Search results for: inadequate

Authors: Krishna Prasad Sharma

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Nepal’s financial sector has become deeper and wider, and the number and types of financial intermediaries have grown rapidly over the past two decades. However, access to financial services remains limited for many people in many parts of rural Nepal. While financial institutions have been expanding rapidly in an urban area in recent years, the access to the rural poor is excessively inadequate due to financial illiteracy and limited numbers of financial institutions that confined only to the district headquarters. Based on the focus group discussion, semi-structured interview of key people and literature review, this paper aims to examine the supply of and demand for financial services in Nepal and the constraints to increasing access to them, and offers way forward for making the financial sector work for all of Nepal’s people, especially the rural poor. While Nepal’s government has tried to increase access to formal financial services for small businesses and low-income households through directed lending programs for small businesses and low-income households, created specialized wholesale and retail institutions, and lowered market entry requirements, formal financial services are declining, and financial intermediation is stagnating. Supply and demand indicators show that, despite government efforts, formal financial institutions do not serve the needs of most of the Nepalese population. While access to and use of formal financial services are limited, in general, the problem is acute for small businesses and low-income households. Indeed, both access and use are closely correlated with business loan size and household income. This study concludes that banks and microfinance institutions with the use of mobile phones can connect hundreds of millions of unbanked and low-income people, especially rural poor to financial services at low costs. While there are many challenges ahead in expanding the service to rural areas, the mobile financial services will be beneficial that makes payments faster and cheaper, more convenient and accessible to a greater number of senders and recipients in rural areas. In rural areas, clients will benefit from money transfer and other mobile and online services.

Keywords: financial inclusion, financial enabling environment, microfinance, branchless banking, rural poor

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Authors: Rachel Fanelwa Ajayi, Anovuyo Jonnas, Emmanuel I. Iwuoha

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Tuberculosis (TB) is an infectious disease caused by the bacterium (Mycobacterium tuberculosis) which has a predilection for lung tissue due to its rich oxygen supply. The mycobacterial cell has a unique innate characteristic which allows it to resist human immune systems and drug treatments; hence, it is one of the most difficult of all bacterial infections to treat, let alone to cure. At the same time, multi-drug resistance TB (MDR-TB) caused by poorly managed TB treatment, is a growing problem and requires the administration of expensive and less effective second line drugs which take much longer treatment duration than fist line drugs. Therefore, to acknowledge the issues of patients falling ill as a result of inappropriate dosing of treatment and inadequate treatment administration, a device with a fast response time coupled with enhanced performance and increased sensitivity is essential. This study involved the synthesis of electroactive platforms for application in the development of nano-biosensors suitable for the appropriate dosing of clinically diagnosed patients by promptly quantifying the levels of the TB drug; Isonaizid. These nano-biosensors systems were developed on gold surfaces using the enzyme N-acetyletransferase 2 coupled to the cysteamine modified poly(8-anilino-1-napthalene sulphonic acid)/zinc oxide nanocomposites. The morphology of ZnO nanoparticles, PANSA/ZnO nano-composite and nano-biosensors platforms were characterized using High-Resolution Transmission Electron Microscopy (HRTEM) and High-Resolution Scanning Electron Microscopy (HRSEM). On the other hand, the elemental composition of the developed nanocomposites and nano-biosensors were studied using Fourier Transform Infra-Red Spectroscopy (FTIR) and Energy Dispersive X-Ray (EDX). The electrochemical studies showed an increase in electron conductivity for the PANSA/ZnO nanocomposite which was an indication that it was suitable as a platform towards biosensor development.

Keywords: N-acetyletransferase 2, isonaizid, tuberculosis, zinc oxide

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Authors: Alshutwi Sitah

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Many countries around the world are struggling to maintain an adequate number of nurses. Inadequate nursing staffing could compromise the quality of patient care. Among many factors that contribute to registered nurses (RN) turnover, the influence of work–family conflict (WFC) has gained little attention. WFC was found to be significantly associated with increased turnover intention (TI) among employees. Furthermore, WFC has been linked to a number of negative consequences, including lower job satisfaction and organizational commitment, sleep insufficiency, insomnia symptoms, obesity, cardiovascular diseases, sleep insufficiency, and high cholesterol. In an effort to find strategies to manage the consequences of WFC, many behavioral, psychological, and career scholars have focused on the role of supervisor support. Family Supportive Supervisor Behaviors (FSSB) has been found to be a promising approach contributing to the reduction of TI in employees’ experiencing WFC. Despite the importance of work–family issues and the influence of FSSB, limited studies have been conducted among the nursing population and none were found that included a sample from Saudi Arabia. Therefore, the main Purpose of this study was to evaluate the influence of FSSB on the relationship among WFC, Stress, and TI in Saudi Arabian registered nurses. Method: A cross-sectional study. Sample: Convenience sampling; 113 Saudi female nurse. Result: Fifty percent of nurses intended to leave their workplace, 68 % of nurses reported having a conflict between work and family, and 44% reported having a high level of stress. A significant positive correlation was found between WFC and TI (r= .43, P < 0.01). A negative correlation was found between FSSB and TI (r= -.53, P < 0.01). Both WFC and stress were associated with TI; however, these associations were buffered (weaken), when nurses had higher FSSB. Conclusion: The FSSB could be seen as a tool to help married, female nurses to demonstrate their professional role without compromising their family responsibilities. Nurses’ turnover is a complex issue that may require multiple prevention strategies; however, enhancing FSSB could be a key resource for maintaining a positive workplace environment and reducing TI.

Keywords: turnover intention, work-family conflict, supervisor support, nursing retention

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Authors: Lokvendra S. Budania, Yogesh K Gaude, Vamsidhar Chamala

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Introduction: Congenitally corrected transposition of great arteries (CCTGA) is a complex congenital heart disease where there are both atrioventricular and ventriculoarterial discordances, usually accompanied by other cardiovascular malformations. Case Report: A 24-year-old primigravida known case of CCTGA at 37 weeks of gestation was referred to our hospital for safe delivery. Her electrocardiogram showed HR-40/pm, echocardiography showed Ejection Fraction of 65% and CCTGA. Temporary pacemaker was inserted by cardiologist in catheterization laboratory, before giving trial of labour in view of complete heart block. She was planned for normal delivery, but emergency Caesarean section was planned due to non-reassuring foetal Cardiotocography Pre-op vitals showed PR-50 bpm with temporary pacemaker, Blood pressure-110/70 mmHg, SpO2-99% on room air. Nil per oral was inadequate. Patency of two peripheral IV cannula checked and left radial arterial line secured. Epidural Anaesthesia was planned, and catheter was placed at L2-L3. Test dose was given, Anaesthesia was provided with 5ml + 5ml of 2% Lignocaine with 25 mcg Fentanyl and further 2.5Ml of 0.5% Bupivacaine was given to achieve a sensory level of T6. Cesarean section was performed and baby was delivered. Cautery was avoided during this procedure. IV Oxytocin (15U) was added to 500 mL of ringer’s lactate. Hypotension was treated with phenylephrine boluses. Patient was shifted to post-operative care unit and later to high dependency unit for monitoring. Post op vitals remained stable. Temporary pacemaker was removed after 24 hours of surgery. Her post-operative period was uneventful and discharged from hospital. Conclusion: Rare congenital cardiac disorders require detail knowledge of pathophysiology and associated comorbidities with the disease. Meticulously planned and carefully titrated neuraxial techniques will be beneficial for such cases.

Keywords: congenitally corrected transposition of great arteries, complete heart block, emergency LSCS, epidural anaesthesia

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Authors: Atiya Khan

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Recent research on the condition of school education in India has reaffirmed the importance of quality teacher professional development, especially in light of the rapid changes in teaching methods, learning theories, curriculum, and major shifts in information and technology that education systems are experiencing around the world. However, the quality of programs of teacher professional development in India is often uneven, in some cases non-existing. The educational authorities in India have long recognized this and have developed a range of programs to assist in-service teacher education. But, these programs have been mostly inadequate at improving the quality of teachers in India. Policy literature and reports indicate that the unevenness of these programs and more generally the lack of quality teacher professional development in India are due to factors such as a large number of teachers, budgetary constraints, top-down decision making, teacher overload, lack of infrastructure, and little or no follow-up. The disparity between the government stated goals for quality teacher professional development in India and its inability to meet the learning needs of teachers suggests that new interventions are needed. The realization that globalization has brought about an increase in the social, cultural, political and economic interconnectedness between countries has also given rise to transnational opportunities for education systems, such as India’s, aiming to build their capacity to support teacher professional development. Moreover, new developments in communication technologies seem to present a plausible means of achieving high-quality professional development for teachers through the creation of social learning spaces, such as transnational learning networks. This case study investigates the potential of one such transnational learning network to support the quality of teacher professional development in India, namely the Australia-Asia BRIDGE School Partnerships Project. It explores the participation of some fifteen teachers and their principals from BRIDGE participating schools in Delhi region of India; focusing on their professional development expectations from the BRIDGE program and account for their experiences in the program, in order to determine the program’s potential for the professional development of teachers in this study.

Keywords: case study, Australia-Asia BRIDGE Project, teacher professional development, transnational learning networks

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Authors: Ahmad B. Habieb, Gabriele Milani, Tavio Tavio, Federico Milani

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Housings in developing countries have often inadequate seismic protection, particularly for masonry. People choose this type of structure since the cost and application are relatively cheap. Seismic protection of masonry remains an interesting issue among researchers. In this study, we develop a low-cost seismic isolation system for masonry using fiber reinforced elastomeric isolators. The elastomer proposed consists of few layers of rubber pads and fiber lamina, making it lower in cost comparing to the conventional isolators. We present a finite element (FE) analysis to predict the behavior of the low cost rubber isolators undergoing moderate deformations. The FE model of the elastomer involves a hyperelastic material property for the rubber pad. We adopt a Yeoh hyperelasticity model and estimate its coefficients through the available experimental data. Having the shear behavior of the elastomers, we apply that isolation system onto small masonry housing. To attach the isolators on the building, we model the shear behavior of the isolation system by means of a damped nonlinear spring model. By this attempt, the FE analysis becomes computationally inexpensive. Several ground motion data are applied to observe its sensitivity. Roof acceleration and tensile damage of walls become the parameters to evaluate the performance of the isolators. In this study, a concrete damage plasticity model is used to model masonry in the nonlinear range. This tool is available in the standard package of Abaqus FE software. Finally, the results show that the low-cost isolators proposed are capable of reducing roof acceleration and damage level of masonry housing. Through this study, we are also capable of monitoring the shear deformation of isolators during seismic motion. It is useful to determine whether the isolator is applicable. According to the results, the deformations of isolators on the benchmark one story building are relatively small.

Keywords: masonry, low cost elastomeric isolator, finite element analysis, hyperelasticity, damped non-linear spring, concrete damage plasticity

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Authors: E. M. Mhlongo, E. Lutge

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In 2010, South Africa’s National Department of Health (NDoH) launched national primary health care (PHC) initiative to strengthen health promotion, disease prevention, and early disease detection. The strategy, called Re-engineering Primary Health Care (rPHC), aims to support a preventive and health-promoting community-based PHC model by using community-based outreach teams (known in South Africa as Ward-based Primary Health Care Outreach teams or WBPHCOTs). These teams provide health education, promote healthy behaviors, assess community health needs, manage minor health problems, and support linkages to health services and health facilities. Ward based primary health care outreach teams are supervised by a professional nurse who is the outreach team leader. In South Africa, the WBPHCOTs have been established, registered, and are reporting their activities in the District Health Information System (DHIS). This study explored and described the challenges faced by outreach team leaders in supporting and supervising the WBPHCOTs. Qualitative data were obtained through interviews conducted with the outreach team leaders at a sub-district level. Thematic analysis of data was done. Findings revealed some challenges faced by team leaders in day to day execution of their duties. Issues such as staff shortages, inadequate resources to carry out health promotion activities, and lack of co-operation from team members may undermine the capacity of team leaders to support and supervise the WBPHCOTs. Many community members are under the impression that the outreach team is responsible for bringing the clinic to the community while the outreach teams do not carry any medication/treatment with them when doing home visits. The study further highlights issues around the challenges of WBPHCOTs at a household level. In conclusion, the WBPHCOTs are an important component of National Health Insurance (NHI), and in order for NHI to be optimally implemented, the issues raised in this research should be addressed with some urgency.

Keywords: community health worker, national health insurance, primary health care, ward-based primary health care outreach teams

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Authors: Jameson Mirimu, Edward Mawejje, Ibra Twinomujuni

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Introduction: Adolescent girls and young women (AGYW) are a vulnerable category whose risk of acquiring HIV is 20 times compared to the general population accounting for 25% of the new infections. Despite proven scientific evidence of preventing HIV acquisition, Oral Pre-Exposure Prophylaxis (PreP) is less used as one of the biomedical interventions among the AGYW. By 2020, only 31000-32000 of the targeted 90,000 persons in Uganda enrolled on Oral PreP LPHS-EC project employed a combination of Expanded Peer Outreach Approach (EPOA) and Effective client follow-up to increase PreP initiation (PrEP_NEW) and continuation for more than three months (PrEP_CT). Method: Quantitatively, data from National Key population Combination tracker retrospectively analyzed by M&E, focused group discussion with AGYWs and Health care workers to identify barriers. Barriers found; hesitancy of AGYW, misconceptions about Oral PrEP, inadequate knowledge and skills in handling adolescent and Data quality issues. To address the mentioned barriers, youth friendly corners initiated in study sites, identified PrEP Champions among the AGYW, oral PrEP dialogues, group Antenatal counselling, CQI Projects initiated, weekly perfomance meetings to track performance. Results: Routine program data review PrEP_NEW and PrEP_CT increased from 5% (4/80) and 4% (2/54), respectively, in July 2022 to 90% (72/80) and 79% (43/54) respectively for PrEP_NEW and PrEP_CT at the end of March 2023. Lessons Learnt: Demystifying misconception about oral Prep through provision of adequate information by involving health care workers through skills enhancement, CQI projects are critical intervention. Conclusion: With improved safe spaces, skills enhancement of health workers, stakeholders’ engagement through Oral Prep dialogues is critical in improving PreP uptake and continuity among the AGYWS.

Keywords: prep, uptake, continuation, AGYW

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Authors: Taiwo Hassanat Bawa-Muhammad, Opeoluwa Hope Adegoke

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Introduction: This study aims to examine the knowledge and perceptions of preconception care among healthcare workers in Nigeria, recognizing its crucial role in ensuring safe pregnancies. Despite its significance, awareness of preconception care remains low in the country. The study seeks to assess the understanding of preconception services and identify the barriers that hinder their efficacy. Methods: Through semi-structured interviews, 129 healthcare workers across six states in Nigeria were interviewed between January and March 2023. The interviews explored the healthcare workers' knowledge of preconception care practices, the socio-cultural influences shaping decision-making, and the challenges that limit accessibility and utilization of preconception care services. Results: The findings reveal a limited knowledge of preconception care among healthcare workers, primarily due to inadequate information dissemination within the healthcare system. Additionally, cultural beliefs significantly influence perceptions surrounding preconception care. Furthermore, financial constraints, distance to healthcare facilities, and poor health infrastructure disproportionately restrict access to preconception services, particularly for vulnerable populations. The study also highlights insufficient skills and outdated training among healthcare workers regarding preconception guidance, primarily attributed to limited opportunities for professional development. Discussion: To improve preconception care in Nigeria, comprehensive education programs must be implemented, taking into account the societal influences that shape perceptions and behaviors. These programs should aim to dispel myths and promote evidence-based practices. Additionally, training healthcare workers and integrating preconception care services into primary care settings, with support from religious and community leaders, can help overcome barriers to access. Strategies should prioritize affordability while emphasizing the broader benefits of preconception care beyond fertility concerns alone. Lastly, widespread literacy campaigns utilizing trusted channels are crucial for effectively disseminating information and promoting the adoption of preconception practices in Nigeria.

Keywords: preconception care, knowledge, healthcare workers, Nigeria, barriers, education, training

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Authors: G. W. Greubel, A. Kalam

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This paper provides a review of the technical problems facing the South African electricity system and discusses a hypothetical ‘virtual grid’ concept that may assist in solving the problems. The proposed solution has potential application across emerging markets with constrained power infrastructure or for companies who wish to be entirely powered by renewable energy. South Africa finds itself at a confluence of forces where the national electricity supply system is constrained with under-supply primarily from old and failing coal-fired power stations and congested and inadequate transmission and distribution systems. Simultaneously, the country attempts to meet carbon reduction targets driven by both an alignment with international goals and a consumer-driven requirement. The constrained electricity system is an aspect of an economy characterized by very low economic growth, high unemployment, and frequent and significant load shedding. The fiscus does not have the funding to build new generation capacity or strengthen the grid. The under-supply is increasingly alleviated by the penetration of wind and solar generation capacity and embedded roof-top solar. However, this increased penetration results in less inertia, less synchronous generation, and less capability for fast frequency response, with resultant instability. The renewable energy facilities assist in solving the under-supply issues but merely ‘kick the can down the road’ by not contributing to grid stability or by substituting the lost inertia, thus creating an expanding issue for the grid to manage. By technically balancing its electricity demand and supply a company with facilities located across the country can be protected from the effects of load shedding, and thus ensure financial and production performance, protect jobs, and contribute meaningfully to the economy. By treating the company’s load (across the country) and its various distributed generation facilities as a ‘virtual grid’, which by design will provide ancillary services to the grid one is able to create a win-win situation for both the company and the grid.

Keywords: load shedding, renewable energy integration, smart grid, virtual grid, virtual power plant

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Authors: Ida Zubaidah

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With the advancement of information and communication technologies, in many cases, geographical distance is no longer considered as a main barrier in distance education. Geographical distance, even from a continent to another, between students and their instructor or students and their campus can be connected by the Internet, telephone or any other means of communication technology. Managing distance learning in an archipelagic country like Indonesia, however, has some different stories. Comprising more than 17,000 islands and 6.000 of them inhabited, Indonesia is considered as one of the most archipelagic countries in the world. In some areas or islands that have adequate public transportation and communication facilities the courses can be delivered quite well. In other areas that geographically very remote and dispersed islander, Universitas Terbuka, an open university in Indonesia, has to have very different strategies in overcoming the specific and even emergency situations in learning delivery. This ongoing research paper aims to share experiences of how Universitas Terbuka makes serious and unique efforts in overcoming the barriers and obstacles in providing educational service in part of difficult areas, especially in eastern areas of Indonesia. The data collection methods are observation of sample areas and in-depth interview with the head of regional offices of Universitas Terbuka in eastern Indonesia, staff, and tutors. Conducting educational deliveries in in difficult areas with no regular and adequate transportation has made the regional office have specific strategies in making the learning process run as smooth as possible. Sending a tutor to an area to meet some students and conducting a series of tutorial, which are supposed to be weekly, in several days is one of the strategies. Recruiting local people to manage the students in the area is another strategy. The absence of regular transportation from island to island, high tides, hurricanes, are among the obstacles faced by the regional offices in doing their job. Non geographical barriers such as unavailability of qualified tutor, inadequate tutor payment, are problems as well. The learning process, however, has to be done in any way, otherwise the distance education mission to reach unreachable cannot be achieved.

Keywords: distance education, Terbuka University, difficult area, geographical barrier, learning services

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Authors: Engineer Dilnawaz Shah

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Solid Waste Management (SWM) is perhaps one of the most important elements constituting the environmental health and sanitation of the urban developing sector. The management system has several components that are integrated as well as interdependent; thus, the efficiency and effectiveness of the entire system are affected when any of its functional components fails or does not perform up to the level mark of operation. Sindh Solid Waste Management Board (SSWMB) is responsible for the management of solid waste in the entire city. There is a need to adopt the engineered approach in the redesigning of the existing system. In most towns, street sweeping operations have been mechanized and done by machinery operated by vehicles. Construction of Garbage Transfer Stations (GTS) at a number of locations within the city will cut the cost of transportation of waste to disposal sites. Material processing, recovery of recyclables, compaction, volume reduction, and increase in density will enable transportation of waste to disposal sites/landfills via long vehicles (bulk transport), minimizing transport/traffic and environmental pollution-related issues. Development of disposal sites into proper sanitary landfill sites is mandatory. The transportation mechanism is through garbage vehicles using either hauled or fixed container systems employing crew for mechanical or manual loading. The number of garbage vehicles is inadequate, and due to comparatively long haulage to disposal sites, there are certain problems of frequent vehicular maintenance and high fuel costs. Foreign investors have shown interest in enterprising improvement schemes and proposed operating a solid waste management system in Karachi. The waste to Energy option is being considered to provide a practical answer to be adopted to generate power and reduce waste load – a two-pronged solution for the increasing environmental problem. The paper presents results and analysis of a recent study into waste generation and characterization probing into waste-to-energy options for Karachi City.

Keywords: waste to energy option, integrated approach, solid waste management, physical and chemical composition of waste in Karachi

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Authors: Endris Yibru Hanurry, Wei-Hsin Hsu, Hsieh-Chih Tsai

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In recent years, the discovery of small interfering RNAs (siRNAs) has got great attention for the treatment of cancer and other diseases. However, the therapeutic efficacy of siRNAs has been faced with many drawbacks because of short half-life in blood circulation, poor membrane penetration, weak endosomal escape and inadequate release into the cytosol. To overcome these drawbacks, we designed a non-viral vector by conjugating polyamidoamine generation 4.5 dendrimer (PDG4.5) with diethylenetriamine (DETA)- and tetraethylenepentamine (TEPA) followed by binding with siRNA to form polyplexes through electrostatic interaction. The result of 1H nuclear magnetic resonance (NMR), 13C NMR, correlation spectroscopy, heteronuclear single–quantum correlation spectroscopy, and Fourier transform infrared spectroscopy confirmed the successful conjugation of DETA and TEPA with PDG4.5. Then, the size, surface charge, morphology, binding ability, stability, release assay, toxicity and cellular internalization were analyzed to explore the physicochemical and biological properties of PDG4.5-DETA and PDG4.5-TEPA polyplexes at specific N/P ratios. The polyplexes (N/P = 8) exhibited spherical nanosized (125 and 85 nm) particles with optimum surface charge (13 and 26 mV), showed strong siRNA binding ability, protected the siRNA against enzyme digestion and accepted biocompatibility to the HeLa cells. Qualitatively, the fluorescence microscopy image revealed the delocalization (Manders’ coefficient 0.63 and 0.53 for PDG4.5-DETA and PDG4.5-TEPA, respectively) of polyplexes and the translocation of the siRNA throughout the cytosol to show a decent cellular internalization and intracellular biodistribution of polyplexes in HeLa cells. Quantitatively, the flow cytometry result indicated that a significant (P < 0.05) amount of siRNA was internalized by cells treated with PDG4.5-DETA (68.5%) and PDG4.5-TEPA (73%) polyplexes. Generally, PDG4.5-DETA and PDG4.5-TEPA were ideal nanocarriers of siRNA in vitro and might be used as promising candidates for in vivo study and future pharmaceutical applications.

Keywords: non-viral carrier, oligoalkylamine, poly(amidoamine) dendrimer, polyplexes, siRNA

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Authors: Gökhan Altay, Cafer Kayadelen

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Rock fall is a movement of huge rock blocks from dip slopes due to physical effects. It generally occurs where loose tuffs lying under basalt flow or stringcourse is being constituted by limestone layers which stand on clay. By corrosion of some parts, big cracks occur on layers and these cracks continue to grow with the effect of freezing-thawing. In this way, the breaking rocks fall down from these dip slopes. Earthquakes which can induce lots of rock movements is another reason for rock fall events. In Turkey, we have a large number of regions prone to the earthquake as in the World so this increases the possibility of rock fall events. A great number of rock fall events take place in Turkey as in the World every year. The rock fall events occurring in urban areas cause serious damages in houses, roads and workplaces. Sometimes it also hinders transportation and furthermore it maybe kills people. In Turkey, rock fall events happen mostly in Spring and Winter because of freezing- thawing of water in rock cracks frequently. In mountain and inclined areas, rock fall is risky for engineering construction and environment. Some countries can invest significant money for these risky areas. For instance, in Switzerland, approximately 6.7 million dollars is spent annually for a distance of 4 km, to the systems to prevent rock fall events. In Turkey, we have lots of urban areas and engineering structure that have the rock fall risk. The embankments are preferable for rock fall events because of its low maintenance and repair costs. Also, embankments are able to absorb much more energy according to other protection systems. The current design method of embankments is only depended on field tests results so there are inadequate studies about this design method. In this paper, the field test modeled in three dimensions and analysis are carried out with the help of ANSYS programme. By the help of field test from literature the numerical model validated. After the validity of numerical models additional parametric studies performed. Changes in deformation of embankments are investigated by the changes in, geometry, velocity and impact height of falling rocks.

Keywords: ANSYS, embankment, impact height, numerical analysis, rock fall

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Authors: Areej Alosimi, Heather Wharrad, Katharine Whittingham

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Palliative care is a crucial element in nursing, especially with the steep increase in non-communicable diseases. Providing education in palliative care can help elevate the standards of care and address the growing need for it. However, palliative care has not been introduced into nursing curricula, specifically in Saudi Arabia, evidenced by students' inadequate understanding of the subject. Digital learning has been identified as a persuasive and effective method to improve education. The study aims to assess the feasibility and accessibility of implementing digital learning in palliative care education in Saudi Arabia by investigating the potential of delivering palliative care nurse education via distance learning. The study will utilize a sequential exploratory mixed-method approach. Phase one will entail identifying needs, developing a web-based program in phase two, and intervention implementation with a pre-post-test in phase three. Semi-structured interviews will be conducted to explore participant perceptions and thoughts regarding the intervention. Data collection will incorporate questionnaires and interviews with nursing students. Data analysis will use SPSS to analyze quantitative measurements and NVivo to analyze qualitative aspects. The study aims to provide insights into the feasibility of implementing digital learning in palliative care education. The results will serve as a foundation to investigate the effectiveness of e-learning interventions in palliative care education among nursing students. This study addresses a crucial gap in palliative care education, especially in nursing curricula, and explores the potential of digital learning to improve education. The results have broad implications for nursing education and the growing need for palliative care globally. The study assesses the feasibility and accessibility of implementing digital learning in palliative care education in Saudi Arabia. The research investigates whether palliative care nurse education can be effectively delivered through distance learning to improve students' understanding of the subject. The study's findings will lay the groundwork for a larger investigation on the efficacy of e-learning interventions in improving palliative care education among nursing students. The study can potentially contribute to the overall advancement of nursing education and the growing need for palliative care.

Keywords: undergraduate nursing students, E-Learning, Palliative care education, Knowledge

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Authors: Bobuchi Ken-Opurum

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The impacts of climate change on urban settlements is growing. In the global south, communities are even more vulnerable and suffer there is an increased vulnerability from due to climate change disasters such as flooding and high temperatures. This is primarily due to high intensity rainfall, low-lying coasts, inadequate infrastructure, and limited resources. According to the Emergency Events Database, floods were the leading cause of disaster -based deaths in the global south between 2006 and 2015. This includes deaths from heat stress related health outcomes. Adapting to climate vulnerabilities is paramount in reducing the significant redevelopment costs from climate disasters. Governments and urban planners provide top-down approaches such as evacuation, and disaster and emergency communication. While they address infrastructure and public services, they are not always able to address the immediate and critical day to day needs of poor and vulnerable populations. There is growing evidence that some bottom-up strategies and grassroots initiatives of self-build housing such as in urban informal settlements are successful in coping and adapting to hydroclimatic impacts. However, these research findings are not consolidated and the evaluation of the resilience outcomes of the bottom-up strategies are limited. Using self-build housing as a model for sustainable and resilient urban planning, this research aimed to consolidate the flood and heat stress resilient design solutions, analyze the effectiveness of these solutions, and develop guidelines and methods for adopting these design solutions into mainstream housing in megathermal climates. The methodological approach comprised of analyses of over 40 ethnographic based peer reviewed literature, white papers, and reports between the years 2000 and 2019 to identify coping strategies and grassroots initiatives that have been applied by occupants and communities of the global south. The results of the research provide a consolidated source and prioritized list of the best bottom-up strategies for communities in megathermal climates to improve the lives of people in some of the most vulnerable places in the world.

Keywords: resilient, design, megathermal, climate change

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Authors: Nomcebo N. Mpili, Cynthia Z. Madlabana

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The South African Primary Health Care (PHC) system has undergone a number of transformations such as the introduction of National Health Insurance (NHI) to bring about easily accessible universal health coverage and to meet the health needs for all its citizens. This provides ongoing challenges to ensure that health workers are equipped with appropriate knowledge, support, and skills to meet these changes. Therefore it is crucial to understand the experiences and challenges of nurses as the backbone of PHC in providing quality healthcare services. In addition there has been a need to understand nurses’ experiences with management support, role ambiguity and role conflict amongst other challenges in light of the current reforms in healthcare. Indeed these constructs are notorious for having a detrimental impact on the outcomes of change initiatives within any organisation, this is no different in healthcare. This draws a discussion on professional nurses within the South African health care system especially since they have been labelled as the backbone of PHC, meaning any healthcare backlog falls on them. The study made use of semi-structured interviews and adopted the interpretative phenomenological approach (IPA) as the researcher aimed to explore the lived experiences of (n= 18) participants. The study discovered that professional nurses experienced a lack of management support within PHC facilities and that management mainly played an administrative and disciplinary role. Although participants mainly held positive perceptions with regards to changes happening in health care however they also expressed negative experiences in terms of how change initiatives were introduced resulting in role conflict and role ambiguity. Participants mentioned a shortage of staff, inadequate training as well as a lack of management support as some of the key challenges faced in facilities. This study offers unique findings as participants have not only experienced the various reforms within the PHC system however they have also been part of NHI pilot. The authors are not aware of any other studies published that examine management support, role conflict and role ambiguity together especially in South African PHC facilities. In conclusion understanding these challenges may provide insight and opportunities available to improve the current landscape of PHC not only in South Africa but internationally.

Keywords: management support, professional nurse, role ambiguity, role conflict

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Authors: P. Dhesi, R. Burns

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Background: The UK has one of the largest immigration detention estates in Europe and is under increasing scrutiny, particularly regarding the lack of transparency over the use of detention and the conditions. Therefore, this research seeks to explore the professional perceptions of the ability of immigration detention in the UK to promote health and dignity. Methods: A phenomenological approach to qualitative methods were used, with social constructivist theorisations of health and dignity. Seven semi-structured interviews were conducted using Microsoft Teams. Participants included a range of immigration detention stakeholders who have visited closed immigration detention centres in the UK in a professional capacity. Recorded interviews were transcribed verbatim, and analysis was data-driven through inductive reflexive thematic analysis of the entire data set to account for the small sample size. This study received ethical approval from University College London Research Ethics Committee. Results: Two global themes were created through analysis: apathetic place and hostile space. Apathetic place discusses the lack of concern for detainees' daily living and healthcare needs within immigration detention in the UK. This is explored through participants' perceptions of the lack of ability of monitoring and evaluation processes to ensure detainees are able to live with dignity and understand the unfulfilled duty of care that exists in detention. Hostile space discusses immigration detention in the UK as a wider system of hostility. This is explored through the disempowering impact on detainees, the perception of a failing system as a result of inadequate safeguarding procedures, and a belief that the intention of immigration detention is misaligned with its described purpose. Conclusion: This research explains why the current immigration detention system in the UK is unable to promote health and dignity, offering a social justice and action-orientated approach to research in this sphere. The findings strengthen the discourse against the use of detention as an immigration control tool in the UK. Implications for further research include a stronger emphasis on investigating alternatives to detention and culturally considerate opportunities for patient-centred healthcare.

Keywords: access to healthcare, dignity, health, immigration detention, migrant, refugee, UK

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Authors: Manjusha R. Vagal, Shyam K. Shrivastava, Umesh Mahantshetty, Sudeep Gupta, Supriya Chopra, Reena Engineer, Amita Maheshwari, Atul Buduk

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Vaginal stenosis is a common side effect associated with pelvic radiotherapy in cervical cancer patients which contributes negatively to woman’s health and prevents adequate vaginal/cervical examination. Vaginal dilation with a dilator is routine practice and is internationally advocated as a prophylactic measure to preserve vaginal patency. This retrospective study was carried out with the aim to know the usefulness of vaginal dilation following pelvic radiation therapy in cervical cancer patients in India. Data from medical records of 183 cervical cancer patients, which met the study criteria, were collected related to the stage of the disease, treatment received, commencement period of dilation post radiation therapy, sexual status and side effects associated to dilation practice. Data related to vaginal dimensions as per the length of insertion of a small, medium and large dilator were collected on regular follow-ups until 36 months and/or more. Vaginal dimensions as measured with the length of medium dilator insertion were used for analysis of dilation therapy results using paired t-test. Patients who underwent vaginal dilation with dilator maintained vaginal patency, also the mean vaginal length significantly increased, from 8.02 cm ± 2.69 to 9.96 ± 2.89 cm with a p value <0.001. There was no significant difference found on vaginal patency with different intervals of initiation of dilation therapy. At the third year and more following dilation therapy, significant increase in vaginal length observed with a p value of 0.0001 in both sexually active and inactive patients. Compilation of vaginal dosage during brachytherapy was inadequate, and hence, the secondary objective of the study to determine the effect of radiotherapy on the outcome of rehabilitation intervention was not studied in detail. This retrospective study has found that dilation therapy with vaginal dilators post pelvic radiotherapy is effective in preventing vaginal stenosis and improving vaginal patency and cannot be substituted with vaginal intercourse. Sexual quality of life assessment in the Indian population needs much attention.

Keywords: dilator, sexually active, vaginal dilation, vaginal stenosis

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Authors: Manzoor Ahmad

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The rapid advancement of mobile technology has transformed the way businesses engage with consumers, making mobile marketing a crucial strategy for organizations worldwide. This paper presents a comprehensive study on the adoption of mobile marketing in Pakistan, aiming to provide valuable insights into the current landscape, challenges, and opportunities in this emerging market. To achieve this objective, a mixed-methods approach was employed, combining quantitative surveys and qualitative interviews with industry experts, marketers, and consumers. The study encompassed a diverse range of sectors, including retail, telecommunications, banking, and e-commerce, ensuring a comprehensive understanding of mobile marketing practices across different industries. The findings indicate that mobile marketing has gained significant traction in Pakistan, with a growing number of organizations recognizing its potential for reaching and engaging with consumers effectively. Factors such as increasing smartphone penetration, affordable data plans, and the rise of social media usage have contributed to the widespread adoption of mobile marketing strategies. However, several challenges and barriers to mobile marketing adoption were identified. These include issues related to data privacy and security, limited digital literacy among consumers, inadequate infrastructure, and cultural considerations. Additionally, the study highlights the need for tailored and localized mobile marketing strategies to address the diverse cultural and linguistic landscape of Pakistan. Based on the insights gained from the study, practical recommendations are provided to support organizations in optimizing their mobile marketing efforts in Pakistan. These recommendations encompass areas such as consumer targeting, content localization, mobile app development, personalized messaging, and measurement of mobile marketing effectiveness. This research contributes to the existing literature on mobile marketing adoption in developing countries and specifically sheds light on the unique dynamics of the Pakistani market. It serves as a valuable resource for marketers, practitioners, and policymakers seeking to leverage mobile marketing strategies in Pakistan, ultimately fostering the growth and success of businesses operating in this region.

Keywords: mobile marketing, digital marketing, mobile advertising, adoption of mobile marketing

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Authors: Adline Nkwam-Uwaoma, Mishack Ndukwu

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Traditionally, child rearing in Nigeria closely reflects the ‘spare the rod and spoil the child’ maxim and as such spanking, flogging, slapping, beating and even starving a child as a form of punishment for wrongdoing and as a method of behaviour modification are common. These are not necessarily considered as maltreatment or abuse of the child. Despite the adoption and implementation of the child rights act in Nigeria, violence against children seems to be on a steady increase. Stories of sexual molestation, rape, child labour, infliction of physical injuries and use of children for rituals by parents, guardians or other members of the society abound. Violence against children is considered as those acts by other persons especially adults that undermine and threaten the healthy life and existence of children or those that violet their rights as humans. In Nigeria newspapers are a major source of News, second only to radio and television in coverage, currency and content. National dailies are newspapers with daily publications and national spread or coverage. This study analysed the frequency, length, prominence level, direction and sources of information reported on violence against children in the selected national daily newspapers. It then provided information on the role of the newspapers in Nigeria in the fight against child violence and public awareness of the impact of violence against children on the development of the nation and the attempts to curtail such violence. The composite week sampling technique in which the four weeks of the month are reduced to one and a sample is randomly selected from each day of the week was used. As such 168 editions of Daily Sun and Punch newspapers published from January to December of 2016 were selected. Data were collected using code sheet and analyzed via content analysis. The result showed that the frequency of the newspapers’ reportage of violence against children in Nigeria was low. Again, it was found that the length or space given to reports on violence against children was inadequate, the direction of the few reports on violence against children was in favour of the course or fight against child violence, and these newspapers gave no prominence to reports on violence against children. Finally, it was found that a major source of News about violence against children was through journalism; government and individual sources provided only minimal information.

Keywords: children, newspapers' reportage, Nigeria, violence

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Authors: Eric A. Morris, Xia Liu, Yee Ka Wong, Greg J. Evans, Jeff R. Brook

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Air quality monitoring stations tend to be widely distributed and are often located far from major roadways, thus, determining where, when, and which traffic-related air pollutants (TRAPs) have the greatest impact on public health becomes a matter of extrapolation. Compact, multipollutant sensor systems are an effective solution as they enable several TRAPs to be monitored in a geospatially dense network, thus filling in the gaps between conventional monitoring stations. This work describes two applications of one such system named AirSENCE for gathering actionable air quality data relevant to smart city infrastructures. In the first application, four AirSENCE devices were co-located with traffic monitors around the perimeter of a city block in Oshawa, Ontario. This study, which coincided with the COVID-19 outbreak of 2020 and subsequent lockdown measures, demonstrated a direct relationship between decreased traffic volumes and TRAP concentrations. Conversely, road construction was observed to cause elevated TRAP levels while reducing traffic volumes, illustrating that conventional smart city sensors such as traffic counters provide inadequate data for inferring air quality conditions. The second application used two AirSENCE sensors on opposite sides of a major 2-way commuter road in Toronto. Clear correlations of TRAP concentrations with wind direction were observed, which shows that impacted areas are not necessarily static and may exhibit high day-to-day variability in air quality conditions despite consistent traffic volumes. Both of these applications provide compelling evidence favouring the inclusion of air quality sensors in current and future smart city infrastructure planning. Such sensors provide direct measurements that are useful for public health alerting as well as decision-making for projects involving traffic mitigation, heavy construction, and urban renewal efforts.

Keywords: distributed sensor network, continuous ambient air quality monitoring, Smart city sensors, Internet of Things, traffic-related air pollutants

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Authors: Suantak Demkhosei Vaiphei

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Mental illness is still considered as an illness not to be treated, resulting India becoming the most depressed country in the world. At present, 150 million Indians are suffering from mental illness and desperately in need of immediate care assessment for their mental health condition. However, only 0.06 per cent of India’s health budget is devoted to mental health treatment, in which the available data suggests that the state of spending the sanctioned budget in this regard is abysmal. Lack of awareness, ignorance, social stigma, and discriminations becomes the underlying factors for worsening the individual mental health conditions. Unfortunately, India becomes the most depressed country in the world, which is hugely affected by anxiety, schizophrenia, and bipolar disorder followed by China and USA as per the latest World Health Organization report. The National Care of Medical Health stated that at least 6.5 per cent of the Indian populations are under serious mental disorder both in the rural and the urban areas’Mental health is the integral part of health and can be affected by a range of psychosocial-economic factors that need comprehensive strategically approach for promotion, prevention, treatment, and recovery. In a low- and middle-income country like India, the advance progress in mental health service is visible consistently slow and minimal. Some of the major barriers can be seen in the existing public health priorities and its influence on funding; challenges to delivery of basic mental health care in the primary care settings; the minimal numbers of well-trained professionals in the area of mental health care; and lack of mental health perspective in public-health leadership. The existing barriers according to WHO (2007) are; lack of funding for mental health services is the core barrier in implementing quality mental health services, including inadequate coordinated and consensus based national mental health advocacy and plans, the absence of mental health in major donor priorities, marketing of expensive pharmaceuticals by industry, cost-effectiveness information on mental health services that is unknown to senior decision-makers and social stigma among others. Moreover, lack of strong mental health advocacy in countries to increase resources for mental health services and the role of social stigma and the view that mental health is a private responsibility are also the two barriers to mental health.

Keywords: mental health, depression, stigma, barriers

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Authors: Bernice Boafoaa Gyapong, Anne Jones, Sam Bassett, Janet Anderson

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Background: Maternal mortality and morbidity are global concerns, especially in sub-Saharan Africa (SSA). Most maternal mortalities occur at the time of birth. Quality intrapartum care is essential for improving maternal and newborn health outcomes. This scoping review aimed to assess and describe the quality of care during childbirth in SSA to provide an overview of the regional trend of the quality of intrapartum care, the challenges to quality care provision, and identify research gaps. Methods: A scoping review based on Arksey and O’Malley’s scoping review framework was conducted. Medline, CINAHL, PsycINFO, and maternal-infant databases were searched to identify the relevant studies for this review. A narrative summary was presented using themes based on the Donabedian structure, process, and outcome quality of care model. Results: A total of five hundred and forty-seven (547) publications were identified. Fifty-six (56) studies conducted in twenty (20) countries were included in the review. Thirty-four (34) were quantitative, sixteen (16) were qualitative, and six (6) were mixed methods. Most of the studies were related to the process component of quality of care. The provision of emergency obstetric care services, infrastructure, and availability of essential staff and equipment for perinatal care was inadequate in many facilities, particularly rural and peripheral health facilities. Many women experienced disrespectful care during childbirth. Routine care during labour and delivery was observed to be sub-optimal, yet some women reported high satisfaction with care. The use of health facilities for delivery was lower in health centres compared to hospitals. Conclusion: There are variations in the quality of maternity care provided in SSA. Intrapartum care quality is generally deficient in SSA, particularly in peripheral health facilities, health centres, and community clinics. Many of the quality-of-care issues identified are related to the structure component. Stakeholders must develop interventions that comprehensively address these interrelated issues to improve maternal healthcare quality, especially in primary healthcare facilities.

Keywords: quality of care, maternity health, Sub-Saharan Africa, intrapartum

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Authors: Esra Ceren Kara, Ufuk Seri̇n

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The Byzantine Empire, which persisted from the 4th to 15th centuries, covered a significant period in history and bequeathed a significant cultural heritage throughout its territories, including Turkey. However, despite its historical and cultural importance, the approach of the political authorities, which emphasizes the Seljuk and Ottoman heritage, to Byzantium in Turkey is reluctant and problematic. Byzantine history and culture have long been neglected and attained negative connotations. This has led to a lack of awareness and understanding of Byzantine heritage among the public and inadequate conservation efforts. This research aims to address this problem by proposing a reinterpretation and presentation of Byzantine heritage in Turkey that emphasizes its cultural value and presents it to the public as a part of a common cultural heritage in order to accomplish effective conservation, raise awareness and provide a better understanding of the Byzantium. In this article, the ways to interpret, present and integrate the Medieval Byzantine heritage into today’s world are analyzed through the selected case study of Trebizond (Trabzon) with a holistic approach by putting emphasis on the Byzantine religious edifices, churches, chapels and monasteries. Although the vestiges of this period are still intact and in use today, their past is unknown to many of their users. This situation is even more evident in the case of the converted churches, which are now used as mosques or mosque-museums. In the city center of Trebizond, 9 out of 12 religious edifices that are still in use were built during the Medieval Byzantine period and converted into mosques under Ottoman and Turkish rule. Currently, these monuments serve as mosques and mosque-museums. However, with the exception of Hagia Sophia and Girls Monastery, their Byzantine past is obscure to many locals. Thus, the promotion of local awareness and conservation of the Medieval Byzantine heritage in the city is required. With this premise, this research will investigate the values and opportunities offered by the Byzantine cultural heritage in Trebizond and the threats to its conservation, and it will offer proposals for a more effective interpretation and presentation so as to foster local awareness and integration of the Medieval Byzantine heritage.

Keywords: Byzantium/Byzantine, Trebizond, cultural heritage, interpretation and presentation, conservation, religious architecture, converted churches interpretation and presentation

Procedia PDF Downloads 78

Authors: Jun Sun, Tsz Tin Yu, Maryam Mirabediny, Matthew Lee, Adele Jones, Denis M. O’Carroll, Michael J. Manefield, Björn Åkermark, Biswanath Das, Naresh Kumar

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Reductive defluorination has emerged as a sustainable approach to clean water from Per and polyfluoroalkyl substances (PFASs), also known as forever organic containments. For last few decades, nano zero valent metals (nZVMs) have been intensively applied in the reductive remediation of groundwater contaminated with chlorinated organic compounds due to its low redox potential, easy application, and low production cost. However, there is inadequate information on the effective reductive defluorination of linear or branched PFAS using nZVMs as reductants because of the lack of suitable catalysts. CoII-5,10,15,20-Tetraphenyl-21H,23H-porphyrin (CoTPP) has been recently reported for effective catalyzing reductive defluorination of branched (br-) perfluorooctane sulfonate (PFOS) by using TiIII citrate as reductant. However, the low water solubility of CoTPP limited its applicability. Here, we explored a series of structurally related soluble cobalt porphyrin catalysts based on our previously reported best performing CoTPP. All soluble porphyrins [[meso-tetra(4-carboxyphenyl)porphyrinato]cobalt(III)]Cl·₇H₂O (CoTCPP), [[meso-tetra(4-sulfonatophenyl) porphyrinato]cobalt(III)]·9H2O (CoTPPS), and [[meso-tetra(4-N-methylpyridyl) porphyrinato]cobalt(II)](I)₄·₄H₂O (CoTMpyP) displayed better defluorination efficiencies than CoTPP. Especially, CoTMpyP presented the best defluorination efficiency for br-PFOS (94 %), branched perfluorooctanoic acid (PFOA) (89 %), and 3,7-Perfluorodecanoic acid (PFDA) (60 %) after 1 day at 70 0C. CoTMpyP-nZn0 system showed 88-164 times higher defluorination rate than VB12-nZn0 system in terms of all investigated br-PFASs. The CoTMpyP-nZn0 also performed effectively at room temperature, demonstrating the potential prospect for in-situ reductive systems. Based on the analysis of the intermediate products, the calculated bond dissociation energies (BDEs) and possible first interaction between CoTMpyP and PFAS, degradation pathways of 3,7-PFDA and 6-PFOS are proposed.

Keywords: cationic, soluble porphyrin, cobalt, vitamin b12, pfas, reductive defluorination

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Authors: Merih Welay Welesilassie

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Understanding educators' readiness to incorporate AI tools into their teaching methods requires comprehensively examining the influencing factors. This understanding is crucial, given the potential of these technologies to personalise learning experiences, improve instructional effectiveness, and foster innovative pedagogical approaches. This study evaluated factors affecting teachers' adoption of AI tools in their English language instruction by extending the Technology Acceptance Model (TAM) to encompass digital readiness support, perceived risk, and trust. A cross-sectional quantitative survey was conducted with 128 English language teachers, supplemented by qualitative data collection from 15 English teachers. The structural mode analysis indicated that implementing AI tools in Ethiopian higher education was notably influenced by digital readiness support, perceived ease of use, perceived usefulness, perceived risk, and trust. Digital readiness support positively impacted perceived ease of use, usefulness, and trust while reducing safety and privacy risks. Perceived ease of use positively correlated with perceived usefulness but negatively influenced trust. Furthermore, perceived usefulness strengthened trust in AI tools, while perceived safety and privacy risks significantly undermined trust. Trust was crucial in increasing educators' willingness to adopt AI technologies. The qualitative analysis revealed that the teachers exhibited strong content and pedagogical knowledge but needed more technology-related knowledge. Moreover, It was found that the teachers did not utilise digital tools to teach English. The study identified several obstacles to incorporating digital tools into English lessons, such as insufficient digital infrastructure, a shortage of educational resources, inadequate professional development opportunities, and challenging policies and governance. The findings provide valuable guidance for educators, inform policymakers about creating supportive digital environments, and offer a foundation for further investigation into technology adoption in educational settings in Ethiopia and similar contexts.

Keywords: digital readiness support, AI acceptance, perceived risc, AI trust

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Authors: Bintou Jobe

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The construction sector, both in the United Kingdom (UK) and developing Anglophone West African countries, specifically The Gambia, is facing significant health and safety challenges. While the UK has established legislation and regulations to support Occupational Health and Safety (OHS) in the industry, the same level of support is lacking in developing countries. The significance of this review is to assess the extent and effectiveness of OHS legislation and regulatory reform in the construction industry, with a focus on understanding the challenges faced by both the UK and developing Anglophone West African countries. It aims to highlight the benefits of implementing an OHS management system, specifically ISO 45001. This study uses a literature review approach, synthesizing publications from the past decade and identifying common themes and best practices related to Occupational Health and Safety in the construction industry. Findings were analysed, compared, and conclusions and recommendations were drawn after developing research questions and addressing them. This comprehensive review of the literature allows for a detailed understanding of the challenges faced by the industry in both contexts. The findings of the study indicate that while the UK has established robust health and safety legislation, many UK construction companies have not fully met the standards outlined in ISO 45001. These challenges faced by the UK include poor data management, inadequate communication of best practices, insufficient training, and a lack of safety culture mirroring those observed in the developing Anglophone countries. Therefore, compliance with OHS management systems has been shown to yield benefits, including injury prevention and centralized health and safety documentation. In conclusion, the effectiveness of OHS legislation for developing Anglophone West African countries should consider the positive impact experienced by the UK. The implementation of ISO 45001 can serve as a benchmark standard and potentially inform recommendations for developing countries. The selection criteria for literature include search keywords and phrases, such as occupational health and safety challenges, The Gambia, developing countries management systems, ISO 45001, and impact and effectiveness of OHS legislation. The literature was sourced from Google Scholar, the UK Health and Safety Executive websites, and Google Advanced Search.

Keywords: ISO 45001, developing countries, occupational health and safety, UK

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Authors: Prashant Neupane, Sumitra Kafle, Asmi Pandey, Laura Mitchell

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Pain following caesarean section can influence recovery, patient satisfaction, breast feeding success and mother-child bonding. Since the introduction of enhanced recovery protocols, mothers are often discharged 24 hours later. We identified concerns within our hospital with mothers tolerating poorly controlled pain in order to achieve earlier discharge and subsequently suffering significant pain at home with inadequate analgesia. Methods: We conducted a prospective audit of analgesic prescribing and post-operative pain scores after caesarean section. Mothers were seen on post-operative day one, their pain score recorded on a verbal analogue score from 0-10, and their prescription chart reviewed. A follow-up phone call was then made on post-operative day 3-7 to enquire about pain scores and analgesia use at home. Following this, a standardized proforma for prescribing after the caesarean section was introduced, including the addition of dihydrocodeine that patients can take home following discharge. There were educational update sessions for anesthetists and midwifes, and then a re-audit was conducted months later. Results: Data was collected from 50 women before and after the introduction of the change. Initial audit showed that there was considerable variation in prescribing, with four women prescribed no regular analgesia at all and inconsistency in the dose of oral morphine prescribed. Women were not given any form of analgesia to take home after discharge and were advised to take regular paracetamol and ibuprofen. However, 31/50 (62%) reported that they needed additional analgesia and eight women (16%) even sought prescription for additional analgesia from elsewhere. After the introduction of the change, prescribing was more consistent with all patients prescribed regular analgesia. 46/50 patients were given dihydrocodeine on discharge. Mean pain scores on post-operative day one improved from 5.16 to 3.9, and at home improved from 6.18 to 2.58. Use of dihydrocodeine at home significantly improved patients reporting of severe pain at home from 24% to zero. Discussion: Lack of strong analgesia out of the hospital and the increased demands on activity levels means that women are frequently in more pain at home after discharge. Introduction of a standardized prescription proforma, including the use of to-take-out dihydrocodeine, was successful in improving patient pain scores and the requirement for additional analgesia, both in hospital and at home.

Keywords: analgesia, caesarean section, post-operative pain, standardised

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Authors: Mokgadi Malatji, Tebogo Mothiba, Rambelani Malema

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Absenteeism is a global problem in the working force and this is no exception in the nursing profession. A lot of attention has been drawn to factors that contribute to absenteeism however little attention has been placed on the effects of absenteeism on the remaining workers/nurses being left behind in the workplace by their colleagues. Nurses absent themselves leaving behind their colleagues to do their work. Nurses who are committed to their work often find themselves working under strenuous conditions due to inadequate staff. These may lead to poor patient care provision, nurses feeling overworked and sick due to the increased workload. The purpose of this study was to investigate the effects of absenteeism on nurses that remained at work at Mankweng Hospital in the Capricorn District, Limpopo Province. A descriptive cross-sectional quantitative research design was conducted to determine if there were any effects of absenteeism on nurses remaining at work. Data collection was done using structured questionnaires. The respondents (n=107), consisted of different categories of registered nurses (professional nurses (n=43), auxiliary nurses (n=40) and staff nurses (n=24)) who participated in this study. The findings indicated that most nurses (76, 6%) are demotivated and they struggle with completion of duties when their colleagues are absent. Patient care that nurses provided when their colleagues were absent was of poor quality as set standards and principles were not adhered to. Individualized patient care was not being implemented due to absenteeism. This simply implies that routine work is being done to cover basic duties. Most nurses (74, 8%) believed that favoritism and lack of appreciation of nurse’s skills and capabilities are being displayed by managers and that this contributes to absenteeism. Nurses who are loyal sacrifice their time and work overtime for absent colleagues and this led to fatigue and stress. From the study findings, it is recommended that nurses be trained frequently to upgrade their studies to motivate them to work. The government can provide this training to improve their skills as this will motivate nurses to work harder and be committed to their work. Training can be offered after a stipulated period. For example, after every five years, a nurse can be provided with a new skill. Team building events must be encouraged for the whole hospital to motivate staff. In conclusion, the study revealed that absenteeism poses detrimental effects on nurses, the hospital and patients. More and more nurses end up changing workplace due to these effects.

Keywords: absenteeism, effects, nurses, remaining at work

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