Protozoa in a stressed area of the Egyptian Mediterranean coast of Damietta, Egypt

AbstractThe Damietta coast is part of the Egyptian Mediterranean coast off the Nile Delta and has recently been polluted as a result of intensive human activities. The environmental parameters and protozoan community in the area were studied biweekly from January to December 2007. The results of the environmental parameters indicated low salinity, oxic and anoxic conditions, high nutrient levels and intensive phytoplankton growth. A total of 69 protozoan species were identified, belonging to Amoebozoa (8 species), Foraminifera (12 species), non-tintinnid ciliates (22 species) and tintinnids (27 species). The numerical density of protozoans was high over the whole area, with annual averages between 8.2×103 cells m−3 and 51.4×103 cells m−3. Spring was the most productive season for protozoans, but several distinct peaks were observed during the year at the sampling sites. The protozoan groups showed clearly different spatial patterns in both composition and abundance: whereas amoebozoans and non-tintinnid ciliates were dominant in the more polluted areas (sites IV and V), tintinnids dominated in the less polluted areas (sites, I, II and III). Several pollution indicators were recorded: amoebozoans – Centropyxis aculeata, Centropyxis sp., Cochliopodium sp., Difflugia sp.; non-tintinnids – Bursaridium sp., Frontonia atra, Holophrya sp., Paramecium sp., Paramecium bursaria, Vasicola ciliata, Vorticella sp., Strombidium sp.; tintinnids – Favella ehrenbergii, Helicostomella subulata, Leprotintinnus nordgvisti, Tintinnopsis beroidea, Stenosemella ventricosa, Tintinnopsis campanula, T. cylindrica, T. lobiancoi, Eutintinnus lusus-undae

Determinants of women's satisfaction with maternal health care: a review of literature from developing countries.

BACKGROUND: Developing countries account for 99 percent of maternal deaths annually. While increasing service availability and maintaining acceptable quality standards, it is important to assess maternal satisfaction with care in order to make it more responsive and culturally acceptable, ultimately leading to enhanced utilization and improved outcomes. At a time when global efforts to reduce maternal mortality have been stepped up, maternal satisfaction and its determinants also need to be addressed by developing country governments. This review seeks to identify determinants of women's satisfaction with maternity care in developing countries. METHODS: The review followed the methodology of systematic reviews. Public health and social science databases were searched. English articles covering antenatal, intrapartum or postpartum care, for either home or institutional deliveries, reporting maternal satisfaction from developing countries (World Bank list) were included, with no year limit. Out of 154 shortlisted abstracts, 54 were included and 100 excluded. Studies were extracted onto structured formats and analyzed using the narrative synthesis approach. RESULTS: Determinants of maternal satisfaction covered all dimensions of care across structure, process and outcome. Structural elements included good physical environment, cleanliness, and availability of adequate human resources, medicines and supplies. Process determinants included interpersonal behavior, privacy, promptness, cognitive care, perceived provider competency and emotional support. Outcome related determinants were health status of the mother and newborn. Access, cost, socio-economic status and reproductive history also influenced perceived maternal satisfaction. Process of care dominated the determinants of maternal satisfaction in developing countries. Interpersonal behavior was the most widely reported determinant, with the largest body of evidence generated around provider behavior in terms of courtesy and non-abuse. Other aspects of interpersonal behavior included therapeutic communication, staff confidence and competence and encouragement to laboring women. CONCLUSIONS: Quality improvement efforts in developing countries could focus on strengthening the process of care. Special attention is needed to improve interpersonal behavior, as evidence from the review points to the importance women attach to being treated respectfully, irrespective of socio-cultural or economic context. Further research on maternal satisfaction is required on home deliveries and relative strength of various determinants in influencing maternal satisfaction