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Community-based development: scaling up the correct use of misoprostol at home births in Afghanistan
Description
Globally, more than 350 000 women die annually from complications during pregnancy and childbirth (UNFPA, 2011). Nearly 99% of these, according to World Health Organization (WHO) trends (2010) occur in the developing world outside of a hospital setting with limited resources including emergency care (WHO, 2012; UNFPA, 2011). The most prevalent cause of death is postpartum hemorrhage (PPH), accounting for 25% of deaths according to WHO statistics (2012). Conditions in Afghanistan are reflective of the scope and magnitude of the problem. In Afghanistan, maternal mortality is thought to be among the highest in the world. The Afghan Mortality Survey (AMS) data implies that one Afghan woman dies about every 2 hours from pregnancy-related causes (AMS, 2010). Lack of empowerment, education and access to health care resources increase a woman's risk of dying during pregnancy (AMS, 2010). This project aims to investigate the prospects of scaling-up the correct use of misoprostol, a prostaglandin E1 analogue, to treat PPH in developing countries where skilled assistance and resources are scant. As there has been little published on the lessons learned from programs already in place, this study is experience-driven, based on the knowledge of industry experts. This study employs a concurrent triangulation approach to synthesize quantitative data obtained from previous studies with qualitative information gathered through the testimonies of key personnel who participated in pilot programs involving misoprostol. There are many obstacles to scaling-up training initiatives in Afghanistan and other low-resource areas. The analysis concludes that the most crucial factors for scaling-up community-based programs include: more studies analyzing lessons learns from community driven approaches; stronger partnerships with community health care workers; overcoming barriers like association with abortion, misuse and product issues; and a heightened global and community awareness of the severity of PPH without treatment. These results have implications for those who actively work in Afghanistan to promote maternal health and other countries that may use Afghanistan's work as a blueprint for reducing maternal mortality through community-based approaches. Keywords: Afghanistan, community-based interventions, community-driven, maternal mortality, MDG5, misoprostol, postpartum hemorrhage, reproduction, scale-up
ContributorsCristy, Candice (Author) / Grossman, Gary (Thesis advisor) / Parmentier, Mary-Jane (Committee member) / Byrd, Denise (Committee member) / Arizona State University (Publisher)
Created2013
Description
By offering increased access to medical care, telemedicine offers significant opportunity for the process of development under Amartya Sen’s definition, that development is freedom, including freedom from illness, early death, and preventable disease. It advances development by freeing people from these burdens. However, like many emerging technologies, organizing information and understanding the field faces significant challenges. This paper applies Bashshur's three-dimensional model of telemedicine to the classification of telemedicine literature found in databases to assess the value of the model as a tool for classification. By standardizing language and creating a repository of research done to date in a centralized location, the field can better understand how it is progressing and where work still needs to be done. This paper aims to see if Bashshur's model serves well for this task.
ContributorsBlum, Alexander (Author) / Parmentier, Mary Jane (Thesis advisor) / Zachary, Gregg (Committee member) / Grossman, Gary (Committee member) / Arizona State University (Publisher)
Created2015
Description
In 1996, President Clinton ordered the formation of the Advisory Committee on Human Radiation Experiments (ACHRE), which undertook to evaluate the morality of a myriad of secret and publicized radiation experiments ranging from 1944 to 1974. The goal of this thesis is to analyze the ways in which that committee formed moral evaluations and the extent to which its strategies related to a broader historical and philosophical discourse. Here I attempt to describe two specific techniques of simplification the committee deploys in order to make a retrospective moral analysis possible. Although the techniques comprise specific problems, frameworks, subjective perspectives, and conceptual links, their unifying principle is the field of choices the techniques produce. In the first technique I outline, I argue that by focusing on the problem of historical relativism, the committee gains a platform through which it would be granted flexibility in making a distinction between moral wrongdoing and blameworthiness. In the second technique of simplification I outline, I argue that the committee's incorporation of a principle to reduce uncertainty as an ethical aim allow it to establish new ways to reconcile scientific aims with moral responsibility. In addition to describing the structure of these techniques, I also demonstrate how they relate to the specific experiments the analysts aim to evaluate, using both the ACHRE experiments as well as the Nuremberg Trial experiments as my examples. My hope is not to show why a given committee made a particular moral evaluation, or to say whether a decision was right or wrong, but rather to illustrate how certain techniques open up a field of choices that allow moral analysts to form retrospective moral judgments.
ContributorsCirjan, Cristian (Author) / Hurlbut, Ben (Thesis director) / Humphrey, Ted (Committee member) / Zachary, Gregg (Committee member) / Barrett, The Honors College (Contributor)
Created2015-05