Potential impact and cost-effectiveness of rotavirus vaccination in Afghanistan.

INTRODUCTION: Despite progress made in child survival in the past 20 years, 5.9 million children under five years died in 2015, with 9% of these deaths due to diarrhea. Rotavirus is responsible for more than a third of diarrhea deaths. In 2013, rotavirus was estimated to cause 215,000 deaths among children under five years, including 89,000 in Asia. As of April 2017, 92 countries worldwide have introduced rotavirus vaccination in their national immunization program. Afghanistan has applied for Gavi support to introduce rotavirus vaccination nationally. This study estimates the potential impact and cost-effectiveness of a national rotavirus immunization program in Afghanistan. METHODS: This study examined the use of Rotarix® (RV1) administered using a two-dose schedule at 6 and 10 weeks of age. We used the ProVac Initiative's UNIVAC model (version 1.2.09) to evaluate the impact and cost-effectiveness of a rotavirus vaccine program compared with no vaccine over ten birth cohorts from 2017 to 2026 with a 3% annual discount rate. All monetary units are adjusted to 2017 US$. RESULTS: Rotavirus vaccination in Afghanistan has the potential to avert more than one million cases; 660,000 outpatient visits; approximately 50,000 hospital admissions; 650,000 DALYs; and 12,000 deaths, over 10 years. Not accounting for any Gavi subsidy, rotavirus vaccination can avert DALYs at US$82/DALY from the government perspective and US$80/DALY from the societal perspective. With Gavi support, DALYs can be averted at US$29/DALY and US$31/DALY from the societal and government perspective, respectively. The average yearly cost of a rotavirus vaccination program would represent 2.8% of the total immunization budget expected in 2017 and 0.1% of total health expenditure. CONCLUSION: The introduction of rotavirus vaccination would be highly cost-effective in Afghanistan, and even more so with a Gavi subsidy

A comparative evaluation of conceptual rainfall–runoff models for a catchment in Victoria Australia using eWater Source

Hydrological modelling at a catchment scale was conducted to investigate the impact of climate change and land-use change individually and in combination with the available streamflow in the Painkalac catchment using an eWater Source hydrological model. This study compares the performance of three inbuilt conceptual models within eWater Source, such as the Australian water balance model (AWBM), Sacramento and GR4J for streamflow simulation. The three-model performance was predicted by bivariate statistics (Nash–Sutcliff efficiency) and univariate (mean, standard deviation) to evaluate the efficiency of model runoff predictions. Potential evapotranspiration (PET) data, daily rainfall data and observed streamflow measured from this catchment are the major inputs to these models. These models were calibrated and validated using eight objective functions while further comparisons of these models were made using objective functions of a Nash–Sutcliffe efficiency (NSE) log daily and an NSE log daily bias penalty. The observed streamflow data were split into three sections. Two-thirds of the data were used for calibration while the remaining one-third of the data was used for validation of the model. Based on the results, it was observed that the performance of the GR4J model is more suitable for the Painkalac catchment in respect of prediction and computational efficiency compared to the Sacramento and AWBM models. Further, the impact of climate change, land-use change and combined scenarios (land-use and climate change) were evaluated using the GR4J model. The results of this study suggest that the higher climate change for the year 2065 will result in approximately 45.67% less streamflow in the reservoir. In addition, the land-use change resulted in approximately 42.26% less flow while combined land-use and higher climate change will produce 48.06% less streamflow compared to the observed flow under the existing conditions

Molecular surveillance of Plasmodium vivax dhfr and dhps mutations in isolates from Afghanistan

<p>Abstract</p> <p>Background</p> <p>Analysis of dihydrofolate reductase (<it>dhfr</it>) and dihydropteroate synthase (<it>dhps</it>) mutations in <it>Plasmodium vivax </it>wild isolates has been considered to be a valuable molecular approach for mapping resistance to sulphadoxine-pyrimethamine (SP). The present study investigates the frequency of SNPs-haplotypes in the <it>dhfr </it>and <it>dhps </it>genes in <it>P. vivax </it>clinical isolates circulating in two malaria endemic areas in Afghanistan.</p> <p>Methods</p> <p><it>P. vivax </it>clinical isolates (n = 171) were collected in two different malaria endemic regions in north-west (Herat) and east (Nangarhar) Afghanistan in 2008. All collected isolates were analysed for SNP-haplotypes at positions 13, 33, 57, 58, 61, 117 and 173 of the <it>pvdhfr </it>and 383 and 553 of the <it>pvdhps </it>genes using PCR-RFLP methods.</p> <p>Results</p> <p>All 171 examined isolates were found to carry wild-type amino acids at positions 13, 33, 57, 61 and 173, while 58R and 117N mutations were detected among 4.1% and 12.3% of Afghan isolates, respectively. Based on the size polymorphism of <it>pvdhfr </it>genes at repeat region, type B was the most prevalent variant among Herat (86%) and Nangarhar (88.4%) isolates. Mixed genotype infections (type A/B and A/B/C) were detected in only 2.3% (2/86) of Herat and 1.2% (1/86) of Nangarhar isolates, respectively. The combination of <it>pvdhfr </it>and <it>pvdhps </it>haplotypes among all 171 samples demonstrated six distinct haplotypes. The two most prevalent haplotypes among all examined samples were wild-type (86%) and single mutant haplotype I₁₃P₃₃F₅₇S₅₈T₆₁<b>N </b>₁₁₇I_173/A₃₈₃A₅₅₃(6.4%).</p> <p>Double (I₁₃P₃₃S₅₇<b>R</b>₅₈T₆₁<b>N</b>₁₁₇I₁₇₃/A₃₈₃A₅₅₃) and triple mutant haplotypes (I₁₃P₃₃S₅₇<b>R </b>₅₈T₆₁<b>N</b>₁₁₇I₁₇₃/<b>G</b>₃₈₃A₅₅₃) were found in 1.7% and 1.2% of Afghan isolates, respectively. This triple mutant haplotype was only detected in isolates from Herat, but in none of the Nangarhar isolates.</p> <p>Conclusion</p> <p>The present study shows a limited polymorphism in <it>pvdhfr </it>from Afghan isolates and provides important basic information to establish an epidemiological map of drug-resistant vivax malaria, and updating guidelines for anti-malarial policy in Afghanistan. The continuous usage of SP as first-line anti-malarial drug in Afghanistan might increase the risk of mutations in the <it>dhfr </it>and <it>dhps </it>genes in both <it>P. vivax </it>and <it>Plasmodium falciparum </it>isolates, which may lead to a complete SP resistance in the near future in this region. Therefore, continuous surveillance of <it>P. vivax </it>and <it>P. falciparum </it>molecular markers are needed to monitor the development of resistance to SP in the region.</p

Digitally strengthened, midwife-led intervention to reach the unreached mothers across ten conflict-prone provinces of Afghanistan during humanitarian crisis

Background: Coronavirus disease 2019 (COVID-19) pandemic had significant negative impact on sexual and reproductive health (SRH) with devastating impact on pregnant women in resource constrain humanitarian settings. This paper provides detailed account of a community midwife-led intervention in ten humanitarian settings of Afghanistan using world health organization (WHO) emergency disaster risk management (EDRM) framework.Objectives: The project is aimed at increasing access to Integrated Package of Essential SRH Services and Minimal Initial Service Package (MISP) with a specific focus on prevention of Postpartum Haemorrhage (PPH) and screening and management of preeclampsia and eclampsia.Methods: The project was implemented through 150 Community outreach midwives (COMs). Each midwife served 300 households; mentored by gynaecologists and supervisors. Midwives were trained through a digitally enabled, simulation based training and equipped with a set of off-the shelf devices and kits.Results: During COVID-19 pandemic and in absence of health care services during crisis, this intervention has played as a lifesaving intervention for the community in Afghanistan. Variable digital literacy, sociocultural barriers, reluctance in adapting to digital platforms, security and uncertainties were some of the challenges faced. Adaptation of outreach methods integrated high impactful digital technologies has been the most appropriate strategy "to reach the unreached".Conclusion: Through this model, national and global stakeholders were engaged even during the crisis in Afghanistan. It also provided vital inputs for the donors, governments, civil society organizations and other stakeholders for sustaining and advancing the delivery of quality SRH services in humanitarian settings

Field trial of three different Plasmodium vivax-detecting rapid diagnostic tests with and without evaporative cool box storage in Afghanistan

<p>Abstract</p> <p>Background</p> <p>Accurate parasitological diagnosis of malaria is essential for targeting treatment where more than one species coexist. In this study, three rapid diagnostic tests (RDTs) (AccessBio CareStart (CSPfPan), CareStart PfPv (CSPfPv) and Standard Diagnostics Bioline (SDBPfPv)) were evaluated for their ability to detect natural <it>Plasmodium vivax </it>infections in a basic clinic setting. The potential for locally made evaporative cooling boxes (ECB) to protect the tests from heat damage in high summer temperatures was also investigated.</p> <p>Methods</p> <p>Venous blood was drawn from <it>P. vivax </it>positive patients in Jalalabad, Afghanistan and tested against a panel of six RDTs. The panel comprised two of each test type; one group was stored at room temperature and the other in an ECB. RDT results were evaluated against a consensus gold standard based on two double-read reference slides and PCR. The sensitivity, specificity and a measure of global performance for each test were determined and stratified by parasitaemia level and storage condition.</p> <p>Results</p> <p>In total, 306 patients were recruited, of which 284 were positive for <it>P. vivax</it>, one for <it>Plasmodium malariae </it>and none for <it>Plasmodium falciparum</it>; 21 were negative. All three RDTs were specific for malaria. The sensitivity and global performance index for each test were as follows: CSPfPan [98.6%, 95.1%], CSPfPv [91.9%, 90.5%] and SDBPfPv [96.5%, 82.9%], respectively. CSPfPv was 16% less sensitive to a parasitaemia below 5,000/μL. Room temperature storage of SDBPfPv led to a high proportion of invalid results (17%), which reduced to 10% in the ECB. Throughout the testing period, the ECB maintained ~8°C reduction over ambient temperatures and never exceeded 30°C.</p> <p>Conclusions</p> <p>Of the three RDTs, the CSPfPan test was the most consistent and reliable, rendering it appropriate for this <it>P. vivax </it>predominant region. The CSPfPv test proved unsuitable owing to its reduced sensitivity at a parasitaemia below 5,000/μL (affecting 43% of study samples). Although the SDBPfPv device was more sensitive than the CSPfPv test, its invalid rate was unacceptably high. ECB storage reduced the proportion of invalid results for the SDBPfPv test, but surprisingly had no impact on RDT sensitivity at low parasitaemia.</p

Earth Virtualization Engines (EVE)

To manage Earth in the Anthropocene, new tools, new institutions, and new forms of international cooperation will be required. Earth Virtualization Engines is proposed as an international federation of centers of excellence to empower all people to respond to the immense and urgent challenges posed by climate change

MANAJEMEN HUMAS MASJID SYUHADA YOGYAKARTA DALAM MEMPERTAHANKAN EKSISTENSI SEBAGAI MASJID PERJUANGAN RAKYAT

The mosque is the center of worship for Muslims around the world. Almost every place has a mosque as a place of Muslim worship. As we have known together basically the mosque is one of the spiritual fulfillment needs which actually does not only function as a place of prayer, but also a central social activity, as well as a center for religious education. The Syuhada Mosque is a mosque that still exists to serve and fight with the people in building a new education-based civilization. The method used by the researcher is a qualitative descriptive study that applies the depth interview with functional public relation phase by Rosady Ruslan, those five phases are; planning, organizing, communicating, controlling, and evaluating. Based on this research, the researcher observes the perspective of public relation management by how a public relation makes planning, organizing, communicating, controlling, and evaluating. According to this research, it can be concluded that by public relation management, the mosque is well managed through five functional public relation management phases, so it could be the new model of the Mosque that undertakes Islamic educational function as a dedication of mujahid (muslim warrior) to the societie

Climate change vulnerability and adaptation strategies for smallholder farmers in Yangi Qala District, Takhar, Afghanistan

© 2019 Elsevier Ltd Smallholder farmers in Afghanistan are already facing various risks in agricultural production due to past continuous insurgencies. Climate change is likely to amplify the risk and make them even more vulnerable. The present study attempted to evaluate the vulnerability profiles of smallholder farmers due to climate change using the IPCC Framework. Primary data on relevant parameters for assessing climate change-led social vulnerability in the region were collected by classifying study region into two zones: the plain and the hills of Yangi Qala District in Takhar province, Afghanistan. Thirteen villages from each zone were selected at random, and face-to-face interviews were conducted with ten randomly selected households in each of the selected villages in both zones based on a pre-tested questionnaire. The questionnaire contained indicators for all three dimensions of vulnerability: exposure, sensitivity and adaptive capacity. The collected data were subjected to a proposed vulnerability index, after estimating the indices of the three dimensions of vulnerability. The Iyenger and Sudershan weighting method was used to assess the contribution of each vulnerability dimension. Vulnerability was classified according to different categories based on beta distribution to evaluate the villages’ vulnerability status. The results showed that about 23% of all 26 sampled villages in both zones had low exposure, 26% moderate exposure and 51% high exposure to climate-change hazards and extreme weather events. High sensitivity was observed in 51%, moderate sensitivity in 7%, and low sensitivity in 42% of villages. High adaptive capacity to climate change was observed in 38% of villages, 19% were moderately adaptive and 42% showed a low adaptive capacity. High vulnerability was observed in 50% of villages, 4% were moderately vulnerable, and 46% had low vulnerability. A high proportion of smallholder farmers in the hilly zone in the sampled district were highly vulnerable, exposed and sensitive with a low adaptive capacity to climate change compared to the plain zone. The high vulnerability in the hilly zone was attributed to limited resources with a low adjustment capability to counter the disturbances, especially in crop cultivation, in response to climate change. A handful of low-cost and local approaches such as improving farmer extension services, introducing small-scale local infrastructure projects, reinforcing informal safety nets and protecting natural ecosystems could be viable cost-effective options that would also be sustainable given their low recurring costs and the limited maintenance required

Focused Screening and Treatment (FSAT): a PCR-based strategy to detect malaria parasite carriers and contain drug resistant P. falciparum, Pailin, Cambodia.

Recent studies have shown that Plasmodium falciparum malaria parasites in Pailin province, along the border between Thailand and Cambodia, have become resistant to artemisinin derivatives. To better define the epidemiology of P. falciparum populations and to assess the risk of the possible spread of these parasites outside Pailin, a new epidemiological tool named "Focused Screening and Treatment" (FSAT), based on active molecular detection of asymptomatic parasite carriers was introduced in 2010. Cross-sectional malariometric surveys using PCR were carried out in 20 out of 109 villages in Pailin province. Individuals detected as P. falciparum carriers were treated with atovaquone-proguanil combination plus a single dose of primaquine if the patient was non-G6PD deficient. Interviews were conducted to elicit history of cross-border travel that might contribute to the spread of artemisinin-resistant parasites. After directly observed treatment, patients were followed up and re-examined on day 7 and day 28. Among 6931 individuals screened, prevalence of P. falciparum carriers was less than 1%, of whom 96% were asymptomatic. Only 1.6% of the individuals had a travel history or plans to go outside Cambodia, with none of those tested being positive for P. falciparum. Retrospective analysis, using 2010 routine surveillance data, showed significant differences in the prevalence of asymptomatic carriers discovered by FSAT between villages classified as "high risk" and "low risk" based on malaria incidence data. All positive individuals treated and followed-up until day 28 were cured. No mutant-type allele related to atovaquone resistance was found. FSAT is a potentially useful tool to detect, treat and track clusters of asymptomatic carriers of P. falciparum along with providing valuable epidemiological information regarding cross-border movements of potential malaria parasite carriers and parasite gene flow