A Rapid Assessment of the Quality of Neonatal Healthcare in Kilimanjaro Region, Northeast Tanzania.

While child mortality is declining in Africa there has been no evidence of a comparable reduction in neonatal mortality. The quality of inpatient neonatal care is likely a contributing factor but data from resource limited settings are few. The objective of this study was to assess the quality of neonatal care in the district hospitals of the Kilimanjaro region of Tanzania. Clinical records were reviewed for ill or premature neonates admitted to 13 inpatient health facilities in the Kilimanjaro region; staffing and equipment levels were also assessed. Among the 82 neonates reviewed, key health information was missing from a substantial proportion of records: on maternal antenatal cards, blood group was recorded for 52 (63.4%) mothers, Rhesus (Rh) factor for 39 (47.6%), VDRL for 59 (71.9%) and HIV status for 77 (93.1%). From neonatal clinical records, heart rate was recorded for3 (3.7%) neonates, respiratory rate in 14, (17.1%) and temperature in 33 (40.2%). None of 13 facilities had a functioning premature unit despite calculated gestational age <36 weeks in 45.6% of evaluated neonates. Intravenous fluids and oxygen were available in 9 out of 13 of facilities, while antibiotics and essential basic equipment were available in more than two thirds. Medication dosing errors were common; under-dosage for ampicillin, gentamicin and cloxacillin was found in 44.0%, 37.9% and 50% of cases, respectively, while over-dosage was found in 20.0%, 24.2% and 19.9%, respectively. Physician or assistant physician staffing levels by the WHO indicator levels (WISN) were generally low. Key aspects of neonatal care were found to be poorly documented or incorrectly implemented in this appraisal of neonatal care in Kilimanjaro. Efforts towards quality assurance and enhanced motivation of staff may improve outcomes for this vulnerable group

Quality Of Antenatal Care In Rural Southern Tanzania: A Reality Check.

Counselling on the danger signs of unpredictable obstetric complications and the appropriate management of such complications are crucial in reducing maternal mortality. The objectives of this study were to identify gaps in the provision of ANC services and knowledge of danger signs as well as the quality of care women receive in case of complications. The study took place in the Rufiji District of Tanzania in 2008 and was conducted in seven health facilities. The study used (1) observations from 63 antenatal care (ANC) sessions evaluated with an ANC checklist, (2) self-assessments of 11 Health workers, (3) interviews with 28 pregnant women and (4) follow-up of 12 women hospitalized for pregnancy-related conditions.Blood pressure measurements and abdominal examinations were common during ANC visits while urine testing for albumin or sugar or haemoglobin levels was rare which was often explained as due to a lack of supplies. The reasons for measuring blood pressure or abdominal examinations were usually not explained to the women. Only 15/28 (54%) women were able to mention at least one obstetric danger sign requiring medical attention. The outcomes of ten complicated cases were five stillbirths and three maternal complications. There was a considerable delay in first contact with a health professional or the start of timely interventions including checking vital signs, using a partograph, and detailed record keeping. Linking danger signs to clinical and laboratory examination results during ANC with the appropriate follow up and avoiding delays in emergency obstetric care are crucial to the delivery of coordinated, effective care interventions

The potential for immunoglobulins and host defense peptides (HDPs) to reduce the use of antibiotics in animal production

Abstract Innate defense mechanisms are aimed at quickly containing and removing infectious microorganisms and involve local stromal and immune cell activation, neutrophil recruitment and activation and the induction of host defense peptides (defensins and cathelicidins), acute phase proteins and complement activation. As an alternative to antibiotics, innate immune mechanisms are highly relevant as they offer rapid general ways to, at least partially, protect against infections and enable the build-up of a sufficient adaptive immune response. This review describes two classes of promising alternatives to antibiotics based on components of the innate host defense. First we describe immunoglobulins applied to mimic the way in which they work in the newborn as locally acting broadly active defense molecules enforcing innate immunity barriers. Secondly, the potential of host defense peptides with different modes of action, used directly, induced in situ or used as vaccine adjuvants is described

Investigation of engineering properties of normal and high strength fly ash based geopolymer and alkali-activated slag concrete compared to ordinary Portland cement concrete

Fly ash-based geopolymer (FAGP) and alkali-activated slag (AAS) concrete are produced by mixing alkaline solutions with aluminosilicate materials. As the FAGP and AAS concrete are free of Portland cement, they have a low carbon footprint and consume low energy during the production process. This paper compares the engineering properties of normal strength and high strength FAGP and AAS concrete with OPC concrete. The engineering properties considered in this study included workability, dry density, ultrasonic pulse velocity (UPV), compressive strength, indirect tensile strength, flexural strength, direct tensile strength, and stress-strain behaviour in compression and direct tension. Microstructural observations using scanning electronic microscopy (SEM) are also presented. It was found that the dry density and UPV of FAGP and AAS concrete were lower than those of OPC concrete of similar compressive strength. The tensile strength of FAGP and AAS concrete was comparable to the tensile strength of OPC concrete when the compressive strength of the concrete was about 35 MPa (normal strength concrete). However, the tensile strength of FAGP and AAS concrete was higher than the tensile strength of OPC concrete when the compressive strength of concrete was about 65 MPa (high strength concrete). The modulus of elasticity of FAGP and AAS concrete in compression and direct tension was lower than the modulus of elasticity of OPC concrete of similar compressive strength. The SEM results indicated that the microstructures of FAGP and AAS concrete were more compact and homogeneous than the microstructures of OPC concrete at 7 days, but less compact and homogeneous than the microstructures of OPC concrete at 28 days for the concrete of similar compressive strength

Effect of mixture proportions on the drying shrinkage and permeation properties of high strength concrete containing class F fly ash

Sustainability of concrete can be improved by using large volume of fly ash as a replacement of cement and by ensuring improved durability of concrete. Durability of concrete containing large volume of class F fly ash is dependent on the design of mixture proportions. This paper presents an experimental study on the effect of mixture proportions on the drying shrinkage and permeation properties of high strength concrete containing large volume local class F fly ash. Concrete mixtures were designed with and without adjustments in the water to binder ratio (w/b) and the total binder content to take into account the incorporation of fly ash up to 40% of total binder. Concretes, in which the mixture proportions were adjusted for fly ash inclusion achieved equivalent strength of the control concrete and showed enhanced properties of drying shrinkage, sorptivity, water permeability and chloride penetration as compared to the control concrete. The improvement of durability properties was less significant when no adjustments were made to the w/b ratio and total binder content. The results show the necessity of the adjustments in mixture proportions of concrete to achieve improved durability properties when using class F fly ash as a cement replacement

Accumulation, tissue distribution, health hazard of microplastics in a commercially important cat fish, Silonia silondia from a tropical large-scale estuary

The current knowledge regarding the presence of microplastics (MPs) in the digestive tracts of fish, particularly the non-edible parts, provides limited assistance in assessing the risk to human health and establishing guideline values for policy-making purposes. Therefore, we conducted the first investigation into MPs within the commercially significant catfish species S. silondia, form a major tropical estuary assessing their accumulation, characteristics, and associated risks in various tissues, particularly the consumable muscle. A sum of 132 MPs were identified, and the mean abundance of MPs were 7.40 ± 4.12 item/DT, 3.20 ± 1.69 item/gill and 2.60 ± 1.65 item/muscle found in digestive tract (DT), gill and muscle of the fish, respectively. The strong relationships of MPs among three different tissues (y = 0.6069x - 22.69, R2 = 0.7589) indicated the pathways and how MPs were influenced by the physiology of organisms. The prevalence of MPs in fish muscle demonstrated their trophic transmission to humans. Moreover, fishes with higher weight had higher MPs in their gill, and DT. The dominant type, color and size of MPs were fibrous (89.67%), violet (41%) and &lt; 0.5 mm sized (94%), respectively. The high percentage of fibers suggests that they might have come from ropes, fishing nets or sewage. FTIR chemical composition analyses of microplastics (MPs) identified three primary polymer types: PET (44.5%), PE (33.3%), and PP (22.2%) in fish. These polymers are commonly associated with packaging materials, household wastes and plastic pipes. Contamination level assessment by CF (CF = 2.76) and PLI (PLI &gt; 1) indicated moderately to highly contaminated fish with MPs ingestion. While the complete understanding of the direct negative effects of microplastics (MPs) on human health remains elusive, their presence in estuarine fish raises concerns for both human and ecosystem health. The findings will be useful for assessing the hazards to human health from exposure to MPs and for creating effective risk management plans to reduce those risks

Assessment of factors associated with complete immunization coverage in children aged 12-23 months: a cross-sectional study in Nouna district, Burkina Faso

This study identifies specific factors associated with immunization status in Nouna health district (Burkina Faso) in order to advance improved intervention strategies in this district and in those with similar environmental and social contexts. While comprehensive communication may improve understanding about immunization, local interventions should also take into account religious specificities and critical economic periods. Communication problems need to be examined; for instance, many respondents did not understand what the health workers wanted; and or they assumed their child was already totally immunized. Particular approaches that take into consideration local distinctions need to be applied

Antimicrobial and antioxidant activity of kaempferol rhamnoside derivatives from Bryophyllum pinnatum

Abstract Background Bryophyllum pinnatum (Lank.) Oken (Crassulaceae) is a perennial succulent herb widely used in traditional medicine to treat many ailments. Its wide range of uses in folk medicine justifies its being called "life plant" or "resurrection plant", prompting researchers' interest. We describe here the isolation and structure elucidation of antimicrobial and/or antioxidant components from the EtOAc extract of B. pinnatum. Results The methanol extract displayed both antimicrobial activities with minimum inhibitory concentration (MIC) values ranging from 32 to 512 μg/ml and antioxidant property with an IC50 value of 52.48 μg/ml. Its partition enhanced the antimicrobial activity in EtOAc extract (MIC = 16-128 μg/ml) and reduced it in hexane extract (MIC = 256-1024 μg/ml). In addition, this process reduced the antioxidant activity in EtOAc and hexane extracts with IC50 values of 78.11 and 90.04 μg/ml respectively. Fractionation of EtOAc extract gave seven kaempferol rhamnosides, including; kaempferitrin (1), kaempferol 3-O-α-L-(2-acetyl)rhamnopyranoside-7-O-α-L-rhamnopyranoside (2), kaempferol 3-O-α-L-(3-acetyl)rhamnopyranoside-7-O-α-L-rhamnopyranoside (3), kaempferol 3-O-α-L-(4-acetyl)rhamnopyranoside-7-O-α-L-rhamnopyranoside (4), kaempferol 3-O-α-D- glucopyranoside-7-O-α-L-rhamnopyranoside (5), afzelin (6) and α-rhamnoisorobin (7). All these compounds, except 6 were isolated from this plant for the first time. Compound 7 was the most active, with MIC values ranging from 1 to 2 μg/ml and its antioxidant activity (IC50 = 0.71 μg/ml) was higher than that of the reference drug (IC50 = 0.96 μg/ml). Conclusion These findings demonstrate that Bryophyllum pinnatum and some of its isolated compounds have interesting antimicrobial and antioxidant properties, and therefore confirming the traditional use of B. pinnatum in the treatment of infectious and free radical damages.</p