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Search Results: 1 - 10 of 32481 matches for " John Ditekemena-Dinanga "
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Multidrug-Resistant Tuberculosis in the Democratic Republic of Congo: Analysis of Continuous Surveillance Data from 2007 to 2016  [PDF]
Serge Bisuta-Fueza, Jean Marie Kayembe-Ntumba, Marie-Jose Kabedi-Bajani, Pascale Mulomba Sabwe, Hippolyte Situakibanza-Nani Tuma, Jean-Pierre Simelo, Ernest Sumaili-Kiswaya, John Ditekemena-Dinanga, Patrick Kayembe-Kalambayi
Journal of Tuberculosis Research (JTR) , 2019, DOI: 10.4236/jtr.2019.71004
Abstract: Background: For countries with limited resources such as the Democratic Republic of the Congo (DRC), the diagnosis of Multidrug-resistant tuberculosis (MDR-TB) is still insufficient. The MDR-TB identification is done primarily among at-risk groups. The knowledge of the true extent of the MDR-TB remains a major challenge. This study tries to determine the proportion of MDR-TB in each group of presumptive MDR-TB patients and to identify some associated factors. Methods: This is an analysis of the DRC surveillance between 2007 and 2016. The proportions were expressed in Percentage. The logistic regression permits to identify the associated factors with the RR-/MDR-TB with adjusted Odds-ratio and 95% CI. Significance defined as p ≤ 0.05. Results: Overall, 83% (5407/6512) of the MDR-TB presumptive cases had each a TB test. 86.5% (4676/5407) had each a culture and drug sensitive testing (DST) on solid medium, and 24.3% (1312/5407) had performed an Xpert MTB/RIF test. The proportion of those with at least one first-line drug resistance was 59.3% [95% CI 57.2 - 61.4] among which 50.1%, [95% CI 47.9 - 52.3] for the isoniazid, 45.6% [95% CI 43.4 - 47.8] for the rifampicin, 49.9% [95% CI 47.8 - 52.1] for ethambutol and 35.8% [95% CI 33.7 - 37.9] for streptomycin. The confirmation of MDR-TB was 42.8% [95% CI 38.4 - 47.8]. Combining both tests, the proportion of RR-/MDR-TB was 49.6% [95% CI 47.9 - 51.4] for all presumptives. This proportion was 60.0% for failures, 40.7% for relapses and 34.7% for defaulters. Associated factors with the diagnosis of MDR-TB were: aged less than 35 years; prior treatment failure; defaulters; the delay between the collection of sputum and the test completion. Conclusion: The proportion of RR-/MDR-TB among the presumptives has been higher than those estimated generally. The National tuberculosis programme (NTP) should improve patient follow-up to reduce TB treatment failures and defaulting. Moreover, while increasing the use of molecular tests, they should reduce sample delivery times when they use culture and DST concomitantly.
Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a review
Ditekemena John,Koole Olivier,Engmann Cyril,Matendo Richard
Reproductive Health , 2012, DOI: 10.1186/1742-4755-9-32
Abstract: Introduction Male participation is a crucial component in the optimization of Maternal and Child Health (MCH) services. This is especially so where prevention strategies to decrease Mother-to-Child Transmission (MTCT) of Human Immunodeficiency Virus (HIV) are sought. This study aims to identify determinants of male partners’ involvement in MCH activities, focusing specifically on HIV prevention of maternal to child transmission (PMTCT) in sub-Saharan Africa. Methods Literature review was conducted using the following data bases: Pubmed/MEDLINE; CINAHL; EMBASE; COCHRANE; Psych INFORMATION and the websites of the International AIDS Society (IAS), the International AIDS Conference and the International Conference on AIDS in Africa (ICASA) 2011. Results We included 34 studies in this review, which reported on male participation in MCH and PMTCT services. The majority of studies defined male participation as male involvement solely during antenatal HIV testing. Other studies defined male involvement as any male participation in HIV couple counseling. We identified three main determinants for male participation in PMTCT services: 1) Socio-demographic factors such as level of education, income status; 2) health services related factors such as opening hours of services, behavior of health providers and the lack of space to accommodate male partners; and 3) Sociologic factors such as beliefs, attitudes and communication between men and women. Conclusion There are many challenges to increase male involvement/participation in PMTCT services. So far, few interventions addressing these challenges have been evaluated and reported. It is clear however that improvement of antenatal care services by making them more male friendly, and health education campaigns to change beliefs and attitudes of men are absolutely needed.
Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect
Richard Matendo, Cyril Engmann, John Ditekemena, Justin Gado, Antoinette Tshefu, Rinko Kinoshita, Elizabeth M McClure, Janet Moore, Dennis Wallace, Waldemar A Carlo, Linda L Wright, Carl Bose
BMC Medicine , 2011, DOI: 10.1186/1741-7015-9-93
Abstract: This study, a secondary analysis of DRC-specific data collected during a multi-country study, was conducted in two phases. The effect of training using the WHO Essential Newborn Care (ENC) program was evaluated using an active baseline design, followed by a cluster randomized trial of training using an adaptation of a neonatal resuscitation program (NRP). The perinatal mortality rates before ENC, after ENC training, and after randomization to additional NRP training or continued care were compared. In addition, the influence of time following resuscitation training was investigated by examining change in perinatal mortality during sequential three-month increments following ENC training.More than two-thirds of deliveries were attended by traditional birth attendants and occurred in homes; these proportions decreased after ENC training. There was no apparent decline in perinatal mortality when the outcome of all deliveries prior to ENC training was compared to those after ENC but before NRP training. However, there was a gradual but significant decline in perinatal mortality during the year following ENC training (RR 0.73; 95% CI: 0.56-0.96), which was independently associated with time following training. The decline was attributable to a decline in early neonatal mortality. NRP training had no demonstrable effect on early neonatal mortality.Training DRC birth attendants using the ENC program reduces perinatal mortality. However, a period of utilization and re-enforcement of training may be necessary before a decline in mortality occurs. ENC training has the potential to be a low cost, high impact intervention in developing countries.This trial has been registered at http://www.clinicaltrials.gov webcite (identifier NCT00136708).More than 98% of the estimated 3.7 million neonatal deaths and 3.2 million stillbirths per year occur in developing countries[1]. In many of these countries, the majority of deliveries occur in homes, either unattended by any health care pro
Classifying perinatal mortality using verbal autopsy: is there a role for nonphysicians?
Cyril Engmann, John Ditekemena, Imtiaz Jehan, Ana Garces, Mutinta Phiri, Vanessa Thorsten, Manolo Mazariegos, Elwyn Chomba, Omrana Pasha, Antoinette Tshefu, Elizabeth M McClure, Dennis Wallace, Robert L Goldenberg, Waldemar A Carlo, Linda L Wright, Carl Bose
Population Health Metrics , 2011, DOI: 10.1186/1478-7954-9-42
Abstract: To determine the extent to which underlying perinatal causes of deaths assigned by nonphysicians in Guatemala, Pakistan, Zambia, and the Democratic Republic of the Congo using a verbal autopsy method are concordant with underlying perinatal cause of death assigned by physician panels.Using a train-the-trainer model, 13 physicians and 40 nonphysicians were trained to determine cause of death using a standardized verbal autopsy training program. Subsequently, panels of two physicians and individual nonphysicians from this trained cohort independently reviewed verbal autopsy data from a sample of 118 early neonatal deaths and 134 stillbirths. With the cause of death assigned by the physician panel as the reference standard, sensitivity, specificity, positive and negative predictive values, and cause-specific mortality fractions were calculated to assess nonphysicians' coding responses. Robustness criteria to assess how well nonphysicians performed were used.Causes of early neonatal death and stillbirth assigned by nonphysicians were concordant with physician-assigned causes 47% and 57% of the time, respectively. Tetanus filled robustness criteria for early neonatal death, and cord prolapse filled robustness criteria for stillbirth.There are significant differences in underlying cause of death as determined by physicians and nonphysicians even when they receive similar training in cause of death determination. Currently, it does not appear that nonphysicians can be used reliably to assign underlying cause of perinatal death using verbal autopsy.Understanding population-based causes of perinatal death (stillbirth [SB] and early neonatal deaths [END], i.e., newborn deaths in the first seven days of life) is essential when developing an effective perinatal health policy [1]. Because there will always be competing demands for health care resources, a robust system constructed to identify and assign a medically-determined cause of death (COD) for each perinatal death is high
Evaluating the Use of Role Playing Simulations in Teaching Negotation Skills to University Students  [PDF]
John Andrew, John Meligrana
Creative Education (CE) , 2012, DOI: 10.4236/ce.2012.36104
Abstract: This paper critically evaluates the use of role-playing simulations in a negotiation course taught to graduate students. The course consisted primarily of a series of simulations involving the alternative dispute resolution (ADR) processes of negotiation, facilitation and mediation. Data were obtained from two sets of questionnaires completed by 41 students before and after the course. A review of previous research reveals that despite the widespread use of role-playing simulations in education, there has been very little empirical evaluation of their effectiveness, especially in conflict resolution and planning. Comparison of the data acquired from the two surveys generated findings regarding student understanding of ADR processes and key issues in conflict resolution; the educational value of simulations; the amenability of types of planning and planning goals to ADR; appropriate learning objectives; the importance of negotiation skills in planning; challenges in conducting effective simulations; the value of simulations in resolving real conflicts; the utility of negotiation theory; and obstacles to applying ADR to planning disputes. More generally, the paper concludes that role-playing simulations are very effective for teaching negotiation skills to students, and preparing them to manage actual conflicts skillfully and to participate effectively in real ADR processes. However, this technique is somewhat less valuable for teaching aspects of planning other than conflict resolution. Surprisingly, prior experience with simulations had no significant influence on the responses to the pre-course survey. Also surprising was the lack of a significant correlation between final exam scores and responses to relevant questions on the post-course survey.
Bronchoscopy Simulation in Anesthesia Resident Education  [PDF]
John McNeil,John Pawlowski
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.33041
Abstract: Simulation in residency training is becoming more popular but there is limited evidence showing that it can improve a resident’s fund of knowledge, particularly in anesthesiology. We looked at whether a bronchoscopy simulation could improve performance on a thoracic anesthesia knowledge test administered both before and after using the simulator. Fourteen first-year anesthesiology residents completed the study with an average improvement on the test of 28% (p < 0.05). We conclude that bronchoscopy simulation is an effective method of educating anesthesiology residents.
Bronchoscopy Simulation in Anesthesia Resident Education  [PDF]
John McNeil, John Pawlowski
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.33041

Simulation in residency training is becoming more popular but there is limited evidence showing that it can improve a resident’s fund of knowledge, particularly in anesthesiology. We looked at whether a bronchoscopy simulation could improve performance on a thoracic anesthesia knowledge test administered both before and after using the simulator. Fourteen first-year anesthesiology residents completed the study with an average improvement on the test of 28% (p < 0.05). We conclude that bronchoscopy simulation is an effective method of educating anesthesiology residents.

Birth attendants as perinatal verbal autopsy respondents in low-and middle-income countries: a viable alternative?
Engmann,C; Garces,A; Jehan,I; Ditekemena,J; Phiri,M; Thorsten,V; Mazariegos,M; Chomba,E; Pasha,O; Tshefu,A; Wallace,D; McClure,EM; Goldenberg,RL; Carlo,WA; Wright,LL; Bose,C;
Bulletin of the World Health Organization , 2012, DOI: 10.1590/S0042-96862012000300012
Abstract: objective: to assess the feasibility of using birth attendants instead of bereaved mothers as perinatal verbal autopsy respondents. methods: verbal autopsy interviews for early neonatal deaths and stillbirths were conducted separately among mothers (reference standard) and birth attendants in 38 communities in four developing countries. concordance between maternal and attendant responses was calculated for all questions, for categories of questions and for individual questions. the sensitivity and specificity of individual questions with the birth attendant as respondent were assessed. findings: for early neonatal deaths, concordance across all questions was 94%. concordance was at least 95% for more than half the questions on maternal medical history, birth attendance and neonate characteristics. concordance on any given question was never less than 80%. sensitivity and specificity varied across individual questions, more than 80% of which had a sensitivity of at least 80% and a specificity of at least 90%. for stillbirths, concordance across all questions was 93%. concordance was 95% or greater more than half the time for questions on birth attendance, site of delivery and stillborn characteristics. sensitivity and specificity varied across individual questions. over 60% of the questions had a sensitivity of at least 80% and over 80% of them had a specificity of at least 90%. overall, the causes of death established through verbal autopsy were similar, regardless of respondent. conclusion: birth attendants can substitute for bereaved mothers as verbal autopsy respondents. the questions in existing harmonized verbal autopsy questionnaires need further refinement, as their sensitivity and specificity differ widely.
Factors Impacting Innovation in New Service Offerings  [PDF]
John Maleyeff
Journal of Service Science and Management (JSSM) , 2011, DOI: 10.4236/jssm.2011.42014
Abstract: Factors that affect the level of innovation in projects to develop new service offerings are analyzed based on field re-search results from 84 service innovation projects. Personal characteristics of developers, process and customer type, and an important characteristic of their organization (i.e., whether or not they possess a strong Lean Six Sigma or simi-lar process improvement orientation) are analyzed. It is shown that, although personal characteristics, process type, or customer type do not affect the level of innovation, organizations with a strong Lean Six Sigma orientation had a lower incidence of radical innovation recommendations.
Deadly Inertia: A History of Constitutional Challenges to Canada's Criminal Code Sections on Prostitution  [PDF]
John Lowman
Beijing Law Review (BLR) , 2011, DOI: 10.4236/blr.2011.22005
Abstract: This paper examines rhetoric surrounding prostitution law reform in Canada from 1970 to the present. During the 1950s and 1960s, there was very little media or political attention paid to prostitution. It was not until the mid 1970s that perceived problems with prostitution law began to surface, driven by concerns that the criminal code statute prohibiting street prostitution was not enforceable. In 1983 the Liberal government appointed the Special Committee on Pornography and Prostitution to consider options for law and policy reform. However, the Conservative government that received the report in 1985 rejected the sweeping law changes the Special Committee recommended, opting instead to rewrite the street prostitution offence. Since then the murder of somewhere between 200 and 300 street prostitutes has prompted renewed calls for law reform. The debate on law reform culminated in 2006 with a parliamentary review that saw all four federal political parties agreeing that Canada’s prostitution laws are “unacceptable,” but unable to agree about how to change them. The majority report held that consenting adult prostitution should be legal, while the minority report held that it should be prohibited. In 2007 the Standing Committee on the Status of Women recommended that Canada adopt the Nordic model of demand-side prohibition. As the deadlock continues, women in the street sex trade continue to be murdered. Faced with this deadly inertia, two groups of sex workers have challenged several Criminal Code sections relating to prostitution, arguing that they violate several of their Constitutional rights, including their right to “life, liberty and security of the person”. The paper concludes with an update on the progress of the Charter challenges now before the courts.
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