Quality of fresh frozen tilapia from selected supermarkets in Malawi

Fish provides a major source of dietary animal protein to Malawi’s population. Majority of tilapia in supermarkets are of different origins and bought from different suppliers. Fish is highly perishable commodity and its quality degrades even in frozen form due to microbial activity. The quality of frozen tilapia (the most commonly traded and consumed fish in Malawi) sold in some reputable supermarkets in Malawi was determined. Fish were collected from nine (9) reputable supermarkets in three (3) regions of the country (north, central and south) and analysed in the laboratory for sensory quality, microbiological, chemical and proximate analyses. Sensory quality evaluation was performed following guidelines earlier developed for fresh tilapia (Oreochromis spp.) in Malawi. Differences and changes in the fish sensory quality were attributed to the effect of storage duration and conditions within the freezer compartment. Two types of bacteria namely, Salmonella spp. and Escherichia coliwere identified on the frozen tilapia, suggesting poor and unhygienic pre-handling. Despite the presence of bacteria on the fish and differences in sensory quality, the frozen tilapia were within the acceptable range for human consumption. Nutrient composition of frozen tilapia was high despite differences (p<0.05) in moisture, ash and crude fat. Fish from different origin were sold mixed in all supermarkets, poor handling along the fish market chain was identified as the major source of fish contamination. Mechanical damages were reminiscent of the effects of frozen storage. There is a need to establish optimum storage time for frozen tilapia in supermarkets to provide products with good quality in terms of sensory properties, nutrient content and safe microbial loads.&nbsp

The Treatment of Possible Severe Infection in Infants: An Open Randomized Safety Trial of Parenteral Benzylpenicillin and Gentamicin Versus Ceftriaxone in Infants <60 days of Age in Malawi

BACKGROUND: The World Health Organization recommends benzylpenicillin and gentamicin as antimicrobial treatment of infants with sepsis in low income settings (LICs), and ceftriaxone or cefotaxime as an alternative. In a meta-analysis from 13 LICs, Staphylococcus aureus, Klebsiella spp. and E.coli accounted for 55% of infants with sepsis. In a review of bacterial meningitis, resistance to third generation cephalosporins was > 50% of all isolates, and 44% of Gram-negative isolates were gentamicin resistant. However, ceftriaxone may cause neonatal jaundice and gentamicin may cause deafness. Therefore, we compared parenteral benzylpenicillin plus gentamicin to ceftriaxone as first line treatment, assessing outcome and adverse events. METHODS:: This was an open randomized trial carried out in the Queen Elizabeth Central Hospital, Blantyre, Malawi from 2010 to 2013. Infants < 60 days of age with possible severe sepsis received either benzylpenicillin and gentamicin or ceftriaxone. Adverse events and outcomes were recorded until 6 months post discharge. RESULTS:: 348 infants were included in analyses. Outcome in the benzylpenicillin and gentamicin or ceftriaxone groups was similar; deaths were 13.7% and 16.5% and sequelae 14.5% and 11.2% respectively. More infants in the penicillin/gentamicin group required phototherapy: 15% v 5%, p=0.03. Thirteen (6%) survivors had bilateral hearing loss. There was no difference between the treatment groups. By 6 months post discharge 11 more infants had died and 17 more children were found to have sequelae. CONCLUSIONS:: Ceftriaxone and gentamicin are safe for infants in our setting. Infants should receive long term follow up as many poor outcomes occurred after hospital discharge

One Hundred Priority Questions for the Development of Sustainable Food Systems in Sub-Saharan Africa

Sub-Saharan Africa is facing an expected doubling of human population and tripling of food demand over the next quarter century, posing a range of severe environmental, political, and socio-economic challenges. In some cases, key Sustainable Development Goals (SDGs) are in direct conflict, raising difficult policy and funding decisions, particularly in relation to trade-offs between food production, social inequality, and ecosystem health. In this study, we used a horizon-scanning approach to identify 100 practical or research-focused questions that, if answered, would have the greatest positive impact on addressing these trade-offs and ensuring future productivity and resilience of food-production systems across sub-Saharan Africa. Through direct canvassing of opinions, we obtained 1339 questions from 331 experts based in 55 countries. We then used online voting and participatory workshops to produce a final list of 100 questions divided into 12 thematic sections spanning topics from gender inequality to technological adoption and climate change. Using data on the background of respondents, we show that perspectives and priorities can vary, but they are largely consistent across different professional and geographical contexts. We hope these questions provide a template for establishing new research directions and prioritising funding decisions in sub-Saharan Africa

One hundred priority questions for the development of sustainable food systems in sub-Saharan Africa

Sub-Saharan Africa is facing an expected doubling of human population and tripling of food demand over the next quarter century, posing a range of severe environmental, political, and socio-economic challenges. In some cases, key Sustainable Development Goals (SDGs) are in direct conflict, raising difficult policy and funding decisions, particularly in relation to trade-offs between food production, social inequality, and ecosystem health. In this study, we used a horizon-scanning approach to identify 100 practical or research-focused questions that, if answered, would have the greatest positive impact on addressing these trade-offs and ensuring future productivity and resilience of food-production systems across sub-Saharan Africa. Through direct canvassing of opinions, we obtained 1339 questions from 331 experts based in 55 countries. We then used online voting and participatory workshops to produce a final list of 100 questions divided into 12 thematic sections spanning topics from gender inequality to technological adoption and climate change. Using data on the background of respondents, we show that perspectives and priorities can vary, but they are largely consistent across different professional and geographical contexts. We hope these questions provide a template for establishing new research directions and prioritising funding decisions in sub-Saharan Africa

Development and validation of quantitative PCR assays for HIV-associated cryptococcal meningitis in sub-Saharan Africa: a diagnostic accuracy study

Background: HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related deaths, with a 10-week mortality rate of 25–30%. Fungal load assessed by colony-forming unit (CFU) counts is used as a prognostic marker and to monitor response to treatment in research studies. PCR-based assessment of fungal load could be quicker and less labour-intensive. We sought to design, optimise, and validate quantitative PCR (qPCR) assays for the detection, identification, and quantification of Cryptococcus infections in patients with cryptococcal meningitis in sub-Saharan Africa. Methods: We developed and validated species-specific qPCR assays based on DNA amplification of QSP1 (QSP1A specific to Cryptococcus neoformans, QSP1B/C specific to Cryptococcus deneoformans, and QSP1D specific to Cryptococcus gattii species) and a pan-Cryptococcus assay based on a multicopy 28S rRNA gene. This was a longitudinal study that validated the designed assays on cerebrospinal fluid (CSF) of 209 patients with cryptococcal meningitis at baseline (day 0) and during anti-fungal therapy (day 7 and day 14), from the AMBITION-cm trial in Botswana and Malawi (2018–21). Eligible patients were aged 18 years or older and presenting with a first case of cryptococcal meningitis. Findings: When compared with quantitative cryptococcal culture as the reference, the sensitivity of the 28S rRNA was 98·2% (95% CI 95·1–99·5) and of the QSP1 assay was 90·4% (85·2–94·0) in CSF at day 0. Quantification of the fungal load with QSP1 and 28S rRNA qPCR correlated with quantitative cryptococcal culture (R2=0·73 and R2=0·78, respectively). Both Botswana and Malawi had a predominant C neoformans prevalence of 67% (95% CI 55–75) and 68% (57–73), respectively, and lower C gattii rates of 21% (14–31) and 8% (4–14), respectively. We identified ten patients that, after 14 days of treatment, harboured viable but non-culturable yeasts based on QSP1 RNA detection (without any positive CFU in CSF culture). Interpretation: QSP1 and 28S rRNA assays are useful in identifying Cryptococcus species. qPCR results correlate well with baseline quantitative cryptococcal culture and show a similar decline in fungal load during induction therapy. These assays could be a faster alternative to quantitative cryptococcal culture to determine fungal load clearance. The clinical implications of the possible detection of viable but non-culturable cells in CSF during induction therapy remain unclear. Funding: European and Developing Countries Clinical Trials Partnership; Swedish International Development Cooperation Agency; Wellcome Trust/UK Medical Research Council/UKAID Joint Global Health Trials; and UK National Institute for Health Research

Development and validation of quantitative PCR assays for HIV-associated cryptococcal meningitis in sub-Saharan Africa: a diagnostic accuracy study

Background: HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related deaths, with a 10-week mortality rate of 25–30%. Fungal load assessed by colony-forming unit (CFU) counts is used as a prognostic marker and to monitor response to treatment in research studies. PCR-based assessment of fungal load could be quicker and less labour-intensive. We sought to design, optimise, and validate quantitative PCR (qPCR) assays for the detection, identification, and quantification of Cryptococcus infections in patients with cryptococcal meningitis in sub-Saharan Africa. Methods: We developed and validated species-specific qPCR assays based on DNA amplification of QSP1 (QSP1A specific to Cryptococcus neoformans, QSP1B/C specific to Cryptococcus deneoformans, and QSP1D specific to Cryptococcus gattii species) and a pan-Cryptococcus assay based on a multicopy 28S rRNA gene. This was a longitudinal study that validated the designed assays on cerebrospinal fluid (CSF) of 209 patients with cryptococcal meningitis at baseline (day 0) and during anti-fungal therapy (day 7 and day 14), from the AMBITION-cm trial in Botswana and Malawi (2018–21). Eligible patients were aged 18 years or older and presenting with a first case of cryptococcal meningitis. Findings: When compared with quantitative cryptococcal culture as the reference, the sensitivity of the 28S rRNA was 98·2% (95% CI 95·1–99·5) and of the QSP1 assay was 90·4% (85·2–94·0) in CSF at day 0. Quantification of the fungal load with QSP1 and 28S rRNA qPCR correlated with quantitative cryptococcal culture (R2=0·73 and R2=0·78, respectively). Both Botswana and Malawi had a predominant C neoformans prevalence of 67% (95% CI 55–75) and 68% (57–73), respectively, and lower C gattii rates of 21% (14–31) and 8% (4–14), respectively. We identified ten patients that, after 14 days of treatment, harboured viable but non-culturable yeasts based on QSP1 RNA detection (without any positive CFU in CSF culture). Interpretation: QSP1 and 28S rRNA assays are useful in identifying Cryptococcus species. qPCR results correlate well with baseline quantitative cryptococcal culture and show a similar decline in fungal load during induction therapy. These assays could be a faster alternative to quantitative cryptococcal culture to determine fungal load clearance. The clinical implications of the possible detection of viable but non-culturable cells in CSF during induction therapy remain unclear

Discrepancy between statistical analysis method and study design in medical research: Examples, implications, and potential solutions.

Medical research is the systematic, rigorous investigation of health-related problems in order to generate new knowledge or confirm existing knowledge, with the potential benefit of evidence-based medical practice and policy guidance. The validity of the findings from medical research requires a thorough process from design, to data collection and data analysis.1 However, the methods that researchers use during analyses are often unsuitable for the designs used during study conduct. Researchers are supposed to choose the study designs at the time of protocol development, before any investigation is carried out. Different study designs have different strengths and weaknesses.2 The selected design should be the most appropriate design to answer the objectives of a study. This decision is crucial, as study design reflects directly on the hypothesis of interest. Sample size and other design aspects of the study are aimed at achieving valid conclusions of a trial or study. It is therefore important to strive for compatibility between study design and analysis plan.</p

Discrepancy between statistical analysis method and study design in medical research: Examples, implications, and potential solutions.

Medical research is the systematic, rigorous investigation of health-related problems in order to generate new knowledge or confirm existing knowledge, with the potential benefit of evidence-based medical practice and policy guidance. The validity of the findings from medical research requires a thorough process from design, to data collection and data analysis.1 However, the methods that researchers use during analyses are often unsuitable for the designs used during study conduct. Researchers are supposed to choose the study designs at the time of protocol development, before any investigation is carried out. Different study designs have different strengths and weaknesses.2 The selected design should be the most appropriate design to answer the objectives of a study. This decision is crucial, as study design reflects directly on the hypothesis of interest. Sample size and other design aspects of the study are aimed at achieving valid conclusions of a trial or study. It is therefore important to strive for compatibility between study design and analysis plan.</p

The epidemiology of trachoma in the Lower Shire Valley of Southern Malawi and implications for the “SAFE” strategy

Aims: To determine the prevalence of trachoma and associated risk factors in the Lower Shire Valley of Southern Malawi. Study Design: Population based cross sectional study. Place and Duration of Study: Lower Shire Valley of southern Malawi between July and October 2012. Methodology: Children aged 1-9 years (total 2957) were assessed for clinical signs of active trachoma follicular (TF) and adults aged 15 and above (total 2247) were assessed for signs of trachoma trichiasis (TT), which is potentially blinding trachoma. A questionnaire survey was conducted to explore the potential risk factors. Results: A total of 2957 children aged 1-9 years who were assessed for clinical signs of TF and 2247 adults aged 15 and above were assessed for signs of TT.The prevalence of TF among children aged 1-9 years was found to be 18.5% (95% CI 16.4-20.8) in Nsanje and 7.8% (95% CI 6.6-9.2) in Mwanza districts respectively. The prevalence of TT in adults aged 15 and above was 0.5% (95% CI: 0.1-0.9) in Nsanje district and 0.2% (95% CI: 0.1-0.4) in Mwanza district, respectively. In regards to risk factors, only the presence of a dirty face was associated with trachoma follicular (TF) in Nsanje and Mwanza districts (P&lt; 0.001). Conclusion: In this study, prevalence of active trachoma infections was 18.5% in Nsanje and 7.8% in Mwanza district. Dirty face was associated with trachoma follicular in both districts. According to WHO, Nsanje therefore needs a SAFE (Surgery, Antibiotics, Face Washing and Environmental) control strategy

The epidemiology of trachoma in the Lower Shire Valley of Southern Malawi and implications for the “SAFE” strategy

Aims: To determine the prevalence of trachoma and associated risk factors in the Lower Shire Valley of Southern Malawi. Study Design: Population based cross sectional study. Place and Duration of Study: Lower Shire Valley of southern Malawi between July and October 2012. Methodology: Children aged 1-9 years (total 2957) were assessed for clinical signs of active trachoma follicular (TF) and adults aged 15 and above (total 2247) were assessed for signs of trachoma trichiasis (TT), which is potentially blinding trachoma. A questionnaire survey was conducted to explore the potential risk factors. Results: A total of 2957 children aged 1-9 years who were assessed for clinical signs of TF and 2247 adults aged 15 and above were assessed for signs of TT.The prevalence of TF among children aged 1-9 years was found to be 18.5% (95% CI 16.4-20.8) in Nsanje and 7.8% (95% CI 6.6-9.2) in Mwanza districts respectively. The prevalence of TT in adults aged 15 and above was 0.5% (95% CI: 0.1-0.9) in Nsanje district and 0.2% (95% CI: 0.1-0.4) in Mwanza district, respectively. In regards to risk factors, only the presence of a dirty face was associated with trachoma follicular (TF) in Nsanje and Mwanza districts (P< 0.001). Conclusion: In this study, prevalence of active trachoma infections was 18.5% in Nsanje and 7.8% in Mwanza district. Dirty face was associated with trachoma follicular in both districts. According to WHO, Nsanje therefore needs a SAFE (Surgery, Antibiotics, Face Washing and Environmental) control strategy