World Health Organization Recommends Research Articles

A replicating RNA vaccine confers protection in a rhesus macaque model of Crimean-Congo hemorrhagic fever

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne febrile illness with a wide geographic distribution. In recent years the geographic range of Crimean-Congo hemorrhagic fever virus (CCHFV) and its tick vector have increased, placing an increasing number of people at risk of CCHFV infection. Currently, there are no widely available vaccines, and although the World Health Organization recommends ribavirin for treatment, its efficacy is unclear. Here we evaluate a promising replicating RNA vaccine in a rhesus macaque (Macaca mulatta) model of CCHF. This model provides an alternative to the established cynomolgus macaque model and recapitulates mild-to-moderate human disease. Rhesus macaques infected with CCHFV consistently exhibit viremia, detectable viral RNA in a multitude of tissues, and moderate pathology in the liver and spleen. We used this model to evaluate the immunogenicity and protective efficacy of a replicating RNA vaccine. Rhesus macaques vaccinated with RNAs expressing the CCHFV nucleoprotein and glycoprotein precursor developed robust non-neutralizing humoral immunity against the CCHFV nucleoprotein and had significant protection against the CCHFV challenge. Together, our data report a model of CCHF using rhesus macaques and demonstrate that our replicating RNA vaccine is immunogenic and protective in non-human primates after a prime-boost immunization.

Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi

BackgroundThe World Health Organization recommends human papillomavirus (HPV) testing for primary cervical cancer screening, including among women living with HIV (WLWH). Low-and-middle-income countries account for 85% of the cervical cancer burden globally, yet have limited access to HPV-based screening, largely due to cost. This study aims to compare the performance of a rapid, isothermal amplification HPV assay (ScreenFire) to that of the Xpert HPV assay for the detection of HPV and cervical precancer among WLWH in Malawi.MethodsWe utilized stored self- and provider-collected specimens from a prospective cohort study of WLWH in Malawi from July 2020 to February 2022. Specimens were tested with both Xpert and ScreenFire HPV assays. The overall and within-channel non-hierarchical agreement between ScreenFire and Xpert was determined for both self- and provider-collected specimens. Hierarchical ScreenFire HPV positivity by channel was compared to Xpert for each histological diagnosis—cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared to <CIN2.Results315 matched self- and provider-collected specimens had valid results from both Xpert and ScreenFire testing and were included in analyses, of which 279 and 36 were HPV positive and HPV negative, respectively, on Xpert self-collection. Of the 315, 245 (78%) had normal pathology, 21 CIN1 (7%), 14 CIN2 (4%), and 35 CIN3 (11%). Of the 245 with normal pathology, 213 (87%) and 188 (77%) were HPV-positive on Xpert and ScreenFire self-collected specimens, respectively. Among provider-collected specimens, the assays had 80% agreement on overall HPV positivity (unweighted kappa 0.59, 95% 0.50–0.69). ScreenFire was HPV-positive in 90% of self-collected specimens that were HPV-positive on Xpert. Channel agreement between the assays was high for both self- and provider-collected specimens, but slightly lower for HPV18/45. In hierarchical analysis, ScreenFire demonstrated high concordance with Xpert testing for detecting CIN2+ cases in all channels, missing no HPV 16 or HPV 18/45 positive CIN2+ case that was positive on Xpert, in both self- and provider-collected specimens.ConclusionIn this study of stored specimens, the ScreenFire HPV assay performed well in the detection of HPV and CIN2+ among WLWH compared to the Xpert HPV assay. If supported by larger validation studies, ScreenFire could be an affordable alternative point-of-care HPV assay for use in LMICs.

Assessment of ground-level ozone pollution in Türkiye according to new WHO limits.

Ground-level ozone is a secondary pollutant and is attributable to respiratory diseases and mortality. For this reason, the World Health Organization (WHO) implemented a new long-term (peak season) limit value for ozone. The previous studies related to ozone in Türkiye were spatially limited to certain locations. In this study, annual mean and peak season ozone concentrations, and limit exceedances were investigated for Türkiye for the year 2021. Moreover, ozone peak seasons were determined for the first time for 126 air quality monitoring stations. The annual mean ozone concentration was determined as 44.3 ± 19.3 µg/m3 whereas the peak season average ozone level was 68.4 ± 27.2 µg/m3. April-September period was the most frequently observed ozone peak season. Among all stations, Erzurum Palandöken was by far the most polluted station in terms of annual mean and limit exceedances of ozone. Ankara Siteler stations have the highest rank in peak season mean. 87 and 83 stations exceeded the short-term and long-term recommendations of WHO, respectively. Four hotspot regions were revealed in terms of peak season exceedance: Adana and surrounding provinces, the surroundings of Burdur and Isparta provinces, and the northeastern and northwestern parts of Türkiye. To protect public health, WHO recommendations for 8-h and peak season limits should be immediately implemented in Turkish regulations.

Targeting strategies for balanced energy and protein (BEP) supplementation in pregnancy: study protocol for the TARGET-BEP cluster-randomized controlled trial in rural Bangladesh

BackgroundThe World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation be provided to all pregnant women living in undernourished populations, usually defined as having a prevalence > 20% of underweight women, to reduce the risk of stillbirths and small-for-gestational-age neonates. Few geographies meet this threshold, however, and a large proportion of undernourished women and those with inadequate gestational weight gain could miss benefiting from BEP. This study compares the effectiveness of individual targeting approaches for supplementation with micronutrient-fortified BEP vs. multiple micronutrient supplements (MMS) alone as control in pregnancy in improving birth outcomes.MethodsThe TARGET-BEP study is a four-arm, cluster-randomized controlled trial conducted in rural northwestern Bangladesh. Eligible participants are married women aged 15–35 years old identified early in pregnancy using a community-wide, monthly, urine-test-based pregnancy detection system. Beginning at 12–14 weeks of gestation, women in the study area comprising 240 predefined sectors are randomly assigned to one of four intervention arms, with sector serving as the unit of randomization. The interventions involving daily supplementation through end of pregnancy are as follows: (1) MMS (control); (2) BEP; (3) targeted BEP for those with pre-pregnancy body mass index (BMI) < 18.5 kg/m2 and MMS for others; (4) targeted BEP for those with pre-pregnancy BMI < 18.5 kg/m2, MMS for others, and women with inadequate gestational weight gain switched from MMS to BEP until the end of pregnancy. Primary outcomes include birth weight, low birth weight (< 2500 g), and small for gestational age, defined using the 10th percentile of the INTERGROWTH-21st reference, for live-born infants measured within 72 h of birth. Project-hired local female staff visit pregnant women monthly to deliver the assigned supplements, monitor adherence biweekly, and assess weight regularly during pregnancy. Trained data collectors conduct pregnancy outcome assessment and measure newborn anthropometry in the facility or home depending on the place of birth.DiscussionThis study will assess the effectiveness of targeted balanced energy and protein supplementation to improve birth outcomes among pregnant women in rural Bangladesh and similar settings.Trial registrationClinicalTrials.gov NCT05576207. Registered on October 5th, 2022.

Efficacy of Albendazole and Mebendazole Against Soil Transmitted Infections among Pre-School and School Age Children: A Systematic Review and Meta-Analysis.

Soil-transmitted helminthic (STH) infections are the leading cause of stunting among children. To lessen the burden, the World Health Organization (WHO) recommended a periodic deworming program through the use of single-dose therapy in the endemic regions. Therefore, the purpose of this study was to synthesize evidence about the efficacy of anthelminthic drugs against STH infections among preschool and school-age children. The Preferred Reposting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were followed in this study. Relevant electronic databases, including PubMed, Scopus, Embase, DOAJ, Science Direct, the WHO Clinical Trials.gov library, Google Scholar, and AJOL databases, were searched for relevant publications. Randomized controlled trials (RCTs) and non-randomized interventional studies focused on the efficacy of albendazole and mebendazole against STHs in children were included in the study. Review Manager was used to analyze the data. A random effects model was used to obtain the pooled estimated efficacy. To evaluate heterogeneity, the I2 test and Cochrane Q (χ2) were employed. The risk of publication bias was investigated using Egger's test and the funnel plot. The protocol of this review was registered at the PROSPERO international prospective register of systematic reviews (CRD42023401196). Of the 69 publications selected for the systematic review, 66 with complete data were included in the meta-analysis. Single doses of albendazole and mebendazole have shown satisfactory efficacy [egg reduction rate (ERR)] against Ascaris lumbricoides [95.54% (95% CI: 88.75-102.34%) and 98.69% (95% CI: 97.68-99.65%), respectively. The effectiveness of these two drugs against Trichuris trichiura and hookworms was comparatively low (< 80% ERR), except for albendazole, which showed high ERRs [93.44% (95%CI: 92.39-94.49%)] against hookworms. The cure rate (CR) of albendazole against T. trichiura, A. lumbricoides, and hookworms were 50.8%, 91.3%, and 78.32%, respectively. Likewise, mebendazole showed CRs of 48.15%, 92.8%, and 49.32% against T. trichiura, A. lumbricoides, and hookworms, respectively. Subgroups such as studies conducted after 2000, diagnostic type (McMaster), and longer follow-up weeks significantly reduced the efficacy of the two drugs against T. trichura. While the combination of albendazole or mebendazole with other drugs and RCT showed significantly improved efficacy against T. trichura. The count of eggs per gram of stool (EPG) was identified as one of the variables that negatively and significantly influenced the efficacy of albendazole or mebendazole against A. lumbricoides. Despite the wide range of ERRs and CR reported in the different articles included in this review, the pooled estimated efficacy of albendazole and mebendazole against STHs falls in the satisfactory category of WHO recommendations. Further evaluation of the combination of anthelminthic drugs as a preventive chemotherapy option and routine drug efficacy testing are necessary to prevent the emergence and widespread use of drug-resistant STHs.

Reversal of Soleus Muscle Atrophy in Older Adults: A Non-Volitional Exercise Intervention for a Changing Climate.

The World Health Organization recommends that older adults undertake at least 150 minutes of moderate intensity physical activity over the course of each week in order to maintain physical, mental, and social health. This goal turns out to be very difficult for most community dwelling older adults to achieve, due to both actual and perceived barriers. These barriers include personal health limitations, confinement issues, and self-imposed restrictions such as fear of injury. Climate change exacerbates the confinement issues and injury fears among the elderly. To assist older adults in obtaining the benefits of increased physical activity under increasingly challenging climate conditions, we propose a targeted non-volitional intervention which could serve as a complement to volitional physical activity. Exogenous neuro-muscular stimulation of the soleus muscles is a non-invasive intervention capable of significantly increasing cardiac output in sedentary individuals. Long-term daily use has been shown to improve sleep, reduce bone loss, and reverse age-related cognitive decline, all of which are significant health concerns for older adults. These outcomes support the potential benefit of exogenous neuro-muscular stimulation as a complementary form of physical activity which older adults may find convenient to incorporate into their daily life when traditional forms of exercise are difficult to achieve due to barriers to completing traditional physical activities as a result of in-home or in-bed confinement, perceptual risks, or real environmental risks such as those arising from climate change.

Influence of physical and water quality parameters on residual chlorine decay in water distribution network

Chlorine is the most common disinfectant in drinking water distribution practice. World Health Organization recommends 0.2–5.0 mg/l of residual chlorine in drinking water. This paper analyzed influence of physical and water quality parameters on chlorine decay in drinking water distribution. Principal component analysis, directed tree and regression were used to investigate influence of these parameters on chlorine from water treatment plant to water consumption points. Results show that initial chlorine, electrical conductivity and distance explain 62 % of chlorine decay with estimated error of 0.045 mg/l. The decision-tree feature importance scores of initial chlorine and electrical conductivity were 0.47 and 0.23 respectively. The combined feature importance scores of physical parameters of distance (0.09), pipe diameter (0.06), flow velocity (0.03), pressure (0.02) and travel time (0.046) were less than that for initial chlorine concentration (0.47) alone. These results show that conventional chlorination at water treatment plants removes largely fast inorganic reactants leaving traces of slow organic reactants as the dominant secondary contaminants in water distribution system. The key policy recommendation is to use water quality parameters more than physical parameters in order to enable water utility managers maintain residual chlorine within safe public health standards.

Maximizing the Effectiveness of 1.5 mg Levonorgestrel for Emergency Contraception: The Case for Pre-Coital Use

ObjectiveU.S. and World Health Organization (WHO) Selected Practice Recommendations state that people may have an advanced supply of emergency contraception (EC) to minimize treatment delays. We sought to characterize the potential improvement in effectiveness of 1.5 mg levonorgestrel as EC (LNG-EC) if it were taken up to a few hours before unprotected sex. Study DesignWe expanded on an existing mathematical model for computing the maximum attainable effectiveness of LNG-EC assuming it exclusively works to disrupt ovulation, and compared results with point estimates from nine studies when it was taken up to 72 hours after sex. We then used the model to assess how effectiveness might have improved if subjects took LNG-EC up to three hours before sex. ResultsTaking LNG-EC immediately after sex could reduce the risk of unintended pregnancy by up to 91%. However, population-average maximum attainable effectiveness levels ranged from just 49% to 67% when accounting for the distributions of post-coital treatment delays in the example studies. These values were within five percentage points of estimates from studies where rigorous methods were used to estimate pregnancy risks. If half of all subjects had an advanced supply of LNG-EC and were motivated to take it a few hours before sex, then maximum attainable effectiveness levels would have ranged from 70% to 81%. ConclusionsAt the individual level, taking LNG-EC a few hours before sex is a logical extension of U.S. and WHO recommendations regarding an advanced supply of EC and - based on modeling results - should be advocated for people who can reasonably anticipate an unprotected act of sex. In the absence of more clinical data, however, people should not routinely rely on pre-coital use of LNG-EC to prevent pregnancy unless modern effective contraceptives are inaccessible to them. ImplicationsBased on mathematical modeling, individuals who anticipate needing to take LNG-EC for an impending unprotected act of sex could further reduce their chance of an undesired pregnancy by taking it a few hours in advance.

Salt and sugar intakes of adults in the central division of Fiji: findings from a nutrition survey in 2022

BackgroundExcess salt and sugar consumption contribute to diseases, such as diabetes and hypertension. This study aimed to estimate salt and sugar intakes and main sources, in a population of adults in the Central Division of Fiji. MethodsOne adult per household was randomly selected to participate (n=700). Sociodemographic characteristics; blood pressure, weight, and height; a 24-hour diet recall; and spot-urine samples were collected, with 24-hour urine samples from a sub-sample (n=200). Sugar intake was estimated from the 24-hour diet recalls and salt intake from the spot-urines. 24-hr diet recall was used to identify main sources of salt and sugar by food groups. Findings534 adults (response rate 76%, 50% women, mean age 42 years) participated. Salt intake was 8.8 g/day (95% CI, 8·7 to 9·0), and free sugar intake was 74.1 g/day (67·5 to 80·7), 16.1% of total energy intake (15.0 to 17·1%). Main sources of salt were mixed cooked dishes (40·9% (38·2 to 43·5)), and bread and bakery products (28·7% (26·5 to 31·0)). Main sources of sugar were table sugars, honey, and related products (24.3% (21·7 to 26·8)), non-alcoholic beverages (21·4% (18·8 to 24·0)) and bread and bakery products (18·0% (16·2 to 19·9)). InterpretationSalt and sugar intakes exceeded World Health Organization recommendations in this sample of adults. Given dietary sources were foods high in salt and sugar, along with the addition to food or drinks, interventions focused on behavior along with environmental strategies to encourage healthier choices are needed. FundingNHMRC and GACD grant APP1169322.

The emergency burden in low and middle-income countries

Injuries are the greatest single cause of surgical disease globally, disproportionately affecting low and middle-income countries and representing 10% of global mortality and 32% greater annual mortality than HIV/AIDS, tuberculosis, and malaria combined. Road traffic injuries are the single greatest contributor to the global injury burden and the leading cause of death for young people aged 5 to 29 years. In May 2023, the 76th World Health Assembly resolved that emergency, critical, and operative care services are an integral part of a comprehensive national primary health care approach and foundational for health systems to effectively address emergencies. However, robust trauma systems and emergency medical services are lacking in low and middle-income countries to adequately address the prehospital injury burden in systematic and financially sustainable approaches, despite the disproportionate burden faced. Replicating formal Tier 2 emergency medical services (staffed by professional emergency responders within well-defined jurisdictions using dedicated vehicles and equipment) from high-income countries has failed, and the World Health Organization recommends Tier 1 systems (community bystander-driven prehospital care by provided by lay first responders) as the first step toward formal emergency medical services in these same settings. The Global Prehospital Consortium has identified 7 priority areas as a framework for future emergency medical services development, forming the basis for the remaining articles in this series, spanning infrastructure and operations, communication, education/training, impact evaluation, financing, governance/legal, and transportation/equipment.

Pan-immune inflammatory value a new diagnostic biomarker in postmenopausal osteoporosis

Aims: Postmenopausal osteoporosis (PMOP) is one of the most common bone diseases. We aimed to investigate the relationship between pan-immune inflammatory value and decreased bone mineral density in postmenopausal women. Methods: This prospective cross-sectional study was composed of 186 postmenopausal women. Osteoporosis was diagnosed with dual‐energy X‐ray absorptiometry (DEXA) results according to World Health Organization (WHO) recommendations and patients were separated into 3 groups; 1. control group with a T-score &gt;-1; 2. group osteopenia with a T-score between -1,0 and -2,5; 3. group osteoporosis with a T-score ≤-2,5. After the physical examinations of all patients, venous blood samples were collected and the pan-immune inflammation value (PIV) was calculated. The parameters were evaluated statistically with the PIV value between the groups. Results: Groups are similar in terms of age, menopausal age, education, and occupation. PIV was significantly higher in postmenopausal women with osteoporosis than women with osteopenia and the control group (p

Strengthening caesarean birth: Sub-Saharan Africa health system evaluation: Scoping review.

Promoting safe caesarean birth (CB) is a challenge in sub-Saharan Africa (SSA) where maternal and neonatal mortality rates are high due to inadequate maternal health services. Although the CB rate in SSA is lower than the World Health Organization (WHO) recommendation, it is often associated with high maternal and neonatal mortality. The aim of this scoping review was to report on the extent to which SSA health systems deliver safe CB. A systematic search across various databases identified 53 relevant studies, comprising 30 quantitative, 10 qualitative and 16 mixed methods studies. These studies focused on clinical protocols, training, availability, accreditation, staff credentialing, hospital supervision, support infrastructure, risk factors, surgical interventions and complications related to maternal mortality and stillbirth. CB rates in SSA varied significantly, ranging from less than 1% to a high rate of 29.7%. Both very low as well as high rates contributed to significant maternal and neonatal morbidity. Factors influencing maternal and perinatal mortality include poor referral systems, inadequate healthcare facilities, poor quality of CBs, inequalities in access to maternity care and affordable CB intervention. The inadequate distribution of healthcare facilities, and limited access to emergency obstetric care impacted the quality of CBs. Early access to quality maternity services with skilled providers is recommended to improve CB safety.Contributions:This scoping review contributes to the body of knowledge motivating for the prioritization of maternal service across SSA.

Vayu bubble continuous positive airway pressure is a promising solution with favorable treatment outcomes for respiratory distress syndrome in newborns: a qualitative study in Bangladesh.

According to Bangladesh Demographic and Health Survey (2022), neonatal mortality, comprising 67% of under-5 deaths in Bangladesh, is significantly attributed to prematurity and low birth weight (LBW), accounting for 32% of neonatal deaths. Respiratory distress syndrome (RDS) is a prevalent concern among preterm and LBW infants, leading to substantial mortality. The World Health Organization (WHO) recommends bubble continuous positive airway pressure (bCPAP) therapy, but the affordability and accessibility of conventional bCPAP devices for a large number of patients become major hurdles in Bangladesh due to high costs and resource intensiveness. The Vayu bCPAP, a simple and portable alternative, offers a constant flow of oxygen-enriched, filtered, humidified, and pressurized air. Our study, conducted in five health facilities, explores the useability, acceptability, and perceived treatment outcome of Vayu bCPAP in the local context of Bangladesh. A qualitative approach was employed in special care newborn units (SCANUs) of selected facilities from January to March 2023. Purposive sampling identified nine key informants, 40 in-depth interviews with service providers, and 10 focus group discussions. Data collection and analysis utilized a thematic framework approach led by trained anthropologists and medical officers. Service providers acknowledged Vayu bCPAP as a lightweight, easily movable, and cost-effective device requiring minimal training. Despite challenges such as consumable shortages and maintenance issues, providers perceived the device as user-friendly, operable with oxygen cylinders, and beneficial during referral transportation. Treatment outcomes indicated effective RDS management, reduced hospital stays, and decreased referrals. Though challenges existed, healthcare providers and facility managers expressed enthusiasm for Vayu bCPAP due to its potential to simplify advanced neonatal care delivery. The Vayu bCPAP device demonstrated useability, acceptability, and favorable treatment outcomes in the care of neonates with RDS. However, sustained quality service necessitates continuous monitoring, mentoring and retention of knowledge and skills. Despite challenges, the enthusiasm among healthcare providers underscores the potential of Vayu bCPAP to save lives and simplify neonatal care delivery. Development of Standard Operating procedure on Vayu bCPAP is required for systematic implementation. Further research is needed to determine how the utilization of Vayu bCPAP devices enhances accessibility to efficient bCPAP therapy for neonates experiencing RDS.

Exploring health care providers’ engagement in prevention and management of multidrug resistant Tuberculosis and its factors in Hadiya Zone health care facilities: qualitative study

BackgroundEngagement of healthcare providers is one of the World Health Organization strategies devised for prevention and provision of patient centered care for multidrug resistant tuberculosis. The need for current research question rose because of the gaps in evidence on health professional’s engagement and its factors in multidrug resistant tuberculosis service delivery as per the protocol in the prevention and management of multidrug resistant tuberculosis.PurposeThe purpose of this study was to explore the level of health care providers’ engagement in multidrug resistant tuberculosis prevention and management and influencing factors in Hadiya Zone health facilities, Southern Ethiopia.MethodsDescriptive phenomenological qualitative study design was employed between 02 May and 09 May, 2019. We conducted a key informant interview and focus group discussions using purposely selected healthcare experts working as directly observed treatment short course providers in multidrug resistant tuberculosis treatment initiation centers, program managers, and focal persons. Verbatim transcripts were translated to English and exported to open code 4.02 for line-by-line coding and categorization of meanings into same emergent themes. Thematic analysis was conducted based on predefined themes for multidrug resistant tuberculosis prevention and management and core findings under each theme were supported by domain summaries in our final interpretation of the results. To maintain the rigors, Lincoln and Guba’s parallel quality criteria of trustworthiness was used particularly, credibility, dependability, transferability, confirmability and reflexivity.ResultsTotal of 26 service providers, program managers, and focal persons were participated through four focus group discussion and five key informant interviews. The study explored factors for engagement of health care providers in the prevention and management of multidrug resistant tuberculosis in five emergent themes such as patients’ causes, perceived susceptibility, seeking support, professional incompetence and poor linkage of the health care facilities. Our findings also suggest that service providers require additional training, particularly in programmatic management of drug-resistant tuberculosis.ConclusionThe study explored five emergent themes: patient’s underlying causes, seeking support, perceived susceptibility, professionals’ incompetence and health facilities poor linkage. Community awareness creation to avoid fear of discrimination through provision of support for those with multidrug resistant tuberculosis is expected from health care providers using social behavioral change communication strategies. Furthermore, program managers need to follow the recommendations of World Health Organization for engaging healthcare professionals in the prevention and management of multidrug resistant tuberculosis and cascade trainings in clinical programmatic management of the disease for healthcare professionals.

Drug utilization and prescribing pattern in the treatment of urolithiasis: a perspective on World Health Organization recommendations

Background: Drug utilization research (DUR) is essential in promoting rational use of medicine, aimed at understanding the patterns of prescription, administration, and utilization of medications. It provides valuable insights into the actual drug usage patterns for specific disease conditions. To evaluate the current utilization pattern of drugs in patients of urolithiasis in the Department of General Medicine and Surgery at Integral Institute of Medical Science and Research Hospital, Lucknow. Methods: Following the approval of the institutional ethics committee, a prospective observational study was conducted at Integral Institute of Medical Science and Research Department of general medicine and surgery over a six-month period. Urolithiasis patients’ prescriptions were analyzed to study the prescribing patterns. Information about patient demographics, co-morbidities, and the number and types of medications prescribed were collected and analyzed. Results: Out of 102 patients studied, a female preponderance over male patients was observed. The co-morbidities that are encountered most commonly were hydronephrosis, cystitis, and renal cyst. There is averaged 7 medicines per prescription, 15.25% of medicines written by the generic name, 83.33% of patients receiving antibiotics, 54.70% of patients receiving injections, and 83% of drugs prescribed are mentioned in the essential medicine list. Analgesics, antibiotics, nutritional supplements, antiemetic, alkalizing agents, and antispasmodics were among the class of medicines given. Conclusions: This study highlights the current use of medicines and drug utilization in urolithiasis management. The findings show important insights for healthcare professionals to enhance medication therapy, encourage cost-effective healthcare delivery and improve quality of patient in urolithiasis management.

Unravelling Chlamydia trachomatis diversity in Amhara, Ethiopia: MLVA-ompA sequencing as a molecular typing tool for trachoma.

Trachoma is the leading infectious cause of blindness worldwide and is now largely confined to around 40 low- and middle-income countries. It is caused by Chlamydia trachomatis (Ct), a contagious intracellular bacterium. The World Health Organization recommends mass drug administration (MDA) with azithromycin for treatment and control of ocular Ct infections, alongside improving facial cleanliness and environmental conditions to reduce transmission. To understand the molecular epidemiology of trachoma, especially in the context of MDA and transmission dynamics, the identification of Ct genotypes could be useful. While many studies have used the Ct major outer membrane protein gene (ompA) for genotyping, it has limitations. Our study applies a typing system novel to trachoma, Multiple Loci Variable Number Tandem Repeat Analysis combined with ompA (MLVA-ompA). Ocular swabs were collected post-MDA from four trachoma-endemic zones in Ethiopia between 2011-2017. DNA from 300 children with high Ct polymerase chain reaction (PCR) loads was typed using MLVA-ompA, utilizing 3 variable number tandem repeat (VNTR) loci within the Ct genome. Results show that MLVA-ompA exhibited high discriminatory power (0.981) surpassing the recommended threshold for epidemiological studies. We identified 87 MLVA-ompA variants across 26 districts. No significant associations were found between variants and clinical signs or chlamydial load. Notably, overall Ct diversity significantly decreased after additional MDA rounds, with a higher proportion of serovar A post-MDA. Despite challenges in sequencing one VNTR locus (CT1299), MLVA-ompA demonstrated cost-effectiveness and efficiency relative to whole genome sequencing, providing valuable information for trachoma control programs on local epidemiology. The findings suggest the potential of MLVA-ompA as a reliable tool for typing ocular Ct and understanding transmission dynamics, aiding in the development of targeted interventions for trachoma control.

Plastic Wound Protector vs Surgical Gauze for Surgical Site Infection Reduction in Open GI Surgery

Surgical site infections (SSIs) are prevalent hospital-acquired infections with significant patient impacts and global health care burdens. The World Health Organization recommends using wound protector devices in abdominal surgery as a preventive measure to lower the risk of SSIs despite limited evidence. To examine the efficacy of a dual-ring, plastic wound protector in lowering the SSI rate in open gastrointestinal (GI) surgery irrespective of intra-abdominal contamination levels. This multicenter, patient-blinded, parallel-arm randomized clinical trial was conducted from August 2017 to October 2022 at 13 hospitals in an academic setting. Patients undergoing open abdominal bowel surgery (eg, for bowel perforation) were eligible for inclusion. Patients were randomized 1:1 to a dual-ring, plastic wound protector to protect the incision site of the abdominal wall (experimental group) or a conventional surgical gauze (control group). The primary end point was the rate of SSI within 30 days of open GI surgery. A total of 458 patients were randomized; after 1 was excluded from the control group, 457 were included in the intention-to-treat analysis (mean [SD] age, 58.4 [12.1] years; 256 [56.0%] male; 341 [74.6%] with a clean-contaminated wound): 229 in the wound protector group and 228 in the surgical gauze group. The overall SSI rate in the intention-to-treat analysis was 15.7% (72 of 458 patients). The SSI rate for the wound protector was 10.9% (25 of 229 patients) compared with 20.5% (47 of 229 patients) with surgical gauze. The wound protector significantly reduced the risk of SSI, with a relative risk reduction (RRR) of 46.81% (95% CI, 16.64%-66.06%). The wound protector significantly decreased the SSI rate for clean-contaminated wounds (RRR, 43.75%; 95% CI, 3.75%-67.13%), particularly for superficial SSIs (RRR, 42.50%; 95% CI, 7.16%-64.39%). Length of hospital stay was similar in both groups (mean [SD], 15.2 [10.5] vs 15.3 [10.2] days), as were the overall postoperative complication rates (20.1% vs 18.8%). This randomized clinical trial found a significant reduction in SSI rates when a plastic wound protector was used during open GI surgery compared with surgical gaze, supporting the World Health Organization recommendation for use of wound protector devices in abdominal surgery. ClinicalTrials.gov Identifier: NCT03170843.

Assessment of Dietary Intake and Nutritional Status of Children (0-23 Months) Accessing Care in Community Infant and Young Child Feeding (C-IYCF) Practices in Hasiya Bayero Pediatric Hospital Kano

Introduction: Infant and young child feeding (IYCF) practices have substantial outcomes for the growth, development, and survival of infants and children during the first two years of age and throughout their lifetime. The study aimed to assess the dietary intake and nutritional status of children (0–23 months) registered for care in Hasiya Bayero Pediatric Hospital Kano. Methodology: A cross-sectional study was conducted among 125 randomly selected caregiver-child pairs accessing care in the hospital. A validated semi-structured questionnaire was used to collect information on socio-demographic and dietary intake information from the respondents. Anthropometric indices of weight for age, length for age, and weight for length measurements were used to assess the nutritional status of children. Result: Female caregivers were the most participants in this study 122 (98.2%). For marital status, almost all 124 (99.4%) of the mothers were married and only 1 each of the mothers reported to be single and being widowed. About 76 (60.8%) of the study population attended secondary education. The major occupation of the caregivers is trading in 92.4%. Dietary intake consists mainly of legumes in 30.0% and cereals in 56.5%. Only 39.0% portion of the population met the minimum World Health Organization (WHO) recommendation of dietary diversity and over 79.8% of the caregivers were still breastfeeding during the period of the study, 18% of them initiated breastfeeding within 1 h of birth and only 16.2% exclusively breastfed their children; majority 70.6% of the caregivers breastfed on demand while with a small proportion of 26.1% and 3.3% responded to breastfeeding when convenient and breastfeeding at a scheduled time respectively. Conclusion: The study revealed that the nutritional status of the children was poor. Up to 60 (51.2%), 98 (88.3%), and 74 (65.1%) of the infants were wasted, underweight, and stunted, respectively. The study also revealed that the nutritional status of the children (WLZ, WAZ, and LAZ) was significantly related to the dietary diversity at p = 0.002, p = 0.001, and p = 0.019, respectively. This study revealed poor IYCF practices in Hasiya Bayero Pediatric Hospital Kano. Therefore, more attention needs to be paid to the specific behaviors surrounding feeding practices and other constraints to children accessing care in Hasiya Bayero Pediatric Hospital Kano.

Adherence to antiretroviral therapy and determining factors in adults living with HIV receiving services at public health facilities amidst the COVID-19 crisis in Bahir Dar city, Northwest Ethiopia.

The COVID-19 pandemic has presented new challenges to adhering to ART, and its influence on adherence and related factors has not been thoroughly studied. This study examines ART adherence and its associated factors during the COVID-19 pandemic. A cross-sectional study was conducted on HIV-positive individuals receiving care and treatment in public health facilities. A total of 612 participants were selected using a multi-stage sampling procedure. Data were collected through interviewer-administered questionnaires and chart reviews. We used Epi-data for data entry and Stata for data analysis. Good adherence to antiretroviral therapy in this study was 76.5% (95% CI, 72.9, 79.7). Divorced marital status (AOR = 0.45,95%CI:0.22,0.90), regular follow-up (AOR = 3.01,95%CI:1.81,5.01), adherence counseling and information in the context of COVID-19 pandemic (AOR = 2.57,95%CI:1.63,4.08), and knowledge about ART (AOR = 1.81,95%CI:1.11,2.94) were significantly associated with adherence to antiretroviral therapy. The observed adherence rate in this study was lower than the World Health Organization recommendation and previous studies. The study highlighted the importance of addressing adherence to ART among HIV-positive adults during the COVID-19 pandemic and other upcoming emerging and reemerging outbreaks. Strategies to improve adherence should consider factors such as marital status, regular follow-up, provision of counseling and information, and enhancing knowledge about ART.

Haem iron versus ferrous iron salts to treat iron deficiency anaemia in Gambian children: protocol for randomised controlled trial {1}

BackgroundThe World Health Organization recommends universal iron supplementation for children aged 6–23 months in countries where anaemia is seen in over 40% of the population. Conventional ferrous salts have low efficacy due to low oral absorption in children with inflammation. Haem iron is more bioavailable, and its absorption may not be decreased by inflammation. This study aims to compare daily supplementation with haem iron versus ferrous sulphate on haemoglobin concentration and serum ferritin concentration after 12 weeks of supplementation.MethodsThis will be a two-arm, randomised controlled trial. Gambian children aged 6–12 months with anaemia will be recruited within a predefined geographical area and recruited by trained field workers. Eligible participants will be individually randomised using a 1:1 ratio within permuted blocks to daily supplementation for 12 weeks with either 10.0 mg of elemental iron as haem or ferrous sulphate. Safety outcomes such as diarrhoea and infection-related adverse events will be assessed daily by the clinical team (see Bah et al. Additional file 4_Adverse event eCRF). Linear regression will be used to analyse continuous outcomes, with log transformation to normalise residuals as needed. Binary outcomes will be analysed by binomial regression or logistic regression, Primary analysis will be by modified intention-to-treat (i.e., those randomised and who ingested at least one supplement dose of iron), with multiple imputations to replace missing data. Effect estimates will be adjusted for baseline covariates (C-reactive protein, alpha-1-acid glycoprotein, haemoglobin, ferritin, soluble transferrin receptor).DiscussionThis study will determine if therapeutic supplementation with haem iron is more efficacious than with conventional ferrous sulphate in enhancing haemoglobin and ferritin concentrations in anaemic children aged 6–12 months.Trial registrationPan African Clinical Trial Registry PACTR202210523178727