Browsing by Subject "East Africa"

Background. The confluence of a capacity-exceeding disease burden and persistent resource shortages have resulted in traumatic brain injury’s (TBI) devastating impact in low and middle income countries (LMIC). Lifesaving care for TBI depends on accurate and timely decision making within the hospital. As result of technology and highly skilled provider shortages, treatment delays are common in low resource settings. This reality demands a low cost, scalable and accurate alternative to support decision making. Decision support tools leveraging the accuracy of modern prognostic modeling techniques represents one possible solution. This thesis is a collation of research dedicated to the advancement of TBI decision support technology in low resource settings. Methods. The study location included three national and referral hospitals in Uganda and Tanzania. We performed a survival analysis, externally validated existing TBI prognostic models, developed our own prognostic model, and performed a feasibility study for TBI decision support tools in an LMIC. Results. The survival analysis revealed a greater surgical benefit for mild and moderate head injuries compared to severe injuries. However, severe injury patients experienced a higher surgery rate than mild and moderate injuries. We developed a prognostic model using machine learning with a good level of accuracy. This model outperformed existing TBI models in regards to discrimination but not calibration. Our feasibility study captured the need for improved prognostication of TBI patients in the hospital. Conclusions. This pioneering work has provided a foundation for further investigation and implementation of TBI decision support technologies in low resource settings.

While the burden of HIV prevalence in Tanzania is concentrated in adults, the incidence in adolescents highlights significant concerns for the future. On a domain-specific basis (e.g. condom use), self-efficacy plays a role in influencing specific behaviors; however, it is unknown if self-efficacy can transcend domains and provide positive outcomes in health challenges like HIV. The primary aims of this study are 1) to examine the relationship between self-efficacy as measured by the Generalized Self-Efficacy scale (GSE) and HIV Testing Avoidance as measured by agreeing or disagreeing with the statement “I would rather not know if I have HIV", and 2) to examine whether this relationship varies by perception of HIV risk and other socio-demographic characteristics in order to identify potentially modifiable or targeted factors for intervention. This study analyzes baseline data collected from a cluster randomized controlled trial of 1095 adolescents recruited from 20 primary schools in the Bagamoyo District and Kinondoni District of Tanzania. A regression analysis was conducted relating Generalized Self-Efficacy and Perceived Risk with HIV Testing Avoidance. Adjusting for geographic district, age, and household composition, higher GSE scores were associated with decreased odds of HIV testing avoidance (OR=0.93, p=<0.001). Stratifying by perceived risk groups, the relationship was similar. Considering the interaction effect between Generalized Self-Efficacy and Perceived Risk, there appears to be very little difference in the relationship between Generalized Self-Efficacy and HIV Testing Avoidance for those with differing Perceived Risk. In our study population, self-efficacy appears to be a key to reducing HIV Testing Avoidance and should be a target of intervention for all in this cohort, regardless of differing risk perceptions.

Injuries represent a significant and growing public health concern in the developing world. Road traffic injuries in particular contribute to a large extent the increasing number of injury victims in low-income countries. The incidence and types of injuries, their impact on patients and the health care system in the countries of East Africa has received limited attention. This study attempts to examine the number and types of injuries, mechanism of injury, and short-term outcomes in a patient population at a referral and consultant hospital in the Kilimanjaro region of Tanzania.