RESUMO
Social network strategy (SNS) testing uses network connections to refer individuals at high risk to HIV testing services (HTS). In Tanzania, SNS testing is offered in communities and health facilities. In communities, SNS testing targets key and vulnerable populations (KVP), while in health facilities it complements index testing by reaching unelicited index contacts. Routine data were used to assess performance and trends over time in PEPFAR-supported sites between October 2021 and March 2023. Key indicators included SNS social contacts tested, and new HIV-positives individuals identified. Descriptive and statistical analysis were conducted. Univariable and multivariable analysis were applied, and variables with P-values <0.2 at univariable analysis were considered for multivariable analysis. Overall, 121,739 SNS contacts were tested, and 7731 (6.4%) previously undiagnosed individuals living with HIV were identified. Tested contacts and identified HIV-positives were mostly aged ≥15 years (>99.7%) and females (80.6% of tests, 79.4% of HIV-positives). Most SNS contacts were tested (78,363; 64.7%) and diagnosed (6376; 82.5%) in communities. SNS tests and HIV-positives grew 11.5 and 6.1-fold respectively, from October-December 2021 to January-March 2023, with majority of clients reached in communities vs. facilities (78,763 vs. 42,976). These results indicate that SNS testing is a promising HIV case-finding approach in Tanzania.
Assuntos
Infecções por HIV , Teste de HIV , Rede Social , Humanos , Tanzânia/epidemiologia , Feminino , Masculino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Adulto , Teste de HIV/métodos , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Programas de Rastreamento/métodos , Apoio Social , CriançaRESUMO
BACKGROUND: Drug regimens that include intensified antibiotics alongside effective anti-inflammatory therapies may improve outcomes in tuberculous meningitis (TBM). Safety data on their use in combination and in the context of human immunodeficiency virus (HIV) are needed to inform clinical trial design. METHODS: We conducted a phase 2, open-label, parallel-design, randomized, controlled trial to assess the safety of high-dose rifampicin, linezolid, and high-dose aspirin in HIV-associated TBM. Participants were randomized (1.4:1:1) to 3 treatment arms (1, standard of care [SOC]; 2, SOC + additional rifampicin [up to 35 mg/kg/d] + linezolid 1200 mg/d reducing after 28 days to 600 mg/d; 3, as per arm 2 + aspirin 1000 mg/d) for 56 days, when the primary outcome of adverse events of special interest (AESI) or death was assessed. RESULTS: A total of 52 participants with HIV-associated TBM were randomized; 59% had mild disease (British Medical Research Council (MRC) grade 1) vs 39% (grade 2) vs 2% (grade 3). AESI or death occurred in 10 of 16 (63%; arm 3) vs 4 of 14 (29%; arm 2) vs 6 of 20 (30%; arm 1; P = .083). The cumulative proportion of AESI or death (Kaplan-Meier) demonstrated worse outcomes in arm 3 vs arm 1 (P = .04); however, only 1 event in arm 3 was attributable to aspirin and was mild. There was no difference in efficacy (modified Rankin scale) between arms. CONCLUSIONS: High-dose rifampicin and adjunctive linezolid can safely be added to the standard of care in HIV-associated TBM. Larger studies are required to determine whether potential toxicity associated with these interventions, particularly high-dose aspirin, is outweighed by mortality or morbidity benefit. CLINICAL TRIALS REGISTRATION: NCT03927313.
Assuntos
Infecções por HIV , Tuberculose Meníngea , Humanos , Rifampina/efeitos adversos , Antituberculosos/efeitos adversos , Aspirina/efeitos adversos , Tuberculose Meníngea/complicações , Tuberculose Meníngea/tratamento farmacológico , Linezolida/efeitos adversos , HIV , Resultado do Tratamento , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológicoRESUMO
α-tocopherol is the physiologically most active form of vitamin E, with numerous biological activities, such as significant antioxidant activity, anticancer capabilities, and anti-aging properties. However, its low water solubility has limited its potential use in the food, cosmetic, and pharmaceutical industries. One possible strategy for addressing this issue is the use of a supramolecular complex with large-ring cyclodextrins (LR-CDs). In this study, the phase solubility of the CD26/α-tocopherol complex was investigated to assess the possible ratios between host and guest in the solution phase. Next, the host-guest association of the CD26/α-tocopherol complex at different ratios of 1:2, 1:4, 1:6, 2:1, 4:1, and 6:1 was studied by all-atom molecular dynamics (MD) simulations. At 1:2 ratio, two α-tocopherol units interact spontaneously with CD26, forming an inclusion complex, as supported by the experimental data. In the 2:1 ratio, a single α-tocopherol unit was encapsulated by two CD26 molecules. In comparison, increasing the number of α-tocopherol or CD26 molecules above two led to self-aggregation and consequently limited the solubility of α-tocopherol. The computational and experimental results indicate that a 1:2 ratio could be the most suitable stoichiometry to use in the CD26/α-tocopherol complex to improve α-tocopherol solubility and stability in inclusion complex formation.
Assuntos
Ciclodextrinas , alfa-Tocoferol , Dipeptidil Peptidase 4 , Antioxidantes , SolubilidadeRESUMO
OBJECTIVE: To determine the influence of major depressive disorders (MDD) on the cognitive function of adults living with HIV and the prevalence of neurocognitive impairment and major depressive disorders. METHODS: The study was a cross-sectional design conducted in a referral hospital in Dodoma region central Tanzania, with a sample of 397 participants attained through systematic sampling. Neurocognitive impairment was assessed by Montreal Cognitive Assessment (MoCA), while MDD was assessed using Mini International Neuropsychiatric Interview (M.I.N.I). Two-sample independent t-tests were done to compute the significance of the mean change of MoCA score between those with or without MDD. Univariate and multivariate ordinal logistic regression models were computed to determine the association between MDD and neurocognitive impairment across all cognitive domains. RESULTS: Of 397 recruited participants, 266 (66.00%) met the criteria for neurocognitive disorder and 22 (5.51%) had major depressive disorder. Participants with MDD performed significantly poorer on cognitive testing than those without MDD (mean difference = 3.74, p-value = 0.0009). Under univariate ordinal regression, impairments in the particular domains of visuospatial-executive function, attention, language, abstraction and orientation were significantly associated with MDD and abstraction (AOR: 3.922, 95% CI: 1.546-9.947, p = 0.0004) remained significant under multivariable regression. CONCLUSION: Major depressive disorder may negatively influence neurocognitive performance in both severity and pattern of presentation. Routine screening for depressive symptoms in HIV care can be beneficial for the overall patient's outcome. Systematic and well-designed studies in the area are crucial for understanding the interaction of neuropsychiatric disorders in the HIV population.
Assuntos
Transtorno Depressivo Maior/epidemiologia , Infecções por HIV , Síndrome da Imunodeficiência Adquirida , Adulto , Cognição , Estudos Transversais , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prevalência , Psicometria , Encaminhamento e Consulta , Tanzânia/epidemiologia , Adulto JovemRESUMO
Amylomaltase is a well-known glucan transferase that can produce large ring cyclodextrins (LR-CDs) or so-called cycloamyloses via cyclization reaction. Amylomaltases have been found in several microorganisms and their optimum temperatures are generally around 60-70 °C for thermostable amylomaltases and 30-45 °C for the enzymes from mesophilic bacteria and plants. The optimum pHs for mesophilic amylomaltases are around pH 6.0-7.0, while the thermostable amylomaltases are generally active at more acidic conditions. Size of LR-CDs depends on the source of amylomaltases and the reaction conditions including pH, temperature, incubation time, and substrate. For example, in the case of amylomaltase from Corynebacterium glutamicum, LR-CD productions at alkaline pH or at a long incubation time favored products with a low degree of polymerization. In this review, we explore the synthesis of LR-CDs by amylomaltases, structural information of amylomaltases, as well as current applications of LR-CDs and amylomaltases.
Assuntos
Ciclodextrinas/síntese química , Sistema da Enzima Desramificadora do Glicogênio/química , Bactérias/enzimologia , Sítios de Ligação , Ciclodextrinas/química , Fungos/enzimologia , Modelos Moleculares , Estrutura Molecular , Ligação Proteica , Conformação ProteicaRESUMO
OBJECTIVE: This study aimed to determine the burden of depression, suicidal ideation and suicidal behaviour amongst adolescents at sites in six sub-Saharan African countries and examine associated risk and protective factors. METHODS: Household-based cross-sectional study involving male and female adolescents ages 10-19 years. A total of 7,662 adolescents from eight sites in six countries participated in the survey. Three sites were urban: Dar es Salaam (Tanzania), Harar (Ethiopia) and Ibadan (Nigeria); five were rural: Dodoma (Tanzania), Iganga/Mayuge (Uganda), Kersa (Ethiopia), Ningo Prampram (Ghana) and Nouna (Burkina Faso). Log-binomials models were used to estimate relative risks and confidence intervals for factors associated with depression and suicidal behaviour. This was supplemented using log-Poisson models as needed. RESULTS: The prevalence of suicidal behaviour over the last 12 months ranged between 1.2% and 12.4% in the eight sites. Depressive symptoms and suicidal ideation/behaviours were associated with older age, female sex, food insecurity, poor access to health care and substance use. Depression was strongly associated with increased risk of suicidal behaviour at two sites where the multivariate model converged: Harar, Ethiopia (RR = 3.5, 95% CI 1.8, 7.0, P < 0.05) and Ibadan, Nigeria (RR = 3.7, 95% CI 2.2, 6.3, P < 0.0001). CONCLUSIONS: Depressive symptoms and suicidal behaviour are common amongst sub-Saharan African adolescents at these 8 sites. Most factors associated with depressive symptoms are modifiable and preventable. Routine screening for depressive symptoms in services frequented by adolescents in these and similar communities would be crucial in early detection and prompt intervention.
OBJECTIF: Cette étude visait à déterminer la charge de morbidité de la dépression, des idées suicidaires et du comportement suicidaire chez les adolescents sur des sites dans six pays d'Afrique subsaharienne et examiner les facteurs de risque et de protection associés. MÉTHODES: Etude transversale réalisée auprès des ménages sur des adolescents masculins et féminins âgés de 10 à 19 ans. 7.662 adolescents de huit sites dans six pays ont participé à l'enquête. Trois sites étaient en zones urbaines: Dar es Salaam (Tanzanie), Harar (Ethiopie) et Ibadan (Nigéria); cinq étaient en zones rurales: Dodoma (Tanzanie), Iganga/Mayuge (Ouganda), Kersa (Ethiopie), Ningo Prampram (Ghana) et Nouna (Burkina Faso). Des modèles de logarithme binomial ont été utilisés pour estimer les risques relatifs et les intervalles de confiance pour les facteurs associés à la dépression et au comportement suicidaire. Cela a été complété à l'aide de modèles log-Poisson lorsque nécessaire. RÉSULTATS: La prévalence des comportements suicidaires au cours des 12 derniers mois variait entre 1,2% et 12,4% dans les huit sites. Les symptômes dépressifs et les idées/comportements suicidaires étaient associés à l'âge plus avancé, au sexe féminin, à l'insécurité alimentaire, au faible accès aux soins de santé et à la toxicomanie. La dépression était fortement associée à un risque accru de comportement suicidaire sur deux sites où il y avait une convergence dans le modèle multivarié: Harar, en Ethiopie (RR = 3,5; IC95%: 1,8-7,0; P < 0,05) et Ibadan, au Nigéria (RR = 3,7; IC95%: 2,2-6,3; P < 0,0001). CONCLUSIONS: Les symptômes dépressifs et les comportements suicidaires sont fréquents chez les adolescents africains subsahariens de ces 8 sites. La plupart des facteurs associés aux symptômes dépressifs sont modifiables et évitables. Le dépistage de routine des symptômes dépressifs dans les services fréquentés par les adolescents dans ces communautés et dans des communautés similaires serait crucial pour la détection précoce et une intervention rapide.
Assuntos
Saúde Mental/estatística & dados numéricos , Ideação Suicida , Adolescente , Saúde do Adolescente , África Subsaariana/epidemiologia , Fatores Etários , Criança , Estudos Transversais , Depressão/epidemiologia , Feminino , Acessibilidade aos Serviços de Saúde , Nível de Saúde , Humanos , Entrevistas como Assunto , Masculino , Fatores Sexuais , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: The objective of this study was to evaluate gender differences in nutritional status, dietary intake, physical activity and hand hygiene among adolescents from diverse geographical settings in sub-Saharan Africa. METHODS: This study utilised cross-sectional data from six countries (Burkina Faso, Ethiopia, Ghana, Nigeria, Tanzania and Uganda) within the ARISE Adolescent Health Survey (n = 7625). Body mass index (BMI) was calculated using measured heights and weights, and z-scores were calculated based on the 2007 WHO growth standards for age and sex. Information on demographics, diet and health behaviours was collected through face-to-face interviews using a standardised questionnaire. Site-specific and pooled prevalence ratios were determined. RESULTS: The prevalence of underweight, overweight and stunting pooled across sites was 14.3%, 6.8% and 18.1%, respectively. Female sex was associated with a lower risk of being underweight (pooled prevalence ratio 0.66, 95% 0.57, 0.77) and stunted (pooled PR 0.63, 95% CI 0.55, 0.71), but a higher risk of being overweight (pooled PR 1.60, 95% CI 1.26, 2.06). Females were also less likely to exercise for 1 h or more per day (pooled PR 0.77, 95% CI 0.67, 0.88), and more likely to wash hands after using toilets or latrines and to wash hands with soap (pooled PRs 1.13, 95% CI 1.05, 1.21 and 1.35, 95% CI 1.23, 1.45, respectively). CONCLUSION: Our results emphasise that sex is a key predictor of nutritional status among sub-Saharan African adolescents and suggest that gender-specific interventions may be required to reduce the double burden of under- and overnutrition.
OBJECTIF: L'objectif de cette étude était d'évaluer les différences entre les sexes en matière d'état nutritionnel, d'apport alimentaire, d'activité physique et d'hygiène des mains chez les adolescents de divers contextes géographiques en Afrique subsaharienne. MÉTHODES: Cette étude a utilisé des données transversales provenant de six pays (Burkina Faso, Ethiopie, Ghana, Nigeria, Tanzanie et Ouganda) dans le cadre de l'enquête sur la santé des adolescents ARISE (n = 7.625). L'indice de masse corporelle (IMC) a été calculé à l'aide des mesures de la taille et du poids et les scores z ont été calculés sur la base des normes de croissance de 2007 de l'OMS pour l'âge et le sexe. Les informations sur la démographie, les comportements diététiques et de santé ont été recueillies lors d'entretiens se face à face à l'aide d'un questionnaire standardisé. Les rapports de prévalences poolés et spécifiques au site ont été déterminés. RÉSULTATS: La prévalence de l'insuffisance pondérale, du surpoids et du retard de croissance, répartie entre les sites, était de 14,3%, 6,8% et 18,1%, respectivement. Le sexe féminin était associé à un risque plus faible d'avoir une insuffisance pondérale (rapport de prévalence poolée, RP: 0,66 ; 95%: 0,57 - 0,77) et d'avoir un retard de croissance (RP poolé: 0,63 ; IC95%: 0.55-0.71), mais un risque plus élevé de surpoids (PR poolé: 1.60; IC95%: 1.26-2.06). Les filles étaient également moins susceptibles de faire de l'exercice physique pendant au moins une heure par jour (RP poolé: 0,77 ; IC95%: 0.67-0.88) et plus susceptibles de se laver les mains après avoir utilisé des toilettes ou des latrines et de se laver les mains au savon (RP poolé: 13.1; IC95%: 1.05-1.21 et 1.35; IC95%: 1.23-1.45 respectivement). CONCLUSION: Nos résultats soulignent que le sexe est un facteur prédictif de l'état nutritionnel chez les adolescents africains subsahariens et suggèrent que des interventions spécifiques au genre pourraient être nécessaires pour réduire la double charge de la sous-nutrition et de la suralimentation.
Assuntos
Índice de Massa Corporal , Comportamentos Relacionados com a Saúde , Estado Nutricional , Adolescente , Saúde do Adolescente , África Subsaariana/epidemiologia , Fatores Etários , Criança , Estudos Transversais , Dieta , Exercício Físico , Feminino , Humanos , Masculino , Sobrepeso/epidemiologia , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Magreza/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To determine the prevalence and risk factors associated with malnutrition among adolescents in a rural Tanzanian community. METHODS: Cross-sectional survey of 1226 randomly selected adolescents from the Dodoma Health and Demographic Surveillance System (HDSS) in the Chamwino district in the Dodoma region. Anthropometric measurements for weight and height were collected. Height-for-age-z-scores (HAZs) and body mass index (BMI)-for-age-z-scores (BAZs) were computed. Descriptive estimates were documented in graphs and tables, and weighted linear regression models were used to examine predictors of malnutrition. RESULTS: Stunting prevalence was 18%, and thinness prevalence was 14%. Overweight and obesity affected 5.23% of participants. Girls had higher HAZs (ß: 0.46, 95% CI 0.33, 0.59, P < 0.0001) and BAZs (ß: 0.20, 95% CI 0.05, 0.35, P = 0.0098) than boys. Age was inversely associated with HAZs (ß: -0.13, 95% CI -0.17, -0.08, P < 0.0001) and BAZs (ß: -0.05, 95% CI -0.10, -0.004, P = 0.0327). Wealth score (ß: 0.10, 95% CI 0.04, 0.16, P = 0.0009) and dietary diversity score (ß: 0.04, 95% CI 0.01, 0.07, P = 0.0080) were positively associated with HAZs and BAZs. Out-of-school adolescents had higher HAZs (ß: -0.49, 95% CI -0.75, -0.23, P = 0.0003) and BAZs (ß: -0.68, 95% CI -0.99, -0.37, P < 0.0001) than adolescents who attended school. CONCLUSION: There are substantial variations of HAZs and BAZs across gender, age, education and wealth, with an emerging burden of overweight and obesity among adolescents in this rural population. Interventions are urgently required to curb both ends of the malnutrition spectrum.
OBJECTIF: Déterminer la prévalence et les facteurs de risque associés à la malnutrition chez les adolescents d'une communauté rurale en Tanzanie. MÉTHODES: Enquête transversale auprès de 1.226 adolescents choisis au hasard dans le Système de Surveillance Démographique et de Santé (SSDS) de Dodoma dans le district de Chamwino, dans la région de Dodoma. Des mesures anthropométriques du poids et de la taille ont été recueillies. Les scores z de la taille pour l'âge (HAZ) et les scores z d'indice de masse corporelle (IMC) pour l'âge (BAZ) ont été calculés. Des estimations descriptives ont été documentées dans des graphiques et des tableaux, et des modèles de régression linéaire pondérés ont été utilisés pour analyser les prédicteurs de la malnutrition. RÉSULTATS: La prévalence du retard de croissance était de 18% et la prévalence de la maigreur était de 14%. Le surpoids et l'obésité touchaient 5,23% des participants. Les filles avaient des scores HAZ (ß: 0,46, IC95%: 0,33-0,59 ; P < 0,0001) et des scores BAZ (ß: 0,20 ; IC95%: 0,05-0,35 ; P = 0,0098) plus élevés que les garçons. L'âge était inversement associé au score HAZ (ß: −0,13, IC95%: −0,17, −0,08, P < 0,0001) et au score BAZ (ß: −0,05 ; IC95%: −0,104, −0,004 ; P = 0,0327). Le score de richesse (ß: 0,10 ; IC95%: 0,04-0,16; P = 0,0009) et le score de diversité alimentaire (ß: 0,04 ; IC95%: 0,01-0,07 ; P = 0,0080) étaient positivement associés aux scores HAZ et BAZ. Les adolescents non scolarisés présentaient des scores HAZ (ß: −0,49 ; IC95%: −0,75, −0,23 ; P = 0,0003) et des scores BAZ plus élevés (ß: −0,68 ; IC95%: −0,99 −0,37 ; P < 0,0001) que les adolescents qui fréquentaient l'école. CONCLUSION: Il existe des variations substantielles dans les scores HAZ et BAZ selon le sexe, l'âge, l'éducation et la richesse, avec une charge émergente de surpoids et d'obésité chez les adolescents dans la population rurale. Des interventions urgentes sont nécessaires pour réduire les deux extrémités du spectre de la malnutrition.
Assuntos
Desnutrição/epidemiologia , População Rural/estatística & dados numéricos , Adolescente , Saúde do Adolescente , Fatores Etários , Índice de Massa Corporal , Pesos e Medidas Corporais , Criança , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Sobrepeso/epidemiologia , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Tanzânia/epidemiologia , Magreza/epidemiologia , Adulto JovemRESUMO
The excretion of cyclodextrin glucanotransferase (CGTase) into the culture medium offers significant advantages over cytoplasmic expression. However, the limitation of Escherichia coli is its inability to excrete high amount of CGTase outside the cells. In this study, modification of the hydrophobic region of the N1R3 signal peptide using site-saturation mutagenesis improved the excretion of CGTase. Signal peptide mutants designated M9F, V10L and A15Y enhanced the excretion of CGTase three-fold and demonstrated two-fold higher secretion rate than the wild type. However, high secretion rate of these mutants was non-productive for recombinant protein production because it caused up to a seven-fold increase in cell death compared to the wild type. Our results indicated that the excretion of CGTase is highly dependent on hydrophobicity, secondary conformation and the type and position of amino acids at the region boundary and core segment of the h-region.
Assuntos
Asparaginase/genética , Glucosiltransferases/genética , Glucosiltransferases/metabolismo , Interações Hidrofóbicas e Hidrofílicas , Mutagênese Sítio-Dirigida , Mutação , Sinais Direcionadores de Proteínas/genética , Asparaginase/química , Asparaginase/metabolismo , Escherichia coli/genética , Escherichia coli/metabolismo , Glucosiltransferases/química , Sinais Direcionadores de Proteínas/fisiologia , Proteínas Recombinantes/biossíntese , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismoRESUMO
Background and Aims: Although exclusive breastfeeding (EBF) has many benefits, it is not commonly practiced in several countries as a result of context-specific challenges. EBF practice is thus a global health discourse because over 200 million children suffer from malnutrition despite the abundance of human milk. The risk of starvation remains very high among African children with less than 40% of them exclusively breastfed. In Africa, the adoption or nonadherence to EBF is a sociocultural issue. Hence, this narrative review examined the sociocultural context of EBF in the region. Methods: PubMed, Google Scholar, and Scopus were searched using keywords related to EBF and Africa. Relevant data from selected studies were synthesized narratively and reported using a structured narrative format. Results: EBF is strongly rooted in every culture and is a culturally determined behavior. Some believe that colostrum is dirty and harmful to newborns and, thus, needs to be purified. Despite the belief that human milk is the best food for babies, mothers often complement human milk with other foods right from birth because of perceived lactation inadequacy. Most African mothers believe in prelacteal feeding to help cleanse the infant's gastrointestinal tract for digestion, quench thirst, flush the bladder and help the mother to rest after childbirth before breastfeeding (BF) is initiated. The role of significant others was equally found important in the decision and duration of BF. The availability of family support (especially from grandmothers and husbands) reportedly encouraged EBF in Africa. The duration and exclusivity of BF in Africa are negatively associated with demographic variables like young age, low level of education, being unmarried, low income, out of employment, and parity (first-time mother). Conclusion: While there have been some efforts and policies to improve EBF, it is important to consider context-specific challenges and sociocultural factors. There is a need for more deliberate efforts to encourage mothers through the implementation of effective best practices concerning EBF in Africa.
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PURPOSE: This study aimed to implement and evaluate integrated, school-based nutrition intervention packages for adolescents in Dodoma, Tanzania. METHODS: A cluster randomized controlled trial was conducted among six secondary schools in Dodoma, Tanzania. Two schools received the full-intervention package of school meals, nutrition education, school gardens, and community workshops. Two schools received the partial-intervention package without the school meals component. Two schools served as the controls and did not receive any intervention. The intervention was implemented over one academic year. The analytical sample included 534 adolescents aged 14 to 17 at baseline and 286 parents. Outcomes included nutrition knowledge, food preferences, diet quality, food insecurity, physical activity, growth, and anemia. Linear models were used to estimate mean differences, and logistic regression models were used to estimate odds ratios (ORs). RESULTS: Compared to the control, both the partial (OR: 0.59; 95% confidence interval [CI]: 0.35, 1.00) and full (OR: 0.49; 95% CI: 0.40, 0.59) interventions were associated with lower odds of poor diet quality among adolescents. Among the parents, both the partial (OR: 0.28; 95% CI: 0.20, 0.40) and full (OR: 0.28; 95% CI: 0.13, 0.58) interventions were associated with lower odds of poor diet quality. The partial (OR: 0.29; 95% CI: 0.18, 0.47) and full (OR: 0.47; 95% CI: 0.30, 0.72) interventions were associated with lower odds of adolescent overweight or obesity. DISCUSSION: School-based nutritional intervention packages incorporating multiple actions may improve the diet quality of adolescents and their household members and reduce the double burden of adolescent malnutrition.
Assuntos
Instituições Acadêmicas , Humanos , Adolescente , Tanzânia , Masculino , Feminino , Jardins , Educação em Saúde/métodos , Serviços de Saúde Escolar , Dieta , Refeições , Exercício Físico , Jardinagem , Serviços de Alimentação , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Preferências Alimentares , Insegurança AlimentarRESUMO
OBJECTIVES: Tanzania observed a gradual increase in the number of measles cases since 2019 with a large outbreak recorded during 2022. This study describes the trend of measles in Tanzania over a 5-year period from 2018-2022. METHODS: This was a descriptive study conducted using routine measles case-based surveillance system including 195 councils of the United Republic of Tanzania. RESULTS: Between 2018 and 2022 there were 12,253 measles cases reported. Out of 10,691 (87.25%) samples tested by enzyme-linked immunosorbent assay, 903 (8.4%) were measles immunoglobulin M positive. The highest number of laboratory-confirmed measles cases was in 2022 (64.8%), followed by 2020 (13.8%), and 2019 (13.5%). Out of 1279 unvaccinated cases, 213 (16.7%) were laboratory-confirmed measles cases compared to 77/723 (10.6%) who were partially vaccinated and 71/1121 (6.3%) who were fully vaccinated (P < 0.001). Children aged between 1-4 years constituted the most confirmed measles cases after laboratory testing, followed by those aged 5-9 years. There was a notable increase in the number of laboratory-confirmed measles cases in children <1 year and 10-14 years during 2022 compared to previous years. The vaccination coverage of the first dose of measles-containing vaccine (MCV1) was maintained >90% since 2013 while MCV2 increased gradually reaching 88% in 2022. CONCLUSIONS: Accumulation of susceptible children to measles due to suboptimal measles vaccination coverage over the years has resulted in an increase in the number of laboratory-confirmed measles cases in Tanzania with more cases recorded during the COVID-19 pandemic. Strengthening surveillance, routine immunization, and targeted strategies are key to achieving the immunity levels required to interrupt measles outbreaks.
Assuntos
Sarampo , Pandemias , Criança , Humanos , Lactente , Pré-Escolar , Tanzânia/epidemiologia , Programas de Imunização , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vacina contra Sarampo , Vacinação , Surtos de Doenças/prevenção & controleRESUMO
Background and Aims: The core ethical perplexity is that physician-assisted suicide and euthanasia (PAS/E) contradicts the core value of medical practice which is about the duty of care to preserve life. While most arguments for and against euthanasia emerge from other continents, no African country legalizes or decriminalizes PAS/E. The essence of this scoping review is to collate evidence and scientific voices on euthanasia in Africa by synthesizing empirical articles on the subject in Africa. Methods: In this scoping review, a systematic search of five electronic research databases-PubMed, SCOPUS, CINHAL Complete, Allied and Complementary Medicine (AMED), and APA PsycInfo-was conducted to identify relevant articles conducted in Africa on euthanasia. After deduplication with the Rayyan software, the retrieved literature were screened for eligibility, and only eligible articles were included in the review. Relevant data from these articles were extracted and analyzed using narrative synthesis. Results: Only 14 articles reporting empirical studies, conducted in Africa, and published in English, were included in the review after a rigorous screening process. The review shows a wide rejection of euthanasia, but there is not much resistance to passive euthanasia, that is, withholding/withdrawing life-saving medical care from a terminally ill patient, mostly due to advanced age of the patient and the incurability of the illness. Many factors, such as religion, profession, and age help in shaping the way an individual view and understand PAS/E. Professionals take the patient's clinical condition and sociocultural context into consideration when making decisions about end-of-life care. The sociocultural context did not favor PAS/E. Conclusion: Euthanasia will continue to be a subject of controversy and debate in Africa and elsewhere. The majority of Africans hold the duty of care and preservation of life as the hallmark of medical practice, which informs the wide rejection of PAS/E.
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Amylomaltase can be used to synthesize large ring cyclodextrins (LR-CDs), applied as drug solubilizer, gene delivery vehicle and protein aggregation suppressor. This study aims to determine the functional amino acid positions of Corynebacterium glutamicum amylomaltase (CgAM) involved in LR-CD synthesis by site-directed mutagenesis approach and molecular dynamic simulation. Mutants named Δ167, Y23A, P228Y, E231Y, A413F and G417F were constructed, purified, and characterized. The truncated CgAM, Δ167 exhibited no starch transglycosylation activity, indicating that the N-terminal domain of CgAM is necessary for enzyme activity. The P228Y, A413F and G417F produced larger LR-CDs from CD36-CD40 as compared to CD29 by WT. A413F and G417F mutants produced significantly low LR-CD yield compared to the WT. The A413F mutation affected all tested enzyme activities (starch tranglycosylation, disproportionation and cyclization), while the G417F mutation hindered the cyclization activity. P228Y mutation significantly lowered the k cat of disproportionation activity, while E231Y mutant exhibited much higher k cat and K m values for starch transglycosylation, compared to that of the WT. In addition, Y23A mutation affected the kinetic parameters of starch transglycosylation and cyclization. Molecular dynamic simulation further confirmed these mutations' impacts on the CgAM and LR-CD interactions. Identified functional amino acids for LR-CD synthesis may serve as a model for future modification to improve the properties and yield of LR-CDs.
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There is a need to identify risk factors, including nutrition-related factors, for depressive disorders among sub-Saharan African (SSA) adolescents. We examined the association of multiple measures with depressive symptoms among adolescents living across six SSA countries. Building on previous analyses, we used data from a cross-sectional study conducted from 2015 to 2017 among adolescents aged 10-19 years in six SSA countries (N = 7512). Depressive symptoms were defined as highest tertile of the 6-item Kutcher Adolescent Depression Scale score. Using mixed-effects Poisson regression models, we pooled data across sites and examined the association of sociodemographic, nutrition, and other indices with depressive symptoms. We additionally assessed effect modification by sex, age, and school-going status. We observed higher risk of depressive symptoms among girls (adjusted risk ratio [RR]: 1.29, 95 % confidence interval [95 % CI]: 1.05-1.58, P = 0.016), older adolescents (RR for 18-19 years: 1.59, 95 % CI: 1.44-1.76, P < 0.001), and adolescents experiencing bullying (RR: 1.43, 95 % CI: 1.26-1.62, P < 0.001) or violence (RR: 1.34, 95 % CI: 1.24-1.45, P < 0.001). Adolescents experiencing food insecurity also had a higher risk of depressive symptoms (RR: 1.90, 95 % CI: 1.64-2.19, P < 0.001) along with those consuming ≥ 5 servings of fruit and vegetables per day (RR: 1.18, 95 % CI: 1.03-1.34, P = 0.015); conversely, those who consumed grains, roots and tubers in the past day were at decreased risk (RR: 0.73, 95 % CI: 0.69-0.77, P < 0.001). There was no strong evidence of effect modification of associations. This study reinforces the potential role of multiple sociodemographic and nutrition-related measures on risk of depressive symptoms in these populations.
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Objective: Language disorders (LD) in autism spectrum disorders (ASD) are highly variable and has a severe impact on the level of functioning in autistic children. Early diagnosis of these language disorders is essential for early interventions for children at risk. The electrophysiological measurements are considered valuable tools for determining language disabilities in children with ASD. This study aimed to study and compare ABR and MMN in autistic children with language disorders. Methods: This study included a group of typically developing children and a group of children diagnosed with autistic spectrum disorders and language disorders. Both groups were matching according to age and gender. After confirming bilateral normal peripheral hearing sensitivity, ABR was done and both absolute and interpeak wave latencies were correlated. MMN using frequency oddball paradigms were also obtained and correlated. Results: More abnormalities were reported in ABR test results in the form of delayed absolute latencies and prolonged interpeak intervals. Also, we reported prolonged latencies of MMN. Consequently, both ABR and MMN are complementary test in evaluating autistic children with language disorders. Conclusion: Our results support the hypothesis of remarkable dysfunction in basic auditory sound processing that may impact the linguistic development of autistic children.
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INTRODUCTION: The World Health Organization recommended the initiation of antiretroviral therapy (ART) for people living with HIV (PLHIV) regardless of CD4 cell counts. Tanzania adopted this recommendation known as test-and-treat policy in 2016. However, programmatic implementation of this policy has not been assessed since its initiation. The objective of the study was to assess the impact of this policy in Tanzania. METHODS: This was a cross-sectional study among PLHIV aged 15 years and older using routinely collected program data. The dependent variable was interruption in treatment (IIT), defined as no clinical contact for at least 90 days after the last clinical appointment. The main independent variable was test-and-treat policy status which categorized PLHIV into the before and after groups. Co-variates were age, sex, facility type, clinical stage, CD4 count, ART duration, and body mass index. The associations were assessed using the generalized estimating equation with inverse probability weighting. RESULTS: The study involved 33,979 PLHIV-14,442 (42.5%) and 19,537 (57.5%) were in the before and after the policy groups, respectively. Among those who experienced IIT, 4,219 (29%) and 7,322 (38%) were in the before and after the policy groups respectively. Multivariable analysis showed PLHIV after the policy was instated had twice [AOR 2.03; 95%CI 1.74-2.38] the odds of experiencing IIT than those before the policy was adopted. Additionally, higher odds of experiencing IIT were observed among younger adults, males, and those with advanced HIV disease. CONCLUSION: Demographic and clinical status variables were associated with IIT, as well as the test-and-treat policy. To achieve epidemic control, programmatic adjustments on continuity of treatment may are needed to complement the programmatic implementation of the policy.
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Fármacos Anti-HIV , Infecções por HIV , Masculino , Adulto , Humanos , Tanzânia/epidemiologia , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Organização Mundial da Saúde , Contagem de Linfócito CD4 , Fármacos Anti-HIV/uso terapêuticoRESUMO
There is very limited data on the extent and determinants of COVID-19 vaccine hesitancy among adults living in sub-Saharan Africa since the global roll-out of vaccines began in 2021. This multi-country survey sought to investigate COVID-19 vaccine hesitancy and other predictors of readiness to get vaccinated. We conducted surveys among adults residing in nine urban and rural areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania in late 2021. Log binomial regression models were used to identify prevalence and factors associated with vaccine hesitancy and beliefs around COVID-19 misinformation. We completed a total of 2,833 interviews. Among all respondents, 9% had never heard of a COVID-19 vaccine, 12% had been vaccinated, and 20% knew someone else who had been vaccinated. The prevalence of vaccine hesitancy varied by country (Ethiopia 29%, Burkina Faso 33%, Nigeria 34%, Ghana 42%, Tanzania 65%), but not by rural or urban context. People who did not think the vaccine was safe or effective, or who were unsure about it, were more likely to be vaccine hesitant. Those who reported they did not have a trusted source of information about the vaccine (aPR: 1.25, 95% CI: 1.18,1.31) and those who thought the vaccine would not be made available to them within the year were more likely to be vaccine hesitant. Women were more likely to be vaccine hesitant (aPR: 1.31, 95% CI: 1.19,1.43) and believe COVID-19 falsehoods (aPR: 1.05, 95% CI: 1.02,1.08). The most commonly believed falsehoods were that the vaccine was developed too fast and that there was not enough information about whether the vaccine was effective or not. Educational campaigns targeted at misinformation and tailored to suit each country are recommended to build trust in COVID-19 vaccines and reduce hesitancy.
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BACKGROUND: Sub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods and nutrition, with recovery slowed down by lagging vaccination progress. OBJECTIVE: This study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. METHODS: We conducted a repeated cross-sectional study using a mobile platform to collect data from July-December, 2021 (round 2). We assessed participants' dietary intake of 20 food groups over the previous seven days and computed the primary outcome, the Prime Diet Quality Score (PDQS), and Dietary Diversity Score (DDS), with higher scores indicating better quality diets. We used generalized estimating equation (GEE) linear regression models to assess factors associated with diet quality during COVID-19. RESULTS: Most of the respondents were male and the mean age was 42.4 (±12.5) years. Mean PDQS (±SD) was low at 19.4(±3.8), out of a maximum score of 40 in this study. Respondents (80%) reported higher than expected prices for all food groups. Secondary education or higher (estimate: 0.73, 95% CI: 0.32, 1.15), medium wealth status (estimate: 0.48, 95% CI: 0.14, 0.81), and older age were associated with higher PDQS. Farmers and casual laborers (estimate: -0.60, 95% CI: -1.11, -0.09), lower crop production (estimate: -0.87, 95% CI: -1.28, -0.46) and not engaged in farming (estimate: -1.38, 95% CI: -1.74, -1.02) were associated with lower PDQS. CONCLUSION: Higher food prices and lower diet quality persisted during the COVID-19 pandemic. Economic and social vulnerability and reliance on markets (and lower agriculture production) were negatively associated with diet quality. Although recovery was evident, consumption of healthy diets remained low. Systematic efforts to address the underlying causes of poor diet quality through transforming food system value chains, and mitigation measures, including social protection programs and national policies are critical.
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COVID-19 , Pandemias , Masculino , Humanos , Adulto , Feminino , Estudos Transversais , COVID-19/epidemiologia , Dieta , Burkina FasoRESUMO
The COVID-19 pandemic has had serious negative health and economic impacts in sub-Saharan Africa. Continuous monitoring of these impacts is crucial to formulate interventions to minimize the consequences of COVID-19. This study surveyed 2,829 adults in urban and rural sites among five sub-Saharan African countries: Burkina Faso, Ethiopia, Nigeria, Tanzania, and Ghana. Participants completed a mobile phone survey that assessed self-reported sociodemographics, COVID-19 preventive practices, psychological distress, and barriers to healthcare access. A modified Poisson regression model was used to estimate adjusted prevalence ratios (aPRs) and 95% CIs to investigate potential factors related to psychological distress and barriers to reduced healthcare access. At least 15.6% of adults reported experiencing any psychological distress in the previous 2 weeks, and 10.5% reported that at least one essential healthcare service was difficult to access 2 years into the pandemic. The majority of participants reported using several COVID-19 preventive methods, with varying proportions across the sites. Participants in the urban site of Ouagadougou, Burkina Faso (aPR: 2.29; 95% CI: 1.74-3.03) and in the rural site of Kintampo, Ghana (aPR: 1.68; 95% CI: 1.21-2.34) had a higher likelihood of experiencing any psychological distress compared with those in the rural area of Nouna, Burkina Faso. Loss of employment due to COVID-19 (aPR: 1.77; 95% CI: 1.47-2.11) was also associated with an increased prevalence of psychological distress. The number of children under 5 years in the household (aPR: 1.23; 95% CI: 1.14-1.33) and participant self-reported psychological distress (aPR: 1.83; 95% CI: 1.48-2.27) were associated with an increased prevalence of reporting barriers to accessing health services, whereas wage employment (aPR: 0.67; 95% CI: 0.49-0.90) was associated with decreased prevalence of reporting barriers to accessing health services. Overall, we found a high prevalence of psychological distress and interruptions in access to healthcare services 2 years into the pandemic across five sub-Saharan African countries. Increased effort and attention should be given to addressing the negative impacts of COVID-19 on psychological distress. An equitable and collaborative approach to new and existing preventive measures for COVID-19 is crucial to limit the consequences of COVID-19 on the health of adults in sub-Saharan Africa.