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Using Indoor Radon Data to Infer the Impact of Home Energy Efficiency Measures on the Air Exchange of Dwellings
Get PDFA major objective of home energy efficiency upgrades is to reduce uncontrolled ventilation in order to reduce heat loss. Such reduction also affects concentrations of indoor pollutants by reducing the ingress of pollutants from the outdoor air and the egress of pollutants generated inside the home, which may lead to increased levels of indoor pollutants. In the absence of routine monitoring of the effect of home energy efficiency measures on air exchange, we develop a simple model of the relationship between indoor radon concentrations and dwelling air exchange and, for the first time, use population radon survey data for the United Kingdom to infer the impact of home energy efficiency improvements on home air infiltration. The model suggests that concentrations of radon rise steeply for quite modest reductions in air exchange, especially at low air exchange levels. We estimate that an increase in indoor radon of 10 Bq/m
3
implies a mean reduction in air change rate of 0.22 air changes/h (ach), with 10th, 50th and 90th centiles of 0.03, 0.15 and 0.51 ach, respectively. Applying the model to observed data on current radon levels in UK homes with different levels of energy efficiency suggests a range of effects depending on the initial and final energy efficiency characteristics of the dwelling. For example, the maximum difference in indoor radon, between a typical UK home without any energy efficiency measures and one with wall insulation, glazing and loft insulation, is around 35 Bq/m
3
, which according to our model would correspond to a reduction in air change rate of 0.79 ach. The results suggest that current home energy efficiency measures may be associated with an appreciable decrease in air exchange in UK homes and that retrofit design principles may need to be re‐evaluated to avoid embedding unintended adverse consequences for indoor air quality and health
From Establishment to ISO15189:2012 Accreditation: The Case of Hararghe Health Research Laboratory, Harar, Ethiopia.
Get PDFBACKGROUND: Accreditation of laboratories offering diagnostic services improves the operation of clinical as well as research performance. OBJECTIVE: This case report describes the journey of Hararghe Health Research Laboratory from it's inception to the International Organization for Standardization 15189:2012 accreditation by the Ethiopian Accreditation Service. METHODS: An external consultant conducted a baseline audit in November 2019 following the World Health Organization African Region's Stepwise Laboratory Quality Improvement Process Towards Accreditation guideline. The follow-up internal audit was conducted in January 2021. Then, an on-site laboratory assessment was conducted by experts from Ethiopian Accreditation Service towards the end of 2022. FINDINGS: The Hararghe Health Research laboratory received multiple remarks during audit by external consultant and drew up a corrective action plan. Some of the actions were revision of quality policy manual, managerial and technical documents, participation in the United Kingdom National External Quality Assessment Scheme and implementation of the International Organization for Standardization 15189:2012 accreditation checklist. The internal audit revealed a total of 26 gaps in the microbiology and 16 in the molecular biology sections and these were filled by the end of April 2022.The laboratory was cited for nine minor non-conformities during an assessment by experts from the Ethiopian Accreditation Service. The laboratory developed a corrective action plan, cleared non-conformities by end of February 2023 and received the accreditation certificate on 3rd May 2023. The laboratory's accreditation achievement in less than five years is a significant milestone and serves as a model for other institutions to achieve it in a similar time frame
"It would be better for those of us who have the disease not to be ashamed": Insights from people living with chronic hepatitis B virus infection and healthcare workers providing HBV care in Kilifi, Kenya.
Get PDFChronic hepatitis B infection (CHB) causes over 1 million deaths annually, with a large burden of morbidity and mortality in the WHO-African Region (WHO-AFRO) where <5% of people are diagnosed and 0.2% are on treatment. Studies have shown that understanding of hepatitis B virus (HBV) here is often poor, and people living with HBV (PLWHB) can experience stigma and discrimination. However there has been little documentation on the impact of an HBV diagnosis on the lives of PLWHB in the WHO-AFRO region or community involvement in improving care provision. We undertook two focus group discussions (FGDs) with PLWHB and two with healthcare workers (HCWs) providing HBV care at Kilifi County Referral Hospital (KCRH), Kenya to explore experiences of living with HBV and barriers to accessing care. FGDs were conducted primarily in Kiswahili, transcribed verbatim and translated into English. The data were analysed thematically using NVivo version 14. PLWHB and HCWs at KCRH had a good understanding of HBV which was likely influenced by a concurrent research study on HBV, however they reported low awareness in the general community, and there is no local name for the infection. Many PLWHB were shocked at their initial diagnosis with mixed reactions from friends and family. Costs of transport and concerns about lost employment were the biggest barriers to care. Many people suggested decentralised clinics would reduce loss to follow up, however others would rather be treated far from home to preserve anonymity. Stigma was highlighted as a major issue, leading to feelings of isolation, rejection and discrimination. Community education, wider testing and advocacy by well-respected community members were mentioned as key methods to reduce HBV transmission. Decentralisation of clinics may improve access to care; however, this needs to be developed in careful consultation with PLWHB to ensure they are acceptable and accessible to all
Evaluating effectiveness and comparative costs of hepatitis C virus self-testing service delivery models in Vietnam: A cross-sectional study
Get PDFHepatitis C virus self-testing (HCVST) has been shown to reach people who may not otherwise test. We conducted a cross-sectional survey to assess the effectiveness and costs of different HCVST distribution models among key populations (KPs) and people living with HIV (PLHIV) in Hanoi and Ho Chi Minh City, Vietnam, between September 2023 and April 2024. We engaged eight community-based organizations (CBOs) and 10 public and private clinics in offering HCVST using oral fluid-based HCV rapid antibody tests along with standard or provider-led HCV testing (HCVT). HCVST effectiveness was assessed by the proportion of first-time testers, HCV positivity yield, and linkage to care. Outcomes were stratified by distribution model (community, facility, online, secondary distribution) and compared to standard HCVT. Cost per HCV diagnosis was calculated in US dollars. Among 2,882 participants tested for HCV, 1,834 used HCVST and 1,048 used standard HCVT. HCVST users were more likely to be first-time testers compared to those opting for standard testing (67.6% vs. 59,1%; p < 0.001). The highest proportion of first-time testers was reached through secondary distribution (91.4%) and community distribution (83.8%). HCV positivity through HCVST was significantly lower at CBOs but similar at clinics compared to standard testing (11% vs. 16%; p < 0.01; 16.8% vs. 20.8%; p = 0.094). HCVST at CBOs and clinics was more costly than standard testing (408 and 218). HCVST was still costlier at CBOs but cheaper at clinics compared to standard testing when kit costs decreased to 417 vs. 357 vs. $408). HCVST effectively reached people with HCV and more first-time testers, compared to standard testing among KPs and PLHIV. While current HCVST distribution approaches are costlier than standard testing, modest reductions in commodity costs could make services comparable to help achieve Vietnam's HCV elimination goals and reach underserved populations
In vitro activity of antibiotic monotherapy and combination therapy with bacteriophages against Staphylococcus aureus LVAD-driveline infections.
Get PDFLeft-ventricular assist devices (LVADs) are increasingly used as a bridge to heart transplantation and destination therapy. These devices, especially the driveline, are susceptible to difficult-to-treat infections, associated with high morbidity and mortality rates. Staphylococcus aureus (S. aureus) is a major causative pathogen of LVAD infections. Antibiotic resistance and biofilm formation can complicate the treatment of these infections. A novel in vitro assay was developed to study the antibiotic susceptibility of S. aureus biofilm grown on LVAD drivelines. Besides antibiotic monotherapy, the effect of various antibiotics combined with rifampicin was studied. Additionally, we explored the efficacy of four individual phages and phage-antibiotic combinations as potential treatment strategies. Our data showed a decrease of susceptibility of the S. aureus biofilms to antibiotic monotherapy compared to planktonic S. aureus. With only rifampicin and erythromycin monotherapy resulting in full bacterial clearance. Combining antibiotics with rifampicin showed similar antimicrobial efficacy against S. aureus biofilms as rifampicin monotherapy. While both individual phages and a phage cocktail were effective against planktonic bacteria, phage efficacy was limited against S. aureus in biofilm. Combining phages with antibiotics did not clearly improve treatment efficacy, compared to antibiotic monotherapy. Contrarily, it even increased bacterial growth when phage administration preceded antibiotic treatment. Here, both antibiotic- and phage monotherapy showed reduced efficacy on LVAD-driveline biofilms. Additionally, phages did not show an additive value to antibiotic treatment of LVAD driveline infections. Further studies are needed to elucidate optimal treatment strategies for LVAD-driveline infections.IMPORTANCECurrent treatment strategies for S. aureus LVAD-driveline infections are based on in vitro antibiotic susceptibility of planktonic bacteria. However, LVAD infections are most often biofilm-related, which decreases antibiotic susceptibility significantly, resulting in discrepancies between in vitro antibiotic susceptibility and in vivo treatment success. Here, we have developed a novel in vitro assay to determine antibiotic susceptibility of S. aureus biofilm, grown in conditions relevant to LVAD-driveline infections. Next to antibiotic susceptibility, the susceptibility of this biofilm to bacteriophage mono- and combination treatment with antibiotics was evaluated as an alternative treatment strategy. In the future, this assay can be used to provide a better insight in in vivo antibiotic- and bacteriophage susceptibility of LVAD-driveline biofilms. Thereby improving in vivo treatment strategies for LVAD-driveline infections
Parasite clearance and protection from Plasmodium falciparum infection (PCPI): a two-arm, parallel, double-blinded, placebo-controlled, randomised trial of presumptive sulfadoxine-pyrimethamine versus artesunate monotherapy among asymptomatic children 3-5 years of age in Zambia.
Get PDFBACKGROUND: The 2022 malaria chemoprevention guidelines of the World Health Organization (WHO) recommend the provision of a full treatment course of an antimalarial medicine at predefined intervals, regardless of whether the child is infected with malaria, to prevent illness in moderate to high perennial malaria transmission settings. Sulfadoxine-pyrimethamine (SP) is usually used for this intervention, now called perennial malaria chemoprevention (PMC). The K540E mutation in the dihydropteroate synthase (dhps) gene circulating in Africa is thought to be associated with treatment failure and reduced chemoprevention efficacy in children but the exact effect remains unclear. METHODS: This protocol is for a two-arm, parallel, double-blind, placebo-controlled, randomised trial in Zambia that is designed to evaluate the effect of parasite genotypes on the efficacy of single-dose SP among asymptomatic children between 3 and 5 years of age. Children are randomly allocated to one of two groups for directly observed treatment. Over seven consecutive days (7 days before day 0), children in the SP group (n = 400) receive placebo artesunate (AS), then active SP (day 0). In contrast, children in the AS group (n = 200) receive active artesunate for seven consecutive days, followed by placebo SP (day 0). Then, on days 0, 2, 5, 7, and weekly thereafter until day 28, children provide blood for thick smear slides. Dried blood spots (DBS) are collected on the same days and weekly from day 28 to day 63 for quantitative polymerase chain reaction (qPCR) and genotype analyses using a platform based on PCR followed by targeted next-generation sequencing. DISCUSSION: We will report unblinded results including: (i) time-to-parasite clearance among SP recipients who were positive on day 0 by qPCR and measured to day 63; (ii) mean duration of SP protection against infection, and (iii) mean duration of symptom-free status among SP recipients who were parasite free on day 0 by qPCR. Our conclusions will reflect on the utility of WHO's new malaria chemoprevention efficacy study protocol with its follow-up to day 28 versus day 63. TRIAL REGISTRATION: ClinicalTrials.gov NCT06166498 11/12/2023
Prevalence and determinants of chronic non-communicable diseases among prison inmates in the city of Tete, Mozambique: a cross-sectional study
Get PDFBACKGROUND: High health inequalities and non-communicable chronic diseases (NCDs) are prevalent in the prison population, particularly in Sub-Saharan African countries, posing significant implications for morbidity and mortality. This study analyzes the prevalence and determinants of these diseases among prisoners in the city of Tete, Mozambique.
METHODS: A cross-sectional study was conducted among inmates at the Tete City Prison, Mozambique. Diabetes Mellitus (DM) was diagnosed based on the criteria established by the International Expert Committee, which defines diabetes as a fasting plasma glucose (FPG) level of ≥ 126 mg/dL (7.0 mmol/L). Participants who reported a previous diagnosis of diabetes by a doctor or health professional were also classified as diabetic. Multivariable logistic regression was used to identify significant risk factors, reporting adjusted Odds Ratios (AOR) with a 95% confidence interval, considering a p-value < 0.05 as significant.
RESULTS: The prevalence of hypertension, DM, and obesity was 36.90% (95% CI: 31.33; 42.73), 10.34% (95% CI: 7.09; 14.44), and 1.38% (95% CI: 0.38; 3.49), respectively. A family history of DM (AOR: 14.95; 95% CI: 3.32; 67.44) and being female (AOR: 2.54; 95% CI: 1.43; 4.52) were identified as risk factors associated with DM and Hypertension, respectively.
CONCLUSION: The study revealed high rates of DM and hypertension among inmates, highlighting family history as a risk factor for DM and the association of female with hypertension. Urgent implementation of preventive measures for hypertension, along with early screenings for individuals with a family history of DM, is essential to mitigate complications in prison environment.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-24387-4
Pregnancy reporting and biases in under-five mortality in three African HDSSs.
Get PDFIn the absence of complete civil registration and vital statistics, Health and Demographic Surveillance Systems (HDSSs) are important sources of population-based data throughout sub-Saharan Africa. However, HDSS data on the vital status of newborns are often unreliable due to omission of those who were born and died between two rounds of data collection and are therefore never enumerated. This study investigates whether pregnancy registration improves estimation of under-five mortality (U5M) in three HDSSs in The Gambia, Kenya, and South Africa. We find that mortality is higher for children whose mother's pregnancy was observed than for children who were first registered after birth. Cox proportional hazards models with inverse probability weights further suggest that this difference is probably due to improved ascertainment of deaths in pregnancy cohorts and unlikely to be driven by a selection effect. These results highlight the importance of pregnancy registration in HDSSs for the estimation of U5M
Real world implementation of AlcoChange, a smartphone digital therapeutic to improve outcomes from alcohol-related liver disease: protocol for an individually randomised parallel group controlled trial.
Get PDFBACKGROUND: Deaths from alcohol-related liver disease (ARLD) are rising in the UK, representing a significant public health crisis. Effective interventions are urgently needed to reduce alcohol consumption and improve outcomes for individuals with ARLD. While behaviour change interventions (BCIs) are effective, their scalability is limited. Digital therapeutics offer a promising avenue for delivering BCIs remotely and at scale. AlcoChange, a novel digital therapeutic combining a smartphone app and digital breathalyser, delivers personalised BCIs based on patient triggers. Preliminary data suggest its potential efficacy in reducing alcohol use. METHODS: This is a multi-centre, two-arm, parallel-group, individually randomised controlled trial comparing usual care (review by a hospital Alcohol Care Team and brief intervention) with usual care plus AlcoChange in patients with ARLD. POPULATION: Adults aged 18 years or older with a diagnosis of ARLD (including cirrhosis, fibrosis, steatohepatitis, or recent alcoholic hepatitis) who have been advised to abstain from alcohol and intend to do so, and who have access to a smartphone. INTERVENTION: Usual care plus AlcoChange, comprising a smartphone app and digital breathalyser delivering personalised behaviour change techniques. COMPARISON: Usual care alone. OUTCOME: The primary outcome is the proportion of patients abstinent or reporting low-risk alcohol consumption (< 14 units/week) at 180 days post-randomisation, assessed using the Timeline Follow-Back (TLFB) method. Secondary outcomes include self-reported alcohol use at various time points, liver disease severity, health-related quality of life, healthcare resource utilisation, and cost-effectiveness. Four hundred participants will be recruited from up to 18 NHS hospitals in England and randomised 1:1. A mixed-methods approach was used to develop the trial protocol, including a theory of change framework and bespoke training materials for the TLFB assessment. DISCUSSION: This trial will evaluate the real-world efficacy and cost-effectiveness of AlcoChange in reducing alcohol consumption and alcohol-related harm in individuals with ARLD. The study addresses the urgent need for scalable interventions to combat the rising burden of ARLD in the UK. The pragmatic design and mixed methods approach to implementation aim to enhance the generalizability and impact of the findings. The trial will provide valuable evidence to inform clinical practice and policy regarding the use of digital therapeutics for alcohol use disorder and liver disease
Evidence gaps on unmet health and social care needs in the WHO Eastern Mediterranean Region Research report
No full textWhy measure unmet needs for health and social care in
the Eastern Mediterranean?
The ageing population of the WHO Eastern Mediterranean Region presents significant challenges in addressing unmet health and social care needs among older people. Although life expectancy is increasing across the region, disparities between countries in healthy life expectancy and access to health care services persist; this is particularly the case for noncommunicable diseases (NCDs), the leading cause of death among older adults. Unmet care needs are exacerbated by systemic issues, sociopolitical instability and the effects of the COVID-19 pandemic.
Aims of this study
To identify and quantify unmet health and social care needs in the WHO Eastern Mediterranean Region, to enable an understanding of the health and economic burdens for individuals and societies as well as the barriers to accessing care