Community Level Research Articles

Ecological perspectives on female and male reproductive success with competition in two Serapias species.

The deceptive strategies by which orchids are pollinated and how these are capable of attracting pollinators remain understudied with regard to their implications on plant fitness. Despite its ecological importance, limited investigations have been conducted on sexual deception and shelter mimicry in orchid species, making it a compelling avenue in orchid biology research. To expand the knowledge of these reproductive mechanisms, we studied the pollination of Serapias lingua and S. parviflora, in co-occurring and isolated sites in Balearic Islands (Spain), further accentuated by the presence of a hybrid, indicating shared pollinators. We employed bagging and hand pollination experiments to examine their reproductive biology. Furthermore, we evaluated the influence of phenotypical and ecological factors on reproductive success, including biometric measurements, reproductive performance and neighborhood diversity (co-flowering and pollinator communities). Reproductive mechanisms between these two orchid species exhibit substantial disparities. Serapias lingua relies primarily on insect-mediated pollination, while S. parviflora demonstrates self-reproduction capacity. Although events of open pollination are rare, hybridization occurs predominantly when S. lingua is the pollen donor. Fruit set in S. parviflora was positively correlated with plant height, while in S. lingua it was negatively associated with flower size. The coexistence of both species positively affected pollinia removal in S. parviflora, but did not exert an influence on reproductive traits in S. lingua. Overall, biometric parameters were diminished in isolated compared to co-occurring sites. At the community level, the increased diversity of co-flowering species in the vicinity exhibited an inhibitory effect on pollinia removal in S. parviflora. Under a context of pollinator loss or phenological mismatch between pollinator presence and flowering, the selfing capacity of S. parviflora would guarantee reproduction whereas S. lingua survival would be compromised. Furthers studies are needed to assess the effects of phenotypical and ecological factors on reproductive success of S. lingua in pollinator-decline scenarios.

Comparing the healthy development of youth Australian Rules Footballers across talent development and community settings

ObjectivesThis study aimed to compare talent development athletes to community-level athletes in Australian Rules Football across various markers of healthy youth development.MethodsSurvey data were collected from 363 youth athletes (126...

The Provision of Psychosocial Support to Students in Jordan: Teachers' Knowledge, Attitudes, Skills, Practices, and Perceived Barriers.

Psychosocial support provision in schools is a promising strategy for overcoming barriers to accessing mental health care. This study aimed to assess teachers' knowledge, attitudes, practices, skills, and perceived barriers in providing psychosocial support to students in Jordan. The sample included teachers working in public schools, private schools, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) schools, and Zaatari camp schools, as well as non-formal education centers. The study utilized a multi-stage stratified cluster sampling technique to select a nationally representative sample. A total of 549 teachers were included, and only 25.2% have ever received mental health training. Most teachers reported a high level of good and acceptable knowledge of psychosocial support and had a positive attitude toward the provision of psychosocial support, however, about a quarter (25.5%) agreed on feeling nervous in discussing students' psychosocial problems with their parents or school administrators. The least enacted practice was the systematic engagement with parents, school administration, and other community resources in students' well-being (sometimes, 31.6%; rarely, 20.4%). Gaps in skills were mainly in communicating with external resources and parents. The main barriers included parents' misunderstanding of teachers' role in providing psychosocial support to students (56.8%), lack of integration of psychosocial support in the curriculum (55.6%), and challenges in identifying students with psychosocial problems due to large class sizes (54.3%). The results show that gaps extend beyond the individual level of teachers to the community level. School-based psychosocial support interventions must consider the multiple factors that influence their implementation at multiple levels, including the individual, relational, community, and societal levels.

Physical activity to address mental health in a remote Australian community: community readiness assessment

Purpose The mental and physical health of those residing in Australian rural and remote communities is poorer compared to major cities. Physical health comorbidities contribute to almost 80% of premature mortality for people living with mental illness. Leisure time physical activity (LTPA) is a well-established intervention to improve physical and mental health. To address the physical and mental health of rural and remote communities through LTPA, the community’s level of readiness should be first determined. This study aims to use the community readiness model (CRM) to explore community readiness in a remote Australian community to address mental health through LTPA. Design/methodology/approach Individual semi-structured interviews were conducted using the CRM on LTPA to address mental health. Quantitative outcomes scored the community’s stage of readiness for LTPA programmes to address mental health using the CRM categories of one (no awareness) to nine (high level of community ownership). Qualitative outcomes were thematically analysed, guided by Braun and Clark. Findings The community scored six (initiation) for community efforts and knowledge of LTPA programmes and seven (stabilisation) for leadership. The community’s attitude towards LTPA and resources for programmes scored four (pre-planning), and knowledge of LTPA scored three (vague awareness). Originality/value To the best of the authors’ knowledge, this is the first Australian study to use CRM to examine community readiness to use LTPA to improve mental health in a remote community. The CRM was shown to be a useful tool to identify factors for intervention design that might optimise community empowerment in using LTPA to improve mental health at the community level.

Omics technology draws a comprehensive heavy metal resistance strategy in bacteria.

The rapid industrial revolution significantly increased heavy metal pollution, becoming a major global environmental concern. This pollution is considered as one of the most harmful and toxic threats to all environmental components (air, soil, water, animals, and plants until reaching to human). Therefore, scientists try to find a promising and eco-friendly technique to solve this problem i.e., bacterial bioremediation. Various heavy metal resistance mechanisms were reported. Omics technologies can significantly improve our understanding of heavy metal resistant bacteria and their communities. They are a potent tool for investigating the adaptation processes of microbes in severe conditions. These omics methods provide unique benefits for investigating metabolic alterations, microbial diversity, and mechanisms of resistance of individual strains or communities to harsh conditions. Starting with genome sequencing which provides us with complete and comprehensive insight into the resistance mechanism of heavy metal resistant bacteria. Moreover, genome sequencing facilitates the opportunities to identify specific metal resistance genes, operons, and regulatory elements in the genomes of individual bacteria, understand the genetic mechanisms and variations responsible for heavy metal resistance within and between bacterial species in addition to the transcriptome, proteome that obtain the real expressed genes. Moreover, at the community level, metagenome, meta transcriptome and meta proteome participate in understanding the microbial interactive network potentially novel metabolic pathways, enzymes and gene species can all be found using these methods. This review presents the state of the art and anticipated developments in the use of omics technologies in the investigation of microbes used for heavy metal bioremediation.

With a little help from my friends: the roles of microbial symbionts in insect populations and communities.

To understand insect abundance, distribution and dynamics, we need to understand the relevant drivers of their populations and communities. While microbial symbionts are known to strongly affect many aspects of insect biology, we lack data on their effects on populations or community processes, or on insects' evolutionary responses at different timescales. How these effects change as the anthropogenic effects on ecosystems intensify is an area of intense research. Recent developments in sequencing and bioinformatics permit cost-effective microbial diversity surveys, tracking symbiont transmission, and identification of functions across insect populations and multi-species communities. In this review, we explore how different functional categories of symbionts can influence insect life-history traits, how these effects could affect insect populations and their interactions with other species, and how they may affect processes and patterns at the level of entire communities. We argue that insect-associated microbes should be considered important drivers of insect response and adaptation to environmental challenges and opportunities. We also outline the emerging approaches for surveying and characterizing insect-associated microbiota at population and community scales. This article is part of the theme issue 'Towards a toolkit for global insect biodiversity monitoring'.

Bayesian spatial mapping of rates of substance use among high-school students in Florida

ABSTRACT Objective In adolescent substance use research, more work has been done in identifying risk factors at individual level while little work was done at community level. The objective of this study is to examine the possible risk factors associated with substance use by high-school students at county level. Methods Data on the percentages of county-level substance use by adolescents and county-level risk factors were obtained from the Florida Department of Health, Division of Public Health Statistics & Performance Management (DPHSM). Spatial beta models were used to examine the associations between risk factors and rates of substance use. Results Geographic variation in rates of substance use by adolescents was observed in Florida, ranging from 6.5% to 28.6% for drug use, and from 14.8% to 36.3% for alcohol. It was found that percentages of black population and individual below poverty level were inversely associated with rates of drug use by adolescents. There were no significant associations between percentages of drug use by adolescents and median income, adult drug use, school suspension, and student emotional/behavioral disability per county. Conclusion Interventions for reducing rates of adolescent substance use may focus on involving parents to monitor financial resources for their children.

Divergence between sea urchins and their microbiota following speciation

Animals have a deep evolutionary relationship with microbial symbionts, such that individual microbes or an entire microbial community can diverge alongside the host. Here, we explore these host-microbe relationships in Echinometra, a sea urchin genus that speciated with the Isthmus of Panama and throughout the Indo-West Pacific. We find that the eggs from five Echinometra species generally associate with a species-specific bacterial community and that the relatedness of these communities is largely congruent with host phylogeny. Microbiome divergence per million years was higher in more recent speciation events than in older ones. We, however, did not find any bacterial groups that displayed co-phylogeny with Echinometra. Together, these findings suggest that the evolutionary relationship between Echinometra and their microbiota operates at the community level. We find no evidence suggesting that the associated microbiota is the evolutionary driver of Echinometra speciation. Instead, divergence between Echinometra and their microbiota is likely the byproduct of ecological, geographic, and reproductive isolations.

New insights into biodiversity-disease relationships: the importance of the host community network characterization

Camera-trapping-based social network analysis (SNA) is a valuable tool to characterize communities and identify species with an outstanding role in pathogen maintenance. This study provides new insights into the contentious debate on the effect of biodiversity on disease risk by combining SNA with the assessment of host diversity indicators and pathogen richness in Spain. The apparent species richness detected by camera traps at each study site ranged from 10 to 33 species (mean ± standard error (SE): 20.73 ± 1.94) and their apparent diversity rates (i.e., Shannon index) ranged from 0.57 to 2.55 (mean ± SE: 1.97 ± 0.16). At the community level, vertebrate host diversity had a marginal dilution effect on the disease risk and was negatively correlated to pathogen richness. The exposure to multiple pathogens, as a proxy of disease risk, was negatively associated with apparent host diversity. The disease risk was driven by the interaction of apparent biodiversity with the presence of livestock and with the centrality of the indicator species (i.e., the wild boar). The maximum risk of co-exposure to pathogens was reached when the lowest apparent biodiversity rates coincided with the highest wild boar centrality in the host community or with the presence of livestock, respectively. The highest confluence of pathogens occurred at lower apparent diversity indexes, higher wild boar relative abundances and predominance of agricultural lands. Our results suggest that the diversity-disease relationship is not linear and depends on the environment and host community characteristics, thereby opening avenues for designing new prevention strategies.

Evolution of community outreach and engagement at National Cancer Institute-Designated Cancer Centers, an evolving journey.

Cancer mortality rates have declined during the last 28 years, but that process is not equitably shared. Disparities in cancer outcomes by race, ethnicity, socioeconomic status, sexual orientation and gender identity, and geographic location persist across the cancer care continuum. Consequently, community outreach and engagement (COE) efforts within National Cancer Institute-Designated Cancer Center (NCI-DCC) catchment areas have intensified during the last 10 years as has the emphasis on COE and catchment areas in NCI's Cancer Center Support Grant applications. This review article attempts to provide a historic perspective of COE within NCI-DCCs. Improving COE has long been an important initiative for the NCI, but it was not until 2012 and 2016 that NCI-DCCs were required to define their catchment areas rigorously and to provide specific descriptions of COE interventions, respectively. NCI-DCCs had previously lacked adequate focus on the inclusion of historically marginalized patients in cancer innovation efforts. Integrating COE efforts throughout the research and operational aspects of the cancer centers, at both the patient and community levels, will expand the footprint of COE efforts within NCI-DCCs. Achieving this change requires sustained commitment by the centers to adjust their activities and improve access and outcomes for historically marginalized communities.

Effects of an extreme weather event over reproduction and survival of Great Tits (Parus major) in eastern Spain

AbstractThe frequency of extreme climatic and weather events has increased since 1950 due to global changes induced by human influence. These events can have significant impacts at the individual, population, and community levels across various taxonomic groups. They can be particularly detrimental to bird populations during their breeding season, affecting specific breeding parameters. This study originated from an exceptionally rare breeding season of a resident Great Tit population recorded in spring 2002 when an unusual mortality of nestlings was observed. We quantified weather conditions (temperature, rainfall) from the end of April, a few days before we started detecting failed nests, and compared them with previous and subsequent years. In early May, when many pairs were incubating or caring for newly hatched chicks, we detected unusually low ambient temperatures and unusually high rainfall. This event likely caused that many first clutches failed completely, and that, compared with previous and subsequent years, fledging and breeding success was relatively low in those which were successful. There was also an increased proportion of replacement clutches that year. Anyway, the overall production of fledglings per breeding pair over the breeding season was 2.39, lower than other years. Although recruitment rate in 2003 was similar to other years, the lower production of fledglings in 2002 probably resulted in a decrease in the number of breeding pairs in the following years.

PSVI-7 A traceable signature for a recovery microbiome composition after a dysbiosis caused by a sanitary challenge in pigs

Abstract Recent insights continue to point to a causal role of the gastrointestinal (GI) microbiome in digestion, nutrient absorption, and host metabolism. The GI microbiome may be a frequent target of perturbation since some challenges (i.e., high density, temperature and air quality fluctuations, presence of endemic enteric pathogens) faced by pigs may altogether create a spectrum of contrasting sanitary conditions. Therefore, our study investigated the influence of increased dietary tryptophan, threonine, and methionine supplementation in pigs from “good” vs. “poor” sanitary conditions, on the GI microbiome over time. For that purpose, female growing pigs were randomly assigned in a 2 × 2 factorial design (n = 30/treatment), consisting of two sanitary conditions (“good” vs. “poor”) and two diets [control (CN) vs. supplemented with specific amino acids (Trp, Thr, and Met+Cys:Lys ratios increased to 20% greater than CN]. Pigs allocated to the “good” sanitary condition treatment were sham-inoculated with pure BHI broth and the barn was cleaned twice a day and disinfected once a week. Whereas, “poor” sanitary condition comprised of all pigs being inoculated with 2 x 109 CFU of Salmonella Typhimurium (ST), in addition to spreading fecal material from a commercial farm under sanitary challenge, followed by leaving the barn uncleaned throughout the study (poor + ST). Fecal samples (n = 11) were collected at day post-challenge (DPC) 0, 10, and 21, and were sequenced for 16S rRNA data analysis of community diversity (alpha and beta) and taxonomic changes over time. Our results demonstrated that both alpha (Shannon and Simpson) and beta diversity metrics were significantly altered at DPC 21 by differentiating “good” vs “poor + ST” treatments, despite amino acids supplementation in the diet. Bacterial taxonomic analysis further captured community level alterations by a marked dysbiosis occurring on pigs allocated under “poor + ST” sanitary conditions. “ST + poor” sanitary conditions altered community structure as measured by co-occurrence networks, which was particularly pointed out at DPI 21. Specifically, Clostridium sensu stricto 1, Intestinibacter, Rombustsia, Terrisporobacter, and Megasphaera were five taxa between others co-enriched in fecal samples from pigs allocated under “poor + ST” sanitary conditions at DPC 21. These putative SCFA-producing bacteria were positively straighter correlated between them (Figure 1), which suggests a traceable signature for a recovery microbiome composition after a dysbiosis. In conclusion, temporal changes in fecal swine microbiome of growing pigs may be reflective of sanitary status despite dietary supplementation of specific amino acids.

Prevalence of oral rehydration solution use and its determinants in the treatment of diarrhea among under-five children in sub-Saharan Africa.

Diarrhea is the second leading cause of under-five deaths claiming half a million children every year. Most of these deaths occurred in sub-Saharan Africa and South Asia. Oral rehydration solution (ORS) has been described as the most effective treatment of diarrhea. However, only 36% of children with diarrhea received ORS in sub-Saharan Africa. This study examined the factors associated with ORS use for children with diarrhea in the sub-region. Demographic and Health Surveys (DHS) data sets of 31 countries in sub-Saharan Africa were used in this study. The data involved 30,102 under-five children with diarrhea. The multivariable analysis involved binary logistic regression. Prevalence of ORS use was 38% in sub-Saharan Africa with countries such as Namibia (71.8%), Zambia (66.4%) and Malawi (63.8%) having the highest rates. Use of ORS was most common among children whose mothers had secondary or higher education (45%), were exposed to media (41%) and attended antenatal care (41%). ORS use was significantly associated with secondary or higher education (OR = 1.63; 95%CI: [1.47-1.81]; p<0.001), exposure to media (OR = 1.17; 95%CI: [1.07-1.27]; p<0.001), antenatal care attendance (OR = 2.33; 95%CI: [1.08-1.27]; p<0.001), child's age (OR = 1.46; 95%CI: [1.35-1.59]; p<0.001), child's size at birth (OR = 1.08; 95%CI: [1.00-1.17]; p<0.05), household size (OR = 1.28; 95%CI:[1.06-1.54]; p<0.05) and source of drinking water (OR = 1.18; 95%CI: [1.09-1.29]; p<0.001). This study revealed a 38% prevalence of ORS use during diarrhea episodes in sub-Saharan Africa. This is low as it is less than the 44% recorded for developing countries as a whole. While this study emphasises the need for a further study on effects of severity of diarrhea on ORS use and factors determining differences in ORS use among countries, it also calls for interventions that will increase use of ORS is sub-Saharan Africa. Such interventions should include increase in literacy rate among girls and women, increase in the proportion of women with access to media, involvement of health workers in programmes that would promote antenatal care utilization among women at community level and provision of social amenities like pipe-borne water.

Empowerment or alienation? Teaching gender and development in postcolonial contexts

ABSTRACT This paper explores how culture, religion, gender, and the politics of knowledge production were entangled in the mission, policies, and practices of the Asian University for Women (AUW) in Bangladesh. The article contributes to documenting how decolonisation efforts in women’s education and empowerment play out in an institution located in the periphery and established with an explicit mission for women’s empowerment. The article critically looks at the (sometimes) contradictory discourses, desires, and agencies at the student, community, staff, and institutional levels, along with the power dynamics and reproduction of colonial and postcolonial practices and legacies in the context of operationalising gender and development (GAD), highlighting the paradoxes and challenges that arise from such endeavours. Finally, this case study highlights how pedagogies of community building at the institutional level become integral in responding to such tensions and conflicts and in countering the alienation from culture and religion that global practices of GAD often create.

Rural Women’s Response to Climate Change: An Exploratory Study of Women’s Grassroot Network in Odisha

The emergence of Feminist Political Ecological (FPE) position allows to rethink about social institutions like Self Help Groups (SHGs) as foundations for building green movements through everyday practice. The collective voice that has helped them emerge economically self-sufficient is reflected in their decision making, when the larger cause of climate change or environmental decision-making are involved. It is time that their actions permeating the ecology and environment gains credence and such coalitions provide ground as movements for achieving the larger collective agenda.   Idea of SHGs as social capital helped the marginalized women create different ‘gendered subjectivities’ and endowed them with a collective voice, be it conservation of their own ecological settings or confronting the social system. The case of Climate Credit Pilot Project and/or conservation of indigenous seed varieties in remote villages of Odisha bear testimony to women’s consciousness regarding climate mitigation initiatives and the meaningful actions associated with environmental justice. Such interventions show that the embedment of economic, social and cultural values of SHG groups align with their instinct for attaining a larger goal of environment protection through household and community level actions.   The gendered subjectivities including increased social consciousness among women, better access to new information, up-skilling has made them better and enlightened decision makers. The practice of joint or consensual action by SHG collectives enable them to address multi-scalar issues like climate change. However, the broader agenda of social and economic empowerment has to align with their decision making power relating to their immediate ecology and environment. In this context, the proposed study will probe emerging social consciousness of women on climate change issues, while examining their larger environmental responsibility in local situation, wherein the women remain at the receiving end. This is a field-based exploratory study of women from subsistence and indigenous communities of three districts in Odisha which interrogates the role of SHGs in creating a social space for women to engage with the question of environmental decision making. The study intends to analyse the field data in relation to environmental rights, responsibilities and knowledge of rural and Adivasi women within the institution of SHGs. It aims to formulate the concept, i.e., can SHGs be seen as co-linear spaces which needs to be strengthened as bearers of green movements at the local level as a response to the climate crisis.

Are we…social enough? Use of social media among members of the Italian Society of Neurology for the study of dementia.

Clinical researchers increasingly embrace social media in their professional lives. The digital revolution has provided new routes for sharing data, disseminating results, and promoting the impact of scientific findings. In this study, we explored the attitude of the members of the Italian Society of Neurology for the study of dementia (SINdem) to use social media with the aim to set up possible corrective actions to maximize digitalization benefits at the individual and community levels. An ad hoc designed survey was implemented and distributed to the SINdem and SINdem4Juniors communities. It explored the different use of social media taking into account frequency, type of social media use (active vs passive; professional vs private). Descriptive statistical analyses were performed alongside statistical comparisons to highlight possible differences in the use. We collected 133 answers showing a prominent use of social media in private life (t(132) = 21.1, p < 0.001), with SINdem4Juniors members showing a higher private use compared to the older SINdem colleagues. Professional use was mainly limited to passive activities such as following others' social profiles (t(132) = 11.9, p < 0.001). Overall scenario suggests that professional use of social media is very limited in both SINdem and SINdem4juniors communities. This evidence points to an urgent need for training interventions and top-down strategies aimed at improving collaboration, dissemination, and sharing through social media among individuals belonging to the same scientific-professional community.

A qualitative study exploring approaches, barriers, and facilitators of the HIV partner notification program in Kerman, Iran

Background HIV partner notification services can help people living with HIV (PLHIV) to identify, locate, and inform their sexual and injecting partners who are exposed to HIV and refer them for proper and timely counseling and testing. To what extent these services were used by PLHIV and what are the related barriers and facilitators in southeast Iran are not known. So, this study aimed to explore HIV notification and its barriers and facilitators among PLHIV in Iran.MethodsIn this qualitative study, the number of 23 participants were recruited from November 2022 to February 2023 including PLHIV (N = 12), sexual partners of PLHIV (N = 5), and staff members (N = 6) of a Voluntary Counseling and Testing (VCT) center in Kerman located in the southeast of Iran. Our data collection included purposive sampling to increase variation. The content analysis was conducted using the Graneheim and Lundman approach. The analysis yielded 221 (out of 322) related codes related to HIV notification, its barriers, and its facilitators. These codes were further categorized into one main category with three categories and nine sub-categories.ResultsThe main category was HIV notification approaches, HIV notification barriers, and facilitators. HIV notification approaches were notification through clear, and direct conversation, notification through gradual preparation and reassurance, notification due to being with PLHIV, notification through suspicious talking of the physician, and notification due to the behavior of others. Also, the barriers were classified into individual, social, and environmental, and healthcare system barriers and the facilitators were at PLHIV, healthcare staff, and community levels. Stigma was a barrier mentioned by most participants. Also, the main facilitator of HIV notification was social support, especially from the family side.ConclusionsThe findings highlighted the multidimensionality of HIV notification emphasizing the importance of tailored support and education to enhance the notification process for PLHIV and their networks. Also, our results show that despite all the efforts to reduce stigma and discrimination in recent years, stigma still exists as a main obstacle to disclosing HIV status and other barriers are the product of stigma. It seems that all programs should be directed towards destigmatization.

A multilevel analysis of the determinants of HIV testing among men in Sub-Saharan Africa: Evidence from Demographic and Health Surveys across 10 African countries.

Sub-Saharan Africa, the epicenter of the HIV epidemic, has seen significant reductions in new infections over the last decade. Although most new infections have been reported among women, particularly adolescent girls, men are still disadvantaged in accessing HIV testing, care, and treatment services. Globally, men have relatively poorer HIV testing, care, and treatment indices when compared with women. Gender norms and the associated concept of masculinity, strength, and stereotypes have been highlighted as hindering men's acceptance of HIV counseling and testing. Therefore, men's suboptimal uptake of HIV testing services will continue limiting efforts to achieve HIV epidemic control. Thus, this study aimed to identify individual, neighborhood, and country-level determinants of sub-optimal HIV testing among men in Sub-Saharan African countries. We analyzed demographic and health datasets from surveys conducted between 2016 and 2020 in Sub-Saharan African Countries. We conducted multivariable multilevel regression analysis on 52,641 men aged 15-49 years resident in 4,587 clusters across 10 countries. The primary outcome variable was ever tested for HIV. HIV testing services uptake among men in these ten Sub-Saharan African countries was 35.1%, with a high of 65.5% in Rwanda to a low of 10.2% in Guinea. HIV testing services uptake was more likely in men with increasing age, some form of formal education, in employment, ever married, and residents in relatively wealthier households. We also found that men who possessed health insurance, had some form of weekly media exposure, and had accessed the internet were more likely to have ever received an HIV test. Unlike those noted to be less likely to have ever received an HIV test if they had discriminatory attitudes towards HIV, comprehensive HIV knowledge, recent sexual activity, and risky sexual behavior were positive predictors of HIV testing services uptake among men. Furthermore, men in communities with high rurality and illiteracy were less likely to receive an HIV test. Individual and community-level factors influence the uptake of HIV testing among Sub-Saharan African men. There was evidence of geographical clustering in HIV testing uptake among men at the community level, with about two-thirds of the variability attributable to community-level factors. Therefore, HIV testing programs will need to design interventions that ensure equal access to HIV testing services informed by neighborhood socioeconomic conditions, peculiarities, and contexts.

Every loaf of bread is political – reflections on collective care responses to Covid-19 in Cape Town

Feminist perspectives on care have demonstrated how capitalism undervalues care work. The Covid-19 pandemic highlighted this further, as systems of production and social reproduction became destabilized globally. In many countries, the formal pandemic response fell short of attending to the daily, fundamental care needs of people living through the crisis, especially those compromised by the socio-economic effects of the pandemic. These needs were often attended to at the community level. This article explores a community-led network of care, known as CANs, that emerged in response to the pandemic in Cape Town. It makes three overarching observations. The first is that community-led responses were characterised by a push towards the collectivisation of care work. The second is that this enabled emergent strategies and relational practices of care, centring notions of solidarity, inter-dependence and horizontal exchange of resources and knowledge. Finally, we observed that, although the devaluation of care work limited the recognition and material support extended to CANs, opportunities to re-politicise care work as resistance work emerged. These represent a prefigurative moment in which alternative logics and strategies can transform the vision of our health and care systems, and the notion of community participation in and ownership of those systems.

Prolonged mass azithromycin distributions and macrolide resistance determinants among preschool children in Niger: A sub-study of a cluster-randomized trial (MORDOR).

Randomized controlled trials found that twice-yearly mass azithromycin administration (MDA) reduces childhood mortality, presumably by reducing infection burden. World Health Organization (WHO) issued conditional guidelines for mass azithromycin administration in high-mortality settings in sub-Saharan Africa given concerns for antibiotic resistance. While prolonged twice-yearly MDA has been shown to increase antibiotic resistance in small randomized controlled trials, the objective of this study was to determine if macrolide and non-macrolide resistance in the gut increases with the duration of azithromycin MDA in a larger setting. The Macrolide Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) study was conducted in Niger from December 2014 to June 2020. It was a cluster-randomized trial of azithromycin (A) versus placebo (P) aimed at evaluating childhood mortality. This is a sub-study in the MORDOR trial to track changes in antibiotic resistance after prolonged azithromycin MDA. A total of 594 communities were eligible. Children 1 to 59 months in 163 randomly chosen communities were eligible to receive treatment and included in resistance monitoring. Participants, staff, and investigators were masked to treatment allocation. At the conclusion of MORDOR Phase I, by design, all communities received an additional year of twice-yearly azithromycin treatments (Phase II). Thus, at the conclusion of Phase II, the treatment history (1 letter per 6-month period) for the participating communities was either (PP-PP-AA) or (AA-AA-AA). In Phase III, participating communities were then re-randomized to receive either another 3 rounds of azithromycin or placebo, thus resulting in 4 treatment histories: Group 1 (AA-AA-AA-AA-A, N = 51), Group 2 (PP-PP-AA-AA-A, N = 40), Group 3 (AA-AA-AA-PP-P, N = 27), and Group 4 (PP-PP-AA-PP-P, N = 32). Rectal swabs from each child (N = 5,340) were obtained 6 months after the last treatment. Each child contributed 1 rectal swab and these were pooled at the community level, processed for DNA-seq, and analyzed for genetic resistance determinants. The primary prespecified outcome was macrolide resistance determinants in the gut. Secondary outcomes were resistance to beta-lactams and other antibiotic classes. Communities recently randomized to azithromycin (groups 1 and 2) had significantly more macrolide resistance determinants than those recently randomized to placebo (groups 3 and 4) (fold change 2.18, 95% CI 1.5 to 3.51, Punadj < 0.001). However, there was no significant increase in macrolide resistance in communities treated 4.5 years (group 1) compared to just the most recent 2.5 years (group 2) (fold change 0.80, 95% CI 0.50 to 1.00, Padj = 0.010), or between communities that had been treated for 3 years in the past (group 3) versus just 1 year in the past (group 4) (fold change 1.00, 95% CI 0.78 to 2.35, Padj = 0.52). We also found no significant differences for beta-lactams or other antibiotic classes. The main limitations of our study were the absence of phenotypic characterization of resistance, no complete placebo arm, and no monitoring outside of Niger limiting generalizability. In this study, we observed that mass azithromycin distribution for childhood mortality among preschool children in Niger increased macrolide resistance determinants in the gut but that resistance may plateau after 2 to 3 years of treatment. Co-selection to other classes needs to be monitored. NCT02047981 https://classic.clinicaltrials.gov/ct2/show/NCT02047981.