scholarly journals Effects of an urban sanitation intervention on childhood enteric infection and diarrhoea in Mozambique

2020 ◽  
Author(s):  
Jackie Knee ◽  
Trent Sumner ◽  
Zaida Adriano ◽  
Claire Anderson ◽  
Farran Bush ◽  
...  
Keyword(s):  
Low Income ◽  
Urban Areas ◽  
Critical Infrastructure ◽  
Controlled Trial ◽  
Prevalence Ratio ◽  
Low Income Countries ◽  
Enteric Infection ◽  
Urban Sanitation ◽  
Protozoan Infection ◽  
The Impact

Background. Onsite sanitation serves more than 740 million people in urban areas, primarily in low-income countries. Although this critical infrastructure may play an important role in controlling enteric infections in high-burden settings, its health impacts have never been evaluated in a controlled trial. Methods. We conducted a controlled before and after trial to evaluate the impact an onsite urban sanitation intervention on the prevalence of bacterial and protozoan infection (primary outcome), soil transmitted helminth (STH) re-infection, and seven-day period prevalence of diarrhoea among children living in informal neighborhoods of Maputo, Mozambique. A non-governmental organization replaced existing shared latrines in poor condition with engineered pour-flush toilets with septic tanks serving household clusters. We enrolled children aged 1-48 months at baseline and measured outcomes before the intervention and at 12 and 24 months following intervention. We measured outcomes concurrently among children served by the sanitation improvements and those in a comparable control arm served by existing poor sanitation. The trial was registered at ClinicalTrials.gov, number NCT02362932. Findings. At baseline, we enrolled 454 children from 208 intervention clusters and 533 children from 287 control clusters. We enrolled or re-visited 462 intervention and 477 control children 12 months 60 after intervention and 502 intervention and 499 control children 24 months after intervention. Despite nearly exclusive use of the intervention, we found no evidence that engineered onsite sanitation affected the overall prevalence of any measured bacterial or protozoan infection (12-month adjusted prevalence ratio 1.05, 95% CI [0.95-1.16]; 24-month adjusted prevalence ratio 0.99, 95% CI [0.91-1.09]), any STH re-infection (1.11 [0.89-1.38]; 0.95 [0.77-1.17]), or diarrhoea (1.69 [0.89-3.21]; 0.84 [0.47-1.51]) after 12 or 24 months of exposure. Among children born into study sites after the intervention and measured at the 24-month visit, we observed a reduced prevalence of any STH re-infection of 49% (adjusted prevalence ratio 0.51 [95% confidence interval 0.27 - 0.95]), Trichuris of 76% (0.24 [0.10 - 0.60]), and Shigella infection by 51% (0.49 [0.28-0.85]) relative to the same age group at baseline. Interpretation. The intervention did not reduce the overall prevalence of enteric infection and diarrhoea among all enrolled children but may have substantially reduced the prevalence of STHs and Shigella among children born into clusters with sanitary improvements.

scholarly journals Impact of improved small-scale livestock farming on human nutrition

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Md. Emran Hossain ◽  
Md. Ahasanul Hoque ◽  
Emanuele Giorgi ◽  
Guillaume Fournié ◽  
Goutam Buddha Das ◽  
...  
Keyword(s):  
Low Income ◽  
Dietary Diversity ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Low Income Countries ◽  
Small Scale ◽  
Micronutrient Deficiencies ◽  
Livestock Farming ◽  
Randomised Controlled ◽  
The Impact

AbstractMicronutrient deficiencies and stunting rates are high in many low-income countries. Increasing and diversifying food intake are often challenging for small-scale farmers in lowland areas as flooding often results in crop losses and drowning of livestock. A cluster-randomised controlled trial was conducted over 12-months in Bangladesh, involving 150 small-scale duck rearing households, including 50 control, and 50 households each in two intervention arms. Interventions focussing on improving duck health and duck nutrition were applied on a village level. Data analysis focussed on assessing the impact of interventions on duck mortality, sales and consumption, and on dietary diversity of household members. Improved duck rearing increased the consumption and the sales of ducks. Household selling more ducks were more likely to purchase and consume milk products, contributing to an improved households’ dietary diversity. Our results suggest that improving duck rearing can provide a suitable and sustainable alternative to maintain and improve dietary diversity of households in flood-prone areas.

Reducing Mortality Among Bleeding Trauma Patients with Tranexamic Acid

2018 ◽  
pp. 241-247
Author(s):  
Haytham M. A. Kaafarani
Keyword(s):  
Randomized Controlled Trial ◽  
Tranexamic Acid ◽  
Hemorrhagic Shock ◽  
Low Income ◽  
Controlled Trial ◽  
Low Income Countries ◽  
Trauma Patients ◽  
Thromboembolic Events ◽  
The World ◽  
The Impact

The CRASH-2 trial is a randomized controlled trial performed in more than 270 hospitals across the world and aimed at studying the impact of tranexamic acid (TXA), an anti-fibrinolytic agent, on mortality in trauma patients presenting with hemorrhagic shock. With more than 20,000 patients, CRASH-2 showed a small but statistically significant decrease in mortality from 16% to 14.5% (p < 0.05), without any increase in thromboembolic events, in patients who received TXA versus placebo. Subset analyses suggested that the benefit was only present if TXA was administered within 3 h from injury. Two main criticisms of the study are (1) TXA reduced mortality but not the number of blood products used or the percentage of patients who needed transfusion, raising questions regarding the mechanism by which the drug worked; (2) the conductance of the study in moderate- to low-income countries, limiting its generalizability to high-income countries with advanced trauma systems.

scholarly journals The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Giorgia Gon ◽  
Abdunoor M. Kabanywanyi ◽  
Petri Blinkhoff ◽  
Simon Cousens ◽  
Stephanie J. Dancer ◽  
...  
Keyword(s):  
Pilot Study ◽  
Study Design ◽  
Low Income ◽  
High Volume ◽  
Surface Cleaning ◽  
Low Income Countries ◽  
Training Period ◽  
Future Research ◽  
Environmental Hygiene ◽  
The Impact

Abstract Background Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. Methods This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. Results Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11–1.60), and by 1.08 (CI = 1.03–1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. Conclusions The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design.

scholarly journals COVID-19 in children treated with immunosuppressive medication for kidney diseases

2020 ◽  
pp. archdischild-2020-320616
Author(s):  
Matko Marlais ◽  
Tanja Wlodkowski ◽  
Samhar Al-Akash ◽  
Petr Ananin ◽  
Varun Kumar Bandi ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Immunosuppressive Therapy ◽  
Low Income ◽  
Kidney Diseases ◽  
Low Income Countries ◽  
Reference Network ◽  
Immunosuppressive Medication ◽  
Immunosuppressive Medications ◽  
Significant Difference ◽  
The Impact

BackgroundChildren are recognised as at lower risk of severe COVID-19 compared with adults, but the impact of immunosuppression is yet to be determined. This study aims to describe the clinical course of COVID-19 in children with kidney disease taking immunosuppressive medication and to assess disease severity.MethodsCross-sectional study hosted by the European Rare Kidney Disease Reference Network and supported by the European, Asian and International paediatric nephrology societies. Anonymised data were submitted online for any child (age <20 years) with COVID-19 taking immunosuppressive medication for a kidney condition. Study recruited for 16 weeks from 15 March 2020 to 05 July 2020. The primary outcome was severity of COVID-19.Results113 children were reported in this study from 30 different countries. Median age: 13 years (49% male). Main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). Immunosuppressive medications used include: glucocorticoids (76%), mycophenolate mofetil (MMF) (54%), tacrolimus/ciclosporine A (58%), rituximab/ofatumumab (11%). 78% required no respiratory support during COVID-19 illness, 5% required bi-level positive airway pressure or ventilation. Four children died; all deaths reported were from low-income countries with associated comorbidities. There was no significant difference in severity of COVID-19 based on gender, dialysis status, underlying kidney condition, and type or number of immunosuppressive medications.ConclusionsThis global study shows most children with a kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. We therefore suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.

scholarly journals Meeting the Challenges of Longitudinal Cluster-Based Trials in Schools: Lessons From the Chicago Trial of Positive Action

2016 ◽  
Vol 40 (4) ◽  
pp. 450-482 ◽  
Author(s):  
Kendra M. Lewis ◽  
David L. DuBois ◽  
Peter Ji ◽  
Joseph Day ◽  
Naida Silverthorn ◽  
...  
Keyword(s):  
Public Schools ◽  
Low Income ◽  
Urban Areas ◽  
Statistical Power ◽  
Student Mobility ◽  
Controlled Trial ◽  
Lessons Learned ◽  
Study Planning ◽  
Positive Action ◽  
Cluster Randomized

We describe challenges in the 6-year longitudinal cluster randomized controlled trial (CRCT) of Positive Action (PA), a social–emotional and character development (SECD) program, conducted in 14 low-income, urban Chicago Public Schools. Challenges pertained to logistics of study planning (school recruitment, retention of schools during the trial, consent rates, assessment of student outcomes, and confidentiality), study design (randomization of a small number of schools), fidelity (implementation of PA and control condition activities), and evaluation (restricted range of outcomes, measurement invariance, statistical power, student mobility, and moderators of program effects). Strategies used to address the challenges within each of these areas are discussed. Incorporation of lessons learned from this study may help to improve future evaluations of longitudinal CRCTs, especially those that involve evaluation of school-based interventions for minority populations and urban areas.

Foreign capital inflows and economic growth: the experience of low-income countries in Sub Saharan Africa

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Atif Awad
Keyword(s):  
Low Income ◽  
Foreign Capital ◽  
Ordinary Least Squares ◽  
Capital Inflows ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Content Type ◽  
Long Run ◽  
Foreign Capital Inflows ◽  
The Impact

Purpose This paper aims to investigate the long-run impact of selected foreign capital inflows, including aid, remittances, foreign direct investment (FDI), trade and debt, on the economic growth of 21 low-income countries in the Sub Saharan Africa (SSA) region, during the period 1990–2018. Design/methodology/approach To obtain this objective and for robust analysis, a parametric approach, which was dynamic ordinary least squares, and a non-parametric technique, which was fully modified ordinary least squares, were used. Findings The results of both models confirmed that, in the long run, trade and aid affected the growth rate of the per capita income in these countries in a positive way. However, external debt seemed to have an adverse influence on such growth. Originality/value First, this is the initial study that has addressed this matter across a homogenous group of countries in the SSA region. Second, while most of the previous studies regarding capital inflows into the SSA region have focused on the impact of only one or two aspects of such foreign capital inflows on growth, the present study, instead, examined the impact of five types of foreign capital inflows (aid, remittances, FDI, trade and debt).

scholarly journals An evaluation of the self-help housing scheme in Botswana, case of Gaborone city

Spatium ◽  
2007 ◽  
pp. 28-36 ◽  
Author(s):  
Horatio Ikgopoleng ◽  
Branko Cavric
Keyword(s):  
Low Income ◽  
Urban Areas ◽  
Urban Families ◽  
Evaluation Study ◽  
Urban Housing ◽  
Urban Centers ◽  
Self Help ◽  
Housing Scheme ◽  
The Government ◽  
The Impact

Botswana like other developing countries faces a problem of acute shortage of housing, particularly for low-income urban families. The current housing problems are the outcomes of the economic, demographic and social changes which the country has experienced since independence in 1966. In particular the urbanization process which surfaced in the early 1980?s. The government has sought to cope with the problem of low-income urban housing by establishing a Self-Help Housing (SHHA) program in the main urban centers. The evaluation findings reveal that, on the whole, the impact of the SHHA approach on the improvement of low-income urban housing has been unsuccessful. The major problems of the scheme are lack of serviced land and inadequate finances for plot development. This has been exacerbated by the high urban development standards which are out of the reach of low-income urban families. The evaluation study also reveals that, there are some indications of non low-income urban households living in SHHA areas. The available evidence reveals that the number of those people in SHHA areas is not as big as has been speculated by most people in the country. However this paper calls for more investigation in this issue and a need for more tight measures to control this illicit practice. The major conclusions are that housing policies in Botswana are not supportive of the general housing conditions in low-income urban areas. Therefore there is a need for urban planners and policy makers of Botswana to take more positive action towards the improvement of low-income urban areas. This would require pragmatic policies geared towards the improvement of those areas. .

scholarly journals Mean Corpuscular Volume as a Marker for Adherence to Zidovudine-Containing Therapy in HIV-Infected Adults

2012 ◽  
Vol 6 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Joseph O Mugisha ◽  
Katherine Donegan ◽  
Sarah Fidler ◽  
Gita Ramjee ◽  
Andrew Hodson ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Low Income ◽  
Mean Corpuscular Volume ◽  
Controlled Trial ◽  
Low Income Countries ◽  
Corpuscular Volume ◽  
Hiv Rna ◽  
Cart Initiation ◽  
Short Course ◽  
Randomised Controlled

Objectives: To assess whether mean corpuscular volume (MCV) is useful in detecting non-adherence to AZTcontaining therapy. Design: Observational study within randomised controlled trial. Methods: We combined data from two treatment arms in SPARTAC, an RCT of short-course cART in primary HIV infection, classifying participants as responders (HIV-RNA decrease ≥1 log10 or reaching <400copies/ml) or nonresponders following cART initiation. We assessed the sensitivity and specificity of using different percentage increases in MCV for accurately differentiating between responders and non-responders. We further examined changes in MCV levels up to 24 weeks after protocol-indicated cART cessation. Results: Of 119 participants included in this analysis, 73 (61%) were women, 71 of whom were randomised in Africa. Ninety-eight (88%) and 84 (85%) were classified as responders at 4 and 12 weeks respectively following cART initiation. MCV increased by a mean 3% and 1% at week 4, and 14% and <1% at 12 weeks for responders and non-responders. A 2% MCV increase at 4 weeks had 62% sensitivity and specificity for identifying virological response. At 12 weeks, an 8% increase had 89% sensitivity and specificity. In responders, MCV remained lower for individuals in African compared to non-African sites throughout and rose from 85 vs 90 fL at cART start to 96 vs 103 fL at 12 weeks post-initiation then fell to 88 vs 93 fL and 86 vs 89 fL at 12 and 48 weeks post-cessation. Conclusion: In low-income countries, where HIV RNA may be unavailable, 12-weekly MCV measurements may be useful in monitoring adherence to AZT-containing regimens.

scholarly journals Poultry farmer response to disease outbreaks in smallholder farming systems

2020 ◽  
Author(s):  
Alexis Delabouglise ◽  
Nguyen Thi Le Thanh ◽  
Huynh Thi Ai Xuyen ◽  
Benjamin Nguyen-Van-Yen ◽  
Phung Ngoc Tuyet ◽  
...  
Keyword(s):  
Avian Influenza ◽  
Low Income ◽  
Low Income Countries ◽  
Farm Size ◽  
Small Scale ◽  
Flock Size ◽  
Smallholder Farming ◽  
Southern Vietnam ◽  
Poultry Farms ◽  
The Impact

AbstractAvian influenza outbreaks have been occurring on smallholder poultry farms in Asia for two decades. Farmer responses to these outbreaks can slow down or accelerate virus transmission. We used a longitudinal survey of 53 small-scale chicken farms in southern Vietnam to investigate the impact of outbreaks with disease-induced mortality on harvest rate, vaccination, and disinfection behaviors. We found that in small broiler flocks (≤16 birds/flock) the estimated probability of harvest was 56% higher when an outbreak occurred, and 214% higher if an outbreak with sudden deaths occurred in the same month. Vaccination and disinfection were strongly positively correlated with flock size and farm size, respectively. Small-scale farmers – the overwhelming majority of poultry producers in low-income countries – tend to rely on rapid sale of birds to mitigate losses from diseases. As depopulated birds are sent to markets or trading networks, this reactive behavior has the potential to enhance onward transmission.One sentence summaryA cohort study of fifty three small-scale poultry farms in southern Vietnam reveals that when outbreaks occur with symptoms similar to highly pathogenic avian influenza, farmers respond by sending their chickens to market early, potentially exacerbating the effects of the outbreak.

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