Requirements and costs for scaling up comprehensive emergency obstetric and neonatal care in health centres in Tanzania

The objective of this study was to identify and determine the costs of essential components of a resource package and strategies for scaling up comprehensive emergency obstetric and neonatal care services in Tanzania. Essential components were identified through lessons learned during implementation of comprehensive emergency obstetric and neonatal care and regular discussions with key stakeholders. The related costs were collected from the health centres, Tanzania Medical Store Department and non-governmental organizations that had upgraded health centres for comprehensive emergency obstetric and neonatal care services provision. The results showed that the estimated costs of upgrading a health centre to provide comprehensive emergency obstetric and neonatal care services was $256,650 (USD) for infrastructure and equipment,$4,463 per person for upgrading skills in either in comprehensive emergency obstetric and neonatal care or anaesthesia for three months and $43,500 per year for medicines and supplies. The total cost for all components per health centre was estimated at$560,802. Scale up required many complementary strategies at all health system levels. Scale up of comprehensive emergency obstetric and neonatal care services in health ccentres in underserved areas is feasible and urgently needed in resource-limited countries.   L'objectif de cette étude était d'identifier et de déterminer les coûts des composants essentiels d'un ensemble de ressources et de stratégies pour étendre les services complets de soins obstétricaux et néonatals d'urgence en Tanzanie. Les éléments essentiels ont été identifiés grâce aux enseignements tirés lors de la mise en oeuvre de soins obstétricaux et néonatals d'urgence complets et de discussions régulières avec les principales parties prenantes. Les coûts correspondants ont été collectés auprès des centres de santé, du département de pharmacie de Tanzanie et d'organisations non gouvernementales qui avaient modernisé les centres de santé pour une prestation complète de services de soins obstétricaux et néonatals d'urgence. Les résultats ont montré que les coûts estimés de la modernisation d'un centre de santé pour fournir des services complets de soins obstétricaux et néonatals d'urgence étaient de 256 650 $(USD) pour l'infrastructure et l'équipement, 4 463$ par personne pour la mise à niveau des compétences en soins obstétricaux et néonatals d'urgence complets ou en anesthésie pour mois et 43 500 $par an pour les médicaments et les fournitures. Le coût total de toutes les composantes par centre de santé a été estimé à 560 802$. La mise à l'échelle a nécessité de nombreuses stratégies complémentaires à tous les niveaux du système de santé. L'extension des services complets de soins obstétricaux et néonatals d'urgence dans les centres de santé des zones mal desservies est faisable et urgente dans les pays à ressources limitées &nbsp

Magnetic Brane-worlds

We investigate brane-worlds with a pure magnetic field and a perfect fluid. We extend earlier work to brane-worlds, and find new properties of the Bianchi type I brane-world. We find new asymptotic behaviours on approach to the singularity and classify the critical points of the dynamical phase space. It is known that the Einstein equations for the magnetic Bianchi type I models are in general oscillatory and are believed to be chaotic, but in the brane-world model this chaotic behaviour does not seem to be possible.Comment: 21 pages, 3 ps figures; To appear in CQ

A Call for Change in the Public Education System in Nova Scotia

The United Nation’s International Decade for People of African Descent and Nova Scotia’s Ministry of African Nova Scotian Affairs recognize that students of African descent continue to experience inequities. As previous studies indicate, parents of Black learners identified that many educators lack knowledge and experience in understanding students of African descent.This study explored student achievement from the perspective of parents of children of African descent attending public schools in Nova Scotia. Participants included individual interviews and focus groups with parents from rural and urban areas. Based on Bronfenbrenner’s ecological theory framework, a thematic analysis of the data was conducted, a dominant storyline related to the families’ experiences in school and subsequent themes emerged: we are treated differently; we don’t feel connected; we know there are challenges: the resistance of parents; and we deal with injustices but persevere. These findings provide recommendations to improve the educational success for Black learners. Keywords: African Canadian, academic achievement and success, Black students, education, schooling challenges, students of African descentLa déclaration des Nations Unies de la Décennie internationale des personnes d’ascendance africaine et le Ministre des affaires Afro-néo-écossaises reconnaissent que les élèves d’ascendance africaine continuent à vivre des inégalités. Des études antérieures démontrent que les parents d’apprenants Noirs ont identifié que plusieurs éducateurs manquent de connaissances et d’expérience quant à la compréhension d’élèves d’ascendance africaine. Cette étude explore la réussite scolaire de la perspective des parents d’enfants d’ascendance africaine fréquentant des écoles publiques en Nouvelle-Écosse. Les participants incluent des entretiens individuels et des groupes de discussion avec des parents provenant de régions rurales et urbaines en Nouvelle-Écosse. Basée sur le cadre théorique écologique de Bronfenbrenner, une analyse thématique des données a été entreprise, un fil conducteur dominant lié aux expériences scolaires des familles, et des thèmes résolutoires ont émergé : nous sommes traités différemment ; et nous ne nous sentons pas connectés ; nous sommes conscients qu’il y a des défis ; la résistance des parents ; et nous font face à des injustices mais nous persistons. Ces constats fournissent des recommandations pour améliorer le succès académique des apprenants Noirs. Mots-clés : Afro-canadiens, performance et succès académique, élèves noirs, éducation, défis scolaires, élèves d’ascendance Africain

Pubertal timing and breast density in young women: a prospective cohort study.

BACKGROUND:Earlier age at onset of pubertal events and longer intervals between them (tempo) have been associated with increased breast cancer risk. It is unknown whether the timing and tempo of puberty are associated with adult breast density, which could mediate the increased risk. METHODS:From 1988 to 1997, girls participating in the Dietary Intervention Study in Children (DISC) were clinically assessed annually between ages 8 and 17 years for Tanner stages of breast development (thelarche) and pubic hair (pubarche), and onset of menses (menarche) was self-reported. In 2006-2008, 182 participants then aged 25-29 years had their percent dense breast volume (%DBV) measured by magnetic resonance imaging. Multivariable, linear mixed-effects regression models adjusted for reproductive factors, demographics, and body size were used to evaluate associations of age and tempo of puberty events with %DBV. RESULTS:The mean (standard deviation) and range of %DBV were 27.6 (20.5) and 0.2-86.1. Age at thelarche was negatively associated with %DBV (p trend = 0.04), while pubertal tempo between thelarche and menarche was positively associated with %DBV (p trend = 0.007). %DBV was 40% higher in women whose thelarche-to-menarche tempo was 2.9 years or longer (geometric mean (95%CI) = 21.8% (18.2-26.2%)) compared to women whose thelarche-to-menarche tempo was less than 1.6 years (geometric mean (95%CI) = 15.6% (13.9-17.5%)). CONCLUSIONS:Our results suggest that a slower pubertal tempo, i.e., greater number of months between thelarche and menarche, is associated with higher percent breast density in young women. Future research should examine whether breast density mediates the association between slower tempo and increased breast cancer risk

Improving access, quality and safety of caesarean section services in underserved rural Tanzania: The impact of knowledge translation strategies

This research was designed to study different approaches to improve access to, and quality of caesarean section services in underserved Tanzania and translate evidence into practice. In 2016, 42 associate clinicians from five health centers were trained in teams for three months in comprehensive emergency obstetric and neonatal care and anesthesia followed by post-training supportive supervision and mentorship. From 2016-2019, 2,179 caesarean sections were performed in the intervention and 969 in the control health centers. Catchment population-based caesarean section rates increased significantly in all five intervention health centers and were more than 10% in three facilities. The risk of a woman dying from complications of caesarean section in the intervention health centers was 2.3 per 1,000 caesarean sections (95% CI 0.7 - 5.3). This educational program was adopted by the government and can be used to meet the demand for caesarean section services in other underserved areas in Africa.   Cette recherche a été conçue pour étudier différentes approches pour améliorer l'accès et la qualité des services de césarienne en Tanzanie mal desservie et traduire les preuves en pratique. En 2016, 42 cliniciens associés de cinq centres de santé ont été formés en équipes pendant trois mois aux soins obstétricaux et néonatals d'urgence complets et à l'anesthésie suivis d'une supervision et d'un mentorat post-formation. De 2016 à 2019, 2 179 césariennes ont été réalisées dans les centres de santé d'intervention et 969 dans les centres de santé témoins. Les taux de césariennes dans la population desservie ont augmenté de manière significative dans les cinq centres de santé d'intervention et étaient supérieurs à 10 % dans trois établissements. Le risque qu'une femme meure des complications d'une césarienne dans les centres de santé d'intervention était de 2,3 pour 1 000 césariennes (IC à 95 % 0,7 - 5,3). Ce programme éducatif a été adopté par le gouvernement et peut être utilisé pour répondre à la demande de services de césarienne dans d'autres régions mal desservies d'Afriqu

Knowledge acquisition after 'Helping Babies Survive' training in rural Tanzania

The article reviews a training programme/workshops dedicated to increasing knowledge through “training of trainers” in childbirth education. There has been a push to improve the ability of healthcare providers in low resource areas where the majority of neonatal deaths occur. The Helping Babies Survive (HBS) suite of programs are intensive, structured courses over 1-3 days, developed by the American Academy of Pediatrics and its partners. HBS consists of Helping Babies Breathe (HBB), Essential Care for Every Baby (ECEB) and Essential Care for Small Babies (ECSB). The HBS training improved the knowledge of healthcare providers. However, knowledge of breastfeeding was inadequate or limited.Canadian Institutes of Health Research (CIHR)Global Affairs Canada (GAC