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Neonatal indicator data in Tanzania District Health Information System: evaluation of availability and quality of selected newborn indicators, 2015-2022.
Get PDFBACKGROUND: The Every Newborn Action Plan (ENAP) indicators are essential in monitoring neonatal healthcare coverage and quality. The District Health Information System (DHIS2), an open-source platform in over 80 countries, supports health data collection and analysis, enabling progress tracking at national and subnational levels. This study evaluates the availability and quality of maternal and newborn health indicators, explicitly focusing on ENAP indicators within Tanzania's DHIS2. METHODS: Using the EN-MINI tool, we assessed data availability for 20 ENAP indicators by analysing their numerators and denominators in Tanzania's DHIS2 (2015-2022) across all healthcare levels. World Health Organization's (WHO) data quality framework was adapted to examine four dimensions: (a) availability of indicators, (b) completeness of indicator reporting, (c) internal consistency of related indicators, and (d) indicator plausibility by comparing DHIS2 data with population-based Demographic and Health Survey (DHS) data. RESULTS: Of the 20 ENAP indicators, 14 were available in Tanzania's DHIS2, with definitions, numerators and denominators aligned with WHO standards. Between 2015 and 2022, the number of facilities reporting at least one delivery annually increased by 19% from 5,898 to 7,016. During this period, 75% to 97% of facilities consistently reported data on skilled attendance at birth and early breastfeeding initiation. In contrast, 4% to 54% of facilities reported on maternal and newborn outcomes, including complications such as stillbirths and maternal mortality. Internal consistency was high (> 94%). However, neonatal mortality rates reported in DHIS2 were lower than those reported in Tanzania DHS for similar periods, even after a 20% adjustment to account for home births. CONCLUSION: Tanzania's DHIS2 captures many ENAP indicators; however, notable variability in data quality persists, with substantial data gaps related to maternal and newborn outcomes and complications. To address these challenges, it is crucial to strengthen routine data review, implement robust quality checks, enhance validation processes, provide targeted training, deliver constructive feedback, and conduct supportive supervision. Placing greater emphasis on using DHIS2 data to monitor progress will help identify gaps and drive improvements in data quality, ultimately supporting better maternal and newborn health outcomes
Trends in certifications of overall vision impairment and that due to diabetic retinopathy/maculopathy in England and Wales, 2009/2010 to 2019/2020: a retrospective database analysis.
Get PDFOBJECTIVES: This study aims to report the trends in the certification of both sight impairment (SI) and severe sight impairment (SSI) in England and Wales during the period of 2010 to 2020, prior to the COVID-19 pandemic. The focus is on diabetic retinopathy/maculopathy as the key causative factor. DESIGN: Retrospective database analysis. SETTING: England and Wales. PARTICIPANTS: Individuals certified as SI or SSI. OUTCOME MEASURES: Trends in certification of vision impairment in England and Wales due to any cause, with specific attention to diabetic retinopathy. METHODS: Certifications of vision impairment made by ophthalmologists in England and Wales were recorded and copies were sent to Moorfields Eye Hospital for epidemiological analysis. All certificates completed in England and Wales over an 11-year period, from April 2009 to March 2020, were queried and analysed on an annual basis. This analysis included all causes, and where both the main cause was diabetic eye disease or where diabetic eye disease was a contributory cause among multiple pathologies. Poisson regression was employed to analyse changes in trends over time for certifications of vision impairment. RESULTS: In England, from 2010 to 2020, there was a small but significant reduction (p<0.001) in the overall rate of certifications for SI and SSI due to any cause, from 43.4 certifications per 100 000 people to 41.7 per 100 000 people. Conversely, in Wales, an initial decline was observed, with a decrease from 50.6 to 40.1 per 100 000 people from 2009/2010 to 2014/2015, respectively. This rate subsequently increased to 51.8 per 100 000 by 2019/2020; however, this was not statistically significant (p=0.087). Individuals in Wales had a 9% higher certification rate compared with those in England (1.09 (95% CI 1.07, 1.10)). For diabetic retinopathy, certifications in England significantly decreased from 72.8 to 41.3 per 100 000 people over the study period; in Wales, the certification rate initially declined from 82.3 to 47.1 per 100 000 by 2016/2017 before increasing to 55.5 per 100 000 in 2019/2020. Despite this fluctuation, there was a significant decrease in certifications due to diabetic retinopathy in Wales during the study period. CONCLUSIONS: The findings underscore the importance of understanding regional variations in certification rates, particularly in the context of diabetic retinopathy. Despite fluctuations in Wales, the overall reduction in certifications due to diabetic retinopathy in both regions suggests a critical need for ongoing public health initiatives aimed at preventing vision impairment linked to diabetes. However, to provide a true reflection of the burden of vision impairment and its various causes, ensuring that all eligible people are certified is a prerequisite. Continuing attempts to limit the incidence of vision impairment due to diabetic retinopathy remain a priority
Impact of commercial gut health interventions on caecal metagenome and broiler performance.
Get PDFBACKGROUND: Maintaining gut health is a persistent and unresolved challenge in the poultry industry. Given the critical role of gut health in chicken performance and welfare, there is a pressing need to identify effective gut health intervention (GHI) strategies to ensure optimal outcomes in poultry farming. In this study, across three broiler production cycles, we compared the metagenomes and performance of broilers provided with ionophores (as the control group) against birds subjected to five different GHI combinations involving vaccination, probiotics, prebiotics, essential oils, and reduction of ionophore use. RESULTS: Using a binning strategy, 84 (≥ 75% completeness, ≤ 5% contamination) metagenome-assembled genomes (MAGs) from 118 caecal samples were recovered and annotated for their metabolic potential. The majority of these (n = 52, 61%) had a differential response across all cohorts and are associated with the performance parameter - European poultry efficiency factor (EPEF). The control group exhibited the highest EPEF, followed closely by the cohort where probiotics are used in conjunction with vaccination. The use of probiotics B, a commercial Bacillus strain-based formulation, was determined to contribute to the superior performance of birds. GHI supplementation generally affected the abundance of microbial enzymes relating to carbohydrate and protein digestion and metabolic pathways relating to energy, nucleotide synthesis, short-chain fatty acid synthesis, and drug-transport systems. These shifts are hypothesised to differentiate performance among groups and cycles, highlighting the beneficial role of several bacteria, including Rikenella microfusus and UBA7160 species. CONCLUSIONS: All GHIs are shown to be effective methods for gut microbial modulation, with varying influences on MAG diversity, composition, and microbial functions. These metagenomic insights greatly enhance our understanding of microbiota-related metabolic pathways, enabling us to devise strategies against enteric pathogens related to poultry products and presenting new opportunities to improve overall poultry performance and health. Video Abstract
"There's just a lot of numbers and I just want to have a drink": The challenge of communicating the energy content of alcohol products.
Get PDFVarious governments are considering the implementation of energy labelling on alcohol products as one element of obesity prevention policies. However, little is known about the most effective ways to communicate energy information to consumers. The aim of the present study was to explore consumers' reactions to different energy information provision formats to assist the development of effective energy labels. Nine focus groups (n = 83 participants) were conducted with Australian adults who reported drinking alcohol at least twice per month. Participants were exposed to an energy-only information label and labels displaying full nutrition information panels. A thematic analysis approach was used to identify key issues. While few participants were overtly enthusiastic about the mandatory display of energy values on alcohol products, there was general support for the provision of this information to assist those drinkers who could benefit from it. Substantial confusion was apparent as participants attempted to distil meaning from the provided information, particularly where it was expressed in terms of serving sizes and standard drinks. Full nutrition panels were particularly problematic in terms of creating a health halo due to the nil or low values for multiple nutrients listed. This was especially notable for information relating to sugar content. Overall, there appears to be inadequate public understanding of the concept of dietary energy in alcoholic beverages and the various terms used to quantify its presence, which is likely to limit the utility of mandatory energy information provision requirements unless they are accompanied by effective community education
The association between coding for chronic kidney disease and kidney replacement therapy incidence at CCG-level in England: an ecological study.
Get PDFBACKGROUND: With ageing of the population, both prevalence of chronic kidney disease (CKD) and incidence of kidney replacement therapy (KRT) are rising. Existing research suggests that Read-coding for CKD in those affected is associated with better implementation of recommended care and fewer hospitalisations for heart failure. AIM: To investigate whether coding for CKD is associated with regional KRT incidence in England. DESIGN & SETTING: This is an ecological study using the clinical commissioning groups (CCGs) in England as geographical units. METHOD: KRT incidence rates were calculated using UK Renal Registry (UKRR) data from January 2019-December 2021. Data on the percentage of uncoded CKD patients (PUCP), who had laboratory evidence of CKD but lacked a diagnostic code, were obtained from the CVDPREVENT Audit, a national audit that extracts routinely held GP data. Data on confounders and acute kidney injury (AKI) mortality as a marker for population frailty were obtained from CVDPREVENT and the UKRR, respectively. Poisson models assessed the association between PUCP and KRT incidence. RESULTS: After adjusting, the PUCP was non-linearly associated with KRT incidence, with the CCGs in the lowest PUCP quintile having a lower KRT incidence than the others. There was evidence that this association was more pronounced in CCGs with high AKI mortality compared with CCGs with low AKI mortality. CONCLUSION: At the geographical level in England, the data suggest that the prevalence of not having formally diagnosed CKD is non-linearly associated with a higher KRT incidence rate, especially in areas with a high AKI mortality
Atopic dermatitis and tobacco smoke exposure during childhood and adolescence.
Get PDFBACKGROUND: Tobacco smoke may affect atopic dermatitis (AD) because of its known effects on humoral and cellular immunity, but prior studies lack data on disease severity and biomarkers over time. OBJECTIVE: We investigated the association between passive and active tobacco smoke exposure (TSE) during childhood and adolescence and the activity and severity of AD. METHODS: A birth cohort of 10,521 individuals was followed through adolescence as part of the Avon Longitudinal Study of Parents and Children. We used mixed-effect models to determine the risk of AD (based on repeated assessments) with passive smoke exposure during childhood, active TSE during adolescence, and using a serum biomarker of tobacco exposure (cotinine) at 3 time points. RESULTS: After adjusting for confounding factors, there was no evidence of a relationship between passive TSE and concurrent AD activity in childhood (adjusted odds ratio, 0.95; 95% confidence interval, 0.83, 1.07) or of an increased risk between active smoking and AD activity in adolescence (adjusted odds ratio, 0.57; 95% confidence interval, 0.44, 0.75). Secondary analyses demonstrated no dose-response relationship and no increased severity of AD with passive or active TSE. Furthermore, we found no increased risk of AD with a cumulative measure of passive TSE across childhood (adjusted relative risk ratio, 0.98; 95% confidence interval, 0.96, 1.00). CONCLUSION: Neither active nor passive TSE was associated with AD during childhood and adolescence
Covid-19 Inquiry Module 4 Report Report from Dr Ben Kasstan-Dabush and Dr Tracey Chantler, titled Vaccine Delivery and Disparities in Coverage
Get PDFValidation of routine lymphatic filariasis morbidity surveillance in the Upper West Region, Ghana.
Get PDFIn Ghana and other countries pursuing elimination of lymphatic filariasis (LF), suspect cases of lymphoedema and hydrocele are routinely enumerated by community health workers (CHWs) during mass drug administration (MDA). These data, in addition to cases captured through the routine out-patient department are used for burden estimation and health service planning. To date there has been no systematic evaluation of the reliability of these data in Ghana. In December 2022, we conducted a cross-sectional survey of LF morbidity in two evaluation units in the Upper West Region of Ghana, including 19,180 participants. Participants with swelling affecting the scrotum or limbs were examined by clinicians to confirm whether symptoms were due to LF. Participants were asked whether their household had been visited by a CHW during the previous MDA. Suspect cases were asked whether they had reported their condition to a CHW or sought care elsewhere. We estimated the prevalence of each condition according to survey data and pre-existing routine data collected by CHWs and compared estimates. Lymphoedema prevalence rates were 87.3 and 61.2 per 10,000 in the two evaluation units, and hydrocele prevalence rates were 111.3 and 65.3 per 10,000 males. Routine enumeration underestimated lymphoedema prevalence by 81% in both cases, and underestimated hydrocele prevalence by 41%-52%. Nearly all households were visited during the previous MDA, but only 60.7% of lymphoedema and 28.3% of hydrocele cases had reported symptoms. 61.8% of lymphoedema and 42.9% of hydrocele cases had sought care from health facilities. Routine surveillance underestimates the prevalence of LF morbidity in the study area. Process modifications, including re-training of CHWs and health workers should be considered to improve data for service planning and validation of LF elimination. Anticipating cessation of MDA, continuous health service delivery, with periodic coverage evaluation, should be prioritised to strengthen passive surveillance
Bacille Calmette-Guérin-specific IgG titres among infants born to mothers with active tuberculosis disease in Uganda.
Get PDFBACKGROUND: Infants born to mothers with active tuberculosis disease (ATB) are at risk of poor clinical outcomes such as low birth weight and perinatal mortality. However, little is known about the influence of maternal ATB exposure on their vaccine responses during infancy. The study explored how maternal ATB affects infants' vaccine responses, hypothesising reduced responses to Bacille Calmette-Guérin (BCG) and other infant vaccines. METHODS: This was a case-control study with a longitudinal component of infants born to mothers with bacteriologically confirmed ATB (cases) and infants born to mothers without ATB (controls) carried out between September 2021 and June 2022. Quantitative BCG, diphtheria, tetanus, and measles-specific IgG ELISA assays were performed on infant plasma harvested from lithium-heparin blood collected on first encounter after birth (0), at 3, 6, and 9 months. We used prism v10.1.2, mixed-effects modelling, and Tukey's multiple comparison testing to determine mean differences (MD) between the cases and controls at all time points. RESULTS: Exposed infant cases had reduced IgG titres to BCG at baseline compared to the controls (p = 0.032), with a mean of 125.8 vs. 141.1 IU/mL, respectively. This difference was, however, not sustained at the other time points. Similarly, we demonstrated trends towards reduced responses to tetanus, diphtheria, and measles vaccines among infant cases at baseline and three months. However, the trend was not sustained at months six and nine. The mean titres for tetanus at baseline and 3 months for cases versus controls are 1.744 vs. 2.917 IU/mL (p < 0.0001) and 1.716 vs. 2.344 IU/mL (p = 0.018), respectively. The mean titres for diphtheria at 3 months for cases versus controls were 0.022 vs. 0.075 IU/mL (p = 0.006), respectively. CONCLUSION: We have demonstrated that maternal TB disease influences vaccine responses to BCG and other infant vaccines. This has implications for increased risk of childhood TB and other preventable diseases. CLINICAL TRIAL NUMBER: Not applicable
Drug resistance-associated mutations in Plasmodium UBP-1 disrupt its essential deubiquitinating activity.
Get PDFDeubiquitinating enzymes function to cleave ubiquitin (Ub) moieties from modified proteins, serving to maintain the pool of free Ub in the cell while simultaneously impacting the fate and function of a target protein. Like all eukaryotes, Plasmodium parasites rely on the dynamic addition and removal of Ub for their own growth and survival. While humans possess around 100 deubiquitinases, Plasmodium contains ∼20 putative Ub hydrolases, many of which bear little to no resemblance to those of other organisms. In this study, we characterize Plasmodium falciparum UBP-1, a large Ub hydrolase unique to Plasmodium spp., which has been linked to endocytosis and drug resistance. We demonstrate its Ub activity, linkage specificity, and assess the repercussions of point mutations associated with drug resistance on catalytic activity and parasite fitness. We confirm that the deubiquitinating activity of UBP-1 is essential for parasite survival, implicating an important role for Ub signaling in endocytosis