Important Preventive Intervention Research Articles

Percutaneous left atrial appendage closure with the Watchman device: a systematic review.

Atrial fibrillation (AF) is the most commonly observed arrhythmia in the world and its prevalence increases with age. The main and most severe complication of AF is ischemic stroke. Oral anticoagulation (OAC) therapy is the standard of care for stroke prevention in the high risk population. Initiation of this treatment is associated with a substantial risk of bleeding complications. Moreover, there is a group of patients who cannot tolerate OAC. In patients with AF the left atrial appendage (LAA) is the main source of thrombus formation. Percutaneous left atrial appendage closure (LAAC) has become an important non-pharmacological intervention for stroke prevention in patients with non-valvular AF. The procedure aims to reduce the risk of thromboembolism without increasing the risk of bleeding. Over the last few years, the safety and long-term efficacy of the procedure in specific populations have increased and more patients are being treated. The Watchman device is the most studied device in this field. Randomized controlled trials demonstrated non-inferiority of percutaneous left atrial appendage closure using the WATCHMAN 2.5 device to OAC (Boston Scientific, Marlborough, MA, USA). The new generation device, WATCHMAN FLX, was introduced and its use was associated with fewer safety events and a higher success rate of effective appendage closure. Nevertheless, several unsolved problems remain, including device-related thrombosis, the post-LAAC antithrombotic regimen, and peri-device leakage. This review will focus on LAAC with the Watchman device for stroke prevention in AF patients. Current status, available literature, clinical safety and efficacy will be summarized.

Utilization of preconception care and associated factors among pregnant mothers in Fiche Town, Central Ethiopia: a community-based cross-sectional study 2021.

Preconception care is an important preventive intervention for adverse pregnancy outcomes. It is recognized as a strategy to optimize women's health and pregnancy outcomes in Western countries. However, preconception care is underutilized in sub-Saharan Africa, like Ethiopia, where maternal mortality is high. Evidence is scarce in the study area about the prevalence and factors associated with preconception care utilization. Therefore this study aimed to assess the proportion of preconception care utilization and associated factors among pregnant mothers in Fiche town, central Ethiopia, 2021. A community-based cross-sectional study was done from May 10 to June 25, 2021. A systematic random sample technique was used to choose 393 pregnant women for the study. A structured, pre-tested, interviewer-administered questionnaire was used to collect data. The data were entered into Epi Data version 3.1 and then exported into SPSS version 25 for analysis. A Bivariable and multivariable logistic regression analysis was used to check for the association. Odds ratio along with 95% was used to describe the association. Finally, a significant association was declared at a p-value less than 0.05. 388 respondents participated in this study, making the response rate 98.7%. Of total study participants only 84 (21.6%; 95% CI, 18, 25.8) utilized preconception care. The study found that diploma or higher level of education (AOR = 3.47, 95% CI: 1.27, 9.53), psychological and financial support from a partner (AOR = 3.86, 95% CI: 2.1, 7.10), joint discussion and plan with a partner (AOR = 3.32, 95% CI: 1.55, 7.13), history of chronic disease (AOR = 3.47, 95% CI: 1.67, 7.25), and good knowledge about preconception care (AOR = 2.42, 95% CI: 1.34, 4.38) were significantly associated with preconception care utilization. Overall, less than a quarter of the pregnant mothers utilized preconception care, indicating that awareness is very low. Pregnant mothers who have a higher educational level, have good communication and support from their partners, have chronic health problems, and have good knowledge about preconception care were more likely to utilize the service. Preconception care is a better opportunity to intervene and maintain the mother in the continuum of care.

Covid-19 Vaccine Hesitancy Amongst a Population of Black Pregnant Women: An On-The-Spot Assessment in a Nigerian Teaching Hospital

Background: COVID-19 vaccination is generally regarded as an important preventive intervention in reducing the spread of SARS-CoV-2 which became a pandemic in March 2020. Although various excuses have been reported as reasons for vaccine hesitancy, vulnerable groups such as pregnant women have been excluded from immunization. This study sought to explore COVID-19 vaccine hesitancy amongst pregnant women receiving ante-natal care at a Nigerian teaching hospital. Methods: One hundred and ninety-eight consecutively selected women attending the ante-natal clinic of the University College Hospital, Ibadan, Nigeria were enlisted, and a self-administered questionnaire was completed by each participant. Data was analysed using the Statistical Package for Social Sciences version 23. Descriptive analysis was generated and summarized with the aid of a pie chart, bar chart and frequency tables. Chi-square statistic was used to test for associations between categorical variables and p value was set at 0.05. Result: The mean age of the participants was 31.78±5.26 years. 152(76.8%) were gainfully employed and only 7 participants (3.5%) lacked formal education. 160 participants (83.3%) had good knowledge about the disease while 120 (62.5%) had good knowledge about the available vaccines. 46 participants (23.2%) had received their 1st vaccination prior to pregnancy and 115 (58.1%) were willing to receive the vaccine in their index pregnancy. 83 participants (41.9%), however, were unwilling to receive the vaccine and this hesitancy did not show any association with knowledge about COVID-19, educational attainment, employment status or ethnicity (p>0.05). Conclusion: There exist vaccine hesitancy amongst pregnant women in developing countries and this may stem from deep socio-cultural beliefs and taboos about care in pregnancy. There is a need for continuous education on vaccine safety and possibly incorporating COVID-19 vaccination where applicable as part of routine immunization in pregnancy.

The effects of yoga on cardiovascular risk factors

Cardiovascular diseases is a group of disorders of the heart and blood vessels, including coronary heart disease, cerebrovascular disease, rheumatic heart disease, peripheral artery disease, congenital heart disease, deep vein thrombosis, and pulmonary embolism. The most important behavioral risk factors for heart disease and stroke are poor diet, physical inactivity, smoking, and harmful alcohol use. The impact of behavioral risk factors may manifest in each individual as high blood pressure, hyperglycemia, hyperlipidemia, overweight, and obesity. The purpose of this study was to give a thorough scientific analysis of yoga’s contribution to the management and prevention of cardiovascular diseases and related risk factors. The records are collected from several databases. We performed an extensive search of the PubMed/Medline electronic database. However, it is believed that the risk of cardiovascular disease can be reduced by adjusting for several risk factors, such as increasing physical activity and using relaxation to reduce stress, both of which are elements of yoga. As yoga has become an increasingly popular form of exercise, it could be an important intervention for primary and secondary cardiovascular disease prevention. Evidence suggests that regular exercise can reduce the risk of death from cardiovascular disease, and it is beneficial when included in primary and secondary prevention strategies. This review assessed the effectiveness of yoga in reducing various cardiovascular risk factors (blood pressure, weight, body mass index, lipid profile, blood sugar). There is promising evidence that the practice of yoga improves cardiovascular health. Yoga practice length has a beneficial relationship with reducing the risk of сardiovascular diseases. Numerous studies used limited sample numbers, varied the forms and lengths of their yoga treatments, and omitted information on the processes behind change. The prevention and management of cardiovascular illnesses and associated risk factors, however, might be greatly aided by yoga. To even further understand the numerous possible mechanisms behind yoga’s effects, more research is necessary.

A plantar surface shear strain methodology utilising Digital Image Correlation

The increase in the global diabetic population is leading to an increase in associated complications such as diabetic foot ulceration (DFU), associated amputations, morbidity, which substantial treatment costs. Early identification of DFU risk is therefore of great benefit. International guidelines recommend off-loading is the most important intervention for healing and prevention of DFU, with current research focused on pressure measurement techniques. The contribution of strain to DFU formation is not well understood due to challenges in measurement. The limited data available in the literature suggest that plantar strain is involved in ulcer formation. As a consequence, there is a need for plantar strain measurement systems to advance understanding and inform clinical treatment. A method was developed to determine plantar strain based on a Digital Image Correlation (DIC) approach. A speckle pattern is applied to the plantar aspect of the foot using a low ink transference method. A raised walkway with transparent panels is combined with a calibrated camera to capture images of the plantar aspect throughout a single stance phase. Plantar strain is then determined using 2D DIC and custom analysis summarises these data into clinically relevant metrics. A feasibility study involving six healthy participants was used to assess the efficacy of this new technique. The feasibility study successfully captured plantar surface strain characteristics continuously throughout the stance phase for all participants. Peak mean and averaged mean strains varied in location between participants when mapped into anatomical regions of plantar interest, ranging from the calcaneus to the metatarsal heads and hallux. This method provides the ability to measure plantar skin strain for use in both research and clinical environments. It has the potential to inform improved understanding of the role of strain in DFU formation. Further studies using this technique can support these ambitions and help differentiate between healthy and abnormal plantar strain regimes.

Malaria Control with Bed Nets; Assessment of Corelates of its Effectiveness for Pregnant Women in Kwaebibirem

Objective: This study aimed to investigate correlates of the effectiveness of Insecticide-treated Bed Nets (ITNs) for prevention of malaria through pregnancy till delivery.Methodology: The hospital-based cross sectional study enrolled 413 Antenatal Care (ANC) attendants at the maternity ward of the Kade government hospital. Differential patterns of use of ITNs among women who had malaria during pregnancy and women who did not have malaria during pregnancy were compared across various variables. Self-reported information by participants were objectively validated from maternal health record books, patient folders and other relevant maternal health registers.Results: ITNs are an important malaria prevention and control intervention among pregnant women who report using them during pregnancy. The period prevalence of malaria through pregnancy however remained high among adolescents irrespective of ITNuse while tertiary educational background and exposure to Intermittent Preventive Therapy with Sulfadoxine-pyrimethamine (IPTp-SP) reduced risk of malaria in pregnancy irrespective of ITN use.Conclusion: Malaria morbidity was generally higher among pregnant women who did not use bed nets during pregnancy despite variations by maternal age, area of residence, gestational age, occupation type, marital status, parity, maternal educational background and IPTp-SP status.Recommendations: Strategies aimed to reduce the period prevalence of malaria during pregnancy should be intensified particularly targeting adolescents. Barriers to sustained universal access to ITNs and IPTp-SP should be eliminated while policies aimed toincrease formal education should be prioritized.

The effect of nutrition education for cancer prevention based on health belief model on nutrition knowledge, attitude, and practice of Iranian women

BackgroundIn recent years, nutrition has received an increasingly important role in the etiology of cancer. Thus, public education about dietary factors associated with cancer risk or prevention could be an important intervention for cancer prevention, particularly in low- and middle-income countries where the burden of cancer is increasing rapidly and the access to care is limited. The age-standardized incidence of breast cancer was 35.8 among Iranian women in 2020. We aimed to study the effect of nutrition education on the knowledge, attitude, and practice of Iranian women towards dietary factors related to cancer.MethodsIn this interventional study, 229 women from public health centers were recruited and underwent three 75-min sessions of education based on the Health Belief Model (HBM). Participants were interviewed by trained interviewers using a validated and reproducible nutrition-related cancer prevention knowledge, attitude, and practice questionnaire (NUTCANKAP) questionnaire designed based on the HBM. Nutritional knowledge, attitude, and practice of participants were assessed through this questionnaire. Three 24-h dietary recalls (one weekend and two nonconsecutive weekdays) were also collected before and one month after the intervention.ResultsThe mean age of the participants was 45.14 years, and the mean BMI was 27.2 kg/m2. After the intervention, the participants had a higher intake of whole grain (p = 0.03) and a lower fat dairy (p = 0.009) and nuts (p = 0.04). However, the intake of high-fat dairy (p = 0.001) decreased after the intervention. We indicated significant differences in knowledge (p < 0.001) and nutritional practice scores (p = 0.01) after education. In addition, after the intervention, there were significant differences in the mean score of the HBM components, except for the perceived self-efficacy.ConclusionParticipation in a nutrition education program positively impacted the knowledge and nutritional practices linked to cancer prevention.

Knowledge and Utilization of Postnatal Care Services among Mothers Residing in a Community of Jhapa District

IntroductionPostnatal care is the most important maternal health care intervention for prevention of impairments, disabilities and also reduction of maternal mortality. However, mothers often only seek postnatal care in the event of complications after birth. The aim of this study is to assess the knowledge and utilization of postnatal care services among mothers in a community at Buddhashanti, Jhapa. MethodsA descriptive cross sectional research design was adopted. Sample was taken from married women in the reproductive age group, residing in Buddhashanti rural municipality of Jhapa District, who had a live baby less than 24 months old, attending immunization outreach clinics. Non-probability purposive sampling was used to collect data. The sample size was 104. Data were collected using a self-developed, semi-structured questionnaire through interview. Descriptive statistics such asfrequency mean and standard deviation were used in the analysis of collected data. Association between dependent and independent variables was measured by using the Chi- square test. ResultsThe finding of the study revealed that less than half (32.7%) of the mothers had good knowledge on postnatal care. Similarly, the majority (87.5%)of mothers had not utilized postnatal care services. Study revealed that level of knowledge had significant association with ethnicity, educational level of respondent and number of ANC visits with p- value 0.002, 0.038, 0.040 respectively. Furthermore, utilization of postnatal care had association with occupation of respondent and typeof delivery (p- value&lt;0.05). ConclusionsThis study showed that respondents had poor knowledge on postnatal care and the majority of respondents had not utilized postnatal care services. Study revealed that ethnicity; educational level of respondent and no. of ANC visit had association with level of knowledge. Furthermore, occupation of respondent and type of delivery had association with utilization of postnatal care.

Boosting the impact of seasonal malaria chemoprevention (SMC) through simultaneous screening and treatment of household members of children receiving SMC in Burkina Faso: a protocol for a randomized open label trial

BackgroundPlasmodium falciparum malaria remains a major public health concern in sub-Sahara Africa. Seasonal malaria chemoprevention (SMC) with amodiaquine + sulfadoxine-pyrimethamine is one of the most important preventive interventions. Despite its implementation, the burden of malaria is still very high in children under five years old in Burkina Faso, suggesting that the expected impact of this promising strategy might not be attained. Development of innovative strategies to improve the efficacy of these existing malaria control measures is essential. In such context, we postulate that screening and treatment of malaria in household members of children receiving SMC could greatly improve the impact of SMC intervention and reduce malaria transmission in endemic settings.MethodsThis randomized superiority trial will be carried out in the Nanoro health district, Burkina Faso. The unit of randomisation will be the household and all eligible children from a household will be allocated to the same study group. Households with 3–59 months old children will be assigned to either (i) control group (SMC alone) or (ii) intervention (SMC+ screening of household members with standard Histidin Rich Protein Rapid Diagnostic Test (HRP2-RDT) and treatment if positive). The sample size will be 526 isolated households per arm, i.e., around 1052 children under SMC coverage and an expected 1315 household members. Included children will be followed-up for 24 months to fully cover two consecutive malaria transmission seasons and two SMC cycles. Children will be actively followed-up during the malaria transmission seasons while in the dry seasons the follow-up will be passive.ConclusionThe study will respond to a major public health concern by providing evidence of the efficacy of an innovative strategy to boost the impact of SMC intervention.

Risk factors associated with malaria infection identified through reactive case detection in Zanzibar, 2012\u20132019

BackgroundOver the past two decades, Zanzibar substantially reduced malaria burden. As malaria decreases, sustainable improvements in control interventions may increasingly depend on accurate knowledge of malaria risk factors to further target interventions. This study aimed to investigate the risk factors associated with malaria infection in Zanzibar.MethodsSurveillance data from Zanzibar’s Malaria Case Notification system from August 2012 and December 2019 were analyzed. This system collects data on malaria cases passively detected and reported by all health facilities (index cases), and household-based reactive case detection (RCD) activities linked to those primary cases. All members of households of the index cases were screened for malaria using a malaria rapid diagnostic test (RDT). Individuals with a positive RDT were treated with artemisinin-based combination therapy. Univariate and multivariate logistic regression analyses were done to investigate the association between RDT positivity among the household members and explanatory factors with adjustment for seasonality and clustering at Shehia level.ResultsA total of 30,647 cases were reported of whom household RCD was completed for 21,443 (63%) index case households and 85,318 household members tested for malaria. The findings show that younger age (p-value for trend [Ptrend] < 0.001), history of fever in the last 2 weeks (odds ratio [OR] = 35.7; 95% CI 32.3–39.5), travel outside Zanzibar in the last 30 days (OR = 2.5; 95% CI 2.3–2.8) and living in Unguja (OR = 1.2; 95% CI 1.0–1.5) were independently associated with increased odds of RDT positivity. In contrast, male gender (OR=0.8; 95% CI 0.7–0.9), sleeping under an LLIN the previous night (OR = 0.9; 95% CI 0.7–0.9), having higher household net access (Ptrend < 0.001), and living in a household that received IRS in the last 12 months (OR = 0.8; 95% CI 0.7–0.9) were independently associated with reduced odds of RDT positivity. A significant effect modification of combining IRS and LLIN was also noted (OR = 0.7; 95% CI 0.6–0.8).ConclusionsThe findings suggest that vector control remains an important malaria prevention intervention: they underscore the need to maintain universal access to LLINs, the persistent promotion of LLIN use, and application of IRS. Additionally, enhanced behavioural change and preventive strategies targeting children aged 5–14 years and travellers are needed.

Assessment on the Effect of Active Management of Third Stage of Labour With and Without Uterine Massage on Maternal Outcome among Postnatal Mothers

The most common cause of maternal death worldwide is postpartum hemorrhage (PPH) and Active Management of Third Stage of Labour (AMTSL) is the most important prophylactic intervention for prevention of PPH. A study was undertaken to assess the effect of AMTSL with and without uterine massage on maternal outcome among postnatal mothers in a selected hospital, WB. In this quasi-experimental study, Total 60 (Experimental Group-30, Control Group-30) postnatal mothers who undergone spontaneous vaginal delivery were selected by non-probability purposive sampling technique followed by randomization. The uterine massage is applied for 1 min immediately after placental delivery to 2 hours of postpartum at every 15 mins interval. The results revealed that there was no statistically significant difference of mean amount of postpartum bleeding between experimental and control group at 1st hour, 2nd hour, 24 hours, and 48 hours [t1= 1.06, t2= 1.52, t3=0.47, t4=0.26 at df (58), p&gt;0.05]. The general condition (BP, Pulse, Respiration) after 1st hour, 2nd hour, 24 hours and 48 hours were comparable and statistically not significant between the two groups. There was no significant association between amount of postpartum bleeding and obstetrical parameters like parity, gravida, POG, presence of episiotomy, birth weight, time of placental delivery, presence of tear and time of initiation of breast feeding etc. for both groups. Based on the results of the current study, it can be concluded that the mothers who received the uterine massage along with AMTSL get no additional benefit as compared to control group. Keywords: Active management of third stage of labour (AMTSL); Uterine massage; Maternal outcome; Postnatal mother.

Application of a Scorecard Tool for Assessing and Engaging Media on Responsible Reporting of Suicide-Related News in India.

Background: Each year there are more than 800,000 deaths by suicide across the world, while India alone accounts for one third of female suicides and one fourth of male suicides worldwide. Responsible media reporting of suicide is an important suicide prevention intervention at the population level. There is sufficient evidence to show that the way suicide is reported and portrayed in the media can have a significant impact on individuals experiencing suicidal thoughts and behaviors. Recognizing the important role of the media in suicide prevention, the World Health Organization (WHO) issued guidelines for responsible reporting of suicides by the media. The Press Council of India, in 2019 endorsed WHO’s guidelines for media reporting of suicides, however there is no evidence that the Indian media is complying with these guidelines. Methods: To encourage responsible media reporting, we developed a scorecard to assess and rate media reports on suicide. We reviewed several resource documents that contained guidelines on responsible reporting of suicide. After consulting with a team of experts, we arrived at a scorecard that consisted of 10 positive and 10 negative parameters. Results: We applied the scorecard to 1318 reports on suicide from 9 English language newspapers, with the highest readership in India between the dates of 1 April to 30 June 2020. For the articles analyzed, the average positive score across all newspapers was 1.32 and the average negative score was 3.31. Discussion: The scorecard can be a useful tool to assess media reports on suicide and provide metrics for the same. It can facilitate improved monitoring and engagement with media organizations, who can quickly check their own reporting compliance to the WHO guidelines and compare how well they are performing compared to their peers over time.

Medical male circumcision and HIV prevention among men in Kwazulu-Natal, South Africa: A propensity score analysis

IntroductionEpidemiological theory and many empirical studies support the hypothesis that there is a protective effect of medical male circumcision (MMC) against HIV infection. We aim to test this claim with evidence from a high endemic community in South Africa. MethodologyWe analysed a cross-sectional dataset, including HIV test outcome and MMC status of males aged 15–49, who participated in the HIV Incidence Provincial Surveillance System study between June 2014 and June 2015. We applied two propensity score methods, inverse probability of treatment weighting (IPTW) and full matching, to approximate a randomised trial investigating the hypothesis that MMC protects against HIV infection. We benchmarked our results using the conventional regression adjustment. Models were adjusted for identified confounders. ResultsThe adjusted odds ratios (OR) provided evidence of a protective effect of MMC against HIV acquisition: IPTW (OR = 0.623, 95% CI: 0.467 – 0.830); Full matching (OR = 0.607, 95% CI: 0.440 – 0.837); Regression (OR = 0.579, 95% CI: 0.426 – 0.789). ConclusionThere is a need to create more programmes that emphasise MMC as an important HIV preventive intervention.

Gastrointestinal Tract: A Neglected Guardian Angel?

Role of the gastrointestinal (GI) system is not limited to the digestion of food and absorption of water and nutrients. Gastrointestinal mucosa forms a barrier preventing translocation of microbes into the blood. Upper GI tract performs important function of swallowing and prevention of aspiration, failure of which mandates enteral tube feeding. Rate of gastric emptying depends on gastric volume and contents and delayed emptying is observed both in solid and in fatty food. Cricoid pressure during intubation is an important intervention for prevention of aspiration in critically ill patients who are considered as full stomach. To utilize mucosal barrier function optimally, hemodynamically stable patients should preferably receive enteral nutrition even if they are on small doses of vasopressors. Post-pyloric feeds may reduce risk of aspiration and hence are recommended for patients who are deemed to have high risk for aspiration. Bowel sounds have poor reproducibility, sensitivity, specificity, accuracy, and interobserver agreement, and absent bowel sounds should not be considered as a contraindication to enteral feeding.How to cite this article: Kothekar AT, Kulkarni AP. Gastrointestinal Tract: A Neglected Guardian Angel? Indian J Crit Care Med 2020;24(Suppl 4):S146–S151.

Knowledge, Attitudes and Practices of Diabetes Amongst Diabetes Patients at A Primary Health Care Centre in Durban, South Africa

Background: Diabetes Mellitus (DM) is considered a major public health problem in South Africa and Globally. The condition is not well-managed globally and in SA. The most important known intervention for prevention and management of DM is lifestyle modification which depends largely on the knowledge, attitude and practices of DM patients and general population. The objective of the study was to investigate the knowledge, attitudes, and practices on diabetes among DM patients. Method: This was a cross-sectional prospective study conducted on diabetic patients attending a primary health care centre in South Africa between January to June 2018. Students t-test and ANOVA tests were conducted to find the mean difference of the knowledge, attitude, and practice scores among the demographic variables. Pearson’s correlation test was conducted to find the relationship between Knowledge, attitudes, and practice towards DM. All statistical tests were performed using two-sided tests at the 0.05 level of significance. Results: Most of the respondents were over the age of 45 years (87%), female (74%), had no education (58%) and unemployed (52%). Results showed that DM patients had poor level of knowledge, had better positive attitudes towards DM and the respondents were practicing positively towards the management of DM. DM patients in the age group of 46-55 years were practicing better towards DM compared to patients from age group of 25-35 years. It was also found that those had no income practiced significantly better than those earning &gt;R3001 per month (p&lt;0.05). It was found that knowledge was moderately positively correlated with practice towards DM (p&lt;0.05). Conclusion: The knowledge and practice levels of lifestyle modifications and control of type 2 diabetes mellitus patients attending KwaDabeka Community Health Centre were generally poor. Nevertheless, majority of these patients have positive attitude toward healthy lifestyle habits which could potentially be harnessed and translated into healthy lifestyle practices. Health education intervention through Health Care Workers might improve the knowledge, attitudes and practices of the DM patients regarding DM.

Room for Improvement: Results of a Baseline Evaluation of Environmental Cleaning in a Resource-Limited Neonatal Unit

Background: Contamination of the near-patient hospital environment including work surfaces and equipment, contributes to skin colonization and subsequent invasive bacterial infections in hospitalized neonates. In resource-limited settings, cleaning of the neonatal ward environment and equipment is seldom standardized and infrequently audited. Methods: A baseline multimodal assessment of surface and equipment cleaning was performed in a 30-bed high-care neonatal ward in Cape Town, South Africa, October 7–9, 2019. Adequacy of routine cleaning was evaluated using ATP bioluminescence assays, fluorescent ultraviolet (UV) markers, and quantitative bacterial surface cultures. For flat surfaces (eg, tables, incubators, trolleys), a 10×10-cm template was used to standardize the swab inoculum; for small equipment and devices with complex surfaces (eg, humidifiers, suction apparatus, stethoscopes), a standard swabbing protocol was developed for each item. Swabs in liquid transport medium were processed in the laboratory by vortexing for 30 seconds, plating onto blood and MacConkey agars, and incubating at 37°C for 48 hours. Manual counting of bacterial colony forming units was performed, followed by conventional biochemical testing and/or VITEK automated identification. Results: Of 100 swabs (58 from surfaces and 42 from equipment), 11 yielded growth of known neonatal pathogens (Enterobacteriaceae, A. baumannii, P. aeruginosa, S. aureus, S. agalactiae, and enterococci), 36 isolated potential neonatal pathogens (mostly coagulase-negative staphylococci). In addition, 4 grew environmental organisms and 49 showed no growth. The highest aerobic colony counts (ACCs) were obtained from swabs of suction tubing, milk kitchen surfaces, humidifiers, and sinks; the median ACC from swabs with any bacterial growth (n = 51) was 3 (IQR, 1–22). Only 40% of the 100 surface and equipment swabs had ATP values &lt;200 relative light units (RLU) threshold for cleanliness. Median ATP values were 301 (IQ range, 179–732) RLUs for surface swabs versus 230 (IQ range, 78–699) RLUs for equipment swabs (P = .233). Of the 100 fluorescent UV markers placed on near-patient surfaces and high-touch equipment, only 23% had been removed after 2 staff shift changes (24 hours later). Surfaces had a higher proportion of UV marker removal than equipment (19 of 58 [32.8%] vs 4 of 42 [9.5%]; P = .008). Conclusions: Environmental cleaning of this neonatal ward was suboptimal, especially for equipment. Improvement of environmental cleaning practices is an important intervention for neonatal infection prevention in resource-limited settings. Future studies should evaluate the impact of staff training, environmental cleaning tools and repeated audit with feedback, on the adequacy of cleaning in neonatal wards.Funding: Funding: for the laboratory work was provided by The Society for Healthcare Epidemiology of America (SHEA) International Ambassador Alumni Research Award and a South African Medical Research Council Self-initiated Research (SIR) Grant to Angela Dramowski, who is supported by a NIH Fogarty Emerging Global Leader Award K43 TW010682.Disclosures: None

Evidence of high bed net usage from a list randomization experiment in rural Gambia

BackgroundRecording behaviours that have the potential to impact health can be doubly challenging if the behaviour takes place in private spaces that cannot be observed directly, and where respondents answer what they think the recorder may want to hear. Sleeping under a long-lasting insecticidal net (LLIN) is an important intervention for malaria prevention, yet it is difficult to gauge the extent to which coverage (how many nets are in the community) differs from usage (how many people actually sleep under a net). List randomization, a novel method which partially obscures respondents’ answers to sensitive questions, was employed to estimate LLIN usage in The Gambia.Methods802 heads-of-household from 15 villages were recruited into a randomized controlled trial assessing the effect of a housing intervention on malaria. These houses were randomly assigned to a housing intervention versus control, with stratification by village so as to ensure balance between arms. From these, 125 households (63 intervention, 52 control) were randomly selected for participation in the list randomization experiment, along with 68 households from the same villages but which were not part of the housing improvement study, resulting in a total of 196 households for the list randomization experiment. Approximately half (n = 97) of the 196 study participants were randomly assigned to the control group and received a four-question list about non-sensitive behaviours; the intervention group (n = 99) received the same list, with the addition of one question on a sensitive behaviour: whether or not they had used a bed net the previous night. Participants were read the list of questions and then said how many of the statements were true. Bed net usage was estimated by calculating the difference in means between the number of affirmative responses between the two groups.ResultsThe mean number of affirmative responses in the control group was 2.60 of four statements (95% confidence interval, 95% CI 2.50–2.70), compared with 3.68 (95% CI 3.59–3.78) in the intervention group. Such difference (1.08; 95% CI 94.9–100%) suggests near universal bed net usage.ConclusionsBed net usage by household heads in these rural villages was found to be high. Though not entirely unexpected given other studies’ estimates of high bed net usage in the area, the list randomization method should be further validated in an area with lower coverage.

Barriers and Enabling Factors Associated with the Implementation of Household Solar Water Disinfection: A Qualitative Study in Northwest Ethiopia.

Household water treatment including solar disinfection (SODIS) is recognized worldwide as an important intervention for prevention and control of diarrheal and other waterborne diseases. However, in Ethiopia's countryside, SODIS is not being practiced. Therefore, the objective of this qualitative study conducted in villages of Dabat district in northwest Ethiopia was to explore barriers to and enabling factors for consistent and wider implementation of SODIS. This phenomenological study design included four focus group discussions with 25 parents of children younger than 5 years and interviews with four key informants to elicit their experiences and opinions. ATLAS.ti 8.0 software (GmbH, Berlin, Germany) was used for data organization, and the content was analyzed thematically. Enabling factors were categorized into four themes, such as supportive values for SODIS (positive attitude, advantage of SODIS, and cultural acceptance of SODIS), consistent use of SODIS (community's interest, health education, availability of bright sunlight, and simplicity of the method), participation of family and community in daily implementation of the SODIS process (controlling theft of bottles and recognizing the importance of SODIS technology), and willingness to pay for new polyethylene terephthalate (PET) bottles. On the other hand, barriers were grouped into three themes such as sociocultural (poor knowledge, hesitation to leave SODIS bottles unguarded outdoor, less attention, and unplanned social events), environmental (cloud, shadow over SODIS bottles, turbidity and leeches in source water, and geographical settings), and behavioral (mishandling of SODIS bottles and drinking water). The analysis of the data revealed that all the participants had positive attitude toward the implementation of SODIS, and it was culturally accepted. They identified the barriers to and enabling factors for the implementation of SODIS. Promoting enabling factors and mitigating barriers are substantially important for consistent implementation of SODIS as a long-term interventional measure widely in rural Ethiopia for the achievement of the goal of safe drinking water for all.

Elimination of Mother-to-Infant Transmission of Hepatitis B Virus: 35 Years of Experience.

Chronic hepatitis B viral (HBV) infection remains a major health threat, especially in high-prevalence areas. Most infants infected by mother-to-infant HBV transmission become chronic carriers. In Taiwan, many important preventive interventions have been implemented to block the perinatal transmission of HBV in the past 35 years. The first nationwide universal HBV vaccination program was launched in Taiwan in July 1984. The three-dose HBV vaccine completion rate reached 98.1% in 2018. The prevalence of Hepatitis B surface antigen (HBsAg) decreased from 9.8% in pre-vaccinated period in 1984 to 0.5% in the vaccinated cohort in 2014. The incidence of hepatocellular carcinoma in children aged 6–9 years significantly declined from 0.52 to 0.13 per 100,000 children born before and after 1984, respectively. Furthermore, we have performed a maternal HBV screening program during pregnancy since 1984, with the screening rate peaked at 93% in 2012. The HBsAg- and HBeAg-seropositive rate in pregnant women declined from 13.4% and 6.4% in 1984–1985 to 5.9% and 1.0% in 2016, respectively. To closely control perinatal HBV infection, we have administered hepatitis B immunoglobulin immediately after birth and checked the serum level of HBsAg and anti-HBs in high-risk babies born to HBsAg-seropositive mothers, irrespective of their HBeAg status, since July 2019. We have also adopted short-term antiviral treatments such as tenofovir 300 mg daily in the third trimester for highly viremic mothers and reduced the perinatal infection rates from 10.7 to 1.5%. Through all these efforts, we expect to meet the global goal of eliminating HBV infection by 2030.

Depression and Uptake of Oral Anticoagulation Therapy in Patients With Atrial Fibrillation: A Danish Nationwide Cohort Study.

Oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF) is a highly important preventive intervention, perhaps especially in those with comorbid depression, who have a worse prognosis. However, OAT may pose particular challenges in depressed patients. To assess whether AF patients with depression have lower OAT uptake. This nationwide register-based 2005-2016 cohort study of all Danes with AF and OAT indication (CHA2DS2VASc stroke risk score ≥2) assessed OAT initiation within 90 days in those with incident AF (N=147,162) and OAT prevalence in those with prevalent AF (N=192,656). The associations of depression with both outcomes were estimated in regression analyses with successive adjustment for socioeconomic characteristics and somatic and psychiatric comorbidity. Comorbid depression was significantly associated with lower frequency of OAT initiation in incident AF patients {adjusted proportion differences (aPDs): -6.6% [95% confidence interval (CI), -7.4 to -5.9]} and lower prevalence of OAT [aPD: -4.2% (95% CI, -4.7 to -3.8)] in prevalent AF patients. Yet, the OAT uptake increased substantially during the period, particularly in depressed patients [aPD for OAT prevalence in 2016: -0.8% (95% CI, -1.6 to -0.0)]. Comorbid depression was associated with a significantly lower OAT uptake in patients with AF, which questions whether depressed patients receive sufficient support to manage this consequential cardiac condition. However, a substantial increase in the overall OAT uptake and a decrease of the depression-associated deficit in OAT were seen over the period during which OAT was developed through the introduction of new oral anticoagulation therapy.