From home deliveries to health care facilities: establishing a traditional birth attendant referral program in Kenya

Objective: To assess the effectiveness of a traditional birth attendant (TBA) referral program on increasing the number of deliveries overseen by skilled birth attendants (SBA) in rural Kenyan health facilities before and after the implementation of a free maternity care policy. Methods: In a rural region of Kenya, TBAs were recruited to educate pregnant women about the importance of delivering in healthcare facilities and were offered a stipend for every pregnant woman whom they brought to the healthcare facility. We evaluated the percentage of prenatal care (PNC) patients who delivered at the intervention site compared with the percentage of PNC patients who delivered at rural control facilities, before and after the referral program was implemented, and before and after the Kenya government implemented a policy of free maternity care. The window period of the study was from July of 2011 through September 2013, with a TBA referral intervention conducted from March to September 2013. Results: The absolute increases from the pre-intervention period to the TBA referral intervention period in SBA deliveries were 5.7 and 24.0 % in the control and intervention groups, respectively (p < 0.001). The absolute increases in SBA delivery rates from the pre-intervention period to the intervention period before the implementation of the free maternity care policy were 4.7 and 17.2 % in the control and intervention groups, respectively (p < 0.001). After the policy implementation the absolute increases from pre-intervention to post-intervention were 1.8 and 11.6 % in the control and intervention groups, respectively (p < 0.001). Conclusion: The percentage of SBA deliveries at the intervention health facility significantly increased compared to control health facilities when TBAs educated women about the need to deliver with a SBA and when TBAs received a stipend for bringing women to local health facilities to deliver. Furthermore, this TBA referral program proved to be far more effective in the target region of Kenya than a policy change to provide free obstetric care

Female homicide in Rio Grande do Sul, Brazil

This study aimed to assess the female homicide rate due to aggression in Rio Grande do Sul, Brazil, using this as a "proxy" of femicide. This was an ecological study which correlated the female homicide rate due to aggression in Rio Grande do Sul, according to the 35 microregions defined by the Brazilian Institute of Geography and Statistics (IBGE), with socioeconomic and demographic variables access and health indicators. Pearson's correlation test was performed with the selected variables. After this, multiple linear regressions were performed with variables with p < 0.20. The standardized average of female homicide rate due to aggression in the period from 2003 to 2007 was 3.1 obits per 100 thousand. After multiple regression analysis, the final model included male mortality due to aggression (p = 0.016), the percentage of hospital admissions for alcohol (p = 0.005) and the proportion of ill-defined deaths (p = 0.015). The model have an explanatory power of 39% (adjusted r2 = 0.391). The results are consistent with other studies and indicate a strong relationship between structural violence in society and violence against women, in addition to a higher incidence of female deaths in places with high alcohol hospitalization

Improving on-farm hatchability of Clarias gariepinus eggs by narrowing the range of incubation temperature

In order to facilitate the reproduction of African catfish Clarias gariepinus by smallholders who cannot afford hatchery buildings, electricity and pipe-borne water, the hatchability of fertilised eggs was assessed under the conditions of a dry and a rainy season, as well as under artificial conditions to protect incubating eggs from wide temperature variability. This comprised incubation in small vs. in large water volumes, in covered vs. in exposed vessels, at surface vs. at bottom of vessels and in brightly coloured vs. in black vessels. During the dull rainy days, temperatureranged from 24 to 27°C in hapas (implanted in a 200,000 L pond) and from 24 - 30°C in 30 L plastic tanks, regardless of covering or depth of measurement. During the bright sunny days, water temperature varied from 23 - 30 °C in the hapas and from 19 – 37 °C in the plastic tanks. Covering with white locally available polythene bags, enabled the narrowing of temperature range in tanks but not in hapas (ponds). Tank colour did not significantly affect the water temperature. Temperature ranges were narrower at bottoms than at surfaces in hapas but not in tanks. Egg hatchability was inversely proportional to temperature range: the narrowest range conferred a hatchability of 57.21 % while the widest range completely inhibited it. These results were used as bases for recommending best practices for on-farm incubation of C. gariepinus eggs.Key words: Smallholders, On-farm incubation, improved hatchability

Popularisation of amphibian tadpoles in nursing African catfish (Clarias gariepinus) fingerlings in hapas

In order to enhance the resistance of Clarias gariepinus fingerlings to the multiple predators of lakes and floodplains, we tested the hypothesis that tadpoles were cheap food supplements for the small-size fingerlings usually produced by hatcheries. Six batches of fingerlings (average weight =10.35 g) were stocked in six hapas and supplied with feed pellets for 56 days. Three of the six batches (experimental triplicate) were additionally supplied with tadpoles caught from surrounding nursery ponds while the other three (control triplicate) received none. Comparison of treatments showed that, consumption of tadpoles conferred significantly higher survivals (P 50g) for growing out, even through re-stocking the many over-exploited lakes and flood plains of Africa.Key words: Fingerlings, catfish, tadpoles, Clarias, re-stockin