Capacity Gaps Research Articles

Current state and future directions for youth sport evaluation practices: an empirical study

ABSTRACT Rationale : The study purpose was to understand the current state and future directions of evaluation within the youth-serving sport sector, given the changing circumstances brought about by the COVID-19 pandemic. Methodology : Using an exploratory approach, semi-structured interviews were conducted with 28 stakeholders who provide or support sport-based youth programming across community to national levels in the Canadian sport context. Findings : Analyses revealed five themes related to evaluation practices before and amid the pandemic. First, an overview of the state of evaluation in the sport sector was provided. The three subsequent themes outlined how organizations pivoted their evaluation priorities and practices throughout the pandemic in planning, implementation, and dissemination. The final theme provides stakeholders’ reflections on how to strengthen evaluation practices in the sport sector moving forward. Practical implications : Findings are important for highlighting where the field of youth sport is moving toward evaluation and capacity gaps that remain. This research has and will continue to inform future knowledge mobilization and capacity-building opportunities of evaluation best practices. Research contributions : This research advances the science of program evaluation by being the first to offer sport-specific perspectives on facilitators and barriers to evaluation both generally and during unprecedented times (e.g. global pandemic).

An integrated environmental nutrition model for dietary sustainability assessment

Environmental nutrition is gradually replacing the environmentally siloed sustainability assessment models to enhance sustainable dietary decisions. However, prominent concerns like the incomprehensive representation of nutritional quality and the difficulty in replicating existing models continue to limit the application of environmental nutrition. In addressing this, the current study presents an easily replicable and comprehensive nutrition mediated life cycle assessment approach termed the Environmental Impact Weighted Daily Value score (EIWDVs) model. This newly developed model comprehensively captures nutrient quantity in a daily value perspective as a nutritional indicator, and environmental impacts results as environmental indicators in the estimation of a nutrition mediated sustainability score. For validation purposes, the study applied this new model and the life cycle assessment (LCA) methodology, respectively, for comparing animal and plant-based foods within two major food categories: dairy products and analogs (e.g., cow milk versus soymilk) and meat and alternative meat products (e.g., beef sausage versus soy meatballs) in a defined future market scenario. Life cycle assessment and environmental nutrition results proved the plant-based alternatives to be sustainable dietary alternatives for achieving environmental nutrition co-benefits. For instance, production of soymilk and soy meatballs could offset up to 64–85% of global warming potential relative to cow milk and beef sausage. About 10% increase in offset values for global warming potential can be achieved when environmental nutrition is considered in dietary sustainability assessment. Nonetheless, the authors challenge the possibility of completely displacing animal-based diets, outlining existing gaps in global capacity and social acceptance, dynamic consumer behavior, and other socio-cultural factors as critical constraints to such a transition. Therefore, an integrated sustainable dietary system that considers plant and animal products with appreciable environmental nutrition performances is proposed as a feasible starting point for a gradual transition to a future of sustainable healthy dieting.

Is Nigeria on course to achieve universal health coverage in the context of its epidemiological and financing transition? A knowledge, capacity and policy gap analysis (a qualitative study)

ObjectivesThis study aimed to assess Nigeria’s preparedness to finance and drive the universal health coverage (UHC) agenda within the context of changing health conditions and resource needs associated with the...

Assessing the surge capacity of hospitals in Ugandan health care systems in managing the COVID-19 pandemic

IntroductionThe increasing cases of COVID-19 poses a threat on the over strained health care systems, especially in developing countries. Health care systems might need a surge to accommodate the ever increasing number of COVID1-19 cases. Hence, we assessed the Ugandan healthcare systems’ capacity to accommodate the surge in the increased caseloads, which might need admission and critical care due to COVID-19.ObjectivesUnderstanding the health systems capacity to accomadate the surge in increase caseload of COVID-19MethodsWe assumed that 2% of the Uganda population get symptomatic infections by COVID-19 based on modelled estimates of Uganda and ascertained the healthcare systems surge capacity for COVID-19 under three transmission curves scenarios; 6, 12 and 18 months. We estimated four measures for hospital surge capacity; ICU bed surge capacity, ICU bed tipping point, hospital bed capacity and hospital bed tipping point. Estimates were made for national level and 132 district local government.ResultsThe capacity of Ugandan health care system to accommodate the increasing numbers of cases due to COVID-19 is hindered by the lack of oxygen. Only 9 in 20 (46%) of hospital beds had oxygen supply. The hospital bed surge capacity varied across districts. Under the 12 months transmission scenario, the proportion of hospital with available beds, that would accommodate COVID-19 cases varied from 4% in Karomoja district, to 84% in Kampala district. The Ugandan healthcare systems faces a critical gap in ICU beds and ventilator capacity. Only 48 out of 132 districts had at least 1 ICU unit. An additional 2,247 bed and 2,756 ventilators (12 months transmission curve) will be needed to accommodate the caseloads due to COVID-19.ConclusionsThe capacity for Ugandan healthcare systems to manage to manage the COVID-19 caseloads is minimal. There need to address the sub-national variations in bed surge capacity, ICU units and ventilators within the Ugandan healthcare system.Disclosure of InterestNone Declared

Improving satellite-based monitoring of the polar regions: Identification of research and capacity gaps

We present a comprehensive review of the current status of remotely sensed and in situ sea ice, ocean, and land parameters acquired over the Arctic and Antarctic and identify current data gaps through comparison with the portfolio of products provided by Copernicus services. While we include several land parameters, the focus of our review is on the marine sector. The analysis is facilitated by the outputs of the KEPLER H2020 project. This project developed a road map for Copernicus to deliver an improved European capacity for monitoring and forecasting of the Polar Regions, including recommendations and lessons learnt, and the role citizen science can play in supporting Copernicus’ capabilities and giving users ownership in the system. In addition to summarising this information we also provide an assessment of future satellite missions (in particular the Copernicus Sentinel Expansion Missions), in terms of the potential enhancements they can provide for environmental monitoring and integration/assimilation into modelling/forecast products. We identify possible synergies between parameters obtained from different satellite missions to increase the information content and the robustness of specific data products considering the end-users requirements, in particular maritime safety. We analyse the potential of new variables and new techniques relevant for assimilation into simulations and forecasts of environmental conditions and changes in the Polar Regions at various spatial and temporal scales. This work concludes with several specific recommendations to the EU for improving the satellite-based monitoring of the Polar Regions.

Socio-ecological gap analysis to forecast species range contractions for conservation

Conservation requires both a needs assessment and prioritization scheme for planning and implementation. Range maps are critical for understanding and conserving biodiversity, but current range maps often omit content, negating important metrics of variation in populations and places. Here, we integrate a myriad of conditions that are spatially explicit across distributions of carnivores to identify gaps in capacity necessary for their conservation. Expanding on traditional gap analyses that focus almost exclusively on quantifying discordance in protected area coverage across a species' range, our work aggregates threat layers (e.g., drought, human pressures) with resources layers (e.g., protected areas, cultural diversity) to identify gaps in available conservation capacity (ACC) across ranges for 91 African carnivores. Our model indicated that all species have some portion of their range at risk of contraction, with an average of 15 percentage range loss. We found that the ACC differed based on body size and taxonomy. Results deviated from current perceptions of extinction risks for species with an International Union for Conservation of Nature (IUCN) threat status of Least Concern and yielded insights for species categorized as Data Deficient. Our socio-ecological gap analysis presents a geospatial approach to inform decision-making and resource allocation in conservation. Ultimately, our work advances forecasting dynamics of species' ranges that are increasingly vital in an era of great socio-ecological change to mitigate human-wildlife conflict and promote inclusive carnivore conservation across geographies.

Challenges to joint planning, monitoring, and evaluation for nutrition-sensitive agriculture in Ethiopia: an exploratory qualitative study

BackgroundNutrition-sensitive agriculture is an effective multi-sectoral approach to address the underlying causes of malnutrition. However, successful implementation requires the involvement of different sectors to jointly plan, monitor, and evaluate key activities, which is often challenged by contextual barriers. Previous studies in Ethiopia have not adequately explored these contextual barriers. Hence, the current study aimed to qualitatively explore the challenges to joint planning, monitoring, and evaluation for nutrition-sensitive agriculture among sectors in Ethiopia.MethodsA qualitative exploratory study was conducted in Tigray and Southern Nations, Nationalities, and Peoples (SNNP) of Ethiopia regional states in 2017. Ninety-four key informants were purposively selected from government agencies primarily in health and agriculture, from local (kebele) to national levels, and ranging from academic organizations, research institutions, and implementing partners. Researchers developed a semi-structured guide and conducted key informant interviews which were audiotaped, transcribed verbatim in local language, and translated to English. All transcriptions were imported into ATLAS.ti Version 7.5 software for coding and analysis. The data analysis followed an inductive approach. Transcriptions were coded line by line; then similar codes were grouped into categories. Subsequently, non-repetitive themes were identified from the categories using thematic analysis methodology.ResultsThe following themes were identified as challenges that hinder joint planning, monitoring, and evaluation to link nutrition to agriculture: (1) limited capacity, (2) workload in home sector (agriculture or nutrition), (3) lack of attention to nutrition interventions, (4) inadequate supportive supervision, (5) problematic reporting system, and (6) weak technical coordinating committees.Conclusions and recommendationsGaps in human and technical resources, limited attention from different sectors, and absence of routine monitoring data hindered joint planning, monitoring, and evaluation activities for nutrition-sensitive agriculture in Ethiopia. Short-term and long-term training for experts and intensification of supportive supervision may address gaps in capacity. Future studies should address whether routine monitoring and surveillance in nutrition-sensitive multi-sectoral activities provides long-term improvement in outcomes.

Priority skills for equity-focused, evidence-based cancer control in community-based organizations: A group concept mapping analysis with academics and practitioners.

Community-based organizations (CBOs) are important equity-promoting delivery channels for evidence-based interventions (EBIs). However, CBO practitioners often cannot access needed support to build EBI skills. Additionally, the capacity-building literature is hindered by inconsistent definitions, limited use of validated measures, and an emphasis on the perspectives of EBI developers versus implementers. To address these gaps, we explored commonalities and differences between CBO practitioners and academics in conceptualizing and prioritizing core EBI skills. We utilized Group Concept Mapping, a mixed-methods approach connecting qualitative data (e.g., regarding the range of critical EBI skills) and quantitative data (e.g., sorting and ranking data regarding unique skills) to create conceptual maps integrating perspectives from diverse participants. A total of 34 practitioners and 30 academics working with cancer inequities participated in the study. Participants nominated 581 core skills for EBI use, and our team (including practitioners and academics) identified 98 unique skills from this list. Participants sorted them into conceptual groups, yielding five clusters: (1) using data and evaluation, (2) selecting and adapting EBIs, (3) connecting with community members, (4) building diverse and equitable partnerships, and (5) managing EBI implementation. The ordering of importance and presence of skill clusters were similar across groups. Overall, importance was rated higher than presence, suggesting capacity gaps. There are helpful commonalities between practitioners' and academics' views of core EBI skills in CBOs and apparent capacity gaps. However, underlying patterns suggest that differences between the groups' perceptions warrant further exploration.

Major hazard industries disaster preparedness: an empirical study of liquefied petroleum gas storage facilities

Liquefied petroleum gas (LPG) storage facilities storing more than 50 tonnes of LPG are classified as major hazard installations (MHIs). This industry involves highly flammable hydrocarbon chemicals that can cause destruction of property and endanger human lives. This study aims to investigate the level of disaster preparedness among 23 LPG storage facilities in Malaysia. The preparedness performance of the facilities was assessed through a five-point instrument measure in six preparedness domains. For overall preparedness, 60% of LPG facilities were rated poor or weak, and remaining 40% were rated as good or satisfactory. This indicates a serious gap in the overall current capacity of the majority of facilities to respond to major hazard disasters. Across all facilities, 'risk assessment' was the best performance domain, while the worst was 'emergency exercise'. The findings provide an overview of the level of preparedness that can guide areas of improvement among LPG facilities in Malaysia.

Piloting the rapid R-MEET framework at a coastal Ramsar Site

Context The Ramsar Convention on Wetlands is critical to conserving wetlands. However, it has received much criticism, particularly about the inadequacy of reporting by Contracting Parties. Aim We previously developed a rapid assessment tool called the Rapid Ramsar Management Effectiveness Evaluation Tool (Rapid R-MEET) to alleviate the reporting burden and emphasise the Convention’s priorities. Methods In this paper, we pilot this tool in the Caroni Swamp Ramsar Site in Trinidad. We also conduct a policy-gap analysis to understand the context in which management decisions are being made. Key results We found serious gaps in management capacity and a complex institutional context in which wetland decision-making takes place that undermine the successful implementation of the Ramsar Convention in the twin island nation. Conclusions These limitations have created a system of Ramsar Sites with minimal monitoring, research, and enforcement to achieve the Convention’s goals, particularly crippling reporting on ecological character. Implications Better coordination among agencies involved in wetland management, as well as more robust resourcing for management, is needed to achieve wetland conservation goals at the national and site levels. We also found that the Rapid R-MEET can be completed efficiently and effectively by external researchers, providing an avenue to increase collaboration, support under-resourced management teams, and improve reporting to the Convention.

Toward a New Paradigm of North-South and South-South Partnerships for Pandemic Preparedness: Lessons Learned from COVID-19 and Other Outbreaks.

COVID-19 underscores the need to reimagine North-South partnerships and redefine best practices for building public health and research capacity to address emergent health threats and pandemic preparedness in low- and-middle income countries (LMICs). Historically, outbreak and emergency responses have failed to ensure that the Global South has the autonomy and capacity to respond to public health threats in a timely and equitable manner. The COVID-19 response, however, has demonstrated that innovations and solutions in the Global South can not only fill resource and capacity gaps in LMICs but can also provide solutions to challenges globally. These innovations offer valuable lessons about strengthening local manufacturing capacity to produce essential diagnostic, treatment, and prevention tools; implementing high-quality research studies; expanding laboratory and research capacity; and promoting effective cooperation and governance. We discuss specific examples of capacity-building from Rwanda, South Africa, and Senegal. To fulfill promises made to the Global South during the COVID-19 pandemic, restore and resume health service delivery, and effectively prevent and respond to the next health threat, we need to prioritize equitable access to local manufacturing of basic health tools while building health systems capacities in the Global South.

Does the Public Health Security Capacity Provide Better Preparedness for Health Emergencies? A Cross-Sectional Analysis of 180 Countries During the COVID-19 Outbreak.

This study aimed to investigate the association between the health security capacities at the national level and preparedness for health emergencies in response to the COVID-19 outbreak. Data were extracted from the GHS report to evaluate the global health security capabilities in 180 countries. A linear regression analysis was performed with COVID-19 outcomes, as measured by the rate of incidence and vaccination doses, CFR, and PCR tests. Spearman correlation was used among potential explanatory factors. The GHS Index was inversely correlated with CFR and incidence rates, whereas it was positively associated with the vaccination and the PCR test rates. Countries with high health security capacities were significantly more likely to provide better preparedness for health emergencies in response to the outbreak. However, the vaccination doses' rate and the number of PCR tests were significantly differ depending on countries' income levels. Although health security capacity is essential to control public health emergencies effectively, it cannot predict whether or how well a country will use them in a crisis. Policymakers should identify their risk factors and capacity gaps and take into consideration the building of health security capacities in national budgets for long-term public health preparedness.

Adept to Adapt: Closing the Gender Capacity Gaps for Scaling Up System of Crop Intensification

The system of rice intensification (SRI) has been introduced as an alternative system for growing rice with lesser inputs and water. Labour is one of the most crucial concerns in the adoption of SRI by farmers. The adaptation to newer methods of rice cultivation is presumed to be easier if the workforce is adept to adapt. The new skills needed to adopt SRI, are transplanting young and single seedlings and use of mechanical weeders. The present study was therefore, undertaken, to identify training needs of women farmers in SRI cultivation. Line sowing was perceived as a new skill to be acquired and rated as highly skilful. Close attention was needed by women farmers/labour to systematically plant within the square. The paper attempts to apply the components of the community capitals framework (CCF) developed by Cornelia and Jan Flora (2013), for closing the gender capacity gaps in the uptake and scaling up of SCI/SRI. The seven forms of capital in this framework are considered not only as individual capabilities and endowments but are viewed as collective resources and are to be considered in the specific order of natural, cultural, human, social, political, financial and built capital. In this paper emphasis is being given to build the Human and Social Capital for closing the gender capacity gaps for scaling up SCI/SRI. There is immense scope of harnessing the potential of training members of women’s self-help groups (SHG) to form a SRI task force to help in the wide spread adoption of SRI by farmers.

Investing in global health security: Estimating cost requirements for country-level capacity building.

The COVID-19 pandemic has highlighted critical gaps in global capacity to prevent, detect, and respond to infectious diseases. To effectively allocate investments that address these gaps, it is first necessary to quantify the extent of the need, evaluate the types of resources and activities that require additional support, and engage the global community in ongoing assessment, planning, and implementation. Which investments are needed, where, to strengthen health security? This work aims to estimate costs to strengthen country-level health security, globally and identify associated cost drivers. The cost of building public health capacity is estimated based on investments needed, per country, to progress towards the benchmarks identified by the World Health Organization's Joint External Evaluation (JEE). For each country, costs are estimated to progress to a score of "demonstrated capacity" (4) across indicators. Over five years, an estimated US$124 billion is needed to reach "demonstrated capacity" on each indicator of the JEE for each of the 196 States Parties to the International Health Regulations (IHR). Personnel costs, including skilled health, public health, and animal health workers, are the single most influential cost driver, comprising 66% of total costs. These findings, and the data generated by this effort, provide cost estimates to inform ongoing health security financing discussions at the global level. The results highlight the significant need for sustainable financing mechanisms for both workforce development and ongoing support for the health and public health workforce.

Participatory Engagement as a Governance Factor Influencing Performance of Devolved Health Care in Kenya

The purpose of devolving the sector was to give county governments the freedom to create novel models and interventions that were tailored to the specific health needs of their communities, to promote effective citizen participation, and to make independent, prompt decisions regarding potential problems with resource mobilization and management. However, the sector is today plagued by enormous problems including capacity gaps, human resource shortages, a lack of vital institutional and legal infrastructure, widespread corruption, and a tense relationship with the federal government. Overall, these issues have caused healthcare to stagnate and even reverse certain improvements, as measured by health indices. Without a question, adequate institutionalization is required to assure good governance and effective public participation in a rights-based approach to health service delivery. The objective of the study was to determine how citizen participation as a governance factor influences organizational performance of devolved health care sector in Kenya. Responsiveness by the county government was used as the moderating variable of the study. The current study utilized descriptive research design and involved cross-sectional collection of data in 47 counties across the country focusing on a number of selected officials who gave information regarding governance factors influencing devolved health care sector in Kenya.Since the study utilized census sampling, the 47 county referral hospitals were targeted. Further purposive sampling was used to arrive at the 188 selected respondents who became the sample size of the study. The study combined the elements of both quantitative and qualitative methods of data collection. Descriptive statistics was used to outline the fundamental characteristics regarding the collected information in the research. Analysis of Variance (ANOVA)table techniques and beta coefficient tables were utilized in the presentation of regression analysis outcomes. The findings of the study revealed that participatory engagement of citizens had positive significant relationship with organizational performance of devolved health care sector. Moreover, with the inclusion of responsiveness by county governments the moderating effect on participatory engagement variable was found to be significant on the organizational performance of devolved health care sector. The study recommends that there is need for the health care sector function to be devolved to the counties to allow for more budgetary allocations, citizen inclusivity in decision making, timely response to health care needs, government planning and interventions and management accountability and transparency. The study also recommends further research on the challenges to involve citizens inthe successful execution of devolved health sector in Kenya. Education should be put as a requirement of participatory processes, since the public needs to be educated to participate in matters regarding health care. Policy makers are also recommended to encourage participatory engagement of citizens as this would provide necessary feedback on what is working and not in order to promote service delivery.

Pulse oximeter provision and training of non-physician anesthetists in Zambia: a qualitative study exploring perioperative care after training

BackgroundPulse oximetry monitoring is included in the WHO Safe Surgery Checklist and recognized as an essential perioperative safety monitoring device. However, many low resource countries do not have adequate numbers of pulse oximeters available or healthcare workers trained in their use. Lifebox, a nonprofit organization focused on improving anesthetic and surgical safety, has procured and distributed pulse oximeters and relevant educational training in over 100 countries. We aimed to understand qualitatively how pulse oximetry provision and training affected a group of Zambian non-physician anesthetists’ perioperative care and what, if any, capacity gaps remain.MethodsWe identified and approached non-physician anesthetists (NPAPs) in Zambia who attended a 2019 Lifebox pulse oximetry training course to participate in a semi-structured interview. Interviews were audio recorded and transcribed. Codes were iteratively derived; the codebook was tested for inter-rater reliability (pooled kappa > 0.70). Team-based thematic analysis identified emergent themes on pulse oximetry training and perioperative patient care.ResultsTen of the 35 attendees were interviewed. Two themes emerged concerning pulse oximetry provision and training in discussion with non-physician anesthetists about their experience after training: (1) Impact on Non-Physician Anesthetists and the Healthcare Team and (2) Impact on Perioperative Patient Monitoring. These broad themes were further explored through subthemes. Increased knowledge brought confidence in monitoring and facilitated quick interventions. NPAPs reported improved preoperative assessments and reaffirmed the necessity of having pulse oximetry intraoperatively. However, lack of device availability led to case delays or cancellations. A portable device travelling with the patient to the recovery ward was noted as a major improvement in postoperative care. Pulse oximeters also improved communication between nurses and NPAPs, giving NPAPs confidence in the recovery process. However, this was not always possible, as lack of pulse oximeters and ward staff unfamiliarity with oximetry was commonly reported. NPAPs expressed that wider pulse oximetry availability and training would be beneficial.ConclusionAmong a cohort of non-physician anesthetists in Zambia, the provision of pulse oximeters and training was perceived to improve patient care throughout the perioperative timeline. However, capacity and resource gaps remain in their practice settings, especially during transfers of care. NPAPs identified a number of areas where patient care and safety could be improved, including expanding access to pulse oximetry training and provision to ward and nursing staff to ensure the entire healthcare team is aware of the benefits and importance of its use.

A framework for advancing sustainable magnetic resonance imaging access in Africa.

Magnetic resonance imaging (MRI) technology has profoundly transformed current healthcare systems globally, owing to advances in hardware and software research innovations. Despite these advances, MRI remains largely inaccessible to clinicians, patients, and researchers in low-resource areas, such as Africa. The rapidly growing burden of noncommunicable diseases in Africa underscores the importance of improving access to MRI equipment as well as training and research opportunities on the continent. The Consortium for Advancement of MRI Education and Research in Africa (CAMERA) is a network of African biomedical imaging experts and global partners, implementing novel strategies to advance MRI access and research in Africa. Upon its inception in 2019, CAMERA sets out to identify challenges to MRI usage and provide a framework for addressing MRI needs in the region. To this end, CAMERA conducted a needs assessment survey (NAS) and a series of symposia at international MRI society meetings over a 2-year period. The 68-question NAS was distributed to MRI users in Africa and was completed by 157 clinicians and scientists from across Sub-Saharan Africa (SSA). On average, the number of MRI scanners per million people remained at less than one, of which 39% were obsolete low-field systems but still in use to meet daily clinical needs. The feasibility of coupling stable energy supplies from various sources has contributed to the growing number of higher-field (1.5 T) MRI scanners in the region. However, these systems are underutilized, with only 8% of facilities reporting clinical scans of 15 or more patients per day, per scanner. The most frequently reported MRI scans were neurological and musculoskeletal. The CAMERA NAS combined with the World Health Organization and International Atomic Energy Agency data provides the most up-to-date data on MRI density in Africa and offers a unique insight into Africa's MRI needs. Reported gaps in training, maintenance, and research capacity indicate ongoing challenges in providing sustainable high-value MRI access in SSA. Findings from the NAS and focused discussions at international MRI society meetings provided the basis for the framework presented here for advancing MRI capacity in SSA. While these findings pertain to SSA, the framework provides a model for advancing imaging needs in other low-resource settings.

Women Political Leaders’ Participation in Local Decision-Making Structures in Tanzania

Purpose: This paper envisioned examining the participation of women political leaders in the local decision-making organs in Tanzania. Specifically, the study aimed to examine the number of women represented in the study local government structures (LGSs), the motives behind women participating in the LGSs and the duration of service in the study LGSs.
 Design/Methodology/Approach: The study used a cross-sectional descriptive research design. A cluster sampling technique was used to obtain the study villages and Mitaa. Both quantitative and qualitative research approaches with different data collection methods were used. To collect quantitative data, questionnaires were administered to 390 household heads both men and women in the study villages/Mitaa, while qualitative data were gathered using an interview guide, Focus Group Discussion (FGD) and non-participant observation checklist. Quantitative data collected were analyzed and presented in tables and figures while the qualitative ones were thematically analyzed.
 Findings: The study revealed that the number of women's participation in various local committees in the study of local government structures has increased by 50% (Dodoma City) and 30% (Bahi District). However, motives for women leaders’ participation are constrained by limited continuity of tenure in the political office. Therefore, suitable interventions are recommended to address the existing capacity gaps.
 Research Limitation: The study targeted to involve an equal number of men and women household heads in each study village and Mitaa, however in some villages it happened to have less number of women than men household heads.
 Practical implication: This study recommends that more spaces should be given to women to participate in local decision-making structures and hold seats to enhance gender equality in politics.
 Originality/Value: This study focuses on the gender parity framework in local politics. It brings an understanding to the various government departments, ministries responsible for women and other stakeholders regarding the opportunities available for women to participate in local politics.

Review of maternal death audits in refugee camps in UNHCR East and Horn of Africa and Great Lakes Region, 2017-2019.

To review the quality of maternal death audits and identify factors contributing to refugee maternal deaths in the East and Horn of Africa. Maternal death audits submitted to The UN Refugee Agency (UNHCR) from 2017 to 2019 in 43 refugee camps in eight countries were analyzed for completeness, obstetric history, cause of death, and contributing factors. A total of 191 refugee maternal death audits were retrieved. The mean age of the deceased was 28 years (range, 15-45 years), and 13% were adolescents and 17% were of advanced maternal age. Most patients (55%) were grand multigravida (≥5 pregnancies). The majority (86%) attended antenatal care visits, with 51% attending four or more visits. Among women who delivered (n= 140), 91% were facility-based deliveries. Most (68%) deaths occurred postpartum. Obstetric hemorrhage (49%) was the leading direct cause of death (with 77 cases of postpartum hemorrhage), followed by hypertensive disorder (19%) and infection (15%). Delays in care were identified in 185 (97%) cases. Delays in receiving care were more prevalent (81%) than in seeking (61%) and reaching (26%) care. Factors contributing to delays in receiving care highlight the capacity gaps in provision of emergency obstetric care, including management of postpartum hemorrhage, requiring urgent additional investments. Audit findings also show the need for attention and action towards family planning, contraception, and adolescent sexual and reproductive health services.

63 Translational Research Capacity in Canadian Pediatric Emergency Departments Participating in the Precision Medicine for Improving the Diagnosis of Pediatric Appendicitis in the Emergency Department (PRIMED) Study

Abstract Background Pediatric clinical and translational research are essential to acquire effective diagnostic and treatment options for children, but they are underfunded and under prioritized in comparison to research focused on treatments for adults. The Precision Medicine for Improving the Diagnosis of Pediatric Appendicitis in the Emergency Department (PRIMED) study aimed to characterize the proteomic and metabolic bio-profiles of children with appendicitis and to investigate these bio-profiles as a clinical prediction tool. Objectives In this current work, we aimed to evaluate translational research capacity at Canadian pediatric Emergency Departments (EDs) and to describe some of the challenges experienced in the implementation of the PRIMED study and various strategies used to improve local research capacity. Design/Methods Participating sites provided basic demographic and administrative data along with laboratory- and human-resource availability during enrolment for the PRIMED study. Data was summarized using descriptive statistics. Eleven pediatric EDs participated in the PRIMED study. Results Six study hospitals (54.5%) used on-site clinical laboratories to process research samples; the remaining hospitals (5/11, 45.5%) required access to research facilities, of which two (18.2%) were off-site. Fewer than two thirds of the study sites (7/11, 63.6%) had any laboratory that would process samples 24 hours per day. Four study sites (36.4%) only enrolled patients during business hours and over half of the sites (6/11, 54.5%) were unable to collect samples for the entire 17:00 to 21:00 peak when the greatest number of pediatric patients present to the ED (Figure 1). There was no nighttime coverage for patient enrollment and sample collection and only three study sites (3/11, 27.3%) had enrollment hours that captured over 75% of the potential study participants. Over half (6/11, 54.5%) of the PRIMED study sites developed novel processes to enable study success, for example creating graduate student on-call schedules and hiring bioscience trained site coordinators to perform sample processing requirements. Conclusion Despite site-specific efforts to overcome resource barriers, the gap in translational research capacity at academic pediatric emergency departments remains a significant concern. University research institutes and pediatric hospitals should invest in infrastructure and human resources to increase after-hours clinical and translational research capacity to optimize child health and wellness outcomes.