Dysglycemia in Children with Severe Acute Malnutrition: A Systematic Review and Meta-Analysis.

Dysglycemia is a common complication of severe acute malnutrition (SAM) in children. Its prevalence and impact on short- and long-term outcomes are not well described. This systematic review was undertaken to review the available evidence on dysglycemia (either hypo- or hyperglycemia) in hospitalized children with SAM. The 2 primary objectives of this systematic review were to understand the prevalence of hypoglycemia and hyperglycemia in children with SAM. A secondary objective was to understand the relation between dysglycemia and clinical outcomes like mortality in children with SAM. MEDLINE was searched with terms related to children, SAM, and dysglycemia. A meta-analysis of proportions was completed to determine the hypoglycemia prevalence and a standard meta-analysis was done to determine the relation between hypoglycemia and mortality. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 2148 articles were identified in the database search of which 16 met the inclusion criteria for the systematic review based on screening done by multiple reviewers. The overall prevalence of hypoglycemia in SAM across studies based on the meta-analysis of proportions was 9% (95% CI: 7%, 12%; I2 = 92%). Meta-analysis results showed that hypoglycemia was associated with a higher chance of mortality during hospitalization in children with SAM (OR: 4.29; 95% CI: 3.04, 6.05; I2 = 0%). According to the GRADE evaluation, the certainty of the evidence for the prevalence of hypoglycemia was low and for hyperglycemia was very low. For the relation between hypoglycemia and mortality, the certainty of the evidence was moderate. A meta-analysis was not carried out for the prevalence of hyperglycemia due to the wide range of definitions used for across studies, but the prevalence ranged from 2% to 38% in the literature. This systematic review highlights the need for further work in this area to include serial glucose measurements to understand the clinical importance of dysglycemia during hospitalization in children with SAM

Access Impediments to Health Care and Social Services Between Anglophone and Francophone African Immigrants Living in Philadelphia with Respect to HIV/AIDS

Objectives To describe the social and cultural differences between Anglophone and Francophone African immigrants which define the impediments that Francophone African immigrants face trying to access health and human services in Philadelphia, Pennsylvania. Methods Surveys and personal interviews were administered to participants in social events, community meetings, and health centers. A Chi-squared analysis was used to contrast the communities. Results Francophone Africans demonstrated less acculturation, education, English fluency, and more legal documentation problems, and thus face greater challenges accessing health care. Anglophone Africans had a higher level of acculturation, fewer language problems, and perceived fewer barriers in accessing health care than Francophone Africans. Conclusions Educating new immigrants, through a more culturally sensitive infectious disease treatment and prevention program, is integral to achieving a higher access and utilization rates of available services; especially in recent Francophone immigrants. A larger study is needed to extend the findings to other cities where immigrants with similar backgrounds or acculturation issues reside

Fertilizer and Soil Health in Africa The Role of Fertilizer in Building Soil Health to Sustain Farming and Address Climate Change

Summary Soil health is commonly defined as the ability to generate sufficient crop yields while maintaining the future productive capacity of soils and the ecosystem services soils regulate and deliver. However, less consensus exists on indicators to assess soil health and its changes over time and space, although soil organic carbon (SOC) is generally acknowledged as a key indicator. In the context of this paper, soil health status is equated with SOC status. Current SOC conditions are influenced by soil properties and climate. Under smallholder farming conditions, SOC is variable and affected by past crop and soil management practices, which are influenced by farmer typology. Although SOC content under cropland is a maximum of 60-70% of that under natural vegetation, there is substantial scope to increase it in smallholder farming conditions. A conceptual framework relating to fertilizer, crop productivity, and soil health is presented here. While fertilizer application commonly results in a substantial increase in crop yield at various scales, a key indicator of fertilizer use, agronomic efficiency (AE), is often observed to be lower than relatively easily achievable values under well-managed conditions, caused by a diversity of factors. Low AE values do not necessarily result in greater greenhouse gas (GHG) emissions because of the low fertilizer application rates in sub-Saharan Africa (SSA), though increases in GHG emissions are likely with increases in fertilizer use. Crop response to organic inputs is substantially lower although organic inputs increase SOC content, which usually results in greater AE values relative to sole application of fertilizer. Increases in crop productivity are associated with increases in SOC, though the relationship is weak and efforts besides fertilizer application itself are required. That said, N(PK) fertilizer has had a positive effect on SOC in most parts of the world except SSA, an observation corroborated by an analysis of past and ongoing long-term experiments, likely related to the low and erratic use of fertilizer in the region. While fertilizer use can be an entry point to increasing soil health, this will not likely happen on degraded soils where responses to fertilizer are limited. In such cases, investments to rehabilitate degraded soils should come first. Several approaches can be followed to determine best fertilizer recommendations, while recognizing nutrients needs by crops and soil-specific properties. Site-specificity commonly requires an assessment of the soil fertility status of a particular field, and analytical tools now allow for the development of locally relevant recommendations at scale with some early successes. While organic inputs do positively impact SOC, attractive options to increase organic inputs in smallholder farming systems are limited and mostly related to in-situ production, with an important emphasis on multi-purpose legumes. Climate adaptation is facilitated by healthy Fertilizer and Soil Health in Africa 2 soils and requires fertilizer to be combined with other crop, soil, and water management practices (Wortmann and Stewart, 2021). While low yields are linked to the ecological yield gap, whereby the potential productivity of crops is set by biological factors, input and output prices determine the economic yield gap, which is usually quite lower than the former because of unfavourable ratio of fertilizer prices to crop product prices. Even though profitability is a key driver of impact, many other factors affect the adoption of appropriate fertilizer and soil health recommendations, including farmers’ production objectives, resource endowment, land tenure, and access to markets. A main bottleneck in engaging smallholder farmers in soil health-restoring practices is the relatively large amount of time such practices take to deliver benefits that are visible to farmers. In the absence of incentive programs, farmers require short-term benefits, generated within their farming systems. Furthermore, associated advice on complementary practices to fertilizer use increases the complexity of information to be conveyed to farmers. Scaling models have moved toward the delivery of bundled services, often digitally enabled, to address challenges with communicating complex information and the necessary complementary crop and soil management practices. Targeted policy interventions can support the delivery of broad digitally enabled fertilizer management recommendations and the creation of conditions that enable smallholder farmers to implement these recommendations at scale. A number of recommendations have been generated from the scientific information, covered under the following headings: (1) key elements of a Fertilizer and Soil Health Action Plan; (2) development of quantitative indicators and targets of soil health; (3) addressing climate change requires choices; (4) incentivizing farmers; (5) soil health investments, which require localized actions (think global, act local); and (6) not only fertilizers, but also auxiliary interventions, as defined by the Integrated Soil Fertility Management (ISFM) approach. Action is needed today to reverse the downward spiral of low and inefficient fertilizer use, resulting in low yields and declining soil health

Factors influencing the awareness and adoption of borehole-garden permaculture in Malawi: Lessons for the promotion of sustainable practices

Using wastewater accumulating around rural waterpoints to irrigate community gardens, borehole-garden permaculture (BGP) presents a method of sustainable water management. BGP also presents public health benefits through the removal of stagnant water around boreholes, key Malaria breeding grounds, and through providing year-round food to supplement diets. By analysing a dataset of over 100,000 cases, this research examines the awareness and adoption of BGP across Malawi. Generalised linear models identified significant variables influencing BGP awareness and uptake revealing that socioeconomic, biophysical and waterpoint-specific variables influenced both the awareness and adoption of BGP. BGP had low uptake in Malawi with only 2.4% of communities surveyed practising BGP while 43.0% of communities were aware of BGP. Communities in areas with unreliable rainfall and high malaria susceptibility had low BGP awareness despite BGP being particularly beneficial to these communities

Local scale water-food nexus : use of borehole-garden permaculture to realise the full potential of rural water supplies in Malawi

Local-scale opportunities to address challenges of the water–food nexus in the developing world need to be embraced. Borehole-garden permaculture is advocated as one such opportunity that involves the sustainable use of groundwater spilt at hand-pump operated borehole supplies that is otherwise wasted. Spilt water may also pose health risks when accumulating as a stagnant pond. Rural village community use of this grey-water in permaculture projects to irrigate borehole gardens is proposed to primarily provide economic benefit whereby garden-produce revenue helps fund borehole water-point maintenance. Water-supply sustainability, increased food/nutrition security, health protection from malaria, and business opportunity benefits may also arise. Our goal has been to develop an, experience-based, framework for delivery of sustainable borehole-garden permaculture and associated benefits. This is based upon data collection and permaculture implementation across the rural Chikwawa District of Malawi during 2009–17. We use, stakeholder interviews to identify issues influencing uptake, gathering of stagnant pond occurrence data to estimate amelioration opportunity, quantification of permaculture profitability to validate economic potential, and critical assessment of recent permaculture uptake to identify continuing problems. Permaculture was implemented at 123 sites representing 6% of District water points, rising to 26% local area coverage. Most implementations were at, or near, newly drilled community-supply boreholes; hence, amelioration of prevalent stagnant ponds elsewhere remains a concern. The envisaged benefits of permaculture were manifest and early data affirm projected garden profitability and spin-off benefits of water-point banking and community micro-loan access. However, a diversity of technical, economic, social and governance issues were found to influence uptake and performance. Example issues include greater need for improved bespoke garden design input, on-going project performance assessment, and coordinated involvement of multi-sector governmental-development bodies to underpin the integrated natural-resource management required. The developed framework aims to manage the identified issues and requires the concerted action of all stakeholders. Based on the probable ubiquity of underlying issues, the framework is expected to be generalizable to the wider developing world. However, this particular application of permaculture represents a fraction of its greater potential opportunity for rural communities that should be explored

A Single-Blind randomized controlled trial to evaluate the effect of extended counseling on uptake of pre-antiretroviral care in eastern uganda

<p>Abstract</p> <p>Background</p> <p>Many newly screened people living with HIV (PLHIV) in Sub-Saharan Africa do not understand the importance of regular pre-antiretroviral (ARV) care because most of them have been counseled by staff who lack basic counseling skills. This results in low uptake of pre-ARV care and late treatment initiation in resource-poor settings. The effect of providing post-test counseling by staff equipped with basic counseling skills, combined with home visits by community support agents on uptake of pre-ARV care for newly diagnosed PLHIV was evaluated through a randomized intervention trial in Uganda.</p> <p>Methods</p> <p>An intervention trial was performed consisting of post-test counseling by trained counselors, combined with monthly home visits by community support agents for continued counseling to newly screened PLHIV in Iganga district, Uganda between July 2009 and June 2010, Participants (N = 400) from three public recruitment centres were randomized to receive either the intervention, or the standard care (the existing post-test counseling by ARV clinic staff who lack basic training in counseling skills), the control arm. The outcome measure was the proportion of newly screened and counseled PLHIV in either arm who had been to their nearest health center for clinical check-up in the subsequent three months +2 months. Treatment was randomly assigned using computer-generated random numbers. The statistical significance of differences between the two study arms was assessed using chi-square and t-tests for categorical and quantitative data respectively. Risk ratios and 95% confidence intervals were used to assess the effect of the intervention.</p> <p>Results</p> <p>Participants in the intervention arm were 80% more likely to accept (take up) pre-ARV care compared to those in the control arm (RR 1.8, 95% CI 1.4-2.1). No adverse events were reported.</p> <p>Conclusions</p> <p>Provision of post-test counseling by staff trained in basic counseling skills, combined with home visits by community support agents had a significant effect on uptake of pre-ARV care and appears to be a cost-effective way to increase the prerequisites for timely ARV initiation.</p> <p>Trial registration</p> <p>The trial was registered by Current Controlled Trials Ltd C/OBioMed Central Ltd as <a href="http://www.controlled-trials.com/ISRCTN94133652">ISRCTN94133652</a> and received financial support from Sida and logistical support from the European Commission.</p

Awareness, Accuracy, and Predictive Validity of Self-Reported Cholesterol in Women

BACKGROUND: Although current guidelines emphasize the importance of cholesterol knowledge, little is known about accuracy of this knowledge, factors affecting accuracy, and the relationship of self-reported cholesterol with cardiovascular disease (CVD). METHODS: The 39,876 female health professionals with no prior CVD in the Women’s Health Study were asked to provide self-reported and measured levels of total and high-density lipoprotein (HDL) cholesterol. Demographic and cardiovascular risk factors were considered as determinants of awareness and accuracy. Accuracy was evaluated by the difference between reported and measured cholesterol. In addition, we examined the relationship of self-reported cholesterol with incident CVD over 10 years. RESULTS: Compared with women who were unaware of their cholesterol levels, aware women (84%) had higher levels of income, education, and exercise and were more likely to be married, normal in weight, treated for hypertension and hypercholesterolemia, nonsmokers, moderate drinkers, and users of hormone therapy. Women underestimated their total cholesterol by 9.7 mg/dL (95% CI: 9.2–10.2); covariates explained little of this difference (R(2) < .01). Higher levels of self-reported cholesterol were strongly associated with increased risk of CVD, which occurred in 741 women (hazard ratio 1.23/40 mg/dL cholesterol, 95% CI: 1.15–1.33). Women with elevated cholesterol who were unaware of their level had particularly increased risk (HR=1.88, P <. 001) relative to aware women with normal measured cholesterol. CONCLUSION: Women with obesity, smoking, untreated hypertension, or sedentary lifestyle have decreased awareness of their cholesterol levels. Self-reported cholesterol underestimates measured values, but is strongly related to CVD. Lack of awareness of elevated cholesterol is associated with increased risk of CVD

Characterising paediatric mortality during and after acute illness in Sub-Saharan Africa and South Asia: a secondary analysis of the CHAIN cohort using a machine learning approach

Background A better understanding of which children are likely to die during acute illness will help clinicians and policy makers target resources at the most vulnerable children. We used machine learning to characterise mortality in the 30-days following admission and the 180-days after discharge from nine hospitals in low and middle-income countries (LMIC). Methods A cohort of 3101 children aged 2–24 months were recruited at admission to hospital for any acute illness in Bangladesh (Dhaka and Matlab Hospitals), Pakistan (Civil Hospital Karachi), Kenya (Kilifi, Mbagathi, and Migori Hospitals), Uganda (Mulago Hospital), Malawi (Queen Elizabeth Central Hospital), and Burkina Faso (Banfora Hospital) from November 2016 to January 2019. To record mortality, children were observed during their hospitalisation and for 180 days post-discharge. Extreme gradient boosted models of death within 30 days of admission and mortality in the 180 days following discharge were built. Clusters of mortality sharing similar characteristics were identified from the models using Shapley additive values with spectral clustering. Findings Anthropometric and laboratory parameters were the most influential predictors of both 30-day and post-discharge mortality. No WHO/IMCI syndromes were among the 25 most influential mortality predictors of mortality. For 30-day mortality, two lower-risk clusters (N = 1915, 61%) included children with higher-than-average anthropometry (1% died, 95% CI: 0–2), and children without signs of severe illness (3% died, 95% CI: 2–4%). The two highest risk 30-day mortality clusters (N = 118, 4%) were characterised by high urea and creatinine (70% died, 95% CI: 62–82%); and nutritional oedema with low platelets and reduced consciousness (97% died, 95% CI: 92–100%). For post-discharge mortality risk, two low-risk clusters (N = 1753, 61%) were defined by higher-than-average anthropometry (0% died, 95% CI: 0–1%), and gastroenteritis with lower-than-average anthropometry and without major laboratory abnormalities (0% died, 95% CI: 0–1%). Two highest risk post-discharge clusters (N = 267, 9%) included children leaving against medical advice (30% died, 95% CI: 25–37%), and severely-low anthropometry with signs of illness at discharge (46% died, 95% CI: 34–62%). Interpretation WHO clinical syndromes are not sufficient at predicting risk. Integrating basic laboratory features such as urea, creatinine, red blood cell, lymphocyte and platelet counts into guidelines may strengthen efforts to identify high-risk children during paediatric hospitalisations. Funding Bill & Melinda Gates Foundation OPP1131320

The Effect of Partner Sex: Nondisclosure of HIV Status to Male and Female Partners Among Men who Have Sex with Men and Women (MSMW)

A common concern within HIV prevention is that HIV positive MSMW do not disclose their HIV status to female partners who are thus at increased risk for HIV infection. The present study uses unique data to examine whether MSMW disclose more often to male rather than female partners. Data were collected on most recent male and/or female primary partner and four most recent casual partners from 150 MSMW (50 African American, 50 Latino, 50 White). MSMW reported on 590 partners (31% female; 69% male). Disclosure was coded as disclosure before sex, disclosure after sex, or nondisclosure. A series of multinomial logistic regressions with partners clustered within respondents were conducted to evaluate effects of respondent characteristics and partner characteristics on timing of disclosure. In bivariate and multivariate analyses there were no significant differences in odds of disclosure to male and female partners before or after sex. Although MSMW were substantially less likely to disclose to HIV negative partners before sex compared to HIV positive partners regardless of sex, when we fully interacted the multivariate model by partner sex, the odds of disclosure to HIV negative male partners compared to HIV positive male partners before sex were significantly higher than the odds of disclosure to HIV negative female partners compared to HIV positive female partners. Patterns of mutual nondisclosure and nonreciprocal disclosure were observed with both primary and casual partners. The paper makes additional methodological contributions to the measurement and analysis of disclosure