Performance of Quantitative Buffy Coat, QBC Fluorescence and Staining Technologies™ Test, and SD Bioline™ Malaria Rapid Test in Malaria Diagnosis in Western Kenya

Malaria remains the most important parasitic disease in sub-Saharan Africa as a cause of morbidity and mortality.  Effective management of malaria relies on prompt and accurate diagnosis to guide treatment.  The World Health Organization (WHO) recommends that all suspected malaria cases be tested before initiation of treatment, thus diagnosis of malaria requires parasitological confirmation of malaria parasites in the blood of suspected patients.  This cross-sectional study conducted at the Ahero County Hospital, Kisumu, Kenya, evaluated the performance of quantitative buffy coat (QBC) (QBC Fluorescence and Staining Technologies™(QBC F.A.S.T.™)-improved QBC system and SD Bioline™ malaria rapid tests) against 'gold standard' (Giemsa blood stained slides microscopy) for the detection of Plasmodium species in children<five years old (n=385)in a malaria holo-endemic area of western Kenya.  Real-time PCR was performed on discrepant samples across the tests and the gold standard (microscopy).Sensitivity of QBC, QBC F.A.S.T.™ and SD Bioline™ malaria rapid tests were 90% (95% CI: 85-94), 77% (95% CI: 71-83) and 91% (95% CI: 86-94), respectively, while specificity was 30% (95% CI: 24-37), 83% (95% CI: 77-88) and 67% (95% CI: 60-73), respectively.  The positive predictive values (PPV) were 58% (95% CI: 52-63), 83% (95% CI: 77-88) and 74% (95% CI: 63-80), respectively, while the negative predictive values (NPV) were 74% (95% CI: 63-84), 78% (95% CI: 71-83) and 87% (95% CI: 81-92), respectively.Although the standard QBC malaria test and the SD Bioline™ malaria rapid diagnostic test (RDT) showed better sensitivity relative to the improved QBC F.A.S.T.™ test, the latter had a better specificity.  The performance of these tests remains modest against microscopy. Keywords: Malaria, Quantitative buffy coat, QBC F.A.S.T.™, SD Bioline

Nosocomial Infections Transmitted Via Computers : A Literature Review

The purpose of this review was to discuss how current literature described nosocomial infections transmitted via computers in hospitals. It also described the various methods used to disinfect computers. The research questions in this study were; What are nosocomial infections? How do contaminated computer devices transmit nosocomial infections? and What infection control methods are applied to decontaminate computers within hospitals? The aim of conducting this study was to create an awareness of the risk of nosocomial infection transmitted via computers and to establish a protocol for cleaning and disinfecting computers in order to minimize the spread of nosocomial infections. The method of data collection used was systematic literature review. The literature search was based on previously published studies, which included; current articles, journals and web searches. The data was selected from literature search by their relevance to the research task, and analyzed through inductive qualitative analysis. The findings reported that, computers in hospitals act as reservoirs for nosocomial pathogens and the spread of nosocomial infection occurs through hand contact of health care workers moving from computers to patients without hand hygiene compliance. It also reported that there has not been any established protocol for cleaning and disinfecting of computers. However, it was found that regular cleaning and disinfection of computers minimizes the potential risk for cross-infection of nosocomial pathogens. In order to reduce the risk of cross infection of nosocomial pathogens from contaminated surfaces to susceptible patients, the nurse’s role in infection control should be emphasized. More research is required on the field of computers and other electronical devices commonly used in hospitals that may act as reservoirs for nosocomial pathogens. The establishment of evidence based cleaning and disinfecting protocol for computers should also be considered within hospitals in Finland, this would improve the quality of infection control and patient care

Organizational Silence Affecting the Effectiveness of Organizations in Kenya: A Case Study of Safaricom Call Center

A Project Report Submitted to the Chandaria School of Business in Partial Fulfillment of the Requirement for the Degree of Masters in Business Administration (MBA)The general objective of this study was to determine organizational silence factors which affect the effectiveness of organizations in Kenya. To attain this, the study determined the causes of organizational silence and the effects of organizational silence that affected the effectiveness of organizations in Kenya. It also determined the strategies that could be used to break organizational silence in Kenya. This study is important because it will help organizations in Kenya have an in depth understanding of organizational silence, in terms of the causes, effects, and strategies of managing this phenomenon that has great effect on their effectiveness. It will also clearly show employees at all levels of the organization the role they play in this silence. This study used a descriptive research design to build a profile of organizational silence in Kenya. It used stratified random sampling to study 92 respondents out of the 1617 employees at Safaricom Call Center (SCC). Primary data was collected using a questionnaire. A detailed research procedure was then used to ensure credibility and accuracy of data obtained. On the causes of silence in the organization, majority of the respondents agreed that management beliefs about junior employees made managers act in ways that led to silence. While on the causes of silence in individuals the study found that the majority of respondents disagreed that speaking up was pointless. They suggested that there was some level of victimization on those who spoke up which led to fear. On the effects of silence on employees, the study found that most employees were not interested in their jobs and neither did they trust organization as much as they did when they joined it. However many of them felt the organization had taken steps to have them engaged and this was consistent with their response that problems or work related issues were also their concerns and not just of management. Most of them felt that the organization had taken into consideration the suggestions employees made on how to improve effectiveness. Respondents felt that problems in the organization could be identified easily if all employees spoke up and that if employees spoke up vi management could get feedback to be used to improve the organization. They also agreed that they would be influenced into silence if they joined an organization where silence was prevalent. On ethical climate as a strategy that could be used to manage silence, the study found that respondents felt that it was wrong for employees to remain silent about wrong things that happened in the organization but they would only speak if it was not to their disadvantage. They suggested they would be encouraged to speak if the organization cared more and created rules to protect them. Most of them agreed that adequate voice mechanism had been adopted and that a verbal assurance of no victimization from the organization would be encouraging enough for employees to voice anything. The study concluded that organizational silence was caused by the management beliefs as well as the organizational structure and culture. On the other hand, within individuals silence was caused by the individuals’ reluctance to go against the public opinion, lack of trust in the supervisors and fear of victimization. Silence had an effect on both the employees and the organization. On the employees it affected their level of commitment and trusts while on the organization, it slowed identification and solving of problems as well as caused development of a negative organizational culture. According to the study, the organization could create an ethical climate as a way of managing silence. They could also adopt practices that would improve employees’ sense of trust. The study recommended that the organization should put greater measures to ensure that a culture of silence does not take root and also adopt practices that would make employees feel safe to speak up for instance strict policies on how management should treat employees to reduce fear among them. Management should device ways of getting employees more engaged. On a positive note the study recommended that management should find out what practices contributed to the fact that employees do not experience burnouts and maintain them. The organization should also maintain the voice mechanisms already in use because employees felt that they were good

Enhancing ESL learners\u27 understanding of reading comprehension: An action research

A growing body of research suggests that one way to improve teaching and learning in schools is to involve teachers in doing research in their own classrooms (DarlingHammond & Mclaughlin, 1995; Herndon, 1994; Lieberman, 1995). The regular classroom teacher as the provider of instruction helps to explore more thoroughly how reading strategies can be integrated into the regular reading class. The teacher researcher can gain an emic (insider) and etic (\u27outsider\u27) view of classrooms (Freeman, 1998). Teachers, may, as Cohen (1998) proposes, assume the roles of diagnostician, learners, coachers, coordinators, language learners and researchers. The investigation into classroom teaching helps teachers to examine what they do as teacher researchers, how the work is structured and how they carry it out on a daily basis, why something works or does not work for the learners, and how in large and small ways the work can be done differently or better (Freeman, 1998). The new direction in reading research is to focus on teachers\u27 direct instruction of comprehension strategies. These strategies are intentional plans which define reading as a problem solving task. The philosophy underpinning this view is that reading comprehension is teachable and through a process of teacher demonstration, modeling, scaffolding and guided practice, students will be able to reach that point of self regulation or independence. This qualitative, classroom based action research focused on how to improve the ESL students\u27 reading comprehension in Tanzanian context using Question-Answer Relationships, and student-generated-question strategies. Data was collected through semi structured interviews, classroom observations, reflections, reflective discussions, and document analysis. The findings revealed that, Question Answer Relationships and student generated Questions enhanced the students\u27 understanding of reading comprehension by improving their thinking process and making them active, confident and collaborative. These findings support research carried out by other researchers in the field of reading comprehension instruction in the English languag

Temporal trends in prevalence of Plasmodium falciparum molecular markers selected for by artemether–lumefantrine treatment in pre-ACT and post-ACT parasites in western Kenya

Artemether–lumefantrine (AL) became the first-line treatment for uncomplicated malaria in Kenya in 2006. Studies have shown AL selects for SNPs in pfcrt and pfmdr1 genes in recurring parasites compared to the baseline infections. The genotypes associated with AL selection are K76 in pfcrt and N86, 184F and D1246 in pfmdr1. To assess the temporal change of these genotypes in western Kenya, 47 parasite isolates collected before (pre-ACT; 1995–2003) and 745 after (post-ACT; 2008–2014) introduction of AL were analyzed. In addition, the associations of parasite haplotype against the IC50 of artemether and lumefantrine, and clearance rates were determined. Parasite genomic DNA collected between 1995 and 2014 was analyzed by sequencing or PCR-based single-base extension on Sequenom MassARRAY. IC50s were determined for a subset of the samples. One hundred eighteen samples from 2013 to 2014 were from an efficacy trial of which 68 had clearance half-lives. Data revealed there were significant differences between pre-ACT and post-ACT genotypes at the four codons (chi-square analysis; p < 0.0001). The prevalence of pfcrt K76 and N86 increased from 6.4% in 1995–1996 to 93.2% in 2014 and 0.0% in 2002–2003 to 92.4% in 2014 respectively. Analysis of parasites carrying pure alleles of K + NFD or T + YYY haplotypes revealed that 100.0% of the pre-ACT parasites carried T + YYY and 99.3% of post-ACT parasites carried K + NFD. There was significant correlation (p = 0.04) between lumefantrine IC50 and polymorphism at pfmdr1 codon 184. There was no difference in parasite clearance half-lives based on genetic haplotype profiles. This study shows there is a significant change in parasite genotype, with key molecular determinants of AL selection almost reaching saturation. The implications of these findings are not clear since AL remains highly efficacious. However, there is need to closely monitor parasite genotypic, phenotypic and clinical dynamics in response to continued use of AL in western Kenya

Fixed dose drug combinations - are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries

Introduction: There are positive aspects regarding the prescribing of fixed-dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower and middle income countries (LMICs) which have the greatest prevalence of both infectious and non-infectious diseases and issues of affordability. Areas covered: Review of potential advantages, disadvantages, cost-effectiveness and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where concerns with their value. Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis and hypertension are valued and listed in country’s essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which is being addressed

Fixed dose drug combinations - are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries

INTRODUCTION : There are positive aspects regarding the prescribing of fixed dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower- and middle-income countries (LMICs) which have the greatest prevalence of both infectious and noninfectious diseases and issues of affordability. AREAS COVERED : Review of potential advantages, disadvantages, cost-effectiveness, and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where there are concerns with their value. EXPERT COMMENTARY : FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates, and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis, and hypertension are valued and listed in the country’s essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which are being addressed.https://www.tandfonline.com/loi/ierp20hj2020School of Health Systems and Public Health (SHSPH

Need for harmonized long-term multi-lake monitoring of African Great Lakes

To ensure the long-term sustainable use of African Great Lakes (AGL), and to better understand the functioning of these ecosystems, authorities, managers and scientists need regularly collected scientific data and information of key environmental indicators over multi-years to make informed decisions. Monitoring is regularly conducted at some sites across AGL; while at others sites, it is rare or conducted irregularly in response to sporadic funding or short-term projects/studies. Managers and scientists working on the AGL thus often lack critical long-term data to evaluate and gauge ongoing changes. Hence, we propose a multi-lake approach to harmonize data collection modalities for better understanding of regional and global environmental impacts on AGL. Climate variability has had strong impacts on all AGL in the recent past. Although these lakes have specific characteristics, their limnological cycles show many similarities. Because different anthropogenic pressures take place at the different AGL, harmonized multi-lake monitoring will provide comparable data to address the main drivers of concern (climate versus regional anthropogenic impact). To realize harmonized long-term multi-lake monitoring, the approach will need: (1) support of a wide community of researchers and managers; (2) political goodwill towards a common goal for such monitoring; and (3) sufficient capacity (e.g., institutional, financial, human and logistic resources) for its implementation. This paper presents an assessment of the state of monitoring the AGL and possible approaches to realize a long-term, multi-lake harmonized monitoring strategy. Key parameters are proposed. The support of national and regional authorities is necessary as each AGL crosses international boundaries