Semi-rural Area Research Articles

Análisis de una plataforma para apoyar en el diagnóstico del síndrome de ovario poliquístico

Polycystic Ovary Syndrome (PCOS) is a common endocrine condition among women of reproductive age and its early diagnosis prevents long-term complications; however, this diagnosis presents difficulties due to the variability of symptoms, cultural taboos and the need for laboratory and imaging tests interpreted by specialists in Gynecology. On the other hand, Artificial Intelligence (AI) techniques have shown great potential to help in the early detection of different diseases. Currently, women in rural and semi-rural areas have little access to specialists and studies, so it is considered useful to have a health platform, which includes AI techniques, in mobile and web environments, that supports the detection of PCOS. This article shows the result of the systems analysis for the aforementioned platform, presenting the functional and non-functional requirements compiled with the help of health professionals in General Medicine and Gynecology.

The Use of a Multimedia-Enabled, Serialized Worked-Example Artifact in an Online Environment for Secondary Education

High school students in rural and semi-rural areas are disadvantaged because their schools struggle to attract and retain instructors who are qualified to teach career and technology courses that ready students for the knowledge economy. The effects of the pandemic moved much knowledge-economy work online by adopting study-from-home (SFH) models; however, educational institutions have been slow to validate corresponding study-from-home instructional models. In response, the current study developed study-from-home instruction using a multimedia-enabled, serialized worked-example artifact to teach financial accounting and modeling for high school students. The study featured grounded theories that inform the design of SFH instruction and online facilitation for a yearlong study. The instruction aimed to promote the far transfer of domain-specific, career-development knowledge regarding financial accounting and modeling. To do so, authors conducted a quasi-experiment with 50 students from five public high schools in rural and semi-rural East Texas. The result shows that socially situated SFH instruction whose design follows the principles of cognitive load theory, situated learning, and cognitive apprenticeship promoted mastery-of-learning outcomes over the course of an academic year. Our findings indicate a promising new direction in the design of remote instruction that delivers complex content to small-screen mobile devices for high school students.

Prevalence of Smoking Among School Students in Iraq.

Background Developing communities like Iraq are critical to building a good community environment. Many complex patterns of behaviors like smoking among adolescents have been exacerbated rapidly in the current era which led to changes in the Iraqi community's perspectives and life expectancy. This study aims to find out the prevalence of smoking among secondary school students in Iraq and their perceived contributing factors. Methods A cross-sectional study design was used with a representative sample of Iraqi school students recruited through a multistage cluster randomization from the Nineveh Governorate's intermediate and secondary schools to ensure the representation of the general public strata. A total of 330 students were randomly selected from eight schools distributed all over Mosul city (the center of Nineveh Governorate) and its boundaries semi-rural areas. Data collection utilized a standardized, anonymous questionnaire based on the Global Youth Tobacco Survey (GYTS) administered within classrooms with the researcher's presence. The questionnaire included questions related to sociodemographic characteristics of the students, smoking state, smoking types, frequency of smoking, relative smoking state, opinion on predisposing factors for initiation of smoking, and knowledge about hazards of smoking. Data analysis was done using SPSS version 26 to calculate frequency distribution with further logistic regression analysis was performed to identify statistically significant factors contributing to initiation of smoking among the student participants with p-value estimation of any compares considered significant below 0.05. Results Prevenance of all types of smoking was 24.5% from 330 students with 30% from 246 males and 7%from 84 females has been encountered. Hookah (Shisha) was the most prevalent type of smoking.About a third of the smoker sample reported smoking at least once daily. Peer pressure (OR=3.49, P< 0.001) or family smoking (OR=1.769, P=0.019) emerged as the strongest influence for initiation of smoking, besides stress (OR=2.23, P= 0.04) and personality traits like stammering and jealousy (OR=2.58, P= 0.013), (OR=2.22, P= 0.017, respectively) have also significant odds. Interestingly, media (movie star) influence played a significant role also. (OR=1.492, P= 0.045). Conclusion The prevalence of smoking among the study sample was 24.5 % out of 330 participating students. Significant influencing factors were found that raised the concern and necessitated the development of targeted interventions. Implementing evidence-based strategies, such as comprehensive school-based educational programs and smoke-free indoor air policies, can significantly improve public health outcomes.

Agri-voltaics near airport facilities. Reconciling the risk of solar glare with power generation

The installation of photovoltaic systems on cultivated land enables both agricultural and green energy production simultaneously. The result is an efficient and inclusive use of land that promotes the rural economy, enables the recovery and maintenance of land and prevents its abandonment when it is considered not profitable. This intent is facilitated in semi-rural areas where there is already the presence of infrastructure connected to the national power grid, but at the same time is limited by other human activities. Runway approach and air traffic control operations impose very stringent constraints on the possibility that photovoltaic panels, reflecting solar radiation, may glare airport operators.This article provides a methodology for verifying such phenomena (control function) and mitigating them by maximizing solar power generation (objective function). Through a case study located in central Italy, positioned near an airport, it was possible to investigate the design variables to protect the landing air routes and the airport control tower.In this case study, with an azimuth angle of 47° and tilt angle of 25°, and thanks to a 5 m high tree screen placed on the edge of the land on which the agri-voltaic installation stands, it is possible to secure airport operations by eliminating all forms of solar glare. At the same time, 21.9 GWh of photovoltaic energy is produced annually, while avoiding the release of 8,773 tons of CO2 into the atmosphere. Compared with the optimal, unconstrained case, photovoltaic panels arranged in this way decrease their annual energy production by only 6.8 %.

Enhancing HIV positivity yield in southern Mozambique: The effect of a Ministry of Health training module in targeted provider-initiated testing and counselling.

In Mozambique, targeted provider-initiated HIV testing and counselling (PITC) is recommended where universal PITC is not feasible, but its effectiveness depends on healthcare providers' training. This study aimed to evaluate the effect of a Ministry of Health training module in targeted PITC on the HIV positivity yield, and identify factors associated with a positive HIV test. We conducted a single-group pre-post study between November 2018 and November 2019 in the triage and emergency departments of four healthcare facilities in Manhiça District, a resource-constrained semi-rural area. It consisted of two two-month phases split by a one-week targeted PITC training module ("observation phases"). The HIV positivity yield of targeted PITC was estimated as the proportion of HIV-positive individuals among those recommended for HIV testing by the provider. Additionally, we extracted aggregated health information system data over the four months preceding and following the observation phases to compare yield in real-world conditions ("routine phases"). Logistic regression analysis from observation phase data was conducted to identify factors associated with a positive HIV test. Among the 7,102 participants in the pre- and post-training observation phases (58.5% and 41.5% respectively), 68% were women, and 96% were recruited at triage. In the routine phases with 33,261 individuals (45.8% pre, 54.2% post), 64% were women, and 84% were seen at triage. While HIV positivity yield between pre- and post-training observation phases was similar (10.9% (269/2470) and 11.1% (207/1865), respectively), we observed an increase in yield in the post-training routine phase for women in triage, rising from 4.8% (74/1553) to 7.3% (61/831) (Yield ratio = 1.54; 95%CI: 1.11-2.14). Age (25-49 years) (OR = 2.43; 95%CI: 1.37-4.33), working in industry/mining (OR = 4.94; 95%CI: 2.17-11.23), unawareness of partner's HIV status (OR = 2.50; 95%CI: 1.91-3.27), and visiting a healer (OR = 1.74; 95%CI: 1.03-2.93) were factors associated with a positive HIV test. Including these factors in the targeted PITC algorithm could have increased new HIV diagnoses by 2.6%. In conclusion, providing refresher training and adapting the current targeted PITC algorithm through further research can help reach undiagnosed PLHIV, treat all, and ultimately eliminate HIV, especially in resource-limited rural areas.

Socio-Demographic Factors Influencing Malaria Vaccine Acceptance for Under-Five Children in a Malaria-Endemic Region: A Community-Based Study in the Democratic Republic of Congo.

Two novel vaccines against malaria are proposed as a complementary control tool to prevent and reduce Plasmodium falciparum related disease and death in under-five children from moderate to high malaria transmission regions. The Democratic Republic of Congo (DRC) has committed to eradicate malaria by 2030, and significant efforts have been deployed to strengthen control and elimination measures. We aimed to understand factors influencing the malaria vaccine acceptability among the general population in eastern DRC. We conducted a survey among adult Congolese in Bukavu in March 2022. The questionnaire was adapted from the Behavioral and Social Drivers of vaccine uptake (BeSD) framework and was administered online and physically. Multivariate logistic regressions were built, and estimates were represented as adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI). Out of 1612 adults (median age: 39 years, 46.15% female) surveyed, only 7.26% were aware of the malaria vaccine. However, 46.53% expressed willingness to vaccinate themselves, and 52.60% were open to vaccinating their under-five children. Adjusting for confounding factors, non-student/non-healthcare worker professions (aOR = 0.58, 95%CI [0.42-0.78]) and middle-income status (aOR = 1.87, 95%CI [1.25-2.80]) were significantly associated with self-vaccination acceptance. Age played a role in under-five child vaccination acceptability, with 25 to over 64 years showing increased acceptability compared to the 18-24 age group. Additionally, non-student/non-healthcare worker professions (aOR = 1.88, 95%CI [1.37-2.59]), medium education levels (aOR = 2.64, 95%CI [1.29-5.79]), and residing in semi-rural areas (aOR = 1.63, 95%CI [1.27-2.10]) were predictors of under-five child vaccination acceptance. The acceptability of the malaria vaccine for self and for under-five children was suboptimal for effective malaria control in this community in the DRC. Our study constitutes a call for the Expanded Program on Immunization to closely work with various stakeholders to strengthen risk communication for community engagement prior to and during the introduction of this novel and lifesaving tool, malaria vaccination.

Patient Education and Decision Support for Long-Acting Injectable HIV Antiretroviral Therapy: Protocol for Tool Development and Pilot Testing with Ryan White HIV/AIDS Program Medical Case Management Programs in New York.

Long-acting injectable (LAI) HIV antiretroviral therapy (ART) presents a major opportunity to facilitate and sustain HIV viral suppression, thus improving health and survival among people living with HIV and reducing the risk of onward transmission. However, realizing the public health potential of LAI ART requires reaching patients who face barriers to daily oral ART adherence and thus can clinically benefit from alternative treatment modalities. Ryan White HIV/AIDS Program Part A medical case management (MCM) programs provide an array of services to address barriers to HIV care and treatment among economically and socially marginalized people living with HIV. These programs have demonstrated effectiveness in improving engagement along the continuum of care, but findings of limited program impact on durable viral suppression highlight the need to further innovate and hone strategies to support long-term ART adherence. This study aims to adapt and expand Ryan White MCM service strategies to integrate LAI ART regimen options, with the larger goal of improving health outcomes in the populations that could most benefit from alternatives to daily oral ART regimens. In 3 phases of work involving patient and provider participants, this study uses role-specific focus groups to elicit perceptions of LAI versus daily oral ART; discrete choice experiment (DCE) surveys to quantify preferences for different ART delivery options and related supports; and a nonrandomized trial to assess the implementation and utility of newly developed tools at 6 partnering Ryan White HIV/AIDS Program Part A MCM programs based in urban, suburban, and semirural areas of New York. Findings from the focus groups and DCEs, as well as feedback from advisory board meetings, informed the design and selection of the tools: a patient-facing, 2-page fact sheet, including frequently asked questions and a side-by-side comparison of LAI with daily oral ART; a patient-facing informational video available on YouTube (Google Inc); and a patient-provider decision aid. Implementation outcomes, measured through provider interviews, surveys, and service reporting, will guide further specification of strategies to integrate LAI ART options into MCM program workflows. The study was funded in late April 2021 and received approval from the institutional review board in May 2021 under protocol 20-096. Focus groups were conducted in late 2021 (n=21), DCEs ran from June 2022 to January 2023 (n=378), and tools for piloting were developed by May 2023. The trial (May 2023 through January 2024) has enrolled >200 patients. This study is designed to provide evidence regarding the acceptability, feasibility, appropriateness, and utility of a package of patient-oriented tools for comparing and deciding between LAI ART and daily oral ART options. Study strengths include formative work to guide tool development, a mixed methods approach, and the testing of tools in real-world safety-net service settings. Clinicaltrials.gov NCT05833542; https://clinicaltrials.gov/study/NCT05833542. DERR1-10.2196/56892.

Duration and Sociodemographic Factors Associated with Exclusive Breastfeeding Among Mothers in Urban and Semi-Rural Areas of Libreville and Lambaréné in Gabon

Background: Exclusive breastfeeding from birth to six months of age has an unparalleled benefit on a child's growth and development. This survey aimed to assess the practice of exclusive breastfeeding (EBF) in Libreville and Lambaréné. Method: This is a prospective study, including mother-child pairs of infants taken to vaccination centers in Libreville (urban area) and Lambaréné (semi-rural area). The data collected included sociodemographic aspects of families, the children's characteristics, and the duration of EBF in months. Result: We included 552 mother-child pairs, 58% of whom were recruited (n = 320) in Libreville. The average age of mothers was 26.5 ± 6.4 years, while fathers were 33.3 ± 7.8 years. The mean age of children was 4.2 ± 3.1 months. Male participants were accounted for 52.2% (n = 288), while females 47.8% (n = 264). The mean duration of exclusive breastfeeding in the whole was 0.9 months. Six-month EBF was generally performed at 9.2% (n = 51, 95% CI = 7.1%-11.9%). The factors influencing the EBF were father’s level of education (all classes combined) (p = 0.025), marital status (p = 0.011), and residential area (OR = 3.40, p &lt;0.001) Conclusion: The duration of exclusive breastfeeding in the two studied is lower than the WHO recommendations. The associated factors found are areas of work to be explored to encourage this important practice for our infants.

‘They didn’t look at me with good eyes' – experiences of the socioeconomic impact of tuberculosis and support needs among adults in a semi-rural area in Mozambique: A Qualitative Study

ABSTRACT Tuberculosis is recognised as a disease of the economically disadvantaged people due to its association with financial vulnerability. Mozambique still faces the challenge of the high burden of TB and associated costs. We aimed to understand the social and economic impacts of TB and the need for social support among people with TB in Mozambique. We conducted a qualitative study using a phenomenological approach focusing on the lived experiences and perceptions of people with TB. A total of 52 semi-structured one-to-one in-depth interviews were conducted and data were analysed using a reflexive thematic analysis. Three themes were drawn from the analysis: (i) TB has a social and economic impact that requires adaptation and resourcefulness amongst those affected; (ii) People with TB have different preferences and needs for social support, and (iii) People with TB have different knowledge of, and experiences with, formal social support. TB affects family and community relationships mainly due to impacts on the household’s finances. People with TB in Mozambique are not entitled to any form of social support, and they need to rely on help from family and the community which is often insufficient. Further investigation is needed on how social support schemes can be developed in Mozambique.

Food Insecurity and Coping Strategies among Elderly Headed Households in Selected Semi-rural Areas in the Eastern Cape Province of South Africa

Food Insecurity and Coping Strategies among Elderly Headed Households in Selected Semi-rural Areas in the Eastern Cape Province of South Africa

Malaria Prevalence in Asymptomatic and Symptomatic Children Living in Rural, Semi-Urban and Urban Areas in Eastern Gabon

BackgroundMalaria remains a major public health issue in the world despite a decline in the disease burden. However, though symptomatic malaria is diagnosed and treated, asymptomatic infections remain poorly known and support transmission. This study assessed the prevalence of symptomatic and asymptomatic Plasmodium spp. infections in three areas in Gabon to monitor and evaluate the impact of malaria.Methods and ResultsA cross-sectional study was conducted in three areas of Gabon. Febrile and afebrile children aged 6 months to 15 years were included in this study. Malaria prevalence was determined by microscopy of and using rapid diagnostic test (RDT). Plasmodium spp. species were identified by PCR according to the Snounou method. The data were recorded in Excel, and the statistical analyses were performed using the software R version R 64 × 3.5.0. A total of 2381(333 asymptomatic and 107 symptomatic) children were included. The overall prevalence of malaria was 40% (952/2381), with the majority (77% symptomatic and 98% asymptomatic) of infections caused by Plasmodium falciparum. A high prevalence of malaria was found in infected children in rural and semi-rural areas. In these two areas, a higher prevalence of Plasmodium malariae was observed in asymptomatic. Furthermore, mixed infections were more prevalent in asymptomatic children than in symptomatic.ConclusionThis study showed that the prevalence of Plasmodium spp. infection varied according to the regions. The main species was Plasmodium falciparum, but in asymptomatic children the prevalence of Plasmodium malariae was high in rural areas. To help fight malaria more effectively asymptomatic infections should be taken into account and treated.

Filarial nematodes in domestic dogs and mosquitoes (Diptera: Culicidae) from semi-rural areas in Central Chile.

Climate change, competent vectors, and reservoir animals are the main factors for developing vector-borne zoonotic diseases. These diseases encompass a significant and widespread category of pathogens (e.g., viruses, bacteria, protozoa, and helminths) transmitted by blood-feeding arthropods, including ticks, fleas, lice, triatomines, mosquitoes, sandflies, and blackflies. In Chile, several studies have explored the role of dogs as reservoirs of vector-borne pathogens; however, there is a lack of research investigating the presence of pathogens in arthropods. Specifically, within the order Diptera, limited knowledge exists regarding their roles as carriers of pathogens. This study aimed to examine the presence of zoonotic filarial nematodes in mosquitoes and dogs within a previously unstudied semi-rural area of Central Chile. Two hundred samples of dog blood and seven hundred and twenty-four mosquitoes were collected during 2021-2022 and studied for filarial nematodes by PCR. The prevalence of microfilaremic dogs detected by Knott's test was 7.5%, with Acanthocheilonema reconditum being the only species identified. Aedes (Ochlerotatus) albifasciatus was the most abundant mosquito species collected, and 15 out of 65 pools were positive for filarial nematodes. Among these pools, 13 tested positive for Acanthocheilonema reconditum, and two tested positive for Setaria equina through PCR. Additionally, five Culex pipiens specimens were positive for Acanthocheilonema reconditum. Despite the absence of zoonotic filarial species, these findings underscore the significance of monitoring pathogens in mosquitoes and animal hosts and continued research into the dynamics of vector-borne diseases, particularly in unexplored regions.

Knowledge assessment about sexually transmitted diseases among high-school pupils in their final year in a French semi-rural area in 2020

Contexte. L’incidence des infections sexuellement transmissibles (IST) augmente depuis les années 2000, notamment chez les jeunes, malgré les campagnes de prévention. Les adolescents sont une population à risque et une cible prioritaire à la prévention des IST. Objectif. Évaluer les connaissances des lycéens en terminale concernant les IST. Méthode. Enquête transversale réalisée début 2020 auprès d’élèves de classes de terminale de trois lycées publics d’un département semi-rural (généraux et technologiques, professionnels), par un auto-questionnaire anonyme. À partir de ces questionnaires, des scores de connaissances ont été établis. Résultats. Cent-trente-cinq élèves ont participé. Le score de connaissances global était de 56,4 %. Le score de connaissances des filles était plus élevé que celui des garçons (p &lt; 0,01), de même que celui des lycéens de filière générale en comparaison à celui des lycéens de filière professionnelle (p &lt; 0,01). Les connaissances les moins élevées concernaient les symptômes des IST, les conséquences à long terme notamment l’infertilité tubaire, le dépistage après prise de risque et les traitements. Conclusion. Les adolescents ont des connaissances moyennes voire faibles concernant les IST. L’information délivrée par les professionnels de santé doit être renforcée. L’accès au dépistage individuel dans les centres et auprès des professionnels de santé doit être facilité. Le médecin généraliste pourrait avoir une place à prendre dans la prévention des IST et doit profiter de chaque consultation pour aborder cette thématique avec les adolescents.

Prevalence of undiagnosed hyperglycemia and hypertension among middle-aged adults in Vietnam: A community-based study

BackgroundThe information on prevalence of undiagnosed hyperglycemia, and hypertension among the adult in Vietnam is limited. The aim of this study was to identify the prevalence of undiagnosed intermediate hyperglycemia, hyperglycemia, and hypertension and some associated factors among adults aged ≥40 years living in Ba Vi district in Hanoi, Vietnam. MethodsA cross-sectional study was conducted among 1814 adults aged ≥40 years nine communes in Ba Vi district, a semi rural area, in Hanoi, Vietnam. Lists of the adults aged ≥40 years living in nine communes, who reported undiagnosed for hypertension, and diabetes, were made. From the lists, the participants were randomly selected based on the selection criteria. Participants were people who reported they are free of hypertension, diabetes, prediabetes at the day of data collection. Participants were collected information on sociodemographic characteristics, blood pressure measurement, and 3 ml fasting venous blood samples by certified phlebotomists. The main study outcomes variables were intermediate hyperglycemia, hyperglycemia, and hypertension. ResultsPrevalence of undiagnosed intermediate hyperglycemia, hyperglycemia, and hypertension among the participants were 47.8 %, 8.2 %, and 40.0 %, respectively. Higher prevalence of undiagnosed intermediate hyperglycemia (53.3 % vs 46.2 %), hyperglycemia (13.5 % vs 7.9 %), and high blood pressure (52.8 % vs 33.9 %) were found among males compared with females. ConclusionHigh prevalence of undiagnosed intermediate hyperglycemia, hyperglycemia, and hypertension were found in the middle-aged adults in Vietnam. Improving the individual's awareness and early screening for diabetes, and hypertension in adults for timely management are necessary.

Analysis of Semi-Rural and Urban Hypertension Prevalence Using WHO Measures

This study investigated the widespread health concern of hypertension and its significant impact on cardiovascular diseases, strokes, and overall health. The research focuses on understanding the prevalence of hypertension in both semi-rural and urban areas, using World Health Organization metrics for a comprehensive evaluation. Despite extensive prior research on hypertension, the distinct frequency gap between semi-rural and urban settings poses a notable challenge. This study addressed issues in data collection, sampling biases, and temporal fluctuations by introducing a novel approach called Hypertension Prevalence Analysis using WHO Measures (HPA-WHOM), which outperforms existing methods. In semi-rural settings, HPA-WHOM estimates a hypertension prevalence of 53.76%, revealing average blood pressure levels, salt intake, physical activity, smoking habits, and alcohol use. These findings underscore HPA-WHOM's effectiveness in understanding hypertension prevalence and associated factors, contributing valuable insights for tailored interventions and global initiatives to combat the worldwide impact of hypertension on public health.

A Simple and Easily Implementable Model for the Prediction of Solar Irradiance for All-Sky Conditions: Model Development, Preliminary Evaluation and Application

A simple and easily implementable model and the associated computer code for predicting the solar irradiance at the earth’s surface have been developed. The input requirements of the model include Julian day, time, geographical latitude, atmospheric pressure and cloud cover. If the latter is not available, then the program user has the option of entering either the daily global solar flux or the duration of sunshine, from which the average cloud cover is estimated. Preliminary model evaluation has been carried out using data from two meteorological stations situated in rural and semi-rural areas of the East Midlands, United Kingdom. The scatter plots of predicted versus observed solar irradiance gave correlation coefficients approximately equal to 0.6 and slopes in the range of 0.80–0.93. The model is being implemented as a submodule within an urban air quality model. This specific application of the solar radiation model is discussed as a typical implementation. This work shows that by adopting relatively simple ‘textbook’ material, i.e., basic theory/information, one can achieve reasonably good solar radiation modelling, with outcomes that can be used for applications where accuracy is not a major requirement.

Study of problems faced by Women Entrepreneurs with special reference to Self Help Groups in Eranakulam District

Entrepreneurship is the act of being an entrepreneur, which can be defined as "one who takes over the world, innovations, finance and business acumen in an effort to transform innovations into economic goods". This may result in new organizations or may be part of revitalizing mature organizations in response to a perceived opportunity. An entrepreneur is a person who has possession of a new enterprise, venture or idea and is accountable for the inherent risks and the outcome. When women enter into a business venture a women entrepreneur is born. Lack of specific skills and restriction on availability of any meaningful employment in the rural or semi rural areas compels a woman to start her own business.&#x0D; A Self-Help Group (SHG) is a registered or unregistered group of micro entrepreneurs having homogenous social and economic backgrounds, voluntarily coming together to save regular small sums of money. They mutually agree to contribute to a common fund and to meet their emergency needs on the basis of mutual help. Also it is a group of people who pool in their resources to become financially stable by taking loans from the money collected by that group and by making everybody of that group self-employed.&#x0D; However a lot of SHG’s face a lot of problems and close down after venturing into their own enterprises. In the present paper the researchers have made an attempt to find out and analyse the reasons for success or failure of the business ventures as established by women SHG’s in the city of Eranakulam.

Monitoring gaseous pollutants using passive sampling in the Philadelphia region

ABSTRACT Air pollution can have deleterious impacts on human health and the environment. Historically, air pollution studies have focused more on cities. However, it is also important to consider the impact on large suburban populations living closer to the major cities. In this study, nitrogen oxides (nitrogen dioxide and nitric oxide), sulfur dioxide, ozone, and ammonia concentrations were measured from fifteen sites in the Greater Philadelphia area, Pennsylvania, USA using Ogawa passive samplers from September 2021 to May 2022. The fall season had the highest mean NOx concentrations (11.03 ± 4.51 ppb), and spring had the highest mean O3 concentration (18.65 ± 6.71 ppb) compared to other seasons. NOx concentrations were higher at suburban (30.43 ± 33.79 ppb) and urban sites (22.49 ± 12.54 ppb) compared to semi-rural sites (11.08 ± 9.20 ppb). SO2 was not detected in most of the measurements. The positive statistically significant correlation between NO and NH3 in urban (R2 = 0.33, p-value <0.05) and suburban sites (R2 = 0.37, p-value <0.05) during winter and spring, respectively, suggests a high attribution of traffic emissions to NH3 at urban and suburban sites. Influence of traffic emissions on air pollutant values for the study region is also supported by similar NOx concentrations between suburban and urban sites as well as decreasing NO2/NOx ratios with increased distance from expressways. This study shows that passive sampling can be effectively used for assessing spatial and seasonal variations in air pollutants within an area of diverse land use. Implications: This study presents the findings of temporal and seasonal patterns for nitrogen dioxide, nitric oxide, tropospheric ozone, and ammonia at urban, suburban, and semi-rural areas of the greater Philadelphia region. The main objective of the study is to monitor air pollution in suburban and semi-rural areas which are not monitored for air pollution. We monitored from a total of fifteen sites in three seasons to assess air pollution in suburban and semi-rural areas near the major city in the United States – Philadelphia. The findings are important to learn how air quality is affected in suburban and semi-rural areas near the major city. The study also shows the useful application of inexpensive passive sampling technique for measuring air pollution.

Incidence and risk factors of neonatal bacterial infections: a community-based cohort from Madagascar (2018–2021)

BackgroundFew studies on neonatal severe bacterial infection are available in LMICs. Data are needed in these countries to prioritize interventions and decrease neonatal infections which are a primary cause of neonatal mortality. The BIRDY project (Bacterial Infections and Antimicrobial Drug Resistant among Young Children) was initially conducted in Madagascar, Senegal and Cambodia (BIRDY 1, 2012–2018), and continued in Madagascar only (BIRDY 2, 2018–2021). We present here the BIRDY 2 project whose objectives were (1) to estimate the incidence of neonatal severe bacterial infections and compare these findings with those obtained in BIRDY 1, (2) to identify determinants associated with severe bacterial infection and (3) to specify the antibiotic resistance pattern of bacteria in newborns.MethodsThe BIRDY 2 study was a prospective community-based mother and child cohort, both in urban and semi-rural areas. All pregnant women in the study areas were identified and enrolled. Their newborns were actively and passively followed-up from birth to 3 months. Data on clinical symptoms developed by the children and laboratory results of all clinical samples investigated were collected. A Cox proportional hazards model was performed to identify risk factors associated with possible severe bacterial infection.FindingsA total of 53 possible severe bacterial infection and 6 confirmed severe bacterial infection episodes were identified among the 511 neonates followed-up, with more than half occurring in the first 3 days. For the first month period, the incidence of confirmed severe bacterial infection was 11.7 per 1,000 live births indicating a 1.3 -fold decrease compared to BIRDY 1 in Madagascar (p = 0.50) and the incidence of possible severe bacterial infection was 76.3, indicating a 2.6-fold decrease compared to BIRDY 1 in Madagascar (p < 0.001). The 6 severe bacterial infection confirmed by blood culture included 5 Enterobacterales and one Enterococcus faecium. The 5 Enterobacterales were extended-spectrum β-lactamases (ESBL) producers and were resistant to quinolones and gentamicin. Enterococcus faecium was sensitive to vancomycin but resistant to amoxicillin and to gentamicin. These pathogns were classified as multidrug-resistant bacteria and were resistant to antibiotics recommended in WHO guidelines for neonatal sepsis. However, they remained susceptible to carbapenem. Fetid amniotic fluid, need for resuscitation at birth and low birth weight were associated with early onset possible severe bacterial infection.ConclusionOur results suggest that the incidence of severe bacterial infection is still high in the community of Madagascar, even if it seems lower when compared to BIRDY 1 estimates, and that existing neonatal sepsis treatment guidelines may no longer be appropriate in Madagascar. These results motivate to further strengthen actions for the prevention, early diagnosis and case management during the first 3 days of life.

Prevalence and Risk Factors of Neonatal Hyperbilirubinemia in a Semi-Rural Area of the Democratic Republic of Congo: A Cohort Study.

Neonatal hyperbilirubinemia (NH) is a frequent condition that, if left untreated, can lead to neurological disability and death. We assessed the prevalence of NH and associated neonatal and maternal risk factors in 362 mothers and 365 newborns in a semi-rural area of the Democratic Republic of Congo. In addition, we explored the knowledge and practices of mothers regarding this condition. We collected demographic data, anthropometric data, and obstetric and medical anamneses. We examined newborns at birth and at 24, 48, and 72 hours and measured bilirubin at birth in umbilical cord and capillary blood and thereafter in capillary blood. Hemoglobin, hematocrit, ABO group, Rhesus factor, glucose-6-phosphate dehydrogenase (G6PD) deficiency, Hemoglobin S (HbS), and malaria were assessed in mothers and newborns. Among 296 newborns (all time points available), 5.7% developed NH (95% CI: 3.4-9.0) between 24 and 72 hours according to National Institute for Health and Care Excellence (NICE) UK guidelines. There was a significantly higher risk in newborns with G6PD deficiency (homo- and hemizygous adjusted Odd Ratio [aOR]: 21.0, 95% CI: 4.1-105.9), preterm births (aOR: 6.1, 95% CI: 1.4-26.9), newborns with excessive birth weight loss (aOR: 5.8, 95% CI: 1.4-23.2), and hyperbilirubinemia at birth (aOR: 14.8, 95% CI: 2.7-79.6). Newborns with feto-maternal ABO incompatibility and G6PD deficiency had significantly higher bilirubin at birth than others. More than 60% of mothers had adequate knowledge of NH, but compliance with phototherapy in the absence of symptoms was low. Although risk factors for NH are common in this area, prevalence was not high, suggesting a need for better case definition. Implementation of point-of-care devices for diagnosis and awareness programs on risk prevention could help reduce neonatal morbidity and mortality associated with hyperbilirubinemia in these areas.