Factors that promote or hinder maternal health service provision by female community health volunteers in rural Nepal

Female Community Health Volunteers (FCHVs) provide basic Maternal Health Services (MHSs) to pregnant women and mothers in their communities. Their contribution to maternal health has been praised, as Nepal managed to reduce its maternal mortality by more than two-thirds and met the Millennium Development Goal 5. However, little published evidence is available on FCHVs’ views and the factors that promote or hinder their services. This thesis explores the role of FCHVs in MHS provision in two regions (the hill and Terai ) of Nepal, from the perspectives of health workers, service users, and FCHVs themselves. A qualitative approach was adopted using semi-structured interviews, focus group discussions (FGDs) and field notes. Interviews were conducted with 20 FCHVs, 11 health workers and 26 women in villages from the two study regions. In addition, four FGDs were held with 19 FCHVs and field notes were taken throughout the data collection. Data were analysed using thematic analysis. Findings indicate that FCHVs play an important role in MHS provision in the hill villages where there is limited access to professional healthcare. The FCHVs detected pregnancies, referred them for health check-ups, accompanied them for deliveries and assisted in child-births. They also distributed medicines and informed women on the availability of safe abortion services. In both regions, the FCHVs raised health awareness among pregnant women/mothers casually or through organised meetings. In the hill villages, they used interesting casual approaches to share maternal health information, for example, singing folk songs with health messages in them or visiting new mothers with nutritious food hampers. Such services were beneficial to the women in the remote villages, who otherwise would not have received any healthcare. The FCHVs also shared maternal health messages through regularly organised mothers' group meetings. Unfortunately, these meetings were also used for monetary discussions, which left a little time for discussion on health topics. Such activity combined with the lack of FCHVs’ education often proved to be counterproductive on their service provision. They have a desire to volunteer, as they saw their service as social responsibility, felt empowered and enjoyed community recognition. However, a lack of financial and non-financial incentives was the key hindrance for them followed by perceived community misconceptions regarding their voluntary status. The FCHVs’ illiteracy and older age also affected their services. Finally, various health systems related factors also hindered their services: a lack of access to medical supplies, inadequate training and supervision. In general, volunteers in the terai region were less supported than those in the hill region. In addition, a perceived lack of respect by some health workers towards volunteers and a lack of coordination between government health centres and NGOs were noted. Overall, the study found that most interviewees perceived FCHVs as a valuable resource in improving the maternal health of the poor women. In some remote hill villages, they are the only MHS providers. Therefore, their contribution to MHS needs to be recognised and respected by both the health workers and the communities. It is important that FCHVs are provided with context specific support - incentives, access to supplies and supportive supervision - to enable them to deliver services more productively and to ensure that these services flourish in the future

A spatially distributed hydroeconomic model to assess the effects of drought on land use, farm profits, and agricultural employment.

In this paper a high-resolution linked hydroeconomic model is demonstrated for drought conditions in a Brazilian river basin.Doi: 10.1029/2008WR00753

Polar opposites? NGOs, left parties and the fight for social change in Nepal

In the early 1990s, when NGOs were rising to prominence as an ostensible force for social change in Nepal, the Maoists were also beginning to organise, and denounced NGOs as agents of imperialism. The Maoists came to prominence by fighting a People’s War launched in 1996, with the intention of improving life for the poor peasant and working-class majority. But after a decade-long struggle, the Maoists became incorporated into the parliamentary system. While Nepal’s first democratic revolution in 1990 met formal, popular political demands, which were consolidated in a subsequent revolution in 2006 overthrowing the monarchy and bringing the People’s War to an end, there was little socio-economic progress for the vast majority. The argument advanced in this article is that this lack of progress relied on the interplay of two phenomena: an anti-Maoist alliance consisting of the international community, the domestic ruling elite and NGOs, and a fundamental ambiguity at the heart of the Maoists’ political theory

A preliminary study of the effects of aircraft noise on families who reside in close proximity to an airport

Background: The use of air transportation has grown in the last century, escalating the noise exposure of families residing in close proximity to airports. The audiological effects need to be assessed to determine the impact of this increase on children and young adults living near to airports in South Africa. Method: Hearing patterns for these individuals were compared to those residing 30 km away from the airport. Sixty people, between the ages of 12-30 years, were assessed. Participants completed a questionnaire and were subjected to a diagnostic audiological test battery and tested using diagnostic distortion product otoacoustic emissions (DPOAEs). Results: Participants residing in close proximity to the airport presented with a notch configuration in the high frequencies, as opposed to those who lived further away. DPOAEs indicated a change in hearing in the high frequencies between the test populations. The positive relationship between the pure tone results and the DPOAEs strengthens the claim that aircraft noise has an effect on the hearing patterns of individuals living near to airports. Participants also experienced annoyance resulting from such noise. Conclusion: The results highlight the need for investigation into the hearing of individuals who reside in close proximity to airports. Comprehensive studies will be informative and beneficial to the field of audiology in South Africa. The highlighted health and safety issues require in-depth study to formulate a stronger argument for monitoring the hearing of families who are exposed to aircraft noise.Keywords: aircraft noise exposure, hearing patterns, distortion product otoacoustic emissions (DPOAEs

Assessing the effects of spatial discretization on large-scale flow model performance and prediction uncertainty

Large-scale physically-based and spatially-distributed models (>100 km2) constitute useful tools for water management since they take explicitly into account the heterogeneity and the physical processes occurring in the subsurface for predicting the evolution of discharge and hydraulic heads for several predictive scenarios. However, such models are characterized by lengthy execution times. Therefore, modelers often coarsen spatial discretization of large-scale physically-based and spatially-distributed models for reducing the number of unknowns and the execution times. This study investigates the influence of such a coarsening of model grid on model performance and prediction uncertainty. The improvement of model performance obtained with an automatic calibration process is also investigated. The results obtained show that coarsening spatial discretization mainly influences the simulation of discharge due to a poor representation of surface water network and a smoothing of surface slopes that prevents from simulating properly surface water-groundwater interactions and runoff processes. Parameter sensitivities are not significantly influenced by grid coarsening and calibration can compensate, to some extent, for model errors induced by grid coarsening. The results also show that coarsening spatial discretization mainly influences the uncertainty on discharge predictions. However, model prediction uncertainties on discharge only increase significantly for very coarse spatial discretizations.Peer reviewe

First-language raters’ opinions when validating word recordings for a newly developed speech reception threshold test

© 2018. The Authors. Licensee: AOSIS.Background: The purpose of this study was to consider the value of adding first-language speaker ratings to the process of validating word recordings for use in a new speech reception threshold (SRT) test in audiology. Previous studies had identified 28 word recordings as being suitable for use in a new SRT test. These word recordings had been shown to satisfy the linguistic criteria of familiarity, phonetic dissimilarity and tone, and the psychometric criterion of homogeneity of audibility. Objectives: The aim of the study was to consider the value of adding first-language speakers’ ratings when validating word recordings for a new SRT test. Method: A single observation, cross-sectional design was used to collect and analyse quantitative data in this study. Eleven first-language isiZulu speakers, purposively selected, were asked to rate each of the word recordings for pitch, clarity, naturalness, speech rate and quality on a 5-point Likert scale. The percent agreement and Friedman test were used for analysis. Results: More than 20% of these 11 participants rated the three-word recordings below ‘strongly agree’ in the category of pitch or tone, and one-word recording below ‘strongly agree’ in the categories of pitch or tone, clarity or articulation and naturalness or dialect. Conclusion: The first-language speaker ratings proved to be a valuable addition to the process of selecting word recordings for use in a new SRT test. In particular, these ratings identified potentially problematic word recordings in the new SRT test that had been missed by the previously and more commonly used linguistic and psychometric selection criteria

The internal and external consistency of a speech reception threshold test for isiZulu speakers with normal hearing sensitivity

(c) 2018 The Author/sBackground and objectives: This study investigated reliability, particularly the internal and external consistency, of a new isiZulu speech reception threshold (SRT) test. Methods: To examine internal consistency, 21 adult isiZulu speakers with normal hearing sensitivity completed the SRT test using the first and second halves of the SRT wordlist in the same test session. To examine external consistency, a separate 23 adult isiZulu speakers with normal hearing sensitivity completed the SRT test, using the whole word list on two occasions 4 weeks apart. Consistency of SRT test scores in these test conditions was measured using intraclass correlation coefficient analyses (a measure of the consistency or reproducibility of different observations of the same quantity) and Bland and Altman analyses of agreement (a comparison of measurement error with the expected variation amongst subjects). Results: Intraclass correlation coefficient values ranged from 0.69 to 0.79, showing the isiZulu test scores were highly consistent between the test and retest conditions used in this study. Bland and Altman analyses showed that isiZulu speakers with normal hearing sensitivity can be expected to return isiZulu SRT test scores that differ by no more than 7.5 dB HL – 8.7 dB HL between original and repeat assessments. Conclusion: The isiZulu SRT test was reliable, showing high internal and external consistency, when used to assess first-language speakers of isiZulu with normal hearing sensitivity. These findings warrant continued development of the isiZulu SRT test for eventual clinical use. This development should include validating this test on first-language speakers of isiZulu with and without hearing loss

Flow Stability in a Heated Channel with Longitudinal Grooves

Conference Abstract. Part of the Proceedings of the Canadian Society for Mechanical Engineering International Congress 2022