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1.
Sci Total Environ ; 810: 152296, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-34896503

RESUMO

Cadmium (Cd) is a widespread environmental contaminant, and its increasing concentrations in rice poses significant risks to human health. Globally, rice is a staple food for millions of people, and consequently, effective strategies to reduce Cd accumulation in rice are needed. This study investigates the effect of soil pH (Soil 1: 4.6; Soil 2: 6.6) and iron (Fe) application (at 0, 1.0 and 2.0 g/kg) on Fe plaque formation, Cd sequestration in Fe plaques and Cd bioaccumulation in different parts of the rice plant for three different Cd-graded paddy soils (0, 1.0 and 3.0 mg/kg, respectively) using two Australian rice cultivars under glasshouse conditions. Results show that grain and straw yield declined as Cd toxicity increased, and the toxic effects of Cd were lower in the Quest cultivar than in the Langi cultivar. With applications of Cd at 1.0 mg/kg and 3.0 mg/kg, Cd concentrations in rice grown in Soil 1 were 1.09 mg/kg and 1.37 mg/kg, respectively, while those in rice grown in Soil 2 were 0.38 mg/kg and 0.52 mg/kg, respectively. Soil pH significantly affected the bioaccumulation of Cd in different parts of the rice plant. At both levels of Cd application, Cd concentration was highest in the root, followed by the stem, leaf, husk and grain. Cd was more concentrated in Fe plaques formed by the application of Fe than in rice plant tissues. The Quest cultivar had a higher ability to produce Fe plaques and a 1.3- and 1.4-times higher Cd concentration compared with the Langi cultivar in Soils 1 and 2, respectively.


Assuntos
Oryza , Poluentes do Solo , Austrália , Cádmio/análise , Humanos , Concentração de Íons de Hidrogênio , Ferro/análise , Solo , Poluentes do Solo/análise
2.
Front Psychiatry ; 12: 755357, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34955916

RESUMO

Background: The COVID-19 pandemic is a global threat which has challenged mental resilience and impacted the psychological well-being of people across all age groups globally. The present study aimed to investigate how financial difficulties during the pandemic correlate with mental health among residents of Bangladesh. Methods: A cross-sectional survey was conducted on 4,020 residents from different parts of Bangladesh between July and September 2020, during a period of elevated risk of COVID-19 infection. A self-reported online questionnaire comprising socio-demographic, financial difficulties and psychometric measures (to assess depression, anxiety and stress) was used to gather information from participants. Multivariable logistic regression analysis was performed to determine the factors associated with mental health consequences. Results: The prevalence of depression, anxiety, and stress in the sample were 71.1%, 62.3%, and 56.7%, respectively. Levels of depression, anxiety, and stress were significantly higher among participants who reported female sex, being unmarried, smaller families, higher monthly family income, poor self-perceived health status, living near people who had been infected by COVID-19, probability of decreased income, food scarcity (both during the pandemic and in the future) and the possibility of unemployment. However, due to the nature of the cross-sectional study performed with a convenience sampling method, the causal relationship between variables cannot be justified. Conclusions: After several months of the COVID-19 pandemic in Bangladesh, more than half of the respondents rated their mental health concerns as moderate to severe. The findings highlight the contributing factors of poor mental health which warrant the creation of interventions that address the economic, financial and mental health impacts of the pandemic.

3.
BMC Public Health ; 21(1): 1851, 2021 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-34645399

RESUMO

BACKGROUND: Several vaccines have been approved for use against coronavirus disease (COVID-19) and distributed globally in different regions. However, general community knowledge, attitudes and perceptions towards COVID-19 vaccinations are poorly understood. Thus, the study aimed to investigate community knowledge, attitudes and perceptions towards COVID-19 vaccinations in Bangladesh. METHODS: An exploratory and anonymous population-based e-survey was conducted among 1658 general individuals (55.6% male; mean age = 23.17 ± 6.05 years; age range = 18-65 years). The survey was conducted using a semi-structured and self-reported questionnaire containing informed consent along with four sections (i.e., socio-demographics, knowledge, attitudes, and perceptions). Multiple linear regression was performed to determine the variables predicting knowledge, and attitudes towards COVID-19 vaccinations. RESULTS: The mean scores of knowledge and attitudes were 2.83 ± 1.48 (out of 5) and 9.34 ± 2.39 (out of 12) respectively. About a quarter of participants thought that the COVID-19 vaccination available in Bangladesh is safe, only 60% will have the vaccination and about two-thirds will recommend it to family and friends. In the multiple regression model, higher SES, having university/ higher levels of education, having nuclear families and having previous history of essential vaccines uptake were associated with knowledge; whilst attitudes were significantly associated with being female and having previous history of essential vaccines uptake. Just over half of the participants thought that everyone should be vaccinated and 61% responded that health workers should be vaccinated first on priority basis. 95% of respondents believed the vaccine should be administered free of charge in Bangladesh and almost 90% believed that the COVID-19 vaccine used in Bangladesh may have side effects. CONCLUSIONS: The findings reflect inadequate knowledge but more positive attitudes towards COVID-19 vaccine among the general population in Bangladesh. In order to improve knowledge, immediate health education programs need to be initiated before mass vaccination are scheduled.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Adolescente , Adulto , Idoso , Bangladesh , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , SARS-CoV-2 , Inquéritos e Questionários , Vacinação , Adulto Jovem
4.
Matern Child Nutr ; : e13267, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34467669

RESUMO

Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6-23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post-natal combinations of lipid-based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet-based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age-appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24-h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2-0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99-1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11-0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01-27) at 12 months of age. The intervention effect was non-significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11-1.57) in 6-23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06-0.49) and 0.16 (0.05-27), respectively, but not with food-secure and severely food-insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes.

5.
J Glob Health ; 11: 04052, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34552721

RESUMO

Background: Updated information on the cause of childhood mortality is essential for developing policies and designing programmes targeting the major burden of disease. There is a paucity of evidence regarding the current estimates of the cause of death in Bangladesh, which is essential for reinvigorating the current policies and reshaping existing strategies to avert preventable deaths. This paper aims to address this critical evidence gap and report the cause, timing and place of death among children under-five years of age using a nationally representative sample. Methods: The present study was undertaken to provide updated estimates of causes of death among children under-five years of age using data from the 2017-18 round of the Bangladesh Demographic and Health Survey (BDHS). The verbal autopsy (VA) questionnaire of the 2017-18 BDHS was adapted from the standardised WHO 2016 instruments. Specially trained physicians reviewed the responses of the VA questionnaire and assigned the cause of death based on the online-2016-version of the International Classification of Diseases (ICD-10). We included 456 deaths among children under-five years of age in our analysis. Descriptive statistics were used to present the causes, timing and places of death with uncertainty ranges (UR). Results: Pneumonia is the major killer (19%), accounting for approximately 24 268 (UR = 21 626-26 695) under-five deaths per-year. It is followed by birth asphyxia (16%), prematurity and low-birth-weight (11%), serious infections including sepsis (8%) causing 20 882 (UR = 18 608-22 970), 14 956 (UR = 13 327-16,452), and 10 723 (UR = 9555-11,795) deaths per-year, respectively. Drowning (8%) caused 10 441 (UR = 9304-11 485) deaths and congenital anomaly (7%) resulted in d 8748 (UR = 7795-9623) deaths per-year. Around 29% of all deaths occurred on the first day, 52% within the first week, and 66% within the first month of life. Around 70% of birth asphyxia, prematurity, and low birth weight-related deaths happen on the day of birth. Approximately 43% of pneumonia-related deaths occur in age 1-11 months, and around 51% of drowning-related deaths happen in age 12-23 months. Conclusions: Pneumonia with other serious infections, birth asphyxia, prematurity and low-birth-weight are responsible for more than half of all deaths among children under-five years of age. Strengthening the existing maternal, neonatal and child health programmes may be helpful in averting the majority of these preventable deaths. A multisectoral approach is required for the prevention of childhood deaths, especially drowning-related fatalities. Special measures need to be taken to prevent and control emerging public health challenges like birth defects and congenital anomalies.


Assuntos
Mortalidade da Criança , Recém-Nascido de Baixo Peso , Autopsia , Bangladesh/epidemiologia , Causas de Morte , Criança , Pré-Escolar , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido
6.
Exp Clin Transplant ; 19(10): 1014-1022, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34309500

RESUMO

OBJECTIVES: Increased demand for quality health care has led to lay-press ranking systems, such as the ranking from US News and World Report (US News). Their "Best Hospitals" publication advertises itself as the go-to resource for patients seeking care in a number of specialty areas. We sought to test the relationship between US News rankings and transplant outcomes. MATERIALS AND METHODS: Using data from 2014 to 2018, we compared outcomes from the Scientific Registry of Transplant Recipients database for liver and kidney transplants against US News-ranked centers using the categories "Nephrology" and "GI Surgery and Gastroenterology" as substitutes, as US News does not rank transplant centers specifically. P < .05 was set as significant. RESULTS: Using hazard ratio data, we found that kidney transplant center rank had only a small impact on postoperative outcomes in terms of patient survival (hazard ratio = 0.996, P = .049) but had no impact on graft survival (hazard ratio = 0.997, P = .077). In addition, liver transplant center rank had no impact on liver graft survival (hazard ratio = 1.003, P = .304). The impact of hospital ranking on survival was minimal compared with other variables. CONCLUSIONS: The US News rankings for "Nephrology" and "GI Surgery and Gastroenterology" have minimal values as a measure of liver and kidney transplant outcomes, highlighting that these lay press rankings are not useful to the unique transplant patient population and that providers should help guide patients to transplant-specific resources.

7.
Biology (Basel) ; 10(6)2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34205133

RESUMO

Kanagawa and Hokkaido were affected by COVID-19 in the early stage of the pandemic. Japan's initial response included contact tracing and PCR analysis on anyone who was suspected of having been exposed to SARS-CoV-2. In this retrospective study, we analyzed publicly available COVID-19 registry data from Kanagawa and Hokkaido (n = 4392). Exponential random graph model (ERGM) network analysis was performed to examine demographic and symptomological homophilies. Age, symptomatic, and asymptomatic status homophilies were seen in both prefectures. Symptom homophilies suggest that nuanced genetic differences in the virus may affect its epithelial cell type range and can result in the diversity of symptoms seen in individuals infected by SARS-CoV-2. Environmental variables such as temperature and humidity may also play a role in the overall pathogenesis of the virus. A higher level of asymptomatic transmission was observed in Kanagawa. Moreover, patients who contracted the virus through secondary or tertiary contacts were shown to be asymptomatic more frequently than those who contracted it from primary cases. Additionally, most of the transmissions stopped at the primary and secondary levels. As expected, significant viral transmission was seen in healthcare settings.

8.
BMC Pregnancy Childbirth ; 21(Suppl 1): 239, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33765947

RESUMO

BACKGROUND: Umbilical cord hygiene prevents sepsis, a leading cause of neonatal mortality. The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) application to the umbilicus after home birth in high mortality contexts. In Bangladesh and Nepal, national policies recommend CHX use for all facility births. Population-based household surveys include optional questions on CHX use, but indicator validation studies are lacking. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study assessing measurement validity for maternal and newborn indicators. This paper reports results regarding CHX. METHODS: The EN-BIRTH study (July 2017-July 2018) included three public hospitals in Bangladesh and Nepal where CHX cord application is routine. Clinical-observers collected tablet-based, time-stamped data regarding cord care during admission to labour and delivery wards as the gold standard to assess accuracy of women's report at exit survey, and of routine-register data. We calculated validity ratios and individual-level validation metrics; analysed coverage, quality and measurement gaps. We conducted qualitative interviews to assess barriers and enablers to routine register-recording. RESULTS: Umbilical cord care was observed for 12,379 live births. Observer-assessed CHX coverage was very high at 89.3-99.4% in all 3 hospitals, although slightly lower after caesarean births in Azimpur (86.8%), Bangladesh. Exit survey-reported coverage (0.4-45.9%) underestimated the observed coverage with substantial "don't know" responses (55.5-79.4%). Survey-reported validity ratios were all poor (0.01 to 0.38). Register-recorded coverage in the specific column in Bangladesh was underestimated by 0.2% in Kushtia but overestimated by 9.0% in Azimpur. Register-recorded validity ratios were good (0.9 to 1.1) in Bangladesh, and poor (0.8) in Nepal. The non-specific register column in Pokhara, Nepal substantially underestimated coverage (20.7%). CONCLUSIONS: Exit survey-report highly underestimated observed CHX coverage in all three hospitals. Routine register-recorded coverage was closer to observer-assessed coverage than survey reports in all hospitals, including for caesarean births, and was more accurately captured in hospitals with a specific register column. Inclusion of CHX cord care into registers, and tallied into health management information system platforms, is justified in countries with national policies for facility-based use, but requires implementation research to assess register design and data flow within health information systems.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Clorexidina/análogos & derivados , Confiabilidade dos Dados , Sepse Neonatal/prevenção & controle , Cordão Umbilical/efeitos dos fármacos , Adulto , Bangladesh , Clorexidina/administração & dosagem , Feminino , Humanos , Recém-Nascido , Sepse Neonatal/microbiologia , Nepal , Gravidez , Sistema de Registros/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Cordão Umbilical/microbiologia , Cordão Umbilical/cirurgia , Adulto Jovem
9.
BMC Pregnancy Childbirth ; 21(Suppl 1): 238, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33765956

RESUMO

BACKGROUND: Population-based household surveys, notably the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), remain the main source of maternal and newborn health data for many low- and middle-income countries. As part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study, this paper focuses on testing validity of measurement of maternal and newborn indicators around the time of birth (intrapartum and postnatal) in survey-report. METHODS: EN-BIRTH was an observational study testing the validity of measurement for selected maternal and newborn indicators in five secondary/tertiary hospitals in Bangladesh, Nepal and Tanzania, conducted from July 2017 to July 2018. We compared women's report at exit survey with the gold standard of direct observation or verification from clinical records for women with vaginal births. Population-level validity was assessed by validity ratios (survey-reported coverage: observer-assessed coverage). Individual-level accuracy was assessed by sensitivity, specificity and percent agreement. We tested indicators already in DHS/MICS as well as indicators with potential to be included in population-based surveys, notably the first validation for small and sick newborn care indicators. RESULTS: 33 maternal and newborn indicators were evaluated. Amongst nine indicators already present in DHS/MICS, validity ratios for baby dried or wiped, birthweight measured, low birthweight, and sex of baby (female) were between 0.90-1.10. Instrumental birth, skin-to-skin contact, and early initiation of breastfeeding were highly overestimated by survey-report (2.04-4.83) while umbilical cord care indicators were massively underestimated (0.14-0.22). Amongst 24 indicators not currently in DHS/MICS, two newborn contact indicators (kangaroo mother care 1.00, admission to neonatal unit 1.01) had high survey-reported coverage amongst admitted newborns and high sensitivity. The remaining indicators did not perform well and some had very high "don't know" responses. CONCLUSIONS: Our study revealed low validity for collecting many maternal and newborn indicators through an exit survey instrument, even with short recall periods among women with vaginal births. Household surveys are already at risk of overload, and some specific clinical care indicators do not perform well and may be under-powered. Given that approximately 80% of births worldwide occur in facilities, routine registers should also be explored to track coverage of key maternal and newborn health interventions, particularly for clinical care.


Assuntos
Confiabilidade dos Dados , Inquéritos Epidemiológicos/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Bangladesh , Feminino , Humanos , Recém-Nascido , Nepal , Assistência Perinatal/organização & administração , Gravidez , Tanzânia
10.
Sci Total Environ ; 754: 142082, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32919317

RESUMO

Extensive evidence of elevated arsenic (As) in the food-chain, mainly rice, wheat and vegetables exists. Nevertheless, the importance of exposure from food towards total As exposure and associated health risks in areas with natural occurring As in drinking water is still often neglected, and accordingly mitigations are largely focused on drinking water only. In this study, the contribution of food over drinking water to overall As exposure was estimated for As exposed populations in Bihar, India. Increased lifetime cancer risk was predicted using probabilistic methods with input parameters based on detailed dietary assessment and estimation of As in drinking water, cooked rice, wheat flour and potato collected from 91 households covering 19 villages. Median total exposure was 0.83 µg/kgBW/day (5th and 95th percentiles were 0.21 and 11.1 µg/kgBW/day) and contribution of food (median = 49%) to overall exposure was almost equal to that from drinking water (median = 51%). More importantly and contrary to previous studies, food was found to contribute more than drinking water to As exposure, even when drinking water As was above the WHO provisional guide value of 10 µg/L. Median and 95th percentile excess lifetime cancer risks from food intake were 1.89 × 10-4 and 7.32 × 10-4 respectively when drinking water As was below 10 µg/L and 4.00 × 10-4 and 1.83 × 10-3 respectively when drinking water As was above 10 µg/L. Our results emphasise the importance of food related exposure in As-endemic areas, and, perhaps surprisingly, particularly in areas with high As concentrations in drinking water - this being partly ascribed to increases in food As due to cooking in high As water. These findings are timely to stress the importance of removing As from the food chain and not just drinking water in endemic areas.


Assuntos
Arsênio , Água Potável , Oryza , Poluentes Químicos da Água , Arsênio/análise , Exposição Ambiental/análise , Farinha , Contaminação de Alimentos/análise , Índia/epidemiologia , Triticum , Poluentes Químicos da Água/efeitos adversos , Poluentes Químicos da Água/análise
11.
J Hazard Mater ; 403: 124064, 2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33265062

RESUMO

This study determines the bioaccessibility of toxic and carcinogenic arsenic (As) in composite food samples and evaluates potential exposure from food intake in Bangladesh children. Total As (tAs), inorganic As (iAs) and bioaccessible As (BAs) in food composite samples consumed by children were compared between an exposed and a control group (based on As in drinking water). Total As concentrations in composite food samples of children exposed to mean As level of 331 µg/l in drinking and cooking water ranged from 586 to 1975 µg/kg, dry weight over 76-90 µg/kg in the unexposed group. Average iAs in food composites was 73.9% (range: 49.3-90.8%). The fraction of BAs using gastric and gastrointestinal phases was 91 ± 13% and 98 ± 11%, respectively. Daily intake of iAs in the exposed group ranged from 0.41 to 6.38 µg per kg body weight (BW), which was much higher than the unexposed group (0.08-0.15 µg per kg BW). High iAs content and BAs in composite food samples indicated the elevated risk to exposed children. Further research should include both adults and children using larger sample size to determine overall As exposure from food intake in Bangladesh, attention must be given to lowering of As in food.


Assuntos
Arsênio , Arsenicais , Arsênio/análise , Arsênio/toxicidade , Bangladesh/epidemiologia , Criança , Dieta , Exposição Ambiental/análise , Contaminação de Alimentos/análise , Humanos , Medição de Risco
12.
Lancet Glob Health ; 9(3): e267-e279, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33333015

RESUMO

BACKGROUND: Progress in reducing maternal and neonatal deaths and stillbirths is impeded by data gaps, especially regarding coverage and quality of care in hospitals. We aimed to assess the validity of indicators of maternal and newborn health-care coverage around the time of birth in survey data and routine facility register data. METHODS: Every Newborn-BIRTH Indicators Research Tracking in Hospitals was an observational study in five hospitals in Bangladesh, Nepal, and Tanzania. We included women and their newborn babies who consented on admission to hospital. Exclusion critiera at admission were no fetal heartbeat heard or imminent birth. For coverage of uterotonics to prevent post-partum haemorrhage, early initiation of breastfeeding (within 1 h), neonatal bag-mask ventilation, kangaroo mother care (KMC), and antibiotics for clinically defined neonatal infection (sepsis, pneumonia, or meningitis), we collected time-stamped, direct observation or case note verification data as gold standard. We compared data reported via hospital exit surveys and via hospital registers to the gold standard, pooled using random effects meta-analysis. We calculated population-level validity ratios (measured coverage to observed coverage) plus individual-level validity metrics. FINDINGS: We observed 23 471 births and 840 mother-baby KMC pairs, and verified the case notes of 1015 admitted newborn babies regarding antibiotic treatment. Exit-survey-reported coverage for KMC was 99·9% (95% CI 98·3-100) compared with observed coverage of 100% (99·9-100), but exit surveys underestimated coverage for uterotonics (84·7% [79·1-89·5]) vs 99·4% [98·7-99·8] observed), bag-mask ventilation (0·8% [0·4-1·4]) vs 4·4% [1·9-8·1]), and antibiotics for neonatal infection (74·7% [55·3-90·1] vs 96·4% [94·0-98·6] observed). Early breastfeeding coverage was overestimated in exit surveys (53·2% [39·4-66·8) vs 10·9% [3·8-21·0] observed). "Don't know" responses concerning clinical interventions were more common in the exit survey after caesarean birth. Register data underestimated coverage of uterotonics (77·9% [37·8-99·5] vs 99·2% [98·6-99·7] observed), bag-mask ventilation (4·3% [2·1-7·3] vs 5·1% [2·0-9·6] observed), KMC (92·9% [84·2-98·5] vs 100% [99·9-100] observed), and overestimated early breastfeeding (85·9% (58·1-99·6) vs 12·5% [4·6-23·6] observed). Inter-hospital heterogeneity was higher for register-recorded coverage than for exit survey report. Even with the same register design, accuracy varied between hospitals. INTERPRETATION: Coverage indicators for newborn and maternal health care in exit surveys had low accuracy for specific clinical interventions, except for self-report of KMC, which had high sensitivity after admission to a KMC ward or corner and could be considered for further assessment. Hospital register design and completion are less standardised than surveys, resulting in variable data quality, with good validity for the best performing sites. Because approximately 80% of births worldwide take place in facilities, standardising register design and information systems has the potential to sustainably improve the quality of data on care at birth. FUNDING: Children's Investment Fund Foundation and Swedish Research Council.


Assuntos
Países em Desenvolvimento , Serviços de Saúde Materno-Infantil/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Inquéritos e Questionários/normas , Antibacterianos/provisão & distribuição , Antibacterianos/uso terapêutico , Aleitamento Materno/estatística & dados numéricos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/tratamento farmacológico , Método Canguru/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/normas , Hemorragia Pós-Parto/prevenção & controle , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade da Assistência à Saúde/normas , Reprodutibilidade dos Testes
13.
BMJ Glob Health ; 5(8)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32792408

RESUMO

INTRODUCTION: Living-donor kidney transplantation is the gold standard treatment for patients with end-stage kidney disease. However, potential donors ubiquitously face financial as well as logistical barriers. To remove these disincentives from living kidney donations, the governments of 23 countries have implemented reimbursement programmes that shift the burdens of non-medical costs from donors to the governments or private entities. However, scientific evidence for the effectiveness of these programmes is scarce. The present study investigates whether these reimbursement programmes designed to ease the financial and logistical barriers succeeded in increasing the number of living kidney donations at the country level. The study examined within-country variations in the timing of such reimbursement programmes. METHOD: The study applied the difference-in-difference (two-way panel fixed-effect) technique on the Poisson distribution to estimate the effects of these reimbursement programmes on a 17 year long (2000-2016) dataset covering 109 countries where living donor kidney transplants were performed. RESULTS: The results indicated that reimbursement programmes have a statistically significant positive effect. Overall, the model predicted that reimbursement programmes increased country-level donation numbers by a factor of 1.12-1.16. CONCLUSION: Reimbursement programmes may be an effective approach to alleviate the kidney shortage worldwide. Further analysis is warranted on the type of reimbursement programmes and the ethical dimension of each type of such programmes.


Assuntos
Transplante de Rim , Doadores Vivos , Humanos , Rim
16.
PLoS One ; 15(5): e0232675, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32392209

RESUMO

BACKGROUND: Serious infections account for 25% of global newborn deaths annually, most in low-resource settings where hospital-based treatment is not accessible or feasible. In Bangladesh, one-third of neonatal deaths are attributable to serious infection; in 2014, the government adopted new policy for outpatient management of danger signs indicating possible serious bacterial infections (PSBI) when referral was not possible. We conducted implementation research to understand what it takes for a district health team to implement quality outpatient PSBI management per national guidelines. METHODS: PSBI management was introduced as part of the Comprehensive Newborn Care Package in 2015. The study piloted this package through government health systems with limited partner support to inform scale-up efforts. Data collection included facility register reviews for cases seen at primary level facilities; facility readiness and provider knowledge and skills assessments; household surveys capturing caregiver knowledge of newborn danger signs and care-seeking for newborn illness; and follow-up case tracking, capturing treatment adherence and outcomes. Analysis consisted of descriptive statistics. RESULTS: Over the 15-month implementation period, 1432 young infants received care, of which 649 (45%) were classified as PSBI. Estimated coverage of care-seeking increased from 22% to 42% during the implementation period. Although facility readiness and providers' skills increased, providers' adherence to guidelines was not optimal. Among locally managed PSBI cases, 75% completed the oral antibiotic course and 15% received the fourth day follow-up. Care-seeking remained high among private providers (95%), predominantly village health doctors (over 80%). CONCLUSIONS: Facility readiness, including health care provider knowledge and skills were strengthened; future efforts should focus on improving provider adherence to guidelines. Social and behavior change strategies targeting families and communities should explore shifting care-seeking from private, possibly less-qualified providers. Strategies to improve private sector management of PSBI cases and improved linkages between private and public sector providers could be explored.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Bangladesh/epidemiologia , Cuidadores , Feminino , Instalações de Saúde , Humanos , Lactente , Recém-Nascido , Laboratórios , Pacientes Ambulatoriais , Aceitação pelo Paciente de Cuidados de Saúde , Encaminhamento e Consulta
17.
Clin Transplant ; 34(7): e13886, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32335953

RESUMO

Higher body mass index (BMI) of deceased-donors is associated with poorer outcomes in transplant recipients. The effect of low donor BMI on recipient graft function is not clear. Scientific Registry of Transplant Recipients data on recipients of deceased-donor kidneys from 2000 to 2019 were categorized by donor BMI (donor BMI < 18, 18-27, and >27). Primary outcome was death-censored graft survival. The impact of multiple recipient and donor variables, including low donor BMI and the difference between donor and recipient BMI, was evaluated using a multivariate Cox proportional-hazards model. Low BMI donors (LBD) were more likely to be younger, female, and white (all P < .05). LBD were less likely to be Hispanic, diabetic, or have hypertension (all P < .001). LBD recipients were more likely to be younger and female (both P < .001). Low donor BMI was not significantly associated with recipient graft survival. Donor-recipient BMI difference did not correlate with an increased risk of graft failure. Similar results were obtained when donors were classified using body surface area (BSA). Small donor size in terms of BMI or BSA or a large discrepancy between donor and recipient size should not necessarily preclude transplantation of an otherwise acceptable kidney.


Assuntos
Índice de Massa Corporal , Transplante de Rim , Doadores de Tecidos , Feminino , Sobrevivência de Enxerto , Humanos , Rim , Masculino , Transplantados , Resultado do Tratamento
18.
Chemosphere ; 241: 125070, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31629236

RESUMO

Arsenic (As) exposure from surface and groundwater in Peru is being recognised as a potential threat but there are limited studies on As in the food-chain and none on As in Peruvian rice. In this study, we have determined the As content in rice cultivated in the Tumbes river basin located in the northern province of Peru, an area known for extensive rice cultivation. We collected rice and soil samples from agricultural fields, soil was collected using grid sampling technique while rice was collected from the heaps of harvested crop placed across the fields. The average total As concentration in rice was 167.94 ±â€¯71 µg kg-1 (n = 29; range 68.39-345.31 µg kg-1). While the rice As levels were not highly elevated, the As content of few samples (n = 7) greater than 200 µg kg-1 could contribute negatively to human health upon chronic exposure. Average concentration of As in soil was 8.63 ±â€¯7.8 mg kg-1 (n = 30) and soil to grain transfer factor was 0.025 ±â€¯0.018 for 12 matched samples. Compared to our previous pilot study in 2006 (samples collected from the same agricultural fields but not from exact locations) there was a 41% decrease in As soil concentration in this study. Rice samples collected in 2006 (n = 5) had a mean concentration of 420 ±â€¯109 µg kg-1. Our data provides a baseline of rice grain As concentrations in Peruvian province of Tumbes and warrants further studies on factors affecting uptake of As by the rice varieties cultivated in Peru and any potential human health risks.


Assuntos
Arsênio/análise , Monitoramento Ambiental , Oryza/química , Poluentes do Solo/análise , Grão Comestível/química , Cadeia Alimentar , Contaminação de Alimentos/análise , Água Subterrânea , Humanos , Peru , Projetos Piloto , Rios , Solo
19.
Sci Total Environ ; 703: 134774, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-31734495

RESUMO

In arsenic (As) endemic areas of south-east Asia, where a subsistence rice-based diet is prevalent, As exposure from food is mainly focused on rice intake. However, consumption of wheat is substantial and increasing. We present a probabilistic assessment of increased cancer risk from wheat-based food intake in a study population of rural Bihar, India where As exposure is endemic. Total As in wheat grains (43.64 ±â€¯48.19 µg/kg, n = 72) collected from 77 households across 19 villages was found to be lower than reported As in wheat grains from other south-east Asian countries but higher than a previous study from Bihar. This is the first study where As concentration in wheat flour was used for risk estimation, bearing in mind that it was the flour obtained after indigenous household processing of the grains that was used for making the home-made bread (chapati) which contributed 95% of wheat intake for the studied population. Interestingly, while 78% of the surveyed participants (n = 154) consumed rice every day, chapati was consumed every day by 99.5% of the participants. In contrast to previous studies, where As concentration in wheat grains was found to be lower than the flour due to the removal of the bran on grinding, we did not find any appreciable lowering of arsenic in the wheat flour (49.80 ±â€¯74.08 µg/kg, n = 58), most likely due to external contamination during processing and grinding. Estimated gender adjusted excess lifetime cancer risk of 1.23 × 10-4 for the studied rural population of Bihar indicated risk higher than the 10-4-10-6 range, typically used by the USEPA as a threshold to guide regulatory values. Hence, our findings suggest As exposure from wheat-based food intake to be of concern not only in As endemic areas of rural Bihar but also in non-endemic areas with similar wheat-based diet due to public distribution of the wheat across India.


Assuntos
Triticum , Arsênio , Farinha , Contaminação de Alimentos , Humanos , Índia , Oryza
20.
Sex Reprod Health Matters ; 27(1): 1610277, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31533580

RESUMO

The World Health Organization has recently set standards emphasising the importance of emotional support during birth for improving the quality of maternal and newborn healthcare in facilities. In this study, we explore the emotional support status of women during birth in rural Bangladesh. A cross-sectional household survey of 1367 women was administered in 2018 in Brahmanbaria district. Outcomes of interest included: presence of a companion of choice; mobility; intake of fluids and food; and position of choice. Associations between outcomes of interest and background characteristics were explored through binary and multiple logistic regressions. Approximately 68% women had a companion of choice during labour or childbirth, significantly higher among women giving birth at home (75%) than in a health facility. Nearly 60% women were allowed to eat and drink during labour, also significantly higher among women giving birth at home. Seventy-per cent women were allowed to be ambulatory during labour (46% in a facility vs. 85% at home). Only 27% women were offered or allowed to give birth in the position of their choice at facility, compared to 54% giving birth at home. Among women giving birth in a facility who did not have a companion of choice, 39% reported that the health provider/health facility management did not allow this. Ensuring emotional support and thereby improving the quality of the experience of care within health facilities should be prioritised by the Bangladesh government both to improve health outcomes of women and newborns and also to promote more humanised, positive childbirth experiences.


Assuntos
Família/psicologia , Trabalho de Parto/psicologia , Parto/psicologia , Apoio Social , Adulto , Bangladesh , Estudos Transversais , Feminino , Instalações de Saúde/estatística & dados numéricos , Parto Domiciliar/psicologia , Parto Domiciliar/estatística & dados numéricos , Humanos , Modelos Logísticos , Gravidez , População Rural , Adulto Jovem
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