Social Science Research within the INDEPTH … 2013 Social Science...Social Science Research within...

Social Science Research within the

INDEPTH Network and the potential contribution of INTREC

Margaret Gyapong Dodowa HDSS

Strengthening Research and Policy on SDH in LMIC in Africa and Asia 19th -21st March

2013, Accra Ghana

OUTLINE

• Background • Example from Dodowa • Report of SSWG meeting • Role of INTREC


2013, Accra Ghana

Background • Endorsement of report on the World Conference on Social

Determinants of Health (Rio de Janeiro, Brazil, 19–21 October 2011) at 65th World Health Assembly.

• Enjoins members states to – Develop and support policies, strategies, programs and action

plans that address social determinants of health, with clearly defined goals, activities and accountability mechanisms and with resources for their implementation,

– Build capacities among policy-makers, managers, and program workers in health and other sectors to facilitate work on social determinants of health;

• Called on the international community to – support the activities off the member states in their bid to

incorporate issues related to the social determinants of health in order to ensure successful disease control and elimination efforts.


2013, Accra Ghana

Background • For the INDEPTH Network this call is

important – Opportunity to look at the wealth of data we

collect within the various HDSS sites to examine the extent to which we can contribute to the call to the member states.

– Opportunity to answer or ask several questions within social determinants of health

THE WHYS BEHIND THE NUMBERS


2013, Accra Ghana

QUESTIONS • What are best strategies for the public sector to employ in

scaling up cost-effective health interventions. • What information do governments need about patterns of

illness among the poor and social, economic and institutional circumstances to select the most appropriate arrangements to protect them from falling into extreme poverty

• To what extent are observed individual characteristics such as health status, gender attitudes, preferences for particular government policies or consumer choices patterned by personal endowments such as personality, age, sex or level of education

• To what extent are these patterned by the social cultural and environmental context in which the individuals exist.


2013, Accra Ghana

ASKING WHY IN MATERNAL HEALTH ISSUES

EXAMPLE FROM DODOWA HDSS


2013, Accra Ghana

Maternal Mortality • NATIONAL FIGURES

• 740 PER 100,000 live births in 1990 • 451 per 100,000 live births in 2008 • Need to reach 185 per 100,000 BY 2015

• At this rate National level will be at 340 per 100,000 BY 2015

• AS AT 2011 • DW 330 PER 100,000 live births


2013, Accra Ghana

HEALTH FACILITY DATA Indicators 2009 2010 2011

No. (%) No. (%) No. (%)

ANC Registrants 5664 99.3 5048 84.8 5078 81.7 ↓

ANC Attendance 17081 19150 18957

ANC 4th Visit

Av ANC Visit

1739

3.0

10.1 2069

3.8

10.8 2478

3.7

13.1 ↑

Total Delivery 3117 54.8 3369 61.6 3163 50.9 ↓

Skilled Delivery 1594 28.1 1984 33.3 2267 36.7 ↑

Deliveries- TBAs 1523 26.6 1384 23.2 896 14.5

Skilled deliveries improved. Post Partum Vit A – 107% Strengthening Research and Policy on SDH in LMIC in Africa and Asia 19th -21st March

2013, Accra Ghana

PLACE OF DELIVERY BY YEAR OF REGISTRATION

0

10

20

30

40

50

60

70

2009 2010 2011

64,6 67,9 67,6

35,4 32,1 32,4

Num

ber o

f birt

hs

Year of registration

Health Facility-based

Non-health facility based


2013, Accra Ghana

Skilled Delivery by Area Council - 2011

0

10

20

30

40

50

60

70

80

90

Asutsuare Ayikuma Dodowa Dawa Ningo Osuwem Prampram

73,5

66,0

83,2

51,4

67,3

37,1

85,9

Prop

ortio

n of

regi

ster

ed b

irths

Area Council Strengthening Research and Policy on SDH in LMIC in Africa and Asia 19th -21st March

2013, Accra Ghana

0

5

10

15

20

25

30

35

40

45

Nil Primary JSS SSS Tertiary

Non Pregnant

Pregnant

perc

enta

ge


2013, Accra Ghana

0

5

10

15

20

25

30

35

40

45

50

Least Poor Less Poor Poor Poorer Poorest

Pregnant

Non Pregnant

Socio Economic Status by pregnancy status


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Why are women in the Dangme West District not fully utilizing free maternal health

services, including antenatal care and skilled

attendance at delivery


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AGE-SPECIFIC FERTILITY RATES BY YEAR, DHDSS

0

0,02

0,04

0,06

0,08

0,1

0,12

0,14

0,16

0,18

15-19 20-24 25-29 30-34 35-39 40-44 45-49

ASFR

s

Age group NB: The continuous rise in ASFR among the age group 15-19 (Teenage pregnancy)

Age-Specific Fertility Rates (ASFR) by Year

Year 2006

Year 2007

Year 2008


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What are the risk factors and reasons for the high prevalence of adolescent pregnancy in the Dangme West District of the Greater Accra Region?


2013, Accra Ghana

Strengthening Social Science Research within the INDEPTH

Network

BRAINSTORMING MEETING Cape Town

14th -16th February 2013


2013, Accra Ghana

Participants

• UCT Dr Johannes John-Langba • Agincourt South Africa: Prof Karol Hofman • Dikgale South Africa: Dr JC Makhubele • Dodowa Ghana: Dr Margaret Gyapong • Kintampo Ghana: Ms Livesy Naafoe Abokyi • Ifakara Tanzania: Ms Angel Singh • Vadu India: Dr Sanjay Juvekar • INTREC: Prof. John Kinsman


2013, Accra Ghana

Expected Outcome of Brainstorming Session

• Assess the social science capacity strengthening needs of selected INDEPTH sites to address SDH

• A research agenda for comparative social science research on emerging issues related to the SDH with INDEPTH sites

• An assessment of existing and future data needs (qualitative data) to effectively address emerging SDH issues at INDEPTH

• Terms of reference for Social Science Working Group with membership based on selected INDEPTH member centres with interest in addressing the SDH of the population


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Assess the social science capacity

strengthening needs


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Questionnaire on Social Science capacities

• Name of site • Person responding • Any Experience with social science research? • Any social research studies done in the site • Any planned areas of social research • Number of social scientists in the site and area of specialization • Of the number of social scientists you have how many can manage

qualitative data manually • Of the number of social scientists you have how many manage

qualitative data with software • Any needs for social research capacity building • What specific social science research challenges/ barriers if any do

you face in your site.


2013, Accra Ghana

24/47 Sites responded

• ACDIS, Agincourt, Bandim, Bandafassi, Chililab, Dabat, Dikgale, Dodalab, Vietnam, Dodowa, Gilgel Gibe, Iganga/ Mayuge, kaya, Kilifi, Kilite Awlaelo, Mbita, Mlomp, Nahuche, Nanoro, Navrongo, Niakhar, Nouna, Ouagadougu, and West Kiang


2013, Accra Ghana

Experience

• Concepts, 15 centers, 74 (1-15) • Data collection, 15 centers 172 (1-50) • Data analysis, 15 centers 84 (1-15) • Report writing, 15 centers 79 (1-15) •


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Social Science Studies

• INTREC project on social determinants of Health- Country report • Policy Brief Adolescent Health Project • NCD risk factor surveillance project • Social and cultural aspects Multidisciplinary studies in social sciences • Consequences of fertility strategies and household composition on

schooling and child labor in urban Burkina Faso • Migration and health at the periphery of Ouagadougou • Street medicine use in Ouagadougou reproductive health, adolescent

health Abortion care • Violence against women and health equity Knowledge, attitudes and

practises of contraception among women in Kaya • HIV testing in Kaya • Education and health Community based Insurance • Home management of childhood deceases Decentralization and

reproductive health Health workers motivation • Sexual behaviour and HIV status


2013, Accra Ghana

Social Science Studies

• Community wealth ranking • Assessment of the Bamako Initiative in Guinea-Bisau • KAP and stigma in relation to tuberculosis and HIV in the community • The social situation of motherless children • Perceptions in relation to severe malaria in children and different ethnic

groups • Explorations of men's roles as fathers • various PhD studies of HIV ART • Attitudes and acceptability of elements of an intervention package for an

RCT Mixed qual and qual studies • Process studies with clinical trials (x 3) • Exploration of men's roles in communities • Community involvement in development of package of school-based HIV

prevention intervention and survey of secondary school learners (N=9000) • Evaluation of different low-threshold interventions in community.


2013, Accra Ghana

Areas of Specialization • Epidemiologists

• Demography

• Child health

• Fertility

• Child protection

• Population and health

• Education

• Poverty

• Anthropology

• Sociology and community

health

• Family-based disclosure

interventions

• Gender

• Behavioural Science

• Ethics

• HIV prevention and men

including MSM

• Urbanization

• Masculinities

• Spatial aspects of

population

• NCD risk factor

surveillance

• Depression, antenatal

and post-natal

• Communication

• Substance abuse on

health

• Economics

• Epidemiology and social

illness of health

• HIV prevention and

youth

• Sexual and

Reproductive Health

• Mortality

• education

• Migration

• Public health


2013, Accra Ghana

Data Management

• Out of 80 Social Scientist, 47 from 16 centres can manage qualitative data manually.

• Out of 80 Social Scientist, 28 from 16 centres can manage qualitative data with software

• Software used to manage qualitative data by the centres are; Nvivo, Open Code 3.6, Atlas-Ti, QSR 9, excel MAX QDA, and SPSS.

•


2013, Accra Ghana

Needs from the sites


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TERMS OF REFERENCE


2013, Accra Ghana

THREE BROAD AREAS

• CATEGORY 1: – Enhance data collection of core/core-plus data to

understanding/address the gaps in existing information (VA narratives)

• CATEGORY 2: – Ensure the linkage of current quantitative HDSS data to

qualitative information available /needs to be collected • CATEGORY 3:

– Enhance the utilization of HDSS sites as platforms to conduct research based on new topic areas, or modules


2013, Accra Ghana

Research Agenda and Data Needs


2013, Accra Ghana

Research Agenda • The quest for therapy, and social support (Category 1 )

– Can VA narratives be used to understand health seeking behavior? – How does VA narratives assist in explain quest for therapy? – What are some of the social support mechanisms associated with

morbidity and motility? • Under-reporting of under five deaths (Category 2 )

– To what extent is under-reporting of under-five deaths influenced by socio-cultural factors?

• Migration and child health (Category 2 ) – What are the underlying reasons for the under-reporting of migration events? – What are the effects of migration on child health?

• Climate change and health (Category 3 ) – How can the mitigation and adaptation strategies to extreme weather events be

improved? – How does social capital and social cohesion influence the mitigation of the impact

of climate change on health?


2013, Accra Ghana

Issues for Discussion

• Data exists that can be explored • Answering the whys behind the numbers may

require new data collection • Studies that could inform health policy and

make an impact • Capacity needs to be built


2013, Accra Ghana

ROLE OF INTREC

•CAPACITY •CAPACITY •CAPACITY


2013, Accra Ghana

Thank you


2013, Accra Ghana

Social Science Research within the INDEPTH … 2013 Social Science...Social Science Research within...

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