FUNCTIONAL STATUS AMONG PATIENTS WITH ESTABLISHED COPD ATTENDING TERTIARY HOSPITALS IN DAR ES SALAAM, TANZANIA

Background Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable non communicable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development. It is associated with a lot of risk factors such as smoking, biomass fuel use for cooking and air pollutants in general. Objectives The primary objective of this research was to determine the functional status of patients with COPD. The secondary objectives were to determine the factors influencing the functional status of patients with COPD. Methods The study was a cross sectional study which enrolled one hundred and twenty participants with COPD attending tertiary hospitals in Dar es salaam, of which majority were enrolled via telephonic interview after being identified from the outpatient registry of patients with COPD attending the tertiary hospitals, and others via face to face interview for those who were directly recruited from the outpatient clinics. The mMRC was used as an estimate of the functional status of the enrolled COPD patients. The redefined GOLD criteria (A, B, C, D) was used to assess disease severity. Results A total of 120 participants were enrolled into with COPD attending the tertiary hospitals with a mean age of 68.18 (±12.372), and 55% of them were males. Majority of the participants were married 76.7%. Majority (45.8%) of the participants engaged in agricultural activities and 12.5% were office employees . Whereas industrial/mine workers made up 5.8%, and 11.7% were retired, entrepreneurs were 9.2%, and others were 19.4%. In terms of education, most of the participants had a primary level of education, which made up 53.3%, secondary school 14.2%, college/university 17.5% and 15% were without any formal education. Cigarette smoking (35%) was found to be the most prevalent risk factor followed by firewood use (34.2%). However, in 11.7% of the participants no obvious risk factor could be identified. Occupational risk factor and previous TB infection each contributed to 11.7% and 7.5% respectively, of the risk factors. Majority of participants had an mMrc score of less than 2 (51.7%), and a CAT score of ≥10 (70.8%). The severity distribution of patients was mostly in class D with 44.2%, followed by class B (25.8%), class A (19.2%), and class C (10.8%) in decreasing order of prevalence. Most of the patients were on combination inhaler medications mostly consisting of long-acting beta agonists and inhaled corticosteroids (58.3%). Only the CAT score showed a significant association with the functional status outcome when the Chi square cross tabulation was done, with a p-value of 0.000. Thereafter a binary logistic regression was done which showed that participants with a CAT score of less than ten were less likely to have a poor function status with an odds ratio of 0.101 with a confidence interval of 95% (0.035-0.286). Conclusion Nearly half of participants with COPD had poor functional status and they had a score of equal or more than two on the mMRC score. However, only the CAT score was found to be statistically significant as a predictor of the functional status outcome. Recommendation Because a significant number of participants in our study had poor function status, further studies must be done in this group of patients to evaluate what interventions can improve their functional status in our setting. The use of mMRC in conjunction with CAT tool can be used as a quick way of assessing patients at high risks and taking appropriate measures. Moreover, more studies are required in this field involving multiple centers and using spirometry to better understand the characteristics of COPD patients in our setting

Theoretical and Experimental Performance Analysis of a Novel Domestic Biogas Burner

This research article published by Hindawi, 2020The inefficient indoor burning of fuelwood on traditional cookstoves generates pollutants, primarily carbon monoxide and many other human health-damaging emissions. It is from this risk that it is necessary to have an immediate shift to alternative cleaner fuel sources. Biogas, which is among the biofuels from biomass, is one of the resources that play a considerable part in a more diverse and sustainable global energy mix. For domestic purposes in rural areas of Tanzania, biogas provides a better option that can supplement the use of fossil fuels such as wood, charcoal, and kerosene, which is nonrenewable. However, the low efficiency experienced in the locally made biogas burners hinders the large-scale use of biogas among the population in the country. With the locally made burners, the users of biogas for the domestic application face problems including heat loss and high gas consumption which affects the whole cooking process. It is against this backdrop that the current study objectives incline on designing and improving the efficiency of the locally manufactured burners to achieve the uniform flow of fuel in the mixing chamber, which will result to the consistent heat distribution around the cooking pot. The optimization of the burner was done by using computational fluid dynamics (CFD) through varying the number of flame portholes and air holes as well as the size of the jet before fabrication. The increased efficiency of the burner has also contributed by the addition of the fuel distributor. The results showed that the optimum hole diameter of the jet was 2.5 mm and that of the manifold was 100 mm. The currently developed biogas burner was tested and compared with the other two locally made burners. The water boiling test (WBT) on these three burners showed that the developed burner has a thermal efficiency of 67.01% against 54.61% and 58.82% of the Centre for Agricultural Mechanization and Rural Technology (CARMATEC) and Simgas, respectively. Additionally, the fuel consumption of the developed burner was 736 g/L as compared to 920 g/L for CARMARTEC and 833 g/L for that of Simgas. The developed burner and its corresponding cookstove are both environmentally friendly and economical for household utilization in Tanzania and other developing countries

Role of human Pegivirus infections in whole; Plasmodium falciparum; sporozoite vaccination and controlled human malaria infection in African volunteers

BACKGROUND: Diverse vaccination outcomes and protection levels among different populations pose a serious challenge to the development of an effective malaria vaccine. Co-infections are among many factors associated with immune dysfunction and sub-optimal vaccination outcomes. Chronic, asymptomatic viral infections can contribute to the modulation of vaccine efficacy through various mechanisms. Human Pegivirus-1 (HPgV-1) persists in immune cells thereby potentially modulating immune responses. We investigated whether Pegivirus infection influences vaccine-induced responses and protection in African volunteers undergoing whole P. falciparum sporozoites-based malaria vaccination and controlled human malaria infections (CHMI). METHODS: HPgV-1 prevalence was quantified by RT-qPCR in plasma samples of 96 individuals before, post vaccination with PfSPZ Vaccine and after CHMI in cohorts from Tanzania and Equatorial Guinea. The impact of HPgV-1 infection was evaluated on (1) systemic cytokine and chemokine levels measured by Luminex, (2) PfCSP-specific antibody titers quantified by ELISA, (3) asexual blood-stage parasitemia pre-patent periods and parasite multiplication rates, (4) HPgV-1 RNA levels upon asexual blood-stage parasitemia induced by CHMI. RESULTS: The prevalence of HPgV-1 was 29.2% (28/96) and sequence analysis of the 5' UTR and E2 regions revealed the predominance of genotypes 1, 2 and 5. HPgV-1 infection was associated with elevated systemic levels of IL-2 and IL-17A. Comparable vaccine-induced anti-PfCSP antibody titers, asexual blood-stage multiplication rates and pre-patent periods were observed in HPgV-1 positive and negative individuals. However, a tendency for higher protection levels was detected in the HPgV-1 positive group (62.5%) compared to the negative one (51.6%) following CHMI. HPgV-1 viremia levels were not significantly altered after CHMI. CONCLUSIONS: HPgV-1 infection did not alter PfSPZ Vaccine elicited levels of PfCSP-specific antibody responses and parasite multiplication rates. Ongoing HPgV-1 infection appears to improve to some degree protection against CHMI in PfSPZ-vaccinated individuals. This is likely through modulation of immune system activation and systemic cytokines as higher levels of IL-2 and IL17A were observed in HPgV-1 infected individuals. CHMI is safe and well tolerated in HPgV-1 infected individuals. Identification of cell types and mechanisms of both silent and productive infection in individuals will help to unravel the biology of this widely present but largely under-researched virus

Residual biomass calculation from individual tree architecture using terrestrial laser scanner and ground-level measurements

Large quantity of residual biomass with possible energy and industrial end can be obtained from management operations of urban forests. The profitability of exploiting this resource is conditioned by the amount of existing biomass within urban community ecosystems. Prior research pointed out that residual biomass from Platanus hispanica and other tree species can be calculated from dendrometric parameters. In this study, two approaches have been analyzed: First, applicability of TLS was tested for residual biomass calculation from crown volume. In addition, traditional models for residual biomass prediction were developed from dendrometric parameters (tree height, crown diameter, and diameter at breast height). Next, a comparison between parameters obtained with both methodologies (standard methodologies vs TLS) was carried out. The results indicate a strong relationship (R2 = 0.906) between crown diameters and between total tree heights (R2 = 0.868). The crown volumes extracted from the TLS point cloud were calculated by 4 different methods: convex hull; convex hull by slices of 5 cm height in the XY plane; triangulation by XY flat sections, and voxel modeling. The highest accuracy was found when the voxel method was used for pruned biomass prediction (R2 = 0.731). The results revealed the potential of TLS data to determine dendrometric parameters and biomass yielded from pruning quitar of urban forestsFernández-Sarría, A.; Velázquez Martí, B.; Sajdak, M.; Martinez, L.; Estornell Cremades, J. (2013). Residual biomass calculation from individual tree architecture using terrestrial laser scanner and ground-level measurements. Computers and Electronics in Agriculture. 93:90-97. doi:10.1016/j.compag.2013.01.012S90979

Enhancing knowledge among smallholders on pollinators and supporting field margins for sustainable food security

Agro-ecological intensification (AEI) harnesses natural processes, such as pollination, that support sustainable food production and can buffer against future risks. However, the transition from conventional agriculture, which relies on inputs that can damage natural ecosystems, to more sustainable food production, is knowledge-intensive. Here, we investigated knowledge gaps among smallholder farmers about pollinators and field margins in a bean agri-system in Tanzania. While 77% of farmers were familiar with and identified honeybees correctly prior to training, only 52% understood their role as a pollinator of crops. Furthermore, 80% and 98% of farmers were unaware of the significance of wild (solitary) bees or the importance of hoverflies as pollinators. A high level of synthetic agrochemical use was reported for the management of pests and weeds, particularly in the more agriculturally intensive production systems. However, an end-line survey conducted one year after training showed an increase in knowledge and the majority of farmers, 99%, 54% and 62% subsequently recognized honeybees, hoverflies and solitary bees respectively, by name. Furthermore, 95%, 69% and 60% of farmers understood the importance of honeybees, hoverflies and solitary bees respectively, as crop pollinators and natural enemies (for hoverflies). Similarly, a majority of farmers recognised the benefits of biopesticides as environmentally over synthetic pesticides as well as the value of field margins in supporting pollinators and other ecosystem services. We argue that, improving understanding among smallholder farmers of ecosystem services and their ecological requirements is both feasible and essential to achieving sustainable intensification in small holder farming systems

Knowledge gaps among smallholder farmers hinder adoption of conservation biological control

Conservation biological control uses habitat management to enhance the survival and impact of arthropod natural enemies for pest control. Its advantages are that it relies on native or established invertebrate populations that are adapted to local agricultural ecosystems and conditions. We surveyed 300 farmers in three agro-ecological zones of Kilimanjaro Region, Tanzania to assess farmers’ knowledge of natural enemies, insect pests and pesticide use and ways of accessing agricultural information to identify hurdles to the adoption of conservation biological control measures. Data were collected through face to face interviews using questionnaires and pictures and by using a novel voice-response mobile phone survey. The farmers surveyed regarded almost all insects as pests, with data analyses revealing that 98.7% of farmers were completely unaware of natural enemies. After completing a short training course, however, awareness was transformed, with 80% of farmers recognising beneficial insects and expressing an intention to change farming practices to enhance their survival within the crop. Access to information about synthetic pesticide alternatives was a limiting factor to uptake of biological control measures with 8.7% of farmers reporting no access to agricultural information, while others were mostly dependent on agricultural officers. These findings identified a severe lack of knowledge among smallholder farmers about beneficial insects which will impact adoption of conservation biological control. We recommend improved access to information and knowledge among the technical officers and the smallholder farmers with direct training on agro-ecological intensification for wider adoption of conservation biological control

HIV Infection Functionally Impairs Mycobacterium tuberculosis-Specific CD4 and CD8 T-Cell Responses.

Human immunodeficiency virus (HIV) infection is the major risk factor predisposing for Mycobacterium tuberculosis progression from latent tuberculosis infection (LTBI) to tuberculosis disease (TB). Since long-term-treated aviremic HIV-infected individuals remained at higher risk of developing TB than HIV-uninfected individuals, we hypothesized that progression from LTBI to pulmonary TB (PTB) might be due not only to CD4 T-cell depletion but also to M. tuberculosis-specific CD4 T-cell functional impairment. To test this hypothesis, M. tuberculosis-specific T-cell frequencies and cytokine profiles were investigated in untreated Tanzanian individuals suffering from LTBI (n = 20) or PTB (n = 67) and compared to those of untreated M. tuberculosis/HIV-coinfected individuals suffering from LTBI (n = 15) or PTB (n = 10). We showed that HIV infection significantly reduced the proportion of Th2 (interleukin 4 [IL-4]/IL-5/IL-13) producing M. tuberculosis-specific CD4 T cells and IL-2-producing M. tuberculosis-specific CD4 and CD8 T cells in individuals with LTBI or PTB (P < 0.05). Interestingly, the loss of IL-2 production was associated with a significant increase of PD-1 expression on M. tuberculosis-specific CD4 and CD8 T cells (P < 0.05), while the loss of Th2 cytokine production was associated with a significant reduction of Gata-3 expression in memory CD4 T cells (P < 0.05). Finally, we showed that the serum levels of IL-1α, IL-6, C-reactive protein (CRP), IL-23, and IP-10 were significantly reduced in M. tuberculosis/HIV-coinfected individuals with PTB compared to those in HIV-negative individuals with PTB (P < 0.05), suggesting that HIV infection significantly suppresses M. tuberculosis-induced systemic proinflammatory cytokine responses. Taken together, this study suggests that in addition to depleting M. tuberculosis-specific CD4 T cells, HIV infection significantly impairs functionally favorable M. tuberculosis-specific CD4 T-cell responses in Tanzanian individuals with LTBI or PTB.IMPORTANCEMycobacterium tuberculosis and human immunodeficiency virus (HIV) infections are coendemic in several regions of the world, and M. tuberculosis/HIV-coinfected individuals are more susceptible to progression to tuberculosis disease. We therefore hypothesized that HIV infection would potentially impair M. tuberculosis-specific protective immunity in individuals suffering from latent tuberculosis infection (LTBI) or active pulmonary tuberculosis (PTB). In this study, we demonstrated that M. tuberculosis/HIV-coinfected individuals have fewer circulating M. tuberculosis-specific CD4 T cells and that those that remained were functionally impaired in both LTBI and PTB settings. In addition, we showed that HIV infection significantly interferes with M. tuberculosis-induced systemic proinflammatory cytokine/chemokine responses. Taken together, these data suggest that HIV infection impairs functionally favorable M. tuberculosis-specific immunity

Different methodologies for calculating crown volume of Platanus hispanica trees by terrestial laser scanner and comparison with classical dendrometric measurements

Terrestrial laser scanners (TLSs) are used in forestry and fruit culture applications to perform a threedimensional geometrical characterization of trees and so make it easier to develop management systems based on that information. In addition, this data can improve the accuracy of dendrometric variable estimations, such as crown volume, obtained by standard methods. The main objective of this paper is to compare classical methods for crown volume estimation with the volumes obtained from the processing of point clouds obtained using a terrestrial laser scanner (TLS) on urban Platanus hispanica trees. This will allow faster quantification of residual biomass from pruning and therefore an improved management in future. The methods applied using TLS data were also evaluated in terms of processing speed. A set of 30 specimens were selected and their main dendrometric parameters (such as diameter breast height, crown diameter, total height, and distance from the crown base to the soil) were manually measured using classical methods. From these dendrometric parameters, the apparent crown volumes were calculated using three geometric models: cone, hemisphere, and paraboloid. Simultaneously, these trees were scanned with a Leica ScanStation2. A laser point cloud was registered for each tree and processed to obtain the crown volumes. Four processing methods were analyzed: (a) convex hull (an irregular polyhedral surface formed by triangles that surround the crown) applied to the whole point cloud that forms the crown; (b) convex hull using slices of 10 cm in height from the top to the base of the crown; (c) XY triangulation in horizontal sections; and (d) voxel discretization. All the obtained volumes (derived from classical methods and TLS) were assessed and compared. The regression equations that compare the volumes obtained by dendrometry and those derived from TLS data showed coefficients of determination (R2) greater than 0.78. The highest R2 (0.89) was obtained in the comparison between the volume calculated using a paraboloid and flat sections, which was also the fastest method. These results show the potential of TLS for predicting the crown volumes of urban trees, such as P. hispanica, to help improve their management, especially the quantification of residual biomass.The authors appreciate the financial support provided by the Spanish Ministry of Science and Innovation in the framework of the Project AGL2010-15334 and by the Generalitat Valenciana in the framework of the Project GV/2012/003.Fernández-Sarría, A.; Martínez, L.; Velázquez Martí, B.; Sajdak, M.; Estornell Cremades, J.; Recio Recio, JA. (2013). Different methodologies for calculating crown volume of Platanus hispanica trees by terrestial laser scanner and comparison with classical dendrometric measurements. Computers and Electronics in Agriculture. 90(1):176-185. https://doi.org/10.1016/j.compag.2012.09.017S17618590

ImPROving TB outcomes by modifying LIFE-style behaviours through a brief motivational intervention followed by short text messages (ProLife): study protocol for a randomised controlled trial

Background: South Africa is among the 7 highest tuberculosis (TB) burden countries. Harmful lifestyle behaviours, such as smoking and alcohol, and poor medication adherence can affect clinical outcomes. Modification of these behaviours is likely to improve TB treatment outcomes and has proven possible using motivational interviewing (MI) techniques or use of short message service (SMS) text messaging. There have been no studies assessing the effect of combined MI and SMS interventions on multiple lifestyle factors and TB treatment outcomes. Methods: This is a prospective, multi-centre, two-arm individual randomised controlled trial looking at the effectiveness and cost-effectiveness of a complex behavioural intervention (the ProLife programme) on improving TB and lifestyle-related outcomes in 3 provinces of South Africa. The ProLife programme consists of an MI counselling strategy, delivered by lay health workers, augmented with subsequent SMS. We aim to recruit 696 adult participants (aged 18 years and over) with drug-sensitive pulmonary TB who are current smokers and/or report harmful or hazardous alcohol use. Patients will be consecutively enrolled at 27 clinics in 3 different health districts in South Africa. Participants randomised individually to the intervention arm will receive 3 MI counselling sessions 1 month apart. Each MI session will be followed by twice-weekly SMS messages targeting treatment adherence, alcohol use and tobacco smoking, as appropriate. We will assess the effect on TB treatment success, using standard World Health Organization (WHO) treatment outcome definitions (primary outcome), as well as on a range of secondary outcomes including smoking cessation, reduction in alcohol use and TB medication and anti-retroviral therapy adherence. Secondary outcomes will be measured at 3 and 6 months follow-up. Discussion: This trial aligns with the WHO agenda of integrating TB care with the care for chronic diseases of life-style, such as provision of smoking cessation treatments, and with the use of digital technologies. If the ProLife programme is found to be effective and cost- effective, the programme could have significant implications for TB treatment globally and could be successfully implemented in a wide range of TB treatment settings