Rural Friendship Bench: A qualitative study in Zaka district, Zimbabwe.

BACKGROUND: We piloted the Friendship Bench-an evidence-based, urban-area task sharing intervention for common mental disorders-in rural Zimbabwe. The intervention combines problem solving therapy with income generating activities. This study sought to understand the intervention's implementation in terms of acceptability, feasibility, and sustainability as well as local attitudes towards mental wellbeing in rural Zimbabwe. METHODS: Using four separate semi-structured interview guides, we conducted in-depth interviews (N = 32) with patients (n = 9), village health workers (n = 12), nurses (n = 6), and community leaders (n = 5). We analyzed our data using thematic analysis with a diverse coding team using an integrative deductive-inductive approach. RESULTS: Five themes emerged: 1) explanatory models for mental illness, 2) clinical workflow and emphasis on documentation, 3) positive feedback about the Friendship Bench, 4) accessibility, and 5) feasibility. CONCLUSION: In its current format, our intervention was acceptable but neither feasible nor sustainable. Sociocultural context is critical in the development of rural task sharing interventions for mental health. We thus recommend a robust pilot and adaptation phase when scaling task sharing interventions in rural sub-Saharan Africa to elevate community voices, leverage existing social structures, and embed interventions as deeply into communities as possible.

Clinical, Virologic, Immunologic Outcomes and Emerging HIV Drug Resistance Patterns in Children and Adolescents in Public ART Care in Zimbabwe.

OBJECTIVE: To determine immunologic, virologic outcomes and drug resistance among children and adolescents receiving care during routine programmatic implementation in a low-income country. METHODS: A cross-sectional evaluation with collection of clinical and laboratory data for children (0-<10 years) and adolescents (10-19 years) attending a public ART program in Harare providing care for pediatric patients since 2004, was conducted. Longitudinal data for each participant was obtained from the clinic based medical record. RESULTS: Data from 599 children and adolescents was evaluated. The participants presented to care with low CD4 cell count and CD4%, median baseline CD4% was lower in adolescents compared with children (11.0% vs. 15.0%, p<0.0001). The median age at ART initiation was 8.0 years (IQR 3.0, 12.0); median time on ART was 2.9 years (IQR 1.7, 4.5). On ART, median CD4% improved for all age groups but remained below 25%. Older age (≥ 5 years) at ART initiation was associated with severe stunting (HAZ <-2: 53.3% vs. 28.4%, p<0.0001). Virologic failure rate was 30.6% and associated with age at ART initiation. In children, nevirapine based ART regimen was associated with a 3-fold increased risk of failure (AOR: 3.5; 95% CI: 1.3, 9.1, p = 0.0180). Children (<10 y) on ART for ≥4 years had higher failure rates than those on ART for <4 years (39.6% vs. 23.9%, p = 0.0239). In those initiating ART as adolescents, each additional year in age above 10 years at the time of ART initiation (AOR 0.4 95%CI: 0.1, 0.9, p = 0.0324), and each additional year on ART (AOR 0.4, 95%CI 0.2, 0.9, p = 0.0379) were associated with decreased risk of virologic failure. Drug resistance was evident in 67.6% of sequenced virus isolates. CONCLUSIONS: During routine programmatic implementation of HIV care for children and adolescents, delayed age at ART initiation has long-term implications on immunologic recovery, growth and virologic outcomes.

A rabbit's revenge: shotgun pellet appendicitis.

INTRODUCTION: Appendicitis and its complications remain a common problem affecting patients of all age groups. Appendicitis due to foreign bodies is rare and carries an estimated frequency of 0.0005%. OBJECTIVE: To present the case of a 44-year-old man with appendicitis induced by an appendicolith containing eight steel shotgun pellets. The man was a recreational hunter and for the past 20 years he consumed wild game on a regular basis. CONCLUSIONS: Ingested blunt or round objects such as gunshot pellets appear less likely to cause perforation, and usually pass through the digestive tract without problems. However, it should be noted that in rare situations appendicitis may result.

Application of modern microbiological diagnostic methods for tuberculosis in Macha, Zambia.

SETTING: Macha, Zambia. OBJECTIVE: To assess the benefits of auramine-O staining fluorescence microscopy and Mycobacterial Growth Indicator Tube (MGIT) liquid culture with molecular identification in tuberculosis (TB) diagnostics. DESIGN: One hundred patients suspected of TB were subjected to three sputum sample examinations applying Ziehl-Neelsen (ZN) and auramine-O staining and MGIT culture. Positive cultures were identified using the GenoType CM assay; cultures identified as Mycobacterium tuberculosis complex were the gold standard for a diagnosis of TB. RESULTS: The 100 patients produced 271 sputum samples; of these, 30 patients had positive cultures. M. tuberculosis complex bacilli were isolated in 17 (56.7%) patients, non-tuberculous mycobacteria (NTM) in 11 (36.7%) and other acid-fast bacilli in two. Forty-eight samples (17.7%) were contaminated. Auramine-O detected 16 (57.1%) patients culture-positive for mycobacteria and 12 patients with culture-proven TB, vs. respectively 8 (28.6%, P = 0.008) and 7 (41.2%, P = 0.044) for ZN. Three of eight auramine-positive/ZN-negative patients were culture-positive for NTM only. CONCLUSION: The auramine-O method significantly increases sensitivity, although the higher NTM detection rate implies that this does not in itself lead to a more accurate diagnosis of TB. MGIT culture is highly sensitive, although contamination rates were a drawback; the high frequency of NTM isolation warrants a robust identification method.

[Meningitis as cause of prelingual deafness]. / Meningitis als oorzaak van prelinguale doofheid.

In an examination of 624 prelingual deaf children in the Christian Institute for deaf children 'Effatha' in Voorburg special attention was paid to deafness caused by meningitis. This diagnosis was made in 70 persons. In 41 of these the pathogen of meningitis could be traced. Streptococcus pneumoniae is the main causative organism of meningitis and subsequent deafness (60%). Haemophilus influenzae, Escherichia coli and Neisseria meningitidis follow with 12, 9 and 7% respectively. We emphasize the timely audiologic control of all children who suffered a meningitis.

A theory on the control of arbitrary movements.

A theory dealing with the control of human, arbitrary movements is proposed. A schema is set up to suggest how the relevant information flows and what kind of operations affect it. A number of successive steps are distinguished in the production of a movement. It is assumed that the intended movement is carried out in the imagination, and that this imaginary movement is composed of a spatial trajectory and an intensity course, which are considered to be independent features of the intended movement. The spatial trajectory will be encoded in a special coding, which is related to the lengths of the muscles that effect the movement. From this special coding of the intended movement static and dynamic control signals can be derived. Because afferent and efferent signals are encoded in the same way in this schema, the evaluation and correction of the performed movement is quite simple. The higher levels in the control schema may function in an abstract way, i.e. the signals at these levels are barely concerned with details of the peripheral motor system. This abstract functioning of the higher levels is based on the numerous feedback mechanisms involved at all levels of control and in the peripheral motor system. Nevertheless, it is possible to incorporate specific peripheral properties in the generation of the control signals. The assumptions in this theory will be discussed and aspects of the proposed control schema will be compared with general control principles.

On the interaction between the central nervous system and the peripheral motor system.

The problem of the control of voluntary human movements is considered from a cybernetic point of view. The human motor system is considered to be divided into a central part and a peripheral part. The peripheral part is relatively well known and may be regarded as a set of subsystems with well known input-output relations. The interaction between the peripheral part and the central part is related to the mechanisms of the peripheral motor part. With regard to the central part two different types of control mechanisms are possible, a) an intricate functioning of the central part which generates the control signals with regard to internal and extrenal dynamical factors, b) the central part has some degree of independence with respect to the dynamics of the peripheral motor part. In the latter case the central part prescribes the desired movement exactly, but the final performance of the movement is also brought about by peripheral feed-back mechanisms. As a functional form of the interaction between the central part and the peripheral part it might be that the control signals are encoded in a way that is related to the muscle lengths.