Diarrhoea, acute respiratory infection, and fever among children in the Democratic Republic of Congo

Several years of war have created a humanitarian crisis in the Democratic Republic of Congo (DRC) with extensive disruption of civil society, the economy and provision of basic services including health care. Health policy and planning in the DRC are constrained by a lack of reliable and accessible population data. Thus there is currently a need for primary research to guide programme and policy development for reconstruction and to measure attainment of the Millennium Development Goals (MDGs). This study uses the 2001 Multiple Indicators Cluster Survey to disentangle children's health inequalities by mapping the impact of geographical distribution of childhood morbidity stemming from diarrhoea, acute respiratory infection, and fever. We observe a low prevalence of childhood diarrhoea, acute respiratory infection and fever in the western provinces (Kinshasa, Bas-Congo and Bandundu), and a relatively higher prevalence in the south-eastern provinces (Sud-Kivu and Katanga). However, each disease has a distinct geographical pattern of variation. Among covariate factors, child age had a significant association with disease prevalence. The risk of the three ailments increased in the first 8–10 months after birth, with a gradual improvement thereafter. The effects of socioeconomic factors vary according to the disease. Accounting for the effects of the geographical location, our analysis was able to explain a significant share of the pronounced residual geographical effects. Using large scale household survey data, we have produced for the first time spatial residual maps in the DRC and in so doing we have undertaken a comprehensive analysis of geographical variation at province level of childhood diarrhoea, acute respiratory infection, and fever prevalence. Understanding these complex relationships through disease prevalence maps can facilitate design of targeted intervention programs for reconstruction and achievement of the MDGs

Accounting for recent trends in the prevalence of diarrhoea in the Democratic Republic of Congo (DRC) : results from consecutive cross-sectional surveys

Objectives: To analyse trends in diarrhoea prevalence by maternal education, access to clean water and improved sanitation, household wealth index; to identify the sources of variation and assess contribution of changes in socioeconomic characteristics in the Democratic Republic of Congo (DRC). Design: Consecutive cross-sectional surveys. Setting: DRC. Participants: The databases contain information on 9748 children from the 2001 Multiple Indicators Cluster Survey and 7987 children from the 2007 Demographic and Health Survey. Interventions: N/A. Primary and secondary outcome measures Whether the child had diarrhoea 14 days preceding the survey. Results: The overall prevalence of diarrhoea decreased by 26 percent (from 22.1% in 2001 to 16.4% in 2007). Findings from the three complementary statistical methods are consistent and confirm a significant decrease in diarrhoea regardless of socioeconomic characteristics. Changes in behaviour and/or in public health policy seem to be the likely main source of the change. There were no significant changes in diarrhoea prevalence associated with variation of the population structure. It is worth mentioning that the decrease in diarrhoea prevalence is in contrast to the generalised poor living conditions of the population. Therefore, it is difficult to ascertain whether the decline in diarrhoea prevalence was due to real improvement in public-health policy or to data quality issues. Conclusions: The decline of diarrhoea prevalence in our study need to be further investigated by conducting district-based or provincial-based studies to validate findings from household surveys such as Demographic and Health Surveys and Multiple Indicators Cluster Survey taking into account the current context of the country: ongoing conflict, poor socioeconomic and poor health infrastructure. However, improvement in living conditions such as access to clean water and improved sanitation will contribute to accelerate the reduction of diarrhoea prevalence as well as reduction of child mortality

Childhood mortality in sub-Saharan Africa : cross-sectional insight into small-scale geographical inequalities from Census data

Objectives To estimate and quantify childhood mortality, its spatial correlates and the impact of potential correlates using recent census data from three sub-Saharan African countries (Rwanda, Senegal and Uganda), where evidence is lacking. Design Cross-sectional. Setting Nation-wide census samples from three African countries participating in the 2010 African Census round. All three countries have conducted recent censuses and have information on mortality of children under 5 years. Participants 111 288 children under the age of 5 years in three countries. Primary and secondary outcome measures Under-five mortality was assessed alongside potential correlates including geographical location (where children live), and environmental, bio-demographic and socioeconomic variables. Results Multivariate analysis indicates that in all three countries the overall risk of child death in the first 5 years of life has decreased in recent years (Rwanda: HR=0.04, 95% CI 0.02 to 0.09; Senegal: HR=0.02 (95% CI 0.02 to 0.05); Uganda: HR=0.011 (95% CI 0.006 to 0.018). In Rwanda, lower deaths were associated with living in urban areas (0.79, 0.73, 0.83), children with living mother (HR=0.16, 95% CI 0.15 to 0.17) or living father (HR=0.38, 95% CI 0.36 to 0.39). Higher death was associated with male children (HR=1.06, 95% CI 1.02 to 1.08) and Christian children (HR=1.14, 95% CI 1.05 to 1.27). Children less than 1 year were associated with higher risk of death compared to older children in the three countries. Also, there were significant spatial variations showing inequalities in children mortality by geographic location. In Uganda, for example, areas of high risk are in the south-west and north-west and Kampala district showed a significantly reduced risk. Conclusions We provide clear evidence of considerable geographical variation of under-five mortality which is unexplained by factors considered in the data. The resulting under-five mortality maps can be used as a practical tool for monitoring progress within countries for the Millennium Development Goal 4 to reduce under-five mortality in half by 2015

Spatial variation of salt intake in Britain and association with socioeconomic status

Objectives: To evaluate spatial effects of variation and social determinants of salt intake in Britain. Design: Cross-sectional survey. Setting: Great Britain. Participants: 2105 white male and female participants, aged 19–64 years, from the British National Diet and Nutrition Survey 2000–2001. Primary outcomes: Participants’ sodium intake measured both with a 7-day dietary record and a 24-h urine collection. By accounting for important linear and non-linear risk factors and spatial effects, the geographical difference and spatial patterns of both dietary sodium intake and 24-h urinary sodium were investigated using Bayesian geo-additive models via Markov Chain Monte Carlo simulations. Results: A significant north–south pattern of sodium intake was found from posterior probability maps after controlling for important sociodemographic factors. Participants living in Scotland had a significantly higher dietary sodium intake and 24-h urinary sodium levels. Significantly higher sodium intake was also found in people with the lowest educational attainment (dietary sodium: coeff. 0.157 (90% credible intervals 0.003, 0.319), urinary sodium: 0.149 (0.024, 0.281)) and in manual occupations (urinary sodium: 0.083 (0.004, 0.160)). These coefficients indicate approximately a 5%, 9% and 4% difference in average sodium intake between socioeconomic groups. Conclusions: People living in Scotland had higher salt intake than those in England and Wales. Measures of low socioeconomic position were associated with higher levels of sodium intake, after allowing for geographic location

Chronic chromosome instability induced by Plk1 results in immune suppression in breast cancer

Chromosomal instability (CIN), the failure of cells to segregate chromosomes correctly during cell division, is a typical feature of solid and hematopoietic tumors. By fostering intratumor heterogeneity and facilitating therapy resistance CIN aids in the growth of tumors. Natural killer (NK) cells have been shown to recognize and destroy cells with complex karyotypes in in vitro experiments. Contrarily, immunosuppressive phenotype has also been noted in human malignancies with high levels of CIN. However, which CIN-associated genetic characteristics influence immune recognition during tumor progression still remains to be elucidated. Previous research from our group demonstrated that overexpression of Polo-like kinase 1 (Plk1) in Her2- positive mammary tumors, resulted in increased CIN levels along with a delay in tumor initiation. Using the same mouse model, I demonstrate that Her2-Plk1 tumors induce a senescence-associated secretory phenotype (SASP) and mediate immune evasion by upregulating PD-L1 and CD206 and inducing non-cell-autonomous NF-kB signaling (RELB). Immune cells from early-stage induced mammary glands were sequenced and the results disclosed the presence of Arg1+ macrophages with EMT signatures, NK cells (CD11b–CD27+) with reduced effector capabilities along with increased infiltration of resting regulatory T cells during development of Her2-Plk1 tumors compared to tumors with low CIN. Thus, immune modulation in tumors possessing high CIN happens very early during tumor development with multiple arms of the immune system playing an important role. We further corroborate similar findings in human breast tumors expressing high levels of PLK1 and find upregulation of gene sets associated with SASP, NF-kB signaling and immune suppression. In conclusion, the results presented from in vivo experiments aid in understanding the interaction between different levels of CIN and the immune system. The study also highlights the need for novel adjuvant therapies such as anti-PDL1 or RELB inhibition in the context of chromosomally unstable tumors expressing PLK

Comprehensive Structural, Thermal and Toxicological Characterization of 1-Ethyl-3-Methylimidazolium Alkylbenzenesulfonate Ionic Liquids

Synthesis and characterization of 1-ethyl-3- methylimidazolium alkylbenzenesulfonate ionic liquids for extraction of lignin from prairie cord grass have been studied. The ionic liquids (ILs) 1-ethyl-3- methylimidazolium benzenesulfonate (EBS), 1-ethyl-3- methylimidazolium toluenesulfonate (ETS) and 1-ethyl-3- methylimidazolium xylenesulfonate (EXS) have been synthesized in this research. An extensive structural, physical, thermal and toxicological characterization has been performed to understand the behavior of these ionic liquids. The reaction yield for the synthesis of EBS, ETS, and EXS ionic liquids was determined to be 91.2 ± 1.5 %, 96.1 ± 0.7 %, 99.0 ± 0.5 % respectively. Spectral analysis using NMR and FTIR confirms the structure of these ionic liquids. The Kamlet-Taft properties of these ionic liquids have been determined using solvatochromic probes limited to Reichardt’s dye, 4-nitroaniline and N,N-diethyl-4- nitroaniline. Viscosity, polarity and hydrogen bond acidity of EBS, EEBS, ETS, and EXS ILs was found to increase with increasing methylation and anion size in the following order EBS \u3c ETS \u3c EXS. Thermal analysis of the ILs has been performed using DSC and TGA. Study of the glass transition and mesomorphic phases has been analyzed using DSC. The TGA has been used to determine thermal stability of the ILs. The EBS and EEBS were found to have decomposition onset around 349 oC, which is higher than the decomposition onset of ETS and EXS at 331°C and 319°C respectively. Thermal behavior of the ILs has been studied at different nitrogen flow rates, where the significant mass loss after 300°C was attributed to thermal decomposition of ILs. Toxicological studies were performed using LDH, MTT and Ames assays. The EXS exhibited highest cytotoxicity and genotoxicity followed by ETS and then EBS. The optimal temperature in the lignin extraction study was found to be at 90 oC for 3 hours without addition of water or steampretreatment. The percent lignin extracted from PCG using EBS, EEBS, ETS and EXS ILs was found to be 17.5±0.28, 17.4±0.53, 19.6±0.07 and 21.9±0.05 respectively

Semiparametric Analysis of the Socio-Demographic and Spatial Determinants of Undernutrition in Two African Countries

We estimate semiparametric regression models of chronic undernutrition (stunting) using the 1992 Demographic and Health Surveys (DHS) from Tanzania and Zambia. We focus particularly on the influence of the child's age, the mother's body mass index, and spatial influences on chronic undernutrition. Conventional parametric regression models are not flexible enough to cope with possibly nonlinear effects of the continuous covariates and cannot flexibly model spatial influences. We present a Bayesian semiparametric analysis of the effects of these two covariates on chronic undernutrition. Moreover, we investigate spatial determinants of undernutrition in these two countries. Compared to previous work with a simple fixed effects approach for the influence of provinces, we model small scale district specific effects using flexible spatial priors. Inference is fully Bayesian and uses recent Markov chain Monte Carlo techniques

The epidemiology of HIV infection in Zambia

Population surveys of health and fertility are an important source of information about demographic trends and their likely impact on the HIV/AIDS epidemic. In contrast to groups sampled at health facilities they can provide nationally and regionally representative estimates of a range of variables. Data on HIV sero-status were collected in the 2001-2 Zambia Demographic and Health Survey (ZDHS) and made available in a separate data file in which HIV status was linked to a very limited set of demographic variables. We utilized this data set to examine associations between HIV prevalence, gender, age and geographical location. We apply the generalized geo-additive semi-parametric model as an alternative to the common linear model, in the context of analyzing the prevalence of HIV infection. This model enables us to account for spatial auto-correlation, non-linear, location effects on the prevalence of HIV infection at the disaggregated provincial level (9 provinces) and assess temporal and geographical variation in the prevalence of HIV infection, while simultaneously controlling for important risk factors. 54 % of the overall sample of 3950 was female. The overall HIV positivity rate was 565 (14.3%). The mean age at HIV diagnosis for male was 30.3 (SD: 11.2) and 27.7 (SD: 9.3) for female respectively. Lusaka and Copperbelt have the first and second highest prevalence of AIDS/HIV (marginal odds ratios of 3.24 and 2.88 respectively) but when the younger age of the urban population and the spatial auto-correlation was taken into account Lusaka and Copper belt were no longer among the areas with the highest prevalence. Nonlinear effects of age at HIV diagnosis were also discussed and the importance of spatial residual effects and control of confounders on the prevalence of HIV infection. The study was conducted to assess the spatia pattern and the effect of confounding risk factors on AIDS/HIV prevalence and to develop a means of adjusting estimates of AIDS/HIV prevalence on the important risk factors. Controlling for important risk factors such as geographical location (spatial auto-correlation), age structure of the population, gender gave estimates of prevalence that are statistically robust. Researchers should be encouraged to use all available information in the data to account for important risk factors when reporting AIDS/HIV prevalence. Where this is not possible, correction factors should be applied, particularly where estimates of AIDS/HIV prevalence are pooled in systematic reviews. Our maps can be used for policy planning and management of AIDS/HIV in Zambia

Factors associated with female genital mutilation in Burkina Faso and its policy implications

Background: Female genital mutilation (FGM) usually undertaken between the ages of 1-9 years and is widely practised in some part of Africa and by migrants from African countries in other parts of the world. Laws prohibit FGM in almost every country. FGM can cause immediate complications (pain, bleeding and infection) and delayed complications (sexual, obstetric, psychological problems). Several factors have been associated with an increased likelihood of FGM. In Burkina Faso, the prevalence of FGM appears to have increased in recent years. Methods: We investigated social, demographic and economic factors associated with FGM in Burkina Faso using the 2003 Demographic Health Survey (DHS). The DHS is a nationally representative cross-sectional survey (multistage stratified random sampling of households) of women of reproductive age (15-49 years). Associations between potential risk factors and the prevalence of FGM were explored using c2 and t-tests and Mann Whitney U-test as appropriate. Logistic regression modelling was used to investigate social, demographic and economic risk factors associated with FGM. Main outcome measures: i) whether a woman herself had had FGM; ii) whether she had one or more daughters with FGM. Results: Data were available on 12,049 women. Response rates by region were at least 90%. Women interviewed were representative of the underlying populations of the different regions of Burkina Faso. Seventy seven percent (9267) of the women interviewed had had FGM. 7336 women had a daughter of whom 2216 (30.2%) had a daughter with FGM and 334 (4.5%) said that they intended that their daughter should have it. Univariate analysis showed that age, religion, wealth, ethnicity, literacy, years of education, household affluence, region and who had responsibility for health care decisions in the household had (RHCD) were all significantly related to the two outcomes (p < 0.01). Multivariate analysis stratified by religion mainly confirmed these findings, however, education is significantly associated with a reduced likelihood of FGM only for Christian women. Conclusions and Policy implications: Factors associated with FGM are varied and complex. Younger women and those from specific groups and religions are less likely to have had FGM. A higher level of education may be protective for women from certain religions. Policies should capitalize on these findings and religious leaders should be involved in continuing programmes of action