Determinants of healthcare seeking for childhood illnesses among caregivers of under-five children in urban slums in Malawi:a population-based cross-sectional study

Background There is considerable evidence that health systems, in so far as they ensure access to healthcare, promote population health even independent of other determinants. Access to child health services remains integral to improving child health outcomes. Cognisant that improvements in child health have been unevenly distributed, it is imperative that health services and research focus on the disadvantaged groups. Children residing in urban slums are known to face a health disadvantage that is masked by the common view of an urban health advantage. Granted increasing urbanisation rates and proliferation of urban slums resulting from urban poverty, the health of under-five children in slums remains a public health imperative in Malawi. We explored determinants of healthcare-seeking from a biomedical health provider for childhood symptoms of fever, cough with fast breathing and diarrhoea in three urban slums of Lilongwe, Malawi. Methods This was a population-based cross-sectional study involving 543 caregivers of under-five children. Data on childhood morbidity and healthcare seeking in three months period were collected using face-to-face interviews guided by a validated questionnaire. Data were entered in CS-Pro 5.0 and analysed in SPSS version 20 using descriptive statistics and logistic regression analyses. Results 61% of caregivers sought healthcare albeit 53% of them sought healthcare late. Public health facilities constituted the most frequently used health providers. Healthcare was more likely to be sought: for younger than older under-five children (AOR = 0.54; 95% CI: 0.30-0.99); when illness was perceived to be severe (AOR = 2.40; 95% CI: 1.34-4.30); when the presenting symptom was fever (AOR = 1.77; 95% CI: 1.10-2.86). Home management of childhood illness was negatively associated with care-seeking (AOR = 0.54; 95% CI: 0.36-0.81) and timely care-seeking (AOR = 0.44; 95% CI: 0.2-0.74). Caregivers with good knowledge of child danger signs were less likely to seek care timely (AOR = 0.57; 95% CI: 0.33-0.99). Conclusions Even in the context of geographical proximity to healthcare services, caregivers in urban slums may not seek healthcare or when they do so the majority may not undertake timely healthcare care seeking. Factors related to the child, the type of illness, and the caregiver are central to the healthcare decision making dynamics. Improving access to under-five child health services therefore requires considering multiple factors

Emotional and behavioural difficulties of children and young people at entry into care

Emotional and behavioural difficulties of a sample of children and young people were identified at the point of entry to local authority care by analysis of social work case files. The files indicated high levels of need, including that in children aged under 5. Bedwetting was identified as an important issue related to the physical health and emotional well-being of looked-after children. There was an association between bedwetting and emotional and behavioural problems. Analysis of placement types at entry to care showed that significantly more boys than girls were first placed in residential care

CCTV as an automated sensor for firearms detection: human-derived performance as a precursor to automatic recognition

CCTV operators are able to detect firearms, via CCTV, but their capacity for surveillance is limited. Thus, it is desirable to automate the monitoring of CCTV cameras for firearms using machine vision techniques. The abilities of CCTV operators to detect concealed and unconcealed firearms in CCTV footage were quantified within a signal detection framework. Additionally, the visual search strategies adopted by the CCTV operators were elicited and their efficacies indexed with respect to signal detection performance, separately for concealed and unconcealed firearms. Future work will automate effective, human visual search strategies using image processing algorithms

Exploring essential skills of CCTV operators: the role of sensitivity to nonverbal cues

The aim of the present research is to investigate the importance of individual differences in the recognition of emotional state from non-verbal, visual cues in relation to the work of CCTV operators. An experiment was conducted to determine whether the detection of a gun carrier can be predicted on the basis of an observer’s ability to recognize emotion conveyed by non-verbal, visual cues. There was a relationship between the emotional state reported by an individual whilst carrying a firearm and the extent to which an observer was ability to determine whether or not this individual was carrying a gun. It was also found that observers with a high ability to recognize emotion from facial expressions were able to spot a gun carrier more accurately than observers with a low ability in this respect. This small-scale pilot study requires replication with a larger number of participants and real CCTV images

Health professionals’ agreement on density judgements and successful abnormality identification within the UK Breast Screening Programme

Higher breast density is associated with a greater chance of developing breast cancer. Additionally, it is well known that higher mammographic breast density is associated with increased difficulty in accurately identifying breast cancer. However, comparatively little is known of the reliability of breast density judgements. All UK breast screeners (primarily radiologists and technologists) annually participate in the PERFORMS self-assessment scheme where they make several judgements about series of challenging recent screening cases of known outcomes. As part of this process, for each case, they provide a radiological assessment of the likelihood of cancer on a confidence scale, alongside an assessment of case density using a three point scale. Analysis of the data from two years of the scheme found that the degree of agreement on case density was significantly greater than no agreement (p < .001). However, only a moderate degree of inter-rater reliability was exhibited (κ = .44) with significant differences between the occupational groups. The reasons for differences between the occupational groups and the relationship between agreement on density rating and case reading ability are explored

The detection of people carrying concealed firearms, via CCTV: do their emotions give them away?

Illegal gun possession is an increasing problem in the UK; at the same time the UK has a massive CCTV deployment. Individuals can detect the emotional state of people shown in image sequences. Additionally, firearms are known to elicit certain emotional states in their bearers. Consequently, it may be possible for CCTV operators to determine if surveillance targets are carrying a concealed firearm on the basis of the target s emotional state. This study investigated whether observers are able to perceive differences in the emotional states of people who are and who are not carrying concealed firearms, as judged monitoring staged CCTV footage. Thirty-one participants viewed 24 mock CCTV clips of individuals walking. Half of the clips featured a concealed firearm, the other half featured a concealed, innocuous object. The results showed that observers were able to differentiate between the two clip types by attributing different moods to those featured in each. However, their estimation of mood was dissimilar to the mood reported by those featured in the clips. Furthermore, observers non-verbal sensitivity and their ability to recognize the mood of carriers showed little relationship. These issues are discussed with regard to the visual cues associated with this mood recognition task

Skills in detecting gun carrying from CCTV

Gun crime is an increasingly common occurrence in the UK. An ongoing research programme is investigating the ability of humans to detect whether or not an individual, captured on CCTV, is carrying a firearm. In the present study we argue that observers respond to cues which individuals inherently produce whilst carrying a concealed firearm. These cues might be reflected in the body language of those carrying firearms and might be apprehended by observers at a conscious or subconscious level. Simulated CCTV footage was generated of individuals who acted as surveillance targets and who carried, concealed on their persons, either firearms or matched innocuous objects. Trained CCTV operators and lay people then viewed this footage and were asked to indicate whether or not they thought the surveillance target was carrying a firearm. The size of the influence of carrying a firearm on a surveillance target’s anxiety level was found to be related to the number of times that individual was deemed to be carrying a firearm. However, the surveillance target’s anxiety level was not related to sensitivity in firearm detection. Additionally, a test of body language decoding ability did not show that the body language reading skills of observers were related to ability to detect a concealed firearm. These initial results provide some insight into the potential for using a surveillance target’s body language to determine if they are concealing a weapon and whether or not such an ability can be acquired through surveillance training and experience

Potential applications of affective computing in the surveillance work of CCTV operators

Affective computing is a branch of artificial intelligence that deals with the design of devices which can process human emotions. The data gathered by passive sensors can be compared to the cues humans use to perceive the affective state of others (e.g. a video camera might capture facial expressions, body posture or gestures). An automatic, machine-based emotion recognition system could operate on the basis of the output of these sensors. CCTV surveillance is a potential application for such a system which might be used to constantly monitor for mal-intent through the emotional cues exhibited by surveillance targets and alert CCTV operators as appropriate. Previous research showed that firearms are known to elicit certain emotional states in their bearers. Consequently, these states might be reflected in the change of the individuals body language. The potential for automating the detection of the associated emotional cues in image processing algorithms is discussed

Can CCTV reliably detect gun crime?

In recent years the highest levels of gun crime in England and Wales have been recorded. Gun crime is known to occur in environments that fall under the view of the networks of CCTV cameras which are endemic in urban Britain. Consequently, CCTV has the potential to detect gun crime. However, CCTV operators face a near impossible task: often, each individual operator is required to monitor multiple cameras for extended time periods. It is not surprising then to find that CCTV has had little effect at reducing gun crime. A new collaborative research programme (MEDUSA) is underway across the UK which will develop a software application to aid CCTV operators detect the precursors of gun crime. MEDUSA aims automatically to detect both guns as objects (concealed or otherwise) and people who intend to commit gun crime, via CCTV. The system is partly based on eliciting the features that skilled CCTV operators identify as indicative of a concealed weapon or suspicious behaviour related to gun crime. Initial studies into the examination of these skills across several CCTV centres indicate that there was little formal instruction in the detection of mal-intent. Much skill is built up from prolonged experience in examining CCTV imagery. Thus, potentially, there is widespread individualisation of detection skills. Further, visual cues specific to gun crime were limited. However, the present methodology relied upon direct report. It is argued that a range of both consciously and subconsciously detected cues could facilitate gun detection via CCTV. Future studies will examine this possibility