We analyze the potential effect of global warming levels (GWLs) of 1.5 °C and 2 °C above pre-industrial levels (1861−1890) on mean temperature and precipitation as well as intra-seasonal ...precipitation extremes over the Greater Horn of Africa. We used a large, 25-member regional climate model ensemble from the Coordinated Regional Downscaling Experiment and show that, compared to the control period of 1971−2000, annual mean near-surface temperature is projected to increase by more than 1 °C and 1.5 °C over most parts of the Greater Horn of Africa, under GWLs of 1.5 °C and 2 °C respectively. The highest temperature increases are projected in the northern region, covering most parts of Sudan and northern parts of Ethiopia, and the lowest temperature increases are projected over the coastal belt of Tanzania. However, the projected mean surface temperature difference between 2 °C and 1. 5 °C GWLs is higher than 0.5 °C over nearly all land points, reaching 0.8 °C over Sudan and northern Ethiopia. This implies that the Greater Horn of Africa will warm faster than the global mean. While projected changes in precipitation are mostly uncertain across the Greater Horn of Africa, there is a substantial decrease over the central and northern parts of Ethiopia. Additionally, the length of dry and wet spells is projected to increase and decrease respectively. The combined effect of a reduction in rainfall and the changes in the wet and dry spells will likely impact negatively on the livelihoods of people within the coastal cities, lake regions, highlands as well as arid and semi-arid lands of Kenya, Tanzania, Somalia, Ethiopia and Sudan. The probable impacts of these changes on key sectors such as agriculture, water, energy and health sectors, will likely call for formulation of actionable policies geared towards adaptation and mitigation of the impacts of 1.5 °C and 2 °C warming.
To describe the evolution of atmospheric processes and rainfall forecast in Tanzania, the Advanced Weather Research and Forecasting (WRF-ARW) model was used. The principal objectives of this study ...were 1) the understanding of mesoscale WRF model and adapting the model for Tanzania; 2) to conduct numerical experiments using WRF model with different convective parameterization schemes (CP's) and investigate the impact of each scheme on the quality of rainfall forecast; and 3) the investigation of the capability of WRF model to successfully simulate rainfall amount during strong downpour. The impact on the quality of rainfall forecast of six CP's was investigated. Two rainy seasons, short season "Vuli" from October to December (OND) and long season "Masika" from March to May (MAM) were targeted. The results of numerical experiments showed that for rainfall prediction in Dar es Salaam and (the entire coast of the Indian Ocean), GD scheme performed better during OND and BMJ scheme during MAM. Results also showed that NC scheme should not be used, which is in agreement to the fact that in tropics rainfall is from convective activities. WRF model to some extent performs better in the cases of extreme rainfall.
In some low-resource settings bubble continuous positive airway pressure (bCPAP) is increasingly used to treat children with pneumonia. However, the time required for healthcare workers (HCWs) to ...administer bCPAP is unknown and may have implementation implications. This study aims to compare HCW time spent administering bCPAP and low-flow nasal oxygen care at a district hospital in Malawi during CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial).
Eligible participants were 1-59 months old with WHO-defined severe pneumonia and HIV-infection, HIV-exposure, severe malnutrition, or hypoxemia and were randomized to either bCPAP or oxygen. We used time motion techniques to observe hospital care in four hour blocks during treatment initiation or follow up (maintenance). HCW mean time per patient at the bedside over the observation period was calculated by study arm.
Overall, bCPAP required an average of 34.71 min per patient more than low-flow nasal oxygen to initiate (bCPAP, 118.18 min (standard deviation (SD) 42.73 min); oxygen, 83.47 min (SD, 20.18 min), p < 0.01). During initiation, HCWs spent, on average, 12.45 min longer per patient setting up bCPAP equipment (p < 0.01) and 11.13 min longer per patient setting up the bCPAP nasal interface (p < 0.01), compared to oxygen equipment and nasal cannula set-up. During maintenance care, HCWs spent longer on average per patient adjusting bCPAP, compared to oxygen equipment (bCPAP 4.57 min (SD, 4.78 min); oxygen, 1.52 min (SD, 2.50 min), p = 0.03).
Effective bCPAP implementation in low-resource settings will likely create additional HCW burden relative to usual pneumonia care with oxygen.
Clinicaltrials.gov NCT02484183 , June 29, 2015.
Background. Previous prospective studies of bacteremia in African children with severe malaria have mainly included children with cerebral malaria, and no study has examined the impact of human ...immunodeficiency virus (HIV) infection. We examined the prevalence and etiology of bacteremia and the impact of HIV infection on bacteremia in Malawian children with severe malaria, as well as the impact of bacteremia and HIV infection on outcome. Methods. From 1996 until 2005, blood for culture was obtained on admission from all children admitted with severe malaria during the rainy season to the Paediatric Research Ward at the Queen Elizabeth Central Hospital in Blantyre, Malawi. HIV testing was performed prospectively from 2001 to 2005 and retrospectively for those admitted from 1996 to 2000. Multivariate regression analysis examined independent risk factors for bacteremia and death. Results. Sixty-four (4.6%) of 1388 children with severe malaria had bacteremia; nontyphoidal Salmonellae (NTS) accounted for 58% of all bacteremias. The prevalence of any bacteremia and of NTS bacteremia was highest in children with severe malarial anemia (11.7% and 7.6%), compared with the prevalence in children with cerebral malaria and severe anemia (4.7% and 3.8%) and in those with cerebral malaria alone (3.0% and 0.9%). HIV infection status was determined in 1119 patients. HIV prevalence was 16% (and was highest in those with severe malaria anemia, at 20.4%), but HIV infection was not significantly associated with bacteremia. Neither bacteremia nor HIV infection was associated with death. Conclusions. Antibiotics are not routinely indicated for children with severe malaria in this region, in which HIV is endemic. However, antibiotic therapy should be used to treat NTS infection if bacteremia is suspected in children with severe malarial anemia.
PDF
