Assessment of factors associated with diabetic retinopathy among diabetic patients in Zambia

Background: Diabetes Mellitus is an emerging public health problem in Africa. Evidence suggests that globalization, rapid urbanization and a nutritional transition have led to the rise in the prevalence of diabetes mellitus in Africa. Diabetic retinopathy is a common complication of diabetes mellitus that causes visual impairment and subsequent blindness. Early detection and prompt treatment can prevent blindness in up to 90% of patients. The common risk factors for diabetic retinopathy include hypertension, hyperglycemia and long duration of diabetes. Other risk factors include obesity, hyperlipidemia, smoking, puberty and pregnancy. There is limited data on diabetic retinopathy and its associated risk factors in Zambia. An understanding of these factors would help in the effective management of diabetic retinopathy. Methods: A secondary data analysis of data obtained from a hospital-based cross-sectional study of diabetic patients attending diabetic clinics in the Copperbelt Province in Zambia was carried out. All diabetic patients that attended the retinopathy-screening program between April 2012 and September 2012 were eligible for the primary study. The secondary data analysis was restricted to patients 18 years and older. Data analysis was carried out by R version 3.3.1. The characteristics of the study population were summarized using descriptive statistics. Univariate logistic regression analysis was used to select potential candidates for the multivariate regression model at p-value cutoff point ≤ 0.25 and variables of known clinical relevance were also included in the multivariable analysis. The final model fitness was checked using Hosmer and Lemeshow chi-square test. Finally, statistical significance was tested at P-value <0.05. Results: The prevalence of diabetic retinopathy was 19.4%. Multivariate analysis showed that the odds of diabetic retinopathy were significantly associated with age (OR =1.05: 95%Cl; 1.03-1.06), duration (OR=1.39: 95%Cl; 1.27-1.52), weight (OR =0.98: 95%Cl; 0.97-0.98), blood glucose (OR =1.04: 95Cl; 1.02-1.07) and systolic blood pressure (OR = 1.01: 95Cl; 1.00-1.02). Conclusion: Duration of diabetes, age, systolic blood pressure, weight and blood glucose levels were significantly associated with diabetic retinopathy in this study. More comprehensive population screening strategies and treatment programs addressing these risk factors should be put in place

A study to explore the role of community disability workers in facilitating livelihood opportunities for disabled youth in rural areas of Southern Botswana

Purpose: This study aimed to explore the role of Community Disability Workers (CDWs) in facilitating livelihood opportunities for disabled youth in rural Southern Botswana. The CDWs in the study worked in Community- based Rehabilitation (CBR) programmes. The elements of the Livelihood component of CBR Guidelines include skills development, self-employment, waged employment, financial assistance and social security. In particular, the study presented the knowledge, skills, practices (activities and methods), and strategies used by CDWs to facilitate access to the livelihood opportunities for disabled youths in rural areas. The literature review explored CBR as a strategy for addressing the needs and demands of people with disabilities. Botswana has implemented a CBR programme which is co-ordinated at the Rehabilitation Division of the Ministry of Health and involves disabled people, health professionals, the community and Non-Governmental Organisations (NGOs). Community health workers coordinate disability activities in rural as well as urban areas and comprise a range of health care practitioners namely physiotherapists, social workers, rehabilitation technicians, rehabilitation officers and health education assistants. In this study, community health workers were referred to as CDWs and only those with tertiary qualifications (certificate, diploma or degree level of training) were used as participants. Methodology: A qualitative research approach using a case study design was adopted. Purposive sampling was used to select seven participants from districts in the southern part of Botswana to participate in the study. The unit of study were the practices of the CDW in facilitating access to livelihood opportunities for disabled youth. Qualitative data was collected through semi-structured interviews with the CDWs. Interviews were digitally recorded and later transcribed verbatim. Analysis of data involved coding for themes and categories emerging from the data in the context within which it appeared. The environmental chapters of the International Classification of Functioning, Disability and Health (ICF) were used for data interpretation. Findings: The findings of the study illustrated the role of CDWs in facilitating livelihood opportunities for disabled youth. Five themes that emerged were related to CDWs’ own experience of disability and rural environments, their knowledge and experience in facilitating livelihoods; their practices and strategies; the barriers to participation experienced by disabled youth; and lastly, the CDWs’ suggestions for increasing participation and inclusion of disabled youth in livelihood opportunities. The findings established that CDWs were involved in facilitating access to health facilities and assistive devices as well as education and skills development. Some strategies used were advocacy, networking, information dissemination, role modelling and follow-ups on former students. The barriers identified were inadequate disability policy; absence of disability friendly public facilities and transport; a poorly resourced public education system and inaccessible job markets. Suggestions made by CDWs included having inclusive policies and structures; addressing educational and training needs; accountability regarding employment; and community sensitisation and mobilisation. The Discussion chapter interpreted the findings in terms of current literature and developed two further themes. One addressed the environmental factors impacting on disability and the other one addressed successful strategies to enhance livelihood opportunities in light of these environmental factors. Recommendations included facilitating information on accessibility of assistive devices; minimising barriers to natural and made-made changes to the environment; building a network of supportive relationships; changing attitudes of community as well as government leadership; and facilitating implementation of inclusive services, systems and policies. In Conclusion, CDWs are well placed to facilitate accessibility of livelihood opportunities for disabled youth. However, they need to be empowered with necessary resources such as disability inclusive policies, systems and services, attitudinal changes and revision of their training modules

Health Policy and Agenda Setting in Contemporary Zambia: the human resources for health strategic plan (2006-2010)

Masters in Public Administration - MPAAgenda setting is about how some issues get onto the policy agenda for discussion and action why others do not. Drawing critically on the ―policy windows‖ approach of J.W Kingdon (2003) this dissertation will describe and explain the shifting of policy agendas in health with reference to human resources in Zambia between 2000 and 2006. This research explores how and why the issue of human resource shortages in health became prominent on the state‘s agenda in 2005.The research is a qualitative study and data was collected using both primary and secondary sources of data across various stakeholders in the country. It tested the applicability of Kingdon‘s conceptual framework to a case study of Zambian health policy by analysing the degree to which agenda-formation is influenced by such factors as issue definition, the presence of policy alternatives, presidential support, interest group advocacy, media attention, political cycles, and public opinion. The general elections scheduled for the following year, coupled with media attention and strong public action contributed to the selection of the human resource crisis as an issue on the state‘s agenda for serious action. Furthermore, the slow progress on the attainment of the health related Millennium Development Goals and the poor performance of some donor funded programmes necessitated the state to act. Despite some weaknesses, Kingdon‘s multiple streams approach was found to be useful in explaining the agenda-setting of the Human Resources for Health Strategic Plan (2006-2010) in Zambia

Reforming the value added tax in Zambia.

This study analyses the reform of value added tax (VAT) in Zambia. It does so by firstly, empirically establishing who pays VAT and secondly by investigating the economic impact of broadening the VAT base. Two options on reforms to broaden the VAT base are considered using a computable general equilibrium model which specifies a VAT with rebates. These are: (a) broadening the VAT base to all sectors and (b) broadening the VAT base to the agricultural sectors except the maize sector which is the source of the country’s staple. The results in general suggest that VAT is mildly regressive. However, the VAT burden is borne more heavily by urban households compared to rural households. In particular, VAT paid on food is borne more heavily by urban households. The results also suggest that in the short-run broadening the VAT base to all sectors has the ability to raise additional revenue but has adverse effects on the economy, particularly on household welfare. Nevertheless, the adverse effects are muted if VAT broadening is accompanied by reduction in the VAT rate. Furthermore, results on the reform that extends the VAT base to the agricultural sectors except the maize sector, has minimal effects on the macro economy, raises some additional revenue and adversely affects the welfare of urban households compared to rural households. At sectoral level, results reveal that in the short-run broadening the VAT base engenders a resource allocation within value-added that is beneficial to the mobile factor, labour due to the impact of rebates on relative prices of intermediate inputs. In addition to this, results show the importance of a well functioning rebate system on the economy. The imperfections in the rebate system are likely to affect the welfare implications of changes to VAT. Results suggest that welfare losses from broadening the VAT base fall with an improvement in the functioning of the rebate system. The conclusions and recommendations from the foregoing are as follows. Given that that the burden of VAT is largely borne by urban households who are relatively better off compared to the rural households, VAT can be extended to cover some of the currently exempted items at low welfare cost. This would create fiscal space to undertake more activities as envisaged in the Fifth National Development Plan. Secondly, extending the VAT coverage to all sectors with very minimal or no exclusions should be accompanied with reductions in the VAT rate. Furthermore, contrary to the widely held view in the debate on VAT reform in Zambia, extending the VAT coverage to agricultural sectors apart from maize sector is not likely to hurt the worse-off socio-economic groups. The short-run welfare losses of such a reform appear to be more disproportionately borne by the urban households whose incidence of poverty is low compared to the rural households. Therefore, bringing more agricultural commodities under VAT coverage provides one of the viable options to reforming VAT in Zambia

Fusion Pore Diameter Regulation by Cations Modulating Local Membrane Anisotropy

The fusion pore is an aqueous channel that is formed upon the fusion of the vesicle membrane with the plasma membrane. Once the pore is open, it may close again (transient fusion) or widen completely (full fusion) to permit vesicle cargo discharge. While repetitive transient fusion pore openings of the vesicle with the plasma membrane have been observed in the absence of stimulation, their frequency can be further increased using a cAMP-increasing agent that drives the opening of nonspecific cation channels. Our model hypothesis is that the openings and closings of the fusion pore are driven by changes in the local concentration of cations in the connected vesicle. The proposed mechanism of fusion pore dynamics is considered as follows: when the fusion pore is closed or is extremely narrow, the accumulation of cations in the vesicle (increased cation concentration) likely leads to lipid demixing at the fusion pore. This process may affect local membrane anisotropy, which reduces the spontaneous curvature and thus leads to the opening of the fusion pore. Based on the theory of membrane elasticity, we used a continuum model to explain the rhythmic opening and closing of the fusion pore

Adhesion of osteoblasts to a nanorough titanium implant surface

This work considers the adhesion of cells to a nanorough titanium implant surface with sharp edges. The basic assumption was that the attraction between the negatively charged titanium surface and a negatively charged osteoblast is mediated by charged proteins with a distinctive quadrupolar internal charge distribution. Similarly, cation-mediated attraction between fibronectin molecules and the titanium surface is expected to be more efficient for a high surface charge density, resulting in facilitated integrin mediated osteoblast adhesion. We suggest that osteoblasts are most strongly bound along the sharp convex edges or spikes of nanorough titanium surfaces where the magnitude of the negative surface charge density is the highest. It is therefore plausible that nanorough regions of titanium surfaces with sharp edges and spikes promote the adhesion of osteoblasts

Temperature and cholera toxin B are factors that influence formation of membrane nanotubes in RT4 and T24 urothelial cancer cell lines

The growth of membrane nanotubes is crucial for intercellular communication in both normal development and pathological conditions. Therefore, identifying factors that influence their stability and formation are important for both basic research and in development of potential treatments of pathological states. Here we investigate the effect of cholera toxin B (CTB) and temperature on two pathological model systems: urothelial cell line RT4, as a model system of a benign tumor, and urothelial cell line T24, as a model system of a metastatic tumor. In particular, the number of intercellular membrane nanotubes (ICNs; ie, membrane nanotubes that bridge neighboring cells) was counted. In comparison with RT4 cells, we reveal a significantly higher number in the density of ICNs in T24 cells not derived from RT4 without treatments (P = 0.005), after 20 minutes at room temperature (P = 0.0007), and following CTB treatment (P = 0.000025). The binding of CTB to GM1–lipid complexes in membrane exvaginations or tips of membrane nanotubes may reduce the positive spontaneous (intrinsic) curvature of GM1–lipid complexes, which may lead to lipid mediated attractive interactions between CTB–GM1–lipid complexes, their aggregation and consequent formation of enlarged spherical tips of nanotubes. The binding of CTB to GM1 molecules in the outer membrane leaflet of membrane exvaginations and tips of membrane nanotubes may also increase the area difference between the two leaflets and in this way facilitate the growth of membrane nanotubes

The role of cholesterol-sphingomyelin membrane nanodomains in the stability of intercellular membrane nanotubes

Intercellular membrane nanotubes (ICNs) are highly curved tubular structures that connect neighboring cells. The stability of these structures depends on the inner cytoskeleton and the cell membrane composition. Yet, due to the difficulty in the extraction of ICNs, the cell membrane composition remains elusive. In the present study, a raft marker, ostreolysin, revealed the enrichment of cholesterol-sphingomyelin membrane nanodomains along ICNs in a T24 (malignant) urothelial cancer cell line. Cholesterol depletion, due to the addition of methyl-β-cyclodextrin, caused the dispersion of cholesterol-sphingomyelin membrane nanodomains and the retraction of ICNs. The depletion of cholesterol also led to cytoskeleton reorganization and to formation of actin stress fibers. Live cell imaging data revealed the possible functional coupling between the change from polygonal to spherical shape, cell separation, and the disconnection of ICNs. The ICN was modeled as an axisymmetric tubular structure, enabling us to investigate the effects of cholesterol content on the ICN curvature. The removal of cholesterol was predicted to reduce the positive spontaneous curvature of the remaining membrane components, increasing their curvature mismatch with the tube curvature. The mechanisms by which the increased curvature mismatch could contribute to the disconnection of ICNs are discussed

Cash or Food? Which Works Better to Improve Nutrition Status and Treatment Adherence for HIV Patients Starting Antiretroviral Therapy

The overall objective of this DFID-funded study was to understand whether cash or food transfers were more effective for HIV-positive individuals starting antiretroviral therapy (ART) in improving nutrition, health status and adherence to ART. HIV-positive individuals initiating ART at the St Francis Mission Hospital in Katete District, Eastern Province, were randomly allocated to two treatment groups (cash and food), and given a food basket or its cash equivalent monthly, for eight months. Both treatment groups saw significant increases (p-value <0.001) in Body Mass Index (BMI), Household Dietary Diversity Score, good adherence to ART, and in mean CD4 count, but there were no significant differences between the two treatment groups in these measures. The study concluded that the provision of cash or food for eight months when clients start ART confers similar and significantly positive effects in improving clients’ nutrition and health. Providing cash is likely to be more cost-effective