Implementation research on sustainable electrification of rural primary care facilities in Ghana and Uganda

Access to energy is essential for resilient health systems; however, strengthening energy infrastructure in rural health facilities remains a challenge. In 2015–19, ‘Powering Healthcare’ deployed solar energy solutions to off-grid rural health facilities in Ghana and Uganda to improve the availability of maternal and child health services. To explore the links between health facility electrification and service availability and use, the World Health Organization (WHO), in partnership with Dodowa Health Research Centre and Makerere University School of Public Health, carried out an implementation research study. The objectives of this study were to (1) capture changes in service availability and readiness, (2) describe changes in community satisfaction and use and (3) examine the implementation factors of sustainable electrification that affect these changes. Data were collected through interviews with over 100 key informants, focus group discussions with over 800 community members and health facility assessment checklist adapted from the WHO’s Service Availability and Readiness Assessment tool. Implementation factors were organized using Normalization Process Theory constructs. The study found that access to energy is associated with increased availability of health services, access to communication technologies, appropriate storage of vaccines and medicines, enhanced health worker motivation and increased community satisfaction. Implementation factors associated with improved outcomes include stakeholder engagement activities to promote internalization, provision of materials and information to encourage participation, and establishment of relationships to support integration. Barriers to achieving outcomes are primarily health systems challenges—such as drug stockouts, lack of transportation and poor amenities—that continue to affect service availability, readiness and use, even where access to energy is available. However, through appropriate implementation and integration of sustainable electrification, strengthened energy infrastructure can be leveraged to catalyze investment in other components of functioning health systems. Improving access to energy in health facilities is, therefore, necessary but not sufficient for strengthening health systems.

Leukotrienes and alpha tumor necrosis factor levels in the bronchoalveolar lavage fluid of patient at risk for the adult respiratory distress syndrome

OBJECTIVE

To examine bronchoalveolar lavage (BAL) fluid of patients at risk for Adult Respiratory Distress Syndrome in the attempt to provide evidence of an increased local production of Leukotrienes (LTS) and Tumor Necrosis Factor (TNF).

DESIGN

Prospective, comparative, clinical study.

SETTING

ICU in a university hospital.

PATIENTS

14 patients at risk for ARDS and 10 control patients undergoing mechanical ventilation, were studied.

INTERVENTION

BAL was performed in each patient at the time admission to the ICU (T0), and after 48 hours (T1).

RESULTS

Our controls never showed levels of TNF > 10 pg/ml and their LTS amounts were always below the detection limit. All patients at risk had levels of TNF ranging between 22 and 130 pg/ml, but no difference was noticed between patients who developed ARDS and those who did not, between survivors and non survivors, and between septic and non septic patients. LTD4 and LTB4 (ranging between 30 to 1365 pg/ml) were detected only in six of the 14 patients. Among these 6 patients, 4 developed ARDS. In these patients we could correlate LTB4 with TNF levels and the number of neutrophils recovered from the BAL fluid.

CONCLUSION

In our patients leukotrienes and TNF in the BAL fluid correlate well with the acute inflammatory phase of ARDS, as reflected by the increase number of leukocytes in the fluid retrieved, but they do not appear to be clearly predictive index for the syndrome.

Investigation on the humoral immune response in patients with gastro-intestinal cancer

The humoral immune reactivity was studied in patients affected by gastro-intestinal cancer. The number of peripheral B lymphocytes, the concentration of serum immunoglobulins (Ig) and of C3 complement factor and the frequency of circulating immuno complexes (CIC) did not significantly differ between patients and age-matched controls, while the C4 factor level was significantly increased. The frequency of serum monoclonal components (M-components) was higher in the patients than in the elderly subjects. Moreover the results concerning the "in vitro" functional response of patient B lymphocytes showed a significant decrease of the proliferative responses to Staphylococcus Aureus Cowan I (SAC) and a significant increase of the IgG and IgM synthesis by peripheral blood mononuclear cells (PBMC) in unstimulated and pokeweed mitogen (PWM) stimulated cultures. The meaning of these results, taken together with those reported by others, is discussed.

The relation of isoniazid (INH) and allied compounds to carcinogenesis in some species of small laboratory animals: a review

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