Metropolitan District Research Articles

Primary healthcare rehabilitation users’ views on activity limitations and participation in South Africa

Background: Increasing functional limitations and disabilities have raised the need for comprehensive rehabilitation services at the primary healthcare (PHC) level, particularly in low- and middle-income countries. To support the integration of these services into PHC in South Africa, assessing outcomes from the service users’ perspectives is essential.Objectives: This study examined service users’ views on their PHC rehabilitation outcomes in a Metropolitan District of Gauteng, South Africa. The aim was to understand perceived changes in activity limitations and participation restrictions following the rehabilitation intervention.Method: A quantitative survey design, including self-rating measurements and structured interviews, was employed. Thirty-eight rehabilitation service users from eight clinics and community health centres were purposively sampled. Participants rated their pre- and post-rehabilitation levels of difficulty in activity limitations and participation restrictions, with open-ended questions providing additional insights. Data analysis used descriptive statistics, quantitative content analysis, and non-parametric tests.Results: Significant improvements in mobility, self-perception, and quality of life were reported by both adult and child service users. Caregivers of child service users also noted positive experiences (p = 0.019) in community, social, and civic life.Conclusion: This study highlights the perceived positive changes experienced by PHC rehabilitation service users in addressing functional limitations and disabilities. It underscores the effectiveness of integrated rehabilitation service delivery in improving user outcomes.Contribution: The findings offer valuable insights into how rehabilitation interventions enhance functional abilities, social participation, and overall well-being. By focusing on activity limitations and participation restrictions from service users’ perspectives, this study supports the priority of providing person-centred rehabilitation services at the PHC level.

Digital educational resources: Impact on communication skills of high school students in Quito, Ecuador

This study analyzes the impact of digital educational resources (DER) on the development of oral and written comprehension and expression skills in high school students in the Metropolitan District of Quito, Ecuador. A quasi-experimental research with a mixed approach was carried out in two educational institutions, in which an experimental group used these digital tools, while a control group continued with traditional methods. The results of the statistical analysis revealed a significant positive effect on the communication skills of the group that used the digital resources, compared to the control group. These findings, contextualized with previous studies, suggest that the appropriate integration of technology in the classroom can considerably improve educational quality. However, effectiveness may vary depending on individual and contextual factors, highlighting the importance of personalized approaches. In conclusion, the study provides empirical evidence on the value of educational technology in secondary education and suggests the need for further research on its implementation to optimize its impact on learning.

Spatial Needs for Healthcare Access During Disasters in Informal Settings for Elderly People with Disabilities

Older adults with disabilities and their caregivers require certain spatial conditions that allow them to carry out protective actions and healthcare access during disasters. This study aims to identify these spatial needs in the first few hours of an emergency within informal settings. For this purpose, a case study methodology with several phases was applied. The first phase focused on case definition through a literature review and case studies selection in the Metropolitan District of Quito-Ecuador. Phase two centered on spatial audits and collecting quotes and experiences from older adults with disabilities and their caregivers, conducted through focus groups. The third phase analyzed quantitative and qualitative data, generating three thematic categories: autonomous, support-driven, and institutional response access needs to healthcare. Findings highlight that special attention should be paid to the relationship between spatial conditions and individual or group behaviors during disasters, as these can exacerbate vulnerable outcomes for older adults.

Beyond error: A qualitative study of human factors in serious adverse events.

The field of healthcare quality and safety has been informed by the study of Human Factors contributing to adverse events. Hitherto, much of the study of Human Factors has been focused on a narrow lens of human error, identifying cognitive-based or knowledge-based errors and cognitive processes such as loss of situational awareness contributing to error. While these factors are important, this narrow approach fails to consider the complexity of relational and systemic factors that also contribute to adverse events. We aimed to explore the relational and systemic human factors, including shared clinician attitudes and behavior, that contribute to serious adverse patient events in a public health setting. The study, set in a metropolitan local health district in New South Wales, Australia, was conducted using a retrospective qualitative multi-incident content analysis design. Serious adverse event reviews (SAER) over 6 months (2022-2023) were subject to qualitative content analysis until data saturation was reached. Data saturation reached at 20 reports. Emergent themes related to human factors in serious adverse events included: (i) delays and inertia-with a subtheme of inertia of ageism; (ii) "All-or-nothing" approach to end-of-life care and planning; (iii) communication lapses; and (iv) implementation gap between standards and practice. Error-based incidents accounted for only 35% of the serious adverse events examined. The sample studied involved mostly (65%) male patients, with a mean age of 69 (70% aged >65), managed across the gamut of specialties, with the most common incident being the management of acutely deteriorating patients. In conclusion, there is more to Human Factors in adverse events than cognitive or knowledge-based error. While identifying and correcting errors is absolutely essential, we need adjunctive "soft measures" to address clinical attitudes, behaviors, and relationships in health care, particularly in increasingly complex, fraught, and stressful health care environments.

An Implementation of Educational Multimedia Applications in Schools of the Metropolitan Districts

An Implementation of Educational Multimedia Applications in Schools of the Metropolitan Districts

'Profound personal and professional impacts': A qualitative study of clinician experiences of a mental health disaster response to Australia's black summer bushfires.

To explore the experiences of clinician and management stakeholders involved in a rural/metropolitan collaborative mental health disaster response to the 2019-2020 Black Summer bushfires in the Snowy Valleys region of southern New South Wales (NSW), Australia. A mental health and drug health service in the Snowy Valleys region of rural NSW in collaboration with a mental health service from metropolitan Sydney, NSW. Mental health clinicians and managers from a rural health district (n = 6) and a metropolitan health district (n = 8) involved in a collaborative disaster response to the 2019-2020 Black Summer bushfire disaster in the Snowy Valleys region of southern NSW, Australia. An interpretive qualitative study design using semi-structured individual interviews, with transcripts analysed using Reflexive Thematic Analysis. Thematic findings on participant experiences are presented under three organising constructs of before (stepping up and jumping right in), during (finding a rhythm of working together), and after (profound personal and professional impacts) the mental health disaster response. Participant experiences had shared and distinct components before, during and after the mental health disaster response, culminating in profound personal and professional impacts. Findings highlight positive aspects and challenges for clinicians participating in a rural/metropolitan collaborative mental health disaster response. The findings of this study contribute new knowledge about experiences of mental health clinicians participating in a disaster response after bushfires, from dual perspectives of members of a bushfire-affected community and those responding from outside a bushfire-affected community, which may inform ongoing planning of responses to disaster in Australia.

School knowledge of infectious diseases in schools: conducting surveillance and on-demand, symptomatic respiratory viral testing in a large pre-kindergarten-12th grade school district.

Limited data about acute respiratory illness (ARI) and respiratory virus circulation are available in congregate community settings, specifically schools. To better characterize the epidemiology of ARI and respiratory viruses in schools, we developed School Knowledge of Infectious Diseases in Schools (School KIDS). School KIDS is a prospective, respiratory viral testing program in a large metropolitan school district (pre-kindergarten-12th grade) in Kansas City, Missouri. During the 2022-2023 school year, all students and staff were eligible to participate in surveillance respiratory viral testing at school by submitting observed self-administered nasal swabs monthly. Participants could also submit a nasal swab for on-demand symptomatic testing when experiencing ≥1 ARI symptom, including cough, fever, nasal congestion, runny nose, shortness of breath, sore throat, and/or wheezing. Swabs were tested in a research laboratory using multipathogen respiratory polymerase chain reaction assays. Participants were evaluated for ongoing viral shedding by collecting two weekly nasal swabs (i.e., convalescent), following initial on-demand symptomatic testing. Participants were asked to complete an electronic survey to capture the presence and type of ARI symptom(s) before the collection of respiratory swabs. From 31 October 2022 to 29 June 2023, School KIDS enrolled 978 participants, including 700 students, representing 3.4% of the district student population, and 278 staff members. Participants submitted a median of six surveillance, one symptomatic, and two convalescent specimens during the study period. A total of 6,315 respiratory specimens, including 4,700 surveillance, 721 on-demand symptomatic, and 894 convalescent specimens, were tested. Overall, a virus was detected in 1,168 (24.9%) surveillance and 363 (50.3%) symptomatic specimens. Of the 5,538 symptom surveys sent to participants before scheduled surveillance testing, 4,069 (73.5%) were completed; ARI symptoms were reported on 1,348 (33.1%) surveys. Respiratory surveillance testing in schools is feasible and provides novel information about respiratory virus detections in students and staff attending school. Schools are an important community setting, and better knowledge of respiratory virus circulation in schools may be useful to identify respiratory virus transmission in the community and assess the impact of effective infection prevention measures.

El diseño de políticas públicas con base en la idea de la otredad y el ejercicio del derecho a la ciudad en el Distrito Metropolitano de Quito- Ecuador

The Ecuadorian State, through the 2008 Constitution of Montecristi, enshrines the right to the city as a fundamental right and guarantees the adoption of policies that allow for its viable exercise through democratic and participatory management. This final Master’s Thesis presents a research project to analyze the effects of the notion of Otherness in the process of public policymaking, so that they serve as mechanisms for the fulfillment of the right to the city in the Quito Metropolitan District. This was done at a exploratory level, aiming to determine the absence and/or ineffectiveness of the exercise of the aforementioned right by means of a diagnosis of public policies enforced during 2019 that show this issue.

Bioclimatic and Energy Performance by Eco-Efficiency in Buildings of the Metropolitan District of Quito, Ecuador

Bioclimatic and Energy Performance by Eco-Efficiency in Buildings of the Metropolitan District of Quito, Ecuador

Socio-economic Status and Frequency of Consumption of Processed Foods among Rural and Urban Adolescents of Kamrup Metropolitan District of Assam

Socio-economic Status and Frequency of Consumption of Processed Foods among Rural and Urban Adolescents of Kamrup Metropolitan District of Assam

The Effects of Financial Rewards and Penalties on Tax Evasion and Whistleblowing Intentions in Accra, Ghana

The study investigates the influence of financial rewards and penalties on individuals’ intentions to report tax evasion. The research, involving 402 respondents in Ghana’s Accra Metropolitan District, uses regression analyses and statistical mediation to analyze cross-sectional survey data. Ghana’s Whistleblower Act of 2006 and the Revenue Administration Act of 2016 establish penalties for tax offenses and mechanisms to encourage truthful reporting. While the Act provides protections for whistleblowers, it faces hurdles such as a lack of confidence and cultural reluctance. The findings show that financial rewards have a limited impact on whistleblowing and tax evasion intentions, while penalties have a significant influence. This supports the deterrence theory of punishment, suggesting that individuals are deterred from engaging in illegal behavior when threatened with punishment. The study also highlights the role of financial rewards in shaping whistleblowing intention but suggests a combination of financial rewards and enforceable penalties to encourage whistleblowing and discourage tax evasion. The findings suggest integrating a model incorporating financial reward and penalties into tax laws, making it mandatory for individuals to report tax evasion, with failure resulting in punishment. This model could serve as a deterrent to individuals who would otherwise not report tax evasion activities.

Urban growth and vulnerability to climate change of Calderón in the Metropolitan district of Quito, Ecuador

The parish of Calderón, located in the Metropolitan District of Quito, has a spatial dynamic characteristic of the expansion processes, with notable population growth, loss of agricultural land, and settlements in vulnerable areas. This research aimed to identify the vulnerability to climate change by analyzing urban growth in this parish to define measures for its climate change adaptation. A three-stage mixed approach methodology was used: the historical and spatial analysis of urban growth, the relationship between urban growth and vulnerability to climate change, and climate change adaptation measures in the parish of Calderón. The thirteen indicators analyzed show a medium-low risk level in their exposure and sensitivity components. However, the opposite is true for the adaptive capacity component, where vulnerability is high. The relationship between the parish’s urban growth and vulnerability to climate change is not direct. On the one hand, the expansion processes affect the territory and the population, causing environmental and social conflicts. On the other hand, factors immersed in urban expansion's spatial dynamics are revealed.

Progress in Eliminating Perinatal HIV Transmission in the Metropolitan DC Area Between 2018-2022.

The number of perinatal HIV cases have continued to decline since the United States achieved the goal of perinatal HIV elimination in 2019. We aimed to evaluate dynamics in perinatal HIV transmission in the metropolitan District of Columbia (DC) area during 2018-2022. Children's National Hospital's (CNH) is a major referral site for the metropolitan DC area, including suburban Maryland and Virginia, and evaluates >95% of HIV-exposed infants (HEI) in the region. A retrospective cohort study of mother-infant pairs with perinatal HIV exposure seen at CNH during 2018-2022. We describe the demographics, intrapartum/postpartum management, and outcomes among mothers and HEI. We analyzed 503 HEI; most (78.9%) were at low risk for perinatal HIV. Most mothers were African or African American (87.1%) and had HIV RNA <50 copies/mL around delivery (78.1%). The proportion of HEI at high risk for perinatal HIV decreased from 28.2% to 15.5% in 2018 and 2020, respectively, but increased to 24.8% in 2022. Most HEI received postnatal antiretroviral drugs for at least 4 weeks (95.3%). Seventy-nine infants (15.7%) were born to mothers diagnosed with HIV during pregnancy. Two infants (0.4%) were diagnosed with perinatally acquired HIV. We report high rates of antiretroviral drugs use among mother-infant pairs and a low rate of perinatal HIV transmission in metropolitan DC. Despite a 1.8-fold decrease in the number of high-risk perinatal HIV exposures since 2018, this rate rebounded in 2022. There remain opportunities to optimize maternal care and reduce the number of high-risk HEI.

Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district

BackgroundPrimary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals.MethodsA retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies.ResultsThe findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30–49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use.ConclusionThis study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.

Experiences of teachers in vocational programmes in special needs schools, City of Cape Town.

Vocational programmes run by teachers in the special needs school context can play a significant role in the vocational development of learners with severe intellectual disability (SID). This study aimed to answer the question 'what are the challenges faced by teachers in the implementation of vocational programmes in selected public special needs schools for learners with SID in the Metropolitan (Metro) District within the City of Cape Town?' The objectives were to describe the challenges as perceived by participants, to highlight common and contrasting challenges in the different schools and to share recommendations on support needed. A qualitative descriptive study was conducted. A combination of purposive and snowball sampling strategies was used to select six teachers from six special needs schools. One-on-one semi-structured interviews with teachers were performed. An interview schedule was used as a tool and all interviews were transcribed and translated into English verbatim. Thematic analysis was applied. The findings showed that teachers encounter inadequate resources, a lack of training, and poor support systems. This study highlights the issues of existing policy and the lack of a mandatory policy on vocational programmes in South Africa. The participants' experiences added to the existing literature by providing valuable insights into the obstacles teachers encounter in this relatively new curriculum. A multifaceted policy framework that is well funded and implemented is much needed to address the challenges identified. The findings may contribute to the development and strengthening of policies on vocational programmes within the South African context.

Initial study on natural fibers for use in concrete mixes as a sustainable materials alternative

Natural fibers are becoming a key point for the development of new concrete mixes because these fibers are recovered from residual biomass. In this paper, we focus on the natural fib‘ers found in the Metropolitan District of Quito, Ecuador. For this purpose, we searched for materials (fibers) available in the Chemical Engineering laboratory at Universidad San Francisco de Quito USFQ. In this paper, we analyze different literature on how the use of fibers influences the mechanical properties of concrete. Based on this analysis and the materials at the laboratory, we have developed recommendations on which natural fibers are of interest for further experimental research. Furthermore, this paper provides an understanding of how natural fibers influence the mechanical properties of concrete. It also proposes a process for the selection and study of any type of natural fiber for further replicability in mix analysis.

Knowledge, Attitude, and Food Safety Practices among Street Food Vendors at a Metropolitan District in Ghana: A Cross-sectional Study.

Street food is a vital component of cities and towns in developing countries. However, food poisoning has been associated with inadequate knowledge of food safety practices and inappropriate food handling. We examined the knowledge, attitude, and practices of street food sellers in the Takoradi Submetropolis, Ghana, on food safety and hygienic practice. In this descriptive cross-sectional study, 406 street food vendors were recruited based on a simple random sampling technique from the Sekondi-Takoradi Metropolis, Ghana, using a structured questionnaire. Data collected were analyzed with the chi-square test and binary logistic regression using Stata (version 16) software. Statistical significance was set at p < 0.05. The level of knowledge was low among 70.4% of the food vendors, and 51% had negative attitudes towards food safety and hygiene. Food hygiene practices were also poor among 52.3% of the participants. The predictors of low knowledge level were senior high (aOR = 0.37, 95% CI (0.19-0.70), p = 0.002) and junior high education (aOR = 0.52, 95% CI (0.27-0.99), p = 0.047). Having senior high education (aOR = 0.37, 95% CI (0.17-0.82), p = 0.014), prior training on food safety and hygiene (aOR = 0.50, 95% CI (0.29-0.84), p = 0.010), and having high level of knowledge (aOR = 0.33, 95% CI (0.20-0.54), p = 0.001) were associated with lower likelihood of negative attitude towards food safety and hygiene. Moreover, having junior high education (aOR = 6.20, 95% CI (2.78-13.87), p = 0.001), high level of knowledge (aOR = 4.70, 95% CI (2.77-7.98), p = 0.001), and positive attitude towards food safety and hygiene (aOR = 1.76, 95% CI (1.08-2.87), p = 0.023) were associated higher odds of good food practice. Knowledge and attitude regarding food safety and hygienic practices was poor among street food vendors. Future initiatives should focus on establishing training programs for food vendors within the metropolitan assembly to improve their knowledge on food safety and hygienic practices.

NATURAL FIBERS FOR SUSTAINABLE CONCRETE MIXES

To meet the sustainable development goals, novel concrete mixes are necessary. Natural fibers are becoming an interesting new element for concrete mixes, because these fibers are biomaterials recovered from residual biomass and fit in the concept of the circular bioeconomy. In this paper, we catalog research insights on concrete mixes with natural fibers, and pay special attention to natural fibers that are available in the Metropolitan District of Quito, Ecuador, to use local bio-based materials. We focus on examining information from the literature on how natural fibers influence the mechanical properties of concrete, namely the tensile, compressive, and flexural strength. Based on this analysis, we have developed recommendations on which natural fibers are of interest for further experimental research, with the aim to develop sustainable concrete mixes for Quito. Moreover, this paper gives insights in how natural fibers influence the mechanical properties of concrete and proposes a framework that translates to other regions and cities for the selection of local and adequate natural fibers.

SOIL CHARACTERIZATION: INTEGRATING IN-SITU TEST, LABORATORY ANALYSIS, AND TERRAIN PARAMETERS

This research introduces an innovative methodology for characterizing geotechnical parameters of soils, crucial for designing foundations for various structures. Rather than relying on general correlations from geotechnical books, the primary goal is to obtain specific characteristic values tailored to the study area. The methodology establishes correlations between in-situ tests and laboratory tests to determine soil parameters in the Valley of the Chillos. The Valley of the Chillos is a geographical region in the southeastern part of Quito, Ecuador. It falls within the administrative zone of Los Chillos in the Metropolitan District of Quito. The valley is surrounded by the inactive Ilaló volcano to the north and the Pasochoa, Antisana, and Lomas de Puengasí mountains to the south, east, and west, respectively. To achieve the research objective, soil samples were collected using the Standard Penetration Test (SPT) at depths ranging from 1 to 15 meters, following the ASTM D-1586 standard. Additionally, undisturbed soil samples from the thin-walled Shelby tube were obtained in the field and subsequently tested in the laboratory. These tests covered aspects such as natural moisture content, granulometric analysis, Unified Soil Classification System, classification, liquid limit, plasticity index, specific gravity, void ratio, and degree of saturation. The results from both field and laboratory tests will be used to calculate the load capacity of foundations specifically for characteristic soils in the Los Chillos Valley, considering their classifications.

Biomass and Carbon Stock of Trees in a Tropical Moist Deciduous Forest of Kamrup Metropolitan District, Assam, India

The present investigation deals with the estimation of biomass and Carbon stock potential of tree species in a tropical moist deciduous forest of Kamrup Metropolitan district of Assam, India. For vegetation sampling of trees, the stratified random method was employed and biomass and Carbon stock of trees were estimated by using an allometric equation. Altogether 39 tree species representing 34 genera and 20 families were reported. A high total density and total basal cover (TBC) were reported during the investigation (1008 stem ha⁻¹ and 71.74 m² ha⁻¹ respectively). Total biomass (TB), total Carbon stock (TCS), and CO₂ equivalent were estimated to be 985.56 Mg ha⁻¹, 492.78 Mg C ha⁻¹, and 1808.50 Mg C ha⁻¹ respectively. Among the trees, Cassia fistula exhibited the highest amount of TB, TCS, and CO₂ equivalent (131.33 Mg ha⁻¹, 65.66 Mg C ha⁻¹, and 240.99 Mg C ha⁻¹ respectively). TCS displayed a positive correlation with density, TBC, and diameter of tree species. The study provides valuable information on biomass and Carbon sequestration potential of trees in the tropical moist deciduous forest, which could be of help to forest policymakers to ensure sustainable management of Carbon stock and hence promotes mitigation of global climate change.