Text messaging and retrieval techniques for a mobile health information system

Mobile phones have been identified as one of the technologies that can be used to overcome the challenges of information dissemination regarding serious diseases. Short message services, a much used function of cell phones, for example, can be turned into a major tool for accessing databases. This paper focuses on the design and development of a short message services-based information access algorithm to carefully screen information on human immunodeficiency virus/acquired immune deficiency syndrome within the context of a frequently asked questions system. However, automating the short message services-based information search and retrieval poses significant challenges because of the inherent noise in its communications. The developed algorithm was used to retrieve the best-ranked question–answer pair. Results were evaluated using three metrics: average precision, recall and computational time. The retrieval efficacy was measured and it was confirmed that there was a significant improvement in the results of the proposed algorithm when compared with similar retrieval algorithms

Ensuring the security and privacy of information in mobile health-care communication systems

The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of a patient’s data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel. Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hospital. With the implementation of electronic patient records and the Internet and Intranets, medical information sharing amongst relevant health-care providers was made possible. But the vital issue in this method of information sharing is security: the patient’s privacy, as well as the confidentiality and integrity of the health-care information system, should not be compromised. We examine various ways of ensuring the security and privacy of a patient’s electronic medical information in order to ensure the integrity and confidentiality of the information

Using wearable sensors for remote healthcare monitoring system

Recent technological advances in wireless communications and wireless sensor networks have enabled the design of low-cost, intelligent, tiny, and lightweight medical sensor nodes that can be strategically placed on human body, create a wireless body area network (WBAN) to monitor various physiological vital signs for a long period of time and providing real-time feedback to the user and medical staff. WBANs promise to re-volutionize health monitoring. In this paper, medical sensors were used to collect physiological data from patients and transmit it to Intelligent Personal digital Assistant (IPDA) using ZigBee/IEEE802.15.4 standard and to medical server using 3G communications. We introduced priority scheduling and data compression into the system to increase transmission rate of physiological critical signals which improve the bandwidth utilization. It also extends the life time of hand-held personal server by reducing power consumption during transmission

Workload Indicators Of Staffing Need Method in determining optimal staffing levels at Moi Teaching and Referal Hospital

Background: There is an increasing demand for quality healthcare in the face of limited resources. With the health personnel consuming up to three quarters of recurrent budgets, a need arises to ascertain that a workforce for any health facility is the optimal level needed to produce the desired product. Objective: To highlight the experience and findings of an attempt at establishing the optimal staffing levels for a tertiary health institution using the Workload Indicators of Staffing Need (WISN) method popularised by the World Health Organisation (WHO), Geneva, Switzerland. Design: A descriptive study that captures the activities of a taskforce appointed to establish optimal staffing levels. Setting: Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya, a tertiary hospital in the Rift Valley province of Kenya from September 2005 to May 2006. Main outcome measures: The cadres of workers, working schedules, main activities, time taken to accomplish the activities, available working hours, category and individual allowances, annual workloads from the previous year\'s statistics and optimal departmental establishment of workers. Results: There was initial resentment to the exercise because of the notion that it was aimed at retrenching workers. The team was given autonomy by the hospital management to objectively establish the optimal staffing levels. Very few departments were optimally established with the majority either under or over staffed. There were intradepartmental discrepancies in optimal levels of cadres even though many of them had the right number of total workforce. Conclusion: The WISN method is a very objective way of establishing staffing levels but requires a dedicated team with adequate expertise to make the raw data meaningful for calculations. East African Medical Journla Vol. 85 (5) 2008: pp. 232-23

Select the best. Positive selection to improve farm saved seed potatoes. Trainers manual.

This training manual is designed to provide step-by step instructions to trainers in teaching potato farmers positive selection, that is, to ‘select the best’. Positive selection can be used to improve the quality of the seed potatoes saved from the farmers own crop. The manual contains two major sections. The first section provides the background behind the technology: what are the major seed borne potato diseases; when can ‘select the best’ be helpful; and how does it actually work. The second section outlines the training program to teach positive selection to a farmer group. The heart of the training program is a demonstration experiment. The training methodology is based on learning by doing, using the field as the classroom

MINIMISING FUNGICIDES BY ALTERNATING FORMULATIONS AND INTERVALS TO IMPROVE POTATO BLIGHT MANAGEMENT AND FARM RETURNS

Late blight ( Phytophthora infestans ) is one of the most devastating and economic disease impacting both ware and the seed potato industry. The disease causes huge crop losses, and its management attracts heavy expenses. Efficacy successes in chemical management, as opposed to biofungicides, has resulted in the development of a number of fungicide formulations to counter emergence of chemically insensitive P. infestans strains. The objective of this study was to evaluate the efficacy and cost-benefits of applying different fungicides in alternate; while varying the spray intervals to manage potato blight and improve on net farm returns. A survey was conducted in Nyandarua County in Kenya, using a structured questionnaire, administered to potato farmers. Milraz\uae (Propineb 700 g kg-1 + Cymoxanil 60 g kg-1), Ridomil\uae (Metalaxyl 4% + mancozeb 64%) and Mistress 72\uae (Cynamoxil 4% + Mancozeb 64%) were used in vitro and field experiments. Plated pea agar and detached leaflets were amended with the fungicides at concentrations of 0, 35, 70 and 100% of the manufacturers recommended rate before inoculating with P. infestans. In the field experiment, the fungicides were applied at intervals of 7, 14 and 21 days spray as single, two or three fungicides in alternations. Results showed that, mycelial and blight lesion growth was curtailed by concentrations of 70 and 100%; while 35% concentration of the fungicides reduced mycelial growth and lesion size by 53 and 2%, respectively. In the field experiment, there were no yield and AUDPC differences (P<0.05) among the fungicides and their combinations. However, spraying the fungicides at weekly and bi-weekly intervals gave the highest yields of 17.65 and 16.4 t ha-1, compared to tri-weekly and unprotected plots that recorded 7.93 and 0.43 t ha-1 , respectively. In addition, application of triple fungicides in alternation reduced late blight severity by 51%; while application of two fungicides in alternation reduced severity by 39% compared to single fungicide application (21%) on average. Maximum net benefit ratio was observed on plots protected using three fungicides (31.58); followed by two fungicides applications (26.81) applied biweekly in alternate relative to single fungicide applied weekly.Le mildiou (Phytophthora infestans) est l\u2019une des maladies les plus d\ue9vastatrices et \ue9conomiques affectant \ue0 la fois l\u2019industrie des pommes de terre de consommation et de semence. La maladie cause non seulement d\u2019\ue9normes pertes de r\ue9coltes, mais aussi, sa gestion attire de lourdes d\ue9penses. Les succ\ue8s d\u2019efficacit\ue9 dans la gestion chimique, par opposition aux biofongicides, ont abouti au d\ue9veloppement d\u2019un certain nombre de formulations de fongicides pour contrer l\u2019\ue9mergence de souches de P. infestans chimiquement insensibles. L\u2019objectif de cette \ue9tude \ue9tait d\u2019\ue9valuer l\u2019efficacit\ue9 et les co\ufbts-avantages de l\u2019application de diff\ue9rents fongicides en alternance, tout en faisant varier l\u2019intervalle de pulv\ue9risation pour g\ue9rer la br\ufblure de la pomme de terre et am\ue9liorer les revenus nets de la ferme. Une enqu\ueate a \ue9t\ue9 men\ue9e dans le comt\ue9 de Nyandarua au Kenya, \ue0 l\u2019aide d\u2019un questionnaire structur\ue9, administr\ue9 aux producteurs de pommes de terre. Milraz\uae (Propineb 700 g kg-1 + Cymoxanil 60 g kg-1), Ridomil\uae (Metalaxyl 4% + mancozeb 64%) et Mistress 72\uae (Cynamoxil 4% + Mancozeb 64%) ont \ue9t\ue9 utilis\ue9s dans des exp\ue9riences in vitro et sur le terrain. La g\ue9lose aux pois sur plaque et la notice d\ue9tach\ue9e ont \ue9t\ue9 modifi\ue9es avec les fongicides \ue0 des concentrations de 0, 35, 70 et 100\ua0% du taux recommand\ue9 par les fabricants avant l\u2019inoculation avec P. infestans. Dans l\u2019exp\ue9rience sur le terrain, les fongicides ont \ue9t\ue9 appliqu\ue9s \ue0 un intervalle de 7, 14 et 21 jours de pulv\ue9risation en tant que simple, deux ou trois fongicides en alternance. Les r\ue9sultats ont montr\ue9 que la croissance des l\ue9sions myc\ue9liennes et de br\ufblure \ue9tait r\ue9duite par des concentrations de 70 et 100\ua0%\ua0; tandis qu\u2019une concentration de 35 % des fongicides a r\ue9duit la croissance myc\ue9lienne et la taille des l\ue9sions de 53 et 2 %, respectivement. Dans l\u2019exp\ue9rience sur le terrain, il n\u2019y avait pas de diff\ue9rences de rendement et d\u2019AUDPC (P<0,05) entre les fongicides et leurs combinaisons. Cependant, la pulv\ue9risation des fongicides \ue0 intervalles hebdomadaires et bihebdomadaires a donn\ue9 les rendements les plus \ue9lev\ue9s de 17,65 et 16,4 t ha-1, par rapport aux parcelles tri-hebdomadaires et non prot\ue9g\ue9es qui ont enregistr\ue9 7,93 et 0,43 t ha-1 , respectivement. De plus, l\u2019application de triples fongicides en alternance a r\ue9duit la gravit\ue9 du mildiou de 51 %; tandis que l\u2019application de deux fongicides en alternance a r\ue9duit la s\ue9v\ue9rit\ue9 de 39 % par rapport \ue0 l\u2019application d\u2019un seul fongicide (21 %) en moyenne. Le rapport b\ue9n\ue9fice net maximum a \ue9t\ue9 observ\ue9 sur les parcelles prot\ue9g\ue9es par trois fongicides (31,58) ; suivi de deux applications de fongicides (26.81) appliqu\ue9es toutes les deux semaines en alternance par rapport au fongicide unique appliqu\ue9 chaque semaine

Prevalence and determinants of human papillomavirus infection and cervical lesions in HIV-positive women in Kenya

Background: We assessed the association of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) with various characteristics, CD4 count and use of combination antiretroviral therapy (cART) among HIV-positive women. Methods: Cross-sectional study of 498 HIV-positive women who underwent HPV PCR-based testing, cytology, and systematic cervical biopsy. Results: In all, 68.7% of women were HPV-positive, 52.6% had high-risk (hr) HPV, and 40.2% multiple type infections. High-risk human papillomavirus-positivity did not vary significantly by age but it was negatively associated with education level. The most frequent types in 113 CIN2/3 were HPV16 (26.5%), HPV35 (19.5%), and HPV58 (12.4%). CD4 count was negatively associated with prevalence of hrHPV (Po0.001) and CIN2/3 among non-users of cART (P¼0.013). Combination antiretroviral therapies users (X2 year) had lower hrHPV prevalence (prevalence ratio (PR) vs non-users¼0.77, 95% confidence interval (CI): 0.61–0.96) and multiple infections (PR¼0.68, 95% CI: 0.53–0.88), but not fewer CIN2/3. The positive predictive value of hrHPV-positivity for CIN2/3 increased from 28.9% at age o35 years to 53.3% in X45 years. Conclusion: The burden of hrHPV and CIN2/3 was high and it was related to immunosuppression level. Combination antiretroviral therapies (X2 year) use had a favourable effect on hrHPV prevalence but cART in our population may have been started too late to prevent CIN2/3

P04.41 Exploring reasons for and outcomes of second stage caesarean section and assisted vaginal birth in selected hospitals in Kenya

Objective: Obstetric vacuum devices for assisted vaginal birth (AVB) can avoid the need for unnecessary second-stage caesarean sections (SSCS), associated with increased morbidity and mortality. Despite emergency obstetric training since 2019, AVB was rarely performed. This study sought to better understand missed opportunities and reasons for non-performance of AVB in Kenya. Method: A mixed-methods design incorporated a review of randomly selected SSCS and AVB case notes, and key informant interviews with healthcare providers, from 8 purposively selected, high-volume hospitals in Kenya. The reviews were carried out by four experienced obstetricians (3 Kenyan, 1 British). The interviews were semi-structured and conducted online and analysed using a thematic approach. Results: Six AVB and 66 SSCS cases were reviewed. Nine percent of SSCS could have been AVB, and 58% reviewers were unable to determine appropriateness due to poor record keeping. Perinatal mortality was 9%, and 11% of infants and 9% of mothers experienced complications following SSCS. Twenty interviews, with obstetricians, midwives and medical officers, explored themes of previous experience, confidence, and adequacy of training relating to AVB. Reasons for non-performance included lack of equipment and staff. Conclusion: Increases in appropriate use of AVB could save the lives of infants and mothers and reduce ongoing morbidity. In order to achieve this, the varied reasons for non-performance of AVB need to be systematically addressed at local, regional and national levels

Molecular epidemiology of Klebsiella pneumoniae invasive infections over a decade at Kilifi County Hospital in Kenya.

Multidrug resistant (MDR) Klebsiella pneumoniae is a common cause of nosocomial infections worldwide. Recent years have seen an explosion of resistance to extended-spectrum ?-lactamases (ESBLs) and emergence of carbapenem resistance. Here, we examine 198 invasive K. pneumoniae isolates collected from over a decade in Kilifi County Hospital (KCH) in Kenya. We observe a significant increase in MDR K. pneumoniae isolates, particularly to third generation cephalosporins conferred by ESBLs. Using whole-genome sequences, we describe the population structure and the distribution of antimicrobial resistance genes within it. More than half of the isolates examined in this study were ESBL-positive, encoding CTX-M-15, SHV-2, SHV-12 and SHV-27, and 79% were MDR conferring resistance to at least three antimicrobial classes. Although no isolates in our dataset were found to be resistant to carbapenems we did find a plasmid with the genetic architecture of a known New Delhi metallo-?-lactamase-1 (NDM)-carrying plasmid in 25 isolates. In the absence of carbapenem use in KCH and because of the instability of the NDM-1 gene in the plasmid, the NDM-1 gene has been lost in these isolates. Our data suggests that isolates that encode NDM-1 could be present in the population; should carbapenems be introduced as treatment in public hospitals in Kenya, resistance is likely to ensue rapidly