Paediatric and obstetric outcomes at a faith-based hospital during the 100-day public sector physician strike in Kenya

Published reviews of national physician strikes have shown a reduction in patient mortality. From 5 December 2016 until 14 March 2017, Kenyan physicians in the public sector went on strike leaving only private (not-for-profit and for-profit) hospitals able to offer physician care. We report on our experience at AIC-Kijabe Hospital, a not-for-profit, faith-based Kenyan hospital, before, during and after the 100-day strike was completed by examining patient admissions and deaths in the time periods before, during and after the strike. The volume of patients increased and exceeded the hospital's ability to respond to needs. There were substantial increases in sick newborn admissions during this time frame and an additional ward was opened to respond to this need. Increased need occurred across all services but staffing and space limited ability to respond to increased demand. There were increases in deaths during the strike period across the paediatric medical, newborn, paediatric surgical and obstetric units with an OR (95% CI) of death of 3.9 (95% CI 2.3 to 6.4), 4.1 (95% CI 2.4 to 7.1), 7.9 (95% CI 3.2 to 20) and 3.2 (95% CI 0.39 to 27), respectively. Increased mortality across paediatric and obstetrical services at AIC-Kijabe Hospital correlated with the crippling of healthcare delivery in the public sector during the national physicians' strike in Kenya

Taenia solium Infections in a Rural Area of Eastern Zambia-A Community Based Study

Taenia solium taeniosis/cysticercosis is a zoonotic infection endemic in many developing countries, with humans as the definitive host (taeniosis) and pigs and humans as the intermediate hosts (cysticercosis). When humans act as the intermediate host, the result can be neurocysticercosis, which is associated with acquired epilepsy, considerable morbidity and even mortality. In Africa, most studies have been carried out in pigs with little or no data in humans available. In this human study, conducted in a rural community in Eastern Zambia, prevalences for taeniosis and cysticercosis were determined at 6.3% and 5.8% respectively, indicating the hyperendemicity of the area. Cysticercosis infection was strongly related with age, with a significant increase in prevalence occurring in individuals from the age of 30 onward. A collected tapeworm was confirmed to be T. solium. Risk factors associated with the transmission and maintenance of the parasite such as free roaming pigs, households without latrines, backyard slaughter of pigs without inspection and consumption of undercooked pork were also present. The findings of this work have identified the need for further research in the transmission dynamics and the burden that this infection has on the resources of poor local people

The incidence of human cysticercosis in a rural community of Eastern Zambia

A community-based longitudinal study was performed in the Eastern Province of Zambia, in which repeated serological samplings were done to determine the incidence of human cysticercosis. Three sampling rounds were carried out at six months intervals. A total of 867 participants presented for all three samplings. All samples were tested for the presence of cysticercus antigens using a monoclonal antibody-based enzyme-linked immunosorbent assay (sero-Ag-ELISA), while a randomly selected sub-sample of 161 samples from each sampling round was tested for specific antibodies using a commercial enzyme-linked immunoelectrotransfer blot (EITB) assay. Stool samples (n = 226) were also collected during the final round of sampling for taeniosis diagnosis by coprology and coproantigen ELISA. Cysticercosis seroprevalence varied from 12.2% to 14.5% (sero-Ag) and from 33.5% to 38.5% (sero-Ab) during the study period. A taeniosis prevalence of 11.9% was determined. Incidence rates of 6300 (sero-Ag, per 100000 persons-year) and 23600 (sero-Ab, per 100000 persons-year) were determined. Seroreversion rates of 44% for sero-Ag and 38.7% for sero-Ab were recorded over the whole period. In conclusion, this study has shown the dynamic nature of T. solium infections; many of the people at risk become (re)infected due to the high environmental contamination, with a high number turning seronegative within a year after infection. An important number of infections probably never fully establish, leading to transient antibody responses and short-term antigen presence. © 2013 Mwape et al

Study and ranking of determinants of Taenia solium infections by classification tree models

Taenia solium taeniasis/cysticercosis is an important public health problem occurring mainly in developing countries. This work aimed to study the determinants of human T. solium infections in the Eastern province of Zambia and rank them in order of importance. A household (HH)-level questionnaire was administered to 680 HHs from 53 villages in two rural districts and the taeniasis and cysticercosis status determined. A classification tree model (CART) was used to define the relative importance and interactions between different predictor variables in their effect on taeniasis and cysticercosis. The Katete study area had a significantly higher taeniasis and cysticercosis prevalence than the Petauke area. The CART analysis for Katete showed that the most important determinant for cysticercosis infections was the number of HH inhabitants (6 to 10) and for taeniasis was the number of HH inhabitants > 6. The most important determinant in Petauke for cysticercosis was the age of head of household > 32 years and for taeniasis it was age < 55 years. The CART analysis showed that the most important determinant for both taeniasis and cysticercosis infections was the number of HH inhabitants (6 to 10) in Katete district and age in Petauke. The results suggest that control measures should target HHs with a high number of inhabitants and older individuals

Fiery red heads: female dominance among head color morphs in the Gouldian finch

Although the evolution of genetic color polymorphisms has received much theoretical interest, few empirical studies have investigated the adaptive function of alternative color morphs. Furthermore, most studies have focused almost exclusively on the evolution and adaptive expression of male coloration, leaving the role of conspicuous female coloration largely unknown. Using the color polymorphic Gouldian finch (Erythrura gouldiae), this study experimentally tests the status signaling function of head color (red, yellow, and black) among the 3 female color morphs. In standardized dominance contests between unfamiliar females of different head colors, red-headed females dominated both black- and yellow-headed females. During contests between the morphs, red-headed females passively displaced black- and yellow-headed opponents, whereas interactions between red-headed dyads were particularly aggressive and more frequent than interactions within dyads of the other color morphs. This effect of red dominance further persisted when head color was experimentally altered; red-manipulated females (of the other morphs) dominated both black- and yellow-headed females, whereas blackened red-headed females were dominated by naturally red-headed birds. Together with similar dominance-related differences among male morphs, these results suggest that the 3 color morphs may display alternative strategies in dominance behavior. Copyright 2007, Oxford University Press.

Seroconversion rates of human cysticercosis in function of sex for both circulating antigen and specific antibody analyses.

<p>P1 stands for period 1 (between Round 1 and Round 2, 6 months), P2 for period 2 (between Round 2 and 3, 6 months) and P3 for period 3 (between Round 1 and 3, 12 months). Ag-ELISA: detection of circulating cysticercus antigen in serum; EITB: detection of specific antibodies in serum.</p

Sero- antigen and antibody conversion and -reversion for the three periods.

<p>SC and SR stand for seroconversion and seroreversion, respectively. P1 stands for period 1 (between Round 1 and Round 2, 6 months), P2 for period 2 (Round 2–3, 6 months) and P3 for period 3 (Round 1–3, 12 months). Ag-ELISA: detection of circulating cysticercus antigen in serum; EITB: detection of specific antibodies in serum.</p

Infection/exposure status changes based on sero-antigen and sero-antibody analysis throughout the study period.

<p>R1, R2 and R3 stand for first, second and third rounds of sampling. N and P stand for negative and positive test result, respectively. Ag-ELISA: detection of circulating cysticercus antigen in serum. “No.” expresses the number of participants that presented the given statuses (e.g. N N N) during the follow up (e.g. 680 participants tested negative at all three sampling rounds, N N N); EITB: detection of specific antibodies in serum “No.” expresses the number of participants that presented the given statuses during the follow up (e.g. 72 participants of the 161 tested negative at all three sampling rounds, N N N. This number is independent of the Ag-ELISA result).</p