The contributions of community based volunteer workforce towards the millennium development goals in Nyando District, Kenya

This paper presents results of a study on the contribution of CBVs to efforts towards the MDGs in Western Kenya. The study was cross sectional, descriptive and exploratory in design. Objective of the study was to describe the contribution of volunteers in services relevant to the achievement of the MDGs. Services rendered by volunteers were relevant to MDGs 1, 2, 4, 5, 6, and 7. Majority of volunteers spent 6-10 hours in a week offering voluntary services. This is equivalent to $20 per person per month, for 40 volunteers serving 5,000 people. They contribute USD 9,600 per year, which is 4$170,000 the population at recommended $34 per capita per year. Majority of volunteers (70%) had served for more than five years, indicating a reasonable retention rate. Due to the budgetary strains and human resource crisis, volunteerism presents an alternative of providing services Keywords: Volunteers, Contributions, Millennium Development Goals, Communit

Proximate composition and vitamin a contribution of biofortified orange fleshed sweet potato value added products

Orange fleshed sweet potato (OFSP) is rich in provitamin A carotenoids and can thus be utilized to tackle Vitamin A deficiency (VAD) in Sub-Saharan Africa (SSA). Puree with high amounts of β-carotene processed from OFSP roots is currently being incorporated in baked products such as bread, cakes, biscuits, and buns. The objective of this study was to evaluate the nutritional composition of OFSP puree supplemented food products, that is, bread, buns, flakes, cakes, biscuits, muffins, soft cookies, golden biscuits and whole wheat flour bread. The composite products made from OFSP puree were analyzed for β-carotene content and proximate analysis. The highest concentration of β-carotene (19.86 mg/100g) was obtained in OFSP flakes. The concentration in buns with 20% puree was 0.58 mg/100g, while bread with 35% puree had a concentration of 3.02 mg/100g. Biscuits, cookies and cakes with high puree of 40% had β-carotene concentrations of 2.39, 1.83, and 2.30 mg/100g respectively. These concentrations are lower than in bread with 35% puree, and we see different proportions of ingredients and other factors such as cooking method, duration of cooking also play a major role in the final β-carotene concentration of the products. The total Retinol Activity Equivalents (RAE) for the OFSP products were significantly different with bread (35% puree) having a higher concentration of 216.67 μg/100g and OFSP buns (20% puree) having a lower concentration of 41.19 μg/100g. Orange fleshed sweet potato flakes had the highest concentration of 1443.2 μg/100g and whole wheat flour bread having the least of 6.9 μg/100g. The moisture content, total ash, crude fiber, crude fat, crude protein, and carbohydrate content of the OFSP products varied between 2.4-29.7%, 0.7-2.4%, 1.0-4.5%, 0.7-18.1%, 5.1-7.9% and 50.7-83.7%, respectively. The findings of this study show that different proportions of OFSP puree: wheat flour is not the only determinant on the final β-carotene concentration of the different OFSP products, the type and quantity of ingredients used, cooking time and method also contribute to the VA content. Diversification of OFSP food products helps increase its consumption and its added value.&nbsp

Management of digital libraries : challenges and opportunities redefining the contemporary information professional’s role

This paper examines digital libraries principally from the management perspective. For the purpose of appreciating the intrinsic concepts involved, it starts with a comprehensive discussion of definitions, followed by basic principles pertaining to digital libraries. Next, it gives a glimpse into a wide-ranging spectrum of reasons as to why digital libraries are mushrooming predominantly in the developed world and also in a few developing countries. Reasons for the management of these types of libraries are also brought into view. Core competencies expected of digital librarians are outlined, in the wake of the new and continuously dynamic technological dispensation. The paper stresses the need for a paradigm shift in information management strategies, in as far as digital libraries are concerned. This is considered to be crucial if at all information professionals are to gain maximum mileage, in their noble mission of satisfying evolving user needs. Urgent attention ought to be directed towards managing of digital libraries, as a means of enabling contemporary information professionals to assert their unique role in society, not only as information gatekeepers but as information gateways, as well

Effect of a Patient-Centered Phone Call by a Clinical Officer at Time of HIV Testing on Linkage to Care in Rural Kenya.

In a randomized controlled trial, we tested whether a structured, patient-centered phone call from a clinical officer after HIV testing improved linkage to/re-engagement in HIV care. Among 130 HIV-positive persons, those randomized to the phone call were significantly more likely to link to care by 7 and 30 days (P = .04)

Effect of a patient-centered hypertension delivery strategy on all-cause mortality: Secondary analysis of SEARCH, a community-randomized trial in rural Kenya and Uganda

Background Hypertension treatment reduces morbidity and mortality yet has not been broadly implemented in many low-resource settings, including sub-Saharan Africa (SSA). We hypothesized that a patient-centered integrated chronic disease model that included hypertension treatment and leveraged the HIV care system would reduce mortality among adults with uncontrolled hypertension in rural Kenya and Uganda. Methods and findings This is a secondary analysis of the SEARCH trial (NCT:01864603), in which 32 communities underwent baseline population-based multidisease testing, including hypertension screening, and were randomized to standard country-guided treatment or to a patient-centered integrated chronic care model including treatment for hypertension, diabetes, and HIV. Patient-centered care included on-site introduction to clinic staff at screening, nursing triage to expedite visits, reduced visit frequency, flexible clinic hours, and a welcoming clinic environment. The analytic population included nonpregnant adults (≥18 years) with baseline uncontrolled hypertension (blood pressure ≥140/90 mm Hg). The primary outcome was 3-year all-cause mortality with comprehensive population-level assessment. Secondary outcomes included hypertension control assessed at a population level at year 3 (defined per country guidelines as at least 1 blood pressure measure \u3c140/90 mm Hg on 3 repeated measures). Between-arm comparisons used cluster-level targeted maximum likelihood estimation. Among 86,078 adults screened at study baseline (June 2013 to July 2014), 10,928 (13%) had uncontrolled hypertension. Median age was 53 years (25th to 75th percentile 40 to 66); 6,058 (55%) were female; 677 (6%) were HIV infected; and 477 (4%) had diabetes mellitus. Overall, 174 participants (3.2%) in the intervention group and 225 participants (4.1%) in the control group died during 3 years of follow-up (adjusted relative risk (aRR) 0.79, 95% confidence interval (CI) 0.64 to 0.97, p = 0.028). Among those with baseline grade 3 hypertension (≥180/110 mm Hg), 22 (4.9%) in the intervention group and 42 (7.9%) in the control group died during 3 years of follow-up (aRR 0.62, 95% CI 0.39 to 0.97, p = 0.038). Estimated population-level hypertension control at year 3 was 53% in intervention and 44% in control communities (aRR 1.22, 95% CI 1.12 to 1.33, p \u3c 0.001). Study limitations include inability to identify specific causes of death and control conditions that exceeded current standard hypertension care. Conclusions In this cluster randomized comparison where both arms received population-level hypertension screening, implementation of a patient-centered hypertension care model was associated with a 21% reduction in all-cause mortality and a 22% improvement in hypertension control compared to standard care among adults with baseline uncontrolled hypertension. Patient-centered chronic care programs for HIV can be leveraged to reduce the overall burden of cardiovascular mortality in SSA

The effectiveness and characteristics of mHealth interventions to increase adolescent's use of sexual and reproductive health services in Sub-Saharan Africa: a systematic review

Background mHealth innovations have been proposed as an effective solution to improving adolescent access to and use of Sexual and Reproductive Health (SRH) services; particularly in regions with deeply entrenched traditional social norms. However, research demonstrating the effectiveness and theoretical basis of the interventions is lacking. Aim Our aim was to describe mHealth intervention components, assesses their effectiveness, acceptability, and cost in improving adolescent's uptake of SRH services in Sub-Saharan Africa (SSA). Methods This paper is based on a systematic review. Twenty bibliographic databases and repositories including MEDLINE, EMBASE, and CINAHL, were searched using pre-defined search terms. Of the 10, 990 records screened, only 10 studies met the inclusion criteria. The mERA checklist was used to critically assess the transparency and completeness in reporting of mHealth intervention studies. The behaviour change components of mHealth interventions were coded using the taxonomy of Behaviour Change Techniques (BCTs). The protocol was registered in the 'International Prospective Register for Systematic Reviews' (PROSPERO-CRD42020179051). Results The results showed that mHealth interventions were effective and improved adolescent's uptake of SRH services across a wide range of services. The evidence was strongest for contraceptive use. Interventions with two-way interactive functions and more behaviour change techniques embedded in the interventions improved adolescent uptake of SRH services to greater extent. Findings suggest that mHealth interventions promoting prevention or treatment adherence for HIV for individuals at risk of or living with HIV are acceptable to adolescents, and are feasible to deliver in SSA. Limited data from two studies reported interventions were inexpensive, however, none of the studies evaluated cost-effectiveness. Conclusion There is a need to develop mHealth interventions tailored for adolescents which are theoretically informed and incorporate effective behaviour change techniques. Such interventions, if low cost, have the potential to be a cost-effective means to improve the sexual and reproductive health outcomes in SSA

Cohort profile : the Kilifi vaccine monitoring study

The Kilifi Vaccine Monitoring Study (KiVMS) is a long-term continuous cohort study set up to investigate effectiveness, impact, coverage, safety and indirect vaccine effects by recruiting birth cohorts and, where applicable, cohorts of older and adults. It is based in the area covered by the Kilifi Health and Demographic Surveillance System, Kilifi, Kenya, and currently has records of 33 962 children in the birth cohort database. A major strength of KiVMS is its unique integration of a vaccine registry, a morbidity surveillance system and the largest health and demographic surveillance system (HDSS) in Africa

Strengthening health professional regulation in Kenya and Uganda : research findings policy brief

Regulation can enhance quality and safety in health care, yet the limited research on health care regulation in LMICs suggests it is often ineffective and clinical malpractice, perhaps partly consequently, widespread. We therefore need to better understand how and why health care regulation in LMICs operates and might be improved. Some research has suggested that developing, 'responsive regulation' (Ayres and Braithwaite, 1992) involving regulator-regulatee dialogue to develop and agree regulatory legitimate regulatory standards, persuade professionals to comply, and detect and sanction noncompliance, may improve regulatory effectiveness in LMICs' health care systems. Using responsive regulation as our 'theory of change', we therefore propose to research health professional regulation for doctors and nurses/midwives in Kenya and Uganda to provide evidence supporting regulators to improve health regulation and, in turn, enhance health systems and the quality and safety of patient care. As we noted, there is very little research on regulation in LMIC health systems or evidence about its impact on health care practices. We therefore propose mixed methods research, which members of the research team have previously used to research professional regulation, to develop this evidence base. This research would involve: Analysis of documentation and interviews with national regulatory stakeholders in Kenya and Uganda; focus groups with doctors and nurses/midwives in Kenya and Uganda about their experiences/perceptions of regulation; four case studies of health professional regulation at county/district level; and an online survey of Kenyan and Ugandan doctors and nurses/midwives at national level. Professionals in the Ugandan and Kenyan health systems are regulated by different profession-specific bodies but both countries are establishing single oversight bodies to monitor regulation across all health professions. These major policy changes, coupled with members of the project team's connections to regulators and health policy-makers in both countries, make this research particularly useful and timely. This foundational project aims to provide evidence to help regulators improve regulation and develop research capacity and provide a foundation for a larger research proposal, piloting regulatory improvements and evaluating their impact. Our international interdisciplinary research team contains experts on regulation, health systems improvement and health policy from Uganda, Kenya and the UK, with experience of conducting research on health systems and regulation, which has had impacted health and regulatory policy. We will collaborate closely with regulatory bodies in Kenya and Uganda throughout the project to ensure that we research issues and questions they believe are important and report findings back to regulatory stakeholders in Kenya and Uganda (at workshops in both countries) and other LMICs (via international regulatory policy and academic conferences, in publications and online) to help them improve health regulation and, in turn, the quality and safety of patient care in Kenya, Uganda and LMICs beyond