Monitoring quality of care in the WHO Africa Region-a study design for measurement and tracking, towards UHC attainment

This paper reports on the design of a study to generate a quality of care index for countries in the World Health Organization Africa Region.Quality of care, for all people at all times, remains pivotal to the advancement of the 2030 agenda and the attainment of Universal Health Coverage. We present a study protocol for deriving a quality of care index, hinged on indicators and data elements currently monitored through routine information systems and institutionalized facility assessments in the World Health Organization Africa Region.This paper seeks to offer more insight into options in the Region for strengthening monitoring processes of quality of care, as a step towards generating empirical evidence which can galvanize action towards an improved care process.The methodology proposed in this study design has broad implications for policymaking and priority setting for countries, emphasizing the need for robust empirical measures to understand the functionality of health systems for the delivery of quality essential services. Application of this protocol will guide policymaking, as countries work to increasingly improve quality of care and adopt policies that will best facilitate their advancement towards Universal Health Coverage

Demand-led approaches to drive post-harvest innovation and nutritious RTB products

Roots, Tubers and Bananas (RTB) Strategy Development Workshop Report

The Economics of Drawdown Irrigation Farming: A Case Study of the Ampaem Area of Ghana

In the study parametric linear programming is used to analyse the profitability of alternate crops (i.e. maize, tomatoes, okro, groundnuts and cowpeas) suited to the Ampaem locality of Ghana. Attention has been focused on the Ampaem drawdown area because the economic and technical opportunities available to farmers are better documented for the area. Moreover the environmental conditions in the area are similar to the other drawdown areas along the Volta Lake; therefore deductions from the analysis can be generally applied for policy recommendations. ... The results show that, out of the five recommended drawdown crops, groundnuts and tomatoes are important as cash crops while maize should be grown for subsistence. Moreover small-scale irrigated agriculture is to be given some attention by policy makers because of the drought nature of drawdown areas along the lake. This will, in turn, help to boost up food production in the country. Finally, in the study, a direct relationship has been established between the maximum lake level and the total drawdown area to be exposed in a particular cropping season

Surgically correctable adrenal-dependent hypertension: a report of five cases

Although endocrine causes of secondary hypertension are relatively uncommon, medical practitioners must maintain a high index of suspicion for them in certain categories of patients. Such patientsinclude young individuals, those with difficult- to-treat hypertension and those presenting with symptoms, clinical signs and/or laboratoryparameters well-known to be associated with Cushing’s syndrome, Conn’s syndrome or phaeochromocytoma. This paper reports on 5 patients identified over a 2-year period with various hormonally-activeadrenal adenomas causing hypertension in an environment where, hitherto, the occurrence of these conditions was generally thought to be rare. Aspects of the patients’ histories, examination and laboratory findings that drew attention to the possibility of the diagnosis in each case are highlighted, as are the confirmatory investigationsand management methods used by a multidisciplinary team of medical practitioners. The clinical outcome with appropriate treatment of adrenalrelated hypertension is good and can result in significantcost savings in the long term

Education for Sustainable Development: Towards the Sustainable University

We  planned  this  conference  in  anticipation  of  the  end  of  the  UN  Decade  of  Education  for  Sustainable   Development  (DESD),  and  the  start  of  the  next  phase  for  those  involved  in  ESD  here  and   internationally.    At  Plymouth  University,  2015  marks  ten  year  anniversary  since  cross-­‐institutional   work  on  sustainability  and  sustainability  education  was  spearheaded  by  the  founding  of  the  Centre  for   Sustainable  Futures  (CSF).    Coincidentally,  2015  also  marks  a  ten  years  since  the  influential  HEFCE   policy  document  ‘Sustainable  Development  in  Higher  Education’  was  released.   Holding  the  conference  in  January  –  named  after  the  Roman  god  of  doorways,  of  endings  and   beginnings  –  we  sought  to  look  at  some  of  what  has  been  achieved  in  sustainability  education  to  date   and  explore  its  prospects  as  we  move  forward.   Following  an  enthusiastic  response  to  the  call  for  abstracts,  the  conference  featured  a  diverse  range   of  research  papers,  posters,  and  roundtable  presentations  from  academics  and  practitioners  across   the  UK  and  beyond.  The  conference  was  arranged  around  three  overarching  themes:     ESD  Pedagogy:  Criticality,  Creativity,  and  Collaboration   What  are  the  teaching  and  learning  processes  that  enable  students  to  develop  their  own  capacity  to   think  critically  and  creatively  in  the  face  of  global  sustainability  challenges  and,  secondly,  to  act   collaboratively  in  ways  that  pursue  more  hopeful  and  sustainable  futures?   Innovative  Learning  Spaces  for  ESD   What  are  the  physical  environments  that  provide  opportunities  for  new  forms  of  sustainability   education  to  flourish?  What  lies  beyond  the  lecture  hall  that  is  conducive  to  student  learning  through   inquiry-­‐based,  active,  participatory,  interdisciplinary  and  experiential  methods?   Towards  the  Sustainable  University   What  are  effective  approaches  for  leading  institutional  change,  organisational  learning,  and  staff  CPD   towards  sustainability?  This  publication  focuses  on  the  last  theme  –  Towards  the  Sustainable  University.    The  previous   PedRIO  Occasional  Paper  8  looks  at  the  first  theme  ESD  Pedagogy:  Criticality,  Creativity,  and   Collaboration

Insulin signalling and the regulation of glucose and lipid metabolism

The epidemic of type 2 diabetes and impaired glucose tolerance is one of the main causes of morbidity and mortality worldwide. In both disorders, tissues such as muscle, fat and liver become less responsive or resistant to insulin. This state is also linked to other common health problems, such as obesity, polycystic ovarian disease, hyperlipidaemia, hypertension and atherosclerosis. The pathophysiology of insulin resistance involves a complex network of signalling pathways, activated by the insulin receptor, which regulates intermediary metabolism and its organization in cells. But recent studies have shown that numerous other hormones and signalling events attenuate insulin action, and are important in type 2 diabetes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62568/1/414799a.pd

Do leadership styles influence productivity?

Background: Leadership and productivity in nursing and midwifery have become topical issues for discussion. This is possibly due to nurses constituting the largest group of the healthcare workforce. Nurses and midwives have been held accountable for low productivity and inappropriate leadership in the past. However, there has been limited consensus in the nursing literature about the impact of nurse managers' leadership styles on nurses' and midwives' productivity levels. Method: Two hundred and seventy five nurses and midwives (response rate of 99.2%) were asked to take part in a cross-sectional survey from five hospitals in the eastern region of Ghana, to examine the impact of nurse managers' leadership styles on self-reported productivity levels. Descriptive summaries, Pearson's correlations and linear regressions are presented. Results: Findings show for every hour of lost productive time, four hours of unpaid overtime in the course of the month was accrued due to staff shortages. Nurse managers' most frequently exercised a supportive leadership style, and a directive leadership style the least. Within the last one month of work experience prior to the study, nurses' self-perception of productivity levels were high (8.39 on a 10-point scale), 10% more productive than their peers in the same unit. Nurses believed their own productivity improved by about 1.8% over the preceding six months. Leadership styles explained only 6.9% (95% CI: 4.6-9.3%) of the variance in nurses' perceived level of productivity. Achievement-oriented leadership style most significantly improved productivity by 18.4% (95% CI: 13.0-24.0%). Implications for management and policy: There is a need to strengthen supervision and establish performance benchmarks within nursing and midwifery to measure staff performance, addressing health worker productivity more seriously through research and policy. Health institutions should invest in leadership development programmes for nurses and midwives to maximise productivity

Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis.

BACKGROUND: Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization-recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. We conducted a systematic review to explore factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women. METHODS AND RESULTS: We searched the Malaria in Pregnancy Library and Global Health Database from 1 January 1990 to 23 April 2013, without language restriction. Data extraction was performed by two investigators independently, and data was appraised for quality and content. Data on barriers and facilitators, and the effect of interventions, were explored using content analysis and narrative synthesis. We conducted a meta-analysis of determinants of IPTp and ITN uptake using random effects models, and performed subgroup analysis to evaluate consistency across interventions and study populations, countries, and enrolment sites. We did not perform a meta-ethnography of qualitative data. Ninety-eight articles were included, of which 20 were intervention studies. Key barriers to the provision of IPTp and ITNs were unclear policy and guidance on IPTp; general healthcare system issues, such as stockouts and user fees; health facility issues stemming from poor organisation, leading to poor quality of care; poor healthcare provider performance, including confusion over the timing of each IPTp dose; and women's poor antenatal attendance, affecting IPTp uptake. Key determinants of IPTp coverage were education, knowledge about malaria/IPTp, socio-economic status, parity, and number and timing of antenatal clinic visits. Key determinants of ITN coverage were employment status, education, knowledge about malaria/ITNs, age, and marital status. Predictors showed regional variations. CONCLUSIONS: Delivery of ITNs through antenatal clinics presents fewer problems than delivery of IPTp. Many obstacles to IPTp delivery are relatively simple barriers that could be resolved in the short term. Other barriers are more entrenched within the overall healthcare system or socio-economic/cultural contexts, and will require medium- to long-term strategies. Please see later in the article for the Editors' Summary