An Intervention Delivered by App Instant Messaging to Increase Acceptability and Use of Effective Contraception Among Young Women in Bolivia: Protocol of a Randomized Controlled Trial.

BACKGROUND: Unintended pregnancy is associated with numerous poorer health outcomes for both women and their children. Fulfilling unmet need for contraception is essential in avoiding unintended pregnancies, yet millions of women in low- and middle-income countries continue to face obstacles in realizing their fertility desires. In Bolivia, family planning progress has improved in recent decades but lags behind other countries in the region. Unmet need for contraception among women aged 15 to 19 years is estimated to be 38%, with the adolescent fertility rate at 70 per 1000 women. Mobile phones are an established and popular mode in which to deliver health behavior support. The London School of Hygiene & Tropical Medicine and the Centro de Investigación, Educación y Servicios in Bolivia have partnered to develop and evaluate a contraceptive behavioral intervention for Bolivian young women delivered by mobile phone. The intervention was developed guided by behavioral science and consists of short instant messages sent through an app over 4 months. OBJECTIVE: The objective of this study is to evaluate the effect of the intervention on young women's use of and attitudes toward the most effective contraceptive methods. METHODS: We will allocate 1310 women aged 16 to 24 years with an unmet need for contraception in a 1:1 ratio to receive the intervention messages or the control messages about trial participation. The messages are sent through the Tú decides app, which contains standard family planning information. Coprimary outcomes are use and acceptability of at least one effective contraceptive method, both measured at 4 months. RESULTS: Recruitment commenced on March 1, 2017 and was completed on July 29, 2017. We estimate that the follow-up period will end in January 2018. CONCLUSIONS: This trial will evaluate the effect of the intervention on young women's use of and attitudes toward the (nonpermanent) effective contraception methods available in Bolivia. TRIAL REGISTRATION: ClinicalTrials.gov NCT02905526; https://clinicaltrials.gov/ct2/show/NCT02905526 (Archived by WebCite at http://www.webcitation.org/6vT0yIFfN)

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Determinación de los parámetros electroquímicos óptimos para la remoción de cromo (III) y DQO en aguas de curtido a traves del proceso de electrocoagulación en un reactor de recirculación

TesisEn los últimos años, los estudios de remoción de Cromo de las aguas de curtido es un área creciente de investigación debido a la cantidad de residuos que no son procesados y son vertidos sin tratamiento alguno. Para el presente caso se colectaron las aguas de curtido proporcionadas por la “Curtiembre Austral”, ubicada en el Parque Industrial de Rio Seco - Arequipa. La muestra de aguas fue almacenada en un tanque de polietileno de alta densidad, para su posterior caracterización. En dicha muestra se determinó la concentración inicial de Cromo (VI), Cromo (III) y la Demanda Química de Oxígeno (DQO), así mismo se determinó la cantidad de Cromo (III), Cromo (VI) removido y la Demanda Química de Oxigeno (DQO) de las aguas de curtido, mediante el empleo de un reactor electroquímico de recirculación constituido por una cuba electroquímica con un volumen de 40 litros de capacidad, conteniendo 7 ánodos de Fierro y 7 cátodos de Aluminio con una separación entre electrodos de 1cm y 2 cm. La energía eléctrica fue suministrada por un transformador rectificador de corriente con una entrada de 220V, salida 3V a 20V y de 0A a 60 A de corriente continua. El tiempo de retención hidráulico se determinó experimentalmente siendo este de 60 minutos para un volumen de 40 litros de agua de curtido, optimizándolo a 240 minutos por corrida. Se determinó la conductividad en cada tratamiento para medir la cantidad de corriente que pasa por el electrolito en función de la concentración iónica. Siendo que a un pH igual a 5 el proceso alcanza su mayor efectividad, a una densidad de corriente de 2,5 A/m2, un tiempo de 90 minutos y una separación de electrodos de 1 cm. Se alcanzó el valor de 0,3mg/L de Cromo (III); 0,05mg/L de Cromo (VI); 0,3mg/L de Cromo Total y 38 mg/L de Demanda Química de Oxigeno (DQO), encontrándose por debajo de los Límites Máximos Permisibles (LMP) para aguas superficiales de curtiembres, aprobado por el DECRETO SUPREMO N° 003-2002 PRODUCE

Additional file 3 of Development of an intervention delivered by mobile phone aimed at decreasing unintended pregnancy among young people in three lower middle income countries

The matrix that displays the change objectives by crossing the determinants and performance objectives. (PDF 354 kb

Development of an intervention delivered by mobile phone aimed at decreasing unintended pregnancy among young people in three lower middle income countries

The collection consists of four files: [1] a discussion guide used in focus group discussions and interviews with the target group; [2] a discussion guide used in interviews with providers; [3] a matrix that displays the change objectives by crossing the determinants and performance objectives; and [4] the behaviour change methods included in the intervention, the basis upon which they were selected, determinants, parameters for effectiveness, and how the parameters were taken into account