scholarly journals Exploring the role of environmental enteropathy in malnutrition, infant development and oral vaccine response

2015 ◽  
Vol 370 (1671) ◽  
pp. 20140143 ◽  
Author(s):  
Allissia A. Gilmartin ◽  
William A. Petri
Keyword(s):  
Low Income ◽  
Infant Development ◽  
Intestinal Inflammation ◽  
Oral Vaccine ◽  
Low Income Countries ◽  
Current Evidence ◽  
Vaccine Response ◽  
Vaccine Failure ◽  
Environmental Enteropathy ◽  
Sanitation And Hygiene

Environmental enteropathy (EE) is a poorly defined state of intestinal inflammation without overt diarrhoea that occurs in individuals exposed over time to poor sanitation and hygiene. It is characterized pathologically by small intestine villous blunting and inflammation. In children from low-income countries, it is implicated as a cause of malnutrition, oral vaccine failure and impaired cognitive development. Here we review the search for non-invasive biomarkers to measure EE non-invasively, and assess the current evidence linking EE to malnutrition, vaccine failure and neurocognitive development.

scholarly journals COVID-19 pandemic: Water, sanitation and hygiene (WASH) as a critical control measure remains a major challenge in low-income countries

2021 ◽  
Vol 191 ◽  
pp. 116793
Author(s):  
Oscar Omondi Donde ◽  
Evans Atoni ◽  
Anastasia Wairimu Muia ◽  
Paul T. Yillia
Keyword(s):  
Low Income ◽  
Control Measure ◽  
Low Income Countries ◽  
Sanitation And Hygiene

scholarly journals Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact

2019 ◽  
Vol 16 (3) ◽  
pp. 359 ◽  
Author(s):  
Celia McMichael
Keyword(s):  
Low Income ◽  
Library Science ◽  
Low Income Countries ◽  
Cochrane Library ◽  
Publication Date ◽  
Program Fidelity ◽  
School Based ◽  
Sanitation And Hygiene ◽  
Hygiene Promotion ◽  
The Impact

Many schools in low-income countries have inadequate access to water facilities, sanitation and hygiene promotion. A systematic review of literature was carried out that aimed to identify and analyse the impact of water, sanitation and hygiene interventions (WASH) in schools in low-income countries. Published peer reviewed literature was systematically screened during March to June 2018 using the databases PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and Google Scholar. There were no publication date restrictions. Thirty-eight peer reviewed papers were identified that met the inclusion criteria. The papers were analysed in groups, based on four categories of reported outcomes: (i) reduction of diarrhoeal disease and other hygiene-related diseases in school students; (ii) improved WASH knowledge, attitudes and hygiene behaviours among students; (iii) reduced disease burden and improved hygiene behaviours in students’ households and communities; (iv) improved student enrolment and attendance. The typically unmeasured and unreported ‘output’ and/or ‘exposure’ of program fidelity and adherence was also examined. Several studies provide evidence of positive disease-related outcomes among students, yet other assessments did not find statistically significant differences in health or indicated that outcomes are dependent on the nature and context of interventions. Thirteen studies provide evidence of changes in WASH knowledge, attitudes and behaviours, such as hand-washing with soap. Further research is required to understand whether and how school-based WASH interventions might improve hygiene habits and health among wider family and community members. Evidence of the impact of school-based WASH programs in reducing student absence from school was mixed. Ensuring access to safe and sufficient water and sanitation and hygiene promotion in schools has great potential to improve health and education and to contribute to inclusion and equity, yet delivering school-based WASH intervention does not guarantee good outcomes. While further rigorous research will be of value, political will and effective interventions with high program fidelity are also key.

scholarly journals Delivering water, sanitation and hygiene interventions to women and children in conflict settings: a systematic review

2020 ◽  
Vol 5 (Suppl 1) ◽  
pp. e002064
Author(s):  
Daina Als ◽  
Sarah Meteke ◽  
Marianne Stefopulos ◽  
Michelle F Gaffey ◽  
Mahdis Kamali ◽  
...  
Keyword(s):  
Low Income ◽  
Quantitative Data ◽  
Grey Literature ◽  
Sub Saharan Africa ◽  
Current Evidence ◽  
Middle Income ◽  
Intervention Delivery ◽  
Conflict Settings ◽  
Sanitation And Hygiene ◽  
Women And Children

BackgroundAccess to safe water and sanitation facilities and the adoption of effective hygiene practices are fundamental to reducing maternal and child morbidity and mortality globally. In armed conflict settings, inadequate water, sanitation and hygiene (WASH) infrastructure poses major health risks for women and children. This review aimed to synthesise the existing information on WASH interventions being delivered to women and children in conflict settings in low-income and middle-income countries (LMICs) and to identify the personnel, sites and platforms being used to deliver such interventions.MethodsWe conducted a systematic search for publications indexed in four databases, and grey literature was searched through the websites of humanitarian agencies and organisations. Eligible publications reported WASH interventions delivered to conflict-affected women or children. We extracted and synthesised information on intervention delivery characteristics, as well as barriers and facilitators.ResultsWe identified 58 eligible publications reporting on the delivery of WASH interventions, mostly in Sub-Saharan Africa. Non-Governmental Organization (NGO)/United Nations (UN) agency staff were reported to be involved in delivering interventions in 62% of publications, with the most commonly reported delivery site being community spaces (50%). Only one publication reported quantitative data on intervention effectiveness among women or children.DiscussionThis review revealed gaps in the current evidence on WASH intervention delivery in conflict settings. Little information is available on the delivery of water treatment or environmental hygiene interventions, or about the sites and personnel used to deliver WASH interventions. Limited quantitative data on WASH intervention coverage or effectiveness with respect to women or children are important gaps, as multiple factors can affect how WASH services are accessed differently by women and men, and the hygiene needs of adolescent girls and boys differ; these factors must be taken into account when delivering interventions in conflict settings.PROSPERO registration numberCRD42019125221

scholarly journals Effects of Anaemia and Iron Supplementation on Vaccine Response: A Birth Cohort Study and a Randomized Trial Follow-Up Study in Kenyan Infants

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1115-1115
Author(s):  
Michael Zimmermann ◽  
Nicole Stoffel ◽  
Mary Uyoga ◽  
Simon Karanja
Keyword(s):  
Birth Cohort ◽  
Low Income ◽  
Iron Supplementation ◽  
Randomised Trial ◽  
Low Income Countries ◽  
Birth Cohort Study ◽  
Measles Vaccine ◽  
Vaccine Response ◽  
The Impact

Abstract Objectives Vaccines often underperform in low-income countries. Iron deficiency anaemia (IDA) may impair adaptive immunity and is common among African infants at time of vaccination. Our objective was to assess whether IDA impairs vaccine response and whether iron supplementation improves vaccine response. Methods We performed two studies in southern Kenya. In study 1, we followed a birth cohort to age 18 mo and assessed whether IDA at time of vaccination with pentavalent, 10-valent pneumococcal and measles vaccines predicted vaccine response. Primary outcomes were serum IgG and seroconversion at age 24wk and 18 mo. Study 2 was a randomised trial cohort follow-up in children who received 5 mg iron daily or no iron for 4 mo starting at age 7.5 mo and received measles vaccine at 9 and 18 mo; primary outcomes were IgG, seroconversion and avidity assessed at 11.5 mo and 4.5y. Results Study 1 ran from August 2013 to May 2017; 573 infants were enrolled and 303 completed the study. Controlling for sex, birthweight, anthropometrics and maternal antibodies, haemoglobin at time of vaccination was the strongest positive predictor of: (A) anti-diphtheria and anti-pertussis IgG at 24wk and 18 mo; (B) anti-pertussis filamentous hemagglutinin IgG at 24wk; and (C) anti-pneumococcus-S19 IgG at 18 mo (for all, P < 0.05). IDA and serum transferrin receptor at vaccination were the strongest predictors of seroconversion against diphtheria and pneumococcus-S19 at 18 mo (P < 0.05 for all). Study 2 ran from October 2014 to March 2019; 155 infants were recruited, 127 and 88 were assessed at age 11.5 mo and 4.5y. Infants who received iron at time of measles vaccination had higher anti-measles IgG (P = 0.0415), seroconversion (P = 0.0531) and IgG avidity (P = 0.0425) at 11.5 mo. Conclusions To our knowledge these are the first prospective data from Africa assessing the impact of IDA at vaccination on vaccine response. IDA at time of vaccination is associated with decreased response to diphtheria, pertussis and pneumococcal vaccines. Primary response to measles vaccine is increased by iron supplementation. Because anaemia is common in African infants and because the vaccine-preventable disease burden is high, if IDA reduces immunogenicity of childhood vaccines its prevention could have major benefits. Funding Sources Bill and Melinda Gates Foundation; ETH Zurich; DSM Nutrition; The Philhuman Foundation

Cambodian girls' recommendations for facilitating menstrual hygiene management in school

2013 ◽  
Vol 3 (4) ◽  
pp. 612-622 ◽  
Author(s):  
Susan Connolly ◽  
Marni Sommer
Keyword(s):  
Low Income ◽  
School Environment ◽  
Low Income Countries ◽  
Comparative Case Study ◽  
Teaching Methodologies ◽  
Menstrual Hygiene ◽  
Menstrual Hygiene Management ◽  
Hygiene Management ◽  
Sanitation And Hygiene

Inadequate school water and sanitation facilities in many low-income countries, including Cambodia, are problematic for pubescent girls as they reach menarche and must subsequently manage monthly menses while attending school. This comparative case study explored girls' own suggestions for improving the pubertal guidance they receive in the classroom, and for modifications of existing school water, sanitation and hygiene (WASH) facilities in order to better meet schoolgirls' menstrual hygiene management needs. Key findings included girls' recommendations for teaching methodologies that encourage questions and practical content regarding puberty and menstrual management before the onset of menarche, and WASH-specific recommendations for the increased availability of water and sanitary materials in toilet stalls and greater privacy from boys and other girls. Incorporating girls' recommendations into WASH, health and education related policy and programming in low-income countries would allow girls to comfortably and confidently manage menses within the school environment.

scholarly journals A review on thimerosal: an irreplaceable element of long-term immunisation strategy in low income countries

2017 ◽  
Vol 6 (8) ◽  
pp. 1846
Author(s):  
Ritika Singla ◽  
Anita K. Gupta ◽  
Anjleen Kaur
Keyword(s):  
Low Income ◽  
Causal Relation ◽  
Low Cost ◽  
Positive Association ◽  
Low Income Countries ◽  
Current Evidence ◽  
Minamata Convention On Mercury ◽  
Continued Use ◽  
Dose Vaccine

Thimerosal, an organic-mercury (Hg) compound containing 49.55% Hg by weight, is added to vaccines as a preservative permitting formulation of multi-dose vaccine vials. Being a derivative of ethylmercury, it has been linked with autism as a possible risk factor based on the assumption that exposure to ethylmercury would have similar neurotoxic effects as another mercurial compound, methylmercury. In 1999, AAP issued a joint statement emphasising the removal of thimerosal from vaccines. Subsequently, several studies have been conducted; those showing positive association between thimerosal exposure and autism have been recognised to be fraught with methodological flaws. On the other hand, many well controlled studies have failed to find any such causal relation and there are others that have clearly demonstrated a much favourable kinetic profile of ethylmercury as compared to methylmercury. Owing to the lack of data, AAP retired its original statement in 2002. Recently, thimerosal has been exempted from regulation by Minamata Convention on Mercury resulting in the continued use of low cost thimerosal containing vaccines in low income countries which cannot afford to run their immunisation program using single dose thimerosal free vaccines, that comparatively cost much higher, as is the case in high income countries. Some bodies view this as a discrimination on the basis of wealth of a nation and have opposed this decision. This review presents various studies regarding the causal association between thimerosal containing vaccines and autism. The current evidence fails to support any such association. Hence this review supports the exemption of thimerosal from regulation and also justifies its use in LICs for uninterrupted vaccination of the most vulnerable population.

scholarly journals Refining clinical algorithms for a neonatal digital platform for low-income countries: a modified Delphi technique

2020 ◽  
Author(s):  
Mari Evans ◽  
Mark H. Corden ◽  
Caroline Crehan ◽  
Felicity Fitzgerald ◽  
Michelle Heys
Keyword(s):  
Expert Opinion ◽  
Low Income ◽  
Delphi Technique ◽  
High Income ◽  
Low Income Countries ◽  
Current Evidence ◽  
Digital Platform ◽  
Modified Delphi ◽  
Modified Delphi Technique ◽  
Clinical Algorithms

ABSTRACTObjectivesTo determine whether a panel of neonatal experts could address evidence gaps in neonatal guidelines by reaching a consensus on four clinical decision algorithms for a neonatal digital platform (NeoTree).DesignTwo-round, modified Delphi technique.Setting and participantsParticipants were neonatal experts from high-income and low-income countries (LICs).MethodsThis was a consensus-generating study. In round one, experts rated items for four clinical algorithms (neonatal sepsis, hypoxic ischaemic encephalopathy, respiratory distress of the newborn, hypothermia) and justified their responses. Items meeting consensus (≥80% agreement) were included. Items not meeting consensus were either excluded, included following revisions or included if they contained core elements of evidence-based guidelines. In round two, experts rated items from round one that did not reach consensus.ResultsFourteen experts participated in round one, ten in round two. Nine were from high-income countries, five from LICs. Experts included physicians and nurse practitioners with an average neonatal experience of 20 years, 12 in LICs. After two rounds, a consensus was reached on 43 of 84 items (52%). Experts consistently stated that items must be in line with local and WHO guidelines (irrespective of the level of supporting evidence or expert opinion). As a result, the final algorithms included 53 items (62%).ConclusionFour algorithms in a neonatal digital platform were reviewed and refined by consensus expert opinion. Revisions to the NeoTree application were made in response to these findings and will be clinically validated in an imminent study.STRENGTHS AND LIMITATIONS OF THIS STUDY➢In this study, a large number of algorithm items were reviewed and evaluated, and half met consensus for inclusion in the management pathways.➢The review was conducted with experts from a broad range of countries and neonatal experience who simultaneously refined the algorithms and highlighted gaps in current evidence, emphasising the need for future research to support international neonatal guidelines.➢Our study method meant that experts were not able to meet in person, which might have promoted dialogue that would have allowed greater clarity in their collective opinion.➢The representation of neonatal experts from LICs was not as robust as from high-income countries, which may have led to an uneven evaluation of the algorithms.

scholarly journals Enteropathy-induced regulatory T cells inhibit intestinal CD4+ T cell responses against oral vaccines

2020 ◽  
Author(s):  
Amrita Bhattacharjee ◽  
Ansen H.P. Burr ◽  
Abigail E. Overacre-Delgoffe ◽  
Justin T. Tometich ◽  
Deyi Yang ◽  
...  
Keyword(s):  
Small Intestine ◽  
T Cell ◽  
Intestinal Inflammation ◽  
Oral Vaccine ◽  
T Cell Responses ◽  
Cd4 T Cell ◽  
Oral Vaccines ◽  
Vaccine Response ◽  
Cell Responses ◽  
Cell Immunity

SummaryEnvironmental Enteric Dysfunction (EED) is an intestinal disease caused by malnutrition and infection that leads to malabsorption and stunting. EED is also associated with a reduced efficacy of oral vaccines. We show in a microbiota and diet-dependent model of EED that oral vaccine-specific CD4+ T cell responses fail in the small intestine but responses in the draining lymph node were unaffected. Accordingly, the number of immunosuppressive RORγT+FOXP3+ Tregs in the small intestine inversely correlated with the response to oral vaccination. Depletion of RORγT+FOXP3+ Tregs indicated that they were necessary for EED-associated inhibition of the vaccine response. Additionally, RORγT+FOXP3+ Tregs are important to regulate EED-associated inflammation as their depletion significantly worsened stunting. We have shown that EED-associated intestinal inflammation leads to a localized intestinal blockade of CD4 T cell immunity. These results support a modular model for immunity where tissue responses can be regulated independently of systemic immunity to prevent autoinflammation.

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