Nanomaterial-Agrichemical Interactions: Association of Environmental Herbicides With Two-Dimensional Graphene Nanoplatelets

Atrazine and glyphosate are the two most common agricultural herbicides used in the United States. Both herbicides can move in the environment, which results in contamination of drinking water sources. Graphene nanoplatelets (GNPs) are an emerging nanoparticle with potential uses for the remediation of environmental contamination. The first aim of this study was to determine binding interactions between atrazine and GNPs to mimic a mixture composition. To determine binding interactions, GNPs with different functional groups (none, carboxylated, or aminylated) were evaluated. GNPs at concentrations of 0, 0.5, 1, 2, or 3 mg/ml were incubated with atrazine at 3 ppb (μg/L) and centrifuged, allowing a supernatant to be collected. The supernatant was used to quantify the concentration of atrazine using an Abraxis Atrazine ELISA assay. The data demonstrated that as the concentration of GNPs increased, the percentage of atrazine bound increased until it plateaued at 2–3 mg/ ml of GNPs. The nonfunctionalized GNPs (N-GNPs) bound the most atrazine compared to the functionalized GNPs. The final aim of this study was to determine whether GNPs can be used as a tool for environmental remediation of atrazine and glyphosate contamination. Mixtures involving N-GNPs (1 mg/ml) and the herbicides atrazine (3 ppb) and glyphosate (700 ppb) were created to mimic environmental conditions. The mixtures were treated with a similar protocol as the first aim. This experiment demonstrated that N-GNPs bind to atrazine, while binding does not occur between glyphosate and N-GNPs. In addition, glyphosate did not interfere with the binding between atrazine and N-GNPs

Unlocking community capability through promotion of self-help for health: experience from Chakaria, Bangladesh

Background People’s participation in health, enshrined in the 1978 Alma Ata declaration, seeks to tap into community capability for better health and empowerment. One mechanism to promote participation in health is through participatory action research (PAR) methods. Beginning in 1994, the Bangladeshi research organization ICDDR,B implemented a project “self-help for health,” to work with existing rural self-help organizations (SHOs). SHOs are organizations formed by villagers for their well-being through their own initiatives without external material help. This paper describes the project’s implementation, impact, and reflective learnings. Methods Following a self-help conceptual framework and PAR, the project focused on building the capacity of SHOs and their members through training on organizational issues, imparting health literacy, and supporting participatory planning and monitoring. Quarterly activity reports and process documentation were the main sources of qualitative data used for this paper, enabling documentation of changes in organizational issues, as well as the number and nature of initiatives taken by the SHOs in the intervention area. Health and demographic surveillance system (HDSS) data from intervention and comparison areas since 1999 allowed assessment of changes in health indicators over time. Results Villagers and members of the SHOs actively participated in the self-help activities. SHO functionality increased in the intervention area, in terms of improved organizational processes and planned health activities. These included most notably in convening more regular meetings, identifying community needs, developing and implementing action plans, and monitoring progress and impact. Between 1999 and 2015, while decreases in infant mortality and increases in utilization of at least one antenatal care visit occurred similarly in intervention and comparison areas, increases in immunization, skilled birth attendance, facility deliveries and sanitary latrines were substantially more in intervention than comparison areas. Conclusion Building community capability by working with pre-existing SHOs, encouraging them to place health on their agendas, strengthening their functioning and implementation of health activities led to sustained improvements in utilization of services for over 20 years. Key elements underpinning success include efforts to build and maintain trust, ensuring social inclusion in project activities, and balancing demands for material resources with flexibility to be responsive to community needs

High concentration of childhood deaths in the low-lying areas of Chakaria HDSS, Bangladesh: findings from a spatial analysis

Background: Despite significant reduction of childhood mortality in Bangladesh, large spatial variations persist. Identification of lower level spatial units with higher concentrations of deaths can be useful for strengthening services in these areas. This paper reports findings from a spatial analysis of deaths in Chakaria, a rural subdistrict, where a Health and Demographic Surveillance System has been in place since 1999. Chakaria is an INDEPTH member site. Methods: An analysis was done of 339 deaths among nearly 24,500 children under the age of five during 2005–2008. One ward, the lowest level of administrative units, was the unit of spatial analysis. Data from 24 wards were analyzed. The Discrete Poisson Probability Model was used to identify the clustering of deaths. Results: Deaths were concentrated within 12 wards located in the low-lying deltaic flood plains of the Chakaria HDSS area. The risk of death in the low-lying areas was statistically, significantly higher, 1.5 times, than the non-low-lying areas (p<0.02). Conclusion: Spatial analysis can be a useful tool for identifying high-risk mortality areas. An understanding of the risk factors prevalent in the low-lying areas can help design effective interventions to reduce mortality in these areas

How safe is sex with condoms? An in-depth investigation of the condom use pattern during the last sex act in an urban area of Bangladesh

The policy of condom intervention is based on achieving ejaculation inside a condom, a "mechanical" goal of sexual interaction. However, most research on condom use has focused upon a simplistic reliance on survey results of condom use during the last sex act. Interviews with 20 hotel-based female sex workers and 15 (male) clients were conducted to explore patterns of claimed condom use during the last sex act. The Health Belief Model guided this study and was found deficient in providing an understanding of condom use. The clients' (male) perceptions of sexuality and "the male's right" to engage in sexual intercourse in commercial settings increased condom use. The invisibility of AIDS reduced participants' perceived susceptibility to and severity of suffering from the disease, while using condoms at any time during intercourse was perceived as being beneficial. Condom interventions need to be based on deeper understanding of the complexity of people's lives

HIV/AIDS-related mortality in Africa and Asia : evidence from INDEPTH health and demographic surveillance system sites

Background: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data. Objective: To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia. Design: Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population. Results: The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates. Conclusions: Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS

Making Health Markets Work Better for Poor People: the Case of Informal Providers

There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. In many countries poor people obtain a large proportion of their outpatient medical care and drugs from informal providers working outside a regulatory framework, with deleterious consequences in terms of the safety and efficacy of treatment and its cost. Interventions that focus only on improving the knowledge of these providers have had limited impact. There is a considerable amount of experience in other sectors with interventions for improving the performance of markets that poor people use. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria. These studies analyse the markets for informal health care services in terms of the sources of health-related knowledge for the providers, the livelihood strategies of these providers and the institutional arrangements within which they build and maintain their reputation. The paper concludes that there is a need to build a systematic understanding of these markets to support collaboration between key actors in building institutional arrangements that provide incentives for better performance.ESR

Amorphous, self-healed, geopolymers (ASH-G and ceramics (ASH-C) made by the geopolymer processing route

This work describes the cross fertilization of conventional whiteware production by a low energy, geopolymer processing method. Bone china is conventionally made using natural cow bone ash (calcined) of hydroxyapatite (HA). In this study HA and dicalcium phosphate (DCP) particulate reinforcements were investigated in potassium-based geopolymer composites (KGP). Particulate reinforcements of 5, 10 and 15 wt % each of hydroxyapatite and dicalcium phosphate particulate were added to potassium geopolymer to compare with composites made from BASF® Metamax metakaolin (KGP MT), Mymensingh clay metakaolin, KGP(MW) and synthetic Mymensingh clay metakaolin, KGP(MW-SYN). Microstructural properties using SEM, XRD and mechanical properties using Instron were investigated for the geopolymer samples at both room and high temperature. The XRD of pure and reinforced geopolymer samples at RT confirmed the formation of geopolymer analogues with the characteristic X-ray amorphous hump at 280 in 2θ, along with the crystalline peaks observed in KGP (MW), as well as in potassium geopolymer reinforced with hydroxyapatite and dicalcium phosphate. Thermally treated geopolymer composites at 11500C/1h exhibited crystalline peaks of leucite, kalsilite, monetite and quartz confirming the signature of geopolymer ceramics at elevated temperature. SEM revealed fully reacted and homogenous aluminosilicate matrix in all the geopolymer samples cured at room temperature for 7 days. Geopolymer composites KGP (MT)-15 DCP, KGP(MW)-15DCP and KGP(MW-SYN)-15DCP after thermal exposure at 11500C revealed microstructural integrity with the formation of phosphate glass, while a self-glazed surface was developed in KGP (MW) after being heated at 1125 0C/1h. Their high temperature properties are superior to RT properties due to amorphous self-healed glass formation (ASH) from the DCP phosphate glass. Their high temperature properties were superior to RT properties due to amorphous self-healed glass formation (ASH) from the DCP phosphate glass. The optimum DCP content was 10 wt % which gave flexure strengths of ~32 MPa after heat treatment at 1150 °C/1h

Adult non-communicable diseases mortality in Africa and Asia : evidence from IDEPTH health and demographic surveillance system sites

Background: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization’s Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15–64 years) and older (65+ years) NCD mortality. Design: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15–64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work

Calculation of Costs of Pregnancy- and Puerperium-related Care: Experience from a Hospital in a Low-income Country

Calculation of costs of different medical and surgical services has numerous uses, which include monitoring the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost allocation was used for collecting information on the cost items and, ultimately, for calculating the unit cost for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive type of case whereas the length of stay due to complications was the major driver of cost. Some constraints in keeping hospital medical records and accounting practices were observed. Despite these constraints, the findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs of different hospital-care services

Digital health and inequalities in access to health services in Bangladesh: Mixed methods study

Background: Globally, the rapid growth of technology and its use as a development solution has generated much interest in digital health. In line with global trends, Bangladesh is also integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper aims to examine the implications of digital health on access to health care in Bangladesh, considering who uses electronic devices to access health information and services and why. Objective: This study aims to understand how access to health care and related information through electronic means (digital health) is affected by sociodemographic determinants (ie, age, gender, education, socioeconomic status, and personal and household ownership of mobile phones) in a semiurban community in Bangladesh. Methods: A cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February 2017 and March 2017) were conducted to understand (1) who owns electronic devices; (2) who, among the owners, uses these to access health information and services and why; (3) the awareness of electronic sources of health information; and (4) the role of intermediaries (family members or peers who helped to look for health information using electronic devices). Results: A total of 90.3% (771/854) of households (471/854, 55.2% of respondents) owned electronic devices, mostly mobile phones. Among these, 7.2% (34/471) used them to access health information or services. Middle-aged (35-54 years), female, less (or not) educated, and poorer people used these devices the least (α=.05, α is the level of significance). The lack of awareness, discomfort, differences with regular care-seeking habits, lack of understanding and skills, and proximity to a health facility were the main reasons for not using devices to access digital health. Conclusions: Although influenced by sociodemographic traits, access to digital health is not merely related to device ownership and technical skill. Rather, it is a combination of general health literacy, phone ownership, material resources, and technical skill as well as social recognition of health needs and inequity. This study’s findings should serve as a basis for better integrating technology within the health system and ensuring equitable access to health care