Impact of newly constructed primary healthcare centres on antenatal care attendance, facility delivery and all-cause mortality: quasi-experimental evidence from Taabo health and demographic surveillance system, Côte d'Ivoire

OBJECTIVES: Access to quality care remains limited, particularly in low-income and middle-income countries. Although better health outcomes for families living in close proximity to healthcare facilities have been documented in cross-sectional studies, evidence on the extent to which additional health facilities can contribute to improved population health remains scanty. We aimed to estimate the causal impact of newly constructed primary healthcare facilities within a health and demographic surveillance (HDSS) site in Cote d'Ivoire. DESIGN: We conducted a quasi-experimental study. Logistic and Cox proportional hazards regression models were used to estimate the impact of new healthcare facilities on healthcare-seeking behaviour and all-cause mortality. SETTING: Data were collected prospectively through the Taabo HDSS located in south-central Cote d'Ivoire between 2010 and 2018. PARTICIPANTS: We analysed 2957 deaths across 440 973 person-year observations as well as 14 132 live births. PRIMARY OUTCOME MEASURES: The primary outcomes were antenatal care (ANC) attendance, facility delivery and mortality. Logistic and Cox proportional hazards models were employed to estimate the impact of the new health facilities on ANC attendance, facility delivery and child as well as adult mortality. RESULTS: Average distance to the nearest healthcare facility declined from 5.5 km before to 2.8 km after opening of four new healthcare facilities in targeted villages. No improvement was observed for ANC attendance, institutional deliveries and adult mortality. New facilities reduced the risk of post-neonatal infant mortality by 46% (HR 0.54, 95% CI 0.31 to 0.94, p<0.05), suggesting a mortality gradient of 2 deaths per 1000 for each additional km (Coef=0.002, 95% CI 0.000 to 0.004, p<0.05). CONCLUSIONS: Our results suggest that new facilities do not necessarily improve healthcare utilisation and health outcomes. Further research is needed to identify the best ways to ensure access to quality care in resource-constrained settings

Dietary diversity in primary schoolchildren of south-central Côte d'Ivoire and risk factors for non-communicable diseases

BACKGROUND: A balanced nutrition is important for children's physical and cognitive development; yet, remains a challenge in many parts of low- and middle-income countries (LMICs). Early detection of nutritional deficiency and metabolic syndrome in school-aged children is necessary to prevent non-communicable diseases (NCDs) in later life. This study aimed at obtaining baseline data on health, nutritional status, and metabolic markers of NCDs among primary schoolchildren in Cote d'Ivoire. METHODS: A cross-sectional survey was conducted among 620 children from 8 public primary schools located in the south-central part of Cote d'Ivoire. Underweight and overweight were defined as a body mass index (BMI; kg/m2) < 5th and 85th up to 95th percentile for sex and age, respectively. Dietary diversity of children was calculated based on a 24-hour recall conducted with the primary caretaker according to the guideline of Food and Agriculture Organization. Anaemia, malaria, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and blood glucose levels (HbA1c) were assessed, using capillary blood samples. Logistic models were performed to identify risk factors associated with overweight, HDL-C, LDL-C, and HbA1c. RESULTS: Among the 620 children (330 girls, 290 boys; Mage 8.0 (+/- 1.7) years), 530 children attended school in a semi-urban and 90 in a rural area. Around 60% of children had a medium dietary diversity score (DDS). Children in peri-urban areas consumed more cereals (80.2% vs. 63.3%, p < 0.05). Most children were normal weight (n = 496), whereas 3.9% of children classified as prediabetic, 5% were underweight, and 15% overweight. LDL-C and HDL-C levels of children were associated with age, high DDS, and moderate anaemia. A significant association was found between prediabetes and malaria infection, as well as medium and high DDS. Overweight was associated with malaria infection and moderate anaemia. CONCLUSION: Overweight, prediabetes, low HDL-C, malaria, and anaemia are the main concerns of children's health in Taabo. Our findings highlight interactions between infectious diseases, particularly malaria, and NCD risk factors. Monitoring NCD risk and infectious disease comorbidity in LMIC paediatric populations simultaneously is essential to better understand the dual diseases burden and apply early prevention measures

Scatterometry reference standards to improve tool matching and traceability in lithographical nanomanufacturing

High quality scatterometry standard samples have been developed to improve the tool matching between different scatterometry methods and tools as well as with high resolution microscopic methods such as scanning electron microscopy or atomic force microscopy and to support traceable and absolute scatterometric critical dimension metrology in lithographic nanomanufacturing. First samples based on one dimensional Si or on Si 3 N 4 grating targets have been manufactured and characterized for this purpose. The etched gratings have periods down to 50 nm and contain areas of reduced density to enable AFM measurements for comparison. Each sample contains additionally at least one large area scatterometry target suitable for grazing incidence small angle X ray scattering. We present the current design and the characterization of structure details and the grating quality based on AFM, optical, EUV and X Ray scatterometry as well as spectroscopic ellipsometry measurements. The final traceable calibration of these standards is currently performed by applying and combining different scatterometric as well as imaging calibration methods. We present first calibration results and discuss the final design and the aimed specifications of the standard samples to face the tough requirements for future technology nodes in lithography

Livestock keepers’ attitudes: Keystone of effective community-based breeding programs

Livestock keepers in southwestern Burkina Faso hold the local Lobi taurine breed, local Zebu cattle, and their crosses. Some communities in the region have begun to implement community-based cattle breeding programs (CBBPs), which involve animal tagging and recording and, potentially, also bull sharing. Based on the hypothesis that the participation of livestock keepers in CBBPs depends on their attitudes towards these programs, we used questionnaires to survey the attitudes of 125 farmers towards cattle breeding strategies and tools. Results were analyzed using principal component analysis. Farmers showed a highly positive attitude towards maintaining the features of their preferred cattle breed, but their attitudes varied substantially towards crossbreeding for breed improvement. Farmers generally agreed that performance was more important than animal appearance, and most of them were willing to cooperate with breeders’ associations but were skeptical about sharing their bulls with other farmers. The majority was reluctant to record performance data, which may be due to a capacity deficit and their confidence in being able to select the best animals based purely on phenotype. Our analysis suggests that breeders’ associations, as a key component of CBBPs, should lay down clear rules and obligations for their members from the outset. Timely consideration of farmers’ attitudes towards different breeding tools may improve their uptake and guarantee the sustainability of CBBPs

Cross-sectional associations between air pollution and chronic bronchitis: an ESCAPE meta-analysis across five cohorts

BACKGROUND: This study aimed to assess associations of outdoor air pollution on prevalence of chronic bronchitis symptoms in adults in five cohort studies (Asthma-E3N, ECRHS, NSHD, SALIA, SAPALDIA) participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE) project. METHODS: Annual average particulate matter (PM10, PM2.5, PMabsorbance, PMcoarse), NO2, nitrogen oxides (NOx) and road traffic measures modelled from ESCAPE measurement campaigns 2008-2011 were assigned to home address at most recent assessments (1998-2011). Symptoms examined were chronic bronchitis (cough and phlegm for &ge;3 months of the year for &ge;2 years), chronic cough (with/without phlegm) and chronic phlegm (with/without cough). Cohort-specific cross-sectional multivariable logistic regression analyses were conducted using common confounder sets (age, sex, smoking, interview season, education), followed by meta-analysis. RESULTS: 15 279 and 10 537 participants respectively were included in the main NO2 and PM analyses at assessments in 1998-2011. Overall, there were no statistically significant associations with any air pollutant or traffic exposure. Sensitivity analyses including in asthmatics only, females only or using back-extrapolated NO2 and PM10 for assessments in 1985-2002 (ECRHS, NSHD, SALIA, SAPALDIA) did not alter conclusions. In never-smokers, all associations were positive, but reached statistical significance only for chronic phlegm with PMcoarse OR 1.31 (1.05 to 1.64) per 5 &micro;g/m(3) increase and PM10 with similar effect size. Sensitivity analyses of older cohorts showed increased risk of chronic cough with PM2.5abs (black carbon) exposures. CONCLUSIONS: Results do not show consistent associations between chronic bronchitis symptoms and current traffic-related air pollution in adult European populations

ProtoDESI: First On-Sky Technology Demonstration for the Dark Energy Spectroscopic Instrument

The Dark Energy Spectroscopic Instrument (DESI) is under construction to measure the expansion history of the universe using the baryon acoustic oscillations technique. The spectra of 35 million galaxies and quasars over 14,000 square degrees will be measured during a 5-year survey. A new prime focus corrector for the Mayall telescope at Kitt Peak National Observatory will deliver light to 5,000 individually targeted fiber-fed robotic positioners. The fibers in turn feed ten broadband multi-object spectrographs. We describe the ProtoDESI experiment, that was installed and commissioned on the 4-m Mayall telescope from August 14 to September 30, 2016. ProtoDESI was an on-sky technology demonstration with the goal to reduce technical risks associated with aligning optical fibers with targets using robotic fiber positioners and maintaining the stability required to operate DESI. The ProtoDESI prime focus instrument, consisting of three fiber positioners, illuminated fiducials, and a guide camera, was installed behind the existing Mosaic corrector on the Mayall telescope. A Fiber View Camera was mounted in the Cassegrain cage of the telescope and provided feedback metrology for positioning the fibers. ProtoDESI also provided a platform for early integration of hardware with the DESI Instrument Control System that controls the subsystems, provides communication with the Telescope Control System, and collects instrument telemetry data. Lacking a spectrograph, ProtoDESI monitored the output of the fibers using a Fiber Photometry Camera mounted on the prime focus instrument. ProtoDESI was successful in acquiring targets with the robotically positioned fibers and demonstrated that the DESI guiding requirements can be met.Comment: Accepted versio

The dynamics of university units as a multi-level process. Credibility cycles and resource dependencies

This paper presents an analysis of resource acquisition and profile development of institutional units within universities. We conceptualize resource acquisition as a two level nested process, where units compete for external resources based on their credibility, but at the same time are granted faculty positions from the larger units (department) to which they belong. Our model implies that the growth of university units is constrained by the decisions of their parent department on the allocation of professorial positions, which represent the critical resource for most units’ activities. In our field of study this allocation is largely based on educational activities, and therefore, units with high scientific credibility are not necessarily able to grow, despite an increasing reliance on external funds. Our paper therefore sheds light on the implications that the dual funding system of European universities has for the development of units, while taking into account the interaction between institutional funding and third-party funding