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Building resilience and enhancing nutrition in Africa’s food systems
Get PDFThe Report, produced in collaboration with the governments of Malawi, Sierra Leone, and Ethiopia, is the result of a 15-month study examining the resilience of food systems in these countries. Funded by Irish Aid, the objective was to foster the development of realistic and pragmatic strategies to substantially enhance each country’s capacity to provide affordable and sustainable, healthy diets for all, ensuring resilience to future challenges, and building on the leadership these countries have demonstrated in the region.
African food systems now face multiple threats, with potentially very serious consequences in the next 20 years. The Global Panel has worked with three African countries – Ethiopia, Malawi and Sierra Leone – to identify the cascade of challenges they are now facing, and how these could impact food systems, and access to sustainable, healthy diets for all in the future.
This report includes important recommendations and advice for leaders at the most senior levels in African countries and international organisations. It is also of direct relevance to decision makers, professionals, actors in the private sector, experts and researchers with interests in food systems and diets. Many of the individuals will be directly concerned with the production, processing, trade, regulation, and supply of food. However, others may work in wider areas of policy and business, for example relating to public health and wellbeing, education and equity, economic development and investment, urbanisation, globalisation and demography.
Finally, it is also of direct relevance to decision makers concerned with the many and diverse threats and crises facing food systems today – environmental, financial, geopolitical and societal.
This report and executive summary set out practical steps which are essential for strengthening the resilience of African food systems and their transformation, and for enhancing nutrition
Translation of PET radiotracers for cancer imaging: recommendations from the National Cancer Imaging Translational Accelerator (NCITA) consensus meeting.
Get PDFBACKGROUND: The clinical translation of positron emission tomography (PET) radiotracers for cancer management presents complex challenges. We have developed consensus-based recommendations for preclinical and clinical assessment of novel and established radiotracers, applied to image different cancer types, to improve the standardisation of translational methodologies and accelerate clinical implementation. METHODS: A consensus process was developed using the RAND/UCLA Appropriateness Method (RAM) to gather insights from a multidisciplinary panel of 38 key stakeholders on the appropriateness of preclinical and clinical methodologies and stakeholder engagement for PET radiotracer translation. Panellists independently completed a consensus survey of 57 questions, rating each on a 9-point Likert scale. Subsequently, panellists attended a consensus meeting to discuss survey outcomes and readjust scores independently if desired. Survey items with median scores ≥ 7 were considered 'required/appropriate', ≤ 3 'not required/inappropriate', and 4-6 indicated 'uncertainty remained'. Consensus was determined as ~ 70% participant agreement on whether the item was 'required/appropriate' or 'not required/not appropriate'. RESULTS: Consensus was achieved for 38 of 57 (67%) survey questions related to preclinical and clinical methodologies, and stakeholder engagement. For evaluating established radiotracers in new cancer types, in vitro and preclinical studies were considered unnecessary, clinical pharmacokinetic studies were considered appropriate, and clinical dosimetry and biodistribution studies were considered unnecessary, if sufficient previous data existed. There was 'agreement without consensus' that clinical repeatability and reproducibility studies are required while 'uncertainty remained' regarding the need for comparison studies. For novel radiotracers, in vitro and preclinical studies, such as dosimetry and/or biodistribution studies and tumour histological assessment were considered appropriate, as well as comprehensive clinical validation. Conversely, preclinical reproducibility studies were considered unnecessary and 'uncertainties remained' regarding preclinical pharmacokinetic and repeatability evaluation. Other consensus areas included standardisation of clinical study protocols, streamlined regulatory frameworks and patient and public involvement. While a centralised UK clinical imaging research infrastructure and open access federated data repository were considered necessary, there was 'agreement without consensus' regarding the requirement for a centralised UK preclinical imaging infrastructure. CONCLUSIONS: We provide consensus-based recommendations, emphasising streamlined methodologies and regulatory frameworks, together with active stakeholder engagement, for improving PET radiotracer standardisation, reproducibility and clinical implementation in oncology
Is elimination of cervical cancer in sight in England?
Get PDFOBJECTIVE: The age-standardised rate of cervical cancer is 8.5 per 100,000 in England, double the WHO "elimination" goal of 4.0 per 100,000, despite England being close to the target coverage for both HPV vaccination and cervical screening. Our aim was to see whether trends in mortality and incidence rates suggest that England is on the path to elimination. METHODS: We discuss trends in mortality since 1953 by birth cohort, and cancer and cancer-in-situ incidence since 2000 by age group in relation to screening and vaccination. RESULTS: Mortality trends suggest a steep decline in HPV prevalence from women born in the 1880s to those born in the 1930s followed by a continuing increase. Cancer incidence and mortality then fell steeply after the introduction of national screening in 1988. Since 2004 women were invited for their first screen at age 25. From 2000-2004 to 2010-2014 invasive cancer incidence at age 25-29 doubled and mortality increased by 77 %. From 2015 to 2022 cervical cancer incidence fell by 90 % below age 25 and by 80 % at age 25-29 following the introduction of HPV vaccination for girls born since 1991. CONCLUSIONS: Raising the age of starting screening from 20 to 25 transiently increased incidence and mortality in women born 1984-1990. Vaccination may enable the NHS to reach its target for cervical cancer incidence of 4.0 per 100,000 by 2040. Whether the switch from cytology to primary HPV testing in 2019 will reduce rates among unvaccinated women born before 1991 is not yet clear
Sleep health epidemiology and associations with menstrual health, mental health, and educational performance among in-school female adolescents in Uganda: A longitudinal study.
Get PDFOBJECTIVES: Few studies have assessed sleep among African adolescents. We aim to understand factors associated with subjective sleep quality among female Ugandan adolescents and the association of poor sleep quality with subsequent menstrual- and mental health, and educational performance.
METHODS: We analyzed data from a cluster-randomized controlled trial that evaluated a menstrual health intervention in 60 Ugandan secondary schools. Data were collected through cross-sectional surveys at baseline (March-June 2022) and endline (July-August 2023), and prospective daily diaries (April-August 2023). We used logistic regression to analyze associations with poor sleep at baseline, and linear regression to analyze associations of poor sleep with subsequent menstrual and mental health, and education performance, adjusting for clustering.
RESULTS: Of 3841 female participants (mean age=15.6years), 580 (15.1%) reported poor sleep quality and 829 (21.6%) reported feeling tired at baseline. Poor sleep was associated with socio-economic factors including smaller household size, lower socioeconomic status, and fewer meals consumed the previous day. There was strong evidence that poor sleep at baseline was associated with multiple dimensions of poor menstrual health including menstrual pain (adjusted odds ratio=1.74, 95%CI 1.29-2.33), more unmet menstrual practice needs (adjusted odds ratio=2.68, 95%CI 1.99-3.60), and with mental health problems (adjusted odds ratio=2.40, 95%CI 1.80-3.19). Results were similar for baseline tiredness. Prospectively reported poor sleep quality was associated with subsequent poor menstrual and mental health, and subsequent poor educational performance.
CONCLUSIONS: Poor sleep is prevalent among in-school female Ugandan adolescents and is associated with subsequent poorer menstrual health, mental health, and educational performance. Improving sleep in this population could benefit menstrual health, mental health and education outcomes
The Promotion of Oral Nicotine Pouches for Non-Smoking Cessation Purposes on TikTok.
Get PDFINTRODUCTION: Oral nicotine pouches (ONPs) are increasingly prevalent among young people and feature widely within social media content. This study systematically analyzes the most viewed videos on TikTok relating to ZYN (the most popular ONP, manufactured by a subsidiary of Philip Morris International) to understand their content sentiment and patterns, as well as the demographics and potential commercial biases of their creators. AIMS AND METHODS: We used an Apify scraper in July 2024 to collect URLs and metadata for the top 100 most viewed videos on TikTok under the #ZYN hashtag. Profiles of content creators, plus their externally linked sites, were examined for commercial connections to ONP entities. We then undertook an inductive manifest content analysis. RESULTS: The top 100 TikTok videos identified garnered over 400 million views and over 3.8 million shares. A total of 10.3% (n = 9) of content creators had an external link to a website that sold ONPs. Videos predominantly indicated positive sentiment toward ZYN products or other ONPs (79%), and portrayed young men enthusing about the products, often employing humor. ZYN products are featured directly in 71% of videos. Few videos contained disclaimers or warnings about potential risks of ONPs and only 5% portrayed ZYN as a vaping or smoking cessation tool. DISCUSSION: Our findings suggest the most widely viewed content relating to ZYN on TikTok is overwhelmingly positive in sentiment, commonly featuring young men and often portraying ONP use in a humorous context, minimizing risks. Many content creators actively sell ONP products through TikTok, some overtly and some via external links. IMPLICATIONS: ZYN oral nicotine pouches are presented positively and primarily for recreational purposes on TikTok. Few videos referenced ZYN for smoking cessation purposes or mentioned the risks of nicotine. 10.3% of the creators linked their profile to an external website selling oral nicotine pouches, which appears inconsistent with TikTok's policies. The use of humor and downplaying or omission of addiction and health risks across most of the sample echoes marketing efforts by the tobacco industry to present oral nicotine pouches as fun and safe
Efficacy, Safety, and Immunogenicity of the MATISSE (Maternal Immunization Study for Safety and Efficacy) Maternal Respiratory Syncytial Virus Prefusion F Protein Vaccine Trial.
Get PDFOBJECTIVE: To evaluate descriptive efficacy data, exploratory immunogenicity data, and safety follow-up through study completion from the global, phase 3 MATISSE (Maternal Immunization Study for Safety and Efficacy) maternal vaccination trial of bivalent respiratory syncytial virus (RSV) prefusion F protein vaccine (RSVpreF).
METHODS: MATISSE was a phase 3, randomized, double-blinded, placebo-controlled trial. Healthy pregnant participants aged 49 years or younger at 24-36 weeks of gestation were randomized (1:1) to receive a single RSVpreF 120 micrograms or placebo dose. Primary efficacy endpoints included newborn and infant severe RSV-associated medically attended lower respiratory tract illness within 180 days after birth. The RSV-A and RSV-B serum neutralizing antibody titers were determined in a subset of pregnant participants and their newborns.
RESULTS: In this final analysis, 7,420 pregnant participants were randomized, and 7,307 children were born (RSVpreF n=3,660, placebo n=3,647). Vaccine efficacy , defined as protection against newborn and infant severe RSV-associated medically attended lower respiratory tract illness, was 82.4% (95% CI, 57.5-93.9) and 70.0% (95% CI, 50.6-82.5) within 90 and 180 days of birth, respectively. The RSVpreF induced robust immune responses in pregnant participants and resulted in highly efficient transfer of maternal antibodies to their newborns across subgroups (by gestational age at delivery and at vaccination, number of days from vaccination to delivery, country, maternal age). Final RSVpreF safety results in pregnant and newborn and infant participants were consistent with the primary analysis with no new safety concerns identified.
CONCLUSION: This final analysis of MATISSE trial data confirms the primary analysis conclusions: Maternal vaccination with RSVpreF has a favorable safety profile in both pregnant and newborn and infant participants and demonstrates efficacy against RSV-associated lower respiratory tract illness in infants through age 6 months. The RSVpreF induces robust immune responses in pregnant individuals, with corresponding high RSV-neutralizing titers in their newborns.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT04424316
Acceptability of fixed-dose combination treatments for hypertension in Kenya: A qualitative study using the Theoretical Framework of Acceptability.
Get PDFFixed-dose combinations (FDCs) - 2-3 anti-hypertensive medications in a single pill - have the potential to improve hypertension treatment and outcomes. Yet, they are not widely implemented. Factors undermining implementation remain unknown, particularly in sub-Saharan Africa, where hypertension is a major cause of disease burden and is poorly controlled. This study explored the acceptability of FDCs among patients, caregivers, and healthcare workers. We conducted semi-structured in-depth interviews with 58 participants from four purposively selected health facilities in Kiambu county, Kenya. Data were analyzed using an iterative thematic analysis approach, guided by the Theoretical Framework of Acceptability. Our findings indicate that FDCs are potentially acceptable to all participant groups. Acceptability is supported by the perception of FDCs as a means of reducing treatment burden (for patients and healthcare workers) and improving treatment adherence, and by patients' deferral to and trust in healthcare workers. However, acceptability among healthcare workers may be undermined by variable levels of knowledge about FDCs, concerns about FDCs as an "inflexible" treatment that does not allow dose titration or identifying causes of side effects, and concerns about inconsistent availability and affordability of FDCs in Kenya. To enhance acceptability and implementation of FDCs for hypertension treatment in Kenya, it is crucial to strengthen the capacity of all healthcare worker cadres to appropriately prescribe, inform patients about, and support adherence to FDCs. These efforts must align with broader initiatives to address upstream health system factors such as poor availability and affordability
Reference-Based Multiple Imputation for Longitudinal Binary Data.
Get PDFINTRODUCTION: In clinical trials, a treatment policy strategy is often used to handle treatment nonadherence. However, estimation in this context is complicated when data are missing after treatment deviation. Reference-based multiple imputation has been developed for the analysis of a longitudinal continuous outcome in this setting. It has been shown that Rubin's variance estimator ensures that the proportional loss of information due to missing data is approximately the same as that seen in analysis under the missing-at-random assumption for a broad range of commonly used reference-based alternatives; that is it is information anchored. However, the best way to implement reference-based multiple imputation for longitudinal binary data is unclear. METHODS: We formulate and describe two algorithms for implementing reference-based multiple imputation for longitudinal binary outcome data using: (i) joint modeling with the multivariate normal distribution and an adaptive rounding algorithm and (ii) joint modeling with a latent multivariate normal model. A simulation study was performed to compare the properties of the two methods. RESULTS: Across the broad range of scenarios evaluated, the latent normal approach typically gave slightly less bias; both methods provided approximately information anchored inference. The advantage of the latent normal approach was more marked with a rarer outcome. However, both approaches may not perform satisfactorily if the outcome prevalence is very rare, that is, ≤ 10 % . DISCUSSION: Reference-based multiple imputation provides a practical information anchored tool for inferences about the treatment effect for a treatment policy estimand with a longitudinal binary outcome. The latent multivariate normal model is the preferred implementation
Quality indicators and patient outcome measures for palliative care in cancer patients: a systematic review.
Get PDFINTRODUCTION: With the exponential rise in global cancer incidence, the surge in demand for palliative care has outstripped capacity, limiting patients' access to quality and holistic palliative care, especially in low- and middle-income countries. Despite an upturn in research activity, evidence in palliative care remains limited, given its complexity as well as the shortage of standardised quality indicators (QIs) and patient outcome measures (POMs). The objective of this systematic review is to assess the QIs and POMs used to evaluate palliative care service on aggregated and individual levels. METHODS: We undertook a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to determine the QIs and/or POMs of palliative care in patients with non-communicable diseases. A Web of Science, EMBASE, PubMed and SOCSCI search between 1 January 2013 and 31 Dec 2022 identified 41 articles. We appraised the quality of all studies using the mixed methods appraisal tool. RESULTS: 26.8% of studies focus on QIs, while 73.2% used POMs. >90% of palliative care research took place in high-income settings. Across domains of palliative care, the outcome of care is most studied, while the structure and process of palliative care are understudied. QIs and POMs identified often had overlapping themes. Due to the multidimensionality and intricacy of palliative care, evidence is limited, patchy and heterogenous in quality. DISCUSSION: There is an overall lack of standardisation of QIs and POMs, as well as variability in evidence of palliative care research. We recommend that stakeholders collaborate to develop a standardised repository of metrics for monitoring and evaluating palliative care services at both individual and system levels, with a particular focus on structural and process indicators. Incorporating validated, patient-centred measures and selecting key items as quality indicators will enable meaningful tracking of changes, guiding resource allocation and driving improvements in patient-centred care. Furthermore, exploring alternative research designs is essential to enhance feasibility, uphold ethical integrity and strengthen the robustness of future studies
Psoriasis and dementia: A population-based matched cohort study of adults in England.
Get PDFOBJECTIVE: Evidence for an association between psoriasis and dementia is limited and conflicting. We aimed to investigate the association using large and representative population-based data and describe risk by dementia subtype and over time. METHODS: We compared dementia risk between people with and without psoriasis using an age-, sex- and primary care practice-matched cohort of adults aged ≥40 years from the Clinical Practice Research Datalink Aurum in England (1997-2021) linked to hospital admissions data, analysed with stratified Cox regression. RESULTS: Among 360,014 individuals with psoriasis and 1,799,617 without, psoriasis was associated with a small increased risk of all-cause dementia (adjusted hazard ratio [aHR] 1.06, 95% CI 1.04-1.08; absolute rate difference 24 per 100,000 person-years). Strength of association increased with time since psoriasis diagnosis (e.g. aHR 0.99, 0.96-1.03 within 0 to 5 years; 1.20, 1.05-1.37 within 20 to 25 years). The association was stronger for vascular dementia (aHR 1.10, 1.06-1.14) than Alzheimer's dementia (aHR 1.03, 1.00-1.06). Hazard ratios were larger for severe psoriasis (all-cause aHR 1.32, 1.25-1.39; vascular aHR 1.58, 1.44-1.74; Alzheimer's aHR 1.11, 1.02-1.21). INTERPRETATION: Long-term risk of all-cause dementia and vascular dementia, but not Alzheimer's dementia, was slightly higher in people with psoriasis, but absolute risk differences were small. Risks were more substantially raised with time since psoriasis diagnosis and in severe psoriasis compared to mild to moderate psoriasis, suggesting a potential dose-response relationship