Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites.

BACKGROUND: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings. OBJECTIVE: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories. DESIGN: All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex. CONCLUSIONS: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs

Optimizing pesticide spray coverage using a novel web and smartphone tool, SnapCard

International audienceThe overuse of pesticides leads to contamination of water and food. Therefore, there is a need for tools and strategies to optimize pesticide application. Here we present SnapCard, a user-friendly and freely available decision support tool for farmers and agricultural consultants, available at snapcard.agric.wa.gov.au. SnapCard allows to predict, measure, and archive pesticide spray coverage quantified from water-sensitive spray cards. Variables include spray settings such as nozzle orifice size, sprayer speed, water carrier rate and adjuvant, and weather variables such as barometric pressure, relative humidity, temperature, and wind speed at ground level. We use separate regression models for four nozzles types. Our results showed that there are strong and positive correlations between water carrier rate and spray coverage for all four nozzle types. Moreover, sprayer speed is highly negatively correlated with obtained spray coverage. In addition, there is no consistent effect of either nozzle type or use of a particular adjuvant, across water carrier intervals. We conclude that varying combinations of spray settings and weather conditions caused marked ranges of spray coverages among the four nozzle types, thus highlighting the importance of selecting the right nozzle orifice size and type. We demonstrate that realistic scenarios of environmental conditions and spray settings can lead to predictions of very low spray coverage with at least one of the four nozzle types. We discuss how the novel and freely available smartphone app, SnapCard, can be used to optimize spray coverage, reduce spray drift, and minimize the risk of resistance development in target pest populations

Treatment of Infections in Young Infants in Low- and Middle-Income Countries:A Systematic Review and Meta-analysis of Frontline Health Worker Diagnosis and Antibiotic Access

BACKGROUND: Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (<2 months) in low- and middle-income countries (LMICs). We aimed to address three questions regarding access to treatment for young infant infections in LMICs: (1) Can frontline health workers accurately diagnose possible bacterial infection (pBI)?; (2) How available and affordable are antibiotics?; (3) How often are antibiotics procured without a prescription? METHODS AND FINDINGS: We searched PubMed, Embase, WHO/Health Action International (HAI), databases, service provision assessments (SPAs), Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and grey literature with no date restriction until May 2014. Data were identified from 37 published studies, 46 HAI national surveys, and eight SPAs. For study question 1, meta-analysis showed that clinical sign-based algorithms predicted bacterial infection in young infants with high sensitivity (87%, 95% CI 82%-91%) and lower specificity (62%, 95% CI 48%-75%) (six studies, n = 14,254). Frontline health workers diagnosed pBI in young infants with an average sensitivity of 82% (95% CI 76%-88%) and specificity of 69% (95% CI 54%-83%) (eight studies, n = 11,857) compared to physicians. For question 2, first-line injectable agents (ampicillin, gentamicin, and penicillin) had low variable availability in first-level health facilities in Africa and South Asia. Oral amoxicillin and cotrimoxazole were widely available at low cost in most regions. For question 3, no studies on young infants were identified, however 25% of pediatric antibiotic purchases in LMICs were obtained without a prescription (11 studies, 95% CI 18%-34%), with lower rates among infants <1 year. Study limitations included potential selection bias and lack of neonatal-specific data. CONCLUSIONS: Trained frontline health workers may screen for pBI in young infants with relatively high sensitivity and lower specificity. Availability of first-line injectable antibiotics appears low in many health facilities in Africa and Asia. Improved data and advocacy are needed to increase the availability and appropriate utilization of antibiotics for young infant infections in LMICs. REVIEW REGISTRATION: PROSPERO International prospective register of systematic reviews (CRD42013004586). Please see later in the article for the Editors' Summary

A Community-Driven Nature-Based Design Framework for the Regeneration of Neglected Urban Public Spaces

Nature-based solutions are a popularising concept within current urban regeneration literature, exploring differing themes in the context of optimising public spaces. Focus on the adaptation of public space design, with the community at the forefront, has been documented to a limited degree, with few studies concentrating on possible design strategies. This literature review revealed that the majority of nature-based design frameworks, since 2017, have suggested the benefits of nature in public spaces to human health and well-being: whether physically or psychologically, and either within the full framework or as part of the framework’s scope. There are however variations in the number and clarity of steps needed to follow each framework, and it is evident that the importance of community driven designs is understated within built environment literature. Many frameworks favoured the use of academic studies as a secondary source for their creation, with few using primary analysis of community acceptance and co-creation. This paper explores the literature available on nature-based solutions and their design frameworks. It maps out the existing studies, to date, and reports on the initial findings for this progressing PhD research. Public spaces are, in their very definition, a space for the public; despite this, development of these spaces, as well as the literature around the subject, is far more theoretical and professionally inclined, rather than community influenced. With an emphasis on sustainable development, this paper suggests that community views on nature-based public spaces need to be the focal point of design frameworks for public urban spaces, which may then be used as a protocol for the production of optimal and effective nature-based public space regeneration