Determinants of lung health across the life course in sub-Saharan Africa

Lung health across the life course is influenced by factors affecting airway and alveolar development and growth during antenatal and perinatal periods, throughout childhood and adolescence, and into adulthood. Lung function trajectories are set in early life and childhood deficits may predispose to non-communicable respiratory diseases, such as asthma and chronic obstructive pulmonary disease, in later years. Potential risk factors are common in many sub-Saharan African (sSA) countries; adverse antenatal environments cause in utero growth restriction and prematurity; HIV and respiratory infections, including TB are common; exposure to air pollution is widespread, including household air pollution from biomass fuel use, traffic-related pollution in rapidly expanding cities, and tobacco smoke exposure. Multiple disadvantages experienced in early life require an integrated approach that addresses reproductive, maternal and child health. Public health strategies need to tackle multiple risk factors, emphasising Universal Health Coverage, to maximise lung health in the world’s poorest, most vulnerable populations. This review explores potential determinants of lung health across the life course. Due to the extensive topic and wide range of related literature, we prioritised more recent citations, especially those from sSA, focusing on risk factors for which there is most information, and which are most prevalent in the region

Prevalence and risk factors for obstructive respiratory conditions among textile industry workers in Zimbabwe, 2006

INTRODUCTION: Workers in the cotton processing industries risk developing obstructive respiratory conditions due to prolonged exposure to cotton dust. We noted a tenfold increase in asthma among workers in a Textile Manufacturing Company. We determined the prevalence of respiratory obstructive conditions among workers in various sections. METHODS: We conducted a cross sectional analytic study. Workers were randomly sampled and data was collected using interviewer-administered questionnaires. Respiratory function was assessed using spirometry and chest auscultation. A walk through survey was conducted and a checklist was used to capture hazards and control measures in the work place. RESULTS: A total of 194 workers participated. The prevalence of severe respiratory obstruction was 27.8%. It was 50.0% among the blowers, 35.3% in waste recovery, 32.5% in carders, 15.0% in spinners and 7.5% among weavers. The mean years of exposure between the affected and the non-affected were significantly different (T =2.20; p less than 0.05). Working in the blowing department was significantly associated with developing respiratory obstruction (OR=3.53; 95% CI= 1.61- 7.79) but working in the weaving department was significantly protective (OR 0.16; CI 0.04-0.59).Working in a department for less than 10 years was protective (OR =0.94; 95% CI= 0.48- 1.85), but not significant. CONCLUSION: Obstructive respiratory conditions are common among textile workers, with those in blowing and waste recovery sections being the most affected. We recommended worker rotation every six months, regular spirometric screening employment of a medical officer

Development of a bi-national Great Lakes coastal wetland and land use map using three-season PALSAR and landsat imagery

Methods using extensive field data and three-season Landsat TM and PALSAR imagery were developed to map wetland type and identify potential wetland stressors (i.e., adjacent land use) for the United States and Canadian Laurentian coastal Great Lakes. The mapped area included the coastline to 10 km inland to capture the region hydrologically connected to the Great Lakes. Maps were developed in cooperation with the overarching Great Lakes Consortium plan to provide a comprehensive regional baseline map suitable for coastal wetland assessment and management by agencies at the local, tribal, state, and federal levels. The goal was to provide not only land use and land cover (LULC) baseline data at moderate spatial resolution (20–30 m), but a repeatable methodology to monitor change into the future. The prime focus was on mapping wetland ecosystem types, such as emergent wetland and forested wetland, as well as to delineate wetland monocultures (Typha, Phragmites, Schoenoplectus) and differentiate peatlands (fens and bogs) from other wetland types. The overall accuracy for the coastal Great Lakes map of all five lake basins was 94%, with a range of 86% to 96% by individual lake basin (Huron, Ontario, Michigan, Erie and Superior)

Incomplete Recovery of Pneumococcal CD4 T Cell Immunity after Initiation of Antiretroviral Therapy in HIV-Infected Malawian Adults

HIV-infected African adults are at a considerably increased risk of life-threatening invasive pneumococcal disease (IPD) which persists despite antiretroviral therapy (ART). Defects in naturally acquired pneumococcal-specific T-cell immunity have been identified in HIV-infected adults. We have therefore determined the extent and nature of pneumococcal antigen-specific immune recovery following ART. HIV-infected adults were followed up at 3, 6 and 12 months after initiating ART. Nasopharyngeal swabs were cultured to determine carriage rates. Pneumococcal-specific CD4 T-cell immunity was assessed by IFN-γ ELISpot, proliferation assay, CD154 expression and intracellular cytokine assay. S. pneumoniae colonization was detected in 27% (13/48) of HIV-infected patients prior to ART. The rates remained elevated after 12 months ART, 41% (16/39) (p = 0.17) and significantly higher than in HIV-uninfected individuals (HIVneg 14%(4/29); p = 0.0147). CD4+ T-cell proliferative responses to pneumococcal antigens increased significantly to levels comparable with HIV-negative individuals at 12 months ART (p = 0.0799). However, recovery of the pneumococcal-specific CD154 expression was incomplete (p = 0.0015) as were IFN-γ ELISpot responses (p = 0.0040) and polyfunctional CD4+ T-cell responses (TNF-α, IL-2 and IFN-γ expression) (p = 0.0040) to a pneumolysin-deficient mutant strain. Impaired control of pneumococcal colonisation and incomplete restoration of pneumococcal-specific immunity may explain the persistently higher risk of IPD amongst HIV-infected adults on ART. Whether vaccination and prolonged ART can overcome this immunological defect and reduce the high levels of pneumococcal colonisation requires further evaluation

Knowledge, risk perceptions, and behaviors related to the COVID-19 pandemic in Malawi

BACKGROUND Behavioral changes are needed to limit the spread and mitigate the impact of the COVID-19 pandemic. OBJECTIVE We measured knowledge and behaviors related to COVID-19 during the early stages of the pandemic in Malawi (Southeast Africa). METHODS Using lists of phone numbers collected prior to the COVID-19 pandemic, we contacted a sample of adults by mobile phone in the six weeks after the first confirmed cases of COVID-19 were recorded in the country. We interviewed 619 respondents (79.5% response rate). RESULTS Approximately half of respondents perceived no risk or only limited risk that they would become infected with the novel coronavirus. Contrary to projections from epidemiological models, a large percentage of respondents (72.2%) expected to be severely ill if they became infected. Increased hand washing and avoiding crowds were the most frequently reported strategies used to prevent spreading SARS-CoV-2. The adoption of other protective behaviors (e.g., face masks) was limited. Respondents in urban areas had more accurate knowledge of disease patterns and had adopted more protective behaviors than rural respondents. CONCLUSIONS In the first weeks of the pandemic, the adoption of preventive behaviors remained limited in Malawi, possibly due to low perceived risk of infection among a large fraction of the population. Additional information campaigns are needed to address misperceptions about the risk of infection with SARS-CoV-2 and the likelihood of severe illness due to COVID-19. CONTRIBUTION This study provides early data on behavioral responses to the COVID-19 pandemic in a low-income country

Direct Activation of STING in the Tumor Microenvironment Leads to Potent and Systemic Tumor Regression and Immunity

SummarySpontaneous tumor-initiated T cell priming is dependent on IFN-β production by tumor-resident dendritic cells. On the basis of recent observations indicating that IFN-β expression was dependent upon activation of the host STING pathway, we hypothesized that direct engagement of STING through intratumoral (IT) administration of specific agonists would result in effective anti-tumor therapy. After proof-of-principle studies using the mouse STING agonist DMXAA showed a potent therapeutic effect, we generated synthetic cyclic dinucleotide (CDN) derivatives that activated all human STING alleles as well as murine STING. IT injection of STING agonists induced profound regression of established tumors in mice and generated substantial systemic immune responses capable of rejecting distant metastases and providing long-lived immunologic memory. Synthetic CDNs have high translational potential as a cancer therapeutic