In a growing number of information processing applications,data takes the form of continuous data streams rather than traditional stored databases.Monitoring systems that seek to provide monitoring services in cloud e...In a growing number of information processing applications,data takes the form of continuous data streams rather than traditional stored databases.Monitoring systems that seek to provide monitoring services in cloud environment must be prepared to deal gracefully with huge data collections without compromising system performance.In this paper,we show that by using a concept of urgent data,our system can shorten the response time for most 'urgent' queries while guarantee lower bandwidth consumption.We argue that monitoring data can be treated differently.Some data capture critical system events;the arrival of these data will significantly influence the monitoring reaction speed which is called urgent data.High speed urgent data collections can help system to react in real time when facing fatal errors.A cloud environment in production,MagicCube,is used as a test bed.Extensive experiments over both real world and synthetic traces show that when using urgent data,monitoring system can lower the response latency compared with existing monitoring approaches.展开更多
Background: Poor birth outcomes are common health problems everywhere in the world. Hence institutional delivery in Ethiopia is very low, improving birth outcomes through recent evidence remained critical. The objecti...Background: Poor birth outcomes are common health problems everywhere in the world. Hence institutional delivery in Ethiopia is very low, improving birth outcomes through recent evidence remained critical. The objective of the study was to determine the prevalence of poor birth outcomes and associated factors among women who delivered in selected health facilities of North Wollo Zone. Methods: A facility based cross-sectional survey was conducted on 295 laboring mothers from May to June 2009. Interviewer administered questionnaire was used to collect the data. Patient’s chart was reviewed to retrieve medical information. Anthropometry of the neonate was taken by standard measurement tools. Data were analyzed using statistical package for social sciences (SPSS), version 15. Binary logistic regression analyses were used to identify predictors of poor birth outcomes. P-value ≤ 0.05 was considered statistically significant. Results: All the data resulted from 295 laboring mothers were made part of the analyses. A total of 266 (90.2%) laboring mothers gave live birth. A quarter, 68 (23.1%) of the laboring mothers had a poor birth outcome. The common adverse outcomes were intrauterine fetal death (IUFD, preterm, and birth defects with the proportion of 29 (42.6%), 22 (32.4%), and 3 (4.4%), respectively). Mother whose husband’s occupation was merchant (AOR = 4.4, 95% CI: 1.0-19.0), driver (AOR = 4.2, 95% CI: 1.12-15.76), & women who were illiterate (AOR = 4.0, 95% CI: 1.2-13.5), primary school completed (AOR = 4.3, 95% CI: 1.3-13.8), non-antenatal care visited (AOR = 3.4, 95% CI: 1.12-10.2), rural residence, (AOR = 2.6, 95% CI: 1.11-5.80), & mother’s HIV status, (AOR = 34.2, 95% CL 5.6, 207.0) were independent predictors of poor birth outcomes. Conclusions: Poor birth outcomes were very common in the study area where low birth weight accounted for much of all adverse pregnancy outcomes. Occupation, residence, antenatal care visit, income, maternal education and HIV status were determinants of poor birth outcomes. Accessing antenatal care in early trimester, mild physical work, maternal education to secondary level and above should be encouraged.展开更多
Background: The Maternal and Child Survival Program of United States Agency for International Development conducted a study in 2017 to assess the outcome of an initiative to strengthen Expanded Programme on Immunizati...Background: The Maternal and Child Survival Program of United States Agency for International Development conducted a study in 2017 to assess the outcome of an initiative to strengthen Expanded Programme on Immunization (EPI) pre-service training. The pre-service training initiative was undertaken by the Ministry of Health (MOH) with support from partners in 2012-2016. The overall objective of the study was to assess the adoption and effectiveness of the initiative in the competency (knowledge, skills and attitude) of graduate nurses. Methods: The study included a conveniently selected sample of 14 pre-service training institutions, 23 field practicum sites, and 29 health facilities in western Kenya, and used quantitative and qualitative methods of data collection. Results: All pre-service training institutions were found to have adapted the WHO EPI prototype curriculum. Overall, tutors followed training method in the classroom as suggested in the curriculum, except evaluation of students’ learning lacked tests or quizzes. Students had opportunities for hands-on practical experience in the field practicum sites. Graduate nurses were found to have acquired the skills for vaccinating children. However, some pre-service training institutions lacked functional skills labs for practical learning of students. In addition, students did not receive up-to-date information on EPI program, and lacked knowledge and skills on monitoring and documentation of EPI coverage during preservice training. Conclusions: It appears that the EPI pre-service training strengthening initiatives facilitated competency-based EPI training of nurses in Kenya. However, preservice training institutions still have scope for improvement in the skills lab, hand-washing practice, providing up-to-date information, and training students on coverage monitoring and documentation.展开更多
Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the del...Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers;more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.展开更多
Karachi, the largest city in Pakistan, having high population growth and a complex health care environment, has highest density of unimmunized (zero dose) and under-immunized children. The main reasons of low immuniza...Karachi, the largest city in Pakistan, having high population growth and a complex health care environment, has highest density of unimmunized (zero dose) and under-immunized children. The main reasons of low immunization coverage in Karachi were lack of governance and accountability in a duplicative and fragmented health management structure, weak and inequitable immunization services, and lack of demand and trust among people for immunization services. The Expanded Programme on Immunization (EPI), Ministry of Health (MOH) in Sindh Province spearheaded a structured and collaborative process to develop strategies for addressing inequity in immunization services towards achieving Universal Immunization Coverage (UIC) in Karachi. The process included a situation analysis with gathering quantitative and qualitative information on the root causes of zero-dose and inequity of the immunization services. The strategies and interventions were developed with multi-layer input and feedback of the stakeholders and partners, and focusing primarily to address gaps in three program areas: governance, leadership and accountability;immunization service delivery;and building demand and trust among the people. The interventions were further prioritized for high-risk areas;identified based on maximum number zero-dose children, presence of large slum areas, measles outbreak and on-going circulation of wild poliovirus. Finally, costing for the Roadmap activities was done through consultation with partners and aligning domestic and external (donor) resources. In this paper, we have highlighted the unique process the Sindh Government undertook in collaboration with the stakeholders and partners to develop strategies and interventions for addressing inequity in urban immunization services in Karachi towards achieving Universal Immunization Coverage (UIC). Similar processes can be adapted, as a potential model, for developing strategies to achieve universal health coverage in the cities of Pakistan and in other countries.展开更多
Tuberculosis(TB)is on the rise in Pakistan and there could be multiple reasons including poverty,difficulty in access to TB treatment services,non-compliance with treatment,social stigma etc.According to the TB progra...Tuberculosis(TB)is on the rise in Pakistan and there could be multiple reasons including poverty,difficulty in access to TB treatment services,non-compliance with treatment,social stigma etc.According to the TB program managers,limited treatment and testing sites for tuberculosis and lack of trained human resources play a major role in compromising TB management.A major lacuna in the TB control program is the absence of active contact tracing strategy.This is essential for a disease where positive cases are known to be able to infect a further 10-15 individuals in a year.Tackling tuberculosis in Pakistan has been beleaguered by funding challenges and other systems’bottlenecks such as lack of skilled human resources and insufficient supply of medicines,despite the fact that disease burden is one of the highest in the world.Although it is a notifiable disease,active case finding,contact tracing and reporting is notoriously low throughout the country.Access to diagnostics and treatment facilities has been limited and stigma attached to the disease remains deeply entrenched among the communities.Researchers have shown that enhanced and active approaches to contact investigation effectively identifies additional patients with TB among household contacts at a relatively modest cost.USAID’s Integrated Health Systems Strengthening and Service Delivery Activity extended support to the Health Departments of Sindh and Khyber Pakhtunkhwa provinces.In collaboration with the two provincial TB programs,community based active contact tracing was conducted on 17,696 individuals,based on the index cases.Among the contacts traced,243 cases were diagnosed as drug sensitive or drug resistant TB.Awareness sessions were conducted to sensitize people on the various aspects of disease and importance of getting tested.The project also supported establishing three satellite Programmatic Management of Drug Resistant Tuberculosis(PMDT)sites for drug resistant TB treatment,enhancing the programs’diagnostic and testing capacity.展开更多
基金supported by the National Key Technology R&D Program(Grant NO. 2012BAH17F01)NSFC-NSF International Cooperation Project(Grant NO. 61361126011)
文摘In a growing number of information processing applications,data takes the form of continuous data streams rather than traditional stored databases.Monitoring systems that seek to provide monitoring services in cloud environment must be prepared to deal gracefully with huge data collections without compromising system performance.In this paper,we show that by using a concept of urgent data,our system can shorten the response time for most 'urgent' queries while guarantee lower bandwidth consumption.We argue that monitoring data can be treated differently.Some data capture critical system events;the arrival of these data will significantly influence the monitoring reaction speed which is called urgent data.High speed urgent data collections can help system to react in real time when facing fatal errors.A cloud environment in production,MagicCube,is used as a test bed.Extensive experiments over both real world and synthetic traces show that when using urgent data,monitoring system can lower the response latency compared with existing monitoring approaches.
文摘Background: Poor birth outcomes are common health problems everywhere in the world. Hence institutional delivery in Ethiopia is very low, improving birth outcomes through recent evidence remained critical. The objective of the study was to determine the prevalence of poor birth outcomes and associated factors among women who delivered in selected health facilities of North Wollo Zone. Methods: A facility based cross-sectional survey was conducted on 295 laboring mothers from May to June 2009. Interviewer administered questionnaire was used to collect the data. Patient’s chart was reviewed to retrieve medical information. Anthropometry of the neonate was taken by standard measurement tools. Data were analyzed using statistical package for social sciences (SPSS), version 15. Binary logistic regression analyses were used to identify predictors of poor birth outcomes. P-value ≤ 0.05 was considered statistically significant. Results: All the data resulted from 295 laboring mothers were made part of the analyses. A total of 266 (90.2%) laboring mothers gave live birth. A quarter, 68 (23.1%) of the laboring mothers had a poor birth outcome. The common adverse outcomes were intrauterine fetal death (IUFD, preterm, and birth defects with the proportion of 29 (42.6%), 22 (32.4%), and 3 (4.4%), respectively). Mother whose husband’s occupation was merchant (AOR = 4.4, 95% CI: 1.0-19.0), driver (AOR = 4.2, 95% CI: 1.12-15.76), & women who were illiterate (AOR = 4.0, 95% CI: 1.2-13.5), primary school completed (AOR = 4.3, 95% CI: 1.3-13.8), non-antenatal care visited (AOR = 3.4, 95% CI: 1.12-10.2), rural residence, (AOR = 2.6, 95% CI: 1.11-5.80), & mother’s HIV status, (AOR = 34.2, 95% CL 5.6, 207.0) were independent predictors of poor birth outcomes. Conclusions: Poor birth outcomes were very common in the study area where low birth weight accounted for much of all adverse pregnancy outcomes. Occupation, residence, antenatal care visit, income, maternal education and HIV status were determinants of poor birth outcomes. Accessing antenatal care in early trimester, mild physical work, maternal education to secondary level and above should be encouraged.
文摘Background: The Maternal and Child Survival Program of United States Agency for International Development conducted a study in 2017 to assess the outcome of an initiative to strengthen Expanded Programme on Immunization (EPI) pre-service training. The pre-service training initiative was undertaken by the Ministry of Health (MOH) with support from partners in 2012-2016. The overall objective of the study was to assess the adoption and effectiveness of the initiative in the competency (knowledge, skills and attitude) of graduate nurses. Methods: The study included a conveniently selected sample of 14 pre-service training institutions, 23 field practicum sites, and 29 health facilities in western Kenya, and used quantitative and qualitative methods of data collection. Results: All pre-service training institutions were found to have adapted the WHO EPI prototype curriculum. Overall, tutors followed training method in the classroom as suggested in the curriculum, except evaluation of students’ learning lacked tests or quizzes. Students had opportunities for hands-on practical experience in the field practicum sites. Graduate nurses were found to have acquired the skills for vaccinating children. However, some pre-service training institutions lacked functional skills labs for practical learning of students. In addition, students did not receive up-to-date information on EPI program, and lacked knowledge and skills on monitoring and documentation of EPI coverage during preservice training. Conclusions: It appears that the EPI pre-service training strengthening initiatives facilitated competency-based EPI training of nurses in Kenya. However, preservice training institutions still have scope for improvement in the skills lab, hand-washing practice, providing up-to-date information, and training students on coverage monitoring and documentation.
文摘Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers;more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.
文摘Karachi, the largest city in Pakistan, having high population growth and a complex health care environment, has highest density of unimmunized (zero dose) and under-immunized children. The main reasons of low immunization coverage in Karachi were lack of governance and accountability in a duplicative and fragmented health management structure, weak and inequitable immunization services, and lack of demand and trust among people for immunization services. The Expanded Programme on Immunization (EPI), Ministry of Health (MOH) in Sindh Province spearheaded a structured and collaborative process to develop strategies for addressing inequity in immunization services towards achieving Universal Immunization Coverage (UIC) in Karachi. The process included a situation analysis with gathering quantitative and qualitative information on the root causes of zero-dose and inequity of the immunization services. The strategies and interventions were developed with multi-layer input and feedback of the stakeholders and partners, and focusing primarily to address gaps in three program areas: governance, leadership and accountability;immunization service delivery;and building demand and trust among the people. The interventions were further prioritized for high-risk areas;identified based on maximum number zero-dose children, presence of large slum areas, measles outbreak and on-going circulation of wild poliovirus. Finally, costing for the Roadmap activities was done through consultation with partners and aligning domestic and external (donor) resources. In this paper, we have highlighted the unique process the Sindh Government undertook in collaboration with the stakeholders and partners to develop strategies and interventions for addressing inequity in urban immunization services in Karachi towards achieving Universal Immunization Coverage (UIC). Similar processes can be adapted, as a potential model, for developing strategies to achieve universal health coverage in the cities of Pakistan and in other countries.
基金supported by the USAID’s Integrated Health Systems Strengthening and Service Delivery Activity,implemented by JSI Research&Training Institute under a cooperative agreement.
文摘Tuberculosis(TB)is on the rise in Pakistan and there could be multiple reasons including poverty,difficulty in access to TB treatment services,non-compliance with treatment,social stigma etc.According to the TB program managers,limited treatment and testing sites for tuberculosis and lack of trained human resources play a major role in compromising TB management.A major lacuna in the TB control program is the absence of active contact tracing strategy.This is essential for a disease where positive cases are known to be able to infect a further 10-15 individuals in a year.Tackling tuberculosis in Pakistan has been beleaguered by funding challenges and other systems’bottlenecks such as lack of skilled human resources and insufficient supply of medicines,despite the fact that disease burden is one of the highest in the world.Although it is a notifiable disease,active case finding,contact tracing and reporting is notoriously low throughout the country.Access to diagnostics and treatment facilities has been limited and stigma attached to the disease remains deeply entrenched among the communities.Researchers have shown that enhanced and active approaches to contact investigation effectively identifies additional patients with TB among household contacts at a relatively modest cost.USAID’s Integrated Health Systems Strengthening and Service Delivery Activity extended support to the Health Departments of Sindh and Khyber Pakhtunkhwa provinces.In collaboration with the two provincial TB programs,community based active contact tracing was conducted on 17,696 individuals,based on the index cases.Among the contacts traced,243 cases were diagnosed as drug sensitive or drug resistant TB.Awareness sessions were conducted to sensitize people on the various aspects of disease and importance of getting tested.The project also supported establishing three satellite Programmatic Management of Drug Resistant Tuberculosis(PMDT)sites for drug resistant TB treatment,enhancing the programs’diagnostic and testing capacity.
