Estimativa de custo de permanência hospitalar para recém-nascidos prematuros de mães adolescentes em um hospital público brasileiro

Objective: To estimate the direct costs of hospital stay for premature newborns of adolescent mothers, in a public hospital. Method: A cost estimate study conducted between 2009 and 2011, in which direct hospital costs were estimated for premature newborns of adolescent mothers, with 22 to 36 6/7 gestational weeks, and treated at the neonatal unit of the hospital. Result: In 2006, there were 5,180 deliveries at this hospital, and 17.8% (922) were newborns of adolescent mothers, of which 19.63% (181) were admitted to the neonatal unit. Out of the 181 neonates, 58% (105) were premature and 80% (84) of them were included in this study. These 84 neonates had a total of 1,633 days in-patient hospital care at a total cost of US$195,609.00. Approximately 72$141,323.00) accounted for hospital services. The mean daily costs ranged from US$97.00 to US$157.00. Conclusion: This study demonstrated that the average cost of premature newborns from adolescent mothers was US$2,328.00 and varied according to birth weight. For those weighing 2,000g. The overall estimated direct cost for the 84 neonates in the study totaled US$195,609.00.ObjetivoEstimar os custos diretos de internações de recém-nascidos prematuros de mães adolescentes em um hospital público. MétodoEstudo de estimativa de custos realizado entre 2009 e 2011, no qual os custos hospitalares diretos foram estimados para recém-nascidos prematuros de mães adolescentes, com 22 a 36 6/7 semanas de gestação, e tratados na unidade neonatal do hospital. ResultadoEm 2006, o hospital em estudo teve 5.180 partos; 17,8% (922) foram de mães adolescentes, e 19,63% (181) recém-nascidos foram admitidos na unidade neonatal. Dos 181 neonatos, 58% (105) eram prematuros, dos quais 80% (84) foram incluídos neste estudo. Estes 84 recém-nascidos totalizaram 1.633 dias de tratamento hospitalar, a um custo total de US$195,609.00. Aproximadamente 72$141,323.00) referiu-se a serviços hospitalares. Os custos médios diários variaram de US$97.00 a US$157.00. ConclusãoEste estudo demonstrou que o custo médio de recém-nascido prematuro de mães adolescentes foi US$2,328.00 e variou de acordo com o peso ao nascimento. Para recém-nascidos com peso 2.000g foi de US$642.00. O custo hospitalar total estimado para os 84 neonatos no estudo foi de US$195,609.00.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Public health and food safety in the WHO African region

Contaminated food continues to cause numerous devastating outbreaks in the African Region. In Africa, a large proportion of ready-to-eat foods are sold by the informal sector, especially as street foods. The hygienic aspects of vending operations and the safety of these foods are problematic for food safety regulators. The global food crisis has worsened an already precarious food situation because when food is in short supply people are more concerned about satisfying hunger than the safety of the food. The aetiological agents include various pathogenic bacteria, parasites and viruses. Chemical contaminants are becoming increasingly important. Human factors including: unhygienic practices and deliberate contamination, environmental factors, such as unsafe water, unsafe waste disposal and exposure of food to insects and dust,undercooked food, and prolonged storage of cooked food without refrigeration are the main predisposing factors. WHO’s position is that food safety must be recognised as a public health function and access to safe food as a basic human right. The work of WHO in food safety is in line with its core functions and various global and regional commitments, especially the document entitled “Food Safety and Health: A Strategy for the WHO African Region (AFR/RC57/4) adopted in 2007. WHO has been supporting countries to strengthen food safety systems and partnerships and advocacy; to develop evidence-based food safety policies; strengthen laboratory capacity for foodborne disease surveillance; enhance participation of countries in the standard-setting activities of the Codex Alimentarius Commission; and strengthen food safety education using the WHO Five Keys to Safer Food . The implementation of the Regional Food Safety Strategy adopts a holistic farm-to-fork approach which addresses the entire food control system. Much has been achieved since the adoption of the document Food Safety and health: A Strategy for the WHO African Region, but commitment to food safety still remains low due to competing priorities. In particular, countries are now shifting away from fragmented food control implementation towards multi-agency and coordinated as well as single agency systems. The Codex Trust Fund has facilitated participation and capacity building for Codex work. Although funding for the Food Safety Programme has increased as compared to the levels in 2002, this remains inadequate. WHO will continue to support countries to strengthen food safety systems in line with its core functions and as enshrined in the regional food safety strategy

Climate Smart Agriculture: More Than Technologies Are Needed to Move Smallholder Farmers Toward Resilient and Sustainable Livelihoods

Climate Smart Agriculture (CSA) is defined as agricultural practices that sustainably increase productivity and system resilience while reducing greenhouse gas emissions1. CSA helps ensure that climate change adaptation and mitigation are directly incorporated into agricultural development planning and investment strategies. Our perspective on CSA is sustainable agriculture, based upon integrated management of water, land and ecosystems at landscape scale. CSA is being widely promoted as the future of African agriculture and as a viable answer to climate change. Because agriculture remains key to development in Africa, CSA has the potential to increase productivity and resilience while reducing the vulnerability of hundreds of millions of smallholder farmers. CSA can benefit smallholder farmers directly by increasing efficiency of precious inputs such as labour, seeds and fertilizers, increasing food security, and opportunities for income generation. By protecting ecosystems and landscapes, CSA helps protect natural resources for future generations. Yet, CSA technologies and approaches alone will not increase resilience or improve livelihoods of significant numbers of small holders who survive within complex systems. Decades and hundreds of millions of dollars invested in research, development and technology transfer have not transformed African smallholders. Evidence shows that top down command and control systems for technology diffusion do not generate sustainable change

Developing and maintaining national food safety control systems: Experiences from the WHO African region

The establishment of effective food safety systems is pivotal to ensuring the safety of the national food supply as well as food products for regional and international trade. The development, structure and implementation of modern food safety systems have been driven over the years by a number of developments. These developments include: a reorientation of quality assurance protocols; emphasis on the development of integrated and holistic food safety systems with a farm-to-table approach; increasedrecognition of the respective roles of the different stakeholders along the food chain; increased food trade coupled with obligations under trade agreements; and advances in the control of foodborne hazards. At its core, a modern food safety system includes enabling food laws, policies, regulations and standards; mechanisms for coordination; operational food inspection and laboratory services as well as national information,education and communication programmes. While progress has been made in some countries in the WHO African Region at modernizing their food safety systems, many others are still grappling with the basics for development of effective food control systems. The traditional food control systems in a number of African countries do not provide the concerned agencies with a clear mandate and authority to prevent food safety problems. Effective food control in a number of these countries is undermined by a number of challenges including limited awareness about food safety, inadequate enabling policy, outdated legislation and regulations; inadequate coordination; and inadequate capacity and resources for food safety. This paper reviews the components of a modern national food safety control system and examines efforts at strengthening national food safety control systems in the African Region. It includesexperiences from countries that have made efforts at strengthening their national food safety control systems in view of current developments. The paper further discusses some of the challenges of food control systems in the Region and prospects for improvements. It concludes by suggesting the way forward for improving national food safety control systems in the Region

Policy considerations for African food systems : towards the United Nations 2021 Food Systems Summit

Achieving food and nutrition security and ending hunger is a complex and multi-faceted global challenge, which requires urgent attention, particularly in Africa. To eliminate hunger, the continent needs to transition to new sustainable, inclusive, and resilient food systems that deliver nutritious food and a healthy planet for all. This paper discusses challenges and opportunities highlighted during the “Food Systems Transformation to Address the SDGs” session convened by the African Research Universities Alliance (ARUA) and partners at the 8th World Sustainability Forum (WSF2020) held in September 2020. The paper reflects on how African food systems need to change to achieve the food systems related and interconnected the Sustainable Development Goals (SDGs). It also presents issues for consideration at the 2021 United Nations Food Systems Summit. Key considerations include (i) the realization that nutrition insecurity is not food insecurity, (ii) the need for Africa to actualize its potential, (iii) the need to demystify policy development processes; (iv) the need to invest in better measurements and indicators; and (v) the need to create nature-based climate-smart solutions.The U.K. Research and Innovation the Global Challenges Research Fund.https://www.mdpi.com/journal/sustainabilityam2022Centre for the Advancement of Scholarshi

The WHO five keys to safer food: A tool for food safety health promotion

Foodborne diseases continue to be significant causes of morbidity and mortality within the African Region. Many cases of foodborne disease occur due to basic errors in food preparation or handling either in food service establishments or at home. Educating food handlers, including consumers, therefore, can significantly reduce the chances of contracting food-borne illnesses and the effects of outbreaks, as well as improve public health. Food safety education programmes need to particularly target certain segments of the population who, either directly have a role in food preparation and/or have increased vulnerability to foodborne diseases. In response to the increasing need to educate food handlers, including consumers about their responsibilities for assuring the safety of food, the World Health Organization (WHO) initiated a health promotion campaign around five simple rules, "the five keys to safer food" to help ensure food safety during food handling and preparation. The core messages of the WHO five keys to safer food are: keep clean; separate raw and cooked; cook thoroughly; keep food at safe temperatures; and use safe water and raw materials. These messages have been adapted to different target audiences and settings such as healthy food markets; emergency situations such as prevention of outbreaks; food safety for travellers; preparation of mass gathering events; streetvended foods; training of women; and growing of safer fruits and vegetables. Educational projects targeting different types of food handlers, high-risk groups andsettings are being implemented in several countries in the African Region. This article discusses how the WHO five keys to safer food have been used as a tool for food safety education. Experiences of selected countries in the African Region in the promotion of the WHO five keys to safer food in different settings are presented. It further discusses opportunities and future perspectives in the promotion of the WHO five keys to safer food in the African Region

Molecular epidemiology of extended-spectrum beta-lactamase-producing extra-intestinal pathogenic Escherichia coli strains over a 2-year period (2017-2019) from Zimbabwe

This study was designed to characterize extended-spectrum beta-lactamase (ESBL)–producing extra-intestinal pathogenic Escherichia coli (E.coli) (ExPEC) associated with urinary tract infections in nine different geographic regions of Zimbabwe over a 2-year period (2017–2019). A total of 48 ESBL-positive isolates from urine specimen were selected for whole-genome sequencing from 1246 Escherichia coli isolates biobanked at the National Microbiology Reference laboratory using phenotypic susceptibility testing results from the National Escherichia coli Surveillance Programme to provide representation of different geographical regions and year of isolation. The majority of ESBL E. coli isolates produced cefotaximase-Munich (CTX-M)-15, CTX-M-27, and CTX-M-14. In this study, sequence types (ST) 131 and ST410 were the most predominant antimicrobial-resistant clones and responsible for the increase in ESBL–producing E. coli strains since 2017. Novel ST131 complex strains were recorded during the period 2017 to 2018, thus showing the establishment and evolution of this antimicrobial-resistant ESBL clone in Zimbabwe posing an important public health threat. Incompatibility group F plasmids were predominant among ST131 and ST410 isolates with the following replicons recorded most frequently: F1:A2:B20 (9/19, 47%), F2:A1: B (5/19, 26%), and F1:A1:B49 (8/13, 62%). The results indicate the need for continuous tracking of different ESBL ExPEC clones on a global scale, while targeting specific STs (e.g. ST131 and ST410) through control programs will substantially decrease the spread of ESBLs among ExPEC

Faecal carriage of ESBL producing and colistin resistant Escherichia coli in avian species over a 2-year period (2017-2019) in Zimbabwe

DATA AVAILABILITY STATEMENT : The data presented in this study are deposited in the NCBI BioProject Number PRJNA 799483 with accession numbers listed in the Supplementary Datasheet 1.INTRODUCTION : Extended spectrum beta-lactamase (ESBL) producing Escherichia coli have become widespread among food producing animals. These strains serve as a reservoir of antibiotic resistance genes (ARGs) and act as a possible source of infection to humans as transmission can occur by direct or indirect contact. METHODS : This study investigated the faecal carriage of ESBL producing and colistin resistant E. coli in poultry over a 2-year period (2017-2019) from Zimbabwe. A total of 21 ESBL positive isolates from poultry cloacal specimens were selected for whole genome sequencing from animal E. coli isolates biobanked at the National Microbiology Reference laboratory using phenotypic susceptibility testing results from the National Escherichia coli Surveillance Program to provide representation of different geographical regions and year of isolation. Cloacal swabs were collected from 3000 broiler live birds from farm 1 and fromfarm2, 40 backyard chickens and 10 duckswere sampled. Antimicrobial susceptibility and ESBL testing were performed as per Clinical Laboratory Standards Institute guidelines. Whole genome sequencing of ESBL producing isolates was used to determine sequence types (STs), ARGs, and phylogroups. RESULTS : Twenty-one of the included E. coli isolates were confirmed as ESBL producers. Three defined sequence type clonal complexes (CCs) were identified (ST10CC, ST155CC and ST23CC), with ST10CC associated with the most antibiotic resistant profile. The ESBL phenotype was linked to the presence of either cefotaximase-Munich-14 (CTX-M-14) or CTX-M-79. Plasmid mediated quinolone resistant determinants identified were qnrB19 and qnrS1 and one ST10CC isolate from farm 1 broiler chickens harbored a mobile colistin resistance gene (mcr-1). Phylogenetic groups most identified were B1, A and unknown. DISCUSSIONS : The avian ESBL producing E. coli belonged to a diverse group of strains. The detection of several ARGs highlights the importance of implementing enhanced control measures to limit the spread in animals, environment, and humans. This is the first report of mcr-1 in Zimbabwe, which further underscores the importance of the One Health approach to control the spread and development of AMR.The National Health Laboratory Service (NHLS) and the University of Pretoria, South Africa, a strategic partnership between National Microbiology Reference Laboratory and Quadram BioSciences Institute.https://www.frontiersin.org/journals/cellular-and-infection-microbiologyam2023Medical Microbiolog

Irrigating Africa: policy barriers and opportunities for enhanced productivity of smallholder farmers

African governments have ambitious plans to expand irrigated agriculture, though existing smallholder schemes have largely failed to use land and water sustainably or become profitable. Six government-owned irrigation schemes in Mozambique, Tanzania and Zimbabwe were assessed to identify common policy barriers and opportunities for higher productivity among smallholder farmers. Issues like insecure land tenure systems, unclear institutional arrangements and poor access to markets have contributed to limited profitability. Reform of currently insecure land tenure, strengthening farmer organizations and reforming policies are recommended so that governments step back from scheme management and foster market linkages to enable more profitable irrigated agriculture.This work was supported by Australian Centre for International Agricultural Research grant number FSC-2013-006