Week 5

Bowden, S., Braker, K., Checchi, F., & Wong, S. (2012). Implementation and utilisation of community-based mortality surveillance: a case study from Chad. Conflict and Health, 6, 11.     http://doi.org.libproxy.chapman.edu/10.1186/1752-1505-6-11

So let me start this by confessing that I severely underestimated 'subject specific database' research on Wednesday evening as Dr. Dunn talked us through it in class. Upon conducting a few quick classroom database searches with subjects like "social science" and "healthcare communication" I had pretty much resigned this assignment to being completed with the assistance of my research assistant and mentor, Mr. G.O. Ogle. Of course,  I'd be sure to write that I had literally given the Leatherby databases the 'ol college try'. So I was really quite surprised to find this article and several others like it when I went back into the databases and searched using the 'Nursing' subject (an idea I got from the class handout on database subjects...and from Daniella in class but don't tell her I admitted she told me so). Additionally, unlike many other research resources I’ve used in studying this topic, this article does not group it’s information about Chad into a compiled study or analysis along with other countries in the Sub-Saharan region. Rather, it’s dedicated to analyzing mortality surveillance in Chadian healthcare systems exclusively.

This article confirmed a suspicion that I had, based on other research, that maternal and child mortality reporting processes were not up to par in Chad. Some of the reasons that it specifically cites have been added to my body of research. These reasons are, a lack of consistent, standardized processes for mortality documentation, making the vital record easier to overlook or more likely to be reported incorrectly. Also the lack of community health care workers contributes to improper reporting and documentation, especially in emergency situations when workers are task saturated. Another reason that was discovered was illiteracy and language barriers between healthcare workers and patients. A considerable amount of Chadians are illiterate and there are currently approximately 120 languages and dialects spoken in the country. Finally, the analyst recounted that violence and security incidents significantly interrupted the records keeping process on multiple occasions. Six different times during the four-year study they noted that mortality data was not recorded for a whole month due to the security threats.

With the article’s special emphasis on record keeping practices for women and children there was the implication that these practices were particularly more lax. This concept invoked some questions that I’ve had now for a few weeks but have not yet delved into answering. After the information I’ve learned in this article I want to finally commit to researching the political and cultural mindsets concerning the value of women and children in Chad and the behaviors, customs, and laws that are or are not in place protecting them or contributing to their mortality.

Week 4

   Ok, so this week we were assigned to conduct research using scholarly (peer

reviewed) journals which I thought was pretty swell because while searching for

books on my topic last week it seemed like all that I could find for the first few

days were articles! So I jumped on the Leather Library homepage, a site that I 

determined three months ago when I enrolled that I would not be getting to 

know very well, add that to the list of things I've been wrong about. I then 

clicked on several unreasonable small fonted links until I got to Academic

Search Premier to look for my article. So, Academic Search Premier was a first 

for me and I have to say that I love the idea of having a data base of articles 

and journals because I am sort of an information junkie and articles and 

scholarly essays are great sources! The search options here looked pretty

similar to the Advanced Search so no trouble there. I conducted three searches

uses a different combination of keywords and narrow my search each time. The

third search contained my article, it called to me from among the eight

that presented themselves. One thing I did differently for the very first time

was was to create a range filter on the publication date. I narrowed it to

between the years 2013-2015 on this third search. 

   
   I chose the article Reflections on Maternal Mortality Millennium Goal, which 

delves into the United Nations’ Millennium Development Goal, set at the 

beginning of the new millennium, of a 75% reduction in global maternal

mortality by the year 2015. The article’s purpose is to broadly address the

global responses in maternal mortality since that time in 2000. From this reflection I discovered that 11 countries' maternal mortality rates worldwide have actually increased since these goals were set 15 years ago. Not surprisingly however, Chad is among those troublesome 11. Then the articles  goes on to explain some reasons for the lack of improvement in the area of maternal mortality which I had not yet read about or even considered. The reasons I found most compelling and useful for my research, was high fertility rates (6.1 in Chad), the absence of laws and policies mandating maternal death notifications, and the lack of political commitment by national and local governments to making maternal mortality and women’s health in general a financial priority within the health budget. I had already read a few statements last week about the role of government in maternal and child mortality but this article solidified in my mind the political responsibility that exist in these issues. Additionally, the issue of maternal death notifications not being required and the effects that this lack of accountability and reporting can be assumed as having was a completely new idea for me. Both of these points are steering me toward conducting more research specifically on the impact that politics, law, and policy are having on Chad’s maternal and child mortality.

Lawson, G. W., & Keirse, M. J. (2013). Reflections on the Maternal Mortality Millennium Goal. Birth: Issues In Perinatal Care, 40(2), 96-102 7p. doi:10.1111/birt.12041