Effect of Support Supervision on Maternal and Newborn Health Services and Practices in Rural Eastern Uganda

Background: Support supervision is one of the strategies used to check the quality of services provided at health facilities. From 2013 to 2015, Makerere University School of Public Health strengthened support supervision in the district of Kibuku, Kamuli and Pallisa in Eastern Uganda to improve the quality of maternal and newborn services. Objective: This article assesses quality improvements in maternal and newborn care services and practices during this period. Methods: District management teams were trained for two days on how to conduct the supportive supervision. Teams were then allocated particular facilities, which they consistently visited every quarter. During each visit, teams scored the performance of each facility based on checklists; feedback and corrective actions were implemented. Support supervision focused on maternal health services, newborn care services, human resources, laboratory services, availability of Information, education and communication materials and infrastructure. Support supervision reports and checklists from a total of 28 health facilities, each with at least three support supervision visits, were analyzed for this study and 20 key-informant interviews conducted. Results: There was noticeable improvement in maternal and newborn services. For instance, across the first, second and third quarters, availability of parenteral oxytocin increased from 57% to 75% and then to 82%. Removal of retained products increased from 14% to 50% to 54%, respectively. There was perceived improvement in the use of standards and guidelines for emergency obstetric care and quality of care provided. Qualitatively, three themes were identified that promote the success of supportive supervision: changes in the support supervision style, changes in the adherence to clinical standards and guidelines, and multi-stakeholder engagement. Conclusion: Support supervision helped district health managers to identify and address maternal and newborn service-delivery gaps. However, issues beyond the jurisdiction of district health managers and facility managers may require additional interventions beyond supportive supervision.DFI

Nauclea latifolia herb root waste reinforced epoxy polymer composite: The study of effects, modelling, certainty and sensitivity analysis

The requirement for cleaner and healthy environment is a drive for waste recycling programs. In this study, suitable reinforcement for composite production was extracted from Nauclea latifolia herb root waste (NLHRW) through alkalization. Proximate composition and crystallinity of NLHRW and alkalized NLHRW (ANLHRW) were determined using gravimetric method and X-ray diffractometer (XRD). The individual and interaction effect of production factors (size, weight fraction, and mould compression force) on composite characteristics (flexural strength (FS), modulus (FM), and water absorption (WA)) of ANLHRW reinforced epoxy polymer composite was investigated, modeled and optimized using response surface methodology (RSM). The thermal stability and failure mechanism of the optimally developed ANLHRW reinforced composite were investigated using thermogravic analyzer (TGA) and Scanning Electron Microscope (SEM). The sensitivities of the composite properties to production factors were investigated using Monte Carlo simulation (MCS). Results showed that alkali treatment improved the cellulose content and crystallinity of the fiber. Fiber size and weight fraction increased the FS and FM while mould compression force reduced the WA of the composite. The determined optimum composite production condition was 322.62 μm fiber size, 24.06 wt% fiber weight fraction and 98.10 N mould compression force to give a composite’s FS of 16.9905 MPa, FM of 1046.36 MPa and WA of 3.71057 %. The percentage validation error was 0.70, 0.56 and 0.80 % for FS, FM and WA respectively. The composite produced with the validated optimum condition showed a decrease in thermal resistance than cured unreinforced epoxy plastic and had varied failure mechanisms such as fiber pull out and fiber breakage. The composite properties were dominantly sensitive to fiber weight fraction. The composite produced can be applied in dry low-load bearing applications such as automobile interiors or wet no-load bearing application such as desert cooler pad