The nominal group technique for participating communities in analyzing rural town water and sanitation situation

Abstract: To explore sanitation problems and their causes, a series of independent group discussions was conducted with residents of a rural town stratified into seven social levels using the Nominal Group [Discussion] Technique (NGT). Indiscriminate open field defecation and garbage disposal were the two most mentioned and ranked problem items followed by unsanitary food and drink services. The top identified cause items were absence of public latrines, failure of the municipality to control town sanitation and absence of solid waste disposal facilities. A Combined group gave the highest Median Agreement Score (MAS) of 10. The smallest median agreement was scored by Youth and Health workers' groups (MAS=6.5) for mentioned, and by youth and Ordinary residents'groups (MAS=4.5) for ranked problem items. Health workers' group (group 7) ranked MAS of 5. The MAS for causes of sanitation problems of the Combined group was 8 for mentioned, and MAS of 4 for ranked items. Development workers ought to give due recognition to communal stratification when making need assessment for better realignment of diverse view points and interests during project development. Modifying and validating NGT for a broader use in assessing community health problems and needs is suggested. [Ethiop. J. Health Dev. 1997;11(1):37-42

Epidemic prone diseases in Ethiopia EPHA Expert Group report

Infectious agents have caused disease and death in human populations throughout history . Some of the most devastating epidemics ever recorded have been caused by uncontrollable spread of dangerous human pathogens. The plague epidemic of the middle ages was responsible for the death of 13 million people in Europe during a four-year period (1). More recently, in the first part of the century , pandemic influenza swept the world by killing 20 million people in less than a Year's time (1). At present the world population is affected by devastating epidemics that have resulted in high morbidity and mortality

Cd20 Expression and Effects on Outcome of Relapsed/ Refractory Diffuse Large B Cell Lymphoma after Treatment with Rituximab

Introduction: Down regulation of CD20 expression has been reported in diffuse large B cell lymphoma (DLBCL)). Therefore, it is important to determine whether chemotherapy with rituximab induces CD20 down regulation and effects survival. Objectives: To determine the incidence of down regulation of CD20 expression in relapsed DLBCL after treatment with rituximab and to compare outcomes and assess pattern of relapse between CD20 negative and CD20 positive cases. Methodology: We retrospectively reviewed patients with relapsed DLBCL who received rituximab in the first line setting at Aga Khan University Hospital between January 2007 and December 2014. Data were recorded on predesigned questionnaires, with variables including demographics, details regarding date of diagnosis and relapse, histology, staging, international prognostic index, treatment and outcomes at initial diagnosis and at relapse. The Chi square test was applied to determine statistical significance between categorical variables. Survival curves were generated by the Kaplan–Meier method. Results: A total of 54 patients with relapsed DLBCL were included in our study, 38 (70 %) males and 16(30%) females. Some 23 (43%) patients were at stage IV at the time of diagnosis and 34 (63%) had B symptoms. The most frequent R-IPI at diagnosis was II in 24 (44%) patients. Only 6 (11%) did not show CD20 expression on re-biopsy for relapsed/refractory disease, 2 with CD20 negative DLBCL responding to second line chemotherapy. A complete response after salvage chemotherapy was noted in 16 (29.6%) cases with relapsed/refractory DLBCL. Seven (13%) patients underwent an autologous bone marrow transplant as consolidation after second line treatment. Median overall survival was 18 months in CD20 positive vs. 13 months in CD20 negative patients. Conclusion: This study demonstrated that a small percentage of patients treated with rituximab lose their CD20 expression at the time of relapse. However, it is unclear whether this is associated with an inferior outcome

A case report of minimally invasive percutaneous ultrasound guided tuberculous iliopsoas abscess drainage in an immunocompromised patient

Introduction and importance Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered as causative agent in at risk individuals in tuberculous endemic regions. Management involves drainage and initiation of adequate antibiotics with radiological guided percutaneous approach considered the appropriate initial approach. Case presentation 50-year-old immunosuppressed presenting with left iliopsoas abscess who underwent ultrasound guided drainage and placement of pigtail catheter successfully without the need for open surgical drainage. Our experience of interventional radiology for diagnosis of causative agent and treatment in a sub-Saharan Africa. Clinical discussion We concur with the recommendation to analyse fluid for tuberculosis in at risk individuals with minimally invasive procedures via interventional radiology as an adequate first line diagnostic and treatment option of psoas abscess. Ultrasound guided catheter placement and drainage successfully drained the abscess by day 10 similarly seen as the average duration in a case series from India. Conclusion The importance of the role of interventional radiology in treatment for complex abdominal pathologies in sub-Saharan Africa with its ability to diagnose and treat via minimally invasive procedures at highest precision and lowest risks and complications while maintaining a high level of suspicion for tuberculosis as the underlying etiology is highlighted

A case report of minimally invasive percutaneous ultrasound guided tuberculous iliopsoas abscess drainage in an immunocompromised patient

Introduction and importance: Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered as causative agent in at risk individuals in tuberculous endemic regions. Management involves drainage and initiation of adequate antibiotics with radiological guided percutaneous approach considered the appropriate initial approach. Case presentation: 50-year-old immunosuppressed presenting with left iliopsoas abscess who underwent ultrasound guided drainage and placement of pigtail catheter successfully without the need for open surgical drainage. Our experience of interventional radiology for diagnosis of causative agent and treatment in a sub-Saharan Africa. Clinical discussion: We concur with the recommendation to analyse fluid for tuberculosis in at risk individuals with minimally invasive procedures via interventional radiology as an adequate first line diagnostic and treatment option of psoas abscess. Ultrasound guided catheter placement and drainage successfully drained the abscess by day 10 similarly seen as the average duration in a case series from India. Conclusion: The importance of the role of interventional radiology in treatment for complex abdominal pathologies in sub-Saharan Africa with its ability to diagnose and treat via minimally invasive procedures at highest precision and lowest risks and complications while maintaining a high level of suspicion for tuberculosis as the underlying etiology is highlighted

Stress, Motivation and Professional Satisfaction among Health Care Workers in HIV/AIDS Care and Treatment Centers in Urban Tanzania: A Cross-Sectional Study.

Shortages of health care workers (HCWs) represents a serious challenge to ensuring effective HIV care in resource-limited settings (RLS). Stress, motivation, and job satisfaction have been linked with HCW retention and are important in addressing HCW shortages. In this cross-sectional study HCW stress, motivation and perceived ability to meet patient needs were assessed in PEPFAR-supported urban HIV care and treatment clinics (CTCs) in Tanzania. A self-administered questionnaire measuring motivation, stress, and perceived ability to and meet patient needs was given to HCWs at 16 CTCs. Scales measuring HCW satisfaction, motivation, and stress were developed using principle components analysis. Hierarchical linear models were used to explore the association of HCW and site characteristics with reported satisfaction, stress, motivation, and ability to meet patients' needs.\ud Seventy-three percent (279) of HCWs completed the questionnaire. Most (73%) HCWs reported minimal/no work-related stress, with 48% reporting good/excellent motivation, but 41% also reporting feeling emotionally drained. Almost all (98%) reported feeling able to help their patients, with 68% reporting work as rewarding. Most reported receipt of training and supervision, with good availability of resources. In the multivariate model, direct clinical providers reported lower motivation than management (p < 0.05) and HCWs at medium-sized sites reported higher motivation than HCWs at larger sites (p < 0.05). HCWs at small and medium sites were more likely to feel able to help patients than those from larger sites (p < 0.05 and p < 0.001 respectively). Despite significant patient loads, HCWs in these PEPFAR-supported CTCs reported high levels of motivation, job satisfaction, ability to meet patients' needs, low levels of stress but significant emotional toll. Understanding the relationship between support systems such as strong supervision and training and these outcomes is critical in designing interventions to improve motivation, reduce stress and increase retention of HCWs

Catalyst Role of University Green Entrepreneurial Support Promoting Green Entrepreneurial Inclinations Among Youth: Empirical Evidence from Oman

Purpose: The primary purpose of this paper is to investigate the green entrepreneurial inclination of youth and sustainable development in Sultanate of Oman. It has a secondary objective of stimulating more research in areas identified as still being under‐explored.   Theoretical framework: The framework is developed covering the personality factors, support factors and inclination towards green entrepreneurship furthermore the moderating role of institutional support has been inculcated.   Design/Methodology/Approach: The paper is discursive using quantitative research methodology, based on analysis and synthesis of green entrepreneurial literature the framework was developed. The data has been collected from 384 students studying in Dhofar University and University and Technology and Applied Sciences, Salalah. Structural Equation modelling has been conducted to test the model.   Findings: Despite a broad spectrum of disciplines that investigate green entrepreneurial inclination and despite this special issue in the area of entrepreneurship, there are still areas open for research into green entrepreneurial intentions. The paper develops a model to explain green entrepreneurial inclination.   Research limitations/Implications: As a conceptual paper, the study is limited to literature and prior empirical research. It offers the benefit of new research directions for researchers/ universities in understanding and promoting the culture of green entrepreneurship among university students. The paper provides researchers with a proposed and tested integrated model of green entrepreneurial inclination.   Originality/Value: The paper links a significant body of literature within a unifying theoretical framework and identifies under‐researched areas of green entrepreneurial inclination of youth in an entrepreneurship context

Does globalization affect the green economy and environment? The relationship between energy consumption, carbon dioxide emissions, and economic growth [correction]

A Correction to this paper has been published.This study analyzes the relationship between globalization, energy consumption, and economic growth among selected South Asian countries to promote the green economy and environment. This study also finds causal association between energy growth and nexus of CO2 emissions and employed the premises of the EKC framework. The study used annual time series analysis, starting from 1985 to 2019. The data set has been collected from the World Development Indicator (WDI). The result of a fully modified ordinary least square (FMOLS) method describes a significantly worse quality environment in the South Asian region. The individual country as Bangladesh shows a positively significant impact on the CO2 emissions and destroys the level of environment regarding non-renewable energy and globalization index. However, negative and positive growth levels (GDP) and square of GDP confirm the EKC hypothesis in this region. This study has identified the causality between GDP growth and carbon emission and found bidirectional causality between economic growth and energy use.WOS:00066917970001

Residency training on the frontlines of the COVID-19 pandemic - a qualitative study from Tanzania

Introduction:&nbsp;the Coronavirus Disease 2019 pandemic has affected residency training globally. The aim of this study was to understand how the pandemic affected teaching and learning in residency programs in low resource settings where residents and faculty were working on the front line treating patients with the disease. Methods:&nbsp;this qualitative study enrolled residents and faculty from the Aga Khan University in Tanzania who were providing front line care during the pandemic. Purposeful sampling was used and data was collected using focus group discussions and in-depth interviews between August and September 2020. Analysis was done using qualitative content analysis. Results:&nbsp;twelve residents and six faculty members participated in this study. Two main themes emerged. The first was: “New and unfamiliar teaching and learning experiences.” Residents and faculty had to adapt to changes in the learning environment and the academic program. Residents had increased responsibilities, including providing front line care and working with reduced supervision. The second theme was: “Learning opportunities amidst crisis.” There were opportunities to improve critical care and procedural skills. They also had opportunities to improve non-technical skills like teamwork and communication. Conclusion:&nbsp;residents and faculty had to adapt to changes in teaching and learning. Residents also had to take up additional responsibilities. Support systems are required to help them adapt to the changes and settle in their new roles. There were opportunities to learn new skills, and training should be restructured to maximize the use of these opportunities

Residency training on the frontlines of the COVID-19 pandemic - a qualitative study from Tanzania

Introduction: the Coronavirus Disease 2019 pandemic has affected residency training globally. The aim of this study was to understand how the pandemic affected teaching and learning in residency programs in low resource settings where residents and faculty were working on the front line treating patients with the disease. Methods: this qualitative study enrolled residents and faculty from the Aga Khan University in Tanzania who were providing front line care during the pandemic. Purposeful sampling was used and data was collected using focus group discussions and in-depth interviews between August and September 2020. Analysis was done using qualitative content analysis. Results: twelve residents and six faculty members participated in this study. Two main themes emerged. The first was: New and unfamiliar teaching and learning experiences. Residents and faculty had to adapt to changes in the learning environment and the academic program. Residents had increased responsibilities, including providing front line care and working with reduced supervision. The second theme was: Learning opportunities amidst crisis. There were opportunities to improve critical care and procedural skills. They also had opportunities to improve non-technical skills like teamwork and communication. Conclusion: residents and faculty had to adapt to changes in teaching and learning. Residents also had to take up additional responsibilities. Support systems are required to help them adapt to the changes and settle in their new roles. There were opportunities to learn new skills, and training should be restructured to maximize the use of these opportunities