An assessment of PCV13 vaccine coverage using a repeated cross-sectional household survey in Malawi [version 1; referees: 3 approved]

Background: The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in Malawi from November 2011 using a three dose primary series at 6, 10, and 14 weeks of age to reduce Streptococcus pneumoniae-related diseases. To date, PCV13 paediatric coverage in Malawi has not been rigorously assessed.  We used household surveys to longitudinally track paediatric PCV13 coverage in rural Malawi. Methods: Samples of 60 randomly selected children (30 infants aged 6 weeks to 4 months and 30 aged 4-16 months) were sought in each of 20 village clinic catchment ‘basins’ of Kabudula health area, Lilongwe, Malawi between March 2012 and June 2014. Child health information was reviewed and mothers interviewed to determine each child’s PCV13 dose status and vaccine timing. The survey was completed six times in 4-8 month intervals. Survey inference was used to assess PCV13 dose coverage in each basin for each age group. All 20 basins were pooled to assess area-wide vaccination coverage over time, by age in months, and adherence to the vaccination schedule. Results: We surveyed a total of 8,562 children in six surveys; 82% were in the older age group. Overall, in age-eligible children, two-dose and three-dose coverage increased from 30% to 85% and 10% to 86%, respectively, between March 2012 and June 2014.  PCV13 coverage was higher in the older age group in all surveys. Although it varied by basin, PCV13 coverage was consistently delayed: median ages at first, second and third doses were 9, 15 and 21 weeks, respectively. Conclusion: In our rural study area, PCV13 introduction did not meet the Malawi Ministry of Health one-year three-dose 90% coverage target, but after 2 years reached levels likely to reduce the prevalence of both invasive and non-invasive paediatric pneumococcal diseases. Better adherence to the PCV13 schedule may reduce pneumococcal disease in younger Malawian children

Muskox Health Ecology Symposium 2016: Gathering to Share Knowledge on Umingmak in a Time of Rapid Change

The Muskox, Ovibos moschatus, also known as Umingmak ‘the Bearded One,’ is a taxonomically unique, cold-adapted, ice-age survivor. Originally native to Canada and Greenland, it has established a circum-Arctic distribution via introduced populations. As a key resident herbivore in northern ecosystems, the muskox has importance that should not be underestimated. Muskoxen play an important role in the cultural identity of Arctic Indigenous peoples and provide a healthy source of country food. More recently, recognition of the economic potential of the species through tourism, sport hunting, and the traditional sale of handicrafts has generated renewed interest in muskoxen and their ecology. Recent documentation of diseases, including several zoonoses, regional mortality events, and population declines have highlighted knowledge gaps in both our understanding of the drivers of muskox population fluctuations and the potential sensitivity of this species to a rapidly changing climate (Kutz et al., 2013, 2015; Handeland et al., 2014; Ytrehus et al., 2015; Tomaselli et al., 2016c; Afema et al., 2017)

Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India.

OBJECTIVE: Understanding the causes of death is key to tackling the burden of three million annual neonatal deaths. Resource-poor settings lack effective vital registration systems for births, deaths and causes of death. We set out to describe cause-specific neonatal mortality in rural areas of Malawi, Bangladesh, Nepal and rural and urban India using verbal autopsy (VA) data. DESIGN: We prospectively recorded births, neonatal deaths and stillbirths in seven population surveillance sites. VAs were carried out to ascertain cause of death. We applied descriptive epidemiological techniques and the InterVA method to characterise the burden, timing and causes of neonatal mortality at each site. RESULTS: Analysis included 3772 neonatal deaths and 3256 stillbirths. Between 63% and 82% of neonatal deaths occurred in the first week of life, and males were more likely to die than females. Prematurity, birth asphyxia and infections accounted for most neonatal deaths, but important subnational and regional differences were observed. More than one-third of deaths in urban India were attributed to asphyxia, making it the leading cause of death in this setting. CONCLUSIONS: Population-based VA methods can fill information gaps on the burden and causes of neonatal mortality in resource-poor and data-poor settings. Local data should be used to inform and monitor the implementation of interventions to improve newborn health. High rates of home births demand a particular focus on community interventions to improve hygienic delivery and essential newborn care

Measurement, reporting and verification of climate-smart agriculture: Change of perspective, change of possibilities?

The World Agroforestry Centre (ICRAF), Unique Forestry and Land Use and Vuna have been working with stakeholders in four countries in eastern and southern Africa (Tanzania, Malawi, Zambia and Zimbabwe) to assess the current state of national CSA M&E and to set out country-specific roadmaps for developing systems for monitoring and reporting on CSA. The project took a country-driven approach to documenting stakeholders’ information needs, exploring how to build on and align with existing M&E systems and international reporting frameworks, and encouraging cross-country comparisons. Though the research was grounded in southern Africa, these lessons are applicable to CSA and other topic-driven initiatives (such as land restoration and the Bonn Challenge) across similar environments and social contexts on the continent and around the world. Here we detail three key findings from the assessment

Mesure, notification et vérification de l’agriculture intelligente face au climat: changement de perspective, changement de possibilités ? Conclusions de l’auto-évaluation nationale des besoins, systèmes et opportunités

Depuis 2009, des milliards de dollars ont été investis dans des programmes d’AIC dans le but d’aider les petits exploitants à augmenter leur productivité tout en s’adaptant aux changements climatiques et en contribuant à les atténuer. Cependant, l’AIC a récemment dépassé les cercles de l’aide au développement et de la société civile, et les pays se sont mis à adopter des stratégies d’AIC dans le cadre de leurs politiques et stratégies de riposte aux changements climatiques et de développement agricole, notamment leurs Contributions déterminées au niveau national (CDN)

Muskox Health Ecology Symposium 2016: Gathering to Share Knowledge on Umingmak in a Time of Rapid Change

The Muskox, Ovibos moschatus, also known as Umingmak ‘the Bearded One,’ is a taxonomically unique, cold-adapted, ice-age survivor. Originally native to Canada and Greenland, it has established a circum-Arctic distribution via introduced populations. As a key resident herbivore in northern ecosystems, the muskox has importance that should not be underestimated. Muskoxen play an important role in the cultural identity of Arctic Indigenous peoples and provide a healthy source of country food. More recently, recognition of the economic potential of the species through tourism, sport hunting, and the traditional sale of handicrafts has generated renewed interest in muskoxen and their ecology. Recent documentation of diseases, including several zoonoses, regional mortality events, and population declines have highlighted knowledge gaps in both our understanding of the drivers of muskox population fluctuations and the potential sensitivity of this species to a rapidly changing climate (Kutz et al., 2013, 2015; Handeland et al., 2014; Ytrehus et al., 2015; Tomaselli et al., 2016c; Afema et al., 2017)

The Challenges and Opportunities of Pharmacoepidemiology in Bone Diseases

Altres ajuts: This work was supported by the National Health Medical Research Council Australia (NHMRC project ID; DA 1114676, DB 1073430, and JRC 1008219). This work was partially supported by the NIHR Biomedical Research Centre, Oxford. DPA is funded by a National Institute for Health Research Clinician Scientist award (CS-2013-13-012). This article presents independent research funded by the National Institute for Health Research (NIHR). Other funding bodies were the Bupa Health Foundation (formerly MBF Foundation) and the Mrs Gibson and Ernst Heine Family Foundation. The views expressed are those of the authors and not necessarily those of the NHMRC and the NIHR.Pharmacoepidemiology is used extensively in osteoporosis research and involves the study of the use and effects of drugs in large numbers of people. Randomized controlled trials are considered the gold standard in assessing treatment efficacy and safety. However, their results can have limited external validity when applied to day-to-day patients. Pharmacoepidemiological studies aim to assess the effect/s of treatments in actual practice conditions, but they are limited by the quality, completeness, and inherent bias due to confounding. Sources of information include prospectively collected (primary) as well as readily available routinely collected (secondary) (eg, electronic medical records, administrative/claims databases) data. Although the former enable the collection of ad hoc measurements, the latter provide a unique opportunity for the study of large representative populations and for the assessment of rare events at relatively low cost. Observational cohort and case-control studies, the most commonly implemented study designs in pharmacoepidemiology, each have their strengths and limitations. However, the choice of the study design depends on the research question that needs to be answered. Despite the many advantages of observational studies, they also have limitations. First, missing data is a common issue in routine data, frequently dealt with using multiple imputation. Second, confounding by indication arises because of the lack of randomization; multivariable regression and more specific techniques such as propensity scores (adjustment, matching, stratification, trimming, or weighting) are used to minimize such biases. In addition, immortal time bias (time period during which a subject is artefactually event-free by study design) and time-varying confounding (patient characteristics changing over time) are other types of biases usually accounted for using time-dependent modeling. Finally, residual "uncontrolled" confounding is difficult to assess, and hence to account for it, sensitivity analyses and specific methods (eg, instrumental variables) should be considered. © 2018 The Authors JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research

Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Clinical and Hypoxemic Childhood Pneumonia over Three Years in Central Malawi: An Observational Study - Fig 2

<p><b>Pneumonia cases and deaths in children under 5 years old by month: January 2012–June 2014:</b> a) Total clinical pneumonia cases at all hospitals, health centres and community health worker clinics b) Clinical pneumonia cases at all hospitals, health centres and community health worker clinics by category c) Hypoxemic pneumonia cases at all hospitals, health centres and community health worker clinics d) Hospital pneumonia deaths.</p

Clinical and hypoxemic pneumonia definitions

<p>Clinical and hypoxemic pneumonia definitions</p