District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study

Background: In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). Methods: This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. Results: The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. Conclusions: The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs

Compounds associated with infection by the root-knot Nematode, Meloidogyne javanica influence the ability of infective juveniles to recognize host plants

Plant root chemistry is altered by parasitism of plant parasitic nematodes (PPN). Here, we 2 investigated the influence of the infective stage juveniles (J2) of Meloidogyne javanica in 3 inducing tomato (Solanum lycopersicum) root volatiles, and chemotactic effect on conspecifics. 4 In olfactometer assays, J2 avoided roots of 2-day infected plants but preferred 7-day infected 5 tomato compared to healthy plants. Chemical analysis showed a two- to seven-fold increase in 6 the amounts of monoterpenes emitted from tomato roots infected with M. javanica relative to 7 healthy roots. In further bioassays, the monoterpenes β-pinene, (+)-(2)-carene, α-phellandrene, 8 and β-phellandrene differentially attracted (51-87%) J2 relative to control. Concurrent reduction 9 and increase in the levels of methyl salicylate and (Z)-methyl dihydrojasmonate, respectively, in 10 the root volatiles reduced J2 responses. These results demonstrate that the host plant can alter its 11 root volatile composition to inhibit PPN attack. The observed plant-produced inhibition of J2 12 warrants further investigation as a potential management tool for growers

Repellency and composition of essential oils of selected ethnobotanical plants used in Western Kenya against bites of Anopheles gambiae Sensu Stricto

The essential oils of Ocimum gratissimum Linn, Hyptis suaveolens (L) Poit and Vitex keniensis, which are used traditionally in Western Kenya for personal and space protection against mosquito bites, were screened for repellence against Anopheles gambiae Sensu Stricto. Essential oils were extracted from their leaves by hydrodistillation, characterised by gas chromatography linked with mass spectrophotometer and electroantennogram detectors. The repellency of the oils and their selected blends was studied by the reduction in probing and feeding on the human arm. The oils showed promising repellency for Anopheles gambiae, O. gratissimum (RD50 = 2.77 × 10-5 mg cm-2, 95% CI), Vitex keniensis (RD = 5.68 × 10-5 mg cm-2) and Hyptis suaveolens (6.27× 10-5 mg cm-2) as compared to that of DEET (control) RD = 1.25×10-5 mg cm-2). The bioactive constituents of each oil were identified by Gas chromatography-linked with Mass spectrometry and Electroantennography. Some compounds were confirmed by co-injections of the oil with available authentic standards. The results provide a scientific rationale for the traditional use of these plants in repelling disease vectors and other biting insects, and lay down some useful groundwork for downstream development of more effective products for personal and space protection

Cyst nematode bio-communication with plants: implications for novel management approaches

Bio-communication occurs when living organisms interact with each other, facilitated by the exchange of signals including visual, auditory, tactile and chemical. The most common form of bio-communication between organisms is mediated by chemical signals, commonly referred to as ‘semiochemicals’, and it involves an emitter releasing the chemical signal that is detected by a receiver leading to a phenotypic response in the latter organism. The quality and quantity of the chemical signal released may be influenced by abiotic and biotic factors. Bio-communication has been reported to occur in both above- and below-ground interactions and it can be exploited for the management of pests, such as cyst nematodes, which are pervasive soil-borne pests that cause significant crop production losses worldwide. Cyst nematode hatching and successful infection of hosts are biological processes that are largely influenced by semiochemicals including hatching stimulators, hatching inhibitors, attractants and repellents. These semiochemicals can be used to disrupt interactions between host plants and cyst nematodes. Advances in RNAi techniques such as host-induced gene silencing to interfere with cyst nematode hatching and host location can also be exploited for development of synthetic resistant host cultivars

Comparing labour induction outcomes using misoprostol and dinoprostone in term pregnancies: A retrospective study at Kiambu Level 5 Hospital between 2018 and 2020.

BackgroundThe Maternal and Perinatal Death Surveillance and Response (MPDSR) was introduced in Kenya in 2016 and implemented at Kiambu Level 5 Hospital (KL5H) three years later in 2019. During a routine MPDSR meeting at KL5H, committee members identified a possible link between the off-label use of 200mcg misoprostol tablets divided eight times to achieve the necessary dose for labour induction (25mcg) and maternal deaths. Following this, an administrative decision was made to switch from misoprostol to dinoprostone for the induction of labour in June of 2019. This study aimed to assess the overall impact of MPDSR as well as the effect of replacing misoprostol with dinoprostone on uterine rupture, maternal and neonatal deaths at KL5H.MethodsWe conducted a retrospective cohort study of women who gave birth at KL5H between January 2018 and December 2020. We defined the pre-intervention period as January 2018-June 2019, and the intervention period as July 2019-December 2020. We randomly selected the records of 411 mothers, 167 from the pre-intervention period and 208 from the intervention period, all of whom were induced. We used Bayes-Poisson Generalised Linear Models to fit the risk of uterine rupture, maternal and perinatal death. 12 semi-structured key person questionnaires was used to describe staff perspectives regarding the switch from misoprostol to dinoprostone. Inductive and deductive data analysis was done to capture the salient emerging themes.ResultsWe reviewed 411 patient records and carried out 12 key informant interviews. Mothers induced with misoprostol (IRR = 3.89; CI = 0.21-71.6) had an increased risk of death while mothers were less likely to die if they were induced with dinoprostone (IRR = 0.23; CI = 0.01-7.12) or had uterine rupture (IRR = 0.56; CI = 0.02-18.2). The risk of dying during childbearing increased during Jul 2019-Dec 2020 (IRR = 5.43, CI = 0.68-43.2) when the MPDSR activities were strengthened. Induction of labour (IRR = 1.01; CI = 0.06-17.1) had no effect on the risk of dying from childbirth in our setting. The qualitative results exposed that maternity unit staff preferred dinoprostone to misoprostol as it was thought to be more effective (fewer failed inductions) and safer, regardless of being more expensive compared to misoprostol.ConclusionWhile the period immediately following the implementation of MPDSR at KL5H was associated with an increased risk of death, the switch to dinoprostone for labour induction was associated with a lower risk of maternal and perinatal death. The use of dinoprostone, however, was linked to an increased risk of uterine rupture, possibly attributed to reduced labour monitoring given that staff held the belief that it is inherently safer than misoprostol. Consequently, even though the changeover was warranted, further investigation is needed to determine the reasons behind the rise in maternal mortalities, even though the MPDSR framework appeared to have been put in place to quell such an increase

Informe global de la corrupción 2006: Corrupción y salud

Este informe presenta una selección de estudios sobre transparencia y corrupción que abarcan desde la relación de la corrupción con los fenómenos socioeconómicos hasta los vínculos entre implementación de políticas y cambios. El punto de partida es el análisis empírico de la corrupción que, en la actualidad, ha logrado una posición firme en un gran número de disciplinas de investigación. El acceso a esta información resulta imprescindible para comprender mejor el campo de la corrupción y permite a los responsables de formular políticas interpretar e incorporar resultados en sus iniciativas anticorrupción

Informe global de la corrupción 2006: Corrupción y salud

Este informe presenta una selección de estudios sobre transparencia y corrupción que abarcan desde la relación de la corrupción con los fenómenos socioeconómicos hasta los vínculos entre implementación de políticas y cambios. El punto de partida es el análisis empírico de la corrupción que, en la actualidad, ha logrado una posición firme en un gran número de disciplinas de investigación. El acceso a esta información resulta imprescindible para comprender mejor el campo de la corrupción y permite a los responsables de formular políticas interpretar e incorporar resultados en sus iniciativas anticorrupción

Rethinking HIV prevention to prepare for oral PrEP implementation for young African women

Introduction: HIV incidence remains high among young women in sub-Saharan Africa in spite of scale-up of HIV testing, behavioural interventions, antiretroviral treatment and medical male circumcision. There is a critical need to critique past approaches and learn about the most effective implementation of evidence-based HIV prevention strategies, particularly emerging interventions such as pre-exposure prophylaxis (PrEP). Discussion Women in sub-Saharan Africa are at increased risk of HIV during adolescence and into their 20s, in part due to contextual factors including gender norms and relationship dynamics, and limited access to reproductive and sexual health services. We reviewed behavioural, behavioural economic and biomedical approaches to HIV prevention for young African women, with a particular focus on the barriers, opportunities and implications for implementing PrEP in this group. Behavioural interventions have had limited impact in part due to not effectively addressing the context, broader sexual norms and expectations, and structural factors that increase risk and vulnerability. Of biomedical HIV prevention strategies that have been tested, daily oral PrEP has the greatest evidence for protection, although adherence was low in two placebo-controlled trials in young African women. Given high efficacy and effectiveness in other populations, demonstration projects of open-label PrEP in young African women are needed to determine the most effective delivery models and whether women at substantial risk are motivated and able to use oral PrEP with sufficient adherence to achieve HIV prevention benefits. Conclusions: Social marketing, adherence support and behavioural economic interventions should be evaluated as part of PrEP demonstration projects among young African women in terms of their effectiveness in increasing demand and optimizing uptake and effective use of PrEP. Lessons learned through evaluations of implementation strategies for delivering oral PrEP, a first-generation biomedical HIV prevention product, will inform development of new and less user-dependent PrEP formulations and delivery of an expanding choice of prevention options in HIV prevention programmes for young African women