Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker's perspective.

BACKGROUND: The impact of the Integrated Management of Childhood Illness (IMCI) strategy has been less than anticipated because of poor uptake. Electronic algorithms have the potential to improve quality of health care in children. However, feasibility studies about the use of electronic protocols on mobile devices over time are limited. This study investigated constraining as well as facilitating factors that influence the uptake of a new electronic Algorithm for Management of Childhood Illness (ALMANACH) among primary health workers in Dar es Salaam, Tanzania. METHODS: A qualitative approach was applied using in-depth interviews and focus group discussions with altogether 40 primary health care workers from 6 public primary health facilities in the three municipalities of Dar es Salaam, Tanzania. Health worker's perceptions related to factors facilitating or constraining the uptake of the electronic ALMANACH were identified. RESULTS: In general, the ALMANACH was assessed positively. The majority of the respondents felt comfortable to use the devices and stated that patient's trust was not affected. Most health workers said that the ALMANACH simplified their work, reduced antibiotic prescription and gave correct classification and treatment for common causes of childhood illnesses. Few HWs reported technical challenges using the devices and complained about having had difficulties in typing. Majority of the respondents stated that the devices increased the consultation duration compared to routine practice. In addition, health system barriers such as lack of staff, lack of medicine and lack of financial motivation were identified as key reasons for the low uptake of the devices. CONCLUSIONS: The ALMANACH built on electronic devices was perceived to be a powerful and useful tool. However, health system challenges influenced the uptake of the devices in the selected health facilities.

Spatially varying selection shapes life history clines among populations of Drosophila melanogaster from sub-Saharan Africa.

Clines in life history traits, presumably driven by spatially varying selection, are widespread. Major latitudinal clines have been observed, for example, in Drosophila melanogaster, an ancestrally tropical insect from Africa that has colonized temperate habitats on multiple continents. Yet, how geographic factors other than latitude, such as altitude or longitude, affect life history in this species remains poorly understood. Moreover, most previous work has been performed on derived European, American and Australian populations, but whether life history also varies predictably with geography in the ancestral Afro-tropical range has not been investigated systematically. Here, we have examined life history variation among populations of D. melanogaster from sub-Saharan Africa. Viability and reproductive diapause did not vary with geography, but body size increased with altitude, latitude and longitude. Early fecundity covaried positively with altitude and latitude, whereas lifespan showed the opposite trend. Examination of genetic variance-covariance matrices revealed geographic differentiation also in trade-off structure, and QST -FST analysis showed that life history differentiation among populations is likely shaped by selection. Together, our results suggest that geographic and/or climatic factors drive adaptive phenotypic differentiation among ancestral African populations and confirm the widely held notion that latitude and altitude represent parallel gradients.

Pas-kaart van Europa met een gedeelte van de kust van Africa tot aen Cabo verde - [Yleisnäkymä - Overview]

1 Amsterdam 1665

Reconceptualizing Chinese state-owned entreprise in Africa : double embeddedness and localization in Ghana

Challenging the view of asymmetrical power relations between China and Africa, this thesis questions the "Chinese comparative advantages" (monolithic state power and economic advantages) of Chinese state-owned enterprises (SOEs) in Africa. It argues that the power dynamics between Chinese and African actors are dialectical and pluralistic, with localized social capital representing the true Chinese competitive advantage in Africa. Based on ethnographical fieldwork conducted in Ghana, this thesis shows that Chinese SOEs pursue their globalization in a double context - that of the deliberate "retreat" of the Chinese state, and more importantly, that of Ghanaian governance and society (characterized by political party patronage, extraversion dynamics, and worker agency). The trajectories of Chinese expatriates' expatriation/ social promotion and their SOEs' globalization/ localization are mutually influenced and reinforced. By cultivating local relationships and knowledge, a provincial Chinese SOE in Ghana can outperform a large Chinese central SOE, even if the latter has more support from the Chinese state. Moreover, the recent effort to build a "socially acceptable Chinese community" in Ghana has renewed the power dynamics between the Chinese state and the SOEs. All these observations provide for constructing a new perspective of Chinese SOEs in Africa - a "second-class" Chinese globalization - the SOEs may begin with few privileges, but promotion over time is possible. -- A contre pied des approches postulant des relations de pouvoir asymétriques entre la Chine et l'Afrique, cette thèse interroge les « avantages comparatifs chinois » (pouvoir de l'État monolithique et avantages économiques) des entreprises publiques chinoises (EPC) en Afrique. Elle soutient l'idée selon laquelle les dynamiques de pouvoir entre les acteurs chinois et africains est dialectique et pluraliste, et le capital social localisé étant le véritable avantage compétitif chinois en Afrique. S'appuyant sur un travail de terrain ethnographique au Ghana, cette thèse montre que les EPC poursuivent leur mondialisation dans un double contexte - celui de la «retraite» délibérée de l'État chinois, et, de façon plus importante, celui de la gouvernance et de la société ghanéennes (caractérisées par un clientélisme des partis politiques, une dynamique d'extraversion et le pouvoir de négociation des travailleurs). Les trajectoires d'expatriation / de promotion sociale des expatriés chinois et la mondialisation / localisation de leurs EPC s'influencent et se renforcent mutuellement. En cultivant des relations et des connaissances locales, une EPC provinciale au Ghana peut surpasser une grande EPC centrale, même si cette dernière reçoit plus de soutien de l'État chinois. En outre, les efforts récents visant à construire une «communauté chinoise socialement acceptable» au Ghana ont renouvelé la dynamique du pouvoir entre l'État chinois et les EPC. Ces observations permettent de construire une nouvelle perspective des EPC en Afrique - la globalisation chinoise de « deuxième classe » - les EPC peuvent débuter avec peu de privilèges, mais leur promotion reste possible avec le temps.

Distribution and risk factors for Plasmodium and helminth co-infections: a cross-sectional survey among children in Bagamoyo district, coastal region of Tanzania.

BACKGROUND: Plasmodium and soil transmitted helminth infections (STH) are a major public health problem, particularly among children. There are conflicting findings on potential association between these two parasites. This study investigated the Plasmodium and helminth co-infections among children aged 2 months to 9 years living in Bagamoyo district, coastal region of Tanzania. METHODS: A community-based cross-sectional survey was conducted among 1033 children. Stool, urine and blood samples were examined using a broad set of quality controlled diagnostic methods for common STH (Ascaris lumbricoides, hookworm, Strongyloides stercoralis, Enterobius vermicularis, Trichuris trichura), schistosoma species and Wuchereria bancrofti. Blood slides and malaria rapid diagnostic tests (mRDTs) were utilized for Plasmodium diagnosis. RESULTS: Out of 992 children analyzed, the prevalence of Plasmodium infection was 13% (130/992), helminth 28.5% (283/992); 5% (50/992) had co-infection with Plasmodium and helminth. The prevalence rate of Plasmodium, specific STH and co-infections increased significantly with age (p < 0.001), with older children mostly affected except for S. stercoralis monoinfection and co-infections. Spatial variations of co-infection prevalence were observed between and within villages. There was a trend for STH infections to be associated with Plasmodium infection [OR adjusted for age group 1.4, 95% CI (1.0-2.1)], which was more marked for S. stercoralis (OR = 2.2, 95% CI (1.1-4.3). Age and not schooling were risk factors for Plasmodium and STH co-infection. CONCLUSION: The findings suggest that STH and Plasmodium infections tend to occur in the same children, with increasing prevalence of co-infection with age. This calls for an integrated approach such as using mass chemotherapy with dual effect (e.g., ivermectin) coupled with improved housing, sanitation and hygiene for the control of both parasitic infections.

High blood pressure in Sub-Saharan Africa: why prevention, detection, and control are urgent and important

In 2010, hypertension in Sub-Saharan Africa was theleading risk for death, incr easing by 67% since 1990.Hypertension was estimated to cause more than500,000 deaths and 10 million years of life lost in2010 in Sub-Saharan Africa. It was also the sixthleading risk for disability (contributing to more than 11million disability-adjusted life years).3In Sub-Saharan Africa, stroke, the major clinical outcome of uncon-trolled hypertension, has increased 46% since 1990 tobecome the fifth leading risk for death.

Clinico-Pathological discrepancies in the Diagnosis of Causes of Maternal Death in Sub-Saharan Africa: Retrospective Analysis

Background Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. Methods and Findings A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n ¼ 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). Conclusions Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.