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Senior female teachers symptoms 6 week pregnancy purchase 100 ml duphalac with mastercard, such as a female headteacher medications during pregnancy chart order duphalac 100 ml with amex, provide powerful role models for getting more girls to perform well at school. Teachers should be helped, wherever possible, to pursue distance education courses to further their own education ("earn and learn"). Teachers who provide good service over a long period of time should be rewarded for their loyalty by promotion to the next level on the refugee incentive scale, that is, seniority should be recognized as a legitimate qualification. Tea provided during the day is an added bonus for keeping up spirits and welcoming visitors. Refugees appreciate outside visitors; they want to learn from them and at the same time they want the visitor to learn about their plight and perhaps spread the information to the wider world. Lessons should be varied; children need to be challenged; teachers should be competent; there should be regular work with prompt feedback; praise; work should be displayed in classroom; counselling should be available when needed; there should be a loving and caring atmosphere in the classroom; the environment should be clean and safe; special care should be provided for children with disabilities; there should be cooperative group work; tests and examinations should take place; house spirit and rivalry should be fostered in inter-house competitions; there should be co-curricular activities, art, music and sports. Refugee children often have greater needs than ordinary children because of the trauma they have been through. But there is clearly much scope for a good refugee programme to motivate refugee children using the above-mentioned methods. On special school occasions, prizes can be awarded to children in front of their parents. Prizes should be awarded to the best girl students, not only to the boys, because this will encourage more girls to improve and will send appropriate gender messages to the boys and community at large. Refugee girls frequently perform less well at school simply because they are given additional household duties at home. We have seen that the Sudanese and Bhutanese refugee communities have played an immense role in both the establishment and on-going management of the refugee education programmes in Uganda and Nepal respectively. It may need to be cultivated, as illustrated in the following example from Pakistan. The main challenge will be to request a reasonable community participation without affecting the quality of education that greatly contributed to the improved access and retention ratios during the last years. Therefore a cautious approach will be necessary as in the case of Balochistan, a province which is already disadvantaged, where to convince and motivate refugees regarding the importance of education took a long time. Participation of the community could be obtained to repair schools and provide labour. This can be achieved through a higher level of community mobilization and outreach programmes. Later they are sustained through follow-up and supervision by the in-school resource teachers who in turn are trained by the office-based resource teachers. In the chapter on quality of education in Education in the refugee-affected areas of Northern Uganda (Sesnan, Brown and Kabba, 1995: 37­43), the section on teachers is the first and by far the largest. Other refugee programmes have also found teachers to be the most important factor for quality. Nine problems were highlighted of which four were concerned with lack of resources (classrooms, furniture, water and teaching materials). The other five problems were all related to teachers (lack of skill using new book, difficulties in teaching French and mathematics, lack of discipline among some teachers, poor attendance of female teachers during pregnancy and heavy workload of teachers). Moreover, in the Somali refugee education programme in Yemen, the following lesson has been learned: "The experience of this programme confirms that although various teaching aids and physical school facilities are of great value, well-trained, dedicated and hard-working teachers are much more important to the success of an education programme" (Gezelius, 1998: 117). The training and support of refugee teachers is therefore of paramount importance for quality education. Davies In a project concept note submitted to the Refugee Education Trust, Robin Shawyer stated: the quality of primary and secondary education available to refugees in east Africa and the Horn is often poor, in large part because of the lack of qualified teachers. Many primary and secondary school teachers in schools attended by refugees need access to training to improve their performance, to reduce the high turnover of teachers, to motivate teachers and students and to develop the skills within the refugee community to meet the continuing educational needs. The lack of trained teachers has an effect on the capacity of the community to develop the skills to become self-reliant (Shawyer, 2000). The importance of teacher training for refugees in east Africa and the Horn has been further confirmed by Sarah Norton-Staal, the Senior Regional Adviser for Refugee Children (7 August 2000, personal communication): I understand that suggestions for proposals are rather urgently requested. I would like to propose, under the priority category of Education, "Enhancing quality of education through teacher training" as a possible project. Lack of female teachers is often noted as a problem and thus females could also be targeted in a teacher training programme.

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Although it affects many fewer women symptoms nicotine withdrawal purchase 100 ml duphalac with amex, cervical cancer is the 13th most common cancer among women in Egypt (Bruni et al medicine x ed discount 100 ml duphalac otc. Early detection is critically important in reducing deaths from both breast and cervical cancer. Women are typically encouraged to begin regular breast self-examinations in their 20s. Breast examinations by a health provider are a more effective mode of detection than breast self-exams (Sankaranarayanan et al. Women are encouraged to have clinical breast examinations every two to three years, beginning in their 20s and annual screening beginning in their 40s. Only 11 percent of women age 15-59 are aware of how to conduct a self-examination to look for signs of breast cancer. Only 6 percent actually had performed breast self-examination in the 12 months prior to the survey. Clinical screening, whether it involved a provider examining the breast or mammography or other clinical screening approaches, is rare. Overall, 2 percent of women age 15-59 said they had ever had any form of clinical screening. In a pap smear, cells are scraped from the cervix and examined under a microscope to detect cell changes that suggest the presence of cancer. Levels of knowledge of the procedure to follow for breast self-examination are generally low in all subgroups. Looking at the age differentials, the proportions who know how to conduct breast self-examination is highest among women 40-44 (17 percent). Women age 40-54 are most likely to have ever had any type of breast examination (11-12 percent). Overall, the highest proportions saying they are aware of how to perform a breast exam were found among women who were working for cash (28 percent), women in the highest wealth category (23 percent), and women with secondary complete or higher education (20 percent). Women in these groups were also most likely to report that they had ever had any type of breast examination (self or clinical). However, even in these groups, the proportion of women who had ever been screened for breast cancer by a health care provider did not exceed 5 percent. One percent or less of women in all subgroups reported that they had ever had a pap smear. Research indicates that caesarean deliveries involve greater risks of morbidity and mortality for both a woman and her baby (American College of Obstetricians and Gynecologists, 2014) so the marked increase in caesarean deliveries over time in Egypt is of considerable concern. Ever-married women age 15-49 who had ever given birth were asked if they had ever had a caesarean delivery. If they reported having a caesarean delivery, they were asked about the number of births they had had that were delivered by a caesarean section and about aspects of the decision-making process prior to the most recent caesarean delivery including when the decision was made to have a caesarean section and the reasons for having the caesarean delivery. Finally, to obtain insights into beliefs that may be contributing to the rise in the rates of caesarean sections, all evermarried women age 15-49 who knew about caesarean deliveries were asked to agree or disagree with statements that are considered common rationales for caesarean deliveries. Background characteristic Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates1 Education No education Some primary Primary complete/ some secondary Secondary complete/ higher Work status Working for cash Not working for cash Wealth quintile Lowest Second Middle Fourth Highest Total 15-49 Number of women 128 681 1,275 1,111 1,003 768 718 1,871 3,814 676 2,836 575 2,261 2,131 599 1,531 43 1,267 433 1,092 2,893 795 4,890 1,074 1,149 1,267 1,143 1,052 5,685 Table 7. Looking at the age differentials, the proportion who ever had a caesarean was higher among women age 20-29 compared with older and younger women. Women in urban areas were more likely to have had a caesarean section than rural women, with the highest rate found in urban Lower Egypt (59 percent). The caesarean delivery level was markedly higher among women in rural Lower Egypt compared with those living in rural Upper Egypt (45 percent and 33 percent, respectively). Around 3 in 10 women who had had a caesarean delivery indicated that the decision was made early in the pregnancy (1-6 months), half said the decision was made later in the pregnancy (7-9 months), while 17 percent indicated the decision was made when the woman was in labor. Not unexpectedly, women who had more than one caesarean delivery were about five times as likely to report the decision to perform a caesarean section was made early in the pregnancy than women who had had only one caesarean section. Overall, around 4 in 10 women said they delivered by caesarean section because they had previously had one or more caesarean deliveries. Over one-third of women who had a caesarean delivery cited problems they experienced during pregnancy as the reason for having the caesarean section. Thirty percent of women mentioned problems during labor while 3 percent said they had a caesarean delivery because of a multiple birth. Finally, a small percentage (3 percent) mentioned that they had requested the caesarean delivery. The results show that almost two-thirds of women agreed with the statement that caesarean deliveries are more risky for the mother than vaginal births.

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Well-functioning community health platforms can serve as vehicles for health information and advocacy and can convene local resources to support successful public health interventions medicine 230 100 ml duphalac with amex. Well-designed and wellimplemented community health platforms can function as the engine in the public health cycle of convening communities to monitor medicine website best duphalac 100ml, review, and act (figure 14. These are functional tasks that are best conducted in a partnership among public health professionals, politicians, and community members. A community that has the ability to engage successfully in the cycle shown in figure 14. In the mid-nineteenth century, functional health departments were established throughout Canada, Europe, and the United States before the development of effective medical care and drove the dramatic decline in mortality in the twentieth century (McKeown, Record, and Turner 1975). However, western governments had largely omitted the creation of functioning local health departments when they formed colonies in the Americas, Africa, and Asia; countries that gained independence in the mid-1900s faced an urgent need to catch up. By the late 20th century, the growing recognition that public health and primary care were lagging became the topic of international concern. Corresponding author: Melissa Sherry, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States; msherry4@jhu. Following the declaration, global health indicators improved despite inadequate adherence to the principles laid out in the declaration. The recent transition from the Millennium Development Goals to the Sustainable Development Goals of the United Nations has renewed attention to strategies that build on local capacity to strengthen community health platforms (Open Working Group of the General Assembly 2014). This chapter presents a brief review of how the public health cycle supports the sustained success of any of the interventions discussed in the Disease Control Priorities volumes. It offers a typology of the stages of development of community health platforms, as well as a framework for assessing their success. The chapter closes with a discussion of investment opportunities for policy makers who are interested in strengthening community health platforms. Background and Historical Context the lack of a clear roadmap to implement community involvement, combined with changes in the global economy, slowed the progress of low- and middle-income countries in achieving the primary health care goals set by Alma-Ata (Lawn and others 2008; Rohde and others 2008). The Cold War fostered a culture of development planning that emphasized interventions that were rapidly deployed and easily measured. Health commodities, such as vaccines, oral rehydration solutions, micronutrients, contraceptives, and antibiotics, became the focus of health care systems (Lawn and others 2008; Perry 2013). The emphasis of global health donors on results and short project cycles made the focus on commodities rather than systems more expedient. The term vertical was used to define projects focused on getting a selected health commodity or service to households in the most expedient way, typically using a stand-alone organization of staff, vehicles, and capital. The term horizontal was used to define initiatives to build more comprehensive institutions of primary care services and for population-level public health. A short-term focus on vertical programs delivering good health at low cost crowded out attention to building long-term horizontal platforms. The World Development Report 1993: Investing in Health (World Bank 1993) offered an excellent listing of population-level public health interventions that could be implemented, but it neglected any discussion of how to make them happen, other than by raising money. This report was novel in that it demonstrated for the first time that international health investments could be justified on the basis of having measureable outcomes and effects. The authors shared aspirations for better policy environments that would be conducive to structural approaches to public health. The lack of a roadmap for creating community health platforms and cross-sectoral action made room for vertical programming to dominate the policy landscape (Lawn and others 2008; Macinko, Starfield, and Erinosho 2009; Rohde and others 2008). These vertical programs saved lives, but they left populations vulnerable by failing to create resilient systems in situ that would marshal local political will and local resources to address the root causes of poor population health. Actions that improve public health are often met with resistance about who will pay for them, because results are often less tangible and urgent than medical interventions. Further, public health actions often threaten the livelihoods of industries and occupations whose harmful aspects are regulated. Examples of public health actions range from the need to pay for sewers and waterworks to the need to enact and enforce restrictions on tobacco, food labeling, and road safety.

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Local Conditions and the Influence of Classroom Tools symptoms ms women generic 100 ml duphalac with mastercard, Rules medications covered by medicare trusted duphalac 100ml, and Pedagogy," Review of Educational Research, 64(1): 119-157. Improving Educational Quality Project, Center for International Research, American Institutes of Research: Washington, D. Schools Count: World Bank Project Designs and the Quality of Education in Sub-Saharan Africa. Planning the Quality of Education: the Collection and Use of Data for Informed Decision-making. The Bhutanese example was chosen because of its comparatively high-quality education. Using the lessons learned from the Bhutanese case study and elsewhere, do-able solutions for improving the quality of education and the attainment of refugee students are sought which could be applicable to refugee situations in other parts of the developing world. A conceptual framework is set up in which the various components of quality are examined ­ actors, tools, environment and outcomes. The actors are further divided into a pyramidal framework with the refugee community at the base, the pupils and teachers in the middle and the programme managers at the apex. Environment is isolated as a separate category because of the unique situation which refugees suffer. It is necessary to look at the broad picture ­ classroom, school, camp, programme, context ­ because recommendations are needed for the programme managers so that they can help to improve the quality of education for refugee children in the classroom and raise the educational attainments of refugees. It is found that the strengths of the Bhutanese programme, such as positive attitudes, the importance given to the teacher and good organization, are often under the control of the various local actors involved, whereas the weaknesses, such as the refugee situation itself, decreasing funding and the lack of further education opportunities, are more likely to be beyond their control. This points a way to improving quality realistically ­ the local actors should focus on strengths rather than weaknesses and maximize the use of available resources. It is suggested that actors in other refugee localities learn from the Bhutanese case study by building on such strengths as motivation and cooperation, teacher training and support, and cost-effective approaches. Special thanks go to Brother Mike Foley, Myriam Houtart, Susanne Kindler-Adam, Helmut Langschwert, Sister Maureen Lohrey, Sister Lolin Menendez, Sarah Norton-Staal, Barry Sesnan, Robin Shawyer, Margaret Sinclair, Chris Talbot and Hans Thoolen. He is grateful to the Bhutanese Refugee Education Programme and Field Director Fr P. Amalraj for their assistance and cooperation during his field trip in Nepal, without which he could not have produced this paper. Most especially, he is grateful to all the refugees he has worked with, in both Uganda and Nepal, for their inspiring example. Further research should be promoted on more specific issues of quality, especially at the classroom level, to find practical ways of dealing with the reality of enormous refugee schools and large classes in situations of stress and limited funding. Sinclair (2001) has considered emergency education with special focus on early emergencies, which characterize the situation at the beginning of a refugee crisis. Naumowicz Gustafson (2000) has considered education for repatriation, which represents the situation at the end of a refugee crisis. The present paper considers education in those indefinite situations in between, which can go on for many years and where "formal" schools are set up in the refugee camps or settlements. The present study is restricted to developing countries (where governments can barely afford education for their own citizens, let alone for refugees). The quality of education given to refugees in these circumstances is often very deficient, with resulting poor standards achieved. The results for the 1998 Burundian National Examination were received during the reporting period. The general performance of the primary schools was very poor due to lack of textbooks and qualified teachers. Other problems reported were poor conditions of the schools, the environment and funding. Both quality and quantity are on diminishing scales, as most camp schools are unattractive to trained teachers, and conditions for economic survival of students are diminished. From the funding available, we hardly succeed to supply the programme with teaching and learning materials, uniforms and furniture. Nobody will believe that refugee children in Aru have never seen a globe of the earth. Unless the international community provides the funds to integrate Liberians into the Guinean school system, more than 10,000 Liberian children and adolescents will be without any educational prospects after next month (Refugees International, 2000).

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