Agricultural Growth, Poverty Reduction and Millennium Development Goals in Africa: Outcomes of AAAE Conference

This report is a summary of emerging issues affecting African agriculture, recent experiences and policy proposals that can guide interventions in improving the sector’s productivity. Agriculture is at the centre of rural poverty reduction in Africa and urgent measures are needed to increase farm yields and incomes in order to stem collapse of economies and societies.AAAE, African Association of Agricultural Economists, millennium development goals in Africa, agricultural policies, agricultural research systems, poverty reduction, agricultural productivity, Agricultural and Food Policy, Community/Rural/Urban Development, Farm Management, Food Security and Poverty, Production Economics, Research and Development/Tech Change/Emerging Technologies, Q010, Q130, Q170, Q180, Q560,

Uptake and Emerging Issues Surrounding Hospital Deliveries Services. Perspective of One General Hospital Located in Arid and Insecure Garissa County of North Eastern Kenya

Background: Increasing the percentage of births delivered in health facilities is important for reducing the relatively high maternal mortality ratio in Kenya. Despite the increasing availability in awareness, affordability, modernization of formal obstetric care in Kenya, the majority of births in Garissa County still occur at home assisted by unskilled traditional birth attendants (TBAs). The objective of this study was to determine the factors affecting uptake of hospital delivery services by attending or receiving various services at Garissa Provincial General Hospital (GPGH).  Methodology: Data on place of delivery, reasons for place of delivery, and a range of potential explanatory factors affecting choice of place of delivery were collected by interviewer-led questionnaire among 338 women attending GPGH. Predictors of place of delivery were explored in an exploratory risk factor analysis using multiple logistic regression. Results: The mean age of the 338 women respondents was 27.03 (SD± 4.66) years, ranging from 17 to 48 years. The majority of the women, 71.6%, were aged between 21 to 30 years, 32.8% had tertiary level education, 86.1% were married, 62.4% attended the GPGH for antenatal care services, and 56.2% were currently pregnant. Three quarters (76.3%) had previously delivered at the GPGH. In multivariate analysis, women who were nulliparous (OR 0.2, 95% CI 0.09 to 0.6), delivered in the hospital in the last 2 years (OR 12.8, 95% CI 5.1 to 32.4) or 3 years ago (OR 13.1, 95% CI 4.9 to 34.4) or those who liked the cleanliness of the hospital (OR 1.9, 95% CI 1.1 to 3.7) and appreciated hospital due to availability of medical supplies (OR 1.8, 95% CI 1.1 to 3.3) were independently associated with utilization of the health facility.Conclusion: A high proportion of women from the county embraced hospital delivery. Among the factors positively affecting uptake of health services in the facility antenatal were hospital cleanliness, equipment and medical supply availability and improved privacy. Keywords: Hospital Delivery, Uptake and emerging issues, Garissa County of North Eastern Kenya

Remdesivir for the Treatment of COVID-19: A Systematic Review of the Literature

In March 2020, the World Health Organization declared the spread of SARS-CoV-2 a global pandemic. To date, coronavirus disease-2019 (COVID-19) has spread to over 200 countries, leading to over 1.6 million cases and over 99,000 deaths. Given that there is neither a vaccine nor proven treatment for COVID-19, there is currently an urgent need for effective pharmacotherapy. To address the need for an effective treatment of SARS-CoV-2 during the worldwide pandemic, this systematic review of intravenous (IV) remdesivir was performed. Remdesivir, an anti-viral prodrug originally developed to treat Ebola virus disease, has shown broad spectrum activity against the Coronavirus family. A recent case report reported improvement of clinical symptoms with remdesivir in a patient with COVID-19. After conducting a systematic search of 18 clinical trial registries and three large scientific databases, we identified 86 potentially eligible items. Following removal of duplicates (n = 21), eligible studies were reviewed independently by two authors. After the first round of screening, inter-rater agreement was 98.5% (κ = 0.925). After the second round of full-text screening, inter-rater agreement was 100%. A total of seven ongoing and recruiting clinical trials of remdesivir (100-200 milligrams, intravenous [IV]) were included. We identified the following primary outcomes: patients discharged (n = 2); time to clinical status improvement (n = 2); improved O2 saturation (n = 2); body temperature normalization (n = 2); and clinical status (n = 1). Secondary outcomes in all identified studies included documentation of adverse events. Phase 3 trials are expected to be completed between April 2020–2023. Therefore, despite supportive data from in vitro and in vivo studies, the clinical effectiveness of IV remdesivir for treatment of COVID-19 and potential side effects remain incompletely defined in the human population

Analysing Rural-Urban Disparity in Access to Safe Toilet in Nigeria

This study examines the socio-economic determinants of access to safe toilet facilities in Nigerian households. It also investigates the factors responsible for rural-urban disparity in accessing safe toilets among Nigerians. It uses the 2013 Demographic Health Survey (DHS) on Nigeria for all the analyses. Binary and Ordered Probit Regressions Models as well as Oaxaca-Blinder decomposition were used to determined factors affecting access to safe toilet facilities in the country. The results shows that, households head age, marital status, gender, household size, education, wealth index, locations, ethnicity and geopolitical variations are the significant determinants of households’ access to safe toilets in Nigeria. While, household size, rural locality, zones, gender, and lower wealth index have negative impacts; households head age, marital status, ethnicity and education level, have positive effects on the households’ access to safe toilets in the country. Secondly, differences in the age of households head, household size, wealth index, gender, zones and marital status are the factors responsible for the rural-urban variation in access to safe toilets in Nigeria. The study recommends poverty reduction programmes, public-private partnership, provision of public toilets, rural development, educational improvement, cultural and value re-orientation and social security programme among others as measures to improve access to safe toilet facilities in the country. Keywords:Safe toilets, socioeconomic, probit, Blinder-Oaxaca decomposition and socio-economic development

Optimization of Process Parameters Influencing Biogas Production from Rumen and municipal waste: Analytical Approach

 Rumen waste with high carbohydrate, protein, and lipid content is considered as a suitable substrate for fermentation for methane gas. In this study, direct substrate and co-digestion of rumen waste (RW) and municipal waste (MW) were used. Samples (fresh cow rumen and food waste) were dried, grinded, and blended with water into a semi-solid to facilitate digestion. Central composite design (CCD) was applied to optimize parameters of co-digestion of RW and MW at a different temperature (29 – 33oC), initial pH values, agitation time (AGT), and carbon-nitrogen ratio (C/N). A comparative analysis was done using RSM in a predictive model of the experimental data obtained in accordance with the CCD. The combined effects of temperature, pH, AGT, and C/N as methane production by fermentation of RW and MW were investigated. Optimization using RSM showed a good fit between the experimental and the predicted data as elucidated by the coefficient of determination with R2 values of 0.9214. Quadratic RSM predicted the maximum yield to be 7764 mL CH4/g volatile solid (VS) at optimal conditions of 31°C; pH 7.05; 6s and C/N ratio 20.33. The maximum methane yield was 8550 mL CH4/g VS, at the optimal conditions for the experimental response obtained. The verification experiment successfully produced 8550 mL CH4/g VS within 30 days of incubation. This experiment indicated that the developed model was successfully and can be used for methane production from animal and municipal waste

Fishermen as a Suitable Population for HIV Intervention Trials

Background. Suitable populations to sustain continued evaluation of HIV and sexually transmitted infection (STI) prevention interventions are required. We sought to determine whether fishermen are a suitable population for HIV intervention trials. Methods. In a cross-sectional descriptive survey, we selected 250 fishermen from proportional to size sampled boats. We collected socioeconomic and behavioral information, and specimens for HIV, herpes simplex virus (HSV-2), syphilis, gonorrhea, chlamydia and human papillomavirus (HPV) tests from consenting participants. Results. One third of the fishermen had concurrent sexual partnerships and two thirds were involved in transactional sex. About 70% were involved in extramarital sex with only one quarter using condoms in their three most recent sexual encounters. HIV prevalence was 26% and HSV-2 and HPV was 57%. Over 98% were willing to participate in a future HIV prevention clinical trial. Conclusion. Fishermen are a high-risk group for HIV/STI infections that may be suitable for HIV prevention trials. A cohort study would be useful to measure the incidence of HIV/STIs to ultimately determine the feasibility of enrolling this population in an HIV/STI prevention clinical trial

Challenges and priorities for pediatric critical care clinician-researchers in low- and middle-income countries

IntroductionThere is need for more data on critical care outcomes and interventions from low- and middle-income countries (LMIC). Global research collaborations could help improve health-care delivery for critically ill children in LMIC where child mortality rates remain high.Materials and methodsTo inform the role of collaborative research in health-care delivery for critically ill children in LMIC, an anonymous online survey of pediatric critical care (PCC) physicians from LMIC was conducted to assess priorities, major challenges, and potential solutions to PCC research. A convenience sample of 56 clinician-researchers taking care of critically ill children in LMIC was targeted. In addition, the survey was made available on a Latin American PCC website. Descriptive statistics were used for data analysis.ResultsThe majority of the 47 survey respondents worked at urban, public teaching hospitals in LMIC. Respondents stated their primary PCC research motivations were to improve clinical care and establish guidelines to standardize care. Top challenges to conducting research were lack of funding, high clinical workload, and limited research support staff. Respondent-proposed solutions to these challenges included increasing research funding options for LMIC, better access to mentors from high-income countries, research training and networks, and higher quality medical record documentation.ConclusionLMIC clinician-researchers must be better empowered and resourced to lead and influence the local and global health research agenda for critically ill children. Increased funding options, access to training and mentorship in research methodology, and improved data collection systems for LMIC PCC researchers were recognized as key needs for success

Survival Benefit for Individuals with Constitutional Mismatch Repair Deficiency Syndrome and Brain Tumors Who Undergo Surveillance Protocol. A Report from the International Replication Repair Consortium

BACKGROUND Constitutional mismatch repair deficiency syndrome (CMMRD) is a severe cancer predisposition syndrome resulting in early onset central nervous system (CNS) and other cancers. International guidelines for surveillance exist but no study has systematically evaluated the efficacy of this protocol. METHODS We surveyed all confirmed CMMRD patients in the International Replication Repair Deficiency Consortium. A surveillance protocol consisting of frequent biochemical, endoscopic and imaging (CNS and total body MRI) studies were employed. Survival analyses and efficacy of each method were assessed. RESULTS Surveillance data were collected from 105 CMMRD individuals from 41 countries. Of the 193 malignant tumors, CNS malignancies were the most common (44%). The surveillance protocol uncovered 49 asymptomatic tumors including 16 glioblastomas and medulloblastomas. Five-year overall survival was 89% for tumors discovered by surveillance, and 61% for symptomatic tumors (p\u3c0.004). Similarly, 5-year survival was 82+/-11% and 24+/-6% for surveillance and non-surveillance of brain tumors (p=0.005). Yearly total body and q6 month brain MRI detected asymptomatic cancers in all but 3 symptomatic CNS gliomas. These were tumors uncovered when time between scans was \u3e6 months as per protocol. Finally, of the low grade tumors identified asymptomatically, 5 were low grade gliomas. All of the low grade gliomas, which were not resected transformed to high grade tumors at a median of 1.6 ± 0.9 years. CONCLUSION These data support a survival benefit in CMMRD patients undergoing a surveillance protocol. Adherence to protocol and resection of lower grade lesions may improve survival for patients with CNS tumors

Bacterial Vaginosis Associated with Increased Risk of Female-to-Male HIV-1 Transmission: A Prospective Cohort Analysis among African Couples

In a prospective study, Craig Cohen and colleagues investigate the association between bacterial vaginosis and the risk of female-to-male HIV-1 transmission

The barriers and facilitators to young people's engagement with bidirectional digital sexual health interventions: A mixed methods systematic review

Background: Sexual health is fundamental to the overall health and wellbeing of individuals and to the social and economic development of communities and countries. However, internationally young people endure a disproportionate burden of sexually transmitted infections and unintended pregnancies which can be associated with poor psycho-social outcomes. Digital sexual health interventions have been developed to increase young people’s access to sexual health services, but are currently underutilised. Aim: This systematic review sought to identify the barriers and facilitators to young people’s engagement with bidirectional digital sexual health interventions, which are standalone two-way tailored interventions between a young person and healthcare professional. Methods: The review was conducted in accordance with the JBI methodology for mixed methods systematic reviews, following a convergent integrated approach to synthesis and integration of qualitative and quantitative evidence. Searches of ten electronic databases were conducted, spanning database inception to January 2022. No restrictions were imposed on language, geographical location or community setting. All included studies were critically appraised with JBI Critical Appraisal tools. Data extraction was performed using standardised tools, followed by data transformation. Data synthesis followed the convergent integrated approach. Each stage was conducted by two independent reviewers. Results: Eight thousand four hundred thirty-nine titles and abstracts and, subsequently, 255 full-texts underwent review. Nine studies were selected for inclusion with no studies added following forward and backward citation tracking. The included studies comprised three qualitative and six quantitative designs. Three meta synthesised findings were identified: (1) The design of a digital intervention for adolescent sexual health needs to reflect the end users’ specific needs (2) Young people need to feel comfortable when using a digital sexual health intervention (3) Potential barriers to engagement need to be addressed. The review identified that although barriers and facilitators to promoting young people’s engagement with bidirectional digital sexual health interventions are nuanced, young people’s privacy and security need to be prioritised for them to engage with digital interventions, regardless of the platform of choice. Conclusions: Co-production of digital sexual health services, in partnership with young people, has shaped many of the insights reported in this systematic review. Further international research which places an emphasis on young people’s perspectives is vital to unleash the full potential of digital technology in this domain