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Abstract Background Postnatal care exhibits the lowest coverage levels in the obstetric continuum of care. The highest rates of maternal and newborn morbidity and mortality occur within 24 h of birth. Assessment of women in this time period could improve the detection of postpartum complications and maternal outcomes. This study determined the patterns of maternal assessment and the factors associated with postpartum complications. Methods This was a cross-sectional study involving observations of immediate postpartum care provided to women following uncomplicated vaginal births at three health facilities in Mpigi and Butambala districts (Uganda) from November 2020 to January 2021. Data were collected using an observation checklist and a data abstraction form for maternal and newborn social demographic data. The collected data were analyzed using Stata version 14.0. Maternal assessment patterns were summarized as frequencies, and the prevalence of postpartum complications was calculated. Logistic regression analysis was performed at both bivariate and multivariate levels to identify factors associated with developing postpartum complications among these women. Results We observed 263 women receiving care at three health facilities in the immediate postpartum period. The level of maternal assessments was very low at 9/263 (3.4%), 29/263(11%) and 10(3.8%) within the first two hours, at three hours and at the fourth hour, respectively. The prevalence of postpartum complications was 37/263 (14.1%), with 67.6% experiencing postpartum hemorrhage (PPH), 13.5% having perineal tears, and 10.8% having cervical tears. Mothers who did not undergo a postpartum check in the first three hours (p = 0.001), those who were discharged after 24 h (p = 0.038), and those who were transferred to the postpartum ward after two hours (p = 0.001) were more likely to have developed postpartum complications. Conclusion The maternal assessment patterns observed in the population were suboptimal. Women who were not assessed at the third hour and those transferred after two hours to the postnatal ward were more likely to have developed postpartum complications.

Abstract Peatlands in the Canadian boreal forest are being negatively impacted by anthropogenic climate change, the effects of which are expected to worsen. Peatland types and sub‐classes vary in their ecohydrological characteristics and are expected to have different responses to climate change. Large‐scale modelling frameworks such as the Canadian Model for Peatlands, the Canadian Fire Behaviour Prediction System and the Canadian Land Data Assimilation System require peatland maps including information on sub‐types and vegetation as critical inputs. Additionally, peatland class and vegetation height are critical variables for wildlife habitat management and are related to the carbon cycle and wildfire fuel loading. This research aimed to create a map of peatland sub‐classes (bog, poor fen, rich fen permafrost peat complex) for the Canadian boreal forest and create an inventory of peatland vegetation height characteristics using ICESat‐2. A three‐stage hierarchical classification framework was developed to map peatland sub‐classes within the Canadian boreal forest circa 2020. Training and validation data consisted of peatland locations derived from various sources (field data, aerial photo interpretation, measurements documented in literature). A combination of multispectral data, L‐band SAR backscatter and C‐Band interferometric SAR coherence, forest structure and ancillary variables was used as model predictors. Ancillary data were used to mask agricultural areas and urban regions and account for regions that may exhibit permafrost. In the first stage of the classification, wetlands, uplands and water were classified with 86.5% accuracy. In the second stage, within the wetland areas only, peatland and mineral wetlands were differentiated with 93.3% accuracy. In the third stage, constrained to only the peatland areas, bogs, rich fens, poor fens and permafrost peat complexes were classified with 71.5% accuracy. Then, ICESat‐2 ATL08 spaceborne lidar data were used to describe regional variations in peatland vegetation height characteristics and regional and class‐wise variations based on a boreal forest wide sample. This research introduced a comprehensive large‐scale peatland sub‐class mapping framework for the Canadian boreal forest, presenting the first moderate resolution map of its kind.

Abstract The 2023 wildfire season in Canada was unprecedented in its scale and intensity, spanning from mid-April to late October and across much of the forested regions of Canada. Here, we summarize the main causes and impacts of this exceptional season. The record-breaking total area burned (~15 Mha) can be attributed to several environmental factors that converged early in the season: early snowmelt, multiannual drought conditions in western Canada, and the rapid transition to drought in eastern Canada. Anthropogenic climate change enabled sustained extreme fire weather conditions, as the mean May–October temperature over Canada in 2023 was 2.2 °C warmer than the 1991–2020 average. The impacts were profound with more than 200 communities evacuated, millions exposed to hazardous air quality from smoke, and unmatched demands on fire-fighting resources. The 2023 wildfire season in Canada not only set new records, but highlights the increasing challenges posed by wildfires in Canada.

Abstract Satellite data are effective for mapping wildfires, particularly in remote locations where monitoring is rare. Geolocated fire detections can be used for enhanced fire management and fire modelling through daily fire progression mapping. Here we present the Canadian Fire Spread Dataset (CFSDS), encompassing interpolated progressions for fires >1,000 ha in Canada from 2002–2021, representing the day-of-burning and 50 environmental covariates for every pixel. Day-of-burning was calculated by ordinary kriging of active fire detections from the Moderate Resolution Imaging Spectroradiometer and the Visible Infrared Imaging Radiometer Suite, enabling a substantial improvement in coverage and resolution over existing datasets. Day of burning at each pixel was used to identify environmental conditions of burning such as daily weather, derived weather metrics, topography, and forest fuels characteristics. This dataset can be used in a broad range of research and management applications, such as retrospective analysis of fire spread, as a benchmark dataset for validating statistical or machine-learning models, and for forecasting the effects of climate change on fire activity.

Background: To emphasize the essence of high-quality care in reducing maternal and neonatal mortality and morbidity, the World Health Organization (WHO) developed standards to support planners. This study describes the structures and care processes that were in place to support perinatal care provided to pregnant women at three district hospitals in Bunyoro region, Uganda using the WHO standards as a benchmark. Methods: A cross-sectional study was conducted using pre-tested structured questionnaires and an observation checklist among 61 facility managers and healthcare providers working in perinatal units. The data were collected on structures that focused on staffing, basic equipment, essential medicines and supplies, diagnostic capacity, and basic amenities. In addition, data were collected on the following processes: Supervision of perinatal care, in-service training for perinatal healthcare providers, transition in care, coordination of care, and continuity of care. Descriptive analysis was used for all the data using the STATA software, version 13. Results: Only 5 out of 18 doctors were designated to perinatal units. Each hospital had only one anesthetic officer. Two out of three of the hospitals did not have vital equipment in their postnatal units nor any communication equipment in all their perinatal units. No maternity unit had a designated waiting space for women in labor. The highest bed density for delivery and maternity beds was 6.6 per 1000 pregnant women. Refresher training was only offered once a year. Receiving units were not notified of the referral. Patient care records were paper-based using papers/exercise books as alternative documentation tools. Medications and laboratory or diagnostic findings were the least documented. Conclusion: There is a shortage of critical human resources, equipment, and delivery and maternity beds. There were gaps in the communication of referrals and documentation of pregnant women’s care. The presence of a robust infrastructure, staffing, equipment, and medicines is critical in the provision of quality care to pregnant women.

Abstract Background Provision of effective care to all women and newborns during the perinatal period is a viable strategy for achieving the Sustainable Development Goal 3 targets on reducing maternal and neonatal mortality. This study examined perinatal care (antenatal, intrapartum, postpartum) and its association with perinatal deaths at three district hospitals in Bunyoro region, Uganda. Methods A cross-sectional study was conducted in which a questionnaire was administered consecutively to 872 postpartum women before discharge who had attended antenatal care and given birth in the study hospitals. Data on care received during antenatal, labour, delivery, and postpartum period, and perinatal outcome were extracted from medical records of the enrolled postnatal women using a pre-tested structured tool. The care received from antenatal to 24 h postpartum period was assessed against the standard protocol of care established by World Health Organization (WHO). Poisson regression was used to assess the association between care received and perinatal death. Results The mean age of the women was 25 years (standard deviation [SD] 5.95). Few women had their blood tested for hemoglobin levels, HIV, and Syphilis (n = 53, 6.1%); had their urine tested for glucose and proteins (n = 27, 3.1%); undertook an ultrasound scan (n = 262, 30%); and had their maternal status assessed (n = 122, 14%) during antenatal care as well as had their uterus assessed for contraction and bleeding during postpartum care (n = 63, 7.2%). There were 19 perinatal deaths, giving a perinatal mortality rate of 22/1,000 births (95% Confidence interval [CI] 8.1–35.5). Of these 9 (47.4%) were stillbirths while the remaining 10 (52.6%) were early neonatal deaths. In the antenatal phase, only fetal examination was significantly associated with perinatal death (adjusted prevalence ratio [aPR] = 0.22, 95% CI 0.1–0.6). No significant association was found between perinatal deaths and care during labour, delivery, and the early postpartum period. Conclusion Women did not receive all the required perinatal care during the perinatal period. Perinatal mortality rate in Bunyoro region remains high, although it’s lower than the national average. The study shows a reduction in the proportion of perinatal deaths for pregnancies where the mother received fetal monitoring. Strategies focused on strengthened fetal status monitoring such as fetal movement counting methods and fetal heart rate monitoring devices during pregnancy need to be devised to reduce the incidence of perinatal deaths. Findings from the study provide valuable information that would support the strengthening of perinatal care services for improved perinatal outcomes.

Abstract Introduction Individualized care planning has been slowly integrated into practice in Uganda with minimal documentation of how the concept is applied in providing care. This study explored the perceptions of midwives about the use of individualized care plans (ICPs) in the provision of immediate postpartum care. Methods An exploratory descriptive qualitative approach was used in this study. We interviewed fifty midwives from 37 health facilities in Uganda's greater Mpigi region. The midwives, who were certificate and diploma holders, were purposively enrolled in the selected facilities. Deductive content analysis was done based on the COM-B model. Results Four themes emerged from the data namely; compatibility, motivation, opportunities, and the midwives’ suggested strategies and targets for improved individualized care planning. The midwives were aware of individualized care planning and they utilized it in their provision of immediate postpartum care especially when assessing clients for risks, preparing clients for referral, caring for Human Immunodeficiency virus (HIV) exposed babies and their mothers, and educating/ supporting first-time mothers (automatic motivation). Having a good nurse-patient relationship, privacy, and ample time to care for the clients were noted as motivators for individualized care plan use, while poor documentation of care, high patient load, and perceived patients’ lack of understanding of the complexities of illness in the immediate postpartum period were the barriers (social opportunity) identified by midwives to the use of individualized care planning. Conclusion There are still capability, motivation, and opportunity hindrances to the use of individualized care planning. Staff recruitment, training, and harmonization of the documentation forms may improve the use of care plans in the postpartum period.

Purpose – Although few studies indicate that financial concerns matter to social entrepreneurs, the literature is unclear about the extent to which a financial motive affects the intention to start a new social enterprise. Moreover, prior research suggests that the intention to start a new enterprise heavily depends on the societal context in which the enterprise operates. Therefore, this study aims to examine the seminal model of social entrepreneurial intention (SEI) developed by Hockerts (2017) in a different social context; additionally, it proposes a new antecedent of SEI – perceived financial security. Design/methodology/approach – This study used two different measurement scales and samples (n = 436 and 241) in a developing country to validate the model and propose a new antecedent, i.e. the perceived financial security, of SEI. Furthermore, the authors employed the partial least square-structural equation model to test the hypotheses. Findings – The results demonstrate that social entrepreneurial self-efficacy, perceived social support and perceived financial security directly predict SEI; they further mediate the relationship between prior experience and SEI. Consequently, the model by Hockerts is extended. Originality/value – This study established perceived financial security as a strong antecedent of SEI, thereby offering a novel insight that a social entrepreneur can be motivated by potential financial concerns.

Abstract Background Life-threatening obstetric complications usually lead to the need for referral and constitute the commonest direct causes of maternal deaths. Urgent management of referrals can potentially lower the maternal mortality rate. We explored the experiences of women referred with obstetric emergencies to Mbarara Regional Referral Hospital (MRRH) in Uganda, in order to identify barriers and facilitating factors. Methods This was an exploratory qualitative study. In-depth interviews (IDIs) were conducted with 10 postnatal women and 2 attendants as key informants. We explored health system and client related factors to understand how these could have facilitated or hindered the referral process. Data was analyzed deductively employing the constructs of the Andersen Healthcare Utilization model. Results Women experienced transport, care delays and inhumane treatment from health care providers (HCPs). The obstetric indications for referral were severe obstructed labor, ruptured uterus, and transverse lie in advanced labor, eclampsia and retained second twin with intrapartum hemorrhage. The secondary reasons for referral included; non-functional operating theatres due to power outages, unsterilized caesarian section instruments, no blood transfusion services, stock outs of emergency drugs, and absenteeism of HCPs to perform surgery. Four (4) themes emerged; enablers, barriers to referral, poor quality of care and poor health facility organization. Most referring health facilities were within a 30–50 km radius from MRRH. Delays to receive emergency obstetric care (EMOC) led to acquisition of in-hospital complications and eventual prolonged hospitalization. Enablers to referral were social support, financial preparation for birth and birth companion’s knowledge of danger signs. Conclusion The experience of obstetric referral for women was largely unpleasant due to delays and poor quality of care which contributed to perinatal mortality and maternal morbidities. Training HCPs in respectful maternity care (RMC) may improve quality of care and foster positive postnatal client experiences. Refresher sessions on obstetric referral procedures for HCPs are suggested. Interventions to improve the functionality of the obstetric referral pathway for rural south-western Uganda should be explored.

Abstract Background Guidelines for clinical practice have been part of the Ministry of health’s efforts to improve the quality of care for over two decades. Their benefits have been documented in Uganda. However, having practice guidelines may not always result in their use in care provision. We explored the midwives’ perceptions towards the ministry of health guidelines for providing immediate postpartum care. Methods An exploratory descriptive qualitative study was conducted in three districts in Uganda from September 2020 to January 2021. In-depth interviews with 50 midwives from 35 health centers and 2 hospitals in Mpigi, Butambala, and Gomba districts were done. Thematic analysis of data was done. Results Three themes emerged; awareness and use of the guidelines, perceived drivers, and perceived barriers to the provision of immediate postpartum care. The subthemes for theme I included; awareness of the guidelines, variations in the postpartum care practices, variations in preparedness to manage women with complications, and varied access to continuing midwifery education. Fear of complications and litigation were the perceived drivers of guideline use. On the other hand, lack of knowledge, busy maternity units, organization of the care, and the midwives’ perceptions about their clients were the barriers to guideline use. Midwives felt that new guidelines and policies regarding immediate postpartum care should be disseminated widely. Conclusion The midwives felt that the guidelines were good for the prevention of postpartum complications but their knowledge of the guidelines for the provision of immediate postpartum care was suboptimal. They desired on-job training and mentorship to help them bridge the knowledge gaps. Variations in patient assessment, monitoring, and pre-discharge care were acknowledged and said to be due to a poor reading culture and health facility factors like patient-midwife ratios, unit setup, and prioritization of labor.

Abstract Background Nearly 60% of maternal and 45% of newborn deaths occur within 24 h after delivery. Immediate postpartum monitoring could avert death from preventable causes including postpartum hemorrhage, and eclampsia among mothers, and birth asphyxia, hypothermia, and sepsis for babies. We aimed at assessing facility readiness for the provision of postpartum care within the immediate postpartum period. Methods A cross-sectional study involving 40 health facilities within the greater Mpigi region, Uganda, was done. An adapted health facility assessment tool was employed in data collection. Data were double-entered into Epi Data version 4.2 and analyzed using STATA version 13 and presented using descriptive statistics. Results Facility readiness for the provision of postpartum care was low (median score 24% (IQR: 18.7, 26.7). Availability, and use of up-to-date, policies, guidelines and written clinical protocols for identifying, monitoring, and managing postpartum care were inconsistent across all levels of care. Lack of or non-functional equipment poses challenges for screening, diagnosing, and treating postnatal emergencies. Frequent stock-outs of essential drugs and supplies, particularly, hydralazine, antibiotics, oxygen, and blood products for transfusions were more common at health centers compared to hospitals. Inadequate human resources and sub-optimal supplies inhibit the proper functioning of health facilities and impact the quality of postpartum care. Overall, private not-for-profit health facilities had higher facility readiness scores. Conclusions Our findings suggest sub-optimal rural health facility readiness to assess, monitor, and manage postpartum emergencies to reduce the risk of preventable maternal/newborn morbidity and mortality. Strengthening health system inputs and supply side factors could improve facility capacity to provide quality postpartum care.

Abstract In the boreal forests of North America, large wildfires often leave residual patches of unburned vegetation, termed fire refugia, which can affect post‐fire ecosystem processes. Although topographic complexity is a major driver of fire refugia in mountainous terrain, refugia in boreal plains are more likely driven by a combination of other bottom‐up controls on fuel configuration as well as top‐down climate controls. In this study, we investigated the role of hydrological, ecological, and topographic heterogeneity, as well as climate moisture patterns, on the presence of fire refugia in forested upland and peatland ecosystems within Alberta's subhumid boreal forests over a 33‐year (1985–2018) period. Generalized linear models were used to model the probability of refugia in forested stands as a function of bottom‐up (vegetation, topography, site moisture, and ecosystem) and top‐down (normal and annual climate moisture deficit) controls. We then developed predictive maps of refugia probability for a range of normal and interannual climate moisture deficit values. We found that forested fens had a probability of refugia that was 64% higher than upland forests, while forested bogs did not differ from forested uplands in refugia likelihood. Climate and physical setting presented the strongest controls on fire refugia in uplands and peatlands, respectively. Increasing amounts of adjacent bogs, but not fens, produced a sixfold increase in refugia probability in uplands, while increasing amounts of adjacent bogs and fens produced roughly two times the refugia probability in forested peatlands. In these upland forest stands, fire refugia probability was negatively related to the interaction between regional climate moisture deficits and interannual deviations from these norms, thus increasing the probability of fire refugia during more severe drought conditions in areas with less arid climates, while decreasing refugia probabilities in drier climates. However, in peatlands themselves, neither regional climate moisture conditions nor the interannual deviations affected refugia. Fire size had a negative effect on fire refugia in all upland‐based models and a positive effect in all peatland‐based models. Our results suggest that large areas of intact peatlands may be capable of promoting fire refugia and thereby slowing climate‐driven, fire‐mediated vegetation transitions in surrounding forest ecosystems.

Teaching entrepreneurship students about failure can help them better cope with business failure and learn from it. This is important given evidence that experienced entrepreneurs are more successful. Entrepreneurship educators raise the concern that teaching students about failure may make them apprehensive about pursuing entrepreneurship. We examine the impact of optimism training on individuals who are learning about business failure (distinguishing between large and small failure) to study the impact of failure on career choice. Using a randomized experiment, we study the underlying mechanism – the feeling of hope – in how failure magnitude impacts an individual's subsequent career choice between wage employment and entrepreneurship. Our findings show that failure magnitude negatively impacts subsequent entrepreneurship career choice by reducing hope. We also find that having an optimistic mind-set moderates this relationship. The negative effect of failure on hope, and subsequent entrepreneurship career choice, is minimized for individuals with an optimistic mind-set. [ABSTRACT FROM AUTHOR]