The Impact of Load Shedding on The Cost of Living: A Zambian Perspective

In this paper, we assess the impact of Zambia Electricity Supply Corporationrsquos (ZESCO) power rationing (load shedding) on the cost of living of the Zambian people. We also assess whether the businesses and households have capacity to resort to alternative sources of energy in the time of crisis. Our results show that, although the rationing does not last for 24 hours in most places, the duration that businesses and households stay out of power is long enough to impact negatively on the livelihoods of the Zambian people and consequently itrsquos Economy. nbs

Accuracy in HIV Rapid Testing among Laboratory and Non-laboratory Personnel in Zambia: Observations from the National HIV Proficiency Testing System.

BACKGROUND: Despite rapid task-shifting and scale-up of HIV testing services in high HIV prevalence countries, studies evaluating accuracy remain limited. This study aimed to assess overall accuracy level and factors associated with accuracy in HIV rapid testing in Zambia. METHODS: Accuracy was investigated among rural and urban HIV testing sites participating in two annual national HIV proficiency testing (PT) exercises conducted in 2009 (n = 282 sites) and 2010 (n = 488 sites). Testers included lay counselors, nurses, laboratory personnel and others. PT panels of five dry tube specimens (DTS) were issued to testing sites by the national reference laboratory (NRL). Site accuracy level was assessed by comparison of reported results to the expected results. Non-parametric rank tests and multiple linear regression models were used to assess variation in accuracy between PT cycles and between tester groups, and to examine factors associated with accuracy respectively. RESULTS: Overall accuracy level was 93.1% (95% CI: 91.2-94.9) in 2009 and 96.9% (95% CI: 96.1-97.8) in 2010. Differences in accuracy were seen between the tester groups in 2009 with laboratory personnel being more accurate than non-laboratory personnel, while in 2010 no differences were seen. In both PT exercises, lay counselors and nurses had more difficulties interpreting results, with more occurrences of false-negative, false-positive and indeterminate results. Having received the standard HIV rapid testing training and adherence to the national HIV testing algorithm were positively associated with accuracy. CONCLUSION: The study showed an improvement in tester group and overall accuracy from the first PT exercise to the next. Average number of incorrect test results per 1000 tests performed was reduced from 69 to 31. Further improvement is needed, however, and the national HIV proficiency testing system seems to be an important tool in this regard, which should be continued and needs to be urgently strengthened

Increased Cytomegalovirus Secretion and Risks of Infant Infection by Breastfeeding Duration From Maternal Human Immunodeficiency Virus Positive Compared to Negative Mothers in Sub-Saharan Africa.

BACKGROUND: Breastfeeding imparts beneficial immune protection and nutrition to infants for healthy growth, but it is also a route for human immunodeficiency virus (HIV) and human cytomegalovirus (HCMV) infection. In previous studies, we showed that HCMV adversely affects infant development in Africa, particularly with maternal HIV exposure. In this study, we analyzed infants risks for acquisition of HCMV infection from breastfeeding and compared HIV-positive and HIV-negative mothers. METHODS: Two cohorts were studied in Zambia. (1) Two hundred sixty-one HIV-infected and HIV-uninfected mothers were compared for HCMV deoxyribonucleic acid (DNA) loads and genotypes (glycoprotein gO) in milk from birth to 4 months postpartum. (2) Maternally HIV-exposed and HIV-unexposed infants were compared for HCMV infection risk factors. The second cohort of 460 infants, from a trial of micronutrient-fortified complementary-food to breastfeeding, were studied between 6 and 18 months of age. Human cytomegalovirus seroprevalence was assayed, and logistic regression was used to calculate risk factors for HCMV infection, including maternal HIV exposure and breastfeeding duration. RESULTS: Human cytomegalovirus was detected in breast milk from 3 days to 4 months postpartum, with significantly raised levels in HIV-positive women and independent of genotype. In infants, HCMV antibody seroprevalence was 83% by 18 months age. Longer breastfeeding duration increased infection risk in maternally HIV-unexposed (odds ratio [OR] = 2.69 for 18 months vs 6 months vs never; 95% CI, 3.71-111.70; P < .001). CONCLUSIONS: Prolonged breastfeeding, which is common in Africa, increased risk of HCMV infection in infants. Both HIV-positive and HIV-negative women had extended milk HCMV secretion. Women who were HIV-positive secreted higher HCMV levels, and for longer duration, with their children at increased infection risk. Human cytomegalovirus control is required to maintain health benefits of breastfeeding

Task-Shifting and Quality of HIV Testing Services: Experiences from a National Reference Hospital in Zambia.

BACKGROUND: With new testing technologies, task-shifting and rapid scale-up of HIV testing services in high HIV prevalence countries, assuring quality of HIV testing is paramount. This study aimed to explore various cadres of providers' experiences in providing HIV testing services and their understanding of elements that impact on quality of service in Zambia. METHODS: Sixteen in-depth interviews and two focus group discussions were conducted with HIV testing service providers including lay counselors, nurses and laboratory personnel at purposively selected HIV testing sites at a national reference hospital in Lusaka. Qualitative content analysis was adopted for data analysis. RESULTS: Lay counselors and nurses reported confidentiality and privacy to be greatly compromised due to limited space in both in- and out-patient settings. Difficulties in upholding consent were reported in provider-initiated testing in in-patient settings. The providers identified non-adherence to testing procedures, high workload and inadequate training and supervision as key elements impacting on quality of testing. Difficulties related to testing varied by sub-groups of providers: lay counselors, in finger pricking and obtaining adequate volumes of specimen; non-laboratory providers in general, in interpreting invalid, false-negative and false-positive results. The providers had been participating in a recently established national HIV quality assurance program, i.e. proficiency testing, but rarely received site supervisory visits. CONCLUSION: Task-shifting coupled with policy shifts in service provision has seriously challenged HIV testing quality, protection of confidentiality and the process of informed consent. Ways to better protect confidentiality and informed consent need careful attention. Training, supervision and quality assurance need strengthening tailored to the needs of the different cadres of providers

Quantifying the burden of rhodesiense sleeping sickness in Urambo district, Tanzania

Sleeping sickness (human African trypanosomiasis - HAT) is a disease transmitted by tsetse flies and is always fatal if left untreated. The disease occurs in foci affecting poor communities with limited access to health service provision and as such the disease is often left undiagnosed, mistaken for more common afflictions. Even if diagnosed, sleeping sickness is costly to treat, both for health services and patients and their families in terms of costs of diagnosis, transport, hospital care, and the prolonged period of convalescence. Here we estimate the health burden of the acute form T. b. rhodesiense sleeping sickness in Urambo District, Tanzania in terms of Disability Adjusted Life Years (DALYs), the yardstick commonly used by policy makers to prioritize disease management practices, representing a year of healthy life lost to disease. In this single district, the burden of the disease over one year was estimated at 979 DALYs and the estimated monetary costs to health services for the 143 treated patients at US$11,841 and to the patients themselves at US$ 3,673 for direct medical costs and US$ 9,781 for indirect non-medical costs. Sleeping sickness thus places a considerable burden on the affected rural communities and health services

Vague heuristics

Even when they are defined with precision, one can often read and hear judgments about the vagueness of heuristics in debates about heuristic reasoning. This opinion is not just frequent but also quite reasonable. In fact, during the 1990s, there was a certain controversy concerning this topic that confronted two of the leading groups in the field of heuristic reasoning research, each of whom held very different perspectives. In the present text, we will focus on two of the papers published in Psychological Review, wherein the arguments of each of these groups were presented:

Preparing to work: dramaturgy, cynicism and normative ‘remote’ control in the socialization of graduate recruits in management consulting

online) This paper examines the socialization of graduate recruits into a knowledge intensive labour process and organizational culture. Theoretically the paper draws upon the idea of ‘preparing for work’ to position this early socialization as a crucial moment in the production of subjectivities suited (and booted) for the labour process of management consulting. Empirically the paper reports on a two-day induction session for new graduate recruits joining a global management consultancy and their responses to this training. Particular attention is given to the use of role-play and a dramaturgical workshop used in part of the training process. The paper argues that the utilization of dramaturgy in training is consistent with the overall approach to control developed in the firm in response to the fact that the labour process of consulting is often conducted on client sites, away from any direct supervisory gaze. As such, the consultants were subjected to a form of cultural control that was designed to function independently of direct supervision. This control did not operate directly upon the new employees professed values, however, but at one step removed so that a ‘cynical distance’ from the content of the organization’s culture was accepted so long as a professional ‘ethic of behaviour’ was established. By focusing on an ‘ethic of behaviour’ these young professionals were encouraged to internalize a self-control akin to that of an actor, rather than internalizing the corporate values entirely

What are communities of practice? A comparative review of four seminal works

This paper is a comparative review of four seminal works on communities of practice. It is argued that the ambiguities of the terms community and practice are a source of the concept's reusability allowing it to be reappropriated for different purposes, academic and practical. However, it is potentially confusing that the works differ so markedly in their conceptualizations of community, learning, power and change, diversity and informality. The three earlier works are underpinned by a common epistemological view, but Lave and Wenger's 1991 short monograph is often read as primarily about the socialization of newcomers into knowledge by a form of apprenticeship, while the focus in Brown and Duguid's article of the same year is, in contrast, on improvising new knowledge in an interstitial group that forms in resistance to management. Wenger's 1998 book treats communities of practice as the informal relations and understandings that develop in mutual engagement on an appropriated joint enterprise, but his focus is the impact on individual identity. The applicability of the concept to the heavily individualized and tightly managed work of the twenty-first century is questionable. The most recent work by Wenger – this time with McDermott and Snyder as coauthors – marks a distinct shift towards a managerialist stance. The proposition that managers should foster informal horizontal groups across organizational boundaries is in fact a fundamental redefinition of the concept. However it does identify a plausible, if limited, knowledge management (KM) tool. This paper discusses different interpretations of the idea of 'co-ordinating' communities of practice as a management ideology of empowerment