Food Safety Audits

Food safety has gained global attention due to rising issues of food-borne illnesses, adulteration, and increased consumer awareness about food safety worldwide. It is a challenge for the governments and the food industry itself to maintain food safety throughout the food and supply chain. There are several systems and processes adopted by various countries to ensure food safety, and the food safety audits are one of the indispensable tools to achieve the goals of food quality and safety. Rising trends of consuming processed foods, eating out in restaurants and cafes, home deliveries of food from outside worldwide have made the auditing process very essential to ensure that the food products are being manufactured, stored, and sold in compliance with national and international standards. This chapter aims at providing an overview of the food audit processes, scope, importance, challenges, and future trends.

Childbirth in South Asia

This book illustrates the continuing challenges as well as the new paradoxes linked to childbirth in South Asia. It brings together anthropologists and sociologists working in different contexts (at the hospital, within the community) and in a variety of settings (rural, urban) in India, Nepal, Pakistan, and Bangladesh. While women in Western countries have pressed for more home deliveries, and for the mitigation of some of the effects of the male appropriation and over-medicalized experience of motherhood, most developing countries are promoting institutionalized deliveries and stigmatizing poor women who deliver at home. In addition, new information technologies are being pressed into service; for example, to identify high-risk mothers and to offer them advice through social media. Such an evolution is particularly salient in South Asia where childbirth has long been an issue, not only for the colonial government, which sometimes used women’s poor health to justify imperialist interests, but also for independent successor states, who have implemented decisive schemes within the last decade, after being long accused of neglecting women’s healthcare. Despite the increased attention being paid to maternal and child health, and the steady rise in institutional deliveries in South Asia, progress on reducing maternal and infant mortality has been slow and halting, with significant disparities across regions and social groups. Far from withering away, traditional birth attendants have seen a resurgence, in part due to the demeaning conditions offered to poor, low-caste, rural women in formal health settings. With this backdrop, the authors explore the ethical and social implications of the changes being introduced in the technologies and social arrangements of childbirth in South Asia.

Why women choose to deliver at home in India: a study of prevalence, factors, and socio-economic inequality

Background To promote institutional delivery, the Government of India, through the Janani Suraksha Yojana (JSY) program, gives monetary reward to all pregnant women who give birth at the government or private health center. Despite providing cash assistance, a higher number of women are still preferring delivering at home. Therefore, this study sought to determine the prevalence of home births and identifying the factors influencing women’s choice of home deliveries. Methods Data from the National Family Health Survey (NFHS) conducted during 2005–06 and 2015–16 were used in the study. The respondents were women 15–49 years; a sample of 36,850 and 190,898 women in 2005–06 and 2015–16 respectively were included in the study. Multivariate logistic regression was used to determine the factors influencing home delivery. Income-related inequality in home delivery was quantified by the concentration index (CI) and the concentration curve (CC), and decomposition analysis was used to examine the inequality in the prevalence of home deliveries. Results The prevalence of home deliveries has reduced from 58.5% in 2005–06 to 18.9% in 2015–16. The odds of delivering babies at home were lower among women who had full ANC in 2005–06 [AOR: 0.34; CI: 0.28–0.41] and in 2015–16 [AOR: 0.41; CI: 0.38–0.45] and were higher among women with four or higher parity in 2005–06 [AOR: 1.70; CI: 1.49–1.92] and in 2015–19 [AOR: 2.16; CI: 2.03–2.30]. Furthermore, the odds of delivering babies at home were higher among rural women and were lower among women with higher education. It was found that the value of CI increased from − 0.25 to − 0.39 from 2005-06 to 2015–16; this depicts that women delivering babies at home got more concentrated among women from lower socio-economic status. Conclusion There is a need to promote institutional deliveries, particular focus to be given to poor women, women with higher parity, uneducated women, and rural women. ANC is the most concurring contact point for mothers to get relevant information about the risks and complications they may encounter during delivery. Therefore, effort should be directed to provide full ANC. Targeted interventions are called for to bring improvements in rural areas.

An Assessment of Knowledge, Attitude, and Practices of Birth and Death Registration in Kilifi County in the Coastal Region in Kenya

Background. Countries need vital statistics for social and economic planning. World Health Organization (WHO) recommends at least 80% coverage to use registration data on births and deaths for social and economic planning. However, registration remains low in developing countries. National coverage for Kenya in 2014 was 62.2% for births and 45.7% for deaths, with wide regional differentials. Kilifi County in the coastal region in Kenya reported rates below the national coverage at 56% for births and 41% for deaths in 2013. Objective. To determine level of knowledge and practice and reasons for low coverage of birth and death in Kilifi County. Method. This is a descriptive cross-sectional study that employed multistage cluster random sampling procedure to select a sample of 420 households from which household heads and women with children below five years old were surveyed. Results. Out of the 420 households sampled, about all respondents (99%) were aware of birth registration while death was 77%. Their main sources of information were assistant chiefs at 77% for both birth and death registration and family and friends at 67% for deaths and 52% for births. Coverage for birth registration was 85% and death 63%. More deaths occurred at home (55%) than in hospital (44%) while 55% of deliveries occurred in hospital and 44% at home. Main reasons for not registering death were ignorance (77%) and transport and opportunity cost (21%) while for birth registration were ignorance (42%), travel and opportunity cost (41%), lack of identification documents (9%), and home deliveries (7%). Conclusion. Registration of birth and death has improved in Kilifi County. The drivers are legal and requirements to access social rights. Reasons for not registering are ignorance and opportunity costs. Community should be sensitized on the importance of registration, address home deliveries and deaths, and increase efficiency in registration. Further research is recommended to determine the severity of teenage pregnancy and orphanhood in the county.

Creativity, the City, and the Future

Could the marriage of online meetings, emails, social media, worldwide pandemic, 'working from home', and home deliveries really signal the end of cities? If the story of cities has not come to an end, how might they evolve in response to these new impulses, particularly in the UK? This paper begins to provide some answers to these pressing questions. It does so by turning to London's urban history, to the 1960s and 1970s anti-urban ethos, to the fall and rise of London and New York in the 1970s and 1980s, and especially by applying to cities theories of innovation that have been developed in the context of managing business and explaining the creative process. The discussion casts doubt on the city pessimists and suggests that although cities may be restructured to combat the impacts of Covid-19, they certainly won't be abandoned.

Prevalence, Causes and Associated Factors for Postpartum Haemorrhage (Pph) At St. Joseph Referral Hospital Peramiho-Songea, Tanzania; A Hospital-Based Retrospective Cross-Sectional Study.

Background: The prevalence of postpartum haemorrhage (PPH) is increasing globally that is from 6.5% in 2000 to 11% in 2016. But there are regional variations where there is decrease of PPH in some parts of Asia and increase in Africa and developed countries. Objectives: The main objective of this study was to assess the prevalence, causes and associated factors for postpartum haemorrhage at St. Joseph referral hospital in Peramiho- Songea from November 2017 to December 2019. Method: The retrospective cross-sectional hospital-based study was used and data was obtained from maternity hospital registry book/data base of St. Joseph mission hospital in Peramiho Songea, from November 2017 to November 2019. Descriptive data was analysed by tables and graphs. Results: The prevalence of PPH in Peramiho referral hospital was 1.3% in 2017, 1.26% in 2018 and 1.4% in 2019. The overage prevalence for the three years is 1.3%. However, 73.3% of total prevalence is from home deliveries in rural areas. The main cause of PPH in the hospital was uterus atony (42%), retained placenta (15.5%), 3rd and 4th grade tears (11.2%), uterine rupture (8.1%) and coagulopathy (5.6%). The main attributing factors were age >35years (34%), other antenatal pregnancy complication (27%), previous PPH (18.6%), Antenatal anaemia (16%), placenta previa, Eclampsia, preeclampsia (12%) each. Conclusion: The prevalence of PPH from this study is slightly high with the main cause being uterine atony and affected mainly those undergone SVD where about two quarter were home deliveries. However further research studies are needed to investigate the main reason for higher home deliveries in Peramiho residence and nearby area.

Prevalence, Causes and associated factors for Postpartum haemorrhage (PPH) at St. Joseph referral hospital Peramiho-Songea, Tanzania; A hospital-based retrospective cross-sectional study.

Background The prevalence of postpartum haemorrhage (PPH) is increasing globally that is from 6.5% in 2000 to 11% in 2016. But there are regional variations where there is decrease of PPH in some parts of Asia and increase in Africa and developed countries. Objectives The main objective of this study was to assess the prevalence, causes and associated factors for postpartum haemorrhage at St. Joseph referral hospital in Peramiho- Songea from November 2017 to December 2019. Method The retrospective cross-sectional hospital-based study was used and data was obtained from maternity hospital registry book/data base of St. Joseph mission hospital in Peramiho Songea, from November 2017 to November 2019. Descriptive data was analysed by tables and graphs. Results The prevalence of PPH in Peramiho referral hospital was 1.3% in 2017, 1.26% in 2018 and 1.4% in 2019. The overage prevalence for the three years is 1.3%. However, 73.3% of total prevalence is from home deliveries in rural areas. The main cause of PPH in the hospital was uterus atony (42%), retained placenta (15.5%), 3rd and 4th grade tears (11.2%), uterine rupture (8.1%) and coagulopathy (5.6%). The main attributing factors were age > 35years (34%), other antenatal pregnancy complication (27%), previous PPH (18.6%), Antenatal anaemia (16%), placenta previa, Eclampsia, preeclampsia (12%) each. Conclusion The prevalence of PPH from this study is slightly high with the main cause being uterine atony and affected mainly those undergone SVD where about two quarter were home deliveries. However further research studies are needed to investigate the main reason for higher home deliveries in Peramiho residence and nearby area.

Effect of a Community Based Social Marketing Strategy on the Uptake of Clean Delivery Kits in Peri-Urban Communities of Karachi, Pakistan

Background: Neonatal and maternal mortality is high in Pakistan. More than half of all deliveries take place at homes by unskilled birth attendants and unhygienic practices are common. The objective of our study was to determine the effect of a community based strategy of social marketing promoting clean delivery kits on the uptake of clean delivery kits for use in home deliveries in peri-urban communities of Karachi, Pakistan. Methods: Following a baseline survey of women who delivered in previous three months as a reference group, end line survey was conducted of women who delivered post intervention to assess need, use and availability of clean delivery kits. Availability of these kits was ensured at accessible stores in these communities. Quantitative component comprised of the baseline and post intervention surveys while qualitative information was sought from focus group discussions. Binary logistic regression was used to analyze quantitative data and ground theory to analyze qualitative data.Results: 603 women were surveyed in the baseline survey and 568 women in the end-line survey. The proportion of women using CDKs in home deliveries increased from 9.3% in the baseline survey to 23.8% (p=<0.05) after the social marketing intervention in the end-line survey. 40% of women reported non-use of kits due to inability to pay for it. However, focus group discussions revealed that many women thought that the kits should be free or should be included in the amount charged by birth attendants. After adjusting for other variables, age of the woman and education of the husband were found significantly associated with use of clean delivery kits in home deliveries. Conclusions: Social marketing strategy targeting pregnant women and their family members can play a significant role in improving use of clean delivery kits in home deliveries. However, many women expect that the cost of the kit to be included in charges paid to birth attendants. A combined approach targeting both pregnant women as well as traditional birth attendants may improve clean delivery kit use to higher levels and be sustainable in the long-run.

Prevalence, progress, and social inequalities of home deliveries in Ghana from 2006 to 2018: insights from the multiple indicator cluster surveys

Background Delivery in unsafe and unsupervised conditions is common in developing countries including Ghana. Over the years, the Government of Ghana has attempted to improve maternal and child healthcare services including the reduction of home deliveries through programs such as fee waiver for delivery in 2003, abolishment of delivery care cost in 2005, and the introduction of the National Health Insurance Scheme in 2005. Though these efforts have yielded some results, home delivery is still an issue of great concern in Ghana. Therefore, the aim of the present study was to identify the risk factors that are consistently associated with home deliveries in Ghana between 2006 and 2017–18. Methods The study relied on datasets from three waves (2006, 2011, and 2017–18) of the Ghana Multiple Indicator Cluster surveys (GMICS). Summary statistics were used to describe the sample. The survey design of the GMICS was accounted for using the ‘svyset’ command in STATA-14 before the association tests. Robust Poisson regression was used to estimate the relationship between sociodemographic factors and home deliveries in Ghana in both bivariate and multivariable models. Results The proportion of women who give birth at home during the period under consideration has decreased. The proportion of home deliveries has reduced from 50.56% in 2006 to 21.37% in 2017–18. In the multivariable model, women who had less than eight antenatal care visits, as well as those who dwelt in households with decreasing wealth, rural areas of residence, were consistently at risk of delivering in the home throughout the three data waves. Residing in the Upper East region was associated with a lower likelihood of delivering at home. Conclusion Policies should target the at-risk-women to achieve complete reduction in home deliveries. Access to facility-based deliveries should be expanded to ensure that the expansion measures are pro-poor, pro-rural, and pro-uneducated. Innovative measures such as mobile antenatal care programs should be organized in every community in the population segments that were consistently choosing home deliveries over facility-based deliveries.