Effective hand hygiene—wash your hands and reduce the risk

Neesha Ridley, Senior Lecturer, University of Central Lancashire, discusses the importance of hand hygiene in preventing healthcare-associated infection

How much do school teachers know about childhood asthma in Ilesa, Nigeria?

Background: Childhood asthma is affected by events and conditions of the school environment. Teachers as de-facto caregivers of children with asthma have a major role to play in ensuring good asthma control in school. This study set out to determine the level of knowledge of school teacher about childhood asthma and factors influencing this knowledge.Methods: Four secondary schools (two private and two public) in Ilesa, South West Nigeria were selected by multistage sampling method. All the teachers in these schools were required to fill a self -administered questionnaire incorporating a validated 40-item asthma knowledge questions. Factors associated with the level of knowledge were determined appropriately.Results: A total of 132 teacher (M: F = 1:2) participated in the study with 85 (64.4%) from private school. The mean (SD) age of the teachers was 38.0 (9.1) years and median (IQR) years in teaching service was 7.0 (5.0 to 15.0) years. Majority (56.1%) of the teachers had university education while only 7 (5.3%) had a post graduate degree. The mean (SD) score of the 40 item questions was 21.5 (7.2) and majority (51.5%) had poor asthma knowledge (score < 22). Poorer knowledge was observed in questions related to the nature and management of childhood asthma than triggers and manifestations. No significant correlation was found between knowledge and age, teaching experience and qualifications (p > 0.05). However, teachers with previous training about childhood asthma had relatively good knowledge about the condition. (p <0.05)Conclusion: The level of knowledge about childhood asthma among school teachers in Ilesa is poor particularly as regards to nature and management of the disease. We advocate for training of school teachers about common childhood conditions including asthma to ensure optimal symptoms control in school.Keywords: Childhood asthma, Knowledge, School teacher

Effects of socio-demographic and nutritional status on Peak Expiratory Flow Rates of rural school children in Ilesa, Nigeria

Background: The Peak Expiratory Flow Rate (PEFR) measured using portable peak flow metres (PFM) is a simple, cheap, readily available and reproducible measure of lung functions, particularly in resource-poor settings. Objective: To determine the effects of socio-demographic and nutritional factors on the PEFR of school children in rural areas of Ilesa, Nigeria. Methods: Multi-stage sampling technique was used to select children from middle schools in rural Ilesa. Their socio-demographics, housing conditions and household cooking fuel used were obtained. Anthropometric parameters and nutritional statuses of the children were determined using the WHO reference growth chart. PEFR was measured using the mini Wright PFM. The factors influencing their PEFR were determined. Results: A total of 250 school children aged 8 to 16 years with male-to-female ratio of 0.9:1 were studied. The mean (SD) age was 12.5 (1.5) years. Over 80.0% used unclean fuel for household cooking and one-half lived in overcrowded homes. The prevalence of stunting, underweight and overweight was 22.8%, 30.8% and 3.2% respectively. The mean ± SD PEFR was 248 ± 58.6 L/min which correlated positively with the weight, height, Body Mass Index and Body Surface Area. The mean PEFR was significantly lower among children exposed to unclean fuels (245.4 ± 59.7L/min vs. 292.0 ± 59.4L/min; p = 0.02), stunted males (220.6 ± 44.9L/min vs. 264.1 ± 62.9L/min; p = 0.009) and underweight females (213.2 ± 37.8L/min vs. 247.5 ± 62.6L/min; p < 0.001). Conclusion: Undernutrition and exposure to noxious substances from unclean household cooking fuels adversely affected the PEFR of rural school children. Early detection and prompt treatment of undernutrition and avoidance of noxious substances from unclean fuels may ensure better lung health among the children in rural areas

Implementation of World Health Organization Integrated Management of Childhood Illnesses (IMCI) Guidelines for the Assessment of Pneumonia in the Under 5s in Rural Malawi

The Cooking and Pneumonia Study (CAPS) is a pragmatic cluster-level randomized controlled trial of the effect of an advanced cookstove intervention on pneumonia in children under the age of 5 years (under 5s) in Malawi (www.capstudy.org). The primary outcome of the trial is the incidence of pneumonia during a two-year follow-up period, as diagnosed by healthcare providers who are using the World Health Organization (WHO) integrated management of childhood illnesses (IMCI) pneumonia assessment protocol and who are blinded to the trial arms. We evaluated the quality of pneumonia assessment in under 5s in this setting via a cross-sectional study of provider-patient encounters at nine outpatient clinics located within the catchment area of 150 village-level clusters enrolled in the trial across the two study locations of Chikhwawa and Karonga, Malawi, between May and June 2015 using the IMCI guidelines as a benchmark. Data were collected using a key equipment checklist, an IMCI pneumonia knowledge test, and a clinical evaluation checklist. The median number of key equipment items available was 6 (range 4 to 7) out of a possible 7. The median score on the IMCI pneumonia knowledge test among 23 clinicians was 75% (range 60% to 89%). Among a total of 176 consultations performed by 15 clinicians, a median of 9 (range 3 to 13) out of 13 clinical evaluation tasks were performed. Overall, the clinicians were adequately equipped for the assessment of sick children, had good knowledge of the IMCI guidelines, and conducted largely thorough clinical evaluations. We recommend the simple pragmatic approach to quality assurance described herein for similar studies conducted in challenging research settings

Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24·3% (95% uncertainty interval [UI] 23·9–24·7), corresponding to 1·92 billion (1·89–1·95) prevalent cases, compared with a prevalence of 28·2% (27·8–28·5) and 1·50 billion (1·48–1·52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52·0 million (35·1–75·1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422·4 [95% UI 286·1–612·9]), haemoglobinopathies and haemolytic anaemias (89·0 [58·2–123·7]), and other neglected tropical diseases (36·3 [24·4–52·8]), collectively accounting for 84·7% (84·1–85·2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation