An investigation of alternative approaches to contraceptive logistics management at the peripheral level

In Bangladesh, contraceptive commodities are received at the peripheral level (thana and below) from thana stores on a monthly basis by using the “pull” system. It is expected that at any point in time a worker or a center at the peripheral level will have a two-to-three-month stock of contraceptives. Many surveys/studies have indicated, however, that stockouts of contraceptives are quite frequent. To investigate an improved system of contraceptive distribution, a three-cell experimental study was undertaken. In the first two cells, contraceptives were delivered following two methods of the “push” system, while in the third cell contraceptives were distributed following the existing system “pull” system. The field experiment lasted for a period of six months. The results of the study are presented in this report

Nonlinear Time History Analysis for Seismic Effects on Reinforced Concrete Building

A typical Reinforced Concrete (RC) building frame comprising of RC columns and connecting beams that participates in resisting the earthquake forces. Due to earthquake, reversal tension generates at both faces of a beam and column; and hence damage occur in the frame for the disability of tension carrying capacity of concrete. Therefore, the structural performance of RC building for seismic load has been analyzed by nonlinear time history analysis method for this study. A residential building located in Dhaka, Bangladesh subjected to various types of gravity load and seismic load was considered to analyze using ETABS software as per the guideline of BNBC (2020). According to the guideline of ATC 40 (1996), the seismic performances like maximum displacement and story drift for RC building were evaluated both at structural and element levels by applying El Centro (1940) ground motion at the base of the structure. Formation of plastic hinges is used as the basis to evaluate the local performance and story drift is used to evaluate the global performance. At first, the considered building was designed only for gravity load, and then for both gravity and seismic load according to BNBC (2020). Further studies have been performed on that building considering double height column at a story level. It was observed that the maximum displacement and story drift exceeds the allowable limit for all the considered cases if seismic load is applied on the structure

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally