Planning a Family:priorities and concerns in rural Tanzanmia

A fertility survey using qualitative and quantitative techniques described a high fertility setting (TFR 5.8) in southern Tanzania where family planning use was 16%. Current use was influenced by rising parity, educational level, age of last born child, breastfeeding status, a\ud preference for longer than the mean birth interval (32 months), not being related to the household head, and living in a house with a tin roof. Three principal concerns amongst women were outlined from the findings. First, that there is a large unmet need for family planning services in the area particularly among teenagers for whom it is associated with induced abortion. Second, that family planning is being used predominantly for spacing but fears\ud associated with it often curtail effective use. Third, that service provision is perceived to be lacking in two main areas — regularity of supply, and addressing rumours and fears associated with family planning. Reproductive health interventions in the area should ultimately be more\ud widespread and, in particular, abortion is highlighted as an urgent issue for further research.\ud The potential for a fast and positive impact is high, given the simplicity of the perceived needs of\ud women from this study. (Afr J Reprod Health 2004; 8[2]:111-123)\u

Low-energy three-body charge transfer reactions with Coulomb interaction in the final state

Three-body charge transfer reactions with Coulomb interaction in the final state are considered in the framework of coordinate-space integro-differential Faddeev-Hahn-type equations within two- and six-state close coupling approximations. The method is employed to study direct muon transfer in low-energy collisions of the muonic hydrogen H$_\mu$ by helium (He$^{++}$) and lithium (Li$^{+++}$) nuclei. The experimentally observed isotopic dependence is reproduced.Comment: 14 pages REVTeX, accepted for publication in Journal of Physics

Measuring children’s harmonic knowledge with implicit and explicit tests

We uses implicit and explicit tasks to measure knowledge of Western harmony in musically trained and untrained Canadian children. Younger children were 6-7 years of age; older children were 10-11. On each trial, participants heard a sequence of five piano chords. The first four chords established a major-key context. The final chord was the standard, expected tonic of the context or one of two deviant endings: the highly unexpected flat supertonic or the moderately unexpected subdominant. In the implicit task, children identified the timbre of the final chord (guitar or piano) as quickly as possible. Response times were faster for the tonic ending than for either deviant ending, but the magnitude of the priming effect was similar for the two deviants, and the effect did not vary as a function of age or music training. In the explicit task, children rated how good each chord sequence sounded. Ratings were highest for sequences with the tonic ending, intermediate for the subdominant, and lowest for the flat supertonic. Moreover, the difference between the tonic and deviant sequences was larger for older children with music training. Thus, the explicit task provided a more nuanced picture of musical knowledge than did the implicit task.info:eu-repo/semantics/acceptedVersio

Risk factors for presentation to hospital with severe anaemia in Tanzanian children: a case-control study.

In malaria endemic areas anaemia is a usually silent condition that nevertheless places a considerable burden on health services. Cases of severe anaemia often require hospitalization and blood transfusions. The objective of this study was to assess risk factors for admission with anaemia to facilitate the design of anaemia control programmes. We conducted a prospective case-control study of children aged 2-59 months admitted to a district hospital in southern Tanzania. There were 216 cases of severe anaemia [packed cell volume (PCV) < 25%] and 234 age-matched controls (PCV > or = 25%). Most cases [55.6% (n = 120)] were < 1 year of age. Anaemia was significantly associated with the educational level of parents, type of accommodation, health-seeking behaviour, the child's nutritional status and recent and current medical history. Of these, the single most important factor was Plasmodium falciparum parasitaemia [OR 4.3, 95% confidence interval (CI) 2.9-6.5, P < 0.001]. Multivariate analysis showed that increased recent health expenditure [OR 2.2 (95% CI 1.3-3.9), P = 0.005], malnutrition [OR 2.4 (95%CI 1.3-4.3), P < 0.001], living > 10 km from the hospital [OR 3.0 (95% CI 1.9-4.9), P < 0.001], a history of previous blood transfusion [OR 3.8 (95% CI 1.7-9.1), P < 0.001] and P. falciparum parasitaemia [OR 9.5 (95% CI 4.3-21.3), P < 0.001] were independently related to risk of being admitted with anaemia. These findings are considered in terms of the pathophysiological pathway leading to anaemia. The concentration of anaemia in infants and problems of access to health services and adequate case management underline the need for targeted preventive strategies for anaemia control

From Theory to Implementation: Adaptations to a Quality Improvement Initiative According to Implementation Context

As countries continue to invest in quality improvement (QI) initiatives in health facilities, it is important to acknowledge the role of context in implementation. We conducted a qualitative study between February 2019 and January 2020 to explore how a QI initiative was adapted to enable implementation in three facility types: primary health centres, public hospitals and private facilities in Lagos State, Nigeria. Despite a common theory of change, implementation of the initiative needed to be adapted to accommodate the local needs, priorities and organisational culture of each facility type. Across facility types, inadequate human and capital resources constrained implementation and necessitated an extension of the initiative’s duration. In public facilities, the local governance structure was adapted to facilitate coordination, but similar adaptations to governance were not possible for private facilities. Our findings highlight the importance of anticipating and planning for the local adaptation of QI initiatives according to implementation environment

The age patterns of severe malaria syndromes in sub-Saharan Africa across a range of transmission intensities and seasonality settings

BACKGROUND: A greater understanding of the relationship between transmission intensity, seasonality and the age-pattern of malaria is needed to guide appropriate targeting of malaria interventions in different epidemiological settings. METHODS: A systematic literature review identified studies which reported the age of paediatric hospital admissions with cerebral malaria (CM), severe malarial anaemia (SMA), or respiratory distress (RD). Study sites were categorized into a 3 × 2 matrix of Plasmodium falciparum transmission intensity and seasonality. Probability distributions were fitted by maximum likelihood methods, and best fitting models were used to estimate median ages and to represent graphically the age-pattern of each outcome for each transmission category in the matrix. RESULTS: A shift in the burden of CM towards younger age groups was seen with increasing intensity of transmission, but this was not the case for SMA or RD. Sites with 'no marked seasonality' showed more evidence of skewed age-patterns compared to areas of 'marked seasonality' for all three severe malaria syndromes. CONCLUSIONS: Although the peak age of CM will increase as transmission intensity decreases in Africa, more than 75% of all paediatric hospital admissions of severe malaria are likely to remain in under five year olds in most epidemiological settings

Using sentinel-1 and sentinel-2 time series for slangbos mapping in the free state province, South Africa

Increasing woody cover and overgrazing in semi-arid ecosystems are known to be the major factors driving land degradation. This study focuses on mapping the distribution of the slangbos shrub (Seriphium plumosum) in a test region in the Free State Province of South Africa. The goal of this study is to monitor the slangbos encroachment on cultivated land by synergistically combining Synthetic Aperture Radar (SAR) (Sentinel-1) and optical (Sentinel-2) Earth observation information. Both optical and radar satellite data are sensitive to different vegetation properties and surface scattering or reflection mechanisms caused by the specific sensor characteristics. We used a supervised random forest classification to predict slangbos encroachment for each individual crop year between 2015 and 2020. Training data were derived based on expert knowledge and in situ information from the Department of Agriculture, Land Reform and Rural Development (DALRRD). We found that the Sentinel-1 VH (cross-polarization) and Sentinel-2 SAVI (Soil Adjusted Vegetation Index) time series information have the highest importance for the random forest classifier among all input parameters. The modelling results confirm the in situ observations that pastures are most affected by slangbos encroachment. The estimation of the model accuracy was accomplished via spatial cross-validation (SpCV) and resulted in a classification precision of around 80% for the slangbos class within each time step

Staff experiences of Providing Maternity Services in Rural Southern Tanzania -- A Focus on Equipment, Drug and Supply Issues.

The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse maternal outcomes through delaying care provision. We aim to describe staff experiences of providing maternal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures that carried potential health risks to themselves as a result. Inadequately stocked and equipped facilities compromise the health system's ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions

Associations between music education, intelligence, and spelling ability in elementary school

Musical education has a beneficial effect on higher cognitive functions, but questions arise whether associations between music lessons and cognitive abilities are specific to a domain or general. We tested 194 boys in Grade 3 by measuring reading and spelling performance, non verbal intelligence and asked parents about musical activities since preschool. Questionnaire data showed that 53% of the boys had learned to play a musical instrument. Intelligence was higher for boys playing an instrument (p < .001). To control for unspecific effects we excluded families without instruments. The effect on intelligence remained (p < .05). Furthermore, boys playing an instrument showed better performance in spelling compared to the boys who were not playing, despite family members with instruments (p < .01). This effect was observed independently of IQ. Our findings suggest an association between music education and general cognitive ability as well as a specific language link

Informed Decisions for Actions in Maternal and Newborn Health 2010–17 Report What works, why and how in maternal and newborn health

IDEAS is a measurement, learning and evaluation project based at the London School of Hygiene & Tropical Medicine (LSHTM). The project aims to find out “what works, why, and how” for maternal and newborn health in three low-resource settings in Nigeria, India, and Ethiopia. The IDEAS team includes 20 research and professional support staff, living in Abuja, Addis Ababa, London, and New Delhi, who have been working since 2010 with the Bill & Melinda Gates Foundation (the foundation) and with the foundation’s implementation partners