Impact of Length and Percent Dosage of Recycled Steel Fibers on the Mechanical Properties of Concrete

The global rapid increase in waste tyres accumulation, as well as the looming social and environmental concerns, have become major threats in recent times. The use of Recycled Steel Fiber (RSF) extracted from waste tyres in fiber reinforced concrete can be of great profitable engineering applications however the choice of suitable length and volume fractions of RSF is presently the key challenge that requires research exploration. The present experimental work aims at investigating the influence of varying lengths (7.62 and 10.16 cm) and dosages (1, 1.5, 2, 2.5, 3, 3.5, and 4%) of RSF on the various mechanical properties and durability of concrete. Test results revealed that the varying lengths and dosages of RSF significantly affect the mechanical properties of concrete. The improvements in the compressive strength, splitting tensile strength, and Modulus of Rupture (MOR) of RSF reinforced concrete observed were about 26, 70, and 63%, respectively. Moreover, the RSF reinforced concrete showed an increase of about 20 and 15% in the yield load and ultimate load-carrying capacity, respectively. The durability test results showed a greater loss in compressive strength and modulus of elasticity and a smaller loss in concrete mass of SFRC. Based on the experimental findings of this study, the optimum dosages of RSF as 2.5 and 2% for the lengths 7.62 and 10.16 cm lengths, respectively are recommended for production of structural concrete. Doi: 10.28991/cej-2021-03091750 Full Text: PD

Paratuberculosis: The Hidden Killer of Small Ruminants

Paratuberculosis (PTB) is a contagious and chronic enteric disease of ruminants and many non-ruminants caused by Mycobacterium avium subsp. paratuberculosis (MAP), and is characterised by diarrhoea and progressive emaciation with consequent serious economic losses due to death, early culling, and reduced productivity. In addition, indirect economic losses may arise from trade restrictions. Besides being a production limiting disease, PTB is a potential zoonosis; MAP has been isolated from Crohn’s disease patients and was associated with other human diseases, such as rheumatoid arthritis, Hashimoto’s thyroiditis, Type 1 diabetes, and multiple sclerosis. Paratuberculosis in sheep and goats may be globally distributed though information on the prevalence and economic impact in many developing countries seem to be scanty. Goats are more susceptible to infection than sheep and both species are likely to develop the clinical disease. Ingestion of feed and water contaminated with faeces of MAP-positive animals is the common route of infection, which then spreads horizontally and vertically. In African countries, PTB has been described as a “neglected disease”, and in small ruminants, which support the livelihood of people in rural areas and poor communities, the disease was rarely reported. Prevention and control of small ruminants’ PTB is difficult because diagnostic assays demonstrate poor sensitivity early in the disease process, in addition to the difficulties in identifying subclinically infected animals. Further studies are needed to provide more insight on molecular epidemiology, transmission, and impact on other animals or humans, socio-economic aspects, prevention and control of small ruminant PTB

Seroprevalence of Mycobacterium avium subsp. paratuberculosis in Dairy Cattle in Khartoum State, Sudan

Paratuberculosis, caused by Mycobacterium avium subspecies paratuberculosis (MAP), is a chronic wasting disease mainly of domestic and wild ruminants. It occurs worldwide, causing significant economic losses through decreased productivity, low fertility, increased cull rates and mortality. It is listed by the OIE (World Organization for Animal Health) as a disease of concern to trade in animals. Prevalence of this disease can be studied by detecting anti-MAP antibodies by Enzyme linked immunosorbent Assay (ELISA). The aim of this study was to investigate the current prevalence of MAP infection in cattle in Khartoum State. The overall apparent prevalence of MAP infection was found to be 6.3% and 18.9% at animal and herd levels, respectively. All seropositive animals were cross-bred females of good body condition; most of them (>90%) were >3 years old and >50% were from medium-sized herds in Omdurman. No significant association (p > 0.05) was found between seropositivity and animal herd size. The prevalence of MAP infection in Khartoum State is still low to medium compared to other parts of the world, but it is comparable to those reported from other African countries. Further studies with the view of designing nationwide surveys in domestic ruminants and camels in other states of the country are needed for establishing control programmes

Mycobacterium avium subsp. paratuberculosis and microbiome profile of patients in a referral gastrointestinal diseases centre in the Sudan

Mycobacterium avium subsp. paratuberculosis (MAP) causes Johne’s disease in animals with zoonotic potential; it has been linked to many chronic diseases in humans, especially gastrointestinal diseases (GID). MAP has been extensively studied in Europe and America, but little reports were published from Africa. Sudan is a unique country with close contact between humans and livestock. Despite such interaction, the one health concept is neglected in dealing with cases of humans with GID. In this study, patients admitted to the reference GID hospital in the Sudan over a period of 8 months were screened for presence of MAP in their faeces or colonic biopsies. A total of 86 patients were recruited for this study, but only 67 were screened for MAP, as 19 did not provide the necessary samples for analysis. Both real-time PCR and culture were used to detect MAP in the collected samples and the microbial diversity in patients´ faecal samples was investigated using 16S rDNA nanopore sequencing. In total, 27 (40.3%) patients were MAP positive: they were 15 males and 12 females, of ages between 21 and 80 years. Logistic regression analysis revealed no statistical significance for all tested variables in MAP positive patients (occupation, gender, contact with animal, milk consumption, chronic disease, etc.). A unique microbiome profile of MAP-positive patients in comparison to MAP-negative was found. These findings suggest that a considerable proportion of the population could be MAP infected or carriers. Therefore, increase awareness at community level is urgently needed to decrease the risk of MAP at human/animal interface. This study represents the first report of MAP in humans in the Sudan; nevertheless, a better view of the situation of MAP in humans in the country requires a larger study including patients with other conditions.Additional co-authors: Ahmad Amanzada, Kamal H. Eltom , ElSagad Eltaye

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Lessons Learned from Sudan's Health Sector Response Addressing Female Genital Mutilation between 2016 - 2018

Thesis (Ph.D.)--University of Washington, 2022About 87% of Sudanese women (15 – 49 years) have undergone female genital mutilation (FGM) mostly performed by midwives (64%). Since 2016, Sudan’s federal ministry of health (FMoH) initiated the largest health program focused on FGM in the country, with an aim of changing midwives’ involvement from being the ones performing FGM to instead being agents of change promoting FGM abandonment to their clients and communities as well as providing appropriate care to those with health related complications. There is a limited body of evidence for this programmatic approach in FGM prevalent and low resource settings as it is a nascent area of work. We used mixed methods, primary and secondary data, as well as implementation science and evaluation frameworks, to study Sudan’s first three years of this program (2016 – 2018). The specific objectives of the study were to 1) determine its scope and scale using program data; 2) identify facilitators and barriers that influenced planning and implementation as perceived by program managers through in-depth interviews; and 3) examine associations between past trainings and current midwives’ knowledge, attitudes and practices in Khartoum state using an exposure based comparative cross-sectional study. The program data analysis showed that Sudan addressed the World Health Organization’s (WHO) four recommended strategic pillars of action for 1) governance and finance, 2) knowledge and skills of health workers, 3) monitoring and evaluation and accountabilty, and 4) creating an enabling environment with significant achievements. There was governmental buy-in with national funds that matched donors’ funds for training activities (pillar 1). A third of all midwives (N=16,183) were trained (pillar 2) and there were several foundational activities on monitoring and evaluation as well as an accountability mechanism for midwives who perform FGM (pillar 3). Various professional and health students’ association members (10 – 59%) made calls to end practice or for its criminalization (pillar 4). Program managers felt that Sudan’s context and FMoH characteristics strongly influenced the health program design and implementation. Reported facilitators included both international and national funding availability, integrating FGM related activities within existent priority health intervention packages, and presence of an evaluation and feedback culture within international organizations. The barriers included power asymetries in decision making and engagement of all players for national and international funds during planning and implementation, low health system functionality and non-willingness to provide FGM prevention services among health workers in health centers. The exposure based cross-sectional study found that trained midwives were more likely to have higher knowledge on FGM types, to be aware that performing FGM was a violation of professional code of conduct and to have greater knowledge on de-infibulation procedure compared to non-trained midwives. In conclusion, Sudan’s experience generated several lessons for its existing program moving forward as well as other countries with a similar profile intending to implement or adopt WHO’s strategic pillars at a large scale. Though the existent programmatic data were rich and of good quality it was not centralized into a database for use by the FMoH. A centralized database which includes costs and interventions’ outcomes will enable program managers to test different scale up modalities to optimize costs and effectiveness. There is a need to identify approaches to strengthen joint accountability, decision-making and engagement of relevant stakeholders as equals and the impact on intervention outcomes, scale and sustainability studied. Training programs targeting midwives would need to address their values and self-efficacy in changing their FGM practices, as well as provide essential clinical skills for managing FGM related health complications. Health system and societal factors that deter midwives from abandoning FGM practice would need to be addressed in tandem through health system strengthening in coordination with other multi-sectoral interventions. Finally, frequent evaluations using dissemination and implementation science frameworks would enable health stakeholders assess implementation effectiveness in timely manner so that the health sector has a meaningful contribution into FGM abandonment efforts as well as improving the quality of life for girls and women affected by FGM

Evaluating the long-term impact of large-scale trainings: an exposure based cross-sectional study on female genital mutilation-related knowledge, attitudes and practices among Sudanese midwives in Khartoum State

Objectives To examine the long-term impact of large-scale training targeting midwives in a setting where they are the main female genital mutilation (FGM) practitioners. We hypothesised that trained midwives would have significantly higher knowledge, greater opposition to midwives’ involvement in this practice, and improved clinical practice in FGM prevention and care compared with non-trained midwives.Design We conducted an exposure based cross-sectional study, using closed-ended and open-ended questions during phone interviews.Setting Khartoum State in Sudan has a high prevalence of FGM (88%) mainly performed by midwives.Participants Midwives who received (n=127) and did not receive FGM training (n=55).Primary and secondary outcome measures We developed primary outcomes aligned to the three levels (reaction, learning and behaviour) of Kirkpatrick’s training evaluation model for descriptive and multivariable analyses in Stata.Results All the midwives interviewed were female, mostly village midwives (92%) and worked in health centres (89%). The mean age and midwifery experience was 51 years (SD=10) and 23 years (SD=12), respectively. Overall, most midwives (>90%) reported being supportive of FGM discontinuation. Midwives who had FGM training were more aware that performing FGM violates code of conduct (p=0.001) and reported to always counsel patients to abandon FGM (p<0.001) compared with midwives who did not report training. However, these associations were not statistically significant in multivariable logistic regression model adjusting for age. Exploratory analysis of training curricula showed higher knowledge, correct attitude and practices among those who reported in-service training before 2016.Conclusion Though past trainings were associated with higher knowledge and greater opposition to midwives’ involvement in FGM, this was not translated into appropriate corrective clinical procedures among affected women during labour. The Sudan Ministry of Health invested heavily in training midwives and it would be important to investigate why trained midwives do not implement recommended FGM-related clinical management