Exit ventriculoperitoneal shunt; enter endoscopic third ventriculostomy (ETV): contemporary views on hydrocephalus and their implications on management

Hydrocephalus has been known to affect humans since the birth of human medicine as it is described by Hippocrates. The management of this condition is however still dodged by challenges due to a poor understanding of its pathophysiology. The ventriculoperitoneal shunt presents considerable problems especially with respect to infection and shunt malfunction. Low income countries, that currently face the greater burden of paediatric hydrocephalus. experience an increased challenge with ventriculoperitoneal shunts due to a shortage of qualified personnel to handle shunt complications. Recent advances in neuro-endoscopic surgery have presented opportunities for alternative treatment options for hydrocephalus such as endoscopic third ventriculostomy (ETV). This paper explores the alternative views in the pathophysiology of hydrocephalus and how they explain the effectiveness of ETV in treating hydrocephalus arising from a variety of causes.

Non-use of Formal Health Services in Malawi: Perceptions from Non-users

Background The study upon which this paper is based was undertaken to understand users’ and non-users’ perceptions concerning facilitators and barriers to equitable and universal access to health care in resource-poor countries such as Malawi. In this study, non-users of health services were defined as people who were not in need of health services or those who had stopped using them due to significant barriers. Methods A total of 80 interviews with non-users of health services were conducted in Rumphi, Ntchisi, Phalombe and Blantyre Districts of Malawi. Interviews focused on why informants were not using formal health services at the time of data collection. In order to identify non-users, snowballing was used health surveillance assistants, village headmen and community members also helped. One focus group discussion was also conducted with non-users of health services who were members of the Zion Church. Results Informants described themselves as non-users of health services due to several reasons: cost of health services; long distances to health facilities; poor attitude of health workers; belief in the effectiveness of traditional medicines; old age and their failure to walk. Others were non-users due to their disability; hence they could not walk over long distances or could not communicate effectively with health providers. Some of these non-users were complete non-users, namely members of the Zion Church and those who believed in traditional medicine, and they stated that nothing could be done to transform them into users of health services. Other non-users stated that they could become users if their challenges were addressed e.g. for those who were non-users of health services due to poor attitudes of health workers, they stated that if these health workers were transferred they would be able to access health services. Conclusions Public health education targeting both health workers and non-users, ensuring a functional outreach program and addressing other health system challenges such as shortage of drugs and human resources would assist in transforming non-users into users of health services.

ASSESSING THE DETERMINANTS OF TISSUE CULTURE BANANA ADOPTION IN WESTERN KENYA

In this study cross-section data was used to analyze the effect of farmers’ demographic, socioeconomic and institutional setting, market access and physical attributes on the probability and intensity of tissue culture banana (TCB) adoption. The study was carried out between July 2011 and November 2011. Both descriptive (mean, variance, promotions) and regression analysis were used in the analysis. A double hurdle regression model was fitted on the data. Using multistage sampling technique, four counties and eight sub-locations were randomly selected. Using random sampling technique, three hundred and thirty farmers were selected from a list of banana households in the selected sub-locations. The adoption level of tissue culture banana (TCB) was about 32%. The results also revealed that the likelihood of TCB adoption was significantly influenced by: availability of TCB planting material, proportion of banana income to the total farm income, per capita household expenditure and the location of the farmer in Kisii County; while those that significantly influenced the intensity of TCB adoption were: occupation of farmers, family size, labour source, farm size, soil fertility, availability/access of TCB plantlets to farmers, distance to banana market, use of manure in planting banana, access to agricultural extension services and index of TCB/non-TCB banana cultivar attributes which were scored by farmers. Compared to West Pokot County, farmers located in Bungoma County are more significantly and likely to adopt TCB technology. Therefore, the results of the study suggest that the probability of adoption and intensity of the use of TCB should be enhanced. This can be done by taking cognizance of these variables in order to meet the priority needs of the smallholder farmers who were the target group. This would lead to alleviating banana shortage in the region for enhanced food security. Subsequently, actors along the banana value chain are encouraged to target the intervention strategies based on the identified farmer, farm and institutional characteristics for enhanced impact on food provision. Opening up more TCB multiplication centres in different regions will make farmers access the TCB technology for enhanced impact on the target population.

A Qualitative Study of the Status of Children’s Play From the Viewpoints of Experts and Suggestions for Promotion Interventions

Background: The latest national census reports the population of Iranian children (1 - 8 years old) about 11 millions. On the other hand, the latest population policies approved by supreme cultural revolution council (SCRC) will make this population increase faster. Childhood development is one of the social determinants of health, of which “child’s play” is a part. Objectives: This study is an effort to identify difficulties and challenges of the plays influential on Iranian children’s health nationwide, in order to present enhancive strategies by utilizing the views of stakeholders and national studies. Patients and Methods: Analyzing children’s play stakeholders, main organizations were identified and views of 13 informed people involved in the field were investigated through deep semi-structured interview. A denaturalized approach was employed in analyzing the data. In addition to descriptions of the state, interventions development, and designing the conceptual model, national reports and studies, and other countries’ experiences were also reviewed. Results: Society’s little knowledge of “children’s plays”, absence of administrators for children’s play, shortage of public facilities for children’s play and improper geographical and demographic availability, absence of policies for Iranian “toy”, and little attention of media to the issue are the five major problems as stated by interviewees. Conclusions: The proposed interventions are presented as “promoting the educational levels of parents and selected administrators for children’s play”, “approving the play and toy policy for Iran 2025”, and “increasing public facilities for children’s play with defined distribution and availability”.