Decline In Prevalence Research Articles

Declines in Adolescent Substance Use After the COVID-19 Pandemic Onset: The Role of Initiation in Grades 7 and 9

PurposeTo examine if the record declines in adolescent substance use after the onset of the COVID-19 pandemic resulted from reduced levels of initiation, defined as any lifetime use. MethodsWe analyzed data from the nationally representative, cross-sectional, annual Monitoring the Future surveys of eighth, 10th, and 12th grade students from 2019 to 2022. Measures included past 12-month use of cannabis, nicotine vaping, and alcohol as well as self-reported grade of initiation of each substance. Analyses are based on randomly selected subsamples of students who received questions on both prevalence and grade of first use, resulting in a total sample size of 96,990 students. ResultsLevels of the past 12-month substance use were markedly lower after the onset of the pandemic, in 2021 and 2022. In eighth and 10th grade, levels were at least one-third lower for cannabis and nicotine vaping and 13%–31% lower for alcohol. In 12th grade, the decreases ranged from 9% to 23%. Lower levels of initiation in seventh grade in 2020-2021 accounted for half or more of the overall prevalence decreases in eighth grade in 2021- 2022. Lower levels of initiation in ninth grade in 2020-2021 accounted for 45% or more of the overall prevalence decreases in 10th grade in 2021-2022. Declines in 12th grade substance use prevalence were not consistently linked to lower initiation in earlier grades. DiscussionMuch of the declines in overall prevalence of adolescent substance use after the onset of the COVID-19 pandemic trace back specifically to declines in substance use initiation in seventh and ninth grades.

English

Teacher attrition and retention are among the major problems in schools worldwide. Particularly in the United States, there is a great demand for teachers in elementary and secondary schools because of teachers transferring to new schools or resigning from the teaching profession altogether. This systematic review focuses on research on the prevalent decline of teacher retention in American elementary and secondary schools. This review aims to communicate reasons for the decrease in teacher retention and consider the impacts of teacher decline on students' academic success. Three databases – Web of Science, Science Direct, and Pro Quest – were utilized to obtain evidence to substantiate the causes and effects of the wave of teacher resignations. The evidence was analyzed to determine reliability using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane review guidelines. The synthesis analysis included fourteen studies. It was clear from the synthesis that support and clear communication from school principals are essential factors of teacher retention in U.S. elementary and secondary schools. Other notable elements that prevent teacher turnover include recognizing the efforts of teachers, enforcing discipline and compliance among the student population, and conducting fair teacher evaluations. To improve teacher retention rates in the United States, school principals must adopt characteristics contributing to teacher retention.   Key words:  Teacher, attrition, retention rates, school principals, elementary, secondary.

Two decades of malaria control in Malawi: Geostatistical Analysis of the changing malaria prevalence from 2000-2022

Background Malaria remains a public health problem in Malawi and has a serious socio-economic impact on the population. In the past two decades, available malaria control measures have been substantially scaled up, such as insecticide-treated bed nets, artemisinin-based combination therapies, and, more recently, the introduction of the malaria vaccine, the RTS,S/AS01. In this paper, we describe the epidemiology of malaria for the last two decades to understand the past transmission and set the scene for the elimination agenda. Methods A collation of parasite prevalence surveys conducted between the years 2000 and 2022 was done. A spatio-temporal geostatistical model was fitted to predict the yearly malaria risk for children aged 2–10 years (PfPR 2–10) at 1×1 km spatial resolutions. Parameter estimation was done using the Monte Carlo maximum likelihood methods. District level prevalence estimates adjusted for population are calculated for the years 2000 to 2022. Results A total of 2,595 sampled unique locations from 2000 to 2022 were identified through the data collation exercise. This represents 70,565 individuals that were sampled in the period. In general, the PfPR2_10 declined over the 22 years. The mean modeled national PfPR2_10 in 2000 was 43.93 % (95% CI:17.9 to 73.8%) and declined to 19.2% (95%CI 7.49 to 37.0%) in 2022. The smoothened estimates of PfPR2_10 indicate that malaria prevalence is very heterogeneous with hotspot areas concentrated on the southern shores of Lake Malawi and the country's central region. Conclusions The last two decades are associated with a decline in malaria prevalence, highly likely associated with the scale up of control interventions. The country should move towards targeted malaria control approaches informed by surveillance data.

Region-wide retreats from lower elevations of range-restricted birds across the Northern Andes.

Local studies show upslope shifts in the distribution of tropical birds in response to warming temperatures. Unanswered is whether these upward shifts occur regionally across many species. We considered a nearly 2000-km length of the Northern Andes, where deforestation, temperature, and extreme weather events have increased during the past decades. Range-restricted bird species are particularly vulnerable to such events and occur in exceptionally high numbers in this region. Using abundant crowd-sourced data from the Cornell Lab of Ornithology database, eBird, and the Global Biodiversity Information Facility, we documented distributions of nearly 200 such species. We examined whether species shifted their elevational ranges over time by comparing observed versus expected occurrences below a low elevational threshold and above a high elevational threshold for 2 periods: before and after 2005. We predicted fewer observations at lower elevations (those below the threshold) and more at upper elevations (those above the threshold) after 2005. We also tested for deforestation effects at lower elevations within each species' distribution ranges. We compared relative forest loss with the differences between observed and expected occurrences across the elevational range. Species' retreats from lower elevations were ubiquitous and involved a 23-40% decline in prevalence at the lowest elevations. Increases at higher elevations were not consistent. The retreats occurred across a broad spectrum of species, from predominantly lowland to predominantly highland. Because deforestation showed no relationship with species retreats, we contend that a warming climate is the most parsimonious explanation for such shifts.

1343-P: Decreasing Lifetime Prevalence of Diabetes-Related Foot Ulcers over 25 Years—Longitudinal Analyses of the Trøndelag Health Study (HUNT), Norway

Background and objectives: Data on time trends in diabetes-related foot ulcer (DFU) prevalence are limited. We aimed to determine trends in the lifetime prevalence of DFU in the Trøndelag Health Study (HUNT) conducted in three waves between 1995 and 2019. Research Design and Methods: This longitudinal population-based study consists of individuals ≥20 years with diabetes who participated in at least one of the three HUNT surveys from 1995-2019. Type 2 diabetes was defined as glutamic acid decarboxylase antibodies (GADA) <5 IU/mL (<0.09 ai) and age at diagnosis ≥30 years. Type 1 diabetes was defined as GADA ≥5 IU/mL (≥ 0.09 ai) and/or age at diagnosis <30 years. We used the following question to assess prevalence of DFU: “Have you had a foot ulcer that required more than three weeks to heal?”. The lifetime prevalence of DFUs was evaluated using cross-sectional data. Results: The total diabetes population was 1630 in HUNT2, 1824 in HUNT3 and 2393 in HUNT4. Approximately 85% of the participants had type 2 diabetes. Among those with type 2 diabetes, the lifetime prevalence (95% confidence interval (CI)) of a DFU requiring three or more weeks to heal was 10.1% (8.5-11.8) in HUNT2, 7.4% (6.2-8.8) in HUNT3 and 5.0% (4.1-6.0) in HUNT4. Corresponding numbers in those with type 1 diabetes were 14.9% (11.1-19.8), 8.5% (5.4-13.3) and 7.2% (4.8-10.5), respectively. The decline in DFU prevalence persisted after adjusting for age, sex, educational level, marital status, work situation, body mass index, systolic blood pressure, smoking, and HbA1c. Conclusion: The results of this longitudinal population-based study suggest that the lifetime prevalence of DFUs in Norway has declined substantially during the past 25 years. Disclosure H.K.R.Riise: None. M.M.Iversen: None. J.Igland: Research Support; Pfizer Inc., Sanofi. M.Graue: None. A.Haugstvedt: Advisory Panel; Novo Nordisk. T.Ostbye: None. E.Søfteland: None. M.Hermann: None. S.Carlsson: None. B.O.Åsvold: None. Funding Western Norway Regional Health Authority (F-12131)

Understanding factors responsible for the slow decline of soil-transmitted helminthiasis following seven rounds of annual mass drug administration (2012–2018) among school children in endemic counties of Kenya: A mixed method study

Soil-transmitted helminthiasis (STH) continue to be a significant health problem in Sub-Saharan Africa especially among school children. In Kenya, treatment of over five million children has been conducted annually in 28 endemic counties since the year 2012. However, the latest monitoring and evaluation (M&E) results indicated a slow decline of prevalence and intensity of STH in some counties after the seven rounds of annual mass drug administration (MDA). The current study sought to determine the factors associated with the slow decline in prevalence and intensity of STH among school children participating in the school deworming programme. Mixed methods cross-sectional study was conducted in three endemic counties of Kenya. For quantitative technique, simple random sampling was used to select 1,874 school children from six purposively selected primary schools. The school children were interviewed, and a single stool collected and analysed using Kato-Katz technique. While for qualitative methods, 15 focus group discussions (FGDs) were conducted with purposively selected parents/guardians of school children. Data was collected through voice records using FGD and analyzed using NVIVO. Prevalence of any STH infection was 30.8% (95%CI: 28.7-32.9), with the highest prevalence observed in Vihiga County (40.7%; 95%CI: 37.4-44.4). Multivariable analysis revealed that geographical location (OR = 3.78, (95%CI: 1.81-7.88) p<0.001), and not washing hands after defecation (OR = 1.91, (95%CI: 1.13-3.20) p = 0.015) were significantly associated with any STH infection. For qualitative analysis, majority of the parents/guardians of SAC felt that poor water sanitation and hygiene practices (WASH) both in school and household level could be a cause of continued STH infection. Also failing to include the rest of the community members in the MDAs were mentioned as possible contributors to observed slow decline of STH. There was moderate STH prevalence and mean intensity despite the seven rounds of repeated annual MDA. The study recommends a revamped awareness creation on WASH and community wide treatment.

Impact of short-term discontinuation of ivermectin-based chemoprevention on onchocerciasis transmission in endemic settings with long history of mass drug administration.

The control of onchocerciasis currently relies on annual distribution of single dose ivermectin. Because ivermectin has minimal effects on the adult parasite, mass drug administration (MDA) campaigns against onchocerciasis require at least 15 years of annual uninterrupted ivermectin distribution. Mathematical models have predicted that short-term disruption of MDA (as was seen during COVID-19) could impacted the microfilaridermia prevalence depending on the pre-control endemicity and the histories of treatment, requiring corrective measures (such as biannual MDA) to mitigate the effect on onchocerciasis elimination. Field evidence supporting this prediction, however, has yet to be gathered. This study aimed to assess the impact of ~2 years disruption of MDA on onchocerciasis transmission indicators. A cross-sectional survey was carried out in 2021 in seven villages of Bafia and Ndikinimeki, two health districts located in the Centre Region, Cameroon, where MDA has been ongoing for two decades, but interrupted in 2020 as a response to the COVID-19 pandemic. Volunteers aged 5 years and above were enrolled for clinical and parasitological examinations for onchocerciasis. Data were compared with pre-COVID-19 prevalence and intensity of infection from the same communities to measure changes over time. A total of 504 volunteers (50.3% males), aged 5-99 years (Median: 38; IQR: 15-54) was enrolled in the two health districts. The overall prevalence of microfilaridermia in 2021 was similar in Ndikinimeki health district (12.4%; 95% CI: 9.7-15.6) and Bafia health district (15.1%; 95% CI: 11.1-19.8) (p-value = 0.16). Microfilaridermia prevalences were either similar between 2018 and 2021 in the communities of Ndikinimeki health district (19.3% vs 12.8% (p = 0.057) for Kiboum 1; and 23.7% vs 21.4% (p = 0.814) for Kiboum 2), or higher in 2019 compared to 2021 in the communities of Bafia health district (33.3% vs 20.0% (p = 0.035) for Biatsota). The mean microfilarial densities in these communities dropped from 5.89 (95% CI: 4.77-7.28) mf/ss to 2.4 (95% CI: 1.68-3.45) mf/ss (p-value < 0.0001), and from 4.81 (95% CI: 2.77-8.31) mf/ss to 4.13 (95% CI: 2.49-6.86) mf/ss (p-value < 0.02) in Bafia and Ndikinimeki health districts, respectively. Community Microfilarial Load (CMFL) dropped from 1.08-1.33 mf/ss in 2019 to 0.052-0.288 mf/ss in 2021 in Bafia health district while remaining stable in the Ndikinimeki health district. The continued decline in prevalence and CMFL observed ~2 years after MDA disruption is consistent with mathematical predictions (ONCHOSIM) and shows that additional efforts and resources are not needed to mitigate the effects of short-term MDA disruption in highly endemic settings prior to intervention with long treatment histories.

Exploring the Relationship Between Community-Level Economic Deprivation and HIV Infection Among Hospital Admissions in Washington, DC.

Introduction Human immunodeficiency virus (HIV) infection is a significant health concern in the United States, affecting 38 million Americans. Despite a recent decline in prevalence, social determinants of health remain an important factor driving infections, particularly among minority populations. However, the relationship between community-level economic deprivation indices and HIV infectionamong hospital admissions has been understudied in the literature. Objectives This study investigated the association between community-level economic deprivation, measured by the Distressed Community Index (DCI), and HIV infection among hospital admissions in Washington, District of Columbia (DC). Methods We utilized data from the State Inpatient Database (SID) for Washington, DC, between 2016 and 2019, identifying all admissions with a history of HIV. The multivariate analysis determined the association between DCI quintiles and HIV infection among hospital admissions. Also included in the multivariate analysis were patients' age, sex, race/ethnicity, insurance type, smoking status, obesity, sexually transmitted infections (STIs), hepatitis B infections, and mental health conditions. Results Of the 213,682 admissions captured in the DCI quintiles, 67.4% were Black, 17.2% were White, and 10.7% were Hispanic. The prevalence of HIV infection in the study population was 4.4%. There was a statistically significant association between the DCI quintiles and HIV infection among hospital admissions. The residents of the richest neighborhoods defined as prosperous quintile (also the reference group) had the lowest odds of HIV infections compared to the other quintiles (comfortable, odds ratio {OR}=1.94 and 95% confidence interval {CI}=1.38-2.74; mid-tier, OR=1.49 and 95% CI=1.04-2.14; at risk, OR=1.75 and 95% CI=1.22-2.49; and distressed, OR=1.97 and 95% CI=1.38-2.82). Other significant predictors of HIV infection were Black race (OR=1.82; 95% CI=1.41-2.33), age between 45 and 65 years (OR=1.55; 95% CI=1.32-1.80), male sex (OR=1.58; 95% CI=1.40-1.77), and depression (OR=1.21; 95% CI=1.03-1.43). Conclusion This study reveals a significant association between increased levels of economic distress and the prevalence of HIV among hospital admissions in Washington, DC. Our findings emphasize the importance of taking social determinants of health into account when addressing HIV prevention and management. Implementing targeted interventions and resources in economically distressed communities may be crucial for reducing HIV prevalence and improving health outcomes for affected populations.

DIFFUSE LEPROMATOUS LEPROSY IN AN HIV-POSITIVE PATIENT

Leprosy is a disease known since ancient times. It is caused by Mycobacterium leprae. The skin, peripheral nerves, eyes, and mucous membranes of the upper respiratory tract are especially affected. Lepromatous leprosy is a clinical entity that has become rare worldwide today with the introduction of polydrug therapy, resulting in a dramatic decline in overall prevalence. In epidemic settings, atypical manifestations should be known because they are a source of disease transmission. Lepromatous leprosy rarely occurs as part of an immune deficiency. We report a case of diffuse leprosy in an HIV-positive patient.

One versus two doses of ivermectin-based mass drug administration for the control of scabies: A cluster randomised non-inferiority trial.

Mass drug administration (MDA) based on two doses of ivermectin, one week apart, substantially reduces prevalence of both scabies and impetigo. The Regimens of Ivermectin for Scabies Elimination (RISE) trial assessed whether one-dose ivermectin-based MDA would be as effective. RISE was a cluster-randomised trial in Solomon Islands. We assigned 20 villages in a 1:1 ratio to one- or two-dose ivermectin-based MDA. We planned to test whether the impact of one dose on scabies prevalence at 12 and 24 months was non-inferior to two, at a 5% non-inferiority margin. We deferred endpoint assessment to 21 months due to COVID-19. We enrolled 5239 participants in 20 villages at baseline and 3369 at 21 months from an estimated population of 5500. At baseline scabies prevalence was similar in the two arms (one-dose 17·2%; two-dose 13·2%). At 21 months, there was no reduction in scabies prevalence (one-dose 18·7%; two-dose 13·4%), and the confidence interval around the difference included values substantially greater than 5%. There was however a reduction in prevalence among those who had been present at the baseline assessment (one-dose 15·9%; two-dose 10·8%). Additionally, we found a reduction in both scabies severity and impetigo prevalence in both arms, to a similar degree. There was no indication of an overall decline in scabies prevalence in either arm. The reduction in scabies prevalence in those present at baseline suggests that the unexpectedly high influx of people into the trial villages, likely related to the COVID-19 pandemic, may have compromised the effectiveness of the MDA. Despite the lack of effect there are important lessons to be learnt from this trial about conducting MDA for scabies in high prevalence settings. Registered with Australian New Zealand Clinical Trials Registry ACTRN12618001086257.

Reduction in COVID-19 related resource loss and decline in prevalence of probable depression in Chinese adults: an application of the Conservation of Resource Theory

BackgroundThe levels of resource losses due to coronavirus disease 2019 (COVID-19) and mental distress may change during the pandemic period. Based on the Conservation of Resource (COR) Theory, this study investigated such changes and the mediation between survey time (Round 2 versus Round 1) and depression via resource losses.MethodsTwo serial random population-based telephone surveys interviewed 209 and 458 Hong Kong Chinese adults in April 2020 and May 2021, respectively. Probable depression was defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥ 10. The validated Conservation of Resources Scale for COVID-19 (CORS-COVID-19) scale was used to assess resource losses due to COVID-19. Multivariable logistic regression analysis, hierarchical logistic regression analysis, and structural equation modeling (SEM) was conducted to test the association, interaction, and mediation hypotheses, respectively.ResultsThe prevalence of probable depression declined from 8.6% to 1.0% over time, together with reductions in losses of financial resource (Cohen’s d = 0.88), future control (Cohen’s d = 0.39), social resource (Cohen’s d = 0.60), and family resource (Cohen’s d = 0.36) due to COVID-19. All the overall scale/subscales of the CORS-COVID-19 were positively and associated with probable depression [adjusted odds ratio (aOR) ranged from 2.72 to 42.30]. In SEM, the survey time was negatively associated with the latent variable of resource loss (β = − 0.46), which in turn was positively associated with probable depression (β = 0.73). In addition, the direct effect of survey time on probable depression was statistically non-significant (β = − 0.08), indicating a full mediation effect of resource losses.ConclusionsThe lessening of the resource losses might have fully accounted for the significant decline in probable depression from Month 3 to 15 since the first COVID-19 outbreak in Hong Kong, China. The level of depression might have increased during the first phase of the pandemic, but might decline in the later phases if resources losses could be lessened. All stakeholders should hence work together to minimize individuals’ COVID-19-related resource losses to prevent depression in the general population, as COVID-19 might be lasting.

Household food insecurity and hunger status in Debre Berhan town, Central Ethiopia: Community-based cross-sectional study.

Food security occurs when all people have physical, social, and economic access to sufficient, safe, and nutritious food that fits their dietary needs and food preferences for an active and healthy life at all times. There is limited evidence on this topic and not well studied in Ethiopia. This study aimed to investigate food insecurity and hunger status among households (HHs) in Debre Berhan town, Ethiopia. A community-based cross-sectional study was undertaken from 1 January 2017 to 30 January 2017. A simple random sampling technique was used to enroll 395 HHs for the study. An interviewer-administered, structured, and pretested questionnaire was used to collect data through a face-to-face interview. The household food security and hunger status were assessed by using the Household Food Insecurity Access Scale and the Household Hunger Scale, respectively. Data were entered and cleaned using Epiata 3.1 and exported to SPSS software version 20 for statistical analysis. Logistic regression was fitted, and an odds ratio with a 95% confidence interval (CI) and a value of p of less than 0.05 were used to identify factors associated with food insecurity. A total of 377 HHs participated in the study with a response rate of 95.4%. The proportion of households with food insecurity was 32.4%, among which mild, moderate, and severe food insecurity accounted for 10.3, 18.8, and 3.2%, respectively. The mean score of the Household Food Insecurity Access Scale was 1.88 ± 3.5. Hunger occurred among 3.2% of households. The mean score of the Household Hunger Scale was 2.17 ± 1.03. Husband or male cohabitant's occupation (AOR = 2.68; 95% CI: 1.31-5.48) and wife or female cohabitant's literacy (AOR = 3.10; 95% CI: 1.01- 9.55) were the only factors associated with HH food insecurity. HH food insecurity and hunger in Debre Berhan town were unacceptably high, which can hamper achieving national targets for food security, nutrition, and health. Intensified efforts are further needed to accelerate the decline in food insecurity and hunger prevalence. Therefore, interventions need to target self-employed merchants in small businesses and women who are uneducated.

Relationship Between Esophageal Disease and Pulmonary Fibrosis

Esophageal disorders are prevalent among patients with chronic lung diseases, including idiopathic pulmonary fibrosis (IPF). Gastroesophageal reflux disease (GERD) has been associated with IPF prevalence, severity, and respiratory decline. The pathophysiologic relationship between GERD and IPF is likely bidirectional, with aspiration of refluxate leading to lung inflammation and fibrosis, while the restrictive pulmonary physiology may contribute to altered transdiaphragmatic pressure gradient and increased reflux. Esophageal symptoms are frequently absent and do not predict esophageal dysfunction or pathologic reflux in patients with IPF, and objective diagnostic tools including upper endoscopy, ambulatory reflux monitoring, and high-resolution manometry are often needed. Impedance-based testing that identifies both weakly/non-acidic and acid reflux may provide important additional diagnostic value beyond pH-based acid testing alone. Novel metrics and maneuvers, including advanced impedance measures on impedance-pH study and provocative testing on HRM, may hold promise to future diagnostic advancements. The main treatment options include medical therapy with acid suppressants and anti-reflux surgery, although their potential benefits in pulmonary outcomes of IPF require further validations. Future directions of research include identifying phenotypes of IPF patients who may benefit from esophageal testing and treatment, determining the optimal testing strategy and protocol, and prospectively assessing the value of different esophageal therapies to improve outcomes while minimizing risks. This review will discuss the pathophysiology, evaluation, and management of esophageal diseases, particularly GERD, in patients with IPF, as informed by the most recent publications in the field, in hopes of identifying targets for future study and research.

The declining trend in HIV prevalence from population-based surveys in Cameroon between 2004 and 2018: myth or reality in the universal test and treat era?

BackgroundHIV remains an epidemic of major public health importance in Cameroon but a decline in HIV prevalence has been observed according to population-based surveys conducted in 2004, 2011 and 2018. We sought to review current evidence for declining HIV prevalence despite increasing survival owing to ‘universal test and treat’ and to explore the reason for the decrease, particularly the role of behavioural change.MethodsWe conducted a secondary analysis using HIV prevalence, behavioural and social determinants data of the Demographic and Health Survey Program databases. Trend lines were fitted to data that were available for a minimum of three points in time during the 1991–2018 period. Regression coefficients associated p-values and 95% confidence intervals were obtained using Microsoft Excel software.ResultsOverall adult HIV prevalence decreased significantly from 5.4% (95%CI: 4.8-6.0) in 2004 to 4.3% (95%CI: 3.8–4.8) in 2011 and further down to 2.7% (95%CI: 2.3–3.1) in 2018 at a rate of about 1.4% every septennium (β = -1.4, R² = 0.98, p = 0.03). Yet, the number of persons surviving with HIV increased from about 0.05 million in 1991 to 0.5 million in 2018 corresponding to an increase in access to antiretroviral therapy from less than 10% to universal coverage of 80% respectively. Concurrent reductions in risky sexual behaviours were observed: a delayed sexual debut by one year, decreased sexual violence by 7%, decreased polygamous unions by 16%, decreased multiple sexual partners by 15.3% and increased condom use by 26.3%.ConclusionThe observed decline in HIV prevalence is statistically valid and reflects the observed decline in risky sexual behaviour that need to be sustained by the National HIV programme. Though universal access to ART has increased the number of persons surviving with HIV, this has not led to an increased prevalence of HIV in a setting with a rising population.

Natural course of health and well-being in non-hospitalised children and young people after testing for SARS-CoV-2: a prospective follow-up study over 12 months.

Despite high numbers of children and young people (CYP) having acute COVID, there has been no prospective follow-up of CYP to establish the pattern of health and well-being over a year following infection. A non-hospitalised, national sample of 5086 (2909 SARS-COV-2 Positive; 2177 SARS-COV-2 Negative at baseline) CYP aged 11-17 completed questionnaires 6- and 12-months after PCR-tests between October 2020 and March 2021 confirming SARS-CoV-2 infection (excluding CYP with subsequent (re)infections). SARS-COV-2 Positive CYP was compared to age, sex and geographically-matched test-negative CYP. Ten of 21 symptoms had a prevalence less than 10% at baseline, 6- and 12-months post-test in both test-positives and test-negatives. Of the other 11 symptoms, in test-positives who had these at baseline, the prevalence of all symptoms declined greatly by 12-months. For CYP first describing one of these at 6-months, there was a decline in prevalence by 12-months. The overall prevalence of 9 of 11 symptoms declined by 12-months. As many CYP first described shortness of breath and tiredness at either 6- or 12-months, the overall prevalence of these two symptoms in test-positives appeared to increase by 6-months and increase further by 12-months. However, within-individual examination demonstrated that the prevalence of shortness of breath and tiredness actually declined in those first describing these two symptoms at either baseline or 6-months. This pattern was also evident for these two symptoms in test-negatives. Similar patterns were observed for validated measures of poor quality of life, emotional and behavioural difficulties, poor well-being and fatigue. Moreover, broadly similar patterns and results were noted for the sub-sample (N=1808) that had data at baseline, 3-, 6- and 12-months post-test. In CYP, the prevalence of adverse symptoms reported at the time of a positive PCR-test declined over 12-months. Some test-positives and test-negatives reported adverse symptoms for the first time at six- and 12-months post-test, particularly tiredness, shortness of breath, poor quality of life, poor well-being and fatigue suggesting they are likely to be caused by multiple factors. NIHR/UKRI (ref: COVLT0022).

Local infectious disease experience influences vaccine refusal rates: a natural experiment.

Vaccination has been critical to the decline in infectious disease prevalence in recent centuries. Nonetheless, vaccine refusal has increased in recent years, with complacency associated with reductions in disease prevalence highlighted as an important contributor. We exploit a natural experiment in Glasgow at the beginning of the twentieth century to investigate whether prior local experience of an infectious disease matters for vaccination decisions. Our study is based on smallpox surveillance data and administrative records of parental refusal to vaccinate their infants. We analyse variation between administrative units of Glasgow in cases and deaths from smallpox during two epidemics over the period 1900-1904, and vaccine refusal following its legalization in Scotland in 1907 after a long period of compulsory vaccination. We find that lower local disease incidence and mortality during the epidemics were associated with higher rates of subsequent vaccine refusal. This finding indicates that complacency influenced vaccination decisions in periods of higher infectious disease risk, responding to local prior experience of the relevant disease, and has not emerged solely in the context of the generally low levels of infectious disease risk of recent decades. These results suggest that vaccine delivery strategies may benefit from information on local variation in incidence.

Changing epidemiology of Plasmodium vivax malaria in Nouakchott, Mauritania: a six-year (2015–2020) prospective study

BackgroundPlasmodium vivax malaria is one of the major infectious diseases of public health concern in Nouakchott, the capital city of Mauritania and the biggest urban setting in the Sahara. The assessment of the current trends in malaria epidemiology is primordial in understanding the dynamics of its transmission and developing an effective control strategy.MethodsA 6 year (2015–2020) prospective study was carried out in Nouakchott. Febrile outpatients with a clinical suspicion of malaria presenting spontaneously at Teyarett Health Centre or the paediatric department of Mother and Children Hospital Centre were screened for malaria using a rapid diagnostic test, microscopic examination of Giemsa-stained blood films, and nested polymerase chain reaction. Data were analysed using Microsoft Excel and GraphPad Prism and InStat software.ResultsOf 1760 febrile patients included in this study, 274 (15.5%) were malaria-positive by rapid diagnostic test, 256 (14.5%) were malaria-positive by microscopy, and 291 (16.5%) were malaria-positive by PCR. Plasmodium vivax accounted for 216 of 291 (74.2%) PCR-positive patients; 47 (16.1%) and 28 (9.6%) had P. falciparum monoinfection or P. vivax–P. falciparum mixed infection, respectively. During the study period, the annual prevalence of malaria declined from 29.2% in 2015 to 13.2% in 2019 and 2.1% in 2020 (P < 0.05). Malaria transmission was essentially seasonal, with a peak occurring soon after the rainy season (October–November), and P. vivax infections, but not P. falciparum infections, occurred at low levels during the rest of the year. The most affected subset of patient population was adult male white and black Moors. The decline in malaria prevalence was correlated with decreasing annual rainfall (r = 0.85; P = 0.03) and was also associated with better management of the potable water supply system. A large majority of included patients did not possess or did not use bed nets.ConclusionsControl interventions based on prevention, diagnosis, and treatment should be reinforced in Nouakchott, and P. vivax-specific control measures, including chloroquine and 8-aminoquinolines (primaquine, tafenoquine) for treatment, should be considered to further improve the efficacy of interventions and aim for malaria elimination.

Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey

ObjectiveTo assess the recent trends in prevalence and management of hypertension in China, nationally and by population subgroups.DesignSix rounds of a national survey, China.SettingChina Chronic Disease and Risk Factors Surveillance,...

Longitudinal and Cross-sectional Analyses of Asymptomatic HIV-1/Malaria Co-infection in Kisumu County, Kenya.

Individuals infected with HIV-1 experience more frequent and more severe episodes of malaria and are likely to harbor asymptomatic parasitemia, thus potentially making them more efficient reservoirs of malaria. Two studies (cross-sectional and longitudinal) were designed in sequence between 2015-2018 and 2018-2020, respectively, to test the hypothesis that HIV-1 infected individuals have higher prevalence of asymptomatic parasitemia and gametocytemia than the HIV-1 negatives. This article describes the overall design of the two studies, encompassing data for the longitudinal study and additional data to the previously published baseline data for the cross-sectional study. In the cross-sectional study, HIV-1 positive participants were significantly older, more likely to be male, and more likely to have parasitemia relative to HIV-1 negatives (P < 0.01). In the longitudinal study, 300 participants were followed for 6 months. Of these, 102 were HIV-1 negative, 106 were newly diagnosed HIV-1 positive, and 92 were HIV-1 positive and on antiretroviral therapy, including antifolates, at enrollment. Overall parasitemia positivity at enrollment was 17.3% (52/300). Of these, 44% (23/52) were HIV-1 negative, 52% (27/52) were newly diagnosed HIV-1 positives, and only 4% (2/52) were HIV-1 positive and on treatment. Parasitemia for those on stable antiretroviral therapy was significantly lower (hazard ratio: 0.51, P < 0.001), compared with the HIV-1-negatives. On follow-up, there was a significant decline in parasitemia prevalence (hazard ratio: 0.74, P < 0.001) among the HIV patients newly initiated on antiretroviral therapy including trimethoprim-sulfamethoxasole. These data highlight the impact of HIV-1 and HIV treatment on asymptomatic parasitemia over time.

Empirical investigation of dynamic relations among foreign direct investment, economic growth and poverty prevalence using African data

This study examined dynamic relations among foreign direct investment (FDI), economic growth and poverty headcount ratio using a sample of 24 African Countries. To achieve this goal, historical data of the variables regarding cross section of countries were collected over 14-year period. The stratified random sampling technique was employed in selecting the sample. Following pre-regression diagnostics, we specified Vector-Auto-Regression model for computation of coefficients of the variables in dynamic relations. These were complimented with computation of relative impulse response function and forecast-error-variance decomposition of regression estimates. We found that FDI did not granger-cause economic growth among African economies, just as growth was found not sustainable and inclusive enough as to achieve substantial poverty reduction. More-so, evidence appeared to support earlier isolated findings that FDI has been largely exploitative and attracted to economies with high growth rates and low poverty ratios. The study reinforces earlier isolated findings that it is not necessarily ‘growth’ that results in decline in poverty prevalence but ‘sustained economic growth’. Hence most developing nations that depend on annual fiscal plans for poverty reduction may consistently miss development targets. Again, contrary to widely held view that foreign direct development leads to economic growth, the study established exceptional case for Africa.