Monitoring Round Research Articles

The relationship of migration behavior with marital status and the number of children in the family

Based on the analysis of the database of the 30th round of the Russian Monitoring of the Economic Situation and Health of the Population (Russian Longitudinal Monitoring Survey – HSE) study in 2021, the relationship between marital status and the children number of men and women in reproductive age with their migration behavior is studied. Migrants are less likely to remain single and childless, but more likely to have three or more children than local natives. These differences are explained, so the author, by the fact that people who have independently changed their place of residence differ from people who live where they were born, more willing to face difficulties related both to living conditions adapting in a new place, and to creating, increasing and maintaining a family. The differences between migrants and natives are greater among men than women. In addition, data from a survey of both spouses in more than 1,200 families conducted by the Department of Family Sociology and Demography of the Faculty of Sociology of Lomonosov Moscow State University 2018–2019 study show that men whose parents had more than two children are much more likely to have three or more children themselves than women who grew up in the families of the same size. Therefore, demographic policy measures should be applied to increase the birth rate what can affect not only mothers, but fathers as well. It is necessary to take into account the data of sociological studies on the conditions necessary for the birth of children, according to both spouses, and not only women. Schools and other educational institutions should form an active life position among children, adolescents and young people, the ability to overcome difficulties, including those in family life necessary for the society to survive and develop.

Biodiversity monitoring for the jarrah (Eucalyptus marginata) forest in south-west Western Australia: An extension to ten-year findings of Forestcheck

Long-term research and monitoring programs can provide important insights into biodiversity patterns to inform sustainable management of multi-use forest ecosystems. This study investigated biodiversity patterns in two forest ecosystems in the southwest region of Australia, as part of a long-term monitoring program, Forestcheck, established to track changes and trends in forest biodiversity associated with management activities. We assessed the effects of forest ecosystem, silvicultural treatment types (gap release and shelterwood/selective harvesting) and time since fire, on taxonomic richness and assemblage patterns across six taxonomic groups (terrestrial vertebrates, birds, macro-invertebrates, vascular plants, macro-fungi and cryptogams). Further, temporal comparisons in taxonomic richness and assemblage were completed for vascular plants and terrestrial vertebrates using data collected in a second round of monitoring. There was a low-level effect of harvesting and prescribed burning disturbance on combined community assemblage, but forest ecosystem had a greater influence on biodiversity patterns. Plant assemblages changed significantly according to ecosystem, silvicultural treatment type and monitoring round when two rounds of monitoring data were considered. These findings support previous assessments of Forestcheck sites, in that the strongest determinant of biodiversity patterns was forest ecosystem, and the greatest effects of disturbance were on assemblage patterns. These results provide some insight into post disturbance patterns and may assist with decision-making in relation to silviculture and prescribed burning regimes, and post-silviculture management, to provide increased opportunity for restoration of diversity.

Understanding the Fate of H2S Injected in Basalts by Means of Time‐Domain Induced Polarization Geophysical Logging

AbstractTo help meet emission standards, hydrogen sulfide (H2S) from geothermal production may be injected back into the subsurface, where basalt offers, in theory, the capacity to mineralize H2S into pyrite. Ensuring the viability of this pollution mitigation technology requires information on how much H2S is mineralized, at what rate and where. To date, monitoring efforts of field‐scale H2S reinjection have mostly occurred via mass balance calculations, typically capturing less than 5% of the injected fluid. While these studies, along with laboratory experiments and geochemical models, conclude effective H2S mineralization, their extrapolation to quantify mineralization and its persistence over time leads to considerable uncertainty. Here, a geophysical methodology, using time‐domain induced polarization (TDIP) logging in two of the injection wells (NN3 and NN4), is developed as a complementary tool to follow the fate of H2S re‐injected at Nesjavellir geothermal site (Iceland). Results show a strong chargeability increase at +40 days, interpreted as precipitation of up to 2 vol.% based on laboratory relationships. A uniform increase is observed along NN4, whereas it is localized below 450 m in NN3. Changes are more pronounced with larger electrode spacing, indicating that pyrite precipitation takes place away from the wells. Furthermore, a chargeability decrease is observed at later monitoring rounds in both wells, suggesting that pyrite is either passivated or re‐dissolved after precipitating. These results highlight that a sequence of overlapping reactive processes (pyrite precipitation, passivation, pore clogging and possibly pyrite re‐dissolution) results from H2S injection and that TDIP monitoring is sensitive to this sequence.

Trends in and Correlates of Short-Acting Contraceptive Stock-Outs: Multicountry Analysis of Performance Monitoring for Action Agile Platform Data.

Understanding trends in contraceptive stock-outs, as well as their structural and demand-side correlates, is critical for policymakers and program managers to identify strategies to further anticipate, reduce, and prevent stock-outs. We analyzed trends as well as supply- and demand-side correlates of short-acting contraceptive method stock-outs by using data from multiple rounds of Performance Monitoring for Action Agile surveys. These data longitudinally measured contraceptive availability over 2 years (between November 2017 and January 2020) across 2,134 public and private service delivery points (SDPs) from urban areas of 5 countries (Burkina Faso, Democratic Republic of the Congo [DRC], India, Kenya, and Nigeria). For each country, we analyzed the trends and used multilevel mixed-effect logistic regression to model the odds of short-acting contraceptive stock-outs, adjusting for key structural and demand-side factors of the SDPs. Stock-outs in short-acting contraceptive methods were common in health facilities and varied markedly, ranging from as low as 2.9% (95% confidence interval [CI]=1.7%, 5.1%) in India to 51.0% (95% CIs=46.8%, 56.0%) in Kenya. During the observation period, stock-out rates decreased by 28% in the SDP samples in India (aOR=0.72, P<.001) and 8% in Nigeria (aOR=0.92, P<.001) but increased by 15% in DRC (aOR=1.15; P=036) and 5% in Kenya (aOR=1.05, P=003) with each round of data collection. Correlates of stock-out rates included the facility managerial authority (private versus public), whether the facility was rated high quality, whether the facility was at an advanced tier, and whether there was high demand for short-acting contraceptives. In conclusion, stock-outs of short-acting contraceptives are still common in many settings. Measuring and monitoring contraceptive stock-outs is crucial for identifying and addressing issues related to the availability and supply of short-acting contraceptives.

Inflation expectations and consumer sentiments of the Urals population

In recent decades, central banks of an increasing number of countries have been using the inflation targeting regime in their monetary policy, since it has proven to be an effective tool for balancing economic growth and inflation. In countries with the regional heterogeneity, local manifestations of inflation may differ significantly, which entails a shift in inflation expectations and their unequal impact on actual dynamics of prices in the future. The article explores the determinants of inflation expectations in Ural regions of Russia. The methodological basis of the study includes monetary concepts developed primarily within the framework of the new Keynesian theory and linking monetary policy with the assessments of inflation expectations. The study uses methods of statistical processing of the data collected during two rounds of monitoring of the population’s inflation expectations. The evidence of the study comes from the surveys conducted on a sample of 2,976 respondents. The study reveals regional, social and allocative heterogeneity in the perception of dynamics of prices and the formation of inflationary expectations. The results of the study contribute to understanding the nature of inflation expectations using the case of the Urals population and can become a basis for developing targeted communication measures aimed at bringing inflation closer to the target.

Biodiversity monitoring informs forest management in south-west Western Australia: Ten-year findings of Forestcheck

Long-term monitoring is an important element of ecologically sustainable forest management and provides the foundation for adaptive management under conditions of uncertainty and change. Management of the jarrah (Eucalyptus marginata) forest in south-west Western Australia is supported by an integrated monitoring program (Forestcheck) established to inform forest managers about trends in key elements of biodiversity associated with management activities. Forty-eight monitoring grids were established across four jarrah forest ecosystems following timber harvesting and silvicultural treatment, as well as in nearby forest that was unharvested or harvested >40 years previously. Biota monitored includes terrestrial vertebrates (mammals, birds, reptiles, and amphibians), vascular plants, epigeous macrofungi, cryptogams (lichens, mosses, and liverworts) and macro-invertebrates. Initial findings from a first round of monitoring between 2001 and 2006 were published previously. Here we report on a second round of monitoring undertaken between 2007 and 2012 and compare findings with the previous round for taxonomic richness, community structure, and response to silvicultural treatment and time since fire. We tested two hypotheses for each of the groups studied: (1) that silvicultural treatment or (2) time since fire had no effect on (a) richness or (b) assemblage composition.A total of 3787 taxa were recorded. Dominant factors influencing total species richness and composition were forest ecosystem type, time of monitoring, time since harvesting and time since fire. Silvicultural treatment had no significant effect on mean richness of invertebrates, macrofungi, vascular plants and birds for either monitoring period but cryptogam richness was higher in unharvested forest and species richness of terrestrial vertebrate fauna was higher in harvested forest. Time since harvest had a significant influence on all species assemblages except terrestrial vertebrates but over time effects were ameliorated other than for cryptogams and birds. Time since fire had no effect on taxonomic richness for any of the groups examined, but significant differences in assemblage composition were detected between three categories of time since fire for all the groups except terrestrial vertebrates.Knowledge of the distribution of individual organisms and the composition of taxon assemblages in jarrah forest has been significantly improved as a result of monitoring, particularly for invertebrates, macrofungi and cryptogams. Some taxa across all groups were only recorded in forest subject to specific management including unharvested reference forest and forest subject to different intensities of timber harvesting, demonstrating that disturbance associated with timber harvesting and post-harvest burning can create conditions favourable for some organisms that are otherwise encountered rarely in mature forest.These results demonstrate the critical role of well-designed, systematic and multi-taxon ecological monitoring programs for evaluating biological responses to often contentious forest management practices.

Information System for Symptom Diagnosis and Improvement of Attention Deficit Hyperactivity Disorder: Protocol for a Nonrandomized Controlled Pilot Study.

BackgroundAttention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders during childhood; however, the diagnosis procedure remains challenging, as it is nonstandardized, multiparametric, and highly dependent on subjective evaluation of the perceived behavior.ObjectiveTo address the challenges of existing procedures for ADHD diagnosis, the ADHD360 project aims to develop a platform for (1) early detection of ADHD by assessing the user’s likelihood of having ADHD characteristics and (2) providing complementary training for ADHD management.MethodsA 2-phase nonrandomized controlled pilot study was designed to evaluate the ADHD360 platform, including ADHD and non-ADHD participants aged 7 to 16 years. At the first stage, an initial neuropsychological evaluation along with an interaction with the serious game developed (“Pizza on Time”) for approximately 30-45 minutes is performed. Subsequently, a 2-week behavior monitoring of the participants through the mADHD360 app is planned after a telephone conversation between the participants’ parents and the psychologist, where the existence of any behaviors characteristic of ADHD that affect daily functioning is assessed. Once behavior monitoring is complete, the research team invites the participants to the second stage, where they play the game for a mean duration of 10 weeks (2 times per week). Once the serious game is finished, a second round of behavior monitoring is performed following the same procedures as the initial one. During the study, gameplay data were collected and preprocessed. The protocol of the pilot trials was initially designed for in-person participation, but after the COVID-19 outbreak, it was adjusted for remote participation. State-of-the-art machine learning (ML) algorithms were used to analyze labeled gameplay data aiming to detect discriminative gameplay patterns among the 2 groups (ADHD and non-ADHD) and estimate a player’s likelihood of having ADHD characteristics. A schema including a train-test splitting with a 75:25 split ratio, k-fold cross-validation with k=3, an ML pipeline, and data evaluation were designed.ResultsA total of 43 participants were recruited for this study, where 18 were diagnosed with ADHD and the remaining 25 were controls. Initial neuropsychological assessment confirmed that the participants in the ADHD group showed a deviation from the participants without ADHD characteristics. A preliminary analysis of collected data consisting of 30 gameplay sessions showed that the trained ML models achieve high performance (ie, accuracy up to 0.85) in correctly predicting the users’ labels (ADHD or non-ADHD) from their gameplay session on the ADHD360 platform.ConclusionsADHD360 is characterized by its notable capacity to discriminate player gameplay behavior as either ADHD or non-ADHD. Therefore, the ADHD360 platform could be a valuable complementary tool for early ADHD detection.Trial RegistrationClinicalTrials.gov NCT04362982; https://clinicaltrials.gov/ct2/show/NCT04362982International Registered Report Identifier (IRRID)RR1-10.2196/40189

Integrating recreation into National Forest Inventories – Results from a forest visitor survey in winter and summer

Forest policy and management traditionally rely on physical forest data from National Forest Inventories (NFIs). Nationwide questionnaire surveys on the other hand provide information on the relationship between the human population and the forest, but data on the link to the physical forest is missing. In order to monitor outdoor recreation, both are needed. The aim of the present study is to bridge this gap by conducting a forest visitor survey in the vicinity of NFI sample plots and linking questionnaire data and NFI data in a multilevel model to determine the visual attractiveness of the forest plots in both winter and summer. In addition to traditional NFI measurements, visibility range was determined by terrestrial laser scanning (TLS). The results show that visual attractiveness was mainly determined by the individual characteristics of forest visitors. Although forest plots were generally liked better in summer, major seasonal differences between forest characteristics were limited to a few parameters, and differences in the characteristics of winter and summer visitors were small. Non-seasonal plot-specific variables played a greater role in explaining visual attractiveness than seasonal differences within the forest plots. TLS proved to be a sophisticated and reliable, but time-consuming, method for determining visibility range. We conclude that the resource-intensive on-site survey yielded interesting results, but that intangible factors and confounding effects made it difficult to pinpoint exactly which features determine forest attractiveness. Future monitoring of forest recreation should aim to strengthen the link between physical forest monitoring, as conducted in NFIs, and socio-cultural forest monitoring. To address the question which methods are suitable to link socio-cultural forest monitoring with an National Forest Inventories (NFI), we recomment to use photos from NFI plots in an online questionnaire survey instead of an on-site study. Although many variables were used in both studies, their explanatory value was considerably lower in the on-site survey than in the online survey. Future on-site studies should aim to capture intangible factors and confounding effects by including more qualitative research, for example by employing Go-Along interviews or visitor-employed photography, in order to provide in-depth information on which social factors should be included in future monitoring approaches. Including standardised visualisations of NFI plots in each round of socio-cultural forest monitoring together with a set of NFI variables relevant for recreation and visual attractiveness could form the missing link between NFIs and socio-cultural forest monitoring.

S02-3 Physical activity policies and good practices in Europe

BackgroundThe establishment of the EU physical activity (PA) guidelines and the HEPA monitoring framework has had an impact on policy development and implementation across the region from 2015. This works presents results from the third round of monitoring in 2021 and discusses trends since 2015.MethodsA questionnaire was distributed in 2021 to all EU Member States of the WHO European Region through the network of PA Focal Points, who were requested to collect data from national colleagues and complete the questionnaire. All EU Member States (27 in 2021) responded to the survey on the implementation of the 23 indicators of the HEPA monitoring framework.ResultsThe results of the 2021 round of data collection on HEPA indicators showed an overall stabilization of the implementation of PA promotion policies. Besides important increases in several indicators, such as indicators 15 (HEPA in the training of physical education teachers), 20 (Schemes to promote physical activity at the workplace) and 21 (Schemes for community interventions to promote physical activity in older adults), many others decreased and others showed no progress. Most national physical activity policies or action plans were multi-sectoral, with good coverage of the sectors recognized as important for HEPA promotion. While some methodological aspects may have affected the results, this round also reflected policy implementation during the COVID-19 pandemic (2019–2021). COVID-19 has had a significant impact on all sectors of society but especially on health, sports, education and mobility, which are major areas for PA promotion and policy implementation.ConclusionsThere seems to be an overall stabilization of the implementation of PA promotion policies since 2015. Public health experts and decision makers could utilise the increase in public awareness of the health benefits of physical activity kindled by the COVID-19 crisis to implement new health-promoting policies. Policy design, development and implementation of HEPA promotion must be strengthened for post-COVID-19 social and economic recovery.

Development Trend and Stability Analysis of Creep Landslide With Obvious Slip Zone Under Rainfall-Taking Xinchang Xiashan Basalt Slope as an Example

The creep slope is a dynamic development process, from stable deformation to instability failure. For the slope with sliding zone, it generally creeps along the sliding zone. If the sliding zone controlling the slope sliding does not have obvious displacement, and the slope has unexpected instability without warning, the harm and potential safety hazard are often much greater than the visible creep. Studying the development trend of this kind of landslide is of great significance to slope treatment and landslide early warning. Taking Xiashan village landslide in Huishan Town, Xinchang County, Zhejiang Province as an example, the landslide point was determined by numerical simulation in 2006. Generally, the landslide is a typical long-term slow deformation towards the free direction. Based on a new round of investigation and monitoring, this paper shows that there are signs of creeping on the surface of the landslide since 2003, and there is no creep on the deep sliding surface. The joint fissures in the landslide area are relatively developed, and rainfall infiltration will soften the soft rock and soil layer and greatly reduce its stability. This paper collects and arranges the rainfall data of the landslide area in recent 30 years, constructs the slope finite element model considering rainfall conditions through ANSYS finite element software, and carries out numerical simulation stability analysis. The results show that if cracks appear below or above the slope’s sliding surface, or are artificially damaged, the sliding surface may develop into weak cracks. Then, the plastic zone of penetration is offset; In the case of heavy rain, the slope can unload itself under the action of rainfall. At this time, the slope was unstable and the landslide happened suddenly.

Factors Associated With the Utilisation and Unmet Need for Modern Contraceptives Among Urban Women in Kenya: A Cross-Sectional Study.

Background: Family planning (FP) is a key intervention in improving maternal and child health. Hence, we assessed the factors associated with utilisation and unmet need for modern contraceptives among urban women in Kenya.Methods: The study used pooled data on 10,474 women 15–49 years from the seven rounds of the performance monitoring for accountability surveys collected between 2014 and 2018. The surveys were conducted in 11 of the 47 counties of Kenya using a multistage cluster design. Sample characteristics were described using frequencies and percentages while factors associated with utilisation and unmet need for modern contraceptives were assessed using multivariable logistic regressions.Results: The prevalence of modern contraceptives use and unmet need for FP among urban women in Kenya was 53.7% [95% confidence interval (CI) 52.1–55.3%] and 16.9% (15.8–18.1%), respectively. The use of modern contraceptive was associated with the county of residence, age, marital status, parity, education, household wealth quintile, exposure to media, and survey year. Teenagers, poorest urban women, women with no formal or primary level of education and those who seek services at a dispensary or health centres had higher odds of unmet need for FP while women who resided in Kitui and Nyamira counties had reduced odds of unmet need for FP. The odds of unmet need decreased with the survey year while that of modern contraceptive use had an inverse trend.Conclusion: Overall modern contraceptive use in urban areas is lower than the national average while the unmet need for FP is higher than national average, highlighting a potential urban-rural disparity in FP indicators in Kenya. Individual sociodemographic and socioeconomic and contextual factors are associated with the use of modern contraceptive and unmet need for FP among urban women in Kenya. Urban family planning policies and programmes in Kenya need to focus on strengthening urban healthcare systems to provide equal and accessible FP services, especially targeted towards teenagers and young women and those of low socioeconomic status.

Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study

BackgroundFamily planning (FP) is a key intervention for preventing unplanned pregnancies, unsafe abortions, and maternal death. Involvement of both women and their partners promotes contraceptive acceptance, uptake and continuation, couple communication and gender-equitable attitude. Partner involvement is a key strategy for addressing about 17.5% of the unmet needs in FP in Kenya. This study assessed the prevalence and factors associated with covert contraceptive use (CCU) in Kenya.MethodsWe used data from the sixth and seventh rounds of the performance monitoring for accountability surveys. We defined CCU as “the use of contraceptives without a partner’s knowledge”. We used frequencies and percentages to describe the sample characteristics and the prevalence of CCU and assessed the associated factors using bivariate and multivariable logistic regressions.ResultsThe prevalence of CCU was 12.2% (95% CI: 10.4–14.2%); highest among uneducated (22.3%) poorest (18.2%) and 35–49 years-old (12.8%) women. Injectables (53.3%) and implants (34.6%) were the commonest methods among women who practice CCU. In the bivariate analysis, Siaya county, rural residence, education, wealth, and age at sexual debut were associated with CCU. On adjusting for covariates, the odds of CCU were increased among uneducated women (aOR 3.79, 95% CI 1.73–8.31), women with primary education (aOR 1.86, 95% CI 1.06–3.29) and those from the poorest (aOR 2.67, 95% CI 1.61–4.45), poorer (aOR 1.79, 95% CI 1.05–3.04), and middle (aOR 2.40, 95% CI 1.52–3.78) household wealth quintiles and were reduced among those with 2–3 (aOR 0.49, 95% CI 0.33–0.72) and ≥ 4 children (aOR 0.62, 95% CI 0.40–0.96). Age at sexual debut (aOR 0.94, 95% CI 0.89–0.99) reduced the odds of CCU.ConclusionAbout one in 10 married women in Kenya use contraceptives covertly, with injectables and implants being the preferred methods. Our study highlights a gap in partner involvement in FP and calls for efforts to strengthen their involvement to increase contraceptive use in Kenya while acknowledging women’s right to make independent choices.

Vaccine temperature management in Lao People's Democratic Republic: A nationwide cross-sectional study

ObjectiveThe objective of the study was to evaluate the duration and frequency of vaccine exposure to suboptimal temperatures during transit from the central vaccine storage in the capital to health centers in Lao PDR. MethodsTemperature data loggers traveled from the capital to the health centre storages (146) with the vaccines to monitor the vaccine temperature nationwide. One health centre per district was selected using a simple random sampling method for the first round of temperature monitoring. One health centre was selected from every forty-nine high risk districts monitor the trend of vaccine temperature at the health centre storage and during outreach sessions in several districts. Vaccines and temperature data loggers were transported using the normal vaccination transportation. FindingsOverall, the vaccines were exposed to temperatures >8 °C for an average of 1648 min, equivalent to 9.0% of the observational period, and to temperatures <0 °C for an average of 184 min, equivalent to 1.35% of the study period. The proportion of exposure to temperatures >8 °C was the highest during the transit from the capital to the province. The proportion of exposure to temperatures <0 °C was the highest during storage at district level. Examined by region, vaccines in the northern provinces had higher risk of exposure to temperatures >8 °C; however, the risk of exposure to temperatures <0 °C was scattered nationwide. Moreover, some health centers showed fluctuations in storage temperature. ConclusionsChallenges associated with cold chain management, and the resulting deterioration of vaccines, might account for outbreaks of vaccine-preventable diseases. The government should examine and invest in suitable technologies and approaches to ensure consistency in cold chain management.

Examining the recent trends in adolescent sexual and reproductive health in five countries of sub\u2010Saharan Africa based on PMA and DHS household surveys

BackgroundThe annual collection of fertility, marriage, sexual behaviour, and contraceptive use data in the nationally representative rounds of Performance Monitoring and Accountability (PMA) surveys in sub-Saharan Africa may contribute to the periodic monitoring of adolescent sexual and reproductive health (ASRH). However, we need to understand the reliability of these data in monitoring the ASRH indicators. We assessed the internal and external consistencies in ASRH indicators in five countries.MethodsWe included countries with at least three nationally representative rounds of PMA surveys and two recent DHS: Ethiopia, Ghana, Kenya, Nigeria, and Uganda. Our analysis focused on four current status indicators of ASRH among girls 15–19 years: ever had sex, currently married, has given birth or currently pregnant, and currently using modern contraceptives among sexually active unmarried girls. We compared the PMA survey and DHS data and tested for statistical significance and assessed trends over time using Jonckheere-Terpstra test statistic.ResultsPMA and DHS survey methodologies were similar and, where there were differences, these were shown to have minimal impact on the indicator values. The comparison of the data points from PMA and DHS for the same years showed statistically significant differences in 12 of the 20 comparisons, which was most common for sexual behaviour (4/5) and least for contraceptive use (2/5). This is partly due to larger confidence intervals in both surveys. The time trends were consistent between the annual PMA surveys in most instances in Ethiopia, Kenya, and Nigeria but less so for Ghana and Uganda. However, both surveys highlight slow progress in adolescent and reproductive health indicators with major disparities between the countries.ConclusionsDespite the differences between PMA 2020 surveys and DHS surveys conducted in the same year, and inconsistencies of the PMA survey time series for several indicators in some countries, we found no systematic issues with PMA surveys and consider PMA surveys a valuable data source for the assessment of levels and trends of ASRH beyond contraceptive use and family planning for indicators of fertility, marriage, and sex among adolescent girls in sub-Saharan Africa.

Need for and use of contraception by women before and during COVID-19 in four sub-Saharan African geographies: results from population-based national or regional cohort surveys

SummaryBackgroundAlthough hindrances to the sexual and reproductive health of women are expected because of COVID-19, the actual effect of the pandemic on contraceptive use and unintended pregnancy risk in women, particularly in sub-Saharan Africa, remains largely unknown. We aimed to examine population-level changes in the need for and use of contraception by women during the COVID-19 pandemic, determine if these changes differed by sociodemographic characteristics, and compare observed changes during the COVID-19 pandemic with trends in the 2 preceding years.MethodsIn this study, we used four rounds of Performance Monitoring for Action (PMA) population-based survey data collected in four geographies: two at the country level (Burkina Faso and Kenya) and two at the subnational level (Kinshasa, Democratic Republic of the Congo and Lagos, Nigeria). These geographies were selected for this study as they completed surveys immediately before the onset of COVID-19 and implemented a follow-up specific to COVID-19. The first round comprised the baseline PMA panel survey implemented between November, 2019, and February, 2020 (referred to as baseline). The second round comprised telephone-based follow-up surveys between May 28 and July 20, 2020 (referred to as COVID-19 follow-up). The third and fourth rounds comprised two previous cross-sectional survey rounds implemented in the same geographies between 2017 and 2019.FindingsOur analyses were restricted to 7245 women in union (married or living with a partner, as if married) who were interviewed at baseline and COVID-19 follow-up. The proportion of women in need of contraception significantly increased in Lagos only, by 5·81 percentage points (from 74·5% to 80·3%). Contraceptive use among women in need increased significantly in the two rural geographies, with a 17·37 percentage point increase in rural Burkina Faso (30·7% to 48·1%) and a 7·35 percentage point increase in rural Kenya (71·6% to 78·9%). These overall trends mask several distinct patterns by sociodemographic group. Specifically, there was an increase in the need for contraception among nulliparous women across all geographies investigated.InterpretationOur findings do not support the anticipated deleterious effect of COVID-19 on access to and use of contraceptive services by women in the earliest stages of the pandemic. Although these results are largely encouraging, we warn that these trends might not be sustainable throughout prolonged economic hardship and service disruptions.FundingBill & Melinda Gates Foundation.TranslationFor the French translation of the abstract see Supplementary Materials section.

Implementing a decade of strengthening the health workforce in the WHO South-East Asia Region: achievements and way forward for primary health care

Background Health workers are the cornerstone of primary health care (PHC) services, the delivery of an effective coronavirus disease 2019 (COVID-19) response and progress towards universal health coverage (UHC). In 2014, the World Health Organization (WHO) South-East Asia Region committed to the Decade for Health Workforce Strengthening 2015–2024, and UHC became a regional flagship with a focus on strengthening the health workforce. Since its inception, three rounds of monitoring with standardized indicators have been completed.Methods In 2019, data on human resources for health were collected through the National Health Workforce Accounts online platform by the country focal points; this was complemented by a regional online consultation in June 2020. A mid-term review report on the Decade for Health Workforce Strengthening was launched during the 73rd session of the Regional Committee in September 2020.Results The availability of doctors, nurses and midwives in the South-East Asia Region has increased by 21% since the decade began in 2014. Nine countries of the region are now above the 2006 WHO threshold of 22.8 doctors, nurses and midwives per 10 000 population, compared with only six countries in 2014. However, only two countries are above the 2016 revised WHO threshold of 44.5 doctors, nurses and midwives per 10 000 population, the density estimated to be needed to achieve the Sustainable Development Goals. Countries of the WHO South-East Asia Region have made progress to different extents during the past 5 years on strengthening governance of human resources for health, data, rural retention and health professional education.Discussion Addressing broader health workforce challenges and particularly PHC workforce challenges will require extra commitment and prioritization by governments for the second half of the decade. COVID-19 presents the necessity and an opportunity to increase long-term investment in the health workforce and in strengthening PHC in the South-East Asia Region.

Reducing adverse medication events in mental health: Australian National Survey.

To determine the extent to which evidence-based medication safety practices have been implemented in public and private mental health inpatient units across Australia. The Reducing Adverse Medication Events in Mental Health survey was piloted in Victoria, Australia, in 2015, and rolled out nationally in 2016. In total, 235 mental health inpatient units from all States and Territories in Australia were invited to participate. The survey included questions about the demographics of the mental health unit, evidence-based strategies to improve prescription writing, the administration and dispensing of medicines and pharmacy-led interventions, and also questions relating to consumer engagement in medication management and shared decision-making. The response rate was 45% (N = 106 units). Overall, the survey found that 57% of the mental health units had fully or partially implemented evidence-based medication safety practices. High levels of implementation (80%) were reported for the use of standardized medication charts such as the National Inpatient Medication Chart as a way to improve medication prescription writing. Most (71%) of the units were using standardized forms for recording medication histories, and 56% were using designated forms for Medication Management Plans. However, less than one-fifth of the units had implemented electronic medication management systems, and the majority of units still relied on paper-based documentation systems.Interventions to improve medicine administration and dispensing were not highly utilized. Individual patient-based medication distribution systems were fully implemented in only 9% of the units, with a high reliance (81%) on ward stock or imprest systems. Tall Man lettering for labelling was implemented in only one-third of the units.Pharmacy services were well represented in mental health units, with 80% having access to onsite pharmacist services providing assessments of current medications and clinical review services, adverse drug reaction reporting and management services, patient and carer education and counselling, and medicines information services. However, pharmacists were involved in only half of medical reconciliations. Their involvement in post-discharge follow-up was limited to 4% of units. Gaps in medication safety practices included limited use of individual patient supply systems for medication distribution, a high reliance on ward stock systems and high reliance on paper-based systems for medication prescribing and administration. With regards to service provision, clinical pharmacist involvement in medical reconciliation services, therapeutic drug monitoring and interdisciplinary ward rounds should be increased. Discharge and post-discharge services were major gaps in service provision.

The status of Ghanaian community health workers' supervision and service delivery: descriptive analyses from the 2017 Performance Monitoring and Accountability 2020 survey.

Introduction: Community-based services are a critical component of high-quality primary healthcare. Ghana formally launched the National Community Health Worker (CHW) program in 2014, to augment the pre-existing Community-based Health Planning and Services (CHPS). To date, however, there is scant data about the program's implementation. We describe the current supervision and service delivery status of CHWs throughout the country. Methods: Data were collected regarding CHW supervision and service delivery during the 2017 round of the Performance Monitoring and Accountability 2020 survey. Descriptive analyses were performed by facility type, supervisor type, service delivery type, and regional distribution. Results: Over 80% of CHWs had at least monthly supervision interactions, but there was variability in the frequency of interactions. Frequency of supervision interactions did not vary by facility or supervisor type. The types of services delivered by CHWs varied greatly by facility type and region. Community mobilization, health education, and outreach for loss-to-follow-up were delivered by over three quarters of CHWs, while mental health counseling and postnatal care are provided by fewer than one third of CHWs. The Western region and Greater Accra had especially low rates of CHW service provision. Non-communicable disease treatment, which is not included in the national guidelines, was reportedly provided by some CHWs in nine out of ten regions. Conclusions: Overall, this study demonstrates variability in supervision frequency and CHW activities. A high proportion of CHWs already meet the expected frequency of supervision. Meanwhile, there are substantial differences by region of CHW service provision, which requires further research, particularly on novel CHW services such as non-communicable disease treatment. While there are important limitations to these data, these findings can be instructive for Ghanaian policymakers and implementers to target improvement initiatives for community-based services.

The status of Ghanaian community health workers’ supervision and service delivery: descriptive analyses from the 2017 Performance Monitoring and Accountability 2020 survey

Introduction: Community-based services are a critical component of high-quality primary healthcare. Ghana formally launched the National Community Health Worker (CHW) program in 2014, to augment the pre-existing Community-based Health Planning and Services (CHPS). To date, however, there is scant data about the program’s implementation. We describe the current supervision and service delivery status of CHWs throughout the country. Methods: Data were collected regarding CHW supervision and service delivery during the 2017 round of the Performance Monitoring and Accountability 2020 survey. Descriptive analyses were performed by facility type, supervisor type, service delivery type, and regional distribution. Results: Over 80% of CHWs had at least monthly supervision interactions, but there was variability in the frequency of interactions. Frequency of supervision interactions did not vary by facility or supervisor type. The types of services delivered by CHWs varied greatly by facility type and region. Community mobilization, health education, and outreach for loss-to-follow-up were delivered by over three quarters of CHWs, while mental health counseling and postnatal care are provided by fewer than one third of CHWs. The Western region and Greater Accra had especially low rates of CHW service provision. Non-communicable disease treatment, which is not included in the national guidelines, was reportedly provided by some CHWs in nine out of ten regions. Conclusions: Overall, this study demonstrates variability in supervision frequency and CHW activities. A high proportion of CHWs already meet the expected frequency of supervision. Meanwhile, there are substantial differences by region of CHW service provision, which requires further research, particularly on novel CHW services such as non-communicable disease treatment. While there are important limitations to these data, these findings can be instructive for Ghanaian policymakers and implementers to target improvement initiatives for community-based services.

The status of Ghanaian community health workers' supervision and service delivery: descriptive analyses from the 2017 Performance Monitoring and Accountability 2020 survey.

Introduction: Community-based services are a critical component of high-quality primary healthcare. Ghana formally launched the National Community Health Worker (CHW) program in 2014, to augment the pre-existing Community-based Health Planning and Services (CHPS). To date, however, there is scant data about the program's implementation. We describe the current supervision and service delivery status of CHWs throughout the country. Methods: Data were collected regarding CHW supervision and service delivery during the 2017 round of the Performance Monitoring and Accountability 2020 survey. Descriptive analyses were performed by facility type, supervisor type, service delivery type, and regional distribution. Results: Over 80% of CHWs had at least monthly supervision interactions, but there was variability in the frequency of interactions. Frequency of supervision interactions did not vary by facility or supervisor type. The types of services delivered by CHWs varied greatly by facility type and region. Community mobilization, health education, and outreach for loss-to-follow-up were delivered by over three quarters of CHWs, while mental health counseling and postnatal care are provided by fewer than one third of CHWs. The Western region and Greater Accra had especially low rates of CHW service provision. Non-communicable disease treatment, which is not included in the national guidelines, was reportedly provided by some CHWs in nine out of ten regions. Conclusions: Overall, this study demonstrates variability in supervision frequency and CHW activities. A high proportion of CHWs already meet the expected frequency of supervision. Meanwhile, there are substantial differences by region of CHW service provision, which requires further research, particularly on novel CHW services such as non-communicable disease treatment. While there are important limitations to these data, these findings can be instructive for Ghanaian policymakers and implementers to target improvement initiatives for community-based services.