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Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), may contribute towards persistently poor child health, growth and cognitive development. Experiencing poor nutrition in utero or during early childhood is furthermore associated with chronic diseases later in life. The primary responsibility for provision of water and sanitation, as a basic service and human right, lies with the State; however, a number of stakeholders are involved. The situation is most critical in sub-Saharan Africa (SSA), where, in 2015, 311 million people lacked a safe water source, and >70% of SSA populations were living without adequate sanitation. The aim of this paper was to conduct a systematic review to investigate the state of literature concerned with WASH and its association with nutritional status, and governance in children from birth to 5 years of age in SSA. Articles were sourced from PubMed Central, Science Direct and ProQuest Social Science databases published between 1990 and 2017. The PRISMA Statement was utilised and this systematic review is registered with PROSPERO (CRD42017071700). The search terms returned 15,351 articles for screening, with 46 articles included. This is indicative of a limited body of knowledge; however, the number of publications on this topic has been increasing, suggesting burgeoning field of interest. Targeted research on the governance of WASH through the identification of the various role players and stakeholders at various levels, while understanding the policy environment in relation to particular health-related outcomes is imperative to address the burden of child undernutrition.
Pulmonary hypertension with transposition of the great arteries is associated with significant morbidity and mortality. At the worst end of the spectrum are patients who undergo extracorporeal support perioperatively. We describe our experience with three patients who received preoperative extracorporeal support and separated from cardiopulmonary bypass successfully on conventional postoperative care, with no significant deficits on follow-up.
Hepatitis E virus genotype 1 (HEV G1) is an important cause of morbidity and mortality in Africa and Asia. HEV G1's natural history, including the incubation period, remains poorly understood, hindering surveillance efforts and effective control. Using individual-level data from 85 travel-related HEV G1 cases in England and Wales, we estimate the incubation period distribution using survival analysis methods, which allow for appropriate inference when only time ranges, rather than exact times are known for the exposure to HEV and symptom onset. We estimated a 29.8-day (95% confidence interval (CI) 24.1–36.0) median incubation period with 5% of people expected to develop symptoms within 14.3 days (95% CI 10.1–21.7) and 95% within 61.9 days (95% CI 47.4–74.4) of exposure. These estimates can help refine clinical case definitions and inform the design of disease burden and intervention studies.
We present the first systematic assessment of the population, demography and distribution of the Endangered Zanzibar red colobus Piliocolobus kirkii, in Unguja in the Zanzibar archipelago, based on a survey effort of 4,725 hours. We estimate the total population comprises 5,862 individuals in 342 groups (mean group size 17.12); 3.4 times the mean of all previous estimates. We calculated a total area of occupancy of 376 km2, with 4,042 individuals living within protected areas. Mean group sizes were significantly higher within protected areas (20.57) than outside (12.80). The number of adult females was 3,179 (54.21%), with a mean of 9.29 per group, and the number of adult males was 932 (15.89%), with a mean of 2.71 per group, giving a ratio of 3.31 adult females to adult males. This ratio was significantly lower outside protected areas. The total number of infants was 958 (16.34%), with a mean of 2.80 per group, and the number of subadults/juveniles was 793 (13.52%), with a mean of 2.32 per group, giving ratios of 0.30 infants to adult females, and 0.25 subadults/juveniles to adult females. The results indicate that P. kirkii is resilient and thriving far better than assumed. However, recruitment is low and the population may be in decline, with individuals outside protected areas most at risk. We tentatively support the categorization of P. kirkii as Endangered on the IUCN Red List, argue for greater protected area status for southern Uzi, Vundwe and Mchamgamle, and discuss conservation implications for this charismatic flagship species.
Indigenous, foodborne transmission of hepatitis E has been increasing across industrialised countries. Public Health England has conducted enhanced surveillance in England and Wales since 2003.This report gives an account of acute infections from 2010 to 2016 and describes modification made to the methods of surveillance to account for changes in reporting behaviours and improve ascertainment.
Since 2010, human hepatitis E infections have increased in England and Wales. Most cases are locally acquired and caused by hepatitis E virus genotype 3 (HEV G3). HEV G3 is linked to the consumption of pork products. The increase is associated with the emergence of a new phylotype, HEV G3-group 2 (G3-2, also known as G3abcdhij). Sixty individuals with confirmed hepatitis E infection and no history of travel outside the UK were recruited: 19 were infected with HEV G3-group 1 (G3-1 or G3efg) and 41 with G3-2. Epidemiological data relating to usual shopping habits and consumption of ham and sausages were analysed together with typing data to identify any associations with HEV phylotype. Study participants who purchased ham and/or sausage from a major supermarket were more likely to have HEV G3-2 infection (Relative risks 1·85, P = 0·06, CI 0·97–3·53). The HEV G3-2 phylotype has not been detected in indigenous UK pigs and it is suggested that human infections could be the result of consumption of products made from pork originating outside the UK. This does not infer blame on the supermarket but the epidemiology of HEV is dynamic and reflects complex animal husbandry practices which need to be explored further.
The Livingstone's fruit bat Pteropus livingstonii is endemic to the small islands of Anjouan and Mohéli in the Comoros archipelago, Indian Ocean. The species is under threat from anthropogenic pressure on the little that remains of its forest habitat, now restricted to the islands’ upper elevations and steepest slopes. We report the results of the most comprehensive survey of this species to date, and present recommendations for ongoing field conservation efforts and monitoring. Morning counts were conducted at roost sites in the wet and dry seasons during 2011–2013. Habitat structure around the roosting sites was characterized and roost numbers compared, to investigate the potential effect of habitat loss and degradation. We estimate the population to comprise c. 1,260 individuals distributed across 21 roosts on the two islands. All occupied roosting sites were restricted to a narrow altitudinal range, and roosting populations in agroforestry areas were smaller than those found in degraded and undisturbed forest. Only one of the 16 roosts on Anjouan was found in undisturbed, old-growth forest with no nearby signs of clearance for agriculture or landslides following tree-felling upslope. Following a suspected severe population decline as a result of widespread and long-term forest loss Livingstone's fruit bat has been recategorized as Critically Endangered on the IUCN Red List.
Iron (Fe)-doped zinc oxide (ZnO) thin films were deposited using two techniques: (i) radio-frequency (RF) sputtering of Fe-doped ZnO targets, and (ii) co-sputtering, where ZnO was RF-sputtered and iron was direct-current (DC)-sputtered. The as-deposited films were polycrystalline, with predominant growth along the (002) direction of hexagonal ZnO, and possessed a considerable concentration of oxygen vacancies. From an optoelectronic point of view, the films were highly transparent, with a band gap of 3.25 eV, and had electrical resistivity values in the range of 100–103 Ω cm. To improve the electrical conductivity of the films, they were annealed in a vacuum and in a hydrogen atmosphere. The annealing process did not affect the optical properties of the films. However, there were substantial structural and chemical changes in the films. Moreover, the electrical conductivity of the films was enhanced drastically upon annealing in hydrogen, where the electrical resistivity was reduced to 3.2 × 10−3 Ω cm.
The microscaphidiid Hexangium sigani Goto & Ozaki, 1929 was found in the intestine of Siganus rivulatus, a siganid fish permanently resident in a lagoon within the mangrove swamps on the Egyptian coast of the Gulf of Aqaba. Intra-molluscan stages of this trematode (mother sporocysts, rediae and cercariae) were found in the gonads and digestive gland of Nassarius pullus (Gastropoda: Nassariidae), a common snail in the same lagoon. Consequently, the life cycle of H. sigani was elucidated under natural conditions: eggs are directly ingested by the snail; mother sporocysts and rediae reach maturity 5–7 and 16–17 weeks post-infection; rediae contain 18–26 developing cercariae; fully developed cercariae are monostome, without penetration glands, emerge from the snail during the night 18–19 weeks post-infection and rapidly encyst on aquatic vegetation (there is no second intermediate host); encysted metacercariae are not progenetic; 2-day-old metacercariae encysted on filamentous algae fed to S. rivulatus developed into fully mature worms 5–6 weeks post-infection. The cycle was completed in about 24 weeks. The intra-molluscan stages are very similar to those of Dictyangium chelydrae Stunkard, 1943, the only described intra-molluscan stages of any microscaphidiid. However, they are also similar to those of the family Mesometridae. The present study of H. sigani describes the first complete microscaphidiid life cycle, and implicitly supports the phylogenetic relationship of this family with the Mesometridae inferred from molecular phylogenetic studies.
Pertussis or whooping cough is a highly contagious community disease mainly caused by Bordetella pertussis and B. parapertussis. We report a minor outbreak of whooping cough (2009–2010) in symptomatic subjects from Bisham, near Swat, Khyber Pukhtoonkhawa province, Pakistan. Interestingly, our results show that all the culture-positive isolates (n = 21) collected from children (average age 3·46 years), were identified as B. parapertussis after routine identification tests and PCR IS481, IS1001 and IS1002. Furthermore, in the affected patients, none had received immunization with diphtheria-pertussis-tetanus (DTPw) vaccine. Therefore, the possibility of the re-emergence of the disease due to limitation of basic health services as a result of the political unrest due to the 9/11 situation is also examined. Moreover, we discuss the importance of vaccinating both adults and children with DTPwPaw vaccine containing both organisms for better protection.
Background: Coronary artery lesions in Kawasaki disease invasively assessed by coronary angiography. Evaluation of myocardial perfusion by single-photon emission computed tomography may identify the haemodynamic significance of coronary lesions. Objective: To evaluate diagnostic accuracy of dipyridamole stress technetium-99 m tetrofosmin, single-photon emission computed tomography as a possible alternative to invasive coronary angiography for detection and follow-up of myocardial ischaemia in patients with Kawasaki disease, and pre- and post-coronary bypass grafting. Patients and methods: Coronary angiography and single-photon emission computed tomography were performed on 21 patients who were classified into three groups – group I (stenosis), group II (giant aneurysms), and group III (small aneurysms). Of the 21 patients, 16 (groups I and II) patients with myocardial perfusion defects, who underwent coronary bypass grafting, were followed up with single-photon emission computed tomography. Result: In group I, all patients had significant coronary stenosis and 100% of them had perfusion defects in the anterior and septal walls. In group II, all patients had giant aneurysms and 83% of them had inferior and inferolateral perfusion defects. In group III, all patients had small aneurysms and 100% of them had normal perfusion. Pre-coronary bypass grafting myocardial ischaemic defects disappeared in all patients after surgery. Sensitivity, specificity, and accuracy of single-photon emission computed tomography were 94, 100, and 95%, respectively. Conclusion: Technetium-99 m tetrofosmin single-photon emission computed tomography can be applied as an accurate non-invasive diagnostic technique for detecting myocardial perfusion defects with coronary artery lesions, and to show improved or even normalised perfusion of the myocardium in patients after surgical revascularisation.
The rhadinorhynchid Sclerocollum saudii Al-Jahdali, 2010 was found in the intestine of its type host, Siganusrivulatus Forsskål & Niebuhr, 1775, a siganid fish permanently resident in a lagoon within the mangrove swamps found on the Egyptian coast of the Gulf of Aqaba (between 28°7′N and 28°18′N). Larval forms of this acanthocephalan (acanthors, acanthellae and cystacanths) were only found in Megaluropus agilis Hoek, 1889 (Crustacea: Gammaridae), a benthic amphipod abundant on algae and seagrasses in the lagoon. So, this life cycle of S. saudii was elucidated under semi-natural conditions: embryonated eggs of S. saudii were directly ingested by the amphipod and hatched in its intestine; the released acanthor penetrated the intestinal epithelium in 12–18 h to reach the connective tissue serosa, where it remained for about 3 days, then penetrated the intestinal wall and remained attached to its outer surface for 4 days. It then detached and dropped free in the amphipod haemocoel and transformed into an oval acanthella, growing for 16 days to reach the cystacanth stage. The cystacanth at 46 days post-infection was infective to fish (excysted in its intestine as an active juvenile). Male and female juveniles reached maturity 17 and 23 days post-infection. Recently copulated females first appeared 26 days post-infection and all females seemed to be copulated at 28 days post-infection; partially and fully gravid females first appeared 31 and 35 days post-infection. Mature males and fully gravid females started to die off naturally 31 and 43 days post-infection and were totally expelled from the fish intestine by 42 and 52 days post-infection. The cycle was completed in 89 days and is similar to other known palaeacanthocephalan life cycles, but has its own characteristics.
Indigenously acquired hepatitis E infections have increased substantially in England and Wales since 2010. Epidemiological investigations were undertaken to determine risk factors for the acquisition of infection. A case-control study (25 cases, 75 controls) was used to test the hypothesis that hepatitis E infection was related to consumption of pork products. In a multivariable model, consumption of pork pie [odds ratio (OR) 6·33, 95% confidence interval (CI) 1·41–28·48, P = 0·009] and consumption of ham and sausages purchased from a major UK supermarket chain (OR 10·12, 95% CI 1·68–60·81, P = 0·023) were significantly associated with indigenous infection. The consumption of sausages and ham purchased from the supermarket was highly correlated; however. separate models showed that each variable was significantly associated with infection (OR 7·59, 95% CI 1·81–31·84, P = 0·004 and OR 10·98, 95% CI 1·84–65·35, P = 0·003, respectively). Although contamination of sausages with HEV has previously been shown this study also raises concerns about other processed pork products and whether current practice in preparing these products is sufficient to prevent transmission of HEV.
Recent changes in the epidemiology of alveolar echinococcosis (AE) in Eurasia have led to increasing concerns about the risk of human AE and the need for a thorough evaluation of the epidemiological situation. The aim of this study was to explore the use of a National Register to detect complex distribution patterns on several scales. The data were human AE cases from the FrancEchino register, diagnosed in France from 1982 to 2011. We used the Kulldorff spatial scan analysis to detect non-random locations of cases. We proposed an exploratory method that was based on the successive detection of nested clusters inside each of the statistically significant larger clusters. This method revealed at least 4 levels of disease clusters during the study period. The spatial variations of cluster location over time were also shown. We conclude that National Human AE registers, although not exempted from epidemiological biases, are currently the best way to achieve an accurate representation of human AE distribution on various scales. Finally, we confirm the multi-scale clustered distribution of human AE, and we hypothesize that our study may be a reasonable starting point from which to conduct additional research and explore the processes that underlie such distributions.
During 2012 real-time syndromic surveillance formed a key part of the daily public health surveillance for the London Olympic and Paralympic Games. It was vital that these systems were evaluated prior to the Games; in particular what types and scales of incidents could and could not be detected. Different public health scenarios were created covering a range of potential incidents that the Health Protection Agency would require syndromic surveillance to rapidly detect and monitor. For the scenarios considered it is now possible to determine what is likely to be detectable and how incidents are likely to present using the different syndromic systems. Small localized incidents involving food poisoning are most likely to be detected the next day via emergency department surveillance, while a new strain of influenza is more likely to be detected via GP or telephone helpline surveillance, several weeks after the first seed case is introduced.