Determinants of Climate Change Adaptation Strategies among Smallholder Farmers in Nine African Mountains

Mountain environments in Africa are facing increasingly rapid changes in temperature and rainfall patterns, which pose challenges for crop production. The growing literature has revealed that smallholder farmers use multiple adaptation strategies to respond to and reduce climate change impacts. However, more research on adaptation strategies and factors influencing the choice of those strategies still needs to be carried out, especially for mountains in Africa. Therefore, this study aimed to identify determinants of smallholder farmers' adoption of common adaptation strategies in the African mountains. A total of 1,350 farmer households were interviewed in nine mountains in seven countries. The results showed that the farmers primarily use on-farm strategies, including the use of improved varieties of crops, increased application of fertilisers and pesticides, soil and water conservation techniques and changes in planting dates. The farmers' choice of adaptation strategies was influenced by age, English or French proficiency, number of adults and children in the family, farm size, livestock ownership, village elevation, and market distance. These findings highlight the importance of considering the unique socio-ecological characteristics and resources of different mountain regions and the cultures of smallholder farmers in designing interventions to support their adaptation to climate change. Keywords: adaptation; Africa; climate change; mountain regions; smallholder farmer

Ultrasonographic assessment of strength of previous cesarean scar during pregnancy

Background: Management of a woman who has undergone a previous cesarean section, has always been a controversial topic, with the inability to precisely confirm the integrity of the scarred lower uterine segment (LUS) being the indication of repeat cesarean section. The objective of this study is to evaluate the accuracy of ultrasonography (USG) in determining the LUS thickness in women with previous cesarean section (CS) and to assess its usefulness in predicting the risk of uterine rupture during a trial of vaginal birth.Methods: A prospective study was conducted on 100 women between 37 to 40 weeks of gestation with a previous CS and 100 primigravidae women serving as control. Thickness of LUS was measured by transabdominal USG. The decision for mode of delivery was based purely on obstetric ground. Patients undergoing CS were considered for analysis.Results: Mean LUS thickness was higher in the control group. Seventy-one patients of control group underwent repeat CS, in which 47 (66.1%) had normal intraoperative finding. 24 (33.7%) had abnormal LUS intraoperatively (LUS thinning). Of these, 20 (28.6%) showed abnormal LUS on USG (<5mm), but 4(5.6%) had normal ultrasonographic finding. Sensitivity, specificity, positive and negative predictive value of ultrasonographic evaluation were found to be 100%, 83.3%, 92% and 100% respectively.Conclusions: Prenatal scar assessment by USG is useful in evaluation of previous cesarean scar and in most cases a near accurate evaluation was possible.

Knowledge, attitudes and practices related to cervical cancer screening in adult women: a hospital based cross-sectional study

Background: The Pap smear is a reliable, inexpensive and effective screening test for cervical cancer; the second most common cancer among women worldwide. We aimed to determine women’s knowledge, attitudes and practice towards Pap smear and barriers for the screening in a public hospital.Methods: It was a hospital based cross sectional study on 300 women who were interviewed face-to-face with a structured questionnaire regarding their socio demographic features (8 questions), knowledge (20 questions), attitudes (7 statements) and practice (undertook test or not) towards Pap smear.Results: A total of 320 women were approached for interview of which 300 responded of which 33.33% had heard of cervical cancer. At least one symptom and one risk factor were known to 13.33% and 20% participants. Only 31.33% participants had heard, and 6.67% actually underwent screening test, however, 76.25% of the participants expressed a favourable attitude for screening.Conclusions: Education level influences attitude towards screening and actual practice depends on age, income, and marital status. This study shows that despite the fact that women had suboptimal level of knowledge regarding cervical cancer, their attitude is favourable for screening. The knowledge and practice of women was inadequate and needs to be promoted.

Current Pharmaceutical Situation (Services) in Yemen and Future Challenges

This article deals with Yemen’s current pharmaceutical scenario and possible future challenges that it may face. The manuscript provides an overview of health services particularly pharmaceutical services and the critical health challenges facing the people of the country. Details included are statistical data with regard to the health of the Yemeni population and their demographic backgrounds following administrative issues, policy for the medicinal trade and production, the regulation and financing. The manuscript also deals with the government’s action about medicines, their procurement, and distribution in the public sector, and the public perception of medicines. Rational use of medicines is determined by the knowledge and attitude of the consumers. Future challenges are also anticipated. World health systems have been facing an incredible transformation to address new challenges with regard to the demographics, disease trends, the emergence and the re-emergence of diseases along with higher costs of health care delivery. This has led to a comprehensive review of health systems and how they function to serve the masses. Some health systems do not seem to adequately provide services that really matter to the people and some deteriorate, following governments’ lack of efficiency in supporting and extending the services. Other issues can also affect the ability of the health systems to deliver including health administration, healthcare financing, the lack of balance of the human resources, inaccessible and poor quality services and the impact of modifications and reform prevalent in other economic areas

An educational intervention’s effect on healthcare professionals’ attitudes towards pharmacovigilance

BackgroundPharmacovigilance concerns the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. Consumer pharmacovigilance is the involvement of consumers in adverse drug reaction (ADR) reporting. Assessing healthcare professionals’ (HCPs) knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance is integral to strengthening adverse drug reaction reporting systems. AimsTo study knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance among HCPs from KIST Medical College, Lalitpur, Nepal, and to plan an appropriate educational intervention to address deficiencies noted.Methods The study was conducted from February 2013 to December 2013 at KIST Medical College using a self-administered, pretested, structured questionnaire. The maximum possible scores for knowledge, attitude, and total were 100, 95, and 195, respectively. Baseline knowledge and attitude were studied. Two months after the questionnaire, an intervention that used a combination of methods about pharmacovigilance and consumer pharmacovigilance was undertaken. Knowledge and attitudes were studied immediately after the intervention. Scores before and after the intervention were compared using Wilcoxon signed-rank test.Results A total of 105 HCPs participated. The median (interquartile range) knowledge, attitude, and total scores before the intervention were 56 (7), 72 (9), and 127 (16), respectively. After the intervention the scores increased significantly to 72 (8), 75 (11.5), and 146 (16.5) (

EN-BIRTH Data Collector Training - Handbook and Manual

The EN-BIRTH study aims to validate selected newborn and maternal indicators for routine facility-based tracking of coverage and quality of care for use at district, national and global levels. The item contains the EN-BIRTH_Trainer's Manual (14 June 2017) and EN-BIRTH_Training Handbook (23 May 2017)

Problems and challenges faced in consumer reporting of adverse drug reactions in developing countries – A case study of Yemen, Nepal and Malaysia

Background: Pharmacovigilance is the “science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems”. The most commonly used adverse drug reaction (ADR) reporting system worldwide is spontaneous and voluntary reporting, which forms the backbone of reporting systems. Aims: To explore the current status of consumer involvement in the pharmacovigilance program in three developing countries, Yemen, Nepal and Malaysia. Method: An analysis was carried out for these three countries based on the current status of pharmacovigilance and involvement of consumers in their pharmacovigilance programs. Results: Malaysia has a good system for involving consumers in their national pharmacovigilance system, whereas Yemen still lacks the well-formed national drug policy. Lack of legislation and regulation which govern the import and distribution of drugs in Yemen is a limiting factor for development of consumer pharmacovigilance. Despite establishment of a pharmacovigilance centre, no reports have been released by the centre. The status of pharmacovigilance in Nepal is still in infancy. The regulatory body is assigned to be a national pharmacovigilance center, and coordinates with seven regional centers for pharmacovigilance activities. Nepal also lacks the involvement of consumers in the national pharmacovigilance program. Conclusion: Consumer reporting may be important for developing countries to implement a proper and effective pharmacovigilance program that can reduce morbidity and mortality rates, as well as reducing the economic burden of ADRs

EN-BIRTH Data Collector Training - Supporting Annexes

The EN-BIRTH study aims to validate selected newborn and maternal indicators for routine facility-based tracking of coverage and quality of care for use at district, national and global levels. The item contains consent forms and participant information, in addition to standard operating procedures (SOP) for adverse clinical events, and managing distress in interviews. The full complement of annex files used during the training can be requested via this site if required

EN-BIRTH Data Collection Tools

The EN-BIRTH study aims to validate selected newborn and maternal indicators for routine facility-based tracking of coverage and quality of care for use at district, national and global levels. The item contains the following data collection tools: Register data extraction, Observation checklist (labour and delivery ward), Observation checklist (kangaroo mother care), Patient record verification tools for antenatal corticosteroid administration, Patient record verification tools for antibiotic administration, and the Maternal recall survey