Productivity of key informants for identifying blind children: evidence from a pilot study in Malawi.

OBJECTIVES: To determine the productivity of village-based 'key informants' (KIs) in identifying blind children. MATERIALS AND METHODS: Ngabu subdistrict (population 101,000) of Chikwawa district was divided into KI catchment areas. KIs, selected by local village leaders, were trained to register children reported to be blind or with severe visual impairment. These children were clinically assessed at designated centres. RESULTS: In total, 44 KIs were selected and trained to cover 196 villages in Ngabu. They identified and referred 151 children, 37 of whom were blind (presenting vision <3/60 best eye). Overall, village leaders tended to choose female KIs (80%) compared to male KIs (20%); however, male KIs tended to be more productive, identifying 4.22 children each (compared to 3.23 for female KIs). Male KIs were 2.7 times more likely to identify blind children compared to female KIs. Only 25% of all identified blind children of school going age were in school. CONCLUSIONS: KIs may be effective in identifying blind children in the community; however, additional work is needed to determine who will be the most effective KI in a community and whether gender roles will limit interpretation of findings from KIs activities

Using primary health care (PHC) workers and key informants for community based detection of blindness in children in Southern Malawi.

BACKGROUND: There is great interest in providing primary eye care (PEC) through integration into primary health care (PHC). However, there is little evidence of the productivity of PHC workers in offering primary eye care after training and integration, and there is need to compare their effectiveness to alternative methods. The current study compared the effectiveness of trained Health Surveillance Assistants (HSAs) versus trained volunteer Key Informants (KIs) in identifying blind children in southern Malawi. METHODS: A cluster community based study was conducted in Mulanje district, population 435 753. Six clusters each with a population of approximately 70 000 to 80 000, 42% of whom were children were identified and randomly allocated to either HSA or KI training. From each cluster 20 HSAs or 20 KIs were selected for training. Training emphasized the causes of blindness in children and their management, and how to identify and list children suspected of being blind. HSAs and KIs used multiple methods (door to door, school screening, health education talks, village announcements, etc.) to identify children. Using the World Health Organization (WHO) estimates (eight blind children per 10 000 children); approximately 144 to 162 blind children were expected in the chosen clusters. Listed children were brought to a centre within the community where they were examined by an ophthalmologist and findings recorded using the WHO form for examining blindness in children. RESULTS: A total of 59 HSAs and 64 KIs were trained. HSAs identified five children of whom two were confirmed as blind (one blind child per 29.5 HSAs trained). On the other hand, the KIs identified a total of 158 children of whom 20 were confirmed blind (one blind child per 3.2 KIs trained). More blind boys than girls were identified (77.3% versus 22.7%) respectively. CONCLUSION: Key Informants were much better at identifying blind children than HSAs, even though both groups identified far fewer blind children compared with WHO estimates. HSAs reported lack of time as a major constraint in identifying blind children. Based on these findings using HSAs for identifying blind children would not be successful in Malawi. Gender differences need to be addressed in all childhood blindness programs to counteract the imbalance

The Empirical Development of a Curriculum in Sports Acrobatics and Spiritual Witnessing

Problem. The purpose of this project was to develop empirically a curriculum to assist Seventh-day Adventist sports acrobatic coaches, physical education instructors, physical education majors and minors to integrate spiritual witnessing concepts into their acrobatics programs. Method. The developmental process of Baker and Schutz (1971) was used to produce and validate the instructional product. First, the content of a curriculum to train Seventh-day Adventist coaches was identified through an examination of acro-gymnastic and witnessing literature. The materials were divided into instructional units, arranged in a logical sequence, and introduced with behavioral objectives. It was established that the product would be successful when 80% of the subjects achieved at least 80% on each objective. In the developmental process, the product was revised several times. Some units were expanded while others were streamlined. Weaknesses exposed during the tryout stages were corrected and participants\u27 and instructor\u27s manuals were prepared. At the conclusion of the final presentation, the required standard for mastery was attained on all objectives. Results. The instructional product met the established criteria -- 80% of the subjects reached each objective at or above the 80% mastery level. The witnessing model. During the development of the witnessing model, it was discovered that assurance of salvation is not common among Seventh-day Adventist young people and they are particularly confused about the concept of God\u27s wrath. They also expressed feelings of not being good enough to please God. The impact of the material showing that God is not their enemy gives people hope and good news to which they can witness. Younger SDA youth responded to the concept that God loves them and desires to take them home with Him. However, at the college level, this concept is much more difficult for them to accept. Obtaining eternal life, to many, seemed to be a gamble

How to create a balanced eye team: an example from Malawi

Malawi has a population of 17 million people, 87% of whom live in rural areas. There just twelve ophthalmologists in the whole country, equating to 1.4 ophthalmologists per million people – far short of the 4 per million recommended by the World Health Organization.1 To make matters worse, eleven of the ophthalmologists are based in urban areas

A design experiment exploring the influence of visual and kinesthetic tools in learning Grade 8 linear algebra in a Namibian secondary school

Based on a broad literature review, understanding algebra is a challenge among learners in middle schools around the world. Early researches also indicated that algebra is often taught through inherent symbols and procedures. This does not exclude Namibian learners in secondary schools whom I have worked with for over 10 years. Examination reports (2014, 2016 and 2017) serve as evidence that learners performed poorly (below 45%) in the area of algebra, with these reports indicating that teachers need to strongly emphasise the issue of solving linear equations. Therefore, this study presents a proposed design research in an attempt to help learners develop meaningful understanding of linear algebra at Grade 8 level. Eight learners whose ages ranged from 13 - 14 years from one Namibian secondary school in Oshikoto region, in northern Namibia, were the participants in this study. The learners represented different groups of learning abilities, ranging from low learning abilities to high learning abilities. The designed programme for this intervention consisting of eight lessons was planned for three weeks and the lessons were conducted in the afternoon to avoid any interruption with normal learning hours. The study used four tools for data collection, namely, benchmark tests (pre-test and post-test), observation, focus groups and unstructured interviews. The data collected for this study was inductively analysed. The purpose of this study was to determine whether and how the specific visual and kinaesthetic teaching tools (diagrams, expansion box and balance method) used may have contributed to learners’ understanding of algebraic concepts and techniques (variables, expressions and equations). The study used diagrams (geometrical plane shapes) for separating terms, an expansion box for expanding brackets and the balance method for solving linear equations. The study revealed the use of diagrams helped the learners in understanding the separation of variable and constant terms when simplifying expressions through addition and/or subtraction. Moreover, the study also revealed that the use of an expansion box was useful for the learners in understanding expansion of brackets in expressions with more than one term. Regarding the use of the balance method, the study showed that learners were already able to solve linear equations by the transfer method, hence, the balance method was not necessary

Analysis of factors affecting performance of a low-temperature Organic Rankine Cycle heat engine

Organic Rankine Cycle (ORC) heat engines convert low-grade heat to other forms of energy such as electrical and mechanical energy. They achieve this by vaporizing and expanding the organic fluid at high pressure, turning the turbine which can be employed to run an alternator or any other mechanism as desired. Conventional Rankine Cycles operate with steam at temperatures above 400 ℃. The broad aspect of the research focussed on the generation of electricity to cater for household needs. Solar energy would be used to heat air which would in turn heat rocks in an insulated vessel. This would act as an energy storage in form of heat from which a heat transfer fluid would collect heat to supply the ORC heat engine for the generation of electricity. The objective of the research was to optimize power output of the ORC heat engine operating at temperatures between 25℃ at the condenser and 90 to 150℃ at the heat source. This was achieved by analysis of thermal energy, mechanical power, electrical power and physical parameters in connection with flow rate of working fluid and heat transfer fluids

Comparison of effectiveness of using trained key informants versus health surveillance assistants in identifying blind and visually impaired children in Malawi.

Eye conditions associated with visual impairment and blindness in children, such as congenital cataract, can lead to long lasting visual problems if treatment is delayed. There is need to determine which method can be more effective in identifying blind and visual impaired children. In this study, two methods of identifying blind and visual impaired children (using key informants versus using health surveillance assistants) were compared in a randomised community study conducted in three districts in Southern Malawi. The ministry of Health was advocating for the training of Health Surveillance Assistants (HSAs) in primary eye care, which included case detection and refer of blind and visually impaired children; and the alternative was the training of key informants (KIs). The study was done to compare the effectiveness of the two methods of case identification and to provide guidelines on optimal approaches of identifying blind and severely visually impaired children in Malawi. Twelve clusters (group of villages) were selected, and six were randomly assigned to each group. After training in case identification and referral, Key informants and Heath surveillance assistant identified children from the clusters, within a six-week period, and the number of blind and visual impaired children identified in each group was determined and compared. In total, 159 Key informants and 151 Health Surveillance Assistants were selected and trained, and they identified 550 children with eye problems, among whom, after examination, only 15.1 % were blind or severely visually impaired. Key informants identified one and half times more blind/severally visual impaired children than HSAs (37 vs 22).The prevalence estimates of blindness among children identified by KIs was 3.3 per 10,000 (95% CI 2.7-3.9), while the prevalence estimates of blindness among children identified by HSAs was 1.9 per 10,000 (95% CI 1.3-2.5).The difference was statistically significant (P=0.03), but overall the number of children identified by both groups was lower than was the expected from prevalence estimates of 8.0 per 10,000. False positives between HSAs and KIs were comparable, with 68.8% of children identified by HSAs as blind, confirmed blind on examination, in comparison to 72.5% of children identified by KIs, also confirmed as blind on examination. Cortical blindness seconded by cataract were the commonest causes of blindness. In conclusion, Keys informants were more effective than Health Surveillance assistants in identifying blind and visually impaired children in Malawi, and this study supports and confirms findings from other areas