Analysis of maternal and newborn training curricula and approaches to inform future trainings for routine care, basic and comprehensive emergency obstetric and newborn care in the low- and middle-income countries: Lessons from Ethiopia and Nepal

Program managers routinely design and implement specialised maternal and newborn health trainings for health workers in low- and middle-income countries to provide better-coordinated care across the continuum of care. However, in these countries details on the availability of different training packages, skills covered in those training packages and the gaps in their implementation are patchy. This paper presents an assessment of maternal and newborn health training packages to describe differences in training contents and implementation approaches used for a range of training packages in Ethiopia and Nepal. We conducted a mixed-methods study. The quantitative assessment was conducted using a comprehensive assessment questionnaire based on validated WHO guidelines and developed jointly with global maternal and newborn health experts. The qualitative assessment was conducted through key informant interviews with national stakeholders involved in implementing these training packages and working with the Ministries of Health in both countries. Our quantitative analysis revealed several key gaps in the technical content of maternal and newborn health training packages in both countries. Our qualitative results from key informant interviews provided additional insights by highlighting several issues with trainings related to quality, skill retention, logistics, and management. Taken together, our findings suggest four key areas of improvement: first, training materials should be updated based on the content gaps identified and should be aligned with each other. Second, trainings should address actual health worker performance gaps using a variety of innovative approaches such as blended and self-directed learning. Third, post-training supervision and ongoing mentoring need to be strengthened. Lastly, functional training information systems are required to support planning efforts in both countries

Molecular Characterization of Leishmania Species Isolated from Cutaneous Leishmaniasis in Yemen

Background: Cutaneous leishmaniasis (CL) is a neglected tropical disease endemic in the tropics and subtropics with a global yearly incidence of 1.5 million. Although CL is the most common form of leishmaniasis, which is responsible for 60% of DALYs lost due to tropical-cluster diseases prevalent in Yemen, available information is very limited. Methodology/Principal Findings: This study was conducted to determine the molecular characterization of Leishmania species isolated from human cutaneous lesions in Yemen. Dermal scrapes were collected and examined for Leishmania amastigotes using the Giemsa staining technique. Amplification of the ribosomal internal transcribed spacer 1(ITS-1) gene was carried out using nested PCR and subsequent sequencing. The sequences from Leishmania isolates were subjected to phylogenetic analysis using the neighbor-joining and maximum parsimony methods. The trees identified Leishmania tropica from 16 isolates which were represented by two sequence types. Conclusions/Significance: The predominance of the anthroponotic species (i.e. L. tropica) indicates the probability of anthroponotic transmission of cutaneous leishmaniasis in Yemen. These findings will help public health authorities to build an effective control strategy taking into consideration person–to-person transmission as the main dynamic of transmissio

Susceptibilidade larval de duas populações de Aedes egypti a inseticidas químicos Larval susceptibility to chemical insecticides of two Aedes egypti populations

OBJETIVO: A susceptibilidade dos insetos tem sido um dos mais importantes aspectos a ser monitorados em programas de saúde pública que tratam do controle de vetores. O estudo objetiva avaliar a susceptibilidade de larvas de Aedes aegypti a inseticidas químicos em áreas sujeitas ou não a controle. MÉTODOS: Bioensaios foram realizados com concentração de diagnóstico e concentração múltipla, segundo padrão da Organização Mundial de Saúde para as coletas de larvas de Aedes aegypti, em uma área não sujeita -- Campinas, SP -- e em uma outra área sujeita -- Campo Grande, MS -- a tratamentos químicos de controle. RESULTADOS: Larvas de Aedes aegypti coletadas em Campinas indicaram resistência potencial à concentração-diagnóstico (CD) de 0,04 ppm do organofosforado temephos. O teste de concentração múltipla registrou sobrevivência de 24,5% à concentração de 0,0125 ppm. A susceptibilidade dessa mesma linhagem foi avaliada para o organofosforado fenitrothion (CD=0,08 ppm) e o piretróide cipermetrina (CD=0,01 ppm), resultando em valores normais para essas concentrações. Larvas de Ae. aegypti coletadas em Campo Grande mostraram susceptibilidade normal ao temephos (CD=0,04 ppm) e à cipermetrina (CD=0,01 ppm). Também foram estabelecidas as CL50 e as CL95 de cipermetrina 25 CE, cyfluthrin 5 CE, betacyfluthrin 1,25 SC e propoxur 20 CE para Ae. aegypti. Com base nos dados da linhagem-padrão Rockefeller, foram estimadas as razões de resistência de 2,9, 2,2, 2,4 e 1,3, respectivamente, pela CL50, e de 3,5, 2,6, 3,9 e 1,3 pela CL95. CONCLUSÃO: Os resultados reforçam a necessidade de avaliações prévias e monitoramento da efetividade dos inseticidas que devem ser usados em programas de controle de mosquitos.<br>OBJECTIVE: Insect susceptibility has been one of the most important aspects to be monitored in public health programs for vector control. The purpose of the study is to assess the susceptibility to chemical insecticides of Aedes aegypti larvae in both areas under vector control and no vector control. METHODS: World Health Organization standard bioassays for diagnostic concentration and multiple concentrations were performed in mosquito larvae collected in an area under no vector control (Campinas, SP) and an area under vector chemical control (Campo Grande, MS), in Brazil. RESULTS: Potential resistance to a diagnostic concentration of temephos (DC=0.04 ppm) was registered for an Ae. aegypti larval population collected in Campinas. Multiple concentration tests confirmed the larvae resistance, with 24.5% of them surviving at the 0.0125 ppm concentration. Bioassays with the organophosphate fenitrothion (DC=0.08 ppm) and pyrethroid cypermethrin (DC=0.01 ppm) in the same population revealed their susceptibility to these agents. Bioassays carried out in an Ae. aegypti larval population collected in Campo Grande showed their susceptibility to temephos (DC=0.04 ppm) and cypermethrin (DC=0.01 ppm). LC50 and LC95 for cypermethrin (CE25), cyfluthrin (CE5), betacyfluthrin (SC1.25) and propoxur (CE20) were determined for Ae. aegypti . Using the Rockefeller standard strain values, ratios of resistance were estimated: 2.9, 2.2, 2.4 and 1.3 for LC50 and 3.5, 2.6, 3.9 and 1.3 for LC95, respectively. CONCLUSION: The findings reinforce the need for routinely monitoring pesticide efficacy as a very important step in vector control management programs

Insecticide resistance in the bed bug comes with a cost

Adaptation to new environmental stress is often associated with an alteration of one or more life history parameters. Insecticide resistant populations of insects often have reduced fitness relative to susceptible populations in insecticide free environments. Our previous work showed that three populations of bed bugs, Cimex lectularius L., evolved significantly increased levels of resistance to one product containing both β-cyfluthrin and imidacloprid insecticides with only one generation of selection, which gave us an opportunity to explore potential tradeoffs between life history parameters and resistance using susceptible and resistant strains of the same populations. Life history tables were compiled by collecting weekly data on mortality and fecundity of bugs from each strain and treatment throughout their lives. Selection led to a male-biased sex ratio, shortened oviposition period, and decreased life-time reproductive rate. Generation time was shortened by selection, a change that represents a benefit rather than a cost. Using these life history characteristics we calculated that there would be a 90% return to pre-selection levels of susceptibility within 2- 6.5 generations depending on strain. The significant fitness costs associated with resistance suggest that insecticide rotation or utilization of non-insecticidal control tactics could be part of an effective resistance management strategy