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You searched for +publisher:"University of Toronto" +contributor:("Sellen, Daniel W"). Showing records 1 – 2 of 2 total matches.

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University of Toronto

1. Callaghan, Mike. Antiretroviral Therapy in Walvis Bay, Namibia.

Degree: PhD, 2015, University of Toronto

Highly Active Antiretroviral therapy (HAART) is a successful means of treating infection with the Human Immunodeficiency Virus (HIV). Namibia was among the first countries in sub-Saharan Africa to achieve universal access to HAART for HIV-positive citizens through the public sector. In this thesis, I explore treatment outcomes in Walvis Bay, a busy port city at Namibia’s coast. I find that gender is the most important factor shaping HAART, with women reporting for testing and treatment in greater numbers than men, sooner in the course of their illness, and enjoying lower mortality after treatment initiation. There are no compelling biological explanations for this distribution; I postulate a series of socio-cultural and political-ecological factors driving outcomes in Walvis Bay. In particular, changing gender roles and different points of entry into care are important at the individual level. I describe a ‘toxic masculinity’ that, however fragile, actively interferes with testing, treatment, and health-seeking behavior. Female identity, conversely, emerges as altogether more stable and more suited to the clinical and social demands of HAART. More broadly, actions are shaped by large-scale processes of urbanization and globalization, and especially the effects these have on labour, subsistence, and culture change. I conclude by suggesting modifications to the rollout program that may help to distribute the benefits of HAART more equitably through the treatment population. This research has important implications for other countries in sub-Saharan Africa as they gradually move toward universal access to HAART. More generally, it may presage future challenges of globalization and infectious disease. Advisors/Committee Members: Lee, Richard B, Sellen, Daniel W, Anthropology.

Subjects/Keywords: Antiretroviral Therapy; Gender; HIV/AIDS; Masculinity; Namibia; Political Ecology; 0326

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Callaghan, M. (2015). Antiretroviral Therapy in Walvis Bay, Namibia. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/70825

Chicago Manual of Style (16th Edition):

Callaghan, Mike. “Antiretroviral Therapy in Walvis Bay, Namibia.” 2015. Doctoral Dissertation, University of Toronto. Accessed April 24, 2019. http://hdl.handle.net/1807/70825.

MLA Handbook (7th Edition):

Callaghan, Mike. “Antiretroviral Therapy in Walvis Bay, Namibia.” 2015. Web. 24 Apr 2019.

Vancouver:

Callaghan M. Antiretroviral Therapy in Walvis Bay, Namibia. [Internet] [Doctoral dissertation]. University of Toronto; 2015. [cited 2019 Apr 24]. Available from: http://hdl.handle.net/1807/70825.

Council of Science Editors:

Callaghan M. Antiretroviral Therapy in Walvis Bay, Namibia. [Doctoral Dissertation]. University of Toronto; 2015. Available from: http://hdl.handle.net/1807/70825


University of Toronto

2. Hackett, Kristy Melissa. Impact of a Community-based Smartphone Intervention on Maternal Health Service Utilization in Rural Tanzania.

Degree: PhD, 2016, University of Toronto

Improving access to safe facility-based delivery (FBD) is a challenge in rural Tanzania, where 50% of women deliver at home without skilled medical assistance. Community health workers (CHWs) may improve women’s demand for, and uptake of FBD services; however CHW performance can be suboptimal without supportive supervision and job aids. This dissertation addresses key questions in maternal health services research and contributes to the evidence base for mobile health (“mHealth”), for which rigorous impact studies in low-income countries remain scarce. This study employed a cluster-randomized, controlled, mixed-methods trial design to evaluate the impact of a smartphone-based intervention (SP+) designed to assist CHWs with data collection, prenatal education delivery, gestational danger sign identification, and referral on women clients’ utilization of FBD. Pairs of CHWs in 32 villages were cluster-randomized to receive training on either SP+ or standard, paper-based protocols for use during household visits with clients. The main outcome (delivery location) was ascertained via postnatal household surveys with 572 randomly selected women. In-depth qualitative interviews with 60 CHWs and 14 healthcare professionals, and focus group discussions with 56 women clients were conducted to explore perceptions of CHW performance, quality of care, and SP+ implementation strength. SP+ was associated with increased FBD: after adjusted analyses, the odds of FBD in intervention villages were two times greater than the odds in control villages (OR=1.95; p=0.02). A key underlying mechanism was increased household visit frequency by smartphone-assisted CHWs; these CHWs reported higher job satisfaction compared to peers in the control group. Qualitative findings suggest that SP+ led to perceived improvements in data management, communication, decision-making support, emergency response, enhanced social status and credibility, and perceived health system improvements among clients. However, concerns regarding privacy and data security were raised. Through triangulation of methods and data sources, I demonstrate how factors influencing women’s use of FBD in this context are multidimensional and thus require multi-level maternal health programs and policies. I argue that while SP support for CHWs can be efficacious in targeting increased FBD, prevailing health system weaknesses including a lack of formal support for CHWs limits the potential impact of such strategies. Advisors/Committee Members: Sellen, Daniel W, Dalla Lana School of Public Health.

Subjects/Keywords: 0573

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Hackett, K. M. (2016). Impact of a Community-based Smartphone Intervention on Maternal Health Service Utilization in Rural Tanzania. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/76500

Chicago Manual of Style (16th Edition):

Hackett, Kristy Melissa. “Impact of a Community-based Smartphone Intervention on Maternal Health Service Utilization in Rural Tanzania.” 2016. Doctoral Dissertation, University of Toronto. Accessed April 24, 2019. http://hdl.handle.net/1807/76500.

MLA Handbook (7th Edition):

Hackett, Kristy Melissa. “Impact of a Community-based Smartphone Intervention on Maternal Health Service Utilization in Rural Tanzania.” 2016. Web. 24 Apr 2019.

Vancouver:

Hackett KM. Impact of a Community-based Smartphone Intervention on Maternal Health Service Utilization in Rural Tanzania. [Internet] [Doctoral dissertation]. University of Toronto; 2016. [cited 2019 Apr 24]. Available from: http://hdl.handle.net/1807/76500.

Council of Science Editors:

Hackett KM. Impact of a Community-based Smartphone Intervention on Maternal Health Service Utilization in Rural Tanzania. [Doctoral Dissertation]. University of Toronto; 2016. Available from: http://hdl.handle.net/1807/76500

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