Progress Towards Elimination of Trachoma in Kenya 2017-2020.

PURPOSE: Trachoma is endemic in Kenya. Since baseline trachoma surveys in 2004, a concerted programme has been undertaken to reduce the prevalence of disease. Here, we report on trachoma prevalence surveys carried out between 2017 and 2020 after interventions were implemented in some areas for trachoma elimination purposes. METHODS: A total of 48 cross-sectional population-based trachoma prevalence surveys were conducted in 39 evaluation units (EUs; covering 45 subcounties) of Kenya between 2017 and 2020. Thirty EUs were surveyed once and nine EUs were surveyed twice over this period. Individuals ≥ 1 year old were assessed for trachomatous inflammation-follicular (TF), trachomatous inflammation-intense (TI) and trichiasis. Data were collected on household access to water, sanitation and hygiene (WASH). RESULTS: A total of 147,573 people were examined. At the end of 2020, in the 39 EUs surveyed, the prevalence of TF in 1-9-year-olds was ≥5% in 11 EUs and the prevalence of trichiasis unknown to the health system in individuals aged ≥15 years was ≥0.2% in 25 EUs. A small minority of households (median <50% for all indicators) had access to improved WASH facilities. CONCLUSION: Kenya has made excellent progress towards elimination of trachoma as a public health problem. However, there is more work to do. Between one and three rounds of antibiotic mass drug administration are required in 11 EUs. Sustained investment in surgical provision, continued TT case-finding, promotion of facial cleanliness and environmental improvement are required throughout the surveyed area.

Prevalence of Trachomatous Trichiasis in Ten Evaluation Units of Embu and Kitui Counties, Kenya.

BACKGROUND: Late-stage blinding sequalae of trachoma such as trachomatous trichiasis (TT) typically take decades to develop and often do so in the absence of ongoing ocular Chlamydia trachomatis infection. This suggests that most TT risk accumulates in early life; as a result, population-level TT incidence and prevalence can remain high years after C. trachomatis transmission among children has decreased. In Embu and Kitui counties, Kenya, the prevalence of trachomatous inflammation - follicular is low in children. In this survey, we set out to determine the prevalence of TT in ten evaluation units (EUs) in these counties. METHODS: We undertook ten cross-sectional prevalence surveys for TT. In each EU, people aged ≥15 years were selected by a two-stage cluster sampling method and examined for TT. Those with TT were asked questions on whether they had been offered management for it. Prevalence was adjusted to the underlying age and gender structure of the population. RESULTS: A total of 18,987 people aged ≥15 years were examined. Per EU, the median number of examined participants was 1,656 (range: 1,451 - 3,016) and median response rate was 86% (range: 81 - 95%). The prevalence of TT unknown to the health system in people aged ≥15 years was above the threshold for elimination (≥0.2%) in all ten EUs studied (range: 0.2-0.7%). TT was significantly more common in older than younger individuals and in women than in men. DISCUSSION: Provision of surgical services should be strengthened in Embu and Kitui counties of Kenya to achieve the World Health Organization threshold for eliminating TT as a public health problem.

The barriers to the full implementation of strategic purchasing and the role of health policy and decision-makers: past, current status, ethical aspects and future challenges.

Healthcare systems are complex, multi-level, highly integrated organizations, comprising of different professional figures, institutions, and resources. Such breadth and complexity reflect the multi-dimensionality of the concept of health, which implies the adoption of a holistic approach. Health, rather than merely being the absence of disorders or infirmity, is a highly dynamic state, which represents the abilities of an individual to cope with adverse social, physical and emotional/psychological events and conditions, continuously adapting to them. Ensuring an adequate health state is one of the most important concerns, and the healthcare systems are called to renew themselves in order to meet with the new challenges and health needs. Throughout the last decades, due to demographic shifts and transitions, epidemiological and societal changes, technological achievements and scientific advancements, healthcare systems have undergone an extensive series of reform plans. Therefore, health policy- and decision-makers have made efforts to develop and implement initiatives for preserving the quality of the healthcare provisions. Strategic purchasing is an approach of purchasing that takes into account several health-related issues such as a proper, comprehensive planning of service delivery, the design and selection of the best packages of services and provisions, the appropriate selection of providers and the allocation of economical and financial incentives to provide better services and to motivate managers to adopt appropriate policies to implement strategic purchasing. Here, we intend to consider the various dimensions and aspects that can be effective in strategic purchasing, as well as the main barriers and obstacles that hinder its full implementation.

Tristetraprolin Is Required for Alveolar Bone Homeostasis.

Tristetraprolin (TTP) is an RNA-binding protein that targets numerous immunomodulatory mRNA transcripts for degradation. Many TTP targets are key players in the pathogenesis of periodontal bone loss, including tumor necrosis factor-α. To better understand the extent that host immune factors play during periodontal bone loss, we assessed alveolar bone levels, inflammation and osteoclast activity in periodontal tissues, and immune response in draining cervical lymph nodes in TTP-deficient and wild-type (WT) mice in an aging study. WT and TTP-deficient (knockout [KO]) mice were used for all studies under specific pathogen-free conditions. Data were collected on mice aged 3, 6, and 9 mo. Microcomputed tomography (µCT) was performed on maxillae where 3-dimensional images were generated and bone loss was assessed. Decalcified sections of specimens were scored for inflammation and stained with tartrate-resistant acid phosphate (TRAP) to visualize osteoclasts. Immunophenotyping was performed on single-cell suspensions isolated from primary and peripheral lymphoid tissues using flow cytometry. Results presented indicate that TTP KO mice had significantly more alveolar bone loss over time compared with WT controls. Bone loss was associated with significant increases in inflammatory cell infiltration and an increased percentage of alveolar bone surfaces apposed with TRAP+ cells. Furthermore, it was found that the draining cervical lymph nodes were significantly enlarged in TTP-deficient animals and contained a distinct pathological immune profile compared with WT controls. Finally, the oral microbiome in the TTP KO mice was significantly different with age from WT cohoused mice. The severe bone loss, inflammation, and increased osteoclast activity observed in these mice support the concept that TTP plays a critical role in the maintenance of alveolar bone homeostasis in the presence of oral commensal flora. This study suggests that TTP is required to inhibit excessive inflammatory host responses that contribute to periodontal bone loss, even in the absence of specific periodontal pathogens.

Towards an understanding of marine fouling effects on the vortex-induced vibrations of circular cylinders: partial coverage issue.

The results of in-water vortex-induced vibration (VIV) experiments on circular cylinders artificially covered with barnacles are reported. The paper focusses on the effects of the partial coverage and the shape of the fouling elements. An artificial barnacle typical of marine fouling was synthesised using 3-D printing. Coverage ratios of 80, 50 and 30% were examined and the results compared with those from a smooth cylinder. The Reynolds number ranged from 5.8 × 103 to 6.6 × 104. The experimental results show that the fouling reduced the peak VIV amplitude, narrowed the synchronisation region and lowered the hydrodynamic force coefficients such as the coefficients of lift force RMS, the mean drag force and the fluctuating drag force RMS. The shape of the artificial barnacles had little effect on the maximum oscillation amplitude. The coverage ratio appeared to have a lower impact on the lift force than those on the amplitude and the frequency responses.

Using the objective structured clinical examinations in undergraduate midwifery students.

The Objective Structured Clinical Examination (OSCE) has been considered a modern type of examination for the assessment of clinical skills within nurse education, but it has been rarely applied in the teaching of midwifery. The aim of the present study was to assess the use of the OSCE as a tool to evaluate the abilities of undergraduate midwifery students and to compare the perspectives of the students regarding the OSCE and traditional examination. Fifty-two midwifery students participated in the study. The export trainer evaluated the internal consistency of the OSCE stations and it was tested by using Cronbach's alpha. Successive groups of students completed a self-administered questionnaire immediately after the final examination. The students' perspective regarding the traditional final examination ranked as unsatisfactory by more than two thirds of the students, while, the students' perspective regarding the OSCE system was ranked as very satisfactory to satisfactory by more than half of the students (p=0.001). There was a significant difference in the students' perspective between the OSCE system and the traditional final examination among the students (49.8±18.3 vs 25.3±18.1) (p=0.001). A significant difference was found in being credible (p=0.0001), consistent/reliable (p=0.001), enhances teaching level (p=0.011), and measures the course category (p=0.008) between two methods of the final examination. Around half of the students expressed their opinion that the OSCE test was a stressful assessment. Overall, students' evaluation of the OSCE was remarkably encouraging. To this end, we recommend the consideration of the validity and reliability of the process for undergraduate midwifery students.

Spatial analysis of Cd and Pb in the Pike (Esox lucius) from Western Anzali wetlands of Iran.

Geostatistical studies are used to estimate pollution burden in aquatic ecosystems and to plan large-scale control programs to protect these environments. Geostatistical studies allow us to predicted pollutant concentrations for areas that have not been sampled. This is done by taking into account the spatial correlations between estimated and sampled points and by minimizing the variance of estimation error. The use of geostatistical techniques in biomonitoring of fish species can illuminate extent and source of pollution, thereby providing an effective tool for developing intervention strategies to protect such environments. This study investigates the spatial distribution patterns of cadmium and lead in the Pike (Esox lucius). Fish were captured in the western parts of the Anzali wetlands located on the Caspian Sea in Iran. The muscle tissue of Anzali Pike had 5 ± 0.25 and 168 ± 18.4 (ng/g dw) cadmium and lead, respectively. Positive relationships were detected between Pike's length and weight (r = 0.85, p < 0.05), length and age (r = 0.35, p < 0.05), and muscle cadmium and lead (r = 0.45, p < 0.05). By contrast, there was a negative relationship between lead levels and weight in Pike (r = -0.36, p < 0.05). For both metals, the resulting metal concentration maps indicated higher pollutant concentrations in the southeast parts of the study area. Considerable boat traffic activity and agricultural activity contribute to the pollution in these areas, undermining the integrity of local habitat for fish survival and reproduction.

Effects of Soy on Body Composition: A 12-Week Randomized Controlled Trial among Iranian Elderly Women with Metabolic Syndrome.

BACKGROUND: To examine the effects of soy [in the form of textured soy protein (TSP) and soy-nut] on body composition in elderly women with metabolic syndrome (MetS). METHODS: A 12-week randomized clinical trial was conducted on 75 women between 60-70 years of age with MetS in rural health clinics around Babol, Iran in 2009. The participants were randomly assigned to one of the three groups of soy-nut (35g/d), TSP (35g/d) and control. Body fat, lean mass and anthropometric indicators were measured before and after intervention, too. RESULTS: Participants were classified as overweight and showing android fat distribution. After 12 weeks of intervention, both soy-nut and TSP groups showed an increase of non-significant in lean mass (0.9 and 0.7 kg), hip circumference (0.45 and 0.28 cm), triceps skinfold (TSF) thickness (0.87 and 0.67mm) and reduction in BMI (-0.15 and -0.33), waist circumference (-0.83 and -1.2) and body fat (-1.5% and -1.7%). Significant increase in the mean change of TSF and lean mass was observed in the users of soy-nut compared to the control group (P<0.01, P<0.05). CONCLUSION: 12-week intervention of soy had a mild favorable effect on body composition in elderly women with MetS.

Sensibilisation of asthmatic patients to extracted antigens from strains of Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger.

OBJECTIVE: The main purpose of this study sought to evaluate the frequency of sensitivity of Iranian asthmatic patients to three regional Aspergillus species of fumigatus, flavus and niger, by detection of antigen-specific IgE in the patients' sera. PATIENTS AND METHODS: Crude extracts were prepared following the disruption of fungi cell walls by the application of glass beads and their protein fractions were isolated by SDS-PAGE. After electrotransfer of protein bands into the nitrocellulose membrane, IgE-immunoblotting was performed against the sera from 32 asthmatic patients in addition to 20 healthy controls. RESULTS: Our results interestingly showed that all of the studied Iranian asthmatic patients were sensitive to A. fumigatus and A. flavus antigens. This frequency was 65.6% in the case of A. niger, however, all control samples were negative. Age/sex analysis generally indicated higher sensitivities of young patients (<30 years old) to Aspergillus species with a statistical significance in the case of A. niger (P=0.02) and additionally more sensitivity of females. Using Immunoblotting assay, 23 IgE-reactive allergenic components from A. fumigatus, 15 from A. flavus and 13 from A. niger in a broad molecular weight spectrum were identified, among which several fragments were not previously reported. CONCLUSION: Overall, this study found a high frequency of sensitivity of Iranian asthmatic patients to regional isolates of A. fumigatus, A. flavus and A. niger, which suggested the importance of these species in development of asthma. Moreover, we reported allergenic profiles of Iranian isolates in different patterns not previously observed.

Chlamydia trachomatis infection in women attending health centres in Babol: prevalence and risk factors.

We determined the prevalence of Chlamydia trachomatis infection and risk factors for infection among 550 sexually active women < 45 years attending gynaecology clinics in Babol, Islamic Republic of Iran. The women were interviewed about sociodemographic and behavioural variables associated with the infection and underwent pelvic examination and blood tests. The prevalence of C. trachomatis was 11.6%. There was a significant association between C. trachomatis infection and income, husband's education and woman's age (< 25 years), and also drug addiction of husband, non-use of condoms and not having heard of sexually transmitted infections. The only clinical signs significantly associated with infection were cervical friability and mucopurulent cervicitis.

Production and characterization of a new antibody specific for the mutant EGF receptor, EGFRvIII, in Camelus bactrianus.

EGFRvIII is the type III deletion mutant form of the epidermal growth factor receptor (EGFR) with transforming activity. This tumor-specific antigen is ligand independent, contains a constitutively active tyrosine kinase domain and has been shown to be present in a number of human malignancies. In this study, we report the production and characterization of camel antibodies that are directed against the external domain of the EGFRvIII. Antibodies developed in camels are smaller (i.e. IgG2 and IgG3 subclasses lack light chains) than any other conventional mammalian antibodies. This property of camel antibodies makes them ideal tools for basic research and other applications such as tumor imaging and cancer therapy. In the present study, camel antibodies were generated by immunization of camelids (Camelus bactrianus and Camelus dromedarius) with a synthetic 14-amino acid peptide corresponding to the mutated sequence of the EGFR, tissue homogenates of several patients with human glioblastoma, medulloblastoma and aggressive breast carcinoma, as well as EGFR-expressing cell lines. Three subclasses of camel IgG [conventional (IgG1, 160 kD) and heavy chain-only antibodies (IgG2 and IgG3, 90 kD)] were separated by their different binding properties to protein A and protein G affinity columns. The anti-EGFRvIII peptide antibodies from immunized camels were purified further using the EGFRvIII synthetic peptide affinity column. The purified anti-EGFRvIII peptide camel antibodies selectively bound to the EGFRvIII peptide and affinity-purified EGFRvIII from malignant tissues and detected a protein band of 140 kD from malignant tissues by Western blot. Affinity analysis showed that the antibodies from C. bactrianus and C. dromedarius reacted with peptide and antigen purified from a small cell lung cancer ascitic fluid with affinities of 2 x 10(8) and 5 x 10(7)M(-1) to the same extent, respectively. Since the functional antigen-binding domain of the anti-EGFRvIII antibodies in camels is much simpler and located only on the heavy chains of proteins, we are currently developing recombinant and smaller versions of the variable domain of these naturally occurring heavy-chain antibodies (V(HH)) for use in tumor imaging and cancer therapy.