116 research outputs found
Measuring Inequalities in the Distribution of Health Workers: The case of Tanzania.
No full textThe overall human resource shortages and the distributional inequalities in the health workforce in many developing countries are well acknowledged. However, little has been done to measure the degree of inequality systematically. Moreover, few attempts have been made to analyse the implications of using alternative measures of health care needs in the measurement of health workforce distributional inequalities. Most studies have implicitly relied on population levels as the only criterion for measuring health care needs. This paper attempts to achieve two objectives. First, it describes and measures health worker distributional inequalities in Tanzania on a per capita basis; second, it suggests and applies additional health care needs indicators in the measurement of distributional inequalities. We plotted Lorenz and concentration curves to illustrate graphically the distribution of the total health workforce and the cadre-specific (skill mix) distributions. Alternative indicators of health care needs were illustrated by concentration curves. Inequalities were measured by calculating Gini and concentration indices.\ud
There are significant inequalities in the distribution of health workers per capita. Overall, the population quintile with the fewest health workers per capita accounts for only 8% of all health workers, while the quintile with the most health workers accounts for 46%. Inequality is perceptible across both urban and rural districts. Skill mix inequalities are also large. Districts with a small share of the health workforce (relative to their population levels have an even smaller share of highly trained medical personnel. A small share of highly trained personnel is compensated by a larger share of clinical officers (a middle-level cadre) but not by a larger share of untrained health workers. Clinical officers are relatively equally distributed. Distributional inequalities tend to be more pronounced when under-five deaths are used as an indicator of health care needs. Conversely, if health care needs are measured by HIV prevalence, the distributional inequalities appear to decline. The measure of inequality in the distribution of the health workforce may depend strongly on the underlying measure of health care needs. In cases of a non-uniform distribution of health care needs across geographical areas, other measures of health care needs than population levels may have to be developed in order to ensure a more meaningful measurement of distributional inequalities of the health workforce
Wearable device monitoring of HIV health in the face of climate change and weather exposures: protocol for a mixed-methods study
No full textIntroduction Climate change and HIV are interconnected epidemics that increase vulnerability in people living with HIV (PLWH), particularly in sub-Saharan Africa. Despite their public health significance, research on the synergistic effects of these epidemics on the health of PLWH is limited. The advancement of non-invasive wearable technology offers an opportunity to leverage objective health data for large-scale research, addressing this knowledge gap. This study will examine the impact of weather events on distinct health variables of PLWH within the Siaya Health and Demographic Surveillance System (HDSS) in rural Kenya.
Methods and analysis Over a period of 6 months, we continuously monitored health parameters of a total of 200 participants including heart rate, activity and sleep, using consumer-grade wearable devices. We will correlate these health data with real-time weather parameters (ambient temperature, wet bulb globe temperature, precipitation level) from five weather stations within the HDSS area and compare between HIV-positive participants and an HIV-negative control group. Additionally, a convergent mixed-methods approach will explore participants’ perceptions of the impact of weather events on their health and personal experiences. The study aims to inform future research on the complex relationship between HIV and weather events, which are projected to increase in frequency in this region due to climate change and provide valuable insights for policymakers to develop effective measures to protect this vulnerable population amid the growing climate crisis.
Ethics and dissemination This study has been approved by the Research Ethics Committees at Kenya Medical Research Institute, Nairobi (approved on 23 October 2023; SERU 4826) and Heidelberg University Hospital, Germany (approved on 14 February 2023; S-824/2022). Written informed consent was obtained from all participants prior to enrolment, with data anonymised and handled according to Kenyan and German data protection regulations. Research findings will be disseminated through peer-reviewed publications and presented at scientific conferences
Land use and land cover changes and spatiotemporal dynamics of anopheline larval habitats during a four-year period in a highland community of Africa
No full textSpatial and temporal variations in the distribution of anopheline larval habitats and land use and land cover (LULC) changes can influence malaria transmission intensity. This information is important for understanding the environmental determinants of malaria transmission heterogeneity, and it is critical to the study of the effects of environmental changes on malaria transmission. In this study, we investigated the spatial and temporal variations in the distribution of anopheline larval habitats and LULC changes in western Kenya highlands over a 4-year period. Anopheles gambiae complex larvae were mainly confined to valley bottoms during both the dry and wet seasons. Although An. gambiae larvae were located in man-made habitats where riparian forests and natural swamps had been cleared, Anopheles funestus larvae were mainly found in permanent habitats in pastures. The association between land cover type and occurrence of anopheline larvae was statistically significant. The distribution of anopheline positive habitats varied significantly between months, during the survey. In 2004, the mean density of An. gambiae was significantly higher during the month of May, whereas the density of An. funestus peaked significantly in February. Over the study period, major LULC changes occurred mostly in the valley bottoms. Overall, farmland increased by 3.9%, whereas both pastures and natural swamps decreased by 8.9% and 20.9%, respectively. The area under forest cover was decreased by 5.8%. Land-use changes in the study area are favorable to An. gambiae larval development, thereby risking a more widespread distribution of malaria vector habitats and potentially increasing malaria transmission in western Kenya highlands
Theology, innovation and Society: Towards developing Dialogical Theology for African society
No full textTheology and society are inseparable due to the fact that they are both composed of that
which makes for both human and universal well-being. Indeed the two have through the ages
inspired each other in the pursuit of a better world. This paper aims to explore three
religions; African Indigenous Religion (AIR) Islam and Christianity as practised in
developing countries such as Kenya, with the intention of deducing whether or not believers
of these religions (can engage) engage in dialogue with each other for the purpose of
providing sustainable solutions for community well-being and wholeness. Theology of
dialogue is a methodology used by the author, as a means for innovation; towards creating
harmony and equilibrium in a plural and multi-religious Kenyan society and Africa in
general. Of significance for this timely theological concept in Africa are the dreams that need
achievement; the Millennium Development Goals and state visions such as the Kenya 2030
vision. In approaching the subject, the author shall endeavor to outline pre-colonial, colonial
and post-colonial religious histories in Africa. The author shall use the Midzi-Chenda
(written Mijiknda) community of Coastal Kenya as a case study population. This choice is
due to their diverse and long-lived inter-cultural and inter-religious experiences, particularly
with the Arab, Portuguese and British conquests along the East Coast of Africa. The triple
conquest experiences influenced the Midzi-Chenda community negatively and positively in all
spheres of their life-system; economic, political and religious, compelling them to embrace
foreign culture, religion and politics, all of which gradually shaped their theological
parameters. This latter experience and the contemporary post-colonial religious wave
significantly situate the theology of dialogue as a benchmark for innovation in African
society
Understanding the Risk Factors, Burden, and Interventions for Chronic Respiratory Diseases in Low- and Middle-Income Countries: A Scoping Review
No full textObjective: This scoping review aims to identify risk factors for COPD and asthma, examine the burden and intervention measures, and clarify the findings in the context of climate change, with a particular focus on LMICs. Methods: Following the PRISMA-ScR guidelines, we conducted a scoping review using PubMed, Embase, and Scopus, focusing on studies published from 2011 to 2024. Results: Our review included 52 studies that encompassed 244,004 participants. Predominantly conducted in SSA (n = 43, 83%) and Asia (n = 16, 31%), they address indoor and ambient air pollution, occupational hazards, and environmental conditions. Climate change exacerbates risks, varying regionally. SSA faces severe household and occupational exposures, while other LMICs deal with industrial and urban pollution. Stigma, social exclusion and economic burden underscore the necessity for intervention strategies (e.g., educational programs, pulmonary rehabilitation, low-emission cookstoves). Conclusion: Our research shows a strong link between air pollution, occupational and environmental exposures, and the prevalence of COPD and asthma in LMICs. It suggests that targeted interventions are effective ways to mitigate these diseases and also highlights the significant impact of climate change on respiratory health
Towards developing an atmospheric space for inter-religious dialogue in Africa
No full textDATA AVAILABILITY : Data sharing is not applicable to this article as no new data
were created or analysed in this study.The author/s is participating in the research project, ‘Religion, Theology and Education’, directed by Prof. Dr Jaco Beyers, Head of Department Religion Studies, Faculty of Theology and Religion, University of Pretoria.Special Collection: Interreligious Dialogue, sub-edited by Jaco Beyers (University of Pretoria, South Africa).The practice of religions and spirituality is common in Africa. In many ways, religion may
be considered as a routine of life, living and practising it either as inherited or borrowed.
Religious pluralism is a reality in Africa, dating back to the 1st century up to the 19th
century when Africa became a bedrock of traders and colonisers both from Europe and
Asia. The paper explores plural religiosity with a view to developing a conducive
atmosphere that may promote a suitable inter-religious dialogue in Africa. Largely, the
most pronounced and practised religions are Christianity symbolised by the cross, Islam
symbolised by the crescent, and African indigenous religion that does not have a common
symbol nor sacred scriptures. We note that, for generations, religions have caused division
among communities, but have in the recent years developed the quest to create good
relations and dialogue with each other. Because of the diverse nature of insecurity in Africa,
it is hoped that inter-religious dialogue may cause community cohesion, integration,
inclusivity, and co-existence. In the wake of different types of inter-religious dialogue that
are globally being researched, this paper suggests a specific inter-religious dialogue that
Africans can exercise: ‘dialogue for life’.
CONTRIBUTION : Inter-religious dialogue for life is contextual in that, it touches upon the life
situations of ordinary people in society. The author argues that, by embracing it religiously,
inter-religious dialogue for life shall address crucial issues such as poverty, radicalisation,
terrorism, climate change, bad governance, and human trafficking that adversely affect
African society.http://www.hts.org.zaam2024Science of Religion and MissiologyNon
The Impact of Wearable Technologies in Health Research: Scoping Review
No full textBackground: Wearable devices hold great promise, particularly for data generation for cutting-edge health research, and their demand has risen substantially in recent years. However, there is a shortage of aggregated insights into how wearables have been used in health research. Objective: In this review, we aim to broadly overview and categorize the current research conducted with affordable wearable devices for health research. Methods: We performed a scoping review to understand the use of affordable, consumer-grade wearables for health research from a population health perspective using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. A total of 7499 articles were found in 4 medical databases (PubMed, Ovid, Web of Science, and CINAHL). Studies were eligible if they used noninvasive wearables: worn on the wrist, arm, hip, and chest; measured vital signs; and analyzed the collected data quantitatively. We excluded studies that did not use wearables for outcome assessment and prototype studies, devices that cost >€500 (US 228; 120/189, 63.5%). The aims and approaches of all 179 studies revealed six prominent uses for wearables, comprising correlations-wearable and other physiological data (40/179, 22.3%), method evaluations (with subgroups; 40/179, 22.3%), population-based research (31/179, 17.3%), experimental outcome assessment (30/179, 16.8%), prognostic forecasting (28/179, 15.6%), and explorative analysis of big data sets (10/179, 5.6%). The most frequent strengths of affordable wearables were validation, accuracy, and clinical certification (104/179, 58.1%). Conclusions: Wearables showed an increasingly diverse field of application such as COVID-19 prediction, fertility tracking, heat-related illness, drug effects, and psychological interventions; they also included underrepresented populations, such as individuals with rare diseases. There is a lack of research on wearable devices in low-resource contexts. Fueled by the COVID-19 pandemic, we see a shift toward more large-sized, web-based studies where wearables increased insights into the developing pandemic, including forecasting models and the effects of the pandemic. Some studies have indicated that big data extracted from wearables may potentially transform the understanding of population health dynamics and the ability to forecast health trends
Wearables for Measuring Health Effects of Climate Change–Induced Weather Extremes: Scoping Review
No full textBACKGROUND: Although climate change is one of the biggest global health threats, individual-level and short-term data on direct exposure and health impacts are still scarce. Wearable electronic devices (wearables) present a potential solution to this research gap. Wearables have become widely accepted in various areas of health research for ecological momentary assessment, and some studies have used wearables in the field of climate change and health. However, these studies vary in study design, demographics, and outcome variables, and existing research has not been mapped. OBJECTIVE: In this review, we aimed to map existing research on wearables used to detect direct health impacts and individual exposure during climate change–induced weather extremes, such as heat waves or wildfires. METHODS: We conducted a scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework and systematically searched 6 databases (PubMed [MEDLINE], IEEE Xplore, CINAHL [EBSCOhost], WoS, Scopus, Ovid [MEDLINE], and Google Scholar). The search yielded 1871 results. Abstracts and full texts were screened by 2 reviewers (MK and IM) independently using the inclusion and exclusion criteria. The inclusion criteria comprised studies published since 2010 that used off-the-shelf wearables that were neither invasive nor obtrusive to the user in the setting of climate change–related weather extremes. Data were charted using a structured form, and the study outcomes were narratively synthesized. RESULTS: The review included 55,284 study participants using wearables in 53 studies. Most studies were conducted in upper–middle-income and high-income countries (50/53, 94%) in urban environments (25/53, 47%) or in a climatic chamber (19/53, 36%) and assessed the health effects of heat exposure (52/53, 98%). The majority reported adverse health effects of heat exposure on sleep, physical activity, and heart rate. The remaining studies assessed occupational heat stress or compared individual- and area-level heat exposure. In total, 26% (14/53) of studies determined that all examined wearables were valid and reliable for measuring health parameters during heat exposure when compared with standard methods. CONCLUSIONS: Wearables have been used successfully in large-scale research to measure the health implications of climate change–related weather extremes. More research is needed in low-income countries and vulnerable populations with pre-existing conditions. In addition, further research could focus on the health impacts of other climate change–related conditions and the effectiveness of adaptation measures at the individual level to such weather extremes
Determinants of pathological response to neoadjuvant chemotherapy in women with breast cancer in Kenya
No full textBackground: Breast cancer (BC) is the most common cause of cancer deaths in Kenya. Standard treatment involves surgery followed by adjuvant chemo/radiotherapy as appropriate. Neoadjuvant chemotherapy (NACT) facilitates surgery in locally advanced breast cancer. The Residual Cancer Burden (RCB) is an objective, standardised measure of pathological response to NACT. Pathological complete response (pCR) (RCB Class 0) is a robust prognostic indicator, used in clinical trials. This study aimed to use RCB to improve understanding of current practice and effectiveness of NACT for breast cancer patients at Aga Khan University Hospital Nairobi (AKUH, N.). Methods: 67 breast cancer patients receiving NACT between March 2012 and March 2020 were identified. Pathological response was evaluated by RCB (Index and Class). Demographics, treatment, and tumour characteristics (e.g. grade, immunohistochemical subtype) in both core biopsy and resection specimens were analysed to determine their influence on RCB. The influence of RCB and NACT on outcome measures (local recurrence, distant metastasis, event-free survival (EFS) was analysed. Results: Seven (12.3%) showed complete response (RCB 0, pCR), while 24 (42.1%) showed minimal response (RCB Class III) (n=57). Data showed trends towards better outcomes with decreasing RCB (p=0.215 for EFS, n=45), and towards lower RCB with increased tumour grade (core biopsy; p=0.269, n=48). In 45 cases with complete NACT regimen data, most received AC-T (n=22, 49%) and FEC-T (n=9, 20%). nine of 67 patients (13.4%) had Breast Conserving Treatment (BCT). Neither RCB, BCT, nor outcomes, were affected by NACT regimen. Six of 40 cases (15%) had clinically significant alterations in biomarker expression. Conclusions: NACT achieved pCR rate of 12.3%, and a BCT rate of 13.4%. RCB index evaluation is feasible, and a useful addition to the standard pathology report following NACT. Alterations in biomarker expression necessitate re-evaluation of IHC subtype in the resection specimen
Lactation characteristics in Alpine and Nera di Verzasca goats in Northern Italy : A statistical bayesian approach
No full textIn the last three decades, we assisted in a shift in the dairy product preferences in developed countries, with an increase in goat-derived products consumption. As already seen in the bovine sector, the diffusion of goat milk consumption has led to an abandonment of the local breeds in favor of the more productive cosmopolitan breeds, with an intense reduction in the livestock biodiversity. However, in several studies, it has been shown that local breeds present unique features such as a robust behavior towards the local climate and a high quality of their dairy products. This study aims to assess the differences between the basic lactation variables (milk yield, fat %, protein %, lactose % and somatic cell count) in the Alpine goat and the local breed Verzasca goat from a Bayesian point of observation. Results indicate that the Nera di Verzasca goat has overall lactation characteristics similar toa cosmopolite breed such as the Alpine goat, except for the milk daily yield reduced with respect to Alpine goats (1.68 ± 0.84 and 2.14 ± 1.03, respectively). Moreover, the Verzasca goat showed a tendency to maintain a lower level of somatic cell count along with lactation (798 ± 1734 and 1216 ± 2828, respectively). These findings help to increase the knowledge about the Italian local goat breeds and are important in the optic of biodiversity conservation
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