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Health inequalities: an analysis of hospitalizations with respect to migrant status, gender and geographical area
de Waure, Chiara
Bruno, Stefania
Furia, Giuseppe
Di Sciullo, Luca
Carovillano, Serena
Specchia, Maria Lucia
Geraci, Salvatore
Ricciardi, Walter
BMC International Health and Human Rights
The quality of care includes several aspects which may be influenced by social-economic status.
This study analyzes hospitalizations for several conditions, such as chronic diseases, cancer and appendectomy, in Italians and immigrant people living in Italy with the aim to evaluate possible inequalities in the quality of health care services due to migrant status, gender and geographical macro-areas (Northern, Central, Southern Italy).
The data source of hospital discharges for stroke, myocardial infarction, chronic liver disease, cervical cancer, mastectomy and appendectomy was the Ministry of Health. ICD 9 codes were used for data collection. Crude and standardized hospitalization rates per 100.000 were calculated. Italian resident population and an estimate of immigrants living in Italy were used as denominators while standardization was done with respect to the European population. The data we used covers the 2006–2008 period.
Immigrants showed significantly higher hospitalization rates for stroke, cervical cancer and appendectomy and significantly lower hospitalization rates for chronic liver diseases and mastectomy. Males showed significantly higher hospitalization rates than females for myocardial infarction, chronic liver diseases and appendectomy. Notwithstanding, differences related to migrant status and gender varied according to geographical macro-area. With respect to that, Southern Italy showed significantly higher hospitalization rates for stroke, myocardial infarction and chronic liver diseases and significantly lower hospitalization rates for mastectomy and appendectomy.
The results of this study may reflect inequalities in the quality of health care, in particular in primary and secondary prevention, access to specialized care and inappropriateness, due to migrant status and gender. Also, differences between macro-areas suggest heterogeneities in the integration policies and the promotion of immigrants' health. Research should be endorsed in this field in order to further describe inequalities and their reasons and in the light of supporting policies development.
Electronic supplementary material
The online version of this article (doi:10.1186/s12914-014-0032-9) contains supplementary material, which is available to authorized users.
Inequalities; Immigrant; Hospitalization; Gender; Citizenship; Italy
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Steps on a journey to TB control in Solomon Islands: a cross-sectional, mixed methods pre-post evaluation of a local language DVD
Massey, Peter D
Asugeni, Rowena
Wakageni, John
Kekeubata, Esau
Maena'aadi, John
Laete'esafi, John
Waneagea, Jackson
Asugeni, Vunivesi
MacLaren, David
Speare, Richard
BMC International Health and Human Rights
In Solomon Islands many people with Tuberculosis (TB) have challenges in accessing services because of socio-cultural, geographic and health service reasons, resulting in delays in TB treatment and low detection rates. The purpose of this project was to (i) develop a local language audio-visual resource (DVD) about TB (ii) share this resource with people in remote villages and (iii) evaluate the process and outcomes.
The project involved the development and evaluation of a DVD in local Kwaio language. The DVD included five short videos based on the Australian Respiratory Council TB Education Flipchart. The DVD also included short videos of: traditional music/chanting (ai'imae); drama that presented an allegory of TB; and a short documentary on the redevelopment of the local TB Ward.
A mixed-methods approach evaluated changes in TB knowledge and investigated the impact of the DVD.
The DVD was recorded and produced in March–June 2013 and screened in 41 villages and hamlets. The pre-post DVD survey was completed by 64% (255/400) of people who viewed the DVD in the villages. Pre-DVD survey responses showed a moderate to high knowledge about TB signs, symptoms and treatment but 76/255 (30%) stated TB was caused by sorcery and 85/255 (33%) incorrectly stated that TB medication should be stopped when a patient feels better.
The post-DVD survey showed a significant increase in people in coastal villages reporting (i) a 3-week cough would trigger a medical assessment and (ii) TB is mainly spread through the air. Statements that TB is not caused by sorcery increased post-DVD in both coastal and mountain villages, however belief in sorcery in mountain villages remained high at 20/70 (29%).
The local DVD resource was developed within local cultural understandings and oral traditions of Kwaio people. Using modern but accessible DVD technology generated a lot of interest about the disease and the stories.
The project evaluation indicates that current delays in seeking treatment may be more due to socio-cultural and health service factors than awareness of the disease. Therefore the development of TB services, including TB education, which are culturally sensitive, remains important.
Tuberculosis; Solomon Islands; Heath education; Culture; Language
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Assessment of a couples HIV counseling and testing program for pregnant women and their partners in antenatal care (ANC) in 7 provinces, Thailand
Lolekha, Rangsima
Kullerk, Nareeluck
Wolfe, Mitchell I
Klumthanom, Kanyarat
Singhagowin, Thapanaporn
Pattanasin, Sarika
Sombat, Potjaman
Naiwatanakul, Thananda
Leartvanangkul, Chailai
Voramongkol, Nipunporn
BMC International Health and Human Rights
Couples HIV testing and counseling (CHTC) at antenatal care (ANC) settings allows pregnant women to learn the HIV status of themselves and their partners. Couples can make decisions together to prevent HIV transmission. In Thailand, men were tested at ANC settings only if their pregnant partners were HIV positive. A CHTC program based in ANC settings was developed and implemented at 16 pilot hospitals in 7 provinces during 2009–2010.
Cross-sectional data were collected using standard data collection forms from all pregnant women and accompanying partners who presented at first ANC visit at 16 hospitals. CHTC data for women and partners were analyzed to determine service uptake and HIV test results among couples. In-depth interviews were conducted among hospital staff of participating hospitals during field supervision visits to assess feasibility and acceptability of CHTC services.
During October 2009-April 2010, 4,524 women initiating ANC were enrolled. Of these, 2,435 (54%) women came for ANC alone; 2,089 (46%) came with partners. Among men presenting with partners, 2,003 (96%) received couples counseling. Of these, 1,723 (86%) men and all pregnant women accepted HIV testing. Among 1,723 couples testing for HIV, 1,604 (93%) returned for test results. Of these, 1,567 (98%) were concordant negative, 6 (0.4%) were concordant positive and 17 (1%) were HIV discordant (7 male+/female- and 10 male-/female+). Nine of ten (90%) executive hospital staff reported high acceptability of CHTC services.
CHTC implemented in ANC settings helps identify more HIV-positive men whose partners were negative than previous practice, with high acceptability among hospital staff.
Couples counseling; Pregnant women; ANC; Thailand
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Thriving beyond survival: Understanding utilization of perinatal health services as predictors of birth registration: A cross-sectional study
Jackson, Michelle
Duff, Putu
Kusumanigrum, Santi
Stark, Lindsay
BMC International Health and Human Rights
There are an estimated 35 million unregistered children in Indonesia. To understand ways to best leverage existing health system-related resources and ensure greater protective measures for these vulnerable children, this study explores the predictive relationship between the utilization of perinatal health services and birth certificate ownership in two Indonesian provinces.
This study employed a cross-sectional design with interviewer-administered household surveys to heads of households in West Nusa Tenggara and East Nusa Tenggara from May to July of 2013. The primary outcome of interest was birth certificate ownership among children under the age of 5 years old. Bivariate and multivariable regression analyses using Generalized Estimating Equations (GEE) considered a set of covariates that represented child and household socio-demographic characteristics along with health services utilization variables during pregnancy and post-pregnancy periods.
389 heads of households were interviewed, yielding data on a sample of 451 children under the age of 5. Fewer than 28% of children in this sample possessed a birth certificate. Nearly 57% (n = 259) of children were delivered in a clinical facility, though only 36% (n = 93) of these were legally registered. Of children born in the home (n = 194), registration dropped to 16% (n = 31). Adjusted analyses accounting for socio-demographic factors suggest that children born in a clinic facility (AOR = 2.33, 95% CI: 1.27, 4.33), hospital (AOR = 2.38, 95% CI: 1.12, 5.09), or in the presence of a skilled birth attendant (AOR = 2.35, 95% CI: 1.31, 4.23) were significantly more likely to be registered. Children whose mothers sought post-natal care were 2.99 times more likely to possess a birth certificate (AOR = 2.99, 95% CI: 1.1, 7.57). Pre-natal care was not associated with birth registration.
These findings suggest that use of perinatal health services increases the likelihood of registering a child's birth despite a lack of formal integration of vital registration with the health sector. Formally leveraging existing community-based health workers and perinatal services may serve to further increase registration rates in hard to reach areas of Indonesia.
Birth registration; Child protection; Health services utilization; Indonesia; Civil registration and vital statistics (CRVS)
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Could international compulsory licensing reconcile tiered pricing of pharmaceuticals with the right to health?
Ooms, Gorik
Forman, Lisa
Williams, Owain D
Hill, Peter S
BMC International Health and Human Rights
The heads of the Global Fund and the GAVI Alliance have recently promoted the idea of an international tiered pricing framework for medicines, despite objections from civil society groups who fear that this would reduce the leeway for compulsory licenses and generic competition. This paper explores the extent to which an international tiered pricing framework and the present leeway for compulsory licensing can be reconciled, using the perspective of the right to health as defined in international human rights law.
We explore the practical feasibility of an international tiered pricing and compulsory licensing framework governed by the World Health Organization. We use two simple benchmarks to compare the relative affordability of medicines for governments – average income and burden of disease – to illustrate how voluntary tiered pricing practice fails to make medicines affordable enough for low and middle income countries (if compared with the financial burden of the same medicines for high income countries), and when and where international compulsory licenses should be issued in order to allow governments to comply with their obligations to realize the right to health.
An international tiered pricing and compulsory licensing framework based on average income and burden of disease could ease the tension between governments' human rights obligation to provide medicines and governments' trade obligation to comply with the Agreement on Trade-Related Aspects of Intellectual Property Rights.
Right to health; Tiered pricing; TRIPS; Medicines; Patent; Compulsory licensing
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Post-crisis Zimbabwe's innovative financing mechanisms in the social sectors: a practical approach to implementing the new deal for engagement in fragile states
Salama, Peter
Ha, Wei
Negin, Joel
Muradzikwa, Samson
BMC International Health and Human Rights
Donor engagement in transitional settings, complex emergencies and fragile states is increasing. Neither short-term humanitarian aid nor traditional development financing are well adapted for such environments. Multi-donor trust funds, in their current form, can be unwieldy and subject to long delays in initiation and work best when national governments are already strong. We reviewed the aid modalities used in Zimbabwe through the period of crisis, 2008–2012 and their results and implications. Literature review and case experience was utilised.
By focusing on working with line ministries in non-contested sectors to determine local priorities rather than following global prescriptions, pooling funds to achieve scale rather than delivering through fragmented projects, and building on national systems and capacities rather than setting up parallel mechanisms, the Transition Fund Model employed in Zimbabwe by UNICEF and partners in partnership with the Inclusive Government was able to achieve important results in health, education, social support and water services in a challenging setting. In addition, forums for collaboration were developed that provided a platform for further action. The initial emphasis on service delivery diffused much of the political delicateness that impeded progress in other sectors. The Zimbabwean experience may provide a model of innovative financing for countries facing similar circumstances.
Such models may represent a new practical application of the Paris Principles, consistent with the major tenets of the 2011 New Deal for Engagement in Fragile States agreed in Busan. As we approach the Millennium Development Goal deadline, an over-arching, mutli-sectoral and independent evaluation of this approach is recommended in order to validate findings and assess broader replicability of this approach.
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From international health to global health: how to foster a better dialogue between empirical and normative disciplines
Ooms, Gorik
BMC International Health and Human Rights
Public health recommendations are usually based on a mixture of empirical evidence and normative arguments: to argue that authorities ought to implement an intervention that has proven effective in improving people's health requires a normative position confirming that the authorities are responsible for improving people's health. While public health (at the national level) is based on a widely accepted normative starting point – namely, that it is the responsibility of the state to improve people's health – there is no widely accepted normative starting point for international health or global health. As global health recommendations may vary depending on the normative starting point one uses, global health research requires a better dialogue between researchers who are trained in empirical disciplines and researchers who are trained in normative disciplines.
Global health researchers with a background in empirical disciplines seem reluctant to clarify the normative starting point they use, perhaps because normative statements cannot be derived directly from empirical evidence, or because there is a wide gap between present policies and the normative starting point they personally support. Global health researchers with a background in normative disciplines usually do not present their work in ways that help their colleagues with a background in empirical disciplines to distinguish between what is merely personal opinion and professional opinion based on rigorous normative research.
If global health researchers with a background in empirical disciplines clarified their normative starting point, their recommendations would become more useful for their colleagues with a background in normative disciplines. If global health researchers who focus on normative issues used adapted qualitative research guidelines to present their results, their findings would be more useful for their colleagues with a background in empirical disciplines.
Although a single common paradigm for all scientific disciplines that contribute to global health research may not be possible or desirable, global health researchers with a background in empirical disciplines and global health researchers with a background in normative disciplines could present their 'truths' in ways that would improve dialogue. This paper calls for an exchange of views between global health researchers and editors of medical journals.
Global health; International health; Human rights; Ethics; Empirical; Normative; Is-ought problem; Interdisciplinary research
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Lessons from Africa: developing a global human rights framework for tuberculosis control and prevention
Slagle, Tracy
Ben Youssef, Mehdi
Calonge, Golda
Ben Amor, Yanis
BMC International Health and Human Rights
Tuberculosis is a highly contagious disease, and there has been a rise in recent years of drug-resistant cases no longer responding to standard treatment.
In order to address this threat and contain possible transmission of drug-resistant cases, some countries have taken strong action, including the compulsory detention of non-adherent drug-resistant patients. These measures have been strongly criticized by human rights advocates, and they raise the question of how to legally protect both citizens and the community.
Following discussions with National Tuberculosis Programs in Africa (the continent with the highest incidence rates of tuberculosis worldwide), we show that of all the countries surveyed, all but one (Swaziland) had either no specific policy addressing tuberculosis, or only general policies regarding public health applicable to tuberculosis. Six countries also reported having policies that address non-adherence to treatment with containment (isolation in health facilities or incarceration), but laws are not adequately enforced. If the international community wants to effectively respond to the threat of tuberculosis transmission, there is a need to go beyond national tuberculosis policies and to implement an international framework for tuberculosis control, inspired by the Framework Convention on Tobacco Control, a key model for future public health treaties that address global burdens of disease. The framework, for which we clarify the conditions and procedures in this piece, would define the rights and responsibilities of the different stakeholders involved: patients, doctors, pharmaceutical firms and public authorities. To facilitate the governance of the national obligations under the Convention, a coordinating body should be set up, under the leadership of the World Health Organization and the Stop TB Partnership.
Successfully implementing policies for tuberculosis that simultaneously address patients' rights and communities' wellbeing will have positive implications for those affected by the disease and serve as a basis for other global health conventions to truly ensure the global right to health.
Tuberculosis; Drug-resistant tuberculosis; Framework convention; Human rights
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Level of male involvement and associated factors in family planning services utilization among married men in Debremarkos town, Northwest Ethiopia
Kassa, Mihretie
Abajobir, Amanuel Alemu
Gedefaw, Molla
BMC International Health and Human Rights
Men's participation is crucial to the success of family planning programs and women's empowerment and associated with better outcomes in reproductive health such as contraceptive acceptance and continuation, and safer sexual behaviors. Limited choice and access to methods, attitudes of men towards family planning, perceived fear of side-effects, poor quality of available services, cultural or religious oppositions and gender-based barriers are some of the reasons for low utilization of family planning. Hence, this study assessed the level of male involvement in family planning services utilization and its associated factors in Debremarkos town, Northwest Ethiopia.
A community-based cross-sectional study was conducted from October to November, 2013. Multi-stage sampling technique was used to select 524 eligible samples. Data were collected by using semi-structured questionnaires. Epi Info and SPSS were used to enter and analyze the data; univariate, bivariate and logistic regression analyses were performed to display the outputs.
Only 44 (8.4%) respondents were using or directly participating in the use of family planning services mainly male condoms. The reasons mentioned for the low participation were the desire to have more children, wife or partner refusal, fear of side effects, religious prohibition, lack of awareness about contraceptives and the thinking that it is the only issue for women. Opinion about family planning services, men approval and current use of family planning methods were associated with male involvement in the services utilization.
In this study, the level of male involvement was low. Lack of information, inaccessibility to the services and the desire to have more children were found to be the reasons for low male involvement in family planning services utilization. Governmental and nongovernmental organizations, donors and relevant stakeholders should ensure availability, accessibility and sustained advocacy for use of family planning services. The family planning programs should incorporate the responsibility and role of males in the uptake of family planning services.
Male involvement; Family planning services; Ethiopia
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Maternal health development programs: comparing priorities of bilateral and private donors
Deleye, Cécile
Lang, Achim
BMC International Health and Human Rights
The face of international aid for health and development is changing. Private donors such as foundations and corporations are playing an increasingly important role, working in international development as direct operators or in partnerships with governments. This study compares maternal health programs of new development actors to traditional governmental donors. It aims to investigate what maternal health programs large governmental donors, foundations and corporate donors are conducting, and how and why they differ.
A total of 263 projects were identified and analyzed. We focus on nine categories of maternal health programs: family planning services, focus on specific diseases, focus on capacity building, use of information and communication technology (ICT), support of research initiatives, cooperation with local non-state or state partners and cooperation with non-local non-state or state partners. Data analysis was carried out using Generalized Linear Mixed-Effects Models (GLMER).
Maternal health policies of public and private donors differ with regard to strategic approaches, as can be seen in their diverging positions regarding disease focus, family planning services, capacity building, and partner choice. Bilateral donors can be characterized as focusing on family planning services, specific diseases and capacity-building while disregarding research and ICT. Bilateral donors cooperate with local public authorities and with governments and NGOs from other developed countries. In contrast, corporations focus their donor activities on specific diseases, capacity-building and ICT while disregarding family planning services and research. Corporations cooperate with local and in particular with non-local non-state actors. Foundations can be characterized as focusing on family planning services and research, while disregarding specific diseases, capacity-building and ICT. Foundations cooperate less than other donors; but when they do, they cooperate in particular with non-state actors, local as well as non-local.
These findings should help developing coordination mechanisms that embrace the differences and similarities of the different types of donors. As donor groups specialize in different contexts, NGOs and governments working on development and health aid may target donors groups that have specialized in certain issues.
Maternal health; Donors; Development projects; Corporations; Foundations
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Ethical considerations of providers and clients on HIV testing campaigns in Burkina Faso
Desclaux, Alice
Ky-Zerbo, Odette
Somé, Jean-François
Obermeyer, Carla Makhlouf
BMC International Health and Human Rights
Campaigns have been conducted in a number of low HIV prevalence African settings, as a strategy to expand HIV testing, and it is important to assess the extent to which individual rights and quality of care are protected during campaigns. In this article we investigate provider and client perceptions of ethical issues, including whether they think that accessibility of counseling and testing sites during campaigns may hinder confidentiality.
To examine how campaigns have functioned in Burkina Faso, we undertook a qualitative study based on individual interviews and focus group discussions with 52 people (providers and clients tested during or outside campaigns and individuals never tested). Thematic analysis was performed on discourse about perceptions and experiences of HIV-testing campaigns, quality of care and individual rights.
Respondents value testing accessibility and attractiveness during campaigns; clients emphasize convenience, ripple effect, the sense of not being alone, and the anonymity resulting from high attendance. Confronted with numerous clients, providers develop context-specific strategies to ensure consent, counseling, confidentiality and retention in the testing process, and they adapt to workplace arrangements, local resources and social norms. Clients appreciate the quality of care during campaigns. However, new ethical issues arise about confidentiality and accessibility. Confidentiality of HIV-status may be jeopardized due to local social norms that encourage people to share their results with others, when HIV-positive people may not wish to do so. Providers' ethical concerns are consistent with WHO norms known as the '5 Cs,' though articulated differently. Clients and providers value the accessibility of testing for all during campaigns, and consider it an ethical matter. The study yields insights on the way global norms are adapted or negotiated locally.
Future global recommendations for HIV testing and counseling campaigns should consider accessibility and propose ways for testing services to respond to new ethical issues related to high demand.
HIV; Testing campaign; Ethics; Burkina Faso; Individual rights; Global norms; Stigma; Africa
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Disease patterns and clinical outcomes of patients admitted in intensive care units of tertiary referral hospitals of Tanzania
Sawe, Hendry R
Mfinanga, Juma A
Lidenge, Salum J
Mpondo, Boniventura CT
Msangi, Silas
Lugazia, Edwin
Mwafongo, Victor
Runyon, Michael S
Reynolds, Teri A
BMC International Health and Human Rights
In sub-Saharan Africa the availability of intensive care unit (ICU) services is limited by a variety of factors, including lack of financial resources, lack of available technology and well-trained staff. Tanzania has four main referral hospitals, located in zones so as to serve as tertiary level referral centers. All the referral hospitals have some ICU services, operating at varying levels of equipment and qualified staff. We analyzed and describe the disease patterns and clinical outcomes of patients admitted in ICUs of the tertiary referral hospitals of Tanzania.
This was a retrospective analysis of ICU patient records, for three years (2009 to 2011) from all tertiary referral hospitals of Tanzania, namely Muhimbili National Hospital (MNH), Kilimanjaro Christian Medical Centre (KCMC), Mbeya Referral Hospital (MRH) and Bugando Medical Centre (BMC).
MNH is the largest of the four referral hospitals with 1300 beds, and MRH is the smallest with 480 beds. The ratio of hospital beds to ICU beds is 217:1 at MNH, 54:1 at BMC, 39:1 at KCMC, and 80:1 at MRH. KCMC had no infusion pumps. None of the ICUs had a point-of-care (POC) arterial blood gas (ABG) analyzer. None of the ICUs had an Intensive Care specialist or a nutritionist. A masters-trained critical care nurse was available only at MNH. From 2009–2011, the total number of patients admitted to the four ICUs was 5627, male to female ratio 1.4:1, median age of 34 years. Overall, Trauma (22.2%) was the main disease category followed by infectious disease (19.7%). Intracranial injury (12.5%) was the leading diagnosis in all age groups, while pneumonia (11.7%) was the leading diagnosis in pediatric patients (<18 years). Patients with tetanus (2.4%) had the longest median length ICU stay: 8 (5,13) days. The overall in-ICU mortality rate was 41.4%.
The ICUs in tertiary referral hospitals of Tanzania are severely limited in infrastructure, personnel, and resources, making it difficult or impossible to provide optimum care to critically ill patients and likely contributing to the dauntingly high mortality rates.
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The government of Kenya cash transfer for orphaned and vulnerable children: cross-sectional comparison of household and individual characteristics of those with and without
Ayuku, David
Embleton, Lonnie
Koech, Julius
Atwoli, Lukoye
Hu, Liangyuan
Ayaya, Samuel
Hogan, Joseph
Nyandiko, Winstone
Vreeman, Rachel
Kamanda, Allan
Braitstein, Paula
BMC International Health and Human Rights
The 'Cash Transfer to Orphans and Vulnerable Children' (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people's health and well-being and other international human rights. The objective of this analysis was to compare the household socioeconomic status, school enrolment, nutritional status, and future outlook of orphaned and separated children receiving the CT compared to those not receiving a CT.
This project analyzes baseline data from a cohort of orphaned and separated children aged <19 years and non-orphaned children living in 300 randomly selected households (HH) in 8 Locations of Uasin Gishu County, Kenya. Baseline data were analyzed using multivariable logistic and Poisson regression comparing children in CT-HH vs. non-CT HH. Odds ratios are adjusted (AOR) with 95% confidence intervals (CI) for guardian age and sex, child age and sex, and intra-HH correlation.
Included in this analysis were data from 1481 children and adolescents in 300 HH (503 participants in CT, 978 in non-CT households). Overall there were 922 (62.3%) single orphans, 324 (21.9%) double orphans, and 210 (14.2%) participants had both parents alive and were living with them. Participants in CT-HH were less likely to have ≥2 pairs of clothes compared to non-CT HH (AOR: 0.32, 95% CI: 0.16-0.63). Those in CT HH were less likely to have missed any days of school in the preceding month (AOR: 0.62, 95% CI: 0.42-0.94) and those aged <1-18 years in CT-HH were less likely to have height stunting for their age (AOR: 0.65, 95% CI: 0.47-0.89). Participants aged at least 10 years in CT-HH were more likely to have a positive future outlook (AOR: 1.72, 95% CI: 1.12-2.65).
Children and adolescents in households receiving the CT-OVC appear to have better nutritional status, school attendance, and optimism about the future, compared to those in households not receiving the CT, in spite of some evidence of continued material deprivation. Consideration should be given to expanding the program further.
Orphans; Africa; Cash transfer; Nutrition; Food security; Mental health
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Socio-economic and demographic determinants of under-five mortality in rural northern Ghana
Kanmiki, Edmund Wedam
Bawah, Ayaga A
Agorinya, Isaiah
Achana, Fabian S
Awoonor-williams, John Koku
Oduro, Abraham R
Phillips, James F
Akazili, James
BMC International Health and Human Rights
In spite of global decline in under-five mortality, the goal of achieving MDG 4 still remains largely unattained in low and middle income countries as the year 2015 closes-in. To accelerate the pace of mortality decline, proven interventions with high impact need to be implemented to help achieve the goal of drastically reducing childhood mortality. This paper explores the association between socio-economic and demographic factors and under-five mortality in an impoverished region in rural northern Ghana.
We used survey data on 3975 women aged 15–49 who have ever given birth. First, chi-square test was used to test the association of social, economic and demographic characteristics of mothers with the experience of under-five death. Subsequently, we ran a logistic regression model to estimate the relative association of factors that influence childhood mortality after excluding variables that were not significant at the bivariate level.
Factors that significantly predict under-five mortality included mothers' educational level, presence of co-wives, age and marital status. Mothers who have achieved primary or junior high school education were 45% less likely to experience under-five death than mothers with no formal education at all (OR = 0.55, p < 0.001). Monogamous women were 22% less likely to experience under-five deaths than mothers in polygamous marriages (OR = 0.78, p = 0.01). Similarly, mothers who were between the ages of 35 and 49 were about eleven times more likely to experience under-five deaths than those below the age of 20 years (OR = 11.44, p < 0.001). Also, women who were married had a 27% less likelihood (OR = 0.73, p = 0.01) of experiencing an under-five death than those who were single, divorced or widowed.
Taken independently, maternal education, age, marital status and presence of co-wives are associated with childhood mortality. The relationship of these indicators with women's autonomy, health seeking behavior, and other factors that affect child survival merit further investigation so that interventions could be designed to foster reductions in child mortality by considering the needs and welfare of women including the need for female education, autonomy and socioeconomic well-being.
Under-five mortality; Socio-economic; Demographic; Determinants; Rural; Ghana
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Community perceptions of rape and child sexual abuse: a qualitative study in rural Tanzania
Abeid, Muzdalifat
Muganyizi, Projestine
Olsson, Pia
Darj, Elisabeth
Axemo, Pia
BMC International Health and Human Rights
Rape of women and children is recognized as a health and human rights issue in Tanzania and internationally. Exploration of the prevailing perceptions in rural areas is needed in order to expand the understanding of sexual violence in the diversity of Tanzania's contexts. The aim of this study therefore was to explore and understand perceptions of rape of women and children at the community level in a rural district in Tanzania with the added objective of exploring those perceptions that may contribute to perpetuating and/or hindering the disclosure of rape incidences.
A qualitative design was employed using focus group discussions with male and female community members including religious leaders, professionals, and other community members. The discussions centered on causes of rape, survivors of rape, help-seeking and reporting, and gathered suggestions on measures for improvement. Six focus group discussions (four of single gender and two of mixed gender) were conducted. The focus group discussions were recorded, transcribed verbatim, and analyzed using manifest qualitative content analysis.
The participants perceived rape of women and children to be a frequent and hidden phenomenon. A number of factors were singled out as contributing to rape, such as erosion of social norms, globalization, poverty, vulnerability of children, alcohol/drug abuse and poor parental care. Participants perceived the need for educating the community to raise their knowledge of sexual violence and its consequences, and their roles as preventive agents.
In this rural context, social norms reinforce sexual violence against women and children, and hinder them from seeking help from support services. Addressing the identified challenges may promote help-seeking behavior and improve care of survivors of sexual violence, while changes in social and cultural norms are needed for the prevention of sexual violence.
Child sexual abuse; Community perceptions; Focus group discussions; Rape; Rural; Sexual violence; Tanzania
Related Articles
Demand and access to mental health services: a qualitative formative study in Nepal
Brenman, Natassia F
Luitel, Nagendra P
Mall, Sumaya
Jordans, Mark J D
BMC International Health and Human Rights
Nepal is experiencing a significant 'treatment gap' in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders.
This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach.
As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand.
This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME's integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting.
Demand; Access; Mental health care; Stigma; Treatment gap; Nepal
Related Articles
Injection practices in Nepal: health policymakers' perceptions
Gyawali, Sudesh
Rathore, Devendra Singh
Shankar, Pathiyil Ravi
Maskey, Manisha
KC, Vikash Kumar
BMC International Health and Human Rights
The unnecessary and unsafe use of injections is common in developing countries like Nepal. Policymakers have an important role in promoting rational and safe injection use. Hence, the present study was carried out to explore the perception of health policymakers regarding safe injection practice in Nepal.
An exploratory qualitative study design was used in this study. Key policymakers from both the central and regional level were selected using purposive sampling. A semi-structured questionnaire advocated by the World Health Organization (WHO) was used after modifying the context. Interviews were conducted to clarify doubts and obtain additional information. The data was analyzed manually using deductive content analysis technique.
In total, eleven policymakers participated. All unanimously agreed that injection safety is a problem and seven participants reported that injections are overused. They shared the opinion that injections are administered by various providers, including formal and informal health providers, and also quacks. Almost half the respondents reported that the National Drug Policy discourages injection overuse, while others reported that the policy contains no provisions regarding injection overuse. Most policymakers stated that only single-use disposable injection equipment is used to provide injection, while others thought that sterilizable glass syringe is also used. More than half of the participants believed that the quality of injection equipment available in the Nepalese market is not regulated by any government institution. Almost two-third of the policymakers stated that syringes and needles are not reused, while the rest thought syringes might be reused without sterilization in some parts of the country. Almost half of the respondents stated that illegal commercialization of used syringes exists in Nepal. Almost all respondents thought that health care institutions have a waste management plan, while more than half of them opined that such plans are limited to tertiary care hospitals located in the capital.
The result of this study revealed a divergence of views among policymakers, even among those in the same ministry. Though there has been some effort from the government to increase the safety of injection practices, greater efforts are required, especially with regard to standardization of policies and procedures related to injection practice.
Drug policy; Hazardous waste; Health policy; Injection; Needle stick injury; Nepal
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A qualitative assessment of health seeking practices among and provision practices for men who have sex with men in Malawi
Wirtz, Andrea L
Kamba, Dunker
Jumbe, Vincent
Trapence, Gift
Gubin, Rehana
Umar, Eric
Strömdahl, Susanne K
Beyrer, Chris
Baral, Stefan D
BMC International Health and Human Rights
In the context of a generalized epidemic and criminalization of homosexuality, men who have sex with men (MSM) in Malawi have a disproportionate burden of HIV compared to other adults. Past research has documented low uptake of HIV prevention and health services among MSM, self-reported fear of seeking health services, and concerns of disclosure of sexual orientation and discrimination in health settings. Qualitative research was conducted among MSM and health service providers in Blantyre, Malawi to understand underlying factors related to disclosure and health seeking behaviors and inform the development of a community-based comprehensive HIV prevention intervention.
Using peer recruitment, eight MSM participants representing a range of ages, orientations, and social and behavioral characteristics were enrolled for in-depth interviews. Five service providers were recruited from the district hospital, local health and STI clinics, and a HIV prevention service organization. We use the Health Belief Model as a framework to interpret the influential factors on 1) health seeking and uptake among MSM, and 2) influences on provision of services by healthcare providers for MSM.
Results highlight disclosure fears among MSM and, among providers, a lack of awareness and self-efficacy to provide care in the face of limited information and political support. Service providers reported concerns of adverse repercussions related to the provision of services to men in same sex sexual relationships. Some MSM demonstrated awareness of HIV risk but believed that within the wider MSM community, there was a general lack of HIV information for MSM, low awareness of appropriate prevention, and low perception of risks related to HIV infection.
Qualitative research highlights the need for appropriate information on both HIV risks and acceptable, effective HIV prevention options for MSM. Information and educational opportunities should be available to the wider MSM community and the health sector. Health sector interventions may serve to increase cultural and clinical competency to address health problems experienced by MSM. To ensure availability and use of services in light of the criminalization and stigmatization of same sex practices, there is need to increase the safety of uptake and provision of these services for MSM.
Health knowledge; Attitudes; Practice; HIV/AIDS; Men who have sex with men (MSM); Stigma; Malawi
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Correction: Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey
Brinda, Ethel Mary
Rodríguez Andrés, Antonio
Enemark, Ulrika
BMC International Health and Human Rights
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A community-based cluster randomized survey of noncommunicable disease and risk factors in a peri-urban shantytown in Lima, Peru
Heitzinger, Kristen
Montano, Silvia M
Hawes, Stephen E
Alarcón, Jorge O
Zunt, Joseph R
BMC International Health and Human Rights
An estimated 863 million people–a third of the world's urban population–live in slums, yet there is little information on the disease burden in these settings, particularly regarding chronic preventable diseases.
From March to May 2012, we conducted a cluster randomized survey to estimate the prevalence of noncommunicable diseases (NCDs) and associated risk factors in a peri-urban shantytown north of Lima, Peru. Field workers administered a questionnaire that included items from the WHO World Health Survey and the WHO STEPS survey of chronic disease risk factors. We used logistic regression to assess the associations of NCDs and related risk factors with age and gender. We accounted for sampling weights and the clustered sampling design using statistical survey methods.
A total of 142 adults were surveyed and had a weighted mean age of 36 years (range 18–81). The most prevalent diseases were depression (12%) and chronic respiratory disease (8%), while lifetime prevalence of cancer, arthritis, myocardial infarction, and diabetes were all less than 5%. Fifteen percent of respondents were hypertensive and the majority (67%) was unaware of their condition. Being overweight or obese was common for both genders (53%), but abdominal obesity was more prevalent in women (54% vs. 10% in men, p < 0.001). Thirty-five percent of men binge drank and 34% reported current smoking; these behaviors were less common among women (4% binge drank, p < 0.001; 8% smoked, p = 0.002). Increasing age was associated with an increased risk of abdominal obesity (Odds Ratio (OR) = 1.04, 95% CI = 1.01, 1.07, p = 0.02), hypertension (OR = 1.06, 95% CI = 1.02, 1.10, p = 0.006), arthritis (OR = 1.07, 95% CI = 1.03, 1.11, p < 0.001) and cancer (OR = 1.13, 95% CI = 1.07, 1.20, p < 0.001) in adjusted models. The prevalences of other NCDs and related risk factors were similar when stratified by age or gender.
This study underlines the important burden of noncommunicable disease in informal settlements in Peru and suggests that prevention and treatment interventions could be optimized according to age and gender.
Peru; Slum; Shantytown; Noncommunicable disease
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Local understandings of care during delivery and postnatal period to inform home based package of newborn care interventions in rural Ethiopia: a qualitative study
Degefie, Tedbabe
Amare, Yared
Mulligan, Brian
BMC International Health and Human Rights
Despite a substantial decrease in child mortality in Ethiopia over the past decade, neonatal mortality remains unchanged (37/1000 live-births). This paper describes a qualitative study on beliefs and practices on immediate newborn and postnatal care in four rural communities of Ethiopia conducted to inform development of a package of community-based interventions targeting newborns.
The study team conducted eight key informant interviews (KII) with grandmothers, 27 in-depth interviews (IDI) with mothers; seven IDI with traditional birth attendants (TBA) and 15IDI with fathers, from four purposively selected communities located in Sidama Zone of Southern Nationalities, Nations, and Peoples (SNNP) Region and in East Shewa and West Arsi Zones of Oromia Region.
In the study communities deliveries occurred at home. After cutting the umbilical cord, the baby is put to the side of the mother, not uncommonly with no cloth covering. This is largely due to attendants focusing on delivery of the placenta which is reinforced by the belief that the placenta is the 'house' or 'blanket' of the baby and that any "harm" caused to the placenta will transfer to the newborn. Applying butter or ointment to the cord "to speed drying" is common practice. Initiation of breastfeeding is often delayed and women commonly report discarding colostrum before initiating breastfeeding. Sub-optimal breastfeeding practices continue, due to perceived inadequate maternal nutrition and breast milk often leading to the provision of herbal drinks. Poor thermal care is also demonstrated through lack of continued skin-to-skin contact, exposure of newborns to smoke, frequent bathing—often with cold water baths for low-birth weight or small babies; and, poor hygienic practices are reported, particularly hand washing prior to contact with the newborn.
Cultural beliefs and newborn care practices do not conform to recommended standards. Local perspectives related to newborn care practices should inform behaviour change messages. Such messages should target mothers, grandmothers, TBAs, other female family members and fathers.
Ethiopia; Newborn care; Qualitative methods; Cultural beliefs
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"If you do vasectomy and come back here weak, I will divorce you": a qualitative study of community perceptions about vasectomy in Southern Ghana
Adongo, Philip Baba
Tapsoba, Placide
Phillips, James F
Tabong, Philip Teg-Nefaah
Stone, Allison
Kuffour, Emmanuel
Esantsi, Selina F
Akweongo, Patricia
BMC International Health and Human Rights
Male involvement in contraceptive use is increasingly becoming a global reproductive health issue. Vasectomy is one of the two male modern contraceptive methods espoused by the National Family Planning Policy in Ghana. Despite these advocacies, there are reports of low patronage of this method in Ghana. This study adhering to RATS guidelines on qualitative research therefore explored the social and cultural factors that may be affecting the low vasectomy uptake in Southern Ghana.
The study was conducted in Sefwi Bibiani-Ahwiaso Bekwai (SBAB) District and Komenda-Edina-Eguafo-Abrem (KEEA) Municipal area in the Western and Central regions of Ghana respectively. Twelve Focus Group Discussions were held with both male and female community members. In-depth interviews were also carried out with Community Health Officers (CHOs), Community Health Volunteers (CHVs) and health managers at both the district and regional levels. The discussions and interviews were recorded, transcribed verbatim and analysed using Nvivo 10.
The study revealed that vasectomy was perceived as an act against God, which was punishable either by death or answerable on judgement day. Vasectomy was also perceived to be a form of castration, which can make men weak and incapable, thereby unable to satisfy their wives sexually, leading to marital conflicts. Women were more concerned about the negative effects of vasectomy on men. Cafalgin and panacin which are locally manufactured analgesics were perceived to have contraceptive abilities and therefore used by men as an alternative to modern contraceptive methods.
Stigma and the misconceptions in the community may be accounting for the low vasectomy uptake in Ghana despite several advocacy strategies. Women were highly influential in a man's decision on vasectomy. This calls for the need to increase health education to demystify the misconceptions about vasectomy. Vasectomy-related campaign messages should target both men and women.
Vasectomy; Pregnancy; Family Planning; Male involvement; Southern Ghana
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Health and human rights in eastern Myanmar prior to political transition: a population-based assessment using multistaged household cluster sampling
Parmar, Parveen K
Benjamin-Chung, Jade
Smith, Linda S
Htoo, Saw Nay
Laeng, Sai
Lwin, Aye
Mahn, Mahn
Maung, Cynthia
Reh, Daniel
Shwe Oo, Eh Kalu
Lee, Thomas
Richards, Adam K
BMC International Health and Human Rights
Myanmar/Burma has received increased development and humanitarian assistance since the election in November 2010. Monitoring the impact of foreign assistance and economic development on health and human rights requires knowledge of pre-election conditions.
From October 2008-January 2009, community-based organizations conducted household surveys using three-stage cluster sampling in Shan, Kayin, Bago, Kayah, Mon and Tanintharyi areas of Myanmar. Data was collected from 5,592 heads of household on household demographics, reproductive health, diarrhea, births, deaths, malaria, and acute malnutrition of children 6–59 months and women aged 15–49 years. A human rights focused survey module evaluated human rights violations (HRVs) experienced by household members during the previous year.
Estimated infant and under-five rates were 77 (95% CI 56 to 98) and 139 (95% CI 107 to 171) deaths per 1,000 live births; and the crude mortality rate was 13 (95% CI 11 to 15) deaths per thousand persons. The leading respondent-reported cause of death was malaria, followed by acute respiratory infection and diarrhea, causing 21.2% (95% CI 16.5 to 25.8), 16.6% (95% CI 11.8 to 21.4), and 12.3% (95% CI 8.7 to 15.8), respectively. Over a third of households suffered at least one human rights violation in the preceding year (36.2%; 30.7 to 41.7). Household exposure to forced labor increased risk of death among infants (rate ratio (RR) = 2.2; 95% CI 1.1 to 4.4) and children under five (RR = 2.1; 95% CI 1.3 to 3.6). The proportion of children suffering from moderate to severe acute malnutrition was higher among households that were displaced (prevalence ratio (PR) = 3.3; 95% CI 1.9 to 5.6).
Prior to the 2010 election, populations of eastern Myanmar experienced high rates of disease and death and high rates of HRVs. These population-based data provide a baseline that can be used to monitor national and international efforts to improve the health and human rights situation in the region.
Burma; Myanmar; Human Rights; Health; Mortality; Malaria
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Factors associated with non-utilisation of health service for childbirth in Timor-Leste: evidence from the 2009-2010 Demographic and Health Survey
Khanal, Vishnu
Lee, Andy H
da Cruz, Jonia Lourenca Nunes Brites
Karkee, Rajendra
BMC International Health and Human Rights
Timor-Leste is a young developing country in Asia. Most of its infrastructure was destroyed after a long armed conflict for independence. Despite recent expansion of health facilities and investment in healthcare, maternal mortality remains high with most mothers still giving birth at home. This study investigated factors affecting the non-utilisation of health service for childbirth in the aftermath of the independence conflict.
The Timor-Leste Demographic and Health Survey 2009-2010 was the latest two-stage national survey, which used validated questionnaires to obtain information from 26 clusters derived from 13 districts of the country. Factors influencing non-utilisation of health facility for childbirth were investigated using univariate and multivariable logistic regression analyses, accounting for the cluster sampling and sample weight of the survey.
Of the total 5986 participants included in the study, 4472 (74.8%) did not deliver their last child at a health facility. Lack of education for the mother (adjusted odds ratio (OR): 2.04; 95% confidence interval (CI) 1.56 to 2.66) and her partner (OR: 1.45; 95% CI 1.14 to 1.84), low household wealth status (OR: 5.20; 95% CI 3.93 to 6.90), and rural residence (OR: 2.83; 95% CI 2.22 to 3.66), were associated with increased likelihood of non-utilisation of health facility for childbirth. Working mothers (OR: 1.55; 95% CI 1.32 to 1.81), who had high parity (OR: 1.78; 95% CI 1.36 to 2.32) and did not attend antenatal care service (OR: 4.68; 95% CI 2.65 to 8.28) were also vulnerable for not delivering at a health facility. Conversely, the prevalence of non-utilisation of health facility for childbirth reduced with increasing number of service components received during antenatal care visits (OR: 0.72; 95% CI 0.64 to 0.80).
Only a quarter of Timorese women delivered at a health facility. In order to reduce maternal mortality, future interventions should target disadvantaged mothers from poor families, those residing in rural areas, have higher parity but no education, and who seldom attend antenatal care service, by improving their utilisation of health facility for childbirth.
Facility-based childbirth; Home delivery; Maternal health services; Timor-Leste
Related Articles
Female genital cutting (FGC) and the ethics of care: community engagement and cultural sensitivity at the interface of migration experiences
Vissandjée, Bilkis
Denetto, Shereen
Migliardi, Paula
Proctor, Jodi
BMC International Health and Human Rights
Female Genital Cutting (FGC) anchored in a complex socio-cultural context becomes significant at the interface of access of health and social services in host countries. The practice of FGC at times, understood as a form of gender-based violence, may result in unjustifiable consequences among girls and women; yet, these practices are culturally engrained traditions with complex meanings calling for ethically and culturally sensitive health and social service provision. Intents and meanings of FGC practice need to be well understood before before any policies that criminalize and condemn are derived and implemented.
FGC is addressed as a global public health issue with complex legal and ethical dimensions which impacts ability to access services, far beyond gender sensitivity. The ethics of terminology are addressed, building on the sustained controversial debate in regards to the delicate issue of conceptualization. An overview of international policies is provided, identifying the current trend of condemnation of FGC practices. Socio-cultural and ethical challenges are discussed in light of selected findings from a community-based research project. The illustrative examples provided focus on Western countries, with a specific emphasis on Canada.
The examples provided converge with the literature confirming the utmost necessity to engage with the FGC practicing communities allowing for ethically sensitive strategies, reduction of harm in relation to systems of care, and prevention of the risk of systematic gendered stigmatization. A culturally competent, gender and ethically sensitive approach is argued for to ensure the provision of quality ethical care for migrant families in host countries. We argue that socio-cultural determinants such as ethnicity, migration, sex and gender need to be accounted for as integral to the social construction of FGC.
Working partnerships between the public health sector and community based organisations with a true involvement of women and men from practicing communities will allow for more sensitive and congruent clinical guidelines. In order to honour the fundamental principles and values of medical ethics, such as compassion, beneficence, non-malfeasance, respect, and justice and accountability, socio-cultural interactions at the interface of health and migration will continue to require proper attention. It entails a commitment to recognise the intrinsic value and dignity of girls' and women's context.
Female genital cutting; Female genital mutilation; Traditional practices; Migration; Public health; Ethics; Harm reduction; Community engagement; Cultural sensitivity
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Excel 2010 For Dummies
Greg Harvey, quot;Excel 2010 For Dummiesquot;
For Dummies | 2010-04-26 | ISBN: 0470489537 | 408 pages | File type: PDF | 10,3 mb
The bestselling Excel book on the market, updated for Excel 2010
As the world's leading spreadsheet application, Excel has a huge user base. The release of Office 2010 brings major changes to Excel, so Excel For Dummies comes to the rescue once more!
In the friendly and non-threatening For Dummies style, this popular guide shows beginners how to get up and running with Excel and helps more experienced users get comfortable with new features.
# Excel is the number one spreadsheet application worldwide, and Excel For Dummies is the number one guide to using it
# With the major changes in Microsoft Office 2010, Excel has new features and a new interface design; users need help to get up to speed
# The book includes everything you need to know to perform basic Excel 2010 tasks
# Covers creating and editing worksheets and charts, formatting cells, entering formulas, inserting graphs, designing database forms, and adding database records
# Also covers printing, adding hyperDownload link: to worksheets, saving worksheets as Web pages, adding existing worksheet data to an existing Web page, and much more
Whether you're new to Excel or just need to understand the 2010 version, Excel 2010 For Dummies provides what you need to know.
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Oracle Certified Professional Java SE 8 Programmer Exam 1Z0-809: A Comprehensive OCPJP 8 Certificati
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Sundance 2016: Logan Lerman, Sarah Gadon and Tracy Letts star in the adaptation of Philip Roth's novel
Following its world premiere at the Sundance Film Festival, Lionsgate's Summit Entertainment has acquired North American rights to James Schamus' directorial debut "Indignation" for $2.5 million, an individual with knowledge of the deal told TheWrap.
Logan Lerman stars in the coming-of-age drama, which is based on the novel by Philip Roth about the son of a kosher butcher who leaves his sheltered family life in New Jersey to attend college in Ohio, where he clashes with the dean (Tracy Letts) and falls for a classmate (Sarah Gadon).
Set in 1951, the "Indignation" drew respectful reviews at Sundance, where Schamus spent years on the other side of the negotiating table as the head of Good Machine and later, Focus Features.
Also Read: James Schamus Directing Debut 'Indignation' Wins Over Sundance Audience
Schamus produced the film with Anthony Bregman and Rodrigo Teixeira. CAA negotiated the domestic deal on behalf of the filmmakers, while FilmNation is handling foreign sales.


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I took a Mucinex DM about 3 hrs ago and was wondering if it is ok to take Tylenol Extra Strength?
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If you are visiting Puerto for a walking holiday then these apartments are a good option. They are clean and tidy with plenty of space and a serviceable kitchen. The breakfast is a basic affair but does the job. Staff are friendly. Not fancy but pleasant and quiet.
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It's easy to wonder what places in Arizona were like 100 years ago or more. A trip to the Pioneer Living History Village provides an answer. Here you can get a glimpse at 19th-century living in the desert.
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This article includes a document describing how to use PGP Universal Server with Directory Synchronization with Nested Groups.
LDAP Directory Synchronization on PGP Universal Server is currently not supported using Nested groups. To use Nested groups with Directory Synchronization, each subgroup must be manually added to the policy on the server.
To add the Nested Groups manually do the following:
1. Log in to the Universal Server
2. Go to Consumers
3. Click on Add Group
4. Click the Membership Tab
5. Check the "Match Consumers Via Directory Synchronization" box
6. Under "All LDAP Directories" select "If any of the following Apply"
7. Then add the Attributes and Values
8. Click the + sign on the right to add another subgroup.
9. When you are done click on Save to save the settings.
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11. Click on Save.
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My html page dynamically loads pages via Ajax for dynamic panels on the page. I need the script tags in the dynamically loaded pages to be executed. I fixed the code from a SO question. It works fine on FF/Safari/Chrome.
But dom nodes of type script work differently on IE. -- I can't seem to add text to a script node in IE 7:
// variable "data" holds the script element's content from an
// incoming html page loaded via ajax
var script = document.createElement("script");
script.type = "text/javascript";
script.appendChild(document.createTextNode(data)); // doesn't work on ie
// also doesn't work on IE 7:
script.innerHTML = data;
script.innerText = data;
Any ideas for getting the sw to work on IE? (Other than using eval.)


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Date: 1909-12-05
County: Dane
City: Madison
Date: 1926-1-07
Date: 1926-1-08
Date: 1930-7-18
Date: 1867-1947
Date: 1861-1932
Date: 1918-2-06
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The Flint Glass Dining Table features a 0.75" inch thick tempered glass top with reclaimed cast iron base. Hand-laid cast iron press legs and custom machined mounting fixtures formed from salvaged vintage machine parts. Large Table Size: 94.5"L x 39.5"D x 29.5"H Total Weight: 552 pounds
The Sydney Stackable Dining Chair made American walnut veneer, natural finish or dark walnut veneer. Bent plywood, some assembly required.Total Dimensions: 17"L x 19.5"D x 32.25"H Seat Height: 17.5" inchesSeat Depth: 17" inches
The Sydney series stools & chairs are made of American walnut veneered bent plywood for durability. The bent plywood frame is suitable for residential and commercial use. Available in natural walnut or dark walnut. Choose from bar height or counter height.Total Size: 19"L x 20.25"W x 43.25"H inchesSeat: 15.75"D x 28.5"H inchesFootrest Height: 11.75" inches Minor assembly required.


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- ITV Report
Live updates
- ITV Report
Man sought in petrol station robbery
CCTV footage taken at the scene shows the suspect pulling a balaclava over his face moments before the raid.Read the full story ›
Man arrested over death of 16-year-old girl
Nottinghamshire Police have arrested a 23-year old man in connection with the death of a 16-year old girl at an address in Newark.
Officers were called to the address in Pierson Street, Newark at around 12.10am this morning (24 July).
Ambulance crews attended to try to resuscitate the girl who was taken to Nottingham's Queens Medical Centre. She was pronounced dead shortly after arriving at hospital.
The 23-year old man remains in police custody pending further enquiries. The girl's death is currently being treated as unexplained.
Man arrested over death of Newark teenager
A 23-year old man has been arrested in connection with the death of a 16-year old girl in Newark.
Emergency services tried to resuscitate the teenager who was found at a house in Pierson Street in the market town at around 12.10am this morning. She was pronounced dead shortly after arriving at hospital.
A 23-year-old man arrested remains in police custody. The girl's death is being treated as 'unexplained.'
The A614 Old Rufford Road in Nottinghamshire is closed in both directions.
It is due to a crash between B6030 and A6075 Ollerton Road.
Police are currently directing traffic.
- ITV Report
Man charged in Nottinghamshire double stabbing
Forty-year-old Pawel Lupa of Gleneagles Drive in Kirkby-in-Ashfield is due before Magistrates tomorrow.Read the full story ›
- ITV Report
Police warning after nuisance 'Pokemon Go' 999 call
The craze, which has reached fever pitch in the US, has sparked a string of incidents nationally in the past week.Read the full story ›
Historic statutes to be installed at new Nottinghamshire fire station
Nottinghamshire Fire and Rescue Service is set to give a nod to the past as historic items are installed into the new site.
The station, which is due to replace Nottingham's Central Fire Station this September, will welcome items from the old station including two stone statue Lions and a mosaic from the hallway floor.
I think it is a really nice touch that we have been able to bring items of our history to our new home and I am looking forward to seeing these items on show at London Road.
The lions were originally installed in 1940 when the Central Fire Station was built and reflect the continuous on-duty nature that fire crews still work by today by doing 12-hour rotating shifts.
It is the start of a new era for NFRS with the opening of London Road and as we say goodbye to such an iconic station, and building in Nottingham's history, I am proud that we will always be able to recognize our history.
- ITV Report
Pictures: Double stabbing in Nottinghamshire
A woman has died and a man has been taken to hospital after a double stabbing in Nottinghamshire.Read the full story ›
Witness appeal: Woman dies after being stabbed in Nottinghamshire
Police are appealing for witnesses to a disturbance in Kirkby-in-Ashfield in which a woman was stabbed and has subsequently died.
Officers were called to reports of a fight at an address in Gleneagles Drive at around 11pm yesterday.
The victim, believed to be in her 40s, had suffered stab wounds and was attended to by paramedics. She died on the way to hospital.
A 32-year-old man was taken to hospital with stab wounds. His injuries are not believed to be life-threatening.
A 40-year-old man has been arrested on suspicion of murder and is in custody.
Detectives would like to hear from anyone who witnessed or knows anything about the incident. They should call Nottinghamshire Police on 101, quoting incident number 1003 of 16 July.
Driver who caused fatal collision while using mobile phone jailed for five years
A Nottinghamshire woman has been jailed for five years for causing a fatal collision while driving on the M1 motorway in November 2014.
Christy George, 38, from Lime Tree Road in Hucknall was found guilty last month of causing death by dangerous driving, causing serious injury by dangerous driving and perverting the course of justice after a trial at Leicester Crown Court.
During the trial George pleaded guilty to causing death whilst uninsured. She was sentenced on Friday to five years in prison.
The court heard George was travelling to work during the evening of Tuesday 25 November along the southbound carriageway of the M1. During her journey she made calls to a friend and her husband using her mobile telephone.
Eye witnesses described her swerving towards the central reservation and then suddenly applying harsh steering to the left, coming back on to the motorway when her vehicle collided with an HGV.
The impact of the collision resulted in the HGV losing control and crossing over the central reservation where it struck a BMW, travelling in the opposite direction.
The driver of the BMW, Murray Simpson, 48, from London, sustained fatal injuries.
Although people are becoming so used to constantly using their mobile phones they need to be aware that following a collision the police will seek to establish whether a mobile phone or other device was in use and if so whether it was a contributory factor in the collision.
The sensible advice in the Highway Code should be followed if drivers want to remain safe and within the law.