Household socio-economic status, social support and infant and child growth in urban South Africa: a cohort study from 1990

The rapid political, economic and social changes experienced by South Africans from 1991, combined with socio-economic inequalities ingrained in South African society at this time, made the early 1990s a unique and well-suited period to investigate child growth inequalities. Furthermore, recent estimates of low birth weight and stunting (≤ 3 years), showing prevalence of 15% (Chen et aI., 2006) and 25.5% (Labadarios, 1999) respectively, indicate that poor intrauterine and postnatal growth patterns continue to represent considerable public health issues in this setting. This study aimed to investigate associations of birth measures of household SES and social support with infant/child growth in urban South Africa. Anthropometric, demographic, socioeconomic and social support data for quantitative analyses were obtained from the 1990 Bt20 cohort (n=3275). [Continues.

Do you take Credit Cards? Security and Compliance for the Credit Card Payment Industry

Security is a significant concern in business and in information systems (IS) education from both a technological and a strategic standpoint. Students can benefit from the study of information systems security when security concepts are introduced in the context of real-world industry standards. The development of a data security standard for organizations operating within the credit card payment industry serves as an excellent example of a real-world security standard that lends itself to classroom study. The establishment and requirements of the Payment Card Industry Data Security Standard (PCI DSS), and the associated consequences for noncompliance, represents a businesslike approach to the organizational protection of data that students will find interesting and one to which they will relate. Everybody uses credit cards! Incorporating the topic of PCI DSS into an activity allows students to learn and apply PCI DSS concepts to a business setting. Just asking “If everyone uses credit cards, why don’t all businesses accept them?” will start a process of exploration for the class. A hypothetical business teaching case, Blue Mountain Jams (BMJ), illustrates the challenge of PCI DSS mandates for small businesses. Small business is given some leeway in self-assessment under PCI DSS to document compliance after the decision is made to accept credit card payments. That leeway gives students the opportunity to learn and analyze the PCI DSS requirements and compliance methods and to determine the best course of action for a business that has made the decision to start accepting credit cards

MCAT Preparation Guide

Competition for admission to American medical schools has always been intense. Now, with more than 40,000 pre-med students applying for the few available slots each year, scoring well on the Medical College Admission Test (MCAT) is more critical than ever. The MCAT Preparation Guide offers students a systematic, sensible way to improve MCAT test scores. It recognizes their need to understand not only the subject areas covered but also the way the MCAT is structured and what test scorers look for. Extensively field tested at the University of Chicago, Tulane University, Howard University, and the University of Kentucky, this Guide has already helped hundreds of students to boost their MCAT scores significantly. With this edition, the Guide becomes available nationwide for the first time. One excellent feature is the chapter on preparing writing samples, a section of the MCAT often omitted or slighted in other guides. Here is a step-by step process for attacking writing sample prompts to produce superior essays. Miriam S. Willey and Barbara M. Jarecky are well-known specialists in teaching exam-taking and study skills to medical students and undergraduates.https://uknowledge.uky.edu/upk_medicine_and_health_sciences/1010/thumbnail.jp

Building malaria out: improving health in the home.

Malaria prevalence has halved in endemic Africa since 2000, largely driven by the concerted international control effort. To achieve the new global targets for malaria control and elimination by 2030, and to sustain elimination once achieved, additional vector control interventions are urgently needed to supplement long-lasting insecticide-treated nets and indoor residual spraying, which both rely on effective insecticides for optimal protection. Improving housing and the built environment is a promising strategy to address this need, with an expanding body of evidence that simple modifications to reduce house entry by malaria vectors, such as closing eaves and screening doors and windows, can help protect residents from malaria. However, numerous questions remain unanswered, from basic science relating to the optimal design of house improvements through to their translation into operational use. The Malaria Journal thematic series on 'housing and malaria' collates articles that contribute to the evidence base on approaches for improving housing to reduce domestic malaria transmission

Community health workers and stand-alone or integrated case management of malaria: a systematic literature review.

A systematic literature review was conducted to assess the effectiveness of strategies to improve community case management (CCM) of malaria. Forty-three studies were included; most (38) reported indicators of community health worker (CHW) performance, 14 reported on malaria CCM integrated with other child health interventions, 16 reported on health system capacity, and 13 reported on referral. The CHWs are able to provide good quality malaria care, including performing procedures such as rapid diagnostic tests. Appropriate training, clear guidelines, and regular supportive supervision are important facilitating factors. Crucial to sustainable success of CHW programs is strengthening health system capacity to support commodity supply, supervision, and appropriate treatment of referred cases. The little evidence available on referral from community to health facility level suggests that this is an area that needs priority attention. The studies of integrated CCM suggest that additional tasks do not reduce the quality of malaria CCM provided sufficient training and supervision is maintained

Trade Secret Law and Information Systems: Can Your Students Keep a Secret?

The impact of intellectual property (IP) law on information systems (IS) professionals in business cannot be overstated. The IS 2010 model curriculum guidelines for undergraduate IS programs stress the importance of information security and knowledge about IP. While copyright and patents are the most well-known types of IP, another, trade secrets, which involve confidential information generated by business to secure financial success, poses a unique challenge partly because IS professionals are often less familiar with trade secrets as a form of IP. Just as important is the crucial role IS plays in actually creating trade secrets. Information must not only be vital and proprietary but also its secrecy must be actively protected and maintained against data security challenges, including unethical behavior by disgruntled employees, corporate espionage, and inadvertent disclosure. Failure to do so results in a determination that information is not legally a protected trade secret. Unlike copyrights and patents, information cannot publically be designated as a trade secret prior to a challenge. Instead, organizations must prove the information is actually a trade secret. Critical to this proof are processes and internal systems businesses use to maintain information secrecy, which determine whether legal remedies exist if the trade secret is wrongfully divulged. This paper discusses trade secret law, methods used to secure trade secrets, and the role of IS in supporting and/or developing those methods. A class exercise provides IS students with insights into trade secret law and acceptable, ethical conduct of IS professionals who protect trade secrets

Linking data sources for measurement of effective coverage in maternal and newborn health: what do we learn from individual- vs ecological-linking methods?

BACKGROUND: Improving maternal and newborn health requires improvements in the quality of facility-based care. This is challenging to measure: routine data may be unreliable; respondents in population surveys may be unable to accurately report on quality indicators; and facility assessments lack population level denominators. We explored methods for linking access to skilled birth attendance (SBA) from household surveys to data on provision of care from facility surveys with the aim of estimating population level effective coverage reflecting access to quality care. METHODS: We used data from Mayuge District, Uganda. Data from household surveys on access to SBA were linked to health facility assessment census data on readiness to provide basic emergency obstetric and newborn care (BEmONC) in the same district. One individual- and two ecological-linking methods were applied. All methods used household survey reports on where care at birth was accessed. The individual-linking method linked this to data about facility readiness from the specific facility where each woman delivered. The first ecological-linking approach used a district-wide mean estimate of facility readiness. The second used an estimate of facility readiness adjusted by level of health facility accessed. Absolute differences between estimates derived from the different linking methods were calculated, and agreement examined using Lin's concordance correlation coefficient. RESULTS: A total of 1177 women resident in Mayuge reported a birth during 2012-13. Of these, 664 took place in facilities within Mayuge, and were eligible for linking to the census of the district's 38 facilities. 55% were assisted by a SBA in a facility. Using the individual-linking method, effective coverage of births that took place with an SBA in a facility ready to provide BEmONC was just 10% (95% confidence interval CI 3-17). The absolute difference between the individual- and ecological-level linking method adjusting for facility level was one percentage point (11%), and tests suggested good agreement. The ecological method using the district-wide estimate demonstrated poor agreement. CONCLUSIONS: The proportion of women accessing appropriately equipped facilities for care at birth is far lower than the coverage of facility delivery. To realise the life-saving potential of health services, countries need evidence to inform actions that address gaps in the provision of quality care. Linking household and facility-based information provides a simple but innovative method for estimating quality of care at the population level. These encouraging findings suggest that linking data sets can result in meaningful evidence even when the exact location of care seeking is not known

Measuring implementation strength: lessons from the evaluation of public health strategies in low- and middle-income settings.

Evaluation of strategies to ensure evidence-based, low-cost interventions reach those in need is critical. One approach is to measure the strength, or intensity, with which packages of interventions are delivered, in order to explore the association between implementation strength and public health gains. A recent systematic review suggested methodological guidance was needed. We described the approaches used in three examples of measures of implementation strength in evaluation. These addressed important public health topics with a substantial disease burden in low-and middle-income countries; they involved large-scale implementation; and featured evaluation designs without comparison areas. Strengths and weaknesses of the approaches were discussed. In the evaluation of Ethiopia's Health Extension Programme, implementation strength scoring for each kebele (ward) was based on aggregated data from interviews with mothers of children aged 12-23 months, reflecting their reports of contact with four elements of the programme. An evaluation of the Avahan HIV prevention programme in India used the cumulative amount of Avahan funding per HIV-infected person spent each year in each district. In these cases, a single measure was developed and the association with hypothesised programme outcomes presented. In the evaluation of the Affordable Medicines Facility-malaria, several implementation strength measures were developed based on the duration of activity of the programme and the level of implementation of supporting interventions. Measuring the strength of programme implementation and assessing its association with outcomes is a promising approach to strengthen pragmatic impact evaluation. Five key aspects of developing an implementation strength measure are to: (a) develop a logic model; (b) identify aspects of implementation to be assessed; (c) design and implement data collection from a range of data sources; (d) decide whether and how to combine data into a single measure; and, (e) plan whether and how to use the measure(s) in outcome analysis

Correlates of the Women's Development Army strategy implementation strength with household reproductive, maternal, newborn and child healthcare practices: a cross-sectional study in four regions of Ethiopia.

BACKGROUND: To address the shortfall in human resources for health, Ethiopia launched the Health Extension Program (HEP) in 2004, establishing a health post with two female health extension workers (HEWs) in every kebele (community). In 2011, the Women's Development Army (WDA) strategy was added, using networks of neighboring women to increase the efficiency of HEWs in reaching every household, with one WDA team leader for every 30 households. Through the strategy, women in the community, in partnership with HEWs, share and learn about health practices and empower one another. This study assessed the association between the WDA strategy implementation strength and household reproductive, maternal, newborn and child health care behaviors and practices. METHODS: Using cross-sectional household surveys and community-level contextual data from 423 kebeles representing 145 rural districts, an internal comparison group design was applied to assess whether HEP outreach activity and household-level care practices were better in kebeles with a higher WDA density. The density of active WDA leaders was considered as WDA strategy implementation strength; higher WDA density in a kebele indicating relatively high implementation strength. Based on this, kebeles were classified as higher, moderate, or lower. Multilevel logit models, adjusted for respondents' individual, household and contextual characteristics, were used to assess the associations of WDA strategy implementation strength with outcome indicators of interest. RESULTS: Average numbers of households per active WDA team leader in the 25th, 50th and 75th percentiles of the kebeles studied were respectively 41, 50 and 73. WDA density was associated with better service for six of 13 indicators considered (p < 0.05). For example, kebeles with one active WDA team leader for up to 40 households (higher category) had respectively 7 (95% CI, 2, 13), 11 (5, 17) and 9 (1, 17) percentage-points higher contraceptive prevalence rate, coverage of four or more antenatal care visits, and coverage of institutional deliveries respectively, compared with kebeles with one active WDA team leader for 60 or more households (lower category). CONCLUSION: Higher WDA strategy implementation strength was associated with better health care behaviors and practices, suggesting that the WDA strategy supported HEWs in improving health care services delivery

Evaluation of a capacity building intervention on malaria treatment for under-fives in rural health facilities in Niger State, Nigeria.

BACKGROUND: Despite the uptake of parasitological testing into policy and practice, appropriate prescription of anti-malarials and artemisinin-based combination therapy (ACT) in accordance with test results is variable. This study describes a National Malaria Control Programme-led capacity building intervention which was implemented in 10 States of Nigeria. Using the experience of Niger State, this study assessed the effect on malaria diagnosis and prescription practices among febrile under-fives in rural health facilities. METHODS: The multicomponent capacity building intervention consisted of revised case management manuals; cascade training from national to state level carried out at the local government area (LGA) level; and on the job capacity development through supportive supervision. The evaluation was conducted in 28, principally government-owned, health facilities in two rural LGAs of Niger State, one in which the intervention case management of malaria was implemented and the other acted as a comparison area with no implementation of the intervention. Three outcomes were considered in the context of rapid diagnostic testing (RDT) for malaria which were: the prevalence of RDT testing in febrile children; appropriate treatment of RDT-positive children; and appropriate treatment of RDT-negative children. Outcomes were compared post-intervention between intervention and comparison areas using multivariate logistic regression. RESULTS: The intervention did not improve appropriate management of under-fives in intervention facilities above that seen for under-fives in comparison facilities. Appropriate treatment with artemisinin-based combinations of RDT-positive and RDT-negative under-fives was equally high in both areas. However, appropriate treatment of RDT-negative children, when defined as receipt of no ACT or any other anti-malarials, was better in comparison areas. In both areas, a small number of RDT-positives were not given ACT, but prescribed an alternative anti-malarial, including artesunate monotherapy. Among RDT-negatives, no under-fives were prescribed artesunate as monotherapy. CONCLUSION: In a context of significant stock-outs of both ACT medicines and RDTs, under-fives were not more appropriately managed in intervention than comparison areas. The malaria case management intervention implemented through cascade training reached only approximately half of health workers managing febrile under-fives in this setting. Implementation studies on models of cascade training are needed to define what works in what context