The Rainbow Project: A Model to Fight Child Malnutrition in Zambia

Child malnutrition in Zambia is a public health priority that must be addressed by networking local authorities, communities and non-governmental organisations (NGOs), through interventions focused both on treatment and prevention. The Rainbow Project, under the Pope John 23rd Association, is a large-scale model of care for orphans and vulnerable children which has been operating since 1998 in Ndola District. It runs a community-based programme that operates through supplementary feeding programmes (SFPs), run by local partner organisations and coordinated by professional figures working in cooperation with district health management teams (DHMTs). The Rainbow Project organises capacity-building activities for people involved inmalnutrition projects at district and community level, radio programmes to sensitise civil society and avoidstigma, and urban agriculture horticulture programmes (container gardening). The networking community-based management is an effective and sustainable way to fight child malnutrition, a major killer for children under five in lower middle-income countries (LMICs)

Hesitancy towards Covid-19 vaccination among the healthcare workers in Iraqi Kurdistan

Objective: To investigate Covid-19 vaccine hesitancy among Iraqi healthcare workers-HCWs. Study design: Cross-sectional survey. Methods: In February 2021, an anonymous questionnaire on the willingness of receiving Covid-19 vaccination was submitted to a sample of HWCs in the Dohuk Governorate, Iraqi Kurdistan Region. Overall, 1704 questionnaires were analysed by means of univariate and multivariate statistics. Results: The sample included 978 males and 726 females (Mean age: 36.9 ± 10.1), working in Primary Health Centres (65.8%) or in Public Hospitals (34.2%). Professions ranged from being physician/paramedics (39.3%) to administrative/laboratory staff (31.7%); 17.0% had attended up to secondary school, the rest had a higher education. Considering health conditions, 1.8% reported a poor health status and 11.5% a chronic disease.Overall, 475 people (27.9%) reported Covid-19 vaccine hesitancy, with fear of side-effects (41.4%) and lack of confidence in using the vaccine (23.5%) being the most common perceived barriers. Midwifes (61.1%) and assistant nurses (45.5%) were the most hesitant; physicians the less (12.3%). According to a binary logistic model, holding lower educational level (adjOR = 2.158; 95% CI:1.654-2.815), being female (adjOR = 1.622; 95% CI:1.289-2.040), having pre-existing chronic disease (adjOR = 1.954; 95% CI:1.280-2.983), and self-perceiving a poor health status (adjOR = 3.673; 95% CI:1.610-8.379) were independent predictors of higher odds of hesitancy. Conclusion: Covid-19 vaccine hesitancy among HCWs represents an important public health concern, since they play a paramount role for a successful vaccination campaign within the community. Our results show the need in Iraq to implement educational interventions for strengthening the confidence of HWCs towards the Covid-19 vaccine, therefore positively influencing the general public's attitude

Epidemiology of Hypoalbuminemia in Hospitalized Patients: A Clinical Matter or an Emerging Public Health Problem?

Serum albumin levels are strongly associated with the morbidity, prognosis, and mortality rates of patients with hypoalbuminemia, which is a frequent problem during hospitalization. An observational retrospective study was carried out to analyze changes in albumin levels in hospitalized patients at the "Fondazione Policlinico Tor Vergata-PTV" in 2018. The prevalence of preexisting hypoalbuminemia at the time of discharge from hospital was investigated using a sample of 9428 patients. Information was collected from the discharge files recorded in the central informatics system of the hospital. Analysis of albumin levels at admission and at discharge was conducted by classes of albuminemia and then stratified by age. At the time of admission, hypoalbuminemia was found to be present in more than half of the sample, with no sex differences. The serum albumin level tended to decrease with age, with pathologic levels appearing from 50 years and progressive worsening thereafter. The condition of marked and mild hypoalbuminemia was more prevalent in patients over 65 years of age. Our findings suggest that hypoalbuminemia should be considered a dangerous condition in itself and a serious public health problem. We aimed to emphasize the role of albumin as useful marker of the in-hospital malnutrition and frailty, to be integrated in the routinely assessment of patients for reconsidering ad hoc healthcare pathways after discharge from hospital, especially when dealing with fragile populations

Increased expression of interleukin-22 in patients with giant cell arteritis

GCA is characterized by arterial remodelling driven by inflammation. IL-22 is an attractive cytokine which acts at the crosstalk between immune and stromal cells. We hypothesized that IL-22 might be induced in GCA and might be involved in disease pathogenesis

Infectious Diseases Seeker (IDS): An Innovative Tool for Prompt Identification of Infectious Diseases during Outbreaks

Background: Several technologies for rapid molecular identification of pathogens are currently available; jointly with monitoring tools (i.e., web-based surveillance tools, infectious diseases modelers, and epidemic intelligence methods), they represent important components for timely outbreak detection and identification of the involved pathogen. The application of these approaches is usually feasible and effective when performed by healthcare professionals with specific expertise and skills and when data and resources are easily accessible. Contrariwise, in the field situation where healthcare workers or first responders from heterogeneous competences can be asked to investigate an outbreak of unknown origin, a simple and suitable tool for rapid agent identification and appropriate outbreak management is highly needed. Most especially when time is limited, available data are incomplete, and accessible infrastructure and resources are inadequate. The use of a prompt, user-friendly, and accessible tool able to rapidly recognize an infectious disease outbreak and with high sensitivity and precision may be a game-changer to support emergency response and public health investigations. Methods: This paper presents the work performed to implement and test an innovative tool for prompt identification of infectious diseases during outbreaks, called Infectious Diseases Seeker (IDS). IDS is a standalone software that runs on the most common operative systems. It has been built by integrating a database containing an interim set of 60 different disease causative agents and COVID-19 data and is able to work in an off-line mode without requiring a network connection. Results: IDS has been applied in a real and complex scenario in terms of concomitant infectious diseases (yellow fever, COVID-19, and Lassa fever), as can be in the second part of 2020 in Nigeria. The outcomes have allowed inferring that yellow fever (YF), and not Lassa fever, was affecting the area under investigation. Conclusions: Our result suggests that a tool like IDS could be valuable for the quick and easy identification and discrimination of infectious disease outbreaks even when concurrent outbreaks occur, like for the case study of YF and COVID-19 pandemic in Nigeria

REFINEMENT OF SEEPAGE VULNERABILITY ESTIMATE IN NATIONAL LEVEE DATABASE OF ITALY

Piping induced by seepage is a frequent cause of failure for earthen levees. The probability that the seepage line in the levee body intercepts the landside slope provides an important indication of the levee vulnerability to seepage. Nevertheless, the definition of the seepage paths associated to assigned water levels is affected by the difficulty in estimating the hydraulic parameters that control the filtration process, chiefly the soil hydraulic conductivity. The ideation of expeditious and operational methods, able to analyse extended levee systems quickly and to identify the most vulnerable portions of the systems, is therefore of paramount importance. To this purpose, an existing practical procedure for the evaluation of levee vulnerability to seepage, based on the definition of a vulnerability index (Camici et al., 2015), is here enhanced and it is used to produce 'synthetic diagrams', easily applicable to derive the seepage probability of the dykes whose hydraulic conductivity is unknown. The procedure is applied for the Tiber River (central Italy) and the Tanaro River (northern Italy). The Italian levee database (DANTE) is briefly presented in the final part of the paper: it is conceived as a dynamic geospatial tool, addressed to collect all the available information on levee systems and to usefully support authorities involved in hydraulic risk mitigation

Levee body seepage: a refinement of an expeditious procedure for fragility curves and vulnerability diagrams' assessment

Extensive flooding can be the result of levee system failures most frequently caused by the piping process due to seepage. The proper description of the seepage line is affected by the difficulty of estimating the hydraulic parameters, mainly the soil hydraulic conductivity. Therefore, the development of simple methods for a quick analysis of extended levee systems is fundamental to identify critical points. In this context, a practical procedure, recently proposed, based on a simple vulnerability index is here enhanced and used to derive diagrams easily applicable for seepage vulnerability estimate, taking the hydraulic parameters' uncertainty into account. The procedure is applied for the Tiber River, in central Italy, and the Tanaro River, in northern Italy, by analyzing 67 and 6 levees, respectively. The results show that the method provides the highest seepage probabilities for levees affected by failures in the past. Therefore, the procedure seems to be able to identify the levees that require detailed investigations. Finally, the Italian levee database (DANTE) is presented as a dynamic geospatial tool for collecting all the available data/information on levee systems to usefully support authorities with the charge of hydraulic risk mitigation for identifying the most vulnerable levees

Improvement in dietary diversity and feeding habits of malnourished under-five children attending supplementary feeding programmmes: a community-based cross-sectional study in Zambia

A community-based cross-sectional study was conducted on 390 under-five malnourished children enrolled in the Rainbow Project supplementary feeding programmmes-SFPs. Dietary diversity, feeding habits and nutritional status at admission (T1) and at discharge (T2) were compared. At T1 the diet was monotonous and unbalanced, with a progressive decline in dietary diversity and anthropometric values noted with children's age growth (p < 0.001). Significant improvements were registered at T2: DDS 5.1 +/- 1.1 SD vs. 8.3 +/- 1.0 SD; meal frequency 3.0 +/- 0.6 SD vs. 4.9 +/- 0.2 SD; animal-protein consumed 62.8% vs. 90.5%; drinking water treated 41.0% vs. 97.2%. At T1, the risk of having ZMUAC < 2.5SD increased when teenage motherhood (AOR: 5.3; CI: 1.8-15.2; p = 0.002), followed by children's age >2 years (AOR: 1.9; CI: 1.1-3.5; p = 0.020). Children's age was associated with an increased risk of WAZ < 2.5 SD (AOR: 4.9; CI: 2.4-10.4; p < 0.001). When considering inadequate DDS, the variable associated was breastfeeding cessation (AOR: 12.0; CI: 4.6-31.4; p < 0.001). Rainbow's SFPs have proved effective in treating under-five malnourished children, irrespective of the severity of malnutrition