Effectiveness of the community-based DOTS strategy on tuberculosis treatment success rates in Namibia

Setting: Directly Observed Treatment Short-course is a key pillar of the global strategy to end tuberculosis. Objective: The effectiveness of community-based compared to facility-based DOTS on tuberculosis treatment success rates in Namibia was assessed. Methods: Annual tuberculosis treatment success, cure, completion and case notification rates were compared between 1996 and 2015 by interrupted time series analysis. The intervention was the upgrading by the Namibian government of the tuberculosis treatment strategy from facility-based to community-based DOTS in 2005. Results: The mean annual treatment success rate during the pre-intervention period was 58.9% (range: 46-66%) and significantly increased to 81.3% (range: 69-87%) during the post-intervention period. Before the intervention there was a non-significant increase (0.3%/year) in the annual treatment success rate. After the intervention, the annual treatment success rate increased abruptly by 12.9% (p <0.001) and continued to increase by 1.1%/year thereafter. The treatment success rate seemed to have stagnated at approximately 85% at the end of the observation period. Conclusion: Expanding facility-based DOTS to community-based DOTS significantly increased the annual treatment success rates. However, the treatment success rate at the end of the observation period had stagnated below the targeted 95% success rate

El Conocimiento Didáctico del Contenido en ciencias: estado de la cuestión

This paper gives a descriptive overview of the literature related to Pedagogical Content Knowledge - PCK - in the sciences. It is expected that this review can contribute to a better understanding of PCK, pointing out what has been investigated about this concept. Specifically, we analyze: a) how PCK is defined, what are its main features and how it has been appropriated by teachers; b) the relationship between PCK, knowledge of the contents to be taught and students learning; c) how PCK was actually used in teachers' training and teachers' evaluation; and, d) the scientific areas in which PCK has been studied. It concludes that PCK is an essential tool for improving the quality of teacher training

Development of treatment-decision algorithms for children evaluated for pulmonary tuberculosis: an individual participant data meta-analysis.

Background: Many children with pulmonary tuberculosis remain undiagnosed and untreated with related high morbidity and mortality. Recent advances in childhood tuberculosis algorithm development have incorporated prediction modelling, but studies so far have been small and localised, with limited generalisability. We aimed to evaluate the performance of currently used diagnostic algorithms and to use prediction modelling to develop evidence-based algorithms to assist in tuberculosis treatment decision making for children presenting to primary health-care centres. Methods: For this meta-analysis, we identified individual participant data from a WHO public call for data on the management of tuberculosis in children and adolescents and referral from childhood tuberculosis experts. We included studies that prospectively recruited consecutive participants younger than 10 years attending health-care centres in countries with a high tuberculosis incidence for clinical evaluation of pulmonary tuberculosis. We collated individual participant data including clinical, bacteriological, and radiological information and a standardised reference classification of pulmonary tuberculosis. Using this dataset, we first retrospectively evaluated the performance of several existing treatment-decision algorithms. We then used the data to develop two multivariable prediction models that included features used in clinical evaluation of pulmonary tuberculosis-one with chest x-ray features and one without-and we investigated each model's generalisability using internal-external cross-validation. The parameter coefficient estimates of the two models were scaled into two scoring systems to classify tuberculosis with a prespecified sensitivity target. The two scoring systems were used to develop two pragmatic, treatment-decision algorithms for use in primary health-care settings. Findings: Of 4718 children from 13 studies from 12 countries, 1811 (38·4%) were classified as having pulmonary tuberculosis: 541 (29·9%) bacteriologically confirmed and 1270 (70·1%) unconfirmed. Existing treatment-decision algorithms had highly variable diagnostic performance. The scoring system derived from the prediction model that included clinical features and features from chest x-ray had a combined sensitivity of 0·86 [95% CI 0·68-0·94] and specificity of 0·37 [0·15-0·66] against a composite reference standard. The scoring system derived from the model that included only clinical features had a combined sensitivity of 0·84 [95% CI 0·66-0·93] and specificity of 0·30 [0·13-0·56] against a composite reference standard. The scoring system from each model was placed after triage steps, including assessment of illness acuity and risk of poor tuberculosis-related outcomes, to develop treatment-decision algorithms. Interpretation: We adopted an evidence-based approach to develop pragmatic algorithms to guide tuberculosis treatment decisions in children, irrespective of the resources locally available. This approach will empower health workers in primary health-care settings with high tuberculosis incidence and limited resources to initiate tuberculosis treatment in children to improve access to care and reduce tuberculosis-related mortality. These algorithms have been included in the operational handbook accompanying the latest WHO guidelines on the management of tuberculosis in children and adolescents. Future prospective evaluation of algorithms, including those developed in this work, is necessary to investigate clinical performance. Funding: WHO, US National Institutes of Health

Adverse events and patients&rsquo; perceived health-related quality of life at the end of multidrug-resistant tuberculosis treatment in Namibia

Evans L Sagwa,1 Nunurai Ruswa,2 Farai Mavhunga,2 Timothy Rennie,3 Hubert GM Leufkens,1,4 Aukje K Mantel-Teeuwisse1 1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; 2National Tuberculosis and Leprosy Program, Ministry of Health and Social Services, Windhoek, Namibia; 3Department of Pharmacy Practice and Policy, University of Namibia School of Pharmacy, Windhoek, Namibia; 4Medicines Evaluation Board, Utrecht, the Netherlands Purpose: The health-related quality of life (HRQoL) of patients completing multidrug-resistant tuberculosis (MDR-TB) treatment in Namibia and whether the occur&shy;rence of adverse events influenced patients&rsquo; rating of their HRQoL was evaluated. Patients and methods: A cross-sectional analytic survey of patients completing or who recently completed MDR-TB treatment was conducted. The patients rated their HRQoL using the simplified Short Form-8&trade; (SF-8) questionnaire consisting of eight Likert-type questions. Three supplemental questions on the adverse events that the patients may have experienced during their MDR-TB treatment were also included. Scoring of HRQoL ratings was norm-based (mean =50, standard deviation =10) ranging from 20 (worst health) to 80 (best health), rather than the conventional 0&ndash;100 scores. We evaluated the internal consistency of the scale items using the Cronbach&rsquo;s alpha, performed descriptive analyses, and analyzed the association between the patients&rsquo; HRQoL scores and adverse events. Results: Overall, 36 patients (20 males, 56%) aged 17&ndash;54&nbsp;years (median =40&nbsp;years) responded to the questionnaire. The median (range) HRQoL score for the physical component summary was 58.6 (35.3&ndash;60.5), while the median score for the mental component summary was 59.3 (26.6&ndash;61.9), indicating not-so-high self-rating of health. There was good internal consistency of the scale scores, with a Cronbach&rsquo;s alpha value of &gt;0.80. In all, 32 (89%) of the 36 patients experienced at least one adverse drug event of any severity during their treatment (median events =3, range 1&ndash;6), of which none was life-threatening. The occurrence of adverse events was not related to HRQoL scores. For patients reporting zero to two events, the median (range) HRQoL score was 56.8 (44.4&ndash;56.8), while for those reporting three or more events, the median score was 55.2 (38.6&ndash;56.8); P=0.34 for difference between these scores. Conclusion: Patients completing treatment for MDR-TB in Namibia tended to score moderately low on their HRQoL, using the generic SF-8 questionnaire. The occurrence of adverse events did not lead to lower HRQoL scores upon treatment completion. Keywords: drug safety, patient-reported health outcomes, SF-8&trade; questionnaire, second-line tuberculosis drugs, Namibi

Three waves of media repression in Zimbabwe

This article seeks to highlight how the media – especially radio – have always been used in Zimbabwe to consolidate the power of the government. This invariably led to oppositional media emerging from outside the country, giving the populace access to alternative discourses from those churned out by state media. The response to the alternative media run by blacks led the Southern Rhodesian and Rhodesian regimes to come up with repressive legislation that criminalised these media. After independence the state media embarked on consolidating the status quo and eliminating some sectors of the community from coverage – a repeat of the past. Legislation inherited from Rhodesia continued to be used in independent Zimbabwe, where the criminalisation of alternative voices and limitations in access to alternative media are predominant. Such a scenario reveals that there have been three waves of media repression in Zimbabwe, from Southern Rhodesia to Rhodesia and then to independent Zimbabwe, to deny the media their independence