Perceptions of adolescents and teachers on school-based sexuality education in rural primary schools in Uganda.

BACKGROUND: Evidence-based sexuality education programmes are a cornerstone in reducing adolescent sexual risk behaviours and promoting sexual health. Several initiatives aimed at reducing sexual and reproductive problems among adolescents have been done. These initiatives include life skill education and abstinence program. Despite these initiatives teen pregnancy, sexually transmitted diseases and abortion are still common among school going adolescents. OBJECTIVES: The purpose of this study was to explore the experiences and perceptions of adolescents and teachers regarding school-based sexuality education in rural primary schools. METHODS: A purposive sample was drawn from primary school-going adolescents aged 12-16 years and teachers aged 28-52 in four rural schools. Eleven audio taped individual interviews and eight focus group discussions were used to collect data. A constant comparison method of data analysis was applied by following the Strauss and Corbin (1998) analysis process of open, axial and selective coding to analyse textual qualitative data until themes, categories and sub-categories were identified and developed. RESULTS: Data analysis revealed that adolescents benefitted from School Based Sexuality Education but the implementation of programmes was undermined by physical and contextual factors such as challenges at national, institutional, community, family and individual levels. CONCLUSION: It is vital to review the teaching and learning resources and to fully integrate sexuality education into the formal school curriculum. A combined effort of major stakeholders including teachers, community leaders, adolescents, healthcare professionals and parents is needed for sexuality education among adolescents to succeed.

Patterns of caesarean-section delivery in Addis Ababa, Ethiopia.

SETTING: The study was conducted in Addis Ababa, the capital city of Ethiopia. Specifically, it was conducted in all healthcare facilities offering maternity and obstetric services. OBJECTIVE: The objective of the study was to explore the patterns of caesarean-section (CS) delivery in Addis Ababa. METHODS: A cross-sectional survey was carried out between December 2013 and January 2014. The population for the study were women aged between 15 and 19 years of age who had given birth in the last 1-3 years before the date of data collection. The Census and Survey Processing System software was used for data capturing and analysing both descriptive and inferential statistics using Statistical Package for Social Sciences version 20.0. RESULTS: Amongst the 835 women who delivered at health facilities, 19.2% had given birth by CS. The prevalence of CS based on medical indication was 91.3%. However, 6.9% of CS performed had no medical indication. Private health facilities performed more CSs than public health facilities, 41.1% and 11.7% respectfully. CS was high amongst women of higher socioeconomic standing. CONCLUSION: Overall, CS deliveries rate in Ethiopia is above the rate recommended by the World Health Organisation. Because socio-economic factors influence CS delivery, governments should play a key role in regulating performance of CSs in private institutions.

Interprofessional Fellowship Training for Emerging Global Health Leaders in Africa to Improve HIV Prevention and Care: The Afya Bora Consortium.

HIV continues to challenge health systems, especially in low- and middle-income countries in Sub-Saharan Africa. A qualified workforce of transformational leaders is required to strengthen health systems and introduce policy reforms to address the barriers to HIV testing, treatment, and other HIV services. The 1-year Afya Bora Consortium Fellowship in Global Health capitalizes on academic partnerships between African and U.S. universities to provide interprofessional leadership training through classroom, online, and service-oriented learning in 5 countries in Africa. This fellowship program prepares health professionals to design, implement, scale-up, evaluate, and lead health programs that are population-based and focused on prevention and control of HIV and other public health issues of greatest importance to African communities and health service settings. Afya Bora nurse fellows acquire leadership attributes and competencies that are continuously and systematically tested during the entire program. This multinational training platform promotes interprofessional networks and career opportunities for nurses.

Respiratory inflammation among workers exposed to airborne dust with endotoxins in a coffee curing factory.

OBJECTIVE: To study dust exposure and inflammatory reactions in the respiratory tract among coffee curing workers in Tanzania. METHODS: A cross-sectional study was conducted in a Tanzanian coffee curing factory. Coffee workers (n = 15) were compared with unexposed controls (n = 18); all workers were nonsmokers. Exhaled nitric oxide was examined using an electrochemistry-based NIOX MINO device. Personal air samples were analyzed for total dust and endotoxins, using gravimetric analysis and the chromogenic Limulus amebocyte lysate endpoint assay, respectively. RESULTS: Total dust levels ranged from 0.2 to 27.9 mg/m, and endotoxin levels ranged from 42 to 75,083 endotoxin units/m. Concentrations of exhaled nitric oxide, analyzed by linear regression and adjusted for age (ß = 0.57; 95% confidence interval, 0.08 to 1.06; P = 0.02), was higher among coffee workers than among the control group. CONCLUSION: The results indicate a relationship between the coffee dust and signs of respiratory inflammation.

Reducing therapeutic injection overuse through patients-prescribers interaction group discussions in Kinondoni District, Dar es Salaam, Tanzania.

Inappropriately prescription of injections has been reported in developing and developed countries. Previous studies in Tanzania showed that over 70% of patients attending out- patient clinics at private dispensaries received at least one injection per consultation, a value higher than WHO recommended target of 10%. This is of concern considering the likelihood of adverse effects of possible use of unsafe syringes to transmit HIV, hepatitis B and C, poliomyelitis and added economic impact on the patient and the healthcare system. This study aimed to investigate the impact of Interaction Group Discussion on behavioural change on injection prescribing practices in ten selected public dispensaries in Kinondoni District, Dar es Salaam, Tanzania. Patient records of injection prescriptions were obtained covering the period three months prior to the study from 5 randomly selected control and 5 randomly selected intervention facilities. At each health facility IGDs were conducted for one month on mothers and prescribers followed by a survey 3 months after IGD to determine the impact of IGDs. Chi-square statistical calculations were made to compare data on the percent of prescriptions with an injection prescribed and in those conforming to national standard treatment guidelines (STG) between baseline and 3 months follow up. Results showed no significant difference between the percentage of prescriptions with an injection prescribed at baseline and 3 months follow-up in public dispensaries (P>0.05, X2 test). Prescribed injections that complied with STG was low at baseline and did not significantly improve 3 months after (P>0.05, X2 test). Comprehensive studies and sensitization of compliance to STG by prescribers are recommended.

Airflow limitation among workers in a labour-intensive coal mine in Tanzania.

OBJECTIVES: To describe the relationship between cumulative respirable dust and quartz exposure and lung functioning among workers in a labour-intensive coal mine. METHODS: The study population comprised 299 men working at a coal mine in Tanzania. Lung function was assessed using a Vitalograph alpha III spirometer in accordance with American Thoracic Society recommendations. Multiple linear regression models were developed to study the relationship between forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC) and FEV(1)/FVC and the cumulative dust or quartz exposure while adjusting for age, height and ever smoking. To evaluate trends for dose response, cumulative exposure concentrations for respirable dust and quartz were ranked and categorized in quartiles and the highest decile, with the first quartile as the reference group. Logistic regression models were used to determine odds ratios for FEV(1)/FVC < 0.7 and FEV(1)% < 80 for categories of cumulative dust or quartz exposure. RESULTS: The prevalence of FEV(1)/FVC < 0.7 among the workers was 17.3%. Workers in the development team (20.5%) had the highest prevalence of FEV(1)% < 80%. The estimates of the effects of cumulative exposure on FEV(1)/FVC were -0.015% per mg years m(-3) for respirable dust and -0.3% per mg years m(-3) for respirable quartz. In logistic regression models, the odds ratios for airway limitation (FEV(1)/FVC < 0.7) for the workers in the highest decile of cumulative dust and quartz exposure versus the referents were 4.36 (95% confidence interval: 1.06, 17.96) and 3.49 (0.92, 13.21), respectively. The upper 10% of workers by cumulative dust and quartz exposure also had higher odds ratios for predicted FEV(1)% < 80% than the reference group odds ratio: 10.38 (1.38, 78.13) and 14.18 (1.72, 116.59), respectively. The results must be interpreted with caution due to a possible healthy worker effect and selection bias. CONCLUSION: Exposure to respirable coal mine dust was associated with airway limitation as measured by FEV(1)/FVC and predicted FEV(1)%.

High exposure to respirable dust and quartz in a labour-intensive coal mine in Tanzania.

Labour-intensive mines are numerous in several developing countries, but dust exposure in such mines has not been adequately characterized. The aim of this study was to identify and quantify the determinants of respirable dust and quartz exposure among underground coal mine workers in Tanzania. Personal respirable dust samples (n = 134) were collected from 90 underground workers in June-August 2003 and July-August 2004. The development team had higher exposure to respirable dust and quartz (geometric means 1.80 and 0.073 mg m(-3), respectively) than the mining team (0.47 and 0.013 mg m(-3)), the underground transport team (0.14 and 0.006 mg m(-3)) and the underground maintenance team (0.58 and 0.016 mg m(-3)). The percentages of samples above the threshold limit values (TLVs) of 0.9 mg m(-3) for respirable bituminous coal dust and 0.05 mg m(-3) for respirable quartz, respectively, were higher in the development team (55 and 47%) than in the mining team (20 and 9%). No sample for the underground transport team exceeded the TLV. Drilling in the development was the work task associated with the highest exposure to respirable dust and quartz (17.37 and 0.611 mg m(-3), respectively). Exposure models were constructed using multiple regression model analysis, with log-transformed data on either respirable dust or quartz as the dependent variable and tasks performed as the independent variables. The models for the development section showed that blasting and pneumatic drilling times were major determinants of respirable dust and quartz, explaining 45.2 and 40.7% of the variance, respectively. In the mining team, only blasting significantly determined respirable dust. Immediate actions for improvements are suggested to include implementing effective dust control together with improved training and education programmes for the workers. Dust and quartz in this underground mine should be controlled by giving priority to workers performing drilling and blasting in the development sections of the mine.

Influence of airways resistance on the nitrogen washout from the lung during forced rebreathing.

The forced rebreathing method was used to determine the rate of change (apparent increase) of residual volume (RV) per breath in a group of 64 healthy non-smokers, 449 healthy smokers and 28 patients with chronic obstructive pulmonary disease (COPD). The mean FEV(1)% FVC in the patients was 48.28% (SD= = 8.9%). The rate of breathing into the bag-bottle system was maintained at 28 breaths per minute for all subjects. An asymptote in the nitrogen washout curve was reached within 5 breaths in healthy subjects as compared to between 7-13 in patients with COPD. The mean apparent increase in RV average 11ml/breath, 15ml/breath and 18ml/breath in healthy non-smokers, smokers and patients with COPD respectively. The mean apparent increase in RV in healthy non-smokers approximated a normal resting oxygen consumption per minute. It was higher in healthy smokers and patients with COPD than in healthy non-smokers. It is concluded that because of a high airway resistance, the forced rebreathing increases the work of breathing in order to overcome resistance to gas flow in the airways. More energy is required and oxygen is removed from the bag-bottle system without a corresponding replacement with carbon dioxide. The volume of the bag-bottle system progressively decreases resulting in a high apparent increase in RV.

Dust exposure during small-scale mining in Tanzania: a pilot study.

Small-scale mining in developing countries is generally labour-intensive and carried out with low levels of mechanization. In the Mererani area in the northern part of Tanzania, there are about 15000 underground miners who are constantly subjected to a poor working environment. Gemstones are found at depths down to 500 m. The objectives of this pilot study were to monitor the exposure to dust during work processes, which are typical of small-scale mining in developing countries, and to make a rough estimation of whether there is a risk of chronic pulmonary diseases for the workers. Personal sampling of respirable dust (n = 15) and 'total' dust (n = 5) was carried out during three consecutive days in one mine, which had a total of 50 workers in two shifts. Sampling started immediately before the miners entered the shaft, and lasted until they reappeared at the mine entrance after 5-8 h. The median crystalline silica content and the combustible content of the respirable dust samples were 14.2 and 5.5%, respectively. When drilling, blasting and shovelling were carried out, the exposure measurements showed high median levels of respirable dust (15.5 mg/m(3)), respirable crystalline silica (2.4 mg/m(3)), respirable combustible dust (1.5 mg/m(3)) and 'total' dust (28.4 mg/m(3)). When only shovelling and loading of sacks took place, the median exposures to respirable dust and respirable crystalline silica were 4.3 and 1.1 mg/m(3). This study shows that the exposure to respirable crystalline silica was high during underground small-scale mining. In the absence of personal protective equipment, the miners in the Mererani area are presumably at a high risk of developing chronic silicosis.