The impacts of culture and gender in HIV/AIDS lived experiences in education workplaces : case study of selected public schools in Gauteng Province of South Africa.

This thesis represents an attempt to capture the complex life experiences of various members of the education sector of Gauteng Province, including those involved in public school governance, teaching, policy design and implementation. The intention was to investigate how elements of culture and gender may be influencing the motivations, abilities and ways in which members of the education sector are (or are not) putting HIV/AIDS policies into action through their lived experiences. A modified case study approach was applied utilizing qualitative and ethnographic techniques to conduct research in five public schools in the Johannesburg area with an array of relevant participants including school principals, governing board members, adult learners and educators. Focusing on attitudes, knowledge, beliefs and practices of the participants, the researcher identified particular aspects of ‘world views’ and/or perceptions, popular discourses and non-biomedical disease explanatory models that impact on the implementation of HIV/AIDS policies in the education sector. The researcher demonstrates the insufficiency of official discourse and Western biomedical constructs for understanding and responding to HIV/AIDS, and concludes that the hybrid nature of perspectives and understandings means that no single approach to the AIDS crisis in education institutions will be effective for addressing the epidemic and its challenges

FOREIGN DIRECT INVESTMENT AND ECONOMIC GROWTH IN NIGERIA

The study is patterned to empirically investigate foreign direct investment (FDI) and the economic growth in Nigeria between 1990 and 2021. It is based on the traditional theory of FDI. For the attainment of its objectives Oil related Foreign Direct Investment (OFDI) and Non-oil related Foreign Direct Investment (NFDI) were used as proxies for study’s explanatory variable FDIwhile gross domestic product (GDP) was used to proxy the study’s dependent variable economic growth in Nigeria. Secondary data from the Central Bank of Nigeria (CBN) statistical bulletin was obtained and employed in the study. In the study stationarity test was indulged in. The ordinary Least Square (OLS) approach was used to carry out the short-run analysis while Johansen co-integration test was employed to carry out the long-run analysis. Also, the Granger causality test was employed in the study so as to ascertain if a causal relationship exists between the study’s variables. Our results reveal the following: Data were stationary at order one (1), positive and insignificant relationship between NFDI and economic growth in Nigeria, negative and insignificant relationship between OFDI and economic growth in Nigeria, positive and significant relationship between FDI and economic growth in Nigeria. The results also reveal the underlisted: In the short-run FDI largely determines economic growth in Nigeria, a long-run relationship between FDI and economic growth in Nigeria, and no causal relationship between FDI and economic growth in Nigeria. Lastly, the study made some recommendations so as to permit economic growth brought about by the inflow and survival of FDI in Nigeria

Antimicrobial Sensitivity in Enterobacteria from AIDS Patients, Zambia

Enterobacteria contribute to two serious clinical syndromes seen in African AIDS patients: diarrhea and septicemia. In West Africa, prophylaxis with sulfamethoxazole-trimethoprim (SXT) reduced illnesses. We report reduced sensitivity of enterobacteria to available antimicrobial agents in Zambia, with only 22% of nontyphoidal salmonellae and 6% of shigellae sensitive to SXT

Epithelial abnormalities in the small intestine of Zambian children with stunting

BACKGROUND: Environmental enteropathy (EE) contributes to impaired linear growth (stunting), in millions of children worldwide. We have previously reported that confocal laser endomicroscopy (CLE) shows fluorescein leaking from blood to gut lumen METHODS: We performed confocal laser endomicroscopy (CLE) in 75 children and collected intestinal biopsies for histology in 91 children. CLE videos were evaluated, employing the Watson score to determine severity of leakiness. Morphometry was carried out on well-orientated mucosa and 3 biopsies were examined by electron microscopy. RESULTS: Confocal laser endomicroscopy demonstrated substantial leakage from circulation to gut lumen in 73 (97%) children. Histology consistently showed characteristic changes of EE: villus blunting, lamina propria and epithelial inflammation, and depletion of secretory cells (Paneth cells and goblet cells). Epithelial abnormalities included marked variability in epithelial height, disorganised and shortened microvilli, dilated intercellular spaces, pseudostratification, formation of synechiae between epithelium on adjacent villi, crypt destruction, and abundant destructive lesions which may correspond to the microerosions identified on CLE. CONCLUSION: Epithelial abnormalities were almost universal in Zambian children with non-responsive stunting, including epithelial microerosions, cell-cell adhesion anomalies, and defects in secretory cells which may all contribute to impairment of mucosal barrier function and microbial translocation

High dose prolonged treatment with nitazoxanide is not effective for cryptosporidiosis in HIV positive Zambian children: a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Treatment of cryptosporidiosis in HIV infected children has proved difficult and unsatisfactory with no drugs having demonstrable efficacy in controlled trials except nitazoxanide. We hypothesised that a prolonged course of treatment with high dose nitazoxanide would be effective in treating cryptosporidiosis in HIV positive Zambian children.</p> <p>Methods</p> <p>We performed a double-blind, randomised, placebo controlled trial in paediatric patients in the UTH in Lusaka. The study included HIV positive children between one and eleven years of age if 2 out of 3 stool samples were positive for oocysts of <it>Cryptosporidium </it>spp. Children were given nitazoxanide suspension in a dose of 200 mg twice daily (bid) for 28 days (if 1-3 years old) or 400 mg bid for 28 days (if 4-11 years old), or matching placebo.</p> <p>Results</p> <p>Sixty children were randomised and 52 were fully evaluated. Only five children were 4 years of age or over and received the higher dose. In the primary efficacy analysis, 11 out of 26 (42%) in the active treatment group achieved a 'Well' clinical response compared to 8 out of 26 (35%) in the placebo group. Parasitological response was declared as 'Eradicated' in 27% in the active group and 35% in the placebo group. Mortality (16/52, 31%) did not differ by treatment allocation.</p> <p>Conclusion</p> <p>We found no significant benefit in children with cryptosporidiosis despite high dose and longer treatment duration. This is the second randomised controlled trial to suggest that in Zambian children with HIV-related immunosuppression nitazoxanide does not eradicate this infection nor provide clinical symptom reduction.</p> <p>Trial Registration</p> <p>The trial was registered as ISRCTN41089957.</p

Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa

Introduction: The impact of Obstructive sleep apnea (OSA) in worsening outcomes is profound,  especially in the presence of comorbid conditions. This study aimed to describe the proportion of patients at a high risk of OSA in our practice setting.Methods: The STOP BANG questionnaire and the Epworth Sleepiness scale were used to assess for OSA  risk and excessive daytime sleepiness respectively. Hospitalized patients and out-patients were  recruited. Intergroup differences in continuous variables were compared using the analysis of variance. The proportion of patients with high risk of OSA and excessive daytime sleepiness was presented as frequencies and group differences compared with the Pearson χ2 test. Independent risk predictors for OSA were assessed in  multivariate logistic regression analysis. Results: A total of 1100 patients (53.4% females) participated in the study. Three hundred and ninety nine  (36.3%) had a high risk of OSA, and 268 (24.4%) had excessive daytime sleepiness. Of the participants with high OSA risk, 138 (34.6%) had excessive daytime sleepiness compared to 130 (18.5%) of those with low OSA risk (p). Conclusion: A significant proportion of patients attending our tertiary care center are at high risk of OSA.Key words: Obstructive sleep apnea, excessive day time sleepiness, tertiary hospital, Nigeria

A novel histological index for evaluation of environmental enteric dysfunction identifies geographic-specific features of enteropathy among children with suboptimal growth

Background: A major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity.Methods: Duodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists via a secure web browser-based platform. A semi-quantitative scoring index composed of 11 parameters encompassing tissue injury and response patterns commonly observed in routine clinical practice was constructed by three gastrointestinal pathologists, with input from EED experts. The pathologists then read the WSIs using the EED histology index, and inter-observer reliability was assessed. The histology index was further used to identify within- and between-child variations as well as features common across and unique to each cohort, and those that correlated with host phenotype.Results: Eight of the 11 histologic scoring parameters showed useful degrees of variation. The overall concordance across all parameters was 96% weighted agreement, kappa 0.70, and Gwet\u27s AC 0.93. Zambian and Pakistani tissues shared some histologic features with GSE, but most features were distinct, particularly abundance of intraepithelial lymphocytes in the Pakistani cohort, and marked villous destruction and loss of secretory cell lineages in the Zambian cohort.Conclusions: We propose the first EED histology index for interpreting duodenal biopsies. This index should be useful in future clinical and translational studies of this widespread, poorly understood, and highly consequential disorder, which might be caused by multiple contributing processes, in different regions of the world

'Rumours' and clinical trials: a retrospective examination of a paediatric malnutrition study in Zambia, southern Africa

BACKGROUND: Many public health researchers conducting studies in resource-constrained settings have experienced negative 'rumours' about their work; in some cases they have been reported to create serious challenges and derail studies. However, what may appear superficially as 'gossip' or 'rumours' can also be regarded and understood as metaphors which represent local concerns. For researchers unaccustomed to having concerns expressed from participants in this manner, possible reactions can be to be unduly perturbed or conversely dismissive.This paper represents a retrospective examination of a malnutrition study conducted by an international team of researchers in Zambia, Southern Africa. The fears of mothers whose children were involved in the study and some of the concerns which were expressed as rumours are also presented. This paper argues that there is an underlying logic to these anxieties and to dismiss them simply as 'rumours' or 'gossip' would be to overlook the historic and socio-economic factors which have contributed to their production. METHODS: Qualitative interviews were conducted with the mothers whose children were involved in the study and with the research nurses. Twenty five face-to-face interviews and 2 focus group discussions (FGDs) were conducted with mothers. In addition, face-to-face interviews were conducted with research nurses participating in the trial. RESULTS: A prominent anxiety expressed as rumours by the mothers whose children were involved in the study was that recruitment into the trial was an indicator that the child was HIV-infected. Other anxieties included that the trial was a disguise for witchcraft or Satanism and that the children's body parts would be removed and sold. In addition, the liquid, milk-based food given to the children to improve their nutrition was suspected of being insufficiently nutritious, thus worsening their condition.The form which these anxieties took, such as rumours related to the stealing of body parts and other anxieties about a stigmatised condition, provide an insight into the historical, socio-economic and cultural influences in such settings. CONCLUSIONS: Employing strategies to understand local concerns should accompany research aims to achieve optimal success. The concerns raised by the participants we interviewed are not unique to this study. They are produced in countries where the historic, socio-economic and cultural settings communicate anxieties in this format. By examining this study we have shown that by contextualizing these 'rumours', the concerns they express can be constructively addressed and in turn result in the successful conduct of research aims