WHO Recommendations Research Articles

Navigating the Waves: A Comprehensive Analysis of India's COVID-19 Journey from 2019 to the Arrival of JN.1 Subvariant in 2023

COVID-19, caused by the SARS-CoV-2 virus, has emerged as a global threat. The journey of COVID-19, from its origins in Wuhan in 2019 to the emergence of various variants, including the recent JN.1 subvariant, is a complex narrative marked by global efforts to control the pandemic. The progression of the virus in India, as illustrated by data from 2020 to 2023, reflects both the challenges faced and the resilience exhibited by different states. The decline in cases in 2023, compared to the previous year, is attributed to factors such as extensive vaccination campaigns, the emergence of less severe variants, and changing immune responses. The inclusion of comprehensive WHO recommendations emphasizes the ongoing importance of preventive measures. The evolving scenario also highlights the need for continued vigilance, international collaboration, and public health initiatives to minimize the impact of the virus. The advent of JN.1 serves as a reminder of the virus's adaptability and the significance of remaining in advance of emerging variants as the globe struggles with COVID-19's unexpected nature.

Nutritional Status, Sugar Sweetened Beverage Consumption and Physical Activity Level in Male and Female College Students Living in Dormitory

Introduction: The global prevalence of obesity is on the rise, including in Indonesia. High energy intake from sugar is a growing concern worldwide due to its association with weight gain, tooth decay, and non-communicable diseases. A prior study revealed that 10.9% of Indonesian adults consumed energy from sweetened beverages in excess of the WHO recommendation. This study aimed to assess the consumption of sweetened beverages in male and female college students in Indonesia. Method: The study was conducted at Universitas Indonesia and involved 107 subjects aged 19-21 years who resided in student dormitories. Result: The result found the median BMI in female was higher than male. In female, 3 out of 10 students was overweight-obese, while 1 out of 10 in male. Interestingly, the median daily intake of sweetened beverages significantly higher in male than female; 387 (25–1580) vs 246 (0–762) ml/day (p=0.001). Added sugar content in beverages in males was higher than half of Indonesian recommendation (28.4 [1.9–134.4] vs 19.2 [0–61.1]) which contributed to energy as much as 170.9 (12.4–625.7) kcal/ day or about 8.9% of total energy intake than female (108.5 [0–394.4] kcal/day). Compared to Indonesian guideline, 12% of male subjects consumed added sugar higher than 50 g/day. Simultaneously, 7 out of 10 subjects consumed energy from sweetened beverages higher than 10% of their total energy intake (WHO recommendation). The BMI and prevalence of overweight-obese were higher in female, while the sweetened beverage was higher in male. It might be caused by the physical activity in male was higher than female. Although male had higher energy intake from SSB, their energy output through physical activity balanced with energy input. Conclusion: These finding alerted the university as educational institution should take an action to prevent this issue since the prevalence of overweight-obesity and sweetened beverage consumption has occurred in young age.

How Safe Are Nepal’s Roads? A Study of Road Safety Legislation and WHO Standards

Around the world, traffic accidents result in significant catastrophes. The consequences of traffic accidents go far beyond the immediate suffering of the individuals involved. This paper aims to examine the road safety legislation and WHO standards adopted in Nepal. The paper is based on secondary data and policy documents related to road safety and WHO standards in the context of Nepal. It presents Nepal’s road network, significant improvements in road safety indicators, and encouraging advancements in road safety. The study finds five major areas for improvement in road safety laws in Nepal: seat-belt regulations, helmet laws, speed laws, child restraint laws, and drinking and driving laws. The study also reveals that Nepal’s current regulatory framework needs to be improved by monitoring actual appropriate helmet fastening and standardization. There is a lack of precise BAC restrictions for drivers and insufficient speed limits under WHO recommendations. Nepal’s child restraint rules also need to be expanded to include seat belt usage in all cars and forbid children from sitting in the front seats. To close those regulatory gaps and protect Nepalese citizens’ safety on the roads, it ends by providing a strict set of recommendations, such as increased enforcement, public awareness campaigns, and changes to road design and concrete making plans. Policymakers, researchers, and stakeholders working to promote street safety measures in Nepal and abroad would find great assistance from this article, which offers a detailed examination and smart recommendations.

Evaluation of drinking water quality and associated health risks in Adama City, Ethiopia

Drinking water deterioration causes to risk of public health which is essential to supply safe water to the public. This study assessed groundwater quality and health risks in Adama City by analyzing groundwater and chlorine samples. Ion photometry techniques detected anions and cations, ensuring accuracy with quality control protocols. Water Quality Index (WQI) and chlorine decay modeling via WaterGEMs assessed water quality. Hazard index (HI) calculations evaluated exposure risks; Pearson correlation analyzed physicochemical relationships. Findings highlighted water quality and hazards. Aquachem software analyzed Adama's groundwater, revealing high total alkalinity and potassium exceeding WHO limits. Other parameters (nitrate, nitrite, chloride, fluoride, and sulfate) met WHO standards. Sodium, calcium, magnesium, iron, manganese, and boron also complied. Multivariate analysis showed significant parameter associations. Water types included Ca–Na–HCO3 (27.27 %), Na–Ca–HCO3 (36.36 %), Na–Ca–Mg–HCO3, Na–HCO3 (9.09 % each), and Na–Mg–HCO3 (18.18 %). Drinking Water Quality Index rated boreholes as "Good." Health risk assessments found no significant fluoride, iron, or manganese risks across ages. Chlorine residual analysis indicated 74 % had levels below WHO recommendations, prompting chlorine dosing adjustments. Findings inform groundwater management in Adama City.

A bio-behavioral model of systemic inflammation at breast cancer diagnosis and fatigue of clinical importance 2 years later

We aimed to generate a model of cancer-related fatigue (CRF) of clinical importance 2 years after diagnosis of breast cancer building on clinical and behavioral factors and integrating pre-treatment markers of systemic inflammation. Women with stage I-III hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer were included from the multimodal, prospective CANTO cohort (NCT01993498). The primary outcome was global CRF of clinical importance [European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 ≥40/100] 2 years after diagnosis (year 2). Secondary outcomes included physical, emotional, and cognitive CRF (EORTC QLQ-FA12). All pre-treatment candidate variables were assessed at diagnosis, including inflammatory markers [interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, interferon γ, IL-1 receptor antagonist, tumor necrosis factor-α, and C-reactive protein], and were tested in multivariable logistic regression models implementing multiple imputation and validation by 100-fold bootstrap resampling. Among 1208 patients, 415 (34.4%) reported global CRF of clinical importance at year 2. High pre-treatment levels of IL-6 (quartile 4 versus 1) were associated with global CRF at year 2 [adjusted odds ratio (aOR): 2.06 (95% confidence interval [CI] 1.40-3.03); P= 0.0002; area under the receiver operating characteristic curve= 0.74]. Patients with high pre-treatment IL-6 had unhealthier behaviors, including being frequently either overweight or obese [62.4%; mean body mass index 28.0 (standard deviation 6.3 kg/m2)] and physically inactive (53.5% did not meet World Health Organization recommendations). Clinical and behavioral associations with CRF at year 2 included pre-treatment CRF [aOR versus no pre-treatment CRF: 3.99 (95% CI 2.81-5.66)], younger age [aOR per 1-year decrement: 1.02 (95% CI 1.01-1.03)], current tobacco smoking [aOR versus never: 1.81 (95% CI 1.26-2.58)], and worse insomnia or pain [aOR per 10-unit increment: 1.08 (95% CI 1.04-1.13), and 1.12 (95% CI 1.04-1.21), respectively]. Secondary analyses indicated additional associations of IL-2 [aOR per log-unit increment: 1.32 (95% CI 1.03-1.70)] and IL-10 [0.73 (95% CI 0.57-0.93)] with global CRF and of C-reactive protein [1.42 (95% CI 1.13-1.78)] with cognitive CRF at year 2. Emotional distress was consistently associated with physical, emotional, and cognitive CRF. This study proposes a bio-behavioral framework linking pre-treatment systemic inflammation with CRF of clinical importance 2 years later among a large prospective sample of survivors of breast cancer.

Yield of TB screening in prisons in Tajikistan.

The rate of TB in prison institutions is estimated to be 23 times higher than in the general population. Limited documentation exists regarding TB screening in Tajikistan's prisons. This study aims to report findings from a TB screening conducted in prison facilities in Tajikistan. A systematic TB screening was conducted between July 2022 and September 2023, following a locally adapted algorithm based on WHO recommendations. The screening yield was calculated as the proportion of confirmed TB cases, with categorical variables compared using a χ2 test. A total of 7,223 screenings were conducted, identifying 31 TB cases, including 17 drug-susceptible TB cases, eight drug-resistant TB cases, and six clinically diagnosed cases. The overall screening yield was 0.43%. Notably, the screening yield was 3.4% among individuals with at least one TB symptom and 0.03% among those without TB symptoms (P < 0.001). The identified rate of TB in these prisons is five times higher than in the general population. Symptomatic individuals had a higher likelihood of TB diagnosis, and using chest X-rays significantly improved screening yield. We recommend increasing the capacity for chest X-ray testing to enhance TB prevention and control within prison settings.

How strong is the evidence supporting the WHO guidelines on physical activity, sedentary behaviour and sleep in early childhood?

The WHO issued recommendations about the ideal amount of physical activity, sedentary behaviour and sleep in infants, toddlers and preschool children. To facilitate their interpretation and translation into public health policies, we analysed the quantity and quality of the evidence that supported the development of each WHO recommendation. All data for each exposure-outcome pair analysed in the studies informing WHO guidelines were extracted, and predefined criteria, based upon GRADE methodology, were used to classify each outcome and study result. Among the 237 studies that could be included, 37 were experimental and 200 were observational, yielding 920 analyses of exposure-outcome associations. Sixty-two analyses used a relevant outcome, with or without significant results. Five of the 10 WHO recommendations were based upon zero analyses with significant results on relevant health outcomes. The remaining recommendations were mostly based upon analyses evaluating obesity-related outcomes. Eight of the 10 GLs thresholds were not supported by any significant analysis on clinically relevant outcomes. While these findings should not be interpreted as an attempt to disprove the benefits of healthy lifestyle habits in early childhood, neither to minimize the work of the experts in this complex research field, very limited evidence currently supports the adoption of recommended thresholds as behavioural surveillance and public health interventions targets. Therefore, until further data are available, public health interventions should be developed balancing whether to focus on the achievement of specific targets that are still not supported by high-quality evidence or on the general promotion of healthy behaviours.

Prevalence of Strongyloides stercoralis and other helminths in four districts of Madagascar

BackgroundEstimation of prevalence of Strongyloides stercoralis infection is required in endemic areas, in order to identify areas in need of control programmes. Data on prevalence of strongyloidiasis in Madagascar are scant. Aim of this work was to estimate prevalence of S. stercoralis in four districts of Madagascar.MethodsFecal and serum samples collected in the context of a previous study on schistosomiasis were tested with S. stercoralis real-time PCR and serology, respectively. A multiplex real-time PCR for Ascaris lumbricoides, Ancylostoma duodenalis, Necator americanus, and Trichuris trichiura was done on fecal samples collected in the areas demonstrating higher prevalence of strongyloidiasis. Comparisons between proportions were made using Fisher exact test, with false discovery rate correction used for post-hoc comparisons. A multivariable Firth logistic regression model was used to assess potential risk factors for S. stercoralis infection.ResultsOverall, 1775 serum samples were tested, of which 102 of 487 (20.9%) and 104 of 296 (35.2%) were serological-positive in Marovoay and in Vatomandry districts (both coastal areas), respectively, compared to 28 of 496 (5.6%) and 30 of 496 (6.1%) in Tsiroanomandidy and in Ambositra districts (both highlands), respectively (adj. p < 0.001). PCR for S. stercoralis was positive in 15 of 210 (7.1%) and in 11 of 296 (3.7%) samples from Marovoay from Vatomandry, respectively, while was negative for all samples tested in the other two districts. High prevalence of A. lumbricoides (45.9%), hookworm (44.6%) and T. trichiura (32.1%) was found in Vatomandry. In the multivariable analysis, strongyloidiasis was associated with hookworm infection. Hookworm infection was also associated with male sex and lower education level.ConclusionsS. stercoralis prevalence proved higher in coastal areas compared to highlands. Different climatic conditions may explain this distribution, along with previous rounds of anthelminthics distributed in the country, which may have reduced the parasite load in the population. The high prevalence of the other soil-transmitted helminths (STH) in Vatomandry was unexpected, given the good coverage with benzimidazole in control campaigns. Further studies are needed to explore the risk factors for STH and S. stercoralis infections in Madagascar, in order to align with the WHO recommendations.

WHO recommendations on psychological interventions for mental disorders

WHO recommendations on psychological interventions for mental disorders

Was priority setting considered in COVID-19 response planning? A global comparative analysis

BackgroundThe COVID-19 pandemic forced governments across the world to consider how to prioritize resource allocation. Most countries produced pandemic preparedness plans that guide and coordinate healthcare, including how to allocate scarce resources such as ventilators, human resources, and therapeutics. The objective of this study was to compare and contrast the extent to which established parameters for effective priority setting (PS) were incorporated into COVID-19 pandemic response planning in several countries around the world. MethodsWe used the Kapriri and Martin framework for effective priority setting and performed a quantitative descriptive analysis to explore whether and how countries’ type of health system, political, and economic contexts impacted the inclusion of those parameters in their COVID-19 pandemic plans. We analyzed 86 country plans across six regions of the World Health Organization. ResultsThe countries sampled represent 40% of nations in AFRO, 54.5% of EMRO, 45% of EURO, 46% of PAHO, 64% of SEARO, and 41% of WPRO. They also represent 39% of all HICs in the world, 39% of Upper-Middle, 54% of Lower-Middle, and 48% of LICs. No pattern in attention to parameters of PS emerged by WHO region or country income levels. The parameters: evidence of political will, stakeholder participation, and use of scientific evidence/ adoption of WHO recommendations were each found in over 80% of plans. We identified a description of a specific PS process in 7% of the plans; explicit criteria for PS in 36.5%; inclusion of publicity strategies in 65%; mention of mechanisms for appealing decisions or implementing procedures to improve internal accountability and reduce corruption in 20%; explicit reference to public values in 15%; and a description of means for enhancing compliance with the decisions in 5%. ConclusionThe findings provide a basis for policymakers to reflect on their prioritization plans and identify areas that need to be strengthened. Overall, there is little consideration for explicit prioritization processes and tools and restricted attention to equity considerations; this may be a starting point for policymakers interested in improving future preparedness and response planning. Although the study focused on the COVID-19 pandemic, priority setting remains one of the policymakers’ most prominent challenges. Policymakers should consider integrating systematic priority setting in their routine decision-making processes.

Intake of Artificial Sweeteners through Soft Drinks in the Preschool- and School-Aged Population.

One of the main public health issues that has recently been observed in a greater number of children is being overweight. The cause certainly lies in the decreasing physical activity of children, but mostly in their eating habits. Soft drinks are recognized as the most significant contributor to body overweight due to high sugar content; thus, as a result of numerous campaigns, part of the sugar is replaced by artificial sweeteners (ASs). Despite their advantage due to their low caloric value, WHO recommends that they should not be used to achieve weight control or as prevention for reducing the risk of non-communicable diseases, as there is no evidence of their effectiveness. Apart from beverages, artificial sweetener combinations are also added to a variety of "low fat" and "high protein" food products, which are highly favored especially among the young population. Therefore, it is necessary to take care of the cumulative intake. The conducted study included a survey of 323 parents of children aged 1-14 years, as well as an analysis of the AS content in the products most often consumed by the respondents. The results of the survey show that a large part of children (40%) aged 3-14 often consume soft drinks. Different products (soft drinks, juices/nectars, syrups) were sampled based on the respondents' responses, and an analysis showed that 54% of them contained one or more ASs. In addition, the survey indicated parents' lack of information about the presence of AS in products, as 51% of parents declared that they do not read the declarations of the products they buy. It is necessary to persist in consumer education and changes in dietary preferences and habits, especially among children.

Prevalence of co-trimoxazole resistance among HIV-infected individuals in Ethiopia: a systematic review and meta-analysis.

Co-trimoxazole is used as a prophylaxis for human immunodeficiency virus (HIV) patients to prevent opportunistic infections. Its widespread use results in the emergence of co-trimoxazole resistance, which is a significant problem. This systematic review and meta-analysis determined the pooled prevalence of co-trimoxazole resistance among HIV-infected individuals in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was applied to report this study. The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the assigned number CRD42024532240. Article search was performed using electronic databases such as PubMed, Medline, EMBASE, Google Scholar, Hinari, Web of Science, Science Direct, and African Journals Online. Data were extracted using a Microsoft Excel spreadsheet and analyzed using STATA version 11.0 software. A random-effects model was used to estimate the pooled effect size of co-trimoxazole resistance across studies with a 95% confidence interval. The heterogeneity was checked using I2 statistic. The presence of publication bias was determined using a funnel plot and Egger's test with a p-value <0.05 evidence of statistically significant bias. Subgroup and sensitivity analyses were performed. Twenty-two studies with 5,788 HIV-infected individuals were included. The pooled prevalence of co-trimoxazole resistance was 61.73% (95% CI: 53.10-70.37%), with heterogeneity (I2 = 87.7%) and statistical significance (p < 0.001). A higher co-trimoxazole resistance was observed in HIV-infected individuals with urinary tract infection; 82.10% (95% CI: 75.03-89.17%). Among the bacterial spp., higher resistance to co-trimoxazole was observed in Escherichia coli; 70.86% (95% CI: 53.44-88.27%) followed by Salmonella spp.; 67.66% (95% CI: 41.51-93.81%) and Proteus spp.; 66.23% (95% CI: 34.65-97.82%). There is a higher prevalence of co-trimoxazole resistance in HIV-infected individuals in Ethiopia. This alarms WHO's recommendation of co-trimoxazole prophylaxis guidelines to review and update it. Additionally, a nationwide assessment of co-trimoxazole resistance in Ethiopia as a whole is required.Systematic review registration: identifier: CRD42024532240.

Growth Assessment in Exclusively Breastfed Against Mixed Fed Infants in Two Hospitals of Fako Division, Southwest Region, Cameroon

Background: Improving breastfeeding rates around the world could save the lives of more than 820,000 children under age 5 every year, the majority (87%) being under 6 months of age. The optimal duration of exclusive breastfeeding is one of the crucial public health issues of WHO. Although breastfeeding provides many health benefits to infants, there is not enough information in our setting to support this assertion. Objective: To determine the prevalence of exclusive breastfeeding and evaluate the growth of exclusive breastfed against mixed fed babies in two hospitals of Fako division. Materials and Methods: A hospital-based, analytic cross-sectional study was carried out with 186 mother-infant pairs from February to April 2022. Data collection consisted of the administration of a pretested questionnaire and anthropometric measurements were taken. Nutritional status and prevalence of respiratory and gastrointestinal infections were then assessed. Bivariate and Multiple logistic regression analysis was done with p-value set at &lt;0.05. Results: The prevalence of exclusive breastfeeding in our setting was 43% while the prevalence of mixed feeding was 57%. The main reasons for practicing mixed feeding were: maternal school or work resumption (43.4%) and insufficient breastmilk (34%). The most common reason for practicing exclusive breastfeeding was medical advice (70%). On multivariate analysis, having a paid job (OR: 0.44, 95 % C.I: 0.203-0.968, p= 0.04) was the only significant predictor of mixed feeding. The incidence of diarrhea was significantly more prevalent (OR: 7.583, 95% C.I: 2.527-22.753, p=0.00) in mixed fed infants compared to exclusively breastfed infants. Conclusion: The prevalence of exclusive breastfeeding in our setting is low so there is need to improve and strengthen breastfeeding education during Antenatal visits. Our findings highlight the importance of breastfeeding to protect against diarrhea-specific morbidity and strengthens the current WHO recommendation of exclusive breastfeeding till 6 months. These results prove the relationship between feeding method and infant morbidity and provides more data with the aim of encouraging more mothers to practice exclusive breastfeeding hence reducing infant morbidity and mortality.

User Acceptability Testing of Mobile Application in Indian Local Languages for Cardiovascular Risk Stratification and Modification among Patients with Type 2 Diabetes

Introduction: Cardiovascular disease is the leading cause of death in patients with type 2 diabetes. Digital health tools like mobile application have fast emerged as a technology capable of closing the gap in cardiovascular disease self- management and revolutionizing the way healthcare is traditionally delivered. One of the causes for low app engagement of Apps in India is perhaps that few of these apps are available in local languages. The goal is to reach as many diabetic patients as possible while avoiding linguistic hurdles.  Methodology: The ‘healthy heart’ mobile app was developed and translated into Hindi and Marathi languages for CVD risk stratification and risk management among Type 2 diabetes mellitus patients. User acceptability testing of the app on its design, presentation, content, and user- friendliness was undertaken. The feedback on utility of the app for CVD risk stratification and modification was assessed. A total 100 multilingual app users profile were noted for CVD Risk Status, Life Style Practices and CVD Risk Factors.  Results: The Healthy Heart multi-lingual app was successfully developed for CVD risk classification and risk management among Type 2 diabetes mellitus patients. The patients had the choice to select the desired language of the app from the versions available in English, Hindi and Marathi. The Mobile App's Home Screen displayed the CVD risk score and category, a health tracker to monitor compliance with WHO recommendations regarding diet, physical activity, addictions, medication adherence, diabetic, and CVD Risk Profile. The majority of respondents rated the App's design, presentation, content, and user- friendliness favorably and emphasized the utility of App for CVD self-management and risk reduction. Characteristics of Type 2 Diabetic patients demonstrated poor compliance for total fruits and vegetable intake, total fat intake and total salt intake, physical activity Guidelines apart from poor control for blood pressure, glycemic control and lipid targets.  Conclusion: The multilingual mobile App for CVD risk stratification, self-management and CVD risk reduction among diabetic patients was successfully developed in Hindi and Marathi language. User acceptability testing results were found to be favorable for the mobile app.

Assessment of soil moisture on radon levels, radon exhalation, natural radioactivity, and radiological risks in offices and laboratories in GAEC

This study investigates the influence of moisture on soil radon exhalation, natural radioactivity in soil, and indoor radon concentrations in offices and laboratories at the Ghana Atomic Energy Commission (GAEC) and their associated radiological risks to workers. Radon exhalation rates were determined using the Sealed Can method. CR-39 SSNTD detectors were used to measure indoor radon concentrations. Gamma spectroscopy using HpGe detector was used to determine the activity concentrations of U-238, Ra-226, Th-232, and K-40 in the soil samples. The results showed mean concentrations of 14.3 ± 2.0 Bq/kg (CI 95%: 10.0–18.0) for U-238, 145.0 ± 10.0 Bq/kg (CI 95%:123.0–167.0) for K-40, 31.5 ± 6.0 Bq/kg (CI 95%: 24.0–39.0) for Th-232, and 15.6 ± 2.0 Bq/kg (CI 95%:14.0–29.0) for Ra-226. The results showed mean surface and mass exhalation rates of 6.9 ± 2.3 × 10−4 Bq/m2/h1 (CI 95%: 5.7 × 10−4 –12.6 × 10−4) and 2.4 ± 0.4 (CI 95%: 1.9–4.2) nBq/kg1/h1 respectively. The findings revealed mean indoor radon concentrations of 93.0 ± 10.0 Bq/m3 (CI 95%: 88.0–98.0), 111.0 ± 12.0 Bq/m3 (CI 95%: 102.0–119.0) and 145.0 ± 13.0 Bq/m3 (CI 95%: 135.0–155.0) in the offices, laboratories, and basements respectively, with laboratories and basements exceeding the WHO reference level of 100 Bq/m3. A strong inverse relationship between moisture levels and exhalation rates (r = −0.8) was observed, leading to a negative correlation (r = −0.3). Between the moisture levels and indoor radon levels. The research findings indicated a mean annual effective dose of 0.6 mSv/yr. (CI 95%: 0.5–0.6) to the workers, which is well below occupational and public dose limits. The lung cancer cases of workers were computed which ranged from 0.9 × 10−8 to 1.2 × 10−8 cases per million people per year, which is less than the limit range of 170–230 per million people per year recommended by ICRP but remaining with safe radiological limits for workers. This study identified moderate radon exposure risks at the GAEC, exceeding the WHO recommendation. The correlation and trend analysis demonstrate strong relationships between moisture, exhalation rates, radium, and indoor radon.

Do pregnant persons want influenza vaccines? Knowledge, attitudes, perceptions, and practices toward influenza vaccines in 8 low- and middle-income countries.

While vaccination is the most effective way to prevent influenza infection and adverse outcomes, and despite WHO recommendations to vaccinate pregnant persons, access to seasonal influenza vaccines remains low. We explored knowledge, attitudes, and practices of pregnant persons about seasonal influenza vaccines to inform actions to improve vaccine uptake among this priority population. We pooled individual-level data from cross-sectional surveys assessing pregnant persons' attitudes toward seasonal influenza vaccines in eight low- and middle-income countries during 2018-2019. The eight countries used a standard protocol and questionnaire to measure attitudes and intents toward influenza vaccination. We stratified by country-level (presence/absence of a national influenza vaccination program, country income group, geographic region) and individual-level factors. Our analysis included 8,556 pregnant persons from eight low- and middle-income countries with and without seasonal influenza vaccination programs. Most pregnant persons (6,323, 74%) were willing to receive influenza vaccine if it was offered for free. Willingness differed by presence of an existing influenza vaccination program; acceptance was higher in countries without influenza vaccination programs (2,383, 89%) than in those with such programs (3,940, 67%, p < 0.001). Most pregnant persons in middle-income countries, regardless of influenza vaccination program status, were willing to be vaccinated against influenza if the vaccine was provided free of charge. National investments in influenza vaccination programs may be well-received by pregnant persons, leading to averted illness both in pregnant persons themselves and in their newborn babies. US Centers for Disease Control and Prevention.

Correlation of Ki-67 Proliferating Index with Histological Types and Characterization of Mucin in Colorectal Carcinoma

Background: Colorectal carcinoma is a major cause of cancer associated with a high rate of morbidity and mortality in the western world. One of the pathologic features considered to be important for prognosis is mucin production. Many authors confirmed that colon carcinomas with high mucin content tend to recur locally and carry a poor prognosis. Aim: Correlation of Ki-67 proliferating index with different type of colorectal carcinoma as well as characterization of mucin. Method: This cross sectional study was conducted at Sir Salimullah Medical College, Department of pathology from July 2014 to June 2016. Ninety eight patients with colorectal carcinoma was enrolled in this study who underwent surgical resection of colon, adenocarcinomas. For histological classification we used the WHO recommendation (2000) and to be more accurate we sub-classified mucinous adenocarcinomas by morphometrical analysis in three categories: pure mucinous, with extracellular mucin more than 80% of the tumoral volume; mixed type, with 50–80% extracellular mucin; and mixed type with less than 50% extracellular mucin and their correlation with Ki-67 proliferating index . For histochemical investigation, we used stains such as: D- PAS and Alcian Blue. A technique of manual tissue array was employed to see Ki-67 expression by IHC method. Ki-67 is a proliferation associated nuclear antigen which can be recognized by MIB-1 monoclonal antibody. Result: It was observed that Ki-67 labeling index was high in nonmucinous tumor compared to mucinous adenocarcinoma and signet ring cell carcinoma which is statistically significant (P&lt;0.05). Histochemical stain of mucin where both D-PAS and Alcian Blue positive cases(mixed type) are more than the Only D-PAS positive cases(pure type). Ki-67 proliferating index was also high in mixed type mucinous adenocarcinoma (&lt;50%) compared to pure (&gt;80%) and mixed type (50-80%). The result was statistically significant (p&lt;0.05). Correlation of Ki-67 proliferating index with histologic type as well as mucin characterization and thereby provide information to clinician to better understanding of the treatment as well as prognosis.

Carbon-modified bentonite ion-exchange electrode in rocking-chair capacitive deionization with superior desalination capacity and high stability

Conventional carbon electrodes possess low desalination capacity and poor cycling stability, while faraday electrode materials are not economical with limited resource for capacitive deionization (CDI) technology. Therefore, exploring new type of electrode materials with high desalination capacity, low cost and excellent cycle stability is highly desirable. Bentonite (Bent) is an excellent ion-exchange material, with high natural abundance, super stability, but it has low conductivity. In this paper, a nitrogen-doped carbon modified Bent (NC@Bent) was prepared by in-situ polymerization of dopamine on the surface of Bent followed by carbonization. The N,C-modified thin layer on Bent improved the conductivity, boosting the charge transportation and ion diffusion. The NC@Bent was used as ion-adsorption electrode, exhibiting excellent electro-adsorption behavior. In a rocking-chair CDI (RCDI) cell, it delivered an extraordinary desalination capacity of 82 mg g−1 and super cycling stability with 90 % capacity retention in 50 cycles. Finally, the total dissolved salts in the actual groundwater were effectively reduced by using the current RCDI cell, meeting the WHO recommendation for drinking water. In consideration of the unique feature of low-cost and non-toxicity of Bent, this ion-exchange electrode material (NC@Bent) has much potential for drinking-water purification.

STUDY OF THE COMPOSITION OF MICROFLORA OF ROOT CANALS IN PRIMARY AND CHRONIC PERIODONTITIS

The problem of chronic focal infection of the pulp and periodontal tissues is relevant for both therapeutic and surgical dentistry. It has been proven that the long-term effect of microbial flora on the filling material, root dentin, periodontium and bone tissue often leads to destructive lesions of the periodontal tissues. Objective: to determine the qualitative and quantitative composition of the microflora of root canals in people with different degrees of manifestation of the inflammatory process. Materials and methods. The article defines the qualitative and quantitative composition of microflora of root canals in acute and chronic periodontitis. A study included 35 patients aged 25 to 35 years who applied to the dental center at the Department of Therapeutic Dentistry of the Dnipro State Medical University for treatment. A clinical and bacteriological study was conducted according to WHO recommendations. Root canal contents were collected with a paper sterile pin on Ames transport sterile medium (10 ml). Within 2-3 hours, the material was delivered to the microbiological laboratory for quantitative bacteriological research using anaerobic cultivation techniques. Isolation of pure cultures of anaerobic microorganisms and their subsequent identification was carried out using nutrient media intended for their cultivation. In order to identify aerobic or facultative anaerobic microflora in the studied material, inoculation was carried out on blood agar and sugar agar. Cultures were incubated for 24–72 hours in a thermostat at 37°C. At the second stage, macroand microscopic examination of colonies, smear preparation and Gram staining were performed. Isolation of pure cultures was carried out by generally accepted measures of bacteriological research. On the basis of the data obtained, microorganisms were identified according to the binary nomenclature with the determination of the amount of the selected strain in the material. Results and discussion. In the content of root canals of teeth in chronic and acute forms of periodontitis, pathogens are more often in the composition of microbial associations, which were detected in 61.1% of acute cases, and in 52.9% of chronic cases, respectively. Microbiological research of the content of root canals indicates different intensity and composition of microbial insemination in different forms of periodontitis. Streptococcus spp., Peptostreptococcus spp., Candidia albicans, Staphylococcus aureus, Staphylococcus epidermidis are more often detected in patients with acute pulpitis, and in patients with chronic forms bacteria from the group of gram-negative obligate anaerobic bacilli Porphyromonas spp., Prevotella intermedia, Streptocoсcus sanguis, Fusobacterium spp., Staphylococcus aureus. Therefore, the prospect of further research consists in studying the influence of the formation of biological film of microorganisms in various forms of periodontitis and the ability to increase resistance to antibiotics.

Acute Diarrhoea in Children Aged Up to 2 Years Age Group: Assessment of Therapeutic Strategies and Hospital Stay Variance, in Tertiary Care Rural Hospital – An Observational Study

Acute Diarrhoea, it is one of the leading causes of under 5 childrens’ morbidity and mortality in India. It is most common in children especially those between 6 months and 2 years. Antimicrobials are mostly used drug for acute diarrhoeal cases according to many studies but according to WHO antibiotics are not required for all the diarrhoeal cases except few bacterial diarrhoeas. Other way, WHO recommends Zinc with low osmolarity ORS for acute diarrhoea. So, this study was designed for assessing the treatment pattern and its outcome in our setup. Objectives: - To assess the use of antibiotics and Zinc among children under 2 years suffering from acute Diarrhoea by analysing average of use and hospital stay. Materials and Methods: - This observational study includes 76 patients, admitted under Paediatric Department of Mahatma Gandhi Institute of Medical Sciences, in the period of 6 months. All the patients admitted during the study period having acute Diarrhoea with moderate dehydration as per definition of WHO was included in the study. Patients with other existing diseases, bloody diarrhoea and seriously ill were excluded. Data was collected from Paediatric ward and was analysed by using GraphPad software. Results: - Over all among the 76 patients, 25(32.89%) patients received antimicrobials only and 31(40.79%) received Zinc only and11(14.47%) patients received both. Hospital stay difference was not statistically significant in culture negative acute diarrhoea cases with the use of zinc and antimicrobials (p = 0.08) but it was significant in culture positive cases (p = 0.03). Conclusion: - In culture negative acute diarrhoeal cases Zinc was mostly used and hospital stay was not found to be significant with and without antimicrobials. Implication: - Uncomplicated acute diarrhoeal cases may be treated with Zinc alone effectively.