The Tanzania Family Planning Training Program:The Impact of an Innovative Training Strategy on Reproductive and Child Health Service Performance of Health Attendants in Tanzania

This report is based on a study, implemented in Kasulu and Kibondo districts in Kigoma Region, Tanzania, to assess the impact of a health attendants’ pilot training strategy on reproductive and child health (RCH) services. The strategy was developed and implemented by the RCH-Unit of Ministry of Health (MOH) with technical assistance from Intrah/PRIME and was implemented with financial support from USAID. The training strategy, covering a period of four months (July to October, 1998), used a combination of on-the-job-training (OJT) and traditional central and distance-based learning (DBL). The training was divided into four modules. Modules 1 and 3 were centrally based while Modules 2 and 4 used OJT and DBL in which the HAs remained at the facilities where they worked. The DBL was backed by supportive supervision from facility in-change staff as onsite supervisors, district-based supervisors and trainers and regional trainers. It also utilized two key leaning aids (developed as part of this strategy): a handbook and solar-powered cassette player with audiotapes. Each trainee was given a solar/battery-powered cassette player and six audiotapes containing course content. The study utilized three different intervention designs to assess three different levels of impact. The study used pre-and post-test assessments of knowledge and skills to determine whether learning occurred among trainees as a result of the training. A non-equivalent control group design was used to compare whether the training significantly influenced provision of reproductive and child health services in trainee facilities over facilities whether providers had not been trained. The study requested feedback from various players on the HA training strategy. This assessment addressed attributes such as appropriateness, acceptance, achievement of the project’s objectives, how the project was comprehended/perceived and the reliability of this training approach. The HA training led to acquisition of knowledge as indicated by a significant change in the mean score of Module 1 pre-test (32.8) compared to post-test mean score (71.4)(P<.05). A similar trend was found in module 3 in which the mean pre-test score (70.5) was significantly lower than the post-test mean score (87.1)(P<.05). The skills assessment demonstrated a substantial gain in two skills: antenatal clinic client assessment and conducting growth monitoring. However, counseling services, care for mothers and neonates during the postpartum period and care during and monitoring progress in labor did not improve. As a result, the investigators conducted that HAs gained adequate skills in some areas while continued learning is essential in others, possibly through further OJT by the RCH trained CO/ACO at the HA work site. Comparison sites are also in need of improved training to improve their RH/FP skills. The data collection period for the service statistics assessment was divided into three blocks: prior to training (March-June 1998), during training (July-October 1998). The intervention group comprised 29 health facilities while the comparison group contained 25 facilities. For the comparison group, data were collected only for the periods before and after training. Six study instruments (five questionnaire and one data collection sheet) were used as data collection tools. From the RCH-Unit through the regional, district and facility levels, the training approach was considered to be suitable, especially for the targeted (HA) cadre. It was agreed that this target group required a training approach that emphasized practice oriented learning methods instead of a traditional didactic approach. To meet these needs, the project provided two key learning aids: the handbook and cassette tapes. The handbook was considered to be appropriate for three reasons: the handbook satisfactorily covered the training content, it was well illustrated, and it utilized language appropriate to the target audience. The cassette tapes were considered to be suitable learning aids because they were audible and contained appropriate and adequate content. However, audibility reportedly decreased sharply as battery power diminished. Nevertheless, feedback also highlighted area for improvement. Respondents pointed out that the approach was expensive. District planning boards that are responsible for financing training in the post health sector reform (HSR) era may not be able to afford to replicate the training. As a result, they may revert to the traditional central training approach. Respondents also reported that the use of solar powered cassette players were found to be vulnerable to frequent breakdown and other minor mishaps, As a result of these failings, a recommendation was made that ordinary battery-powered cassette players be adopted for future training. A recommendation was also made to review and edit the handbook was easy to understand and the illustrations were clear, they reported that there was room for improvement in these areas as well. The sustainability of this training strategy depends on the availability of sufficient funding to carry out all of the project’s elements, especially learning at the work site. The feasibility of replicating this successful intervention remains to be demonstrated.The HA training strategy set out to achieve certain objectives: develop a curriculum and two complimentary learning aids; select and prepare trainers, and both on and offsite supervisors; update facility in charge staff on RCH; and train a selected number of HAs. It was also planned as a pilot study for testing all of the components and documenting the strengths and weaknesses of the approach. In addition, the training was geared at empowered both the DHMT members and staff at the intervention facilities. This evaluation conducted that the HA training strategy achieved these objective. \u

Participation for what: social change or social control?

The publication is special, both content-wise and process-wise, as it is entirely produced by (alumni and present) ISS PhD students, and Open Acces available. The book contains seven articles that were carefully selected out of the contributions for the Development Dialogue, which was held at ISS in 2008. All the articles question participatory processes and practices in development: participation by whom, for what, and how? These remain vital questions for moving forward in building new narratives and generating appropriate development strategies

Assessment of carnitine excretion and its ratio to plasma free carnitine as a biomarker for primary carnitine deficiency in newborns

In the Netherlands, newborns are referred by the newborn screening (NBS) Program when a low free carnitine (C0) concentration (&lt;5 μmol/l) is detected in their NBS dried blood spot. This leads to ~85% false positive referrals who all need an invasive, expensive and lengthy evaluation. We investigated whether a ratio of urine C0 / plasma C0 (RatioU:P) can improve the follow-up protocol for primary carnitine deficiency (PCD). A retrospective study was performed in all Dutch metabolic centres, using samples from newborns and mothers referred by NBS due to low C0 concentration. Samples were included when C0 excretion and plasma C0 concentration were sampled on the same day. RatioU:P was calculated as (urine C0 [μmol/mmol creatinine])/(plasma C0 [μmol/l]). Data were available for 59 patients with genetically confirmed PCD and 68 individuals without PCD. The RatioU:P in PCD patients was significantly higher (p value &lt; 0.001) than in those without PCD, median [IQR], respectively: 3.4 [1.2–9.5], 0.4 [0.3–0.8], area under the curve (AUC) 0.837. Classified for age (up to 1 month) and without carnitine suppletion (PCD; N = 12, Non-PCD; N = 40), medians were 6.20 [4.4–8.8] and 0.37 [0.24–0.56], respectively. The AUC for RatioU:P was 0.996 with a cut-off required for 100% sensitivity at 1.7 (yielding one false positive case). RatioU:P accurately discriminates between positive and false positive newborn referrals for PCD by NBS. RatioU:P is less effective as a discriminative tool for PCD in adults and for individuals that receive carnitine suppletion.</p

Actors and networks or agents and structures: towards a realist view of information systems

Actor-network theory (ANT) has achieved a measure of popularity in the analysis of information systems. This paper looks at ANT from the perspective of the social realism of Margaret Archer. It argues that the main issue with ANT from a realist perspective is its adoption of a `flat' ontology, particularly with regard to human beings. It explores the value of incorporating concepts from ANT into a social realist approach, but argues that the latter offers a more productive way of approaching information systems

Soft topographic map for clustering and classification of bacteria

In this work a new method for clustering and building a topographic representation of a bacteria taxonomy is presented. The method is based on the analysis of stable parts of the genome, the so-called “housekeeping genes”. The proposed method generates topographic maps of the bacteria taxonomy, where relations among different type strains can be visually inspected and verified. Two well known DNA alignement algorithms are applied to the genomic sequences. Topographic maps are optimized to represent the similarity among the sequences according to their evolutionary distances. The experimental analysis is carried out on 147 type strains of the Gammaprotebacteria class by means of the 16S rRNA housekeeping gene. Complete sequences of the gene have been retrieved from the NCBI public database. In the experimental tests the maps show clusters of homologous type strains and present some singular cases potentially due to incorrect classification or erroneous annotations in the database

Assessment of carnitine excretion and its ratio to plasma free carnitine as a biomarker for primary carnitine deficiency in newborns

In the Netherlands, newborns are referred by the newborn screening (NBS) Program when a low free carnitine (C0) concentration (<5 μmol/l) is detected in their NBS dried blood spot. This leads to ~85% false positive referrals who all need an invasive, expensive and lengthy evaluation. We investigated whether a ratio of urine C0 / plasma C0 (RatioU:P) can improve the follow-up protocol for primary carnitine deficiency (PCD). A retrospective study was performed in all Dutch metabolic centres, using samples from newborns and mothers referred by NBS due to low C0 concentration. Samples were included when C0 excretion and plasma C0 concentration were sampled on the same day. RatioU:P was calculated as (urine C0 [μmol/mmol creatinine])/(plasma C0 [μmol/l]). Data were available for 59 patients with genetically confirmed PCD and 68 individuals without PCD. The RatioU:P in PCD patients was significantly higher (p value < 0.001) than in those without PCD, median [IQR], respectively: 3.4 [1.2–9.5], 0.4 [0.3–0.8], area under the curve (AUC) 0.837. Classified for age (up to 1 month) and without carnitine suppletion (PCD; N = 12, Non-PCD; N = 40), medians were 6.20 [4.4–8.8] and 0.37 [0.24–0.56], respectively. The AUC for RatioU:P was 0.996 with a cut-off required for 100% sensitivity at 1.7 (yielding one false positive case). RatioU:P accurately discriminates between positive and false positive newborn referrals for PCD by NBS. RatioU:P is less effective as a discriminative tool for PCD in adults and for individuals that receive carnitine suppletion

Fusion of secretory vesicles isolated from rat liver

Secretory vesicles isolated from rat liver were found to fuse after exposure to Ca2+. Vescle fusion is characterized by the occurrence of twinned vesicles with a continuous cleavage plane between two vesicles in freeze-fracture electron microscopy. The number of fused vesicles increases with increasing Ca2+-concentrations and is half maximal around 10–6 m. Other divalent cations (Ba2+, Sr2+, and Mg2+) were ineffective. Mg2+ inhibits Ca2+-induced fusion. Therefore, the fusion of secretory vesiclesin vitro is Ca2+ specific and exhibits properties similar to the exocytotic process of various secretory cells. Various substances affecting secretionin vivo (microtubular inhibitors, local anethetics, ionophores) were tested for their effect on membrane fusion in our system. The fusion of isolated secretory vesicles from liver was found to differ from that of pure phospholipid membranes in its temperature dependence, in its much lower requirement for Ca2+, and in its Ca2+-specificity. Chemical and enzymatic modifications of the vesicle membrane indicate that glycoproteins may account for these differences

Search for a W' boson decaying to a bottom quark and a top quark in pp collisions at sqrt(s) = 7 TeV

Results are presented from a search for a W' boson using a dataset corresponding to 5.0 inverse femtobarns of integrated luminosity collected during 2011 by the CMS experiment at the LHC in pp collisions at sqrt(s)=7 TeV. The W' boson is modeled as a heavy W boson, but different scenarios for the couplings to fermions are considered, involving both left-handed and right-handed chiral projections of the fermions, as well as an arbitrary mixture of the two. The search is performed in the decay channel W' to t b, leading to a final state signature with a single lepton (e, mu), missing transverse energy, and jets, at least one of which is tagged as a b-jet. A W' boson that couples to fermions with the same coupling constant as the W, but to the right-handed rather than left-handed chiral projections, is excluded for masses below 1.85 TeV at the 95% confidence level. For the first time using LHC data, constraints on the W' gauge coupling for a set of left- and right-handed coupling combinations have been placed. These results represent a significant improvement over previously published limits.Comment: Submitted to Physics Letters B. Replaced with version publishe