Some factors associated with non-acceptance of measles immunization in Chikwawa District: A population with high measles immunization coverage

Data from a child health survey in Chikwawa District was used to investigate characteristics of non-acceptance of measles immunization. 9.3% of the children with vaccination cards had not been vaccinated. Distance to a static health centre and failure to attend a growth monitoring clinic were predictors of lack of immunizaiion. There were fewer missed opportunities during mobile clinics compared to static clinics. The high cost of mobile clinics does not make expansion of this method attractive. Strengthening educational efforts at the community level regarding measles immunization may be a more reasonable method for improving measles coverage

Productivity of key informants for identifying blind children: evidence from a pilot study in Malawi.

OBJECTIVES: To determine the productivity of village-based 'key informants' (KIs) in identifying blind children. MATERIALS AND METHODS: Ngabu subdistrict (population 101,000) of Chikwawa district was divided into KI catchment areas. KIs, selected by local village leaders, were trained to register children reported to be blind or with severe visual impairment. These children were clinically assessed at designated centres. RESULTS: In total, 44 KIs were selected and trained to cover 196 villages in Ngabu. They identified and referred 151 children, 37 of whom were blind (presenting vision <3/60 best eye). Overall, village leaders tended to choose female KIs (80%) compared to male KIs (20%); however, male KIs tended to be more productive, identifying 4.22 children each (compared to 3.23 for female KIs). Male KIs were 2.7 times more likely to identify blind children compared to female KIs. Only 25% of all identified blind children of school going age were in school. CONCLUSIONS: KIs may be effective in identifying blind children in the community; however, additional work is needed to determine who will be the most effective KI in a community and whether gender roles will limit interpretation of findings from KIs activities

Attitudes and practices regarding child spacing in Chikwawa district

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Village health volunteers: key issues facing agencies in Malawi

In March 1991 the International Eye Foundation and Adventist Development Be Relief Agency conducted a workshop on village health volunteers, bringing together representatives from Malawibased non-governmental organizations, the Ministry of Health, and USAID. The participants discussed recruitment, training, rewards, retention, and roles of village health volunteers. This paper presents background data on village health volunteers in Malawi and elsewhere and reviews the key issues facing health care providers in working with village health volunteers. A copy of the workshop report can be obtained from IEF or ADRA

Clinical features and the factors associated with poor outcome of measles patients at Queen Elizabeth Central Hospital

In the twelve month period from March 1992 to February 1993. 266 consecutive children with measles were admitted to the children's unit at Queen Elizabeth Central Hospital (QECH). Blantyre. During the 12 month period the overall mortality was 10.9%; mortality was highest (22.5%) in children 12-23 months age. One-third of the children admitted were under 9 months of age. not eligible for measles vaccination. Pneumonia complicated illness of 30% of cases and was the greatest clinical predictor of mortality. Among infants under 9 months of age, who were receiving inappropriate food supplementation before 4 months of age the risk of death was 6.4 times the risk of death in children who were not receiving food supplementation. Other aspects of measles epidemiology are discussed

Findings from a Rapid Assessment of Avoidable Blindness (RAAB) in Southern Malawi

BACKGROUND: Data on prevalence and causes of avoidable blindness in Malawi are not readily available. The purpose of this study was to determine the prevalence and causes of blindness in persons aged 50 and above in southern Malawi to plan eye care services for the community. METHODOLOGY: A population-based survey was conducted in 7 districts in southern Malawi. Villages were selected by probability proportionate to size within each district. Clusters were further subdivided into segments. A predetermined number of segments were selected randomly in each cluster. The survey team moved from house to house in each segment until they had examined 50 people over the age of 50. Examination consisted of visual acuity measurement with tumbling "E" chart and ocular examination by an ophthalmologist. Participants were categorized by visual acuity. Those who were visually impaired (VA<6/18 in the better eye with available correction) were assigned a main cause of visual loss. Further information was sought from anyone who had received cataract surgery. RESULTS: A total number of 3,583 persons aged 50 and above were sampled; among these 3,430 (95.7%) were examined. The prevalence of blindness (presenting visual acuity <3/60 in the better eye) among persons aged 50 and above was 3.3% (95% CI 2.5-4.1). Cataract was the most common cause of blindness contributing to 48.2% of all cases, followed by glaucoma (15.8%) and cornea scarring (12.3%). The cataract surgical coverage in blind persons was 44.6%. CONCLUSION: The prevalence of blindness and visual impairment in persons aged 50 and above was lower than the WHO estimate for Malawi. The majority of the causes were avoidable, with cataract accounting for approximately half of all cases of blindness. The data suggests that expansion of eye care programs to address avoidable causes of blindness is necessary in this area of southern Malawi

Findings from a Rapid Assessment of Avoidable Blindness (RAAB) in Southern Malawi

BACKGROUND: Data on prevalence and causes of avoidable blindness in Malawi are not readily available. The purpose of this study was to determine the prevalence and causes of blindness in persons aged 50 and above in southern Malawi to plan eye care services for the community. METHODOLOGY: A population-based survey was conducted in 7 districts in southern Malawi. Villages were selected by probability proportionate to size within each district. Clusters were further subdivided into segments. A predetermined number of segments were selected randomly in each cluster. The survey team moved from house to house in each segment until they had examined 50 people over the age of 50. Examination consisted of visual acuity measurement with tumbling "E" chart and ocular examination by an ophthalmologist. Participants were categorized by visual acuity. Those who were visually impaired (VA<6/18 in the better eye with available correction) were assigned a main cause of visual loss. Further information was sought from anyone who had received cataract surgery. RESULTS: A total number of 3,583 persons aged 50 and above were sampled; among these 3,430 (95.7%) were examined. The prevalence of blindness (presenting visual acuity <3/60 in the better eye) among persons aged 50 and above was 3.3% (95% CI 2.5-4.1). Cataract was the most common cause of blindness contributing to 48.2% of all cases, followed by glaucoma (15.8%) and cornea scarring (12.3%). The cataract surgical coverage in blind persons was 44.6%. CONCLUSION: The prevalence of blindness and visual impairment in persons aged 50 and above was lower than the WHO estimate for Malawi. The majority of the causes were avoidable, with cataract accounting for approximately half of all cases of blindness. The data suggests that expansion of eye care programs to address avoidable causes of blindness is necessary in this area of southern Malawi

Inertial Weldment of Rhenium and Inconel 718

Inertia welding has been found to be a successful method for joining pure rhenium to Inconel 718, and with additional experimentation, this process may have great potential for rocket nozzle applications. Refractory metals are ideally suited to this application, where high temperatures and oxidizing environment survivability is required, but not all of the thruster must be made of these materials, only the areas that require them. A bolted joint between the two metals is not ideal, especially for small thrusters where the mess of a bolted join will come at a steep price. A welded joint would be preferred for flight thrusters

Monitoring interval-training responses for swimming using the 3-min all-out exercise test.

International Journal of Exercise Science 9(5): 545-553, 2016. The purpose of this study was to determine whether the 3-min all-out exercise test (3MT) could be applied to create an off-season high intensity, interval training (HIIT) program to improve performance, specifically critical velocity (CV), in the sport of swimming. We tested a group of competitive female swimmers (age = 19 ± 1 yrs, height = 169 ± 7 cm, body mass = 69 ± 9 kg) to determine their swimming CV and finite energy capacity \u3eCV (D’), and created a four week (2 d∙wk-1) personalized interval training program. Participants were divided in to two groups, a 150yd interval group (n =11) and a 250yd interval group (n =6). Each group completed a series of intervals designed to deplete a given percentage of D’ at velocities exceeding CV. A 3MT following the training period was administered to assess for any changes in CV, D’, average velocity during the first 150s of the test (V150s) and total distance traveled (D). Both groups improved their CV (+0.04 m∙s-1), V150s (+0.03 m∙s-1) and D (+8.64 m) (p \u3c 0.05), however, significant interactions for D’ between groups was not observed (p \u3e 0.05). We conclude that HIIT prescriptions based on a 3MT can improve swim performance over a four-week period. Future research on the fidelity of measuring CV and D’ using a swimming 3MT is needed to help aid practitioners in interpreting true training adaptations

Traditional eye medicine use in microbial keratitis in Uganda : a mixed methods study [version 2; peer review: 2 approved]

Background: Traditional eye medicine (TEM) is frequently used to treat microbial keratitis (MK) in many parts of Africa. Few reports have suggested that this is associated with a worse outcome. We undertook this large prospective study to determine how TEM use impacts presentation and outcome of MK and to explore reasons why people use TEM for treatment in Uganda. Methods: In a mixed method prospective cohort study, we enrolled patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018 and collected information on history, TEM use, microbiology and 3-month outcomes. We conducted qualitative interviews with patients, carers traditional healers on reasons why people use TEM. Outcome measures included presenting vision and at 3-months, comparing TEM Users versus Non-Users. A thematic coding framework was deployed to explore reasons for use of TEM. Results: Out of 313 participants enrolled, 188 reported TEM use. TEM Users had a delayed presentation; median presenting time 18 days versus 14 days, p= 0.005; had larger ulcers 5.6 mm versus 4.3 mm p=0.0005; a worse presenting visual acuity median logarithm of the minimum angle of resolution (Log MAR) 1.5 versus 0.6, p=0.005; and, a worse visual acuity at 3 months median Log MAR 0.6 versus 0.2, p=0.010. In a multivariable logistic regression model, distance from the eye hospital and delayed presentation were associated with TEM use. Reasons for TEM use included lack of confidence in conventional medicine, health system breakdown, poverty, fear of the eye hospital, cultural belief in TEM, influence from traditional healers, personal circumstances and ignorance. Conclusion: TEM users had poorer clinical presentation and outcomes. Capacity building of the primary health centres to improve access to eye care and community behavioural change initiatives against TEM use should be encouraged