Calcium Requirements for Bone growth and Development in Gambian Children.

Previous studies have demonstrated that rural Gambian children have poor growth, delayed puberty and low bone mineral status. Their calcium intake is low (300 - 400 mg/d). This study examined the benefit of an increase in calcium intake on growth and bone mineral development in Gambian children. 160 subjects, aged 8-12 years old (80 M, 80 F) were recruited into a randomised, double-blind, placebo-controlled study of calcium supplementation. Bone mineral status was evaluated using single photon absorptiometry of the radius, and ultrasound measurements at the calcaneus. Anthropometry was performed and pubertal status assessed. Dietary intake was measured, and information on subject characteristics, physical activity and lifestyle factors were obtained. Fasting blood and 24h urine were collected for measurement of biochemical indices of calcium and bone metabolism. Data was collected at baseline, after 12 months of supplementation (714 mg Ca /d) and 12 months after withdrawal of the supplement. Analysis of baseline data showed there were no differences in subject characteristics and bone variables between boys and girls, except that girls had significantly greater triceps skinfold thickness (p≤0.0001). There were no significant differences between the supplemented and placebo groups in subject characteristics, anthropometry or bone variables at baseline. The Gambian children were smaller by ≥1 SD for their age compared with British reference children and the majority were prepubertal. At outcome, the supplemented group had significantly higher BMC, BMD and size- adjusted BMC at the mid-shaft and distal radius compared with the placebo group. No differences were observed in response between boys and girls or at different ages or pubertal status. There was no significant effect of the calcium supplement on weight, height or bone width. At follow-up, the supplemented group still had significantly higher BMC, BMD and size-adjusted BMC at the mid-shaft radius and, although not significant, a similar trend was seen at the distal radius. The calcium supplemented group had significantly lower concentrations of plasma osteocalcin, parathyroid hormone, phosphate, lower urinary titratable acid and phosphate outputs, and had a greater urinary calcium output than the placebo group at outcome. At follow-up the only difference remaining was a lower PTH in the calcium supplemented group. The results suggest that Gambian children on a low calcium diet may benefit from a higher calcium intake by lowering bone turnover rate. Further studies are needed to determine the long-term benefit of calcium supplement on bone mineral acquisition of Gambian children

Prevention and treatment for COVID-19 associated severe pneumonia in the Gambia (PaTS-COVID-19), a single-blinded randomized clinical trial: study protocol

Background: The coronavirus disease (COVID-19) pandemic resulted in an unprecedent global response for the development of COVID-19 vaccines. However, as viral mutations continue to occur, potentially decreasing the efficacy of currently available vaccines, and inequity of vaccine access continues, identifying safe and effective drugs to minimise severity of COVID-19 disease remains a priority. Methods: We designed an adaptive individually randomised single blinded non identical placebo-controlled trial to evaluate the safety and efficacy of repurposing licenced treatments for COVID-19 patients in an African setting. The trial has two cohorts: Cohort 1 recruits mild and moderate COVID-19 cases and their household contacts. Cases are actively followed up for 14 days, with a final visit at day 28. There are two co-primary endpoints: clinical progression to severe-pneumonia and persistence of the virus at day 14. The primary endpoint for household contacts is infection during a 14-day follow-up period. Cohort 2 recruits hospitalized patients with severe COVID-19 associated pneumonia followed up actively until discharge or death, and passively until day 90, with a final visit. The primary endpoint is clinical progression or death. Conclusions: This randomised trial will contribute African-specific data to the global response to COVID-19. Besides the efficacy of drugs on clinical progression, the trial will provide information on the dynamics of intra-household transmission. Trial registration: This study is registered with Clinical Trials.gov with registration number NCT04703608 and with Pan African clinical trials registry with registration number PACTR202101544570971

DYNAMIC ECONOMIC GROWTH OF THE GAMBIA

Penelitian ini bertujuan untuk menganalisis pertumbuhan ekonomi Gambia melalui faktor-faktor seperti keterbukaan perdagangan, investasi, dan pengeluaran pemerintah dengan menggunakan model regresi linier dinamis. Studi ini menggunakan data tahunan dari tahun 1980 hingga 2020. Hasil penelitian menunjukkan bahwa pengeluaran pemerintah dan investasi langsung asing memiliki hubungan yang positif dan signifikan dengan pertumbuhan ekonomi Gambia sedangkan keterbukaan perdagangan memiliki hubungan yang signifikan tetapi negatif. Pemerintah Gambia perlu meningkatkan pengeluarannya pada sektor ekonomi produktif untuk merangsang pertumbuhan ekonomi dan membangun institusi yang kuat dan bersemangat yang berdampak pada aktivitas ekonomi lintas batas, hukum dan ketertiban, liberalisasi keuangan, kebijakan privatisasi, dan sistem keuangan domestik yang efisien. Untuk mendorong keterbukaan perdagangan, pemerintah perlu membangun infrastruktur yang memadai, jaringan komunikasi, dan pasokan energi energi yang andal dan terjangkau yang akan mengarah pada peningkatan efisiensi

The effect of long-term calcium supplementation on indices of iron, zinc and magnesium status in lactating Gambian women

The effect of long-term supplementation with CaCO3 on indices of Fe, Zn and Mg status was investigated in a randomized, double-blind intervention study of sixty lactating Gambian women. The supplement contained 1000 mg Ca and was consumed between meals 5 d/week, for 1 year starting 1.5 weeks postpartum. Compliance was 100%. Plasma ferritin concentration, plasma Zn concentration and urinary Mg output were measured before, during and after supplementation at 1.5, 13, 52 and 78 weeks postpartum. No significant differences in mineral status were observed at any time between women in the supplement and placebo groups. Analysis of the longitudinal data series showed that plasma ferritin and Mg excretion were characteristic of the individual (

Bone mineral contents and plasma osteocalcin concentrations of Gambian children 12 and 24 mo after the withdrawal of a calcium supplement.

BACKGROUND: Our randomized, placebo-controlled supplementation study of 160 rural Gambian children aged 8.3-11.9 y showed that an increase in calcium intake of 714 mg/d for 12 mo resulted in a 5% increase in forearm bone mineral acquisition and a 22% decrease in plasma osteocalcin concentration, a bone formation marker, but had no effect on height or bone dimensions. OBJECTIVE: We investigated whether these results were sustained after supplement withdrawal. DESIGN: All participants were followed up 12 (FU1) and 24 (FU2) mo after supplementation ended. Bone mineral content (BMC), bone mineral density (BMD), and BMC adjusted for bone width, body weight, and height (size-adjusted BMC) were measured at the midshaft and distal radius. Plasma osteocalcin concentration was measured at FU1. RESULTS: At follow-up, the calcium group had greater bone mineral status than did the placebo group at the midshaft radius (mean difference +/- SE), FU1: BMC (4.7 +/- 1.6%; P = 0.004), BMD (5.1 +/- 1.1%; P </= 0.0001), size-adjusted BMC (5.0 +/- 1.1%; P </= 0.0001); FU2: BMC (3.8 +/- 1.6%; P = 0.02), BMD (2.7 +/- 1.3%; P = 0.04), size-adjusted BMC (2.5 +/- 1.3%; P = 0.06). Similar differentials were observed at the distal radius but were not significant. No significant differences in plasma osteocalcin concentrations (FU1: -0.5 +/- 6.5%; P = 0.9) were observed between groups. CONCLUSION: Although some of the effects of calcium supplementation were still evident at follow-up, further studies are required to determine whether short-term increases in calcium intake have lasting benefits for Gambian children

Sampling framework.

Sampling framework.</p

COVID 19 kap survey tool questionnaires.

(DOCX)</p

Covid19 kap information sheet & consent form.

(DOCX)</p

Diagnostic options for pulmonary fungal diseases in Africa

Background Fungal lung diseases are global in distribution and require specific tests for diagnosis. We report a survey of diagnostic service provision in Africa. Methods A written questionnaire was followed by a video conference call with each respondent(s) and external validation. To disseminate the questionnaire, a snowball sample was used. Results Data were successfully collected from 50 of 51 African countries with populations >1 million. The questionnaire was completed by respondents affiliated with 72 health facilities. Of these 72 respondents, 33 (45.8%) reported data for the whole country while others reported data for a specific region/province within their country. In the public sector, chest X-ray and computed tomography are performed often in 49 countries (98%) and occasionally in 37 countries (74%), and less often in the private sector. Bronchoscopy and spirometry were done often in 28 countries (56%) and occasionally in 18 countries (36%) in the tertiary health facilities of public sector. The most conducted laboratory diagnostic assay was fungal culture (often or occasionally) in 29 countries (58%). In collaboration with the Africa Centre for Disease Control and Prevention, regional webinars and individual country profiles provided further data validation. Conclusion This survey has found a huge disparity of diagnostic test capability across the African continent. Some good examples of good diagnostic provision and very high-quality care were seen, but this was unusual. The unavailability of essential testing such as spirometry was noted, which has a high impact in the diagnosis of lung diseases. It is important for countries to implement tests based on the World Health Organization Essential Diagnostics List