Home birth without skilled attendants despite millennium villages project intervention in Ghana: insight from a survey of women’s perceptions of skilled obstetric care

BACKGROUND: Skilled birth attendance from a trained health professional during labour and delivery can prevent up to 75 % of maternal deaths. However, in low- and middle-income rural communities, lack of basic medical infrastructure and limited number of skilled birth attendants are significant barriers to timely obstetric care. Through analysis of self-reported data, this study aimed to assess the effect of an intervention addressing barriers in access to skilled obstetric care and identified factors associated with the use of unskilled birth attendants during delivery in a rural district of Ghana. METHODS: A cross-sectional survey was conducted from June to August 2012 in the Amansie West District of Ghana among women of reproductive age. Multi-stage, random, and population proportional techniques were used to sample 50 communities and 400 women for data collection. Weighted multivariate logistic regression analysis was used to identify factors associated with place of delivery. RESULTS: A total of 391 mothers had attended an antenatal care clinic at least once for their most recent birth; 42.3 % of them had unskilled deliveries. Reasons reported for the use of unskilled birth attendants during delivery were: insults from health workers (23.5 %), unavailability of transport (21.9 %), and confidence in traditional birth attendants (17.9 %); only 7.4 % reported to have had sudden labour. Other factors associated with the use of unskilled birth attendants during delivery included: lack of partner involvement aOR = 0.03 (95 % CI; 0.01, 0.06), lack of birth preparedness aOR = 0.05 (95 % CI; 0.02, 0.13) and lack of knowledge of the benefits of skilled delivery aOR = 0.37 (95 % CI; 0.11, 1.20). CONCLUSIONS: This study demonstrated the importance of provider-client relationship and cultural sensitivity in the efforts to improve skilled obstetric care uptake among rural women in Ghana

Prenatal and early-life exposure to the Great Chinese Famine increased the risk of tuberculosis in adulthood across two generations

Significance Food system collapse incurs major societal costs that may extend across generations. The Great Chinese Famine—widely acknowledged as the largest famine in human history—was associated with tremendous short-term adverse health consequences, yet its long-term effect on infectious disease incidence has not been estimated. We conducted a cohort analysis of &gt;1 million pulmonary tuberculosis (PTB) cases in a major center of ongoing transmission that experienced high famine mortality, finding a substantial burden of active PTB potentially attributable to the famine in the birth cohort that experienced prenatal and early-life exposure to famine, as well in their putative offspring. The Great Chinese Famine occurred &gt;60 y ago, yet continues to contribute to the high PTB burden in China.</jats:p

Prenatal and early-life exposure to the Great Chinese Famine increased the risk of tuberculosis in adulthood across two generations.

Global food security is a major driver of population health, and food system collapse may have complex and long-lasting effects on health outcomes. We examined the effect of prenatal exposure to the Great Chinese Famine (1958-1962)-the largest famine in human history-on pulmonary tuberculosis (PTB) across consecutive generations in a major center of ongoing transmission in China. We analyzed &gt;1 million PTB cases diagnosed between 2005 and 2018 in Sichuan Province using age-period-cohort analysis and mixed-effects metaregression to estimate the effect of the famine on PTB risk in the directly affected birth cohort (F1) and their likely offspring (F2). The analysis was repeated on certain sexually transmitted and blood-borne infections (STBBI) to explore potential mechanisms of the intergenerational effects. A substantial burden of active PTB in the exposed F1 cohort and their offspring was attributable to the Great Chinese Famine, with more than 12,000 famine-attributable active PTB cases (&gt;1.23% of all cases reported between 2005 and 2018). An interquartile range increase in famine intensity resulted in a 6.53% (95% confidence interval [CI]: 1.19-12.14%) increase in the ratio of observed to expected incidence rate (incidence rate ratio, IRR) in the absence of famine in F1, and an 8.32% (95% CI: 0.59-16.6%) increase in F2 IRR. Increased risk of STBBI was also observed in F2. Prenatal and early-life exposure to malnutrition may increase the risk of active PTB in the exposed generation and their offspring, with the intergenerational effect potentially due to both within-household transmission and increases in host susceptibility

Mean-Gini analysis of stochastic externalities: The case of groundwater contamination

The mean-Gini approach is used to analyze stochastic externalities generated by agricultural production. The model addresses the problem of groundwater pollution caused by excessive fertilizer application. Inherent in the mean-Gini approach to expected utility maximization is a two-fold value: the simplicity of the two-parameter mean-variance model and satisfaction of necessary and sufficient conditions for stochastic dominance. Price and quantity policy recommendations to control externalities are formulated based upon the relative assessment of uncertainty by the regulatory authority and the farmers. Using the Gini as a measure of risk allows for the quantification of control policy measures under differentiated risk aversion and multiple sources of pollution. The model shows that when producers underestimate uncertainty, quota policies restricting fertilizer are more efficient than tax policies in reducing groundwater contamination. Copyright Kluwer Academic Publishers 1995Stochastic externalities, water pollution policies, stochastic dominance,