Survey of rehabilitation support for children 0-15 years in a rural part of Kenya

Abstract Purpose: Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0-15 years) and their families in rural Kenya. Method: A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. Results: Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. Conclusions: The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms. Implications for Rehabilitation There needs to be greater investment in rehabilitation provision in developing countries. Consideration of community-based initiatives is required to support better access for all. In order to argue the case for improved resources, better skills and mechanisms for recording, monitoring and evaluating practice are needed

The practice of physicians and nurses in the Brazilian Family Health Programme – evidences of change in the delivery health care model

The article analyzes the practice of physicians and nurses working on the Family Health Programme (Programa de Saúde da Família or PSF, in Portuguese). A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams' work agenda to their routine labour activities

Determinação de regiões homólogas para registro de uma série multitemporal de imagens de satélite usando algoritmos genéticos

O presente trabalho faz parte do programa GEOSAFRAS, estimativa e safras no Brasil, coordenado pela Companhia Nacional de Abastecimento e do Programa das Nações Unidas para o Desenvolvimento. Uma aplicação muito comum no gerenciamento de safras é o monitoramento de mudanças nos campos de cultivo usando imagens de satélite adquiridas em diferentes datas. Para isto, a compatibilidade espacial entre essas imagens é um requisito básico, mais ainda quando se trata de imagens de diferentes sensores. Nesse artigo é descrita uma metodologia para a semi-automação do processo de correção geométrica com a finalidade de facilitar o ajuste geométrico entre imagens de diferentes sensores. Inicialmente, uma imagem base é manualmente corrigida a partir de dados extraídos de uma carta topográfica digital. Após essa correção, a imagem corrigida é utilizada como elemento base de referência para corrigir as outras imagens (denominadas neste trabalho de imagens de ajuste), as quais são adquiridas em datas diferentes e/ou de diferentes sensores. Depois de corrigida a imagem base todas as imagens (base e de ajuste) são segmentadas e classificadas. Os segmentos classificados como vegetação florestal são escolhidos para compor a malha relacional. As imagens de ajuste são registradas pelo processo imagem-imagem usando os centróides dos segmentos de vegetação florestal. Os segmentos de vegetação florestal presentes na imagem base são confrontados com os segmentos correspondentes nas imagens de ajuste, para buscar correspondências (matching). O processo de matching é realizado através da aplicação de algoritmos genéticos. Ao obter um resultado satisfatório na busca de correspondência, calcula-se os centróides correspondentes aos segmentos detectados, os quais são utilizados como pontos de controle para o processo de registro das imagens. Os resultados mostram que os algoritmos genéticos encontraram a solução ótima na maior parte dos experimentos realizados. Porém, para a imagem LANDSAT 2002 reamostrada a solução encontrada foi sub-ótima, pois um segmento sofreu grandes variações em relação ao mesmo segmento na imagem base

Monitoring and evaluation of human resources for health: an international perspective

BACKGROUND: Despite the undoubted importance of human resources to the functions of health systems, there is little consistency between countries in how human resource strategies are monitored and evaluated. This paper presents an integrated approach for developing an evidence base on human resources for health (HRH) to support decision-making, drawing on a framework for health systems performance assessment. METHODS: Conceptual and methodological issues for selecting indicators for HRH monitoring and evaluation are discussed, and a range of primary and secondary data sources that might be used to generate indicators are reviewed. Descriptive analyses are conducted drawing primarily on one type of source, namely routinely reported data on the numbers of health personnel and medical schools as covered by national reporting systems and compiled by the World Health Organization. Regression techniques are used to triangulate a given HRH indicator calculated from different data sources across multiple countries. RESULTS: Major variations in the supply of health personnel and training opportunities are found to occur by region. However, certain discrepancies are also observed in measuring the same indicator from different sources, possibly related to the occupational classification or to the sources' representation. CONCLUSION: Evidence-based information is needed to better understand trends in HRH. Although a range of sources exist that can potentially be used for HRH assessment, the information that can be derived from many of these individual sources precludes refined analysis. A variety of data sources and analytical approaches, each with its own strengths and limitations, is required to reflect the complexity of HRH issues. In order to enhance cross-national comparability, data collection efforts should be processed through the use of internationally standardized classifications (in particular, for occupation, industry and education) at the greatest level of detail possible

Orientação exterior de um par estereoscópico Ikonos II com base no modelo não-rigoroso DLT

O crescente avanço tecnológico ocorrido nos últimos anos, tanto da área da Informática, Fotogrametria e também Sensoriamento Remoto, vem contribuindo significativamente para diversas pesquisas sobre extração de informações tridimensionais a partir de imagens de alta resolução. No presente trabalho, uma solução utilizando modelagem não rigorosa baseada na transformação matemática DLT (Direct Linear Transformation) foi utilizada para a orientação exterior de um par estereoscópico de imagens Ikonos II e determinação de coordenadas tridimensionais por intersecção fotogramétrica. O objetivo principal foi o de avaliar o desempenho do modelo na aplicação, como também a obtenção de melhor configuração de pontos de apoio necessários na orientação exterior para fins da determinação de coordenadas tridimensionais por interseção espacial. Os experimentos realizados permitiram recomendar a configuração adequada para a distribuição dos pontos de apoio, onde a exatidão planimétrica foi equivalente a precisão teórica tolerável igual a um pixel de erro nas observações, enquanto a exatidão altimétrica ficou próxima de 1,5 pixels

Human resources for health and burden of disease: an econometric approach

<p>Abstract</p> <p>Background</p> <p>The effect of health workers on health has been proven to be important for various health outcomes (e.g. mortality, coverage of immunisation or skilled birth attendants). The study aim of this paper is to assess the relationship between health workers and disability-adjusted life years (DALYs), which represents a much broader concept of health outcome, including not only mortality but also morbidity.</p> <p>Methods</p> <p>Cross-country multiple regression analyses were undertaken, with DALYs and DALYs disaggregated according to the three different groups of diseases as the dependent variable. Aggregate health workers and disaggregate physicians, nurses, and midwives were included as independent variables, as well as a variable accounting for the skill mix of professionals. The analysis also considers controlling for the effects of income, income distribution, percentage of rural population with access to improved water source, and health expenditure.</p> <p>Results</p> <p>This study presents evidence of a statistically negative relationship between the density of health workers (especially physicians) and the DALYs. An increase of one unit in the density of health workers per 1000 will decrease, on average, the total burden of disease between 1% and 3%. However, in line with previous findings in the literature, the density of nurses and midwives could not be said to be statistically associated to DALYs.</p> <p>Conclusions</p> <p>If countries increase their health worker density, they will be able to reduce significantly their burden of disease, especially the burden associated to communicable diseases. This study represents supporting evidence of the importance of health workers for health.</p