2,094 research outputs found
Staff experiences of Providing Maternity Services in Rural Southern Tanzania -- A Focus on Equipment, Drug and Supply Issues.
No full textThe poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse maternal outcomes through delaying care provision. We aim to describe staff experiences of providing maternal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures that carried potential health risks to themselves as a result. Inadequately stocked and equipped facilities compromise the health system's ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions
The silent burden of anaemia in Tanzania children:a community-based study
No full textObjective was to document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old,thereby assisting in the development of effective strategies for controlling anaemia.\ud
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Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern\ud
United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed.\ud
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Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6–11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1–5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron\ud
was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was notassociated with risk of anaemia.\ud
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Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria
Intermittent preventive treatment for malaria in infants: a decision-support tool for sub-Saharan Africa.
No full textOBJECTIVE: To develop a decision-support tool to help policy-makers in sub-Saharan Africa assess whether intermittent preventive treatment in infants (IPTi) would be effective for local malaria control. METHODS: An algorithm for predicting the effect of IPTi was developed using two approaches. First, study data on the age patterns of clinical cases of Plasmodium falciparum malaria, hospital admissions for infection with malaria parasites and malaria-associated death for different levels of malaria transmission intensity and seasonality were used to estimate the percentage of cases of these outcomes that would occur in children aged <10 years targeted by IPTi. Second, a previously developed stochastic mathematical model of IPTi was used to predict the number of cases likely to be averted by implementing IPTi under different epidemiological conditions. The decision-support tool uses the data from these two approaches that are most relevant to the context specified by the user. FINDINGS: Findings from the two approaches indicated that the percentage of cases targeted by IPTi increases with the severity of the malaria outcome and with transmission intensity. The decision-support tool, available on the Internet, provides estimates of the percentage of malaria-associated deaths, hospitalizations and clinical cases that will be targeted by IPTi in a specified context and of the number of these outcomes that could be averted. CONCLUSION: The effectiveness of IPTi varies with malaria transmission intensity and seasonality. Deciding where to implement IPTi must take into account the local epidemiology of malaria. The Internet-based decision-support tool described here predicts the likely effectiveness of IPTi under a wide range of epidemiological conditions
Measuring Access and Practice: Designing a Survey Methodology for the Hygiene, Sanitation and Water Sector
No full textAccess to safe water and sanitary means of excreta disposal are essential elements of
human development and poverty alleviation. It is estimated that one in four people in
the developing world lacks access to water while over half the population has no
access to sanitation. From the Alma-Ata declaration in 1978 to the recent Millennium
Development Goals, efforts to improve this situation have been hampered by the lack
of meaningful indicators to measure hygiene, sanitation and water coverage and
establish progress towards the goals and targets set out by the international
community.
This thesis aims to determine if measuring prevalence of access to water~ sanitation
and the practice of hygienic behaviour in hous~hold surveys can be.improved. With
no indicators available in current international' laws and targets, various aspects of
access and practice were examined to design indicators for field-testing. By using
- existing data sets, the research established that there is a high geographic clustering of
the measures of interest, which results in large design effects (deff) and rates of
homogeneity (roh) in cluster surveys. Based on the calculated roh optimum numbers
ofcluster and sample size were calculated for the field trials. This requires
introducing survey costs in the sample size calculations. The high clustering of water
and sanitation indicator require large sample sizes, resulting in large amounts of data
which organisations in the four field trials in Kosovo, South Africa, Kenya and Laos
found difficult to handle. Practical problems in the implementation of the survey
method resulted in non-sampling errors and could cause reluctance in adoption the
methodology. The research improved water and sanitation indicators but found that
for individual behaviour such as hygiene the household is not a suitable sampling unit.
It also showed that observation among interviewers have to be better standardised to
reduce the inter-surveyor.variation. Representative sampling is the current bottleneck
in the development of such a survey method. Current method requires a good
understanding of sampling theory as well as reliable sample frames, which are rarely
available to implementing organisations. Alternative sampling methods are
suggested, and recommendations are made for the further development ofthe survey
method designed in this research, which to date may be too complex for widespread
use
Effect of home-based counselling on newborn care practices in southern Tanzania one year after implementation : a cluster-randomised controlled trial
No full textIn Sub-Saharan Africa over one million newborns die annually. We developed a sustainable and scalable home-based counselling intervention for delivery by community volunteers in rural southern Tanzania to improve newborn care practices and survival. Here we report the effect on newborn care practices one year after full implementation.; All 132 wards in the 6-district study area were randomised to intervention or comparison groups. Starting in 2010, in intervention areas trained volunteers made home visits during pregnancy and after childbirth to promote recommended newborn care practices including hygiene, breastfeeding and identification and extra care for low birth weight babies. In 2011, in a representative sample of 5,240 households, we asked women who had given birth in the previous year both about counselling visits and their childbirth and newborn care practices.; Four of 14 newborn care practices were more commonly reported in intervention than comparison areas: delaying the baby's first bath by at least six hours (81% versus 68%, OR 2.0 (95% CI 1.2-3.4)), exclusive breastfeeding in the three days after birth (83% versus 71%, OR 1.9 (95% CI 1.3-2.9)), putting nothing on the cord (87% versus 70%, OR 2.8 (95% CI 1.7-4.6)), and, for home births, tying the cord with a clean thread (69% versus 39%, OR 3.4 (95% CI 1.5-7.5)). For other behaviours there was little evidence of differences in reported practices between intervention and comparison areas including childbirth in a health facility or with a skilled attendant, thermal care practices, breastfeeding within an hour of birth and, for home births, the birth attendant having clean hands, cutting the cord with a clean blade and birth preparedness activities.; A home-based counselling strategy using volunteers and designed for scale-up can improve newborn care behaviours in rural communities of southern Tanzania. Further research is needed to evaluate if, and at what cost, these gains will lead to improved newborn survival.; Trial Registration Number NCT01022788 (http://www.clinicaltrials.gov, 2009)
Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.
No full textOBJECTIVE\ud
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To estimate the cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) using sulfadoxine-pyrimethamine (SP).\ud
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METHODS\ud
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In two previous IPTi trials in Ifakara (United Republic of Tanzania) and Manhiça (Mozambique), SP was administered three times to infants before 9 months of age through the Expanded Programme on Immunization. Based on the efficacy results of the intervention and on malaria incidence in the target population, an estimate was made of the number of clinical malaria episodes prevented. This number and an assumed case-fatality rate of 1.57% were used, in turn, to estimate the number of disability-adjusted life years (DALY) averted and the number of deaths averted. The cost of the intervention, including start-up and recurrent costs, was then assessed on the basis of these figures.\ud
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FINDINGS\ud
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The cost per clinical episode of malaria averted was US 0.8-4.0) in Ifakara and US 1.7-30.3) in Manhiça; the cost per DALY averted was US 1.6-12.2) in Ifakara and US 3.6-92.0) in Manhiça; and the cost per death averted was US 43.0-330.9) in Ifakara and US 95.6-2498.4) in Manhiça.\ud
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CONCLUSION\ud
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From the health system and societal perspectives, IPTi with SP is expected to produce health improvements in a cost-effective way. From an economic perspective, it offers good value for money for public health programmes
<i>cpn</i>60 UT sequence-based subgroups of <i>G. vaginalis</i>.
No full text<p>A. Phylogenetic tree of <i>G. vaginalis</i>-like cpn60 UT sequences comprising four distinct clades: A, B, C and D. Bootstrap values for each node are indicated. 101, 315-A, 41V, 409-05, 5-1, AMD, ATCC 14018<sup>T</sup>, ATCC 14019, and HMP9231 are <i>G. vaginalis</i> isolates with whole genome sequence information available in Genbank (Accession numbers AEJD00000000, AFDI00000000, AEJE00000000, CP001849, ADAN00000000, ADAM00000000, ADNB00000000, CP002104 and CP002725 respectively). Isolates with names starting with “N” are isolates from Kenyan women from Schellenberg <i>et al. </i><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0043009#pone.0043009-Schellenberg1" target="_blank">[6]</a>. W11 was isolated from a Canadian woman (Schellenberg, Unpublished). Sequences highlighted in red were used as representatives of the subgroups in the distribution analysis of metagenomic sequence data. B. Pairwise distances for the 26 <i>G. vaginalis</i> cpn60 UT sequences included in the phylogenetic analysis. Distances for both inter-subgroup comparisons (white bars) and intra-subgroup comparisons (black bars) are indicated.</p
Distinguishing characters of Niphargus gebhardti Schellenberg, 1934 and Niphargus molnari Mehely, 1927 (Crustacea: Amphipoda): a clarification
No full textTwo endemic Niphargus species, N. gebhardti Schellenberg, 1934 and N. molnari Méhely, 1927 are known from two caves of the Mecsek Mts. (SW Hungary). The species are morphologically close to each other and differ only in few characters. Although, the original descriptions contain only scattered information and few drawings, more characters can be found in the additional literature. The purpose of this paper is to summarize the available distinguishing morphological characters and to provide sufficient drawings to ease the identification of N. gebhardti and N. molnari
Deletion of vitamin D receptor leads to premature emphysema/COPD by increased matrix metalloproteinases and lymphoid aggregates formation
No full textDeficiency of vitamin D is associated with accelerated decline in lung function. Vitamin D is a ligand for nuclear hormone vitamin D receptor (VDR), and upon binding it modulates various cellular functions. The level of VDR is reduced in lungs of patients with chronic obstructive pulmonary disease (COPD) which led us to hypothesize that deficiency of VDR leads to significant alterations in lung phenotype that are characteristics of COPD/emphysema associated with increased inflammatory response. We found that VDR knock-out (VDR(-/-)) mice had increased influx of inflammatory cells, phospho-acetylation of nuclear factor-kappaB (NF-κB) associated with increased proinflammatory mediators, and up-regulation of matrix metalloproteinases (MMPs) MMP-2, MMP-9, and MMP-12 in the lung. This was associated with emphysema and decline in lung function associated with lymphoid aggregates formation compared to WT mice. These findings suggest that deficiency of VDR in mouse lung can lead to an early onset of emphysema/COPD because of chronic inflammation, immune dysregulation, and lung destruction
Evaluating the effectiveness of IPTi on malaria using routine health information from sentinel health centres in southern Tanzania.
No full textBACKGROUND\ud
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Intermittent preventive treatment of malaria in infants (IPTi) consists of the administration of a treatment dose of sulphadoxine-pyrimethamine (SP) at the time of routine vaccinations. The use of routine Health Management and Information Services (HMIS) data to investigate the effect of IPTi on malaria, anaemia, and all-cause attendance in children aged 2-11 months presenting to 11 health centres in southern Tanzania is described.\ud
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METHODS\ud
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Clinical diagnosis of malaria was confirmed with a positive blood slide reading from a quality assurance laboratory. Anaemia was defined using two thresholds (mild [Hb<11 g/dL], severe [Hb<8 g/dL]). Incidence rates between IPTi and non-implementing health centres were calculated using Poisson regression, and all statistical testing was based on the t test due to the clustered nature of the data.\ud
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RESULTS\ud
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Seventy two per cent of infants presenting in intervention areas received at least one dose of IPTi--22% received all three. During March 2006-April 2007, the incidence of all cause attendance was two attendances per person, per year (pppy), including 0.2 episodes pppy of malaria, 0.7 episodes of mild and 0.13 episodes of severe anaemia. Point estimates for the effect of IPTi on malaria varied between 18% and 52%, depending on the scope of the analysis, although adjustment for clustering rendered these not statistically significant.\ud
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CONCLUSIONS\ud
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The point estimate of the effect of IPTi on malaria is consistent with that from a large pooled analysis of randomized control trials. As such, it is plausible that the difference seen in health centre data is due to IPTi, even thought the effect did not reach statistical significance. Findings draw attention to the challenges of robust inference of effects of interventions based on routine health centre data. Analysis of routine health information can reassure that interventions are being made available and having desired effects, but unanticipated effects should trigger data collection from representative samples of the target population
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