Factors associated with patient and health service delays in the management of TB in Central Equatoria State in 2008

Background: Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis. Delays in diagnosis and treatment increase morbidity and mortality from tuberculosis, and the risk of transmission in the community.Methods: We conducted a cross-sectional survey at three TB treatment centres in Central Equatoria State, South Sudan. Smearpositive TB patients were enrolled in three study sites and interviewed within two days of beginning treatment using a structured questionnaire. This study was conducted to investigate factors that affect patient and health service delays in diagnosis and treatment of pulmonary tuberculosis (PTB) in Central Equatoria State.Results: 129 patients were enrolled in the study. The median patient’s, health provider’s and total pre-treatment periods are 4, 10 and 16 weeks respectively. The health care provider delay for patient diagnosis and start of treatment had the greatest contribution to overall total pre-treatment delayConclusions and recommendations: In Central Equatoria State, health care provider delay was the most frequent type of delay observed and was a major contributor to the overall total delay. This study indicated the need for strengthening the capacity of health workers for early detection and referral of TB patients. Further research is needed to identify reasons for health provider delay.Keywords: Mycobacterium tuberculosis, health service delays, South Suda

Bancroftian filariasis in Kwale District, Kenya

Objective: To determine the prevalence of Wuchereria bancrofti infection in an area designated for filariasis control trial.Design: A cross-sectional survey.Setting: Three villages in Kinango location, Kwale district, Coast Province, Kenya.Subjects/participants: Oral informed consent to participate was obtained from adults and parents or guardians of children below fifteen years of age.Main outcome measures: Microfilaraemia prevalences, microfilarial densities and clinical manifestations.Results: The overall prevalence of microfilaraemia in the population was 16.4%. The prevalence of microfilaraemia was age-dependent and the overall microfilarial density (MFD) was 69.4 mf/ml (geometric mean) and significantly higher in males (95.8 mf/ml) than in females (48.6 mf/ml) (p < 0.05). The prevalence of clinical signs of infection was also agedependent with elephantiasis being significantly higher in females (2.3%) than in males (0.9%) (p < 0.05). Among the males, the major clinical manifestation was hydrocele (10.4%).Conclusion: These findings show high prevalence of bancroftian filariasis in Kwale district and warrant similar studies followed by implementation of intervention measures to reduce transmission in all areas of endemicity in the Coast Province

Under-two child mortality according to maternal HIV status in Rwanda: assessing outcomes within the National PMTCT Program

Introduction: We sought to compare risk of death among children aged under-2 years born to HIV positive mother (HIV-exposed) and to HIV negative mother (HIV non-exposed), and identify determinants of under-2 mortality among the two groups in Rwanda. Methods: In a stratified, two-stage cluster sampling design, we selected mother-child pairs using national Antenatal Care (ANC) registers. Household interview with each mother was conducted to capture socio-demographic data and information related to pregnancy, delivery and post-partum. Data were censored at the date of child death. Using Cox proportional hazard model, we compared the hazard of death among HIV-exposed children and HIV nonexposed children. Results: Of 1,455 HIV-exposed children, 29 (2.0%; 95% CI: 1.3%-2.7%) died by 6 months compared to 18 children of the 1,565 HIV non-exposed children (1.2%; 95% CI: 0.6%-1.7%). By 9 months, cumulative risks of death were 3.0% (95%; CI: 2.2%-3.9%) and 1.3% (96%; CI: 0.7%-1.8%) among HIV-exposed and HIV non-exposed children, respectively. By 2 years, the hazard of death among HIVexposed children was more than 3 times higher (aHR:3.5; 95% CI: 1.8-6.9) among HIV-exposed versus non-exposed children. Risk of death by 9-24 months of age was 50% lower among mothers who attended 4 or more antenatal care (ANC) visits (aHR: 0.5, 95% CI: 0.3-0.9), and 26% lower among families who had more assets (aHR: 0.7, 95% CI: 0.5-1.0). Conclusion: Infant mortality was independent of perinatal HIV exposure among children by 6 months of age. However, HIV-exposed children were 3.5 times more likely to die by 2 years. Fewer antenatal visits, lower household assets and maternal HIV seropositive status were associated with increased mortality by 9-24 months.Key words: HIV, PMTCT, maternal HIV infection, infant mortality, child mortality, under-five mortality, Rwand

Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers

Cytomegalovirus (CMV) infection can be acquired in utero or postnatally through horizontal transmission and breastfeeding. The effect of postnatal CMV infection on postnatal HIV transmission is unknown

Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women

Background: Little is known about the influence of antiretroviral therapy with or without micronutrient supplementation on the micronutrient concentrations of HIV-infected lactating women in resource-constrained settings

The Utilization and Preservation Practices of Jute Mallow (Corchorus olitorius) in Western Kenya

Background: Jute mallow (Corchorus olitorius) is a nutritious African leafy vegetable that is grown and consumed by local communities in Kenya. However, despite its nutritional superiority, its utilization is limited primarily due to its seasonality. Aim: This study sought to document the utilization and preservation practices of jute mallow in Western Kenya. Methodology: A cross-sectional study, that involved a household survey (n =139), of jute mallow producers in Kakamega County of Western Kenya, was conducted. Results: Half (50.4%) of the households sourced their vegetables from their farms, while 37.4% sourced them from roadside vendors during the dry season. Jute mallow was mainly (57.6%) consumed as an accompaniment with other vegetables including African Nightshade and Amaranth. Approximately half (52.51%) of the households, employed a method of preservation. There was a significant association (p = 0.01) between age and preservation practices, where middle-aged people (35-50 years) had a higher likelihood of employing a preservation method. &nbsp;Women were also significantly (p = 0.024) more likely to preserve vegetables than men. Sun drying was practiced by 15.8% of the study population, 18.7% practiced fermentation, while 18% practiced both fermentation and sun-drying. The methods of sun-drying were well developed, where prior blanching, was incorporated by 33.3% of the participants. Sun-drying extended the shelf-life of jute mallow by 4.02 ± 3.151 months, while fermentation was 7 days. The leaves of both forms of preservation had relatively high acceptability ratios to the fresh forms at 40% and 48% for fermented and dried forms, respectively.&nbsp; Conclusion: There is a huge potential for low-cost preservation methods in ensuring the availability of jute mallow. However, it is necessary to investigate the viability of these methods on the nutritional quality and safety of jute mallow to improve food security

Prevalence of vitamin A deficiency among pre-school and school aged children in Arssi zone, Ethiopia

Objective: To investigate vitamin A status of pre-school and school aged children in the study area. Design: Cross-sectional Setting: Arssi, Ethiopia Subjects: Four hundred and two children Results: Night blindness, Bitots spot, corneal xerosis, corneal ulceration and corneal scar were observed in 7.2%, 2.2 %, 0.2%, 0.5%, and 0.5% of the children respectively. The prevalence of xerophthalmia was higher in school aged children than pre-school children (P< 0.0001). Based on the WHO recommended cut-off level, serum retinol levels were in the “low” range

The evolution of rapid production: How to adopt novel manufacturing technology

This research focuses on the evolution and adoption of rapid production. We investigate the ways novel rapid production technology offers competitive advantage to companies, and argue that benefiting from this technology requires significant changes in business beyond manufacturing. The study is centered on core areas that need to be addressed when adopting such rapid production technology: business models, processes, IPR, industry characteristics, product/service transition, logistics and materials. Of note, whereas 3D printing has been praised as the "next big thing" in personal fabrication, it is just a stage in an ongoing transition from rapid prototyping toward rapid manufacturing. In the study, we establish and discuss two frameworks: 1) evolutionary steps in rapid production, and 2) key business imperatives to be addressed when adopting rapid production technology. We conclude by arguing that all firms should adopt rapid production technology to avoid becoming at a disadvantage

Child care practices and nutritional status of children aged 0-2 years in Thika, Kenya

Objective: To assess time allocation for child care and the nutritional status of children aged 0-2 years. Design: Cross sectional descriptive survey using a structured questionnaire and taking of anthropometric measurements to determine the nutritional status of children aged 0 to 2 years. In addition, two day (10 hour) observations were conducted in a subsample of households to assess time allocation for the main child care activities. Setting: A low-income peri-urban section of Thika town (in Makongeni estate), Kenya. Subjects: A random sample of 150 mothers and their 0-2 year old children. Results: Mother's knowledge about child care influences the amount and type of care that is given to children. Time taken to perform various activities was also found to vary with the mother's education level, her occupation, number of children less than five years in the house and the child's age and birth order. Comparatively, children who were malnourished (stunted) had less time devoted to them for breastfeeding, food preparation and feeding. Although mothers were the primary caregivers, the responsibility of care giving was shared with other household members as well as with neighbours. Conclusion: The amount and type of care that a child receives is determined to a large extent by the mother and caregivers knowledge. (East African Medical Journal: 2002 79(10): 524-529