Heavy precipitation events over East Africa in a changing climate: results from CORDEX RCMs

The study assesses the performance of 24 model runs from five COordinated Regional climate Downscaling Experiment (CORDEX) regional climate models (RCMs) in simulating East Africa’s spatio-temporal precipitation characteristics using a set of eight descriptors: consecutive dry days (CDD), consecutive wet days (CWD), simple precipitation intensity index (SDII), mean daily annual (pr_ANN), seasonal (pr_MAM and pr_OND) precipitation, and representatives of heavy precipitation (90p) and very intense precipitation (99p) events. Relatively better performing RCM runs are then used to assess projected precipitation changes (for the period 2071–2099 relative to 1977–2005) over the study domain under the representative concentration pathway (RCP) 8.5 scenario. The performance of RCMs is found to be descriptor and scope specific. Overall, RCA4 (r1i1p1) forced by CNRM-CERFACS-CNRM-CM5 and MPI-M-MPI-ESM-LR, REMO2009 (r1i1p1) forced by MPI-M-MPI-ESM-LR, and RCA4 (r2i1p1) forced by MPI-M-MPI-ESM-LR emerge as the top four RCM runs. We show that an ensemble mean of the top four model runs outperforms an ensemble mean of 24 model simulations and ensemble means for all runs in an RCM. Our analysis of projections shows a reduction (increase) in mean daily precipitation for MAM(OND), an increase(decrease) in CDD(CWD) events, and a general increase in SDII and the width of the right tail of the precipitation distribution (99p–90p). An increase in SDII and 99p–90p implies a possibility of occurrence of heavy and extreme precipitation incidences by the end of the twenty-first century. Our findings provide important information to support the region’s climate change adaptation and mitigation efforts

Do strategies to improve quality of maternal and child health care in lower and middle income countries lead to improved outcomes? A review of the evidence

Objectives: Efforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship. Methods: We undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence. Findings: Methodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions. Conclusion: Existing evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on nonfacility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care. Copyright