The application and use of the partogram in evaluating the Saving Mothers programme in South Africa in 2002.

Thesis (M.PH.)-University of KwaZulu-Natal, 2004.The SA National Department of Health made maternal deaths notifiable in 1997. It also commissioned a National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) to confidentially investigate all maternal deaths, to write the "Saving Mothers Report" and to make recommendations based on the findings of the study. The Department of Health in 2003 commissioned an evaluation of the extent to which the 10 recommendations contained in the first "Saving Mother's Report" had been implemented. This rapid appraisal was carried out by Centre for Health and Social Studies (CHESS), University of Natal. A report 'The Progress with the Implementation of the Key Recommendations of the 1998 "Saving Mothers Report" on the Confidential Enquiry into Maternal Deaths in South Africa - A Rapid Appraisal," was published in 2003. The data collected on Recommendation 5 on the use of the obstetric partogram in 46 selected provincial hospitals in all the 9 provinces was only partially analysed in this report. This study reports on a secondary analysis of the 942 questionnaires that were completed on the use and application of the partogram in hospitals in South Africa. In the rapid appraisal experienced field workers evaluated the use of the partogram using a 36-point checklist. Provincial and national averages for each of these variables were calculated and hospitals were evaluated into how they performed according to these averages using Lot Quality Assurance Sampling methodologies. Using national and provincial averages, the hospitals in each province are compared with one another provincially and nationally. In addition, the application and use of partograms in areas and levels of hospitals are described. An attempt is made to show if there is relation between the number of deliveries and the recording of the partogram. The main findings were that, of all the provinces KwaZulu-Natal had the lowest number variables below the national average from the 36 variables used as a checklist. Eastern Cape and Limpopo had the highest number of variables below the national average. The hospital with the highest number below the national average is in the Eastern Cape. In the recording of the chart rural and level one hospitals are low in comparison with urban and level three hospitals. There was no relation in the recording of the chart and the number of deliveries

Manipulating the physiological quality of in vitro plantlets and transplants of potato

In vitro techniques have been introduced in potato seed production systems in recent years. This research project aimed at studying the morphological and physiological changes in plants and crops in the last three phases of a seed production system that included an in vitro multiplication, an in vitro normalisation (growing cuttings to rooted plantlets), a transplant production, and a tuber production (field) phase.Leaf area was identified as an important plant parameter for plant growth in the normalisation and transplant production phases. Explants and plantlets with larger initial leaf area performed better than those with smaller initial leaf area. In vitro treatments mainly affected leaf area of transplants through their effects on early above-ground leaf area. Leaf area increase was better described by logistic than by exponential or expolinear curves in all phases of growth, suggesting restriction of leaf area increase in all phases.Low temperature decreased leaf and stem dry weights in all phases, and increased tuber fresh and dry yields, average tuber weight, leaf/stem ratio, specific leaf area and harvest index in the tuber production phase. Growing in vitro plants at low normalisation temperatures increased leaf and total plant dry weights early in the transplant production and tuber production phases. It resulted in higher tuber yields, heavier individual tubers and higher harvest index.Fertilising plants with higher nitrogen (40 versus 10 mg N per plant) during transplant production resulted in plants with higher groundcover in the field. This led to higher interception of solar radiation and higher tuber yield in one of the two experiments. Growing plants at higher temperature (26/20 versus 12/18 °C) during transplant production increased leaf area at the end of the transplant production phase. After transplanting to the field, it resulted in crops with higher groundcover, which intercepted more incoming solar radiation. Yield tended to be higher, but differences could not be assessed as statistically significant. A glasshouse experiment showed that high temperature during transplant production increased leaf and stem dry weights in the tuber production phase, but reduced tuber dry weights and harvest index when temperatures during tuber production were high. Thus, high temperature during transplant production may favour haulm growth and light interception in the field, but may also reduce dry matter partitioning to tubers.Conditions in the tuber production phase were found to be of greater importance for final yield than conditions and treatments in earlier phases.Strategies to optimise the production and use of propagules and transplants should focus on achieving leafy starting material, reducing stress during changes in environment and optimising conditions during tuber production. Production of transplants should be adjusted to the expected growth conditions in the tuber production phase.Key words:Solanum tuberosum L., in vitro plantlet, seed production, normalisation, transplant production, tuber production, acclimatisation, leaf area, groundcover, logistic growth, temperature, nitrogen, dry matter production, specific leaf area, harvest index, radiation interception, radiation use efficiency.</p

Level of adherence to ocular hypotensive agents and its determinant factors among glaucoma patients in Menelik II Referral Hospital, Ethiopia

BACKGROUND: Good adherence to ocular hypotensive agents is important to control intraocular pressure and hence to prevent progressive glaucomatous optic nerve head damage. Periodic investigation of adherence is crucial in glaucoma treatment. The purpose of this study was to assess level of adherence to ocular hypotensive agents and to identify factors affecting adherence among glaucoma patients at a tertiary public eye care center. METHODS: The study was a hospital-based cross-sectional study that was conducted in Menelik II Referral Hospital from June 1, 2015 to July 31, 2015. A systematic random sampling technique was used to select 359 study participants from the source population. The study patients were interviewed and their medical charts were reviewed using a pretested structured questionnaire. Adherence was assessed using Morisky Medication Adherence Scale - 8 and adherence determinant factors were identified using multivariate binary logistic regression analysis. The association was declared statistically significant at p < 0.05. RESULTS: Among the 359 study glaucoma patients, 42.6 % were adherent to their prescribed hypotensive agents. Higher educational level (AOR = 4.60, 95 % CI: 1.01–21.03, p < 0.049), being self - employed (AOR = 6.14, 95 % CI: 1.37–27.50, p < 0.018) and taking lesser frequency of drops (AOR = 2.89, 95 % CI: 1.25–6.66, p < 0.013) were significantly associated with adherence, whereas being a farmer (AOR = 0.07, 95 % CI: 0.01–0.75, p < 0.028), having very low monthly family income (AOR = 0.22, 95 % CI: 0.06–0.77, p < 0.019) and self - purchasing of medications (AOR = 0.30, 95 % CI: 0.10–0.93, p < 0.036) were significantly associated with non-adherence. CONCLUSIONS: The study has identified the adherence level to the prescribed ocular hypotensive agents to be sub-optimal and is influenced by different factors among glaucoma patients of the public tertiary center. We recommend glaucoma care providers to pay due attention on the importance of adherence

Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to$24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and$195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential

Preliminary Assessment of Low Cost Local Sorbent Materials for Water Defluoridation in Keren, Eritrea

Water in some parts of Eritrea has fluoride level above WHO guideline of 1.5 mg/L. One of the communities in Eritrea exposed to high fluoride in water is Keren community and as a result, they suffer dental and skeletal fluorosis. Fluoride sorbent local materials named crushed burnt clay pot, household ash, Keren and Adigerghish soil were studied in a batch defluoridation. The effect of amount of adsorbent, pH, contact time, particle size and fluoride concentration were examined

Trends in US Emergency Department Use After Sexual Assault, 2006-2019

IMPORTANCE: Adult sexual assault (SA) survivors experience numerous emergent health problems, yet few seek emergency medical care. Quantifying the number and types of survivors presenting to US emergency departments (EDs) after SA can inform health care delivery strategies to reduce survivor morbidity and mortality. OBJECTIVE: To quantify ED use and factors that influenced seeking ED care for adult SA from 2006 through 2019. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used SA data from the Nationwide Emergency Department Sample from 2006 through 2019, which includes more than 35.8 million observations of US ED visits from 989 hospitals, a 20% stratified sample of hospital-based EDs. The study also used the Federal Bureau of Investigation\u27s Uniform Crime Reporting Program, which includes annual crime data from more than 18 000 law enforcement agencies representing more than 300 million US inhabitants. The study sample included any adult aged 18 to 65 years with an ED visit in the Nationwide Emergency Department Sample coded as SA. The data were analyzed between January 2020 and June 2022. MAIN OUTCOMES AND MEASURES: Annual SA-related ED visits, subsequent hospital admissions, and associated patient-related factors (age, sex, race and ethnicity, income quartile, and insurance) were analyzed using descriptive statistics. RESULTS: Data were from 120 to 143 million weighted ED visits reported annually from 2006 through 2019. Sexual assault-related ED visits increased more than 1533.0% from 3607 in 2006 to 55 296 in 2019. Concurrently, admission rates for these visits declined from 12.6% to 4.3%. Female, younger, and lower-income individuals were more likely to present to the ED after SA. Older and Medicaid-insured patients were more likely to be admitted. Overall, the rate of ED visits for SA outpaced law enforcement reporting. CONCLUSIONS AND RELEVANCE: This cross-sectional study found that US adult SA ED visits increased from 2006 through 2019 and highlighted the populations who access emergency care most frequently and who more likely need inpatient care. These data can inform policies and the programming needed to support this vulnerable population