Digital Commons Network^™

Neonatal Vitamin A Supplementation For The Prevention Of Mortality And Morbidity In Term Neonates In Developing Countries, Batool A. Haider, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Vitamin A deficiency is a major public health problem in developing countries. Vitamin A supplementation in children greater than six months of age has been found to be beneficial, with no effect of supplementation between one to five months. Supplementation in the neonatal period has been suggested to have an impact by increasing body stores in early infancy.
Objectives: To evaluate the role of vitamin A supplementation in term neonates in developing countries with respect to the prevention of mortality and morbidity.
Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, May …

Aku-Nama : Summer 2011, Volume 4, Issue 1, Aga Khan University Alumni Association

The Aga Khan University Newsletter and Magazine for Alumni (AKU-NAMA)

No abstract provided.

Monitoring And Evaluation Of Electronic Resources In Academic And Research Institutions In Kenya, Nasra Gathoni, Evan Njoroge, Agatha Kabugu, Damiana Kiilu, Felicitas Ratanya, Jane Gikandi, Eddah Wasike

Libraries

The revolution of Information Communication and Technology has brought a great change in the way libraries are providing services. Libraries have continued to embrace these technologies vis‐à‐vis Internet thus seeing the introduction of electronic resources to the library collection and services. The availability of good internet connectivity is essential in the provision of electronic resources. Kenya has had internet since 1996 (Mutula, 2001) and over the years there has been great effort to improve connectivity such as the recent introduction of fibre optic cable in 2009. The need for good internet connectivity has also been supported by initiatives such as …

Tanzanian Nurses Understanding And Practice Of Spiritual Care, Khairunnisa Aziz Dhamani, Pauline Paul, Joanne Kaye Olson

School of Nursing & Midwifery, East Africa

Spirituality, as a basic characteristic of humans and a contributor to human health, is regarded as part of nursing practice. The purpose of this study was to examine how Tanzanian nurses understand spirituality and spiritual care. Using the qualitative method of interpretive description, fifteen registered nurses engaged in clinical practice in a Tanzanian hospital were recruited to participate in this study. In-depth interviews using open-ended questions were carried out, tape-recorded, and transcribed verbatim. Data collection and inductive analysis occurred concurrently. In this paper, key findings are grouped under the following headings: meaning of spiritual care, recognition of spiritual needs, and …

Impact Of Interventions To Prevent And Manage Preeclampsia And Eclampsia On Stillbirths, Mehnaz Jabeen, Mohammad Yawar Yakoob, Aamer Imdad, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Pre-eclampsia and Eclampsia are relatively common complications of pregnancy, leading to considerable maternal and fetal mortality and morbidity. We sought to review the effect of aspirin, calcium supplementation, antihypertensive agents and magnesium sulphate on risk stillbirths.

Methods:

A systematic literature search was conducted to identify studies evaluating the above interventions. We used a standardized abstraction and grading format and performed meta-analyses where data were available from more than one studies. The estimated effect on stillbirths was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules for multiple outcomes. For interventions with insufficient evidence for overall effect, …

Effect Of Screening And Management Of Diabetes During Pregnancy On Stillbirths, Madiha Syed, Hasan Javed, Mohammad Yawar Yakoob, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Diabetes during pregnancy is associated with significant risk of complications to the mother, fetus and newborn. We reviewed the potential impact of early detection and control of diabetes mellitus during pregnancy on stillbirths for possible inclusion in the Lives Saved Tool (LiST).

Methods:

A systematic literature search up to July 2010 was done to identify all published randomized controlled trials and observational studies. A standardized data abstraction sheet was employed and data were abstracted by two independent authors. Meta-analyses were performed with different sub-group analyses. The analyses were graded according to the CHERG rules using the adapted GRADE criteria …

Aku Newsletter : Spring 2011, Volume 12, Issue 1, Aga Khan University

The Aga Khan University Newsletters

No abstract provided.

Malaria Rapid Testing By Community Health Workers Is Effective And Safe For Targeting Malaria Treatment: Randomised Cross-Over Trial In Tanzania, M. Mubi, A. Janson, M. Warsame, A. Martensson, K. Kallander, M.G. Petzold, B. Ngasala, G. Maganga, L.L. Gustafsson, A. Massele, G. Tomson, Zul Premji, A. Bjorkman

Pathology, East Africa

Background: Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. We assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients.

Methodology/Principal Findings: Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. …

Pre-Referral Rectal Artesunate In Severe Malaria: Flawed Trial, K.F. Hirji, Zul Premji

Pathology, East Africa

Background:Immediate injectable treatment is essential for severe malaria. Otherwise, the afflicted risk lifelong impairment or death. In rural areas of Africa and Asia, appropriate care is often miles away. In 2009, Melba Gomes and her colleagues published the findings of a randomized, placebo-controlled trial of rectal artesunate for suspected severe malaria in such remote areas. Enrolling nearly 18,000 cases, the aim was to evaluate whether, as patients were in transit to a health facility, a pre-referral artesunate suppository blocked disease progression sufficiently to reduce these risks. The affirmative findings of this, the only trial on the issue thus far, …

Multilingual Education In South Africa: The Role Of Publishers, Viv Edwards, Jacob Marriote Ngwaru

Institute for Educational Development, East Africa

The South African constitution and related legislative tools provide a supportive framework for multilingual education. Successful implementation, however, requires appropriate learning materials and questions remain as to the vision and commitment of publishers to producing them. Based on an analysis of currently available books for children and interviews with publishers and key figures in the book value chain, this paper explores both the educational rationale for African language publishing and the issues that constrain expansion. These issues include the heavy dependence on the schools market in a society where the majority of the population cannot or do not buy books, …

Where Hope Takes Root, Faculty Of Arts And Sciences, East Africa

Faculty of Arts and Sciences Archives

Our Vision, A Liberal Arts Education for Africa, Inspiring Lives Educating Leaders, A Hub of Inquiry

African Language Books For Children: Issues For Authors, Viv Edwards, Jacob Marriote Ngwaru

Institute for Educational Development, East Africa

Growing interest in bilingual education in sub-Saharan Africa has highlighted an urgent need for reading material in African languages. In this paper, we focus on authors, one of several groups of stakeholders with responsibility for meeting this demand. We address three main issues: the nature and extent of African language publishing for children; the challenges for authors; and the available support. Our analysis is based on interviews and focus group discussions with publishers, authors, translators, educationalists, and representatives of book promotion organisations from nine African countries and documentary data on children's books in African languages in South Africa. Although there …

Efficacy And Safety Of Artemether-Lumefantrine In The Treatment Of Acute, Uncomplicated Plasmodium Falciparum Malaria: A Pooled Analysis, M. Makanga, Q. Bassat, C.O. Falade, Zul Premji, S. Krudsood, P. Hunt, V. Walter, H.-P. Beck, A.-C. Marrast, M. Cousin, P.J. Rosenthal

Pathology, East Africa

Randomized trials have confirmed the efficacy and safety of artemether-lumefantrine (AL) for treatment of uncomplicated Plasmodium falciparum malaria. Data from seven studies supported by Novartis (1996-2007), including 647 adults (> 16 years of age, 83.3% completed the study) and 1,332 children (≤ 16 years of age, 89.3% completed the study) with microscopically confirmed uncomplicated P. falciparum malaria and treated with the recommended regimen of AL, were pooled. The 28-day polymerase chain reaction-corrected parasitologic cure rate (primary efficacy endpoint) was 97.1% (495 of 510) in adults and 97.3% (792 of 814) in children (evaluable population). Gametocytemia prevalence after day was 4.2% …

Population Health Metrics Research Consortium Gold Standard Verbal Autopsy Validation Study: Design, Implementation, And Development Of Analysis Datasets, C.J.L. Murray, A.D. Lopez, R. Black, R. Ahuja, S.M. Ali, A. Baqui, L. Dandona, E. Dantzer, Vinita Das, U. Dhingra, A. Dutta, W. Fawzi, A.D. Flaxman, S. Gomez, B. Hernandez, R. Joshi, H. Kalter, A. Kumar, V. Kumar, R. Lozano, M. Lucero, S. Mehta, B. Neal, S.L. Ohno, R. Prasad, D. Praveen, Zul Premji, D. Ramirez-Villalobos, H. Remolador, I. Riley, M. Romero, M. Said, D. Sanvictores

Pathology, East Africa

Background: Verbal autopsy methods are critically important for evaluating the leading causes of death in populations without adequate vital registration systems. With a myriad of analytical and data collection approaches, it is essential to create a high quality validation dataset from different populations to evaluate comparative method performance and make recommendations for future verbal autopsy implementation. This study was undertaken to compile a set of strictly defined gold standard deaths for which verbal autopsies were collected to validate the accuracy of different methods of verbal autopsy cause of death assignment.

Methods: Data collection was implemented in six sites in four …

Plasmodium Falciparum Population Dynamics During The Early Phase Of Anti-Malarial Drug Treatment In Tanzanian Children With Acute Uncomplicated Malaria, A.M. Carlsson, B.E. Ngasala, S. Dahlstrom, C. Membi, I.M. Veiga, L. Rombo, S. Abdulla, Zul Premji, J.P. Gil, A. Bjorkman, A. Martensson

Pathology, East Africa

Background: This study aimed to explore Plasmodium falciparum population dynamics during the early phase of anti-malarial drug treatment with artemisinin-based combination therapy in children with clinical malaria in a high transmission area in Africa.

Methods: A total of 50 children aged 1-10 years with acute uncomplicated P. falciparum malaria in Bagamoyo District, Tanzania, were enrolled. Participants were hospitalized and received supervised standard treatment with artemether-lumefantrine according to body weight in six doses over 3 days. Blood samples were collected 11 times, i.e. at time of diagnosis (-2 h) and 0, 2, 4, 8, 16, 24, 36, 48, 60 and 72 …

Effectiveness Of Artemether-Lumefantrine Provided By Community Health Workers In Under-Five Children With Uncomplicated Malaria In Rural Tanzania: An Open Label Prospective Study, B.E. Ngasala, M. Malmberg, A.M. Carlsson, P.E. Ferreira, M.G. Petzold, D. Blessborn, Y. Bergqvist, J.P. Gil, Zul Premji, A. Martensson

Pathology, East Africa

Background: Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home.

Methods: An open label, single arm prospective study was conducted in two rural villages …

Community Screening And Treatment Of Asymptomatic Carriers Of Plasmodium Falciparum With Artemether-Lumefantrine To Reduce Malaria Disease Burden: A Modelling And Simulation Analysis, S.E. Kern, A.B. Tiono, M. Makanga, A. Gbadoe, Zul Premji, O. Gaye, I. Sagara, D. Ubben, M. Cousin, F. Oladiran, O. Sander, B. Ogutu

Pathology, East Africa

Background: Asymptomatic carriers of Plasmodium falciparum serve as a reservoir of parasites for malaria transmission. Identification and treatment of asymptomatic carriers within a region may reduce the parasite reservoir and influence malaria transmission in that area.

Methods: Using computer simulation, this analysis explored the impact of community screening campaigns (CSC) followed by systematic treatment of P. falciparum asymptomatic carriers (AC) with artemether-lumefantrine (AL) on disease transmission. The model created by Okell et al (originally designed to explore the impact of the introduction of treatment with artemisinin-based combination therapy on malaria endemicity) was modified to represent CSC and treatment of …

Aku Newsletter : Winter 2011, Volume 12, Issue 2, Aga Khan University

The Aga Khan University Newsletters

No abstract provided.

African Language Publishing For Children In South Africa: Challenges For Translators, Viv Edwards, Jacob Marriote Ngwaru

Institute for Educational Development, East Africa

The commitment to multilingualism embedded in the 1996 South African Constitution has wide ranging implications for many aspects of education. This paper focuses on the dearth of teaching and learning materials in African languages required to deliver effective bilingual education, and on the potential role of translation in offering solutions for this problem. Drawing on an analysis of currently available African language books for children and interviews with educators, writers, publishers, translators and organisations concerned with book promotion, it explores issues which have emerged as critical for both the quality and availability of translation. Attention is drawn to the ways …

Detection Of Extended Spectrum Beta Lactamases Genotypes And Their Association With Cephalosporin Susceptibility In Community Acquired Enterobacteriaceae Infections, Daniel W. Maina

Master of Medicine in Clinical Pathology

Background: Infections caused by Extended Spectrum Beta-Lactamases (ESBLs) producing enterobacteriaceae have become a global problem. Initially confined to the hospital set-up, they are increasingly being reported in the community. These infections are often resistant to a wide variety of B- lactams including extended spectrum cephalosporins, with clinical and epidemiological implications for healthcare systems and necessitate surveillance measures based on local data. Local information on the genotypes of ESBLs and their association with cephalosporin resistance in community acquired ESBL-producing Enterobacteriaceae isolates is scanty, hence the need for this study. Aim: To detect ESBLs genotypes and correlate these with susceptibility to cephalosporins …

Aku-Nama : Summer 2010, Volume 3, Issue 1, Aga Khan University Alumni Association

The Aga Khan University Newsletter and Magazine for Alumni (AKU-NAMA)

No abstract provided.

Akhuwat Issue No. 77, Aga Khan University

AKHUWAT Newsletters

• AKU-East Africa Convocation Ceremonies
• Achievements and Appointments
• Dr Farhat Abbas Conferred Tamgha-e-Imtiaz
• Sohail Habib - Director Professional Services
• Music in Muslim Contexts
• Professor Tariq Rahman Speaks at AKU-ISMC
• Appointed to Prime Minister’s Education Task
• PTAN Conference 2010
• World Cancer Day
• World Kidney Day
• AKU 25^th Anniversary Quiz Game
• AKU Ilizarov Course
• WGW Celebrates International Women’s Day
• JCI Accreditation of Aga Hospital, Karachi
• The Millennium Lifetime Award 2008
• “Shoot for the Moon – Even if you miss you will end up among the stars”
• Retirements
• Obituary
• Professor Dr Sheikh Arshad Saeed
• Dr Syed Arif Ali Zaidi

Aku Newsletter : Spring 2010, Volume 11, Issue 1, Aga Khan University

The Aga Khan University Newsletters

No abstract provided.

Latent Tuberculosis Among Pregnant Mothers In A Resource Poor Setting In Northern Tanzania: A Cross-Sectional Study, Faheem G. Sheriff, Karim P. Manji, Mohamed P. Manji, Mohamedsuhel M. Chagani, Rose M. Mpembeni, Ahmed Jusabani, Zaheerabbas A. Alwani

Faculty of Health Sciences, East Africa

Background:

Untreated latent TB infection (LTBI) is a significant risk factor for active pulmonary tuberculosis, hence predisposing to adverse pregnancy outcomes and mother to child transmission. The prevalence of latent tuberculosis in pregnancy and its association, if any, with various socio-demographic, obstetric and clinical characteristics was evaluated.

Methods:

Northern Tanzania was chosen as the study site. In a cross-sectional study, a total of 286 pregnant women from 12 weeks gestational age to term were assessed. Screening was undertaken using an algorithm involving tuberculin skin testing, symptom screening in the form of a questionnaire, sputum testing for acid fast bacilli followed …

Why Planning Does Not Work? Land Use Planning And Residents' Rights In Tanzania, Joe Lugalla

Institute for Educational Development, East Africa

No abstract provided.

Deceptive Cultural Practices That Sabotage Hiv/Aids Education In Tanzania And Kenya, Mary Oluga, Susan Kiragu, Mussa K. Mohamed, Shelina Walli

Institute for Educational Development, East Africa

In spite of numerous HIV/AIDS‐prevention education efforts, the HIV infection rates in Sub‐Saharan Africa remain high. Exploring and understanding the reasons behind these infection rates is imperative in a bid to offer life skills and moral education that address the root causes of the pandemic. In a recent study concerning effective HIV/AIDS‐prevention education, conducted in Tanzania and Kenya among teacher trainees and their tutors, the notion of mila potofu (defined by educators as ‘deceptive’ cultural practices) emerged as a key reason for educators’ difficulties in teaching HIV/AIDS prevention education in schools and for high HIV infection rates. Since these cultural …

Who Gets Prompt Access To Artemisinin-Based Combination Therapy? A Prospective Community-Based Study In Children From Rural Kilosa, Tanzania, D.O. Simba, M. Warsame, D. Kakoko, Z. Mrango, G. Tomson, Zul Premji, M. Petzold

Pathology, East Africa

Background: Effective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania.

Methods and Findings: In a community-based study, 1,235 randomly selected children under five were followed up weekly for six months, in 2008. Using a structured questionnaire, children's caretakers were asked about the child's febrile history in the last seven days, and treatment …

Understanding Caretakers' Dilemma In Deciding Whether Or Not To Adhere With Referral Advice After Pre-Referral Treatment With Rectal Artesunate, D.O. Simba, D.C. Kakoko, M. Warsame, Zul Premji, M.F. Gomes, G. Tomson, E. Johansson

Pathology, East Africa

Background: Malaria kills. A single rectal dose of artesunate before referral can reduce mortality and prevent permanent disability. However, the success of this intervention depends on caretakers' adherence to referral advice for follow-up care. This paper explores the dilemma facing caretakers when they are in the process of deciding whether or not to transit their child to a health facility after pre-referral treatment with rectal artesunate.

Methods: Four focus group discussions were held in each of three purposively selected villages in Mtwara rural district of Tanzania. Data were analysed manually using latent qualitative content analysis.

Results: The theme «Caretakers dilemma …

Population Genetic Analysis Of Large Sequence Polymorphisms In Plasmodium Falciparum Blood-Stage Antigens, A.D. Ahouidi, A.K. Bei, D.E. Neafsey, O. Sarr, S. Volkman, D. Milner, J. Cox-Singh, M.U. Ferreira, O. Ndir, Zul Premji, S. Mboup, M.T. Duraisingh

Pathology, East Africa

Plasmodium falciparum, the causative agent of human malaria, invades host erythrocytes using several proteins on the surface of the invasive merozoite, which have been proposed as potential vaccine candidates. Members of the multi-gene PfRh family are surface antigens that have been shown to play a central role in directing merozoites to alternative erythrocyte receptors for invasion. Recently, we identified a large structural polymorphism, a 0.58 Kb deletion, in the C-terminal region of the PfRh2b gene, present at a high frequency in parasite populations from Senegal. We hypothesize that this region is a target of humoral immunity. Here, by analyzing 371 …

Treatment Of Asymptomatic Carriers With Artemether-Lumefantrine: An Opportunity To Reduce The Burden Of Malaria?, B. Ogutu, A.B. Tiono, M. Makanga, Zul Premji, A.D. Gbadoe, D. Ubben, A.C. Marrast, O. Gaye

Pathology, East Africa

Background: Increased investment and commitment to malaria prevention and treatment strategies across Africa has produced impressive reductions in the incidence of this disease. Nevertheless, it is clear that further interventions will be necessary to meet the international target of a reversal in the incidence of malaria by 2015. This article discusses the prospective role of an innovative malaria control strategy - the community-based treatment of asymptomatic carriers of Plasmodium falciparum, with artemisinin-based combination therapy (ACT). The potential of this intervention was considered by key scientists in the field at an Advisory Board meeting held in Basel, in April 2009. …