Health Seeking behavior; perspective of the Marginalized Somali Community in Garissa County, a Semi-Arid Region of North Eastern Kenya

Appropriate medical care seeking could prevent a significant number of deaths and complications due to ill health. Unfortunately, healthcare seeking behaviors (HSB) differs according to place, the affected, disease types, beliefs and the opportunities to seek care. These decisions are not isolated to individuals but are embedded in a broader household and social organizational decision process and the capacity to allow seeking of care. This descriptive cross-sectional community-based study used a multistage cluster sampling method to enrol consenting adults from different households located in the seven (7) sub-counties in Garissa County. The data were collected by interviewing 405 adult population and the answers reported in pretested structured questionnaires. Among the surveyed respondents, the mean age (±SD) was 35.17 (12.9) years, 68.1% had no formal education, 72.8% were female and 81.2% were married. Health care seeking during the latest illness was reported by three quarters of the respondents (n=293, 72.3%). The treatment or advice during the latest illness was sought by the majority in the Government / public hospitals (n=226, 55.5%), followed by in the private hospitals (n= 37, 9.1%) and among Traditional or homeopathic or spiritual healers (n = 28, 6.9%). In multivariate analysis, household headship, possession of health insurance, reasons for choosing preferred healthcare facility, durations prior to seeking treatment and the perceived three common illnesses in the community were associated with seeking treatment during the latest illness both in any of the healthcare facility and in the government/public hospitals. Gender, occupation and reasons for choosing preferred healthcare facility independently influenced seeking treatment during the latest illness both in any of the health facility and in private hospitals.  Durations prior to seeking treatment was the only independent factor associated with seeking treatment both in any of the healthcare facility and among Traditional or homeopathic or spiritual healers. During the latest illnesses among this marginalized population, appropriate health seeking behavior was significantly high with the majority preferring the government/public facilities. Gender, occupation, household headship, possession of health insurance, reasons for choosing preferred hospital, availability and the preference of current health facility, duration with illness and perceived illnesses in the community are the predictors of HSB. Improvement in education, health facilities and medical services in the community, introduction of community based integrated management of common community illness are imperative to improve HSB among the Somali community in this Semi-arid region of Kenya. Keywords: Health seeking, Latest illnesses, Somali community, Semi-arid County of Keny

Méningite récurrente révélant une maladie de Behçet: à propos de deux cas

Les étiologies des méningites sont surtout infectieuses. Les causes non infectieuses, sont souvent de  diagnostic difficile et incertain, tel est le cas de la maladie de Behçet. Nous rapportons deux observations de patients ayant présenté des épisodes récurrents de méningite. Dans un premier temps, la suspicion d’une étiologie infectieuse a conduit à introduire un traitement anti-infectieux probabiliste. La découverte à posteriori d’une aphtose bipolaire a permis de poser le diagnostic de maladie de Behçet. Une corticothérapie s’est révélée efficace. La maladie de Behçet doit toujours faire partie des diagnostics différentiels des méningites récurrentes.Key words: Méningite récurrente, maladie de Behçet, neuro-Behçe

Tackling the global challenge of illegal wildlife trafficking and trade

UK Department for International Development (DFID) and the European Unio

Badanie porównawcze czynności lewej komory w grupie chorych z bezobjawową twardziną układową i w grupie kontrolnej

Introduction. Cardiac involvement in systemic sclerosis (SSc) represents a major cause of morbidity and mortality and constitutes a turning point in this disease. The aim of this study was to describe echocardiographic data in asymptomatic patients with SSc and compare them to results obtained in a control population in order to unmask subclinical cardiac involvement during systemic sclerosis. Material and methods. A prospective study was conducted between 2012 and 2017 including two groups: group A included 25 asymptomatic scleroderma patients without other comorbidities, while group B consisted of 25 control and healthy subjects. The two groups were examined by echocardiography coupled with tissue Doppler and 2D strain. Results. The mean age of our patients was 45 ± 7 years. The sex ratio was 0.8. The control population was epidemiologically similar to the group of patients. The anatomical data of the left ventricle and the ejection fraction were normal and comparable between the two groups, but the Tei index was significantly higher in group A (0.8 ± 0.04 vs. 0.28 ± 0.07, p &lt; 0.01). Tissue Doppler velocity S peak measurement was reduced in group A compared to group B (5.6 ± 0.5 vs. 9.30 ± 0.5, p &lt; 0.01), and global longitudinal strain was also altered in scleroderma patients (–11 ± 0.4 vs. –18 ± 0.3, p &lt; 0.01). There was no significant difference in E/A ratio, however early left ventricular diastolic dysfunction was revealed by a higher E/Ea and E/Vp ratio in group A compared to group B with respectively (13 ± 1.8 vs. 6 ± 1.6, p &lt; 0.01) and (2.2 ± 0.6 vs. 1.5 ± 0.6, p &lt; 0.01), a longer Ap–Am duration (≥ 20 ms), and a higher volume of the left atrium was noted in group A. The mean value of the pulmonary pressions was 37.9 ± 9 mm Hg in patients with scleroderma versus 25 ± 3 mm Hg for the control group (p &lt; 0.01). There was no right ventricular dysfunction. Conclusions. Cardiac involvement during systemic sclerosis precedes clinical expression. Echocardiography coupled with tissue Doppler and 2D strain are useful to detect these abnormalities at a subclinical stage of the disease.Wstęp. Zajęcie serca w twardzinie układowej (SSc) jest główną przyczyną chorobowości i śmiertelności oraz stanowi punkt zwrotny w przebiegu choroby. Celem pracy jest opisanie obrazu echokardiografii u niewykazujących objawów chorych z SSc i porównanie z wynikami uzyskanymi w populacji kontrolnej, by wykryć subkliniczny proces chorobowego w sercu w przebiegu twardziny SSc. Materiał i metody. Badanie prospektywne przeprowadzono w latach 2012–2017. Pacjentów podzielono na dwie grupy: grupa A składała się z 25 chorych z bezobjawową SSc bez chorób współistniejących, grupę B utworzono z 25 zdrowych osób stanowiących grupę kontrolną. W obu grupach przeprowadzono badania echokardiograficzne z doplerowskim obrazowaniem tkanek i badaniem odkształcenia miokardium w obrazowaniu dwuwymiarowym (2D strain). Wyniki. Średnia wieku pacjentów wynosiła 45 ± 7 lat. Współczynnik płci wynosił 0,8. Grupa kontrolna była podobna pod względem charakterystyki epidemiologicznej do grupy chorych na SSc. Parametry anatomiczne lewej komory i frakcja wyrzutowa były prawidłowe i porównywalne w obu grupach, natomiast wskaźnik Tei był istotnie wyższy w grupie A (0,8 ± 0,04 vs. 0,28 ± 0,07; p < 0,01). Maksymalna prędkość ruchu miokardium S w tkankowej echokardiografii doplerowskiej była zmniejszona w grupie A w porównaniu z grupą B (5,6 ± 0,5 vs. 9,30 ± 0,5; p < 0,01). Również globalne odkształcenie podłużne było mniejsze u chorych na SSc (–11 ± 0,4 vs. –18 ± 0,3; p < 0,01). Nie stwierdzono istotnej różnicy w wartości współczynnika E/A, jednak w grupie A wykryto dysfunkcję rozkurczową lewej komory na podstawie wyższych współczynników E/Ea i E/Vp niż w grupie B (odpowiednio 13 ± 1,8 vs. 6 ± 1,6; p < 0,01 i 2,2 ± 0,6 vs. 1,5 ± 0,6; p < 0,01). Ponadto w grupie A zaobserwowano dłuższy czas trwania Ap–Am (≥ 20 ms) oraz większą objętość lewego przedsionka. Średnia wartość ciśnienia w tętnicy płucnej wynosiła 37,9 ± 9 mm Hg u pacjentów z SSc i 25 ± 3 mm Hg w grupie kontrolnej (p < 0,01). Nie stwierdzono dysfunkcji prawej komory. Wnioski. Zajęcie serca w przebiegu SSc poprzedza pojawienie się objawów. Badanie echokardiograficzne z doplerem tkankowym i ocena odkształcenia miokardium w obrazowaniu 2D są pomocne w wykrywaniu zmian w subklinicznym stadium choroby

Psychosocial Effects of Obstetric Fistula on Young Mothers in Western Kenya

This includes sensitization of the society about fistula to re-integrate the recovering fistula survivors so as to reduce the associated stigma. Relevant groups and NGOs should offer counselling services to fistula victims on issues that can affect their psychological and social wellbeing. Obstetric fistula has remained one of the most devastating complications a woman experiences in the course of delivery in Kenya. Many women suffer long term morbidity and become social outcasts. The aim of this study was to examine the psychosocial consequences of obstetric fistula on young women in the western Kenya region. The study population consisted of women living with obstetric fistula, their families and care givers. The sampling frame consisted of 190 primary respondents. The study adopted a cross-sectional descriptive survey design. The data from the respondents was collected through questionnaires, interview schedules and Focus Group Discussions. The Statistical Package for Social Sciences (SPSS) was used for data analysis. Descriptive statistics such as frequencies, means, percentages and standard deviations were generated for data analysis. The study results show that the main psychological effects of fistula were sadness, shame and loss of self-worth. The study also points at stigmatization, social worthlessness and isolation as the main social effects of fistula. The study recommends addressing negative cultural practices that contribute to obstetric fistula occurrence

Comparative Study to Optimize Surface Roughness of the Titanium Alloy Ti-6Al-4V by Applying Taguchi, RSM and TLBO Methods

Titanium alloys are used in aeronautics and the shipbuilding industry for their good intrinsic properties, namely low density (40% less than steel), very good mechanical properties and resistance to corrosion. The purpose of this study is to optimize the cutting conditions during the turning of Ti-6Al-4V titanium alloy with Minimum of Quantity of Lubrication (MQL) conditions leading to minimize the surface roughness (Ra). The tests were carried out according to a Taguchi L18 design plan by varying four input factors namely: the cutting speed, the feed rate, the depth of cut and the cutting tool material (coated carbide with (PVD) (GC1125) and uncoated carbide (H13A)). Analysis of variance (ANOVA) was used to found the contribution of each factor and to determine which parameters had a significant influence on the surface roughness. The treatment of the results made it possible to propose a mathematical model, which allows predicting Ra. In addition, Taguchi Signal/Noise (S/N) analysis was used in order to optimize the cutting conditions permitting to minimize Ra. The Desirability Function (DF) was also determined. In addition, the obtained results were compared to the one determined using Response Surface Methodology (RSM) and Teaching and Learning Based Optimization (TLBO). It is important to note that the TLBO method gave a very satisfactory result

DeepFakes for Privacy: Investigating Perceptions and Effectiveness of State-of-the-Art Privacy-Enhancing Face Obfuscation Methods

There are many contexts in which a person’s face needs to be obfuscated for privacy, such as in social media posts. We present a user-centered analysis of the effectiveness of DeepFakes for obfuscation using synthetically generated faces, and compare it with state-of-the-art obfuscation methods: blurring, masking, pixelating, and replacement with avatars. For this, we conducted an online survey (N=110) and found that DeepFake obfuscation is a viable alternative to state-of-the-art obfuscation methods; it is as effective as masking and avatar obfuscation in concealing the identities of individuals in photos. At the same time, DeepFakes blend well with surroundings and are as aesthetically pleasing as blurring and pixelating. We discuss how DeepFake obfuscation can enhance privacy protection without negatively impacting the photo’s aesthetics

Distribution of resting cysts of the potentially toxic dinoflagellate Alexandrium pseudogonyaulax in recently-deposited sediment within Bizerte Lagoon (Mediterranean coast, Tunisia)

This study investigated the spatial distribution of Alexandrium pseudogonyaulax resting cysts in recently deposited sediment of Bizerte lagoon (South-Western Mediterranean, Tunisia). This lagoon is the subject of many anthropogenic impacts, such as holding important fishing and aquaculture activities. A. pseudogonyaulax has been shown to produce Goniodomin A, which is a biologically-active compound. We showed that this dinoflagellate produces two types of resting cysts, which could be distinguished by the presence or the absence of a paratabulate wall. The average cyst density across the whole lagoon was rather high, reaching 639 cysts g1 of dry sediment (DS). Cyst densities varied widely among the sampled stations, with the highest density of 1685 cyst g1 DS being recorded at station 51 near a mussel farm. With respect to sediment characteristics, the highest cyst densities were found within silty sediments with high water content values. The distribution of A. pseudongoyaulax cysts in Bizerte lagoon appears to be related to hydrodynamic factors.peer-reviewe