The Burden of Rabies in Tanzania and Its Impact on Local\ud Communities

Rabies remains a major public health threat in many parts of the world and is responsible for an estimated 55,000 human deaths annually. The burden of rabies is estimated to be around US$20 million in Africa, with the highest financial expenditure being the cost of post-exposure prophylaxis (PEP). However, these calculations may be substantial underestimates because the costs to households of coping with endemic rabies have not been investigated. We therefore aimed to estimate the household costs, health-seeking behaviour, coping strategies, and outcomes of exposure to rabies in rural and urban communities in Tanzania. Extensive investigative interviews were used to estimate the incidence of human deaths and bite exposures. Questionnaires with bite victims and their families were used to investigate health-seeking behaviour and costs (medical and non-medical costs) associated with exposure to rabies. We calculated that an average patient in rural Tanzania, where most people live on less than US$1 per day, would need to spend over US$100 to complete WHO recommended PEP schedules. High costs and frequent shortages of PEP led to poor compliance with PEP regimens, delays in presentation to health facilities, and increased risk of death. The true costs of obtaining PEP were twice as high as those previously reported from Africa and should be considered in re-evaluations of the burden of rabies

A Mathematical Model of CA1 Hippocampal Neurons with Astrocytic Input

Over time astrocytes have been thought to function in an auxiliary manner, providing neurons with metabolic and structural support. However, recent research suggests they may play a fundamental role in the generation and propagation of focal epileptic seizures by causing synchronized electrical bursts in neurons. It would be helpful to have a simple mathematical model that represents this dynamic and incorporates these updated experimental results. We have created a two-compartment model of a typical neuron found in the hippocampal CA1 region, an area often thought to be the origin of these seizures. The focus is on properly modeling the astrocytic input to examine the pathological excitation of these neurons and subsequent transmission of the signals. In particular, we consider the intracellular astrocytic calcium fluctuations which are associated with slow inward currents in neighbouring neurons. Using our model, a variety of experimental results are reproduced, and comments are made about the potential differences between graded and “all-or-none” astrocytes

Knowledge, Attitudes and Practices (KAP) about rabies prevention and control: a community survey in Tanzania

BACKGROUND: Despite being entirely preventable,canine rabies still kills 55,000 people/year in developing countries. Information about local beliefs and practices can identify knowledge gaps that may affect prevention practices and lead to unnecessary deaths. METHODOLOGY/PRINCIPAL FINDINGS: We investigated knowledge, attitudes and practices related to rabies and its prevention and control amongst a cross-section of households (n = 5,141)in urban and rural areas of central, southern and northern Tanzania. Over 17% of respondents owned domestic dogs (average of 2.3 dogs/household), >95% had heard about rabies, and >80% knew that rabies is transmitted through dog bites. People who (1)had greater education,(2)originated from areas with a history of rabies interventions,(3)had experienced exposure by a suspect rabid animal,(4)were male and(5)owned dogs were more likely to have greater knowledge about the disease. Around 80% of respondents would seek hospital treatment after a suspect bite, but only 5% were aware of the need for prompt wound cleansing after a bite. Although >65% of respondents knew of dog vaccination as a means to control rabies, only 51% vaccinated their dogs. Determinants of dog vaccination included(1)being a male-headed household,(2)presence of children,(3)low economic status,(4)residing in urban areas,(5)owning livestock,(6)originating from areas with rabies interventions and(7)having purchased a dog. The majority of dog-owning respondents were willing to contribute no more than US$0.31 towards veterinary services. CONCLUSIONS/SIGNIFICANCE: We identified important knowledge gaps related to, and factors influencing the prevention and control of rabies in Tanzania. Increasing knowledge regarding wound washing, seeking post-exposure prophylaxis and the need to vaccinate dogs are likely to result in more effective prevention of rabies; however, greater engagement of the veterinary and medical sectors is also needed to ensure the availability of preventative services

Altering sensory learning by chronic inactivation of VIP interneurons

Vasoactive intestinal polypeptide-expressing interneurons (VIP-INs) play a key role in the regulation of cortical circuits and are implicated in perceptual function and psychiatric disease. However, their role in perceptual augmentation and learning remains understudied. We performed chronic, localized ablation of VIP-INs in the primary visual cortex of adult mice using caspase-induced apoptosis to better understand how VIP-INs contribute to visual perception and the ability to learn a visual detection task. We find that chronic VIP-IN ablation does not affect naïve performance on a full-screen visual contrast detection task. However, mice with suppressed levels of VIP-INs achieved their final expert state more rapidly and exhibited a greater detection advantage during high-arousal compared to control mice. These results suggest VIP-INs have an important role in modulating the learning process of cortical networks in the primary visual cortex

Heterogeneity in the spread and control of infectious disease: consequences for the elimination of canine rabies

Understanding the factors influencing vaccination campaign effectiveness is vital in designing efficient disease elimination programmes. We investigated the importance of spatial heterogeneity in vaccination coverage and human-mediated dog movements for the elimination of endemic canine rabies by mass dog vaccination in Region VI of the Philippines (Western Visayas). Household survey data was used to parameterise a spatially-explicit rabies transmission model with realistic dog movement and vaccination coverage scenarios, assuming a basic reproduction number for rabies drawn from the literature. This showed that heterogeneous vaccination reduces elimination prospects relative to homogeneous vaccination at the same overall level. Had the three vaccination campaigns completed in Region VI in 2010–2012 been homogeneous, they would have eliminated rabies with high probability. However, given the observed heterogeneity, three further campaigns may be required to achieve elimination with probability 0.95. We recommend that heterogeneity be reduced in future campaigns through targeted efforts in low coverage areas, even at the expense of reduced coverage in previously high coverage areas. Reported human-mediated dog movements did not reduce elimination probability, so expending limited resources on restricting dog movements is unnecessary in this endemic setting. Enhanced surveillance will be necessary post-elimination, however, given the reintroduction risk from long-distance dog movements

Group psychotherapy for female adult survivors of interpersonal psychological trauma: a preliminary study in Scotland

Background: There is limited evidence on manualised group interventions that facilitate thedevelopment of trauma recovery skills, affect regulation and meaning making for survivors ofinterpersonal trauma.Aim: The study aimed to provide preliminary evidence on the effectiveness of grouppsychotherapy (based on Trauma Recovery and Empowerment Model, TREM) for psychologicaldistress in adult survivors of interpersonal trauma.Method: Participants were a consecutive series of female patients (n¼71) from the waiting listsof five National Health Service (NHS) Boards in Scotland. Participants completed a set of selfratedmeasures (PCL, CORE, SCL-90, DES and RSES) at baseline, mid-intervention, postinterventionand 3-month follow-up.Results: Effect sizes were small to medium across measures and assessment points at posttreatmentand follow-up. With regard to clinical significance, at post-treatment, a proportion of9.9% to 54.9% of participants achieved clinical significance across measures. At follow-up, aproportion of 9.9% to 62.0% of participants achieved clinical significance across measures.Conclusions: Group psychotherapy may be useful for a proportion of participants and especiallyso for symptoms of dissociation and self-esteem. Survivors of interpersonal trauma should beoffered a choice of individual or group treatment modalities to reduce drop-out rate andmaximise outcomes

A quantile-based g-computation approach to addressing the effects of exposure mixtures

Exposure mixtures frequently occur in data across many domains, particularly in the fields of environmental and nutritional epidemiology. Various strategies have arisen to answer questions about mixtures, including methods such as weighted quantile sum (WQS) regression that estimate a joint effect of the mixture components.We demonstrate a new approach to estimating the joint effects of a mixture: quantile g-computation. This approach combines the inferential simplicity of WQS regression with the flexibility of g-computation, a method of causal effect estimation. We use simulations to examine whether quantile g-computation and WQS regression can accurately and precisely estimate effects of mixtures in common scenarios. We examine the bias, confidence interval coverage, and bias-variance tradeoff of quantile g-computation and WQS regression, and how these quantities are impacted by the presence of non-causal exposures, exposure correlation, unmeasured confounding, and non-linear effects. Quantile g-computation, unlike WQS regression allows inference on mixture effects that is unbiased with appropriate confidence interval coverage at sample sizes typically encountered in epidemiologic studies and when the assumptions of WQS regression are not met. Further, WQS regression can magnify bias from unmeasured confounding that might occur if important components of the mixture are omitted. Unlike inferential approaches that examine effects of individual exposures, methods like quantile g-computation that can estimate the effect of a mixture are essential for understanding effects of potential public health actions that act on exposure sources. Our approach may serve to help bridge gaps between epidemiologic analysis and interventions such as regulations on industrial emissions or mining processes, dietary changes, or consumer behavioral changes that act on multiple exposures simultaneously.Comment: Main manuscript (3 figures, 4 tables, 7000 words) + appendi