Impact of cost sharing on utilization of primary health care Services: providers versus household perspectives

This study is set to match and compare results of the analysis of impacts of cost sharing on households with those on health-care providers in two selected districts in Tanzania. The setting is intended to establish and compare concurrently the impact of cost sharing on health-care utilization as viewed from both the providers and beneficiary households. The findings of the study indicate that quality of primary health care has improved as a result of the introduction of cost sharing. Attendance and hence utilization in health facilities has also increased. Mortality rate, at least for one district has not worsened. By implication then, cost sharing appears to have a positive impact on the provision of primary health care, except for a few cases that fail to consult because of the fees. An appropriately managed exemption facility is likely to eliminate the negative impact.

O impacto das telenovelas brasileiras nos luandenses

Vivemos uma era em que os distintos pontos geográficos do globo se tornaram mais próximos em virtude do estreitamento proporcionado pelo profundo avanço tecnológico dos meios de transporte, mas também pela evolução vertiginosa das novas tecnologias de comunicação que têm permitido fazer com que eventos ocorridos numa determinada região do planeta sejam vistos num outro ponto geográfico, com diferença de apenas algumas horas ou mesmo em tempo real. Graças a esse avanço tecnológico e ao consequente desenvolvimento do processo comercial de transmissão e receção de sinal de televisão por satélite e/ou por cabo, a par do veloz fluxo de informação, são também disponibilizados aos recetores conteúdos de entretenimento que refletem práticas culturais com características marcadamente identitárias, de outras sociedades. Considerando que determinadas condicionantes históricas e económicas do mundo não possibilitam um fluxo bidirecional dos referidos produtos televisivos e o facto de as empresas prestadoras destes serviços se dedicarem exclusivamente à venda de produtos, cujos conteúdos retratam práticas culturais de determinados países (em melhores condições de desenvolvimento económico e tecnológico) existe a possibilidade de se estar diante de um processo de difusão cultural e de aculturação de que são alvo os cidadãos dos países recetores dos referidos conteúdos. Este trabalho pretende efetuar uma análise do impacto das telenovelas brasileiras no comportamento dos luandenses, baseando-se numa pesquisa desenvolvida nos sete municípios da Província de Luanda. Os resultados da pesquisa revelam a presença de componentes culturais brasileiras em práticas sociais dos luandenses há várias gerações e mostram o papel transformador que as telenovelas brasileiras continuam a desempenhar nesta sociedade. A ausência nos canais de televisão locais de mensagens e imagens das representações endógenas favorece a apropriação de práticas culturais exógenas emitidas pelas produções brasileiras e a sua ressignificação no quotidiano local.

Quality of life after first-ever stroke: An interviewbased study from Blantyre, Malawi

Background In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL. Aim The aim of this study was to describe QOL more than six months after first-ever stroke in Malawi. Methods This was an interview-based study about a stroke-surviving cohort. Adult patients were interviewed six or twelve months after their first ever stroke. HIV status, modified stroke severity scale (mNIHSS) score, and brain scan results were recorded during the acute phase of stroke. At the time of the interviews, the modified Rankin scale (mRS) was used to assess functional outcome. The interviews applied the Newcastle Stroke-specific Quality of Life Measure (NEWSQOL). All the data were analysed using Statview™: the X2 test compared proportions, Student’s t-test compared means for normally distributed data, and the Kruskal-Wallis test was used for nonparametric data. Results Eighty-one patients were followed up at least six months after the acute stroke. Twenty-five stroke patients (ten women) were interviewed with the NEWSQOL questionnaire. Good functional outcome (lower mRS score) was positively associated with better QOL in the domains of activities of daily living (ADL)/self-care (p = 0.0024) and communication (p = 0.031). Women scored worse in the fatigue (p = 0.0081) and cognition (p = 0.048) domains. Older age was associated with worse QOL in the ADL (p = 0.0122) domain. Seven patients were HIV-seroreactive. HIV infection did not affect post-stroke QOL. Conclusion In Malawi, within specific domains, QOL after stroke appeared to be related to patients’ age, sex, and functional recovery in this small sample of patients.

The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study

Background In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL. Background Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization’s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. Methods A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Results Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. Conclusions The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.

THE ASSOCIATION OF DEMOGRAPHIC VARIABLES AND DIETARY HABITS ON BODY MASS INDEX OF FOREIGN-BORN POPULATION IN SOUTH KOREA

The Republic of Korea (Korea) has been composed of a single ethnic group and, until very recently, has had little or no experience with large-volume of immigrants. The country, once known for its large-scale emigration, has emerged as a popular destination. As the foreign-born populations continue to grow, they experience dietary pattern changes. Dietary changes of immigrants are often associated with weight increase and consequently the risk of non-communicable diseases such as diabetes. This study examined the association of demographic variables and dietary habits on Body Mass Index (BMI) of foreign nationals living in Korea, based on a cross-sectional sample of 193 foreign-born men (120) and women (73). A web-based survey program, Zoho survey, was used to capture self-reported region of origin, socio-demographic variables, weight, height, frequency of physical activity, and food frequencies. For the entire sample (n=193), the World Health Organization (WHO) classification and the Korean Society for the Study of Obesity cut-off points of BMI were used. The average BMI was 24.6 (SD=3.6) kg/m2. Significant associations were observed between BMI and age (χ² (8, N=193) =26.22, p<.01), gender (χ² (2, N=193) =11.45, p<.01), and religious affiliation (χ² (4, N=191) =9.53, p<.05). On average, participants had meat and carbonated drinks 2.2 times a week; high calorie foods 1.5 times a week; and, dairy products 2.4 times a week. A significant correlation (r=.14, p<.05) between BMI and eating meat was also observed. This study showed that the BMI varied with age, gender and religion. Frequent consumption of meat was associated with a significant increase in BMI. This increase in BMI could be associated with the dietary changes experienced by the newcomers or absence of more familiar products. Consequently, as the volume of immigrants continues to increase in Korea, it is imperative to consider designing and implementing public health policies specifically in relation to a healthy diet that can impact the prevalence of preventable chronic diseases. Thus, health education among foreign-born population in Korea should focus on reducing the intake of meat and high energy foods.

Sino-African State Trading in Services: Added-Value through Angola-Model loaning, GATS commitments or FTAs?

Paper presented by Charlotte Sieber-Gasser at the 5th Annual TRAPCA Conference, Arusha (Tanzania), 25-26 November 2010. Despite the increasing volume of trade between China and African countries, not one single conventional free trade agreement (FTA) or economic partnership agreement (EPA) has yet been signed between an African country and China. Initially, Sino-African trade relations were to a very large extent centred on investments secured through bilateral investment agreements (BITs). The more recent Chinese investments on the African continent, however, are more informally based on FDI contracts with the state at the receiving end and a government-owned private company as the investor, or loosely attached to loans commonly known under term ‘the Angola-Model’. This rather unusual basis for economic integration and development assistance, outside the trodden path of free trade agreements and ODA, requires further analysis in order to understand how the current legal framework between China and the African continent impacts economic development and national sovereignty, and what kind of distributive consequences it may have.

Ruminal methane emission by dairy cattle in southeast Brazil.

ABSTRACT: Ruminal gases, particularly methane, generated during the fermentative process in rumen, represent a partial loss of feed energy and are also pointed to as an important factors in greenhouse effect. This study aimed at quantifying methane (CH 4) emission rates from lactating and dry cows and heifers, 24 month-old in average, on pasture under Southeast Brazil tropical conditions, using the tracer gas technique, sulphur hexafluoride (SF 6), four animals per category, distributed in four blocks. Measurements were performed in February and June, 2002, with Holstein and Brazilian Dairy Crossbred (Holstein ¾ x Gir (Zebu) ¼), maintained on fertilized Tanzania-grass (Panicum maximum Jacq. cv. Tanzania) and fertilized Brachiaria-grass (Brachiaria decumbens cv. Basilisk) pastures. Heifers of both breeds were maintained on unfertilized Brachiaria-grass to simulate conditions of extensive cattle farming systems. CH 4 and SF 6 levels were measured with gas chromatography. Differences in CH4 emissions were measured (p < 0.05) for genetical groups. Holstein produced more methane (299.3g day?1) than the Crossbred (264.2 g day?1). Lactating cows produced more methane (353.8 g day?1) than dry cows (268.8 g day?1) and heifers (222.6 g day?1). Holstein, with greater milk production potential, produced less CH4 (p < 0.05) per unit of dry matter intake (19.1 g kg?1) than the Crossbred (22.0 g kg?1). Methane emission by heifers grazing fertilized pasture (intensive system) was 222.6 g day?1, greater (p < 0.05) than that of heifers on unfertilized pasture (179.2 g day?1). Methane emission varied as function of animal category and management intensity of production system.

Social Mobility and Demand for Redistribution. A Comparative Analysis

The literature on preferences for redistribution has paid little attention to the effect of social mobility on the demand for redistribution, which is in contrast with the literature on class-voting, where studies on the effect of social mobility has been very common. Some works have addressed this issue but no systematic test of the hypotheses connecting social mobility and preferences has been done. In this paper we use the diagonal reference models to estimate the effect of origin and destination class on preferences for redistribution in a sample of European countries using data from the European Social Survey. Our findings indicate that social origin matters to a little extent to explain preferences, as newcomers tend to adopt the preferences of the destination class. Moreover, we have found only limited evidence supporting the acculturation hypothesis and not support for the status maximization hypothesis. Furthermore, the effect of social origin varies largely between countries. In a second step of the analysis we investigate what are the national factors explaining this variation. The empirical evidence we present leads to conclude that high rates of upward social mobility sharply reduce the effect of social origin on preferences for redistribution

Espécies de Meloidogyne em hortaliças e outras culturas provenientes de áreas periurbanas da África Subsaariana

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Biológicas, Departamento de Fitopatologia, Programa de Pós-Graduação em Fitopatologia, 2016.

Culture shock and reverse culture shock: the moderating role of cultural intelligence in international students' adaptation

This study extends previous research by examining the role of cultural intelligence (CQ) in both culture shock and reverse culture shock. Specifically, this study asserts that CQ acts as a moderating mechanism that lessens the negative effects of both culture shock and reverse culture shock on psychological and sociocultural adaptation among international students. Two studies were conducted in Australia to test these assertions. Study 1 (n = 189) was participated in by new international students. An online survey was set up and disseminated. Results indicated that culture shock is significantly but negatively related to both psychological and sociocultural adaptation. In addition, results demonstrated that CQ moderates the relationship by lessening the impact of culture shock on students’ psychological and sociocultural adaptation. Study 2 (n = 123) was participated in by international students who had recently graduated and returned to their home countries. An online survey was also set up and disseminated. Results indicated that reverse culture shock is significantly but negatively related to both psychological and sociocultural adaptation. CQ also served as a moderator in lessening the impact of reverse culture shock on both forms of adaptation.

The consequences of intergroup ideologies and prejudice control for discrimination and harmony

In the present study, we investigated two literature bases by way of a community survey across Australia. We investigated four acculturation orientations (assimilation, multiculturalism, color-blind, and polyculturalism ideologies) and the motivations to respond without prejudice. We examined what predicted support for Harmony Day as well as explicit discrimination. Multiculturalism, polyculturalism, and internal motivation to respond without prejudice correlated with positive attitudes in both scenarios. External motivation to respond without prejudice was positively correlated with discrimination. Conversely, color-blind ideology had no effect, and assimilation ideology related positively to explicit discrimination and negatively with Harmony Day. Using a multiple regression analysis, there was a difference in emphasis in different contexts. Our findings provide antiprejudice practitioners with material for discussions which can promote positive intergroup relations.

BENEFICIAL REUSE OF LOCALLY-AVAILABLE WASTE MATERIALS AS LIGHTWEIGHT AGGREGATE IN LIGHTWEIGHT CONCRETE

This study investigated the physical characteristics of lightweight concrete produced using waste materials as coarse aggregate. The study was inspired by the author’s Peace Corps service in Kilwa, Tanzania. Coconut shell, sisal fiber, and PET plastic were chosen as the test waste products due to their abundance in the area. Two mixes were produced for each waste product and the mix proportions designed for resulting compressive strengths of 3000 and 5000 psi. The proportions were selected based on guidelines for lightweight concrete from the American Concrete Institute. In preparation for mixing, coconut shells were crushed into aggregate no larger than 3/4 inch, sisal fiber was cut into pieces no longer than 3/8 inch, and PET plastic was shredded into 1/4 inch-wide strips no longer than 6 inches. Replicate samples were mixed and then cured for 28 days before they were tested for compressive strength, unit weight, and absorption. The resulting data were compared to ASTM Standards for lightweight concrete masonry units to determine their adequacy. Based on these results, there is potential for coconut shell to be used as coarse aggregate in lightweight concrete. Sisal fiber was unsuccessful in producing the appropriate compressive strength. However, the reduction in spalling of the hardened concrete and the induction of air in the mixes incorporating sisal fiber suggests that it has the potential to improve other characteristics of lightweight concrete. Concrete mixes using PET plastic as aggregate resulted in adequate compressive strengths, but were too dense to be considered ‘lightweight’ concrete. With some adjustments to slightly decrease absorption and unit weight, the PET plastic concrete mixes could be classified as medium weight concrete and, therefore, achieve many of the same benefits as would be seen with lightweight concrete.

Elemental Analysis and Forensic Comparison of Soils by Laser-Induced Breakdown Spectroscopy (LIBS) and Laser Ablation Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS)

The elemental analysis of soil is useful in forensic and environmental sciences. Methods were developed and optimized for two laser-based multi-element analysis techniques: laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) and laser-induced breakdown spectroscopy (LIBS). This work represents the first use of a 266 nm laser for forensic soil analysis by LIBS. Sample preparation methods were developed and optimized for a variety of sample types, including pellets for large bulk soil specimens (470 mg) and sediment-laden filters (47 mg), and tape-mounting for small transfer evidence specimens (10 mg). Analytical performance for sediment filter pellets and tape-mounted soils was similar to that achieved with bulk pellets. An inter-laboratory comparison exercise was designed to evaluate the performance of the LA-ICP-MS and LIBS methods, as well as for micro X-ray fluorescence (μXRF), across multiple laboratories. Limits of detection (LODs) were 0.01-23 ppm for LA-ICP-MS, 0.25-574 ppm for LIBS, 16-4400 ppm for µXRF, and well below the levels normally seen in soils. Good intra-laboratory precision (≤ 6 % relative standard deviation (RSD) for LA-ICP-MS; ≤ 8 % for µXRF; ≤ 17 % for LIBS) and inter-laboratory precision (≤ 19 % for LA-ICP-MS; ≤ 25 % for µXRF) were achieved for most elements, which is encouraging for a first inter-laboratory exercise. While LIBS generally has higher LODs and RSDs than LA-ICP-MS, both were capable of generating good quality multi-element data sufficient for discrimination purposes. Multivariate methods using principal components analysis (PCA) and linear discriminant analysis (LDA) were developed for discriminations of soils from different sources. Specimens from different sites that were indistinguishable by color alone were discriminated by elemental analysis. Correct classification rates of 94.5 % or better were achieved in a simulated forensic discrimination of three similar sites for both LIBS and LA-ICP-MS. Results for tape-mounted specimens were nearly identical to those achieved with pellets. Methods were tested on soils from USA, Canada and Tanzania. Within-site heterogeneity was site-specific. Elemental differences were greatest for specimens separated by large distances, even within the same lithology. Elemental profiles can be used to discriminate soils from different locations and narrow down locations even when mineralogy is similar.

Challenging masculinity in CSR disclosures:silencing of women’s voices in Tanzania’s mining industry

This paper presents a feminist analysis of corporate social responsibility (CSR) in a male-dominated industry within a developing country context. It seeks to raise awareness of the silencing of women’s voices in CSR reports produced by mining companies in Tanzania. Tanzania is one of the poorest countries in Africa, and women are often marginalised in employment and social policy considerations. Drawing on work by Hélène Cixous, a post-structuralist/radical feminist scholar, the paper challenges the masculinity of CSR discourses that have repeatedly masked the voices and concerns of ‘other’ marginalised social groups, notably women. Using interpretative ethnographic case studies, the paper provides much-needed empirical evidence to show how gender imbalances remain prevalent in the Tanzanian mining sector. This evidence draws attention to the dynamics faced by many women working in or living around mining areas in Tanzania. The paper argues that CSR, a discourse enmeshed with the patriarchal logic of the contemporary capitalist system, is entangled with tensions, class conflicts and struggles which need to be unpacked and acknowledged. The paper considers the possibility of policy reforms in order to promote gender balance in the Tanzanian mining sector and create a platform for women’s concerns to be voiced.

African 2, a clonal complex of Mycobacterium bovis epidemiologically important in East Africa

We have identified a clonal complex of Mycobacterium bovis isolated at high frequency from cattle in Uganda, Burundi, Tanzania, and Ethiopia. We have named this related group of M. bovis strains the African 2 (Af2) clonal complex of M. bovis. Af2 strains are defined by a specific chromosomal deletion (RDAf2) and can be identified by the absence of spacers 3 to 7 in their spoligotype patterns. Deletion analysis of M. bovis isolates from Algeria, Mali, Chad, Nigeria, Cameroon, South Africa, and Mozambique did not identify any strains of the Af2 clonal complex, suggesting that this clonal complex of M. bovis is localized in East Africa. The specific spoligotype pattern of the Af2 clonal complex was rarely identified among isolates from outside Africa, and the few isolates that were found and tested were intact at the RDAf2 locus. We conclude that the Af2 clonal complex is localized to cattle in East Africa. We found that strains of the Af2 clonal complex of M. bovis have, in general, four or more copies of the insertion sequence IS6110, in contrast to the majority of M. bovis strains isolated from cattle, which are thought to carry only one or a few copies.