An isolated superior sternal cleft in a neonate in western Kenya: case report

Sternal cleft is a rare congenital anomaly and very few cases have been described especially in Africa. This is a case of an isolated superior sternal cleft in a term neonate in Western Kenya

Primacy of effective communication and its influence on adherence to artemether-lumefantrine treatment for children under five years of age: a qualitative study.

BACKGROUND\ud \ud Prompt access to artemesinin-combination therapy (ACT) is not adequate unless the drug is taken according to treatment guidelines. Adherence to the treatment schedule is important to preserve efficacy of the drug. Although some community based studies have reported fairly high levels of adherence, data on factors influencing adherence to artemether-lumefantrine (AL) treatment schedule remain inadequate. This study was carried-out to explore the provider's instructions to caretakers, caretakers' understanding of the instructions and how that understanding was likely to influence their practice with regard to adhering to AL treatment schedule.\ud \ud METHODS\ud \ud A qualitative study was conducted in five villages in Kilosa district, Tanzania. In-depth interviews were held with providers that included prescribers and dispensers; and caretakers whose children had just received AL treatment. Information was collected on providers' instructions to caretakers regarding dose timing and how to administer AL; and caretakers' understanding of providers' instructions.\ud \ud RESULTS\ud \ud Mismatch was found on providers' instructions as regards to dose timing. Some providers' (dogmatists) instructions were based on strict hourly schedule (conventional) which was likely to lead to administering some doses in awkward hours and completing treatment several hours before the scheduled time. Other providers (pragmatists) based their instruction on the existing circumstances (contextual) which was likely to lead to delays in administering the initial dose with serious treatment outcomes. Findings suggest that, the national treatment guidelines do not provide explicit information on how to address the various scenarios found in the field. A communication gap was also noted in which some important instructions on how to administer the doses were sometimes not provided or were given with false reasons.\ud \ud CONCLUSIONS\ud \ud There is need for a review of the national malaria treatment guidelines to address local context. In the review, emphasis should be put on on-the-job training to address practical problems faced by providers in the course of their work. Further research is needed to determine the implication of completing AL treatment prior to scheduled time

Higgs Production and H0→cc‾H^0 \to c\overline{c} at a Future Muon-Ion Collider

We investigate the production of Higgs bosons in neutral- and charged-current interactions at a future Muon-Ion Collider (MuIC) with emphasis on $H^0 \to c\overline{c}$ decay. In particular, we focus on the leading production mechanisms and explore the impact of a range of Parton Distribution Function (PDF) scenarios, with emphasis on the role of heavy intrinsic quark flavor. We emphasize estimates of non-resonant di-charm background production and explore the impact of this background on a possible future measurement of $H^0 \to c\overline{c}$ at a future Muon-Ion Collider facility.Comment: 40 pages,38 figure

The role of networks in opportunity identification: a focus on African transnational entrepreneurs

There is a growing body of work which highlights the importance of Transnational Entrepreneurs (TEs) as catalysts for economic development in both their home and host countries. However, their opportunity identification predispositions are less understood. Thus, this study explores the nature and practices of TEs of African origin and it also focuses on how they identify viable business opportunities in their host countries. In addition, the study defines the role networks play in assisting them to achieve their business objectives. Through its application of social network constructs for data collection and analysis, this study contributes to the ongoing discourse on TEs. Specifically, it provides new insights into the way TEs of African origin living in the UK identify and exploit business opportunities. Its key findings indicate that the human capital of TEs (in particular their host country work experience), active search, and their use of family and kinship networks underpins the way they identify opportunities in a foreign country. However, perhaps the most remarkable finding of this study is that, while TEs employ both formal and informal network ties in their host countries, they seem to rely exclusively on their informal networks in their home countries

Provider-initiated symptom screening for tuberculosis in Zimbabwe: diagnostic value and the effect of HIV status.

OBJECTIVE: To assess the diagnostic value of provider-initiated symptom screening for tuberculosis (TB) and how HIV status affects it. METHODS: We performed a secondary analysis of randomly selected participants in a community-based TB-HIV prevalence survey in Harare, Zimbabwe. All completed a five-symptom questionnaire and underwent sputum TB culture and HIV testing. We calculated the sensitivity, specificity, and positive and negative predictive values of various symptoms and used regression analysis to investigate the relationship between symptoms and TB disease. FINDINGS: We found one or more symptoms of TB in 21.2% of 1858 HIV-positive (HIV+) and 9.9% of 7121 HIV-negative (HIV-) participants (P or = 2 weeks' duration, any symptom and a positive sputum culture had sensitivities of 48%, 81% and 65%, respectively; in HIV- participants, the sensitivities were 45%, 71% and 74%, respectively. Symptoms had a similar sensitivity and specificity in HIV+ and HIV- participants, but in HIV+ participants they had a higher positive and a lower negative predictive value. CONCLUSION: Even smear-positive TB may be missed by provider-initiated symptom screening, especially in HIV+ individuals. Symptom screening is useful for ruling out TB, but better TB diagnostics are urgently needed for resource-poor settings

Nutritional status of children admitted for diarrhoeal diseases in a referral hospital in western Kenya

Objectives: To determine the prevalence of malnutrition among children admitted with acute diarrhoea disease at Moi Teaching and Referral Hospital and to establish the effect of malnutrition on duration of hospital stay. Design: Prospective observational study. Setting: Paediatric wards of Moi Teaching and Referral Hospital, Eldoret, Kenya Subjects: A total of 191 children aged 6 and 59 months admitted with acute diarrhoea disease, without chronic co-morbidities or visible severe malnutrition, were systematically enrolled into the study between November 2011 and March 2012. Outcome Measures: Nutritional status based on WHO WHZ scores taken at admission and duration of hospital stay. Results:The mean age was 13.2 months with a male to female sex ratio of 1.16:1. Of all the children seen with acute diarrhoeal diseases, 43.9% had acute malnutrition ( Conclusion: Routine anthrometry including weight for height identifies more children with malnutrition in acute diarrhoeal diseases. Presence of malnutrition did not affect duration of hospital stay

Malaria Parasitaemia among Febrile Children Infected with Human Immunodeficiency Virus in the Context of Prophylactic Cotrimoxazole as Standard of Care: A Cross- Sectional Survey in Western Kenya

Objective: To document the prevalence of malaria parasitaemia among the HIV infected febrile children in a malaria endemic area. Design: A cross-sectional study. Setting: An ambulatory paediatric HIV clinic in Western Kenya, between November 2011 and December 2012. Subjects: A total of 245 febrile HIV infected children aged less than 14 years attending the HIV clinic in the Webuye level IV hospital were included in the study. A systematic sampling method was used. Main outcomes: A blood sample was taken for malaria parasite testing. Presence or absence of malaria parasites was documented. Clinical and socio-demographic characteristics of the participants were also recorded. Results: A total of 245 participants were recruited mean age being 5.53 years. Malaria prevalence was 81.9%. Most participants (97%) were on cotrimoxazole prophylaxis. Some of the factors found to be positively associated with malaria parasitaemia were; male sex, care taker category (parent), WHO stage 3 and 4 of HIV disease, and a high absolute CD4 count. However, only the caretaker association was statistically significant. Conclusion: The frequency of malaria parasitaemia among febrile HIV infected children is still high regardless of the high cotrimoxazole prophylaxis uptake. It is also noted that there is a shift in the age group of fever among children toward the older age group. This implies that policies may need to be relooked at to include the older age group in the aggressive malaria prevention measures to avoid losing on the already made gains

Dealing with adversity: innovation among small and medium-sized enterprises in developing economies

Purpose: Small and medium-sized enterprises in developing countries, particularly in the Sub-Saharan African region, find it hard to innovate due to severe resource constraints and high institutional voids. Given this, the paper examines three international strategic responses that small and medium-sized enterprises in Sub-Saharan Africa adopt to implement innovations in the face of weak institutional environments. Design/methodology/approach: Using comprehensive data from the World Bank Enterprise Survey, the study applies the Instrumental Variable Probit approach to analyse a sample of 8,466 SMEs from eleven countries in the Sub-Saharan African region. Findings: The empirical results show that foreign ownership negatively affects product and process innovation. Additionally, the results reveal that small and medium-sized enterprises that leverage exporting and international quality certifications are likely to implement innovations. Originality/value: The paper contributes to the literature by suggesting that small and medium-sized enterprises must exploit strategic alternatives to improve their innovation efforts when operating in a weak institutional environment. Thus, by exploring international strategic responses to institutional difficulties when implementing innovations, this paper goes beyond the prevailing research approach in developing countries that mainly emphasises the barriers to innovation

Industry expertise, information leakage, and the choice of M&A advisors

This paper examines the impacts of M&A advisors’ industry expertise on firms’ choice of advisors in mergers and acquisitions. We show that an investment bank's expertise in merger parties’ industries increases its likelihood of being chosen as an advisor, especially when the acquisition is more complex, and when a firm in M&A has less information about the merger counterparty. However, due to the concerns about information leakage to industry rivals through M&A advisors, acquirers are reluctant to share advisors with rival firms in the same industry, and they are more likely to switch to new advisors if their former advisors have advisory relationship with their industry rivals. In addition, we document that advisors with more industry expertise earn higher advisory fees and increase the likelihood of deal completion.Chang acknowledges financial support from Rega Capital Management Limited and Academic Research Fund Tier 1 provided by Ministry of Education (Singapore). Shekhar acknowledgesfunding provided under the Faculty Research Grant scheme of the Faculty of Economics and Commerce, the University of Melbourne. Tam acknowledges research funding (MYRG074(Y1-L2)-FBA11-THK) provided by University of Macau

Measuring Morbidity Associated with Urinary Schistosomiasis: Assessing Levels of Excreted Urine Albumin and Urinary Tract Pathologies

Urinary schistosomiasis is a debilitating disease caused by a parasitic worm that dwells in the blood vessels, particularly those surrounding the human bladder wall. Although not directly associated with high patient mortality, this disease is linked to both short-term morbidity, e.g. visible blood in urine (acute), as well as long-term sequelae, e.g. urinary tract pathologies (chronic). Numerous control programmes based upon chemotherapy have been implemented in sub-Saharan Africa in an attempt to reduce the burden of disease inflicted, particularly in children. Although there are rapid tests to assess the prevalence of acute manifestations of disease (i.e. blood in urine), namely urine-reagent strips, monitoring of chronic manifestations (i.e. urinary tract pathologies) is still rather laborious, time-consuming and requires specialised equipment, e.g. portable ultrasonography, as well as highly trained staff. This study has attempted to evaluate associations between albuminuria (albumin in urine, a new application for the HemoCue photometer) and urinary tract pathologies, and consequently assess this new biochemical marker as a potential rapid proxy of chronic disease sequelae typical in children in areas where urinary schistosomiasis is of public health importance