Reproductive, maternal, newborn, child and adolescent health services in humanitarian and fragile settings: A mixed methods study of midwives' and women's experiences.

Insufficient progress has been made to reduce morbidity and mortality for women, children and adolescents particularly in Humanitarian and Fragile settings (HFS). Midwives play a critical and unique role in ensuring communities receive quality and safe essential sexual, reproductive, maternal, newborn, child, and adolescent health services. A lack of knowledge exists on the availability and experiences of midwifery services in HFS. This manuscript provides an overview of the midwifery density in HFS and a synthesis of the experiences of women receiving midwifery care, and barriers and facilitators for midwives providing essential SRMNCAH services in HFS. Guided by an expert committee, a concurrent mixed methods approach was applied, using secondary analysis of primary quantitative and qualitative data sources. Quantitative analysis of the global distribution of midwives compared to fragility was undertaken. Qualitative analysis of experiences of receipt and provision of midwifery care was undertaken across four settings providing humanitarian care. There is a critically low density of midwives in humanitarian and fragile settings. Sub-Saharan Africa accounts for the highest levels of fragility yet lowest density of midwives able to provide SRMNCAH services. Lack of finances both constrains midwives from effectively providing services and prevent communities from utilising services. Sub-optimal working conditions through rising workloads, insufficient and/or inconsistent resources were frequently reported to impede midwives from providing care in HFS. Uniquely for HFS, threats to the safety and security of midwives to conduct their work was widely reported. Key facilitators identified included, complex adaptive health system designs to respond effectively to the rapidly changing HFS environment, realisation of supporting "power, agency and status" as instrumental for midwives to provide quality care and promotion of community-centric approaches may enable continuity of care and uptake of essential SRMNCAH services. Midwives are critical to protect the health and well-being of communities. They require urgent protection and prioritisation in HFS areas where the need is greatest.

Impact of socio-cultural practice of infant/young child gum lancing during teething.

BACKGROUND: Fever and diarrhea are among the common morbidities that do occur during infancy and are sometimes wrongly associated with teething by the community. Some societies practice gum lancing, ordinarily referred to as gum cutting, as a remedy for the "teething diarrhoea". These myths have a potential of giving false security with the belief that these symptoms are part of the teething process, and so medical attention may not be sought when necessary. There are few studies focusing on the outcome of such practices despite their known potential dangers. OBJECTIVE: To describe various methods of gum lancing and clinical presentation, management and outcome of gum lancing among the Akamba people as seen in Kangundo District Hospital. METHOD: One hundred and fifteen infants/children who were brought to the hospital with a positive history of gum lancing. RESULTS: The common presenting complaints were persistent diarrhoea (74.0%), fever (44.3%), difficulty in breathing (27.8%) and refusal to feed (20.9%). 58.3% cases warranted admission and these included severe dehydration and shock (47.8%), severe and very severe pneumonia (40.3%), meningitis (26.9%) and generalized sepsis (17.9%). There were a total of 7 mortalities (6.1%), 3 on arrival and 4 within the pediatric ward. Invasive gum lancing procedures and delayed seeking of medical attention were associated with severe disease and poorer outcomes. CONCLUSION: The impact of gum lancing is of both a public health and economic significance. It is associated with unfavorable outcome if prompt measures are not put in place. There is need to conduct community sensitization and educate caregivers on the truths of teething and dangers of gum lancing as well as seeking health services for fever and diarrhoea. Use of broad-spectrum antibiotics and adequate rehydration are necessary in management of the victims.

Comparison of two-stage sorption design models for the removal of lead ions by polyvinyl-modified Kaolinite clay.

Kaolinite clay obtained from Ubulu-Ukwu, Delta State in Nigeria was modified with polyvinyl-alcohol (PVA) reagent to obtained PVA-modified Kaolinite clay. Kinetic and equilibrium data were obtained for the batch adsorption of Pb(2+) onto PVA-modified Kaolinite clay. Time-dependent Langmuir and pseudo-second order kinetic models (TDLM and PSOM) were developed to predict the optimized minimum operating time for the adsorption of Pb(2+) onto PVA-modified Kaolinite clay in a two-stage batch adsorber system. Results obtained suggest that the two-stage batch adsorber process leads to improved contact time and increased percentage Pb(2+) removal. Data from both models (TDLM and PSOM) were compared using t-test and F-test and were found to be precise enough for use in the optimization of kinetic data for a two-stage adsorption of Pb(2+) ions from aqueous solution.