scholarly journals Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247474
Author(s):  
Theodros Getachew ◽  
Solomon Mekonnen Abebe ◽  
Mezgebu Yitayal ◽  
Lars Åke Persson ◽  
Della Berhanu
Keyword(s):  
Community Education ◽  
Respiratory Infections ◽  
Correct Classification ◽  
Diarrheal Diseases ◽  
Health Extension Workers ◽  
Childhood Illnesses ◽  
Health Extension Program ◽  
Extension Program

Background Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers’ ability to correctly classify common childhood illnesses in four regions of Ethiopia. Methods Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. Results Health extensions workers’ consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers’ sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89–100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81–2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81–2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77–3.92]. Conclusion This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. Trial registration ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912.

scholarly journals A Functioning Model of a Dual-Band Radar System That Classifies Targets under the Influence of Interference and Noise

2020 ◽  
Vol 6 (4) ◽  
pp. 112-119
Author(s):  
V. Makarenkov
Keyword(s):  
Gaussian Noise ◽  
Radar System ◽  
White Gaussian Noise ◽  
Dual Band ◽  
Correct Classification ◽  
Noise Interference ◽  
Active Noise ◽  
Complex Target

There is proposed a model of a signal received from a complex target formed by a set of rapidly fluctuating point reflectors. Signal reception is carried out against the background of narrow-broadband active noise interference and white Gaussian noise. A functioning model of a dual-band radar system is proposed, in which the problem of classifying rapidly fluctuating point reflectors as a part of complex target against the background of interference and noise is solved. The article examines the issue of assessing the quality of this model, as well as meeting the re-quirements for ensuring a given value of the probability of correct classification of goals.

scholarly journals Disparities in the implementation of the Health Extension Program in Ethiopia: doing more and better towards universal health coverage

2021 ◽  
Author(s):  
Tilahun Haregu ◽  
Yibeltal Kiflie Alemayehu ◽  
Yibeltal Assefa Alemu ◽  
Girmay Medhin ◽  
Mulu Abraha Woldegiorgis ◽  
...  
Keyword(s):  
Health Services ◽  
Child Nutrition ◽  
Large Scale ◽  
Maternal Health Services ◽  
Health Coverage ◽  
Health Extension Workers ◽  
Health Extension Program ◽  
Interregional Disparities ◽  
Rate Ratios ◽  
Extension Program

Abstract IntroductionLarge-scale implementation of the Health Extension Program (HEP) has enabled Ethiopia to make significant progress in health services coverage and health outcomes. However, evidence on equity and disparities in implementation of the HEP and its outputs is limited. The aim of this study was to examine disparities in the implementation of the HEP in Ethiopia.MethodsWe used data from the 2019 National HEP assessment conducted between Oct 2018 and Sept 2019 in nine regions in the country. Data was collected from 62 districts, 343 Health posts, 179 Health centres, 584 Health Extension Workers (HEWs), 7,043 women from 7,122 Households. This study focused on selected input, service delivery, and service coverage indicators. We used rate differences, rate ratios and index of disparity to assess disparities in HEP implementation across regions.ResultsWe found wide interregional disparities in HEP implementation. Developing regional states (DRS) had significantly availability of qualified HEWs (Rate Ratio (RR) = 0.54), proportion of households visited by Health Extension workers (RR = 0.40, and proportion of mothers who received education on child nutrition (RR = 0.45) as compared national average. There are also significant disparities in HEP implementation among DRS in proportion of household visited by HEWs in the past 12 months (Index of disparity = 1.58) and proportion of adolescents who interacted with HEWs (Index of disparity = 1.43). Despite low overall coverage of health services in DRS, the contribution of the HEP for maternal health services is relatively high.ConclusionThere exist significant interregional disparities in HEP implementation in Ethiopia. The level of disparity among DRS is also remarkable. If the country is to achieve UHC, it is important that these disparities are addressed systematically and strategically. This calls for further attention in all regions, in general, and a tailored approach in DRS, in particular.

Recognition of Heartbeat Categories Applying a Novel Preprocessing Scheme and Neural Networks

2020 ◽  
Author(s):  
Andres Hernandez-Matamoros ◽  
Hamido Fujita ◽  
Hector Perez-Meana
Keyword(s):  
Quality Of Life ◽  
Neural Networks ◽  
Heart Disease ◽  
P Wave ◽  
Correct Classification ◽  
Major Contributor ◽  
Automated Diagnosis ◽  
Ecg Signals

Heart disease is the principal cause of mortality and the major contributor to reduced quality of life. The electrocardiogram is used to monitor the cardiovascular system. The correct classification of the beats in electrocardiograms gives an opportunity to have treatment more focused. The manual analysis of the ECG signals faces different problems. For this reason, automated diagnosis systems are fed by ECG signals to detect anomalies. In this paper, we propose a method based on a novel preprocessing approach and neural networks for the classification of heartbeats which is able to classify five categories of arrhythmias in accordance with the AAMI standard. The preprocessing stage allows each beat to have “P wave-R peak-R peak” information. We evaluated the proposed method on the MIT-BIH database, which is one of the most used databases. According to the results, the proposed approach is able to make predictions with the average accuracies of 97%. The average accuracies are compared to different approaches that use different preprocessing and classifier stages. Our approach is superior to that of most of them.

scholarly journals Veterinary meat inspection of bovine carcasses in theCzechRepublic during the period of 1995–2002

2012 ◽  
Vol 48 (No. 7) ◽  
pp. 183-189 ◽  
Author(s):  
V. Vecerek ◽  
A. Kozak ◽  
M. Malena ◽  
B. Tremlova ◽  
P. Chloupek
Keyword(s):  
Infectious Diseases ◽  
Respiratory Infections ◽  
Meat Inspection ◽  
Human Consumption ◽  
Safety Hazards ◽  
Food Borne ◽  
Cattle Herds

The results of veterinary meat inspection classification of 4 000 372 bovine carcasses reflect long-term aspects of health status in cattle herds and the quality of transport and handling of animals at slaughterhouses. Veterinary inspectors recorded the data obtained from meat inspection classification of bovine carcasses at slaughterhouses in the CzechRepublicduring the period of 1995–2002 together with the reasons for classification. The trends were evaluated by a comparison of two periods (Period I, 1995–1998, and Period II, 1999–2002) by means of calculating the indexes of values from Period II compared to those of Period I. Bovine carcasses classified as capable for human consumption (edible) were found in 87.87% of cases (88.83% during Period I and 86.58% during Period II, index 0.97), while those classified as capable for processing (conditionally edible) were found in 7.53% of cases (7.38% during Period I and 7.71% during Period II, index 1.04), and those condemned in 4.60% of cases (3.79% during Period I and 5.71% during Period II, index 1.51). The most important reason for classifying the carcasses as condemned was the finding of sensorial changes in meat, which occurred in 2.56% of cases (2.23% during Period I and 3.00% during Period II, index 1.35), followed by lesions due to non-infectious diseases – 1.00% (0.81% during Period I and 1.25% during Period II, index 1.53), added deleterious substances – 0.88% (0.60% during Period I and 1.27% during Period II, index 2.11), lesions due to respiratory infections – 0.03% (0.02% during Period I and 0.04% during Period II, index 1.74), and lesions due to miscellaneous infectious diseases – 0.10% (0.10% during Period I and 0.10% during Period II, index 1.05). Other reasons to condemn the carcasses included improper identification, lesions due to digestive infections, lesions due to tuberculosis, lesions due to paratuberculosis, lesions due to salmonellosis, leucosis and parasitic diseases. The occurrence of these conditions was on the level of mere hundredths of per cent. According to the results of meat inspection classification, the risk of food-borne diseases originating from bovine carcasses tends to be greater in the lesions due to non-infectious conditions with a long-term increasing trend. A considerable increase in the numbers of bovine carcasses condemned because of lesions due to paratuberculosis (index 4.62) represents an alarming finding with regard to potential food safety hazards.

scholarly journals Caregivers’ and Health Extension Workers’ Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia: A Qualitative Study

2021 ◽  
Vol 18 (7) ◽  
pp. 3816
Author(s):  
Atkure Defar ◽  
Kassahun Alemu ◽  
Zemene Tigabu ◽  
Lars Åke Persson ◽  
Yemisrach B. Okwaraji
Keyword(s):  
Health Workers ◽  
Capacity Development ◽  
The Other ◽  
Child Health Services ◽  
Quality Of Services ◽  
Health Extension Workers ◽  
Childhood Illnesses ◽  
Outreach Services ◽  
Sick Children

Introduction: Ethiopian Health Extension Workers provide facility-based and outreach services, including home visits to manage sick children, aiming to increase equity in service coverage. Little is known about the scope of the outreach services and caregivers’ and health workers’ perceptions of these services. We aimed at exploring mothers’ and health extension workers’ perceptions and experiences of the outreach services provided for the management of childhood illnesses. Methods: Four focus groups and eight key informant interviews were conducted. A total of 45 community members participated. Interviews were recorded, transcribed verbatim, and translated into English. We applied thematic content analysis, identified challenges in providing outreach services, and suggestions for improvement. We balanced the data collection by selecting half of the participants for interview and focus group discussions from remote areas and the other half from areas closer to the health posts. Results: Mothers reported that health extension workers visited their homes for preventive services but not for managing childhood illnesses. They showed lack of trust in the health workers’ ability to treat children at home. The health extension workers reported that they provide sick children treatment during outreach services but also stated that in most cases, mothers visit the health posts when their child is sick. On the other hand, mothers considered distance from home to health post not to be a problem if the quality of services improved. Workload, long distances, and lack of incentives were perceived as demotivating factors for outreach services. The health workers called for support, incentives, and capacity development activities. Conclusions: Mothers and health extension workers had partly divergent perceptions of whether outreach curative services for children were available. Mothers wanted improvements in the quality of services while health workers requested capacity development and more support for providing effective community-based child health services.

scholarly journals Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods

2020 ◽  
Vol 17 (16) ◽  
pp. 5803
Author(s):  
Yemisrach B. Okwaraji ◽  
Zelee Hill ◽  
Atkure Defar ◽  
Della Berhanu ◽  
Desta Wolassa ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Qualitative Interviews ◽  
Pragmatic Trial ◽  
Health Priorities ◽  
Care Seeking ◽  
Health Extension Workers ◽  
District Health ◽  
Health Extension Program ◽  
Grassroots Level ◽  
Extension Program

An intervention called ‘Optimising the Health Extension Program’, aiming to increase care-seeking for childhood illnesses in four regions of Ethiopia, was implemented between 2016 and 2018, and it included community engagement, capacity building, and district ownership and accountability. A pragmatic trial comparing 26 districts that received the intervention with 26 districts that did not found no evidence to suggest that the intervention increased utilisation of services. Here we used mixed methods to explore how the intervention was implemented. A fidelity analysis of each 31 intervention activities was performed, separately for the first phase and for the entire implementation period, to assess the extent to which what was planned was carried out. Qualitative interviews were undertaken with 39 implementers, to explore the successes and challenges of the implementation, and were analysed by using thematic analysis. Our findings show that the implementation was delayed, with only 19% (n = 6/31) activities having high fidelity in the first phase. Key challenges that presented barriers to timely implementation included the following: complexity both of the intervention itself and of administrative systems; inconsistent support from district health offices, partly due to competing priorities, such as the management of disease outbreaks; and infrequent supervision of health extension workers at the grassroots level. We conclude that, for sustainability, evidence-based interventions must be aligned with national health priorities and delivered within an existing health system. Strategies to overcome the resulting complexity include a realistic time frame and investment in district health teams, to support implementation at grassroots level.

scholarly journals Veterinary meat inspection of pig carcasses in the Czech Republic during the period of 1995–2002

2012 ◽  
Vol 48 (No. 8) ◽  
pp. 207-214 ◽  
Author(s):  
A. Kozak ◽  
V. Vecerek ◽  
P. Chloupek ◽  
B. Tremlova ◽  
M. Malena
Keyword(s):  
Respiratory Infections ◽  
Meat Inspection ◽  
Boar Taint ◽  
Safety Hazards ◽  
Salmonella Infections ◽  
Food Borne ◽  
Pig Carcasses

The results of meat inspection classification of pig carcasses reflect long-term aspects of health status in pig production farms and the quality of transport and handling of animals at slaughterhouses. Veterinary inspec­tors recorded the data obtained from meat inspection classification of 36 028 821 pig carcasses at slaughterhouses in theCzechRepublicduring the period of 1995–2002 together with the reasons for classification. The trends were evaluated by a comparison of two periods (Period I: 1995–1998; Period II: 1999–2002) by means of calculating the indexes of values from Period II compared to those of Period I. Pig carcasses classified as capable for human con­sumption (edible) were found in 97.28% of cases (97.26% during Period I and 97.31% during Period II, index 1.00), while those classified as capable for processing (conditionally edible) were found in 2.15% of cases (2.28% during Period I and 2.02% during Period II, index 0.89), and those condemned in 0.57% of cases (0.47% during Period I and 0.67% during Period II, index 1.43). The reasons for classifying the carcasses as condemned were as follows: sensorial changes in meat – 0.33% (0.26% during Period I and 0.41% during Period II, index 1.56), lesions due to non-infec­tious diseases – 0.12% (0.12% during Period I and 0.12% during Period II, index 0.97), added deleterious substances – 0.05% (0.03% during Period I and 0.07% during Period II, index 2.50), lesions due to respiratory infections – 0.03% (0.03% during Period I and 0.04% during Period II, index 1.70), boar taint – 0.02% (0.02% during Period I and 0.03% during Period II, index 1.36). Other reasons to condemn the carcasses included tuberculous lesions, lesions due to miscellaneous infections, digestive infections, parasitic diseases, and Salmonella infections. The occurrence of these conditions was on the level of mere hundredths of per cent. No case of Aujeszky’s disease was found. According to the results of meat inspection classification, the risk of food-borne diseases originating from pig carcasses tends to be greater in the lesions due to non-infectious conditions with a long-term increasing trend. A considerable increase in the numbers of pig carcasses condemned due to added deleterious substances (index 2.50) is an alarming finding with regard to potential food safety hazards.

Dynamics of the processes in metal machining

1998 ◽  
Vol 2 ◽  
pp. 115-122
Author(s):  
Donatas Švitra ◽  
Jolanta Janutėnienė
Keyword(s):  
High Frequency ◽  
Machine Tools ◽  
Metal Cutting ◽  
Cutting Tool ◽  
Low Frequency ◽  
Metal Cutting Machine ◽  
Cutting Machine ◽  
Metal Machining

In the practice of processing of metals by cutting it is necessary to overcome the vibration of the cutting tool, the processed detail and units of the machine tool. These vibrations in many cases are an obstacle to increase the productivity and quality of treatment of details on metal-cutting machine tools. Vibration at cutting of metals is a very diverse phenomenon due to both it’s nature and the form of oscillatory motion. The most general classification of vibrations at cutting is a division them into forced vibration and autovibrations. The most difficult to remove and poorly investigated are the autovibrations, i.e. vibrations arising at the absence of external periodic forces. The autovibrations, stipulated by the process of cutting on metalcutting machine are of two types: the low-frequency autovibrations and high-frequency autovibrations. When the low-frequency autovibration there appear, the cutting process ought to be terminated and the cause of the vibrations eliminated. Otherwise, there is a danger of a break of both machine and tool. In the case of high-frequency vibration the machine operates apparently quiently, but the processed surface feature small-sized roughness. The frequency of autovibrations can reach 5000 Hz and more.

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