Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies

Background: Bacterial meningitis (BM) is a severe infection responsible for high mortality and disabling sequelae. Early identification of patients at high risk of these outcomes is necessary to prevent their occurrence by adequate treatment as much as possible. For this reason, several prognostic models have been developed. The objective of this study is to summarize the evidence regarding prognostic factors predicting death or sequelae due to BM in children 0-18 years of age. Methods: A search in MEDLINE and EMBASE was conducted to identify prognostic studies on risk factors for mortality and sequelae after BM in children. Selection of abstracts, full-text articles and assessment of methodological quality using the QUIPS checklist was performed by two reviewers independently. Data on prognostic factors per outcome were summarized. Results: Of the 31 studies identified, 15 were of moderate to high quality. Due to substantial heterogeneity in study characteristics and evaluated prognostic factors, no quantitative analysis was performed. Prognostic factors found to be statistically significant in more than one study of moderate or high quality are: complaints > 48 hours before admission, coma/impaired consciousness, (prolonged duration of) seizures, (prolonged) fever, shock, peripheral circulatory failure, respiratory distress, absence of petechiae, causative pathogen Streptococcus pneumoniae, young age, male gender, several cerebrospinal fluid (CSF) parameters and white blood cell (WBC) count. Conclusions: Although several important prognostic factors for the prediction of mortality or sequelae after BM were identified, the inability to perform a pooled analysis makes the exact (independent) predictive value of these factors uncertain. This emphasizes the need for additional well-conducted prognostic studie

Uptake of Crop Insurance among Smallholder Farmers: Insights from Maize Producers in Kenya

In spite of agriculture being an important source of income growth and a potential source of investment opportunities in Kenya, farmers face numerous production risks including climate change and variability. While literature suggests that crop insurance has the potential to unlock key services that enhance farm productivity, crop insurance uptake evidence is limited, hence, this study sought to inform on ways of making crop insurance work for the smallholder producers. Data was collected from 400 maize-producing households in areas where weather index-based insurance had been promoted. Results show that uptake of crop insurance is very low and declining and, the insurance concept is also not well understood by farmers. In addition, basis risk hinders uptake of crop insurance since farmers exhibited high levels of dissatisfaction with claim payments. Furthermore, awareness and training on crop insurance, density of automated weather stations and ownership of savings account are integral factors in enhancing its uptake. Our findings therefore highlight the need to educate farmers on the principles of crop insurance and different products that exist. Similarly, designing of crop insurance products and selection of target crop enterprises should involve all stakeholders to enhance uptake. Acknowledgement

Increased serum malondialdehyde level in neonates with hypoxic-ischaemic encephalopathy: Prediction of disease severity

Increased serum level of malondialdehyde (sMDA) in neonates with hypoxic-ischaemic encephalopathy (HIE) was evaluated as a possible criterion for determining HIE severity. Mean body weight and gestational age in a healthy control group of neonates (n = 63) and in neonates with HIE (n = 69) were statistically similar. Apgar scores at 1 and 5 min for the HIE group were significantly lower than for the control group. The mean sMDA level for the HIE group was significantly higher than the control group. Within the HIE group, the sMDA level for neonates with Sarnat's grade II and III was significantly higher than for those with Sarnat's grade I. There was a significant correlation between Sarnat's grading and the sMDA level. The sMDA level was significantly higher for neonates who died (n = 20) compared with those who survived (n = 49). In conclusion, the sMDA level was highest in neonates with HIE and correlated with HIE severity. The sMDA concentration could, therefore, be used as a criterion for predicting disease severity. Copyright © 2010 Field House Publishing LLP

Sweetpotato seed systems in Uganda, Tanzania, and Rwanda

Surveys were made of the seed systems used in Uganda, Tanzania, and Rwanda and to investigate the reasons underlying them. Along the equator in Uganda, where rainy seasons are evenly spaced and occur twice a year, vine cuttings from mature plants only are used as planting material. Where there is a long dry season, the seed system includes a diversity of means of conservation: the passive production of volunteer plants from groundkeeper roots sprouting when the rains come; small-scale propagation of plants in the shade or backyard production using waste domestic water; and relatively large-scale propagation in wetlands or irrigated land. The last is the only means of obtaining sufficient quantity for sales, but is also the most expensive. Volunteers only produce planting material one or two months after the start of the rains and tend to be regarded as common property; nevertheless, they are an important source of planting material for poorer farmers. Although farmers perceive multiple benefits from planting early, planting material is in short supply at the beginning of the rains and mainly larger scale farmers gain these benefits. Farmers select carefully to avoid using plants with symptoms of virus disease as planting material and may also remove any diseased plants from crops