Constraints driven reverse logistics model for Plastic Solid Waste (PSW)

Abstract: The recovery and recycling of Plastic Solid Waste (PSW) is an important aspect of achieving sustainability. The study reviewed technical constraints (Modeling levers) that influence households’ participation in waste recovery and recycling programs from both developed and developing economies. A questionnaire based on the identified levers is developed and distributed to test the validity and significance of the levers. The results are adopted in the development of a levers’ based reverse logistics (RLs) model for PSW in the Zambian context. The model provides a new and useful engineering approach for the management of PSW in both developed and developing economies influenced by similar levers

Microfinance Programs as a Means of Alleviating Poverty: Lessons from MFIs in Newly Industrialized Countries

The history of modern microfinance activities can be traced back to 1976, when Muhammad Yunus set up the Grameen Bank as a project of assisting poor women to access credit for income generating activities in Bangladesh. Since then several microfinance institutions modeled on the Grameen Bank have been developed and implemented in reaching majority of the unbanked poor population in many countries around the globe. Microfinance is now being considered by many countries and governments as one of the most important and effective strategies of poverty alleviation. Among the beneficiaries of micro financing are women Microfinance has enabled them to be self employed thus improving their security, autonomy, self confidence and status within the household.  This study examines microfinance as a poverty alleviation strategy. Lessons from microfinance institutions in Kenya reveal that microfinance has provided poor people in Kenya especially women with an opportunity to engage in income generating activities. Keywords: Poverty, micro-finance, micro-credit, development, investments, interest

Childbearing and family planning choices of women living with HIV and AIDS: the lived experiences

Objective: The main objective of this study was to assess the reproductive choices for Women Living with HIV on ART in the urban health centres within Lusaka.Methods: Nine hundred and fifty six HIV-positive women receiving care in the zoned health centres were randomly sampled and 12 health care workers who were purposefully sampled and were available in the ART setting participated in the study. A survey questionnaire, in-depth interviews and focus group discussions were the main data collection tools used. Quantitative data was analysed using SPSS while qualitative data was analysed using qualitative content analysis rooted in grounded theory (Precaution Adoption Model (PAPM).Results: The majority of the respondents in this study n = 503 (64%) felt that it was important to be safe from becoming pregnant whereas n = 429 (46%) felt that it was not. Health workers counselled the respondents on nearly all of the available contraceptive methods, with an emphasis on the oral pill, injectable hormonal drug, and on male and female condoms – with the greatest emphasis on the male condom. The reasons that women had for selecting particular family planning methods varied temporally. Some women engaged in unprotected sex because their partner was also HIV seropositive. Even in situations when an HIV-positive woman was told of her sero status and given counselling on the risks of motherto- child-transmission (MTCT), the majority of women would still engage in unprotected sex that often led to pregnancy. Nurses preferentially discouraged the women from getting pregnant using the counselling methods described. The rationale for the counselling methods was based on age, education, medical and gynaecological complications. In the current health care setup, it was not demonstrated that reproductive health issues of people living with HIV and AIDS could be provided within the ART clinic.Conclusion: As HIV continues to spread among women of childbearing age, there is an increasing need for support programs for infected women regarding sex, safer sex, pregnancy and family planning. The healthcare challenges for this group must be addressed with a twopronged approach- women must prioritize the risk to their health with repeated exposures to HIV and the healthcare workers must empower them to make these decisions. For this to occur, it is crucial that HIV positive women have easy access to reproductive healthcare counselling in juxtaposition to the ART Clinic. The health care workers that directly counsel these women have a pivotal role in addressing these concerns. Nursing professionals who comprise the bulk of healthcare workers providing these services can play a major role in meeting these needs

A global perspective on the influence of environmental exposures on the nervous system

Economic transitions in the era of globalization warrant a fresh look at the neurological risks associated with environmental change. These are driven by industrial expansion, transfer and mobility of goods, climate change and population growth. In these contexts, risk of infectious and non-infectious diseases are shared across geographical boundaries. In low- and middle-income countries, the risk of environmentally mediated brain disease is augmented several fold by lack of infrastructure, poor health and safety regulations, and limited measures for environmental protection. Neurological disorders may occur as a result of direct exposure to chemical and/or non-chemical stressors, including but not limited to, ultrafine particulate matters. Individual susceptibilities to exposure-related diseases are modified by genetic, epigenetic and metagenomic factors. The existence of several uniquely exposed populations, including those in the areas surrounding the Niger Delta or north western Amazon oil operations; those working in poorly regulated environments, such as artisanal mining industries; or those, mostly in sub-Saharan Africa, relying on cassava as a staple food, offers invaluable opportunities to advance the current understanding of brain responses to environmental challenges. Increased awareness of the brain disorders that are prevalent in low- and middle-income countries and investments in capacity for further environmental health-related research are positive steps towards improving human health

Hypertensive retinopathy and its association with cardiovascular, renal and cerebrovascular morbidity in Congolese patients : cardiovascular topic

Signs indicating hypertensive retinopathy can help determine the extent of hypertensive cardiovascular, renal and cerebrovascular damage

Estimating the real-world effects of expanding antiretroviral treatment eligibility: Evidence from a regression discontinuity analysis in Zambia.

BACKGROUND: Although randomized trials have established the clinical efficacy of treating all persons living with HIV (PLWHs), expanding treatment eligibility in the real world may have additional behavioral effects (e.g., changes in retention) or lead to unintended consequences (e.g., crowding out sicker patients owing to increased patient volume). Using a regression discontinuity design, we sought to assess the effects of a previous change to Zambia's HIV treatment guidelines increasing the threshold for treatment eligibility from 350 to 500 cells/μL to anticipate effects of current global efforts to treat all PLWHs. METHODS AND FINDINGS: We analyzed antiretroviral therapy (ART)-naïve adults who newly enrolled in HIV care in a network of 64 clinics operated by the Zambian Ministry of Health and supported by the Centre for Infectious Disease Research in Zambia (CIDRZ). Patients were restricted to those enrolling in a narrow window around the April 1, 2014 change to Zambian HIV treatment guidelines that raised the CD4 threshold for treatment from 350 to 500 cells/μL (i.e., August 1, 2013, to November 1, 2014). Clinical and sociodemographic data were obtained from an electronic medical record system used in routine care. We used a regression discontinuity design to estimate the effects of this change in treatment eligibility on ART initiation within 3 months of enrollment, retention in care at 6 months (defined as clinic attendance between 3 and 9 months after enrollment), and a composite of both ART initiation by 3 months and retention in care at 6 months in all new enrollees. We also performed an instrumental variable (IV) analysis to quantify the effect of actually initiating ART because of this guideline change on retention. Overall, 34,857 ART-naïve patients (39.1% male, median age 34 years [IQR 28-41], median CD4 268 cells/μL [IQR 134-430]) newly enrolled in HIV care during this period; 23,036 were analyzed after excluding patients around the threshold to allow for clinic-to-clinic variations in actual guideline uptake. In all newly enrolling patients, expanding the CD4 threshold for treatment from 350 to 500 cells/μL was associated with a 13.6% absolute increase in ART initiation within 3 months of enrollment (95% CI, 11.1%-16.2%), a 4.1% absolute increase in retention at 6 months (95% CI, 1.6%-6.7%), and a 10.8% absolute increase in the percentage of patients who initiated ART by 3 months and were retained at six months (95% CI, 8.1%-13.5%). These effects were greatest in patients who would have become newly eligible for ART with the change in guidelines: a 43.7% increase in ART initiation by 3 months (95% CI, 37.5%-49.9%), 13.6% increase in retention at six months (95% CI, 7.3%-20.0%), and a 35.5% increase in the percentage of patients on ART at 3 months and still in care at 6 months [95% CI, 29.2%-41.9%). We did not observe decreases in ART initiation or retention in patients not directly targeted by the guideline change. An IV analysis found that initiating ART in response to the guideline change led to a 37.9% (95% CI, 28.8%-46.9%) absolute increase in retention in care. Limitations of this study include uncertain generalizability under newer models of care, lack of laboratory data (e.g., viral load), inability to account for earlier stages in the HIV care cascade (e.g., HIV testing and linkage), and potential for misclassification of eligibility status or outcome. CONCLUSIONS: In this study, guidelines raising the CD4 threshold for treatment from 350 to 500 cells/μL were associated with a rapid rise in ART initiation as well as enhanced retention among newly treatment-eligible patients, without negatively impacting patients with lower CD4 levels. These data suggest that health systems in Zambia and other high-prevalence settings could substantially enhance engagement even among those with high CD4 levels (i.e., above 500 cells/μL) by expanding treatment without undermining existing care standards

EC3-A modern telecommunications matrix for cervical cancer prevention in Zambia

Objectives.: Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa. Materials and methods.: We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world's poorest countries. Results.: Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic cervical cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation. Conclusions.: The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications

Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia

<p>Abstract</p> <p>Background</p> <p>Mental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes for developing and implementing mental health policies in Ghana, South Africa, Uganda and Zambia as part of the Mental Health and Poverty Project.</p> <p>Methods</p> <p>The study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework.</p> <p>Results</p> <p>Mental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources.</p> <p>Conclusions</p> <p>Mental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.</p

A case study analysis of a constructionist knowledge building community with activity theory

This article investigates how activity theory can help research a constructionist community. We present a constructionist activity model called CONstructionism Through ACtivity Theory (CONTACT) model and explain how it can be used to analyse the constructionist activity in knowledge building communities. We then illustrate the model through its application to analysing the Wiki-supported community associated with a computer game. Our analysis focuses mainly on two perspectives: individual and collective actions, as well as individual and collective mediations. Experiences and challenges from the analysis are reported to demonstrate how CONTACT is helpful in analysing such communities

Ovarian Activity and Oestrous Signs among Group-Housed, Lactating Sows: Influence of Behaviour, Environment and Production

Animal welfare concerns require the development of housing systems that allow the animals to express their natural behaviour. One example of this is the group-housing system for lactating sows. The present study aimed at exploring ovarian activity in such a system. Thirty-eight sows farrowing individually outdoors during spring and summer, and indoors during autumn and winter, and group-housed in groups of four during weeks 3–7 of the lactation period, were monitored regarding reproductive functions, behaviour and production during their first to fourth lactation period. Average ovulation frequency during lactation was 47%. Only 50% of these ovulating cases were accompanied by a standing oestrus. Lactational ovulation frequency was higher in later parities (p < 0.001). Ovulation frequency was higher (p < 0.05) during winter (74%) and spring (69%), than during summer (10%) and autumn (23%). Occurrence of lactational ovulation was associated with some aspects of suckling behaviour and also with litter weight gain (p < 0.05). Forty-nine per cent of the lactational ovulations occurred during the seventh week of lactation. Timing of ovulation seemed positively (p = 0.08) associated with weight loss during lactation. Compared with the sows that were anoestrus during lactation, oestradiol-17β values were higher (p < 0.05) only in the week before occurrence of lactational ovulation. Weaning-to-oestrous interval was prolonged (p < 0.05) among the sows that ovulated during lactation. The present study identifies several factors influencing ovarian activity among group-housed sows, thereby providing tools for the control of lactational ovulation in group-housing systems