Ambient PM2.5 Temporal Variation and Source Apportionment in Mbarara, Uganda

Air pollution is the leading environmental cause of death globally, and most mortality occurs in resource-limited settings such as sub-Saharan Africa. The African continent experiences some of the worst ambient air pollution in the world, yet there are relatively little African data characterizing ambient pollutant levels and source admixtures. In Uganda, ambient PM2.5 levels exceed international health standards. However, most studies focus only on urban environments and do not characterize pollutant sources. We measured daily ambient PM2.5 concentrations and sources in Mbarara, Uganda from May 2018 through February 2019 using Harvard impactors fitted with size-selective inlets. We compared our estimates to publicly available levels in Kampala, and to World Health Organization (WHO) air quality guidelines. We characterized the leading PM2.5 sources in Mbarara using x-ray fluorescence and positive matrix factorization. Daily PM2.5 concentrations were 26.7 µg m–3 and 59.4 µg m–3 in Mbarara and Kampala, respectively (p < 0.001). PM2.5 concentrations exceeded WHO guidelines on 58% of days in Mbarara and 99% of days in Kampala. In Mbarara, PM2.5 was higher in the dry as compared to the rainy season (30.8 vs. 21.3, p < 0.001), while seasonal variation was not observed in Kampala. PM2.5 concentrations did not vary on weekdays versus weekends in either city. In Mbarara, the six main ambient PM2.5 sources identified included (in order of abundance): traffic-related, biomass and secondary aerosols, industry and metallurgy, heavy oil and fuel combustion, fine soil, and salt aerosol. Our findings confirm that air quality in southwestern Uganda is unsafe and that mitigation efforts are urgently needed. Ongoing work focused on improving air quality in the region may have the greatest impact if focused on traffic and biomass-related sources

Blindness in Childhood in Developing Countries: Time for a Reassessment?

Paul Courtright and colleagues argue that the changing patterns of global childhood blindness suggest a need to reassess research, training, and programmatic requirements

Carbon sequestration and biodiversity following 18 years of active tropical forest restoration

Vast areas of degraded tropical forest, combined with increasing interest in mitigating climate change and conserving biodiversity, demonstrate the potential value of restoring tropical forest. However, there is a lack of long-term studies assessing active management for restoration. Here we investigate Above-Ground Biomass (AGB), forest structure, and biodiversity, before degradation (in old-growth forest), after degradation (in abandoned agricultural savanna grassland), and within a forest that is actively being restored in Kibale National Park, Uganda. In 1995 degraded land in Kibale was protected from fire and replanted with native seedlings (39 species) at a density of 400 seedlings ha-1. Sixty-five plots (50 m × 10 m) were established in restoration areas in 2005 and 50 of these were re-measured in 2013, allowing changes to be assessed over 18 years. Degraded plots have an Above Ground Biomass (AGB) of 5.1 Mg dry mass ha-1, of which 80% is grass. By 2005 AGB of trees ≥10 cm DBH was 9.5 Mg ha-1, increasing to 40.6 Mg ha-1 by 2013, accumulating at a rate of 3.9 Mg ha-1 year-1. A total of 153 planted individuals ha-1 (38%) remained by 2013, contributing 28.9 Mg ha-1 (70%) of total AGB. Eighteen years after restoration, AGB in the plots was 12% of old-growth (419 Mg ha-1). If current accumulation rates continue restoration forest would reach old-growth AGB in a further 96 years. Biodiversity of degraded plots prior to restoration was low with no tree species and 2 seedling species per sample plot (0.05 ha). By 2005 restoration areas had an average of 3 tree and 3 seedling species per sample plot, increasing to 5 tree and 9 seedling species per plot in 2013. However, biodiversity was still significantly lower than old-growth forest, at 8 tree and 16 seedling species in an equivalent area. The results suggest that forest restoration is beneficial for AGB accumulation with planted stems storing the majority of AGB. Changes in biodiversity appear slower; possibly due to low stem turnover. Overall this restoration treatment is an effective means of restoring degraded land in the area, as can be seen from the lack of regeneration in degraded plots, which remain low-AGB and diversity, largely due to the impacts of fire and competition with grasses

Towards more accurate HIV testing in sub-Saharan Africa: a multi-site evaluation of HIV RDTs and risk factors for false positives

Introduction: Although individual HIV rapid diagnostic tests (RDTs) show good performance in evaluations conducted by WHO, reports from several African countries highlight potentially significant performance issues. Despite widespread use of RDTs for HIV diagnosis in resource-constrained settings, there has been no systematic, head-to-head evaluation of their accuracy with specimens from diverse settings across sub-Saharan Africa. We conducted a standardized, centralized evaluation of eight HIV RDTs and two simple confirmatory assays at a WHO collaborating centre for evaluation of HIV diagnostics using specimens from six sites in five sub-Saharan African countries. Methods: Specimens were transported to the Institute of Tropical Medicine (ITM), Antwerp, Belgium for testing. The tests were evaluated by comparing their results to a state-of-the-art reference algorithm to estimate sensitivity, specificity and predictive values. Results: 2785 samples collected from August 2011 to January 2015 were tested at ITM. All RDTs showed very high sensitivity, from 98.8% for First Response HIV Card Test 1–2.0 to 100% for Determine HIV 1/2, Genie Fast, SD Bioline HIV 1/2 3.0 and INSTI HIV-1/HIV-2 Antibody Test kit. Specificity ranged from 90.4% for First Response to 99.7% for HIV 1/2 STAT-PAK with wide variation based on the geographical origin of specimens. Multivariate analysis showed several factors were associated with false-positive results, including gender, provider-initiated testing and the geographical origin of specimens. For simple confirmatory assays, the total sensitivity and specificity was 100% and 98.8% for ImmunoComb II HIV 12 CombFirm (ImmunoComb) and 99.7% and 98.4% for Geenius HIV 1/2 with indeterminate rates of 8.9% and 9.4%. Conclusions: In this first systematic head-to-head evaluation of the most widely used RDTs, individual RDTs performed more poorly than in the WHO evaluations: only one test met the recommended thresholds for RDTs of ≥99% sensitivity and ≥98% specificity. By performing all tests in a centralized setting, we show that these differences in performance cannot be attributed to study procedure, end-user variation, storage conditions, or other methodological factors. These results highlight the existence of geographical and population differences in individual HIV RDT performance and underscore the challenges of designing locally validated algorithms that meet the latest WHO-recommended thresholds

Addfile 1 crude RDTs 04072016.pdf

Additional files to diagnostic accuracy study of HIV tests<br