Estimating Under Five Mortality in Space and Time in a Developing World Context

Accurate estimates of the under-5 mortality rate (U5MR) in a developing world context are a key barometer of the health of a nation. This paper describes new models to analyze survey data on mortality in this context. We are interested in both spatial and temporal description, that is, wishing to estimate U5MR across regions and years, and to investigate the association between the U5MR and spatially-varying covariate surfaces. We illustrate the methodology by producing yearly estimates for subnational areas in Kenya over the period 1980 - 2014 using data from demographic health surveys (DHS). We use a binomial likelihood with fixed effects for the urban/rural stratification to account for the complex survey design. We carry out smoothing using Bayesian hierarchical models with continuous spatial and temporally discrete components. A key component of the model is an offset to adjust for bias due to the effects of HIV epidemics. Substantively, there has been a sharp decline in U5MR in the period 1980 - 2014, but large variability in estimated subnational rates remains. A priority for future research is understanding this variability. Temperature, precipitation and a measure of malaria infection prevalence were candidates for inclusion in the covariate model.Comment: 36 pages, 11 figure

In a network of lines that intersect: The socio-economic development impact of marine resource management and conservation in Southeast Asia

Marine protected areas (MPAs) are rapidly spreading to meet global conservation targets, but new governance arrangements can have unintended impacts on socio-economic development that can undermine and counteract their intended outcomes. We use an exploratory mixed-method research design to understand these development impacts and their underlying mechanisms, guided by an innovative activity space framework that situates marine resource management and conservation in a network of relationships between communities, human services, and nature. Qualitative research – based on 22 interviews in Koh Sdach Archipelago, Cambodia – demonstrates how the local community experienced improving relationships with the state and a slowing deterioration of marine resources, but also social division, heightened livelihood anxiety, and potentially a false sense of economic security. We hypothesise on this basis that marine conservation could impede socio-economic development, for which we find support in our quantitative analysis across Cambodia, the Philippines, and Timor-Leste: MPAs materialised in better-off communities but were associated with slower and partly regressive socio-economic development, in particular decreasing wealth and increasing child mortality. These findings suggest that the rapid global expansion of MPA coverage in its current, environmental-conservation-focused form is problematic as it disregards local social realities. Livelihood adaptation support should complement the implementation of marine resource governance mechanisms to mitigate unintended negative consequences

Symptom management, nutrition and hydration at end-of-life: a qualitative exploration of patients', carers' and health professionals' experiences and further research questions

Background Symptom management is an essential aspect of palliative and end-of-life care, but evidence suggests that patients’ symptoms may not always be relieved, causing significant harm to patients and magnifying their relatives’ distress. A growing body of evidence focuses on symptom management at the end-of-life, but research funding for palliative care remains disproportionately low. It is therefore crucial that research funding is targeted at areas of importance to patients and relatives. The Palliative and end-of-life care Priority Setting Partnership (PeolcPSP) undertook a UK-wide free-text survey to establish research priorities within palliative and end-of-life care and disseminated its results in 2015. Much of the data were related more broadly to personal perceptions and experiences rather than specific research questions. The aim of this article is to report on a supplementary analysis exploring the experiences and questions of PeolcPSP survey respondents regarding symptoms, hydration and nutrition. Methods The PeolcPSP data (n=1403) were coded by a team of qualitative researchers in a supplementary analysis. There were 190 responses that related to symptoms, nutrition and hydration. The data were analysed thematically using Braun and Clarke’s approach. Results Five themes were identified: pain, breathlessness, agitation, nutrition and hydration. The majority of responses related to symptoms that were sub-optimally managed, in particular pain. Nutrition and hydration were of significant concern, particularly for carers. Overall, respondents consistently asked about the most effective, evidence-based methods for managing symptoms and suggested areas where further research is necessary. Conclusions This study highlights the perceptions and experiences of patients, families and professionals within palliative care, highlighting the need for improved care, communication and further research to establish which treatments are most effective within a palliative care population. This is essential to reduce harm and distress for patients and families

Neonatal azithromycin administration to prevent infant mortality: study protocol for a randomised controlled trial.

IntroductionBiannual mass azithromycin distribution to children aged 1-59 months has been shown to reduce all-cause mortality. Children under 28 days of age were not treated in studies evaluating mass azithromycin distribution for child mortality due to concerns related to infantile hypertrophic pyloric stenosis (IHPS). Here, we report the design of a randomised controlled trial to evaluate the efficacy and safety of administration of a single dose of oral azithromycin during the neonatal period.Methods and analysisThe Nouveaux-nés et Azithromycine: une Innovation dans le Traitement des Enfants (NAITRE) study is a double-masked randomised placebo-controlled trial designed to evaluate the efficacy of a single dose of azithromycin (20 mg/kg) for the prevention of child mortality. Newborns (n=21 712) aged 8-27 days weighing at least 2500 g are 1:1 randomised to a single, directly observed, oral dose of azithromycin or matching placebo. Participants are followed weekly for 3 weeks after treatment to screen for adverse events, including IHPS. The primary outcome is all-cause mortality at the 6-month study visit.Ethics and disseminationThis study was approved by the Institutional Review Boards at the University of California, San Francisco in San Francisco, USA (Protocol #18-25027) and the Comité National d'Ethique pour la Recherche in Ouagadougou, Burkina Faso (Protocol #2018-10-123). The findings of this trial will be presented at local, regional and international meetings and published in open access peer-reviewed journals.Trial registration numberNCT03682653; Pre-results

Effect of food hygiene training on food handlers´ knowledge in Sokoto Metropolis: a quasi-experimental study

Introduction: training intervention for food handlers is necessary to increase their knowledge and awareness about food hygiene. Research in this area has been given low attention in Nigeria, especially in the Northern part of the country. Therefore, we assessed the effect of food hygiene training on the knowledge of food hygiene among food handlers in Sokoto metropolis. Methods: we conducted a quasi-experimental study between January and July 2019. We used a multistage sampling technique to select 360 food handlers randomized into intervention and control groups. We conducted a training intervention after the baseline data collection. Post-intervention data collection was conducted six months after the intervention. We estimated the proportion of respondents with good knowledge at baseline and post-intervention. We assessed the difference in pre-and post-intervention proportions using McNemars Marginal Homogeneity test at 5% level of significance. Results: in the intervention and control groups, 19 (10.6%) and 18 (10.0%) had primary education respectively, p = 0.231. At baseline, 23 (12.8%) and 22 (12.2%) in intervention and control groups respectively had good knowledge, p= 0.515. At post-intervention, the proportion of those with good knowledge in the intervention group increased to 56.7%, p < 0.001; while in the control group, there was no significant difference in the proportion of those with good knowledge, p = 0.248. Conclusion: the training intervention has significantly improved the knowledge of the food handlers. We recommend that the National Food and Drug Agency, in collaboration with restaurant owners, ensure regular on-the-job training of food handlers

Palliative and end of life care priority setting partnership (PeolcPSP): Bereavement: experiences, needs and supportive interventions

This report presents data arising from 1403 completed responses from the first PeolcPSP survey, which was open from December 2013 to May 2014. The report focuses on analysing survey data that are outside the scope of the James Lind Alliance protocol, which focuses on clinical interventional research questions in relation to evidence uncertainties

HMDB: the Human Metabolome Database

The Human Metabolome Database (HMDB) is currently the most complete and comprehensive curated collection of human metabolite and human metabolism data in the world. It contains records for more than 2180 endogenous metabolites with information gathered from thousands of books, journal articles and electronic databases. In addition to its comprehensive literature-derived data, the HMDB also contains an extensive collection of experimental metabolite concentration data compiled from hundreds of mass spectra (MS) and Nuclear Magnetic resonance (NMR) metabolomic analyses performed on urine, blood and cerebrospinal fluid samples. This is further supplemented with thousands of NMR and MS spectra collected on purified, reference metabolites. Each metabolite entry in the HMDB contains an average of 90 separate data fields including a comprehensive compound description, names and synonyms, structural information, physico-chemical data, reference NMR and MS spectra, biofluid concentrations, disease associations, pathway information, enzyme data, gene sequence data, SNP and mutation data as well as extensive links to images, references and other public databases. Extensive searching, relational querying and data browsing tools are also provided. The HMDB is designed to address the broad needs of biochemists, clinical chemists, physicians, medical geneticists, nutritionists and members of the metabolomics community. The HMDB is available at

ENFERMEDADES RELACIONADAS AL ESTILO DE VIDA EN LIMA, PERÚ

Introducción: Las enfermedades relacionadas al estilo de vida son uno de los mayores retos de salud del siglo 21. Objetivos: El propósito de esta investigación fue obtener una base de datos para estudiar la prevalencia de enfermedades de las personas que viven en pobreza en Lima, Perú. Metodología: La investigación estuvo localizada en los distritos de Comas y Carabayllo en Lima, Perú. Contamos con un total de 829 adultos y 770 niños (0-17 años de edad) participantes. La data fue recolectada a través de clínicas comunitarias gratuitas, estas incluyeron muestras de sangre para evaluar la hemoglobina, glucosa, hemoglobina glicosilada, lípidos, vitamina D, y anticuerpos en contra de Chagas y Helicobacter pylori. Para la población pediátrica sólo se utilizó los records médicos; no se utilizaron muestras de sangre con propósitos de investigación. Resultados: Los resultados más significativos fueron: 50,9% con presión arterial sanguínea elevada siendo sistólica o diastólica, 47% Con hemoglobina glicosilada elevada, 24% glucosa en ayuno elevada, 57,2% con un al menos un parámetro elevado del panel lípido, 32,6% hemoglobina baja, 97,2% Vitamina D baja, 59% positivo para anticuerpos de Helicobacter, y 5,6% positivo con anticuerpos de Chagas. La prevalencia de sobrepeso y obesidad fue 65,1% para adultos y 42,3% para la población pediátrica. Conclusión: Los resultados demuestran anomalías relacionadas al estilo de vida. Esta información puede utilizarse para desarrollar estrategias de prevención y tratamiento de las enfermedades relacionadas al estilo de vida, con enfoque en la educación y cambios en el estilo de vida.   DOI: https://doi.org/10.25176/RFMH.v17.n2.83