223 research outputs found
The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literature
No full textBackground: While the main causes of maternal mortality in low and middle income countries are well understood, less is known about whether patterns for maternal deaths among adolescents are the same as for older women. This study systematically reviews the literature on cause of maternal death in adolescence. Where possible we compare the main causes for adolescents with those for older women to ascertain differences and similarity in patterns of mortality. Methods: An initial search for papers and grey literature in English, Spanish and Portuguese was carried out using a number of electronic databases based on a pre-determined search strategy. The outcome of interest was the proportion of maternal deaths amongst adolescents by cause of death. A total of 15 papers met the inclusion criteria established in the study protocol. Results: The main causes of maternal mortality in adolescents are similar to those of older women: hypertensive disorders, haemorrhage, abortion and sepsis. However there was marked heterogeneity between papers which could indicate country or regional differences in the importance of specific causes of adolescent maternal mortality. When compared with causes of death for older women, hypertensive disorders were found to be a more important cause of mortality for adolescents in a number of studies in a range of settings. In terms of indirect causes of death, there are indications that malaria is a particularly important cause of adolescent maternal mortality in some countries. Conclusion: The main causes of maternal mortality in adolescents are broadly similar to those for older women, although the findings suggest some heterogeneity between countries and regions. However there is evidence that the relative importance of specific causes may differ for this younger age group compared to women over the age of 20 years. In particular hypertensive conditions make up a larger share of maternal deaths in adolescents than older women. Further, large scale studies are needed to investigate this question further. <br/
Community engagement in maternal and perinatal death surveillance and response: a realist review
No full textBackgroundCommunity engagement in maternal and perinatal death surveillance and response (MPDSR) could support health systems in providing people-centred care and ensure accountability for the prevention of maternal and perinatal deaths. Although community engagement activities in MPDSR have been described, the literature does not adequately explain which community engagement in MPDSR strategies succeed, the contexts in which they work, the outcomes they produce, and for whom.MethodsWe conducted a realist review, which involved the identification and refinement of programme theories. An initial literature search identified four initial programme theories (IPTs) that explain how community engagement works in the different parts of the MPDSR cycle.Six databases (Medline, Embase, Scopus, Global Health, CINAHL Plus and Web of Science) and Google were searched for papers and grey literature published between 2004 and August 2022. We used retroductive analysis on included articles to support the identification of generative causation using the heuristic of ‘context-mechanism-outcome configuration’ (CMOCs), which explained what mechanisms were triggered in different contexts and the outcomes that were produced. The findings were then used to refine the IPTs and produce final programme theories.ResultsForty-five articles from 40 studies reported some form of community engagement in MPDSR. We identified 20 CMO configurations that were synthesised into five programme theories:(1)Fear of blame demotivates community members and health professionals from engaging in MPDSR.(2)Dialogue between health professionals and community members improves collaboration and empowers community members to propose innovative solutions.(3)Trusted social connections between bereaved families and community volunteers enables them to identify and report deaths.(4)Financial and non-financial incentives motivate community members and health professionals to engage in MPDSR.(5)Community engagement is more sustainable when it is routinised and integrated into the health system.ConclusionImplementing community engagement in MPDSR requires a systems approach that addresses the five Programme Theories collectively, rather than implementing community engagement in specific parts of the MPDSR cycle as our initial programme theories had suggested. Establishing conducive participatory spaces that promote dialogue, trust and minimise blame culture is critical for the success of community engagement in MPDSR programmes. Community members can be engaged in MPDSR processes in health facilities and community settings and high- and low-income countries
Mathai-Quillen forms and Lefschetz theory
No full textMathai-Quillen forms are used to give an integral formula for the Lefschetz number of a smooth map of a closed manifold. Applied to the identity map, this formula reduces to the Chern-Gauss-Bonnet theorem. The formula is computed explicitly for constant curvature metrics. There is in fact a one-parameter family of integral expressions. As the parameter goes to infinity, a topological version of the heat equation proof of the Lefschetz fixed submanifold formula is obtained. As the parameter goes to zero and under a transversality assumption, a lower bound for the number of points mapped into their cut locus is obtained. For diffeomorphisms with Lefschetz number unequal to the Euler characteristic, this number is infinite for most metrics, in particular for metrics of non-positive curvature.First author draf
A cross-sectional study of partograph utilization as a decision making tool for referral of abnormal labour in primary health care facilities of Bangladesh.
No full textBACKGROUND:In Bangladesh, female paramedics known as Family Welfare Visitors (FWVs), conduct normal deliveries in first-level primary care facilities, or Union Health and Family Welfare Centres (UH&FWC). Utilization of partographs allow for early identification of abnormal labour and referral for advanced care to Emergency Obstetric Care (EmOC) facilities. A systematic assessment of the quality of partograph utilization in clinical-decision making will contribute to understanding the use of the tool by health workers. METHODS:In 2013, the USAID supported MaMoni HSS project, led in country by Save the Children, trained FWVs on the use of partographs in five UH&FWCs in Habiganj district. As part of the follow-up after training, intrapartum case record forms, accompanying partographs, and referral registers for all obstetric cases managed in these five facilities from July 2013 to June 2014 were reviewed. Partographs were reviewed to identify abnormal labour cases based on pre-defined indications. All referred cases were ascertained from the case records in the referral registers. Five health workers were interviewed to assess their knowledge, attitude and experience in partograph use and to explore the challenges for referral decision making associated with the tool. RESULTS:A total of 1,198 deliveries were managed at the study sites, of which 663 presented with cervical dilatation of 8 cm or less. Partographs were initiated in 98% of these cases. Indication of abnormal labour was found in 71 partographs (11%) and among them, only 1 was referred to a higher-level facility. Foetal heart rate and cervical dilatation were appropriately recorded in 61% and 70% of the partographs, respectively. Interviews with health workers revealed poor interpretation of referral indications from the partographs. Limited accessibility to the nearest EmOC facility, inadequate time for referral, and non-compliance to referral by clients were identified by the interviewed health workers as the key barriers for referral decision making. CONCLUSIONS:Supporting the health workers at first-level primary care facilities to better interpret and act on partograph data in a timely manner, and strengthening the referral systems are needed to ensure that women in labour receive the prompt quality care they and their babies require to survive
On a Generalized Entropy Measure Leading to the Pathway Model with a Preliminary Application to Solar Neutrino Data
No full textAn entropy for the scalar variable case, parallel to Havrda-Charvat entropy, was introduced by the first author, and the properties and its connection to Tsallis non-extensive statistical mechanics and the Mathai pathway model were examined by the authors in previous papers. In the current paper, we extend the entropy to cover the scalar case, multivariable case, and matrix variate case. Then, this measure is optimized under different types of restrictions, and a number of models in the multivariable case and matrix variable case are obtained. Connections of these models to problems in statistical and physical sciences are pointed out. An application of the simplest case of the pathway model to the interpretation of solar neutrino data by applying standard deviation analysis and diffusion entropy analysis is provided
Evolution and future trends in battle injuries to the CNS
No full textDespite advances in personal protection, brain and spinal injuries amongst combatants pose significant management challenges. Battle field medical care has evolved over the year. In this article we discuss evolutions of military medicine, study current protocols and outcomes and discuss future perspectives. Mention is also made of some original work by the author
Dynamics of finite-sized light spheres in turbulence
No full textWe report experimental results on the Lagrangian dynamics of finite-size light particles in turbulence. Using an orthogonal camera setup and 3D particle tracking, we study the velocity and acceleration statistics of rigid light spheres in a water tunnel with nearly homogeneous and isotropic turbulence. The Reynolds number (ReY) is varied from 180 to 300, and the study covers a range of size ratios (4 < D/η < 16) for marginally light spheres. We find that the normalised acceleration PDF decreases in intermittency with increasing size ratio - in qualitative agreement with the predictions of the Faxén corrected model. We also present preliminary results on the rotational dynamics of large light spheres in turbulence
Algebra cochains, the bivariant JLO cocycle and the Mathai-Quillen form
No full textThis is a first investigation by the author of the similarity between
Quillen's superconnection formalism, his constructions of (periodic) cyclic
cocycles via algebra cochains on a bar construction, and Kasparov bimodules for
KK-theory. In this article, we do so by deriving a slight extension of the
Mathai-Quillen Thom form via a bivariant JLO cocycle. The main idea (which is
in fact not really new) is that KK-cycles should be thought of as
superconnection forms; these methods will be applied to other contexts
elsewhere
Early warning systems to improve maternal health in Nigeria: design, validation, and evaluation of a modified obstetric early warning chart for use in low-resource settings
No full textBackground: One basic way to prevent maternal deaths in healthcare facilities is through early detection of changes in physiological parameters that are suggestive of clinical deterioration before such changes become irreversible and fatal. This is the aim of the Early Warning Systems (EWS). The objectives of this PhD were to introduce and evaluate the use of obstetric EWS in Nigerian tertiary hospitals.
Methods: A preliminary investigation of the evidence supporting the usefulness of EWS in obstetric practice was achieved via a systematic literature review. The baseline formative research employed mainly qualitative methods to assess the feasibility of implementing EWS in three Nigerian tertiary hospitals. Then a robust dataset, consisting of 4360 women with severe maternal outcome (SMO: maternal death or near miss) and 1000 obstetric admissions without SMO diagnosis, collected across 42 Nigerian tertiary hospitals, was used to develop a statistically derived obstetric EWS model and score-based chart for use in low-resource settings using a case-control multivariate logistic regression analysis. The resulting EWS chart was implemented across all obstetric units of a university teaching hospital in Nigeria. Two other teaching hospitals were recruited as control facilities. Following implementation, we employed mixed research methods to assess the effectiveness of EWS in improving health outcomes and explore the experience of health workers/managers implementing the EWS.
Results: The systematic review showed that EWS are effective in predicting severe obstetric morbidity and mortality, can potentially contribute to improved quality of care/health outcomes, and may be feasible to implement in low-resource settings. The feasibility study confirmed the absence of EWS, a checklist or any guidelines on how to trigger response to obstetric emergencies across the three hospitals. Vital signs were routinely monitored despite shortages of monitoring equipment and human resources. However, understanding of their potential utility as early pointers to maternal deterioration was deficient among healthcare workers.
The resulting EWS from our SMO model consisted of seven clinical parameters (respiratory rate, temperature, systolic blood pressure, pulse rate, consciousness level, urine output and delivery mode for postpartum patients). The model had excellent screening characteristics for SMO (86% (95% CI 81–90) sensitive and 92% (95% CI 89–94) specific and maintained good discriminatory power across all our internal validation data sets (area under ROC curves consistently above 90%).
Following implementation, nurses and doctors found EWS easy to use, easy to evaluate at a glance, and accurate, but, usage rate was considerably low (<50%). Significant improvement in quality of vital signs monitoring was experienced in the intervention, but not in any of the control sites. Rotation of clinical staff, shortages of monitoring equipment and human resources for health were identified challenges.
Conclusion: To the best of our knowledge, this research reports for the first time an internally validated statistically developed diagnostic predictive model for obstetric morbidity and mortality among all women admitted to obstetric wards in a low-resource setting. Our findings showed that it is feasible to implement the obstetric EWS in low-resource settings and this can improve the quality of patient care through better monitoring frequency and medical review based on abnormally high EWS scores. The EWS we developed could be used to evaluate quality of patient care through assessing whether trigger events result in clinical action, and timeliness of clinical action. Surveillance of patients who trigger action could allow for further evaluation and discussion of quality of care, for example at maternal morbidity and mortality meetings.
Overall, with staff education on usefulness of EWS, coupled with continuous training and retraining, it is feasible to implement obstetric EWS as a potentially acceptable patient monitoring tool to cope with the unique demands faced by obstetric practice in low-resource tertiary healthcare settings
- …
