Availability of diagnostic services and essential medicines for non-communicable respiratory diseases in African countries

BACKGROUND: The global burden of disease due to asthma and chronic obstructive pulmonary disease (COPD) is substantial and particularly great in low‐ and middle‐income countries, including many African countries. Management is affected by availability of diagnostic tests and essential medicines. The study aimed to explore the availability of spirometry services and essential medicines for asthma and COPD in African countries. METHOD: Questionnaires were delivered to healthcare workers at the annual meeting of the Pan African Thoracic Society Methods in Epidemiology and Clinical Research (PATS MECOR) and International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA). Data were analysed using simple descriptive statistics. RESULTS: A total of 37 questionnaires representing 13 African countries were returned. Spirometry availability was 73.0%. The most common reasons for non‐availability were lack of knowledge of the utility of the test. Within the study sample, 33.3% faced sporadic availability due to maintenance issues. Essential medicines availability ranged from 37.8% for inhaled corticosteroid‐long‐acting beta‐agonist inhalers to 100% for prednisolone 5 mg tablets, mainly due to supply chain problems. CONCLUSION: There is varied availability of spirometry and WHO essential medicines for COPD and asthma in African countries. Strategies are needed to improve access to basic effective care for people with non‐communicable lung disease in Africa

Predictors associated with critical care need and in-hospital mortality among children with laboratory-confirmed COVID-19 infection in a high HIV infection burden region

IntroductionDespite the extra mortality associated with COVID-19 death globally, there is scant data on COVID-19-related paediatric mortality in Sub-Saharan Africa. We assessed predictors of critical care needs and hospital mortality in South African children with laboratory-confirmed SARS-CoV-2 infection in region with high HIV infection burden.MethodsWe conducted a secondary multicentre analysis of the AFREhealth cohort (a multinational, multicentre cohort of paediatric COVID-19 clinical outcomes across six African countries) of children admitted to the Inkosi Albert Luthuli, a quaternary hospital in KwaZulu-Natal, South Africa, with confirmed RT-PCR between March 2020 and December 2020. We constructed multivariable logistic regression to explore factors associated with the need for critical care (high care/ intensive care hospitalisation or oxygen requirement) and cox-proportional hazards models to further assess factors independently associated with in-hospital death.ResultsOf the 82 children with PCR-confirmed SARS-CoV-2 infection (mean ± SD age: 4.2 ± 4.4 years), 35(42.7%) were younger than one year, 52(63%) were female and 59(71%) had a pre-existing medical condition. Thirty-seven (45.2%) children required critical care (median (IQR) duration: 7.5 (0.5–13.5) days) and 14(17%) died. Independent factors associated with need for critical care were being younger than 1 year (aPR: 3.02, 95%CI: 1.05–8.66; p = 0.04), having more than one comorbidity (aPR: 2.47, 95%CI: 1.32–4.61; p = 0.004), seizure (aPR: 2.39, 95%CI: 1.56–3.68; p < 0.001) and impaired renal function. Additionally, independent predictors of in-hospital mortality were exposure to HIV infection (aHR: 6.8, 95%CI:1.54–31.71; p = 0.01), requiring invasive ventilation (aHR: 3.59, 95%CI: 1.01–12.16, p = 0.048) and increase blood urea nitrogen (aHR: 1.06, 95%CI: 1.01–1.11; p = 0.017). However, children were less likely to die from COVID-19 if they were primarily admitted to quaternary unit (aHR: 0.23, 95%CI: 0.1–0.86, p = 0.029).ConclusionWe found a relatively high hospital death rate among children with confirmed COVID-19. During COVID-19 waves, a timely referral system and rapid identification of children at risk for critical care needs and death, such as those less than one year and those with comorbidities, could minimize excess mortality, particularly in high HIV-infection burden countries

Preterm birth, birth weight, infant weight gain and their associations with childhood asthma and spirometry: a cross-sectional observational study in Nairobi, Kenya

Background In sub-Saharan Africa, the origins of asthma and high prevalence of abnormal lung function remain unclear. In high-income countries (HICs), associations between birth measurements and childhood asthma and lung function highlight the importance of antenatal and early life factors in the aetiology of asthma and abnormal lung function in children. We present here the first study in sub-Saharan Africa to relate birth characteristics to both childhood respiratory symptoms and lung function. Methods Children attending schools in two socioeconomically contrasting but geographically close areas of Nairobi, Kenya, were recruited to a cross-sectional study of childhood asthma and lung function. Questionnaires quantified respiratory symptoms and preterm birth; lung function was measured by spirometry; and parents were invited to bring the child’s immunisation booklet containing records of birth weight and serial weights in the first year. Results 2373 children participated, 52% girls, median age (IQR), 10 years (8–13). Spirometry data were available for 1622. Child immunisation booklets were available for 500 and birth weight and infant weight gain data were available for 323 and 494 children, respectively. In multivariable analyses, preterm birth was associated with the childhood symptoms ‘wheeze in the last 12 months’; OR 1.64, (95% CI 1.03 to 2.62), p=0.038; and ‘trouble breathing’ 3.18 (95% CI 2.27 to 4.45), p<0.001. Birth weight (kg) was associated with forced expiratory volume in 1 s z-score, regression coefficient (β) 0.30 (0.08, 0.52), p=0.008, FVC z-score 0.29 (95% CI 0.08 to 0.51); p=0.008 and restricted spirometry, OR 0.11 (95% CI 0.02 to 0.78), p=0.027. Conclusion These associations are in keeping with those in HICs and highlight antenatal factors in the aetiology of asthma and lung function abnormalities in sub-Saharan Africa

The handbook for standardised field and laboratory measurements in terrestrial climate-change experiments and observational studies

Climate change is a worldwide threat to biodiversity and ecosystem structure, functioning, and services. To understand the underlying drivers and mechanisms, and to predict the consequences for nature and people, we urgently need better understanding of the direction and magnitude of climate‐change impacts across the soil–plant–atmosphere continuum. An increasing number of climate‐change studies is creating new opportunities for meaningful and high‐quality generalisations and improved process understanding. However, significant challenges exist related to data availability and/or compatibility across studies, compromising opportunities for data re‐use, synthesis, and upscaling. Many of these challenges relate to a lack of an established “best practice” for measuring key impacts and responses. This restrains our current understanding of complex processes and mechanisms in terrestrial ecosystems related to climate change

Good Practices in the Co-Production of Knowledge: Working Well Together in Environmental Change Research

This living document proposes good relational practices to support climate change researchers in and beyond the Columbia University Climate School in their efforts to pursue and practice knowledge co-production in their climate-related scholarship, research, and practice. For the purpose of this document, climate researchers are anyone from any background who contributes, in any form, to enhancing our shared understanding, strategies, and responses to climate change. Although this document is focused on research, it also importantly provides communities (Indigenous and non-Indigenous alike), private sector organizations, and others who are carrying out and connected to climate-related work a window into how climate researchers might interact with them, how they can further advocate on their own behalf through the language and aspirations of co-production, and how they can anticipate interacting with researchers through co-production relational way. The document starts with a brief introduction and description of what it does and does not intend to communicate. It then transitions into a framework for good relational practices in knowledge co-production generated through an extensive review of co-production literature in the climate sciences, one-on-one conversations with 9 Columbia University affiliated researchers and practitioners, and a 2.5 day convening with 36 contributors, including Columbia researchers, Indigenous leaders, government representatives, the private sector, and external academics. The framework brings together 28 relational principles and 22 recommended good relational practices, which are summarized under the framework section. The principles and practices are then filtered into 30 reflexive questions, or points of reflection, climate researchers can ask themselves to help use and learn from the good relational practices. The principles, good practices and points of reflection are categorized into 6 interrelated pillars of co-production: The people theme brings attention to the ways in which individual and group identities shape the direction of knowledge co-production efforts. The purpose theme represents the meanings and motivations associated with knowledge co-production. The power theme refers to how power and power relations are understood and enacted through and around efforts to co-produce knowledge. The politics theme centers on the effects of policies and politics on knowledge co-production work at different scales. The pathways theme focuses on tools, approaches, and strategies used to co-produce knowledge in relevant, rigorous, and meaningful ways. The progress theme embodies the broad aspiration that knowledge co-production will catalyze transformative change, whether societal, scientific, cultural, or otherwise. The guidelines are followed with two sections about the motivations for this document and a condensed overview of the history and development of co-production within the environmental and climate sciences. The last section, Steps towards ‘good relational practices’, details how information was gathered and summarized for this document. Drawing from this information, climate researchers are encouraged to use, learn from, and reflect on the information in this document to consider why and how knowledge co-production may or may not be appropriate for their climate-related research

The handbook for standardized field and laboratory measurements in terrestrial climate change experiments and observational studies (ClimEx)

1. Climate change is a world‐wide threat to biodiversity and ecosystem structure, functioning and services. To understand the underlying drivers and mechanisms, and to predict the consequences for nature and people, we urgently need better understanding of the direction and magnitude of climate change impacts across the soil–plant–atmosphere continuum. An increasing number of climate change studies are creating new opportunities for meaningful and high‐quality generalizations and improved process understanding. However, significant challenges exist related to data availability and/or compatibility across studies, compromising opportunities for data re‐use, synthesis and upscaling. Many of these challenges relate to a lack of an established ‘best practice’ for measuring key impacts and responses. This restrains our current understanding of complex processes and mechanisms in terrestrial ecosystems related to climate change. 2. To overcome these challenges, we collected best‐practice methods emerging from major ecological research networks and experiments, as synthesized by 115 experts from across a wide range of scientific disciplines. Our handbook contains guidance on the selection of response variables for different purposes, protocols for standardized measurements of 66 such response variables and advice on data management. Specifically, we recommend a minimum subset of variables that should be collected in all climate change studies to allow data re‐use and synthesis, and give guidance on additional variables critical for different types of synthesis and upscaling. The goal of this community effort is to facilitate awareness of the importance and broader application of standardized methods to promote data re‐use, availability, compatibility and transparency. We envision improved research practices that will increase returns on investments in individual research projects, facilitate second‐order research outputs and create opportunities for collaboration across scientific communities. Ultimately, this should significantly improve the quality and impact of the science, which is required to fulfil society's needs in a changing world

Intercrystalline distal-effect on the afterglow phenomenon in photoluminescent SrAl2O4:CeIII, Ln nanotube growth

We report a new method for the synthesis of photoluminescent SrAl(2)O(4):Ce(3+), Dy(3+), Eu(2+) nanotubes, PL-SNT:Ce(III), Ln, using solid-state reaction and post-annealing approach. This new optical nanotubular structure was characterized by HRTEM, SEM, AFM, EDX, steady-state and time-resolved PL spectroscopy. A series of f-f and f-d-transitions with light emission in structured bands peaking at 488 nm arising from the polymorphism of the host lattice was correlated with an intercrystalline distal-effect on the afterglow phenomenon

MITIGASI PERUBAHAN IKLIM MELALUI PENANAMAN MANGROVE DI DESA LHOK BUBON KECAMATAN SAMATIGA KABUPATEN ACEH BARAT

Mitigation of climate change is a business activity to reduce the risk of increasing greenhouse gas emissions in the atmosphere, gases can occur naturally in the environment and can also arise due to human activities. Mangroves are carbon-rich ecosystems and have an important role in climate regulation, namely by their ability to store large amounts of carbon as an effort to offset anthropogenic CO2 emissions. Mangrove ecosystems are able to store high carbon which is useful in reducing greenhouse gas emissions, mangrove ecosystems are also able to store carbon three to four times greater than ordinary tropical forests. The activity was carried out in Lhok Bubon Village, Samatiga District, West Aceh District. This activity was attended by the academic community of FPIK UTU with 50 participants. The method of implementing community service activities used was counseling and demonstration methods with students through planting 100 mangrove stems, namely Rhizopora sp. Protecting the mangrove ecosystem is our common awareness, especially students as the next generation of the nation, one of which is by not cutting down mangrove trees to be used as firewood or charcoal, opening up ponds and destroying the original habitat of mangrove ecosystems that can disrupt coastal aquatic biota. Students are given education (counseling) about the importance of conserving mangrove ecosystems from the threat of climate change mitigation. Students are very enthusiastic and active, it can be seen from the seriousness in participating in mangrove planting activities through discussions, questions and answers, and hands-on practice. Sustainability of a program like this is needed and efforts are made to become a routine program of gampong activities, NGO activities and also academic activities, because with sustainability it will be faster to see the results that have been expected together