Testing methods for new pit latrine designs in rural and peri-urban areas of Malawi where conventional testing is difficult to employ

There is a trend towards participation of users in the design of appropriate sanitation facilities for low-income countries. However, testing the safety and durability of these technologies for rural and peri-urban communities is a challenge in low-income countries due to the lack of resources and access to conventional tests. This paper highlights testing methods used for pit latrine designs developed through participatory design approaches in Malawi. Two designs were tested with devised and/or conventional methods: (i) a corbelled pit latrine targeted for rural areas and (ii) an improved transitional pit latrine targeted for peri-urban areas. Devised testing methods proved to be useful and easy to implement by masons in the rural and peri-urban areas of Malawi. Novel pit latrine designs in Malawi require robust and innovative approaches to address the limited access to conventional tests. Both the conventional and devised testing methods demonstrated that the two designs have a satisfactory life-span and can support the users' load. The findings of this paper can be a model for the scale-up of integration of community ideas for participatory pit latrine design testing based in low-income countries where conventional testing is difficult to employ

Access to groundwater and link to the impact on quality of life: A look at the past, present and future public health needs in Mzimba District, Malawi

Imagine a world where you have to get up at 4am to walk for two hours in the dark to fetch water. This remains true in Malawi, where it is said that the Millennium Development Goals have been met. This research aimed at understanding the impact access to groundwater has on people\u27s ‘Being’, ‘Belonging’ and ‘Becoming,’ as well as on people\u27s capabilities and on their quality of life in Mzimba District, Malawi. Being, Belonging and Becoming define three life domains. Being reveals ‘who one is,’ Belonging reflects ‘connections with one\u27s environments’ and Becoming relates to ‘achieving personal goals, hopes and aspirations.’ The study comprised of 210 households, four treatment groups based on communities consisting of households with access to a hand pump and compared to four control group communities, where households had no access to a hand pump. Results showed current awareness of environmental issues is linked to recognising future (5 years in advance) environmental challenges. There is a need to create awareness of water quality within the communities and point-of-use household water treatment. Both the treatment- and control group had a gap in sanitation facilities, with up to 27 people (5–6 households) sharing a single pit latrine. Polygamous marriages had implications on self-respect and led to neglect on the first wives. Focus group discussions revealed HIV, disabilities and mental health issues, including the use of drugs and alcohol, affect freedom, and created a burden, not only for affected individuals, but also for their extended families. Focus groups highlighted safe and clean drinking water, improved sanitation facilities, better hygiene, and accessible public health services as pressing needs. The implications of this study demonstrate, rural individuals ‘Being’, ‘Belonging’ and ‘Becoming’ need to be considered when addressing pressing public health needs, as Malawi works toward the Sustainable Development Goals for water supply

A flood damage allowance framework for coastal protection with deep uncertainty in sea-level rise

Future projections of Antarctic ice sheet (AIS) mass loss remain characterized by deep uncertainty (i.e., behavior is not well understood or widely agreed upon by experts). This complicates decisions on long-lived projects involving the height of coastal flood protection strategies that seek to reduce damages from rising sea levels. If a prescribed margin of safety does not properly account for sea-level rise and its uncertainties, the effectiveness of flood protection will decrease over time, potentially putting lives and property at greater risk. We develop a flood damage allowance framework for calculating the height of a flood protection strategy needed to ensure that a given level of financial risk is maintained (i.e., the average flood damage in a given year). The damage allowance framework considers decision-maker preferences such as planning horizons, preferred protection strategies (storm surge barrier, levee, elevation, and coastal retreat), and subjective views of AIS stability. We use Manhattan (New York City)\textemdash with the distribution of buildings, populations, and infrastructure fixed in time\textemdash as an example to show how our framework could be used to calculate a range of damage allowances based on multiple plausible AIS outcomes. Assumptions regarding future AIS stability more strongly influence damage allowances under high greenhouse gas emissions (Representative Concentration Pathway [RCP] 8.5) compared to those that assume strong emissions reductions (RCP2.6). Design tools that specify financial risk targets, such as the average flood damage in a given year, allow for the calculation of avoided flood damages (i.e., benefits) that can be combined with estimates of construction cost and then integrated into existing financial decision-making tools, like benefit-cost or cost-effectiveness analyses

Effect of oral fluconazole 1200 mg/day on QT interval in African adults with HIV-associated cryptococcal meningitis.

We assessed the effect of fluconazole 1200 mg/day on the QT interval in cryptococcal meningitis patients. Mean corrected QT (QTc) change from baseline to day 7 was 10.1 ms (IQR: -28 to 46 ms) in the fluconazole treatment group and -12.6 ms (IQR: -39 to 13.5 ms) in those not taking fluconazole (P = 0.04). No significant increase in QTc measurements over 500 ms was observed with fluconazole. Nevertheless, it remains important to correct any electrolyte imbalance and avoid concomitant drugs that may increase QTc

Sustainable Diets: another hurdle or a better food future?,

The notion of sustainable diets has emerged forcibly onto the food policy agenda in recent years, but has also met resistance. The article reviews the case for sustainable diets. It counterbalances the current dominant policy emphasis on raising food output as the best route to a sustainable food future. The article suggests that a process of democratic experimentation is underway. Some official guidelines have emerged alongside a mix of civil society and academic formulations. More coherence of data, principles and purpose is needed at the global and regional policy-making levels for these to become effective in the common task of reducing the food system’s negative impact on health, environment and economies

Methylation pattern of CDH13 gene in digestive tract cancers

Recently, the loss of CDH13 (T-cadherin, H-cadherin) gene expression accompanied by CDH13 promoter methylation was identified in colon cancers. We examined CDH13 methylation in oesophageal and gastric carcinomas. Five of 37 oesophageal cancers (14%) and 23 of 66 gastric cancers (35%) demonstrated abnormal methylation of the CDH13 promoter. Abnormal methylation was frequently found in gastric cancers of patients at all clinical stages just as in E-cadherin, another of the cadherin family, suggesting that these cancers could be methylated at an early stage. These results suggested that CDH13 might play a variety of roles depending on the tissue type

Standard of care in advanced HIV disease: review of HIV treatment guidelines in six sub-Saharan African countries.

BACKGROUND: The World Health Organization (WHO) recommends an evidence-based package of care to reduce mortality and morbidity among people with advanced HIV disease (AHD). Adoption of these recommendations by national guidelines in sub-Saharan Africa is poorly documented. We aimed to review national guidelines for AHD management across six selected countries in sub-Saharan Africa for benchmarking against the 2021 WHO recommendations. METHODS: We reviewed national guidelines from six countries participating in an ongoing randomized controlled trial recruiting people with AHD. We extracted information addressing 18 items of AHD diagnosis and management across the following domains: [1] Definition of AHD, [2] Screening, [3] Prophylaxis, [4] Supportive care, and [5] HIV treatment. Data from national guideline documents were compared to the 2021 WHO consolidated guidelines on HIV and an agreement score was produced to evaluate extent of guideline adoption. RESULTS: The distribution of categories of agreement varied for the national documents. Four of the six countries addressed all 18 items (Malawi, Nigeria, Sierra Leone, Uganda). Overall agreement with the WHO 2021 guidelines ranged from 9 to 15.5 out of 18 possible points: Malawi 15.5 points, Nigeria, and Sierra Leone 14.5 points, South Africa 13.5 points, Uganda 13.0 points and Botswana with 9.0 points. Most inconsistencies were reported for the delay of antiretroviral therapy (ART) in presence of opportunistic diseases. None of the six national guidelines aligned with WHO recommendations around ART timing in patients with tuberculosis. Agreement correlated with the year of publication of the national guideline. CONCLUSION: National guidelines addressing the care of advanced HIV disease in sub-Saharan Africa are available. Besides optimal timing for start of ART in presence of tuberculosis, most national recommendations are in line with the 2021 WHO standards

Mapping Water Levels across a Region of the Cuvette Centrale Peatland Complex

Inundation dynamics are the primary control on greenhouse gas emissions from peatlands. Situated in the central Congo Basin, the Cuvette Centrale is the largest tropical peatland complex. However, our knowledge of the spatial and temporal variations in its water levels is limited. By addressing this gap, we can quantify the relationship between the Cuvette Centrale’s water levels and greenhouse gas emissions, and further provide a baseline from which deviations caused by climate or land-use change can be observed, and their impacts understood. We present here a novel approach that combines satellite-derived rainfall, evapotranspiration and L-band Synthetic Aperture Radar (SAR) data to estimate spatial and temporal changes in water level across a sub-region of the Cuvette Centrale. Our key outputs are a map showing the spatial distribution of rainfed and flood-prone locations and a daily, 100 m resolution map of peatland water levels. This map is validated using satellite altimetry data and in situ water table data from water loggers. We determine that 50% of peatlands within our study area are largely rainfed, and a further 22.5% are somewhat rainfed, receiving hydrological input mostly from rainfall (directly and via surface/sub-surface inputs in sloped areas). The remaining 27.5% of peatlands are mainly situated in riverine floodplain areas to the east of the Congo River and between the Ubangui and Congo rivers. The mean amplitude of the water level across our study area and over a 20-month period is 22.8 ± 10.1 cm to 1 standard deviation. Maximum temporal variations in water levels occur in the riverine floodplain areas and in the inter-fluvial region between the Ubangui and Congo rivers. Our results show that spatial and temporal changes in water levels can be successfully mapped over tropical peatlands using the pattern of net water input (rainfall minus evapotranspiration, not accounting for run-off) and L-band SAR data