Community Based Skilled Birth Attendants Programme in Bangladesh; Intervention towards Improving Maternal Health

Aim To review the strength and weakness of a community based skilled birth attendant (CSBA) program in Bangladesh. Specific Objective To explore perceptions of the providers, decision makers and community regarding newly trained community based skilled birth attendants To understand challenges, gaps and obstacles and recommend potential solutions for programme improvement. Design A descriptive study, using a qualitative approach was chosen to elicit the views and experiences of different stakeholders and the beneficiaries of the program was undertaken. The study intended to enhance understanding on gaps and challenges during program implementation by getting insight into different views. The data were captured through different methods including in-depth interviews (IDIs) and Focus Group Discussions (FGDs). In addition, the initial review of the existing literature and other related policies and documents were also employed. Participants Nine in-depth interviews were conducted with graduate CSBAs, 10 with Key informants including government, donor agencies and CSBAs’ trainers. Three FGDs were conducted with two groups of community women and a group of CSBAs trainees. Finding In general, the role and scope of work of CSBAs found to be uncertain; with no clear consensus on their job description or clarity of their role. Most of the respondents appreciated the role of the CSBAs in reducing maternal mortality; however, the real impact was still uncertain due to many barriers. The main barriers was low job satisfaction, lack of supportive work environment, supportive policies and low acceptability at the community which had led to the provider being demoralised and resulted in low productivity. Conclusion To achieve the MDG’s targets related to maternal and child health, the health systems cannot function without competent and well trained skilled providers who can provide quality services. The CSBA program may not be the best solution in the long term but it could be a temporary option for emergency response to the crisis of human resources in health system but in long term government of Bangladesh needs to revise their policies and strategies to train more qualified health providers

Is “Empowerment” A Trickle-Down Effect of The Afghanistan Midwifery Education Program?

IntroductionThe patriarchal Afghan society has thousands of years of history. For most parts it has been governed by its tribal systems. The society has systematically evolved with its thousands of years old tradition, which has resulted in the subjugation of women. Although it is widely assumed that the midwifery education program (MEP) has contributed to female empowerment, no formal investigation has been carried out that explores the actual impact of MEP on the status of women midwifery graduates. Therefore, this study systematically explores the trickle down effects of MEP on women’s empowerment. Methodology Design: Exploratory qualitative study Study sites: Purposively selected to represent a range of contexts in Afghanistan: Kabul, Parwan, Paktia, Bamyan and Badakhshan. Study Participants: Graduates of the midwifery education program and key informants from the Ministry of Public Health, Community – based Midwifery Education (CME) implementers, donors, and the midwifery association. Methods: 9 In-depth Interviews (IDIs), 9 Key Informant Interviews (KIIs), and 4 Focus Group Discussions (FGDs), with photo elicitations, were conducted. FindingsAccording to the study respondents, empowered women are those who are well educated, can work and earn an income, are fully aware of their rights and can take part in the nation building processes. The study demonstrated, in particular, the impact of midwifery education on women’s empowerment at various levels i.e. individual, family, and society at large. Conclusion:The midwifery profession, being the most acceptable profession for women in a conservative society like Afghanistan, has empowered women in a way that they are seen as a role model for the next generation and it has created a momentum for a better future for the women in Afghanistan

Needs and Expectations: A Membership Survey of the Midwifery Association in Afghanistan

A survey of the Afghan Midwives Association (AMA) members was conducted in April 2013 to determine the profile of the midwifery workforce, and to provide guidance on the professional needs and expectations of midwives in the future. Of the estimated 3,000 members across the country, around 500 participated in the Annual Congress, 400 questionnaires were distributed randomly among participants, and 357 were returned (89% response rate representing 12% of the overall membership). The results showed that most members are pleased with the Association, and value its work, particularly its ability to advocate on their behalf with the Ministry of Public Health, on midwifery matters. They also appreciated that AMA provided an opportunity to share professional information and experiences in a context where many work in remote and isolated areas. As a result, a majority of the members believed that the Association must better identify the needs of its members and develop strategies to improve its services accordingly. Whilst there was general support for the mandatory payment of fees, some found this to be expensive; this calls for a review of the contribution that the types of membership given to each of the members, considering their income. Most respondents believe that an area for improvement is communication and access to information. Although some of them have information about the current governance mechanisms and agendas, a significant proportion is not aware of these and, consequently, participation in regularly updated activities is often limited. This survey has identified opportunities that the Association could use to improve their coverage and membership. These opportunities include using mobile phones to increase communication with members

Provision of Mentorship Services for Midwives Working in Remote Areas in the Workplaces of Afghanistan

Background Midwives working in remote facilities have little opportunity to receive technical support and coaching services. To close this gap and support rural midwives the Afghan Midwives Association (AMA) designed a field-based mentorship program for midwives working in remote areas. Methods The process included five stages: Conduct base line assessment of mentees (midwives) and health facilities. Identify and select of mentees through competitive process. Provide on-the-job coaching and mentoring services to the mentees. Assess the progress of the midwives regularly using existing quality assurance performance standards. End-line / final evaluation Results: That results of assessments were encouraging antenatal care (ANC), rising from an average of 20% at the baseline to 88% in the final assessment round. Comparable improvements were found for normal labor, childbirth, and immediate newborn care (19% to 85%), postnatal care (16% to 85%), management of antenatal, intra-partum and postpartum complications (15% to 94%), and support systems (38% to 81%)

Strengthening Midwifery Education, Regulation and Association; A case study from Afghanistan

Immediately after the fall of the Taliban in 2002, the midwifery system in Afghanistan underwent a massive reform, and Afghanistan has since developed a strong midwifery pre service educational (PSE) system to achieve the relevant MDG goals. Establishment and involvement of professional associations, and partnerships with the government and other key stakeholders have contributed in shared knowledge, resources, and coordinated activities to speed up achieving these goals. The International Confederation of Midwives (ICM) and its partners believe that the midwifery profession needs to be a strong voice in reducing maternal and child mortality. The three pillars of the midwifery profession, including education, regulation, and a strong professional association (ERA), are all essential in order to achieve this. With the support and technical guidance of national and international partners, the midwifery pillars in Afghanistan continue to develop and become stronger. Despite all this success, still, there is a long way to go. For instance, Pre-service education needs further strengthening especially the faculty development part for higher education, and in order to maintain the competencies of midwives throughout their career span there is a dire need of establishing a regulatory body so that the quality and safety of mothers’ and newborns’ health can be ensured. Moreover, the Afghan Midwives Association (AMA) still needs to increase its organizational capacity for a stronger, more visible, and efficient contribution to the national road map of strategic approaches to accelerate the reduction of maternal and neonatal mortality in the country. The present article provides an overview on strengthening the three pillars of the midwifery profession in Afghanistan, and examines the factors which have influenced midwifery in Afghanistan towards a positive change both at the individual and societal level

Pattern of Breast Cancer Presentation

To study the various types of breastcancer presenting in local hospital to ensure betterfacilities, early diagnosis and better treatmentoptionsMethods: In this descriptive study all breast cancerpatients, over a period of two years were included.Triple assessment of patients done for diagnosis andtreatment given all were included in data.Results: Total number of patients who presentedwere 1982. Benign breast disease patients were 1746(88.0%). Breast cancer were 236(11.90%). Fivehundred and two mammographies were done, 197were BIRAD 5. Preferably confirmation was donethrough trucut biopsy (35), FNAC was done in 74and where needed incisional biopsy in fungatingtumors (n=15) and excisional biopsy where in spiteof all modalities diagnosis was not confirmed (n=11). Age varied from 24 to 75 years. Majority (126)were in stage 3. Forty two patients receivedneoadjuvant chemotherapy. Modified radicalmastectomy (n=114), Breast conservation ( n=13) andsimple mastectomy (n=17) were performed .Receptorstatus was dtermined.Conclusion: The most common stage ofpresentation is stage 3. Such patients need downstaging and then surgery. They required propercounseling and support for their treatment. Femalesusually present late due to domestic issues. Earlydiagnosis, treatment and full support is required totreat breast cancer. This study will help to providebetter facilities for early diagnosis and treatment

Frequency Of Bacterial Co-Infections Isolated from Covid-19 Positive Patients From Tertiary Care Hospital Of Karachi

Objective: This study aims to determine the frequency of bacterial co-infections in COVID-19-positive patients. Methodology: A prospective cross-sectional study was conducted in the Department of Microbiology, Pakistan, from November 15, 2021, to April 15, 2022. Blood and respiratory tract samples were collected, including sputum, bronchial lavage, and tracheal aspirate. Clinical specimens were inoculated onto a Sheep blood agar plate, Chocolate agar plate (aerobic with 5% CO2), and MacConkey’s agar. Identification was followed by specific and standard microbiological protocols. COVID-19 was confirmed by qualitative PCR. Antimicrobial susceptibility testing was performed using the Kirby Bauer disc diffusion method. Results: A total of 202 clinical samples, including blood, sputum, tracheal aspirates, and bronchial lavage, were collected from COVID-19-positive patients. Male patients were more common in sputum and tracheal aspirates, while female patients were more common in blood cultures. The majority of patients were over 60 years of age. Acinetobacter baumannii was predominantly isolated from blood and tracheal aspirates, exhibiting multidrug resistance, but showing complete sensitivity towards Colistin. Klebsiella pneumonia exhibited high prevalence in sputum, with complete resistance observed in Cephalosporins and Co-trimoxazole. Conclusion: The study concludes a high frequency of superadded bacterial co-infections, caused most prominently by Acinetobacter baumannii, Klebsiella pneumonia, and Pseudomonas aeruginosa. The majority of these are multidrug-resistant pathogens, therefore, urgent action is required to control the spread of nosocomial infections by resistant strains, which are responsible for the high mortality rate among COVID-19 critical patients

Effectiveness of Fosfomycin against Extended Spectrum Beta-Lactamase Producing Escherichia coli in Urinary Cultures

Background: Urinary tract infections (UTI) considered, as the most frequently diagnosed infections constitute Escherichia coli (E. coli) as the most common etiological agents isolated from urinary cultures. Fosfomycin is becoming the best treatment option for UTI because of its rapid absorption, good concentration in urine. The present study aimed to determine and compare the susceptibility of Fosfomycin, presented as a favorable choice against E. coli producing extended spectrum beta-lactamase (ESBL) in urinary cultures of patients. Methods: This cross sectional study with non-probability consecutive sampling was held at Ziauddin University Hospital Microbiology Laboratory. A total of 222 urinary isolates of in and out patients yielding growth of ESBL positive E. coli were identified using standard microbiological technique. Susceptibility testing of antimicrobials was accomplished according to Clinical Laboratory Standard Institute (CLSI) guidelines. Detection of ESBL was done by double disk diffusion technique. Independent sample t-test was used to compare mean ages and Chi-squared test for the ESBL positivity in various age groups. A p-value of less than 0.05 was considered as statistically significant. Results: The mean age of the patients was 56.68±21.18 years. There were 59(26.58%) male and 163(73.42%) female. The sensitivity of ESBL producing E. coli to Fosfomycin was 94.59 % (210/222) which was much higher as compared to other antimicrobials, Meropenem (89%), Amikacin (83%) and Nitrofurantoin (78%). There was no statistically significant variance among the age groups with respect to fosfomycin susceptibility (p=0.601). Conclusion: Fosfomycin have high antimicrobial activity against ESBL positive E. coli in urinary samples. It could be a good treatment choice for urinary tract infections. Keywords: Urinary Tract Infections; Fosfomycin; Escherichia coli; Beta-Lactamases

Assessment of knowledge, preventive behaviours and risk perception related to Covid-19 among medical students of Rawalpindi

Objectives: The study was conducted to determine the knowledge, preventive behaviours and perception of risk related to Covid-19 among the medical students who are the front line workers and are more susceptible to be infected. Methodology: This analytical cross sectional study was conducted in medical students of 1st, 2nd and 3rd year MBBS of various medical institutions of Rawalpindi. Study duration was 5 months (March 2020 to July 2020). The sample size was 425. Age ranging from 18 to 21 and 273 (64.2%) comprised of females. The inclusion criteria were those students who gave consent and filled out the questionnaire and the exclusion criteria was who didn't concede. The data was analysed on SPSS. Confidence interval was set to be 95% with 5% margin of error. Results: Most of the students were aware of the basic Covid-19 related knowledge like common symptoms, incubation period, transmission and the basic preventive measures which was on average higher than the previous studies conducted on medical students and on health care workers. Students were also having high level of performance in preventive behaviours in perspective of Covid-19 but risk perception is of moderate level. Conclusion: Participants were found to have high levels of knowledge related to Covid-19 except use of N95 masks and use of anti-viral drugs for treatment. Among self-reported preventive behaviours section, lowest score is related to frequency of cleaning and disinfecting items that can be easily touched with hands (i.e. door handles and surfaces). Participants had moderate risk perception despite having high levels of knowledge and high performance in self-reported behaviours. Keywords: Covid-19, medical students, risk perceptio

Quantum tunneling from scalar fields in rotating black strings

Using the Hamilton-Jacobi method of quantum tunneling and complex path integration, we study Hawking radiation of scalar particles from rotating black strings. We discuss tunneling of both charged and uncharged scalar particles from the event horizons. For this purpose, we use the Klein-Gordon equation and find the tunneling probability of outging scalar particles. The procedure gives Hawking temperature for rotating charged black strings as well.Comment: Corrections and change