Magnitude and Causes of Maternal Deaths at Health Facilities in Eritrea in 2007.

Objective: To measure the level of maternal mortality in health facilities as well as the magnitude and proportion of obstetric complications in health facilities in Eritrea. Methods: The study was a cross-sectional survey of all hospitals and health centers in Eritrea and a random sample of around a third of health stations. Medical records of all patients who encountered obstetric complications in 2007 were reviewed. Findings: The main causes of obstetric complications among hospital admissions in 2007 were abortion complications (45.6%), obstructed/prolonged labor (18.4%), abnormal fetal presentation (10.3%) and preeclampsia/ eclampsia (7.7%). The number of maternal deaths at facilities was relatively small. Out of the 6,315 patients who were admitted for obstetric complications in 2007, 41 were classified as maternal deaths. The leading causes of maternal deaths included pre-eclampsia/ eclampsia in 22.0 percent of the cases, abortion complications in 19.5 percent of the cases and postpartum sepsis in 17.1 percent of the cases and post-partum hemorrhage in 14.6 percent of cases. The case-fatality rate for obstetric complications was low at 0.75 percent. The majority of maternal deaths (65 percent) occurred in the post-partum period, while 32 percent occurred during the ante-partum period, and 3 percent during intra-partum or during labor or delivery Conclusion: Over all it can be concluded that the Eritrean health system is performing well with the current demand for services. The issue of abortion requires special attention because it is the leading obstetric complication, which accounts for 46 percent of maternal complications and is responsible for one fifth of maternal deaths. Although the case fatality rate of all obstetric complications combined is not high (0.75 percent), the cause specific case fatality rates for the leading causes of maternal mortality was high Keywords: Maternal mortality, obstetric complications, abortion, case fatality rat

The influence of coal fly ash on the mechanical properties of hot mix asphalt mixture

Coal is one of the most important sources of energy, providing for over 40% of global electricity generation. Coal fly ash (CFA) is the by-product of thermal generation of energy in coal-fired power plant. CFA has been widely employed in the construction of concrete; however, there are only a few cases in which asphalt pavements have employed coal fly ash. This paper aims to determine the performances of CFA as filler in hot mix asphalt (HMA) mixture. This study used four CFA contents as filler by weight of aggregate in the dry method, namely CFA-0, CFA-2, CFA-4, and CFA-6. The mixtures were tested for stability, flow, stiffness, moisture damage, and Cantabro loss test. The findings indicated that the stability values of asphalt mixtures containing CFA were higher than conventional mixture. In addition, incorporating CFA also improved resistance towards moisture damage and durability. As a result, it can be inferred that CFA can be employed as filler substitute in HMA mixtures

Can Reproductive Health Voucher Programs Improve Quality of Postnatal Care? A Quasi-Experimental Evaluation of Kenya’s Safe Motherhood Voucher Scheme

This study tests the group-level causal relationship between the expansion of Kenya’s Safe Motherhood voucher program and changes in quality of postnatal care (PNC) provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I) and facilities accredited since 2010-2011 (phase II) relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH) voucher program’s causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02), where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02), with the largest quality improvements in counselling on family planning methods (IRR 5.0; p=0.01) and return to fertility (IRR 2.6; p=0.01). Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and new-born. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement

Rheological criteria assessment of a rapid setting emulsion as compared to quick set for emulsified asphalt cold mixes

Pavement deterioration is inevitable on roads. Unlike structural failures that can only be remedied by total reconstruction, road's functional failures are corrected through effective maintenance works. Preventive maintenance in the form of an emulsified asphalt cold slurry micro-surfacing is considered superior to corrective maintenance - which is a reactive approach. Exploring alternative(s) to the normal quick setting emulsion used for pavement preservation maintenance will make it more robust and cost-effective. This study conducted an assessment of the key parameters specified by the department of public works (Jabatan Kerja Raya) JKR-2008 and International Slurry Surfacing Association (ISSA A143) specifications for emulsified asphalts emulsions used for cold mixes, specifically, emulsified asphalt micro-surfacing mixtures used for pavement maintenance. Cationic quick set (CQS-1h) and Rapid Set (RS-1k) emulsions were tested in the Transportation laboratory of UTM under controlled laboratory conditions. Tests include settlement and storage stability, particle charge, residue by evaporation, sieve test, and Say bolt Furol viscosity, while the residue from evaporation was tested for microstructural and mechanical performance, results were compared with JKR-2008 and ISSA A143 standard specifications. The result indicated that although the desirability for opening traffic within 1hr is not guaranteed with RS-1k, yet, it gives promising similar properties with CQS whilst satisfying cold mix requirement

Time for global scale-up, not randomized trials, of uterine balloon tamponade for postpartum hemorrhage.

Maternal death is the greatest health disparity globally, with postpartum hemorrhage the most common cause. As senior leaders in obstetrics and maternal health from Bolivia, Canada, Colombia, Côte d'Ivoire, Honduras, India, Kenya, Nepal, Niger, Norway, Peru, Tanzania, the UK, the USA, and Zambia, we are deeply disturbed by recent calls for randomized controlled trials (RCTs) of uterine balloon tamponade (UBT) in women with uncontrolled postpartum hemorrhage (PPH). Our collective experience, in combination with mounting evidence, unequivocally supports the effectiveness of commercial and condom UBTs in averting death and disability from PPH associated with atonic uterus. We believe it would be highly unethical to embark on an RCT of UBT, now or in the future, unless compared with a proven equivalent intervention. This article is protected by copyright. All rights reserved

Quality of Care in Humanitarian Surgery

Humanitarian surgical programs are set up de novo, within days or hours in emergency or disaster settings. In such circumstances, insuring quality of care is extremely challenging. Basic structural inputs such as a safe structure, electricity, clean water, a blood bank, sterilization equipment, a post-anesthesia recovery unit, appropriate medications should be established. Currently, no specific credentials are needed for surgeons to operate in a humanitarian setting; the training of more humanitarian surgeons is desperately needed. Standard perioperative protocols for the humanitarian setting after common procedures such as Cesarean section, burn care, open fractures, and amputations and antibiotic prophylaxis, and post-operative pain management must be developed. Outcome data, especially long-term outcomes, are difficult to collect as patients often do not return for follow-up and may be difficult to trace; standard databases for post-operative infections and mortality rates should be established. Checklists have recently received significant attention as an instrument to support the improvement of surgical quality; knowing which items are most applicable to humanitarian settings remains unknown. In conclusion, the quality of surgical services in humanitarian settings must be regulated. Many other core medical activities of humanitarian organizations such as therapeutic feeding, mass vaccination, and the treatment of infectious diseases, such as tuberculosis and human immunodeficiency virus, are subject to rigorous reporting of quality indicators. There is no reason why surgery should be exempted from quality oversight. The surgical humanitarian community should pull together before the next disaster strikes