Impact Of Supply- and Demand-Side Interventions Integrated with Antenatal Care on Use of Maternal Health Services-Western Kenya, 2013‒2014.

We evaluated whether antenatal supply-side and demand-side interventions in 10 public health care facilities (HCFs) increased the percentage of women who had four or more antenatal care (ANC4+) visits and HCF deliveries from baseline to follow-up compared with women in 10 public control HCFs in Kenya. We compared maternal registry data during baseline and follow-up periods between public intervention and public control HCFs; we added seven private intervention HCFs and five private control HCFs to evaluate an unanticipated pilot insurance program that enabled women to use private intervention HCFs. From baseline to follow-up, ANC4+ visits and HCF deliveries in public intervention HCFs were 1.64 and 1.19 times greater, respectively, than in public control HCFs. Health care facility deliveries were 1.5 times higher in private intervention HCFs than public intervention HCFs. Results suggested that the combined antenatal and insurance interventions motivated increased ANC4+ visits and HCF deliveries. Women appeared to prefer private HCFs for delivery.

Future winters present a complex energetic landscape of decreased costs and reduced risk for a freeze-tolerant amphibian, the Wood Frog (Lithobates sylvaticus).

Winter climate warming is rapidly leading to changes in snow depth and soil temperatures across mid- and high-latitude ecosystems, with important implications for survival and distribution of species that overwinter beneath the snow. Amphibians are a particularly vulnerable group to winter climate change because of the tight coupling between their body temperature and metabolic rate. Here, we used a mechanistic microclimate model coupled to an animal biophysics model to predict the spatially explicit effects of future climate change on the wintering energetics of a freeze-tolerant amphibian, the Wood Frog (Lithobates sylvaticus), across its distributional range in the eastern United States. Our below-the-snow microclimate simulations were driven by dynamically downscaled climate projections from a regional climate model coupled to a one-dimensional model of the Laurentian Great Lakes. We found that warming soil temperatures and decreasing winter length have opposing effects on Wood Frog winter energy requirements, leading to geographically heterogeneous implications for Wood Frogs. While energy expenditures and peak body ice content were predicted to decline in Wood Frogs across most of our study region, we identified an area of heightened energetic risk in the northwestern part of the Great Lakes region where energy requirements were predicted to increase. Because Wood Frogs rely on body stores acquired in fall to fuel winter survival and spring breeding, increased winter energy requirements have the potential to impact local survival and reproduction. Given the geographically variable and intertwined drivers of future under-snow conditions (e.g., declining snow depths, rising air temperatures, shortening winters), spatially explicit assessments of species energetics and risk will be important to understanding the vulnerability of subnivium-adapted species.