A Comparative Analysis of First Day Neonatal Mortality Between Adolescents and Adult Females Giving Birth at Ligula Hospital in Mtwara, South Eastern Tanzania 2008 – 2009

Objective: Compare first day neonatal mortality between adolescents and adults delivering at the main referral hospital in Mtwara, TanzaniaDesign: Cross-sectional chart reviewSetting: The study was conducted at the main referral hospital in Mtwara, Tanzania. Rates of adolescent pregnancy at the hospital were 15.5% in 2009 and 14.3% in 2010Subjects: A total of 450 adolescent and adult females delivering at Ligula Hospital between 2008 and 2009 were included in the study.Outcome measures: First day neonatal mortality between adolescents and adults was the primary outcome. Secondary outcomes included neonatal birth weight, parity, gravidity, prematurity, HIV and neonates delivered.Results: First day neonatal mortality was 5.56%. Birth weight was the only risk factor significantly associated with neonatal mortalityConclusion: Younger women have predisposal to neonatal mortality due to underlying causal mechanisms. In order to validate the results of this study, further research on risk and causes of first day neonatal mortality at facilities is warranted

Anti-diabetic drugs in the private and public sector in Dar es Salaam, Tanzania

Objectives: To compare availability, cost, affordability and sources of anti-diabetic drugs between private and public health facilities in Dar es Salaam, Tanzania. Design: Cross sectional descriptive study.Setting: Diabetic clinics in private and public health facilities in Dar es Salaam, Tanzania. Subjects: Eighty patients randomly selected and 45 health facility personnel staff working in the diabetic clinics. Semi-structured questionnaires and a checklist were used to collect the information. Results: Oral hypoglycaemic agents were available in all seven private and three public facilities that were studied. Private facilities stocked more types of oral hypoglycaemic agents than public facilities, which stocked only chlorpropamide and tolbutamide, based on the National Essential Drugs List. The cost of chlorpropamide was five times higher in private facilities compared to public facilities. Insulin was also available in all the facilities. The price of animal insulin in private health facilities was ten times that in public health facilities. Human insulin, which is generally more expensive than animal insulin, was only available in private facilities. Although prices were much lower in public facilities, affordability emerged as a common issue in both private and public facilities. Conclusions: Urban private health facilities offer a wider choice for the needs of diabetic patients but this advantage is compromised by higher prices as compared to public facilities as well as inconsistent supply across facilities. Public health facilities offer only a limited selection of essential oral hypoglycaemics and insulin but at a lower price and across all facilities. Twenty six per cent and 10% of patients in public and private facilities respectively are unable to afford anti-diabetic drugs. The need for intervention to increase affordability of anti-diabetic drugs is evident. Financing and cost of drugs needs to be addressed, either by means of health insurance or other mechanisms, in this era of increasing prevalence of diabetes mellitus among developing countries

Managment of diabetic ketoacidosis in children and adolescents in sub-Saharan Africa: A review

Background: Diabetic ketoacidosis (DKA) is a complex metabolic state of hyperglycaemia, ketosis, and acidosis. Diabetes in sub-Saharan Africa is, in many patients a serious disease with a poor prognosis. Most deaths, however, are due to preventable causes.Objective: To improve knowledge on the management of DKA in sub-Saharan Africa.Data sources: Literature review from different published sources. Data synthesis: Health systems in sub-Saharan Africa are currently organised for the treatment of episodes of illness and not long-term conditions like diabetes. Therefore the high rates of DKA is essentially due to lack of training of health professionals, lack of facilities in most hospitals, lack of public awareness as well as lack of health education to individual patients/families. In addition erratic insulin supply coupling with infections, low parental education, poor insulin storage and lack of facilities for self monitoring of blood glucose.Conclusion: A complex unfavourable social and economic environment is the basis of the high prevalence of DKA in sub-Saharan Africa. Several episodes of DKA can be prevented by effective public awareness programmes and education to healthcare providers

Anti-Diabetic Drugs In The Private And Public Sector In Dar Es Salaam, Tanzania

Objectives: To compare availability, cost, affordability and sources of anti-diabeticdrugs between private and public health facilities in Dar es Salaam, Tanzania.Design: Cross sectional descriptive study.Setting: Diabetic clinics in private and public health facilities in Dar es Salaam,Tanzania.Subjects: Eighty patients randomly selected and 45 health facility personnel staffworking in the diabetic clinics. Semi-structured questionnaires and a checklist wereused to collect the information.Results: Oral hypoglycaemic agents were available in all seven private and three publicfacilities that were studied. Private facilities stocked more types of oral hypoglycaemicagents than public facilities, which stocked only chlorpropamide and tolbutamide,based on the National Essential Drugs List. The cost of chlorpropamide was five timeshigher in private facilities compared to public facilities. Insulin was also available inall the facilities. The price of animal insulin in private health facilities was ten timesthat in public health facilities. Human insulin, which is generally more expensive thananimal insulin, was only available in private facilities. Although prices were muchlower in public facilities, affordability emerged as a common issue in both privateand public facilities.Conclusions: Urban private health facilities offer a wider choice for the needs ofdiabetic patients but this advantage is compromised by higher prices as compared topublic facilities as well as inconsistent supply across facilities. Public health facilitiesoffer only a limited selection of essential oral hypoglycaemics and insulin but at alower price and across all facilities. Twenty six per cent and 10% of patients in publicand private facilities respectively are unable to afford anti-diabetic drugs. The needfor intervention to increase affordability of anti-diabetic drugs is evident. Financingand cost of drugs needs to be addressed, either by means of health insurance orother mechanisms, in this era of increasing prevalence of diabetes mellitus amongdeveloping countries

A Qualitative Exploration of the Mental Health and Psychosocial Contexts of HIV-Positive Adolescents in Tanzania

Although 85% of HIV-positive adolescents reside in sub-Saharan Africa, little is known about the psychosocial and mental health factors affecting their daily well-being. Identifying these contextual variables is key to development of culturally appropriate and effective interventions for this understudied and high-risk population. The purpose of this study was to identify salient psychosocial and mental health challenges confronted by HIV-positive youth in a resource-poor Tanzanian setting. A total of 24 qualitative interviews were conducted with a convenience sample of adolescents aged 12–24 receiving outpatient HIV care at a medical center in Moshi, Tanzania. All interviews were audio-recorded, transcribed, and coded using thematic analysis. Psychosocial challenges identified included loss of one or more parents, chronic domestic abuse, financial stressors restricting access to medical care and education, and high levels of internalized and community stigma among peers and other social contacts. Over half of youth (56%) reported difficulties coming to terms with their HIV diagnosis and espoused related feelings of self-blame. These findings highlight the urgent need to develop culturally proficient programs aimed at helping adolescents cope with these manifold challenges. Results from this study guided the development of Sauti ya Vijana (The Voice of Youth), a 10-session group mental health intervention designed to address the psychosocial and mental health needs of HIV-positive Tanzanian youth

Experiences of Women of Color with a Nurse Patient Navigation Program for Linkage and Engagement in HIV Care

Patient navigation, a patient-centered model of care coordination focused on reducing barriers to care, is an emerging strategy for linking patients to and retaining them in HIV care. The Guide to Healing Program (G2H), implemented at the Infectious Diseases Clinic at UNC Chapel Hill, provided patient navigation to women of color (WOC) new to or re-engaging in HIV care through a ‘nurse guide’ with mental health training and experience. The purpose of this study was to qualitatively explore patients' experiences working with the nurse guide. Twenty-one semi-structured telephone interviews with G2H participants were conducted. Interviews were transcribed and thematic analysis was utilized to identify patterns and themes in the data. Women's experiences with the nurse guide were overwhelmingly positive. They described the nurse guide teaching them critical information and skills, facilitating access to resources, and conveying authentic kindness and concern. The findings suggest that a properly trained nurse in this role can provide critical medical and psychosocial support in order to eliminate barriers to engagement in HIV care, and successfully facilitate patient HIV self-management. The nurse guide model represents a promising approach to patient navigation for WOC living with HIV

Effect of haze on fruit development, pigmentation and productivity of Passiflora quadrangularis L. (Giant Granadilla Passion Fruit)

The world today faces air pollution as a major environmental problem, as industrialisation and anthropogenic activity are growing rapidly. Agricultural fires in Indonesia and Borneo, along with forest and peatland fires, are responsible for transboundary haze that contributes to environmental degradation in Malaysia (Aziz et al., 2018). Haze occurrence in Malaysia has become a common feature over the last two decades. The most extreme haze phenomena were observed in April 1983, August 1990, June 1991, August 1994, and March 1998 (Jamal et al., 2014). Kuching’s API reading in September 1997, spiked to 893 was the highest ever recorded in Malaysia (Ahmad et al., 2006). Most of these haze episodes occurred in conjunction with a period of prolonged drought associated with the El-Nino phenomenon. Haze events are projected to increase as forest and peat fields burning increases due to global warming and prolonged drought worsen (Hawa, 2008). Haze is generally considered to be a product of high concentrations of fine particulate matter circulating in the atmosphere. As the numbers of these particles increase, their cumulative effect causes lower light intensity on Earth and results in reduced visibility (Philip, 2001). Haze development interrupts the natural air circulation, which decreases the dispersion and dilution of suspended contaminants and particles. Haze is often caused by an excessive amount of pollutants, i.e., particulate matter, sulphur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2) and ozone (O3). Increased aerosol loadings in the atmosphere are aided by burned biomass. Greenwald et al. (2006) showed that atmospheric haze resulting from distant forest fires reduced solar radiation at almost all spectra. About 73-92% of overall light extinction comes from organic carbon and sulfate particles trapped in haze (Yanhong et al., 1996). The field data collected in the Yangtze Delta region of China shows that aerosols reduce solar radiation by about 30% on clear days (Xu et al., 2003). Studies have shown that haze has major effects on various ecosystems as its impact on solar radiation, temperature, and relative humidity resulting in reduced plant photosynthetic activity (Yanhong et al., 1996; Davies and Unam, 1999; Aziz et al., 2018). The photosynthetically active radiation (PAR), a solar radiation utilised by plants and ambient temperature, was reduced by the haze, which indicates a reduction in photosynthesis rate and stomatal conductance. Based on the experimental measurement of the light-CO2 relationship, Fan et al. (1990) reported an increase in cloudiness might decrease net CO2 uptake by the plants. Studies by Aziz et al. (2018) on the yield of Malaysian rice varieties during the haze event in March 2014 showed a major reduction in the net photosynthetic rate and stomatal conductivity due to the reduction of PAR solar radiation. The PAR level at which a plant is exposed is related positively to the photosynthetic and has a significant effect on plant development and growth. Lately, the occurrence of haze over the country has been a great concern. Understanding the plant behaviours and responses is very important to explain their physiological patterns and tolerance when exposed to haze conditions. Therefore, this study was carried out to determine the effects of haze on the fruit development and productivity of Passiflora quadrangularis during the haze event in July to September 2019 at Bintulu due to forest fires in Indonesia and Borneo

The need for an integrated approach for chronic disease research and care in Africa

With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa