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Wastewater surveillance overcomes socio-economic limitations of laboratory-based surveillance when monitoring disease transmission: The South African experience during the COVID-19 pandemic.
Get PDFWastewater and environmental surveillance has been promoted as a communicable disease surveillance tool because it overcomes inherent biases in laboratory-based communicable disease surveillance. Yet, little empirical evidence exists to support this notion, and it remains largely an intuitive, though highly plausible hypothesis. Our interdisciplinary study uses WES data to show evidence for underreporting of SARS-CoV-2 in the context of measurable and statistically significant associations between economic conditions and SARS-CoV-2 incidence and testing rates. We obtained geolocated, anonymised, laboratory-confirmed SARS-CoV-2 cases, wastewater SARS-CoV-2 viral load data and socio-demographic data for Gauteng Province, South Africa. We spatially located all data to create a single dataset for sewershed catchments served by two large wastewater treatment plants. We conducted epidemiological, persons infected and principal component analysis to explore the relationships between variables. Overall, we demonstrate the co-contributory influences of socio-economic indicators on access to SARS-CoV-2 testing and cumulative incidence, thus reflecting that apparent incidence rates mirror access to testing and socioeconomic considerations rather than true disease epidemiology. These analyses demonstrate how WES provides valuable information to contextualise and interpret laboratory-based epidemiological data. Whilst it is useful to have these associations established for SARS-CoV-2, the implications beyond SARS-CoV-2 are legion for two reasons, namely that biases inherent in clinical surveillance are broadly applicable across pathogens and all pathogens infecting humans will find their way into wastewater albeit in varying quantities. WES should be implemented to strengthen surveillance systems, especially where economic inequalities limit interpretability of conventional surveillance data
The Effects of Sudan's Armed Conflict on Economy and Health: A Perspective.
Get PDFSudan's economy has been greatly affected by the armed conflict through 15 different channels at both micro and macro levels. The requested fund to save live of sudanese population is 2.6 billion US$ from which only 33% was allocated. The humanitarian crisis in Sudan has lead to contraction in economy and thus agriculture, health, water supply, education, and bankig which all resulted in increased mortality and morbidity rates, food insecurity, violation in human rights and inflation. There is a rising humanitarian need for assistance, in addition to urgent interventions to stop war and cease fire. International law must be enforced through international organizations, the voice of Sudanese civil society must be coordinated if not united, and several measures must be taken after the conflict resolved to address the impacts of conflict
Factors influencing breast milk donation to a human milk bank in Iran: implications for policymakers and planners.
Get PDFBACKGROUND: The World Health Organization (WHO) actively promotes breastfeeding as the optimal source of nourishment for infants and young children. However, not all newborns have access to breast milk, leading to deprivation of its nutritional benefits or incurring financial burdens from alternative feeding options. Establishing Human Milk Banks (HMBs) can help ensure equitable access to donated human milk. However, several factors may hinder breast milk donation. This study aims to identify the factors influencing milk donation to HMBs in Iran. METHODS: We conducted a case-control study involving mothers who had given birth at least one year prior to the study. The study included 51 cases (mothers who donated their milk to HMBs) and 153 controls. Data were collected using a questionnaire designed to gather retrospective information on individual health, social networks, and other relevant factors. Logistic regression analysis was performed to examine the relationships between breast milk donation and these factors. Additionally, qualitative data were collected through face-to-face interviews with HMB senior staff and mothers. Thematic analysis was employed to identify perspectives on factors influencing milk donation. RESULTS: Family factors, social influences, individual social welfare scores, and breast milk adequacy were significantly associated with increased milk donation. Among these, family support emerged as one of the strongest predictors of milk donation. CONCLUSION: To establish HMBs and promote human milk donation, health policymakers and planners should implement strategies that motivate mothers to donate. Evidence-based training and motivational programs for mothers and their families, which address barriers to milk donation, are essential to achieving this goal
"It empowered me to move my timeline forward": first person thematically analysed accounts of a novel behavioural intervention to support status-sharing in young adults with perinatally acquired HIV in UK and Uganda.
Get PDFYoung adults living with perinatally acquired HIV (PAH) face many stressors. Sharing one's status may help with coping with these challenges but there are no rigorously evaluated interventions to support HIV status sharing in this population. The aim of this study was to explore the experiences of participants in a novel HIV status-sharing intervention guided by motivational interviewing. We used a cross-sectional, qualitative design. Ten young adults from Uganda (20-25 years; 6 female), nine from the UK (19-29 years; 7 female) and five therapists (2 UK; 3 Uganda) participated in individual semi-structured interviews. The data were analysed using thematic analysis. Seven theoretical themes were identified. Participants reported positive experiences of the intervention, a desire for more support and the importance of peer interaction. This study provides evidence for the acceptability of a novel HIV-sharing intervention for young adults with PAH. The intervention could inform HIV sharing guidance and clinical practice
Synergistic antibacterial activity of curcumin and phage against multidrug-resistant Acinetobacter baumannii.
Get PDFAcinetobacter baumannii is a priority bacterial pathogen and leading cause of nosocomial infections, particularly in intensive care units (ICUs). The average incidence of carbapenem-resistant A. baumannii infections in ICUs is 41.7 cases/1,000 patients, highlighting the urgent need for more effective alternative therapies to replace carbapenems. Thus, this study aimed to investigate for the first time the antibacterial activity of curcumin in combination with the novel phage vB_AbaSI_1 to combat multidrug-resistant (MDR) A. baumannii in vitro. Phage vB_AbaSI_1 (capsid diameter 91 nm, contractile tail 94/20 nm) was isolated from sewage and infects ~ 29% of the 131 bacterial isolates examined. The 52,783 kb phage genome has 75 ORFs, encodes an integrase, lacks tRNAs/virulence genes, and belongs to the Caudoviricetes. Commercially sourced curcumin (400 µg/mL), combined with phage vB_AbaSI_1 (MOI 100) reduced MDR A. baumannii 131 to undetectable levels 1 h post-treatment at 37 °C, and this efficacy was further extended for 5 h in double-dosed phage/curcumin-treated cultures. In contrast, treatment with just phage vB_AbaSI_1 reduced bacterial growth but rebounded within 3 h, while curcumin-only treated cultures showed only 1-log bacterial reduction compared to untreated control. The phage/curcumin synergy occurred exclusively with phage-susceptible strains pre-curcumin exposure. This suggests the potential disruption of bacterial cell membrane during phage infection allowing curcumin entry, as no synergy was observed with phage-resistant strains. This innovative strategy of combining phage and curcumin showed great efficacy at controlling MDR A. baumannii and has a potential for therapeutic deployment. Future work will focus on engineering the phage to make it therapeutically acceptable
Helminth driven gut inflammation and microbial translocation associate with altered vaccine responses in rural Uganda.
Get PDFVaccine responses are sometimes impaired in rural, low-income settings. Helminth-associated gut barrier dysfunction and microbial translocation (MT) may be implicated. We used samples from a trial of praziquantel treatment-effects on vaccine responses in Schistosoma mansoni (Sm)-endemic Ugandan islands, measuring intestinal fatty acid-binding protein 2 (I-FABP2), lipopolysaccharide-binding protein, anti-endotoxin core antibodies (EndoCab), soluble CD14 (sCD14) in plasma, and faecal lipocalin-2, occult blood (FOB), and calprotectin (fCAL), and evaluating their associations with baseline helminth infection, praziquantel treatment, and responses to BCG, yellow fever, typhoid, HPV, and tetanus-diphtheria vaccines. Sm associated positively with fCAL and FOB, hookworm with I-FABP2, and any helminth with EndoCab IgM, fCAL and FOB. Sm associated inversely with sCD14. Praziquantel treatment reduced all marker concentrations, significantly fCAL and FOB, implying that Sm-associated gut inflammation and MT is reversible. Associations of assessed markers with vaccine-specific responses were predominantly inverse. Interventions to improve gut barrier function may enhance vaccine responsiveness
Exploring patient and health care provider perspectives on barriers to diabetic retinopathy screening in public health facilities in North India.
Get PDFDiabetic retinopathy (DR), a prevalent microvascular complication of diabetes mellitus (DM), can be prevented with early detection and timely intervention. DR is asymptomatic in its early stages, highlighting the importance of screening for accurate referral and effective management. Multiple barriers impede access to diabetic retinopathy screening (DRS), creating significant public health challenges in regions with high DM prevalence. This study explores the perspectives of people with DM (PwDM) and healthcare providers (HCP) on these barriers. A qualitative study using in-depth interviews (IDI) was conducted between October 2022 and January 2023 in Punjab and Chandigarh. Through purposive sampling, IDIs were conducted with 7 PwDM and 19 HCPs, including retina specialists, ophthalmologists, optometrists, medical officers (MO), Community Health Officers (CHO), and ASHA workers from various public health facilities. A semi-structured topic guide facilitated the interviews, and thematic analysis was applied, utilizing the healthcare access barrier (HCAB) model as a framework. The study identified financial barriers due to insurance unawareness and employment constraints. Structural challenges included insufficient DRS infrastructure, untrained staff, the need for accompaniment, and limited access to screening sites. Limited awareness and misconceptions about DR characterized cognitive barriers, while psychological barriers involved mistrust of the health system, anxiety, and frustration from low vision. Addressing these issues is essential to improve DRS uptake and eye health outcomes. Managing diabetes and VTDR is challenging, highlighting the need for community-level DRS. Enhancing DR awareness and promoting public health insurance benefits are crucial for overcoming barriers and improving screening rates
"Ashamed of being seen in an HIV clinic": a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trial.
Get PDFBACKGROUND: There is high post-hospital discharge mortality among persons with HIV who are hospitalized, and post-hospital survival is strongly associated with early HIV clinic linkage, clinic attendance, and antiretroviral therapy adherence. The Daraja intervention, a context-tailored case management strategy implemented and tested through a randomized trial in Tanzania, was associated with improved HIV clinic linkage, retention, and ART initiation and adherence. METHODS: We conducted in-depth interviews (IDIs) in a sub-sample of 40 study participants (20 control and 20 intervention) 12 months after enrollment into the trial to gain an in-depth understanding of the barriers to HIV care engagement and the perceived mechanisms through which the Daraja intervention impacted these barriers. We also conducted IDIs with 20 health care providers. We used a thematic analysis approach to generate themes following the Gelberg-Andersen behavioral model for vulnerable population domains. RESULTS: Perceived stigma, coupled with the mistrust of healthcare providers, underemployment or lack of reliable income, unreliable transport, and a lack of social support, were identified as key barriers to HIV clinic attendance and ART adherence. Perceived stigma complicated not only linking to and attending an HIV clinic but also decision-making regarding the choice of the clinic's location. The Daraja intervention was reported to help normalise HIV diagnosis, plug the social support gap, increase patients' self-efficacy and their capacity of participants to navigate the HIV clinic during HIV clinic linkage. CONCLUSION: These qualitative research results identified several important barriers to engaging in HIV care and provide insights into the mechanisms through which the Daraja intervention operated to affect the perceived stigma, social support, self-efficacy, and increased capacity of participants to navigate the HIV clinic during HIV clinic linkage. DARAJA TRIAL REGISTRATION: ClinicalTrials.gov, NCT03858998. Registered on 01 March 2019
Understanding Patterns of the Gut Microbiome May Contribute to the Early Detection and Prevention of Type 2 Diabetes Mellitus: A Systematic Review
Get PDFThe rising burden of type 2 diabetes mellitus (T2DM) is a growing global public health problem, particularly prominent in developing countries. The early detection of T2DM and prediabetes is vital for reversing the outcome of disease, allowing early intervention. In the past decade, various microbiome–metabolome studies have attempted to address the question of whether there are any common microbial patterns that indicate either prediabetic or diabetic gut microbial signatures. Because current studies have a high methodological heterogeneity and risk of bias, we have selected studies that adhered to similar design and methodology. We performed a systematic review to assess if there were any common changes in microbiome belonging to diabetic, prediabetic and healthy individuals. The cross-sectional studies presented here collectively covered a population of 65,754 people, with 1800 in the 2TD group, 2770 in the prediabetic group and 61,184 in the control group. The overall microbial diversity scores were lower in the T2D and prediabetes cohorts in 86% of the analyzed studies. Re-programming of the microbiome is potentially one of the safest and long-lasting ways to eliminate diabetes in its early stages. The differences in the abundance of certain microbial species could serve as an early warning for a dysbiotic gut environment and could be easily modified before the onset of disease by changes in lifestyle, taking probiotics, introducing diet modifications or stimulating the vagal nerve. This review shows how metagenomic studies have and will continue to identify novel therapeutic targets (probiotics, prebiotics or targets for elimination from flora). This work clearly shows that gut microbiome intervention studies, if performed according to standard operating protocols using a predefined analytic framework (e.g., STORMS), could be combined with other similar studies, allowing broader conclusions from collating all global cohort studies efforts and eliminating the effect-size statistical insufficiency of a single study
Behaviour change interventions to improve household sanitation and hygiene practices in urban settings: A systematic scoping review.
Get PDFINTRODUCTION: Behaviour change interventions have the potential to improve sanitation and hygiene practices in urban settings. However, evidence on which behaviour change interventions have successfully improved sanitation and hygiene practices in urban settings is unclear. METHODS: We performed electronic searches across five databases and one grey literature database to identify relevant studies published between January 1, 1990 and November 20, 2023 in English. Eligible study designs included randomised and non-randomised controlled trials with a concurrent control. Studies were eligible for inclusion if they reported a behaviour change intervention for improving sanitation and/or hygiene practices in an urban setting. Individual behaviour change intervention components were mapped to one of nine intervention functions of the capabilities, opportunities, motivations, and behaviour (COM-B) framework. Risk of bias was assessed for each study using an adapted Newcastle-Ottawa scale. RESULTS: After de-duplication, 8249 documents were screened by abstract and title, with 79 documents retrieved for full-text screening. We included 13 studies ranging from low- to high-quality. The behaviour change interventions had mixed effects on sanitation and hygiene practices in urban settings. Specifically, interventions improved latrine quality but not safe child faeces disposal. Interventions often improved handwashing with soap at key times and sometimes increased the presence of soap and water at the handwashing facility, used as a proxy measure for handwashing. There is limited evidence on food hygiene practices. Most behavioural outcomes were measured between 6 and 12 months after intervention implementation, which may undermine the sustainability of behaviour change interventions. CONCLUSION: Despite overall mixed behavioural effects on sanitation and hygiene practices, behaviour change interventions can improve certain behaviours in urban settings, such as latrine quality improvements and handwashing with soap at the household or compound level. More ambitious behaviour change interventions are needed to reduce disparities in sanitation and hygiene access in urban areas globally