Why do women deliver where they had not planned to go? A qualitative study from peri-urban Nairobi Kenya.

BACKGROUND: In urban Kenya, couples face a wide variety of choices for delivery options; however, many women end up delivering in different facilities from those they had intended while pregnant. One potential consequence of this is delivering in facilities that do not meet minimum quality standards and lack the capacity to provide treatment for obstetric and neonatal complications. METHODS: This study investigated why women in peri-urban Nairobi, Kenya deliver in facilities they had not intended to use. We used 60 in-depth audio-recorded interviews in which mothers shared their experiences 2-6 months after delivery. Descriptive statistics were used to summarize socio-demographic characteristics of participants. Qualitative data were analyzed in three steps i) exploration and generation of initial codes; ii) searching for themes by gathering coded data that addressed specific themes; and iii) defining and naming identified themes. Verbatim excerpts from participants were provided to illustrate study findings. The Health Belief Model was used to shed light on individual-level drivers of delivery location choice. RESULTS: Findings show a confluence of factors that predispose mothers to delivering in unintended facilities. At the individual level, precipitate labor, financial limitations, onset of pain, complications, changes in birth plans, undisclosed birth plans, travel during pregnancy, fear of health facility providers, misconception of onset of labor, wrong estimate of delivery date, and onset of labor at night, contributed to delivery at unplanned locations. On the supply side, the sudden referral to other facilities, poor services, wrong projection of delivery date, and long distance to chosen delivery facility, were factors in changes in delivery location. Lack of transport discouraged delivery at a chosen health facility. Social influences included others\u27 perspectives on delivery location and lack of aides/escorts. CONCLUSIONS: Results from this study suggest that manifold factors contribute to the occurrence of women delivering in facilities that they had not intended during pregnancy. Future studies should consider whether these changes in delivery location late in pregnancy contribute to late facility arrival and the use of lower quality facilities. Deliberate counseling during antenatal care regarding birth plans is likely to encourage timely arrival at facilities consistent with women\u27s preferences

Study on Magnesium based Pyrotechnic Composition as a Priming Charge

A new pyrotechnic composition containing Mg/KNO3/phenolic resin has been formulated and studied in detail for its sensitivity, mechanical and thermal properties, moisture and environmental effects and performance in a closed vessel. The data generated reveal that this composition shows superior performance, better mechanical properties and less susceptibility to moisture as compared to gunpowder. In addition, performance of the composition under extreme hot (45 degree centigrade) and cold (-26 degree centigrade) environmental conditions is not affected at all. Differential thermal analyser results indicate that phenolic resin plays a vital role in reducing the ignition temperature of Mg/KNO/sub 3/ system

Kidney injury molecule-1: a urinary biomarker for contrast induced acute kidney injury.

Back ground: Urinary kidney injury molecule 1 (KIM-1) is early biomarker for renal damage. A few studies have been published analyzing the potential use of urinary kidney injury molecule-1 (KIM-1) as a biomarker for acute kidney injury. However no study has been done related to Acute Kidney Injury associated with contrast administration. Aim: To search for new markers to identify Acute Kidney Injury (ARF) associated with contrast administration earlier than serum creatinine. Material and Methods: We studied 100 consecutive patients with normal serum creatinine undergoing angiographic procedure. We assessed urine KIM-1, at 4h, 8h, and 24 hours after the angiographic procedure. Serum creatinine was measured at basal, 24h and 48 hours after the procedure. Results: There was a significant rise in urinary KIM-1 levels at 24 hours after the angiographic procedure. The presence of contrast induced nephropathy associated with acute Kidney Injury was 12%. Conclusion: The present study highlighted the importance of urinary KIM-1 in detecting Acute Kidney Injury associated with contrast administration earlier than Serum creatinine. Key words: Neutrophil-gelatinase-associated lipocalin. Contrast-induced nephropathy. Cystatin C. Glomerular Filtration Rate (GFR), Kidney injury molecule -1 (KIM-1)

Regional climate messages for South Asia

It was essential to understand the extent of climatic variability and the associated biophysical response to ascertain appropriate entry points for the RRP phase. To enhance our understanding of historical climate change and climate variability in the three ASSAR sub-regions, we investigated trends in temperature and precipitation in the broader landscape surrounding the sub-regions (hereafter ASSAR sub-region envelopes).International Development Research Centre (IDRC) - CanadaUK's Department for International Development (DFID) UKCollaborative Adaptation Research Initiative in Africa and Asia (CARIAA