Web server load prediction and anomaly detection from hypertext transfer protocol logs

As network traffic increases and new intrusions occur, anomaly detection solutions based on machine learning are necessary to detect previously unknown intrusion patterns. Most of the developed models require a labelled dataset, which can be challenging owing to a shortage of publicly available datasets. These datasets are often too small to effectively train machine learning models, which further motivates the use of real unlabeled traffic. By using real traffic, it is possible to more accurately simulate the types of anomalies that might occur in a real-world network and improve the performance of the detection model. We present a method able to predict and categorize anomalies without the aid of a labelled dataset, demonstrating the model’s usability while also gathering a dataset from real noisy network traffic. The proposed long short-term memory (LTSM) based intrusion detection system was tested in a real-world setting of an antivirus company and was successful in detecting various intrusions using 5-minute windowing over both the predicted and real update curves thereby demonstrating its usefulness. Our contribution was the development of a robust model generally applicable to any hypertext transfer protocol (HTTP) traffic with almost real-time anomaly detection, while also outperforming earlier studies in terms of prediction accuracy

Effect of maternal age on facility-based delivery: analysis of first-order births in 34 countries of sub-Saharan Africa using demographic and health survey data.

OBJECTIVES: Increasing access to skilled birth attendance, usually via childbirth in health facilities, is a key intervention to reduce maternal and perinatal mortality and morbidity. Yet, in some countries of sub-Saharan Africa, the uptake is <50%. Age and parity are determinants of facility-based delivery, but are strongly correlated in high fertility settings. This analysis assessed the independent effect of age on facility-based delivery by restricting to first-order births. It was hypothesised that older first-time mothers in this setting might have lower uptake of facility-based deliveries than women in the most common age groups for first birth. SETTING: The most recent Demographic and Health Surveys from 34 sub-Saharan African countries were used to assess women's delivery locations. PARTICIPANTS: 72 772 women having their first birth in the 5 years preceding the surveys were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Proportions and 95% CIs of facility-based deliveries were estimated overall and by country. Multivariable logistic regression was used to calculate the odds of facility-based delivery for different maternal age groups (15-19, 20-24 and ≥25 years) for a pooled sample of all countries. RESULTS: 59.9% of women had a facility-based delivery for their first birth (95% CI 58.6 to 61.2), ranging from 19.4% in Chad to 96.6% in Rwanda. Compared with women aged 15-19 years, the adjusted odds of having a facility-based delivery for those aged 20-24 was 1.4 (95% CI 1.3 to 1.5, p<0.001) and for those aged ≥25, 1.9 (95% CI 1.6 to 2.2, p<0.001). CONCLUSIONS: Older age at first birth was independently associated with significantly higher odds of facility-based delivery. This went against the hypothesis. Further mixed-method research is needed to explore how increased age improves uptake of facility-based delivery. Promoting facility-based delivery, while ensuring quality of care, should be prioritised to improve birth outcomes in sub-Saharan Africa

A look back on how far to walk: Systematic review and meta-analysis of physical access to skilled care for childbirth in Sub-Saharan Africa.

OBJECTIVES: To (i) summarize the methods undertaken to measure physical accessibility as the spatial separation between women and health services, and (ii) establish the extent to which distance to skilled care for childbirth affects utilization in Sub-Saharan Africa. METHOD: We defined spatial separation as the distance/travel time between women and skilled care services. The use of skilled care at birth referred to either the location or attendant of childbirth. The main criterion for inclusion was any quantification of the relationship between spatial separation and use of skilled care at birth. The approaches undertaken to measure distance/travel time were summarized in a narrative format. We obtained pooled adjusted odds ratios (aOR) from studies that controlled for financial means, education and (perceived) need of care in a meta-analysis. RESULTS: 57 articles were included (40 studied distance and 25 travel time), in which distance/travel time were found predominately self-reported or estimated in a geographic information system based on geographic coordinates. Approaches of distance/travel time measurement were generally poorly detailed, especially for self-reported data. Crucial features such as start point of origin and the mode of transportation for travel time were most often unspecified. Meta-analysis showed that increased distance to maternity care had an inverse association with utilization (n = 10, pooled aOR = 0.90/1km, 95%CI = 0.85-0.94). Distance from a hospital for rural women showed an even more pronounced effect on utilization (n = 2, pooled aOR = 0.58/1km increase, 95%CI = 0.31,1.09). The effect of spatial separation appears to level off beyond critical point when utilization was generally low. CONCLUSION: Although the reporting and measurements of spatial separation in low-resource settings needs further development, we found evidence that a lack of geographic access impedes use. Utilization is conditioned on access, researchers and policy makers should therefore prioritize quality data for the evidence-base to ensure that women everywhere have the potential to access obstetric care

Socio-economic inequalities in curative health-seeking for children in Egypt: analysis of the 2008 Demographic and Health Survey.

BACKGROUND: The existence and magnitude of socio-economic inequalities in health-seeking behaviours for child curative care in Egypt and mechanisms underlying these associations have not been comprehensively assessed. This study examined whether socio-economic position (SEP) was associated with health-seeking behaviours for diarrhoea and acute respiratory infection (ARI) in children and explored potential mechanisms underlying these associations using mediation analysis. METHODS: Children aged under-five years living with their mothers sampled by the 2008 Egypt Demographic and Health Survey were used to estimate the prevalence of diarrhoea and ARI in the two-week period preceding the survey. If either illness was reported, three dimensions of health-seeking were examined in adjusted mediation models, separately by illness: whether medical care was sought, whether such care was timely (within one day of symptom onset), and whether it was sought from private providers. Latent variables of parental socio-cultural capital and household-level economic capital were the main exposures of interest. RESULTS: In the sample of 10,006 children, 8.4% had diarrhoea and 7.6% had ARI. Care was sought for 62.0% of children with diarrhoea and 78.5% with ARI; two-thirds of care-seeking for both illnesses was timely. More than 7 in 10 children who sought care were taken to private providers. Socio-cultural capital or economic capital were not independently associated with seeking care for either illness. Socio-cultural capital was positively associated with timely care-seeking, and economic capital was positively associated with private provider use in adjusted analyses for both illnesses. CONCLUSIONS: SEP was not a strong determinant of care-seeking for diarrhoea or ARI, but there was a modest positive effect of SEP on timely receipt of care and private provider use. Further research is needed to explore perceptions of illness severity and the availability and quality of care from public and private providers

Is childbirth location associated with higher rates of favourable early breastfeeding practices in Sub-Saharan Africa?

BACKGROUND: Favourable early breastfeeding practices have a beneficial impact throughout an infants' lifespan. Childbirth location is likely to affect these practices through support during the intrapartum and immediate postpartum period. This study aimed to investigate the association between childbirth location and favourable early breastfeeding practices in Sub-Saharan Africa (SSA). METHODS: Demographic and Health Survey (2000-2013) data across 30 SSA countries were utilised. Childbirth location was categorised as home vs facility, and further into public vs private sector. Early breastfeeding practices included: early initiation of breastfeeding (EIBF) (within 1 hour of birth), and no prelacteal feeding (fed only breast milk in the first 3 days). Multivariate logistic regression models adjusted for confounders were used to assess this association. RESULTS: Overall, 50.0% (country range 32.6%-95.5%) of infants received EIBF and 61.0% had no prelacteal feeding. Compared with home births, facility deliveries had higher adjusted odds of EIBF (adjusted odds ratio, aOR = 1.39, 95% confidence interval (CI) = 1.30-1.48, P < 0.001) and no prelacteal feeding (aOR = 1.75, 95% CI = 1.63-1.89, P < 0.001). Private sector facilities had lower adjusted odds of no prelacteal feeding (aOR = 0.89, 95% CI = 0.81-0.99, P = 0.036) when compared to public sector facilities. There was no evidence to suggest delivery sector was associated with EIBF (aOR = 0.93, 95% CI = 0.85-1.03, P = 0.212). CONCLUSIONS: This study showed early breastfeeding practices are suboptimal and are associated with delivery location in SSA. Further research is required to better understand how characteristics of care may explain these patterns in order to improve feeding practices

Incidence of and Risk Factors for Lactational Mastitis: A Systematic Review.

BACKGROUND: Lactational mastitis is a maternal morbidity that affects the wellbeing of women and their babies, including through breastfeeding discontinuation. RESEARCH AIM: To systematically review the available global literature on the frequency of lactational mastitis, and to summarize the evidence on risk factors for lactational mastitis. We also describe gaps in the evidence and identify priority areas for future research. METHODS: We systematically searched and screened 6 databases and included 26 articles, conducted meta-analysis of disease frequency, and narratively synthesized evidence on risk factors. RESULTS: In 11 (42%) articles researchers reported a measure of disease frequency; 5 (19%) reported risk factors, and 10 (39%) included both. Overall, the quality of studies was low, related to suboptimal measurement of disease frequency, high risk of bias, reverse causality, and incomplete adjustment for confounding. Meta-analysis was based on 3 studies (pooled incidence between birth and Week 25 postpartum: 11.1 episodes per 1,000 breastfeeding weeks; 95% CI [10.2-12.0]); with high heterogeneity across contexts and highest incidence in the first four weeks postpartum. Researchers assessed 42 potential risk factors; nipple damage was the most frequently studied and strongly associated with mastitis. There was a scarcity of studies from low-resource settings. CONCLUSIONS: Lactational mastitis is a common condition, but the wide variability in incidence across contexts suggested that a substantial portion of this burden might be preventable. Provision of care to breastfeeding women at risk for or affected by mastitis is currently constrained due to a critical lack of high quality epidemiological evidence about its incidence and risk factors

Time trends in facility-based and private-sector childbirth care: analysis of Demographic and Health Surveys from 25 sub-Saharan African countries from 2000 to 2016.

BACKGROUND: Africa, and sub-Saharan Africa in particular, remains one of the regions with modest improvements to maternal and newborn survival and morbidity. Good quality intrapartum and early postpartum care in a health facility as well as delivery under the supervision of trained personnel is associated with improved maternal and newborn health outcomes and decreased mortality. We describe and contrast recent time trends in the scale and socio-economic inequalities in facility-based and private facility-based childbirth in sub-Saharan Africa. METHODS: We used Demographic and Health Surveys in two time periods (2000-2007 and 2008-2016) to analyse levels and time trends in facility-based and private facility-based deliveries for all live births in the five-year survey recall period to women aged 15-49. Household wealth quintiles were used for equity analysis. Absolute numbers of births by facility sector were calculated applying UN Population Division crude birth rates to the total country population. RESULTS: The percentage of all live births occurring in health facilities varied across countries (5%-85%) in 2000-2007. In 2008-2016, this ranged from 22% to 92%. The lowest percentage of all births occurring in private facilities in 2000-2007 period was in Ethiopia (0.3%) and the highest in the Democratic Republic of Congo at 20.5%. By 2008-2016, this ranged from 0.6% in Niger to 22.3% in Gabon. Overall, the growth in the absolute numbers of births in facilities outpaced the growth in the percentage of births in facilities. The largest increases in absolute numbers of births occurred in public sector facilities in all countries. Overall, the percentage of births occurring in facilities was significantly lower for poorest compared to wealthiest women. As the percentage of facility births increased in all countries over time, the extent of wealth-based differences had reduced between the two time periods in most countries (median risk ratio in 2008-2016 was 2.02). The majority of countries saw a narrowing in both the absolute and relative difference in facility-based deliveries between poorest and wealthiest. CONCLUSIONS: The growth in facility-based deliveries, which was largely driven by the public sector, calls for increased investments in effective interventions to improve service delivery and quality of life for the mother and newborn. The goal of universal health coverage to provide better quality services can be achieved by deploying interventions that are holistic in managing and regulating the private sector to enhance performance of the health care system in its entirety rather than interventions that only target service delivery in one sector

Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries.

INTRODUCTION: Antenatal care (ANC) provides a critical opportunity for women and babies to benefit from good-quality maternal care. Using 10 countries as an illustrative analysis, we described ANC coverage (number of visits and timing of first visit) and operationalised indicators for content of care as available in population surveys, and examined how these two approaches are related. METHODS: We used the most recent Demographic and Health Survey to analyse ANC related to women's most recent live birth up to 3 years preceding the survey. Content of care was assessed using six components routinely measured across all countries, and a further one to eight additional country-specific components. We estimated the percentage of women in need of ANC, and using ANC, who received each component, the six routine components and all components. RESULTS: In all 10 countries, the majority of women in need of ANC reported 1+ ANC visits and over two-fifths reported 4+ visits. Receipt of the six routine components varied widely; blood pressure measurement was the most commonly reported component, and urine test and information on complications the least. Among the subset of women starting ANC in the first trimester and receiving 4+ visits, the percentage receiving all six routinely measured ANC components was low, ranging from 10% (Jordan) to around 50% in Nigeria, Nepal, Colombia and Haiti. CONCLUSION: Our findings suggest that even among women with patterns of care that complied with global recommendations, the content of care was poor. Efficient and effective action to improve care quality relies on development of suitable content of care indicators

Qualitative data for: "The landscape of validation of global maternal and newborn health indicators through key informant interviews"

Anonymised notes recorded when performing semi-structured interviews with 32 respondents, considered to be experts on the five types of maternal and newborn indicators (health system and input, care access and availability, quality of care and safety, coverage and outcomes, as well as impact). We included experts in both qualitative and quantitative methods to assess indicator validity. This work was commissioned by the Mother and Newborn Information for Tracking Outcomes and Results Technical Advisory Group (MoNITOR), which functions as a Technical Advisory body to the World Health Organization on matters of measurement, metrics, and monitoring of maternal and newborn health for the Departments of Maternal, Newborn, Child and Adolescent Health and Reproductive Health and Research