Services In Town Research Articles

Variegated urban and rural spaces: Defining village types in China

China’s system of territorial spatial planning requires an integrated layout of ecological, agricultural, and urban functional space. This paper examines urban and rural villages and finds that villages can be classified into five types: urban villages, suburban villages, rural villages, semi-ecological villages, and eco-villages. These villages have multiple functions such as ecological services, agricultural production, and town services, according to the relationship between villages and territorial space. Urban villages refer to villages within the urban space, which have certain urban socio-ecological service functions; suburban villages are villages located at the junction of urban and agricultural spaces, which adapt their functions to the needs of the town; rural villages refer to villages located in the vast agricultural space, which are dominated by large-scale agriculture, and which need to undertake the function of guaranteeing food security; semi-ecological villages refer to villages at the junction of the agricultural space and the eco-villages, which can develop diversified ecological services; and eco-villages refer to villages that are in, or essentially in, eco-space, and have an important role to play in the maintenance of natural ecosystems.

Adolescent girls and young women’s (AGYW) access to and use of contraception services in Cape Town: perspectives from AGYW and health care providers

BackgroundAccess and use of contraception services by adolescent girls and young women (AGYW) remains suboptimal, exposing AGYW to early and often unexpected pregnancy. Unexpected pregnancies are a public health concern, associated with poor neonatal and maternal health outcomes, as well as school dropout, which may result in economic hardships. This study aimed to explore (a) AGYW perceptions and experiences of receiving contraception services from health care providers and (b) health care providers’ perceptions and experiences of providing contraception services to AGYW.MethodsData were collected through semi-structured individual interviews with AGYW aged 15–24 years old and health care providers working in eight health care facilities around the Cape Town metropolitan area, in South Africa’s Western Cape Province. Thematic analysis was used to analyse the data.ResultsAGYW and health care providers voiced varying, and often contrasting, perceptions of some of the barriers that hinder AGYW’s access to contraception services. AGYW indicated that provider-imposed rules about when to access contraceptive services hindered access, while health care providers felt that these rules were necessary for coordinating their work. In addition, AGYW highlighted health care providers’ hostile attitudes towards them as an important factor discouraging access. On the contrary, health care providers did not think that their attitudes hampered AGYW’s access to and use of contraception services, instead they emphasised that challenges at the health system level were a major issue, which they feel they have little control over. Such challenges made health care providers’ work unpleasant and frustrating, impacting on their work approach and how they receive and offer services to AGYW.ConclusionThe expectation of negative attitudes from health care providers continues to be at the centre of AGYW discouragement towards accessing contraception services. System challenges are among some of the key drivers of health care provider’s hostile attitudes, posing challenges to the efficient provision of services. In order to improve AGYW’s access to and use of contraception services, and subsequently achieve the country’s SDGs, conscious efforts need to be directed towards improving the workload and working conditions of health care providers.

IMPACT OF NOREPINEPHRINE DOSAGE INCREASE AND VOLUME EXPANSION ON CAPILLARY REFILL TIME IN SEPTIC SHOCK PATIENTS

Background: When evaluating patients with acute circulatory failure, one clinical feature that may be quickly determined at the bedside is the capillary refill time (CRT).Objective: The objective of this observational study was to describe the changes in CRT that occur as a result of volume expansion and increased dosages of norepinephrine, along with related macro-circulatory variables, in patients suffering from septic shock. Study Design: This was an observational study. Setting: The study was conducted at Bahria Town International Hospital Lahore and Services Institute of Medical Sciences. Duration of Study: The study was conducted over six months from January 2, 2023, to July 30, 2023. Methods: We measured mean arterial pressure (MAP), cardiac index (CI), and five consecutive CRT readings in 40 septic shock patients. These measurements were taken before and after a 500 mL saline infusion in 20 patients and before and after an increase in norepinephrine dosage in another 20 patients. Results: The "norepinephrine" group had lower SAPS II and SOFA scores than the "volume expansion" group. When all patients were assessed together, volume expansion significantly lowered heart rate while increasing MAP, diastolic arterial pressure, CI, CVP, and CRT. Fluid-induced increases in CI of ≥ 15% were observed in 11 patients (55%). In fluid responders, fluid infusion significantly raised MAP by 31% (11-49%) and CI by 26% (20-42%). Increased norepinephrine levels may lower CRT in patients with a baseline value of fewer than 3 seconds. Increasing norepinephrine has a low possibility of decreasing CRT in patients with baseline CRT ≥ 3 seconds if the MAP increase is <15%. However, the decrease in CRT is inconsistent in patients with baseline CRT ≥ 3 seconds when norepinephrine increases MAP by ≥ 15%. Univariate regression analysis revealed a correlation between the absolute value of CRT and lactate levels, heart rate, norepinephrine dosage, gender, SAPS II, and ICU mortality. In a multivariate analysis that included all physiological parameters with a p-value <0.1 in univariate linear regression, only lactate upon admission had a significant association with the absolute value of CRT. Conclusion: CRT uncommonly improves with therapy in individuals with septic shock and prolonged CRT when volume expansion raises cardiac output by <15% and increasing the dosage of norepinephrine increases MAP by <15%. CRT's response varies when there are significant effects of fluid infusion on cardiac output and norepinephrine on MAP; in some patients, it decreases while remaining consistent in others. CRT functions as an indicator of microcirculation in this context.

School-based healthcare services in Cape Town, South Africa: When there's a will, there's a way.

South African secondary schools do not deliver school-based healthcare services despite high rates of human immunodeficiency virus (HIV) infection, sexually transmitted infections, and unplanned pregnancies among adolescents, ongoing sub-optimal uptake of healthcare services from public healthcare facilities by adolescents, and national policy support for such services. A pilot school health nursing programme (SHNP) was offered to 44 secondary schools in a single health sub-district within the Western Cape, South Africa. The programme included fortnightly nurse visits that offered a standard package of healthcare services, including sexual and reproductive health services tailored according to school preference.Of the 44 schools, 42 gave permission for the SHNP to operate, with the majority of schools selecting the full comprehensive package of services. Programme implementation was truncated such that delivery only occurred over two school terms (20 weeks); however, 344 students attended the service. The majority of service users were female with a median age of 16 years, and over a half attended the service for sexual and reproductive health services.Contribution:A key challenge to school-based health service delivery arose from inadequate stakeholder support and differential views of adolescent healthcare needs among government officials, parents, guardians, school staff and governing bodies. These findings motivate for ongoing multi-level stakeholder engagement around the reality of adolescent healthcare needs and further opportunities to deliver school health services for longer time periods such that their feasibility, acceptability, and potential to impact healthcare outcomes can be assessed in this setting.

Assessment of Solid Waste Management Practices and Role of Community Participation in Mettu Town, Ethiopia

Solid waste management has become a major public health and environmental concern in urban areas of Ethiopia. The purpose of this study is to evaluate the status of the existing solid waste management and to assess the attitude and role of the community in Mettu town. In order to accomplish these objectives, both primary and secondary data were gathered and analyzed by descriptive statistics. The sample size included of 96 members of households, business owners, kebele leaders, municipal workers, solid waste collectors and health extension workers who were selected randomly. Based on the data that generated from the respondents municipal solid waste management system is very weak in terms of status, spatial coverage, community involvement, and solid waste management facility. Among 96 about 84 (87.5%) respondents are not satisfied with the existing solid waste management. The communities participate very careless to clean their front yards, street and see it as the responsibility of the municipality. This poor status of solid waste management is intensified by poor contribution of stakeholders. Therefore, the government should be engaged in awareness creation and training all communities and stakeholders to upgrade the existing low status of solid waste management services in Mettu town.

Anemia Among Women Using Family Planning at Public Health Facilities in Ambo Town, Central Ethiopia: Multi-Center Cross-Sectional Study.

Anemia affects more than a quarter of non-pregnant women over the globe, with Sub-Saharan Africa bearing a disproportionate share. Although the use of family planning is beneficial in reducing anemia, lack of scientific study on anemia among family planning users of reproductive-age women is notable, particularly in the study setting. The purpose of this study was to determine the extent of anemia and associated factors in women who used family planning. A cross-sectional multi-centered study was conducted from March 3 to 29, 2019, among 443 non-pregnant reproductive age (15 to 49 years) women receiving family planning services in Ambo town. Sample size was calculated using Epi-info version 7 software. Participants were selected by systematic random sampling technique. Trained data collectors collected data using a structured pretested questionnaire, as well as venous blood and stool samples. Epi-Data and SPSS were used to enter and analyze data. The effect of independent variables on the outcome variable was determined by binary logistic regression analysis with adjusted odds ratio at 95% confidence interval and 5% margin of error. P-value <0.05 was used to declare statistical significance. This study revealed 28% (95% CI:23.9%, 32.3%) magnitude of anemia. Age of 25-35 years [AOR:2.84, 95% CI:1.74, 4.64], implantable family planning method [AOR: 0.34, 95% CI: 0.12, 0.96], no previous use of family planning [AOR:2.62, 95% CI: 1.62, 4.24], household food insecurity [AOR: 2.04, 95% CI: 1.06, 3.93], parasite infestations [AOR:2.01, 95% CI: 1.12, 3.63], and regular intake of coffee/tea within 30 minutes post meal [AOR:3.85, 95% CI:1.24, 11.92] were independently associated with anemia. Anemia is a moderate public health concern among reproductive-age women receiving family planning services in the study area. There are missed opportunities to address the anemia burden during family planning services. This study emphasizes the importance of nutritional screening for early detection and targeted interventions for healthcare workers in reducing missed opportunities to prevent and control anemia in vulnerable populations.

Access to postpartum tubal ligation services in Cape Town, South Africa – an observational study

Many women receiving antenatal care in public health services in Cape Town choose bilateral tubal ligation as their preferred method of postpartum contraception during their antenatal course. If the sterilisation does not occur immediately, these women are discharged on an alternative form of contraception and, ideally, an interval date for bilateral tubal ligation is arranged. To assess the access to tubal ligation services in the Metro West area of Cape Town, South Africa, in women who request permanent contraception following delivery, looking specifically at the number of women requesting bilateral tubal ligation who receive the procedure intrapartum, immediately postpartum or as an interval procedure. Other objectives included determining the reproductive outcomes if bilateral tubal ligation was not performed, investigating the alternative forms of contraception provided and to study the demographics of the population requesting bilateral tubal ligation as a form of contraception. The study was conducted as a cross-sectional observational study collecting data over a period of 3 months, from June 2019 to August 2019. Maternity case records for deliveries between June 2019 and August 2019 from four facilities were reviewed. The facilities, representing all levels of care, were Vanguard Midwife Obstetric Unit, Wesfleur Hospital (district hospital), New Somerset Hospital (regional hospital), Groote Schuur Hospital (tertiary hospital). There were 260 women who requested tubal ligation as their choice of contraception. Only 50% of these received a tubal ligation. Of the 131 tubal ligations performed, 2 were interval sterilisations. Ninety-one percent (120/131) of the tubal ligations were done at the time of caesarean section. Of the 129 women who received alternative forms of contraception, 13 women had a recurrent pregnancy. The study suggests that only 50% of women requesting tubal ligation as form of contraception actually end up receiving the procedure. Alternative forms of contraception are widely used and relied upon, but not without risks of recurrent pregnancy. Interval tubal ligation was not easily accessed by those women who were referred for the procedure.

Fatores críticos de sucesso do enoturismo em São Joaquim, Santa Catarina, Brasil

The article analyzes the critical success factors of wine tourism in São Joaquim, Santa Catarina, Brazil in the perception of tourism stakeholders. This research is characterized as exploratory and the approach to data treatment was qualitative. The techniques of data collection applied were the bibliographic research for the elaboration of the theoretical framework and the documentary research to characterize the local and regional tourism market and later, application of individual structured interview with the destination stakeholders. The results showed that the critical success factors perceived are related to wine, wineries, visitation, tasting, gastronomy and wine sales. On the other hand, the weaknesses pointed out were those related to the product, especially with regard to marketing and communication, the support services such as hotel and gastronomy, the auxiliary services in town, such as banking, trade and information.

Postabortion Contraceptive Utilization, Preferences, and Associated Factors among Women Receiving Abortion Care Services in Health Facilities of Ambo Town, Ethiopia.

The World Health Organization recommends the use of effective contraception for the prevention of unintended pregnancy and unsafe abortion. The main aim of postabortion contraceptive services is to prevent recurrent pregnancy and ultimately mitigate the associated maternal mortality. To assess postabortion contraceptive utilization (PACU) and postabortion contraceptive preferences (PACP) and the associated factors among women receiving abortion care services in Ambo town, Oromia Region, Western Ethiopia. A cross-sectional study was conducted at the health facilities in Ambo town from 22 July to 24 September 2021. The data was collected using a structured questionnaire. Bivariate and multivariable logistic regression was done to determine the factors associated with postabortion contraceptive utilization and preferences. Out of 388 participants who were included in the final analysis, 262 (67.5%) had utilized postabortion contraceptives of which 173 (66%) received contraceptive methods of their primary preference. The multivariate logistic regression showed that cohabiting couples showed lower utilization (AOR = 0.15; 95% CI: 0.06-0.21; p value = 0.004) than married ones and planning to have an additional child within 1-3 years (AOR = 7.41; 95% CI: 2.18-11.41; p value = 0.005) or after 3-5 years (AOR = 6.67: 95% CI: 5.12-10.18; p value = 0.033) was identified to be significantly associated with postabortion contraceptive utilization. Having a secondary education level (AOR = 3.06; 95% CI: 1.54-6.07; p value = 0.001) and having experience of domestic violence (AOR = 2.19; 95% CI: 1.27-3.81; p value = 0.005) were significantly associated with unsatisfied postabortion contraceptive preference. Conclusions and Recommendations. About two-thirds of the women who were given abortion services received postabortion contraceptives whereas almost two-thirds of them received a contraceptive method of their primary preference. Marital status, duration before additional child planned, and being counseled on contraceptive determined postabortion contraceptive utilization. Having a secondary education level and having experienced domestic violence were significantly associated with unsatisfied PACP.

The Port City of Haiphong, 1874–1940: The Position of the Chinese Community in a French Colonial City

This article discusses the position of the Chinese community in Haiphong, the largest port city in Northern Vietnam during the French colonial period. The Chinese had arrived and lived in Haiphong, as well as many other places in Vietnam long before the advent of the French. Nevertheless, a large-scale influx of Chinese migrants to Haiphong only happened after the French established colonial rule over Indochina and took full control of the town in the late nineteenth century. Haiphong became a strategic port in the transportation system of French Indochina, as well as within the French colonial empire. In Haiphong, the Chinese gathered in a separate residential quarter having the social and cultural life distinct from the French and Vietnamese communities. Yet, they were actively engaged in various economic activities of the town, notetably trade, intrustry, and financial services. The bombardment and occupation of Haiphong by the Japanese army in late 1940 caused great damages and casualties to the Chinese community. The prolonged warfares and the establishment of the communist regime in Vietnam after 1945 virtually ended the economic hegemony of the Chinese in Haiphong, as well other cities in Northern Vietnam.

An assessment of the role of small towns in the development of periphery population centers using network analysis

In Iran, the new towns' policy has not been successful regarding urban and regional development. In Iran, many rural areas have become towns, particularly in the last two decades. The present town of Arjmand in Firouzkooh county is one of them. This study aims to review the role of Arjmand town as a small population center in the development of the rural areas on the outskirts. For this purpose, 7 functions in the form of 49 variables were compared and reviewed using the network analysis method and existing relations and trends in the rural district under study in two sections before and after Arjmand's urbanization. Data analysis shows that in the 1st period, rural areas of Qazqanchai district were most dependent on this town due to the concentration of most services in Firouzkooh. But, in the 2nd period, with the concentration of most of these services in Arjmand town, dependencies of rural district settlements on Firouzkooh were reduced. A review of the centrality value of Arjmand shows that in both periods, Arjmand has played a vital role as a central point in providing services to its outskirts and reduction of rural dependency on the city center.

APP-BASED RIDE SERVICES AND THE SUSTAINABILITY OF METERED TAXIS IN SOUTH AFRICA

Developments in technology have disrupted many industries. Companies can no longer afford to ignore such vital technology. Many people in South Africa believe that the entry of ride-hailing apps like Uber and Bolt threatens the future of the country's traditional taxi industry. The paper sought to ascertain the influence of app-based ride solutions on the sustainability of conventional metered taxis and the ensuing survival strategies. A hybrid approach using both qualitative and quantitative data was adopted. Twenty participants and 80 respondents provided the qualitative and quantitative data utilized. The results suggest high-quality services and comfort vehicles offered by app-based services like Uber and Bolt have harmed the long-term viability of traditional metered taxis in the Cape Town metropolitan area. Since the advent of app-based ride services (Uber and Bolt), metered taxi operators have faced new challenges, including technological advancement, the demand for high-end transportation, and changing consumer tastes. The research could be helpful to companies providing metered taxi services in Cape Town by pointing to ways to improve operations. Hopefully, the findings of this research will aid regulators and other interested parties in making it easier for taxi companies that use meters to compete. Theoretically, the study may also contribute to the literature on the subject.

Small Town Politics, Stigma, and Services: Understanding the Unique Needs of Rural Families Post-Reunification

Research pertaining to effective foster care reunification strategies is well established. However, a gap exists in the literature surrounding social services for rural families post-reunification due to a lack of service provision for families following reunification. Reunified families often need additional support to prevent future reentry into foster care. Caseworkers work closely with families, offering a unique perspective as to what social services are most effective at preventing reentry into foster care. Due to recruitment constraints in during the COVID-19 pandemic, a pilot study with a sample of four (N = 4) Department of Family and Children’s Services [DFCS] caseworkers was conducted. Utilizing a qualitative framework, this pilot study investigated a sample of caseworkers’ perceptions as related to social services for improving family unity post-reunification, as well as barriers that exist for families accessing social services in rural southeast Georgia. Findings indicate that post-reunification services must be targeted and consistent to remain effective at maintaining family unity. Implications for social services providers, families, policymakers, and child welfare advocates are discussed. Future social services research examining the nuanced relationships between the geographic and social locations of families is needed to illuminate social services that support desirable and sustainable outcomes post-reunification.

Amblyopia: An Uncommon Presentation of Paediatric Conversion Disorder

AimsConversion disorder is common among children and adolescents, particularly in non-Western societies like in Bangladesh. Diverse presentation of the disorder makes it difficult to diagnose which ultimately may lead to poor prognosis.MethodsPatient X is a 10-year-old girl, a 5th grade student, hailing from a District town, Bangladesh, attending child and adolescent consultation services with the complaint of sudden loss of vision in both eyes for 3 weeks. Earlier, she underwent thorough examination and investigation and intervention by the different specialists (GP, ophthalmologist, and neurologist). At one point she was given zero power glasses. Her symptom was then fluctuating. She was not attending school as she was away for treatment purposes. X complained of not seeing lines of books when her parents tried to persuade her to do schoolwork at home. Eventually she was referred for psychiatric evaluation after no improvement. Assessment was completed and parental discord, violent act of father towards mother, overprotective as well as inconsistent parenting, attention seeking behaviour of X were identified. General and systemic examinations were normal. Her finding was inconsistent with any physical disorder. Investigation was normal. Thus, diagnosis of conversion disorder was given. General treatment (reassurance, psychoeducation, adopting daily life programme) along with specific treatment (symptom reduction by suggestion, relaxation, and family therapy) were provided. Improvement was noted during the follow-ups.ResultsThe conversion disorder of this girl happened at her period of transition from childhood to adolescence. Psychopathology of hysteria still is not clear despite huge research efforts. Based on psychodynamic explanations, the core psychopathologies of her symptoms are primary gain - resolution of her witnessing severe parental discord that she failed to cope with happened through her presenting symptoms without awareness though later she does in awareness; secondary gain- she receives additional reinforcement in the form of extra care, parental help seeking behaviour, unnecessary interventions, demand fulfilment that mostly present in awareness. Other psychopathologies are conversion- the patient's psychological distress converted to presenting somatic symptoms through an intrapsychic process; repression-la belle indifference of the patient has developed through a process of displacing distressful experience, from awareness that gives relief to the distress.ConclusionManifestations of conversion disorder can simply be explained as cry for help, give indication of the problem areas, help in understanding personality traits, making intervention and prevention plans. Early identification of stressors is crucial for the treatment of this disorder.

IDF21-0259 Development of a self-care program for older people with type 2 diabetes attending community health centers

Background: Diabetes is a growing problem globally, with the major impact being experienced in low and middle-income countries. In South Africa, diabetes is a major cause of morbidity and mortality and a burden to the overstretched health services, community, family, and people with the disease. Self-care management is a cornerstone of diabetes care. Aim: To inform the development of a self-care management program for older people attending public sector primary health care services in Cape Town, South Africa by using the PRECEDE planning model. Method: (1) This research study is based on the theoretical framework of the PRECEDE-PROCEED model (PPM). (2) In the PPM, a complete needs assessment involving phases should be made before planning a health promotion intervention. Results: This research study incorporates five interlinked studies, The first was a systematic review of studies that assessed the prevalence of type 2 diabetes mellitus among older people in African countries conducted between 2000 and 2015 with the objective of providing data for the monitoring of future trends. the overall prevalence of diabetes was 13.7% (95% CI 11·3–16·3) and was twofold higher in studies based on the oral glucose tolerance test than in those using fasting plasma blood glucose. The second is a secondary analysis of the Study on global AGEing and adult health (SAGE) South Africa Wave 1 data that examined the prevalence of self-reported diabetes and the association between diabetes and each health-related quality of life and disability amongst South Africa’s older adults. The results were that diabetes was associated with lower quality of life and greater disability. The third, a cross-sectional survey, examines the knowledge of older people with diabetes attending primary care clinics. Its major finding is that there was a lack of knowledge about the complications of diabetes, suggesting that the available diabetes educational opportunities have not been effective. Importantly, however, social support was positively associated with both knowledge and a number of self-care aspects. The fourth is a qualitative study consisting of a documentary review. This found that generally older persons face numerous barriers in managing their condition. Further, there are multiple efforts to re-orientate the healthcare system to focus more effectively on non-communicable diseases for the population which would benefit older patients with diabetes. Finally, the study includes a systematic review of peer and non-professional health worker-led diabetes self-management programmes (COMP-DSMP) in low and middle-income country primary health care settings, and also examines the implementation strategies and associated diabetes-related health outcomes This found equivocal evidence supporting the use of COMP-DSMP for people with diabetes in these countries and suggested that the models of a peer/CHW-led programme need to be further explored, especially given the inevitability of a professional healthcare workforce shortage in LMICs Discussion: This research alerts policymakers and clinicians to some of the specific issues considered to be pertinent and important in the care and management of older persons with diabetes. Many of these would also be applicable to older individuals with other chronic conditions.

Alternative mechanisms for delivery of medication in South Africa: A scoping review.

BackgroundThe number of people in South Africa with chronic conditions is a challenge to the health system. In response to the coronavirus infection, health services in Cape Town introduced home delivery of medication by community health workers. In planning for the future, they requested a scoping review of alternative mechanisms for delivery of medication to patients in primary health care in South Africa.MethodsDatabases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Data was analysed both quantitatively and qualitatively.ResultsA total of 4253 publications were identified and 26 included. Most publications were from the last 5 years (n = 21), research (n = 24), Western Cape (n = 15) and focused on adherence clubs (n = 17), alternative pick-up-points (n = 14), home delivery (n = 5) and HIV (n = 17). The majority of alternative mechanisms were supported by a centralised dispensing and packaging system. New technology such as smart lockers and automated pharmacy dispensing units have been piloted. Patients benefited from these alternatives and had improved adherence. Available evidence suggests alternative mechanisms were cheaper and more beneficial than attending the facility to collect medication.ConclusionA mix of options tailored to the local context and patient choice that can be adequately managed by the system would be ideal. More economic evaluations are required of the alternatives, particularly before going to scale and for newer technology.

A mixed reception: perceptions of pregnant adolescents\u2019 experiences with health care workers in Cape Town, South Africa

BackgroundMaternal mortality among adolescent mothers in South Africa is higher than many middle-income countries. This is largely attributable to conditions that can be prevented or managed by high quality antenatal care. The way in which pregnant adolescents are treated at antenatal clinics influences their timely utilization of antenatal services. This qualitative study reports on the experiences of pregnant adolescents with health care workers when accessing antenatal care.MethodsPregnant girls aged 13–19 (n = 19) who attended public health care facilities that provide Basic Antenatal Care (BANC) services in Cape Town, South Africa were recruited. Four face to face in-depth interviews and four mini focus group discussions were undertaken, facilitated by a topic guide. Thematic analyses were used to analyse the data.ResultsExperiences that reinforce antenatal attendance, such as respectful and supportive treatment, were outweighed by negative experiences, such as victimization; discrimination against being pregnant at a young age; experiencing disregard and exclusion; inadequate provision of information about pregnancy, health and childbirth; clinic attendance discouragement; and mental health turmoil.ConclusionsThere is evidence of a discordant relationship between the health care workers and the pregnant adolescents. Adolescents feel mistreated and discriminated against by the health care workers, which in turn discourages their attendance at antenatal clinics. Maternal health care workers need to receive support and regular training on the provision of youth friendly antenatal care and be regularly evaluated, to promote the provision of fair and high quality antenatal services for adolescent girls.

WEATHER FACTORS AND AMBULANCE CALLS FOR RESPIRATORY CAUSES IN THE CITY OF PETROZAVODSK

Aim: To study associations between selected weather factors on the number of ambulance calls for selected respiratory diseases in the city of Petrozavodsk, Northwest Russia. Methods: Data on the number of ambulance calls in the city of Petrozavodsk were obtained for the period from 2015-2017. Associations between weather factors and the number of ambulance calls for respiratory diseases were studied by correlation analysis. Pearson's correlation coefficients were calculated. Separate analyses were performed for acute upper respiratory tract infections (J06), viral pneumonia (J12), acute bronchitis (J20) and asthma (J45). An additional analysis was performed for the warm- (14 months with the mean monthly temperature from +9.8 to +18.4 °C) and the cold (22 months with a temperature from -14.9 to +5.0 °C) seasons. Results: The overall number of ambulate calls for viral pneumonia decreased during the study period. Significant associations between air temperature and atmospheric pressure and the number of calls for respiratory deceases, particularly for acute respiratory tract infections. During the cold season the influence of the temperature factor on the number of calls decreased for the most cases except acute bronchitis. The lowest number of calls for acute bronchitis was observed during summers. In summer, the number of calls for acute bronchitis was positively associated with wind speed and inversely associated with mean temperature and humidity. The number of calls for acute respiratory infections was positively associated with intraday increase in barometric pressure and wind speed. In autumn, significant correlations were observed between the North-West wind, which carries air pollutants from the industrial part of the city to the residential area and the number ambulance calls. In winter, an inverse association between humidity and ambulance calls for viral pneumonia was found. In spring, significant associations between the number of ambulance calls for several respiratory causes and cloudiness were observed. Conclusion: Significant associations between weather factors and the number of ambulance calls for respiratory causes were observed in the city of Petrozavodsk. Our results can contribute to better planning of ambulance services in town.

Sustainability of community-managed small town and rural water systems in northern Ghana: lessons from Upper West Region

AbstractThis study assessed sustainability of small town and rural water services in northern Ghana using lessons from Jirapa Municipality. A case study design, deploying mixed methods, was employed. Data were obtained from household questionnaires administration and in-depth interviews with community leaders and institutional stakeholders in the water sector. The results revealed that, though access to potable water has increased since the introduction of community-management of water services in Jirapa Municipality, there are still difficulties in terms of adequate water supply. Sustainability challenges revealed by the study are managerial and technical, including ineffective water-management committees, inadequate operations and maintenance capacity, inadequate funds to maintain facilities and lack of continuing support. The study concludes that the apparently improved access to potable water in the Municipality may be short-lived. To improve and sustain water services, water-management committees should be established and trained in administration, operations, maintenance and tariff setting. Also, innovative ways, such as establishing a ‘water-management fund’, should be used to provide continuing support to communities.

A Survey of Solid Waste Management Services in Woldya Town (Ethiopia): Challenges and Opportunities for Improvement

In different cities and towns of Ethiopia, solid waste is a major environmental problem. Woldya town also face the challenges of solid waste management. Effective and efficient solid waste management in a town is a mandatory to ensure human and animal health and also to ensure clean and sound able environment in urban development. The aim of this study is to assess challenges and opportunities for improvement of solid waste management services in Woldya town. Interviews, questionnaires and observation were the major tools used for data gathering. The data were analyzed using tables, percentages, pie chart followed by explanation. In Woldya town the residents use illegal methods of solid waste disposal; this includes burning, open dump and ditch. The key challenges of solid waste management services in the town are lack of Awareness, lack of manpower, lack of facilities and financial constraints. The communities recommended that solid waste management can be improved through community participation, increasing funding, create awareness and encourage waste minimization. This study recommends environmental education related to solid waste management plays a great role to promote attitudinal change of the community and strong community participation, improve institutional capacity, strengthen financial capacity, promote private sector participation and preparing disposal site for solid waste