Non-Participation in Child Health Days or Routine Immunization Services among Children under 5 Years of Age—Somaliland 2012

After two decades of conflict, Somalia remains a fragile state where large scale displacement and inadequate access to functioning health services have left children vulnerable to morbidity and mortality from vaccine preventable disease: a survey was conducted to better understand the reasons for non-vaccination among children in Somaliland.Labaatan sano oo burbur ah kaddib, Soomaaliya waxay ahayd dowlad nugul, taasoo keentay in ay adkaato in la gaarsiiyo daryeel caafimaad caruurata, xaaladdaasina waxa dhallaanka ka dhigtay in ay u nuglaadaan cudurka jadeecada iyo geerida cudurrada leh tillaal kahortag: waxaa la sameeyey baaritaan ku saabsan sababaha keenay in dhallaanka Somaliland ay u waayeen gargaarka xagga tallaalaka.Dopo due decenni di conflitto, la Somalia rimane uno stato fragile in cui gli spostamenti su larga scala e un accesso inadeguato ai servizi sanitari hanno lasciato i bambini vulnerabili alla morbilità e la mortalità per malattie a prevenzione vaccinale: è stata condotta un'indagine per approfondire i motivi del mancato ricorso alla vaccinazione tra i bambini in Somaliland

Aspects determining the risk of pesticides to wild bees: risk profiles for focal crops on three continents.

In order to conduct a proper risk assessment of pesticides to bees, information is needed in three areas: (i) the toxicity of the pesticide; (ii) the probability of bee exposure to that pesticide; and (iii) the population dynamics of the bee species in question. Information was collected on such factors affecting pesticide risk to (primarily wild) bees in several crops in Brazil, Kenya and The Netherlands. These data were used to construct ?risk profiles? of pesticide use for bees in the studied cropping systems. Data gaps were identified and potential risks of pesticides to bees were compared between the crops. Initially, risk profiling aims to better identify gaps in our present knowledge. In the longer term, the established risk profiles may provide structured inputs into risk assessment models for wild and managed bees, and lead to recommendations for specific risk mitigation measures.Edição dos Proceedings of the 11 International Symposium Hazards of Pesticides to Bees, Wageningen, nov. 2011

A digital dashboard for reporting mental, neurological and substance use disorders in Nairobi, Kenya: Implementing an open source data technology for improving data capture

The availability of quality and timely data for routine monitoring of mental, neurological and substance use (MNS) disorders is a challenge, particularly in Africa. We assessed the feasibility of using an open-source data science technology (R Shiny) to improve health data reporting in Nairobi City County, Kenya. Based on a previously used manual tool, in June 2022, we developed a digital online data capture and reporting tool using the open-source Kobo toolbox. Primary mental health care providers (nurses and physicians) working in primary healthcare facilities in Nairobi were trained to use the tool to report cases of MNS disorders diagnosed in their facilities in real-time. The digital tool covered MNS disorders listed in the World Health Organization’s (WHO) Mental Health Gap Action Program Intervention Guide (mhGAP-IG). In the digital system, data were disaggregated as new or repeat visits. We linked the data to a live dynamic reproducible dashboard created using R Shiny, summarising the data in tables and figures. Between January and August 2023, 9064 cases of MNS disorders (4454 newly diagnosed, 4591 revisits and 19 referrals) were reported using the digital system compared to 5321 using the manual system in a similar period in 2022. Reporting in the digital system was real-time compared to the manual system, where reports were aggregated and submitted monthly. The system improved data quality by providing timely and complete reports. Open-source applications to report health data is feasible and acceptable to primary health care providers. The technology improved real-time data capture, reporting, and monitoring, providing invaluable information on the burden of MNS disorders and which services can be planned and used for advocacy. The fast and efficient system can be scaled up and integrated with national and sub-national health information systems to reduce manual data reporting and decrease the likelihood of errors and inconsistencies

Non-Invasive Sampling of Schistosomes from Humans Requires Correcting for Family Structure

For ethical and logistical reasons, population-genetic studies of parasites often rely on the non-invasive sampling of offspring shed from their definitive hosts. However, if the sampled offspring are naturally derived from a small number of parents, then the strong family structure can result in biased population-level estimates of genetic parameters, particularly if reproductive output is skewed. Here, we document and correct for the strong family structure present within schistosome offspring (miracidia) that were collected non-invasively from humans in western Kenya. By genotyping 2,424 miracidia from 12 patients at 12 microsatellite loci and using a sibship clustering program, we found that the samples contained large numbers of siblings. Furthermore, reproductive success of the breeding schistosomes was skewed, creating differential representation of each family in the offspring pool. After removing the family structure with an iterative jacknifing procedure, we demonstrated that the presence of relatives led to inflated estimates of genetic differentiation and linkage disequilibrium, and downwardly-biased estimates of inbreeding coefficients (F[subscript IS]). For example, correcting for family structure yielded estimates of F[[subscript ST] among patients that were 27 times lower than estimates from the uncorrected samples. These biased estimates would cause one to draw false conclusions regarding these parameters in the adult population. We also found from our analyses that estimates of the number of full sibling families and other genetic parameters of samples of miracidia were highly intercorrelated but are not correlated with estimates of worm burden obtained via egg counting (Kato-Katz). Whether genetic methods or the traditional Kato-Katz estimator provide a better estimate of actual number of adult worms remains to be seen. This study illustrates that family structure must be explicitly accounted for when using offspring samples to estimate the genetic parameters of adult parasite populations

Prevalence of all epilepsies in urban informal settlements in Nairobi, Kenya: a two-stage population-based study

BACKGROUND: WHO estimates that more than 50 million people worldwide have epilepsy and 80% of cases are in low-income and middle-income countries. Most studies in Africa have focused on active convulsive epilepsy in rural areas, but there are few data in urban settings. We aimed to estimate the prevalence and spatial distribution of all epilepsies in two urban informal settlements in Nairobi, Kenya. METHODS: We did a two-stage population-based cross-sectional study of residents in a demographic surveillance system covering two informal settlements in Nairobi, Kenya (Korogocho and Viwandani). Stage 1 screened all household members using a validated epilepsy screening questionnaire to detect possible cases. In stage 2, those identified with possible seizures and a proportion of those screening negative were invited to local clinics for clinical and neurological assessments by a neurologist. Seizures were classified following the International League Against Epilepsy recommendations. We adjusted for attrition between the two stages using multiple imputations and for sensitivity by dividing estimates by the sensitivity value of the screening tool. Complementary log-log regression was used to assess prevalence differences by participant socio-demographics. FINDINGS: A total of 56 425 individuals were screened during stage 1 (between Sept 17 and Dec 23, 2021) during which 1126 were classified as potential epilepsy cases. A total of 873 were assessed by a neurologist in stage 2 (between April 12 and Aug 6, 2022) during which 528 were confirmed as epilepsy cases. 253 potential cases were not assessed by a neurologist due to attrition. 30 179 (53·5%) of the 56 425 individuals were male and 26 246 (46·5%) were female. The median age was 24 years (IQR 11-35). Attrition-adjusted and sensitivity-adjusted prevalence for all types of epilepsy was 11·9 cases per 1000 people (95% CI 11·0-12·8), convulsive epilepsy was 8·7 cases per 1000 people (8·0-9·6), and non-convulsive epilepsy was 3·2 cases per 1000 people (2·7-3·7). Overall prevalence was highest among separated or divorced individuals at 20·3 cases per 1000 people (95% CI 15·9-24·7), unemployed people at 18·8 cases per 1000 people (16·2-21·4), those with no formal education at 18·5 cases per 1000 people (16·3-20·7), and adolescents aged 13-18 years at 15·2 cases per 1000 people (12·0-18·5). The epilepsy diagnostic gap was 80%. INTERPRETATION: Epilepsy is common in urban informal settlements of Nairobi, with large diagnostic gaps. Targeted interventions are needed to increase early epilepsy detection, particularly among vulnerable groups, to enable prompt treatment and prevention of adverse social consequences. FUNDING: National Institute for Health Research using Official Development Assistance

Incidence and Correlates of HIV-1 RNA Detection in the Breast Milk of Women Receiving HAART for the Prevention of HIV-1 Transmission

The incidence and correlates of breast milk HIV-1 RNA detection were determined in intensively sampled women receiving highly active antiretroviral therapy (HAART) for the prevention of mother-to-child HIV-1 transmission.Women initiated HAART at 34 weeks of pregnancy. Breast milk was collected every 2-5 days during 1 month postpartum for measurements of cell-associated HIV DNA and cell-free HIV RNA. Plasma and breast milk were also collected at 2 weeks, 1, 3 and 6 months for concurrent HIV-1 RNA and DNA measurements. Regression was used to identify cofactors for breast milk HIV-1 RNA detection.Of 259 breast milk specimens from 25 women receiving HAART, 34 had detectable HIV-1 RNA (13%, incidence 1.4 episodes/100 person-days 95% CI = 0.97-1.9). Fourteen of 25 (56%) women had detectable breast milk HIV-1 RNA [mean 2.5 log(10) copies/ml (range 2.0-3.9)] at least once. HIV-1 DNA was consistently detected in breast milk cells despite HAART, and increased slowly over time, at a rate of approximately 1 copy/10(6) cells per day (p = 0.02). Baseline CD4, plasma viral load, HAART duration, and frequency of breast problems were similar in women with and without detectable breast milk HIV-1 RNA. Women with detectable breast milk HIV-1 RNA were more likely to be primiparous than women without (36% vs 0%, p = 0.05). Plasma HIV-1 RNA detection (OR = 9.0, 95%CI = 1.8-44) and plasma HIV-1 RNA levels (OR = 12, 95% CI = 2.5-56) were strongly associated with concurrent detection of breast milk HIV-1 RNA. However, no association was found between breast milk HIV-1 DNA level and concurrent breast milk HIV-1 RNA detection (OR = 0.96, 95%CI = 0.54-1.7).The majority of women on HAART had episodic detection of breast milk HIV-1 RNA. Breast milk HIV-1 RNA detection was associated with systemic viral burden rather than breast milk HIV-1 DNA

Interactions between Natural Populations of Human and Rodent Schistosomes in the Lake Victoria Region of Kenya: A Molecular Epidemiological Approach

One of the world's most prevalent neglected diseases is schistosomiasis, which infects approximately 200 million people worldwide. Schistosoma mansoni is transmitted to humans by skin penetration by free-living larvae that develop in freshwater snails. The origin of this species is East Africa, where it coexists with its sister species, S. rodhaini. Interactions between these species potentially influence their epidemiology, ecology, and evolutionary biology, because they infect the same species of hosts and can hybridize. Over two years, we examined their distribution in Kenya to determine their degree of overlap geographically, within snail hosts, and in the water column as infective stages. Both species were spatially and temporally patchy, although S. mansoni was eight times more common than S. rodhaini. Both species overlap in the time of day they were present in the water column, which increases the potential for the species to coinfect the same host and interbreed. Peak infective time for S. mansoni was midday and dawn and dusk for S. rodhaini. Three snails were coinfected, which was more common than expected by chance. These findings indicate a lack of obvious isolating mechanisms to prevent hybridization, raising the intriguing question of how the two species retain separate identities

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

The critical need for pooled data on coronavirus disease 2019 in African children : an AFREhealth call for action through multicountry research collaboration

Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and coinfections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policy-making for COVID-19 while concurrently addressing other major diseases affecting children in African countries.The US National Institutes of Health (NIH)/ Fogarty International Centre (FIC) to the African Forum for Research and Education in Health (AFREhealth).https://academic.oup.com/cidam2022Paediatrics and Child Healt