Vaccination and nutritional status of children in Karawari, East Sepik Province, Papua New Guinea

Delivery of health care services to rural and remote populations in Papua New Guinea (PNG) is problematic. This is mainly due to difficulties with transportation and communication. Hence, the children in this region of PNG are likely to be at risk of malnutrition compounded by inadequate vaccination that may predispose them to preventable diseases. This study was conducted to determine the vaccination and nutritional status of children less than 5 years old in the remote and rural Karawari area of PNG. 105 children were included in the study, of whom 55% were male and 45% female. The mean age of children included in the study was 32.6 months. Their age, height, and weight by gender was not significantly different. Overall, 85% of children had incomplete vaccination. However, children above the median age of 32 months (34%) were more likely to be fully vaccinated for their age, χ2 (1) = 23.294, p < 0.005. In addition, 25% of children were below the -1 SD (Z-scores) for weight-for—height, 33% below the -1 SD for weight-for-age, and 25.5% below the -1 SD for height-for-age compared to WHO standards. A large proportion of children had poor nutrition status and lack protection from vaccine preventable diseases. This study recommends that the government should introduce a surveillance system for detecting issues of importance to the rural majority. We also recommend that the PNG government reopen the nearby health centre, and/ or establish new facilities within the region, with adequately trained and compensated staff

The role of iron oxide nanoparticles in the diagnosis of vascular diseases: a systematic review

Background: Vascular diseases remain a cause of high patient mortality globally. Current diagnoses are often through contrast-enhanced computed-tomography or magnetic-resonance-imaging (MRI) with approximately 80% sensitivity. Iron oxide nanoparticles are increasingly used in enhancing vascular disease diagnosis due to their ability to selectively deliver imaging agents to specific locations. This article describes studies investigating the use of iron oxide nanoparticles in the diagnosis of vascular diseases in humans. Method: A literature search was conducted to identify studies assessing the role of nanoparticles in the management of vascular diseases using PubMed from Jan 2011 to June 2016. The following search terms were applied "vascular diseases" AND "nanoparticles". Human studies investigating the role of nanoparticles in vascular diseases were included. Studies excluded were ex vivo and in vitro human association studies, and non-English studies. Results: Nine out of 179 studies met the inclusion criteria. Sample size ranged from 1 to 23 median 14, inter-quartile range (IQR, 5.5 - 20.0). Five studies reported that ultra-small super paramagnetic iron oxide (USPIO) enhanced MRI assessment of vascularity, and macrophage content in atherosclerotic carotid plaques. Three studies demonstrated that ultra-small super paramagnetic iron oxide improved MRI diagnosis of myocardial infarction and allows the detection of the peri-infarct zone. One study did not support the latter findings. Conclusions: Iron oxide nanoparticles are effective at improving detection and diagnosis of vascular diseases, although the long term effects of these agents are not yet known

The role of iron oxide nanoparticles in the diagnosis of vascular diseases: a systematic review

Background: Vascular diseases remain a cause of high patient mortality globally. Current diagnoses are often through contrast-enhanced computed-tomography or magnetic-resonance-imaging (MRI) with approximately 80% sensitivity. Iron oxide nanoparticles are increasingly used in enhancing vascular disease diagnosis due to their ability to selectively deliver imaging agents to specific locations. This article describes studies investigating the use of iron oxide nanoparticles in the diagnosis of vascular diseases in humans. Method: A literature search was conducted to identify studies assessing the role of nanoparticles in the management of vascular diseases using PubMed from Jan 2011 to June 2016. The following search terms were applied "vascular diseases" AND "nanoparticles". Human studies investigating the role of nanoparticles in vascular diseases were included. Studies excluded were ex vivo and in vitro human association studies, and non-English studies. Results: Nine out of 179 studies met the inclusion criteria. Sample size ranged from 1 to 23 median 14, inter-quartile range (IQR, 5.5 - 20.0). Five studies reported that ultra-small super paramagnetic iron oxide (USPIO) enhanced MRI assessment of vascularity, and macrophage content in atherosclerotic carotid plaques. Three studies demonstrated that ultra-small super paramagnetic iron oxide improved MRI diagnosis of myocardial infarction and allows the detection of the peri-infarct zone. One study did not support the latter findings. Conclusions: Iron oxide nanoparticles are effective at improving detection and diagnosis of vascular diseases, although the long term effects of these agents are not yet known

Prevalence of hepatitis B virus amongst refugees, asylum seekers and internally displaced persons in low- and middle-income countries: A systematic review

Hepatitis B, caused by the hepatitis B virus (HBV), is a global public health issue that affects 290 million people worldwide. Most people with hepatitis B are in low- and middle-income countries (LMIC), where health systems and resources are often constrained. Refugees, asylum seekers and internally displaced persons (IDPs) often face barriers in seeking health care and are a priority population at risk of hepatitis B. No systematic review to date has evaluated the prevalence of hepatitis B amongst refugees in in LMIC. We undertook a systematic review of the literature identifying 28 studies addressing this topic. Though few studies on this topic exist, the available evidence suggests a high prevalence amongst refugees in LMIC, with wide variation between and within countries. Possible risk factors contributing to hepatitis B include unsafe injections, low immunization coverage, low awareness, mother-to-child transmission, and limited health services. Further study is needed to better understand the prevalence and risk factors for hepatitis B amongst refugees in LMIC, to inform public health responses. Vulnerable populations such as refugees are an important group to consider in national and global efforts to eliminate hepatitis B

Time taken by individuals with respiratory symptoms to present to primary care: a descriptive study of assessments at Australian General Practitioner-led respiratory clinics

Effective control of coronavirus disease 2019 (COVID-19) has been challenging, in part due to significant asymptomatic and pre-symptomatic transmission of disease. Reducing the time between symptom onset and COVID-19 testing and isolation allows enhanced outbreak control. The purpose of this study is to describe the time taken by participants to present to general practitioner-led (GP) respiratory clinics for assessment following the development of symptoms, and to explore associations between demographic and geographic characteristics and the time to presentation. A total of 314,148 participants, who were assessed in GP respiratory clinics between 1 February and 31 August 2021, were included in the analysis. The median age of participants at presentation was 33 years (interquartile range, IQR: 15–49). The median time from development of symptoms to presentation for assessment at GP respiratory clinics was 2 days (IQR: 1–3). Participants were more likely to present within one day of symptom onset if they were aged between 15 and 64 years (43.4%), lived in urban areas (40.9%) or were non-Indigenous (40.2%). Participants in New South Wales and Victoria had twice the odds (OR 2.01; 95% confidence interval (CI): 1.95, 2.08) of presenting at a GP respiratory clinic within one day of symptom onset in August 2021, when there was a COVID-19 outbreak in those states, than they did in March 2021, when there was no COVID-19 outbreak in Australia. The number of days from symptom onset to presentation at a GP respiratory clinic was strongly associated with the presence of a COVID-19 outbreak. Participant age, location of the clinic, and Indigenous status of participants were also associated with the time to presentation. This study highlights the importance of recognising COVID-19 as a potential cause of symptoms, as well as the importance of providing easily accessible, and culturally appropriate, testing facilities for the population

Evaluation of the effect of border closure on COVID-19 incidence rates across nine African countries: an interrupted time series study

Background: Border closure is one of the policy changes implemented to mitigate against coronavirus disease 2019 (COVID-19). We evaluated the effect of border closure on the incidence rate of COVID-19 across nine African countries. Methods: An interrupted time series analysis was used to assess COVID-19 incidence rates in Egypt, Tunisia, Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Ghana, Nigeria, Senegal and South Africa (SA). Data were collected between 14 February and 19 July 2020 from online data repositories. The linear trend and magnitude of change were evaluated using the itsa function with ordinary least-squares regression in Stata with a 7-d deferred interruption point, which allows a period of diffusion post-border closure. Results: Overall, the countries recorded an increase in the incidence rate of COVID-19 after border closure. However, when compared with matched control groups, SA, Nigeria, Ghana, Egypt and Kenya showed a higher incidence rate trend. In contrast, Ethiopia, DRC and Tunisia showed a lower trend compared with their controls. Conclusions: The implementation of border closures within African countries had minimal effect on the incidence of COVID-19. The inclusion of other control measures such as enhanced testing capacity and improved surveillance activities will reveal the effectiveness of border closure measures

Group B Streptococcal bacteraemia - changing trends in a tropical region of Australia

Background: Group B streptococcus (GBS) is a recognised perinatal and neonatal pathogen. There are reports of increasing GBS sepsis globally outside this demographic. North Queensland is part of tropical Australia, with a relatively high proportion of Indigenous Australians. Aims: This study aims to analyse the epidemiology of GBS bacteraemia and explore associated risk factors. Methods: This was a 10-year retrospective review of GBS bacteraemia in a tertiary facility in North Queensland, between 2010 and February 2020. Data variables collected included; demographics, risk factors, clinical source and outcomes. Multivariable logistic regression was performed to examine the association of Indigenous status and other relevant clinical factors with mortality from GBS bacteraemia at three months. Results: Of the 164 total cases, 123 were not pregnancy related. The rate of GBS bacteraemia for the Indigenous population was 12.48 per 100, 000 and 4.84 per 100, 000 for the non-Indigenous population. Indigenous patients were more likely to be diabetic and have chronic kidney disease compared to the non-Indigenous patients. Males [AOR = 4.34, 95% CI (1.14, 16.56), P=0.031] and immunosuppressed patients, [AOR = 11.49, 95% CI (2.73, 48.42), P<0.001] were more likely to experience mortality at three months from GBS bacteraemia even after adjusting for other risk factors respectively. Conclusion: GBS bacteraemia is deviating from being primarily a neonatal disease. While the Indigenous population of North Queensland have a disproportionate burden of GBS disease, the demographics affected differ. GBS appears to target the older non-Indigenous patients with greater comorbidities. In the non-Indigenous population, invasive GBS disease is an emerging issue. 3-month mortality appears to be increased in males and the immunosuppressed

Epidemiology, risk factors and measures for preventing drowning in Africa: a systematic review

Background: Drowning is a leading cause of unintentional injury related mortality worldwide, and accounts for roughly 320,000 deaths yearly. Over 90% of these deaths occur in low- and middle-income countries with inadequate prevention measures. The highest rates of drowning are observed in Africa. The aim of this review is to describe the epidemiology of drowning and identify the risk factors and strategies for prevention of drowning in Africa. Methods: A review of multiple databases (MEDLINE, CINAHL, PsycINFO, Scopus and Emcare) was conducted from inception of the databases to the 1st of April 2019 to identify studies investigating drowning in Africa. The preferred reporting items for systematic review and meta-analysis (PRISMA) was utilised. Results: Forty-two articles from 15 countries were included. Twelve articles explored drowning, while in 30 articles, drowning was reported as part of a wider study. The data sources were coronial, central registry, hospital record, sea rescue and self-generated data. Measures used to describe drowning were proportions and rates. There was a huge variation in the proportion and incidence rate of drowning reported by the studies included in the review. The potential risk factors for drowning included young age, male gender, ethnicity, alcohol, access to bodies of water, age and carrying capacity of the boat, weather and summer season. No study evaluated prevention strategies, however, strategies proposed were education, increased supervision and community awareness. Conclusions: There is a need to address the high rate of drowning in Africa. Good epidemiological studies across all African countries are needed to describe the patterns of drowning and understand risk factors. Further research is needed to investigate the risk factors and to evaluate prevention strategies

Occupational tuberculosis in health care workers in sub-Saharan Africa: a systematic review

Background: Tuberculosis (TB) is a leading cause of death globally. Sub-Saharan Africa (SSA) in particular has a high burden of TB, which places health care workers (HCWs) at increased risk of occupational exposure to TB. Aim: To describe the incidence, and prevalence of latent TB infection/disease in HCWs, and explore the effectiveness of infection control measures to protect HCWs in SSA. Method: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted using the databases: PubMed, Web of Science, Scopus, and Medline, up to March 2016. Thirteen studies were found reporting the prevalence, incidence of latent TB infection/TB disease among HCWs, and the effectiveness of infection control strategies in SSA. Results: The median prevalence of latent TB infection (using a positive tuberculin skin test) in HCWS was 61% (range 45% to 84%). Markers of occupational exposure associated with latent TB infection among HCWS were longer duration of work, and exposure to TB patients. The median annual incidence of TB infection attributable to occupational exposure was 29% (range 19.3% to 38%) after accounting for the infection in the general population. The rate of active TB in HCWS was higher than in the general population. Administrative, personal and engineering control measures had no impact on the development of TB disease. Conclusions: The risk of acquiring TB disease among HCWs in SSA was high and was associated with poor infection control measures. This may impact on the recruitment, longevity and retention of HCWs

Emerging therapeutic potential of nanoparticles in pancreatic cancer: a systematic review of clinical trials

Pancreatic cancer is an aggressive disease with a five year survival rate of less than 5%, which is associated with late presentation. In recent years, research into nanomedicine and the use of nanoparticles as therapeutic agents for cancers has increased. This article describes the latest developments in the use of nanoparticles, and evaluates the risks and benefits of nanoparticles as an emerging therapy for pancreatic cancer. The Preferred Reporting Items of Systematic Reviews and Meta-Analyses checklist was used. Studies were extracted by searching the Embase, MEDLINE, SCOPUS, Web of Science, and Cochrane Library databases from inception to 18 March 2016 with no language restrictions. Clinical trials involving the use of nanoparticles as a therapeutic or prognostic option in patients with pancreatic cancer were considered. Selected studies were evaluated using the Jadad score for randomised control trials and the Therapy CA Worksheet for intervention studies. Of the 210 articles found, 10 clinical trials including one randomised control trial and nine phase I/II clinical trials met the inclusion criteria and were analysed. These studies demonstrated that nanoparticles can be used in conjunction with chemotherapeutic agents increasing their efficacy whilst reducing their toxicity. Increased efficacy of treatment with nanoparticles may improve the clinical outcomes and quality of life in patients with pancreatic cancer, although the long-term side effects are yet to be defined. The study registration number is CRD42015020009