34,511 research outputs found
Geographical access to care at birth in Ghana: a barrier to safe motherhood
No full textBackground: appropriate facility-based care at birth is a key determinant of safe motherhood but geographical access remains poor in many high burden regions. Despite its importance, geographical access is rarely audited systematically, preventing integration in national-level maternal health system assessment and planning. In this study, we develop a uniquely detailed set of spatially-linked data and a calibrated geospatial model to undertake a national-scale audit of geographical access to maternity care at birth in Ghana, a high-burden country typical of many in sub-Saharan Africa.Methodology and findings: we assembled detailed spatial data on health facilities, roads, rivers, and other landscape features influencing journeys. These were used in a geospatial model to estimate journey-time for all women of childbearing age (WoCBA) to their nearest health facility offering differing levels of care at birth, taking into account different transport types and availability. We calibrated the model using data on actual journeys made by women seeking care at birth. We found that a third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from any facility likely to offer emergency obstetric and neonatal care (EmONC) classed at the ‘partial’ standard or better. Nearly half (45%) live that distance or further from ‘comprehensive’ EmONC facilities, offering life-saving blood transfusion and surgery. In the most remote regions these figures rose to 63% and 81%, respectively. Poor levels of access were found in many regions that meet international targets based on facilities-per-capita ratios.Conclusions and significance: detailed data assembly combined with geospatial modelling can provide nation-wide audits of geographical access to care at birth to support systemic maternal health planning, human resource deployment, and strategic targeting. Current international benchmarks of maternal health care provision are inadequate for these purposes because they fail to take account of the location and accessibility of services relative to the women they serve<br/
Letter from Carl Hayden to George W. P. Hunt
No full textLetter from Carl Hayden to Governor George W. P. Hunt asking the governor to submit the idea of a national park near the rim of the Grand Canyon to the state legislature during the special session. Hayden mentions the state of Arizona would be charged about 1.25 an acre. W. W. Bass and Bass Camp are also included in the letter
Bayesian geostatistical analysis and prediction of Rhodesian human African trypanosomiasis
No full textBackgroundThe persistent spread of Rhodesian human African trypanosomiasis (HAT) in Uganda in recent years has increased concerns of a potential overlap with the Gambian form of the disease. Recent research has aimed to increase the evidence base for targeting control measures by focusing on the environmental and climatic factors that control the spatial distribution of the disease.ObjectivesOne recent study used simple logistic regression methods to explore the relationship between prevalence of Rhodesian HAT and several social, environmental and climatic variables in two of the most recently affected districts of Uganda, and suggested the disease had spread into the study area due to the movement of infected, untreated livestock. Here we extend this study to account for spatial autocorrelation, incorporate uncertainty in input data and model parameters and undertake predictive mapping for risk of high HAT prevalence in future.Materials and MethodsUsing a spatial analysis in which a generalised linear geostatistical model is used in a Bayesian framework to account explicitly for spatial autocorrelation and incorporate uncertainty in input data and model parameters we are able to demonstrate a more rigorous analytical approach, potentially resulting in more accurate parameter and significance estimates and increased predictive accuracy, thereby allowing an assessment of the validity of the livestock movement hypothesis given more robust parameter estimation and appropriate assessment of covariate effects.ResultsAnalysis strongly supports the theory that Rhodesian HAT was imported to the study area via the movement of untreated, infected livestock from endemic areas. The confounding effect of health care accessibility on the spatial distribution of Rhodesian HAT and the linkages between the disease's distribution and minimum land surface temperature have also been confirmed via the application of these methods.ConclusionsPredictive mapping indicates an increased risk of high HAT prevalence in the future in areas surrounding livestock markets, demonstrating the importance of livestock trading for continuing disease spread. Adherence to government policy to treat livestock at the point of sale is essential to prevent the spread of sleeping sickness in Uganda
Letter from George W. P. Hunt to President Calvin Coolidge
No full textLetter from Governor George W. P. Hunt to Calvin Coolidge arguing for more autonomy in Arizona state matters
Letter from George W. P. Hunt to Carl Hayden
No full textLetter from Governor George W. P. Hunt to Carl Hayden expressing his support for legislation that would grant National Park status to the Grand Canyon
Letter from Carl Hayden to George W. P. Hunt
No full textLetter from Carl Hayden to George W. P. Hunt outlining the proposed national park boundaries and the cost of a township if the state of Arizona decided to acquire one on the rim of the Grand Canyon
Genuine memoirs of the celebrated Miss Maria Brown [electronic resource] : Exhibiting the life of a courtezan, in the most fashionable scenes of dissipation. Published by the author of a W** of P*** In two volumes.
No full textAuthor of a W** of P*** [Woman of Pleasure] = John Cleland, to whom this work is sometimes attributed.Electronic reproduction.English Short Title Catalog,Reproduction of original from British Library
Dr. Edward P. Wimberly, ITC, July 2011
No full textThis video is a conversation with Dr. Edward P. Wimberly. Dr. Wimberly talks about his book, "No Shame in Wesley's Gospel: A Twenty-First Century Pastoral Gospel". Brad Ost, AUC Woodruff Library, is the interviewer
Information for decision making from imperfect national data: tracking major changes in health care use in Kenya using geostatistics
No full textBackground: most Ministries of Health across Africa invest substantial resources in some form of health management information system (HMIS) to coordinate the routine acquisition and compilation of monthly treatment and attendance records from health facilities nationwide. Despite the expense of these systems, poor data coverage means they are rarely, if ever, used to generate reliable evidence for decision makers. One critical weakness across Africa is the current lack of capacity to effectively monitor patterns of service use through time so that the impacts ofchanges in policy or service delivery can be evaluated. Here, we present a new approach that, for the first time, allows national changes in health service use during a time of major health policy change to be tracked reliably using imperfect data from a national HMIS.Methods: monthly attendance records were obtained from the Kenyan HMIS for 1 271 government-run and 402 faith-based outpatient facilities nationwide between 1996 and 2004. Aspace-time geostatistical model was used to compensate for the large proportion of missing records caused by non-reporting health facilities, allowing robust estimation of monthly and annualuse of services by outpatients during this period.Results: we were able to reconstruct robust time series of mean levels of outpatient utilisation of health facilities at the national level and for all six major provinces in Kenya. These plots revealed reliably for the first time a period of steady nationwide decline in the use of health facilities in Kenyabetween 1996 and 2002, followed by a dramatic increase from 2003. This pattern was consistent across different causes of attendance and was observed independently in each province.Conclusion: the methodological approach presented can compensate for missing records in health information systems to provide robust estimates of national patterns of outpatient service use. This represents the first such use of HMIS data and contributes to the resurrection of these hugely expensive but underused systems as national monitoring tools. Applying this approach to Kenya has yielded output with immediate potential to enhance the capacity of decision makers in monitoring nationwide patterns of service use and assessing the impact of changes in health policy and service deliver
Ranking of elimination feasibility between malaria-endemic countries
No full textExperience gained from the Global Malaria Eradication Program (1955-72) identified a set of shared technical and operational factors that enabled some countries to successfully eliminate malaria. Spatial data for these factors were assembled for all malaria-endemic countries and combined to provide an objective, relative ranking of countries by technical, operational, and combined elimination feasibility. The analysis was done separately for Plasmodium falciparum and Plasmodium vivax, and the limitation of the approach were discussed. The relative ranking suggested that malaria elimination would be most feasible in countries in the Americas and Asia, and least feasible in countries in central and west Africa. The results differed when feasibility was measured by technical or operational factors, highlighting the different types of challenge faced by each country. The results are not intended to be prescriptive, predictive, or to provide absolute assessments of feasibility, but they do show that spatial information is available to facilitate evidence-based assessments of the relative feasibility of malaria elimination by country that can be rapidly updated
- …
