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Prevalence and 10-Year Risk of Intracerebral Hemorrhage in Central China Using Estimates From the 1 Million Cross-Sectional Study
No full textBackground and Objectives: Intracerebral hemorrhage (ICH) is a common and fatal type of stroke, especially in central China. However, recent epidemiologic data are scarce. The study aimed to investigate the latest prevalence of ICH in central China and assess the risk of ICH in the next 10 years based on the Resident Health Records (RHR) data. Methods First, this cross-sectional study was based on a large-scale face-to-face investigation of ICH, which was launched on residents aged 20 years or older from January 1, 2021, to December 31, 2021, and estimated the prevalence of ICH in Hunan, a representative province in central China. Then, based on the RHR database, we assessed the ICH risk, population attributable fraction (PAF), and effects of ICH prevention under different risk factor control scenarios over the next decade by the China Kadoorie Biobank (CKB)-cardiovascular disease (CVD) model. Results: In 2021, 1.78 million participants enrolled in the investigation (mean age = 50.1 years; 51% male). The age-standardized prevalence rate of ICH was 159.2 (95% CI 153.7-164.9) per 100,000. The prevalence rate of ICH in men was 193.6 (95% CI 185.2-202.5) per 100,000, while in women was 124.0 (95% CI 117.1-131.3) per 100,000, and it increased with age. Spatial aggregation was observed, with the peak prevalence rate of ICH at 327.3 (95% CI 293.1-365.5) per 100,000 in Zhuzhou, followed by Changsha was 215.8 (95% CI 190.6-243.9) per 100,000, while Shaoyang had the lowest rate was 62.8 (95% CI 51.2-77.1) per 100,000. For the assessment of 10-year ICH risk, we included a total of 8.36 million participants aged 30-79 with the RHR database into the CKB-CVD model. We found that there will be 354,146 cases (ICH risk: 4.2%) of ICH among the participants in the next decade. Controlling hypertension showed the highest potential for ICH prevention, with a PAF of 8.6%. By controlling hypertension, smoking, waist circumference, and diabetes, 56,673 ICH cases (PAF 19.1%) can be avoided in the next decade. Discussion: The ICH prevalence in central China remained high. Strict blood pressure control could significantly reduce the risk of ICH in the next 10 years. It is important to continually improve ICH prevention strategies in the general population
Interventions to support parents, families and caregivers in caring for preterm or low birth weight infants at home: A systematic review and meta-analysis
Get PDFThe aim of this study was to determine what interventions, approaches, or strategies to support mothers/fathers/caregivers and families in caring for preterm (<37 gestational weeks) or low birthweight (<2,500g) infants in the home have been effective in improving outcomes. We conducted a systematic review and meta-analysis. A comprehensive search of relevant electronic databases, including MEDLINE, Embase, CINAHL and Cochrane Central Register of Controlled Trials was completed in September 2024. Studies were included if they utilised interventions which focused on providing support to participants (mother/father/parents, families or caregivers) to care for their infants in the home. Two reviewers independently screened papers in Covidence and extracted data. Random effects meta-analyses were undertaken. Quality of studies and certainty of evidence were assessed using CASP and GRADE, respectively. Critical outcomes based on WHO preterm and low birthweight criteria comprised infant mortality, morbidity, growth and neurodevelopment. Priority outcomes comprised breastfeeding, care seeking, parent-infant interaction, mother-child attachment and parental health and wellbeing. Forty-seven studies were included. There is some evidence that support interventions may improve outcomes related to infant mortality, improvements in infant growth, exclusive breastfeeding, infant cognitive development, immunisation uptake, and reduction in maternal stress and depression. However, the overall certainty of evidence is low or very low in the majority of studies. We conclude that interventions providing support for parents to care for infants in the home may improve outcomes for this population. There is a need for well-considered large scale support interventions, prioritised and developed with women and families.</p
RhD alloimmunization in pregnancy and hemolytic disease of the fetus and newborn in Africa: A systematic review and meta-analysis
Get PDFAlthough hemolytic disease of the fetus and newborn (HDFN), caused by maternal alloimmunization against fetal erythrocytes, has been nearly eliminated in high-income settings, it likely remains a significant public health problem in low-resource settings in Africa and elsewhere. We performed a comprehensive literature review across six major databases to determine the proportion of RhD-negativity, anti-D immunoprophylaxis utilization, RhD-alloimmunization prevalence, and the burden of RhD-mediated HDFN among pregnant women in Africa. A random-effects model was used to determine pooled estimates. We included 74 studies from 17 countries (42 from Nigeria), published between 1960 and 2024, involving 245,046 pregnancies, mostly from tertiary centers. The proportion of RhD negativity was 4.8 % (95 % CI: 4.1–5.7 %). The proven RhD alloimmunization rate was 5.8 % (95 % CI: 4.1–8.2 %). In multigravida women, the proportion of RhD alloimmunization was 5.7 % (95 % CI: 3.1–10.4 %). Anti-D immunoprophylaxis utilization after a previous pregnancy, reported in 18 studies (1490/3756 women), was 29.7 % (95 % CI: 18.0–45.0 %), with no effect on alloimmunization rate. Nine studies (including 50 neonates from 168 alloimmunized women) provided data on HDFN, with a pooled prevalence of 36.2 % (95 % CI: 16.8–61.4 %). In many papers, the specificity of the alloantibodies was not determined. Data on gravidity and the clinical definition of HDFN were incomplete. We conclude that there is a lack of robust data from Africa, thereby hampering HDFN prevention efforts. To eliminate HDFN in Africa, integrated strategies are urgently needed, including universal RhD typing and antibody screening, access to polyclonal anti-D immunoprophylaxis, and population-based surveillance.</p
Quantifying venom in African snakes: Insights into protein content, yield and body size associations
No full textSnake venoms are complex mixtures primarily composed of toxic proteins used during prey capture and defence. There is limited knowledge concerning the protein concentration of snake venom and the biases of different protein determination methods. Here, we assess the ability of the Qubit protein assay, bicinchoninic acid (BCA) assay, Bradford assay and NanoDrop spectrometry (A280 with a mass extinction coefficient of one) to accurately quantify protein concentrations of toxins isolated from venom, including three-finger toxins and phospholipase A2. The Bradford assays severely underestimated three-finger toxin concentrations and NanoDrop spectrometry overestimated phospholipase A2 concentrations, whilst the BCA assay was the most accurate. Venom from six major African venomous snake genera was also assessed: coral cobras (Aspidelaps spp.); mambas (Dendroaspis spp.); cobras (Naja spp.); bush vipers (Atheris sp.); adders (Bitis spp.); and saw-scaled vipers (Echis sp.). Protein concentration results were inconsistent between methods. Protein concentrations were found to be lowest for Bitis spp. venom and highest for Naja spp. venom and did not vary between species of the same genus. However, in general, Elapidae species had venoms with significantly higher protein concentrations than Viperidae species. Moreover, there was greater variability between Elapidae species. We also determined wet venom yields and used this to provide a tentative estimate of the total protein quantity that may be injected during a snake bite. We found snake weight and length influenced wet venom yield for the Atheris squamigera but not for Bitis arietans and Echis romani. Our results aim to improve our understanding of the physical properties of snake venom
Analysis of insecticide-treated bednet market dynamics between 2004–2021 and monetary value of additional bednet longevity
No full textBackgroundInsecticide-treated bednets (ITNs), a cornerstone of malaria prevention, are distributed via mass campaigns across Africa every three years, at huge cost to National Ministries of Health and development partners. While WHO sets global standards for ITNs as a public health commodity, they typically remain in use for less than the assumed three years, due to accumulation of damage, and retention times vary according to the product and use context. However, it is currently unclear whether ITN prices reflect their value in terms of physical durability.MethodsWe explored how various ITN product and market characteristics have influenced real ITN prices since 2004. We used ITN price and retention data across sub-Saharan Africa to calculate the country specific equivalent annual cost of ITNs and defined country-specific price thresholds that the market should be willing-to-pay to secure nets that would be retained and used for exactly three years or, separately for six months longer than current estimates suggest.FindingsThe ITN market has become less concentrated in the last two decades, but it remains dominated by a few large buyers and suppliers. ITN prices have decreased dramatically since 2010. Among individual sales, we found no evidence that increased durability is rewarded through higher price. The value for equivalent annual cost per person protected and the willingness-to-pay for a net that is retained for longer depends on baseline net price and is greater in countries with shorter existing ITN retention times.InterpretationSubstantial public health and efficiency gains could be realized if bednets were used for longer periods. However, achieving this requires changes in the market on both the supply and demand sides, including a shift towards value-based procurement. This approach would better incentivize manufacturers to innovate and invest in producing more durable nets by linking pricing to their long-term effectiveness. An explicit price threshold, along with improved information on net durability across different contexts, could help foster innovation and direct investment where it is most needed
Prevalence of preserved ratio impaired spirometry: A systematic review and meta-analysis
No full textObjective: To summarise the prevalence of preserved ratio impaired spirometry (PRISm), intending to inform prevention strategies and clinical management. Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library databases for cohort studies investigating the prevalence of PRISm. The quality of included studies was assessed with appropriate tools for evaluating risk of bias in prevalence studies. Publication bias was assessed using funnel plots and Egger’s test. Results: After deduplication, 24 of the 33 initially eligible studies were included in the meta-analysis. The pooled prevalence of PRISm was 10% (95% CI: 0.08, 0.12). Smoking was a significant risk factor for PRISm, while no significant association was found with respiratory symptoms. PRISm was significantly associated with comorbidities including hypertension, diabetes, cardiovascular disease, and stroke. Moreover, individuals with PRISm had higher all-cause mortality (OR 1.84, 95% CI: 0.99, 3.41) and cardiovascular mortality (OR 1.82, 95% CI: 1.35, 2.44). Lung function trajectories were heterogeneous, with 10–50% reverting to normal, 20–60% remaining stable, and 6–53% progressing to chronic obstructive pulmonary disease (COPD). Conclusions: PRISm is associated with a high prevalence, smoking, cardiometabolic comorbidities, increased all-cause and cardiovascular mortality, and heterogeneous lung function trajectories, underscoring its clinical importance beyond COPD.</p
Operationalising people-centred community-led self-help groups to improve mental health and wellbeing for people with skin-neglected tropical diseases : a case study from Kasai, DRC
No full textIntroduction: People affected by skin-neglected tropical diseases (NTDs) may experience stigma and discrimination due to visible physical impairments, negatively affecting their mental health, wellbeing, and quality of life. To address these challenges, our partnership used a community-based participatory research (CBPR) approach to co-develop, test, and evaluate a community-led intervention that included self-help groups. In this article, we critically evaluate the intervention implementation process, to provide clear implementation considerations when operationalising self-help groups for NTDs, a missing component of the evidence base. Method: Photovoice activities with self-help group members and leaders explored the experience of peer-support amongst people affected by skin NTDs. Additional data included reports from self-help group meetings and reflective sessions, in-depth interviews with group members, and key-informant interviews with stakeholders. Data were analysed using framework analysis using NVivo 12. Results: Five interrelated elements were identified as central to people-centred community-led self-help groups for people affected by skin NTDs in Kasai, DRC: 1) relevant and actionable needs-based activities; 2) a shared purpose amongst group members; 3) inclusivity and equity in roles, responsibilities, and benefits; 4) committed leadership; and 5) continuous capacity strengthening and support from research and implementing partners. Conclusion: This is one of the first studies presenting insights from people affected by skin NTDs on how community-led self-help groups can be operationalised in a people-centred way. The findings highlight key implementation considerations that may inform the design and delivery of self-help group interventions in low-resource settings, potentially supporting sustainability and user-led engagement.</p
Mitochondrial genome analysis and molecular identification of two Culex tritaeniorhynchus (Diptera: Culicidae) clades from the Republic of Korea
Get PDFCulex tritaeniorhynchus is the primary vector of Japanese encephalitis virus (JEV) and is thought to exist as 2 forms: the continental type (Ct-C) and the Japanese type (Ct-J), distinguished by variations in the cytochrome oxidase subunit 1 (COI) region of mitochondrial DNA (mtDNA). However, the extent of genetic variation within and between the 2 types remains largely unexamined. To address this gap in the literature, we performed mitochondrial genome sequencing and additionally developed a rapid and cost-effective identification method that may facilitate efficient vector management and research. The method for type identification is based on a restriction fragment length polymorphism (RFLP) assay, targeting type-specific sequence variations in the COI region. Phylogenetic analysis using mtDNA confirmed that Ct-C and Ct-J represent genetically distinct taxa within the genus Culex. The proposed molecular identification method has been validated to effectively differentiate between the 2 types in the ROK. Early detection of cryptic invasions is critical for effective vector management. The results of this study confirm that the 2 types of Cx. tritaeniorhynchus, the primary vector of JEV, represent genetically distinct lineages. These findings may serve as a foundational reference for developing vector control strategies aimed at suppressing JEV in East Asia.</p
Updating Anopheles funestus group members in Burkina Faso species distribution and contribution to malaria transmission
Get PDFBackground: Anopheles funestus group and Anopheles gambiae complexes are among the most efficient malaria vectors in Africa, thriving in a variety of environments and well adapted to develop in semi-permanent and permanent water bodies. This study investigated the spatial distribution of the An. funestus group and their contribution to malaria transmission in Burkina Faso. Methods: An entomological survey was conducted from October to December 2022 across 67 sites within the ecological zones of Burkina Faso (once a month); An. funestus was detected in 22 of these sites. Mosquitoes were collected using pyrethrum spray catches (PSC) and identified at the species complex level using morphological keys. A polymerase chain reaction (PCR) was performed for species identification among An. funestus group, blood meal sources and Plasmodium falciparum infection. Results: A total of 617 members of the An. funestus group (45 males and 572 females) were collected across eight regions of Burkina Faso. Anopheles funestus s.s. was the most prevalent specie identified with a frequency of up to 95% (589/617). Most An. funestus s.s. were found in the Hauts-Bassins and the Sud-Ouest regions with 30% (177/589) and 55% (329/589), respectively. Hybrids between An. rivulorum and An. rivulorum-like were identified at a frequency of 3.57% (22/617). Additionally, results showed a high prevalence of zoophilic behaviour (64.3% of the blood source) in An. funestus. Plasmodium falciparum infection was detected in 5.76% (33/572) of the An. funestus s.l. populations with a frequency of 5.6% (32/572) and 0.174% (1/572) in An. funestus s.s. and An. rivulorum-like, respectively. Conclusions: This study updates the distribution of the An. funestus group and its potential role in malaria transmission in Burkina Faso. It emphasizes the need to strengthen malaria vector surveillance and highlights the importance of incorporating An. funestus in developing innovative vector control interventions.</p