Reproductive age mortality survey: a tool to determine level of underreporting of maternal mortality

Background: For achieving sustainable development goals, tracking all maternal deaths without missing any is a crucial step. Underreporting of maternal deaths is an issue especially in developing countries like India. Objectives of this study were to estimate maternal deaths using Reproductive Age Mortality Survey (RAMOS) methodology in a district of North India and to study medical causes responsible for maternal deaths.Methods: A Reproductive Age Mortality Study (RAMOS) was carried out in a district of North India for the period 2009 to 2012. Records of female deaths in the reproductive age group were reviewed using multiple sources and verbal autopsy was conducted. Maternal deaths thus identified were compared with the officially reported maternal deaths for the same period for finding out the under reporting. Verbal autopsy was conducted to find out causes of maternal deaths.Results: A total of 16 women were identified as maternal deaths using RAMOS methodology. The officially reported maternal deaths were 8, thus under reporting of 100%. The 16 maternal deaths consisted of 14 (87.5%) direct maternal deaths and 2 (12.5%) indirect maternal deaths. One or the other form of delay was recognized in 8 of 16 maternal deaths. There was delay in recognizing the warning signs for urgent health care requirement (first delay) in 4 of 16 maternal deaths. There was delay on part of health facility to diagnose the complication and act appropriately (third delay) in 4 cases.Conclusions: It is concluded that the reporting system for maternal deaths need to be strengthened. Health workers should be adequately trained on reporting maternal death cases. On this foundation verbal autopsy should be conducted for all the reported deaths of women of reproductive age group to know the circumstances leading to maternal deaths.

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Client′s satisfaction with the health services under Janani Suraksha Yojana in rural area of Himachal Pradesh

Background: Satisfaction can be defined as the extent of an individual′s experience compared with his or her expectations. Client satisfaction is one of the commonly used outcome measures of patient care and is an important indicator of quality of primary care and healthcare performance. Objective: To assess the satisfaction with the services among Janani Suraksha Yojana (JSY) beneficiaries in a rural field practice area of Indira Gandhi Medical College (IGMC), Shimla, and to recommend measures for improvements of services being provided to the beneficiaries. Materials and Methods: A community-based, cross-sectional study was undertaken from April 2013 to March 2014 in the rural field practice area of IGMC, Shimla, among the JSY beneficiaries who delivered and received the services under the JSY Scheme in the previous 1 year. The data were collected using a pretested, predesigned, and semi-structured questionnaire and these data were analyzed using SPSS (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). Results: The study observed that 49 (69%) of beneficiaries were found to be satisfied with services received at subcenter and the amount of JSY incentive received. It was also revealed that out of 64 beneficiaries who delivered at hospital, most 52 (81%) of them were satisfied with the services received at the place of delivery. It was found that 51 (65.38%) and 16 (20.5%) beneficiaries were found satisfied and dissatisfied with the behavior of health functionaries at subcenter, respectively. Conclusion: Client satisfaction is one of the most important determinants of health service utilization. There is a need for regular training program for health functionaries on improvement of communication skills and quality of care

Reproductive age mortality survey: a tool to determine level of underreporting of maternal mortality

Background: For achieving sustainable development goals, tracking all maternal deaths without missing any is a crucial step. Underreporting of maternal deaths is an issue especially in developing countries like India. Objectives of this study were to estimate maternal deaths using Reproductive Age Mortality Survey (RAMOS) methodology in a district of North India and to study medical causes responsible for maternal deaths.Methods: A Reproductive Age Mortality Study (RAMOS) was carried out in a district of North India for the period 2009 to 2012. Records of female deaths in the reproductive age group were reviewed using multiple sources and verbal autopsy was conducted. Maternal deaths thus identified were compared with the officially reported maternal deaths for the same period for finding out the under reporting. Verbal autopsy was conducted to find out causes of maternal deaths.Results: A total of 16 women were identified as maternal deaths using RAMOS methodology. The officially reported maternal deaths were 8, thus under reporting of 100%. The 16 maternal deaths consisted of 14 (87.5%) direct maternal deaths and 2 (12.5%) indirect maternal deaths. One or the other form of delay was recognized in 8 of 16 maternal deaths. There was delay in recognizing the warning signs for urgent health care requirement (first delay) in 4 of 16 maternal deaths. There was delay on part of health facility to diagnose the complication and act appropriately (third delay) in 4 cases.Conclusions: It is concluded that the reporting system for maternal deaths need to be strengthened. Health workers should be adequately trained on reporting maternal death cases. On this foundation verbal autopsy should be conducted for all the reported deaths of women of reproductive age group to know the circumstances leading to maternal deaths.

A hybrid cuckoo search algorithm for cost optimization of mechanically stabilized earth walls

Having a wide range of applications in civil engineering practice, Mechanically Stabilized Earth Walls (MSEWs) are regarded as efficient and reliable alternatives to the conventional retaining structure types. As is often the case in engineering, the performance and cost-effectiveness of these structures rely on robust design strategies, which must be proficient to yield optimal solutions in multimodal spaces. While the inherent characteristics of engineering problems often render the design a challenging task, metaheuristic algorithms are suitable options provided that problem-specific considerations and modifications are implemented. In this regard, Cuckoo Search (CS) and its variants are successful in many engineering applications. In the present study, CS is adopted to optimize the reinforcement type, length, and layout of MSEWs and a hybrid CS (HCSDE) variant based on Differential Evolution formulation is developed to further enhance the search capability of the algorithm. The proposed algorithm is applied to various MSEW design benchmarks and comparatively evaluated with respect to well-established methods such as Genetic Algorithm and Particle Swarm Optimization. The results of the study indicate that CS is competent for the problem and the capability of the algorithm can be further enhanced through the proposed adaptations in HCSDE. The improved solutions of HCSDE compared to the other optimization methods highlight the proposed formulation as a promising algorithm for practical implementations