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2022 ◽  
pp. 218-229
Author(s):  
Wilson Truman Okaka

The Ugandan government has decentralized climate change policy strategies at the local government district development planning levels to build local community adaptive capacity for accelerated action for disaster resilience. This chapter focuses on the local community response by Isingiro local government district authority. The purpose is to provide a context of the significance of eco-services and natural biodiversity resources in the semi-arid district, located in the South-Western Uganda, elaborate on the district climate change action plan for community-based adaptation strategies, and the biodiversity conservation district development plan. For decades, most households and local communities have perpetually suffered from the severe climatic stress of galloping heatwaves, shocking floods, ferocious frequent whirlwinds and wind storms, catastrophic droughts, perennial food insecurity, malnutrition, migrations, and famines. The district has adopted strategies to enhance biodiversity conservation for eco-services for food security and sustainable community livelihoods.


2021 ◽  
pp. 8-14
Author(s):  
P. Swathi ◽  
K. Radhikajyothi

BACKGROUND: Preterm birth remains a major health issue worldwide. Preterm delivery affects over 7–12% of births in India and is responsible for up to 75% of neonatal deaths. Despite advances in medical technology, the prevalence of preterm birth is increasing. Discovery of antenatal corticosteroid for fetal maturation and its adoption into clinical practice highlights several fascinating and universal truths about science and medicine. The challenge in human studies is to demonstrate antenatal corticosteroid administration in pregnancy contributes to developmental programming and how this is manifested in later life. The World Health Organization recommends the use of one course of antenatal steroids for all pregnant women between 26 and 35 weeks of gestation who are at risk of preterm delivery within 7 days. Both, the American College of Obstetricians and Gynaecologists and the Royal College of Obstetricians and Gynaecologists recommend their use between 24 and 34 weeks of gestation (1). The use of antenatal steroids after 34 or 35 weeks of gestation is not recommended unless there is evidence of fetal pulmonary immaturity. Despite this, antenatal steroids are widely used globally across all gestational periods. In a diverse country like India, diversity in clinical practice is a reality. Hence, the present research study intends to study the maternal and perinatal outcomes with antenatal corticosteroid administration in preterm deliveries at Government district hospital, Nandyal in South India. AIMS AND OBJECTIVES Ÿ To determine the incidence of RDS at District hospital, Nandyal among neonates delivered between 28-37 weeks due to PTL, PPROM or severe PET whose mothers received ACS and in those whose mothers did not receive ACS. Ÿ To determine the severity of RDS at District hospital, Nandyal among neonates delivered between 28-37 weeks due to PTL, PPROM or severe PET whose mothers received ACS and in those whose mothers did not receive ACS. Ÿ To compare the neonatal mortality among neonates delivered between 28-37 weeks due to PTL, PPROM or severe PET whose mothers received ACS with those whose mothers did not receive ACS. Ÿ To determine the effectiveness of antenatal corticosteroid administration in preventing early neonatal respiratory distress syndrome in early preterm labour versus late preterm labour. Ÿ To determine the effectiveness of ACS administration in preventing neonatal complications with respect to the mode of delivery. METHODOLOGY: Study was conducted at Government District Hospital, Nandyal from 01/01/2019 to 30/10/2019. A structured questionnaire was prepared under guidance of thesis guide. All pregnant women with gestational age between 28 completed weeks to 37 completed weeks, presenting in OPD either in labour or getting admitted due to any other maternal medical complication, are initially assessed thoroughly to estimate the gestational age by history, LMP, early USG, and clinical examination. They are given a course of ACS if they were not expecting delivery within next 1 hour, after explaining the benets and risks of ACS as per recommendations of Federation of International st Gynecology and Obstetrics. Those who did not receive ACS or those who delivered within 24hrs of administration of 1 dose of ACS were considered as subjects in NACS group. Those who received ACS were considered as subjects in ACS group. After delivery, the neonate is followed up in NICU until discharged or until 7 days whichever is shorter. Mother is followed up for any clinical signs of infection, until she is discharged. Data is analyzed scientically. RESULTS: In Antenatal corticosteroids group (ACS), there were 36 subjects within 20 years, 43 subjects between 20-25 years, 29 subjects between 25-30 years, 25 subjects between 30-35 years. In No Antenatal corticosteroids group (NACS), there were 32 subjects within 20 years, 49 subjects between 20-25 years, 25 subjects between 25-30 years, 10 subjects between 30-35 years. Study observed that Antenatal corticosteroids group had lower incidence of Respiratory distress syndrome compared to No Antenatal corticosteroids group (12.07% versus 23.28%). Antenatal corticosteroids group had lower incidence of severe Respiratory distress syndrome compared to No Antenatal corticosteroids group (21.3 % versus 33.33%) among those who had Respiratory Distress Syndrome. Antenatal corticosteroids group had fewer admissions to NICU than No Antenatal corticosteroids group (20.69% versus 33.62%). Antenatal corticosteroids group had lower mortality than No Antenatal corticosteroids group (12.07 % versus 22.41%). Antenatal corticosteroids group had 35 % less chances of Respiratory distress syndrome compared to No Antenatal corticosteroids group. In No Antenatal corticosteroids group, subjects who underwent vaginal delivery had 10% less risk compared to those who underwent LSCS for their neonates to have Respiratory distress syndrome. In Antenatal corticosteroids group, subjects who underwent vaginal delivery had 14.29 % less risk compared to those who underwent LSCS for their neonates to have Respiratory distress syndrome. Antenatal corticosteroids group had maternal infection rate comparable to No Antenatal Corticosteroids group. CONCLUSION: Use of antenatal corticosteroids was found to be benecial in pregnant women with Gestational age of 28 completed weeks to less than 37 completed weeks at Government District hospital, Nandyal. Antenatal corticosteroids did not have statistically signicant adverse effects (i.e. increased rate of infection) in mothers.


2021 ◽  
Vol 5 (1) ◽  
pp. 220
Author(s):  
Ni Nyoman Kencanawati ◽  
Muhajirah Muhajirah ◽  
Zainudin Zainudin

ABSTRAKPerbaikan jalan lingkungan di Kabupaten Lombok Timur merupakan program dari Kementerian PUPR melalui Direktorat Jenderal Cipta Karya  yang ditujukan untuk mengurangi kesenjangan antar wilayah, pengentasan kemiskinan, memperbaiki tata kelola pemerintah daerah (kabupaten, kecamatan dan desa) serta memperkuat kelembagaan masyarakat di tingkat desa. Pelaksanaan program ini melibatkan Disperkim Provinsi NTB dan Dinas Cipta Karya PUPR Provinsi NTB sebagai pendamping dan pengawas teknis. Program ini dilaksanaan sejak Tahun 2017 hingga saat ini. Artikel ini bertujuan untuk mengevaluasi pelaksanaan program dan memberikan rekomendasi untuk pelaksanaan pada tahun berikutnya. Wilayah yang menjadi target evaluasi terdapat pada  beberapa kecamatan meliputi Kecamatan Pringgasela, Kecamatan Sembalun, Kecamatan Aikmel, Kecamatan Pringgabaya dan Kecamatan Wanasaba. Bila dilihat secara persentase nilai capaian dari pelaksaanaan program, maka diperoleh rata-rata mencapai di atas 80%. Bahkan untuk Kecamatan Priggabaya dan Wanasaba pada Tahun 2020 mencapai 91% dan 92% berturut-turut. Selain itu  Kecamatan Wanasaba memiliki persentase pencapaian tertinggi yaitu 93% di Tahun 2020. Pencapaian pelaksaaan menunjukkan persentase yang terus meningkat sehingga tercapai tujuan utama yang dinginkan. Sebagai rekomendasi untuk pelaksanaan tahun ongoing dan tahun selanjutnya maka dalam pelaksanaan sebaiknya melibatkan partisipasi dari masyarakat sehingga program dapat mencapai seluruh daerah yang ditargetkan dan menghasilkan nilai capaian sebesar 100%. Kata kunci: jalan lingkungan; perbaikan; evaluasi; capaian; lombok timur. ABSTRACTThe improvement of side roads in East Lombok Regency is a program of the Ministry of PUPR through the Direktorat Jenderal Cipta Karya which is aimed at reducing regional disparities, alleviating poverty, improving local government (district, sub-district, and village), and strengthening community institutions at the village level. The implementation of this program involves the Disperkim Provinsi NTB dan Dinas Cipta Karya PUPR  as assistants and technical supervisors. This program has been implemented since 2017 until now. This article aims to evaluate the implementation of the program and provide recommendations for implementation in the following year. The evaluation target areas are located in several sub-districts including Pringgasela, Sembalun, Aikmel, Pringgabaya, and Wanasaba. According to a percentage of the achievement value of program implementation, the average achieved is above 80%. Even for the Districts of Priggabaya and Wanasaba in 2020, it reached 91% and 92%, respectively. In addition, Wanasaba District has the highest percentage of achievement, which is 93% in 2020. The achievement trend increases since the program has been initiated in 2017. As a recommendation for the implementation of the ongoing year and the following year, the implementation should involve the participation of the community. Thus the problems that have occurred so far can be avoided and are expected to reach all targeted areas to produce an achievement value of 100%. Keywords: side roads; repair; evaluation; achievement; east lombok. 


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049126
Author(s):  
Jakub Gajewski ◽  
Mengyang Zhang ◽  
Leon Bijlmakers ◽  
Chiara Pittalis ◽  
Eric Borgstein ◽  
...  

ObjectiveThis paper reports perioperative mortality and postoperative infection rates of surgical patients who underwent operations at district-level hospitals in Malawi and Zambia, and the associations of these outcomes with patient characteristics based on routinely available data.DesignProspective cohort study.SettingEight government district hospitals in Malawi and nine mission and government district hospitals in Zambia.Outcome measuresPerioperative mortality and postoperative infection were used as primary outcome measures in this study. Logistic regression and penalised maximum likelihood logistic regression were used to examine the factors correlated with surgical outcomes.ResultsThe average perioperative mortality rates were 0.19% and 0.43% in Malawi and Zambia, respectively. Penalised maximum likelihood logistic regression showed that age (OR=1.046, 95% CI 1.016 to 1.078) and American Society of Anesthesiologists physical status score II (OR=6.658, 95% CI 2.363 to 18.762) were significantly associated with perioperative deaths. General surgery procedures were significantly more likely than obstetrical procedures to result in perioperative deaths (OR=3.821, 95% CI 1.226 to 11.908). The average rates of postoperative infections in Malawi and Zambia were 2.69% and 2.24%, respectively. Age (OR=1.010, 95% CI 1.000 to 1.020) and male sex (OR=0.407, 95% CI 0.260 to 0.637) were significantly associated with postoperative infections. Additional factors, general procedures (OR=2.319, 95% CI 1.397 to 3.850) and trauma-related procedure (OR=5.490, 95% CI 2.632 to 11.449) were significantly associated with infection rates. There was no significant correlation between surgical outcomes and cadre of lead surgeon (a non-physician clinician or doctor).ConclusionRates of mortality and postoperative infections in this sample of district-level hospitals in Malawi and Zambia were relatively low, with poorer preoperative physical status as the main predictor of both greater postoperative infection and mortality. The study demonstrates that outcomes of major surgical cases do not depend on the cadre (type) of surgeon performing it, and outcomes can be monitored using routine data, at district level in these countries.Trial registration numberISRCTN66099597.


2021 ◽  
Author(s):  
◽  
Laura Hardcastle

<p>Although frequently ignored, New Zealand’s democratically-elected, subnational bodies provide many of the day-to-day services we rely upon, from water and sewerage to healthcare and education. However, the broad discretion enjoyed by ministers responsible for local government, District Health Boards, school boards of trustees and tertiary institution councils means elected representatives could easily be removed with little justification. This paper reviews the ministerial intervention regimes for each of these bodies and concludes that a principled approach to their use is needed to protect democratic values and prevent a concentration of power with the ministers. It suggests democracy, subsidiarity, the scale of the problem, the importance/centrality of the function, timing, complexity, transparency, consultation, apolitical decision-making and minimising interventions as principles upon which to critically analyse past interventions and ensure these powers are used more effectively in future.</p>


2021 ◽  
Author(s):  
◽  
Laura Hardcastle

<p>Although frequently ignored, New Zealand’s democratically-elected, subnational bodies provide many of the day-to-day services we rely upon, from water and sewerage to healthcare and education. However, the broad discretion enjoyed by ministers responsible for local government, District Health Boards, school boards of trustees and tertiary institution councils means elected representatives could easily be removed with little justification. This paper reviews the ministerial intervention regimes for each of these bodies and concludes that a principled approach to their use is needed to protect democratic values and prevent a concentration of power with the ministers. It suggests democracy, subsidiarity, the scale of the problem, the importance/centrality of the function, timing, complexity, transparency, consultation, apolitical decision-making and minimising interventions as principles upon which to critically analyse past interventions and ensure these powers are used more effectively in future.</p>


2021 ◽  
pp. archdischild-2021-322964
Author(s):  
Jennifer Carns ◽  
Sara Liaghati-Mobarhan ◽  
Aba Asibon ◽  
Alfred Chalira ◽  
Norman Lufesi ◽  
...  

ObjectiveTo determine whether a national quality improvement programme implementing continuous positive airway pressure (CPAP) at government hospitals in Malawi improved outcomes for neonates prioritised by an algorithm recommending early CPAP for infants weighing 1.0–1.3 kg (the 50th percentile weight at 30 weeks’ gestation).DesignThe analysis includes neonates admitted with respiratory illness for 5.5 months before CPAP was introduced (baseline period) and for 15 months immediately after CPAP was implemented (implementation period). A follow-up data analysis was completed for neonates treated with CPAP for a further 11 months.Setting and patientsNeonates with admission weights of 1.0–1.3 kg before (106 neonates treated with nasal oxygen) and after implementation of CPAP (153 neonates treated with nasal oxygen, 103 neonates treated with CPAP) in the newborn wards at Malawi government district hospitals. Follow-up analysis included 87 neonates treated with CPAP.InterventionNeonatal CPAP.Main outcome measureWe assessed survival to discharge at 23 government district hospitals with no significant differences in transfer rates before and after implementation of CPAP.ResultsSurvival improved for neonates with admission weights from 1.0 to 1.3 kg treated with CPAP (30.1%) as compared with neonates of the same weight band treated with oxygen during the baseline (17.9%) and implementation (18.3%) periods. There was no significant difference in survival for neonates treated with CPAP during the implementation and follow-up periods (30.1% vs 28.7%).ConclusionsSurvival for neonates weighing 1.0–1.3 kg significantly increased with a nurse-led CPAP service in a low-resource setting and improvements were sustained during follow-up.


2021 ◽  
Vol 8 (8) ◽  
pp. 455-463
Author(s):  
Eduard Lodewyk Pesiwarissa

The purpose of the study was to determine the development planning strategy in improving the welfare of the community in Teluk Kimi District, Nabire Regency. The research applied qualitative and descriptive reaserch methods to gather primary data. Sources of data gathering ranges from informants, events and documents review. The data collection techniques were done by means of interviews, observations and documentation. In Teluk Kimi District, Nabire Regency, there are 5 villages consisting of: 1, Samabusa Village; 2. Air Mandidi Village; 3. Kimi Village; 4. Lani Village; 5.Waharia village, with samples using purposive Snow Balling technique. As many as 43 respondents are local government, district government, village government and community leaders. Method of analysis applying SWOT analysis. The results of the study are, strategic planning for village development in Teluk Kimi District, Nabire Regency has several strategies that can be done in the village development prograns by utilizing majority of the population who are still of productive age. Increasing the capacity of village and community apparatus, Utilizing existing village facilities and infrastructure, exploring and developing potential nature to the maximum, Establish good cooperation and communication between institutions to achieve the village development mission, build priority facilities and infrastructure to support the community's economy, Improve the village economy through Village Owned Enterprises, Increase empowerment activities for the community, maintain order and security at the village well, Preserving local wisdom, arts and culture in the Mee Pago area in a heterogeneous environment in Teluk Kimi District, Nabire Regency.


2021 ◽  
Vol 7 (2) ◽  
pp. 190
Author(s):  
Syamsul Huda ◽  
Widodo Sunaryo ◽  
Martinus Tukiran ◽  
Nancy Yusnita ◽  
Idarianty Idarianty ◽  
...  

Training effectiveness is one of the determinant factor that could improve employees’ job performance. When we found in a government district office at Jambi Province where the organization had provided many training program to the employees but it had not had significant impact on their employees’ job performance. We realized that we need to study the factors which assumed to have relationship with the training effectiveness. Prior research in training effectiveness found that employees perceived toward the training program designed by organization and individual employees’ emotional intelligence had influence the training effectiveness. Based on those findings we formulated the aim of this study that is to investigate the relationship between the training program and employees’ emotional intelligence with the training effectiveness. This study designed as a quantitative research used sample of 209 employees derived by random sampling from its population. This study utilized questionnaires as instruments to collect empirical data. The correlational analysis technique used to analyze the data. This study had generated findings that there were strong relationship between the training program and employees’ emotional intelligence with training effectiveness.


2021 ◽  
Vol 14 (2) ◽  
pp. 123-127
Author(s):  
Haroledpeter Haroledpeter PL ◽  
Sampathkumar Madhusudhan ◽  
Thirupathykumaresan Thirupathykumaresan P ◽  
Keerthiyurenikka Keerthiyurenikka J ◽  
Murugakadavul Arumugavignesh ◽  
...  

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