The mainstay in the management of preterm neonates with respiratory distress syndrome (RDS) include early Continuous Positive Airway Pressure (CPAP), timely surfactant replacement and mechanical ...ventilation. Preterm neonates with RDS who fail CPAP are at higher risk for chronic lung disease as well as death. Unfortunately, in low resource settings CPAP may be the only treatment available for these neonates.
To determine the prevalence of CPAP failure among premature newborns with RDS and associated factors.
We conducted a prospective observational study over the first 72 h of life on 174 preterm newborns with RDS receiving CPAP at Muhimbili National Hospital (MNH). At MNH newborns with Silverman Andersen Score (SAS) of ≥ 3 are commenced on CPAP; surfactant and mechanical ventilation are very scarce. Study newborns not maintaining oxygen saturation > 90% or with SAS score ≥ 6 despite being on 50% oxygen and PEEP of 6 cmH
O and those with > 2 episodes of apnoea needing stimulation or positive pressure ventilation in 24 h were considered as CPAP failure. The prevalence of CPAP failure was determined as a percentage and factors associated were determined by logistic regression. A p-value of < 0.05 was considered significant and 95% confidence interval was used.
Of the enrolled newborns, 48% were male and 91.4% were in-born. The mean gestational age and weight were 29 weeks (range 24-34 weeks) and 1157.7 g (range 800-1500 g) respectively. Of the mothers 44 (25%) received antenatal corticosteroids. Overall CPAP failure was 37.4% and among those weighing ≤ 1200g, it was 44.1% . Most failure occurred within the first 24 h. No factor was identified to be independently associated with CPAP failure. Mortality among those who failed CPAP was 33.8% and 12.8% among those who did not.
In resource limited settings like ours with low up take of antenatal corticosteroids and scarce surfactant replacement a significant portion of preterm neonates especially those weighing ≤ 1200 g with RDS fail CPAP therapy.
This paper argues that the lack of serious attempts to incorporate Islamic studies in Kenya’s academic culture can best be understood by looking at the colonial and postcolonial policies toward ...university education there. The early missionary influence that shaped the nature of the indigenous educational system had a farreaching impact upon creating a culture of resistance among Muslims toward western education. In the postcolonial period, the new governments tried to create a level playing field for all of their citizens, regardless of religious orientation. But the colonial imapct had already left its mark on Muslims in terms of their visibility at the university level. The Kenyan government did not interfere in what academic programs should be prioritized at this level. But because Christians outnumbered Muslims in academia, their influence created a dearth of indigenous university-generated information and knowledge on Muslim institutions and society. This gap was left to foreign researchers to fill. As a result, Kenya has no indigenous Islamic intellectual culture. If this status quo does not change, Kenyan Muslims will remain vulnerable to foreign Islamist influences.
Few studies have differentiated risk factors for term-small for gestational age (SGA), preterm-appropriate for gestational age (AGA), and preterm-SGA, despite evidence of varying risk of child ...mortality and poor developmental outcomes.
We analyzed birth outcome data from singleton infants, who were enrolled in a large randomized, double-blind, placebo-controlled trial of neonatal vitamin A supplementation conducted in Tanzania. SGA was defined as birth weight <10th percentile for gestation age and sex using INTERGROWTH standards and preterm birth as delivery at <37 complete weeks of gestation. Risk factors for term-SGA, preterm-AGA, and preterm-SGA were examined independently using log-binomial regression.
Among 19,269 singleton Tanzanian newborns included in this analysis, 68.3 % were term-AGA, 15.8 % term-SGA, 15.5 % preterm-AGA, and 0.3 % preterm-SGA. In multivariate analyses, significant risk factors for term-SGA included maternal age <20 years, starting antenatal care (ANC) in the 3(rd) trimester, short maternal stature, being firstborn, and male sex (all p < 0.05). Independent risk factors for preterm-AGA were maternal age <25 years, short maternal stature, firstborns, and decreased wealth (all p < 0.05). In addition, receiving ANC services in the 1(st) trimester significantly reduced the risk of preterm-AGA (p = 0.01). Significant risk factors for preterm-SGA included maternal age >30 years, being firstborn, and short maternal stature which appeared to carry a particularly strong risk (all p < 0.05).
Over 30 % of newborns in this large urban and rural cohort of Tanzanian newborns were born preterm and/or SGA. Interventions to promote early attendance to ANC services, reduce unintended young pregnancies, increased maternal height, and reduce poverty may significantly decrease the burden of SGA and preterm birth in sub-Saharan Africa.
Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12610000636055 , registered on 3(rd) August 2010.
Low birth weight (LBW) is a significant public health concern given its association with early-life mortality and other adverse health consequences that can impact the entire life cycle. In many ...countries, accurate estimates of LBW prevalence are lacking due to inaccuracies in collection and gaps in available data. Our study aimed to determine LBW prevalence among facility-born infants in selected areas of Kenya and Tanzania and to assess whether the introduction of an intervention to improve the accuracy of birth weight measurement would result in a meaningfully different estimate of LBW prevalence than current practice.
We carried out a historically controlled intervention study in 22 health facilities in Kenya and three health facilities in Tanzania. The intervention included: provision of high-quality digital scales, training of nursing staff on accurate birth weight measurement, recording and scale calibration practices, and quality maintenance support that consisted of enhanced supervision and feedback (prospective arm). The historically controlled data were birth weights from the same facilities recorded in maternity registers for the same calendar months from the previous year measured using routine practices and manual scales. We calculated mean birth weight (95% confidence interval CI), mean difference in LBW prevalence, and respective risk ratio (95% CI) between study arms.
Between October 2019 and February 2020, we prospectively collected birth weights from 8441 newborns in Kenya and 4294 in Tanzania. Historical data were available from 9318 newborns in Kenya and 12,007 in Tanzania. In the prospective sample, the prevalence of LBW was 12.6% (95% confidence intervals CI: 10.9%-14.4%) in Kenya and 18.2% (12.2%-24.2%) in Tanzania. In the historical sample, the corresponding prevalence estimates were 7.8% (6.5%-9.2%) and 10.0% (8.6%-11.4%). Compared to the retrospective sample, the LBW prevalence in the prospective sample was 4.8% points (3.2%-6.4%) higher in Kenya and 8.2% points (2.3%-14.0%) higher in Tanzania, corresponding to a risk ratio of 1.61 (1.38-1.88) in Kenya and 1.81 (1.30-2.52) in Tanzania.
Routine birth weight records underestimate the risk of LBW among facility-born infants in Kenya and Tanzania. The quality of birth weight data can be improved by a simple intervention consisting of provision of digital scales and supportive training.
The onset of economic globalization by the end of the 20th century foisted progressively new modes of collaboration on most of the American social movements. New Social Movements (NSMs) such as the ...environmental movement, the environmental justice movement, and the labour unions, were propelled into rapprochement that soon gave rise to new forms of coalition dubbed the blue-green/the blue-green-brown alliances. Revisiting this cross-movement reconciliation from a sustainability studies’ perspective, this paper contends that these alliances, oscillating between failure and success, helped theoretically set up the three sides of the ‘Sustainability Triangle,’ – an integrative framework premised on the ‘three Es,’ i.e., Environment/Ecology, Economy/Employment, and Equality/Equity. Utilizing a critical comparative analysis of these three movements, this paper also vets the extent to which this framework fosterages a shared ‘sustainability identity’ amongst these groups and bridges the ‘job-versus-the-environment’ divide that beleaguered their alliances and almost brought them to a grinding halt.
IntroductionChildren who are born to women living with HIV are at a greater risk of suboptimal neurodevelopment; however, evidence from sub-Saharan Africa is limited and functional developmental ...outcomes are rarely assessed in this vulnerable population. The School Readiness among HIV-Exposed Children (SRHEC) cohort study aims to assess the school readiness of preschool aged children born to women living with HIV and to identify the biological, environmental and social factors that contribute to school readiness in this population.Methods and analysisThe SRHEC cohort is an observational follow-up study of children born to HIV-infected pregnant women who were previously enrolled in a maternal vitamin D supplementation randomised, placebo-controlled trial in Dar es Salaam, Tanzania. This parent trial enrolled 2300 pregnant women and followed mothers and infants up to 1-year postpartum. Mother/caregiver and child pairs will be eligible for the SRHEC follow-up study if the child is between 3 and 6.5 years of age at assessment, and the mother/caregiver provides informed consent. The International Development and Early Learning Assessment tool will be used to assess children’s school readiness, including their early literacy, early numeracy, motor, socialemotional, and executive function skills. Data on maternal and child health and nutritional status (eg, anthropometry, blood pressure and diet) will be collected using standardised instruments and survey-based questionnaires. Data on maternal/caregiver depression and anxiety, maternal exposure to intimate partner violence, and HIV-related stigma will also be collected. Generalised linear and logistic regressions will be used to assess the relationship between child school readiness and biological, social, environmental factors.Ethics and disseminationThis study received ethical clearance from the Tanzanian National Institute of Medical Research, the Muhimbili University of Health and Allied Sciences, and the Harvard T.H. Chan School of Public Health. We will disseminate our results in the form of scientific conference presentations and peer-reviewed publications.
Infants need to receive care in environments that limit their exposure to pathogens. Inadequate water, sanitation, and hygiene (WASH) environments and suboptimal infection prevention and control ...practices in healthcare settings contribute to the burden of healthcare-associated infections, which are particularly high in low-income settings. Specific research is needed to understand infant feeding preparation in healthcare settings, a task involving multiple behaviors that can introduce pathogens and negatively impact health. To understand feeding preparation practices and potential risks, and to inform strategies for improvement, we assessed facility WASH environments and observed infant feeding preparation practices across 12 facilities in India, Malawi, and Tanzania serving newborn infants. Research was embedded within the Low Birthweight Infant Feeding Exploration (LIFE) observational cohort study, which documented feeding practices and growth patterns to inform feeding interventions. We assessed WASH-related environments and feeding policies of all 12 facilities involved in the LIFE study. Additionally, we used a guidance-informed tool to carry out 27 feeding preparation observations across 9 facilities, enabling assessment of 270 total behaviors. All facilities had 'improved' water and sanitation services. Only 50% had written procedures for preparing expressed breastmilk; 50% had written procedures for cleaning, drying, and storage of infant feeding implements; and 33% had written procedures for preparing infant formula. Among 270 behaviors assessed across the 27 feeding preparation observations, 46 (17.0%) practices were carried out sub-optimally, including preparers not handwashing prior to preparation, and cleaning, drying, and storing of feeding implements in ways that do not effectively prevent contamination. While further research is needed to improve assessment tools and to identify specific microbial risks of the suboptimal behaviors identified, the evidence generated is sufficient to justify investment in developing guidance and programing to strengthen infant feeding preparation practices to ensure optimal newborn health.
This article argues that the evolution of, and challenges to, sustainable development cannot be understood completely outside its contemporary global context, consisting mainly of three ...interconnected spheres, i.e., the global governance system, the North-South debate, and global trade liberalization. As the boundaries of these three spheres get more and more blurred in a context of an intensifying globalization, the project of sustainable development is very often faced with obstacles that set back its evolution and might very well bring it to a halt. Above all, sustainable development is now caught in the crossfire between the push for exponential economic growth, on the one hand, and a compelling need to reverse catastrophic ecological threats and social exigencies, on the other. More often than not, the current structure and scope of global governance constitutes more of a hindrance than a help to the emerging paradigm of sustainable development. Accordingly, this article seeks to pinpoint the different challenges to the implementation of sustainable development in the field of global governance and to discuss to what extent these challenges are inherent in the structure and scope of this system. In a similar vein, this article examines and discusses the challenges to sustainability within two other highly interrelated spheres, namely global trade and the North-South politics. With this end in view, a special focus is placed throughout this paper on the interconnectedness of, and overlap between, these three global spheres and the determinant role played by the major actors therein.
Ideologically, the two projects of globalization and sustainable development are informed by totally different sets of principles and values. This article launches a thorough conceptual and ...theoretical juxtaposition of these two projects, which shows that these two phenomena overlap structurally but diverge ideologically on a number of economic, social, and ecological issues. In essence, the juxtaposition between globalization and sustainable development provides an illuminating insight into the structural affinity as well as the subsequent potential clashes between the two. This article examines the different aspects of affinity between these two projects, analyses the most significant differences and contradictions between the two, and analyses potential solutions to harness globalization forces to sustainability. By conducting such a critical comparative analysis of these two projects, a deeper insight is gained with regard to any potential that would make them mutually supportive rather than mutually exclusive.
Purpose
The purpose of this study was to identify and assess the regulatory and institutional constraints in managing procurement records in Tanzania’s procuring entities.
Design/methodology/approach
...This study used a mixed study design. There were explorative case study and questionnaire survey study methods used sequentially. In total, 15 procuring entities were used for exploratory case study, while 200 respondents were administered with questionnaires. A 75 per cent response rate was realised.
Findings
Results indicated that management and care of procurement records is constrained by regulatory and institutional constraints. The identified and assessed constraints were inter alia: incapacity of institutional actors, inadequate regulatory and institutional arrangements, inadequacy of storage space, equipment and facilities and insufficiency of security and safety measures.
Research limitations/implications
This research focussed on the procuring entities found in Dar es Salaam, which accounts for 40.72 per cent of the total procuring entities in Tanzania. Based on this, the generalisation of research findings can be sought in that particular context.
Practical implications
Findings imply that procurement records management and care is highly influenced by the constraining factors that hinder efficient records keeping in most procuring entities in Tanzania.
Social implications
Majority of procurement management units and user departments’ staff were found to possess inadequate knowledge, skills and competences in management and care of procurement records. The procuring entities should ensure that procurement staffs are trained in records and archives management practices.
Originality/value
This study contributes towards adding knowledge to the existing body of knowledge on the procurement records and archives management systems.
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