A generic theory of change-based framework with core indicators for monitoring the effectiveness of large-scale food fortification programs in low- and middle-income countries.

Large-scale food fortification (LSFF) programs are widely implemented in low- and middle-income countries (LMIC) to alleviate micronutrient deficiencies. However, these programs may not achieve the desired impact due to poor design or bottlenecks in program implementation. Monitoring and evaluation (M&E) frameworks and a set of agreed indicators can help to benchmark progress and to strengthen the evidence-base of effectiveness in a standardized way. We aimed to formulate recommendations towards core indicators for evaluating the effectiveness of LSFF programs with their associated metrics, methods, and tools (IMMT). For this, we used a multi-method iterative approach, including a mapping review of the literature, semi-structured interviews with international experts, compilation of a generic Theory of Change (ToC) framework for LSFF program delivery, and selection of IMMT for M&E of LSFF programs at key stages along the ToC delivery framework. Lastly, we conducted exploratory, qualitative interviews with key informants in Nigeria to explore experiences and perceptions related to the implementation of LSFF programs in Nigeria's context, and their opinion towards the proposed set of core IMMT. The literature search resulted in 14 published and 15 grey literature documents, from which we extracted a total of 41 indicators. Based on the available literature and interviews with international experts, we mapped a ToC delivery framework and selected nine core indicators at the output, outcome and impact level for M&E of the effectiveness of LSFF programs. Key informants in Nigeria revealed that the main bottlenecks for implementation of the proposed IMMT are related to the lack of technical capacity, equipment, laboratory infrastructure, and financial resources. In conclusion, we propose a set of nine core indicators for enabling comprehensive M&E of the effectiveness of LSFF programs in LMIC. This proposed set of core indicators can be used for further evaluation, harmonization and integration in national and international protocols for M&E of LSFF programs.

Critical review of indicators, metrics, methods, and tools for monitoring and evaluation of biofortification programs at scale.

Sound monitoring and evaluation (M&E) systems are needed to inform effective biofortification program management and implementation. Despite the existence of M&E frameworks for biofortification programs, the use of indicators, metrics, methods, and tools (IMMT) are currently not harmonized, rendering the tracking of biofortification programs difficult. We aimed to compile IMMT for M&E of existing biofortification programs and recommend a sub-set of high-level indicators (HLI) for a harmonized global M&E framework. We conducted (1) a mapping review to compile IMMT for M&E biofortification programs; (2) semi-structured interviews (SSIs) with biofortification programming experts (and other relevant stakeholders) to contextualize findings from step 1; and (3) compiled a generic biofortification program Theory of Change (ToC) to use it as an analytical framework for selecting the HLI. This study revealed diversity in seed systems and crop value chains across countries and crops, resulting in differences in M&E frameworks. Yet, sufficient commonalities between implementation pathways emerged. A set of 17 HLI for tracking critical results along the biofortification implementation pathway represented in the ToC is recommended for a harmonized global M&E framework. Further research is needed to test, revise, and develop mechanisms to harmonize the M&E framework across programs, institutions, and countries.

The Use of Antimicrobials in Italian Heavy Pig Fattening Farms.

Data on antimicrobial use (AMU) in heavy pig production (>150 kg) are limited. The aim of this study was to investigate the AMU in this production. Data from 2015 were collected for 143 fattening farms. The AMU was estimated through a treatment index per 100 days (TI100) using the defined daily dose animal for Italy (DDDAit). When possible, a comparison with the European Medicines Agency's defined daily doses for animals (DDDvet) was performed. The median TI100 was 10.7 (range, 0.2-49.5). Group treatments represented 94.6% of overall consumption. The AMU calculated using DDDAit and DDDvet were strongly correlated (ρ = 0.976; p < 0.001). The AMU was negatively correlated with injectables use (ρ = -0.46, p < 0.001) and positively correlated with oral products (ρ = 0.21, p = 0.014), premixes (ρ = 0.26, p = 0.002), and mortality (ρ = 0.18; p = 0.027). Farm size was negatively correlated with AMU (ρ = -0.29, p < 0.001). Smaller farms were more frequently above the median TI100 (odds ratio = 2.3, 95% confidence interval = 1.2-4.7), suggesting that they may have lower biosecurity and management standards. The results of this study should provide useful insights for the development of an Italian monitoring system.

Correction to: The synergistic effect of organic acids, phytochemicals and a permeabilizing complex reduces Salmonella Typhimurium 1,4,[5],12:i-shedding in pigs.

This article was originally published with all author names incorrectly listed. All author names have now been transposed and appear correctly above.

The synergistic effect of organic acids, phytochemicals and a permeabilizing complex reduces Salmonella Typhimurium 1,4,[5],12:i-shedding in pigs.

Salmonella Typhimurium (including S.Typhimurium 1,4,[5],12:i-) and other enteric pathogens cause acute infection in pigs during the weaning stage, often evolving into chronic infections responsible for the introduction of zoonotic bacteria into the slaughterhouse and thus determining carcass contamination. In addition to being zoonotic hazards, these pathogens are responsible for economic losses in affected farms. Traditionally, antibiotic treatments have been largely administered in order to reduce the infection burden but it favored, as a direct consequence, an increase in the number of multi-drug resistance strains. In order to overcome antibiotic-resistance concerns, new alternative control strategies should be developed. In this context, a blend of organic acids, phytochemicals and a permeabilizing complex, administered in feed (Group A - 459 piglets) or water (Group B - 458 piglets), was tested in field conditions for its capability of reducing Salmonella-infection in weaned piglets of an endemic farm. Data recorded were compared to results of a control group (Group C - 456 piglets). Zootechnical parameters were recorded in all animals, while microbiological, serological and PCR analyses were conducted in 15 piglets for each group. Results demonstrated that additive administered in feed improved animal weight gain (better average daily gain [A.D.G.] and increment), and rapidly reduced Salmonella-shedding in feces. Administration of additive in feed gave better results than in water.

Simulation of reduction of proximal aortic stiffness by an elastic wrap and effects on pulse pressure.

Aortic stiffness is a major cause of age-related increase in arterial pulse pressure (PP) and associated increase in work load for the heart. A method to treat this condition is proposed: wrapping the ascending aortic wall with a highly compliant elastic material such that reducing the vessel diameter will shift the pulsatile load from the aortic wall to the wrap, thus increasing the functional compliance of the ascending aorta and decreasing the cardiac load. A multibranched mathematical model of the arterial system, in which every segment of the arterial tree is represented as a uniform elastic circular tube, has been used to simulate the effect of the wrapping procedure on PP and impedance changes, by varying the radius (R) and the stiffness (E) of the ascending aortic segment. The results of the simulation show that PP decreases with an increase in R and a decrease in E. A similar trend, but with a different sensitivity, is observed for the characteristic impedance (Z(c)) changes. The model shows that PP in the ascending aorta can be lowered by 8.8% by reducing R of 20% and decreasing the functional E by 80%, in good agreement with preliminary results obtained from an in vitro pilot study of elastic wrap in aortas. In conclusion, the modelling study demonstrates that the proposed aortic wrapping procedure is able to compensate for the increase in PP associated with R reduction by a decrease in PP determined by a reduction in functional E. Therefore, it supports the use of the aortic wrap as a potential non-pharmacological treatment of age-related increase in PP.