Breast cancer awareness in the sub-Saharan African ABC-DO cohort: African Breast Cancer—Disparities in Outcomes study

A greater understanding of the nature and drivers of poor breast cancer (BC) awareness in sub-Saharan Africa (SSA) will inform much needed awareness programmes. We aimed to assess the level and nature of BC awareness in the multi-country African Breast Cancer—Disparities in Outcome (ABC-DO) cohort of women newly diagnosed with BC during 2014–2017. Awareness indicators were assessed during a baseline interview at/near diagnosis. Logistic/ordinal regression was used to estimate odds ratios (OR) for indicators of BC awareness in relation to woman-level characteristics for individual settings and then meta-analyzed. In the 1,451 women included, almost all Namibian non-black women (n = 104) knew of BC and its curability, while in Namibian black and Zambian women, one in 7 (~ 15%) had not previously heard of BC and 25–40% did not know it was curable. In Uganda and Nigeria awareness was lowest: one in four women had no BC awareness, and 2 in 3 had no knowledge of its cure potential. Low educational level, unskilled employment, low socioeconomic position, rural residence, older age, being unmarried, and in some settings HIV-positivity, were associated with lower BC awareness—e.g., having unskilled employment was associated with not having heard of BC (summary OR 3.37; 95% confidence interval (CI) 2.17–5.23), believing that it is incurable (2.43; 1.81–3.26), and not recognizing a breast lump symptom (1.85; 1.41–2.43) but with between-setting variation (I2 > 68% for all). The findings provide evidence of the level and difference in BC awareness and beliefs across different settings, highlighting the urgent need for context-specific education programmes in the SSA region

Low HIV testing rates among tuberculosis patients in Kampala, Uganda

<p>Abstract</p> <p>Background</p> <p>HIV testing among tuberculosis patients is critical in improving morbidity and mortality as those found to be HIV positive will be offered a continuum of care including ART if indicated. We conducted a cross-sectional study in three Kampala City primary care clinics: to assess the level of HIV test uptake among newly diagnosed pulmonary tuberculosis (PTB) patients; to assess patient and health worker factors associated with HIV test uptake; and to determine factors associated with HIV test uptake at the primary care clinics</p> <p>Methods</p> <p>Adult patients who had been diagnosed with smear-positive PTB at a primary care clinic or at the referral hospital and who were being treated at any of the three clinics were interviewed. Associations between having taken the test as the main outcome and explanatory variables were assessed by multivariate logistic regression.</p> <p>Results</p> <p>Between April and October 2007, 112 adults were included in the study. An HIV test had been offered to 74 (66%). Of the 112 patients, 61 (82%) had accepted the test; 45 (74%) had eventually been tested; and 32 (29%) had received their test results.</p> <p>Patients who were <25 yeas old, female or unemployed, or had reported no previous HIV testing, were more likely to have been tested. The strongest predictor of having been tested was if patients had been diagnosed at the referral hospital compared to the city clinic (adjusted OR 24.2; 95% CI 6.7-87.7; p < 0.001). This primarily reflected an "opt-out" (uptake 94%) versus an "opt-in" (uptake 53%) testing policy.</p> <p>Conclusions</p> <p>The overall HIV test uptake was surprisingly low at 40%. The HIV test uptake was significantly higher among TB patients who were identified at hospital, among females and in the unemployed.</p

The terrain of urbanisation process and policy frameworks: A critical analysis of the Kampala experience

Kampala is urbanising in an unplanned manner, but without a clear picture of the underlying dynamics. The city is characterised by lack of proper zoning of economic activities and construction of physical infrastructure without regard to subsequent spatial quality and environmental conservation. Consequently, there are sharp differences in residential standards where expensive housing and luxury flats co-exist with shanty towns and informal settlements, with about 60% of the city’s population living in unplanned informal settlements and often faced with challenges of unemployment. The unprecedented increase in the urban population in Kampala and the prospects for further increases in the near future have economic and social implications concerning employment, housing, education and health, among others. Understanding the nature of the dynamics of the growth or decline of cities like Kampala helps planners to support the processes that lead to harmonious urban development and to deal with the negative consequences of urban growth. This paper reflects the urbanisation dynamics explaining Kampala’s urbanisation process with the view to analysing the implications for an alternative urban policy framework. It argues that the conditions that have allowed the situation to exist have serious policy implications which require the need for an integrated policy framework that can be used to effectively prevent or halt Kampala’s unplanned urbanisation while promoting planned urbanisation. Induced by the migration and lack of information, understanding urban dynamics is crucial to the development of urban policies that can effectively ensure that further urban changes occur in a systematic and satisfactory manner. The current urban process in developing countries like Uganda is associated with poverty, environmental degradation and population demands that outstrip service capacity

Insecticide-treated net (ITN) ownership, usage, and malaria transmission in the highlands of western Kenya

<p>Abstract</p> <p>Background</p> <p>Insecticide-treated bed nets (ITNs) are known to be highly effective in reducing malaria morbidity and mortality. However, usage varies among households, and such variations in actual usage may seriously limit the potential impact of nets and cause spatial heterogeneity on malaria transmission. This study examined ITN ownership and underlying factors for among-household variation in use, and malaria transmission in two highland regions of western Kenya.</p> <p>Methods</p> <p>Cross-sectional surveys were conducted on ITN ownership (possession), compliance (actual usage among those who own ITNs), and malaria infections in occupants of randomly sampled houses in the dry and the rainy seasons of 2009.</p> <p>Results</p> <p>Despite ITN ownership reaching more than 71%, compliance was low at 56.3%. The compliance rate was significantly higher during the rainy season compared with the dry season (62% vs. 49.6%). Both malaria parasite prevalence (11.8% vs. 5.1%) and vector densities (1.0 vs.0.4 female/house/night) were significantly higher during the rainy season than during the dry season. Other important factors affecting the use of ITNs include: a household education level of at least primary school level, significantly high numbers of nuisance mosquitoes, and low indoor temperatures. Malaria prevalence in the rainy season was about 30% lower in ITN users than in non-ITN users, but this percentage was not significantly different during the dry season.</p> <p>Conclusion</p> <p>In malaria hypo-mesoendemic highland regions of western Kenya, the gap between ITNownership and usage is generally high with greater usage recorded during the high transmission season. Because of the low compliance among those who own ITNs, there is a need to sensitize households on sustained use of ITNs in order to optimize their role as a malaria control tool.</p

Regulating disasters? The role of international law in disaster prevention and management

Purpose – This article explores the role of international law in disaster prevention and management, with a particular focus on the emerging field of international disaster law, and its relationship with international human rights law. It further introduces the four articles of the special column of this journal issue, dedicated to disasters and international law. Design/methodology/approach – The analysis is based upon primary sources of legislation and policy, as well as academic literature on disasters and international law. Findings – Although the field of international disaster law is at its infancy, we argue that this emergent area does have the potential to gain widespread recognition as a distinct field of law, and that this could be of benefit for the wider disaster management community. Originality/value – The article introduces key legal features and themes relating to international law and disasters, highlighting their relevance for disaster management. The added value is to widen the discussion on aspects of disasters regulated by international law, thus facilitating the future exchange with other academic subjects and operational fields. Keywords – disasters; international law; disaster management; treaties; human rights; international disaster law; international human rights law. Paper type – Research pape

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

No 102/04.0402.A13/VI.1 Télégramme Officiel

A telegram informing the PRESIREP PRIME MINISTER MINISTER-STAFF of the Rwandan Army, recommending and asking the Government of Rwanda to urgently mobilize all "voluntary" forces to move against the "enemy" either inside or outside Rwanda.UT Librarie

Assessing the suitability of the MAGIC model for analysis of acidification potential in the oil sands region of northeastern Alberta

This thesis is an evaluation of the suitability of the Model of Acidification of Groundwater in Catchments (MAGIC) for estimating acidification potential in lakes in the oil sands producing region of Northeastern Alberta. Parameterization of the model is undertaken for two study lakes representing cases with differing acidification potential. Applications of MAGIC for these cases demonstrate that the model is robust for explaining the behavior of these different natural systems. Additional applications of the model demonstrate how it may be used to predict the impact of various projections of oil sands emissions on the future status of lakes affected by acidifying emissions. Under all cases, it is shown that oil sands production may occur without resulting in harmful effects on these two study lakes. Improvements in the parameterization of the model are also identified, and these include gathering more soil data and information regarding nitrogen immobilization. Extensions of this work that would lead to a greater understanding of acidification in the Oil Sands Region include: regionalizing MAGIC for Northeastern Alberta, including climate change considerations, and incorporating this or other predictive models as part of a greater management system to assess the potential acidification of lakes.Applied Science, Faculty ofCivil Engineering, Department ofGraduat

Rugaaju the bull

Humourous dramatization aimed at conveying the importance of trees and agroforestry to rural livelihood