Insights into Unmet Need in Kenya

Background Despite the recent increase in contraceptive prevalence, a quarter of women of reproductive age in Kenya reported unmet need for family planning in 2008/9. Any advances in our understanding of the causes of unmet need could have profound implications for programmes. Objectives This study aims to establish the relative importance of lack of access and attitudinal resistance towards use of contraception in different population and geographical strata of Kenya. It is intended to inform policy makers on the priority that should be given to behaviour change communication or improved access/information, and also helpful to interventions to reduce health concerns and fear of side effects, such as provision of broader method mix and better counselling. Methods Data from the Kenya DHS 2008/9 were used for the analysis. All analyses were based on married/cohabiting fecund women who were exposed to risk of pregnancy at the time of the survey We identified whether married women with unmet need have access (defined by knowledge of pills and injectables, and a supply source) and attitudinal acceptance (defined by intention to use in the future). We assessed variations of unmet need across different strata by bivariate and multivariate analyses. Self-reported reasons for unmet need were assessed. Results Among 2676 exposed women, 28% had unmet need. Of these, half were classified as possessing both access and a positive attitude and a further one-third as having access but no intention to use in the future. The majority in both groups had previously used a modern method, in most cases pills or injectables. The main self-reported reason for non-use in both groups was health concerns and fear of side effects. Small minorities (6-7%) of women with an unfavourable attitude reported that they were opposed to contraception or mentioned religious reasons for non-use. Lack of access was associated with unmet need in 16% of cases and lack of information was the most common reason for non-use among these women. With the exception of the North Eastern Province where access was very limited, regional variations were minor. However, lack of access (i.e. method and/or supply source), was much more common in women with no schooling and the poorest segment than among other strata. Lack of access also appeared to be one reason why postpartum women have higher unmet need than other women. Discussion and implications Most women having unmet need for family planning in Kenya were aware of the two main contraceptive methods and a supply source, but many of the poorest, least educated women and those living in North Eastern Province were disadvantaged in this regard. Targeted expansion of access/information is a priority to meet the need of the disadvantaged populations. Among those with access, most (68%) have previously tried a modern method. Thus the origin of unmet need stems largely from discontinuation of use than outright rejection of contraception based on personal or religious opposition. The central problem appears to be health concerns and side effects. Many women try a modern method but discontinue use because of these concerns and do not switch to an alternativ

How to recognise a kick : A cognitive task analysis of drillers’ situation awareness during well operations

Acknowledgements This article is based on a doctoral research project of the first author which was sponsored by an international drilling rig operator. The views presented are those of the authors and should not be taken to represent the position or policy of the sponsor. The authors wish to thank the industrial supervisor and the drilling experts for their contribution and patience, as well as Aberdeen Drilling School for allowing the first author to attend one of their well control courses.Peer reviewedPostprin

Does perceived organisational support influence career intentions?:The qualitative stories shared by UK early career doctors

Our thanks to all those FP2 doctors who participated in the interviews. Our thanks also to the Foundation Programme Directorate staff in the Scotland Deanery, NHS Education for Scotland, for sending out the email correspondence to the two regions involved in the interviews. No patients or any members of the public were involved in this study. Funding: Our thanks go to NHS Education for Scotland for funding Gillian Scanlan’s programme of work through the Scottish Medical Education Research Consortium (SMERC) and for funding the open-access fee for this paper.Peer reviewedPublisher PD

Institutional delivery in rural India: the relative importance of accessibility and economic status.

BACKGROUND: Skilled attendance at delivery is an important indicator in monitoring progress towards Millennium Development Goal 5 to reduce the maternal mortality ratio by three quarters between 1990 and 2015. In addition to professional attention, it is important that mothers deliver their babies in an appropriate setting, where life saving equipment and hygienic conditions can also help reduce the risk of complications that may cause death or illness to mother and child. Over the past decade interest has grown in examining influences on care-seeking behavior and this study investigates the determinants of place of delivery in rural India, with a particular focus on assessing the relative importance of community access and economic status. METHODS: A descriptive analysis of trends in place of delivery using data from two national representative sample surveys in 1992 and 1998 is followed by a two-level (child/mother and community) random-effects logistical regression model using the second survey to investigate the determinants. RESULTS: In this investigation of institutional care seeking for child birth in rural India, economic status emerges as a more crucial determinant than access. Economic status is also the strongest influence on the choice between a private-for-profit or public facility amongst institutional births. CONCLUSION: Greater availability of obstetric services will not alone solve the problem of low institutional delivery rates. This is particularly true for the use of private-for-profit institutions, in which the distance to services does not have a significant adjusted effect. In the light of these findings a focus on increasing demand for existing services seems the most rational action. In particular, financial constraints need to be addressed, and results support current trials of demand side financing in India

Does initial postgraduate career intention and social demographics predict perceived career behaviour?:A national cross-sectional survey of UK postgraduate doctors

Acknowledgements: Our thanks to all those FP2 doctors who participated in the survey. Our thanks also to the Foundation Programme Directors across the UK for allowing permission to conduct research on this data set. No patients or any members of the public were involved in this study. Funding: Our thanks go to NHS Education for Scotland for funding Gillian Scanlan’s programme of work through the Scottish Medical Education Research Consortium (SMERC). Data sharing statement: The data reported is from the UKFPO dataset, and any data shared would need the permission of the UK Foundation Programme directorsPeer reviewedPublisher PD

Generation and detection of NOON states in superconducting circuits

NOON states, states between two modes of light of the form $|N,0\rangle+e^{i\phi}|0,N\rangle$ allow for super-resolution interformetry. We show how NOON states can be efficiently produced in circuit quntum electrodynamics using superconducting phase qubits and resonators. We propose a protocol where only one interaction between the two modes is required, creating all the necessary entanglement at the start of the procedure. This protocol makes active use of the first three states of the phase qubits. Additionally, we show how to efficiently verify the success of such an experiment, even for large NOON states, using randomly sampled measurements and semidefinite programming techniques.Comment: 15 pages and 3 figure

Alien Registration- Cleland, Vera J. (Portland, Cumberland County)

https://digitalmaine.com/alien_docs/23076/thumbnail.jp

Alien Registration- Cleland, Vera J. (Portland, Cumberland County)

https://digitalmaine.com/alien_docs/23077/thumbnail.jp

Electron-phonon coupling and longitudinal mechanical-mode cooling in a metallic nanowire

We investigate electron-phonon coupling in a narrow suspended metallic wire, in which the phonon modes are restricted to one dimension but the electrons behave three-dimensionally. Explicit theoretical results related to the known bulk properties are derived. We find out that longitudinal vibration modes can be cooled by electronic tunnel refrigeration far below the bath temperature provided the mechanical quality factors of the modes are sufficiently high. The obtained results apply to feasible experimental configurations.Comment: 4+ pages, 3 figure