Quality of Neonatal Health Care: Learning From Health Workers’ Experiences in Critical Care in Kilimanjaro Region, Northeast Tanzania

Neonatal deaths are generally attributed to suboptimal standards of health care. Health care worker motivation and adherence to existing guidelines are rarely studied. To assess the performance of health workers for neonatal health care in the hospitals of Kilimanjaro region. A descriptive study using a semi-structured interview for health care workers at a tertiary referral hospital and peripheral health facilities (regional referral, district hospitals and health centres).was used. Health Care Workers (HCW) were asked to recall a scenario of a critically ill neonate admitted in the wards and the treatment that was provided. The WHO Emergency Triage Assessment and Treatment (ETAT) guidelines were used as a standard reference for knowledge of critical care. Birth asphyxia was the most recalled health problem requiring critical care, reported by 27.5% of 120 HCW at both peripheral hospitals and by 46.4% of 28 health workers in tertiary referral centres. Half of the HCW commented on their own performance (47.5%, n=140). HCW presented with low to moderate levels of knowledge for critical care were at 92%. Supplementary training was associated with a higher levels of knowledge of neonatal critical care (p value = 0.05). HCW in peripheral hospital had lower levels of knowledge (only 44.7% at peripheral hospitals had sufficient ratings compared to 82.1% at the referral centre). [Pearson χ2 (2) = 12.10, p value = 0.002]. Guided Practical-Competence Diagnostic Specific neonatal health care training is highly needed in the peripheral facilities of rural Kilimanjaro region

What’s on your keyboard? A systematic review of the contamination of peripheral computer devices in healthcare settings

Objective To determine the extent and type of microbial contamination of computer peripheral devices used in healthcare settings, evaluate the effectiveness of interventions to reduce contamination of these devices and establish the risk of patient and healthcare worker infection from contaminated devices. Design Systematic review Methods We searched four online databases: MEDLINE, CINAHL, Embase and Scopus for articles reporting primary data collection on contamination of computer-related equipment (including keyboards, mice, laptops and tablets) and/or studies demonstrating the effectiveness of a disinfection technique. Pooling of contamination rates was conducted where possible, and narrative synthesis was used to describe the rates of device contamination, types of bacterial and viral contamination, effectiveness of interventions and any associations between device contamination and human infections. Results Of the 4432 records identified, a total of 75 studies involving 2804 computer devices were included. Of these, 50 studies reported contamination of computer-related hardware, and 25 also measured the effects of a decontamination intervention. The overall proportion of contamination ranged from 24% to 100%. The most common microbial contaminants were skin commensals, but also included potential pathogens including methicillin-resistantStaphylococcus aureus, Clostridiumdifficile, vancomycin-resistantenterococci and Escherichia coli. Interventions demonstrating effective decontamination included wipes/pads using isopropyl alcohol, quaternary ammonium, chlorhexidine or dipotassium peroxodisulfate, ultraviolet light emitting devices, enhanced cleaning protocols and chlorine/bleach products. However, results were inconsistent, and there was insufficient data to demonstrate comparative effectiveness. We found little evidence on the link between device contamination and patient/healthcare worker colonisation or infection

Enhancing Information Quality as Part of the Disease Surveillance System in Malawi, Africa: Reflections on a mHealth Intervention

Public health surveillance and response to disease outbreaks is still a hurdle in many developing countries across sub-Saharan Africa. Pivotal in disease surveillance and response is the reliance on valid information, hence, the need for information which has high Information Quality (IQ) characteristics. A key issue with disease surveillance systems, stem from the diverse range of data sources with various levels of information quality that may affect the trustworthiness of the information. However, with the increasing diffusion of mobile phone technologies, there are opportunities to improve IQ. The aim of this study was to assess the information quality in data collected through a smartphone application. Based on qualitative data from interviews, workshop and system specifications, it was found that information quality improves with the use of smartphone applications but aspects such as user competence and trustworthiness, must be addressed to maximize the benefits of using mobile technologies for disease surveillance

Penalized Partial Least Squares Based on B-Splines Transformations

We propose a novel method to model nonlinear regression problems by adapting the principle of penalization to Partial Least Squares (PLS). Starting with a generalized additive model, we expand the additive component of each variable in terms of a generous amount of B-Splines basis functions. In order to prevent overfitting and to obtain smooth functions, we estimate the regression model by applying a penalized version of PLS. Although our motivation for penalized PLS stems from its use for B-Splines transformed data, the proposed approach is very general and can be applied to other penalty terms or to other dimension reduction techniques. It turns out that penalized PLS can be computed virtually as fast as PLS. We prove a close connection of penalized PLS to the solutions of preconditioned linear systems. In the case of high-dimensional data, the new method is shown to be an attractive competitor to other techniques for estimating generalized additive models. If the number of predictor variables is high compared to the number of examples, traditional techniques often suffer from overfitting. We illustrate that penalized PLS performs well in these situations

Organophosphonate bridged anatase mesocrystals: low temperature crystallization, thermal growth and hydrogen photo-evolution

The sol-gel co-condensation of organo-phosphonates to titanium alkoxides enables access to novel organic-inorganic hybrids based on phosphonate-bridged titanium dioxide. In this contribution, we bring new perspectives to the long established sol-gel mineralization of titanium alkoxide species, by harnessing the virtues of the well-designed phosphonate-terminated phosphorus dendrimers as reactive amphiphilic nanoreactor, confined medium and cross-linked template to generate discrete crystalline anatase nanoparticles at low temperature (T = 60 degrees C). An accurate investigation on several parameters (dendrimer generation, dendrimer-to-titanium alkoxide ratio, precursor reactivity, temperature, solvent nature, salt effect) allows a correlation between the network condensation, the opening porous framework and the crystalline phase formation. The evolution of the dendrimer skeleton upon heat treatment has been deeply monitored by means of P-31 NMR, XPS and Raman spectroscopy. Increasing the heteroatom content within a titania network provides the driving force for enhancing their photocatalytic water splitting ability for hydrogen production.Brahmi, Y.; Katir, N.; Macia Agullo, JA.; Primo Arnau, AM.; Bousmina, M.; Majoral, J.; García Gómez, H.... (2015). Organophosphonate bridged anatase mesocrystals: low temperature crystallization, thermal growth and hydrogen photo-evolution. Dalton Transactions. 44(35):15544-15556. doi:10.1039/c5dt02367jS1554415556443

Quality of Neonatal Healthcare in Kilimanjaro Region, Northeast Tanzania: Learning from Mothers' Experiences.

With a decline of infant mortality rates, neonatal mortality rates are striking high in development countries particularly sub Saharan Africa. The toolkit for high quality neonatal services describes the principle of patient satisfaction, which we translate as mother's involvement in neonatal care and so better outcomes. The aim of the study was to assess mothers' experiences, perception and satisfaction of neonatal care in the hospitals of Kilimanjaro region of Tanzania. A cross sectional study using qualitative and quantitative approaches in 112 semi structured interviews from 14 health facilities. Open ended questions for detection of illness, care given to the baby and time spent by the health worker for care and treatment were studied. Probing of the responses was used to extract and describe findings by a mix of in-depth interview skills. Closed ended questions for the quantitative variables were used to quantify findings for statistical use. Narratives from open ended questions were coded by colours in excel sheet and themes were manually counted. 80 mothers were interviewed from 13 peripheral facilities and 32 mothers were interviewed at a zonal referral hospital of Kilimanjaro region. 59 mothers (73.8%) in the peripheral hospitals of the region noted neonatal problems and they assisted for attaining diagnosis after a showing a concern for a request for further investigations. 11 mothers (13.8%) were able to identify the baby's diagnosis directly without any assistance, followed by 7 mothers (8.7%) who were told by a relative, and 3 mothers (3.7%) who were told of the problem by the doctor that their babies needed medical attention. 24 times mothers in the peripheral hospitals reported bad language like "I don't have time to listen to you every day and every time." 77 mothers in the periphery (90.6%) were not satisfied with the amount of time spent by the doctors in seeing their babies. Mothers of the neonates play great roles in identifying the illness of the newborn. Mother's awareness of what might be needed during neonatal support strategies to improve neonatal care in both health facilities and the communities

DNA Damage and Reactive Nitrogen Species are Barriers to Vibrio cholerae Colonization of the Infant Mouse Intestine

Ingested Vibrio cholerae pass through the stomach and colonize the small intestines of its host. Here, we show that V. cholerae requires at least two types of DNA repair systems to efficiently compete for colonization of the infant mouse intestine. These results show that V. cholerae experiences increased DNA damage in the murine gastrointestinal tract. Agreeing with this, we show that passage through the murine gut increases the mutation frequency of V. cholerae compared to liquid culture passage. Our genetic analysis identifies known and novel defense enzymes required for detoxifying reactive nitrogen species (but not reactive oxygen species) that are also required for V. cholerae to efficiently colonize the infant mouse intestine, pointing to reactive nitrogen species as the potential cause of DNA damage. We demonstrate that potential reactive nitrogen species deleterious for V. cholerae are not generated by host inducible nitric oxide synthase (iNOS) activity and instead may be derived from acidified nitrite in the stomach. Agreeing with this hypothesis, we show that strains deficient in DNA repair or reactive nitrogen species defense that are defective in intestinal colonization have decreased growth or increased mutation frequency in acidified nitrite containing media. Moreover, we demonstrate that neutralizing stomach acid rescues the colonization defect of the DNA repair and reactive nitrogen species defense defective mutants suggesting a common defense pathway for these mutants