Current status and future prospects of epidemiology and public health training and research in the WHO African region

Background To date little has been published about epidemiology and public health capacity (training, research, funding, human resources) in WHO/AFRO to help guide future planning by various stakeholders. Methods A bibliometric analysis was performed to identify published epidemiological research. Information about epidemiology and public health training, current research and challenges was collected from key informants using a standardized questionnaire. Results From 1991 to 2010, epidemiology and public health research output in the WHO/AFRO region increased from 172 to 1086 peer-reviewed articles per annum [annual percentage change (APC) = 10.1%, P for trend 90%) reported that this increase is only rarely linked to regional post-graduate training programmes in epidemiology. South Africa leads in publications (1978/8835, 22.4%), followed by Kenya (851/8835, 9.6%), Nigeria (758/8835, 8.6%), Tanzania (549/8835, 6.2%) and Uganda (428/8835, 4.8%) (P < 0.001, each vs South Africa). Independent predictors of relevant research productivity were ‘in-country numbers of epidemiology or public health programmes' [incidence rate ratio (IRR) = 3.41; 95% confidence interval (CI) 1.90-6.11; P = 0.03] and ‘number of HIV/AIDS patients' (IRR = 1.30; 95% CI 1.02-1.66; P < 0.001). Conclusions Since 1991, there has been increasing epidemiological research productivity in WHO/AFRO that is associated with the number of epidemiology programmes and burden of HIV/AIDS cases. More capacity building and training initiatives in epidemiology are required to promote research and address the public health challenges facing the continen

Current status and future prospects of epidemiology and public health training and research in the WHO African region

Since 1991, there has been increasing epidemiological research productivity in WHO/AFRO that is associated with the number of epidemiology programmes and burden of HIV/AIDS cases. More capacity building and training initiatives in epidemiology are required to promote research and address the public health challenges facing the continent

Labour Productivity and Yield Determinants in Cocoa Farming: Evidence from Abia State, Nigeria

The study examined labour productivity and yield determinants among cocoa farmers in Abia state, Nigeria. A multistage purposive sampling technique was adopted in selecting 60 cocoa farmers from the two agricultural zones in Abia State. The analytical techniques used involve inferential statistics like percentages, means, frequency and percentages. Also Log-linear and multiple regression analysis were also used. The results indicated that mean ages was 39 and the use of family labour, hired labour, exchange labour and casual labour constituted 25.0%, 21.67%, 8.3% and 15.0% of labour-use portfolio while the share croppers carried the balance of (30.0%). Also under storey clearing was estimated as 18.3% and fertilizer application was 16.7 %. Labour was engaged more on agrochemical spraying while cocoa harvesting operations gave the averages of 35.0 % and 30.0 % respectively. Results showed that the coefficient of multiple determinations was 0.892.The coefficient for level of education was estimated as 0.809 with t-ratio of 14.308 at (p<0.001).Also farming experience has coefficient of 0.159 t-ratio of 2.169 at (p<0.05) and Farm size has -0.052 coefficient, t-ratio of-1.888 at (p<0.01) were significant determinants of labour productivity. Also multiple regression result of the determinants of output indicated that the coefficient of multiple determination was 0.870 Planting materials, fertilizer use and Capital were significant determinant of output among cocoa farmers at (p<0.001),(p<0.05) and (p<0.01) respectively. The result further showed that poor farm wages (labour payments) ranked highest (38.3 percent) among labour inhibitor in the study area. The study therefore recommends adequate policy that would encourage provision of capital and farm inputs to cocoa farmers

Labour Productivity and Yield Determinants in Cocoa Farming: Evidence from Abia State, Nigeria

The study examined labour productivity and yield determinants among cocoa farmers in Abia state, Nigeria. A multistage purposive sampling technique was adopted in selecting 60 cocoa farmers from the two agricultural zones in Abia State. The analytical techniques used involve inferential statistics like percentages, means, frequency and percentages. Also Log-linear and multiple regression analysis were also used. The results indicated that mean ages was 39 and the use of family labour, hired labour, exchange labour and casual labour constituted 25.0%, 21.67%, 8.3% and 15.0% of labour-use portfolio while the share croppers carried the balance of (30.0%). Also under storey clearing was estimated as 18.3% and fertilizer application was 16.7 %. Labour was engaged more on agrochemical spraying while cocoa harvesting operations gave the averages of 35.0 % and 30.0 % respectively. Results showed that the coefficient of multiple determinations was 0.892.The coefficient for level of education was estimated as 0.809 with t-ratio of 14.308 at (p<0.001).Also farming experience has coefficient of 0.159 t-ratio of 2.169 at (p<0.05) and Farm size has -0.052 coefficient, t-ratio of-1.888 at (p<0.01) were significant determinants of labour productivity. Also multiple regression result of the determinants of output indicated that the coefficient of multiple determination was 0.870 Planting materials, fertilizer use and Capital were significant determinant of output among cocoa farmers at (p<0.001),(p<0.05) and (p<0.01) respectively. The result further showed that poor farm wages (labour payments) ranked highest (38.3 percent) among labour inhibitor in the study area. The study therefore recommends adequate policy that would encourage provision of capital and farm inputs to cocoa farmers

Update on diagnostic and treatment of uncomplicated and complicated malaria in adults and selected vulnerable populations

Although malaria remains one of the most important infectious causes of morbidity and mortality world-wide with 40% of the global population at risk, significant progress has been made toward elimination, notably with the development and use of rapid diagnostic tests, insecticide-treated bed nets, indoor residual spraying, and artemisinin-based combination therapies (ACTs). P. falciparum infection remains the most common cause of severe infection and death, but non-P. P. falciparum infections, including the recently emerged 5(th) plasmodium species, P. knowlesi, are increasingly recognized as causes of severe disease, especially in southeast Asia. Chemotherapy for severe infections has been revolutionized following results of the SEQUAMAT and AQUAMAT trials showing that parenteral artesunate (versus quinine) reduced severe malaria mortality by 34.7% and 22.5% in Asian adults and African children, respectively, making it the drug of choice for severe malaria. However, rising rates of artemisinin resistance, currently confined to the Greater Mekong sub-region, are threatening the long-term efficacy of artemisinins. HIV infection remains an important risk factor for death and severe disease due to malaria. The full amplitude of mutual interactions between these conditions is only beginning to be elucidated while the complex, multi-directional and pharmacokinetic interactions between antimalarial agents and HIV drugs continue to emerge

Steady state haemoglobin level increases with the proportion of erythrocyte membrane n-3 fatty acids in sickle cell anaemia

Previous studies indicate that perturbation of erythrocyte and/or plasma lipids occurs in homozygous sickle cell disease (SCD), and treatment with n-3 fatty acids (FA) is beneficial to affected individuals (Tomer et al, Thromb Haemost 2001; 966–974). Phosphatidylserine has a role in sickle erythrocyte-endothelial adhesion, which contributes to vessel occlusion in SCD (Setty et al, Blood 2002; 1564–1571). Considering that n-3 and n-6 FA are essential structural and functional components of the red cell membrane, the objective of this study was to find out if abnormalities of these FA affect the degree of anaemia in SCD. We recruited 43 HbSS patients and 43 racially-matched, healthy, HbAA controls living in the same environment; analysed the fatty acid composition of erythrocyte membrane choline (CPG), serine (SPG) and ethanolamine (EPG) phosphoglycerides and sphingomyelin (SPM); and sought for relationship between steady-state Hb level in SCD and the proportion of n-3 FA in the red cell membrane. HbSS individuals had high levels of adrenic and docosapentanoic acids in CPG, EPG, SPG (p<0.001), and SPM (p<0.05). Arachidonic acid (AA) was increased in CPG (p<0.001) and EPG (p<0.005) of the patients. In contrast, linoleic acid (LA) was low in patients' CPG, EPG, SPG and SPM (p<0.001). Both LA and AA were reduced in plasma CPG, triglycerides and cholesterol esters of SCD patients. There was significant positive correlation between steady-state Hb level and n-3 FA content of erythrocytes: docosahexaenoic (DHA, p<0.01, r = 0.63) and eicosapentanoic (EPA) acids in red cell CPG, and EPA in EPG (p<0.05, r = 0.60); figs. 1&2. The observed high AA with low DHA/EPA levels favour red cell adherence to vascular endothelium and vaso-occlusion. The data suggest that in SCD: synthesis of AA and/or membrane uptake of LA and AA may be abnormal; increased proportions of erythrocyte membrane DHA and EPA confer some resistance to haemolysis

Blood mononuclear cells and platelets have abnormal fatty acid composition in homozygous sickle cell disease

Leukocyte adhesion to vascular endothelium contributes to vaso-occlusion and widespread organ damage in sickle cell disease (SCD). Previously, we found high expression of the adhesion molecules αMβ2 integrin and L-selectin in HbSS individuals with severe disease. The n-6 and n-3 polyunsaturated fatty acids (FA) are vital structural and functional components of cell and sub-cellular membranes. They modulate cell adhesion, inflammation, aggregation and vascular tone. We investigated the FA composition of mononuclear cells (MNC) and platelets of HbSS patients in steady-state (n = 28); and racially matched, healthy HbAA controls (n = 13). MNC phospholipids of the patients had low levels of docosahexanoic acid (DHA, p<0.01), n-3 metabolites (p<0.05) and total n-3 polyunsaturated FA (p<0.05); table 1. In contrast, arachidonic (AA, p<0.005), AA:DHA ratio (p<0.005, fig 1) and total n-6 metabolites (p<0.05) were increased in the patients. Similarly, platelets from HbSS patients had low levels of eicosapentanoic acid (EPA, p<0.05), and raised AA (p<0.05) in choline phosphoglycerides (CPG); with reduced linoleic acid (LA, p<0.005) and DHA (p<0.05) in ethanolamine phosphoglycerides. Platelet CPG had lower DHA levels in HbSS individuals with complications of SCD compared to those who had no complications (p<0.05, fig.2). Reduced EPA and DHA relative to AA favours the production of aggregatory and pro-inflmmatory eicosanoids that activate leukocytes and platelets. This may lead to enhanced inflammation, leukocyte adhesion, platelet aggregation and vaso-occlusion in SCD. Table 1: Fatty Acid Composition of MNC Total Phospholipids in HbSS Patients and HbAA Controls Fatty Acids HbSS Patients HbAA Controls 24:0 0.71 [0.30]*** 1.3 [0.4] saturates ∑ 38.2 [3.6] 39.1 [1.7] 16:1 0.69 [0.45] 0.56 [0.11] 18:1 14.4 [1.8]* 12.9 [1.9] 24:1 1.2 [0.3] 1.1 [0.4] ∑monoenes 16.2 [2.1]** 14.3 [1.4] 18:2n-6 6.1 [0.9] 7.0 [1.4] 18:3n-6 0.11 [0.04]* 0.23 [0.17] 20:2n-6 0.56 [0.18]** 0.83 [0.32] 20:3n-6 (DHGLA) 1.2 [0.2]* 1.4 [0.2] 20:4n-6 20.2 [1.7]*** 18.1 [1.8] 22:4n-6 1.7 [0.4] 1.6 [0.4] 22:5n-6 0.3 [0.21] 0.24 [0.14] n-6 metabolites ∑ 24.1 [1.9]* 22.6 [1.7] n-6 ∑ 30.2 [2.0] 29.7 [2.2] 20:5n-3 (EPA) 0.43 [0.16] 0.61 [0.35] 22:6n-3 (DHA) 1.9 [0.4]** 2.5 [0.6] ∑n-3metabolites 4.3 [0.9]* 4.8 [0.4] n-3 ∑ 4.5 [0.9]* 5.0 [0.4] DHGLA:AA ratio 0.06 [0.01]**** 0.08 [0.01] AA:EPA ratio 52.4 [20.9] 38.6 [18.4] Values are Means [SD}. *p<0.05, **p<0.01, ***p<0.005, ****p<0.00