Has decentralisation affected child immunisation status in Indonesia?

Background: The past two decades have seen many countries, including a number in Southeast Asia, decentralising their health system with the expectation that this reform will improve their citizens’ health. However, the consequences of this reform remain largely unknown. Objective: This study analyses the effects of fiscal decentralisation on child immunisation status in Indonesia. Design: We used multilevel logistic regression analysis to estimate these effects, and multilevel multiple imputation to manage missing data. The 2011 publication of Indonesia's national socio-economic survey (Susenas) is the source of household data, while the Podes village census survey from the same year provides village-level data. We supplement these with local government fiscal data from the Ministry of Finance. Results: The findings show that decentralising the fiscal allocation of responsibilities to local governments has a lack of association with child immunisation status and the results are robust. The results also suggest that increasing the number of village health centres (posyandu) per 1,000 population improves probability of children to receive full immunisation significantly, while increasing that of hospitals and health centres (puskesmas) has no significant effect. Conclusion: These findings suggest that merely decentralising the health system does not guarantee improvement in a country's immunisation coverage. Any successful decentralisation demands good capacity and capability of local governments

Pattern of Valvular Involvement in Rheumatic Heart Disease (RHD) Patients attending Referral Cardiac Center in Nepal

Rheumatic heart disease (RHD) is very common in developing countries. It is one of the commonest cardiac problems in Nepal. It is more common in rural areas than in the cities. We performed a retrospective study of RHD patients attending and undergoing echocardiography in Shahid Gangalal National Heart Centre (SGNHC) from January 2002 to December 2002. There were a total of 1843 RHD patients among which 787 (42.8%) were males and 1056 (57.2%) were females.</jats:p

Coronary angiographic profile of Nepalese people A study of 450 cases in SGNHC

Coronary Artery disease (CAD) remains a major health problem. Stable angina, unstable angina and myocardial infarction are the major manifestations of CAD. This study is aimed to assess the coronary artery profile in these groups and its relation to the major conventional risk factors and the distribution of the disease in differant ethnic group of Napalase population.</jats:p

Mortality trends in Acute Coronary Syndrome In Sahid Gangalal National Heart Centre

At the beginning of 20th century cardiovascular disease accounted for less than 10% of mortality worldwide. It has increased to 50% in the developed and 25% in the developing world at the end of the century. There has been steady decline in mortality due to acute myocardial infarction resulting from development of Coronary Care Unit, aspirin, beta blockade and Thrombolysis.</jats:p

Feasibility of using fly ash, lime, and bentonite to neutralize acidity of pore fluids

Acidic groundwater resulting from the poorly planned use of acid sulfate soils has become a major environmental issue in coastal Australia over the last several years. Use of permeable reactive barriers (PRBs) designed to generate alkalinity by promoting sulfate reduction has recently become popular as an alternative solution to this problem. However, recent studies have also revealed that the long-term performance of such PRBs can be significantly undermined by chemical precipitation and clogging of pore space, which would decrease the buffer capacity and hydraulic conductivity of the reactive material. This study seeks to explore the feasibility of using bentonite in addition to lime and fly ash to form mixtures with a high buffer capacity and permeability that would enable groundwater flow through PRBs over a substantial period of time. A series of laboratory experiments, including buffer capacity and leaching tests, were performed on different mixtures of fly ash with lime and bentonite using acidic fluids of low pH. It was found that the ability of such mixtures to neutralize acidic fluids was mostly controlled by the content of lime. Laboratory data also showed that an addition of bentonite to lime-fly ash mixtures could decrease the buffer capacity of soil. Compaction tests indicated that the presence of bentonite would increase the dry density of mixtures at the optimum moisture content. A series of hydraulic conductivity tests were carried out to study changes in the coefficient of permeability of lime-fly ash mixtures with different contents of bentonite permeated with acidic liquids. The obtained results revealed that the coefficient of permeability of the specimens tended to increase over a period of time, likely due to the changes in the diffuse double layer of bentonite particles.Griffith Sciences, Griffith School of EngineeringFull Tex