Hydrology and public health: linking human leptospirosis and local hydrological dynamics in Trinidad, West Indies

Abstract Background Human leptospirosis is currently one of the most widespread bacterial zoonoses and is the only epidemic-prone infection that can be transmitted directly from contaminated water. Transmission in humans is caused by direct or indirect contact with contaminated water, soil or infected urine, blood or tissue of carrier animals. Initial symptoms are similar with those suffered during influenza, dengue or viral hepatitis. As the disease progresses, internal organs can be compromised causing severe hemorrhages, organ failure and, potentially, death. Human leptospirosis is a growing global public health problem although, in endemic areas, it is considered a neglected disease. Hydrological factors, including rainfall and floods, have been frequently related to human leptospirosis. In the Caribbean, leptospirosis is endemic and it is a disease under surveillance. Based on confirmed cases, in Trinidad &amp; Tobago the average annual incidence of human leptospirosis ranges between 1.78 to 1.84 cases per 100,000 population. Methods In this paper, we used Geographical Information System (GIS) analysis and Geographically Weighted Poisson Regression (GWPR) for the development of ecological models, to assess the spatial variability in the relationships between local hydrological factors and human leptospirosis occurrence at the community level on the island of Trinidad. Five explanatory covariates were developed for the analysis: rainfall, river drainage density, proportion of soil with free drainage, proportion of soil with imperfect/impeded drainage, and a topographic wetness index. Results The GWPR model presented an improvement (AICc = 392.46; deviance = 583.36) over the Global regression model (AICc = 595.52; deviance = 381.78), indicating spatial variability in the relationship of human leptospirosis and hydrological factors. Pseudo t-values of rainfall, imperfect/impeded drainage soil and the topographic wetness index showed high values (|t| &gt;1.96) indicating that local relationships with leptospirosis occurrence may be significant. Conclusion Results suggest that rainfall, imperfect/impeded drainage soil and topographic wetness index influence the local dynamics of human leptospirosis. </jats:sec

The dilemmas of risk-sensitive development on a small volcanic island

In the Small Islands Developing State (SIDS) of St Vincent and the Grenadines in the Caribbean, the most destructive disasters in terms of human casualties have been the multiple eruptions of La Soufrière volcano situated in the north of St Vincent. Despite this major threat, people continue to live close to the volcano and national development plans do not include risk reduction measures for volcanic hazards. This paper examines the development options in volcanic SIDS and presents a number of conundrums for disaster risk management on the island of St Vincent. Improvements in monitoring of volcanic hazards and ongoing programmes to enhance communications systems and encourage community preparedness planning have increased awareness of the risks associated with volcanic hazards, yet this has not translated into more risk-informed development planning decisions. The current physical development plan in fact promotes investment in infrastructure in settlements located within the zone designated very high-hazard. However, this is not an anomaly or an irrational decision: severe space constraints in SIDS, as well as other historical social and economic factors, limit growth and options for low-risk development. Greater attention needs to be placed on developing measures to reduce risk, particularly from low-intensity hazards like ash, limiting where possible exposure to volcanic hazards and building the resilience of communities living in high-risk areas. This requires planning for both short- and longer-term impacts from renewed activity. Volcanic SIDS face multiple hazards because of their geography and topography, so development plans should identify these interconnected risks and options for their reduction, alongside measures aimed at improving personal preparedness plans so communities can learn to live with risk

The current use of the artemisinin-based Combination Therapies in adult patients at a Tertiary Hospital, South-South Nigeria

Objective: The antimalarial preferences, tolerability, and cost of the Artemisinin-based combination therapies (ACTs) among adult patients and caregivers are largely understudied despite being the recommended treatment for Plasmodium falciparum. We, therefore, evaluated antimalarial preferences, tolerability, and cost of the ACTs among adult patients attending the University of Benin Teaching Hospital, Nigeria.&nbsp; Methods: This was a cross-sectional study conducted among adult patients and their caregivers at the University of Benin Teaching Hospital, Nigeria, using a semi-structured questionnaire. Their preferred antimalarial medication, previous use of antimalarial monotherapies, current ACT use; cost considerations, and adverse effects profile were sought. Result: Six hundred respondents were recruited with a mean age of 41.4±16.3years and M/F ratio of 1.4. The majority (88.0 %), reported that they had between 1-5 episodes of malaria fever in a year. Only 28.2% received doctors’ prescriptions while 85.8% purchased their antimalarial medications from a pharmacy. Sixty percent of the respondents used at least one ACT; mainly Artemether-Lumefantrine (AL) 312 (52.0%). Only 9.3% reported previous adverse effects with the ACTs with 4.0% of respondents discontinuing their medications. The mean (SD) cost of purchasing ACTs was 1,516.47±760.3 (3.65 USD) Naira. Conclusion: This study showed adult patients’ preference for the ACTs, especially Artemether-Lumefantrine despite some inclination towards antimalarial monotherapies and parenteral route. There was also a high rate of use of malaria presumptive treatment, but only a few reported adverse effects. There is a need to make ACTs affordable because the cost is still presently high for most Nigerians

Management of snakebite victims using low dose antisnake venom in a tertiary hospital in Southern Nigeria: A 5-year Retrospective study

Objective: Antisnake venom (ASV) is a specific antidote for the  management of snake bite envenomations. This study profiled the  treatment and outcome of adult snake bite victims managed using low dose antisnake venom.Methods: This was a 5-year retrospective study that involved all adult  patients who presented in University of Benin Teaching Hospital, Benin City, Nigeria, with a history of snake bite. Information obtained were  demographic characteristics, clinical features, and administered treatment per established. All patients with a diagnosis of snake bite envenomation were administered ASV.Results: Sixty patients were seen during the study period, 35(58.3%)  males, 25(41.7%) females with a mean age was 34.7±13.3. The mean time from bite to presentation was 14.67±14.05 hours with range of 1- 48 hours. Twenty patients (33.3%) had snake bite envenomations, of these eleven (57.9%) were managed and discharged after administration of 30 to 40 mls of polyvalent ASV. The mean dose of PASV used was 3.9 ± 2.0 vials. The most encountered clinical indication for ASV administration was  progressive painful swelling. No death was recorded throughout this period studied.Conclusion: Adoption of the low dose regimen in the management of snake bite envenomations may be as effective as the traditional high dose regimen.Key words: Snake bite, envenomation, polyvalent antisnake venom,  Nigeria

Soil Friction Angle as an Instability Factor in Landslide Susceptibility Modeling

Abstract Landslide susceptibility mapping and modeling is critical in the understanding and consequent management of land resources. A study was conducted to ascertain the effect of an intrinsic soil property on landslide susceptibility mapping. Soil friction angle was added as instability factor in the form of PFAS (Peak friction angle -Slope) and RFAS (Residual friction angle -slope). These novel parameters replaced two traditional parameter; lithology and slope. Results indicated that PFAS and RFAS were significant additions and increased the predictive capabilities of the model

Advancing geospatial information management for disaster risk management in the Caribbean

The Caribbean is highly vulnerable to the impacts of climate change, extreme weather events and other natural hazards. The subregion is also exposed to anthropogenic hazards, including petroleum and other industrial chemical spills, fires, and soil, air and water pollution. These hazards can result in loss of life and other health impacts, damage to infrastructure, social and economic disruptions and ecological degradation. To significantly reduce the negative effects of these hazards, it is important that key stakeholders, including national disaster management agencies, development partners, and the private sector, particularly insurance companies be integrally engaged in the shaping of comprehensive disaster risk management (DRM) strategies and plans. The success of DRM will depend on the effective management of relevant information and data. Geospatial Information Management (GIM) has enabled more timely, data-driven, informed DRM decision-making. This research provides an introduction to the status and use of GIM in support of DRM in the Caribbean region. The data and information obtained from on-line surveys and desk studies indicated that the Caribbean countries are at varying stages of progress towards the integration of GIM in DRM. Policy setting, legislation, education, capacity building, technological investment and institutional strengthening driving geospatial data management are priority areas identified for further advancing this progress. The study offers recommendations towards further strengthening the use of GIM in DRM both nationally and at the level of the Caribbean region.Abstract .-- Introduction .-- I. Methodology .-- II. Geospatial Information Management and Disaster Risk Management .-- III. Geospatial Information Management for Disaster Risk Management in the Caribbean .-- IV. Recommendations for advancing geospatial information management for disaster risk management

The current use of the artemisinin-based Combination Therapies in adult patients at a Tertiary Hospital, South-South Nigeria

Objective: The antimalarial preferences, tolerability, and cost of the Artemisinin-based combination therapies (ACTs) among adult patients and caregivers are largely understudied despite being the recommended treatment for Plasmodium falciparum. We, therefore, evaluated antimalarial preferences, tolerability, and cost of the ACTs among adult patients attending the University of Benin Teaching Hospital, Nigeria.  Methods: This was a cross-sectional study conducted among adult patients and their caregivers at the University of Benin Teaching Hospital, Nigeria, using a semi-structured questionnaire. Their preferred antimalarial medication, previous use of antimalarial monotherapies, current ACT use; cost considerations, and adverse effects profile were sought. Result: Six hundred respondents were recruited with a mean age of 41.4±16.3years and M/F ratio of 1.4. The majority (88.0 %), reported that they had between 1-5 episodes of malaria fever in a year. Only 28.2% received doctors’ prescriptions while 85.8% purchased their antimalarial medications from a pharmacy. Sixty percent of the respondents used at least one ACT; mainly Artemether-Lumefantrine (AL) 312 (52.0%). Only 9.3% reported previous adverse effects with the ACTs with 4.0% of respondents discontinuing their medications. The mean (SD) cost of purchasing ACTs was 1,516.47±760.3 (3.65 USD) Naira. Conclusion: This study showed adult patients’ preference for the ACTs, especially Artemether-Lumefantrine despite some inclination towards antimalarial monotherapies and parenteral route. There was also a high rate of use of malaria presumptive treatment, but only a few reported adverse effects. There is a need to make ACTs affordable because the cost is still presently high for most Nigerians

Ther Adv Drug Saf

Background: Our aim in this study was to evaluate the effect of a combined educational intervention and year-long monthly text message reinforcements via the Short Messaging System (SMS) on the knowledge, attitude and practice (KAP) of healthcare professionals (HCPs) towards pharmacovigilance. Methods: Six randomly selected teaching hospitals in the South-South zone of Nigeria were randomized in 1:1 ratio into intervention and control groups. The educational intervention consisted of delivering a seminar followed by sending monthly texts message reinforcements via SMS over 12 months. Then a semi-structured questionnaire regarding the KAP of pharmacovigilance was completed by HCPs working in the hospitals after the intervention. Data was analysed descriptively and inferentially. Results: A total of 931 HCPs participated in the post intervention study (596 in the intervention and 335 in the control). The M:F ratio was 1:1.5. According to the KAP questionnaire, a significant difference was observed between the intervention and control groups, regarding knowledge of the types of adverse drug reactions (ADRs). ADR resulting from pharmacological action of the drug (85.6% versus 77%, p = 0.001), the fact that ADRs can persist for a long time; (60.1% versus 53.4%, p = 0.024) and a higher awareness of the ADR reporting form (48.7% versus 18.8%, p < 0.001). Most respondents in the intervention group (68.5% versus 60.6%, p = 0.001) believed they should report ADRs even if they were unsure an ADR has occurred, a greater proportion of HCPs from the intervention group had significantly observed an ADR (82% versus 73.4%, p = 0.001). Furthermore, of the 188 who had ever reported an ADR, 41% from the intervention group used the national ADR reporting form compared with 19.8% from the controls (p < 0.001). Conclusion: This educational intervention and the use of SMS as a reinforcement tool appeared to have positively impacted on the knowledge and practice of pharmacovigilance in South-South Nigeria with a less-than-impressive change in attitude. Continuous medical education may be required to effect long-lasting changes

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic