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

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

Assessment of Respiratory Symptoms and Lung Function among Workers Exposed to Cotton Dust at Arba Minch Textile Factory, Arba Minch, Southern Ethiopia, 2017

Background: Textile industry is considered as a number one priority sector by the Ethiopian governmen

Adoption and impacts of improved post-harvest technologies on food security and welfare of maize-farming households in Tanzania: a comparative assessment

Open Access ArticleDuring the last decade, post-harvest losses (PHL) reduction has been topping the agenda of governments as a pathway for addressing food security, poverty, and nutrition challenges in Africa. Using survey data from 579 households, we investigated the factors that affect farmers’ decisions to adopt post-harvest technologies: mechanized shelling, drying tarpaulins, and airtight storage validated for reducing PHL in Tanzania’s maize-based systems, and the impacts on households’ food security and welfare. Mechanized shelling addressed a labor issue, while tarpaulins and airtight storage addressed product quality and quantity concerns. The results revealed large farm sizes and location in higher production potential zones (proxies for higher production scale) and neighbors' use of the technologies as universal drivers for adoption. Access to credit and off-farm income were unique determinants for airtight storage, while group membership increased the probability of adopting drying tarpaulin and airtight storage. The technologies have positive impacts on food security and welfare: drying tarpaulins and airtight storage significantly increased food availability (18–27%), food access (24–26%), and household incomes (112–155%), whereas mechanized shelling improved food and total expenditures by 49% and 68%, respectively. The share of total household expenditure on food decreased by 42%, 11%, and 51% among tarpaulin, mechanized shelling, and airtight storage adopter households, signaling significant improvements in food security and reductions in vulnerability. The results point to the need for policy support to enhance the adoption of these technologies, knowledge sharing among farmers, and financial resources access to support investments in the technologies

Non-communicable diseases in Ethiopia: policy and strategy gaps in the reduction of behavioral risk factors

Introduction: Non-communicable diseases (NCDs) are the leading cause of death worldwide. Over 80% of NCD deaths occur in developing countries. Four modifiable behaviors, namely tobacco use, consumption of unhealthy diet, physical inactivity, and the harmful use of alcohol, contribute to 80% of the NCD burden. Studies show that the vast majority of NCDs can be prevented through behavioral risk-reduction interventions. Properly executed, the interventions could lead to a decrease in the burden of NCDs, ranging from a 30% drop in the prevalence of cancer to a 75% reduction in cardiovascular diseases. This study examined the policy and strategy gaps in the reduction of the modifiable NCD behavioral risk factors in Ethiopia to inform and guide policy-makers and other stakeholders. Methodology: This study used a data triangulation methodology with a sequential, explanatory, mixed-method design conducted in two stages. The authors carried out quantitative analysis on the prevalence and distribution of behavioral risk factors from the Ethiopia NCD STEPwise approach to surveillance (STEPS) survey. Qualitative data on national policies and strategies complemented the analysis of the progress made so far and the existing gaps. Results and Discussion: Ethiopia has made substantial progress in responding to the NCD epidemic by developing a health sector NCD strategic action plan, generating evidence, and setting time-bound national targets on NCD behavioral risk factors. Activities mainly aimed at reducing tobacco use, such as implementation of the ratified WHO Framework Convention on Tobacco Control (FCTC), using evidence of the Global Adult Tobacco Survey (GATS), and the articulation of legislative measures are ongoing. On this paper our analysis reveals policy and strategy gaps, status in law enforcement, social mobilization, and awareness creation to reduce the major behavioral risk factors. Conclusions: NCDs share common risk factors and risk reduction strategies creates an opportunity for an effective response. However, the national response still needs more effort to have a sufficient impact on the prevention of NCDs in Ethiopia. Thus, there is an urgent need for the country to develop and implement targeted strategies for each behavioral risk factor and design functional, multisectoral coordination. There is also a need for establishing sustainable financial mechanisms, such as increasing program budgets and levying ‘sin taxes,’ to support the NCD prevention and control program. Ethiop. J. Health Dev. 2019; 33(4):259-268] Key words: NCDs, behavioral risk factors, policy, strategy, multisectoral coordination, Ethiopi

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Nitric oxide production in the exhaled air of patients with pulmonary tuberculosis in relation to HIV co-infection

Background: Nitric oxide (NO) is essential for host defense in rodents, but the role of NO during tuberculosis (TB) in man remains controversial. However, earlier observations that arginine supplementation facilitates anti-TB treatment, supports the hypothesis that NO is important in the host defense against TB. Local production of NO measured in fractional exhaled air (FeNO) in TB patients with and without HIV co-infection has not been reported previously. Thus, our aim was to investigate levels of FeNO in relation to clinical symptoms and urinary NO metabolites (uNO). Methods: In a cross sectional study, FeNO and uNO were measured and clinical symptoms, chest x-ray, together with serum levels of arginine, tumor necrosis factor alpha (TNF-alpha) and interleukin 12 (IL-12) were evaluated in sputum smear positive TB patients (HIV+/TB, n = 36, HIV-/TB, n = 59), their household contacts (n = 17) and blood donors (n = 46) from Gondar University Hospital, Ethiopia. Results: The proportion of HIV-/TB patients with an increased FeNO level (> 25 ppb) was significantly higher as compared to HIV+/TB patients, but HIV+/TB patients had significantly higher uNO than HIV-/TB patients. HIV+ and HIV-/TB patients both had lower levels of FeNO compared to blood donors and household contacts. The highest levels of both uNO and FeNO were found in household contacts. Less advanced findings on chest x-ray, as well as higher sedimentation rate were observed in HIV+/TB patients as compared to HIV-/TB patients. However, no significant correlation was found between FeNO and uNO, chest x-ray grading, clinical symptoms, TNF-alpha, IL-12, arginine levels or sedimentation rate. Conclusion: In both HIV negative and HIV co infected TB patients, low levels of exhaled NO compared to blood donors and household were observed. Future studies are needed to confirm whether low levels of exhaled NO could be a risk factor in acquiring TB and the relative importance of NO in human TB.Original Publication: Jonna Idh, Anna Westman, Daniel Elias, Feleke Moges, Assefa Getachew, Aschalew Gelaw, Tommy Sundqvist, Tony Forslund, Addis Alemu, Belete Ayele, Ermias Diro, Endalkachew Melese, Yared Wondmikun, Sven Britton, Olle Stendahl and Thomas Schoen, Nitric oxide production in the exhaled air of patients with pulmonary tuberculosis in relation to HIV co-infection, 2008, BMC INFECTIOUS DISEASES, (8), 146. http://dx.doi.org/10.1186/1471-2334-8-146 Publisher: BioMed Central http://www.biomedcentral.com

Intestinal parasitosis and shigellosis among diarrheal patients in Gondar teaching hospital, northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>Diarrheal diseases are the major causes of morbidity and mortality in developing world. Understanding the etiologic agents of diarrheal diseases and their association with socio-demographic characteristics of patients would help to design better preventive measures. Thus, this study was aimed to determine the prevalence of intestinal parasites and enteropathogenic bacteria in diarrheic patients.</p> <p>Methods</p> <p>A cross-sectional study involving 384 consecutive diarrheal patients who visited Gondar teaching hospital, Gondar, Ethiopia from October 2006 to March 2007 was conducted. Stool specimens were collected and examined for intestinal parasites and enteropathogenic bacteria following standard parasitological and microbiological procedures.</p> <p><b><it>Results</it></b></p> <p>Intestinal parasites were diagnosed in 36.5% of the patients. The most frequently encountered protozoan parasite was <it>Entamoeba histolytica/dispar </it>(7.3%) followed by <it>Giardia lamblia </it>(5.0%), C<it>ryptosporidium parvum </it>(1.8%) and <it>Isospora belli </it>(1.3%). The dominant helminthic parasite identified was <it>Ascaris lumbricoides </it>(5.5%) followed by <it>Strongyloides stercoralis </it>and <it>Schistosoma mansoni </it>(3.1% each), hookworm infection (1.8%), and <it>Hymenolepis </it>species (1.3%). Multiple infections of intestinal parasites were also observed in 6.3% of the patients. Among the enteropathogenic bacteria <it>Shigella </it>and <it>Salmonella </it>species were isolated from 15.6% and 1.6%, respectively, of the patients. <it>Escherichia coli O57:H7 </it>was not found in any of the stool samples tested. Eighty eight percent and 83.3% of the <it>Shigella </it>and <it>Salmonella </it>isolates were resistant to one or more commonly used antibiotics, respectively.</p> <p>Intestinal parasitosis was higher in patients who live in rural area, in patients who were washing their hands after visiting toilet either irregularly with soap and without soap or not at all, in patients who used well and spring water for household consumption, and in patients who had nausea (<it>P </it>< 0.05). Statistically significant associations were also observed between Shigella infections and patients who were using well and spring water for household consumption, and patients who had dysentery and mucoid stool (<it>P </it>< 0.05).</p> <p>Conclusions</p> <p>The high prevalence of intestinal parasites and <it>Shigella </it>species in diarrheic patients calls for institution of appropriate public health intervention measures to reduce morbidity and mortality associated with these diseases. The rational use of antibiotics should also be practiced.</p