A strategy to improve skills in pharmaceutical supply management in East Africa: the regional technical resource collaboration for pharmaceutical management

<p>Abstract</p> <p>Background</p> <p>International initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief and the President's Malaria Initiative have significantly increased availability and access to medicines in some parts of the developing world. Despite this, however, skills remain limited on quantifying needs for medications and ordering, receiving and storing medications appropriately; recording medications inventories accurately; distributing medications for use appropriately; and advising patients on how to use medications appropriately. The Regional Technical Resource Collaboration for Pharmaceutical Management (RTRC) has been established to help address the problem of skills shortage in pharmaceutical management in East Africa.</p> <p>Methods</p> <p>The initiative brings together academic institutions from four East African countries to participate in skills-building activities in pharmaceutical supply management. The initiative targeted the institutions' ability to conduct assessments of pharmaceutical supply management systems and to develop and implement effective skills-building programmes for pharmaceutical supply chain management.</p> <p>Results</p> <p>Over a two-year period, the RTRC succeeded in conducting assessments of pharmaceutical supply management systems and practices in Kenya, Rwanda, Tanzania and Uganda. In 2006, the RTRC participated in a materials-development workshop in Kampala, Uganda, and contributed to the development of comprehensive HIV/AIDS pharmaceutical management training materials; these materials are now widely available in all four countries. In Tanzania and Uganda the RTRC has been involved with the training of health care workers in HIV/AIDS pharmaceutical management. In Kenya, Tanzania and Uganda the RTRC has been conducting operations research to find solutions to their countries' skills-shortage problems. Some of the interventions tested include applying and evaluating the effectiveness of a novel skills-building approach for pharmaceutical supply management.</p> <p>Conclusion</p> <p>Nurturing collaboration between regional institutions in resource-limited countries to build in-country skills in pharmaceutical supply management appears to be an effective intervention. Support from local programmes and technical assistance from organizations and institutions with the necessary expertise is critical for success, particularly at inception. The skills acquired by local institutions can be incorporated into both pre-service and in-service teaching curricula. This ensures long-term availability of skills in-country. The ability of trained institutions to mobilize their own resources for skills-building activities is crucial for the success and sustainability of these programmes.</p

The riverine source of CH4 and N2O from the Republic of Congo, western Congo Basin

We discuss concentrations of dissolved CH4, N2O, O2, NO3− and NH4+, and emission fluxes of CH4 and N2O for river sites in the western Congo Basin, Republic of Congo (ROC). Savannah, swamp forest and tropical forest samples were collected from the Congo main stem and seven of its tributaries during November 2010 (41 samples; “wet season”) and August 2011 (25 samples; “dry season”; CH4 and N2O only). Dissolved inorganic nitrogen (DIN: NH4+ + NO3−; wet season) was dominated by NO3- (63 ± 19 % of DIN). Total DIN concentrations (1.5–45.3 µmol L−1) were consistent with the near absence of agricultural, domestic and industrial sources for all three land types. Dissolved O2 (wet season) was mostly undersaturated in swamp forest (36 ± 29%) and tropical forest (77 ± 36%) rivers but predominantly supersaturated in savannah rivers (100 ± 17%). The dissolved concentrations of CH4 and N2O were within the range of values reported earlier for sub-Saharan African rivers. Dissolved CH4 was found to be supersaturated (11.2–9553 nmol L−1; 440–354,444 %), whereas N2O ranged from strong undersaturation to super-saturation (3.2–20.6 nmol L −1 ; 47–205%). Evidently, rivers of the ROC are persistent local sources of CH4 and can be minor sources or sinks for N2O. During the dry season the mean and range of CH4 and N2O concentrations were quite similar for the three land types. Wet and dry season mean concentrations and ranges were not significant for N2O for any land type or for CH4 in savannah rivers. The latter observation is consistent with seasonal buffering of river discharge by an underlying sandstone aquifer. Significantly higher wet season CH4 concentrations in swamp and forest rivers suggest that CH4 can be derived from floating macrophytes during flooding and/or enhanced methanogenesis in adjacent flooded soils. Swamp rivers also exhibited both low (47%) and high (205%) N2O saturation but wet season values were overall significantly lower than in either tropical forest or savannah rivers, which were always supersaturated (103–266%) and for which the overall means and ranges of N2O were not significantly different. In swamp and forest rivers O2 saturation co-varied inversely with CH4 saturation (log %) and positively with % N2O. A significant positive correlation between N2O and O2 saturation in swamp rivers was coincident with strong N2O and O2 undersaturation, indicating N2O consumption during denitrification in the sediments. In savannah rivers persistent N2O supersaturation and a negative correlation between N2O and O2 suggest N2O production mainly by nitrification. This is consistent with a stronger correlation between N2O and NH4+ than between N2O and NO3− . Our ranges of values for CH4 and N2O emission fluxes (33–48 705 µmol CH4 m−2 d−1 ; 1–67 µmol N2O m−2 d−1) are within the ranges previously estimated for sub-Saharan African rivers but they include uncertainties deriving from our use of "basin-wide" values for CH4 and N2O gas transfer velocities. Even so, because we did not account for any contribution from ebullition, which is quite likely for CH4 (at least 20%), we consider our emission fluxes for CH4 to be conservative

Utilisation De La Consultation Prénatale Dans Les Structures De Soins De L’Armée Du Salut A Kinshasa De 2020 A 2022

Malgré des forts investissements faits pour les soins prénatals dans les pays en développement comme en RDC, les femmes n’utilisent pas toujours de façon optimale les services qui leur sont offerts. En effet, le taux d’utilisation de la consultation prénatale (CPN) reste très faible : seulement 35,93% des femmes ont réalisé au moins les 4 visites prénatales en 2022(DHS2). Il est donc de bonne politique, plusieurs temps après, que des états de lieux soient faits pour estimer contribuer à l’amélioration de la santé maternelle.Ainsi, dans cette recherche théorique, qui vise à vérifier et décrire le niveau d’utilisation de la CPN dans les structures de soins salutistes de 2019 à 2022 ; il se dégage que l’utilisation de la CPN dans le réseau sanitaire salutiste, partenaire important du système national de santé, reste encore faible avec un taux moyen de CPN 4 allant de 14 à 22% entre 2019 et 2022. Il faut reconnaître que les structures qui disposent d’une maternité sont mieux utilisées en CPN, soit La maternité de BOMOI avec plus de 150% et CS AMBA avec plus de 26% de taux d’utilisation de CPN4. En outre, les conditions socio-économiques des femmes seraient une condition indispensable de l'utilisation de la CPN

Stand dynamics of Pericopsis elata in a forest concession in Democratic Republic of the Congo

Pericopsis elata (afrormosia), bien représentée dans la cuvette centrale congolaise, est une des principales espèces commerciales les plus exploitées en RDC alors qu’elle est inscrite sur la liste rouge des espèces menacées de l’UICN. Afin de garantir sa durabilité, des simulations de sa population ont été réalisées dans les forêts de la concession 010/11 de la Société Africaine de la Forestière (SAFO) à partir des données d’un inventaire d’aménagement. Plusieurs scenarios ont été effectués en variant certains paramètres tel le diamètre minimum d’exploitabilité (DME), la durée de rotation et le taux de prélèvement. Les résultats montrent qu’avec un DME de 60 cm, le taux de reconstitution est de 15 % si on extrait 96 % des tiges exploitables, correspondant au taux de prélèvement fixé par le concessionnaire, et de 31 % si on extrait 75 % des tiges exploitables. En analysant d’autres scénarios, il ressort qu’en fixant le DME à 110 cm et en maintenant le taux de prélèvement à 96 %, il est possible de reconstituer 48 % des tiges exploitables au bout de la durée légale de rotation, soit 25 ans. Enfin, il a été est observé que le fait de remonter le DME à 110 cm ou de réduire le taux de prélèvement à 75 % peut favoriser la régénération et la croissance de P. elata dans la concession étudiée et ainsi assurer le maintien des effectifs de cette espèce. Mots clés: Pericopsis elata, taux de reconstitution, taux de prélèvement, DMEPericopsis elata is an exploitable species that is well represented in the Congolese basin. Although it is on the IUCN Red List of Threatened Species, it is one of the most exploited commercial species in the DRC. In order to ensure its sustainability, simulations of its population were carried out in the forests of the Société Africaine de la Forestière (SAFO) 010/11 concession using data from a management inventory. Several scenarios were carried out by varying certain parameters such as the minimum exploitable diameter (MED), the duration of rotation and the harvesting rate, knowing that the harvesting rate set by the concessionaire is 96%. The results show that with a 60 cm MED, the recovery rate is 15% if 96% of the harvestable stems are extracted, and 31% if 75% of the harvestable stems are extracted. Analysis of other scenarios shows that by varying the EMR to 110 cm and maintaining the removal rate at 96%, it is possible to recover 48% of the harvestable stems at the end of the legal rotation period of 25 years. It is observed that raising the EMR to 110 cm or reducing the removal rate to 75% can promote the regeneration and growths of P. elata in the concession studied and ensure the maintenance of the species' numbers. Key words: Pericopsis elata, recovery rate, removal rate, EMR, allowable cu

Affections Neuroméningées Au Cours Du VIH Dans Le Service Des Maladies Infectieuses Du CHU De Brazzaville : Prévalence Et Facteurs Associés Au Décès

Goal . Neuromeningeal determine the prevalence of disease in PLHIV and identify factors associated with death. Methodology. Retrospective study on descriptive and analytical referred cases hospitalized in the Infectious Diseases department during the period 1 January 2013 to 31 May 2015. Results. One hundred and fifty patients included (10.5% of admissions) with mean age of 41.1 ± 11.8 years (range 19 to 69) women (n = 86, 57.3%), sex ratio of 1,3. were without jobs (n = 68; 45.3%), single (n = 96; 64%), heterosexually infected by HIV-1 (100%). The average time of consultation was 19.2 ± 1.3 days. Fever (n = 99; 66.0%), disorders of consciousness (n = 66; 44.0%) were the main reasons for consultations. Meningeal stiffness (40%), focal signs (n =62; 41,4%) were the main signs consideration. CSF was clear (n = 94; 62.7%), hyperproteinorachique (59.8%), hypoglycorrachique (43.8%). Examining the ink was positive in 39 cases (34.8%) The Gerh was positive in 35 patients .the CT abnormalities were dominated abscess (n = 12; 15.4%).. Thirty four patients were on TDF + FTC + EFV regimen. The average hospital stay was 14.4 ± 9.5 days. Overall mortality was 83.2% mainly due to cerebral herniation (n = 28; 33.3%). Conclusion. The prevalence and lethality of diseases neuromeningeal of HIV are high. The diagnosis delay and TNM influence the prognosis of patients; Hence the importance of early detection of HIV infection for its management to prevent immunosuppression

The biogeochemistry of carbon across a gradient of streams and rivers within the Congo Basin

Author Posting. © American Geophysical Union, 2014. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research: Biogeosciences 119 (2014): 687–702, doi:10.1002/2013JG002442.Dissolved organic carbon (DOC) and inorganic carbon (DIC, pCO2), lignin biomarkers, and theoptical properties of dissolved organic matter (DOM) were measured in a gradient of streams and rivers within the Congo Basin, with the aim of examining how vegetation cover and hydrology influences the composition and concentration of fluvial carbon (C). Three sampling campaigns (February 2010, November 2010, and August 2011) spanning 56 sites are compared by subbasin watershed land cover type (savannah, tropical forest, and swamp) and hydrologic regime (high, intermediate, and low). Land cover properties predominately controlled the amount and quality of DOC, chromophoric DOM (CDOM) and lignin phenol concentrations (∑8) exported in streams and rivers throughout the Congo Basin. Higher DIC concentrations and changing DOM composition (lower molecular weight, less aromatic C) during periods of low hydrologic flow indicated shifting rapid overland supply pathways in wet conditions to deeper groundwater inputs during drier periods. Lower DOC concentrations in forest and swamp subbasins were apparent with increasing catchment area, indicating enhanced DOC loss with extended water residence time. Surface water pCO2 in savannah and tropical forest catchments ranged between 2,600 and 11,922 µatm, with swamp regions exhibiting extremely high pCO2 (10,598–15,802 µatm), highlighting their potential as significant pathways for water-air efflux. Our data suggest that the quantity and quality of DOM exported to streams and rivers are largely driven by terrestrial ecosystem structure and that anthropogenic land use or climate change may impact fluvial C composition and reactivity, with ramifications for regional C budgets and future climate scenarios.This work was supported by the National Science Foundation as part of the ETBC Collaborative Research: Controls on the Flux, Age, and Composition of Terrestrial Organic Carbon Exported by Rivers to the Ocean (0851101 and 0851015).2014-10-3

A multicentre, randomised, double-blind, placebo-controlled trial with the interleukin-1 receptor antagonist anakinra in patients with systemic-onset juvenile idiopathic arthritis (ANAJIS trial)

To assess the efficacy of the interleukin 1 receptor antagonist anakinra in systemic-onset juvenile idiopathic arthritis (SJIA).status: publishe

Is Persistent Motor or Vocal Tic Disorder a Milder Form of Tourette Syndrome?

BACKGROUND: Persistent motor or vocal tic disorder (PMVT) has been hypothesized to be a forme fruste of Tourette syndrome (TS). Although the primary diagnostic criterion for PMVT (presence of motor or vocal tics, but not both) is clear, less is known about its clinical presentation. OBJECTIVE: The goals of this study were to compare the prevalence and number of comorbid psychiatric disorders, tic severity, age at tic onset, and family history for TS and PMVT. METHODS: We analyzed data from two independent cohorts using generalized linear equations and confirmed our findings using meta‐analyses, incorporating data from previously published literature. RESULTS: Rates of obsessive–compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) were lower in PMVT than in TS in all analyses. Other psychiatric comorbidities occurred with similar frequencies in PMVT and TS in both cohorts, although meta‐analyses suggested lower rates of most psychiatric disorders in PMVT compared with TS. ADHD and OCD increased the odds of comorbid mood, anxiety, substance use, and disruptive behaviors, and accounted for observed differences between PMVT and TS. Age of tic onset was approximately 2 years later, and tic severity was lower in PMVT than in TS. First‐degree relatives had elevated rates of TS, PMVT, OCD, and ADHD compared with population prevalences, with rates of TS equal to or greater than PMVT rates. CONCLUSIONS: Our findings support the hypothesis that PMVT and TS occur along a clinical spectrum in which TS is a more severe and PMVT a less severe manifestation of a continuous neurodevelopmental tic spectrum disorder. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Societ