aOR: 1.7 [1.1, 2.6]). Interventions to reduce psychological distress among women initiating ART should consider the familial context, as high DMP among women not in a relationship was associated with psychological distress. High DMP may indicate weak social ties and fewer material resources, particularly among women not in a relationship.

Transition in second birth intention in a low fertility context: the case of Jiangsu, China

ABSTRACTWhen China’s decades-long one-child policy was replaced by a two-child policy, the circumstances under which women intend to have a second child become of great concern. This study examines the determinants of women’s second birth intention, as well as how the intention changes over time alongside changes in other life circumstances. Using panel data from the Jiangsu Fertility Intention and Behaviour Study (JFIBS, 2007, 2010), we find that women with more economic and familial/social resources are more likely to want a second child, while women who work in non-agriculture sectors and have higher decision-making power in the family are less inclined to have a second child. We also find that a sizeable increase of family income encourages women to upwardly revise their intention towards a desire for two children. The role of policy change on Chinese women’s second birth intention is also discussed.

How Does Women’s Decision-Making Power Affect Budget Share, Nutrition and Education in Pakistan?

Understanding the effects of power distribution, particularly women’s decision making, on human development is important. This study used a set of direct measures of decision-making power from the Pakistan Social and Living Standard Measurement Survey and examined the relationship between women’s decision-making power and the food budget share, nutrition and child schooling. It found that in Pakistan, the relationship between women’s decision-making power and nutrition was not linear and varied depending on rural or urban residence. There was no clear evidence that higher women’s decision-making power would lead to better nutrition availability in Pakistan, but overall households were more likely to consume less grain and more vegetables. When women had higher decision-making power, children, particularly rural girls, were more likely to be enrolled in school.

Women's empowerment and contraceptive use: the role of independent versus couples' decision-making, from a lower middle income country perspective.

IntroductionThere is little available evidence of associations between the various dimensions of women's empowerment and contraceptive use having been examined - and of how these associations are mediated by women's socio-economic and demographic statuses. We assessed these phenomena in Pakistan using a structured-framework approach.MethodsWe analyzed data on 2,133 women who were either using any form of contraceptive or living with unmet need for contraception. The survey was conducted during May - June 2012, with married women of reproductive age (15–49 years) in three districts of Punjab. The dimensions of empowerment were categorized broadly into: economic decision-making, household decision-making, and women's mobility. Two measures were created for each dimension, and for the overall empowerment: women's independent decisions, and those taken jointly by couples. Contraceptive use was categorized as either female-only or couple methods on the basis of whether a method requires the awareness of, or some support and cooperation from, the husband. Multinomial regression was used, by means of Odds Ratios (OR), to assess associations between empowerment dimensions and female-only and couple contraceptive methods.ResultsOverall, women tend to get higher decision-making power with increased age, higher literacy, a greater number of children, or being in a household that has superior socio-economic status. The measures for couples' decision-making for overall empowerment and for each dimension of it showed positive associations with couple methods as well as with female-only methods. The only exception was the measure of economic empowerment, which was associated only with the couple method.ConclusionCouples' joint decision-making is a stronger determinant of the use of contraceptive methods than women-only decision-making. This is the case over and above the contribution of women's socio-demographic and economic statuses. Effort needs to be made to educate women and their husbands equally, with particular focus on highly effective contraceptive methods.

Determinants of Child Morbidity and Factors Governing Utilisation of Child Health Care: Evidence from Rural India

Acute respiratory infections and diarrhea, has been globally identified, as poising major threats to survival of children under the age of five. This is also true for India, where these two diseases, have been the major causes behind infant mortality both in 1997 as well as 1998. Prevention as well as effective treatment of these diseases depends on a host of individual, household and community level behavioural factors. The objective of this paper is to estimate the role played by such factors in determining the utilisation of formal health care to cure diarrhoea and certain respiratory illnesses plaguing young children. We have also simultaneously tried to explore the factors that explain why a child may be more prone towards contracting either of the above-mentioned two diseases. Our analysis is based on the survey data drawn from the National Family Health Survey (1998-99) for the fourteen major states of India. The major findings are briefly enlisted as follows: Firstly, a woman with greater educational qualification and also higher decision-making power within the household exhibited greater willingness toward health care usage for her sick child. Secondly, formal health care is more likely to be sought for children whose mother are more aware of existing health care packages and the requisite symptoms of the diseases i.e. diarrhea and cough. For instance, respondents who are aware of existence of oral rehydration salts, used worldwide to treat diarrhea, are significantly more prone towards seeking formal curative care, if her child has diarrhoea. Thirdly, children who were reported to show signs of being severely ill, for each of the above-mentioned diseases, are also the ones who have a significantly higher probability of being taken for treatment. Finally, not only the child's nutritional intake (after adjusting for age) but also that of the mother has a strong influence on the likelihood of the child contracting these diseases.