Planning a Family:priorities and concerns in rural Tanzanmia

A fertility survey using qualitative and quantitative techniques described a high fertility setting (TFR 5.8) in southern Tanzania where family planning use was 16%. Current use was influenced by rising parity, educational level, age of last born child, breastfeeding status, a\ud preference for longer than the mean birth interval (32 months), not being related to the household head, and living in a house with a tin roof. Three principal concerns amongst women were outlined from the findings. First, that there is a large unmet need for family planning services in the area particularly among teenagers for whom it is associated with induced abortion. Second, that family planning is being used predominantly for spacing but fears\ud associated with it often curtail effective use. Third, that service provision is perceived to be lacking in two main areas — regularity of supply, and addressing rumours and fears associated with family planning. Reproductive health interventions in the area should ultimately be more\ud widespread and, in particular, abortion is highlighted as an urgent issue for further research.\ud The potential for a fast and positive impact is high, given the simplicity of the perceived needs of\ud women from this study. (Afr J Reprod Health 2004; 8[2]:111-123)\u

Low-energy three-body charge transfer reactions with Coulomb interaction in the final state

Three-body charge transfer reactions with Coulomb interaction in the final state are considered in the framework of coordinate-space integro-differential Faddeev-Hahn-type equations within two- and six-state close coupling approximations. The method is employed to study direct muon transfer in low-energy collisions of the muonic hydrogen H$_\mu$ by helium (He$^{++}$) and lithium (Li$^{+++}$) nuclei. The experimentally observed isotopic dependence is reproduced.Comment: 14 pages REVTeX, accepted for publication in Journal of Physics

How people-centred health systems can reach the grassroots: experiences implementing community-level quality improvement in rural Tanzania and Uganda

Background Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Information Power (EQUIP) intervention with the aim of improving maternal and newborn health. Village volunteers were taught how to generate change ideas to improve health-seeking behaviours and home-based maternal and newborn care practices. Interaction was encouraged between communities and health staff. Aim To describe experiences implementing EQUIP’s QI approach at the community level. Methods A mixed methods process evaluation of community-level QI was conducted in Tanzania and a feasibility study in Uganda. We outlined how village volunteers were trained in and applied QI techniques and examined the interaction between village volunteers and health facilities, and in Tanzania, the interaction with the wider community also. Results Village volunteers had the capacity to learn and apply QI techniques to address local maternal and neonatal health problems. Data collection and presentation was a persistent challenge for village volunteers, overcome through intensive continuous mentoring and coaching. Village volunteers complemented health facility staff, particularly to reinforce behaviour change on health facility delivery and birth preparedness. There was some evidence of changing social norms around maternal and newborn health, which EQUIP helped to reinforce. Conclusions Community-level QI is a participatory research approach that engaged volunteers in Tanzania and Uganda, putting them in a central position within local health systems to increase health-seeking behaviours and improve preventative maternal and newborn health practices

KINET: A social marketing programme of treated nets and net treatment for malaria control in Tanzania, with evaluation of child health and long-term survival

We present a large-scale social marketing programme of insecticide-treated nets in 2 rural districts in south-western Tanzania (population 350 000) and describe how the long-term child health and survival impact will be assessed. Formative and market research were conducted in order to understand community perceptions, knowledge, attitudes and practice with respect to the products to be socially marketed. We identified Zuia Mbu (Kiswahili for ‘prevent mosquitoes') as a suitable brand name for both treated nets and single-dose insecticide treatment sachets. A mix of public and private sales outlets is used for distribution. In the first stage of a stepped introduction 31 net agents were appointed and trained in 18 villages: 15 were shop owners, 14 were village leaders, 1 was a parish priest and 1 a health worker. For net treatment 37 young people were appointed in the same villages and trained as agents. Further institutions in both districts such as hospitals, development projects and employers were also involved in distribution. Promotion for both products was intense and used a variety of channels. A total of 22 410 nets and 8072 treatments were sold during the first year: 18 months after launching, 46% of 312 families with children aged under 5 years reported that their children were sleeping under treated nets. A strong evaluation component in over 50 000 people allows assessment of the long-term effects of insecticide-treated nets on child health and survival, anaemia in pregnancy, and the costs of the intervention. This evaluation is based on cross-sectional surveys, and case-control and cohort studie

Standing in a Garden of Forking Paths

According to the Path Principle, it is permissible to expand your set of beliefs iff (and because) the evidence you possess provides adequate support for such beliefs. If there is no path from here to there, you cannot add a belief to your belief set. If some thinker with the same type of evidential support has a path that they can take, so do you. The paths exist because of the evidence you possess and the support it provides. Evidential support grounds propositional justification. The principle is mistaken. There are permissible steps you may take that others may not even if you have the very same evidence. There are permissible steps that you cannot take that others can even if your beliefs receive the same type of evidential support. Because we have to assume almost nothing about the nature of evidential support to establish these results, we should reject evidentialism

Application of realistic effective interactions to the structure of the Zr isotopes

We calculate the low-lying spectra of the zirconium isotopes Z=40 with neutron numbers from N=52 to N=60 using the 1p1/20g9/2 proton and 2s1d0g7/20h11/2 neutron sub-shells to define the model space. Effective proton-proton, neutron--neutron and proton-neutron interactions have been derived using 88Sr as closed core and employing perturbative many-body techniques. The starting point is the nucleon-nucleon potential derived from modern meson exchange models. The comprehensive shell-model calculation performed in this work provides a qualitative reproduction of essential properties such as the sub-shell closures in 96Zr and 98Zr.Comment: To appear in Phys Rev C, june 2000, 8 figs, Revtex latex styl

The DEAR experiment on DAΦNE

DEAR is one of the first experiments at the new DAΦNE Ø-factory at the Laboratori Nazionali di Frascati dell'INFN. The objective of the DEAR experiment is to perform a precision measurement of the strong interaction shifts and widths of the K-series lines in kaonic hydrogen and the first observation of the same quantities in kaonic deuterium. The aim is to obtain a precise determination of the isospin-dependent kaon-nucleon scattering lengths which will represent a breakthrough in KN low-energy phenomenology and will allow us to determine the kaon-nucleon sigma terms. The sigma terms give a direct measurement of chiral symmetry breaking and are connected to the strangeness content of the proton. First results on background measurements with the DEAR NTP setup installed on DAΦNE are reported

Malaria in pregnant women in an area with sustained high coverage of insecticide-treated bed nets

BACKGROUND\ud \ud Since 2000, the World Health Organization has recommended a package of interventions to prevent malaria during pregnancy and its sequelae that includes the promotion of insecticide-treated bed nets (ITNs), intermittent preventive treatment in pregnancy (IPTp), and effective case management of malarial illness. It is recommended that pregnant women in malaria-endemic areas receive at least two doses of sulphadoxine-pyrimethamine in the second and third trimesters of pregnancy. This study assessed the prevalence of placental malaria at delivery in women during 1st or 2nd pregnancy, who did not receive intermittent preventive treatment for malaria (IPTp) in a malaria-endemic area with high bed net coverage.\ud \ud METHODS\ud \ud A hospital-based cross-sectional study was done in Ifakara, Tanzania, where bed net coverage is high. Primi- and secundigravid women, who presented to the labour ward and who reported not using IPTp were included in the study. Self-report data were collected by questionnaire; whereas neonatal birth weight and placenta parasitaemia were measured directly at the time of delivery.\ud \ud RESULTS\ud \ud Overall, 413 pregnant women were enrolled of which 91% reported to have slept under a bed net at home the previous night, 43% reported history of fever and 62% were primigravid. Malaria parasites were detected in 8% of the placenta samples; the geometric mean (95%CI) placental parasite density was 3,457 (1,060-11,271) parasites/mul in primigravid women and 2,178 (881-5,383) parasites/mul in secundigravid women. Fifteen percent of newborns weighed <2,500 g at delivery. Self-reported bed net use was statistically associated with lower risk for low birth weight [OR 0.34 (95% CI: 0.16-0.74) and OR 0.22 (95% CI: 0.08-0.59) for untreated and treated bed nets, respectively], but was not associated with placental parasitaemia [OR 0.74 (0.21-2.68) and OR 1.64 (0.44-6.19) for untreated and treated bed nets, respectively].\ud \ud CONCLUSION\ud \ud The observed incidence of LBW and prevalence of placental parasitaemia at delivery suggests that malaria remains a problem in pregnancy in this area with high bed net coverage when eligible women do not receive IPTp. Delivery of IPTp should be emphasized at all levels of implementation to achieve maximum community coverage

Associations between music education, intelligence, and spelling ability in elementary school

Musical education has a beneficial effect on higher cognitive functions, but questions arise whether associations between music lessons and cognitive abilities are specific to a domain or general. We tested 194 boys in Grade 3 by measuring reading and spelling performance, non verbal intelligence and asked parents about musical activities since preschool. Questionnaire data showed that 53% of the boys had learned to play a musical instrument. Intelligence was higher for boys playing an instrument (p < .001). To control for unspecific effects we excluded families without instruments. The effect on intelligence remained (p < .05). Furthermore, boys playing an instrument showed better performance in spelling compared to the boys who were not playing, despite family members with instruments (p < .01). This effect was observed independently of IQ. Our findings suggest an association between music education and general cognitive ability as well as a specific language link