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

Risk assessment to groundwater of pit latrine rural sanitation policy in developing country settings

Parallel global rise in pit-latrine sanitation and groundwater-supply provision is of concern due to the frequent spatial proximity of these activities. Study of such an area in Malawi has allowed understanding of risks posed to groundwater from the recent implementation of a typical developing-country pit-latrine sanitation policy to be gained. This has assisted the development of a risk-assessment framework approach pragmatic to regulatory-practitioner management of this issue. The framework involves water-supply and pit-latrine mapping, monitoring of key groundwater contamination indicators and surveys of possible environmental site-condition factors and culminates in an integrated statistical evaluation of these datasets to identify the significant factors controlling risks posed. Our approach usefully establishes groundwater-quality baseline conditions of a potentially emergent issue for the study area. Such baselines are foundational to future trend discernment and contaminant natural attenuation verification critical to policies globally. Attribution of borehole contamination to pit-latrine loading should involve, as illustrated, the use of the range of contamination (chemical, microbiological) tracers available recognising none are ideal and several radial and capture-zone metrics that together may provide a weight of evidence. Elevated, albeit low-concentration, nitrate correlated with some radial metrics and was tentatively suggestive of emerging latrine influences. Longer term monitoring is, however, necessary to verify that the commonly observed latrine-borehole separation distances (29–58 m), alongside statutory guidelines, do not constitute significant risk. Borehole contamination was limited and correlation with various environmental-site condition factors also limited. This was potentially ascribed to effectiveness of attenuation to date, monitoring of an emergent problem yet to manifest, or else contamination from other sources. High borehole usage and protective wall absence correlated with observed microbiological contamination incidence, but could relate to increased human/animal activity close to these poorly protected boreholes. Additional to factors assessed, a groundwater-vulnerability factor is recommended that critically relies upon improved proactive securing of underpinning data during borehole/latrine installations. On-going concerns are wide ranging, including poorly constrained pit-latrine input, difficulties in assessing in-situ plume natural attenuation and possible disposal of used motor oils to latrines

Kliničke praktične smjernice za perioperacijsku i poslijeoperacijsku skrb o arterijsko-venskim fistulama i umetcima za hemodijalizu u odraslih

Krvožilni pristup omogućuje hemodijalizu koja spašava život. Stoga je nužna dobra funkcija krvožilnog pristupa koja omogućuje prikladan krvni protok radi uklanjanja tvari koje se u uremiji zadržavaju u krvi bolesnika, uz istodobno sniženje rizika od sustavne infekcije na najmanju moguću mjeru. Godine 2007. Europske smjernice najbolje prakse (engl. European Best Practice Guidelines – EBPG), prethodnice trenutačne Europske najbolje bubrežne prakse (engl. European Renal Best Practice – ERBP), donijele su nacrt skupine preporuka – vodiča pri donošenju odluka o upućivanju na pregled radi krvožilnog pristupa, o procjeni i nadzoru izbora pristupa te o postupcima kod komplikacija. (1) Otad su se znatno razvili ne samo dokazi na kojima se temelje ove preporuke nego i procesi nastajanja smjernica. (2) Kao odgovor na to, ERBP je ažurirao prethodno djelo u suradnji s raznim stručnjacima iz tog područja uključujući i predstavnike Društva za krvožilni pristup (engl. Vascular Access Society – VAS), kirurge za krvožilni pristup, radiologe, medicinske sestre za dijalizu, znanstvenike, bolesnike i one koji se za njih brinu. Nastojanje da se pridržavaju sve strože metodike izrade smjernica nalagalo je određena odricanja u pogledu područja obuhvata ovih smjernica. Posljedično, one ne „pokrivaju” baš sve iste teme kao njihova prethodna verzija. Neka su područja zajednička, a neka su arhivirana da bi ustupila mjesto novim pitanjima kojima su prednost dali i pružatelji zdravstvene skrbi i oni za koje se skrbi. Odvojeno su objavljene pojedinosti postupka izbora djelokruga problematike koju su smjernice obuhvatile. (3) Nastajanje ovih smjernica slijedilo je strog proces pregleda i procjene dokaza koji se temeljio na sustavnim pregledima rezultata kliničkih istraživanja te opservacijskih podataka gdje je to bilo potrebno. Strukturirani pristup slijedio je model sustava GRADE (hrv. stupanj), koji svakoj preporuci pripisuje stupanj s obzirom na sigurnost sveukupnih dokaza te snagu. (4) Gdje je to bilo primjereno skupina za izradu smjernica unijela je nestupnjevan savjet za kliničku praksu, a koji nije proistekao iz pregleda sustavnih dokaza. Kliničke praktične smjernice iz 2019. godine specifično pokrivaju peritransplantacijske i poslijetransplantacijske aspekte arterijsko-venskih (AV) fistula i umetaka (graftova). Drugi dio, koji je bio u nastajanju kada su ove smjernice išle u tisak, pokrit će aspekte izbora krvožilnog pristupa, prijeoperacijske procjene krvnih žila i središnje venske katetere. Unatoč nedostatku dokaza velike sigurnosti za većinu područja krvožilnih pristupa, ERBP se posvetio izradi smjernica velike kakvoće, dajući smjernicu gdje god je moguće, a popis preporuka za istraživanje ondje gdje se nije moglo uputiti smjernicom. Nadamo se da će ove smjernice i one planirane pomoći stručnoj zajednici pri donošenju odluka o postupcima, postupnicima i skrbi vezanima s krvožilnim pristupima, pomoći bolesnicima i onima koji se za njih brinu da steknu uvid u problematiku te olakšati zajedničko donošenje odluka u tom području

Spatially resolved single-cell atlas of the lung in fatal Covid19 in an African population reveals a distinct cellular signature and an interferon gamma dominated response

Postmortem single-cell studies have transformed understanding of lower respiratory tract diseases (LRTD) including Covid19 but there is almost no data from African settings where HIV, malaria and other environmental exposures may affect disease pathobiology and treatment targets. We used histology and high-dimensional imaging to characterise fatal lung disease in Malawian adults with (n=9) and without (n=7) Covid19, and generated single-cell transcriptomics data from lung, blood and nasal cells. Data integration with other cohorts showed a conserved Covid19 histopathological signature, driven by contrasting immune and inflammatory mechanisms: in the Malawi cohort, by response to interferon-gamma (IFN-γ) in lung-resident alveolar macrophages, in USA, European and Asian cohorts by type I/III interferon responses, particularly in blood-derived monocytes. HIV status had minimal impact on histology or immunopathology. Our study provides data resources and highlights the importance of studying the cellular mechanisms of disease in underrepresented populations, indicating shared and distinct targets for treatment

Household income, fetal size and birth weight:an analysis of eight populations

International audienceBackground The age at onset of the association between poverty and poor health is not understood. Our hypothesis was that individuals from highest household income (HI), compared to those with lowest HI, will have increased fetal size in the second and third trimester and birth. Methods. Second and third trimester fetal ultrasound measurements and birth measurements were obtained from eight cohorts. Results were analysed in cross-sectional two-stage individual patient data (IPD) analyses and also a longitudinal one-stage IPD analysis. Results The eight cohorts included 21 714 individuals. In the two-stage (cross-sectional) IPD analysis, individuals from the highest HI category compared with those from the lowest HI category had larger head size at birth (mean difference 0.22 z score (0.07, 0.36)), in the third trimester (0.25 (0.16, 0.33)) and second trimester (0.11 (0.02, 0.19)). Weight was higher at birth in the highest HI category. In the one-stage (longitudinal) IPD analysis which included data from six cohorts (n=11 062), head size was larger (mean difference 0.13 (0.03, 0.23)) for individuals in the highest HI compared with lowest category, and this difference became greater between the second trimester and birth. Similarly, in the one-stage IPD, weight was heavier in second highest HI category compared with the lowest (mean difference 0.10 (0 .00, 0.20)) and the difference widened as pregnancy progressed. Length was not linked to HI category in the longitudinal model. Conclusions The association between HI, an index of poverty, and fetal size is already present in the second trimester

Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. [Erratum]

Text has been added to the article in the ‘Study Selection’ paragraph, explaining the inclusion criteria for selecting the abstracts