Quantifying long-term health and economic outcomes for survivors of group B Streptococcus invasive disease in infancy: protocol of a multi-country study in Argentina, India, Kenya, Mozambique and South Africa.

Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa.  The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization

Civil society leadership in the struggle for AIDS treatment in South Africa and Uganda

Includes abstract.Includes bibliographical references.This thesis is an attempt to theorise and operationalise empirically the notion of ‘civil society leadership’ in Sub-Saharan Africa. ‘AIDS leadership,’ which is associated with the intergovernmental institutions charged with coordinating the global response to HIV/AIDS, is both under-theorised and highly context-specific. In this study I therefore opt for an inclusive framework that draws on a range of approaches, including the literature on ‘leadership’, institutions, social movements and the ‘network’ perspective on civil society mobilisation. This framework is employed in rich and detailed empirical descriptions (‘thick description’) of civil society mobilisation around AIDS, including contentious AIDS activism, in the key case studies of South Africa and Uganda. South Africa and Uganda are widely considered key examples of poor and good leadership (from national political leaders) respectively, while the Treatment Action Campaign (TAC) and The AIDS Support Organisation (TASO) are both seen as highly effective civil society movements. These descriptions emphasise ‘transnational networks of influence’ in which civil society leaders participated (and at times actively constructed) in order to mobilise both symbolic and material resources aimed at exerting influence at the transnational, national and local levels

Developmental impairments following severe falciparum malaria in children.

OBJECTIVE: Neurological deficits are reported in children after cerebral malaria (CM) but little is known about the prevalence and characteristics of persisting neurocognitive consequences. The prevalence of developmental impairments following other complications of falciparum malaria, such as multiple, prolonged or focal seizures, is not known. Thus, our objective was to investigate the long-term developmental outcome of CM and malaria with complicated seizures (M/S). METHODS: We followed up a cohort of children previously exposed to CM or M/S and children unexposed to either condition. All children between 6 and 9 years of age, exposed to CM, and an equal number of children exposed to M/S were identified from databases of hospital admissions from 1991 to 1998. The unexposed group was randomly selected from a census database. The children's performance was measured using assessments of cognition, motor, speech and language, hearing and vision. A parental questionnaire was used to identify children with epilepsy. RESULTS: CM group scores were significantly lower than unexposed group scores on the assessments of higher level language (adjusted mean difference -1.63, 95% CI: -2.99 to -0.27), vocabulary (-0.02, 95% CI: -0.04 to -0.01), pragmatics (OR 2.81, 95% CI: 1.04-7.6) and non-verbal functioning (-0.33, 95% CI: -0.61 to -0.06). The areas of significantly reduced functioning for the M/S group were concentrated on phonology (OR 2.74, 95% CI: 1.26-5.95), pragmatics (OR 3.23, 95% CI: 1.2-8.71) and behaviour (OR 1.8, 95% CI: 1.0-3.23). The performance of the active epilepsy group was significantly poorer than that of the group without epilepsy on the tests of comprehension, syntax, pragmatics, word finding, memory, attention, behaviour and motor skills. CONCLUSIONS: CM and M/S are associated with developmental impairments. If these impairments persist, this may have implications for least 250,000 children in Sub-Saharan Africa each year. Active epilepsy significantly increases the risk of cognitive and behavioural problems in children with a history of severe malaria

Ownership Structure and Financial Performance of Listed Firms in Kenya: Mediation Role of Corporate Diversification

Purpose: The study aimed at examining the mediating role of corporate diversification between ownership structure and financial performance of listed firms in Kenya. Methodology/Approach/Design: As guided by explanatory research design, 65 listed firms from 2003 to 2017 were targeted. However, panel data of 35 firms were considered after excluding suspended and delisted as far as the study period is concerned. Results: The panel regression analysis finding indicated that corporate diversification positively and significantly mediated between institutional ownership and financial performance (β = .005, p-value = .000). Furthermore, there was a negative but statistically significant mediation effect of corporate diversification between foreign ownership and financial performance (β = -.0019, p-value = .023). These mediation effects existed despite the direct effect between institutional and as well foreign ownership and financial performance being statistically insignificant. Practical Implications: The study, therefore, suggested to the management of listed firms to ensure proper implementation of corporate diversification as it transmits the effect of ownership structure on financial performance. More importantly, policymakers are suggested to streamline taxation of foreign investors, tackle malpractices in the firm leading to embezzlement of investor funds. Future studies need to enlarge the scope to incorporate unlisted firms as well as firms listed in different stock exchanges in East Africa. Other types of ownership structure as managerial, family and state need to be analyzed. In addition, other forms and measures of corporate diversification could be investigated by future researchers. Originality/Value: To attain the main objective, the study used panel regression analysis and path diagrams to examine the effect of ownership structure on financial performance via corporate diversification

Physical Activity and Depressive Mood in the Daily Life of Older Adults

Empirical evidence suggests that physical activity is related to less depressive moods. However, little is known about this association in the everyday life of older adults, limiting the ecological validity of prior findings. This study examined within-person associations between physical activity and depressive mood in older adults across 7 days. Moreover, the study tested the extent to which need-fulfillment can explain this association. The sample consisted of 68 adults aged 65 to 93 years. Physical activity was assessed objectively with accelerometers, whereas need-fulfillment and depressive mood were assessed at the end of each day using self-reports. Results from multilevel analysis suggest that daily physical activity was negatively related to daily depressive mood within persons. Although need-fulfillment did not explain the association between physical activity and depressive mood, it was a statistically significant predictor of daily depressive mood and even attenuated the effect of physical activity on depressive mood to nonsignificance

Quality improvement approach for increasing linkage to HIV care and treatment among newly-diagnosed HIV-infected persons in Kenyan urban informal settlements during 2011–2015

Background: Pre-enrollment loss to follow-up and delayed linkage to HIV care and treatment (C&T) of newly-diagnosed HIV-infected individuals are associated with increased morbidity and mortality.Objective: To describe quality improvement approach utilized by Eastern Deanery AIDS Relief Program (EDARP) to increase linkage to HIV C&T of newly-diagnosed HIV-infected individuals.Design: Cross-sectional descriptive assessement of a three-phased continuous quality improvement (CQI) project among 20,972 newly diagnosed HIV patients at 14 EDARP health facilities in Nairobi, Kenya. Phase 1 – physically escorting patients to the HIV C&T clinic; Phase 2 – use of linkage registers and timely tracking and tracing individuals who missed appointments; Phase 3 – use of patient HIV literacy materials. Routine patient data collected during the CQI interventions implemented between October 2011 and September 2015 were analyzed.Results: Implementation of the three CQI phases significantly increased linkage to HIV C&T from 60% at baseline in 2011 to 98% in 2015 (p<0.0001). Factors associated with decreased linkage to HIV C&T through this CQI intervention were: age (adolescents aged 10–19 years), [odds ratio (OR) 0.60, 95% confidence interval (CI): 0.51-7.0]; female sex [OR 0.64, (95% CI: 0.59-0.70)] and unemployement [OR 0.84, (95% CI: 0.77-0.92)]. First time tester [OR 1.9, (95% CI: 1.8-2.1)] and divorcees [OR 2.0, (95% CI: 1.7-2.3)], (p<0.001) had increased likelihood of linkage to HIV C&T.Conclusion: Successful linkage to HIV C&T services for newly-diagnosed HIV-infected individuals is achievable through adoption of feasible and low-cost multi-pronged CQI interventions