Search

The purpose of this study was to identify factors associated with mental health service utilization among adults with head injury with loss of consciousness (LOC) using Andersen’s model of health. This secondary data analysis used the 2011–2014 National Health and Nutrition Examination Survey with data collected from 7,399 adults. Binary logistic regression was conducted to determine odds associated with predisposing, enabling, and needs factors on head injury with LOC and mental health service utilization. A total of 948 (12.8 percent) adults 40 years and older self-reported head injury with LOC. Head injury with LOC was higher among men and people with lower income, illicit drug use history, and moderate to severe depression. Mental health service utilization for people with head injury with LOC was lower among older-age adults and those with no health insurance. However, utilization was higher among adults with military service, history of drug use, and moderate to severe depression. Social workers in health care settings play critical roles serving adults with traumatic brain injury (TBI) through mental health and substance use disorder treatment and bridging gaps in service access. Social workers should recognize the complex needs of clients with TBI and factors affecting mental health service use.

As countries scale up pre-exposure prophylaxis (PrEP) for HIV prevention, diverse PrEP delivery models are needed to expand access to populations at HIV risk that are unwilling or unable to access clinic-based PrEP care. To identify factors that may influence implementation of retail pharmacy-based PrEP delivery in Kenya, we conducted in-depth interviews with 40 pharmacy clients, 16 pharmacy providers, 16 PrEP clients, and 10 PrEP providers from two provinces. Most participants expressed strong support for expanding PrEP to retail pharmacies, though conditioned their acceptance on assurances that care would be private, respectful, safe, and affordable. Participant-reported determinants of feasibility centered primarily on ensuring that the intervention is compatible with retail pharmacy operations (e.g., staffing levels, documentation requirements). Future research is needed to develop and test tailored packages of implementation strategies that are most effective at integrating PrEP delivery into routine pharmacy practice in Kenya and other high HIV prevalence settings.Ya que varios países están ampliando sus programas de profilaxis previa a la exposición al VIH (PrEP, por sus siglas en inglés), se necesitan modelos diversos para ampliar el acceso a poblaciones que no están dispuestos a acceder, o que no pueden acceder, a los servicios de PrEP que se ofrecen en las instalaciones de salud. Para identificar los factores que pueden influir en la prestación de servicios de PrEP a través de farmacias privadas, realizamos entrevistas en profundidad con 40 clientes de farmacia, 16 proveedores de servicios de farmacia, 16 usuarios de PrEP, y 10 proveedores de PrEP. La mayoría de los participantes manifestó su firme apoyo a la propuesta de expandir la provisión de PrEP a las farmacias privadas, aunque condicionó su aceptación a la garantía de que la atención sea privada, respetuosa, segura, y asequible. Según los participantes, los factores determinantes de la viabilidad de ofrecer PrEP en las farmacias privadas se centran en asegurar de que la intervención sea compatible con las operaciones de las farmacias privadas (p. ej., el número de personal, los requisitos de documentación). Se necesitan investigaciones adicionales para desarrollar y evaluar diferentes paquetes de estrategias de implementación para descubrir cuáles son los más eficaces para integrar los servicios de PrEP en la prestación rutinaria de servicios de farmacia tanto en Kenia como en otros lugares de alta prevalencia del VIH.

Introduction Scant literature exists on the non-urgent use of emergency departments in Sub-Saharan Africa and its effects on the provision of effective emergency care services. With the surge in the prevalence of non-communicable diseases compounded by an already prevailing significant problem of communicable diseases and injuries in this setting, there has been a rising demand for emergency care services. This has led to ED overcrowding, increased healthcare costs, extended waiting periods and overstretched essential services. The main objective of this study was to determine why patients visit the ED for non-urgent care. Methods A descriptive qualitative study was conducted at a tertiary university hospital ED in Nairobi, Kenya. Purposive sampling was used to select patients triaged as less urgent or non-urgent. In-depth interviews were conducted until thematic saturation was achieved. The interviews were audio recorded, transcribed verbatim and analyzed thematically. Results Thematic saturation was reached after interviewing twenty-four patients. The obtained data was discussed under three main themes: (1) reasons why patients visited the ED for non-urgent care, (2) patients understanding of the roles of the ED, and (3) patients' perceptions about the urgency of their medical conditions. Several factors were identified as contributing to the non-urgent use of the ED including positive experiences during past visits, a perception of availability of better services and the closure of other departments after office-hours and on weekends. It was found that non-urgent ED visits occurred despite most patients having an understanding of the role of the ED as an appropriate location for the treatment of patients with life threatening conditions. Conclusion This study highlights several reasons why patients with non-urgent medical conditions seek care in the ED despite being able to correctly identify its purpose within the national emergency care framework. Regular patient education regarding which conditions warrant ED attendance and alternative sites of care for non-urgent conditions could potentially help reduce ED patient numbers.

Background Tick-borne diseases (TBDs) constitute a major constraint for livestock development in sub-Saharan Africa, with East Coast fever (ECF) being the most devastating TBD of cattle. However, in Burundi, detailed information is lacking on the current prevalence of TBDs and on the associated economic losses from mortality and morbidity in cattle as well as the costs associated with TBD control and treatment. The aim of this study was, therefore, to assess the prevalence and spatial distribution of tick-borne pathogens (TBPs) in cattle across the major agro-ecological zones (AEZs) in Burundi. Methods In a cross-sectional study conducted in ten communes spanning the five main AEZs in Burundi, blood samples were taken from 828 cattle from 305 farms between October and December 2017. Evidence of Theileria parva infection was assessed by antibody level, measured using a polymorphic immunodominant molecule (PIM) antigen-based enzyme-linked immunosorbent assay (ELISA) and by a T. parva-specific p104 gene-based nested PCR. Antibodies against Theileria mutans infection were detected using the 32-kDa antigen-based indirect ELISA, while the 200-kDa antigen and the major surface protein 5 (MSP5)-based indirect ELISA were used to detect antibodies against Babesia bigemina and Anaplasma marginale, respectively. Results The prevalence of T. parva across the ten communes sampled ranged from 77.5 to 93.1% and from 67.8 to 90.0% based on the ELISA and PCR analysis, respectively. A statistically significant difference in infection was observed between calves and adult cattle; however, T. parva infection levels were not significantly associated with sex and breed. The seroprevalence indicating exposure to T. mutans, B. bigemina and A. marginale ranged from 30 to 92.1%, 33.7 to 90% and 50 to 96.2%, respectively. Mixed infections of TBPs were detected in 82.91% of cattle sampled, with 11 different combinations of pathogen species detected . Conclusions The findings indicate that T. parva, A. marginale and B. bigemina infections are endemic in Burundi. Knowledge of the spatial distribution of TBPs will facilitate the design of effective targeted strategies to control these diseases. There is a need for further investigations of the distribution of tick vectors and the population structure of TBPs in order to identify the key epidemiological factors contributing to TBD outbreaks in Burundi.

Summary: Systemic antineoplastic treatment agents represent one of the fastest developing medical fields. Oncological treatment is becoming increasingly individualized and new targets with corresponding agents, are constantly being developed. In tandem with this progress, new combinations and algorithms have evolved and patient’s outcome have improved. Expanding tumors rely on a growing neovascular network to maintain their increased metabolism, which is caused by an accelerated reproduction rate. Accordingly, interrupting this supply mechanism is a major component of antineoplastic pharmaceutics and is a hallmark of cancer treatment. With advances in cancer treatment, long-term side effects have become an important consideration, especially in cases of neoplasia in young patients. While neuropathy and cardiotoxicity are well documented, vascular adverse events remain poorly understood. The mutual risk factors, like smoking and increased age, complicate the association between the vascular pathology and the earlier antineoplastic therapy. A deeper understanding of the effects of chemotherapy on peripheral arterial disease could lead to more detailed pathophysiological insight into both maladies and to new treatment options.

BackgroundThe most common type of monogenic diabetes is maturity-onset diabetes of the young (MODY), a clinically and genetically heterogeneous group of endocrine disorders that affect 1–5% of all patients with diabetes mellitus. MODY is characterized by autosomal dominant inheritance but de novo mutations have been reported. Clinical features of MODY include young-onset hyperglycemia, evidence of residual pancreatic function, and lack of beta cell autoimmunity or insulin resistance. Glucose-lowering medications are the main treatment options for MODY. The growing recognition of the clinical and public health significance of MODY by clinicians, researchers, and governments may lead to improved screening and diagnostic practices. Consequently, this review article aims to discuss the epidemiology, pathogenesis, diagnosis, and treatment of MODY based on relevant literature published from 1975 to 2020.Main bodyThe estimated prevalence of MODY from European cohorts is 1 per 10,000 in adults and 1 per 23,000 in children. Since little is known about the prevalence of MODY in African, Asian, South American, and Middle Eastern populations, further research in non-European cohorts is needed to help elucidate MODY’s exact prevalence. Currently, 14 distinct subtypes of MODY can be diagnosed through clinical assessment and genetic analysis. Various genetic mutations and disease mechanisms contribute to the pathogenesis of MODY. Management of MODY is subtype-specific and includes diet, oral antidiabetic drugs, or insulin.ConclusionsIncidence and prevalence estimates for MODY are derived from epidemiologic studies of young people with diabetes who live in Europe, Australia, and North America. Mechanisms involved in the pathogenesis of MODY include defective transcriptional regulation, abnormal metabolic enzymes, protein misfolding, dysfunctional ion channels, or impaired signal transduction. Clinicians should understand the epidemiology and pathogenesis of MODY because such knowledge is crucial for accurate diagnosis, individualized patient management, and screening of family members.

Background Sacred lotus (Nelumbo nucifera) is a vital perennial aquatic ornamental plant. Its flower shape determines the horticultural and ornamental values. However, the mechanisms underlying lotus flower development are still elusive. MADS-box transcription factors are crucial in various features of plant development, especially in floral organogenesis and specification. It is still unknown how the MADS-box transcription factors regulate the floral organogenesis in lotus. Results To obtain a comprehensive insight into the functions of MADS-box genes in sacred lotus flower development, we systematically characterized members of this gene family based on the available genome information. A total of 44 MADS-box genes were identified, of which 16 type I and 28 type II genes were categorized based on the phylogenetic analysis. Furthermore, the structure of MADS-box genes and their expressional patterns were also systematically analyzed. Additionally, subcellular localization analysis showed that they are mainly localized in the nucleus, of which a SEPALLATA3 (SEP3) homolog NnMADS14 was proven to be involved in the floral organogenesis. Conclusion These results provide some fundamental information about the MADS-box gene family and their functions, which might be helpful in not only understanding the mechanisms of floral organogenesis but also breeding of high ornamental value cultivars in lotus.

Background HIV remains the largest cause of disease burden among men and women of reproductive age in sub-Saharan Africa. Voluntary medical male circumcision (VMMC) reduces the risk of female-to-male transmission of HIV by 50–60%. The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries for VMMC campaigns and set a coverage goal of 80% for men ages 15–49. From 2008 to 2017, over 18 million VMMCs were reported in priority countries. Nonetheless, relatively little is known about local variation in male circumcision (MC) prevalence. Methods We analyzed geo-located MC prevalence data from 109 household surveys using a Bayesian geostatistical modeling framework to estimate adult MC prevalence and the number of circumcised and uncircumcised men aged 15–49 in 38 countries in sub-Saharan Africa at a 5 × 5-km resolution and among first administrative level (typically provinces or states) and second administrative level (typically districts or counties) units. Results We found striking within-country and between-country variation in MC prevalence; most (12 of 14) priority countries had more than a twofold difference between their first administrative level units with the highest and lowest estimated prevalence in 2017. Although estimated national MC prevalence increased in all priority countries with the onset of VMMC campaigns, seven priority countries contained both subnational areas where estimated MC prevalence increased and areas where estimated MC prevalence decreased after the initiation of VMMC campaigns. In 2017, only three priority countries (Ethiopia, Kenya, and Tanzania) were likely to have reached the MC coverage target of 80% at the national level, and no priority country was likely to have reached this goal in all subnational areas. Conclusions Despite MC prevalence increases in all priority countries since the onset of VMMC campaigns in 2008, MC prevalence remains below the 80% coverage target in most subnational areas and is highly variable. These mapped results provide an actionable tool for understanding local needs and informing VMMC interventions for maximum impact in the continued effort towards ending the HIV epidemic in sub-Saharan Africa.

Teenage pregnancy can have adverse social and health outcomes, and rates are high in Flint, Michigan as compared to the rest of the state and the USA. It is important to understand contributing factors to adolescent pregnancy to be able to better address this issue. This study examined qualitative data from interviews with 100 community members who participated in the Flint Women's Study, a study designed to better understand the hopes, dreams and needs of women in Flint, and their suggestions for how to address identified needs. Using a Community Based Participatory Approach, data were collected and analysed by a team of community members and academic researchers. The paper focuses on the theme of family planning among young women which included attitudes about contraception, sexuality education and bio-medical and structural barriers to accessing reproductive health. Community members emphasised the need for increased access to comprehensive contraception options, improved sexuality education in schools and from health care providers, and ultimately valuing young women.

Compliance with cardiac performance measures for guideline-directed medical therapy remains suboptimal. There is a compelling need to identify modifiable factors that influence compliance rates, so that these factors can be addressed as targets of quality improvement. This study examines the relationship between cardiovascular provider experience and compliance with performance measures for outpatients with coronary artery disease (CAD), heart failure, and atrial fibrillation in the PINNACLE Registry. We hypothesize that providers who have been practicing longer, especially those further out from certification who may not be required to recertify, will have lower compliance rates with key cardiac performance measures. Using clinical data from January 1, 2013 to March 31, 2014 in the PINNACLE Registry, we employed a multilevel hierarchical logistic regression analysis to examine the relationship between cardiac performance measures and provider experience, defined by the number of years since initial cardiology board certification (

Gibberellins (GAs) mediated elongation growth and its associated proteomics in rice is relevant to crop productivity in many diversified ecological conditions. There is dearth of precise investigations conducted on proteome dynamics involved in leaf sheath elongation in both wild and mutant rice plants in response to GAs treatments. To explore the molecular mechanism of GA-induced leaf sheath elongation in rice, we conducted a comparative proteomics analysis of wild type rice and a GA biosynthesis deficient mutant osko2. The mutant displayed an obvious dwarfism phenotype, which could be dramatically rescued by application of exogenous GA3. The average levels of GAs in the dwarf mutant plants were lower than the wild type of rice. The proteomic analysis showed a total of 6352 proteins that were quantified, among which 688 differentially expressed proteins were identified as GA-responsive. The biological process classification indicated that metabolic process, cellular process and single-organism process related proteins were the dominant protein groups, and the differentially expressed proteins were largely located in chloroplast, cytoplasm, and nucleus and extracellular. Furthermore, these proteins were mainly involved in cell elongation, signal transduction, photosynthesis, and carbohydrate and protein metabolism. These results suggested that proteins involved in cell elongation, signal transduction and carbohydrate metabolism are regulated by GA in rice leaf-sheath growth.

During seed germination, cells embark on extensive post-transcriptional and post-translational modifications (PTM), providing a perfect platform to study these events in embryo rebooting from relative quiescenct to highly active state. PR-619, a deubiquitylase inhibitor, delayed the rice seed germination and resulted in the accumulation of ubiquitylated proteins, which indicated the protein ubiquitylation is involved in this process. Using the K-Ɛ-GG antibody enrichment method integrated with high-resolution mass spectrometry, a list of 2576 lysine ubiquitylated (Kub) sites in 1171 proteins was compiled for rice embryos at 0, 12 and 24 h after imbibition (HAI). Of these, the abundance of 1419 Kub sites in 777 proteins changed significantly. Most of them substantially increased within the first 12 HAI, which is similar to the dynamic state previously observed for protein phosphorylation, implying that the first 12 HAI are essential for subsequent switch during rice seed germination. We also quantitatively analyzed the embryo proteome in these samples. Generally, a specific protein's abundance in the ubiquitylome was uncorrelated to that in the proteome. The differentially ubiquitinated proteins were greatly enriched in the categories of protein processing, DNA and RNA processing/regulation related, signaling, and transport. The DiGly footprint of the Kub sites was significantly reduced on K48, a linkage typically associated with proteasome-mediated degradation. These observations suggest ubiquitylation may modulate the protein function more than providing 26S degradation signals in the early stage of rice seed germination. Revealing this comprehensive ubiquitylome greatly increases our understanding of this critical PTM during seed germination.

As demographic shifts are occurring in many urban cities in the USA, human service organisations (HSOs) are challenged to provide services conducive to the local region’s demographic profile. In order to create urban societies where immigrant populations can thrive, prosper and become productive citizens, it is important to understand the human service landscape of the region. As part of a larger community-based participatory research project, this study explores human services geared towards the New American population in a midwestern region of the USA. This includes human service access and utilisation, as well as barriers and facilitators of human service provision and delivery, among the growing New American population. Based on the responses received from a web-based survey, in-depth interviews and focus group discussions, this study (N = 165) uses a human service equity lens to situate HSOs and community capacity at the centre of migration and human service research. Knowledge gained from this study will help promote improved service delivery systems; address the quality of direct services; and improve accessibility, accountability and service coordination among HSOs to serve the diverse New American population, which can be replicated to many other similar urban regions across the globe.

Background There is a global emphasis on engaging community health volunteers (CHVs) in low- to middle-income countries (LMICs) to reach to the vast underserved populations that live in rural areas. Retention of CHVs in most countries has however been difficult and turnover in many settings has been reported to be high with profound negative effects on continuity of community health services. In rural Kenya, high attrition among CHVs remains a concern. Understanding challenges faced by CHVs in rural settings and how to reduce attrition rates with sustainable income-generating activities (IGAs) is key to informing the implementation of contextual measures that can minimise high turnover. This paper presents findings on the challenges of volunteerism in community health and the preferred IGAs in rural Kilifi county, Kenya. Methods The study employed qualitative methods. We conducted 8 key informant interviews (KIIs) with a variety of stakeholders and 10 focus group discussions (FGDs) with CHVs. NVIVO software was used to organise and analyse our data thematically. Results Community Health Volunteers work is not remunerated and it conflicts with their economic activities, child care and other community expectations. In addition, lack of supervision, work plans and relevant training is a barrier to delivering CHVs’ work to the communities. There is a need to remunerate CHVs work as well as provide support in the form of basic training and capital on entrepreneurship to implement the identified income generating activities such as farming and events management. Conclusions Strategies to support the livelihoods of CHVs through context relevant income generating activities should be identified and co-developed by the ministry of health and other stakeholders in consultation with the CHVs.

Background:Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers.Objective:To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders.Our approach:Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries.Results:There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production.Conclusions:There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.

Introduction Post‐abortion clinics located in regions with high HIV burden may ideal locations to integrate counselling and delivery of HIV pre‐exposure prophylaxis (PrEP), aligning with normative goals for integrated delivery of HIV and reproductive health care. The objective of this study was to gauge the degree to which Kenyan women seeking care for a pregnancy loss, including induced abortion, are at risk for HIV and whether women would welcome an introduction to PrEP prior to discharge from post‐abortion care. Methods We conducted a mixed‐methods study from August 2019 to February 2020 with women ages 15 to 30 recruited sequentially as they were accessing post‐abortion care at public and private facilities in Thika and Kisumu, Kenya. Data collection was through a cross‐sectional survey and laboratory testing for common sexually transmitted infections (N = 200), and in‐depth interviews (N = 30). Descriptive statistics summarize PrEP knowledge and referrals and a multivariable log‐link binomial model estimated correlates of receiving a referral for PrEP. Qualitative data were analysed using inductive and deductive approaches. Results Among 200 HIV‐negative women (median age 21.0, interquartile range 19.0 to 22.0), the prevalence of Chlamydia trachomatis was 18.2% and Neisseria gonorrhoeae was 2.0%. Half of the women scored ≥5 on a validated tool that would correspond to an expected HIV incidence of 9.5% per year. Approximately half (55.8%) of women were familiar with PrEP prior to the study and 33.3% received a referral from study staff to a clinic offering PrEP. In qualitative interviews, women expressed interest in accessing PrEP from the gynaecology ward that provided post‐abortion care but they preferred alternative locations for PrEP refills. Conclusions Kenyan women accessing post‐abortion care have substantial HIV risk and were favourable about the idea of receiving support to initiate PrEP as part of care offered during post‐abortion care. These settings can be integrated into national PrEP programmes as locations providing PrEP referrals and initiation.

Those caring for patient-prisoners experience distinct challenges that may impede effective treatment. Previous studies have investigated these issues from the perspective of forensic or correctional nurses, yet overlooked the lived experiences of nurses based in public health hospitals caring for patient-prisoners. In this study, semi-structured interviews were conducted with five nurses caring for patient-prisoners in public hospitals in Kenya. Interviews were analysed using interpretative phenomenological analysis. Four superordinate themes were identified: fear of patient-prisoner, time constraint, labelling, and optimism on recidivism. The fear of patient-prisoner theme included two sub-themes: perceived dangerousness and communication hindrance. The time constraint theme included three sub-themes: workload, short hospital stay, and task-oriented system. The labelling theme contained the loss of individual identity and representative of a group of sub-themes. Optimism on recidivism involved two sub-themes: reformation and rebuilding one’s life. Future research should investigate the extent to which these impact on the patient-prisoner experience.

HIV/AIDS is a leading cause of disease burden in sub-Saharan Africa. Existing evidence has demonstrated that there is substantial local variation in the prevalence of HIV; however, subnational variation has not been investigated at a high spatial resolution across the continent. Here we explore within-country variation at a 5 × 5-km resolution in sub-Saharan Africa by estimating the prevalence of HIV among adults (aged 15–49 years) and the corresponding number of people living with HIV from 2000 to 2017. Our analysis reveals substantial within-country variation in the prevalence of HIV throughout sub-Saharan Africa and local differences in both the direction and rate of change in HIV prevalence between 2000 and 2017, highlighting the degree to which important local differences are masked when examining trends at the country level. These fine-scale estimates of HIV prevalence across space and time provide an important tool for precisely targeting the interventions that are necessary to bringing HIV infections under control in sub-Saharan Africa., Fine-scale estimates of the prevalence of HIV in adults across sub-Saharan Africa reveal substantial within-country variation and local differences in both the direction and rate of change in the prevalence of HIV between 2000 and 2017.

Background While international students form an increasing population of higher education students in Turkey, there is limited empirical evidence about their health services utilization. The study aim was to investigate healthcare access among a group of international students studying in Ankara city and identify potential barriers that affect full healthcare utilization. Method A total of 535 international students from 83 countries completed an online-based questionnaire. The survey was conducted from September until October 2020. Variables between groups within the study sample were compared using ANOVA and Chi-square tests (with Fisher’s exact test). Logistic regression analysis was used to evaluate the relationships between variables related to access to health services. Results Of the study population, 80.6% accessed the general practitioner (GP), 40% accessed the student health centres, and 11.4% were admitted to the hospital at least once. About 80% of international students reported changing their views to access healthcare more because of the COVID-19 pandemic. Conclusion Lack of awareness of healthcare support systems, perceived stigma associated with mental health services, and language barriers were the main barriers affecting healthcare access by international students. Implications Study findings indicate the need for education of international students on available healthcare, targeted health promotion, and training of health providers on effective communication.

Background Although the high burden of both active smoking and human immunodeficiency virus (HIV) is clearly known, the relationship between them is still not well characterized. Therefore, we estimated the global prevalence of active smoking in people living with HIV (PLHIV) on antiretroviral therapy (ART) and investigated the association between exposure to active smoking and risk for suboptimal adherence to ART. Main text: We searched PubMed, Embase, and Web of Science to identify articles published until September 19, 2019. Eligible studies reported the prevalence of active smoking in PLHIV on ART or investigated the association between active smoking and ART adherence; or enough data to compute these estimates. We used a random-effects model to pool data and quantified heterogeneity (I2). The global prevalence of active smoking was 36.1% (95% CI: 33.7–37.2; 329 prevalence data; 462 104 participants) with substantial heterogeneity. The prevalence increased with level of country income; from 10.1% (95% CI: 6.8–14.1) in low-income to 45.2% (95% CI: 42.7–47.7) in high-income countries; P CI: 7.8–14.0) and West and Central Africa 4.4% (2.9–6.3); P CI: 1.37–1.80; I2 = 56.8%; 19 studies; 48 450 participants); even after considering adjusted estimates: 1.67 (95% CI: 1.39–2.01; I2 = 53.0%; 14 studies). Conclusions This study suggests a high prevalence of active smoking in PLHIV on ART and an association between active smoking and ART suboptimal adherence. As such, healthcare providers and policy makers should focus on adopting and implementing tobacco harm reduction strategies in HIV care, especially in sub-Saharan Africa known as epicenter of HIV pandemic with highest number of active tobacco smoking among PLHIV on ART.

Background In a recent study using DNA barcoding, we identified the plants fed upon by four Afro-tropical mosquito species that vector dengue, malaria, and Rift Valley fever. Herein, we have expanded on this study by investigating the role of three of the plants, Pithecellobium dulce (Fabaceae), Leonotis nepetifolia (Lamiaceae), and Opuntia ficus-indica (Cactaceae), on the survival, fecundity, and egg viability of the dengue vector Aedes aegypti. Methods We tested these effects using females that received (i) an initial three rations of blood meals and (ii) no blood meal at all. Two controls were included: age-matched females fed on glucose solution with or without an initial blood meal and those fed exclusively on blood meals. Data were collected daily over a 30-day period. The amino acid contents of Ae. aegypti guts and their respective diets were detected by coupled liquid chromatography-mass spectrometry. Results Females fed on P. dulce and an exclusively blood meal diet had a shorter survival than those fed on glucose. On the other hand, females fed on L. nepetifolia survived longer than those fed exclusively on blood meals, whereas those fed on O. ficus-indica had the shortest survival time. With an initial blood meal, females fed on L. nepetifolia laid 1.6-fold more eggs while those fed on the other diets laid fewer eggs compared to those fed exclusively on blood meals. Hatching rates of the eggs laid varied with the diet. Mass spectroscopic analysis of gut contents of mosquitoes exposed to the different diets showed qualitative and quantitative differences in their amino acid levels. Conclusion Our findings highlight the central role of plant nutrients in the reproductive fitness of dengue vectors, which may impact their disease transmission potential. Graphical Abstract

Background: Kenya has made a policy decision to use contributory health insurance as one of its key pre-payment health financing mechanisms. The National Hospital Insurance Fund (NHIF) is the main health insurer in Kenya. While the NHIF has hitherto focused its efforts on providing health insurance coverage to individuals in the formal sector, it has recently broadened its focus to include individuals in the informal sector. This paper provides an analysis of the perceptions, and experiences of informal sector individuals in Kenya with regard to enrolment with the NHIF. Methods: We collected data through key informant interviews (39) in two purposefully selected counties. Study participants were drawn from healthcare facilities contracted by the NHIF, and current, former, and prospective informal sector members. We analyzed data using a grounded approach. Results: Participants felt that the NHIF provided inadequate information about the registration and membership processes as well as benefit entitlements. There was variable and inconsistent communication by the NHIF. There was also variance between the official benefit package and the actual benefits received by members. The NHIF registration requirements and processes presented an administrative barrier to obtaining membership. The NHIF premium level and contribution mechanism presents a financial barrier to current and prospective members. Healthcare providers discriminated against NHIF members compared to cash-payers or private insurance holders. Conclusions: The NHIF could improve enrolment and retention of informal sector individuals by; 1) using communication strategies that are effective at reaching the informal sector, 2) improving the affordability of the premium rates, 3) simplifying the enrolment requirements and process, and 4) strengthening accountability mechanisms between itself and healthcare facilities to ensure that enrolled members receive the benefits that they are entitled to, and that client experience at healthcare facilities are satisfactory.

CONSTANS-LIKE 5 of Nelumbo nucifera is capable of promoting potato tuberization through CONSTANS-FLOWERING LOCUS T and gibberellin signaling pathways with a probable association with lotus rhizome enlargement. Lotus (Nelumbo nucifera) is an aquatic plant that is affiliated to the Nelumbonaceace family. It is widely used as an ornamental, vegetable, and medicinal herb with its rhizome being a popular vegetable. To explore the molecular mechanism underlying its rhizome enlargement, we conducted a systematic analysis on the CONSTANS-LIKE (COL) gene family, with the results, indicating that this gene plays a role in regulating potato tuber expansion. These analyses included phylogenetic relationships, gene structure, and expressional patterns of lotus COL family genes. Based on these analyses, NnCOL5 was selected for further study on its potential function in lotus rhizome formation. NnCOL5 was shown to be located in the nucleus, and its expression was positively associated with the enlargement of lotus rhizome. Besides, the overexpression of NnCOL5 in potato led to increased tuber weight and starch content under short-day conditions without changing the number of tubers. Further analysis suggested that the observed tuber changes might be mediated by affecting the expression of genes in CO–FT and GA signaling pathways. These results provide valuable insight in understanding the functions of COL gene as well as the enlargement of lotus rhizome.

Background Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. Methods A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. Results The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. Conclusions Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.

Post-translational modifications (PTMs) of proteins enable modulation of their structure, function, localization and turnover. To date, over 660 PTMs have been reported, among which, reversible PTMs are regarded as the key players in cellular signaling. Signaling mediated by PTMs is faster than re-initiation of gene expression, which may result in a faster response that is particularly crucial for plants due to their sessile nature. Ubiquitylation has been widely reported to be involved in many aspects of plant growth and development and it is largely determined by its target protein. It is therefore of high interest to explore new ubiquitylated proteins/sites to obtain new insights into its mechanism and functions. In the last decades, extensive protein profiling of ubiquitylation has been achieved in different plants due to the advancement in ubiquitylated proteins (or peptides) affinity and mass spectrometry techniques. This obtained information on a large number of ubiquitylated proteins/sites helps crack the mechanism of ubiquitylation in plants. In this review, we have summarized the latest advances in protein ubiquitylation to gain comprehensive and updated knowledge in this field. Besides, the current and future challenges and barriers are also reviewed and discussed.

Busseola fusca (Fuller) (Lepidoptera: Noctuidae), the maize stalk borer, is a widespread crop pest in sub-Saharan Africa that has been the focus of biological research and intensive management strategies. Here, we present a comprehensive annotated transcriptome of B. fusca (originally collected in the Western Province of Kenya) based on ten pooled libraries including a wide array of developmental stages, tissue types, and exposures to parasitoid wasps. Parasitoid wasps have been used as a form of biocontrol to try and reduce crop losses with variable success, in part due to differential infectivities and immune responses among wasps and hosts. We identified a number of loci of interest for pest management, including genes potentially involved in chemoreception, immunity, and response to insecticides. The comprehensive sampling design used expands our current understanding of the transcriptome of this species and deepens the list of potential target genes for future crop loss mitigation, in addition to highlighting candidate loci for differential expression and functional genetic analyses in this important pest species.

The prevalence of substance use among the foreign-born has gained increasing attention. Cumulative migration stressors - including historical trauma, violence, family separation, and poverty - present challenges to human service systems wherein services may not adequately meet the needs of these groups.

Background Although the baby-friendly community initiative (BFCI) has been proposed as a community-level approach to improve infant feeding practices, there is little data on its variation in effectiveness by HIV status. We conducted a study to determine the effectiveness of BFCI in changing knowledge and attitudes towards exclusive breastfeeding (EBF) and increasing the rates among HIV negative and HIV positive women in rural Kenya. Methods A community-based cluster-randomized controlled trial was implemented from April 2015 to December 2016 among 901 women enrolled across 13 clusters. The intervention groups received a minimum of 12 personalized home-based counselling sessions on infant feeding by trained community health volunteers from their first or second trimester of pregnancy until 6 months postpartum. Other interventions included education sessions at maternal child clinics, mother-to-mother support group meetings and bi-monthly baby-friendly gatherings targeting influencers. The control group received standard health education at the facility and during monthly routine home visits by community health volunteers not trained on BFCI. Primary outcome measures were the rates of EBF at week 1, months 2, 4 and 6 postpartum. Secondary outcomes included knowledge and attitudes regarding breastfeeding for HIV-exposed infants. Statistical methods included analysis of covariance and logistic regression. Results At 6 months, EBF rates among HIV negative mothers were significantly higher in the BFCI intervention arm compared to the control arm (81.7% versus 42.2% p = 0.001). HIV positive mothers in the intervention arm had higher EBF rates at 6 months than the control but the difference was not statistically significant (81.8% versus 58.4%; p = 0.504). In HIV negative group, there was greater knowledge regarding EBF for HIV-exposed infants in the intervention arm than in the control (92.1% versus 60.7% p = 0.001). Among HIV positive mothers, such knowledge was high among both the intervention and control groups (96% versus 100%, p > 0.1). HIV negative and positive mothers in the intervention arm had more favourable attitudes regarding EBF for HIV-exposed infants than the control (84.5% versus 62.1%, p = 0.001) and (94.6% versus 53.8% to p = 0.001) respectively. Conclusions BFCI interventions can complement facility-based interventions to improve exclusive and continued breastfeeding knowledge, attitudes, and behaviours among HIV negative and positive women.

ObjectivesThe aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods.DesignCross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability.SettingThree deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya).Main outcome measureTypes of foods and beverages sold and/or advertised.ResultsJamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets.ConclusionOur study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action.

Institutionalization of children who are deprived of parental care is a thriving phenomenon in the global South, and has generated considerable concern both nationally and internationally, in the last two decades. In Kenya, the number of children growing up in live-in care institutions has been growing ever since the country&rsquo, s early post-independence years. Although legislative and regulatory measures aimed at child protection have been in place for a number of years now, and the national government appears to be standing by the commitment it expressed in recent times to implement care reform which encompasses de-institutionalization, the national child protection system remains very dependent on institutional care. Against the backdrop of a global and national movement towards de-institutionalization of child care and child protection, in this paper we tease out the range of factors reinforcing Kenya&rsquo, s over-reliance on live-in institutions as a child care and child protection model. Numerous factors&mdash, structural, political, economic, socio-cultural, and legal&mdash, contribute to the complexity of the issue. We highlight this complexity, bringing together different angles, while pointing out the interests of the different stakeholders in reinforcing institutional care. We argue that the sustainability, efficiency and effectiveness of the intended change from institutional care to alternative family-based care requires that a root-cause approach be adopted in addressing the underlying child care and child protection issues.

BackgroundOf the total 56 million deaths worldwide during 2012, 38 million (68%) were due to noncommunicable diseases (NCDs), particularly cardiovascular diseases (17.5 million deaths) cancers (8.2 million) which represents46.2% and 21.7% of NCD deaths, respectively). Nearly 80 percent of the global CVD deaths occur in low- and middle-income countries. Some of the major CVDs such as ischemic heart disease (IHD) and stroke and CVD risk conditions, namely, hypertension and dyslipidaemia share common modifiable risk factors including smoking, unhealthy diets, harmful use of alcohol and physical inactivity. The CVDs are now putting a heavy strain of the health systems at both national and local levels, which have previously largely focused on infectious diseases and appalling maternal and child health. We set out to estimate district-level co-occurrence of two cardiovascular diseases (CVDs), namely, ischemic heart disease (IHD) and stroke; and two major risk conditions for CVD, namely, hypertension and dyslipidaemia in South Africa.MethodThe analyses were based on adults health collected as part of the 2012 South African National Health and Nutrition Examination Survey (SANHANES). We used joint disease mapping models to estimate and map the spatial distributions of risks of hypertension, self-report of ischaemic heart disease (IHD), stroke and dyslipidaemia at the district level in South Africa. The analyses were adjusted for known individual social demographic and lifestyle factors, household and district level poverty measurements using binary spatial models.ResultsThe estimated prevalence of IHD, stroke, hypertension and dyslipidaemia revealed high inequality at the district level (median value (range): 5.4 (0-17.8%); 1.7 (0-18.2%); 32.0 (12.5-48.2%) and 52.2 (0-71.7%), respectively). The adjusted risks of stroke, hypertension and IHD were mostly high in districts in the South-Eastern parts of the country, while that of dyslipidaemia, was high in Central and top North-Eastern corridor of the country.ConclusionsThe study has confirmed common modifiable risk factors of two cardiovascular diseases (CVDs), namely, ischemic heart disease (IHD) and stroke; and two major risk conditions for CVD, namely, hypertension and dyslipidaemia. Accordingly, an integrated intervention approach addressing cardiovascular diseases and associated risk factors and conditions would be more cost effective and provide stronger impacts than individual tailored interventions only. Findings of excess district-level variations in the CVDs and their risk factor profiles might be useful for developing effective public health policies and interventions aimed at reducing behavioural risk factors including harmful use of alcohol, physical inactivity and high salt intake.

Background Estimates of Group B Streptococcus (GBS) disease burden, antimicrobial susceptibility, and serotypes in pregnant women are limited for many resource-limited countries including Kenya. These data are required to inform recommendations for prophylaxis and treatment of infections due to GBS. Methods We evaluated the prevalence, antimicrobial susceptibility patterns, serotypes, and risk factors associated with rectovaginal GBS colonization among pregnant women receiving antenatal care at Kenyatta National Hospital (KNH) between August and November 2017. Consenting pregnant women between 12 and 40 weeks of gestation were enrolled. Interview-administered questionnaires were used to assess risk factors associated with GBS colonization. An anorectal swab and a lower vaginal swab were collected and cultured on Granada agar for GBS isolation. Positive colonies were tested for antimicrobial susceptibility to penicillin G, ampicillin, vancomycin, and clindamycin using the disk diffusion method. Serotyping was performed by latex agglutination. Logistic regression was used to identify factors associated with GBS colonization. Results A total of 292 women were enrolled. Median age was 30 years (Interquartile range {IQR} 26–35) and a median gestational age of 35 weeks (IQR 30–37). Overall GBS was identified in 60/292 (20.5%) of participants. Among the positive isolates, resistance was detected for penicillin G in 42/58 (72.4%) isolates, ampicillin in 32/58 (55.2%) isolates, clindamycin in 14/46 (30.4%) isolates, and vancomycin in 14/58 (24.1%) isolates. All ten GBS serotypes were isolated, and 37/53 (69.8%) of GBS positive participants were colonized by more than one serotype. None of the risk factors was associated with GBS colonization. Conclusion The prevalence of GBS colonization was high among antenatal women at KNH. In addition, a high proportion of GBS isolates were resistant to commonly prescribed intrapartum antibiotics. Hence, other measures like GBS vaccination is a potentially useful approaches to GBS prevention and control in this population. Screening of pregnant mothers for GBS colonization should be introduced and antimicrobial susceptibility test performed on GBS positive samples to guide antibiotic prophylaxis.

In the recent past, surface Electromyography (sEMG) signals has been effectively applied in control interfaces for robots, prosthetic hands, legs and other areas. Few works has focused on neck EMG control in spite of the neck being central to human movements and engagements. We propose a neck EMG model that estimates head movements and apply the signals to control a game developed in Unity 3D engine. The game involves randomly falling and accelerating objects. The user slides the games’ player character (paddle) using neck EMG to intercept as many objects. EMG signal is rectified and FIR filtered and used to control the position of a sliding probe of the game in real-time. The paper utilizes an equation model and a Machine Learning model to translate the filtered signal to corresponding neck rotation. From the results, all the subjects reported accuracy of over 70% which confirm the applicability of the interface and ease of use in that there is little or no calibration needed. The control model using equation showed intuitive direction and speed control while the Machine Learning scheme offered more stable direction control but limited speed control of the sliding paddle. The control interface can be applied in multiple areas that involve neck activity e.g. in rehabilitation as well as gaming interface to enable entertainment for the disabled.

Background Little data exists about the methodology of contextualizing version two of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in resource-poor settings. This paper describes the contextualisation and pilot testing of the guide in Kilifi, Kenya. Methods Contextualisation was conducted as a collaboration between the KEMRI-Wellcome Trust Research Programme (KWTRP) and Kilifi County Government's Department of Health (KCGH) between 2016 and 2018. It adapted a mixed-method design and involved a situational analysis, stakeholder engagement, local adaptation and pilot testing of the adapted guide. Qualitative data were analysed using content analysis to identify key facilitators and barriers to the implementation process. Pre- and post-training scores of the adapted guide were compared using the Wilcoxon signed-rank test. Results Human resource for mental health in Kilifi is strained with limited infrastructure and outdated legislation. Barriers to implementation included few specialists for referral, unreliable drug supply, difficulty in translating the guide to Kiswahili language, lack of clarity of the roles of KWTRP and KCGH in the implementation process and the unwillingness of the biomedical practitioners to collaborate with traditional health practitioners to enhance referrals to hospital. In the adaptation process, stakeholders recommended the exclusion of child and adolescent mental and behavioural problems, as well as dementia modules from the final version of the guide. Pilot testing of the adapted guide showed a significant improvement in the post-training scores: 66.3% (95% CI 62.4–70.8) v. 76.6% (95% CI 71.6–79.2) (p < 0.001). Conclusion The adapted mhGAP-IG version two can be used across coastal Kenya to train primary healthcare providers. However, successful implementation in Kilifi will require a review of new evidence on the burden of disease, improvements in the mental health system and sustained dialogue among stakeholders.

Rhipicephalus appendiculatus is the major tick vector of Theileria parva, an apicomplexan protozoan parasite that causes the most economically important and lethal disease of cattle in East and central Africa. The African cape buffalo (Syncerus caffer) is the major wildlife host of T. parva from southern Uganda and Kenya to southern Africa. We show herein that R. appendiculatus appears to be absent from the two largest national parks in northern Uganda. Syncerus caffer is common in both of these national parks, specifically Murchison falls (MFNP) and Kidepo Valley (KVNP). We re-confirmed the previously reported absence of T. parva in buffalo sampled in the two northern parks based on RLB data using a nested PCR based on the T. parva p104 gene. By contrast, T. parva-infected R. appendiculatus ticks and parasite-infected buffalo were present in Lake Mburo (LMNP) in South central Uganda. This suggests that the distribution of R. appendiculatus, which is predicted to include the higher rainfall regions of northern Uganda, may be limited by additional, as yet unknown factors.

Background Flower morphology, a phenomenon regulated by a complex network, is one of the vital ornamental features in Nelumbo nucifera. Stamen petaloid is very prevalent in lotus flowers. However, the mechanism underlying this phenomenon is still obscure. Results Here, the comparative transcriptomic analysis was performed among petal, stamen petaloid and stamen through RNA-seq. Using pairwise comparison analysis, a large number of genes involved in hormonal signal transduction pathways and transcription factors, especially the MADS-box genes, were identified as candidate genes for stamen petaloid in lotus. Conclusions Taken together, these results provide an insight into the molecular networks underlying lotus floral organ development and stamen petaloid. Electronic supplementary material The online version of this article (10.1186/s12864-018-4950-0) contains supplementary material, which is available to authorized users.

IN BRIEF “Quality Improvement Success Stories” are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a successful effort to improve glycemic control in presurgical patients with an A1C >8%.

Purpose The Child Depression Inventory (CDI) is a commonly used measure of depression among youth and has been used in studies conducted in sub-Saharan Africa demonstrating positive effects of financial asset-building interventions on physical and mental health outcomes. However, before we can be certain that asset building does indeed improve mental health functioning, we must first be sure that the instruments used to measure mental health in this population are valid and culturally appropriate. Methods This two-part study used baseline data from a sample of youth (N = 1,348, 13–18 years) participating in the YouthSave-Impact Study Kenya to clarify the psychometric properties of the 10-item CDI (study A), and then used the 10-item CDI to assess the relationship between financial assets and mental health functioning among this sample of adolescents (study B). Results Factor analysis on the 10-item CDI indicated a one-factor eight-item measure with excellent model fit. Invariance testing indicated that the measure performed differently for male and female respondents. Finally, using the latent structure as the dependent variable, the second part of the analysis established that cash savings were associated with depression. Female and male adolescents with savings reported lower depression (female β = −.17, p ≤ .003; male β = −.12, p ≤ .020) than other youth. Conclusion This study identified a reasonable one-factor eight-item depression measure that was noninvariant across gender. This validated measure was used to confirm the association between financial assets and mental health outcomes, hence, supporting the hypothesis that financial assets are associated with mental health outcomes.

Spectroscopic techniques utilizing FTIR, 1 H and 13 C NMR spectral fingerprints of the neat oils, as well as standard titrimetric and GC–MS analyses were all employed to determine the quality parameters and fatty acid (FA) profiles for Soxhlet-extracted seed oils of four indigenous plants from Botswana: Tylosema esculentum (morama), Schinziophyton rautanenii (mungongo), Citrullus lanatus (kgengwe) and Bauhinia petersiana (mogose). The physicochemical parameters and FA composition obtained from spectroscopic methods were found to be similar to those obtained from classical procedures indicating that oil quality parameters can reliably be obtained from spectroscopic data. The FA analysis showed the presence of 73–84% unsaturated FAs in the four seed oils. In addition, spectroscopic data clearly established the presence of the uncommon tri-unsaturated FA, α -eleostearic acid ( α -ESA) in mungongo seed oil which was quantified as 25% by 13 C NMR. Generally, the high levels of unsaturated FAs in the oils indicate their suitability in health food supplements. Industrial relevance The four plants studied are highly treasured in the areas where they grow due to the fact that they have for centuries provided food security, and means of livelihood for populations living in the Kalahari Desert and other marginal regions of the southern Africa region. Currently, there is a drive to add value to such often underutilized plants to aid in poverty alleviation by processing and marketing the products as healthy food supplements or cosmetic formulations. To this end, reliable methods for characterization and comparison of the FA composition of the seed oils from different geographical locations is required. The development of rapid, non-destructive spectroscopic techniques that can be applied directly on the neat oils is therefore an important venture.

There was concern that the COVID-19 pandemic would adversely affect TB and HIV programme services in Kenya. We set up real-time monthly surveillance of TB and HIV activities in 18 health facilities in Nairobi so that interventions could be implemented to counteract anticipated declining trends. Aggregate data were collected and reported monthly to programme heads during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data collected during the pre-COVID period (March 2019–February 2020). During the COVID-19 period, there was an overall decrease in people with presumptive pulmonary TB (31.2%), diagnosed and registered with TB (28.0%) and in those tested for HIV (50.5%). Interventions to improve TB case detection and HIV testing were implemented from August 2020 and were associated with improvements in all parameters during the second six months of the COVID-19 period. During the COVID-19 period, there were small increases in TB treatment success (65.0% to 67.0%) and referral of HIV-positive persons to antiretroviral therapy (91.2% to 92.9%): this was more apparent in the second six months after interventions were implemented. Programmatic interventions were associated with improved case detection and treatment outcomes during the COVID-19 period, suggesting that monthly real-time surveillance is useful during unprecedented events.

Efforts to eliminate mother-to-child transmission of HIV in Tanzania are guided by a four-prong strategy advocated by the World Health Organization (WHO). Prong 2, prevention of unintended pregnancies among women living with HIV, has, however, received the least attention and contraceptive use to prevent unintended pregnancies remains low. This study explored the perceived barriers to the use of modern methods of contraception, and factors influencing contraceptive choice among HIV-positive women in urban Dar-es-Salaam, Tanzania. A qualitative multi-site study was conducted, utilising in-depth interviews and focus group discussions with 37 sexually active HIV-positive women aged between 20 and 44 years, attending three health facilities within Dar-es-Salaam. The theoretical framework was a patient centred model. Four barriers were identified: the influence of the women’s spousal relationships; personal beliefs and the relationship of these in understanding her disease; the influence of the social demands on the woman and her relationships; and the importance of a woman’s relationship with her healthcare provider/healthcare system. Being the bearers of bad news (HIV-positive status) the pregnant women experienced conflicts, violence, abandonment and rejection. The loss in negotiating power for the women was in relation to their intimate partners, but also in the patient–healthcare provider relationship. The role of the male partner as a barrier to contraceptive use cannot be understated. Therefore, the results suggest that healthcare providers should ensure patient-focused education and provide support that encompasses the importance of their relationships. Additional research is required to elucidate the functional association between contraceptive choices and personal and social relationships.Keywords: barriers, influence, modern contraceptive methods, patient centred, perceptions, qualitative research

Background. Globally, family planning services are being strengthened and the range of contraceptive choices expanded. Data on contraceptive coverage and service gaps could help to shape these initiatives. Objective. To assess contraception coverage in South Africa (SA) and identify underserved populations and aspects of programming that require strengthening. Methods. Data from a 2012 SA household survey assessed contraception coverage among 6 296 women aged 15 - 49 years and identified underserved populations. Results. Two-thirds had an unintended pregnancy in the past 5 years, a quarter of which were contraceptive failures. Most knew of injectable (92.0%) and oral contraception (89.9%), but fewer of intrauterine devices (56.1%) and emergency contraception (47.3%). Contraceptive prevalence was 49.1%, and 41.8% women used modern non-barrier methods. About half had ever used injectable contraception. Contraception was lower in black Africans and younger women, who used a limited range of methods. Conclusion. Contraception coverage is higher than many previous estimates. Rates of unintended pregnancy, contraceptive failure and knowledge gaps, however, demonstrate high levels of unmet need, especially among black Africans and young women.

To assess compliance with infection prevention and control practices in primary health care in Kenya.We used an observational, patient-tracking tool to assess compliance with infection prevention and control practices by 1680 health-care workers during outpatient interactions with 14 328 patients at 935 health-care facilities in 2015. Compliance was assessed in five domains: hand hygiene; protective glove use; injections and blood sampling; disinfection of reusable equipment; and waste segregation. We calculated compliance by dividing the number of correct actions performed by the number of indications and evaluated associations between compliance and the health-care worker's and facility's characteristics.Across 106 464 observed indications for an infection prevention and control practice, the mean compliance was 0.318 (95% confidence interval, CI: 0.315 to 0.321). The compliance ranged from 0.023 (95% CI: 0.021 to 0.024) for hand hygiene to 0.871 (95% CI: 0.866 to 0.876) for injection and blood sampling safety. Compliance was weakly associated with the facility's characteristics (e.g. public or private, or level of specialization) and the health-care worker's knowledge of, and training in, infection prevention and control practices.The observational tool was effective for assessing compliance with infection prevention and control practices across multiple domains in primary health care in a low-income country. Compliance varied widely across infection prevention and control domains. The weak associations observed between compliance and the characteristics of health-care workers and facilities, such as knowledge and the availability of supplies, suggest that a broader focus on behavioural change is required.Évaluer le respect des pratiques de prévention et de lutte contre les infections lors d’activités de soins primaires au Kenya.Grâce à un outil observationnel de suivi des patients, nous avons évalué le respect des pratiques de prévention et de lutte contre les infections par 1 680 agents de santé, lors de leurs interactions avec 14 328 patients, pris en charge en consultation externe dans 935 centres de santé en 2015. Le respect de ces pratiques a été évalué dans cinq domaines: hygiène des mains; utilisation de gants de protection; injections et prélèvements sanguins; désinfection des équipements réutilisables et tri des déchets. Nous avons calculé le niveau de respect de ces pratiques en divisant le nombre d'actions correctes par le nombre de cas pour lesquels l'application de ces pratiques était indiquée, et nous avons évalué les liens éventuels entre le respect des bonnes pratiques et les caractéristiques des agents de santé et des centres de santé.Sur les 106 464 cas observés pour lesquels l'application des pratiques de prévention et de lutte contre les infections était indiquée, le respect de ces pratiques a été évalué à un niveau moyen de 0,318 (intervalle de confiance de 95%, IC: 0,315 à 0,321). Le niveau de respect a varié entre 0,023 (IC 95%: 0,021 à 0,024) pour l'hygiène des mains et 0,871 (IC 95%: 0,866 à 0,876) pour la sûreté des injections et des prélèvements. Le niveau de respect de ces pratiques semble peu dépendre des caractéristiques du centre de santé (ex. : établissement public, privé ou niveau de spécialisation) ou des connaissances des pratiques de prévention et de lutte contre les infections par les agents de santé et de leur formation à ces pratiques.L'outil observationnel s'est avéré efficace pour évaluer le niveau de respect des pratiques de prévention et de lutte contre les infections, dans de nombreux domaines liés aux soins de santé primaires, dans un contexte de faibles ressources. Le niveau de respect varie considérablement en fonction du domaine de pratiques considéré. Le lien ténu observé entre le niveau de respect et les caractéristiques des agents de santé ou des centres de santé (connaissances des agents ou disponibilité des fournitures nécessaires, par exemple) suggère que l'accent doit encore être davantage mis sur le changement des comportements.Evaluar el cumplimiento de las prácticas de prevención y control de infecciones en la atención sanitaria primaria en Kenya.Se utilizó una herramienta de observación para el seguimiento de los pacientes con el fin de evaluar el cumplimiento de las prácticas de prevención y control de infecciones por parte de 1 680 trabajadores sanitarios durante interacciones ambulatorias con 14 328 pacientes en 935 centros sanitarios en 2015. El cumplimiento se evaluó en cinco ámbitos: higiene de las manos, uso de guantes protectores, inyecciones y muestras de sangre, desinfección de equipos reutilizables y separación de residuos. Se calculó el cumplimiento dividiendo el número de acciones correctas realizadas entre el número de indicaciones y asociaciones evaluadas entre el cumplimiento, los trabajadores sanitarios y las características de los centros.En 106 464 indicaciones observadas para las prácticas de prevención y control de infecciones, el cumplimiento medio fue de un 0,318 (intervalo de confianza, IC, del 95%: 0,315 a 0,321). El cumplimiento varió de un 0,023 (IC del 95%: 0,021 a 0,024) para la higiene de las manos a un 0,871 (IC del 95%: 0,866 a 0,876) para la seguridad de las inyecciones y las muestras de sangre. El cumplimiento apenas se relacionó con las características del centro (por ejemplo, público o privado, o nivel de especialización) y el conocimiento y la formación del trabajador sanitario en cuanto a prácticas de prevención y control de infecciones.La herramienta de observación fue eficaz para evaluar el cumplimiento de las prácticas de prevención y control de infecciones en varios ámbitos de la atención sanitaria primaria en un país de ingresos bajos. El cumplimiento varió enormemente en los ámbitos de prevención y control de infecciones. Las escasas asociaciones observadas entre el cumplimiento y las características de los trabajadores sanitarios y los centros, como los conocimientos y la disponibilidad de suministros, sugieren que es necesario un mayor enfoque sobre el cambio de comportamiento.تقييم الامتثال لعمليات ممارسة مكافحة العدوى والوقاية منها في الرعاية الصحية الأولية في كينيا.استخدمنا أداة رصدية وتتبعية للمريض لتقييم امتثاله لعمليات ممارسة مكافحة العدوى والوقاية منها من قبل 1680 من العاملين في مجال الرعاية الصحية أثناء التفاعلات الخارجية مع 14,328 مريض في 953 منشأة رعاية صحية في عام 2015. وتم تقييم الامتثال على خمسة محاور: نظافة اليد، واستخدام القفازات الواقية، وعينات الدم والحقن، وتعقيم المواد التي يُعاد استخدامها، وفرز النفايات. وقمنا بحساب الامتثال عن طريق قسمة عدد الإجراءات الصحية التي تم اتخاذها على عدد المؤشرات والجمعيات التي تم تقييمها وفقًا للامتثال والعاملين بالرعاية الصحية وخصائص المنشآت الصحية.عبر 106,464 مؤشر ملحوظ لعملية ممارسة مكافحة العدوى والوقاية منها، كان متوسط الامتثال 0.318 (بنسبة أرجحية مقدارها 95‏%: 0.315 إلى 0.321). وتراوح الامتثال لنظافة اليد ما بين 0.023 (بنسبة أرجحية مقدارها ‏‏95%: 0.021 إلى 0.024) إلى 0.871 (بنسبة أرجحية مقدارها 95‏%: 0.866 إلى 0.876) لسلامة عينات الدم والحقن. ويرتبط الامتثال بشكل ضعيف مع خصائص المنشأة الطبية (على سبيل المثال ما إذا كانت عامة أو خاصة، أو مستوى التخصص) ومعرفة عامل الرعاية الصحية بعمليات ممارسة مكافحة العدوى والوقاية منها وتدريبه على تلك العمليات.كانت الأداة الرصدية فعالة في تقييم الامتثال لعمليات ممارسة مكافحة العدوى والوقاية منها عبر محاور متعددة في الرعاية الصحية الأولية في دولة منخفضة الدخل. وقد اختلف الامتثال بشكل واسع عبر محاور مكافحة العدوى والوقاية منها. وتشير الارتباطات الضعيفة الملحوظة بين الامتثال وخصائص العاملين في الرعاية الصحية والمنشآت الصحية – مثل المعرفة وتوفر المواد – إلى ضرورة وجود تركيز أوسع على التغييرات السلوكية.旨在评估肯尼亚初级卫生护理中感染防控做法的合规性。.2015 年，我们采用观察性患者追踪工具对 935 家卫生护理机构 1680 名卫生保健工作人员在 14 328 名患者门诊会谈中的感染防控做法的合规性进行了评估。我们对五个领域的合规性进行了评估： 手卫生；防护手套的使用；注射和血液样本；可重复使用设备的消毒以及废弃物隔离。 我们通过正确行为数目除以指标数目计算了合规性，同时评估了合规性与卫生护理工作人员和机构特点之间的关联。.在一项感染防控做法的 106 464 个观察指标中，合规率为 0.318（95% 置信区间，CI： 0.315 至 0.321）。 合规率范围包括从手卫生的 0.023（95% CI： 0.021 至 0.024）到感染和血液样本安全性的 0.871（95% CI： 0.866 至 0.876）。 合规性与机构的特点（例如公立或私立，或专业化程度）、卫生护理工作人员有关感染防控做法的知识以及在此方面的培训关联性不大。.观察工具在评估低收入国家多个初级卫生护理领域的感染防控做法的合规性方面卓有成效。 感染防控领域之间的合规性差别很大。 据观察，合规性与卫生护理工作人员和机构的特点（如知识和物资供应）的关联性不大，这表明需要加大对行为变化的关注。.Провести оценку степени соблюдения мероприятий по профилактике и контролю инфекций в первичной медико-санитарной помощи в Кении.Мы использовали инструмент для отслеживания пациентов для оценки степени соблюдения мероприятий по профилактике и контролю инфекций 1680 работниками здравоохранения во время амбулаторного приема 14 328 пациентов в 935 медицинских учреждениях в 2015 году. Степень соблюдения оценивали в пяти областях: гигиена рук, использование защитных перчаток, инъекции и забор крови, дезинфекция многоразового оборудования, сортировка отходов. Мы рассчитали степень соблюдения путем деления количества выполненных правильных действий на количество показаний и провели оценку взаимосвязи между соблюдением и характеристиками работников здравоохранения и медицинских учреждений.В 106 464 наблюдаемых показаниях для мероприятий по профилактике и контролю инфекций среднее значение степени соблюдения составило 0,318 (95%-й доверительный интервал, ДИ: от 0,315 до 0,321). Значения степени соблюдения варьировались от 0,023 (95%-й ДИ: от 0,021 до 0,024) для гигиены рук до 0,871 (95%-й ДИ: от 0,866 до 0,876) для безопасного проведения инъекций и забора крови. Степень соблюдения была слабо связана с характеристиками медицинских учреждений (например, государственные или частные, уровень специализации) и квалификацией работников здравоохранения, а также с обучением по проведению мероприятий по профилактике и контролю инфекций.Инструмент наблюдения был эффективен для оценки степени соблюдения мероприятий по профилактике и контролю инфекций в нескольких областях в первичной медико-санитарной помощи в стране с низким уровнем дохода. Степень соблюдения широко варьируется по областям применения профилактики и контроля инфекций. Слабая взаимосвязь, наблюдаемая между степенью соблюдения и характеристиками работников здравоохранения и медицинских учреждений, таких как квалификация и доступность расходных материалов, позволяет предположить, что требуется обратить более пристальное внимание на изменение поведения.

The process of base excision repair (BER) recognizes and repairs small lesions or inappropriate bases on DNA through either a short-patch or long-patch pathway. The enzymes involved in BER have been well-characterized on DNA substrates and, somewhat surprisingly, many of these enzymes, including several DNA glycosylases, AP endonuclease (APE), FEN1 endonuclease, and DNA ligases have been shown to have activity on DNA substrates within nucleosomes. DNA polymerase β (Pol β), however, exhibits drastically reduced or no activity on nucleosomal DNA. Interestingly, acetylation of Pol β, by the acetyltransferase, p300, inhibits its 5′ dRP-lyase activity and presumably pushes repair of DNA substrates through the long patch base excision repair (LP-BER) pathway. In addition to the major enzymes involved in BER, a chromatin architectural factor, HMGB1, was found to directly interact with and enhance the activity of APE1 and FEN1, and thus may aid in altering the structure of the nucleosome to be more accessible to BER factors. In this work, we investigated whether acetylation of Pol β, either alone or in conjunction with HMGB1, facilitates its activity on nucleosome substrates. We find acetylated Pol β exhibits enhanced strand displacement synthesis activity on DNA substrates, but, similar to the unmodified enzyme, has little or no activity on nucleosomes. Preincubation of DNA templates with HMGB1 has little or no stimulatory effect on Pol β and even is inhibitory at higher concentrations. In contrast, pre-incubation of nucleosomes with HMGB1 rescues Pol β gap-filling activity in nucleosomes, suggesting that this factor may help overcome the repressive effects of chromatin.

In modern pathology, optical microscopy plays an important role in disease diagnosis by revealing microscopic structures of clinical specimens. However, the fundamental physical diffraction limit prevents interrogation of nanoscale anatomy and subtle pathological changes when using conventional optical imaging approaches. Here, we describe a simple and inexpensive protocol, called expansion pathology (ExPath), for nanoscale optical imaging of common types of clinical primary tissue specimens, including both fixed-frozen or formalin-fixed paraffin embedded (FFPE) tissue sections. This method circumvents the optical diffraction limit by chemically transforming the tissue samples into tissue-hydrogel hybrid and physically expanding them isotropically across multiple scales in pure water. Due to expansion, previously unresolvable molecules are separated and thus can be observed using a conventional optical microscope.

Background Hepatitis B Virus (HBV) is highly endemic in Sub-Saharan Africa with 70 to 90% of the population becoming infected before the age of 40 years. Healthcare workers (HCWs) including healthcare students (HCSs) are at an increased risk of contracting HBV due to occupational exposure. HCSs are especially at a high risk because of their inexperience with infection control procedures and insufficient knowledge about the level of risk when dealing with patients. Despite the availability of an effective vaccine, and its recommendation by Kenya’s Ministry of Health, few HCW and students are vaccinated. The aim of this study was to evaluate the influence of awareness, attitude, practices, and access factors on hepatitis B vaccination uptake by HCSs at Kenya Medical Training College (KMTC). Methods This was a concurrent mixed methods study. For the quantitative arm, a structured questionnaire was used to assess the awareness, knowledge, attitudes and practices towards HBV disease and vaccination. Accessibility of the HBV vaccine in the participating campuses was also assessed. Two FGDs were carried out: one comprised of student representatives of the participating campuses while the second comprised of members of staff. Quantitative data was analysed using STATA (version 15) while NVIVO (version 11) was used for qualitative data. Results Out of 634 students invited to participate in the study, 487 participated (response rate 76.8%). Majority of the respondents were from Nairobi Campus (44.2%) and from the Department of Nursing (31.2%). HBV vaccine uptake rate was 85.8% while the non-vaccination rate was 14.3%. Full vaccination was reported by only 20.2% of respondents. The major reason for not receiving the recommended doses was the unavailability of the vaccine when students went for it. The qualitative study revealed challenges in the implementation of the vaccination program at KMTC. Conclusions Full vaccination rates remained low despite good knowledge of HBV infection and positive attitude towards vaccination. There is therefore need to streamline vaccination programs in medical colleges to ensure availability and accessibility of the vaccine to healthcare students.

Background: To optimally allocate limited health resources in responding to the HIV epidemic, South Africa has undertaken to generate local epidemiological profiles identifying high disease burden areas. Central to achieving this, is the need for readily available quality health data linked to both large and small geographic areas. South Africa has relied on national population-based surveys: the Household HIV Survey and the National Antenatal Sentinel HIV and Syphilis Prevalence Survey (ANC) amongst others for such data for informing policy decisions. However, these surveys are conducted approximately every 2 and 3 years creating a gap in data and evidence required for policy. At subnational levels, timely decisions are required with frequent course corrections in the interim. Routinely collected HIV testing data at public health facilities have the potential to provide this much needed information, as a proxy measure of HIV prevalence in the population, when survey data is not available. The South African District health information system (DHIS) contains aggregated routine health data from public health facilities which is used in this article. Methods: Using spatial interpolation methods we combine three “types” of data: (1) 2015 gridded high-resolution population data, (2) age-structure data as defined in South Africa mid-year population estimates, 2015; and (3) georeferenced health facilities HIV-testing data from DHIS for individuals (15–49 years old) who tested in health care facilities in the district in 2015 to delineate high HIV disease burden areas using density surface of either HIV positivity and/or number of people living with HIV (PLHIV). For validation, we extracted interpolated values at the facility locations and compared with the real observed values calculating the residuals. Lower residuals means the Inverse Weighted Distance (IDW) interpolator provided reliable prediction at unknown locations. Results were adjusted to provincial published HIV estimates and aggregated to municipalities. Uncertainty measures map at municipalities is provided. Data on major cities and roads networks was only included for orientation and better visualization of the high burden areas. Results: Results shows the HIV burden at local municipality level, with high disease burden in municipalities in eThekwini, iLembe and uMngundgudlovu; and around major cities and national routes. Conclusion: The methods provide accurate estimates of the local HIV burden at the municipality level. Areas with high population density have high numbers of PLHIV. The analysis puts into the hand of decision makers a tool that they can use to generate evidence for HIV programming. The method allows decision makers to routinely update and use facility level data in understanding the local epidemic.

Lotus (Nelumbo nucifera) is a perennial aquatic basal eudicot belonging to a small family Nelumbonaceace, which contains only one genus with two species. It is an important horticultural plant, with its uses ranging from ornamental, nutritional to medicinal values, and has been widely used, especially in Southeast Asia. Recently, the lotus obtained a lot of attention from the scientific community. An increasing number of research papers focusing on it have been published, which have shed light on the mysteries of this species. Here, we comprehensively reviewed the latest advancement of studies on the lotus, including phylogeny, genomics and the molecular mechanisms underlying its unique properties, its economic important traits, and so on. Meanwhile, current limitations in the research of the lotus were addressed, and the potential prospective were proposed as well. We believe that the lotus will be an important model plant in horticulture with the generation of germplasm suitable for laboratory operation and the establishment of a regeneration and transformation system.

Diseases are the worst enemy to man currently. This study was aimed at isolating pathogenic bacteria from water obtained from shallow wells in Dundori Kenya. Also, the study aimed at testing the isolates for sensitivity to antibiotic metabolites previously extracted from Actinomycetes isolates from soils of Egerton University. Water samples were collected from shallow wells randomly selected from Dundori and abbreviated as A, B, C, D, and E. Bacterial pathogens were isolated from the water samples using the membrane filtration technique. The isolates were characterized using biochemical means. Antimicrobial sensitivity testing was carried out using Kirby Bauer disk diffusion method. Data analysis was carried out using the Statistical Package for Social Sciences (SPSS). Comparison of means was carried out using one way ANOVA. Shallow wells B, D and E were highly contaminated with pathogenic bacteria. Biochemical characterization of the isolates indicated that the most common isolates were Vibrio cholera, Klebsiella pneumoniae, Proteus sp, Escherichia coli, and Staphylococcus aureus. There was no significant difference between the zones of inhibition produced by the antibiotic metabolites (F=2.149 P=1340) when tested against the test isolates. There were no significant differences between the MIC's of the antibiotic metabolites on the bacterial pathogens (F=2.01 P=0.15). Water from some shallow wells in Dundori is highly contaminated with Klebsiella pneumoniae, Escherichia coli, Proteus sp., Vibrio cholerae and Staphylococcus aureus. The pathogens can effectively be controlled using antibiotics from the Actinomycetes. There is a need to sensitize the residents of the study area on ways of preventing seepage of contaminants into the shallow wells.

Cellular proteins are modified by lysine acetylation wherein an acetyltransferase transfers an acetyl group from acetyl co enzyme A onto the e-amino group of lysine residues. This modification is extremely dynamic and can be reversed by a deacetylase that removes the acetyl group. Addition of acetyl group to the lysine residue neutralizes its positive charge, thereby functioning as a molecular switch in regulating the enzymatic functions of the protein, its stability, and it cellular localization. Since this modification is extremely dynamic within the cell, biochemical studies characterizing changes in protein function are imperative to understand how this modification alters protein function in a specific cellular pathway. This unit describes in detail expression and purification of a recombinant nuclease and acetyltransferase, in vitro acetylation of the recombinant protein and biochemical assays to study the changes in enzymatic activity of the in vitro acetylated nuclease.