National Control Strategy Research Articles

Screening of insecticide resistance in Aedes aegypti populations collected from parishes in Eastern Jamaica.

Owing to the increased reports in Aedes-borne diseases in the Caribbean and Latin America, the United States Agency for International Development assisted the Jamaican Ministry of Health and Wellness in conducting insecticide susceptibility tests on Aedes aegypti populations.Sentinel sites were established in seven parishes of Jamaica (St. Catherine, Kingston and St. Andrew, St. Thomas, Portland, St. Mary and St. Ann) and Aedes aegypti eggs were collected, reared to adults per collected population and their susceptibility to varying pyrethroids and organophosphates were tested using the World Health Organization paper bioassays for these insecticides. The Centers for Disease Control and Prevention bottle bioassay was used to assess susceptibility to the carbamate, bendiocarb. The voltage gated sodium channel gene mutations V1016I and I1011V, normally associated with pyrethroid resistance, were also analysed.The results showed that Aedes aegypti collected from all parishes exhibited resistance to pyrethroids at the following concentrations, permethrin 0.25–2.5%; deltamethrin 0.03–0.15%; lambda-cyhalothrin 0.03–0.3%; and etofenprox 0.5–2.5%. The insecticide deltamethrin at concentration 0.3% was the only pyrethroid tested that resulted in high mortality, 94.9 ± 0.34% knockdown within 1 hour of exposure and 98.95 ± 0.01% mortality (p <0.01) at 24 hours post exposure. The frequency of the voltage gated sodium channel gene mutation V1016I was high in the tested population, possibly accounting for the reduced sensitivity to pyrethroids. Organophosphate resistance was also observed in all populations tested. Mortality rates for 0.8% Malathion was 0.8 ± 0.70–60.68 ± 0.38% after 24 hour and 0.00–47.10 ± 3.02%, for pirimiphos-methyl 0.21%. Bendiocarb applied as 12.5 μg/ bottle resulted in mortality rates of 76.25 ± 4.30–100 ± 0.00% after 30 minutes of exposure.The results showed that Ae. aegypti from the seven parishes analysed demonstrated resistance to the insecticides tested. Deltamethrin and bendiocarb at concentrations 0.3% and 12.5μg respectively, were considered most effective, causing high mortality in the local populations. Routine monitoring and evaluations of Ae. aegypti populations from the included parishes are recommended. Additionally, the study results represent the most comprehensive testing to date with local Aedes aegypti populations distributed across different parishes of Jamaica and should be useful to guide national and sub national strategies for vector control and surveillance.

BCG vaccine protection from severe coronavirus disease 2019 (COVID-19)

A series of epidemiological explorations has suggested a negative association between national bacillus Calmette-Guérin (BCG) vaccination policy and the prevalence and mortality of coronavirus disease 2019 (COVID-19). However, these comparisons are difficult to validate due to broad differences between countries such as socioeconomic status, demographic structure, rural vs. urban settings, time of arrival of the pandemic, number of diagnostic tests and criteria for testing, and national control strategies to limit the spread of COVID-19. We review evidence for a potential biological basis of BCG cross-protection from severe COVID-19, and refine the epidemiological analysis to mitigate effects of potentially confounding factors (e.g., stage of the COVID-19 epidemic, development, rurality, population density, and age structure). A strong correlation between the BCG index, an estimation of the degree of universal BCG vaccination deployment in a country, and COVID-19 mortality in different socially similar European countries was observed (r2 = 0.88; P = 8 × 10-7), indicating that every 10% increase in the BCG index was associated with a 10.4% reduction in COVID-19 mortality. Results fail to confirm the null hypothesis of no association between BCG vaccination and COVID-19 mortality, and suggest that BCG could have a protective effect. Nevertheless, the analyses are restricted to coarse-scale signals and should be considered with caution. BCG vaccination clinical trials are required to corroborate the patterns detected here, and to establish causality between BCG vaccination and protection from severe COVID-19. Public health implications of a plausible BCG cross-protection from severe COVID-19 are discussed.

Complete Sequence-Based Genotyping of mgc2/pvpA Genes in Chicken-Derived Mycoplasma gallisepticum Isolates of Iran.

Mycoplasma gallisepticum (MG) is a major pathogen of the poultry industry throughout the world. MG causes chronic respiratory disease in chickens and infectious sinusitis in turkeys. Despite constant improvements in the biosecurity of the poultry industry in Iran, MG infection still occurs and causes significant economic issues. To evaluate genetic variability, 10 Iranian MG isolates along with 17 available sequences were characterized by gene-targeted sequencing (GTS) analysis of complete mgc2/pvpA genes. According to the findings, 21 different sequence types within the sample set of 27 strains were typed by this method. The discriminatory power of this typing assay was established to be 0.97. Although no insertions and deletions of nucleotides were observed in the mgc2 gene among the Iranian strains, different lengths of pvpA genes with 1086, 1095, and 1101 nucleotides were detected within direct repeats (DRs) 1 and 2. Generally, eight tetrapeptides Pro-Arg-Pro-Met/Gln/Asn were found in the DRs of PvpA. Analysis of the carboxyl ends of PvpA proteins exhibited various repeats of prolines. In the phylogenetic tree of partial and complete mgc2/pvpA genes, all Iranian MG isolates were clustered into two distinct groups. Because this typing assay could provide a higher discriminatory power than the previously reported GTS scheme of partial mgc2/ pvpA genes, these results can be considered a blueprint for future national control and diagnostic strategies. Furthermore, consistent surveillance with larger datasets will be needed to clarify the epidemiologic characteristics of MG outbreaks in different poultry hosts.

From alternative dispute resolution to pluralist dispute resolution: towards an integrated dispute-resolution mechanism in China

AbstractSince 1978, we have observed the steady development of institutions, mechanisms and processes of dispute resolution in China. In the last ten years or so, we then noted frequent issuance of new rules and measures as well as revision of existing laws, the promotion of mediation as the preferred method for resolving disputes and, more recently, the promotion of an integrated dispute-resolution system as a national strategy for comprehensive social control (as well as for resolving disputes), in the name of reforming and strengthening ‘the Mechanism for Pluralist Dispute Resolution’. Careful examination of these latest developments suggests that fundamental changes are taking place that may potentially alter the course of the development of the Chinese dispute-resolution system. These developments are the focus of this paper with an aim to ascertain the nature of the developments and their future direction or directions.

Noninvasive biomarkers predict improvement in liver fibrosis after successful generic DAAs based therapy of chronic hepatitis C in Egypt

BackgroundThe scale of HCV problem in Egypt prioritized the development of a national control strategy that employs the use of locally manufactured generic direct-acting antivirals (DAAs). Achieving sustained virologic response in chronic HCV patients is the key for preventing fibrosis progression and ultimately its resolution. Objective(s)To evaluate impact of generic DAAs on liver fibrosis in chronic HCV patients using some non-invasive biomarkers (NIBMs). MethodsA total of 280 chronic HCV patients (18 treatment experienced and 262 naive) were enrolled and received the standard of care. All patients were clinically evaluated before starting treatment and at 4, 12 and 24 weeks of treatment. ResultsThe sensitivity and the specificity of the tested NIBMs for predicting cirrhosis versus liver ultrasound ranged between 75.0-79.6% and 59.4–67.2% respectively. All NIBMs showed significant linear decline during the treatment and follow up periods among responders but tended to fluctuate in values toward an increase among non-responders. In cox regression analysis, normal baseline ALT, AST, total serum cholesterol, serum albumin, WBCS, prothrombin activity and early stages of liver fibrosis predicted improvement in liver fibrosis by 1.5–2 folds. The mean probability of recovery at 1, 3, 6 months varied between the different scores and ranged from 0.059 to 0.637, 0.125–0.741, 0.538–0.951 respectively. ConclusionThe results provide prognostic data on the improvement in liver fibrosis over the treatment course and follow up periods without the need for a liver biopsy. Early detection and management of HCV infection should be emphasized to maximize the benefits of the treatment.

Prevalence of overweight and obesity in China: Results from a cross-sectional study of 441 thousand adults, 2012–2015

ObjectivesObesity has become a global health public problem. The study aims to examine the latest prevalence of overweight and obesity in China. MethodsData came from the China Hypertension Survey (CHS), a nationally representative cross-sectional study among residents aged ≥18 years from October 2012 to December 2015. Overweight and obesity were defined as 25≤BMI<30kg/m2 and BMI≥30kg/m2 according to the WHO classifications, respectively. ResultsThe data of 441 306 participants were analyzed. The prevalence of overweight and obesity was 28.1% and 5.2% respectively. The prevalence of overweight and obesity varied considerably across provinces. The prevalence of overweight was the highest in Beijing, which was 2.8 fold of the lowest in Guangxi (40.9% vs. 14.6%). The prevalence of obesity was the highest in Tianjin, which was 9.4 fold of the lowest in Hainan (12.2% vs. 1.3%). There was a striking north-south gradient with the prevalence higher in Northeast and Northwest China and lower in Southeast China. Multivariate logistic regression analysis indicated that sex, age, education, smoking, marital status and family history of cardiovascular disease were significantly associated with overweight and obesity. ConclusionsOverweight and obesity are highly prevalent among Chinese adults, and their prevalence varies greatly among different population subgroups and provinces. National and provincial obesity control and prevention strategies should be public health priorities in China.

Drivers, Risk Factors and Dynamics of African Swine Fever Outbreaks, Southern Highlands, Tanzania.

African swine fever remains an important pig disease globally in view of its rapid spread, economic impacts and food implications, with no option of vaccination or treatment. The Southern Highlands zone of Tanzania, an important pig-producing hub in East Africa, is endemic with African swine fever (ASF). From approximately the year 2010, the recurrence of outbreaks has been observed and it has now become a predictable pattern. We conducted exploratory participatory epidemiology and participatory disease surveillance in the Southern Highlands to understand the pig sector and the drivers and facilitators of infections, risk factors and dynamics of ASF in this important pig-producing area. Pigs continue to play a major role in rural livelihoods in the Southern Highlands and pork is a major animal protein source. Outbreaks of diseases, particularly ASF, have continued to militate against the scaling up of pig operations in the Southern Highlands. Intra- and inter-district and trans-border transnational outbreaks of ASF, the most common disease in the Southern Highlands, continue to occur. Trade and marketing systems, management systems, and lack of biosecurity, as well as anthropogenic (human) issues, animals and fomites, were identified as risk factors and facilitators of ASF infection. Changes in human behavior and communication in trade and marketing systems in the value chain, biosecurity and pig management practices are warranted. Relevant training must be implemented alongside the launch of the national ASF control strategy for Tanzania, which already established a roadmap for combating ASF in Tanzania. The high-risk points (slaughter slabs, border areas, and farms with poor biosecurity) and high-risk period (November–March) along the pig value chain must be targeted as critical control points for interventions in order to reduce the burden of infection.

Prevention Considerations in Cardiovascular Diseases regarding the premature mortality reduction

Introduction. Cardiovascular diseases are recognized as worldwide (1) and national public health issue (2, 3). This is argued by having a leading position in the structure of general mortality and disability, the substantial loss of quality of life and the health system needs for increased costs. Prevention and control of cardiovascular disease has become one of the priority directions for global and national noncommunicable disease control strategies developed to reduce premature mortality (1, 5). The major cardiovascular diseases mortality was identified some aspects of premature mortality among the adult population in the Republic of Moldova. Overall decrease of mortality due to cardiovascular diseases among adults (-5.9%) has been accompanied by a relatively slower decrease in premature mortality (-2.4%) in the Republic of Moldova (6). Primary, secondary and tertiary prevention measures are essential in reducing the burden of cardiovascular disease and contribute to improving cardiovascular health at the population level. Nature is helping people to maintain their health through mechanisms much closer to them than pharmaceutical ones through the curative action of the various natural factors that form the climate of the respective territorial area. Material and method. There is a descriptive study based on statistical data of the World Health Organization and official vital statistics of the Republic of Moldova. Results and discussions. The climatic conditions of Moldova are favorable to cardiovascular prevention and rehabilitation. Moldova is located in the temperate continental climate influenced by the proximity of the Black Sea and the interference of warm-humid air from the Mediterranean. The annual air temperatures average in the country is 9,30C. In the Republic of Moldova the warm weather with a confortable temperature lasts 175 days and the relative humidity oscillates in the average from 66 to 87%. The country's thermal regime is the most important curative factor for treating chronic diseases and opportunity for the amplification of medical rehabilitation programs for patients with cardiovascular diseases. Application of methods based on the action of climatic factors in cardiovascular rehabilitation process contributes to its efficiency. Increasing the role of tertiary prevention is a good practice for the quality improvement of medical services for this category of patients. By making appropriate, timely and complex measures of primary, secondary and tertiary prevention cardiovascular disease can be substantially prevented. Conclusions. Strengthening cardiovascular prevention centered on a complex approach to all its primary, secondary, and tertiary components is an opportunity to reduce premature mortality in the population. Key words: Cardiovascular diseases, prevention, premature mortality,

Risk perception of antimicrobial resistance by infection control specialists in Europe: a case-vignette study

BackgroundUsing case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients.MethodsIn this study, sixteen case-vignettes were developed to simulate hospitalised patient scenarios in the field of AMR and IC. A total of 245 IC specialists working in different hospitals from 15 European countries were contacted, among which 149 agreed to participate in the study. Using an online database, each participant scored five randomly-assigned case-vignettes, regarding the perceived risk associated with six different multidrug resistant organisms (MDRO). The intra-class correlation coefficient (ICC), varying from 0 (poor) to 1 (perfect), was used to assess the agreement for the risk on a 7-point Likert scale. High risk and low/neutral risk scorers were compared regarding their national, organisational and individual characteristics.ResultsBetween January and May 2017, 149 participants scored 655 case-vignettes. The perceptions of the individual (clinical outcome) and collective (spread) risks were consistently lower than other MDRO for extended spectrum beta-lactamase producing Enterobacteriaceae cases and higher for carbapenemase producing Enterobacteriaceae (CPE) cases. Regarding CPE cases, answers were influenced more by the resistance pattern (93%) than for other MDRO. The risk associated with vancomycin resistant Enterococci cases was considered higher for the collective impact than for the individual outcome (63% vs 40%). The intra-country agreement regarding the individual risk was globally poor varying from 0.00 (ICC: 0–0.25) to 0.51 (0.18–0.85). The overall agreement across countries was poor at 0.20 (0.07–0.33). IC specialists working in hospitals preserved from MDROs perceived a higher individual (local, p = 0.01; national, p < 0.01) and collective risk (local and national p < 0.01) than those frequently exposed to bacteraemia. Conversely, IC specialists working in hospitals with a high MDRO clinical burden had a decreased risk perception.ConclusionsThe perception of the risk associated with AMR varied greatly across IC specialists and countries, relying on contextual factors including the epidemiology. IC specialists working in high prevalence areas may underestimate both the individual and collective risks, and might further negatively promote the MDRO spread. These finding highlight the need to shape local and national control strategies according to risk perceptions and contextual factors.

Epidemiological characteristics of amoebic dysentery in China, 2015-2018

Objective: To understand the characteristics and changes of the incidence of amoebic dysentery in China during 2015-2018, explore the causes of high incidence in some areas and provide a data base for the development of national prevention and control strategies and measures. Methods: Data were collected from the infectious disease reporting management information system from Chinese Disease Control and Prevention. To understand the seasonal, population and area distributions of amoebic dysentery, descriptive epidemiological method and software SPSS 16.0 were used to analyze the amoebic dysentery data. Results: A total of 4 366 amoebic dysentery cases were reported without death in China during 2015-2018. The reported average annual incidence was 0.08/100 000, and the overall proportion of laboratory confirmed cases was 68.23%(2 979/4 366). Amoeba dysentery mainly occurred during May to October. One seasonal peak was observed in 2015 and 2017 (July and June, respectively), and two seasonal peaks were observed in 2016 and 2018 (June and October). The patients were mainly children aged under 5 years (42.28%, 1 846/4 366), and the incidence rate decreased with age in children aged under 10 years. Of these, children under 1 years of age had the highest incidence rate (1.28/100 000). The number of cumulative reported cases in Guangxi, Henan, Guangdong, Heilongjiang and Jiangxi provinces ranked top five from 2015-2018, accounting for 64.50% (2 816/4 366) of the total. The cumulative cases in Dongxing county, Guangxi, in Suixian county, Henan and in Ranghulu district, Heilongjiang, respectively accounted for more than 50.00% of the total number of cases in their provinces. Conclusions: The incidence rate of amoebic dysentery reported in China during 2015-2018 showed a decreasing trend, with a higher incidence in children under 5 years old and a higher number of cases in some areas. It is suggested to further investigate and analyze the diagnosis and reporting of amoeba dysentery in key areas and promote the update of the diagnostic standards for amoeba dysentery.

A review of Kenya\u2019s cancer policies to improve access to cancer testing and treatment in the country

BackgroundCancer is the third-leading cause of mortality in Kenya, resulting in unique challenges to the country’s health system. An increase in the number of cancer cases in Kenya over the past decade resulted in legislative actions and policies to guide delivery of cancer services. Kenya’s new national cancer control strategy and past policy efforts provide an opportunity to synergise information and enhance understanding to improve cancer diagnosis and treatment in the country. The objectives of this study are to (1) document policy-modifiable factors based on a review of policy documents and results of a key informant survey and (2) develop recommendations to improve policies affecting cancer testing and treatment services in Kenya. This study builds upon our previous study Improving Access to Cancer Testing and Treatment in Kenya (Makau Barasa et al. J Global Oncol 2(216), 2017).MethodsThe study applied an in-depth systematic review of Kenya’s cancer policies and guidelines, a qualitative analysis of results from a section of a semi-structured key informant survey focused on the opinions of clinicians delivering cancer services as well as cancer support groups and advocacy leaders, and a stakeholder analysis identifying key policy-makers and implementers. Details of the complete key informant survey were published in our previous study.ResultsKenya’s cancer policies have guided progress made in providing the legal and implementation frameworks for the development and delivery of cancer services at the national and county levels. Some policy implementation gaps are noted. These include inadequate financing for cancer services, limited research and data to support policy formulation, and the concentration of cancer services in urban areas. The key informant survey identified policy-modifiable actions that can address some of the gaps and improve the delivery of and access to cancer testing and treatment services in the country. Some of these include addressing the financial barriers affecting cancer testing and treatment services; increasing stakeholder engagement in training health personnel to deliver cancer testing and treatment services; decentralising cancer services and improving cancer surveillance and research; and increasing education and awareness about cancer symptoms, screening procedures and treatment options. A set of priority policy actions were selected from the study findings and used to develop recommendations for Kenya’s policy-makers and stakeholders.ConclusionsRevisions to Kenya’s cancer policies are seeking to address gaps noted in past policies and to improve access to cancer testing and treatment in Kenya. However, based on study findings, additional actions can be taken to strengthen policy implementation. Considering the policy formulation and implementation process and costs, this study recommends focusing on three priority policy actions that can have significant impact on improving access to cancer testing and treatment services. These include addressing financing, insurance and human resources gaps; increasing stakeholder engagement; and decentralising health services for better surveillance and data to inform policies.

Spread trend of COVID-19 epidemic outbreak in China: using exponential attractor method in a spatial heterogeneous SEIQR model.

In this paper we introduce a method of global exponential attractor in the reaction-diffusion epidemic model in spatial heterogeneous environment to study the spread trend and long-term dynamic behavior of the COVID-19 epidemic. First, we prove the existence of the global exponential attractor of general dissipative evolution systems. Then, by using the existence theorem, the global asymptotic stability and the persistence of epidemic are discussed. Finally, combine with the official data of the COVID-19 and the national control strategy, some numerical simulations on the stability and global exponential attractiveness of the COVID-19 epidemic are given. Simulations show that the spread trend of the epidemic is in line with our theoretical results, and the preventive measures taken by the Chinese government are effective.

Oral health and tobacco research in the Eastern Mediterranean Region in relation to the Framework Convention on Tobacco Control: a scoping review.

Tobacco use is associated with oral diseases. Evaluating research on tobacco use and oral health can provide insight into the prevailing situation and help engage dental personnel in tackling the tobacco problem. This study aimed to map knowledge gaps on tobacco and oral health research in the Eastern Mediterranean Region based on four articles of the Framework Convention on Tobacco Control (FCTC). These were: article 12 - use of communication tools to promote tobacco education and awareness; article 14 - promotion of tobacco cessation; article 20 - exchange of information on determinants and outcomes of tobacco use; and article 22 - international cooperation to transfer expertise to strengthen national tobacco control strategies. A scoping review was conducted that included publications on tobacco use and oral health in the Region. PubMed, Scopus, Web of Science, Google Scholar and Proquest theses were searched. Information extracted included: country, study type, whether more than one country was included and whether the publication addressed FCTC articles 12, 14, 20 or 22. In all, 322 publications were included, of which 82.0% were observational studies and 4.3% were clinical trials. Most publications (87.9%) were from the Islamic Republic of Iran, Jordan, Pakistan Saudi Arabia and Yemen. Only 32 (9.9%) publications included participants from more than one country. Of all the publications, 21.5% related to article 12 of the FCTC, 4.3% to article 14, 94.7% to article 20 and 6.5% article 22. Research on oral health and tobacco needs to be better aligned with the FCTC articles.

Temporal Pattern of Mutations in the Knockdown Resistance (kdr) Gene of Aedes aegypti Mosquitoes Sampled from Southern Taiwan

Aedes mosquitoes are the principal dengue vector in Taiwan, where the use of insecticides is a key element in the national control strategy. However, control efforts are constrained by the development of resistance to most insecticides, including pyrethroids. In this study, mutations in the voltage-gated sodium channel (VGSC) gene resulting in knockdown resistance (kdr) were examined in Aedes aegypti. Fragments of the VGSC gene were polymerase chain reaction (PCR)-amplified followed by restriction fragment length polymorphism analysis in samples from various settings in Southern Taiwan covering dry and wet seasons from 2013 to 2015. Three kdr mutations were identified: V1023G, D1794Y, and F1534C, with observed frequencies of 0.36, 0.55, and 0.33, respectively, in the dry season of 2013-2014. Exploring for temporal changes, the most important observation was the 1534C allele frequency increment in the following season to 0.60 (P < 0.05). This study suggests that continued insecticide pressure is driving the mutational changes, although the selection is ambiguous in the mosquito population.

EPA funded radon research in Ireland and its impact on the National Radon Control Strategy

Radon is a radioactive gas formed in the ground by the radioactive decay of uranium which is present in all rocks and soils. It is the greatest source of exposure to ionising radiation for people living in Ireland and the leading cause of lung cancer after smoking. It is estimated that exposure to radon accounts for approximately 14% of all lung cancers in Ireland, which equates to around 300 lung cancer cases annually. In November 2011 the then Minister for the Environment, Community and Local Government, announced the Government decision to establish an Inter-Agency (IA) group to develop a national radon control strategy (NRCS) for Ireland. The purpose of the strategy is to reduce the number of lung cancers in Ireland that are caused by radon. The IA group comprises experts from the key Government Departments and State Agencies relevant to tackling the radon problem in Ireland. A Research Working Group (RWG) was established by the IA group to identify knowledge gaps and to point to areas where further targeted research could support and improve the effectiveness of the NRCS. The RWG reviewed the research ideas collected during the development of the NRCS including those raised in the stakeholder and public consultations. The research ideas were divided into four thematic areas, this paper will present an overview of the EPA funded radon research that falls under the theme that focuses on radon preventive measures and also outline the impact of this work at a national and international level.

Non-melanoma skin cancer in Serbia (1999-2015) -the need for national prevention and control strategy

Background/Aim. Non-melanoma skin cancers (NMSC) are ones of the most rapidly increasing cancers worldwide. Although NMSCs have a relatively low mortality rate, they are an important public health concern and the most costly cancers in many countries. The two main objectives in this study were: first, to analyze the trend of age-standardized incidence rate of NMSCs in Serbia and second, to assess the need for national prevention and control strategy based on analyzed trend. Methods. From the Serbian Cancer Registry, we extracted all cases of NMSCs registered in central Serbia from January 1, 1999 to December 31, 2015. Joinpoint regression analysis was used to define trends and annual percentage change (APC). Results. NMSCs significantly increased for both genders with APC of +2.32% (p &lt; 0.001). Significantly increasing trend of incidence rates was higher in women (APC, +2.63%; p &lt; 0.0001) than in men (APC, +2.01%; p &lt; 0.001). Conclusion. Our results show a continuously increasing incidence rate of NMCS in Serbia. Without the national preventive strategy, current sporadic activities are highly unlikely to result in reducing the growing trends

Correlation between Breast Self-Examination Practices and Demographic Characteristics, Risk Factors and Clinical Stage of Breast Cancer among Iraqi Patients.

BACKGROUND:Breast Cancer (BC) is the most common cancer and the leading cause of cancer death among women globally. The disease can be cured with limited resources if detected early. Breast self-examination (BSE) is considered a cost-effective feasible approach for early detection of that cancer in developing countries.AIM:To determine the correlation between BSE performance and demographic characteristics, risk factors and clinical stage of BC among Iraqi patients.METHODS:This retrospective study included a total of 409 female patients diagnosed with BC at the Referral Training Center for Early Detection of Breast Cancer and the National Cancer Research Center in Baghdad. The studied variables included the age of the patient, occupation, marital and educational status, parity, history of lactation, contraceptive pill intake, family history of cancer and the clinical stage of the disease.RESULTS:Our findings revealed that the most important predictors for practicing BSE was family history of BC or any other cancers (OR = 3.87, P = 0.018) followed by being a governmental employee (OR = 1.87, P = 0.024), history of contraceptive use (OR = 1.80, P = 0.011) and the high level of education (OR = 1.73, P = 0.004). On the other hand, there was no significant correlation between the practice of BSE and the BC stage at the time of presentation.CONCLUSION:There is a relatively poor practice of BSE among Iraqi patients diagnosed with BC. It is mandatory to foster the national cancer control strategies that focus on raising the level of awareness among the community through public education as a major approach to the early detection of cancer in Iraq.

Prevalence of Abdominal Obesity in China: Results from a Cross-Sectional Study of Nearly Half a Million Participants.

This study aimed to examine the latest prevalence of abdominal obesity in China based on nationally representative data. A stratified, multistage,random sampling method was used to obtain a nationally representative sample of residents aged ≥ 18 years from 31 provinces in mainland China from October 2012 to December 2015. Abdominal obesity was defined as a waist circumference ≥ 90 cm for men and a waist circumference ≥ 85 cm for women. The data of 441,306 participants were analyzed. The prevalence of abdominal obesity was 29.1% (28.6% in men and 29.6% in women); the number of adults with abdominal obesity was estimated to be 277.8 million (approximately 140.1 million in men and 137.7 million in women). The prevalence of abdominal obesity varied considerably among provinces. In general, the prevalence of abdominal obesity was higher in the northern, lower in the southern, higher in the western, and lowerin the eastern areas of China. Besides the regional disparities, the prevalence of abdominal obesity varied greatly among different population subgroups. Abdominal obesity is highly prevalent among Chinese adults. National and provincial obesity control and prevention strategies should be public health priorities in China. To better control obesity, the underlying reasonsfor the regional disparities need to be addressed.

Knowledge, attitudes and practices of young people in Zimbabwe on cervical cancer and HPV, current screening methods and vaccination

BackgroundThe rise in cervical cancer trends in the past two decades has coincided with the human immunodeficiency virus (HIV) epidemic especially in the sub-Saharan African region. Young people (15 to 24 years old) are associated with many risk factors such as multiple sexual partners, early sexual debut, and high HIV incidences, which increase the chances of developing cervical cancer. The National Cancer Prevention and Control Strategy for Zimbabwe (2014–2018) highlights that no cancer communication strategy focusing on risk factors as primary cancer prevention. Therefore, the study aims to determine the knowledge, attitude and practices of young people in Zimbabwe on cervical cancer, screening, human papillomavirus (HPV) and vaccination.MethodsA cross-sectional survey assessing young people’s knowledge, attitude and practices concerning cervical cancer was conducted in five provinces in Zimbabwe. A total of 751 young people were recruited through a three-stage cluster design from high schools and universities. Knowledge, attitudes and practices were assessed using questions based and adapted from the concepts of the Health Belief Model (HBM) and the Cervical Cancer Measuring tool kit-United Kingdom (UK).ResultsMost young people, 87.47% (656/750) claimed to know what the disease called cervical cancer is, with a mean score of 89.98% [95% CI 73.71.11–96.64] between high school and 86.72% [95% CI 83.48–89.40] among university students. There was no significant difference in mean scores between high school and university students (p = 0.676). A risk factor knowledge proficiency score of ≥13 out of 26 was achieved in only 13% of the high school respondents and 14% of the university respondents with a broad range of misconceptions about cervical cancer risk factors in both females and males. There was not much difference on comprehensive knowledge of cervical cancer and its risk factors between female and male students, with the difference in knowledge scores among high school (p = 0.900) and university (p = 0.324) students not statistically significant. In contrast, 43% of respondents heard of cervical cancer screening and prevention, and 47% knew about HPV transmission and prevention. Parents’ educational level, province and smoking, were some of the factors associated with knowledge of and attitude towards cervical among high school and university students.ConclusionThis study revealed that young people in Zimbabwe have an idea about cervical cancer and the seriousness thereof, but they lack adequate knowledge of risk factors. Cervical cancer education and awareness emphasising causes, risk factors and care-seeking behaviours should be commissioned and strengthen at the community, provincial and national level. Developing a standard cervical cancer primary prevention tool that can be integrated into schools can be a step towards addressing health inequity.

Targeting remaining pockets of malaria transmission in Kenya to hasten progress towards national elimination goals: an assessment of prevalence and risk factors in children from the Lake endemic region

BackgroundWith an overall decline of malaria incidence, elimination of malaria is gradually becoming the next target for many of countries affected by the disease. In Kenya the national malaria control strategy is aiming to reach pre-elimination for most parts of the country. However, considerable heterogeneity in prevalence of the disease within the country and especially the remaining high prevalent region of the Lake endemic region is likely to slow progress towards this target. To achieve a sustained control and an eventual elimination, a clear understanding of drivers of ongoing malaria transmission in remaining hotspots is needed.MethodsData from the 2015 Malaria Indicator Survey (MIS) were analysed for prevalence of malaria parasitaemia in children (6 months to 14 years) of different countries within the highly endemic Lake region. Univariate and multivariate logistic regression analysis were preformed to explore associations between selected risk factors and being parasitaemic. A predictive model was built for the association between malaria and the risk factors with the aim of identifying heterogeneities of the disease at the lower administrative levels.ResultsOverall, 604/2253 (27%, 95% CI 21.8–32.2) children were parasitaemic. The highest prevalence was observed in Busia County (37%) and lowest in Bungoma County (18%). Multivariate logistic regression analysis showed that the 10–14 years age group (OR = 3.0, 95% CI 2.3–4.1), households in the poorest socio-economic class (OR = 2.1, 95% CI 1.3–3.3), farming (OR = 1.4, 95% CI 1.2–2.5) and residence in Busia (OR = 4.6, 95% CI 2.1–8.2), Kakamega (OR = 2.6, 95% CI 1.3–5.4), and Migori counties (OR = 4.6 95% CI 2.1–10.3) were associated with higher risk of parasitaemia. Having slept under a long-lasting insecticide-treated bed net (LLIN) was associated with a lower risk (OR = 0.7, 95% CI 0.6–0.9). No association were found between malaria infection and the gender of the child, the household head, and the education status of the household head.Discussion and conclusionDetailed analysis of malaria prevalence data in a hotspot area can identify new threats and avail opportunities for directing intervention. In the Lake endemic region of Kenya, interventions should be focused more on counties with the highest prevalence, and should target older children as well as children from the lower socio-economic strata. Precisely targeting interventions in remaining hotspots and high-risk populations will likely make impact and accelerate progress towards pre-elimination targets.