Are head injuries to cyclists an important cause of death in road travel fatalities?

Background: Despite the well-recognised benefit for individuals and communities of increased active travel, cycling remains a minority travel mode in many high income countries. Fear of injury is often cited as a reason. Campaigns to promote cycle helmet wear are alleged to contribute to this. However, there is little information on whether head injuries to cyclists are an important cause of death in road travel fatalities, compared with other road users. // Methods: We examined secondary causes of death for road travel deaths in England 2007–2012, comparing travel modes and grouped causes of death (from national mortality statistics) as numbers and as rates, using distance travelled and time spent travelling by mode, age, and sex from National Travel Surveys for the same six years. // Results: Head injury was the main cause of death for 269 cyclists, 1324 pedestrians and 1046 drivers, accounting for 46%, 42% and 25% of road travel deaths at all ages in each mode respectively. Head injury was the commonest cause of death in cyclists, but most pedestrian and driver fatalities were from multiple injuries. Rates of fatal head injury per bnkm in males aged 17+ for cycling, walking, and driving were 11.2(95% CI 9.7–12.9), 23.4(21.8–25.0) and 0.7(0.6–0.7) respectively. Female fatality rates were 8.8(6.2–12.0), 9.6(8.7–10.7) and 0.4(0.4–0.5) per bnkm respectively. Using time as the denominator, rates were 0.16(0.14–0.19),0.10(0.10–0.11) and 0.03 (0.028–0.032) respectively in men and 0.10 (0.07–0.14), 0.04(0.037–0.045), and 0.01(0.012–0.016) respectively in women, per million hours travelled. // Conclusion: Answering the question ‘How important are head injuries in cyclists as a cause of road travel death?’ depends on the metric used for assessing importance. Pedestrians and drivers account for five and four times the number of fatal head injuries as cyclists. The fatal head injury rate is highest for cyclists by time travelled and for pedestrians using distance travelled

Prevalence and antimicrobial susceptibility pattern of thermophilic Campylobacter spp. isolated from ovine carcasses and faeces in Ethiopia

The foodborne thermophilic Campylobacter species are considered to be the leading cause of human gastroenteritis worldwide with emerging antimicrobial resistant strains. Consumption of raw or undercooked meat is an important source for zoonotic infection. A cross-sectional study was conducted on sheep destined for slaughter at a slaughterhouse in Addis Ababa to determine the prevalence of thermophilic Campylobacter spp. A total of 160 carcass swabs and 160 rectal swabs were bacteriologically examined from which 21 (13.1%) and 12 (7.5%) thermophilic Campylobacter spp. were isolated, respectively. Biochemical test results of the carcass isolates indicated 12 (57.1%) to be C. jejuni, 6 (28.6%) C. coli and 3 (14.3%) C. lari. Similar examination of abattoir environment pool samples of eight sampling days revealed 7 (87.5%) to be positive for the thermophilic Campylobacter spp. None of the wash water samples were positive for the bacteria. Antimicrobial susceptibility pattern test towards twelve antimicrobials using standard disc diffusion method revealed higher resistance (38.1%) for amoxicillin-clavulanic acid and kanamycin (38.1%) followed by streptomycin, oxytetracycline and compound sulphonamide (33.3% each). Most isolates were susceptible to ceftriaxone and clindamycin (4.8% each) and to a lesser degree to erythromycin (9.5%). Multidrug resistance was observed in 52.4% of the isolates examined. Isolation of thermophilic Campylobacter spp., with higher isolation rate for C. jejuni, the primary cause of human campylobacteriosis, from sheep meat and the existence of resistant isolates highlight the potential threat to public health. Therefore, implementation of Campylobacter prevention and control strategies from farm production to consumption of sheep meat are crucial

Isolation of multidrug-resistant Escherichia coli O157 from goat caecal contents and carcasses in the Somali region of Ethiopia

Background: Toxigenic E. coli is an important cause of gastroenteritis in developing countries. In Ethiopia, gastroenteritis due to foodborne disease is a leading cause of death. Yet, there is no surveillance for E. coli O157 and little is known about the carriage of this pathogen in Ethiopia’s livestock. Also, antimicrobial resistance patterns are not well known in this part of the world. Methods: A cross-sectional study was conducted in 2014 to determine the prevalence and antibiotic resistance of E. coli O157 in goat meat, caecal content, and environmental samples collected at a large abattoir in the Somali region of Ethiopia. The samples were enriched in modified tryptone broth containing novobiocin, and plated onto sorbitol MacConkey agar. Isolates were confirmed using indole test and latex agglutination. Antimicrobial susceptibility testing was conducted using the disc diffusion method. Results: A total of 235 samples, including 93 goat carcass swabs, 93 caecal contents, 14 water, 20 hand and 15 knife swabs were collected. Overall, six (2.5%) samples were contaminated with E. coli O157 of which two (2.1%) were isolated from caecal contents, three (3.2%) from carcass swabs and one (7.1%) from water. All isolates were resistant to at least two antibiotics. Two isolates (33.3%) were resistant to over five antimicrobials tested. Abattoir facilities and slaughter technique were conducive to carcass contamination. Conclusions: This study highlights how poor hygiene and slaughter practice can result in contaminated meat, which is especially risky in Ethiopia because of the common practice of eating raw meat. The presence of multidrug-resistant strains of E. coli O157 in goats in a remote pastoralist system may be due to natural resistance and/or transfer of resistance from humans

Trends and effects of antiretroviral therapy coverage during pregnancy on mother-to-child transmission of HIV in Sub-Saharan Africa : evidence from panel data analysis

Background: Antiretroviral therapy for pregnant women infected with HIV has evolved significantly over time, from single dosage antiretroviral and zidovudine alone to lifelong combination of antiretroviral therapy, but the effect of the intervention on population-level child HIV infection has not been well studied in sub-Saharan Africa. Therefore, this study aimed to establish the trend and effect of ART coverage during pregnancy on mother-to-child HIV transmission in sub-Saharan Africa from 2010 to 2019. Methods: Country-level longitudinal ecological study design was used. Forty-one sub-Saharan Africa countries were included using publicly available data from the United Nations Programme on HIV/AIDS, World Health Organization, and World Bank. We created a panel dataset of 410 observations for this study from the years 2010–2019. Linear fixed effects dummy variable regression models were conducted to measure the effect of ART coverage during pregnancy on MTCT rate. Regression coefficients with their 95% confidence intervals (CIs) were estimated for each variable from the fixed effects model. Results: ART coverage during pregnancy increased from 32.98 to 69.46% between 2010 and 2019. Over the same period, the rate of HIV transmission from mother to child reduced from 27.18 to 16.90% in sub-Saharan Africa. A subgroup analysis found that in southern Africa and upper-middle-income groups, higher ART coverage, and lower MTCT rates were recorded. The fixed-effects model result showed that ART coverage during pregnancy (β=− 0.18, 95% CI − 0.19–− 0.16) (p<0.001) and log-transformed HIV incidence-to-prevalence ratio (β=5.41, 95% CI 2.18–8.65) (p<0.001) were significantly associated with mother-to-child HIV transmission rate. Conclusions: ART coverage for HIV positive pregnant women and HIV incidence-to-prevalence ratio were significantly associated with MTCT rate in sub-Saharan Africa. Based on these findings we suggest countries scale up ART coverage by implementing varieties of proven strategies and control the HIV epidemic to achieve the global target of eliminating MTCT of HIV in the region

Measuring socioeconomic inequalities in prenatal HIV test service uptake for prevention of mother to child transmission of HIV in East Africa : a decomposition analysis

BACKGROUND: Despite efforts made towards the elimination of mother-to-child HIV transmission, socioeconomic inequality in prenatal HIV test uptake in East Africa is not well understood. Therefore, this study aimed at measuring socioeconomic inequalities in prenatal HIV test uptake and explaining its main determinants in East Africa. METHOD: We analysed a total weighted sample of 45,476 women aged 15-49 years who birthed in the two years preceding the survey. The study used the most recent DHS data from ten East African countries (Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Uganda, Zambia, and Zimbabwe). The socioeconomic inequality in prenatal HIV test uptake was measured by the concentration index and illustrated by the concentration curve. Then, regression based Erreygers decomposition method was applied to quantify the contribution of socioeconomic factors to inequalities of prenatal HIV test uptake in East Africa. RESULTS: The concentration index for prenatal HIV test uptake indicates that utilization of this service was concentrated in higher socio-economic groups with it being 15.94% higher among these groups in entire East Africa (p <0.001), 40.33% higher in Ethiopia (p <0.001) which was the highest and only 1.87% higher in Rwanda (p <0.01) which was the lowest. The decomposition analysis revealed that household wealth index (38.99%) followed by maternal education (13.69%), place of residence (11.78%), partner education (8.24%), watching television (7.32%), listening to the radio (7.11%) and reading newsletters (2.90%) made the largest contribution to socioeconomic inequality in prenatal HIV test in East Africa. CONCLUSION: In this study, pro-rich inequality in the utilization of prenatal HIV tests was evident. The decomposition analysis findings suggest that policymakers should focus on improving household wealth, educational attainment, and awareness of mother-to-child transmission of HIV (MTCT) through various media outlets targeting disadvantaged sub-groups

Analyzing Pathways of Nurturing Informal Seed Production into Formal Private Ventures for Sustainable Seed Delivery and Crop Productivity: Experiences from Ethiopia

Sustaining crop production and productivity in sub-Saharan Africa requires the availability and use of quality seed of improved varieties by smallholder farmers. The private sector has been considered as the best way to sustain seed supply and crop productivity. Unfortunately, the private sector’s share in the seed production and delivery in sub-Saharan Africa countries has not been very substantial for decades. As a consequence, farmer access to quality seed of recently released varieties remains very low. This manuscript analyzes the experiences of informal seed producers who graduated to formal private seed enterprises to understand the effectiveness of the support they receive to become viable seed ventures. We used comparative research methods to analyze the qualitative and quantitative data collected to understand the underlying mechanisms. The findings showed that the analyzed seed enterprises started with as little as about USD 300 and have already multiplied over tenfold their initial capital. They benefited from a wide variety of supports, e.g., quality seed production, marketing, partnerships, and value chain development trainings and infrastructures, from extension workers, research centers, national and international NGOs, and the other private seed enterprise operators like large public seed enterprises and agro-dealers. The seed enterprises are producing pre-basic, basic, and certified seed of cereals and self-pollinated legume crops delivered directly to farmers, institutional markets, and agro-dealers. The seed production data have been increasing for the past three years with an area expanding from about 30 ha to over 150 ha per year for chickpea. The seed production and delivery practices being employed are smallholder farmer-based practices that are environmentally friendly. For sustainable and reliable seed production and delivery systems in sub-Saharan Africa, a bold step is needed whereby the informal seed production entities are nurtured and upgraded into formal certified seed production ventures that deliver social and economic benefits to the promotors and the communities

Comparative fatality risk for different travel modes by age, sex, and deprivation

BACKGROUND: Cycling is perceived as an unsafe travel mode in many countries. However, road deaths in England have fallen sharply since 2007. We explored whether differences in fatality rates by age, sex and mode persist, and the impact of deprivation on these. METHODS: Using ONS (cycling, pedestrian) and STATS19 (driving) 2007-2012 data for travel-related deaths, including pedestrian falls, and National Travel Surveys 2007-2012 travel data, we calculated fatality rates for England by distance (f/bnkm) and time travelled (million hours’ use, f/mhu) by age, travel mode, and sex or residential Index of Multiple Deprivation. RESULTS: Fatality rates fell significantly 2007-2009 to 2010-2012: male f/bnkm from 2.8 (95%CI 2.7-2.9) to 2.0(1.9-2.1) for driving; 32.1(28.5-36.0) to 20.8(18.1-23.9) for cycling; and 51.4(48.5-54.4) to 36.7(34.3-39.3) for walking. Fatality rates varied by gender, age, and mode. Fatality rate ratios were generally higher for males than females for driving and walking. For males 17-20y, fatality rates were 19.5(17.7-21.4)/bnkm (0.76(0.69-0.83)/mhu) for drivers and 22.5(14.2-33.7)/bnkm (0.28(0.18-0.42)/mhu) for cyclists. Age-specific rates were J-shape for cycling, U-shape for driving, and increased exponentially with age for walking. Fatality rates aged 80+ were an order of magnitude higher in each mode than the all-age mean. Compared with those aged 17-20, rate ratios were significantly lower for male drivers 21+ and female drivers 21-74, but were higher for male cyclists aged 55+ and pedestrians 45+ (male) and 65+ (female). People living in the most deprived quintile generally had higher fatality rates than those in the least deprived quintile overall (three modes combined) and for walking but not for cycling; Rate ratios were highest for pedestrians 35-64 and drivers 35-54.CONCLUSIONS: Fatality rates for walking, cycling and driving are higher for males than females at almost every age and vary more by age than by travel mode. Deprivation exacerbates walking and driving fatality rates

Integrative genomics reveals pathogenic mediator of valproate-induced neurodevelopmental disability

Prenatal exposure to the anti-seizure medication sodium valproate (VPA) is associated with an increased risk of adverse postnatal neurodevelopmental outcomes, including lowered intellectual ability, autism spectrum disorder and attention-deficit hyperactivity disorder. In this study, we aimed to clarify the molecular mechanisms underpinning the neurodevelopmental consequences of gestational VPA exposure using integrative genomics. First, we assessed the effect of gestational VPA on fetal brain gene expression using a validated rat model of valproate teratogenicity that mimics the human scenario of chronic oral valproate treatment during pregnancy at doses which are therapeutically relevant to the treatment of epilepsy. Two different rat strains were studied - inbred Genetic Absence Epilepsy Rats from Strasbourg (GAERS), a model of genetic generalized epilepsy, and inbred Non-Epileptic Control rats. Female rats were fed standard chow or VPA mixed in standard chow for 2 weeks prior to conception and then mated with same-strain males. In the VPA-exposed rats maternal oral treatment was continued throughout pregnancy. Fetuses were extracted via C-section on gestational day 21 (one day prior to birth) and fetal brains were snap frozen and genome-wide gene expression data generated. We found that gestational VPA exposure via chronic maternal oral dosing was associated with substantial drug-induced differential gene expression in the pup brains, including dysregulated splicing, and observed that this occurred in the absence of evidence for significant neuronal gain or loss. The functional consequences of VPA-induced gene expression were explored using pathway analysis and integration with genetic risk data for psychiatric disease and behavioural traits. The set of genes down-regulated by VPA in the pup brains were significantly enriched for pathways related to neurodevelopment and synaptic function, and significantly enriched for heritability to human intelligence, schizophrenia and bipolar disorder. Our results provide a mechanistic link between chronic fetal VPA exposure and neurodevelopmental disability mediated by VPA-induced transcriptional dysregulation