Facility and community results-based financing to improve maternal and child nutrition and health in The Gambia

In 2013, the Government of The Gambia implemented a novel results-based financing (RBF) intervention designed to improve maternal and child nutrition and health through a combination of community, facility and individual incentives. In a mixed-methods study, we used a randomized 2 x 2 study design to measure these interventions' impact on the uptake of priority maternal health services, hygiene and sanitation. Conditional cash transfers to individuals were bundled with facility results-based payments. Community groups received incentive payments conditional on completion of locally-designed health projects. Randomization occurred separately at health facility and community levels. Our model pools baseline, midline and endline exposure data to identify evidence of the interventions' impact in isolation or combination. Multivariable linear regression models were estimated. A qualitative study was embedded, with data thematically analyzed. We analyzed 5,927 household surveys: 1,939 baseline, 1,951 midline, and 2,037 endline. On average, community group interventions increased skilled deliveries by 11 percentage points, while the facility interventions package increased them by seven percentage points. No impact was found, either in the community group or facility intervention package arms on early ANC. The community group intervention led to 49, 43 and 48 percentage point increases in handwashing stations, soaps at station and water at station, respectively. No impact was found on improved sanitation facilities. The qualitative data help understand factors underlying these changes. No interaction was found between the community and facility interventions. Where demand-side barriers predominate and community governance structures exist, community group RBF interventions may be more effective than facility designs

SARS-CoV-2 seroprevalence in pregnant women in Kilifi, Kenya from March 2020 to March 2022

BackgroundSeroprevalence studies are an alternative approach to estimating the extent of transmission of SARS-CoV-2 and the evolution of the pandemic in different geographical settings. We aimed to determine the SARS-CoV-2 seroprevalence from March 2020 to March 2022 in a rural and urban setting in Kilifi County, Kenya.MethodsWe obtained representative random samples of stored serum from a pregnancy cohort study for the period March 2020 to March 2022 and tested for antibodies against the spike protein using a qualitative SARS-CoV-2 ELISA kit (Wantai, total antibodies). All positive samples were retested for anti-SARS-CoV-2 anti-nucleocapsid antibodies (Euroimmun, ELISA kits, NCP, qualitative, IgG) and anti-spike protein antibodies (Euroimmun, ELISA kits, QuantiVac; quantitative, IgG).ResultsA total of 2,495 (of 4,703 available) samples were tested. There was an overall trend of increasing seropositivity from a low of 0% [95% CI 0–0.06] in March 2020 to a high of 89.4% [95% CI 83.36–93.82] in Feb 2022. Of the Wantai test-positive samples, 59.7% [95% CI 57.06–62.34] tested positive by the Euroimmun anti-SARS-CoV-2 NCP test and 37.4% [95% CI 34.83–40.04] tested positive by the Euroimmun anti-SARS-CoV-2 QuantiVac test. No differences were observed between the urban and rural hospital but villages adjacent to the major highway traversing the study area had a higher seroprevalence.ConclusionAnti-SARS-CoV-2 seroprevalence rose rapidly, with most of the population exposed to SARS-CoV-2 within 23 months of the first cases. The high cumulative seroprevalence suggests greater population exposure to SARS-CoV-2 than that reported from surveillance data

Pharmaceutical pollution of the world's rivers

Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world's rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals

Effects of changing climate and vegetation on Trypanosomosis burden in the Gambia

The aim of this one year long longitudinal study was to update the current prevalence of trypanosomosis in cattle, tsetse density and challenge that could have been influenced by changes in climatic factors and land use.A total of 3651 cattle blood samples were collected from 120 randomly selected cattle herds in both Kiang West and Niamina East Districts of The Gambia during six bimonthly sampling in 2011. The blood samples were examined using the dark ground buffy coat technique to establish the cattle trypanosomosis prevalence at both herd and animal levels. During the same period, a total of 317 biconical traps were set up and harvested for two consecutive days to calculate the tsetse density and challenge. Land cover/use map for the two study sites were compared with past reports to assess the changing vegetation cover. Records on rainfall, temperature and humidity were used to assess their trends over the past three decades. All data were analysed using linear regression, logistic regression, poisson and negative binominal regression models in STATA 11 and scatter plot graphs in MS Excel.Results of the survey on tsetse abundance and trypanosomosis prevalence shows overall tsetse density (TTD), tsetse challenge, trypanosomosis prevalence animal level and herd level of 2.0, 13.9, 3.1% and 53% in Kiang West; 2.5, 16.5, 3.2% and 55% in Niamina East, respectively. The bimonthly TTD, tsetse challenge, trypanosomosis prevalence animal level and herd level at the study sites varied as follows: 0.05-10.15 TTD, 0.00-87.63 tsetse challenge, 1.0-5.9% trypanosomosis prevalence animal level and 20-100% trypanosomosis prevalence herd level. Comparing these values with published findings, it appears that trypanosomosis prevalence and TTD in Kiang West remains the same but the tsetse challenge has increased; whilst in Niamina East the trypanosomosis prevalence remain the same but both TTD and tsetse challenge are decreasing. The assessed climatic factors showed a significant increase during the past three decades, and the habitats of tsetse flies appear to have reduced.It is concluded that the study areas have African Animal Trypanosomosis (AAT) problem ranking of Low to Medium with some hotspots of High to Very Severe tsetse burden. Recommendations for Farmers, PROGEBE and Policy makers include strategic cattle feeding, tsetse fly control, treatment of infected animals, capacity building and recruitment of additional livestock technicians.Keywords: trypanosomosis, tsetse density, tsetse challenge, climate changes, The Gambi

Air Pollution Exposure Among Adult Chronic Airway Disease Patients in the Gambia: A Pilot Case-control Study

Background: Chronic Airway Diseases (CADs) are of public health importance in both the developed countries and Low-and-middle-income countries (LMICs). Air pollution has a role in the causation of CADs and the worsening of already established CADs. This study examines the extent to which adult CAD patients and age and sex-matched controls in The Gambia are exposed to fine particulate matter and carbon monoxide. Methodology: In a clinic-based pilot case-control study,50adult patients with diagnosis of asthma or COPD presenting at respiratory clinics in the Western Health region in The Gambia were consecutively recruited along with 50 age and sex-matched controls who presented for non-cardiorespiratory conditions. Baseline spirometry, clinical examination and chest x-ray were done alongside the questionnaire administration. Home and personal PM2.5, CO and Exhaled CO were subsequently measured. Results: The median (SD) age of cases was 51.5±26 years and controls 52.0±24.8 years. Most cases were urban dwellers, presented with wheeze, cough, shortness of breath and weight loss. Two-thirds (25/40) of the asthmatics had a poor asthma control test score, whilst 90% (9/10) of the COPD patients had CAT scores showing at least a medium impact on their lives. Three-quarters (21/50) of cases had ≥1exacerbation in the previous year. Passive smoking occurred in one-quarter of the cases. There is slightly more personal and home exposure to PM2.5 among controls (61.2μg/m3) than cases(51.8μg/m3). Controls had slightly more home CO exposure 71.2 μg/m3) compared to cases (65.2μg/m3). Cases have more personal CO exposure as the controls. Also, occupational dust exposure and exposure to burning refuse occurred among the cases. Conclusion: As compared with controls, Chronic airway disease patients in The Gambia, present with significantly advanced disease, are likely to have had at least one exacerbation in the last year, and are exposed to personal CO, second-hand smoke, occupational dust and burning refuse. There is need for concerted efforts among all stakeholders to reduce such exposure, thus preventing worsening of already established