Device associated healthcare associated infection (DA-HAI): a detailed analysis of risk factors and outcomes in a university hospital in Rome, Italy.

Introduction: This study investigates the impact of invasive procedures on healthcare-associated infections (HAI) at Policlinico Universitario Tor Vergata in Rome, Italy, aiming to understand their role in device-associated HAI and to inform prevention strategies. Methods: A retrospective cohort analysis was conducted, examining mandatory discharge records and microbiology data from 2018 across all departments. The study focused on adult patients, analysing the correlation between invasive procedures and HAI through univariate and multivariate logistic regression. Results: Of the 12,066 patients reviewed, 1,214 (10.1%) experienced HAI. Univariate analysis indicated an association between invasive procedures and HAI (OR = 1.81, P < 0.001), which was not observed in multivariable analysis. Specific procedures significantly raised HAI risks: temporary tracheostomy (AOR = 22.69, P <0.001), central venous pressure monitoring (AOR = 6.74, P <0.001) prolonged invasive mechanical ventilation (AOR = 4.44, P <0.001), and venous catheterisation (AOR = 1.58, P <0.05). Aggregated high-risk procedures had an increased likelihood of HAI in multivariable analysis (OR = 2.51, P < 0.001). High-risk departments were also notably associated with HAI (OR = 6.13, P < 0.001). Conclusions: This study suggests that specific invasive procedures, such as temporary tracheostomy, significantly increase HAI risks. The results highlighting the need for targeted infection prevention and control procedures and supports the need for innovative methods such as record-linkage in policymaking to address HAI. These findings inform clinical practice and healthcare policy to improve patient safety and care quality.

Investigating Physical, Social, Emotional, and Health Frailties of Cancer Survivors after Cancer Treatment: The Urgent Call for Tailored Multidisciplinary Survivorship Plans in Italy.

BACKGROUND: Understanding the specific needs of cancer survivors is essential for healthcare policy. In Italy, dedicated studies are lacking, so we aimed to investigate the physical, mental, social, and health difficulties encountered by these patients. METHODS: We conducted a cross-sectional study on breast or colorectal cancer survivors (people 5+ years free from it and its treatments) using an ad hoc survey including validated questionnaires (Grauer-Palombi, SF-36, PREDIMED). Participants were recruited within the Oncology Unit of the "Policlinico Tor Vergata", Italy. RESULTS: A total of 62 patients (80.6% females; years range: 37-87) agreed to be interviewed. A profile of cancer survivors was drafted: an overaged person with multiple co-morbidities, not well-nourished, adhering to the Mediterranean diet, reporting critical conditions as for physical and functional status. The mean number of co-morbidities was 3.6 ± 2.4 SD, with a statistically significant difference between age groups (under and over 65). Compared to the general population, the sample showed more frailties, especially when >65. The risk of having multimorbidity (four or more co-morbidities) significantly increased in those over 65 (OR: 4.72; CI: 1.43-15.59). CONCLUSION: There is an urgent need for survivorship care planning for the patient-centered continuum of care. Assessing and monitoring their specific needs will help propose appropriate and tailored responses.

Vaccine Hesitancy, Knowledge, and COVID-19 Vaccination in a Sample of Italian and Albanian Healthcare Students Attending an University in Albania.

BACKGROUND: Vaccine hesitancy (VH) has increased over the past decade with large geographical variations between countries, posing a threat to global public health. This phenomenon is growing in the general population as well as among healthcare workers (HCWs), who are the most reliable source of vaccine-related information for patients. Special attention must therefore be paid to medical students, who are the future HCWs. METHODS: We conducted a cross-sectional study (November 2022-January 2023) on all the Albanian and Italian students attending medical science courses at the Catholic University "Our Lady of Good Counsel" (Tirane, Albania) to investigate VH and the factors contributing to it (using the Vaccination Attitude Examination Scale-VAX), including COVID-19 vaccination. Vaccine knowledge was assessed using the Zingg and Siegrist Scale. Students were asked to voluntarily answer an anonymous questionnaire. RESULTS: 689 questionnaires were collected (58.8% Albanians, 72.3% female; 70.4% aged 20-25 years; 70.4% attending the Medicine and Surgery course). Generally, students showed low VH, especially Italians (p < 0.001); however, some hesitancy was observed regarding the potential long-term effects of vaccines, especially among Albanians (p < 0.05). The results also showed a significant difference in vaccine knowledge scores between different course years (χ2 = 90.058; df = 40; p = < 0.001) and different degree courses (χ2 = 89.932; df = 40; p = < 0.001). With regard to COVID-19 vaccination, being of Albanian origin significantly increases the risk of not being vaccinated (OR = 7.215; 95%CI 3.816-13.640, p < 0.001), highlighting possible differences in vaccine coverage and policy between the two countries. CONCLUSION: Vaccine hesitancy should be addressed at early stages during medical sciences courses, in order to protect future healthcare workers, to preserve essential health services, and reduce the risk of further pandemics.

Prevalence and risk factors of posttraumatic stress symptoms among Internally Displaced Christian couples in Erbil, Iraq.

Background: Research about the impact of war and displacement experiences on the mental health of Internally Displaced People (IDPs) has recently grown. However, a limited number of studies focus on minorities. The objective of the present preliminary study was to estimate the prevalence of posttraumatic stress symptoms (PTSSs) among IDPs who live outside camps and belong to the Christian minority in Iraq, and to identify possible predictors. Methods: Overall, 108 internally displaced Christians (54 married couples) participated in the study. Traumatic events and PTSSs were assessed using the Harvard Trauma Questionnaire. Multivariable linear regression models were used to investigate possible predictors of PTSSs. Multivariable logistic regression models have been developed to estimate the odds of presenting PTSSs. Results: Results demonstrated high rates of trauma exposure, with all participants having experienced at least three traumatic events. The estimated prevalence of PTSSs was 20.3%. A low economic status, the number of traumatic events, and a second experience of displacement were associated with increased PTSSs. Five traumatic events were identified as the main predictors of PTSSs. Conclusion: Findings from the current preliminary study indicated the impact of war-related traumatic events on IDPs' mental health and the negative effects of post-displacement experiences. These findings may have important implications for setting up psychosocial interventions, as well as for further promoting physical and mental health services among these populations.

A novel, integrated approach for understanding and investigating Healthcare Associated Infections: A risk factors constellation analysis.

INTRODUCTION: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) are major public health threats in upper- and lower-middle-income countries. Electronic health records (EHRs) are an invaluable source of data for achieving different goals, including the early detection of HAIs and AMR clusters within healthcare settings; evaluation of attributable incidence, mortality, and disability-adjusted life years (DALYs); and implementation of governance policies. In Italy, the burden of HAIs is estimated to be 702.53 DALYs per 100,000 population, which has the same magnitude as the burden of ischemic heart disease. However, data in EHRs are usually not homogeneous, not properly linked and engineered, or not easily compared with other data. Moreover, without a proper epidemiological approach, the relevant information may not be detected. In this retrospective observational study, we established and engineered a new management system on the basis of the integration of microbiology laboratory data from the university hospital "Policlinico Tor Vergata" (PTV) in Italy with hospital discharge forms (HDFs) and clinical record data. All data are currently available in separate EHRs. We propose an original approach for monitoring alert microorganisms and for consequently estimating HAIs for the entire period of 2018. METHODS: Data extraction was performed by analyzing HDFs in the databases of the Hospital Information System. Data were compiled using the AREAS-ADT information system and ICD-9-CM codes. Quantitative and qualitative variables and diagnostic-related groups were produced by processing the resulting integrated databases. The results of research requests for HAI microorganisms and AMR profiles sent by the departments of PTV from 01/01/2018 to 31/12/2018 and the date of collection were extracted from the database of the Complex Operational Unit of Microbiology and then integrated. RESULTS: We were able to provide a complete and richly detailed profile of the estimated HAIs and to correlate them with the information contained in the HDFs and those available from the microbiology laboratory. We also identified the infection profile of the investigated hospital and estimated the distribution of coinfections by two or more microorganisms of concern. Our data were consistent with those in the literature, particularly the increase in mortality, length of stay, and risk of death associated with infections with Staphylococcus spp, Pseudomonas aeruginosa, Klebsiella pneumoniae, Clostridioides difficile, Candida spp., and Acinetobacter baumannii. Even though less than 10% of the detected HAIs showed at least one infection caused by an antimicrobial resistant bacterium, the contribution of AMR to the overall risk of increased mortality was extremely high. CONCLUSIONS: The increasing availability of health data stored in EHRs represents a unique opportunity for the accurate identification of any factor that contributes to the diffusion of HAIs and AMR and for the prompt implementation of effective corrective measures. That said, artificial intelligence might be the future of health data analysis because it may allow for the early identification of patients who are more exposed to the risk of HAIs and for a more efficient monitoring of HAI sources and outbreaks. However, challenges concerning codification, integration, and standardization of health data recording and analysis still need to be addressed.

Improvement in dietary diversity and feeding habits of malnourished under-five children attending supplementary feeding programmmes: a community-based cross-sectional study in Zambia.

A community-based cross-sectional study was conducted on 390 under-five malnourished children enrolled in the Rainbow Project supplementary feeding programmmes-SFPs. Dietary diversity, feeding habits and nutritional status at admission (T1) and at discharge (T2) were compared. At T1 the diet was monotonous and unbalanced, with a progressive decline in dietary diversity and anthropometric values noted with children's age growth (p < 0.001). Significant improvements were registered at T2: DDS 5.1 ± 1.1 SD vs. 8.3 ± 1.0 SD; meal frequency 3.0 ± 0.6 SD vs. 4.9 ± 0.2 SD; animal-protein consumed 62.8% vs. 90.5%; drinking water treated 41.0% vs. 97.2%. At T1, the risk of having ZMUAC < 2.5SD increased when teenage motherhood (AOR: 5.3; CI: 1.8-15.2; p = 0.002), followed by children's age >2 years (AOR: 1.9; CI: 1.1-3.5; p = 0.020). Children's age was associated with an increased risk of WAZ < 2.5 SD (AOR: 4.9; CI: 2.4-10.4; p < 0.001). When considering inadequate DDS, the variable associated was breastfeeding cessation (AOR: 12.0; CI: 4.6-31.4; p < 0.001). Rainbow's SFPs have proved effective in treating under-five malnourished children, irrespective of the severity of malnutrition.

Hesitancy toward Childhood Vaccinations: Preliminary Results from an Albanian Nursing Staff's Investigation.

Healthcare professionals are important models for their patients since their individual knowledge and attitudes toward vaccination can influence the patient's willingness to adhere to vaccination campaigns. After developing a structured questionnaire, it was administered to a sample of nursing staff working in public vaccination centers in Albania (December 2020-January 2021), in order to conduct a preliminary investigation aimed at describing knowledge, attitudes, beliefs, and hesitancy toward childhood vaccinations. Among the sample of nurses involved in the administration of vaccines (n.64, 92% females), most of them were confident about vaccines and favorable to childhood vaccinations (90%). However, when specifically investigating beliefs, nearly a quarter of the sample showed to be hesitant; 22% were unsure or partially agreed that vaccines might cause conditions such as autism and multiple sclerosis. A high risk of hesitancy was identified in the youngest staff especially when their work experience was below 10 years or when they graduated less than 10 years before (OR: 5.3, CI: 1.4-19.5; and OR: 4.2 CI: 1.2-14.6). Similarly, a low acceptance rate (54%) was detected for future childhood SARS-CoV-2 vaccines among the nurses, which is a sign of high levels of vaccine hesitancy. With regard to knowledge about childhood vaccine contraindications, none of the nurses identified all the ten correct answers, while only 13% answered at least six questions correctly. These preliminary results highlight the need of investigating more Albanian nursing staff's knowledge and attitudes toward child vaccinations, therefore investing in tailored training. Due to the ongoing Covid-19 pandemic and the roll-out of mass vaccination, the role of healthcare workers remains crucial and needs more support to manage the changing public opinion as well as quickly evolving vaccine technologies.

Biological Risk in Italian Prisons: From the COVID-19 Management to the Development of a Standardized Model for Emergency Response.

Within the confinements of critical infrastructures, the COVID-19 pandemic is posing a series of challenges to Health Management. In the spotlight of highly contagious and quick spreading diseases within such enclosed facilities, whether it be a detention facility or otherwise, the health and safety of those living within its internment is paramount. This paper aims to highlight the specific challenges and the possible solutions to counteract this problem, starting from the lessons learnt from the Italian prison system case study. Following the general description of the available resources within the Italian prisons, the study aimed at specifically describing the first counteracting measures deployed by the Italian prison authorities during the first phase of the COVID-19 outbreak (February-July 2020). The aim was to propose an integrated plan capable of responding to a biological threat within the prisons. In particular, the study describes the actions and technical features that, in accordance with national and international legal frameworks and the relevant organisational bodies that run the Italian Prison Service, had been adopted in managing, right from the start, the COVID-19 pandemic until Summer 2020. Available information and data showed the ability of the prison administration to comply almost completely with WHO's technical and human rights recommendations and also, in successfully handling prison emergencies both in terms of the sick and the deceased in line with the epidemiological framework of the general population. In addition, the paper proposes a draft of guidelines that should involve the National Health Service and the Prison Service that are aimed at supporting the local prison facilities with drawing up their own biological incident contingency plans. An approved, legal, standardised plan could increase the awareness of prison managers. It could even increase their self-confidence, in particular, with regard to cases of dispute and their ability to respond to them. In fact, it is valuable and forward-thinking to be able to demonstrate that every endeavour has been taken and that 'certified' best practices have been put in place in accordance with the national standards.

The exacerbated prevalence of acute malnutrition and growth retardation in Roma children living in camps.

BACKGROUND: Child malnutrition is still a concern in marginalized groups of populations, such as immigrants living in very low socio-economic conditions. Roma children are within the most hard-to-reach populations, susceptible to undernutrition and growth retardation. In the city of Rome (Italy), the Hospital "Bambino Gesù", in collaboration with the Catholic Association Community of Saint'Egidio, is dedicating free services for the health and nutritional needs of vulnerable people. METHODS: A retrospective analysis was conducted on immigrant children visited at different ages (0-11 years old). Records including nutritional and growth assessment were collected from 2016 up to May 2020. Malnutrition was classified following the WHO 2006 standards. Data for Roma children living in extra-urban camps and non-Roma immigrant children living in urban areas were analyzed, odds ratios and univariate binary regressions were performed to investigate the risk of malnutrition within the two groups. RESULTS: A sample of 414 children (57% under-five; 51.9% Roma), was included in the database. In the under-five children, underweight accounted for 7.6%, stunting for 11.7%, and wasting for 2.9%. The first year of life was the most crucial for nutritional status. Compared to the counterpart, Roma children accounted for nearly the total rate of malnutrition (wasting 4.8% vs. 1%; stunting 21.4% vs. 2%; underweight 14.2% vs. 1%). Univariate logistic regression confirmed under-five Roma children being at the highest risk of stunting at 12 months (OR: 16.1; CI 2-132; p = 0.01). When considering the 176 school-aged children, undernutrition affected most Roma children (13% vs 1.9%), followed by stunting (5.8% vs 0.9%). Univariate logistic regression confirmed that Roma school-aged children were more likely to be underweight (OR: 7.8; CI 1.6-37.6; p = 0.01). CONCLUSIONS: Malnutrition in immigrant children is still of high concern in Italy. Its prevalence in Roma children living in extra-urban camps exceeds that of immigrant children living in urban areas and the rates of underweight, stunting and wasting of Roma children living in the Balkans. This exacerbating condition highlights the need of better assisting this fragile population that is at most risk of poverty, food insecurity and social exclusion in Italy, particularly during this pandemic crisis.

Infectious Diseases Seeker (IDS): An Innovative Tool for Prompt Identification of Infectious Diseases during Outbreaks.

BACKGROUND: Several technologies for rapid molecular identification of pathogens are currently available; jointly with monitoring tools (i.e., web-based surveillance tools, infectious diseases modelers, and epidemic intelligence methods), they represent important components for timely outbreak detection and identification of the involved pathogen. The application of these approaches is usually feasible and effective when performed by healthcare professionals with specific expertise and skills and when data and resources are easily accessible. Contrariwise, in the field situation where healthcare workers or first responders from heterogeneous competences can be asked to investigate an outbreak of unknown origin, a simple and suitable tool for rapid agent identification and appropriate outbreak management is highly needed. Most especially when time is limited, available data are incomplete, and accessible infrastructure and resources are inadequate. The use of a prompt, user-friendly, and accessible tool able to rapidly recognize an infectious disease outbreak and with high sensitivity and precision may be a game-changer to support emergency response and public health investigations. METHODS: This paper presents the work performed to implement and test an innovative tool for prompt identification of infectious diseases during outbreaks, called Infectious Diseases Seeker (IDS). IDS is a standalone software that runs on the most common operative systems. It has been built by integrating a database containing an interim set of 60 different disease causative agents and COVID-19 data and is able to work in an off-line mode without requiring a network connection. RESULTS: IDS has been applied in a real and complex scenario in terms of concomitant infectious diseases (yellow fever, COVID-19, and Lassa fever), as can be in the second part of 2020 in Nigeria. The outcomes have allowed inferring that yellow fever (YF), and not Lassa fever, was affecting the area under investigation. CONCLUSIONS: Our result suggests that a tool like IDS could be valuable for the quick and easy identification and discrimination of infectious disease outbreaks even when concurrent outbreaks occur, like for the case study of YF and COVID-19 pandemic in Nigeria.

Epidemiology of Hypoalbuminemia in Hospitalized Patients: A Clinical Matter or an Emerging Public Health Problem?

Serum albumin levels are strongly associated with the morbidity, prognosis, and mortality rates of patients with hypoalbuminemia, which is a frequent problem during hospitalization. An observational retrospective study was carried out to analyze changes in albumin levels in hospitalized patients at the "Fondazione Policlinico Tor Vergata-PTV" in 2018. The prevalence of preexisting hypoalbuminemia at the time of discharge from hospital was investigated using a sample of 9428 patients. Information was collected from the discharge files recorded in the central informatics system of the hospital. Analysis of albumin levels at admission and at discharge was conducted by classes of albuminemia and then stratified by age. At the time of admission, hypoalbuminemia was found to be present in more than half of the sample, with no sex differences. The serum albumin level tended to decrease with age, with pathologic levels appearing from 50 years and progressive worsening thereafter. The condition of marked and mild hypoalbuminemia was more prevalent in patients over 65 years of age. Our findings suggest that hypoalbuminemia should be considered a dangerous condition in itself and a serious public health problem. We aimed to emphasize the role of albumin as useful marker of the in-hospital malnutrition and frailty, to be integrated in the routinely assessment of patients for reconsidering ad hoc healthcare pathways after discharge from hospital, especially when dealing with fragile populations.

Supporting Iraqi Kurdistan Health Authorities in Post-conflict Recovery: The Development of a Health Monitoring System.

Background: Iraq has endured several conflicts and socio-political tensions that have disrupted its public health system. Nowadays, because health data are not collected on a routine basis, the country still lacks proper statistics and, consequently, response plans to meet present and future health needs of its population. An international partnership is developing in the Iraqi Kurdistan a Health Monitoring System with the aim of supporting evidence-based health policy decisions. Methods: The pilot phase for assessing the feasibility of the programme was launched in 2015. In 2018 the implementation phase began. The first step was to choose the software platform and the coding system, as well as to identify the public hospitals (PH) and Public Health Centers (PHC) to be included in the e-health system. The technical infrastructure of each PHC or PH was updated. The staff of each center was trained in the use of the e-health system and in disease coding. Several seminars introduced regional and district health managers to the basic concepts of data-driven decision making. A local team of experts was trained to create a highly specialized staff with the objective of "training the trainers" and ensuring the future self-sufficiency of the system. Results: By September 2019, 59 PHC and PH were entering data in the Health Monitoring System, while 258 health operators (medical doctors, administrative staff, nurses, statisticians, IT and public health specialists, pharmacists) have been already trained. Currently, more than 600,000 disease events have been collected. Additionally, further 734 medical doctors, statisticians, and health managers have been trained on the basics of public health practice. The goal during the next 3 years is to reach 120 operative centers within the region, envisaging a subsequent expansion of the system to all Iraq. Conclusions: The creation of a functioning health monitoring system is feasible also in regions characterized by socio-political tensions. However, multiple stakeholder partnerships are essential. The provision of an e-health information system, coupled with the establishment of a team of local experts, allows the routinely and timely collection of health information, facilitating prompt responses to present and emerging needs, while guiding the formulation and evaluation of health policies.

Access to health care, nutrition and dietary habits among school-age children living in socio-economic inequality contexts: results from the "ForGood: Sport is Well-Being" programme.

Social frailty is a warring phenomenon in Europe, negatively impacting children's health and nutrition. We present the results of a social programme facilitating access to physical activities for vulnerable children in Italy. 311 school-age children enrolled in the programme between 2015 and 2017 were assessed for health and lifestyle, anthropometric and nutritional status. Data were compared by origin (Italians vs. immigrants) and then immigrants were split into sub-groups: first- and second-generation. Poor socio-economic status exposed children to a lack of access to health services, and drove imbalanced eating behaviour. 20.8% of children were not registered with the National Health Services (immigrants p < .0001); 22% were not fully vaccinated (no differences between groups). A double burden of malnutrition coexisted: overweight was higher for Italians, underweight and poor linear growth for immigrants. Nearly 40% of children had a poor Mediterranean Diet adequacy (KIDMED index). Our findings show that when social programmes, besides their main scope of inclusion and integration, holistically approach their beneficiaries, they can play an important role in monitoring lifestyle conditions and facilitating access to primary health care.

Early assessment of weight velocity can support frontline health workers in predicting malnutrition in HIV-exposed infants: preliminary results from a DREAM cohort in Malawi.

BACKGROUND: Children born to HIV-positive mothers are particularly susceptible to malnutrition. Currently, monitoring programs rely on punctual anthropometric measurements to assess child growth. Growth velocities could be an additional tool in identifying critical time windows for prevention and implementation of early intervention for malnutrition. METHODS: A retrospective analysis was conducted using data from 817 HIV exposed but uninfected children extracted from DREAM program database. By using the WHO reference for growth standards, patterns of weight velocity for different intervals of assessment from one to 18 months of age were explored. Odds ratios and multinomial logistic regressions between selected weight velocity Z-scores thresholds and successive malnutrition indices (at 6, 12, 18 months of age) were calculated. RESULTS: Weight velocity was above the standard mean in the first 3 months, then progressively declined over time. In children with normal nutritional status, significant risks of becoming malnourished (mild malnutrition - underweight [OR 10.8; 95% CI: 4.5-26], chronic malnutrition - stunting [OR 8.3; 95% CI: 2-34.9] and acute malnutrition - wasting [OR 11.7; 95% CI: 1.5-90.5]) started when weight velocity Z-scores <0, at all interval ages. Multinomial regression showed that in the first 6 months, the weight velocity decrements strongly impacted on underweight (OR 17.9; 95% CI: 4-80.7), while the risk of Stunting occurred later at 18 months (OR 8.7; 95% CI: 4.3-17.6), with highest impact at the lowest thresholds. CONCLUSIONS: The assessment of weight velocity Z-scores, coupled with the already validated malnutrition indices, can support frontline health workers in early prediction of child malnutrition and performing nutritional counselling in the context of HIV/AIDS and food insecurity.

Developing a Public Health Monitoring System in a War-torn Region: A Field Report From Iraqi Kurdistan.

Wars, terrorism, and embargos destroyed facilities and shattered the public health system of Iraq. Today, there is limited documented knowledge about the health situation of the Iraqi population, particularly because health data are not systematically collected. Therefore, the capacity of the health system to address the major health problems of the population is considerably reduced. This report describes the implementation, started in 2015, of an electronic system for epidemiological monitoring and health surveillance, designed to collect and manage health care data in Iraqi Kurdistan. The aim of the program is to network all of the main health centers and hospitals of the region, then of the whole country, and to train medical and administrative staff in the management and analysis of health data. In countries recovering from war, a functioning health monitoring system is essential in guiding the development of appropriate public health interventions, a key instrument to prepare the health system to respond to future emergencies.

A novel approach for geographical risk mapping of morbidity and mortality rates: the case of Val D'Agri, Italy.

While associations between exposure to air pollutants and increased morbidity and mortality are well established, few rigorous studies on this issue are available. The aim of the current study is to implement a new approach to the spatial analysis of mortality and morbidity, based on testing for the presence of the same association in other areas of similar size. Additionally, we perform a case study in Val d'Agri (VA), an area of Basilicata Region, Southern Italy, where oil and natural gas extraction began in 1998. In order to examine the spatial distribution of morbidity and mortality in the region of interest, Hospital discharge (2001-2013) and mortality (2003-2014) rates for the main environment-related diseases were calculated. In addition, a comparison between the period 1980-1998 and the period 1999-2014 was performed for cardiovascular disease mortality. For the period under study, a neutral scenario emerged for cancer and respiratory diseases, where we found no differences in morbidity and mortality as compared to the national benchmark. In some cases significantly lower values (as compared to the nation-wide benchmark) were found. Conversely, a slight excess in morbidity and mortality (as compared to the nation-wide benchmark) emerged for cardiovascular diseases. Still, this excess was common to a number of municipalities in the surroundings of VA, and appeared to be already present in 1980. Higher rates of cardiovascular diseases, lower rates of neoplastic disorders no differences in mortality for respiratory causes (as compared to the nation-wide benchmark) were found in multiple areas of the region, and were therefore not specific to VA. In summary, our data do not support the hypothesis of a role of industrial activities related to oil extraction in VA in determining mortality and morbidity patterns and trends.

Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015⁻17 in Zambia.

BACKGROUND: Child malnutrition, in all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012⁻14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in 2015⁻17. METHODS: The outcomes were compared with International Standards and with those of 2012⁻14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. RESULTS: The data for 900 under-five year-old malnourished children were analyzed. Rainbow's 2015⁻17 outcomes met International Standards, for total and also when stratified for different type of malnutrition. A better performance than 2012⁻14 was noted in the main areas previously identified as critical: mortality rates were halved (5.6% vs. 3.1%, p = 0.01); significant improvements in average weight gain and mean length of stay were registered for recovered children (p < 0.001). HIV infection (5.5; 1.9⁻15.9), WAZ <⁻3 (4.6; 1.3⁻16.1), and kwashiorkor (3.5; 1.2⁻9.5) remained the major predictors of mortality. Secondly, training community volunteers consistently increased the awareness of a child's HIV status (+30%; p < 0.001). CONCLUSION: Rainbow SFPs provide an integrated community-based approach for the treatment and prevention of child malnutrition in Zambia, with its effectiveness significantly enhanced after the gaps in activities were filled.

Community-Based Management of Child Malnutrition in Zambia: HIV/AIDS Infection and Other Risk Factors on Child Survival.

(1) BACKGROUND: Supplementary feeding programs (SFPs) are effective in the community-based treatment of moderate acute malnutrition (MAM) and prevention of severe acute malnutrition (SAM); (2) METHODS: A retrospective study was conducted on a sample of 1266 Zambian malnourished children assisted from 2012 to 2014 in the Rainbow Project SFPs. Nutritional status was evaluated according to WHO/Unicef methodology. We performed univariate and multivariate Cox proportional risk regression to identify the main predictors of mortality. In addition, a time-to event analysis was performed to identify predictors of failure and time to cure events; (3) RESULTS: The analysis included 858 malnourished children (19 months ± 9.4; 49.9% males). Program outcomes met international standards with a better performance for MAM compared to SAM. Cox regression identified SAM (3.8; 2.1-6.8), HIV infection (3.1; 1.7-5.5), and WAZ <-3 (3.1; 1.6-5.7) as predictors of death. Time to event showed 80% of children recovered by SAM/MAM at 24 weeks. (4) CONCLUSIONS: Preventing deterioration of malnutrition, coupled to early detection of HIV/AIDS with adequate antiretroviral treatment, and extending the duration of feeding supplementation, could be crucial elements for ensuring full recovery and improve child survival in malnourished Zambian children.

Schistosoma haematobium infection, health and nutritional status in school-age children in a rural setting in Northern Senegal.

BACKGROUND: The aim of this study was to investigate the occurrence of urinary schistosomiasis in school children in a rural village of Northern Senegal, and to evaluate the impact of this parasitic infection on children's health, growth, and nutritional status. METHODS: A cross-sectional survey was carried out on 465 children resident in the village of Kassak Nord, in Senegal, in an area which is highly endemic for Schistosoma haematobium. Data on health, nutritional status and urinary schistosomiasis were collected. RESULTS: The overall prevalence of urinary schistosomiasis in school children in Kassak was 47.4%. As for malnutrition, 29.7% of children were malnourished (BMI-for-age Z-score [BAZ] <-2) and 14.5% had a significant linear growth retardation (height-for-age Z-score [HAZ] <-2). Children with urinary schistosomiasis showed lower mean BAZ and HAZ than uninfected children (HAZ positives -0.7±1.4 vs. HAZ negatives -0.4±1.4, P=0.004; BAZ positives -1.5±1 vs. BAZ negatives -1.3±1.1, P=0.03). It was also found that infected children were at greater risk of malnutrition (BAZ<-2; OR 1.5; 95% CI 1.01-2.26). CONCLUSIONS: The results of this study support the hypothesis that urinary schistosomiasis affects negatively childhood health and nutritional status and are of importance for planning intervention aimed to monitoring and control Urinary Schistosomiasis and malnutrition.