Community-based rehabilitation program for cerebral PALSY (CP) children in North Uganda

Background: CP is a common neurologic disease in children, with a worldwide estimated prevalence of 93 million. Data on the African context are limited. Purpose: This study was aimed at evaluating the efficacy of a mixed outpatient/home physiotherapy program in children with CP admitted to St. Mary's Lacor Hospital (Gulu), the reference center of north Uganda. Methods: This is an observational, uncontrolled, prospective study. All children with CP (aged from 0.5 to 12 years) admitted in the Physiotherapy Unit from January to December 2017 were enrolled. A written consent form (English or Acholi language) was obtained from the mother/ caregiver. Each patient was evaluated at baseline and every two weeks for three months. CP sub-types were defined according to Surveillance of Cerebral Palsy in Europe classification. The child\ub4s abilities were staged through the Gross Motor Function Classification System Expanded and Revised (GMFCS-E&R; scale from I to V, the higher the worse). Changes in motor function were measured through the 66-item version (GMFM-66; scores ranging from 0 to 100, the higher the better). At baseline and subsequent visits, Bobath treatment was applied for 30 minutes by an experienced physiotherapist, who trained the caregiver on customized home exercises following a diary prescription. The functional status reported by the caregiver and the overall compliance were assessed. Changes in GMFCS-E&R and GMFM-66 at 6 and 12 weeks were recorded. The normality of score distributions was tested (Shapiro-Wilks). If confirmed, repeated ANOVA modeling was applied to scores across time points. Results: Fifty-two consecutive children were enrolled (mean age 2.2 years, range 0.5-9.9). Spastic bilateral (19 patients, 36%) and dystonic (16, 31%) were the most common CP sub-types. The main cause of CP were asphyxia during the delivery (26 cases, 50%) and cerebral malaria (10, 19%). Thirty-three/52 cases (67%) presented level V GMFCS-E&R. GMFM-66 mean score at baseline was 19.86 range: 0-52.9. Seventeen/52 (33%) children were assessed at 6 and/or 12 weeks, while 35 (67%) missed at least three study visits (reasons: 28 transportation cost, 2 remote home, 4 other). In 16/17 (94%) patients home exercises were performed correctly. The GMFM-66 mean score increased from 14.8 at baseline to 20.4 and to 24.9 at 6 weeks (p=0.02) and 12 weeks (p=0.00), respectively. The improvement was observed irrespectively from CP sub-type or cause of disability. Conclusion(s): Although on a small number of patients, this study suggests that a mixed outpatient/home physiotherapy program can improve CP disability in compliant children treated in a developing country, like north Uganda. The high drop-out rate and its causes point towards the need for implementing local community programs and/or transport facilities. Implications: These results suggest that a mixed outpatient/home physiotherapy program can benefit children with CP living in developing countries and strengthen the need of a policy aimed at improving the access to the physiotherapy service. In addition, they confirm that neurological damage during the assisted delivery is the major cause of CP in this conte

Cyst nematode bio-communication with plants: implications for novel management approaches

Bio‐communication occurs when living organisms interact with each other, facilitated by the exchange of signals including visual, auditory, tactile and chemical. The most common form of bio‐communication between organisms is mediated by chemical signals, commonly referred to as ‘semiochemicals’, and it involves an emitter releasing the chemical signal that is detected by a receiver leading to a phenotypic response in the latter organism. The quality and quantity of the chemical signal released may be influenced by abiotic and biotic factors. Bio‐communication has been reported to occur in both above‐ and below‐ground interactions and it can be exploited for the management of pests, such as cyst nematodes, which are pervasive soil‐borne pests that cause significant crop production losses worldwide. Cyst nematode hatching and successful infection of hosts are biological processes that are largely influenced by semiochemicals including hatching stimulators, hatching inhibitors, attractants and repellents. These semiochemicals can be used to disrupt interactions between host plants and cyst nematodes. Advances in RNAi techniques such as host‐induced gene silencing to interfere with cyst nematode hatching and host location can also be exploited for development of synthetic resistant host cultivars. © 2020 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry

Targeted Next Generation Sequencing for malaria research in Africa:Current status and outlook

Targeted Next Generation Sequencing (TNGS) is an efficient and economical Next Generation Sequencing (NGS) platform and the preferred choice when specific genomic regions are of interest. So far, only institutions located in middle and high-income countries have developed and implemented the technology, however, the efficiency and cost savings, as opposed to more traditional sequencing methodologies (e.g. Sanger sequencing) make the approach potentially well suited for resource-constrained regions as well. In April 2018, scientists from the Plasmodium Diversity Network Africa (PDNA) and collaborators met during the 7th Pan African Multilateral Initiative of Malaria (MIM) conference held in Dakar, Senegal to explore the feasibility of applying TNGS to genetic studies and malaria surveillance in Africa. The group of scientists reviewed the current experience with TNGS platforms in sub-Saharan Africa (SSA) and identified potential roles the technology might play to accelerate malaria research, scientific discoveries and improved public health in SSA. Research funding, infrastructure and human resources were highlighted as challenges that will have to be mitigated to enable African scientists to drive the implementation of TNGS in SSA. Current roles of important stakeholders and strategies to strengthen existing networks to effectively harness this powerful technology for malaria research of public health importance were discussed

A hyperchaotic system without equilibrium

Abstract: This article introduces a new chaotic system of 4-D autonomous ordinary differential equations, which has no equilibrium. This system shows a hyper-chaotic attractor. There is no sink in this system as there is no equilibrium. The proposed system is investigated through numerical simulations and analyses including time phase portraits, Lyapunov exponents, and Poincaré maps. There is little difference between this chaotic system and other chaotic systems with one or several equilibria shown by phase portraits, Lyapunov exponents and time series methods, but the Poincaré maps show this system is a chaotic system with more complicated dynamics. Moreover, the circuit realization is also presented

Allele Frequency–Based and Polymorphism-Versus-Divergence Indices of Balancing Selection in a New Filtered Set of Polymorphic Genes in Plasmodium falciparum

Signatures of balancing selection operating on specific gene loci in endemic pathogens can identify candidate targets of naturally acquired immunity. In malaria parasites, several leading vaccine candidates convincingly show such signatures when subjected to several tests of neutrality, but the discovery of new targets affected by selection to a similar extent has been slow. A small minority of all genes are under such selection, as indicated by a recent study of 26 Plasmodium falciparum merozoite-stage genes that were not previously prioritized as vaccine candidates, of which only one (locus PF10_0348) showed a strong signature. Therefore, to focus discovery efforts on genes that are polymorphic, we scanned all available shotgun genome sequence data from laboratory lines of P. falciparum and chose six loci with more than five single nucleotide polymorphisms per kilobase (including PF10_0348) for in-depth frequency–based analyses in a Kenyan population (allele sample sizes >50 for each locus) and comparison of Hudson–Kreitman–Aguade (HKA) ratios of population diversity (π) to interspecific divergence (K) from the chimpanzee parasite Plasmodium reichenowi. Three of these (the msp3/6-like genes PF10_0348 and PF10_0355 and the surf4.1 gene PFD1160w) showed exceptionally high positive values of Tajima's D and Fu and Li's F indices and have the highest HKA ratios, indicating that they are under balancing selection and should be prioritized for studies of their protein products as candidate targets of immunity. Combined with earlier results, there is now strong evidence that high HKA ratio (as well as the frequency-independent ratio of Watterson's θ/K) is predictive of high values of Tajima's D. Thus, the former offers value for use in genome-wide screening when numbers of genome sequences within a species are low or in combination with Tajima's D as a 2D test on large population genomic samples

Epidemiology of Subpatent Plasmodium Falciparum Infection: Implications for Detection of Hotspots with Imperfect Diagnostics.

At the local level, malaria transmission clusters in hotspots, which may be a group of households that experience higher than average exposure to infectious mosquitoes. Active case detection often relying on rapid diagnostic tests for mass screen and treat campaigns has been proposed as a method to detect and treat individuals in hotspots. Data from a cross-sectional survey conducted in north-western Tanzania were used to examine the spatial distribution of Plasmodium falciparum and the relationship between household exposure and parasite density. Dried blood spots were collected from consenting individuals from four villages during a survey conducted in 2010. These were analysed by PCR for the presence of P. falciparum, with the parasite density of positive samples being estimated by quantitative PCR. Household exposure was estimated using the distance-weighted PCR prevalence of infection. Parasite density simulations were used to estimate the proportion of infections that would be treated using a screen and treat approach with rapid diagnostic tests (RDT) compared to targeted mass drug administration (tMDA) and Mass Drug Administration (MDA). Polymerase chain reaction PCR analysis revealed that of the 3,057 blood samples analysed, 1,078 were positive. Mean distance-weighted PCR prevalence per household was 34.5%. Parasite density was negatively associated with transmission intensity with the odds of an infection being subpatent increasing with household exposure (OR 1.09 per 1% increase in exposure). Parasite density was also related to age, being highest in children five to ten years old and lowest in those > 40 years. Simulations of different tMDA strategies showed that treating all individuals in households where RDT prevalence was above 20% increased the number of infections that would have been treated from 43 to 55%. However, even with this strategy, 45% of infections remained untreated. The negative relationship between household exposure and parasite density suggests that DNA-based detection of parasites is needed to provide adequate sensitivity in hotspots. Targeting MDA only to households with RDT-positive individuals may allow a larger fraction of infections to be treated. These results suggest that community-wide MDA, instead of screen and treat strategies, may be needed to successfully treat the asymptomatic, subpatent parasite reservoir and reduce transmission in similar settings

Clinical Epidemiology of Malaria in the Highlands of Western Kenya

Malaria in the highlands of Kenya is traditionally regarded as unstable and limited by low temperature. Brief warm periods may facilitate malaria transmission and are therefore able to generate epidemic conditions in immunologically naive human populations living at high altitudes. The adult:child ratio (ACR) of malaria admissions is a simple tool we have used to assess the degree of functional immunity in the catchment population of a health facility. Examples of ACR are collected from inpatient admission data at facilities with a range of malaria endemicities in Kenya. Two decades of inpatient malaria admission data from three health facilities in a high-altitude area of western Kenya do not support the canonical view of unstable transmission. The malaria of the region is best described as seasonal and meso-endemic. We discuss the implications for malaria control options in the Kenyan highlands

Using participatory workshops to assess alignment or tension in the community for minimally invasive tissue sampling prior to start of child mortality surveillance: lessons From 5 sites across the CHAMPS network

The Child Health and Mortality Prevention Surveillance (CHAMPS) program is a 7-country network (as of December 2018) established by the Bill & Melinda Gates Foundation to identify the causes of death in children in communities with high rates of under-5 mortality. The program carries out both mortality and pregnancy surveillance, and mortality surveillance employs minimally invasive tissue sampling (MITS) to gather small samples of body fluids and tissue from the bodies of children who have died. While this method will lead to greater knowledge of the specific causes of childhood mortality, the procedure is in tension with cultural and religious norms in many of the countries where CHAMPS works - Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. Participatory Inquiry Into Community Knowledge of Child Health and Mortality Prevention (PICK-CHAMP) is a community entry activity designed to introduce CHAMPS to communities and gather initial perspectives on alignments and tensions between CHAMPS activities and community perceptions and priorities. Participants' responses revealed medium levels of overall alignment in all sites (with the exception of South Africa, where alignment was high) and medium levels of tension (with the exception of Ethiopia, where tension was high). Alignment was high and tension was low for pregnancy surveillance across all sites, whereas Ethiopia reflected low alignment and high tension for MITS. Participants across all sites indicated that support for MITS was possible only if the procedure did not interfere with burial practices and rituals

INSPIRE datahub: a pan-African integrated suite of services for harmonising longitudinal population health data using OHDSI tools

Introduction Population health data integration remains a critical challenge in low- and middle-income countries (LMIC), hindering the generation of actionable insights to inform policy and decision-making. This paper proposes a pan-African, Findable, Accessible, Interoperable, and Reusable (FAIR) research architecture and infrastructure named the INSPIRE datahub. This cloud-based Platform-as-a-Service (PaaS) and on-premises setup aims to enhance the discovery, integration, and analysis of clinical, population-based surveys, and other health data sources. Methods The INSPIRE datahub, part of the Implementation Network for Sharing Population Information from Research Entities (INSPIRE), employs the Observational Health Data Sciences and Informatics (OHDSI) open-source stack of tools and the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) to harmonise data from African longitudinal population studies. Operating on Microsoft Azure and Amazon Web Services cloud platforms, and on on-premises servers, the architecture offers adaptability and scalability for other cloud providers and technology infrastructure. The OHDSI-based tools enable a comprehensive suite of services for data pipeline development, profiling, mapping, extraction, transformation, loading, documentation, anonymization, and analysis. Results The INSPIRE datahub's “On-ramp” services facilitate the integration of data and metadata from diverse sources into the OMOP CDM. The datahub supports the implementation of OMOP CDM across data producers, harmonizing source data semantically with standard vocabularies and structurally conforming to OMOP table structures. Leveraging OHDSI tools, the datahub performs quality assessment and analysis of the transformed data. It ensures FAIR data by establishing metadata flows, capturing provenance throughout the ETL processes, and providing accessible metadata for potential users. The ETL provenance is documented in a machine- and human-readable Implementation Guide (IG), enhancing transparency and usability. Conclusion The pan-African INSPIRE datahub presents a scalable and systematic solution for integrating health data in LMICs. By adhering to FAIR principles and leveraging established standards like OMOP CDM, this architecture addresses the current gap in generating evidence to support policy and decision-making for improving the well-being of LMIC populations. The federated research network provisions allow data producers to maintain control over their data, fostering collaboration while respecting data privacy and security concerns. A use-case demonstrated the pipeline using OHDSI and other open-source tools