WHO Recommendations Research Articles

Postoperative continuation of antibiotic prophylaxis beyond 24 h is unnecessary for abdominal surgeries in children and neonates

PurposeDespite recent WHO recommendations, antibiotic prophylaxis is routinely continued for several days after surgery. We conducted a retrospective study to evaluate the safety and efficacy of antibiotic prophylaxis cessation within 24 h after abdominal surgeries MethodsWe retrospectively reviewed the charts of patients who underwent 3 representative gastrointestinal surgeries (1; transumbilical small bowel procedure for intestinal atresia or stenosis, 2; extrahepatic bile duct resection, and hepaticojejunostomy for congenital biliary dilatation, 3; stoma closure for intestinal perforation, anorectal malformation, or inflammatory bowel disease) at our institution between 2011 and 2023. The demographic data collected included age, preoperative hemoglobin level, albumin level, body mass index, and ASA class. Intraoperative and postoperative data were also collected. The patients were divided into 2 groups according to the duration of perioperative antibiotics (‘within 24 h’ and ‘beyond 24 h’), and the incidence of superficial incisional SSI (siSSI) was compared between the 2 groups in each procedure ResultsDuring the study period, 25 cases underwent transumbilical small bowel procedure, 23 cases underwent hepaticojejunostomy, and 45 cases underwent stoma closure. The preoperative care bundle including bowel preparation, cleansing, and operative procedures has not changed during the study period. First- and third-generation cephalosporins were administered to all the patients. All patients received their first single dose of antibiotics within 60 min before the skin incision. In particular, 14 patients who underwent small-bowel procedures received only a single dose. The SSI rates for small bowel procedures, hepaticojejunostomy, and stoma closure were 0%, 4.4%, and 4.4%, respectively. No SSIs were observed in any of the procedures in the 'within 24 h' group ConclusionBased on our study, we conclude that ≤24 h of postoperative continuation of antibiotic prophylaxis is sufficient for siSSI prevention in hepaticojejunostomy and stoma closure. Additionally, single-dose antibiotic prophylaxis is adequate for neonatal small bowel procedures.

MODELOS DE ALEITAMENTO MATERNO E SUAS INDICAÇÕES: UMA REVISÃO LITERÁRIA

Human milk is a food rich in macro and micronutrients, as well as anti-inflammatory agents, immunoglobulins, and antioxidants that promote the infants’s health. Breastfeeding brings significant benefits to both mothers and babies, such as reducing postpartum complications and promoting neuropsychomotor and immunological development in the baby. However, there are situations that may hinder breastfeeding, such as low milk production or the mother’s health conditions, which requires the use of formula. This work conducts an integrative review of the forms of breastfeeding and the circumstances that may influence the choice of the most suitable method for mothers and babies in the first six months of life. The methodology involved analyzing articles published between 2010 and 2024 in various databases. The results highlight that breastfeeding is the ideal form of nutrition, promoting emotional bonds and nutritional benefits. However, the choice between breastfeeding and formula should consider socioeconomic and health variables. The concluding remarks reaffirm that exclusive breastfeeding is the WHO recommendation until six months, but the introduction of formula may be necessary in specific cases. Contraindications to breastfeeding are discussed, emphasizing the importance of individualized decisions to ensure the child’s well-being.

Innovative tools from WHO Europe to protect children from digital marketing of unhealthy products

Abstract Children in the WHO European Region are extensively exposed to marketing of unhealthy products, including tobacco, alcohol, HFSS foods, and gambling, which negatively influences their dietary choices, behaviors, and perceptions of a norm, threatening their health rights. Recognizing the urgency to protect children’s developmental potential and rights, WHO has actively addressed this issue both within Europe and globally. In 2010, WHO issued recommendations for Member States on marketing foods and beverages to children. Building on these efforts, the CLICK framework for monitoring digital marketing to children was introduced in 2018. In 2023, WHO released guidelines urging countries to adopt comprehensive, mandatory policies to protect children from HFSS food marketing. Despite political commitments and policies, children and adolescents continue to be exposed to unhealthy product marketing, increasing their risk of NCDs as online activity rises. At the same time, while efforts have focused on restricting specific products, rapid changes in digital marketing strategies necessitate broader measures. Emerging trends include promoting brand loyalty among young children through brand characters and logos. Tools and support are urgently needed to monitor and implement WHO recommendations in online settings, including brand marketing. Despite WHO recommendations, few countries have implemented mandatory policies. Reliable monitoring mechanisms are essential. To address this gap, the WHO Regional Office for Europe developed the KidAd platform to monitor children’s exposure to digital advertising.

Impact of loneliness and social support on leisure physical activity in adolescents in Luxembourg

Abstract Background Healthy lifestyle includes a regular practice of vigorous physical activity in adolescents’ leisure time. Engaging in physical activity (PA) depends on individual, social and environmental factors. Previous literature has showed that social support and loneliness can influence the practice of PA. The study aims to analyse the relation between PA during leisure time and social support and loneliness among adolescents in Luxembourg. Methods The study includes 7049 adolescents from the Health Behaviours in School-aged Children (HBSC) Luxembourg 2022 survey. PA in leisure time was categorised according to WHO recommendations for vigorous physical activity. Perceived social support (friends, family, teacher, and classmate) was dichotomised in high support and in low/medium and loneliness in feel often lonely and not feel often lonely. It was executed a binomial logistic regression to analyse the PA levels in leisure time by loneliness and social support, controlling by age, migration background, perceived wealth, and family structure, split by gender. Results In Luxembourg, boys who perceived high support from most of the sources and didn’t feel often lonely had higher chances to reach WHO recommendations for PA during leisure time (e.g. loneliness: OR = 1.38, CI95%[1.11-1.74]; family support: OR = 1.31, CI 95%[1.10-1.56]), except for teacher support (OR = 0.79, CI95%[0.67-0.93]). In contrast, girls who only perceived high support from classmates (OR = 1.21, CI95%[1.05-1.4]) and teachers (OR = 1.19, CI95%[1.01-1.38]) had higher chances to be physically active. Conclusions This is the first study to investigate the impact of social support and loneliness among adolescents in Luxembourg. Future research should investigate social-related barriers and facilitators of PA during leisure time. Key messages • Understanding adolescents social support can guide towards effective strategies that promote physical activity during leisure time. • Boys benefit from several social support sources, while girls thrive with encouragement from classmates and teachers to stay physically active in leisure time.

A Groundbreaking Prevalence Survey Conducted in Mauritania for Enhanced Sickle Cell Control

Abstract Issue/Problem Sickle cell disease is a major concern in sub-Saharan Africa, with a prevalence of 0.5 to 2% among children and a mortality rate exceeding 50% in untreated cases. However, the lack of reliable data hampers effective public health policies and resource allocation. To address this, Mauritania’s Ministry of Health, with technical support from NGO Santé Sud, conducted its first prevalence survey in 2023-24. The findings will support advocacy for a national strategy on the disease and offer valuable insights for neighboring countries with similar challenges. Description of the problem The prevalence survey comprised 3 field missions over 7 weeks, conducted across 24 primary healthcare facilities during immunization days, in Nouakchott, Dakhlet-Nouadibou, Trarza, Ghorgol, Brakna, Guidimakha and Assaba regions: 1,642 infants (0-9 months) underwent screening for sickle cell disease, with parents’ consent, and 30 paramedics and laboratory technicians were trained to administer point-of-care tests. Results The survey found that 9.7% of tested children were carriers of hemoglobinopathies, with 0.6% diagnosed with sickle cell disease. Lab technicians and nurses have improved knowledge about the disease and are better equipped for point-of-care testing. This initiative is expected to enhance sickle cell disease control by providing crucial data for advocacy and may lead to a nationwide newborn screening program, in line with WHO recommendations. Lessons This initiative highlighted the efficiency of screening infants for sickle cell disease, emphasizing the need for effective organization involving stakeholders from central to local levels. Screening during immunization days proved highly efficient in testing numerous children. Success depends on adequate human resources, technical skills, and dedicated health personnel. Additionally, having a team member to inform and counsel families, especially when test results are positive, proved crucial. Key messages • A prevalence survey on sickle cell disease to generate robust data for advocacy efforts in Mauritania. • Conducting a prevalence survey on sickle cell disease in Mauritania for a better control of the disease.

A comparative analysis of national dementia plans: preventive strategies in five European countries

Abstract Background About 8.5% of people aged +65 live with dementia in Europe. Preventive measures can avert up to 40% of cases. The aim of the study is to analyse National Dementia Plans (NDP) in Europe, to elicit how much dementia prevention is considered a priority and whether policies are evidence-based. Methods A qualitative comparative analysis was performed between NDPs of countries with the best healthy life expectancy in the elderly in Europe. The NDPs of France, Ireland, Italy, Spain, and Sweden were included. The consensus on actions and elements of prevention policies was evaluated, according to the WHO recommendations and to Cheung’s framework designed for evaluating chronic diseases policies. Results All the NDPs prioritised early diagnosis, public awareness, and community engagement for dementia risk reduction. They fostered the development of information system for data collection and established committees for progress monitoring. However, not all NDPs defined timelines for policy implementation and most of them expired years ago. NDPs included prevention research agenda, but their preventive actions did not address alcohol consumption, traumatic brain injury, and air pollution, representing 3 well-known risk factors attributable for the 15% of preventable cases. Neither integration of dementia with other chronic disease preventive strategies was present and a clear allocation of funds for NDPs always missed. Conclusions NDPs partially address risk factors of preventable cases. All countries need to update their NDPs, integrating new scientific evidence and allocating clear financial funds. This can potentially prevent millions of new cases, decreasing the burden of disease and improving the sustainability of health systems. Key messages • NDPs do not target adequately dementia in Europe. • New evidence-based preventive policies, including most recent identified risk factors, would have a clear impact on burden of disease and health systems’ sustainability.

Reduced physical activity in youth during the COVID-19 pandemic: systematic review and meta-analysis

Abstract Background Emerging research suggests that physical activity among children and adolescents decreased during the COVID-19 pandemic. As a summarizing analysis of changes in youth’s physical activity for Europe is lacking, we performed a systematic review and meta-analysis to close this research gap. Amongst others, we examined the relevance of restriction stringency policies and potentially vulnerable groups. Methods In consideration of the PRISMA statement, we searched seven databases and included studies for children and adolescents (≤19 years) of the WHO European Region that compared physical activity during the pandemic with a pre-pandemic baseline using validated measurement instruments. We used the Oxford Stringency Index as an indicator of restriction stringency. Screening for eligibility, data extraction, assessment of the study risk of bias (using ROBINS-E instrument) and certainty grading of evidence (using the GRADE approach), were all done in duplicate. Data were pooled in random effects models (Trial registration: PROSPERO: CRD42023395871). Results Of 14,897 non-duplicate records, 26 publications (n = 15,038 pre-pandemic, n = 13,041 during pandemic) met our inclusion criteria. Comparison before vs during the COVID-19 pandemic revealed a significant reduction in total physical activity (standardized mean difference [SMD], -0.57 [95% CI, -0.95; -0.20]) and moderate-to-vigorous physical activity (SMD, -0.43 [95% CI, -0.75; -0.10]), corresponding to a decrease of 12 min/day (a 20% reduction of the WHO recommendation). Subgroup analyses suggested that children aged 8-12 were particularly affected. The analyses outline a possible association between school closures and more reductions in physical activity. Conclusions A sharp decline in all forms of physical activity was recorded among European children and adolescents during the COVID-19 pandemic, particularly in middle childhood. Policy-makers, teachers and practitioners must act to reverse this decline. Key messages • Physical activity in European children & adolescents decreased significantly during the COVID-19 pandemic. • Immediate action by policy-makers and practitioners is imperative to reverse this trend.

Physical activity and sedentarism among non-binary gender identified university students

Abstract Background Physical inactivity (PA) and sedentary behavior (SB) are modifiable risk factors for non-communicable diseases (NCDs). Data indicates that non-binary gender identified people find it difficult to perform PA, this is a disadvantage for them to reach their full health potential. Methods Students were selected by convenience sampling to complete a survey between October-November 2023. A validated PA questionnaire was included. PA and SB were classified into 4 levels: Active but sedentary, extremely sedentary, physically active and discreetly active. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Results Out of 32 students did not identified themselves as binary gender. In our sample, 28,1% (vs 12.9% binary students) don’t do PA. Of those doing PA, 52,2% don’t meet World Health Organization recommendations. Among those who perform PA, there no difference in the amount of minutes/week of moderate or intense physical activity performed. Regarding SB, 93,8% spend >6 hours/day in SB (vs 84.7% binary students, mean 7,82 vs 8,75, Sg. 0,032). When grouped into PA/SB categories 65,6% (vs 40,5%) were extremely sedentary in contrast to 1,4% physically active (vs 8.8%). Conclusions In Spain, 1 in 4 young people does not identify with the male/female categories. In our sample, physical inactivity and sedentarism are higher among those who do not identify as male/female. Once they commit to physical activity, there is no difference in the time spent between those who meet the WHO recommendations. More research is needed to understand the reasons for these differences and ensure barrier-free access to healthy lifestyle habits on campus. Key messages • Non-binary gender identified students are less physically active and more sedentary than their peers. • Once they commit to physical activity recommendations, there are no differences among their performance.

Measured obesity and overweight in adults: the Italian Health Examination Survey 2023-CUORE Project

Abstract Background The WHO recommends to halt the rise of obesity by 2025, considering 2010 as baseline. This analysis aims to assess if Italy can meet the WHO target in the general adult population using data measured in the periodic health examination surveys (HESs) conducted within the CUORE Project. Methods In the HES started in 2023, mean level of BMI and prevalence of obesity (BMI > =30 kg/m2) and overweight (25 < =BMI< 30 kg/m2) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (727 men and 706 women), from 7 (of 20) Italian Regions, in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. Insufficient physical activity was defined as less than 150 minutes of moderate-intensity activity per week, or equivalent. The survey is funded by the Italian Ministry of Health-CCM. Results Prevalence of obesity was 23% (95% C.I. 16-29%) in men and 25% (19-31%) in women; prevalence of overweight was 47% (39-54%) in men and 30% (24-37%) in women. Mean level of BMI was 27.5 kg/m2 (27.2-27.8 kg/m2) in men and 26.9 kg/m2 (26.4-27.3 kg/m2) in women. Obesity resulted tendencially higher in persons with insufficient physical activity (27%, with 95% C.I. 17-36% in men; 28%, 19-37% in women) than among those without (19%, 11-27% in men; 21%, 12-30% in women), and in persons with primary or secondary school education (29%, 17-40% in men; 32%, 20-44% in women) than in those with higher educational level (20%, 12-27% in men; 21%, 14-28% in women). Conclusions Going in the direction of WHO target, preliminary data collected within 2023 showed a prevalence of obesity not statistically different in comparison to HES data of 15 and 5 years ago, both in men and women, however, 70% of men and 55% of women are in the overweight/obesity condition. Preventive actions at national and community level should be still massively implemented. Key messages • Prevalence of obesity and overweight resulted still at epidemic level in the Italian adult general population. • In the Italian adult population stable obesity prevalence trend was observed in comparison to 15 and 5 years ago.

Lipids and glycemia profiles in adults: the Italian Health Examination Survey 2023 - CUORE Project

Abstract Background WHO recommends monitoring glycemic and lipid profiles in the population to control and prevent NCDs. The target for glycemic/diabetes is to halt the rise within 2025 (2010 as baseline). The Italian Ministry of Health (MoH) has strengthened prevention/health promotion and supported their periodic assessment through national health examination surveys (HESs), financed by MoH-CCM and conducted within the CUORE Project. Methods In 2023 a new HES started including the assessment of fasting serum glycemia, total and HDL cholesterolemia and triglyceridemia. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy and aged 35-74 years are available (687 men, 704 women). Glycemia and lipids profiles were assayed by a central lab. Elevated glycemia/diabetes (DM): glycemia ≥ 126 mg/dl and/or on medication. Elevated total cholesterol/hypercholesterolemia (HChol): total cholesterol ≥ 240 mg/dl and/or on medication. Results Glycemia mean level was 97 mg/dl (95%CI: 95-99) in men and 90 mg/dl (89-91) in women; DM resulted 10% (5-14) and 8% (4-12) respectively. Among those with DM, about 2 in 10 men and 1 in 10 women were unaware; about 2 and 3 of 10 were aware but not on medication, respectively. Total cholesterol mean level was 192 mg/dl (189-195) in men and 200 (197-202) in women; HChol resulted 24% (18-31) and 29% (22-36) respectively. Mean level of HDL cholesterol was 48 mg/dl (48-49) in men and 59 mg/dl (58-60) in women; mean level of triglycerides was 121 mg/dl (115-126) and 95 mg/dl (92-98) respectively. Among those with HChol, about 1 in 10 men and 2 in 10 women were unaware; about 2 of 10 were aware but not on medication. Conclusions Compared to 2008, these preliminary data showed a significant decrease of glycemia, total cholesterol and triglycerides means values both in men and women, as well as of DM and HChol prevalence, but improvements on their awareness and control are still necessary. Key messages • In the Italian adult general population significant improvements in lipids and glycemia profiles occurred compared to 15 years ago. • The implementation of periodic health examination surveys is important for estimating indicators based on objective measurements and for estimating awareness and control of risk conditions.

Association of healthy lifestyle on overweight and obesity among adolescents in Luxembourg

Abstract Background Adolescent overweight and obesity are significant public health challenges. Understanding the impact of healthy lifestyle behaviours is crucial for effective intervention strategies. The aim of this study is to analyse the association between healthy lifestyle behaviours with overweight and obesity among adolescents in Luxembourg. Methods The study was based on the HBSC Luxembourg 2022 survey and includes 8415 adolescents aged 11 to 18 years. Adolescents self-reported the frequency of fruit and vegetable consumption, physical activity, height, and body mass. Eating and physical activity behaviours were categorized based on WHO recommendations. Body Mass Index categorization followed International Obesity Task Force criteria. Binomial logistic regression of obesity and overweight with the interaction between healthy diet and physical activity was performed, controlling for age, gender, family affluence, migration background, and family structure. Results The results indicated a significant protective effect of healthy lifestyle behaviours against overweight and obesity. For overweight, adolescents engaging in either fruit and vegetable consumption (OR = 0.829, 95% CI [0.697-0.986]) or physical activity (OR = 0.719, 95% CI [0.566-0.913]) showed reduced odds compared to those with unhealthy behaviours. For obesity, similar associations were observed. Adolescents engaging in physical activity (OR = 0.407, 95% CI [0.235-0.705]) showed reduced odds compared to those with unhealthy behaviours. Combining both behaviours resulted in the lowest risk of obesity (OR = 0.366, 95% CI [0.177-0.760]) and overweight (OR = 0.473, 95% CI [0.340-0.658]). Conclusions Promoting health eating and physical activity behaviours are important strategies for preventing overweight and obesity in youth in Luxembourg. Implementing targeted interventions aimed to promote these behaviours could mitigate the burden of overweight and obesity in this population. Key messages • Healthy lifestyle matters: Fruit and vegetables consumption or regular physical activity significantly reduce the risk of overweight and obesity among adolescents. • Combining behaviours counts: Concurrent engagement in both fruit and vegetables consumption and physical activity offers the greatest protection against overweight and obesity.

Analyzing and forecasting air pollution concentration in the capital and Southern Thailand using a lag-dependent Gaussian process model.

The air pollution problem has now amassed worldwide attention due to its multifaceted harm to human health. Exploring the concentration of air pollution and improving forecast have important consideration worldwide. In this research, we analyze the air pollution concentration of Southern Thailand and compare it with the central region. Also, we proposed a methodology based on the lag-dependent Gaussian process (LDGP), a Bayesian non-parametric machine learning model, with a stable optimization approach, which is a cluster-based multi-starter technique based on the Nelder-Mead optimizer. This model also provides the confidence band for forecasted values. We also used autoregressive deep neural network (AR-DNN), autoregressive random forest (AR-RF), gradient boosting (GB), and K-nearest neighbors (KNN) models. A comparison of the proposed methodology was performed on the daily air pollution data collected from the southern provinces and also from the capital of Thailand from 1 January 2018 to 31 December 2022. We used well-established performance evaluation measures to compare the performance of the models. To evaluate the bias due to overfit, we performed a tenfold cross-validation for all the pollutants in each region and compared the models to choose the best one. Moreover, we explored the concentration of air pollution in these regions. Results of descriptive analysis revealed that Bangkok had a much higher concentration of air pollution as compared to the southern region. However, the southern region had higher exposure to PM air pollutants as per WHO recommendations and also had higher exposure to O3 and CO levels. The proposed LDGP model outperformed the other machine learning models for forecasting all air pollutants. Hence, it is recommended to be used by experts for further research and studies with different kernel functions. This research is also expected to contribute to local government planning and prevention and worldwide use of the same methodology for the sustainability of public health.

Performance of WHO mid-upper arm circumference cut-off to diagnose severe acute malnutrition in under-fives

Background Many studies indicate that the current WHO recommendation of cut-off value mid-upper arm circumference (MUAC) is not sensitive to detect severe acute malnutrition (SAM) in under-fives cases. Various new cut-off values have been proposed with better diagnostic values but have a wide interval, 12.1 cm—14.5 cm, which may be due to different races or habitus. Objective To evaluate the diagnostic value of MUAC in diagnosing SAM compared to the weight for height Z score (WFZ) index, to evaluate sensitivity, specificity, positive and negative predictive value of MUAC with 11.5 cm as standard cut-off, and to find an alternative cut-off value that may offer better diagnostic performance. Methods We collected 421 subjects consecutively in January-February 2020 in Cipto Mangunkusumo Hospital and Puskesmas Cengkareng. We performed brief conversations for demographic data and did the measurement of physical examination and anthropometric measurement by trained researchers and research assistants. Results Mid-upper arm circumference has excellent diagnostic value to assess SAM in under-fives with area under curve 0,939 (CI95% 0,903-0,974). Diagnostic values MUAC using cut off 11.5 cm were 21% sensitivity (Se) 21%, 99.7% spesificity (Sp)and Youden Index (YI) of 0.20. By using 13.3 cm as a new cut-off value, MUAC has Se 89%, Sp 87%, and YI of 0.76. Conclusion We conclude that WHO MUAC cut-off using 11.5 cm has lower performance to detect SAM cases than the proposed new cut-off value of 13.3 cm. New MUAC cut-off should be considered to detect more SAM cases among under-fives.

Determinants of Caesarean Deliveries in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey

Caesarean section, a frequently conducted surgical procedure in obstetrics, is instrumental in safeguarding the well-being of both mothers and infants by addressing complications related to pregnancy and childbirth. While it significantly contributes to reducing maternal and infant mortality rates, its overuse can pose serious health risks. The prevalence of caesarean deliveries has surged globally, including in Bangladesh. This rise in caesarean deliveries has prompted this research to investigate the prevalence and various associated factors in the country. To achieve the study objectives, data were extracted from the Bangladesh Demographic and Health Survey (BDHS) conducted from 2017 to 2018. After preprocessing the data, a total of 4,884 women were included in the study. Frequency analysis was conducted to illustrate the distribution of sociodemographic characteristics among Bangladeshi women. Chi-square tests were performed to assess their association with caesarean delivery. Furthermore, multi-level logistic regression analysis was employed to identify the variables that have a significant impact on the likelihood of caesarean delivery. The study revealed that in Bangladesh, the prevalence of caesarean section deliveries was approximately 33.1%, with the majority of these occurring in the Dhaka division, accounting for approximately 25.3%. Women aged 20 or older were 1.62 times more likely to opt for a C-section during childbirth (OR 1.62, [1.38-1.89]) compared to those under 20. Overweight or obese women had twice the likelihood of delivering via C-section. Higher socioeconomic status also increased the probability of choosing a caesarean delivery. Women who had exposure to any form of media were 57% more likely to opt for a caesarean delivery (OR 1.57 [1.31-1.87]), while not working women had a 48% higher likelihood of having a C-section. Additionally, the study found that the use of caesarean delivery was positively associated with the husband's education level, the number of children previously born, and the number of antenatal care visits. The study revealed that the rate of C-sections in Bangladesh surpasses WHO recommendations significantly. It also identified various factors driving this trend, including women's education levels, socioeconomic status, media exposure, female obesity, age at first childbirth, and husband’s education. These insights may serve as a foundation for developing strategies to regulate the caesarean delivery rate. Urgent policy directives are essential within Bangladesh's healthcare system, coupled with vigilant monitoring of clinical indications for C-sections, to mitigate the adverse effects of unnecessary procedures. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 31−44

Safety Evaluation of the Novel Cocktail of Monoclonal Antibodies for Postexposure Prophylaxis in Category III Animal Exposures

Abstract Introduction: Rabies monoclonal antibody (mAb) is a life-saving immune-biological for postexposure prophylaxis (PEP) in all Category III animal exposures. A novel cocktail of mAbs derived using recombinant DNA technology is presently available for usage. The WHO recommends monitoring the clinical use and outcomes of mAb products. Methods: An open-label, postmarketing study was conducted at the anti-rabies clinic in the southern part of India. PEP was provided to all the study participants per the national guidelines. All the subjects were assessed for any adverse events (AEs) following PEP up to 35 days; if any, were treated free of cost at the study center. Results: The present study included 309 subjects across all age groups, 59.2% were adults, 33.3% of children, and 7.5% elderly. Majority of the patients were exposed to dogs (89.6%) and most of them had lacerations (86.3%) in different parts of their body. A total of 19 (6.2%) AEs were reported. All the AEs were local reactions, namely pain (2.6%), erythema (1.4%), tenderness (1%), induration (0.6%), and swelling (0.6%). All reported AEs were mild (Grade 1 severity) and resolved completely with symptomatic treatment. Conclusion: The novel cocktail of mAbs was safe for PEP in Category III animal exposures across all the age groups and supports its continued and improved usage for Universal Health Coverage to prevent rabies.

Age- and sex-dependent associations between self-reported physical activity levels and self-reported cardiovascular risk factors: a population-based cross-sectional survey

BackgroundThe amount of regular physical activity (PA) can modulate the prevalence of traditional risk factors for cardiovascular disease (CVD) such as obesity, systemic hypertension, hypercholesterolemia, and type 2 diabetes (T2D). However, how different PA levels either below (< 600 MET min/week), within (600–1200 MET min/week), or above (> 1200 MET min/week) the range of the minimal WHO recommendations impact the age- and sex-dependent prevalence of these risk factors remains to be elucidated.MethodsThis cross-sectional study was performed to evaluate these relationships using population-based self-reported data collected in a central European country (Austria, 2019). The sample included a total of 15,461 persons (7166 males: 16–95 + years, BMI 26.6 ± 4.4; 8295 females: 16–95 + years, BMI 25.1 ± 5.0). Besides various lifestyle factors (e.g., dietary habits, smoking, and alcohol consumption), variables of particular interest were the age- and sex-dependent amount of weekly PA and prevalence of risk factors for CVD. Sex-specific logistic regression analyses were applied to estimate adjusted odds ratios (ORs) for the associations between self-reported PA and risk factor prevalence.ResultsRelatively small beneficial effects were found regarding the prevalence of risk factors for CVD when achieving PA levels corresponding to 600–1200 MET min/week as compared to those who did not meet these recommendations. However, exceeding the WHO recommendations provided much more pronounced benefits, especially in younger and older age groups. Adjusted ORs revealed that high volumes of PA (> 1200 MET min/week) were associated with a 32–43% reduction in the prevalence of obesity and T2D compared to those who did not achieve the WHO recommendations (< 600 MET min/week), as well as with a lower prevalence of systemic hypertension only in women and a lower prevalence of hypercholesterolemia only in men.ConclusionsExceeding minimal WHO recommendations for PA promises large beneficial effects, particularly on the prevalence of obesity and T2D. Demonstrated sex differences in PA levels and their association with cardiovascular risk factors may provide an important basis for preventive health counseling.

To Study the Knowledge, Attitude and Practice of Postpartum Exercises in Nursing Mothers

Postpartum period has three distinct phases - immediate, early and remote.[1] First six weeks following childbirth known as puerperal period is a stressful for any women due to physiological and psychological adaptation which happens during this period and pelvic organ returns to pre pregnant state.[1] Breastfeeding starts immediately after the birth of the infant and as per the recommendation of WHO it is to be continued exclusively for 6 months.[2] During this period, Postpartum exercises like Kegel’s, abdominal and breathing exercises helps to improve the pelvic floor and abdominal muscle tone, bowel and bladder function and cardiovascular fitness which will have a positive influence on the health of the mother.[3] Two hundred and sixteen postpartum nursing mothers between the time period of six weeks to six months and Women who have given birth in hospitals and have been informed about post- natal exercises during the duration of hospitalization.In conclusion, the findings of this study provided an excellent insight on how many of the participants had knowledge about postnatal exercises and attitude is relatively positive which they were fully aware of the potential benefits of postnatal exercises but most of them did not practice postnatal exercises in their postpartum period regularly because majority of mothers were facing barriers because of household chores and baby care. Key Words: knowledge, attitude and practice of postpartum exercises, nursing mothers, postpartum health.

ONT sequencing identifies a high prevalence of crt sensitive, triple mutant dhfr and single mutant dhps parasites within an ANC population in Nigeria.

Malaria in pregnancy is a major public health issue, particularly among vulnerable populations in malaria-endemic sub-Saharan African countries. To mitigate its risks, WHO recommends sulphadoxine-pyrimethamine (SP) for chemoprevention and artemisinin-based combination therapy (ACT) to treat uncomplicated Plasmodium falciparum malaria. These interventions have helped to alleviate the risk associated with malaria in pregnancy; however, in the context of the emergence of SP- and ACT-resistant P. falciparum, maintained efficacy is under threat. Molecular surveillance is a reliable tool to monitor the emergence of resistance where molecular markers are known. Thus, the objective of the study was to use a multiplexed amplicon Oxford Nanopore sequencing approach to assess the molecular markers for antimalarial resistance among pregnant women in Nigeria. Dried blood spots (DBS) were collected from pregnant women who received IPTp-SP at the enrollment and follow-up visits. P. falciparum genomic DNA was extracted by the Chelex® method and Pf18S qPCR was used to detect parasite DNA in each sample. With nested PCR assays, fragments of Pfdhps, Pfdhfr, Pfmdr1, Pfcrt, Pfk13 and Pfama1 genes were amplified and multiplexed amplicon-based sequencing was conducted on the minION Oxford Nanopore Technology. In total, 251 pregnant women were enrolled in the study and 457 DBS samples were collected. P. falciparum genomic DNA was detected in 12% (56/457) of the samples, 31 at baseline and the remaining during the follow-up visits. Pfama1, pfk13, Pfdhps, Pfdhfr, Pfmdr1 and Pfcrt were successfully sequenced in a single run. Notably, k13 artemisinin resistance mutations were absent, the frequencies of Pfdhfr and Pfdhps SP resistance haplotypes, IRN for pyrimethamine resistance and ISGKA/IAGKA associated with sulphadoxine resistance were 82% (36/44) and 64% (27/42), respectively, and the Pfcrt CVIET resistant haplotype was at approximately 22% (7/32). Here a multiplexed amplicon-based ONT assay established that triple mutant Pfdfhr-IRN, double mutant Pfdhps-SG haplotypes and the chloroquine sensitive strain were prevalent among pregnant women in Nigeria.

New Strides in Prevention of Malaria during Pregnancy Present Multitudinous Opportunities.

Pregnant women are at a higher risk of developing complications from malaria, a mosquito-borne disease caused by Plasmodium parasites, resulting in considerable maternal and infant morbidity and mortality. Malaria in pregnancy causes unfavorable and life-threatening outcomes for both the mother and fetus not limited to maternal anemia, hypoglycaemia, cerebral malaria, pulmonary edema, and puerperal sepsis. WHO recommends wide-ranging strategies for this detrimental but preventable disease; however, numerous challenges persist in ensuring high uptake of preventive therapies, effective usage of insecticide-treated bed nets, and early initiation and optimal antenatal care coverage for pregnant women. This work distils recent global advances in preventive strategies for malaria in pregnancy. We discuss three mainstay interventions by WHO, viz. intermittent preventive treatment of malaria in pregnancy (IPTp), utilization and outcomes of insecticide-treated bed nets (ITNs), and headways in malaria case management using therapeutic drugs. We cover multitudinous facets of antenatal care, WHO-advised community-based delivery of IPTp (c-IPTp), intermittent screening and treatment for malaria in pregnancy (ISTp), a malaria vaccine for pregnant women, and auxiliary factors that are crucial for improving prevention outcomes. Despite the reduction in malaria globally, malaria in pregnancy remains a prevalent issue in endemic areas, which warrants strengthening of preventative strategies. This work attempts to consolidate pivotal observations of the prevention of malaria during pregnancy by highlighting key advances, priority areas, new opportunities, research gaps, and challenges that need to be addressed to ensure improved outcomes in pregnant women infected with malaria.

APERFEIÇOAMENTO SOBRE O RASTREIO DA TUBERCULOSE PARA OS AGENTES COMUNITÁRIOS DE SAÚDE DA ESTRATÉGIA DE SAÚDE DA FAMÍLIA DO NASCENTE I E II EM ARARIPINA-PE.

Tuberculosis (TB), a disease formerly described as typhus, was known in the 19th century as the white plague, decimating hundreds of thousands of people around the world. TB can be caused by any of the seven species that make up the Mycobacterium tuberculosis complex: M. tuberculosis, M. bovis, M. africanum, M. canetti, M. microti, M. pinnipedi and M. caprae. M. tuberculosis is transmitted by air, from a person with pulmonary or laryngeal TB, who eliminates bacilli in the environment (source case), to another person, by inhaling aerosols from coughing, talking or sneezing. Primary pulmonary TB usually occurs after the individual's first contact with the bacillus and is therefore more common in children. Its main characteristic is a dry or productive cough. Evening fever, without chills, does not usually exceed 38.5ºC. Night sweats and anorexia are common. Tuberculosis is a serious disease, but it is curable in the vast majority of cases, as long as the treatment is followed correctly. In Brazil, treatment is standardized and free of charge, provided by the National Tuberculosis Control Program (PNCT) in Health Units. In Brazil, tuberculosis treatment is standardized and consists of two phases: intensive and maintenance. The basic regimen recommended by the Ministry of Health (BRASIL, 2019) for adults and adolescents aged 10 and over includes rifampicin, isoniazid, pyrazinamide and ethambutol (RHZE). Directly Observed Treatment (DOT) is a fundamental strategy for ensuring patient adherence to tuberculosis treatment and reducing abandonment rates. Adopted by the Ministry of Health (MoH) based on WHO recommendations, DOT consists of direct observation of drug intake by health professionals. Community health workers (CHWs) are essential for tuberculosis control, from diagnosis to the outcome of cases. Their duties include Spreading the word to their community about tuberculosis as an important current public health problem. Educate the population about airborne transmission of tuberculosis and the preventive measures that can be adopted. To be aware of the main symptoms of tuberculosis (cough, fever, weight loss and night sweats) at all meetings with the community, as well as publicizing them, and referring suspected cases to the health unit.