478 research outputs found

    Pertussis and Influenza Vaccination during Pregnancy: Maternal and Neonatal Health Outcomes

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    Background and objectives Vaccination during pregnancy can enhance transplacental transfer of protective antibody to the fetus and protect the infant against disease during the first few months of life. Despite the recommendation of maternal influenza and pertussis vaccination to protect pregnant women and their infants against these serious infections, uptake of the vaccines has been suboptimal globally. This thesis aims to determine the most effective interventions used to improve maternal pertussis vaccine uptake, identify psychosocial factors influencing acceptance and uptake of maternal pertussis and seasonal influenza vaccination and evaluate evidence for the safety and benefits of these two routinely recommended vaccines during pregnancy in improving maternal and neonatal health outcomes. Methods A systematic review was conducted to identify strategies effective in improving uptake of pertussis vaccine among pregnant women. A prospective cohort study of low risk, nulliparous women with singleton pregnancies were recruited between 2015-2018 at two major maternity hospitals in Adelaide, South Australia, with the primary aim to develop screening tests to identify adverse pregnancy outcomes. Using this multicentre prospective cohort with comprehensive clinical, lifestyle, sociodemographic data, and documented maternal vaccination status, the thesis examined psychosocial predictors of maternal vaccination and evaluated the safety and impact of maternal seasonal influenza and pertussis vaccines on pregnancy and birth outcomes. Poisson regression models were used to identify psychosocial factors influencing acceptance and uptake of the two routinely recommended antenatal vaccines. To evaluate the impact of maternal influenza and pertussis vaccination on health outcomes for mothers and infants, Cox proportional-hazards and log-binomial models were applied. Results The systematic review included six original published studies that reported on interventions to increase uptake of pertussis vaccine among pregnant women. Observational studies showed i) a midwife delivered maternal vaccination program improved uptake of pertussis vaccine during pregnancy from 20% to 90%; ii) implementation of an automated reminder within the electronic medical record improved uptake from 48% to 97%; iii) an increase in maternal pertussis vaccine uptake from 36% to 61% after strategies to increase provider awareness of recommendations were introduced. In contrast, interventions in all three randomised controlled trials (RCTs) (two involved education of pregnant women, one had multi-component interventions) did not demonstrate improvement in the uptake of pertussis vaccination during pregnancy, although two of the RCT studies failed to attain their sample size estimates. Data from the prospective cohort showed that women’s willingness to receive the recommended maternal vaccines was high (90%) and independent of psychosocial factors. However, a difference in the actual receipt of pertussis (79%) and seasonal influenza vaccines (48%) during pregnancy was observed. A history of major depressive disorder was the strongest predictor of pertussis (adjusted prevalence ratios, aPR 1.16, 95% CI:1.06–1.26) and influenza vaccination uptake during pregnancy (aPR 1.32; 95% CI: 1.14–1.58). Pregnant women presenting with elevated depressive symptoms were also more likely to receive maternal pertussis vaccination (aPR 1.14, 95% CI:1.00–1.30). In contrast, women with very high-perceived stress levels (aPR 0.87; 95% CI: 0.76–0.99) were less likely to receive maternal pertussis vaccination. Women with mild depressive symptoms (aPR 1.21, 95% CI: 1.00–1.44) and mild anxiety symptoms (aPR 1.21, 95% CI: 0.99–1.48) were more likely to receive influenza vaccine during pregnancy. Data analyses of the prospective cohort found no significant difference in the risk of adverse pregnancy (spontaneous abortion, chorioamnionitis, gestational hypertension, pre-eclampsia, gestational diabetes, preterm premature rupture of the membranes, spontaneous preterm birth) and birth outcomes (congenital anomalies, small for gestational age births, low birth weight, admission to the neonatal care unit, low Apgar scores and mechanical ventilation) among women who received seasonal influenza or pertussis vaccinations in pregnancy compared with unvaccinated pregnant women. This thesis also presents evidence that maternal influenza vaccination reduces the risk of pre-delivery hospitalisation with influenza-like illness during pregnancy (adjusted hazard ratios, aHR 0.61; 95% CI: 0.39–0.97). Furthermore, the thesis findings suggest a protective effect of maternal seasonal influenza in reducing the rates of low birthweight (aHR 0.46, 95% CI: 0.23–0.94) and small for gestational age births (aHR 0.65, 95% CI: 0.40–1.04) during periods of high influenza activity. Conclusions There is limited high quality evidence for interventions to increase uptake of pertussis vaccine among pregnant women. Based on the existing research, incorporating midwife led maternal vaccination programs, increasing healthcare provider awareness of recommendations and implementation of a provider reminder system to target unvaccinated pregnant women are the most effective strategies to improve uptake of pertussis vaccine during pregnancy. The psychosocial predictors of maternal vaccination identified in this thesis can be used in designing effective interventions and maternal vaccination programs. The thesis findings on the safety of maternal pertussis and influenza vaccination and additional potential benefits of influenza vaccine during pregnancy in improving neonatal outcomes can be used to promote antenatal vaccination to expecting mothers and healthcare providers. Furthermore, these findings may aid evidence-based decision making for policy makers in countries considering implementation of universal antenatal seasonal influenza and pertussis vaccination programs.Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 202

    Tracking English and Translated Arabic News using GHSOM

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    The Oromo of Ethiopia, 1500-1850: With special emphasis on the Gibe region.

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    Amda-Siyon (1314-1344) was the founder of the powerful Christian empire. His wars were accompanied by carnage and destruction which sent tribes and groups fleeing from the storm centre, abandoning their territory, to seek refuge in difficult areas, where geographic features and distance from the zone of conflict held out hope of asylum. This altered the pattern of ethnic distribution during his reign. There are a number of indications which, beyond a shadow of doubt, establish that some groups, including some Oromo groups, who arrived in the region earlier, were forced to flee from the storm centre. The establishment of a number of Christian military colonies, in Bali, Dawaro, Fatagar, Hadiya, waj and other areas, acted as a powerful dam that checked the flow of pastoral Oromo from the southern region to the central highlands. In the first half of the sixteenth century, the jihad of Imam Ahmad destroyed that dam. With the appalling massacre and destruction on both sides went the fall and destruction of both their defence systems. It is not so much that as so many scholars have presumed, "the so-called Galla invasion" destroyed both countries, as that the two states so battered each other that the way was made clear for surges of advance by the Oromo pastoralists. This happened, fortuitously, at the time when the Oromo perfected their complex gada system, a unique institution, which mobilized them for dynamic warfare and also provided them with a mechanism which enabled them easily and quickly to turn their enemies into allies. This dissertation is an attempt to explain the rapid migration of pastoral Oromo, their settlement in the Gibe region, their formation into states and their Islamization. The five Oromo states of the Gibe region were formed shortly after 1800. Although the existence of these states spanned no more than a few decades, before their annexation by Menelik, the king of Shawa, this brief period was packed with events of crucial importance. It witnessed rapid, agricultural, social, cultural, political, religious and commercial progress, unsurpassed in any of the other Oromo areas in Ethiopia. In the field of religion, the Gibe region became the most famous centre of Islamic learning for all the Oromo of Ethiopia. Even today, along with Dawe in Wallo, the Gibe region is regarded as the best centre of Islamic learning in the Horn of Africa. In the field of commerce, the whirlwind of trading activities in the Gibe region gave birth to an aggressive and dynamic Oromo merchant class, the Africa. In all these states, trading was a highly organized business in which goverment played a key role. This led to the development of an impressive network of institutionized trade, which enabled the Afkala traders to engage in a brisk trade all year round. The caravan routes which crisscrossed the Gibe region and interwove it with the surrounding lands, made the area the major emporium in the whole of southwestern Ethiopia, where the products of the surrounding lands were collected, to be funnelled to the north through Gojjam or to the east through Shawa. The transit trade that entered and left the Gibe region supplied its beneficial effects to the kings in the forms of gifts and customs duties. Indeed, the Gibe states enjoyed prosperity. While the full effect of this prosperity did not reach beyond the land-owning class, the poor peasants in the Gibe region, probably enjoyed a higher standard of living than any peasants in the Ethiopian region. The abundance of cereal crops, supplemented by root crops, guaranteed their safety from famine. Cattle and fowl provided them with milk and meat. The light burden of taxation and the possibility of earning more and buying land also contributed to the better standard of living of the ordinary peasant

    Excessive Daytime Sleepiness and Associated Factors Among Women in Perinatal Period

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    Background and Objective Excessive daytime sleepiness (EDS) is an important public health issue requiring adequate screening and management to avoid such harmful consequences. The study aimed to assess the prevalence and risk factors of EDS in the perinatal period. Methods Institution-based cross-sectional study was carried out in selected public health institutions of Ethiopia on systematic selected 362 women during perinatal period. We used a validated Epworth daytime sleepiness tool to collect data. Epi-InfoTM 7 and SPSS version 26 were used for data entry and analysis, respectively. Bivariable and multivariable binary logistic regression analyses were conducted to determine the associated factors. Results The prevalence of EDS was 16.6% (95% CI: 12.6–20.7). Excessive pregnancy-related concern (adjusted odds ratio [AOR] = 0.232, 95% CI: 0.087–0.621), having depression symptoms (AOR = 8.045, 95% CI: 3.375–19.174), anxiety symptoms (AOR = 4.905, 95% CI: 2.083– 11.550) and having a chronic medical illness (AOR = 5.441, 95% CI: 2.273–13.021) were the factors associated with EDS. Conclusions The results of the current study suggested that perinatal EDS among women in northern part of Ethiopia is a highly prevalent and associated with excessive pregnancy concern, depression, anxiety, and medical illness

    Strategies in the teaching of Geography in higher education preparatory secondary schools of Ethiopia

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    Education systems are currently undergoing transformational changes throughout the world and one of these changes is a shift from a philosophy of positivist paradigm to constructivist paradigm of teaching. Accordingly, constructivists claim children actively construct their knowledge rather than absorb information spoken to them by teachers. Therefore, the constructivist teaching of Geography places emphasis on the fact that learners should think more, understand and responsible for their own learning. This study thus focused on the practice of constructivist methods in the teaching of Geography at preparatory secondary schools of Ethiopia. Geography is colourful and an outdoor oriented subject in which learners could get good opportunities to construct their knowledge through various in-and-out of school activities. Thus, constructivist methods are useful for Geography learners to develop their intellectual capacity for life-long learning and for generic skills such as critical thinking, information processing, problem solving, decision-making, etc. Therefore, the main purpose of this study was to investigate the merits and reasons for teacher dominance in the pedagogy of Geography and to suggest learner-centered teaching strategies in the context of constructivist principles on learners’ learning activities to liberate them from passive learning pedagogy. The study was confined to six Higher Education Preparatory Secondary Schools out of 20 preparatory schools of the South Wollo Administrative Zone of Amhara state of Ethiopia. It employed mixed-method approaches (qual-quant) and descriptive survey design. The target population for this study was 1053 Social Science learners and 12 Geography departmental heads and teachers. Among 1053 learners 199 learners were sampled through random sampling technique. But all Geography teachers and departmental heads were taken as the main participants through purposive sampling techniques. Semi-structured interviews, observation, documents and questionnaire were the main data collection instruments for the study. Data that were collected through interviews, observation and open-ended questionnaire were analysed inductively using narrations and descriptions through words, phrases and statements, whereas the data collected from documents were organised in the form of tables and analysed via percentage and mean. However, data that were collected through close-ended questionnaires were edited, coded, classified, tabulated and organised in the form of tables havebeen analysed through frequency, percentage and mean via SPSS software. Based on the analysed data, findings were depicted. The findings of the study revealed that Geography is a unique discipline and its syllabus was prepared in line with the country’s education policy which encourages constructivist approaches of teaching. However, majority of teachers frequently practice traditional teaching methods. Moreover, the study also identified that lack of teachers’ professional training about the practice of a variety of learner-centered methods and continuous assessment techniques, lack of experience about learner-centered teaching methods both on the part of teachers and learners, low interest and commitment on the part of teachers, teachers’ failure to utilise teaching materials, placing of less competent learners in the Social Science stream, learners’ low interest to learn and incapability to learn through learner-centered methods, learners’ low engagement in the teaching activities, learners’ disturbance, shortage of time, absence of plasma TV transmission and shortage of resources such as school facilities, instructional media, reference books, Geography room, department room, pedagogical center, lounge and scarcity of budget were considerable hindrances on the implementation of Geography syllabus through the constructivist approaches of teaching methods. Based on the findings of the study, recommendations were made to the concerned bodies to alleviate the hindrances and to encourage the practice of constructivist teaching methods and making the learners free from teachers’ dependency.Curriculum and Instructional StudiesD. Ed. (Curriculum Studies

    Trade liberalization and women's livelihood adaptation in Kampala - Uganda

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    The main objective of this study is to explicate or explore the relationship between the process of trade liberalization and Ugandan women in the informal sector. In examining this relationship, I will employ the following questions as tools of analysis: What is the effect of the process of trade liberalization on their livelihood? What are the opportunities or benefits that are available for them? Does the process of trade liberalization affect them negatively or positively? Is there any initiative on the part of the government that can improve their conditions of life
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