Conclusion We conclude that poor education, poor economic status, non-completion of four ANC visits and belonging to Province 2 particularly determined either group of women to deliver at home, whereas residing in rural areas, living far from health facility, and belonging to Province 7 determined marginalised women to deliver at home. Preventing mothers from delivering at home would thus require focusing on specific geographical areas besides considering wider socioeconomic determinants.
This book tells the story of how White Rhodesians, three-quarters of whom were ill-prepared for revolutionary change, reacted to the ‘terrorist’ war and the onset of Black rule in the 1970s. It shows how internal divisions — both old and new — undermined the supposed unity of White Rhodesia, how most Rhodesians begrudgingly accepted the inevitability of Black majority rule without adjusting to its implications, and how the self-appointed defenders of Western civilization sometimes adopted uncivilized methods of protecting the ‘Rhodesian way of life’. This account is based on archival research and personal interviews. It sets out to tell the story from the inside and to incorporate the diverse dimensions of the Rhodesian experience. The book suggests that the Rhodesians were more differentiated than has often been assumed and that perhaps their greatest fault was a capacity for self-delusion.
Background Between 1990 and 2017, Nepal experienced a shift in the burden of disease from communicable, maternal, neonatal and nutritional (CMNN) diseases to non-communicable diseases (NCDs). With an increasing ageing population and life-style changes including tobacco use, harmful alcohol consumption, unhealthy diets, and insufficient physical activity, the proportion of total deaths from NCDs will continue to increase. An analysis of current diseases pattern and projections of the trends informs planning of health interventions. This analysis aims to project the mortality and risk factor of disease until 2040, based on past trends. Methods This study uses secondary data from the Global Burden of Disease (GBD) Study which analyses historic data from 1990 to 2016 to predict key variables such as, the mortality rates, life expectancy and Years of Life Lost for different causes of death from 2017 to 2040. ‘GBD Foresight Visualization’, a visualisation tool publicly available in the webpage of Institute for Health Metrics and Evaluation was the source of data for this analysis. GBD forecasting uses three-component modelling process: the first component captures variations due to risk factors and interventions, the second takes into consideration the variation due to measures of development quantified as social development index and the third uses an autoregressive integrated moving average model to capture the unexplained component correlated over time. We extracted Nepal specific data from it and reported number of deaths, mortality rates (per 100,000 population) as well as causes of death for the period 1990 to 2040. Results In 1990, CMNN diseases were responsible for approximately two-thirds (63.6%) of total deaths in Nepal. The proportion of the deaths from the CMNN diseases has reduced to 26.8% in 2015 and is estimated to be about a fifth of the 1990 figure (12.47%) in 2040. Conversely, deaths from NCDs reflect an upward trend. NCDs claimed a third of total deaths (29.91%) in the country in 1990, while in 2015, were responsible for about two-thirds of the total deaths (63.31%). In 2040, it is predicted that NCDs will contribute to over two-thirds (78.64%) of total deaths in the country. Less than a tenth (6.49%) of the total deaths in Nepal in 1990 were associated with injuries which increased to 13.04% in 2015 but is projected to decrease to 8.89% in 2040. In 1990, metabolic risk factors including high systolic blood pressure, high total cholesterol, high fasting plasma glucose, high body mass index and impaired kidney functions collectively contributed to a tenth of the total deaths (10.38%) in Nepal, whereas, in 2040 more than a third (37.31%) of the total deaths in the country could be attributed to it. Conclusion A reverse of the situation in 1990, NCDs are predicted to be the leading cause of deaths and metabolic risk factors are predicted to contribute to the highest proportion of deaths in 2040. NCDs could demand a major share of resources within the health sector requiring extensive multi-sectoral prevention measures, re-allocation of resources and re-organisation of the health system to cater for long-term care.
Objectives: To determine changes in the prevalence of sexually transmitted infection (STI)/HIV in female sex workers (FSWs) after a community HIV prevention intervention project in five border provinces of Vietnam. Methods: The project focused on providing user-friendly STI services for FSWs using mobile teams operating at multiple sites depending on local client preferences. 911 FSWs were enrolled at baseline and 982 in the exit survey. Study participants were interviewed about sociodemographic characteristics, sexual behaviour, history of STIs and selected features of their husbands or cohabiting partners, and were tested for STIs. Results: The overall prevalence rates of HIV, syphilis, herpes simplex virus 2 (HSV-2) antibodies, gonorrhoea (GC), Chlamydia trachomatis (CT), and GC and/or CT among FSWs in the five border provinces in 2004 were 3.6%, 12.9%, 24.9%, 2.9%, 9.1% and 11.3%, respectively. Compared with baseline values, GC and/or CT decreased significantly from 19.9% to 11.3%, GC from 10.7% to 2.9% and CT from 11.9% to 9.1%. HIV decreased from 4.5% to 3.6%, and HSV-2 antibodies from 27.7% to 24.9%. After adjustment for possible confounders, a significant overall decrease in having GC and/or CT (OR = 0.46, 95% CI 0.33 to 0.65; p,0.001) and GC alone (OR = 0.22, 95% CI 0.13 to 0.37; p,0.001) was found, and the overall prevalence of syphilis increased significantly (OR = 1.55, 95% CI 1.11 to 2.17 p = 0.011). A marked increase in syphilis from 1.0% to 14.1% was identified in the Lai Chau province. Conclusions: Implementation of the project was associated with a reduction in GC and/or CT infections in FSWs, more so with GC than with CT. A notable increase in syphilis in Lai Chau was identified. HIV/STI interventions in FSWs can be implemented by government services and should be intensified and expanded to other provinces.
Many students think they know how to use the Internet and the disconnection detected in the USA between libraries and students will be mirrored in the UK. The proliferation of material available makes our role to guide them towards the best information more relevant than ever. This can include a variety of approaches including sensible use of Google and Google Scholar alongside intute and our own subscription databases. Web 2.0 approaches have moved the agenda towards provision of more interactive solutions for engaging our students. Social networking sites, for example, Facebook, and social bookmarking sites like del.icio.us, give us new opportunities to promote ourselves and engage with our users. RSS feeds will be forming part of our teaching to researchers and provision of instant messaging information and advice may grow in the future. Podcasting, flickr and YouTube give us new formats for providing tours and enhancing our instructional material. Blogs can be used to discuss the use of resources, and wikis to build up resource lists. They can both be important sources for current information and students need to understand their strengths and weaknesses. Librarians have an important opportunity to use Web 2.0 tools to broaden and enhance their Information Literacy message.
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