Losing women along the path to safe motherhood: why is there such a gap between women's use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda.

BACKGROUND: Thousands of women and newborns still die preventable deaths from pregnancy and childbirth-related complications in poor settings. Delivery with a skilled birth attendant is a vital intervention for saving lives. Yet many women, particularly where maternal mortality ratios are highest, do not have a skilled birth attendant at delivery. In Uganda, only 58 % of women deliver in a health facility, despite approximately 95 % of women attending antenatal care (ANC). This study aimed to (1) identify key factors underlying the gap between high rates of antenatal care attendance and much lower rates of health-facility delivery; (2) examine the association between advice during antenatal care to deliver at a health facility and actual place of delivery; (3) investigate whether antenatal care services in a post-conflict district of Northern Uganda actively link women to skilled birth attendant services; and (4) make recommendations for policy- and program-relevant implementation research to enhance use of skilled birth attendance services. METHODS: This study was carried out in Gulu District in 2009. Quantitative and qualitative methods used included: structured antenatal care client entry and exit interviews [n = 139]; semi-structured interviews with women in their homes [n = 36], with health workers [n = 10], and with policymakers [n = 10]; and focus group discussions with women [n = 20], men [n = 20], and traditional birth attendants [n = 20]. RESULTS: Seventy-five percent of antenatal care clients currently pregnant reported they received advice during their last pregnancy to deliver in a health facility, and 58 % of these reported having delivered in a health facility. After adjustment for confounding, women who reported they received advice at antenatal care to deliver at a health facility were significantly more likely (aOR = 2.83 [95 % CI: 1.19-6.75], p = 0.02) to report giving birth in a facility. Despite high antenatal care coverage, a number of demand and supply side barriers deter use of skilled birth attendance services. Primary barriers were: fear of being neglected or maltreated by health workers; long distance and other difficulties in access; poverty, and material requirements for delivery; lack of support from husband/partner; health systems deficiencies such as inadequate staffing/training, work environment, and referral systems; and socio-cultural and gender issues such as preferred birthing position and preference for traditional birth attendants. CONCLUSIONS: Initiatives to improve quality of client-provider interaction and respect for women are essential. Financial barriers must be abolished and emergency transport for referrals improved. Simultaneously, supply-side barriers must be addressed, notably ensuring a sufficient number of health workers providing skilled obstetric care in health facilities and creating habitable conditions and enabling environments for them

Reduction of blood culture contamination rate by an educational intervention

Background: Although mechanical dyssynchrony parameters derived by speckle tracking echocardiography (STE) may predict response to cardiac resynchronization therapy (CRT), comparability of parameters derived with different STE vendors is unknown. Methods: In the MARC study, echocardiographic images of heart failure patients obtained before CRT implantation were prospectively analysed with vendor specific STE software (GE EchoPac and Philips QLAB) and vendor-independent software (TomTec 2DCPA). Response was defined as change in left ventricular (LV) end-systolic volume between examination before and six-months after CRT implantation. Basic longitudinal strain and mechanical dyssynchrony parameters (septal to lateral wall delay (SL-delay), septal systolic rebound stretch (SRSsept), and systolic stretch index (SSI)) were obtained from either separate septal and lateral walls, or total LV apical four chamber. Septal strain patterns were categorized in three types. The coefficient of variation and intra-class correlation coefficient (ICC) were analysed. Dyssynchrony parameters were associated with CRT response using univariate regression analysis and C-statistics. Results: Two-hundred eleven patients were analysed. GE-cohort (n = 123): age 68 years (interquartile range (IQR): 61-73), 67% male, QRS-duration 177ms (IQR: 160-192), LV ejection fraction: 26 +/- 7%. Philips-cohort (n = 88): age 67 years (IQR: 59-74), 60% male, QRS-duration: 179 ms (IQR: 166-193), LV ejection fraction: 27 +/- 8. LV derived peak strain was comparable in the GE-(GE: -7.3 +/- 3.1%, TomTec: -6.4 +/- 2.8%, ICC: 0.723) and Philips-cohort (Philips: -7.7 +/- 2.7%, TomTec: -7.7 +/- 3.3%, ICC: 0.749). SL-delay showed low ICC values (GE vs. TomTec: 0.078 and Philips vs. TomTec: 0.025). ICC's of SRSsept and SSI were higher but only weak (GE vs. TomTec: SRSsept: 0.470, SSI: 0.467) (Philips vs. QLAB: SRSsept: 0.419, SSI: 0.421). Comparability of septal strain patterns was low (Cohen's kappa, GE vs. TomTec: 0.221 and Philips vs. TomTec: 0.279). Septal strain patterns, SRSsept and SSI were associated with changes in LV end-systolic volume for all vendors. SRSsept and SSI had relative varying C-statistic values (range: 0.530-0.705) and different cut-off values between vendors. Conclusions: Although global longitudinal strain analysis showed fair comparability, assessment of dyssynchrony parameters was vendor specific and not applicable outside the context of the implemented platform. While the standardization taskforce took an important step for global peak strain, further standardization of STE is still warranted

Two decades of antenatal and delivery care in Uganda: a cross-sectional study using Demographic and Health Surveys.

BACKGROUND: Uganda halved its maternal mortality to 343/100,000 live births between 1990 and 2015, but did not meet the Millennium Development Goal 5. Skilled, timely and good quality antenatal (ANC) and delivery care can prevent the majority of maternal/newborn deaths and stillbirths. We examine coverage, equity, sector of provision and content of ANC and delivery care between 1991 and 2011. METHODS: We conducted a repeated cross-sectional study using four Uganda Demographic and Health Surveys (1995, 2000, 2006 and 2011).Using the most recent live birth and adjusting for survey sampling, we estimated percentage and absolute number of births with ANC (any and 4+ visits), facility delivery, caesarean sections and complete maternal care. We assessed socio-economic differentials in these indicators by wealth, education, urban/rural residence, and geographic zone on the 1995 and 2011 surveys. We estimated the proportions of ANC and delivery care provided by the public and private (for-profit and not-for-profit) sectors, and compared content of ANC and delivery care between sectors. Statistical significance of differences were evaluated using chi-square tests. RESULTS: Coverage with any ANC remained high over the study period (> 90% since 2001) but was of insufficient frequency; < 50% of women who received any ANC reported 4+ visits. Facility-based delivery care increased slowly, reaching 58% in 2011. While significant inequalities in coverage by wealth, education, residence and geographic zone remained, coverage improved for all indicators among the lowest socio-economic groups of women over time. The private sector market share declined over time to 14% of ANC and 25% of delivery care in 2011. Only 10% of women with 4+ ANC visits and 13% of women delivering in facilities received all measured care components. CONCLUSIONS: The Ugandan health system had to cope with more than 30,000 additional births annually between 1991 and 2011. The majority of women in Uganda accessed ANC, but this contact did not result in care of sufficient frequency, content, and continuum of care (facility delivery). Providers in both sectors require quality improvements. Achieving universal health coverage and maternal/newborn SDGs in Uganda requires prioritising poor, less educated and rural women despite competing priorities for financial and human resources

Assessing Communities of Practice in health policy : A conceptual framework as a first step towards empirical research

Peer reviewe

Vaccines of the future

Meteorological observations at Bayelva Station in 2016 (level 1

Bringing the State back in. Corporate Social Responsibility and the paradoxes of Norwegian state capitalism in the international energy sector

This theme section brings the state back into anthropological studies of corporate social responsibility through the lens of Norwegian energy corporations working abroad. Th ese transnational corporations (TNCs) are expected by the government to act responsibly when &ldquo;going global.&rdquo; Yet, we have observed that abroad, Norwegian corporations backed by state capital largely operate like any other TNCs. We argue that the driver for the adaptation to global capitalism is not coming from the embracing of neoliberal policies in Norway, but is rather inherent to the ways internationalization of the Norwegian economy is unfolding. To the extent that the Norwegian state has an impact on the corporations&rsquo; international endeavors, it relates primarily to the imperative of managing Norway&rsquo;s reputation as a humanitarian superpower

Ship to shore: Mercy Ships, healing and faith along the southern West African coast

In Benin in mid 2004, radio stations began announcing the forthcoming arrival of a Christian hospital ship. It was going to dock in the country’s main port in Cotonou and provide free surgeries for hundreds of people over a period of four months. Presenting the first ethnographic account of Mercy Ships, this dissertation provides a lens for reflecting on the ever-growing number of faith-based organisations in West Africa. This dissertation addresses the following questions: does sought-out contact with the services and environment of this hospital ship change people – both patients and crewmembers – and the way they live, think about and understand their lives? In those circumstances when changes occur, how do they come about? By addressing these questions, this dissertation contributes to a body of work in the anthropology of faith, healing, medical humanitarianism and international development. It not only explores the personal value and meaning for people volunteering with and treated by this faith-based organisation, but it also explores how the hospital ship is enacted and experienced, and how, perhaps surprisingly, it is both the lives of the crewmembers as well as the patients that are changed, as they project their faith and visions of lives well lived onto their ship experience. The promise of the ship as a catalyst for change in the imaginations of crew and patients; the blend of medical and social care on board; the perseverance through physical and emotional challenges; and the separation of the ship from land all blend to create powerful encounters that shape their experiences. These encounters demonstrate how the act of faith can become a form of healing, and likewise, how healing can create and strengthen faith. Throughout their journeys, patients and volunteers grapple with their faith which is intimately intertwined with their physical, social and spiritual well-being

Introduction. Bringing the State Back In: Corporate Social Responsibility and the Paradoxes of Norwegian State Capitalism in the International Energy and Extraction Industries

publishedVersio

An interdisciplinary cruise dedicated to understanding ocean eddies upstream of the Prince Edward Islands

A detailed hydrographic and biological survey was carried out in the region of the South-West Indian Ridge during April 2004. Altimetry and hydrographic data have identified this region as an area of high flow variability. Hydrographic data revealed that here the Subantarctic Polar Front (SAF) and Antarctic Polar Front (APF) converge to form a highly intense frontal system. Water masses identified during the survey showed a distinct separation in properties between the northwestern and southeastern corners. In the north-west, water masses were distinctly Subantarctic (>8.5°C, salinity >34.2), suggesting that the SAF lay extremely far to the south. In the southeast corner water masses were typical of the Antarctic zone, showing a distinct subsurface temperature minimum of <2.5°C. Total integrated chl-a concentration during the survey ranged from 4.15 to 22.81 mg chl-a m[superscript (-2)], with the highest concentrations recorded at stations occupied in the frontal region. These data suggest that the region of the South-West Indian Ridge represents not only an area of elevated biological activity but also acts as a strong biogeographic barrier to the spatial distribution of zooplankton

Introduction Anthropological Knowledge and Practice in Global Health

Since the turn of the millennium, conceptual and practice-oriented shifts in global health have increasingly given emphasis to health indicator production over research and interventions that emerge out of local social practices, environments and concerns. In this special issue of Anthropology in Action, we ask whether such globalised contexts allow for, recognise and sufficiently value the research contributions of our discipline. We question how global health research, ostensibly inter-or multi-disciplinary, generates knowledge. We query ‘not-knowing’ practices that inform and shape global health evidence as influenced by funders’ and collaborators’ expectations. The articles published here provide analyses of historical and ethnographic field experiences that show how sidelining anthropological contributions results in poorer research outcomes for the public. Citing experiences in Latin America, Angola, Senegal, Nigeria and the domain of global health evaluation, the authors consider anthropology’s roles in global health