From their own perspective - constraints in the Polio Eradication Initiative: perceptions of health workers and managers in a district of Pakistan's Punjab province

<p>Abstract</p> <p>Background</p> <p>The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. This paper describes the perceptions of health workers and managers regarding constraints in the Polio Eradication Initiative (PEI) to ultimately provide evidence for designing future interventions.</p> <p>Methods</p> <p>A qualitative cross-sectional study using focus group discussions and in-depth interviews was conducted in the Nankana Sahib District of Pakistan's Punjab province. Study subjects included staff at all levels in the PEI at district headquarters, in all 4 tehsils (sub-districts) and at 20 randomly selected primary health centers. In total, 4 FGD and 7 interview sessions were conducted and individual session summary notes were prepared and later synthesized, consolidated and subjected to conceptual analysis.</p> <p>Results</p> <p>The main constraints identified in the study were the poor condition of the cold chain in all aspects, poor skills and a lack of authority in resource allocation and human resource management, limited advocacy and communication resources, a lack of skills and training among staff at all levels in the PEI/EPI in almost all aspects of the program, a deficiency of public health professionals, poor health services structure, administrative issues (including ineffective means of performance evaluation, bureaucratic and political influences, problems in vaccination areas and field programs, no birth records at health facilities, and poor linkage between different preventive programs), unreliable reporting and poor monitoring and supervision systems, limited use of local data for interventions, and unclear roles and responsibilities after decentralization.</p> <p>Conclusion</p> <p>The study highlights various shortcomings and bottlenecks in the PEI, and the barriers identified should be considered in prioritizing future strategies.</p

SIGN Nail Experience in Manipal Teaching Hospital

Abstract Fifty-two patients who underwent intramedullary nailing of long bone fractures using the SIGN nail at the Department of Orthopedics, Manipal Teaching Hospital from July 2010 to July 2014 were reviewed. Healing of the fracture, incidence of post-operative complications, implant failures, weight bearing capability were described and analyzed based on the medical records and official website of SIGN. Demographic of patients, fracture configuration, size of nail and screws used, the pre and post-operative radiographs were also reviewed. Post operatively with a mean follow-up of 6 months, 46.1% of the patients had beginning callus, 40.4% of the patients were already healed, 3.8% had infection and outcome was undetermined in 9.7%. No implant failure was noted in this study

A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal

Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees with low SBA utilization among 1-year intervention and control groups. The eligible participants for the survey were women that had delivered a baby within the past 12 months preceding the survey. Implementation was administered by trained health volunteers, youth groups, mothers' groups and health facility management committee members. Post-intervention, we used difference-in-differences and mixed-effects regression models to assess and analyse any increase in the utilization of skilled birth care and antenatal care (ANC) services. All analyses were done by intention to treat. Our trial registration number was ISRCTN78892490 (http://www.isrctn.com/ISRCTN78892490). Interviewees included 1746 and 2098 eligible women in the intervention and control groups, respectively. The 1-year intervention was effective in increasing the use of skilled birth care services (OR = 1.57; CI 1.19-2.08); however, the intervention had no effect on the utilization of ANC services. Expanding the intervention with modifications, e.g. mobilizing more active and stable community groups, ensuring adequate human resources and improving quality of services as well as longer or repeated interventions will help achieve greater effect in increasing the utilization of SBA.CC BY-NC 4.0</p

Simultaneous identities: ethnicity and nationalism in mother tongue education in Nepal *

The scholarly works on ethnicity and nationalism have been highly dominated by binary frameworks. In addition, the normative preference for civic consciousness and the concerns of national disintegration often separate the notions of ethnicity and nationalism. This article suggests that the notions of ethnicity and nationalism cannot be understood exclusively as a choice between maintaining the integrity of the nation and completely rejecting it. Drawing on fieldwork in mother tongue schools in Nepal, the article draws attention to the ways in which school actors discursively positioned ethnic identity as imperative to national identity, the one that bolsters the notion of Nepali nationhood. By paying close attention to the everyday context within which discourses of nationalism are situated, this article argues for an analytical necessity to approach ethnicity and nationalism in relation to each other to appreciate the process of symbolic negotiations in public spaces