Delivery care in Quang Ninh province, Northern Vietnam : resources and access to safe care.

Every mother and child has the right to survive childbirth which requires skilled birth attendants together with referral and available emergency obstetric care (EmOC). The objective of the study was to describe delivery care routines at different levels in the health care system in Quang Ninh province, Northern Vietnam. The design was cross sectional using a structured questionnaire. Two districts in Quang Ninh province with 40 Community Health Centres (CHC), three district hospitals and one region hospital was included in the study, in total 138 (CHC n=105 and hospitals n=33) health care providers participated. In our study 20% (CHC) of the health care providers assisting deliveries at CHC were midwives and health care provider’s in our study further report to have assisted at less then 10 deliveries/year (81% of respondents at CHC). Findings show that the health care provider’s routines and care for women during labour and delivery vary and that there is a need for re-training and that women in labour should be cared for by health care providers with adequate training like midwifery. In our study CHC had poor resources to provide basic or comprehensive EmOC. Our findings indicate that there is a need for re-training in delivery care among health care providers and since the number of deliveries at CHC is few they should be handled by someone who is a skilled birth attendant. Our findings also show a variation in care routines during labour and delivery among health care providers at CHC and hospital levels and this also show the need for re-training and support from proper authorities in order to improve maternal and newborn health.

Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam

BACKGROUND: In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members. METHODS: Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis. RESULTS: Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators' lack of health knowledge was regarded as a deficit for assisting the groups' assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups. CONCLUSIONS: This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Mortality rates, prevalence of malnutrition, and prevalence of lost pregnancies among the drought-ravaged population of Tete province Mozambique

Background: Tete Province, Mozambique has experienced chronic food insecurity and a dramatic fall in livestock numbers due to the cyclic problems characterized by the floods in 2000 and severe droughts in 2002 and 2003. The Province has been a beneficiary of emergency relief programs, which have assisted >22% of the population. However, these programs were not based on sound epidemiological data, and they have not established baseline data against which to assess the impact of the programs. Objective: The objective of this study was to document mortality rates, causes of death, the prevalence of malnutrition, and the prevalence of lost pregnancies after 2.5 years of humanitarian response to the crisis. Methods: A two-stage, 30-cluster household survey was conducted in the Cahora Bassa and Changara districts from 22 October to 08 November 2004. A total of 838 households were surveyed, with a population size of 4,688 people. Results: Anthropometric data were collected among children 6-59 months of age. In addition, crude mortality rates (CMRs), under five mortality rates (U5MRs), causes of deaths, and prevalence of lost pregnancies were determined among the sample population. The prevalence of malnutrition was 8.0% (95% confidence interval (CI)=6.2-9.8%) for acute malnutrition, 26.9% (95% CI=24.0-29.9%) for being underweight, and 37.0% (95% CI=33.8-40.2%) for chronic malnutrition. Boys were more likely to be underweight than were girls (odds ratio (OR)=1.34; 95% CI=1.00, 1.82; p<0.05) after controlling for age, household size, and food aid beneficiary status. Similarly, children 30-59 months of age were significantly less likely to suffer from acute malnutrition (OR=0.45; 95% CI=0.26, 0.79; p<0.01) and less likely to be underweight (OR=0.37; 95% CI=0.27, 0.51; p<0.01) than children 6-29 months of age, after adjusting for the other, aforementioned factors. The proportion of lost pregnancies was estimated at 7.7% (95% CI=4.5-11.0%). A total of 215 deaths were reported during the year preceding the survey. Thirty-nine (18.1%) children <5 years of age died. The CMR was 1.23/10 000/day (95% CI=1.08-1.38), and an U5MR was 1.03/10 000/day (95% CI=0.71-1.35). Diarrheal diseases, malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) accounted for more than two-thirds of all deaths. Conclusions: The observed CMR in Tete Province, Mozambique is three times higher than the baseline rate for sub-Saharan Africa and 1.4 times higher than the CMR cut-off point used to define excess mortality in emergencies. The current humanitarian response in Tete Province would benefit from an improved alignment of food aid programming in conjunction with diarrheal disease control, HIV/AIDS, and malaria prevention and treatment programs. The impact of the food programs would be improved if mutually acceptable food aid programme objectives, verifiable indicators relevant to each objective, and beneficiary targets and selection criteria are developed. Periodic re-assessments and evaluations of the impact of the program and evidenced-based decision-making urgently are needed to avert a chronic dependency on food aid.

Permian brachiopods from the Tupe formation, San Juan Province, Precordillera, Argentina

The brachiopod fauna from the Tupe Formation at La Herradura Creek, located on the west flank of Perico Hill, San Juan Province, Argentina, palaeogeographically belongs to the western sector of the Paganzo basin ('Guandacol embayment'). The stratigraphical section of the Tupe Formation at La Herradura Creek is the stratotype of the Tivertonia jachalensis-Streptorhynchus inaequiornatus biozone, was previously regarded as being of Late Carboniferous age but here is assigned to the earliest Permian (Asselian). We describe and review the biozone assemblage, which consists of Streptorhynchus inaequiornatus, Tivertonia jachalensis, Kochiproductus sp., Costatumulus sp., Coronalosia argentinensis, Tupelosia paganzoensis, Trigonotreta pericoensis, Septosyringothyris sp. aff. Septosyringothyris jaguelensis and Crurithyris? sp. This brachiopod assemblage is related to Indian and Australian Early Permian faunas and its presence in the La Herradura Creek section provides new evidence in support of an Asselian (Early Permian) age for the Tivertonia jachalensis-Streptorhynchus inaequiornatus biozone. This assemblage is also important for intra- and inter-basinal correlation because several of its characteristic species have been identified from other sections of the Paganzo basin and the Riacuteo Blanco basin. The proposed age for this biozone is consistent with the age of palynological data from slightly above the marine faunas from the stratotype locality.

A new Brachiopod fauna from the early to middle permian of Southern Qinghai Province, Northwest China

A new brachiopod fauna is described from the Early and Middle Permian of Zadoi and Zhidoi counties, southern Qinghai (Changdu block), northwest China. This fauna includes 13 species in nine genera with Spinomarginifera concentrica n. sp. and Transennatia waterhousei n. sp. The Early to Middle Permian brachiopod fauna from southern Qinghai is very similar to the contemporary Cathaysian faunas of South China with which the new fauna shares 70 per cent of its species. On the other hand, the Qinghai brachiopods also demonstrate a significant link with the Permian brachiopod fauna of the Sino-Mongolian-Japanese Province in northeast China, as suggested by Marginifera septentrionalis and Attenuatella. In particular, the occurrence of the bipolar brachiopod genus Attenuatella suggests that southern Qinghai may have played an important role as a biogeographic stepping stone in the marine faunal interchanges between the northern and southern hemispheres during the Early and Middle Permian.

Analysis of employee turnover amongst construction managers in Hubei Province

This study determined the most important factors affecting turnover intention and developed a prediction model of construction manager turnover in Hubei Province, China. This prediction model can help human resource managers take appropriate actions to reduce the rate of construction manager turnover and keep good construction managers.

Frequency of Anti-HBc & HBV DNA detection in blood donors of Kerman province, Iran

Hepatitis B is a serious global infection disease and a major cause of mortality and morbidity worldwide. However, data on Occult Hepatitis B in Iran are scare. The current study assessed the frequency of Anti-HBc and HBV DNA in serum sample of healthy blood donors negative for HBsAg stratified by sex and age; and also investigated the relationship between detection of HBV-DNA and anti-HBc positivity. Since anti-HBc screening is not performed in Iranian Blood Bank, we assessed whether anti-HBc could be adopted as a screening assay for the donated blood. The study included a total of 1525 blood samples of blood donors negative for hepatitis B virus surface antigen ( 87% male with a mean age ± SD: of 31±8yr; and 13% female with a mean age ± SD of 30±6yr). Eight percent (121 out of 1525) of the blood samples with negative HBs-Ag were positive for Anti-HBc and were all from males. HBV-DNA was detected in 36 out of 121 anti-HBc+ specimens (29.7%). The study found a positive relation between anti-HBc positivity and detection of HBV-DNA in serum samples of HBs-Ag negative blood donors. Findings from this study suggest that, introducing anti HBc screening in Iran maybe very practical in order to limit the transmission risk of Occult Hepatitis B virus through blood transfusion.

An ethnography of life and changes among Tibetan nomads of Minyag Dora Karmo, Ganzi Tibetan Autonomous Prefecture, Sichuan Province

This article describes the pastoral movements and material culture of a community of nomads in Eastern Tibet and how they negotiate changes brought about not only by national government policies and international development plans, but also by a local lama.

Learning from rural planning development to encourage urban and regional planning ; indigenous villages versus city development in Bali province

The most important crises in the planning system is related to the significance of "capitalist state" influences [3]. In the global context, Bengs states that there is a matter partiality between "global capitalism" and "national democracy"[4]. Bengs stresses that planning is closely related to the economy of a country, which is in one side the government wants to reduce taxes, while on the other side there is a dilemma of the global and indefinite solicitation of assets. Hall (2002) discusses the problems of the city; those are city planning, history of planning, and geographical setting. City planning is not only planning in one region but also including the district around the city, such as river basin and a certain regional culture. The urban planner should involve all those aspects in the city planning. Friedmann (2003) distinguishes planning theory into three types. First, planning theory is related to planning in particular fields such as land utilization, transportation, urban design, regional development, environmental planning etc. Second, the type of theory related to planning tout court, and the third type is the theory about planning itself. Sanyal (2002) states that although planners have limited autonomy, their actions affect policy result [5]. Friedman (2003) supports Sanyal's argument stressing that planners learned from their actions not from theories.