Population Differences in Death Rates in HIV-Positive Patients with Tuberculosis.

SETTING: Randomised controlled clinical trial of Mycobacterium vaccae vaccination as an adjunct to anti-tuberculosis treatment in human immunodeficiency virus (HIV) positive patients with smear-positive tuberculosis (TB) in Lusaka, Zambia, and Karonga, Malawi. OBJECTIVE: To explain the difference in mortality between the two trial sites and to identify risk factors for death among HIV-positive patients with TB. DESIGN: Information on demographic, clinical, laboratory and radiographic characteristics was collected. Patients in Lusaka (667) and in Karonga (84) were followed up for an average of 1.56 years. Cox proportional hazard analyses were used to assess differences in survival between the two sites and to determine risk factors associated with mortality during and after anti-tuberculosis treatment. RESULTS: The case fatality rate was 14.7% in Lusaka and 21.4% in Karonga. The hazard ratio for death comparing Karonga to Lusaka was 1.47 (95% confidence interval [CI] 0.9-2.4) during treatment and 1.76 (95%CI 1.0-3.0) after treatment. This difference could be almost entirely explained by age and more advanced HIV disease among patients in Karonga. CONCLUSION: It is important to understand the reasons for population differences in mortality among patients with TB and HIV and to maximise efforts to reduce mortality

Design of the HIV Prevention Trials Network (HPTN) Protocol 054: A cluster randomized crossover trial to evaluate combined access to Nevirapine in developing countries

HPTN054 is a cluster randomized trial designed to compare two approaches to providing single dose nevirapine to HIV-seropositive mothers and their infants to prevent mother-to-child transmission of HIV in resource limited settings. A number of challenging issues arose during the design of this trial. Most importantly, the need to achieve high participation rates among pregnant, HIV-seropositive women in selected prenatal care clinics led us to develop a method of collecting anonymous and unlinked information on a key surrogate endpoint instead of pursuing linked and identified information on a clinical endpoint. In addition, since group counseling is the standard model for prenatal care in sub-Saharan Africa, the prenatal care clinic serves as the unit of randomization. However, constraints on the number of suitable clinics and other logistical difficulties necessitated a unique type of hybrid parallel/stepped wedge cluster randomized design in which some clinics cross over between the two treatment modalities and some do not. We describe the design for the HPTN054 trial with an emphasis on the logistic and statistical features that allowed us to address these issues. We also provide some general statistical results that are useful for computing power in parallel, crossover, stepped wedge or mixed designs of cluster randomized trials

Promoting Entrepreneurship amid Youth in Windhoek’s Informal Settlements: A Namibian Case

Considering the high unemployment rate among Namibian youth and a lack of job opportunities, the promotion of entrepreneurship has gained wider attention in the country. A number of initiatives have been started such as entrepreneurship trainings and workshops, business idea competitions, etc. All these aim to inspire young people to think of alternative income sources. As part of a two-year funded community outreach research and development (R&D) project, we have investigated participatory approaches to engage marginalized youth into conceptualizing their own context, imparting skills, and deriving new career paths. This article reports and reflects on one of the interventions we have recently concluded with a group of youth in Havana, an informal settlement in the outskirts of Windhoek. We conducted what we entitled “The Havana Entrepreneur”, a series of interactions inspired upon the model of the American reality game show “The Apprentice”. Over a number of weeks two youth groups were given challenges to tackle by means of competing against one another. After completion of each challenge, groups were rated by a number of judges on skills demonstrated such as marketing, presentation, reflection and creativity among others. We observed an increase in, and improvement of skills revealed along tasks’ completion, besides an openly expressed self-realization and discovery of abilities by participants. Moreover, the youth are currently engaged in the continuation of activities beyond the initial entrepreneurial interactions. Thus we suggest replicating “The Havana Entrepreneur”, including the recording on camera of it by the youth themselves as a new mode to instigating a wider entrepreneurial spirit in informal settlements

Quality of education : a case for Zambia and Norway

Global knowledge, GK 30

Investigation of Hindrances Towards Women Involvement in Tour Guiding Activities in Tanzania: A Case of Arusha Municipality

Tourism is the large and fast growing industry which serves as a source of economic gain worldwide. The millennium Development Goals clearly state to "eradicate extreme poverty and hunger" as goal number one and " to promote gender equality and empower women" as goal number three. Unfortunately women do not seem to actively engage in tourism activities. This study therefore set to specifically investigate hindrances towards women involvement in tour guide activities in Arusha municipality. Three objectives were used; to assess the current trend of women involvement in tour guiding activities in Arusha municipality, to establish challenges faced by women in tour guiding activities and to examine support given to women in their participation to tour guide activities. Descriptive survey was employed as a research design. Convenience sampling method was applied to obtain 13 tourism subordinate staff 22 tour guides, and 31 tourism students while purposive technique was applied to obtain 10 officials and 30 students in FGD. Data was collected through interview, questionnaire and FGD. Qualitative data was processed and analyzed using computer Microsoft word, Excel and computer software SPSS (16.0) where qualitative data was analyzed using descriptive technique. The study established that women participation in tour guide activities were constrained by unconducive working environments, responsibilities in the family matters, constraints of culture and traditions, lack of education, gender inequality and financial problems. The study strongly recommends the Government and policy makers to strengthen rules and project systems to empower women and gender equality within tourism industry and tourism stake holders

The factors affecting the adoption of e-pacra services through the government service bus: a case study of pacra customers in Lusaka.

ThesisThe study was conducted to establish the factors affecting the adoption of e-PACRA services through the Government Service Bus. The study adapted the UTAUT model as a conceptual framework to formulate and generate the five hypotheses as determinants and predictors, and the survey questionnaire was used for data collection. The research study assessed the factors affecting the adoption of the e-PACRA services that were provided through the Government Service Bus under the Smart Zambia Institute in order to ascertain and identify whether adoption and actual usage of electronic services were affected by the five constructs/predictors of the UTAUT model. The study was conducted in Lusaka, the capital city of Zambia, and the Cochrane’s Formula was used to derive the sample size of 132. The target population was the PACRA customers that primarily register businesses and use online services. The location, site, and interfaces used to conduct the study were the One-Stop Shop in Lusaka’s CBD and complimentary information from PACRA’s head office and Smart Zambia Institute. The data captured was qualitatively and quantitatively analysed from the structured questionnaires collected from various respondents. The survey questionnaire used was generated based on the UTAUT conceptual model and took into account the five predictors: PE, SI, EE, FC, and BI, to determine the adoption and actual use of the e-PACRA services. The response rate was 100% of 132 respondents through the survey questionnaires, with 85 (64.4%) being male and 47 (35.6%) being female. Parameters included age, educational attainment, employment type, and marital status, which were descriptively represented. The study also used a five-point Likert scale in its questionnaire. The output of the data was eventually analysed by SPSS and the ANOVA test to determine the relationship between variables. Three out of the five (5) hypotheses were accepted as they showed a statistically significant relationship between the variables. These variable constructs, effort expectancy, facilitating conditions, and behavioural intention, represented the building models 2, 4, and 5 in this study. The measure of the p-value was at ≤ 0.05. The research implications suggest how the findings may be important for policy, socio-economic development, practice, theory, and subsequent research. Keywords: PACRA, Smart Zambia Institute, e-PACRA, e-Government, Government Service Bus, UTAUT Mode

Ensuring Quality in AFRINEST and SATT: Clinical Standardization and Monitoring

Background: Three randomized open-label clinical trials [Simplified Antibiotic Therapy Trial (SATT) Bangladesh, SATT Pakistan and African Neonatal Sepsis Trial (AFRINEST)] were developed to test the equivalence of simplified antibiotic regimens compared with the standard regimen of 7 days of parenteral antibiotics. These trials were originally conceived and designed separately; subsequently, significant efforts were made to develop and implement a common protocol and approach. Previous articles in this supplement briefly describe the specific quality control methods used in the individual trials; this article presents additional information about the systematic approaches used to minimize threats to validity and ensure quality across the trials. Methods: A critical component of quality control for AFRINEST and SATT was striving to eliminate variation in clinical assessments and decisions regarding eligibility, enrollment and treatment outcomes. Ensuring appropriate and consistent clinical judgment was accomplished through standardized approaches applied across the trials, including training, assessment of clinical skills and refresher training. Standardized monitoring procedures were also applied across the trials, including routine (day-to-day) internal monitoring of performance and adherence to protocols, systematic external monitoring by funding agencies and external monitoring by experienced, independent trial monitors. A group of independent experts (Technical Steering Committee/Technical Advisory Group) provided regular monitoring and technical oversight for the trials. Conclusions: Harmonization of AFRINEST and SATT have helped to ensure consistency and quality of implementation, both internally and across the trials as a whole, thereby minimizing potential threats to the validity of the trials’ results

Implementation of the new WHO recommendations on HIV and infant feeding: Challenges and the way forward

Breast milk provides all the nutrient needs of the infant especially in the first six months of life and also protects the growing infant from pneumonia, diarrhoea, and malnutrition, which are the major causes of morbidity and mortality in the African Region. However breastfeeding is also known to transmit the Human Immunodeficiency Virus (HIV) from mother to the child. Several guidelines have been developed to guide policy makers, health workers and mothers on the most appropriate methods to feed HIV exposed infants. Previous HIV and infant feedingguidelines emphasized on preventing infants from becoming infected with HIV by counseling HIV-infected mothers to avoid all breastfeeding. Over the period, programme implementers and researchers have reported difficulties in implementing earlier recommendations and guidelines on HIV and infant feeding within health-care systems. New evidence now shows that giving Anti-Retroviral therapy (ARVs) to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV through breastfeeding. Thus, in 2010 World HealthOrganization (WHO) issued the latest guidelines on HIV and infant feeding entitled Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. The 2010 WHO guidelines have changed the recommendations on how HIV infected mothers should feed their infants, and how health workers should support them. National authorities in each country can decide which infant feeding practice will be primarily promoted and supported by Maternal and Child Health services, i.e. breastfeeding with an antiretroviral intervention to reduce transmission or avoidance of all breastfeeding. Previous guidelines and  recommendations on infant feeding in the context of HIV have undergone frequent changes over the past decade. The adaptation and implementation of previous and current guidelines at national level have met challenges. These include lack of consensus among key stakeholders, inadequate funding for the additional cost of providing ARVs to the mother or the child and difficulties in communicating the recommendations in the new guidelines clearly to mothers, health workers and policy makers. To address these challenges a number of proposals have been suggested such as coordinated consensus building process, costing of interventions and a phased implementation approach to ensure successful scale up over time. This paper describes the process of adapting global HIV and infant feeding recommendations and guidelines at national level. It also reviews the challenges encountered in implementation and proposes the way forward in addressing them

Challenges and Opportunities in Cassava Production among the Rural Households in Kilifi County in the Coastal Region of Kenya

In Kenya, food security and poverty alleviation are some of the most important factors that the country must address in order to achieve the vision 2030. Cassava has potential not only as food for humans, but also as feed for livestock and as a substrate for biofuel production.  Although various constraints have been reported to afflict farmers in cassava production, a base line survey in the study sites (Kilifi and Kaloleni) was necessary to identify specific constraints facing farmers in this region so as to identify areas of intervention in production and utilization. Lack of disease free planting materials was identified as one of the major constraints since cassava mosaic disease (CMD) and the cassava brown streak disease (CBSD) pose serious threats in yield losses. The two diseases are transmitted by vectors and by diseased planting materials and almost all the farmers obtain their planting materials from their neighbours thus aiding in disease dissemination and compounding the problem. There is need to enable the community produce quality cassava seed and operate sustained cassava business, integrate legumes into cassava cropping systems and create an innovative value addition chain for utilization of cassava. Eighty percent of Kenya is marginal area and cassava being drought tolerant can enable the potential of these areas to be tapped thus helping to deal with the persistent food insecurity which is a common feature in these areas. Key words: Cassava, cowpeas, cultivars, production constraints, utilizatio