Comparison of demographic and clinical characteristics between pulmonary and extra-pulmonary tuberculosis patients in Kiambu County, 2012-2015

Background: Tuberculosis (TB) continues to be a public health challenge globally. The most common organ to be involved is the lung although it can affect any organ in the body. The diagnosis of extra-pulmonary TB (EPTB) has faced many challenges mainly due to inadequate expertise to diagnose or lack of equipment for diagnosis.Objective: To compare the demographic and clinical characteristics between pulmonary and extrapulmonary tuberculosis in Kiambu CountyDesign: Retrospective cross-sectional studySetting: Kiambu County, KenyaSubjects: Tuberculosis patients notified in TIBU surveillance systemResults: Of the 15, 833 patients analyzed, 2,704 (17%) had extra-pulmonary tuberculosis. Male to female ratio was 1:1.7 in PTB and 1:1.3 in EPTB patients. There was declining trend of TB cases notified over the years for both PTB and EPTB. Pleural TB accounted for 38% with TB lymphadenitis accounting for 14% of the EPTB subtypes. TB-HIV co-infection was higher among EPTB (36%) compared to PTB (30%). The treatment success rate was 85% and 86% among PTB and EPTB cases respectively. The mortality was 10% among EPTB and 5% in PTB cases. The 5-14 age category were more likely to developing EPTB compared to PTB (AOR 4.67 95% CI (1.5-13.99). Kabete zone was most affected with EPTB (AOR 2.11(1.19-2.74) while a protective factor was observed among the HIV positive clients (AOR 0.58 (0.43 - 0.78)Conclusion: There was a general decline in cases for both EPTB and PTB. However, the age category most affected was 5-14 years. The co-infectivity rate was higher among the EPTB patients compared to the PTB patients. High index of suspicion and appropriate diagnostic tools are needed in evaluation particularly in EPTB which will assist in early management of the patients. ART uptake could play a big role in protecting HIV positive clients from getting EPTB

Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage

Background: Delays in the detection or treatment of postpartum hemorrhage can result in complications or death. A blood-collection drape can help provide objective, accurate, and early diagnosis of postpartum hemorrhage, and delayed or inconsistent use of effective interventions may be able to be addressed by a treatment bundle.Methods: We conducted an international, cluster-randomized trial to assess a multicomponent clinical intervention for postpartum hemorrhage in patients having vaginal delivery. The intervention included a calibrated blood-collection drape for early detection of postpartum hemorrhage and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), supported by an implementation strategy (intervention group). Hospitals in the control group provided usual care. The primary outcome was a composite of severe postpartum hemorrhage (blood loss, ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. Key secondary implementation outcomes were the detection of postpartum hemorrhage and adherence to the treatment bundle.Results: A total of 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Among hospitals and patients with data, a primary-outcome event occurred in 1.6% of the patients in the intervention group, as compared with 4.3% of those in the usual-care group (risk ratio, 0.40; 95% confidence interval [CI], 0.32 to 0.50; P<0.001). Postpartum hemorrhage was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group (rate ratio, 1.58; 95% CI, 1.41 to 1.76), and the treatment bundle was used in 91.2% and 19.4%, respectively (rate ratio, 4.94; 95% CI, 3.88 to 6.28).Conclusions: Early detection of postpartum hemorrhage and use of bundled treatment led to a lower risk of the primary outcome, a composite of severe postpartum hemorrhage, laparotomy for bleeding, or death from bleeding, than usual care among patients having vaginal delivery

Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage

Background: Delays in the detection or treatment of postpartum hemorrhage can result in complications or death. A blood-collection drape can help provide objective, accurate, and early diagnosis of postpartum hemorrhage, and delayed or inconsistent use of effective interventions may be able to be addressed by a treatment bundle.Methods: We conducted an international, cluster-randomized trial to assess a multicomponent clinical intervention for postpartum hemorrhage in patients having vaginal delivery. The intervention included a calibrated blood-collection drape for early detection of postpartum hemorrhage and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), supported by an implementation strategy (intervention group). Hospitals in the control group provided usual care. The primary outcome was a composite of severe postpartum hemorrhage (blood loss, ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. Key secondary implementation outcomes were the detection of postpartum hemorrhage and adherence to the treatment bundle.Results: A total of 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Among hospitals and patients with data, a primary-outcome event occurred in 1.6% of the patients in the intervention group, as compared with 4.3% of those in the usual-care group (risk ratio, 0.40; 95% confidence interval [CI], 0.32 to 0.50; P<0.001). Postpartum hemorrhage was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group (rate ratio, 1.58; 95% CI, 1.41 to 1.76), and the treatment bundle was used in 91.2% and 19.4%, respectively (rate ratio, 4.94; 95% CI, 3.88 to 6.28).Conclusions: Early detection of postpartum hemorrhage and use of bundled treatment led to a lower risk of the primary outcome, a composite of severe postpartum hemorrhage, laparotomy for bleeding, or death from bleeding, than usual care among patients having vaginal delivery

Homo Æqualis: A Cross-Society Experimental Analysis of Three Bargaining Games ∗

Abstract. Data from three bargaining games—the Dictator Game, the Ultimatum Game, and the Third-Party Punishment Game—played in 15 societies are presented. The societies range from US undergraduates to Amazonian, Arctic, and African hunter-gatherers. Behaviour within the games varies markedly across societies. The paper investigates whether this behavioural diversity can be explained solely by variations in inequality aversion. Combining a single parameter utility function with the notion of subgame perfection generates a number of testable predictions. While most of these are supported, there are some telling divergences between theory and data: uncertainty and preferences relating to acts of vengeance may have influenced play in the Ultimatum and Third-Party Punishment Games; and a few subjects used the games as an opportunity to engage in costly signalling. 1

Are men better negotiators everywhere? A meta‐analysis of how gender differences in negotiation performance vary across cultures

Prior research has found that each culture and gender influences negotiation strategies and outcomes, but less is known about their interplay. We integrate these two research streams by providing a meta-analytic review of the interactive impact of gender and culture on negotiation performance. We reviewed 185 studies that reported gender differences in intracultural negotiation performance across 30 societies that varied across seven cultural dimensions. Results showed that Hofstede's individualism–collectivism, GLOBE's in-group collectivism and assertiveness practices, and Schwartz's harmony moderated the gender effect on negotiation performance. We found that in cultures lower in individualism, higher in in-group collectivism practices, lower in assertiveness practices, and higher in harmony, women more likely outperformed men in negotiations. Implications for the role of gender and culture in negotiations and organizations more broadly are discussed.Nanyang Technological UniversityNanyang Technological University Tier 1 Grant, Grant/Award Number: 2014‐Tier1‐ 002‐15