Assessing the Delivery and Effectiveness of a New Immunisation Training Initiative at District Level in Zambia

Objectives: The objective of the study was to evaluate the effectiveness of the training initiative to identify the challenges of immunisation at the district level in Zambia. The secondary objective was to assess the immediate impact of the training on the perceived competence of trainees who attended the Mid Level Management (MLM) course on immunisation.Methods: A needs assessment of the EPI programme in Zambia was conducted. Participants were assessed on their ability, competence, knowledge and skills in areas such as understanding the Reach Every District (RED) strategy, vaccine management, cold chain management, and immunisation monitoring. Based on these assessments, 12 areas were identified as of particular relevance, and the World Health Organisation MLM course manual was adapted to reflect them. Two groups of 25 participants were assessed at two different time points with an interval of six months.Results: There was a significant increase (p<0.05) after training in the participants' perceived ability, competence, knowledge and skills in all the targeted areas except for understanding the RED strategy, capacity to supervise immunisation activities and immunisation coverage.Conclusion: The two training groups showed significant improvement after training in perceived ability, competence, knowledge and skills in most targeted areas. To sustain high immunisation coverage, there is an urgent need to improve supportive supervisory visits and to have more frequent and regular MLM immunisation training workshops

Correlates of HIV-1 Genital Shedding in Tanzanian Women

BACKGROUND: Understanding the correlates of HIV shedding is important to inform strategies to reduce HIV infectiousness. We examined correlates of genital HIV-1 RNA in women who were seropositive for both herpes simplex virus (HSV)-2 and HIV-1 and who were enrolled in a randomised controlled trial of HSV suppressive therapy (aciclovir 400 mg b.i.d vs. placebo) in Tanzania. METHODOLOGY: Samples, including a cervico-vaginal lavage, were collected and tested for genital HIV-1 and HSV and reproductive tract infections (RTIs) at randomisation and 6, 12 and 24 months follow-up. Data from all women at randomisation and women in the placebo arm during follow-up were analysed using generalised estimating equations to determine the correlates of cervico-vaginal HIV-1 RNA detection and load. PRINCIPAL FINDINGS: Cervico-vaginal HIV-1 RNA was detected at 52.0% of 971 visits among 482 women, and was independently associated with plasma viral load, presence of genital ulcers, pregnancy, bloody cervical or vaginal discharge, abnormal vaginal discharge, cervical ectopy, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, an intermediate bacterial vaginosis score and HSV DNA detection. Similar factors were associated with genital HIV-1 RNA load. CONCLUSIONS: RTIs were associated with increased presence and quantity of genital HIV-1 RNA in this population. These results highlight the importance of integrating effective RTI treatment into HIV care services

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity

The high burden of tuberculosis (TB) and human immunodeficiency virus (HIV) in a large Zambian prison: a public health alert.

BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) represent two of the greatest health threats in African prisons. In 2010, collaboration between the Centre for Infectious Disease Research in Zambia, the Zambia Prisons Service, and the National TB Program established a TB and HIV screening program in six Zambian prisons. We report data on the prevalence of TB and HIV in one of the largest facilities: Lusaka Central Prison. METHODS: Between November 2010 and April 2011, we assessed the prevalence of TB and HIV amongst inmates entering, residing, and exiting the prison, as well as in the surrounding community. The screening protocol included complete history and physical exam, digital radiography, opt-out HIV counseling and testing, sputum smear and culture. A TB case was defined as either bacteriologically confirmed or clinically diagnosed. RESULTS: A total of 2323 participants completed screening. A majority (88%) were male, median age 31 years and body mass index 21.9. TB symptoms were found in 1430 (62%). TB was diagnosed in 176 (7.6%) individuals and 52 people were already on TB treatment at time of screening. TB was bacteriologically confirmed in 88 cases (3.8%) and clinically diagnosed in 88 cases (3.8%). Confirmed TB at entry and exit interventions were 4.6% and 5.3% respectively. Smear was positive in only 25% (n = 22) of bacteriologically confirmed cases. HIV prevalence among inmates currently residing in prison was 27.4%. CONCLUSION: Ineffective TB and HIV screening programs deter successful disease control strategies in prison facilities and their surrounding communities. We found rates of TB and HIV in Lusaka Central Prison that are substantially higher than the Zambian average, with a trend towards concentration and potential transmission of both diseases within the facility and to the general population. Investment in institutional and criminal justice reform as well as prison-specific health systems is urgently required

The coffee rust crises in Colombia and Central America (2008–2013): impacts, plausible causes and proposed solutions

Coffee rust is a leaf disease caused by the fungus, Hemileia vastatrix. Coffee rust epidemics, with intensities higher than previously observed, have affected a number of countries including: Colombia, from 2008 to 2011; Central America and Mexico, in 2012-13; and Peru and Ecuador in 2013. There are many contributing factors to the onset of these epidemics e.g. the state of the economy, crop management decisions and the prevailing weather, and many resulting impacts e.g. on production, on farmers' and labourers' income and livelihood, and on food security. Production has been considerably reduced in Colombia (by 31 % on average during the epidemic years compared with 2007) and Central America (by 16 % in 2013 compared with 2011-12 and by 10 % in 2013-14 compared with 2012-13). These reductions have had direct impacts on the livelihoods of thousands of smallholders and harvesters. For these populations, particularly in Central America, coffee is often the only source of income used to buy food and supplies for the cultivation of basic grains. As a result, the coffee rust epidemic has had indirect impacts on food security. The main drivers of these epidemics are economic and meteorological. All the intense epidemics experienced during the last 37 years in Central America and Colombia were concurrent with low coffee profitability periods due to coffee price declines, as was the case in the 2012-13 Central American epidemic, or due to increases in input costs, as in the 2008-11 Colombian epidemics. Low profitability led to suboptimal coffee management, which resulted in increased plant vulnerability to pests and diseases. A common factor in the recent Colombian and Central American epidemics was a reduction in the diurnal thermal amplitude, with higher minimum/lower maximum temperatures (+0.1 °C/-0.5 °C on average during 2008-2011 compared to a low coffee rust incidence period, 1991-1994, in Chinchiná, Colombia; +0.9 °C/-1.2 °C on average in 2012 compared with prevailing climate, in 1224 farms from Guatemala). This likely decreased the latency period of the disease. These epidemics should be considered as a warning for the future, as they were enhanced by weather conditions consistent with climate change. Appropriate actions need to be taken in the near future to address this issue including: the development and establishment of resistant coffee cultivars; the creation of early warning systems; the design of crop management systems adapted to climate change and to pest and disease threats; and socio-economic solutions such as training and organisational strengthening. (Résumé d'auteur