Community mobilisation and health management committee strengthening to increase birth attendance by trained health workers in rural Makwanpur, Nepal: study protocol for a cluster randomised controlled trial

Background: Birth attendance by trained health workers is low in rural Nepal. Local participation in improving health services and increased interaction between health systems and communities may stimulate demand for health services. Significant increases in birth attendance by trained health workers may be affected through community mobilisation by local women's groups and health management committee strengthening. We will test the effect of community mobilisation through women's groups, and health management committee strengthening, on institutional deliveries and home deliveries attended by trained health workers in Makwanpur District. Design: Cluster randomised controlled trial involving 43 village development committee clusters. 21 clusters will receive the intervention and 22 clusters will serve as control areas. In intervention areas, Female Community Health Volunteers are supported in convening monthly women's groups. The groups work through an action research cycle in which they consider barriers to institutional delivery, plan and implement strategies to address these barriers with their communities, and evaluate their progress. Health management committees participate in three-day workshops that use appreciative inquiry methods to explore and plan ways to improve maternal and newborn health services. Follow-up meetings are conducted every three months to review progress. Primary outcomes are institutional deliveries and home deliveries conducted by trained health workers. Secondary outcome measures include uptake of antenatal and postnatal care, neonatal mortality and stillbirth rates, and maternal morbidity

Magnesium sulphate for the management of preeclampsia and eclampsia in low and middle income countries: a systematic review of tested dosing regimens.

OBJECTIVE: To review systematically the magnesium sulphate (MgSO4) dosing regimens tested in low and middle income countries (LMICs) for women with preeclampsia (prevention) and/or eclampsia (treatment). DATA SOURCES: We searched Medline, EMBASE, IPA, CINAHL, CDSR, and CENTRAL databases for relevant English language publications. STUDY SELECTION: Our search yielded 753 publications, of which 26 (10 randomized controlled trials and 16 observational studies) evaluated MgSO4 for preeclampsia and/or eclampsia in World Bank-classified LMICs. DATA EXTRACTION: Independent, by two authors. DATA SYNTHESIS: Twenty-five studies were conducted in hospital settings and one in the community. Rates of eclampsia were usually < 5% (median 3.0%, range 0.0% to 26.5%) even when MgSO4 was administered for eclampsia. When dosage varied from the standard Pritchard or Zuspan regimens, almost all (n = 22) reduced the dose or duration of treatment, most commonly because of concerns about maternal safety, cost, or resource availability. Four trials of a loading dose only (4 g IV + 10 g IM) versus loading plus maintenance dosing of 5 g/4 hr IM found no difference in eclampsia recurrence (RR 1.64; 95% CI 0.48 to 5.65, n = 396). One study documented less eclampsia recurrence associated with community administration of a MgSO4 loading dose before referral to a care facility versus treatment in a care facility (RR 0.23; 95% CI 0.11 to 0.49, n = 265). CONCLUSION: Use of MgSO4 for eclampsia treatment and prevention has been well-studied in LMICs, but concern remains about potential toxicity. Further studies are needed to identify the minimum effective dosage of MgSO4 for management of preeclampsia and eclampsia and whether MgSO4 loading can be safely administered in the community

Participant Profiling and Pattern of Crop-Foraging in Chacma Baboons (Papio hamadryas ursinus) in Zimbabwe: Why Does Investigating Age–Sex Classes Matter?

International audienceTransformation and loss of natural habitat to urbanization and agriculture provide new opportunities for primates to feed on anthropogenic food sources. Currently, mitigation strategies fail to target the individuals responsible for initiating and maintaining this behavior. As primates mainly forage on crops in groups, we investigate the crop-foraging behavior of a group of 40 chacma baboons in Zimbabwe from the perspective of collective movements, i.e., when a group of animals move together in the same direction, thus resulting in a change of location. We collected data on 110 crop-foraging events during 35 days in March–April 2014. We recorded baboon movement and behavior with a camcorder and obtained further information through video analysis. Most crop-foraging events involved less than 20% of the troop and lasted less than 3 min. Although crop-foraging parties were composed of all age–sex classes, adult females and particularly adult males initiated most crop-foraging events and made direct movements (without stopping on the road) more often than nonadult participants. Baboons made up to five successive attempts to crop forage in a single crop-foraging event. Neither the number of participants nor the success of the crop-foraging events increased over the successive attempts. Finally, crop-foraging events were more successful and more frequent in unguarded areas than in guarded areas. These results suggest that group members are highly synchronized and that crop-foraging is based on a collective decision such as classical foraging movements. In addition, the short duration of the crop-foraging events might prevent detection of baboons by farmers. The more frequent initiation of crop-foraging by adults compared to nonadults might be explained by greater energetic needs or a greater tendency of adults to take risks. These preliminary data can help inform long-term strategies for farmers to reduce crop losses to baboons, as guarding helps reduce damage but does not prevent it

Analytical lenses on barriers in the governance of climate change adaptation

Barriers to adaptation have become an important concept in scientific and political discussions in the governance of climate change adaptation. Over the past years, these discussions have been dominated by one analytical lens in examining barriers and proposing ways to overcome them: the problem solving lens. In this paper, we aim to demonstrate theoretically and empirically that the choice of analytical lens influences how barriers to adaptation are constructed and the intervention strategies proposed. Drawing from recent governance literature, we explore the rationale of three dominant philosophies in the study of governance: the optimist, the realist, and the pessimist philosophy. Next, we demonstrate how these philosophies are operationalized and guide scientific inquiry on barriers to adaptation through four empirically rooted analytical lenses: i) governance as problem solving, ii) governance as competing values and interests, iii) governance as institutional interaction, and iv) governance as dealing with structural constraints. We investigate the Dutch government’s Spatial Adaptation to Climate Change programme through each of the four lenses. We discuss how each analytical lens frames barriers in a specific way, identifies different causes of barriers, leads to competing interpretations of key events, and presents other types of interventions to overcome barriers. We conclude that it is necessary to increase analytical variety in order to critically engage in theoretical debates about barriers and to empower policy practitioners in their search for successful intervention strategies to implement adaptation measure