Assessment of the effect of place of selection on performance of health posts and turnover of health extension workers in Jimma Zone, Ethiopia

Magister Public Health - MPHThe Health Extension Program (HEP) was initiated under the Health Sector Development Program (HSDP II) in 2002/03. The central philosophy of these initiatives was based on the belief that if the right knowledge and skill is transferred, each household can take responsibility for producing and maintaining its own health. The HEP is delivered through Health Extension Workers (HEWs), who are local women and have completed grade 10. Recruitment of these workers is conducted by kebele (village) and woreda (district) councils. Following this they are provided with a one year training prior to being employed by the district health office. The HEP guideline states that all HEWs should be assigned to a health post within their own community.The rationale for this requirement is that health policy makers and mangers believe that the deployment of non-local HEWs results in poor performance and turnover. However, there is no evidence to support this assumption. This study was conducted to better understand the effect of place of selection on the performance of health posts and turnover of Health Extension Workers in Jimma Zone, Ethiopia.A cross sectional analytical study design was utilized to assess the effect of place of selection on the performance of health posts and turnover of HEWs in a randomly selected sample of six districts of Jimma Zone. A systematic record review on the activity reports for the Ethiopian Fiscal Year (EFY) 2003 was conducted on all selected health posts in Jimma Zone(239 randomly selected health posts from all functional rural and urban health posts in Jimma Zone) obtained from the district health office. Descriptive statistics was computed to describe the socio demographic characteristics and the level of performance. Chi-square test was performed to test the relationship amongst the variables.The finding from this study showed that HEWs who are assigned outside of their communities performed as well or even better than those recruited from the same communities.The differences between the relationship of staff turnover and retention couldn‟t be estimated due to limited availability of information related to this factor. Overall, despite the widely held opinion among policy makers that recruiting HEWs from the same community enhances their performance; there is little empirical evidence to support this argument based on the findings from this study. Thus, it is essential to explore additional factors and criteria in the selection and recruitment process beyond residence-based measures in the expectation to enhance the performance of the HEWs

Pattern of Presentation of Spinal Dysraphism: A Study of 72 Patients in Hayatabad Medical Complex Peshawar, Pakistan

Objective:  To review the pattern of presentation and current understanding of patients with spinal dysraphism in our local population. Material and Methods:  Cases of spinal dysraphism of any gender and age were admitted via OPD, emergency or referred from another department were included in the study. Information on demographics, developmental history, presenting symptoms , presence/absence of back swelling, hairy patches, a nevus, dimple, an appendage/ skin tag, lower limb function, sensory/ motor deficit, bowel and bladder dysfunction were recorded. MRI spine was done in all patients to know the exact diagnosis. Results:  Out of 72 cases, 52 (72.2%) presented with spina bifida Aperta (spina bifida cystica) while 20 (27.7%) with spina bifida occulta. Total 53 (73.6%) patients presented at the age of 0 – 1 years. 41 (56.9%) of the patient presented with visible sac, 35 (48.6%) swelling over the back, in 5 (6.9%) of patient have hairy patch and dermal sinus each, while 28 (38.8%) patients have neurological deficit. Most common type of spinal dysraphism was myelomeningocele 45 (62.5%). Postoperative course of patients with spinal dysraphism was found to be uneventful in 56 (77.7%), wound infection was seen in 11 (15.2%), deterioration of neurological status in 3 (4.16%) of cases. Conclusion:  Spinal dysraphism is not an uncommon condition in our local population its clinical presentation and features are in line with internationally reported literature. Our population is least aware of the adverse neurological outcomes of the condition and face difficulties to access the adequate healthcare for spinal dysraphism

Urease Inhibitor Application Stages and Nitrogen Levels Influenced on Morpo-Phenological Traits of Wheat Cultivars

A field trial was carried out at New Developmental Farm of The University Agriculture, Peshawar, Pakistan during winter 2012-13, in order to study the urease inhibitor application stages and nitrogen levels influenced on morpo-phenological traits of wheat cultivars. Therefore the field experiment was conducted in randomized complete block design with split plot arrangement having four replications.  Nitrogen levels (60, 120 and 150 kg ha-1) and urease inhibitor  stages (100% sowing stage, 50% sowing stage + 50% booting stage and 100% booting stage) were allotted to main plots, while  wheat cultivars (Siran and Atta Habib)  were allotted to sub plots.  Plots treated with 120 kg N ha-1 took maximum days to booting (128), improved plant height (97.9 cm), leaf area tiller-1 (117.8 cm2), spike length (11.3 cm) and biological yield (10382 kg ha-1) but maximum (185) days to maturity  was observed when plots treated with 150 kg N ha-1 as compared with control plots. Application of urease inhibitor 100% at sowing stage took maximum booting (133) days, maturity (186) days, improved plant height (102 cm), leaf area tiller-1 (128 cm2), spike length (11.6 cm) and biological yield (11386 kg ha-1) as compared with urease application 100% at booting stage. Wheat cultivar Siran had significantly took maximum booting (123) days, maturity (178) days, plant height (94.5 cm), leaf area tiller-1 (97.6 cm2), spike length (10.3 cm) and biological yield (9331 kg ha-1) as compared to Atta Habib. Hence cultivar Siran treated with 120 kg N ha-1 and coated urease inhibitor 100% at sowing stage produced the best results in terms of plant height, leaf area tiller-1, physiological maturity and biological yield. Keywords: Wheat (Triticum aestivum L.), urease inhibitor application stages, nitrogen levels, wheat cultivars, phenology, morpholog

Governance of elementary education: An analytical view

The issue of education, and making it accessible to the public, has been one of the major concerns of Pakistan since decades. It is a problem which has garnered quite a lot of attention over the years, both at home and abroad. Education at the elementary level requires special attention because this is the most critical stage of an individual’s entire academic trajectory, and has important implications for the country as well. The Punjab government has recently launched many new schemes in order to increase enrollment rates and to provide this basic facility to the vast millions deprived of it. The method chosen for this purpose has been public-private partnerships and privatization, with the help of millions of dollars in aid from international donor agencies. This paper argues that these projects initiated by the Punjab government are based on neo-liberal policies which challenge the spirit of public service and create further inconsistencies in the society. Specifically, the implementation of new managerialism in local governance has meant that the right for education for all is seriously undermined, and has further eroded the belief in the state as the provider of basic necessities. The paper then argues that these concerns require policy re-examinations and changes in order to reverse the damage incurred through these reforms

Feasibility Analysis and Production Increase Strategy for Marine Ornamental Fish Agribusiness

The marine ornamental fish business has experienced significant growth every year in Indonesia. This study aims to conduct feasible business analysis for marine ornamental fish commodities at PT. Indotama Putra Wahana. This study aims to evaluate the financial feasibility and investment in the marine ornamental fish business by achieving maximum sustainable profits. The research was conducted from March to July 2023. Data collection was carried out using primary and secondary data using interview methods and direct field observations (PT. Indotama Putra Wahana, DKI Jakarta). Data were analyzed using NPV (Net Present Value), Payback Period, Profitability Index, IRR (Internal Rate of Return), and BEP (Break Even Point). The results show that the NPV of cash flows for 10 years with a discount rate of 20% has a Profitability Index of 1.2. This indicates that the marine ornamental fish business has promising prospects. Data analysis also shows that the payback period is 3.4 years, the Net Present Value is IDR 9.972.734.254, and the IRR (Internal Rate of Return) is 21.8% which exceeds the interest rate of 11.5%. Break Even Point (BEP) of IDR 1.489.913.724 or 8.343 fish. These values indicate that this marine ornamental fish business generates positive income or profits

Revision of the Ethiopian Essential Health Service Package: An Explication of the Process and Methods Used

To make progress toward universal health coverage, countries should define the type and mix of health services that respond to their populations’ needs. Ethiopia revised its essential health services package (EHSP) in 2019. This paper describes the process, methodology and key features of the new EHSP. A total of 35 consultative workshops were convened with experts and the public to define the scope of the revision, develop a list of health interventions, agree on the prioritization criteria, gather evidence and compare health interventions. Seven prioritization criteria were employed: disease burden, cost effectiveness, equity, financial risk protection, budget impact, public acceptability and political acceptability. In the first phase, 1,749 interventions were identified, including existing and new interventions, which were regrouped and reorganized to identify 1,442 interventions as relevant. The second phase removed interventions that did not match the burden of disease or were not relevant in the Ethiopian setting, reducing the number of interventions to 1,018. These were evaluated further and ranked by the other criteria. Finally, 594 interventions were classified as high priority (58%), 213 as medium priorities (21%) and 211 as low priority interventions (21%). The current policy is to provide 570 interventions (56%) free of charge while guaranteeing the availability of the remaining services with cost-sharing (38%) and cost-recovery (6%) mechanisms in place. In conclusion, the revision of Ethiopia’s EHSP followed a participatory, inclusive and evidence-based prioritization process. The interventions included in the EHSP were comprehensive and were assigned to health care delivery platforms and linked to financing mechanisms.publishedVersio

Self-Refine: Iterative Refinement with Self-Feedback

Like people, LLMs do not always generate the best text for a given generation problem on their first try (e.g., summaries, answers, explanations). Just as people then refine their text, we introduce SELF-REFINE, a framework for similarly improving initial outputs from LLMs through iterative feedback and refinement. The main idea is to generate an output using an LLM, then allow the same model to provide multi-aspect feedback for its own output; finally, the same model refines its previously generated output given its own feedback. Unlike earlier work, our iterative refinement framework does not require supervised training data or reinforcement learning, and works with a single LLM. We experiment with 7 diverse tasks, ranging from review rewriting to math reasoning, demonstrating that our approach outperforms direct generation. In all tasks, outputs generated with SELF-REFINE are preferred by humans and by automated metrics over those generated directly with GPT-3.5 and GPT-4, improving on average by absolute 20% across tasks.Comment: Code, data, and demo at https://selfrefine.info

Giant room-temperature electrostrictive coefficients in lead-free relaxor ferroelectric ceramics by compositional tuning

A thermotropic phase boundary between non-ergodic and ergodic relaxor phases is tuned in lead-free Bi1/2Na1/2TiO3-based ceramics through a structural transition driven by compositional modification (usually named as "morphotropic approach"). The substitution of Bi(Ni1/2Ti1/2)O-3 for Bi-1/2(Na0.78K0.22)(1/2)TiO3 induces a transition from tetragonal to "metrically" cubic phase and thereby, the ergodic relaxor ferroelectric phase becomes predominant at room temperature. A shift of the transition temperature (denoted as TF-R) in the non-ergodic-to-ergodic phase transition is corroborated via temperature-dependent dielectric permittivity and loss measurements. By monitoring the chemical composition dependence of polarization-electric field and strain-electric field hysteresis loops, it is possible to track the critical concentration of Bi(Ni1/2Ti1/2)O-3 where the (1 - x)Bi-0.5(Na0.78K0.22)(0.5)TiO3-xBi(Ni0.5Ti0.5)O-3 ceramic undergoes the phase transition around room temperature. At the Bi(Ni0.5Ti0.5)O-3 content of x = 0.050, the highest room-temperature electrostrictive coefficient of 0.030 m(4)/C-2 is achieved with no hysteretic characteristic, which can foster the realization of actual electrostrictive devices with high operational efficiency at room temperature

Modelling and development of sustainable energy systems

Due to the recent climate change, organizations all over the globe are developing plans for reducing carbon emissions by developing clean energy technologies and energy efficient devices. However, the path for transition to green energy system is still unclear and in general, the representation of green energy supply for transition pathways is limited. Therefore, this study outlines a plan for getting Swedish energy sector completely carbon neutral by 2050. The approach can also be applicable to the majority of nations worldwide. Computer based simulations are performed on Energy PLAN software for making clean, green and sustainable energy system that can balance every component of entire energy system during the study period 2022 to 2050. This study takes into account the sustainable use of renewable sources for all economic sectors as well as the interchange of energy with nearby nations under the two scenarios. Additionally, the energy system works in tandem with other industries to create a fully carbon-free environment. The results revealed that, 50% de-carbonization is possible till 2035 and 100% de-carbonization is possible till 2050. This enables a discussion of how ambitious 10-year goals might serve as a first step toward the mid-century elimination of fossil fuels from the energy sector

The role of techno-economic factors for net zero carbon emissions in Pakistan

The Government of Pakistan has established clean energy transition goals in the national Alternative and Renewable Energy (ARE) Policy. The goal of this policy is to increase the 30% capacity of green energy in total energy mix by 2030. In this regard, the aim of this study is to develop a de-carbonization plan for achieving net zero emissions through the deployment of a green energy system for the period 2021 to 2040 by incorporating the ARE policy targets. The Low Emissions Analysis Platform (LEAP®) software is used for finding the unidirectional causality among gross domestic product, population within the country, energy demand, renewable energy production and CO2 emissions for Pakistan. The results revealed that energy production of 564.16 TWh is enough to meet the energy demand of 480.10 TWh with CO2 emissions of 22.19 million metric tons, having a population of 242.1 million people and GDP growth rate of 5.8%, in the year 2040 in Pakistan. The share of green energy production is 535.07 TWh, which can be utilized fully for meeting energy demand in the country, and almost zero emissions will produce till 2040. CO2 emissions produced by burning natural gas were 20.64 million metric tons in 2020, which then reduced to 3.25 million metric tons in 2040. CO2 emissions produced by burning furnace oil are also reduced from 4.19 million metric tons in 2020 to 2.06 million metric tons in 2040. CO2 emissions produced by burning coal were 24.85 million metric tons in 2020, which then reduced to 16.88 million metric tons in 2040. Energy demand is directly related to the population and GDP of the country, while renewable utilization is inversely proportional to carbon emissions. The declining trend of carbon emissions in Pakistan would help to achieve net zero emissions targets by mid-century. This technique would bring prosperity in the development of a clean, green and sustainable environment