Building Local Capacity in a Low-Resource Setting to Increase Access to Health Care: An Evaluation of Blood Pressure Monitoring Training.

Cardiovascular risk factors such as hypertension are common and largely uncontrolled in Malawi. In this low-resource setting, Community Health Workers (CHWs) can increase access to home-based blood pressure (BP) monitoring. The purpose of this study is to evaluate the effectiveness of a CHW training focused on BP monitoring and referral criteria, as well as the accuracy of referral decision-making and documentation. The participants were a purposive sample of all active home-based palliative care CHWs at St. Gabriel's Hospital (n = 60) located in Namitete, Malawi, serving over 250,000 people within a 50 km radius. This was a retrospective cross-sectional study conducted in December 2020 using both quantitative (descriptive, paired t-test) and qualitative (thematic) analysis. Participants showed significantly greater knowledge on the post-test (M = 8.98, SD = 1.213) compared to the pretest (M = 7.96, SD = 1.231), t (54)-5.0557.475, p < .001. All participants who attended both days of training demonstrated competency on a skills checklist in 100% of the rehabilitation and BP monitoring skills taught. Through document analysis of record books, referral decisions for patients with hypertension were 87.57% accurate and 81.07% of entries (n = 713) were complete. Participants reported the lack of both transportation and equipment as barriers to their work. They reported trainings, supplies, and support from the hospital as facilitators to their work. This study shows that BP can be monitored in remote villages, accurate referrals can be made, and stroke prevention education can be provided. These interventions increase the chances of more equitable care for this vulnerable population in a resource-limited setting.

Using a health-rating system to evaluate the usefulness of Caenorhabditis elegans as a model for anthelmintic study.

Soil-transmitted helminths (STHs) are intestinal parasitic nematodes that infect humans, and are transmitted through contaminated soil. These nematodes include the large roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), and hookworm (Ancylostoma ceylanicum, Ancylostoma duodenale, and Necator americanus). Nearly 1.5 billion people (~24% of the population) worldwide are infected with at least one species of these parasites, burdening the poor, in particular, children and pregnant women. To combat these diseases, the WHO only recognizes four anthelmintic drugs, including the preferred drug, albendazole, for mass drug administration (MDA). These four drugs have a total of two different mechanisms of action, and, as expected, resistance has been observed. This problem calls for new drugs with different mechanisms of action. Although there is precedence for the use of Caenorhabditis elegans (C. elegans), a free-living nematode, as a model for drug screening and anthelmintic testing, their usefulness for such anthelmintic study is not clear as past research has shown that C. elegans did not show a strong response to albendazole, the MDA drug of choice, in comparison with various STHs under similar treatment. To further examine if C. elegans has the potential to be a good model organism for anthelmintic drug study, we employed a health rating scale in order to tease out potential effects of albendazole, and other anthelmintics, that may have been missed using a binary, dead/alive scale. Using the health-rating scale we found that although the worms may have not been dying, they were sick, showing dose responses to anthelmintic drugs, including albendazole, reinforcing C. elegans as a useful model for anthelmintic study.

Cost-effective mapping of benthic habitats in inland reservoirs through split-beam sonar, indicator kriging, and historical geologic data.

Because bottom substrate composition is an important control on the temporal and spatial location of the aquatic community, accurate maps of benthic habitats of inland lakes and reservoirs provide valuable information to managers, recreational users, and scientists. Therefore, we collected vertical, split-beam sonar data (roughness [E1], hardness [E2], and bathymetry) and sediment samples to make such maps. Statistical calibration between sonar parameters and sediment classes was problematic because the E1:E2 ratios for soft (muck and clay) sediments overlapped a lower and narrower range for hard (gravel) substrates. Thus, we used indicator kriging (IK) to map the probability that unsampled locations did not contain coarse sediments. To overcome the calibration issue we tested proxies for the natural processes and anthropogenic history of the reservoir as potential predictive variables. Of these, a geologic map proved to be the most useful. The central alluvial valley and mudflats contained mainly muck and organic-rich clays. The surrounding glacial till and shale bedrock uplands contained mainly poorly sorted gravels. Anomalies in the sonar data suggested that the organic-rich sediments also contained trapped gases, presenting additional interpretive issues for the mapping. We extended the capability of inexpensive split-beam sonar units through the incorporation of historic geologic maps and other records as well as validation with dredge samples. Through the integration of information from multiple data sets, were able to objectively identify bottom substrate and provide reservoir users with an accurate map of available benthic habitat.