The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study.

BACKGROUND: In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai. METHODS: Between May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis. RESULTS: All study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers' group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs. CONCLUSIONS: Our findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings

Table_1_Comparison of performance of automatic recognizers for stutters in speech trained with event or interval markers.XLSX

IntroductionAutomatic recognition of stutters (ARS) from speech recordings can facilitate objective assessment and intervention for people who stutter. However, the performance of ARS systems may depend on how the speech data are segmented and labelled for training and testing. This study compared two segmentation methods: event-based, which delimits speech segments by their fluency status, and interval-based, which uses fixed-length segments regardless of fluency.MethodsMachine learning models were trained and evaluated on interval-based and event-based stuttered speech corpora. The models used acoustic and linguistic features extracted from the speech signal and the transcriptions generated by a state-of-the-art automatic speech recognition system.ResultsThe results showed that event-based segmentation led to better ARS performance than interval-based segmentation, as measured by the area under the curve (AUC) of the receiver operating characteristic. The results suggest differences in the quality and quantity of the data because of segmentation method. The inclusion of linguistic features improved the detection of whole-word repetitions, but not other types of stutters.DiscussionThe findings suggest that event-based segmentation is more suitable for ARS than interval-based segmentation, as it preserves the exact boundaries and types of stutters. The linguistic features provide useful information for separating supra-lexical disfluencies from fluent speech but may not capture the acoustic characteristics of stutters. Future work should explore more robust and diverse features, as well as larger and more representative datasets, for developing effective ARS systems.</p

Supplementary Material - Details on Methods and Data from Uncertain impacts on economic growth when stabilizing global temperatures at 1.5°C or 2°C warming

Empirical evidence suggests that variations in climate affect economic growth across countries over time. However, little is known about the relative impacts of climate change on economic outcomes when global mean surface temperature (GMST) is stabilized at 1.5°C or 2°C warming relative to pre-industrial levels. Here we use a new set of climate simulations under 1.5°C and 2°C warming from the ‘Half a degree Additional warming, Prognosis and Projected Impacts' (HAPPI) project to assess changes in economic growth using empirical estimates of climate impacts in a global panel dataset. Panel estimation results that are robust to outliers and breaks suggest that within-year variability of monthly temperatures and precipitation has little effect on economic growth beyond global nonlinear temperature effects. While expected temperature changes under a GMST increase of 1.5°C lead to proportionally higher warming in the Northern Hemisphere, the projected impact on economic growth is larger in the Tropics and Southern Hemisphere. Accounting for econometric estimation and climate uncertainty, the projected impacts on economic growth of 1.5°C warming are close to indistinguishable from current climate conditions, while 2°C warming suggests statistically lower economic growth for a large set of countries (median projected annual growth up to 2% lower). Level projections of gross domestic product (GDP) <i>per capita</i> exhibit high uncertainties with median projected global average GDP <i>per capita</i> approximately 5% lower at the end of the century under 2°C warming relative to 1.5°C. The correlation between climate-induced reductions in <i>per capita</i> GDP growth and national income levels is significant at the <i>p</i> < 0.001 level, with lower-income countries experiencing greater losses, which may increase economic inequality between countries and is relevant to discussions of loss and damage under the United Nations Framework Convention on Climate Change.This article is part of the theme issue ‘The Paris Agreement: understanding the physical and social challenges for a warming world of 1.5°c above pre-industrial levels'

Supplementary Material - Details on Methods and Data from Uncertain impacts on economic growth when stabilizing global temperatures at 1.5°C or 2°C warming

Empirical evidence suggests that variations in climate affect economic growth across countries over time. However, little is known about the relative impacts of climate change onto economic outcomes when global mean surface temperature (GMST) is stabilized at 1.5°C or at 2°C warming relative to pre-industrial levels. Here we use a new set of climate simulations under 1.5°C and 2°C warming from the ‘Half a degree Additional warming, Prognosis and Projected Impacts' project (HAPPI), to assess changes in economic growth using empirical estimates of climate impacts in a global panel dataset. Panel estimation results that are robust to outliers and breaks suggest that within-year variability of monthly temperatures and precipitation has little effect on economic growth beyond global nonlinear temperature effects. While expected temperature changes under a GMST increase of 1.5°C lead to proportionally higher warming in the Northern Hemisphere, the projected impact onto economic growth is larger in the Tropics and Southern Hemisphere. Accounting for econometric estimation and climate uncertainty, the projected impacts onto economic growth of 1.5°C warming are close to indistinguishable from current climate conditions, while 2°C warming suggests statistically lower economic growth for a large set of countries (median projected annual growth up to 2% lower). Level projections of GDP <i>per capita</i> exhibit high uncertainties; with median projected global average GDP <i>per capita</i> approximately 5% lower at the end of the century under 2°C warming relative to 1.5°C. The correlation between climate-induced reductions in <i>per capita</i> GDP growth and national income levels is significant at the <i>p</i> < 0.001 level, with lower income countries experiencing greater losses, which may increase economic inequality between countries and is relevant to discussions of Loss and Damage under the UNFCCC.This article is part of the theme issue ‘The Paris Agreement: understanding the physical and social challenges for a warming world of 1.5°c above pre-industrial levels'

Additional file 3: Figure S2. of Evolution of mitosome metabolism and invasion-related proteins in Cryptosporidium

A) Syntenic relationship between the genomes of Cryptosporidium parvum and C. ubiquitum or C. andersoni. Syntenic sequences (identity >75%) are connected with lines. The colors of lines represent different chromosomes of C. parvum. B) Venn diagram of shared orthologs and species-specific genes among four Cryptosporidium species. Because of the use of different gene prediction approaches in genome annotation, species-specific genes are generally over-estimated. (DOCX 2376 kb

Additional file 2: Figure S1. of Evolution of mitosome metabolism and invasion-related proteins in Cryptosporidium

A) Similarity in codon usage frequency among Cryptosporidium parvum, C. ubiquitum and C. andersoni. As expected, the third position of the most commonly used codons mostly has A or T, except for the UGG codon for tryptophan and UTG codon for methionine. B) The most over-represented sequence motifs in upstream regions of protein-encoding genes of C. parvum, C. ubiquitum and C. andersoni. The E2F-like motif, 5′-TGGCGCCA-3′, is the dominant one in all Cryptosporidium species. (DOCX 429 kb

Additional file 6: Table S3. of Comparative genomics reveals Cyclospora cayetanensis possesses coccidia-like metabolism and invasion components but unique surface antigens

Comparison of essential cellular metabolic pathways among some common apicomplexan parasites. (XLSX 70 kb