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

Socio-demographic determinants of anaemia and nutritional status in the Democratic Republic of Congo, Uganda and Malawi

Anaemia is a worldwide public health concern. Anaemia is multifactorial and its related factors are classified according to their position in the pathophysiological process. Socioeconomic and demographic factors such as poor education, cultural norms such as food taboos can predispose children and women to anaemia through immediate causes such as physiological, biological, diet and infections. However, socioeconomic and demographic factors associated with anaemia are not widely reported and it is difficult to find published literature on this subject, which could be due to the lack of data. The objective of this research is to provide an understanding of socioeconomic and demographic factors related with anaemia among children and women and the links between anaemia during childhood and child nutritional status which can be used as a basis for policy formulation, planning and implementation.Almost three quarters of children and half of women in DRC (2007), Uganda (2006) and Malawi (2004) are anaemic. Multilevel ordinal regression models were fitted for anaemia among children and multilevel logistic regression models for anaemia among women. The models showed variations in anaemia prevalence within the countries at the community level. However, country level interactions indicate that there are no significant differences in the risk of anaemia in children and women between these countries. Endogenous switching regression models were fitted to the data to explore the link between anaemia and child’s health outcomes. Anaemia is endogenous to children’s nutritional status (weight-for-age z-scores) which should be accounted for. The prevalence of anaemia is high in DRC (71%), Uganda (74%) and Malawi (73%) and anaemia is a severe public health problem in the three countries. Although it will take considerable time for the three countries to control anaemia, it is not an impossible task. By improving nutrition and iron status, and treating helminth and malaria infections, the prevalence of anaemia can decrease as observed in Malawi in 2010. More effort is needed to identify the pathways through which anaemia within each country may be addressed

Geo-additive models of Childhood Undernutrition in three Sub-Saharan African Countries

We investigate the geographical and socioeconomic determinants of childhood undernutrition in Malawi, Tanzania and Zambia, three neighboring countries in Southern Africa using the 1992 Demographic and Health Surveys. We estimate models of undernutrition jointly for the three countries to explore regional patterns of undernutrition that transcend boundaries, while allowing for country-specific interactions. We use semiparametric models to flexibly model the effects of selected so-cioeconomic covariates and spatial effects. Our spatial analysis is based on a flexible geo-additive model using the district as the geographic unit of anal-ysis, which allows to separate smooth structured spatial effects from random effect. Inference is fully Bayesian and uses recent Markov chain Monte Carlo techniques. While the socioeconomic determinants generally confirm what is known in the literature, we find distinct residual spatial patterns that are not explained by the socioeconomic determinants. In particular, there appears to be a belt run-ning from Southern Tanzania to Northeastern Zambia which exhibits much worse undernutrition, even after controlling for socioeconomic effects. These effects do transcend borders between the countries, but to a varying degree. These findings have important implications for targeting policy as well as the search for left-out variables that might account for these residual spatial patterns

Evaluation of geospatial methods to generate subnational HIV prevalence estimates for local level planning

Objective: There is evidence of substantial subnational variation in the HIV epidemic. However, robust spatial HIV data are often only available at high levels of geographic aggregation and not at the finer resolution needed for decision making. Therefore, spatial analysis methods that leverage available data to provide local estimates of HIV prevalence may be useful. Such methods exist but have not been formally compared when applied to HIV. Design/methods: Six candidate methods – including those used by the Joint United Nations Programme on HIV/AIDS to generate maps and a Bayesian geostatistical approach applied to other diseases – were used to generate maps and subnational estimates of HIV prevalence across three countries using cluster level data from household surveys. Two approaches were used to assess the accuracy of predictions: internal validation, whereby a proportion of input data is held back (test dataset) to challenge predictions; and comparison with location-specific data from household surveys in earlier years. Results: Each of the methods can generate usefully accurate predictions of prevalence at unsampled locations, with the magnitude of the error in predictions similar across approaches. However, the Bayesian geostatistical approach consistently gave marginally the strongest statistical performance across countries and validation procedures. Conclusions: Available methods may be able to furnish estimates of HIV prevalence at finer spatial scales than the data currently allow. The subnational variation revealed can be integrated into planning to ensure responsiveness to the spatial features of the epidemic. The Bayesian geostatistical approach is a promising strategy for integrating HIV data to generate robust local estimates

Inhibition of the JAK2/STAT3 pathway in ovarian cancer results in the loss of cancer stem cell-like characteristics and a reduced tumor burden

Background Current treatment of ovarian cancer patients with chemotherapy leaves behind a residual tumor which results in recurrent ovarian cancer within a short time frame. We have previously demonstrated that a single short-term treatment of ovarian cancer cells with chemotherapy in vitro resulted in a cancer stem cell (CSC)-like enriched residual population which generated significantly greater tumor burden compared to the tumor burden generated by control untreated cells. In this report we looked at the mechanisms of the enrichment of CSC-like residual cells in response to paclitaxel treatment. Methods The mechanism of survival of paclitaxel-treated residual cells at a growth inhibitory concentration of 50% (GI50) was determined on isolated tumor cells from the ascites of recurrent ovarian cancer patients and HEY ovarian cancer cell line by in vitro assays and in a mouse xenograft model. Results Treatment of isolated tumor cells from the ascites of ovarian cancer patients and HEY ovarian cancer cell line with paclitaxel resulted in a CSC-like residual population which coincided with the activation of Janus activated kinase 2 (JAK2) and signal transducer and activation of transcription 3 (STAT3) pathway in paclitaxel surviving cells. Both paclitaxel-induced JAK2/STAT3 activation and CSC-like characteristics were inhibited by a low dose JAK2-specific small molecule inhibitor CYT387 (1 μM) in vitro. Subsequent, in vivo transplantation of paclitaxel and CYT387-treated HEY cells in mice resulted in a significantly reduced tumor burden compared to that seen with paclitaxel only-treated transplanted cells. In vitro analysis of tumor xenografts at protein and mRNA levels demonstrated a loss of CSC-like markers and CA125 expression in paclitaxel and CYT387-treated cell-derived xenografts, compared to paclitaxel only-treated cell-derived xenografts. These results were consistent with significantly reduced activation of JAK2 and STAT3 in paclitaxel and CYT387-treated cell-derived xenografts compared to paclitaxel only-treated cell derived xenografts. Conclusions This proof of principle study demonstrates that inhibition of the JAK2/STAT3 pathway by the addition of CYT387 suppresses the ‘stemness’ profile in chemotherapy-treated residual cells in vitro, which is replicated in vivo, leading to a reduced tumor burden. These findings have important implications for ovarian cancer patients who are treated with taxane and/or platinum-based therapies. Keywords: Ovarian carcinoma, Cancer stem cell, Metastasis, Ascites, Chemoresistance, Recurrence, JAK2/STAT3 pathwa

Taenia solium Infections in a Rural Area of Eastern Zambia-A Community Based Study

Taenia solium taeniosis/cysticercosis is a zoonotic infection endemic in many developing countries, with humans as the definitive host (taeniosis) and pigs and humans as the intermediate hosts (cysticercosis). When humans act as the intermediate host, the result can be neurocysticercosis, which is associated with acquired epilepsy, considerable morbidity and even mortality. In Africa, most studies have been carried out in pigs with little or no data in humans available. In this human study, conducted in a rural community in Eastern Zambia, prevalences for taeniosis and cysticercosis were determined at 6.3% and 5.8% respectively, indicating the hyperendemicity of the area. Cysticercosis infection was strongly related with age, with a significant increase in prevalence occurring in individuals from the age of 30 onward. A collected tapeworm was confirmed to be T. solium. Risk factors associated with the transmission and maintenance of the parasite such as free roaming pigs, households without latrines, backyard slaughter of pigs without inspection and consumption of undercooked pork were also present. The findings of this work have identified the need for further research in the transmission dynamics and the burden that this infection has on the resources of poor local people

Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants

<p>Abstract</p> <p>Background</p> <p>Regions with geographically diverse ecology and socioeconomic circumstances may have different disease exposures and child health outcomes. This study assessed variations in the risks of death in children under age 5 across regions of Nigeria and determined characteristics at the individual and community levels that explain possible variations among regions.</p> <p>Methods</p> <p>Multilevel Cox proportional hazards analysis was performed using a nationally representative sample of 6,029 children from 2,735 mothers aged 15-49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios (HR) with 95% confidence intervals (CI) were used to express measures of association among the characteristics. Variance partition coefficients and Wald statistic were used to express measures of variation.</p> <p>Results</p> <p>Patterns of under-5 mortality cluster within families and communities. The risks of under-5 deaths were significantly higher for children of mothers residing in the South South (Niger Delta) region (HR: 1.30; 95% CI: 1.76-2.20) and children of mothers residing in communities with a low proportion of mothers attending prenatal care by a doctor (HR: 1.36; 95% CI: 1.15-1.86). In addition, the cross-level interaction between mothers' education and community prenatal care by a doctor was associated with a more than 40% higher risk of dying (HR: 1.41; 95% CI: 1.21-1.78).</p> <p>Conclusion</p> <p>The findings suggest the need to differentially focus on community-level interventions aimed at increasing maternal and child health care utilization and improving the socioeconomic position of mothers, especially in disadvantaged regions such as the South South (Niger Delta) region. Further studies on community-levels determinants of under-5 mortality are needed.</p

Difficulties diagnosing neurosarcoidosis (clinical observations)

Sarcoidosis - granulomatous disease of unknown etiology. The defeat of the nervous system is combined with changes in other organs, in 1 % of cases occurs in isolation. Because of non-specific clinical manifestations and the lack of pathognomonic signs of the disease, diagnosis is often neurosarcoidosis is difficult for clinicians. We describe two clinical cases of patients observed in the Tyumen Regional Center of MS. In the first case describes a 53-year-old woman with bilateral lesions of the optic nerve. After differential diagnosis optikomielitom Devika, intrathoracic lymph nodes biopsy, which confirmed the presence of sarcoid granulomas in the tissue. The second patient also debuted disease with neurological symptoms, was diagnosed with multiple sclerosis. Within two years the patient was receiving the immunomodulatory therapy with interferon beta-1 beta. After 15 years from the onset of the disease revealed changes in the lungs, could verify the diagnosis neurosarcoidosis. These cases demonstrate the need for our clinical suspicion against neurosarcoidosis in the differential diagnosis of diseases associated with central nervous system.Саркоидоз - гранулематозное заболевание неизвестной этиологии. Поражение нервной системы сочетается с изменениями в других органах, в 1% случаев протекает изолированно. Ввиду неспецифичности клинических проявлений и отсутствия патогномоничных признаков заболевания, нередко диагностика нейросаркоидоза представляет трудности для клиницистов. Мы описываем два клинических случая пациентов, наблюдавшихся в Тюменском областном Центре рассеянного склероза. В первом случае описана 53-летняя женщина с двухсторонним поражением зрительных нервов. После дифференциальной диагностики с оптикомиелитом Девика, проведена биопсия внутригрудных лимфоузлов, результат которой подтвердил наличие в ткани саркоидных гранулем. У второго пациента заболевание также дебютировало с неврологической симптоматики, был поставлен диагноз рассеянный склероз. В течение 2 лет пациент получал иммуномодулирующую терапию препаратом интерферона бета-1-бета. Спустя 15 лет от начала заболевания выявлены изменения в легких, позволившие верифицировать диагноз нейросаркоидоз. Приведенные нами случаи демонстрируют необходимость клинической настороженности в отношении нейросаркоидоза при проведении дифференциальной диагностики заболеваний, сопровождающихся поражением центральной нервной системы

Under-Five Mortality in High Focus States in India: A District Level Geospatial Analysis

<div><h3>Background</h3><p>This paper examines if, when controlling for biophysical and geographical variables (including rainfall, productivity of agricultural lands, topography/temperature, and market access through road networks), socioeconomic and health care indicators help to explain variations in the under-five mortality rate across districts from nine high focus states in India. The literature on this subject is inconclusive because the survey data, upon which most studies of child mortality rely, rarely include variables that measure these factors. This paper introduces these variables into an analysis of 284 districts from nine high focus states in India.</p> <h3>Methodology/Principal Findings</h3><p>Information on the mortality indicator was accessed from the recently conducted Annual Health Survey of 2011 and other socioeconomic and geographic variables from Census 2011, District Level Household and Facility Survey (2007–08), Department of Economics and Statistics Divisions of the concerned states. Displaying high spatial dependence (spatial autocorrelation) in the mortality indicator (outcome variable) and its possible predictors used in the analysis, the paper uses the Spatial-Error Model in an effort to negate or reduce the spatial dependence in model parameters. The results evince that the coverage gap index (a mixed indicator of district wise coverage of reproductive and child health services), female literacy, urbanization, economic status, the number of newborn care provided in Primary Health Centers in the district transpired as significant correlates of under-five mortality in the nine high focus states in India. The study identifies three clusters with high under-five mortality rate including 30 districts, and advocates urgent attention.</p> <h3>Conclusion</h3><p>Even after controlling the possible biophysical and geographical variables, the study reveals that the health program initiatives have a major role to play in reducing under-five mortality rate in the high focus states in India.</p> </div