29 research outputs found
Information needs and study behaviour of non- traditional students with particular reference to university libraries in Kenya
No full textThe purpose of the study was to investigate the information needs and study behaviour of nontraditional university students, university libraries' role in information provision, how it impacts on the academic development of the students, challenges they face and make recommendations on how the university libraries can improve the situation. The non-traditional students face many challenges that include lack of adequate time to study, communication breakdowns, inadequate information resources, lack of support from their employers or sponsors, family commitments and shortage of trained library personnel. Meeting the needs of non-traditional students by the university libraries is essential to the social role of the library. These can only be achieved if university libraries adequately revamp and organize library and information services in recognition of their growing user needs, which include access of information in the comfort of their locations; whenever and wherever they are. Data was collected from the existing sources which included both print and electronic media as well as utilizing the author's professional experience. The study recommended that proper planning for non-traditional students need to be done with the urgency it deserves in line with their growing demand for library and information services across universities. The planning should be done in a way that the traditional students should not have undue advantage over the non-traditional ones
Why liberalization alone has not improved agricultural productivity in Zambia : the role of asset ownership and working capital constraints
No full textThe authors use a large panel data set from Zambia to examine factors that could explain the relatively lackluster performance of the country's agricultural sector after liberalization. Zambia's liberalization significantly opened the economy but failed to alter the structure of productionor help realize efficiency gains. They reach two main conclusions. First, not owning productive assets (in Zambia, draft animals and implements) limits improvements in agricultural productivity and household welfare. Owning oxen increases income directly, allows farmers to till their fields efficiently when rain is delayed, increases the area cultivated, and improves access to credit and fertilizer markets. Second, the authors reject the hypothesis that the application of fertilizer is unprofitable because of high input prices. Rather, fertilizer use appears to have declined because of constraints on supplies, which government intervention exacerbated instead of alleviating. (Extending the use of fertilizer to the many producers not currently using it would be profitable, but increasing the amount applied by the few producers who now have access to it would not be.) Policies to foster accumulation of the assets needed for agricultural production (including draft animals and implements) and to provide complementary public goods (education, credit, and good agricultural extension services) could greatly help reduce poverty and improve productivity.Economic Theory&Research,Environmental Economics&Policies,Labor Policies,Banks&Banking Reform,Agricultural Knowledge&Information Systems,Environmental Economics&Policies,Economic Theory&Research,Banks&Banking Reform,Agricultural Knowledge&Information Systems,Agricultural Research
Digital CXR with computer aided diagnosis versus symptom screen to define presumptive tuberculosis among household contacts and impact on tuberculosis diagnosis.
No full textBACKGROUND: Household (HH) contact tracing is a strategy that targets high risk groups for TB. Symptom based screening is the standard used to identify HH contacts at risk for TB during HH contact tracing for TB. However, this strategy may be limited due to poor performance in predicting TB. The objective of this study was to compare CXR with Computer Aided Diagnosis (CAD) against symptom screen for defining presumptive TB and how TB detection changes with each method. METHODS: Household contacts of consecutive index bacteriologically confirmed TB cases were visited by study teams and given TB/HIV education to raise awareness of the risk of TB following close contact with a TB patient. Contacts were encouraged to visit the health facility for screening; where symptoms history was obtained and opt out HIV testing was provided as part of the screening process. CXR was offered to all regardless of symptoms, followed by definitive sputum test with either Xpert MTB RIF or smear microscopy. RESULTS: Among 919 HH contacts that presented for screening, 865 were screened with CXR and 464 (53.6%) had an abnormal CXR and the rest had a normal CXR. Among 444 HH contacts with valid sputum results, 274 (61.7%) were symptom screen positive and 255 (57.4%) had an abnormal CXR. Overall, TB was diagnosed in 32/444 (7.2%); 13 bacteriologically unconfirmed and 19 bacteriologically confirmed. Of 19 bacteriologically confirmed TB 8 (42.1%) were symptom screen negative contacts with an abnormal CXR and these 6/8 (75.0%) were HIV positive. Among the 13 bacteriologically unconfirmed TB cases, 7 (53.8%) were HIV positive and all had an abnormal CXR. CONCLUSION: Symptom screen if used alone with follow on definitive TB testing only for symptom screen positive individuals would have missed eight of the 19 confirmed TB cases detected in this study. There is need to consider use of other screening strategies apart from symptom screen alone for optimal rule out of TB especially in HIV positive individuals that are at greatest risk of TB and present atypically
DISCORDANT RESULTS BETWEEN GENOTYPIC ASSAYS (XPERT MTB/RIF AND HAIN MTBDRPLUS) AND BACTEC MGIT 960 SYSTEM FOR DETECTION OF RIFAMPICIN-RESISTANT<i>MYCOBACTERIUM TUBERCULOSIS</i>ISOLATES IN ZAMBIA
No full textThe sensitivity and specificity of using a computer aided diagnosis program for automatically scoring chest X-rays of presumptive TB patients compared with Xpert MTB/RIF in Lusaka Zambia.
No full textOBJECTIVE: To determine the sensitivity and specificity of a Computer Aided Diagnosis (CAD) program for scoring chest x-rays (CXRs) of presumptive tuberculosis (TB) patients compared to Xpert MTB/RIF (Xpert). METHOD: Consecutive presumptive TB patients with a cough of any duration were offered digital CXR, and opt out HIV testing. CXRs were electronically scored as normal (CAD score ≤ 60) or abnormal (CAD score > 60) using a CAD program. All patients regardless of CAD score were requested to submit a spot sputum sample for testing with Xpert and a spot and morning sample for testing with LED Fluorescence Microscopy-(FM). RESULTS: Of 350 patients with evaluable data, 291 (83.1%) had an abnormal CXR score by CAD. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CXR compared to Xpert were 100% (95%CI 96.2-100), 23.2% (95%CI 18.2-28.9), 33.0% (95%CI 27.6-38.7) and 100% (95% 93.9-100), respectively. The area under the receiver operator curve (AUC) for CAD was 0.71 (95%CI 0.66-0.77). CXR abnormality correlated with smear grade (r = 0.30, p<0.0001) and with Xpert CT(r = 0.37, p<0.0001). CONCLUSIONS: To our knowledge this is the first time that a CAD program for TB has been successfully tested in a real world setting. The study shows that the CAD program had high sensitivity but low specificity and PPV. The use of CAD with digital CXR has the potential to increase the use and availability of chest radiography in screening for TB where trained human resources are scarce
Implementation Research to Inform the Use of Xpert MTB/RIF in Primary Health Care Facilities in High TB and HIV Settings in Resource Constrained Settings.
No full textBACKGROUND: The current cost of Xpert MTB RIF (Xpert) consumables is such that algorithms are needed to select which patients to prioritise for testing with Xpert. OBJECTIVE: To evaluate two algorithms for prioritisation of Xpert in primary health care settings in a high TB and HIV burden setting. METHOD: Consecutive, presumptive TB patients with a cough of any duration were offered either Xpert or Fluorescence microscopy (FM) test depending on their CXR score or HIV status. In one facility, sputa from patients with an abnormal CXR were tested with Xpert and those with a normal CXR were tested with FM ("CXR algorithm"). CXR was scored automatically using a Computer Aided Diagnosis (CAD) program. In the other facility, patients who were HIV positive were tested using Xpert and those who were HIV negative were tested with FM ("HIV algorithm"). RESULTS: Of 9482 individuals pre-screened with CXR, Xpert detected TB in 2090/6568 (31.8%) with an abnormal CXR, and FM was AFB positive in 8/2455 (0.3%) with a normal CXR. Of 4444 pre-screened with HIV, Xpert detected TB in 508/2265 (22.4%) HIV positive and FM was AFB positive in 212/1920 (11.0%) in HIV negative individuals. The notification rate of new bacteriologically confirmed TB increased; from 366 to 620/ 100,000/yr and from 145 to 261/100,000/yr at the CXR and HIV algorithm sites respectively. The median time to starting TB treatment at the CXR site compared to the HIV algorithm site was; 1(IQR 1-3 days) and 3 (2-5 days) (p<0.0001) respectively. CONCLUSION: Use of Xpert in a resource-limited setting at primary care level in conjunction with pre-screening tests reduced the number of Xpert tests performed. The routine use of Xpert resulted in additional cases of confirmed TB patients starting treatment. However, there was no increase in absolute numbers of patients starting TB treatment. Same day diagnosis and treatment commencement was achieved for both bacteriologically confirmed and empirically diagnosed patients where Xpert was used in conjunction with CXR
Distinguishing between types of data and methods of collecting them
No full textThe author examines the role of different data collection methods--including the types of data they produce--in the analysis of social phenomena in developing countries. He points out that one confusing factor in the"quantitative-qualitative"debate is that a distinction is not clearly made between methods of data collection used and types of data generated. He maintains the divide between quantitative and qualitative types of data but analyzes methods according to their"contextuality": the degree to which they try to understand human behavior in the social, cultural, economic, and political environment of a given place. He emphasizes that it is most fruitful to think of both methods and data as lying on a continuum stretching from more to less contextual methodology and from more to less qualitative data output. Using characteristic information needs for health planning derived from data on the use of health services, he shows that each combination of method (more or less contextual) and data (more or less qualitative) is a unique primary source that can fulfill different information requirements. He concludes that: 1) Certain information about health utilization can be obtained only through contextual methods--in which case strict statistical representability must give way to inductive conclusions, assessments of internal validity, and replicability of results. 2) Often contextual methods are needed to design appropriate noncontextual data collection tools. 3) Even where noncontextual data collection methods are needed, contextual methods can play an important role in assessing the validity of the results at the local level. 4) In cases where different data collection methods can be used to probe general results, the methods can--and need to be--formally linked.Early Child and Children's Health,Health Monitoring&Evaluation,Health Systems Development&Reform,Housing&Human Habitats,Public Health Promotion,Health Monitoring&Evaluation,Poverty Assessment,ICT Policy and Strategies,Health Systems Development&Reform,Scientific Research&Science Parks
The Effect of HIV on the Association of Hyperglycaemia and Active Tuberculosis in Zambia, a Case–Control Study
No full textAbstract Objectives To determine if HIV modifies the association between hyperglycaemia and active tuberculosis in Lusaka, Zambia. Methods A case–control study among newly—diagnosed adult tuberculosis cases and population controls in three areas of Lusaka. Hyperglycaemia is determined by random blood glucose (RBG) concentration measured at the time of recruitment; active tuberculosis disease by clinical diagnosis, and HIV status by serological result. Multivariable logistic regression is used to explore the primary association and effect modification by HIV. Results The prevalence of RBG concentration ≥ 11.1 mmol/L among 3843 tuberculosis cases was 1.4% and among 6977 controls was 1.5%. Overall, the adjusted odds ratio of active tuberculosis was 1.60 (95% CI 0.91–2.82) comparing those with RBG concentration ≥ 11.1– < 11.1 mmol/L. The corresponding adjusted odds ratio among those with and without HIV was 5.47 (95% CI 1.29–23.21) and 1.17 (95% CI 0.61–2.27) respectively; p-value for effect modification by HIV = 0.042. On subgroup analysis, the adjusted odds ratio of smear/Xpert-positive tuberculosis was 2.97 (95% CI 1.49–5.90) comparing RBG concentration ≥ 11.1– < 11.1 mmol/L. Conclusions Overall, no evidence of association between hyperglycaemia and active tuberculosis was found, though among those with HIV and/or smear/Xpert-positive tuberculosis there was evidence of association. Differentiation of hyperglycaemia caused by diabetes mellitus and stress-induced hyperglycaemia secondary to tuberculosis infection is important for a better understanding of these findings
Diagnosis of rifampicin-resistant tuberculosis: Discordant results by diagnostic methods.
No full textThe performance of the Xpert© MTB/RIF and MTBDRplus assays for the detection of rifampicin resistant Mycobacterium tuberculosis was compared to culture-based drug susceptibility testing in 30 specimens with rifampicin-resistant and rifampicin-indeterminate Xpert MTB/RIF results collected between March 2012 and March 2014. Xpert MTB/RIF and MTBDRplus were 100% sensitive and 100% concordant for rifampicin resistance detection, but 3 of 13 samples (23%) positive for rifampicin resistance on Xpert MTB/RIF and MTBDRplus were negative for rifampicin resistance on mycobacteria growth indicator tube drug susceptibility testing. Specificity was 72% for Xpert MTB/RIF and 80% for MTBDRplus. Positive predictive value for Xpert MTB/RIF for multidrug resistant tuberculosis was 47.8% for new patients and 77.8% for previously treated patients; negative predictive value was 100% for both new and previously treated patients. The discordant rifampicin resistance test results indicate a need to fully characterise circulating rifampicin resistant Mycobacterium tuberculosis strains in Zambia and to inform the development of guidelines for decision-making in relation to diagnosis of drug-resistant tuberculosis
Simulated algorithm, combined HIV and CXR algorithm.
No full text<p>Simulated algorithm, combined HIV and CXR algorithm.</p
