海運に於ける競爭と獨占(二)

BackgroundAnaemia in pregnancy is associated with adverse maternal and fetal outcome. Unfortunately, in developing countries its prevalence has continued to rise. To improve the situation, iron supplement is routinely prescribed during pregnancy. We therefore examine the impact of the intervention as being currently practised in our clinical setting.MethodsIn total, 255 prenatal clinic attendees who had more than 8 weeks of prescribed iron supplements were sampled. Data was obtained on their socio-demographic features, haemoglobin concentration at booking, compliance with iron supplements and third trimester haemoglobin value.ResultsObserved iron supplementation compliance rate was 184(72.2%). There was a significant drop in mean haemoglobin (Hb) concentration between the two time points (booking Hb: 32.56±2.99; third trimester Hb: 31.67±3.01; mean diff: 0.89±3.04; t = 4.673; 95% CI= 0.52–1.27; p= <0.001). Anaemia increased from 132(51.8%) to 150(58.8%) by the third trimester. Increase in anaemia occurred in both iron-compliant and non-compliant groups. Non-compliance however had higher odds of predicting anaemia by the third trimester (OR: 1.83; 95% CI: 1.03–3.26; p: 0.04).ConclusionAlthough iron supplementation is still a good intervention in developing countries, it is not sufficient to reduce overall prevalence of anaemia by the third trimester. There is a need to look beyond the approach and reinforce the importance of better feeding practices, food fortification and reduced frequency of pregnancies

Seasonal Transmitting Potential of Malaria Vectors in Six Communities in Ekiti State, Nigeria

Malaria vectors are found virtually in all communities of Nigeria. Understanding the transmitting potential of these vectors in  relationship with the malaria parasite (MP) infection is essential to design a sustainable community base control programme. This study aimed at determining this relationship in six communities in Ekiti State, Nigeria. The communities were randomly selected through a multistage sampling. Blood samples were screened for MPinfection among human volunteers during dry and rainy seasons in each community. Adult mosquitoes were collected indoors for twelve months in the communities using light traps. Female  Anopheles mosquitoes collected were characterized by Polymerase Chain Reactions and circumsporozoite proteins of the infected mosquitoes were detected by Enzyme-Linked Immunosorbent Assay. Prevalence of MP infection, human biting rates (HBR), sporozoite rates and entomological inoculation rates (EIRs) were determined using appropriate formulae. Overall prevalence of MPinfection was 26% in dry season and 38% in rainy season (P=0.001). Female Anopheles mosquitoes collected were 428. Strong relationship existed between HBR and MP infection in rainy  season (R2 = 0.671) but the relationship was weak (R2 = 0.209) in dry season. Sporozoites were detected in 2.3% of the female Anopheles mosquitoes collected. EIRs were between 0.100 - 0.252 infective bites/person/night.  Transmission of malaria parasites occurred throughout the year particularly during rainy season when there were recorded EIRs. Malaria control interventions will be more appropriate during raining season in this region. Keywords: Anophelesmosquitoes, Nigeria, transmission, malaria, seaso

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran