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1.
J Glob Health ; 14: 04042, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38426844

ABSTRACT

Background: Hundreds of millions of people become infected globally every year while seeking care in health facilities that lack basic needs like infection control measures and personal protective equipment (PPE). We aimed to evaluate the availability of infection control items and PPE in eight low- and middle-income countries and identify disparities in the availability of those items. Methods: In this study, we combined publicly available nationally representative cross-sectional health system surveys (Service Provision Assessments by the Demographic and Health Survey Programme) conducted in eight countries between 2013 and 2018: Afghanistan, Bangladesh, the Democratic Republic of the Congo, Haiti, Malawi, Nepal, Senegal, and Tanzania. The availability of infection control items was evaluated using a list of six items (a waste receptacle, a sharps container, disinfectant, single-use disposable or auto-disposable syringes, soap and running water, or an alcohol-based hand rub, and guidelines for standard precautions). PPE includes four items: gloves, medical masks, gowns, and eye protection. We considered these items available in a facility if they were observed in general outpatient areas or any service-specific area (i.e. delivery room). Results: We analysed data from 7948 health facilities (694 hospitals and 7254 health centres/clinics). Overall, among the infection control items and PPE, most surveyed facilities had high availability of single-use disposable or auto-disposable syringes (91.40%) and latex gloves (92.56%). Of infection control measures, guidelines for infection control were the least available during the survey, with the lowest (6.15%) in Nepal and the highest (68.18%) in Malawi. Of the PPE items, eye protection was the least available during the survey, with the lowest (5.4% in Senegal) and the highest (28.17%) in Haiti. Only 1567 (19.71%) facilities looked to have all the basic infection control materials, and 1023 (12.87%) of the analysed facilities possessed all of the PPE. Within the same country, the availability of items varied more between hospitals and health centres/clinics than between them. Conclusions: All eight of our study countries experience shortages of the most fundamental standard precaution items to avert infection. Steps must be taken in each of these countries to reduce inadequacies and disparities and enhance efficiency in the conversion of health-system inputs into the facility's availability of standard precaution items for infection control - to curb the risk of infectious disease transmission.


Subject(s)
Developing Countries , Personal Protective Equipment , Humans , Cross-Sectional Studies , Health Facilities , Infection Control
2.
JMIR Pediatr Parent ; 7: e51574, 2024 Mar 06.
Article in English | MEDLINE | ID: mdl-38488632

ABSTRACT

Background: Children (aged 0-14 years) living with HIV often experience lower rates of HIV diagnosis, treatment, and viral load suppression. In Haiti, only 63% of children living with HIV know their HIV status (compared to 85% overall), 63% are on treatment (compared to 85% overall), and 48% are virally suppressed (compared to 73% overall). Electronic medical records (EMRs) can improve HIV care and patient outcomes, but these benefits are largely dependent on providers having access to quality and nonmissing data. Objective: We sought to understand the associations between EMR data missingness and interruption in antiretroviral therapy treatment by age group (pediatric vs adult). Methods: We assessed associations between patient intake record data missingness and interruption in treatment (IIT) status at 6 and 12 months post antiretroviral therapy initiation using patient-level data drawn from iSanté, the most widely used EMR in Haiti. Missingness was assessed for tuberculosis diagnosis, World Health Organization HIV stage, and weight using a composite score indicator (ie, the number of indicators of interest missing). Risk ratios were estimated using marginal parameters from multilevel modified Poisson models with robust error variances and random intercepts for the facility to account for clustering. Results: Data were drawn from 50 facilities and comprised 31,457 patient records from people living with HIV, of which 1306 (4.2%) were pediatric cases. Pediatric patients were more likely than adult patients to experience IIT (n=431, 33% vs n=7477, 23.4% at 6 months; P<.001). Additionally, pediatric patient records had higher data missingness, with 581 (44.5%) pediatric records missing at least 1 indicator of interest, compared to 7812 (25.9%) adult records (P<.001). Among pediatric patients, each additional indicator missing was associated with a 1.34 times greater likelihood of experiencing IIT at 6 months (95% CI 1.08-1.66; P=.008) and 1.24 times greater likelihood of experiencing IIT at 12 months (95% CI 1.05-1.46; P=.01). These relationships were not statistically significant for adult patients. Compared to pediatric patients with 0 missing indicators, pediatric patients with 1, 2, or 3 missing indicators were 1.59 (95% CI 1.26-2.01; P<.001), 1.74 (95% CI 1.02-2.97; P=.04), and 2.25 (95% CI 1.43-3.56; P=.001) times more likely to experience IIT at 6 months, respectively. Among adult patients, compared to patients with 0 indicators missing, having all 3 indicators missing was associated with being 1.32 times more likely to experience IIT at 6 months (95% CI 1.03-1.70; P=.03), while there was no association with IIT status for other levels of missingness. Conclusions: These findings suggest that both EMR data quality and quality of care are lower for children living with HIV in Haiti. This underscores the need for further research into the mechanisms by which EMR data quality impacts the quality of care and patient outcomes among this population. Efforts to improve both EMR data quality and quality of care should consider prioritizing pediatric patients.

3.
Article in English | MEDLINE | ID: mdl-38464872

ABSTRACT

Objectives: To identify the prevalence and determinants of continued breastfeeding in Haitian children aged 12-23 months. Methods: Three cross-sectional surveys were conducted yearly during the summers of 2017 to 2019 as part of a 4-year (2016-2020) multisectoral maternal and infant health initiative in the regions of Les Cayes, Jérémie, and Anse d'Hainault in Haiti. A total of 455 children 12-23 months of age and their mothers participated in the study. A child was considered to be continuing breastfeeding if the mother reported giving breast milk in the 24-hour dietary recall. Unadjusted and adjusted prevalence ratios were estimated, and associations were assessed between continued breastfeeding and explanatory factors related to sociodemographic characteristics, household food security, maternal nutrition, and breastfeeding knowledge and practices. Results: The prevalence of continued breastfeeding was 45.8%. Continued breastfeeding was significantly more prevalent among younger children, children who did not have a younger sibling, children whose mother was not pregnant, those living in the Jérémie region, children who had been exclusively breastfed for less than 1 month, and children whose mother knew the World Health Organization's recommendation for continued breastfeeding up to 2 years or beyond. Conclusions: The study results highlight the need for geographically equitable access to tailored and adequate health services and education that support breastfeeding in a way that is compatible with the local context.

4.
Ecancermedicalscience ; 18: 1675, 2024.
Article in English | MEDLINE | ID: mdl-38439808

ABSTRACT

Haiti is a low-income country with one of the lowest human development index rankings in the world. Its childhood cancer services are provided by a single hospital with the only dedicated paediatric oncology department in the country. Our objective was to assess the cost and cost-effectiveness of all types of childhood cancer in Haiti to help prioritise investments and to support national cancer control planning. All costing data were collected from the year 2017 or 2018 hospital records. Costs were classified into 11 cost categories, and the proportion of the overall budget represented by each was calculated and converted from Haitian Gourde to United States dollars. The 5-year survival rate was retrieved from hospital records and used to calculate the cost-effectiveness of disability-adjusted life year (DALY) averted, using a healthcare costing perspective. Additional sensitivity analyses were conducted accounting for late-effect morbidity and early mortality and discounting rates of 0%, 3% and 6%. The annual cost of operating a paediatric oncology unit in Haiti treating 74 patients with newly diagnosed cancer was $803,184 overall or $10,854 per patient. The largest cost category was pharmacy, constituting 25% of the overall budget, followed by medical personnel (20%) and administration (12%). The cost per DALY averted in the base-case scenario was $1,128, which is 76% of the gross domestic product per capita, demonstrating that treating children with cancer in Haiti is very cost-effective according to the World Health Organisation Choosing Interventions that are Cost-Effective (WHO-CHOICE) threshold. In the most conservative scenario, the cost per DALY averted was cost-effective by WHO-CHOICE criteria. Our data will add to the growing body of literature illustrating a positive return on investment associated with diagnosing and treating children with cancer in even the most resource-limited environments. We anticipate that these data will aid local stakeholders and policymakers when identifying cancer control priorities and making budgetary decisions.

5.
BMJ ; 384: q663, 2024 Mar 15.
Article in English | MEDLINE | ID: mdl-38490681
6.
Soc Sci Med ; 347: 116733, 2024 Mar 02.
Article in English | MEDLINE | ID: mdl-38493681

ABSTRACT

In Haiti, pathological confirmation of a cancer diagnosis is often delayed or impossible, imaging is expensive and imperfect, and many tests are unavailable. Physicians frequently struggle to establish cancers at a level of certainty required by "evidence based" standards, delaying definitive diagnosis and rendering some cancers permanently "suspected." I use 22 months of participant observation at the two largest cancer treatment programs in Haiti, as well as throughout Haiti's fragmented healthcare system, to look closely at processes of diagnosis and management of suspected 'cancers' which may never fully come to be. I argue that as global oncology becomes increasingly standardized, local practices are forced into alignment with a global knowledge basis that governs the knowability/unknowability of cancer. Using three case studies drawn from this work, I examine relationships among visibility, power, expertise and the replication of inequity through the governance of knowledge production. Finally, I examine the implications of these processes for cancer care in the global south.

7.
J Med Internet Res ; 26: e49139, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38427404

ABSTRACT

BACKGROUND: Previous work suggests that Google searches could be useful in identifying conjunctivitis epidemics. Content-based assessment of social media content may provide additional value in serving as early indicators of conjunctivitis and other systemic infectious diseases. OBJECTIVE: We investigated whether large language models, specifically GPT-3.5 and GPT-4 (OpenAI), can provide probabilistic assessments of whether social media posts about conjunctivitis could indicate a regional outbreak. METHODS: A total of 12,194 conjunctivitis-related tweets were obtained using a targeted Boolean search in multiple languages from India, Guam (United States), Martinique (France), the Philippines, American Samoa (United States), Fiji, Costa Rica, Haiti, and the Bahamas, covering the time frame from January 1, 2012, to March 13, 2023. By providing these tweets via prompts to GPT-3.5 and GPT-4, we obtained probabilistic assessments that were validated by 2 human raters. We then calculated Pearson correlations of these time series with tweet volume and the occurrence of known outbreaks in these 9 locations, with time series bootstrap used to compute CIs. RESULTS: Probabilistic assessments derived from GPT-3.5 showed correlations of 0.60 (95% CI 0.47-0.70) and 0.53 (95% CI 0.40-0.65) with the 2 human raters, with higher results for GPT-4. The weekly averages of GPT-3.5 probabilities showed substantial correlations with weekly tweet volume for 44% (4/9) of the countries, with correlations ranging from 0.10 (95% CI 0.0-0.29) to 0.53 (95% CI 0.39-0.89), with larger correlations for GPT-4. More modest correlations were found for correlation with known epidemics, with substantial correlation only in American Samoa (0.40, 95% CI 0.16-0.81). CONCLUSIONS: These findings suggest that GPT prompting can efficiently assess the content of social media posts and indicate possible disease outbreaks to a degree of accuracy comparable to that of humans. Furthermore, we found that automated content analysis of tweets is related to tweet volume for conjunctivitis-related posts in some locations and to the occurrence of actual epidemics. Future work may improve the sensitivity and specificity of these methods for disease outbreak detection.


Subject(s)
Conjunctivitis , Epidemics , Social Media , Humans , United States , Infodemiology , Disease Outbreaks , Language
8.
Lancet ; 403(10432): 1123, 2024 Mar 23.
Article in English | MEDLINE | ID: mdl-38522436
9.
Article in English | PAHO-IRIS | ID: phr-59317

ABSTRACT

[ABSTRACT]. Objectives To identify the prevalence and determinants of continued breastfeeding in Haitian children aged 12–23 months. Methods Three cross-sectional surveys were conducted yearly during the summers of 2017 to 2019 as part of a 4-year (2016–2020) multisectoral maternal and infant health initiative in the regions of Les Cayes, Jérémie, and Anse d’Hainault in Haiti. A total of 455 children 12–23 months of age and their mothers participated in the study. A child was considered to be continuing breastfeeding if the mother reported giving breast milk in the 24-hour dietary recall. Unadjusted and adjusted prevalence ratios were estimated, and associations were assessed between continued breastfeeding and explanatory factors related to sociodemographic character- istics, household food security, maternal nutrition, and breastfeeding knowledge and practices. Results The prevalence of continued breastfeeding was 45.8%. Continued breastfeeding was significantly more prevalent among younger children, children who did not have a younger sibling, children whose mother was not pregnant, those living in the Jérémie region, children who had been exclusively breastfed for less than 1 month, and children whose mother knew the World Health Organization’s recommendation for continued breastfeeding up to 2 years or beyond. Conclusions The study results highlight the need for geographically equitable access to tailored and adequate health services and education that support breastfeeding in a way that is compatible with the local context.


[RESUMEN]. Objetivos. Determinar la prevalencia y los determinantes asociados a la continuación de la lactancia materna en la población infantil haitiana de entre 12 y 23 meses. Métodos. Durante los veranos del 2017 al 2019 se llevaron a cabo tres encuestas transversales anuales como parte de una iniciativa multisectorial de salud materna e infantil de 4 años (2016 a 2020) en las regiones de Les Cayes, Jérémie y Anse d’Hainault de Haití. En el estudio participaron 455 menores de edades comprendidas entre 12 y 23 meses y sus madres. Se consideró que un menor continuaba con la lactancia materna si, en la evaluación de la alimentación basada en el recuerdo de 24 horas, la madre declaraba la toma de leche materna. Se calcularon los cocientes de prevalencia ajustados y sin ajustar y se evaluó la asociación entre la continuación de la lactancia materna y posibles factores explicativos relacionados con las características sociodemográficas, la seguridad alimentaria de la familia, la nutrición materna y los conocimientos y prácticas en materia lactancia materna. Resultados. La prevalencia de la continuación de la lactancia materna fue del 45,8%. Esta prevalencia fue significativamente mayor cuando se trataba de lactantes de menor edad, cuando no había hermanos menores, cuando la madre no estaba embarazada, en los residentes en la región de Jérémie, cuando había habido una alimentación exclusiva con leche materna durante menos de un mes y cuando la madre conocía la recomendación de la Organización Mundial de la Salud de continuar con la lactancia materna hasta los dos años o más. Conclusiones. Los resultados del estudio ponen de relieve la necesidad de disponer de un acceso geográfico equitativo a unos servicios de salud y una educación que respalden la lactancia materna de una manera compatible con el contexto local.


[RESUMO]. Objetivos Identificar a prevalência e os determinantes do aleitamento materno continuado em crianças haitianas de 12 a 23 meses de idade. Métodos Três pesquisas transversais foram realizadas anualmente nos verões de 2017 a 2019 como parte de uma iniciativa multissetorial de saúde materno-infantil de quatro anos (2016–2020) nas regiões de Les Cayes, Jérémie e Anse d’Hainault no Haiti. Um total de 455 crianças de 12 a 23 meses de idade e suas mães participaram do estudo. Considerou-se que a criança continuava sendo amamentada se a mãe relatasse ter dado leite materno no recordatório alimentar de 24 horas. Foram estimadas as taxas de prevalência não ajustadas e ajustadas e foram avaliadas as associações entre o aleitamento materno continuado e os fatores explicativos relacionados às características sociodemográficas, à segurança alimentar da família, à nutrição materna e aos conhecimentos e práticas de aleitamento materno. Resultados A prevalência de aleitamento materno continuado foi de 45,8%. O aleitamento materno continuado foi significativamente mais prevalente entre crianças mais novas, crianças que não tinham irmão mais novo, crianças cuja mãe não estava grávida, residentes da região de Jérémie, crianças que haviam sido exclusivamente amamentadas por menos de um mês e crianças cuja mãe conhecia a recomendação da Organização Mundial da Saúde de manter o aleitamento materno por 2 anos ou mais. Conclusões Os resultados do estudo destacam a necessidade de acesso geograficamente equitativo a educação e serviços de saúde adaptados e adequados para apoiar o aleitamento materno de forma compatível com o contexto local.


Subject(s)
Breastfeeding and Complementary Feeding , Prevalence , Epidemiology , Infant Health , Haiti , Breast Feeding , Prevalence , Epidemiology , Infant Health , Breast Feeding , Prevalence , Infant Health
10.
medRxiv ; 2024 Mar 07.
Article in English | MEDLINE | ID: mdl-38496497

ABSTRACT

Background: The primary barrier to curing HIV infection is the pool of intact HIV proviruses integrated into host cell DNA throughout the bodies of people living with HIV (PLHIV), called the HIV reservoir. Reservoir size is impacted by the duration of HIV infection, delay in starting antiretroviral therapy (ART), and breakthrough viremia during ART. The leading infectious cause of death worldwide for PLHIV is TB, but we don't know how TB impacts the HIV reservoir. Methods: We designed a case-control study to compare HIV provirus-containing CD4 in PLHIV with vs. without a history of active TB disease. Study participants in the pilot and confirmatory cohort were enrolled at GHESKIO Centers in Port au Prince, Haiti. Intact and non-intact proviral DNA were quantified using droplet digital PCR of PBMC-derived CD4 cells. For a subset, Th1 and Th2 cytokines were assayed in plasma. Kruskal-Wallis tests were used to compare medians with tobit regression for censoring. Results: In the pilot cohort, we found that PLHIV with history of active pulmonary TB (n=20) had higher intact provirus than PLHIV without history of active TB (n=47) (794 vs 117 copies per million CD4, respectively; p<0.0001). In the confirmatory cohort, the quantity of intact provirus was higher in the TB group (n=13) compared with the non-TB group (n=18) (median 102 vs. 0 intact provirus per million CD4, respectively p=0.03). Additionally, we found that the frequencies of CD4+ T cells with any detectable proviral fragment was directly proportional to the levels of IL1B (p= 0.0025) and IL2 (p=0.0002). Conclusions: This is the first assessment of HIV provirus using IPDA in a clinical cohort from a resource limited setting, and the finding of larger reservoir in PLHIV with history of TB has significant implications for our understanding of TB-HIV coinfection and HIV cure efforts in TB-endemic settings.

11.
Gynecol Oncol Rep ; 51: 101329, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38322734

ABSTRACT

Placental trophoblastic site tumor (PSTT) is a rare type of gestational trophoblastic neoplasia (GTN). PSTT has a higher mortality than other types of gestational trophoblastic disease (GTD), with a rate of 16.1%, due to its relatively unpredictable behavior and reduced response to chemotherapy. Its diagnostic and management are very challenging in Low resources settings particularity in Haiti where MRI, PET Scan and IHC are not available. Further, the follow-up is very difficult because of social, political, and economic issues limiting the capacity of our patients to be present at all scheduled visits. No case of PSTT has been publicly described yet the Haitian experience in the literature in the management of such case compared to the developed world. We present a case of PSTT successfully diagnosed and managed at Mirebalais University Hospital (MUH) in Haiti with the support of telepathology and intentional partners while highlighting the difference that we observed compare to the developed world.

12.
Glob Ment Health (Camb) ; 11: e19, 2024.
Article in English | MEDLINE | ID: mdl-38414724

ABSTRACT

Mental health is a significant public health challenge globally, and one anticipated to increase following the COVID-19 pandemic. In many rural regions of developing nations, little is known about the prevalence of mental health conditions and factors that may help mitigate poor outcomes. This study assessed the impact of the COVID-19 pandemic on mental health and social support for residents of rural Haiti. Data were collected from March to May 2020. The Patient Health Questionnaire subscales for anxiety and depression, and the Perceived Stress Scale were utilized in addition to tailored questions specific to COVID-19 knowledge. Half (51.8%) of the 500 survey respondents reported COVID-19-related anxiety and worrying either daily or across a few days. Half (50.2%) also reported experiencing depression daily or across several days. Most (70.4%) did not have any social support, and 28.0% experienced some stress, with 13.4% indicating high perceived stress. Furthermore, 4.6% had suitable plumbing systems in their homes. The results were immediately actionable, informing the implementation of a mental health counseling program for youth following a loss of social support through school closures. Long-term investments must be made as part of public health responses in rural communities in developing nations, which remain under-studied.

13.
Anim Biosci ; 2024 Feb 23.
Article in English | MEDLINE | ID: mdl-38419541

ABSTRACT

Latin America is a culturally, geographically, politically, and economically diverse region. Agriculture in Latin America is marked by a remarkable diversity of production systems, reflecting various agroecological zones, farm sizes, and technological levels. In the last decade, the swine industry increased by 30.6%, emerging as a great contributor to food security and economic development in Latin America. Brazil and Mexico dominate the pig production landscape, together accounting for 70% of sow inventory in the region. The swine industry in Latin America is predominantly comprised of small and medium-sized farms, however, in the past 30 years, the number of pig producers in Brazil dropped by 78%, whereas pork production increased by 326%. Similar to the global pork industry, the growing demand for pork, driven by population growth and changing dietary habits, presents an opportunity for the industry with an expected growth of 16% over the next decade. The export prospects are promising, however subject to potential disruptions from global market conditions and shifts in trade policies. Among the challenges faced by the swine industry, disease outbreaks, particularly African Swine Fever (ASF), present significant threats, necessitating enhanced biosecurity and surveillance systems. In 2023, ASF was reported to the Dominican Republic and Haiti, Porcine Reproductive and Respiratory Syndrome (PRRS) in Mexico, Costa Rica, the Dominican Republic, Colombia, and Venezuela, and Porcine Epidemic Diarrhea (PED) in Mexico, Peru, the Dominican Republic, Colombia, and Ecuador. Additionally, feed costs, supply chain disruptions, and energy expenses have affected mainly the smaller and less efficient producers. The swine industry is also transitioning towards more sustainable and environmentally friendly practices, including efficient feed usage, and precision farming. Ensuring long-term success in the swine industry in Latin America requires a holistic approach that prioritizes sustainability, animal welfare, and consumer preferences, ultimately positioning the industry to thrive in the evolving global market.

14.
Sci Total Environ ; 920: 170609, 2024 Apr 10.
Article in English | MEDLINE | ID: mdl-38316296

ABSTRACT

Spatial and temporal variations of mercury (Hg) concentrations, enrichment, and potential ecological risks were studied in a suite of lead-210 (210Pb) dated sediment cores from 13 Wider Caribbean Region coastal environments. Broad variability of Hg concentrations (19-18761 ng g-1) was observed, encompassing even background levels (38-100 ng g-1). Most Hg concentration profiles exhibited a characteristic upward trend, reaching their peak values in the past two decades. Most of the sediment sections, showing from moderately to very severe Hg enrichment, were found in cores from Havana Bay and Sagua River Estuary (Cuba), Port-au-Prince Bay (Haiti), and Cartagena Bay (Colombia). These were also the most seriously contaminated sites, which can be considered regional Hg 'hotspots'. Both Havana Bay and Port-au-Prince Bay reportedly receive waste from large cities with populations exceeding 2 million inhabitants, and watersheds affected by high erosion rates. The records from the Sagua River Estuary and Cartagena Bay reflected historical Hg contamination associated with chloralkali plants, and these sites are of very high ecological risk. These results constitute a major contribution to the scarce regional data on contaminants in the Wider Caribbean Region and provide reference information to support the evaluation of the effectiveness of the Minamata Convention.

15.
Qual Health Res ; : 10497323241229420, 2024 Feb 08.
Article in English | MEDLINE | ID: mdl-38332547

ABSTRACT

Intestinal ostomy can have significant effects on lives and lived experiences. However, limited research exists on the experiences of persons with ostomy in low-resource settings, such as rural Haiti. This study aimed to explore the lived experiences of Haitians with an ostomy, focusing on the physical, psychological, and social aspects of their post-operative lives. We conducted 9 semi-structured, in-depth interviews with participants who had undergone ostomy surgery at the Hôpital Universitaire de Mirebalais in Haiti. Employing interpretative phenomenological analysis (IPA), we iteratively examined transcripts to identify convergent and divergent codes, which were then grouped into themes to better understand the participants' experiences. Three themes emerged: (a) ostomy as a social disease, which has severe impacts on relationships and place in society; (b) ostomy as altering self-image, leading participants to reflect on their identity and the underlying causes of their condition and to reevaluate their necessities and abilities; and (c) ostomy as an arduous medical journey, characterized by pain, distress, uncertainty, and disillusionment, but also resiliency, improvisation, and hope. This study highlights the multifaceted experiences of persons with ostomy in the low-resource rural environment of Haiti and underscores the need for improved access to medical care, financial support, and psychosocial and caregiving resources for these individuals. Findings also emphasize the importance of medical providers' improved understanding in making medical decisions, and cultural and socioeconomic factors in developing effective support strategies.

16.
Plant Dis ; 2024 Feb 04.
Article in English | MEDLINE | ID: mdl-38311794

ABSTRACT

Banana (Musa spp.) is an economically important fruit and food crop globally as well as in China. In March 2023, a bulb rot disease was observed on more than 20% of cultivated dwarf bananas in a plantation in Wuming County of Guangxi Province, a major hub of banana production in China. Infected plants showed crackles at the basal part of stem and were relatively dwarf, while yellowing of the leaves was not observed. When the rhizomes were cut open, water-soaked lesions with a yellow or black margin can be seen in the bulb. In severe infections, the internal tissue became dry or wet rot, and there was typical dark-brown cavity formation in the bulb. The rot was limited to the bulb. To isolate the causal agent, dissected diseased tissues (5×5 mm) were surface sterilized with 75% ethanol (30 s) and 2% NaClO (3 min), followed by three rinses with sterile water. The sterilized sections were soaked in 2 mL of sterile water and shaken for 5 min in a vortex oscillator. The suspension was streaked on Luria-Bertani (LB) agar medium, and incubated at 28℃ for 24 h. Single colonies were re-streaked three times to obtain purified isolation. Twelve pure bacterial cultures with similar morphology were isolated from three plants taken from the field. The bacterial colonies were yellowish white, mucoid, round, and raised with translucent surfaces on the LB agar plate. Three strains Gxkv1, Gxkv2 and Gxkv3 were selected for further analyses. The 16S rDNA gene (GenBank Accession OR461756, PP094726 and PP109349) were amplified using primer pair 27F/1492R (Frank et al. 2008). Comparing 16S sequences against GenBank showed 99.86%-100% sequence identity to Klebsiella variicola strain (MZ475068) for the three isolates Gxkv1 (1,398/1,398 bp), Gxkv2 (1,398/1,396 bp) and Gxkv3 (1,398/1,398 bp). A multilocus phylogenetic analysis was conducted by neighbor-joining method (1,000 bootstrap values) based on three housekeeping gene sequences of gyrA (GenBank Accession No. OR515493, PP105747, PP105748), rpoB (OR515494, PP105751, PP105752 ) and infB (OR515495, PP105749, PP105750) genes which were amplified by gyrA-A/gyrA-C, CM31b/CM7 and infB867F/infB1819R primer sets, respectively (Rosenblueth et al. 2004). The results of phylogenetic analysis showed the three strains belong to the K. variicola clade. A pathogenicity test was conducted on six healthy 3-month-old dwarf banana plants by spraying 10 mL of bacterial suspensions of Gxkv1 (108 CFU/mL) into the rhizome which wounded with a sterilized needle; another six healthy control plants were sprayed with 10 mL of sterile water. Following inoculation, the plants were placed in a greenhouse at 28-32°C. After 30 days, all inoculated plants showed symptoms similar to those observed in the field, while the control plants remained healthy. Bacteria were successfully reisolated from the symptomatic tissues and identified to be K. variicola by PCR mentioned above. K. variicola has been reported to cause rhizome rot of banana in India (Loganathan et al. 2021), and to cause plantain soft rot in Haiti (Fulton et al. 2021). Besides, previous reports from China only showed K. variicola causing banana sheath rot (Fan et al. 2015, Sun et al. 2023). To our knowledge, this is the first report of bulb rot disease of banana caused by K. variicola in Guangxi Province, China. This finding will provide important information for studying the epidemiology and management of this pathogen.

17.
Disaster Med Public Health Prep ; 18: e23, 2024 Feb 14.
Article in English | MEDLINE | ID: mdl-38351541

ABSTRACT

OBJECTIVE: This study explored the barriers and facilitators of mask-wearing behaviors during the pandemic in Taiwan, the United States, the Netherlands, and Haiti. METHODS: Face-to-face interviews were conducted in Taiwan and online interviews were conducted with participants in the United States, the Netherlands, and Haiti. RESULTS: In general, the habit of wearing a mask before coronavirus disease 2019 (COVID-19) was reported by Taiwanese participants. Additionally, Taiwanese participants perceived that wearing a mask was a social responsibility during the pandemic, suggesting that the collectivistic context might influence mask-wearing behavior. Unlike the Taiwanese population, some people in the United States and the Netherlands were reluctant to wear masks due to perceived restrictions on their freedom. Participants from Haiti mentioned that people who wore masks encountered violence, bullying, and discrimination. The results of this study suggest that political leadership and mask mandates have a strong impact on people's mask-wearing behavior. CONCLUSIONS: These findings have valuable implications for the design of diverse behavioral interventions to enhance mask-wearing as part of infectious disease preparedness. Additionally, the findings from these countries offer valuable insights for the development of effective public health interventions to enhance society's resilience during the current pandemic and future infectious disease outbreaks.


Subject(s)
COVID-19 , Pandemics , United States/epidemiology , Humans , Netherlands , Taiwan/epidemiology , Pandemics/prevention & control , Haiti/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Masks
18.
J Med Biogr ; : 9677720231223501, 2024 Feb 28.
Article in English | MEDLINE | ID: mdl-38414384

ABSTRACT

In the chronicles of medical advancement, Dr Paul Farmer stands out as a transformative figure whose unwavering commitment to healthcare equity has reshaped treatments for the disenfranchised. An American anthropologist and physician, Farmer has had a profound impact on global health which encapsulates a legacy driven by the steadfast belief that healthcare is an inalienable human right. This article explores Farmer's monumental contributions, showcasing how his dedication has revolutionized the landscape of healthcare, particularly for those marginalized and underserved. As the architect of Partners In Health and a guiding force at Harvard Medical School, he fostered a novel paradigm of enduring, community-focused medical care. His unyielding advocacy from Haiti to Rwanda confronted entrenched health disparities and galvanized support for increased access to primary and secondary care. His poignant critiques and policy recommendations during the COVID-19 crisis highlighted his relentless pursuit of health justice - advocating for equitable vaccine distribution and tackling racial health disparities. His scholarly works on overlooked health dilemmas and the urgency of global healthcare reflect a legacy that transcends his lifetime. While his passing is deeply felt, Farmer's visionary ethos continues to inspire, beckoning us toward a more equitable healthcare horizon.

19.
Diseases ; 12(2)2024 Jan 31.
Article in English | MEDLINE | ID: mdl-38391778

ABSTRACT

Zika virus (ZIKV) and chikungunya virus (CHIKV) are arthropod-borne viruses with significant pathogenicity, posing a substantial health and economic burden on a global scale. Moreover, ZIKV-CHIKV coinfection imposes additional therapeutic challenges as there is no specific treatment for ZIKV or CHIKV infection. While a growing number of studies have documented the ZIKV-CHIKV coinfection, there is currently a lack of conclusive reports on this coinfection. Therefore, we performed a systematic review and meta-analysis to determine the true statistics of ZIKV-CHIKV coinfection in the global human population. Relevant studies were searched for in PubMed, Scopus, and Google Scholar without limitation in terms of language or publication date. A total of 33 studies containing 41,460 participants were included in this meta-analysis. The study protocol was registered with PROSPERO under the registration number CRD42020176409. The pooled prevalence and confidence intervals of ZIKV-CHIKV coinfection were computed using a random-effects model. The study estimated a combined global prevalence rate of 1.0% [95% CI: 0.7-1.2] for the occurrence of ZIKV-CHIKV coinfection. The region of North America (Mexico, Haiti, and Nicaragua) and the country of Haiti demonstrated maximum prevalence rates of 2.8% [95% CI: 1.5-4.1] and 3.5% [95% CI: 0.2-6.8], respectively. Moreover, the prevalence of coinfection was found to be higher in the paediatric group (2.1% [95% CI: 0.0-4.2]) in comparison with the adult group (0.7% [95% CI: 0.2-1.1]). These findings suggest that the occurrence of ZIKV-CHIKV coinfection varies geographically and by age group. The results of this meta-analysis will guide future investigations seeking to understand the underlying reasons for these variations and the causes of coinfection and to develop targeted prevention and control strategies.

20.
HIV Res Clin Pract ; 25(1): 2316538, 2024 Feb 08.
Article in English | MEDLINE | ID: mdl-38396369

ABSTRACT

To address high HIV prevalence rates in Haiti, disseminating information about HIV transmission has been emphasized. Yet, after several decades, we do not know how effective HIV information dissemination has been in reducing HIV misconceptions. Using the 2005-06, 2012, and 2016-17 Haiti Demographic and Health Surveys and applying logistic regression, we found nuanced gender dynamics in endorsing HIV misconceptions over time. Among females at the bivariate level, the odds of endorsement of HIV misconceptions in 2012 (OR = 0.87, p < 0.05) and 2016-17 (OR = 0.68, p < 0.001) had declined compared to 2005-06. At the multivariate level, however, we observed that demographic factors suppressed the difference between 2005-06 and 2012, although those in 2016-17 (OR = 0.71, p < 0.001) were still less likely to endorse HIV misconceptions. However, this relationship disappeared once we added behavioral factors (OR = 0.93, p > 0.05). Among males, after controlling for demographic, socioeconomic, and behavioral factors at the multivariate level, those in 2012 (OR = 1.55, p < 0.001) and 2016-17 (OR = 1.24, p < 0.01) were more likely to endorse HIV misconceptions compared to men in 2005-06. We recommend that while improving women's access to HIV services, it is important to incorporate the HIV needs of males into the National HIV policy priority areas.


Subject(s)
HIV Infections , Male , Humans , Female , Haiti/epidemiology , HIV Infections/epidemiology , HIV Infections/prevention & control , Health Knowledge, Attitudes, Practice
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