Purpura in the newborn

Generalised purpura is rare and of the many possible causes, perhaps the most common is thrombocytopenia associated with idiopathic thrombocytopenic purpura (I.T.P.) in the mother. One such case is presented in this study: The child was born from a 28-year old primigravida who in 1954, at the age of twelve years, had undergone splenectomy for I.T.P. On examination the male newborn had generalised purpura and areas of ecchymosis. The treatment provided to the neonate is described. Neonatal thrombocytopenia presents as generalized petechaie, purpuric spots and bleeding from various sites, e.g. melaena, haematuria and umbilical cord haemorrhage. In most cases no treatment is required as the condition is mild and resolves spontaneously. With severe thrombocytopenia, one must treat actively because of the threat of intracranial bleeding.peer-reviewe

Using mixed methods to evaluate perceived quality of care in southern Tanzania.

OBJECTIVE: To compare perceived quality of maternal and newborn care using quantitative and qualitative methods. DESIGN: A continuous household survey (April 2011 to November 2013) and in-depth interviews and birth narratives. SETTING: Tandahimba district, Tanzania. PARTICIPANTS: Women aged 13-49 years who had a birth in the previous 2 years were interviewed in a household survey. Recently delivered mothers and their partners participated in in-depth interviews and birth narratives. INTERVENTION: None. MAIN OUTCOME MEASURES: Perceived quality of care. RESULTS: Quantitative: 1138 women were surveyed and 93% were confident in staff availability and 61% felt that required drugs and equipment would be available. Drinking water was easily accessed by only 60% of respondents using hospitals. Measures of interaction with staff were very positive, but only 51% reported being given time to ask questions. Unexpected out-of-pocket payments were higher in hospitals (49%) and health centres (53%) than in dispensaries (31%). Qualitative data echoed the lack of confidence in facility readiness, out-of-pocket payments and difficulty accessing water, but was divergent in responses about interactions with health staff. More than half described staff interactions that were disrespectful, not polite, or not helpful. CONCLUSION: Both methods produced broadly aligned results on perceived readiness, but divergent results on perceptions about client-staff interactions. Benefits and limitations to both quantitative and qualitative approaches were observed. Using mixed methodologies may prove particularly valuable in capturing the user experience of maternal and newborn health services, where they appear to be little used together

Birth preparedness and place of birth in Tandahimba district, Tanzania: what women prepare for birth, where they go to deliver, and why.

BACKGROUND: As making preparations for birth and health facility delivery are behaviours linked to positive maternal and newborn health outcomes, we aimed to describe what birth preparations were made, where women delivered, and why. METHODS: Outcomes were tabulated using data derived from a repeated sample (continuous) quantitative household survey of women aged 13-49 who had given birth in the past year. Insights into why behaviours took place emerged from analysis of in-depth interviews (12) and birth narratives (36) with recently delivered mothers and male partners. RESULTS: Five hundred-twenty three women participated in the survey from April 2012-November 2013. Ninety-five percent (496/523) of women made any birth preparations for their last pregnancy. Commonly prepared birth items were cotton gauze (93 %), a plastic cover to deliver on (84 %), gloves (72 %), clean clothes (70 %), and money (42 %). Qualitative data suggest that preparation of items used directly during delivery was perceived as necessary to facilitate good care and prevent disease transmission. Sixty-eight percent of women gave birth at a health facility, 30 % at home, and 2 % on the way to a health facility. Qualitative data suggested that health facility delivery was viewed positively and that women were inclined to go to a health facility because of a perception of: increased education about delivery and birth preparedness; previous health facility delivery; and better availability and accessibility of facilities in recent years. Perceived barriers: were a lack of money; absent health facility staff or poor provider attitudes; women perceiving that they were unable to go to a health facility or arrange transport on their own; or a lack of support of pregnant women from their partners. CONCLUSIONS: The majority of women made at least some birth preparations and gave birth in a health facility. Functional items needed for birth seem to be given precedence over practices like saving money. As such, maintaining education about the importance of these practices, with an emphasis on emergency preparedness, would be valuable. Alongside education delivered as part of focussed antenatal care, community-based interventions that aim to increase engagement of men in birth preparedness, and support agency among women, are recommended

Health policy and systems research training: global status and recommendations for action.

OBJECTIVE: To investigate the characteristics of health policy and systems research training globally and to identify recommendations for improvement and expansion. METHODS: We identified institutions offering health policy and systems research training worldwide. In 2014, we recruited participants from identified institutions for an online survey on the characteristics of the institutions and the courses given. Survey findings were explored during in-depth interviews with selected key informants. FINDINGS: The study identified several important gaps in health policy and systems research training. There were few courses in central and eastern Europe, the Middle East, North Africa or Latin America. Most (116/152) courses were instructed in English. Institutional support for courses was often lacking and many institutions lacked the critical mass of trained individuals needed to support doctoral and postdoctoral students. There was little consistency between institutions in definitions of the competencies required for health policy and systems research. Collaboration across disciplines to provide the range of methodological perspectives the subject requires was insufficient. Moreover, the lack of alternatives to on-site teaching may preclude certain student audiences such as policy-makers. CONCLUSION: Training in health policy and systems research is important to improve local capacity to conduct quality research in this field. We provide six recommendations to improve the content, accessibility and reach of training. First, create a repository of information on courses. Second, establish networks to support training. Third, define competencies in health policy and systems research. Fourth, encourage multidisciplinary collaboration. Fifth, expand the geographical and language coverage of courses. Finally, consider alternative teaching formats

The grande multipara

The grande multipara is a woman who has given birth seven or more times. This is a survey consisting of a study of all the para 7 or over delivered at St. Luke`s Hospital, Malta, during the two-year period 1963-1964. A series of 638 grande multipara is studied. The findings show a higher rate than average for certain obstetrical abnormalities, such as toxemia, abruptio placentae, still-birth and malpresentations. Notwithstanding, the maternal mortality is not affected.peer-reviewe

How people-centred health systems can reach the grassroots: experiences implementing community-level quality improvement in rural Tanzania and Uganda

Background Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Information Power (EQUIP) intervention with the aim of improving maternal and newborn health. Village volunteers were taught how to generate change ideas to improve health-seeking behaviours and home-based maternal and newborn care practices. Interaction was encouraged between communities and health staff. Aim To describe experiences implementing EQUIP’s QI approach at the community level. Methods A mixed methods process evaluation of community-level QI was conducted in Tanzania and a feasibility study in Uganda. We outlined how village volunteers were trained in and applied QI techniques and examined the interaction between village volunteers and health facilities, and in Tanzania, the interaction with the wider community also. Results Village volunteers had the capacity to learn and apply QI techniques to address local maternal and neonatal health problems. Data collection and presentation was a persistent challenge for village volunteers, overcome through intensive continuous mentoring and coaching. Village volunteers complemented health facility staff, particularly to reinforce behaviour change on health facility delivery and birth preparedness. There was some evidence of changing social norms around maternal and newborn health, which EQUIP helped to reinforce. Conclusions Community-level QI is a participatory research approach that engaged volunteers in Tanzania and Uganda, putting them in a central position within local health systems to increase health-seeking behaviours and improve preventative maternal and newborn health practices

Learner Interest, Reading Comprehension and Achievement in Web-Based Learning

The web-based learning environment provides access to education for those who are unable to be physically present in a classroom. In situations where comprehensive learner analysis is cost prohibitive, fiscally prudent guidelines for learner analysis that include learner interest and the cultural attribute of language may be feasible alternatives to omitting learner analysis altogether as an online instructional design consideration. Community colleges routinely collect student data during the college admission process, such as the COMPASS reading score, which may be useful in predicting student success in web-based courses. Therefore, learner characteristics such as the COMPASS reading score, learner interest in course topic, and interest in web-based learning were examined to determine their utility as predictors of achievement in an online introductory health care course. Learner interests were measured using the Course Interest Scale and Web Interest Scale developed in 2008 by Nummenmaa and Nummenmaa. Simple and multiple regression analyses were utilized to determine potential associations. The results demonstrated that the COMPASS reading score positively predicted achievement and was statistically significant, F(1, 17) = 8.05, p = .011 when considered solely, when combined with course interest, F(2, 16) = 4.42, p = .030, and when combined with web interest, F(2, 16) = 3.79, p = .045. These findings indicated that the COMPASS reading score and other data routinely collected on community college students may be useful as predictors of success in online courses and may be effective for guiding student learning format design selections. Using familiar measures such as the COMPASS test score to predict achievement in web-based courses may promote learning outcomes, course completion rates, and graduation rates in community colleges.https://fuse.franklin.edu/ss2014/1037/thumbnail.jp