Effect of Support Supervision on Maternal and Newborn Health Services and Practices in Rural Eastern Uganda

Background: Support supervision is one of the strategies used to check the quality of services provided at health facilities. From 2013 to 2015, Makerere University School of Public Health strengthened support supervision in the district of Kibuku, Kamuli and Pallisa in Eastern Uganda to improve the quality of maternal and newborn services. Objective: This article assesses quality improvements in maternal and newborn care services and practices during this period. Methods: District management teams were trained for two days on how to conduct the supportive supervision. Teams were then allocated particular facilities, which they consistently visited every quarter. During each visit, teams scored the performance of each facility based on checklists; feedback and corrective actions were implemented. Support supervision focused on maternal health services, newborn care services, human resources, laboratory services, availability of Information, education and communication materials and infrastructure. Support supervision reports and checklists from a total of 28 health facilities, each with at least three support supervision visits, were analyzed for this study and 20 key-informant interviews conducted. Results: There was noticeable improvement in maternal and newborn services. For instance, across the first, second and third quarters, availability of parenteral oxytocin increased from 57% to 75% and then to 82%. Removal of retained products increased from 14% to 50% to 54%, respectively. There was perceived improvement in the use of standards and guidelines for emergency obstetric care and quality of care provided. Qualitatively, three themes were identified that promote the success of supportive supervision: changes in the support supervision style, changes in the adherence to clinical standards and guidelines, and multi-stakeholder engagement. Conclusion: Support supervision helped district health managers to identify and address maternal and newborn service-delivery gaps. However, issues beyond the jurisdiction of district health managers and facility managers may require additional interventions beyond supportive supervision.DFI

Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based training approaches on day of birth care among maternal and newborn healthcare providers in Ebonyi and Kogi States, Nigeria; a randomized controlled trial

Abstract Background There is limited information from low and middle-income countries on learning outcomes, provider satisfaction and cost-effectiveness on the day of birth care among maternal and newborn health workers trained using onsite simulation-based low-dose high frequency (LDHF) plus mentoring approach compared to the commonly employed offsite traditional group-based training (TRAD). The LDHF approach uses in-service learning updates to deliver information based on local needs during short, structured, onsite, interactive learning activities that involve the entire team and are spaced over time to optimize learning. The aim of this study will be to compare the effectiveness and cost of LDHF versus TRAD approaches in improving knowledge and skill in maternal and newborn care and to determine trainees’ satisfaction with the approaches in Ebonyi and Kogi states, Nigeria. Methods This will be a prospective cluster randomized control trial. Sixty health facilities will be randomly assigned for day of birth care health providers training through either LDHF plus mobile mentoring (intervention arm) or TRAD (control arm). There will be 150 trainees in each arm. Multiple choices questionnaires (MCQs), objective structured clinical examinations (OSCEs), cost and satisfaction surveys will be administered before and after the trainings. Quantitative data collection will be done at months 0 (baseline), 3 and 12. Qualitative data will also be collected at 12-month from the LDHF arm only. Descriptive and inferential statistics will be used as appropriate. Composite scores will be computed for selected variables to determine areas where service providers have good skills as against areas where their skills are poor and to compare skills and knowledge outcomes between the two groups at 0.05 level of statistical significance. Discussion There is some evidence that LDHF, simulation and practice-based training approach plus mobile mentoring results in improved skills and health outcomes and is cost-effective. By comparing intervention and control arms the authors hope to replicate similar results, evaluate the approach in Nigeria and provide evidence to Ministry of Health on how and which training approach, frequency and setting will result in the greatest return on investment. Trial registration The trial was retrospectively registered on 24th August, 2017 at ClinicalTrials.Gov: NCT03269240

Introducing criteria based audit into Ugandan maternity units(*)



Problem: Maternal mortality in Uganda has remained unchanged at 500/100 000 over the past 10 years despite concerted efforts to improve the standard of maternity care. It is especially difficult to improve standards in rural areas, where there is little money for improvements. Furthermore, staff may be isolated, poorly paid, disempowered, lacking in morale, and have few skills to bring about change. Design: Training programme to introduce criteria based audit into rural Uganda. Setting: Makerere University Medical School, Mulago Hospital (large government teaching hospital in Kampala), and Mpigi District (rural area with 10 small health centres around a district hospital). Strategies for change: Didactic teaching about criteria based audit followed by practical work in own units, with ongoing support and follow up workshops. Effects of change: Improvements were seen in many standards of care. Staff showed universal enthusiasm for the training; many staff produced simple, cost-free improvements in their standard of care. Lessons learnt: Teaching of criteria based audit to those providing health care in developing countries can produce low cost improvements in the standards of care. Because the method is simple and can be used to provide improvements even without new funding, it has the potential to produce sustainable and cost effective changes in the standard of health care. Follow up is needed to prevent a waning of enthusiasm with time

EXERGY PARAMETRIC ANALYSIS AND PREDICTION OF TURMERIC RHIZOME SLICES DRYING USING NEURO-FUZZY, NEURAL-NETWORK AND REGRESSION TECHNIQUES

This study presents exergy parametric analysis and prediction of turmeric rhizome drying using first and second law of thermodynamics as well as soft-computing techniques. The drying experiments were conducted at inlet drying temperature: (40-650C), air velocity (1.5-3m/s), drying time: (30-240 minutes) and sample thickness: (2-5mm). The Neuro-Fuzzy Exhaustive Search (NFES) parametric analysis results revealed that drying time (RMSE=0.0031), temperature (RMSE=0.096), temperature (RMSE=0.046) and sample thickness (RMSE=0.748) are the most single relevant parameters for Exergy Loss (EL), Exergy Efficiency (EE), Exergetic Improvement Potential (EIP) and Sustainability Index (SI) respectively. Whereas temperature-time (RMSE=0.0031), temperature-velocity (RMSE=0.0945), temperature-time (RMSE=0.046) and time-thickness (RMSE=0.7534) are the most important two-input combinations for EL, EE, EIP and SI correspondingly. NFES also revealed that time-temperature-velocity (RMSE=0.004), temperature-velocity-thickness (RMSE=0.082), time-temperature-velocity (RMSE=0.0436) and time-temperature-thickness (RMSE=0.758) are the three-input significant combination for EL, EE, EIP and SI respectively. The ANN results show that two-input combination architectures gave the highest R2 with minimum RMSE for the exergy-sustainability indicators. Therefore, this study shows that NFES and ANN are reliable tools for the analyses of turmeric rhizome drying thermo-sustainability indicators

Nauclea latifolia herb root waste reinforced epoxy polymer composite: The study of effects, modelling, certainty and sensitivity analysis

The requirement for cleaner and healthy environment is a drive for waste recycling programs. In this study, suitable reinforcement for composite production was extracted from Nauclea latifolia herb root waste (NLHRW) through alkalization. Proximate composition and crystallinity of NLHRW and alkalized NLHRW (ANLHRW) were determined using gravimetric method and X-ray diffractometer (XRD). The individual and interaction effect of production factors (size, weight fraction, and mould compression force) on composite characteristics (flexural strength (FS), modulus (FM), and water absorption (WA)) of ANLHRW reinforced epoxy polymer composite was investigated, modeled and optimized using response surface methodology (RSM). The thermal stability and failure mechanism of the optimally developed ANLHRW reinforced composite were investigated using thermogravic analyzer (TGA) and Scanning Electron Microscope (SEM). The sensitivities of the composite properties to production factors were investigated using Monte Carlo simulation (MCS). Results showed that alkali treatment improved the cellulose content and crystallinity of the fiber. Fiber size and weight fraction increased the FS and FM while mould compression force reduced the WA of the composite. The determined optimum composite production condition was 322.62 μm fiber size, 24.06 wt% fiber weight fraction and 98.10 N mould compression force to give a composite’s FS of 16.9905 MPa, FM of 1046.36 MPa and WA of 3.71057 %. The percentage validation error was 0.70, 0.56 and 0.80 % for FS, FM and WA respectively. The composite produced with the validated optimum condition showed a decrease in thermal resistance than cured unreinforced epoxy plastic and had varied failure mechanisms such as fiber pull out and fiber breakage. The composite properties were dominantly sensitive to fiber weight fraction. The composite produced can be applied in dry low-load bearing applications such as automobile interiors or wet no-load bearing application such as desert cooler pad