Congenital cystic adenomatoid malformation: case report

Congenital cystic adenomatoid malformation of the lung is a rare lesion that typically manifests as severe progressive respiratory distress in the neonate secondary to expansion of the affected lung. We present a neonate in whom this condition was diagnosed and managed at the Aga Khan University Hospital. In presenting this patient, we hope to highlight the radiological aspects of this condition which, with prompt recognition and management and in the absence of pulmonary hypoplasia, foetal hydrops or other congenital anomalies, has a favourable prognosis

Cost Analysis of Community Health Strategy Implementation: Case Study of Butere District, Kenya

Cost analysis of community health strategy is the Identification of current and anticipated costs in operating a community health unit with an examination of the impact of those costs of setting them up. The purpose of the study was to look at the cost of implementing community health strategy in a rural set up in Kenya. The study was a longitudinal and was carried out in Butere District US$2549.9 was used to set up community health unit and US$7532 was spent in operation costs. The total cost of implementing and running a functional community health unit in Kenya’s rural set up is equivalent to US$10,081.9

MARKETING AGENCY SERVICES AND MEMBERS SATISFACTION: A CASE OF COFFEE CO-OPERATIVES SOCIETIES IN NANDI COUNTY, KENYA

This paper examined the influence of coffee marketing agency services provided to members of Co-operatives in Nandi County Kenya. The objectives of the study were to investigate the influence of timely coffee payments on members satisfaction, to investigate the influence of coffee prices on members satisfaction, to investigate the influence of commission charged on members satisfaction and to investigate the influence of advance payments on members satisfaction. The study focused on Songhor Division which is one of the divisions with highest concentration of coffee farmers in Nandi County, Kenya. The target population of the study was 1122 members with a sample size of 285 chosen . Results of the study showed that there was no significant influence on timely coffee payments and coffee prices on member satisfaction but the study established that there exist significant influence on commissions charged on coffee and advance coffee payments on member satisfaction. The study recommended that coffee cooperative societies in the area need to look for better markets for their coffee, members should also improve their coffee quality and coffee payments need to be made within a short period of time

Segurança e reação de hipersensibilidade tardia na pele de macacos vervet imunizados com antígeno sonicado de Leishmania donovani junto com adjuvantes

In this study, we report on the safety and skin delayed-type hypersensitivity (DTH), responses of the Leishmania donovani whole cell sonicate antigen delivered in conjunction with alum-BCG (AlBCG), Montanide ISA 720 (MISA) or Monophosphoryl lipid A (MPLA) in groups of vervet monkeys. Following three intradermal injections of the inoculums on days 0, 28 and 42, safety and DTH responses were assessed. Preliminary tumor necrosis factor alpha (TNF-&#945;) and interferon gamma (IFN-&#947;) levels were also measured and these were compared with DTH. Only those animals immunized with alum-BCG reacted adversely to the inoculum by producing ulcerative erythematous skin indurations. Non-parametric analysis of variance followed by a post-test showed significantly higher DTH responses in the MISA+Ag group compared with other immunized groups (p < 0.001). The MPLA+Ag group indicated significantly lower DTH responses to the sonicate antigen compared with the AlBCG+Ag group. There was a significant correlation between the DTH and cytokine responses (p < 0.0001). Based on this study we conclude that Leishmania donovani sonicate antigen containing MISA 720 is safe and is associated with a strong DTH reaction following immunization.Neste estudo reportamos segurança e resposta de hipersensibilidade tardia (DTH) do antígeno sonicado de células totais de Leishmania donovani introduzidos juntamente com alume-BCG (AIBCG) Montanide ISA 720 (MISA) ou lípide A monofosforilado (MPLA) em grupos de macacos vervet. Depois de três injeções intradérmicas do inóculo nos dias 0, 28 e 42 segurança e resposta DTH foram avaliados. Preliminarmente níveis de fator de necrose tumoral alfa (TNF-&#945;) e interferon gama (IFN-&#947;) foram também medidos e comparados com o DTH. Somente os animais imunizados com alume-BCG reagiram de maneira diversa ao inóculo produzindo indurações ulceradas e eritematosas na pele. Análise não paramétrica de variação seguida por um teste posterior mostraram resposta significantemente mais alta do DTH no grupo MISA + Ag quando comparado com outros grupos imunizados (p < 0.001). O grupo MPLA + Ag demonstrou resposta DTH significantemente menor do antígeno sonicado comparado com o grupo AIBCG + Ag. Houve correlação significante entre o DTH e a resposta às citocinas (p < 0.0001). Baseados neste estudo concluímos que o antígeno sonicado de Leishmania donovani contendo MISA 720 é seguro e está associado com forte reação DTH após imunização

Antimicrobial resistance among farming communities in Wakiso District, Central Uganda: A knowledge, awareness and practice study

Background Antibiotics are increasingly becoming ineffective as antimicrobial resistance (AMR) continues to develop and spread globally—leading to more difficult to treat infections. Countries such as Uganda are still challenged with implementation of AMR related strategies due to data paucity. This includes a lack of data on the prevailing knowledge and awareness of antimicrobial resistance and antibiotic use among farming communities, both commercial and subsistence, which are instrumental in the implementation of targeted interventions. The aim of our study was to assess the knowledge, attitudes and practices on AMR among subsistence and commercial farmers in Wakiso district, central Uganda. Methods A cross-sectional study was conducted using a semi-structured questionnaire in Wakiso district, Central Uganda in between June and September 2021. Polytomous latent class analyses were performed to group participants based on their responses. Multivariable regression and conditional inference trees were used to determine the association between demographic factors and knowledge on antibiotics and AMR. Results A total of 652 respondents participated in the study among whom 84% were able to correctly describe what antibiotics are. Subsistence farmers (OR = 6.89, 95% CI [3.20; 14.83]), and to a lesser extent, farming community members which obtained their main income by another business (OR = 2.25, 95% CI [1.345; 3.75]) were more likely to be able to describe antibiotics correctly than individuals involved in commercial farming. Based on the latent class analysis, three latent classes indicating different levels of knowledge on AMR, were found. Subsistence farming, higher educational level and younger age were found to be associated with belonging to a class of better knowledge. Conclusion The majority of participants were able to correctly describe antibiotics and aware of AMR, however there was some degree of misunderstanding of several AMR concepts. Targeted AMR interventions should improve awareness and also ensure that not only subsistence farmers, but commercial farmers, are included

The challenges of achieving high training coverage for IMCI: case studies from Kenya and Tanzania

Health worker training is a key component of the integrated management of childhood illness (IMCI). However, training coverage remains low in many countries. We conducted in-depth case studies in two East African countries to examine the factors underlying low training coverage 10 years after IMCI had been adopted as policy. A document review and in-depth semi-structured interviews with stakeholders at facility, district, regional/provincial and national levels in two districts in Kenya (Homa Bay and Malindi) and Tanzania (Bunda and Tarime) were carried out in 2007–08

A Review of the Participation of Smallholder Farmers in Land-based Carbon Payment Schemes

There is renewed interest in the engagement of smallholder farmers in carbon markets. This follows in the wake of commitments by governments and companies to reduce or avoid the release of greenhouse gases. It is well known that soil can store large amounts of carbon, and soil stewardship offers a means to harness this potential. However, issues around permanence and scaling in smallholder farmer systems must be addressed if progress is to be made in this area. In this review, we examine the engagement of smallholder farmers in carbon sequestration payment schemes that promote sustainable land management (SLM). Drawing on a review of documents from carbon payment projects, interviews with key informants, and scientific literature, we highlight approaches for smallholder engagement along the project cycle, identify key barriers to participation, and outline options to enhance farmers’ agency. In assessing a total of ten projects, we observe considerable variation in participation across the projects. Project design tools classified as co-decision tools were common, with 60 % of projects reporting the use of individualised land management plans, 30 % the use of participatory rural appraisals (PRAs) and 10 % participatory mapping. However, few projects featured detailed frameworks for the incorporation of community feedback. The key informant interviews and literature review revealed that low carbon revenues, insecure land tenure, and high transaction costs are the primary barriers to participation, placing disproportionate pressure on marginalised households. Further, designing and implementing rigorous, participatory, and cost-effective monitoring reporting and verification (MRV) methodologies remains a challenge for many project proponents. We also find that flexible contracts can foster broad participation by including details that are attractive to mallholders such as longer terms, local contract providers and low-cost SLM measures. Projects that strengthen community institutions and social capital can stimulate participation among the marginalised, reduce transaction costs, and promote equity as well as smallholder agency. Engagement with communitybased organisations or other civil society actors can facilitate communication between project proponents and farmers, bolster farmers’ bargaining power, and reduce transaction costs during implementation

The effectiveness and characteristics of mHealth interventions to increase adolescent's use of sexual and reproductive health services in Sub-Saharan Africa: a systematic review

Background mHealth innovations have been proposed as an effective solution to improving adolescent access to and use of Sexual and Reproductive Health (SRH) services; particularly in regions with deeply entrenched traditional social norms. However, research demonstrating the effectiveness and theoretical basis of the interventions is lacking. Aim Our aim was to describe mHealth intervention components, assesses their effectiveness, acceptability, and cost in improving adolescent's uptake of SRH services in Sub-Saharan Africa (SSA). Methods This paper is based on a systematic review. Twenty bibliographic databases and repositories including MEDLINE, EMBASE, and CINAHL, were searched using pre-defined search terms. Of the 10, 990 records screened, only 10 studies met the inclusion criteria. The mERA checklist was used to critically assess the transparency and completeness in reporting of mHealth intervention studies. The behaviour change components of mHealth interventions were coded using the taxonomy of Behaviour Change Techniques (BCTs). The protocol was registered in the 'International Prospective Register for Systematic Reviews' (PROSPERO-CRD42020179051). Results The results showed that mHealth interventions were effective and improved adolescent's uptake of SRH services across a wide range of services. The evidence was strongest for contraceptive use. Interventions with two-way interactive functions and more behaviour change techniques embedded in the interventions improved adolescent uptake of SRH services to greater extent. Findings suggest that mHealth interventions promoting prevention or treatment adherence for HIV for individuals at risk of or living with HIV are acceptable to adolescents, and are feasible to deliver in SSA. Limited data from two studies reported interventions were inexpensive, however, none of the studies evaluated cost-effectiveness. Conclusion There is a need to develop mHealth interventions tailored for adolescents which are theoretically informed and incorporate effective behaviour change techniques. Such interventions, if low cost, have the potential to be a cost-effective means to improve the sexual and reproductive health outcomes in SSA