Poor Districts Research Articles

Effects and determinants of tuberculosis drug stockouts in South Africa

BackgroundThe frequent occurrence of medicine stockouts represents a significant obstacle to tuberculosis control in South Africa. Stockouts can lead to treatment alterations or interruptions, which can impact treatment outcomes. This study investigates the determinants and effects of TB drug stockouts and whether poorer districts are disproportionately affected.MethodsTB stockout data, health system indicators and TB treatment outcomes at the district level were extracted from the District Health Barometer for the years 2011, 2012 and 2013. Poverty terciles were constructed using the Census 2011 data to investigate whether stockouts and poor treatment outcomes were more prevalent in more impoverished districts. Fixed-effects regressions were used to estimate the effects of TB stockouts on TB treatment outcomes.ResultsTB stockouts occurred in all provinces but varied across provinces and years. Regression analysis showed a significant association between district per capita income and stockouts: a 10% rise in income was associated with an 8.50% decline in stockout proportions. In terms of consequences, after controlling for unobserved time invariant heterogeneity between districts, a 10% rise in TB drug stockouts was found to lower the cure rate by 2.10% (p < 0.01) and the success rate by 1.42% (p < 0.01). These effects were found to be larger in poorer districts.ConclusionsThe unequal spread of TB drug stockouts adds to the socioeconomic inequality in TB outcomes. Not only are stockouts more prevalent in poorer parts of South Africa, they also have a more severe impact on TB treatment outcomes in poorer districts. This suggests that efforts to cut back TB drug stockouts would not only improve TB treatment outcomes on average, they are also likely to improve equity because a disproportionate share of this burden is currently borne by the poorer districts.

Mental health of children exposed to intimate partner violence against their mother: A longitudinal study from Brazil.

Exposure to intimate partner violence (IPV) is an important adverse childhood experience, but there are few longitudinal studies in low and middle-income countries. To investigate the consequences of exposure to IPV for a child's mental health. 614 mother-child pairs were evaluated in a poor urban district in Recife, northeastern Brazil. Women were interviewed in pregnancy, postpartum and six to nine years after delivery, and asked about their experience of IPV, and the exposure of their child to violence. The Strengths and Difficulties Questionnaire (SDQ) was completed by child's mother and teacher. Ten types of child experience of IPV and the age of onset of exposure were compared with the child's behavioral profile at school age. The mothers reported that 372/614 (60.6%) children had been exposed to IPV. The commonest types of child exposure to IPV were "prenatally", "overheard", "eyewitnessed", and 10.0% of children were physically or verbally involved in the IPV. Mothers reported high SDQ Total Difficulties scores in 71.7% of all children exposed to IPV and teachers in 59.8%. Multivariate logistic regression analysis demonstrated the strongest association with behavioral difficulties was with exposure to IPV in the age group 1-2 years (OR 2.5 [95% CI: 1.3-4.8]). Young children are sensitive to the age of first exposure to IPV and to the type of IPV. Interventions to reduce IPV should be targeted on vulnerable women from poor urban communities during their pregnancies and in the first two years of their child's life.

Spatial analysis of intentional homicides in João Pessoa, Paraíba, Brazil, 2011-2016.

to describe spatial patterns of intentional homicides in João Pessoa, Paraíba, Brazil, 2011-2016. this was an ecological study using census tracts as units of analysis; the study used data on intentional homicides of victims living in João Pessoa obtained by cross-checking Mortality Information System SIM information with Public Security information; mortality coefficients were calculated for the whole period and its triennia and were later smoothed using the local empirical Bayesian method; spatial autocorrelation techniques were applied to the smoothed coefficients which were using Moran's spatial statistics. significant spatial autocorrelation was detected for the period as a whole I=0.679, p=0.01, the 1st triennium I=0.508, p=0.01, and the 2nd triennium I=0.572, p=0.01; areas of greater risk were identified distributed among the western, northwestern, southeastern, and far south zones of the city, mainly in regions with low socioeconomic conditions; census tracts with low coefficients were located in areas of medium/high socioeconomic status. homicides in João Pessoa were high in poor districts and these are priority areas for intervention.

Western Imaginary of Jihadism

Western jihadism is a complex phenomenon in which the imaginary dimension, the subjectivity of the actors linked to their socio-economic condition but also to their ethnicity, and beyond that, what I call their subjectivation (the ability to empower oneself as a social actor), play a significant role. In Europe, among the Muslim offshoots of migrant workers, most of the psychological developments associated with Jihadism occurs in very specific urban structures, the poor districts or suburbs, where a high concentration of urban poor live with a burden of social stigma linked to the high criminality rate. These settings are often de facto ghettoes. The development of a specific urban imagination often gives meaning to the jihadist commitment among young people living in this type of settlement. This imaginary often feeds on a feeling of stigmatization among these people. Jihadism is not a quest for meaning, but its discovery, the wielding of it through embracing death and inflicting it on the ‘infidels’. It is, in another way, a punishment of society, an act of vengeance against it, be it due to personal reasons (mainly for the young downtrodden of the immigrant origin who feel stigmatized by the society) or due to the lack of ideal, utopia and social justice in society (the case of the young middle class people). This study aims at underlining the fact that social imaginaries should be at the root of socio-anthropological analysis and without understanding the meaning of social action, quantitative views give us at best a unilateral, at most a distorted view of social action and social behavior.

Building pilot model of community organizing for new rural construction in the extremely difficult communes in poor districts of the North West, Central Highlands and South West - Results and issues

The author of this paper has studied the situation of constructing pilot model of community organization of new rural construction in three extremely difficult communes in three poor districts (Program 30a) in the North West, Central Highlands and South West, depth analysis of the results, assessment of the advantages and problems of building the model of social management organization (Internalunity Development Board, Club of Information, Education and Communication, Green CleanBeautiful-Safety-Friendly Environment Board, Community Convention Development Board) and the model of organization of production management is suitable with the economic, cultural and social conditions of each locality, is suitable with the customs and habits of each ethnic minorities group (Production of hybrid rice with high yield and economic efficiency, Growing coffee and growing coffee grafted with butter, Rice with fish intercropping). Since then, the author proposed groups of solutions to improve the efficiency of implementing the pilot model of community building in new rural areas in three extremely difficult communes in three poor districts (Program 30A) in three areas of North West, The Central Highlands, the South West in the direction of sustainable development and the replication of the model into the provinces in the coming time.

Building pilot model of community organizing for new rural construction in the extremely difficult communes in poor districts of the North West, Central Highlands and South West - Results and issues

Building pilot model of community organizing for new rural construction in the extremely difficult communes in poor districts of the North West, Central Highlands and South West - Results and issues

The Impact of Texas “Wealth Equalization” Program on the Academic Performance of Poor and Wealthy Schools

The purpose of this study is to examine the propositions of “money matters/doesn’t matter” in a zero-sum public school system. Specifically, this study seeks to assess the impact of Texas Wealth Equalization Program on the academic performance of contributing wealthy school districts and the receiving poor school districts. Although the primary interest of this study is the aforementioned two sets of school districts, the study also incorporates a set of intermediate districts into the analysis in order to control for the possible threat of history. The study uses three state and national assessment tools to measure school performance. The results show that answer to the propositions of “money matters/doesn’t matter” is contextual. Controlling for the possible threat of history, the findings show that transfer of nearly $3.4 billion from wealthy to poor school districts did not result in lower academic achievement among the students of rich school districts while it resulted in modest performance improvement in poor districts. Policy implications of Wealth Equalization are discussed.

The Incidence of Mortality Upon the Rich and Poor Districts of Paris and London

The Incidence of Mortality Upon the Rich and Poor Districts of Paris and London

Exposure to Floods, Climate Change, and Poverty in Vietnam

With 70% of its population living in coastal areas and low-lying deltas, Vietnam is highly exposed to riverine and coastal flooding. This paper conducts a “stress-test” and examines the exposure of the population and poor people in particular to current and future flooding in Vietnam and specifically in Ho Chi Minh City. We develop new high-resolution flood hazard maps at 90 m horizontal resolution, and combine this with spatially-explicit socioeconomic data on poverty at the country and city level, two datasets often kept separate. The national-level analysis finds that a third of today’s population is already exposed to a flood, which occurs once every 25 years, assuming no protection. For the same return period flood under current socioeconomic conditions, climate change may increase the number exposed to 38 to 46% of the population (an increase of 13–27% above current exposure), depending on the severity of sea level rise. While poor districts are not found to be more exposed to floods at the national level, the city-level analysis of Ho Chi Minh City provides evidence that slum areas are more exposed than other urban areas. The results of this paper provide an estimate of the potential exposure under climate change, including for poor people, and can provide input on where to locate future investments in flood risk management.

Prevalence and determinants of congenital cytomegalovirus infection at a rural South African central hospital in the Eastern Cape

Background: The Nelson Mandela Academic Hospital (NMAH) in Mthatha, Eastern Cape, is a rural central hospital, serving one of the poorest districts in South Africa. The prevalence of and risk factors for congenital cytomegalovirus (CMV) in this area are not known. The aim was to evaluate the prevalence of congenital CMV and associated risk factors for babies born at NMAH.Methods: This was a cross-sectional study to determine the prevalence of congenital CMV infection among babies born at Nelson Mandela Academic Hospital. Mother–baby pairs delivered consecutively from Monday to Friday, who gave informed consent, were included. Demographic information was collected on a questionnaire. All babies were tested for congenital CMV using a saliva swab PCR within the first week of life.Results: A total of 302 births were assessed. Congenital CMV was prevalent in 18 births (5.96%; 95% CI 3.29–8.63) and had an equal prevalence between HIV-exposed and HIV-unexposed newborns (prevalence ratio [PR] = 1.00; 95% CI 0.94–1.06; p = 0.869).Conclusions: The prevalence of congenital CMV of 5.96% is similar to findings from other resource-limited settings. There was no significant association between maternal HIV status and congenital CMV. With the prevalence of congenital CMV being as high as it is in the studied setting, clinicians are advised to have a high index of suspicion, especially when mothers are CMV seropositive.

DIFFERENT FACES OF SECURITY PERCEPTIONS OF THE HUMAN SECURITY CONCEPT

The perception of safety is a very individual feeling although it is the standard and the level of living that undoubtedly affect various fears and threats appearing in rich and poor societies. The aim of this article is to compare attitudes towards safety and its perception by people living aside, but in completely different social and economic conditions. Both South and North Koreas are historically very close to each other yet, totally different conditions of living on both sides of the Korean Peninsula make safety quite opposite notions. The residents of the Brasilian districts of poverty and crime, infamous favelas, live in a world where being a member of a gang ensures safety. For other inhabitants of Brasil and tourists, security means staying as far away as possible from favelados i.e., the residents of poor districts. For determined African refugees, Europe seems to be a safety heaven and even the risk of losing their lives on the long and most dangerous route to Europe is worth taking. However, for many Europeans their safety ends with the influx of immigrants.

‘Synonymization’ threat and the implications for the funding of school districts with relatively high populations of black students

ABSTRACTEducation stakeholders have used descriptors of poverty and race as if they were synonymous. This ‘synonymization’ of identities is particularly evident for black and poor students. We define ‘synonymization’ as a policy threat that emerges when policymakers conflate two marginalized identities, resulting in policies that ostensibly, but not actually, address biased structures. From this construct, we posit two claims: (1) largely poor districts are not largely black districts and (2) dollars appropriated to largely poor districts are not equivalent to dollars appropriated to largely black districts. Our analysis supports those claims. We also found that higher correlations between portion poor and portion black do not lessen the negative impact of synonymization for the collective as one would have expected. While funding and poverty were significantly associated, there was no significant association between funding and portions of black students even when poverty and black student profile were significantly linked.

'I think we are going to leave these cases'. Obstacles to surgery in rural Malawi: a qualitative study of provider perspectives.

Surgical services at district level in Malawi are poor, yet the majority of the population resides in rural areas. This study aimed to explore the perceived obstacles to surgery from the perspective of the cadre directly responsible for surgical service delivery at district hospitals. Qualitative interviews were conducted with 16 clinical officers (COs) receiving surgical training in eight public district hospitals and their 12 trainers. Thematic analysis of data was conducted using a top-down coding method. Despite readiness of the COs to conduct operations, other staff essential for surgery were sometimes unavailable to support them. Respondents attributed this to lack of skills, weak motivation or poor work ethic of their colleagues. Lack of commitment to do surgery, passiveness, lack of initiative in problem-solving and 'laziness' of surgical team members were among the reasons provided by study participants, accounting for unnecessary cancellations of elective surgery and inappropriate referrals of emergency cases. Other factors included infrastructure breakdowns and stock-outs of surgical supplies. There were instances where COs, and their supervisors, showed initiative in finding solutions to problems resulting from poor district hospital management practices. This study demonstrates how the motivation of surgical team members is a key factor in deciding whether or not to perform operations; and that shortages of supplies or infrastructure need not be an absolute obstacle to service delivery. Scale-up of surgical services at district level requires investments to improve surgical and anaesthetic skills, to strengthen human resources and facility management, and to ensure the availability of reliable infrastructure and essential supplies.

The Fiscal Disparity and Achievement Gap between Extremely Wealthy and Poor School Districts in Illinois

This study investigates the achievement gap and horizontal disparity of schools’ funding by exploring and comparing the differences of funding between extremely wealthy and poor school districts in Illinois before funding reforms took place on August 2017. We find that the students in wealthiest school districts had an average of 51% higher proficiency on standardized tests than did the students in extremely poor districts. The extremely poor school districts received about $4582 less per student than the wealthiest school districts, based on data from total funding sources in 2014. Our results indicate that federal and state funding did not have sufficient equalization impact on interdistrict property tax funding disparity.

Correction: Evaluation of a community-based intervention to improve maternal and neonatal health service coverage in the most rural and remote districts of Zambia.

[This corrects the article DOI: 10.1371/journal.pone.0190145.].

Modeling of social management organization in three communes with special difficulties in three poor districts (Program 30A) in the North West, Central Highlands and the South West - Results and lessons learned

Analysis of the specific results of the organizational model of social management, we found that the model of the project “Building a model of organization building community New Rural in 3 poor communes towels in 3 districts of poverty (Program 30A) of the three regions North West, Central Highlands and Southwest “ has made a very positive impact on the community, contributing very important in improving the internal resources of rural communities villages in new countryside construction. Through the activities of the awareness project of ethnic minorities are enhanced. They have learned to use scientific and technical advances in cultivation and intensive farming; maintaining clean, beautiful village. Conventions of villages hamlets have been revised and supplemented to meet the requirements of law and relevant customs and practices, local knowledge, ethnic psychological characteristics of rural communities villages; community spirit of each of the households increasingly advanced workers

Why do rural women in the most remote and poorest areas of Zambia predominantly attend only one antenatal care visit with a skilled provider? A qualitative inquiry

BackgroundWhile focused antenatal care (ANC) has served as an entry point in the continuum of care for both mothers and children, fewer than a third of pregnant women in the most remote and poorest communities of Zambia achieve the four ANC visits recommended by the World Health Organization. Current evidence suggests that attending ANC provided by a skilled healthcare worker at least once is common and associated with skilled birth attendance. The aim of this study was to explain why one ANC visit with a skilled provider seemed more common than four ANC visits among women in the remote and poorest districts of Zambia.MethodsA qualitative case study design was conducted in 2012 among 84 participants in the selected remote and poorest districts of Zambia. Focus group discussions were conducted with mothers and community health volunteers, while key informant interviews were conducted with healthcare providers. Thematic analysis was conducted.ResultsMost women delayed starting antenatal care visits due to uncertainties about the timing for initiation of ANC and due to waiting for confirmation of the pregnancy by an elderly woman. Attendance of ANC once with a skilled provider was due to the need to assess their health status and that of their baby. In some facilities, attendance of ANC at least once was enforced by financial charges imposed on women for late ANC initiation, and/or incentives provided by nongovernmental organisations. Unavailability of services at health posts closest to these remote communities led to failure to return for subsequent ANC visits. Women’s livelihoods such as nomadic lifestyles made it harder for them to initiate and make additional ANC visits.ConclusionThe popularity of ANC attendance once by a skilled provider among the remote and poorest women of Zambia was explained through perceived unavoidable social and economic barriers to care, and the punitive and incentive procedures implemented by health services. Maximising comprehensive care by skilled healthcare workers in the one visit a woman makes at the health facility, may lead to optimal utilisation of quality focused ANC. Enhancing community-based interventions may increase the potential to reach the vulnerable populations.

Voices from the frontline: barriers and strategies to improve tuberculosis infection control in primary health care facilities in South Africa

BackgroundTuberculosis (TB) infection control at primary healthcare (PHC) level remains problematic, especially in South Africa. Improvements are significantly dependent on healthcare workers’ (HCWs) behaviours, underwriting an urgent need for behaviour change. This study sought to 1) identify factors influencing TB infection control behaviour at PHC level within a high TB burden district and 2) in a participatory manner elicit recommendations from HCWs for improved TB infection control.MethodA qualitative case study was employed. TB nurses and facility managers in the Mangaung Metropolitan District, South Africa, participated in five focus group and nominal group discussions. Data was thematically analysed.ResultsUtilising the Information Motivation and Behaviour (IMB) Model, major barriers to TB infection control information included poor training and conflicting policy guidelines. Low levels of motivation were observed among participants, linked to feelings of powerlessness, negative attitudes of HCWs, poor district health support, and general health system challenges. With a few exceptions, most behaviours necessary to achieve TB risk-reduction, were generally regarded as easy to accomplish.ConclusionsStrategies for improved TB infection control included: training for comprehensive TB infection control for all HCWs; clarity on TB infection control policy guidelines; improved patient education and awareness of TB infection control measures; emphasis on the active role HCWs can play in infection control as change agents; improved social support; practical, hands-on training or role playing to improve behavioural skills; and the destigmatisation of TB/HIV among HCWs and patients.

Colonial Containment? Repression of Pro-Independence Street Demonstrations in Algiers, Casablanca and Paris, 1945–1962

This article draws on three examples of the violent repression of pro-independence nationalist street demonstrations: Casablanca, 7–8 December 1952; Algiers, 10–13 December 1960; Paris, 17 October 1961. Changes in the urban landscape due to migration, urban planning and housing policy brought the threat perceptions of the colonial authorities to centre upon certain poor districts and their inhabitants, in the context of strengthening pro-independence nationalism. These developments help explain where and how this lethal repression took place, as well as its key objectives (containment, punishment, deterrence). The late colonial authorities experienced great difficulties in spatially containing pro-independence demonstrations and urban mobility more widely.

Innovation, Dosage and Responsiveness in the Implementation of the Program “Edúcame Primero Perú” for Reducing Child Labour

"Educame Primero Peru" [Educate First, Peru] is a program designed to prevent child labour. It is aimed for 6 to 12 year old children at risk. During the scholastic year 2015–2016, 151 children from three schools in two poor districts of Lima (Peru) participated in the program. In this paper, we examine the impact of various components of program implementation related to psychological well-being and child labour. The qualitative description of the program is based on the participant observation of the 151 children, their families and their teachers. Sixty percent of the participants were boys and 40% girls, all between 8 and 13 years (M = 10.38, DT = 1.22). In a second phase, we collected longitudinal quantitative indicators of innovation, dosage and responsiveness of participants within a group of 36 children who took part throughout a 10 months implementation program in two schools in Villa El Salvador. We describe the process of transfer and adaptation of the program in Peru, from previous experiences in other Latin American countries. Qualitative observation allowed us to document the influence of organizational dynamics and the relationship with families for the proper functioning of the program. The results showed a significant improvement in the responsiveness of the stakeholders in the second phase of the program. Participants positively improved their attitude towards peers and program facilitators, as well as, continued to assist to the workshops. In the discussion, we propose that part of the improvement could be attributed to the reorganization in smaller groups in the program sessions. Small group intervention seems to increase the intensity of implementation. Hence, we explored to what extent small-scale intervention indirectly contributes to improve academic outcomes, psychological adjustment and child labour.