Commonly cited incentives in the community implementation of the emergency maternal and newborn care study in western Kenya

Background: Mortality of mothers and newborns is an important public health problem in low-income countries. In the rural setting, implementation of community based education and mobilization are strategies that have sought to reduce these mortalities. Frequently such approaches rely on volunteers within each community. Objective: To assess the perceptions of the community volunteers in rural Kenya as they implemented the EmONC program and to identify the incentives that could result in their sustained engagement in the project. Method: A community-based cross sectional survey was administered to all volunteers involved in the study. Data were collected using a self-administered supervision tool from all the 881 volunteers. Results: 881 surveys were completed. 769 respondents requested some form of incentive; 200 (26%) were for monetary allowance, 149 (19.4%) were for a bicycle to be used for transportation, 119 (15.5%) were for uniforms for identification, 88 (11.4%) were for provision of training materials, 81(10.5%) were for training in Home based Life Saving Skills (HBLSS), 57(7.4%) were for provision of first AID kits, and 39(5%) were for provision of training more facilitators, 36(4.7%) were for provision of free medication. Conclusion: Monetary allowances, improved transportation and some sort of identification are the main incentives cited by the respondents in this context

Maternal age extremes and adverse pregnancy outcomes in low-resourced settings

IntroductionAdolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low- and middle-income countries where the burden of adverse pregnancy outcomes is highest.ObjectiveTo describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries.Patients and methodsWe performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia between 2010 and 2020. We included pregnant women and their neonates. We describe the prevalence and adverse pregnancy outcomes associated with pregnancies in these maternal age groups (<20, 20–24, 25–29, 30–35, and >35 years). Relative risks and 95% confidence intervals of each adverse pregnancy outcome comparing each maternal age group to the reference group of 20–24 years were obtained by fitting a Poisson model adjusting for site, maternal age, parity, multiple gestations, maternal education, antenatal care, and delivery location. Analysis by region was also performed.ResultsWe analyzed 602,884 deliveries; 13% (78,584) were adolescents, and 5% (28,677) were advanced maternal age (AMA). The overall maternal mortality ratio (MMR) was 147 deaths per 100,000 live births and increased with advancing maternal age: 83 in the adolescent and 298 in the AMA group. The AMA groups had the highest MMR in all regions. Adolescent pregnancy was associated with an adjusted relative risk (aRR) of 1.07 (1.02–1.11) for perinatal mortality and 1.13 (1.06–1.19) for neonatal mortality. In contrast, AMA was associated with an aRR of 2.55 (1.81 to 3.59) for maternal mortality, 1.58 (1.49–1.67) for perinatal mortality, and 1.30 (1.20–1.41) for neonatal mortality, compared to pregnancy in women 20–24 years. This pattern was overall similar in all regions, even in the <18 and 18–19 age groups.ConclusionThe maternal mortality ratio in the LMICs assessed is high and increased with advancing maternal age groups. While less prevalent, AMA was associated with a higher risk of adverse maternal mortality and, like adolescence, was associated with adverse perinatal mortality with little regional variation

Attitude of graduate dental students in The Netherlands towards rubber dam use

The use of rubber dam isolation during restorative procedures is often used. This survey study analyzed several aspects of the use of rubber dam isolation of fifth and sixth year's dental students at three Dutch universities using the COM-B model. This model explains behavior (B) from 3 factors: capacity (C), opportunity (O), and motivation (M). In the period of February-August 2022, a total of 81 students completed the survey (Academic Center for Dentistry Amsterdam, ACTA, n = 25; Radboud University, RU, n=28; Center for Dentistry and Oral Hygiene, CTM, n = 28). There were significant differences on all 3 factors between universities. RU students felt more confident than CTM students in applying the rubber dam in the anterior zone. At RU, teachers were significantly less likely to encourage the use of rubber dams. CTM students were more likely to assess the use of rubber dams as more important in the longevity of direct restorations (motivation). Students struggled the most with rubber dam use in subgingival cases and would like that their teachers were more adept in manipulation of soft tissues. Within the Netherlands, the education in rubber dam use should focus more on practical skills in these subgingival cases, including soft tissue handling.</p

Attitude of graduate dental students in The Netherlands towards rubber dam use

The use of rubber dam isolation during restorative procedures is often used. This survey study analyzed several aspects of the use of rubber dam isolation of fifth and sixth year's dental students at three Dutch universities using the COM-B model. This model explains behavior (B) from 3 factors: capacity (C), opportunity (O), and motivation (M). In the period of February-August 2022, a total of 81 students completed the survey (Academic Center for Dentistry Amsterdam, ACTA, n = 25; Radboud University, RU, n=28; Center for Dentistry and Oral Hygiene, CTM, n = 28). There were significant differences on all 3 factors between universities. RU students felt more confident than CTM students in applying the rubber dam in the anterior zone. At RU, teachers were significantly less likely to encourage the use of rubber dams. CTM students were more likely to assess the use of rubber dams as more important in the longevity of direct restorations (motivation). Students struggled the most with rubber dam use in subgingival cases and would like that their teachers were more adept in manipulation of soft tissues. Within the Netherlands, the education in rubber dam use should focus more on practical skills in these subgingival cases, including soft tissue handling.</p

Attitude of graduate dental students in The Netherlands towards rubber dam use

The use of rubber dam isolation during restorative procedures is often used. This survey study analyzed several aspects of the use of rubber dam isolation of fifth and sixth year's dental students at three Dutch universities using the COM-B model. This model explains behavior (B) from 3 factors: capacity (C), opportunity (O), and motivation (M). In the period of February-August 2022, a total of 81 students completed the survey (Academic Center for Dentistry Amsterdam, ACTA, n = 25; Radboud University, RU, n=28; Center for Dentistry and Oral Hygiene, CTM, n = 28). There were significant differences on all 3 factors between universities. RU students felt more confident than CTM students in applying the rubber dam in the anterior zone. At RU, teachers were significantly less likely to encourage the use of rubber dams. CTM students were more likely to assess the use of rubber dams as more important in the longevity of direct restorations (motivation). Students struggled the most with rubber dam use in subgingival cases and would like that their teachers were more adept in manipulation of soft tissues. Within the Netherlands, the education in rubber dam use should focus more on practical skills in these subgingival cases, including soft tissue handling.</p

Attitude of graduate dental students in The Netherlands towards rubber dam use

The use of rubber dam isolation during restorative procedures is often used. This survey study analyzed several aspects of the use of rubber dam isolation of fifth and sixth year's dental students at three Dutch universities using the COM-B model. This model explains behavior (B) from 3 factors: capacity (C), opportunity (O), and motivation (M). In the period of February-August 2022, a total of 81 students completed the survey (Academic Center for Dentistry Amsterdam, ACTA, n = 25; Radboud University, RU, n=28; Center for Dentistry and Oral Hygiene, CTM, n = 28). There were significant differences on all 3 factors between universities. RU students felt more confident than CTM students in applying the rubber dam in the anterior zone. At RU, teachers were significantly less likely to encourage the use of rubber dams. CTM students were more likely to assess the use of rubber dams as more important in the longevity of direct restorations (motivation). Students struggled the most with rubber dam use in subgingival cases and would like that their teachers were more adept in manipulation of soft tissues. Within the Netherlands, the education in rubber dam use should focus more on practical skills in these subgingival cases, including soft tissue handling.</p