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Objective To explore the characteristics of allied health professionals (AHPs) working with people with disabilities in western New South Wales (NSW). Design A cross-sectional survey was conducted using an online questionnaire. Setting Rural western NSW. Participants AHPs including physiotherapists, speech pathologists, occupational therapists and psychologists (‘therapists’) working with people with disabilities. Main outcome measure AHPs characteristics. Results The majority of respondents were women (94%), with a mean age of 39 years; average time since qualification was 14 years; mean years in current position was 6. Most worked with people with a lifelong disability. Two thirds reported that family ties kept them in rural areas; 71% grew up in a rural/remote area. Most participants (94%) enjoyed the rural lifestyle, and 84% reported opportunities for social interaction as good or very good. Participants with dependent children were less likely to cease working in western NSW within 5 years than those without dependent children (P < 0.05). Conclusions The characteristics of therapists working with people with disabilities in rural NSW were identified. Overall working, but also social conditions and community attachment were important for this group. Understanding the workforce will contribute to policy development to meet increasing demands for therapy services.

Growing number of evidence have reported that exposure to air pollution was associated with unfavourable birth outcomes while increased exposure to green spaces was associated with better birth outcomes. However, the effect of interactions between air pollution and green spaces on pregnancy outcomes remain unclear. Using the data on all the live births recorded in Sydney between 2016 January and 2017 December, we built up multilevel linear and logistic regression models with random intercepts for statistical area level 2 (SA2) to examine the association between residential levels of air pollution (NO2, PM2.5, SO2 and O3) and pregnancy outcomes including birthweight, low birthweight, and preterm birth. This was followed by assessment of potential effect modification by green space quantity by fitting 2-way interaction term between each air pollutants and green space quantity separately. Furthermore, building on the 2-way interaction term, we explored 3-way interactions by adding area level socio-economic status and population density. Higher levels of PM2.5, NO2 and SO2 were statistically significantly associated with decrease in birthweights (p < 0.05) in the adjusted models. We observed statistically significantly association between the lower risks of preterm birth and higher levels of NO2 in the adjusted models (p < 0.05). However, none of the other air pollutants were statistically significantly associated with the odds of low birthweight and preterm birth. In the adjusted models, green space quantity was statistically significantly associated with reduced odds of preterm birth (p < 0.05). The results for birthweights were in the same direction (p < 0.05) however, some of these associations did not remain statistically significant after adjusting the models for air pollution. In general, no associations were found for low birthweight. Statistically significant 2-way interactions between green space quantity and NO2, PM2.5 and SO2 levels indicated that association between moderate levels of NO2, PM2.5 and birthweight weakened in the greener areas (>20 %) especially in the affluent and densely populated areas while the effect of SO2 did not differ consistently across green space levels with benefit of exposure to the greenest areas (>40 %) was evident, yet not statistically significant. Our findings suggest that increasing green spaces in cities may help supporting a healthy start in life by decreasing harms of moderate levels of air pollution. Replication in different contexts and consideration of potentially contrasting results with different types of green space is warranted.

<p>Lack of diet diversity causing micronutrient deficiency is common in developing countries and is gaining attention due to the hidden consequences of impaired physical and cognitive development. This paper describes the propagation of a sustainable perennial kitchen garden (KG) model to address household (HH) diet diversity in Melghat. Nutrient dense plants, comprising of minimum one tree (perennial) and one green leafy vegetable (GLV) were given to participating HHs along with qualitative interventions. Baseline survey was conducted in winter 2011 followed by seasonal surveys over 2 years to record changes in KG practices, dietary intake and childcare practices. Marked increase from 4% at baseline to 95% at endline was seen in the KG maintainance. Increased diversity was seen in all food categories other than cereals and pulses. Variety of GLVs consumed increased over the two winters as well as the 2 summers. However, no change in the quantity of GLV consumed was noted which was attributed to the duration of the study period being insufficient for the trees to grow and provide adequate leaves for consumption. Notably, livelihood component was not promoted and HHs were encouraged to harvest and distribute excess seeds to relatives and neighbours. The study generated huge demand from HHs within the intervention and neighbouring villages. It concludes that a well designed perennial KG along with imparting adequate knowledge can be a sustainable practice to increase diet diversity and GLV intake which would help address micronutrient deficiencies in the community.</p>

HIV prevalence is rising and has been consistently higher among women in Rwanda whereas a decreasing national HIV prevalence rate in the adult population has stabilised since 2005. Factors explaining the increased vulnerability of women to HIV infection are not currently well understood. A statistical mapping at smaller geographic units and the identification of key HIV risk factors are crucial for pragmatic and more efficient interventions. The data used in this study were extracted from the 2010 Rwanda Demographic and Health Survey data for 6952 women. A full Bayesian geo-additive logistic regression model was fitted to data in order to assess the effect of key risk factors and map district-level spatial effects on the risk of HIV infection. The results showed that women who had STIs, concurrent sexual partners in the 12 months prior to the survey, a sex debut at earlier age than 19 years, were living in a woman-headed or high-economic status household were significantly associated with a higher risk of HIV infection. There was a protective effect of high HIV knowledge and perception. Women occupied in agriculture, and those residing in rural areas were also associated with lower risk of being infected. This study provides district-level maps of the variation of HIV infection among women of child-bearing age in Rwanda. The maps highlight areas where women are at a higher risk of infection; the aspect that proximate and distal factors alone could not uncover. There are distinctive geographic patterns, although statistically insignificant, of the risk of HIV infection suggesting potential effectiveness of district specific interventions. The results also suggest that changes in sexual behaviour can yield significant results in controlling HIV infection in Rwanda.

Number of observed and expected number of AE cases by year (1994â 2013) in NHAR for the period 1 January 1994 to 31 December 2013. (DOCX 72 kb)

Background Regular monitoring of HIV patients who are receiving antiretroviral therapy (ART) is required to ensure patient benefits and the long-term effectiveness and sustainability of ART programs. Prompted by WHO recommendations for expansion and decentralization of HIV treatment and care in low and middle income countries, we conducted a systematic review to assess the feasibility of treatment monitoring in these settings. Methods A comprehensive search strategy was developed using a combination of MeSH and free text terms relevant to HIV treatment and care, health service delivery, health service accessibility, decentralization and other relevant terms. Five electronic databases and two conference websites were searched to identify relevant studies conducted in LMICs, published in English between Jan 2006 and Dec 2015. Outcomes of interest included the proportion of patients who received treatment monitoring and health system factors related to monitoring of patients on ART under decentralized HIV service delivery models. Results From 5363 records retrieved, twenty studies were included in the review; all but one was conducted in sub-Saharan African countries. The majority of studies (15/20) had relatively short follow-up duration (≤24 months), and only two studies were specifically designed to assess treatment monitoring practices. The most frequently studied follow-up period was 12 months and a wide range of treatment monitoring coverage was observed. The reported proportions of patients on ART who received CD4 monitoring ranged from very low (6%; N = 2145) to very high (95%; N = 488). The median uptake of viral load monitoring was 86% with studies in program settings reporting coverage as low as 14%. Overall, the longer the follow-up period, the lower the proportion of patients who received regular monitoring tests; and programs in rural areas reported low coverage of laboratory monitoring. Moreover, uptake in the context of research had significantly better where monitoring was done by dedicated research staff. In the absence of point of care (POC) testing, the limited capacity for blood sample transportation between clinic and laboratory and poor quality of nursing staff were identified as a major barrier for treatment monitoring practice. Conclusions There is a paucity of data on the uptake of treatment monitoring, particularly with longer-term follow-up. Wide variation in access to both virological and immunological regular monitoring was observed, with some clinics in well-resourced settings supported by external donors achieving high coverage. The feasibility of treatment monitoring, particularly in decentralized settings of HIV treatment and care may thus be of concern and requires further study. Significant investment in POC diagnostic technologies and, improving the quality of and training for nursing staff is required to ensure effective scale up of ART programs towards the targets of 90-90-90 by the year 2020. Electronic supplementary material The online version of this article (doi:10.1186/s12981-017-0131-5) contains supplementary material, which is available to authorized users.

Background: The aim of this study was to quantify RF-EMF exposure applying a tested protocol of RF-EMF exposure measurements using portable devices with a high sampling rate in different microenvironments of Switzerland, Ethiopia, Nepal, South Africa, Australia and the United States of America. Method: We used portable measurement devices for assessing RF-EMF exposure in 94 outdoor microenvironments and 18 public transport vehicles. The measurements were taken either by walking with a backpack with the devices at the height of the head and a distance of 20–30 cm from the body, or driving a car with the devices mounted on its roof, which was 170–180 cm above the ground. The measurements were taken for about 30 min while walking and about 15–20 min while driving in each microenvironment, with a sampling rate of once every 4 s (ExpoM-RF) and 5 s (EME Spy 201). Results: Mean total RF-EMF exposure in various outdoor microenvironments varied between 0.23 V/m (non-central residential area in Switzerland) and 1.85 V/m (university area in Australia), and across modes of public transport between 0.32 V/m (bus in rural area in Switzerland) and 0.86 V/m (Auto rickshaw in urban area in Nepal). For most outdoor areas the major exposure contribution was from mobile phone base stations. Otherwise broadcasting was dominant. Uplink from mobile phone handsets was generally very small, except in Swiss trains and some Swiss buses. Conclusions: This study demonstrates high RF-EMF variability between the 94 selected microenvironments from all over the world. Exposure levels tended to increase with increasing urbanity. In most microenvironments downlink from mobile phone base stations is the most relevant contributor. Keywords: Radio-frequency electromagnetic fields (RF-EMF), Microenvironment, Uplink, Downlink, Exposure assessment, Mobile phone handset, Mobile phone base station