Knowledge and perceptions of quality of obstetric and newborn care of local health providers: a cross-sectional study in three districts in Malawi

Aim Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers’ knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. Methods his study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). Results Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians’ place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. Conclusion Serious deficiencies in providers’ knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.

THE PROSPECT OF BIOGAS AMONG SMALL-HOLDER DAIRY GOAT FARMERS IN THE ULUGURU MOUNTAINS, TANZANIA

Biogas can be a clean cooking alternative where biomass is the dominant source of cooking energy and where feedstock for anaerobic digestion is available. By substituting woody biomass for energy, biogas may reduce local deforestation. Tanzania has more than 15.6 million goats. Dairy goats of different breeds are found in the mid- to high altitudes of the country. Population density has made firewood increasingly scarce and there are few energy alternatives in mountainous areas such as in the Uluguru Mountains. In Mgeta ward, Morogoro region, introduction of Norwegian dairy goats in the 1980s has improved livelihoods in the area. In this study, goat manure was assessed as feedstock for biogas and as fertilizer. Field work among small-holder dairy goat farmers in Mgeta was conducted to measure daily manure production, and to provide a basic model for prediction of the quantity of droppings which may be collected by farmers. Biogas and fertilizer potential from goat manure was compared to cow and pig manure. Buswell’s formula was used to calculate approximate methane yield. The results show that goat manure from Mgeta can yield 167 l∙kg Volatile Solids-1 (VS). Compared with other substrates approximate methane yield can be ranked as pig > guatemala grass > cow > goat. The average goat of 25 kg in Mgeta leaves 61 kg Total Solids (TS) droppings per year. It was estimated that 15 goats capita-1 would be required to meet the total cooking energy needs of small-holder households in the study location. N:P:K content in goat manure (TS) is 2:1:1, similar to cow and pig manure. Goat droppings had to be macerated to reduce particle size for anaerobic digestion. Biogas from dairy goats could be combined with the year-round irrigated horticulture production in Mgeta. Vegetable gardens in the slope below the digesters could be fertilized by gravitation with the NH4+-rich bioslurry, to save labour and increase yields.

The Role of Lung Ultrasound in Diagnosis of Respiratory Distress Syndrome in Newborn Infants

Background: Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and mortality. The risk of developing RDS decreases with both increasing gestational age and birth weight. Objectives: The aim of this study was to evaluate the value of lung ultrasound in the diagnosis of respiratory distress syndrome (RDS) in newborn infants. Materials and Methods: From March 2012 to May 2013, 100 newborn infants were divided into two groups: RDS group (50 cases) and control group (50 cases). According to the findings of chest x-ray, there were 10 cases of grade II RDS, 15 grade III cases, and 25 grade IV cases in RDS group. Lung ultrasound was performed at bedside by a single expert. The ultrasound indexes observed in this study included pleural line, A-line, B-line, lung consolidation, air bronchograms, bilateral white lung, interstitial syndrome, lung sliding, lung pulse etc. Results: In all of the infants with RDS, lung ultrasound consistently showed generalized consolidation with air bronchograms, bilateral white lung or alveolar-interstitial syndrome, pleural line abnormalities, A-line disappearance, pleural effusion, lung pulse, etc. The simultaneous demonstration of lung consolidation, pleural line abnormalities and bilateral white lung, or lung consolidation, pleural line abnormalities and A-line disappearance co-exists with a sensitivity and specificity of 100%. Besides, the sensitivity was 80% and specificity 100% of lung pulse for the diagnosis of neonatal RDS. Conclusions: This study indicates that using an ultrasound to diagnose neonatal RDS is accurate and reliable too. A lung ultrasound has many advantages over other techniques. Ultrasound is non-ionizing, low-cost, easy to operate, and can be performed at bedside, making this technique ideal for use in NICU.