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Abstract Objective Neurocysticercosis (NCC) is considered the major cause of epilepsy in endemic regions. In the rural areas of the Bolivian Chaco prevalence of NCC among people with epilepsy (PWE) was 27.4%, according to a population‐based survey carried out in 1994. The aim of the study was to estimate the prevalence of Epilepsy Associated with Tonic–Clonic Seizures (EATCS) and to evaluate the prevalence of NCC among PWE in the rural communities of the Bolivian Chaco after 30 years. Methods Twenty‐two rural communities (total population 12 852) were involved in the study. PWE in the study area were ascertained by multiple sources and the diagnosis was confirmed by a neurologist. All PWE identified were invited to undergo brain CT scan examination and diagnosis of NCC was sought according to the revised Del Brutto criteria. Results Seventy‐eight PWE (30 men, 38.4%; mean age at onset was 12.7 ± 13.2 years) with EATCS were identified giving a crude prevalence of 6.1/1000 (95% CI: 4.7–7.3). Due to the COVID‐19 lockdown, the study was interrupted in 2020 and only 36 PWE (46%) of the whole sample underwent CT scan examination. Of these, 8 (22.2%) fulfilled the criteria for NCC of whom 6 (75%) presented only single or multiple calcifications. Significance This is the first study reassessing the prevalence of NCC among PWE after 30 years, in the same rural area and using a population‐based design. T. solium is still endemic in the Bolivian Chaco where more than 20% of EATCS may be attributable to NCC. Our findings show a substantially unchanged prevalence of NCC over the past 30 years despite improved knowledge, underlining the need for active intervention programs to control T. solium transmission in this area. Plain Language Summary Neurocysticercosis is still endemic in the Bolivian Chaco. The proportion of epilepsy attributable to neurocysticercosis is about 22%. Systematic efforts towards elimination of neurocysticercosis in these areas should be implemented.

Objective: Neurocysticercosis (NCC) is considered the major cause of epilepsy in endemic regions. In the rural areas of the Bolivian Chaco prevalence of NCC among people with epilepsy (PWE) was 27.4%, according to a population‐based survey carried out in 1994. The aim of the study was to estimate the prevalence of Epilepsy Associated with Tonic–Clonic Seizures (EATCS) and to evaluate the prevalence of NCC among PWE in the rural communities of the Bolivian Chaco after 30 years. Methods: Twenty‐two rural communities (total population 12 852) were involved in the study. PWE in the study area were ascertained by multiple sources and the diagnosis was confirmed by a neurologist. All PWE identified were invited to undergo brain CT scan examination and diagnosis of NCC was sought according to the revised Del Brutto criteria. Results: Seventy‐eight PWE (30 men, 38.4%; mean age at onset was 12.7 ± 13.2 years) with EATCS were identified giving a crude prevalence of 6.1/1000 (95% CI: 4.7–7.3). Due to the COVID‐19 lockdown, the study was interrupted in 2020 and only 36 PWE (46%) of the whole sample underwent CT scan examination. Of these, 8 (22.2%) fulfilled the criteria for NCC of whom 6 (75%) presented only single or multiple calcifications. Significance: This is the first study reassessing the prevalence of NCC among PWE after 30 years, in the same rural area and using a population‐based design. T. solium is still endemic in the Bolivian Chaco where more than 20% of EATCS may be attributable to NCC. Our findings show a substantially unchanged prevalence of NCC over the past 30 years despite improved knowledge, underlining the need for active intervention programs to control T. solium transmission in this area. Plain Language Summary: Neurocysticercosis is still endemic in the Bolivian Chaco. The proportion of epilepsy attributable to neurocysticercosis is about 22%. Systematic efforts towards elimination of neurocysticercosis in these areas should be implemented. [ABSTRACT FROM AUTHOR]

Abstract Objective The objective of this study is to estimate the prevalence of epilepsy with Tonic–Clonic (TC) seizures in rural areas of the Bolivian Gran Chaco and to evaluate the usefulness of telemedicine in this context. Methods The study was carried out in the Isozo Area, southern‐eastern Bolivia. Twenty‐five rural communities with a population of 8258 inhabitants were included in the survey. Trained community‐health workers administered a validated single screening question to the householders (stage I). A second face‐to‐face questionnaire was administered to each positive subject (stage II). At stage II subjects were also screened using the smartphone app “Epilepsy Diagnosis Aid”. Subjects screened positive at stage II underwent a complete neurological examination to confirm the diagnosis (stage III). Due to the COVID‐19 lockdown, some subjects have been evaluated through a digital platform (Zoom®). Results One‐thousand two‐hundred and thirteen interviews were performed at stage I, corresponding to a total screened population of 6692 inhabitants. Thirty‐eight screened positive were identified at stage I and II and of these, 28 people with epilepsy were identified, giving an overall prevalence of 4.2/1000 (95% CI 2.6–5.7). Prevalence rate steeply increased with age reaching a peak of 7.9/1000 in the population aged 20–29 years without significant differences between women and men. For almost 50% of the screened positive subjects, confirmation of epilepsy by a neurologist at stage III was achieved through simple videoconsultation. After a simultaneous awareness campaign, 22 self‐reported PWE requested a consultation and, among them, 11 had a diagnosis of epilepsy confirmed. Significance This study shows a prevalence estimate close to those reported for LMIC. Simple videoconsultation and specific apps may be valuable tools in epidemiological research. Awareness campaigns are important allies for a full case identification, particularly in contexts where higher rates of stigma are recorded.

Objective: The objective of this study is to estimate the prevalence of epilepsy with Tonic–Clonic (TC) seizures in rural areas of the Bolivian Gran Chaco and to evaluate the usefulness of telemedicine in this context. Methods: The study was carried out in the Isozo Area, southern‐eastern Bolivia. Twenty‐five rural communities with a population of 8258 inhabitants were included in the survey. Trained community‐health workers administered a validated single screening question to the householders (stage I). A second face‐to‐face questionnaire was administered to each positive subject (stage II). At stage II subjects were also screened using the smartphone app "Epilepsy Diagnosis Aid". Subjects screened positive at stage II underwent a complete neurological examination to confirm the diagnosis (stage III). Due to the COVID‐19 lockdown, some subjects have been evaluated through a digital platform (Zoom®). Results: One‐thousand two‐hundred and thirteen interviews were performed at stage I, corresponding to a total screened population of 6692 inhabitants. Thirty‐eight screened positive were identified at stage I and II and of these, 28 people with epilepsy were identified, giving an overall prevalence of 4.2/1000 (95% CI 2.6–5.7). Prevalence rate steeply increased with age reaching a peak of 7.9/1000 in the population aged 20–29 years without significant differences between women and men. For almost 50% of the screened positive subjects, confirmation of epilepsy by a neurologist at stage III was achieved through simple videoconsultation. After a simultaneous awareness campaign, 22 self‐reported PWE requested a consultation and, among them, 11 had a diagnosis of epilepsy confirmed. Significance: This study shows a prevalence estimate close to those reported for LMIC. Simple videoconsultation and specific apps may be valuable tools in epidemiological research. Awareness campaigns are important allies for a full case identification, particularly in contexts where higher rates of stigma are recorded. [ABSTRACT FROM AUTHOR]

Abstract Background The periodic and seasonal outbreaks of cholera in Ghana make the disease a vital health concern. The country is cholera endemic with several communities within cholera hotspots. This study, therefore, assesses health literacy on cholera and the association between health literacy competency and health outcome. Methods The study adopted a health literacy framework that theorized the pathways between health literacy and health outcomes controlling for confounding factors. A survey questionnaire was administered to a representative sample of 401 individual household heads in James Town, Accra, Ghana. Reliability analysis was undertaken to ascertain the internal consistency of the instrument. Bivariate methods of analyses used were chi-square tests, ANOVA, Mann–Whitney U test, and Kruskal–Wallis test. Binary logistic regression models were run to examine the relative effects of health literacy competency on health outcome (having not had cholera). Results There are substantial knowledge gaps about environmental risk factors for cholera like the presence of the cholera germ in coastal water, as well as the likelihood of contracting cholera due to overcrowded spaces. However, better knowledge on cholera risk factors was found to be associated with better health literacy competency (food safety and personal hygiene practices). An increase in health literacy competency score was associated with lower likelihood of having had cholera, after controlling for intermediate factors. Conclusion Furthering health literacy on cholera environmental risk factors as well as a deliberate and targeted effort in encouraging consistency in the translation of disease knowledge into healthier practices may improve the well-being of the people.

Abstract Introduction Epilepsy represents around 0.7% of the overall global burden of diseases and is particularly prevalent and associated with significant disability in low- and middle-income countries (LMIC) in Latin American Countries (LAC). A community-based epilepsy awareness program was carried out by our group in the rural areas of the Chaco region, Plurinational state of Bolivia, to improve the knowledge about epilepsy, with a first part directed toward general practitioners and a second part toward nurses and community health workers (CHWs) of the rural communities with a positive outcome. The objective of the study was to assess the level of knowledge, attitudes, and practices toward epilepsy, the stigma related to epilepsy and the quality of life in people with epilepsy (PWE) before and after the interventional campaign directed toward representative members of the rural communities in the Chaco region in Bolivia. Methods The study was conducted in three areas of Bolivia. Key subjects from each community were randomly selected. Before and after the courses they answered a questionnaire to assess their knowledge, attitudes, beliefs, and practices about epilepsy, a validated Stigma Scale of Epilepsy (SSE) and Quality of Life in Epilepsy Inventory-10 (QOLIE-10). Results Two hundred sixteen subjects were involved in the program. Only 133 (61.6%) subjects completed the questionnaires a month after the educational program. A significant improvement was recorded in knowledge, attitudes, and practices toward epilepsy, and a significant reduction was found in the mean SSE total score (38.3 ± 14.7 vs. 28.5 ± 12.3; p < 0.01), reflecting a reduction of stigma levels. Regarding the quality of life, after the training, PWE stated to experience less depression, memory difficulties, work or social issues, and seizure worry. Conclusion Our study confirms that continuous educational campaigns can lead to a significant change in the social perception and attitudes toward epilepsy. Highlights • Epilepsy represents around 0.7% of the overall global burden of diseases. • Education is the best method to improve knowledge and reduce stigma in epilepsy. • Educational campaigns could lead to a significant change in the social perception and attitudes toward epilepsy. [ABSTRACT FROM AUTHOR]

Introduction Epilepsy represents a major global healthcare issue, particularly in low- and middle-income countries (LMIC), where nonmedical health workers play a key role in providing care to people with epilepsy (PWE). Over the last 20 years, many projects have been carried out by our group in the Chaco region, Plurinational State of Bolivia, with the aim of enhancing knowledge about epilepsy. However, the level of knowledge of epilepsy that nonmedical health workers have reached has never been assessed until now. The main objective of our study was to assess the level of knowledge, attitudes, and practices (KAP) towards epilepsy among nonmedical health staff of the rural communities of the Chaco region in Bolivia. Methods The study was conducted in three departments of Bolivia. The nonmedical health personnel were invited to participate in a training program. They answered a validated questionnaire to evaluate their knowledge and attitudes towards epilepsy before and after the courses. Results One hundred nineteen subjects [42 men (36.2%); mean age 29.3 ± 1.1 years] were interviewed among community health workers and nurses before the courses, demonstrating a very good level of knowledge regarding epilepsy and its causes. Only 55 health workers participated in the second training module, and their answer did not significantly differ from the baseline. Conclusion Our study confirms the usefulness of continuous educational campaigns, especially directed to nonspecialist healthcare providers of rural communities of LMIC, as they may be the only persons responsible for providing healthcare to PWE in that setting. Moreover, the importance of the baseline assessment of KAP was highlighted in order to adapt the educational campaigns to the baseline level of knowledge found. [ABSTRACT FROM AUTHOR]

Introduction Epilepsy represents a major health problem in low- and middle-income countries where treatment gap (TG) levels are high. The reduction of epilepsy TG in the rural area of the Chaco region, Plurinational State of Bolivia, has been the aim of many projects based on the reinforcement of the primary care setting. To plan educational campaigns directed to the healthcare professionals, it is necessary to establish their baseline knowledge level. The objective of our study was to assess the baseline level of knowledge, attitudes, and practices (KAP) towards epilepsy among general practitioners (GPs) of the rural communities of the Chaco region. Methods The study was conducted in three departments of Bolivia. All the GPs living in these areas were invited to participate in the study consisting of two training modules six months apart from each other, each with two-day duration. They answered a validated questionnaire to evaluate the KAP towards epilepsy before and after the courses. Results Fifty GPs [30 men (60%); mean age: 32.1 ± 5.8 years] participated in the first training course. After six months, 31 GPs (62%) [19 men (61.3%); mean age: 33 ± 5.0 years] participated in the second module. Before the training, the majority of GPs declared a low level of satisfaction about their epilepsy knowledge, which improved after the courses. A change in practices was recorded after the training, with an increased confidence to manage antiepileptic treatment. Conclusion Our study showed the significant impact of specific training programs on epilepsy among GPs. [ABSTRACT FROM AUTHOR]

Abstract Objective: Respiratory syncytial virus (RSV) is most common during the rainy season in a number of low‐ to middle‐income tropical settings, a pattern driven by seasonal changes in climate and nutrition. We investigated the seasonality of RSV in the high‐income tropical setting of North Queensland, Australia. Methods: We used RSV hospital admissions data from Cairns and Townsville to assess the seasonality of RSV. We examined the seasonal scale associations between selected meteorological exposures and RSV admissions using cross‐correlation of weekly data. Results: In both Cairns and Townsville, RSV admissions were highest in the latter half of the rainy season. In Cairns, RSV admissions were most strongly correlated with rainfall four weeks previously. In Townsville, RSV admissions were most strongly correlated with rainfall six weeks previously. Conclusions: The seasonality of RSV in the tropical setting of North Queensland appears to be driven by seasonal variations in rainfall. Further research is needed to assess the impact of climate on RSV incidence in the tropics.

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During the first quarter of the twentieth century, tropical neurasthenia was a popular diagnosis for a nervous condition experienced by Europeans in the topics. Tropical neurasthenia was not psychosis or madness, but was rather an ennui or loss of “edge” brought about by the strains of tropical life, especially the unfamiliar, hot climate. A catch-all for a wide range of symptoms, many missionaries, colonial staff, and settlers throughout Empire were repatriated because of it, although this article concentrates on Colonial Service employees working in British East Africa. While histories of tropical neurasthenia have usefully (and correctly) explained this diagnosis as an expression of the anxieties of the colonial regime, this article adds a new dimension to the historiography by arguing that tropical neurasthenia can only be properly understood as a hybrid form, dependent not only upon the peculiarities of the colonial situation, but also descended from British and American clinical understandings of neurasthenia. Moreover, once tropical neurasthenia is properly acknowledged as being typical of clinical understandings of the time, other reasons for its comparatively long endurance in the colonial situation emerge. This article shows that tropical neurasthenia remained a popular diagnosis in East Africa not only because (as historians have argued previously) it dovetailed with prevalent ideas of colonial acclimatization, but also because it was a practically useful tool in the management and regulation of colonial personnel. [ABSTRACT FROM PUBLISHER]

In low- and middle-income countries (LMIC), epilepsy still represents a significant health challenge. In the Bolivian Chaco, we have previously found high levels of stigma towards people with epilepsy (PWE) especially expressed by high school students. In order to increase the knowledge about epilepsy, we have tested a comic book-based intervention on a sample of high school students. The study has been conducted in the Bolivian Chaco region where two urban and two rural classrooms have been randomly selected. Students have been administered a knowledge, attitudes, and practices (KAP) questionnaire, and then they underwent a comic book-based educational program where they were randomly assigned either to an autonomous reading or a character interpretation methodology. The same KAP questionnaire has been administered after the teaching session and at a three months follow-up. Mean KAP scores at the baseline were compared with the after teaching and the three-month assessment. Eighty-three students with a mean age of 15.5 ± 0.9 years, of whom 38 (45.8%) males, were recruited. After the comic book session, students improved in the global score (p < 0.001) and in the knowledge (p < 0.001), attitudes (p = 0.004), and practices (p < 0.001) subscores. Both the autonomous reading and the character interpretation groups significantly improved in the global score, but only the latter improved in all the subscores. At the three months follow-up, there were no differences in the global, knowledge, and attitudes subscores, compared with scores immediately after the intervention. Using a comic book to teach about epilepsy led to a significant improvement in the knowledge, attitudes, and practices about the disease in high school students of LMIC. This teaching strategy can be easily implemented in LMIC. • In low and middle-income countries (LMIC), epilepsy represents a health challenge. • In LMIC, there are high levels of stigma towards people with epilepsy. • Improving knowledge about epilepsy leads to a reduction of stigma. • Our study showed the usefulness of a teaching program for students in LMIC. • A comic book-based intervention can be an effective teaching strategy for students. [ABSTRACT FROM AUTHOR]

Introduction: Outdoor workers are at risk of developing skin cancer because they are exposed to high levels of harmful ultraviolet radiation. The Outdoor Workers Sun Protection Project investigated sun protection strategies for high risk outdoor workers in rural and regional Australia., Methods: Fourteen workplaces (recruitment rate 37%) across four industries in rural and regional Queensland, Australia were recruited to the OWSPP. In 2011-2012, data were collected using pre- and post-intervention interviews and discussion groups. This article presents two workplaces as case study examples., Results: The flat organisational structure of workplace 1 supported the implementation of the Sun Safety Action Plan (SSAP), whilst the hierarchical organisational nature of workplace 2 delayed implementation of the SSAP. Neither workplace had an existing sun protection policy but both workplaces adopted one. An effect related to the researchers' presence was seen in workplace 1 and to a lesser degree in workplace 2. Overt reciprocity was seen between management and workers in workplace 1 but this was not so evident in workplace 2. In both workplaces, the role of the workplace champion was pivotal to SSAP progression., Conclusions: These two case studies highlight a number of contextually bound workplace characteristics related to sun safety. These issues are (1) the structure of workplace, (2) policy, (3) an effect related to the researchers' presence, (4) the workplace champion and (5) reciprocity. There are several recommendations from this article. Workplace health promotion strategies for sun safety need to be contextualised to individual workplaces to take advantage of the strengths of the workplace and to build capacity.

Introduction: Malnutrition that occurs during adolescence has important consequences for the future growth and development of the individual, particularly in girls in developing countries. Besides limiting growth, adolescent malnutrition has important consequences for society. Despite this, there is a lack of information on the nutritional status of adolescent girls in Ethiopia. This study was therefore performed to help redress this lack of data and to provide information for future improvements by health planners and policy makers., Methods: A comparative cross-sectional study design was employed to determine the urban-rural disparity in nutritional status of adolescent school girls in the Mizan district in south-western Ethiopia. A two-stage sampling procedure was used to randomly select 622 adolescent girls, 311 each from urban and rural locations. Trained field workers used structured questionnaires to obtain the desired information from the respondents. Anthropometric measurements of height and weight were collected using standard procedures and appropriate quality control measures. Height-for-age Z-scores and body mass index (BMI)-for-age Z-scores were generated using AnthroPlus software. The independent sample t-test and χ2 test were used to determine statistical significance., Results: There were no significant differences in the ages or physical activities of the two populations of girls studied. Consumption of cereal, vegetables, sweets, sugars, fats, meat, and eggs was similar between the two groups, although slight differences were found with regard to legumes, milk, and fruit consumption. No significant differences were found in the prevalence of mild underweight girls and overweight girls in the urban and rural groups (26.5% vs 22.3% and 7.5% vs 5.2%, respectively). Significant stunting was, however, present in the rural population (40.9% vs. 17.8% in the urban group). Although overall lower than the reference data provided by WHO, the mean BMI-for-age Z-scores and height-for-age Z-scores were significantly higher in the urban girls than in their rural counterparts, with mean differences of 0.18 (95% confidence interval (CI) 0.02-0.34) and 0.58 (95% CI 0.45-0.72), respectively., Conclusions: Malnutrition was present in both urban and rural adolescent girls. The most obvious disparity between the two populations was significant stunting in the rural population. There is therefore an urgent need for strategies to address severe nutritional problems in rural adolescent girls and to improve the nutrition of adolescent girls within the urban environment.

Introduction: Malaria remains a significant public health problem in endemic regions of the world, most especially in sub-Saharan Africa. As part of the global efforts to control malaria, dichlorodiphenyltrichloroethane (DDT), a cheap and effective chemical, was endorsed by the World Health Organization for use in indoor residual spraying (IRS). However, in the light of evidence on the acute toxicity of DDT, concerns have grown about the safety or the possible chronic health effects from the continued use of this persistent chemical, generating much debate and research efforts over the years. The purpose of this study was to identify, appraise and synthesise evidence about the chronic adverse effects of long-term exposure to DDT in children, 0-18 years, in zones where IRS is practised, in order to contribute to informing policy decisions., Methods: Twenty-seven electronic databases were systematically searched using pre-defined inclusion/exclusion criteria. Two were trial registers while 25 others indexed studies of various designs. Other complementary methods were also employed in searching for both published and grey literature. Eligible studies were critically appraised using amended versions of available validated guidelines (and in a case, an improvised guideline) and a narrative synthesis was undertaken., Results: Only nine studies met the inclusion/exclusion criteria out of 3281 hits generated. Five of the studies are of high quality while four are of moderate quality. For the three studies on neurodevelopment, evidence suggestive of negative impact of DDT was found. For the three studies on endocrine/congenital disorders, ambivalent evidence existed. In the case of the immunity-related outcome, there was growing but insufficient evidence of negative effect. The only study on survival outcome was inconclusive., Conclusions: Empirically, insufficient evidence exists with regard to the chronic adverse effects of long-term exposure of children to DDT through IRS. Considering the dearth of studies and the fact that many adverse effects might take much longer time to manifest, inferences drawn are weak. It would therefore require a series of well-coordinated observational studies done in the context of IRS to adequately address this evidence gap in the future.

Introduction: Anthropogenic factors, as well as environmental factors, can explain fine-scale spatial differences in vector densities and seasonal variations in malaria. In this pilot study, numbers of Anopheles gambiae were quantified in concessions in a rural area of southern Benin, West Africa, in order to establish whether vector number and human factors, such as habitat and living practices, are related., Methods: The courtyard homes of 64 concessions (houses and private yards) were systematically and similarly photographed. Predefined features in the photographed items were extracted by applying an analysis grid that listed vector resting sites or potential breeding sites and also more general information about the building materials used. These data were analysed with respect to entomological data (number of mosquitoes caught per night) using the Kruskal-Wallis test, Pearson correlation coefficients, and analysis of covariance (ANCOVA)., Results: Three recurrent habitat/household types and living practices were identified that corresponded to different standards of living. These were related to the average number of mosquitoes captured per night: type I=0.88 anopheles/night; type II=0.85; and type III 0.55, but this was not statistically significant (Kruskal-Wallis test; p=0.41). There were no significant relationships between the number of potential breeding sites and number of mosquitoes caught (Pearson's correlation coefficient=-0.09, p=0.53). ANCOVA analysis of building materials and numbers of openings did not explain variation in the number of mosquitoes caught., Conclusions: Three dwelling types were identified by using predetermined socio-environmental characteristics but there was no association found in this study between vector number and habitat characteristics as was suspected.

Introduction: Snakebite envenoming is a major cause of morbidity and mortality in rural areas of the tropics. Timely administration of effective antivenom remains the mainstay of management., Methods: The study was a quantitative descriptive study aimed at exploring the causes and effects of delay, distance and time taken to access care on snakebite outcomes in Nigeria. All prospective snakebite victims reporting to Kaltungo General Hospital were enrolled. Data on demography, date and time bitten, date and time admitted, site of bite, circumstances of snakebite, responsible snake, clinical features, 20-minute whole-blood clotting test, antivenom administered and outcome were recorded. Delay arising from use of traditional first aid (TFA), time elapsed from snakebite to presentation and the shortest distance from bite location to the hospital was calculated or obtained using a global positioning system., Results: The association between delay before hospital presentation and poor outcome was not statistically significant, even though there was a 2% higher likelihood of poor outcome among those with a 1-hour delay compared to those without delay (odds ratio 1.02, 95% confidence interval 1.00-1.03). There was no difference in distance from bite location to hospital between those with a poor outcome (74) compared to those with a good outcome (325). Those with a poor outcome had more severe envenomation requiring more antivenoms and longer hospital stays. Given poor access to antivenom therapy at distant locations &#8805;100 km, victims were more likely to use TFA such as black 'snake' stone, with consequent prolonged delays. Antivenoms should be more readily available at distant places., Conclusions: Community education on avoiding potentially harmful TFA and prompt access to care is recommended. There is a need to provide snakebite care to multiple peripheral, relatively more rural inaccessible areas.

Objectives: High rates of household participation are critical to the success of door-to-door vector control campaigns. We used the Health Belief Model to assess determinants of participation, including neighbour participation as a cue to action, in a Chagas disease vector control campaign in Peru., Methods: We evaluated clustering of participation among neighbours; estimated participation as a function of household infestation status, neighbourhood type and number of participating neighbours; and described the reported reasons for refusal to participate in a district of 2911 households., Results: We observed significant clustering of participation along city blocks (p<0.0001). Participation was significantly higher for households in new versus established neighbourhoods, for infested households, and for households with more participating neighbours. The effect of neighbour participation was greater in new neighbourhoods., Conclusions: Results support a 'contagion' model of participation, highlighting the possibility that one or two participating households can tip a block towards full participation. Future campaigns can leverage these findings by making participation more visible, by addressing stigma associated with spraying, and by employing group incentives to spray.

Background: The prevalence of anaemia in Africa is the highest in the world. Especially women are at risk because of blood loss during menstruation and increased iron requirements during pregnancy. This study examined determinants of the haemoglobin (Hb) level of African women at individual/household, cluster, district, and national level. Special attention was paid to socioeconomic factors and the presence of health facilities., Methods: Data were derived from Demographic and Health Surveys conducted between 2003 and 2010 in 21 African countries. We included all women aged 15-49 who participated in a women's survey and had a Hb measurement. Multilevel models were used to examine the influence of various factors at different hierarchical levels simultaneously., Results: 104 899 women were included in the study, of which 23.1% were anaemic (Hb<110 g/L). Socioeconomic factors were strongly related to the Hb level of women. Wealth, education, having a job, occupation of the partner, presence of a toilet facility, context educational level and preventive health measures were positively associated with the Hb level. Interaction analysis indicated that socioeconomic differences in the Hb level of women were reduced by the presence of health facilities., Conclusions: Interventions aimed at improving the Hb level of African women should take socioeconomic and contextual aspects into account. Increasing availability of health facilities might be a tool for reducing socioeconomic differences.

Introduction: The Asia-Pacific region is the likeliest location for the next significant outbreak of highly pathogenic avian influenza (HPAI). Indonesia has experienced HPAI H5N1 outbreaks in poultry and humans each year since 2003 and has had the highest case fatality rate for human cases. The purposes of this study were to capture the knowledge of avian influenza and of poultry-raising practices in two regions of Indonesia and to evaluate the impact and extent of activities undertaken to 2010 through the National Strategic Plan for Avian Influenza Control at the village level., Methods: A combination of quantitative and qualitative methods was used to investigate the multiple influences on behaviours, decisions and actions taken by poultry-raising households, and by villages and communities, regarding the threat of HPAI. Between June 2010 and May 2011 a structured survey of 400 households was conducted on Lombok and of 402 on Bali, inviting Sector 3 (small-scale independent commercial poultry farms) and Sector 4 (village household) poultry raisers to participate. Focus groups and in-depth interviews were convened with key stakeholders, including livestock and animal health and public health officials, community leaders and villagers., Results: From the focus group and in-depth interviews, it appears that the flow of information through the national HPAI control program has been efficient at the top levels (from national to provincial, then to districts and subdistricts). However, these findings show that effective transmission of information from subdistrict to rural village level and from village leaders to community members has been limited. The degree of community preparedness for HPAI on Bali and Lombok appears minimal. Knowledge of government activities was more extensive at Bali sites, while only limited government programs and activities occurred at the village level on Lombok. Activities conducted by government agencies from provincial to village level were limited in scope and need to be further developed to ensure safe poultry-handling practices and biosecurity measures. On both Bali and Lombok, community respondents knew the signs and symptoms of sick birds but did not differentiate well between HPAI and other bird diseases. On both islands, more than 60% of respondents were reluctant to report sudden deaths of poultry. The lack of a government compensation program for destroyed flocks contributed to this unwillingness to report., Conclusions: While the Indonesian government's planning efforts for HPAI are commendable, the plan has not been effective, as it depends on the cooperative actions of people with small rural farms who have not been consulted in the development of the plan, have not been adequately instructed on the nature of the plan, and perceive no benefits to themselves from prevention efforts. Context-appropriate mechanisms for communicating zoonotic risk and options for risk mitigation that do not result in net loss to poor households are also needed.

Introduction: Early diagnosis and supervised treatment remains the mainstay for tuberculosis (TB) control in India., Methods: A facility-based cross-sectional study was conducted to assess diagnostic and treatment practices of tuberculosis management as per the Revised National Tuberculosis Control Programme at a secondary level health facility in north India. This hospital mostly caters to rural and peri-urban populations in the Ballabgarh block of Faridabad district, Haryana. A sample size of 244 was calculated. Consecutive chest symptomatic patients were recruited in the study. Information about socio-demographic characteristics and treatment was obtained from a routine history-taking process in the outpatient clinic. Results were expressed as mean, standard deviation (SD) and odds ratio (OR) with 95% confidence interval (CI)., Results: A total of 250 pulmonary TB suspects were recruited, out of which 55.4% were males and mean age of study participants was 35.4 years (SD 14.6). Almost half (47.1%) of the participants had sought treatment from government hospitals, followed by 46.7% from private hospitals. Those who had visited a private facility were significantly more likely not to receive sputum acid-fast bacillus (AFB) diagnostic testing (OR=7.26, 95% CI 4.04-13.08), likely to be taking a second-line anti-TB drug as an antibiotic trial (OR=3.65, 95% CI 1.17-11.30), be empirically taking anti-TB drugs (OR=5.28, 95% CI 1.50-118.64) and getting a serological test done (OR=9.58, 95% CI 1.20-76.0) than those who went to a government health facility. Those who made at least three visits to a private facility were significantly more likely to have taken a second-line anti-TB drug as an antibiotic trial (OR=3.56, 95% CI 1.36- 9.28) and be empirically taking anti-TB drugs (OR=5.75, 95% CI 2.18-15.20) than those that made fewer than three visits., Conclusions: This study documented inappropriate diagnostic and treatment practices in TB management and highlights the need to generate awareness about it among health practitioners in north India.

The disease melioidosis, caused by the bacterium Burkholderia pseudomallei, remains an important and sometimes neglected cause of disease in tropical regions of Australia. Infection may present in myriad ways, and diagnosis often requires consideration of this organism prior to culture. Laboratory identification of B. pseudomallei requires specialised testing beyond that available in many routine diagnostic microbiology laboratories. For this reason, cases outside of the traditional endemic zone, often occurring years after initial exposure to the organism, may remain undiagnosed or are delayed in diagnosis. Furthermore, the high levels of intrinsic antimicrobial resistance associated with B. pseudomallei often render empirical therapies ineffective. Health professionals, particularly those in rural and remote areas of Australia, must consider melioidosis in their differential diagnoses and remain abreast of advances in the field of this important emerging disease.

Introduction: Australian natural resource exploration and production companies are employing paramedics to provide emergency medical response, primary health care, injury prevention, and health promotion services in remote locations nationally and internationally. Although Australian paramedic practice has steadily evolved to include increasingly complex medical interventions in the prehospital setting, paramedics are not yet registered health professionals, and in many states and territories their title is not protected. Similarly, tertiary-level education is becoming the entry to practice standard for traditional ambulance paramedics; however, certificate- and diploma-level paramedic courses remain an acceptable pathway to private and industrial paramedic jobs. To ensure acceptable patient safety standards are maintained and to protect all related stakeholders, the role, skills, training, and professional capacity of industrial paramedics must be defined., Methods: The study objective was to explore the published literature for a definition for the discipline of industrial paramedicine. A comprehensive systematic analysis was conducted using the EBSCOhost (health), MEDLINE, SCOPUS, and CINAHL electronic databases. The primary search terms "remote", "offshore", "mining", and "oil" were combined with the secondary search terms "paramedic" and "emergency medical services"., Results: An initial search using the combined two-term sets identified 870 citations. After application of the inclusion and exclusion criteria to a title and abstract review, 69 citations met the criteria including those discovered by searching the reference lists. Of these, nine citations were excluded because full-text papers could not be found and eight citations were excluded based on review of the full article. The result was 40 articles that discuss the role of paramedics in the remote or offshore environment (ROP) and 12 articles that discuss the provision of emergency medical services in the mining or oil and gas sectors (MOEMS). There is no single definition or comprehensive role description for industrial paramedic practice within the literature., Conclusions: Worldwide, there is little high-quality published evidence to adequately reflect all aspects of industrial paramedic practice. However, based on the literature available, this definition is offered: 'An industrial paramedic is an advanced clinical practitioner in paramedicine with an expanded scope of practice. The industrial paramedic provides emergency response, primary health care, chronic disease management, injury prevention, health promotion, medical referral, and repatriation coordination at remote mining sites, offshore installations, and other isolated industry settings. The industrial paramedic is resourceful, adaptable, and comfortable working independently. Industrial paramedics practice on site with limited resources, remotely located from tertiary care, and use telemedicine to consult with other health professionals as required. Industrial paramedics are experts at rapidly assessing, prioritising, and establishing control in their unpredictable workspace to reduce risks and create an environment conducive to quality patient care. The industrial paramedic preferably holds a specialised tertiary qualification and is committed to maintaining their clinical competency through continuing professional development.' Further research is required to validate, refute, or expand this proposed definition.