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

Next-generation sequencing for diagnosis of thoracic aortic aneurysms and dissections: diagnostic yield, novel mutations and genotype phenotype correlations

Additional file 1. Complementary data on primer sequences, SKI amplification and survival analyses

Health System Support for Childbirth care in Southern Tanzania: Results from a Health Facility Census.

Progress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth offered at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth. Health centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2--3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months. Essential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries have both low staffing and low caseload which constraints the ability to provide high-quality childbirth care. Improvements in quality of care are essential so that women delivering in facility receive "skilled attendance" and adequate care for common obstetric complications such as post-partum haemorrhage

Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran

<p>Abstract</p> <p>Background</p> <p>One factor that contributes to high maternal mortality in developing countries is the delayed use of Emergency Obstetric-Care (EmOC) facilities. The objective of this study was to determine the factors that hinder midwives and parturient women from using hospitals when complications occur during home birth in Sistan and Baluchestan province, Iran, where 23% of all deliveries take place in non- hospital settings.</p> <p>Methods</p> <p>In the study and data management, a mixed-methods approach was used. In the quantitative phase, we compared the existing health-sector data with World Health Organization (WHO) standards for the availability and use of EmOC services. The qualitative phase included collection and analysis of interviews with midwives and traditional birth attendants and twenty-one in-depth interviews with mothers. The data collected in this phase were managed according to the principles of qualitative data analysis.</p> <p>Results</p> <p>The findings demonstrate that three distinct factors lead to indecisiveness and delay in the use of EmOC by the midwives and mothers studied. Socio-cultural and familial reasons compel some women to choose to give birth at home and to hesitate seeking professional emergency care for delivery complications. Apprehension about being insulted by physicians, the necessity of protecting their professional integrity in front of patients and an inability to persuade their patients lead to an over-insistence by midwives on completing deliveries at the mothers' homes and a reluctance to refer their patients to hospitals. The low quality and expense of EmOC and the mothers' lack of health insurance also contribute to delays in referral.</p> <p>Conclusions</p> <p>Women who choose to give birth at home accept the risk that complications may arise. Training midwives and persuading mothers and significant others who make decisions about the value of referring women to hospitals at the onset of life-threatening complications are central factors to increasing the use of available hospitals. The hospitals must be safe, comfortable and attractive environments for parturition and should give appropriate consideration to the ethical and cultural concerns of the women. Appropriate management of financial and insurance-related issues can help midwives and mothers make a rational decision when complications arise.</p

Why don't some women attend antenatal and postnatal care services?: a qualitative study of community members' perspectives in Garut, Sukabumi and Ciamis districts of West Java Province, Indonesia

<p>Abstract</p> <p>Background</p> <p>Antenatal, delivery and postnatal care services are amongst the recommended interventions aimed at preventing maternal and newborn deaths worldwide. West Java is one of the provinces of Java Island in Indonesia with a high proportion of home deliveries, a low attendance of four antenatal services and a low postnatal care uptake. This paper aims to explore community members' perspectives on antenatal and postnatal care services, including reasons for using or not using these services, the services received during antenatal and postnatal care, and cultural practices during antenatal and postnatal periods in Garut, Sukabumi and Ciamis districts of West Java province.</p> <p>Methods</p> <p>A qualitative study was conducted from March to July 2009 in six villages in three districts of West Java province. Twenty focus group discussions (FGDs) and 165 in-depth interviews were carried out involving a total of 295 respondents. The guidelines for FGDs and in-depth interviews included the topics of community experiences with antenatal and postnatal care services, reasons for not attending the services, and cultural practices during antenatal and postnatal periods.</p> <p>Results</p> <p>Our study found that the main reason women attended antenatal and postnatal care services was to ensure the safe health of both mother and infant. Financial difficulty emerged as the major issue among women who did not fulfil the minimum requirements of four antenatal care services or two postnatal care services within the first month after delivery. This was related to the cost of health services, transportation costs, or both. In remote areas, the limited availability of health services was also a problem, especially if the village midwife frequently travelled out of the village. The distances from health facilities, in addition to poor road conditions were major concerns, particularly for those living in remote areas. Lack of community awareness about the importance of these services was also found, as some community members perceived health services to be necessary only if obstetric complications occurred. The services of traditional birth attendants for antenatal, delivery, and postnatal care were widely used, and their roles in maternal and child care were considered vital by some community members.</p> <p>Conclusions</p> <p>It is important that public health strategies take into account the availability, affordability and accessibility of health services. Poverty alleviation strategies will help financially deprived communities to use antenatal and postnatal health services. This study also demonstrated the importance of health promotion programs for increasing community awareness about the necessity of antenatal and postnatal services.</p

Embedding open education at universities: Issues to resolve

Universities have a long tradition of freely sharing information and knowledge, through books, journals, the classroom and conferences. However, over the last century, access to this information has become increasingly commercialised and profit-driven. With the advent of internet technologies, access to information and knowledge is, once again, more readily available, and various ‘open’ initiatives have emerged to challenge the commercialised approach

Zastosowanie kultur wieloroślinek w namnażaniu wierzbówki kiprzycy (Chamaenerion angustifolium (L.) Scop.)

Introduction: Willow herb (Chamaenerion angustifolium (L.) Scop. syn. Epilobium angustifolium L. from Onagraceae family is a valuable medicinal plant that has been used in the treatment of urogenital disorders including BPH (Benign Prostatic Hypertrophy). The raw material is a rich source of polyphenols as well as steroids, triterpenoids and fatty acids. Due to frequent interspecific hybridization, plants collected in wild display a very diverse and variable content of active compounds. This poses a challenge in obtaining high quality and homogenous raw material. Application of the in vitro cultures and micropropagation techniques may offer a solution for alternative methods of cultivation. Objective: This work presents preliminary results of the first implementation of in vitro cultures of willow herb to obtain material for medicinal purposes. Methods: Sterile seedlings were donors of explants, which were used for induction of multi-shoots culture according to a modified protocol described by Turker and co-workers. Statistical analysis was used for assessment of significance of differences among variables. Results: Six different genotypes (lines) originating from root explants were chosen for clonal propagation. Efficiency of the elaborated method was 16–20 shoots per explant. Finally, over 3000 acclimatized plants were obtained and used for field crops. Conclusions: The use of Ch. angustifolium in vitro cultures can contribute to the introduction of this valuable herb for field crops and increase the availability of the raw material for food and pharmaceutical industries.Wstęp: Ziele wierzbówki kiprzycy Chamaenerion angustifolium (L.) Scop. syn. Epilobium angustifolium L. (rodzina Onagraceae) stanowi cenny surowiec zielarski w leczeniu schorzeń układu moczowo-płciowego, w tym także łagodnego przerostu prostaty (ang. Benign Prostatic Hypertrophy, BPH). Surowiec zawiera liczne związki fenolowe, jak również steroidy, triterpenoidy i kwasy tłuszczowe. Niezwykle łatwe krzyżowanie się wierzbówki z innymi gatunkami pokrewnymi prowadzi do powstania mieszańców o bardzo zróżnicowanej i zmiennej zawartości związków aktywnych, co nastręcza trudności w uzyskaniu wyrównanego surowca o wysokiej jakości. Alternatywnym rozwiązaniem może być zastosowanie mikropropagacji do otrzymywania i namnażania wyselekcjonowanych genotypów w kulturach in vitro. Cel: Praca przedstawia wstępne wyniki badań, gdzie po raz pierwszy zastosowano kultury in vitro do namnażania wierzbówki kiprzycy w celu pozyskania surowca do produkcji suplementu diety. Metody: Do inicjacji kultur wieloroślinek (multi-shoots) wg zmodyfikowanej metody Turkera (2008) posłużyły eksplantaty pochodzące ze sterylnych siewek. Analizy statystycznej użyto do określenia istotności różnic zmiennych. Wyniki: Do klonalnego namnażania wybrano sześć różnych linii (genotypów) pochodzących z eksplantatów korzeniowych. Wydajność opracowanej metody wynosiła 16–20 pędów na eksplantat. Ostatecznie otrzymano ponad 3000 zaaklimatyzowanych roślin, które posłużyły do założenia upraw polowych. Wnioski: Zastosowanie kultur in vitro wierzbówki kiprzycy może przyczynić się do zwiększenia dostępności tego surowca zielarskiego dla celów zarówno przemysłu spożywczego, jak i farmaceutycznego

Embedding Open Education at universities: Issues to resolve

Universities have a long tradition of sharing information and knowledge, through books, journals and conferences. Recently, various 'open' initiatives have emerged to extend this sharing to teaching materials, in what we broadly call Open Education. This presentation will unpack some of the concepts involved in Open Education, including Open Content, (an overarching term encompassing Open Educational Resources, OER; Open Textbooks; and Open Courseware), and Open Courses. We will discuss various elements of open content, exploring their emerging use at Murdoch University. Apart from some human factors, the major barriers to the use and production of open content are: •Intellectual property (IP) legislation and regulations, which assert the University's ownership of IP embodied in teaching materials, and impede the ability of staff to freely share content. •Transnational education (TNE) business models, in which the University licenses access to the content of a unit to another entity. The presentation will discuss the use of Creative Commons licensing to protect the rights of both the university and the individual creator, while still allowing use and repurposing by others. It will also explore the idea of licensing certification for passing a unit rather than licensing access to content. It will then turn to the concept of Open Courses, which complement open content by adding learning tasks and teacher support, either implicitly or explicitly. The conversation will continue with a critique of the evolving, and much-hyped, Massively Open Online Course (MOOC) concept, analysing the pros and cons of open access to a largely teacher-free learning environment from a pedagogical perspective and the nature of students who might successfully engage with it. The presentation will conclude with an analysis of the institutional factors involved in contributing to Open Education. We argue that a considered approach to Open Education can provide benefits to students, staff and the institution, but that a wholesale adoption of the MOOC approach may be costly, with insufficient return on investment