Paper-based microfluidic devices by asymmetric calendaring.

We report a simple, efficient, one-step, affordable method to produce open-channel paper-based microfluidic channels. One surface of a sheet of paper is selectively calendared, with concomitant hydrophobization, to create the microfluidic channel. Our method involves asymmetric mechanical modification of a paper surface using a rolling ball (ball-point pen) under a controlled amount of applied stress (σz) to ascertain that only one side is modified. A lubricating solvent (hexane) aids in the selective deformation. The lubricant also serves as a carrier for a perfluoroalkyl trichlorosilane allowing the channel to be made hydrophobic as it is formed. For brevity and clarity, we abbreviated this method as TACH (Targeted Asymmetric Calendaring and Hydrophobization). We demonstrate that TACH can be used to reliably produce channels of variable widths (size of the ball) and depths (number of passes), without affecting the nonworking surface of the paper. Using tomography, we demonstrate that these channels can vary from 10s to 100s of microns in diameter. The created hydrophobic barrier extends around the channel through wicking to ensure no leakages. We demonstrate, through modeling and fabrication, that flow properties of the resulting channels are analogous to conventional devices and are tunable based on associated dimensionless numbers.

Practical education strategies for promoting growth monitoring, oral rehydration, breastfeeding and immunization.

PIP: Malnutrition and infection, which strike as many as 40,000 African children daily, through the use of basic health care measures. The 4 simple techniques are: growth monitoring, oral rehydration, breast feeding, and immunization (GOBI). It is a task of political and social groups to put present technology to work at a reasonable cost, and to help communities learn to apply them effectively at the local level. Change from an agricultural culture to an industrial one has caused upheaval, but through the development of knowledge and skills at the community level, hunger and disease can be controlled. GOBI training should focus on the changing roles of women, men, and children; changing environments caused by technological innovations, and creative parenthood. The community needs intellectual, emotional, and social skills to be able to take this responsibility. The imagery for GOBI should be symbols of reality and life familiar to the particular community. Training in GOBI strategies need specific expertise in oral rehydration, breast feeding, immunization, and growth monitoring. Child health care must be taken out of hospitals and care centers and put back into the community where a culturally appropriate holistic approach can be carried out.^ieng

Improving service quality.

PIP: This paper describes the Client Oriented, Provider Efficient (COPE) Services, a new initiative of the Family Planning Association of Kenya (FPAK) for improving services to its clients, and for increasing contraceptive prevalence rate. Developed by the Association for Voluntary Surgical Contraception International, COPE has proved to be successful in improving quality of clinic services in Kenya since its introduction into FPAK clinics in 1989. It works by helping family planning service providers in various FPAK clinics become more aware of expressed as well as implied/perceived needs of their clients through the application of its set of tools: self-assessment, client interviews, client flow analysis, and plan of action. Due to its success, a lot of family planning provision organizations in Kenya are interested in incorporating COPE quality improvement tools.^ieng

Client participation and provider communication in family planning counseling: transcript analysis in Kenya.

To examine how much and in what ways clients participate in family planning consultations, and how providers influence their behavior, investigators analyzed transcripts of 178 counseling sessions with female clients in Kenya and developed coding guides that focus on client participation. The results show that providers dominate most counseling sessions, and clients rarely take an active role. The most common way for clients to participate is by volunteering additional information when they respond to providers' questions. Providers may encourage clients to play a more active role by building a sense of rapport, by relating contraceptive information specific to each client's personal situation, and by rewarding clients' attempts to participate.

Attitudes toward voluntary surgical contraception in four districts of Kenya.

A series of 32 focus groups were held among men and women in the catchment areas of four active voluntary surgical contraception (VSC) programs in Kenya. Women who had had tubal ligation and their husbands were uniformly favorable to this method. The majority of couples using reversible methods saw tubal ligation as a logical future choice. Participants were frank about economic motives, and many were willing to endure criticism of the older generation in accepting tubal ligation. By contrast, attitudes toward vasectomy were uniformly negative. These findings dispel the idea that tubal ligation is culturally unacceptable in the sub-Saharan African context. Rather, favorable attitudes appear to have emerged due to readily accessible, low-cost VSC services in the areas studied.