Civil Society Organization Sustainability in Kenya

The design and development of this study emerged as the result of an action research partnership between Brad Tucker of Washington University in St. Louis and the Aga Khan Foundation East Africa's Yetu Initiative. Consultations between study collaborators led to the following observations: 1) The conceptualization and the study of organizational sustainability and effectiveness (OS/OE) – both in scholarship and in practice – are fragmented and, while emphasizing the critical importance of context, do not explain how context impacts sustainability. 2) Existing conceptualizations of OS/OE lack the perspectives of key stakeholders – namely the management and staff of the local NPOs themselves. 3) There is a considerable disconnect between the level of investment in organizational development (through international funding and capacity building) and the expected level of return (in the form of enhanced organizational performance/effectiveness) of that investment. 4) There seems to be an increasing belief in the potential of community philanthropy/local fundraising to enhance organizational sustainability/effectiveness of local nonprofits even in the often resource-constrained countries of the Global South. These four observations gave rise to several questions this study was designed to address. Kenya was chosen as the specific context in which to address these questions due to the ongoing work of the Yetu Initiative as well as the primary investigator's previous work experience and contacts there

Interventions to Promote Cancer Awareness and Early Presentation: Systematic Review

Low cancer awareness contributes to delay in presentation for cancer symptoms and may lead to delay in cancer diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research. We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled or uncontrolled studies of interventions delivered to communities. We found some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation. We found limited evidence that public education campaigns reduce stage at presentation of breast cancer, malignant melanoma and retinoblastoma

The gaps between healthcare service and building design : a state of the art review

Healthcare buildings are designed to achieve diverse objectives, ranging from providing appropriate environments where care can be delivered to communities to increasing operational efficiency and improving patient flows and the patient experience. Improvements in operational efficiency should result from state-of-the-art buildings, more appropriate layouts, departmental adjacencies, efficient clinical and business processes and enhanced information systems. However, complexities around requirements and stakeholders management may prevent the achievement of such objectives. The aim of this article is to identify and understand how healthcare services (re)design and building design can be integrated to facilitate increased performance both in terms of service delivery and future changes. Findings indicate that current approaches and innovation are restricted due to functional barriers in the design process, and that there is a need to support the development of operations driven design through time (e.g. flexible and durable) that satisfies diverse needs

Resource virtualisation of network routers

There is now considerable interest in applications that transport time-sensitive data across the best-effort Internet. We present a novel network router architecture, which has the potential to improve the Quality of Service guarantees provided to such flows. This router architecture makes use of virtual machine techniques, to assign an individual virtual routelet to each network flow requiring QoS guarantees. We describe a prototype of this virtual routelet architecture, and evaluate its effectiveness. Experimental results of the performance and flow partitioning of this prototype, compared with a standard software router, suggest promise in the virtual routelet architecture

Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières

BACKGROUND: Chagas disease (American trypanosomiasis) is a zoonotic or anthropozoonotic disease caused by the parasite Trypanosoma cruzi. Predominantly affecting populations in poor areas of Latin America, medical care for this neglected disease is often lacking. Médecins Sans Frontières/Doctors Without Borders (MSF) has provided diagnostic and treatment services for Chagas disease since 1999. This report describes 10 years of field experience in four MSF programs in Honduras, Guatemala, and Bolivia, focusing on feasibility protocols, safety of drug therapy, and treatment effectiveness. METHODOLOGY: From 1999 to 2008, MSF provided free diagnosis, etiological treatment, and follow-up care for patients <18 years of age seropositive for T. cruzi in Yoro, Honduras (1999-2002); Olopa, Guatemala (2003-2006); Entre Ríos, Bolivia (2002-2006); and Sucre, Bolivia (2005-2008). Essential program components guaranteeing feasibility of implementation were information, education, and communication (IEC) at the community and family level; vector control; health staff training; screening and diagnosis; treatment and compliance, including family-based strategies for early detection of adverse events; and logistics. Chagas disease diagnosis was confirmed by testing blood samples using two different diagnostic tests. T. cruzi-positive patients were treated with benznidazole as first-line treatment, with appropriate counseling, consent, and active participation from parents or guardians for daily administration of the drug, early detection of adverse events, and treatment withdrawal, when necessary. Weekly follow-up was conducted, with adverse events recorded to assess drug safety. Evaluations of serological conversion were carried out to measure treatment effectiveness. Vector control, entomological surveillance, and health education activities were carried out in all projects with close interaction with national and regional programs. RESULTS: Total numbers of children and adolescents tested for T. cruzi in Yoro, Olopa, Entre Ríos, and Sucre were 24,471, 8,927, 7,613, and 19,400, respectively. Of these, 232 (0.9%), 124 (1.4%), 1,475 (19.4%), and 1,145 (5.9%) patients, respectively, were diagnosed as seropositive. Patients were treated with benznidazole, and early findings of seroconversion varied widely between the Central and South American programs: 87.1% and 58.1% at 18 months post-treatment in Yoro and Olopa, respectively; 5.4% by up to 60 months in Entre Ríos; and 0% at an average of 18 months in Sucre. Benznidazole-related adverse events were observed in 50.2% and 50.8% of all patients treated in Yoro and Olopa, respectively, and 25.6% and 37.9% of patients in Entre Ríos and Sucre, respectively. Most adverse events were mild and manageable. No deaths occurred in the treatment population. CONCLUSIONS: These results demonstrate the feasibility of implementing Chagas disease diagnosis and treatment programs in resource-limited settings, including remote rural areas, while addressing the limitations associated with drug-related adverse events. The variability in apparent treatment effectiveness may reflect differences in patient and parasite populations, and illustrates the limitations of current treatments and measures of efficacy. New treatments with improved safety profiles, pediatric formulations of existing and new drugs, and a faster, reliable test of cure are all urgently needed

A randomised controlled trial of the clinical effectiveness and cost-effectiveness of different knee prostheses : the Knee Arthroplasty Trial (KAT)

Peer reviewedPublisher PD

Prevention of postpartum hemorrhage in low-resource settings: current perspectives.

BackgroundPostpartum hemorrhage (PPH) is the leading cause of maternal death in low-income countries and is the primary cause of approximately one-quarter of global maternal deaths. The purpose of this paper is to provide a review of PPH prevention interventions, with a particular focus on misoprostol, and the challenges and opportunities that preventing PPH in low-resource settings presents.MethodsUsing PubMed, we conducted a review of the literature on the randomized controlled trials of interventions to prevent PPH. We then searched PubMed and Google Scholar for nonrandomized field trials of interventions to prevent PPH. We limited our review to interventions that are discussed in the current World Health Organization (WHO) recommendations for PPH prevention and present evidence regarding the use of these interventions. We focused our review on nondrug PPH prevention interventions compared with no intervention and uterotonics versus placebo; this review does not decipher the relative effectiveness of uterotonic drugs. We describe challenges to and opportunities for scaling up PPH prevention interventions.ResultsActive management of the third stage of labor is considered the "gold standard" strategy for reducing the incidence of PPH. It combines nondrug interventions (controlled cord traction and cord clamping) with the administration of an uterotonic drug, the preferred uterotonic being oxytocin. Unfortunately, oxytocin has limited application in resource-poor countries, due to its heat instability and required administration by a skilled provider. New heat-stable drugs and drug formulations are currently in development that may improve the prevention of PPH; however, misoprostol is a viable option for provision at home by a lay health care worker or the woman herself, in the interim.ConclusionAs the main cause of maternal mortality worldwide, PPH prevention interventions need to be prioritized. Increased access to prophylactic uterotonics, regardless of where deliveries occur, should be the primary means of reducing the burden of this complication

Reducing smoking in adolescents: cost-effectiveness results from the cluster randomized ASSIST (A Stop Smoking In Schools Trial)

Introduction: School-based smoking prevention programmes can be effective, but evidence on cost-effectiveness is lacking. We conducted a cost-effectiveness analysis of a school-based “peer-led” intervention.&lt;p&gt;&lt;/p&gt; Methods: We evaluated the ASSIST (A Stop Smoking In Schools Trial) programme in a cluster randomized controlled trial. The ASSIST programme trained students to act as peer supporters during informal interactions to encourage their peers not to smoke. Fifty-nine secondary schools in England and Wales were randomized to receive the ASSIST programme or usual smoking education. Ten thousand seven hundred and thirty students aged 12–13 years attended participating schools. Previous work has demonstrated that the ASSIST programme achieved a 2.1% (95% CI = 0%–4.2%) reduction in smoking prevalence. We evaluated the public sector cost, prevalence of weekly smoking, and cost per additional student not smoking at 24 months.&lt;p&gt;&lt;/p&gt; Results: The ASSIST programme cost of £32 (95% CI = £29.70–£33.80) per student. The incremental cost per student not smoking at 2 years was £1,500 (95% CI = £669–£9,947). Students in intervention schools were less likely to believe that they would be a smoker at age 16 years (odds ratio [OR] = 0.80; 95% CI = 0.66–0.96).&lt;p&gt;&lt;/p&gt; Conclusions: A peer-led intervention reduced smoking among adolescents at a modest cost. The intervention is cost-effective under realistic assumptions regarding the extent to which reductions in adolescent smoking lead to lower smoking prevalence and/or earlier smoking cessation in adulthood. The annual cost of extending the intervention to Year 8 students in all U.K. schools would be in the region of £38 million and could result in 20,400 fewer adolescent smokers.&lt;p&gt;&lt;/p&gt

On the difference between exclosures and enclosures in ecology and the environment

Rehabilitation of degraded land in arid and semiarid environments often involves excluding livestock from degraded sites, creating what are usually but unfortunately not consistently, called _exclosures_. Their main objective is to allow native vegetation to regenerate as a means of providing fodder and woody biomass, to reduce soil erosion and to increase rain water infiltration. We are concerned that some of the alternative names for this practice that are reported in the international literature, including _closed area_, _area closure_ and _enclosure_, may lead to confusion and misunderstanding, especially when these are used as synonyms. Here we aim to illustrate the difference between exclosures and enclosures using recent ecological and environmental literature and provide guidance for their proper use