Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa

The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in a province in South Africa with the possibility of nationwide use

100 years of mortality due to chronic obstructive pulmonary disease in Australia: the role of tobacco consumption

Global studies of the long-term association between tobacco consumption and chronic obstructive pulmonary disease (COPD) have relied upon descriptions of trends.To statistically analyse the relationship of tobacco consumption with data on mortality due to COPD over the past 100 years in Australia.Tobacco consumption was reconstructed back to 1887. Log-linear Poisson regression models were used to analyse cumulative cohort and lagged time-specific smoking data and its relationship with COPD mortality.Age-standardised COPD mortality, although likely misclassified with other diseases, decreased for males and females from 1907 until the start of the Second World War in contrast to steadily rising tobacco consumption. Thereafter, COPD mortality rose sharply in line with trends in smoking, peaking in the early 1970s for males and over 20 years later for females, before falling again. Regression models revealed both cumulative and time-specific tobacco consumption to be strongly predictive of COPD mortality, with a time lag of 15 years for males and 20 years for females.Sharp falls in COPD mortality before the Second World War were unrelated to tobacco consumption. Smoking was the primary driver of post-War trends, and the success of anti-smoking campaigns has sharply reduced COPD mortality levels

Suppressed ion-scale turbulence in a hot high-β plasma.

An economic magnetic fusion reactor favours a high ratio of plasma kinetic pressure to magnetic pressure in a well-confined, hot plasma with low thermal losses across the confining magnetic field. Field-reversed configuration (FRC) plasmas are potentially attractive as a reactor concept, achieving high plasma pressure in a simple axisymmetric geometry. Here, we show that FRC plasmas have unique, beneficial microstability properties that differ from typical regimes in toroidal confinement devices. Ion-scale fluctuations are found to be absent or strongly suppressed in the plasma core, mainly due to the large FRC ion orbits, resulting in near-classical thermal ion confinement. In the surrounding boundary layer plasma, ion- and electron-scale turbulence is observed once a critical pressure gradient is exceeded. The critical gradient increases in the presence of sheared plasma flow induced via electrostatic biasing, opening the prospect of active boundary and transport control in view of reactor requirements

Tobacco consumption and pancreatic cancer mortality: what can we conclude from historical data in Australia?

Tobacco consumption is an established risk factor for pancreatic cancer yet studies of long-term mortality trends have not statistically analysed this relationship. We sought evidence for this relationship based on an analysis of long-term population-level data in Australia.Pancreatic cancer mortality data from 1931, tobacco consumption data and fruit and vegetable consumption data for Australia were utilized. Log-linear Poisson regression models were used to analyse pancreatic cancer mortality from 1931 with cumulative cohort and lagged time-specific tobacco consumption data and fruit and vegetable consumption data.Pancreatic cancer mortality rose steadily for males until it began falling from the 1970s, and continued rising for females until 2006. These trends correspond with a long-term rise in male tobacco consumption until the 1960s and a later peak for females. Our models show that cumulative tobacco consumption predicts pancreatic cancer mortality for both sexes but with time lags only being significant for males. Fruit and vegetable consumption provides a protective effect against mortality in some of the models.The success of smoking reduction programmes in Australia has contributed to the decline in pancreatic cancer mortality for males, providing important evidence about the need for tobacco control measures in populations where it is still increasing. Continued declines in female tobacco consumption should lead to a reversal of the long-term rise in female pancreatic cancer mortality

Determinants of women's satisfaction with maternal health care: a review of literature from developing countries.

BACKGROUND: Developing countries account for 99 percent of maternal deaths annually. While increasing service availability and maintaining acceptable quality standards, it is important to assess maternal satisfaction with care in order to make it more responsive and culturally acceptable, ultimately leading to enhanced utilization and improved outcomes. At a time when global efforts to reduce maternal mortality have been stepped up, maternal satisfaction and its determinants also need to be addressed by developing country governments. This review seeks to identify determinants of women's satisfaction with maternity care in developing countries. METHODS: The review followed the methodology of systematic reviews. Public health and social science databases were searched. English articles covering antenatal, intrapartum or postpartum care, for either home or institutional deliveries, reporting maternal satisfaction from developing countries (World Bank list) were included, with no year limit. Out of 154 shortlisted abstracts, 54 were included and 100 excluded. Studies were extracted onto structured formats and analyzed using the narrative synthesis approach. RESULTS: Determinants of maternal satisfaction covered all dimensions of care across structure, process and outcome. Structural elements included good physical environment, cleanliness, and availability of adequate human resources, medicines and supplies. Process determinants included interpersonal behavior, privacy, promptness, cognitive care, perceived provider competency and emotional support. Outcome related determinants were health status of the mother and newborn. Access, cost, socio-economic status and reproductive history also influenced perceived maternal satisfaction. Process of care dominated the determinants of maternal satisfaction in developing countries. Interpersonal behavior was the most widely reported determinant, with the largest body of evidence generated around provider behavior in terms of courtesy and non-abuse. Other aspects of interpersonal behavior included therapeutic communication, staff confidence and competence and encouragement to laboring women. CONCLUSIONS: Quality improvement efforts in developing countries could focus on strengthening the process of care. Special attention is needed to improve interpersonal behavior, as evidence from the review points to the importance women attach to being treated respectfully, irrespective of socio-cultural or economic context. Further research on maternal satisfaction is required on home deliveries and relative strength of various determinants in influencing maternal satisfaction

Evaluation of a quality improvement intervention for obstetric and neonatal care in selected public health facilities across six states of India

Background While increase in the number of women delivering in health facilities has been rapid, the quality of obstetric and neonatal care continues to be poor in India, contributing to high maternal and neonatal mortality. Methods The USAID ASSIST Project supported health workers in 125 public health facilities (delivering approximately 180,000 babies per year) across six states to use quality improvement (QI) approaches to provide better care to women and babies before, during and immediately after delivery. As part of this intervention, each month, health workers recorded data related to nine elements of routine care alongside data on perinatal mortality. We aggregated facility level data and conducted segmented regression to analyse the effect of the intervention over time. Results Care improved to 90–99% significantly (p < 0.001) for eight of the nine process elements. A significant (p < 0.001) positive change of 30–70% points was observed during post intervention for all the indicators and 3–17% points month-to-month progress shown from the segmented results. Perinatal mortality declined from 26.7 to 22.9 deaths/1000 live births (p < 0.01) over time, however, it is not clear that the intervention had any significant effect on it. Conclusion These results demonstrate the effectiveness of QI approaches in improving provision of routine care, yet these approaches are underused in the Indian health system. We discuss the implications of this for policy makers.by Enisha Sarin, Subir K. Kole, Rachana Patel, Ankur Sooden, Sanchit Kharwal, Rashmi Singh, Mirwais Rahimzai and Nige Livesle