Effects of a four-year health systems intervention on the use of maternal and infant health services: results from a programme evaluation in two districts of rural Chad

BACKGROUND: Attendance of maternal and infant care services in rural Chad are consistently low. Our study aimed to assess the use of antenatal (ANC) and postnatal care (PNC) services, health facility delivery and infant health services after 4 years of a health systems intervention for improving the infrastructure, supplies, training and sensitization for maternal and infant health in two districts of rural Chad. METHODS: Data from a repeated cross-sectional household survey conducted in Yao and Danamadji in 2015 and in 2018 were analyzed. A stratified two-stage cluster sampling methodology was applied to achieve a representative sample of the rural settled and mobile population groups in the study area. A generalized linear model was applied to determine the health care utilization rates. Multivariate regression models were used to assess the association between the programme intervention and utilization outcomes of selected maternal and infant health services. RESULTS: Complete datasets were available for 1284 households at baseline. The endline analysis included 1175 households with complete survey data. The use of at least one ANC amongst pregnant women increased in both settled communities (from 80% in 2015 to 90% in 2018) and amongst mobile pastoralist communities (from 48% in 2015 to 56% in 2018). The rate of home delivery among settled communities and mobile pastoralists changed little between baseline and endline and remained high for both population groups. Individuals that were covered by the health systems intervention were however significantly more likely to attend ANC and less likely to give birth at home. PNC services only showed improvements amongst the settled communities (of 30%). Infants' reported health outcomes and vaccination coverage considerably improved; the latter especially among mobile pastoralist (from 15% in 2015 to 84% in 2018). CONCLUSION: A combination of health systems strengthening interventions was associated with an increased use of certain maternal and infant health services. However, to facilitate equitable access to and use of health care services in particular in times of increased vulnerability and by certain population groups in hard-to-reach areas, reinforced health education and culturally adapted communication strategies, including gender-specific messaging will be needed over a sustained period

Mangroves facing climate change: landward migration potential in response to projected scenarios of sea level rise

Mangrove forests prominently occupy an intertidal boundary position where the effects of sea level rise will be fast and well visible. This study in East Africa (Gazi Bay, Kenya) addresses the question of whether mangroves can be resilient to a rise in sea level by focusing on their potential to migrate towards landward areas. The combinatory analysis between remote sensing, DGPS-based ground truth and digital terrain models (DTM) unveils how real vegetation assemblages can shift under different projected (minimum (+9 cm), relative (+20 cm), average (+48 cm) and maximum (+88 cm)) scenarios of sea level rise (SLR). Under SLR scenarios up to 48 cm by the year 2100, the landward extension remarkably implies an area increase for each of the dominant mangrove assemblages except for Avicennia marina and Ceriops tagal, both on the landward side. On the one hand, the increase in most species in the first three scenarios, including the socio-economically most important species in this area, Rhizophora mucronata and C. tagal on the seaward side, strongly depends on the colonisation rate of these species. On the other hand, a SLR scenario of +88 cm by the year 2100 indicates that the area flooded only by equinoctial tides strongly decreases due to the topographical settings at the edge of the inhabited area. Consequently, the landward Avicennia-dominated assemblages will further decrease as a formation if they fail to adapt to a more frequent inundation. The topography is site-specific; however non-invadable areas can be typical for many mangrove settings

Learning from natural sediments to tackle microplastics challenges: A multidisciplinary perspective

Although the study of microplastics in the aquatic environment incorporates a diversity of research fields, it is still in its infancy in many aspects while comparable topics have been studied in other disciplines for decades. In particular, extensive research in sedimentology can provide valuable insights to guide future microplastics research. To advance our understanding of the comparability of natural sediments with microplastics, we take an interdisciplinary look at the existing literature describing particle properties, transport processes, sampling techniques and ecotoxicology. Based on our analysis, we define seven research goals that are essential to improve our understanding of microplastics and can be tackled by learning from natural sediment research, and identify relevant tasks to achieve each goal. These goals address (1) the description of microplastic particles, (2) the interaction of microplastics with environmental substances, (3) the vertical distribution of microplastics, (4) the erosion and deposition behaviour of microplastics, (5) the impact of biota on microplastic transport, (6) the sampling methods and (7) the microplastic toxicity. When describing microplastic particles, we should specifically draw from the knowledge of natural sediments, for example by using shape factors or applying methods for determining the principal dimensions of non-spherical particles. Sediment transport offers many fundamentals that are transferable to microplastic transport, and could be usefully applied. However, major knowledge gaps still exist in understanding the role of transport modes, the influence of biota on microplastic transport, and the importance and implementation of the dynamic behaviour of microplastics as a result of time-dependent changes in particle properties in numerical models. We give an overview of available sampling methods from sedimentology and discuss their suitability for microplastic sampling, which can be used for creating standardised guidelines for future application with microplastics. In order to comprehensively assess the ecotoxicology of microplastics, a distinction must be made between the effects of the polymers themselves, their physical form, the plastic-associated chemicals and the attached pollutants. This review highlights areas where we can rely on understanding and techniques from sediment research - and areas where we need new, microplastic-specific knowledge - and synthesize recommendations to guide future, interdisciplinary microplastic research

A Service of zbw Trend growth, unemployment and optimal monetary policy Trend Growth, Unemployment and Optimal Monetary Policy Trend Growth, Unemployment and Optimal Monetary Policy Trend Growth, Unemployment and Optimal Monetary Policy

Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. We analyze the implications of changes in the trend growth rate for optimal monetary policy in the presence of search and matching unemployment. We show that trend growth in itself does not generate a trade-off for the monetary authority, but that it interacts importantly with the inefficiencies stemming from the labor market. Higher trend growth exacerbates the inefficiencies of the labor market and therefore calls for larger deviations from price stability. Terms of use: Documents in Abstract We analyze the implications of changes in the trend growth rate for optimal monetary policy in the presence of search and matching unemployment. We show that trend growth in itself does not generate a trade-off for the monetary authority, but that it interacts importantly with the inefficiencies stemming from the labor market. Higher trend growth exacerbates the inefficiencies of the labor market and therefore calls for larger deviations from price stability