Factors affecting home delivery in rural Tanzania

BACKGROUND\ud \ud Studies of factors affecting place of delivery have rarely considered the influence of gender roles and relations within the household. This study combines an understanding of gender issues relating to health and help-seeking behaviour with epidemiological knowledge concerning place of delivery.\ud \ud METHODS\ud \ud In-depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were collected in a cross-sectional survey of 21,600 randomly chosen households.\ud \ud RESULTS\ud \ud Issues of risk and vulnerability, such as lack of money, lack of transport, sudden onset of labour, short labour, staff attitudes, lack of privacy, tradition and cultures and the pattern of decision-making power within the household were perceived as key determinants of the place of delivery. More than 9000 women were interviewed about their most recent delivery in the quantitative survey. There were substantial variations between ethnic groups with respect to place of delivery (P<0.0001). Women who lived in male-headed households were less likely to deliver in a health facility than women in female-headed households (RR 0.86, 95% CI 0.80-0.91). Mothers with primary and higher education were more likely to deliver at a health facility (RR 1.30, 95% CI 1.23-1.38). Younger mothers and the least poor women were also more likely to deliver in a health facility compared with the older and the poorest women, respectively.\ud \ud CONCLUSIONS\ud \ud To address neonatal mortality, special attention should be paid to neonatal health in both maternal and child health programmes. The findings emphasize the need for a systematic approach to overcome health-system constraints, community based programmes and scale-up effective low-cost interventions which are already available

The Changing Epidemiology of Malaria in Ifakara Town, Southern Tanzania.

Between 1995 and 2000 there were marked changes in the epidemiology of malaria in Ifakara, southern Tanzania. We documented these changes using parasitological and clinical data from a series of community- and hospital-based studies involving children up to the age of 5 years. There was a right shift and lowering in the age-specific parasite prevalence in the community-based cohort studies. The incidence of clinical malaria in placebo-receiving infants in additional study cohorts dropped from 0.8 in 1995 to 0.43 episodes per infant per year in 2000, an incidence rate ratio of 0.53 (95% confidence interval: 0.404, 0.70, P<0.0001). At the same time, there was an increase in the total number of malaria admissions and a marked right shift in the age pattern of these admissions (median age in 1995 1.55 years vs. 2.33 in 2000, P<0.0001). However, the burden of malaria deaths remained in infants. We discuss how these dramatic changes in the epidemiology of malaria may have arisen from the use of currently available malaria control tools. Caution is required in the interpretation of hospital-based data as it is likely to underestimate the impact of anaemia on mortality in the community, where most paediatric deaths occur. Even in low/moderate malaria transmission settings, where older children suffer most malaria episodes, targeting effective malaria control at infants may produce important reductions in infant mortality caused by malaria

The silent burden of anaemia in Tanzania children:a community-based study

Objective was to document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old,thereby assisting in the development of effective strategies for controlling anaemia.\ud \ud Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern\ud United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed.\ud \ud Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6–11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1–5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron\ud was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was notassociated with risk of anaemia.\ud \ud Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria

Access to Artemisinin-Based Anti-Malarial Treatment and its Related Factors in Rural Tanzania.

Artemisinin-based combination treatment (ACT) has been widely adopted as one of the main malaria control strategies. However, its promise to save thousands of lives in sub-Saharan Africa depends on how effective the use of ACT is within the routine health system. The INESS platform evaluated effective coverage of ACT in several African countries. Timely access within 24 hours to an authorized ACT outlet is one of the determinants of effective coverage and was assessed for artemether-lumefantrine (Alu), in two district health systems in rural Tanzania. From October 2009 to June 2011we conducted continuous rolling household surveys in the Kilombero-Ulanga and the Rufiji Health and Demographic Surveillance Sites (HDSS). Surveys were linked to the routine HDSS update rounds. Members of randomly pre-selected households that had experienced a fever episode in the previous two weeks were eligible for a structured interview. Data on individual treatment seeking, access to treatment, timing, source of treatment and household costs per episode were collected. Data are presented on timely access from a total of 2,112 interviews in relation to demographics, seasonality, and socio economic status. In Kilombero-Ulanga, 41.8% (CI: 36.6-45.1) and in Rufiji 36.8% (33.7-40.1) of fever cases had access to an authorized ACT provider within 24 hours of fever onset. In neither of the HDSS site was age, sex, socio-economic status or seasonality of malaria found to be significantly correlated with timely access. Timely access to authorized ACT providers is below 50% despite interventions intended to improve access such as social marketing and accreditation of private dispensing outlets. To improve prompt diagnosis and treatment, access remains a major bottle neck and new more innovative interventions are needed to raise effective coverage of malaria treatment in Tanzania

Note on paramoudra-like carbonate concretions in the Urenui Formation, North Taranaki: possible plumbing system for a Late Miocene methane seep field

A reconnaissance study of calcitic and dolomitic tubular concretions in upper slope mudstone of the Late Miocene Urenui Formation exposed along the north Taranaki coastline indicates that they have a complex diagenetic history involving different phases of carbonate cementation and likely hydrofracturing associated with build up of fluid/gas pressures. The concretions resemble classical paramoudra in the European chalk, but are not siliceous and do not have a trace fossil origin. Stable oxygen and carbon isotope data suggest that the micritic carbonate cements in the Urenui paramoudra were probably sourced primarily from ascending methane fluid/gases, and that they precipitated entirely within the host mudstone below the seafloor. We suggest the paramoudra may mark the subsurface plumbing networks of a Late Miocene cold seep system, in which case they have relevance to the evolution and migration of hydrocarbons in Taranaki Basin, at this site perhaps focussed along the Taranaki Fault. The presence of dislodged and mass-emplaced paramoudra in the axial conglomerate of channels within the Urenui mudstone suggests there could be a connection between the loci of seep field development and slope failure and canyon cutting on the Late Miocene Taranaki margin

Spin density wave anomaly at 140 K in the ternary iron arsenide BaFe2As2

The ternary iron arsenide BaFe2As2 with the tetragonal ThCr2Si2-type structure exhibits a spin density wave (SDW) anomaly at 140 K, very similar to LaFeAsO, the parent compound of the iron arsenide superconductors. BaFe2As2 is a poor Pauli-paramagnetic metal and undergoes a structural and magnetic phase transition at 140 K, accompanied by strong anomalies in the specific heat, electrical resistance and magnetic susceptibility. In the course of this transition, the space group symmetry changes from tetragonal (I4/mmm) to orthorhombic (Fmmm). 57Fe Moessbauer spectroscopy experiments show a single signal at room temperature and full hyperfine field splitting below the phase transition temperature (5.2 T at 77 K). Our results suggest that BaFe2As2 can serve as a new parent compound for oxygen-free iron arsenide superconductors.Comment: 4 pages, 6 figures, submitted to PR

Where there’s ‘willingness’ there’s a way: barriers and facilitators to maternal, newborn and child health data sharing by the private health sector in Uttar Pradesh, India

In India and Uttar Pradesh (UP), the private health sector plays an important role in health care services, including institutional deliveries, but there is limited information on the availability of maternal, newborn and child health (MNCH) data that private facilities maintain and share with the public health information system. Sharing data could help the public sector plan their resources more efficiently. Aim of the study: To explore current practices of MNCH data availability and sharing/reporting by private health facilities and the barriers and facilitators to data sharing

Tubular carbonate concretions as hydrocarbon migration pathways? Examples from North Island, New Zealand

Cold seep carbonate deposits are associated with the development on the sea floor of distinctive chemosyn¬thetic animal communities and carbonate minerali¬sation as a consequence of microbially mediated anaerobic oxidation of methane. Several possible sources of the methane exist, identifiable from the carbon isotope values of the carbonate precipitates. In the modern, seep carbonates can occur on the sea floor above petroleum reservoirs where an important origin can be from ascending thermogenic hydrocar¬bons. The character of geological structures marking the ascent pathways from deep in the subsurface to shallow subsurface levels are poorly understood, but one such structure resulting from focused fluid flow may be tubular carbonate concretions. Several mudrock-dominated Cenozoic (especially Miocene) sedimentary formations in the North Island of New Zealand include carbonate concretions having a wide range of tubular morphologies. The concretions are typically oriented at high angles to bedding, and often have a central conduit that is either empty or filled with late stage cements. Stable isotope analyses (δ13C, δ18O) suggest that the carbonate cements in the concretions precipitated mainly from ascending methane, likely sourced from a mixture of deep thermogenic and shallow biogenic sources. A clear link between the tubular concretions and overlying paleo-sea floor seep-carbonate deposits exists at some sites. We suggest that the tubular carbonate concretions mark the subsurface plumbing network of cold seep systems. When exposed and accessible in outcrop, they afford an opportunity to investigate the geochemical evolution of cold seeps, and possibly also the nature of linkages between subsurface and surface portions of such a system. Seep field development has implications for the characterisation of fluid flow in sedimentary basins, for the global carbon cycle, for exerting a biogeochemical influence on the development of marine communities, and for the evaluation of future hydrocarbon resources, recovery, and drilling and production hazards. These matters remain to be fully assessed within a petroleum systems framework for New Zealand’s Cenozoic sedimentary basins

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