Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.472
Filtrar
2.
Br J Nurs ; 29(1): 55, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31917938

RESUMO

Sophie Emery, Student Children's Nurse at the University of Hertfordshire, reflects on her elective placement in Zambia.


Assuntos
Educação em Enfermagem/organização & administração , Intercâmbio Educacional Internacional , Estudantes de Enfermagem/psicologia , Humanos , Reino Unido , Zâmbia
3.
Global Health ; 15(1): 82, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31847871

RESUMO

BACKGROUND: A recurring discussion in the literature relates to the possible contradictions among the Sustainable Development Goals (SDGs). The focus has been on economic goals, such as economic growth and goals related to climate change. We explore the possible contradictions that may arise between economic goals and health goals, specifically, the goal on Non-Communicable Diseases (NCDs) - SDG3.4. As a way to achieve SDG3.4, countries have been urged to introduce sin taxes, such as those on sugar. Yet others have argued that such taxes may affect employment (SDG 8.5), economic growth (SDG 8.1), and increase poverty (SDG1). However, there is limited or no reliable evidence, using actual experience, on the effect of sugar tax on health and economic outcomes. This makes it hard to assess the possible contradictions in SDGs that sugar taxes may generate. MAIN BODY: Using a conceptual framework on SDGs that views relationships among SDGs as either contradictory, reinforcing, or neutral, we carefully consider whether there are contradictions between SDG 3.4 on one hand and SDG 1, SDG 8.1, and SDG 8.5 on the other hand. We illustrate this using Zambia which recently introduced an equivalent 3% tax on non-alcoholic beverages, implicitly targeted at sugar-sweetened beverages (SSBs), given the stated goal of reducing NCDs. Concerns are that such a tax would be detrimental to the Zambia sugar value chain which contributes about 6% to GDP, in which case the achievement of SDG 3.4 (health) would be at odds with, or contradict, SDG 1, SDG 8.1, and SDG 8.5 (poverty eradication, economic growth, and creation of employment). We discuss that the existence of contradictions depend on a number of contextual factors, which allows us to make two conclusions about sugar taxation in Zambia. First, the current tax rate of 3% is likely neutral (no contradictions or reinforcing relationships) because it is too low to have any health or employment effects. However, the revenue raised can be reinvested to improve livelihoods. Secondly, the tax rate should be increased but care has to be exercised to ensure that the rate is not too high to generate contradictions. There will be need to carefully assess important parameters such as elasticities and explore alternative economic livelihoods. CONCLUSION: Without paying due consideration to important contextual factors, Zambia and many LMIC risk experiencing contradictions among SDGs.


Assuntos
Desenvolvimento Econômico , Emprego , Doenças não Transmissíveis/prevenção & controle , Desenvolvimento Sustentável , Impostos , Humanos , Zâmbia
4.
Afr J Reprod Health ; 23(3): 106-119, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31782636

RESUMO

Unmet need for contraception remains a challenge especially in low and middle-income countries. Community participation or the -active involvement of affected populations in all stages of decision-making and implementation of policies, programs, and services‖ is a precondition for attaining the highest standard of health. Participation as a key component of rights and quality of care frameworks could increase met needs. However, it has been inadequately addressed in contraceptive programs. A qualitative, exploratory methodology that included focus group discussions and in-depth interviews with community members, healthcare providers, and other stakeholders were conducted to identify domains or key thematic areas of action through which stakeholders could be engaged. The study conducted in Kenya, South Africa, and Zambia explored knowledge and use of contraceptives, barriers and enablers to access, quality of care, and participatory practices. Thematic analysis was used, facilitated by NVivo (version 10 QSR International) with a single master codebook. Comparing the thematic areas that emerged from the county data, four domains were selected: quality of care, informed decision-making, acceptability, and accountability. These domains informed the theory of change of a participatory programme aiming to meet unmet needs. Identifying possible generalizable domains establishes measurable and comparable intermediate outcomes for participatory programs despite diverse African contexts.


Assuntos
Participação da Comunidade , Anticoncepção , Serviços de Planejamento Familiar/estatística & dados numéricos , Pessoal de Saúde , Determinação de Necessidades de Cuidados de Saúde , Anticoncepção/métodos , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Entrevistas como Assunto , Quênia , Pesquisa Qualitativa , África do Sul , Zâmbia
5.
Zootaxa ; 4603(2): zootaxa.4603.2.1, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31717225

RESUMO

Six new species of Stenometopiini are described: Stirellus paracatalinus sp. nov. from Mexico, Stirellus lesioensis sp. nov. from Republic of Congo, Stirellus paralesioensis sp. nov. from South Africa, Stirellus kitwensis sp. nov. from Zambia, Stirellus madagascarensis sp. nov. from Madagascar, and Stirellus petfordensis sp. nov. from Australia. Ten species are redescribed: Kinonia elongata Ball, Stirellus catalinus (Beamer Tuthill), Stirellus labiatus (Gillette), Stirellus mexicanus (Osborn Ball), Stirellus picinus (Berg), Stirellus laetus (Melichar), Stirellus multipunctatus Duan, Webb Zhang, Stirellus neospeciosus Duan, Webb Zhang, Stirellus rubrolineatus (Distant), and Stirellus sagittarius (Naudé). Kinonia elongata Ball, S. catalinus (Beamer Tuthill) and S. labiatus (Gillette), all described from the Southwestern USA, are recorded from Mexico for the first time. Stirellus picinus (Berg) is recorded from the Virgin Islands (Guana Island) for the first time. Stirellus laetus (Melichar), S. multipunctatus Duan, Webb Zhang, S. neospeciosus Duan, Webb Zhang, and S. rubrolineatus (Distant) are recorded from Thailand for the first time.


Assuntos
Hemípteros , Animais , Austrália , Congo , Madagáscar , México , África do Sul , Tailândia , Zâmbia
6.
Medicine (Baltimore) ; 98(44): e17383, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689745

RESUMO

The risk of postnatal HIV transmission exists throughout the breastfeeding period. HIV shedding in breast milk beyond six months has not been studied extensively. The aim of this study was to determine prevalence and determinants of HIV shedding in breast milk during continued breastfeedingA cross-sectional study was nested in the PROMISE-PEP trial in Lusaka, Zambia to analyze breast milk samples collected from both breasts at week 38 post-partum (mid-way during continued breastfeeding). We measured concurrent HIV deoxyribonucleic acid (DNA) and HIV ribonucleic acid (RNA) as proxies for cell-associated HIV (CAV) and cell-free HIV (CFV) shedding in breast milk respectively. Participants' socio-demographic date, concurrent blood test results, sub clinical mastitis test results and contraceptive use data were available. Logistic regression models were used to identify determinants of HIV shedding in breast milk (detecting either CAV or CFV).The prevalence of HIV shedding in breast milk at 9 months post-partum was 79.4% (95%CI: 74.0 - 84.0). CAV only, CFV only and both CAV and CFV were detectable in 13.7%, 17.3% and 48.4% mothers, respectively. The odds of shedding HIV in breast milk decreased significantly with current use of combined oral contraceptives (AOR: 0.37; 95%CI: 0.17 - 0.83) and increased significantly with low CD4 count (AOR: 3.47; 95%CI: 1.23 - 9.80), unsuppressed plasma viral load (AOR: 6.27; 95%CI: 2.47 - 15.96) and severe sub-clinical mastitis (AOR: 12.56; 95%CI: 2.48 - 63.58).This study estimated that about 80% of HIV infected mothers not on ART shed HIV in breast milk during continued breastfeeding. Major factors driving this shedding were low CD4 count, unsuppressed plasma viral load and severe sub-clinical mastitis. The inverse relationship between breast milk HIV and use of combined oral contraceptives needs further clarification. Continued shedding of CAV may contribute to residual postnatal transmission of HIV in mothers on successful ART.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Leite Humano/virologia , Adulto , Antirretrovirais , Aleitamento Materno , Contagem de Linfócito CD4 , Ácidos Nucleicos Livres , Anticoncepcionais Orais Combinados/administração & dosagem , Estudos Transversais , DNA Viral , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa , Modelos Logísticos , Mastite/epidemiologia , Mães , Prevalência , RNA Viral , Fatores Socioeconômicos , Carga Viral , Eliminação de Partículas Virais/fisiologia , Adulto Jovem , Zâmbia
8.
Zootaxa ; 4563(2): zootaxa.4563.2.11, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-31716549

RESUMO

The new species Haptomerus maculosus Borovec Nakládal, sp. n. is described, illustrated and compared with its related species. A key to all Haptomerus species is presented. New data for other species of Haptomerus are presented. The relationships of Haptomerus species are discussed with particular attention to the relationships of species from the Afrotropical region and those from southern Europe.


Assuntos
Besouros , Gorgulhos , Animais , Europa (Continente) , Zâmbia
9.
Zootaxa ; 4668(3): zootaxa.4668.3.7, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31716621

RESUMO

The present paper contains descriptions of four new species of the genus Tumicla Wallengren, 1863: T. elephantina sp. nov. (South Mozambique), T. mbeghai sp. nov. (NE Tanzania), T. admiranda sp. nov. (SE Democratic Republic of the Congo) and T. smithi sp. nov. (Central Zambia). The male paratype specimen of T. doa Kühne 2007 is proved to be not conspecific with the holotype female but belongs to an undescribed species described here as T. mbeghai sp. nov. rendering Tumicla doa to be known by the female holotype only. Adults, male and female genitalia of the new and related species are illustrated.


Assuntos
Mariposas , Animais , República Democrática do Congo , Feminino , Masculino , Moçambique , Tanzânia , Zâmbia
10.
Zootaxa ; 4646(3): zootaxa.4646.3.6, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31717005

RESUMO

A new species of tree snake Dipsadoboa montisilva Branch, Conradie Tolley sp. nov. (Serpentes: Colubridae) is described from the 'sky islands' of Mount Mabu and Mount Ribáuè in northern Mozambique. Features of scalation, colour, body form and habitat distinguish the new species from other Dipsadoboa. This is supported by a phylogenetic analysis using one mitochondrial marker (cytochrome b) that shows the new Mozambican species is divergent from other sampled Dipsadoboa, including D. flavida and D. aulica, the only congeners known to occur in Mozambique. Morphologically, the new Dipsadoboa forms part of the D. werneri-shrevei complex from east and southeast Africa, but differs in having higher subcaudal counts, a different temporal pattern and only two supralabials entering the orbit. Phylogenetically, it occurs in a clade with D. shrevei and D. werneri. The status of D. shrevei in East Africa is reassessed, particularly in terms of the poorly-known Dipsadoboa shrevei kageleri from northern Tanzania. It is morphologically well defined from D. shrevei shrevei and utilises a different habitat. Although based on limited genetic data, it appears to be well-defined from typical D. shrevei and is accordingly raised to specific status. The only Tanzanian record for typical D. shrevei from Mtene, Rondo Plateau in southeast Tanzania is well isolated from the species' range to the west (e.g. Zambia, Angola) and the published scalation features, particularly ventral counts, do not fully accord with D. shrevei. The Rondo Plateau population is treated as Dipsadoboa incerta sedis, and because we return D. shrevei to its binomial status, we can no longer consider D. shrevei as occurring in Tanzania. Biogeographically, the Rondo Plateau population may have a stronger affinity to the new Mozambican species. The discovery of isolated populations of the new species in mid-altitude forest remnants on Mt Mabu and Mt Ribáuè emphasizes the high conservation importance of the Mozambique forest 'sky islands' from which numerous other endemic new species have been recently discovered. These species are impacted by ongoing habitat destruction through slash and burn clearing for subsistence agriculture.


Assuntos
Colubridae , Angola , Animais , Florestas , Ilhas , Moçambique , Filogenia , Tanzânia , Zâmbia
11.
BMC Public Health ; 19(1): 1329, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640657

RESUMO

BACKGROUND: Uptake of Isoniazid Preventive Therapy (IPT) among People Living with HIV in Zambia has continued to be low despite various evidence for its added benefit in reducing TB incidence and mortality when taken with antiretroviral therapy. In 2017, only 18% of People Living with HIV newly enrolled in care were initiated on IPT in Zambia. MAIN TEXT: Various challenges including policy and management level factors, supply chain factors, health worker perceptions about IPT, monitoring and evaluation factors and limited demand creation activities have constrained the scale up of IPT in Zambia. Lessons that have been learnt while addressing the above challenges are shared and they can be applied by government ministries, project managers, public health specialists to strengthen IPT activities in their settings. CONCLUSION: Zambia has both a high burden of TB and HIV and without preventing new cases of TB from reactivation of latent TB infection, it will be difficult to control TB. All stakeholders involved in prevention of TB among PLHIV need to commit to addressing the challenges limiting scale up of IPT.


Assuntos
Antirretrovirais/uso terapêutico , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Isoniazida/uso terapêutico , Tuberculose/prevenção & controle , Feminino , Infecções por HIV/epidemiologia , Humanos , Incidência , Saúde Pública , Tuberculose/epidemiologia , Zâmbia
14.
Int J Equity Health ; 18(1): 126, 2019 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-31558147

RESUMO

INTRODUCTION: Unsafe abortion is a major contributor to the continued high global maternal mortality and morbidity rates. Legal abortion frameworks and access to sexuality education and contraception have been pointed out as vital to reduce unsafe abortion rates. This paper explores the relationship between abortion law, policy and women's access to safe abortion services within the different legal and political contexts of Ethiopia, Tanzania and Zambia. The research is inspired by recent calls for contextualized policy research. METHODS: The research was based in Addis Ababa (Ethiopa), Dar es Salaam (Tanzania) and Lusaka (Zambia) and had a qualitative exploratory research design. The project involved studying the three countries' abortion laws and policies. It moreover targeted formal organizations as implementers of policy as well as stakeholders in support of, or in opposition to the existing abortion laws. Semi-structured interviews were carried out with study participants (79) differently situated vis-à-vis abortion, exploring their views on abortion-related legal- and policy frames and their perceived implications for access. RESULTS: The abortion laws have been classified as 'liberal' in Zambia, 'semi-liberal' in Ethiopia and 'restrictive' in Tanzania, but what we encountered in the three study contexts was a seeming paradoxical relationship between national abortion laws, abortion policy and women's actual access to safe abortion services. The study findings moreover reveal that the texts that make up the three national abortion laws are highly ambiguous. The on-paper liberal Zambian and semi-liberal Ethiopian laws in no way ensure access, while the strict Tanzanian law is hardly sufficient to prevent young women from seeking and obtaining abortion. In line with Walt and Gilson's call to move beyond a narrow focus on the content of policy, our study demonstrates that the connection between law, health policy and access to health services is complex and critically dependent on the socio-economic and political context of implementation. CONCLUSIONS: Legal frameworks are vital instruments for securing the right to health, but broad contextualized studies rather than classifications of law along a liberal-restrictive continuum are demanded in order to enhance existing knowledge on access to safe abortion services in a given context.


Assuntos
Aborto Induzido/legislação & jurisprudência , Aborto Induzido/estatística & dados numéricos , Política de Saúde , Acesso aos Serviços de Saúde , Aborto Induzido/efeitos adversos , Adolescente , Adulto , Etiópia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Segurança , Tanzânia , Adulto Jovem , Zâmbia
15.
Int J Equity Health ; 18(1): 116, 2019 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-31558168

RESUMO

BACKGROUND: Reproductive health problems such as HIV, unwanted pregnancy and unsafe abortion among adolescents are closely linked to insufficient knowledge about sexuality and reproduction and lack of access to contraceptives. Supported by international agencies, Zambia has introduced an ambitious nation-wide program for comprehensive sexuality education (CSE) to be implemented into ordinary school activities by teachers. The curriculum is firmly based in a discourse of sexual and reproductive rights, not commonly found in the public debate on sexuality in Zambia. This paper explores how teachers perceive the curriculum and practice discretion when implementing the CSE in mid-level schools in Nyimba district in Zambia. METHODS: Using a case study design, data were collected through in-depth interviews with 18 teachers and analyzed thematically drawing upon theories of discretion and policy implementation. RESULTS: Individual teachers make decisions on their own regarding what and when to teach CSE. This discretion implies holding back information from the learners, teaching abstinence as the only way of preventing pregnancy or cancelling sexuality education sessions altogether. Teachers' choices about the CSE program were linked to lack of guidance on teaching of the curriculum, especially with regards to how to integrate sexuality education into existing subjects. Limited prioritization of CSE in the educational sector was observed. The incompatibility of CSE with local norms and understandings about adolescent sexuality combined with teacher-parent role dilemmas emerged as problematic in implementing the policy. Limited ownership of the new curriculum further undermined teachers' motivation to actively include CSE in daily teaching activities. Use of discretion has resulted in arbitrary teaching thus affecting the acquisition of comprehensive sexual and reproductive health knowledge among learners. CONCLUSION: The CSE had limited legitimacy in the community and was met with resistance from teachers tasked with its' implementation. In order to enhance ownership to the CSE program, local concerns about the contents of the curriculum and the parent-teacher role dilemma must be taken into consideration. Not addressing these challenges may undermine the policy's intention of increasing knowledge about sexuality and reproduction and empowering adolescents to access contraceptive services and avoid unwanted pregnancies.


Assuntos
Comportamento de Escolha , População Rural , Professores Escolares/psicologia , Instituições Acadêmicas/organização & administração , Educação Sexual/organização & administração , Adolescente , Adulto , Currículo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Política Organizacional , Gravidez , Pesquisa Qualitativa , Professores Escolares/estatística & dados numéricos , Zâmbia
16.
Int J Gynaecol Obstet ; 147(2): 258-267, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31472075

RESUMO

OBJECTIVE: To understand how knowledge and perceptions of condoms and partner communication influence use of condoms in a high HIV prevalence setting and gender-specific differences. METHODS: A cross-sectional study was conducted in Zambia from 2015 to 2016. The survey included questions on demographics, sexual behavior, contraceptive perceptions, and behaviors. We constructed multivariate regression models using the Theory of Planned Behavior to determine associations between knowledge, perceptions, and perceived control with intended, communicated, and reported use of condoms by gender. RESULTS: The participants were 2388 sexually active urban residents aged 18-24 years. In the sample, 1646 (69%) were female, 841 (35%) married, and 1894 (61%) unemployed. Partner communication was the predictor most associated with use of condoms. Among women, partner communication was associated with over three times higher odds of condom use (odds ratio [OR] 3.51, 95% confidence interval [CI] 2.65-4.65) but being married reduced the odds of condom use by 76% (OR 0.24, 95% CI 0.17-0.33). For men, a network of friends that was supportive of the use of contraception was associated with increased odds of 55% for use of condoms (OR 1.55, 95% CI 1.10-2.18). CONCLUSION: Public health programs aimed at increasing safer sexual behavior and use of condoms must consider improving gender equity and partner communication, as knowledge of contraceptives and positive perceptions are not enough to ensure their use.


Assuntos
Preservativos/estatística & dados numéricos , Anticoncepção/psicologia , Relações Interpessoais , Parceiros Sexuais/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Razão de Chances , Grupo Associado , Fatores Sexuais , Comportamento Sexual/psicologia , Inquéritos e Questionários , Adulto Jovem , Zâmbia
17.
Malar J ; 18(1): 307, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488139

RESUMO

BACKGROUND: While bed nets and insecticide spraying have had significant impact on malaria burden in many endemic regions, outdoor vector feeding and insecticide resistance may ultimately limit their contribution to elimination and control campaigns. Complementary vector control methods such as endectocides or systemic insecticides, where humans or animals are treated with drugs that kill mosquitoes upon ingestion via blood meal, are therefore generating much interest. This work explores the conditions under which long-lasting systemic insecticides would have a substantial impact on transmission and burden. METHODS: Hypothetical long-lasting systemic insecticides with effective durations ranging from 14 to 90 days are simulated using an individual-based mathematical model of malaria transmission. The impact of systemic insecticides when used to complement existing vector control and drug campaigns is evaluated in three settings-a highly seasonal high-transmission setting, a near-elimination setting with seasonal travel to a high-risk area, and a near-elimination setting in southern Africa. RESULTS: At 60% coverage, a single round of long-lasting systemic insecticide with effective duration of at least 60 days, distributed at the start of the season alongside a seasonal malaria chemoprevention campaign in a high-transmission setting, results in further burden reduction of 30-90% depending on the sub-populations targeted. In a near-elimination setting where transmission is sustained by seasonal travel to a high-risk area, targeting high-risk travellers with systemic insecticide with effective duration of at least 30 days can result in likely elimination even if intervention coverage is as low as 50%. In near-elimination settings with robust vector control, the addition of a 14-day systemic insecticide alongside an anti-malarial in mass drug administration (MDA) campaigns can decrease the necessary MDA coverage from about 85% to the more easily achievable 65%. CONCLUSIONS: While further research into the safety profile of systemic insecticides is necessary before deployment, models predict that long-lasting systemic insecticides can play a critical role in reducing burden or eliminating malaria in a range of contexts with different target populations, existing malaria control methods, and transmission intensities. Continued investment in lengthening the duration of systemic insecticides and improving their safety profile is needed for this intervention to achieve its fullest potential.


Assuntos
Antimaláricos/uso terapêutico , Controle de Doenças Transmissíveis/métodos , Inseticidas/uso terapêutico , Malária/prevenção & controle , Controle de Mosquitos/métodos , Humanos , Modelos Teóricos , Nigéria , Zâmbia
18.
BMC Health Serv Res ; 19(1): 570, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412849

RESUMO

BACKGROUND: The focus of the community anti-retroviral therapy Group model is on drug refill, adherence and support groups. However, laboratory services are completely neglected in this model, and stable patient still have to go to the clinic for blood draws after drugs refills from the community. Due to the introduction of new ART drugs, the guidelines now recommend the use of viral loads to guide decision in switching all patients from NNRTI to dolutegravir based first line ART regimens. But the national viral load testing coverage stands at 37% and and falls short of meeting the global UNAIDS and phlebotomy delivery system is congested. The purpose of this study was to identify the perceptions in decentralizing phlebotomy services into the community anti-retroviral therapy Group model. METHOD: A qualitative case study design was used. Data were collected through ten Focused group discussions among community anti-retroviral therapy Group members, community and health care workers at anti-retroviral therapy clinics and in-depth interviews with five key informants. Data were managed with the help of Nvivo version 10 and analyzed using thematic method. RESULTS: Positive perceptions were identified as those which contributed to decongesting phlebotomy rooms, reduced missing phlebotomy appointments, work Load, and lost results. Improved quality of phlebotomy service delivery and testing coverage, innovative access to laboratory services and encouraged patient's accountability. The negative perceptions were compromised sample integrity, inability to perform prevention control and patients less contact with clinicians. CONCLUSION: The study has demonstrated that decentralizing phlebotomy services within the CAG model has greater potential to improve the quality of services delivery for patients. In addition, it has perceived threats on the quality of specimen collected, patient's safety, and health care.


Assuntos
Antirretrovirais/uso terapêutico , Serviços de Saúde Comunitária , Infecções por HIV/sangue , Flebotomia , Serviços de Saúde Comunitária/estatística & dados numéricos , Estudos de Viabilidade , Grupos Focais , Infecções por HIV/tratamento farmacológico , Humanos , Flebotomia/estatística & dados numéricos , Pesquisa Qualitativa , Zâmbia
19.
Sensors (Basel) ; 19(16)2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31394848

RESUMO

Southern African savannas are an important dryland ecosystem, as they account for up to 54% of the landscape, support a rich variety of biodiversity, and are areas of key landscape change. This paper aims to address the challenges of studying this highly gradient landscape with a grass-shrub-tree continuum. This study takes place in South Luangwa National Park (SLNP) in eastern Zambia. Discretely classifying land cover in savannas is notoriously difficult because vegetation species and structural groups may be very similar, giving off nearly indistinguishable spectral signatures. A support vector machine classification was tested and it produced an accuracy of only 34.48%. Therefore, we took a novel continuous approach in evaluating this change by coupling in situ data with Landsat-level normalized difference vegetation index data (NDVI, as a proxy for vegetation abundance) and blackbody surface temperature (BBST) data into a rule-based classification for November 2015 (wet season) that was 79.31% accurate. The resultant rule-based classification was used to extract mean Moderate Resolution Imaging Spectroradiometer (MODIS) NDVI values by season over time from 2000 to 2016. This showed a distinct separation between each of the classes consistently over time, with woodland having the highest NDVI, followed by shrubland and then grassland, but an overall decrease in NDVI over time in all three classes. These changes may be due to a combination of precipitation, herbivory, fire, and humans. This study highlights the usefulness of a continuous time-series-based approach, which specifically integrates surface temperature and vegetation abundance-based NDVI data into a study of land cover and vegetation health for savanna landscapes, which will be useful for park managers and conservationists globally.


Assuntos
Conservação dos Recursos Naturais , Pradaria , Imagens de Satélites/métodos , Clima , Florestas , Humanos , Análise de Componente Principal , Estações do Ano , Máquina de Vetores de Suporte , Temperatura Ambiente , Zâmbia
20.
BMC Public Health ; 19(1): 1120, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416432

RESUMO

BACKGROUND: Retention in care is critical for children living with HIV taking antiretroviral therapy (ART). Loss to follow-up (LTFU) is high in HIV treatment programs in resource limited settings. We estimated the cumulative incidence of LTFU and identified associated risk factors among children on ART at Livingstone Central Hospital (LCH), Zambia. METHODS: Using a retrospective cohort study design, we abstracted data from medical records of children who received ART between 2003 and 2015. Loss to follow-up was defined as no clinical and pharmacy contact for at least 90 days after the child missed their last scheduled clinical visit. Non-parametric competing risks models were used to estimate the cumulative incidence of death, LTFU and transfer. Cause-specific Cox regression was used to estimate the hazard ratios of the risk factors of LTFU. RESULTS: A total of 1039 children aged 0-15 years commenced ART at LCH between 2003 and 2015. Median duration of follow-up was 3.8 years (95% CI: 1.2-6.5), median age at ART initiation was 3.6 years (IQR: 1.3-8.6), 179 (17%) started treatment during their first year of life. At least 167 (16%) were LTFU and we traced 151 (90%). Of those we traced, 39 (26%) had died, 71 (47%) defaulted, 20 (13%) continued ART at other clinics and 21 (14%) continued treatment with gaps. The cumulative incidence of LTFU for the entire cohort was 2.7% (95% CI: 1.9-3.9) at 3 months, 4.1% (95% CI: 2.9-5.4) at 6 months and 14.1% (95% CI: 12.4-16.9) after 5 years on ART. Associated risk factors were: 1) non-disclosure of HIV status at baseline, aHR = 1.9 (1.2-2.9), 2) No phone ownership, aHR = 2.1 (1.6-2.9), 3) starting treatment between 2013 to 2015, aHR = 5.6 (2.2-14.1). CONCLUSION: Among the children LTFU mortality and default were substantially high. Children who started treatment in recent years (2013-2015) had the highest hazard of LTFU. Lack of access to a phone and non-disclosure of HIV-status to the index child was associated with higher hazards of LTFU. We recommend re-enforcement of client counselling and focused follow-up strategies using modern technology such as mobile phones as adjunct to current approaches.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Perda de Seguimento , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Registros Médicos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Zâmbia/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA