Determinants of an integrated cervical cancer screening services in primary healthcare: sharing lessons from Kisumu, Kenya

Background. The successful integration of cervical cancer screening service (CCASS) into primary healthcare’s routine services depends on locality-specific and context-based service determinants. Objective. This paper aims to identify the abovementioned determinants and discusses how health administrators can manage their influence on CCASS delivery at the primary healthcare level. Methods. We conducted in-depth face-to-face interviews using a structured questionnaire with CCASS nurse providers and managers in four randomly selected primary health facilities. Information on the method(s) of screening utilised, the challenges faced, and the changes observed in CCASS provision were collected. Service managers were asked how they managed unplanned CCASS disruption, factors influencing CCASS replication, and aftercare support to cancer-affected women. Nurse providers were interviewed on the management of CCASS awareness and critical changes required to sustain CCASS service effectiveness. We used a constant interactive and inductive approach for data analysis. Results. Nine thematic categories of CCASS determinants were identified: ‘cultural’, ‘socioeconomic’, ‘individual’, ‘health system’, ‘evidence-based operations’, ‘outcome-based resourcing’, ‘workflow improvement and standardisation’, ‘inclusive partner’s management’, ‘utilisation’. These determinants were grouped into three domains: ‘conceptual’, ‘outcomes’, and ‘growth’ domains, to correspond to clusters of determinants that are likely to influence the CCASS lifecycle in its formative, continuous delivery or productivity, and reproductive phases. Conclusions. The findings show that sustaining an efficient integrated CCASS delivery at the PHC level requires phase-appropriate continuous adaptive improvements of service determinants within that locality

Sonographic Correlation of Liver Dimension and Anthropometric Variables of Height, Weight and Body Mass Index (BMI)

Background: Estimation of liver size can be used as an index to monitor various aspects of liver disease and response to therapy.Purpose: To evaluate the relationship between anthropometric variables (Height, Weight and Body Mass Index) with liver size was carried out in subjects with clinically and sonographically confirmed normal liver.Materials & Methods: This prospective sonographic study was carried out in Calabar, Uyo, Zaria and Makurdicosmopolitan cities of Nigeria. Scans were performed on 388 subjects and their liver sizes measured in the Midclavicular and anterior axillary lines, respectively. Patients’ heights and weights were also measured and used to calculate their respective body mass indices.Results: Mean liver diameter in the study population was 12.9±1.7cm (Range 9.2 – 15.2cm) and 11.6±1.7cm (Range 8.0 – 14.5cm) at the midclavicular and anterior axillary lines respectively. About 98.5 % of the study population had liver sizes ≤15.0cm while 1.5% had sizes at the upper limits of 15.3 – 16cm. Height and BMI appeared to have sone influence on liver size (r=+60; P<0.05, +0.65; P<0.05) respectively at the midclavicular line but not at the anterior axillary line. An insignificant relationship was observed with weight and liver size (r= +0.1; P<0.05) both in the MCL and AAL.Conclusion: Liver size is affected more by individual’s height and body mass index and less by their weight in the region studied

Endoparasites of Bucks Raised under Intensive and Semi-Intensive System

An investigation was carried out on bucks in intensive and semi-intensive systems of management. A total of sixteen (16) bucks (male goats) were randomly purchased for the study. The animals were divided into four groups of four animals per treatment and fed Panicum maximum, Gliricidia sepium for Treatment 1 while Treatment 2 were fed Panicum maximum, Gliricidia sepium plus concentrates. Those in T3 were fed concentrate and allowed to graze and T4 were fed Panicum maximum and were also allowed to forage. The result showed significant difference (P<0.05) in infestations of strongyles amongst the treatments

Seasonal trophodynamics of bacterioplankton and heterotrophic microflagellates in Southampton Water

The trophodynamics of the heterotrophic microplankton population in the Southampton Water estuary was investigated over almost two seasonal cycles. Water samples were collected from two sites, Netley buoy in the mid-estuary and at Calshot buoy at the mouth of the estuary. Bacterioplankton abundance, 3H thymidine uptake rates, bacteria secondary production and microflagellate abundance were routinely measured at both sites at approximately two weekly intervals. Bacterioplankton abundance (determined from epifluorescence cell counts) and carbon prodution (estimated by 3H thymidine uptake rate) ranged from 0.27 to 19.4 x 109 cells l-1 and 0.06 to 19.0 &mu;g C l^-1 hr^-1 respectively with specific growth rates of 0.02 to 0.2 hr^-1. These estimates suggested that bacterial production required a substantial input of dissolved organic carbon into the estuary which is at least in part supplied by phytoplankton primary production in the estuary. The temporal and spatial distribution of bacterial parameters covaried with phytoplankton biomass (determined by chlorophyll a concentration). Heterotrophic microflagellate abundance determined by epifluorescence microscopy ranged from 0.5 to 9.8 x 10^6 cells l^-1. The estimated grazing rates were consistent with bacterial growth rates which suggests these organisms to be the dominant bacteriovores in the estuary. In a second phase of this study, the bioenergetics and physiology of a heterotrophic microflagellate (identified as colourless Chrysomonad, diameter, 8 - 12&mu;m) isolated from Southampton Water were studied in batch cultures grown at 10, 15, and 20oC. The results indicated that the isolated phagotrophic microflagellate can effectively ingest bacteria at rates between 1 and 220 bacteria flagellate-1 hr-1 depending on the initial bacteria concentration and growth temperature. The growth rates, clearance rates and ingestion rates of the Chrysomonad isolate were determined at each temperature using a mixed bacterial culture as a food source. Measurements of the microflagellate respiration and ammonium excretion rates were determined using a combination of differential filtration and inhibitor. Rates of ammonium excretion and respiration of the microflagellate showed an increase over the range of growth temperatures used. Estimates of ammonium excretion rates were consistently higher in cultures of microflagellates with added prokaryotic inhibitors than those with `active' bacterial cells. The differences were attributed to bacterial uptake of excreted ammonium. Results from this study have established that bacteria can form an important component of the plankton in productive estuaries and seasonal changes in their abundance and secondary production are correlated with phytoplankton biomass. The bacterioplankton were actively grazed by heterotrophic microflagellates at rates consistent with bacterial growth rate. The possible role of these microflagellate bacteria grazers in the estuarine plankton is discussed with reference to the flow of energy to higher trophic levels through the `microbial loop'.</p

Revista de información de la Comisión Nacional Española de Cooperación con la UNESCO

Título anterior de la publicación : Boletín de la Comisión Española de la UNESCOSe presenta una versión abreviada del discurso que ofreció el Director de la Sección del Patrimonio Cultural de Nigeria, Ekpo Okpo Eyo, en una conferencia celebrada en Washington con el copatrocinio de la Unesco y la Smithsonian Institution de Estados Unidos. En su discurso el Sr. Okpo se refiere al escaso acceso que tienen los países del tercer mundo a su propio Patrimonio Cultural ya que, estas obras fueron expoliadas y no han retornado a sus países de origen alegando que aquellos pueblos no entenderían el significado artístico de las mismas o bien, alegando excusas de posible deterioro por casusas medioambientales. Por otro lado, también acusa a las autoridades competentes de los países occidentales de la inoperancia ante el conocimiento del tráfico de bienes culturales de los países pobres y de los saqueos a los tesoros artísticos africanos que se realizan de manera constante y abierta en los que, se roban piezas únicas de culto para el pueblo africano poniéndose posteriormente a la venta para que museos poco escrupulosos los adquieran para formar parte de sus colecciones.Ministerio Educación CIDEBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]