Public Health In Low-income Countries Research Articles

Bacilli load in PTB- intestinal helminths co-infected and PTB non -infected patients at selected public health facilities in Jimma zone, Oromia, Ethiopia: comparative cross-sectional study

BackgroundTuberculosis (TB) and intestinal helminths are diseases that pose a dual burden on public health in low-income countries. Previous studies have shown that helminths can affect the shedding of bacteria or the bacterial load in the sputum of active TB patients. However, there is limited information on bacterial load in TB patients with helminth infections.ObjectiveThis study aimed to compare bacterial load in helminths-infected and non-infected pulmonary tuberculosis patients at selected public health facilities in Jimma zone, Oromia, Ethiopia.MethodsThe study was conducted in Jimma Zone, Oromia, Ethiopia. A facility-based comparative cross-sectional study was employed from August 01, 2020, to January 2021. A total of 124 (55 intestinal helminths-infected and 69 non-infected) newly diagnosed smear-positive pulmonary tuberculosis (PTB) patients were included in the study. A convenience sampling technique was employed to recruit study participants, and a semi-structured questionnaire was used to collect data regarding socio-demographic characteristics and possible risk factors for intestinal helminths co-infection. Stool examination was performed using both wet mount and Kato Katz technique. Additionally, weight and height measurements, sputum, and blood samples were taken to determine body mass index, bacilli load, and diabetic mellitus, respectively. Data were entered into Epi-Data software version 3.1 and analyzed using Statistical Packages for Social Sciences (SPSS) Version 25. A statistically significant difference was defined as a P-value of less than 0.05.ResultsIntestinal helminths reduced bacilli load 3 times more than intestinal helminths non-infected PTB (AOR = 3.44; 95% CI; 1.52, 7.79; P = 0.003) However, diabetes mellitus, HIV, drinking alcohol and cigarette smoking were not associated with bacilli load. The rate of co-infection TB with intestinal helminths was 44%. The three most prevalent parasites detected were Trichuris trichiura 29 (66%), hookworm 19 (43%), and Ascaris lumbricoides 11(25%)). Among co-infected patients about 36 (81.8%) had a single parasite infection, and 19 (43.2%) had multiple infections. A body mass index < 18.5 (AOR = 3.26; 95% CI; 1.25, 8.56;P = 0.016) and untrimmed fingernail status (AOR = 3.63; 95%CI;1.32,9.93;P = 0.012) were significantly associated with PTB- intestinal helminth –co-infection.ConclusionHelminth infection was associated with a lower bacilli load compared to helmenths non-infected PTB. The rate of co-infection TB with intestinal helminths was 44%. Trichuris trichiura was the most prevalent helminth. Untrimmed fingernail and a body mass index were associated with PTB-intestinal helminth co-infection.

Decline in youth drinking in high-income settings: Implications for public health in low-income countries.

Declining drinking among youth in many high-income countries has attracted scholarly attention and debates. Still, researchers are yet to globalize such research or examine its public health implications for low-resource settings. This commentary has two interrelated purposes. First, using evidence from Nigeria, it highlights how declining youth drinking in high-income countries may impact public health in low-income countries. Second, it highlights the necessity for research to examine youth drinking behaviours simultaneously worldwide. The declining drinking trends among young people in high-income countries have occurred simultaneously with global alcohol corporations being more aggressive in low-income countries like Nigeria. Relatedly, alcohol corporations may employ evidence regarding declines in drinking to argue against implementing stringent policies or other effective interventions in Nigeria (and other low-income settings), claiming theirapparent successin the falling drinking trends in high-income settings. The article argues that research on the drinking decline among young people should be globalized because without commensurate attempts to examine their drinking behaviours/trends worldwide simultaneously, public and/or global health may be harmed for the reasons explored in this article.

What research tells us about knowledge transfer strategies to improve public health in low-income countries: a scoping review

ObjectivesThis study describes the current state of research on knowledge transfer strategies to improve public health in low-income countries, to identify the knowledge gaps on this topic.MethodsIn this scoping review, a descriptive and systematic process was used to analyse, for each article retained, descriptions of research context and methods, types of knowledge transfer activities and results reported.Results28 articles were analysed. They dealt with the evaluation of transfer strategies that employed multiple activities, mostly targeting health professionals and women with very young children. Most often these studies used quantitative designs and measurements of instrumental use with some methodological shortcomings. Results were positive and suggested recommendations for improving professional practices, knowledge and health-related behaviours. The review highlights the great diversity of transfer strategies used, strategies and many conditions for knowledge use.ConclusionsThe review provides specific elements for understanding the transfer processes in low-income countries and highlights the need for systematic evaluation of the conditions for research results utilization.Electronic supplementary materialThe online version of this article (doi:10.1007/s00038-015-0716-5) contains supplementary material, which is available to authorized users.

Performance of vertical flow constructed wetlands for faecal sludge drying bed leachate: Effect of hydraulic loading

The discharge of raw faecal sludge directly into the environment is a common practice that threatens environmental and public health in low-income countries. Planted drying beds are a promising and low-cost option for treatment of faecal sludge and the production of fodder plants, but current research shows the leachate quality does not meet guidelines for discharge. This paper investigates the use of Vertical Flow Constructed Wetlands (VFCWs) planted with Echinochloa pyramidalis for polishing of leachate from faecal sludge drying beds. At a pilot-scale, three hydraulic loads (50, 100 and 150mm/d) were applied with single loadings once a week on VFCWs (corresponding to 31±9, 63±19, 94±28g/m2/month of BOD5; 21±6, 42±12, 63±19 TKN; and 2±1; 4±4; 6±6 PO4–P, respectively, for hydraulic loading rates of 50, 100 and 150mm/d). Infiltration flow rate, plant growth, rhizospheric bacteria, and leachate characteristics were monitored. VFCWs were effective in reducing on average more than 80% of the pollutants monitored (COD, BOD5, NH4–N, TKN, PO4–P, and faecal bioindicators), which met all National Cameroon and WHO guidelines for safe reuse in agriculture, except for total nitrogen and faecal indicators. Results confirmed a correlation between plant density and rhizospheric bacteria growth with increasing hydraulic load. These are important results, demonstrating that VFCWs can operate efficiently at multiple hydraulic loadings, and are hence adaptable to different sized treatment schemes. It also illustrates that if plant production for fodder is a goal, increased loading rates are preferable as they achieve overall treatment goals and result in greater plant production.

Global Health and Development: Conceptualizing Health between Economic Growth and Environmental Sustainability

After World War II, health was firmly integrated into the discourse about national development. Transition theories portrayed health improvements as part of an overall development pattern based on economic growth as modeled by the recent history of industrialization in high-income countries. In the 1970s, an increasing awareness of the environmental degradation caused by industrialization challenged the conventional model of development. Gradually, it became clear that health improvements depended on poverty-reduction strategies including industrialization. Industrialization, in turn, risked aggravating environmental degradation with its negative effects on public health. Thus, public health in low-income countries threatened to suffer from lack of economic development as well as from the results of global economic development. Similarly, demands of developing countries risked being trapped between calls for global wealth redistribution, a political impossibility, and calls for unrestricted material development, which, in a world of finite land, water, air, energy, and resources, increasingly looked like a physical impossibility, too. Various international bodies, including the WHO, the Brundtland Commission, and the World Bank, tried to capture the problem and solution strategies in development theories. Broadly conceived, two models have emerged: a "localist model," which analyzes national health data and advocates growth policies with a strong focus on poverty reduction, and a "globalist" model, based on global health data, which calls for growth optimization, rather than maximization. Both models have focused on different types of health burdens and have received support from different institutions. In a nutshell, the health discourse epitomized a larger controversy regarding competing visions of development.

Haematite in Lateritic Soils Aids Groundwater Disinfection

Microbiologically contaminated water severely impacts public health in low-income countries, where treated water supplies are often inaccessible to much of the population. Groundwater represents a water source that commonly has better microbiological quality than surface water. A 2-month intensive flow and quality monitoring programme of a spring in a densely settled, unsewered parish of Kampala, Uganda, revealed the persistent presence of high chloride and nitrate concentrations that reflect intense loading of sewage in the spring’s catchment. Conversely, thermotolerant coliform bacteria counts in spring water samples remained very low outside of periods of intense rainfall. Laboratory investigations of mechanisms responsible for this behavior, achieved by injecting a pulse of H40/1 bacteriophage tracer into a column packed with locally derived granular laterite, resulted in near-total tracer adsorption. X-ray diffraction (XRD) analysis showed the laterite to consist predominantly of quartz and kaolinite, with minor amounts (<5%) of haematite. Batch studies comparing laterite adsorption capacity with a soil having comparable mineralogy, but with amorphous iron oxide rather than haematite, showed the laterite to have a significantly greater capacity to adsorb bacteriophage. Batch study results using pure haematite confirmed that its occurrence in laterite contributes substantially to micro-organism attenuation observed and serves to protect underlying groundwater.

Looking at the effects of performance-based financing through a complex adaptive systems lens

The debate on PBF is misdirected. As is too often the case in international aid financing, agencies try to prove the effectiveness of their contribution by isolating it as the main reason for success.1 In reaction, opponents will often use the same approach in an attempt to prove that another factor is actually the cause of an observed change. We argue that this endless and futile debate, often present among experts in health systems strengthening, will not contribute to improving public health in low-income countries. Rather than searching for the impossible proof of whether PBF works or not, we should instead try to learn useful lessons from experiences. We agree with Ireland et al. that the focus of PBF assessment should be on “why” and “how” the intervention works.2 Comprehensive evaluation of PBF is needed as part of complete health system reform. We think that, to respond to some of these key questions, health systems should be analysed using a complex adaptive systems lens, as others have advocated in the past.3,4 A complex adaptive system is a collection of interacting components, each of which has its own rules and responsibilities. The behaviour of this kind of system is different to the sum of the behaviour of each of its components. Examples of complex adaptive systems include the human brain, ecosystems and manufacturing businesses. Health system “behaviour” and particularly counterintuitive behaviour (unexpected changes or lack of change) can be analysed using a complex adaptive systems lens when PBF is introduced, often with a mix of other interventions such as in a context of system reform. The purpose of this analysis is not to isolate causal factors but rather to identify “macro” characteristics of the system that may explain behaviour change. Although it has often been ignored in health system evaluation, social simulation can be useful for this approach. The most frequently used technique, agent-based modelling, uses computer simulation centred on a collection of autonomous agents whose interactions are based on a set of rules. These simulations can integrate empirical data or existing knowledge or opinions.5 One of the powerful features of agent-based modelling lies in its capacity to study complex phenomena in a simple and flexible way. Indeed, this approach does not require a high level of mathematical or programming skills, making it accessible to many researchers. Furthermore, it allows for an iterative learning process that is easy to set up compared to long and costly data collection processes. While this methodological approach may not “prove” the effectiveness of an intervention, it could provide insight into the reason a health system behaves in a given way (whether it changes or remains in a steady-state) when PBF is introduced. We believe that this type of information, although maybe less appealing to the usual stakeholders in development aid debates, is much more useful in evaluating PBF.

Key aspects of health policy development to improve surgical services in Uganda.

Recently, surgical services have been gaining greater attention as an integral part of public health in low-income countries due to the significant volume and burden of surgical conditions, growing evidence of the cost-effectiveness of surgical intervention, and global disparities in surgical care. Nonetheless, there has been limited discussion of the key aspects of health policy related to surgical services in low-income countries. Uganda, like other low-income sub-Saharan African countries, bears a heavy burden of surgical conditions with low surgical output in health facilities and significant unmet need for surgical care. To address this lack of adequate surgical services in Uganda, a diverse group of local stakeholders met in Kampala, Uganda, in May 2008 to develop a roadmap of key policy actions that would improve surgical services at the national level. The group identified a list of health policy priorities to improve surgical services in Uganda. The priorities were classified into three areas: (1) human resources, (2) health systems, and (3) research and advocacy. This article is a critical discussion of these health policy priorities with references to recent literature. This was the first such multidisciplinary meeting in Uganda with a focus on surgical services and its output may have relevance to health policy development in other low-income countries planning to improve delivery of surgical services.

Peoples-uni

Working to improve public health in low-income countries by building skills using the internet: Richard Heller issues a call for volunteers