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)

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

Diffusion of Subsidized ACTs in Accredited Drug Shops in Tanzania: Determinants of Stocking and Characteristics of Early and Late Adopters.

Many households in sub-Saharan Africa utilize the private sector as a primary source of treatment for malaria episodes. Expanding access to effective treatment in private drug shops may help reduce incidence of severe disease and mortality. This research leveraged a longitudinal survey of stocking of subsidized artemisinin combination therapies (ACTs), an effective anti-malarial, in Accredited Drug Dispensing Outlets (ADDOs) in two regions of Tanzania. This provided a unique opportunity to explore shop and market level determinants of product diffusion in a developing country retail market. 356 ADDOs in the Rukwa and Mtwara regions of Tanzania were surveyed at seven points between Feb 2011 and May 2012. Shop level audits were used to measure the availability of subsidized ACTs at each shop. Data on market and shop level factors were collected during the survey and also extracted from GIS layers. Regression and network based methodologies were used. Shops classified as early and late adopters, following Rogers' model of product diffusion, were compared. The Bass model of product diffusion was applied to determine whether shops stocked ACTs out of a need to imitate market competitors or a desire to satisfy customer needs. Following the introduction of a subsidy for ACTs, stocking increased from 12% to nearly 80% over the seven survey rounds. Stocking was influenced by higher numbers of proximal shops and clinics, larger customer traffic and the presence of a licensed pharmacist. Early adopters were characterized by a larger percentage of customers seeking care for malaria, a larger catchment and sourcing from specific wholesalers/suppliers. The Bass model of product diffusion indicated that shops were adopting products in response to competitor behavior, rather than customer demand. Decisions to stock new pharmaceutical products in Tanzanian ADDOs are influenced by a combination of factors related to both market competition and customer demand, but are particularly influenced by the behavior of competing shops. Efforts to expand access to new pharmaceutical products in developing country markets could benefit from initial targeting of high profile shops in competitive markets and wholesale suppliers to encourage faster product diffusion across all drug retailers

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

Risk of Injection-Site Abscess among Infants Receiving a Preservative-Free, Two-Dose Vial Formulation of Pneumococcal Conjugate Vaccine in Kenya.

There is a theoretical risk of adverse events following immunization with a preservative-free, 2-dose vial formulation of 10-valent-pneumococcal conjugate vaccine (PCV10). We set out to measure this risk. Four population-based surveillance sites in Kenya (total annual birth cohort of 11,500 infants) were used to conduct a 2-year post-introduction vaccine safety study of PCV10. Injection-site abscesses occurring within 7 days following vaccine administration were clinically diagnosed in all study sites (passive facility-based surveillance) and, also, detected by caregiver-reported symptoms of swelling plus discharge in two sites (active household-based surveillance). Abscess risk was expressed as the number of abscesses per 100,000 injections and was compared for the second vs first vial dose of PCV10 and for PCV10 vs pentavalent vaccine (comparator). A total of 58,288 PCV10 injections were recorded, including 24,054 and 19,702 identified as first and second vial doses, respectively (14,532 unknown vial dose). The risk ratio for abscess following injection with the second (41 per 100,000) vs first (33 per 100,000) vial dose of PCV10 was 1.22 (95% confidence interval [CI] 0.37-4.06). The comparator vaccine was changed from a 2-dose to 10-dose presentation midway through the study. The matched odds ratios for abscess following PCV10 were 1.00 (95% CI 0.12-8.56) and 0.27 (95% CI 0.14-0.54) when compared to the 2-dose and 10-dose pentavalent vaccine presentations, respectively. In Kenya immunization with PCV10 was not associated with an increased risk of injection site abscess, providing confidence that the vaccine may be safely used in Africa. The relatively higher risk of abscess following the 10-dose presentation of pentavalent vaccine merits further study

Persistent anthrax as a major driver of wildlife mortality in a tropical rainforest

Anthrax is a globally important animal disease and zoonosis. Despite this, our current knowledge of anthrax ecology is largely limited to arid ecosystems, where outbreaks are most commonly reported. Here we show that the dynamics of an anthrax-causing agent, Bacillus cereus biovar anthracis, in a tropical rainforest have severe consequences for local wildlife communities. Using data and samples collected over three decades, we show that rainforest anthrax is a persistent and widespread cause of death for a broad range of mammalian hosts. We predict that this pathogen will accelerate the decline and possibly result in the extirpation of local chimpanzee (Pan troglodytes verus) populations. We present the epidemiology of a cryptic pathogen and show that its presence has important implications for conservation

Quality of care for the treatment for uncomplicated malaria in South-East Nigeria: how important is socioeconomic status?

Introduction: Ensuring equitable coverage of appropriate malaria treatment remains a high priority for the Nigerian government. This study examines the health seeking behaviour, patient-provider interaction and quality of care received by febrile patients of different socio-economic status (SES) groups. Methods: A total of 1642 febrile patients and caregivers exiting public health centres, pharmacies and patent medicine dealers were surveyed in Enugu state, South-East Nigeria to obtain information on treatment seeking behaviour, patient-provider interactions and treatment received. Socioeconomic status was estimated for each patient using exit survey data on household assets in combination with asset ownership data from the 2008 Nigeria Demographic and Health Survey. Results: Among the poorest SES group, 29% sought treatment at public health centres, 13% at pharmacies and 58% at patent medicine dealers (p < 0.01). Very few of those in the richest SES group used public health centres (4%) instead choosing to go to pharmacies (44%) and patent medicine dealers (52%, p < 0.001). During consultations with a healthcare provider, the poorest compared to the richest were significantly more likely to discuss symptoms with the provider, be physically examined and rely on providers for diagnosis and treatment rather than request a specific medicine. Those from the poorest SES group were however, least likely to request or to receive an antimalarial (p < 0.001). The use of artemisinin combination therapy (ACT), the recommended treatment for uncomplicated malaria, was low across all SES groups. Conclusions: The quality of malaria treatment is sub-optimal for all febrile patients. Having greater interaction with the provider also did not translate to better quality care for the poor. The poor face a number of significant barriers to accessing quality treatment especially in relation to treatment seeking behaviour and type of treatment received. Strategies to address these inequities are fundamental to achieving universal coverage of effective malaria treatment and ensuring that the most vulnerable people are not left behind

Delivering medical abortion at scale: a study of the retail market for medical abortion in Madhya Pradesh, India.

BACKGROUND: Medical abortion (mifepristone and misoprostol) has the potential to contribute to reduced maternal mortality but little is known about the provision or quality of advice for medical abortion through the private retail sector. We examined the availability of medical abortion and the practices of pharmacists in India, where abortion has been legal since 1972. METHODS: We interviewed 591 pharmacists in 60 local markets in city, town and rural areas of Madhya Pradesh. One month later, we returned to 359 pharmacists with undercover patients who presented themselves unannounced as genuine customers seeking a medical abortion. RESULTS: Medical abortion was offered to undercover patients by 256 (71.3%) pharmacists and 24 different brands were identified. Two thirds (68.5%) of pharmacists stated that abortion was illegal in India. Only 106 (38.5%) pharmacists asked clients the timing of the last menstrual period and 38 (13.8%) requested to see a doctor's prescription - a legal requirement in India. Only 59 (21.5%) pharmacists correctly advised patients on the gestational limit for medical abortion, 97 (35.3%) provided correct information on how many and when to take the tablets in a combination pack, and 78 (28.4%) gave accurate advice on where to seek care in case of complications. Advice on post-abortion family planning was almost nonexistent. CONCLUSIONS: The retail market for medical abortion is extensive, but the quality of advice given to patients is poor. Although the contribution of medical abortion to women's health in India is poorly understood, there is an urgent need to improve the practices of pharmacists selling medical abortion