Gestational age data completeness, quality and validity in population-based surveys: EN-INDEPTH study.

BACKGROUND: Preterm birth (gestational age (GA) <37 weeks) is the leading cause of child mortality worldwide. However, GA is rarely assessed in population-based surveys, the major data source in low/middle-income countries. We examined the performance of new questions to measure GA in household surveys, a subset of which had linked early pregnancy ultrasound GA data. METHODS: The EN-INDEPTH population-based survey of 69,176 women was undertaken (2017-2018) in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda. We included questions regarding GA in months (GAm) for all women and GA in weeks (GAw) for a subset; we also asked if the baby was 'born before expected' to estimate preterm birth rates. Survey data were linked to surveillance data in two sites, and to ultrasound pregnancy dating at <24 weeks in one site. We assessed completeness and quality of reported GA. We examined the validity of estimated preterm birth rates by sensitivity and specificity, over/under-reporting of GAw in survey compared to ultrasound by multinomial logistic regression, and explored perceptions about GA and barriers and enablers to its reporting using focus group discussions (n = 29). RESULTS: GAm questions were almost universally answered, but heaping on 9 months resulted in underestimation of preterm birth rates. Preference for reporting GAw in even numbers was evident, resulting in heaping at 36 weeks; hence, over-estimating preterm birth rates, except in Matlab where the peak was at 38 weeks. Questions regarding 'born before expected' were answered but gave implausibly low preterm birth rates in most sites. Applying ultrasound as the gold standard in Matlab site, sensitivity of survey-GAw for detecting preterm birth (GAw <37) was 60% and specificity was 93%. Focus group findings suggest that women perceive GA to be important, but usually counted in months. Antenatal care attendance, women's education and health cards may improve reporting. CONCLUSIONS: This is the first published study assessing GA reporting in surveys, compared with the gold standard of ultrasound. Reporting GAw within 5 years' recall is feasible with high completeness, but accuracy is affected by heaping. Compared to ultrasound-GAw, results are reasonably specific, but sensitivity needs to be improved. We propose revised questions based on the study findings for further testing and validation in settings where pregnancy ultrasound data and/or last menstrual period dates/GA recorded in pregnancy are available. Specific training of interviewers is recommended

Saudi international students’ perceptions of their transition to the UK and the impact of social media

In their transition to a new country, international students often feel lost, anxious or stressed. Saudi students in the UK in particular may face further challenges due to the cultural, social and religious differences that they experience. There is a lot of evidence that social media play a crucial role in this experience. By interviewing 12 Saudi students from different cities in the UK, the aim of this study is to investigate how they perceive their transition to the UK and how social media is involved. The analysis indicates that Saudi students’ perceptions of transition tend to fall in to one of two markedly different camps. Some students see transition as an opportunity to detach themselves from their home country and to engage with the new society. Those students turn to social media as a tool allowing them to build bridges with the new society. Other students feel less enthusiastic to make a full engagement with the UK society. Those students find social media as a good tool to maintain connections and links with family and friends in their home country

Active transport accessibility by the seniors of retirement villages in Australia : lessons for developing countries

The ageing population (i.e., seniors) in Australia is increasing. Accessibility to basic services by the seniors is a prime issue in maintaining their quality of life. Transport has been identified as being directly related to quality of life because it affects many areas of a persons’ life, such as community integration or isolation, access to social networks, ability to maintain independence, and access to essential services and recreational pursuits. Trend of the seniors wanting to actively participate in societal life is growing over time; so, it is necessary to determine whether the transport needs of the seniors are being met effectively. The aim of this paper is to draw seniors’ perceptions of current active transport services in Australia undertaking a case study on six retirement villages in Brisbane and the Gold Coast in order to provide some strategic guidelines to improve the systems. In particular, the study provides major city-specific seniors’ perceptions about public bus and information services, especially their level of satisfaction with the current bus services. The study also highlights some lessons learned for the seniors of developing countries large cities

Performance analysis of an integrated fixed bed gasifier model for different biomass feedstocks

Energy recovery from biomass by gasification technology has attracted significant interest because it satisfies a key requirement of environmental sustainability by producing near zero emissions. Though it is not a new technology, studies on its integrated process simulation and analysis are limited, in particular for municipal solid waste (MSW) gasification. This paper develops an integrated fixed bed gasifier model of biomass gasification using the Advanced System for Process ENngineering (Aspen) Plus software for its performance analysis. A computational model was developed on the basis of Gibbs free energy minimization. The model is validated with experimental data of MSW and food waste gasification available in the literature. A reasonable agreement between measured and predicted syngas composition was found. Using the validated model, the effects of operating conditions, namely air-fuel ratio and gasifier temperature, on syngas production are studied. Performance analyses have been done for four different feedstocks, namely wood, coffee bean husks, green wastes and MSWs. The ultimate and proximate analysis data for each feedstock was used for model development. It was found that operating parameters have a significant influence on syngas composition. An air-fuel ratio of 0.3 and gasifier temperature of 700 °C provides optimum performance for a fixed bed gasifier for MSWs, wood wastes, green wastes and coffee bean husks. The developed model can be useful for gasification of other biomasses (e.g., food wastes, rice husks, poultry wastes and sugarcane bagasse) to predict the syngas composition. Therefore, the study provides an integrated gasification model which can be used for different biomass feedstocks

Supporting ultra poor people with rehabilitation and therapy among families of children with cerebral palsy in rural Bangladesh (SUPPORT CP): Protocol of a randomised controlled trial

Introduction Poverty is a key contributor to delayed diagnosis and limited access to early intervention and rehabilitation for children with cerebral palsy (CP) in rural Bangladesh. 97% of families of children with CP live below the poverty line in Bangladesh. Therefore, in low-and middle-income countries (LMICs), efforts to improve outcomes for children with CP (including health-related quality of life, motor function, communication, and nutritional attainments) should also include measures to improve family economic and social capital. We propose a randomised controlled trial (RCT) to evaluate the effectiveness of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) program for ultra-poor families of children with CP in rural Bangladesh. Material and methods This will be a cluster RCT comparing three arms: (a) integrated microfinance/livelihood and community-based rehabilitation (IMCBR); (b) community-based rehabilitation (CBR) alone; and (c) care-as-usual (i.e. no intervention). Seven clusters will be recruited within each arm. Each cluster will consist of 10 child-caregiver dyads totalling 21 clusters with 210 dyads. Parents recruited in the IMCBR arm will take part in a microfinance/livelihood program and Parent Training Module (PTM), their children with CP will take part in a Goal Directed Training (GDT) program. The programs will be facilitated by specially trained Community Rehabilitation Officers. The CBR arm includes the same PTM and GDT interventions excluding the microfinance/livelihood program. The care-as-usual arm will be provided with information about early intervention and rehabilitation. The assessors will be blinded to group allocation. The duration of the intervention will be 12 months; outcomes will be measured at baseline, 6 months, 12 months, and 18 months. Conclusion This will be the first RCT of an integrated microfinance/livelihood and CBR program for children with CP in LMIC settings. Evidence from the study could transform approaches to improving wellbeing of children with CP and their ultra-poor families