Assessment of the quality of the acute flaccid paralysis (AFP) reporting system, Mpumalanga, South Africa

The WHO member countries undertook to eliminate poliomyelitis globally by the year 2000. Acute flaccid paralysis (AFP) surveillance finds paralytic cases of polio so that swift action can be taken and shows that wild poliovirus has been eliminated when polio cases no longer occur. Mpumalanga Province, a rural province in the north-east of South Africa, developed a rapid reporting system where infection control nurses at the public and private sector hospitals report weekly to the AFP surveillance Officer, including zero reporting, on 9 infectious disease syndromes that require rapid action on clinical presentation alone. This system was implemented in 1998 and included AFP. The non-polio AFP reporting rate increased from 0.37 in 1997 to 0.55 during 1998 with more than 80% of the units reporting weekly. The binomial exact confidence intervals however include 1. A hospital record review of all paediatric admissions revealed that only 2 AFP cases were missed by the system. The AFP reporting rate remains below the international standard of 1 per 100 000 children under 15 years of age despite an adequate reporting system. The role of chance variation, particularly in small geographical areas, has not been discussed in official polio-eradication guidelines but it is . imperative that population size be taken into account when judging the rate of AFP case detection. With the low international reference rate and play of chance variation it is possible that regions with relatively small populations, low non-polio AFP detection rates and no cases of polio detected for an extended period may have adequate surveillance systems supporting polio free certification. In these areas additional criteria for determining the adequacy of the surveillance system should also be considered.Dissertation (MMed)--University of Pretoria, 2006.School of Health Systems and Public Health (SHSPH)Unrestricte

Public health systems strengthening in Africa: The role of South Africa Field Epidemiology and Laboratory Training Programme

The South Africa Field Epidemiology and Laboratory Training Programme (SAFELTP) was created in 2006 after recognizing the need to build and sustain the country's human resource capacity in field (applied) epidemiology and public health practice. The programme was formed as a collaboration between the South Africa Department of Health (DoH), the National Institute for Communicable Diseases (NICD), the National Health Laboratory Services (NHLS), the US Centers for Disease Control and Prevention (CDC) and the University of Pretoria. The primary goal of the programme was to produce field-trained epidemiologists equipped with knowledge and practical skills to effectively and efficiently address the public health priorities of South Africa. SAFELTP is a 2-year full-time training, consisting of a combination of classroom-based instruction (30%) and mentored field work (70%). The training places emphasis on public health surveillance, investigation of disease epidemics, public health laboratory practice and communication of epidemiologic information, among other aspects of epidemiology research. At completion, residents are awarded a Master of Public Health (MPH) degree from the University of Pretoria. Since its inception in 2006, 48 residents have enrolled onto the programme and 30 (62%) of them have completed the training. Over the past 5 years, the residents have conducted more than 92 outbreak investigations, 47 surveillance evaluations, 19 planned studies, analyzed 37 large databases and presented more than 56 papers at local and international conferences. In recognition of the high-quality work, at least five SAFELTP residents have received awards at various international scientific conferences during the 5 years. In conclusion, the South Africa FELTP is now fully established and making valuable contributions to the country's public health system, albeit with innumerable challenges

The use of hospital-based nurses for the surveillance of potential disease outbreaks

Objective: To study a novel surveillance system introduced in Mpumalanga Province, a rural area in the north-east of South Africa, in an attempt to address deficiences in the system of notification for infectious conditions that have the potential for causing outbreaks. Methods: Hospital-based infection control nurses in all of Mpumalanga's 32 public and private hospitals were trained to recognize, report, and respond to nine clinical syndromes that require immediate action. Sustainability of the system was assured through a schedule of regular training and networking, and by providing feedback to the nurses. The system was evaluated by formal review of hospital records, evidence of the effective containment of a cholera outbreak, and assessment of the speed and appropriateness of responses to other syndromes. Findings: Rapid detection, reporting and response to six imported cholera cases resulted in effective containment, with only 19 proven secondary cholera cases, during the two-year review period. No secondary cases followed detection and prompt response to 14 patients with meningococcal disease. By the end of the first year of implementation, all facilities were providing weekly zero-reports on the nine syndromes before the designated time. Formal hospital record review for cases of acute flaccid paralysis endorsed the value of the system. Conclusion: The primary goal of an outbreak surveillance system is to ensure timely recognition of syndromes requiring an immediate response. Infection control nurses in Mpumalanga hospitals have excelled in timely weekly zero-reporting, participation at monthly training and feedback sessions, detection of priority clinical syndromes, and prompt appropriate response. This review provides support for the role of hospital-based nurses as valuable sentinel surveillance agents providing timely data for action

The unexpected rise of cohabitation in the Philippines: evidence of socioeconomic disadvantage or a second demographic transition?

Cohabitation has increased rapidly in the Philippines, quadrupling in prevalence from 6% in 1993 to 24% in 2013 among young adult women. This increase is dramatic and exceptional given the slow change in other family behaviours, such as low divorce rates and continued high fertility, and the persistent influence of the Catholic Church. While cohabitation is often framed as evidence of ideational change and liberalization, its continued uptake over time may be associated with socioeconomic conditions. Using the 2013 National Demographic and Health Surveys, we apply a discrete-time competing risks model to examine the relationship between socioeconomic status and cohabitation, using education as proxy for resources and opportunities available to women. Our findings demonstrate that lower levels of education are significantly associated with a higher risk of cohabitation, which suggests rising cohabitation in the Philippines is more linked to socioeconomic disadvantage than the devaluing of marriage among educated elites

The Iowa Homemaker vol.7, no.5

The Place of the Child, page 1 Grape Juice and Milk for School Children by Melba Nisewanger, page 2 Another Way to Save Fuel by Lucile Harris, page 2 White Meat, and Dark by Margaret L. Marnette, page 3 Home Economics Research at Iowa State by Melba NIsewanger, page 4 For His Majesty, the Baby by Bernice Millerke, page 5 Girls’ 4-H Page, page 6 State Home Economics Association Meeting, Nov. 3-4, Des Moines by Marcia Turner, page 8 In Far-Off Alaska by Robert Kallenberg, page 10 Who’s There and Where by Cleo Fitzsimmons, page 12 Homecoming by Gertrude Brown, page 13 In Praise of Sauerkraut by Helen Goeppinger, page 1

The Lantern Vol. 17, No. 3, Summer 1949

• All the Silver in Taxco • The Fall • Parlor Games • Something There Is • Friday Night • Evening • Checker-Board Country • A Noise • Expected Up In Heaven Today • When Time Has Torn My Youth • Impression of Deathhttps://digitalcommons.ursinus.edu/lantern/1048/thumbnail.jp

The Lantern Vol. 17, No. 1, Fall 1948

• In the Arms of the Sea • The Expressed Should Be Repressed • Puppy Love • Tommy • How to Eat a Ravioli Dinner • The Divine Blessing • On Thunder • There Is No Hell • Old Love Re-met • Autumn Eve • Dr. Cornelius Weygandthttps://digitalcommons.ursinus.edu/lantern/1046/thumbnail.jp

The Lantern Vol. 17, No. 1, Fall 1948

• In the Arms of the Sea • The Expressed Should Be Repressed • Puppy Love • Tommy • How to Eat a Ravioli Dinner • The Divine Blessing • On Thunder • There Is No Hell • Old Love Re-met • Autumn Eve • Dr. Cornelius Weygandthttps://digitalcommons.ursinus.edu/lantern/1046/thumbnail.jp