243 research outputs found
Dynamic sea surface topography, gravity and improved orbit accuracies from the direct evaluation of SEASAT altimeter data
A method for the simultaneous solution of dynamic ocean topography, gravity and orbits using satellite altimeter data is described. A GEM-T1 based gravitational model called PGS-3337 that incorporates Seasat altimetry, surface gravimetry and satellite tracking data has been determined complete to degree and order 50. The altimeter data is utilized as a dynamic observation of the satellite's height above the sea surface with a degree 10 model of dynamic topography being recovered simultaneously with the orbit parameters, gravity and tidal terms in this model. PGS-3337 has a geoid uncertainty of 60 cm root-mean-square (RMS) globally, with the uncertainty over the altimeter tracked ocean being in the 25 cm range. Doppler determined orbits for Seasat, show large improvements, with the sub-30 cm radial accuracies being achieved. When altimeter data is used in orbit determination, radial orbital accuracies of 20 cm are achieved. The RMS of fit to the altimeter data directly gives 30 cm fits for Seasat when using PGS-3337 and its geoid and dynamic topography model. This performance level is two to three times better than that achieved with earlier Goddard earth models (GEM) using the dynamic topography from long-term oceanographic averages. The recovered dynamic topography reveals the global long wavelength circulation of the oceans with a resolution of 1500 km. The power in the dynamic topography recovery is now found to be closer to that of oceanographic studies than for previous satellite solutions. This is attributed primarily to the improved modeling of the geoid which has occurred. Study of the altimeter residuals reveals regions where tidal models are poor and sea state effects are major limitations
Responding to the maternal health care challenge: The Ethiopian Health Extension Program
Background: Responding to challenges in achieving Millennium Development Goals (MDG), the Ethiopian government initiated the Health Extension Program in 2003 as part of the Health Sector Development Program (HSDP) to improve equitable access to preventive, promotive and select curative health interventions through paid community level health extension workers.Objective: To explore Ethiopia’s progress toward achieving MDG 5 that focuses on improved maternal health through the Health Extension Program.Methods: This paper reviews available survey data and literature to determine the feasibility of reaching the targets specified for MDG 5 and for HSDP.Important findings: Achieving the set targets is a daunting task despite reaching the physical targets of two health extension workers per kebele. The 2015 MDG target for the Maternal Mortality Ratio (MMR) is 218 while the 2005 MMR estimate is 673. The HSDP target is 32% skilled birth attendant use by 2010 but only about 12% use was found in the four most populated regions of the country in 2009.Conclusions: Accelerating progress towards these targets is possible through the Health Extension Program at the worker level through improved promotion of family planning and specific maternal interventions, such as misoprostol for active management of third stage of labor, immediate postpartum visits, and improved coordination from community to referral level. [Ethiop. J. Health Dev. 2010;24 Special Issue 1:105-109
Postpartum Haemorrhage and Eclampsia: Differences in Knowledge and Care-seeking Behaviour in Two Districts of Bangladesh
In high- and low-performing districts of Bangladesh, the study explored the demand-side of maternal healthcare by looking at differences in perceived knowledge and care-seeking behaviours of women in relation to postpartum haemorrhage or eclampsia. Haemorrhage and eclampsia are two major causes of maternal mortality in Bangladesh. The study was conducted during July 2006–December 2007. Both postpartum bleeding and eclampsia were recognized by women of different age-groups as severe and life-threatening obstetric complications. However, a gap existed between perception and actual care-seeking behaviours which could contribute to the high rate of maternal deaths associated with these conditions. There were differences in care-seeking practices among women in the two different areas of Bangladesh, which may reflect sociocultural differences, disparities in economic and educational opportunities, and a discrimination in the availability of care
Investigating Financial Incentives for Maternal Health: An Introduction
Projection of current trends in maternal and neonatal mortality
reduction shows that many countries will fall short of the UN
Millennium Development Goal 4 and 5. Underutilization of maternal
health services contributes to this poor progress toward reducing
maternal and neonatal morbidity and mortality. Moreover, the quality of
services continues to lag in many countries, with a negative effect on
the health of women and their babies, including deterring women from
seeking care. To enhance the use and provision of quality maternal
care, countries and donors are increasingly using financial incentives.
This paper introduces the JHPN Supplement, in which each paper reviews
the evidence of the effectiveness of a specific financial incentive
instrument with the aim of improving the use and quality of maternal
healthcare and impact. The US Agency for International Development and
the US National Institutes of Health convened a US Government Evidence
Summit on Enhancing Provision and Use of Maternal Health Services
through Financial Incentives on 24-25 April 2012 in Washington, DC. The
Summit brought together leading global experts in finance, maternal
health, and health systems from governments, academia, development
organizations, and foundations to assess the evidence on whether
financial incentives significantly and substantially increase
provision, use and quality of maternal health services, and the
contextual factors that impact the effectiveness of these incentives.
Evidence review teams evaluated the multidisciplinary evidence of
various financial mechanisms, including supply-side incentives (e.g.
performance-based financing, user fees, and various insurance
mechanisms) and demand-side incentives (e.g. conditional cash
transfers, vouchers, user fee exemptions, and subsidies for
care-seeking). At the Summit, the teams presented a synthesis of
evidence and initial recommendations on practice, policy, and research
for discussion. The Summit enabled structured feedback on
recommendations which the teams included in their final papers
appearing in this Supplement. Papers in this Supplement review the
evidence for a specific financial incentive mechanism (e.g. pay for
performance, conditional cash transfer) to improve the use and quality
of maternal healthcare and makes recommendations for programmes and
future research. While data on programmes using financial incentives
for improved use and indications of the quality of maternal health
services support specific conclusions and recommendations, including
those for future research, data linking the use of financial incentives
with improved health outcomes are minimal
An Examination of Women Experiencing Obstetric Complications Requiring Emergency Care: Perceptions and Sociocultural Consequences of Caesarean Sections in Bangladesh
Little is known about the physical and socioeconomic postpartum
consequences of women who experience obstetric complications and
require emergency obstetric care (EmOC), particularly in resource-poor
countries such as Bangladesh where historically there has been a strong
cultural preference for births at home. Recent increases in the use of
skilled birth attendants show socioeconomic disparities in access to
emergency obstetric services, highlighting the need to examine birthing
preparation and perceptions of EmOC, including caesarean sections.
Twenty women who delivered at a hospital and were identified by
physicians as having severe obstetric complications during delivery or
immediately thereafter were selected to participate in this qualitative
study. Purposive sampling was used for selecting the women. The study
was carried out in Matlab, Bangladesh, during March 2008 - August 2009.
Data-collection methods included in-depth interviews with women and,
whenever possible, their family members. The results showed that the
women were poorly informed before delivery about pregnancy-related
complications and medical indications for emergency care. Barriers to
care-seeking at emergency obstetric facilities and acceptance of
lifesaving care were related to apprehensions about the physical
consequences and social stigma, resulting from hospital procedures and
financial concerns. The respondents held many misconceptions about
caesarean sections and distrust regarding the reason for recommending
the procedure by the healthcare providers. Women who had caesarean
sections incurred high costs that led to economic burdens on family
members, and the blame was attributed to the woman. The postpartum
health consequences reported by the women were generally left
untreated. The data underscore the importance of educating women and
their families about pregnancy-related complications and preparing
families for the possibility of caesarean section. At the same time,
the health systems need to be strengthened to ensure that all women in
clinical need of lifesaving obstetric surgery access quality EmOC
services rapidly and, once in a facility, can obtain a caesarean
section promptly, if needed. While greater access to surgical
interventions may be lifesaving, policy-makers need to institute
mechanisms to discourage the over-medicalization of childbirth in a
context where the use of caesarean section is rapidly rising
NASA Ocean Altimeter Pathfinder Project
The NOAA/NASA Pathfinder program was created by the Earth Observing System (EOS) Program Office to determine how existing satellite-based data sets can be processed and used to study global change. The data sets are designed to be long time-series data processed with stable calibration and community consensus algorithms to better assist the research community. The Ocean Altimeter Pathfinder Project involves the reprocessing of all altimeter observations with a consistent set of improved algorithms, based on the results from TOPEX/POSEIDON (T/P), into easy-to-use data sets for the oceanographic community for climate research. Details are currently presented in two technical reports: Report# 1: Data Processing Handbook Report #2: Data Set Validation This report describes the validation of the data sets against a global network of high quality tide gauge measurements and provides an estimate of the error budget. The first report describes the processing schemes used to produce the geodetic consistent data set comprised of SEASAT, GEOSAT, ERS-1, TOPEX/ POSEIDON, and ERS-2 satellite observations
Staff experiences of Providing Maternity Services in Rural Southern Tanzania -- A Focus on Equipment, Drug and Supply Issues.
The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse maternal outcomes through delaying care provision. We aim to describe staff experiences of providing maternal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures that carried potential health risks to themselves as a result. Inadequately stocked and equipped facilities compromise the health system's ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions
Factors influencing place of delivery for women in Kenya: an analysis of the Kenya Demographic and Health Survey, 2008/2009
Background
Maternal mortality in Kenya increased from 380/100000 live births to 530/100000 live births between 1990 and 2008. Skilled assistance during childbirth is central to reducing maternal mortality yet the proportion of deliveries taking place in health facilities where such assistance can reliably be provided has remained below 50% since the early 1990s. We use the 2008/2009 Kenya Demographic and Health Survey data to describe the factors that determine where women deliver in Kenya and to explore reasons given for home delivery.
Methods
Data on place of delivery, reasons for home delivery, and a range of potential explanatory factors were collected by interviewer-led questionnaire on 3977 women and augmented with distance from the nearest health facility estimated using health facility Global Positioning System (GPS) co-ordinates. Predictors of whether the woman’s most recent delivery was in a health facility were explored in an exploratory risk factor analysis using multiple logistic regression. The main reasons given by the woman for home delivery were also examined.
Results
Living in urban areas, being wealthy, more educated, using antenatal care services optimally and lower parity strongly predicted where women delivered, and so did region, ethnicity, and type of facilities used. Wealth and rural/urban residence were independently related. The effect of distance from a health facility was not significant after controlling for other variables. Women most commonly cited distance and/or lack of transport as reasons for not delivering in a health facility but over 60% gave other reasons including 20.5% who considered health facility delivery unnecessary, 18% who cited abrupt delivery as the main reason and 11% who cited high cost.
Conclusion
Physical access to health facilities through distance and/or lack of transport, and economic considerations are important barriers for women to delivering in a health facility in Kenya. Some women do not perceive a need to deliver in a health facility and may value health facility delivery less with subsequent deliveries. Access to appropriate transport for mothers in labour and improving the experiences and outcomes for mothers using health facilities at childbirth augmented by health education may increase uptake of health facility delivery in Kenya
Maternal deaths in Pakistan : intersection of gender, class and social exclusion.
Background: A key aim of countries with high maternal mortality rates is to increase availability of competent
maternal health care during pregnancy and childbirth. Yet, despite significant investment, countries with the
highest burdens have not reduced their rates to the expected levels. We argue, taking Pakistan as a case study,
that improving physical availability of services is necessary but not sufficient for reducing maternal mortality
because gender inequities interact with caste and poverty to socially exclude certain groups of women from
health services that are otherwise physically available.
Methods: Using a critical ethnographic approach, two case studies of women who died during childbirth were
pieced together from information gathered during the first six months of fieldwork in a village in Northern Punjab,
Pakistan.
Findings: Shida did not receive the necessary medical care because her heavily indebted family could not afford it.
Zainab, a victim of domestic violence, did not receive any medical care because her martial family could not afford
it, nor did they think she deserved it. Both women belonged to lower caste households, which are materially poor
households and socially constructed as inferior.
Conclusions: The stories of Shida and Zainab illustrate how a rigidly structured caste hierarchy, the gendered
devaluing of females, and the reinforced lack of control that many impoverished women experience conspire to
keep women from lifesaving health services that are physically available and should be at their disposal
Violence against Women with Chronic Maternal Disabilities in Rural Bangladesh
This study explored violence against women with chronic maternal
disabilities in rural Bangladesh. During November 2006 - July 2008,
in-depth interviews were conducted with 17 rural Bangladeshi women
suffering from uterine prolapse, stress incontinence, or fistula.
Results of interviews showed that exposure to emotional abuse was
almost universal, and most women were sexually abused. The common
triggers for violence were the inability of the woman to perform
household chores and to satisfy her husband's sexual demands.
Misconceptions relating to the causes of these disabilities and the
inability of the affected women to fulfill gender role expectations
fostered stigma. Emotional and sexual violence increased their
vulnerability, highlighting the lack of life options outside marriage
and silencing most of them into accepting the violence. Initiatives
need to be developed to address misperceptions regarding the causes of
such disabilities and, in the long-term, create economic opportunities
for reducing the dependence of women on marriage and men and transform
the society to overcome rigid gender norms
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