Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania

BACKGROUND: The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. METHODS: Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. RESULTS: The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". CONCLUSIONS: Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker cadres with little pre-service training. Attention should be paid to the identification of informal practices resulting from individual coping strategies and "street-level bureaucracy" in order to tackle problems before they become part of the organizational culture

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Efficacy of reduced rates of chlorantraniliprole seed treatment on insect pests of irrigated drill‐seeded rice

© 2019 Society of Chemical Industry Background: For the past decade, insecticidal seed treatment has been the most widely used control tactic against insect pests of rice (Oryza sativa L.) in the USA. Seed treatments are used primarily to control the most economically important early-season pest of rice, the rice water weevil (Lissorhoptrus oryzophilus Kuschel). This study was conducted to evaluate the efficacy of reduced rates of chlorantraniliprole seed treatment against the rice water weevil, fall armyworm (Spodoptera frugiperda J.E. Smith), and sugarcane borer (Diatraea saccharalis F.) under field and laboratory conditions. Concentrations of chlorantraniliprole in plant tissues were determined at vegetative and reproductive developmental stages of rice plants. Results: Chlorantraniliprole seed treatment reduced the densities of rice water weevil larvae relative to non-treated controls even at rates 75% lower than the label rate. Increased mortality of fall armyworm larvae was observed at reduced seed treatment rates relative to a non-treated control. Chlorantraniliprole seed treatment increased the mortality of sugarcane borer larvae at all rates relative to controls and the mortality was consistently higher in larvae that were fed stems from treated plants at the vegetative developmental stage than larvae that were fed stems from plants at the reproductive stage. Concentrations of chlorantraniliprole in plant tissues increased with seed treatment rate and decreased with plant age. Conclusion: This study has shown that reduced chlorantraniliprole seed treatment rates can provide adequate control against the rice water weevil, fall armyworm, and sugarcane borer, particularly at early developmental stages of rice plants. © 2019 Society of Chemical Industry

Seroprevalence of brucellosis in donkeys (Equus asinus) and assessment of donkey management practices in Gamawa local government area, Bauchi state, Nigeria

This study was conducted to determine the seroprevalence of brucellosis in donkeys (Equus asinus) and its association with donkey management practices in Gamawa Local Government Area, Bauchi State, Nigeria using Rose Bengal Plate Test (RBPT) and Serum Agglutination Test (SAT). A total of 1000 donkeys were sampled comprising of 585 males and 415 females. Two hundred donkeys were sampled from each of the five clusters in the study area viz: Gamawa East, Gamawa West, Udubo East, Udubo West and donkey Market. Simple percentages and chi-square (χ2) test were used to analyzed the data by subjecting it to SPSS-16 statistical software. The overall prevalence of brucellosis in donkeys was 114 (11.4%), out of which 51 (8.7%) males and 63 (15.2%) females were positive. Prevalence of Brucellosis was higher in females 63 (15.2%) than males. Breed of donkeys has significant influence on prevalence of brucellosis. Prevalence was higher among ≥7 age group 16 (19.8%) than in 5-6, 3-4 and ≤2 age groups (P&lt;0.01) and in donkey market 34 (17%) than the other locations (P&lt;0.05). It can be concluded from the findings of this study that there is 11.4% prevalence of brucellosis among donkeys in the study area with higher prevalence in female donkeys, older donkeys and donkey market. Keywords: Seroprevalence, Brucellosis, Donkey, (RBPT), (SAT), Gamaw

Influence of Solvents on Properties of ZnS Thin Films Synthesized by Chemical Spray Pyrolysis Technique

In this paper, the influence of solvents on the structural, optical, surface and electrical properties of spray-deposited ZnS thin films has been studied. Different precursor mixtures were prepared from ethylene glycol, deionized water and alcohol solvents and sprayed on heated glasses via a simple and cost-effective technique known as spray pyrolysis. XRD patterns confirmed cubic and tetragonal phases of synthesized ZnS material. The optical analysis of the synthesized ZnS films showed that films prepared using ethylene glycol solvent have the highest transmittance and the best bandgap (3.61 eV). Surface morphology showed the absence of voids and pinholes in the Scanning Electron Micrograph of ZnS film prepared from ethylene glycol and electrical studies showed that ZnS films prepared using the same solvent have the lowest resistivity