Short-Term Administration of Rifampin in the Prevention or Eradication of Infection Due to Foreign Bodies

Short-term administration of rifampin was evaluated as a means of preventing or eradicating infection due to foreign bodies. Tissue cages were implanted into guinea pigs and subsequently infected with 103 colony-forming units of Staphylococcus aureus Wood 46. Infection developed in all tissue cages. Rifampin was administered thereafter intraperitoneally at a dosage of 7.5 mg/kg every 12 hr for 48 hr, and the tissue-cage fluid was monitored for possible development of infection by quantitative bacteriologic methods for 15 days. In all cases rifampin prevented or eradicated tissue-cage infection if treatment was initiated either 3 hr before or ⩽12 hr after inoculation of microorganisms but was ineffective if initiated >12 hr after inoculation. In cases of failure of treatment, rifampin-resistant variants could be demonstrated. Rifampin seems to prevent or eradicate tissue-cage infection only if given early after bacterial inoculatio

Burden, timing and causes of maternal and neonatal deaths and stillbirths in sub-Saharan Africa and South Asia: Protocol for a prospective cohort study

OBJECTIVES: The AMANHI mortality study aims to use harmonized methods, across eleven sites in eight countries in South Asia and sub–Saharan Africa, to estimate the burden, timing and causes of maternal, fetal and neonatal deaths. It will generate data to help advance the science of cause of death (COD) assignment in developing country settings. METHODS: This population–based, cohort study is being conducted in the eleven sites where approximately 2 million women of reproductive age are under surveillance to identify and follow–up pregnancies through to six weeks postpartum. All sites are implementing uniform protocols. Verbal autopsies (VAs) are conducted for deaths of pregnant women, newborns or stillbirths to confirm deaths, ascertain timing and collect data on the circumstances around the death to help assign causes. Physicians from the sites are selected and trained to use International Classification of Diseases (ICD) principles to assign CODs from a limited list of programmatically–relevant causes. Where the cause cannot be determined from the VA, physicians assign that option. Every physician who is trained to assign causes of deaths from any of the study countries is tested and accredited before they start COD assignment in AMANHI. IMPORTANCE OF THE AMANHI MORTALITY STUDY: It is one of the first to generate improved estimates of burden, timing and causes of maternal, fetal and neonatal deaths from empirical data systematically collected in a large prospective cohort of women of reproductive age. AMANHI makes a substantial contribution to global knowledge to inform policies, interventions and investment decisions to reduce these deaths

Leadership effectiveness in local government : the case of Amathole District Municipality

Local government is a complex sphere of government that was established on the principles of deepening democracy and advancing developmental local government. This is premised on the fact that local government is highly legislated; furthermore it is the sphere that is the closest to the people. Local government has endured a lot of criticism ranging from lack of leadership, inexperienced and unqualified managers, lack of service delivery and the poor quality of the services provided. The critical question being asked in this research study is whether the current calibre of leadership is achieving the principles of local government. Councillors, by virtue of their establishment, were meant to be the voice of communities. Councillors have a supervisory role to play in the council, but the skills, capacities and experience of councillors are often lacking. The media reports daily on problems and crises called “challenges” facing municipalities. Government has acknowledged that there are challenges in local government. This raises the issue of cadre deployment, whether it assists government in achieving its developmental objectives. Cadre deployment is a strategy of the ruling party which was meant to bring the previously disadvantaged groups to a position of power. This was meant to try to balance the imbalances of the past. This research study argues that the high volume of dissatisfaction by communities may be aggravated by the non-effectiveness of the political bearers in the municipal councils. This study identifies a number of contributing factors to the challenge at hand, such as the deployment of people to council structures; requirement in terms of academic qualification; and lack of leadership. Furthermore, this study investigates what could be the problem with the cadre deployment strategy of the ruling party; asking whether the problem is with the strategy itself or with its implementation. This research study therefore seeks to evaluate the impact the political leaders have on local government, focusing on service delivery. The study will first outline the state of local government in South Africa; compare the design of SA local government to international and African countries as well as looking at the key variables that result in the lack of service delivery. The issue of woman empowerment will also be discussed, evaluating the role that the country up to local government has played in ensuring that the 50/50 representation is achieved. The conclusion from this research is that a framework for the selection of council candidates should be developed. The framework will outline the basic skills and qualification requirements. The recommendations include improvements in the processes of interacting with communities; enforcing the code of conduct; developing ways that the municipality can educate communities on government operations; improved community participation and increased accountability. The impact of the lack of leadership in councillors undermines the democratic principles of developmental local government

Assessing monitoring and evaluation as the control measure to enhance organisational performance with the reference to the Eastern Cape provincial treasury

The growing demand for governments and organisations to demonstrate principles of accountability, transparency and participatory decision making, which are the cornerstones of good governance, has fostered renewed efforts to transform the public service to ultimately produce tangible results and meet the needs of the beneficiaries of service delivery. Effective performance management practised across the entire organization in an integrated, iterative and sustained way that can help public service organizations overcome the challenges and deliver more with less. This study focuses on the assessment of monitoring and evaluation as the control measure to enhance organisational performance with the reference to the Eastern Cape Provincial Treasury and assess critical role in supporting performance management and also provides methodological options to support performance management. Monitoring and Evaluation (M&E) are management activities that are necessary to ensure the achievement of policy goals in the form of concrete results. The study revealed that the current M and E system is not effective in that there are no clearly defined standards of what a quarterly progress report entail, especially the portfolio of evidence and because the main problem stems from the definition of what constitutes departmental performance. In determining what needs to be done, the effectiveness suffers since we opt for mainly indicators that are “safe”, that the department are sure they can achieve and not necessarily those that will enhance organizational performance. The study revealed that each programme manager should monitor and evaluate his/her processes on a continuous basis without having to wait for M&E unit. M&E unit will then provide an objective evaluation of the process already in place and constant engagement between M&E unit and line management, feedback sessions between staff and M&E unit are essential about the achievement of targets as outlined in the APP and Operational Plan. The study further revealed that there should be continuous meetings to discuss how directorates should sufficiently report on their quarterly targets to avoid inadequate reported information and the department must go step by step in performing activities towards achieving a set vision and on way to the vision, not forgetting to take away risks that may take us to another direction that was not intended as per our vision. The study thus recommends that, inter alia, the department must introduce strong mechanisms to deal with non-implementation of corrective measures regarding under performance and the poor quality of information provided in performance reports related to the performance indicators in the Annual Performance Plans.The introduction of an early warning sign system to warn all programmes when the performance of their planned indicators are not be achieved. The Top Management should continue to use the performance management information as the tool to improve the organisational performance by linking and aligning individual, team and organisational objectives and results, it also provides a means to recognise and reward good performance and to manage under-performance. However the Top Management should be able to conduct in-depth analysis into underperformance to detect whether the underperformance is related to the bad crafting of the indicators or if it relates to the work not done. The department should invest money on training of officials in M&E because it plays a critical role supporting performance management at various levels, in that it contributes to a thinking that is results oriented and also provides methodological options to support performance management. This means that all officials must be capacitated to manage M&E systems in the department that will ensure the production of accurate, objective and reliable information. The M&E unit in the department must facilitate such skills development and provide reasonable technical support where required. The training could be designed to instill a deeper understanding and knowledge of the concepts of M&E and their correct application in order to avoid misunderstandings and misinterpretations which could hinder the achievement of the desired results

Older persons’ perceptions of services that support positive ageing in the Khayelitsha and Gugulethu districts of the Western cape

Globally people are growing older, and nearly every country is experiencing an increase in their ageing populace. In 1960 older people made up 5 % of the world population, while in 2018, they were about 9% of the overall population. Projections are that in 2050 people over the age of 65 will make up 16% of the overall population. To respond to an ageing population, a government must ensure that its policy framework can respond to the needs of its citizens. A society that supports a positive ageing environment improves older people’s well-being. In our complex society, each person is dependent on others in various ways, and social, emotional and practical interdependence is a feature of the human social condition. This means that older people do not function well in isolation but need support for positive ageing. This research project focused on older people’s perceptions of services that support their positive ageing in the Khayelitsha and Gugulethu districts of the Western Cape, South Africa. The theoretical framework employed in the study is Systems Theory. The research approach utilised in the study is qualitative with an explorative and descriptive research design. A non-probability purposive, criterion-based sampling technique was employed. The researcher recruited eleven older persons aged sixty years and above in the Khayelitsha and Gugulethu areas. An NGO that works with older persons’ served as gatekeepers. Semi-structured telephonic interviews were conducted. The data collected was analysed using thematic data analysis. The trustworthiness of the research process was enhanced using Guba’s model. Ethical principles as set out in the Belmont report were also adhered to. The key findings of the current study indicated that in Khayelitsha and Gugulethu areas, there are available services that support positive ageing, such as clubs, excursions and social grants. Environmental aspects challenging positive ageing included unfavourable home conditions such as financial burden and ill-treatment, poverty and unemployment, health problems, and COVID-19 effects. Older people mentioned that there are available but inadequate services such as municipal services and care facilities. Thus, they recommended that there should be poverty alleviation schemes, community development projects such as crafting, gardening, sewing, and more institutions and home-based care for older people.Thesis (MA) -- Faculty of Health Sciences, 202

Older persons’ perceptions of services that support positive ageing in the Khayelitsha and Gugulethu districts of the Western cape

Globally people are growing older, and nearly every country is experiencing an increase in their ageing populace. In 1960 older people made up 5 % of the world population, while in 2018, they were about 9% of the overall population. Projections are that in 2050 people over the age of 65 will make up 16% of the overall population. To respond to an ageing population, a government must ensure that its policy framework can respond to the needs of its citizens. A society that supports a positive ageing environment improves older people’s well-being. In our complex society, each person is dependent on others in various ways, and social, emotional and practical interdependence is a feature of the human social condition. This means that older people do not function well in isolation but need support for positive ageing. This research project focused on older people’s perceptions of services that support their positive ageing in the Khayelitsha and Gugulethu districts of the Western Cape, South Africa. The theoretical framework employed in the study is Systems Theory. The research approach utilised in the study is qualitative with an explorative and descriptive research design. A non-probability purposive, criterion-based sampling technique was employed. The researcher recruited eleven older persons aged sixty years and above in the Khayelitsha and Gugulethu areas. An NGO that works with older persons’ served as gatekeepers. Semi-structured telephonic interviews were conducted. The data collected was analysed using thematic data analysis. The trustworthiness of the research process was enhanced using Guba’s model. Ethical principles as set out in the Belmont report were also adhered to. The key findings of the current study indicated that in Khayelitsha and Gugulethu areas, there are available services that support positive ageing, such as clubs, excursions and social grants. Environmental aspects challenging positive ageing included unfavourable home conditions such as financial burden and ill-treatment, poverty and unemployment, health problems, and COVID-19 effects. Older people mentioned that there are available but inadequate services such as municipal services and care facilities. Thus, they recommended that there should be poverty alleviation schemes, community development projects such as crafting, gardening, sewing, and more institutions and home-based care for older people.Thesis (MA) -- Faculty of Health Sciences, 202

Antiretroviral treatment program retention among HIV-infected children in the Democratic Republic of Congo.

BACKGROUND: Retaining patients with HIV infection in care is still a major challenge in sub- Saharan Africa, particularly in the Democratic Republic of Congo (DRC) where the antiretroviral treatment (ART) coverage is low. Monitoring retention is an important tool for evaluating the quality of care. METHODS AND FINDINGS: A review of medical records of HIV-infected children was performed in three health facilities in the DRC: the Amo-Congo Health center, the Monkole Clinic in Kinshasa, and the HEAL Africa Clinic in Goma. Medical records of 720 children were included. Kaplan Meier curves were constructed with the probability of retention at 6 months, 1 year, 2 years and 3 years. Retention rates were: 88.2% (95% CI: 85.1%-90.8%) at 6 months; 85% (95% CI: 81.5%-87.6%) at one year; 79.4% (95%CI: 75.5%-82.8%) at two years and 74.7% (95% CI: 70.5%-78.5%) at 3 years. The retention varied across study sites: 88.2%, 66.6% and 92.5% at 6 months; 84%, 59% and 90% at 12 months and 75.7%, 56.3% and 85.8% at 24 months respectively for Amo-Congo/Kasavubu, Monkole facility and HEAL Africa. After multivariable Cox regression four variables remained independently associated with attrition: study site, CD4 cell count <350 cells/µL, children younger than 2 years and children whose caregivers were member of an independent church. CONCLUSIONS: Attrition remains a challenge for pediatric HIV positive patients in ART programs in DRC. In addition, the low coverage of pediatric treatment exacerbates the situation of pediatric HIV/AIDS

Assessing determinants of programmatic performance of community management of malaria, pneumonia, and diarrhea in children in Africa: protocol and data collection for a mixed methods evaluation of integrated community case management

BACKGROUND: Integrated community case management (iCCM) is a child health program designed to provide integrated community-based care for children with pneumonia, malaria, or diarrhea in hard-to-reach areas of low- and middle-income countries. The foundation of the intervention is service delivery by community health workers (CHWs) who depend on reliable provision of drugs and supplies, consistent supervision, comprehensive training, and community acceptance and participation to perform optimally. The effectiveness of the program may also depend on a number of other elements, including an enabling policy environment, financing mechanisms from the national to the local level, data transmission systems, and appropriate monitoring and evaluation. The extent to which these factors act upon each other to influence the effectiveness and viability of iCCM is both variable and challenging to assess, especially across different implementation contexts. OBJECTIVE: In this paper, we describe a mixed methods systems-based study protocol to assess the programmatic components of iCCM that are associated with intervention effectiveness and report preliminary results of data collection. METHODS: This protocol uses a mixed qualitative and quantitative study design based on a systems thinking approach within four iCCM programs in Malawi, Democratic Republic of the Congo, and Niger State and Abia State in Nigeria. Routine monitoring data are collected to determine intervention effectiveness, namely testing, treatment, and referral outcomes. Surveys with CHWs, supervisors, and caregivers are performed to collect quantitative data on their demographics, activities, and experiences within the program and how these relate to the areas of intervention effectiveness. Focus group discussions are conducted with these stakeholders as well as local traditional leaders to contextualize these data. Key informant interviews are undertaken with national- and district-level program stakeholders and officers knowledgeable in critical program processes. RESULTS: We performed 3836 surveys and 45 focus group discussions of 379 participants with CHWs, supervisors, caregivers, and traditional leaders, as well as 120 key informant interviews with district- and national-level program managers, health officers, and ministry officials. Policy and program documents were additionally collected for review. CONCLUSIONS: We expect that evidence from this study will inform child health programs and practice in low- and middle-income settings as well as future policy development within the iCCM intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33076

Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo

Long-lasting insecticidal nets (LLIN) are a highly effective means for preventing malaria infection and reducing associated morbidity and mortality. Mass free distribution campaigns have been shown to rapidly increase LLIN ownership and use. Around 3.5 million LLINs were distributed free of charge in the Kasaï Occidental Province in the Democratic Republic of Congo (DRC) in September-October 2014, using two different approaches, a fixed delivery strategy and a door-to-door strategy including hang-up activities.; Repeated community-based cross-sectional surveys were conducted 2 months before and six months after the mass distribution. Descriptive statistics were used to measure changes in key malaria household indicators. LLIN ownership and use were compared between delivery strategies. Univariate and multivariate logistic regression analyses were used to identify factors associated with LLIN use before and after the mass distribution. A comparative financial cost analysis between the fixed delivery and door-to-door distribution strategies was carried out from the provider's perspective.; Household ownership of at least one LLIN increased from 39.4% pre-campaign to 91.4% post-campaign and LLIN universal coverage, measured as the proportion of households with at least one LLIN for every two people increased from 4.1 to 41.1%. Population access to LLIN within the household increased from 22.2 to 80.7%, while overall LLIN use increased from 18.0 to 68.3%. Higher LLIN ownership was achieved with the fixed delivery strategy compared with the door-to-door (92.5% [95% CI 90.2-94.4%] versus 85.2% [95% CI 78.5-90.0%]), while distribution strategy did not have a significant impact on LLIN use (69.6% [95% CI 63.1-75.5%] versus 65.7% [95% CI 52.7-76.7%]). Malaria prevalence among children aged 6-59 months was 44.8% post-campaign. Living in a household with sufficient numbers of LLIN to cover all members was the strongest determinant of LLIN use. The total financial cost per LLIN distributed was 6.58 USD for the fixed distribution strategy and 6.61 USD for the door-to-door strategy.; The mass distribution campaign was effective for rapidly increasing LLIN ownership and use. These gains need to be sustained for long-term reduction in malaria burden. The fixed delivery strategy achieved a higher LLIN coverage at lower delivery cost compared with the door-to-door strategy and seems to be a better distribution strategy in the context of the present study setting