Apoio institucional para agentes comunitários de saúde usando o programa de Atenção Integrada às Doenças Prevalentes na Infância em Ruanda / Institutional support to community health workers using integrated management of childhood illness program in Rwanda

O objetivo foi explorar o apoio e descrever a supervisão de agentes comunitários de saúde que implementam o programa de atenção integrada às doenças prevalentes na infância (AIDPI). Um desenho não experimental, exploratório, descritivo e quantitativo foi adotado neste estudo. Os dados foram coletados entre 305 participantes (30% da população) por meio de um questionário estruturado. Dupla digitação foi utilizada e os dados foram limpos e analisados usando o Statistics Package of Social Sciences (SPSS) 19. Em Ruanda, o apoio e supervisão são fornecidos pela instituição base e supervisores. Os agentes comunitários de saúde (ACS) frequentemente enfrentam escassez de medicamentos e equipamentos (63,3%) e 87,5% ficaram sem equipamentos, medicamentos e consumíveis, o que criou barreiras para a assistência das crianças doentes. Para melhorar o apoio institucional dado aos agentes comunitários de saúde, supervisão de apoio contínua e regular, além do fornecimento de suprimentos, é essencial.

The objective was to explore the support given to community health workers who use the integrated management of childhood illness (IMCI) approach and describe the supervision given to them. A non-experimental, exploratory, descriptive, quantitative design was used for this study. Data were collected using a structured questionnaire; 305 were interviewed (30% sample). The data were double entered, cleaned, and analyzed using Statistics Package of Social Sciences (SPSS) 19. Support and supervision in Rwanda are provided by the base institution and by supervisors. CHWs often had a shortage of drugs and equipment (63.3%) and 87.5% have experienced run out of equipment, medicines, and consumables. This created barriers to caring for sick children. To improve institutional support for community health workers, regular and continuous supportive supervision and supplies are essential.

Low topotype diversity of recent foot-and-mouth disease virus serotypes O and A from districts located along the Uganda and Tanzania border

Foot-and-mouth disease (FMD) is one of the most important livestock diseases in East Africa with outbreaks reported annually that cause severe economic losses. It is possible to control disease using vaccination, but antigenic matching of the vaccine to circulating strains is critical. To determine the relationship between foot-and-mouth disease viruses circulating in districts along the Uganda and Tanzanian border between 2016 and 2017 and currently used vaccines, phylogenetic analysis of the full VP1 virus sequences was carried out on samples collected from both sides of the border. A total of 43 clinical samples were collected from animals exhibiting signs of FMD and VP1 sequences generated from 11 of them. Eight out of the 11 sequences obtained belonged to serotype O and three belonged to serotype A. The serotype O sequences obtained showed limited nucleotide divergence (average of 4.9%) and belonged to topotype East Africa-2, whereas the most common O-type vaccine strain used in the region (O/KEN/77/78) belonged to East Africa-1. The serotype A viruses belonged to topotype Africa-G1 (average nucleotide divergence 7.4%), as did vaccine strain K5/1980. However, vaccine strain K35/1980 belonged to Africa G VII with an average sequence divergence of 20.5% from the study sequences. The genetic distances between current vaccine strains and circulating field strains underscores the crucial need for regular vaccine matching and the importance of collaborative efforts for better control of FMD along this border area.

Modelling protection behaviour towards micronutrient deficiencies: Case of iodine biofortified vegetable legumes as health intervention for school-going children

BACKGROUND/OBJECTIVES: Despite successes recorded in combating iodine deficiency, more than 2 billion people are still at risk of iodine deficiency disorders. Rural landlocked and mountainous areas of developing countries are the hardest hit, hence the need to explore and advance novel strategies such as biofortification. SUBJECTS/METHODS: We evaluated adoption, purchase, and consumption of iodine biofortified vegetable legumes (IBVL) using the theory of protection motivations (PMT) integrated with an economic valuation technique. A total of 1,200 participants from three land-locked locations in East Africa were recruited via multi-stage cluster sampling, and data were collected using two, slightly distinct, questionnaires incorporating PMT constructs. The survey also elicited preferences for iodine biofortified foods when offered at a premium or discount. Determinants of protection motivations and preferences for iodine biofortified foods were assessed using path analysis modelling and two-limit Tobit regression, respectively. RESULTS: Knowledge of iodine, iodine-health link, salt iodization, and biofortification was very low, albeit lower at the household level. Iodine and biofortification were not recognized as nutrient and novel approaches, respectively. On the other hand, severity, fear, occupation, knowledge, iodine status, household composition, and self-efficacy predicted the intention to consume biofortified foods at the household level; only vulnerability, self-efficacy, and location were the most crucial elements at the school level. In addition, results demonstrated a positive willingness-to-pay a premium or acceptance of a lesser discount for biofortification. Furthermore, preference towards iodine biofortified foods was a function of protection motivations, severity, vulnerability, fear, response efficacy, response cost, knowledge, iodine status, gender, age. and household head. CONCLUSIONS: Results lend support for prevention of iodine deficiency in unprotected populations through biofortification; however 'threat' appraisal and socio-economic predictors are decisive in designing nutrition interventions and stimulating uptake of biofortification. In principle, the contribution is threefold: 1) Successful application of the integrated model to guide policy formulation; 2) Offer guidance to stakeholders to identify and tap niche markets; 3) stimulation of rural economic growth around school feeding programmes.

Travel Pattern and Prescription Analysis at a Single Travel Clinic Specialized for Yellow Fever Vaccination in South Korea / 감염과화학요법

BACKGROUND: Travel-related risks for infectious diseases vary depending on travel patterns such as purpose, destination, and duration. In this study, we describe the patterns of travel and prescription of vaccines as well as malaria prophylaxis medication (MPM) at a travel clinic in South Korea to identify the gaps to fill for the optimization of pre-travel consultation. MATERIALS AND METHODS: A cohort of travel clinic visitors in 2011 was constructed and early one-third of the visitors of each month were reviewed. During the study period, 10,009 visited the travel clinic and a retrospective chart review was performed for 3,332 cases for analysis of travel patterns and prescriptions. RESULTS: People receiving yellow fever vaccine (YFV) (n = 2,933) were traveling more frequently for business and tourism and less frequently for providing non-medical service or research/education compared to the 399 people who did not receive the YFV. Overall, most people were traveling to Eastern Africa, South America, and Western Africa, while South-Eastern Asia was the most common destination for the non-YFV group. Besides YFV, the typhoid vaccine was the most commonly prescribed (54.2%), while hepatitis A presented the highest coverage (74.7%) considering the natural immunity, prior and current vaccination history. Additionally, 402 (82.5%) individuals received a prescription for MPM among the 487 individuals travelling to areas with high-risk of malaria infection. Age over 55 was independently associated with receiving MPM prescription, while purpose of providing service and travel duration over 10 days were associated with no MPM prescription, despite travelling to high-risk areas. CONCLUSION: Eastern Africa and South America were common travel destinations among the visitors to a travel clinic for YFV, and most of them were travelling for tourism and business. For the individuals who are traveling to areas with high-risk for malaria, more proactive approach might be required in case of younger age travelers, longer duration, and travel purpose of providing service to minimize the risk of malaria infection.

A arte moderna e os imaginários da alteridade / Modern art and the imaginéries of alterity / Arte moderno e imaginarios de alteridad

Este artigo busca esclarecer e discutir as relações entre a arte moderna e os imaginários da alteridade - entendendo imaginário não apenas como um repertório de imagens ou os caminhos temáticos possíveis de serem reapropriados pelo artista, mas também a própria capacidade de imaginar, de perceber e recriar as imagens do mundo. Deste modo, mostra-se como um dos pontos de ruptura de toda uma série de artistas ocidentais, que já podem ser classificados como modernos, foi precisamente uma nova postura com relação ao imaginário e à arte de outros povos. O texto aborda mais especificamente as alteridades oriundas dos povos orientais e as alteridades oriundas da África negra, demonstrando como, a partir destes imaginários de alteridade, os modernos artistas ocidentais conseguiram recriar a sua própria arte

This article attempts to clarify and discuss of relations between modern art and the imaginaries of the alterity - understanding imaginary as not only a repertory of images or the thematic ways possible of been reapropriated by the artists, but also the capacity itself of to imagine, of perceive and recreate the images of the world. In this way, the intent is to show how one of the points of rupture of several occidental artists, which can be classified as moderns, was precisely a new posture in relation to the imaginary and the art of the other peoples. The essays aboard more specifically the alterities referent to the oriental peoples and the alterities referents to the black Africa, showing how, working with these alterities imaginaries, the modern occidental artists had success in recreate his own art

Biosafety education relevant to genetically engineered crops for academic and non-academic stakeholders in East Africa

Development and deployment of genetically engineered crops requires effective environmental and food safety assessment capacity. In-country expertise is needed to make locally appropriate decisions. In April 2007, biosafety and biotechnology scientists, regulators, educators, and communicators from Kenya, Tanzania, and Uganda, met to examine the status and needs of biosafety training and educational programs in East Africa. Workshop participants emphasized the importance of developing biosafety capacity within their countries and regionally. Key recommendations included identification of key biosafety curricular components for university students; collaboration among institutions and countries; development of informational materials for non-academic stakeholders and media; and organization of study tours for decision makers. It was emphasized that biosafety knowledge is important for all aspects of environmental health, food safety, and human and animal hygiene. Thus, development of biosafety expertise, policies and procedures can be a stepping stone to facilitate improved biosafety for all aspects of society and the environment.

East African sleeping sickness in Chennai.

A traveler to East Africa developed fever, an eschar on his forearm and thrombocytopenia shortly after returning home to Chennai, India. Trypanosoma brucei rhodesiense infection was diagnosed on examination of his peripheral smear. He made a full recovery after receiving a course of suramin.

1 case of imported Plasmodium vivax malaria with delayed manifestations due to inadequate chemoprophylaxis / 대한내과학회지

Malaria is the world's most important parasitic infec tion. Although it has been eradicated from temperate zones including Korea , increasing numbers of travellers visit tropical malarious countries and imported malaria becomes important medical problem in the developed countries. In Korea with increasing travellers to malaria endemic area, the incidence of imported malaria shows rising tendency same as the developed countries. It beco mes important to provide general personal protective me asures and chemoprophylaxis to trevellers, when employed in appropriate manner, that can be highly effective in preventing malaria . We recently experienced a case of imported Plasmodium vivax malaria with delayed mani festations due to inadequate chemoprophylaxis. A 53- year-old woman with history of trevel to East Africa 4 months ago and chief complaint of fever was diagnosed as tertian malaria. She had irregularly taken prophylatic antimalarial during travel and had not taken it after return but should have taken it at least 4 weeks after return.