Malaria Prevalence in Under Five Children Utilising Insecticide Treated Nets Through Voucher Scheme Programme in Mtwara Municipality

Objective: To determine the malaria prevalence in under five year old children, comparing those utilising with those not utilising insecticide treated nets in Mtwara Municipality.Design: Descriptive cross-sectional study.Setting: Five streets that were randomly selected in Mtwara Municipality.Subjects: Three hundred and ninety eight (398) under five year old  children.Results: In the 398 under five year old children in this study, 18(4.5%) and 20(5.0%) tested positive by RDT and microscopy, respectively. Of the 385 who always used Insecticide Treated Nets (ITNs), 16 (4.2%) had malaria, compared to four among the 13 who rarely/or never used nets (30.8%). Thus there is a relationship between the use of the treated nets and prevalence of malaria (x2 P-value 0.002). Inspite of the decline in malaria prevalence anaemia remain a big problem as among those 378 who tested negative for malaria, 81% had haemoglobin level below normal (8 and 11g/dl).Conclusion: Malaria infection has been prevented by the ITNs in under five years children as the prevalence of malaria is only 4.2% among net users compared to 30.8% non net users. The ITNs are useful since the overall five percent prevalence of malaria is less than expected in Mtwara region which had the prevalence of 33.6 percent in 2007 and less to the overall national prevalence of seven percent in under fives in urban areas in 2009. Plasmodium falciparum species is still a notorious cause of the disease among under fives compared to other types, thus the preventive measures should scientifically target this species at large

What role for local government in sanitation promotion? Lessons from Tanzania

Progress in rural access to sanitation is far behind agreed targets, especially in Sub-Saharan Africa. As a result, new policies are being defined which shift the role of public investment from infrastructure to sanitation promotion, and give the responsibility of service delivery to local government. This paper analyses the role that local governments can have in sanitation promotion in this new framework. The implementation of the National Sanitation Campaign in Tanzania is analysed using the problem driven governance and political economy analysis methodology. Results show that direct implementation enhances local governments' commitment, but that not all functions carried out are suited to their capacities, motivations and constraints. The challenges identified emerge as a combination of technical weaknesses in the implementation of the adopted methodologies, the political economy of local governments, and the economic and social particularities of rural areas, which are similar to other countries across the region. Recommendations for a more effective service delivery model are made, balancing the role of local government between direct execution, coordination and supportive supervision. The fact of having a government programme with some direct implementation can bring about important differences in the national ownership of, and interest in rural sanitation, which are greatly needed.</jats:p

Treatment practices for degedege, a locally recognized febrile illness, and implications for strategies to decrease mortality from severe malaria in Bagamoyo District, Tanzania

Malaria remains one of the chief causes of mortality among young children in sub-Saharan Africa. Verbal autopsies for cases of childhood mortality in Bagamoyo District, Tanzania demonstrated that degedege, a locally defined illness of children characterized by fever and convulsions, is frequently treated by traditional healers. To investigate this further, an ethnographic study was carried out in one village that included in-depth interviews with 14 traditional healers and 3 focus groups with parents. Parents and traditional healers were unanimous in their conviction that degedege requires traditional treatments, at least initially, and that these treatments are effective. While traditional healers do refer cases that are not improving to the District Hospital, this frequently occurs late in the course of the illness, after one or more stages of traditional treatments. The prognosis will thus be poor for those children who are suffering from severe malaria. Consideration should be given to enlisting the support of traditional healers in efforts to improve treatment for severe malaria, including teaching them how to distinguish febrile convulsions from cases of severe malaria

Optimizing community case management strategies to achieve equitable reduction of childhood pneumonia mortality:An application of Equitable Impact Sensitive Tool (EQUIST) in five low- and middle-income countries

BACKGROUND: The aim of this study was to populate the Equitable Impact Sensitive Tool (EQUIST) framework with all necessary data and conduct the first implementation of EQUIST in studying cost–effectiveness of community case management of childhood pneumonia in 5 low– and middle–income countries with relation to equity impact. METHODS: Wealth quintile–specific data were gathered or modelled for all contributory determinants of the EQUIST framework, namely: under–five mortality rate, cost of intervention, intervention effectiveness, current coverage of intervention and relative disease distribution. These were then combined statistically to calculate the final outcome of the EQUIST model for community case management of childhood pneumonia: US$ per life saved, in several different approaches to scaling–up. RESULTS: The current ‘mainstream’ approach to scaling–up of interventions is never the most cost–effective. Community–case management appears to strongly support an ‘equity–promoting’ approach to scaling–up, displaying the highest levels of cost–effectiveness in interventions targeted at the poorest quintile of each study country, although absolute cost differences vary by context. CONCLUSIONS: The relationship between cost–effectiveness and equity impact is complex, with many determinants to consider. One important way to increase intervention cost–effectiveness in poorer quintiles is to improve the efficiency and quality of delivery. More data are needed in all areas to increase the accuracy of EQUIST–based estimates

The gap between knowledge and practice of risky sexual behaviors for HIV among University students and staff in Moshi Town in Tanzania

Knowledge on HIV spread is important in combating HIV/AIDS, however its impact can only be realized if put into practice. This study was carried out in a Higher Learning Institution in Moshi Township in Kilimanjaro Region to assess the level of awareness of university communities about HIV/AIDs and its link with practice of risky sexual behaviors (RSB). We have found an adequate level of knowledge on the spread, risk behaviors and methods for protection leading to attendance to voluntary testing and counseling by 61% of respondents. Conversely, we have observed great extent of practice of RSBs including early sexual debut (16.7 years), having multiple and extramarital partners, involvement in practices that lead to unprotected sexual intercourse. We report an obvious gap between knowledge and behavior. This study therefore recommends that serious operational interventions must be put in place targeting the most sexually active groups, the youth in preliminary schools to sensitize on RSBs and ways to avoid them before they are engaged in sexual activities

Predictive value of oocyte morphology in human IVF: a systematic review of the literature

BACKGROUND: Non-invasive selection of developmentally competent human oocytes may increase the overall efficiency of human assisted reproduction and is regarded as crucial in countries where legal, social or religious factors restrict the production of supernumerary embryos. The purpose of this study was to summarize the predictive value for IVF success of morphological features of the oocyte that can be obtained by light or polarized microscopic investigations. METHODS: Studies about oocyte morphology and IVF/ICSI outcomes were identified by using a systematic literature search. RESULTS: Fifty relevant articles were identified: 33 analysed a single feature, 9 observed multiple features and investigated the effect of these features individually, 8 summarized the effect of individual features. Investigated structures were the following: meiotic spindle (15 papers), zona pellucida (15 papers), vacuoles or refractile bodies (14 papers), polar body shape (12 papers), oocyte shape (10 papers), dark cytoplasm or diffuse granulation (12 papers), perivitelline space (11 papers), central cytoplasmic granulation (8 papers), cumulus–oocyte complex (6 papers) and cytoplasm viscosity and membrane resistance characteristics (2 papers). None of these features were unanimously evaluated to have prognostic value for further developmental competence of oocytes. CONCLUSIONS: No clear tendency in recent publications to a general increase in predictive value of morphological features was found. These contradicting data underline the importance of more intensive and coordinated research to reach a consensus and fully exploit the predictive potential of morphological examination of human oocytes

Amphiregulin cooperates with bone morphogenetic protein 15 to increase oocyte developmental competence by gap junction-mediated enhanced metabolite supply

This study assessed the participation of amphiregulin (AREG) and bone morphogenetic protein 15 (BMP15) during maturation of bovine cumulus oocyte complexes (COCs) on cumulus cell function and their impact on subsequent embryo development. AREG treatment of COCs enhanced blastocyst formation and quality only when in the presence of BMP15. Expression of hyaluronan synthase 2 was enhanced by follicle stimulating hormone (FSH) but not by AREG, which was reflected in the level of cumulus expansion. Although both FSH and AREG stimulated glycolysis, AREG treated COCs had higher glucose consumption, lactate production and ratio of lactate production to glucose uptake. Autofluorescence levels in oocytes, indicative of NAD(P)H and FAD++, were increased with combined AREG and BMP15 treatment of COCs. In contrast, these treatments did not alter autoflouresence levels when cumulus cells were removed from oocytes, even in the presence of other COCs, suggesting oocyte-cumulus gap-junctional communication (GJC) is required. FSH contributed to maintaining GJC for an extended period of time. Remarkably, BMP15 was equally effective at maintaining GJC even in the presence of AREG. Hence, AREG stimulation of COC glycolysis and BMP15 preservation of GJC may facilitate efficient transfer of metabolites from cumulus cells to the oocyte thereby enhancing oocyte developmental competence. These results have implications for improving in vitro oocyte maturation systems.Satoshi Sugimura, Lesley J Ritter, Melanie L Sutton-McDowall, David G Mottershead, Jeremy G Thompson and Robert B Gilchris

Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa

BACKGROUND: Over thirty years have passed since the Alma-Ata Declaration on primary health care in 1978. Many governments in the first decade following the declaration responded by developing national programmes of community health workers (CHWs), but evaluations of these often demonstrated poor outcomes. As many CHW programmes have responded to the HIV/AIDS pandemic, international interest in them has returned and their role in the response to other diseases should be examined carefully so that lessons can be applied to their new roles. Over half of the deaths in African children under five years of age are due to malaria, diarrhoea and pneumonia - a situation which could be addressed through the use of cheap and effective interventions delivered by CHWs. However, to date there is very little evidence from randomised controlled trials of the impacts of CHW programmes on child mortality in Africa. Evidence from non-randomised controlled studies has not previously been reviewed systematically. METHODS: We searched databases of published and unpublished studies for RCTs and non-randomised studies evaluating CHW programmes delivering curative treatments, with or without preventive components, for malaria, diarrhoea or pneumonia, in children in sub-Saharan Africa from 1987 to 2007. The impact of these programmes on morbidity or mortality in children under six years of age was reviewed. A descriptive analysis of interventional and contextual factors associated with these impacts was attempted. RESULTS: The review identified seven studies evaluating CHWs, delivering a range of interventions. Limited descriptive data on programmes, contexts or process outcomes for these CHW programmes were available. CHWs in national programmes achieved large mortality reductions of 63% and 36% respectively, when insecticide-treated nets and anti-malarial chemoprophylaxis were delivered, in addition to curative interventions. CONCLUSIONS: CHW programmes could potentially achieve large gains in child survival in sub-Saharan Africa if these programmes were implemented at scale. Large-scale rigorous studies, including RCTs, are urgently needed to provide policymakers with more evidence on the effects of CHWs delivering these interventions

miR-135A Regulates Preimplantation Embryo Development through Down-Regulation of E3 Ubiquitin Ligase Seven in Absentia Homolog 1A (SIAH1A) Expression

Background: MicroRNAs (miRNAs) are small non-coding RNA molecules capable of regulating transcription and translation. Previously, a cluster of miRNAs that are specifically expressed in mouse zygotes but not in oocytes or other preimplantation stages embryos are identified by multiplex real-time polymerase chain reaction-based miRNA profiling. The functional role of one of these zygote-specific miRNAs, miR-135a, in preimplantation embryo development was investigated. Methodology/Principal Findings: Microinjection of miR-135a inhibitor suppressed first cell cleavage in more than 30% of the zygotes. Bioinformatics analysis identified E3 Ubiquitin Ligase Seven In Absentia Homolog 1A (Siah1a) as a predicted target of miR-135a. Western blotting and 3′UTR luciferase functional assays demonstrated that miR-135a down-regulated the expression of Siah1 in HeLa cells and in mouse zygotes. Siah1a was expressed in preimplantation embryos and its expression pattern negatively correlated with that of miR-135a. Co-injection of Siah1a-specific antibody with miR-135a inhibitor partially nullified the effect of miR-135a inhibition. Proteasome inhibition by MG-132 revealed that miR-135a regulated proteasomal degradation and potentially controlled the expression of chemokinesin DNA binding protein (Kid). Conclusions/Significance: The present study demonstrated for the first time that zygotic specific miRNA modulates the first cell cleavage through regulating expression of Siah1a. © 2011 Pang et al.published_or_final_versio