Challenges in the management of HIV-infected malnourished children in Sub-Saharan Africa

Infection with HIV, and oftentimes coinfection with TB, complicates the care of severely malnourished children in sub-Saharan Africa. These superimposed infections challenge clinicians faced with a population of malnourished children for whose care evidence-based guidelines have not kept up. Even as the care of HIV-uninfected malnourished children has improved dramatically with the advent of community-based care and even as there are hopeful signs that the HIV epidemic may be stabilizing or ameliorating, significant gaps remain in the care of malnourished children with HIV. Here we summarize what is currently known, what remains unknown, and what remains challenging about how to treat severely malnourished children with HIV and TB.Publisher PDFPeer reviewe

Nominal marking in Northern Tshwa (Kalahari Khoe)

Languages of the Khoe family have a complex pronominal system that distinguishes three categories each for person, gender, and number. However, while languages of the Khoekhoe branch and the western subgroup of Kalahari Khoe obligatorily or optionally mark nouns and nominal classifiers for gender and number, the nominal marking system in eastern Kalahari Khoe appears to be undergoing serious reduction. This article discusses data on personal pronouns and nominal gender-number marking in four little-known Northern Tshwa varieties, including data from Tjwao, a severely endangered language spoken by fewer than ten individuals in western Zimbabwe. We analyse personal pronoun use, case distinctions and nominal marking, focussing on characterising features and commonalities shared across the cluster. Our findings show a high degree of uniformity within Northern Tshwa, and at the same time suggest a more complex nominal marking system than was previously assumed for varieties of the Eastern Kalahari Khoe subgroup

The sensitivity of GCC firms’ stock returns to exchange rate, interest rate, and oil price volatility

This study seeks to investigate the sensitivity of stock returns to exchange rate, interest rate and oil price volatility in the Gulf Cooperation Council (GCC) countries. It employs both the multivariate ordinary least square (OLS) regression and the exponential generalized autoregressive conditional heteroscedastic in mean (EGARCH-M) models to analyse the data collected from Bloomberg and Datastream on the GCC countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates) for the period January 2007 to June 2012. The study shows that stock returns in GCC countries are influenced by the exchange rate risk, interest rate risk and oil price risk. However, the exposure is highest for exchange rate risk and lowest for interest rate risk. While the effects of these risks were mixed, overall, exchange rate risk and oil price risk showed a positive and significant relationship as compared to the interest rate risk that showed a negative significant effect on firm values. The level of the effect of these risks also differed from country to country. Further, foreign operations and firm size had a significant influence on the extent of the firms’ exposure to all the three risks. The study findings suggest that the volatility of stock returns affected by changes in the risk factors could indicate non-prioritisation of risk management by firms. This has implications in terms of consideration of the long-term exposure of firms to these three risks and thus, the need for effective risk management strategies

Mozambique’s peace decades since the end of the conflict: Inclusive or managed democracy?

The article analyses Mozambique’s post-conflict democratisation and argues that Mozambique has become a ‘managed democracy’ in the new period. Mozambique is viewed by the donor community and multilateral  institutions, such as the World Bank and the International Monetary Fund, as a success story of post-war reconstruction and used as a model to be emulated. The article traces the trajectory of democratisation under the auspices of a liberal peace theoretical framework which was agreed upon in the General Peace Agreement ending the conflict in 1992. Secondary quantitative data were made available from leading International Organisations such as the World Bank and the Mo Ibrahim Governance Index. The article found that, despite Mozambique’s commitments to build an inclusive democracy, corruption unmasks Mozambique’s success story. The authors conclude that  democratic consolidation has been accompanied by extractive political and economic institutions leading to a disgruntled citizenry. The country’s peace agreement remains fragile, and faces the reality that political stability has not been accompanied by social justice, equity and deepening democratisation

The Influence of Packaging and Brand Equity on Over-The-Counter Herbal Medicines in Kumasi, Ghana

In today`s competitive business environment, packaging and brand equity provide a competitive advantage to a firm which may increase and maintain its market share. However, the role of packaging in supporting the brand equity is relatively new in the over-the-counter pharmaceutical market and currently, there is a lack of empirical research to uncover its significance in this product segment. This paper seeks to investigate the impact of packaging on brand equity through the mediating effect of dimensions of brand equity in the over-the-counter drug market in Kumasi metropolis. Based on Aaker`s customer-based brand equity model, eight hypotheses were formulated and tested through structural equation modelling. Using systematic sampling, data was collected through survey questionnaires from a sample of 348 consumers who patronize in herbal medicines from herbal stores in Kumasi Metropolis. The study found that packaging significantly contributes to support brand equity of plant medicines through the mediating effect of brand awareness, brand association and brand loyalty. These results indicate that brand managers in the plant medicine industry need to consider packaging as an important brand-building tool in their marketing strategy to enhance brand equity in the over-the-counter pharmaceutical market. This will enh0ance their competitive distinctiveness in the over-the-counter market.&nbsp

The Link between Brand Equity and Loyalty: Evidence from Traditional Medicine Market in Kumasi Metropolis, Ghana

Abstract: Building a vibrant brand in a highly competitive market is of strategic importance as it provides greater loyalty which generates large market share and decreases competitive pressure on a firm. However, there is a lack of empirical evidence on the role of brand equity in supporting the formation of loyalty in the traditional medicine market. The aim of this research is to investigate the impact of brand equity on loyalty in the traditional medicine market. Based on the dimensionality of Aaker`s brand equity framework, four research propositions were put forward and evaluated by using structural equation modelling. The study relied on a sample of 348 customers who buy herbal medicines from the traditional medicine market in Kumasi metropolis. The study established that perceived quality, brand association and awareness significantly contribute to enhance the value of the brands which in turn, creates loyalty in the traditional medicine market in the Kumasi Metropolis. Recognizing the strategic importance of loyalty to the success of a firm, traditional health practitioners should direct their efforts towards developing perceived quality, brand association and awareness to enhance the value of their brands to support loyalty in the Kumasi traditional medicine market

Ward Round in Moyo House: Management issues in malnourished children with HIV and Tuberculosis (TB)

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Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital Blantyre, Malawi in 1996-97.

In order to design appropriate interventioos, we collected clinical and demographic data prospectively on all children aged one day to 14 years admitted with a diagnosis of bacterial meningitis (BM) from April 1st 1996 to March 31st 1997 to the Queen Elizabeth Central Hospital (QECH), Blantyre Malawi. During the study period 267 children (2.7% of all paediatric admissions) were found to have BM; 83% were under 5 years of age, 61 % under one year and 23% under one month. The most common causative organisms in the post neonatal period (n = 206) were Streptococcus pneumoniae (27%), Haemophilus influenzae type b (Hib) 21 %, and Salmonella typhimurium (6%). In the neonatal group «I month, n = 61) the most common causes were Streptococcus agalactiae (23%), S. typhimurium (15%), S. pneumoniae (11. 5%) and other gram negative rods (11.5%). Nineteen of 21 salmonella infections were in children under one year of age and all S. agalactiae were in infants under three months. There was delay on presentation: the average length of fever was 4.6 days, 39.5% had convulsed prior to arrival and 57% had an altered level of consciousness. An initial diagnosis of malaria had probably contributed to the delay in 22.5% , (42 of 186 tested). Forty eight percent were < 80% weight for age, with 18% < 60 % weight for age. The overall mortality was 40%. The outcome was worst in salmonella infections, particularly neonatal salmonella BM with a case fatality rate (CFR) of 89% (8 of 9 cases). Coma on presentation worsened prognosis (mortality 64% if Blantyre Coma Score <3, 26% if > 3). Fifteen percent of survivors had sequelae on discharge. Twenty percent of Hib isolates were resistant to chloramphenicol, but all salmonellae were sensitive. Five percent of S. pneumoniae were resistant to penicillin and 8% to chloramphenicol. Earlier access to adequate health care and awareness of BM in a malaria endemic area would reduce mortality and morbidity. Vaccination against Hib infection would have reduced death by 18 (17%) and prevented sequelae in 7

Modelling the relationship between groundwater depth and NDVI using time series regression with Distributed Lag M

Groundwater plays a key role in hydrological processes, including in determining aboveground vegetal growth characteristics and species distribution. This study aimed at estimating time-series data of Normalized Difference Vegetation Index (NDVI) using groundwater depth as a predictor in two land cover types: grassland and shrubland. The study also investigated the significance of past (lagged) groundwater and NDVI in estimating the current NDVI. Results showed that lagged groundwater depth and vegetation conditions influence the amount of current NDVI. It was also observed that first lags of groundwater depth and NDVI were significant predictors of NDVI in grassland. In addition, first and second lags of NDVI were consistently significant predictors of NDVI in shrubland. This shows the importance of vegetation type when modelling the relationship between groundwater depth and NDVI.Keywords: Groundwater depth; Landsat NDVI; Time-series analysis; Distributed Lag Model

Ward Round – A patient with multi-organ failure

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