History of rotavirus research in children in Malawi: the pursuit of a killer

Rotavirus gastroenteritis is a major health problem among Malawian children. Studies spanning 20 years have described the importance, epidemiology and viral characteristics of rotavirus infections in the country. Despite a wide diversity of circulating rotavirus strains causing severe disease inyoung infants, a clinical trial of a human rotavirus vaccine clearly demonstrated the potential for rotavirus vaccination to greatly reduce the morbidity and mortality due to rotavirus diarrhoea in Malawi. This new enteric vaccine initiative represents a major opportunity to improve the health andsurvival of Malawian children

A systematic review of economic evaluations of whole genome sequencing for the surveillance of bacterial pathogens

Whole-genome sequencing (WGS) has unparalleled ability to distinguish between bacteria, with many public health applications. The generation and analysis of WGS data require significant financial investment. We describe a systematic review summarizing economic analyses of genomic surveillance of bacterial pathogens, reviewing the evidence for economic viability. The protocol was registered on PROSPERO (CRD42021289030). Six databases were searched on 8 November 2021 using terms related to ‘WGS’, ‘population surveillance’ and ‘economic analysis’. Quality was assessed with the Drummond–Jefferson checklist. Following data extraction, a narrative synthesis approach was taken. Six hundred and eighty-one articles were identified, of which 49 proceeded to full-text screening, with 9 selected for inclusion. All had been published since 2019. Heterogeneity was high. Five studies assessed WGS for hospital surveillance and four analysed foodborne pathogens. Four were cost–benefit analyses, one was a cost–utility analysis, one was a cost-effectiveness analysis, one was a combined cost-effectiveness and cost–utility analysis, one combined cost-effectiveness and cost–benefit analyses and one was a partial analysis. All studies supported the use of WGS as a surveillance tool on economic grounds. The available evidence supports the use of WGS for pathogen surveillance but is limited by marked heterogeneity. Further work should include analysis relevant to low- and middle-income countries and should use real-world effectiveness data

What happens to ART-eligible patients who do not start ART? Drop out between screening and ART initiation: a cohort study in Karonga, Malawi

BACKGROUND: Routine ART programme statistics generally only provide information about individuals who start treatment. We aimed to investigate the outcome of those who are eligible but do not start ART in the Malawi programme, factors associated with this dropout, and reasons for not starting treatment, in a prospective cohort study.METHODS: Individuals having a first screening visit at the ART clinic at Karonga District Hospital, northern Malawi, between September 2005 and July 2006 were interviewed. Study follow-up to identify treatment outcomes was conducted at the clinic and in the community. Logistic regression models were used to identify factors associated with dropout before ART initiation among participants identified as clinically eligible for ART.RESULTS: 88 participants eligible for ART at their first screening visit (out of 633, 13.9%) defaulted before starting ART. Participants with less education, difficulties in dressing, a more delayed ART initiation appointment, and mid-upper arm circumference (MUAC) < 22 cm were significantly less likely to have visited the clinic subsequently. Thirty-five (58%) of the 60 participants who defaulted and were tracked at home had died, 21 before their ART initiation appointment.CONCLUSIONS: MUAC and reported difficulties in dressing may provide useful screening indicators to identify sicker ART-eligible individuals at high risk of dropping out of the programme who might benefit from being brought back quickly or admitted to hospital for observation. Individuals with less education may need adapted health information at screening. Deaths of ART-eligible individuals occurring prior to ART initiation are not included in routine programme statistics. Considering all those who are eligible for ART as a denominator for programme indicators would help to highlight this vulnerable group, in order to identify new opportunities for further improving ART programmes

Characteristics and outcomes in paediatric patients presenting with congenital colorectal diseases in sub-Saharan Africa

In sub-Saharan Africa, there is a high burden of paediatric surgical conditions and a paucity of data regarding outcomes of congenital colorectal anomalies. A retrospective, descriptive analysis utilizing the Kamuzu Central Hospital (Lilongwe, Malawi) paediatric acute care surgery database (age ≤ 18 years) over 44 months was performed. Of the 133 children presenting, 82 had Hirschsprung disease (HD) (2.4 ± 2.7 years) and 51 had anorectal malformations (ARM) (1.8 ± 2.4 years). Of the latter, 51.0% underwent surgery, mainly exploratory laparotomy (n = 15, 57.7%) and posterior sagittal anorectoplasty (n = 7, 26.9%). Of those with HD, 50.0% underwent operative intervention (77.3% boys), including exploratory laparotomy (n = 17, 41.5%) and definitive pull-through (n = 8, 19.5%). A dearth of expert paediatric surgeons and limited exposure to paediatric conditions in general surgeons limits definitive surgery. An emphasis on paediatric surgical training and improvement of referral networks for definitive therapy will improve patient outcomes

Simulation of the 23 July 2012 Extreme Space Weather Event: What if This Extremely Rare CME Was Earth Directed?

Extreme space weather events are known to cause adverse impacts on critical modern day technological infrastructure such as high-voltage electric power transmission grids. On 23 July 2012, NASA's Solar Terrestrial Relations Observatory-Ahead (STEREO-A) spacecraft observed in situ an extremely fast coronal mass ejection (CME) that traveled 0.96 astronomical units (approx. 1 AU) in about 19 h. Here we use the SpaceWeather Modeling Framework (SWMF) to perform a simulation of this rare CME.We consider STEREO-A in situ observations to represent the upstream L1 solar wind boundary conditions. The goal of this study is to examine what would have happened if this Rare-type CME was Earth-bound. Global SWMF-generated ground geomagnetic field perturbations are used to compute the simulated induced geoelectric field at specific ground-based active INTERMAGNET magnetometer sites. Simulation results show that while modeled global SYM-H index, a high-resolution equivalent of the Dst index, was comparable to previously observed severe geomagnetic storms such as the Halloween 2003 storm, the 23 July CME would have produced some of the largest geomagnetically induced electric fields, making it very geoeffective. These results have important practical applications for risk management of electrical power grids

Improving the productivity and resilience of smallholder farmers with maize-legume and legume-legume systems in Malawi

Smallholder farmers in southern africa must cope with declining soil fertility and production risks associated with frequent droughts (jayne et al., 2014). Legume integration through rotations or intercropping in maize-based farming systems are promoted to increase crop diversification and soil fertility. Anovel strategy, doubled up legumes, could help develop production systems that fulfil sustainable intensification (SI) indicators. It is however crucial to understand resource competition in mixed cropping systems under variable soil and climate conditions

Recommendations for Next‐Generation Ground Magnetic Perturbation Validation

Data‐model validation of ground magnetic perturbation forecasts, specifically of the time rate of change of surface magnetic field, dB/dt, is a critical task for model development and for mitigation of geomagnetically induced current effects. While a current, community‐accepted standard for dB/dt validation exists (Pulkkinen et al., 2013), it has several limitations that prevent more complete understanding of model capability. This work presents recommendations from the International Forum for Space Weather Capabilities Assessment Ground Magnetic Perturbation Working Team for creating a next‐generation validation suite. Four recommendations are made to address the existing suite: greatly expand the number of ground observatories used, expand the number of events included in the suite from six to eight, generate metrics as a function of magnetic local time, and generate metrics as a function of activity type. For each of these, implementation details are explored. Limitations and future considerations are also discussed.Plain Language SummarySpace weather forecast models of magnetic field perturbations are important for protecting the power grid and other vulnerable infrastructure. These models must be validated by comparing their predictions to observations. This paper makes recommendations for how future models should be validated in order to best test their capabilities.Key PointsWe present a new validation suite for models of ground magnetic perturbations, dB/dt, of interest for geomagnetically induced currentsThe existing standard remains useful but provides limited information, so an expanded set of metrics is defined hereThis work is a result of the International Forum for Space Weather Capabilities Assessment and represents a new community consensusPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147786/1/swe20777_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147786/2/swe20777.pd

Temporal changes in minimum and maximum temperatures at selected locations of southern Africa

Open Access JournalAgriculture is threatened by ever increasing temperatures and this trend is predicted to continue for the near and distant future. The negative impact of rising temperatures on agri-food systems is also compounded by the erratic and highly variable rainfall in most parts of southern Africa. Minimum and maximum temperatures’ variability and trend analysis were undertaken using daily time series data derived from 23 meteorological stations spread across Malawi, Mozambique, South Africa and Zimbabwe. The modified Mann–Kendall and Theil–Sen slope models were used to assess temperature trends and their magnitudes. Temperature varied with location and minimum temperature was more variable than maximum temperature. Semi-arid regions had higher variation in minimum temperature compared to humid and coastal environments. The results showed an upward trend in minimum (0.01–0.83 °C over a 33–38 year period) and maximum (0.01–0.09 °C over a 38–57 year period) temperatures at 9 and15 locations, respectively. A downward trend in minimum temperature (0.03–0.20 °C over 38–41 years) occurred in South Africa at two locations and Dedza (Malawi), while a non-significant decline in maximum temperature (0.01 °C over 54 years) occurred at one location in coastal dry sub-humid Mozambique. The results confirm the increase in temperature over 33–79 years, and highlight the importance of including temperature when designing climate change adaption and mitigation strategies in southern Africa and similar environments

Cost-effectiveness of COVID rapid diagnostic tests for patients with severe/critical illness in low- and middle-income countries: A modeling study

ARUap:idPdleiaasgencoosntfiicrmtethsatsta(lRlhDeaTdsi)nfgolervceolsroarnearveiprruessednisteedacsoerr(eCcOtlyV: ID) are used in low- and middle- income countries (LMICs) to inform treatment decisions. However, to date, it is unclear when this use is cost-effective. Existing analyses are limited to a narrow set of countries and uses. The aim of this study is to assess the cost-effectiveness of COVID RDTs to inform the treatment of patients with severe illness in LMICs, considering real world practice. We assessed the cost-effectiveness of COVID testing across LMICs using a decision tree model, differentiating results by country income level, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) prevalence, and testing scenario (none, RDTs, polymerase chain reaction tests—PCRs and combinations). LMIC experts defined realistic care pathways and treatment options. Using a healthcare provider perspective and net monetary benefit approach, we assessed both intended (COVID symptom alleviation) and unintended (treatment side effects) health and economic impacts for each testing scenario. We included the side effects of corticosteroids, which are often the only available treatment for COVID. Because side effects depend both on the treatment and the patient’s underlying illness (COVID or COVID-like illnesses, such as influenza), we considered the prevalence of COVID-like illnesses in our analyses. We found that SARS-CoV-2 testing of patients with severe COVID-like illness can be cost-effective in all LMICs, though only in some circumstances. High influenza prevalence among suspected COVID cases improves cost-effectiveness, since incorrectly provided corticosteroids may worsen influenza outcomes. In low- and some lower-middle-income countries, only patients with a high index of suspicion for COVID should be tested with RDTs, while other patients should be presumed to not have COVID. In some lower-middleincome and upper-middle-income countries, suspected severe COVID cases should almost always be tested. Further, in these settings, negative test results in patients with a high initial index of suspicion should be confirmed through PCR and, during influenza outbreaks, positive results in patients with a low initial index of suspicion should also be confirmed with a PCR. The use of interleukin-6 receptor blockers, when supported by testing, may also be cost-effective in higher-income LMICs. The cost at which they would be cost-effective in low-income countries ($162 to$406 per treatment course) is below current prices. The primary limitation of our analysis is substantial uncertainty around some of the parameters in our model due to limited data, most notably on current COVID mortality with standard of care, and insufficient evidence on the impact of corticosteroids on patients with severe influenza.Fogarty International CenterRevisión por pare

Interhemispheric comparison of GPS phase scintillation at high latitudes during the magnetic-cloud-induced geomagnetic storm of 5–7 April 2010

Arrays of GPS Ionospheric Scintillation and TEC Monitors (GISTMs) are used in a comparative scintillation study focusing on quasi-conjugate pairs of GPS receivers in the Arctic and Antarctic. Intense GPS phase scintillation and rapid variations in ionospheric total electron content (TEC) that can result in cycle slips were observed at high latitudes with dual-frequency GPS receivers during the first significant geomagnetic storm of solar cycle 24 on 5–7 April 2010. The impact of a bipolar magnetic cloud of north-south (NS) type embedded in high speed solar wind from a coronal hole caused a geomagnetic storm with maximum 3-hourly Kp = 8- and hourly ring current Dst =−73 nT. The interhemispheric comparison of phase scintillation reveals similarities but also asymmetries of the ionospheric response in the northern and southern auroral zones, cusps and polar caps. In the nightside auroral oval and in the cusp/cleft sectors the phase scintillation was observed in both hemispheres at about the same times and was correlated with geomagnetic activity. The scintillation level was very similar in approximately conjugate locations in Qiqiktarjuaq (75.4° N; 23.4° E CGM lat. and lon.) and South Pole (74.1° S; 18.9° E), in Longyearbyen (75.3° N; 111.2° E) and Zhongshan (74.7° S; 96.7° E), while it was significantly higher in Cambridge Bay (77.0° N; 310.1° E) than at Mario Zucchelli (80.0° S; 307.7° E). In the polar cap, when the interplanetary magnetic field (IMF) was strongly northward, the ionization due to energetic particle precipitation was a likely cause of scintillation that was stronger at Concordia (88.8° S; 54.4° E) in the dark ionosphere than in the sunlit ionosphere over Eureka (88.1° N; 333.4° E), due to a difference in ionospheric conductivity. When the IMF tilted southward, weak or no significant scintillation was detected in the northern polar cap, while in the southern polar cap rapidly varying TEC and strong phase scintillation persisted for many hours. This interhemispheric asymmetry is explained by the difference in the location of solar terminator relative to the cusps in the Northern and Southern Hemisphere. Solar terminator was in the immediate proximity of the cusp in the Southern Hemisphere where sunlit ionospheric plasma was readily convected into the central polar cap and a long series of patches was observed. In contrast, solar terminator was far poleward of the northern cusp thus reducing the entry of sunlit plasma and formation of dense patches. This is consistent with the observed and modeled seasonal variation in occurrence of polar cap patches. The GPS scintillation and TEC data analysis is supported by data from ground-based networks of magnetometers, riometers, ionosondes, HF radars and all-sky imagers, as well as particle flux measurements by DMSP satellites