Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis

In high-income countries, group antenatal care (ANC) offers an alternative to individual care and is associated with improved attendance, client satisfaction, and health outcomes for pregnant women and newborns. In low- and middle-income country (LMIC) settings, this model could be adapted to address low antenatal care uptake and improve quality. However, evidence on key attributes of a group care model for low-resource settings remains scant. We conducted a systematic review of the published literature on models of group antenatal care in LMICs to identify attributes that may increase the relevance, acceptability and effectiveness of group ANC in such settings. We systematically searched five databases and conducted hand and reference searches. We also conducted key informant interviews with researchers and program implementers who have introduced group antenatal care models in LMICs. Using a pre-defined evidence summary template, we extracted evidence on key attributes—like session content and frequency, and group composition and organization—of group care models introduced across LMIC settings. Our systematic literature review identified nine unique descriptions of group antenatal care models. We supplemented this information with evidence from 10 key informant interviews. We synthesized evidence from these 19 data sources to identify attributes of group care models for pregnant women that appeared consistently across all of them. We considered these components that are fundamental to the delivery of group antenatal care. We also identified attributes that need to be tailored to the context in which they are implemented to meet local standards for comprehensive ANC, for example, the number of sessions and the session content. We compiled these attributes to codify a composite “generic” model of group antenatal care for adaptation and implementation in LMIC settings. With this combination of standard and flexible components, group antenatal care, a service delivery alternative that has been successfully introduced and implemented in high-income country settings, can be adapted for improving provision and experiences of care for pregnant women in LMIC. Any conclusions about the benefits of this model for women, babies, and health systems in LMICs, however, must be based on robust evaluations of group antenatal care programs in those settings. Electronic supplementary material The online version of this article (10.1186/s12978-018-0476-9) contains supplementary material, which is available to authorized users

Assessment of Impact of Anaesthesia Practices on Quality of Life of Anaesthesiologists Practicing in Rajasthan

Objective : To assess the impact of anaesthesia practices on quality of life. Anesthesiology is among the most stressful medical disciplines. Analysis of burnout is essential because it is associated with safety and quality of care. Methods :After approval from the institutional ethics committee, an online survey consisting of questionnaire comprising 20 questions was sent to 1000 practicing anaesthesiologists. The answers received were then categorized and analyzed. Demographic profile, job satisfaction and quality of life was assessed through the questionnaire. Quality of life was studied in terms of quality time spent with family , destressing methods used, workouts and exercise done, academic events attended, and ailments acquiredResults: Maximum of the anaesthesiologists were males (61.9%) and belonged to the age group of 25 to 40 years (45.2 %). 54.8 % were practicing in government hospitals while 33.3% worked in private hospitals and 11.9% were free lancers. Only 9.8 % found their salary to be excellent .50 % of the anaesthesiologists worked approximately 6 to 10 hours a day ,46.3% anaesthesiologists did 5 – 10 emergency call duties a month. Only 42 percent had any ot assistant or technician for helping them.54.8 % of the anaesthesiologists felt the work of anesthetist as stressful .46.3 % of the practicing anaesthesiologists acquired ailments as occupational hazard of their practice,out of which 12.2% suffered from backache, 7.3% hypertension,14.6 % acid peptic disease.9.8% had acquired more than one disease.Only 26.2% practicing anaesthesiologist did regular exercise .Only 59.5 % anaesthesiologists spent quality time with their family and this they found a stress buster . Conclusion: The prevalence of burnout syndrome among anesthesiologists is relatively high, and it seems higher in younger physicians with lower experience

Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya

Background: Quality of healthcare is an important determinant of future progress in global health. However, the distributional aspects of quality of care have received inadequate attention. We assessed whether high quality maternal care is equitably distributed by (1) mapping the quality of maternal care in facilities located in poorer versus wealthier areas of Kenya; and (2) comparing the quality of maternal care available to Kenyans in and not in poverty. Methods: We assessed three measures of maternal care quality: facility infrastructure and clinical quality of antenatal care and delivery care, using indicators from the 2010 Kenya Service Provision Assessment (SPA), a standardized facility survey with direct observation of maternal care provision. We calculated poverty of the area served by antenatal or delivery care facilities using the Multidimensional Poverty Index. We used regression analyses and non-parametric tests to assess differences in maternal care quality in facilities located in more and less impoverished areas. We estimated effective coverage with a minimum standard of care for the full population and those in poverty. Results: A total of 564 facilities offering at least one maternal care service were included in this analysis. Quality of maternal care was low, particularly clinical quality of antenatal and delivery care, which averaged 0.52 and 0.58 out of 1 respectively, compared to 0.68 for structural inputs to care. Maternal healthcare quality varied by poverty level: at the facility level, all quality metrics were lowest for the most impoverished areas and increased significantly with greater wealth. Population access to a minimum standard (≥0.75 of 1.00) of quality maternal care was both low and inequitable: only 17% of all women and 8% of impoverished women had access to minimally adequate delivery care. Conclusion: The quality of maternal care is low in Kenya, and care available to the impoverished is significantly worse than that for the better off. To achieve the national targets of maternal and neonatal mortality reduction, policy initiatives need to tackle low quality of care, starting with high-poverty areas

Assessment of fluoride in groundwater and urine, and prevalence of fluorosis among school children in Haryana, India

Abstract Considering the health effects of fluoride, the present study was undertaken to assess the concentration of fluoride in groundwater, and urine of school children in Bass region of Haryana state. Fluoride in groundwater was observed to vary from 0.5 to 2.4 mg/l with an average concentration of 0.46 mg/l. On the other hand, F− in urine ranged from below the detection limit to 1.8 mg/l among girls and 0.17–1.2 mg/l among the boys. Higher average concentration of fluoride in urine (0.65 mg/l for boys and 0.34 mg/l for girls) may be ascribed to exposure to bioavailable fluoride through food, milk, tea, toothpaste, etc., in addition to intake through groundwater. Relatively more intake of water and food by the boys might be the reason for more cases of severe dental fluorosis (44%) among boys compared to girls (29% cases of moderate to severe dental fluorosis). The groundwater quality for drinking was compromised with respect to dissolved solids, hardness, magnesium ions, and dissolved iron. Hydro-geochemical investigation revealed that rock–water interaction, in terms of direct cation exchange, dominantly regulates groundwater chemistry, and groundwater is of Ca-Na-HCO3 type

Can India’s primary care facilities deliver? A cross-sectional assessment of the Indian public health system’s capacity for basic delivery and newborn services

Objectives: To assess input and process capacity for basic delivery and newborn (intrapartum care hereafter) care in the Indian public health system and to describe differences in facility capacity between rural and urban areas and across states. Design: Cross-sectional study. Setting: Data from the nationally representative 2012–2014 District Level Household and Facility Survey, which includes a census of community health centres (CHC) and sample of primary health centres (PHC) across 30 states and union territories in India. Participants: 8536 PHCs and 4810 CHCs. Outcome measures We developed a summative index of 33 structural and process capacity items matching the Indian Public Health Standards for PHCs as a metric of minimum facility capacity for intrapartum care. We assessed differences in performance on this index across facility type and location. Results: About 30% of PHCs and 5% of CHCs reported not offering any intrapartum care. Among those offering services, volumes were low: median monthly delivery volume was 8 (IQR=13) in PHCs and 41 (IQR=73) in CHCs. Both PHCs and CHCs failed to meet the national standards for basic intrapartum care capacity. Mean facility capacity was low in PHCs in both urban (0.64) and rural (0.63) areas, while in CHCs, capacity was slightly higher in urban areas (0.77vs0.74). Gaps were most striking in availability of skilled human resources and emergency obstetric services. Poor capacity facilities were more concentrated in the more impoverished states, with 37% of districts from these states receiving scores in the lowest third of the facility capacity index (<0.70), compared with 21% of districts otherwise. Conclusions: Basic intrapartum care capacity in Indian public primary care facilities is weak in both rural and urban areas, especially lacking in the poorest states with worst health outcomes. Improving maternal and newborn health outcomes will require focused attention to quality measurement, accountability mechanisms and quality improvement. Policies to address deficits in skilled providers and emergency service availability are urgently required

Additional file 1: of Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis

Database search strategy. (DOCX 21 kb

Additional file 2: of Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis

Semi-structured interview guide for key informant interviews. (DOCX 14 kb

Citral enrichment in Lemongrass (Cymbopogon flexuosus) oil using spinning band equipped high vacuum distillation column and sensory evaluation of fractions

Citral is the major constituent of Lemongrass oil (LGO) and has various application in the food, cosmetic and pharmaceutical industry. The present study was focused on enhancement of citral content in LGO employing spinning band column equipped high vacuum fractional distillation setup. The collected fractions were investigated for volatile composition using gas chromatography-mass spectrometry (GC–MS), antioxidant activity using 1,1-diphenyl-2-picrylhydrazyl (DPPH) method and antibacterial activity against Gram-positive and Gram-negative bacteria. The total citral content varied from 1.90 to 88% in various fractions with highest in major fraction, residue experiment-B (RSD, Ex-B, 88%) with collection of 63 mL. RSD, Ex-B demonstrated the lowest IC50 value of 6.77±0.42µL/mL with 55.84 percent inhibition. Further, strong inhibition was demonstrated by RSD, Ex-B against all tested bacterial strains. The sensory analysis revealed that Lemongrass leaves were dominated with lemony, fresh and grassy; LGO with lemony and fresh; and RSD (Ex-B) with lemony, sweet and fresh notes. The distillation process changed the overall aroma profile of RSD (Ex-B) by eliminating grassy and off odors and makes it useful product for flavor and fragrance application. Citral rich fractions have high economic value as well as application in food industry as a flavor, preservative; in home care and self-hygiene products