Simulating the Impact of Traffic Calming Strategies

This study assessed the impact of traffic calming measures to the speed, travel times and capacity of residential roadways. The study focused on two types of speed tables, speed humps and a raised crosswalk. A moving test vehicle equipped with GPS receivers that allowed calculation of speeds and determination of speed profiles at 1s intervals were used. Multi-regime model was used to provide the best fit using steady state equations; hence the corresponding speed-flow relationships were established for different calming scenarios. It was found that capacities of residential roadway segments due to presence of calming features ranged from 640 to 730 vph. However, the capacity varied with the spacing of the calming features in which spacing speed tables at 1050 ft apart caused a 23% reduction in capacity while 350-ft spacing reduced capacity by 32%. Analysis showed a linear decrease of capacity of approximately 20 vphpl, 37 vphpl and 34 vphpl when 17 ft wide speed tables were spaced at 350 ft, 700 ft, and 1050 ft apart respectively. For speed hump calming features, spacing humps at 350 ft reduced capacity by about 33% while a 700 ft spacing reduced capacity by 30%. The study concludes that speed tables are slightly better than speed humps in terms of preserving the roadway capacity. Also, traffic calming measures significantly reduce the speeds of vehicles, and it is best to keep spacing of 630 ft or less to achieve desirable crossing speeds of less or equal to 15 mph especially in a street with schools nearby. A microscopic simulation model was developed to replicate the driving behavior of traffic on urban road diets roads to analyze the influence of bus stops on traffic flow and safety. The impacts of safety were assessed using surrogate measures of safety (SSAM). The study found that presence of a bus stops for 10, 20 and 30 s dwell times have almost 9.5%, 12%, and 20% effect on traffic speed reductions when 300 veh/hr flow is considered. A comparison of reduction in speed of traffic on an 11 ft wide road lane of a road diet due to curbside stops and bus bays for a mean of 30s with a standard deviation of 5s dwell time case was conducted. Results showed that a bus stop bay with the stated bus dwell time causes an approximate 8% speed reduction to traffic at a flow level of about 1400 vph. Analysis of the trajectories from bust stop locations showed that at 0, 25, 50, 75, 100, 125, 150, and 175 feet from the intersection the number of conflicts is affected by the presence and location of a curbside stop on a segment with a road diet

Water, Sanitation, Hygiene, and Nutrition in Bangladesh: Can Building Toilets Affect Children's Growth?

This report provides a systematic review of the evidence to date, both published and grey literature, on the relationship between water and sanitation and nutrition. It also examines the potential impact of improved water, sanitation, and hygiene (WASH) on undernutrition. This is the first report that undertakes a thorough review and discussion of WASH and nutrition in Bangladesh

The silent burden of anaemia in Tanzania children:a community-based study

Objective was to document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old,thereby assisting in the development of effective strategies for controlling anaemia.\ud \ud Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern\ud United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed.\ud \ud Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6–11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1–5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron\ud was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was notassociated with risk of anaemia.\ud \ud Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria

Care-seeking patterns for fatal malaria in Tanzania.

BACKGROUND\ud \ud Once malaria occurs, deaths can be prevented by prompt treatment with relatively affordable and efficacious drugs. Yet this goal is elusive in Africa. The paradox of a continuing but easily preventable cause of high mortality raises important questions for policy makers concerning care-seeking and access to health systems. Although patterns of care-seeking during uncomplicated malaria episodes are well known, studies in cases of fatal malaria are rare. Care-seeking behaviours may differ between these groups.\ud \ud METHODS\ud \ud This study documents care-seeking events in 320 children less than five years of age with fatal malaria seen between 1999 and 2001 during over 240,000 person-years of follow-up in a stable perennial malaria transmission setting in southern Tanzania. Accounts of care-seeking recorded in verbal autopsy histories were analysed to determine providers attended and the sequence of choices made as the patients' condition deteriorated.\ud \ud RESULTS\ud \ud As first resort to care, 78.7% of malaria-attributable deaths used modern biomedical care in the form of antimalarial pharmaceuticals from shops or government or non-governmental heath facilities, 9.4% used initial traditional care at home or from traditional practitioners and 11.9% sought no care of any kind. There were no differences in patterns of choice by sex of the child, sex of the head of the household, socioeconomic status of the household or presence or absence of convulsions. In malaria deaths of all ages who sought care more than once, modern care was included in the first or second resort to care in 90.0% and 99.4% with and without convulsions respectively.\ud \ud CONCLUSIONS\ud \ud In this study of fatal malaria in southern Tanzania, biomedical care is the preferred choice of an overwhelming majority of suspected malaria cases, even those complicated by convulsions. Traditional care is no longer a significant delaying factor. To reduce mortality further will require greater emphasis on recognizing danger signs at home, prompter care-seeking, improved quality of care at health facilities and better adherence to treatment

Development of behaviour change communication strategy for a vaccination-linked malaria control tool in southern Tanzania.

BACKGROUND\ud \ud Intermittent preventive treatment of malaria in infants (IPTi) using sulphadoxine-pyrimethamine and linked to the expanded programme on immunization (EPI) is a promising strategy for malaria control in young children. As evidence grows on the efficacy of IPTi as public health strategy, information is needed so that this novel control tool can be put into practice promptly, once a policy recommendation is made to implement it. This paper describes the development of a behaviour change communication strategy to support implementation of IPTi by the routine health services in southern Tanzania, in the context of a five-year research programme evaluating the community effectiveness of IPTi.\ud \ud METHODS\ud \ud Mixed methods including a rapid qualitative assessment and quantitative health facility survey were used to investigate communities' and providers' knowledge and practices relating to malaria, EPI, sulphadoxine-pyrimethamine and existing health posters. Results were applied to develop an appropriate behaviour change communication strategy for IPTi involving personal communication between mothers and health staff, supported by a brand name and two posters.\ud \ud RESULTS\ud \ud Malaria in young children was considered to be a nuisance because it causes sleepless nights. Vaccination services were well accepted and their use was considered the mother's responsibility. Babies were generally taken for vaccination despite complaints about fevers and swellings after the injections. Sulphadoxine-pyrimethamine was widely used for malaria treatment and intermittent preventive treatment of malaria in pregnancy, despite widespread rumours of adverse reactions based on hearsay and newspaper reports. Almost all health providers said that they or their spouse were ready to take SP in pregnancy (96%, 223/242). A brand name, key messages and images were developed and pre-tested as behaviour change communication materials. The posters contained public health messages, which explained the intervention itself, how and when children receive it and safety issues. Implementation of IPTi started in January 2005 and evaluation is ongoing.\ud \ud CONCLUSION\ud \ud Behaviour Change Communication (BCC) strategies for health interventions must be both culturally appropriate and technically sound. A mixed methods approach can facilitate an interactive process among relevant actors to develop a BCC strategy

The role of neuro-electrophysiological diagnostic tests in clinical medicine

Objective: To summarise and discuss the role of neuro-electrophysiological diagnostic tests in clinical medicine. Data Sources: Published original research and reviews to date. Study Selection: The review was with emphasis on diagnosis of peripheral neuropathic and neuromuscular disorders. Data extraction and synthesis: On-line and manual library searches provided information and data on which the summaries and discussions were based. Some physicians are not yet aware of some of the tests and some may not know their indications. In this article a review is made of evoked potential tests, nerve conduction tests and electromyography in diagnosis of neurological diseases. An attempt has been made to clearly show their indications, and relative importance. Conclusion: Studies clearly show that neuro-electrophysiological tests are important in neurological diagnosis in clinical medicine and are an extension of the physical examination. East African Medical Journal Vol. 83(1) 2006: 52-6

Reply to Correspondence: is the strength of association between indicators of dietary quality and the nutritional status of children being underestimated?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102165/1/mcn12107.pd