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Maseko L, Adams F, Myezwa H. Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district. BMC Health Serv Res 2024; 24:501. [PMID: 38649859 PMCID: PMC11035128 DOI: 10.1186/s12913-024-10965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Primary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals. METHODS A retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies. RESULTS The findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30-49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use. CONCLUSION This study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.
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Affiliation(s)
- Lebogang Maseko
- Occupational Therapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
| | - Fasloen Adams
- Department of Health and Rehabilitation Sciences, Division of Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Hellen Myezwa
- Physiotherapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Maritim B, Koon AD, Kimaina A, Goudge J. Citizen engagement in national health insurance in rural western Kenya. Health Policy Plan 2024; 39:387-399. [PMID: 38334694 PMCID: PMC11005831 DOI: 10.1093/heapol/czae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 11/01/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024] Open
Abstract
Effective citizen engagement is crucial for the success of social health insurance, yet little is known about the mechanisms used to involve citizens in low- and middle-income countries. This paper explores citizen engagement efforts by the National Health Insurance Fund (NHIF) and their impact on health insurance coverage within rural informal worker households in western Kenya. Our study employed a mixed methods design, including a cross-sectional household survey (n = 1773), in-depth household interviews (n = 36), six focus group discussions with community stakeholders and key informant interviews (n = 11) with policymakers. The findings reveal that NHIF is widely recognized, but knowledge of its services, feedback mechanisms and accountability systems is limited. NHIF enrolment among respondents is low (11%). The majority (63%) are aware of NHIF, but only 32% know about the benefit package. There was higher awareness of the benefit package (60%) among those with NHIF compared to those without (28%). Satisfaction with the NHIF benefit package was expressed by only 48% of the insured. Nearly all respondents (93%) are unaware of mechanisms to provide feedback or raise complaints with NHIF. Of those who are aware, the majority (57%) mention visiting NHIF offices for assistance. Most respondents (97%) lack awareness of NHIF's performance reporting mechanisms and express a desire to learn. Negative media reports about NHIF's performance erode trust, contributing to low enrolment and member attrition. Our study underscores the urgency of prioritizing citizen engagement to address low enrolment and attrition rates. We recommend evaluating current citizen engagement procedures to enhance citizen accountability and incorporate their voices. Equally important is the need to build the capacity of health facility staff handling NHIF clients in providing information and addressing complaints. Transparency and information accessibility, including the sharing of performance reports, will foster trust in the insurer. Lastly, standardizing messaging and translations for diverse audiences, particularly rural informal workers, is crucial.
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Affiliation(s)
- Beryl Maritim
- Consortium for Advanced Research Training in Africa (CARTA), P.O. Box 10787, Nairobi 00100, Kenya
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 51 2193, 60 York Rd, Parktown, Johannesburg 2193, South Africa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, 00100, Nairobi 00100, Kenya
| | - Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E8143, Baltimore, MD 21205, USA
| | - Allan Kimaina
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, 00100, Nairobi 00100, Kenya
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 51 2193, 60 York Rd, Parktown, Johannesburg 2193, South Africa
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Wandera SO, Golaz V, Kwagala B, Ntozi JPM, Ayuku DO. "These are just finishing our medicines": older persons' perceptions and experiences of access to healthcare in public and private health facilities in Uganda. BMC Health Serv Res 2024; 24:396. [PMID: 38553700 PMCID: PMC10979571 DOI: 10.1186/s12913-024-10741-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/18/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND There is limited research on the experiences of access to medicines for non-communicable diseases (NCDs) in health facilities among older persons in Uganda. This paper explores the perspectives of older persons and healthcare providers concerning older persons' access to essential medicines in Uganda. METHODS It is based on qualitative data from three districts of Hoima, Kiboga, and Busia in Uganda. Data collection methods included seven (07) focus group discussions (FGDs) and eighteen (18) in-depth interviews with older persons. Nine (9) key informant interviews with healthcare providers were conducted. Deductive and inductive thematic analysis (using Health Access Livelihood Framework) was used to analyze the barriers and facilitators of access to healthcare using QSR International NVivo software. RESULTS The key facilitators and barriers to access to healthcare included both health system and individual-level factors. The facilitators of access to essential medicines included family or social support, earning some income or Social Assistance Grants for Empowerment (SAGE) money, and knowing a healthcare provider at a health facility. The health system barriers included the unavailability of specialized personnel, equipment, and essential medicines for non-communicable diseases, frequent stock-outs, financial challenges, long waiting times, high costs for medicines for NCDs, and long distances to health facilities. CONCLUSION Access to essential medicines for NCDs is a critical challenge for older persons in Uganda. The Ministry of Health should make essential drugs for NCDS to be readily available and train geriatricians to provide specialized healthcare for older persons to reduce health inequities in old age. Social support systems need to be strengthened to enable older persons to access healthcare.
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Affiliation(s)
- Stephen Ojiambo Wandera
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda.
- Department of Mental Health and Behavioral Sciences and Mental Health, Moi University, Eldoret, Kenya.
| | - Valerie Golaz
- Institut National d'Etudes Demographiques (INED), Paris, Aubervilliers, France
| | - Betty Kwagala
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - James P M Ntozi
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - David Otundo Ayuku
- Department of Mental Health and Behavioral Sciences and Mental Health, Moi University, Eldoret, Kenya
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Natusch D, Aust PW, Caraguel C, Taggart PL, Ngo VT, Alexander GJ, Shine R, Coulson T. Python farming as a flexible and efficient form of agricultural food security. Sci Rep 2024; 14:5419. [PMID: 38485710 PMCID: PMC10940618 DOI: 10.1038/s41598-024-54874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 02/17/2024] [Indexed: 03/18/2024] Open
Abstract
Diminishing natural resources and increasing climatic volatility are impacting agri-food systems, prompting the need for sustainable and resilient alternatives. Python farming is well established in Asia but has received little attention from mainstream agricultural scientists. We measured growth rates in two species of large pythons (Malayopython reticulatus and Python bivittatus) in farms in Thailand and Vietnam and conducted feeding experiments to examine production efficiencies. Pythons grew rapidly over a 12-month period, and females grew faster than males. Food intake and growth rates early in life were strong predictors of total lifetime growth, with daily mass increments ranging from 0.24 to 19.7 g/day for M. reticulatus and 0.24 to 42.6 g/day for P. bivittatus, depending on food intake. Pythons that fasted for up to 4.2 months lost an average of 0.004% of their body mass per day, and resumed rapid growth as soon as feeding recommenced. Mean food conversion rate for dressed carcasses was 4.1%, with useable products (dressed carcass, skin, fat, gall bladder) comprising 82% of the mass of live animals. In terms of food and protein conversion ratios, pythons outperform all mainstream agricultural species studied to date. The ability of fasting pythons to regulate metabolic processes and maintain body condition enhances food security in volatile environments, suggesting that python farming may offer a flexible and efficient response to global food insecurity.
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Affiliation(s)
- D Natusch
- School of Natural Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
| | - P W Aust
- Department of Zoology, University of Oxford, Oxford, UK
- Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Caraguel
- School of Animal & Veterinary Science, The University of Adelaide, Adelaide, SA, 5371, Australia
| | - P L Taggart
- School of Animal & Veterinary Science, The University of Adelaide, Adelaide, SA, 5371, Australia
| | - V T Ngo
- National Key Laboratory, Institute of Tropical Biology, Vietnamese Academy of Sciences and Technology, 9/621 Hanoi Highway, Thu Duc City, Ho Chi Minh City, Vietnam
| | - G J Alexander
- Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Shine
- School of Natural Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - T Coulson
- Department of Zoology, University of Oxford, Oxford, UK
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Gbogbo S, Nyankson E, Agyei-Tuffour B, Adofo YK, Mensah B. Multicomponent Photocatalytic-Dispersant System for Oil Spill Remediation. ACS Omega 2024; 9:8797-8809. [PMID: 38434850 PMCID: PMC10905576 DOI: 10.1021/acsomega.3c05982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024]
Abstract
In the present work, the potential application of a fabricated halloysite nanotubes-Ag-TiO2 (HNT-Ag-TiO2) composite loaded with a binary surfactant mixture made up of lecithin and Tween 80 (LT80) in remediating oil spillages was examined. The as-prepared Ag-TiO2 that was used in the fabrication of the HNT-Ag-TiO2-LT80 composite was characterized by X-ray diffraction, Raman spectroscopy, UV-vis and diffuse reflectance spectroscopy, CV analyses, and SEM-EDX. The synthesized composite was also characterized by thermogravimetric analysis, Fourier-transform infrared spectroscopy, and scanning electron microscopy-energy dispersive X-ray spectroscopy. The synthesized composite was active in both the UV and visible light regions of the electromagnetic spectrum. The oil-remediating potential of the as-prepared composite was examined on crude oil, and aromatics and asphaltene fractions of crude oil. The composite was able to reduce the surface tension, form stable emulsions and smaller oil droplet sizes, and achieve a high dispersion effectiveness of 91.5%. A mixture of each of the crude oil and its fractions and HNT-Ag-TiO2-LT80 was subjected to photodegradation under UV light irradiation. The results from the GC-MS and UV-vis analysis of the photodegraded crude oil revealed that the photocatal composite was able to photodegrade the crude oil, aromatics, and asphaltene fractions of crude oil with the formation of intermediate photodegradation products depicting that the HNT-Ag-TiO2-LT80 has a potential as an oil spill remediation material.
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Affiliation(s)
- Selassie Gbogbo
- Department of Materials Science
and Engineering, University of Ghana, Legon, LG 77 Accra, Ghana
| | - Emmanuel Nyankson
- Department of Materials Science
and Engineering, University of Ghana, Legon, LG 77 Accra, Ghana
| | - Benjamin Agyei-Tuffour
- Department of Materials Science
and Engineering, University of Ghana, Legon, LG 77 Accra, Ghana
| | - Yaw Kwakye Adofo
- Department of Materials Science
and Engineering, University of Ghana, Legon, LG 77 Accra, Ghana
| | - Bismark Mensah
- Department of Materials Science
and Engineering, University of Ghana, Legon, LG 77 Accra, Ghana
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Chimwaza-Manda W, Kamndaya M, Chipeta EK, Sikweyiya Y. Sexual health knowledge acquisition processes among very young adolescent girls in rural Malawi: Implications for sexual and reproductive health programs. PLoS One 2024; 19:e0276416. [PMID: 38394159 PMCID: PMC10889655 DOI: 10.1371/journal.pone.0276416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/14/2023] [Indexed: 02/25/2024] Open
Abstract
Early adolescence is a period characterized by enormous biological, cognitive, sexual, emotional, and social changes. Sexual curiosity and the desire to acquire sexual health (SH) information are part of these developments. Understanding the SH knowledge acquisition process is critical for designing interventions that can best support very young adolescents (VYAs). This study explored the SH knowledge acquisition processes among VYA girls aged 10 to 14 years who attended the DREAMs Girl Only Clubs (GOCs) and those who did not. The GOCs were a part of a larger comprehensive HIV prevention project called DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) which provided an evidence-based core package of interventions to VYAs to prevent HIV. In-depth interviews were conducted with 43 VYA girls aged 10-14 years in two rural southern districts of Zomba and Machinga in Malawi. Twenty-three VYA girls were GOC participants and 20 VYAs were not. Guided by the Social Ecological Model, a thematic analysis approach was used to analyze the data with the assistance of Nvivo 12 software. The SH knowledge acquisition processes were the interaction of various factors at the microsystem (self-efficacy, attitudes, trust and the beginning of menstruation), mesosystem (communication of SH issues between VYAs and their immediate family and peers), and exosystem levels (availability of life skills programs and mother-groups in schools and availability of GOCs). Compared to Non-GOC participants, GOC participants demonstrated an in-depth knowledge of SH issues and positive sexual behaviors such as HIV testing. Limitations to SH knowledge acquisition were adult messages' focus on sexual relationship avoidance and on girls who have started menstruation; the perception of adults not being knowledgeable about SH and school teachers hiding some SH information. VYAs' SH interventions that provide VYAs with accurate, consistent, and age-appropriate SH information such as the GOCs have the potential to address the limitations that other sources have in reaching VYAs. Integrating such interventions with programs that empower parents, other adults, and teachers with comprehensive SH information and with skills on how to deliver SH information to VYAs can enhance VYAs' SH knowledge acquisition and influence positive behavior change.
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Affiliation(s)
- Wanangwa Chimwaza-Manda
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mphatso Kamndaya
- School of Applied Sciences, Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | | | - Yandisa Sikweyiya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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Etiang P, Musoba A, Nalumenya D, Ndekezi C, Bbira J, Ochwo S, Tweyongyere R, Muhanguzi D. Distribution and prevalence of ixodid tick species (Acari: Ixodidae) infesting cattle in Karamoja region of northeastern Uganda. BMC Vet Res 2024; 20:50. [PMID: 38326882 PMCID: PMC10851484 DOI: 10.1186/s12917-023-03802-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 11/01/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Ticks and tick-borne diseases (TTBDs) are a significant threat to livestock production in sub-Saharan Africa. Transhumance pastoralism practiced in Karamoja region and other factors like cattle trade, communal grazing and the presence of wildlife predispose cattle to TTBDs. Tick species abundance and distribution data can be used as a tool for early disease diagnosis and inform tick control strategies. However, these data for north-eastern Uganda are currently limited; previous surveys were relatively localized and targeted fewer cattle kraals and numbers. METHODS We randomly collected tick specimens from 1,534 cattle spread across Karamoja region in both the peak month of the rainy (May 2020) and the dry (February2021) seasons. The ticks were identified using morpho-taxonomic keys and the tick species identities confirmed by the 16 S rRNA gene sequencing and phylogenetic analysis. RESULTS A collection of 18,637 ticks was examined and fifteen tick species from three genera (ten Rhipicephalus; three Amblyomma; two Hyalomma species) were identified. Rhipicephalus appendiculatus was the most dominant (37.9%) tick species, followed by Amblyomma variegatum (32.3%); A. lepidum (17.3%); R. evertsi evertsi (7.8%); and R. decoloratus (1.4%). Eight of these tick species were ubiquitous in the study districts while six were found in isolated areas. The peak month of the dry season collection was associated with a higher proportion of tick-infested cattle (91%) compared to the peak month of the rainy season (89.8%); a difference that was not found statistically significant (χ2 = 0.5077, n = 1385, p = 0.476). The overall cattle infestation rate was mainly dominated by five tick species namely: A. variegatum (55%), R. appendiculatus (53%), A. lepidum (41%), R. evertsi (22%), and R. decoloratus (8%). The proportion of tick-infested cattle was highest in Napak District (95.4%) and lowest in Amudat District (80.9%) during the peak month of the rainy season. Napak and Amudat Districts also had the highest and lowest proportion of tick-infested cattle (94.8% and 80.7% respectively) during the peak month of the dry season. Rhipicephalus microplus was confirmed in Amudat, Kaabong and Napak districts. CONCLUSION This study demonstrates high tick infestation rates in cattle by a battery of tick species in Karamoja region. We identified both R. microplus and R. decoloratus which indicates that R. microplus has recently been introduced in this region. This calls for effective tick control responses to prevent further spread of this invasive cattle tick specie.
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Affiliation(s)
- Patrick Etiang
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Abubakar Musoba
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, P.O. Box 7062, Kampala, Uganda
| | - David Nalumenya
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Christian Ndekezi
- Medical Research Council, Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM), Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Johnson Bbira
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Sylvester Ochwo
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, P.O. Box 7062, Kampala, Uganda
- Center for Animal Health and Food Safety, University of Minnesota, St. Paul, MN, 55108, USA
| | - Robert Tweyongyere
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Dennis Muhanguzi
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, P.O. Box 7062, Kampala, Uganda.
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Höft MA, Duvenage L, Salie S, Keeton R, Botha A, Schwartz IS, Govender NP, Brown GD, Hoving JC. The pathogenesis of experimental Emergomycosis in mice. PLoS Negl Trop Dis 2024; 18:e0011850. [PMID: 38198478 PMCID: PMC10805315 DOI: 10.1371/journal.pntd.0011850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/23/2024] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
Emergomyces africanus is a recently identified thermally-dimorphic fungal pathogen that causes disseminated infection in people living with advanced HIV disease. Known as emergomycosis, this disseminated disease is associated with very high case fatality rates. Over the last decade, improved diagnostics and fungal identification in South Africa resulted in a dramatic increase in the number of reported cases. Although the true burden of disease is still unknown, emergomycosis is among the most frequently diagnosed dimorphic fungal infections in Southern Africa; and additional species in the genus have been identified on four continents. Little is known about the pathogenesis and the host's immune response to this emerging pathogen. Therefore, we established a murine model of pulmonary infection using a clinical isolate, E. africanus (CBS 136260). Both conidia and yeast forms caused pulmonary and disseminated infection in mice with organisms isolated in culture from lung, spleen, liver, and kidney. Wild-type C57BL/6 mice demonstrated a drop in body weight at two weeks post-infection, corresponding to a peak in fungal burden in the lung, spleen, liver, and kidney. An increase in pro-inflammatory cytokine production was detected in homogenized lung supernatants including IFN-γ, IL-1β, IL-6, IL12-p40 and IL-17 at three- and four-weeks post-infection. No significant differences in TNF, IL-12p70 and IL-10 were observed in wild-type mice between one and four-weeks post-infection. Rag-1-deficient mice, lacking mature T-and B-cells, had an increased fungal burden associated with reduced IFN-γ production. Together our data support a protective T-helper type-1 immune response to E. africanus infection. This may provide a possible explanation for the susceptibility of only a subset of people living with advanced HIV disease despite hypothesized widespread environmental exposure. In summary, we have established a novel murine model of E. africanus disease providing critical insights into the host immune components required for eliminating the infection.
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Affiliation(s)
- Maxine A. Höft
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lucian Duvenage
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sumayah Salie
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Roanne Keeton
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alfred Botha
- Department of Microbiology, Stellenbosch University, Stellenbosch, South Africa
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Nelesh P. Govender
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, United Kingdom
| | - Gordon D. Brown
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, United Kingdom
| | - Jennifer Claire Hoving
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, United Kingdom
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Akyea-Bobi NE, Akorli J, Opoku M, Akporh SS, Amlalo GK, Osei JHN, Frempong KK, Pi-Bansa S, Boakye HA, Abudu M, Akorli EA, Acquah-Baidoo D, Pwalia R, Bonney JHK, Quansah R, Dadzie SK. Entomological risk assessment for transmission of arboviral diseases by Aedes mosquitoes in a domestic and forest site in Accra, Ghana. PLoS One 2023; 18:e0295390. [PMID: 38060554 PMCID: PMC10703219 DOI: 10.1371/journal.pone.0295390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Dengue, Zika and chikungunya are Aedes-borne viral diseases that have become great global health concerns in the past years. Several countries in Africa have reported outbreaks of these diseases and despite Ghana sharing borders with some of these countries, such outbreaks are yet to be detected. Viral RNA and antibodies against dengue serotype-2 have recently been reported among individuals in some localities in the regional capital of Ghana. This is an indication of a possible silent transmission ongoing in the population. This study, therefore, investigated the entomological transmission risk of dengue, Zika and chikungunya viruses in a forest and domestic population in the Greater Accra Region, Ghana. All stages of the Aedes mosquito (egg, larvae, pupae and adults) were collected around homes and in the forest area for estimation of risk indices. All eggs were hatched and reared to larvae or adults for morphological identification together with larvae and adults collected from the field. The forest population had higher species richness with 7 Aedes species. The predominant species of Aedes mosquitoes identified from both sites was Aedes aegypti (98%). Aedes albopictus, an important arbovirus vector, was identified only in the peri-domestic population at a prevalence of 1.5%, significantly higher than previously reported. All risk indices were above the WHO threshold except the House Index for the domestic site which was moderate (19.8). The forest population recorded higher Positive Ovitrap (34.2% vs 26.6%) and Container (67.9% vs 36.8%) Indices than the peri-domestic population. Although none of the mosquito pools showed the presence of dengue, chikungunya or Zika viruses, all entomological risk indicators showed that both sites had a high potential arboviral disease transmission risk should any of these viruses be introduced. Continuous surveillance is recommended in these and other sites in the Metropolis to properly map transmission risk areas to inform outbreak preparedness strategies.
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Affiliation(s)
- Nukunu Etornam Akyea-Bobi
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Jewelna Akorli
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Millicent Opoku
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Samuel Sowah Akporh
- Vestergaard NMIMR Vector Labs, Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Godwin Kwame Amlalo
- Vestergaard NMIMR Vector Labs, Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Joseph Harold Nyarko Osei
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Kwadwo Kyereme Frempong
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Sellase Pi-Bansa
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Helena Anokyewaa Boakye
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Mufeez Abudu
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Esinam Abla Akorli
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Dominic Acquah-Baidoo
- Vestergaard NMIMR Vector Labs, Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | - Rebecca Pwalia
- Vestergaard NMIMR Vector Labs, Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
| | | | - Reginald Quansah
- Department of Biological, Environmental and Occupational Health, School of Public Health, University of Ghana, Legon, Accra
| | - Samuel Kweku Dadzie
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra
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10
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Gumede SB, Wensing AMJ, Lalla-Edward ST, de Wit JBF, Francois Venter WD, Tempelman HA, Hermans LE. Predictors of Treatment Adherence and Virological Failure Among People Living with HIV Receiving Antiretroviral Therapy in a South African Rural Community: A Sub-study of the ITREMA Randomised Clinical Trial. AIDS Behav 2023; 27:3863-3885. [PMID: 37382825 PMCID: PMC10598166 DOI: 10.1007/s10461-023-04103-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/30/2023]
Abstract
A large proportion of people living with HIV (PLHIV) in sub-Saharan Africa reside in rural areas. Knowledge of enablers and barriers of adherence to antiretroviral treatment (ART) in these populations is limited. We conducted a cohort study of 501 adult PLHIV on ART at a rural South African treatment facility as a sub-study of a clinical trial (ClinicalTrials.gov NCT03357588). Socio-economic, psychosocial and behavioral characteristics were assessed as covariates of self-reported adherence difficulties, suboptimal pill count adherence and virological failure during 96 weeks of follow-up. Male gender was an independent risk factor for all outcomes. Food insecurity was associated with virological failure in males. Depressive symptoms were independently associated with virological failure in both males and females. Household income and task-oriented coping score were protective against suboptimal pill-count adherence. These results underscore the impact of low household income, food insecurity and depression on outcomes of ART in rural settings and confirm other previously described risk factors. Recognition of these factors and targeted adherence support strategies may improve patient health and treatment outcomes.
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Affiliation(s)
- Siphamandla B Gumede
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa.
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands.
| | - Annemarie M J Wensing
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ndlovu Research Consortium, Elandsdoorn, South Africa
| | - Samanta T Lalla-Edward
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
| | - John B F de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - W D Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
| | - Hugo A Tempelman
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
- Ndlovu Research Consortium, Elandsdoorn, South Africa
| | - Lucas E Hermans
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ndlovu Research Consortium, Elandsdoorn, South Africa
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11
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Kalinjuma AV, Glass TR, Masanja H, Weisser M, Msengwa AS, Vanobberghen F, Otwombe K. Statistical methods applied for the assessment of the HIV cascade and continuum of care: a systematic scoping review. BMJ Open 2023; 13:e071392. [PMID: 37996221 PMCID: PMC10668296 DOI: 10.1136/bmjopen-2022-071392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/28/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES This scoping review aims to identify and synthesise existing statistical methods used to assess the progress of HIV treatment programmes in terms of the HIV cascade and continuum of care among people living with HIV (PLHIV). DESIGN Systematic scoping review. DATA SOURCES Published articles were retrieved from PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete and Excerpta Medica dataBASE (EMBASE) databases between April and July 2022. We also strategically search using the Google Scholar search engine and reference lists of published articles. ELIGIBILITY CRITERIA This scoping review included original English articles that estimated and described the HIV cascade and continuum of care progress in PLHIV. The review considered quantitative articles that evaluated either HIV care cascade progress in terms of the Joint United Nations Programme on HIV and AIDS targets or the dynamics of engagement in HIV care. DATA EXTRACTION AND SYNTHESIS The first author and the librarian developed database search queries and screened the retrieved titles and abstracts. Two independent reviewers and the first author extracted data using a standardised data extraction tool. The data analysis was descriptive and the findings are presented in tables and visuals. RESULTS This review included 300 articles. Cross-sectional study design methods were the most commonly used to assess the HIV care cascade (n=279, 93%). In cross-sectional and longitudinal studies, the majority used proportions to describe individuals at each cascade stage (276/279 (99%) and 20/21 (95%), respectively). In longitudinal studies, the time spent in cascade stages, transition probabilities and cumulative incidence functions was estimated. The logistic regression model was common in both cross-sectional (101/279, 36%) and longitudinal studies (7/21, 33%). Of the 21 articles that used a longitudinal design, six articles used multistate models, which included non-parametric, parametric, continuous-time, time-homogeneous and discrete-time multistate Markov models. CONCLUSIONS Most literature on the HIV cascade and continuum of care arises from cross-sectional studies. The use of longitudinal study design methods in the HIV cascade is growing because such methods can provide additional information about transition dynamics along the cascade. Therefore, a methodological guide for applying different types of longitudinal design methods to the HIV continuum of care assessments is warranted.
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Affiliation(s)
- Aneth Vedastus Kalinjuma
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Dar es Salaam, United Republic of Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Tracy Renée Glass
- Medicines Department, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Honorati Masanja
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Dar es Salaam, United Republic of Tanzania
| | - Maja Weisser
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Dar es Salaam, United Republic of Tanzania
- Medicines Department, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Amina Suleiman Msengwa
- Department of Statistics, University of Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Fiona Vanobberghen
- Medicines Department, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kennedy Otwombe
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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12
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Harryparsad R, Meyer B, Taku O, Serrano M, Chen PL, Gao X, Williamson AL, Mehou-Loko C, d’Hellencourt FL, Smit J, Strauss J, Nanda K, Ahmed K, Beksinska M, Buck G, Morrison C, Deese J, Masson L. Prevalence and incidence of sexually transmitted infections among South African women initiating injectable and long-acting contraceptives. PLoS One 2023; 18:e0294285. [PMID: 37948399 PMCID: PMC10637674 DOI: 10.1371/journal.pone.0294285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND South Africa is among the countries with the highest prevalence of sexually transmitted infections (STIs), including Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). In 2017, there were an estimated 6 million new CT, 4.5 million NG and 71 000 Treponema pallidum infections among South African men and women of reproductive age. METHODS We evaluated STI prevalence and incidence and associated risk factors in 162 women aged 18-33 years old, residing in eThekwini and Tshwane, South Africa who were part of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial. Women were randomised to use depot medroxyprogesterone acetate (n = 53), copper intrauterine device (n = 51), or levonorgestrel (n = 58) implant. Lateral vaginal wall swab samples were collected prior to contraceptive initiation and at months one and three following contraceptive initiation for STI testing. RESULTS There were no significant differences in STI incidence and prevalence across contraceptive groups. At baseline, 40% had active STIs (CT, NG, Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) or herpes simplex virus-2 shedding across all age groups- 18-21 years (46%), 22-25 years (42%) and 26-33 years (29%). The incidence of STIs during follow-up was exceptionally high (107.9/100 women-years [wy]), with younger women (18-21 years) more likely to acquire CT (75.9/100 wy) compared to 26-33 year olds (17.4/100 wy; p = 0.049). TV incidence was higher in the 26-33 year old group (82.7/100 wy) compared to the 18-21 year olds (8.4/100 wy; p = 0.01). CONCLUSIONS Although the study participants received extensive counselling on the importance of condom use, this study highlights the high prevalence and incidence of STIs in South African women, especially amongst young women, emphasising the need for better STI screening and management strategies.
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Affiliation(s)
- Rushil Harryparsad
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Bahiah Meyer
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Ongeziwe Taku
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Myrna Serrano
- Virginia Commonwealth University, Richmond, Virginia, United State of America
| | - Pai Lien Chen
- FHI 360, Durham, North Carolina, United States of America
| | - Xiaoming Gao
- FHI 360, Durham, North Carolina, United States of America
| | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Celia Mehou-Loko
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | | | - Jennifer Smit
- MRU, University of the Witwatersrand, Durban, South Africa
| | - Jerome Strauss
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, United States of America
| | - Kavita Nanda
- FHI 360, Durham, North Carolina, United States of America
| | - Khatija Ahmed
- Setshaba Research Centre, Pretoria, South Africa
- Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa8 Pfizer, Inc., Pennsylvania, PA, United States of America
| | - Mags Beksinska
- MRU, University of the Witwatersrand, Durban, South Africa
| | - Gregory Buck
- Virginia Commonwealth University, Richmond, Virginia, United State of America
| | | | - Jennifer Deese
- Disease Elimination Program, Life Sciences Discipline, Burnet Institute, Melbourne, Australia
| | - Lindi Masson
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa8 Pfizer, Inc., Pennsylvania, PA, United States of America
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Central Clinical School, Monash University, Melbourne, Australia
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13
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Zelazo PR. Schema formation and stimulus-schema discrepancy: A basic unit and its properties. Dev Psychol 2023:2024-21621-001. [PMID: 37917486 DOI: 10.1037/dev0001643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Research with 2-day-old neonates shows that they create mental representations-schemata-for their experiences and that this cognitive ability is hardwired and functional at birth. This research and studies with older infants indicate that both the formation and the expansion of schemata occur through moderate discrepancies, a concept that Jerome Kagan promoted conceptually and through his research. Discrepancy, as distinct from novelty, is insufficiently acknowledged in the literature on schema theory. The schema is both cognitive and affective and develops in unison in a curvilinear pattern with a gradual onset and exponential expansion. Optimal attentiveness and positive affect occur at the peak of formation and to moderate discrepancies. Redundancy beyond the optimal level produces decreasing interest and positive affect and increasing negative affect resulting in boredom and avoidance. These characteristics of schema development are difficult to study with older children and adults. Rumelhart (1980) regarded the schema as the "building block of cognition" and Kagan (2002) called its expansion through moderate discrepancies an "engine of change" implying widespread application for cognition and behavior throughout life. Kagan urged the search for structure (form) as opposed to function in cognition, and the curvilinear pattern of schema development and its characteristics, it is argued, is the structure he sought. Implications and select applications of schema development and expansion are presented. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Cadmus EO, Adebusoye LA, Owoaje ET. Ageing in place or stuck in place: Preferred care setting for community-dwelling older persons in a low-resource country in Sub Saharan Africa. PLoS One 2023; 18:e0292939. [PMID: 37844096 PMCID: PMC10578603 DOI: 10.1371/journal.pone.0292939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Ageing in Place is the emerging social policy drive for long-term care coordination of older persons globally. This decision may be the only viable option in many low- and middle-income countries like Nigeria. Nevertheless, the risk of older persons being 'stuck in place' is high if their preferences are not considered or other alternatives are neither acceptable nor available. This study determined factors associated with the preferred care setting among community-dwelling older persons and explored their views about their choices. METHODS The study utilised a mixed-methods approach. Participants were older persons (≥ 60 years) in a selected rural and urban community in Oyo State, south-western Nigeria. Quantitative data were collected using an interviewer-administered, semi-structured questionnaire and analysed using Stata version 14 at p<0.05. Qualitative data collection involved 22 Focus Group Discussions (FGD). The discussions were audiotaped, transcribed verbatim and analysed thematically using ATLAS.ti version 8. Selected quotations were used to illustrate themes. RESULTS 1,180 participants (588 rural vs 592 urban) were interviewed with a mean age of 73.2 ±9.3 years. More rural participants preferred to AIP (61.6%) compared to urban participants (39.2%), p = 0.001. Factors associated with the decision for rural participants were older age [OR:2.07 (95%CI:1.37-3.14)], being male [OR:2.41(95%CI:1.53-3.81)] and having assistance at home [OR:1.79 (95%CI:1.15-2.79)]. In comparison, significant factors for urban participants were older age (≥70years) [OR:1.54(95%CI:1.03-2.31)] and home-ownership [OR:5.83 (95%CI:3.82-8.91)]. The FGD revealed that the traditional expectation of reciprocity of care mostly influenced the desire to AIP. Advantages include improved social connectedness, quality of care, community participation and reduced isolation. Interestingly, participants were not opposed to the option of institutional care. CONCLUSION Ageing in place is preferred and influenced by advanced age and home ownership in our setting. Information provided could guide age-friendly housing policies and community-based programmes for the care of older persons.
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Affiliation(s)
- Eniola Olubukola Cadmus
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
| | - Lawrence Adekunle Adebusoye
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
| | - Eme Theodora Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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15
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Majamanda MD, Chisoni F, Selemani A, Kearns I, Maree J. Paediatric oncology nursing education and training programmes: a scoping review protocol. BMJ Open 2023; 13:e070694. [PMID: 37813530 PMCID: PMC10565288 DOI: 10.1136/bmjopen-2022-070694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION The care of children with cancer is a highly specialised field which requires well-educated, trained and dedicated nurses to provide high-quality care. In low/middle-income countries, the survival rate of children with cancer is low as compared with that of high-income countries due to the limited number of specialised oncology healthcare professionals, especially nurses. To address this problem, a number of paediatric oncology education and training programmes have been developed for nurses. The objective of this scoping review is to describe the existing literature focusing on paediatric oncology nursing education and training programmes; to map the content, delivery methods, duration and mode of assessment. METHODS The review will include articles published in English, from 2012 to 2022, that describe a paediatric oncology nursing education programme, from any setting. The review will follow Joanna Briggs Institute methodology for scoping reviews guidelines. A systematic search of literature will be performed in CINAHL, Dimensions, Embase, PubMed and Scopus. A two-stage standardised screening process will be employed to evaluate eligibility of the articles. All abstracts that will be considered relevant will be reviewed in full text form by the two reviewers independently. Conflicts will be resolved by consensus of all reviewers through a meeting. Data will be extracted by two independent reviewers using a developed data extraction tool. The results will be reported in extraction tables and diagrams with a narrative summary. ETHICS AND DISSEMINATION This scoping review is part of the multiphase study which obtained ethical clearance from College of Medicine Research Ethics Committee in Malawi and Human Research Ethics Committee of the University of Witwatersrand, South Africa. The scoping review will be published in a peer reviewed journal. The findings will also be presented at national and international conferences. TRIAL REGISTRATION NUMBER https://doi.org/10.17605/OSF.IO/X3Q4H.
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Affiliation(s)
- Maureen Daisy Majamanda
- Child Health Nursing, Kamuzu University of Health Sciences, Blantyre, Malawi
- Consortium for Advanced Research Training in Africa, Nairobi, Kenya
- Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Felix Chisoni
- Library, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Apatsa Selemani
- Consortium for Advanced Research Training in Africa, Nairobi, Kenya
- Library, Kamuzu University of Health Sciences, Blantyre, Malawi
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Irene Kearns
- Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Johanna Maree
- Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
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Adofo YK, Nyankson E, Agyei-Tuffour B, Amoako C, Duodu CP, Gbogbo S, Saalia FK. Chicken Feather Protein Dispersant for Effective Crude Oil Dispersion in the Marine Environment. ACS Omega 2023; 8:34948-34958. [PMID: 37780021 PMCID: PMC10536068 DOI: 10.1021/acsomega.3c04417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023]
Abstract
Various studies report that aside from the adverse impact of the crude oil on the marine environment, there is the likelihood that chemical dispersants used on the surface of water as oil-treating agents themselves possess a degree of toxicity, which have additional effects on the environment. To eliminate the subject of toxicity, there exist several materials in nature that have the ability to form good emulsions, and such products include protein molecules. In this study, chicken feathers which are known to contain ≥90% protein were used to formulate a novel dispersant to disperse crude oil in seawater (35 ppt). Protein from chicken feathers was extracted and synthesized into the chicken feather protein (CFP) dispersant using deionized water as a solvent. Emulsions formed from CFP-synthesized dispersants were stable over a considerably long period of time, whereas the droplet sizes of the emulsion formed were on the average very small in diameter, making droplet coalescence very slow. The CFP dispersants exhibited moderate surface and interfacial activity at normal seawater salinity. Using the US EPA's baffled flask test, at 800 and 1000 mg/ml CFP surfactant-to-oil ratios, dispersion effectiveness values of 56.92 and 68.64 vol % were obtained, respectively, which show that CFP has a great potential in crude oil dispersion. Moreover, the acute toxicity test performed on Nile tilapia showed that CFP was practically nontoxic with an LC50 value of more than 100 mg/L after 96 h of exposure. The results obtained showed that the CFP dispersant is environmentally friendly.
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Affiliation(s)
- Yaw Kwakye Adofo
- Material
Science and Engineering Department, School of Engineering Sciences, University of Ghana, Legon-Accra LG 77, Ghana
| | - Emmanuel Nyankson
- Material
Science and Engineering Department, School of Engineering Sciences, University of Ghana, Legon-Accra LG 77, Ghana
| | - Benjamin Agyei-Tuffour
- Material
Science and Engineering Department, School of Engineering Sciences, University of Ghana, Legon-Accra LG 77, Ghana
| | - Christian Amoako
- Material
Science and Engineering Department, School of Engineering Sciences, University of Ghana, Legon-Accra LG 77, Ghana
| | - Collins Prah Duodu
- Department
of Marine and Fisheries Sciences, School of Biological Sciences, University of Ghana, Legon-Accra LG 77, Ghana
| | - Selassie Gbogbo
- Material
Science and Engineering Department, School of Engineering Sciences, University of Ghana, Legon-Accra LG 77, Ghana
| | - Firibu K. Saalia
- Department
of Food Process Engineering, School of Engineering Sciences, University of Ghana, Legon-Accra LG 77, Ghana
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Atiba FA, Popoola OA, Odukogbe AA, Ihunwo AO. Prevalence and consumption pattern of kolanut among pregnant women in Ibadan metropolis. Sci Rep 2023; 13:14422. [PMID: 37660226 PMCID: PMC10475128 DOI: 10.1038/s41598-023-41754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/31/2023] [Indexed: 09/04/2023] Open
Abstract
Kolanut contains caffeine and it is widely consumed in various social contexts in Nigeria and other Sub-Saharan African countries. While some studies have suggested that kolanut is consumed by pregnant women, there is a dearth of information on the prevalence, consumption pattern and reasons for kolanut consumption among this group. This study investigated kolanut use among pregnant women in Ibadan, Oyo State, Nigeria. A cross-sectional study involving 478 consenting pregnant women in all trimesters of pregnancy was conducted. Semi-structured questionnaires were used to collect data. Associations between kolanut use and respondent characteristics were investigated using the chi-square test and logistic regression analysis. The mean age of the women was 28.7 ± 6.3 years. One hundred and sixty-two (33.9%) of women reported kolanut use during pregnancy, 140 (29.3%) in the current pregnancy. Fifty-five (39.3%) pregnant women reported frequent use and 46 (32.9%) used it in high quantities. Significant associations were found between current kolanut use and Hausa respondents (p = 0.014), educational level; secondary (p = 0.032), tertiary (p = 0.006), TBA (p = 0.005). The majority (93.7%) used kolanut to prevent spitting, nausea, and vomiting. This study showed that kolanut use is quite common among pregnant women and frequently used in large quantities.
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Affiliation(s)
- F A Atiba
- Department of Anatomy, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - O A Popoola
- Departrment of Community Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - A A Odukogbe
- Department of Obstetrics and Gynecology College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - A O Ihunwo
- School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kalinjuma AV, Hussey H, Mollel GJ, Letang E, Battegay M, Glass TR, Paris D, Vanobberghen F, Weisser M. Body mass index trends and its impact of under and overweight on outcome among PLHIV on antiretroviral treatment in rural Tanzania: A prospective cohort study. PLoS One 2023; 18:e0290445. [PMID: 37607169 PMCID: PMC10443839 DOI: 10.1371/journal.pone.0290445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Increased body weight is an important risk factor for cardiovascular disease and is increasingly reported as a health problem in people living with HIV (PLHIV). There is limited data from rural sub-Saharan Africa, where malnutrition usually presents with both over- and undernutrition. We aimed to determine the prevalence and risk factors of underweight and overweight/obesity in PLHIV enrolled in a cohort in rural Tanzania before the introduction of integrase inhibitors. METHODS This nested study of the prospective Kilombero and Ulanga Antiretroviral Cohort included adults aged ≥19 years initiated on antiretroviral therapy between 01/2013 and 12/2018 with follow-up through 06/2019. Body Mass Index (BMI) was classified as underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), or overweight/obese (≥25.0 kg/m2). Stratified piecewise linear mixed models were used to assess the association between baseline characteristics and follow-up BMI. Cox proportional hazard models were used to assess the association between time-updated BMI and death/loss to follow-up (LTFU). RESULTS Among 2,129 patients, 22,027 BMI measurements (median 9 measurements: interquartile range 5-15) were analysed. At baseline, 398 (19%) patients were underweight and 356 (17%) were overweight/obese. The majority of patients were female (n = 1249; 59%), and aged 35-44 years (779; 37%). During the first 9 months, for every three additional months on antiretroviral therapy, BMI increased by 2% (95% confidence interval 1-2%, p<0.0001) among patients underweight at baseline and by 0.7% (0.5-0.6%, p<0.0001) among participants with normal BMI. Over a median of 20 months of follow-up, 107 (5%) patients died and 592 (28%) were LTFU. Being underweight was associated with >2 times the hazard of death/LTFU compared to participants with normal BMI. CONCLUSION We found a double burden of malnutrition, with underweight being an independent predictor of mortality. Monitoring and measures to address both states of malnutrition among PLHIV should be integrated into routine HIV care.
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Affiliation(s)
- Aneth Vedastus Kalinjuma
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Tanzania
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hannah Hussey
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Tanzania
- Division of Public Health, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Getrud Joseph Mollel
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Emilio Letang
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Barcelona Institute for Global Health, Hospital Clínic-University of Barcelona, Barcelona, Spain
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tracy R. Glass
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel Paris
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Maja Weisser
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Adeoye IA, Bamgboye EA, Omigbodun AO. Gestational weight gain among pregnant women in Ibadan, Nigeria: Pattern, predictors and pregnancy outcomes. PLoS One 2023; 18:e0290102. [PMID: 37594997 PMCID: PMC10437817 DOI: 10.1371/journal.pone.0290102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 08/02/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Gestational weight gain (GWG) is a risk factor for adverse pregnancy outcomes, future obesity and chronic diseases among women. However, has not received much attention in many low and middle-income countries such as Nigeria. We investigated the pattern, associated factors and pregnancy outcomes of GWG in Ibadan, Nigeria, using the Ibadan Pregnancy Cohort Study (IbPCS). METHODOLOGY The IbPCS is a multicentre prospective cohort study conducted among 1745 pregnant women recruited from four health facilities in Ibadan, Nigeria. GWG, the primary outcome, was categorised according to the Institute of Medicine's classification into insufficient, adequate and excessive weight gain. Pregnancy outcomes were the secondary outcome variables. Logistic regression analysis (Adjusted odds ratios and 95% confidence interval CI) was used to examine associations, and Poisson regression analyses were used to investigate associations with outcomes. RESULTS Only 16.9% of women had optimal GWG, 56.8% had excessive GWG, and 26.9% had insufficient GWG. Excessive GWG was associated with high income '> #20,000-' (AOR: 1.64, 95% CI: 1.25-2.17), being overweight (AOR: 2.12, 95% CI: 1.52-2.95) and obese (AOR: 1.47, 95% CI: 1.02-2.13) after adjusting for confounders. In contrast, increased odds of insufficient GWG have associated women with depression (AOR: 1.70, 95% CI 1.17-2.47). There was no significant association between inappropriate GWG and pregnancy outcomes However, there was an increased odds for postpartum haemorrhage (AOR: 2.44, 95% CI 1.14-5.22) among women with obesity and excessive GWG. CONCLUSIONS Excessive GWG was the most typical form of GWG among our study participants and was associated with high maternal income, and being overweight or obese. GWG needs to be monitored during antenatal care, and interventions that promote appropriate GWG should be implemented among pregnant women in Nigeria.
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Affiliation(s)
- Ikeola A. Adeoye
- Faculty of Public Health, Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Consortium of Advanced Research for Africa (CARTA), Nairobi, Kenya
| | - Elijah A. Bamgboye
- Faculty of Public Health, Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Akinyinka O. Omigbodun
- Faculty of Clinical Sciences, Department Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Matsuane C, Kiage BN, Karanja J, Kavoo AM, Rimberia FK. Hypolipidaemic effects of papaya ( Carica papaya L.) juice on rats fed on a high fat and fructose diet. J Nutr Sci 2023; 12:e76. [PMID: 37457684 PMCID: PMC10345780 DOI: 10.1017/jns.2023.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Papaya (Carica papaya L.) is a highly nutritious and less-caloric fruit, commonly consumed for its minerals and vitamins and hence may help in controlling obesity and abdominal discomforts. The present study investigated the hypolipidaemic effects of papaya juice extract on male Albino Wistar rats (7 weeks old; 185 ± 17 g) fed on a high fat and fructose diet (HFFD) for 6 weeks. The rats were divided into groups I-IV of five rats each and fed on either a HFFD (i.e. the Control), HFFD + 200 mg papaya, HFFD + 350 mg papaya or a HFFD + 500 mg papaya. On day 34, after an overnight fast, blood samples were obtained by cardiac puncture under 99⋅8 % Chloroform anaesthesia for the determination of serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and high-density cholesterol (HDL-c). The atherogenic (AI) and coronary risk (CRI) indices were also calculated. Statistical analysis was performed using ANOVA where means were separated using Tukey's HSD test. Resulted showed that all rats given papaya juice had an increasing, non-significant HDL-c and reduced LDL-c levels while rats fed on HFFD had the highest TC (53⋅2 mg/dl) and TG (37⋅6 mg/dl) levels. Papaya juice statistically reduced the AI and CRI of the rats. In conclusion, consumption of HFFD + 500 mg was the most effective in the reduction of rats' blood lipids and fats, due to its anti-obesity and hypolipidaemic properties, thus can be used in the management of dyspilidaemic disorders.
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Affiliation(s)
- Christinah Matsuane
- Department of Horticulture and Food Security, Jomo Kenyatta University of Agriculture and Technology, P.O. Box, Nairobi 62000-00200, Kenya
- Department of Crop and Soil Sciences, Botswana University of Agriculture and Natural Resources, Private Bag 0027, Gaborone, Botswana
| | - Beatrice N. Kiage
- Department of Human Nutrition, Jomo Kenyatta University of Agriculture and Technology, P.O. Box, Nairobi 62000-00200, Kenya
| | - Josephine Karanja
- Department of Horticulture and Food Security, Jomo Kenyatta University of Agriculture and Technology, P.O. Box, Nairobi 62000-00200, Kenya
| | - Agnes M. Kavoo
- Department of Horticulture and Food Security, Jomo Kenyatta University of Agriculture and Technology, P.O. Box, Nairobi 62000-00200, Kenya
| | - Fredah K. Rimberia
- Department of Horticulture and Food Security, Jomo Kenyatta University of Agriculture and Technology, P.O. Box, Nairobi 62000-00200, Kenya
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Ntamatungiro AJ, Eichenberger A, Okuma J, Vanobberghen F, Ndege R, Kimera N, Francis JM, Kagura J, Weisser M. Transitioning to Dolutegravir in a Programmatic Setting: Virological Outcomes and Associated Factors Among Treatment-Naive Patients With HIV-1 in the Kilombero and Ulanga Antiretroviral Cohort in Rural Tanzania. Open Forum Infect Dis 2023; 10:ofad321. [PMID: 37520425 PMCID: PMC10375425 DOI: 10.1093/ofid/ofad321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Background Virological outcome data after programmatic transition from non-nucleoside reverse transcriptase inhibitor (NNRTI)-based to dolutegravir (DTG)-based antiretroviral therapy (ART) regimens in sub-Saharan Africa (SSA) outside of clinical trials are scarce. We compared viral suppression and associated factors in treatment-naïve people living with HIV (PLHIV) starting DTG- based versus NNRTI-based ART. Methods We compared virological suppression at 12 months, after treatment initiation in the two cohorts of participants aged ≥15 years, initiating DTG- and NNRTI-based ART. Drug resistance was assessed among participants with viremia ≥50 copies/mL on DTG. Results Viral suppression was achieved for 165/195 (85%) and 154/211 (73%) participants in the DTG- and NNRTI- cohorts, respectively (P = 0.003). DTG-based ART was associated with >2 times the odds of viral suppression versus NNRTI-based ART (adjusted odds ratio, 2.10 [95% confidence interval {CI}, 1.12-3.94]; adjusted risk ratio, 1.11 [95% CI, 1.00-1.24]). HIV-1 genotypic resistance testing (GRT) before ART initiation was done in 14 of 30 viremic participants on DTG, among whom nucleoside reverse transcriptase inhibitor (NRTI), NNRTI, and protease inhibitors resistance was detected in 0 (0%), 2 (14%) and 1 (7%), respectively. No resistance was found in the 2 of 30 participants with available GRT at the time of viremia ≥50 copies/mL. Conclusions Virological suppression at 1 year was higher in participants initiating DTG- versus NNRTI-based ART. In those with viremia ≥50 copies/mL on DTG-based ART, there was no pretreatment or acquired resistance to the DTG co-administered NRTIs, although the number of samples tested was small.
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Affiliation(s)
- Alex J Ntamatungiro
- Correspondence: Alex J. Ntamatungiro, MS, Department of Interventions and Clinical Trials, Ifakara Health Institute, 5 Ifakara St, Plot 463 Mikocheni, PO Box 78373, Dar es Salaam, Tanzania (); Anna Eichenberger, MS, Department of Infectious Diseases, Bern University Hospital, Freiburgstrasse 16, 3010 Bern, Switzerland ()
| | - Anna Eichenberger
- Correspondence: Alex J. Ntamatungiro, MS, Department of Interventions and Clinical Trials, Ifakara Health Institute, 5 Ifakara St, Plot 463 Mikocheni, PO Box 78373, Dar es Salaam, Tanzania (); Anna Eichenberger, MS, Department of Infectious Diseases, Bern University Hospital, Freiburgstrasse 16, 3010 Bern, Switzerland ()
| | - James Okuma
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Fiona Vanobberghen
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Ndege
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Namvua Kimera
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Tanzania
| | - Joel M Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
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Bazaanah P, Mothapo RA. Sustainability of drinking water and sanitation delivery systems in rural communities of the Lepelle Nkumpi Local Municipality, South Africa. Environ Dev Sustain 2023:1-33. [PMID: 37362991 PMCID: PMC10088694 DOI: 10.1007/s10668-023-03190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/23/2023] [Indexed: 06/28/2023]
Abstract
Water and sanitation are core for the growth and development of communities. Yet, South African local municipalities are often unable to sustainably deliver safe water and basic sanitation for all. Drawing on perspectives of ecological economics, this study analysed the sustainability of water and sanitation systems in rural communities of the Lepelle Nkumpi Local Municipality. Mixed research approach was used to collect the data from 657 household and institutional respondents. The study found that households used water for multi-purposes including consumptive, productive and domestic, but existing facilities are in deplorable condition. Pollution arising from agrochemicals, waste systems, mining, sewerage, and industrial effluence significantly affected water systems in the communities. Bridging demand-supply gaps require initiatives like bulk water supply and implementation of the free basic water policy in underprivileged areas. Tariffs should either be waived or adjusted for extremely poor households. Waste management initiatives, like capacity building, public education, investments, and facility upgrade, could help avert spread of waterborne infections and improve the resident's health.
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Affiliation(s)
- Prosper Bazaanah
- Council for Scientific and Industrial Research (CSIR-Water Research Institute), Accra, Ghana
- Future Africa at University of Pretoria, Pretoria, South Africa
| | - Raesibe A. Mothapo
- Faculty of Arts and Design, Tshwane University of Technology, Pretoria, South Africa
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Zakumumpa H, Kwiringira J, Katureebe C, Spicer N. Understanding Uganda's early adoption of novel differentiated HIV treatment services: a qualitative exploration of drivers of policy uptake. BMC Health Serv Res 2023; 23:343. [PMID: 37020290 PMCID: PMC10075495 DOI: 10.1186/s12913-023-09313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Although differentiated service delivery (DSD) for HIV treatment was endorsed by the WHO in its landmark 2016 guidelines to lessen patients' need to frequently visit clinics and hence to reduce unnecessary burdens on health systems, uptake has been uneven globally. This paper is prompted by the HIV Policy Lab's annual report of 2022 which reveals substantial variations in programmatic uptake of differentiated HIV treatment services across the globe. We use Uganda as a case study of an 'early adopter' to explore the drivers of programmatic uptake of novel differentiated HIV treatment services. METHODS We conducted a qualitative case-study in Uganda. In-depth interviews were held with national-level HIV program managers (n = 18), district health team members (n = 24), HIV clinic managers (n = 36) and five focus groups with recipients of HIV care (60 participants) supplemented with documentary reviews. Our thematic analysis of the qualitative data was guided by the Consolidated Framework for Implementation Research (CFIR)'s five domains (inner context, outer setting, individuals, process of implementation). RESULTS Our analysis reveals that drivers of Uganda's 'early adoption' of DSD include: having a decades-old HIV treatment intervention implementation history; receiving substantial external donor support in policy uptake; the imperatives of having a high HIV burden; accelerated uptake of select DSD models owing to Covid-19 'lockdown' restrictions; and Uganda's participation in clinical trials underpinning WHO guidance on DSD. The identified processes of implementation entailed policy adoption of DSD (such as the role of local Technical Working Groups in domesticating global guidelines, disseminating national DSD implementation guidelines) and implementation strategies (high-level health ministry buy-in, protracted patient engagement to enhance model uptake, devising metrics for measuring DSD uptake progress) for promoting programmatic adoption. CONCLUSION Our analysis suggests early adoption derives from Uganda's decades-old HIV intervention implementation experience, the imperative of having a high HIV burden which prompted innovations in HIV treatment delivery as well as outer context factors such as receiving substantial external assistance in policy uptake. Our case study of Uganda offers implementation research lessons on pragmatic strategies for promoting programmatic uptake of differentiated treatment HIV services in other countries with a high HIV burden.
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Affiliation(s)
- Henry Zakumumpa
- School of Public Health, Makerere University, Kampala, Uganda.
| | | | - Cordelia Katureebe
- Ministry of Health, AIDS Control Program, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Spicer
- London School of Hygiene and Tropical Medicine, London, UK
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Horta Ribeiro M, Hosseinmardi H, West R, Watts DJ. Deplatforming did not decrease Parler users’ activity on fringe social media. PNAS Nexus 2023; 2:pgad035. [PMID: 36959908 PMCID: PMC10029837 DOI: 10.1093/pnasnexus/pgad035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/25/2022] [Accepted: 01/23/2023] [Indexed: 03/24/2023]
Abstract
Online platforms have banned (“deplatformed”) influencers, communities, and even entire websites to reduce content deemed harmful. Deplatformed users often migrate to alternative platforms, which raises concerns about the effectiveness of deplatforming. Here, we study the deplatforming of Parler, a fringe social media platform, between 2020 January 11 and 2021 February 25, in the aftermath of the US Capitol riot. Using two large panels that capture longitudinal user-level activity across mainstream and fringe social media content (N = 112, 705, adjusted to be representative of US desktop and mobile users), we find that other fringe social media, such as Gab and Rumble, prospered after Parler’s deplatforming. Further, the overall activity on fringe social media increased while Parler was offline. Using a difference-in-differences analysis (N = 996), we then identify the causal effect of deplatforming on active Parler users, finding that deplatforming increased the probability of daily activity across other fringe social media in early 2021 by 10.9 percentage points (pp) (95% CI [5.9 pp, 15.9 pp]) on desktop devices, and by 15.9 pp (95% CI [10.2 pp, 21.7 pp]) on mobile devices, without decreasing activity on fringe social media in general (including Parler). Our results indicate that the isolated deplatforming of a major fringe platform was ineffective at reducing overall user activity on fringe social media.
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Affiliation(s)
| | - Homa Hosseinmardi
- Computational Social Science Lab, University of Pennsylvania, PA 19104, USA
| | - Robert West
- School of Computer and Communication Sciences, EPFL, 1015 Lausanne, Philadelphia, Switzerland
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Carlson CJ, Boyce MR, Dunne M, Graeden E, Lin J, Abdellatif YO, Palys MA, Pavez M, Phelan AL, Katz R. The World Health Organization's Disease Outbreak News: A retrospective database. PLOS Glob Public Health 2023; 3:e0001083. [PMID: 36962988 PMCID: PMC10021193 DOI: 10.1371/journal.pgph.0001083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/04/2022] [Indexed: 05/31/2023]
Abstract
The World Health Organization (WHO) notifies the global community about disease outbreaks through the Disease Outbreak News (DON). These online reports tell important stories about both outbreaks themselves and the high-level decision making that governs information sharing during public health emergencies. However, they have been used only minimally in global health scholarship to date. Here, we collate all 2,789 of these reports from their first use through the start of the Covid-19 pandemic (January 1996 to December 2019), and develop an annotated database of the subjective and often inconsistent information they contain. We find that these reports are dominated by a mix of persistent worldwide threats (particularly influenza and cholera) and persistent epidemics (like Ebola virus disease in Africa or MERS-CoV in the Middle East), but also document important periods in history like the anthrax bioterrorist attacks at the turn of the century, the spread of chikungunya and Zika virus to the Americas, or even recent lapses in progress towards polio elimination. We present three simple vignettes that show how researchers can use these data to answer both qualitative and quantitative questions about global outbreak dynamics and public health response. However, we also find that the retrospective value of these reports is visibly limited by inconsistent reporting (e.g., of disease names, case totals, mortality, and actions taken to curtail spread). We conclude that sharing a transparent rubric for which outbreaks are considered reportable, and adopting more standardized formats for sharing epidemiological metadata, might help make the DON more useful to researchers and policymakers.
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Affiliation(s)
- Colin J. Carlson
- Center for Global Health Science and Security, Georgetown University Medical Center, Washington, DC, United States of America
- Department of Microbiology and Immunology, Georgetown University Medical Center, Washington, DC, United States of America
- Department of Biology, Georgetown University, Washington, DC, United States of America
| | - Matthew R. Boyce
- Center for Global Health Science and Security, Georgetown University Medical Center, Washington, DC, United States of America
| | - Margaret Dunne
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ellie Graeden
- Center for Global Health Science and Security, Georgetown University Medical Center, Washington, DC, United States of America
| | - Jessica Lin
- Center for Global Health Science and Security, Georgetown University Medical Center, Washington, DC, United States of America
| | - Yasser Omar Abdellatif
- Center for Global Health Science and Security, Georgetown University Medical Center, Washington, DC, United States of America
| | - Max A. Palys
- Center for Global Health Science and Security, Georgetown University Medical Center, Washington, DC, United States of America
| | - Munir Pavez
- Center for Global Health Science and Security, Georgetown University Medical Center, Washington, DC, United States of America
| | - Alexandra L. Phelan
- Center for Global Health Science and Security, Georgetown University Medical Center, Washington, DC, United States of America
- Department of Microbiology and Immunology, Georgetown University Medical Center, Washington, DC, United States of America
| | - Rebecca Katz
- Center for Global Health Science and Security, Georgetown University Medical Center, Washington, DC, United States of America
- Department of Microbiology and Immunology, Georgetown University Medical Center, Washington, DC, United States of America
- Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, United States of America
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Mkhize S, Libhaber E, Sewpaul R, Reddy P, Baldwin-Ragaven L. Child and adolescent food insecurity in South Africa: A household-level analysis of hunger. PLoS One 2022; 17:e0278191. [PMID: 36576919 PMCID: PMC9797094 DOI: 10.1371/journal.pone.0278191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 11/13/2022] [Indexed: 12/29/2022] Open
Abstract
Food insecurity impacts childhood nutritional status, physical and cognitive development, and increases lifetime risk for chronic disease. Previous South African studies have examined hunger at the sub-national level without a specific focus on children and adolescents. This study determines the national prevalence of childhood food insecurity, from birth to adolescence, and identifies factors associated with hunger within the household. Individual and household-level data were extracted from the South African National Health and Nutrition Examination Survey (SANHANES-1). Prevalence of food insecurity was assessed using the Community Childhood Hunger Identification Project (CCHIP) index. Multinomial logistic regression analyses were conducted on all households (with and without children) to determine the predictors of food insecurity, with additional analyses adjusting for child dependency and sociodemographic characteristics of household heads in households with children. Of 5 098 households surveyed, 68.6% had children and adolescents present (0-19 years). Of these households, 32.5% (95% Confidence Interval [CI]: 29.5-35.7) were experiencing hunger and 26.3% (95% CI: 23.9-28.8) were at risk of hunger. Among all the households, significant associations for experiencing hunger were the presence of children and adolescents: Adjusted Odds Ratio (AOR) = 1.68 (95% CI: 1.12-2.53); being female-headed: AOR = 1.53 (95% CI: 1.21-1.94) and informally-located; AOR = 1.6 (95% CI: 1.07-2.43). Of the racial groups, having a non-African household head, Coloured: AOR = 0.29 (95% CI: 0.19-0.44) and White/Indian/Asian: AOR = 0.12 (95% CI: 0.04-0.33) conferred lower odds of experiencing hunger; and, the household head having secondary/tertiary education conferred lower odds of experiencing hunger; AOR = 0.40 (95% CI: 0.28-0.56) as well as being at risk of hunger; AOR = 0.69 (95% CI: 0.52-0.92). Receiving social grants, pensions, or remittances more than doubled the odds of experiencing hunger; AOR = 2.15 (95% CI: 1.49-3.09). After adjusting for child dependency in households with children, having at least one older child (age 15-19 years old) did not change the odds of food insecurity. In summary, only 41% of South African households with children and adolescents were food secure. The associations between household head sociodemographics, household location and size on household food insecurity indicate a need for multi-sectoral interventions to bolster sustainable food systems for households with children and adolescents and to improve public protections for female-headed, African-headed and informally-located households dependent on social grants.
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Affiliation(s)
- Siluleko Mkhize
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elena Libhaber
- School of Clinical Medicine and Health Sciences Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronel Sewpaul
- Health and Wellbeing, Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Priscilla Reddy
- Health and Wellbeing, Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
| | - Laurel Baldwin-Ragaven
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
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Manda WC, Sikweyiya Y, Kaunda-Khangamwa BN, Selemani A, Jimu S, Kamndaya M. Adolescent sexual health interventions that include very young adolescents in sub-Saharan Africa: a scoping review protocol. BMJ Open 2022; 12:e063343. [PMID: 36379647 PMCID: PMC9668002 DOI: 10.1136/bmjopen-2022-063343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Targeting very young adolescents (VYAs) with sexual health (SH) interventions is increasingly being recognised as one of the strategies for addressing SH challenges in late adolescence. However, there is a dearth of literature regarding SH interventions implemented specifically for VYAs in sub-Saharan Africa (SSA). This scoping review aims to provide a summary of documented evidence on SH interventions that include VYAs in SSA, identify gaps in existing interventions and provide recommendations for further programmatic work on SH for VYAs. METHODS AND ANALYSIS The methods for this scoping review will be guided by the framework proposed by Arksey and O'Malley and further enhanced by Levac et al and the Joanna Briggs Institute. We will search electronic databases: Popline, EMBASE, PubMed, CINAHL, Dimensions, African Journals Online (AJOL) and specific summon country-specific search. We will include published studies from SSA and only adolescent SH interventions published from the year 2003-2022. Furthermore, we will include programmatic and intervention literature that has not been published in peer-reviewed articles. The data will be charted using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review. The data will then be collated and summarised. ETHICS AND DISSEMINATION The scoping review methodology involves putting together information from articles or grey literature that is either publicly available or shared by the authors, this study does not require ethical approval. Findings of this scoping review will be published in a scientific journal and presented at relevant scientific fora and conferences. This scoping review will provide a comprehensive overview of the evidence base of adolescent SH interventions for VYAs in SSA and will highlight critical gaps in the existing interventions and areas where further programmatic work is needed for VYAs in SSA. REGISTRATION https://archive.org/details/osf-registrations-gn538-v1.
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Affiliation(s)
- Wanangwa Chimwaza Manda
- Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Yandisa Sikweyiya
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Apatsa Selemani
- Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | | | - Mphatso Kamndaya
- Applied Sciences, Malawi University of Business and Applied Sciences, Blantyre, Malawi
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Kontar J, Osseiran A, Makki F, El Chammay R. Promoting follow-up attendance among mental health patients at a primary healthcare center in Lebanon: A randomized controlled trial. SAGE Open Med 2022; 10:20503121221135990. [PMID: 36385793 PMCID: PMC9647270 DOI: 10.1177/20503121221135990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/13/2022] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE In 2015, the Lebanese Ministry of Public Health launched the 2015-2020 National Mental Health Strategy in an effort to integrate Mental Health into Primary Healthcare centers. One of the key objectives of the strategy was to increase the detection, assessment, and management of mental disorders including depression. In addition to diagnosis and patient education, a successful management of depression requires that patients systematically follow-up with their healthcare provider to ensure that they are on the optimal path to recovery. This study evaluates the impact of a visual self-assessment card to increase patients' attendance to a follow-up appointment with their healthcare provider. METHODS A clustered randomized controlled trial was implemented at a Primary Healthcare center located in South Lebanon. The final sample consisted of 405 patients (209 treated and 196 untreated patients) who were diagnosed with mild-to-severe depression using the Patient Health Questionnaire (PHQ-9 > 4). Patients were asked to attend a follow-up appointment with their health provider 2-3 weeks following the initial assessment. Treated patients were provided with a visual self-assessment card that tracked their daily mood changes and reminded them of their follow-up appointment. RESULTS Overall, the results provide evidence supporting the use of the self-assessment card to remind mental health patients of their follow-up appointments. Patients who received the card were 9 percentage points more likely to attend their follow-up appointment (p = 0.05), with new patients (vs existing patients) exhibiting a 15 percentage points increase (p < 0.05). CONCLUSION Efforts focused on increasing compliance with follow-up appointments should be at the cornerstone of mental health integration approaches. Not only do our findings suggest a great potential for cost-effective interventions but also highlight new avenues to optimize on the use of reminders to promote compliance.
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Affiliation(s)
| | | | - Fadi Makki
- Nudge Lebanon, Beirut, Lebanon
- B4Development, Doha, Qatar
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Dugbartey GJ, Alornyo KK, Adams I, Atule S, Obeng-Kyeremeh R, Amoah D, Adjei S. Targeting hepatic sulfane sulfur/hydrogen sulfide signaling pathway with α-lipoic acid to prevent diabetes-induced liver injury via upregulating hepatic CSE/3-MST expression. Diabetol Metab Syndr 2022; 14:148. [PMID: 36229864 PMCID: PMC9558364 DOI: 10.1186/s13098-022-00921-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/05/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Diabetes-induced liver injury is a complication of diabetes mellitus of which there are no approved drugs for effective treatment or prevention. This study investigates possible hepatoprotective effect of alpha-lipoic acid (ALA), and sulfane sulfur/hydrogen sulfide pathway as a novel protective mechanism in a rat model of type 2 diabetes-induced liver injury. METHODS Thirty Sprague-Dawley rats underwent fasting for 12 h after which fasting blood glucose was measured and rats were randomly assigned to diabetic and non-diabetic groups. Type 2 diabetes mellitus (T2DM) was induced in diabetic group by administration of nicotinamide (110 mg/kg) and streptozotocin (55 mg/kg). Diabetic rats were treated daily with ALA (60 mg/kg/day p.o.) or 40 mg/kg/day DL-propargylglycine (PPG, an inhibitor of endogenous hydrogen sulfide production) for 6 weeks and then sacrificed. Liver, pancreas and blood samples were collected for analysis. Untreated T2DM rats received distilled water. RESULTS Hypoinsulinemia, hyperglycemia, hepatomegaly and reduced hepatic glycogen content were observed in untreated T2DM rats compared to healthy control group (p < 0.001). Also, the pancreas of untreated T2DM rats showed severely damaged pancreatic islets while liver damage was characterized by markedly increased hepatocellular vacuolation, sinusoidal enlargement, abnormal intrahepatic lipid accumulation, severe transaminitis, hyperbilirubinemia, and impaired hepatic antioxidant status and inflammation compared to healthy control rats (p < 0.01). While pharmacological inhibition of hepatic sulfane sulfur/hydrogen sulfide with PPG administration aggravated these pathological changes (p < 0.05), ALA strongly prevented these changes. ALA also significantly increased hepatic expression of hydrogen sulfide-producing enzymes (cystathionine γ-lyase and 3-mecaptopyruvate sulfurtransferase) as well as hepatic sulfane sulfur and hydrogen sulfide levels compared to all groups (p < 0.01). CONCLUSIONS To the best of our knowledge, this is the first experimental evidence showing that ALA prevents diabetes-induced liver injury by activating hepatic sulfane sulfur/hydrogen sulfide pathway via upregulation of hepatic cystathionine γ-lyase and 3-mecaptopyruvate sulfurtransferase expressions. Therefore, ALA could serve as a novel pharmacological agent for the treatment and prevention of diabetes-induced liver injury, with hepatic sulfane sulfur/hydrogen sulfide as a novel therapeutic target.
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Affiliation(s)
- George J Dugbartey
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Karl K Alornyo
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Ismaila Adams
- Department of Medical Pharmacology, University of Ghana Medical School, Korle-Bu, Accra, Ghana
| | - Stephen Atule
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Richard Obeng-Kyeremeh
- Department of Animal Experimentation, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Daniel Amoah
- Department of Animal Experimentation, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Samuel Adjei
- Department of Animal Experimentation, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
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Adeoye IA, Okekunle AP. Dietary patterns and associated factors among pregnant women in Ibadan, Nigeria: Evidence from Ibadan pregnancy cohort study. PLoS One 2022; 17:e0273796. [PMID: 36107862 PMCID: PMC9477303 DOI: 10.1371/journal.pone.0273796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Maternal nutrition is vital for an optimal intrauterine environment, foetal development, birth weight, pregnancy and neonatal outcomes. We assessed the maternal dietary patterns using a data-driven technique and the associated sociodemographic factors among pregnant women in Ibadan, Nigeria. Methodology Dietary assessment was performed during the enrolment of participants for the Ibadan Pregnancy Cohort Study, a prospective cohort study, conducted among 1745 pregnant women enrolled early in pregnancy (≤ 20 weeks) at four comprehensive obstetric facilities within the Ibadan metropolis. A qualitative food frequency questionnaire was used to assess the pregnant population’s intake of food and drinks three months prior to their enrollment. We determined dietary patterns by applying principal component analysis with a varimax rotation. Multivariate analysis was used to investigate the association between sociodemographic factors and dietary patterns at 5% statistical significance. Results Mean age and gestational age at enrolment were 29.8 (± 5.3) years and 16.4 (±4.2) weeks, respectively. White rice was the most frequently consumed meal [794 (45.5%) daily, 898 (51.4%)] weekly in our study population. Five major dietary patterns were identified, and they accounted for 28.8% of the total variation: "protein-rich diet with non-alcoholic beverages" (15.6%); "fruits" (4.1%); "typical diet with alcohol" (3.8%); "legumes" (2.8%), "refined grains" (2.6%). Maternal education and income were inversely associated with the consumption of a "protein-rich diet with non-alcoholic beverages", "typical diet with alcohol", and "legumes" in a dose-response fashion. Also, employed women had a higher mean intake of fruits [adjusted β: 0.33 (0.02; 0.65) p = 0.040] compared with women without employment. Conclusions and recommendation We described five dietary patterns of pregnant women using a data-driven technique, principal component analysis, in Nigeria. We also identified factors influencing maternal dietary patterns, which can inform public health interventions, especially behavioural change communication during antenatal care.
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Affiliation(s)
- Ikeola A. Adeoye
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Consortium for Advanced Research in Africa (CARTA), Nairobi, Kenya
- * E-mail:
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Delgado-Diaz DJ, Jesaveluk B, Hayward JA, Tyssen D, Alisoltani A, Potgieter M, Bell L, Ross E, Iranzadeh A, Allali I, Dabee S, Barnabas S, Gamieldien H, Blackburn JM, Mulder N, Smith SB, Edwards VL, Burgener AD, Bekker LG, Ravel J, Passmore JAS, Masson L, Hearps AC, Tachedjian G. Lactic acid from vaginal microbiota enhances cervicovaginal epithelial barrier integrity by promoting tight junction protein expression. Microbiome 2022; 10:141. [PMID: 36045402 PMCID: PMC9429363 DOI: 10.1186/s40168-022-01337-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Women with a cervicovaginal microbiota dominated by Lactobacillus spp. are at reduced risk of acquiring sexually transmitted infections including HIV, but the biological mechanisms involved remain poorly defined. Here, we performed metaproteomics on vaginal swab samples from young South African women (n = 113) and transcriptomics analysis of cervicovaginal epithelial cell cultures to examine the ability of lactic acid, a metabolite produced by cervicovaginal lactobacilli, to modulate genital epithelial barrier function. RESULTS Compared to women with Lactobacillus-depleted microbiota, women dominated by vaginal lactobacilli exhibit higher abundance of bacterial lactate dehydrogenase, a key enzyme responsible for lactic acid production, which is independently associated with an increased abundance of epithelial barrier proteins. Physiological concentrations of lactic acid enhance epithelial cell culture barrier integrity and increase intercellular junctional molecule expression. CONCLUSIONS These findings reveal a novel ability of vaginal lactic acid to enhance genital epithelial barrier integrity that may help prevent invasion by sexually transmitted pathogens. Video abstract.
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Affiliation(s)
- David Jose Delgado-Diaz
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Microbiology, Monash University, Clayton, VIC, 3168, Australia
| | - Brianna Jesaveluk
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Microbiology, Monash University, Clayton, VIC, 3168, Australia
| | - Joshua A Hayward
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Microbiology, Monash University, Clayton, VIC, 3168, Australia
| | - David Tyssen
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Arghavan Alisoltani
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Division of Biomedical Sciences, University of California Riverside School of Medicine, Riverside, CA, 92521, USA
| | - Matthys Potgieter
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Liam Bell
- Centre for Proteomic and Genomic Research, Cape Town, 7925, South Africa
| | - Elizabeth Ross
- Centre for Proteomic and Genomic Research, Cape Town, 7925, South Africa
| | - Arash Iranzadeh
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Imane Allali
- Laboratory of Human Pathologies Biology, Department of Biology, Faculty of Sciences, Mohammed V University in Rabat, 1014, Rabat, Morocco
| | - Smritee Dabee
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, 98101, USA
| | - Shaun Barnabas
- Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, 7505, South Africa
| | - Hoyam Gamieldien
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Jonathan M Blackburn
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
| | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Centre for Infectious Diseases Research (CIDRI) in Africa Wellcome Trust Centre, University of Cape Town, Cape Town, 7925, South Africa
| | - Steven B Smith
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Vonetta L Edwards
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Adam D Burgener
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Canada
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, 7925, South Africa
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jo-Ann S Passmore
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Centre for the AIDS Programme of Research in South Africa, Durban, 4013, South Africa
- National Health Laboratory Service, Cape Town, 7925, South Africa
| | - Lindi Masson
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Centre for the AIDS Programme of Research in South Africa, Durban, 4013, South Africa
- Central Clinical School, Monash University, Melbourne, 3004, Australia
| | - Anna C Hearps
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, 3004, Australia
| | - Gilda Tachedjian
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Microbiology, Monash University, Clayton, VIC, 3168, Australia.
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3010, Australia.
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Magutah K, Mbuthia G, Akiruga JA, Haile D, Thairu K. Effect of fixed 7.5 minutes' moderate intensity exercise bouts on body composition and blood pressure among sedentary adults with prehypertension in Western-Kenya. PLOS Glob Public Health 2022; 2:e0000806. [PMID: 36962441 PMCID: PMC10021634 DOI: 10.1371/journal.pgph.0000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 06/24/2022] [Indexed: 06/18/2023]
Abstract
Prehypertension is a modifiable risk factor for cardiovascular disease observed to affect an estimated 25-59% of global population and closely associated with body composition. Without appropriate interventions, one-third of individuals with prehypertension would develop full-blown hypertension within 4 years. The existing exercise recommendations need substitutes that appeal more yet accord similar or better outcomes in desire to halt this progression. This study evaluated the effect of Fixed 7.5-minute Moderate Intensity Exercise (F-7.5m-MIE) bouts on Body Composition and Blood Pressure (BP) among sedentary adults with prehypertension in Western-Kenya in a Randomized Control Trial (RCT) performed throughout the day compared to the single-continuous 30-60-minute bouts performed 3 to 5 times weekly. This RCT, with three arms of Experimental Group1 (EG1) performing the F-7.5m-MIE bouts, Experimental Group 2 (EG2) performing current World Health Organization (WHO) recommendation of ≥30-min bouts, and, control group (CG), was conducted among 665 consenting pre-hypertensive sedentary adults enrolled from western Kenya. EG1 and EG2 performed similar weekly cumulative minutes of moderate intensity exercises. Adherence was determined using activity monitors and exercise logs. Data regarding demographic characteristics, heart rate, BP, and anthropometric measures were collected at baseline and 12th week follow-up. Data regarding univariate, bivariate and multivariate (repeated measurements between and within groups) analysis were conducted using STATA version 13 at 5% level of significance. The study revealed that males (92.1% in EG1, 92% in EG2 and 96.3% in CG) and females (94.6% in EG1, 89.3% in EG2 and 95% in CG) in the three arms completed the exercise at follow-up respectively. At 12th week follow-up from all exercise groups, males' and females' measurements for waist-hip-ratio, waist-height-ratio, systolic BP (SBP), heart rate and pulse pressure showed significant drops from baseline, while diastolic BP (DBP) and body mass index (BMI) reported mixed results for males and females from the various treatments. Both treatments demonstrated favourable outcomes. However, differences in the change between baseline and endpoint yielded mixed outcomes (SBP; p<0.05 for both males and females, DBP; p<0.05 for males and females, waist-height-ratio; p = 0.01 and <0.05 for males and females respectively, waist-hip-ratio; P = 0.01 and >0.05 for males and females respectively, BMI; p>0.05 for both males and females, heart rate; p<0.05 for males and females and pulse pressure; p = 0.01 and >0.05 for males and females respectively). The study design however could not test for superiority. The study demonstrated that the F-7.5m- MIE treatment programme and the WHO recommended 3-5 times weekly bouts of 30-60 minutes regime produced comparably similar favourable outcomes in adherence and BP reductions with improved body composition. Trial registration: Trial registered with Pan African Clinical Trial Registry (www.pactr.org): no. PACTR202107584701552. (S3 Text).
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Affiliation(s)
- Karani Magutah
- Department of Medical Physiology, School of Medicine, Moi University, Eldoret, Kenya
| | - Grace Mbuthia
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - James Amisi Akiruga
- Department of Family Medicine, Medical Education and Community Health, Moi University School of Medicine, Eldoret, Kenya
| | - Diresibachew Haile
- Department of Medical Physiology, School of Medicine, Moi University, Eldoret, Kenya
| | - Kihumbu Thairu
- Department of Medical Physiology, School of Medicine, University of Nairobi, Nairobi, Kenya
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Adeniji FIP, Lawanson AO, Osungbade KO. The microeconomic impact of out-of-pocket medical expenditure on the households of cardiovascular disease patients in general and specialized heart hospitals in Ibadan, Nigeria. PLoS One 2022; 17:e0271568. [PMID: 35849602 PMCID: PMC9292125 DOI: 10.1371/journal.pone.0271568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Cardiovascular diseases (CVDs) present a huge threat to population health and in addition impose severe economic burden on individuals and their households. Despite this, there is no research evidence on the microeconomic impact of CVDs in Nigeria. Therefore, this study estimated the incidence and intensity of catastrophic health expenditures (CHE), poverty headcount due to out-of-pocket (OOP) medical spending and the associated factors among the households of a cohort of CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan, Nigeria.
Methods
This study adopts a descriptive cross-sectional study design. A standardized data collection questionnaire developed by the Initiative for Cardiovascular Health Research in Developing Countries was adapted to electronically collect data from all the 744 CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan between 4th November 2019 to the 31st January 2020. A sensitivity analysis, using rank-dependent thresholds of CHE which ranged from 5%-40% of household total expenditures was carried out. The international poverty line of $1.90/day recommended by the World Bank was utilized to ascertain poverty headcounts pre-and post OOP payments for healthcare services. Categorical variables like household socio-demographic and clinical characteristics, CHE and poverty headcounts, were presented using percentages and proportions. Unadjusted and adjusted logistic regression models were used to assess the factors associated with CHE and poverty. Data were analyzed using STATA version 15 and estimates were validated at 5% level of significance.
Results
Catastrophic OOP payment ranged between 3.9%-54.6% and catastrophic overshoot ranged from 1.8% to 12.6%. Health expenditures doubled poverty headcount among households, from 8.13% to 16.4%. Having tertiary education (AOR: 0.49, CI: 0.26–0.93, p = 0.03) and household size (AOR: 0.40, CI: 0.24–0.67, p = 0.001) were significantly associated with CHE. Being female (AOR: 0.41, CI: 0.18–0.92, p = 0.03), household economic status (AOR: 0.003, CI: 0.0003–0.25, p = <0.001) and having 3–4 household members (AOR: 0.30, CI: 0.15–0.61, p = 0.001) were significantly associated with household poverty status post payment for medical services.
Conclusion
OOP medical spending due to CVDs imposed enormous strain on household resources and increased the poverty rates among households. Policies and interventions that supports universal health coverage are highly recommended.
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Affiliation(s)
- Folashayo Ikenna Peter Adeniji
- Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
- * E-mail:
| | - Akanni Olayinka Lawanson
- Department of Economics, Faculty of Economics & Management Sciences, University of Ibadan, Ibadan, Nigeria
| | - Kayode Omoniyi Osungbade
- Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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Ssemugabo C, Bradman A, Ssempebwa JC, Sillé F, Guwatudde D. Pesticide Residues in Fresh Fruit and Vegetables from Farm to Fork in the Kampala Metropolitan Area, Uganda. Environ Health Insights 2022; 16:11786302221111866. [PMID: 35846167 PMCID: PMC9277444 DOI: 10.1177/11786302221111866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
This study assessed concentrations of pesticide residues in fruits and vegetables from farm-to-fork in Kampala Metropolitan Area, Uganda. A total of 160 samples of fruit and vegetables collected from farms, markets, streets, restaurants and homes were analysed using liquid chromatography-tandem mass spectrometry; and Gas Chromatograph-Mass Spectrometer for dithiocarbamates. Multiple pesticide residues were detected in majority of the samples (95.6%). The proportions of the most frequently detected pesticides residue classes were organophosphates (91.3%), carbamates (67.5%), pyrethroids (60.0%) dithiocarbamates (48.1%) and neonicotinoids (42.5%). Among organophosphates, propotamophos, acephate, fonofos, monocrotophos and dichlorvos were the most detected active ingredients; aminocarb, methomyl and pirimicarb were the commonly detected carbamates; while imidacloprid, a neonicotinoid and lambda-cyhalothrin, pyrethroid were also highly detected. Twenty-seven pesticide were tested at all stages, of which the concentrations either decreased or increased along the chain. Multiple pesticide residues occurred in commonly consumed fruit and vegetables with decreasing or increasing concentrations from farm-to-fork.
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Affiliation(s)
- Charles Ssemugabo
- Department of Disease Control and
Environmental Health, School of Public Health, Makerere University College of Health
Sciences, Kampala, Uganda
| | - Asa Bradman
- Department of Public Health, School of
Social Sciences, Humanities and Arts; University of California Merced, Merced, CA,
USA
- Center for Children’s Environmental
Health Research, School of Public Health, University of California, Berkeley, CA,
USA
| | - John C. Ssempebwa
- Department of Disease Control and
Environmental Health, School of Public Health, Makerere University College of Health
Sciences, Kampala, Uganda
| | - Fenna Sillé
- Department of Environmental Health and
Engineering, The Johns Hopkins University Bloomberg School of Public Health,
Baltimore, MD, USA
| | - David Guwatudde
- Department of Epidemiology and
Biostatistics, School of Public Health, Makerere University College of Health
Sciences, Kampala, Uganda
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Letting FK, Venkataramana PB, Ndakidemi PA. Farmers' Participatory Plant Selection of Lablab ( Lablab purpureus (L.) Sweet) in Tanzania. Front Plant Sci 2022; 13:784032. [PMID: 35812964 PMCID: PMC9261736 DOI: 10.3389/fpls.2022.784032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
Farmer-participatory breeding approach is an important component in the crop improvement of lablab (Lablab purpureus (L.) Sweet). The study was carried out to obtain the knowledge, practices and preferences of lablab through 31 lablab growing-farmers from Arusha, Kondoa, Karatu, Same and Babati districts of Tanzania toward initiating a lablab breeding program. Semi-structured questionnaires were administered and focused group discussions were held to collect data on the socio-demographic factors, production practices, constraints and farmer's preferred traits of lablab. Selection of preferred traits and accessions was also done by the farmers in the field. Results showed that the chief constraints of lablab production are pests and diseases, poor marketability, low seed quality, inadequate rainfall, expensive agrochemicals, low yield, and poor storage facilities. The major pests are pod borer (field) and bruchids (storage). Preferred traits for lablab improvement include the development of insect pests and disease-resistant varieties, early maturing, high yield, black colored seed for market, short cooking time, and dense foliage. Genotypes EK2, D360, HA4, and D96 with preferred traits were identified by farmers, which forms critical decisions in crop improvement. This study describes the current view of lablab production and generates the understanding of farmers' perceptions and preferences vital for breeding priorities and programs to increase its production, utilization and consumption.
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Affiliation(s)
- Fanuel K. Letting
- Department of Sustainable Agriculture, Biodiversity and Ecosystems Management, School of Life Sciences and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Department of Seed, Crop and Horticultural Sciences, School of Agriculture and Biotechnology, University of Eldoret, Eldoret, Kenya
| | - Pavithravani B. Venkataramana
- Department of Sustainable Agriculture, Biodiversity and Ecosystems Management, School of Life Sciences and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Patrick A. Ndakidemi
- Department of Sustainable Agriculture, Biodiversity and Ecosystems Management, School of Life Sciences and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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Webb EL, Dietrich JJ, Ssemata AS, Nematadzira TG, Hornschuh S, Kakande A, Tshabalala G, Muhumuza R, Mutonyi G, Atujuna M, Bere T, Bekker LG, Abas MA, Weiss HA, Seeley J, Stranix-Chibanda L, Fox J. Symptoms of post-traumatic stress and associations with sexual behaviour and PrEP preferences among young people in South Africa, Uganda and Zimbabwe. BMC Infect Dis 2022; 22:466. [PMID: 35578175 PMCID: PMC9109411 DOI: 10.1186/s12879-022-07430-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND It is not known whether post-traumatic stress disorder (PTSD) increases HIV-risk behaviours among young people in sub-Saharan Africa. We assessed associations of PTSD symptoms with sexual behaviour, HIV risk perception, and attitudes towards PrEP among young people taking part in the CHAPS community survey. We hypothesised that PTSD symptoms would increase sexual behaviours associated with HIV risk, hinder PrEP uptake and influence preference for daily versus on-demand PrEP. METHODS Young people without HIV, aged 13-24 years, were purposively recruited in Johannesburg and Cape Town in South Africa, Wakiso in Uganda, and Chitungwiza in Zimbabwe, and surveyed on socio-demographic characteristics, PrEP knowledge and attitudes, sexual behaviour, HIV perception and salience, and mental health. PTSD symptoms were measured using the Primary Care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders 5 (PC-PTSD-5). Logistic and ordinal logistic regression was used to assess associations between PC-PTSD-5 score and socio-demographic characteristics, sexual behaviour, HIV risk perception, PrEP attitudes, and substance use, adjusting for age, sex, setting, depression and anxiety. RESULTS Of 1330 young people (51% male, median age 19 years), 522 (39%) reported at least one PTSD symptom. There was strong evidence that having a higher PC-PTSD-5 score was associated with reported forced sex (OR 3.18, 95%CI: 2.05-4.93), self-perception as a person who takes risks (OR 1.12, 95%CI: 1.04-1.20), and increased frequency of thinking about risk of HIV acquisition (OR 1.16, 95%CI: 1.08-1.25). PTSD symptoms were not associated with willingness to take PrEP, preference for on-demand versus daily PrEP, or actual HIV risk behaviour such as condomless sex. CONCLUSIONS Symptoms consistent with probable PTSD were common among young people in South Africa, Uganda and Zimbabwe but did not impact PrEP attitudes or PrEP preferences. Evaluation for PTSD might form part of a general assessment in sexual and reproductive health services in these countries. More work is needed to understand the impact of PTSD on HIV-risk behaviour, forced sex and response to preventive strategies including PrEP.
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Affiliation(s)
- Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK.
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa
- African Social Sciences Unit of Research and Evaluation (ASSURE), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Stefanie Hornschuh
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ayoub Kakande
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Gugulethu Tshabalala
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Millicent Atujuna
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Tarisai Bere
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Melanie A Abas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Lynda Stranix-Chibanda
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Gumede SB, Venter F, de Wit J, Wensing A, Lalla-Edward ST. Antiretroviral therapy uptake and predictors of virological failure in patients with HIV receiving first-line and second-line regimens in Johannesburg, South Africa: a retrospective cohort data analysis. BMJ Open 2022; 12:e054019. [PMID: 35428623 PMCID: PMC9013990 DOI: 10.1136/bmjopen-2021-054019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study described the demographics, treatment information and identified characteristics associated with virological failure and being lost to follow-up (LTFU) for patients with HIV on first-line and second-line antiretroviral therapy (ART) regimens in a large South African cohort. DESIGN A quantitative retrospective cohort study using secondary data analysis. SETTING Seven Johannesburg inner city facilities. PARTICIPANTS Unique records of 123 002 people with HIV receiving ART at any point in the period 1 April 2004 to 29 February 2020 were included. MEASURES Demographic characteristics, ART status, CD4 count information and retention status were collected and analysed as covariates of outcomes (viral load (VL) and LTFU). RESULTS Of the total study patients, 95% (n=1 17 260) were on a first-line regimen and 5% (n=5742) were on a second-line regimen. Almost two-thirds were female (64%, n=79 226). Most patients (60%, n=72 430) were initiated on an efavirenz-based, tenofovir disoproxil fumarate-based and emtricitabine-based regimen (fixed-dose combination). 91% (n=76 737) achieved viral suppression at least once since initiating on ART and 60% (n=57 981) remained in care as at the end of February 2020. Patients from the community health centre and primary healthcare clinics were not only more likely to be virally suppressed but also more likely to be LTFU. Patients on second-line regimens were less likely to reach viral suppression (adjusted OR (aOR)=0.26, CI=0.23 to 0.28) and more likely to be LTFU (aOR=1.21, CI=1.09 to 1.35). Being older (≥25 years) and having a recent CD4 cell count≥100 cells/µL were predictors of viral suppression and retention in patients on ART. CONCLUSION Patients on first-line regimens had higher VL suppression rates and were more likely to remain in care than those on a second-line regimen. Being younger and having low CD4 cell counts were associated with poor outcomes, suggesting priority groups for ART adherence support.
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Affiliation(s)
- Siphamandla Bonga Gumede
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Annemarie Wensing
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Adeomi AA, Fatusi A, Klipstein-Grobusch K. 'Children eat all things here': a qualitative study of mothers' perceptions and cultural beliefs about underweight and overweight children and adolescents in selected communities in two Nigerian states. BMJ Open 2022; 12:e059020. [PMID: 35387832 PMCID: PMC8987745 DOI: 10.1136/bmjopen-2021-059020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The perception of mothers about causes of underweight and overweight among children or adolescents and associated cultural beliefs may influence nutritional status. However, data from qualitative studies on this subject and regarding age 6-19 are scarce in Nigeria. OBJECTIVE This study aimed to explore mothers' perceptions and cultural beliefs about underweight and overweight children and adolescents in selected communities in a northern and a southern Nigerian state. DESIGN This was a qualitative study using focus group discussions (FGD). Eight FGD sessions were held. The interviews were transcribed verbatim, and the transcripts were coded and analysed using NVivo V.11, and direct quotations representing the themes generated from the perspectives were cited as appropriate. SETTING The study was carried out in eight randomly selected rural and urban communities in Gombe and Osun states of Nigeria. PARTICIPANTS Seventy-six mothers of children and adolescents aged 6-19 years. RESULTS The mothers identified concepts, causes and community experience of underweight and overweight children and adolescents, however, some gaps and misconceptions were observed. These included perspectives that suggest a limited understanding of the concepts of mild and moderate malnutrition and stunting and citing of 'witches and wizards' as causes of malnutrition. The mothers observed that being underweight was more prevalent in rural communities of Osun and Gombe states, while overweight was more prevalent in urban communities in Osun state. The majority of the women reported no known food taboo or restrictions, and no cultural beliefs relating to the nutrition of children and adolescents. CONCLUSION Gaps and misconceptions exist in the perceptions of mothers on underweight and overweight children and adolescents. Food taboos, food restrictions and other cultural beliefs were not reported by majority of the mothers. Educational programmes for mothers on child/adolescent nutrition should target identified gaps and misconceptions.
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Affiliation(s)
- Adeleye Abiodun Adeomi
- Community Health, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Adesegun Fatusi
- Community Health, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
- Community Medicine, University of Medical Sciences, New York, Ondo, Nigeria
| | - Kerstin Klipstein-Grobusch
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
- Division of Epidemiology & Biostatistics, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
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Mutz DC. Effects of changes in perceived discrimination during BLM on the 2020 presidential election. Sci Adv 2022; 8:eabj9140. [PMID: 35235354 PMCID: PMC8890711 DOI: 10.1126/sciadv.abj9140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
Few Americans change their choice of presidential candidate to a different political party from election to election. This study evaluates whether and in what direction the Black Lives Matter movement affected the small percentage of voters whose presidential votes changed from 2016 to 2020. Six waves of nationally representative probability surveys are used to establish that significant increases in the extent to which Americans perceived discrimination against Blacks and to which people favored more government efforts to address racial inequality both occurred in 2020. Using panel data, results suggest that increases in perceptions of racial inequality significantly increased the probability of vote switching toward the Democratic candidate. Attention to racial injustice also primed voters to rely more heavily on this issue when evaluating candidates.
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Affiliation(s)
- Diana C Mutz
- Department of Political Science and Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Exposure to fungal pathogens from the environment is inevitable and with the number of at-risk populations increasing, the prevalence of invasive fungal infection is on the rise. An interesting group of fungal organisms known as thermally dimorphic fungi predominantly infects immunocompromised individuals. These potential pathogens are intriguing in that they survive in the environment in one form, mycelial phase, but when entering the host, they are triggered by the change in temperature to switch to a new pathogenic form. Considering the growing prevalence of infection and the need for improved diagnostic and treatment approaches, studies identifying key components of fungal recognition and the innate immune response to these pathogens will significantly contribute to our understanding of disease progression. This review focuses on key endemic dimorphic fungal pathogens that significantly contribute to disease, including Histoplasma, Coccidioides and Talaromyces species. We briefly describe their prevalence, route of infection and clinical presentation. Importantly, we have reviewed the major fungal cell wall components of these dimorphic fungi, the host pattern recognition receptors responsible for recognition and important innate immune responses supporting adaptive immunity and fungal clearance or the failure thereof.
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Affiliation(s)
- Maxine A. Höft
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town 7925, South Africa
- Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- MRC Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
| | - Lucian Duvenage
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town 7925, South Africa
- Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- MRC Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
| | - J. Claire Hoving
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town 7925, South Africa
- Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- MRC Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
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Sekoni O, Mall S, Christofides N. The relationship between protective factors and common mental disorders among female urban slum dwellers in Ibadan, Nigeria. PLoS One 2022; 17:e0263703. [PMID: 35134096 PMCID: PMC8824382 DOI: 10.1371/journal.pone.0263703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND On the African continent, many people live in conditions of adversity known to be associated with the onset of mental disorders, yet not all develop a mental disorder. The prevalence of common mental disorders such as depression and anxiety in the general population of Nigeria is comparatively low. Prevalence data of mental disorders in slum settings in Nigeria is sparse. There is a need to better understand the relationship between protective factors and the occurrence of common mental disorders in the Nigerian slum context. This study aimed to describe the relationship between protective factors and the occurrence of common mental disorders among female urban slum dwellers in Ibadan, Nigeria. METHODS AND FINDINGS A cross sectional household survey of 550 women was conducted in slum settlements in Ibadan, Nigeria. Interviewer administered questionnaires were completed to elicit information on protective factors (social connectedness, self-esteem, social support, resilience) and common mental disorders (depression, anxiety and stress). The DASS-21 was used to measure common mental disorders and protective factors were measured using the Social Connectedness Scale, Multidimensional Scale of Perceived Social Support, Resilience scale and the Rosenberg Self Esteem Scale. A multivariable logistic regression model was employed to examine associations while adjusting for relevant confounders. Common mental disorders were reported by 14.0% of the respondents. Resilience and social support were found to be protective against reporting symptoms of common mental disorders. Women who reported higher levels of social support and resilience were less likely to report common mental disorders (OR:0.96, 95% CI 0.93, 0.98) and (OR:0.95, 95% CI 0.91, 0.99) respectively. Women who were 65 years and older were also less likely to report the occurrence of common mental disorders (OR:0.38, 95% CI 0.15, 0.98) compared to those aged 18-34 years. CONCLUSION Social support and resilience appear to be protective against common mental disorders among these respondents. Further research should be conducted to explore the pathways through which protective factors reduce the likelihood of the occurrence of common mental disorders. This would be important in the development of mental health interventions.
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Affiliation(s)
- Olutoyin Sekoni
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- School of Public Health, University of the Witwatersrand, Johannesburg, Guateng, South Africa
| | - Sumaya Mall
- School of Public Health, University of the Witwatersrand, Johannesburg, Guateng, South Africa
| | - Nicola Christofides
- School of Public Health, University of the Witwatersrand, Johannesburg, Guateng, South Africa
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Howey MC, DeLucia CM. Spectacles of Settler Colonial Memory: Archaeological Findings from an Early Twentieth-Century "First" Settlement Pageant and Other Commemorative Terrain in New England. Int J Hist Archaeol 2022; 26:974-1007. [PMID: 35002216 PMCID: PMC8720164 DOI: 10.1007/s10761-021-00635-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 06/14/2023]
Abstract
In 1923, rural New England mill town Dover, New Hampshire, staged a Tercentenary pageant of extraordinary proportions to celebrate its "first" settlement. This public spectacle memorialized a specific, and deeply exclusionary, narrative of English settler colonialism, shaped by social anxieties of the post-First World War United States. Recent archaeological research has found possible remnants from this spectacle on a seventeenth-century site. In disturbing this site, the Tercentenary pageant appears to have disregarded actual significant material traces from the very era it aimed to memorialize--traces that offer distinct, fuller understandings of deeply nuanced Native-settler interactions in the Piscataqua River region. Dover's pageant is situated in a regional analysis of Native and Euro-colonial commemorative place-making of the early twentieth century, exploring how different communities pursued multivocal, monovocal, or other approaches in their performative engagements with the seventeenth century.
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Affiliation(s)
- Meghan C.L. Howey
- Anthropology Department, University of New Hampshire, 73 Main Street, Durham, NH 03824 USA
- Earth Systems Research Center, Institute for the Study of Earth, Oceans and Space, University of New Hampshire, Morse Hall, Durham, NH 03824 USA
| | - Christine M. DeLucia
- History Department, Williams College, Hollander Hall, Williamstown, MA 01267 USA
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Zhao J, Demir F, Ghosh PK, Earley A, Kim M. Reforming the countermeasures injury compensation program for COVID-19 and beyond: An economic perspective. J Law Biosci 2022; 9:lsac008. [PMID: 35382431 PMCID: PMC8977129 DOI: 10.1093/jlb/lsac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/05/2022] [Indexed: 05/25/2023]
Abstract
As of Aug. 2, 2021, 1693 injury claims associated with COVID-19 medical countermeasures have been filed in the Countermeasures Injury Compensation Program (CICP), of which 686 claims were related to COVID-19 vaccines and urgently needed compensation decisions. However, from an economic and public policy perspective, we find that the CICP design has unintended consequences: locating CICP in the executive agency DHHS potentially creates a conflict of interest, and not permitting judicial review generates a lack of checks and balances, both of which could jeopardize justice. These fundamental problems would subsequently weaken four key performance indicators of CICP compared with its judicial counterpart in the Court of Federal Claims. CICP lacks accountability, transparency, and cost-effectiveness efficiency, with 94% of its total costs spent on administration rather than compensation. CICP's ability to compensate is also questionable. If COVID-19 claims were compensated at its historical rate, CICP would face around $21.16 million in compensation outlays and $317.94 million in total outlays, 72.1 times its current balance. To ensure just compensation for injured petitioners during COVID-19 and future public health emergencies, we recommend Congress (1) initiate a major reform by relocating CICP from DHHS to the Claims Court or (2) keep CICP within DHHS and make incremental changes by permitting judicial review of DHHS administrative adjudication of CICP claims. We further recommend Congress audit and adjust budgets for CICP and DHHS promptly propose an injury table for COVID-19 claims. This is the first study that contributes an economic perspective to the limited literature on CICP and also provides unique and rich economic data.
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Johnson WG, Bowman DM. Inherited regulation for advanced ARTs: comparing jurisdictions' applications of existing governance regimes to emerging reproductive technologies. J Law Biosci 2022; 9:lsab034. [PMID: 35145707 PMCID: PMC8825444 DOI: 10.1093/jlb/lsab034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/20/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Over the past 5 years, advanced assisted reproductive technologies (ARTs), such as mitochondrial replacement therapies (MRTs) and heritable human genome editing (HHGE), have raised global policy concerns and fears of 'unregulated' proliferation. Yet, few innovations are ever truly unregulated and more often fall within the scope of one or more pre-existing regulatory regimes, a process referred to as 'inherited regulation'. While the United Kingdom has enacted new legislation to specifically authorize and closely regulate MRTs, many jurisdictions will likely default to current oversight systems to manage advanced ARTs. This article evaluates and compares how several jurisdictions have already used four types of inherited regulatory regimes to manage MRTs and HHGE. Cases are drawn from jurisdictions where inherited regulatory interventions on advanced ARTs have taken place (USA, Greece, Ukraine, China, and Russia) and include jurisdictions closely connected with those cases (Mexico and Spain). When accounting for political, cultural, and religious contexts, many of these inherited regimes offer promise as starting points for governance of advanced ARTs, yet each will require further adjustments and tailoring to adequately manage the benefits and risks of these powerful innovations.
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Affiliation(s)
- Walter G Johnson
- Sandra Day O’Connor College of Law, Arizona State University, 111 E Taylor Street, Phoenix, AZ 85004, USA
| | - Diana M Bowman
- Sandra Day O’Connor College of Law, Arizona State University, 111 E Taylor Street, Phoenix, AZ 85004, USA
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Gumede SB, de Wit JBF, Venter WDF, Lalla-Edward ST. Study protocol: Strengthening understanding of effective adherence strategies for first-line and second-line antiretroviral therapy (ART) in selected rural and urban communities in South Africa. PLoS One 2021; 16:e0261107. [PMID: 34932588 PMCID: PMC8691643 DOI: 10.1371/journal.pone.0261107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022] Open
Abstract
Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel convergent study will be conducted in seven high volume public health facilities in Gauteng and one in Limpopo province in South Africa. The study consists of four phases; a retrospective secondary data analysis of a large cohort of patients on ART (using TIER.Net, an ART patient and data management system for recording and monitoring patients on ART and tuberculosis (TB)) from seven Johannesburg inner-city public health facilities (Gauteng province); a secondary data analysis of the Intensified Treatment Monitoring Accumulation (ITREMA) trial (a randomized control trial which ran from June 2015 to January 2019) conducted at the Ndlovu Medical Center (Limpopo province); in-depth interviews with people living with Human Immunodeficiency Virus (PLHIV) who are taking ART (in both urban and rural settings); and a systematic review of the impact of treatment adherence interventions for chronic conditions in sub-Saharan Africa. Data will be collected on demographics, socio-economic status, treatment support, retention in care status, disclosure, stigma, clinical markers (CD4 count and viral load (VL)), self-reported adherence information, intrapersonal, and interpersonal factors, community networks, and policy level factors. The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting and Population, Interventions, Comparisons and Outcomes (PICO) criteria. Analyses will involve tests of association (Chi-square and t-test), thematic analysis (deductive and inductive approaches) and network meta-analysis. Using an integrated multilevel socio-ecological framework this study will describe the factors associated with adherence for PLHIV who are taking first-line or second-line ART. Implementing evidence-based adherence approaches, when taken up, will improve patient's overall health outcomes. Our study results will provide guidance regarding context-specific intervention strategies to improve ART adherence.
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Affiliation(s)
- Siphamandla Bonga Gumede
- Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Faculty of Social and Behavioural Sciences, Department of Interdisciplinary Social Science, Utrecht University, The Netherlands
| | - John Benjamin Frank de Wit
- Faculty of Social and Behavioural Sciences, Department of Interdisciplinary Social Science, Utrecht University, The Netherlands
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Stander J, Chabeda A, Rybicki EP, Meyers AE. A Plant-Produced Virus-Like Particle Displaying Envelope Protein Domain III Elicits an Immune Response Against West Nile Virus in Mice. Front Plant Sci 2021; 12:738619. [PMID: 34589108 PMCID: PMC8475786 DOI: 10.3389/fpls.2021.738619] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/13/2021] [Indexed: 05/27/2023]
Abstract
West Nile virus (WNV) is a globally disseminated Flavivirus that is associated with encephalitis outbreaks in humans and horses. The continuous global outbreaks of West Nile disease in the bird, human, and horse populations, with no preventative measures for humans, pose a major public health threat. The development of a vaccine that contributes to the "One Health" Initiative could be the answer to prevent the spread of the virus and control human and animal disease. The current commercially available veterinary vaccines are generally costly and most require high levels of biosafety for their manufacture. Consequently, we explored making a particulate vaccine candidate made transiently in plants as a more cost-effective and safer means of production. A WNV virus-like particle-display-based vaccine candidate was generated by the use of the SpyTag/SpyCatcher (ST/SC) conjugation system. The WNV envelope protein domain III (EDIII), which contains WNV-specific epitopes, was fused to and displayed on AP205 phage virus-like particles (VLPs) following the production of both separately in Nicotiana benthamiana. Co-purification of AP205 and EDIII genetically fused to ST and SC, respectively, resulted in the conjugated VLPs displaying EDIII with an average coupling efficiency of 51%. Subcutaneous immunisation of mice with 5 μg of purified AP205: EDIII VLPs elicited a potent IgG response to WNV EDIII. This study presents the potential plants being used as biofactories for making significant pharmaceutical products for the "One Health" Initiative and could be used to address the need for their local production in low- and middle-income countries (LMICs).
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Affiliation(s)
- Jennifer Stander
- Biopharming Research Unit, Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Aleyo Chabeda
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Edward P. Rybicki
- Biopharming Research Unit, Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Ann E. Meyers
- Biopharming Research Unit, Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
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Obembe TA, Levin J, Fonn S. Prevalence and factors associated with catastrophic health expenditure among slum and non-slum dwellers undergoing emergency surgery in a metropolitan area of South Western Nigeria. PLoS One 2021; 16:e0255354. [PMID: 34464387 PMCID: PMC8407567 DOI: 10.1371/journal.pone.0255354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Out of Pocket (OOP) payment continues to persist as the major mode of payment for healthcare in Nigeria despite the introduction of the National Health Insurance Scheme (NHIS). Although the burden of health expenditure has been examined in some populations, the impact of OOP among slum dwellers in Nigeria when undergoing emergencies, is under-researched. This study sought to examine the prevalence, factors and predictors of catastrophic health expenditure amongst selected slum and non-slum communities undergoing emergency surgery in Southwestern Nigeria. METHODS The study utilised a descriptive cross-sectional survey design to recruit 450 households through a multistage sampling technique. Data were collected using pre-tested semi-structured questionnaires in 2017. Factors considered for analysis relating to the payer were age, sex, relationship of payer to patient, educational status, marital status, ethnicity, occupation, income and health insurance coverage. Variables factored into analysis for the patient were indication for surgery, grade of hospital, and type of hospital. Households were classified as incurring catastrophic health expenditure (CHE), if their OOP expenditure exceeded 5% of payers' household budget. Analysis of the data took into account the multistage sampling design. RESULTS Overall, 65.6% (95% CI: 55.6-74.5) of the total population that were admitted for emergency surgery, experienced catastrophic expenditure. The prevalence of catastrophic expenditure at 5% threshold, among the population scheduled for emergency surgeries, was significantly higher for slum dwellers (74.1%) than for non-slum dwellers (47.7%) (F = 8.59; p = 0.019). Multiple logistic regression models revealed the significant independent factors of catastrophic expenditure at the 5% CHE threshold to include setting of the payer (whether slum or non-slum dweller) (p = 0.019), and health insurance coverage of the payer (p = 0.012). Other variables were nonetheless significant in the bivariate analysis were age of the payer (p = 0.017), income (p<0.001) and marital status of the payer (p = 0.022). CONCLUSION Although catastrophic health expenditure was higher among the slum dwellers, substantial proportions of respondents incurred catastrophic health expenditure irrespective of whether they were slum or non-slum dwellers. Concerted efforts are required to implement protective measures against catastrophic health expenditure in Nigeria that also cater to slum dwellers.
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Affiliation(s)
- Taiwo A. Obembe
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jonathan Levin
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Sharon Fonn
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Sekoni O, Mall S, Christofides N. Prevalence and factors associated with PTSD among female urban slum dwellers in Ibadan, Nigeria: a cross-sectional study. BMC Public Health 2021; 21:1546. [PMID: 34384401 PMCID: PMC8359091 DOI: 10.1186/s12889-021-11508-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 07/19/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of and factors associated with PTSD among adult females in Nigeria, particularly those who live in slums. PTSD is a mental health condition that develops among some individuals who experience or witness a traumatic event. Several other factors could place individuals at heightened risk of PTSD including stress and comorbid mental disorders. Therefore, this study aimed to examine the prevalence and factors associated with PTSD among female urban slum dwellers in Ibadan, Nigeria. METHODS We conducted a cross sectional survey using multistage sampling of 550 women aged 18 and above from selected slums. Interviewer administered questionnaires were used to elicit information on experience of childhood trauma, recent stressors, intimate partner violence, other mental disorders, sociodemographic characteristics and PTSD. PTSD was measured using the Harvard Trauma Questionnaire (HTQ) which is based on DSM IV. A multivariable linear regression model was built to test associations between PTSD and independent variables. RESULTS The prevalence for PTSD was found to be 4.18% and the mean PTSD score was 5.80 ± 7.11. Sexual abuse in childhood, past year intimate partner violence and anxiety were significantly associated with higher PTSD scores. PTSD was not significantly associated with a history of recent stressors. Education, employment and marital status were not associated with PTSD however, age and wealth index showed marginal association with PTSD. CONCLUSION The prevalence of PTSD among women living in Ibadan slums was relatively low. Both child sexual abuse and intimate partner violence can be prevented. We also recommend longitudinal studies to better understand risk and protective factors.
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Affiliation(s)
- Olutoyin Sekoni
- Department of Community Medicine, College of Medicine, University of Ibadan, Queen Elizabeth Road, Ibadan, Nigeria.
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, South Africa.
| | - Sumaya Mall
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, South Africa
| | - Nicola Christofides
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, South Africa
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Zakumumpa H, Makobu K, Ntawiha W, Maniple E. A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda. PLoS One 2021; 16:e0254214. [PMID: 34292984 PMCID: PMC8297836 DOI: 10.1371/journal.pone.0254214] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 06/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Since 2017, Uganda has been implementing five differentiated antiretroviral therapy (ART) delivery models to improve the quality of HIV care and to achieve health-system efficiencies. Community-based models include Community Client-Led ART Delivery and Community Drug Distribution Points. Facility-based models include Fast Track Drug Refill, Facility Based Group and Facility Based Individual Management. We set out to assess the extent of uptake of these ART delivery models and to describe barriers to uptake of either facility-based or community-based models. Methods Between December 2019 and February 2020, we conducted a mixed-methods study entailing a cross-sectional health facility survey (n = 116) and in-depth interviews (n = 16) with ART clinic managers in ten case-study facilities as well as six focus group discussions (56 participants) with patients enrolled in differentiated ART models. Facilities were selected based on the 10 geographic sub-regions of Uganda. Statistical analyses were performed in STATA (v13) while qualitative data were analysed by thematic approach. Results Most facilities 63 (57%) commenced implementation of differentiated ART delivery in 2018. Fast Track Drug Delivery was the most common facility-based model (implemented in 100 or 86% of health facilities). Community Client-Led ART Delivery was the most popular community model (63/116 or 54%). Community Drug Distribution Points had the lowest uptake with only 33 (24.88%) facilities implementing them. By ownership-type, for-profit facilities reported the lowest uptake of differentiated ART models. Barriers to enrolment in community-based models include HIV-related stigma and low enrolment of adult males in community models. Conclusion To the best of our knowledge this is the first study reporting national coverage of differentiated ART delivery models in Uganda. Overall, there has been a higher uptake of facility-based models. Interventions for enhancing the uptake of differentiated ART models in for-profit facilities are recommended.
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Affiliation(s)
- Henry Zakumumpa
- Makerere University, School of Public Health, Kampala, Uganda
- * E-mail:
| | - Kimani Makobu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Everd Maniple
- Kabale University, School of Medicine, Kabale, Uganda
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Morakinyo OM, Adebowale AS, Obembe TA, Oloruntoba EO. Association between household environmental conditions and nutritional status of women of childbearing age in Nigeria. PLoS One 2020; 15:e0243356. [PMID: 33306726 PMCID: PMC7732090 DOI: 10.1371/journal.pone.0243356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 11/20/2020] [Indexed: 11/18/2022] Open
Abstract
Maternal undernutrition remains a leading cause of morbidity and mortality in Nigeria. Yet, most interventional programmes are focused on infant and child nutrition outcomes and not on maternal nutrition‐related outcomes. Evidence suggests that the integration of household environmental interventions into nutrition actions can make a difference in reducing the burden of maternal undernutrition. This study examined the influence of household environmental conditions (HHEC) on the nutritional status of women of childbearing age in Nigeria using secondary data from the 2013 Nigeria Demographic and Health Survey. The original sample of 38,948 women age 15–49 years was selected using multi-stage probability sampling. The sample for the current analysis was 23,344 after exclusion of women due to health status or provision of incomplete information. The dependent and main independent variables were undernutrition (defined as Body Mass Index below 18.5) and HHEC (generated from cooking fuel, toilet type, source of drinking water, and housing materials) respectively. Data were analysed using descriptive statistics, Chi-square, and logistic regression model at 5% level of significance. The prevalence of undernutrition among women living in houses with unimproved and improved HHEC was 17.2% and 7.2% respectively. The adjusted odds of undernutrition was significantly higher among women who lived in houses with unimproved HHEC (aOR = 2.02, C.I = 1.37–2.97, p <0.001). The odds of undernutrition are greater in young women (aOR = 2.38, C.I. = 1.88–3.00, p <0.001) compared to older, and those of lower wealth status (aOR = 2.14, CI = 1.69–2.71, p <0.001) compared to higher. Other predictors of undernutrition in women of reproductive age in Nigeria include the level of education, marital status, and working status. Living in a house with unimproved environmental conditions is a predictor of undernutrition in women. The integration of environmental and nutrition programmes could assist in addressing this burden in Nigeria.
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Affiliation(s)
- Oyewale Mayowa Morakinyo
- Faculty of Public Health, Department of Environmental Health Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- * E-mail:
| | - Ayo Stephen Adebowale
- Faculty of Public Health, Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Taiwo Akinyode Obembe
- Faculty of Public Health, Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elizabeth Omoladun Oloruntoba
- Faculty of Public Health, Department of Environmental Health Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
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