Women’s Participation in Decision Making Structures and Processes: A Case Study on the Local Government Institution in Bangladesh

Since 1976, women’s participation has been empowered as part of the development discourse for achieving sustainable development in Bangladesh. Women’s empowerment in the local government structures and processes has a substantial influence on the National Gender Policy of Bangladesh. This study has critically assessed the extent of the women’s participation in the decisionmaking processes of the Local Government Institutions (LGIs) through participants’ observation, qualitative and quantitative methods. The study evolves the success and failure attempts of the women’s participation in the LGI’s structures and decision-making processes as per Local Government (Union Parishad) Act-2009. The study also finds the UPs are too politicized to make them socially inclusive, pro-poor friendly and distribute equally the benefits of aids and social safety net services. The centralized power of UP chairs, manipulation and tokenism practices in the UP’s governance and decision-making processes had diminished the gender sensitivity, transparency, and accountability of the institution. The study also suggests increasing the number of women representatives in UP’s structures, making functional the roles of woman’s vice-chair, activating the Ward level meetings, standing committees and project implementation committees, as well as regularizing the effective monitoring with transparent and accountable manner for making the UP gender responsive and people oriented. Social Science Review, Vol. 37(2), Dec 2020 Page 267-286

Spatiotemporal Prediction of the Occurrence of Vancomycin-resistant Enterococcus

Background: Vancomycin-resistant enterococci (VRE) is the cause of severe patient health and monetary burdens. Antibiotic use is a confounding effect to predict VRE in patients, but the antibiotic use of patients who may have frequented the same ward as the patient in question is often neglected. This study investigated how the occurrence and spread of VRE can be explained by patient movements between hospital wards and their antibiotic use.Methods: Intrahospital patient movements, antibiotic use and PCR screening data were used from a hospital in the Netherlands. The PageRank algorithm was used to calculate two daily centrality measures based on the spatiotemporal graph to summarise the flow of patients and antibiotics at the ward level. A decision tree model was used to determine a simple set of rules to estimate the daily probability of VRE occurrence for each hospital ward. The model performance was improved using a random forest model and compared using 30% test sample.Results: Centrality covariates summarising the flow of patients and their antibiotic use between hospital wards can be used to predict the daily occurrence of VRE at the hospital ward level. The decision tree model produced a simple set of rules that can be used to determine the daily probability of VRE occurrence for each hospital ward. An acceptable area under the ROC curve (AUC) of 0.755 was achieved using the decision tree model and an excellent AUC of 0.883 by the random forest model on the test set. These results confirms that the random forest model performs better than a single decision tree for all levels of model sensitivity and specificity on data not used to estimate the models.Conclusion: This study showed how the movements of patients inside hospitals and their use of antibiotics could predict VRE occurrence at the ward level. Two daily centrality measures were proposed to summarise the flow of patients and antibiotics at the ward level. An early warning system for VRE can be developed to test and further develop infection prevention plans and outbreak strategies using these results.

Hospital-level work organization drives the spread of SARS-CoV-2 within hospitals: insights from a multi-ward model

Despite extensive protective measures, SARS-CoV-2 widely circulates within healthcare facilities, posing a significant risk to both patients and healthcare workers. Several control strategies have been proposed; however, the global efficacy of local measures implemented at the ward level may depend on hospital-level organizational factors. We aimed at better understanding the role of between-ward interactions on nosocomial outbreaks and their control in a multi-ward psychiatric hospital in Western France. We built a stochastic compartmental transmission model of SARS-CoV-2 in the 24-wards hospital, accounting for the various infection states among patients and staff, and between-ward connections resulting from staff sharing. We first evaluated the potential of hospital-wide diffusion of local outbreaks, depending on the ward they started in. We then assessed control strategies, including a screening area upon patient admission, an isolation ward for COVID-19 positive patients and changes in staff schedules to limit between-ward mixing. Much larger and more frequent outbreaks occurred when the index case originated in one of the most connected wards with up to four times more transmissions when compared to the more isolated ones. The number of wards where infection spreads was brought down by up to 53 % after reducing staff sharing. Finally, we found that setting up an isolation ward reduced the number of transmissions by up to 70 %, while adding a screening area before admission seemed ineffective.

The micro-hotspots of cholera in Kano State, Nigeria, 2010-2019—analysis of patient characteristics, Spatio-temporal patterns and contextual determinants at the ward level

Cholera is endemic in Nigeria, and Kano State reports outbreaks yearly with a case fatality rate (CFR) of 3.3% from 2010 to 2019. The lack of data at ward level has enabled the disease to evade focused interventions. The goal of this study was to describe the geographic distributions, care-seeking behaviors, Spatio-temporal cluster patterns of the micro-hotspots (hotspots wards) linked with suspected and confirmed cases and deaths of cholera in Kano State.Suspected and confirmed cholera morbidity and mortality at the ward level from 2010-2019 were acquired from the Nigeria Centre for Disease Control. Population and waterbody data were obtained from the Nigeria Expanded Program on Immunization and online, respectively. Data analysis used SaTScan and methods recommended by the Global Task Force on Cholera Control.During these ten years, 18,483 suspected and confirmed cases (617 deaths) were reported with 67.7% of the cases and 72% of the deaths from rural wards. The ages of the cases ranged from 1 month to 100 years with a distribution skewed to the older years. CFRs were statistically higher in the <5-year olds compared to those >14 years (p-value = 0.0005). For 2010-2019, gender was statistically associated with cholera outcome (survived/died) (p-value = 0.0006), and women in the rural setting disproportionately died from cholera than women in the urban area (p-value = 0.003). Cholera severity, as measured by hospitalization and death, was higher in the urban (77.4%) compared with the rural (53.4%) setting with the highest severity (84.7%) registered among those >14 years. Rapid Diagnostic Tests (RDT) were performed in 1.3% (249) samples of all suspected cases and ranged from 0.7% among the 5-14 year-olds in the rural to 3.5 % among the < 5-year-olds in the urban areas. Of the stool samples collected, 62.7% tested positive for V. cholerae using RDT. The positivity rate was least in the urban setting amongst the <5 years (41.2%) while care-seeking-behavior ranged from 52.1% in the urban to 82.7% in the rural settings. Seasonal patterns of disease often differed between urban and rural settings with outbreaks occurring in both the dry and rainy seasons, but with more intense transmission occurring during the rainy season from week 22 (early June) to week 40 (late September). A Spatio-temporal clustering analysis detected 168 micro-hotspots out of 404 wards, with a population of 4,876,254, having a significantly higher risk (relative risk 1.01-18.73) compared to the State as a whole. While 79 micro-hotspots with a population of 2,119,974 had a RR ≥ 2. The micro-hotspots tended to cluster around waterbodies. SaTScan and GTFCC methods generally agreed in micro-hotspots detection.This study shows the epidemiology of cholera in Kano State differs between urban and rural settings and that hotspot maps at the ward level, not hotpots maps at the Local Government Area level, are best suited for targeting interventions including vaccines. Appropriate studies are needed to further delineate the urban and rural divide of outbreaks but targeting interventions to the identified high-priority micro-hotspots will facilitate cholera elimination from the state.Author summaryCholera is endemic in Nigeria since 1970, and Kano State reports outbreaks almost every year. From 2010-2019, Kano State reported 18,483 cases and 617 deaths, for a case fatality rate of 3.3%. Focusing interventions at the Local Government Area instead of the ward (local) level contributed to the continuous threat from cholera in Kano State. When we divided the state into its two geographic areas (urban and rural), there were very different epidemiology as well as Spatio-temporal patterns of clustering of wards with elevated relative risk (micro-hotspots). Nearly two-thirds of the cases and deaths were reported from rural wards. The ages of the cases ranged from 1 month to 100 years with case fatality ratios higher in the <5-years olds compared to those >14 years (p-value = 0.0005). Women in the rural area not only had more cases but also were more likely to die from cholera than women in the urban area (p-value = 0.003). The hospitalization rate was higher in the urban than rural setting whereas care-seeking behavior was higher in rural than urban areas. Rapid Diagnostic Tests to confirm cholera was very low overall. Seasonal patterns of disease differed between urban and rural areas with outbreaks occurring in both the dry and rainy seasons, but with more cases from June to September, during the rainy season. A population of 4,876,254 live in the 168 micro-hotspots in which cholera risks were 1.01 to 18.73 times higher compared to the State as a whole. Following the Global Task Force on Cholera Control recommendations, interventions should focus on these identified micro-hotspots for cholera elimination from Kano State.

“Red Vienna” and the rise of the populist right

While research on the spatial variation in populist right voting focuses on the role of “places left behind”, this paper examines the spatial distribution of populist right voting in one of the fastest growing capital cities of Europe, Vienna. Combining detailed electoral data of the 2017 national elections at the statistical ward level and the location of municipal housing units, the paper examines why the populist right “Austrian Freedom Party” (FPOE) performs better in the former bulwarks of socialism, in the municipal housing areas of “Red Vienna”. The paper links the socio-demographic development of Vienna and its municipal housing policy with election results and explores three possible reasons for elevated FPOE shares in municipal housing areas: rising housing costs pushed an increasing number of socially and economically vulnerable into the municipal housing sector and so increased the FPOE voter pool in those areas; European Union accession and changes in regulation allowed foreign citizens to apply to and obtain municipal housing flats triggering a backlash from Austrian municipal housing residents; and municipal housing is located in disadvantaged neighbourhoods further enhancing the FPOE voter pool. The paper demonstrates that higher FPOE vote shares in areas with high municipal housing shares are due primarily to higher shares of formally less educated residents, neighbourhood context and they are marginally elevated in those municipal housing areas experiencing a larger influx of foreign residents.

Transmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan

The spread of vancomycin-resistant enterococci (VRE) is a major threat in nosocomial settings. A large-scale multiclonal VRE outbreak has rarely been reported in Japan due to low VRE prevalence. We evaluated the transmission of vancomycin resistance in a multiclonal VRE outbreak, conducted biological and genomic analyses of VRE isolates, and assessed the implemented infection control measures. In total, 149 patients harboring VanA-type VRE were identified from April 2017 to October 2019, with 153 vancomycin-resistant Enterococcus faecium isolated being grouped into 31 pulsotypes using pulsed-field gel electrophoresis, wherein six sequence types belonged to clonal complex 17. Epidemic clones varied throughout the outbreak; however, they all carried vanA-plasmids (pIHVA). pIHVA is a linear plasmid, carrying a unique structural Tn1546 containing vanA; it moves between different Enterococcus spp. by genetic rearrangements. VRE infection incidence among patients in the “hot spot” ward correlated with the local VRE colonization prevalence. Local prevalence also correlated with vancomycin usage in the ward. Transmission of a novel transferrable vanA-plasmid among Enterococcus spp. resulted in genomic diversity in VRE in a non-endemic setting. The prevalence of VRE colonization and vancomycin usage at the ward level may serve as VRE cross-transmission indicators in non-intensive care units for outbreak control.

Rural–urban migration and ethnic diversification in Kathmandu Metropolitan City, Nepal

This article analyzes rural–urban migration and subsequent caste/ethnic diversification in Kathmandu Metropolitan City (KMC) using ward-level (the smallest spatial unit) data from Nepal’s National Population and Housing Census 2011 ( CBS, 2012 ). KMC has 975,453 residents with migrants constituting 57 percent of the population. Almost all caste/ethnic groups (122 out of 125 in total) are present in KMC, with Newar, Brahmins and Chhetris as the largest groups. Eighty-six percent of the migrants are rural-urban migrants. Thirty-five percent of all rural–urban migrants in the country are in KMC. In this study, I examine ethnic diversity using the ethnic diversification index (EDI). The index of 83.7 percent reflects the significant role of migration in urbanization. The diversified landscape also demonstrates distance function, educational differentials and regional segregation of migrants.

Guide for Organising a Community Clean-up Campaign

While it is the government’s and municipality’s mandate to ensure that its citizens stay in a clean and safe environment, it is of concern that waste management remains a big challenge in urban areas especially in developing countries. Increased economic development, rapid population growth and improvement of living standards are among the factors attributed to increased quantity and complexity of solid waste being generated. On the other hand, while people generate wastes, they continue to be looked at as passive recipients of municipality services. Ultimately, citizens fail to recognise their role in waste management and become unwilling to either pay for service delivery or participate in clean-up campaigns. Waste dumps are prime breeding sites for communicable disease vectors such as rodents, mosquitoes and houseflies, which can exacerbate the prevalence of water, food and waterborne diseases such as cholera and typhoid. This chapter thus describes the methodology of successfully conducting a community-led cleanup campaign. It is based on experience gained during implementation of an urban water, sanitation and hygiene (WASH) project. Ward level clean-up campaigns were organised and conducted by community members and local leaders. Besides clearing illegal dumpsites, the activity was also used to raise awareness on the consequence of waste dumping. The experience showed that organising a clean-up campaign only requires careful timeous planning. Overall, tt was concluded that not only does the activity serve the practical purpose of cleaning, but it also creates a greater sense of unity and friendship among community members. Additionally, the power of beautification in a clean-up campaign wold naturally motivate residents to believe that their problems could be solved, resulting in a shared responsibility for sustainable management of waste and commons at local level.

Congruence of Nurse Staffing and Activities with Patient Needs

This study aimed to discover the correlation between patient satisfaction with nursing care activities and staffing patterns. The research was conducted at the medical ward of a secondary care regional hospital in Slovenia over one month. Data was collected with regard to the following: (1) patients cared for daily and number of hours/patients day at the ward level, (2) patient needs (using a classification system), (3) nurse activities as observed at 10-minute intervals, and (4) the Patient Perception of Hospital Experience with Nursing tool. A total of 218 patients were involved, and their satisfaction with nursing care was found to be high. Patient satisfaction was negatively correlated with the number of patients cared for at the unit daily, but positively with the number of care hours per patient day, the proportion of registered nurses in the nursing team, the realized percentage of the registered nurse personnel requirements, and with some direct care activities. The correlation also revealed three process items (undivided attention, explanation, and things are done without asking) being the special strengths of nursing care activities. The results show that nurse-staffing and process patterns affect patient experience. It is thus recommended to increase the amount of nursing care offered by registered nurses, while nurses’ competences can affect the process of care, and thus patient satisfaction.