Community knowledge variation, bed-net coverage, the role of a district health care system and their implications for malaria control in Southern Malawi

This paper presents data on the pattern of knowledge of caregivers, bed-net coverage and the role of a rural district healthcare system, and their implications for malaria transmission, treatment, prevention and control in Chikhwawa, southern Malawi, using multi-level logistic regression modelling with Bayesian estimation. The majority of caregivers could identify the main symptoms of malaria, that the mosquito was the vector, and that insecticide-treated nets (ITN) could be used to cover beds as an effective preventative measure, although cost was a prohibitive factor. Use of bed nets displayed significant variation between communities. Groups that were more knowledgeable on malaria prevention and symptoms included young mothers, people who had attended school, wealthy individuals, those residing closest to government hospitals and health posts, and communities that had access to a health surveillance assistant (HSA). HSAs should be trained on malaria intervention programmes, and tasked with the responsibility of working with village health committees to develop community-based malaria intervention programmes. These programmes should include appropriate and affordable household improvement methods, identification of high-risk groups, distribution of ITNs and the incorporation of larval control measures, to reduce exposure to the vector and parasite. This would reduce the transmission and prevalence of malaria at community level

Generation of a restriction minus enteropathogenic Escherichia coli E2348/69 strain that is efficiently transformed with large, low copy plasmids

<p>Abstract</p> <p>Background</p> <p>Many microbes possess restriction-modification systems that protect them from parasitic DNA molecules. Unfortunately, the presence of a restriction-modification system in a given microbe also hampers genetic analysis. Although plasmids can be successfully conjugated into the enteropathogenic <it>Escherichia coli </it>strain E2348/69 and optimized protocols for competent cell preparation have been developed, we found that a large, low copy (~15) bioluminescent reporter plasmid, pJW15, that we modified for use in EPEC, was exceedingly difficult to transform into E2348/69. We reasoned that a restriction-modification system could be responsible for the low transformation efficiency of E2348/69 and sought to identify and inactivate the responsible gene(s), with the goal of creating an easily transformable strain of EPEC that could complement existing protocols for genetic manipulation of this important pathogen.</p> <p>Results</p> <p>Using bioinformatics, we identified genes in the unfinished enteropathogenic <it>Escherichia coli </it>(EPEC) strain E2348/69 genome whose predicted products bear homology to the HsdM methyltransferases, HsdS specificity subunits, and HsdR restriction endonucleases of type I restriction-modification systems. We constructed a strain carrying a deletion of the conserved enzymatic domain of the EPEC HsdR homologue, NH4, and showed that its transformation efficiency was up to four orders of magnitude higher than that of the parent strain. Further, the modification capacity of NH4 remained intact, since plasmids that were normally recalcitrant to transformation into E2348/69 could be transformed upon passage through NH4. NH4 was unaffected in virulence factor production, since bundle forming pilus (BFP) subunits and type III secreted (T3S) proteins were present at equivalent levels to those seen in E2348/69. Further, NH4 was indistinguishable from E2348/69 in tissue culture infection model assays of localized adherence and T3S.</p> <p>Conclusion</p> <p>We have shown that EPEC strain E2348/69 utilizes a type I restriction-modification system to limit entry of new DNA. This restriction-modification system does not appear to be involved in virulence determinant expression or infection phenotypes. The <it>hsdR </it>mutant strain should prove useful in genetic analysis of the important diarrheal pathogen EPEC.</p

Care-seeking for diarrhoea in Southern Malawi : attitudes, practices and implications for diarrhoea control

This paper examined care-seeking behaviour and its associated risk factors when a family member had diarrhoea. Data was obtained from a survey conducted in Chikwawa, a district in Southern Malawi. Chikwawa is faced with a number of environmental and socioeconomic problems and currently diarrhoea morbidity in the district is estimated at 24.4% statistically higher than the national average at 17%. Using hierarchically built data from a survey of 1,403 households nested within 33 communities, a series of two level binary logistic regression models with Bayesian estimation were used to determine predictors of care-seeking behaviour. The results show that 68% of mothers used oral rehydration solutions (ORS) last time a child in their family had diarrhoea . However, when asked on the action they take when a member of their household has diarrhoea two thirds of the mothers said they visit a health facility. Most respondents (73%) mentioned distance and transport costs as the main obstacles to accessing their nearest health facility and the same proportion of respondents mentioned prolonged waiting time and absence of health workers as the main obstacles encountered at the health facilities. The main predictor variables when a member of the family had diarrhoea were maternal age, distance to the nearest health facility, school level, and relative wealth, household diarrhoea endemicity, and household size while the main predictor variables when a child had diarrhoea were existence of a village health committee (VHC), distance to the nearest health facility, and maternal age . Most households use ORS for the treatment of diarrhoea and village health committees and health surveillance assistants (HSAs) are important factors in this choice of treatment. Health education messages on the use and efficacy of ORS to ensure proper and prescribed handling are important. There is need for a comprehensive concept addressing several dimensions of management and proper coordination of delivery of resources and services; availability of adequate healthcare workers at all levels; affordability to accessibility of healthcare resources and services to all communities; acceptability and quality of care; intensification of health education messages on the use and management of ORS, and prompt and timely treatment of diarrhoeal illness

Analysis for Racial and Gender Disparities in the Stanford School of Medicine Clerkship Evaluation System

Stanford School of Medicine completed an analysis of our assessment system, the Criterion-Based Evaluation System (CBES), from 2011-2019, investigating for gender- and race-based disparities. Since January 2022, the USMLE Step 1 examination is now pass/fail2. In January 2021, Step 2 Clinical Skills was eliminated3. With these two changes, accurate clerkship assessments will be playing an increased role in residency applications. Concurrently, several medical schools have presented their findings on disparities and bias within their systems of medical student evaluation4,5,6. Medical schools nationwide must re-examine their methods of assessment of medical students

The pattern of variation between diarrhoea and malaria coexistence with corresponding risk factors in, Chikhwawa, Malawi : a bivariate multilevel analysis

Developing countries face a huge burden of infectious diseases, a number of which co-exist. This paper estimates the pattern and variation of malaria and diarrhea coexistence in Chikhwawa, a district in Southern Malawi using bivariate multilevel modelling with Bayesian estimation. A probit link was employed to examine hierarchically built data from a survey of individuals (n = 6,727) nested within households (n = 1,380) nested within communities (n = 33). Results show significant malaria [σ2ul = 0.901 (95% CI : 0.746,1.056) ] and diarrhea [σ2ul = 1.009  (95% CI : 0.860,1.158) ] variations with a strong correlation between them [ru(1,2) = 0.565 ] at household level. There are significant malaria [σ2v1 = 0.053 (95% CI : 0.018,0.088) ] and diarrhea [σ2v2 = 0.099 (95% CI : 0.030,0.168 ] variations at community level but with a small correlation [rv(1,2) = 0.124 ] between them. There is also significant correlation between malaria and diarrhea at individual level [re(1,2) 0.241]. These results suggest a close association between reported malaria-like illness and diarrheal illness especially at household and individual levels in Southern Malawi

Role of tidal wetland stability in lateral fluxes of particulate organic matter and carbon

Author Posting. © American Geophysical Union, 2019. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research-Biogeosciences 124(5), (2019): 1265-1277, doi:10.1029/2018JG004920.Tidal wetland fluxes of particulate organic matter and carbon (POM, POC) are important terms in global budgets but remain poorly constrained. Given the link between sediment fluxes and wetland stability, POM and POC fluxes should also be related to stability. We measured POM and POC fluxes in eight microtidal salt marsh channels, with net POM fluxes ranging between −121 ± 33 (export) and 102 ± 28 (import) g OM·m−2·year−1 and net POC fluxes ranging between −52 ± 14 and 43 ± 12 g C·m−2·year−1. A regression employing two measures of stability, the unvegetated‐vegetated marsh ratio (UVVR) and elevation, explained >95% of the variation in net fluxes. The regression indicates that marshes with lower elevation and UVVR import POM and POC while higher elevation marshes with high UVVR export POM and POC. We applied these relationships to marsh units within Barnegat Bay, New Jersey, USA, finding a net POM import of 2,355 ± 1,570 Mg OM/year (15 ± 10 g OM·m−2·year−1) and a net POC import of 1,263 ± 632 Mg C/year (8 ± 4 g C·m−2·year−1). The magnitude of this import was similar to an estimate of POM and POC export due to edge erosion (−2,535 Mg OM/year and − 1,291 Mg C/year), suggesting that this system may be neutral from a POM and POC perspective. In terms of a net budget, a disintegrating wetland should release organic material, while a stable wetland should trap material. This study quantifies that concept and demonstrates a linkage between POM/POC flux and geomorphic stability.Use of brand names is for identification purposes only and does not constitute endorsement by the U.S. Government. This study was supported by the USGS Coastal and Marine Geology Program, the Department of the Interior Hurricane Sandy Recovery program (GS2‐2D), and the USGS Mendenhall Post‐doctoral Research Program. Viktoria Unger and Paula Zelanko are acknowledged for field and lab assistance. Core collection was funded under NJ SeaGrant/NOAA Grant 6210‐0011. Gil Pontius provided helpful feedback on statistical measures. Kevin Kroeger and two anonymous reviewers provided constructive reviews of the manuscript. All time series and water sample data are available at the U.S. Geological Survey's Oceanographic Time‐Series Data Collection (at https://stellwagen.er.usgs.gov/).2019-10-2

Reducing long distance truck driver’s intention to leave: An analysis of professional drivers and owner operators using importance/performance methods

Since it is widely known that turnover is highest among unsatisfied employees, the authors argue that long haul professional drivers (PDs) and owner operators (OOs) can be retained by using a yearly importance/performance analysis of company drivers. Because qualified drivers are becoming more scarce and difficult to recruit/retain, carriers need to focus on increasing driver retention. In this article, we suggest an Importance/Performance (IP) model which uses an “if then” perspective, relating intention to leave as a function of the PD/OO: IP structure. This model is used to explain the managerial changes that could be made to retain professional drivers and owner operators