Public policy, health system, and community actions against illness as platforms for response to NCDs in Tanzania: a narrative review

This review was supported by grants from the Netherlands Organization for International Co-operation in Higher Education and the Ifakara Health Institute, Tanzania

Outpatient management of urinary tract infections by medical officers in Nairobi, Kenya: lack of benefit from audit and feedback on adherence to treatment guidelines

Abstract Introduction Acute uncomplicated urinary tract infections are common in outpatient settings but are not treated optimally. Few studies of the outpatient use of antibiotics for specific diagnoses have been done in sub-Saharan Africa, so little is known about the prescribing patterns of medical officers in the region. Methods Aga Khan University has 16 outpatient clinics throughout the Nairobi metro area with a medical officer specifically assigned to that clinic. A baseline assessment of evaluation and treatment of suspected UTI was performed from medical records in these clinics. Then the medical officer from each of the 16 clinics was recruited from each clinic was recruited with eight each randomized to control vs. feedback groups. Both groups were given a multimodal educational session including locally adapted UTI guidelines and emphasis on problems identified in the baseline assessment Each record was scored using a scoring system that was developed for the study according to adequacy of history, physical examination, clinical diagnosis matching recorded data, diagnostic workup and treatment. Three audits were done for both groups; baseline (audit 1), post-CME (audit 2), and a final audit, which was after feedback for the feedback group (audit 3). The primary analysis assessed overall guideline adherence in the feedback group versus the CME only group. Results The overall scores in both groups showed significant improvement after the CME in comparison to baseline and for each group, the scores in most domains also improved. However, audit 3 showed persistence of the gains attained after the CME but no additional benefit from the feedback. Some deficiencies that persisted throughout the study included lack of workup of possible STI and excess use of non-UTI laboratory tests such as CBC, stool culture and H. pylori Ag. After the CME, the use of nitrofurantoin rose from only 4% to 8% and cephalosporin use increased from 49 to 67%, accompanied by a drop in quinolone use. Conclusion The CME led to modest improvements in patient care in the categories of history taking, treatment and investigations, but feedback had no additional effect. Future studies should consider an enforcement element or a more intensive feedback approach

Collaboration paradox: Scientific productivity, the Internet, and problems of research in developing areas

(Ghana). The approach taken in the analysis was developed in a series of meetings held at the National Center for Ecological Analysis and Synthesis in Santa Barbara during this same period of time. This group of ‘Bobcows ’ was convened by Edward Hackett to examine the process of scientific collaboration in a variety of forms. We based the present work on similar analyses by Barry Bozeman, Sooho Lee, John Walsh and Nancy Mahoney. However, our gratitude is first and foremost to the outstanding teams of postgraduate interviewers from Loyola College of Social Sciences (Kerala), th

When do scientists adopt the Internet? Dimensions of connectivity in developing areas

We examine the diffusion of information and communication technologies (ICTs) in the knowledge production sectors of three developing areas. Using interviews with 918 scientists in one South Asian and two African locations, we address three fundamental questions: (1) To what degree has the research community in the developing world adopted the Internet? (2) How can the disparities in Internet adoption best be characterized? (3) To what extent is Internet use associated with research productivity? Our findings indicate that while the vast majority of scientists describe themselves as current email users, far fewer have ready access to the technology, use it in diverse ways, or have extensive experience. These results are consistent with the notion that Internet adoption should not be characterized as a single act on the part of users. The rapid development of the Internet and the cumulative skills required for its effective use are equally important, particularly its impact on productivity. These findings lead us to qualify crude generalizations about the diffusion of the Internet in developing areas. © 2005 Akadémiai Kiadó, Budapest All rights reserved

Collaboration paradox: Scientific productivity, the Internet, and problems of research in developing areas

We examine the ways in which the research process differs in developed and developing areas by focusing on two questions. First, is collaboration associated with productivity? Second, is access to the Internet (specifically use of email) associated with reduced problems of collaboration? Recent analyses by Lee & Bozeman (2005) and Walsh & Maloney (2003) suggest affirmative answers to these questions for US scientists. Based on a comparative analysis of scientists in Ghana, Kenya, and the State of Kerala in south-western India (N 918), we find that: (1) collaboration is not associated with any general increment in productivity; and (2) while access to email does attenuate research problems, such difficulties are structured more by national and regional context than by the collaborative process itself. The interpretation of these results suggests a paradox that raises issues for future studies: those conditions that unsettle the relationship between collaboration and productivity in developing areas may undermine the collaborative benefits of new information and communication technologies. © SSS and SAGE Publications

Mobile phones andcore network growth in Kenya: Strengthening weak ties

In contrast to recent US studies showing a decrease in core network size, our Kenyan data reveals substantial network growth. We attribute this to the diffusion of mobile telephones. Results from pooled survey data from Nairobi professionals and entrepreneurs in 2002 and 2007 as well as qualitative interviews from 2007 to 2009 show virtual saturation in the diffusion of phones during this period, but no direct effect of technology use. What explains this puzzle is a network effect of mobile telephony: increased technological access to existing networks in a context of resource scarcity leads to a strengthening of weak ties and the enhancement of core networks among Kenyans. Video ethnographic data before and after the 2007 post-election unrest supports this interpretation, showing that mobile phones are a crucial resource in managing interpersonal networks for instrumental purposes. © 2010 Elsevier Inc

Are mobile phones changing social networks? a longitudinal study of core networks in Kerala

Mobile telephony has diffused more rapidly than any Indian technology in recent memory, yet systematic studies of its impact are rare, focusing on technological rather than social change. We employ network surveys of separate groups of Kerala residents in 2002 and again in 2007 to examine recent shifts in mobile usage patterns and social relationships. Results show (1) near saturation of mobiles among both the professionals and nonprofessionals sampled, (2) a decrease in the number of social linkages across tie types and physical locations, and (3) a shift towards friends and family but away from work relationships in the core networks of Malayalis. We interpret these findings as support for the bounded solidarity thesis of remote communication that emphasizes social insulation and network closure as mobiles shield individuals from their wider surroundings. © The Author(s) 2011

Additional file 1 of Outpatient management of urinary tract infections by medical officers in Nairobi, Kenya: lack of benefit from audit and feedback on adherence to treatment guidelines

Additional file 1: Appendix 1. Guidelines for diagnosis and treatment of acute UTI in women. Appendix 2. UTI Scoring sheet. Appendix 3. Scoring criteria on the Medical Officers’ adherence to locally adopted Acute Uncomplicated UTI management guidelines

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