1,722,249 research outputs found
Criteria-Based Audit on Management of Eclampsia Patients at a Tertiary Hospital in Dar es Salaam, Tanzania.
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Criteria-based audits have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the introduction of a criteria-based audit in a tertiary hospital in an African setting, assesses the quality of care among eclampsia patients and discusses possible interventions in order to improve the quality of care. We conducted a criteria based audit of 389 eclampsia patients admitted to Muhimbili National Hospital (MNH), Dar es Salaam Tanzania between April 14, 2006 and December 31, 2006. Cases were assessed using evidence-based criteria for appropriate care. Antepartum, intrapartum and postpartum eclampsia constituted 47%, 41% and 12% of the eclampsia cases respectively. Antepartum eclampsia was mostly (73%) preterm whereas the majority (71%) of postpartum eclampsia cases ware at term. The case fatality rate for eclampsia was 7.7%. Medical histories were incomplete, the majority (75%) of management plans were not reviewed by specialists in obstetrics, specialist doctors live far from the hospital and do not spend nights in hospital even when they are on duty, monitoring of patients on magnesium sulphate was inadequate, and important biochemical tests were not routinely done. Two thirds of the patient scheduled for caesarean section did not undergo surgery within agreed time. Potential areas for further improvement in quality of emergency care for eclampsia relate to standardizing management guidelines, greater involvement of specialists in the management of eclampsia and continued medical education on current management of eclampsia for junior staff.\u
Community-Based Environmental Management for Malaria Control: Evidence from a small-scale intervention in Dar es Salaam, Tanzania.
Full text linkHistorically, environmental management has brought important achievements in malaria control and overall improvements of health conditions. Currently, however, implementation is often considered not to be cost-effective. A community-based environmental management for malaria control was conducted in Dar es Salaam between 2005 and 2007. After community sensitization, two drains were cleaned followed by maintenance. This paper assessed the impact of the intervention on community awareness, prevalence of malaria infection, and Anopheles larval presence in drains. A survey was conducted in neighbourhoods adjacent to cleaned drains; for comparison, neighbourhoods adjacent to two drains treated with larvicides and two drains under no intervention were also surveyed. Data routinely collected by the Urban Malaria Control Programme were also used. Diverse impacts were evaluated through comparison of means, odds ratios (OR), logistic regression, and time trends calculated by moving averages. Individual awareness of health risks and intervention goals were significantly higher among sensitized neighbourhoods. A reduction in the odds of malaria infection during the post-cleaning period in intervention neighbourhoods was observed when compared to the pre-cleaning period (OR = 0.12, 95% CI 0.05-0.3, p < 0.001). During the post-cleaning period, a higher risk of infection (OR = 1.7, 95% CI 1.1-2.4, p = 0.0069) was observed in neighbourhoods under no intervention compared to intervention ones. Eighteen months after the initial cleaning, one of the drains was still clean due to continued maintenance efforts (it contained no waste materials and the water was flowing at normal velocity). A three-month moving average of the percentage of water habitats in that drain containing pupae and/or Anopheles larvae indicated a decline in larval density. In the other drain, lack of proper resources and local commitment limited success. Although environmental management was historically coordinated by authoritarian/colonial regimes or by industries/corporations, its successful implementation as part of an integrated vector management framework for malaria control under democratic governments can be possible if four conditions are observed: political will and commitment, community sensitization and participation, provision of financial resources for initial cleaning and structural repairs, and inter-sectoral collaboration. Such effort not only is expected to reduce malaria transmission, but has the potential to empower communities, improve health and environmental conditions, and ultimately contribute to poverty alleviation and sustainable development
Spatially aggregated clusters and scattered smaller loci of elevated malaria vector density and human infection prevalence in urban Dar es Salaam, Tanzania
Full text linkBACKGROUND: Malaria transmission, primarily mediated by Anopheles gambiae, persists in Dar es Salaam (DSM) despite high coverage with bed nets, mosquito-proofed housing and larviciding. New or improved vector control strategies are required to eliminate malaria from DSM, but these will only succeed if they are delivered to the minority of locations where residual transmission actually persists. Hotspots of spatially clustered locations with elevated malaria infection prevalence or vector densities were, therefore, mapped across the city in an attempt to provide a basis for targeting supplementary interventions.
METHODS: Two phases of a city-wide population-weighted random sample of cross-sectional household surveys of malaria infections were complemented by two matching phases of geographically overlapping, high-resolution, longitudinal vector density surveys; spanning 2010-2013. Spatial autocorrelations were explored using Moran's I and hotspots were detected using flexible spatial scan statistics.
RESULTS: Seven hotspots of spatially clustered elevated vector density and eight of malaria infection prevalence were detected over both phases. Only a third of vectors were collected in hotspots in phase 1 (30 %) and phase 2 (33 %). Malaria prevalence hotspots accounted for only half of malaria infections detected in phase 1 (55 %) and phase 2 (47 %). Three quarters (76 % in phase 1 and 74 % in phase 2) of survey locations with detectable vector populations were outside of hotspots. Similarly, more than half of locations with higher infection prevalence (>10 %) occurred outside of hotspots (51 % in phase 1 and 54 % in phase 2). Vector proliferation hazard (exposure to An. gambiae) and malaria infection risk were only very loosely associated with each other (Odds ratio (OR) [95 % Confidence Interval (CI)] = 1.56 [0.89, 1.78], P = 0.52)).
CONCLUSION: Many small, scattered loci of local malaria transmission were haphazardly scattered across the city, so interventions targeting only currently identifiable spatially aggregated hotspots will have limited impact. Routine, spatially comprehensive, longitudinal entomological and parasitological surveillance systems, with sufficient sensitivity and spatial resolution to detect these scattered loci, are required to eliminate transmission from this typical African city. Intervention packages targeted to both loci and hotspots of transmission will need to suppress local vector proliferation, treat infected residents and provide vulnerable residents with supplementary protective measures against exposure
Factors Affecting the Implementation of Intermittent Preventive Treatment of Malaria in Pregnancy in Dar es Salaam Health Facilities.
Full text linkTanzania adapted the World Health Organization (WHO) policy of giving two doses of Sulphadoxine- Pyrimethamine (SP) to pregnant women attending Antenatal clinics (ANCs) in order to control malaria in pregnancy. Implementation of IPT policy has been observed to face various challenges making the targeted coverage of 80% too far from being achieved. The main objective of this study was to identify factors affecting the uptake of Intermittent Preventive Treatment of Malaria among pregnant women attending ANCs in Dar-es Salaam region. A cross sectional study was carried out where interviewer guided questionnaires were administered to 302 pregnant women and 25 healthcare workers. The Reproductive and Child Health (RCH) cards of the pregnant women were also inspected for additional information. Focus Group Discussions (FGD) were conducted to the ANC staff and non participatory ANC observations were made using a standardized checklist. The IPT program in Dar es salaam public health facilities has successfully achieved higher coverage for both IPT 1 and IPT 2, (90% and 79.5% respectively).Gestation age appeared to have an influence on knowledge of pregnant women in IPT (p=0.04) and knowledge seem to have a significant relationship with IPT coverage (p= 0.03). Generally there was high knowledge among health care workers and availability of drug for IPT administration was good (92%), the probable reason for high coverage. The IPT program has successfully achieved higher coverage for both IPT 1 and IPT 2. Factors that were observed to influence coverage include knowledge of both healthcare workers and pregnant women, availability of SP and monitoring of IPT services. Knowledge of the pregnant women was found to be generally high and had an influence on the coverage of IPT. Health worker knowledge and attitude on IPTp was found to be high. Improved monitoring of IPT services will enhance copying of the best practice from one health facility to others. There should be continuous efforts that the health care workers are now practicing, probably by providing them with refresher training. More advocacies are needed including creation of clear IEC messages to help the healthcare workers in implementing the program. The IPT program should provide standardized improved IEC messages that will provide well understood information. The study also recommends that a similar study should be conducted in private health facilities to find out if they contribute significantly to the coverage of IPT Dar es salaam region\u
Achieving high coverage of larval-stage mosquito surveillance: challenges for a community-based mosquito control programme in urban Dar es Salaam, Tanzania.
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Preventing malaria by controlling mosquitoes in their larval stages requires regular sensitive monitoring of vector populations and intervention coverage. The study assessed the effectiveness of operational, community-based larval habitat surveillance systems within the Urban Malaria Control Programme (UMCP) in urban Dar es Salaam, Tanzania.\ud
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METHODS\ud
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Cross-sectional surveys were carried out to assess the ability of community-owned resource persons (CORPs) to detect mosquito breeding sites and larvae in areas with and without larviciding. Potential environmental and programmatic determinants of habitat detection coverage and detection sensitivity of mosquito larvae were recorded during guided walks with 64 different CORPs to assess the accuracy of data each had collected the previous day.\ud
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RESULTS\ud
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CORPs reported the presence of 66.2% of all aquatic habitats (1,963/2,965), but only detected Anopheles larvae in 12.6% (29/230) of habitats that contained them. Detection sensitivity was particularly low for late-stage Anopheles (2.7%, 3/111), the most direct programmatic indicator of malaria vector productivity. Whether a CORP found a wet habitat or not was associated with his/her unfamiliarity with the area (Odds Ratio (OR) [95% confidence interval (CI)] = 0.16 [0.130, 0.203], P < 0.001), the habitat type (P < 0.001) or a fence around the compound (OR [95%CI] = 0.50 [0.386, 0.646], P < 0.001). The majority of mosquito larvae (Anophelines 57.8% (133/230) and Culicines 55.9% (461/825) were not reported because their habitats were not found. The only factor affecting detection of Anopheline larvae in habitats that were reported by CORPs was larviciding, which reduced sensitivity (OR [95%CI] = 0.37 [0.142, 0.965], P = 0.042).\ud
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CONCLUSIONS\ud
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Accessibility of habitats in urban settings presents a major challenge because the majority of compounds are fenced for security reasons. Furthermore, CORPs under-reported larvae especially where larvicides were applied. This UMCP system for larval surveillance in cities must be urgently revised to improve access to enclosed compounds and the sensitivity with which habitats are searched for larvae
Guide for task teams on procurement procedures used in social funds
Full text linkSince the creation of the first Social fund 14 years ago in Bolivia, these funds have been developed in more than 40 countries around the world. Over time they have diversified as well to serve as a very useful instrument for human development. The recommendations in this study are based on an analysis of a sample of procurement audits/ex-post reviews of social funds worldwide. The study provides recommendations for improving the procurement process based on these analyses. In addition, the document provides a description of World Bank instruments in the procurement area. These descriptions can serve as a guide to Task Team Leaders throughout the procurement process. Finally, conclusions and recommendations are given to help improve the administration of procurement for Social funds.Community Development and Empowerment,Business in Development,Business Environment,Pharmaceuticals&Pharmacoeconomics,Decentralization
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The role of households in solid waste management in East African capital cities
No full text Solid Management is a concern in East African capital cities. The absence of managing solid waste is a serious problem. An ever bigger concern is the growing quantities of waste that are generatedat households level in informal settlements. In most cases proper safeguard measures are largely ineffective or not in place at all. Moreover, unsafe disposal of waste in the region is coupled with poor hygiene. There is no doubt that East African capital cities need to formulate effective ways to manage their waste. This book is a result of PhD research within the framework of the PROVIDE project funded by INREF and carried out in East African capital cities (Dar es Salaam, Nairobi and Kampala). The work was carried out at the Environmental Policy (ENP) group with professor Gert Spaargaren and Dr. Peter Oosterveer as promotor and co-promotor. The focus of the research was to highlight the role of households in the production and management of domestic solid wastes. </p
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