Dynamic sea surface topography, gravity and improved orbit accuracies from the direct evaluation of SEASAT altimeter data

A method for the simultaneous solution of dynamic ocean topography, gravity and orbits using satellite altimeter data is described. A GEM-T1 based gravitational model called PGS-3337 that incorporates Seasat altimetry, surface gravimetry and satellite tracking data has been determined complete to degree and order 50. The altimeter data is utilized as a dynamic observation of the satellite's height above the sea surface with a degree 10 model of dynamic topography being recovered simultaneously with the orbit parameters, gravity and tidal terms in this model. PGS-3337 has a geoid uncertainty of 60 cm root-mean-square (RMS) globally, with the uncertainty over the altimeter tracked ocean being in the 25 cm range. Doppler determined orbits for Seasat, show large improvements, with the sub-30 cm radial accuracies being achieved. When altimeter data is used in orbit determination, radial orbital accuracies of 20 cm are achieved. The RMS of fit to the altimeter data directly gives 30 cm fits for Seasat when using PGS-3337 and its geoid and dynamic topography model. This performance level is two to three times better than that achieved with earlier Goddard earth models (GEM) using the dynamic topography from long-term oceanographic averages. The recovered dynamic topography reveals the global long wavelength circulation of the oceans with a resolution of 1500 km. The power in the dynamic topography recovery is now found to be closer to that of oceanographic studies than for previous satellite solutions. This is attributed primarily to the improved modeling of the geoid which has occurred. Study of the altimeter residuals reveals regions where tidal models are poor and sea state effects are major limitations

Delivering at Home or in a Health Facility? Health-Seeking Behaviour of Women and the Role of Traditional birth attendants in Tanzania.

Traditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women's health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system. Qualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania. The results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative. Instead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health

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

Asia

French version available in IDRC Digital Library: Trouver des méthodes contraceptives sûre

Analyzing the discharge regime of a large tropical river through remote sensing, ground-based climatic data, and modeling

This study demonstrates the potential for applying passive microwave satellite sensor data to infer the discharge dynamics of large river systems using the main stem Amazon as a test case. The methodology combines (1) interpolated ground-based meteorological station data, (2) horizontally and vertically polarized temperature differences (HVPTD) from the 37-GHz scanning multichannel microwave radiometer (SMMR) aboard the Nimbus 7 satellite, and (3) a calibrated water balance/water transport model (WBM/WTM). Monthly HVPTD values at 0.25° (latitude by longitude) resolution were resampled spatially and temporally to produce an enhanced HVPTD time series at 0.5° resolution for the period May 1979 through February 1985. Enhanced HVPTD values were regressed against monthly discharge derived from the WBM/WTM for each of 40 grid cells along the main stem over a calibration period from May 1979 to February 1983 to provide a spatially contiguous estimate of time-varying discharge. HVPTD-estimated flows generated for a validation period from March 1983 to February 1985 were found to be in good agreement with both observed arid modeled discharges over a 1400-km section of the main stem Amazon. This span of river is bounded downstream by a region of tidal influence and upstream by low sensor response associated with dense forest canopy. Both the WBM/WTM and HVPTD-derived flow rates reflect the significant impact of the 1982–1983 El Niño-;Southern Oscillation (ENSO) event on water balances within the drainage basin

Maternal deaths in Pakistan : intersection of gender, class and social exclusion.

Background: A key aim of countries with high maternal mortality rates is to increase availability of competent maternal health care during pregnancy and childbirth. Yet, despite significant investment, countries with the highest burdens have not reduced their rates to the expected levels. We argue, taking Pakistan as a case study, that improving physical availability of services is necessary but not sufficient for reducing maternal mortality because gender inequities interact with caste and poverty to socially exclude certain groups of women from health services that are otherwise physically available. Methods: Using a critical ethnographic approach, two case studies of women who died during childbirth were pieced together from information gathered during the first six months of fieldwork in a village in Northern Punjab, Pakistan. Findings: Shida did not receive the necessary medical care because her heavily indebted family could not afford it. Zainab, a victim of domestic violence, did not receive any medical care because her martial family could not afford it, nor did they think she deserved it. Both women belonged to lower caste households, which are materially poor households and socially constructed as inferior. Conclusions: The stories of Shida and Zainab illustrate how a rigidly structured caste hierarchy, the gendered devaluing of females, and the reinforced lack of control that many impoverished women experience conspire to keep women from lifesaving health services that are physically available and should be at their disposal

Impact of contraceptive counselling training among counsellors participating in the FIGO postpartum intrauterine device initiative in Bangladesh.

OBJECTIVE: To evaluate the impact of structured training given to dedicated family planning counsellors on postpartum intrauterine device (PPIUD) services across six tertiary hospitals in Bangladesh. METHODS: Family planning counsellors underwent structured training on postpartum family planning, PPIUD in particular, over a four-day period. Impact of training was evaluated by comparing PPIUD counselling rates, consent rates, insertion rates, and removal rates five months before and five months after the training, using data from women delivering in the participating facilities. RESULTS: A total of 27 622 women were included in this analysis: 11 263 (40.8%) before the training intervention and 16 359 (59.2%) after it. There was an increase in the proportion of women who were counselled (from 75.3% to 83.8%, P<0.001), and a small decrease in the proportion of women agreeing to have a PPIUD inserted following counselling (13.7% vs 12.9%, P=0.03). Overall insertion rate was similar before and after training (9.5% vs 9.8%, P=0.42), while removal rate reduced from 2.8% to 1.8% (P=0.41). CONCLUSION: Structured training had no impact on overall PPIUD insertion rate. However, it did impact numbers of women receiving counselling, perceived quality of the counselling received, and overall removal rates

Responding to the maternal health care challenge: The Ethiopian Health Extension Program

Background: Responding to challenges in achieving Millennium Development Goals (MDG), the Ethiopian government initiated the Health Extension Program in 2003 as part of the Health Sector Development Program (HSDP) to improve equitable access to preventive, promotive and select curative health interventions through paid community level health extension workers.Objective: To explore Ethiopia’s progress toward achieving MDG 5 that focuses on improved maternal health through the Health Extension Program.Methods: This paper reviews available survey data and literature to determine the feasibility of reaching the targets specified for MDG 5 and for HSDP.Important findings: Achieving the set targets is a daunting task despite reaching the physical targets of two health extension workers per kebele. The 2015 MDG target for the Maternal Mortality Ratio (MMR) is 218 while the 2005 MMR estimate is 673. The HSDP target is 32% skilled birth attendant use by 2010 but only about 12% use was found in the four most populated regions of the country in 2009.Conclusions: Accelerating progress towards these targets is possible through the Health Extension Program at the worker level through improved promotion of family planning and specific maternal interventions, such as misoprostol for active management of third stage of labor, immediate postpartum visits, and improved coordination from community to referral level. [Ethiop. J. Health Dev. 2010;24 Special Issue 1:105-109

Maternal Near Miss and Mortality in a Rural Referral Hospital in Northern Tanzania: A Cross-Sectional Study.

Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. In order to lower maternal morbidity and mortality in the immediate term, reduction of delay in the provision of quality obstetric care is of prime importance. The aim of this study is to assess the occurrence of severe maternal morbidity and mortality in a rural referral hospital in Tanzania as proposed by the WHO near miss approach and to assess implementation levels of key evidence-based interventions in women experiencing severe maternal morbidity and mortality. A prospective cross-sectional study was performed from November 2009 until November 2011 in a rural referral hospital in Tanzania. All maternal near misses and maternal deaths were included. As not all WHO near miss criteria were applicable, a modification was used to identify cases. Data were collected from medical records using a structured data abstraction form. Descriptive frequencies were calculated for demographic and clinical variables, outcome indicators, underlying causes, and process indicators. In the two-year period there were 216 maternal near misses and 32 maternal deaths. The hospital-based maternal mortality ratio was 350 maternal deaths per 100,000 live births (95% CI 243-488). The maternal near miss incidence ratio was 23.6 per 1,000 live births, with an overall case fatality rate of 12.9%. Oxytocin for prevention of postpartum haemorrhage was used in 96 of 201 women and oxytocin for treatment of postpartum haemorrhage was used in 38 of 66 women. Furthermore, eclampsia was treated with magnesium sulphate in 87% of all cases. Seventy-four women underwent caesarean section, of which 25 women did not receive prophylactic antibiotics. Twenty-eight of 30 women who were admitted with sepsis received parenteral antibiotics. The majority of the cases with uterine rupture (62%) occurred in the hospital. Maternal morbidity and mortality remain challenging problems in a rural referral hospital in Tanzania. Key evidence-based interventions are not implemented in women with severe maternal morbidity and mortality. Progress can be made through up scaling the use of evidence-based interventions, such as the use of oxytocin for prevention and treatment of postpartum haemorrhage