PMNCH Knowledge Summary 23: Human Rights & Accountability

Panel presentation for the Global Maternal Health Conference, held in Tanzania in January 2013, organised by Kate Sabot Presentation Outline (1) Overview of PMNCH (2) Overview of Knowledge Summary Process (3) KS 23 Highlight

The use of social network analysis to study health care provider advice and performance

Introduction: Social network analysis quantifies and visualises communication pathways between actors. This thesis focuses on the application of social network analysis methods to explore healthcare worker professional communication and performance by conducting a systematic review and a network study in Ethiopia. Paper 1: The systematic review analysed what social network methods have been used to study professional communication and performance among healthcare providers. Ten databases were searched from 1990 through April 2016, yielding 5,970 articles. There was marked diversity across all six studies meeting our search criteria in terms of research questions, health sector area, patient outcomes and network analysis methods. The paucity of articles, the complete lack of studies in low and middle-income contexts, the limited number in non-tertiary settings and few longitudinal, experimental designs or network interventions present clear research gaps. Paper 2: A cross-sectional, mixed-methods observational network study captured professional advice networks of 160 healthcare workers in eight primary health care units across four regions of Ethiopia. Data included health care worker advice seeking and giving for the provision of antenatal care, childbirth care, postnatal care and newborn care. Adjacency matrices were uploaded into UCINET 6.0 to calculate network metrics. Networks were visualised using NetDraw. Qualitative interviews of 20 purposively selected subjects followed the collection of quantitative network data to interpret and explain network roles and patterns observed. Expanded field notes were analysed using MaxQDA10. Results: Informal, inter-and intra-cadre advice networks existed. Fellow staff were preferred, but not limited to the primary health care unit. Average network-level metrics: density .26 (SD.11), degree centrality .45 (SD.08), distance 1.94 (SD.26), ties 95.63 (SD 35.46), network size 20.25 (SD 3.65). Conclusion: The systematic review found that network methods are underutilised in this area. The subsequent network study in Ethiopia serves to provide foundational information on healthcare worker professional advice networks

Knowledge Summary 23: Human Rights & Accountability

Progress has been made in reducing maternal and child mortality, yet millions continue to die from preventable causes. These deaths represent an accountability challenge and a major concern shared by both the health and human rights communities. The Millennium Development Goals (MDGs) commit to reducing these deaths. Powerful complementarities exist between MDGs and human rights.1 The MDGs generate attention, mobilise resources and contribute technical health monitoring approaches. Human rights offer a fundamental emphasis on accountability, systematic and sustained attention to inequities and a legal grounding of commitments. This knowledge summary explores human rights accountability systems at community, country, regional and international levels and the potential synergies for achieving both human rights and public health goals including, and beyond, the MDGs

High platelet content can increase storage lesion rates following Intercept pathogen inactivation primarily in platelet concentrates prepared by apheresis

Background: Pathogen inactivation methods for platelet concentrates are increasingly being used in blood banks worldwide. In vitro studies have demonstrated its effects on storage lesion, but little routine quality control data on blood banking outcomes have been reported. Materials and Methods: Swirling of distributed products was monitored before and after implementation of Intercept pathogen inactivation. Metabolic parameters pH, glucose and lactic acid were determined in a random cohort of expired pathogen-inactivated products. Storage lesion indicators in apheresis concentrates with premature low swirling were compared to concentrates with normal swirling. Results: During validation for implementing Intercept pathogen inactivation, pH and glucose levels decreased faster in apheresis platelet concentrates with high platelet content than with low platelet content or than in pathogen-inactivated pooled buffy coat-derived products. In routine products, glucose exhaustion was more often found in apheresis compared to buffy coat-derived platelet concentrates despite 3-7% more plasma carryover in the former. Annual incidence of premature low swirling increased significantly by 50% following implementation of pathogen inactivation implementation for apheresis but not for pooled buffy coat platelet concentrates. In addition, apheresis concentrates with premature low swirling had a significantly higher median platelet count (50 x 10(11)) than unaffected products (35 x 10(11)). Conclusion: The risk of increased storage lesion rates following Intercept pathogen inactivation is higher for apheresis than for buffy coat-derived platelet concentrates, especially when platelet contents are higher than 50 x 10(11)

Informed Decisions for Actions in Maternal and Newborn Health 2010–17 Report What works, why and how in maternal and newborn health

IDEAS is a measurement, learning and evaluation project based at the London School of Hygiene & Tropical Medicine (LSHTM). The project aims to find out “what works, why, and how” for maternal and newborn health in three low-resource settings in Nigeria, India, and Ethiopia. The IDEAS team includes 20 research and professional support staff, living in Abuja, Addis Ababa, London, and New Delhi, who have been working since 2010 with the Bill & Melinda Gates Foundation (the foundation) and with the foundation’s implementation partners

"Even if the test result is negative, they should be able to tell us what is wrong with us": a qualitative study of patient expectations of rapid diagnostic tests for malaria.

BACKGROUND: The debate on rapid diagnostic tests (RDTs) for malaria has begun to shift from whether RDTs should be used, to how and under what circumstances their use can be optimized. This has increased the need for a better understanding of the complexities surrounding the role of RDTs in appropriate treatment of fever. Studies have focused on clinician practices, but few have sought to understand patient perspectives, beyond notions of acceptability. METHODS: This qualitative study aimed to explore patient and caregiver perceptions and experiences of RDTs following a trial to assess the introduction of the tests into routine clinical care at four health facilities in one district in Ghana. Six focus group discussions and one in-depth interview were carried out with those who had received an RDT with a negative test result. RESULTS: Patients had high expectations of RDTs. They welcomed the tests as aiding clinical diagnoses and as tools that could communicate their problem better than they could, verbally. However, respondents also believed the tests could identify any cause of illness, beyond malaria. Experiences of patients suggested that RDTs were adopted into an existing system where patients are both physically and intellectually removed from diagnostic processes and where clinicians retain authority that supersedes tests and their results. In this situation, patients did not feel able to articulate a demand for test-driven diagnosis. CONCLUSIONS: Improvements in communication between the health worker and patient, particularly to explain the capabilities of the test and management of RDT negative cases, may both manage patient expectations and promote patient demand for test-driven diagnoses

Laplace Operators on Fractals and Related Functional Equations

We give an overview over the application of functional equations, namely the classical Poincar\'e and renewal equations, to the study of the spectrum of Laplace operators on self-similar fractals. We compare the techniques used to those used in the euclidean situation. Furthermore, we use the obtained information on the spectral zeta function to define the Casimir energy of fractals. We give numerical values for this energy for the Sierpi\'nski gasket

Cytomolecular identification of individual wheat-wheat chromosome arm associations in wheat-rye hybrids

Chromosome pairing in the meiotic metaphase I of wheatrye hybrids has been characterized by sequential genomic and fluorescent in situ hybridization allowing not only the discrimination of wheat and rye chromosomes, but also the identification of the individual wheat and rye chromosome arms involved in the chromosome associations. The majority of associations (93.8%) were observed between the wheat chromosomes. The largest number of wheat-wheat chromosome associations (53%) was detected between the A and D genomes, while the frequency of B-D and A-B associations was significantly lower (32 and 8%, respectively). Among the A-D chromosome associations, pairing between the 3AL and 3DL arms was observed with the highest frequency, while the most frequent of all the chromosome associations (0.113/ cell) was found to be the 3DS-3BS. Differences in the pairing frequency of the individual chromosome arms of wheat-rye hybrids have been discussed in relation to the homoeologous relationships between the constituent genomes of hexaploid wheat

Prevalence of Malaria Parasitemia and Purchase of Artemisinin-Based Combination Therapies (ACTs) among Drug Shop Clients in Two Regions in Tanzania with ACT Subsidies.

Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6-18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9-11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2-6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5-7.4).\ud Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops