Beyond counting stillbirths to understanding their determinants in low-and middle-income countries: a systematic assessment of stillbirth data availability in household surveys

Objective: To systematically map data availability for stillbirths from all countries with DHS surveys to outline the limitations and challenges with using the data for understanding the determinants and causes of stillbirths, and for cross-country comparisons. Methods: We assessed data sources from the DHS program website, including published DHS reports and their associated questionnaires for surveys completed between 2005 and 2015. Results: Between 2005 and 2015, the DHS program completed 114 surveys across 70 LMICs. Ninety- eight (86.0%) surveys from 66 countries collected stillbirth data adequately to calculate a stillbirth rate, while 16 surveys from 12 countries did not. The method used to count stillbirths varied; 96 (84.2%) surveys used a live birth history with a reproductive calendar, while 16 (14.0%) surveys from 12 countries did a full pregnancy history. Based on assessment of questionnaires, antenatal and delivery care information for stillbirths was only available in 15 surveys (13.2%) from 12 countries (17.1%). Data on maternal conditions/complications were captured in 17 surveys (16.0%), but only in six could these be linked to stillbirths. Data on other recognized risk factors were scarce, varying considerably across surveys. Upon further examination of datasets from surveys with maternity care data on non-live births we found incomplete capture of these data; only two surveys had adequately and completely collected them for stillbirths. Conclusion: Substantial variation exists in DHS surveys in the measurement of stillbirths, with limited scope to examine risk factors or causes. Without immediate improvements our understanding of country-specific trends and determinants for stillbirths will remain hampered, limiting the development, and prioritization of programmatic interventions to prevent these deaths

An intelligent system for facility management

A software system has been developed that monitors and interprets temporally changing (internal) building environments and generates related knowledge that can assist in facility management (FM) decision making. The use of the multi agent paradigm renders a system that delivers demonstrable rationality and is robust within the dynamic environment that it operates. Agent behaviour directed at working toward goals is rendered intelligent with semantic web technologies. The capture of semantics though formal expression to model the environment, adds a richness that the agents exploit to intelligently determine behaviours to satisfy goals that are flexible and adaptable. The agent goals are to generate knowledge about building space usage as well as environmental conditions by elaborating and combining near real time sensor data and information from conventional building models. Additionally further inferences are facilitated including those about wasted resources such as unnecessary lighting and heating for example. In contrast, current FM tools, lacking automatic synchronisation with the domain and rich semantic modelling, are limited to the simpler querying of manually maintained models.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Autonomous Airborne Refueling Demonstration: Phase I Flight-Test Results

The first phase of the Autonomous Airborne Refueling Demonstration (AARD) project was completed on August 30, 2006. The goal of this 15-month effort was to develop and flight-test a system to demonstrate an autonomous refueling engagement using the Navy style hose-and-drogue air-to-air refueling method. The prime contractor for this Defense Advanced Research Projects Agency (DARPA) sponsored program was Sierra Nevada Corporation (SNC), Sparks, Nevada. The responsible flight-test organization was the National Aeronautics and Space Administration (NASA) Dryden Flight Research Center (DFRC), Edwards, California, which also provided the F/A-18 receiver airplane (McDonnell Douglas, now The Boeing Company, Chicago, Illinois). The B-707-300 tanker airplane (The Boeing Company) was contracted through Omega Aerial Refueling Services, Inc., Alexandria, Virginia, and the optical tracking system was contracted through OCTEC Ltd., Bracknell, Berkshire, United Kingdom. Nine research flights were flown, testing the functionality and performance of the system in a stepwise manner, culminating in the plug attempts on the final flight. Relative position keeping was found to be very stable and accurate. The receiver aircraft was capable of following the tanker aircraft through turns while maintaining its relative position. During the last flight, six capture attempts were made, two of which were successful. The four misses demonstrated excellent characteristics, the receiver retreating from the drogue in a controlled, safe, and predictable manner that precluded contact between the drogue and the receiver aircraft. The position of the receiver aircraft when engaged and in position for refueling was found to be 5.5 to 8.5 ft low of the ideal position. The controller inputs to the F/A-18 were found to be extremely small

Temporal trends and recent correlates in sedentary behaviours in Chinese children

<p>Abstract</p> <p>Background</p> <p>Sedentary behaviours (television, video and computer) are related to health outcomes independent of physical activity. Few studies have examined trends and correlates of sedentary behaviours among youth in developing nations. The current study is to examine temporal trends in sedentary behaviours and recent correlates of screen use in Chinese children during a period of economic transition.</p> <p>Methods</p> <p>Secondary analysis of China Health and Nutrition Surveys. Cross-sectional data on sedentary behaviours including screen use among children aged 6-18 years from four surveys in 1997 (n = 2,469), 2000 (n = 1,838), 2004 (n = 1,382) and 2006 (n = 1,128). Temporal trends in screen use by socio-demographic characteristics were examined. The correlates of spending more than 2 hours per day on screen time in the most recent survey data (2006, n = 986) were analysed using survey logistic regression analysis.</p> <p>Results</p> <p>Daily screen time significantly increased in each subgroup by age, sex and urban/rural residence, with the largest increase for urban boys aged 13-18 years from 0.5 hours to 1.7 hours, and for rural boys aged 6-12 years from 0.7 hours to 1.7 hours (p < 0.0001). Daily time in both homework and extracurricular cultural activity increased significantly from 2000 to 2004 but was stable from 2004 to 2006. Boys (OR: 1.41, 95%CI: 1.09 -1.82), having a TV in the bedroom (OR: 1.86, 95%CI: 1.15 - 3.01), having access to internet at home (OR: 1.93, 95%CI: 1.12 - 3.31) or at internet cafés (OR: 2.01, 95%CI: 1.21 - 3.34), or often watching TV with parents (OR: 2.27, 95%CI: 1.37 - 3.74) were all associated with being more likely to be high screen users (≥ 2 hours/day). While children aged 13-18 years (OR: 0.67, 95%CI: 0.46-0.97) were less likely to be high screen users. Children whose parents often have rules on their TV viewing (OR: 0.64, 95%CI: 0.37 - 1.10) were slightly but not significantly less likely to be high screen users.</p> <p>Conclusion</p> <p>This study confirms sedentary behaviour has increased over the last decade in Chinese children. Efforts to ensure Chinese youth meet screen time guidelines include limiting access to screen technologies and encouraging parents to monitor their own screen time and to set limits on their child's screen time.</p

An intelligent system for facility management

A software system has been developed that monitors and interprets temporally changing (internal) building environments and generates related knowledge that can assist in facility management (FM) decision making. The use of the multi agent paradigm renders a system that delivers demonstrable rationality and is robust within the dynamic environment that it operates. Agent behaviour directed at working toward goals is rendered intelligent with semantic web technologies. The capture of semantics though formal expression to model the environment, adds a richness that the agents exploit to intelligently determine behaviours to satisfy goals that are flexible and adaptable. The agent goals are to generate knowledge about building space usage as well as environmental conditions by elaborating and combining near real time sensor data and information from conventional building models. Additionally further inferences are facilitated including those about wasted resources such as unnecessary lighting and heating for example. In contrast, current FM tools, lacking automatic synchronisation with the domain and rich semantic modelling, are limited to the simpler querying of manually maintained models

Validity of self-reported weight, height and resultant body mass index in Chinese adolescents and factors associated with errors in self-reports

<p>Abstract</p> <p>Background</p> <p>Validity of self-reported height and weight has not been adequately evaluated in diverse adolescent populations. In fact there are no reported validity studies conducted in Asian children and adolescents. This study aims to examine the accuracy of self-reported weight, height, and resultant BMI values in Chinese adolescents, and of the adolescents' subsequent classification into overweight categories.</p> <p>Methods</p> <p>Weight and height were self-reported and measured in 1761 adolescents aged 12-16 years in a cross-sectional survey in Xi'an city, China. BMI was calculated from both reported values and measured values. Bland-Altman plots with 95% limits of agreement, Pearson's correlation and Kappa statistics were calculated to assess the agreement.</p> <p>Results</p> <p>The 95% limits of agreement were -11.16 and 6.46 kg for weight, -4.73 and 7.45 cm for height, and -4.93 and 2.47 kg/m²for BMI. Pearson correlation between measured and self-reported values was 0.912 for weight, 0.935 for height and 0.809 for BMI. Weighted Kappa was 0.859 for weight, 0.906 for height and 0.754 for BMI. Sensitivity for detecting overweight (includes obese) in adolescents was 56.1%, and specificity was 98.6%. Subjects' area of residence, age and BMI were significant factors associated with the errors in self-reporting weight, height and relative BMI.</p> <p>Conclusions</p> <p>Reported weight and height does not have an acceptable agreement with measured data. Therefore, we do not recommend the application of self-reported weight and height to screen for overweight adolescents in China. Alternatively, self-reported data could be considered for use, with caution, in surveillance systems and epidemiology studies.</p

Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia

<p>Abstract</p> <p>Background</p> <p>Trained birth attendants at delivery are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants. This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province.</p> <p>Methods</p> <p>A qualitative study using focus group discussions (FGDs) and in-depth interviews was conducted in six villages of three districts in West Java Province from March to July 2009. Twenty FGDs and 165 in-depth interviews were conducted involving a total of 295 participants representing mothers, fathers, health care providers, traditional birth attendants and community leaders. The FGD and in-depth interview guidelines included reasons for using a trained or a traditional birth attendant and reasons for having a home or an institutional delivery.</p> <p>Results</p> <p>The use of traditional birth attendants and home delivery were preferable for some community members despite the availability of the village midwife in the village. Physical distance and financial limitations were two major constraints that prevented community members from accessing and using trained attendants and institutional deliveries. A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications. The limited availability of health care providers was reported by residents in remote areas. In these settings the village midwife, who was sometimes the only health care provider, frequently travelled out of the village. The community perceived the role of both village midwives and traditional birth attendants as essential for providing maternal and health care services.</p> <p>Conclusions</p> <p>A comprehensive strategy to increase the availability, accessibility, and affordability of delivery care services should be considered in these West Java areas. Health education strategies are required to increase community awareness about the importance of health services along with the existing financing mechanisms for the poor communities. Public health strategies involving traditional birth attendants will be beneficial particularly in remote areas where their services are highly utilized.</p

Influence of Zinc Supplementation in Acute Diarrhea Differs by the Isolated Organism

Zinc supplementation is recommended in all acute diarrheas in children from developing countries. We aimed to assess whether zinc supplementation would be equally effective against all the common organisms associated with acute diarrheas. We used data on 801 children with acute diarrhea recruited in a randomized, double blind controlled trial (ISRCTN85071383) of zinc and copper supplementation. Using prespecified subgroup analyses, multidimensionality reduction analyses, tests of heterogeneity, and stepwise logistic regression for tests of interactions, we found that the influence of zinc on the risk of diarrhea for more than 3 days depended on the isolated organism—beneficial in Klebsiella, neutral in Esherichia coli and parasitic infections, and detrimental in rotavirus coinfections. Although we found similar results for the outcome of high stool volume, the results did not reach statistical significance. Our findings suggest that the current strategy of zinc supplementation in all cases of acute diarrheas in children may need appropriate fine tuning to optimize the therapeutic benefit based on the causative organism, but further studies need to confirm and extend our findings