Sawubona MAMA : Using mHealth to improve maternal, neonatal and child health outcomes in South Africa

BACKGROUND: At the end of the first decade of the 2000’s, South Africa had poor, and worsening, maternal and neonatal health outcomes. In parallel, the use of mobile phone technology to support health care (mHealth) increased dramatically. Maternal mHealth has potential to support maternal care; studies of its effects have been limited, but the results have been encouraging. The Mobile Alliance for Maternal Action (MAMA) project launched a maternal mHealth project in South Africa aiming to improve maternal, neonatal, and child health outcomes using informational SMS/text messages. AIM: To assess the informative maternal health SMS intervention, MAMA SMS, in Johannesburg, South Africa by comparing maternal and infant health outcomes of users with non-users, conducting a cost-effective analysis on the intervention, reporting on feedback given during focus group discussions attended by users, and conducting a comparison study on users of MomConnect, the maternal mHealth programme that replaced MAMA SMS. METHODS: Sub-study I was cluster observational study of mother-infant-pairs who were followed from pregnancy to one year postnatal to monitor maternal health outcomes. The intervention arm which received the SMS intervention included 87 pairs while the control arm included 90 pairs. Sub-study II was a cohort study of HIV-positive women and their infants who were followed from pregnancy until one year postnatal, to monitor maternal health and HIV-related outcomes. The intervention arm, which received the SMS intervention included 235 mother-infant-pairs, while the control arm included 586 pairs. Sub-study III was a cost-effectiveness analysis study measuring costs at the societal level, along with measured changes in health care utilisation and health outcomes measured in sub-study I. Data were entered into the Lives Saved Tool and used to forecast lives saved and DALYs averted of gradually scaling up program activities to reach 60% of pregnant women across Gauteng province within 5 years. Sub-study IV was a qualitative study based on data from four FGDs with MAMA SMS participants who had been receiving messages for at least four months. 15 females and three males participated with ages ranging from 20 to 36 years. Sub-study V used the same methods as sub-study I to investigate the MomConnect maternal mHealth intervention implemented by the National Department of Health and based on MAMA SMS. The intervention arm included 115 participants while the control arm had 37 participants. RESULTS: Intervention participants were more likely to attend all recommended antenatal and postnatal visits including all recommended first year vaccinations (RR: 1.71, 95% CI: 1.30-2.23) and were more likely to attend at least the recommended four antenatal visits (RR: 1.59, 95% CI: 1.23-2.04) (sub-study I). HIV-positive intervention participants also attended more ANC visits (5.16 vs. 3.95, p < 0.01) and were more likely to attend at least the recommended four ANC visits (relative risk (RR): 1.41, 95% confidence interval (CI): 1.15–1.72). Birth outcomes of intervention participants improved as they had an increased chance of a normal vaginal delivery (RR: 1.10, 95% CI: 1.02–1.19) and a lower risk of delivering a low-birth weight infant (<2500 g) (RR: 0.14, 95% CI: 0.02–1.07). In the intervention group, there was a trend towards higher attendance to infant polymerase chain reaction (PCR) testing within six weeks after birth (81.3% vs. 75.4%, p = 0.06) (sub-study II). Incremental costs per DALY averted from a societal perspective ranged from $1,985 USD in the first year of implementation to$200 USD in the 5th year. At a willingness to pay threshold of $2,000 USD, the intervention had a 40% probability of being cost effective in year 1 versus 100% in years 2 through 5 (sub-study III). Focus group participant feedback regarding the health system was mixed, with some participants having positive experiences, and a number of participants sharing negative experiences such as long waiting times, understaffed clinics and poor service. They reported that the messages were timely, written clearly and seemed supportive. Most participants reported regularly sharing the messages with both friends and family (sub-study IV). MomConnect recipients showed no differences in health outcomes measured, including complete maternal health coverage, number of ANC visits attended, likelihood of low-birthweight infants, or EPI coverage compared to the control arm. The control arm had higher than expected baseline coverage for all outcomes measured (sub-study V). CONCLUSIONS: The results from the clinical studies show an improvement in achieving complete maternal-infant continuum of care, provide evidence of a positive impact of informative maternal mHealth messaging sent to pregnant women and new mothers, particularly if the baseline or starting health outcomes are sub-optimal (sub-studies I, II and V). The cost effectiveness evaluation findings suggest that SMS-based maternal health information messages delivered to pregnant women may be a cost-effective strategy for bolstering ANC and childhood immunizations, even at very small margins of coverage increases. Primary data obtained prospectively as part of more rigorous study designs are needed to validate modelled results (sub-study III). By providing timely and relevant information to pregnant women and new parents, contextually relevant maternal mHealth interventions could play a cost-effective part in improving maternal and child health outcomes and quality of care across the globe (sub-study IV)

Uncloaking the Secrecy Behind Large-Scale Land Deals

Large-scale investments in agriculture and forestry have far-reaching implications for the lives of affected individuals and communities. They are also an integral part of efforts by national governments to implement the Sustainable Development Goals (SDGs) and improve the governance of land resources. Despite their significance, these “land deals” and the contracts that govern them are often cloaked in secrecy, removed from relevant spheres of public scrutiny and debate

The Design, construction, and implementation of an engineering software command processor and macro compiler

This paper presents the design and construction of a software translator that serves as a foundation, or central engine, around which an entire engineering software system can be constructed. To provide the user with a powerful interface to drive an application, a high-level procedural language similar to FORTRAN or BASIC is integrated into the translator. An application shell was also written to provide the user with an interactive command line environment for using the translator. The translator, language, and application shell together mechanize a programming and command interpreter environment. Users can interactively enter commands from the keyboard or load and process pre-written macro files from disk. The language gives users the ability to create variables, arrays, and functions, process complex mathematical expressions, and develop sophisticated macro programs. The language is quite capable of solving very complex engineering problems. Several engineering examples are presented including a solution to a four-bar crank mechanism, adding a material library to an application, a command line integration solver, a Runge-Kutta routine for solving sets of differential equations, and a convolution integral routine. The translator is modular, easily extensible, written entirely in C/C++, and readily portable to different platforms. A set of diagnostic tools is integrated into the translator to aid the developer in future development work. Complete theory and design details for all phases of the translator and language are presented. Performance issues are studied including a comparison against C/C++ and MS-DOS Qbasic. Exploration in application integration for a simulation package similar to CSMP is investigated. A complete Language and Compiler Guide is supplied with the program

Quantity and quality of freshwater rearing habitat in relation to juvenile Pacific salmon abundance in the Kulukak River, Alaska

Thesis (M.S.) University of Alaska Fairbanks, 2012Monitoring of freshwater habitat and its influence on stream-rearing fish is essential for recognizing and mitigating the impacts of human- and climate-induced changes. For the purposes of developing a monitoring program in the U.S. Fish and Wildlife Service Togiak National Wildlife Refuge, densities and habitat relationships of juvenile coho salmon Oncorhynchus kisutch and sockeye salmon O. nerka were estimated in two tributaries of the Kulukak River, Alaska, in July 2010. Multiple-pass depletion electrofishing was used to estimate density in a random sample of habitat units belonging to one of four categorical habitat classes. Regression methods were also used to quantify the physical habitat associations of juvenile coho and sockeye salmon density in the study areas. Densities of juvenile coho and sockeye salmon ranged from 0.22 fish-m⁻² in West Fork riffles and 0.05 fish·m⁻² East Fork riffles to 2.22 fish M⁻² and 1.32 fish-m⁻² in East Fork eddy drop zones (EDZ), respectively. The largest proportions of freshwater habitat were comprised of run (71 %) and EDZ habitats (44%) in the East Fork and West Fork, respectively. Regression coefficients for coho and sockeye salmon densities were positive with respect to proportional areas of in-stream overhanging vegetation (0.78 and 0.74, respectively), large wood (0.99 and 0.97, respectively), and undercut banks (0.99 and 0.02, respectively). Conversely, coho and sockeye salmon density was negatively related to depth ( -1.45 and -0.52, respectively) and velocity ( -2.45 and -1.67, respectively). Although substrate size was negatively related to sockeye salmon density ( -0.40), this variable had a weak positive relationship with coho salmon density (0.08). These findings suggest that EDZ habitats are important for juvenile coho and sockeye salmon during summer rearing and in-stream cover is an essential component of these rearing habitats.1. Estimation of coho and sockeye salmon density and abundance by habitat class -- 2. Relationships between juvenile coho and sockeye salmon density and physical characteristics of freshwater rearing habitat -- Conclusions -- References

India’s Revised Model BIT: Two Steps Forward, One Step Back?

In December 2015, the Indian government approved the final text of its revised model bilateral investment treaty (BIT). Shortly thereafter, in February 2016, India published a joint interpretative statement to clarify its understanding of certain treaty provisions found in existing Indian treaties. These recent developments in Indian investment treaty policy are products of a multi-year review process ,prompted at least in part by the 2011 finding against India in the White Industries claim - the first such known finding against the state – and by several notices of dispute received following the determination in that case

International Investment Law and the Extractive Industries Sector

Since the 1990s, international investment law has been rapidly evolving, resulting in a complex web of over 3,000 investment treaties. These treaties have been used to challenge a wide range of host state actions and inactions that have allegedly negatively affected foreign investors or investments. Those challenges, in turn, expose host states to potentially significant financial costs, and can restrict the ability of such states to maximize the benefits, and limit the environmental and social harms, that can result from the exploitation of natural resources. This briefing note provides an introduction to international investment law, with a view to assisting stakeholders in grasping the diverse and significant implications of this body of law for the governance of investments in the extractive industries sector

Articulating a Rights-Based Argument for Land Contract Disclosure

In March 2017, CCSI presented a working paper titled Articulating a Rights-Basted Argument for Land Contract Disclosure at the World Bank Land & Poverty Conference. The paper explores whether and how existing state obligations under human rights law require disclosure of land contracts and more transparent contracting processes around land investments. It focuses on the extent to which guidelines for responsible land-based investment, which encourage greater transparency, reflect existing host and home state obligations. Based on a review of relevant human rights law and authoritative interpretations thereof, the paper articulates rights-based arguments for land contract disclosure, based in particular on rights to participation and the right of access to information. This rights-based approach, which has not been fully articulated to date, bolsters understanding of the extent to which best practice recommendations regarding transparency in land investments are reflected in binding human rights obligations, and thereby provides arguments for pushing the transparency agenda forward with states. Moreover, where uncertainty exists regarding how best to implement recommendations regarding land contract disclosure, rights-based arguments can serve to inform and shape measures adopted in pursuit of implementation. The paper also seeks to encourage greater discussion of the links between human rights law and transparency in land investments within the various for a and communities of practice focused on these issues, and to lend legal weight to policy arguments. CCSI is undertaking further research to finalize this paper. The final version will be published on our website

Outcome Report of Workshop on International Investment and the Rights of Indigenous Peoples

On May 12, 2016, the United Nations (UN) Special Rapporteur on the rights of indigenous peoples, Victoria Tauli-Corpuz, and the Columbia Center on Sustainable Investment hosted a one-day workshop on international investment and the rights of indigenous peoples. This outcome document synthesizes the discussions that took place during the May 12 workshop. The workshop was part of a series of consultations undertaken to support the Special Rapporteur\u27s Second Thematic Analysis on the Impact of International Investment Agreements on the Rights of Indigenous Peoples. Held at the Ford Foundation in New York, the workshop brought together 53 academics, practitioners, indigenous representatives, and civil society representatives to explore strategies for strengthening the rights and interests of indigenous peoples in the context of international investment. The workshop provided an opportunity for participants to share their diverse perspectives, experiences, and insights regarding the intersection of international investment and human rights, and to discuss creative and pragmatic approaches to short and long-term reform of both the investment and human rights regimes, with the ultimate goal of ensuring that indigenous rights are respected, protected, and fulfilled. The workshop also built on an earlier report by the Special Rapporteur setting out her concerns regarding the impact of investment and free trade agreements on the human rights of indigenous peoples. That report, which was presented to the 70th session of the UN General Assembly, outlined direct and systemic impacts of investment and free trade agreements on the rights of indigenous peoples, and called for a more thorough review of the implications of these agreements to develop and implement effective options for reform. This outcome document summarizes discussions that took place regarding: the interaction between investment and human rights law; the key challenges facing stakeholders seeking to improve the content of investor-state contracts; and options for strengthening the human rights regime to address the challenges posed by international investment. Workshop discussions on all three topics highlighted the challenges that remain, and the need for further solutions for strengthening the rights of indigenous peoples in the context of international investment

Agricultural Investments under International Investment Law

International investment law, based primarily on international investment treaties, plays an important role in the governance of investment in agriculture, forestry, and fishing. The obligations established by these treaties, and enforced by means of investor–state arbitration, can present challenges for policy-makers and others seeking to ensure that investments are sustainable, including by affecting the ways in which the costs and benefits of investments are distributed among different actors. CCSI partnered with the International Institute for Environment and Development (IIED) and the International Institute for Sustainable Development (IISD) to produce a briefing note on agricultural investments under international investment law. The briefing note provides an overview of the following issues: Who and what do international investment treaties protect, and how are they enforced? Why does international investment law matter for the governance of sustainable, responsible investment in agriculture? How can investment treaties and investor-state arbitration impact laws, policies, and other actions or measures taken by states concerning investment in agriculture? What impact does international investment law have on local perspectives, responsible governance of tenure, and responsible business conduct? And how can policy-makers address challenges posed by investment treaties and investor-state arbitration