Quantitative Risk Assessment of Developing Salmonellosis through Consumption of Beef in Lusaka Province, Zambia

Based on the Codex Alimentarious framework, this study quantitatively assessed the risk of developing salmonellosis through consumption of beef in Lusaka Province of Zambia. Data used to achieve this objective were obtained from reviews of scientific literature, Government reports, and survey results from a questionnaire that was administered to consumers to address information gaps from secondary data. The Swift Quantitative Microbiological Risk Assessment (sQMRA) model was used to analyse the data. The study was driven by a lack of empircally-based risk estimation despite a number of reported cases of salmonellosis in humans. A typology of consumers including all age groups was developed based on their beef consumption habits, distinguishing between those with low home consumption, those with medium levels of home consumption, and those with high levels through restaurant consumption. This study shows that the risk of developing salmonellosis in this population, from consuming beef, was generally low. At ID50 of 9.61 × 103 cfu/g and a retail contamination concentration of 12 cfu/g, the risk of developing salmonellosis through the consumption of beef prepared by consumers with low and medium levels of beef consumption was estimated at 0.06% and 0.08%, respectively, while the risk associated with restaurant consumption was estimated at 0.16% per year. The study concludes that the risk of developing salmonellosis among residents in Lusaka province, as a result of beef consumption, was generally low, mainly due to the methods used for food preparation. Further work is required to broaden the scope of the study and also undertake microbiological evaluation of ready-to-eat beef from both the household and restaurant risk exposure pathways

Learning and livelihoods: The experience of the FSIPM project in southern Malawi

Do resource-poor farmers in sub-Saharan Africa face severe crop losses from pests and diseases? What are the different ways that rural households earn a living, and who are the poor? How does social organization shape the way that new technology is used and shared? How can we encourage farmers to participate in the design and evaluation of field experiments, yet still obtain results that are statistically valid? How can we create 'learning projects' that can change direction in response to the needs of their clients and what they find on the ground? These were some of the questions that challenged the Farming Systems Integrated Pest Management Project during four years of intensive fieldwork with resource-poor farmers in the Blantyre Shire Highlands, southern Malawi. In searching for answers, the project drew on expertise from pest management, agronomy, economics and anthropology. Learning and Livelihoods: The Experience of the FSIPM Project in Southern Malawi reflects on the project's experience, reviews the major lessons learned, and outlines an agenda for a follow-up project that addresses smallholders' needs for food security, cash income and information about new technology. The book will appeal not only to those interested in Malawi but also to those concerned with the wider issues raised by developing technology with resource poor farmers

Taking stock of community-based flood risk management in Malawi: different stakeholders, different perspectives

Current flood risk strategies in Malawi are characterized by community-based flood risk management (CB-FRM), even though studies explicitly documenting evidence of successful CB-FRM remain limited. This paper investigates the realities and challenges of CB-FRM as seen through a lens of different stakeholders. In order to capture the experiences of CB-FRM, a predominantly qualitative research framework was developed. In 2016, 11 focus group discussions with stakeholder groups (local communities, local government and non-governmental organisations) were held. Additionally, informal discussions, field visits, a short survey and an extensive desk study were undertaken. The findings were analysed according to the major themes that emerged related to the realities and challenges of specific stakeholder groups. Although response and relief still remain prominent components of CB-FRM in Malawi, a number of mitigation and preparedness activities is observed. However, a lack of in-country resources, relief-oriented aid approaches and an ‘aid dependency’ syndrome represent obstacles. Different stakeholder groups share similar challenges in terms of financing, participation, decentralised governance and project management. Lack of project sustainability and localised ownership also emerged as major challenges. The identified challenges shed light on the frontiers and directions in which improvements are needed, thus offering a valuable contribution to the existing knowledgebase

Effect of Dexrazoxane and Amifostine on the Vertebral Bone Quality of Doxorubicin Treated Male Rats

Doxorubicin (DOX) is widely used in combination cocktails for treatment of childhood hematological cancers and solid tumors. A major factor limiting DOX usage is DOX-induced cardiotoxicity. However, it is not known whether protectants like dexrazoxane (DXR) and amifostine (AMF) can prevent DOX-mediated bone damage. The present study investigated whether administration of AMF alone or in combination with DXR would prevent any DOX-mediated bone damage. Male rat pups were treated with DOX, DXR, AMF, and their combinations. On neonate day 38, the bone mineral density (BMD), bone mineral content (BMC) and the micro-architecture of the lumbar vertebrae were analyzed. We have shown that when male rats are treated with DOX, DXR, DOX+DXR, AMF, DOX+AMF or DOX+DXR+AMF, there is a decrease in lumbar vertebral BMD (p<0.05). Furthermore, the relative bone volume (BV/TV) was decreased by DXR, DOX+DXR, and DOX+AMF treatments. Interestingly, DOX+AMF significantly increased BV/TV when compared to DXR treatment (p<0.04). The trabecular number (Tb.N) decreased with DXR and DOX+DXR and increased with DOX+AMF treatments. This information will be useful in designing better cancer combination therapies that do not lead to vertebrae deterioration

Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study

Background Obstetric fistula affects a woman’s life physically, psychosocially, and economically. Although surgery can repair the physical damage of fistula, the devastating consequences that affect a woman’s quality of life may persist when she reintegrates into her community. This qualitative study assessed long-term outcomes among women who underwent obstetric fistula repair in Malawi. We explored three domains: overall quality of life before and after repair, fertility and pregnancy outcomes after repair, and understanding of fistula. Methods In-depth interviews were conducted in Chichewa with 20 women from seven districts across Central Malawi. All women were interviewed 1 to 2 years after surgical repair for obstetric fistula at the Fistula Care Centre in Lilongwe, Malawi. Interviews were independently coded and analyzed using content analysis. Results About half of women were married and nine of 20 women reported some degree of urinary incontinence. With the exception of relationship challenges, women’s concerns before and after repair were different. Additionally, repair had resolved many of the concerns women had before repair. However, challenges, both directly and indirectly related to fistula, persisted. Improvements in quality of life at the individual level included feelings of freedom, confidence and personal growth, and improved income-earning ability. Interpersonal quality of life improvements included improved relationships with family and friends, reduced stigma, and increased participation with their communities. Nearly half of women desired future pregnancies, but many were uncertain about their ability to bear children and feared additional pregnancies could cause fistula recurrence. Most women were well informed about fistula development but myths about witchcraft and fear of delivery were present. Nearly all women would recommend fistula repair to other women, and many were advocates in their communities. Conclusions Nearly all women believed their quality of life had improved at the individual and interpersonal levels since fistula repair, even among women who continued to have urinary incontinence. Contrary to other studies, women reported they were welcomed back by their communities and had limited challenges when reintegrating. Despite the overall improvements in quality of life, many continued to have relationship problems and were concerned about future fertility. These issues need to be further explored in other studies

Age at Antiretroviral Therapy Initiation Predicts Immune Recovery, Death, and Loss to Follow-Up Among HIV-Infected Adults in Urban Zambia

We analyzed the association of age at antiretroviral therapy (ART) initiation with CD4+ T cell count recovery, death, and loss to follow-up (LTFU) among HIV-infected adults in Zambia. We compared baseline characteristics of patients by sex and age at ART initiation [categorized as 16–29 years, 30–39 years, 40–49 years, 50–59 years, and 60 years and older]. We used the medication possession ratio to assess adherence and analysis of covariance to measure the adjusted change in CD4+ T cell count during ART. Using Cox proportional hazard regression, we examined the association of age with death and LTFU. In a secondary analysis, we repeated models with age as a continuous variable. Among 92,130 HIV-infected adults who initiated ART, the median age was 34 years and 6,281 (6.8%) were aged ≥50 years. Compared with 16–29 year olds, 40–49 year olds (–46 cells/mm3), 50–59 year olds (–53 cells/mm3), and 60+ year olds (–60 cells/mm3) had reduced CD4+ T cell gains during ART. The adjusted hazard ratio (AHR) for death was increased for individuals aged ≥40 years (AHR 1.25 for 40–49 year olds, 1.56 for 50–59 year olds, and 2.97 for 60+ year olds). Adherence and retention in care were poorest among 16–29 year olds but similar in other groups. As a continuous variable, a 5-year increase in age predicted reduced CD4+ T cell count recovery and increased risk of death. Increased age at ART initiation was associated with poorer clinical outcomes, while age <30 years was associated with a higher likelihood of being lost to follow-up. HIV treatment guidelines should consider age-specific recommendations

Institutionalizing Provider-Initiated HIV Testing and Counselling for Children: An Observational Case Study from Zambia

Background: Provider-initiated testing and counselling (PITC) is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia’s Southern Province, and serving a catchment area of 1.2 million people. Methods and Principal Findings: Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS) uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074), 98.5 % of children were counselled, and 98.2 % were tested. Of children tested (n = 4983), 15.5 % were determined HIVinfected; 77.6 % of these results were determined by DNA polymerase chain reaction (PCR) testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital’s inpatient and outpatient departments (n = 1342), 99.3 % were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PIT