The power of peers: An effectiveness evaluation of a cluster-controlled trial of group antenatal care in rural Nepal

Background: Reducing the maternal mortality ratio to less than 70 per 100,000 live births globally is one of the Sustainable Development Goals. Approximately 830 women die from pregnancy-or childbirth-related complications every day. Almost 99% of these deaths occur in developing countries. Increasing antenatal care quality and completion, and institutional delivery are key strategies to reduce maternal mortality, however there are many implementation challenges in rural and resource-limited settings. In Nepal, 43% of deliveries do not take place in an institution and 31% of women have insufficient antenatal care. Context-specific and evidence-based strategies are needed to improve antenatal care completion and institutional birth. We present an assessment of effectiveness outcomes for an adaptation of a group antenatal care model delivered by community health workers and midwives in close collaboration with government staff in rural Nepal. Methods: The study was conducted in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized, cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allowed for iterative improvement in design by making changes to improve the quality of the intervention. We evaluated effectiveness through a difference in difference analysis of institutional birth rates between groups prior to implementation of the intervention and 1 year after implementation. Additionally, we assessed the change in knowledge of key danger signs and the acceptability of the group model compared with individual visits in a nested cohort of women receiving home visit care and home visit care plus group antenatal care. Using a directed content and thematic approach, we analyzed qualitative interviews to identify major themes related to implementation. Results: At baseline, there were 457 recently-delivered women in the six village clusters receiving home visit care and 214 in the seven village clusters receiving home visit care plus group antenatal care. At endline, there were 336 and 201, respectively. The difference in difference analysis did not show a significant change in institutional birth rates nor antenatal care visit completion rates between the groups. There was, however, a significant increase in both institutional birth and antenatal care completion in each group from baseline to endline. We enrolled a nested cohort of 52 participants receiving home visit care and 62 participants receiving home visit care plus group antenatal care. There was high acceptability of the group antenatal care intervention and home visit care, with no significant differences between groups. A significantly higher percentage of women who participated in group antenatal care found their visits to be 'very enjoyable' (83.9% vs 59.6%, p = 0.0056). In the nested cohort, knowledge of key danger signs during pregnancy significantly improved from baseline to endline in the intervention clusters only (2 to 31%, p < 0.001), while knowledge of key danger signs related to labor and childbirth, the postpartum period, and the newborn did not in either intervention or control groups. Qualitative analysis revealed that women found that the groups provided an opportunity for learning and discussion, and the groups were a source of social support and empowerment. They also reported an improvement in services available at their village clinic. Providers noted the importance of the community health workers in identifying pregnant women in the community and linking them to the village clinics. Challenges in birth planning were brought up by both participants and providers. Conclusion: While there was no significant change in institutional birth and antenatal care completion at the population level between groups, there was an increase of these outcomes in both groups. This may be secondary to the primary importance of community health worker involvement in both of these groups. Knowledge of key pregnancy danger signs was significantly improved in the home visit plus group antenatal care cohort compared with the home visit care only group. This initial study of Nyaya Health Nepal's adapted group care model demonstrates the potential for impacting women's antenatal care experience and should be studied over a longer period as an intervention embedded within a community health worker program. Trial registration: ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered

Murine Typhus and Febrile Illness, Nepal

Murine typhus was diagnosed by PCR in 50 (7%) of 756 adults with febrile illness seeking treatment at Patan Hospital in Kathmandu, Nepal. Of patients with murine typhus, 64% were women, 86% were residents of Kathmandu, and 90% were unwell during the winter. No characteristics clearly distinguished typhus patients from those with blood culture–positive enteric fever

Compliance with the smoke-free public places legislation in Nepal: A cross-sectional study from Biratnagar Metropolitan City

Background Smoke-free legislation banning tobacco smoking in public places was implemented across Nepal in 2014 with the ambition to reduce the impact of second-hand smoking. As part of a comprehensive policy package on tobacco control, the implementation of the legislation has seen a marked reduction in tobacco consumption. Yet there remains uncertainty about the level of compliance with smoke-free public places. Objectives This study assesses the compliance with smoke-free laws in public places and the factors associated with active smoking in public places in Biratnagar Metropolitan City, Nepal. Methods A cross-sectional study was conducted in the Biratnagar metropolitan city in Province 1 of Nepal from July to December 2019. A total of 725 public places within the metropolitan city were surveyed using a structured survey tool. Active smoking was the primary outcome of the study which was defined as smoking by any person during the data collection time at the designated public place. Results The overall compliance with smoke-free legislation was 56.4%. The highest compliance (75.0%) was observed in Government office buildings. The lowest compliance was observed in eateries, entertainment, and shopping venues (26.3%). There was a statistically significant association between active smoking and the presence of ‘no smoking’ notices appended at the entrance and the odds of active smoking in eateries, entertainment, hospitality, shopping venues, transportations and transits was higher compared to education and health care institutions. None of the ‘no smoking’ notices displayed fully adhered to the contents as prescribed by the law. Conclusion As more than half of the public places complied with the requirements of the legislation, there was satisfactory overall compliance with the smoke-free public places law in this study. The public venues (eateries, shopping venues and transportations) that are more frequently visited and have a high turnover of the public have lower compliance with the legislation. The content of the message in the ‘no smoking’ notices needs close attention to adhere to the legal requirements

Teacher Burnout and Collegiality at the Workplace in Higher Education Institutions in the Arab Gulf Region

The purpose of this study was to investigate the influence of teacher burnout on collegial relationships among faculty members in two higher education institutions- one in Kuwait and the other in the United Arab Emirates. A quantitative methodology was employed using a self-constructed online questionnaire. The results of the study showed that there was no statistically significant difference between the teachers’ perception of burnout and collegiality by gender, age group, and years of experience in teaching at a 0.05 level of significance. However, there was a statistically significant difference between the teachers in Kuwait and the UAE in their perception of burnout, although the difference was not significant for collegiality at a 0.05 level of significance. The findings also showed that the participants’ gender, age, and work experience were not predictors of collegiality, but the perception of burnout was a significant predictor of collegiality. Conclusions were drawn from the study’s findings, with implications for policy, practice, and future research

Teacher Burnout and Collegiality at the Workplace in Higher Education Institutions in the Arab Gulf Region

The purpose of this study was to investigate the influence of teacher burnout on collegial relationships among faculty members in two higher education institutions- one in Kuwait and the other in the United Arab Emirates. A quantitative methodology was employed using a self-constructed online questionnaire. The results of the study showed that there was no statistically significant difference between the teachers&rsquo; perception of burnout and collegiality by gender, age group, and years of experience in teaching at a 0.05 level of significance. However, there was a statistically significant difference between the teachers in Kuwait and the UAE in their perception of burnout, although the difference was not significant for collegiality at a 0.05 level of significance. The findings also showed that the participants&rsquo; gender, age, and work experience were not predictors of collegiality, but the perception of burnout was a significant predictor of collegiality. Conclusions were drawn from the study&rsquo;s findings, with implications for policy, practice, and future research

Finite-strain Landau theory applied to the high-pressure phase transition of lead titanate

Standard Landau theory coupled to infinitesimal strain allows a concise description of the temperature-driven ferroelectric tetragonal-to-cubic phase transition in PbTiO3 at ambient pressure. Unfortunately, it fails to cover its high-pressure counterpart at ambient temperature. For example, the experimental transition pressure is vastly underestimated and neither the change from first to second order with increasing pressure nor the unusual pressure dependence of the tetragonal unit cell parameters observed in experiment are reproduced. Here we demonstrate that a combination of density functional theory and a recently constructed finite-strain extension of Landau theory provides a natural mechanism for resolving these discrepancies between theory and experiment. Our approach also allows us to determine the full tetragonal-cubic phase boundary in the (P,T) plane including an estimate of the tricritical point. We show that a careful analysis of the thermal elastic baseline is an essential ingredient to the success of this theory

Developing Culturally Contextualised Mathematics Resource Materials: Capturing Local Practices of Tamang and Gopali Communities

Setting out to develop culturally contextualised curriculum support materials for teachers and students and a material for parental awareness, the project produced five sets of support materials incorporating the cultural practices of Tamang and Gopali communities. By following a two-phase procedural strategy the project demonstrated a unique possibility of integrating Nepali local cultural practices in school mathematics curriculum

Coronavirus disease vaccination among persons with disabilities : understanding vaccine perceptions and hesitancy in Ghana

The effects of coronavirus disease 2019 (COVID-19) have been felt globally and in all spheres of life. Developing vaccines was an important milestone in ensuring the protection of lives, but there are concerns about vaccine availability in sub-Saharan African (SSA) countries. The living conditions of persons with disabilities, in particular, in SSA societies have been described as deplorable and unsustainable, and they are at risk of discrimination. Such persons appear to be already struggling to obtain other basic services, and the extent of vaccine accessibility to this population remains unknown. This study aimed to assess the perceptions of persons with disabilities in Ghana of COVID-19 vaccines. Between July 2021 and December 2021, 336 persons with disabilities (hearing, visual, and physical) were recruited from two regions in Ghana. The attitude toward the COVID-19 vaccination scale was adapted for this study. The results showed that persons with disabilities were ambivalent toward vaccination, and differences were observed between participant groups. The background variables found to influence attitude were age, place of residence, educational qualification, gender, and COVID-19 acquisition status. The study concludes with a clarion call to policymakers to expedite public education for persons with disabilities

Characterizing Nutritional, Antioxidant and Antimicrobial Values of Diploknema butyracea (Roxburgh) H. J. Lam from the Chepang Community, Makwanpur, Nepal

The multipurpose tree Diploknema butyracea (Roxb. H.J. Lam), known locally as Chiuri, is vital for food security and beekeeping in rural Nepal. This study examines its nutritional and phytochemical traits sourced from a Chepang community in Makwanpur, Nepal. This research focuses on macronutrients like carbohydrates, protein, fat, and ash alongside phytochemicals such as phenolic content, vitamin C, β-carotene, and lycopene. The study aimed to estimate this fruit's antimicrobial and antioxidant characteristics. The pulp and seed samples were analyzed for their nutritional and phytochemical components using standard methods (AOAC 1995). We determined the antioxidant and antimicrobial activity using the DPPH assay and agar diffusion method. This fruit has a high-fat content: 30.29% in the seed and 20.23% in the pulp. The pulp and seed also contain noteworthy levels of the total phenolic content (486.08 ± 0.006 and 182. 26 ± 0.001 mg Gallic Acid Equivalent (G.A.E.s) /100 g), vitamin C (20.70 ± 0.002 and 19.08 ± 0.005 mg Ascorbic Acid (A.A.)/100 g) with trace extents of compounds lycopene, β-carotene and carotenoids. We observed the antioxidant activity at 2207 ± 0.01 g/mL in pulp and 1841.05 ± 0.77 g/mL in seed, which is a substantial value. Both were discovered to be effective against Candida albicans at doses ranging from 25 to 100 mg/mL. By performing this study, we concluded that D. butyracea is a significant food source that can also be used medically