Factors associated with the unsuccessful TB treatment outcomes in the northern regions of Namibia: a mixed methods study.

BACKGROUND: Tuberculosis (TB) is among the leading causes of death globally. The disease has a huge burden in Namibia, with a case notification rate of at least 442 per 100,000. To date, Namibia is among the countries with the highest global TB burden, despite all efforts to reduce it. This study aimed to determine the factors associated with the unsuccessful treatment outcomes of the Directly Observed Therapy Short course (DOTS) programme in the Kunene and Oshana regions. METHODS: The study utilised a mixed-methods explanatory-sequential design to collect data from all TB patient records and healthcare workers who work directly with the DOTS strategy for TB patients. The relationship between independent and dependent variables was analysed using multiple logistic regression analysis, while interviews were analysed using inductive thematic analysis. RESULTS: The overall treatment success rates of the Kunene and Oshana regions throughout the review period were 50.6% and 49.4%, respectively. The logistic regression analyses showed that in the Kunene region, the type of DOT used (Community-based DOTS) (aOR = 0.356, 95% CI: 0.835-2.768, p = 0.006) was statistically significant with the unsuccessful treatment outcomes. While in the Oshana region, age groups 21-30 years old (aOR = 1.643, 95% CI = 1.005-2.686, p = 0.048), 31-40 years old (aOR = 1.725, 95% CI = 11.026-2.9, p = 0.040), 41-50 years old (aOR = 2.003, 95% CI = 1.155-3.476, p = 0.013) and 51-60 years old (aOR = 2.106, 95% CI = 1.228-3.612, p = 0.007) had statistically significant associations with the poor TB-TO. Inductive thematic analysis revealed that patients in the Kunene region were challenging to reach owing to their nomadic lifestyle and the vastness of the area, adversely affecting their ability to observe TB therapy directly. In the Oshana region, it was found that stigma and poor TB awareness among adult patients, as well as mixing anti-TB medication with alcohol and tobacco products among adult patients, was a prevalent issue affecting TB therapy. CONCLUSION: The study recommends that regional health directorates embark on rigorous community health education about TB treatment and risk factors and establish a robust patient observation and monitoring system to enhance inclusive access to all health services and ensure treatment adherence.

Protein Identification of Venoms of the African Spitting Cobras, Naja mossambica and Naja nigricincta nigricincta.

Cobra snakes, including Naja mossambica and Naja nigricincta nigricincta, are one of the major groups of snakes responsible for snakebites in southern Africa, producing significant cytotoxicity and tissue damage. The venom of N. mossambica has been briefly characterised, but that of N. n. nigricincta is not reported. The current study identifies the venom proteins of N. mossambica and N. n. nigricincta. This is achieved using sodium dodecyl sulphate (SDS)-polyacrylamide gel eletrophroresis (PAGE), followed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Most of the proteins were less than 17 kDa in both snakes. N. mossambica was found to have 75 proteins in total (from 16 protein families), whereas N.n. nigricincta had 73 (from 16 protein families). Of these identified proteins, 57 were common in both snakes. The proteins identified belonged to various families, including the three-finger toxins (3FTx), Cysteine-rich secretory proteins (CRiSP), Phospholipase A2 (PLA2) and Venom metalloproteinase M12B (SVMP). The current study contributes to the profile knowledge of snake venom compositions, which is of fundamental value in understanding the proteins that play a major role in envenomation.

A pragmatic approach to introducing mixed methods research training for pharmacy students in Namibia.

BACKGROUND AND PURPOSE: Pharmacy and medical training were introduced for the first time in Namibia in 2011 and 2010 respectively. All students must complete a research project as part of their training, which is supported by various courses in the respective curricula including research methods. Following a revision of the medical curriculum, there was an opportunity to review the way research methods was taught for both degrees, piloting in pharmacy then expanding to other disciplines. An educational activity that was part of the research methods course for training pharmacy students in Namibia is described. EDUCATIONAL ACTIVITY AND SETTING: The activity described related to a new approach in the running of the research methods course for pharmacy students and included, in a portfolio-based approach, a group project. Students were tasked to collect qualitative data from medical student colleagues that they then needed to codify and ultimately articulate into a survey questionnaire. The questionnaire was subsequently sent out to collect responses on medicines-related items that could be analyzed quantitatively in subsequent teaching sessions. Supportive lectures, tutorials and portfolio assignments were provided during the project. Data were collected the following year to create a more substantive dataset and a screencast video made to benefit future students in the course. FINDINGS AND DISCUSSION: Through the course of this activity students developed a questionnaire survey tool based on qualitative responses to brief interviews with medical students and emergent themes based on qualitative analyses. A dataset was created that allowed demonstration of quantitative analyses and extraction of sub-scales from the questionnaire. Further educational resources were developed to ensure sustainability of this educational resource and retention in the taught curriculum. SUMMARY: The current article discusses the development, implementation and evaluation of this research methods course component. The application of data collected as part of the activity and its relevance to the educational activity is examined as well as lessons learned for the future running of the project and further evaluation.