Showing papers by "Makerere University published in 2020"
University Hospital Bonn1, University of Miami2, All India Institute of Medical Sciences3, University of the Witwatersrand4, University of Texas MD Anderson Cancer Center5, University of Panama6, Kenyatta National Hospital7, University of Navarra8, Indiana University9, Mongolian National University10, King's College London11, University of Lausanne12, Makerere University13, American University of Beirut14, George Washington University15, University of Oxford16, Catholic University of Korea17
TL;DR: The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span.
332 citations
TL;DR: To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—the authors estimated additional population equivalents with UHC effective coverage from 2018 to 2023, and quantified frontiers of U HC effective coverage performance on the basis of pooled health spending per capita.
304 citations
Royal Veterinary College1, University of Ghana2, Ambrose Alli University3, Mercy Medical Center (Baltimore, Maryland)4, University of KwaZulu-Natal5, University of London6, University of Khartoum7, Sokoine University of Agriculture8, National Institute for Medical Research9, Kilimanjaro Christian Medical College10, Makerere University11, Zambian Ministry of Health12, University College London13, Queen Mary University of London14
TL;DR: While lockdown measures may have helped inhibit community transmission, the pattern and nature of the epidemic remains unclear and there are signs of lockdown harming health by affecting the functioning of the health system and causing social and economic disruption.
Abstract: Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. However, the term ‘lockdown’ is not well-defined. Indeed, WHO’s reference to ‘so-called lockdown measures’ indicates the absence of a clear and universally accepted definition of the term ‘lockdown’. We propose a definition of ‘lockdown’ based on a two-by-two matrix that categorises different communicable disease measures based on whether they are compulsory or voluntary; and whether they are targeted at identifiable individuals or facilities, or whether they are applied indiscriminately to a general population or area. Using this definition, we describe the design, timing and implementation of lockdown measures in nine countries in sub-Saharan Africa: Ghana, Nigeria, South Africa, Sierra Leone, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. While there were some commonalities in the implementation of lockdown across these countries, a more notable finding was the variation in the design, timing and implementation of lockdown measures. We also found that the number of reported cases is heavily dependent on the number of tests carried out, and that testing rates ranged from 2031 to 63 928 per million population up until 7 September 2020. The reported number of COVID-19 deaths per million population also varies (0.4 to 250 up until 7 September 2020), but is generally low when compared with countries in Europe and North America. While lockdown measures may have helped inhibit community transmission, the pattern and nature of the epidemic remains unclear. However, there are signs of lockdown harming health by affecting the functioning of the health system and causing social and economic disruption.
188 citations
Institute of Tropical Medicine Antwerp1, University of Lagos2, London School of Economics and Political Science3, University of London4, University College London5, Eduardo Mondlane University6, Nagasaki University7, Makerere University8, Muhimbili University of Health and Allied Sciences9, VU University Amsterdam10, Leiden University11
TL;DR: Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19, and formal information-sharing channels for providers must be established and mental health support provided.
Abstract: INTRODUCTION: The COVID-19 pandemic has substantially impacted maternity care provision worldwide. Studies based on modelling estimated large indirect effects of the pandemic on services and health outcomes. The objective of this study was to prospectively document experiences of frontline maternal and newborn healthcare providers. METHODS: We conducted a global, cross-sectional study of maternal and newborn health professionals via an online survey disseminated through professional networks and social media in 12 languages. Information was collected between 24 March and 10 April 2020 on respondents' background, preparedness for and response to COVID-19 and their experience during the pandemic. An optional module sought information on adaptations to 17 care processes. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregating by low-income and middle-income countries (LMICs) and high-income countries (HICs). RESULTS: We analysed responses from 714 maternal and newborn health professionals. Only one-third received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, 47% of participants in LMICs and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based practices. CONCLUSIONS: Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information-sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations and support rapid development of effective responses.
167 citations
University of the Witwatersrand1, Spanish National Research Council2, University of Cape Town3, Abdelmalek Essaâdi University4, South African National Bioinformatics Institute5, National Institutes of Health6, University of Mauritius7, University of Cambridge8, Covenant University9, Makerere University10, Pasteur Institute11, Ain Shams University12, University of Maryland, Baltimore13, Baylor College of Medicine14, National Health Laboratory Service15
TL;DR: The findings refine the current understanding of continental migration, identify gene flow and the response to human disease as strong drivers of genome-level population variation, and underscore the scientific imperative for a broader characterization of the genomic diversity of African individuals to understand human ancestry and improve health.
Abstract: The African continent is regarded as the cradle of modern humans and African genomes contain more genetic variation than those from any other continent, yet only a fraction of the genetic diversity among African individuals has been surveyed1. Here we performed whole-genome sequencing analyses of 426 individuals—comprising 50 ethnolinguistic groups, including previously unsampled populations—to explore the breadth of genomic diversity across Africa. We uncovered more than 3 million previously undescribed variants, most of which were found among individuals from newly sampled ethnolinguistic groups, as well as 62 previously unreported loci that are under strong selection, which were predominantly found in genes that are involved in viral immunity, DNA repair and metabolism. We observed complex patterns of ancestral admixture and putative-damaging and novel variation, both within and between populations, alongside evidence that population from Zambia were a likely intermediate site along the routes of expansion of Bantu-speaking populations. Pathogenic variants in genes that are currently characterized as medically relevant were uncommon—but in other genes, variants denoted as ‘likely pathogenic’ in the ClinVar database were commonly observed. Collectively, these findings refine our current understanding of continental migration, identify gene flow and the response to human disease as strong drivers of genome-level population variation, and underscore the scientific imperative for a broader characterization of the genomic diversity of African individuals to understand human ancestry and improve health. Whole-genome sequencing analyses of African populations provide insights into continental migration, gene flow and the response to human disease, highlighting the importance of including diverse populations in genomic analyses to understand human ancestry and improve health.
165 citations
University of Aberdeen1, Joint Global Change Research Institute2, United Nations Economic Commission for Africa3, University of the West Indies4, Norwegian University of Science and Technology5, Ministry of Agriculture and Rural Development6, Makerere University7, Rutgers University8, International Food Policy Research Institute9, National Institute for Environmental Studies10, Institut national de la recherche agronomique11, International Trademark Association12, University of Bristol13, University of Virginia14, University of New England (Australia)15, Karlsruhe Institute of Technology16, University of Edinburgh17
TL;DR: A number of practices, such as increased food productivity, dietary change and reduced food loss and waste, can reduce demand for land conversion, thereby potentially freeing‐up land and creating opportunities for enhanced implementation of other practices, making them important components of portfolios of practices to address the combined land challenges.
Abstract: There is a clear need for transformative change in the land management and food production sectors to address the global land challenges of climate change mitigation, climate change adaptation, combatting land degradation and desertification, and delivering food security (referred to hereafter as "land challenges"). We assess the potential for 40 practices to address these land challenges and find that: Nine options deliver medium to large benefits for all four land challenges. A further two options have no global estimates for adaptation, but have medium to large benefits for all other land challenges. Five options have large mitigation potential (>3 Gt CO2 eq/year) without adverse impacts on the other land challenges. Five options have moderate mitigation potential, with no adverse impacts on the other land challenges. Sixteen practices have large adaptation potential (>25 million people benefit), without adverse side effects on other land challenges. Most practices can be applied without competing for available land. However, seven options could result in competition for land. A large number of practices do not require dedicated land, including several land management options, all value chain options, and all risk management options. Four options could greatly increase competition for land if applied at a large scale, though the impact is scale and context specific, highlighting the need for safeguards to ensure that expansion of land for mitigation does not impact natural systems and food security. A number of practices, such as increased food productivity, dietary change and reduced food loss and waste, can reduce demand for land conversion, thereby potentially freeing-up land and creating opportunities for enhanced implementation of other practices, making them important components of portfolios of practices to address the combined land challenges.
163 citations
12 Oct 2020
TL;DR: In this paper, the authors examine the evidence of nearly 18,000 papers on whether incentive-based programmes lead to the adoption of sustainable practices and their effect on environmental, economic and productivity outcomes.
Abstract: The increasing pressure on agricultural production systems to achieve global food security and prevent environmental degradation necessitates a transition towards more sustainable practices. The purpose of this scoping review is to understand how the incentives offered to farmers motivate the adoption of sustainable agricultural practices and, ultimately, how and whether they result in measurable outcomes. To this end, this scoping review examines the evidence of nearly 18,000 papers on whether incentive-based programmes lead to the adoption of sustainable practices and their effect on environmental, economic and productivity outcomes. We find that independent of the incentive type, programmes linked to short-term economic benefit have a higher adoption rate than those aimed solely at providing an ecological service. In the long run, one of the strongest motivations for farmers to adopt sustainable practices is perceived benefits for either their farms, the environment or both. Beyond this, the importance of technical assistance and extension services in promoting sustainable practices emerges strongly from this scoping review. Finally, we find that policy instruments are more effective if their design considers the characteristics of the target population, and the associated trade-offs between economic, environmental and social outcomes. A more sustainable agriculture is needed to address global food security and environmental degradation. This scoping review surveys the incentives for farmers to adopt sustainable practices benefiting their farms, the environment or both.
158 citations
Jewish General Hospital1, McGill University2, Public Health Research Institute3, University of York4, Stanford University5, Concordia University6, University of Calgary7, Johns Hopkins University School of Medicine8, Makerere University9, University of Auckland10, Bar-Ilan University11, Iran University of Medical Sciences12, University of Washington13, Australian National University14, University of Newcastle15, University of São Paulo16, The Chinese University of Hong Kong17, University of North Carolina at Chapel Hill18, University of Rochester Medical Center19, Utrecht University20, Charité21, Singapore Ministry of Health22, Harvard University23, University of Pittsburgh24, University of Macau25, University of Hamburg26, Goethe University Frankfurt27, University of Queensland28, University of Ioannina29, Shimane University30, University of New South Wales31, Tan Tock Seng Hospital32, National University of Singapore33, Mahidol University34, Saint Joseph's College35, Universiti Putra Malaysia36, Universidade Federal de Pelotas37, Niigata Seiryo University38, Katholieke Universiteit Leuven39, University Medical Center Freiburg40, Royal Edinburgh Hospital41, Universiti Sains Malaysia42, Allina Health43, Royal Women's Hospital44, University of Amsterdam45, Monash University46, University of California, San Francisco47, King's College London48
TL;DR: Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar, and bivariate random-effects models to assess diagnostic accuracy were similar.
Abstract: BACKGROUND: Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9. METHODS: We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy. RESULTS: 16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (-0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01). CONCLUSIONS: PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
154 citations
Ido Didi Fabian1, Ido Didi Fabian2, Elhassan Abdallah3, Shehu U. Abdullahi4 +473 more•Institutions (155)
TL;DR: This cross-sectional analysis reports the retinoblastoma stage at diagnosis across the world during a single year, investigates associations between clinical variables and national income level, and investigates risk factors for advanced disease at diagnosis.
Abstract: Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.
151 citations
TL;DR: Comparison shows that the data quality between audio-recorded transcripts and interview scripts written directly after the interview were comparable in the detail captured, suggesting that in some circumstances not recording is the best approach, not ‘second best’.
Abstract: The use of audio recordings has become a taken-for-granted approach to generating transcripts of in-depth interviewing and group discussions. In this paper we begin by describing circumstances where the use of a recorder is not, or may not be, possible, before sharing our comparative analysis of audio-recorded transcriptions and interview scripts made from notes taken during the interview (by experienced, well-trained interviewers). Our comparison shows that the data quality between audio-recorded transcripts and interview scripts written directly after the interview were comparable in the detail captured. The structures of the transcript and script were usually different because in the interview scripts, topics and ideas were grouped, rather than being in the more scattered order of the conversation in the transcripts. We suggest that in some circumstances not recording is the best approach, not 'second best'.
103 citations
Institute of Tropical Medicine Antwerp1, University of Lagos2, London School of Economics and Political Science3, University of London4, University College London5, Eduardo Mondlane University6, Nagasaki University7, Makerere University8, Muhimbili University of Health and Allied Sciences9, VU University Amsterdam10
TL;DR: Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19, and formal information sharing channels for providers must be established and mental health support provided.
Abstract: Objective To prospectively document experiences of frontline maternal and newborn healthcare providers during the COVID-19 pandemic. Design Cross-sectional study via an online survey disseminated through professional networks and social media in 12 languages. We analysed responses using descriptive statistics and qualitative thematic analysis disaggregating by low- and middle-income countries (LMICs) and high-income countries (HICs). Setting 81 countries, between March 24 and April 10, 2020. Participants 714 maternal and newborn healthcare providers. Main outcome measures Preparedness for and response to COVID-19, experiences of health workers providing care to women and newborns, and adaptations to 17 outpatient and inpatient care processes during the pandemic. Results Only one third of respondents received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, only 47% of participants in LMICs, and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing, and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based. Conclusions Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations, and support rapid development of effective responses. Key Messages What is already known In addition to lack of healthcare worker protection, staffing shortages, heightened risk of nosocomial transmission and decreased healthcare use described in previous infectious disease outbreaks, maternal and newborn care during the COVID-19 pandemic has also been affected by large-scale lockdowns/curfews. The two studies assessing the indirect effects of COVID-19 on maternal and child health have used models to estimate mortality impacts. Experiences of frontline health professionals providing maternal and newborn care during the COVID-19 pandemic have not been empirically documented to date. What this study adds Respondents in high-income countries more commonly reported available/updated guidelines, access to COVID-19 testing, and dedicated isolation rooms for confirmed/suspected COVID-19 maternity patients. Levels of stress increased among health professionals globally, including due to changed working hours, difficulties in reaching health facilities, and staff shortages. Healthcare providers were worried about the impact of rapidly changing care practices on health outcomes: reduced access to antenatal care, fewer outpatient visits, shorter length-of-stay in facilities after birth, banning birth companions, separating newborns from COVID-19 positive mothers, and postponing routine immunisations. COVID-19 illustrates the susceptibility of maternity care services to emergencies, including by reversing hard-won gains in healthcare utilisation and use of evidence-based practices. These rapid findings can inform countries of the main issues emerging and help develop effective responses.
Johns Hopkins University School of Medicine1, Universiti Tunku Abdul Rahman2, University of Health Sciences Antigua3, University of London4, Kenya Medical Research Institute5, University of Jordan6, Iran University of Medical Sciences7, University of Oxford8, University of California, San Francisco9, University College London10, University of Cape Town11, University of Maragheh12, University of Liverpool13, King's College London14, Emory University15, University of the Witwatersrand16, Makerere University17, University of Sydney18, Bill & Melinda Gates Foundation19, Kathmandu20, University of the West Indies21, World Health Organization22, An-Najah National University23, Tufts University24, Northampton General Hospital25, Institute for Health Metrics and Evaluation26
TL;DR: The number of children and adolescents with these 4 disabilities is far higher than the 2004 estimate, increases from infancy to adolescence, and accounts for a substantial proportion of all-cause YLD.
Abstract: BACKGROUND: Estimates of children and adolescents with disabilities worldwide are needed to inform global intervention under the disability-inclusive provisions of the Sustainable Development Goals. We sought to update the most widely reported estimate of 93 million children METHODS: We analyzed Global Burden of Disease Study 2017 data on the prevalence of childhood epilepsy, intellectual disability, and vision or hearing loss and on years lived with disability (YLD) derived from systematic reviews, health surveys, hospital and claims databases, cohort studies, and disease-specific registries. Point estimates of the prevalence and YLD and the 95% uncertainty intervals (UIs) around the estimates were assessed. RESULTS: Globally, 291.2 million (11.2%) of the 2.6 billion children and adolescents (95% UI: 249.9–335.4 million) were estimated to have 1 of the 4 specified disabilities in 2017. The prevalence of these disabilities increased with age from 6.1% among children aged CONCLUSIONS: The number of children and adolescents with these 4 disabilities is far higher than the 2004 estimate, increases from infancy to adolescence, and accounts for a substantial proportion of all-cause YLD.
TL;DR: A modified COVID-19 screening algorithm is proposed for use in resource-limited settings that do not have established local transmission and is meant to be a rapid and simple tool to decide who requires isolation and targeted testing for SARS-CoV-2.
TL;DR: The biggest gap in the PrEP cascade was PrEP uptake, particularly for young and mobile individuals, highlighting the need for novel approaches and long-acting formulations as PrEP roll-out expands.
TL;DR: In this paper, a pragmatic cluster-randomised trial was conducted to compare conventional LLINs with those containing piperonyl butoxide (PBO), a synergist that can partially restore pyrethroid susceptibility in mosquito vectors.
University of California, San Francisco1, Brigham and Women's Hospital2, Harvard University3, University of London4, Institut de recherche pour le développement5, University of Botswana6, Brighton and Sussex Medical School7, University College London8, Imperial College London9, National Institute for Health Research10, Makerere University11, Centers for Disease Control and Prevention12, University of California, Berkeley13, French Institute of Health and Medical Research14
TL;DR: Universal test and treat (UTT) was evaluated in four randomized population‐based trials conducted in sub‐Saharan Africa during expanded antiretroviral treatment (ART) eligibility by World Health Organization guidelines and the UNAIDS 90‐90‐90 campaign.
Abstract: Author(s): Havlir, Diane; Lockman, Shahin; Ayles, Helen; Larmarange, Joseph; Chamie, Gabriel; Gaolathe, Tendani; Iwuji, Collins; Fidler, Sarah; Kamya, Moses; Floyd, Sian; Moore, Janet; Hayes, Richard; Petersen, Maya; Dabis, Francois; (Universal Test, Treat Trials) UT3 Consortium | Abstract: IntroductionAchieving HIV epidemic control globally will require new strategies to accelerate reductions in HIV incidence and mortality. Universal test and treat (UTT) was evaluated in four randomized population-based trials (BCPP/Ya Tsie, HPTN 071/PopART, SEARCH, ANRS 12249/TasP) conducted in sub-Saharan African(SSA) during expanded antiretroviral treatment (ART) eligibility by World Health Organization guidelines and the UNAIDS 90-90-90 campaign.DiscussionThese three-year studies were conducted in Botswana, Zambia, Uganda, Kenya and South Africa in settings with baseline HIV prevalence from 4% to 30%. Key observations across studies were: (1) Universal testing (implemented via a variety of home and community-based testing approaches) achieved g90% coverage in all studies. (2) When coupled with robust linkage to HIV care, rapid ART start and patient-centred care, UTT achieved among the highest reported population levels of viral suppression in SSA. Significant gains in population-level viral suppression were made in regions with both low and high baseline population viral load; however, viral suppression gains were not uniform across all sub-populations and were lower among youth. (3) UTT resulted innmarked reductions in community HIV incidence when universal testing and robust linkage were present. However, HIV elimination targets were not reached. In BCPP and HPTN 071, annualized HIV incidence was approximately 20% to 30% lower in the intervention (which included universal testing) compared to control arms (no universal testing). In SEARCH (where both arms had universal testing), incidence declined 32% over three years. (4) UTT reduced HIV associated mortality by 23% in the intervention versus control communities in SEARCH, a study in whichnmortality was comprehensively measured.ConclusionsThese trials provide strong evidence that UTT inclusive of universal testing increases population-level viral suppression and decreases HIV incidence and mortality faster than the status quo in SSA and should be adapted at a sub-country level as a public health strategy. However, more is needed, including integration of new prevention interventions into UTT, in order to reach UNAIDS HIV elimination targets.
TL;DR: Ecotoxicological risk assessment showed that sulfamethoxazole, oxytetracycline, erythromycin, and diclofenac pose a high toxic risk to aquatic organisms in the lake, while ciprofloxacin, norfloxACin, and ibuprofen pose a medium risk.
TL;DR: It is found that interventions to limit antimicrobial resistance should be founded upon a bottom-up understanding of antimicrobial use at the farm-level given limited input from animal health professionals and under-resourced regulatory capacities within most low- and middle-income countries.
Abstract: The nutritional and economic potentials of livestock systems are compromised by the emergence and spread of antimicrobial resistance. A major driver of resistance is the misuse and abuse of antimicrobial drugs. The likelihood of misuse may be elevated in low- and middle-income countries where limited professional veterinary services and inadequately controlled access to drugs are assumed to promote non-prudent practices (e.g., self-administration of drugs). The extent of these practices, as well as the knowledge and attitudes motivating them, are largely unknown within most agricultural communities in low- and middle-income countries. The main objective of this study was to document dimensions of knowledge, attitudes and practices related to antimicrobial use and antimicrobial resistance in livestock systems and identify the livelihood factors associated with these dimensions. A mixed-methods ethnographic approach was used to survey households keeping layers in Ghana (N = 110) and Kenya (N = 76), pastoralists keeping cattle, sheep, and goats in Tanzania (N = 195), and broiler farmers in Zambia (N = 198), and Zimbabwe (N = 298). Across countries, we find that it is individuals who live or work at the farm who draw upon their knowledge and experiences to make decisions regarding antimicrobial use and related practices. Input from animal health professionals is rare and antimicrobials are sourced at local, privately owned agrovet drug shops. We also find that knowledge, attitudes, and particularly practices significantly varied across countries, with poultry farmers holding more knowledge, desirable attitudes, and prudent practices compared to pastoralist households. Multivariate models showed that variation in knowledge, attitudes and practices is related to several factors, including gender, disease dynamics on the farm, and source of animal health information. Study results emphasize that interventions to limit antimicrobial resistance should be founded upon a bottom-up understanding of antimicrobial use at the farm-level given limited input from animal health professionals and under-resourced regulatory capacities within most low- and middle-income countries. Establishing this bottom-up understanding across cultures and production systems will inform the development and implementation of the behavioral change interventions to combat antimicrobial resistance globally.
Harvard University1, University of Göttingen2, Stanford University3, Heidelberg University4, Kathmandu5, The Fred Hollows Foundation6, Makerere University7, National University of Benin8, Partners In Health9, National Institute for Medical Research10, Tribhuvan University11, Stellenbosch University12, University of the East13, University of Geneva14, Saint Francis University15, Centers for Disease Control and Prevention16, Boston University17, University of Birmingham18, University of the Witwatersrand19, Public Health Foundation of India20
TL;DR: LMICs included in this analysis may be at an advanced stage in the nutrition transition but with no reversal in the socioeconomic gradient of diabetes risk, in contrast to the association seen in high-income countries.
Abstract: OBJECTIVE Diabetes is a rapidly growing health problem in low- and middle-income countries (LMICs), but empirical data on its prevalence and relationship to socioeconomic status are scarce. We estimated diabetes prevalence and the subset with undiagnosed diabetes in 29 LMICs and evaluated the relationship of education, household wealth, and BMI with diabetes risk. RESEARCH DESIGN AND METHODS We pooled individual-level data from 29 nationally representative surveys conducted between 2008 and 2016, totaling 588,574 participants aged ≥25 years. Diabetes prevalence and the subset with undiagnosed diabetes was calculated overall and by country, World Bank income group (WBIG), and geographic region. Multivariable Poisson regression models were used to estimate relative risk (RR). RESULTS Overall, prevalence of diabetes in 29 LMICs was 7.5% (95% CI 7.1–8.0) and of undiagnosed diabetes 4.9% (4.6–5.3). Diabetes prevalence increased with increasing WBIG: countries with low-income economies (LICs) 6.7% (5.5–8.1), lower-middle-income economies (LMIs) 7.1% (6.6–7.6), and upper-middle-income economies (UMIs) 8.2% (7.5–9.0). Compared with no formal education, greater educational attainment was associated with an increased risk of diabetes across WBIGs, after adjusting for BMI (LICs RR 1.47 [95% CI 1.22–1.78], LMIs 1.14 [1.06–1.23], and UMIs 1.28 [1.02–1.61]). CONCLUSIONS Among 29 LMICs, diabetes prevalence was substantial and increased with increasing WBIG. In contrast to the association seen in high-income countries, diabetes risk was highest among those with greater educational attainment, independent of BMI. LMICs included in this analysis may be at an advanced stage in the nutrition transition but with no reversal in the socioeconomic gradient of diabetes risk.
The Chinese University of Hong Kong1, University of North Carolina at Chapel Hill2, McGill University3, University of Rochester4, VU University Amsterdam5, Utrecht University6, University of Washington7, Stanford University8, Concordia University9, National University of Singapore10, Nanyang Technological University11, Harvard University12, University of Pittsburgh13, University of Macau14, University of Hamburg15, Johns Hopkins University16, Goethe University Frankfurt17, University of Queensland18, University of Ioannina19, Shimane University20, Icahn School of Medicine at Mount Sinai21, University of New South Wales22, University of York23, Charité24, University of Calgary25, University of Auckland26, Makerere University27, Bar-Ilan University28, Technische Universität München29, Australian National University30, King's College London31, Neuroscience Research Australia32, Tan Tock Seng Hospital33, Public Health Research Institute34, Mackay Memorial Hospital35, Mahidol University36, United States Department of Veterans Affairs37, Saint Joseph's College38, Universiti Putra Malaysia39, Universidade Federal de Pelotas40, Niigata Seiryo University41, National Institute of Standards and Technology42, Katholieke Universiteit Leuven43, Istituto Superiore di Sanità44, University of Edinburgh45, Universiti Sains Malaysia46, Allina Health47, Royal Women's Hospital48, University of Newcastle49, Deakin University50, University of Amsterdam51, Monash University52, University of California, San Francisco53
TL;DR: An individual participant data meta-analysis is used to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHZ-9 cutoff score of ≥10.
Abstract: Background: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. Objective: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. Methods: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. Results: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88). Conclusions: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.
10 Jul 2020
TL;DR: In this article, the socio-cultural, economic and psychosocial impact of the pandemic on urban refugees in Uganda is examined, and the authors argue that contingency planning must involve refugees and their communities to access accurate and relevant information in appropriate languages.
Abstract: Considering the COVID-19 global public health crisis, this paper examines the socio-cultural, economic and psychosocial impact of the pandemic on urban refugees in Uganda. We analyse the living conditions of urban refugees that make it problematic for them to adhere to public health measures. Since COVID-19 is perceived as “imported”, refugees are assumed as its potential transmitters, consequently experiencing heightened stigma and isolation. Lack of culturally and linguistically accessible information and services excludes them from on-going efforts to prevent the pandemic. The lockdown has affected refugee livelihoods and increased income insecurity, sexual and gender-based violence and anxiety. Given the paucity of government-led services to contain the epidemic, we argue that contingency planning must involve refugees and their communities to access accurate and relevant information in appropriate languages. It is also important to build the capacity of frontline workers to understand the specific needs of refugees to deliver appropriate protection in the context of the pandemic.
Rutgers University1, Joint Global Change Research Institute2, University of the West3, Norwegian University of Science and Technology4, Ministry of Agriculture and Rural Development5, Makerere University6, United Nations Economic Commission for Africa7, International Food Policy Research Institute8, National Institute for Environmental Studies9, Institut national de la recherche agronomique10, International Trademark Association11, University of Aberdeen12
TL;DR: This study examined 40 different options, implemented through land management, value chains, or risk management, for their relative impacts across 18 Nature's Contributions to People (NCP) and the 17 Sustainable Development Goals (SDG).
Abstract: Interlocked challenges of climate change, biodiversity loss, and land degradation require transformative interventions in the land management and food production sectors to reduce carbon emissions, strengthen adaptive capacity, and increase food security. However, deciding which interventions to pursue and understanding their relative co-benefits with and trade-offs against different social and environmental goals have been difficult without comparisons across a range of possible actions. This study examined 40 different options, implemented through land management, value chains, or risk management, for their relative impacts across 18 Nature's Contributions to People (NCPs) and the 17 Sustainable Development Goals (SDGs). We find that a relatively small number of interventions show positive synergies with both SDGs and NCPs with no significant adverse trade-offs; these include improved cropland management, improved grazing land management, improved livestock management, agroforestry, integrated water management, increased soil organic carbon content, reduced soil erosion, salinization, and compaction, fire management, reduced landslides and hazards, reduced pollution, reduced post-harvest losses, improved energy use in food systems, and disaster risk management. Several interventions show potentially significant negative impacts on both SDGs and NCPs; these include bioenergy and bioenergy with carbon capture and storage, afforestation, and some risk sharing measures, like commercial crop insurance. Our results demonstrate that a better understanding of co-benefits and trade-offs of different policy approaches can help decision-makers choose the more effective, or at the very minimum, more benign interventions for implementation.
TL;DR: This method represents a useful tool for studying remdesivir and GS-441524 clinical pharmacokinetics, particularly during the current COVID-19 outbreak, and it was demonstrated that, when possible, sample thermal inactivation could be a good choice in order to improve biosafety.
Abstract: Background Remdesivir has received significant attention for its potential application in the treatment of COVID-19, caused by SARS-CoV-2. Remdesivir has already been tested for Ebola virus disease treatment and found to have activity against SARS and MERS coronaviruses. The remdesivir core contains GS-441524, which interferes with RNA-dependent RNA polymerases alone. In non-human primates, following IV administration, remdesivir is rapidly distributed into PBMCs and converted within 2 h to the active nucleoside triphosphate form, while GS-441524 is detectable in plasma for up to 24 h. Nevertheless, remdesivir pharmacokinetics and pharmacodynamics in humans are still unexplored, highlighting the need for a precise analytical method for remdesivir and GS-441524 quantification. Objectives The validation of a reliable UHPLC-MS/MS method for remdesivir and GS-441524 quantification in human plasma. Methods Remdesivir and GS-441524 standards and quality controls were prepared in plasma from healthy donors. Sample preparation consisted of protein precipitation, followed by dilution and injection into the QSight 220 UHPLC-MS/MS system. Chromatographic separation was obtained through an Acquity HSS T3 1.8 μm, 2.1 × 50 mm column, with a gradient of water and acetonitrile with 0.05% formic acid. The method was validated using EMA and FDA guidelines. Results Analyte stability has been evaluated and described in detail. The method successfully fulfilled the validation process and it was demonstrated that, when possible, sample thermal inactivation could be a good choice in order to improve biosafety. Conclusions This method represents a useful tool for studying remdesivir and GS-441524 clinical pharmacokinetics, particularly during the current COVID-19 outbreak.
TL;DR: In this commentary, insights from those on the ground in low-income and middle-income countries (LMICs) are used to highlight both the impact of COVID-19 on facility births and the innovative local solutions needed to protect mothers and newborns from the effects of the virus.
Abstract: ### Summary box
There are an estimated 5. 4 million largely preventable maternal and perinatal deaths each year.1–3 Improving the survival and well-being of mothers and newborns is indisputably a global priority. This is as true today as ever and as the world grapples with the COVID-19 pandemic. For maternal and newborn health (MNH), a critical question today is not only the extent to which pregnant or postpartum women and newborns are vulnerable to COVID-19-infection4 but also the degree to which the safety of giving birth and accessing treatment for complications in health facilities is being compromised by the direct and indirect effects of the virus, thereby reversing hard progress in MNH over the last 30 years. We know that infectious disease outbreaks can devastate provision of such care, for example, during the Ebola outbreak in West Africa.5 In this commentary, we use insights from those on the ground in low-income and middle-income countries (LMICs) to highlight both the impact of COVID-19 on facility births and the innovative local solutions …
TL;DR: Traditional processing improves microbial safety but alters the nutritional value of edible insects through boiling, toasting, and solar-drying, while species- and treatment-specific patterns exist.
Abstract: Edible insects are increasingly being considered as food and feed ingredients because of their rich nutrient content. Already, edible insect farming has taken-off in Africa, but quality and safety concerns call for simple, actionable hazard control mechanisms. We examined the effects of traditional processing techniques—boiling, toasting, solar-drying, oven-drying, boiling + oven-drying, boiling + solar-drying, toasting + oven-drying, toasting + solar-drying—on the proximate composition and microbiological quality of adult Acheta domesticus and Ruspolia differens, the prepupae of Hermetia illucens and 5th instar larvae of Spodoptera littoralis. Boiling, toasting, and drying decreased the dry matter crude fat by 0.8–51% in the order: toasting > boiling > oven-drying > solar-drying, whereas the protein contents increased by 1.2–22% following the same order. Boiling and toasting decreased aerobic mesophilic bacterial populations, lowered Staphylococcus aureus, and eliminated the yeasts and moulds, Lac+ enteric bacteria, and Salmonella. Oven-drying alone marginally lowered bacterial populations as well as yeast and moulds, whereas solar-drying alone had no effect on these parameters. Oven-drying of the boiled or toasted products increased the aerobic mesophilic bacteria counts but the products remained negative on Lac+ enteric bacteria and Salmonella. Traditional processing improves microbial safety but alters the nutritional value. Species- and treatment-specific patterns exist.
TL;DR: In this article, the impact of nano-material based superhydrophobic coatings on metal/alloys with a concise discussion of associated challenges, potential solutions and future opportunities is discussed.
TL;DR: Research is proposed in three broad areas as urgently needed to inform responses in low- and middle-income countries: transmission patterns of SARS-CoV-2, the clinical characteristics of the disease, and the impact of pandemic prevention and response measures.
Abstract: In the early months of the pandemic, most reported cases and deaths due to COVID-19 occurred in high-income countries. However, insufficient testing could have led to an underestimation of true infections in many low- and middle-income countries. As confirmed cases increase, the ultimate impact of the pandemic on individuals and communities in low- and middle-income countries is uncertain. We therefore propose research in three broad areas as urgently needed to inform responses in low- and middle-income countries: transmission patterns of SARS-CoV-2, the clinical characteristics of the disease, and the impact of pandemic prevention and response measures. Answering these questions will require a multidisciplinary approach led by local investigators and in some cases additional resources. Targeted research activities should be done to help mitigate the potential burden of COVID-19 in low- and middle-income countries without diverting the limited human resources, funding, or medical supplies from response activities.
TL;DR: Among children with sickle cell anemia in sub-Saharan Africa, hydroxyurea with dose escalation had superior clinical efficacy to that of fixed-dose hydroxyUREa, with equivalent safety.
Abstract: Background Hydroxyurea has proven safety, feasibility, and efficacy in children with sickle cell anemia in sub-Saharan Africa, with studies showing a reduced incidence of vaso-occlusive ev
TL;DR: In this article, the authors developed bio-composite carbonized briquettes from rice husks, coffee husks and groundnut shells, in varying proportions, after carbonization and application of starch binder.
TL;DR: Activity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user’s requirements.
Abstract: Understanding how prostheses are used in everyday life is central to the design, provision and evaluation of prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits of monitoring daily living and the barriers to long-term monitoring, with particular focus on low-resource settings. A systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of studies that monitored the activity of prosthesis users during daily-living. Sixty lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast, the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb studies focused on the development or validation of actimeters, algorithms and/or scores for activity classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb studies were fairly evenly spread between development of algorithms, comparison of everyday activity to clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the degree of symmetry in activity levels between the arm with the prosthesis and the intact arm. Activity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user’s requirements. However, the cost, limited battery-life and lack of availability in many countries mean that using sensors to understand the daily use of prostheses and the types of activity being performed has not yet become a feasible standard clinical practice. This review provides recommendations for the research and clinical communities to advance this area for the benefit of prosthesis users.