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The design of a case register for tuberculosis: A pilot study in the south-western Cape

The development and piloting of a tuberculosis register that aims at providing a single source of information for the surveillance of tuberculosis and the measures for its control are discussed. Old-fashioned punch cards are appropriate in both isolated rural and sophisticated urban settings.The card system proved an effective and efficient clinic based epidemiological tool but its implementation on a broad scale depends on the rationalisation of current administrative procedures

Molecular genetic characterization of two solvent pathway dehydrogenases from Clostridium Acetobutylicum

Clostridium acetobutylicum P262 is an endospore-forming Gram-positive anaerobic bacterium, which has been used for the industrial production of acetone and butanol from carbohydrate substrates. This study forms part of a wider research effort into the genetics and molecular biology of C. acetobutylicum, which has as an ultimate goal the commercial improvement, and a fundamental understanding of the ABE fermentation. The aim of this study was to isolate and characterize genes involved in solventogenesis. The cloning, expression and characterization of the terminal solventogenic butanol dehydrogenase gene ( adhl), and the central pathway β-hydroxybutyryl-CoA dehydrogenase gene (hbd), which form part of a but operon are described

A DESCRIPTION HIGHLIGHTING THE PSYCHOSOCIAL PROBLEMS EXPERIENCED BY LEARNERS IN THREE SECONDARY SCHOOLS IN THE WESTERN CAPE

This paper provides a description of the psychosocial problems experienced by learners in threesecondary schools in the Western Cape. This research aimed at eliciting the personalexperiences of learners and then describing these data in comparison with current theoreticalknowledge. The results of this research have been used as the scientific underpinning for thedevelopment of a multidisciplinary support service to learners in Western Cape secondaryschools: the primary aim of the Community Keepers (CK) organisation

Organising for Effective Academic Entrepreneurship

The contribution has three parts. In the first part the concept of academic entrepreneurship is explained, defined and put into the context of the entrepreneurial university. In the second part four cases are described: - (1) The Nikos case at the University of Twente: In Nikos teaching, research and spin-off activities are combined into one research institute. - (2) The NICENT case at the University of Ulster: NICENT is set up under the Science and Enterprise Centre activities in the UK. It focuses on education and training of students (undergraduates, graduates and post-graduates) and the stimulation of academic entrepreneurship in the academic constituency. - (3) The S-CIO case at Saxion Universities for Applied Sciences: In 2004 Saxion set up this Centre to have a one-stop shop for all entrepreneurial activities at the University. - (4) The Chair in Technological Entrepreneurship at Tshwane University: The focus of the Chair is on education of (under)graduate students in (technological) entrepreneurship and on the stimulation of entrepreneurship in the wider community. Each case has its own specific angle on academic entrepreneurship and in the thrid part the four cases are compared and analysed according to the model presented in the first part. Finally, some conclusions are formulated regarding the organisation of effective academic entrepreneurship

Adherence to self-administered tuberculosis treatment in a high HIV-prevalence setting: a cross-sectional survey in Homa Bay, Kenya.

Good adherence to treatment is crucial to control tuberculosis (TB). Efficiency and feasibility of directly observed therapy (DOT) under routine program conditions have been questioned. As an alternative, Médecins sans Frontières introduced self-administered therapy (SAT) in several TB programs. We aimed to measure adherence to TB treatment among patients receiving TB chemotherapy with fixed dose combination (FDC) under SAT at the Homa Bay district hospital (Kenya). A second objective was to compare the adherence agreement between different assessment tools

Effectiveness of a Prevention of Mother-to-Child HIV Transmission Programme in an Urban Hospital in Angola

BACKGROUND: Antiretroviral therapy is effective in reducing rates of mother-to child transmission of HIV to low levels in resource-limited contexts but the applicability and efficacy of these programs in the field are scarcely known. In order to explore such issues, we performed a descriptive study on retrospective data from hospital records of HIV-infected pregnant women who accessed in 2007-2010 the Luanda Municipal Hospital service for prevention of mother-to-child transmission (PMTCT). The main outcome measure was infant survival and HIV transmission. Our aim was to evaluate PMTCT programme in a local hospital setting in Africa. RESULTS: Data for 104 pregnancies and 107 infants were analysed. Sixty-eight women (65.4%) had a first visit before or during pregnancy and received combination antiretroviral treatment (ART) in pregnancy. The remaining 36 women (34.6%) presented after delivery and received no ART during pregnancy. Across a median cohort follow-up time of 73 weeks, mortality among women with and without ART in pregnancy was 4.4% and 16.7%, respectively (death hazard ratio: 0.30, 95% CI 0.07-1.20, p = 0.089). The estimated rates of HIV transmission or death in the infants over a median follow up time of 74 weeks were 8.5% with maternal ART during pregnancy and 38.9% without maternal ART during pregnancy. Following adjustment for use of oral zidovudine in the newborn and exposure to maternal milk, no ART in pregnancy remained associated with a 5-fold higher infant risk of HIV transmission or death (adjusted odds ratio: 5.13, 95% CI: 1.31-20.15, p = 0.019). CONCLUSIONS: Among the women and infants adhering to the PMTCT programme, HIV transmission and mortality were low. However, many women presented too late for PMTCT, and about 20% of infants did not complete follow up. This suggests the need of targeted interventions that maintain the access of mothers and infants to prevention and care services for HIV

Improving a Mother to Child HIV Transmission Programme through Health System Redesign: Quality Improvement, Protocol Adjustment and Resource Addition

Health systems that deliver prevention of mother to child transmission (PMTCT) services in low and middle income countries continue to underperform, resulting in thousands of unnecessary HIV infections of newborns each year. We used a combination of approaches to health systems strengthening to reduce transmission of HIV from mother to infant in a multi-facility public health system in South Africa.All primary care sites and specialized birthing centers in a resource constrained sub-district of Cape Metro District, South Africa, were enrolled in a quality improvement (QI) programme. All pregnant women receiving antenatal, intrapartum and postnatal infant care in the sub-district between January 2006 and March 2009 were included in the intervention that had a prototype-innovation phase and a rapid spread phase. System changes were introduced to help frontline healthcare workers to identify and improve performance gaps at each step of the PMTCT pathway. Improvement was facilitated and spread through the use of a Breakthrough Series Collaborative that accelerated learning and the spread of successful changes. Protocol changes and additional resources were introduced by provincial and municipal government. The proportion of HIV-exposed infants testing positive declined from 7.6% to 5%. Key intermediate PMTCT processes improved (antenatal AZT increased from 74% to 86%, PMTCT clients on HAART at the time of labour increased from 10% to 25%, intrapartum AZT increased from 43% to 84%, and postnatal HIV testing from 79% to 95%) compared to baseline.System improvement methods, protocol changes and addition/reallocation of resources contributed to improved PMTCT processes and outcomes in a resource constrained setting. The intervention requires a clear design, leadership buy-in, building local capacity to use systems improvement methods, and a reliable data system. A systems improvement approach offers a much needed approach to rapidly improve under-performing PMTCT implementation programmes at scale in sub-Saharan Africa

What Will It Take to Eliminate Pediatric HIV? Reaching WHO Target Rates of Mother-to-Child HIV Transmission in Zimbabwe: A Model-Based Analysis

Using a simulation model, Andrea Ciaranello and colleagues find that the latest WHO PMTCT (prevention of mother to child transmission of HIV) guidelines plus better access to PMTCT programs, better retention of women in care, and better adherence to drugs are needed to eliminate pediatric HIV in Zimbabwe