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Why do tuberculosis patients default in Tashkent City, Uzbekistan? A qualitative study
No full textBACKGROUND: Tuberculosis (TB) control in Tashkent City, Uzbekistan, is organised in accordance with the DOTS strategy. Intensive phase treatment is provided in hospital, while the continuation phase is given on an ambulatory basis. In 2005, the defaulter rate was 21%. An earlier quantitative study explored when patients default and identified some of the risk factors associated with default, but did not answer the question: 'Why do patients default?' OBJECTIVE: To investigate reasons for defaulting and to identify possible solutions. METHODS: We conducted a qualitative follow-up study consisting of 32 in-depth interviews with defaulters, patients who had completed treatment and health care providers. RESULTS: Communication between patients and health care staff is poor. Patients lack proper information on TB and its treatment. There is a widespread belief that TB is not curable. Hospitalisation is problematic due to poor general conditions in TB hospitals, costs incurred by patients during hospitalisation and because TB patients need to earn a living or take care of their families. CONCLUSION: Poor communication between health care staff and TB patients is a key issue underlying several of the causes of default identified, and needs to be addressed. Reducing the period of hospitalisation may also improve adherence to TB treatmen
Spatial analysis of Leishmania donovani exposure in humans and domestic animals in a recent kala azar focus in Nepal
No full textSUMMARY Visceral leishmaniasis (VL) is a major public health problem in the Indian subcontinent where the Leishmania donovani transmission cycle is described as anthroponotic. However, the role of animals (in particular domestic animals) in the persistence and expansion of VL is still a matter of debate. We combined Direct Agglutination Test (DAT) results in humans and domestic animals with Geographic Information System technology (i.e. extraction maps and scan statistic) to evaluate the exposure to L. donovani on these 2 populations in a recent VL focus in Nepal. A Poisson regression model was used to assess the risk of infection in humans associated with, among other factors, the proportion of DAT-positive animals in the proximities of the household. The serological results showed that both humans and domestic animals were exposed to L. donovani. DAT-positive animals and humans were spatially clustered. The presence of serologically positive goats (IRR=9.71), past VL cases (IRR=2.62) and the proximity to a forest island dividing the study area (IRR=3.67) increased the risk of being DAT-positive in humans. Even if they are not a reservoir, domestic animals, and specially goats, may play a role in the distribution of L. donovani, in particular in this new VL focu
Comparison between active and passive surveillance within the Network of Epidemiological Surveillance of Animal Diseases in Chad
No full textA comparative study between passive and active surveillance based on herd visits (villages) was conducted over a period of 24 months. It included 106 surveillance stations of the animal disease epidemiological surveillance network in Chad distributed randomly into 52 stations of active surveillance and 54 stations of passive surveillance. Nine diseases of various vaccination and expected prevalence status were monitored. The active surveillance stations carried out four herd visits monthly to look for the diseases under surveillance and organised four farmers awareness-raising meetings to stimulate them to make disease notifications. The passive surveillance stations held each month four farmer awareness-raising meetings. The suspicions recorded by the stations were consigned to a suspicion form specific to each disease, indicating whether a call from the farmer, a visit to the herd or a awareness-raising meeting was the source. The results showed that, irrespective of surveillance type, all diseases under surveillance, except the rare diseases (Rinderpest and Rift Valley fever) were reported by the surveillance agents. However, suspicions recorded following farmer calls are significantly more important than suspicions carried out during herd visits or meetings. Nevertheless, a considerable number of suspicions is recorded during awareness-raising meetings. Finally approximately 83% of the herd visits realised by the active surveillance stations showed negative results (no suspicion identified). Passive surveillance stimulated by awareness-raising meetings appears to be better adapted to Chads conditions and less expensive for the surveillance of existing diseases. However, for the rare diseases, other methods of specific active surveillance (such as for example sentinel herds) remain important to complete passive surveillance
Evaluation of a U.S. evidence-based parenting intervention in rural western Kenya: from Parents Matter! to Families Matter!
No full textWe evaluated Families Matter! Program (FMP), an intervention designed to improve parent-child communication about sexual risk reduction and parenting skills. Parents of 10- to 12-year-olds were recruited in western Kenya. We aimed to assess community acceptability and FMP's effect on parenting practices and effective parent-child communication. Data were collected from parents and their children at baseline and 1 year postintervention. The intervention's effect was measured on six parenting and parent-child communication composite scores reported separately for parents and children. Of 375 parents, 351 (94%) attended all five intervention sessions. Parents' attitudes regarding sexuality education changed positively. Five of the six composite parenting scores reported by parents, and six of six reported by children, increased significantly at 1 year postintervention. Through careful adaptation of this U.S. intervention, FMP was well accepted in rural Kenya and enhanced parenting skills and parent-child sexuality communication. Parents are in a unique position to deliver primary prevention to youth before their sexual debut as shown in this Kenyan progra
Evaluation of a "pan" FRET real-time PCR test for the discrimination of Theileria spcies in cattle and Africna buffalo (Syncerus caffer)
No full textFinancing the Millennium Development Goals for health and beyond: sustaining the 'Big Push'
No full textBody weight changes and clinical outcome in adults on antiretroviral therapy in countries with limited resources
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Motivaçao e satisfaçao com o trabalho e o impactor da epidemia da infecçao por VIH em profissionais de saúde na provincía de Tete, Moçambique
No full textThis study intended to assess the level of motivation and degree of satisfaction of public sector health professionals from Tete Province before the introduction, in a pilot multi-institutional initiative, of a set of incentives. So, in February of 2008, using criteria of convenience and accessibility, several Health Units were visited in different areas (urban and rural) of Tete Province, namely: Tete City, Changara, Moatize, Ang¢nia and Songo. Forty two health workers participated in this study, filling first individual questionnaires (anonymous) and subsequently participating in a focus group (total of seven). The questionnaire included a mix of closed and open-ended questions for the purpose of assessing health professionals' level of motivation and satisfaction. The data obtained through the questionnaires were summarized to facilitate their posterior coding and insertion in a database to allow a statistical descriptive analysis. The content of the focus group was analysed searching for trends and/or patterns of opinions, experiences, ideas or perceptions expressed by the participants. In a general way, workers are motivated for their jobs and satisfied with their supervisors ("bosses"), their colleagues and with their employer. Meanwhile, the study also shows the existence of some dissatisfaction related to the current process of career promotion and progression, and to the present salaries and package of subsidies and incentives
