Working relationships between obstetric care staff and their managers: a critical incident analysis

Background Malawi continues to experience critical shortages of key health technical cadres that can adequately respond to Malawi’s disease burden. Difficult working conditions contribute to low morale and frustration among health care workers. We aimed to understand how obstetric care staff perceive their working relationships with managers. Methods A qualitative exploratory study was conducted in health facilities in Malawi between October and December 2008. Critical Incident Analysis interviews were done in government district hospitals, faith-based health facilities, and a sample of health centres’ providing emergency obstetric care. A total of 84 service providers were interviewed. Data were analyzed using NVivo 8 software. Results Poor leadership styles affected working relationships between obstetric care staff and their managers. Main concerns were managers’ lack of support for staff welfare and staff performance, lack of mentorship for new staff and junior colleagues, as well as inadequate supportive supervision. All this led to frustrations, diminished motivation, lack of interest in their job and withdrawal from work, including staff seriously considering leaving their post. Conclusions Positive working relationships between obstetric care staff and their managers are essential for promoting staff motivation and positive work performance. However, this study revealed that staff were demotivated and undermined by transactional leadership styles and behavior, evidenced by management by exception and lack of feedback or recognition. A shift to transformational leadership in nurse-manager relationships is essential to establish good working relationships with staff. Improved providers’ job satisfaction and staff retentionare crucial to the provision of high quality care and will also ensure efficiency in health care delivery in Malawi

Maternal Serum Concentrations of Selenium, Copper, and Zinc during Pregnancy Are Associated with Risk of Spontaneous Preterm Birth: A Case-Control Study from Malawi

Preterm birth is delivery before 37 completed weeks. A study was conducted to evaluate the association of maternal serum concentrations of selenium, copper, and zinc and preterm birth. There were 181 women in this nested case-control study, 90/181 (49.7%) term and 91/181 (50.3%) preterm pregnant women. The overall mean serum concentration of selenium was 77.0, SD 19.4 μg/L; of copper was 2.50, SD 0.52 mg/L; and of zinc was 0.77, SD 0.20 mg/L with reference values of 47-142 μg/L, 0.76-1.59 mg/L, and 0.59-1.11 mg/L, respectively. For preterm birth, mean serum concentration for selenium was 79.7, SD 21.6 μg/L; for copper was 2.61, SD 0.57 mg/L; and for zinc was 0.81, SD 0.20 mg/L compared to that for term births: selenium (74.2; SD 16.5 μg/L; p=0.058), copper (2.39; SD 0.43 mg/L; p=0.004), and zinc (0.73; SD 0.19 mg/L; p=0.006), respectively. In an adjusted analysis, every unit increase in maternal selenium concentrations gave increased odds of being a case OR 1.01 (95% CI: 0.99; 1.03), p=0.234; copper OR 1.62 (95% CI: 0.80; 3.32), p=0.184; zinc OR 6.88 (95% CI: 1.25; 43.67), p=0.032. Results show that there was no deficiency of selenium and zinc and there were high serum concentrations of copper in pregnancy. Preterm birth was associated with higher maternal serum concentrations of copper and zinc

Differences in sexual size dimorphism among farmed tilapia species and strains undergoing genetic improvement for body weight

Many tilapia (Oreochromis spp.) farmers produce all-male populations because of the superior growth rate of males compared to females. To investigate differences in body weight at harvest of males and females among different tilapia strains, we analyzed data from 62,787 individuals collected from pedigreed breeding programs of O. niloticus (GIFT from Malaysia, the Abbassa line from Egypt, and the Akosombo line from Ghana), O. shiranus (the Bunda College-Domasi selection line), O. aureus (a selection line under development in Abbassa, Egypt, and a selection line from Israel) and a synthetic selection line of Red tilapia under development in Jitra, Malaysia, derived from stock from Malaysia, Taiwan and Thailand (O. sp.). Mixed models were separately fitted to the data from each selection line. There was a significant sex effect in all strains (P < 0.001). A significant (P < 0.001) sex by generation interaction was observed in all strains (scale effect, not reversal of rankings), except Red tilapia and O. shiranus. Least squares means showed a large range in the magnitude of body weight differences between sexes across the seven strains. The largest percentage difference between females and males was in O. aureus from Egypt (female body weight was 52.2% that of males at harvest), whereas the smallest difference was observed in the GIFT strain of O. niloticus (female body weight 84.7% that of males). Female to male body weight percentages for Red tilapia, O. shiranus, Egypt O. niloticus, Israeli O. aureus and Ghana O. niloticus were 81.3, 81.0, 69.1, 61.7 and 61.0, respectively. We discuss the results in relation to the potential productivity improvements due to superior growth rates of all-male culture compared to mixed-sex culture in tilapia populations differing in the female to male body weight ratio

Slow acceptance of universal antiretroviral therapy (ART) among mothers enrolled in IMPAACT PROMISE studies across the globe

CITATION: Stranix‑Chibanda, L., et al. 2019. Slow acceptance of universal antiretroviral therapy (ART) among mothers enrolled in IMPAACT PROMISE studies across the globe. AIDS and Behavior, 23:2522-2531, doi:10.1007/s10461-019-02624-3.The original publication is available at https://link.springer.comThe PROMISE trial enrolled asymptomatic HIV-infected pregnant and postpartum women not eligible for antiretroviral treatment (ART) per local guidelines and randomly assigned proven antiretroviral strategies to assess relative efficacy for perinatal prevention plus maternal/infant safety and maternal health. The START study subsequently demonstrated clear benefit in initiating ART regardless of CD4 count. Active PROMISE participants were informed of results and women not receiving ART were strongly recommended to immediately initiate treatment to optimize their own health. We recorded their decision and the primary reason given for accepting or rejecting the universal ART offer after receiving the START information. One-third of participants did not initiate ART after the initial session, wanting more time to consider. Six sessions were required to attain 95% uptake. The slow uptake of universal ART highlights the need to prepare individuals and sensitize communities regarding the personal and population benefits of the “Treat All” strategy.https://link.springer.com/article/10.1007/s10461-019-02624-3Publisher's versio

Inclusão social e desenvolvimento econômico na América Latina

América Latina e o Caribe são uma das regiões com maior diversidade étnica, racial e cultural do mundo. Essa diversidade representa um ativo importante e constitui um elemento-chave para alcançar uma estabilidade econômica e política duradoura e para construir uma sociedade justa, coesa e democrática. A região deve, porém, superar uma longa e conflitante história de práticas de exclusão que levou a sociedades divididas e desiguais, impedindo a concretização da riqueza representada pela diversidade. Esta coleção de artigos é resultado de um esforço do Banco Interamericano de Desenvolvimento para contribuir para o desenvolvimento de uma região que valoriza suas culturas indígenas, reconhece suas diferentes raízes étnicas, promove o papel de liderança da mulher e dá voz às pessoas portadoras de deficiências e com HIV/aids. Faz parte de uma iniciativa do Banco de apoiar os países da região na construção de sociedades socialmente mais inclusivas e mais coesas. A região deve enfrentar os desafios desse ideal, o qual não apenas representa uma promessa de crescimento e desenvolvimento, mas também um imperativo ético irrefutável.

Sexual Diversity, Social Inclusion and HIV/AIDS

Despite a number of programmes to prevent HIV among men who have sex with men (MSM) and, more generally, sexually diverse populations, gay and other homosexually active men continue to be at heightened risk of HIV and its consequences. This paper analyses some of the reasons for this situation and offers policy and programmatic recommendations to contribute to a solution. The social exclusion of MSM and transgender individuals is an overwhelming reality in the majority of countries worldwide. Although progress has been achieved in some countries, in most of the world the situation remains problematic. Present challenges to equality and to the realization of health, include the membership of groups or subcultures with high HIV prevalence, lower quality and coverage of services and programmes and the impact of higher-level influences such as laws, public policies, social norms and culture, which together configure an environment that is hostile to the integration and needs of certain groups. A social inclusion perspective on HIV prevention and AIDS-related care implies the adoption of strategies to understand and confront social vulnerability. Sexual exclusion intensifies the burden of HIV transmission and morbidity. As part of a comprehensive response there is an urgent need to: (i) improve our understanding of the characteristics and HIV burden among sexually diverse populations; (ii) creatively confront legal, social and cultural factors enhancing sexual exclusion; (iii) ensure the provision of broad-based and effective HIV prevention; (iv) offer adequate care and treatment; and (v) confront special challenges that characterize work with these populations in lower and middle-income countries