I read the bitter news of article published recently. Intentionally some PLHA people transmitted HIV/AIDS

Metabolic acidosis is common in severe malnourished pediatric patients.

Objective: The objective of this study was to treat severe malnourished children according to results of renal metabolic study.

Method: The study was prospective, clinical trial (therapeutic). Overload test with sodium bicarbonate at 5% was performed to 30 severe malnutrition: marasmus, kwashiorkor or mixed, from 6 months to 5 years, primary etiology, hemodynamically stable, metabolic acidosis, hyperchloremia and anion gap urinary positive, which in turn they divided into two groups: 15 were treated according to the results of renal metabolic study (study group) and 15 receiving usual care (control group). The calcium / creatinine and uric / creatinine ratio was determined. Test of statistical significance were used: Student t Test, chi square Test or Fisher exact probability. Z Test the percentage difference. Cramer’s V Test. Statistical significance (p<0.05).

Results and Discussion: In 12 (40.0%) patients distal renal tubular acidosis was observed. There was a significant difference (p<0.013) between the dry weight and weight at discharge in both the study and control group. There was a significant difference (p<0.05) between the mean value of serum albumin entry and exit in the study group and not in the control group. It is important to treat metabolic acidosis in severe malnutrition to clinical improvement (weight) and biochemical outcomes (serum albumin), breaking the vicious circle in which these patients are frequently involved.

The intestinal microbiota in health is characterized by stability and diversity; any changes under different metabolic or inflammatory diseases cause an imbalance, changes in the composition and consequently modification in the intestinal homeostasis. The intestinal microbiota is influenced by the microorganisms that enter with the diet. Malnutrition processes, both obesity and malnourishment, induces changes in the intestinal microbiota composition, affecting mainly lactobacillus, bifidobacteria and bacteroides populations. These changes are accompanied by alterations in the intestinal villi architecture and in the intestinal barrier function. The intestinal ecosystem is a complex microenvironment where, multiple cells type (prokaryote and eukaryote) interacting constantly. The microbiota modifications induced by changes in the eating habits have repercussion on intestinal immunity. Probiotic microorganisms contained in different foods constitute an alternative to induce a positive balance in the microbiota. On the other hand several studies demonstrate their ability to stimulate the immune system at the intestinal level. We summarize here the results published specifically on the relationship between microbiota, obesity and intestinal immune system.

Background: Immense literature reports that condoms’ demand, distribution, and actual utilization are often constrained by social-cultural, psychological and supply factors. This article reports a qualitative study of the experiences, perceptions and attitudes of religious leaders and parents in relation to condom promotion in Tanzania.

Methodology: In-Depth Interviews (IDIs) with religions leaders and Focus Group Discussions (FGDs) with parents were conducted in Mpwapwa and Mbeya Rural districts between November 2011 and June 2012. FGD and IDI were tape recorded for later transcription verbatim. Transcribed reports supplemented with handwritten f ield notes were analyzed both manually and with help of NVIVO software.

Results: Mixed opinions were obtained from IDIs and FGDs on about the issue of condom promotion through mass media and school health programs. A few religious leaders and majority of non-Catholic parents partly supported the existing condom promotion strategies, contrary to Catholic and Islamic faith leaders who strongly opposed. All IDI and FGD participants seemed to appreciate that young children were already aware of what sex is and therefore like adults children have the right to information concerning HIV prevention including the issue of condom use. However, the majority were not in favor of health education targeting young children on condom use campaigns on ground that doing so exposes and tempts young and virgin children to premature sexual behaviors. Meanwhile, encouraging adult people to use condoms also was perceived as promoting promiscuity behaviors.

Conclusion: Condom advocates should maintain dialogue with religious leaders and faith adherents if they expect to overcome the challenge of dogmas prohibiting condom usage during sex by arriving at a mutual understanding of the benefits of condom use.

Background: Cholera outbreaks in Tanzania’s commercial capital, Dar es Salaam, have been occurring almost each year since 1974 with a Case Fatality Rate (CFR) averaging to 10.5%. This study analyzed major source waters for the city to ascertain safety for human consumption. The objective of the study was to determine the extent to which borehole and tap water meet the recommended drinking water quality standards by domestic and international organizations.

Methods: Total viable and coliform counts were evaluated using the standard plate count method. The physicochemical parameters were analyzed using standard methods.

Results and discussion: With respect to WHO standards, all water samples passed the pH and TDS parameters. With exception of tap water, all borehole water samples failed on turbidity standard maximum of 5 NTU for drinking water. Seven out of eleven (63.6%) borehole water samples and tap water sample failed on microbiological purity of drinking water standards and considered unfit for human consumption as revealed with the presence of unacceptable levels of fecal coliforms.

Conclusion: The implication of these findings is that, large number of Dar es Salaam city dwellers sourcing drinking water from boreholes and tap water are continuously ingesting fecally contaminated water that predispose them to infectious microbial risks of pathogenic gastrointestinal bacteria and viruses. Household based water treatment and safe storage (HWTS) is highly recommended to safeguard health of consumers of water from these sources. Regular assessment of all parameters mentioned in this study is advocated.

Background: Shortage of health workers in developing countries including Tanzania is a major obstacle to the scale-up of HIV/AIDS care, and implementation of health interventions toward achieving the Sustainable Development Goals (SDGs). This situation has necessitated informal task shifting practices that might compromise the quality of health care services. In this paper, we report Health Workers (HWs)’perceived effects of task shifting on HIV/AIDS and Reproductive and Child Health (RCH) service delivery in Tanzania.

Methods: A cross-sectional study was conducted in nine randomly selected districts identified in nine regions, Tanzania. Data were collected from HWs through interviews conducted using a structured questionnaire. This was achieved in 57 Health Facilities (HFs) including government (public) owned and faith-based ones. Data were double entered into computer using EpiData (3.1) before the analysis that was conducted with support of STATA (11) software.

Results: A total of 566 HWs participated in the study. Of these, 412 (72.8%) were females. Four hundred and forty-three (76.5%) workers reported to know others who were involved or had personal experiences in practicing duties that were beyond their official job descriptions and this is what was referred to as a kind of ‘Informal Task-shifting’. Most (n=439, 77.6%) of staff reported the latter task shifting practice to have had a positive effect on the health service delivery; ensuring continuity of health care service provision was reported by 292 (66.5%) of the respondents. Meanwhile, 281(49.6%) of the reporters claimed that informal task shifting practices had negative consequences. Of the most frequently mentioned to be negative effect was the provision of poor quality health care services to patients, as reported by 166 (n=281, 63.8%) of the workers.

Conclusion: Given the persistent HWs crisis situation in Tanzania, task-shifting was found to be highly welcome and valued among the HWs visited as it was seen as an alternative initiative for continuation of health service delivery at Health Facility levels. This informs the government of Tanzania to consider officially approving the initiative and continue monitoring its implementation in order to maintain the quality of health care services.

Mercury (Hg) is considered one of the most dangerous toxic metals to the environment and to human. High Hg level may induce different types of toxic effects on human health and the main target is the Central Nervous System (CNS). One of the main mechanisms involved in neurotoxicity caused by Hg is the oxidative stress and its effect on antioxidant systems. Currently it is known that deforestation is one of the main reasons for the high levels of Hg in the aquatic ecosystems in Amazon. However, to the best of our knowledge, there are no recent investigations that evaluate the Hg exposure in a human population of the Low Amazon region. The present work aims to fill the gap of the lack of information related to how the urban and floodplain populations of Santarém city (Pará state, Brazilian Amazon) is affected by Hg exposure, also investigating the GSTM1 and GSTT1 polymorphisms for the population studied. Our results show that the individuals studied are environmentally exposed to Hg due to the fish intake. Additionally, the analysis of our data suggests that fish intake, age, and sex are more relevant for prediction of Hg level in blood than the polymorphisms of GSTM1 and GSTT1 genes.

After being discovered on the borders of Mozambique and Tanzania in 1952, the Chikungunya Virus (CHIKV) is now classified as a category C priority pathogen, as it has spread to over 40 countries worldwide. As the virus circulates through either human or mosquito vectors, it is important to closely monitor its progression within vulnerable countries, as it mimics the tenacity of other dangerous diseases such as the Dengue virus and more recently the Zika virus that has caused an outbreak in Brazil and has spread to other Latin American regions. The purpose of this study is to provide an overview of the Chikungunya viral infection by relating the history with the spread of the disease as well as its impact on global populations. Understanding the transmission of the virus, as well as its current spread (in relation to Central / East Africa), will enable conclusions to be made about which treatment and prevention methods should be implemented in order to target those specific demographics. The demographics that were found to have the highest prevalence of Chikungunya include Southeast Asia and Central Africa. Since this virus has the ability for global spread, containing it and preventing further spread, requires preventative measures that must be undertaken globally.

Until recently, biologists thought evolution was too slow a process to be observed in a human lifetime. Today, from studies of the adaptation of mammals and birds to an urban environment, we are learning that spectacular transformations of species may be fast and that non genetic factors have been previously underestimated.

Background: To identify effective methods of developing and delivering consumer health education materials related to reproductive health and the environment.

Methods: One focus group (n=58). Inclusion criteria were self-selected attendees from the 2014 Reproductive Health and the Environment conference held in Los Angeles. The focus group was divided into eight groups with seven to ten participants. A table facilitator and note taker were assigned to each group. The same four reproductive health and the environment consumer education publications were reviewed by each group and were selected because of their widespread availability and/or were developed by noted health professionals. The identical questions were posed to the participants by the table facilitator and related to the readability level, format, target audience, and content.

Results and discussion: The reoccurring themes identified in the publications were focused on readability levels being too high for a low literacy population, and content too complex and presented in hard to follow formats. Additionally, the fear levels were considered at a level that could immobilize action instead of motivating change. The font styles and sizes, along with a cluttered design, were other variables that limited the impact of some of the publications reviewed. A wallet card format was the recommendation for a future publication. Surveys with drafts of the wallet card were distributed to 20 women in the target audience soliciting their responses to the information and format.

Conclusion: A community participatory process for developing the wallet card and translating it into Spanish translation was essential for individuals and communities to take action in reducing exposure. Affordable and easy to adopt recommendations for actions are essential when targeting low income women.

Background: Adolescents’ social and health vulnerabilities are growing public health concerns worldwide as vulnerable adolescents have difficulties in maintaining their physical and psychosocial wellbeing. Adolescents from poor economic settings are more vulnerable because of lack of basic necessities and parental guidance.

Methods: The data are derived from the Nepal Adolescent and Youth Survey (NAYS) 2010/11 conducted among 14,754 adolescents from 72 districts of Nepal, using Probability Proportion to Size (PPS) method and multi-stage random sampling procedures.

Results: The survey shows that 16 percent of the adolescents were out of formal schooling, 32 percent reported that they were physically beaten, 14 percent told that they ever consumed alcohol, 16 percent were vulnerable from injury, 51.9 percent were vulnerable from illness requiring medical treatment and around 14 percent of the adolescents reported at least one perceived psychosocial problems. From Gender perspectives early marriage, psychosocial problems and out of schooling were the major factors responsible for vulnerability in girls while injury was the common vulnerability factor for boys. Being girl, being older and belonging to Brahmin/ Chhetri caste and residing in mountain region were the major predictors for out of schooling while contributing factors for child marriage were being girl, being older, residing in rural localities and belonging to Janajati caste. Boys, lower age’s adolescents and residing in mountain region were more vulnerable for physical violence. Alcohol was major cause of vulnerability among boys, older age, living in mountain region, belonging to Janajati caste and having lower wealth quintiles.

Conclusion: Adolescents social and health vulnerabilities are high especially among girls and those from remote areas and belonging to Dalit caste. The factors associated with vulnerabilities had mainly the socio economic causes and difficulties in access in health services.

Introduction: Diabetes mellitus is a chronic illness that requires comprehensive evidence-based care. With many evidence arising about the importance of engaging the patient in self-management, we sought to analyze the situation in the state of Qatar, which has one of the highest diabetes prevalence rates in the region; to improve patients’ final health outcomes.

Methods: A structured questionnaire was administered to type II diabetic patients (n=513), aged 35-86 years from both sexes. The participants were a convenience sample of patients attending the diabetic clinics of two primary health care centers. The primary independent variables were: patient understanding of diabetes, provider’s Participatory Decision-Making (PDM) style, and Communication (PCOM). Moreover, we aimed to assess the effect these variables had on the primary outcome, which is diabetes self-management. Associations between two or more qualitative variables were analyzed using chi-square test, with a continuity correction factor when appropriate. The unpaired ‘t’ and Mann-Whitney U tests were also utilized, with a calculation of the Cronbach’s alpha.

Results: Using ANOVA models, each of the primary independent variables was shown to be a significant predictor of diabetes self-management (P<0.001). However, after implementing multivariate regression, only the patient understanding variable was strongly associated with diabetes self-management. Finally, there was no significant correlation between PDM style, PCOM, patient understanding, or self-diabetes management on one hand and age or gender on the other.

Conclusion: The study demonstrates that if diabetics understood their disease, they would have a better chance at self-management; despite the importance of provider participatory decision-making and communication in enhancing that understanding.

Background: People living with disability in the context of a generalised HIV/AIDS epidemic potentially shoulder multiple burdens of disability, poverty, stigma and discrimination. This is obvious when a person is both disabled and HIV positive. Despite the fact that they are at equal or increased risk for HIV infection, more often, their specific needs regarding HIV/AIDS prevention, treatment, care and support services are not well aligned with existing HIV/AIDS policies and programmes.

Objectives: The objectives of this study among others were to determine the important factors affecting disabled people’s access to HIV/AIDS information, counselling, testing, treatment care and support services, and to assess whether the design, content and format of HIV/ AIDS IEC materials are accessible, friendly and communicate the required messages to the disabled for behaviour change, prevention, treatment, care and support services in order to inform programming for HIV and AIDS interventions which are currently not user friendly to the special needs of people living with disabilities.

Methodology: This study employed cross sectional design whereby qualitative and quantitative methods of data collection and analysis were used. In qualitative methods of data collection, key informant interviews were used as a principal technique whereas structured questionnaire with close-ended questions was the key technique for quantitative data collection. Analysis of quantitative data was done using STATA® statistical software. Thematic content analysis was used for qualitative data analysis.

Results: The major findings of this study are summarised as follows: The physically disabled people constitute the highest (43%) of the studied population. In addition 79.9% indicated that main reason of perceiving themselves to be at the same or higher (compared to non-disabled peers) level of risk of HIV infection is because they are sexually active, contrary to the popular misconception by community members that disabled people are not sexually active. The level of stigma and discrimination against disabled people is still high in the communities. In this study, 49.4% of the interviewed participants believed/thought that they stigmatised and discriminated because of either being disabled or being HIV+. Related to this, 39% of the interviewed participants said that they have ever experienced stigma and discrimination either in the communities they live or when they were seeking health care at health facilities. Moreover, majority (90%) of the blind, 77.5% of the mentally challenged, 60.4% of the dumb and 58.8% of the physically challenged) of the disabled people considered that the existing IEC materials are not user-friendly (in terms of format and content) to the needs of different types of disabled people.

Conclusion: The descriptive findings from quantitative and qualitative data permit two major conclusions regarding barriers which affect disabled people from accessing HIV/AIDS services. Firstly, access and utilisation of HIV/AIDS services among disabled people is mainly affected by high levels of stigma and discrimination by community members and health care workers. Secondly, unfriendliness of the existing IEC intervention aggravates the marginalisation of disabled people from accessing HIV/AIDS prevention messages and information about treatment, care and support services related.

Background: Tanzania continues to work towards improving her health system in order to provide quality health services amid serious shortages of resources. A serious impediment towards attaining Sustainable Development Goals (SDGs) especially those related to HIV/AIDS, Reproductive and Child Health (RCH), is a shortage of health workers both in terms of numbers and skill-mix. While the problem of shortage is affecting the whole health care delivery system, we focus on the provision of HIV/AIDS and RCH services. The aim of this paper is to gather insights from health managers in Tanzania by exploring their views and experiences about task shifting practices in the delivery of HIV/AIDS and RCH services.

Methods: This was a cross-sectional exploratory study employing qualitative methods of data collection and analysis. It was conducted between June and August in 2012. The study involved interviews with health managers from national level, in nine regions and nine districts of Tanzania. The regions and districts were randomly selected. At the national, regional and district levels, key Informants were selected on the basis of their potential to provide relevant information on task-shifting from practice and their experiences in the fields of HRH, HIV/AIDS and RCH. Analysis of data from in-depth interviews was an ongoing field exercise. Analysis had followed the principles of grounded theory and employed multiple coding.

Results: Task shifting practices are widespread in all health facilities across all cadres of health workers in Tanzania. HIV/AIDS and RCH services are available both in urban and rural areas. However health managers were of the view that due to huge shortage of skilled health workers in rural areas with higher levels of task shifting practices, quality of HIV/AIDS and RCH services in rural areas were considered to be low compared to services provided in urban areas. In addition, it was revealed that task shifting was implemented informally due to absence of policies and guidelines needed to guide the implementation, training and mentorship, monitoring and Evaluation. These guidelines are needed in order to ensure continuity of access and quality of health care services. Finally the study found that in some ways and on top of the acute shortage of health workers, ineffective strategies for attracting and retaining skilled health workers which characterize many rural areas, contribute to increasing the magnitude of task shifting practices in the country.

Conclusion: The absence of policies and guidelines for guiding the implementation of task shifting in the country affect planning and harmonization of important aspects of task shifting such as training, mentorship and supportive supervision. If such policies and guidelines are to be formulated, they can set up a framework to regulate, monitor and evaluate task shifting practices. In the context of professional, regulatory and other barriers to policy change, there is a need to address these challenges before formalizing task shifting practices. However, it is encouraging to see that the Ministry of Health and Social Welfare has committed itself and it is now engaging different stakeholders to ensure that task shifting policy and guidelines are in place by the year 2017.

Introduction: Anemia, especially iron deficiency anemia, is an important public health problem in developing countries. Pregnant women, owing to their high iron demand are vulnerable to anemia. Reportedly 52% of pregnant women in developing countries, in contrast to 20% in developed countries, are affected. It is associated with serious maternal as well as fetal complications, such as preterm delivery, low birth weight, perinatal mortality and in severe anemia maternal death. Iron supplements are considered the most effective way to prevent and treat IDA but it should be taken regularly.

Objectives: The objectives of the study are estimate the prevalence of anemia, iron deficiency and iron deficiency anemia in addition to the associated factors among Arab pregnant women in Qatar.

Methodology: All eligible Arab women who attended the antenatal clinics of PHCCs during the data collection period were enrolled, a total of 450 women were interviewed using Arabic version questionnaire, hemoglobin and serum ferritin concentration were investigated to estimate anemia, ID and IDA.

Results: The prevalence of anemia was 27.1% (Hb<11g/dl), of which 74.5% were mildly anemic while 25.5% were moderately anemic. The prevalence of ID was 35.4% (SF <15µg/l) and the prevalence of IDA was 15.9%.

Anemia was significantly associated with gestational age, while ID was significantly associated with nationality, gestational age and inter-pregnancy space.

Conclusion & Recommendations: Anemia, ID and IDA during pregnancy are major problems as the prevalence of anemia among pregnant women in the current study was 27.1% which is considered as moderate based on WHO classification. However, Prevalence of ID and IDA were high. This prevalence is similar to that found in other developing countries but still behind the status in the industrialized countries, so preventive strategies and interventions must be instituted. Revising Maternal Health Program at Primary Health Care level to address the problem of ID & IDA among pregnant women.