The acceptability of cervical electrical impedance spectroscopy within a multi-modal preterm birth screening package: a mixed methods study.

BACKGROUND: Reducing the rate of preterm birth is a cornerstone of global efforts to address child mortality, however existing screening tests offer imperfect prediction. Cervical electrical impedance spectroscopy (EIS) is a novel technique to quantify the ripening changes which precede labour. Mid-trimester EIS measurements have been shown to accurately predict preterm birth in asymptomatic women. This study aimed to comprehensively evaluate the acceptability of cervical EIS to low and high-risk women as part of a package of screening tests performed during a larger prospective trial. METHODS: In this parallel convergent mixed methods study, 40 women completed questionnaires before and after screening tests (EIS, cervical length measurement and fetal fibronectin quantification). Quantitative outcomes were anxiety levels before and after screening (Spielberger State Trait Anxiety Inventory, STAI-6), pain (Short Form McGill Pain Questionnaire) and ratings of EIS device appearance and test acceptability (visual analogue scales). Twenty-one women (11 high-risk, 10 low-risk) also attended a semi-structured qualitative interview. Interviews were recorded and transcribed, then thematic analysis was performed. A convergence coding matrix was constructed to enable triangulation of quantitative and qualitative results. RESULTS: High risk women demonstrated a significant reduction in anxiety following screening (mean STAI-6 score 34.5 vs. 29.0, p = 0.002). A similar trend was observed among low-risk participants. Ratings of pain, EIS device appearance and procedural acceptability did not differ between groups. Mean pain ratings were low (visual analogue scale 0.97 and 1.01), comparing favourably to published evaluations of conventional screening tests. Qualitative analysis provided insight into both the physical consequences and emotional experiences of screening. Additional determinants of the screening experience included device design, pre-existing perspectives on intimate examination, attitudes to knowledge in pregnancy and interaction with clinical staff. Finally, a range of practical considerations regarding wider use of EIS were identified, with valuable complementary detail regarding acceptability for use in antenatal care. CONCLUSIONS: Cervical EIS is well tolerated and acceptable to both low and high-risk women when performed as part of a multi-modal screening package. These results provide useful insights to inform the design of future study and screening protocols

The Dryland Eco-Farm: A Potential Solution to the Main Constraints of Rain-Fed Agriculture in the Semi-Arid Tropics of Africa

This chapter presents the results of studies on a production system called Dryland Eco-Farm (DEF) that addresses a range of constraints to agricultural productivity in dryland Africa. It combines the use of live hedges and alleys of Acacia colei, “demi-lunes” in which are planted domesticated Ziziphus mauritiania. Annual crops like pearl millet (Pennisetum glaucum (L.) R.Br.), cowpeas and roselle (Hibiscus sabdariffa) are planted in rotation. This trial tests the effect of the system on (1) soil erosion control, soil fertility and water use efficiency, (2) crop yield and biomass production, and (3) improving income generation and diversification. Average pearl millet yields in the DEF were twice the control (880 vs. 430 kg ha–1) when no mineral fertilizer was applied. With the application of NPK, millet yields were almost similar under both conditions (950 vs. 780 kg ha–1). Cowpea yields were on average seven times higher than the control without NPK (1,400 vs. 200 kg ha–1 total biomass) and three times with NPK (1,850 vs. 650 kg ha–1 total biomass). Roselle yield increased four times on average without NPK (205 vs. 60 kg ha–1 calices yield) and two times with NPK (234 vs. 114 kg ha–1). Therefore, the system has the potential to produce yield response similar to that of the recommended rate of 100 kg of the 15-15-15 fertilizer per ha. The return to land is estimated at US 224 for the DEF compared to US224fortheDEFcomparedtoUS77 for the traditional millet–cowpea system. This system has the potential to improve productivity and rural livelihood in the drylands of Africa while sustaining the natural resources base

Bioreclamation of degraded African lands with women empowerment

The Sudano Sahel is a semi arid region south of the Sahara with a population greater than 60 million people. Its borders are delineated by the 300-800 mm/year rain isohyets (Fig. 1). The Sahel environment is very hostile. Air temperatures are always high. During March-June they can climb to 45ºC. The intensity of monsoonal rains can be higher than 100 mm/hr resulting in significant water runoff and soil erosion. The prevalent acid sandy soil is very poor in nutrients and it has very low organic carbon content (Schlecht et al., 2006). The soil is undergoing a continuous process of erosion, mostly by wind but also by water (Manu et al., 1998). Between 80-90% of the population lives from rain-fed agriculture, producing in the rainy season (June-September) a limited number of staple crops (millet, sorghum, groundnuts, and cowpeas). Droughts result in crop failure in two out of five years. Population growth rate is around 3% resulting in diminishing area of cultivated land per household. There is a need to identify innovative alternatives for increasing agricultural productivity and income generation in such a harsh environment.More than 50% of the Sahelian soil is degraded (Lal, 1988). Most of these degraded lands are crusted lateritic soils (Fig. 2). Both the cation exchange capacity and the water holding capacity of the degraded laterites are significantly higher than those of the predominantly sandy soils.Women in Africa, particularly in the Sudano Sahel, are a marginalized sector of the society. There they have no or only little inheritance rights for goods, they are not allowed to own land, they have no voting rights in community matters and have a higher percentage of illiteracy than men (Mulenkey, 2002). Yet women are bearing the burden to feed their families and to help their husbands in farm operations in addition to their daily chores. The lack of nutritional balance in the daily diets of rural Africa is becoming a matter of concern to the international community (World Bank, 1997). In dry West Africa between 13-15% of children are suffering from acute nutritional deficiency (USAID, 2006). The Bioreclamation of Degraded Lands (BDL) system developed by ICRISAT provides solutions to these constraints. The BDL is an integrated system aiming at increasing food production and income of women through the utilization of degraded lands for production of rain-fed fruit trees and vegetables

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)