n/a

The Adaptive Exponentially Weighted Moving Average (AEWMA) control
chart has the advantage of detecting in balance mixed range of mean shifts. Its
performance has been studied under the assumption that the process parameters
are known. Under this assumption, previous studies have shown that AEWMA
provides superior statistical performance when compared to other different types
of control charts. In practice, however, the process parameters are usually
unknown and are required to be estimated. Using a Markov chain approach, it is
shown that the performance of the AEWMA control chart is affected when
parameters are estimated compared with the known parameters case. The effect of
different standard deviation estimators on the chart performance is also
investigated. Finally, a performance comparison is conducted between the EWMA
chart and the AEWMA chart when the process parameters are unknown. We
recommend the use of the AEWMA chart over the ordinary Exponentially
Weighted Moving Average (EWMA) chart especially when a small number of
Phase I samples is available to estimate the unknown parameters.

Background: Postnatal care (PNC) is considered a challenge, fulfilling very important needs of two very vulnerable individuals namely the puerperal woman and the neonate. Improving the service quality provided during this period is considered as the most important intervention for preventing maternal and neonatal morbidity and mortality. However less is known about the utilization of postnatal care. The objectives of the study are to identify the possible predictors characterize women utilizing PNC among rural Egyptian women, assess the quality of PNC services offered women, identify possible barriers contributed to under utilization of PNC services in rural health units and explore the health care providers’ perspectives for enhancing PNC utilization. Methods: The study is an exploratory study that was conducted in 3 randomly selected PHC units in Shebien el Kanater, Qaliobia, Egypt using quantitative data: the total sample size was accounted for 600 women. A structured interview questionnaire was designed to collect data from the mothers regarding socio-demographic data, maternal history, pattern of antenatal care (ANC) / natal care (NC) and pattern of PNC utilization. This interview last for 25 to 30 minutes. Qualitative component: Eight in-depth interviews were conducted with health care providers including Traditional birth attendants and Raeda Riffias (rural health workers/visitors). Eight focus group discussions were also conducted with women who had babies younger than one year. The discussion guide included information about importance of postnatal care, barriers to utilization and suggestions for improvement. Results: the study showed that the Mean age at marriage 19.8±2.9. Only 34.2% of sampled women were examined late within the 40 days following delivery. From neonates, 80% were examined postnatal for the first time at the first month of life. Women who received ANC in their last pregnancy were (80.5%). (81.2%) of women delivered vaginal while only (17.6%) by caesarean section. home deliveries which are still present (15.8%). About 81% delivered at a health facility. More than half of women received PNC home visit only once. Shortages of skilled staff, equipment and supplies maltreatment of HCPs and PHC unit employees, inadequate quality of services provided, crowdedness and absence of standard protocol including all components of PNC services for mothers and their babies were common complaints in the community. In a multivariate logistic regression analysis, the following predictors were significantly associated with the utilization of PNC: Income (P value =0.001), utilization of ANC (P value =0.000) and delivery place (P value =0.02). Conclusion and Recommendations: only 34.2% of women were examined late within the 42 days following delivery. The possible predictors related to PNC utilization were family income, utilization of ANC services and the place of delivery. Fair quality of PNC services offered to babies but on the other hand bad quality of PNC services provided to rural Egyptian women. Raising awareness of mothers by seminars presented by nurses or health visitors discussing importance of PNC services and consequences of not receiving it on both mother and child health. Policymakers should consider delivering PNC services at both health facilities and at home to overcome financial, geographical and cultural barriers during the postnatal period.