Seasonality and prevalence of respiratory syncytial virus in Kinshasa, Democratic Republic of Congo

The Democratic Republic of Congo (DRC) with its tropical climate in the past was thought not to house many respiratory viruses, with time and after many outbreaks began researches and surveillance on respiratory viruses circulating in the country. The first was influenza sentinel surveillance which showed that around 10% of suspected samples received were positive for influenza and 90% were negative, therefore a research was needed to find which other virus was present and causing infection in the remaining 90%. This study aimed to screen Respiratory Syncytial Virus (RSV) among those remaining samples in Kinshasa in order to determine the proportion and seasonal factors influencing the virus. The samples used were nasopharyngeal swabs collected from different Influenza surveillance sites in Kinshasa: Kalembelembe, Boyambi, Kinshasa General Hospital, Kingasani Hospital Centre and RVA clinic during the period of January to September 2016. 169 Samples were randomly selected for the research and were chosen regardless of the patient’s age, sex, geographic group and symptoms. Molecular analysis was done to determine if the samples were RSV positive or negative at the National Reference Laboratory (NRL) in Kinshasa using real time reverse transcription-polymerase chain reaction (rRT-PCR). 13.6% were positive for RSV. The prevalence was higher in female 65.2% than in male 34.8%, over 95% of RSV infection occurred during the rainy season and among the positive cases 60.9% were from hospitalized patients with severe acute respiratory infection and 39.1% were from influenza-like illness or infection. The largest proportion (78.3%) of RSV positives was found in children under the age of 2 years. This study showed that RSV is found in Kinshasa, DRC at most during the rainy season and tend to fade away during the dry season. Children are the most affected especially those younger than 2 years and RSV was more prevalent in female than in male.open석

An investigation into the implementation of the senior secondary agriculture curriculum in the Caprivi region of Namibia

Shortly after independence, Namibia embarked on a major process of educational reform. It was in this reform that the apartheid educational legacy was redressed. Namibians viewed the apartheid educational system as being irrelevant and that it did not meet their needs and expectations. One of the reform aims was to involve education in the development of knowledge and skills for self sufficiency and sustainable development, therefore Agriculture was incorporated into the school curriculum as a key area to achieve this aim. Learners taking the subject are expected to be equipped with relevant theoretical and practical skills that provide a sound foundation in this discipline. This case study was undertaken to gain a better understanding about how the participating teachers perceived and implemented the Agriculture curriculum at the senior secondary school level in their schools. In carrying out the case study a qualitative research method was employed using semi-structured interviews, observation and document analysis for data collection. It would appear from this study that Agriculture is unable to fully achieve the reform ideals at the senior secondary school level, as sixteen years after independence these teachers are still teaching the subject to learners with very limited resources and academic support. This scenario shows that there are marked inconsistencies between policy and praxis, between the stated goals and aims of the reform and the curriculum designed to achieve these. In this half-thesis I therefore argue that without well qualified teachers, suitable resources and infrastructure to implement the curriculum in these schools, the pre-vocational nature of the subject as suggested in the subject policy document will be compromised. The study concludes by proposing certain teaching strategies and possibilities for systemic development that can be used to effect quality curriculum implementation in the region where the research was situated

Theoretical and practical ramifications of altering the amount of sorts required from an outbound dock

Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management; and, (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division; in conjunction with the Leaders for Global Operations Program at MIT, 2013.Cataloged from PDF version of thesis.Includes bibliographical references (p. 89-90).Amazon has been enjoying a rapid pace of growth over the last few years. One unfortunate side effect of this growth is the overall increased complexity of the network Amazon utilizes to deliver packages from the Amazon warehouses (coined "fulfillment centers" or "FCs") to the final customers. Specifically, Amazon now requires the outbound docks of the FCs to handle more volume that needs to be delivered to more locations. The increased number of outbound locations necessitates more package sorting operations on the dock. This thesis focuses on the operation of the outbound docks and performs time studies, capacity analyses, various warehouse case studies, and discrete event simulations to discover the ultimate bottleneck of a dock as more of these sorts are added. This sorting capacity analysis uncovers that the space available on a dock as an inventory buffer between the sorting and truck loading operations to ultimately be the source of constraint as more sorts are required from a building. This buffer constraint is then explored and quantified to create a mathematical formulation for estimating the ultimate outbound sorting capacity of an FC. Given the max sorting capacity of an FC, this thesis then dives in to the practical applications of operations management principles for executing on a sort plan. The principles of minimizing non-value added work, optimizing the number of packages going through the most labor efficient process paths, worker interference on labor efficiencies, and employing flexible capacity will be explored and applied to the outbound dock.by Matthew O. Kasenga.S.M.M.B.A

Effect of Treated Wastewater from Anaerobic Digester Coupled with Anaerobic Baffled Reactor as Fertigation on Soil Nutrient Residues, Growth and Yield of Maize Plants

Water scarcity, wastewater management and growing food demand associated with global population increase, are among the drivers cited for water reuse in agriculture. The current study intends to contribute on the influence of treated wastewater from the anaerobic digester coupled with anaerobic baffled reactor (ABR) as a fertigation on soil nutrient residues, growth and yield attributes of maize plants by using surface drip irrigation system to apply the treated wastewater. The experiment consisted of experimental plots irrigated with treated wastewater and control plots irrigated with tap water; all with three replications. The treated wastewater was lightly alkaline with pH of 7.8±0.2 and high concentration of nutrients than tap water, but were within the acceptable levels. Fertigation with treated wastewater improved soil fertility evidenced by significant improvement (P≤0.05) in plant height, leaf area Index (LAI) and maize yield. Plant height was 1.5 times taller and LAI was about 2.5 times more in treatment than in control plots. Yield attributes in experimental plots including number of grains per cob, (97±11.3); weight of grains per cob, (80.7±7.9 g); mass of 100 grains, (35.0±3.5 g), and grain yield, (745.8±62.9 Kg/ha) were significantly higher (P≤0.05) compared to their counterpart control plots. The grain yield in experimental plots was about 37% higher than the yield in control plots. Therefore, fertigation with treated wastewater from the anaerobic digester coupled with ABR improves maize yield and is advisable in areas with water scarcity

Promising outcomes of a national programme for the prevention of mother-to-child HIV transmission in Addis Ababa: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Prevention of Mother-to-Child HIV Transmission (PMTCT) is still the most effective intervention in combating new HIV infections. In 2008, revised national PMTCT guidelines that incorporated new policies on HIV counselling and testing, antiretroviral prophylaxis regimen and infant HIV diagnosis came into effect in Ethiopia. In the present study we have examined trends in PMTCT service utilization and assessed the rate of MTCT in relation to policy changes in the national PMTCT programme.</p> <p>Methods</p> <p>Reports from February 2004 to August 2009 were reviewed in 10 sub-cities in Addis Ababa, Ethiopia. The data was collected from May to October 2009.</p> <p>Results</p> <p>The proportion of women who received HIV counselling and testing among new antenatal care attendees increased from 50.7% (95% CI 50.2-51.2) in 2007 to 84.5% (95% CI 84.1-84.9) in 2009 following the shift to routine opt-out testing. Nevertheless, in 2009 only 53.7% of the positive women and 40.7% of their infants received antiretroviral prophylaxis. The HIV prevalence among antenatal attendees decreased significantly from 10.5% in 2004 to 4.6% in 2009 in parallel to the increased number of women being tested. The HIV positive women were over 18 times (RR 18.5, p < 0.0001) more likely to be referred for treatment, care and support in 2009 than in 2004. The proportion of partners tested for HIV decreased by 14% in 2009 compared to 2004, although the absolute number was increasing year by year. Only 10.6% (95% CI 9.9-11.2) of the HIV positive women completed their follow up to infant HIV testing. The cumulative probability of HIV infection among babies on single dose nevirapine regimen who were tested at >=18 months was 15.0% (95% CI 9.8-22.1) in 2007, whereas it was 8.2% (95% CI 5.55-11.97) among babies on Zidovudine regimen who were tested at >=45 days in 2009.</p> <p>Conclusion</p> <p>The paper demonstrates trends in PMTCT service utilization in relation to changing policy. There is marked improvement in HIV counselling and testing service utilization, especially after the policy shift to routine opt-out testing. However, despite policy changes, the ARV prophylaxis uptake, the loss to follow up and the partner testing have remained unchanged across the years. This should be a matter of immediate concern and a topic for further research.</p

The implications of policy changes on the uptake of a PMTCT programme in rural Malawi: first three years of experience

Objective: To study how the demand for antenatal care (ANC), HIV testing and hospital delivery was influenced by policy changes among pregnant women in rural Malawi. Design: Retrospective analysis of monthly reports. Setting: Malamulo SDA hospital in Thyolo district, Makwasa, Malawi. Methods: Three hospital-based registers were analysed from 2005 to 2007. These were general ANC, delivery and Prevention of Mother to Child Transmission (PMTCT) registers. Observations were documented regarding the introduction of specific policies and when changes were effected. Descriptive analytical methods were used. Results: The ANC programme reached 4,528 pregnant mothers during the study period. HIV testing among the ANC attendees increased from 52.6 to 98.8% after the introduction of routine (opt-out) HIV testing and 15.6% of them tested positive. After the introduction of free maternity services, ANC attendance increased by 42% and the ratio of hospital deliveries to ANC attendees increased from 0.50:1 to 0.66:1. Of the HIV-tested ANC attendees, 52.6% who tested positive delivered in the hospital and got nevirapine at the time of delivery. Conclusions: Increasing maternity service availability and uptake can increase the coverage of PMTCT programmes. Barriers such as economic constraints that prevent women in poor communities from accessing services can be removed by making maternity services free. However, it is likely, particularly in resource-poor settings, that significant increases in PMTCT coverage among those at risk can only be achieved by substantially increasing uptake of general ANC and delivery services.We thank the Swedish Institute, Sweden for the financial support without which the study would have been a non-starter. We are also grateful for the support given by the unit of Epidemiology and Public Health Sciences, Umea University. Furthermore, we thank the management and staff of Malamulo SDA Hospital, P/Bag 2, Makwasa, Malawi for their support throughout the entire period of carrying out the study. This work was undertaken within the Centre for Global Health at Umea University with support from FAS, the Swedish Council for Working Life and Social Research (grant no. 2006-1512).</p

Uptake of prevention of mother to child transmission interventions in Kenya: health systems are more influential than stigma

<p>Abstract</p> <p>Background</p> <p>We set out to determine the relative roles of stigma versus health systems in non-uptake of prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional assessment of all consenting mothers accompanying infants for six-week immunizations.</p> <p>Methods</p> <p>Between September 2008 and March 2009, mothers at six maternal and child health clinics in Kenya's Nairobi and Nyanza provinces were interviewed regarding PMTCT intervention uptake during recent pregnancy. Stigma was ascertained using a previously published standardized questionnaire and infant HIV-1 status determined by HIV-1 polymerase chain reaction.</p> <p>Results</p> <p>Among 2663 mothers, 2453 (92.1%) reported antenatal HIV-1 testing. Untested mothers were more likely to have less than secondary education (85.2% vs. 74.9%, p = 0.001), be from Nyanza (47.1% vs. 32.2%, p < 0.001) and have lower socio-economic status. Among 318 HIV-1-infected mothers, 90% reported use of maternal or infant antiretrovirals. Facility delivery was less common among HIV-1-infected mothers (69% vs. 76%, p = 0.009) and was associated with antiretroviral use (p < 0.001). Although internal or external stigma indicators were reported by between 12% and 59% of women, stigma was not associated with lower HIV-1 testing or infant HIV-1 infection rates; internal stigma was associated with modestly decreased antiretroviral uptake. Health system factors contributed to about 60% of non-testing among mothers who attended antenatal clinics and to missed opportunities in offering antiretrovirals and utilization of facility delivery. Eight percent of six-week-old HIV-1-exposed infants were HIV-1 infected.</p> <p>Conclusions</p> <p>Antenatal HIV-1 testing and antiretroviral uptake was high (both more than 90%) and infant HIV-1 infection risk was low, reflecting high PMTCT coverage. Investment in health systems to deliver HIV-1 testing and antiretrovirals can effectively prevent infant HIV-1 infection despite substantial HIV-1 stigma.</p

Non-adherence to the single dose nevirapine regimen for the prevention of mother-to-child transmission of HIV in Bindura town, Zimbabwe: a cross-sectional analytic study

<p>Abstract</p> <p>Background</p> <p>The Prevention of Mother to Child Transmission of HIV (PMTCT) programme was introduced at Bindura Hospital in 2003. Seven additional satellite PMTCT clinics were set up in the district to increase service coverage but uptake of PMTCT interventions remained unsatisfactory. In this study we determined the prevalence of and factors associated with non-adherence to the single dose nevirapine (SD-NVP) regimen for PMTCT in Bindura town.</p> <p>Methods</p> <p>An analytic cross-sectional study was conducted in four health institutions in Bindura town. Participants were mother-baby pairs on the PMTCT programme attending routine six weeks post natal visits in the participating health institutions from March to July 2008. We interviewed 212 mothers using a structured questionnaire.</p> <p>Results</p> <p>The non-adherence rate to the maternal nevirapine dose was 30.7%, while non-adherence to the newborn nevirapine dose was 26.9%. The combined mother-baby pair nevirapine non-adherence was 42.9%. Non-adherence to the maternal dose of nevirapine was associated with lack of maternal secondary education (POR = 2.38; 95%CI: 1.05-3.39) and multi-parity (POR = 2.66; 95%CI: 1.05-6.72), while previous maternal exposure to the PMTCT programme (POR = 0.22; 95%CI: 0.08-0.57) and giving the mother a NVP tablet to take home during antenatal care (POR = 0.03; 95%CI: 0.01-0.09) were associated with improved maternal adherence to nevirapine. Non-adherence to the infant dose of nevirapine was associated with maternal non-disclosure of HIV results to sexual partner (POR = 2.75; 95%CI: 1.04-7.32) and home deliveries (POR = 48.76; 95%CI: 17.51-135.82).</p> <p>Conclusions</p> <p>Non-adherence to nevirapine prophylaxis for PMTCT was high in Bindura. Ensuring institutional deliveries, encouraging self-disclosure of HIV results by the mothers to their partners and giving HIV positive mothers nevirapine doses to take home early in pregnancy all play significant roles in improving adherence to PMTCT prophylaxis.</p