Особенности Формирования И Развития Местного Самоуправления В Республике Армения (На Примере Муниципалитета Города Гавар Гехаркуникской Области)

New sovereign states appeared after the collapse of the USSR, which have to develop democratic society for a long time. With the development of public administration decentralization, a significant part of the obligations and powers to manage the property of cities and rural areas, health, education, culture, and sports was transferred to the localities. The process of the legal field of municipality development began, which has not been completed to this day. The optimization of municipality management in modern conditions will allow to achieve the highest possible results, enhance the involvement of the local population in the development of the city, to address the issues of local importance more effectively. The great difficulty in the study of modern problems of local self-government is conditioned by the presence of different points of view on the issue of its essence, the absence of a unified theory of local self-government and the existence of different models and forms of its organization. The absence of the established interaction practice between population, government and judicial structures, the underdevelopment of political culture, apathy and lack of confidence in the authority points to the insufficiency of control forms and responsibility specified in the law of the Republic of Armenia on local self-government. The article substantiates the need to increase the importance of local self-government in society, allows to realize the diversity of population interests, satisfy their socio-economic needs, act as the most important means of Armenia region stabilization and development and the state as a whole, the formation of civil society. The municipality must solve local problems with its own forces and means, and be responsible for its decisions. Local governments should own and manage municipal property, including local finances independently - these are the necessary economic conditions for the exercise of their authority.Nuevos estados soberanos aparecieron después del colapso de la URSS, que deben desarrollar una sociedad democrática durante mucho tiempo. Con el desarrollo de la descentralización de la administración pública, una parte significativa de las obligaciones y poderes para administrar la propiedad de las ciudades y las zonas rurales, la salud, la educación, la cultura y el deporte se transfirieron a las localidades. Comenzó el proceso del campo legal del desarrollo del municipio, que no se ha completado hasta el día de hoy. La optimización de la gestión municipal en condiciones modernas permitirá lograr los mejores resultados posibles, mejorar la participación de la población local en el desarrollo de la ciudad, para abordar los problemas de importancia local de manera más efectiva. La gran dificultad en el estudio de los problemas modernos del autogobierno local está condicionada por la presencia de diferentes puntos de vista sobre el tema de su esencia, la ausencia de una teoría unificada del autogobierno local y la existencia de diferentes modelos y formas de su organización. La ausencia de la práctica establecida de interacción entre la población, el gobierno y las estructuras judiciales, el subdesarrollo de la cultura política, la apatía y la falta de confianza en la autoridad apuntan a la insuficiencia de formas de control y responsabilidad especificadas en la ley de la República de Armenia sobre el gobierno local. El artículo confirma la necesidad de aumentar la importancia del autogobierno local en la sociedad, permite darse cuenta de la diversidad de intereses de la población, satisfacer sus necesidades socioeconómicas, actuar como el medio más importante de estabilización y desarrollo de la región de Armenia y el estado como un en conjunto, la formación de la sociedad civil. El municipio debe resolver los problemas locales con sus propias fuerzas y medios, y ser responsable de sus decisiones. Los gobiernos locales deben poseer y administrar la propiedad municipal, incluidas las finanzas locales de forma independiente; estas son las condiciones económicas necesarias para el ejercicio de su autoridad. После распада СССР появились новые суверенные государства, которым предстоит долгий путь по построению демократического общества. С развитием децентрализации государственного управления значительная часть обязательств и полномочий по управлению имуществом городов и сельской местности, здравоохранением, образованием, культурой, спортом была передана на места. Начался процесс формирования правового поля муниципалитетов, который не завершён и по сей день. Оптимизация управления муниципалитетами в современных условиях позволит достичь максимально возможных результатов, активизации вовлечения местного населения в процесс развития города, более эффективному решению вопросов местного значения. Большая сложность в исследовании современных проблем местного самоуправления заключается в наличии разных точек зрения по вопросу о его сущности, отсутствии единой теории местного самоуправления и существовании разных моделей и форм его организации. Отсутствие сложившейся практики взаимодействия населения, властных и судебных структур, неразвитость политической культуры, апатия и отсутствие доверия к органам власти указывает на недостаточность обозначенных в законе Республики Армения о местном самоуправлении форм контроля и ответственности. В статье обосновывается необходимость повышения значимости местного самоуправления в жизни общества, позволяющая реализовать многообразие интересов населения, удовлетворить их социально-экономические потребности, выступать в качестве важнейшего средства стабилизации и развития регионов Армении и государства в целом, формирования гражданского общества. Муниципальное образование должно решать местные проблемы своими силами и средствами, и нести ответственность за свои решения. Органы местного самоуправления должны владеть и управлять муниципальной собственностью, в том числе самостоятельно распоряжаться местными финансами - это необходимые экономические условия для осуществления их властных полномочий

Time for global scale-up, not randomized trials, of uterine balloon tamponade for postpartum hemorrhage.

Maternal death is the greatest health disparity globally, with postpartum hemorrhage the most common cause. As senior leaders in obstetrics and maternal health from Bolivia, Canada, Colombia, Côte d'Ivoire, Honduras, India, Kenya, Nepal, Niger, Norway, Peru, Tanzania, the UK, the USA, and Zambia, we are deeply disturbed by recent calls for randomized controlled trials (RCTs) of uterine balloon tamponade (UBT) in women with uncontrolled postpartum hemorrhage (PPH). Our collective experience, in combination with mounting evidence, unequivocally supports the effectiveness of commercial and condom UBTs in averting death and disability from PPH associated with atonic uterus. We believe it would be highly unethical to embark on an RCT of UBT, now or in the future, unless compared with a proven equivalent intervention. This article is protected by copyright. All rights reserved

Theory-driven process evaluation of a complementary feeding trial in four countries

We conducted a theory-driven process evaluation of a cluster randomized controlled trial comparing two types of complementary feeding (meat versus fortified cereal) on infant growth in Guatemala, Pakistan, Zambia and the Democratic Republic of Congo. We examined process evaluation indicators for the entire study cohort (N = 1236) using chi-square tests to examine differences between treatment groups. We administered exit interviews to 219 caregivers and 45 intervention staff to explore why caregivers may or may not have performed suggested infant feeding behaviors. Multivariate regression analysis was used to determine the relationship between caregiver scores and infant linear growth velocity. As message recall increased, irrespective of treatment group, linear growth velocity increased when controlling for other factors (P < 0.05), emphasizing the importance of study messages. Our detailed process evaluation revealed few differences between treatment groups, giving us confidence that the main trial’s lack of effect to reverse the progression of stunting cannot be explained by differences between groups or inconsistencies in protocol implementation. These findings add to an emerging body of literature suggesting limited impact on stunting of interventions initiated during the period of complementary feeding in impoverished environments. The early onset and steady progression support the provision of earlier and comprehensive interventions

Junk food use and neurodevelopmental and growth outcomes in infants in low-resource settings

Introduction Feeding infants a sub-optimal diet deprives them of critical nutrients for their physical and cognitive development. The objective of this study is to describe the intake of foods of low nutritional value (junk foods) and identify the association with growth and developmental outcomes in infants up to 18 months in low-resource settings. Methods This is a secondary analysis of data from an iron-rich complementary foods (meat versus fortified cereal) randomized clinical trial on nutrition conducted in low-resource settings in four low- and middle-income countries (Democratic Republic of the Congo, Guatemala, Pakistan, and Zambia). Mothers in both study arms received nutritional messages on the importance of exclusive breastfeeding up to 6 months with continued breastfeeding up to at least 12 months. This study was designed to identify the socio-demographic predictors of feeding infants’ complementary foods of low nutritional value (junk foods) and to assess the associations between prevalence of junk food use with neurodevelopment (assessed with the Bayley Scales of Infant Development II) and growth at 18 months. Results 1,231 infants were enrolled, and 1,062 (86%) completed the study. Junk food feeding was more common in Guatemala, Pakistan, and Zambia than in the Democratic Republic of Congo. 7% of the infants were fed junk foods at 6 months which increased to 70% at 12 months. Non-exclusive breastfeeding at 6 months, higher maternal body mass index, more years of maternal and paternal education, and higher socioeconomic status were associated with feeding junk food. Prevalence of junk foods use was not associated with adverse neurodevelopmental or growth outcomes. Conclusion The frequency of consumption of junk food was high in these low-resource settings but was not associated with adverse neurodevelopment or growth over the study period

Evaluation of meat as a first complementary food for breastfed infants: impact on iron intake: Nutrition Reviews©, Vol. 66, No. S1

The rationale for promoting the availability of local, affordable, non-fortified food sources of bioavailable iron in developing countries is considered in this review. Intake of iron from the regular consumption of meat from the age of 6 months is evaluated with respect to physiological requirements. Two major randomized controlled trials evaluating meat as a first and regular complementary food are described in this article. These trials are presently in progress in poor communities in Guatemala, Pakistan, Zambia, Democratic Republic of the Congo, and China

Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings

Background: Improved complementary feeding is cited as a critical factor for reducing stunting. Consumption of meats has been advocated, but its efficacy in low-resource settings has not been tested

Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: a prospective longitudinal cohort analysis

Abstract Background Because large, prospective, population-based data sets describing maternal outcomes are typically not available in low- and middle-income countries, it is difficult to monitor maternal mortality rates over time and to identify factors associated with maternal mortality. Early identification of risk factors is essential to develop comprehensive intervention strategies preventing pregnancy-related complications. Our objective was to describe maternal mortality rates in a large, multi-country dataset and to determine maternal, pregnancy-related, delivery and postpartum characteristics that are associated with maternal mortality. Methods We collected data describing all pregnancies from 2010 to 2013 among women enrolled in the multi-national Global Network for Women’s and Children’s Health Research Maternal and Neonatal Health Registry (MNHR). We reported the proportion of mothers who died per pregnancy and the maternal mortality ratio (MMR). Generalized linear models were used to evaluate the relationship of potential medical and social factors and maternal mortality and to develop point and interval estimates of relative risk associated with these factors. Generalized estimating equations were used to account for the correlation of outcomes within cluster to develop appropriate confidence intervals. Results We recorded 277,736 pregnancies and 402 maternal deaths for an MMR of 153/100,000 live births. We observed an improvement in the total MMR from 166 in 2010 to 126 in 2013. The MMR in Latin American sites (91) was lower than the MMR in Asian (178) and African sites (125). When adjusted for study site and the other variables, no formal education (RR 3.2 [1.5, 6.9]), primary education only (RR 3.4 [1.6, 7.5]), secondary education only (RR 2.5 [1.1, 5.7]), lack of antenatal care (RR 1.8 [1.2, 2.5]), caesarean section delivery (RR 1.9 [1.3, 2.8]), hemorrhage (RR 3.3 [2.2, 5.1]), and hypertensive disorders (RR 7.4 [5.2, 10.4]) were associated with higher risks of death. Conclusions The MNHR identified preventable causes of maternal mortality in diverse settings in low- and middle-income countries. The MNHR can be used to monitor public health strategies and determine their association with reducing maternal mortality. Trial Registration clinicaltrials.gov NCT0107347

Stillbirth rates in low-middle income countries 2010 - 2013: a population-based, multi-country study from the Global Network

Abstract Background Stillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care. Methods We undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Results From 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95% CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95% CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95% CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95% CI 2.4, 3.2) and breech (RR 3.0, 95% CI 2.6, 3.5). Altogether, 67.4% of the stillbirths were non-macerated. 7.6% of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9%). Conclusions Stillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8% of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings. Study registration Clinicaltrials.gov (ID# NCT01073475