The effects of HIV and AIDS on fertility in East and Central Africa

Concern has been expressed about the fertility of people infected with HIV: the worry has been that on learning of their condition, HIV-affected individuals may attempt to accomplish unmet reproductive goals knowing that they will not live a normal life span. This article addresses the potential effects of AIDS on fertility and reproductive decisions in East and Central Africa. The problem is seen in terms of a tightly knit continuum of biological, epidemiologic and cultural contexts, and the prevailing conditions of response to the epidemic. AIDS can influence fertility among individuals and groups regardless of any awareness of serostatus by increasing death rates among reproductive populations, and damaging the physical capacities of infected men and women to reproduce. In much of the region, high prevalence of STDs may simultaneously impair the fertility of men and women and increase their risk of contracting HIV. These biological conditions are compounded among those for whom fertility is a highly valued marker of adult status, where the social and economic marginality of young women contributes to reliance on commercialized sex, where the mobility of young men leads to instability in sexual partnerships and frequent partner change, or where women lack the ability to negotiate their fertility with spouses. It appears that even focused programs of testing and counselling with HIV-positive women in Europe and in Africa have not motivated a significant change in reproductive action. Were there a demonstrable effect of counselling on the fertility choices of infected persons, there are numerous practical limitations on the role that interventions can play in affecting the fertility of HIV-positive people

Issues SMEs Face Within the Internationalisation Process

The paper presents the correlation between different variables and internationalisation, such as: the size of the company, the activity field, the level of innovation. It also emphasizes the barriers the SMEs face in the process. In the end of the paper, one presents some of the solutions proposed in order to sustain the SMEs overcome these barriers.SMEs, internationalisation, innovation, success.

Rates and Causes of Death in Chiradzulu District, Malawi, 2008: A Key Informant Study

In September 2008, we measured all-cause mortality in Chiradzulu District, Malawi (population 291 000) over a 60-day retrospective period, using capture-recapture analysis of three lists of deaths provided by (i) key community informants, (ii) graveyard officials and (iii) health system sources. Estimated crude and under-5-year mortality rates were 18.6 (95% CI 13.9-24.5) and 30.6 (95% CI 17.5-59.9) deaths per 1000 person-years. We also classified causes of death through verbal autopsy interviews on 50 deaths over the previous 40 days. Half of deaths were attributable to infection, and half of deaths among children aged under 5 were attributable to neonatal causes. HIV/AIDS was the leading cause of death (16.6%), with a cause-attributable mortality rate of 1.8 (0.4-3.6) deaths per 1000 person-years

Community social valuation: use of nominal group technique in ranking of health conditions from two communities in Temeke and Moshi Districts in Tanzania

This study used the nominal group technique to explore societal value preferences in the ranking of health conditions from two communities in Temeke and Moshi districts in Tanzania. The nominal group technique was applied to a community of lay people including patients and community leaders. In this study we found a relatively high stability of ranking values across sites and informant groups. The nominal group technique was easy for lay people to understand and less time consuming compared to other methods used in health state valuation. The findings indicate that the nominal group technique can be used in the valuation process with a population of lay people to obtain societal preferences as a basis for priority setting in health. This study was limited to using criteria as a guide in the voting exercise, which may have framed respondent's final voting judgement. Further studies are needed to assess informant's responses and test validity and reliability of this method with larger sample size in different sites and informant groups. In conclusion, the nominal group technique may be considered to obtain societal preferences to compliment the current burden of disease data for priority setting. Tanzania Health Research Bulletin Vol.6(2) 2004: 42-5

MESIN DIESEL 4 SILINDER TIPE C240 (Sistem Pendingin)

Sistem pendinginan (cooling system) adalah suatu rangkaian untuk mengatasi terjadinya over heating pada mesin sehingga mesin tetap dapat bekerja secara optimal. Komponen sistem pendinginan Mesin Diesel Tipe C240 ini terdiri dari radiator, pompa air, kipas pendingin, tutup radiator. Cara kerja sistem pendinginan ini menggunakan sistem tekan yang memanfaatkan pompa air sebagai media pendingin. Gangguan-gangguan yang sering terjadi pada sistem pendingin adalah kebocoran, keretakkan komponen sistem pendingin, serta gangguan dari kotoran yang mengendap sehingga aliran air tidak maksimal. Usaha yang perlu diperhatikan untuk mencegah terjadinya kerugian akibat kerusakan komponen mesin adalah dengan merawat dan memeriksa kondisi mesin secara berkala

Facteurs de demande liés à l’enregistrement des naissances, des mariages et des décès : revue de la littérature

Affaires mondiales Canad

Demand-side factors related to the registration of births, marriages, and deaths : a literature review

This report considers civil registration throughout life, and includes evidence from interventions aimed at improving registration at multiple levels. Strategies include greater integration of birth registration within existing health services, such as immunization and the use of multimedia campaigns. Demand-side barriers are defined as those that influence demand, operating at individual, household, and community levels. Less than 50 percent of all births are registered in Africa (UNICEF 2019), and evidence suggests that disparities in registration in the region are linked to social inequalities. The scope and implications of under-registration are wide ranging.Global Affairs Canad

Mortality measurement in transition: proof of principle for standardised multi-country comparisons*

OBJECTIVE To demonstrate the viability and value of comparing cause-specific mortality across four socioeconomically and culturally diverse settings using a completely standardised approach to VA interpretation.METHODS Deaths occurring between 1999 and 2004 in Butajira (Ethiopia), Agincourt (South Africa), FilaBavi (Vietnam) and Purworejo (Indonesia) health and socio-demographic surveillance sites were identified. VA interviews were successfully conducted with the caregivers of the deceased to elicit information on signs and symptoms preceding death. The information gathered was interpreted using the InterVA method to derive population cause-specific mortality fractions for each of the four settings.RESULTS The mortality profiles derived from 4784 deaths using InterVA illustrate the potential of the method to characterise sub-national profiles well. The derived mortality patterns illustrate four populations with plausible, markedly different disease profiles, apparently at different stages of health transition.CONCLUSIONS Given the standardised method of VA interpretation, the observed differences in mortality cannot be because of local differences in assigning cause of death. Standardised, fit-for-purpose methods are needed to measure population health and changes in mortality patterns so that appropriate health policy and programmes can be designed, implemented and evaluated over time and place. The InterVA approach overcomes several longstanding limitations of existing methods and represents a valuable tool for health planners and researchers in resource-poor settings

Core Verbal Autopsy Procedures with Comparative Validation Results from Two Countries

BACKGROUND: Cause-specific mortality statistics remain scarce for the majority of low-income countries, where the highest disease burdens are experienced. Neither facility-based information systems nor vital registration provide adequate or representative data. The expansion of sample vital registration with verbal autopsy procedures represents the most promising interim solution for this problem. The development and validation of core verbal autopsy forms and suitable coding and tabulation procedures are an essential first step to extending the benefits of this method. METHODS AND FINDINGS: Core forms for peri- and neonatal, child, and adult deaths were developed and revised over 12 y through a project of the Tanzanian Ministry of Health and were applied to over 50,000 deaths. The contents of the core forms draw upon and are generally comparable with previously proposed verbal autopsy procedures. The core forms and coding procedures based on the International Statistical Classification of Diseases (ICD) were further adapted for use in China. These forms, the ICD tabulation list, the summary validation protocol, and the summary validation results from Tanzania and China are presented here. CONCLUSIONS: The procedures are capable of providing reasonable mortality estimates as adjudged against stated performance criteria for several common causes of death in two countries with radically different cause structures of mortality. However, the specific causes for which the procedures perform well varied between the two settings because of differences in the underlying prevalence of the main causes of death. These differences serve to emphasize the need to undertake validation studies of verbal autopsy procedures when they are applied in new epidemiological settings

The global burden of tuberculosis mortality in children: a mathematical modelling study

Background: Tuberculosis (TB) in children is increasingly recognised as an important component of the global TB burden, with an estimated 1 million cases in 2015. Although younger children are vulnerable to severe forms of TB disease, no age-disaggregated estimates of paediatric TB mortality exist, and TB has never appeared in official estimates of under-five child mortality. Methods: We estimated deaths in children aged <5 and 5 to <15 for 217 countries and territories using a case-fatality-based approach. We used paediatric TB notifications data, HIV and antiretroviral treatment estimates to disaggregate the World Health Organization (WHO) paediatric TB incidence estimates by age, HIV and treatment status. Systematic review evidence on corresponding case fatality ratios was then applied. Findings: We estimated that 239,000 (95% uncertainty interval [UI] 194,000 - 298,000) children aged <15 died due to TB globally in 2015; around 80% of these deaths - 191,000 (95%UI: 132,000 - 257,000) - were in children <5 years old. Over 70% of deaths occurred in the WHO South-East Asia and Africa regions. We estimated around 20% of paediatric TB deaths globally were in children with HIV infections, with this proportion nearer 30% in the WHO Africa region. Over 96% of all TB deaths occurred in children not receiving TB treatment. Interpretation: Tuberculosis is a top ten cause of death in children and a key omission from previous analyses of under-5 mortality. Almost all these deaths occur in children not on tuberculosis treatment, implying substantial scope to reduce this burden. Funding: UNITAID, NIH, NIH