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Who is utilizing anti-retroviral therapy in Ghana: An analysis of ART service utilization
Dako-Gyeke Phyllis,Snow Rachel,Yawson Alfred E
International Journal for Equity in Health , 2012, DOI: 10.1186/1475-9276-11-62
Abstract: Introduction The global scale-up of antiretroviral therapy (ART) for HIV patients has led to concerns regarding inequities in utilization of ART services in resource-limited contexts. In this paper, we describe regional and sex differentials in the distribution of ART among adult HIV patients in Ghana. We highlight the need for interventions to address the gender-based and geographic inequities related to the utilization of ART services in Ghana. Methods We reviewed National AIDS/STIs Control Program’s ART service provision records from January 2003 through December 2010, extracting data on adults aged 15+ who initiated ART in Ghana over a period of eight years. Data on the number of patients on treatment, year of enrollment, sex, and region were obtained and compared. Results The number of HIV patients receiving ART in Ghana increased more than 200-fold from 197 in 2003, to over 45,000 in 2010. However, for each of six continuous years (2005-2010) males comprised approximately one-third of adults newly enrolled on ART. As ART coverage has expanded in Ghana, the proportion of males receiving ART declined from 41.7% in 2004 to 30.1% in 2008 and to 27.6% in 2010. Also, there is disproportionate regional ART utilization across the country. Some regions report ART enrollment lower than their percent share of number of HIV infected persons in the country. Conclusions Attention to the comparatively fewer males initiating ART, as well as disproportionate regional ART utilization is urgently needed. All forms of gender-based inequities in relation to HIV care must be addressed in order for Ghana to realize successful outcomes at the population level. Policy makers in Ghana and elsewhere need to understand how gender-based health inequities in relation to HIV care affect both men and women and begin to design appropriate interventions.
Plasmodium infection and its risk factors in eastern Uganda
Rachel L Pullan, Hasifa Bukirwa, Sarah G Staedke, Robert W Snow, Simon Brooker
Malaria Journal , 2010, DOI: 10.1186/1475-2875-9-2
Abstract: In 2008, a cross-sectional survey was conducted in four contiguous villages in Mulanda, sub-county in Tororo district, eastern Uganda, to investigate the epidemiology and risk factors of Plasmodium species infection. All permanent residents were invited to participate, with blood smears collected from 1,844 individuals aged between six months and 88 years (representing 78% of the population). Demographic, household and socio-economic characteristics were combined with environmental data using a Geographical Information System. Hierarchical models were used to explore patterns of malaria infection and identify individual, household and environmental risk factors.Overall, 709 individuals were infected with Plasmodium, with prevalence highest among 5-9 year olds (63.5%). Thin films from a random sample of 20% of parasite positive participants showed that 94.0% of infections were Plasmodium falciparum and 6.0% were P. malariae; no other species or mixed infections were seen. In total, 68% of households owned at least one mosquito although only 27% of school-aged children reported sleeping under a net the previous night. In multivariate analysis, infection risk was highest amongst children aged 5-9 years and remained high in older children. Risk of infection was lower for those that reported sleeping under a bed net the previous night and living more than 750 m from a rice-growing area. After accounting for clustering within compounds, there was no evidence for an association between infection prevalence and socio-economic status, and no evidence for spatial clustering.These findings demonstrate that mosquito net usage remains inadequate and is strongly associated with risk of malaria among school-aged children. Infection risk amongst adults is influenced by proximity to potential mosquito breeding grounds. Taken together, these findings emphasize the importance of increasing net coverage, especially among school-aged children.In Uganda, malaria remains the leading cause
Prevalence of the metabolic syndrome in a rural population in Ghana
Gyakobo Mawuli,Amoah Albert GB,Martey-Marbell De-Anne,Snow Rachel C
BMC Endocrine Disorders , 2012, DOI: 10.1186/1472-6823-12-25
Abstract: Background The Metabolic syndrome (MS) which is a constellation of cardiometabolic risk factors including dyslipidaemia, hypertension, hyperglycaemia, central obesity, and endothelial dysfunction was hitherto relatively uncommon among Africans south of the Sahara. This study seeks to determine the prevalence of MS, its components and risk factors among a rural population in Ghana based on two popular international algorithms. Methods This was a cross-sectional survey of a rural population in Ghana conducted between November and December, 2007. Two hundred and twenty-eight (228) settler farmers, families and staff associated with the GOPDC Ltd, between the ages of 35 and 64 years, were randomly selected for the study; pregnant women were excluded. The prevalence of MS was estimated using the IDF and ATPIII criteria. Results The final subject pool included 102 males, and 104 females. The mean age of all subjects was 44.4 ± 6.9 years. The overall prevalence of MS by the IDF and ATPIII criteria were 35.9% and 15.0%, respectively, but there was an alarming female preponderance by both criteria {IDF: males = 15.7%, females =55.8%; ATPIII: males = 5.9%, females = 24.0%; sex differences p<0.001 for both criteria}. The most important determinants for IDF-defined MS were central obesity (55.3%), low High Density Lipoprotein (42.7%) and high Blood Pressure (39.5%). Conclusion The triad of central obesity, high blood pressure and low HDL were most responsible for the syndrome in this rural population.
Materials with low DC magnetic susceptibility for sensitive magnetic measurements
Rakshya Khatiwada,Lawrence Dennis,Rachel Kendrick,Marjan Khosravi,Michael Peters,Erick Smith,Mike Snow
Physics , 2015,
Abstract: Materials with very low DC magnetic susceptibility have many scientific applications. To our knowledge however, relatively little research has been conducted with the goal to produce a totally nonmagnetic material. This phrase in our case means after spatially averaging over macroscopic volumes, it possesses an average zero DC magnetic susceptibility. We report measurements of the DC magnetic susceptibility of three different types of nonmagnetic materials at room temperature: (I) solutions of paramagnetic salts and diamagnetic liquids, (II) liquid gallium-indium alloys and (III) pressed powder mixtures of tungsten and bismuth. The lowest measured magnetic susceptibility among these candidate materials is in the order of 10^-9 cgs volume susceptibility units, about two orders of magnitude smaller than distilled water. In all cases, the measured concentration dependence of the magnetic susceptibility is consistent with that expected for the weighted sum of the susceptibilities of the separate components within experimental error. These results verify the Wiedemann additivity law and thereby realize the ability to produce materials with small but tunable magnetic susceptibility. For our particular scientific application, we are also looking for materials with the largest possible number of neutrons and protons per unit volume. The gallium-indium alloys fabricated and measured in this work possess to our knowledge the smallest ratio of volume magnetic susceptibility to nucleon number density per unit volume for a room temperature liquid, and the tungsten-bismuth pressed powder mixtures possess to our knowledge the smallest ratio of volume magnetic susceptibility to nucleon number density per unit volume for a room temperature solid. This ratio is a figure of merit for a certain class of precision experiments that search for possible exotic spin-dependent forces of Nature.
Gender, Migration and HIV in Rural KwaZulu-Natal, South Africa
Carol S. Camlin,Victoria Hosegood,Marie-Louise Newell,Nuala McGrath,Till B?rnighausen,Rachel C. Snow
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0011539
Abstract: Research on migration and HIV has largely focused on male migration, often failing to measure HIV risks associated with migration for women. We aimed to establish whether associations between migration and HIV infection differ for women and men, and identify possible mechanisms by which women's migration contributes to their high infection risk.
Key factors leading to reduced recruitment and retention of health professionals in remote areas of Ghana: a qualitative study and proposed policy solutions
Rachel C Snow, Kwesi Asabir, Massy Mutumba, Elizabeth Koomson, Kofi Gyan, Mawuli Dzodzomenyo, Margaret Kruk, Janet Kwansah
Human Resources for Health , 2011, DOI: 10.1186/1478-4491-9-13
Abstract: In-depth interviews were carried out with 84 doctors and medical leaders, including 17 regional medical directors and deputy directors from across Ghana, and 67 doctors currently practicing in 3 regions (Greater Accra, Brong Ahafo, and Upper West); these 3 regions were chosen to represent progressively more remote distances from the capital of Accra.All participants felt that rural postings must have special career or monetary incentives given the loss of locum (i.e. moonlighting income), the higher workload, and professional isolation of remote assignments. Career 'death' and prolonged rural appointments were a common fear, and proposed policy solutions focused considerably on career incentives, such as guaranteed promotion or a study opportunity after some fixed term of service in a remote or hardship area. There was considerable stress placed on the need for rural doctors to have periodic contact with mentors through rural rotation of specialists, or remote learning centers, and reliable terms of appointment with fixed end-points. Also raised, but given less emphasis, were concerns about the adequacy of clinical equipment in remote facilities, and remote accommodations.In-depth discussions with doctors suggest that while salary is important, it is career development priorities that are keeping doctors in urban centers. Short-term service in rural areas would be more appealing if it were linked to special mentoring and/or training, and led to career advancement.The need for human resources in the health sectors of Africa (private or public), has appropriately garnered attention from international policy experts, as well as Ministries of Health throughout the region [1-4]. However, Ministries and donors alike remain uncertain about which, if any, targeted investments have the potential to measurably improve the number, retention and distribution of health personnel [5-8]. Investments have been cautious, and HRH has been described as a potential black hole until int
The contribution of molecular epidemiology to the understanding and control of viral diseases of salmonid aquaculture
Michael Snow
Veterinary Research , 2011, DOI: 10.1186/1297-9716-42-56
Abstract: Improved taxonomic classification of virusesA better understanding of the natural distribution of virusesAn improved understanding of the origins of viral pathogens in aquacultureAn improved understanding of the risks of translocation of pathogens outwith their natural host rangeAn increased ability to trace the source of new disease outbreaksDevelopment of a basis for ensuring development of appropriate diagnostic toolsAn ability to classify isolates and thus target future research aimed at better understanding biological functionWhile molecular epidemiological studies have no doubt already made a significant contribution in these areas, the advent of new technologies such as pyrosequencing heralds a quantum leap in the ability to generate descriptive molecular sequence data. The ability of molecular epidemiology to fulfil its potential to translate complex disease pathways into relevant fish health policy is thus unlikely to be limited by the generation of descriptive molecular markers. More likely, full realisation of the potential to better explain viral transmission pathways will be dependent on the ability to assimilate and analyse knowledge from a range of more traditional information sources. The development of methods to systematically record and share such epidemiologically important information thus represents a major challenge for fish health professionals in making the best future use of molecular data in supporting fish health policy and disease control.1. Introduction1.1 What is molecular epidemiology?1.2 Setting the scene: fish viruses, aquaculture and molecular epidemiology2. Case studies highlighting the contribution of molecular epidemiology to the understanding and control of viral disease of salmonid aquaculture2.1 Viral haemorrhagic septicaemia virus2.1.1 Overview2.1.2 Molecular epidemiology facilitates the taxonomic classification of VHSV and provides a basis for understanding the relationship between isolates2.1.3 Understanding genetic relati
Five new species of Rhodamnia (Myrtaceae, Myrteae) from New Guinea
Neil Snow
PhytoKeys , 2012, DOI: 10.3897/phytokeys.19.4098
Abstract: Five new species of Rhodamnia are proposed for New Guinea, including R. asekiensis, R. daymanensis, R. makumak, R. taratot, and R. waigeoensis. Rhodamnia sharpeana, known previously only in Australia, is reported for the first time for Papua New Guinea. Detailed species descriptions and associated taxonomic data are provided for all species. A key is provided for species of Rhodamnia with stellate trichomes. Given the overall paucity of collections, all species are tentatively assigned as Data Deficient following IUCN conservation recommendations.
Breeding Baby Bureaucracies: Essential Factors for the Effective Development of New Organizations
Eric Snow
Dalhousie Journal of Interdisciplinary Management , 2010, DOI: 10.5931/djim.v6i1.37
Abstract: New government organizations face a range of challenges in establishing themselves during and after their initial creation. Without proper consideration, these challenges can hamper organizational development or even cause it to collapse altogether. This paper seeks to identify these challenges in order to explore the strengths and weaknesses of new organizations and to investigate how best to use this knowledge to ensure the successful development of new organizations. This will be accomplished through the discussion of past experiences and the exploration of literature on organizational development. Research points to a set of key criteria that help to reinforce organizations over the course of their development, mitigate potential threats, and establish organizations both internally and within their broader environment. These criteria include the development of a clear organizational objective, support from other institutions, exceptional leadership, and effective use of time. The best practices established here may serve as a framework for the development of new organizations in the future.
Downgrading Complexity in the Exxon Valdez Crisis: Using Information as a Risk Mitigation Tool in Complex Adaptive Systems
Eric Snow
Dalhousie Journal of Interdisciplinary Management , 2010, DOI: 10.5931/djim.v6i1.38
Abstract: In a high-stakes crisis environment, trial and error can be too costly an approach. The Exxon Valdez oil spill provides an example of how complex adaptive systems can have simple, preventable problems and complex, unpredictable problems can come together with disastrous consequences. Not every possible contingency can be accounted for. However, research and experience can be applied to mitigate these types of risks by using information to reduce or "downgrade" the complexity of the contributing situations. The Cynefin contexts of complexity can be used to assess problems when they arise. Downgrading the level of complexity for a given problem can turn formerly complex or complicated situations into simple ones that require less knowledge and resources to resolve and can reduce the risk of failure. The possibility and consequences of failure may remain, but downgraded complexity can reduce the likelihood of this failure and make problems more manageable when they do occur.
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