Final-year medical students’ ratings of service-learning activities during an integrated primary care block

Background. Service learning (SL) has as its pedagogy the ability to link medical education to the community through the identification of healthcare needs for citizens residing in rural and urban underserved communities. Integrated Primary Care (IPC) is a clinical block through which final-year medical students manage common presenting problems in context and engage the community in a reciprocal manner.Objective. To assess the educational value and enjoyment of the 27 SL activities (SLAs) undertaken by final-year medical students as part of the IPC block.Methods. A cross-sectional descriptive study was conducted among final-year medical students (N=245), focusing on logbook activities during 1 academic year.Results. Students reported positively on the educational value of the majority of the 17 clinical SLAs, but only 3 activities were ranked the same for enjoyment and educational value. For non-clinical activities, only 2 of 10 were matched for educational and enjoyment value. There was no significant difference in the rating of educational value and enjoyment between rural and urban underserved sites.Conclusions. The study provided insight into clinical and non-clinical SLAs that accumulate value for students when they are based in primary healthcare settings. The lack of enjoyment on reflective activities is a concern that should be explored through a qualitative review of SLAs

Strengthening iron folate supplementation of pregnant women in Ntchisi District, Malawi

While an estimated 45% of pregnant women in Malawi are anaemic, only 33% take iron tablets for a minimum of 90 days during pregnancy. The study explored the capacity of health facilities and communities to strengthen antenatal iron folate supplementation in Ntchisi, to support the achievement of Malawi’s nutrition target on halving anaemia in women of reproductive age by 2025. This qualitative study employed systematic random and purposeful sampling. Eight Focus Group Discussions with mothers of children 0-23 months, eight with Care Group volunteers and eight in-depth interviews with Village Health Workers (Health Surveillance Assistants) were conducted in each village falling within the catchment area of each of 8 health facilities. Health facilities had been sampled each from the 7 Traditional Authorities with the district hospital and direct observations had been conducted at each for antenatal care service delivery. 10 key informants from the health facilities and the District Health Office were interviewed. Thus a total of 16 FGDs, 8 HSA interviews, and 10 key informant interviews provided the data analysed in this paper. Data were analysed manually using thematic framework analysis. Poor access to and follow up of antenatal care at the health facility has limited access to iron folate supplements, as the health facility is the main source of Iron folates. Recurrent depletion of stock of iron folate were reported by mothers at most health facilities. Consumer demand for the tablets was low due to side effects, poor acceptability, associated myths, forgetfulness and frustration from having to take a daily medication. There was limited training and education materials at the health facility and community with inadequate support given to women. The absence of clear policies and guidelines on iron folate supplementation resulted in inconsistencies in messaging. Uptake and adherence were not routinely monitored. There is a need to improve the main building blocks of the iron folate programme, including the: delivery system, tablet supply, patient education, consumer demand, monitoring and evaluation and polic

Oxidative stress biomarkers in West African Dwarf goats reared under intensive and semi-intensive production systems

This study explored the variation in physiological oxidative status of West African Dwarf (WAD) goats as the rainy season progressed in a humid climate in south-west Nigeria. A total of 24 growing WAD bucks, averaging 10.5 kg + 0.78 liveweight, were reared under intensive and semi-intensive management systems during the rainy season. Twelve (12) bucks were used for each management system. Animals raised intensively were fed Megathyrsus maximus hay ad libitum, while those reared semi-intensively were allowed to graze freely in a fenced paddock. Their diets were supplemented with a maize grain-based concentrate. Blood samples were collected at the onset of the experiment and fortnightly throughout the 16-week experimental period. Oxidative stress biomarkers in blood were measured and analysed separately for each rearing system using repeated measures analysis. Means of oxidative stress biomarkers measured at the beginning and end of the rainy season were compared using a T-test. Results showed that intensively managed goats had significantly higher levels of bilirubin and uric acid in the early season than in the late rainy season. In semi-intensively managed goats, bilirubin, uric acid, and glutathione (GSH) levels were significantly higher at the start compared with the end of the rainy season. It could be concluded that the antioxidant capacity of WAD goats was greater early in the rainy season compared with the late rainy season under both management systems. Thus, during the early raining season WAD goats tend to have higher antioxidant capacity and, consequently, better immune responses, while the opposite is true during the late rainy season.Keywords: bucks, immune response, seaso

Ileosigmoid knotting in pregnancy: A case report from Zimbabwe

Ileosigmoid knotting (ISK), also known as compound volvulus, is a rare cause of intestinal obstruction wherein the ileum wraps around the base of the sigmoid colon and forms a knot with rapid progression to gangrene. The worldwide incidence of ISK ranges from 1 in 1500 to 1 in 66,431. ISK is particularly rare in pregnancy, with the majority of cases occurring in the third trimester. The preoperative diagnosis of ISK in pregnancy is challenging because the condition is often mistaken for other obstructive or nonobstructive emergencies and delayed because of concerns regarding imaging in pregnancy. We report a case of a gravid woman presenting at 13 weeks' gestation with features suggestive of intestinal obstruction and who underwent an emergency laparotomy during which a diagnosis of ISK was made. Her recovery was uneventful, and she was able to carry the pregnancy to term.Keywords: ileosigmoid knotting; pregnancy; intestinal obstructio

Medical students using the technique of 55-word stories to reflect on a 6-week rotation during the integrated primary care block

Background. Reflection and reflective practice are identified as a core competency for graduates in health professions education. Students are expected to be in a position to process experiences in a variety of ways through reflective learning. In doing so, they can explore the understanding of their actions and experiences, and the impact of these on themselves and others. Objectives. To draw on 5-weekly reflections by final-year medical students during the integrated primary care block placement. These reflections explore the learning that occurred during the rotation and the change in experiences during this period, and illustrate the use of reflection as a tool to support the development of professional practice. Methods. This descriptive qualitative study analysed students’ 55-word reflective stories during a 6-week preceptorship in either a rural or urban primary healthcare centre. The writing technique of short 55-word reflective stories was used to record student experiences. Inductive thematic analysis was conducted using MAXQDA software. This involved identifying the most commonly used words for each week through a word cloud, highlighting each week’s most notable focus for learning to generate themes and sub-themes. Results. Analysis of 127 logbook entries generated 464 stories on a range of experiences that had a significant impact on learning. Students’ reflections in the first 2 weeks were linked to personal experiences and views about the block. In subsequent weeks, reflections focused on the individual responses of students to the learning experiences regarding the curriculum, patient care, ethics, professionalism and the health system. Conclusions. The reflections highlighted the key learning experiences of the medical students and illustrated how meaning is constructed from these experiences. The 55-word stories as a reflection tool have potential to support reflection for students, and provide valuable insight into medical students’ learning journey during their clinical training

Growth performance, haemo-biochemical parameters and meat quality characteristics of male Japanese quails fed a Lippia javanica-based diet

A total of 105 male Japanese quails (153.2 ± 10.21 g) (Cortunix cortunix japonica) were reared in an environmentally controlled house to investigate the effect of inclusion of Lippia javanica leaf meal on growth performance, haematological and serum biochemical parameters, and carcass and meat quality characteristics. The quails were randomly allocated to 15 pens, with each pen holding 7 quails. Pens were then randomly allocated to the following experimental diets: 1) commercial grower diet without antibiotics [NegCon]; 2) commercial grower diet with antibiotics, coxistac and olaquindox [PosCon]; and 3) commercial grower diet without antibiotics in which L. javanica was included at the rate of 25 g/kg [Ljav25]. Experimental diets and fresh water were offered ad libitum. Weekly feed intake and body weights were recorded to calculate feed conversion efficiency (FCE). At 9 weeks of age, quails were slaughtered at a local poultry abattoir for assessment of blood parameters, carcass and meat quality characteristics. Repeated measures analysis showed no significant week × diet interaction effect on average weekly feed intake (AWFI), average weekly weight gain (AWG) and FCE. Diet had no significant influence on AWFI, AWG, FCE, and haematological parameters. There was no dietary effect on overall FI, overall WG and overall FCE. Alanine transaminase (ALT) was the only serum biochemical parameter influenced by diet. Quails offered Ljav25 had higher ALT content (56.83 u/L) than those offered PosCon (18.0 u/L). Diets had no significant impact on carcass characteristics and internal organs, except for gizzard weights. Immediately after slaughter, diets caused no effect on meat quality parameters, except meat lightness (L*), whereas at 24 h post slaughter, diets had significant impact on meat yellowness (b*). No dietary variation was observed for peak positive force (PPF) values of quail meat. NegCon diet promoted the least cooking losses (16.51%) when compared to PosCon and Ljav25 diets, which significantly did not differ. It was concluded that inclusion of L. javanica in quail diets at 25 g/kg feed promoted similar growth performance, health status, and carcass and meat quality traits as the commercial grower diet containing antibiotics. Lippia javanica leaf meal, therefore, has potential as an alternative to antibiotic growth promoters in Japanese quails.Keywords: Antibiotics, health, Lippia javanica, physiological response, quail

Mortality under early access to antiretroviral therapy vs Eswatini’s national standard of care : the MaxART clustered randomized stepped‐wedge trial

Objectives Current WHO guidelines recommend the treatment of all HIV-infected individuals with antiretroviral therapy (ART) to improve survival and quality of life, and decrease infection of others. MaxART is the first implementation trial of this strategy embedded within a government-managed health system, and assesses mortality as a secondary outcome. Because primary findings strongly supported scale-up of the 'treat all' strategy (hereafter Treat All), this analysis examines mortality as an additional indicator of its impact. Methods MaxART was conducted in 14 Eswatinian health clinics through a clinic-based stepped-wedge design, by transitioning clinics from then-national standard of care (SoC) to the Treat All intervention. All-cause, disease-related, and HIV-related mortality were analysed using the Cox proportional hazards model, censoring SoC participants at clinic transition. Median follow-up time among study participants was 292 days. There were 36/2034 deaths in SoC (1.77%) and 49/1371 deaths in Treat All (3.57%). Results Between September 2014 and August 2017, 3405 participants were enrolled. In SoC and Treat All interventions, respectively, the multivariable-adjusted 12-month all-cause mortality rates were 1.42% [95% confidence interval (CI): 0.66-2.17] and 1.60% (95% CI: 0.78-2.40), disease-related mortality rates were 1.02% (95% CI: 0.40-1.64) and 1.10% (95% CI: 0.46-1.73), and HIV-related mortality rates were 1.03% (95% CI: 0.40-1.65) and 0.99% (95% CI: 0.40-1.58). Treat All had no impact on all-cause [hazard ratio (HR) = 1.12, 95% CI: 0.58-2.18, P = 0.73], disease-related (HR = 1.04, 95% CI: 0.52-2.11, P = 0.90), or HIV-related mortality (HR = 0.93, 95% CI: 0.46-1.87, P = 0.83). Conclusion There was no immediate benefit of the Treat All strategy on mortality, nor evidence of harm. Longer follow-up of participants is needed to establish long-term consequences

Using detergent to enhance detection sensitivity of African trypanosomes in human CSF and blood by Loop-Mediated Isothermal Amplification (LAMP)

<p><b>Background:</b> The loop-mediated isothermal amplification (LAMP) assay, with its advantages of simplicity, rapidity and cost effectiveness, has evolved as one of the most sensitive and specific methods for the detection of a broad range of pathogenic microorganisms including African trypanosomes. While many LAMP-based assays are sufficiently sensitive to detect DNA well below the amount present in a single parasite, the detection limit of the assay is restricted by the number of parasites present in the volume of sample assayed; i.e. 1 per µL or 103 per mL. We hypothesized that clinical sensitivities that mimic analytical limits based on parasite DNA could be approached or even obtained by simply adding detergent to the samples prior to LAMP assay.</p> <p><b>Methodology/Principal Findings:</b> For proof of principle we used two different LAMP assays capable of detecting 0.1 fg genomic DNA (0.001 parasite). The assay was tested on dilution series of intact bloodstream form Trypanosoma brucei rhodesiense in human cerebrospinal fluid (CSF) or blood with or without the addition of the detergent Triton X-100 and 60 min incubation at ambient temperature. With human CSF and in the absence of detergent, the LAMP detection limit for live intact parasites using 1 µL of CSF as the source of template was at best 103 parasites/mL. Remarkably, detergent enhanced LAMP assay reaches sensitivity about 100 to 1000-fold lower; i.e. 10 to 1 parasite/mL. Similar detergent-mediated increases in LAMP assay analytical sensitivity were also found using DNA extracted from filter paper cards containing blood pretreated with detergent before card spotting or blood samples spotted on detergent pretreated cards.</p> <p><b>Conclusions/Significance:</b> This simple procedure for the enhanced detection of live African trypanosomes in biological fluids by LAMP paves the way for the adaptation of LAMP for the economical and sensitive diagnosis of other protozoan parasites and microorganisms that cause diseases that plague the developing world.</p&gt

A Viral Vectored Prime-Boost Immunization Regime Targeting the Malaria Pfs25 Antigen Induces Transmission-Blocking Activity

The ookinete surface protein Pfs25 is a macrogamete-to-ookinete/ookinete stage antigen of Plasmodium falciparum, capable of exerting high-level anti-malarial transmission-blocking activity following immunization with recombinant protein-in-adjuvant formulations. Here, this antigen was expressed in recombinant chimpanzee adenovirus 63 (ChAd63), human adenovirus serotype 5 (AdHu5) and modified vaccinia virus Ankara (MVA) viral vectored vaccines. Two immunizations were administered to mice in a heterologous prime-boost regime. Immunization of mice with AdHu5 Pfs25 at week 0 and MVA Pfs25 at week 10 (Ad-MVA Pfs25) resulted in high anti-Pfs25 IgG titers, consisting of predominantly isotypes IgG1 and IgG2a. A single priming immunization with ChAd63 Pfs25 was as effective as AdHu5 Pfs25 with respect to ELISA titers at 8 weeks post-immunization. Sera from Ad-MVA Pfs25 immunized mice inhibited the transmission of P. falciparum to the mosquito both ex vivo and in vivo. In a standard membrane-feeding assay using NF54 strain P. falciparum, oocyst intensity in Anopheles stephensi mosquitoes was significantly reduced in an IgG concentration-dependent manner when compared to control feeds (96% reduction of intensity, 78% reduction in prevalence at a 1 in 5 dilution of sera). In addition, an in vivo transmission-blocking effect was also demonstrated by direct feeding of immunized mice infected with Pfs25DR3, a chimeric P. berghei line expressing Pfs25 in place of endogenous Pbs25. In this assay the density of Pfs25DR3 oocysts was significantly reduced when mosquitoes were fed on vaccinated as compared to control mice (67% reduction of intensity, 28% reduction in prevalence) and specific IgG titer correlated with efficacy. These data confirm the utility of the adenovirus-MVA vaccine platform for the induction of antibodies with transmission-blocking activity, and support the continued development of this alternative approach to transmission-blocking malaria subunit vaccines