Dissertations / Theses: 'Resource-limited setting'

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Dang, Thi Minh Ha. "Diagnosis of tuberculosis in a high burden resource limited setting." Thesis, Open University, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.552790.

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It is estimated that over nine million new tuberculosis (TB) cases worldwide occurred in 2009. However, only 63% of these cases were notified, which is lower than the 75% target set by the DOTS strategy. The lack of ideal diagnostic tests is one of the major barriers to effective TB reduction. The aim of this thesis is to evaluate the efficiency of a novel liquid culture based technique (Microscopic Observation Drug Susceptibility Assay-MODS) and a new generation fluorescence microscope (Light Emitting Diodes fluorescence microscope - LED fluorescence microscope) in diagnosis of TB and multi drug resistant tuberculosis (MDR- TB) in Viet Nam, a resource limited, high burden setting. In the studies described in this thesis, MODS had a higher sensitivity than homogenous smear microscopy, detecting an additional 13% of cases, in diagnosis of TB. Importantly, the pooled sensitivity of MODS (53.0%) was comparable to that of Mycobacteria Growth Indicator Tube technique (MGIT) (57.8%) with clinical presentation as the gold standard. In terms of multi drug resistant tuberculosis (MDR- TB) diagnosis, MODS had rather low sensitivity in detection of Isoniazid (INH) or Rifampicin (RIF) resistant and MDR isolates, 72.6%, 72.7% and 77.8%, respectively against the proportional drug susceptibility testing (DST) method. The low sensitivity of DST-MODS in this study was probably due to low bacterial load samples and use of a high INH critical concentration (O.4~g/ml). For LED microscopy, the detection rate, sensitivity, specificity and false negative of LED 40X were comparable to those of conventional fluorescence microscope and light microscope. The false positive rate • of LED 40X increased in comparison with Ziehl-Neelsen (ZN) reading in the early phases of the evaluation (2.6% and 2.7% vs 0% in the validation and implementation phases vs continuation phase, respectively), probably due to lack of experience among technicians, but no significant difference was found (P>0.05). In the last phase, no false positive result was recorded. Although the reading time of fluorescence-LED (FM-LED) and ZN reading were less than 2 minutes, ZN-light microscope (ZN-LM) reading time was shorter than that of FM-LED40X, especially in positive smears (P=0.007) in the early study phase. By the end of the study, FM-LED reading time was shorter than ZN-LM which was recorded in the early phase. With high experienced technicians there may be little or no additional benefit to case detection if a light microscope is replaced by a fluorescence microscope. In general, MODS and LED microscopy are reliable methods for use in diagnosis of TB in resource limited settings due to their accuracy, reliability and low costs. Large scale operational projects should be conducted to evaluate the feasibility and cost-effectiveness of these methods in countries where these techniques are to be implemented.

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Hatherill, Mark. "Transport of critically ill children in a resource-limited setting." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/10987.

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Includes bibliographical references.
Transportation of critically ill children by inexperienced personnel may be associated with increased risk of transfer-related adverse events and mortality. To audit paediatric intensive care unit (PICU) transfer activity and transfer-related adverse events in a resource-limited setting. Twenty-two bed regional PICU of a university children's hospital in Cape Town, South Africa. Prospective one-year audit of all children transferred directly to PICU from other hospitals. Data were collected for patient demographics and diagnostic category, referring hospital, transferring personnel, mode of transport, and the incidence of technical, clinical, and critical adverse events. Data are median (interquartile range, IQR). The transfers of 202 children, median age 2.8 months (1.1-14), median weight 3.5 kg (2.5-8.1) were analysed.

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Horn, Alan Richard. "Early prediction of hypoxic ischaemic encephalopathy in newborn infants in a resource-limited setting." Doctoral thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/11188.

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Includes bibliographical references.
Hypoxic ischaemic encephalopathy (HIE) after birth is an important cause of neonatal morbidity and mortality, particularly in resource-limited regions. Therapeutic hypothermia initiated within the first 6 hours of life, in settings that can offer neonatal intensive care, is a therapy that can reduce death or severe disability in newborn infants with moderate or severe HIE. Therapeutic hypothermia has not been shown to be safe or effective in low-resource settings where neonatal intensive care is not available; however, there are situations such as in some centres in South Africa, where limited neonatal intensive care (NICU) is available against a background of moderate neonatal mortality rates, relatively low socio-economic conditions and limited capacity for long-term follow-up. In such settings, accurate case definition and early prediction of HIE and outcome may assist with the appropriate allocation of resources. The amplitude-integrated electro-encephalogram (aEEG) is an ideal tool to use for prediction of outcome and the need for cooling, but it’s availability is limited, particularly at primary and secondary hospitals.

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Dos, Passos Gary. "Microvascular free tissue transfer for the head and neck reconstructive in a resource-limited setting." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22754.

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Background: Free tissue transfer has become the standard of care for the reconstruction of head and neck oncological defects. The Groote Schuur Hospital provides a microsurgical reconstructive service in a resource-limited setting, without access to venous couplers, invasive monitoring devices, modern microscopes or sophisticated pre-operative imaging. The reconstructive surgeons perform all anastomoses under x4.5 loupe magnification. Methods: A retrospective chart review was undertaken of cases performed by the service over a 3-year period. Demographic factors, indications for flap cover, operative details (flap used, duration and lowest recorded temperature), intensive care and hospital length of stay, and other outcomes were recorded and evaluated (including flap and systemic complications, donor site morbidity, haematomas as well as returns to theatre). Results: Over a 36-month period, 109 flaps for head and neck reconstruction were performed. The main indication for surgery was squamous cell carcinoma of the oral cavity. The mean operating time for resection and reconstruction was 6.02 h (range of 4 to 12 h). Virtually, all reconstructions were performed using one of either radial forearm, free fibula or anterolateral thigh flaps. We report a complete flap loss rate of 6 %. All four successful salvages were undertaken in the early (less than 24 h) post-operative period. Hypothermia intra-operatively appears to correlate very closely with pejorative outcomes. Conclusions: By restricting reconstructive options to three main 'workhorse' flaps and by utilising a simultaneous two-team approach for tumour ablation and flap elevation, success rates comparable to international standards have been achieved. Limited resources should not be regarded as an impassable barrier to providing a successful microvascular head and neck reconstructive service.

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Allison, Waridibo Evelyn National Centre in HIV Epidemiology &amp Clinical Research Faculty of Medicine UNSW. "Epidemiological and clinical aspects of diagnosing paediatric Human Immunodeficiency Virus (HIV) infection in a resource limited setting." Awarded by:University of New South Wales. National Centre in HIV Epidemiology & Clinical Research, 2009. http://handle.unsw.edu.au/1959.4/44515.

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Diagnosis of paediatric HIV infection presents a spectrum of challenges particularly in countries where resources are constrained. This program of research aims to illuminate epidemiological and clinical aspects of HIV diagnosis in resource limited settings focusing in particular on the nation of Papua New Guinea (PNG). This body of work commences with an exploration of current literature pertaining to diagnosis of HIV infection in resource constrained settings. This exploration encompasses the current epidemiological data available on HIV infection in the paediatric population worldwide, currently available methods of diagnosis and other aspects of diagnosis of paediatric HIV infection in developing nations including sampling considerations, breast feeding, health services, human resources and the relationship between early diagnosis and early treatment. The next chapter presents an epidemiological analysis of the HIV epidemic in PNG and a description of the paediatric services at Port Moresby General Hospital (PMGH) the site for most of the research presented in the thesis. The original research presented in the thesis begins with a report (Chapter 3) of a survey of paediatric diagnosis and treatment services in PNG in comparison to other countries in the Asia Pacific region. This is followed by an exploratory retrospective study elucidating factors associated with HIV testing and HIV positive serostatus in children admitted to PMGH. Selection for testing was found to be significantly associated with age, length of hospital stay and diagnoses of diarrhoea, malnutrition and oral candidiasis. Tuberculosis was associated with HIV positive serostatus. In advance of a prospective study to ascertain clinical predictors of HIV infection, a study to evaluate acceptability of HIV testing amongst carers of children admitted to PMGH was undertaken. Testing was acceptable to the majority of carers interviewed. This program of research concludes with a prospective cross-sectional study revealing low weight for age, persistent fever, lymphadenopathy and oral candidiasis to be independent predictors of HIV infection in children admitted to PMGH. An algorithm for clinically directed screening of children for HIV infection in a hospital setting was subsequently developed. Finally evidence based clinical recommendations and suggestions for the direction of future research efforts were made.

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Mohamed, Suraya. "Factors influencing the implementation of health promoting schools : a multiple case study of three secondary schools in a resource limited community in Cape Town." University of the Western Cape, 2016. http://hdl.handle.net/11394/4988.

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Philosophiae Doctor - PhD
Introduction: This study was conducted because of a gap in information on the factors influencing the health promoting schools (HPS) implementation process in South Africa (SA) specifically and in secondary schools globally. The aim of this context- sensitive, practice-based study was to explore and understand the complexity of the factors that influenced the implementation process of HPS in three secondary schools in a resource-limited setting in Cape Town, SA. This research drew on a five year project that initiated the implementation of HPS in these schools. Methodology: An exploratory qualitative study was used, adopting a multiple case study design. The sample included two principals, ten teachers and 30 students involved in HPS implementation at their schools, and the three school facilitators, who served as mentors to the schools. The data collection methods included: individual interviews, focus group discussions, documentary review, secondary data and observations. A conceptual framework was developed drawing on the settings approach and various implementation frameworks and was used to analyse the findings. Thematic analysis was employed and the data for each case were analysed separately first before undertaking cross case analysis. Findings: A combination of several internal and external factors influenced the ability of the schools to implement and integrate HPS as a whole school approach. A key factor was the degree of understanding of the HPS concept by all key actors and where there was lucid understanding, there was better integration. Significant school factors included the schools’ readiness for change; a culture of collaboration and cooperation; existing school structures, practices and workload; the leadership style and management role of the principals; the role and influence of HPS champion teachers; and the role that students played. The major external factors included the role of the education district; the role of project team as external catalysts for change; and the community context. The main achievements in all schools were discrete activities, including co-curricular activities rather than changes to routine school functions. This highlighted the difficulty in implementing HPS as a whole school approach, a challenge typical of all health promoting settings. Conclusion: The findings illustrate the challenge of achieving full integration of HPS, although the influencing factors, and hence level of integration varied mainly according to context. This highlights the complexity of the different factors and their impact. The study demonstrates the paradox of HPS implementation. In that, despite the recognition of the value of HPS, the challenges to address the complexity of factors that would have brought about change through a whole school approach were too great. It was too difficult to change the status quo from what was routinely done to a more radical way of working due to the conservatism of traditional ways of working and extent of adjustment that it would have resulted. It was therefore only possible to put simple, discrete, strategies in place and that was not too resource intensive. The study concluded that this does not imply that HPS should not be attempted, particularly where there are adverse conditions that would benefit from HPS. Starting with marginal changes, it can be effective in increasing the schools’ readiness for change, building on the achievements both in activities and structures, and the resultant commitment by those involved. Once they experience these changes it will more likely enable schools to incrementally attempt more complex changes. The key recommendations for within the school include: building the understanding and capacity of relevant actors to actively support the implementation of HPS; building the capacity of the principal to create an environment which is conducive to change; and providing support for the HPS champions and students. Recommendations for those external to the school include: support from external catalysts who can provide expertise and mentorship; support from the education district, especially in terms of policies on integration, resources, and raising the profile of HPS; and better collaboration between the education and health sectors. Although most of the literature on HPS implementation identifies similar issues to those found in this study, the complexity has not, to date, been sufficiently described. The contribution of this study, therefore, is to take the debate on the complexity of the factors influencing HPS implementation forward.

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Waruingi, Alice Anne Wambui. "Creating a Cost Effectiveness Model for the Prevention of Prematurity in a Low-Income, Resource-Poor Setting." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428064755.

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Munangatire, Takaedza. "Nursing students perceptions and experiences of high fidelity simulation as a learning and teaching strategy in a resource limited setting." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/95867.

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Thesis (MPhil)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Introduction and Background High fidelity simulation (HFS) refers to a mannequin that is modeled to represent a human and is programmed to produce physiologic functions such as palpable pulses, voices and abdominal sounds through computer interfaces. Recent introduction of HFS for learning nursing skills like critical thinking and problem solving in the developing world (Lesotho) has generated debate. The debate is centered on the acceptability of HFS, its effectiveness as a learning strategy compared to its high cost, especially in resource limited settings. Its acceptability in the developing world to date is mixed, affecting its ultimate utilization. Therefore contextual differences between developing and developed countries suggest that research findings on the evaluation of acceptability of HFS in the two places could be different. Additionally, health sciences education is a highly complex discipline with huge differences in practices within and across classes, schools, sites and countries, making it difficult to generalize findings from other settings to the setting of Lesotho. Aim The purpose of this study was to explore third year diploma in nursing students’ perceptions and experiences of HFS use in learning nursing skills. Methods A qualitative descriptive design was utilized to investigate HFS use at a school of nursing. Sixteen participants took part in three separate focus group discussions in two groups of five, and one group of six participants. The data was analyzed thematically. Results Students had mixed perceptions, positive and negative, based on the nature of their experiences which were both fulfilling and frustrating. This study revealed five key themes that shaped students experiences, hence perceptions of using HFS in learning. The themes are authentic learning environment, unique learning opportunities, access, contextual factors and transfer of skills. Discussion Student nurses had both positive and negative experiences of using HFS in learning. They believe that HFS is a valuable learning strategy but that it needs to be better utilized. Student nurses perceive HFS as providing an authentic learning environment which allows learning of complex skills like critical thinking and problem solving. On the other hand, they believe that learning can be improved if HFS is more accessible for use by students and if supervisors are adequately trained and students are better oriented on the use of HFS in learning. Conclusions HFS is viewed as an effective learning strategy among nursing students in resource limited settings, although there in need to improve its utilization for better learning experiences and outcomes.
AFRIKAANSE OPSOMMING: Inleiding en Agtergrond Hoëtrou-simulasie (HTS) verwys na ’n pop wat gemodelleer is om ’n mens te verteenwoordig en geprogrammeer is om fisiologiese funksies soos tasbare polse, stemme en abdominale klanke te lewer deur rekenaar-koppelvlakke. Onlangse bekendstelling van HTS in die aanleer van verpleegvaardighede soos kritiese denke en probleemoplossing in die ontwikkelende wêreld (Lesotho) het debat laat ontstaan. Die debat sentreer om die aanvaarbaarheid van HTS en sy effektiwiteit as ’n leerstrategie in vergelyking met sy hoë koste, veral in hulpbronbeperkte omgewings. HTS se aanvaarbaarheid op verskillende plekke in die ontwikkelende wêreld tot op datum is gemeng, wat die uiteindelike gebruik daarvan raak. Daarom dui kontekstuele verskille tussen ontwikkelende en ontwikkelde lande aan dat navorsingsbevindings oor die beoordeling van aanvaarbaarheid van HTS in die twee omgewings kan wissel. Bykomend is opleiding in die gesondheidswetenskappe ’n uiters komplekse dissipline met groot verskille in praktyke binne en oor klasse, skole, omgewings en lande, wat dit moeilik maak om bevindings van ander omgewings tot die omgewing van Lesotho te veralgemeen. Doel Die doel van hierdie studie was om derdejaar-diplomaverpleegstudente se persepsies en ervarings van die gebruik van HTS vir die aanleer van verpleegvaardighede te ondersoek. Metodes ’n Kwalitatiewe gevallestudieontwerp is benut om die verskynsel van HTS by Paray Verpleegkundeskool te ondersoek. Sestien deelnemers het aan die verskillende fokusgroepbesprekings deelgeneem in twee groepe van vyf, en een groep van ses deelnemers. Die data is ontleed met die gebruik van die konstante vergelykingsanalise-model. Resultate Studente het gemengde waarnemings, positief en negatief, ervaar, gebaseer op die aard van hul ondervindings wat sowel vervullend as frustrerend was. Hierdie studie het vyf sleuteltemas geopenbaar wat studente se ondervindings, en sodoende hul waarnemings van die gebruik van HTS in opleiding gevorm het. Die temas is outentieke leeromgewing, unieke leergeleenthede, toegang, kontekstuele faktore en oordrag van vaardighede. Bespreking Studentverpleegsters aanvaar die gebruik van HTS om verpleegvaardighede te leer. Hulle glo dat HTS ’n waardevolle leerstrategie is, wat egter beter benut moet word. Studentverpleegsters beskou HTS as ŉ verskaffer van ŉ outentieke leeromgewing wat die aanleer van komplekse vaardighede soos kritiese denke en probleemoplossing toelaat. Aan die ander kant glo hulle dat opleiding verbeter kan word indien HTS meer toeganklik is vir gebruik deur studente en indien toesighouers voldoende opgelei is en studente beter voorgelig word in die gebruik van HTS as opleidingsmiddel. Gevolgtrekkings HTS is ŉ aanvaarbare leerstrategie onder verpleegstudente in omgewings met beperkte hulpbronne, hoewel daar ŉ behoefte is om die benutting daarvan vir beter leerervarings en uitkomstes te verbeter.

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Nagai, Shuko. "Effects of earlier initiated continuous Kangaroo Mother Care (KMC) for stable low-birth-weight (LBW) infants in a resource-limited setting." 京都大学 (Kyoto University), 2012. http://hdl.handle.net/2433/157857.

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Muchiri, Jane Wanjiku. "Development and evaluation of a nutrition education programme for adults with type 2 diabetes mellitus in a resource limited setting of the Moretele sub-district, North West Province (South Africa)." Thesis, University of Pretoria, 2013. http://hdl.handle.net/2263/31618.

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Background: Diabetes self-management education, including nutrition education (NE) is an essential component of diabetes management. Effective NE can assist individuals with type 2 diabetes mellitus (DM) in resource limited settings to improve their dietary self-care; an area cited among the most difficult with consequent improvement in health outcomes. Aim: To develop a NE programme that is tailored to the needs of adults with type 2 DM in a resource limited setting and to evaluate the programme's effectiveness on health outcomes. Setting: Makapanstad and Mathibestad community health centres in the Moretele sub-district, North West Province (South Africa). Methods: The study was done in three phases employing mixed methods research. Qualitative methods, using focus group discussions with 31 diabetic patients (a convenience purposive sample), and an open ended self-administered questionnaire with ten health professionals serving them, assessed the NE needs and preferences (phase 1). The data were analysed according to the framework approach. The results from the needs assessment were used to plan a tailored NE programme (phase 2). A randomised controlled trial (quantitative) with a sample of 82 patients (with HbA1c ≥ 8), allocated to either intervention or control groups, evaluated the effect of the NE programme (phase 3). Outcomes [HbA1c, dietary behaviours, blood lipids, blood pressure, body mass index (BMI), diabetes knowledge and attitudes towards diabetes and its treatment] were assessed at baseline, six months and 12 months respectively. An analysis of covariance (ANCOVA) compared the groups on measured outcomes using baseline values, age, gender, and clinic as covariates. Rank ANCOVA was used for dietary intake. The level of significance for all tests was set at α < 0.05 for a two-tailed test. Results: Needs assessment Diabetes related knowledge deficits and inappropriate dietary practices, including food portion control problems, inadequate intake of vegetables and fruits and unbalanced diets, were observed. Eight barriers and two facilitators to dietary adherence were identified. Financial constraint was the major barrier while social support was the major facilitator. NE recommendations included content related to the disease and diet, group education at the clinic, a competent educator, provision of education materials and inclusion of family members. The planned NE programme consisted of eight weekly training sessions and six follow-up sessions (monthly and bi-monthly), vegetable gardening demonstrations and education materials. Nutrition education programme effects: Seventy six participants (38 per group) completed the study. The differences in HbA1c (primary outcome) between the intervention and control groups were -0.62% (p=0.15) at six months and -0.67% (p=0.16) at 12 months. Few participants, four from the intervention group and one from the control group, achieved HbA1c target (<7%) at both six and 12 months, [(p=0.20), (p=0.36)] respectively. There were no significant between group differences in BMI, lipid profile and blood pressure at six months and 12 months. Starchy foods intake (median servings) were significantly lower in the intervention group compared to the control group, 9.3 vs. 10.8 (p=0.005) at six months and 9.9 vs. 11.9 (p=0.017) at 12 months. The proportion of participants growing own vegetables significantly increased in the intervention group compared to the control group 17/41 vs. 5/40 (p=0.003) at six months and 16/38 vs. 5/38 at 12 months. No significant group differences in the intake of energy, macronutrients, vegetable and fruits, sodium, cholesterol and fibre were observed at six and 12 months. Diabetes knowledge improved in the intervention group +0.95 (p=0.033) and +2.2 (p=0.000) when compared with the control group at six and 12 months respectively. There were no significant group differences in the attitudes towards diabetes and its treatment. Conclusions: The qualitative needs assessment provided insight for planning a tailored NE programme. The NE improved some dietary behaviours (starchy foods portion control and growing own vegetables) and diabetes knowledge. A non-significant lowering of HbA1c was observed.
Thesis (Phd)--University of Pretoria, 2013.
Human Nutrition
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Cantrell, Ronald Alexander. "Diagnosing antiretroviral treatment failure in resource-limited settings." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008p/cantrell.pdf.

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Mtema, Zacharia John. "Integrated disease surveillance and response systems in resource-limited settings." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/5224/.

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Infectious diseases are a major public health burden causing millions of deaths every year. Government authorities need to be able to monitor disease incidence and evaluate their interventions for disease control. Monitoring the status of infectious diseases is one of the most challenging problems facing the public health sector, and epidemiological surveillance systems for infectious diseases, particularly notifiable diseases are essential. Despite initiatives to encourage reporting of infectious diseases, underreporting and poor surveillance are on-going challenges for many developing countries. Most surveillance systems in these settings use traditional paper-based methods, which are both inefficient and impractical. There is a need for alternative tools to strengthen infectious disease surveillance systems in resource-limited settings. The remarkable progress made in mobile computing technology has the potential to improve infectious disease surveillance systems. However, user experience in digital technologies and infrastructure needs to be given greater attention. My study investigated the use of mobile phone devices as surveillance tools in health information systems. A mobile phone-based surveillance system was developed and applied in Tanzania as an alternative approach to traditional paper-based systems. Using this system different factors that affect the usability of mobile phone-based systems were investigated, by examining the quality of surveillance data in the context of completeness, timeliness and costs. After two years of operation in twenty-eight districts in southern Tanzania, numerous factors were identified that affect user accuracy and speed of use of the mobile phone-based surveillance. These include user experience in digital technology, particularly mobile device ownership; digital technology literacy, such as access and use of SMS and user’s age. The mobile phone-based surveillance system was more accurate compared to the traditional paper-based system with greater data reporting, more complete data and timelier reporting. Initially the mobile phone-based surveillance system required more capital investment, although the running costs of paper-based surveillance were greater. The utility of the mobile phone-based surveillance in monitoring and evaluating large-scale rabies control interventions was examined and the data produced was used to analyse the impacts of interventions on reducing disease incidence. Significant relationships were detected between the incidence of reported bite injuries in the focal district the previous month and in neighbouring districts that month, with more injuries detected in mainland Tanzania than on the island of Pemba. The relationship between bite injuries and vaccination coverage was complicated, with some evidence that vaccination reduced bite incidence. However, more data and a better model are needed to fully understand the impact of vaccination on bite incidence. The system provided timely information on the implementation of control measures and incidence of bite injuries, vital for improving control efforts. Use of automated short text messages (SMS) as part of the mobile phone-based surveillance was assessed to determine whether they could improve patient’s adherence to treatment regimens. Patients who received SMS reminders had significantly better compliance than those who did not, with attendance improved by at least 10%. Use of SMS reminders has the potential to improve patients’ compliance in other treatment regimens that require repeat clinic visits or administration of medicines. This thesis documented how the use of mobile phone devices can be used to improve surveillance in resource-limited settings. The use of effective integrated surveillance system could empower major stakeholders concerned with public health problems by providing them with appropriate real-time information on disease incidence and control interventions. In the final chapter the challenges encountered and insights gained in the application of mobile computing in strengthening infectious diseases surveillance are discussed. Despite infrastructural challenges such as unreliable power and Internet, mobile computing technologies can improve patient care and authorities can be prompted in a timely manner about infectious disease outbreaks and of supply shortages. In conclusion, innovative tools that can strengthen and integrate human and animal surveillance can improve the control and prevention of infectious diseases. Mobile phones have great potential for this, and can be used to strengthen health information systems.

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Sankar, Ramya. "Power of networks : a study of health franchises in resource limited settings." Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/57524.

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Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2009.
This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student submitted PDF version of thesis.
Includes bibliographical references (p. 62-64).
Billions of dollars are spent to develop drugs for infectious diseases in developing countries. How will these drugs along with clinical services be delivered to the patients who currently do not have access to them? Health franchises have been around since early 1990s, creating networks of shops and clinics that provide specialized care to low income individuals. This thesis attempts to understand the underlying mechanisms of successful health franchises. Two cases are taken into consideration, CFWshops in Kenya and Mi Farmacita Nacional (MFN) in Mexico. Both are pharmaceutical shops with small clinics attached to them. The two cases were examined through a framework derived from successful commercial franchises and franchise theory. The elements that were addressed include operational structure, marketing strategy, product and service offerings, monitoring of businesses, and financial structure. CFWshops and MFN had some stark differences in how they addressed each of these elements. Unlike typical commercial franchises, health franchises aim to provide social benefits to the population. This goal requires franchises to not only create a business strategy to be financially sustainable and take advantage of networks, but also show health improvements in the community. The success of a health franchise is dependent on the health impacts it provides because its mission is not to generate a profit for the stakeholders but rather the value added to the customer by providing access that was not there before.
(cont.) The comparative case analysis suggests several key recommendations. Health innovations in resource limited settings should create networks with other public and private health groups to leverage existing knowledge and best practices. This reduces cost and time of learning and allows businesses to utilize existing channels to provide access for drugs and services to individuals who currently are not receiving them.
by Ramya Sankar.
S.M.in Technology and Policy

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Monu, Ruban. "Design and implementation of a basic laboratory information system for resource-limited settings." Thesis, Georgia Institute of Technology, 2010. http://hdl.handle.net/1853/34792.

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Basic Laboratory Information System (BLIS) is a joint initiative of C4G @ Georgia Tech, the Centers for Disease Control and Prevention (CDC) and Ministries of Health in several countries in Africa. The vast majority of health laboratories in Africa, engaged in routinely testing samples drawn from patients (for HIV, malaria etc.), have been using non-standardized paper logs and manual entries for keeping track of patients, test samples and results. Besides the obvious burden of tedious record-keeping, these methods increase the chances of errors due to transcription and mismatches, making it difficult to track patient history or view critical population-wide data. In 2008, PEPFAR (the United States President's Emergency Plan for AIDS Relief) together with the CDC was reauthorized with a $48 billion budget over five years to combat HIV/AIDS, tuberculosis, and malaria. The focus of PEPFAR has shifted from rapid scale-up to the quality and reliability of the clinical health programs and having an effective laboratory management system is one of its goals. C4G BLIS is a robust, customizable and easy-to-use system that keeps track of patients, samples, results, lab workflow and reports. It is meant to be an effective and sustainable enhancement to manual logs and paper-based approaches. The system is designed to work in resource-constrained laboratories with limited IT equipment and across sites with good, intermittent or no internet availability. With varied practices, workflow and terminology being followed across laboratories in various African countries, the system has been developed to enable each laboratory or country to customize and configure the system in a way that suits them best. We describe various aspects of BLIS including its flexible database schema design, configurable reports and language settings, end-user customizability and development model for rapid incorporation of user feedback. Through BLIS, we aim to demonstrate a sustainable ICT solution brought about by the early and constant involvement of the target laboratory staff and technicians, identifying their short- and long-term needs, and ensuring that the system can match these needs. We will present preliminary evaluation results from laboratories in Cameroon, Ghana, Tanzania and Uganda.

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Spaar, Anne. "Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings /." Zürich, 2008. http://www.public-health-edu.ch/new/Abstracts/SA_25.03.09.pdf.

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Bendou, Hocine. "Baobab LIMS: An open source biobank laboratory information management system for resource-limited settings." University of the Western Cape, 2019. http://hdl.handle.net/11394/6773.

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Philosophiae Doctor - PhD
A laboratory information management system (LIMS) is central to the informatics infrastructure that underlies biobanking activities. To date, a wide range of commercial and open source LIMS are available. The decision to opt for one LIMS over another is often influenced by the needs of the biobank clients and researchers, as well as available financial resources. However, to find a LIMS that incorporates all possible requirements of a biobank may often be a complicated endeavour. The need to implement biobank standard operation procedures as well as stimulate the use of standards for biobank data representation motivated the development of Baobab LIMS, an open source LIMS for Biobanking. Baobab LIMS comprises modules for biospecimen kit assembly, shipping of biospecimen kits, storage management, analysis requests, reporting, and invoicing. Baobab LIMS is based on the Plone web-content management framework, a server-client-based system, whereby the end user is able to access the system securely through the internet on a standard web browser, thereby eliminating the need for standalone installations on all machines. The Baobab LIMS components were tested and evaluated in three human biobanks. The testing of the LIMS modules aided in the mapping of the biobanks requirements to the LIMS functionalities, and furthermore, it helped to reveal new user suggestions, such as the enhancement of the online documentation. The user suggestions are demonstrated to be important for both LIMS strengthen and biobank sustainability. Ultimately, the practical LIMS evaluations showed the ability of Boabab LIMS to be used in the management of human biobanks operations of relatively different biobanking workflows.

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17

Aranda, Jan Clara Beatriz. "Understanding context in design research : the case of medical devices in resource-limited settings." Thesis, University of Cambridge, 2018. https://www.repository.cam.ac.uk/handle/1810/273186.

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The design of medical devices has failed to satisfy the needs of resource-limited settings (RLSs). Whether purposefully designed for RSLs or transferred from a high-income country, the resulting devices often misalign with the characteristics of the context and the real needs of users. The challenges of contextualising medical devices in RLSs are widely acknowledged, but research to overcome these issues in practice is lacking. This study focuses on examining and defining the context for medical devices in RLSs. Two perspectives were employed for the study of context of medical devices in RLSs. The first approach, using design expert interviews and a systematic literature review, resulted in a contextual framework with factors relevant for the design, use and deployment of medical devices in RLSs. These factors were categorised in eight groups: public health, industrial, technological, institutional, financial, socio-cultural, geographical or environmental and economic. This approach, however, falls short in understanding the complexities behind these contextual factors. In order to tackle these limitations, the second approach used generative techniques for network mapping and mixed-methods for network analysis. This network approach resulted in the identification of networks surrounding MDs in RLSs, and the roles played by medical devices in these networks. These roles were categorised by type of interaction in six types: wellbeing, affiliation, organisational, clinical practice, cognitive and technical. Three assemblies of entities were also identified that were responsible for ensuring that MDs stay in the network and are available, used, maintained, and ultimately replaced when they fail. From this perspective, the investigation focused on how devices move in the network, change roles and are supported by other actors. In other words, the elements that assemble and allow medical devices to exist and subsist in the networks of care. Complexity and non-reducibility are at the core of this approach. The results from the exercise show that the approach sheds light on interesting and unexpected aspects of the use, adoption or deployment of medical devices in RLSs. However, the approach is abstract and overwhelmingly difficult to grasp in practical research. The approaches are compared and contrasted using an example of a MDs designed for RLSs. The approaches are not seen as competing but as complementary views of context. Their advantages and disadvantages are described, and recommendations are made for their application and improvement. The conclusions from this study contribute to new approaches to exploring the context of use for products in Design research by using, on the one hand, the concept of the collectives---as proposed by the actor-network theory---and, on the other hand, the idea of a holistic contextual framework for product design and development. For the field of global health, this research contributes to improving the design of much-needed technologies as solutions to global challenges.

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Nannan, Nadine. "Measuring child mortality in resource limited settings using alternative approaches: South African case study." Doctoral thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27836.

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Post the Millennium Development Goal project a significant number of countries are still faced with the challenge of monitoring child mortality. Despite numerous enquiries since 1996 to provide this basic health indicator, South Africa has experienced prolonged periods of uncertainty regarding the level and trend of infant and under-5 mortality. The thesis develops an analytical framework to review all available data sources and methods of analysis and presents the results of the four approaches adopted to measure child mortality trends. Reviewing the demographic indicators produced from seven census and survey enquiries, the overall performance and the strengths and limitations of each approach is evaluated. Poor and extremely poor quality of data for child mortality emerges as a pervasive challenge to census and survey data. The thesis presents the remarkable improvement in the completeness of birth and death registration through South Africa's CRVS system, particularly since 2000, illustrating the possibility of using CRVS data to monitor provincial child mortality in the future and highlighting statistical challenges arising from the movement of children. In conclusion, South Africa should focus on improving CRVS for purposes of monitoring childhood mortality provincially and the comprehensive evaluation of available data is a useful lesson for other upper-middle-income countries.

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19

Liu, Charles. "Brief Surgical Procedure Code Lists for Outcomes Measurement and Quality Improvement in Resource-Limited Settings." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27007744.

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Conditions amenable to surgery represent a significant portion of the burden of disease worldwide, accounting for 10% of deaths and 14% of disability-adjusted life years lost. Today, however, over five billion people worldwide lack access to safe, timely, and affordable surgical care, and the outcomes experienced by surgical patients are least understood in low- and middle-income countries (LMICs). An important barrier to improving access to and quality of surgical care in resource-poor settings is the dearth of reliable data, due in part to the lack of a standardized system for classifying surgical procedures. The applicability of existing procedure coding systems in LMIC hospital settings is limited by their size, complexity, and cost of implementation. The coding of surgical procedures has been a particular challenge in Uganda and at Mbarara Regional Referral Hospital (MRRH), a 323-bed hospital and one of the country’s busiest surgical centers. A brief procedure code list could improve data collection for administrative, quality improvement, and research purposes at MRRH and in other resource-limited settings. Here, we describe the creation and validation of three abbreviated surgical procedure code lists at MRRH. We reviewed operating room logbooks to identify all surgical operations performed between January 1 and December 31, 2014. Based on the documented indication for surgery and procedure(s) performed, we assigned each operation up to four procedure codes from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Volume 3. These codes were aggregated to generate procedure code lists. Each surgical procedure was assigned codes by one of two investigators working independently, and a random 20% of procedures were assigned codes by both investigators to evaluate inter-rater reliability. During the one-year study period, 6464 surgical procedures were performed at MRRH, to which we assigned 435 unique procedure codes. The Kappa statistic representing inter-rater reliability in assignment of codes was 0.7037. 111 procedure codes represented 90% of codes assigned, 180 represented 95%, and 278 represented 98%. These constituted short, intermediate-sized, and long code lists, respectively.

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20

Kilonzo, Nduku. "The practical and policy requirements for implementing post rape care services in resource limited settings." Thesis, University of Liverpool, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.445954.

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21

Haniffa, Rashan. "Developing a methodology for the evaluation of acute and critical care outcomes in resource-limited settings." Thesis, University of Oxford, 2017. http://ora.ox.ac.uk/objects/uuid:0057e38d-a5ee-4089-9ee0-247c7ffb9596.

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The burden of acute and critical illness in LMICs is high, and proportionally higher with poorer outcomes than in HIC. Structured surveillance, enabling systematic evaluation of acute and critical care outcomes, is largely lacking in LMICs. Many tools, including but not limited to prognostic models and decision-support tools, developed in HIC are mostly not validated in LMICs. In addition, acute and critical care skills training, necessary for improving the quality of care and outcomes, is not readily accessible for many healthcare workers. This thesis describes a baseline profile of acute and critical care services in Sri Lanka; the development and implementation of a national, electronic, critical and acute care surveillance system and an assessment of the feasibility of HIC decision-support tools in LMIC settings. It further describes a co-designed, sustainable, national acute and critical care training programme, supported by the surveillance platform. Baseline profile: Overall ICU mortality was 17% but no severity of illness data was available. Overall, only 5.1% of those who had CPR attempted in hospital were alive after 24 hours, with most arrests anticipated by the junior medical team. Only 4.4% of wards use DNAR instructions. The 99 national ICU's had relatively (to other LMICs) good staffing; 790 doctors (1.6 per bed) and 1989 nurses (3.9 per bed, 87.9% ICUs had 1:1 nurse to patient ratio). Evaluation of the applicability of APACHE II was hampered by arterial blood gases and electrolytes being available in only 18.7% and 63.4 % of ICU admissions respectively, and complete case records (for APACHE II) was only available in 1.6% of instances. A surveillance platform for acute and critical care, fusing mobile data entry with visual analytics, was developed and implemented in 56 Sri Lankan hospitals, supporting clinicians in finding ICU beds. The dataset confirmed the low availability of variables commonly used to detect deterioration in acutely unwell ward patients; respiratory rate (65.24 %), mentation (32.89%) and oxygen saturation (23.94%), in a cohort of 16,386 patients. The platform was used for the validation of prognostic models and EWS tools, which showed that the performance of single variable trigger systems was comparable to more complex EWS's regarding identification of at-risk patients. A simpler critical care prognostic model, (TropICS), based on variables more commonly available in LMICs and collected through the platform, was derived and evaluated, and shown to outperform APACHE II in this setting. The platform can also support critical care training; the thesis describes the development, execution, and evaluation of two clinically focused training programmes. A 2-year modular programme in Bangladesh, India and Nepal showed a positive impact on patient outcomes. In Sri Lanka, a peer-delivered, acute and critical care structured training programme was delivered to over 4,500 nurses, physiotherapists and doctors, increasing knowledge and confidence. In summary, the work in this thesis describes a setting-adapted acute and critical care surveillance system, enabling the evaluation of the feasibility and performance of prognostication and decision-support tools, providing a template for LMIC settings. The studies show the importance of evaluation of clinical and benchmarking tools for feasibility and performance, and their adaptation where necessary, prior to their implementation in LMICs. In addition, the studies show that locally developed, sustainable training programmes aimed at improving outcomes in critically ill patients are possible in resource-limited settings. This thesis provides evidence that a clinician-led data platform in a LMIC can provide opportunities to evaluate (and potentially improve) outcomes by an inter-dependent cycle of enhanced information availability, quality improvement, capacity-building, training, and research.

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22

Wang, Shuqi. "Development and assessment of internal positive controls for HIV-1 nucleic acid based tests in resource-limited settings." Thesis, University of Cambridge, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.611570.

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23

Zambuko, Chido Linda. "Development implementation and evaluation of a nutrition education programme for primary school children in resource-limited settings in Pretoria." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/65956.

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Background: School based nutrition education programmes play a critical role in promoting positive dietary change in children. Psychosocial mediators of behaviour change such as behaviour intentions, nutrition knowledge and self-efficacy motivate children to change nutrition behaviour. Aim: To develop, implement and evaluate a school based nutrition education programme (NEP) tailored to the needs of seven to nine year olds living in resource limited settings in Pretoria, Gauteng Province, South Africa. Study design: Quasi experimental without a control group. Study setting: Two resource limited primary schools in Pretoria. Study participants: Learners, aged seven to nine years, in Grades 1-3 from the two selected schools that met the inclusion criteria. Informed consent and assent were obtained. Method: The NEP was developed based on analysis of the learners’ dietary practices data as reported by the parents and learners. These data were collected as part of the situational analysis for a larger study and was availed to the researcher on completion of the data collection. The qualitative domain was employed to determine the nutrition education (NE) needs of the learners. The study then proceeded in two phases; Phase 1, which resulted in the development of the NEP and NE materials as informed by the literature review and the outcome of the situational analysis and guided by the Social Cognitive Theory, the South African Food Based Dietary Guidelines and the six steps for designing a NEP by Contento. In Phase 2, the NEP was implemented with a conveniently selected sample of Grade 1, 2 and 3 learners from the two schools (School 1 and 2). All participants received nine nutrition lessons over six weeks. The quantitative domain was employed to evaluate the effects of the NEP on the food choice intentions of Grade 1 learners, and self-efficacy and nutrition knowledge of Grade 2 and 3 learners. Outcomes were measured at baseline, at six weeks and at 12 months respectively. A modified validated Pathways knowledge, attitudes and behaviour questionnaire was used. Paired t-test evaluated the effect of the NEP on the three outcomes and the independent samples test compared the differences between the schools and gender. The ANCOVA assessed the effect of school and gender on the measured outcomes, with the pre-assessment score as the covariate. The McNemar test was used to compare differences between related percentages. The repeated measures ANOVA was used to assess the effect of time on the measured outcomes. The statistical package SPSS version 22 was used to analyse the data and a significance level of 0.05 was employed. Ethical approval was sought from the Faculties of Education and Health Sciences of the University of Pretoria (Number: D2015/ 375A). Approval was also sought from the Gauteng Department of Basic Education (DoBE), as well as the primary schools that were involved in the study. Results: Situational analysis: The situational analysis revealed that the learners had unhealthy eating habits characterised by skipping breakfast, monotonous diets and high consumption of unhealthy energy dense foods in both the school and home environments. Some food groups such as legumes were completely missing from the learners’ diets. Evaluation of the NEP: Grade 1 (n=49) and Grade 2 and 3 learners (n=108), aged seven to nine years completed the study at six weeks and at 12 months. At post-assessment (six weeks), a significant improvement in the overall food choice intentions of Grade 1 learners was observed (M=0.41974 vs. M=0.5671; P<0.0001) (M=mean). Significant improvements were also observed in School 1 (P=0.001) and in School 2 (P=0.014) with a greater improvement in School 1. The girls in School 1 had significantly higher improvement in mean scores as compared to girls in School 2 (P=0.0001), while the boys in School 1 also had higher improvement in mean scores as compared to the boys in School 2, though not significant (P=0.275). However, at 12 months a significant decrease in the overall food choice intentions was observed from baseline to 12 months (M=0.436 vs. M=0.561 vs. M=0.446; P=0.0002) for Grade 1 learners. At six weeks, a decrease for overall self-efficacy mean scores (P=0.483) of Grade 2 and 3 learners were observed in School 1 (P=0.634) and School 2 (P=0.082), although not significant. School 1 had non significant higher mean self-efficacy scores as compared to School 2 (P=0.903). The improvement in the mean self-efficacy score was significantly higher for girls in School 1 as compared to the girls in School 2 (P=0.036). The boys in School 2 had higher non significant mean improvement of scores as compared to the boys in School 1 (P=0.351). At 12 months a significant decrease in overall self-efficacy mean scores was observed from baseline to 12 months (M=0.801 vs. M=0.791 vs. M=0.735; P=0.000) for the Grade 2 and 3 group as a whole.
Dissertation (MSc)--University of Pretoria, 2017.
Food Science
MSc
Unrestricted

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Strock, Christopher Moore. "Seeing Beyond Service - Redefining the Problem of Water and Sanitation Service Delivery in Resource-Limited Settings to Enable Effective Solutions." Diss., Virginia Tech, 2010. http://hdl.handle.net/10919/28523.

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The purpose of this study was to examine the effectiveness of water and sanitation service delivery in resource-limited settings using two different social theories (modernization and world system). Understanding that barriers to effectiveness are rooted in global structures that tend to present at local levels helps redefine the problem leading to comprehensive policies and practices. The guiding research questions included an identification of an effectiveness gap in services delivered in developed countries compared to those in developing countries. This study included a survey of water and sanitation professionals gauging their opinions on trends within the sector. Survey respondents demonstrated that the sector tends to align with localized (i.e. modernist) approaches. This may explain the perpetuation of differential patterns in water and sanitation access and associated diseases and deaths in developing countries. Through a case study of Partners In Health (PIH), a medical-oriented non-governmental organization used as a proxy for water and sanitation organizations, this work illustrated why personal and organizational philosophies and perspectives influence how we organize and act. It concludes with a discussion of engineering decision making through the lenses offered by modernization and world system theories; presents an organizational structure that allows organizations to overcome theoretical and geographic boundaries; and offers a set of recommendations learned from PIH and those the sector does well. This research shows how water and sanitation organizations, practices, and policies that consider local and global forces are more effective at delivering services in developing countries than those focusing solely on local forces.
Ph. D.

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25

Wozniak, Roberta. "The evaluation of potential weight-estimation methods in a primarily HIV positive cohort in Botswana for use in resource limited settings." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/43843.

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Appropriate drug dosing in children should be calculated based on a child’s weight. In resource constrained settings however, inaccurate drug dosing is common due to the absence of working weight scales. Existing proxies for weight, such as those based on age or height, have been shown to be problematic, especially in populations in developing countries. Long bone measurements in children, such as ulna and tibia lengths, have yet to be studied as surrogate measures for weight. The purpose of this study was 1) to examine the association between weight and a series of proxy anthropometric measurements including height, ulna and tibia lengths, mid-upper arm circumference (MUAC), and triceps skinfolds in a primarily HIV positive population of Botswana children (18 months – 12 years); 2) to determine what percentage of the study population has a predicted weight within 10% of their actual weight; and 3) to determine a simple weight-prediction method that would most accurately predict a child’s weight (18 months – 12 years). This study was a cross-sectional survey carried out in a clinical setting at the Botswana-Baylor Children’s Clinical Centre of Excellence in Gaborone, Botswana. We measured weight, height, mid-upper arm circumference (MUAC), triceps skinfolds, ulna length, and tibia length in 777 children between the ages of 18 months and 12 years. Univariate linear regression and multiple linear regression analysis were performed using SPSS and coefficients of determination (R2) were calculated. Accuracy of the weight-prediction method was defined as having a predicted weight within 10% of the child’s actual weight. The MUAC-Tibia and the MUAC-Ulna weight-prediction models had the highest accuracy for predicting a child’s weight with adjusted R2 values of 0.95 and 0.94, respectively. Of the participants, 82% of weights were predicted to within 10% using the MUAC-Tibia method and 79% using the MUAC-Ulna method. Due to the high degree of accuracy, the MUAC-Tibia or MUAC-Ulna weight-prediction methods could potentially be used to estimate a child’s weight. Studies are needed to confirm these findings in other resource poor settings where there is no access to working scales.

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Ekeh, Peter Nnamdi. "Survey on nail discoloration and association with CD4 count among untreated HIV patients at Apin Centre, Nigeria." Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_4320_1362393499.

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Eligibility for antiretroviral therapy (ART) in HIV-infected patients is defined either by a cluster of differentiation antigen 4 (CD4) count of less than 200cells/mm3 or clinical diagnosis of WHO stage III and IV. Therefore, the decision to start ART becomes difficult when CD4 cell count is not available. With limited laboratory infrastructure, the decision to start ART is usually made based on clinical symptoms leading to late commencement of ART. This calls for alternative criteria to see if nail discoloration (ND) correlates with low CD4 count among untreated HIV infected patients. This will serve as a complementary screening tool for identifying asymptomatic ARV naive HIV patients with a CD4 cell count of less than 200cells/mm3 which signifies
severe immunosuppression. Study Design and Setting: This was a quantitative cross-sectional descriptive and analytical study involving adult ART naï
ve HIV infected patients in WHO stage I and II. Systematic sampling was used to select the participants from all adult ART naï
ve HIV infected patients attending APIN clinic, located at the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Data Collection: Face-to-face interviews, physical examination and relevant laboratory investigations with selected participants were conducted using a questionnaire guide. Questions on socio-demographic characteristics, clinical data, general physical examinations including finger nail examination and photographing with subsequent laboratory investigations including CD4 count and western blot were employed. Data Analysis: Variables were categorized and data analyzed using descriptive statistics including the frequency, percentage frequency
mean and standard deviation of continuous variables. Association between CD4 count of &le
200cells/mm3 and ND was tested using the chisquare test with an alpha level of 0.05. Prevalence of ND, sensitivity, specificity, positive predictive and negative predictive values and accuracy of the screening test of ND was calculated. Results: 394 patients had their fingernails photographed and assessed. It was shown that distal banded and grey nails were the common types of ND seen with a prevalence of 38%. There was an association between CD4 count &le
200cells/mm3 and ND (p<
0.0001). CD4 count &le
200cells/mm3 was a risk factor for developing ND (RR=2.3[1.8-3.6]). The association has a sensitivity of 78%, specificity of 55%, positive predictive value of 50%, and negative predictive value of 80% and accuracy of test 63%. Conclusion: With a significant association (p<
0.0001) and a sensitivity of 78%, ND can be a useful clinical indicator of immune dysfunction mediated by HIV among patients in WHO stage I or II. ND can either be a clinical sign or a symptom in HIV patients with a CD4 of &le
200cells/mm3 as seen in the study as the specificity and sensitivity of ND compared favourably with other WHO stage III diagnosis. Recommendations: Nail discoloration should complement CD4 count as an additional staging sign to help identify patients likely to benefit from ART especially in resource-limited settings. Finally, all patients with grey or distal banded should be on co-trimoxaxole prophylaxis in line with WHO /national guideline on the use of co-trimoxaxole for all HIV positive patients with a CD4 cell count of &le
350cells/mm3.

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Garcia, Albert D. "Evaluation of Proficiency Testing Program for Laboratories Conducting HIV-1 DNA Detection for Early Infant Diagnosis from Dried Blood Spot Specimens in Resource-Limited Settings." Digital Archive @ GSU, 2013. http://digitalarchive.gsu.edu/iph_theses/253.

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Early diagnosis of HIV in infants is critical because it can remarkably impact an infant’s survival. DNA PCR is the standard test for diagnosis of HIV-1 in infants and young children less than 18 months of age. For settings that lack the adequate infrastructure for processing whole blood and cold-chain transportation, the collection of dried blood spots (DBS) has facilitated the detection of HIV-1 in infants as early as 4-6 weeks after birth. Molecular testing using DBS provides an accurate method for the identification of HIV-1 but quality testing depends greatly on adequate quality assurance. A voluntary, cost-free external quality assurance program established by the U.S. Centers for Disease Control and Prevention, Global AIDS Program was implemented to monitor the performance of laboratories conducting HIV EID from DBS in an effort to provide the critically needed external quality assurance measures in resource-constrained settings. Known HIV- positive and negative DBS specimens to be used as internal controls and ten blinded DBS specimens are shipped internationally tri-annually with a 30 day testing result turnaround. Peer comparison is provided after each testing time point. Advances by resource-constrained countries to conduct EID have resulted in more children being tested, which resulted in enrollment and participation expanding significantly to include greater than 104 laboratories from 36 countries. Mean test scores have improved with each testing but false negative results are twice as likely as false positive discordant outcomes.

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Consestein, Caleb Madden. "The HIV epidemic in resource-limited settings: exploring the health disparities between HIV-negative infants born to HIV-negative mothers and those born to HIV positive mothers." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12333.

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Thesis (M.A.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
The HIV/AIDS epidemic has had a devastating impact on families and communities all across the world since it began. Nowhere is this more true than in low- and middle-income countries, especially in sub-Saharan Africa (SSA). While infections can be counted and number of deaths estimated, the burden the virus has had on societies as a whole are far more difficult to quantify and, indeed, may never be fully realized. A truly unfortunate phenomenon within the epidemic is the vertical infection of hundreds of thousands of newborn children every year born to HIV-positive mothers. Infection may occur while the infant is developing in the womb, during delivery, and after birth through breastfeeding-a feeding practice that is necessary to ensure survival in the face of the poverty and limited resources in SSA. Thankfully, in the past 5-10 years, the immense benefits of antiretroviral therapy have begun to be extended to low- and middle-income countries around the world, many of them in SSA. The medications that helped halt the spread of the disease in the developed world over the last couple of decades are now starting to be provided to the regions of the world that need them more than any other. Substantial progress has been made, especially in the reduction of vertical transmission from mother to child. With antiretroviral treatment transmission rates from mother-to-child can be as low as 1% however in the absence of treatment transmission rates can be as high as 40%. Indeed, antiretroviral(ARV)-based prevention of mother-to-child transmission has been considered by many to be one of the greatest public health initiatives in recent history. As the scale-up in treatment continues many challenges remain that include proper programmatic design to ensure judicious allocation of resources. Additionally, a mysterious set of observations that are raising concerns involve the health outcomes of those infants, born to HIV-positive mothers, who are exposed to the virus, but remain uninfected themselves. As this population of HIV-exposed, but uninfected children has begun to grow ever larger as transmission rates continue to decrease in the presence of ARV treatment, it has become increasingly clear that although these children do far better than their HIV-infected counterparts, they do not perform as well as HIV-negative children born to HIV-negative mothers. The enormous size of this growing patient population has led to an increased urgency among health experts to determine the causal factors for these observed disparities. The goal of this paper is to evaluate the current literature on HIV-exposed infant experiences in utero, during delivery, and after birth. Specifically, the literature demonstrates an enormous variety of factors that not only determine whether or not an infant becomes infected, but may also contribute to its health beyond the neonatal period. With this basis, the observed health disparities among HIV-exposed, uninfected (EU) infants reported in the literature will then be discussed along with the biological phenomena researchers propose as causes for these findings. Findings in health disparities between EU infants and infants that have never been exposed to HIV (NE infants) vary in type and magnitude. There have been statistically significant differences found in rates of mortality, infection, growth, and malnutrition as well as meaningful trends in other areas. Proposed causes for the findings are even more varied and range from decreased maternal health and ability to care for the child, to toxic effects of the ARV medications the infant is exposed to in the womb and after birth through breastfeeding. This review finds that a predominant cause still remains to be found and it is likely that multiple factors, both biological and social, likely contribute, and more research is needed in many areas to address this. As the postnatal period is the time over which healthcare practitioners and mothers have the most control, this review highlights several more questions to be answered about nature of exposure during this time period. Specifically, differences in breast milk between infected and uninfected mothers needs to be more fully elucidated.

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Little, Kirsty Elizabeth. "Measuring the impact of public health programms for HIV infected pregnant women and their children in resource limited settings : Estimating mother to child transmission and assessing paediatric treatment needed." Thesis, University College London (University of London), 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.498216.

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Ateba, ndongo Francis. "Traitement antirétroviral précoce des nourrissons infectés par le VIH-1 : évaluation de la réponse virologique à court et moyen termes dans un pays d’Afrique sub-saharienne (Cameroun) Could caregiver reporting adherence help detect virological failure in Cameroonian early treated HIV-infected infants Virological response to early combined antiretroviral therapy in HIV-infected infants: evaluation after 2 years of treatment in the PEDIACAM study, Cameroon Low Birth Weight in Perinatally HIV-Exposed Uninfected Infants: Observations in Urban Settings in Cameroon Feasibility of Routinely Offering Early Combined Antiretroviral Therapy to HIV-infected Infants in a Resource-limited Country: The ANRS-PediaCAM Study in Cameroon Different factors associated with loss to follow-up of infants born to HIV-infected or uninfected mothers: observations from the ANRS12140-PEDIACAM study in Cameroon Cytomegalovirus infection in HIV-infected versus non-infected infants and HIV disease progression in Cytomegalovirus infected versus non-infected infants early treated with cART in the ANRS 12140—Pediacam study in Cameroon." Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS322.

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Introduction : Depuis 2015, l’OMS recommande la mise sous traitement antirétroviral systématique de tous les enfants infectés par le VIH pour réduire la mortalité précoce liée au VIH chez les nourrissons en l’absence de traitement. Cependant, malgré la disponibilité des tests de dépistage et des médicaments antirétroviraux, l’initiation précoce de ces traitements reste un défi majeur dans les pays à ressources limitées. L’étude ANRS 12140-PEDIACAM est mise en place pour évaluer la faisabilité, l’efficacité et la tolérance en routine du traitement précoce des enfants infectés par le VIH au Cameroun. Objectifs : Les objectifs de cette thèse visaient à étudier la mortalité et la réponse virologique à deux et quatre ans après l’initiation précoce d’un traitement antirétroviral chez les nourrissons infectés par le VIH, et à identifier les facteurs associés à l’obtention et au maintien d’un succès virologique.Méthodes : Les analyses ont porté sur les 190 enfants infectés par le VIH traités avant l’âge de 1 an (médiane=4 mois), inclus dans les trois sites cliniques du Cameroun participant à la cohorte prospective ANRS PEDIACAM initiée en 2007. La première étude a évalué les performances d’un critère basé sur le nombre de doses manquées de traitement rapporté dans un questionnaire d’observance pour dépister un échec virologique chez les nourrissons. La seconde étude portait sur l’estimation de la fréquence et des facteurs associés à l’obtention d’un succès virologique et à la mortalité à deux ans du traitement, utilisant un modèle de survie à risque compétitif. La troisième concernait l’évolution de la réponse virologique entre 2 et 4 ans du traitement selon le statut virologique obtenu à deux ans.Résultats : Les performances du questionnaire d’observance administré à l’accompagnant du nourrisson s’avèrent limitées, avec une valeur prédictive positive trop faible pour dépister un échec virologique en l’absence de charge virale disponible. La mortalité reste élevée à un an du traitement précoce (18,0% [IC95% : 13,0 - 24,0]). Elle est de 3,3% [IC95% : 0,4 - 6,2] entre 2 et 4 ans de traitement. La probabilité d’atteindre au moins un succès virologique avant 2 ans de traitement est de 80% environ, mais celle d’obtenir une suppression virologique maintenue sur au moins 6 mois n’est que de 67% au seuil de 1000 copies/mL, et de 60% au seuil de 400 copies/mL. A 4 ans du traitement initial, la proportion de charge virale contrôlée (<400 copies/mL) est de 75,2% [68,3-82,1]) chez les 144 enfants toujours vivants et suivis, mais pour 12% la charge virale n’a pas été mesurée. Le seul facteur associé significativement au succès virologique dans les 2 ans du traitement initial est la bonne observance rapportée par l’accompagnant. Et seuls un succès virologique obtenu à 2 ans et l’initiation plus récente du traitement antirétroviral sont associés à un charge virale contrôlée à 4 ans.Conclusion : Même si l’intérêt du traitement précoce des nourrissons infectés par le VIH est démontré, le succès virologique à moyen et long terme passe par des stratégies favorisant l’administration quotidienne soutenue des médicaments et une surveillance régulière de la réponse virologique. L’évaluation de l’observance par questionnaire présente une trop faible performance pour dépister précocement un échec virologique. Il est urgent de donner un accès large à la mesure de la charge virale en routine dans les pays à ressources limitées pour dépister rapidement les échecs virologiques chez les enfants recevant un traitement antirétroviral
Introduction: Since 2015, the WHO recommends to start antiretroviral treatment promptly in all HIV-infected children in order to reduce HIV related mortality. Despite increasing availability of screening tests and antiretroviral drugs, early initiation of antiretroviral treatment (ART) remains challenging in resource-limited countries. The ANRS 12140-Pediacam study assesses feasibility, effectiveness and tolerability in routine practice of early treatment of HIV-infected children in Cameroon. Objectives: The objectives of this thesis are to study mortality and virologic response at 2 and 4 years of early initiation of ART in HIV-infected infants and identify factors associated with virologic success. Methods: The analysis concerned the 190 HIV-infected infants who have initiated ART no later than 1 year (median=4 months) and were enrolled in the 3 Cameroon clinical sites involved in the PEDIACAM prospective cohort study since 2007. The first study evaluated adherence criterium based on the number of missed doses as reported through an adherence questionnaire in oerder to detect virologic failure in infants. The second study concerned the evaluation of the frequency and the factors associated with virologic success and mortality at 2 years of ART initiation, using competing risk regression. The third study concerned the evolution of virologic response between 2 and 4 years of QRT initiation depending on virologic status achieved at 2 years of ART initiation. Results: The performances of adherence questionnaire administered to the infant's caregiver are limited; the positive predictive value is low for detecting virologic failure in the absence of viral load exam. The mortality is high at 1 year after early ART initiation (18.0% [95% CI: 13.0 – 24.0]). The mortality is 3.3% [95%CI: 0.4 – 6.2] between 2 and 4 years of ART initiation. The probability of achieving at least once virologic success within the first 2 years of ART is around 80.0% but the probability of maintaining virologic success for at least 6 months was 67% for threshold=1000 copies/mL and 60% for threshold=400 copies/mL. At 4 years of ART initiation, the proportion of virologic success (viral load<400 copies/mL) is 75.2% [68.3-82.1]) in the 144 children still alive among whom viral load exam was not performed. The only factor associated with virologic success at 2 years of ART initiation is good adherence as reported by the caregiver. Et seuls un succès virologique obtenu à 2 ans et l’initiation plus récente du traitement antirétroviral sont associés à un charge virale contrôlée à 4 ans.Conclusion: Although the interest of early ART in HIV-infected infants is demonstrated, the mid and long term virologic success pass through strategies enhancing supporting steady and daily administration of drugs and regular monitoring of virologic response. The steady evaluation of adherence as reported by questionnaire has a very low performance for early detecting virologic failure. It is urgent to widely get access to routine viral load exam in resource-limited countries for quickly detecting virologic failures in children receiving antiretroviral treatment

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Guiro, Abdoul Karim, and 康貴柏. "Knowledge, attitudes, beliefs and practices about HAART among people living with HIV/AIDS in a resource-limited setting: the case of an NGO (AMMIE) in Burkina Faso." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/npf7na.

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碩士
國立陽明大學
公共衛生研究所
97
Introduction: HAART has become available in Burkina Faso in recent years, and it is critical to assess factors, which will affect patients’ adherence to treatment, such as perception about illness and disease, potential effect of medical treatment, side effects, and impact on social life. The aim of the study was to investigate knowledge, attitude, beliefs, and practices (KABPs) about HAART of people living with HIV/AIDS in the northern region of Burkina Faso. Methods: A clinic-based cross sectional survey was conducted in the Northern region of Burkina Faso, using a structured questionnaire. Of the 412 patients evaluated 306 (74%) were on HAART and had been interviewed in AMMIE’s clinic, 106 (26%) were not on HAART and had been interviewed in their compound during home visit. Results: Participant had good knowledge about the effect of HAART: 80% knew it could prevent Mother to Child Transmission, 78% knew it cannot cure HIV. Only 24% knew that HIV could be prevented after having sex with someone already infected. The positive attitude score (8 questions) ranged between 8 and 17, with a mean score of 9, indicating generally positive attitudes towards HAART, but there was some concerns about HAART: 87% of the respondents knew that HAART can have side effects, 27% were worried about others might find they were on HAART, 52% agreed that HAART was difficult to take, 23% were worried about having to take HAART in the future, 39% were worried about HAART side effects, and 23% reported that the side effects affect their daily activities. The adherence rate (had ever forgotten to take one’s medication 7 days prior to the survey) was quite high according to self-report, reaching 95%. Also 49% out of 268 respondents were regularly using condom and, 65% had regular visit to the clinic, and 65.5% were able to stay in their jobs. Being on HAART, and having a regular visit to the clinic were significant predictors of knowledge about HAART in multivariate logistic analyses. Having a good attitude toward HAART was a significant predictor for having good adherence to HAART. Distance, number of support, and positive attitude toward HAART was significant predictor of having regular visit to the clinic. Finally marital status, socioeconomic status, distance, number of support and positive attitude toward HAART were significant predictors of being able to stay in work. Conclusion: The study population has generally positive knowledge, attitude, and adherence towards HAART especially for those taking HAART and had regular visit to the clinic. This is encouraging that HAART is well accepted by the people. Nevertheless an appropriate intervention is necessary to reinforce education message that HAART cannot cure HIV/AIDS and that HIV can be prevented after having sex with an infected person. Finally an outreaching program may be necessary to take care of those who did not visit regularly and those who were lost to follow up.

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Long, Lawrence Camdon. "The impact of a large scale treatment program on HIV treatment delivery in a resource limited setting: a case study of urban treatment in Johannesburg, South Africa." Thesis, 2016. http://hdl.handle.net/10539/22522.

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A thesis submitted to the Faculty of Health Sciences, University of Witwatersrand, in fulfillment of the requirements for the degree of Doctor of Philosophy Johannesburg, 2016
Introduction This thesis investigates the impact of a large-scale HIV treatment program on the outcomes and costs associated with HIV treatment delivery, using urban South Africa as a case study. In order to investigate HIV treatment delivery it is broken down into two major components; 1) the chronic outpatient treatment of HIV and 2) the acute inpatient treatment of HIV related conditions. Outpatient HIV treatment Through task shifting the South African outpatient HIV treatment program evolved over time to scale up in an environment of limited resources. There is no economic evaluation of task shifting in a routine environment in South Africa. Papers 1 and 2 focus on understanding the outcomes, costs, and cost effectiveness of partial and full task shifting. The results of this work provided evidence to support the shift to nurse initiation and management of antiretroviral treatment (NIMART). It also highlighted the fact that within the NIMART program there may be a need to triage patients between primary health clinics and hospital based outpatient clinics to better utilize scarce resources. Inpatient HIV treatment Prior to antiretroviral treatment (ART) inpatient care of acute HIV related conditions was common, but with the rollout of antiretrovirals in 2004 it was anticipated that this would reduce. Since 2004 there has been no economic evaluation, which speaks specifically to the shifting HIV burden on inpatient facilities. Papers 3 and 4 focus on understanding the HIV burden on inpatient facilities by examining the outcomes (mortality) and costs associated with HIV positive admissions. The results show that almost half (45%) of inpatient medical admissions were confirmed HIV positive, not on ART and accounted for the majority of the costs. In addition to that, the majority of medical inpatients (58%) who died were HIV positive, which lends support to other evidence that suggests that national HIV mortality is seriously under reported in South Africa. Conclusion Large-scale ART continues to move outpatient HIV treatment further along the task-shifting continuum, while maintaining outcomes with some potential reductions in cost. However, large-scale ART has not had the expected impact of substantially reducing the HIV burden on inpatient facilities.
MT2017

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Müller, Alexandra Denise. "Adherence to paediatric antiretroviral therapy in South Africa." Doctoral thesis, 2009. http://hdl.handle.net/11858/00-1735-0000-0006-AF61-4.

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Freiman, J. Morgan. "Evidence toward a novel approach to hepatitis C virus testing in resource-limited settings." Thesis, 2018. https://hdl.handle.net/2144/27854.

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RATIONALE: A low cost point of care test (POCT) to diagnose hepatitis C virus (HCV) viremia could be a critical step toward HCV elimination. The aim of this study is to inform the limit of detection (LOD) for an affordable POC test. METHODS: This study analyzed a convenience sample of cross-sectional HCV testing data from reference laboratories and clinical research studies in 9 countries. Participants of all ages with quantified HCV viremia were included. We analyzed the distribution of HCV viral load for the first detectable HCV RNA available, and derived the clinical sensitivity for a POCT with an LOD of 3 log IU/mL. Bivariate and multivariate analyses were then performed to identify demographic and clinical characteristics associated with low-level viremia (< 3 log IU/mL). RESULTS: The dataset included 53,295 participants from Cambodia, Canada, Cameroon, Georgia, Indonesia, Malaysia, Pakistan, Thailand, and Vietnam. Log HCV RNA was normally distributed, and ≥ 3 log IU/mL corresponded with clinical sensitivity of 98%. Neither HIV co-infection nor cirrhosis were significantly associated with low-level viremia, whereas bivariate analyses showed increased odds of 2.47 (95% CI 2.04, 2.99) for low-level HCV RNA among those ≤ 30 years old compared to those > 30, and an OR of 1.17 (1.02, 1.34) among females compared to males. Stepwise multivariate regression found no significant confounding. CONCLUSION: In this global dataset, a POCT with a LOD of 3 log IU/mL would identify 98% of chronic HCV infections. The increase OR among those ≤ 30 years old year olds is likely explained by a greater frequency among younger persons of recent infection, where fluctuating viremia is well described. A POCT for HCV that could identify persons with 3 log IU/mL or greater would likely facilitate affordable product development and expand the reach of HCV testing in resource-limited settings.
2019-03-17T00:00:00Z

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Lameiras, Ana Catarina Martins. "Current laboratory diagnostic methods for sickle cell disease and a novel approach : usefulness in resource-limited settings." Master's thesis, 2015. http://hdl.handle.net/10451/24778.

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Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Sickle cell disease represents a major public health problem, especially in Africa, where most of the cases occur. The characteristic feature of the condition is the occurrence of the abnormal hemoglobin S, which polymerizes. Affected individuals may display severe complications, often leading to early death. Therefore, they need to be properly identified to start a treatment as early as possible. However, currently available laboratory diagnostic methods are not feasible in resource-limited settings, since they are time-consuming, usually require expertise and expensive equipment and consumables, and do not allow point of care testing. Thus, there is an urgent need for a reliable low-cost diagnostic test. Some new approaches are under development to overcome this issue. This review summarizes existing methods and new approaches for the diagnosis of the disease and gives the background for my on-going study to use the birefringence of polymerized hemoglobin S to develop a novel diagnostic method (work in progress). An optical assay able to detect light depolarization of haemoglobin S may not only give the diagnosis, but may eventually serve as a novel clinical parameter to assess disease severity.
A doença de células falciformes constitui um importante problema de saúde pública, principalmente em África, onde ocorre a maioria dos casos. Esta doença caracteriza-se pela presença de uma variante da hemoglobina normal, a hemoglobina S, que polimeriza. Estes doentes podem apresentar complicações graves, que frequementemente conduzem a morte prematura. Consequentemente, precisam de ser identificados adequadamente para iniciarem o tratamento o mais cedo possível. No entanto, os métodos diagnósticos laboratoriais disponíveis actualmente não são aplicáveis em regiões com poucos recursos, uma vez que requerem tempo, experiência e equipamentos e consumíveis caros e não permitem realizar o teste no local onde o doente é atendido. Deste modo, há uma necessidade urgente de um teste diagnóstico de baixo custo. Novos métodos estão a ser desenvolvidos para ultrapasssar este problema. Esta revisão aborda os métodos existentes e novas técnicas para o diagnóstico da doença e apresenta o meu projecto em curso de um novo método de diagnóstico utilizando a propriedade de birefringência dos polímeros de hemoglobina S (trabalho em densenvolvimento). Um método óptico capaz de detectar a depolarização da luz pela hemoglobina S poderá não só permitir o diagnóstico, mas também eventualmente constituir um novo parâmetro clínico para avaliar a gravidade da doença.

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Wu, Xunyi. "Novel, Rapid and Cost-effective Methods for Concentration, Detection and Monitoring of Waterborne Pathogens in Resource-Limited Settings." Thesis, 2021. https://thesis.library.caltech.edu/14241/1/Thesis_Alison%20Xunyi%20Wu_0606.pdf.

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Waterborne pathogenic organisms including bacteria, viruses, protozoa and helminths, are responsible for a series of diseases which is a major public health concern worldwide. This issue is extremely severe in developing regions due to the scarcity of clean water supply and poor sanitation. Therefore, point-of-use (POU) detection and quantification processes as well as a monitoring program of waterborne pathogens are needed to ensure the safety of water and protect human health. However, the polymerase chain reaction (PCR) technology and its related detection platforms rely on complicated thermal cycling, centralized laboratory equipment and trained personnel, thus making PCR-based systems incapable of POU testing of environmental waters. In this dissertation, we develop a portable 3D-printed system with super-absorbent polymer (SAP) microspheres for sample enrichment, and a membrane-based in-gel loop-mediated isothermal amplification (mgLAMP) system for absolute quantification of pathogens. We also explored the interactions between microbial indicator of Escherichia coli (E. coli) and waterborne pathogen Vibrio Cholerae (V. Cholerae). The main results are as follows:

1. The application of detection and quantification methods is often hindered by the low pathogen concentrations in natural waters. Rapid and efficient sample concentration methods are urgently needed. Here we present a novel method to pre-concentrate microbial pathogens in water using a portable 3D-printed system with super-absorbent polymer (SAP) microspheres, which can effectively reduce the actual volume of water in a collected sample. The SAP microspheres absorb water while excluding bacteria and viruses by size exclusion and charge repulsion. The 3D-printed system with optimally-designed SAP microspheres could rapidly achieve a 10-fold increase in the concentration of E. coli and bacteriophage MS2 within 20 minutes with concentration efficiencies of 87% and 96%, respectively. Fold changes between concentrated and original samples from qPCR and RT-qPCR results were found to be 11.34-22.27 for E. coli with original concentrations of 10⁴-10⁶ cell·mL^-1; and 8.20-13.81 for MS2 with original concentrations of 10⁴-10⁶ PFU·mL^-1. Furthermore, SAP microspheres can be reused 20 times without performance loss thereby significantly decreasing the cost of our concentration system.

2. Following sample concentration, accurate quantification methods for waterborne pathogens are needed, especially at the point of sample collection. The surge of COVID-19 in late 2019 called for a more urgent need for a rapid and cost-effective quantification of SARS-CoV-2 in environmental waters. Quantification results contribute to wastewater-based epidemiology (WBE) which helps the monitoring of prevalent infections within a community and early detections of contamination. Here we demonstrated the usage of our portable membrane-based in-gel loop-mediated isothermal amplification (mgLAMP) system for absolute quantification of SARS CoV-2 in wastewater samples within a one-hour timeframe for point-of-use (POU) testing and data management. The limit of detection (LOD) of mgLAMP for SARS-CoV-2 quantification in Milli-Q water was observed to be down to 1 copy/mL, and that in surface water collected from Kathmandu, Nepal was down to 100 copies/mL. Both were 100-fold lower than that of RT-qPCR in corresponding matrices. Compared to alternative detection methods, our platform has a very high level of tolerance against inhibitors thanks to the restriction of the hydrogel matrix. This enables the highly sensitive detection in either clinical or environmental samples.

3. Regular environmental surveillance of waterborne pathogens is key to ensure the safety of water and protect public health. Due to the diversity of pathogenic bacteria in environmental waters, regular monitoring of so many pathogens for individuality is impractical. Therefore, microbial indicators are used to gauge the total pathogen concentration; and manage waterborne health risks. In this study, the interactions of V. cholerae, the etiologic agent of reemerging cholera, with E. coli, the most commonly used indicator for waterborne pathogens. Specifically, we investigated through evaluating the survival and growth of both bacteria under different temperature and nutrition deprivation using plate culturing and real-time polymerase chain reaction (qPCR). During co-growth, it was challenging for V. Cholerae to maintain initial population advantages as E. coli consumes nutrition more effectively. Whereas during co-existence, V. Cholerae soon fell into a viable-but–non-culturable state under environmental stress in 3-5 days while E. coli stay viable more than 14 days. We found that V. cholerae interacts with E. coli differently depending on the composition of the water that is sampled and analyzed. This suggests that bacterium-bacterium interactions influenced by the intrinsic chemical and biological parameters of ambient water will be a contributing mechanism in regulating the proliferation of V. cholerae.

In summary, two platforms for environmental sample concentration and detection have been developed and tested using ambient and engineered waters. In addition, interactions between a microbial indicator, E. coli, and the pathogenic bacteria, V. Cholerae, were studied. The chapters in this thesis describe in detail: (1) A hand-pressed 3D-printed system to produce SAP microspheres was developed with the goal of achieving efficient concentrations of environmental microorganisms for subsequent analysis. The simplified concentration procedure and can be easily integrated into various detection platforms; (2) A portable membrane-based in-gel loop-mediated isothermal amplification (mgLAMP) system was developed for absolute quantification of SARS-CoV-2 in environmental water samples within one hour, enabling a 100-fold lower detection limit compared to the gold-standard of RT-qPCR; and (3) Differences in bacterium-bacterium interactions of V. cholerae and E. coli under as a function of water composition indicated that environmental stress presented in ambient water matrices should be taken into consideration while using a microbial indicator such as E. coli to estimate the risk of waterborne pathogens. These collective advances allow for the rapid and ultrasensitive POU testing of waterborne pathogens that should provide for more effective monitoring strategies in terms of the use of indicator microorganisms.

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Mushamiri, Ivy. "The HIV Care Continuum: Measuring Latent Enablers and Assessing Pathways to Viral Load Suppression in Resource-Limited Settings." Thesis, 2020. https://doi.org/10.7916/d8-5b92-s602.

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The HIV care continuum captures the proportion of people who engage in various steps of the treatment cascade from the time of HIV diagnosis to the achievement of viral load suppression. Viral load suppression is the ultimate goal of HIV treatment as it is the best way to mitigate the spread of HIV and contain the epidemic. The best pathway to viral load suppression is not always clear. There are several factors that aid or hinder HIV patients from engaging in every step of the care continuum until they achieve and sustain viral load suppression. This dissertation aims to measure the underlying enablers of engagement in HIV care, relate them to potential barriers, and assess the effect of each enabler and barrier on future engagement in care and viral load suppression using data collected from people living with HIV (PLHIV) in Eswatini. Firstly, a systematic review was conducted to summarize the methodologies used to measure and analyze barriers and enablers of engagement in HIV care. A search of all peer-reviewed articles published in English globally since 1996 yielded a final selection of 228 articles. The vast majority of the studies were qualitative and descriptive, and there was a scarcity of quantitative studies utilizing predictive methods that can measure the effect of a barrier or enabler on future engagement in care. Secondly, an empirical analysis was conducted to assess the dimensionality (factor structure) of enablers of engagement in care using a sample largely representative of HIV patients in care in Eswatini. This analysis demonstrated the use of psychometric techniques that can capture underlying latent enablers. These techniques are useful for standardizing the measurements of enablers across studies and programs and can be used to predict future engagement in care. This analysis found financial and access enablers to be the most prominent underlying factors supporting engagement in care in Eswatini, suggesting that these should be an important consideration when designing interventions to retain HIV patients in care in resource-limited settings similar to Eswatini. Thirdly, in an additional empirical analysis, the latent enablers previously identified were used to select potential barriers and assess their effect on linkage to care, retention in care, and viral load suppression. The analysis also involved an assessment of the mediational pathway from the potential barriers to care to viral load suppression that goes through retention in care. Only perceived HIV stigma was related to any step of the care continuum, with low perceived stigma being marginally associated with less viral load suppression. Retention in care did not mediate the relationship between perceived stigma and viral load suppression. More psychometric studies are needed to standardize the measurement of underlying factors affecting engagement in HIV care. This dissertation demonstrated their utility by measuring latent enablers of engagement in care, assessing the downstream effects of the latent enablers and corresponding barriers, and assessing the mechanisms by which the barriers affect viral load suppression.

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Gadabu, Oliver Jintha. "Prescribing cotrimoxazole prophylactic therapy (CPT) before and after an electronic medical record system implementation in two selected hospitals in Malawi." Diss., 2013. http://hdl.handle.net/10500/14404.

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Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another.
Health Studies
M.A. (Public Health)

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Komu, Patricia Wangui. "Adherence to Highly Active Antiretroviral Therapy and its major determinants among patients at Rundu Hospital, Namibia." Thesis, 2008. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_5696_1262815913.

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Aim: To obtain baseline data on adherence levels and the major determinants of adherence among patients on HAART at Rundu Hospital, Namibia.

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Mohlajoa, Katlego Thabo. "Determinants contributing to exclusive breastfeeding in HIV-infected mothers of infants aged 0-6 months who attend an NGO Health Centre in Elandsdoorn Village." Diss., 2016. http://hdl.handle.net/10500/22199.

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Text in English
Breastfeeding is particularly important in resource-poor regions of the world, where limited access to clean water increases the risk of diarrhoeal disease if replacement feeding is used. However, human immunodeficiency virus type 1 (HIV-1) is transmitted through human milk. Purpose of the study The purpose of this study was to describe the determinants contributing to exclusive breastfeeding in HIV-infected mothers of infants aged 0 to 6 months who attend an NGO Health Centre in Elandsdoorn Village. Methods A quantitative research approach using a non-experimental cross-sectional study was undertaken to conduct this study. A self-reported study questionnaire was used to collect data from study participants. Purposive sampling was used to sample 75 mothers from 18 to 45 years of age who were HIV-positive. SPSS version 23 was used to analyse the data. Results The study results indicated that there are determinants contributing to exclusive breastfeeding and a need to establish a more comprehensive approach to educating pregnant women on reproductive health issues, and exclusive breastfeeding in particular. Factors contributing to low levels of exclusive breastfeeding included breast problems, societal influence, maternal health concerns, insufficient support, fear of stigmatisation, and babies’ health concerns. This caused mothers to discontinue exclusive breastfeeding. Conclusions The intention of this study was to reveal the determinants of exclusive breastfeeding affecting mothers who are HIV-infected and breastfeeding their infants.
Health Studies
M.P.H.

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