High incidence of poor in-hospital outcomes of term newborns with hypoxic-ischaemic encephalopathy admitted at a regional referral hospital in Dodoma, Tanzania.

AIM: Hypoxic-ischaemic encephalopathy (HIE) is one of the leading causes of neonatal deaths and neurological impairment with the highest impact in resource-limited settings. This study aimed to determine the incidence of poor in-hospital outcomes and related factors among newborns with HIE in Tanzania. METHODS: A prospective observational study in which 170 newborns with HIE (diagnosed using the Thompson clinical score) were followed from 1 September 2020 to 28 February 2021 at the neonatal ward of Dodoma Regional Referral Hospital in Dodoma, central Tanzania, until discharge or death. Clinical parameters were recorded. Multinomial logistic regression analysis was applied to determine factors associated with adverse outcomes. RESULTS: Out of 170 newborns, 44.7% (76/170) had poor outcomes (death 27.1% (46/170); neurological deficits 17.6% (30/170)). Severe HIE (Thompson score > 14) (p < 0.0001), history of aspiration (adjusted odds ratio (AOR) = 3.06, 95% confidence interval (CI) [1.170, 8.014], p = 0.0226) and 5th-min APGAR of <7 (AOR = 2.88, 95% CI [1.133, 7.310], p = 0.0262) were associated with mortality. Severe HIE, delivery at other facilities (AOR = 3.106 CI [1.158, 8.332], p = 0.0244) and abnormal heart rate (<100 or ≥160 beats/min) on admission (AOR = 3.469 [1.200, 10.030], p = 0.0216) predicted neurological impairment at discharge. CONCLUSION: Hypoxic-ischaemic encephalopathy is associated with a high incidence of poor outcomes in resource-limited settings. To improve outcomes newborns with severe HIE, history of aspiration, referred from other facilities, 5th-min APGAR score of <7 and abnormal heart rate need improved quality of neonatal care.

Spontaneously rotating clusters of active droplets.

We report on the emergence of spontaneously rotating clusters in active emulsions. Ensembles of self-propelling droplets sediment and then self-organise into planar, hexagonally ordered clusters which hover over the container bottom while spinning around the plane normal. This effect exists for symmetric and asymmetric arrangements of isotropic droplets and is therefore not caused by torques due to geometric asymmetries. We found, however, that individual droplets exhibit a helical swimming mode in a small window of intermediate activity in a force-free bulk medium. We show that by forming an ordered cluster, the droplets cooperatively suppress their chaotic dynamics and turn the transient instability into a steady rotational state. We analyse the collective rotational dynamics as a function of droplet activity and cluster size and further propose that the stable collective rotation in the cluster is caused by a cooperative coupling between the rotational modes of individual droplets in the cluster.

Global child health in Germany - Time for action.

Child health is central to the SDG agenda. Universities in the UK and other European countries provide leadership in research and education for global child health to inform related policy and practice, but the German contribution is inadequate. German paediatricians and other child health professionals could make more substantial contributions to the debate at home and internationally, but lack opportunities for scholarship and research. We argue, that there is a momentum to advance global child health in academia and call on German universities to realise this potential.

Topological Stabilization and Dynamics of Self-Propelling Nematic Shells.

Liquid shells (e.g., double emulsions, vesicles, etc.) are susceptible to interfacial instability and rupturing when driven out of mechanical equilibrium. This poses a significant challenge for the design of liquid-shell-based micromachines, where the goal is to maintain stability and dynamical control in combination with motility. Here, we present our solution to this problem with controllable self-propelling liquid shells, which we have stabilized using the soft topological constraints imposed by a nematogen oil. We demonstrate, through experiments and simulations, that anisotropic elasticity can counterbalance the destabilizing effect of viscous drag induced by shell motility and inhibit rupturing. We analyze their propulsion dynamics and identify a peculiar meandering behavior driven by a combination of topological and chemical spontaneously broken symmetries. Based on our understanding of these symmetry breaking mechanisms, we provide routes to control shell motion via topology, chemical signaling, and hydrodynamic interactions.

Adherence to the integrated management of childhood illness guidelines in Namibia, Kenya, Tanzania and Uganda: evidence from the national service provision assessment surveys.

BACKGROUND: Integrated Management of Childhood Illness (IMCI) is regarded as a standard public health approach to lowering child mortality in developing countries. However, little is known about how health workers adhere to the guidelines at the national level in sub-Saharan African countries. METHODS: Data from the Service Provision Assessment surveys of Namibia (NA) (survey year: 2009), Kenya (KE) (2010), Tanzania (TZ) (2006) and Uganda (UG) (2007) were analysed for adherence to the IMCI guidelines by health workers. Potential influencing factors included the survey country, patient's age, the different levels of the national health system, the training level of the health care provider (physician, non-physician clinician, nurse-midwife, auxiliary staff), and the status of re-training in IMCI. RESULTS: In total, 6856 children (NA: 1495; KE: 1890; TZ: 2469; UG: 1002 / male 51.2-53.5%) aged 2-73 months (2-24 months, 65.3%; median NA: 19 months; KE: 18 months; TZ: 16 months; UG: 15 months) were clinically assessed by 2006 health workers during the surveys. Less than 33% of the workers carried out assessment of all three IMCI danger signs, namely inability to eat/drink, vomiting everything, and febrile convulsions (NA: 11%; KE: 11%; TZ: 14%; UG: 31%) while the rate for assessing all three of the IMCI main symptoms of cough/difficult breathing, diarrhoea, and fever was < 60% (NA: 48%; KE: 34%; TZ: 50%; UG: 57%). Physical examination rates for fever (temperature) (NA: 97%; KE: 87%; TZ: 73%; UG: 90%), pneumonia (respiration rate/auscultation) (NA: 43%; KE: 24%; TZ: 25%; UG: 20%) and diarrhoea (dehydration status) (NA: 29%; KE: 19%; TZ: 20%; UG: 39%) varied widely and were highest when assessing children with the actual diagnosis of pneumonia and diarrhoea. Adherence rates tended to be higher in children ≤ 24 months, at hospitals, among higher-qualified staff (physician/non-physician clinician) and among those with recent IMCI re-training. CONCLUSION: Despite nationwide training in IMCI the adherence rates for assessment and physical examination remained low in all four countries. IMCI training should continue to be provided to all health staff, particularly nurses, midwives, and auxiliary staff, with periodic re-training and an emphasis to equally target children of all age groups.

Chemotaxis and autochemotaxis of self-propelling droplet swimmers.

Chemotaxis and autochemotaxis play an important role in many essential biological processes. We present a self-propelling artificial swimmer system that exhibits chemotaxis as well as negative autochemotaxis. Oil droplets in an aqueous surfactant solution are driven by interfacial Marangoni flows induced by micellar solubilization of the oil phase. We demonstrate that chemotaxis along micellar surfactant gradients can guide these swimmers through a microfluidic maze. Similarly, a depletion of empty micelles in the wake of a droplet swimmer causes negative autochemotaxis and thereby trail avoidance. We studied autochemotaxis quantitatively in a microfluidic device of bifurcating channels: Branch choices of consecutive swimmers are anticorrelated, an effect decaying over time due to trail dispersion. We modeled this process by a simple one-dimensional diffusion process and stochastic Langevin dynamics. Our results are consistent with a linear surfactant gradient force and diffusion constants appropriate for micellar diffusion and provide a measure of autochemotactic feedback strength vs. stochastic forces. This assay is readily adaptable for quantitative studies of both artificial and biological autochemotactic systems.

Curling Liquid Crystal Microswimmers: A Cascade of Spontaneous Symmetry Breaking.

We report curling self-propulsion in aqueous emulsions of common mesogenic compounds. Nematic liquid crystal droplets self-propel in a surfactant solution with concentrations above the critical micelle concentration while undergoing micellar solubilization [Herminghaus et al., Soft Matter 10, 7008 (2014)]. We analyzed trajectories both in a Hele-Shaw geometry and in a 3D setup at variable buoyancy. The coupling between the nematic director field and the convective flow inside the droplet leads to a second symmetry breaking which gives rise to curling motion in 2D. This is demonstrated through a reversible transition to nonhelical persistent swimming by heating to the isotropic phase. Furthermore, autochemotaxis can spontaneously break the inversion symmetry, leading to helical trajectories in 3D.

Is the WHO Guide on Essential Practice of Postpartum Newborn Care Used in a District Health Care Facility?

BACKGROUND: It is unclear whether algorithms with evidence-based interventions are used in a setting where the work load is high and qualified staff is scarce to identify neonates with life-threatening conditions. METHODS: The nurse-midwives' knowledge and opinion about the World Health Organization (WHO) guide on postpartum newborn care were assessed in a hospital in Tanzania before and after training. Their adherence to this guide was evaluated by analysing 100 neonatal records. RESULTS: Before training, 44% of the nurse-midwives were familiar with the WHO guide. All nurse-midwives supported the implementation of the guide. In all, 21% of the postpartum record forms were fully completed. Risk factors for illness were missed in 27%. CONCLUSION: Nurse-midwives' expertise in the WHO guide on postpartum newborn care cannot be taken for granted. The complexity of this guide demands expertise and makes its use time-consuming and thus its practicability disputable in a setting with limited resources.

Dimensionality matters in the collective behaviour of active emulsions.

The behaviour of artificial microswimmers consisting of droplets of a mesogenic oil immersed in an aqueous surfactant solution depends qualitatively on the conditions of dimensional confinement; ranging from only transient aggregates in Hele-Shaw geometries to hexagonally packed, convection-driven clusters when sedimenting in an unconfined reservoir. We study the effects of varying the swimmer velocity, the height of the reservoir, and the buoyancy of the droplet swimmers. Two simple adjustments of the experimental setting lead to a suppression of clustering: either a decrease of the reservoir height below a certain value, or a match of the densities of droplets and surrounding phase, showing that the convection is the key mechanism for the clustering behaviour.

Interfacial mechanisms in active emulsions.

Active emulsions, i.e., emulsions whose droplets perform self-propelled motion, are of tremendous interest for mimicking collective phenomena in biological populations such as phytoplankton and bacterial colonies, but also for experimentally studying rheology, pattern formation, and phase transitions in systems far from thermal equilibrium. For fuelling such systems, molecular processes involving the surfactants which stabilize the emulsions are a straightforward concept. We outline and compare two different types of reactions, one which chemically modifies the surfactant molecules, the other which transfers them into a different colloidal state. While in the first case symmetry breaking follows a standard linear instability, the second case turns out to be more complex. Depending on the dissolution pathway, there is either an intrinsically nonlinear instability, or no symmetry breaking at all (and hence no locomotion).

Immunisation coverage and its associations in rural Tanzanian infants.

INTRODUCTION: In Tanzania, vaccination rates (VRs) range from 80% to 90% for standard vaccines, but little information is available about rural populations and nomadic pastoralists. This study investigates levels and trends of the immunisation status of infants at eight mobile reproductive-and-child-health (RCH) clinics in a rural area in northern Tanzania (with a large multi-tribal population that has a significant population of nomadic pastoralists) for the years 1998, 1999, 2006 and 2007. In addition, the influence of tribal affiliation and health system-related factors on the immunisation status in this population is analysed. METHODS: Vaccination data of 3868 infants for the standard bacillus Calmette-Guérin (BCG), poliomyelitis, diphtheria, pertussis, tetanus and measles vaccines were obtained from the RCH clinic records retrospectively, and coverage for both single vaccines and full vaccination by the end of first year of life were calculated. These results were correlated with data on predominant tribal affiliation at the clinic site, skilled attendance at birth, service provision and vaccine availability as independent variables. RESULTS: In 1998, the full vaccination rate (FVR) across all RCH clinics was 72%, significantly higher than in the other years (1999: 58%; 2006: 58%; 2007: 57%) (p<0.0001). BCG and measles VRs were highest in 1998 and 1999, whereas VR was lowest for poliomyelitis in 1999, and for diphtheria-pertussis-tetanus in 2007 (all p<0.001). Measles VR showed a declining trend (1998: 72%; 1999: 73%; 2006: 62%; 2007: 59%) affecting the FVR, except in 1999 when poliomyelitis VR was lower (67%). FVR > 80% was only achieved at one clinic during 3 years. No clinic showed a consistent increase of VRs over time. In univariate analysis, predominant tribal affiliation (Datoga tribe) was associated with a low FVR (odds ratio (OR) 4.6 (95% confidence interval (CI) 3.8-5.5)), as were low rates of skilled attendance at birth (OR 3.6 (CI 2.9-4.4)). Other health system-related factors associated with low FVRs included interruption of scheduled monthly immunisation clinics (OR 9.8 (CI 2.1-45.5)) and lack of vaccines (OR 1.2-2.9, depending on vaccine). In multivariate analysis, predominant Datoga tribal affiliation and lack of vaccines retained their association with the risk of low rates of vaccination. CONCLUSIONS: Vaccination rates in this difficult-to-reach population are markedly lower than the national average for almost all years and clinics. Affiliation to the nomadic Datoga tribe and lack of vaccines determine VRs in this rural population. Improvements in immunisation service delivery, vaccine availability, stronger involvement of the nomadic communities and special outreach services for this population are required to improve VRs in these remote areas of Tanzania.

A telemedicine network to support paediatric care in small hospitals in rural Tanzania.

We reviewed our experience with the Tanzanian Telemedicine Network in supporting paediatric care at 40 small, rural hospitals in the country. The network began operating in 2008. Store and forward telemedicine was provided via the open source software iPath. The 33 volunteer consultants were based in several countries, although most of them had practical experience in Tanzania. During the first three years of network operation there were 533 referrals. There were 159 paediatric cases (median age five years). Three paediatric specialists provided most consultations (64%), but other specialists provided recommendations when required. The response time was usually less than two days (median 6 h; inter-quartile range 2-24 h). A precise recommendation was not always provided, but since all consultants had an intimate knowledge of the state of health services in Tanzania, their advice was usually well adapted to the local circumstances of the hospitals. Referral to a higher level of care was recommended in 26 cases (16%). A simple web-based telemedicine system combined with email alerts is feasible in remote locations in Tanzania, even where fast Internet connections are not available.

The effects of standardised protocols of obstetric and neonatal care on perinatal and early neonatal mortality at a rural hospital in Tanzania.

The care of pregnant women and neonates in peripheral hospitals in many developing countries is in a critical state. Through a retrospective analysis we assessed the effects of the introduction of standardised protocols in obstetric and neonatal care (implementation from 1998 onwards) on perinatal and neonatal outcomes of all deliveries over seven years (1996-2002) at a first-referral hospital in rural Tanzania. In all, there were 18 026 deliveries (18 316 live births and 606 stillbirths). Perinatal mortality rates (PMR) varied from 42.8-54.5/1000 live births during the years. Early neonatal mortality rates (eNMR) fell from 21.9/1000 live births in 1996 to 14.8/1000 live births in 2002 (all p > 0.05). Fresh stillbirth rates decreased over time (p = 0.041), however macerated stillbirth rates increased during the second half of the period (p = 0.067). Sixty-two to seventy-two percent of eNMR occurred on the first day of life (p < 0.001). Maternal mortality ratio declined from 729/100 000 live births in 1996 to 119/100 000 live births in 2002 (p = 0.002). Our clinical project was associated with a reduction of PMR and eNMR (and maternal mortality ratios), but with considerable fluctuations during the years. Improving obstetric and neonatal care in the hospital setting in developing countries is essential, but needs long-term commitment and support.