Differential expression levels of activating and inhibitory receptors on NK cell subsets: Relevance to NK cell function

NO abstract availabl

Differential gene expression profiling of NK cells

No abstract availabl

Sources of Community Health Worker Motivation: A Qualitative Study in Morogoro Region, Tanzania.

There is a renewed interest in community health workers (CHWs) in Tanzania, but also a concern that low motivation of CHWs may decrease the benefits of investments in CHW programs. This study aimed to explore sources of CHW motivation to inform programs in Tanzania and similar contexts. We conducted semi-structured interviews with 20 CHWs in Morogoro Region, Tanzania. Interviews were digitally recorded, transcribed, and coded prior to translation and thematic analysis. The authors then conducted a literature review on CHW motivation and a framework that aligned with our findings was modified to guide the presentation of results. Sources of CHW motivation were identified at the individual, family, community, and organizational levels. At the individual level, CHWs are predisposed to volunteer work and apply knowledge gained to their own problems and those of their families and communities. Families and communities supplement other sources of motivation by providing moral, financial, and material support, including service fees, supplies, money for transportation, and help with farm work and CHW tasks. Resistance to CHW work exhibited by families and community members is limited. The organizational level (the government and its development partners) provides motivation in the form of stipends, potential employment, materials, training, and supervision, but inadequate remuneration and supplies discourage CHWs. Supervision can also be dis-incentivizing if perceived as a sign of poor performance. Tanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. Policy-makers and program managers should consider the burden that a lack of remuneration imposes on the families of CHWs. In addition, CHWs' intrinsic desire to volunteer does not preclude a desire for external rewards. Rather, adequate and formal financial incentives and in-kind alternatives would allow already-motivated CHWs to increase their commitment to their work

The critically endangered kipunji Rungwecebus kipunji of southern Tanzania: First census and assessment of distribution conservation status assessment

We present the first assessments of the population, distribution and conservation status of the recently described kipunji Rungwecebus kipunji in forests in the Southern Highlands and Udzungwa Mountains of southern Tanzania. Surveys totalling 2,864 hours and covering 3,456 km of transects were undertaken to determine distribution and group numbers, following which 772 hours of simultaneous multi-group observations in Rungwe-Kitulo and Ndundulu forests, in the Southern Highlands and Udzungwa Mountains respectively, enabled 209 total counts to be carried out. We estimate there are c. 1,042 individuals in Rungwe-Kitulo, with 25–39 individuals per group (mean 30.65 ± SE 0.62, n = 34), and 75 individuals, with 15–25 per group (mean 18.75 ± SE 2.39, n = 4) in Ndundulu. We estimate a total kipunji population of 1,117 in 38 groups, with 15–39 per group (mean 29.39 ± SE 0.85, n = 38). The Ndundulu population may no longer be viable and the Rungwe-Kitulo population is highly fragmented, with isolated sub-populations in degraded habitat. We recorded areas of occupancy of 1,079 and 199 ha in Rungwe-Kitulo and Ndundulu, respectively, giving a total of 1,278 ha. We estimate the species’ extent of occurrence to be 1,769 ha, with 1,241 and 528 ha in Rungwe-Kitulo and Ndundulu, respectively. We believe the kipunji faces an extremely high risk of extinction in the wild and recommend the species and genus be categorized as Critically Endangered on the IUCN Red List

Treatment of chronic myeloid leukemia in rural Rwanda: promising early outcomes

Purpose The burden of cancer is rising in low- and middle-income countries, yet cancer treatment requires resources that are often not available in these settings. Although management of chronic myeloid leukemia (CML) has been described in low- and middle-income countries, few programs involve patients treated in rural settings. We describe characteristics and early outcomes of patients treated for CML at rural district hospitals in Rwanda. Methods We conducted a retrospective review of patients with confirmed BCR-ABL–positive CML who were enrolled between July 1, 2009 and June 30, 2014. Types of data included patient demographics, diagnostic work up, treatment, clinical examination, laboratory testing, and death. Results Forty-three patients were included, with a maximum follow-up of 58 months. Of 31 patients who were imatinib-naïve at enrollment, 54.8% were men and the median age at diagnosis was 36.9 years (interquartile range: 29-42 years). Approximately two-thirds of patients (67.7%) were on the national public insurance scheme. The imatinib dose was reduced for 16 patients and discontinued for five. Thirty-two of the 43 patients continued to have normal blood counts at last follow-up. Four patients have died and four are lost to follow-up. Conclusion Our experience indicates that CML can be effectively managed in a resource-constrained rural setting, despite limited availability of on-site diagnostic resources or specialty oncology personnel. The importance of model public-private partnerships as a strategy to bring high-cost, life-saving treatment to people who do not have the ability to pay is also highlighted

Knowledge, beliefs, and perceptions of tuberculosis among community members in Ntcheu district, Malawi

Peter Nyasulu,1,2 Simon Sikwese,2,3 Tobias Chirwa,2 Chandra Makanjee,4 Madalitso Mmanga,5 Joseph Omoniyi Babalola,6 James Mpunga,7 Hastings T Banda,8 Adamson S Muula,9,10 Alister C Munthali11 1Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 2School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 3Pakachere Institute of Health and Development Communication, Blantyre, Malawi; 4Department of Medical Radiation Sciences, University of Canberra, Canberra, WA, Australia; 5District TB Office, Department of Environmental Health, District Health Office, Ntcheu, Malawi; 6Division of Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 7National Tuberculosis Control Program, Community Health Sciences Unit, Ministry of Health, Lilongwe, 8Research for Equity and Community Health (REACH) Trust, Lilongwe, 9Department of Community Health, College of Medicine, University of Malawi, Blantyre, 10African Centre of Excellence in Public Health and Herbal Medicine, College of Medicine, University of Malawi, Blantyre, 11Centre for Social Research, University of Malawi, Zomba, Malawi Introduction: The global burden of tuberculosis (TB) remains significantly high, with overreliance on biomedical interventions and inadequate exploration of the socioeconomic and cultural context of the infected population. A desired reduction in disease burden can be enhanced through a broader theoretical understanding of people’s health beliefs and concerns about TB. In this qualitative study, we explore the knowledge, beliefs, and perceptions of community members and people diagnosed with TB toward TB in Ntcheu district, Malawi. Methods: Using a qualitative phenomenological study design, data were obtained from eight focus-group discussions and 16 individual in-depth interviews. The community’s experiences and perceptions of TB were captured without using any preconceived framework. Adult participants who had had or never had a diagnosis of TB were purposively selected by sex and age and enrolled for the study. Discussions and individual interviews lasting about 60 minutes each were audiotaped, transcribed, and translated into English and analyzed using MaxQDA 10 software for qualitative analysis. Results: Most participants believed that TB was curable and would go for diagnosis if they had symptoms suggestive of the disease. However, based on their beliefs, individuals expressed some apprehension about the spread of TB and the social implications of being diagnosed with the disease. This perception affected participants’ responses about seeking diagnosis and treatment. Conclusion: A supportive and collective approach consisting of a combination of mass media, interactive communication campaigns, emphasizing TB symptoms, transmission, and stigma could be useful in addressing barriers to early diagnosis and care-seeking behavior. Keywords: tuberculosis, knowledge, perception of TB, beliefs, Ntcheu, Malaw

Cost of providing quality cancer care at the Butaro Cancer Center of Excellence in Rwanda

Purpose The cost of providing cancer care in low-income countries remains largely unknown, which creates a significant barrier to effective planning and resource allocation. This study examines the cost of providing comprehensive cancer care at the Butaro Cancer Center of Excellence (BCCOE) in Rwanda. Methods A retrospective costing analysis was conducted from the provider perspective by using secondary data from the administrative systems of the BCCOE. We identified the start-up funds necessary to begin initial implementation and determined the fiscal year 2013-2014 operating cost of the cancer program, including capital expenditures and fixed and variable costs. Results A total of $556,105 US dollars was assessed as necessary start-up funding to implement the program. The annual operating cost of the cancer program was found to be $957,203 US dollars. Radiotherapy, labor, and chemotherapy were the most significant cost drivers. Radiotherapy services, which require sending patients out of country because there are no radiation units in Rwanda, comprised 25% of program costs, labor accounted for 21%, and chemotherapy, supportive medications, and consumables accounted for 15%. Overhead, training, computed tomography scans, surgeries, blood products, pathology, and social services accounted for less than 10% of the total. Conclusion This study is one of the first to examine operating costs for implementing a cancer center in a low-income country. Having a strong commitment to cancer care, adapting clinical protocols to the local setting, shifting tasks, and creating collaborative partnerships make it possible for BCCOE to provide quality cancer care at a fraction of the cost seen in middle- and high-income countries, which has saved many lives and improved survival. Not all therapies, though, were available because of limited financial resources

The critically endangered kipunji Rungwecebus kipunji of southern Tanzania: First census and assessment of distribution conservation status assessment

We present the first assessments of the population, distribution and conservation status of the recently described kipunji Rungwecebus kipunji in forests in the Southern Highlands and Udzungwa Mountains of southern Tanzania. Surveys totalling 2,864 hours and covering 3,456 km of transects were undertaken to determine distribution and group numbers, following which 772 hours of simultaneous multi-group observations in Rungwe-Kitulo and Ndundulu forests, in the Southern Highlands and Udzungwa Mountains respectively, enabled 209 total counts to be carried out. We estimate there are c. 1,042 individuals in Rungwe-Kitulo, with 25–39 individuals per group (mean 30.65 ± SE 0.62, n = 34), and 75 individuals, with 15–25 per group (mean 18.75 ± SE 2.39, n = 4) in Ndundulu. We estimate a total kipunji population of 1,117 in 38 groups, with 15–39 per group (mean 29.39 ± SE 0.85, n = 38). The Ndundulu population may no longer be viable and the Rungwe-Kitulo population is highly fragmented, with isolated sub-populations in degraded habitat. We recorded areas of occupancy of 1,079 and 199 ha in Rungwe-Kitulo and Ndundulu, respectively, giving a total of 1,278 ha. We estimate the species’ extent of occurrence to be 1,769 ha, with 1,241 and 528 ha in Rungwe-Kitulo and Ndundulu, respectively. We believe the kipunji faces an extremely high risk of extinction in the wild and recommend the species and genus be categorized as Critically Endangered on the IUCN Red List

Patient characteristics, early outcomes, and implementation lessons of cervical cancer treatment services in rural Rwanda

Purpose Low- and middle-income countries account for 86% of all cervical cancer cases and 88% of cervical cancer mortality globally. Successful management of cervical cancer requires resources that are scarce in sub-Saharan Africa, especially in rural settings. Here, we describe the early clinical outcomes and implementation lessons learned from the Rwanda Ministry of Health’s first national cancer referral center, the Butaro Cancer Center of Excellence (BCCOE). We hypothesize that those patients presenting at earlier stage and receiving treatment will have higher rates of being alive. Methods The implementation of cervical cancer services included developing partnerships, clinical protocols, pathology services, and tools for monitoring and evaluation. We conducted a retrospective study of patients with cervical cancer who presented at BCCOE between July 1, 2012, and June 30, 2015. Data were collected from the electronic medical record system and by manually reviewing medical records. Descriptive, bivariable and multivariable statistical analyses were conducted to describe patient demographics, disease profiles, treatment, and clinical outcomes. Results In all, 373 patients met the study inclusion criteria. The median age was 53 years (interquartile rage, 45 to 60 years), and 98% were residents of Rwanda. Eighty-nine percent of patients had a documented disease stage: 3% were stage I, 48% were stage II, 29% were stage III, and 8% were stage IV at presentation. Fifty percent of patients were planned to be treated with a curative intent, and 54% were referred to chemoradiotherapy in Uganda. Forty percent of patients who received chemoradiotherapy were in remission. Overall, 25% were lost to follow-up. Conclusion BCCOE illustrates the feasibility and challenges of implementing effective cervical cancer treatment services in a rural setting in a low-income country