Patience Afulani, MBChB, MPH, PhD
Assistant Professor, Department of Epidemiology & Biostatistics
Dr. Afulani conducts research on the social and health system factors underlying disparities in reproductive, maternal, neonatal, and child health (RMNCH). Her research has extended the evidence on how RMNCH outcomes are shaped by quality of care in health facilities as well as by social determinants. In addition, she has contributed to improved measurement of person-centered reproductive health care, and to the development of evidence-based interventions to improve RMNCH outcomes and reduce disparities.
Dr. Afulani’s prior work examined sources of disparities in quality of antenatal care and how this affects use of skilled birth attendants and birth outcomes in Ghana and Burkina Faso. In addition, she led the development of the person-centered maternity care (PCMC) scale and supported the development of a person-centered family planning scale, both of which were validated in Kenya and India. She also conducted research into sources of disparities in PCMC and barriers to providing PCMC in Kenya. In addition, she has worked on projects to design and evaluate interventions to improve quality of care including PCMC in Ghana, Kenya, and India. She has also conducted research on the health and reproductive behavior of migrants from Africa, and on the consequences of food insecurity in the United States.
Dr. Afulani’s current projects include an NICHD K99/R00 award on addressing provider stress and unconscious bias to improve quality of person-centered maternal health care in Kenya; a UCSF Preterm Birth Initiative grant on measurement of PCMC among women at risk for preterm birth in California; and a Gates-funded project to improve quality of care (including PCMC) through low-tech simulation training of providers in India.
Education:
- University of California, Los Angeles, School of Public Health, PhD in Public Health
- University of California, Los Angeles, School of Public Health, MPH in Community Health Sciences
- University of Ghana Medical School, MBChB (Bachelor of Medicine and Surgery)
In the news:
- COVID-19 has left Ghana's healthcare workers stressed—but simple things can help (op-ed) | The Conversation
- The role of bias in how women are treated during childbirth: A Kenya case study (op-ed) | The Conversation
- Responsive and respectful maternity care needs protection during COVID-19 crisis (op-ed) | The Conversation
- What drives abuse of women in childbirth? We asked those providing the care (op-ed) |The Conversation
- Antenatal care in Kenya needs improvement (op-ed) | The Conversation
- Subtle abuse affects women during childbirth (op-ed) | The Conversation
- Childbirth is hard: Health systems shouldn't make it harder (op-ed) | Apolitical
- Study shows women want men out of delivery rooms | Standard Digital
Publications:
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Caring for providers to improve patient experience (CPIPE): intervention development process. Glob Health Action. 2023 12 31; 16(1):2147289. Afulani PA, Oboke EN, Ogolla BA, Getahun M, Kinyua J, Oluoch I, Odour J, Ongeri L. PMID: 36507905; PMCID: PMC9754039.
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Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana. BMC Health Serv Res. 2023 Mar 14; 23(1):254. Afulani PA, Okiring J, Aborigo RA, Nutor JJ, Kuwolamo I, Dorzie JBK, Semko S, Okonofua JA, Mendes WB. PMID: 36918860; PMCID: PMC10015736.
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The Case for Using a Behavior Change Model to Design Interventions to Promote Respectful Maternal Care. Glob Health Sci Pract. 2023 Feb 28; 11(1). Diamond-Smith N, Walker D, Afulani PA, Donnay F, Lin SPY, Peca E, Stanton ME. PMID: 36853643; PMCID: PMC9972382.
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Sources of stress and coping mechanisms: Experiences of maternal health care providers in Western Kenya. PLOS Glob Public Health. 2023; 3(2):e0001341. Getahun M, Oboke EN, Ogolla BA, Kinyua J, Ongeri L, Sterling M, Oluoch I, Lyndon A, Afulani PA. PMID: 36962929; PMCID: PMC10022275.View in: PubMed Mentions:
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Context Matters: Factors Affecting Implementation of Simulation Training in Nursing and Midwifery Schools in North America, Africa and Asia. Clin Simul Nurs. 2023 Feb; 75:1-10. Baayd J, Heins Z, Walker D, Afulani P, Sterling M, Sanders JN, Cohen S. PMID: 36743129; PMCID: PMC9859761.View in: PubMed Mentions:
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Associations between self-reported obstetric complications and experience of care: a secondary analysis of survey data from Ghana, Kenya, and India. Reprod Health. 2023 Jan 06; 20(1):7. Kapula N, Sacks E, Wang DT, Odiase O, Requejo J, Afulani PA, Revisioning EmONC Quality of Care Workgroup. PMID: 36609381.
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Cultural adaptation of the person-centered maternity care scale at governmental health facilities in Cambodia. PLoS One. 2023; 18(1):e0265784. Naito YT, Fukuzawa R, Afulani PA, Kim R, Aiga H. PMID: 36595538; PMCID: PMC9810154.
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Training nurse simulation educators at scale to improve maternal and newborn health: a case study from Bihar, India. BMC Med Educ. 2022 Dec 15; 22(1):869. Madriz S, Afulani P, Spindler H, Ghosh R, Subramaniam N, Mahapatra T, Das A, Sonthalia S, Gore A, Cohen SR, Handu S, Walker D. PMID: 36522624.
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IMAgiNE EURO: Data for action on quality of maternal and newborn care in 20 European countries during the COVID-19 pandemic. Int J Gynaecol Obstet. 2022 12; 159 Suppl 1:5-8. Benová L, Lawn JE, Graham W, Chapin EM, Afulani PA, Downe S, Hailegebriel TD, Lincetto O, Sacks E. PMID: 36530004; PMCID: PMC9878030.
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Pregnancy-related COVID worry, depressive symptom severity, and mediation through sleep disturbance in a low-income, primarily Latinx population in California's Central valley. J Psychiatr Res. 2023 01; 157:96-103. Felder JN, Afulani PA, Coleman-Phox K, Omowale SS, McCulloch CE, Lessard L, Kuppermann M. PMID: 36459760; PMCID: PMC10019815.
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Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care. BMC Pregnancy Childbirth. 2022 Nov 02; 22(1):804. Kapula N, Shiboski S, Dehlendorf C, Ouma L, Afulani PA. PMID: 36324136; PMCID: PMC9628025.
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Factors associated with person-centered care during pregnancy and birth for Black women and birthing people in California. Birth. 2022 Aug 25. Altman MR, Afulani PA, Melbourne D, Kuppermann M. PMID: 36005865.
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Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review. PLOS Global Public Health. 2022 Jun 15; 2(6):e0000582. Bohren BM, Vazquez Corona VM, Odiase OO, Wilson WA, Sudhinaraset SM, Diamond-Smith DN, Berryman BJ, Tunçalp TÖ, Afulani AP. .View in: Publisher Site Mentions:
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Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review. PLOS Glob Public Health. 2022; 2(6):e0000582. Bohren MA, Vazquez Corona M, Odiase OJ, Wilson AN, Sudhinaraset M, Diamond-Smith N, Berryman J, Tun?alp ?, Afulani PA. PMID: 36962453; PMCID: PMC10021469.
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Impact of hair type, hair sample weight, external hair exposures, and race on cumulative hair cortisol. Psychoneuroendocrinology. 2022 08; 142:105805. Moody SN, van Dammen L, Wang W, Greder KA, Neiderhiser JM, Afulani PA, Willette A, Shirtcliff EA. PMID: 35687978.
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Adaptation of the Person-Centered Maternity Care Scale in the United States: Prioritizing the Experiences of Black Women and Birthing People. Womens Health Issues. 2022 Jul-Aug; 32(4):352-361. Afulani PA, Altman MR, Castillo E, Bernal N, Jones L, Camara T, Carrasco Z, Williams S, Sudhinaraset M, Kuppermann M. PMID: 35277334.
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Self-reported provision of person-centred maternity care among providers in Kenya and Ghana: scale validation and examination of associated factors. BMJ Glob Health. 2021 11; 6(12). Afulani PA, Aborigo RA, Nutor JJ, Okiring J, Kuwolamo I, Ogolla BA, Oboke EN, Dorzie JBK, Odiase OJ, Steinauer J, Walker D. PMID: 34853033; PMCID: PMC8638154.
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Continuous Labor Support and Person-Centered Maternity Care: A Cross-Sectional Study with Women in Rural Kenya. Matern Child Health J. 2022 Jan; 26(1):205-216. Kiti G, Prata N, Afulani PA. PMID: 34665357; PMCID: PMC8770390.
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Job satisfaction among healthcare workers in Ghana and Kenya during the COVID-19 pandemic: Role of perceived preparedness, stress, and burnout. . 2021 Oct 13; 1(10):e0000022. Afulani AP, Nutor NJ, Agbadi AP, Gyamerah GA, Musana MJ, Aborigo AR, Odiase OO, Getahun GM, Ongeri OL, Malechi MH, Madadi MM, Arhinful AB, Kelly KA, Awoonor-Williams AJ. .View in: Publisher Site Mentions:
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Job satisfaction among healthcare workers in Ghana and Kenya during the COVID-19 pandemic: Role of perceived preparedness, stress, and burnout. PLOS Glob Public Health. 2021; 1(10):e0000022. Afulani PA, Nutor JJ, Agbadi P, Gyamerah AO, Musana J, Aborigo RA, Odiase O, Getahun M, Ongeri L, Malechi H, Madadi MO, Arhinful B, Kelly AM, Awoonor-Williams JK. PMID: 36962085; PMCID: PMC10021773.
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Examining person-centered maternity care in a peri-urban setting in Embakasi, Nairobi, Kenya. PLoS One. 2021; 16(10):e0257542. Oluoch-Aridi J, Afulani P, Makanga C, Guzman D, Miller-Graff L. PMID: 34634055; PMCID: PMC8504752.
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Community Perceptions of Person-Centered Maternity Care in Migori County, Kenya. Frontiers in Global Women's Health. 2021 Oct 8; 2:668405. Odiase OO, Akinyi AB, Kinyua KJ, Afulani AP. .View in: Publisher Site Mentions:
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Community Perceptions of Person-Centered Maternity Care in Migori County, Kenya. Front Glob Womens Health. 2021; 2:668405. Odiase O, Akinyi B, Kinyua J, Afulani P. PMID: 34816219; PMCID: PMC8593945.
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Provider perceptions of lack of supportive care during childbirth: A mixed methods study in Kenya. Health Care Women Int. 2022 09; 43(9):1062-1083. Buback L, Kinyua J, Akinyi B, Walker D, Afulani PA. PMID: 34534038; PMCID: PMC9080303.
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Understanding disparities in person-centred maternity care: the potential role of provider implicit and explicit bias. Health Policy Plan. 2021 Apr 21; 36(3):298-311. Afulani PA, Ogolla BA, Oboke EN, Ongeri L, Weiss SJ, Lyndon A, Mendes WB. PMID: 33491086; PMCID: PMC8599771.
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Development of the person-centered prenatal care scale for people of color. Am J Obstet Gynecol. 2021 10; 225(4):427.e1-427.e13. Afulani PA, Altman MR, Castillo E, Bernal N, Jones L, Camara TL, Carrasco Z, Williams S, Sudhinaraset M, Kuppermann M. PMID: 33862014.
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Exploring women's childbirth experiences and perceptions of delivery care in peri-urban settings in Nairobi, Kenya. Reprod Health. 2021 Apr 19; 18(1):83. Oluoch-Aridi J, Afulani PA, Guzman DB, Makanga C, Miller-Graff L. PMID: 33874967; PMCID: PMC8054117.
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Inadequate preparedness for response to COVID-19 is associated with stress and burnout among healthcare workers in Ghana. PLoS One. 2021; 16(4):e0250294. Afulani PA, Gyamerah AO, Nutor JJ, Laar A, Aborigo RA, Malechi H, Sterling M, Awoonor-Williams JK. PMID: 33861808; PMCID: PMC8051822.
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Person-centered antenatal care and associated factors in Rwanda: a secondary analysis of program data. BMC Pregnancy Childbirth. 2021 Apr 10; 21(1):290. Miller P, Afulani PA, Musange S, Sayingoza F, Walker D. PMID: 33838658; PMCID: PMC8037834.
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Psychological and physiological stress and burnout among maternity providers in a rural county in Kenya: individual and situational predictors. BMC Public Health. 2021 03 06; 21(1):453. Afulani PA, Ongeri L, Kinyua J, Temmerman M, Mendes WB, Weiss SJ. PMID: 33676479; PMCID: PMC7936594.
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Person-centered maternity care and postnatal health: associations with maternal and newborn health outcomes. AJOG Glob Rep. 2021 Feb; 1(1):100005. Sudhinaraset M, Landrian A, Golub GM, Cotter SY, Afulani PA. PMID: 33889853; PMCID: PMC8041064.
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Providing respectful maternity care in northern Ghana: A mixed-methods study with maternity care providers. Midwifery. 2021 Mar; 94:102904. Moyer CA, McNally B, Aborigo RA, Williams JEO, Afulani P. PMID: 33341537.
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The Relationship Between Counseling and Adherence to Antiretroviral Therapy Among Pregnant and Breastfeeding Women Enrolled in Option B. AIDS Educ Prev. 2020 10; 32(5):378-391. Nutor JJ, Slaughter-Acey JC, Afulani PA, Obimbo MM, Mojola SA. PMID: 33112676.
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Development and validation of a person-centered abortion scale: the experiences of care in private facilities in Kenya. BMC Womens Health. 2020 09 19; 20(1):208. Sudhinaraset M, Landrian A, Afulani PA, Phillips B, Diamond-Smith N, Cotter S. PMID: 32950052; PMCID: PMC7501655.
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Perceived preparedness to respond to the COVID-19 pandemic: a study with healthcare workers in Ghana. J Glob Health Sci. 2020; 2:e24. Patience A. Afulani, Akua O. Gyamerah, Raymond A. Aborigo, Jerry John Nutor, Hawa Malechi, Amos Laar, Mona Sterling, and John Koku Awoonor-Williams8. View Publication.
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Providers' perceptions of communication and women's autonomy during childbirth: a mixed methods study in Kenya. Reprod Health. 2020 Jun 03; 17(1):85. Afulani PA, Buback L, Kelly AM, Kirumbi L, Cohen CR, Lyndon A. PMID: 32493424; PMCID: PMC7268432.
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Providers' perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya. Health Policy Plan. 2020 Jun 01; 35(5):577-586. Afulani PA, Kelly AM, Buback L, Asunka J, Kirumbi L, Lyndon A. PMID: 32154878; PMCID: PMC7225569.
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A Rapid Review of Available Evidence to Inform Indicators for Routine Monitoring and Evaluation of Respectful Maternity Care. Glob Health Sci Pract. 2020 03 30; 8(1):125-135. Afulani PA, Buback L, McNally B, Mbuyita S, Mwanyika-Sando M, Peca E. PMID: 32234844; PMCID: PMC7108935.
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Provider knowledge and perceptions following an integrated simulation training on emergency obstetric and neonatal care and respectful maternity care: A mixed-methods study in Ghana. Midwifery. 2020 Jun; 85:102667. Afulani PA, Dyer J, Calkins K, Aborigo RA, Mcnally B, Cohen SR. PMID: 32114318.
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Association between person-centered maternity care and newborn complications in Kenya. Int J Gynaecol Obstet. 2020 Jan; 148(1):27-34. Sudhinaraset M, Landrian A, Afulani PA, Diamond-Smith N, Golub G. PMID: 31544243; PMCID: PMC6939318.
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Accountability for respectful maternity care. Lancet. 2019 11 09; 394(10210):1692-1693. Afulani PA, Moyer CA. PMID: 31604661.
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Quality of antenatal care and associated factors in a rural county in Kenya: an assessment of service provision and experience dimensions. BMC Health Serv Res. 2019 Oct 07; 19(1):684. Afulani PA, Buback L, Essandoh F, Kinyua J, Kirumbi L, Cohen CR. PMID: 31590662; PMCID: PMC6781384.
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Providers and women's perspectives on person-centered maternity care: a mixed methods study in Kenya. Int J Equity Health. 2019 06 10; 18(1):83. Sudhinaraset M, Giessler K, Golub G, Afulani P. PMID: 31182105; PMCID: PMC6558853.
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Toward the development of a short multi-country person-centered maternity care scale. Int J Gynaecol Obstet. 2019 Jul; 146(1):80-87. Afulani PA, Feeser K, Sudhinaraset M, Aborigo R, Montagu D, Chakraborty N. PMID: 31004349.
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Measuring what matters for maternal and newborn health. Lancet Glob Health. 2019 05; 7(5):e544-e545. Diamond-Smith N, Afulani P. PMID: 30898496.
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Can integrated clinical simulation trainings improve person-centred maternity care? Results from a pilot project in Ghana. The Lancet Global Health. 2019 Mar 1; 7:s47. Afulani AP, Aborigo AR, Cohen CS, Moyer MC, Walker WD, Williams WJ. .View in: Publisher Site Mentions:
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Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana. Birth. 2019 09; 46(3):523-532. Afulani PA, Aborigo RA, Walker D, Moyer CA, Cohen S, Williams J. PMID: 30680785.
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Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India. Lancet Glob Health. 2019 Jan; 7(1):e96-e109. Afulani PA, Phillips B, Aborigo RA, Moyer CA. PMID: 30554766; PMCID: PMC6293963.
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Food insecurity, mental health, and use of mental health services among nonelderly adults in the United States. Journal of Hunger & Environmental Nutrition. 2018 Oct 29; 1-22. Afulani AP, Coleman-Jensen CA, Herman HD. .View in: Publisher Site Mentions:
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Politics and Public Service Provision in Africa’s New Democracies. International Journal of Politics, Culture, and Society. 2018 Sep 1; 31(3):207-227. Asunka AJ, Afulani AP. .View in: Publisher Site Mentions:
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Validation of the person-centered maternity care scale in India. Reprod Health. 2018 Aug 29; 15(1):147. Afulani PA, Diamond-Smith N, Phillips B, Singhal S, Sudhinaraset M. PMID: 30157877; PMCID: PMC6114501.
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Development of a Person-Centered Family Planning Scale in India and Kenya. Stud Fam Plann. 2018 09; 49(3):237-258. Sudhinaraset M, Afulani PA, Diamond-Smith N, Golub G, Srivastava A. PMID: 30069983.
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Predictors of person-centered maternity care: the role of socioeconomic status, empowerment, and facility type. BMC Health Serv Res. 2018 05 11; 18(1):360. Afulani PA, Sayi TS, Montagu D. PMID: 29751805; PMCID: PMC5948900.
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Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya. BMC Pregnancy Childbirth. 2018 May 10; 18(1):150. Afulani P, Kusi C, Kirumbi L, Walker D. PMID: 29747593; PMCID: PMC5946503.
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What makes or mars the facility-based childbirth experience: thematic analysis of women's childbirth experiences in western Kenya. Reprod Health. 2017 Dec 29; 14(1):180. Afulani PA, Kirumbi L, Lyndon A. PMID: 29284490; PMCID: PMC5747138.
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Conceptualizing pathways linking women's empowerment and prematurity in developing countries. BMC Pregnancy Childbirth. 2017 Nov 08; 17(Suppl 2):338. Afulani PA, Altman M, Musana J, Sudhinaraset M. PMID: 29143627; PMCID: PMC5688445.
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Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity. Gates Open Res. 2017 Nov 06; 1:1. Sudhinaraset M, Afulani P, Diamond-Smith N, Bhattacharyya S, Donnay F, Montagu D. PMID: 29355215; PMCID: PMC5764229.
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Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population. Reprod Health. 2017 Sep 22; 14(1):118. Afulani PA, Diamond-Smith N, Golub G, Sudhinaraset M. PMID: 28938885; PMCID: PMC5610540.
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Transnational ties and the health of sub-Saharan African migrants: The moderating role of gender and family separation. Soc Sci Med. 2016 11; 168:63-71. Afulani PA, Torres JM, Sudhinaraset M, Asunka J. PMID: 27639482.
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Political accountability and public service provision in Africa: evidence from Ghana. Annals of Global Health. 2016 Aug 20; 82(3):332-333. Asunka AJ, Afulani AP. .View in: Publisher Site Mentions:
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Explaining disparities in use of skilled birth attendants in developing countries: a new conceptual framework. Annals of Global Health. 2016 Aug 20; 82(3):375. Afulani AP, Moyer MC. .View in: Publisher Site Mentions:
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Determinants of stillbirths in Ghana: does quality of antenatal care matter? BMC Pregnancy Childbirth. 2016 06 02; 16(1):132. Afulani PA. PMID: 27255155; PMCID: PMC4891927.
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Explaining Disparities in Use of Skilled Birth Attendants in Developing Countries: A Conceptual Framework. PLoS One. 2016; 11(4):e0154110. Afulani PA, Moyer C. PMID: 27105309; PMCID: PMC4841546.
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Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample. Am J Public Health. 2015 Oct; 105(10):e48-59. Herman D, Afulani P, Coleman-Jensen A, Harrison GG. PMID: 26270308; PMCID: PMC4566547.
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Improve Antenatal Care in Ghana’s Lower-Level Health Facilities. 2015. Afulani PA. View Publication.
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Socialization, Adaptation, Transnationalism, and the Reproductive Behavior of Sub-Saharan African Migrants in France. Population Research and Policy Review. 2015 Aug 1; 34(4):561-592. Afulani AP, Asunka AJ. .View in: Publisher Site Mentions:
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Determinants of maternal health and health-seeking behavior in sub-Saharan Africa: The role of quality of care. 2015. Afulani PA. View Publication.
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Deconstructing rural/urban and socioeconomic differentials in quality of antenatal care in Ghana. Annals of Global Health. 2015 Mar 12; 81(1):106. Afulani AP. .View in: Publisher Site Mentions:
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Rural/urban and socioeconomic differentials in quality of antenatal care in Ghana. PLoS One. 2015; 10(2):e0117996. Afulani PA. PMID: 25695737; PMCID: PMC4335004.
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Food Insecurity and Health Outcomes Among Older Adults: The Role of Cost-Related Medication Underuse. J Nutr Gerontol Geriatr. 2015; 34(3):319-42. Afulani P, Herman D, Coleman-Jensen A, Harrison GG. PMID: 26267444.
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Delaying and reducing medication use as a coping mechanism for food insecurity (268.6). The FASEB Journal. 2014 Apr 1; 28. Herman HD, Afulani AP, Harrison HG, Coleman-Jensen CA. .View in: Publisher Site Mentions:
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Using community health workers in community-based growth promotion: what stakeholders think. Health Educ Res. 2012 Dec; 27(6):1005-17. Afulani PA, Awoonor-Williams JK, Opoku EC, Asunka J. PMID: 22791682.