Search

OBJECTIVE: The multi-country evaluation of Integrated Management of Childhood Illness (IMCI) effectiveness, cost and impact (MCE) is a global evaluation to determine the impact of IMCI on health outcomes and its cost-effectiveness. MCE studies are under way in Bangladesh, Brazil, Peru, Uganda and the United Republic of Tanzania. The objective of this analysis from the Bangladesh MCE study was to describe the quality of care delivered to sick children under 5 years old in first-level government health facilities, to inform government planning of child health programmes. METHODS: Generic MCE Health Facility Survey tools were adapted, translated and pre-tested. Medical doctors trained in IMCI and these tools conducted the survey in all 19 health facilities in the study areas. The data were collected using observations, exit interviews, inventories and interviews with facility providers. FINDINGS: Few of the sick children seeking care at these facilities were fully assessed or correctly treated, and almost none of their caregivers were advised on how to continue the care of the child at home. Over one-third of the sick children whose care was observed were managed by lower-level workers who were significantly more likely than higher-level workers to classify the sick child correctly and to provide correct information on home care to the caregiver. CONCLUSION: These results demonstrate an urgent need for interventions to improve the quality of care provided for sick children in first-level facilities in Bangladesh, and suggest that including lower-level workers as targets for IMCI case-management training may be beneficial. The findings suggest that the IMCI strategy offers a promising set of interventions to address the child health service problems in Bangladesh.

My enrolment at university was a significant milestone in my life. During my first three days as a student with autism spectrum disorder, I experienced both positive and negative situations at different campuses, including overcrowded lecture halls, residences, faculty houses, and interacting with other students. My literature review and theoretical interpretation are guided by historical institutionalism and Bakhtin's concept of "outsideness". These frameworks address how historical events shape the social, political, and economic behaviour of institutions in a system that treats new students who must adapt to the university's rules, regulations, and traditions as outsiders. The frameworks mentioned above were used to understand what I experienced during my first three days at university, which set the tone for the rest of my undergraduate education, punctuated by ableness, whiteness, masculinity, and fluctuating forms of support. [ABSTRACT FROM AUTHOR]

To meet the demands of our highly technological and globally competitive society, it is becoming increasingly important for all learners in South Africa to obtain skills and knowledge in mathematics. However, South Africa performed the worst of all the countries who participated in the Trends in International Mathematics and Science Study (TIMMS). Education in South Africa is now confronted with the dilemma of how to improve the mathematics performance of learners. One way of dealing with this dilemma is to apply Howard Gardner's Theory of Multiple Intelligences in the classroom. This intervention should contribute positively to the South African Government's Foundation for Learning Campaign. This article suggests specific ways in which teachers can incorporate the different intelligences in their teaching and learning activities in the mathematics classroom. Recommendations are made for the application of the Multiple Intelligences Theory in the mathematics classroom, and topics for future research are suggested.

Explores the implications of South Africa's national Entrepreneurship Education curriculum for teacher training, and suggests some guidelines for compiling a relevant curriculum for teacher training. (EV)

Morocco has made significant strides in building its HIV research capacity. Based on a wealth of empirical data, the objective of this study was to conduct a comprehensive and systematic literature review and analytical synthesis of HIV epidemiological evidence in this country. Data were retrieved using three major sources of literature and data. HIV transmission dynamics were found to be focused in high-risk populations, with female sex workers (FSWs) and clients contributing the largest share of new HIV infections. There is a pattern of emerging epidemics among some high-risk populations, and some epidemics, particularly among FSWs, appear to be established and stable. The scale of the local HIV epidemics and populations affected show highly heterogeneous geographical distribution. To optimize the national HIV response, surveillance and prevention efforts need to be expanded among high-risk populations and in geographic settings where low intensity and possibly concentrated HIV epidemics are emerging or are already endemic. [ABSTRACT FROM PUBLISHER]

Although interspecific body size frequency distributions are well documented for many taxa, including the insects, intraspecific body size frequency distributions (IaBSFDs) are more poorly known, and their variation among mass-based and linear estimates of size has not been widely explored. Here we provide IaBSFDs for 16 species of insects based on both mass and linear estimates and large sample sizes (n≥100). In addition, we review the published IaBSFDs for insects, though doing so is complicated by their under-emphasis in the literature. The form of IaBSFDs can differ substantially between mass-based and linear measures. Nonetheless, in non-social insects they tend to be normally distributed (18 of 27 species) or in fewer instances positively skewed. Negatively skewed distributions are infrequently reported and log transformation readily removes the positive skew. Sexual size dimorphism does not generally cause bimodality in IaBSFDs. The available information on IaBSFDs in the social insects suggests that these distributions are usually positively skewed or bimodal (24 of 30 species). However, only c. 15% of ant genera are polymorphic, suggesting that normal distributions are probably more common, but less frequently investigated. Although only 57 species, representing seven of the 29 orders of insects, have been considered here, it appears that whilst IaBSFDs are usually normal, other distribution shapes can be found in several species, though most notably among the social insects. By contrast, the interspecific body size frequency distribution is typically right-skewed in insects and in most other taxa. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the prevalence of diabetes, impaired glucose tolerance (IGT), impaired fasting glycemia (IFG), and associated risk factors in a rural South African black community.Research Design and Methods: This was a cross-sectional survey conducted by random cluster sampling of adults aged >15 years. Participants had a 75-g oral glucose tolerance test using the 1998 World Health Organization criteria for disorders of glycemia.Results: Of 1,300 subjects selected, 1,025 subjects (815 women) participated (response rate 78.9%). The overall age-adjusted prevalence of diabetes was 3.9%, IGT 4.8%, and IFG 1.5%. The prevalence was similar in men and women for diabetes (men 3.5%; women 3.9%) and IGT (men 4.6%; women 4.7%) but higher in men for IFG (men 4.0%; women 0.8%). The prevalence of diabetes and IGT increased with age both in men and women, with peak prevalence in the 55- to 64-year age-group for diabetes and in the >or=65-year age-group for IGT. Of the cases of diabetes, 84.8% were discovered during the survey. In multivariate analysis, the significant independent risk factors associated with diabetes included family history (odds ratio 3.5), alcohol ingestion (2.8), waist circumference (1.1), systolic blood pressure (1.0), serum triglycerides (2.3), and total cholesterol (1.8); hip circumference was protective (0.9).Conclusions: There is a moderate prevalence of diabetes and a high prevalence of total disorders of glycemia, which suggests that this community, unlike other rural communities in Africa, is well into an epidemic of glucose intolerance. There is a low proportion of known diabetes and a significant association with potentially modifiable risk factors. [ABSTRACT FROM AUTHOR]

Background. The variability in CD4[+] cell counts within and among human immunodeficiency virus (HIV)-positive and -negative African populations has not been explained but has important implications for understanding the incidence of HIV-related opportunistic infections, especially tuberculosis, in both individuals and populations. Methods. In HIV-negative African adults, CD4+ cell counts vary within populations (interquartile ranges [IQRs], 169-603 cells/microL) and among populations (means vary from 699 to 1244 cells/microL), with similarly wide variations in HIV-positive adults. We developed dynamic mathematical models to predict the distribution of CD4[+] cell counts in HIV-positive adults using the distribution in HIV-negative adults. Results. Under the assumption that survival is independent of the CD4[+] cell count before seroconversion, we fitted the observed distributions in HIV-positive adults. At a CD4[+] cell count of 200 cells/microL, the median life expectancy of HIV-positive Zambians (4.0 years) was predicted to be 1.7 times that of HIV-positive South Africans (2.3 years). Conclusions. The model provides a way to estimate the changing distribution of CD4[+] cell counts and, hence, the changing incidence of HIV-related opportunistic infections as the epidemic matures. This could substantially improve the planning of health services, including the need and demand for antiretroviral therapy. Better data are needed to test the model and its assumptions more rigorously and to fully understand the variability in CD4[+] cell counts within and among populations. Copyright © 2006 Infectious Diseases Society of America [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this study was to assess the effect of Integrated Management of Childhood Illness (IMCI) case management training on the use of antimicrobial drugs among health-care workers treating young children at first-level facilities. Antimicrobial drugs are an essential child-survival intervention. Ensuring that children younger than five who need these drugs receive them promptly and correctly can save their lives. Prescribing these drugs only when necessary and ensuring that those who receive them complete the full course can slow the development of antimicrobial resistance. METHODS: Data collected through observation-based surveys in randomly selected first-level health facilities in Brazil, Uganda and the United Republic of Tanzania were statistically analysed. The surveys were carried out as part of the multi-country evaluation of IMCI effectiveness, cost and impact (MCE). FINDINGS: Results from three MCE sites show that children receiving care from health workers trained in IMCI are significantly more likely to receive correct prescriptions for antimicrobial drugs than those receiving care from workers not trained in IMCI.They are also more likely to receive the first dose of the drug before leaving the health facility, to have their caregiver advised how to administer the drug, and to have caregivers who are able to describe correctly how to give the drug at home as they leave the health facility. CONCLUSIONS: IMCI case management training is an effective intervention to improve the rational use of antimicrobial drugs for sick children visiting first-level health facilities in low-income and middle-income countries. Copyright © 2004 World Health Organization [ABSTRACT FROM AUTHOR]

Demographic forecasting models of the South African population, incorporating geographical distribution and age prevalence data on HIV infection, have been used to predict future mortality due to AIDS. In the year 2010, approximately 500 000 AIDS-related deaths are predicted, up from 100 000 this year. If anything, these models have underestimated the course of the epidemic so far. There is a need for better models to understand the dynamics of AIDS as well as to measure the effects of co-factors, in order to marshall the most effective response nationally. [ABSTRACT FROM AUTHOR]

South Africa is experiencing an explosive epidemic of HIV/AIDS, with about one in four women attending ante-natal clinics nationwide being HIV-positive. In order to understand the natural history of the epidemic, to design and target interventions to manage it and to evaluate the impact of interventions that are implemented, it is essential to gather information on the patterns of infection. In particular it is important to know how these vary with gender, age, migrancy status and between urban and rural settings. Ideally, one should measure age-specific incidence but this is difficult to do. Many datasets are available, however, on age-specific prevalence of infection and these are used to investigate the risk of infection with age among a number of different populations. The populations under consideration include women attending ante-natal clinics, urban and rural populations, migrant workers and commercial sex workers. Data are also presented from one work-based survey and from a study of cancer patients at a major hospital in Soweto. We were able to identify four different patterns of infection among a) women attending ante-natal clinics; b) women in the general population; c) men in the general population; and d) migrant workers. It is interesting that we were unable to show differences between urban and rural populations. Furthermore, the patterns of infection appear to be fairly constant over time, although as the epidemic saturates and reaches a steady state this must change. These data highlight, in particular, the extremely high risk of infection among 15-25-year-old women and among migrant workers of all ages. They should serve not only to highlight the urgency of the situation and the need to deal with the spread of infection effectively, but should also provide a basis for detailed epidemiological modelling, which can be used to predict the future course of the epidemic, plan an effective response and evaluate the impact of interventions. [ABSTRACT FROM AUTHOR]

For all of the last century, the economy of South Africa, and so also of its neighbouring countries, has depended on migrant labour from rural areas. This is particularly so for the mining industry, especially hard-rock mining, and this has led to a system of 'oscillating' migration whereby men from rural areas come to live and work on the mines, without their wives or families, but return home regularly. This pattern of oscillating migration is an important determinant of health and, especially at the start of the epidemic, contributed to the spread of HIV in the region. In this paper we describe an extensive, community-led, intervention designed to develop ways to manage and limit the spread of HIV in Carletonville, the largest gold-mining complex in the world. We first consider the political and economic context within which earlier attempts to develop HIV intervention programmes were made and then show how the Carletonville project was designed to go beyond these early attempts and avoid some of the pitfalls encountered then. The Carletonville project was based on a set of assumptions. First, that HIV should not be treated as another biomedical problem to be dealt with by changing individual behaviour but rather that it must be understood within the social, cultural and normative conditions that pertain in particular communities. Secondly, that in the short to medium term the most effective interventions would involve the treatment of sexually transmitted diseases and the use of community-based peer educators to promote safer sexual practices and the use of condoms. Thirdly, that for the intervention to be sustainable in the long term, it would require the full commitment of all the local stakeholders including the state, the private sector, the trade unions and local community-based organizations. Fourthly, that in order to understand the nature and pattern of the epidemic, to focus our intervention efforts so that they have the maximum effect, to make se... [ABSTRACT FROM AUTHOR]

Summary The purpose of this study was to document thromboelastographic (TEG) changes in abruptio placentae and to compare these results with that of conventional tests used to monitor coagulation. This was a prospective study of 30 patients with abruptio placentae. All coagulation investigations including the TEG were performed on admission, immediately following delivery, and after periods of 4 hours and 24 hours. Results showed that standard coagulation tests detected coagulation abnormalities except the platelet count returned to normal limits within 24 hours of delivery. There was strong correlation between fibrinogen levels and the TEG parameters, ma and k time ( r=0.8). There was moderate correlation between platelet count and ma ( r=0.6). In conclusion, minor abnormalities in the clotting profile are clinically unimportant. The TEG does not detect such minor abnormalities because of its inherent ability to test the coagulation cascade as a whole. Major abnormalities are clinically relevant and the TEG detect 75% of them. Further, the TEG establishes the diagnosis of hypercoagulability an early sign of disseminated intravascular coagulation. Although standard laboratory tests are still necessary to detect coagulation abnormalities on admission, the TEG is a useful test in large obstetric units where laboratory results are not immediately available for the purposes of monitoring and treating ongoing coagulation defects. [ABSTRACT FROM AUTHOR]

Summary Although the Eclampsia Trial Collaborative Group reported that magnesium sulphate was more effective in preventing recurrent convulsions in eclampsia than phenytoin, confirmatory evidence that phenytoin is not useful as a prophylactic anticonvulsant agent in eclampsia is necessary. This prospective descriptive study enrolled 68 women with eclampsia. Recurrence of seizures occurred in 18 (26.5%) patients following phenytoin therapy. In 16 patients, the seizure recurrence occurred between the loading dose and first maintenance dose at 6 hours. There was no statistical difference in the clinical characteristics of those who had seizure recurrence compared with those that did not. Seizure recurrence following phenytoin therapy in eclampsia is unacceptably high. These results suggest that phenytoin is not effective as a prophylactic anticonvulsant in eclampsia. No conclusions about its effectiveness compared with alternative prophylactic anticonvulsants can be made from this descriptive study. [ABSTRACT FROM AUTHOR]

The UNAIDS Estimation and Projection Package (EPP) was developed to aid in country-level estimation and short-term projection of HIV/AIDS epidemics. This paper describes advances reflected in the most recent update of this tool (EPP 2007), and identifies key issues that remain to be addressed in future versions. The major change to EPP 2007 is the addition of uncertainty estimation for generalised epidemics using the technique of Bayesian melding, but many additional changes have been made to improve the user interface and efficiency of the package. This paper describes the interface for uncertainty analysis, changes to the user interface for calibration procedures and other user interface changes to improve EPP’s utility in different settings. While formal uncertainty assessment remains an unresolved challenge in low-level and concentrated epidemics, the Bayesian melding approach has been applied to provide analysts in these settings with a visual depiction of the range of models that may be consistent with their data. In fitting the model to countries with longer-running epidemics in sub-Saharan Africa, a number of limitations have been identified in the current model with respect to accommodating behaviour change and accurately replicating certain observed epidemic patterns. This paper discusses these issues along with their implications for future changes to EPP and to the underlying UNAIDS Reference Group model.