Introduction: A laboratory’s ability to consistently produce high-quality and reliable results hinges on adopting laboratory standards that guide daily practices to ensure steady quality improvement. Although assessm...Introduction: A laboratory’s ability to consistently produce high-quality and reliable results hinges on adopting laboratory standards that guide daily practices to ensure steady quality improvement. Although assessment is an extremely rewarding exercise in health care quality improvement processes, it is always considered very time consuming and expensive in developing world settings. A quarterly internal audit was conducted in 25 FHI360 supported Antiretroviral Treatment laboratories in the North West of Nigeria which can surely provide reference for other countries. Methodology: A checklist adapted from the World Health Organization/African Regional Office laboratory accreditation checklist was used to quantitatively evaluate 7 quality essentials (QEs). A team composed of technical staff from FHI360, State Ministry of Health and facility laboratory heads, conducted the audits, developed and monitored intervention plans. Information obtained with the checklist was captured in excel, validated and imported into Grappa Prism software version 5.0 for analysis. Results: Most (92%) facilities were at secondary level with (8%) at tertiary level. The mean total score on all QEs across the facilities was 63.34 ± 9.77 in quarter (Q) 1, 68.8 ± 10.91 in Q2, 72.59 ± 8.02 in Q3 and 72.72 ± 9.16 in Q4 (p ≤ 0.0001). The most improved QE through Q1-Q4 was organization and personnel (32.2%), while signage/bench top reference had an 18.6% point decline. In ranking facilities based on differences of total scores between Q4 and Q1, Kachia General Hospital was the highest with 27 point increase. Considering the mean percentage score for all quarters per facility, 4 had ≥ 80%, 19 had between 60%-80% and 2 had <60%. The total non-conformities cited for QI-Q4 were 185, 100, 78 and 64 respectively with highest recorded in internal and external quality control and the least in facility and safety. Conclusion: We recorded some improvement in most QEs confirming the benefits of internal audits, reviews and follow-up. However, much more is needed in terms of technical assistance, capacity building, mentorship, and commitment at facility and state level to meet minimum acceptable laboratory quality standards.展开更多
Objective To explore factors influencing the quality of life of people living with HIV/AIDS （PLHA） and receiving antiretroviral therapy （ART） in rural China. Methods In-depth interviews with 20 PLHA recruited from...Objective To explore factors influencing the quality of life of people living with HIV/AIDS （PLHA） and receiving antiretroviral therapy （ART） in rural China. Methods In-depth interviews with 20 PLHA recruited from the USAID-funded Longitudinal cohort of eligible PLHA receiving treatment were conducted in March 1999. Participants were Enhanced Evaluation of ART Project, which tracks a at five collaborating treatment centers in Guangxi Autonomous Region, China. An interview guide （semi-structured with open-ended questions） was developed to provide a qualitative examination of the quality of life of PLHA. Results Participants identified that ART affects physical health, including the experience of pain, side effects, and opportunistic infections. ART imposes lifestyle constraints such as reduced mobility due to drug procurement, and social restrictions due to the daily drug regimen. Participants discussed the psychological burden of taking drugs, and the fear of accidental transmission to others, or having their disease status known by others, as well as optimistic feelings about their future due to ART. ART poses a significant drain on individual＇s economic resources due to related medical costs, and inability to seek seasonal migrant labor due to reduced mobility. Conclusion While China＇s national free ART program improved the physical health of those surveyed, their social and economic needs were left unaddressed. To improve life outcomes for PLHA, and by extension, the wider Chinese population, quality of life measures should be included when evaluating the success of the ART program.展开更多
Introduction: Despite the success derived from antiretroviral therapy, drug resistance (DR) mutations are known to develop and are major impediments to treatment of HIV patients. Therefore, periodic assessment of HIVD...Introduction: Despite the success derived from antiretroviral therapy, drug resistance (DR) mutations are known to develop and are major impediments to treatment of HIV patients. Therefore, periodic assessment of HIVDR is needed to ensure continuous HAART efficacy. This study assessed the magnitude of drug resistance as well as HIV genetic variability in drug-naive and treated patients in Nigeria. Methodology: Genotypic analysis was performed by sequencing plasma specimens from 40 individuals in a cross sectional study involving 202 HIV infected patients from all the six geopolitical zones of Nigeria. Sequences were analyzed for presence of HIVDR mutation using the algorithm in Stanford HIVDR database and confirmed by IAS-USA 2009 mutation list. Phylogenetic and recombination analyses were done using PAUP V4.0 and REGA V2.0 respectively. Results: Major DR mutations were detected in the reverse transcriptase (RT) gene of 5 (33%) drug experienced and 2 (8%) na?ve patients. Most common mutations were M184V and K103N with no protease (PR) mutations detected. Thymidine analogue mutations (TAMs) and a complex multi resistance mutation Q151M were detected in 3 samples. Polymorphic substitutions were observed in both PR and RT gene. Phylogenetic analysis revealed Group M isolates of G (20), J (1), circulating recombinant forms: CRF02_AG (14), CRF-18-cpx (1), CRF06_cpx (3) and a unique AD recombinant (1). Conclusion: Our findings corroborate previous studies on circulating DR viruses in Nigeria while genetic diversity is on the increase. In view of ART scale-up, monitoring the resistance pattern and genetic diversity will aid in appropriate prevention strategies.展开更多
Background: In January 2010, the implementation of quality management systems toward WHO-AFRO laboratory accreditation commenced in the Antiretroviral Treatment Laboratory of the Infectious Disease Hospital, Kano, Nig...Background: In January 2010, the implementation of quality management systems toward WHO-AFRO laboratory accreditation commenced in the Antiretroviral Treatment Laboratory of the Infectious Disease Hospital, Kano, Nigeria. Quality improvement projects were instituted in 2011 in line with ISO 15189 requirements for accreditation of medical laboratory. In this study we evaluated the performance of the laboratory through some set of quality indicators (QI). Methodology: This was a retrospective study to evaluate laboratory QIs monitored from January 2011 to December 2013. The QIs were specimen rejection rate (SSR), turnaround time (TAT), proficiency testing performance (PTP) and client satisfaction survey (CSS). Data was collected into an excel file for analysis and percentage performance compared among years. SSR & TAT were evaluated with the Sigma scale. Results: A total of 7920 (2194 in 2011, 2715 in 2012, 3011 in 2013) specimens were received for testing. 22 (0.28%) specimens were rejected and 81 (1.02%) specimens’ results were reported after the acceptable TAT, giving a Sigma level of 4.27 and 3.82 for SSR and TAT respectively. There was steady improvement in PTP: CD4+ from 67% in 2011 to 90% in 2013, hematology from 81% in 2012 to 83% in 2013, blood film reading 79% in 2011 to 83% in 2013 and chemistry from 90% in 2011 to 93% in 2013. HIV serology recorded 100% throughout. CSS increased from 59% in 2012 to 78% in 2013. However, there was no statistically significance difference reported for PTP and CSS over the years (P > 0.05). Conclusion: The study highlights the need to continuously evaluate QIs and calls for more effort to improve on PTP and focuses on understanding and improving on clients concerns.展开更多
Climate change is increasingly affecting farm-level decisions on when to plant and which climate smart agriculture (CSA) options to use. This study was conducted to determine the profitability and farmer acceptability...Climate change is increasingly affecting farm-level decisions on when to plant and which climate smart agriculture (CSA) options to use. This study was conducted to determine the profitability and farmer acceptability of different CSA options for maize-bean production in drought-prone areas of Uganda. It was conducted on-farm in Rakai and Nakasongola districts during 2020 and 2021. Variables included: planting date (early vs late);varieties (common beans: NABE 4 and NAROBEAN 2, and maize: Longe 5 and Bazooka);intercropping versus pure stand;and fertiliser use (manure, Diammonium phosphate (DAP) or combination). The experimental design was split-split plot, replicated six times. Over two years, early planting caused 16% and up to 46% higher yields of maize and beans, respectively, than late planting, resulting in 14% - 28% and 18% - 43% higher Benefit/Cost (B/C) ratio for maize and beans, respectively. Intercropping reduced maize and beans yield by 16% - 25% and 52% - 57%, respectively. The B/C was highest for sole maize;intercropping was more profitable than sole beans. Fertilizer (DAP) was most profitable when Bazooka was early-planted as sole crop followed by intercrop. For late planted-crop, manure was better. These practices were more beneficial when applied simultaneously for both crops excluding bean variety. Farmers’ lessons stressed the importance of early planting and fertilizer use;however, majority indicated they were to adopt more than two of the practices tested.展开更多
The prevalence of HIV in high risk population is influenced significantly the behavioral and sociodemographic characteristics. However, considering the complexity of behavior among female sex workers, the relationship...The prevalence of HIV in high risk population is influenced significantly the behavioral and sociodemographic characteristics. However, considering the complexity of behavior among female sex workers, the relationship between a particular behavioral pattern and the HIV status of this “at risk” population assumes significance. Data generated in a community-based cross-sectional study earlier carried out to assess the prevalence estimates, at district level, of HIV status in eight districts of State of Andhra Pradesh, India was used to carry out factor analysis to explore the role of demographic and behavioral pattern and their relationship with the HIV status among female sex workers. Data on 3083 female sex workers in the study revealed that there existed nine patterns among demographic and behavioral characteristics, which explained 62% of the total variation through factor analysis. Further, cluster analysis was performed to identify the groups of individuals having similar characteristics. Two of those clusters had sizeable numbers having similar characteristics. FSWs belonging to cluster 2 had significantly high risk factors compared with Cluster 1. The overall prevalence of HIV was 11.4% (10.6% in cluster 1 and 15.9% in cluster 2) among high risk population. There exists a strong relationship between behavioral patterns and HIV positive.展开更多
Background: To demonstrate that customized demand generation leads to increased voluntary HIV counseling and testing (VCT) among Sex Workers (SWs). Methods: FHI 360 Aastha implemented Vivek intervention among SWs in M...Background: To demonstrate that customized demand generation leads to increased voluntary HIV counseling and testing (VCT) among Sex Workers (SWs). Methods: FHI 360 Aastha implemented Vivek intervention among SWs in Mumbai and Thane, India using customized demand generation through outreach services for VCT. Program monitoring data and integrated counseling and testing center tracking sheets were used to assess the intervention effect. Results: Higher proportion of registered SWs tested during: 1) Vivek months than other months (17% vs. 5%, p < 0.001);2) Post-initiation non-Vivek months than pre-Vivek months (4.7%, vs. 1.5% p < 0.001). Conclusions: Customized demand generation approach is successful in increasing HIV testing.展开更多
The study aimed to assess the impact of Avahan intervention program on risk behaviors. Knowledge of HIV/STIs and their prevalence among self-identified men who have sex with men (MSM) in four select districts of Andhr...The study aimed to assess the impact of Avahan intervention program on risk behaviors. Knowledge of HIV/STIs and their prevalence among self-identified men who have sex with men (MSM) in four select districts of Andhra Pradesh, India, covers about 1600 respondents in each of the two rounds. The response rates of MSM in R1 and R2 were about 70%. Higher numbers of MSM in R2 had literacy level of ≥10th class, were either students, self-employed/business men and belonged to 20 - 24 years. Higher proportion of MSM in R2 reportedly had knowledge of HIV and its prevention, at least two signs/symptoms of STIs in men. Significantly higher numbers of MSM in R2 were exposed to programme interventions and consistent condom users. HIV prevalence declined significantly in one district, increased in one and remained similar in two districts. The prevalence of STIs decreased significantly in two districts, while remained similar in the other.展开更多
Isoniazid preventive therapy(IPT) is the administration of isoniazid(INH) to people with latent tuberculosis(TB) infection(LTBI) to prevent progression to active TB disease. Despite being life-saving for human immunod...Isoniazid preventive therapy(IPT) is the administration of isoniazid(INH) to people with latent tuberculosis(TB) infection(LTBI) to prevent progression to active TB disease. Despite being life-saving for human immunodeficiency virus(HIV)-infected persons who do not have active TB, IPT is poorly implemented globally due to misconceptions shared by healthcare providers and policy makers. However, amongst HIV-infected patients especially those living in resource-limited settings with a high burden of TB, available evidence speaks for IPT: Among HIV-infected persons, active TB- the major contraindication to IPT, can be excluded with symptom screening; chest X-ray and tuberculin skin testing are unreliable and often lead to logistic delays resulting in increased numbers of people with LTBI progressing to active TB; the use of IPT has not been found to increase the risk of the development of INH mono-resistance; IPT is cost-effective and cheaper than the cost of treating cases of active TB that would develop without IPT; ART and IPT have an additive effect on the prevention of TB, and both are safe and beneficial even in children. In order to sustain the recorded gains from ART scale-up and to further reduce TB-related morbidity and mortality, more efforts are needed to scale-up IPT implementation globally.展开更多
Objective:We examined the association between body mass index(BMI)and body fat percentage(BF%)measured by dual-energy X-ray absorptiometry(DXA)among adults and children in China.Methods:We searched four databases-PubM...Objective:We examined the association between body mass index(BMI)and body fat percentage(BF%)measured by dual-energy X-ray absorptiometry(DXA)among adults and children in China.Methods:We searched four databases-PubMed,China National Knowledge Infrastructure,Wanfang,and Vip for studies published in the past 22 years.Meta-analysis was conducted using random-or fixed-effect models.Results:In total of 21 studies met inclusion criteria and were included in review,and 17 ot them in meta-analysis.They were conducted across China.Their sample size ranged from 62 to 5726,and participants'age ranged from 6-80 years.Meta-analysis revealed strong associations between BMI and BF% measured by DXA in adults(pooled r=0.71,95% CI:0.66 to 0.74)and children(pooled r=0.60,95% CI:0.52 to 0.68).The association was stronger in Northern China than in East China in children(β=-0.40,95%CI:-0.65 to-0.14)and in Central China in adults(β=-0.25;95% CI:-0.51 to-0.01).Urban children's BMI was strongly associated with BF%than rural(β=0.19;95%CI:0.04 to 0.35),whereas it was stronger in adults living in rural than in urban(β=-0.35;95% CI:-0.66 to-0.05).Conclusions:BMI was strongly associated with BF%measured by DXA,and the association in children and adults in China varied by residence and region.展开更多
Introduction: Perinatal asphyxia is one of the leading causes of perinatal death and a recognized cause of neuromotor disability among survivors. About 20% - 30% of asphyxiated newborns who develop hypoxic ischemic en...Introduction: Perinatal asphyxia is one of the leading causes of perinatal death and a recognized cause of neuromotor disability among survivors. About 20% - 30% of asphyxiated newborns who develop hypoxic ischemic encephalopathy (HIE) die during the neonatal period, and one third to one half of survivors are left with cerebral palsy and mental retardation. Objective of the Study: Was to determine the effect of magnesium sulphate as neuroprotective drug in hypoxic ischemic encephalopathy resulting from severe perinatal asphyxia. Materials and Methods: A prospective administration of magnesium sulphate to 52 severely asphyxiated newborns with hypoxic ischemic encephalopathy was conducted over one year period from 1st August 2017 to 31st July 2018. Results: Most (96.2%) of patients were term baby (GA ≥ 37 weeks). Most (90.4%) were in-hospital born, vaginal delivery accounted for 55.8% and 44.2% assisted delivery respectively. About one half (55.8%) of the patients commenced MgSO4 therapy at <6 hours after birth, while 30.6% and 16.6% commenced MgSO4 therapy at 6 - <24 hours and >24 hours after birth respectively. Time of commencement of first enteral feeding (p = 0.018) and time to full enteral feeding (p = 0.015) showed significant correlation with the survival without neurological deficit. The earlier the commencement of MgSO4 therapy, the better the proportion with strong palmar grasp, sucking reflex, tone and early resolution of encephalopathy. Conclusion: All the study subjects treated with magnesium sulphate had impressive improvement;however there is a need to conduct randomized placebo-controlled trial treatment of severe perinatal asphyxia so as to determine its effects on early resolution of hypoxic ischemic encephalopathy/neuroprotective activity.展开更多
Background: Effective ART with low viral loads and absence of STIs significantly reduce chances of sexual transmission of HIV. ART is therefore a key pillar in HIV prevention. Appropriate support is however essential ...Background: Effective ART with low viral loads and absence of STIs significantly reduce chances of sexual transmission of HIV. ART is therefore a key pillar in HIV prevention. Appropriate support is however essential for optimum treatment outcome, patient safety and HIV prevention benefit. The scale-up of ART continues to strain the already overstretched human resources in public facilities, impacts on the quality of care, and contributes to loss to follow-up. Task shifting is therefore a strategy to augment the limited human resources. Methodology: In partnership with the Livingstone General Hospital (LGH) and four private pharmacists, the COH III Project through Howard University is promoting quality HIV care by engaging the pharmacists in adherence counselling and treatment monitoring. The LGH ART pharmacist allocates consenting stable ART clients to pharmacies based on willingness to be referred and patient preference. Patients are given schedule of visits to pharmacies where the pharmacists provide medication/adherence counselling and monitor side effects. Patients with medication/treatment issues are referred back to the LGH ART clinic for follow-up. Results: Between October 2012 and August 2013, 280 patients were enrolled and followed up by the four pharmacists. 69% of patients visited the pharmacy at least once, 25% at least twice and 13% at least thrice. The 33 client referrals by pharmacists to LGH were related to adverse drug reactions, suspected treatment failure, pregnancy, and treatment monitoring. The intervention has reduced workload for the ART pharmacist;improved communication of treatment challenges and identification of patients with medication related problems, and reduced travel distances and waiting times. This has resulted in improved adherence and better patient outcomes. Conclusion: Private pharmacists present an opportunity to improve quality of HIV interventions in poor human resource capacity settings. The necessary legal and regulatory framework needs to however be developed to guide the process.展开更多
Summary What is already known about this topic?The World Health Organization consolidated guidelines on recommend care for tuberculosis(TB)and support for multidrug-resistant TB(MDR-TB)patients.But guidelines have not...Summary What is already known about this topic?The World Health Organization consolidated guidelines on recommend care for tuberculosis(TB)and support for multidrug-resistant TB(MDR-TB)patients.But guidelines have not provided detailed guidance or tools for health services providers to implement comprehensive patient care.展开更多
Background:Onchocerciasis is endemic in 12 of the 14 health districts of Sierra Leone.Good treatment coverage of community-directed treatment with ivermectin was achieved between 2005 and 2009 after the 11-year civil ...Background:Onchocerciasis is endemic in 12 of the 14 health districts of Sierra Leone.Good treatment coverage of community-directed treatment with ivermectin was achieved between 2005 and 2009 after the 11-year civil conflict.Sentinel site surveys were conducted in 2010 to evaluate the impact of five annual rounds of ivermectin distribution.Methods:In total,39 sentinel villages from hyper-and meso-endemic areas across the 12 endemic districts were surveyed using skin snips in 2010.Results were analyzed and compared with the baseline data from the same 39 villages.Results:The average microfilaridermia(MF)prevalence across 39 sentinel villages was 53.10%at baseline.The MF prevalence was higher in older age groups,with the lowest in the age group of 1-9 years(11.00%)and the highest in the age group of 40-49 years(82.31%).Overall mean MF density among the positives was 28.87 microfilariae(mf)/snip,increasing with age with the lowest in the age group of 1-9 years and the highest in the age group of 40-49 years.Males had higher MF prevalence and density than females.In 2010 after five rounds of mass drug administration,the overall MF prevalence decreased by 60.26%from 53.10%to 21.10%;the overall mean MF density among the positives decreased by 71.29%from 28.87 mf/snip to 8.29 mf/snip;and the overall mean MF density among all persons examined decreased by 88.58%from 15.33 mf/snip to 1.75 mf/snip.Ten of 12 endemic districts had>50%reduction in MF prevalence.Eleven of 12 districts had≥50%reduction in mean MF density among the positives.Conclusions:A significant reduction of onchocerciasis MF prevalence and mean density was recorded in all 12 districts of Sierra Leone after five annual MDAs with effective treatment coverage.The results suggested that the onchocerciasis elimination programme in Sierra Leone was on course to reach the objective of eliminating onchocerciasis in the country by the year 2025.Annual MDA with ivermectin should continue in all 12 districts and further evaluations are needed across the country to assist the NTDP with programme decision making.展开更多
文摘Introduction: A laboratory’s ability to consistently produce high-quality and reliable results hinges on adopting laboratory standards that guide daily practices to ensure steady quality improvement. Although assessment is an extremely rewarding exercise in health care quality improvement processes, it is always considered very time consuming and expensive in developing world settings. A quarterly internal audit was conducted in 25 FHI360 supported Antiretroviral Treatment laboratories in the North West of Nigeria which can surely provide reference for other countries. Methodology: A checklist adapted from the World Health Organization/African Regional Office laboratory accreditation checklist was used to quantitatively evaluate 7 quality essentials (QEs). A team composed of technical staff from FHI360, State Ministry of Health and facility laboratory heads, conducted the audits, developed and monitored intervention plans. Information obtained with the checklist was captured in excel, validated and imported into Grappa Prism software version 5.0 for analysis. Results: Most (92%) facilities were at secondary level with (8%) at tertiary level. The mean total score on all QEs across the facilities was 63.34 ± 9.77 in quarter (Q) 1, 68.8 ± 10.91 in Q2, 72.59 ± 8.02 in Q3 and 72.72 ± 9.16 in Q4 (p ≤ 0.0001). The most improved QE through Q1-Q4 was organization and personnel (32.2%), while signage/bench top reference had an 18.6% point decline. In ranking facilities based on differences of total scores between Q4 and Q1, Kachia General Hospital was the highest with 27 point increase. Considering the mean percentage score for all quarters per facility, 4 had ≥ 80%, 19 had between 60%-80% and 2 had <60%. The total non-conformities cited for QI-Q4 were 185, 100, 78 and 64 respectively with highest recorded in internal and external quality control and the least in facility and safety. Conclusion: We recorded some improvement in most QEs confirming the benefits of internal audits, reviews and follow-up. However, much more is needed in terms of technical assistance, capacity building, mentorship, and commitment at facility and state level to meet minimum acceptable laboratory quality standards.
基金supported by USAID under the TASCIII TASC Order 2-Technical Support for HIV/AIDS Prevention,Care and Treatment-RDMA,Contract Number:GHS-I-00-07-0007-00
文摘Objective To explore factors influencing the quality of life of people living with HIV/AIDS （PLHA） and receiving antiretroviral therapy （ART） in rural China. Methods In-depth interviews with 20 PLHA recruited from the USAID-funded Longitudinal cohort of eligible PLHA receiving treatment were conducted in March 1999. Participants were Enhanced Evaluation of ART Project, which tracks a at five collaborating treatment centers in Guangxi Autonomous Region, China. An interview guide （semi-structured with open-ended questions） was developed to provide a qualitative examination of the quality of life of PLHA. Results Participants identified that ART affects physical health, including the experience of pain, side effects, and opportunistic infections. ART imposes lifestyle constraints such as reduced mobility due to drug procurement, and social restrictions due to the daily drug regimen. Participants discussed the psychological burden of taking drugs, and the fear of accidental transmission to others, or having their disease status known by others, as well as optimistic feelings about their future due to ART. ART poses a significant drain on individual＇s economic resources due to related medical costs, and inability to seek seasonal migrant labor due to reduced mobility. Conclusion While China＇s national free ART program improved the physical health of those surveyed, their social and economic needs were left unaddressed. To improve life outcomes for PLHA, and by extension, the wider Chinese population, quality of life measures should be included when evaluating the success of the ART program.
文摘Introduction: Despite the success derived from antiretroviral therapy, drug resistance (DR) mutations are known to develop and are major impediments to treatment of HIV patients. Therefore, periodic assessment of HIVDR is needed to ensure continuous HAART efficacy. This study assessed the magnitude of drug resistance as well as HIV genetic variability in drug-naive and treated patients in Nigeria. Methodology: Genotypic analysis was performed by sequencing plasma specimens from 40 individuals in a cross sectional study involving 202 HIV infected patients from all the six geopolitical zones of Nigeria. Sequences were analyzed for presence of HIVDR mutation using the algorithm in Stanford HIVDR database and confirmed by IAS-USA 2009 mutation list. Phylogenetic and recombination analyses were done using PAUP V4.0 and REGA V2.0 respectively. Results: Major DR mutations were detected in the reverse transcriptase (RT) gene of 5 (33%) drug experienced and 2 (8%) na?ve patients. Most common mutations were M184V and K103N with no protease (PR) mutations detected. Thymidine analogue mutations (TAMs) and a complex multi resistance mutation Q151M were detected in 3 samples. Polymorphic substitutions were observed in both PR and RT gene. Phylogenetic analysis revealed Group M isolates of G (20), J (1), circulating recombinant forms: CRF02_AG (14), CRF-18-cpx (1), CRF06_cpx (3) and a unique AD recombinant (1). Conclusion: Our findings corroborate previous studies on circulating DR viruses in Nigeria while genetic diversity is on the increase. In view of ART scale-up, monitoring the resistance pattern and genetic diversity will aid in appropriate prevention strategies.
文摘Background: In January 2010, the implementation of quality management systems toward WHO-AFRO laboratory accreditation commenced in the Antiretroviral Treatment Laboratory of the Infectious Disease Hospital, Kano, Nigeria. Quality improvement projects were instituted in 2011 in line with ISO 15189 requirements for accreditation of medical laboratory. In this study we evaluated the performance of the laboratory through some set of quality indicators (QI). Methodology: This was a retrospective study to evaluate laboratory QIs monitored from January 2011 to December 2013. The QIs were specimen rejection rate (SSR), turnaround time (TAT), proficiency testing performance (PTP) and client satisfaction survey (CSS). Data was collected into an excel file for analysis and percentage performance compared among years. SSR & TAT were evaluated with the Sigma scale. Results: A total of 7920 (2194 in 2011, 2715 in 2012, 3011 in 2013) specimens were received for testing. 22 (0.28%) specimens were rejected and 81 (1.02%) specimens’ results were reported after the acceptable TAT, giving a Sigma level of 4.27 and 3.82 for SSR and TAT respectively. There was steady improvement in PTP: CD4+ from 67% in 2011 to 90% in 2013, hematology from 81% in 2012 to 83% in 2013, blood film reading 79% in 2011 to 83% in 2013 and chemistry from 90% in 2011 to 93% in 2013. HIV serology recorded 100% throughout. CSS increased from 59% in 2012 to 78% in 2013. However, there was no statistically significance difference reported for PTP and CSS over the years (P > 0.05). Conclusion: The study highlights the need to continuously evaluate QIs and calls for more effort to improve on PTP and focuses on understanding and improving on clients concerns.
文摘Climate change is increasingly affecting farm-level decisions on when to plant and which climate smart agriculture (CSA) options to use. This study was conducted to determine the profitability and farmer acceptability of different CSA options for maize-bean production in drought-prone areas of Uganda. It was conducted on-farm in Rakai and Nakasongola districts during 2020 and 2021. Variables included: planting date (early vs late);varieties (common beans: NABE 4 and NAROBEAN 2, and maize: Longe 5 and Bazooka);intercropping versus pure stand;and fertiliser use (manure, Diammonium phosphate (DAP) or combination). The experimental design was split-split plot, replicated six times. Over two years, early planting caused 16% and up to 46% higher yields of maize and beans, respectively, than late planting, resulting in 14% - 28% and 18% - 43% higher Benefit/Cost (B/C) ratio for maize and beans, respectively. Intercropping reduced maize and beans yield by 16% - 25% and 52% - 57%, respectively. The B/C was highest for sole maize;intercropping was more profitable than sole beans. Fertilizer (DAP) was most profitable when Bazooka was early-planted as sole crop followed by intercrop. For late planted-crop, manure was better. These practices were more beneficial when applied simultaneously for both crops excluding bean variety. Farmers’ lessons stressed the importance of early planting and fertilizer use;however, majority indicated they were to adopt more than two of the practices tested.
文摘The prevalence of HIV in high risk population is influenced significantly the behavioral and sociodemographic characteristics. However, considering the complexity of behavior among female sex workers, the relationship between a particular behavioral pattern and the HIV status of this “at risk” population assumes significance. Data generated in a community-based cross-sectional study earlier carried out to assess the prevalence estimates, at district level, of HIV status in eight districts of State of Andhra Pradesh, India was used to carry out factor analysis to explore the role of demographic and behavioral pattern and their relationship with the HIV status among female sex workers. Data on 3083 female sex workers in the study revealed that there existed nine patterns among demographic and behavioral characteristics, which explained 62% of the total variation through factor analysis. Further, cluster analysis was performed to identify the groups of individuals having similar characteristics. Two of those clusters had sizeable numbers having similar characteristics. FSWs belonging to cluster 2 had significantly high risk factors compared with Cluster 1. The overall prevalence of HIV was 11.4% (10.6% in cluster 1 and 15.9% in cluster 2) among high risk population. There exists a strong relationship between behavioral patterns and HIV positive.
文摘Background: To demonstrate that customized demand generation leads to increased voluntary HIV counseling and testing (VCT) among Sex Workers (SWs). Methods: FHI 360 Aastha implemented Vivek intervention among SWs in Mumbai and Thane, India using customized demand generation through outreach services for VCT. Program monitoring data and integrated counseling and testing center tracking sheets were used to assess the intervention effect. Results: Higher proportion of registered SWs tested during: 1) Vivek months than other months (17% vs. 5%, p < 0.001);2) Post-initiation non-Vivek months than pre-Vivek months (4.7%, vs. 1.5% p < 0.001). Conclusions: Customized demand generation approach is successful in increasing HIV testing.
文摘The study aimed to assess the impact of Avahan intervention program on risk behaviors. Knowledge of HIV/STIs and their prevalence among self-identified men who have sex with men (MSM) in four select districts of Andhra Pradesh, India, covers about 1600 respondents in each of the two rounds. The response rates of MSM in R1 and R2 were about 70%. Higher numbers of MSM in R2 had literacy level of ≥10th class, were either students, self-employed/business men and belonged to 20 - 24 years. Higher proportion of MSM in R2 reportedly had knowledge of HIV and its prevention, at least two signs/symptoms of STIs in men. Significantly higher numbers of MSM in R2 were exposed to programme interventions and consistent condom users. HIV prevalence declined significantly in one district, increased in one and remained similar in two districts. The prevalence of STIs decreased significantly in two districts, while remained similar in the other.
文摘Isoniazid preventive therapy(IPT) is the administration of isoniazid(INH) to people with latent tuberculosis(TB) infection(LTBI) to prevent progression to active TB disease. Despite being life-saving for human immunodeficiency virus(HIV)-infected persons who do not have active TB, IPT is poorly implemented globally due to misconceptions shared by healthcare providers and policy makers. However, amongst HIV-infected patients especially those living in resource-limited settings with a high burden of TB, available evidence speaks for IPT: Among HIV-infected persons, active TB- the major contraindication to IPT, can be excluded with symptom screening; chest X-ray and tuberculin skin testing are unreliable and often lead to logistic delays resulting in increased numbers of people with LTBI progressing to active TB; the use of IPT has not been found to increase the risk of the development of INH mono-resistance; IPT is cost-effective and cheaper than the cost of treating cases of active TB that would develop without IPT; ART and IPT have an additive effect on the prevention of TB, and both are safe and beneficial even in children. In order to sustain the recorded gains from ART scale-up and to further reduce TB-related morbidity and mortality, more efforts are needed to scale-up IPT implementation globally.
基金funded in part by the United Nations Children's Fund(UNICEF)(grant number:UNICEF 2018-Nutrition-2.1.2.3)the Chinese Nutrition Society-National Nutrition Science Research Grant(grant number:CNS-NNSRG2019-97).
文摘Objective:We examined the association between body mass index(BMI)and body fat percentage(BF%)measured by dual-energy X-ray absorptiometry(DXA)among adults and children in China.Methods:We searched four databases-PubMed,China National Knowledge Infrastructure,Wanfang,and Vip for studies published in the past 22 years.Meta-analysis was conducted using random-or fixed-effect models.Results:In total of 21 studies met inclusion criteria and were included in review,and 17 ot them in meta-analysis.They were conducted across China.Their sample size ranged from 62 to 5726,and participants'age ranged from 6-80 years.Meta-analysis revealed strong associations between BMI and BF% measured by DXA in adults(pooled r=0.71,95% CI:0.66 to 0.74)and children(pooled r=0.60,95% CI:0.52 to 0.68).The association was stronger in Northern China than in East China in children(β=-0.40,95%CI:-0.65 to-0.14)and in Central China in adults(β=-0.25;95% CI:-0.51 to-0.01).Urban children's BMI was strongly associated with BF%than rural(β=0.19;95%CI:0.04 to 0.35),whereas it was stronger in adults living in rural than in urban(β=-0.35;95% CI:-0.66 to-0.05).Conclusions:BMI was strongly associated with BF%measured by DXA,and the association in children and adults in China varied by residence and region.
文摘Introduction: Perinatal asphyxia is one of the leading causes of perinatal death and a recognized cause of neuromotor disability among survivors. About 20% - 30% of asphyxiated newborns who develop hypoxic ischemic encephalopathy (HIE) die during the neonatal period, and one third to one half of survivors are left with cerebral palsy and mental retardation. Objective of the Study: Was to determine the effect of magnesium sulphate as neuroprotective drug in hypoxic ischemic encephalopathy resulting from severe perinatal asphyxia. Materials and Methods: A prospective administration of magnesium sulphate to 52 severely asphyxiated newborns with hypoxic ischemic encephalopathy was conducted over one year period from 1st August 2017 to 31st July 2018. Results: Most (96.2%) of patients were term baby (GA ≥ 37 weeks). Most (90.4%) were in-hospital born, vaginal delivery accounted for 55.8% and 44.2% assisted delivery respectively. About one half (55.8%) of the patients commenced MgSO4 therapy at <6 hours after birth, while 30.6% and 16.6% commenced MgSO4 therapy at 6 - <24 hours and >24 hours after birth respectively. Time of commencement of first enteral feeding (p = 0.018) and time to full enteral feeding (p = 0.015) showed significant correlation with the survival without neurological deficit. The earlier the commencement of MgSO4 therapy, the better the proportion with strong palmar grasp, sucking reflex, tone and early resolution of encephalopathy. Conclusion: All the study subjects treated with magnesium sulphate had impressive improvement;however there is a need to conduct randomized placebo-controlled trial treatment of severe perinatal asphyxia so as to determine its effects on early resolution of hypoxic ischemic encephalopathy/neuroprotective activity.
文摘Background: Effective ART with low viral loads and absence of STIs significantly reduce chances of sexual transmission of HIV. ART is therefore a key pillar in HIV prevention. Appropriate support is however essential for optimum treatment outcome, patient safety and HIV prevention benefit. The scale-up of ART continues to strain the already overstretched human resources in public facilities, impacts on the quality of care, and contributes to loss to follow-up. Task shifting is therefore a strategy to augment the limited human resources. Methodology: In partnership with the Livingstone General Hospital (LGH) and four private pharmacists, the COH III Project through Howard University is promoting quality HIV care by engaging the pharmacists in adherence counselling and treatment monitoring. The LGH ART pharmacist allocates consenting stable ART clients to pharmacies based on willingness to be referred and patient preference. Patients are given schedule of visits to pharmacies where the pharmacists provide medication/adherence counselling and monitor side effects. Patients with medication/treatment issues are referred back to the LGH ART clinic for follow-up. Results: Between October 2012 and August 2013, 280 patients were enrolled and followed up by the four pharmacists. 69% of patients visited the pharmacy at least once, 25% at least twice and 13% at least thrice. The 33 client referrals by pharmacists to LGH were related to adverse drug reactions, suspected treatment failure, pregnancy, and treatment monitoring. The intervention has reduced workload for the ART pharmacist;improved communication of treatment challenges and identification of patients with medication related problems, and reduced travel distances and waiting times. This has resulted in improved adherence and better patient outcomes. Conclusion: Private pharmacists present an opportunity to improve quality of HIV interventions in poor human resource capacity settings. The necessary legal and regulatory framework needs to however be developed to guide the process.
文摘Summary What is already known about this topic?The World Health Organization consolidated guidelines on recommend care for tuberculosis(TB)and support for multidrug-resistant TB(MDR-TB)patients.But guidelines have not provided detailed guidance or tools for health services providers to implement comprehensive patient care.
基金All the studies reported in this paper were funded by WHO through OCP or APOC,who also provided technical support in the design,implementation(quality control)interpretation of the baseline data.
文摘Background:Onchocerciasis is endemic in 12 of the 14 health districts of Sierra Leone.Good treatment coverage of community-directed treatment with ivermectin was achieved between 2005 and 2009 after the 11-year civil conflict.Sentinel site surveys were conducted in 2010 to evaluate the impact of five annual rounds of ivermectin distribution.Methods:In total,39 sentinel villages from hyper-and meso-endemic areas across the 12 endemic districts were surveyed using skin snips in 2010.Results were analyzed and compared with the baseline data from the same 39 villages.Results:The average microfilaridermia(MF)prevalence across 39 sentinel villages was 53.10%at baseline.The MF prevalence was higher in older age groups,with the lowest in the age group of 1-9 years(11.00%)and the highest in the age group of 40-49 years(82.31%).Overall mean MF density among the positives was 28.87 microfilariae(mf)/snip,increasing with age with the lowest in the age group of 1-9 years and the highest in the age group of 40-49 years.Males had higher MF prevalence and density than females.In 2010 after five rounds of mass drug administration,the overall MF prevalence decreased by 60.26%from 53.10%to 21.10%;the overall mean MF density among the positives decreased by 71.29%from 28.87 mf/snip to 8.29 mf/snip;and the overall mean MF density among all persons examined decreased by 88.58%from 15.33 mf/snip to 1.75 mf/snip.Ten of 12 endemic districts had>50%reduction in MF prevalence.Eleven of 12 districts had≥50%reduction in mean MF density among the positives.Conclusions:A significant reduction of onchocerciasis MF prevalence and mean density was recorded in all 12 districts of Sierra Leone after five annual MDAs with effective treatment coverage.The results suggested that the onchocerciasis elimination programme in Sierra Leone was on course to reach the objective of eliminating onchocerciasis in the country by the year 2025.Annual MDA with ivermectin should continue in all 12 districts and further evaluations are needed across the country to assist the NTDP with programme decision making.
