Towards improving the measurement of unsafe abortion: substantive estimates and methodological insights from Zambia.

Background: Measuring unsafe abortion is essential to understand the magnitude of the problem and monitor progress in women’s reproductive health. However, legal and societal constraints in high-burden contexts foster underreporting of induced abortions which makes obtaining accurate estimates challenging. My PhD examines the methodological challenges around defining and measuring unsafe abortions using Zambia as my country context. Methods: First, I conducted interrupted time series analysis on admissions for abortion-related complications and deaths from 2007-2015 at University Teaching Hospital (UTH), Lusaka to assess the impact of key contextual changes. Second, I collected data from women hospitalized for abortion-related complications in three provinces to estimate the incidence of abortion-related near-miss in 2014. Third, I compared estimates of the incidence of induced abortion in the three provinces using data from 3 methodological approaches. Results: The prevalence of unsafe and induced abortion is high in Zambia. Following the release of clinical guidelines in May 2009, there was an immediate decline in the absolute number of abortion complications by 86 cases (p=0.003). The abortion-related near-miss incidence rate was 72 per 100,000 women, and it was feasible to apply the adapted WHO near-miss criteria in Zambia. Estimates of the incidence of induced abortion per 1000 women ranged from 30 to 80. There was variation in the proportion of women estimated to seek facility care for abortion-related complications in each approach. Conclusion: The burden of unsafe abortion is high in Zambia despite its liberal law. Although there is no gold standard method to measure the burden of unsafe abortion, my findings suggest there is scope to improve use of available data to describe the burden of the most unsafe abortions and evaluate the impact of interventions on abortion-related indicators in restrictive contexts

Toxicity of cassava wastewater effluents to African catfish: Clarias gariepinus (Burchell, 1822)

The relative lethal and sublethal toxicity of cassava wastewater effluents from a local food factory were investigated on Clarias gariepinus fingerlings using a renewable static bioassay. The physico-chemical characteristics of the cassava wastewater effluents showed a number of deviations from the standards of the Federal Environmental Protection Agency (FEPA) on the guidelines for effluent discharges. Considering the pollutants of the effluent, cyanide (CN) is suspected to be primarily responsible for the toxicity, although synergistic effect of other pollutants cannot be ruled out. At each exposure, in the two tests, the test-organisms showed signs of serious stress, swimming pattern changed and mortality increased over relatively small increase in concentration. The LC50 for lethal and sublethal tests were 0.024 mg1-1 and 0.0064 mg1-1, respectively. The differences observed in the mortalities and bioconcentration of metals in fish muscles of varying concentrations were significant (

Effect of heat moisture treatment and annealing on physicochemical properties of red sorghum starch

Red sorghum starch was physically modified by annealing and heat moisture treatment. The swelling power and solubility increased with increasing temperature range (60-90°), while annealing and heatmoisturetreatment decreased swelling power and solubility of starch. Solubility and swelling were pH dependent with higher values obtained at pH 12 in both native and modified starches. Water absorption capacities of both annealed and heat-moisture treated starches increased with increasing levels of moisture treatment while highest value was observed in annealed starch. Oil absorption capacity of annealed starch was increased which was contrast to heat-moisture treated starches which decreased from 160 glg in native starch to 140 glg in HMR18 and HMR27. Pasting analysis in the Rapid Visco Analyser (RVA) revealed that both annealing and heat-moisture treatment increased pastingtemperature, while alkaline water retention improved after physical modification

Incidence of abortion-related near-miss complications in Zambia: cross-sectional study in Central, Copperbelt and Lusaka Provinces

OBJECTIVES: To describe the magnitude and severity of abortion-related complications in health facilities and calculate the incidence of abortion-related near-miss complications at the population level in three provinces in Zambia, a country where abortion is legal but stigmatized. STUDY DESIGN: We conducted a cross-sectional study in 35 district, provincial and tertiary hospitals over 5 months. All women hospitalized for abortion-related complications were eligible for inclusion. Cases of abortion-related near-miss, moderate and low morbidity were identified using adapted World Health Organization (WHO) near-miss and the prospective morbidity methodology criteria. Incidence was calculated by annualizing the number of near-misses and dividing by the population of women of reproductive age. We calculated the abortion-related near-miss rate, abortion-related near-miss ratio and the hospital mortality index. RESULTS: Participating hospitals recorded 26,723 births during the study. Of admissions for post-abortion care, 2406 (42%) were eligible for inclusion. Near-misses constituted 16% of admitted complications and there were 14 abortion-related maternal deaths. The hospital mortality index was 3%; the abortion-related near-miss rate for the three provinces was 72 per 100,000 women, and the near-miss ratio was 450 per 100,000 live births. CONCLUSIONS: Abortion-related near-miss and mortality are challenges for the Zambian health system. Adapted to reflect health systems capabilities, the WHO near-miss criteria can be applied to routine hospital records to obtain useful data in low-income settings. Reducing avoidable maternal mortality and morbidity due to abortion requires efforts to de-stigmatize access to abortion provision, and expanded access to modern contraception. IMPLICATIONS: The abortion-related near-miss rate is high in Zambia compared with other restrictive contexts. Our results suggest that near-miss is a promising indicator of unsafe abortion; can be measured using routine hospital data, conveniently defined using the WHO criteria; and can be incorporated into the frequently utilized prospective morbidity methodology

Optimising material procurement for construction waste minimization: An exploration of success factors

Although construction waste occurs during the actual construction activities, there is an understanding that it is caused by activities and actions at design, materials procurement and construction stages of project delivery processes. This study investigates the material procurement and logistics measures for mitigating waste generated by construction activities. In a bid to explore the phenomenon from the perspectives of experts from the construction industry, this study used a combination of descriptive interpretive research and survey approach as its methodological framework. The study suggests that four features characterised waste efficient logistic and procurement process. These include suppliers' commitment to low waste measures, low waste purchase management, effective materials delivery management and waste efficient Bill of Quantity. In addition, the key requisite strategies for mitigating construction waste through materials procurement include commitment to take back scheme , procurement of waste efficient materials/technology and use of minimal packaging. The use of Just-in-Time (JIT) delivery system and prevention of over ordering are also important for mitigating waste through materials procurement processes. These implies that while the key measures are critical success factors for reducing waste through procurement process, the four established features are required of all procurement process. Measures through which the procurement process could enhance waste efficiency are further highlighted and discussed in the paper. Findings of this study could assist in understanding a set of measures that should be taken during materials procurement process, thereby corroborating waste management practices at design and construction stages of project delivery process

A framework for big data analytics approach to failure prediction of construction firms

This study explored use of big data analytics (BDA) to analyse data of a large number of construction firms to develop a construction business failure prediction model (CB-FPM). Careful analysis of literature revealed financial ratios as the best form of variable for this problem. Because of MapReduce’s unsuitability for iteration problems involved in developing CB-FPMs, various BDA initiatives for iteration problems were identified. A BDA framework for developing CB-FPM was proposed. It was validated by using 150,000 datacells of 30,000 construction firms, artificial neural network, Amazon Elastic Compute Cloud, Apache Spark and the R software. The BDA CB-FPM was developed in eight seconds while the same process without BDA was aborted after nine hours without success. This shows the issue of not wanting to use large dataset to develop CB-FPM due to tedious duration is resolvable by applying BDA technique. The BDA CB-FPM largely outperformed an ordinary CB-FPM developed with a dataset of 200 construction firms, proving that use of larger sample size with the aid of BDA, leads to better performing CB-FPMs. The high financial and social cost associated with misclassifications (i.e. model error) thus makes adoption of BDA CB-FPMs very important for, among others, financiers, clients and policy maker

Waste effectiveness of the construction industry: Understanding the impediments and requisites for improvements

© 2015 Elsevier B.V. All rights reserved.Construction industry contributes a large portion of waste to landfill, which in turns results in environmental pollution and CO2 emission. Despite the adoption of several waste management strategies, waste reduction to landfill continues seeming an insurmountable challenge. This paper explores factors impeding the effectiveness of existing waste management strategies, as well as strategies for reducing waste intensiveness of the construction industry. Drawing on series of semi structured focus group discussions with experts from the UK leading construction companies, this paper combines phenomenological approach with a critical review and analysis of extant literatures. Five broad categories of factors and practices are responsible for ineffectiveness of construction and demolition waste management strategies, which subsequently results in waste intensiveness of the industry. These include end of pipe treatment of waste, externality and incompatibility of waste management tools with design tools, atomism of waste management strategies, perceived or unexpected high cost of waste management, and culture of waste behaviour within the industry. To reduce waste intensiveness of the construction industry, the study suggests that six factors are requisites. These are tackling of waste at design stage, whole life waste consideration, compliance of waste management solutions with BIM, cheaper cost of waste management practice, increased stringency of waste management legislation and fiscal policies, and research and enlightenment. The proposed strategies are not only important for achieving low waste construction projects, they are important for reducing waste intensiveness of the construction. Implementation of the suggested measures would drive waste management practices within the construction industry

Comparing the use and content of antenatal care in adolescent and older first-time mothers in 13 countries of west Africa: a cross-sectional analysis of Demographic and Health Surveys

Background West Africa has the highest proportion of married adolescents, and the highest adolescent childbirth rate and maternal death rate in sub-Saharan Africa. However, few studies have focused on the type and quality of health care accessed by pregnant young women in countries in this subregion. Methods We obtained data from Demographic and Health Surveys done between 2010 and 2014, to compare the use, timing, source, and components of antenatal care between adolescent and older first-time mothers in 13 west African countries. The sample included primiparous women who were aged 15–49 years with a livebirth in the 5-year survey recall period, and women were assigned to one of three groups on the basis of age at the time of childbirth: adolescent (10–19 years), young adults (20–24 years), or adults (25 years or older). We calculated the percentage of women who: attended at least one antenatal care visit, completed at least one visit during the first trimester of pregnancy, attended four or more appointments in antenatal care, and received four components of antenatal care (blood pressure measurement, urine tests, blood tests, and information on complications), as well as the sector where the women received care. We primarily report the comparison between adolescents and young adults. Findings In 2016, we acquired data from the Demographic Health Surveys from 13 west African countries between 2010 and 2014 on primiparous women. The study sample was 19 211 women, of whom 10 025 (52%) were adolescents, 6099 (32%) were young adults, and 3087 (16%) were adults. Overall, 17 386 (91%) of 19 211 first-time mothers made use of antenatal care facilities on at least one occasion. 3597 (41%) of 8741 adolescents compared with 8202 (47%) of all 17 386 women began the use of antenatal care during the first trimester. Across west Africa, 5430 (62%) of 8741 adolescents had four or more antenatal care visits compared with 4067 (71%) of 5717 young adults and 2358 (81%) of 2928 adults. Of those who had four or more visits to antenatal care, 2779 (51%) of 5430 adolescents received all the antenatal care components examined compared with 2488 (61%) of 4067 young adults and 1600 (68%) of 2358 adults. Although most women received antenatal care in the public sector, in nine of the 13 countries, the proportion of women that used the private sector was higher in older mothers. Interpretation Although a large percentage of west African adolescents use some antenatal care for their first birth, they seek care later, make fewer visits during pregnancy, and receive fewer components of care than older first-time mothers. Governments must ensure the pregnancy care accessed by adolescent mothers is of high quality and tailored to meet their needs

Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation.

: The optimal rhythm management strategy for people with non-paroxysmal (persistent or long-standing persistent) atrial fibrilation is currently not well defined. Antiarrhythmic drugs have been the mainstay of therapy. But recently, in people who have not responded to antiarrhythmic drugs, the use of ablation (catheter and surgical) has emerged as an alternative to maintain sinus rhythm to avoid long-term atrial fibrillation complications. However, evidence from randomised trials about the efficacy and safety of ablation in non-paroxysmal atrial fibrillation is limited. : To determine the efficacy and safety of ablation (catheter and surgical) in people with non-paroxysmal (persistent or long-standing persistent) atrial fibrillation compared to antiarrhythmic drugs. : We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, conference abstracts, clinical trial registries, and Health Technology Assessment Database. We searched these databases from their inception to 1 April 2016. We used no language restrictions. : We included randomised trials evaluating the effect of radiofrequency catheter ablation (RFCA) or surgical ablation compared with antiarrhythmic drugs in adults with non-paroxysmal atrial fibrillation, regardless of any concomitant underlying heart disease, with at least 12 months of follow-up. : Two review authors independently selected studies and extracted data. We evaluated risk of bias using the Cochrane 'Risk of bias' tool. We calculated risk ratios (RRs) for dichotomous data with 95% confidence intervals (CIs) a using fixed-effect model when heterogeneity was low (I² &lt;= 40%) and a random-effects model when heterogeneity was moderate or substantial (I² &gt; 40%). Using the GRADE approach, we evaluated the quality of the evidence and used the GRADE profiler (GRADEpro) to import data from Review Manager 5 to create 'Summary of findings' tables. : We included three randomised trials with 261 participants (mean age: 60 years) comparing RFCA (159 participants) to antiarrhythmic drugs (102) for non-paroxysmal atrial fibrillation. We generally assessed the included studies as having low or unclear risk of bias across multiple domains, with reported outcomes generally lacking precision due to low event rates. Evidence showed that RFCA was superior to antiarrhythmic drugs in achieving freedom from atrial arrhythmias (RR 1.84, 95% CI 1.17 to 2.88; 3 studies, 261 participants; low-quality evidence), reducing the need for cardioversion (RR 0.62, 95% CI 0.47 to 0.82; 3 studies, 261 participants; moderate-quality evidence), and reducing cardiac-related hospitalisation (RR 0.27, 95% CI 0.10 to 0.72; 2 studies, 216 participants; low-quality evidence) at 12 months follow-up. There was substantial uncertainty surrounding the effect of RFCA regarding significant bradycardia (or need for a pacemaker) (RR 0.20, 95% CI 0.02 to 1.63; 3 studies, 261 participants; low-quality evidence), periprocedural complications, and other safety outcomes (RR 0.94, 95% CI 0.16 to 5.68; 3 studies, 261 participants; very low-quality evidence). : In people with non-paroxysmal atrial fibrillation, evidence suggests a superiority of RFCA to antiarrhythmic drugs in achieving freedom from atrial arrhythmias, reducing the need for cardioversion, and reducing cardiac-related hospitalisations. There was uncertainty surrounding the effect of RFCA with significant bradycardia (or need for a pacemaker), periprocedural complications, and other safety outcomes. Evidence should be interpreted with caution, as event rates were low and quality of evidence ranged from moderate to very low.<br/