Achieving Long-Term Poverty Reduction and Institutional Sustainability in Microfinance through the Dynamic User-Focussed Approach

Microfinance institutions that are primarily poverty reduction (PR) oriented must be confused about the prioritisation of institutional sustainability (IS) recent times. While theoretical arguments show a trade-off  between PR and IS, empirical evidence indicates the contrary. This paper examines an MFI in Ghana which describes itself as explicitly poverty-oriented to ascertain how the PR objective is affected when they prioritise IS. Findings from the qualitative study reveal that when the MFI emphasised sustainability, it had significant negative implication for PR. The dynamic user-focussed approach is proposed as a solution to the conundrum poverty oriented MFIs encounter when they prioritise sustainability. Keywords: Institutional sustainability, microfinance, poverty reductio

Associations of body composition measures and C2, a marker for small artery elasticity: The MESA.

ObjectiveLower C2, a continuous blood pressure waveform characteristic asserted to represent small artery elasticity, predicts future cardiovascular disease events. It is hypothesized that the paradoxical positive association between body mass index (BMI) and C2 may reflect muscle instead of excess fat.MethodsIn a multi-ethnic, community-living cohort of 1,960 participants, computed tomography scans of the abdomen were used to measure visceral adipose tissue (VAT) and total abdominal muscle tissue (TAMT), and applanation tonometry of the radial arteries was used to assess C2. The period cross-sectional associations between BMI, TAMT, and VAT with C2 were ascertained.ResultsThe mean age was 62 ± 9 years and 51% were male. After adjustments for age, gender, ethnicity, pack years smoking cigarettes, diabetes, hypertension, and total and HDL cholesterol, higher BMI (standardized beta = 0.09, P-value < 0.01) and more TAMT (standardized beta = 0.12, P-value < 0.01) were significantly associated with higher C2. In contrast, more VAT (standardized beta = -0.09, P-value < 0.01) was associated with lower C2.ConclusionsIn multivariable analysis, VAT, in contrast to TAMT and BMI, was associated with less compliant small arteries. Visceral fat may be a better marker for detrimental excess body fat than BMI

Osteomyelitis of the frontal bone

Osteomyelitis of the skull is a rare clinical presentation. It usually occurs as a complication of trauma or sinusitis. Its complications can be lifethreatening though the initial symptoms and signs are subtle. Early diagnosis and appropriate management to prevent CNS complications reduce morbidity and mortality significantly. Intracranial complications of sinusitis, focal infections and meningitis remain a great challenge. Mortality from complications is 20-40%. The prevalence of skull osteomyelitis is about 1.5% of all osteomyelitis

An Alternative to the MVU Estimator to Estimate the Level of DC in AWGN

In statistics, Maximum Likelihood Estimation (MLE) is a method of estimating the parameters of a particular statistical model, finding parameter values that maximize probability, observations, and the parameters are specified. The MLE can be seen as a special case of maximum post-positive estimation (MAP), which includes a uniform preventive distribution of parameters, or as a variant of the MAP that ignores the above and is therefore unregulated. Now let's look at an alternative to the MVU estimator, which is desirable in situations where the minimum variance unbiased (MVU) estimator does not exist or cannot be found, even if it exists. This estimator, which relies on the principle of maximum likelihood, is primarily the common method for obtaining a practical estimator. It has the clear advantage of being a crank turning procedure, which allows you to implement it for complicated estimation problems. A clear advantage of MLE is that it can be found numerically for a given data-set. The safest way to find the MLE is to search the grid, as long as the space between the searches are small enough, we are sure to find the MLE. Keywords: Maximum Likelihood Estimation, minimum variance unbiased, Estimator, Probability Distribution Function. DOI: 10.7176/ISDE/11-3-05 Publication date: June 30th 202

Surgically correctable adrenal-dependent hypertension: a report of five cases

Although endocrine causes of secondary hypertension are relatively uncommon, medical practitioners must maintain a high index of suspicion for them in certain categories of patients. Such patientsinclude young individuals, those with difficult- to-treat hypertension and those presenting with symptoms, clinical signs and/or laboratoryparameters well-known to be associated with Cushing’s syndrome, Conn’s syndrome or phaeochromocytoma. This paper reports on 5 patients identified over a 2-year period with various hormonally-activeadrenal adenomas causing hypertension in an environment where, hitherto, the occurrence of these conditions was generally thought to be rare. Aspects of the patients’ histories, examination and laboratory findings that drew attention to the possibility of the diagnosis in each case are highlighted, as are the confirmatory investigationsand management methods used by a multidisciplinary team of medical practitioners. The clinical outcome with appropriate treatment of adrenalrelated hypertension is good and can result in significantcost savings in the long term

Women empowerment and uptake of antenatal care services : A meta-analysis of Demographic and Health Surveys from 33 Sub-Saharan African countries

Background: Women empowerment has been linked to increased skilled antenatal care (ANC) service use. However, there is no evidence on the net effect of women empowerment on ANC in the Sub-saharan African (SSA) region. We aim to address the knowledge gap on whether or not women empowerment positively influences the uptake of ANC at the SSA regional level. Methods: We analyzed the Demographic Health Survey (DHS) datasets from 33 SSA countries. Following the DHS data analysis guideline, we measured women empowerment using two indicators. The first indicator is an index, which comprises decision-making on women’s own health, household purchase and visit to family or relatives whilst disagreeing statements that husband is justified in beating his wife constitutes the second indictor. We performed confounder-adjusted logistic regression analysis for the two indicators with ANC attendance in each of the 33 countries. Then, we pooled the adjusted Odds Ratios (OR) using the random effect model through the two-stage Individual Participant Data meta-analysis technique. Summary findings are reported in OR and corresponding 95 %CI and are presented in a forest plot. Results: Moderately empowered women had marginally higher odd of skilled ANC service across the SSA region (aOR = 1.19; 95 %CI: 1.03, 1.38, with a prediction interval of 0.58, 2.45). Conversely, being involved in the three decisions (aOR = 1.15; 95 %CI: 0.99, 1.33, with prediction interval 0.57, 2.31), and attitude towards wife-beating (aOR = 0.97; 95 %CI: 0.88, 1.06, with prediction interval of 0.63, 1.48) had no statistically significant relationship with ANC. Conclusions: Women empowerment did not predict the use of skilled ANC in the context of the SSA region. We recommend that further studies be conducted in order to understand how women empowerment affects skilled ANC service utilization in the region

Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial

In a cluster randomized trial, Kojo Yeboah-Antwi and colleagues find that integrated management of malaria and pneumonia in children under five by community health workers is both feasible and effective. BACKGROUND. Pneumonia and malaria, two of the leading causes of morbidity and mortality among children under five in Zambia, often have overlapping clinical manifestations. Zambia is piloting the use of artemether-lumefantrine (AL) by community health workers (CHWs) to treat uncomplicated malaria. Valid concerns about potential overuse of AL could be addressed by the use of malaria rapid diagnostics employed at the community level. Currently, CHWs in Zambia evaluate and treat children with suspected malaria in rural areas, but they refer children with suspected pneumonia to the nearest health facility. This study was designed to assess the effectiveness and feasibility of using CHWs to manage nonsevere pneumonia and uncomplicated malaria with the aid of rapid diagnostic tests (RDTs). METHODS AND FINDINGS. Community health posts staffed by CHWs were matched and randomly allocated to intervention and control arms. Children between the ages of 6 months and 5 years were managed according to the study protocol, as follows. Intervention CHWs performed RDTs, treated test-positive children with AL, and treated those with nonsevere pneumonia (increased respiratory rate) with amoxicillin. Control CHWs did not perform RDTs, treated all febrile children with AL, and referred those with signs of pneumonia to the health facility, as per Ministry of Health policy. The primary outcomes were the use of AL in children with fever and early and appropriate treatment with antibiotics for nonsevere pneumonia. A total of 3,125 children with fever and/or difficult/fast breathing were managed over a 12-month period. In the intervention arm, 27.5% (265/963) of children with fever received AL compared to 99.1% (2066/2084) of control children (risk ratio 0.23, 95% confidence interval 0.14–0.38). For children classified with nonsevere pneumonia, 68.2% (247/362) in the intervention arm and 13.3% (22/203) in the control arm received early and appropriate treatment (risk ratio 5.32, 95% confidence interval 2.19–8.94). There were two deaths in the intervention and one in the control arm. CONCLUSIONS. The potential for CHWs to use RDTs, AL, and amoxicillin to manage both malaria and pneumonia at the community level is promising and might reduce overuse of AL, as well as provide early and appropriate treatment to children with nonsevere pneumonia.United States Agency for International Development (GHSA-00-00020-00) with Boston University; President's Malaria Initiativ

Availability and Utilization of Malaria Prevention Strategies in Pregnancy in Eastern India

BACKGROUND. Malaria in pregnancy in India, as elsewhere, is responsible for maternal anemia and adverse pregnancy outcomes such as low birth weight and preterm birth. It is not known whether prevention and treatment strategies for malaria in pregnancy (case management, insecticide-treated bednets, intermittent preventive therapy) are widely utilized in India. METHODS. This cross-sectional study was conducted during 2006-2008 in two states of India, Jharkhand and Chhattisgarh, at 7 facilities representing a range of rural and urban populations and areas of more versus less stable malaria transmission. 280 antenatal visits (40/site) were observed by study personnel coupled with exit interviews of pregnant women to assess emphasis upon, availability and utilization of malaria prevention practices by health workers and pregnant women. The facilities were assessed for the availability of antimalarials, lab supplies and bednets. RESULTS. All participating facilities were equipped to perform malaria blood smears; none used rapid diagnostic tests. Chloroquine, endorsed for chemoprophylaxis during pregnancy by the government at the time of the study, was stocked regularly at all facilities although the quantity stocked varied. Availability of alternative antimalarials for use in pregnancy was less consistent. In Jharkhand, no health worker recommended bednet use during the antenatal visit yet over 90% of pregnant women had bednets in their household. In Chhattisgarh, bednets were available at all facilities but only 14.4% of health workers recommended their use. 40% of the pregnant women interviewed had bednets in their household. Only 1.4% of all households owned an insecticide-treated bednet; yet 40% of all women reported their households had been sprayed with insecticide. Antimalarial chemoprophylaxis with chloroquine was prescribed in only 2 (0.7%) and intermittent preventive therapy prescribed in only one (0.4%) of the 280 observed visits. CONCLUSIONS. A disconnect remains between routine antenatal practices in India and known strategies to prevent and treat malaria in pregnancy. Prevention strategies, in particular the use of insecticide-treated bednets, are underutilized. Gaps highlighted by this study combined with recent estimates of the prevalence of malaria during pregnancy in these areas should be used to revise governmental policy and target increased educational efforts among health care workers and pregnant women.United States Agency for International Development/India mission (cooperative agreement GHS-A-00-03-00020-00); National Institute of Allergy and Infectious Disease (R03 HD52167-01); Indian National Institute of Malaria Research; Indo-US Program for Contraception and Reproductive Health Researc

D 5.5.1.1. Final report on sensory testing in Africa for Group 1. Project AFTER “African Food Tradition rEvisited by Research”

This deliverable concerns the sensory evaluation of the reengineered group 1 African products in the AFTER project. Specifically, it related to reengineered akpan and gowe from Benin, kenkey from Ghana and Kishk Sa'eedi in Egypt. Concerning reengineered akpan from Benin, the sensory evaluation was undertaken in Montpellier, France. Re-engineering of akpan has focused primarily on improvement of sanitary properties of the product, which was a great achievement and will allow producing Akpan on a larger scale in SMEs in Africa. Sensory evaluation of the Akpan products was carried out using CATA and JAR techniques that have been developed for use with consumers instead of a trained panel. Three Akpan products were tested by 102 consumers: Akpan added with 10% sugar (AS10), Akpan added with 3% spray-dried milk and 8.7% sugar (AMS8.7) and Akpan added with 3% spray-dried milk and 15% sugar (AMS15). Independently of the Akpan tasted, Acidity or Sweetness attributes were scored “Just About Right, as I like” by 56 to 77% of consumers. Odour perception was perceived differently, depending on consumers. However, Texture was found “Too weak”, too liquid by the majority of consumers (49 to 55%) and Taste “too strong” (46 to 54%). The most frequently CATA descriptors checked by consumers which better described Akpan products were: “Artificial”, “Floral”, “New/Different”, “Strong in Taste”, “Mealy”, followed by “Liquid”, “Drinking yoghurt”, “Sweet”, “Acidic”, and “Rough”. At the opposite, an ideal-yoghurt was described as Creamy, Natural, Good for health, Refreshing, Homogeneous, with a texture of a Bulgarian yoghurt-type, Thick, Sweet, Attractive, Nutritious and Milk taste. In terms of sensory evaluation, the three Akpan products did not significantly. If we remove the terms such as “artificial”, “strong in taste”, “floral” due to a manufacturing error (use of a few drops of citronella essential oil instead of citronella infusion as a traditional flavouring of Akpan in Benin), it remains the terms “mealy”, “liquid” “drinking yoghurt” that better describe the product and were previously used for describing traditional Akpan product. This suggests that sensory properties of the reengineered Akpan may not be acceptable to French consumers who prefer a product with a creamy, homogeneous, Bulgarian yoghurt-type taste. Gowe in Benin was not tested using sensory evaluation. Sensory testing of Gowe in Benin was not undertaken because this was planned to be undertaken in Europe. The reason is because the methodology used in sensory evaluation is independent of the location provided the samples are the same. However, the particular samples provided for French sensory testing contained a concentration of aflatoxin that was higher than the minimum EU allowable limit. It was not possible to repeat the sensory test in France because it would have taken too long to obtain a replacement supply from Benin and to repeat the processing (takes one week). In which case the samples would have been took different to enable a comparison. The sensory evaluation of kenkey was carried at the Food Research Institute, Ghana. Current trends in urbanization, and the increasing popularity of kenkey among consumers, require larger scale production with consistent quality. Testing was conducted to determine the sensory profile of white reengineered kenkey made using the optimum pre-process conditions of steeping time (30 and 45h), steeping temperature (30ᵒC and 35ᵒC) and dough fermentation time of 12 hours. The qualitative descriptive analysis showed that the sensory profile of white kenkey was dependent on preprocessing variables. Thus merely optimizing the pre-processing variables with regards to acid production and other readily measurable constituents though could shorten the production process could not guarantee the best product sensory quality. The results show that all the descriptors generated were appropriate for differentiating sensory qualities among samples and could be used for basic research and product development for white kenkey. Soft and sticky texture in white kenkey was highly appreciated. Sensory evaluation of Kishk Sa'eedi (KS) was undertaken in Egypt. KS is an Egyptian indigenous wheat-based fermented food prepared traditionally according to the method applied by Upper Egyptians. This work is done to characterize sensory properties and sensory profile of the reengineered KS. Quantitative descriptive analysis (QDA) coupled with principal component analysis (PCA) was used to study the interrelationship among and between sensory attributes. 14 terms regarding appearance, odour, flavour and texture of the samples, was selected and a glossary describing each descriptor was developed. Three KS samples were profiled by 11 assessors using the chosen 14 sensory descriptors. Mean intensity ratings of the descriptive attributes showed that there were significant differences (p<0.05) within KS samples for all the 14 attributes tested. In general, high ratings for creamy colour, fresh odour, KS taste and fracturability are considered as positive effects that would be favoured by panellists while increase in caramel colour, sour taste, denseness and mouth coating are regarded as undesirable. The re-engineered KS sample perceived as less sour and less salty compared with the traditional ones. With regard to texture quality, reengineered sample was easy to fracture, and scored higher for grittiness. Meanwhile, the sample was rated lower than the traditional ones with regard to Kishk taste and fermented odour. Descriptive sensory evaluations between of the traditional and re-engineered KS samples showed that tastes i.e. sour, salty, and KS taste; fracutability and grittiness were discriminating attributes. Fermented odour, colour i.e. creamy and caramel; presence of fissure and presence of bran were least discriminating. Evaluation of the KS sensory characteristics provide in depth understanding of the sensory quality criteria as perceived by the sensory trained panel. The present study showed that substantial differences in sensory character were noted between the traditional and re-engineered KS in particular, differences in colour, fresh odour, KS taste, fracutability and mouth coating. This work showed that the application of QFD and PCA techniques could provide the useful information to KS and helped to identify the importance of product attributes. In conclusion the sensory evaluation showed clear sensory differences between the traditional and reengineered products relating to akpan from Benin, kenkey from Ghana and Kishk Sa'eedi from Egypt. Other deliverables will report on the acceptance by consumers