On dogs, people, and a rabies epidemic: results from a sociocultural study in Bali, Indonesia

Background

Previously free of rabies, Bali experienced an outbreak in 2008, which has since caused a large number of human fatalities. In response, both mass dog culling and vaccination have been implemented. In order to assess potential community-driven interventions for optimizing rabies control, we conducted a study exploring the relationship between dogs, rabies, and the Balinese community. The objectives of this study were to: i) understand the human-dog relationship in Bali; ii) explore local knowledge, attitudes, and practices (KAPs) relating to rabies; and iii) assess potential community-driven activities to optimize rabies control and surveillance.

Methods

Conducted between February and June 2011, the study combined a questionnaire (n = 300; CI = 95 %; error margin = 5 %) and focus group discussions (FGDs) in 10 villages in the Denpasar, Gianyar, and Karangasem regencies. The questionnaire included a Likert scale to assess community knowledge and attitudes. For the knowledge assessment, three points were given for a correct answer, while wrong answers and uncertain answers were given zero points. For the attitudes assessment, three points were given for a positive answer, two points for a neutral answer, and one point for a negative answer. Respondent knowledge was categorized as good (score >40), fair (score 20–40), or poor (score <20), based on a maximum total score 60. Respondent attitudes were categorized as positive (score >26), neutral (score 13–26), or negative (score <13), based on a maximum total score of 39. Mixed-gender FGDs in each sub-village (banjar) were conducted, each involving 7–15 participants to complement the questionnaire results. On a follow-up research trip in mid-2013, the data analysis was triangulated and validated using semi-structured interviews. Questionnaire data were analyzed descriptively using SPSS 17.0, while qualitative data from interviews and FGDs were analyzed manually according to accepted methods of coding and memo writing. The chi-square test was then used to analyze the statistical relationships between knowledge and attitudes of the respondents.

Results

Out of the total 300 respondents, most were predominantly male (82 %), Hindu (99 %), married (96 %), older than 30 years of age (92 %), and owned dogs (72 %). Dog ownership was motivated by culture, personal taste, and function, with dogs was being used as guards (85 %) and companion animals (27 %), and was sometimes related to religious or traditional obligations (2 %). Relating to their culture and local beliefs, and eventually becoming their way of life, 79 % of respondents kept free-roaming dogs. With the rabies outbreak in Bali and Western breeds becoming more popular, more responsible dog ownership (leashing, confining, regular feeding) became more acceptable and changed community perceptions on keeping dogs, even though the sustainability of this practice cannot be gauged. In addition, the economic situation posed major problems in rural areas. The level of community knowledge about rabies and its associated control programs were generally fair and community attitudes were positive. However, community KAPs still need to be improved. A total of 74 % respondents reported to have vaccinated their dogs in 2011, but only few were found to report rabid animals to livestock officers (12 %) and a significant number believed that washing a bite wound was not important (62 %). Moreover, free-roaming dog practices and discarding of unwanted female puppies still continue and possibly create difficulties for rabies elimination as these practices potentially increase the stray dog population. We identified three major sociocultural aspects with potential for community-driven interventions to optimize current rabies elimination efforts: integrating local notions of ahimsa (non-violence) into education campaigns, engaging communities through the local banjar sociopolitical system, and working with traditional legal structures to increase local compliance with rabies control.

Conclusion

The human-dog relationship in Bali is multifaceted. Due to the uniqueness of the culture and the local beliefs, and encouraged by a socioeconomic aspect, a number of local practices were found to be constituting risk factors for continued rabies spread. Community knowledge and attitudes, which can consequently result in behavioral changes, needs to be improved across different genders, ages, educational backgrounds, and roles in the community, regardless of the individual village’s experiences with rabies. Furthermore, community-driven activities based on sociocultural conditioning and community capacity at the banjar and village levels, such as public awareness activities, vaccination, dog registration, dog population management, and rapid response to dog bites, were identified as being able to complement the rabies control program in Bali. The program also needs recognition or acknowledgement from governments, especially local government as well as regular mentoring to improve and sustain community participation.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-015-0061-1) contains supplementary material, which is available to authorized users.

Slum Livestock Agriculture

Slums are unplanned squatter human settlements in peri-urban and urban areas where more than 800 million people live. These densely populated areas lack basic public services. Livestock raised in these conditions compete with humans for space and water, and pose a risk to human and animal health. Notwithstanding the risk of disease transmission, slum livestock agriculture plays an essential role in the livelihoods of people and deserves consideration in urban planning and policy making.

Economics of brucellosis impact and control in low-income countries

Most data and evidence on the economic burden of brucellosis and the benefits of its control are from high-income and middle-income countries. However, the burden of brucellosis is greatest in low-income countries. This paper focuses on estimating the economic burdens of brucellosis in low-income countries in tropical Asia and Africa. The prospects for national, technically feasible, and economically viable, national brucellosis control programmes in most low-income countries are limited. However, some targeted control programmes will be beneficial and can probably be feasibly managed and provide good economic returns. More ambitious control will require a more general strengthening of Veterinary Services and livestock-sector capacity, using risk-management-based approaches.

Identification of potential risk factors associated with highly pathogenic avian influenza subtype H5N1 outbreak occurrence in Lagos and Kano States, Nigeria, during the 2006-2007 epidemics

Highly pathogenic avian influenza HPAI H5N1 was first reported in Africa in 2006, in Nigeria. The country experienced severe outbreaks in 2006 and 2007, strongly affecting the poultry population. Current knowledge on potential risk factors for HPAI H5N1 occurrence in poultry farms in Nigeria is limited. Therefore, we conducted a case-control study to identify potential farm-level risk factors for HPAI H5N1 occurrence in two areas of the country that were affected by the disease in 2006 and 2007, namely the States of Lagos and Kano. A case-control study was conducted at the farm level. A convenience sample of 110 farms was surveyed. Data on farm characteristics, farm management and trade practices were collected. Logistic regression was used to identify factors associated with farms that confirmed positive for HPAI. Having a neighbouring poultry farm was identified as a potential risk factor for disease occurrence [OR, 5.23; 95% CI, (0.88-30.97); P-value = 0.048]. Farm staff washing their hands before handling birds was a protective factor [OR, 0.14; 95% CI, (0.05-0.37); P-value <0.001], as well as not allowing traders to enter the farm [OR, 0.23; 95% CI, (0.08-0.70); P-value = 0.008]. Our study highlighted the importance of trade and proximity between poultry farms in the epidemiology of HPAI H5N1 and the role of biosecurity in disease prevention in Kano and Lagos States. Despite the limitations owing to the sampling strategy, these results are consistent with other risk factor studies previously conducted on HPAI H5N1 in both Africa and other regions, suggesting similar risk factor patterns for HPAI H5N1 virus spread and substantiating current knowledge regarding the epidemiology of the disease. Finally, this study generated information from areas where data are difficult to obtain.

Field trial of a synthetic tsetse-repellent technology developed for the control of bovine trypanosomosis in Kenya

We conducted a field trial among Maasai cattle-keepers in Nkuruman and Nkineji areas of Kenya to evaluate the effectiveness of a synthetic tsetse-repellent technology developed for the control of trypanosomosis in cattle. The technology was a repellent (2-methoxy 4-methylphenol) emitted from dispensers attached to collars worn by cattle. Treatment was allocated at the herd level to ensure adequate protection of all the animals in a herd, with measurements of effectiveness conducted at the individual-animal level. The trial began in April 2005 and ran for 16 months including a baseline phase of 4 months. We recruited 12 herds in each area using a restricted random-sampling technique and distributed them equally into intervention (repellent) and control groups. Sample size was determined using a formal power calculation. Effectiveness or minimal worthwhile difference was defined as a 50% reduction in the incidence of trypanosome infection in the treated versus control group (effectiveness below which the technology was considered by experts as not viable compared to existing control techniques). All the animals in the recruited herds were screened monthly (buffy-coat technique) for trypanosome infections. The analysis followed the principle of intention-to-treat by which subjects are analysed according to their initial treatment assignment, regardless of the mechanical performance of the device. Crude and adjusted effects of the technology were 23% (p<0.001) and 18% (p=0.08) reduction in the infection incidence in the treatment compared to the control groups, respectively. The impact of the technology estimated in this study did not achieve the threshold of 50% reduction in the trypanosome infection incidence set a priori to indicate effectiveness (p<0.001). We therefore concluded that the prototype repellent technology package was not sufficiently effective in reducing trypanosome infection incidence under natural tsetse challenge to merit commercial development.

Factors limiting the health of semi-scavenging ducks in Bangladesh

Duck rearing is well suited to coastal and lowland areas in Bangladesh. It is an important component of sustainable livelihood strategies for poor rural communities as an additional source of household income. An epidemiological study was conducted during January 2005-June 2006 on 379 households in Chatkhil of the Noakhali District, Bangladesh which were using the recently devised "Bangladesh duck model". The overall objective of the study was to identify factors that significantly contributed to mortality and constrained productivity and to generate sufficient knowledge to enable establishment of a disease surveillance system for household ducks. The overall mortality was 15.0% in Chatkhil, with predation causing a significantly higher mortality compared with diseases (p < 0.001). Common diseases were duck plague and duck cholera. Morbid ducks frequently displayed signs associated with diseases affecting the nervous and digestive systems. Haemorrhagic lesions in various organs and white multiple foci on the liver were frequently observed in dead ducks. Epidemiological analysis with a shared frailty model that accounted for clustering of data by farm was used to estimate the association between survival time and risk factors. The overall mortality rate due to disease was significantly lower in vaccinated than in non-vaccinated ducks in all zones except zone 2 (p < 0.001). Only vaccinated ducks survived in zone 1. In conclusion, duck mortality and untimely sale of ducks appeared to be important constraints for household duck production in Chatkhil. Vaccination against duck plague appears to be an effective preventive strategy in reducing the level of associated duck mortality. A successful network was established amongst farmers and the surveillance team through which dead ducks, with accompanying information, were readily obtained for analysis. Therefore, there is an opportunity for establishing a long-term disease surveillance programme for rural ducks in Chatkhil of the Noakhali District of Bangladesh.

Mitral valve-tricuspid valve distance as a sonographic marker of trisomy 21

OBJECTIVE

Pathologic studies suggest that a decreased mitral valve-tricuspid valve distance (MTD) is found in trisomy 21 fetuses without cardiac defects. We assessed the feasibility of using the MTD as a second-trimester sonographic marker for trisomy 21.

METHODS

We performed a retrospective case-control study of all cases of trisomy 21 at our institution from 1998 to 2008. Cases without a prenatally identified cardiac defect and with adequate images from 15 to 26 weeks' gestation were assessed. The distance between the medial insertions of the mitral and tricuspid valves (i.e. the MTD) onto the ventricular septum was obtained. We also obtained the MTD from normal controls during the study period. Multiple linear regression analysis was used to assess the effects of gestational age and trisomy 21 on MTD. Gestational age-specific percentiles and multiples of the median were calculated, and curves were fitted using linear regression analysis.

RESULTS

We identified 57 trisomy 21 fetuses with a measurable MTD and compared these with 634 control fetuses. Multiple linear regression analysis revealed a positive correlation between MTD and gestational age and a negative correlation between trisomy 21 and MTD. Using a cut-off of the 5(th) percentile, the MTD detected 70% of trisomy 21 cases with a 3.8% false-positive rate in the controls.

CONCLUSIONS

The MTD increases with gestational age and is lower in fetuses with trisomy 21. Twenty (35%) of the 57 cases had no sonographic marker of trisomy 21 except an MTD below the 5(th) percentile for gestational age. The MTD was a useful independent marker for trisomy 21 in the second trimester.

Fetal nuchal translucency thickness evaluation in the overweight and obese gravida

OBJECTIVE

To evaluate the time required and failure rate for completion of nuchal translucency thickness (NT) measurements with increased maternal body mass index (BMI).

METHODS

This was a retrospective review of ultrasound examinations for NT measurement in 11-14-week singleton pregnancies performed at a single site from 2004 to 2007. Women were stratified by prepregnancy BMI into normal weight (BMI, 18.5-24.9 kg/m(2)), overweight (BMI, 25.0-29.9 kg/m(2)) and obese Class I (BMI, 30.0-34.9 kg/m(2)), Class II (BMI, 35.0-39.9 kg/m(2)) and Class III (BMI >or= 40.0 kg/m(2)) groups. The failure rate, the time required for measurement, and the total study time in min were evaluated by BMI class for the first attempt and for all attempts at NT measurement.

RESULTS

A total of 2508 women underwent attempted NT screening with complete data available on 1678 women (1707 examinations). The failure rate for NT screening varied significantly according to BMI (P < 0.001). At the first attempt, the median time for NT measurement varied significantly according to BMI (normal weight group, 9.7 (interquartile range (IQR) 4.4, 19.0) min; overweight group, 8.8 (4.0, 19.8) min; obese Class I, 9.6 (4.8, 20.4) min; Class II, 14.1 (5.0, 28.2) min; Class III, 12.3 (4.6, 22.7) min; P < 0.01), as did the total study time (normal group, 16.4 (10.1, 26.6) min; overweight group, 15.7 (9.8, 25.0) min, Class I, 17.3 (10.3, 29.2) min; Class II, 23.0 (12.2, 36.1) min; Class III, 18.7 (11.0, 30.8) min; P = 0.002). For all attempts also, the median time for NT measurement varied significantly according to BMI (normal weight group, 9.7 (IQR 4.4, 19.0) min; overweight group, 8.8 (4.0, 19.9) min; obese Class I, 9.6 (4.8, 21.0) min; Class II, 14.1 (5.0, 28.7) min; Class III, 12.3 (4.6, 22.5) min; P < 0.01), as did the total study time (normal weight group, 16.4 (10.2, 26.7) min; overweight group, 15.7 (9.8, 25.1) min; Class I, 17.6 (10.4, 29.9) min; Class II, 23.2 (12.0, 37.5) min; Class III, 18.7 (11.9, 31.9) min; P < 0.001).

CONCLUSION

As maternal BMI increases, the time required to obtain NT measurements and the failure rate increase. Before the ultrasound examination, patients with a BMI over 30 should be counseled regarding the need for additional time and failure rates for first-trimester screening.

Overview on urban and peri-urban agriculture: definition, impact on human health, constraints and policy issues

OBJECTIVES

To collate and synthesize current knowledge of components of urban agriculture (UA) with a thematic emphasis on human health impact and a geographic emphasis on East Africa.

DATA SOURCES

Data management followed a structured approach in which key issues were first identified and then studies selected through literature search and personal communication.

DATA EXTRACTION

Evidence-based principles.

DATA SYNTHESIS

Urban agriculture is an important source of food security for urban dwellers in East Africa. Descriptors of UA are location, areas, activities, scale, products, destinations, stakeholders and motivation. Many zoonotic and food-borne diseases have been associated with UA but evidence on human health impact and management is lacking. Major constraints to UA are illegality and lack of access to input and market; policy options have been developed for overcoming these.

CONCLUSION

Urban agriculture is an important activity and likely to remain so. Both positive and negative human health impacts are potentially important but more research is needed to understand these and set appropriate policy and support levels.

Risk assessment for Escherichia coli O157:H7 in marketed unpasteurized milk in selected East African countries

We carried out a study to assess the risk associated with the presence of Shiga toxigenic Escherichia coli (STEC) in informally marketed unpasteurized milk in urban East Africa. Data for the risk models were obtained from on-going and recently completed studies in Kenya and Uganda. Inputs for the model were complemented with data from published literature in similar populations. A fault-tree scenario pathway and modular process risk model approach were used for exposure assessment. Hazard characterization was based on a socioeconomic study with dose-responses derived from the literature. We used a probabilistic approach with Monte Carlo simulation and inputs from farm and household surveys. The qualitative analysis suggested a low to moderate risk of infection from consuming milk and that the widespread consumer practice of boiling milk before consumption was an important risk mitigator. Quantitative analysis revealed that two to three symptomatic STEC infections could be expected for every 10,000 unpasteurized milk portions consumed, with a possible range of 0 to 22 symptomatic cases. Sensitivity analyses to assess the uncertainty and variability associated with the model revealed that the factor with the greatest influence on disease incidence was the prevalence of STEC in dairy cattle. Risk assessment is a potentially useful method for managing food safety in informal markets.

Invited review: Role of livestock in human nutrition and health for poverty reduction in developing countries

Livestock keeping is critical for many of the poor in the developing world, often contributing to multiple livelihood objectives and offering pathways out of poverty. Livestock keeping also affects an indispensable asset of the poor, their human capital, through its impact on their own nutrition and health. This paper outlines the linkages between livestock keeping and the physical well-being of the poor, and examines a number of commonly held beliefs that misrepresent livestock development issues related to these linkages. These beliefs limit the scope of intervention programs to promote livestock and limit their potential contribution to poverty reduction. Recognition of the complexity of the role livestock play in household decision-making and of the opportunities foregone due to these misconceptions can enhance the ability of livestock to contribute to human well-being in the developing world.

Comparing FAMACHA eye color chart and Hemoglobin Color Scale tests for detecting anemia and improving treatment of bovine trypanosomosis in West Africa

African animal trypanosomosis (AAT) is considered the most important cattle disease in sub-Saharan Africa but its diagnosis in the field is difficult, resulting in inappropriate treatments, excessive delay in treatments and under-treatment. A field study in West Africa investigated the usefulness of anemia in the diagnosis of trypanosomosis. A total of 20,772 cattle blood samples were taken from 121 villages in 3 countries. The average packed cell volume (PCV) of trypanosomosis positive cattle was 23%, versus 28% for negative cattle. In a sub-set of animals, other causes of anemia were investigated showing most of the anemia burden was attributable to trypanosomosis. Anemia was a reasonably accurate indicator of trypanosomosis in the study area, with a sensitivity of 56% and a specificity of 80% and a diagnostic odds ratio of 4.2, the highest of all the signs evaluated (anemia, emaciation, staring coat, lymphadenopathy, fever, lacrimation and salivary or nasal discharge). Having confirmed the usefulness of anemia as a predictor of trypanosomosis, two potential pen-side tests for anemia were evaluated (the first reported trial of their use in cattle), firstly a color chart developed for anemia detection in sheep through visual inspection of conjunctival membranes (FAMACHA) and secondly the Hemoglobin Color Scale (HbCS) developed for assessing hemoglobin levels in human patients by comparing blood drops on filter paper with color standards. In a population of cattle suspected by their owners to be sick with trypanosomosis (n=898) the sensitivity of the HbCS test was 56% and the specificity was 77%, while the sensitivity of the FAMACHA test was 95% and the specificity was 22%. The higher sensitivity but lower specificity suggests the FAMACHA may be useful as a screening test and the HbCS as a confirmatory test. The two tests were also evaluated in cattle randomly selected from the village herd. Using cut-off points to optimize test performance, the HbCS test had a sensitivity of 81% and a specificity of 62% (n=505 cattle), while the FAMACHA had a sensitivity of 92% and a specificity of 30% (n=298 cattle). Recommendations are made for the appropriate use of these tests in the West African region.

An FPGA-Based Vision Prosthesis Prototype: Implementing an Efficient Multiplexing Method for Addressing Electrodes

A prototype of an epi-retinal vision prosthesis based upon an efficient electrode addressing schema has been developed. This system has the ability to stimulate multiple electrode regions simultaneously, hence greatly improving the maximum rate of stimulation compared to many currently available neural stimulation devices based on serial stimulation protocols. To minimize the problem of cross talk between stimulating electrodes, a hexagon layout of electrodes was implemented. Basic tests were completed using a field programmable gate array logic system driving analogue circuitry to inject current into physiological saline via electrodes in hexagon arrangements and in a simple paired arrangement. The hexagon layout of electrodes was shown to clearly reduce the interaction between multiple current sources and hence cross talk.

Cardiovascular changes with the laryngeal mask airway in cardiac anaesthesia

BACKGROUND

The laryngeal mask airway (LMA) causes fewer haemodynamic changes, particularly in mean arterial pressure (MAP) and heart rate (HR), than tracheal intubation using either laryngoscopy or the intubating LMA. There are no data for patients with coronary artery disease.

METHOD

We studied 27 patients having coronary artery bypass grafting, prospectively randomized to be managed with either the LMA or tracheal intubation using either laryngoscopy or the ILMA. We used invasive monitoring to compare the haemodynamic effects in each group during induction and emergence from anaesthesia.

RESULTS

Both methods of intubation caused an increase in MAP compared with the LMA (P<0.05). Mixed venous oxygen saturation increased in the intubated patients but not with the LMA (P<0.05). HR did not change at induction in the LMA group. Changes at extubation were similar in all groups but cardiac index was lower in the LMA group (P<0.05).

CONCLUSION

The LMA allows airway management without hypertension and tachycardia and should be considered when anaesthetizing patients with coronary disease.

Topical diclofenac versus placebo: a double blind, randomized clinical trial in patients with osteoarthritis of the knee

OBJECTIVE

To assess the efficacy and safety of a topical formulation of 2% diclofenac in lecithin organogel in the treatment of pain associated with mild to moderate osteoarthritis (OA) of the knee.

METHODS

Seventy patients completed a double blind, randomized, placebo controlled, parallel group design 2 week clinical trial. Patient responses to disease-specific (WOMAC VA3.0) and quality of life (Medical Outcome Survey SF-36) health status measures were assessed. Global assessments were also made at baseline and post-treatment. The physician conducted a global assessment and range of motion of the knee at baseline and post-treatment.

RESULTS

T tests on the aggregated WOMAC total score and aggregated subscale scores revealed significant improvement (p<0.05) on the aggregated total score and the pain, stiffness, and physical function subscales from baseline to post-treatment for the active treatment group versus the placebo group. Analysis of gain scores from the aggregated WOMAC total score and aggregated subscale scores also revealed that this improvement was significantly greater than the improvement recorded by the placebo treatment group on the aggregated total and the pain and physical function subscale scores. Other efficacy measures exhibited no significant differences between or within treatment groups.

CONCLUSION

A topical formulation of 2% diclofenac in a lecithin organogel appears to have therapeutic value in patients with mild to moderate OA of the knee as determined by responses from the WOMAC (VA3.0) osteoarthritis health status measure.

Modified lapidus arthrodesis for adolescent hallux abducto valgus

The Lapidus arthrodesis was originally described for the surgical correction of hallux valgus associated with metatasus primus adductus. It was popularized on the adult patient with moderate to severe hallux valgus deformity. However, the authors present a retrospective review of 23 adolescents between the ages of 13 and 20 who underwent the procedures. Characteristics of adolescent hallux valgus include a smaller dorsal medial eminence, less valgus rotation of the hallux, and certain mechanical influences. These influences may include a generalized increase in motion at the first metatarsocuneiform joint. The modified Lapidus arthrodesis eliminates motion at the first metatarsocuneiform joint and therefore directly addresses an etiology of the deformity. Both preoperative and postoperative radiographs were evaluated for reduction in the 1-2 intermetatarsal angle. Patients were evaluated through either chart review or telephone interview for present activity level, comfortable footgear, and overall satisfaction of the procedure. Twenty-seven out of 30 feet (90%) had either a good or excellent result with only three complications and two recurrences over a mean follow-up of 61 months.

A comparison of intrathecal morphine-6-glucuronide and intrathecal morphine sulfate as analgesics for total hip replacement

Postoperative analgesia was assessed after intrathecal administration of morphine-6-glucuronide (M6G) 100 micrograms and 125 micrograms in 75 patients undergoing total hip replacement. Analgesia was excellent and was similar to that obtained after intrathecal administration of morphine sulfate 500 micrograms. Visual analog pain scores recorded postoperatively were low (median = 0) and were similar in all three groups. However, at 6 and 10 h after operation significantly more patients in the M6G 125 group recorded pain as 0 compared with patients in the morphine group (P < 0.04, P < 0.01) and significantly more patients in the M6G 100 group recorded pain as 0 at 24 h after operation compared with patients in the morphine group (P < 0.04). Postoperative meperidine consumption using a patient-controlled system was also similar in each of the three treatment groups. Nausea and emesis occurred frequently in all groups; morphine (nausea 88%, vomiting 76%), M6G 100 micrograms (nausea 76%, vomiting 64%), and M6G 125 micrograms (nausea 88%, vomiting 60%). Respiratory depression occurred in two and three patients, respectively, in the M6G 100-microgram and 125-microgram groups but did not occur in any patient who received morphine sulfate. The lack of statistical significance in the difference in incidence of respiratory depression between the groups may represent a type II error. However, the risk of late respiratory depression developing after administration of any intrathecal opioid necessitates careful postoperative observation of patients. As M6G is a potent intrathecal analgesic further investigation of this drug using small doses may be useful.

Radiographic evaluation of bone grafts

Autogenous and allogenic bone grafts are frequently used in foot and ankle surgery. Indications may include treatment of nonunions, acute fractures, arthrodesis procedures, and reconstructive osteotomies. Proper perioperative management of these procedures requires a through understanding of the radiographic changes that occur after bone grafting. This article describes normal and abnormal radiographic presentations in both the recipient and donor sites after bone graft surgery.