Main Client Research Articles

Položaj kraljevačkih novčanih zavoda u bankarskom sistemu Kraljevine Jugoslavije

Banking business activity in Kraljevo stretches back from 1885, from the foundation of the Kraljevo's Shareholder Saving Bank and until the WWI three local monetary institutes were doing their business activity. Sufferings in the war and altered labour conditions caused that Kraljevo's Economic Bank for Commerce and Industry and Kraljevo's Shareholder Economic Bank carry out the fusion, and that new institute was called the Kraljevo's Economic Bank. During the first after war years, the institutes constantly increased their principal funds, and where in 1924 the third institute had been founded - the Kraljevo's Commercial Credit Institute, the possibility of the financing of city's economy was facilitated. In comparison with other centres in Serbia, Kraljevo's banks from collective point of view disposed of the least basic capital funds, but relations of the amount of capital funds as per the bank numbers makes us knowledgeable that Kraljevo's banks disposed of similar amounts of capital funds as the largest number of banks in other cities. In case we compare the amount of capital funds with the number of citizens, it is noticeable that the residents of Kraljevo disposed of more resources in comparison with the centres as Niš or Kragujevac. Although this data may point out at first sight greater possibility of Kraljevo's banks for the economic development of the place, it is the fact that all cities and towns, even the centres in Serbia, disposed with insufficient capital funds in order to be able to develop more intensively from economic point of view. The prosperity in the operation of Kraljevo's banks lasted until 1931 after that the banking crisis in the Kingdom of Yugoslavia disabled normal work of monetary institutes. The main clients of Kraljevo's banks were, starting from 1925, farmers so that the moratorium on the repayment of agricultural debts in 1932 paralyzed the work of banks. In that way Kraljevo's banks are found in the position as the largest number of the banks in the state, thus they were found under the protection as per the Regulation on the Protection of Monetary Institutes or their bailers or they reduced their business activity tithe repayment of old saving deposits.

Facilitators to Immediate Post Partum Intra Uterine Contraceptive Device Uptake among Mothers Delivering in Meru Hospital

Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is important to promote uptake of family planning services because it is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. It is also enshrined in health related Sustainable Development Goals. Post Partum Intra Uterine Contraceptive Device (PPIUCD) is the oldest methods of family planning. During the ancient times, foreign bodies like stones were introduced into the woman’s uterus for prevention of pregnancy. Post partum method of contraception is highly recommended because it is long acting, convenient, safe and highly effective with minimal side effects compared to the hormonal methods. Despite these advantages, the method is the lowest in use globally, regionally and locally. According to the Meru Hospital records for the year 2017, the immediate PPIUCD uptake was very low at 3.4%. The broad objective of this study was to assess the factors that facilitate uptake of PPIUCD at Meru Hospital. The study site was post natal ward maternity department of Meru Hospital for a period of two months that is September and October in the year 2018. A descriptive research design was used and the study population was the mothers who were admitted in the ward during the study period. A sample size of 74 respondents was used as the representative to the target population of 289 mothers. Simple random sampling was used to get the sample for the facilitators. Data were collected using structured questionnaires and interview schedules. The data collection instruments were pretested at Embu Level five Hospital and split half reliability test technique used. Validity was ensured through review of literature from similar studies and by consulting supervisors in the department. Permission to conduct the study was sought from National Commission for Science, Technology and Innovation through Chuka University Ethics and Research Committee. Descriptive analysis was done to get percentages using Statistical Package for Social Science (SPSS) for windows version 23.0. Qualitative data were analyzed by grouping data into themes according to the study objectives. The analyzed data were presented in tables, charts and narratives. The findings of the study revealed that; the main client related facilitators to PPIUCD uptake were older age above 30 years, employment, tertiary level of education and knowledge on the method as a result of the providers’ effort to share information. That is 70% of older aged mothers, 60% of the employed and 40% with tertiary education had the insertion. The main provider facilitator to PPIUCD uptake was timely counseling and insertion services. 20% of those who had the insertion said that timely counseling was done during antenatal period. The main method related facilitator to PPIUCD uptake was past experience and preference to alternative methods of contraception. 50% of those who accepted the insertion had previous bad experience and side effects of other alternative methods. Some 30% of users perceived that the method was effective and convenient because once inserted no need for frequent visits to the clinic. The study concluded that clients, providers and method factors facilitated uptake of immediate PPIUCD. The study recommends putting in place strategies to improve the uptake of the method by considering the client, provider and method related facilitators.

The Visit Rate of Bardejov Spa in the Context of its History

Abstract The main objective of this article was to evaluate the impact of historical events on the visit rate of Bardejov Spa in various periods of its development (in the years of 1814–2016). The collection of information on clients’ spa visits, especially the oldest data, was difficult (19th century and 1st and 2nd World War). Much information was available only in the State Archive of the Ministry of the Interior of the Slovak Republic in Hungarian and Latin. Some data for several years were not available at all, and some data were not recorded in writing. The paper summarizes the history of the spa, natural medical sources, spa treatment and indications. At present, the number of guests has an increasing trend, as evidenced by the visit rate for 2016, as well as by current data for 2017. In 2016, Bardejov Spa reached a pick of the visit rate with 25,863 clients. In 2017, there were 27,170 clients. The main clients are the Slovaks, about 90%.

Migrants and language learning in Russia (late seventeenth–first part of eighteenth century)

ABSTRACTIn the eighteenth and early nineteenth centuries Russia experienced a considerable lack of teachers. In this situation, foreign migrants became Russia’s preferred teachers for more than a century. Foreigners were particularly welcome to teach languages and a whole range of other subjects such as history, geography, and mathematics. All teaching was done in a foreign language. Foreigners became important actors in cultural transfers from Western Europe to Russia. Social elites (the nobility, particularly its upper strata) became the main clients of these foreign teachers. This process ended up producing several generations of aristocracy possessing a sort of hybrid culture, both Russian and Western-European with a particular predominance of French culture starting from the generation of the middle of the eighteenth century. In my paper I will first analyse the national composition of the teaching staff in some major Russian educational institutions, first and foremost the institutions for the nobility or in which noble students were present, and in private education; then I will give a brief overview of the geographical origin of the students in these institutions. I will finally analyse the positive aspects as well as the problems caused by this situation and will show what reactions the predominance of foreign teaching staff in Russia provoked in Russian society.

The insoluble problems of books: what does Altmetric.com have to offer?

PurposeThe purpose of this paper is to analyze the capabilities, functionalities and appropriateness of Altmetric.com as a data source for the bibliometric analysis of books in comparison to PlumX.Design/methodology/approachThe authors perform an exploratory analysis on the metrics the Altmetric Explorer for Institutions, platform offers for books. The authors use two distinct data sets of books. On the one hand, the authors analyze the Book Collection included in Altmetric.com. On the other hand, the authors use Clarivate’s Master Book List, to analyze Altmetric.com’s capabilities to download and merge data with external databases. Finally, the authors compare the findings with those obtained in a previous study performed in PlumX.FindingsAltmetric.com combines and orderly tracks a set of data sources combined by DOI identifiers to retrieve metadata from books, being Google Books its main provider. It also retrieves information from commercial publishers and from some Open Access initiatives, including those led by university libraries, such as Harvard Library. We find issues with linkages between records and mentions or ISBN discrepancies. Furthermore, the authors find that automatic bots affect greatly Wikipedia mentions to books. The comparison with PlumX suggests that none of these tools provide a complete picture of the social attention generated by books and are rather complementary than comparable tools.Practical implicationsThis study targets different audience which can benefit from the findings. First, bibliometricians and researchers who seek for alternative sources to develop bibliometric analyses of books, with a special focus on the Social Sciences and Humanities fields. Second, librarians and research managers who are the main clients to which these tools are directed. Third, Altmetric.com itself as well as other altmetric providers who might get a better understanding of the limitations users encounter and improve this promising tool.Originality/valueThis is the first study to analyze Altmetric.com’s functionalities and capabilities for providing metric data for books and to compare results from this platform, with those obtained via PlumX.

Inequality in utilization of cesarean delivery in Bangladesh: a decomposition analysis using nationally representative data

ObjectiveThis study examined the inequality in cesarean section (CS) utilization and its socio-economic contributors. Study designRetrospective two-stage stratified sample design. MethodsData were extracted from two rounds of the Bangladesh Demographic and Health Survey conducted in 2004 and 2014. Concentration Index of CS utilization was calculated using the wealth quintile. Regression-based decomposition method was applied to assess the socio-economic contributors of inequality in CS utilization. ResultsThe rate of CS utilization increased from 4.98% in 2004 to 24.21% in 2014. The utilization of CS was highly concentrated among the women of higher socio-economic status (SES) in both rounds of the survey. Results of the decomposition models revealed wealth quintile, higher education, higher number of antenatal visits, and being overweight or obese as the critical factors contributing to the inequalities of CS utilization. ConclusionBangladesh is now observing a rapid rise in CS utilization and women with higher SES are the main client group of this life saving procedure. There may have inadequate access for those who are relatively less advantaged, even when CS is necessary. Strong initiative from the government is necessary to ensure proper access to this service regardless of women's SES.

СЪВРЕМЕННИ АСПЕКТИ ПРИ ИЗБОРА НА ИНСТРУМЕНТИ И ТЕХНОЛОГИИ ЗА РАЗРАБОТВАНЕ НА WEB-САЙТОВЕ

he report explores and analyzes the application of the most popular programming languages from different organizations: GitHub; Stackoverflow; the TIOBE's Community index. The main client technologies: HTML; CSS; JavaScript; Typescript are presented and analysed. Features are characterized and the advantages and the disadvantages of the server technologies are described: Java; PHP; Python; Ruby. The application areas for web site development technologies have been defined. The creation of a quality web site is a complex and complicated process, but by observing some guidelines and recommendations in the work process can help to select the tools and the technologies in its design and development.

Educational Quality Gap from Students' Viewpoints; Results from a Survey in Mashhad University of Medical Sciences

Introduction: Students are the main clients for an educational system. It is believed that using their viewpoints to determine the educational gap is of great value. This can also help to promote educational programs. The aim of this study was to evaluate educational service quality based on students’ points of view in Mashhad University of Medical Sciences (MUMS) in 2016. Method: In a cross-sectional design, 540 students from all seven faculties of MUMS were surveyed. Quota-stratified-cluster sampling method was used to recruit post third-semester students. We used the validated SERVQUAL questionnaire which had 27 paired questions for measuring service quality in 5 domains: Assurance, Responsiveness, Empathy, Confidence and Tangibles. SPSS 16 with p Results: Mean age was 22.7±4.2 years. Sixty-one percent (327) were female. There was a significant negative gap in all domains in all faculties (p<0.001). The highest and lowest gap of MUMS was in responsiveness (-33.8±22.2) and confidence (-26.9±20.9), respectively. Dentistry (-41.4±21.6) and medicine (-30.7±15.7) faculties had the highest and nursing (-25.6±17.2) and health (-25.8±14.9) faculties had the lowest educational quality gap. No gender difference was found. Increasing semester worsened the quality gap in four domains (from r=-0.09, p=0.04 up to r=-0.20, p<0.001). Conclusions: A negative gap in all domains in all faculties shows that students' expectations are not met properly. We believe that some of these gaps can be easily solved by proper management and reconstruction of presenting services.

Lack of a peroxiredoxin suppresses the lethality of cells devoid of electron donors by channelling electrons to oxidized ribonucleotide reductase.

The thioredoxin and glutaredoxin pathways are responsible of recycling several enzymes which undergo intramolecular disulfide bond formation as part of their catalytic cycles such as the peroxide scavengers peroxiredoxins or the enzyme ribonucleotide reductase (RNR). RNR, the rate-limiting enzyme of deoxyribonucleotide synthesis, is an essential enzyme relying on these electron flow cascades for recycling. RNR is tightly regulated in a cell cycle-dependent manner at different levels, but little is known about the participation of electron donors in such regulation. Here, we show that cytosolic thioredoxins Trx1 and Trx3 are the primary electron donors for RNR in fission yeast. Unexpectedly, trx1 transcript and Trx1 protein levels are up-regulated in a G1-to-S phase-dependent manner, indicating that the supply of electron donors is also cell cycle-regulated. Indeed, genetic depletion of thioredoxins triggers a DNA replication checkpoint ruled by Rad3 and Cds1, with the final goal of up-regulating transcription of S phase genes and constitutive RNR synthesis. Regarding the thioredoxin and glutaredoxin cascades, one combination of gene deletions is synthetic lethal in fission yeast: cells lacking both thioredoxin reductase and cytosolic dithiol glutaredoxin. We have isolated a suppressor of this lethal phenotype: a mutation at the Tpx1-coding gene, leading to a frame shift and a loss-of-function of Tpx1, the main client of electron donors. We propose that in a mutant strain compromised in reducing equivalents, the absence of an abundant and competitive substrate such as the peroxiredoxin Tpx1 has been selected as a lethality suppressor to favor RNR function at the expense of the non-essential peroxide scavenging function, to allow DNA synthesis and cell growth.

Negotiating client positions: parents with custodial disagreements talking about their experiences with child welfare workers

Children living with prolonged parental custodial disagreements are in a vulnerable position and may be in need of child welfare assistance. However, the responsibilities of the child welfare service (CWS) in cases involving custodial disagreements are unclear. This article examines how parents with custodial disagreements narrate and make meaning of their encounters with child welfare caseworkers. These professional encounters occur in a legal grey zone between the family law system, dealing with issues of residence and contact, and the child welfare system, dealing with issues of possible child abuse or inadequate care. The article draws on interviews with 15 Norwegian parents, and uses clientization and positioning as analytic tools to analyse the parents’ accounts of how they are categorized by the professionals. More precisely, by introducing the concept of client position, the article shows how parents describe their negotiations with caseworkers regarding what constitute problems in the family and how these problems might be dealt with. The analysis identified three main client positions being available for parents in grey zone cases: the legitimately concerned parent, the parent in conflict, and the parent lacking ability to care. Implications for the child’s client position and prospect of child welfare involvement are discussed.

JEPM April 2017—Abstracts

This study examined the inequality in cesarean section (CS) utilization and its socio-economic contributors.Retrospective two-stage stratified sample design.Data were extracted from two rounds of the Bangladesh Demographic and Health Survey conducted in 2004 and 2014. Concentration Index of CS utilization was calculated using the wealth quintile. Regression-based decomposition method was applied to assess the socio-economic contributors of inequality in CS utilization.The rate of CS utilization increased from 4.98% in 2004 to 24.21% in 2014. The utilization of CS was highly concentrated among the women of higher socio-economic status (SES) in both rounds of the survey. Results of the decomposition models revealed wealth quintile, higher education, higher number of antenatal visits, and being overweight or obese as the critical factors contributing to the inequalities of CS utilization.Bangladesh is now observing a rapid rise in CS utilization and women with higher SES are the main client group of this life saving procedure. There may have inadequate access for those who are relatively less advantaged, even when CS is necessary. Strong initiative from the government is necessary to ensure proper access to this service regardless of women's SES.

State-Business Relations and Clientelism in Qatar

The business community has emerged as one of the main clients of the state in Qatar. This clientelistic relationship is anchored in three main developments. First, given the multiple commercial and familial linkages between Qatari merchants and individuals occupying the central organs of the state, divisions between the “state” and “business” are more conceptual than actual in Qatar. Second, family and clan dynamics are often highly consequential in shaping patterns of interaction between Qatari merchants and the state, and specifically the Al Thani ruling family. Third, these interactions occur within and between concentric circles of power and influence that begin with a small core of political and economic decision-makers and extend to successive layers of society. In the process, the erosion of the private sector’s autonomy to the centralized, rentier state is further accentuated through its dependence on multiple and overlapping clientelistic networks and linkages connecting the state to the inner reaches of the Qatari society.

A Multi-criteria Framework for Decision Process in Retrofit Optioneering through Interactive Data Flow

Aim of this research is to deliver a system of procedures and instruments that allows comparing different scenarios of restoration and retrofit of existing buildings applicable each time a relevant decision about the asset has to be made. The system developed takes advantages of Building Information Modeling (BIM) and Analytical Hierarchy Process (AHP), thus to focus on main clients’ needs. Decisions about real estate assets are frequently made by managers with incomplete and scattered data, not sufficient to fully support the decision making process. Using a BIM model as a central repository of information could strongly support to compare objectively different scenarios and consequently to decide the application of a multi-criteria matrix involving management, energy, economic and social issues. BIM and BEM (Building Energy Modelling) techniques have a wide potential and analysis capabilities; however, they are often adopted without an integrated framework, causing missing performances and costs overrun. The result is a system enabling to analyze the asset, to produce BIM and BEM models ready to include life cycle data, to evaluate feasible alternatives and scenarios and to extract relevant performance indicators for decision makers’ support. An existing office building in Milan representing an awkward field for intervention is the case study for the system application. While the tools and software adopted are commonly used, the system of procedures developed by the authors can be considered as an ensemble of workflows otherwise typically used independently. Using them together enhance the decision process providing data on which to set up a strategic plan of the refurbishment considering costs, continuity in occupancy and energy efficiency.

Analysis of a combined heating and cooling system model under different operating strategies

The paper presents an analysis of a combined heating and cooling system model under different operating strategies. Cooling demand for air conditioning purposes has grown steadily in Poland since the early 1990s. The main clients are large office buildings and shopping malls in downtown locations. Increased demand for heat in the summer would mitigate a number of problems regarding District Heating System (DHS) operation at minimum power, affecting the average annual price of heat (in summertime the share of costs related to transport losses is a strong cost factor). In the paper, computer simulations were performed for different supply network water temperature, assuming as input, real changes in the parameters of the DHS (heat demand, flow rates, etc.). On the basis of calculations and taking into account investment costs of the Absorption Refrigeration System (ARS) and the Thermal Energy Storage (TES) system, an optimal capacity of the TES system was proposed to ensure smooth and efficient operation of the District Heating Plant (DHP). Application of ARS with the TES system in the DHS in question increases net profit by 19.4%, reducing the cooling price for consumers by 40%.

Sigma 1 Receptor and Ion Channel Dynamics in Cancer.

SigmaR1 is a multitasking chaperone protein which has mainly been studied in CNS physiological and pathophysiological processes such as pain, memory, neurodegenerative diseases (amyotrophic lateral sclerosis , Parkinson's and Alzheimer's diseases, retinal neurodegeneration ), stroke and addiction . Strikingly, G-protein and ion channels are the main client protein fami lies of this atypical chaperone and the recent advances that have been performed for the last 10 years demonstrate that SigmaR1 is principally activated following tissue injury and disease development to promote cell survival. In this chapter, we synthesize the data enhancing our comprehension of the interaction between SigmaR1 and ion channels and the unexpected consequences of such functional coupling in cancer development. We also describe a model in which the pro-survival functions of SigmaR1 observed in CNS pathologies are hijacked by cancer cells to shape their electrical signature and behavior in response to the tumor microenvironment .

Safe and sound? How funding mix affects homelessness support for Indigenous Australians

© Australian Housing and Urban Research Institute Limited 2016. The impact of mixed funding sources on homelessness support for Indigenous Australians forms one part of the research program in the AHURI Inquiry into the funding of homelessness services in Australia, which aims to understand the mix of government and non-government funding and how the funding of services that support people who are experiencing homelessness influences service provision and outcomes for those people. Indigenous Australians are 14 times more likely to become homeless than other Australians, and their homelessness situations are likely to be more severe. This research examines the extent to which the needs of homeless and at-risk Indigenous Australians are being met. The research used relevant findings from the AHURI Australian homelessness funding and delivery survey (Flatau, Zaretzky et al. 2016) plus five case-studies and three focus groups. Twenty-seven organisations with Indigenous Australians as a main client group participated in the survey. Findings in this research show that financial support to organisations that provide services to Indigenous Australians experiencing homelessness is primarily provided by governments through the National Partnership Agreement on Homelessness (NPAH) which funds Specialist Homelessness Services (SHS), with 94 per cent of funds from governments and the next largest source of funds (only 2%) from rent revenue. No federal or state program specifically targets supporting homeless Indigenous people or those at risk of experiencing homelessness. Services for homeless Indigenous people are overwhelmingly 'mainstreamed', with SHS funds going to Indigenous organisations but no targeted support or coordination with programs which are targeted at Indigenous Australians. Funding uncertainty is a major issue, and the problems (including operational inefficiency, inability of organisations to innovate, and impacts on staff recruitment and retention) caused by this precarity are notably similar, regardless of the location or type of service, with larger organisations best placed to cope. Homeless Indigenous Australians may not be receiving the kinds of support which are best suited to them, and current support may not be culturally appropriate. More than half of the survey respondents anticipate that negative consequences such as excessive reporting would result from attempting to further diversify their funding sources, including seeking funds from non-NAHA/NPAH sources.

Main banks’ influence on financial reporting quality in Japan

ABSTRACTThis study investigated main banks’ influence on the quality of accounting firms’ audits and corporate firms’ earnings, focusing on companies on Japan’s Nikkei 500 index. We posed three questions in this research study about main banks’ influence on corporate clients’ earnings management. First, does a weakened main bank relationship influence corporate clients’ financial reporting quality? Second, does Japan’s firewall deregulation influence firms’ earnings quality? Finally, does the relationship between accounting firms and main banks affect client firms’ earnings quality? Our main findings were that main banks are not related to client firms’ earnings management; however, main banks mitigate client firms’ earnings management after firewall deregulation. On the other hand, firewall deregulation does motivate firms to manipulate their earnings management. Finally, using Pong and Kita’s (2006) study as a framework, we found that main banks and client firms using the same accounting firms had no influence on earnings management. Based on these evidences presented, our findings suggest that the quality of corporate clients’ financial reporting changes before and after firewall deregulation.

스마트 폰 UI의 디자인 철학에 따른 잠재적 사용자 확보

지금까지 스마트 폰 사용자는 Innovator, Early Adopter가 주 고객이었다면 가격 안정화와 인터넷을 즐기는 노인세대가 등장하면서 소외계층에 대한 중요성 및 체계적인 분류와 집중, 전략의 필요해졌다. 그리고 노년계층만으로 국한된 소외계층이 아닌 자신의 의지에 따라 사용자가 될 수 있는 잠재적 사용자에 대한 세분화와 그들을 확보할 수 있는 UI에 대한 분석이 필요하다. 그들을 확보하기 위해 iPhone의 스큐어모피즘, MS 메트로UI, Google 머티리얼 UI가 변하는 과정에서 UI의 기본구성요소(WIMP)가 어떻게 적용되어 왔는지 분석하였다. 분석결과 스큐어모피즘은 완전히 새로운 것이 아닌 사용자에게 외면 받았던 부분을 보완 개선하는 방식으로 천천히 잠재적 사용자를 확보하고 있고 메트로 UI는 터치UI개념으로 처음부터 잠재적 사용자를 고려하였지만 새롭고 획기적인 UI로 그들을 확보하지 못했다. 하지만 Google의 머티리얼 UI는 스큐어모피즘 UI와 메트로 UI의 단점을 보완하고 가성비를 내세워 잠재적 사용자 중 최종수용자까지 확보할 수 있는 UI로 발전하고 있다. 따라서 잠재적 사용자를 확보하기 위해서는 스마트폰을 왜(why) 사용해야 하는지에 대해 사용자 스스로가 공감할 수 있도록 해야 하며 직접적인 대화와 관찰의 피드백을 통해 더욱 체계적인 UI연구로 접근해야 함을 제언한다. Innovator and Early Adopter are main clients of smart phone until now, but the silver generation enjoying price stability and the Internet emerges, so a strategy of the importance, systematic classification, and focus of a neglected class is needed. It is necessary to analyze UI that can departmentalize not a neglected class limited to the silver generation but potential users who can be voluntarily users and can secure them. To secure them, the researcher analyzes how Windows, Icons, Mouse Pull-Down-Menus(WIMP) of UI has been applied in the process that skeuomorphism UI of iPhone, Metro UI of MS, and Material UI of Google change. As a result of an analysis, skeuomorphism is not entirely new and has secured potential users slowly with a method to compensate and improve a part that users disregard. As a concept of touch UI, Metro UI considered potential users from the beginning but did not secure them with new and epoch-making UI. However, Material UI of Google compensates the weaknesses of skeuomorphism UI and Metro UI and emphasizes cost-effectiveness, so has developed into UI that can secure final consumers of potential users. Therefore, to secure potential users, it should make users themselves understand why they should use smart phone, and it should approach with more organized studies on UI through feedback of observation and direct talks.

Клиенто-ориентированная организационная культура как вектор трансформации высшей школы

In the article the role of organizational culture as a customer-oriented trajectory of management at university is considered. The authors analyze the main clients of the educational environment on the basis of which the model of customer-oriented organizational culture of the university is proposed, reflecting the structural platform of organizational culture, the integration of internal and external customers in the socio-cultural environment of the university, as well as sequential communications and transformations of external customers in the internal customers.

Healthcare Programmes for Truck Drivers in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

BackgroundTruck drivers have unique health needs, and by virtue of their continuous travel, experience difficulty in accessing healthcare. Currently, planning for effective care is hindered by lack of knowledge about their health needs and about the impact of on-going programmes on this population’s health outcomes. We reviewed healthcare programmes implemented for sub-Saharan African truck drivers, assessed the evaluation methods, and examined impact on health outcomes.MethodsWe searched scientific and institutional databases, and online search engines to include all publications describing a healthcare programme in sub-Saharan Africa where the main clients were truck drivers. We consulted experts and organisations working with mobile populations to identify unpublished reports. Forest plots of impact and outcome indicators with unadjusted risk ratios and 95% confidence intervals were created to map the impact of these programmes. We performed a subgroup analysis by type of indicator using a random-effects model to assess between-study heterogeneity. We conducted a sensitivity analysis to examine both the summary effect estimate chosen (risk difference vs. risk ratio) and model to summarise results (fixed vs. random effects).ResultsThirty-seven publications describing 22 healthcare programmes across 30 countries were included from 5,599 unique records. All programmes had an HIV-prevention focus with only three expanding their services to cover conditions other primary healthcare services. Twelve programmes were evaluated and most evaluations assessed changes in input, output, and outcome indicators. Absence of comparison groups, preventing attribution of the effect observed to the programme and lack of biologically confirmed outcomes were the main limitations. Four programmes estimated a quantitative change in HIV prevalence or reported STI incidence, with mixed results, and one provided anecdotal evidence of changes in AIDS-related mortality and social norms. Most programmes showed positive changes in risk behaviours, knowledge, and attitudes. Our conclusions were robust in sensitivity analyses.ConclusionDiverse healthcare programmes tailored to the needs of truck drivers implemented in 30 sub-Saharan African countries have shown potential benefits. However, information gaps about availability of services and their effects impede further planning and implementation of effective healthcare programmes for truck drivers.