Stakeholders' Participation in Planning and Priority Setting in the Context of a Decentralised Health Care system: the case of prevention of mother to child Transmission of HIV Programme in Tanzania.

In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania. This qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied in-depth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers. Two plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector. The challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery

Increased waterborne blaNDM-1 resistance gene abundances associated with seasonal human pilgrimages to the Upper Ganges River

Antibiotic resistance (AR) is often rooted in inappropriate antibiotic use, but poor water quality and inadequate sanitation exacerbate the problem, especially in emerging countries. An example is increasing multi-AR due to mobile carbapenemases, such as NDM-1 protein (coded by blaNDM-1 genes), which can produce extreme drug-resistant phenotypes. In 2010, NDM-1 positive isolates and blaNDM-1 genes were detected in surface waters across Delhi and have since been detected across the urban world. However, little is known about blaNDM-1 levels in more pristine locations, such as the headwaters of the Upper Ganges River. This area is of particular interest because it receives massive numbers of visitors during seasonal pilgrimages in May/June, including visitors from urban India. Here we quantified blaNDM-1 abundances, other AR genes (ARG) and coliform bacteria in sediments and water column samples from seven sites in the Rishikesh-Haridwar region of the Upper Ganges and five sites on the Yamuna River in Delhi to contrast blaNDM-1 levels and water quality conditions between season and region. Water quality in the Yamuna was very poor (e.g., anoxia at all sites), and blaNDM-1 abundances were high across sites in water (5.4 ± 0.4 log(blaNDM-1·mL-1); 95% confidence interval) and sediment (6.3 ± 0.7 log(blaNDM-1·mg-1)) samples from both seasons. In contrast, water column blaNDM-1 abundances were very low across all sites (2.1 ± 0.6 log(blaNDM-1·mL-1)) in February in the Upper Ganges and water quality was good (e.g., near saturation oxygen). However, per capita blaNDM-1 levels were 20 times greater in June in the Ganges water column relative to February and blaNDM-1 levels significantly correlated with fecal coliform levels (r=0.61; p=0.007). Given waste management infrastructure is limited in Rishikesh-Haridwar; data imply blaNDM-1 levels are higher in visitor's wastes than local residents, which results in seasonally higher blaNDM-1 levels in the river. Pilgrimage areas without adequate waste treatment are possible "hot spots" for AR transmission, and waste treatment must be improved to reduce broader AR dissemination via exposed returning visitors

"It is her responsibility": partner involvement in prevention of mother to child transmission of HIV programmes, northern Tanzania

<p>Abstract</p> <p>Background</p> <p>Partner involvement has been deemed fundamental in prevention of mother to child transmission (PMTCT) programmes, but is difficult to achieve. This study aimed to explore acceptability of the PMTCT programme components and to identify structural and cultural challenges to male involvement.</p> <p>Methods</p> <p>The study was conducted during 2007-2008 in rural and urban areas of Moshi in the Kilimanjaro region of Tanzania. Mixed methods were used, and included focus group discussions with fathers and mothers, in-depth interviews with fathers, mothers and health personnel, and a survey of 426 mothers bringing their four-week-old infants for immunization at five reproductive and child health clinics.</p> <p>Results</p> <p>Routine testing for HIV of women at the antenatal clinic was highly acceptable and appreciated by men, while other programme components, notably partner testing, condom use and the infant feeding recommendations, were met with continued resistance. Very few men joined their wives for testing and thus missed out on PMTCT counselling. The main barriers reported were that women did not have the authority to request their husbands to test for HIV and that the arena for testing, the antenatal clinic, was defined as a typical female domain where men were out of place.</p> <p>Conclusions</p> <p>Deep-seated ideas about gender roles and hierarchy are major obstacles to male participation in the PMTCT programme. Empowering women remains a huge challenge. Empowering men to participate by creating a space within the PMTCT programme that is male friendly should be feasible and should be highly prioritized for the PMTCT programme to achieve its potential.</p

Among-individual variation in white seabream (Diplodus sargus) spatial behaviour and protection in a coastal no-take area

Marine protected areas (MPAs), and specially no-take areas (NTAs), play an important role in protecting target populations from fisheries. When developing spatial conservation and management tools, the design has mainly focused on population-level measures of fish home ranges, spawning and feeding areas, and migration routes. Intraspecific differences in fish behaviour, however, are often not accounted for, even though they could influence the level of realized protection. In this study, we investigated the intraspecific variation in spatial behaviour of a harvested fish, Diplodus sargus, and how it impacts the degree of protection granted by a NTA in the south of Portugal. We identified four behavioural types according to their spatial behaviour: residents, commuters, seasonal visitors, and single users. Time at risk (i.e. outside the NTA) greatly varied among the four groups, but also over the year for the seasonal and the single users. Our study shows how acoustic telemetry can assist spatial conservation and fisheries management and provides novel insight regarding the role of individual variation in behaviour to understand protection granted by MPAs to harvested species. It also suggests that incorporating such information into all stages of MPA design and implementation can result in increased resilience of the protected populations.info:eu-repo/semantics/publishedVersio

‘As soon as they can hold a glass, they begin taking alcohol’: a qualitative study on early childhood substance use in Mbale District, Uganda

Background Globally, substance use is a leading contributor to the burden of disease among young people, with far reaching social, economic and health effects. Following a finding of harmful alcohol use among 5-8-year-old children in Mbale District, Uganda, this study aims to investigate community members’ views on early childhood substance use among children below the age of 10 years. Methods In 2016, we conducted eight focus group discussions with 48 parents and 26 key informant interviews with teachers, health workers, alcohol distributors, traditional healers, religious leaders, community leaders and youth workers. We used thematic content analysis. Four participants and two research assistants reviewed and confirmed the findings. Results Alcohol in everyday life: ‘Even children on laps taste alcohol’: Almost all participants confirmed the existence of and concern for substance use before age 10. They described a context where substance use was widespread in the community, especially intake of local alcoholic brews. Children would access substances in the home or buy it themselves. Those living in poor neighbourhoods or slums and children of brewers were described as particularly exposed. Using substances to cope: ‘We don’t want them to drink’: Participants explained that some used substances to cope with a lack of food and resources for childcare, as well as traumatic experiences. This made children in deprived families and street-connected children especially vulnerable to substance use. Participants believed this was a result of seeing no alternative solution. Conclusions To our knowledge, this is the first study to describe the context and conditions of childhood substance use before age 10 in Mbale District, Uganda. The study shows that community members attributed early childhood substance use to a social context of widespread use in the community, which was exacerbated by conditions of material and emotional deprivation. These social determinants for this practice deserve public health attention and intervention.publishedVersio

The evolving story of catadromy in the European eel (Anguilla anguilla)

Anguillid eels were once considered to be the classic example of catadromy. However, alternative life cycles have been reported, including skipping the freshwater phase and habitat shifting between fresh, brackish, and saltwater throughout the growth phase. There is a lack of knowledge regarding these alternate life strategies, for example, the proportion of individuals in the population that adopt them compared to classic catadromy. We provide a description of these alternate life cycle strategies in temperate anguillids, their possible drivers, and the methods available to investigate them. These methods (lethal and non-lethal), include otolith microchemistry, fatty acid and stable isotope analyses, parasite identification, blood transcriptomics, and electronic tags. We argue that since the current management framework for the European eel and other temperate eels is based mainly on the freshwater component of the population, it ignores eels growing in saline waters. Many of the factors that are thought to be responsible for the precipitous decline of the eel population are more prevalent in freshwater systems. Therefore, the contribution of saline eels may be more important than currently estimated. The habitat-shifting ability of eels may be all the more crucial for the persistence and recovery of those species that are endangered

Hjemme, borte eller uavgjort? Kvalitet og effektivitet i pleie- og omsorgstjenestene

Hvordan organiserer norske kommuner sine pleie- og omsorgstjenester – og hvorfor? Er noen måter å organisere tjenestene på mer ressurseffektive enn andre? Hvilke kommuner produserer best kvalitet på tjenestene? Er god kvalitet kjennetegnet ved sykehjemsplass til alle som trenger det – eller til å hjelpe alle til å bli boende hjemme så lenge som mulig? Dette er noen av spørsmålene som drøftes i denne rapporten. Problemstillingene belyses ved hjelp av casestudier og registerdata. Ved hjelp av ulike analyseteknikker søker vi etter kommunetypologier – og deretter etter sammenhenger mellom typologier, effektivitet og kvalitet

Total Catch of a Red-Listed Marine Species Is an Order of Magnitude Higher than Official Data

Accurate information on total catch and effort is essential for successful fisheries management. Officially reported landings, however, may be underestimates of total catch in many fisheries. We investigated the fishery for the nationally red-listed European lobster (Homarus gammarus) in south-eastern Norway. Probability-based strip transect surveys were used to count buoys in the study area in combination with catch per unit effort data obtained independently from volunteer catch diaries, phone interviews, and questionnaires. We estimate that recreational catch accounts for 65% of total catch in the study area. Moreover, our results indicate that only a small proportion (24%) of lobsters landed commercially were sold through the legal market and documented. Total estimated lobster catch was nearly 14 times higher than reported officially. Our study highlights the need for adequate catch monitoring and data collection efforts in coastal areas, presents a clear warning to resource managers that illegal, unreported and unregulated (IUU) fisheries in coastal areas should not be ignored, and shows the potential impact of recreational fisheries

Kvinners erfaringer med abortnemnder

Denne rapporten presenterer resultatene fra en amfunnsvitenskapelig studie om kvinners erfaringer med abortnemnder. Rapporten bygger på 13 dybdeintervju med kvinner som hadde erfaring med å søke om og gjennomleve andretrimesterabort innenfor et abortnemndsystem. Kvinnene hadde fått sine abortbegjæringer behandlet i nemnd ved åtte ulike sykehus i hele landet. Studien undersøkte kvinnenes helhetlige prosess med å søke andretrimesterabort innen rammene av et abortnemndsystem, opplevelser knyttet til selve møtet med nemnden og kvinnenes erfaringer knyttet til nemndenes myndighet til å fatte beslutning om deres liv samtidig som de skal ivareta kvinnenes rett til informasjon og veiledning. Kvinnene fortalte sine historier fra de oppdaget svangerskapet til tiden etter at abortfødsel var overstått. Analysen som presenteres i denne rapporten fokuserer på temaene 1) Forventninger og forberedelser til nemndsmøtet, 2) Å møte abortnemnden og 3) Tidsrammer og oppfølging. Studien viser at tiden før selve nemndsmøtet preges av varierende forkunnskaper og ulik og mangelfull informasjon til kvinnene om plikter og rettigheter ved nemndsbehandling. Muligheten for å få avslag preget kvinnene i forkant av nemndsmøtet, og gjorde kvinnenes beslutningsprosess vanskeligere. Videre viser studien at abortnemndene organiseres svært ulikt fra sykehus til sykehus. Noen kvinner opplevde at nemnden ga råd og støtte utover det å avklare om aborten oppfylte lovens kriterier. Mens noen opplevde nemndsmøtet som både belastende og meningsløst, opplevde andre det som en støtte. Metaforer som «eksamen» eller «avhør» ble brukt til å beskrive noen av kvinnenes møte med nemnden. Kvinner som hadde søkt om å få avslutte et ønsket svangerskap var frustrert over at partner ikke hadde plass som part i nemndsystemet. Tidsaspektet formet kvinnenes opplevelser med nemndsbehandling. For noen var det å vente på nemnden en belastning. For andre gjorde lovens grenser for svangerskapets avslutning at vanskelige avgjørelser måtte tas på kort tid. Kvinnene hadde et stort behov for støtte og oppfølging etter abortfødsel, og i dag er det ikke noe system som sikrer dette. Abortnemndene utgjør bare én del av et større system som aktiveres når en kvinne søker en andretrimesterabort. Kvinnenes erfaringer med abortnemndsystemet preges av skjevheten i makt mellom dem selv og nemnden. Denne skjevheten begrenser rommet for tvil og muligheten for en god og opplysende dialog. Noen kvinner opplever at møtet med nemnd gir dem større kontroll over egen situasjon. Slik det fungerer i dag favoriserer nemndsystemet ressurssterke kvinner og kan bidra til å ytterligere marginalisere sårbare kvinner. Uklarhet og ulik praksis knyttet til abortnemndens oppgave utover det å fatte et vedtak om andretrimesterabort, skaper risiko for at viktig informasjon ikke formidles. Dette svekker kvinners rett til å ikke delta i nemndsmøte samt hennes mulighet til å handle på bakgrunn av riktig informasjon. Dagens system tar i liten grad høyde for at de fleste andrestrimesteraborter er avbrudd av ønskede svangerskap. For kvinner som opplever dette virker abortnemdsystemet fremmedgjørende og lite forståelsesfullt. Dette kan gjøre den vanskelige tiden etter en gjennomført abort ekstra krevende. Dagens helsesystem sikrer ikke god oppfølging til kvinnene som gjennomgår en andretrimesterabort. Tiden etter en gjennomført abortfødsel er den mest sårbare for kvinnene som har vært gjennom abortnemndsystemet. Det er grunn til å stille spørsmål til ressursbruken knyttet til nemndsmøtene i kontrast til få ressurser til oppfølgingstjenester