Analysis of the 2007-2018 National Health Interview Survey (NHIS): Examining Neurological Complications among Children with Sickle Cell Disease in the United States.

This study compared neurological complications among a national sample of United States children with or without sickle cell disease (SCD) and evaluated health status, healthcare and special education utilization patterns, barriers to care, and association of SCD status and demographics/socioeconomic status (SES) on comorbidities and healthcare utilization. Data was acquired from the National Health Interview Survey (NHIS) Sample Child Core questionnaire 2007-2018 dataset that included 133,542 children. An affirmation from the guardian of the child determined the presence of SCD. Regression analysis was used to compare the associations between SCD and demographics/SES on neurological conditions at p < 0.05. Furthermore, adjusted odds ratios (AORs) were estimated for having various neurological conditions. Of the 133,481 children included in the NHIS, the mean age was 8.5 years (SD: 0.02) and 215 had SCD. Of the children with SCD, the sample composition included male (n = 110), and Black (n = 82%). The SCD sample had higher odds of having neuro-developmental conditions (p < 0.1). Families of Black children (55% weighted) reported household incomes < 100% of federal poverty level. Black children were more likely to experience longer wait times to see the doctor (AOR, 0.3; CI 0.1-1.1). Compared to children without SCD, those with SCD had a greater chance of seeing a medical specialist within 12 months (AOR 2.3; CI 1.5-3.7). This representative sample of US children with SCD shows higher odds of developing neurological complications, increased healthcare and special education services utilization, with Black children experiencing a disproportionate burden. This creates the urgency to address the health burden for children with SCD by implementing interventions in healthcare and increasing education assistance programs to combat neurocognitive impairments, especially among Black children.

An Analysis of the Prevalence and Factors Influencing Food Insecurity among University Students Participating in Alcohol Consumption in KwaZulu-Natal Province.

Food insecurity among the student population is a prominent issue in South African university institutions. However, personal experiences and the myriad of underlying factors contributing to the issue remain poorly documented. Among other factors, these universities are characterized by the admission of a majority of their student population from poor backgrounds with limited financial capabilities, and this affects their food security status. The purpose of this study was to view the patterns of food insecurity among students, with a focus on alcohol consumption as one of the various factors influencing student food security status. Data were collected from 156 student respondents from the University of KwaZulu-Natal, Durban University of Technology, Mangosuthu University of Technology, and the University of Zululand. The Household Food Insecurity Access Scale revealed that from the total sample, only 21.79% reported themselves as food secure, whilst the remainder reported varying levels of food insecurity with 17.31% of students being food insecure, 16.03% mildly food insecure, and 44.87% severely food insecure. On the other hand, a prevalence of 73.08% (n = 114) of alcohol consumption was found among the sampled students. Ordered probit models results suggested that students' alcohol consumption prevalence was determined by gender, level of study, exercise/playing sport, marital status, and distance to campus, which all had statistically significant effects on students' alcohol consumption. Most crucially, gender, institution and campus positively affected students' food security status, while the income variable made a negative significant contribution towards student food security status. Therefore, a link between students' finances and food insecurity was evident. However, further research is required to delve into the link between the level and impact of students' alcohol consumption and its implications on their financial status, and thus food security status. This is crucial information which will help policymakers understand these underlying factors and experiences and thus find solutions for issues related with food insecurity.

Youth Participation in Agriculture: A Scoping Review.

Providing economic opportunities for youth in agriculture is essential to securing the future of agriculture in Africa, addressing poverty, unemployment, and inequality. However, barriers limit youth participation in agriculture and the broader food system. This scoping review aimed to investigate the opportunities and challenges for youth in participating in agriculture and the food system in Africa. This review conducted a scoping review using the PRISMA guideline. Published studies were retrieved from online databases (Web of Science, Cab Direct, and Science Direct) for 2009 to 2019. The findings showed that existing agricultural interventions are production-centric and provide low-income earnings and inadequate social protection. We also found that the youth have pessimistic perceptions about agriculture's capability of improving their living standards. This could be ascribed to the minimal youth involvement in agricultural activities and the youth's shared understanding of the agricultural sector's contribution to general economic growth. From a policy perspective, the literature revealed that current agricultural development programs do not adequately address structural issues underpinning youth participation in the economy. Therefore, to enhance the involvement of youths in agriculture, there is a need for policy implementation in the area of integrated agricultural-based interventions that are context-specific and promote meaningful youth participation in shaping future food systems.

Implementation of the therapeutic use of hydroxyurea for sickle cell disease management in resource-constrained settings: a systematic review of adoption, cost and acceptability.

OBJECTIVES: Mortality associated with sickle cell disease (SCD) is high in many low- and middle-income countries (LMICs). Hydroxyurea, a medicine to effectively manage SCD, is not widely available in resource-constrained settings. We identified and synthesised the reported implementation outcomes for the therapeutic use of hydroxyurea for SCD in these settings. DESIGN: Systematic review. DATA SOURCES: PubMed, Embase, Cochrane, Web of Science Plus, Global Health, CINAHL, and PsycINFO were searched February through May 2019 without any restrictions on publication date. ELIGIBILITY CRITERIA: We included empirical studies of hydroxyurea for management of SCD that were carried out in LMICs and reported on implementation outcomes. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently assessed studies for inclusion, carried out data extraction using Proctor et al.'s implementation and health service outcomes, and assessed the risk of bias using ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions). RESULTS: Two cross-sectional surveys (n=2) and one cohort study (n=1) reported implementation of hydroxyurea for SCD management, namely regarding outcomes of adoption (n=3), cost (n=3) and acceptability (n=1). These studies were conducted exclusively among paediatric and adults populations in clinical settings in Nigeria (n=2) or Jamaica (n=1). Adoption is low, as observed through reported provider practices and patient adherence, in part shaped by misinformation and fear of side effects among patients, provider beliefs regarding affordability and organisational challenges with procuring the medicine. There was no difference in the cost of hydroxyurea therapy compared with blood transfusion in the paediatric population in urban Jamaica. Risk of bias was low or moderate across the included studies. CONCLUSIONS: This review rigorously and systematically assessed the evidence on implementation of hydroxyurea in resource-constrained settings such as LMICs. Findings suggest that knowledge regarding implementation is low. To address the know-do gap and guide clinical practice, implementation research is needed. Integrating effective interventions into existing health systems to improve hydroxyurea uptake is essential to reducing SCD-associated mortality. PROSPERO REGISTRATION NUMBER: CRD42020155953.