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Enablers and barriers of handwashing with soap in low-income settlements of Mombasa, Kenya
Get PDFHandwashing with soap (HWWS) is an effective public health preventive measure. Review studies indicate that interventions on handwashing with soap reduce the risk of diarrhoeal diseases by approximately 30% and respiratory tract infections by up to 17% (Ross, Bick, Ayieko, et al., 2023; Wolf, Hubbard, Brauer, et al., 2022). Studies have also shown that HWWS, combined with interventions on water and sanitation, results in improved growth outcomes among children under five (Bekele et al., 2020; George, Monira, Zohura, et al., 2021; Hasan, Asif, Barua, et al., 2023).
The World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF) Joint Monitoring Program (JMP) estimated that by 2022, 75% of the global population had access to basic handwashing facilities (HWFs) measured by the presence of a handwashing facility with water and soap within the premises (UNICEF and WHO, 2023a). Access to a basic HWF is an indicator for HWWS, as studies have confirmed HWWS at critical times increases as a result of the presence of a HWF (Jetha, Bisserbe, McManus, et al., 2021; Mbakaya et al., 2020; Okello, Kapiga, Grosskurth, et al., 2019; White, Thorseth, Dreibelbis, et al., 2020; Wolde, Abate, Mandefro, et al., 2022).
These JMP estimates indicate that Sub-Saharan Africa (SSA) had the lowest regional coverage of basic HWFs by 2022, with only 30% of the population having access to basic HWFs (UNICEF and WHO, 2023b). This limited coverage may indicate or lead to inadequate HWWS. In addition, significant disparities in access exist between urban and rural areas of Africa, with urban areas exhibiting higher access (32%) than rural areas (17%) (UNICEF and WHO, 2023a,b). Despite this advantage, urban areas of Africa have significant proportions of the population residing in Low Income Areas (LIAs) which are characterised by several challenges including intermittent water supply, high costs of water, lack of handwashing facilities, and a higher risk to hygiene related health outcomes (Beard & Mitlin, 2021; Corburn, Vlahov, Mberu, et al., 2020; Kisaakye et al., 2021).
Research studies examining hindrances (barriers) and enablers of HWWS in LIAs of Africa are limited. However, studies conducted in LIAs in other regions have identified financial resources, availability of water and soap, and the presence of dirt on the hands as factors that promote HWWS (Kalam, Davis, Islam, et al., 2021; Khan, Chakraborty, Brown, et al., 2021; Rahman, Nizame, Unicomb, et al., 2017).
Similar to other African countries, studies examining the enablers and barriers for HWWS in LIAs in Kenya are limited, with most of the available studies focusing on food hygiene or COVID-19 related knowledge regarding HWWS (Austrian, Pinchoff, Tidwell, et al., 2020; Davis, Cumming, Aseyo, et al., 2018; Mumma, Simiyu, Aseyo, et al., 2019; Robinson & Howland, 2022; Watson, Okumu, Wasonga, et al., 2024).
This study builds on a prior survey in LIAs of Kenyan cities that examined determinants of access to basic HWFs and of HWWS (Simiyu et al., 2025). The study indicated a lower likelihood of access to basic HWFs and of HWWS among residents of Mombasa compared to residents in low-income areas of other cities in Kenya (Simiyu et al., 2025). This study, therefore, explores the barriers and enablers of HWWS in the low-income settlements of Mombasa and identifies intervention strategies for improvement of HWWS within these areas
Can generative artificial intelligence enhance evidence-based and personalized medicine?
Get PDFShould clinical applications of generative artificial intelligence (GAI) be designed to follow treatment guidelines rigidly, provide individualized recommendations, or be somewhere in-between? A recent study in PLOS Medicine comparing GAI versus physician treatment recommendations highlights the importance of context- and patient-specific circumstances in decision-making
Evaluation of methods to classify ipsilateral breast tumour recurrences as local recurrence or new primary tumour.
Get PDFIpsilateral breast tumour recurrence (IBTR) may represent a true local recurrence (LR) from residual malignancy or a new primary (NP) tumour, with important implications for prognosis and treatment. However, no classification system exists to distinguish between these entities. This systematic review of studies evaluating classification methods for IBTR as LR or NP, identified 19 studies reporting 25 systems. Most were clinicopathological (21/25) and four were genomic. Tumour location (72%) and histological subtype (68%) were the most frequently applied criteria. IBTR rates ranged from 2 to 12%, with NP proportions between 13-82% and LR between 18-87%. Time to recurrence was shorter for LR than NP. Across studies, NP was consistently associated with superior survival outcomes. The methodological quality of included studies constrains the certainty of findings. Validation of clinicopathological and genomic criteria is needed before a classification system can be recommended, but pragmatic clinicopathological decisions remain essential in the interim
Broadening the dimensions of the Water-Energy-Food (WEF) nexus: A narrative review
Get PDFThe water-energy-food (WEF and its variants) nexus addresses the intricate linkages between human and natural systems to ensure sustainable management of natural resources without compromising economic, social, and environmental well-being. Despite this, the WEF nexus has been mainly approached as a focused biophysical system connecting those three dimensions. This review maps the extent to which the WEF nexus has been conceptualised and the consideration of additional dimensions linked to environmental and social outcomes. The aim is to broaden the WEF nexus concept to enhance its applicability to human, planetary, and sustainable development outcomes. Of the identified nexus frameworks, approximately 50% are sectorally unbalanced, as they centralise one or more resource node(s). Water and energy are key nexus nodes in most frameworks. The second most popular framing is water-energy-food-climate, followed by water-energy-land (WEL) and water-energy-food-land-ecosystems. In addition, the current WEF nexus approach is biased towards input-oriented conceptualisation. It fails to make explicit linkages to outcome- and impact-based dimensions, such as politics, gender, environment, planetary health and the economy. This limits its relevance and practical application in decision-making and policymaking for addressing sustainability and developmental challenges. Models and tools should be improved to be more holistic, including WEF resources and other linked resources, and should be useful for monitoring all sustainability outcomes (economic, social, and environmental). We propose a conceptual broadening of the WEF nexus to a WEF+ nexus, with the “plus” representing added outcomes-based dimensions such as environment, climate, people, planet and health. This conceptual broadening balances WEF resource securities with human, planetary and sustainable development outcomes
What if Every Patient’s Immune System Could be Guided by the World’s Most Powerful Computers to Fight Cancer? The UK Cancer Vaccines AI and Supercompute Project
Get PDFOrganic acids - a dual-action mode influencing both host and pathogen integrity to reduce Salmonella infection.
Get PDFIn this study, we aimed to describe the mechanism by which a blend of organic acids (AuraShield - As) prevents Salmonella Typhimurium SE10/72 infection of primary chicken caecal epithelial cells (PECC) and caecal biopsies. First, our results show a MIC of 0.50% and an MBC of 1% against Salmonella Typhimurium SE10/72, with a sub-inhibitory concentration of 0.25% selected for further experiments. At this level, in vitro and ex vivo, As significantly decreased the ability of S. Typhimurium to attach to and invade PECC cells and caecal biopsies alongside bacterial motility and biofilm formation. The sub-inhibitory concentration also considerably reduced LDH release from infected PECC cells. It drastically attenuated the inflammatory response, as measured by levels of interferons (IFN) and cytokines IL-1β, IL-6, and IL-8 in infected PECC cells and in chicken caecal biopsies. These results were also mirrored when caecal biopsies were infected. The presence of As during infection also significantly reduced intracellular Ca2+ levels in both PECC cells and caecal biopsies and restored TEER levels. Conclusively, As reduces bacterial invasion in PECC cells and caecal biopsies, impairs bacterial growth, and causes bacterial membrane permeabilisation. It further reduces cytotoxicity and inflammation in PECC cells and caecal biopsies, apparently through a mechanism that involves regulation of intracellular calcium levels
How did labelling provision on menus for online food delivery change after implementation of England's calorie labelling regulations?
Get PDFThis study describes the provision of calorie labelling in the digital out-of-home food sector after the implementation of mandatory calorie labelling for large businesses in England in April 2022. Using online menu data from two major food delivery services between June 2022 and October 2023, the number of restaurants available for delivery and the share of restaurants displaying calories was determined for every neighbourhood (Lower layer Super Output Area/Data Zone) in Great Britain. Among restaurants that display calories, we determined the share of labelled menu items and these items' calorie content. We assessed differences by area deprivation and restaurant type. Online food delivery was available in ∼89% of Great Britain, with more restaurants available in more deprived neighbourhoods. The share of restaurants that display calories was overall low and decreasing over time (median 14% in June 2022 to 12% in October 2023), and was lowest in most deprived (9%) compared with 14% in the least deprived neighbourhoods in October 2023. Among restaurants displaying calories, the share of labelled items was high (79%-76%), while calorie content decreased slightly (by 14 kcal/food item and 5 kcal/drink item). Changes by deprivation were limited and heterogenous by restaurant type. The observed, small reduction in median calorie content may suggest positive, structural change and warrants further investigation. However, the coverage of calorie labelling is limited, and the lower provision in more deprived neighbourhoods may widen dietary health inequalities
Integrating a single-dose intravenous iron therapy (ferric carboxymaltose) for maternal anaemia in Nigeria: Insights from stakeholder engagement.
Get PDFBACKGROUND: Maternal anaemia contributes to high maternal morbidity and adverse birth outcomes in Nigeria. Oral iron supplementation is common but limited by poor adherence, side effects and systemic barriers. Ferric carboxymaltose (FCM), a single-dose intravenous iron formulation, offers a promising alternative, yet its routine use in Nigeria remains limited. Policymakers, providers and community leaders influence adoption of health services, making their perspectives key to successful integration. AIM: To explore stakeholder perspectives on integrating FCM for maternal anaemia into routine maternal health services. SETTING: The study was conducted in Lagos State, Nigeria. METHODS: A qualitative descriptive study was conducted. Thirty-three purposively selected stakeholders participated, representing government agencies, healthcare providers, academic institutions, non-governmental organisations, professional associations and community leaders. Participants were grouped by affiliation and roles to encourage open dialogue. Discussions followed a semi-structured guide, were audio-recorded, transcribed verbatim and thematically analysed using an inductive approach. RESULTS: Three interrelated themes emerged: (1) health workers are not sufficiently prepared for intravenous iron delivery but could be through sensitisation, reorientation and resourcing; (2) sociocultural and religious influences, alongside misconceptions, require targeted community engagement and (3) affordability is a barrier but could be addressed through strategic policy levers. CONCLUSION: Successful integration of FCM requires investment in health system capacity, sustained community engagement and alignment with financing and policy frameworks. CONTRIBUTION: The findings illustrate how stakeholder-informed analysis can reveal the practical, cultural and financial conditions necessary for sustainable uptake of FCM, advancing understanding of how maternal health innovations can be integrated within fragmented health systems
Eating alone, social life, and self-rated health: insights from a cross-sectional study of 70- to 75-year-olds in Sweden.
Get PDFOBJECTIVES: Commensality is central to social life - supporting social relations and even happiness - while eating alone is linked to poorer mental and physical health. This study examines whether eating alone and engagement in social activities are associated with loneliness and self-rated health among community-living older adults in Sweden. METHOD: Data from a national cross-sectional survey of 695 adults aged 70-75 years were used to assess both the frequency and subjective experience of eating alone and engagement in social activities. Using logistic regression and interaction analysis, the associations with loneliness and self-rated health were examined. RESULTS: The frequency and subjective experience of eating alone were both associated with loneliness. The association between eating alone and loneliness was not dependent on whether eating alone was perceived as bothersome. Lower engagement in social activities was associated with loneliness and lower self-rated health. No associations between the frequency and subjective experience of eating alone and self-rated health were observed. CONCLUSION: In this sample, the proportion of loneliness was high in groups bothered by eating alone, indicating specific subgroups for whom eating alone can be problematic. More research is needed to understand the issue of eating alone - and who it affects. This could help guide the development and implementation of policies targeting groups vulnerable to loneliness and poor health
Antimicrobial and anti-inflammatory properties of Maranta arundinacea extract against Campylobacter jejuni and Campylobacter coli in T84 cells.
Get PDFCampylobacter, a bacterium commonly found in the chicken gut, is the leading cause of bacterial foodborne gastroenteritis globally. Despite various interventions aimed at controlling Campylobacter in the food chain, such as enhanced biosecurity measures, improved hygiene practices and farm-level controls, reducing its prevalence remains a significant challenge. While the European Union's (EU) 2006 ban on antimicrobials as growth promoters was primarily intended to control antimicrobial resistance, its impact on Campylobacter load has been limited. The emergence of antibiotic-resistant Campylobacter has created a requirement to develop alternative methods to improve food safety, enhance performance and mitigate pathogenic bacteria. This study explored the potential of Maranta arundinacea (arrowroot) extract as a prospective dietary supplement for both humans and chickens. The investigation focused on its safety, its ability to reduce Campylobacter in T84 intestinal epithelial cells and its anti-inflammatory properties. Results showed that 4% and 25% concentrations of arrowroot extract were non-cytotoxic to human T84 cells and significantly reduced bacterial growth in Campylobacter jejuni strains. Additionally, the extract inhibited the growth of Campylobacter coli strains and Escherichia coli, with statistical significance observed against E. coli at the 25% concentration. These results suggest that arrowroot extract could be a promising natural alternative for addressing antibiotic resistance and enhancing food safety