High Burden Of Infectious Diseases Research Articles

Climate change and epidemiological trends of malaria and Lassa fever transmission in Nigeria (2015-2022): A systematic review and meta-analysis

Background: Climate change exacerbates infectious disease transmission in Nigeria, a country with a high burden of infectious diseases. Objective: To conduct a systematic review and meta-analysis examining the relationship between climate variability and infectious disease transmission in Nigeria. Methods: We systematically searched major databases, identifying 25 studies, with 11 studies meeting the inclusion criteria for meta-analysis using R version 4.4.1. Results: The meta-analysis revealed significant associations between temperature increases and malaria (pooled effect estimate = 1.034, 95% CI: 1.016-1.052) and Lassa fever (pooled effect estimate = 1.029, 95% CI: 1.015-1.043) transmission. Egger's funnel plot showed no significant publication bias, and sensitivity analysis confirmed the robustness of the findings. Conclusion: This study provides evidence for the association between climate variability and infectious disease transmission in Nigeria. This underscores the urgent need for targeted interventions to protect vulnerable populations, including children under 5, pregnant women, the elderly, people with comorbidity, and low-income communities.

Artificial Intelligence and Cardiology Practice in Nigeria: Are We Ready?

Cardiovascular diseases are the leading cause of death globally. As cardiovascular risk factors continuously rise to pandemic levels, there is intense pressure worldwide to improve cardiac care in preventive cardiology, cardio-diagnostics, therapeutics, and interventional cardiology. Artificial intelligence (AI), an advanced branch of computer science has ushered in the fourth industrial revolution with myriad opportunities in healthcare including cardiology. The developed world has embraced the technology, and the pressure not to be left behind is intense for both policymakers and practicing physicians/cardiologists in low to middle-income countries (LMICs) like Nigeria. This is especially daunting for LMICs who are already plagued with a high burden of infectious disease, unemployment, physician burnt, brain drain, and a developing cardiac practice. Should the focus of cardiovascular care be on men or machines? Is the technology sustainable in a low-resource setting? What lessons did we learn from the COVID-19 pandemic? We attempt to zero in on the dilemmas of AI in the Nigerian setting including AI acceptance, the bottlenecks of cardiology practice in Nigeria, the role of AI, and the type of AI that may be adapted to strengthen cardiovascular care of Nigerians.

Post-independence health research productivity in Portuguese-speaking African countries: A bibliometric analysis of 43 years of research and higher education in Mozambique

BackgroundAfrica has a high double burden of infectious and non-communicable diseases underscoring the critical need for robust scientific research. However, it is also associated with low scientific research productivity. Mozambique, which gained independence in 1975, serves as a poignant example. However, there remains a notable scarcity of evidence evaluating the country's trajectory in scientific and academic development. This study aims to evaluate 43 years of health-related scientific knowledge production through bibliometric analysis, focusing on key indicators. Additionally, it seeks to characterize the higher education institutions within the country. MethodsThe data was retrieved from the Web of Science Core Collection using an advanced search tool with Boolean research strategies, covering the period from 1976 to 2022 for all PALOP and 1976 to 2019 for Mozambique. To map Mozambican higher institutions, information was sourced from the Ministry of Science Technology and Higher Education database. Descriptive statistics were employed to summarize the findings, while the VOSviewer program version 1.6.19 was utilized to visualize distance-based bibliometric networks, focusing on co-authorship among institutions and keyword co-occurrence. ResultsPortuguese-speaking African countries (PALOP) contribute 2.5 % (10,933 out of 442,309) to Africa's total scientific output, with Mozambique leading at 63.6 % (6,951 publications) followed by Angola at 16.6 % (1,811 publications). All PALOP countries experienced decreased scientific productivity during the third year of the COVID-19 pandemic. In Mozambique, over 70 % (1,710 out of 2,380) of health-related publications from 2011 to 2019 were concentrated in this period. Key journals for health sciences include PLOS ONE, Malaria Journal, and Tropical Medicine & International Health, focusing on HIV, malaria, and tuberculosis. Higher education institutions in Mozambique show regional disparities, with 67.9 % in the South and only 8.9 % in the North, indicating significant inequality in their distribution across the country. ConclusionThis study highlights Mozambique's significant progress in health research productivity over 43 years, establishing it as a leader among PALOP countries. The substantial increase in publications, particularly after 2008, underscores the nation's growing research capacity and commitment to addressing critical health challenges such as HIV, malaria, and tuberculosis. However, regional disparities in higher education access and limited research contributions from private universities remain high in Mozambique.

Determinants and prevalence of zero-dose children in Somalia: Analysis of the 2020 Health Demographic Survey data.

Despite global progress in childhood vaccination coverage, fragile and humanitarian countries, with high burden of infectious diseases, continue to report a significant number of zero-dose and under-vaccinated children. Efforts to equitably reach zero-dose children remain thus critical. This study assesses the prevalence and determinants of zero-dose children in fragile context of Somalia. We used secondary data from 2020 Somali Health and Demographic Survey (SHDS) to determine status of unvaccinated children aged between 12 to 23 months. Variables related to socio-demographic, household, health seeking, and community level factors were extracted from the SHDS data. Variables that were shown to be significantly associated with zero-dose children at p< 0.05 in the single logistic regression analysis were identified and included in a final multiple logistic regression analysis. A total of 2,304 women and their children aged between 12-23 months were used to determine the prevalence and determinants of zero dose children in Somalia. Approximately 60.2% of the children were zero dose children and did not receive any dose of the four basic routine vaccines. Children living in rural and nomadic areas were more likely to be zero dose (aOR 1.515, 95% CI: 1.189-1.93). Mother with primary education and above (aOR 0.519, 95% CI: 0.371-0.725), those who attended antenatal care (aOR 0.161, 95% CI: 0.124-0.209) and postnatal care (aOR 0.145, 95% CI: 0.085-0.245) and listen frequently to radio (aOR 2.212, 95% CI: 1.106-4.424) were less likely to have children with zero dose than with their counterparts. Majority of children under two years of age in Somalia are reported to be zero dose children. Context and population specific interventions that target vulnerable mothers and their children, in rural and nomadic areas, and from lower wealth quintile index families with no education and adequate access to antenatal and postnatal care remain critical.

Immunity against measles, mumps, rubella, and varicella among homeless individuals in Germany - A nationwide multi-center cross-sectional study.

Homeless individuals suffer a high burden of vaccine-preventable infectious diseases. Moreover, they are particularly susceptible to adverse infection outcomes with limited access to the health care system. Data on the seroprevalence of measles, mumps, rubella, and varicella within this cohort are missing. The seroprevalence of measles, mumps, rubella, and varicella was determined within the homeless population in Germany. Predictors of lacking immune protection were determined using multivariable logistic regression analysis. Homeless individuals in Germany (n = 611) showed a seroprevalence of 88.5% (95% CI: 85.8-91.0) for measles, 83.8% (95% CI: 80.6-86.6) for mumps, 86.1% (95% CI: 83.1-88.7) for rubella, and 95.7% (95% CI 93.8-97.2) for varicella. Measles seroprevalences declined from individuals born in 1965 to individuals born in 1993, with seroprevalences not compatible with a 95% threshold in individuals born after 1980. For mumps, seroprevalences declined from individuals born in 1950 to individuals born in 1984. Here, seroprevalences were not compatible with a 92% threshold for individuals born after 1975. Seronegativity for measles, mumps and rubella was associated with age but not with gender or country of origin. Herd immunity for measles and mumps is not achieved in this homeless cohort, while there was sufficient immune protection for rubella and varicella. Declining immune protection rates in younger individuals warrant immunization campaigns also targeting marginalized groups such as homeless individuals. Given that herd immunity thresholds are not reached for individuals born after 1980 for measles, and after 1975 for mumps, vaccination campaigns should prioritize individuals within these age groups.

Typhoid intestinal perforation in Francophone Africa, a scoping review.

Typhoid intestinal perforation (TIP) is a leading cause of peritonitis and indication for emergency surgery in Africa, with reported mortality rates up to 30% in pediatric patients. Currently, data on TIP in Western databases are primarily from countries that speak English, likely due to non-English publication and citation biases. Despite the high burden of infectious diseases in Francophone Africa, data from these countries regarding TIP remain limited. This study aims to highlight the incidence and morbidity of TIP in Francophone African countries using an extended search algorithm. We conducted a scoping review using the PubMed, EMBASE, and SCOPUS databases with the keywords "peritonitis", "non-traumatic ileal perforation", and "typhoid" in Francophone African countries. Additionally, we contacted surgeons in Africa and concurrently used citation chasing to obtain data not found in western databases. In total, 32 studies from 12 countries were identified and included in this review. A total of 22 publications were in French. Patient median age was 20 years and TIP caused a median of 35% of acute peritonitis cases. Mortality rates ranged from 6-37% (median: 16%). Rate of complications ranged from 15-92% (median: 46%). Ileostomy creation as a treatment for TIP varied between hospitals (0-79%), with the highest rates reported in Niger. In Francophone Africa, TIP is associated with high morbidity and mortality, most commonly in children and young adults. Interventions, including improved sanitation and the introduction of typhoid conjugate vaccines into routine vaccination programs, have the potential to significantly decrease typhoid fever and its complications.

Clinical presentation, management, and outcome of suspected central nervous system infections in Indonesia: a prospective cohort study

BackgroundLittle is known about the etiology, clinical presentation, management, and outcome of central nervous system (CNS) infections in Indonesia, a country with a high burden of infectious diseases and a rising prevalence of HIV.MethodsWe included adult patients with suspected CNS infections at two referral hospitals in a prospective cohort between April 2019 and December 2021. Clinical, laboratory, and radiological assessments were standardized. We recorded initial and final diagnoses, treatments, and outcomes during 6 months of follow-up.ResultsOf 1051 patients screened, 793 were diagnosed with a CNS infection. Patients (median age 33 years, 62% male, 38% HIV-infected) presented a median of 14 days (IQR 7–30) after symptom onset, often with altered consciousness (63%), motor deficits (73%), and seizures (21%). Among HIV-uninfected patients, CNS tuberculosis (TB) was most common (60%), while viral (8%) and bacterial (4%) disease were uncommon. Among HIV-infected patients, cerebral toxoplasmosis (41%) was most common, followed by CNS TB (19%), neurosyphilis (15%), and cryptococcal meningitis (10%). A microbiologically confirmed diagnosis was achieved in 25% of cases, and initial diagnoses were revised in 46% of cases. In-hospital mortality was 30%, and at six months, 45% of patients had died, and 12% suffered from severe disability. Six-month mortality was associated with older age, HIV, and severe clinical, radiological and CSF markers at presentation.ConclusionCNS infections in Indonesia are characterized by late presentation, severe disease, frequent HIV coinfection, low microbiological confirmation and high mortality. These findings highlight the need for earlier disease recognition, faster and more accurate diagnosis, and optimized treatment, coupled with wider efforts to improve the uptake of HIV services.

Drug preparation, injection-related infections, and harm reduction practices among a national sample of individuals entering treatment for opioid use disorder

BackgroundThe rise in injection drug use in the USA has led to an increase in injection site infections. We performed a national survey of people who use drugs to evaluate common drug use preparation, harm reduction practices, and experiences with injection site infections.MethodsA survey was disseminated to members of the Survey of Key Informants’ Patients Program from 2021 to 2022 and distributed to patients 18 years or older newly entering one of 68 substance use disorder treatment programs across the USA with a primary diagnosis of an opioid use disorder. Participants were surveyed about practices when preparing and using drugs, along with self-reported infections and drug use complications.Results1289 participants responded to the survey. Sexually transmitted infections were common, with 37.6% reporting ever having had any sexually transmitted infection. Injection-associated infections had affected 63.4% of participants who had ever used injection drugs. Many respondents reported not seeking professional medical assistance for infection management, including 29% draining abscesses without seeking medical care and 22.8% obtaining antibiotics through non-healthcare sources. Non-sterile injection practices included sharing needles with others who were febrile or ill (18%), using needles previously used to drain wounds/abscesses (9.9%) for subsequent injection drug use, and licking needles (21.2%).ConclusionPatients entering treatment for opioid use disorder reported a high burden of infectious diseases. A number of easily-modifiable high risk behaviors for developing injection-related infections were identified. Efforts are needed to disseminate targeted harm reduction education to PWID on how to reduce their risks for injection-related infections.

Public health and research ethics education: the experience of developing a new cadre of bioethicists at a Ugandan institution

Research ethics education is critical to developing a culture of responsible conduct of research. Many countries in sub-Saharan Africa (SSA) have a high burden of infectious diseases like HIV and malaria; some, like Uganda, have recurring outbreaks. Coupled with the increase in non-communicable diseases, researchers have access to large populations to test new medications and vaccines. The need to develop multi-level capacity in research ethics in Uganda is still huge, being compounded by the high burden of disease and challenging public health issues. Only a few institutions in the SSA offer graduate training in research ethics, implying that the proposed ideal of each high-volume research ethics committee having at least one member with in-depth training in ethics is far from reality. Finding best practices for comparable situations and training requirements is challenging because there is currently no “gold standard” for teaching research ethics and little published information on curriculum and implementation strategies. The purpose of this paper is to describe a model of research ethics (RE) education as a track in an existing 2-year Master of Public Health (MPH) to provide training for developing specific applied learning skills to address contemporary and emerging needs for biomedical and public health research in a highly disease-burdened country. We describe our five-year experience in successful implementation of the MPH-RE program by the Mbarara University Research Ethics Education Program at Mbarara University of Science and Technology in southwestern Uganda. We used curriculum materials, applications to the program, post-training and external evaluations, and annual reports for this work. This model can be adapted and used elsewhere in developing countries with similar contexts. Establishing an interface between public health and research ethics requires integration of the two early in the delivery of the MPH-RE program to prevent a disconnect in knowledge between research methods provided by the MPH component of the MPH-RE program and for research in ethics that MPH-RE students are expected to perform for their dissertation. Promoting bioethics education, which is multi-disciplinary, in institutions where it is still “foreign” is challenging and necessitates supportive leadership at all institutional levels.

Prevalence, resistance profiles and factors associated with skin and soft-tissue infections at Jinja regional referral hospital: A retrospective study.

Skin and soft-tissue infections (SSTI) are common cases of hospital-acquired infections with aetiological agents exhibiting antimicrobial resistance (AMR). This is a global public health predicament responsible for a high burden of infectious diseases and threatens the achievement of Sustainable Development Goals (SDGs), especially in Low- and Middle-Income countries (LMICs). This study determined the prevalence of SSTI, proportion of laboratory-investigated cases, AMR-profiles, and factors associated with SSTI and multi-drug resistance (MDR). This was based on records of patients suspected of SSTI for the period of 2019-2021 at Jinja Regional Referral Hospital. The analysis involved 268 randomly selected patient reports using WHONET 2022 and Stata 17 at the 95% confidence level. The prevalence of SSTI was 66.4%. Cases that involved laboratory testing were 14.1%. Staphylococcus aureus (n = 51) was the most isolated organism. MDR pathogens explained 47% of infections. Methicillin-resistant Staphylococcus aureus (MRSA) was up to 44%. In addition, 61% of Gram-negatives had the potential to produce extended-spectrum beta-lactamases (ESBL), while 27% were non-susceptible to carbapenems. Ward of admission was significantly associated with infection (aPR = 1.78, 95% CI: 1.00-3.18, p-value = 0.04). Age category (19-35) was an independent predictor for MDR infections (aPR = 2.30, 95%CI:1.02-5.23, p-value = 0.04). The prevalence of SSTI is high with MDR pathogens responsible for almost half of the infections. Gentamicin and ciprofloxacin can be considered for empirical management of strictly emergency SSTI cases suspected of Staphylococcus aureus. Given the high resistance observed, laboratory-based diagnosis should be increased to use the most appropriate treatment. Infection Prevention and Control (IPC) strategies should be heightened to reduce the prevalence of SSTI. Recognizing SSTI under the Global Antimicrobial resistance Surveillance System (GLASS) would lead to improved preparedness and response to AMR.

Zinc – a scoping review for Nordic Nutrition Recommendations 2023

Zinc is essential for several biological processes including those critical for the immune system, DNA synthesis, cell division, and growth. Zinc is involved in the pathophysiology of chronic diseases and protects proteins and lipids from oxidative damage. Inadequate zinc intake and low plasma zinc concentration are associated to an increased risk of chronic diseases such as cardiovascular diseases and type 2 diabetes; however, the evidence is limited. Zinc deficiency increases the risk of infections and poor growth and may contribute to the high burden of infectious diseases and stunting in children living in low- and middle-income countries. The risk of zinc deficiency in the populations of the Nordic and Baltic countries is low.

Migration in French Guiana: Implications in health and infectious diseases

In French Guiana, more than a third of the population, and nearly half of the adults, are of foreign origin. This immigration is explained by the French standard of living, which is attractive to nationals of surrounding countries. Infectious diseases remain in the top 10 causes of premature death, often in the most precarious populations. In this context we aimed to synthesize the state of the knowledge regarding immigration and infectious diseases in French Guiana and the general implications that follow this diagnosis.For HIV, although the majority of patients are of foreign origin, estimates of the presumed date of infection based on CD4 erosion modelling and from molecular analyses suggest that the majority of transmissions in foreign-born individuals occur in French Guiana and that the Guiana shield has been a crossroad between Latin America and the Caribbean. Among key populations bridging these regions illegal gold miners are very mobile and have the greatest proportion B Caribbean HIV viruses. Gold miners have been a key vulnerable population for falciparum malaria and other tropical diseases such as leishmaniasis, leprosy, or leptospirosis. The complex history of migrations in French Guiana and on the Guiana Shield is also reflected in the fingerprinting of mycobacterium tuberculosis and the high incidence of tuberculosis in French Guiana, notably in immigrants, reflects the incidences in the countries of origin of patients. The high burden of infectious diseases in immigrants in French Guiana is first and foremost a reflection of the precarious living conditions within French Guiana and suggests that community-based proactive interventions are crucial to reduce transmission, morbidity, and mortality from infectious diseases.

Antimicrobial Resistance in Papua New Guinea: A Narrative Scoping Review.

Antimicrobial-resistant bacterial infections are a known threat to the public health of low-income countries and are undercharacterized in Papua New Guinea. A scoping literature review of scientific peer-reviewed publications on antimicrobial resistance in Papua New Guinea was conducted, and their results were summarized. Many of the available data on resistant bacteria in Papua New Guinea have come from Port Moresby and Goroka and have been focused on Staphylococcus aureus, as well as important pediatric pathogens such as Streptococcus pneumoniae and Haemophilus influenzae. Progressive resistance to the commonly used antibiotics penicillin and chloramphenicol among most clinically important bacterial pathogens has prompted healthcare workers to adopt expensive broad-spectrum antibiotics. There is already evidence of resistance to newly adopted antibiotics among several Gram-negative organisms. Drivers of antimicrobial resistance in Papua New Guinea include a high burden of infectious diseases, inappropriate antibiotic prescription practices, poor regulation of antibiotics, incomplete adherence, substandard drug quality, and overcrowding of healthcare facilities. There is a lack of information on antimicrobial resistance among priority pathogens and from several important regions of Papua New Guinea.

An extensively drug-resistant Pseudomonas aeruginosa isolate from Myanmar

ObjectivesAntimicrobial resistance (AMR) including multidrug-resistant (MDR) and extensively drug-resistant (XDR) Pseudomonas aeruginosa has emerged as one of the serious public health threats across the globe. Southeast Asia is a ‘hot spot’ of antimicrobial-resistant bacteria including MDR P. aeruginosa. Despite Myanmar being located in Southeast Asia and suffering from a high infectious disease burden, data on MDR and XDR P. aeruginosa from Myanmar is limited. In this communication, we report the draft genome of an XDR P. aeruginosa isolate, MMXDRPA001 that was identified during a routine diagnosis in Myanmar. MethodsAn MMXDRPA001 isolate colonising a hospitalised patient was characterised by antibiotic resistance profiling following standard methods and whole-genome sequencing using an Illumina MiSeq platform. The generated reads were de novo assembled using SPAdes (v.3.9.1). Annotation was performed by Prokka (v.1.14.0). Sequence type, antimicrobial resistance and virulence-related genes were predicted from the sequence. The phylogenetic relationships of all P. aeruginosa isolates were determined using core genome single nucleotide polymorphisms (SNPs) analysis utilising Snippy (v.4.6.0) and Gubbins (v.2.3.4). ResultsP. aeruginosa MMXDRPA001 was resistant to most antipseudomonal β-lactams, aminoglycosides and quinolones. The assembly comprised 145 contigs totalling 6,808,493 bases of sequence and a total of 6,183 coding sequences. The isolate belonged to sequence type (ST) 235, contained carbapenemase-encoding gene blaIMP-1 and was clonally related to a previously reported isolate from Thailand. ConclusionsThe identification of an international high-risk clone of ST235 XDR isolate in Myanmar, genomically relating to that from a neighbouring country underscores the need for coordinated AMR surveillance throughout healthcare settings in Myanmar and in the Southeast Asia region.

Infectious Disease And Diabetes.

In this communication, we provide a bird's eye view of the various ways in which infectious diseases intersect with diabetes. We list the ways in which infectious diseases can influence glucose homoeostasis and diabetes management, and explores how diabetes care is associated with infections and infection management. This is especially important for health care providers in regions with a high burden of infectious disease.

Challenges of Diagnosing Mendelian Susceptibility to Mycobacterial Diseases in South Africa.

Inborn errors of immunity (IEI) are genetic disorders with extensive clinical presentations. They can range from increased susceptibility to infections to significant immune dysregulation that results in immune impairment. While IEI cases are individually rare, they collectively represent a significant burden of disease, especially in developing countries such as South Africa, where infectious diseases like tuberculosis (TB) are endemic. This is particularly alarming considering that certain high penetrance mutations that cause IEI, such as Mendelian Susceptibility to Mycobacterial Disease (MSMD), put individuals at higher risk for developing TB and other mycobacterial diseases. MSMD patients in South Africa often present with different clinical phenotypes than those from the developed world, therefore complicating the identification of disease-associated variants in this setting with a high burden of infectious diseases. The lack of available data, limited resources, as well as variability in clinical phenotype are the reasons many MSMD cases remain undetected or misdiagnosed. This article highlights the challenges in diagnosing MSMD in South Africa and proposes the use of transcriptomic analysis as a means of potentially identifying dysregulated pathways in affected African populations.

A spectrum of non-spore-forming fermentative and non-fermentative Gram-negative bacteria: multi-drug resistance, extended-spectrum beta-lactamase, and carbapenemase production

BackgroundIn developing countries, the co-existence of a high burden of infectious diseases caused by Gram-negative bacteria and the rapid increase and spread of multidrug-resistant bacteria have become a serious health threat.ObjectiveProfiling of Gram-negative bacteria and determining the magnitude of their antimicrobial resistance among patients.ResultsA total of 175 non-spore-forming Gram-negative bacteria were isolated from 873 different clinical samples. Of a total of 175 bacteria, 154 (88%) were fermentative Gram-negative bacteria, while 21 (12%) were non-fermentative Gram-negative bacteria. E. coli with a frequency of 58.3% and K. pneumoniae with a frequency of 18.3% were the predominant fermentative Gram-negative bacteria, while P. aeruginosa 9 (5.1%) and A. baumannii 6 (3.4%) were the predominant non-fermentative Gram-negative bacteria. The highest percentage level of antibiotic resistance was seen against ampicillin (86%), and the lowest against meropenem (9.8). About 49 (28%) Gram-negative bacilli were positive for ESBLase. The overall prevalence rate of MDR bacteria was 80.5%, of which 100% of A. baumannii, 90.6% of K. pneumonia. Sixteen isolates were resistant to meropenem, out of which 11 tested for carbapenemase production. Five of the nine were metallo-lactamase producers, with the remaining four being serine carbapenemase producers.ConclusionThe prevalence of Gram-negative bacterial infection was found to be 20%, with a significant proportion (80.0%) due to fermentative Gram-negative bacteria and the remaining 20% due to non-fermentative Gram-negative bacteria. The study has also demonstrated a high prevalence rate of MDR, ESBLase, and carbapenemase-producing Gram-negative bacteria. Antimicrobial resistance of Gram-negative bacteria should be monitored on a regular basis, and an effective infection control program should be implemented.

Principaux facteurs expliquant l'hésitation vaccinale contre la Covid-19 en Tanzanie

WHO defines vaccine hesitancy as delay in acceptance or refusal of vaccines despite the availability of vaccine services. It is a complex phenomenon that varies through time, place and vaccines. In this comment, we highlight the context-specific variation of Covid-19 vaccine hesitancy in Tanzania. We suggest Covid-19 hesitancy in Tanzania is influenced with high burden of infectious disease, poor testing capabilities and demographic characteristics.

Does the immune system of milk increase activity for infants experiencing infectious disease episodes in Kilimanjaro, Tanzania?

Multiple studies have reported that milk immune content increases for infants experiencing infectious disease (ID) episodes, suggesting that the immune system of milk (ISOM) offers enhanced protection when needed to combat ID. To test the hypothesis that ISOM content and/or activity increases during an infant's ID episode, we characterized milk secretory immunoglobulin A (sIgA; a major ISOM constituent) and in vitro interleukin-6 (IL-6) responses to Salmonella enterica and Escherichia coli, as system-level biomarkers of ISOM activity, in a prospective study among 96 mother-infant dyads in Kilimanjaro, Tanzania. After control for covariates, no milk immune variables (sIgA, Coef: 0.03; 95% CI -0.25, 0.32; in vitro IL-6 response to S. enterica, Coef: 0.23; 95% CI: -0.67, 1.13; IL-6 response to E. coli, Coef: -0.11; 95% CI: -0.98, 0.77) were associated with prevalent ID (diagnosed at the initial participation visit). Among infants experiencing an incident ID (diagnosed subsequent to the initial participation), milk immune content and responses were not substantially higher or lower than the initial visit (sIgA, N: 61; p: 0.788; IL-6 response to S. enterica, N: 56; p: 0.896; IL-6 response to E. coli, N: 36; p: 0.683); this was unchanged by exclusion of infants with ID at the time of initial participation. These findings are not consistent with the hypothesis that milk delivers enhanced immune protection when infants experience ID. In environments with a high burden of ID, dynamism may be less valuable to maternal reproductive success than stability in the ISOM.

Persistent Malnutrition among Children under five in Pastoral Communities of Aweil Centre, South Sudan

Malnutrition is one of the leading causes of morbidity and mortality among children globally, and has been linked to 60% of the 10.9M deaths annually of under-fives. High prevalence of infectious diseases contributes to malnutrition and vice versa making the situation even worse. In WHO’s African region, the median stunting prevalence is 31.3%.&#x0D; The worst scenarios are seen in the war tone countries; for example Aweil Center of South Sudan has consistently high malnutrition rates despite running nutrition projects by UN agencies, government and other partners with relative stability. Results from Survey carried out in 2013 indicated poverty levels at 76%, severe acute malnutrition (SAM) prevalence rate of 6.3% (95% CI, 4.5-8.9), Global acute malnutrition (GAM) rate of 22.4% (95% CI, 17.8-27.7) with under five mortality rate of 152 deaths/ 1,000 live births.&#x0D; A cross-sectional study with two-stage cluster sampling method done to determine the associated factors of malnutrition among children 6-59 months in Aweil Center County. The results showed high burden of infectious diseases like fever, diarrhea, eye, skin and respiratory tract infections at 94.5% with p-value 0.00022 (95%C.I, 0.1667-0.291). Very low household dietary diversity score of only 24 % (125out of 513 families). There was low coverage of primary health care interventions; e.g. Vitamin A, LLITN and measles vaccinations at 53%, 52.8% and 55% respectively. Accessibility to CBDs for iCCM associated with better nutrition status of children p-value 0.032 and OR 0.62 (95% CI 0.41-0.94). Poor feeding methods, family planning practices; and poor access roads to markets impact on nutrition status of children.&#x0D; Multifaceted approach is needed to root out the persistent malnutrition from Aweil Center: Shift from food aid to support of food production, scale up of primary health care and iCCM interventions to include IPT for malnourished children and community awareness on feeding practices and family planning