Aflatoxin risk management in commercial groundnut products in Malawi (Sub-Saharan Africa): a call for a more socially responsible industry

This study was performed as a follow-up to a study from 2013, to assess the impact of management interventions on aflatoxin incidence and levels in commercial groundnut products in Malawi. Sixty-seven samples of commercial groundnut products were analyzed for aflatoxin using a fluorometric method. Total aflatoxin levels ranged from 1.5 to 1200 μg/kg in raw groundnuts and 83–820 μg/kg in groundnut flour from vendors. In branded groundnut flour and peanut butter from supermarkets, aflatoxin levels ranged from 13 to 670 μg/kg and 1.3 to 180 μg/kg, respectively. About 93, 88, 78 and 72% of the samples analyzed contained aflatoxin levels above regulatory limit used in Malawi (3 μg/kg), EU (4 μg/kg), most developing countries (10 μg/kg), and the USA (20 μg/kg), respectively. Despite much effort, aflatoxin levels remain persistently high in commercial groundnut. Considering the difficulty of achieving an efficient government regulation system due to resource constraint, the authors recommend the promotion of a socially responsible groundnut processing industry that has consumer welfare as its central feature

Comparative evaluation of a low-cost solar powered otoscope with a traditional device among health care workers in Malawi

Objectives: To comparatively evaluate a low-cost otoscope with a traditional device among health care workers in Malawi. Methods: The study is a prospective, comparative, qualitative observational survey of health care worker's opinions using 5-point Likert rating scales and tick box categories in a 10-item survey questionnaire. Twenty-five mixed cadre health care workers from the Ear, Nose, and Throat Department of the Queen Elizabeth Hospital, Blantyre in Malawi were recruited. Outcomes measures used were ease of speculum attachment, handling, insertion, stability, the quality of view, color, build, brightness, overall ease of use, and their suitability for local work. Results: The low-cost otoscope scored statistically higher in overall combined performance, as well as in the remaining four out of the nine attributes. Notably, 54.2% of users rated the low-cost device more suitable than the traditional device for use in low-middle income countries, 25% were equivocal, and 20.8% preferred the traditional device. Conclusion: This study found the Arclight otoscope to be an appropriate and practical substitute for more expensive traditional otoscopes for the delivery of ENT services in low resource settings. Level of Evidence: N/

Lithostratigraphy, biostratigraphy and chemostratigraphy of Upper Cretaceous and Paleogene sediments from southern Tanzania : Tanzania Drilling Project Sites 27 to 35

The 2008 Tanzania Drilling Project (TDP) expedition recovered common planktonic foraminifera (PF), calcareous nannofossils (CN) and calcareous dinoflagellates with extraordinary shell preservation at multiple Cenomanian-Campanian sites that will be used for paleoclimatic, paleoceanographic, and biostratigraphic studies. New cores confirm the existence of a more expanded and continuous Upper Cretaceous sequence than had previously been documented in the Lindi and Kilwa regions of southeastern coastal Tanzania. This TDP expedition cored 684.02. m at eight Upper Cretaceous sites (TDP Sites 28-35) and a thin Paleocene section (TDP Site 27).TDP Sites 29, 30, 31 and 34 together span the lowermost Turonian to Coniacian (PF Whiteinella archaeocretacea to Dicarinella concavata Zones and CN Zones UC6a-9b), with TDP Site 31 being the most biostratigraphically complete Turonian section found during TDP drilling. A discontinuous section from the Santonian-upper Campanian (PF D. asymetrica to Radotruncana calcarata Zones and CN Zones UC12-16) was collectively recovered at TDP Sites 28, 32 and 35, while thin sequences of the lower Cenomanian (PF Thalmanninella globotruncanoides Zone and CN subzones UC3a-b) and middle Paleocene (Selandian; PF Zone P3a and CN Zone NP5) were cored in TDP Sites 33 and 27, respectively. Records of \u3b4 13C org and \u3b4 13C carb from bulk sediments generated for all the Cretaceous sites show largely stable values through the sections. Only a few parallel \u3b4 13C org and \u3b4 13C carb shifts have been found and they are interpreted to reflect local processes. The \u3b4 18O carb record, however, is consistent with Late Cretaceous cooling trends from the Turonian into the Campanian. Lithologies of these sites include thick intervals of claystones and siltstones with locally abundant, finely-laminated fabrics, irregular occurrences of thin sandstone layers, and sporadic bioclastic debris (e.g., inoceramids, ammonites). Minor lithologies represent much thinner units of up to medium-grained, massive sandstones. The %CaCO 3 (~5-40%) and %C org (~0.1-2%) are variable, with the highest %CaCO 3 in the lower Campanian and the highest %C org in the Turonian. Lithofacies analysis suggests that deposition of these sediments occurred in outer shelf-upper slope, a setting that agrees well with inferences from benthic foraminifera and calcareous dinoflagellates

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated