15 research outputs found
Research needs for an improved primary care response to chronic non-communicable diseases in Africa.
Get PDFWith non-communicable diseases (NCDs) projected to become leading causes of morbidity and mortality in developing countries, research is needed to improve the primary care response, especially in sub-Saharan Africa. This region has a particularly high double burden of communicable diseases and NCDs and the least resources for an effective response. There is a lack of good quality epidemiological data from diverse settings on chronic NCD burden in sub-Saharan Africa, and the approach to primary care of people with chronic NCDs is currently often unstructured. The main primary care research needs are therefore firstly, epidemiological research to document the burden of chronic NCDs, and secondly, health system research to deliver the structured, programmatic, public health approach that has been proposed for the primary care of people with chronic NCDs. Documentation of the burden and trends of chronic NCDs and associated risk factors in different settings and different population groups is needed to enable health system planning for an improved primary care response. Key research issues in implementing the programmatic framework for an improved primary care response are how to (i) integrate screening and prevention within health delivery; (ii) validate the use of standard diagnostic protocols for NCD case-finding among patients presenting to the local health facilities; (iii) improve the procurement and provision of standardised treatment and (iv) develop and implement a data collection system for standardised monitoring and evaluation of patient outcomes. Important research considerations include the following: selection of research sites and the particular NCDs targeted; research methodology; local research capacity; research collaborations; ethical issues; translating research findings into policy and practice and funding. Meeting the research needs for an improved health system response is crucial to deliver effective, affordable and equitable care for the millions of people with chronic NCDs in developing countries in Africa
Sample registration of vital events with verbal autopsy: a renewed commitment to measuring and monitoring vital statistics
Get PDFRegistration of births, recording deaths by age, sex and cause, and calculating mortality levels and differentials are fundamental to evidence-based health policy, monitoring and evaluation. Yet few of the countries with the greatest need for these data have functioning systems to produce them despite legislation providing for the establishment and maintenance of vital registration. Sample vital registration (SVR), when applied in conjunction with validated verbal autopsy, procedures and implemented in a nationally representative sample of population clusters represents an affordable, cost-effective, and sustainable short- and medium-term solution to this problem. SVR complements other information sources by producing age-, sex-, and cause-specific mortality data that are more complete and continuous than those currently available. The tools and methods employed in an SVR system, however, are imperfect and require rigorous validation and continuous quality assurance; sampling strategies for SVR are also still evolving. Nonetheless, interest in establishing SVR is rapidly growing in Africa and Asia. Better systems for reporting and recording data on vital events will be sustainable only if developed hand-in-hand with existing health information strategies at the national and district levels; governance structures; and agendas for social research and development monitoring. If the global community wishes to have mortality measurements 5 or 10 years hence, the foundation stones of SVR must be laid today
Intrahepatic CD8+ lymphocyte trapping during tolerance induction using mushroom derived formulations: A possible role for liver in tolerance induction
No full textAIM: To determine the immunomodulatory effect of Shiitake (a mushroom extract), we tested its effect on liver-mediated immune regulation in a model of immune-mediated colitis. METHODS: Four groups of mice were studied. Colitis was induced by intracolonic instillation of TNBS in groups A and B. Groups A and C were treated daily with Shiitake extract, while groups B and D received bovine serum albumin. Mice were evaluated for development of macroscopic and microscopic. The immune effects of Shiitake were determined by FACS analysis of intra-hepatic and intrasplenic lymphocytes and IFN-¿ ELISPOT assay. RESULTS: Administration of Shiitake resulted in by an increased intrasplenic/intrahepatic CD4/CD8 lymphocyte ratio. These effects were accompanied by a 17% increase in the number of intrahepatic natural killer T (NKT) cells. A similar effect was observed when Shiitake was administered to animals without disease induction. CONCLUSION: Shiitake extract affected livermediated immune regulation by altering the NKT lymphocyte distribution and increasing intrahepatic CD8+ T lymphocyte trapping, thereby leading to alleviation of immune-mediated colitis marked alleviation of colitis, manifested by significant improvement in the macroscopic and microscopic scores, and by reduction in IFN-¿-producing colonies in group A, compared to group B mice (1.5 pfu/mL vs 3.7 pfu/mL, respectively). This beneficial effect was associated with a significant increase in the intrahepatic CD8+ lymphocyte trapping, demonstrate
Verbal autopsy completion rate and factors associated with undetermined cause of death in a rural resource-poor setting of Tanzania.
Get PDFUNLABELLED\ud
\ud
ABSTRACT:\ud
\ud
BACKGROUND\ud
\ud
Verbal autopsy (VA) is a widely used tool to assign probable cause of death in areas with inadequate vital registration systems. Its uses in priority setting and health planning are well documented in sub-Saharan Africa (SSA) and Asia. However, there is a lack of data related to VA processing and completion rates in assigning causes of death in a community. There is also a lack of data on factors associated with undetermined causes of death documented in SSA. There is a need for such information for understanding the gaps in VA processing and better estimating disease burden.\ud
\ud
OBJECTIVE\ud
\ud
The study's intent was to determine the completion rate of VA and factors associated with assigning undetermined causes of death in rural Tanzania.\ud
\ud
METHODS\ud
\ud
A database of deaths reported from the Ifakara Health and Demographic Surveillance System from 2002 to 2007 was used. Completion rates were determined at the following stages of processing: 1) death identified; 2) VA interviews conducted; 3) VA forms submitted to physicians; 4) coding and assigning of cause of death. Logistic regression was used to determine factors associated with deaths coded as "undetermined."\ud
\ud
RESULTS\ud
\ud
The completion rate of VA after identification of death and the VA interview ranged from 83% in 2002 and 89% in 2007. Ninety-four percent of deaths submitted to physicians were assigned a specific cause, with 31% of the causes coded as undetermined. Neonates and child deaths that occurred outside health facilities were associated with a high rate of undetermined classification (33%, odds ratio [OR] = 1.33, 95% confidence interval [CI] (1.05, 1.67), p = 0.016). Respondents reporting high education levels were less likely to be associated with deaths that were classified as undetermined (24%, OR = 0.76, 95% CI (0.60, -0.96), p = 0.023). Being a child of the deceased compared to a partner (husband or wife) was more likely to be associated with undetermined cause of death classification (OR = 1.35, 95% CI (1.04, 1.75), p = 0.023).\ud
\ud
CONCLUSION\ud
\ud
Every year, there is a high completion rate of VA in the initial stages of processing; however, a number of VAs are lost during the processing. Most of the losses occur at the final step, physicians' determination of cause of death. The type of respondent and place of death had a significant effect on final determination of the plausible cause of death. The finding provides some insight into the factors affecting full coverage of verbal autopsy diagnosis and the limitations of causes of death based on VA in SSA. Although physician review is the most commonly used method in ascertaining probable cause of death, we suggest further work needs to be done to address the challenges faced by physicians in interpreting VA forms. There is need for an alternative to or improvement of the methods of physician review
Prostemma (Prostemma) guttula subsp. asiaticum Kerzhner 1968
No full textProstemma (Prostemma) guttula asiaticum Kerzhner, 1968 (Figs. 1, 3, 5–6, 15, 31, 46–47, 63) Material examined. ISRAEL: Har Hermon, Man Valley [Marg' Man, Hermon], faunistics (1 ♀); Bab el Hawa, 2.viii. 1979, P. Amitai (1 ♀), 23.vi. 1981, faunistics (1 ♀); Khushnīya [Golan, Hushnye], 25.xii. 1973 (1 ♀); Nahal 'Iyyon Nature Reserve [haTanur], 21.iii. 1974, D. Furth (1 ♀); Sasa, 7.v. 1976, J. Kugler (1 ♂); Haifa, 4.xii. 1945, H. Bytinski-Salz (1 ♂); Karmel, Hawwat Maqura, 21.i. 1984, E. Shney-Dor (1 ♀); Zikhron Ya'aqov [Zichron Y.], 20.i. 1975 (1 ♂); Gan Shemu`el [Gan-Shmuel], 29.viii. 1971, M. Tintepulver (1 ♀); Nahal Poleg [Wadi Falik], 7.iii. 1962, J. Kugler (1 ♂); Sidna 'Ali Mosque, North to Herzliyya, sea shore [Sidni-Ali], 14.ii. 1972, G. Tsabar (1 ♀); Savyon [Savion], 12.iii. 1982, Y. Zvik (1 ♂), 19.vi. 1982, Y. Zvik (1 ♀); Nahal Peza`el, 17.vii. 1983, Y. Zvik (1 ♀); Tel Aviv, 14.ii. 1945, H. Bytinski-Salz (1 ♀); Ramat Gan, Bar Ilan University [Bar-Ailan], 15.v. 1981, Y. Zvik (1 ♀); Giv'at Koah, 23.ii. 1972, Y. Zvik (1 ♀); Ganne Yehuda [Ganey Yehuda], 21.iii. 1982, Y. Zvik (2 ♀); Holon, 5.iii. 1958, Ch. Levinsohn (1 ♂); 21.ii. 1958 (1 ♂); Bet 'Oved [Beit Oved], 21.ii. 1958, R. Rosin (1 ♂); Ben Shemen, 4.ii. 1984, S. Eliav (1 ♀); Latrun, 20.iii. 1982, E. Shney-Dor (1 ♀); Alon Shevut [Alon-Shvut], 11.xi. 1981, Y. Zvik (1 ♀); 'En Hemed [Aqua Bella], 10.v. 1950, J. Wahrman (1 ♀); Yerushalayim [Jerusalem], 2.ii. 1976, S. Blondheim (1 ♀), 12.v. 1976, P. Amitai (1 ♂), 5.iv. 1989, L. Orlev (1 ♂); Sha'alvim [Sha`albim], 21.ii. 1981, E. Shney-Dor (1 ♂); Qiryat Gat [Kiriat-Gat], 4.v. 1982, Y. Zvik (1 fifth instar); Ziqim, 9.i. 1978, G. Levy (1 ♀). Distribution. Palaearctic. Southern Europe, Mediterranean, Central Asia. General distribution in Israel: Fig. 63. Previous records. Bodenheimer, 1937: 205 (“ Palestine ”, as Prostema guttula (Fabricius)); Linnavuori, 1961: 37 (Zichron), 1973: 48 (Bet Oved); Kerzhner, 1981: 103 (Jerusalem). Biology. This species occurs in dry open areas on the soil surface under rocks and bushes. It was observed feeding on larvae and adults of Sphragisticus nebulosus Fall. (Heteroptera: Lygaeidae), and in the laboratory preferred Alydus calcaratus, Aellopus atratus, Beosus maritimus, and Lygus pratensis (Heteroptera: Lygaeidae), but accepted also flies and beetles (Kerzhner, 1981). Comments. The male genitalia of Prostema guttula in Israeli specimens fit those of the subspecies asiaticum Kerzhner. Paramere laterally smoothly rounded, without any protrusion (Figs. 15–16). Phallus: Fig. 31.Published as part of Novoselsky, T., Freidberg, A., Dorchin, N., Meltzer, N. & Kerzhner, I., 2014, The Nabidae (Hemiptera: Heteroptera) of Israel and the Sinai Peninsula, pp. 471-492 in Zootaxa 3827 (4) on pages 473-476, DOI: 10.11646/zootaxa.3827.4.3, http://zenodo.org/record/22438
Enhancing Survival of Mothers and Their Newborns in Tanzania
Get PDF\ud
\ud
The main purpose of the present studies was to examine the problem of maternal and perinantal mortality in an upcountry region of a low-income country. This was done by estimating the magnitude of maternal and perinatal mortality, both in the hospital and in the community, through elucidating the underlying causes of maternal and perinatal mortality, and by initiating low-cost interventions and monitoring mechanisms in order to enhance the survival of mothers and their newborns, in Kigoma, Tanzania. To utilize all available evidence to register the causes, contributory factors and real magnitude of maternal in a regional hospital as well as to estimate the magnitude of maternal mortality in the community. To formulate low-cost interventions to address the identified contributing factors to maternal mortality and to follow these interventions over time. To perform regular audits of the causes of maternal mortality in order to elucidate avoidance causes. To monitor and adjust the interventions during the study period, while assessing the impact of these interventions. To investigate the suspected causes of obstetric risk knowledge among community members, health workers, and traditional birth attendants. To assess the utilization of the simple “three phases of delay model” in the audit of maternal and perinatal mortality. A retrospective analysis of mortality in the hospital setting utilizing all available evidence was undertaken for three years, 1984-1987. The magnitude, causes and contributory factors to maternal mortality were examined in the in the hospital setting. This led to the formulation of 22 specific, low –cost interventions, which utilized local resources. These interventions were followed-up for a period of 7years. Monitoring was conducted through monthly audit-oriented meetings. Maternal mortality in the in the community being served by the hospital was assessed utilizing the “sisterhood method”, followed by an assessment of perceptions of obstetric risk among community members, health workers and peripheral staff in order to evaluate factors contributing to futher non-reduction of maternal mortality in the hospital. Finally an assessment utilizing the three phases of delay methodology was conducted focusing on the reduction of maternal and perinatal mortality. There was gross underreporting of martenal death in the official statistics (849 against 350 per 100,000 live births, respectively). Major causes were haemorrhage , obstracted labour , infections and rupture of the uterus. Several other associated factors comprised lack of equipment, drug/blood and issues concerning staff and community distrust of the obstetric unit. The application of the 22 specific interventions saw a progressive reduction in the maternal mortality ratio (from 849 to 275 per 100,000 live birth) after the 7-year period (p<0.001). This was despite an increase in the number admissions to the unit (3,000 to 4,296 respectively). Also the fatality rate for the major causes of death was reduced from 9.2 to 3.1%. However, The community assessment undertaken in 2001 revealed the actual MMR at that time to be 447 (urban) and (rural) per 100,000. The result of the assessment in perceptions of obstetric risk revealed low knowledge among the community, staff and traditional birth attendants and that there was distrust in the health system. A final audit using the “ three phases of delay methodology” revealed that the major causes of perinatal and maternal deaths occurred in the health system. Maternal and perinatal mortality can be reduced through low-cost interventions available in most low-resource settings. Regular audit of maternal and perinatal deaths can be undertaken in the these settings. Low-cost methodology. T o be of value audits must be sustained and used as monitoring mechanisms for service delivery improvements and as managerial tools to reduce maternal and perinatal deaths the “three phases of delay model” is a simple and user-friendly method for the audit of both perinatal and maternal deaths. \u
Estimating the prevalence and predictors of musculoskeletal disorders in Tanzania: a cross-sectional pilot study
Get PDFIntroduction: musculoskeletal (MSK) disorders account for approximately 20% of all years lived with disability worldwide however studies of MSK disorders in Africa are scarce. This pilot study aimed to estimate the community-based prevalence of MSK disorders, identify predictors, and assess the associated disability in a Tanzanian population.
Methods: a cross-sectional study was conducted in one village in the Kilimanjaro region from March to June 2019. The Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) examinations were used during household and school visits. Individuals positive in GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and Modified Health Assessment Questionnaire (MHAQ).
Results: among the 1,172 individuals enrolled in households, 95 (8.1%, 95% CI: 6.6 - 9.8) showed signs of MSK disorders using the GALS/pGALS examination and 37 (3.2%, 95% CI: 2.2 - 4.3) using the REMS. Among 682 schools enrolled children, seven showed signs of MSK disorders using the GALS/pGALS examination (1.0%, 95% CI: 0.4 - 2.1) and three using the REMS (0.4%, 95% CI: 0.0 - 1.3). In the household-enrolled adult population, female gender and increasing age were associated with GALS and REMS-positive findings. Among GALS-positive adults, increasing age was associated with REMS-positive status and increasing MHAQ score.
Conclusion: this Tanzanian study demonstrates a prevalence of MSK disorders and identifies predictors of MSK disorders comparable to those seen globally. These findings can inform the development of rheumatology services and interventions in Tanzania and the design of future investigations of the determinants of MSK disorders, and their impacts on health, livelihoods, and well-being
Estimating the prevalence and predictors of musculoskeletal disorders in Tanzania: a cross-sectional pilot study
Get PDFIntroduction
Musculoskeletal (MSK) disorders account for approximately 20% of all years lived with disability worldwide however studies of MSK disorders in Africa are scarce. This pilot study aimed to estimate the community-based prevalence of MSK disorders, identify predictors, and assess the associated disability in a Tanzanian population.
Methods
A cross-sectional study was conducted in one village in the Kilimanjaro region from March to June 2019. The Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) examinations were used during household and school visits. Individuals positive in GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and Modified Health Assessment Questionnaire (MHAQ).
Results
Among the 1,172 individuals enrolled in households, 95 (8.1%, 95% CI: 6.6 - 9.8) showed signs of MSK disorders using the GALS/pGALS examination and 37 (3.2%, 95% CI: 2.2 - 4.3) using the REMS. Among 682 schools enrolled children, seven showed signs of MSK disorders using the GALS/pGALS examination (1.0%, 95% CI: 0.4 - 2.1) and three using the REMS (0.4%, 95% CI: 0.0 - 1.3). In the household-enrolled adult population, female gender and increasing age were associated with GALS and REMS-positive findings. Among GALS-positive adults, increasing age was associated with REMS-positive status and increasing MHAQ score.
Conclusion
This Tanzanian study demonstrates a prevalence of MSK disorders and identifies predictors of MSK disorders comparable to those seen globally. These findings can inform the development of rheumatology services and interventions in Tanzania and the design of future investigations of the determinants of MSK disorders, and their impacts on health, livelihoods, and well-being
Population policies and education: exploring the contradictions of neo-liberal globalisation
Get PDFThe world is increasingly characterised by profound income, health and social inequalities (Appadurai, 2000). In recent decades development initiatives aimed at reducing these inequalities have been situated in a context of increasing globalisation with a dominant neo-liberal economic orthodoxy. This paper argues that neo-liberal globalisation contains inherent contradictions regarding choice and uniformity. This is illustrated in this paper through an exploration of the impact of neo-liberal globalisation on population policies and programmes. The dominant neo-liberal economic ideology that has influenced development over the last few decades has often led to alternative global visions being overlooked. Many current population and development debates are characterised by polarised arguments with strongly opposing aims and views. This raises the challenge of finding alternatives situated in more middle ground that both identify and promote the socially positive elements of neo-liberalism and state intervention, but also to limit their worst excesses within the population field and more broadly. This paper concludes with a discussion outling the positive nature of middle ground and other possible alternatives
Reducing neonatal mortality in rural Ghana: understanding current newborn care practices and their cultural context
Get PDFDramatic improvements have been made in child survival over the last 30 years. However, despite the gains of the child survival revolution, neonatal mortality rates have stagnated as infant and child mortality has decreased. Every year 4 million newborns die before they reach 28 days of life. The Millennium Development Goals urge the reduction of under five mortality (from the 1990 level) by two thirds by the year 2015; this will not be achievable unless there is at least a halving in the number of neonatal deaths, which currently account for 36% of all childhood deaths. Some promising interventions have recently been shown to improve newborn survival through home and community based care and there is considerable interest in whether these can be implemented on a wide scale. They are particularly needed where a large proportion of births take place at home and access to health services is suboptimal. Such interventions depend on understanding sociocultural factors that form the basis for newborn care practices. Research elucidating these factors has recently been identified as a priority in several peer reviewed publications and within the international health community. Although the number of newborn deaths is highest in South Asia, the risk of newborn death is highest in Sub Saharan Africa, with West Africa having the highest rates. The present study critically examined the social, cultural, and behavioural factors that play a role in determining care practices during childbirth and the neonatal period in Kintampo District in rural Ghana. A qualitative, ethnographic, study design was used including participant observation, in-depth interviews, semi- structured interviews, expert interviews, narratives, and group discussions, with grounded theory as the guiding theoretical paradigm. It was carried out in four sites: Kintampo town and three villages, Apesika, Jema, and Kawampe. The study benefited from the ongoing ObaapaVitA Vitamin A maternal mortality trial database. This allowed triangulation of the ethnographic findings through analysis of birth cohort data on all 2,878 singletons born alive to mothers in the trial in Kintampo District within the year July 2003 - June 2004. Available data included: location of birth, presence of an attendant, wrapping and drying after birth, substances applied to the umbilical cord, bathing and early infant feeding practices. Narrative interviews from verbal autopsies conducted through the ObaapaVitA trial were also used to capture information on actual newborn deaths. The study findings are presented separately for the following three domains: Pregnancy and Preparation for Childbirth; Neonatal Care Practices; and Newborn Illness, Death and Care Seeking. These highlight several gaps in current practices where improvements might lead to reductions in neonatal mortality. Lessons learned have also been drawn together, both from the perspective of implications for the design of interventions to reduce neonatal mortality and concerning methodological issues in conducting formative research on newborn care practices
