Where do Women Give Birth in Rural Tanzania?

Skilled birth attendance is one of the key factors in improving maternal and neonatal health but coverage is frequently less than 50% in many African and Asian countries, especially in rural areas. This article reports the findings on skilled birth attendance in a remote area with a large nomadic population in northern Tanzania. In a secondary analysis of data from a retrospective study on immunisation rates, data were compiled on the rates of skilled birth attendance at 8 mobile reproductive and child health clinics run by a rural first-referral hospital in the Mbulu area, covering the years 1998, 1999, 2006 and 2007. These data were analysed according to tribal affiliation and distance from health institutions with obstetric services. Based on 3851 data sets, average rates of skilled birth attendance were 27%, 24%, 28% and 30% in 1998, 1999, 2006 and 2007, respectively (p = 0.02). At individual clinics, rates could be as low as 5-10%. Only at one clinic, significant improvement occurred over time (p< 0.01). In the univariate analysis, affiliation to the Iraqw tribe was a strong predictor of higher rates of skilled birth attendance in comparison with the nomadic Datoga tribe for all years combined (odds ratio [OR] 2.43 [95% confidence interval {CI} 1.92-3.07]), whereas distance showed only a minor influence (OR 1.02 [95% CI 1.01-1.02]). In the multivariate analysis, only tribal affiliation in 2007 (OR 2.69 [95% CI 1.12-6.46]) and for all years combined (OR 1.65 [95% CI 1.04-2.61]) was a significant factor. This study documented lower than the national average rates of skilled birth attendance in a rural area in Tanzania, especially among the nomadic Datoga tribe, over several years. The effect of distance was not consistent. To increase rates of women giving birth with skilled attendance in rural, remote settings and in populations with large proportions of nomadic people, a multi-facetted approach involving education in and sensitisation for pregnancy- and delivery-related issues, support for planned and emergency transportation, and improved quality of obstetric and neonatal services needs to be explored

Exploring Temporal Computation in Neuronal Systems

This thesis presents two approaches to identifying computational properties of networks of neurons. The first of these involves a bottom-up approach through detailed modelling of neuronal properties, while the second is a top-down approach using principal component analysis that quantifies the behaviour of neurons in complex networks from measurements. An object-oriented modelling tool has been developed that is fast, flexible, and easy to use. A graphical user interface allows the user to manipulate neurons, synapses, and currents visually on the screen during prototyping. Subsequently, a systematic study of the model can be processed in batch mode, for example to tune it to a particular behaviour. Small invertebrate neuronal circuits have been considered where the neuronal outputs can be related to the behaviour of the animal. The fundamental problem faced by experimental neurobiologists is that only one state variable per neuron is readily accessible, i.e. the membrane potential at the cell body. A neuron contains a vast number of state variables, but these are generally all hidden. The modelling tool enables one to "record" from hidden state variables and to manipulate inaccessible parameters of the real neurons. The tool has been evaluated through an investigation involving a leech heart model. Significant findings include non-spiking oscillations, and the modelling has suggested further experimental work involving the real system. The modelling tool provided close to real-time performance in this application which indicates its potential for its interactive use in an experimental environment, including dynamic voltage-clamp. The top-down approach uses principal component analysis to quantify a trace of neuronal activity during a time interval. During this interval, the feedback loops within the neuron and through the neuronal network will affect the output of the neuron. Thus, the resulting measure of the neuronal output will indirectly include the states of "hidden" compartments away from the cell soma and other inaccessible state variables, like channel states. Although the technique offer no promise for tracing these hidden state variables, it will enable us to include them in quantifying the outputs of a neuron. Further, the technique serves as an "objective critic" that display the largest sources of variance over the data set. Therefore, one avoids testing successively and explicitly through a large set of possible features. This also makes the measure low-dimensional and easy to analyse further. Application of the Karhunen-Loeve transform to the crayfish swimmeret showed that the principal components represented features like spike count, burst width, burst concentration, and burst latency. The burst latency proved to be significantly modulated. Principal component analysis was also performed on the membrane potential after having removed the action potentials with a low pass filter. The membrane potential deviations did not correlate with those of the spikes from the same neuron. This demonstrates the point that the membrane potential at the cell body does not solely determine the spiking pattern, but other (unobservable) state variables influence the spiking dynamics. Recently developed imaging techniques show possibilities in terms of measuring the spatial distribution of the membrane potential and ion concentrations throughout a cell, as well as the temporal interaction between these state variables. These imaging techniques are of potential value for validating theoretical models of a more complex kind for the study of which the object-oriented modelling tool could be readily applied. This work has shown that the Karhunen-Loeve transform can be used to quantify the relative coupling strength between two outputs. The coupling strength is estimated at the level of behaviour and relative to normal background activity in the system. This compares to the absolute estimate that at the level of individual synapses measures the coupling strength between two cells. The techniques above enables the effective coupling between two cells to be measured, where the coupling may occur through several pathways and through several cells. These results suggest that the long range intersegmental coupling is not much weaker than short range intrasegmental coupling and that the coupling performs phase locking only

What do District Health Planners in Tanzania think about improving priority setting using 'Accountability for Reasonableness'?

<p>Abstract</p> <p>Background</p> <p>Priority setting in every health system is complex and difficult. In less wealthy countries the dominant approach to priority setting has been Burden of Disease (BOD) and cost-effectiveness analysis (CEA), which is helpful, but insufficient because it focuses on a narrow range of values – need and efficiency – and not the full range of relevant values, including legitimacy and fairness. 'Accountability for reasonableness' is a conceptual framework for legitimate and fair priority setting and is empirically based and ethically justified. It connects priority setting to broader, more fundamental, democratic deliberative processes that have an impact on social justice and equity. Can 'accountability for reasonableness' be helpful for improving priority setting in less wealthy countries?</p> <p>Methods</p> <p>In 2005, Tanzanian scholars from the Primary Health Care Institute (PHCI) conducted 6 capacity building workshops with senior health staff, district planners and managers, and representatives of the Tanzanian Ministry of Health to discussion improving priority setting in Tanzania using 'accountability for reasonableness'. The purpose of this paper is to describe this initiative and the participants' views about the approach.</p> <p>Results</p> <p>The approach to improving priority setting using 'accountability for reasonableness' was viewed by district decision makers with enthusiastic favour because it was the first framework that directly addressed their priority setting concerns. High level Ministry of Health participants were also very supportive of the approach.</p> <p>Conclusion</p> <p>Both Tanzanian district and governmental health planners viewed the 'accountability for reasonableness' approach with enthusiastic favour because it was the first framework that directly addressed their concerns.</p

Diagnostic accuracy of post-mortem MRI for thoracic abnormalities in fetuses and children

OBJECTIVES: To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for non-cardiac thoracic pathology in fetuses and children, compared with conventional autopsy. METHODS: Institutional ethics approval and parental consent was obtained. A total of 400 unselected fetuses and children underwent PMMR before conventional autopsy, reported blinded to the other dataset. RESULTS: Of 400 non-cardiac thoracic abnormalities, 113 (28 %) were found at autopsy. Overall sensitivity and specificity (95 % confidence interval) of PMMR for any thoracic pathology was poor at 39.6 % (31.0, 48.9) and 85.5 % (80.7, 89.2) respectively, with positive predictive value (PPV) 53.7 % (42.9, 64.0) and negative predictive value (NPV) 77.0 % (71.8, 81.4). Overall agreement was 71.8 % (67.1, 76.2). PMMR was most sensitive at detecting anatomical abnormalities, including pleural effusions and lung or thoracic hypoplasia, but particularly poor at detecting infection. CONCLUSIONS: PMMR currently has relatively poor diagnostic detection rates for the commonest intra-thoracic pathologies identified at autopsy in fetuses and children, including respiratory tract infection and diffuse alveolar haemorrhage. The reasonable NPV suggests that normal thoracic appearances at PMMR exclude the majority of important thoracic lesions at autopsy, and so could be useful in the context of minimally invasive autopsy for detecting non-cardiac thoracic abnormalities. KEY POINTS: • PMMR has relatively poor diagnostic detection rates for common intrathoracic pathology • The moderate NPV suggests that normal PMMR appearances exclude most important abnormalities • Lung sampling at autopsy remains the "gold standard" for pulmonary pathology

Post mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol)

<p>Abstract</p> <p>Background</p> <p>Minimally invasive autopsy by post mortem magnetic resonance (MR) imaging has been suggested as an alternative for conventional autopsy in view of the declining consented autopsy rates. However, large prospective studies rigorously evaluating the accuracy of such an approach are lacking. We intend to compare the accuracy of a minimally invasive autopsy approach using post mortem MR imaging with that of conventional autopsy in fetuses, newborns and children for detection of the major pathological abnormalities and/or determination of the cause of death.</p> <p>Methods/Design</p> <p>We recruited 400 consecutive fetuses, newborns and children referred for conventional autopsy to one of the two participating hospitals over a three-year period. We acquired whole body post mortem MR imaging using a 1.5 T MR scanner (Avanto, Siemens Medical Solutions, Enlargen, Germany) prior to autopsy. The total scan time varied between 90 to 120 minutes. Each MR image was reported by a team of four specialist radiologists (paediatric neuroradiology, paediatric cardiology, paediatric chest & abdominal imaging and musculoskeletal imaging), blinded to the autopsy data. Conventional autopsy was performed according to the guidelines set down by the Royal College of Pathologists (UK) by experienced paediatric or perinatal pathologists, blinded to the MR data. The MR and autopsy data were recorded using predefined categorical variables by an independent person.</p> <p>Discussion</p> <p>Using conventional post mortem as the gold standard comparator, the MR images will be assessed for accuracy of the anatomical morphology, associated lesions, clinical usefulness of information and determination of the cause of death. The sensitivities, specificities and predictive values of post mortem MR alone and MR imaging along with other minimally invasive post mortem investigations will be presented for the final diagnosis, broad diagnostic categories and for specific diagnosis of each system.</p> <p>Clinical Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01417962">NCT01417962</a></p> <p><b>NIHR Portfolio Number: </b>6794</p

Avian Colibacillosis and Salmonellosis: A Closer Look at Epidemiology, Pathogenesis, Diagnosis, Control and Public Health Concerns

Avian colibacillosis and salmonellosis are considered to be the major bacterial diseases in the poultry industry world-wide. Colibacillosis and salmonellosis are the most common avian diseases that are communicable to humans. This article provides the vital information on the epidemiology, pathogenesis, diagnosis, control and public health concerns of avian colibacillosis and salmonellosis. A better understanding of the information addressed in this review article will assist the poultry researchers and the poultry industry in continuing to make progress in reducing and eliminating avian colibacillosis and salmonellosis from the poultry flocks, thereby reducing potential hazards to the public health posed by these bacterial diseases

A Norwegian Satellite for Space-based Observations of AIS in the High North

The Automatic Identification System (AIS) for maritime vessels introduced by the International Maritime Organization (IMO) is basically an anti collision system for vessels at sea. Vessels are broadcasting messages on two channels in the maritime VHF band on regular basis to neighboring vessels for collision avoidance, and to shore stations for vessel traffic services (VTS). AIS messages can also be received by a VHF receiver in space for wide area observation of maritime activity.Norway is about to build its first dedicated satellite (AISSat-1) for such space-based observation of AIThe justification for the mission is based on careful modeling of the global AIS detection probability, with particular emphasis on observation of Norwegian ocean areas in the High North (and High South).AISSat-1 is based on a dedicated low cost high-performance nano-satellite platform (just 20×20×20cm) with three-axis attitude control. The platform will be built by the Space Flight Laboratory at the University of Toronto (UTIAS/SFL), Canada. The AIS sensor is a software defined radio developed by Kongsberg Seatex (KSX), Trondheim Norway.This paper will in some detail discuss AIS detection probability modeling results, mission architecture, satellite, payload, and AIS data distribution on ground. It is believed that AISSat-1 currently is one of the most advanced nano-satellites being developed and is possibly the only nano-satellite dedicated to demonstrate a much needed and future oriented national maritime situational awareness service

AISSat-1 Early Results

AISSat-1 was launched on July 12, 2010 and is believed to be the first high performance nano-satellite to provide an observational service to governmental authorities. The primary mission objective is to perform maritime observation in the Norwegian High North and High South, thereby making a considerable contribution to the maritime situational awareness (MSA) of these areas. The satellite is built, tested and prepared for flight by the Space Flight Laboratory at the University of Toronto Institute for Aerospace Studies (UTIAS/SFL), and is based on the 20 cm cube Generic Nano-satellite Bus (GNB). UTIAS/SFL also handled the launch of AISSat-1 by an Indian Polar Satellite Launch Vehicle (PSLV) from southern India. The payload is an AIS receiver developed and manufactured by Kongsberg Seatex AS, Trondheim Norway. The Norwegian Defence Research Establishment (FFI), Kjeller Norway developed the AISSat-1 mission concept and has been responsible for managing the project and for testing and preparing the AIS payload for flight. The Automatic Identification System (AIS) for maritime vessels was introduced by the International Maritime Organization (IMO) to enhance the safety of life at sea (SOLAS). Vessels greater than 300 gt or carrying 12 or more passengers are broadcasting AIS messages on two channels in the maritime VHF band on regular basis to neighboring vessels for collision avoidance, and also to shore stations for vessel traffic services (VTS). AISSat-1 is designed to receive these AIS messages in space, and to forward the messages to the Norwegian Coastal Administration (NCA), with the aim to extend the range of the Norwegian ground based AIS network to also cover ocean areas at the high seas. Some early results from AISSat-1 presented here clearly demonstrate that a low cost high performance nano-satellite can provide excellent and much needed maritime observation information to government authorities