Dynamics of Cough Frequency in Adults Undergoing Treatment for Pulmonary Tuberculosis.

Background: Cough is the major determinant of tuberculosis transmission. Despite this, there is a paucity of information regarding characteristics of cough frequency throughout the day and in response to tuberculosis therapy. Here we evaluate the circadian cycle of cough, cough frequency risk factors, and the impact of appropriate treatment on cough and bacillary load. Methods: We prospectively evaluated human immunodeficiency virus-negative adults (n = 64) with a new diagnosis of culture-proven, drug-susceptible pulmonary tuberculosis immediately prior to treatment and repeatedly until treatment day 62. At each time point, participant cough was recorded (n = 670) and analyzed using the Cayetano Cough Monitor. Consecutive coughs at least 2 seconds apart were counted as separate cough episodes. Sputum samples (n = 426) were tested with microscopic-observation drug susceptibility broth culture, and in culture-positive samples (n = 252), the time to culture positivity was used to estimate bacillary load. Results: The highest cough frequency occurred from 1 pm to 2 pm, and the lowest from 1 am to 2 am (2.4 vs 1.1 cough episodes/hour, respectively). Cough frequency was higher among participants who had higher sputum bacillary load (P < .01). Pretreatment median cough episodes/hour was 2.3 (interquartile range [IQR], 1.2-4.1), which at 14 treatment days decreased to 0.48 (IQR, 0.0-1.4) and at the end of the study decreased to 0.18 (IQR, 0.0-0.59) (both reductions P < .001). By 14 treatment days, the probability of culture conversion was 29% (95% confidence interval, 19%-41%). Conclusions: Coughs were most frequent during daytime. Two weeks of appropriate treatment significantly reduced cough frequency and resulted in one-third of participants achieving culture conversion. Thus, treatment by 2 weeks considerably diminishes, but does not eliminate, the potential for airborne tuberculosis transmission

Determining a cost effective intervention response to HIV/AIDS in Peru

BACKGROUND: The HIV epidemic in Peru is still regarded as concentrated -- sentinel surveillance data shows greatest rates of infection in men who have sex with men, while much lower rates are found in female sex workers and still lower in the general population. Without an appropriate set of preventive interventions, continuing infections could present a challenge to the sustainability of the present programme of universal access to treatment. Determining how specific prevention and care strategies would impact on the health of Peruvians should be key in reshaping the national response. METHODS: HIV/AIDS prevalence levels for risk groups with sufficient sentinel survey data were estimated. Unit costs were calculated for a series of interventions against HIV/AIDS which were subsequently inputted into a model to assess their ability to reduce infection transmission rates. Interventions included: mass media, voluntary counselling and testing; peer counselling for female sex workers; peer counselling for men who have sex with men; peer education of youth in-school; condom provision; STI treatment; prevention of mother to child transmission; and highly active antiretroviral therapy. Impact was assessed by the ability to reduce rates of transmission and quantified in terms of cost per DALY averted. RESULTS: Results of the analysis show that in Peru, the highest levels of HIV prevalence are found in men who have sex with men. Cost effectiveness varied greatly between interventions ranging from peer education of female commercial sex workers at $US 55 up to$US 5,928 (per DALY averted) for prevention of mother to child transmission. CONCLUSION: The results of this work add evidence-based clarity as to which interventions warrant greatest consideration when planning an intervention response to HIV in Peru. Cost effectiveness analysis provides a necessary element of transparency when facing choices about priority setting, particularly when the country plans to amplify its response through new interventions partly funded by the GFATM

Validation of a Spatial Agent-Based Model for Taenia Solium Transmission (“cystiagent”) Against a Large Prospective Trial of Control Strategies in Northern Peru

Background: The pork tapeworm (Taenia solium) is a parasitic helminth that imposes a major health and economic burden on poor rural populations around the world. As recognized by the World Health Organization, a key barrier for achieving control of T. solium is the lack of an accurate and validated simulation model with which to study transmission and evaluate available control and elimination strategies. CystiAgent is a spatially-explicit agent based model for T. solium that is unique among T. solium models in its ability to represent key spatial and environmental features of transmission and simulate spatially targeted interventions, such as ring strategy. Methods/Principal findings: We validated CystiAgent against results from the Ring Strategy Trial (RST)–a large cluster-randomized trial conducted in northern Peru that evaluated six unique interventions for T. solium control in 23 villages. For the validation, each intervention strategy was replicated in CystiAgent, and the simulated prevalences of human taeniasis, porcine cysticercosis, and porcine seroincidence were compared against prevalence estimates from the trial. Results showed that CystiAgent produced declines in transmission in response to each of the six intervention strategies, but overestimated the effect of interventions in the majority of villages; simulated prevalences for human taenasis and porcine cysticercosis at the end of the trial were a median of 0.53 and 5.0 percentages points less than prevalence observed at the end of the trial, respectively. Conclusions/Significance: The validation of CystiAgent represented an important step towards developing an accurate and reliable T. solium transmission model that can be deployed to fill critical gaps in our understanding of T. solium transmission and control. To improve model accuracy, future versions would benefit from improved data on pig immunity and resistance, field effectiveness of anti-helminthic treatment, and factors driving spatial clustering of T. solium infections including dispersion and contact with T. solium eggs in the environment. Author summary: Neurocysticercosis, caused by the ingestion of Taenia solium eggs, is a major cause of human epilepsy around the world. A wide spectrum of tools to fight T. solium is are now available and include antiparasitic treatment for pigs and humans, porcine vaccines, and sanitation improvements; however, the ideal combination of interventions applied to populations to maximize effectiveness and feasibility is not known. Transmission models are one tool that can be used to compare and evaluate different intervention strategies, but no currently available T. solium models have been tested for accuracy. In this research, we validated our model (“CystiAgent”) by comparing simulations of the model to the results of a large-scale trial testing a variety of T. solium control interventions. The model was calibrated using observed epidemiological data from these villages and evaluated for its ability to reproduce the effect of T. solium control interventions. The validation showed that the model was able to reproduce the baseline levels of disease, but generally overestimated the effect that each intervention would have on transmission. These results will allow us to identify limitations of the current model to improve future versions, and represent a step forward in the creation of a tool to design and evaluate future programs to control and eliminate T. solium

Young Lives: an International Study of Childhood Poverty: Round 4, 2013-2014

Abstract copyright UK Data Service and data collection copyright owner.The Young Lives survey is an innovative long-term project investigating the changing nature of childhood poverty in four developing countries. The study is being conducted in Ethiopia, India, Peru and Vietnam and has tracked the lives of 12,000 children over a 20-year period, through 5 (in-person) survey rounds (Round 1-5) and, with the latest survey round (Round 6) conducted over the phone in 2020 and 2021 as part of the Listening to Young Lives at Work: COVID-19 Phone Survey.Round 1 of Young Lives surveyed two groups of children in each country, at 1 year old and 5 years old. Round 2 returned to the same children who were then aged 5 and 12 years old. Round 3 surveyed the same children again at aged 7-8 years and 14-15 years, Round 4 surveyed them at 12 and 19 years old, and Round 5 surveyed them at 15 and 22 years old. Thus the younger children are being tracked from infancy to their mid-teens and the older children through into adulthood, when some will become parents themselves.The 2020 phone survey consists of three phone calls (Call 1 administered in June-July 2020; Call 2 in August-October 2020 and Call 3 in November-December 2020) and the 2021 phone survey consists of two additional phone calls (Call 4 in August 2021 and Call 5 in October-December 2021) The calls took place with each Young Lives respondent, across both the younger and older cohort, and in all four study countries (reaching an estimated total of around 11,000 young people).The Young Lives survey is carried out by teams of local researchers, supported by the Principal Investigator and Data Manager in each country.Further information about the survey, including publications, can be downloaded from the Young Lives website. This study includes data and documentation for Round 4 only. Round 1 is available under SN 5307, Round 2 under SN 6852, Round 3 under SN 6853 and Round 5 under SN 8357.Latest edition:For the third edition (August 2022), the Peruvian younger cohort household level data file (pe_r4_ychh_youngerhousehold) has been updated to include the mother's health variables. In addition, an error in the Vietnamese younger cohort reading comprehension variables (vn_r4_yccog_youngerchildtest) has been corrected.Main Topics: Older Cohort Household Questionnaire (age 19): includes sections on: Parental background; Household and child education; Livelihoods and asset framework; Household food and non-food consumption and expenditure; Social capital; Economic changes and recent life history; Socio-economic status.Older Cohort Child Questionnaire (age 19): includes sections on: Parents and Caregiver update; Mobility; Subjective well-being; Education; Employment, earnings, and time-use; Feelings and attitudes; Household decision-making; Marital and living arrangements; Fertility; Anthropometry; Health and nutrition.Older Cohort Cognitive Tests (age 19): includes Mathematics test; Reading comprehension test.Older Cohort Self-Administered Questionnaire (age 19): includes sections on: Relationship with parents, Smoking, Violence, Alcohol, Sexual behaviour (administered in Peru only).Younger Cohort Household Questionnaire (age 12): includes sections: on Parental background; Household and child education; Livelihoods and asset framework; Household food and non-food consumption and expenditure; Social capital; Economic changes and recent life history; Socio-economic status, Health; Anthropometry (for the study child and a sibling); Caregiver perceptions and attitudes.Younger Cohort Child Questionnaire (age 12): includes sections on Schooling; Time-use; Health; Social networks; Feelings and attitudes.Younger Cohort Cognitive Tests (age 12): include Peabody Picture Vocabulary Test (administered to the study child and a sibling); Mathematics test; Reading comprehension test. In Ethiopia only an additional English and Amharic reading test.Community Questionnaire: (administered in the main communities where Young Lives children live) includes sections on: General characteristics of the locality; Social environment; Access to services; Economy; Local prices; Social protection; Educational services; Health services; Migration. Mini-community questionnaire: (administered in communities into which one or study children moved) includes sections on: General characteristics of the locality; Social environment; Access to Services; Economy; Local prices.</ul

Young Lives: an International Study of Childhood Poverty: Round 5, 2016

Abstract copyright UK Data Service and data collection copyright owner.The Young Lives survey is an innovative long-term project investigating the changing nature of childhood poverty in four developing countries. The study is being conducted in Ethiopia, India, Peru and Vietnam and has tracked the lives of 12,000 children over a 20-year period, through 5 (in-person) survey rounds (Round 1-5) and, with the latest survey round (Round 6) conducted over the phone in 2020 and 2021 as part of the Listening to Young Lives at Work: COVID-19 Phone Survey.Round 1 of Young Lives surveyed two groups of children in each country, at 1 year old and 5 years old. Round 2 returned to the same children who were then aged 5 and 12 years old. Round 3 surveyed the same children again at aged 7-8 years and 14-15 years, Round 4 surveyed them at 12 and 19 years old, and Round 5 surveyed them at 15 and 22 years old. Thus the younger children are being tracked from infancy to their mid-teens and the older children through into adulthood, when some will become parents themselves.The 2020 phone survey consists of three phone calls (Call 1 administered in June-July 2020; Call 2 in August-October 2020 and Call 3 in November-December 2020) and the 2021 phone survey consists of two additional phone calls (Call 4 in August 2021 and Call 5 in October-December 2021) The calls took place with each Young Lives respondent, across both the younger and older cohort, and in all four study countries (reaching an estimated total of around 11,000 young people).The Young Lives survey is carried out by teams of local researchers, supported by the Principal Investigator and Data Manager in each country.Further information about the survey, including publications, can be downloaded from the Young Lives website. This study includes data and documentation for Round 5 only. Round 1 is available under SN 5307, Round 2 under SN 6852, Round 3 under SN 6853 and Round 4 under SN 7931.Latest edition:For the second edition (August 2022), the Peruvian younger cohort household level data file (pe_r5_ychh_youngerhousehold) has been updated to include the mother's health variables.Main Topics: Older Cohort Household Questionnaire (age 22): includes sections on: Parental background; Household education; Livelihoods and asset framework; Economic changes and recent life history; Socio-economic status; Public Programmes.Older Cohort Child Questionnaire (age 22): includes sections on: Mobility; Subjective Wellbeing; Education; General Perceptions; Employment, earnings and time-use; Feelings and Attitudes; Household decision-making; Marital and Living Arrangements; Gender roles and social norms; Fertility; Health and Nutrition; Computer and other digital devices and internet use and skills; Social Capital; Anthropometry.Older Cohort Self-Administered Questionnaire (age 22): includes sections on: Relationship with parents, Smoking, Violence, Alcohol, Sexual behaviour (administered in Peru only).Younger Cohort Household Questionnaire (age 15): includes sections: on Parental background; Household education and time use; Livelihoods and asset framework; Consumption; Social Capital; Economic changes and recent life history; Socio-economic status, Health; Anthropometry (for the study child and a sibling); Caregiver perceptions and attitudes.Younger Cohort Child Questionnaire (age 15): includes sections on Mobility; Time use and work activities; Education and job aspirations; Health; Social norms and gender roles; social networking; Marriage and parenthood expectation; Feelings and Attitudes; Computer, other digital devices and internet usage; Anthropometry.Younger Cohort Cognitive Tests (age 15): include Peabody Picture Vocabulary Test (administered to the study child and a sibling); Mathematics test; Reading comprehension test. In Ethiopia only an additional English and Amharic reading test.Community Questionnaire: (administered in the main communities where Young Lives children live) includes sections on: General characteristics of the locality; Social environment; Access to services; Economy; Local prices; Social protection; Educational services; Health services; Migration.Mini-community questionnaire: (administered in communities into which one or study children moved) includes sections on: General characteristics of the locality; Social environment; Access to Services; Economy; Local prices.</ul