Mobile-Bayesian Diagnostic System for Childhood Infectious Diseases

About 5.9 million children under the age of 5 died in 2015, Preterm birth, delivery complications and infections source a great number of neonatal deaths. the Sustainable Development goals (SDGs) 3.2 is to end preventable deaths of newborns and children under 5 years of age, with a target to reduce neonatal mortality to at least 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births in all countries. However quality and accessible healthcare service is essential to achieve this goal whereas most undeveloped and developing countries still have poor access to quality healthcare. with the emergences on mobile computing and telemedicine, this work provide diagnostics alternative for childhood infectious diseases using Naïve Bayesian classier which has been proven to be efficient in handling uncertainty as regards learning of incomplete data. In this research, sample data was collected from hospitals to model a pediatric system using Naïve Bayes classifier, which produce a 70% accuracy level suitable for a decision support system. The model was also integrated into a SMS platform to enable ease of usage

Scotland Chikwawa Health Initiative - improving health from community to hospital

The Scotland Chikwawa Health Initiative is a three year programme funded by the Scottish Executive International Development Fund which aims to achieve measurable reductions in major causes of disease and death in four villages within the Chikwawa District of Malawi alongside improving the hospital environment for the good of both staff and patients. The initiative has developed a holistic approach to health improvements through the provision of infrastructure at both health facilities and within communities, and training of government personnel and community volunteers. Specific areas targeted have included water and sanitation, maternal health, and communicable disease control with provision of training and materials to facilitate interventions and health education. At the end of the second year the programme has already seen reductions in diarrhoeal disease (30% overall in target communities), improved access to safe water, an increase in the uptake of growth monitoring and immunisations in children under the age of five years (15% increase since training volunteers), improved safe delivery of babies within the community (245 babies delivered safely in target communities with 25 referred due to complications) and increased community health activity (training and integration of village health committees, water point committees, traditional birthing attendants and health surveillance assistants). The programme hopes to act as a model for the District to follow in other communities to achieve it’s obligations under the Malawi Ministry of Health Essential Health Package

Epidemiology of cryptosporidiosis in rural Malawi

A hospital and community based study was conducted in Malawi, within a rural population over a 23 month period, to identify the incidence, causative species and possible determinants for cryptosporidiosis in under fives. 5.9% (25/423) of samples collected were positive for Cryptosporidium oocysts of which 18 amplified by PCR-RFLP indicating the following species: C. hominis, C. parvum, C. meleagridis and C. andersoni. Consenting positive cases were included in a case control study. 96 home interviews were conducted in 24 communities (cases n=24; unmatched controls n=72). A total of 61 risk factors were investigated with a questionnaire, and combined with quantitative data from samples of domesticated animal stools and drinking water. Oocysts were not isolated from domesticated animals or water samples. Multivariate logistic regression of questionnaire data revealed an increased risk of cryptosporidiosis associated with ownership of pigs (OR 7.2, 95%CI 1.9–27.5, p=0.004), presence of diarrhoea in the household (OR 8.8, 95%CI 1.8–53.4, p=0.008), bathing in the river (OR 76.7, 95%CI 1.1–23.8, p=0.037) and no education within the household (OR 3.6, 95%CI 1.1–11.8, p=0.038). Bacteriological results indicating faecal contamination of both drinking water stored within the home (76%), and the surface of guardians’ hands (75%) were indicative of poor hygienic practices and potential sources of infection

Ecological sanitation - Implementation, opportunities and challenges in Chikwawa

Ecological sanitation (EcoSan) in not a new technology but rather a recognition that human excreta is a valuable natural resource (not a waste to be disposed of), containing plant nutrients which after containment and sanitization can be recycled in agriculture to enhance food production, with minimal risk of pollution of the environment and with minimal threat to human health. Various organizations are implementing EcoSan technologies in Malawi. Chikwawa is a rural district that is currently implementing EcoSan initiatives with resources from the Scotland Chikwawa Health Initiative and the US Ambassador’s Self Help Fund. The benefits from EcoSan are clear. For example, EcoSan systems help reduce the risk of spreading diseases by containing and treating human excreta before collecting it; minimising surface and groundwater contamination and recylcing the nutrients found in excreta and returning them to soil to enhance food production. However, EcoSan poses some challenges in its implementation such as a correct utilization, acceptability and sustainability of the concept

Loss to Follow-Up (LTFU) during Tuberculosis Treatment

Loss to follow-up (LTFU) is a serious issue in the field of tuberculosis (TB) since it can lead to TB outbreaks and drug resistance. The proportion of LTFU patients differs among different countries, regions, year, and institutions. In some countries, the number of patients that were LTFU nearly reaches half of the total patients. Underlying factors such as age, gender, education, residence, financial factors, migration, and social stigma are discussed in this chapter. These factors should always be taken into consideration whenever a treatment program is designed. Suggestions have been made regarding some interventions that could potentially solve the problem of LTFU. With these points in mind, an ambitious approach should be taken to reduce the number of LTFU patients up to zero

Addressing Limitations in Foodborne Outbreak Investigation: Recall Bias and the Feasibility of New Surveillance Strategies

Accurate data on the incidence of foodborne illness and food histories for affected individuals represent two important barriers to enteric outbreak surveillance and response. Innovative tools to collect and analyze this type of public health intelligence will play an important role in research efforts to improve understanding of the extent, impact of and risk factors for foodborne disease in Canada and around the world. Ethica, a smartphone based application used to acquire, store, and analyze data on human behaviour, provided an opportunity to gather information on the occurrence of enteric illness and the food consumption behaviour of 96 university students over a 10-week period. Nausea or vomiting were reported by 34% of participants, and 29% reported diarrhea at least once during the study using at least one of the available reporting options, but only 7% reported they sought medical care. Real-time data collected through digital images, meal descriptions, and microsurveys were used as a reference to measure the sensitivity and specificity of traditional food history questionnaires administered through an email link after 7 or 18 days (2.5 weeks). The validity of food history data collected after 7 days was found to be consequentially low with sensitivities ranging from 14.3% for sprouts to 100% for leafy greens and specificities ranging from 30.4% for beef to 80.4% for peanuts. Similarly, the sensitivities of questions administered after 18 days ranged from 15.8% for sprouts to 77.8% for tomatoes, with specificities ranging from 21.2% for leafy greens to 92.1% for melons. The impact of recall bias on the accuracy of food history data was found to vary with food type. Bayesian latent class analysis was conducted to determine the sensitivities and specificities in the absence of a true gold standard – the results support those of frequentist approach. These findings serve as a first step in measuring the occurrence of self-reported foodborne illness and the implications of recall bias on outbreak investigations so that these biases can be accounted for research and public health practice

Global Burden of Sickle Cell Anaemia in Children under Five, 2010-2050: Modelling Based on Demographics, Excess Mortality, and Interventions

The global burden of sickle cell anaemia (SCA) is set to rise as a consequence of improved survival in high-prevalence low- and middle-income countries and population migration to higher-income countries. The host of quantitative evidence documenting these changes has not been assembled at the global level. The purpose of this study is to estimate trends in the future number of newborns with SCA and the number of lives that could be saved in under-five children with SCA by the implementation of different levels of health interventions.First, we calculated projected numbers of newborns with SCA for each 5-y interval between 2010 and 2050 by combining estimates of national SCA frequencies with projected demographic data. We then accounted for under-five mortality (U5m) projections and tested different levels of excess mortality for children with SCA, reflecting the benefits of implementing specific health interventions for under-five patients in 2015, to assess the number of lives that could be saved with appropriate health care services. The estimated number of newborns with SCA globally will increase from 305,800 (confidence interval [CI]: 238,400-398,800) in 2010 to 404,200 (CI: 242,500-657,600) in 2050. It is likely that Nigeria (2010: 91,000 newborns with SCA [CI: 77,900-106,100]; 2050: 140,800 [CI: 95,500-200,600]) and the Democratic Republic of the Congo (2010: 39,700 [CI: 32,600-48,800]; 2050: 44,700 [CI: 27,100-70,500]) will remain the countries most in need of policies for the prevention and management of SCA. We predict a decrease in the annual number of newborns with SCA in India (2010: 44,400 [CI: 33,700-59,100]; 2050: 33,900 [CI: 15,900-64,700]). The implementation of basic health interventions (e.g., prenatal diagnosis, penicillin prophylaxis, and vaccination) for SCA in 2015, leading to significant reductions in excess mortality among under-five children with SCA, could, by 2050, prolong the lives of 5,302,900 [CI: 3,174,800-6,699,100] newborns with SCA. Similarly, large-scale universal screening could save the lives of up to 9,806,000 (CI: 6,745,800-14,232,700) newborns with SCA globally, 85% (CI: 81%-88%) of whom will be born in sub-Saharan Africa. The study findings are limited by the uncertainty in the estimates and the assumptions around mortality reductions associated with interventions.Our quantitative approach confirms that the global burden of SCA is increasing, and highlights the need to develop specific national policies for appropriate public health planning, particularly in low- and middle-income countries. Further empirical collaborative epidemiological studies are vital to assess current and future health care needs, especially in Nigeria, the Democratic Republic of the Congo, and India

Healthcare utilization patterns for acute febrile illness in Bangladesh, Nepal, and Pakistan: Results from the surveillance for enteric fever in Asia project

Background: Characterizing healthcare-seeking patterns for acute febrile illness is critical for generating population-based enteric fever incidence estimates from facility-based surveillance data.Methods: We used a hybrid model in the Surveillance for Enteric Fever in Asia Project (SEAP) to assess incidence of enteric fever at 6 study hospitals in 3 countries. We recruited individuals presenting to the hospitals and obtained blood cultures to evaluate for enteric fever. For this analysis, we undertook cluster random household surveys in Dhaka, Bangladesh (2 sites); Karachi, Pakistan; Kathmandu, Nepal; and Kavrepalanchok, Nepal between January 2017 and February 2019, to ascertain care-seeking behavior for individuals with 1) fever for ≥3 consecutive days within the past 8 weeks; or 2) fever resulting in hospitalization within the past year. We also collected data about disease severity and household demographics and assets. We used mixed-effect multivariable logistic regression models to identify determinants of healthcare seeking at study hospitals and determinants of culture-confirmed enteric fever.Results: We enrolled 31 841 households (53 926 children) in Bangladesh, 25 510 households (84 196 children and adults) in Nepal, and 21 310 households (108 031 children and adults) in Pakistan. Children \u3c5 years were most likely to be taken to the study hospitals for febrile illness at all sites. Household wealth was positively correlated with healthcare seeking in 4 of 5 study sites, and at least one marker of disease severity was positively associated with healthcare seeking in 3 of 5 catchment areas. Wealth and disease severity were variably predictive of blood culture-confirmed enteric fever.Conclusions: Age, household wealth, and disease severity are important determinants of healthcare seeking for acute febrile illness and enteric fever risk in these communities, and should be incorporated into estimation models for enteric fever incidence

Plasmodium vivax Malaria Endemicity in Indonesia in 2010

BACKGROUND: Plasmodium vivax imposes substantial morbidity and mortality burdens in endemic zones. Detailed understanding of the contemporary spatial distribution of this parasite is needed to combat it. We used model based geostatistics (MBG) techniques to generate a contemporary map of risk of Plasmodium vivax malaria in Indonesia in 2010. METHODS: Plasmodium vivax Annual Parasite Incidence data (2006-2008) and temperature masks were used to map P. vivax transmission limits. A total of 4,658 community surveys of P. vivax parasite rate (PvPR) were identified (1985-2010) for mapping quantitative estimates of contemporary endemicity within those limits. After error-checking a total of 4,457 points were included into a national database of age-standardized 1-99 year old PvPR data. A Bayesian MBG procedure created a predicted PvPR(1-99) endemicity surface with uncertainty estimates. Population at risk estimates were derived with reference to a 2010 human population surface. RESULTS: We estimated 129.6 million people in Indonesia lived at risk of P. vivax transmission in 2010. Among these, 79.3% inhabited unstable transmission areas and 20.7% resided in stable transmission areas. In western Indonesia, the predicted P. vivax prevalence was uniformly low. Over 70% of the population at risk in this region lived on Java and Bali islands, where little malaria transmission occurs. High predicted prevalence areas were observed in the Lesser Sundas, Maluku and Papua. In general, prediction uncertainty was relatively low in the west and high in the east. CONCLUSION: Most Indonesians living with endemic P. vivax experience relatively low risk of infection. However, blood surveys for this parasite are likely relatively insensitive and certainly do not detect the dormant liver stage reservoir of infection. The prospects for P. vivax elimination would be improved with deeper understanding of glucose-6-phosphate dehydrogenase deficiency (G6PDd) distribution, anti-relapse therapy practices and manageability of P. vivax importation risk, especially in Java and Bali