Literature on human resources for health in Africa has focused on personal health services. Little is known about graduate public health education. This paper maps "advanced" public health education ...in Africa. Public health includes all professionals needed to manage and optimize health systems and the public's health.
Data were collected through questionnaires and personal visits to departments, institutes and schools of community medicine or public health. Simple descriptive statistics were used to analyse the data.
For more than 900 million people, there are fewer than 500 full-time staff, around two-thirds of whom are male. More men (89%) than women (72%) hold senior degrees. Over half (55%) of countries do not have any postgraduate public health programme. This shortage is most severe in lusophone and francophone Africa. The units offering public health programmes are small: 81% have less than 20 staff, and 62% less than 10. On the other hand, over 80% of Africans live in countries where at least one programme is available, and there are six larger schools with over 25 staff. Programmes are often narrowly focused on medical professionals, but "open" programmes are increasing in number. Public health education and research are not linked.
Africa urgently needs a plan for developing its public health education capacity. Lack of critical mass seems a key gap to be addressed by strengthening subregional centres, each of which should provide programmes to surrounding countries. Research linked to public health education and to educational institutions needs to increase.
Promoting safe caesarean birth (CB) is a challenge in sub-Saharan Africa (SSA) where maternal and neonatal mortality rates are high due to inadequate maternal health services. Although the CB rate ...in SSA is lower than the World Health Organization (WHO) recommendation, it is often associated with high maternal and neonatal mortality.
The aim of this scoping review was to report on the extent to which SSA health systems deliver safe CB.
A systematic search across various databases identified 53 relevant studies, comprising 30 quantitative, 10 qualitative and 16 mixed methods studies.
These studies focused on clinical protocols, training, availability, accreditation, staff credentialing, hospital supervision, support infrastructure, risk factors, surgical interventions and complications related to maternal mortality and stillbirth. CB rates in SSA varied significantly, ranging from less than 1% to a high rate of 29.7%. Both very low as well as high rates contributed to significant maternal and neonatal morbidity. Factors influencing maternal and perinatal mortality include poor referral systems, inadequate healthcare facilities, poor quality of CBs, inequalities in access to maternity care and affordable CB intervention.
The inadequate distribution of healthcare facilities, and limited access to emergency obstetric care impacted the quality of CBs. Early access to quality maternity services with skilled providers is recommended to improve CB safety.Contributions: This scoping review contributes to the body of knowledge motivating for the prioritization of maternal service across SSA.
OBJECTIVE: Literature on human resources for health in Africa has focused on personal health services. Little is known about graduate public health education. This paper maps "advanced" public health ...education in Africa. Public health includes all professionals needed to manage and optimize health systems and the public's health. METHODS: Data were collected through questionnaires and personal visits to departments, institutes and schools of community medicine or public health. Simple descriptive statistics were used to analyse the data. FINDINGS: For more than 900 million people, there are fewer than 500 full-time staff, around two-thirds of whom are male. More men (89%) than women (72%) hold senior degrees. Over half (55%) of countries do not have any postgraduate public health programme. This shortage is most severe in lusophone and francophone Africa. The units offering public health programmes are small: 81% have less than 20 staff, and 62% less than 10. On the other hand, over 80% of Africans live in countries where at least one programme is available, and there are six larger schools with over 25 staff. Programmes are often narrowly focused on medical professionals, but "open" programmes are increasing in number. Public health education and research are not linked. CONCLUSION: Africa urgently needs a plan for developing its public health education capacity. Lack of critical mass seems a key gap to be addressed by strengthening subregional centres, each of which should provide programmes to surrounding countries. Research linked to public health education and to educational institutions needs to increase.
In Xiamen offshore area, sediment polychlorinated biphenyls (PCBs) concentrations ranged from 2.33 to 30.94 ng/g, with an average value of 8.94 ng/g. The in situ organic carbon normalized partition ...coefficients (log
K′
oc
) of the 12 co-polar congeners PCBs between sediments and porewater were from 1.50 to 2.64, and the log
K′
oc
decreased with increasing chlorine number. PCB congeners pattern of marine organism were characterized by 5–6 CB chlorinated compounds, and the world health organization total dioxin equivalents of PCBs in organism ranged from 1.45 to 88.26 pg/g lipid.
The phytoplankton lake community model PROTECH (Phytoplankton RespOnses To Environmental CHange) was applied to the eutrophic lake, Esthwaite Water (United Kingdom). It was validated against ...monitoring data from 2003 and simulated well the seasonal pattern of total chlorophyll, diatom chlorophyll and Cyanobacteria chlorophyll with respective R2‐values calculated between observed and simulated of 0.68, 0.72 and 0.77 (all P<0.01). This simulation was then rerun through various combinations of factorized changes covering a range of half to double the flushing rate and from −1 to +4 °C changes in water temperature. Their effect on the phytoplankton was measured as annual, spring, summer and autumn means of the total and species chlorophyll concentrations. In addition, Cyanobacteria mean percentage abundance (%Cb) and maximum percentage abundance (Max %Cb) was recorded, as were the number of days that Cyanobacteria chlorophyll concentration exceed two World Health Organization (WHO) derived risk thresholds (10 and 50 mg m−3). The phytoplankton community was dominated in the year by three of the eight phytoplankton simulated. The vernal bloom of the diatom Asterionella showed little annual or seasonal response to the changing drivers but this was not the case for the two Cyanobacteria that also dominated, Anabaena and Aphanizomenon. These Cyanobacteria showed enhanced abundance, community dominance and increased duration above the highest WHO risk threshold with increasing water temperature and decreasing flushing rate: this effect was greatest in the summer period. However, the response was ultimately controlled by the availability of nutrients, particularly phosphorus and nitrogen, with occasional declines in the latter's concentration helping the dominance of these nitrogen‐fixing phytoplankton.
After the 1988 measles outbreak, annual notification rates for measles in Hong Kong SAR between 1989 and 1999 were 0.4-4.9 per 100 000, with peaks in 1992, 1994 and 1997. The first half-year ...incidence rates per 100 000 were 2.3 in 1997, 0.5 in 1995 and 1.2 in 1996. Monthly notification rates increased from a baseline of <10 cases to 59 in May 1997. Serological surveillance showed only 85.5% of children aged 1-19 years had measles antibodies. An epidemic, mainly because of failure of the first dose to produce immunity, seemed imminent in mid-1997. A mass immunization campaign targeted children aged 1-19 from July to November 1997. The overall coverage was 77%. The rate of adverse events was low. After the campaign, measles notification fell to 0.9 per 100 000 in 1998. A two-dose strategy and supplementary campaigns will maintain measles susceptibility at levels low enough to make measles elimination our goal.
Prognostic factors for adult patients with supratentorial World Health Organization (WHO) Grade 2 astrocytomas and poorly defined.
The prognostic importance of pretreatment patient- and tumor-related ...factors was analyzed retrospectively in 197 adult patients with supratentorial astrocytomas (n = 153) or oligoastrocytomas (n = 44) using the multivariate Cox proportional hazards model. Endpoints were death and date of malignant transformation. All patients were treated similarly between 1979 and 1992 with iodine-125 implants as the primary treatment.
A new prognostic pattern was detected. Unfavorable prognostic factors with regard to survival were 1) a tumor volume > or = 20 mL; 2) a performance status < or = 80; and 3) age > or = 40 years for the female subpopulation. Midline shift (another important tumor-related factor after univariate analysis) was highly correlated with tumor volume and therefore not included in the multivariate model. Risk factors of malignant transformation were 1) a tumor volume > or = 20 mL; 2) an enhancement in the computed tomography scan; and 3) age > or = 40 years for the female subpopulation. Prognostic factors created subsets of patients with 5-year survival rates ranging from as low as 5% to as high as 79%.
Any treatment decision or evaluation of treatment efficacy should take into account the strong influence of both patient- and tumor-related factors. Any further study design should consider the detected interaction between gender and age and the importance of tumor volume.
Background
Cesarean birth (CB) rates have been increasing rapidly globally, including in Bangladesh. This study aimed to assess national trends in CB rates and to investigate associated factors in ...Bangladesh.
Methods
We analyzed data from the five most recent Bangladesh Demographic and Health Surveys (BDHS) between 2003 and 2018. A total of 27,328 ever‐married women aged 15–49 who had a live birth in the 2 years preceding the survey were included in this study. We estimated the prevalence of CB from 2003 to 2018, as well as changes in the prevalence. Logistic regression analysis was used to measure the association between dependent and independent variables.
Results
The overall prevalence of CB among Bangladeshi mothers was 3.99% in 2003–04; this rate increased to 33.22% in 2017–18. The annual percentage change in CB rate was 16.34% from 2004 to 2017–18, which is alarming relative to the World Health Organization's cesarean birth recommended threshold. Several factors, such as maternal age, maternal and paternal education, working status of the mother, maternal BMI, age at first pregnancy, antenatal care (ANC) use, administrative division, and wealth status, had a significant influence on the rising rate of CB in Bangladesh.
Conclusions
This study documents the alarming rate of CB increase in Bangladesh since 2003. It is critical that authorities implement more effective national monitoring measures to identify the causes of this dramatic increase and work to mitigate the rate of unnecessary CB in Bangladesh.
PDF
