New Policies, New Technologies: Modelling the Potential for Improved Smear Microscopy Services in Malawi

Background To quantify the likely impact of recent WHO policy recommendations regarding smear microscopy and the introduction of appropriate low-cost fluorescence microscopy on a) case detection and b) laboratory workload.Methodology/Principal Findings An audit of the laboratory register in an urban hospital, Lilongwe, Malawi, and the application of a simple modelling framework. The adoption of the new definition of a smear-positive case could directly increase case detection by up to 28%. Examining Ziehl-Neelsen (ZN) sputum smears for up to 10 minutes before declaring them negative has previously been shown to increase case detection (over and above that gained by the adoption of the new case definition) by 70% compared with examination times in routine practice. Three times the number of staff would be required to adequately examine the current workload of smears using ZN microscopy. Through implementing new policy recommendations and LED-based fluorescence microscopy the current laboratory staff complement could investigate the same number of patients, examining auramine-stained smears to an extent that is equivalent to a 10 minutes ZN smear examination.Conclusions/Significance Combined implementation of the new WHO recommendations on smear microscopy and LED-based fluorescence microscopy could result in substantial increases in smear positive case-detection using existing human resources and minimal additional equipment

MT-ND5 Mutation Exhibits Highly Variable Neurological Manifestations at Low Mutant Load.

Mutations in the m.13094T>C MT-ND5 gene have been previously described in three cases of Leigh Syndrome (LS). In this retrospective, international cohort study we identified 20 clinically affected individuals (13 families) and four asymptomatic carriers. Ten patients were deceased at the time of analysis (median age of death was 10years (range: 5·4months-37years, IQR=17·9years). Nine patients manifested with LS, one with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS), and one with Leber hereditary optic neuropathy. The remaining nine patients presented with either overlapping syndromes or isolated neurological symptoms. Mitochondrial respiratory chain activity analysis was normal in five out of ten muscle biopsies. We confirmed maternal inheritance in six families, and demonstrated marked variability in tissue segregation, and phenotypic expression at relatively low blood mutant loads. Neuropathological studies of two patients manifesting with LS/MELAS showed prominent capillary proliferation, microvacuolation and severe neuronal cell loss in the brainstem and cerebellum, with conspicuous absence of basal ganglia involvement. These findings suggest that whole mtDNA genome sequencing should be considered in patients with suspected mitochondrial disease presenting with complex neurological manifestations, which would identify over 300 known pathogenic variants including the m.13094T>C

'Lost' smear-positive pulmonary tuberculosis cases: where are they and why did we lose them?

SETTING: Ntcheu District, rural Malawi. OBJECTIVES: 1) To locate smear-positive pulmonary tuberculosis patients who were identified during the first 6 months of 2000 but did not start treatment ('lost cases'); 2) to describe these patients' pathways to diagnosis, health status and socio-demographic characteristics; and 3) to explore why these patients did not start treatment. METHODS: Lost cases were traced from programme registers and interviewed using the qualitative research critical incidents narrative (CIN) interviews technique. Results were triangulated with responses from health care workers through focus group discussions. RESULTS: The laboratory registered 157 new smear-positive patients. Twenty three (15%) of these were 'lost' (did not appear in the treatment register). CIN interviews were conducted with five lost patients and 14 carets of lost patients who had died. Long pathways to diagnosis were the norm. Health system structural barriers were the main factors behind these pathways, including requirement for hospital attendance, delays in symptom recognition and receipt of sputum results, and the misconception that negative smears excluded tuberculosis. CONCLUSION: Some smear-positive cases experience very long pathways to diagnosis and are lost from this free public health system. The diagnostic process needs to become more responsive to patients' needs

New policies, new technologies:modelling the potential for improved smear microscopy services in Malawi

BACKGROUND: To quantify the likely impact of recent WHO policy recommendations regarding smear microscopy and the introduction of appropriate low-cost fluorescence microscopy on a) case detection and b) laboratory workload.METHODOLOGY/PRINCIPAL FINDINGS: An audit of the laboratory register in an urban hospital, Lilongwe, Malawi, and the application of a simple modelling framework. The adoption of the new definition of a smear-positive case could directly increase case detection by up to 28%. Examining Ziehl-Neelsen (ZN) sputum smears for up to 10 minutes before declaring them negative has previously been shown to increase case detection (over and above that gained by the adoption of the new case definition) by 70% compared with examination times in routine practice. Three times the number of staff would be required to adequately examine the current workload of smears using ZN microscopy. Through implementing new policy recommendations and LED-based fluorescence microscopy the current laboratory staff complement could investigate the same number of patients, examining auramine-stained smears to an extent that is equivalent to a 10 minutes ZN smear examination.CONCLUSIONS/SIGNIFICANCE: Combined implementation of the new WHO recommendations on smear microscopy and LED-based fluorescence microscopy could result in substantial increases in smear positive case-detection using existing human resources and minimal additional equipment.</p

Number of TB suspects (by sex) classified as smear-positive PTB cases using different thresholds for case definition.

*<p>P<0.05 and **p<0.01 when compared to the definition “At least 1 smear with ≥1 AFB/smear”; Chi square for trend, males, p<0.001; females p<0.05.</p>†<p>sex not known for one patient.</p

Current workload based on examination of three specimens from TB suspects; comparison of ZN and FM.

*<p>Time taken to find a ZN smear neg  = 10 mins; Scanty  = 5 mins; 1+  = 2.5 mins; 2+  = 1.0 min; 3+  = 0.5 min. FU pos  = 2.5 mins.</p>**<p>Time taken to find an FM smear neg  = 2.5 mins; Scanty  = 2.0 mins; 1+  = 1.5 mins; 2+  = 0.5; 3+  = 0.25 min. FU pos  = 1.5 mins.</p>#<p>No of negative smears and positive smears (at different grades) calculated based on proportions of smears that were negative and positive (at different grades) in laboratory register at Bwaila Hospital.</p>†<p>Staff Full Time (Hands-on) Equivalent based on real working hours reported by Mundy et al. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0007760#pone.0007760-Mundy2" target="_blank">[26]</a>.</p

Predicted reduction in workload through examining only two specimens from TB suspects; comparison of ZN and FM.

*<p>Time taken to find a ZN smear neg  = 10 mins; scanty  = 5 mins; 1+  = 2.5 mins; 2+  = 1.0 min; 3+  = 0.5 min. FU pos  = 2.5 mins.</p>**<p>Time taken to find an FM smear neg  = 2.5 mins; scanty  = 2.0 mins; 1+  = 1.5 mins; 2+  = 0.5; 3+  = 0.25 min. FU pos  = 1.5 mins.</p>#<p>No of negative smears and positive smears (at different grades) calculated based on proportions of smears that were negative and positive (at different grades) in laboratory register at Bwaila Hospital.</p>†<p>Staff Full Time (Hands-on) Equivalent based on real working hours reported by Mundy et al. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0007760#pone.0007760-Mundy2" target="_blank">[26]</a>.</p

Proceedings of the International Workshop on Social Impact of AI for Africa 2022

This workshop proceedings contain articles on the various research ideas of the International Workshop on Social Impact of AI for Africa 2022 (SIAIA-22). This Workshop served as a critical juncture in the academic exploration of Artificial Intelligence (AI) within the African context. As an auxiliary event of the thirty-sixth AAAI Conference on Artificial Intelligence (AAAI-22), the workshop was positioned at the forefront of ongoing international scholarly discourse on the social implications and equitable deployment of AI technologies in Africa. SIAIA-22 was Organized by the AAAI Diversity and Inclusion Program, United States on 26 February 2022. Workshop Title: International Workshop on Social Impact of AI for Africa 2022Workshop Acronym: SIAIA-22Workshop Date: 16 February 2022Workshop Location:  OnlineWorkshop Organizers: AAAI Diversity and Inclusion Program, United State