Health challenges of elderly people caring for children orphaned by AIDS in a community setting in South Africa

The HIV epidemic has resulted in the death of many people in their reproductive years, leaving behind orphans who are sometimes cared for by their elderly relatives despite the feebleness of their aging bodies. The purpose of the study was to explore and describe the health challenges of elderly people caring for children orphaned by AIDS. This research was conducted as a qualitative phenomenological exploratory, descriptive, and contextual study, conducted in the Mafikeng Municipality of North-West province in South Africa. Data were collected from December 2011 to February 2012 through individual face-to-face interviews and field notes. Elderly people’s health challenges in caring for children orphaned by AIDS centred on physical, psycho-emotional, economic and, psychosocial constraints, linked to re-parenting at an old age or because of losing their own children and relatives to AIDS. They experienced physical exhaustion as a challenge of caring for the children orphaned by AIDS as the capacity of their bodies was now reduced and they also had to meet the physical, emotion and spiritual needs of the orphans as well as providing them with food, clothing and shelter. Lack of sleep, dizziness, elevated blood pressure, low glucose levels and asthmatic attacks were also aggravated by contemplating how to fend for these children or owing to the fact that the orphans were very stubborn and took the elderly for granted. This study afforded an understanding of the health challenges elderly people experience in caring for children orphaned by AIDS. The study also recommended some of the interventions that can assist elderly people in this role they play of caring. Based on the findings, it can be deduced that on top of health challenges they face, they are obliged to deal with the added burden of caring for orphaned children by AIDS.Department of HE and Training approved lis

Zimbabwe dollarisation: short term gift, long term curse - reintroducing the Zimbabwe dollar using the gold standard

Historical analysis suggests that in the short to medium term, dollarization as a monetary policy measure, post a period of high inflation, reduces economic volatility, stabilises the inflation of goods and services, and restores economic predictability. However, in fully dollarized economics (as opposed to dual currency economies,) in the medium term, the effects of dollarization do not create a suitable environment for long term sustainable growth. This paper discusses the benefits and challenges of full dollarization and suggests a further policy measure of re-introducing the local currency through a managed regime. The paper looks to smoothing out money supply volatility through Zimbabwe dollar introduction. Understanding the responsiveness of the economy to monetary liquidity is explained through theoretical and extrapolative statistical analysis derived from a short-range historic time series

A mobile Deaf-to-hearing communication aid for medical diagnosis

This paper describes how a deaf to hearing communication aid built for a mobile phone can be used to provide semi-synchronous communication between a Deaf person and a hearing person who cannot sign. Deaf people with access to mobile phones have become accustomed to using Short Messaging Services, to communicate with both hearing and Deaf people. However Most Deaf people have basic literacy levels and hence prefer not to communicate with text, but with South Africa Sign Language. The prototype uses interpreted communication between sign language and English. The mock-up is meant to help a Deaf person convey their medical conditions to a doctor face-to-face in the office. The prototype is made using prerecorded sign language videos for the Deaf person and English text for the hearing doctor. The interaction on the mobile phone is done inside the phone's browser using video streaming, instead of playing the video in a third-party media player. The design goal was to present the system on a mobile phone from the computer-based prototype. This paper takes a look at the background, related systems, the methods, the design and user testing of such a system on a mobile phone; using two prototypes client-server and client only.Telkom, Cisco, THRIP, SANPADDepartment of HE and Training approved lis

Maternal nicotine expose during gestation and lactation induce premature aging of the lungs of the offspring

Magister Scientiae (Medical Bioscience) - MSc(MBS)Tobacco smoking remains one of the leading causes of death worldwide. Despite all the efforts made by governments, researchers and communities to educate women about the dangerous effects of tobacco smoke and nicotine, smoking during pregnancy continues to be a common habit and accounts for a significant percentage of fetal morbidity and mortality. The offspring is, as a result, exposed to nicotine through the blood and the milk of the mother. Nicotine is therefore expected to interact with the developing fetus and the offspring of mothers who smoke or use Nicotine Replacement therapy for smoking cessation, resulting in the interference with normal fetal lung development. Maternal cigarette smoke or nicotine exposure produces adverse effects in the lungs of offspring, these include; intrauterine growth retardation, low birth weight, premature birth, reduced pulmonary function at birth, and a high occurrence of respiratory illnesses after birth. The main objectives of this study were to determine: 1) the effects of maternal nicotine exposure during gestation and lactation on lung development in the offspring, 2) if there is evidence of premature aging of the lungs of the lungs of the nicotine exposed offspring, and 3) whether tomato juice can have protective effects on the fetal lung development and function in the offspring. From the study, it was established that maternal nicotine exposure had no significant effect on the growth parameters of the offspring. However, it results in the late onset of gradual parenchymal damage which resembles premature aging. The study also found that the consumption of tomato juice may have protective effects on the premature aging of the lungs of the offspring.South Afric

Cell phone notification via bluetooth for Web 2.0 applications

This paper discusses how an Instant Messaging application on a computer can use Bluetooth in order to provide vibration notification on a mobile phone. The initial motivation was to aid Deaf1 office workers to know when events happened on the computer on their desks. Deaf people with access to modern technology have become accustomed to using Instant Messaging, email and video conferencing. However, most of these applications are designed for hearing users and often use audible notification. Cell phone vibration offers a way to convey similar notifications because many Deaf users have a cell phone. The use of SMS has also become widespread among Deaf users because they cannot hear or speak, even though they might be somewhat text illiterate. Vibration notification in addition to aural notification is common on most cell phones and Deaf users can use the former. This paper describes a Bluetooth notification system to notify a Deaf user with vibration on a cell phone whenever a new Instant Message is received on a given computer. A design goal was to provide an application programming interface to the notification system so that it can be used with any form of Web 2.0 desktop communication tool.Telkom, Cisco, THRIP, SANPADDepartment of HE and Training approved lis

Premature aging of the lungs of the offspring induced by maternal nicotine exposure during gestation and lactation: protective effects of tomato juice

Philosophiae Doctor - PhDexposed to nicotine through the blood and the milk of the mother. Nicotine is thus expected to interact with the developing fetus and the offspring of mothers who smoke or use NRT for smoking cessation, resulting in the interference with normal fetal and neonatal lung development. Maternal cigarette smoke or nicotine exposure produces adverse effects in the lungs of offspring, these include; intrauterine growth retardation, low birth weight, premature birth, reduced pulmonary function at birth, and a high occurrence of respiratory illnesses after birth. This study aimed at investigating the effects of maternal nicotine exposure during gestation and lactation on lung development in the offspring; to establish whether tomato juice can have protective effects on the fetal lung development and function in the offspring; and to determine if nicotine cases premature aging of the lungs of the offspring. It was therefore shown that maternal exposure to nicotine during gestation and lactation ad no significant effect on the growth parameters of the offspring. Maternal nicotine exposure during gestation and lactation had no effect on the growth parameters of the offspring, but resulted in compromised lung structure and function. The morphometric results demonstrated decrease in alveolar number, increase in alveolar size, and decrease in lung parenchyma of the nicotine exposed animals showing a gradual deterioration of the lung parenchyma. Structural alterations include emphysematous lesions, where the latter was accompanied by an increase in alveolar size (Lm), and a decrease in the tissue volume of the lung parenchyma. Thickening of alveolar walls was also evident and serves as an indication of remodeling of the extracellular matrix, also a characteristic of emphysema. A consequence of the gradual deterioration of the lung parenchyma is a decrease in the alveolar surface area available for gas exchange. The present study showed that the emphysematous lesions were conceivably a result of a reduced rate of cell proliferation accompanied by the increase in senescent cells numbers in the alveolar walls of the exposed offspring. The data of this study suggests that maternal nicotine exposure during gestation and lactation induces premature aging of the lungs of the offspring rendering the lungs of the offspring more susceptible to disease later in life. Since these structural changes occurred later in the life of the offspring and long after nicotine withdrawal, it is suggested that it is programmed during gestation and lactation. Smoking and NRT result in an increased load of oxidants in the mother and fetus. It also reduces the level of anti-oxidants and thereby compromising the ability of the mother to protect the fetus. It is hypothesized that this oxidant-antioxidant imbalance will program the lungs to age prematurely. The supplementation of the mother’s diet with tomato juice, rich in lycopene, other anti-oxidants such as vitamin C, as well as phytonutrients protected the lungs of the offspring against the adverse effects of maternal nicotine exposure. This supports the hypothesis mentioned above. The study further showed that the effects of grand-maternal nicotine exposure during gestation and lactation on the lungs of the F1 offspring is also transferred to the F2 offspring. This is most likely via the paternal and maternal germ line. Since tomato juice supplementation of the mother’s diet with tomato juice prevented the adverse effects of maternal nicotine exposure on the lungs of the offspring, it is conceivable that it will prevent transfer of these changes to the F2 generation.South Afric

A Mobile Deaf-to-hearing communication aid for medical diagnosis

>Magister Scientiae - MScMany South African Deaf people use their mobile phones for communication with SMSs yet they would prefer to converse in South African Sign Language. Deaf people with a capital `D' are different from deaf or hard of hearing as they primarily use sign language to communicate. This study explores how to design and evaluate a prototype that will allow a Deaf person using SASL to tell a hearing doctor how s/he is feeling and provide a way for the doctor to respond. A computer{based prototype was designed and evaluated with the Deaf people in a previous study. Results from the user trial of the computer{based mock{up indicated that Deaf users would like to see the prototype on a cell phone. Those user trial results, combined with our own user survey results conducted with Deaf people, are used as requirements. We built a prototype for a mobile phone browser by embedding SASL videos inside XHTML pages using Adobe Flash. The prototype asks medical questions using SASL videos. These questions are arranged in an organized way that helps in identifying a medical problem. The answers to the questions are then displayed in English and shown to the doctor on the phone. A content authoring tool was also designed and implemented. The content authoring tool is used for populating the prototype in a context free manner allowing for plug and play scenarios such as a doctor's office, Department of Home A airs or police station. A focus group consisting of Deaf people was conducted to help in the design and pilot trial of the system. A final user trial was conducted with more than thirty Deaf people and the results are presented and analyzed. Data is collected with questionnaires, semi-structured interviews and video recordings. The results indicate that most of the Deaf people found the system easy to learn, easy to navigate through, did not get lost and understood the sign language in the videos on the mobile phone. The hand gestures and facial expressions on the sign language videos were clear. Most of them indicated they would like to use the system for free, and that the system did not ask too many questions. Most of them were happy with the quality of the sign language videos on the mobile phone and would consider using the system in real life. Finally they felt their private information was safe while using the system. Many South African Deaf people use their mobile phones for communication with SMSs yet they would prefer to converse in South African Sign Language. Deaf people with a capital `D' are different from deaf or hard of hearing as they primarily use sign language to communicate. This study explores how to design and evaluate a prototype that will allow a Deaf person using SASL to tell a hearing doctor how s/he is feeling and provide a way for the doctor to respond. A computer{based prototype was designed and evaluated with the Deaf people in a previous study. Results from the user trial of the computer{based mock{up indicated that Deaf users would like to see the prototype on a cell phone. Those user trial results, combined with our own user survey results conducted with Deaf people, are used as requirements. We built a prototype for a mobile phone browser by embedding SASL videos inside XHTML pages using Adobe Flash. The prototype asks medical questions using SASL videos. These questions are arranged in an organized way that helps in identifying a medical problem. The answers to the questions are then displayed in English and shown to the doctor on the phone. A content authoring tool was also designed and implemented. The content authoring tool is used for populating the prototype in a context free manner allowing for plug and play scenarios such as a doctor's office, Department of Home A airs or police station. A focus group consisting of Deaf people was conducted to help in the design and pilot trial of the system. A final user trial was conducted with more than thirty Deaf people and the results are presented and analyzed. Data is collected with questionnaires, semi-structured interviews and video recordings. The results indicate that most of the Deaf people found the system easy to learn, easy to navigate through, did not get lost and understood the sign language in the videos on the mobile phone. The hand gestures and facial expressions on the sign language videos were clear. Most of them indicated they would like to use the system for free, and that the system did not ask too many questions. Most of them were happy with the quality of the sign language videos on the mobile phone and would consider using the system in real life. Finally they felt their private information was safe while using the system.South Afric

Epidemiology of antimicrobial resistance at the livestock-human interface in an urban environment: a One Health approach

Livestock have been implicated as a reservoir for antimicrobial resistant (AMR) bacteria that may spread to humans, with the keeping of livestock widely postulated as a risk factor for AMR in humans. However, quantitative evidence of the role of livestock in the emergence and transmission of AMR bacteria to human populations is lacking. This thesis focuses on the role of livestock keeping as a potentially high-risk interface for AMR transmission between humans and livestock in urban Nairobi. To achieve this, E. coli isolates were systematically collected from sympatric human and livestock populations in 99 households across Nairobi, Kenya. E. coli was characterised both phenotypically (through antimicrobial susceptibility testing) and genetically (through whole genome sequencing). In the first part of this thesis, I conduct a comprehensive systematic review to investigate existing evidence that food animals are responsible for transfer of resistant E. coli and their AMR determinants to humans. I demonstrate that the current evidence regarding transmission of drug resistance between food animals and humans is limited and that similarity of AMR bacteria or AMR determinants in the two populations does not, by itself, provide information on directionality of transfer. I highlight the need to use high resolution genomic analysis on human and livestock bacterial samples collected in time and space to better understand the direction and frequency of AMR transmission between these populations. Next, utilising AMR phenotypes and genotypes, I explored the variation in carriage of AMR E. coli and investigated the role of livestock ownership as a risk factor for AMR carriage in humans. First, I explored the epidemiology of clinically relevant AMR phenotypes and AMR genetic markers. I detected high rates of AMR phenotypes, with 47.6% and 21.1% of isolates displaying resistance to ≥ 3 and ≥5 antimicrobial classes respectively. Whole-genome sequencing revealed 60 acquired genes and 14 point mutations conferring AMR to 9 antimicrobial classes. sul2, strA, strB, tetA, and blaTEM-1B were the most frequently detected AMR genes conferring resistance to sulfonamides, aminoglycosides, tetracyclines, and β-lactams respectively – the most commonly found phenotypes. Highest carriage of AMR genes and phenotypes was observed in humans, pigs and poultry compared to goats, rabbits and bovines. Secondly, I demonstrated that the presence of livestock in the household did not influence phenotypic or genotypic AMR carriage in humans, but the impact of keeping livestock on human AMR carriage was instead influenced by presence of animal manure in the household. Utilising high resolution sequencing data, I proceeded to investigate the patterns of bacterial relatedness and strain sharing as a proxy for transmission potential. I showed that livestock and human isolates are genetically heterogeneous, with minimal evidence of clustering by host group, and that E. coli genomes in humans did not segregate according to livestock ownership. Next, I found evidence of 91 sharing events differing by less than ten base pairs (59 involving livestock isolates only 23 human isolates only, and 9 between humans and livestock), and that most of the sharing events were confined within households with only occasional instances of spread between household. I also demonstrate that high-resolution sequence-based analysis of SNPs is more discriminatory than MLST – a widely used tool in describing transmission of E. coli. Next, I described the patterns of antimicrobial sales in humans and livestock, and the level of awareness and common behaviours related to antimicrobial prescribing amongst human and veterinary pharmacists in urban Nairobi. β- lactams, fluoroquinolones, first and second generation cephalosporins, and metronidazole were the most commonly purchased human antimicrobials while tetracyclines, sulphonamides, penicillins, and macrolides were the most commonly purchased veterinary antimicrobials. This finding was in line with the resistance phenotypes and genotypes described in this thesis. I found that whilst most pharmacists were knowledgeable about antimicrobial use and AMR, inappropriate prescribing practices were common and that over the counter sale of antimicrobials, without a prescription, was a common occurrence in both human and veterinary drug stores. In the final section of the thesis, I investigated the co-occurrence patterns of acquired AMR genes and the role of conjugative plasmids on the epidemiology of AMR spread. I found evidence of co-location of multiple AMR genes in both human and livestock isolates, potentially enabling acquisition and dissemination of multi-drug resistance phenotypes in a single step. I found a diversity of known plasmids and plasmid replicons that were associated with the distribution of acquired AMR genes. To conclude, I discuss the findings of this thesis in the context of the current epidemiology of AMR pathogens at the human-livestock interface and highlight future directions for research on AMR transmission, and discuss implications of my findings for public health. This thesis demonstrates how fine-scale genomic analysis explicitly embedded within an epidemiologically structured sampling framework can be utilized to track bacterial sharing and in the surveillance of AMR prevalence in a low income urban setting. The connectivity of bacteria and their AMR determinants between humans and livestock and the ultimate impacts upon human health lends strong support for a holistic ‘One Health’ perspective for AMR surveillance

Anatomical variations of the superior cerebellar artery: A cadaveric study at the University Teaching Hospitals, Lusaka, Zambia

The superior cerebellar artery usually arises from the terminal end of the basilar artery. It may also originate from the posterior cerebral artery and or from a common trunk with the posterior cerebral artery. The anatomical variations of superior cerebellar artery show ethnic differences, but there are few reports on African populations in particular none from Zambia. Variations of the superior cerebellar artery might cause compression symptoms of cranial nerves III, IV and V. Furthermore, the presence of such variations has been considered to be a factor in the aetiology of  aneurysms and thrombus formation leading to cerebellar infarcts. The objectives of the study were to explore anatomical variations on the origin of the superior cerebellar artery; to measure the outer diameter at its origin and the length of superior cerebellar artery to its first bifurcation; to establish the presence of duplication , triplication , hypoplasia , agenesis , fenestration and any other anomalies that were detectable. This was a descriptive cross-sectional study in which 46 post-mortem human cadaveric brains were systematically sampled. A total of 113 superior cerebellar arteries were identified in 42 male and four female cadavers of age ranging between 18 and 65 years (mean 34.05±9.237mm). Superior cerebellar artery arose from the basilar artery as a single vessel in 49.5%, the common trunk arose in 6.2% and posterior cerebral artery origin was seen in 5.7%. Overall duplication of the superior cerebellar artery was seen in 35.5% and triplication in 5.3%. Nineteen (16.8%) of the superior cerebellar arteries were hypoplastic (less than 1mm) and ninety-four (83.2%) were normal. The diameter of the superior cerebellar artery at its origin ranged 0.25mm to 2.48mm (mean 1.42±0.54mm). The length of the superior cerebellar artery to its first bifurcation ranged from 3.77mm to 33.53mm (mean 21.92±7.40mm). Statistically, gender had no significant association of superior cerebellar artery variations (p>0.05). This knowledge will improvediagnosis and management of patients with vascular disorders of the posterior circulation. The newly identified patterns could be a contribution to the SCA classification system. Key words: Superior cerebellar artery, duplication, triplication and hypoplasi

Cadaveric embalming using a modified Thiel method as an alternative to the formalin method

Formalin embalming method is cheaper and commonly used. Thiel method is said to be complex, expensive, not commonly used but offers better cadavers for student teaching. The study aimed at exploring the effects of two embalming methods; modified Thiel and formalin methods on cadavers in terms of muscle softness, joint flexibility, tissue colour, formalin smell and the ease with which structures can be identified. This was an experimental study design done over the period of three months where four adult male cadavers were embalmed (two under each method) and the outcome was compared. Using gravity about Ten Litres of arterial and five Litres venous Thiel fluids was slowly infused into each Thiel cadaver through the carotid artery and femoral vein respectively and cadavers remained overnight. Thiel cadavers were submerged in the tank containing about 300L of Thiel fluid, covered with a blanket and left for eight weeks. Each formalin cadaver was infused with about 15Litres of 10% formalin using the carotid artery and then wrapped in transparent plastics. Thereafter, cadavers were codified and placed in different rooms where participants examined and dissected some regions starting with Thiel cadavers and crossing over to the formalin cadavers after twenty-four hours. Thiel cadavers were softer than formalin (mean = 4.89 ± 0.53 Thiel and 2.1 ± 1.26 for formalin). For joint flexibility, at least 75% of participants strongly agreed for Thiel and at least 75% of the participants strongly disagreed for formalin (mean = 4.81 ± 0.86 Thiel and 1.71 ± 1.13 formalin). Tissue colour was closer to natural in Thiel compared to the formalin cadavers (mean = 4.82 ± 0.55 Thiel and 1.77 ± 1.07 formalin). There were no complaints due to irritant formalin smell in Thiel cadavers as opposed to the formalin ones (mean = 1.15 ± 0.55 Thiel and 4.56 ± 1.15 formalin). At least 75% agreed that it was easy to identify structures in the Thiel cadavers than formalin (mean = 4.67 ± 0.61 and 2.61 ± 1.14 formalin). Thiel embalming method offers good quality cadavers that are soft, flexible; tissue colour closer to natural state and without is strong formalin smell and structures can easily be identified. Key words: Cadaveric embalming, modified Thiel, formalin method