Search

Protein-energy malnutrition (PEM) remains a public health concern in most developing nations. In Africa, PEM can be attributed to monotonous diets based on cereals, roots, and tubers, with little or no protein of animal origin. Diversifying cropping systems to include protein dense pseudo-cereals such as Quinoa (Chenopodium quinoa Willd.) could help provide more protein in the diet of vulnerable populations. Quinoa is a crop with potential for biodiversification because it has a high nutritional value; however, it is underutilized in Africa, and information about the nutritional quality of the grain grown in contrasting environments is limited. Within the framework of FAO's commemoration of 2013 as the 'The International Year of the Quinoa' (IYQ), a Technical Cooperation Programme (TCP) project was developed with some African countries to assess the capacity of quinoa to adapt to different agro-ecological regions and the nutritional quality of the resulting grain. For this study, we evaluated the protein content and amino acid profile of three genotypes of quinoa that had been grown under diverse altitudes, soil, and climate conditions in Ethiopia, Kenya, Uganda, and Zambia. The mean protein content (g/100g) of Kancolla, Titicaca and BBR varieties grown in Africa ranged from 14.33 [+ or -]0.20 to 17.61 [+ or -]0.55, 14.23 [+ or -]0.25 to 16.65 [+ or -]0.55, and 13.13 [+ or -]0.2 to 16.23 [+ or -]0.49, respectively. On the other hand, the protein content (g/100g) of Kancolla, Titicaca, and BBR seeds grown in Peru was 13.80 [+ or -]0.10, 17.43 [+ or -]0.31, and 17.07 [+ or -]0.11, respectively. The Kancolla variety [grown in Ethiopia and Kenya] had a significantly higher protein content than that obtained from Peru [P < 0.001]. Regarding the profile of essential amino acids, Quinoa is essentially richer in methionine than most cereals. Levels of methionine were lower in the seeds grown in Africa compared to those from Peru [P < 0.001]. In terms of environmental influences, the protein content was relatively higher in quinoa seeds grown in high-altitude areas, where soils have a low pH and high nitrogen content. We conclude that Quinoa can be introduced to Africa, especially to high altitudes and warm regions where the soil has a low pH and high nitrogen content. The crop would be ideal for diversifying local diets. Key words: Africa, Agro-ecology, Chenopodium quinoa, protein, amino acid content, biodiversity, diets, INTRODUCTION Protein-energy malnutrition (PEM) remains a public health concern in most developing nations. A recent review concluded that, although the 'protein gap' waned during the 1970s, contemporary studies have challenged [...]

Background: Neonatal acute kidney injury (nAKI) has been reported to be common among neonates admitted to the Neonatal Intensive Care Unit (NICU) and is associated with increased mortality and prolonged duration of hospital stay. However, data on this entity from sub-Saharan Africa are scanty., Objectives: This study aimed to assess the burden, risk factors, and short-term outcomes of nAKI in neonates admitted to a low-resource NICU in Zambia., Design: The design of the study is a prospective cohort study., Setting: The setting of this study was the NICU at the Women and Newborn Hospital of the University Teaching Hospitals (WNBH-UTHs)., Patients: In total, 322 neonates who were admitted to the NICU between November 2021 and December 2022., Methods: A serum creatinine was determined on all patients at admission (within 24 hours), at 72 hours and day 7. The modified neonatal Kidney Disease: Improving Global Outcome (KDIGO) Criteria were used to define nAKI. Data were extracted using a predesigned form and analyzed using SPSS. A P -value less than .05 was considered statistically significant., Results: The prevalence of nAKI was 13.7% (44/322). On multivariable regression analysis, antepartum hemorrhage (adjusted odds ratio [AOR] 5.58; 95% confidence interval [CI]: [1.62-19.13], P  = .007), vomiting in the neonate (AOR 5.76; 95% CI: [1.10-30.32], P  = .04), history of use of unit second-line antibiotics, meropenem (AOR 4.37; 95% CI: [1.97-9.69], P  < .001), and ciprofloxacin (AOR 4.53; 95% CI: [1.22-16.84], P  = .02) were associated with increased risk of nAKI. Acute kidney injury (AKI) was significantly associated with longer length of hospital stay and higher mortality ( P  < .05)., Limitations: The study did not use the urine output criteria to define nAKI and this may have led to an underestimation of nAKI prevalence. Additionally, kidney, ureter, and bladder ultrasound was not performed on any of the study participants., Conclusion: AKI is common in neonates admitted to the NICU at WNBH-UTHs, and it is associated with a higher risk of mortality and prolonged length of hospital stay. Further studies among the various NICU sub-populations are needed to better characterize risks and outcomes., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Whilst malaria is a prominent aetiology associated with acute kidney injury (AKI) in many parts of Africa, a shift in the traditional AKI aetiologies has been witnessed in sections of the continent. Additionally, limited access to dialysis worsens patient outcomes in these low-resource settings. This retrospective cross-sectional study aimed to determine the associated aetiologies, predictors of need for dialysis and malaria-associated AKI (MAKI), and outcomes of AKI and dialysis among children evaluated by the renal service in Lusaka, Zambia., Methods: The study sampled all children aged 16 years or below, diagnosed with AKI between 2017 and 2021, by the renal unit at the University Teaching Hospitals- Children's Hospital (UTH-CH), and retrospectively abstracted their records for exposures and outcomes. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Frequency and percentage distributions were used to describe the occurrence of AKI aetiologies and treatment outcomes. Predictors of the need for dialysis, MAKI, and poor treatment outcome were identified by using multivariable logistic regression models., Results: A total of 126 children diagnosed with AKI were included in this study. Malaria was the most frequent aetiology of AKI(61.1% (77/126, 95% Confidence Interval (CI): 52.0%-69.7%)). Of the 126 children with AKI, 74.6% (94) underwent dialysis. Predictors of the need for dialysis were oliguria (p = 0.0024; Odds ratio (OR) = 7.5, 95% CI: 2.1-27.7) and anuria (p = 0.0211; OR = 6.4, 95% CI = 1.3, 30.7). A fifth (18.3%, 23/126) of the children developed chronic kidney disease (CKD), 5.6% (7/126) died and, a year later, 77% (97/126) were lost to follow-up., Conclusion: At UTH-CH, malaria is the most frequent aetiology among children with AKI undergoing dialysis and children from low-medium malaria incidence areas are at risk; a considerable proportion of children with AKI need dialysis and Tenchoff catheter use in AKI is advocated., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2023 Mwaba et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Contrast-associated acute kidney injury (CAAKI) is defined as acute kidney injury (AKI) occurring within 72 hours of administration of contrast media (CM) and is linked to adverse outcomes including longer hospital stay, increased hospital mortality, and a higher risk of chronic kidney disease in later life. Risk factors for the development of CAAKI in the Zambian pediatric population have not been well studied., Objectives: The objective of this study was to assess the burden of CAAKI, ascertain its risk factors, and describe short-term outcomes in hospitalized children at the University Teaching Hospitals (UTH) undergoing contrast-enhanced radiological investigations., Methods: This was a prospective observational study of in-patients undergoing contrast-enhanced radiological procedures, between September 2020 and September 2021. The participants were recruited from the Children's Hospital, the Cancer Diseases Hospital, and the Pediatric Surgical Ward at the University Teaching Hospital in Lusaka, Zambia. The primary outcome variable was occurrence of AKI at 48 hours post CM administration. We used 2 criteria to define CAAKI in our study-the European Society of Urogenital Radiology (ESUR) and the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Multivariable logistic regression models were formulated to assess for risk factors of CAAKI., Results: Of the 201 enrolled participants, 123 (61.2%) were male and the median age of the participants was 5 years (interquartile range [IQR] = 3-10). The mean hemoglobin was 103 g/L (standard deviation [SD] = 26), median creatinine was 30.9 µmol/l (IQR = 22.6-43), and the glomerular filtration rate (GFR) was 102.5 mL/min/1.73 m 2 (IQR = 76.2-129.4). Forty-six (22.9%) developed CAAKI using the ESUR compared with 4.5% (9/201) using the KDIGO criteria. Independent risk factors of CAAKI were receiving a higher dose of CM (adjusted odds ratio [aOR] = 2.54; 95% confidence interval [CI] = [1.12-5.74]), prematurity (aOR = 4.6; 95% CI = [1.05-16.7]), and a higher eGFR (aOR= 1.01; 95% CI = [1.01-1.02]). Females had higher odds of CAAKI (aOR = 2.48; 95% CI = [1.18-5.18]) when compared with males. One CAAKI participant (2.2%) died; none of the participants who developed CAAKI and survived required dialysis and most of them (90%) were discharged before day 7. Day 7 eGFR results had returned to or near baseline values for those whose creatinine results were available., Conclusions: Using the ESUR criteria, a significant proportion (22.9%) of children undergoing contrast-enhanced computed tomography (CT) scans at the UTH developed CAAKI. In contrast, using the KDIGO criteria only 4.5% had CAAKI. Being born as a preterm baby, being female, having a higher eGFR at baseline, and receiving a higher dose of CM were found to be independent risk factors for CAAKI development in Zambian children. Most of the cases of CAAKI in children were transient and of little clinical significance as only a minority of patients developing CAAKI required kidney replacement therapy and all resolved by day 7 post administration of CM., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Acute kidney injury (AKI) increases the risk of adverse outcomes. The renal angina index (RAI) has previously been used to predict patients at risk of developing severe AKI (sAKI)., Method: This single-centre prospective observational study aimed to assess the prevalence of sAKI in PICU as the primary outcome and the duration of mechanical ventilation and PICU stay, RRT need, and mortality as secondary outcomes. The utility of the RAI in predicting day 3 sAKI was also assessed. We enrolled 122 patients aged 1 month to 16 years whose baseline characteristics were collected via questionnaire. RAI was calculated on day 0 with a score of ≥8 being considered positive. sAKI was defined as KDIGO stages 2 and 3., Results: sAKI prevalence was 14.8% and its development was associated with longer duration of mechanical ventilation ( p  = 0.001) and higher mortality ( p  = 0.011). A positive Day 0 RAI predicted day 3 sAKI with sensitivity 55.6%, specificity 85.6%, PPV 40.0%, NPV 91.8%, and AUC of 0.77. Exclusion of children older than 5 years improved RAI performance (sensitivity 72.7%, specificity 88.0%, PPV 57.1%, NPV 93.6%, AUC 0.80). A modified RAI based on local AKI risk factors had equivalent performance to RAI (Z - score 0.78 (CI -0.077-0.033), p  = 0.435) with sensitivity 72.2%, specificity 80.8%, PPV 39.4%, NPV 94.4% and AUC 0.80., Conclusion: The RAI can be an effective tool in ruling out sAKI in patients and a modification of RAI based on population-based risk factors improves the test's sensitivity and NPV.

Background: Recent research has established that acute kidney injury (AKI) is a common problem in severe paediatric malaria. Limited access to kidney diagnostic studies in the low resources settings where malaria is common has constrained research on this important problem., Methods: Enrolment data from an ongoing clinical trial of antipyretics in children with central nervous system (CNS) malaria, CNS malaria being malaria with seizures or coma, was used to identify risk factors for AKI at presentation. Children 2-11 years old with CNS malaria underwent screening and enrollment assessments which included demographic and anthropomorphic data, clinical details regarding the acute illness, and laboratory studies including creatinine (Cr), quantitative parasite count (qPC), quantitative histidine rich protein 2 (HRP2), lactate, and bilirubin levels. Children with a screening Cr > 106 µmol/l were excluded from the study due to the potential nephrotoxic effects of the study drug. To identify risk factors for AKI at the time of admission, children who were enrolled in the study were categorized as having AKI using estimates of their baseline (i.e. before this acute illness) kidney function and creatinine at enrollment applying the Kidney Disease: Improving Global Outcome (KDIGO) 2012 guidelines. Logistic regressions and a multivariate model were used to identify clinical and demographic risk factors for AKI at presentation among those children enrolled in the study., Results: 465 children were screened, 377 were age-appropriate with CNS malaria, 22 (5.8%) were excluded due to Cr > 106 µmol/l, and 209 were enrolled. Among the 209, AKI using KDIGO criteria was observed in 134 (64.1%). One child required dialysis during recovery. Risk factors for AKI in both the logistic regression and multivariate models included: hyperpyrexia (OR 3.36; 95% CI 1.39-8.12) and age with older children being less likely to have AKI (OR 0.72; 95% CI 0.62-0.84)., Conclusion: AKI is extremely common among children presenting with CNS malaria. Hyperpyrexia with associated dehydration may contribute to the AKI or may simply be a marker for a more inflammatory systemic response that is also affecting the kidney. Appropriate fluid management in children with CNS malaria and AKI may be challenging since generous hydration to support kidney recovery could worsen malaria-induced cerebral oedema in this critically ill population. Trial registration https://clinicaltrials.gov/ct2/show/NCT03399318., (© 2022. The Author(s).)

Munchausen syndrome by proxy is a form of abuse in which an adult, usually the mother, deceives health workers by exaggerating, falsifying or directly inducing psychological or physical symptoms in the child victim for psychological gratification. In 2013, the American Academy of Pediatrics coined the term 'caregiver-fabricated illness in a child' to describe this form of child abuse. A 7-year-old girl had many encounters with health workers over a period of 4 years and presented with evolving clinical features including refractory seizures and red urine for which she was followed up as a case of acute intermittent porphyria. She was later discovered to be the victim of chronic monocrotophos organophosphate poisoning by her mother. If all medical staff who manage children are to avoid becoming inadvertent participants in medical child abuse, this case report is an important reminder that a high index of suspicion is warranted in cases which present a diagnostic dilemma and who respond unexpectedly to treatment. Abbreviations AIP: Acute intermittent porphyria; APSAC: American Professional Society on the Abuse of Children; ASM: anti-seizure medication; CFIC: caregiver-fabricated illness in a child; CT: computed tomography: DVT: deep vein thrombosis; EEG: electroencephalogram: ESR: erythrocyte sedimentation rate; HDW: high-dependency ward; ICU: intensive care unit; LFT: liver function test; MBP: Munchausen syndrome by proxy; NICU: neonatal intensive care unit; RFT: renal function test; TB: Tuberculosis; UTH-CH: University Teaching Hospitals Children's Hospital.

Purpose: Formal education in the radiation sciences is critical for the safe and effective delivery of radiotherapy. Practices and patterns of radiation sciences education and trainee performance in the radiation sciences are poorly described. This study assesses the current state of radiation sciences education in Africa and evaluates a high-yield, on-site educational program in radiation biology and radiation physics for oncology and radiation therapy trainees in Africa., Methods: An anonymous survey was distributed to members of the African Organization for Research and Treatment in Cancer Training Interest Group to assess current attitudes and practices toward radiation sciences education. A 2-week, on-site educational course in radiation biology and radiation physics was conducted at the Cancer Diseases Hospital in Lusaka, Zambia. Pre- and postcourse assessments in both disciplines were administered to gauge the effectiveness of an intensive high-yield course in the radiation sciences., Results: Significant deficiencies were identified in radiation sciences education, especially in radiation biology. Lack of expert instructors in radiation biology was reported by half of all respondents and was the major contributing factor to deficient education in the radiation sciences. The educational course resulted in marked improvements in radiation biology assessment scores (median pre- and posttest scores, 27% and 55%, respectively; P < .0001) and radiation physics assessment scores (median pre- and posttest scores, 30% and 57.5%, respectively; P < .0001)., Conclusion: Radiation sciences education in African oncology training programs is inadequate. International collaboration between expert radiation biology and radiation physics instructors can address this educational deficiency and improve trainee competence in the foundational radiation sciences that is critical for the safe and effective delivery of radiotherapy.

Background: Long delays to diagnosis is a major cause of late presentation of breast diseases in sub-Saharan Africa., Aims: We designed and implemented a single-visit breast care algorithm that overcomes health system-related barriers to timely diagnosis of breast diseases., Methods: A multidisciplinary team of Zambian healthcare experts trained a team of mid- and high-level Zambian healthcare practitioners how to evaluate women for breast diseases, and train trainers to do likewise. Working collaboratively, the two teams then designed a clinical platform that provides multiple breast care services within a single visit. The service platform was implemented using a breast outreach camp format, during which breast self-awareness, psychosocial counseling, clinical breast examination, breast ultrasound, ultrasound-guided biopsy, imprint cytology of biopsy specimens and surgical treatment or referral, were offered within a single visit., Results: Eleven hundred and twenty-nine (1129) women attended the camps for breast care. Mean age was 35.9 years. The majority were multiparous (79.4%), breast-fed (76.0%), and reported hormone use (50.4%). Abnormalities were detected on clinical breast examination in 122 (10.8%) women, 114 of whom required ultrasound. Of the 114 who underwent ultrasound, 48 had identifiable lesions and were evaluated with ultrasound-guided core needle biopsy (39) or fine-needle aspiration (9). The concordance between imprint cytology and histopathology was 100%, when breast specimens were classified as either benign or malignant. However, when specimens were classified by histopathologic subtype, the concordance between imprint cytology and histology was 85.7% for benign and 100% for malignant lesions. Six (6) women were diagnosed with invasive cancer. Eighteen (18) women with symptomatic breast lesions had next-day surgery., Significance: Similar to its impact on cervical cancer prevention services, a single visit breast care algorithm has the potential to overcome health system-related barriers to timely diagnosis of breast diseases, including cancer, in rural African settings.

Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions., Competing Interests: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. Melissa S. LopezNo relationship to discloseEllen S. BakerStock or Other Ownership: MerckAndrea M. MilbourneNo relationship to discloseRose M. GowenNo relationship to discloseAna M. RodriguezNo relationship to discloseCesaltina LorenzoniNo relationship to discloseCatherine MwabaResearch Funding: Mylan Zambia (Inst) Travel, Accommodations, Expenses: Fresenius Kabi South AfricaSusan Citonje MsadabweTravel, Accommodations, Expenses: AstraZenecaJosé Humberto TavaresNo relationship to discloseGeorgia Fontes-CintraNo relationship to discloseGustavo Zucca-MatthesNo relationship to discloseDonato Callegaro-FilhoNo relationship to discloseDanielle Ramos-MartinNo relationship to discloseIcaro Thiago de CarvalhoNo relationship to discloseRobson CoelhoNo relationship to discloseRenato Moretti-MarquesNo relationship to discloseThiago ChulamTravel, Accommodations, Expenses: A.C. Camargo Cancer CenterMila Pontremoli-SalcedoNo relationship to discloseFernanda NozarNo relationship to discloseVeronica FiolTravel, Accommodations, Expenses: UrufarmaMauricio MazaNo relationship to discloseSanjeev AroraNo relationship to discloseErnest T. HawkEmployment: MD Anderson Cancer Center Honoraria: National Cancer Institute, Huntsman Cancer Institute, Mayo Clinic Cancer Center, Kansas University Medical Center, Ohio State University Comprehensive Cancer Center, Roswell Park Cancer Institute, Simmons Comprehensive Cancer Center, University of Nebraska Medical Center, University of South Alabama Mitchell Cancer Institute, Johns Hopkins University, Oncology Nursing Society Conference, Weill Cornell Medical College, ASCO, American Association for Cancer Research Consulting or Advisory Role: Cancer Prevention Pharmaceuticals, PLx Pharma, POZEN Research Funding: National Institutes of Health/National Cancer Institute (Inst), the Cancer Prevention Research Institute of Texas (Inst), Cancer Prevention Pharmaceuticals (Inst) Patents, Royalties, Other Intellectual Property: John Wiley & Sons Travel, Accommodations, Expenses: National Cancer Institute, American Association for Cancer Research, Huntsman Cancer Institute, Kansas University Medical Center, Mayo Clinic Cancer Center, Ohio State University Comprehensive Cancer Center, Roswell Park Cancer Institute, Simmons Comprehensive Cancer Center, University of Nebraska Medical Center, Johns Hopkins University, Oncology Nursing Society Conference, Weill Cornell Medical College, ASCO, American Association for Cancer Research, American Cancer Society, Association of American Cancer Institutes—Cancer Center Administrators Forum, Alliance Prevention Committee, First Annual Meta-ECHO MeetingKathleen M. SchmelerResearch Funding: Becton Dickinson Patents, Royalties, Other Intellectual Property: UpToDate

Health workers (N=692) in five Zambian hospitals were interviewed to assess HIV/AIDS risk-taking and status awareness. They comprised of physicians, nurses, clinical officers and paramedics. Only 33% had been tested for HIV and only 24% said their partner had been tested. 26 percent of sexually active respondents had multiple partners; thirty-seven percent of these had not used condoms. Only 60% of respondents believed condoms were effective in preventing HIV. Women were less likely to trust or use condoms even in high-risk relationships. The data suggest a need to develop HIV/AIDS programs for health workers, with emphasis towards gender-based obstacles hampering safer behaviors.