Neonatal mortality within 24 hours of birth in six low- and lower-middle-income countries

OBJECTIVE: To assess the rates, timing and causes of neonatal deaths and the burden of stillbirths in rural Uttar Pradesh, India. We discuss the implications of our findings for neonatal interventions. METHODS: We used verbal autopsy interviews to investigate 1048 neonatal deaths and stillbirths. FINDINGS: There were 430 stillbirths reported, comprising 41% of all deaths in the sample. Of the 618 live births, 32% deaths were on the day of birth, 50% occurred during the first 3 days of life and 71% were during the first week. The primary causes of death on the first day of life (i.e. day 0) were birth asphyxia or injury (31%) and preterm birth (26%). During days 1–6, the most frequent causes of death were preterm birth (30%) and sepsis or pneumonia (25%). Half of all deaths caused by sepsis or pneumonia occurred during the first week of life. The proportion of deaths attributed to sepsis or pneumonia increased to 45% and 36% during days 7–13 and 14–27, respectively. CONCLUSION: Stillbirths and deaths on the day of birth represent a large proportion of perinatal and neonatal deaths, highlighting an urgent need to improve coverage with skilled birth attendants and to ensure access to emergency obstetric care. Health interventions to improve essential neonatal care and care-seeking behavior are also needed, particularly for preterm neonates in the early postnatal period

Cryptovirology Ransomware: A Review of Dissemination and Mitigation Techniques

Digital assets are generally regarded as one of the most valuable assets for an organization. When they are captured for ransom purposes, a serious problem arises, and ransomware is responsible for this. When ransomware gets onto a computer or other electronic device, the data on it is encrypted, made inaccessible, or taken away until a ransom is paid. The culprits behind these activities release and disseminate new and sophisticated variants of illicit wealth and notorious practices. Hardware and antivirus software that detect intrusions are not a permanent solution, as hackers can bypass them easily. After ransomware has been executed on an electronic device, it is extremely difficult or nearly impossible to recover the data, and now is the time to draw attention to this threat. In this study, various aspects of ransomware’s propagation, encryption, and mitigation techniques are discussed. We have also used the RanSim simulator to detect malware in a system, and details of the experiment are presented in the later sections. The methodology used for this study can be classified as exploratory research to explore the recent literature on the topic. This study contributes by highlighting recent trends in ransomware, their consequences, and prevention and mitigation techniques. Keywords: RanSim, Ransomware, Ransomware Threats and Mitigation, System Implications of Ransomware, Trusted Computing. Digital assets are generally regarded as one of the most valuable assets for an organization. When they are captured for ransom purposes, a serious problem arises, and ransomware is responsible for this. When ransomware gets onto a computer or other electronic device, the data on it is encrypted, made inaccessible, or taken away until a ransom is paid. The culprits behind these activities release and disseminate new and sophisticated variants of illicit wealth and notorious practices. Hardware and antivirus software that detect intrusions are not a permanent solution, as hackers can bypass them easily. After ransomware has been executed on an electronic device, it is extremely difficult or nearly impossible to recover the data, and now is the time to draw attention to this threat. In this study, various aspects of ransomware’s propagation, encryption, and mitigation techniques are discussed. We have also used the RanSim simulator to detect malware in a system, and details of the experiment are presented in the later sections. The methodology used for this study can be classified as exploratory research to explore the recent literature on the topic. This study contributes by highlighting recent trends in ransomware, their consequences, and prevention and mitigation techniques

A double blind community-based randomized trial of Amoxicillin Versus Placebo for fast breathing Pneumonia in children aged 2-59 months in Karachi, Pakistan (RETAPP)

Background: Fast breathing pneumonia is characterized by tachypnoea in the absence of danger signs and is mostly viral in etiology. Current guidelines recommend antibiotic therapy for all children with fast breathing pneumonia in resource limited settings, presuming that most pneumonia is bacterial. High quality clinical trial evidence to challenge or support the continued use of antibiotics, as recommended by the World Health Organization is lacking. Methods/Design: This is a randomized double blinded placebo-controlled non-inferiority trial using parallel assignment with 1:1 allocation ratio, to be conducted in low income squatter settlements of urban Karachi, Pakistan. Children 2-59 months old with fast breathing, without any WHO-defined danger signs and seeking care at the primary health care center are randomized to receive either three days of placebo or amoxicillin. From prior studies, a sample size of 2430 children is required over a period of 28 months. Primary outcome is the difference in cumulative treatment failure between the two groups, defined as a new clinical sign based on preset definitions indicating illness progression or mortality and confirmed by two independent primary health care physicians on day 0, 1, 2 or 3 of therapy. Secondary outcomes include relapse measured between days 5-14. Modified per protocol analysis comparing hazards of treatment failure with 95 % confidence intervals in the placebo arm with hazards in the amoxicillin arm will be done. Discussion:This study will provide evidence to support or refute the use of antibiotics for fast breathing pneumonia paving a way for guideline change

Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: A mixed-methods study

Background: Great disparities in immunization coverage exist in Pakistan between urban and rural areas. However, coverage estimates for large peri-urban slums in Sindh are largely unknown and implementation challenges remain unexplored. This study explores key supply- and demand-side immunization barriers in peri-urban slums, as well as strategies to address them. It also assesses immunization coverage in the target slums.Methods: Conducted in four peri-urban slums in Karachi, this mixed-methods study consists of a baseline cross-sectional coverage survey of a representative sample of 840 caregivers of children aged 12-23 months, and 155 in-depth interviews (IDIs) through purposive sampling of respondents (caregivers, community influencers and immunization staff). After identifying the barriers, a further six IDIs were then conducted with immunization policy-makers and policy influencers to determine strategies to address these barriers, resulting in the development of an original validated implementation framework for immunization in peri-urban slums. A thematic analysis approach was applied to qualitative data.Results: The survey revealed 49% of children were fully vaccinated, 43% were partially vaccinated and 8% were unvaccinated. Demand-side immunization barriers included household barriers, lack of knowledge and awareness, misconceptions and fears regarding vaccines and social and religious barriers. Supply-side barriers included underperformance of staff, inefficient utilization of funds, unreliable immunization and household data and interference of polio campaigns with immunization. The implementation framework\u27s policy recommendations to address these barriers include: (1) improved human resource management; (2) staff training on counselling; (3) re-allocation of funds towards incentives, outreach, salaries and infrastructure; (4) a digital platform integrating birth registry and vaccination tracking systems for monitoring and reporting by frontline staff; (5) use of digital platform for immunization targets and generating dose reminders; and (6) mutual sharing of resources and data between the immunization, Lady Health Worker and polio programmes for improved coverage.Conclusions: The implementation framework is underpinned by the study of uncharted immunization barriers in complex peri-urban slums, and can be used by implementers in Pakistan and other developing countries to improve immunization programmes in limited-resource settings, with possible application at a larger scale. In particular, a digital platform integrating vaccination tracking and birth registry data can be expanded for nationwide use

How Internship Experience Mediates Career Decision? Insight from Business Institutions

This research paper aims to examine business graduates’ pre-employment decisions relevant to pursue a satisfied and successful career after going through internship training. Subjects were the students who have undergone through an internship program and data was analyzed by using SPSS software. A five point Likert Scale has been used to examine the relation of dependent variable person career (PC) fit and independent variables (job attributes, PO-fit and PJ-fit).The internees degree of perceived pay, benefits, promotion as related to future growth opportunities , job location, peers’ relationship, firm’s image and job duties as major factors and key criterion to pursue a satisfied and successful career .The results also indicate that person job (PJ) fit contributes more than person organization (PO) fit towards person career (PC) fit.Offering internship programs and trainings allows employers the opportunity of exploring full time fresh graduates pool and best talent to recruit

Facies Analysis and Sedimentary Architecture of Hybrid Event Beds in Submarine Lobes: Insights from the Crocker Fan, NW Borneo, Malaysia

Hybrid event beds represent the combined effect of multiple geological processes, which result in complex depositional geometries and distinct facies distribution in marine environments. Previous work on hybrid event beds highlights the classification, origin, and types of hybrid facies. However, in the present study, we discuss the development of hybrid event beds in submarine lobes with an emphasis on the analysis of proximal to distal, frontal to lateral relationships and evolution during lobe progradation. Detailed geological fieldwork was carried out in the classical deep-marine Late Paleogene Crocker Fan to understand the relationship between the character of hybrid bed facies and lobe architecture. The results indicate that hybrid facies of massive or structureless sandstone with mud clasts, clean to muddy sand, and chaotic muddy sand with oversized sand patch alternations (H1–H3) are well developed in proximal to medial lobes, while distal lobes mainly contain parallel to cross-laminated clean to muddy hybrid facies (H3–H5). Furthermore, lateral lobes have less vertical thickness of hybrid beds than frontal lobes. The development of hybrid beds takes place in the lower part of the thickening upward sequence of lobe progradation, while lobe retrogradation contains hybrid facies intervals in the upper part of stratigraphy. Hence, the development of hybrid beds in submarine lobe systems has a significant impact on the characterization of heterogeneities in deep-marine petroleum reservoirs at sub-seismic levels

Neonatal mortality within 24 hours of birth in six low- and lower-middle-income countries.

OBJECTIVE: To estimate neonatal mortality, particularly within 24 hours of birth, in six low- and lower-middle-income countries. METHODS: We analysed epidemiological data on a total of 149 570 live births collected between 2007 and 2013 in six prospective randomized trials and a cohort study from predominantly rural areas of Bangladesh, Ghana, India, Pakistan, the United Republic of Tanzania and Zambia. The neonatal mortality rate and mortality within 24 hours of birth were estimated for all countries and mortality within 6 hours was estimated for four countries with available data. The findings were compared with published model-based estimates of neonatal mortality. FINDINGS: Overall, the neonatal mortality rate observed at study sites in the six countries was 30.5 per 1000 live births (range: 13.6 in Zambia to 47.4 in Pakistan). Mortality within 24 hours was 14.1 per 1000 live births overall (range: 5.1 in Zambia to 20.1 in India) and 46.3% of all neonatal deaths occurred within 24 hours (range: 36.2% in Pakistan to 65.5% in the United Republic of Tanzania). Mortality in the first 6 hours was 8.3 per 1000 live births, i.e. 31.9% of neonatal mortality. CONCLUSION: Neonatal mortality within 24 hours of birth in predominantly rural areas of six low- and lower-middle-income countries was higher than model-based estimates for these countries. A little under half of all neonatal deaths occurred within 24 hours of birth and around one third occurred within 6 hours. Implementation of high-quality, effective obstetric and early newborn care should be a priority in these settings

Multiomics characterization of preterm birth in low- and middle-income countries

Importance: Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies.Objective: To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB.Design, setting, and participants: This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in low- and middle-income countries (LMICs; ie, Matlab, Bangladesh; Lusaka, Zambia; Sylhet, Bangladesh; Karachi, Pakistan; and Pemba, Tanzania). These cohorts were established to study maternal and fetal outcomes and were supported by the Alliance for Maternal and Newborn Health Improvement and the Global Alliance to Prevent Prematurity and Stillbirth biorepositories. Data were analyzed from December 2018 to July 2019.Exposures: Blood and urine specimens that were collected early during pregnancy (median sampling time of 13.6 weeks of gestation, according to ultrasonography) were processed, stored, and shipped to the laboratories under uniform protocols. Plasma samples were assayed for targeted measurement of proteins and untargeted cell-free ribonucleic acid profiling; urine samples were assayed for metabolites.Main outcomes and measures: The PTB phenotype was defined as the delivery of a live infant before completing 37 weeks of gestation.Results: Of the 81 pregnant women included in this study, 39 had PTBs (48.1%) and 42 had term pregnancies (51.9%) (mean [SD] age of 24.8 [5.3] years). Univariate analysis demonstrated functional biological differences across the 5 cohorts. A cohort-adjusted machine learning algorithm was applied to each biological data set, and then a higher-level machine learning modeling combined the results into a final integrative model. The integrated model was more accurate, with an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI, 0.72-0.91) compared with the models derived for each independent biological modality (transcriptomics AUROC, 0.73 [95% CI, 0.61-0.83]; metabolomics AUROC, 0.59 [95% CI, 0.47-0.72]; and proteomics AUROC, 0.75 [95% CI, 0.64-0.85]). Primary features associated with PTB included an inflammatory module as well as a metabolomic module measured in urine associated with the glutamine and glutamate metabolism and valine, leucine, and isoleucine biosynthesis pathways.Conclusions and relevance: This study found that, in LMICs and high PTB settings, major biological adaptations during term pregnancy follow a generalizable model and the predictive accuracy for PTB was augmented by combining various omics data sets, suggesting that PTB is a condition that manifests within multiple biological systems. These data sets, with machine learning partnerships, may be a key step in developing valuable predictive tests and intervention candidates for preventing PTB

Neonatal mortality within 24 hours of birth in six low- and lower-middle-income countries.

Objective: To estimate neonatal mortality, particularly within 24 hours of birth, in six low- and lower-middle-income countries. Methods: We analysed epidemiological data on a total of 149 570 live births collected between 2007 and 2013 in six prospective randomized trials and a cohort study from predominantly rural areas of Bangladesh, Ghana, India, Pakistan, the United Republic of Tanzania and Zambia. The neonatal mortality rate and mortality within 24 hours of birth were estimated for all countries and mortality within 6 hours was estimated for four countries with available data. The findings were compared with published model-based estimates of neonatal mortality. Findings: Overall, the neonatal mortality rate observed at study sites in the six countries was 30.5 per 1000 live births (range: 13.6 in Zambia to 47.4 in Pakistan). Mortality within 24 hours was 14.1 per 1000 live births overall (range: 5.1 in Zambia to 20.1 in India) and 46.3% of all neonatal deaths occurred within 24 hours (range: 36.2% in Pakistan to 65.5% in the United Republic of Tanzania). Mortality in the first 6 hours was 8.3 per 1000 live births, i.e. 31.9% of neonatal mortality. Conclusion: Neonatal mortality within 24 hours of birth in predominantly rural areas of six low- and lower-middle-income countries was higher than model-based estimates for these countries. A little under half of all neonatal deaths occurred within 24 hours of birth and around one third occurred within 6 hours. Implementation of high-quality, effective obstetric and early newborn care should be a priority in these settings