'The Accra Conditionality of Participation!?' The role of civil society organisations in

Resulting from CSO critique of the Paris Declaration signatories of the Accra Agenda committed themselves to deepen CSO engagement in national aid effectiveness. Therefore the purpose herein is to increase understanding over functions, mechanisms, hindrances and opportunities facing CSO in this process in Tanzania. The primary method for achieving this was semi-structured interviews with 21 persons from the Government of Tanzania, Development Partners and CSOs. It was concluded that there are a multitude of functions for CSOs in aid effectiveness. Whereas Development Partners stressed the importance of advocacy Government highlighted service delivery as main function of CSOs. Regarding mechanisms, it was concluded that there already exist structures allowing CSOs participation. However, the quality of them are perceived to be low and they are more on an ad hoc basis rather than part of an ongoing participatory system. The non-conducive socio-political environment and low capacity of CSOs were identified as main hindrances whereas the increased transparency of Government was considered the main opportunity. Lastly the importance of letting CSOs determining themselves which role(s) they should play and how was stressed in order to avoid some kind of Accra conditionality of participation' driven by Development Partners and Government

Social empowerment for and by Aymara women : A study of social empowerment processes in relation to local development programmes

The vulnerable social situation of the indigenous women in Bolivia is often on the agenda of many organisations (CSOs and NGOs). Especially, the deep rooted socio-political discrimination of this group has been addressed in several researches and during various international development forums. However, few of these investigations have tried to understand in what ways the Aymara women themselves want to be supported by organisations in order to become socially empowered. In regard to this, the contemplation of this Master Thesis has been to, in an inductive manner, increase the understanding of the concept of social empowerment from the perspectives of Aymara women and NGOs/CSOs. To do so a qualitative field based study, aimed at letting Aymara women themselves explain the social situation, was conducted in Bolivia during the spring 2007. The outcome of this research has also served as a foundation to a discussion, with special references to the Swedish aid-agency Svalorna Latinamerika, concerning what NGOs and CSOs ought to consider when working with social empowerment of Aymara women. The overarching methodological approach of the study has been that of a bottom-up implementation analysis. In order to retrieve information from the field techniques such as socio-anthropological studies, observations, interactions and interviews have been applied. Several interesting insights and conclusions have been retrieved from the investigation. The primarily conclusion drawn is that empowerment can neither be received nor given as it has the features of a learning process. Accordingly, in regard to this organisations must adopt the role of 'supporters' rather than 'suppliers'. Secondly, it has been reasoned that any undertaking aimed at supporting social empowerment for and of Aymara women must be synchronised with the progression of the women's learning processes. This specifically suggests that organisations must adopt long-run as well as holistic programmes rather than ad hoc activities. The overall conclusion drawn is that if the social empowerment for and of Aymara women is to benefit from the undertakings of organisations the planning, implementation and evaluation of the activities must primarily be based on terms given by the women.

Poverty Reduction through the participation of the poor!? : A study of the Poverty Reduction Strategies in Uganda and Bolivia from a civil-society perspective

The situation of the low developed countries has been on the agenda of IMF and the World Bank throughout the years. However, after the disastrous failure of the Structural Adjustment Programs, the two financial institutions left the ideas of 'one model fits all' and economic growth equals development. Rather, tailored development programs and poverty reduction became the new foci. Further, it is today stressed that the broad-based participation of the civil-society and the ownership of the nation over the development process are the most important factors for successful and sustainable development. These ideas conforms the basis of the Poverty Reduction Strategy (PRS) initiative which was adopted by IMF and the World Bank in 1999. This paper will investigate indications and perceptions, given by the civil-society, of the concepts of its participation and ownership within the Poverty Reduction Processes in Bolivia and Uganda. The objective is also to, in an inductive manner, develop and increase the understanding of how, and through what means, the two concepts have been realised and contextualised. In order to fulfil this purpose, the contents and origins of the PRS initiative are outlined and the definitions of participation and national ownership, in accordance to IMF and the World Bank, are stated. Secondly, against the derived theoretical framework an empirical pilot study will be conducted, based on literature studies. The primary conclusion drawn from the analysis is that it is impossible to broaden the understanding of what types of participation that have been applied. However, important and interesting insights have been reached in relation to how participation has been contextualised. First and foremost, for a genuine participation of the civil-society it is not enough with physical presence at official consultation meetings. The people must be enabled to actively and directly participate in, and influence the agenda of, all the stages of the PRS process. In regard to national ownership it has been concluded that the term bestow more than the balance between national, governmental and international influence - it is also a feeling of being able to participate in, and influence the outcome of, PRS process. Overall, the major finding is that for a real apprehension of national ownership and participation the perception of the civil-society must be accounted for. It is the people who decide whether they have been adequately involved and if they see themselves to be the owners of the process

Små barn med förmaksseptumdefekt

Background: Secundum atrial septal defect (ASD II), situated within the fossa ovalis, is the third most common congenital heart defect and even more common among preterm children. Spontaneous closure usually occurs during the first year of life. Most children with an ASD II remain asymptomatic during early childhood. Guidelines recommend ASD II closure in the presence of a significant left-to-right shunt. Percutaneous device closure, which is most commonly used, and surgery are both considered safe, with few major adverse events. In Sweden, approximately 6% of all children are born preterm. The morbidity of preterm children includes increased risk of chronic pulmonary disease and altered cardiac morphology and function which remain into adulthood. Most studies on ASD II incidence and interventional and surgical risks following ASD II closure are based on otherwise healthy children. Preterm children are a special subset of patients with ASD II and the hypothesis in this thesis is that preterm birth may be associated with increased risks of ASD II diagnosis and adverse events following closure. Aim: The overall aim of this thesis was to assess the incidence of ASD II, independent risk factors associated to ASD II diagnosis, and adverse events following ASD II interventional closure. Methods: Paper I: A retrospective case-control study assessing associated risk factors for adverse events after percutaneous device closure among children with an interventional weight of less than 15 kg. Paper II: A cohort study assessing a preterm and a term cohort and time to first adverse event within one month or one year after ASD II closure, as well as number of events. Paper III: A retrospective case-control study assessing the association between major and minor adverse events after ASD II closure, and potential paediatric risk factors. Paper IV: A national registry-based retrospective incidence and case-control study calculating the incidence of ASD II diagnosis among term and preterm children and assessing potential maternal, neonatal, and paediatric risk factors for ASD II. Results: Paper I: No independent risk factor was associated with adverse events after percutaneous device closure. However, major adverse events occurred in 11 (10%) of the children weighing less than 15 kg, compared with six (4%) children weighing over 15 kg (p = 0.04). Paper II: There was no difference between the preterm and term cohorts in time to first adverse event or in multiple adverse events within one month or within a year, neither in number of major events (p = 0.69) nor in number of minor events (p = 0.84). However, the preterm cohort was younger (2.1 versus 3.4 years, p < 0.01), lighter (11.6 versus 15.1 kg, p < 0.01), had a smaller ASD II size (12.0 versus 13.0 mm, p< 0.01), and a larger ASD II size to weight ratio (1.1 versus 0.8, p < 0.01) compared with the term cohort. Paper III: ASD II with significant clinical symptoms was associated with both minor OR = 2.18, (CI 95% 1.05–8.06) and major OR = 2.80 (CI 95% 1.23–6.37) adverse events following closure. Paper IV: The yearly overall incidence of ASD II was 150 per 100,000 live births. However, this incidence ranged from 449 to 1,737 per 100,000 live births, with higher incidence in preterm children. ASD II was associated with a presence of persistent ductus arteriosus; OR = 8.11 (CI 95% 2.80–16.69), female gender; OR = 1.39 (CI 95% 1.18–1.63), and being small for gestational age; OR = 1.86 (CI 95% 1.29–2.68). Being born preterm was also associated with ASD II diagnosis: born at 32–36 gestational weeks; OR = 3.21 (CI 95% 2.46–4.19), and born at < 32 gestational weeks; OR = 4.02 (CI 95% 2.80–7.12). Conclusions: Preterm children have a high incidence of ASD II diagnosis, increasing with lower gestational age at birth, and is an independent risk factor for ASD II diagnosis. Few adverse events occurred among children following ASD II closure, and there were no neonatal or paediatric risk factors (including procedural body weight and gestational age) associated with adverse events. There was an association between clinical symptomatic ASD II and major adverse events. Despite younger procedural age, larger ASD II size to weight ratio and increased comorbidity, preterm children appeared to have similar risks of adverse events during the first year after ASD II closure when compared with term children. Preterm children and children with symptomatic ASD II need careful management both prior to and after ASD II closure. A new, structured follow-up programme with assessment of indication and timing of treatment and closure should be considered for children born preterm

Risk factors for isolated atrial septal defect secundum morbidity

Abstract Atrial septal defect secundum is a common type of congenital heart defect and even more common among children born premature. The aim of this study was to assess premature birth as a potential associated risk factors for cardiac morbidity in children with isolated ASD II. In this retrospective national registry-based case–control study all children born in Sweden between 2010 and 2015 with an isolated ASD II diagnosis were included. Association between premature birth and cardiac morbidity in children with isolated ASD II was assessed by different outcomes-models using conditional logistic regression and adjustments were made for confounding factors. Overall, 11% of children with an isolated ASD II received treatment for heart failure. Down syndrome was the only independent risk factors for associated with cardiac morbidity in children with ASD II (OR = 2.25 (95%CI 1.25–4.07). Preterm birth in children was not associated with an increased risk of ASD II cardiac morbidity

QTc interval-dependent body posture in pediatrics

Background: Syncope is a common and often benign disorder presenting at the pediatric emergency department. Long-QT syndrome may be presented with syncope, ventricular arrhythmias or sudden death and is vital to exclude as an underlying cause in children presented with syncope. Few studies have assessed QTc in relation to body posture in children. In this study, we assessed the QTc interval while laying down and during active standing in children with known long-QT syndrome compared to healthy controls. Methods: Children aged 1-18 years with long-QT syndrome (N = 17) matched to two healthy controls (N = 34) were included in this case-control study. The ECG standing was performed immediately after the ECG in the supine position. The QTc interval and QTc-difference by changing the body position were calculated. Results: All children with long-QT syndrome were treated with propranolol. QTc was prolonged among long-QT syndrome children while lying down and when standing up, compared to controls. A prolongation of QTc appeared when standing up for both cases and controls. There was no significant difference in QTc increase between the groups. A QTc over 440 ms was observed among four cases lying down and in eight cases while standing, but not in any of the controls. The standing test with a cut-off of 440 ms showed a sensitivity of 47% and a specificity of 100% for case-status in our study. Conclusion: QTc measured on ECG when rapidly rising up is prolonged in both healthy and LQTS children. More importantly, it prolongs more in children with LQTS and increases in pathological levels

Risk factors for adverse events within one year after atrial septal closure in children : a retrospective follow-up study

Introduction: Secundum atrial septal defect is one of the most common congenital heart defects. Previous paediatric studies have mainly addressed echocardiographic and few clinical factors among children associated with adverse events. The aim of this study was to identify neonatal and other clinical risk factors associated with adverse events up to one year after closure of atrial septal defect. Methods: This retrospective case-control study includes children born in Sweden between 2000 and 2014 that were treated surgically or percutaneously for an atrial septal defect. Conditional logistic regression was used to evaluate the association between major and minor adverse events and potential risk factors, adjusting for confounding factors including prematurity, neonatal sepsis, neonatal general ventilatory support, symptomatic atrial septal defects, and pulmonary hypertension. Results: Overall, 396 children with 400 atrial septal defect closures were included. The median body weight at closure was 14.5 (3.5-110) kg, and the median age was 3.0 (0.1-17.8) years. Overall, 110 minor adverse events and 68 major events were recorded in 87 and 49 children, respectively. Only symptomatic atrial septal defects were associated with both minor (odds ratio (OR) = 2.18, confidence interval (CI) 95% 1.05-8.06) and major (OR = 2.80 CI 95% 1.23-6.37) adverse events. Conclusion: There was no association between the investigated neonatal comorbidities and major or minor events after atrial septal defect closure. Patients with symptomatic atrial septal defects had a two to four times increased risk of having a major event, suggesting careful management and follow-up of these children prior to and after closure

Early Complications After Percutaneous Closure of Atrial Septal Defect in Infants with Procedural Weight Less than 15 kg

Atrial septal defect (ASD) is the most common congenital cardiac lesion accounting for 10-15% of all cardiac malformations. In the majority of cases, the secundum type of the ASD is closed percutaneously in the catheterization laboratory. Although transcatheter closure of ASD is considered safe and effective in pediatric patients, there are limited data regarding the efficacy and safety of device ASD closure in smaller infants. The aim of this study was to determine risk of complications within 72 h following device closure of ASD in children of body weight <15 kg compared to larger children. Overall 252 children who underwent transcatheter closure of ASD at Children's Heart Centre in Lund, Sweden, between 1998 and 2015 were included. Data regarding demographics, comorbidity and complications occurring during and after device procedure until discharge were retrieved from the hospital's databases. Echocardiographic data were obtained from the digital and videotape recordings. Nearly half of the study cohort (n = 112; 44%) had a procedural weight <15 (median 11.3) kg with a median procedural age of 2.02 years. Among this study group, 22 (9%) children had post-procedural in-hospital complications, of which 16 (7%) were considered as major and six (2%) considered as minor. No deaths occurred. There was no significant difference in of the occurrence of major or minor complications between the two groups (p = 0.32). Larger ASD was more often associated with minor complications, OR 1.37 (95% CI 0.99-1.89), which most often consisted of transient arrhythmias during or after the procedure. Percutaneous ASD device closure can be performed safely in low-weight infants with a risk of post-procedural in-hospital complications comparable to larger/older children. Nevertheless, careful considerations of the indications to device closure is needed, particularly in children with larger ASD, as recommended by the current international guidelines for ASD closure