scholarly journals Implementation challenges from a prospective, interventional biopsy-based study of Environmental Enteropathy in rural Pakistan

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 549
Author(s):  
Sheraz Ahmed ◽  
Najeeha Iqbal ◽  
Kamran Sadiq ◽  
Fayaz Umrani ◽  
Arjumand Rizvi ◽  
...  
Keyword(s):  
Community Intervention ◽  
Invasive Procedure ◽  
Sample Collection ◽  
Middle Income ◽  
Implementation Challenges ◽  
Malnourished Children ◽  
Environmental Enteropathy ◽  
Recall Data ◽  
Field Team ◽  
Successful Execution

The Study of Environmental Enteropathy (EE) and Malnutrition in Pakistan (SEEM) is a community intervention trial designed to understand the pathophysiology of EE and its associated clinical phenotypes in children less than two years of age. Undernutrition is the underlying cause of three million deaths worldwide annually, accounting for 45% of all deaths among children under five years of age. Linear growth stunting affects a further 165 million, especially in low- and middle-income countries. In Pakistan,  an estimated one in three children are underweight and nearly half are stunted. This manuscript summarizes the challenges faced by the field team and the solutions employed for achieving our research objectives at the rural Matiari field site. Our study design involved a longitudinal collection of field data and biological samples which required constant engagement of field staff with the participating families. Challenges faced in SEEM included: 1) quality assurance parameters of anthropometry data; 2) 24-hour food recall data collection; 3) clinical management of sick enrolled children; 4) obtaining informed consent for upper gastrointestinal (UGI)endoscopy (an invasive procedure); and 5) biological sample collection (blood, urine, stool) from enrolled children. We enrolled 350 malnourished children(Weight for Height Z (WHZ) score <-2) and 50 well-nourished children(WHZ score ≥ 0 and height-for-age Z (HAZ) score ≥ -1)   with more than 95% success rate of collecting blood, urine and stool specimens. We collected 72% microbiome stool samples within 30 minutes of the child passing stool. We conducted a UGI biopsy in 63 children.   Solutions to these challenges included good project governance, the establishment of credibility, and the development of a longitudinal bidirectional relationship embedded in trust and effective communication with the caretakers of the enrolled children.     Continuous monitoring, regular training of staff, and effective teamwork were key factors that led to the successful execution of our study.

scholarly journals Implementation challenges from a prospective, interventional biopsy-based study of Environmental Enteropathy in rural Pakistan

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 549
Author(s):  
Sheraz Ahmed ◽  
Najeeha Iqbal ◽  
Kamran Sadiq ◽  
Fayaz Umrani ◽  
Arjumand Rizvi ◽  
...  
Keyword(s):  
Good Governance ◽  
Community Intervention ◽  
Invasive Procedure ◽  
Upper Gastrointestinal Endoscopy ◽  
Sample Collection ◽  
Implementation Challenges ◽  
Malnourished Children ◽  
Environmental Enteropathy ◽  
Sick Children ◽  
Upper Gastrointestinal

The Study of Environmental Enteropathy (EE) and Malnutrition in Pakistan (SEEM) is a community intervention trial designed to understand the pathophysiology of EE and its associated clinical phenotypes in children less than two years of age. Undernutrition is the underlying cause of three million deaths annually, accounting for 45% of all deaths among children under five years of age. Linear growth stunting affects a further 165 million. In Pakistan, where our study is focused, an estimated one in three children are underweight and nearly half are stunted. This manuscript summarizes the challenges faced by the field team and the solutions employed for achieving our research objectives at the rural field site, Matiari.  Our study design involved a longitudinal collection of field data and biological samples which required constant engagement of field staff with the participating families. Challenges faced in SEEM included: 1) quality assurance parameters of anthropometry data; 2) 24-hour food recall data collection; 3) clinical management of acutely sick children enrolled in our study; 4) obtaining informed consent for upper gastrointestinal endoscopy (an invasive procedure); and 5) biological sample collection (blood, urine, stool) from malnourished children at the community level.  We accomplished our goal of enrolling 350 malnourished children and 50 well-nourished children with a more than 95% success rate of collecting blood, urine and stool specimens. We collected 72% microbiome stool samples within 30 minutes of the child passing stool. We conducted an upper gastrointestinal biopsy in 63 children.   Broadly, solutions to these challenges included good governance, the establishment of credibility, and the development of a longitudinal bidirectional relationship embedded in trust and effective communication with the caretakers of the children enrolled in our study.     Continuous monitoring, regular training of staff, and effective teamwork were key factors that led to the successful execution of our study.

Su1591 IDENTIFICATION OF A BILE ACID BIOMARKER IN MALNOURISHED CHILDREN WITH ENVIRONMENTAL ENTEROPATHY IN PAKISTAN

2020 ◽  
Vol 158 (6) ◽  
pp. S-1349
Author(s):  
Kenneth D. Setchell ◽  
Xueheng Zhao ◽  
Rong Huang ◽  
Edward A. Dobrzykowski ◽  
Elizabeth A. Maier ◽  
...  
Keyword(s):  
Bile Acid ◽  
Malnourished Children ◽  
Environmental Enteropathy

scholarly journals Uptake of routine viral load testing among people living with HIV and its implementation challenges in Yangon region of Myanmar: a mixed-methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032678
Author(s):  
Khine Khine Thinn ◽  
Pruthu Thekkur ◽  
Nang Thu Thu Kyaw ◽  
Nyein Su Aye ◽  
Tin Maung Zaw ◽  
...  
Keyword(s):  
Viral Load ◽  
Mixed Methods ◽  
Clinical Stage ◽  
Virological Suppression ◽  
Mixed Methods Study ◽  
People Living With Hiv ◽  
Sample Collection ◽  
Implementation Challenges ◽  
Wage Loss ◽  
Living With Hiv

ObjectivesIn 2017, Myanmar implemented routine viral load (VL) monitoring for assessing the response to antiretroviral therapy (ART) among people living with HIV (PLHIV). The performance of routine VL testing and implementation challenges has not yet assessed. We aimed to determine the uptake of VL testing and factors associated with it among PLHIV initiated on ART during 2017 in ART clinics of Yangon region and to explore the implementation challenges as perceived by the healthcare providers.DesignAn explanatory mixed-methods study was conducted. The quantitative component was a cohort study, and the qualitative part was a descriptive study with in-depth interviews.SettingSix ART clinics operated by AIDS/sexually transmitted infection teams under the National AIDS Programme.Primary outcome measures(1) The proportion who underwent VL testing by 30 March 2019 and the proportion with virological suppression (plasma VL <1000 copies/mL); (2) association between patient characteristics and ‘not tested’ was assessed using log binomial regression and (3) qualitative codes on implementation challenges.ResultsOf the 567 PLHIV started on ART, 498 (87.8%) retained in care for more than 6 months and were eligible for VL testing. 288 (57.8%, 95% CI: 53.3% to 62.2%) PLHIV underwent VL testing, of which 263 (91.3%, 95% CI: 87.1% to 94.4%) had virological suppression. PLHIV with WHO clinical stage 4 had significantly higher rates of ‘not being tested’ for VL. Collection of sample for VL testing only twice a month, difficulties in sample collection and transportation, limited trained workforce, wage loss and out-of-pocket expenditure for patients due to added visits were major implementation challenges.ConclusionsThe VL test uptake was low, with only six out of ten PLHIV tested. The VL testing uptake needs to be improved by strengthening sample collection and transportation, adopting point-of-care VL tests, increasing trained workforce, providing compensation to patients for wage loss and travel costs for additional visits.

scholarly journals An integrated lab-on-a-chip device for RNA extraction, amplification and CRISPR-Cas12a-assisted detection for COVID-19 screening in resource-limited settings

2022 ◽  
Author(s):  
Bongkot Ngamsom ◽  
Alexander Iles ◽  
Moses Kamita ◽  
Racheal Kimani ◽  
Pablo Rodriguez-Mateos ◽  
...  
Keyword(s):  
Saliva Sample ◽  
Rna Extraction ◽  
Lab On A Chip ◽  
Cross Reactivity ◽  
Contact Tracing ◽  
Molecular Diagnostic ◽  
N Gene ◽  
Sample Collection ◽  
Middle Income ◽  
Specificity And Sensitivity

In response to the ongoing COVID-19 pandemic and disparities of vaccination coverage in low-and middle-income countries, it is vital to adopt a widespread testing and screening programme, combined with contact tracing, to monitor and effectively control the infection dispersion in areas where medical resources are limited. This work presents a lab-on-a-chip platform, namely IFAST-CRISPR, as an affordable, rapid and high-precision molecular diagnostic means for SARS-CoV-2 detection. The herein proposed sample-to-answer platform integrates RNA extraction, amplification and CRISPR-Cas-based detection with lateral flow readout in one device. The microscale dimensions of the device containing immiscible liquids, coupled with the use of silica paramagnetic beads and GuHCl, streamline sample preparation, including RNA concentration, extraction and purification, in 15 min with minimal hands-on steps. By combining RT-LAMP with CRISPR-Cas12 assays targeting the nucleoprotein (N) gene, visual identification of ≥ 470 copies mL-1 genomic SARS-CoV-2 samples was achieved in 45 min, with no cross-reactivity towards HCoV-OC43 nor H1N1. On-chip assays showed the ability to isolate and detect SARS-CoV-2 from 1,000 genome copies mL-1 of replication-deficient viral particles in 1 h. This simple, affordable and integrated platform demonstrated a visual, faster, and yet specificity and sensitivity-comparable alternative to the costly gold-standard RT-PCR assay, requiring only a simple heating source. Further investigations on multiplexing and direct interfacing of the accessible Swan-brand cigarette filter for saliva sample collection could provide a complete work flow for COVID-19 diagnostics from saliva samples suitable for low-resource settings.

scholarly journals The Prevalence of Acute and Chronic Malnutrition Among Children Under Five in a Rural Haitian Town: A Population-Based Survey (P11-103-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Connor Orrico ◽  
Jon Zelasko ◽  
Vinny Polsinelli ◽  
Vijay Aswani
Keyword(s):  
Household Survey ◽  
Population Based ◽  
Western Hemisphere ◽  
Acute Malnutrition ◽  
Formal Schooling ◽  
Middle Income ◽  
Persistent Problem ◽  
Malnourished Children ◽  
Low Middle Income Countries ◽  
Population Based Survey

Abstract Objectives Both chronic and acute malnutrition in children under 5 remain a persistent problem in low and low-middle income countries. Haiti faces the highest burden of childhood malnutrition in the Western Hemisphere. We attempted to describe the prevalence of malnutrition in children in a farming community in Haiti and record characteristics of the those experiencing the disease. Methods A household survey was conducted within the town of Fontaine in the Nord department of Haiti on all children under the age of 5. A total of 535 children were assessed. Anthropometric data was taken on the children and household information was assessed via a population-based survey. Results Of the children assessed, 28% (149/535) were either chronically or acutely malnourished. Of the children who were malnourished: 36.4% (43/118) had 3 or more bouts of diarrhea in the past 3 months and only 5.3% (7/132) had stopped breastfeeding before 1 year of age. On average, the mothers of these children had completed 6.2 years of formal schooling. A slight majority of mothers, 54.7% (81/148), either “never” or “rarely” were concerned their child was malnourished. Of the households with malnourished children 88.4% (130/147) had reported running out of food in the last month. When asked what caused children in Fontaine to be malnourished, mothers of malnourished children cited a lack of food, 56.2% (82/146), and a lack of access to employment, 25.3% (37/146), most frequently. Conclusions Malnutrition commonly affects children in Fontaine. Efficacious prevention interventions could possibly include decreasing food insecurity, or increasing girls’ education level. Funding Sources None.

scholarly journals Nutritional services for children in Beira, Mozambique: a study reporting on participatory use of data to generate quality improvement recommendations

2019 ◽  
Vol 8 (4) ◽  
pp. e000758 ◽  
Author(s):  
Marzia Lazzerini ◽  
Kajal Chhaganlal ◽  
Augusto Cesar Macome ◽  
Giovanni Putoto
Keyword(s):  
Low Income ◽  
Recovery Rate ◽  
Severe Acute Malnutrition ◽  
Phase 1 ◽  
Participatory Approach ◽  
Health Hazards ◽  
Acute Malnutrition ◽  
Phase 2 ◽  
Middle Income ◽  
Malnourished Children

BackgroundExisting literature suggest frequent gaps in the quality of care (QoC) provided to children with malnutrition in low-income and middle-income countries. Beira is the second largest city in Mozambique. This study included two phases: phase 1 was a systematic assessment of the QoC provided to malnourished children in Beira; phase 2 aimed at using findings of the assessment to develop recommendations, with a participatory approach, to improve QoC.MethodsIn phase 1, all facilities offering nutritional care to children in Beira were included, and exit health outcomes were reviewed against international SPHERE standards. A sample of four (66%) facilities was randomly selected for a comprehensive assessment of all areas contributing to QoC using an adapted WHO tool. In phase 2, key stakeholders were identified, and using a participatory approach, a list of actions for improving the QoC for malnourished children was agreed.ResultsIn phase 1, outcomes of 1428 children with either severe acute malnutrition or moderate acute malnutrition (MAM) were reviewed. In-hospital recovery rate (70.1%) was almost in line with the SPHERE standard (75%), while at outpatient level, it was significantly lower (48.2%, risk ratio (RR) 0.68, p<0.0001). Recovery rate was significantly lower in HIV seropositive compared with seronegative (39.2% vs 52.8%, RR 1.34, p=0.005). High heterogeneity in MAM recovery rate was detected among facilities (range 32.5%–61.0%). Overall, out of all domains contributing to QoC in the sample, 28/46 (60.8%) indicated suboptimal care with significant health hazards and 13/46 (28.2%) indicated totally inadequate care with severe health hazards. In phase 2, a list of 38 actions to improve QoC for malnourished children was agreed among 33 local and national stakeholders.ConclusionsLarge heterogeneity in QoC for malnourished children in Beria was detected. The study documents a concrete example of using data proactively, for agreeing actions to improve QoC.

scholarly journals Child Salivary SIgA and Its Relationship to Enteric Infections and EED Biomarkers in Maputo, Mozambique

2020 ◽  
Vol 17 (9) ◽  
pp. 3035
Author(s):  
Frederick G. B. Goddard ◽  
Jacqueline Knee ◽  
Trent Sumner ◽  
Rassul Nalá ◽  
Thomas Clasen ◽  
...  
Keyword(s):  
Linear Models ◽  
Immunoglobulin A ◽  
Invasive Procedure ◽  
Antibody Detection ◽  
Sample Collection ◽  
Cross Sectional ◽  
Immunological Responses ◽  
Different Ages ◽  
Enteric Infections ◽  
Salivary Secretory Immunoglobulin A

Characterizing child immunological responses to enteric infections with antibody detection in serum can be challenging in resource-constrained field settings, because sample collection requires trained individuals and its invasive procedure may lead to low response rates, especially among children. Saliva may present a promising non-invasive alternative. The objectives of this research were to compare salivary antibody levels in children to enteric infections and biomarkers of environmental enteric dysfunction (EED). We collected saliva samples from children aged one to six years enrolled in a sanitation trial in Maputo, Mozambique, and characterized salivary secretory immunoglobulin A (SIgA) concentrations with enzyme-linked immunosorbent assays. We used multilevel linear models to analyze cross-sectional associations between salivary SIgA and the number of concurrent enteric pathogen infections, as well as EED biomarkers in matched stool samples. Median salivary SIgA concentrations in this study population were 54 μg/mL (inter-quartile range (IQR): 34, 85 μg/mL), and SIgA levels were similar between children of different ages. SIgA was lower in children experiencing a higher number of concurrent infections −0.04 log μg/mL (95% confidence interval (CI): −0.08 to −0.005 log μg/mL), but was not associated with any of the included EED biomarkers. Contrary to evidence from high-income countries that suggests salivary SIgA increases rapidly with age in young children, the high prevalence of enteric infections may have led to a suppression of immunological development in this study sample and could in part explain the similar SIgA levels between children of different ages.

scholarly journals Patient identification and tube labelling – a call for harmonisation

2016 ◽  
Vol 54 (7) ◽  
Author(s):  
Edmée C. van Dongen-Lases ◽  
Michael P. Cornes ◽  
Kjell Grankvist ◽  
Mercedes Ibarz ◽  
Gunn B.B. Kristensen ◽  
...  
Keyword(s):  
Working Group ◽  
Clinical Laboratory ◽  
Improve Patient Safety ◽  
Clinical Chemistry ◽  
Venous Blood ◽  
Invasive Procedure ◽  
European Countries ◽  
European Federation ◽  
Sample Collection ◽  
Patient Identification

AbstractVenous blood sampling (phlebotomy) is the most common invasive procedure performed in patient care. Guidelines on the correct practice of phlebotomy are available, including the H3-A6 guideline issued by the Clinical Laboratory Standards Institute (CLSI). As the quality of practices and procedures related to venous blood sample collection in European countries was unknown, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase conducted an observational study in 12 European countries. The study demonstrated that the level of compliance of phlebotomy procedures with the CLSI H3-A6 guideline was unacceptably low, and that patient identification and tube labelling are amongst the most critical steps in need of immediate attention and improvement. The process of patient identification and tube labelling is an essential safety barrier to prevent patient identity mix-up. Therefore, the EFLM Working Group aims to encourage and support worldwide harmonisation of patient identification and tube labelling procedures in order to reduce the risk of preanalytical errors and improve patient safety. With this Position paper we wish to raise awareness and provide recommendations for proper patient and sample identification procedures.

scholarly journals The Distinctive Serum Metabolomes of Gastric, Esophageal and Colorectal Cancers

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 720
Author(s):  
Zhenxing Ren ◽  
Cynthia Rajani ◽  
Wei Jia
Keyword(s):  
Aerobic Glycolysis ◽  
Invasive Procedure ◽  
Screening Tests ◽  
Blood Collection ◽  
Gastrointestinal Cancers ◽  
Sample Collection ◽  
Non Invasive ◽  
Metabolite Profiles ◽  
Serum Metabolomics ◽  
The Warburg Effect

Three of the most lethal cancers in the world are the gastrointestinal cancers—gastric (GC), esophageal (EC) and colorectal cancer (CRC)—which are ranked as third, sixth and fourth in cancer deaths globally. Early detection of these cancers is difficult, and a quest is currently on to find non-invasive screening tests to detect these cancers. The reprogramming of energy metabolism is a hallmark of cancer, notably, an increased dependence on aerobic glycolysis which is often referred to as the Warburg effect. This metabolic change results in a unique metabolic profile that distinguishes cancer cells from normal cells. Serum metabolomics analyses allow one to measure the end products of both host and microbiota metabolism present at the time of sample collection. It is a non-invasive procedure requiring only blood collection which encourages greater patient compliance to have more frequent screenings for cancer. In the following review we will examine some of the most current serum metabolomics studies in order to compare their results and test a hypothesis that different tumors, notably, from EC, GC and CRC, have distinguishing serum metabolite profiles.

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