Fluoride removal performance of phosphoric acid treated lime: Breakthrough analysis and point-of-use system performance

Fluoride in drinking water above permissible levels is responsible for dental and skeletal fluorosis. In this study, removal of fluoride ions from water using phosphoric acid treated lime was investigated in continuous and point-of-use system operations. In the continuous column operations, fluoride removal performance was investigated as a function of the fluoride concentration, flow rate and amount of adsorbent mass. Early saturation and lower fluoride removal were observed at higher flow rate and initial concentration, and at lower mass. Two domestic defluoridation point-of-use systems operated intermittently to process 20 ..day.1 of water were used. High fluoride uptake capacity (FUC) from groundwater was observed depicting the suitability of the new media in defluoridation. However, further research is required to optimise the point-ofuse systems performances

Cost-effectiveness of conditional cash transfers to retain women in the continuum of care during pregnancy, birth and the postnatal period: protocol for an economic evaluation of the Afya trial in Kenya

Introduction A wealth of evidence from a range of country settings indicates that antenatal care, facility delivery and postnatal care can reduce maternal and child mortality and morbidity in high-burden settings. However, the utilisation of these services by pregnant women, particularly in low/middle-income country settings, is well below that recommended by the WHO. The Afya trial aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased utilisation of these services in rural Kenya and thus retain women in the continuum of care during pregnancy, birth and the postnatal period. This protocol describes the planned economic evaluation of the Afya trial. Methods and analysis The economic evaluation will be conducted from the provider perspective as a within-trial analysis to evaluate the incremental costs and health outcomes of the cash transfer programme compared with the status quo. Incremental cost-effectiveness ratios will be presented along with a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Sensitivity analyses will be undertaken to explore uncertainty and to ensure that results are robust. A fiscal space assessment will explore the affordability of the intervention. In addition, an analysis of equity impact of the intervention will be conducted. Ethics and dissemination The study has received ethics approval from the Maseno University Ethics Review Committee, REF MSU/DRPI/MUERC/00294/16. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference. Trial registration number NCT0302107

Fresh driver for economic growth: fracking the UK nation

Purpose The purpose of this paper was to examine UK shale gas viability. The recent commitment to shale gas exploration in the UK through fracking has given rise to well-publicised economic benefits and environmental concerns. There is potential for shale gas exploration in different parts of the UK over the next couple of decades. As argued in this study, if it does, it would transform the energy market and provide long-term energy security at affordable cost. Design/methodology/approach Interviews with senior practitioners and local communities were recorded, transcribed and entered into qualitative research software Nvivo. Validity and reliability were achieved by first assessing the plausibility in terms of already existing knowledge on some of the economic and environmental issues raised by participants. Findings Findings from this study suggest that environmental, health and safety risks can be managed effectively provided operational best practices are implemented and monitored by the Health and Safety Executive; Department of Energy, Climate Change; and the Mineral Planning Authorities. Participants further suggested that the integration of shale gas technology will protect consumers against rising energy prices and ensure that government does not get exposed to long-term geopolitical risks. Practical implications The present study corroborates the position that environmental, health and safety risks can be managed effectively provided operational best practices are implemented and monitored by the Health and Safety Executive; Department of Energy, Climate Change; and the Mineral Planning Authorities. Social implications The present study confirms that the government is committed to ensuring that the nation maximises the opportunity that cost-effective shale gas technology presents, not just investment, cheap energy bills and jobs but providing an energy mix that will underpin the UK long-term economic prosperity. Originality/value The present study corroborates the position that environmental, health and safety risks can be managed effectively provided operational best practices are implemented and monitored by the Health and Safety Executive; Department of Energy, Climate Change; and the Mineral Planning Authorities. As shown in this study, the UK has a very strong regulatory regime compared to USA; therefore, environmental, health and safety risks will be very well managed and unlikely to escalate into the crisis being envisioned

Reliability of Community Health Worker Collected Data for Planning and Policy in a Peri-Urban Area of Kisumu, Kenya

A general introduction of this article is as follows: Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally (Aqil et al. in Health Policy Plan 24(3): 217–228, 2009; Bradshaw et al. in initial burden of disease estimates for South Africa, 2000. South African Medical Research Council, Cape Town, 2003). The need for sound information is especially urgent in the case of emergent diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics (Aqil et al. in Health Policy Plan 24(3): 217–228, 2009). The government of Kenya, through the ministry of public health and sanitation has rolled out the community health strategy as a way of improving health care at the household level. This involves community health workers collecting health status data at the household level, which is then used for dialogue at all the levels to inform decisions and actions towards improvement in health status. A lot of health interventions have involved the community health workers in reaching out to the community, hence successfully implementing these health interventions. Large scale involvement of community health workers in government initiatives and most especially to collect health data for use in the health systems has been minimal due to the assumption that the data may not be useful to the government, because its quality is uncertain. It was therefore necessary that the validity and reliability of the data collected by community health workers be determined, and whether this kind of data can be used for planning and policy formulation for the communities from which it is collected. This would go a long way to settle speculation on whether the data collected by these workers is valid and reliable for use in determining the health status, its causes and distribution, of a community. Our general objective of this article is to investigate the validity and reliability of Community Based Information, and we deal with research question “What is the reliability of data collected at the Community level by Community health workers?”. The methods which we use to find an reliable answer to this question is “Ten percent of all households visited by CHWs for data collection were recollected by a technically trained team. Test/retest method was applied to the data to establish reliability. The Kappa score, sensitivity, specificity and positive predictive values were also used to measure reliability”. Finally our findings are as follows: Latrine availability and Antenatal care presented good correspondence between the two sets of data. This was also true for exclusive breast feeding indicator. Measles immunization coverage showed less consistency than the rest of the child health indicators. At last we conclude and recommend that CHWs can accurately and reliably collect household data which can be used for health decisions and actions especially in resource poor settings where other approaches to population based data are too expensive

Surgical outcomes in eastern Uganda: A one-year cohort study

© 2018 The Author(s). Introduction: There is urgent need to improve access to safe surgical treatments for patients in low-and middle-income countries (LMICs). However, few data exist to characterise clinical outcomes for this patient population. Methods: Consecutive patients undergoing surgery at a referral hospital in Uganda were prospectively followed between October 2016 and October 2017. The primary outcome was in-hospital, postoperative mortality. Secondary outcomes were in-hospital complications for patients undergoing laparotomy and Caesarean section. Results are presented as n (%) or odds ratios (OR) with 95% confidence intervals. Results: A total of 4 773 patients of mean age 28 years were included; 3 754 were female (79.0%) and 4 259 patients (89.4%) were classified as American Society of Anesthesiologists class I or II. Some 3 501 (73.8%) procedures were performed on an emergency basis. The most frequent procedure was Caesarean section (2 634 patients [55.3%]). There were 93 deaths (2.0%), 49 of which occurred after the day of surgery (59.0%). In multivariable analysis, patients undergoing general (abdominal) surgery were at greatest risk of death (OR 4.34 [2.02–9.30]). Postoperative complications were recorded for 24/412 (5.8%) patients undergoing Caesarean section and 18/107 (16.8%) patients undergoing emergency laparotomy. Infection was the most frequent complication in these patient groups (33/519 patients [6.4%]). Conclusions: This study confirms the feasibility of longitudinal audit of postoperative outcomes in LMICs. Data collected over a one-year period were highly consistent with the findings of a recent seven-day cohort study conducted across Africa

The clinical presentation of culture-positive and culture-negative, qPCR-attributable shigellosis in the Global Enteric Multicenter Study and derivation of a Shigella severity score: implications for pediatric Shigella vaccine trials

BACKGROUND: Shigella is a leading cause of childhood diarrhea and target for vaccine development. Microbiologic and clinical case definitions are needed for pediatric field vaccine efficacy trials. METHODS: We compared characteristics of moderate to severe diarrhea (MSD) cases in the Global Enteric Multicenter Study (GEMS) between children with culture positive Shigella to those with culture-negative, qPCR-attributable Shigella (defined by an ipaH gene cycle threshold <27.9). Among Shigella MSD cases, we determined risk factors for death and derived a clinical severity score. RESULTS: Compared to culture-positive Shigella MSD cases (n=745), culture-negative/qPCR-attributable Shigella cases (n=852) were more likely to be under 12 months, stunted, have a longer duration of diarrhea, and less likely to have high stool frequency or a fever. There was no difference in dehydration, hospitalization, or severe classification from a modified Vesikari score. Twenty-two (1.8%) Shigella MSD cases died within the 14-days after presentation to health facilities, and 59.1% of these deaths were in culture-negative cases. Age < 12 months, diarrhea duration prior to presentation, vomiting, stunting, wasting, and hospitalization were associated with mortality. A model-derived score assigned points for dehydration, hospital admission, and longer diarrhea duration but was not significantly better at predicting 14-day mortality than a modified Vesikari score. CONCLUSIONS: A composite severity score consistent with severe disease or dysentery may be a pragmatic clinical endpoint for severe shigellosis in vaccine trials. Reliance on culture for microbiologic confirmation may miss a substantial number of Shigella cases but is currently required to measure serotype specific immunity

Status and distribution of mangroves forests of the world using earth observation satellite data.

ABSTRACT Aim Our scientific understanding of the extent and distribution of mangrove forests of the world is inadequate. The available global mangrove databases, compiled using disparate geospatial data sources and national statistics, need to be improved. Here, we mapped the status and distributions of global mangroves using recently available Global Land Survey (GLS) data and the Landsat archive. Methods We interpreted approximately 1000 Landsat scenes using hybrid supervised and unsupervised digital image classification techniques. Each image was normalized for variation in solar angle and earth-sun distance by converting the digital number values to the top-of-the-atmosphere reflectance. Ground truth data and existing maps and databases were used to select training samples and also for iterative labelling. Results were validated using existing GIS data and the published literature to map &apos;true mangroves&apos; . Results The total area of mangroves in the year 2000 was 137,760 km 2 in 118 countries and territories in the tropical and subtropical regions of the world. Approximately 75% of world&apos;s mangroves are found in just 15 countries, and only 6.9% are protected under the existing protected areas network (IUCN I-IV). Our study confirms earlier findings that the biogeographic distribution of mangroves is generally confined to the tropical and subtropical regions and the largest percentage of mangroves is found between 5°N and 5°S latitude. Main conclusions We report that the remaining area of mangrove forest in the world is less than previously thought. Our estimate is 12.3% smaller than the most recent estimate by the Food and Agriculture Organization (FAO) of the United Nations. We present the most comprehensive, globally consistent and highest resolution (30 m) global mangrove database ever created. We developed and used better mapping techniques and data sources and mapped mangroves with better spatial and thematic details than previous studies

Modelling the impact of climate change on Tanzanian forests

This research article was published by Wiley Online Library in 2020Aim: Climate change is pressing extra strain on the already degraded forest eco system in Tanzania. However, it is mostly unknown how climate change will affect the distribution of forests in the future. We aimed to model the impacts of climate change on natural forests to help inform national-level conservation and mitigation strategies. Location: Tanzania. Methods: We conducted maximum entropy (MaxEnt) modelling to simulate forest habitat suitability using the Tanzanian national forest inventory survey (1,307 oc currences) and environmental data. Changes in forest habitats were simulated under two Representative Concentration Pathways (RCPs) emission scenarios RCP 4.5 and RCP 8.5 for 2055 and 2085. Results: The results indicate that climate change will threaten forest communities, especially fragmented strips of montane forests. Even under optimistic emission scenario, the extent of montane forest is projected to almost halve by 2085, inter secting many biodiversity hotspots across the Eastern Arc Mountains. Similarly, cli mate change is predicted to threaten microhabitat forests (i.e. thickets), with losses exceeding 70% by 2085 (RCP8.5). Other forest habitats are predicted to decrease (lowland forest and woodland) representing essential ecological networks, whereas suitable habitats for carbon-rich mangroves are predicted to expand by more than 40% at both scenarios. Conclusions: Climate change will impact forests by accelerating habitat loss, and fragmentation and the remaining land suitable for forests will also be subject to pres sures associated with rising demand for food and biofuels. These changes are likely to increase the probability of adverse impacts to the country's indigenous flora and fauna. Our findings, therefore, call for a shift in conservation efforts, focusing on (i) the enhanced management of existing protected areas that can absorb the impacts of future climate change, and (ii) expanding conservation efforts into newly suitable regions through effective land use planning and land reclamation, helping to preserve and enhance forest connectivity between fragmented patches

Status and distribution of mangroves forests of the world using earth observation satellite data.

ABSTRACT Aim Our scientific understanding of the extent and distribution of mangrove forests of the world is inadequate. The available global mangrove databases, compiled using disparate geospatial data sources and national statistics, need to be improved. Here, we mapped the status and distributions of global mangroves using recently available Global Land Survey (GLS) data and the Landsat archive. Methods We interpreted approximately 1000 Landsat scenes using hybrid supervised and unsupervised digital image classification techniques. Each image was normalized for variation in solar angle and earth-sun distance by converting the digital number values to the top-of-the-atmosphere reflectance. Ground truth data and existing maps and databases were used to select training samples and also for iterative labelling. Results were validated using existing GIS data and the published literature to map &apos;true mangroves&apos; . Results The total area of mangroves in the year 2000 was 137,760 km 2 in 118 countries and territories in the tropical and subtropical regions of the world. Approximately 75% of world&apos;s mangroves are found in just 15 countries, and only 6.9% are protected under the existing protected areas network (IUCN I-IV). Our study confirms earlier findings that the biogeographic distribution of mangroves is generally confined to the tropical and subtropical regions and the largest percentage of mangroves is found between 5°N and 5°S latitude. Main conclusions We report that the remaining area of mangrove forest in the world is less than previously thought. Our estimate is 12.3% smaller than the most recent estimate by the Food and Agriculture Organization (FAO) of the United Nations. We present the most comprehensive, globally consistent and highest resolution (30 m) global mangrove database ever created. We developed and used better mapping techniques and data sources and mapped mangroves with better spatial and thematic details than previous studies