Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania

BACKGROUND: The postpartum period represents a critical window where many maternal and child deaths occur. We assess the quality of postpartum care (PPC) as well as efforts to improve service delivery through additional training and supervision in Health Centers (HCs) in Morogoro Region, Tanzania. METHODS: Program implementers purposively selected nine program HCs for assessment with another nine HCs in the region remaining as comparison sites in a non-randomized program evaluation. PPC quality was assessed by examining structural inputs; provider and client profiles; processes (PNC counselling) and outcomes (patient knowledge) through direct observations of equipment, supplies and infrastructure (n = 18) and PPC counselling (n = 45); client exit interviews (n = 41); a provider survey (n = 62); and in-depth provider interviews (n = 10). RESULTS: While physical infrastructure, equipment and supplies were comparable across study sites (with water and electricity limitations), program areas had better availability of drugs and commodities. Overall, provider availability was also similar across study sites, with 63% of HCs following staffing norms, 17% of Reproductive and Child Health (RCH) providers absent and 14% of those providing PPC being unqualified to do so. In the program area, a median of 4 of 10 RCH providers received training. Despite training and supervisory inputs to program area HCs, provider and client knowledge of PPC was low and the content of PPC counseling provided limited to 3 of 80 PPC messages in over half the consultations observed. Among women attending PPC, 29 (71%) had delivered in a health facility and sought care a median of 13 days after delivery. Barriers to PPC care seeking included perceptions that PPC was of limited benefit to women and was primarily about child health, geographic distance, gaps in the continuity of care, and harsh facility treatment. CONCLUSIONS: Program training and supervision activities had a modest effect on the quality of PPC. To achieve broader transformation in PPC quality, client perceptions about the value of PPC need to be changed; the content of recommended PPC messages reviewed along with the location for PPC services; gaps in the availability of human resources addressed; and increased provider-client contact encouraged

Using evidence to drive action: a "revolution in accountability" to implement quality care for better maternal and newborn health in Africa

Introducing evidence-based accountability mechanisms at national and subnational levels into maternal newborn health programs can accelerate reductions in maternal and newborn mortality. Clearly packaged evidence has the potential to catalyze change, if it is communicated not only to the public but also to key policymakers. Evidence for Action (E4A) is a DFID-funded program that contributes to global efforts toward improving accountability in maternal and neonatal health. It uses evidence to drive action and accountability to improve maternal and newborn survival in six African countries: Ethiopia, Ghana, Malawi, Nigeria, Sierra Leone, and Tanzania. This paper introduces the E4A program, the rationale that underpins the program design, and presents initial findings on how information and data currently feed into accountability and implementation across the six E4A countries

CHALLENGES IN MAINTAINING EMOTION REGULATION IN A SLEEP AND ENERGY DEPRIVED STATE INDUCED BY THE 4800KM ULTRA-ENDURANCE BICYCLE RACE; THE RACE ACROSS AMERICA (RAAM)

Multiday ultra-endurance races present athletes with a significant number of physiological and psychological challenges. We examined emotions, the perceived functionality (optimal-dysfunctional) of emotions, strategies to regulate emotions, sleep quality, and energy intake-expenditure in a four-man team participating in the Race Across AMerica (RAAM); a 4856km continuous cycle race. Cyclists reported experiencing an optimal emotional state for less than 50% of total competition, with emotional states differing significantly between each cyclist over time. Coupled with this emotional disturbance, each cyclist experienced progressively worsening sleep deprivation and daily negative energy balances throughout the RAAM. Cyclists managed less than one hour of continuous sleep per sleep episode, high sleep latency and high percentage moving time. Of note, actual sleep and sleep efficiency were better maintained during longer rest periods, highlighting the importance of a race strategy that seeks to optimise the balance between average cycling velocity and sleep time. Our data suggests that future RAAM cyclists and crew should: 1) identify beliefs on the perceived functionality of emotions in relation to best (functional-optimal) and worst (dysfunctional) performance as the starting point to intervention work; 2) create a plan for support sufficient sleep and recovery; 3) create nutritional strategies that maintain energy intake and thus reduce energy deficits; and 4) prepare for the deleterious effects of sleep deprivation so that they are able to appropriately respond to unexpected stressors and foster functional working interpersonal relationship

Late Quaternary variability of sedimentary nitrogen isotopes in the eastern South Pacific

Author Posting. © American Geophysical Union, 2007. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Paleoceanography 22 (2007): PA2207, doi:10.1029/2006PA001308.We present high-resolution bulk sedimentary δ 15N data from the southern edge of the present-day oxygen minimum zone of the eastern South Pacific. The record is interpreted as representing changes in water column nitrogen removal during the last 70,000 years. We found significant fluctuations in the isotopic signal that suggest major reorganizations of the oxygen minimum zone at millennial timescales. These fluctuations were not related to other millennial-scale changes like the Northern Hemisphere's Dansgaard-Oeschger climate swings or local changes in primary productivity, so appear to be dictated by the Southern Hemisphere's climate rhythm. This is preliminarily corroborated by an overall agreement between our δ 15N data and the sedimentary proxy of ice sheet dynamics in Patagonia, which is in turn correlated with surface water properties at the midlatitude subduction region of the eastern South Pacific intermediate waters. Finally, potential implications on late Quaternary changes in atmospheric CO2 concentrations are discussed.This work was funded by the Chilean National Commission for Scientific and Technological Research (CONICYT) through the FONDAP Program and by the Fundacio´n Andes. Additional support was provided by the German Ministry for Science and Education through the PUCK project. R.D.P.H. was supported by graduate fellowships coming from Fundacio´n Andes, CONICYT, and MECESUP/UCO2002

High resolution reconstruction of Southwest Atlantic sea-ice and its role in the carbon cycle during marine isotope stages 3 and 2

Recent modeling suggests that changes in Southern Ocean sea-ice extent potentially regulated the exchange of CO2 release between the ocean and atmosphere during glacials. Unfortunately, a lack of high-resolution sea-ice records from the Southern Ocean has prevented detailed testing of these model-based hypotheses with field data. Here we present high-resolution records of Southern Ocean sea-ice, for the period 35–15 cal ka BP, derived from diatom assemblages measured in three glacial sediment cores forming an ∼8° transect across the Scotia Sea, southwest Atlantic. Chronological control was achieved through a novel combination of diatom abundance stratigraphy, relative geomagnetic paleointensity data, and down-core magnetic susceptibility and ice core dust correlation. Results showed that the winter sea-ice edge reached its maximum northward extent of ∼53°S, at least 3° north of its modern limit, between ∼25 and ∼23.5 cal ka BP, predating the Last Glacial Maximum (LGM). Maximum northward expansion of the summer sea-ice edge also pre-dated the LGM, advancing to at least 61°S, and possibly as far north as 55°S between ∼31 and ∼23.5 cal ka BP, a ∼12° advance from its modern position. A clear shift in the seasonal sea-ice zone is evident following summer sea-ice edge retreat at ∼23.5 cal ka BP, potentially related to austral insolation forcing. This resulted in an expanded seasonal sea-ice zone between ∼22.5 cal ka BP and deglaciation. Our field data confirm that Southern Ocean sea-ice had the physical potential to influence the carbon cycle both as a physical barrier and more importantly through the suppression of vertical mixing and cycling of pre-formed nutrients. Our data indicates that Southern Ocean sea-ice was most effective as a physical barrier between ∼31 and ∼23.5 cal ka BP and as a mechanism capable of reducing vertical mixing between ∼22.5 cal ka BP and deglaciation. However, poor correlations with atmospheric CO2 variability recorded in ice cores, particularly the lack of a CO2 response during a rapid sea-ice meltback event, recorded at our study sites at the same time as Antarctic Isotopic Maximum 2, suggest that Southern Ocean sea-ice in the Scotia Sea did not play a controlling role in atmospheric CO2 variation during the glacial