Low-income Countries Worldwide Research Articles

KARYOLOGICAL CHANGES OF BUCCAL EPITHELIOCYTES IN CHILDREN WITH ACUTE RESPIRATORY PATHOLOGY CAUSED BY SARS-COV-2

Pneumonia is one of the leading causes of death in children under 5 years of age in lowincome countries worldwide. This problem became especially acute with the onset ofthe new coronaviral infection caused by SARS-CoV-2. Community- acquired pneumoniais also one of the most common diseases in children, which requires extensive use ofantibiotics and admission to pediatric clinics. That is why diagnosis of the infectiousinflammatory process activity and prediction of the disease severity is the main factorin optimizing the treatment of children who suffer from infectious respiratory pathology.Objective – to improve the prediction of the severe course of acute respiratory pathologycaused by the SARS-CoV-2 virus by analyzing the results of kariological indicators ofexfoliative cells of the buccal epithelium in children of different ages. Materials and methods. 63 children with acute respiratory pathology caused by theSARS-CoV-2 virus (average age – 10.6±0.5 years) were comprehensively examinedby the method of simple random sampling using the «experiment- control» method.The verification of the etiological factor of inflammation of the respiratory tract wascarried out by the method of polymerase chain reaction with reverse transcriptase(a set of COVID-19 Multiplex RT-PCR in real time from Labsystems Diagnostics Oy) ina nasopharyngeal swab and/or lung expiratory tissue.Fixed smears- imprints of exfoliative cells of the buccal epithelium were stained with azureeosin according to Romanovsky- Giemsa. By light microscopy of cytological samples,changed cells with nuclear abnormalities were evaluated and the number of cells withmicronuclei and karyological indicators of exfoliative cells of the buccal epithelium per100 cells in the preparation were determined.Results.Pathological changes of buccal epithelium exfoliative cells as protrusion, karyopyknosis,karyorrhexis and apoptosis are directly proportional to the disease severity and reflect exclusivelytoxic effects. Identification of the morphological changes expressiveness in the buccal epitheliumcells can be used as a diagnostic factor in prediction of the severe disease, and accordingly,serves as an impetus in optimization of the conducted treatment strategy.Conclusions. A greater number of pathological cells in smears- imprints of the buccalepithelium, and, accordingly, slightly higher cytogenetic indices are determined in patientswith pneumonia and multisystem inflammatory syndrome associated with SARS-CoV-2, whohad a severe and extremely severe course of the disease. Significantly fewer pathologicallychanged cells are found in patients with acute respiratory tract infection of multiplelocalization and bronchitis, who mostly had a medium- severe course of the disease, whichcan be used to predict the severity of the infectious- inflammatory process in children.

An Assessment of the Russo-Ukrainian Conflict on the European Cereal Exports Using Network Theory

Abstract Cereal grains are basic nutrients in the human diet. Given the production capacity gap between countries, food security is subject to global challenges. The Russian invasion of Ukraine from February 2022 has inevitably raised concerns on the resilience of the agro-food system. In this paper, we use network theory to examine the export flows of the European producers of wheat, maize, and barley. Based on annual data from the United Nations Comtrade database, we build specific weighted and directed networks to comparatively assess the dynamics of cereal exporting patterns. We employ centrality metrics for network statistics and modularity for community detection. The central hub for all three cereals remained unchanged. Our results show the following core countries Russia for wheat, France for barley and Ukraine for maize. Their main export destination is also the same, from Russia to Türkiye, France to China and Ukraine to China respectively. Compared to the previous year, several destinations including low-income countries worldwide did not appear as recipients of the Ukrainian exports, but additional countries located in Europe and interconnected by land emerged as partners. This study provides a general assessment of the European exports to support a better understanding of the community structure under the Russo-Ukrainian conflict setting.

An epidemiological survey of porcine cysticercosis in Rungwe District, Tanzania

Taeniasis/cysticercosis caused by tapeworms belonging to the genus Taenia, poses serious veterinary and public health problems, resulting in economic burden in endemic low-income countries worldwide. However, little epidemiological data exist on infection status among pigs in many areas in Tanzania. We conducted a cross-sectional survey in Rungwe District, Mbeya Region, Tanzania, to define the prevalence and risk factors associated with porcine cysticercosis transmission. One-hundred sixty-nine pigs from 152 households were examined for circulating taeniid antigens by cysticercosis antigen (Ag) enzyme-linked immunosorbent assay (ELISA). Agarose gel electrophoresis was used to differentially diagnose Taenia species-specific cysticerci DNA bands. Structured questionnaires were administered in the surveyed households to collect information on risk factors for porcine cysticercosis transmission. Sera from eleven household pigs tested positive for porcine cysticercosis in the Ag-ELISA with an apparent prevalence of 6.5 % (95 % C.I. 3.8–11.3 %) and estimated true prevalence of 6.1 % (95 % C.I. 3.3–10.9 %). DNA Gel electrophoresis confirmed that 100 % of cysticerci isolated amongst pigs slaughtered in the study area belonged to T. solium. Of the five surveyed wards, positive household pigs were from Bulyaga, Kiwira, and Mpuguso. Lack of knowledge on porcine cysticercosis among household members was found to be significantly associated with positivity of Taenia species antigen in pigs sera (OR = 7.742, p = 0.017). Our results show that porcine cysticercosis is prevalent in Rungwe. There is a definite need to establish control measures against this potential zoonosis to safeguard veterinary and public health in the Rungwe District.

Use of quality improvement methodology to improve care of women with hypertensive disease in pregnancy and haemorrhage in Yemen (low-income, high-insecurity setting)

This safety improvement project used quality improvement methods in a Comprehensive Emergency Obstetric and Newborn Care facility in Yemen, managed by an international humanitarian non-governmental organisation. It is responsible for...

Pan-GWAS of Streptococcus agalactiae Highlights Lineage-Specific Genes Associated with Virulence and Niche Adaptation.

Streptococcus agalactiae (group B streptococcus; GBS) is a colonizer of the gastrointestinal and urogenital tracts, and an opportunistic pathogen of infants and adults. The worldwide population of GBS is characterized by clonal complexes (CCs) with different invasive potentials. CC17, for example, is a hypervirulent lineage commonly associated with neonatal sepsis and meningitis, while CC1 is less invasive in neonates and more commonly causes invasive disease in adults with comorbidities. The genetic basis of GBS virulence and the extent to which different CCs have adapted to different host environments remain uncertain. We have therefore applied a pan-genome-wide association study (GWAS) approach to 1,988 GBS strains isolated from different hosts and countries. Our analysis identified 279 CC-specific genes associated with virulence, disease, metabolism, and regulation of cellular mechanisms that may explain the differential virulence potential of particular CCs. In CC17 and CC23, for example, we have identified genes encoding pilus, quorum-sensing proteins, and proteins for the uptake of ions and micronutrients which are absent in less invasive lineages. Moreover, in CC17, carriage and disease strains were distinguished by the allelic variants of 21 of these CC-specific genes. Together our data highlight the lineage-specific basis of GBS niche adaptation and virulence.IMPORTANCE GBS is a leading cause of mortality in newborn babies in high- and low-income countries worldwide. Different strains of GBS are characterized by different degrees of virulence, where some are harmlessly carried by humans or animals and others are much more likely to cause disease.The genome sequences of almost 2,000 GBS samples isolated from both animals and humans in high- and low- income countries were analyzed using a pan-genome-wide association study approach. This allowed us to identify 279 genes which are associated with different lineages of GBS, characterized by a different virulence and preferred host. Additionally, we propose that the GBS now carried in humans may have first evolved in animals before expanding clonally once adapted to the human host.These findings are essential to help understand what is causing GBS disease and how the bacteria have evolved and are transmitted.

How can schools be integrated in promoting well-being, preventing mental health problems and averting substance-use disorders in urban populations?

Mental health and substance use problems are among the most prevalent and challenging problems faced by both high-income and low-income countries worldwide. This review will focus on summarizing scattered evidence of school-based interventions to promote well-being and prevent mental health problems and substance use disorders in children and adolescents. We focus on two main areas of research: promotion of healthy school climate and prevention of bullying. Choosing among available interventions might be challenging, both because of the difficulties in assessing their efficacy and tailoring interventions to specific needs, but also because of the scarcity of intervention in low-resource settings. We provide some guidance on principles encompassed by the available evidence that can be used for policymakers and local communities aiming to integrate mental health promotion and prevention into their schools. Developing, implementing, scaling and sustaining school-based interventions is a necessity of our field if we want to move closer to sustainable development goals.

Could Mucuna pruriens be the answer to Parkinson's disease management in sub-Saharan Africa and other low-income countries worldwide?

Parkinson's disease (PD) is a progressive, disabling, neurodegenerative disease that requires long term care and pharmaceutical treatment. Levodopa remains the gold standard treatment for PD globally, although it is largely unavailable and unaffordable for the majority of patients in many sub-Saharan African and other low-income countries (LICs). We suggest the potential for Mucuna pruriens (MP), a leguminous plant, to replace or supplement levodopa-based medicines in countries where levodopa is unaffordable and inaccessible due to its low costs of preparation and high natural availability. MP has been shown to induce a great improvement of motor symptoms with few adverse events in recent studies. However, caution is important until more robust data on the long-term safety of MP are available. We believe that MP could potentially be part of the answer to affordable, symptomatic treatment of PD in LICs worldwide.

Effects of 'The Vicious Worm' educational tool on Taenia solium knowledge retention in Zambian primary school students after one year.

BackgroundTaenia solium is a neglected zoonotic parasite endemic throughout many low-income countries worldwide, including Zambia, where it causes human and pig diseases with high health and socioeconomic burdens. Lack of knowledge is a recognized risk factor, and consequently targeted health educational programs can decrease parasite transmission and disease occurrence in endemic areas. Preliminary assessment of the computer-based education program ‘The Vicious Worm’ in rural areas of eastern Zambia indicated that it was effective at increasing knowledge of T. solium in primary school students. The aim of this study was to evaluate the impact of ‘The Vicious Worm’ on knowledge retention by re-assessing the same primary school students one year after the initial education workshops.Methodology/Principal findingsFollow-up questionnaires were administered in the original three primary schools in eastern Zambia in 2017, 12 months after the original workshops. In total, 86 pupils participated in the follow-up sessions, representing 87% of the initial workshop respondents. Knowledge of T. solium at ‘follow-up’ was significantly higher than at the initial ‘pre’ questionnaire administered during the Vicious Worm workshop that took place one year earlier. While some specifics of the parasite’s life cycle were not completely understood, the key messages for disease prevention, such as the importance of hand washing and properly cooking pork, remained well understood by the students, even one year later.Conclusions/SignificanceResults of this study indicate that ‘The Vicious Worm’ may be an effective tool for both short- and long-term T. solium education of rural primary school students in Zambia. Inclusion of educational workshops using ‘The Vicious Worm’ could be recommended for integrated cysticercosis control/elimination programs in sub-Saharan Africa, particularly if the content is simplified to focus on the key messages for prevention of disease transmission.

Elevated blood pressure in the developing world: a role for clinical pharmacists.

The objective of this study was to evaluate the prevalence and patient knowledge of elevated blood pressure amongst a cross-section of patients in underserved communities in three selected low-income countries worldwide: El Salvador, India and Kenya. Mobile medical clinics were established as part of medical mission trips in El Salvador, India and Kenya. Willing male and female patients, at least 25 years of age, who presented at each clinic were screened for elevated blood pressure, including 332 patients in El Salvador, 847 patients in India and 160 patients in Kenya. Patients were classified into Stage I or II elevated blood pressure based on modified JNCVII guidelines. A questionnaire was completed regarding their knowledge about the existence and management of their disease state. Of the 1339 patients screened, 368 presented with elevated blood pressure (27%). Of these patients, 147 had been previously informed of hypertension or an elevated blood pressure (39.9%), 28 reported receiving antihypertensive medication (7.6%) and 24 reported awareness of non-pharmaceutical treatment options (6.5%). In Kenya, 81 patients were screened in a rural setting and 79 in an urban setting. Patients demonstrating controlled blood pressure were 63 (78%) and 38 (48%), respectively, demonstrating a significant difference between the rural versus urban settings (P = 0.00359). All regions demonstrated similar trends in the prevalence of elevated blood pressure, highlighting the need for increased disease state education in these regions.

'Better medicines for children' within the Integrated Management of Childhood Illness framework: a qualitative inquiry in Uganda.

BackgroundThe Integrated Management of Childhood Illnesses is the main approach for treating children in more than 100 low income countries worldwide. In 2007, the World Health Assembly urged countries to integrate ‘better medicines for children’ into their essential medicines lists and treatment guidelines. WHO regularly provides generic algorithms for IMCI and publishes the Model Essential Medicines List with child-friendly medicines based on new evidence for member countries to adopt. However, the status of ‘better medicines for children’ within the Integrated Management of Childhood Illnesses approach in Uganda has not been studied.MethodsQualitative interviews were conducted with: two officials from the ministry of health; two district health officials and, 22 health workers from public health facilities. Interview transcripts were manually analyzed for manifest and latent content.ResultsChild-appropriate dosage formulations were not included in the package for the Integrated Management of Childhood Illnesses and ministry officials attributed this to resource constraints and lack of initial guidance from the World Health Organization. Underfunding reportedly undercut efforts to: orient health workers; do support supervision and update treatment guidelines to reflect ‘better medicines for children’. Health workers reported difficulties in administering tablets and capsules to under-five children and that’s why they preferred liquid oral dosage formulations, suppositories and injections.ConclusionsThe IMCI strategy in Uganda was not revised to reflect child-appropriate dosage formulations – a missed opportunity for improving the quality of management of childhood illnesses. Funding was an obstacle to the integration of child-appropriate dosage formulations. Ministry of health should prioritize funding for the Integrated Management of Childhood Illnesses and revising the Essential Medicines and Health Supplies List of Uganda, the Uganda Clinical Guidelines and, the Treatment Charts for the Integrated Management of Childhood Illnesses to reflect child-appropriate dosage formulations.

Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults.

Pain on propofol injection is an untoward effect and this condition can reduce patient satisfaction. Intravenous lidocaine injection has been commonly used to attenuate pain on propofol injection. Although many studies have reported that lidocaine was effective in reducing the incidence and severity of pain, nevertheless, no systematic review focusing on lidocaine for preventing high-intensity pain has been published. The objective of this review was to determine the efficacy and adverse effects of lidocaine in preventing high-intensity pain on propofol injection. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10), Ovid MEDLINE (1950 To October 2014), Ovid EMBASE (1988 to October 2014), LILACS (1992 to October 2014) and searched reference lists of articles.We reran the search in November 2015. We found 11potential studies of interest, those studies were added to the list of 'Studies awaiting classification' and will be fully incorporated into the formal review findings when we update the review. We included randomized controlled trials (RCTs) using intravenous lidocaine injection as an intervention to decrease pain on propofol injection in adults. We excluded studies without a placebo or control group. We collected selected studies with relevant criteria. We identified risk of bias in five domains according to the following criteria: random sequence generation, allocation concealment, adequacy of blinding, completeness of outcome data and selective reporting. We performed meta-analysis by direct comparisons of intervention versus control. We estimated the summary odds ratios (ORs) and 95% confidence intervals using the random-effects Mantel-Haenszel method in RevMan 5.3. We used the I(2) statistic to assess statistical heterogeneity. We assessed overall quality of evidence using the GRADE approach. We included 87 studies, 84 of which (10,460 participants) were eligible for quantitative analysis in the review. All participants, aged 13 years to 89 years, were American Society of Anesthesiologists (ASA) I-III patients undergoing elective surgery. Each study was conducted in a single centre in high- , middle- and low-income countries worldwide. According to the risk of bias assessment, all except five studies were identified as being of satisfactory methodological quality, allowing 84 studies to be combined in the meta-analysis. Five of the 84 studies were assessed as high risk of bias: one for participant and personnel blinding, one for incomplete outcome data, and three for other potential sources of bias.The overall incidence of pain and high-intensity pain following propofol injection in the control group were 64% (95% CI 60% to 67.9%) and 38.1% (95% CI 33.4% to 43.1%), respectively while those in the lidocaine group were 30.2% (95% CI 26.7% to 33.7%) and 11.8% (95% CI 9.7% to 13.8%). Both lidocaine admixture and pretreatment were effective in reducing pain on propofol injection (lidocaine admixture OR 0.19, 95% CI 0.15 to 0.25, 31 studies, 4927 participants, high-quality evidence; lidocaine pretreatment OR 0.13, 95% CI 0.10 to 0.18, 43 RCTs, 4028 participants, high-quality evidence). Similarly, lidocaine administration could considerably decrease the incidence of pain when premixed with the propofol (OR 0.19, 95% CI 0.15 to 0.24, 36 studies, 5628 participants, high-quality evidence) or pretreated prior to propofol injection (OR 0.14, 95% CI 0.11 to 0.18, 52 studies, 4832 participants, high-quality evidence). Adverse effects of lidocaine administration were rare. Thrombophlebitis was reported in only two studies (OR not estimated, low-quality evidence). No studies reported patient satisfaction. Overall, the quality of the evidence was high. Currently available data from RCTs are sufficient to confirm that both lidocaine admixture and pretreatment were effective in reducing pain on propofol injection. Furthermore, there were no significant differences of effect between the two techniques.

002.1 Point-of-care testing and immediate treatment of curable sexually transmitted and genital infections among antenatal women in papua new guinea

Background Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and bacterial vaginosis (BV), are associated with adverse maternal and neonatal health outcomes, particularly preterm birth and low birth weight. These infections are highly prevalent in many low-income settings but remain undiagnosed and therefore untreated in pregnancy because of a lack of suitable diagnostic technology. In 2014, we conducted the first feasibility study of newly-available, easy to use and highly-accurate point-of-care (POC) STI assays in a routine clinical setting in Papua New Guinea (PNG) in preparation for a large-scale field trial to evaluate the potential of this strategy to improve pregnancy outcomes. Methods Women aged 18–35 years attending their first antenatal visit were invited to participate. Following informed consent procedures, women completed a short interview, obstetric examination, and provided self-collected vaginal specimens for clinic-based STI testing, conducted by trained clinic staff: CT/NG and TV were tested using the Cepheid GeneXpert platform, and BV tested using the BVBlue Test. Participants were provided with same-day POC test results, and antibiotic treatment as indicated. Women were also provided routine onsite antenatal HIV and syphilis screening. Results A total of 125 women were enrolled. The prevalence of CT was 20.0%; NG, 11.2%; TV, 37.6%; BV 18.4%; and more than half (67/125) had one or more of these infections. Over 70% of those with a POC-confirmed STI would not have been detected on clinical grounds alone. The prevalence of HIV was 1.6% and active syphilis, 4.0% in this population. All women with an STI and their sexual partners were successfully treated. Conclusion Antenatal POC STI testing and treatment proved feasible in an antenatal setting in PNG. If this strategy is proven to be effective in our future field trial (2015–18), it has the potential to improve pregnancy outcomes in all high-burden, low-income countries worldwide. Disclosure of interest statement Nothing to Disclose

The Role of Animal Source Foods in Improving Nutritional Health in Urban Informal Settlements: Identification of Knowledge Gaps and Implementation Barriers

Childhood undernutrition is a health crisis in the rapidly expanding informal settlements of low-income countries worldwide. Nearly half of Kenyan children in the Kibera settlement, in Nairobi, were reported to be stunted, indicating low height-for-age. Stunted children are at greater risk for poor cognitive and physical health outcomes in the long-term, problems that tend to be perpetuated in subsequent generations. Animal-source foods (ASF) supply a calorically dense source of micro- and macronutrients, and supplementation with ASF has been shown to improve linear growth and cognition. Correspondingly, increasing consumption of ASF by pregnant women and children has been proposed as a means to disrupt the intergenerational cycle of undernutrition caused by food insecurity. Household surveys indicate that consumption of ASF is low in urban slums, despite the availability of these foods in local markets. Here we review the studies addressing the role of ASF in the diets of the urban poor and identify knowledge gaps relevant to improving nutrition by increasing consumption of ASF. Based predominantly on studies in Kibera and greater Nairobi, these gaps include determining the minimal amount and frequency of dietary ASF to prevent stunting, defining how consumer preferences, markets, and income interact to impede or promote ASF consumption, and understanding the interaction between diet and both clinical and sub-clinical enteric disease on growth outcomes.

The role of animal source foods in improving nutritional health in urban informal settlements: identification of knowledge gaps and implementation barriers

Childhood undernutrition is a health crisis in the rapidly expanding informal settlements of low-income countries worldwide. Nearly half of Kenyan children in the Kibera settlement, in Nairobi, were reported to be stunted, indicating low height-for-age. Stunted children are at greater risk for poor cognitive and physical health outcomes in the long-term, problems that tend to be perpetuated in subsequent generations. Animal-source foods (ASF) supply a calorically dense source of microand macronutrients, and supplementation with ASF has been shown to improve linear growth and cognition. Correspondingly, increasing consumption of ASF by pregnant women and children has been proposed as a means to disrupt the intergenerational cycle of undernutrition caused by food insecurity. Household surveys indicate that consumption of ASF is low in urban slums, despite the availability of these foods in local markets. Here we review the studies addressing the role of ASF in the diets of the urban poor and identify knowledge gaps relevant to improving nutrition by increasing consumption of ASF. Based predominantly on studies in Kibera and greater Nairobi, these gaps include determining the minimal amount and frequency of dietary ASF to prevent stunting, defining how consumer preferences, markets, and income interact to impede or promote ASF consumption, and understanding the interaction between diet and both clinical and sub-clinical enteric disease on growth outcomes.

Do economic constraints on food choice make people fat? A critical review of two hypotheses for the poverty–obesity paradox

In low income countries worldwide, rising standards of living have spurred an unprecedented rise in obesity. However, in numerous wealthy countries the trend frequently reverses with poorer and less educated women more likely to be overweight than their wealthier compatriots. One prominent explanation for this reverse gradient is that economic deprivation leads to food choices which paradoxically increase energy intake. If true, this would challenge current evolutionary accounts for the modern obesity epidemic and have serious implications for how policy makers tackle increasing obesity in the US and worldwide. In this article, we critically review the hypothesis that deprivation leads people to choose cheaper foods which in turn foster overconsumption of energy. Though the hypothesis is consistent with numerous cross-sectional studies, available longitudinal studies from high-, middle-, and low-income countries show the reverse-that when populations experience resource declines, they experience either declines in BMI or decelerations in BMI growth. Most notably, the recent recession in the US coincides with a clear deceleration in women's obesity across income groups. We conclude by briefly reviewing other plausible explanations for the reverse gradient among women in developing countries. Finally, we discuss how theoretical perspectives and comparative, historical approaches from human biology are useful tools for examining the current wealth of hypotheses about obesity in population health.