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A restatement of the protein transition
Get PDFAbstract
A protein transition is promoted as a pathway toward a sustainable food system, but its application and progress are potentially hindered by diverse, often conflicting narratives among various stakeholders. These narratives are constituted and underpinned by statements and nurture a growing polarisation by isolation of their underlying scientific evidence. The multidimensional and interdisciplinary nature of a protein transition does not go well with an isolated approach in academia. The latter leads to fragmented and incomplete scientific evidence that fails to fully grasp the complexity of the issue, while being used to form partial statements that feed societal and political debates. Through a Restatement approach, this paper aims to (i) synthesise scientific evidence from multiple academic disciplines related to a protein transition and (ii) critically reflect on the implications of the current fragmented scientific evidence landscape of a protein transition in academia and beyond. The Restatement is structured into three sections: Background, Context, and Impacts, with subsections that each cover 4–17 statements, with a total of 68 statements. We connected each statement to its supporting scientific evidence which revealed the complexity of how evidence is related and interpreted, in addition to the inconsistent use of terminology and resulting ambiguities. The main takeaway from the Restatement is that a protein transition cannot be reduced to a single message of a dietary shift but that it should be approached more holistically, while using the available evidence within the appropriate context and critical consideration of the methodologies used to obtain that evidence. This Restatement can be used by researchers and decision-makers working toward more sustainable food systems in the European Union and beyond, to understand the contexts and methods that are not within their own field of expertise. In addition, we stress that overcoming polarisation in a protein transition largely relies on critical reflections of the assumptions, interests and power dynamics shaping the protein transition debate
Estimating the direct medical cost of illness of COVID-19 hospitalisations in Kuwait: efficiency trade-offs from real-world data analysis.
Get PDFBACKGROUND: COVID - 19 has had a profound impact on the economy, health systems within countries, and individuals around the world. To provide insight that may enhance the preparedness for future pandemics, a comprehensive cost assessment is vital. This study aims to estimate the direct cost of illness (CoI), as well as the national burden of treating hospitalised COVID-19 patients.
METHODS: This study is prevalence-based retrospective study containing all patients admitted to a single designated hospital in Kuwait for the treatment of COVID-19. Micro (bottom-up) and macro (top-down) costing methods were used to evaluate direct medical CoI from a hospital perspective. Cost components were grouped as consumables, equipment, and human resources, and sensitivity analysis was used to account for uncertainty of inputs. The cost per admission was reported in local currency and international dollars (PPP, with overheads accounting for 45% of this figure, while consumables, human resources, and equipment accounted for 30%, 19%, and 7%, respectively. The sensitivity analysis demonstrated that overall cost uncertainty was primarily driven by variations in human resource costs rather than by uncertainties related to personal protective equipment (PPE) or ventilator use.
CONCLUSION: The substantial economic impact of COVID-19 on Kuwait's healthcare system has emphasised the significant role human resource costs has on overall expenditure. These findings provide valuable insights for future pandemic preparedness
Assessing adoption of human and AI-enabled diabetic retinopathy screening in primary healthcare settings: findings from a pragmatic trial.
Get PDFINTRODUCTION: Diabetic retinopathy (DR) screening with defined referral pathways is essential for early detection and effective management of DR. This study assessed the adoption of three DR screening (DRS) models in primary healthcare settings, focusing on referral adherence rates and stakeholders' perceptions of the interventions. METHODS: A cross-sectional study was conducted in the Mohali district of Punjab, India, between February 2023 and January 2024. This pragmatic study compared three DRS arms (n = 200 each): I) facility-based screening at health and wellness centres (HWCs) by non-ophthalmologists, II) community-based AI DRS screening at home, and III) standard care involving counselling and referral to district hospitals (DHs). Participants with referable DR or ungradable images were advised for ophthalmology opinion, and their follow-up status and reasons for any non-compliance were assessed after one month. The adoption (acceptability and scalability) of the DRS was assessed via in-depth interviews with stakeholders involved in providing diabetes and DR care in public health settings. RESULTS: Among the 600 participants screened, the average age was 58.22 years (SD ± 11.52). Most participants, 300 (59.57%), were aged 51-70 years, comprising 245 (40.77%) males and 355 (59.23%) females. The referral adherence rates were low, ranging from 13% to 17% across Arms I, II, and III. Barriers to follow-up included lack of awareness, financial limitations, health concerns, perceived good eye health, and transportation challenges. Qualitative findings reveal that DRS, implemented through HWCs and community-based models, is feasible and well-accepted by patients. Stakeholders largely supported the implementation of DRS within primary healthcare settings, though responses varied. Likewise, DRS through HWCs and community-based models is feasible and well-accepted among patients. CONCLUSION: The non-adherence to referrals among study participants is mainly attributable to economic constraints and knowledge gaps. Enhanced point-of-care counselling targeting groups at higher risk of non-adherence for follow-ups, along with a streamlined referral process, can improve the uptake of referral recommendations. TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI): 2022/10/046283
Validation of Shona Symptom Questionnaire (SSQ-14), Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder scale (GAD-7) in Unguja Island, Zanzibar.
Get PDFBACKGROUND: Due to the dearth of resources in low- and middle-income countries, the use of culturally appropriate and psychometrically robust screening tools for common mental disorders (CMDs) administrable by lay health workers (LHWs) is critical to both identifying people that need care and collecting prevalence data to inform policy decisions. The Shona Symptom Questionnaire (SSQ-14), Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder Scale (GAD-7) were validated as part of introducing the Friendship Bench in Zanzibar, Tanzania. METHODS: The present cross-sectional study was conducted at two primary healthcare units. The three screening tools were translated into Swahili and administered to a random sample of 475 participants alongside a standardised clinical assessment done by a psychiatrist, the gold-standard diagnostic technique to which the performance characteristics of the tools were compared. The structural validity of the tools was assessed via confirmatory factor analysis (CFA). Reliability was measured using Cronbach’s alpha. Prevalence estimates of CMDs were derived from the clinical assessments. RESULTS: The optimal cut-off point for the SSQ-14 was ≥ 7 (sensitivity = 76% and specificity = 70%); for the PHQ-9 was ≥ 5 (sensitivity = 69% and specificity = 63%); and for the GAD-7 was ≥ 3 (sensitivity = 69% and specificity = 64%). The area under the receiver operating characteristic curves (AUC) indicated acceptable diagnostic accuracy, i.e., AUCSSQ-14 = 0.78, AUCPHQ-9 = 0.69 and AUCGAD-7 = 0.70. CFA yielded two- and one-factor structures for the PHQ-9 and GAD-7, and SSQ-14 respectively. The internal reliability of the tools was high, i.e.,αSSQ-14 = 0.82, αPHQ-9 = 0.81 and αGAD-7 = 0.83. The prevalence of CMDs, depression, and anxiety was of 25%, 18% and 8% respectively. CONCLUSIONS: The tools are recommended for use by lay health workers in this setting and population. The high prevalence of CMDs reported highlights the importance of implementing evidence-based psychological interventions delivered by LHWs and reinforces the need for simple, validated, and culturally appropriate screening tools administrable by LHWs to do so, especially in low-resourced settings. SUPPLEMENTARY INFORMATIONF: The online version contains supplementary material available at 10.1186/s40359-025-03584-1
Assessing the Potential of Drone Remotely Sensed Data in Detecting the Soil Moisture Content and Taro Leaf Chlorophyll Content Across Different Phenological Stages
Get PDFSoil moisture content is an important determinant of crop productivity, especially in agricultural systems that are dependent on rainfall. Climate variability has introduced water management challenges for smallholder farmers in Southern Africa. The emergence of unmanned aerial vehicle (UAV)-borne remote sensing offers modern solutions for monitoring soil moisture, plant health and overall crop productivity in real-time. This study evaluated the utility of UAV-acquired data in conjunction with random forest regression in predicting soil moisture content and chlorophyll across different growth stages of taro. The estimation models achieved R2 values up to 0.90 with rRMSE as low as 1.25%, demonstrating the robust performance of random forest in concert with different spectral datasets in estimating soil moisture and chlorophyll. Correlation analysis confirmed the association between these two variables, with the strongest correlation observed during the vegetative stage (r = 0.81, p < 0.05) and the weakest during the late vegetative stage (r = 0.78, p < 0.05). The results showed that UAV bands were crucial in predicting soil moisture and chlorophyll across all stages. These results demonstrate the utility of remote sensing, particularly UAV-borne sensors, in monitoring crop productivity in smallholder farms. By employing UAV-borne sensors, farmers can improve on-farm water management and make better and more informed decisions
Active vaccine safety surveillance: Experience from a prospective cohort event monitoring study of COVID-19 vaccines in Kenya.
Get PDFAlthough active vaccine safety surveillance (VSS) can complement passive VSS while overcoming the inherent limitations of spontaneous safety monitoring, it remains rare in sub-Saharan Africa. We conducted post-authorization active VSS of COVID-19 vaccines in Kilifi, Kenya using a cohort event monitoring study design. Participants were followed weekly over 13 weeks for adverse events. A subset was followed daily for one week for solicited systemic reactogenicity events (chills, fatigue, fever, headache, joint pain, malaise, muscle aches, nausea). The daily prevalence of reactogenicity events was compared to the 3-day pre-vaccine average using McNemar's test. The association of baseline characteristics with reactogenicity events was assessed using logistic regression. Between 28th September 2022 and 30th June 2023, 2,440 participants were enrolled into the cohort; 1,000 systematically sampled participants were included in the reactogenicity sub-study. Most were aged 17-39 years (1683; 69.0%) and were female (1895; 77.7%); 535 (28.2%) female participants were pregnant. The three most frequently reported reactogenicity events were fatigue (422; 44.1%), headache (370; 38.7%), and malaise (346; 36.2%); the proportion of severe events ranged from 2.3% (22; nausea) to 5.0% (48; malaise). Except for headache, the prevalence of systemic reactogenicity events was significantly higher in the first two days post-vaccination than pre-vaccination (p-values <0.05). The odds of reactogenicity events were higher among non-pregnant women (adjusted odds ratio [aOR] 1.81; 95% CI 1.28-2.55) and pregnant women (aOR 1.69; 1.03-2.78) than among men, and higher among Johnson & Johnson (aOR 2.05; 1.40-3.00) and Moderna (aOR 4.19; 2.34-7.51) vaccine recipients than among Pfizer vaccine recipients. The prevalence of pregnancy complications was 2.6% (95% CI 1.4-3.5%) against a background prevalence of 3-49%. Reactogenicity events following COVID-19 vaccination were generally non-severe and transient. There was no elevated risk of pregnancy-related complications. Addressing operational barriers is essential for enhancing the utility and feasibility of future active VSS
Adequacy of recommendations for adverse event management in national and international treatment guidelines for rifampicin-susceptible tuberculosis: a systematic review.
Get PDFBACKGROUND: Adverse events during tuberculosis treatment are common and are a major challenge for patients and front-line care providers. We did a systematic review of treatment guidelines for rifampicin-susceptible tuberculosis to evaluate the adequacy of recommendations for adverse event management. METHODS: We searched websites, guideline registries, PubMed, and mobile health Apps to identify treatment guidelines published from October 2004 to October 2024. We recorded the presence and evidence base for specific recommendations for management of nausea/vomiting, hepatotoxicity, skin reactions, neuropathy, visual changes, drug fever, and arthralgias. FINDINGS: We included 47 guidelines: 25 from high-burden countries, 12 international and prominent national guidelines, and 10 non-governmental guidelines. 37 guidelines (79%) included recommendations for managing adverse events: 24 (96%) of guidelines from high-burden countries, eight (80%) of those from non-governmental organizations, and four (33%) of international and prominent national guidelines. Four recommendations had formal ratings of supporting evidence. INTERPRETATION: International and prominent national guidelines frequently lack recommendations for adverse event management or had non-specific recommendations. Research on prevention and management of common and serious adverse events should be a priority for improving the patient's experience and the outcomes of tuberculosis treatment. FUNDING: This research was supported by Wellcome Trust Clinical Grants
Climate change and malaria: an old enemy of Africa is back.
Get PDFBACKGROUND: Malaria is one of the deadliest transmissible diseases in Sub-Saharan Africa. The control of malaria is hindered by socio-economic and environmental factors and its growth is also associated with climate change, particularly temperature increases combined with precipitations and humidity. OBJECTIVES: This study aims to analyse the trends of malaria in the last two decades and assess the influences of climate change on the transmission of malaria in Africa. METHODS: Malaria incidence and evolution trends were used to evaluate the current burden of malaria in Africa. The Pearson correlation coefficient, joinpoint regression and linear regression models were applied to identify significant temporal shifts in malaria incidence trends across the selected countries and determine the impact of climate change on the transmission of malaria. RESULTS: Our findings reveal that mean temperature is the main climatic factor affecting the transmission of malaria in many countries, including Angola, Cameroon, Ivory Coast, Ghana, Mozambique, and Uganda. Warmer temperatures generally increase the risk of malaria transmission, except in Ghana, where higher temperatures are associated with a decreased risk. Precipitation has a significant negative association with malaria incidence in Burkina Faso and Uganda, indicating that increased rainfall reduces transmission. CONCLUSIONS: The study results provide useful insights on how climate change influences malaria in African countries, and reiterates the need for a greater engagement of policymakers and social partners, in intensifying the action needed to fight the transmission of malaria in Sub-Sahara Africa
Liver function tests among children with moderate acute malnutrition: A secondary analysis of a randomized trial from Burkina Faso.
Get PDFOBJECTIVES: Hepatic steatosis has been described in children with severe acute malnutrition, but the degree of liver damage in children with moderate acute malnutrition (MAM) is unknown. This study aimed to investigate the development of malnutrition-associated liver damage by describing liver function tests among children with MAM. METHODS: This study was a randomized 2 × 2 × 3 factorial trial, Treatfood, conducted in Burkina Faso. Children (6-23 months) with MAM received either a lipid-based nutrient supplement or a corn-soy blend, containing either dehulled soy or soy isolate and different quantities of dried skim milk. Malaria rapid diagnostic tests and liver function tests were performed at inclusion and after 3 months of supplementation and compared to Danish reference intervals. Associations were analyzed with linear regressions or tobit regressions, and odds ratios were calculated with logistic regressions, all age- and sex-adjusted. RESULTS: In total, 1405 children had one or more liver function tests measured at baseline. The median age was 11.4 months [interquartile range: 8.2-16.1]. Few children had elevated concentrations of liver function tests at baseline. Concentrations of total bilirubin were 19% (95% confidence interval: 2-40) greater among children with length-for-age Z-scores <-3 compared with children with Z-scores ≥-2. The concentrations of total bilirubin and alkaline phosphatase were negatively associated with age. Minor changes in the serum concentrations of liver function tests were observed after intervention. CONCLUSIONS: Liver function tests were largely within the normal range, whereby no signs of manifest liver damage were found. Children with stunted growth had higher bilirubin, which might indicate subclinical liver damage. CLINICAL TRIAL REGISTRATION: ISRCTN number: ISRCTN42569496
Using causal loop diagrams to explore the maternal and child health system response to payment for performance in Zambia, and it's generalisability across settings.
Get PDFThis study investigates the generalisability of pathways depicted by causal loop diagrams (CLDs) in payment for performance (P4P) schemes by adapting and validating the Tanzanian CLDs to the Zambian context. Specifically, it explores whether the health system pathways represented by CLDs, are consistent across different settings and how variations in programme design and local context influence these pathways. Using a five-stage approach, the study adapted the Tanzanian CLDs to reflect the Zambian P4P programme context, validating them through stakeholder interviews, workshops, and secondary qualitative data. The findings show that while the overarching pathways influencing P4P outcomes are similar, differences in programme design and contextual factors shape their intensity and impact. Notably, Zambia's higher facility autonomy and stronger trust in the health system contributed to greater health worker motivation and service delivery compared to Tanzania. Programme design features such as safeguards for non-incentivised services and adequate funding for facility investment with provider autonomy influenced performance outcomes. Additionally, contextual factors such as trust in the system mitigated programme delays, while decentralised procurement systems enhanced P4P effectiveness. These findings highlight the need for context-specific adaptation when implementing P4P programmes. The study advances the application of CLDs for cross-country health system analysis, highlighting both their potential and limitations in comparing health interventions across diverse settings