Training community healthcare workers on the use of information and communication technologies: a randomised controlled trial of traditional versus blended learning in Malawi, Africa

Background: Despite the increasing uptake of information and communication technologies (ICT) within healthcare services across developing countries, community healthcare workers (CHWs) have limited knowledge to fully utilise computerised clinical systems and mobile apps. The ‘Introduction to Information and Communication Technology and eHealth’ course was developed with the aim to provide CHWs in Malawi, Africa, with basic knowledge and computer skills to use digital solutions in healthcare delivery. The course was delivered using a traditional and a blended learning approach. Methods: Two questionnaires were developed and tested for face validity and reliability in a pilot course with 20 CHWs. Those were designed to measure CHWs’ knowledge of and attitudes towards the use of ICT, before and after each course, as well as their satisfaction with each learning approach. Following validation, a randomised controlled trial was conducted to assess the effectiveness of the two learning approaches. A total of 40 CHWs were recruited, stratified by position, gender and computer experience, and allocated to the traditional or blended learning group using block randomisation. Participants completed the baseline and follow-up questionnaires before and after each course to assess the impact of each learning approach on their knowledge, attitudes, and satisfaction. Per-item, pre-post and between-group, mean differences for each approach were calculated using paired and unpaired t-tests, respectively. Per-item, between-group, satisfaction scores were compared using unpaired t-tests. Results: Scores across all scales improved after attending the traditional and blended learning courses. Self-rated ICT knowledge was significantly improved in both groups with significant differences between groups in seven domains. However, actual ICT knowledge scores were similar across groups. There were no significant differences between groups in attitudinal gains. Satisfaction with the course was generally high in both groups. However, participants in the blended learning group found it more difficult to follow the content of the course. Conclusions: This study shows that there is no difference between blended and traditional learning in the acquisition of actual ICT knowledge among community healthcare workers in developing countries. Given the human resource constraints in remote resource-poor areas, the blended learning approach may present an advantageous alternative to traditional learning

Prevalence of complications of male circumcision in Anglophone Africa: a systematic review

BACKGROUND: There is growing evidence that male circumcision (MC) prevents heterosexual acquisition of HIV by males in sub-Saharan Africa, the region of the world heavily affected by the HIV pandemic. While there is growing support for wide-spread availability and accessibility of MC in Africa, there is limited discussion about the prevalence of physical complications of male circumcision on the continent. METHODS: A systematic literature search and review of articles in indexed journals and conference abstracts was conducted to collect and analyze prevalence of complications of MC in Anglophone sub-Saharan Africa. Information extracted included: indications for MC, complications reported, age of patients and category of circumcisers. RESULTS: There were 8 articles and 2 abstracts that were suitable for the analysis. The studies were not strictly comparable as some reported on a wide range of complications while others reported just a limited list of possible complications. Prevalence of reported complications of MC ranged from 0% to 50.1%. Excluding the study with 50.1%, which was on a series of haemophilia patients, the next highest prevalence of complications was 24.1%. Most of the complications were minor. There was no firm evidence to suggest that MCs performed by physician surgeons were associated with lower prevalence of complications when compared with non-physician health professionals. CONCLUSION: The available data are inadequate to obtain a reasonable assessment of the prevalence of complications of MC in sub-Saharan Africa. Some of the available studies however report potentially significant prevalence of complications, though of minor clinical significance. This should be considered as public health policy makers consider whether to scale-up MC as an HIV preventative measure. Decision for the scale-up will depend on a careful cost-benefit assessment of which physical complications are certainly an important aspect. There is need for standardized reporting of complications of male circumcision

Vitamin A levels in HIV/AIDS

(East African Medical Journal 2001 78 (9): 451-453

Contracting out of health services in developing countries

Contracting out is emerging as a common policy issue in a number of developing countries. The theoretical case for contracting out suggests many advantages in combining public finance with private provision. However, practical difficulties such as those of ensuring that competition takes place between potential contractors, that competition leads to efficiency and that contracts and the process of contracting are effectively managed, suggest that such advantages may not always be realized. Most countries are likely only to contemplate restricted contracting of small-scale non-clinical services in the short term. Prerequisites of more extensive models appear to be the development of information systems and human resources to that end. Some urban areas of larger countries may have the existing preconditions for more successful large-scale contracting.sch_iih9pub316pub

VITAMIN A LEVELS IN HIVIAIDS

Objective: To study the correlation of vitamin A concentrations in patients with AIDS, HIVpositive symptom free and HIV negative symptom free men and women.Design: A cross-sectional study.Subjects: Male and female volunteers aged between 15 and 60 yean willing to undergo anHIV-test.Setting: Participants came from different backgrounds within the city of Ndola. Some wereurban while others were peri-urban dwellers. They were included in the study only if theywere willing to undergo the HIV test regardless of their place of residence.Main outcome measures: After obtaining consent blood samples were taken from theparticipants using needle and syringe. Whole blood was used to measure haematologicalindices while serum was used to measure vitamin A concentrations and HIV status.Results: One hundred and thirty five participants were recruited for the study. Vitamin Awas analysed in eighty seven HIV negative symptom free, forty one HIV-positive symptomfree and seven AIDS cases. 'There was a significant difference (p<O.OS) in the variance ofvitamin A levels in the three groups. Vitamin A deficiency is defined as blood concentrationsbelow 30 Wdl. Using this cut-off point, the Odds Ratio for deficiency if HIV-positive wasfound to be 6.3 (2.5,16.7 p<0.0001). The Odds Ratio for HIV and serum vitamin A def~iencywas approximately the same for males and females. There was a modest correlation betweenvitamin A concentrations and haemoglobin (r=0.34,95 % CI 0.18,0.48, p<0.0001).Conclusion: Vitamin A concentration is lowered in HIV infection. The depletion of vitaminA seems to increase with progression of the infection leading to AIDS disease. Whetherregular supplementation of vitamin A to the HIV infected individual can lead to a delayedprogression to AIDS needs to be explored

Area and edge effects in radiometric forces

The radiometric force on several configurations of heated plates placed in a stagnant gas is examined experimentally, with a high-resolution thrust stand, and numerically using the direct simulation Monte Carlo method and a discrete ordinate solution of a model kinetic equation. A wide range of pressure from 0.006 to 6 Pa was examined, corresponding to Knudsen numbers from 20 to 0.02, in argon and helium test gases. The radiometric force, important in a number of emerging micro- and nanoscale applications, is shown to be mostly area dependent in the transitional regime where it reaches its maximum at Kn~0.1