150 research outputs found

    Reducing barriers to accessing fistula repair: Implementation research in Katsina

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    Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Katsina state

    Traditional preparations used as uterotonics in Sub‐Saharan Africa and their pharmacologic effects

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    BackgroundLittle is known about the use of traditional preparations for uterotonic effects at or near delivery in Sub‐Saharan Africa.ObjectiveTo describe (1) use of traditional preparations in Sub‐Saharan Africa intended to have uterotonic effects at or near birth; and (2) results of pharmacologic investigations of the uterotonic properties of such preparations.Search strategyStructured review of 13 databases.Selection criteriaArticles describing use of traditional preparations in Sub‐Saharan Africa with primary data, published in English between January 1, 1980 and June 30, 2010.Data collection and analysisFull‐text review using standard spreadsheet templates.Main resultsObjective 1 analysis identified 208 plant species used for uterotonic effects at or near delivery. The most common use was labor induction/augmentation (n = 185). Other uses were to expel the placenta, shorten the third stage of labor, manage retained placenta (n = 61), and prevent/manage postpartum hemorrhage (n = 20). Objective 2 analysis identified 82 species with uterotonic activity confirmed through pharmacologic evaluation. Studies also identified potentiating/inhibiting effects of extracts on pharmaceutical uterotonics.ConclusionNumerous plants are used for uterotonic effects in Sub‐Saharan Africa; uterotonic activity has been confirmed in many through pharmacologic evaluation. Such use may increase the risk of adverse outcomes. Further research is needed on the uterotonic efficacy of traditional preparations and on interventions to address use during labor.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135671/1/0-mmc1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135671/2/ijgo16.pd

    Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa.

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    High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions. Global maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar). A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries. As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined, comprehensive, and validated index may enable ongoing and efficient observation-based assessment of care quality during labor and delivery in sub-Saharan Africa, facilitating targeted quality improvement

    Reducing barriers to accessing fistula repair: Implementation research in Ebonyi

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    Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Ebonyi state

    Ecological system with fear induced group defence and prey refuge

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    In this study, we investigate the dynamics of a spatial and non spatial prey-predator interaction model that includes the following: (i) fear effect incorporated in prey birth rate; (ii) group defence of prey against predators; and (iii) prey refuge. We provide comprehensive mathematical analysis of extinction and persistence scenarios for both prey and predator species. To better explore the dynamics of the system, a thorough investigation of bifurcation analysis has been performed using fear level, prey birth rate, and prey death rate caused by intra-prey competition as bifurcation parameter. All potential occurrences of bi-stability dynamics have also been investigated for some relevant sets of parametric values. Our numerical evaluations show that high levels of fear can stabilize the prey-predator system by ruling out the possibility of periodic solutions. Also, our model Hopf bifurcation is subcritical in contrast to traditional prey-predator models, which ignore the cost of fear and have supercritical Hopf bifurcations in general. In contrast to the general trend, predator species go extinct at higher values of prey birth rates. We have also found that, contrary to the typical tendency for prey species to go extinct, both prey and predator populations may coexist in the system as intra-prey competition level grows noticeably. The stability and Turing instability of associated spatial model have also been investigated analytically. We also perform the numerical simulation to observe the effect of different parameters on the density distribution of species. Different types of spatiotemporal patterns like spot, mixture of spots and stripes have been observed via variation of time evolution, diffusion coefficient of predator population, level of fear factor and prey refuge. The fear level parameter (k) has a great impact on the spatial dynamics of model system
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