Verbal autopsy interpretation: a comparative analysis of the InterVA model versus physician review in determining causes of death in the Nairobi DSS

<p>Abstract</p> <p>Background</p> <p>Developing countries generally lack complete vital registration systems that can produce cause of death information for health planning in their populations. As an alternative, verbal autopsy (VA) - the process of interviewing family members or caregivers on the circumstances leading to death - is often used by Demographic Surveillance Systems to generate cause of death data. Physician review (PR) is the most common method of interpreting VA, but this method is a time- and resource-intensive process and is liable to produce inconsistent results. The aim of this paper is to explore how a computer-based probabilistic model, InterVA, performs in comparison with PR in interpreting VA data in the Nairobi Urban Health and Demographic Surveillance System (NUHDSS).</p> <p>Methods</p> <p>Between August 2002 and December 2008, a total of 1,823 VA interviews were reviewed by physicians in the NUHDSS. Data on these interviews were entered into the InterVA model for interpretation. Cause-specific mortality fractions were then derived from the cause of death data generated by the physicians and by the model. We then estimated the level of agreement between both methods using Kappa statistics.</p> <p>Results</p> <p>The level of agreement between individual causes of death assigned by both methods was only 35% (κ = 0.27, 95% CI: 0.25 - 0.30). However, the patterns of mortality as determined by both methods showed a high burden of infectious diseases, including HIV/AIDS, tuberculosis, and pneumonia, in the study population. These mortality patterns are consistent with existing knowledge on the burden of disease in underdeveloped communities in Africa.</p> <p>Conclusions</p> <p>The InterVA model showed promising results as a community-level tool for generating cause of death data from VAs. We recommend further refinement to the model, its adaptation to suit local contexts, and its continued validation with more extensive data from different settings.</p

Performance of Sustainable Road Pavements Founded on Clay Subgrades Treated with Eco-Friendly Cementitious Materials

Clays encountered during road construction are mostly weak and result in major pavement failures due to their low California bearing ratio (CBR) and high swelling potential. In this study, sustainable and eco-friendly waste materials including brick dust waste (BDW), ground granulated blastfurnance slag (GGBS), recycled plastic (RP) and recycled glass (RG) at varying proportions of 11.75% and 23.5% were used as partial replacement for cement and lime in clay treatment. After determining the water content by conducting Atterberg limit and compaction test, A CBR and swell characteristics of treated and untreated clay were also conducted. A road pavement design was conducted using the Design Manual for Road and Bridges (DMRB) as a guide to determine the performance of treated clay with varying CBR values. A road pavement failure analysis was also conducted to understand the defect formation within pavement structures supported by eco-friendly treated clay. The embodied carbon of treated clay was calculated and a life cycle cost analysis (LCCA) of flexible pavement with treated clay and road with imported materials was conducted. The results show a liquid limit of 131.26 and plastic limit of 28.74 for high plasticity index (clay 1) and liquid limit of 274.07 and a plastic limit of 45.38 for extremely high plasticity index (clay 2). An increase in CBR values from 8% and 9% to 57% and 97% with a reduction in swell values from 4.11% and 5.03% to 0.38% and 0.56% were recorded. This resulted in a reduction in pavement thickness and stresses within the road pavement leading to reduced susceptibility of the pavement to fatigue, rutting and permanent deformation. Very low embodied carbon was recorded for eco-friendly treated clay and a high life cycle cost (LCC) with clay removed and replaced with imported materials compared with clay treated using eco-friendly waste materials. The study concluded that carbon and overall construction costs can be reduced using waste materials in road construction. Owners and operators can save money when clay is treated and used in road construction instead of removing clay and replacing it with imported materials

Risk factors for perinatal mortality in Nigeria: the role of place of delivery and delivery assistants

Background: This study examines the association between place of delivery, delivery assistants and perinatal mortality in Nigeria. Previous studies have found these factors to be associated with the risk of perinatal mortality. This study therefore aims to determine the extent to which these two factors predict perinatal mortality in the Nigerian context as this information will be useful in informing health policy decisions and actions in so far as a desirable reduction in childhood mortality in Nigeria is concerned. Methods: This study uses cross sectional design through secondary analysis of the 2003 Nigerian Demographic and Health Survey (NDHS). The variables representing place of delivery and delivery assistants have been fitted into logistic regression models to determine their association with perinatal mortality. Several other known risk factors for perinatal mortality such as maternal education and birth weight, to mention a few, have also been investigated using the logistic regression analysis. Results: 5783 live singleton births were analyzed with 194 newborns dying within the first seven days of life giving an early neonatal mortality rate (ENMR) of 33.5 per 1000 and an estimated perinatal mortality rate (PNMR) of 72.4 per 1000 live births. The results also show that place of delivery [p=0.8777] and delivery assistants [p=0.3812] are not significantly associated with perinatal mortality even after disaggregating the analysis by rural and urban areas. However being small in size at birth [AOR= 2.13, CI=1.41 – 3.21], female [AOR=0.57, CI= 0.42 – 0.77] and having a mother who practiced traditional religion [AOR= 4.37, CI= 2.31 – 8.26], were all significantly associated with perinatal mortality. Conclusions: Place of delivery and delivery assistants are not good predictors of perinatal mortality in the Nigerian context. However various limitations of the study design used such as the issue of uncontrolled confounding may have affected the findings. Nonetheless, the increased risk of perinatal deaths in small babies and the decreased risk of death among female babies are consistent with other studies and have both been attributed elsewhere to biologic mechanisms

Sociolinguistics of the Varieties of West African Pidgin Englishes—A Review

Language contact is a key issue in the field of sociolinguistics. One notable phenomenon in the field of language contact is Pidgin English. Historically, Pidgin began as a language marked by traditional interference used chiefly by the prosperous and privileged sections of a community, represented by the unskilled and illiterate class of the society (Quirk et al., 1985). However, nowadays, it has gained status in some communities to the extent that it has become the mother-tongue of such communities. This paper, therefore, investigates the sociolinguistics of the multiplicity of West African Pidgins of Cameroon, Nigeria and Ghana against some sociolinguistic variables of gender, attitudes, code switching, borrowing, slang, and domains of language use. The paper has been structured into two main parts. The first section contains the reviews/synopses of the various papers or works that have been used for the study. The second section deals with a discussion on the prominent sociolinguistic variables found in the various papers

Salt intakes in sub-Saharan Africa : a systematic review and meta-regression

Sodium intake in much of sub-Saharan Africa is above the World Health Organization's recommended maximum intake and may be set to increase as the continent undergoes considerable urbanization. Few identified studies used stringent measurement criteria or representative population samples. High quality studies will be required to identify where and with whom to intervene, in order to meet the World Health Organization's target of a 30 % reduction in population sodium intake and to demonstrate progress towards this target

Mechanical properties and microstructure of fibre-reinforced clay blended with by-product cementitious materials

Clayey soils endure adverse changes in strength and volume due to seasonal changes in moisture content and temperature. It has been well recognised that high cement content has been successfully employed in improving the mechanical properties of clayey soils for geotechnical infrastructural purposes. However, the environmental setbacks regarding the use of high cement content in soil reinforcement have necessitated the need for a greener soil reinforcement technique by incorporating industrial by-product materials and synthetic fibres with a reduced amount of cement content in soil-cement mixtures. Therefore, this study presents an experimental study to investigate the mechanical performance of polypropylene and glass fibre-reinforced cement-clay mixtures blended with ground granulated blast slag (GGBS), lime and micro silica for different mix compositions and curing conditions. The unconfined compressive strength, linear expansion and microstructural analysis of the reinforced soils have been studied. The results show that an increase in polypropylene and glass fibre contents caused an increase in unconfined compressive strength but brought on the reduction of linear expansion of the investigated clay from 7.92% to 0.2% at fibre content up to 0.8% for cement-clay mixture reinforced with 5% Portland cement (PC). The use of 0.4–0.8% polypropylene and glass fibre contents in reinforcing cement-clay mixture at 5% cement content causes an increase in unconfined compressive strength (UCS) values above the minimum UCS target value according to American Society for Testing and Materials (ASTM) 4609 after 7 and 14 days curing at 20◦ C to 50◦ C temperature. Therefore, this new clean production of fibre-reinforced cement-clay mixture blended with industrial by-product materials has great potential for a wide range of applications in subgrade reinforcement

Expansion and Consolidation of the Educational Activities of the Seventh-day Adventist (SDA) Mission at Asante Bekwai in Ghana from 1932-1955: Achievements and Challenges

The article focuses on the activities of the Seventh-day Adventist (SDA) Church at Asante Bekwai, a popular traditional township in Ashanti Region of Ghana.  Historical documents such as archival data from Public Records and Archival Administration (PRAAD) Office in Kumasi, files at SDA Educational Unit, Kumasi, log books and board of governors’ meeting minutes of some SDA Schools in Ashanti constituted the major sources of information for the study. Secondary sources including books, scholarly writings and oral interviews with persons of considerable knowledge about the early activities of the Mission were also utilised to augment the discussions. The major findings of the study were that the SDA Church at Asante Bekwai utilized the favourable local conditions there to promote theological studies, teacher and secondary education; contingent on the philosophy of idealism, which largely stressed on moral development and character training.  However, financial difficulties, which impeded the provision of adequate infrastructure and other educational equipment,  were the major obstacles which confronted  the educational efforts of the Mission  during the period. It was therefore anticipated that the Church from 1955 onwards would take measures to surmount the challenges. Key Words: Asante Bekwai, SDA Mission, Bekwai SDA Training College, Missionaries, Jesse Clifford

Salt reduction interventions in Sub-Saharan Africa : a systematic review

Background: Salt intake is associated with hypertension, the leading risk factor for cardiovascular disease. To promote population-level salt reduction, the World Health Organization recommends intervention around three core pillars: Reformulation of processed foods, consumer awareness, and environmental changes to increase availability and affordability of healthy food. This review investigates salt reduction interventions implemented and evaluated in sub-Saharan Africa (SSA). Methods: MEDLINE and google scholar electronic databases were searched for articles meeting inclusion criteria. Studies that reported evaluation results of a salt intervention in SSA were identified. Titles and abstracts were screened, and articles selected for full-text review. Quality of included articles was assessed, and a narrative synthesis of the findings undertaken. PROSPERO registration number CRD42015019055. Results: Seven studies representing four countries—South Africa, Nigeria, Ghana, and Tanzania—were included. Two examined product reformulation, one in hypertensive patients and the other in normotensive volunteers. Four examined consumer awareness interventions, including individualised counselling and advisory health sessions delivered to whole villages. One study used an environmental approach by offering discounts on healthy food purchases. All the interventions resulted in at least one significantly improved outcome measure including reduction in systolic blood pressure (BP), 24 hour urinary sodium excretion, or mean arterial BP. Conclusions: More high quality studies on salt reduction interventions in the region are needed, particularly focused on consumer awareness and education in urban populations given the context of rapid urbanisation; and essentially, targeting product reformulation and environmental change, for greater promise for propagation across a vast, diverse continent

Asante Bekwai United Schools’ Arts and Crafts Centre: a Model of Technical/Vocational Education (TVE) Curriculum Diversification and Utilization of local Expertise in colonial Ghana (1940-1950)

The paper discusses the general organization and operation of Asante Bekwai United Schools’ Arts and Crafts Centre as a model of TVE in the country during the 1940s.  In particular, it focuses, inter alia, on the positive consequences of judiciously utilizing the “top-down change” and “bottom-up change” to use the words of  Fullan (2007) in TVE educational policy formulation and implementation in colonial Ghana.  This feat was achieved through the leadership efforts of  the British colonial administration, the four missionary bodies then  at Asante Bekwai (namely the Methodist Mission, the English Church Mission, the Catholic Mission and the Seventh-day Adventist Mission) the Asante Bekwai traditional authority and the Achimota College in Accra.  It further discusses the nature of the curriculum of the Centre and its utilization of local expertise in the teaching and learning process   It further discusses the effects of the income generation activities at the Centre.  In this endeavour, a critical analysis of relevant historical information retrieved from the Public Record and Archives Department (PRAAD) office in Asante Region of Ghana was undertaken by the authors. The study, inter alia, revealed that the collaboration between the Centre and stakeholders greatly contributed to the steady progress of the Centre. It was again observed   that the curriculum of the Centre was quite versatile; capable of equipping its beneficiaries to acquire relevant skills for productive livelihoods. The vibrant nature of the Centre was also evident by the fact that the income that was generated from the activities was used to procure some tools for the Centre. Undoubtedly, such an educational initiative was bound to grapple with teething challenges and it was anticipated that such challenges would be quickly addressed for smooth progress of the Centre. Future studies into such challenges and their remedies are thus encouraged. Keywords: Asante Bekwai; Arts and Crafts; mat weaving; pottery, curriculum, Achimot

HIV mortality in urban slums of Nairobi, Kenya 2003-2010: a period effect analysis.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.BACKGROUND: It has been almost a decade since HIV was declared a national disaster in Kenya. Antiretroviral therapy (ART) provision has been a mainstay of HIV treatment efforts globally. In Kenya, the government started ART provision in 2003 with significantly scale-up after 2006. This study aims to demonstrate changes in population-level HIV mortality in two high HIV prevalence slums in Nairobi with respect to the initiation and subsequent scale-up of the national ART program. METHODS: We used data from 2070 deaths of people aged 15-54 years that occurred between 2003 and 2010 in a population of about 72,000 individuals living in two slums covered by the Nairobi Urban Health and Demographic Surveillance System. Only deaths for which verbal autopsy was conducted were included in the study. We divided the analysis into two time periods: the "early" period (2003-2006) which coincides with the initiation of ART program in Kenya, and the "late" period (2007-2010) which coincides with the scale up of the program nationally. We calculated the mortality rate per 1000 person years by gender and age for both periods. Poisson regression was used to predict the risk of HIV mortality in the two periods while controlling for age and gender. RESULTS: Overall, HIV mortality declined significantly from 2.5 per 1,000 person years in the early period to 1.7 per 1,000 person years in the late period. The risk of dying from HIV was 53 percent less in the late period compared to the period before, controlling for age and gender. Women experienced a decline in HIV mortality between the two periods that was more than double that of men. At the same time, the risk of non-HIV mortality did not change significantly between the two time periods. CONCLUSIONS: Population-level HIV mortality in Nairobi's slums was significantly lower in the approximate period coinciding with the scale-up of ART provision in Kenya. However, further studies that incorporate ART coverage data in mortality estimates are needed. Such information will enhance our understanding of the full impact of ART scale-up in reducing adult mortality among marginalized slum populations in Kenya