Factors Associated with Severe Disease from Malaria, Pneumonia and Diarrhea among Children in Rural Tanzania - a Hospital-Based Cross-Sectional Study.

Mild cases of malaria, pneumonia and diarrhea are readily treatable with complete recovery and with inexpensive and widely available first-line drugs. However, treatment is complicated and expensive, and mortality is higher when children present to the hospital with severe forms of these illnesses. We studied how care seeking behaviours and other factors contributed to severity of malaria, pneumonia and diarrhoea among children less than five years in rural Tanzania. We interviewed consecutive care-takers of children diagnosed with malaria, pneumonia and/or diarrhea at Korogwe and Muheza district hospitals, in north-eastern Tanzania, between July 2009 and January 2010, and compared characteristics of children presenting with severe and those with non-severe disease. A total of 293 children with severe and 190 with non-severe disease were studied. We found persistent associations between severity of disease and caretaker's lack of formal education (OR 6.6; 95% confidence interval (CI) 2.7-15.8) compared to those with post-primary education, middle compared to high socio-economic status (OR 1.9; 95% CI 1.2-3.2), having 4 or more children compared to having one child (OR 2.5; 95% CI 1.4-4.5), having utilized a nearer primary health care (PHC) facility for the same illness compared to having not (OR 5.2; 95% CI 3.0-9.1), and having purchased the first treatment other than paracetamol from local or drug shops compared to when the treatment was obtained from the public hospitals for the first time (OR 3.2; 95% CI 1.9-5.2). The old officially abandoned first line anti-malaria drug Sulfadoxin-pyrimethamine (SP) was found to still be in use for the treatment of malaria and was significantly associated with childrens' presentation to the hospital with severe malaria (OR 12.5; 95% CI 1.6-108.0). Our results indicate that caretakers with no formal education, with lower SES and with many children can be target groups for interventions in order to further reduce child mortality from treatable illnesses. Furthermore, the quality of the available drug shops and PHC facilities need to be closely monitored

Severe acute maternal morbidity and associated deaths in conflict and post-conflict settings in Africa

SETTING:  Five hospitals in four conflict and post-conflict countries (Democratic Republic of Congo, Somaliland, Sierra Leone and Burundi). OBJECTIVES:  To report among hospital deliveries: 1) the proportion of severe acute maternal morbidity (SAMM), 2) the pattern of SAMM, and 3) maternal deaths according to type of SAMM. METHODS:  An audit of data from a standardised database implemented in all the sites in the study. RESULTS:  Of the 18 675 deliveries, there were 6314 (34%) known SAMM cases with 63 associated deaths, implying that for every 100 SAMM cases there was one maternal death. In descending order, the death-to-SAMM ratios per 1000 deliveries were: 1:7 for sepsis, 6 for haemorrhage 1:70 for hypertensive disorder and 1:398 for obstructed labour. A substantial proportion of deaths (38%) that occurred in hospitals could not be categorised into the standardised SAMM conditions available in the database. CONCLUSION:  As this is the first study using multi-centre data from conflict and post-conflict countries, these findings are relevant to improving maternal health in such settings. Findings, implications and possible ways forward in addressing various challenges are discussed

Strategisk planlegging og styring i kommunesektoren

The topic of this study is strategic planning and management in the municipal sector, specifically, the extent to which local government has adopted strategic planning and management, which planning and management elements that are used, and what is the nature of municipal strategy. We also examined whether the size of the municipality, economic freedom and the strategic positions – prospector, defender and reactor – are affecting the municipality's strategic management. In recent years there has been carried out many international studies on the use of strategic management in the public sector. We wanted to assess how the situation is in Norwegian municipalities, and based our examination on a survey conducted by Poister and Streib in 2005. They pointed out that strategic planning has been used in the public sector for over 20 years, and their results suggest that there is increasing use of complex links between multiple management processes in strategic work. We adjusted this study to fit Norwegian conditions and added questions about strategic content from a study by Andrews, Boyne and Walker (2006). The data was collected via a questionnaire sent to all municipalities. There are responses from a total of 176 municipalities, which yielded a response rate of 41%. We also collected secondary data from Statistics Norway (SSB). The results from our survey show that local authorities make extensive use of strategic planning and management processes and, in general, experience the effects of strategic planning as positive. We found that municipalities connect several strategic management processes of planning in a complex way, though to varying degrees. It was also an objective of this study to gain more knowledge about what is the content of municipal strategy. The data suggest that municipalities are not passively controlled by the expectations and orders from external stakeholders, but act proactively within the room to maneuver that exists to create public value. A regression analysis showed that the factors of municipality size, economic freedom and the strategic positions advocate, defender and reactive, explains 33 percent of the variation in the strategic management of municipal councils. The analysis also showed that the strategic position prospector is more correlated to the variation in strategic management than the size of the municipality and economic freedom. The size of the municipality and the strategic position defender is more influential to variation in strategic management than economic freedom.Master i styring og ledels

Sexual violence in post-conflict Liberia: survivors and their care.

Using routine data from three clinics offering care to survivors of sexual violence (SV) in Monrovia, Liberia, we describe the characteristics of SV survivors and the pattern of SV and discuss how the current approach could be better adapted to meet survivors' needs. There were 1500 survivors seeking SV care between January 2008 and December 2009. Most survivors were women (98%) and median age was 13 years (Interquartile range: 9-17 years). Sexual aggression occurred during day-to-day activities in 822 (55%) cases and in the survivor's home in 552 (37%) cases. The perpetrator was a known civilian in 1037 (69%) SV events. Only 619 (41%) survivors sought care within 72 h. The current approach could be improved by: effectively addressing the psychosocial needs of child survivors, reaching male survivors, targeting the perpetrators in awareness and advocacy campaigns and reducing delays in seeking care

Is transcription of data on antiretroviral treatment from electronic to paper-based registers reliable in Malawi?

SETTING: Antiretroviral treatment (ART) clinics at one central hospital, three district hospitals and one mission hospital in the central and southern regions of Malawi. OBJECTIVE: To measure the extent of inaccuracies in the transcription of case registration and recorded deaths between electronic medical data (EMR) and paper registers. This was done to inform the Ministry of Health on the reliability of the paper-based system as backup in case of EMR failure. DESIGN: Retrospective analysis of routine programme data. RESULTS: A total of 31 763 registrations and 2922 deaths in the EMR were compared with those in the paper registers. In one hospital, up to 24% of overall case registrations were missing from the paper registers. At other sites, the differences were minor and included duplicate patients who should have been classified as ‘transfer in’ patients in the paper register. There were major differences in the number of registered deaths in two of the five facilities. CONCLUSION: There are varying degrees of agreement between the EMR and paper registers which compromise the use of the latter as a backup solution in case of EMR failure. The reasons for this unreliability and ways forward to address the problem are discussed

High mortality in tuberculosis patients despite HIV interventions in Swaziland.

SETTING: All health facilities providing tuberculosis (TB) care in Swaziland. OBJECTIVE: To describe the impact of human immunodeficiency virus (HIV) interventions on the trend of TB treatment outcomes during 2010-2013 in Swaziland; and to describe the evolution in TB case notification, the uptake of HIV testing, antiretroviral therapy (ART) and cotrimoxazole preventive therapy (CPT), and the proportion of TB-HIV co-infected patients with adverse treatment outcomes, including mortality, loss to follow-up and treatment failure. DESIGN: A retrospective descriptive study using aggregated national TB programme data. RESULTS: Between 2010 and 2013, TB case notifications in Swaziland decreased by 40%, HIV testing increased from 86% to 96%, CPT uptake increased from 93% to 99% and ART uptake among TB patients increased from 35% to 75%. The TB-HIV co-infection rate remained around 70% and the proportion of TB-HIV cases with adverse outcomes decreased from 36% to 30%. Mortality remained high, at 14-16%, over the study period, and anti-tuberculosis treatment failure rates were stable over time (<5%). CONCLUSION: Despite high CPT and ART uptake in TB-HIV patients, mortality remained high. Further studies are required to better define high-risk patient groups, understand the reasons for death and design appropriate interventions