How far are we from adhering to national asthma guidelines: The awareness factor

AbstractBackgroundThe Saudi national asthma protocol (SNAP) for asthma management was released in 1995 in an attempt to streamline asthma management practices in Saudi Arabia and improve the quality of care for asthma. Up to our knowledge, few studies assessed the adherence of Saudi physicians to the national asthma guidelines.ObjectivesThe objective of this present study was to assess the level of adherence of pediatricians and primary care physicians (PCPs) to the current SNAP recommendations and identify barriers to physician adherence.MethodologyThis is a cross-sectional study involving pediatricians and PCPs selected randomly from five major governmental hospitals in Riyadh, Saudi Arabia. Subjects were administered a self-administered questionnaire comprising 24 questions assessing their awareness of SNAP and their level of adherence to the recommendations.ResultsThe response rate was 38% (80/206). Out of most of the physicians who responded, 70% (56) were aware of SNAP, and only 78.2% (n=43) of them had modified their management of asthmatic patients according to the SNAP recommendations. The level of knowledge of the pharmacotherapy and diagnostic parts of the guidelines ranged between 41.5% and 90.7% in the pharmacotherapy part, and 53.7–59.6% in the diagnostic part. The most common barriers to adherence to SNAP were lack of awareness (25.2%), patient non- compliance (18.9%) and lack of resources (13.5%). There was no significant difference in awareness between pediatricians and PCPs (69.2%, 70.7% respectively).ConclusionThis study reveals a substantial gap between the actual care provided by pediatricians and PCPs to asthmatic patients and the recommendations formulated in the Saudi National Asthma Protocol (SNAP). Lack of awareness remains the most common barrier for adherence to the guidelines followed by patient non-compliance. To improve SNAP guideline adherence, tailored interventions that address barriers to adherence need to be implemented

The income and food security impacts of soil and water conservation technologies in Tanzania

Open Access JournalSoil and water conservation technologies are critical in reducing drought and soil erosion risks and increasing crop yields and incomes. Yet, there is limited empirical evidence on the extent and impacts of adopting soil and water conservation technologies in Tanzania. The study’s objective is to evaluate the adoption (as well as the duration of adoption) and the impacts of soil and water conservation technologies on income and food security in Tanzania. The study employs a control function approach and the instrumental variable quantile treatment effects model to survey data from 575 households to estimate the average and distributional impacts of adoption. The results show that the adoption and duration of adopting soil and water conservation technologies had significant and positive effects on the total value of crop production and household income. Moreover, we find that the adoption and its duration had a significant and positive impact on the food security indicator—household dietary diversity. The results from the instrumental variable quantile treatment effects model also show that the impacts of adopting soil and water conservation technologies on the outcome variables are positive and significant, although they vary significantly across the income and food security distributions. The results indicate that even though adoption benefits households in both the lower and upper quantiles of the income and food security distributions, the marginal impacts of adoption are generally more significant for the households in the upper quantiles. The paper concludes by discussing the policy options for increasing and sustaining the adoption and impacts of soil and water conservation technologies in Tanzania

Distribution of Pseudocercospora species causing Sigatoka leaf diseases of banana in Uganda and Tanzania

Open Access Article; Published online: 11 Oct 2019Sigatoka leaf diseases are a major constraint to banana production. A survey was conducted in Tanzania and Uganda to assess the distribution of Pseudocercospora species and severity of Sigatoka leaf diseases. Pseudocercospora species were identified using species‐specific primers. Sigatoka‐like leaf diseases were observed in all farms and on all cultivars, but disease severity varied significantly (P < 0.001) between countries, districts/regions within countries, altitudinal ranges and banana cultivars. In all regions except Kilimanjaro, P. fijiensis, the causal agent of black Sigatoka, was the only pathogen associated with Sigatoka disease. Mycosphaerella musae was associated with Sigatoka‐like symptoms in Kilimanjaro region. Black Sigatoka disease was more severe in Uganda, with a mean disease severity index (DSI) of 37.5%, than in Tanzania (DSI = 19.9%). In Uganda, black Sigatoka disease was equally severe in Luwero district (mean DSI = 40.4%) and Mbarara district (mean DSI = 37.9%). In Tanzania, black Sigatoka was most severe in Kagera region (mean DSI = 29.2%) and least in Mbeya region (mean DSI = 11.5%). Pseudocercospora fijiensis, the most devastating sigatoka pathogen, was detected at altitudes of up to 1877 m a.s.l. This range expansion of P. fijiensis, previously confined to altitudes lower than 1350 m a.s.l. in East Africa, is of concern, especially for smallholder banana farmers growing the susceptible East African Highland bananas (EAHB). Among the banana varieties sampled, the EAHB, FHIA hybrids and Mchare were the most susceptible. Here, the loss of resistance in Yangambi KM5, a banana variety previously resistant to P. fijiensis, is reported for the first time

Distribution of Pseudocercospora species causing Sigatoka leaf diseases of banana in Uganda and Tanzania

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Telecytology in East Africa: a feasibility study of forty cases using a static imaging system

We conducted a pilot study to assess the feasibility of telecytology as a diagnostic tool in difficult cases originating from a hospital in East Africa. Forty cytology cases considered difficult by a referring pathologist were posted on a telepathology website. Six pathologists independently assessed the static images. Telecytology diagnoses were compared with the consensus diagnoses made on glass slides and also with the histogical diagnoses when available. The diagnostic agreement of the six pathologists was 71–93% and tended to be higher for pathologists with more experience. Reasons for discordance included poor image quality, presence of diagnostic cells in thick areas of smears, sampling bias and screening errors. The consensus diagnoses agreed with histological diagnoses in all 17 cases in which a biopsy was performed. Diagnostic accuracy rates (i.e. telecytology diagnosis vs. histological diagnosis) for individual pathologists were 65–88%. To ensure diagnostic accuracy both referring and consulting pathologists must have adequate training in cytology, image acquisition and image-based diagnosis and the diagnostic questions of importance must be clearly communicated by the referring pathologist when posting a case