Ancient genomes reveal origin and rapid trans-Eurasian migration of 7th century Avar elites.

The Avars settled the Carpathian Basin in 567/68 CE, establishing an empire lasting over 200 years. Who they were and where they came from is highly debated. Contemporaries have disagreed about whether they were, as they claimed, the direct successors of the Mongolian Steppe Rouran empire that was destroyed by the Turks in ∼550 CE. Here, we analyze new genome-wide data from 66 pre-Avar and Avar-period Carpathian Basin individuals, including the 8 richest Avar-period burials and further elite sites from Avar's empire core region. Our results provide support for a rapid long-distance trans-Eurasian migration of Avar-period elites. These individuals carried Northeast Asian ancestry matching the profile of preceding Mongolian Steppe populations, particularly a genome available from the Rouran period. Some of the later elite individuals carried an additional non-local ancestry component broadly matching the steppe, which could point to a later migration or reflect greater genetic diversity within the initial migrant population.

Physiological and Genetic Adaptations to Diving in Sea Nomads.

Understanding the physiology and genetics of human hypoxia tolerance has important medical implications, but this phenomenon has thus far only been investigated in high-altitude human populations. Another system, yet to be explored, is humans who engage in breath-hold diving. The indigenous Bajau people ("Sea Nomads") of Southeast Asia live a subsistence lifestyle based on breath-hold diving and are renowned for their extraordinary breath-holding abilities. However, it is unknown whether this has a genetic basis. Using a comparative genomic study, we show that natural selection on genetic variants in the PDE10A gene have increased spleen size in the Bajau, providing them with a larger reservoir of oxygenated red blood cells. We also find evidence of strong selection specific to the Bajau on BDKRB2, a gene affecting the human diving reflex. Thus, the Bajau, and possibly other diving populations, provide a new opportunity to study human adaptation to hypoxia tolerance. VIDEO ABSTRACT.

Perceptions of TB-HIV comorbidity among the Nomads in Adamawa State, Nigeria.

The recalcitrance of Mycobacterium tuberculosis (MTB) to eradication was related to achieving a nonreplicating (dormant) state and the increasing global burden of HIV coinfection. Consequently, understanding the knowledge and perception of the population at risk of tuberculosis-HIV infection is essential to designing a strategy of intervention embraced by the target population. A cross-sectional study was conducted among Nomads in Adamawa State, Nigeria. A multistage sampling technique was employed to recruit consented participants. Self-administered questionnaires were used to gather the required information from 4 nomadic schoolteachers in each selected school. Data were entered into a Microsoft Excel sheet where trends and tables of collated data were developed. The findings show that only 13.5% of the participants expressed the correct perceptions of the complementary relationship between HIV and TB. More people in government employment (35%) understand the coexisting relationship of TB-HIV infections. At the same time, cattle herders and crop farmers who practice the prevalent occupation lack knowledge of TB-HIV relatedness. Across gender, only a proportion of males (14.8%) than females (10.5%) were more likely to show an understanding of the complementary association of HIV and TB, and this difference showed statistical significance (p = 0.0001). In conclusion, male gender, education at a degree or professional level, and employment with the government are factors associated with positive perceptions of TB/HIV relatedness. Thus, there is a need to intensify communication to educate Nomads on HIV and TB-related issues.

Malaria infection and predictor factors among Chadian nomads' children.

BACKGROUND: In Chad, malaria remains a significant public health concern, particularly among nomadic populations. Geographical factors and the mobility of human populations have shown to be associated with the diversity of Plasmodium species. The study aims to describe the malaria prevalence among nomadic children and to investigate its associated factors. METHODS: A cross-sectional study was conducted in February and October 2021 among nomadic communities in Chad. Blood sample were collected and tested from 187 Arab, Fulani and Dazagada nomadic children aged 3-59 months using malaria rapid diagnostic test (RDT). A structured electronic questionnaire was administered to their parents to collect information about the socio­economic data. Malaria testing results were categorized according to the SD BIOLINE Malaria Ag Pf/Pan RDT procedures. Logistic regression analysis was used to determine key risk factors explaining the prevalence of malaria. STATA version IC 13 was used for statistical analysis. RESULTS: The overall malaria prevalence in nomadic children was 24.60%, with 65.20% being Plasmodium falciparum species and 34.8% mixed species. Boys were twice as likely (COR = 1.83; 95% CI, 0.92-3.62; p = 0.083) to have malaria than girls. Children whose parents used to seek traditional drugs were five times more likely (AOR = 5.59; 95% CI, 1.40-22.30, p = 0.015) to have malaria than children whose parents used to seek health facilities. Children whose parents reported spending the last night under a mosquito net were one-fifth as likely (AOR = 0.17; 95% CI, 0.03-0.90, p = 0.037) to have malaria compared to children whose parents did not used a mosquito net. Furthermore, Daza children were seventeen times (1/0.06) less likely (AOR = 0.06; 95% CI, 0.01-0.70, p = 0.024) to have malaria than Fulani children and children from households piped water as the main source were seven times more likely (AOR = 7.05; 95% CI, 1.69-29.45; p = 0.007) to have malaria than those using surface water. CONCLUSIONS: Malaria remains a significant public health issue in the nomadic communities of Chad. Community education and sensitization programs within nomad communities are recommended to raise awareness about malaria transmission and control methods, particularly among those living in remote rural areas. The National Malaria Control Program (NMCP) should increase both the coverage and use of long-lasting insecticidal nets (LLINs) and seasonal malaria chemoprevention (SMC) in addition to promoting treatment-seeking behaviors in nomadic communities.

Low Immunization Completion among Under-Five Children: Are Underserved Nomadic and Farming Communities in a North Central State of Nigeria doing Better?

Background: The recent drop in immunization coverage in Nigeria has left more than 3.25 million children unimmunized and has risen concern over immunization completion among the under-five children. More so among underserved communities of pastoralist nomads and farmers that were isolated from immunization services because of operational and sociocultural factors. Materials and Methods: A cross-sectional analytical (comparative analysis) study was carried out among 550 eligible caregivers of under-five children in nomadic and farming communities in Niger State, Nigeria. The mothers and caregivers paired with under-five children were recruited into the study using a multistage sampling technique. Data was collected using a validated interviewer-administered questionnaire. Data was analyzed with the statistical software package (version 23). Results: More than half of the under-five children studied were males in both the nomadic (57.5%) and farming (52.0%) communities. The aggregated score of immunization knowledge was significantly (P < 0.001) better (Good 44.4%; Fair 49.8%) among farmers compared to their nomads' counterpart (Good 21.1%; Fair 43.6%). Conversely, almost all the respondents (98.2%) in nomadic community significantly had a good overall perception of childhood immunization compared to 77.1% in the farming community. More farmers' children (99.6%) had received immunization compared to 92.4% of the nomads' children. About 87.3% of farmers compared to 76% of the nomads' (76.0%) children reported immunization completion. About 50.5% of the farmers' and 41.4% of the nomads' children have achieved immunization on card inspection. Conclusion: This study revealed that average immunization completion reported among under-five children in both farming and nomadic communities is higher than the national average. It is recommended that more strategies are needed to intensify immunization campaigns targeted at populations in Nigeria.

Knowledge and social beliefs of malaria and prevention strategies among itinerant Nomadic Arabs, Fulanis and Dagazada groups in Chad: a mixed method study.

BACKGROUND: Nomadic populations in Chad are at increased risk of contracting malaria because of their lifestyle. Being highly mobile they are often excluded from disease control programmes, and access to preventive measures and treatment is more difficult. Effective malaria control interventions take account of local modes of transmission, patterns of care-seeking behaviour and community perceptions of cause and prevention practices. There is currently little information about malaria knowledge and perceptions among nomadic groups in Chad, or their awareness of malaria control interventions and this study sought to address this knowledge gap. METHODS: A mixed methods study, including a cross-sectional survey with men and women (n = 78) to determine the level of knowledge and use of malaria prevention strategies among Arabs, Peuls and Dagazada nomadic groups. Three focus group discussions were conducted with women to explore their representation of malaria and knowledge of preventive methods. Key informant interviews were held with leaders of nomadic groups (n = 6) to understand perception of malaria risk among itinerant communities. RESULTS: Nomads are aware of the risk of malaria, recognize the symptoms and have local explanations for the disease. Reported use of preventive interventions such as Seasonal Malaria Chemoprevention (SMC) for children and Intermittent Preventive Treatment (IPT) of malaria in pregnancy was very low. However, 42.3% of respondents reported owning at least one LLIN and 60% said they slept under an LLIN the night before the survey. In case of a malaria episode, nomads seek clinicians, informal drug sellers in the street or market for self-medication, or traditional medicine depending on their financial means. Interviews with nomad leaders and discussions with women provide key themes on: (i) social representation of malaria risk and (ii) social representation of malaria and (iii) perspectives on malaria prevention and (iv) malaria treatment practices. CONCLUSION: The nomadic groups included in this study are aware of risk of malaria and their level of exposure. Local interpretations of the cause of malaria could be addressed through tailored and appropriate health education. Except for LLINs, malaria prevention interventions are not well known or used. Financial barriers lowered access to both mosquito nets and malaria treatment. Reducing the barriers highlighted in this study will improve access to the healthcare system for nomadic groups, and increase the opportunity to create awareness of and improve uptake of SMC and IPT among women and children.

'Grey nomad' travellers' use of remote health services in Australia: a qualitative enquiry of hospital managers' perspectives.

BACKGROUND: For more than the last two decades, older Australians travelling domestically in self-sufficient accommodation and recreational vehicles for extended periods of time have been referred to as 'Grey Nomads'. By 2021 more than 750,000 such recreational vehicles were registered in Australia. Tourism data for the year to September 2017 show 11.8 million domestic camping and caravanning trips in Australia, 29% of which were people aged 55 and over. As the 'baby boomer' generation increasingly comes to retirement, the size of this travelling population is growing. This term applies to the spike in birth rates after World War II from 1946-1964. This growing group of domestic travellers are potential healthcare consumers in remote areas but relatively little is known about their travel, healthcare needs or care seeking practices. Grey nomads have been described as reflective of the age-comparable sector of the Australian population in that many live with chronic illness. Early concerns were raised that they may "burden" already stretched rural and remote healthcare services but relatively little is known about the impact of these travellers. METHODS: The aim of this study was to explore the utilisation of healthcare services in remote locations in Australia by grey nomads including women travellers, from the perspective of healthcare professionals working in these settings. The study objective was to interview healthcare professionals to seek their experience and details of service delivery to grey nomads. In March 2020 [prior to state border closures due to the COVID-19 pandemic] a field study was conducted to identify the impact of grey nomads on healthcare services in remote New South Wales and Queensland. A qualitative approach was taken to explore the perspectives of nursing healthcare managers working in remote towns along a popular travel route. With appropriate Research Ethics Committee approval, managers were purposively sampled and sample size was determined by data saturation. Thirteen managers were contacted and twelve interviews were scheduled to take place face to face in the healthcare facilities (small hospitals with acute care and aged care services) at mutually convenient times. A semi-structured interview schedule was developed in line with the research aim. The interviews were audio-recorded, transcribed and thematic analysis was undertaken concurrently with data collection for ongoing refinement of questions and to address emerging issues. RESULTS: These nursing managers described a strong service and community ethos. They regarded travellers' healthcare needs no differently to those of local people and described their strong commitment to the provision of healthcare services for their local communities, applying an inclusive definition of community. Traveller presentations were described as predominantly exacerbations of chronic illness such as chest pain, medication-related attendances, and accidents and injuries. No hospital activity data for traveller presentations were available as no reports were routinely generated. Travellers were reported as not always having realistic expectations about what healthcare is available in remote areas and arriving with mixed levels of preparedness. Most travellers were said to be well-prepared for their travel and self-management of their health. However, the healthcare services that can be provided in rural and remote areas needed to be better understood by travellers from metropolitan areas and their urban healthcare providers. CONCLUSION: Participants did not perceive travellers as a burden on health services but recommendations were made regarding their expectations and preparedness. Australia's national transition to electronic health records including a patient-held record was identified as a future support for continuity of care for travellers and to facilitate treatment planning. With no current information to characterise traveller presentations, routinely collected hospital data could be extracted to characterise this patient population, their presentations and the resources required to meet their care needs.

Metabolic syndrome and its relation to dietary patterns among a selected urbanised and semi-urbanised Tibetan population in transition from nomadic to settled living environment.

OBJECTIVE: To explore the scope of metabolic syndrome (MetS) and its relationship to the major dietary patterns among an urbanised and semi-urbanised Tibetan population in transition from nomadic to settled settings. DESIGN: Cross-sectional. SETTING: Community-based. PARTICIPANTS: Urbanised and semi-urbanised Tibetan adults (n 920, aged 18-90 years), who have moved from nomadic to settled living environments, answered questionnaires on food consumption frequency and lifestyle characteristics through structured face-to-face interviews and completed anthropometric measurement and metabolic biomarker tests. RESULTS: MetS prevalence was 30·1 % in males and 32·1 % in females. Low HDL-cholesterol and central obesity were the leading metabolic abnormalities (86·3 and 55·8 %, respectively). Three major dietary patterns - urban, western and pastoral - were identified. Beef/mutton was an important food group for all three identified dietary patterns. In addition, the urban dietary pattern was characterised by frequent consumption of vegetables, tubers/roots and refined carbohydrates; the western pattern was characterised by sweetened drinks, snacks and desserts; and the pastoral pattern featured tsamba (roasted Tibetan barley), Tibetan cheese, butter tea/milk tea and whole-fat dairy foods. Individuals in the highest quintile of urban dietary pattern scores were found to be at a higher risk of developing MetS (OR 2·43, 95 % CI 1·41, 4·18) and central obesity (OR 1·91, 95 % CI 1·16, 3·14) after controlling for potential confounders. CONCLUSIONS: MetS was common among urbanised and semi-urbanised Tibetan adult population in transition. The urban dietary pattern, in particular, was a risk factor for MetS. To prevent MetS, nutrition interventions need to be tailored to address the variety of local diet patterns to promote healthy eating.

Grey nomads with diabetes self-management on the road - a scoping review.

INTRODUCTION: This scoping literature review explored the characteristics and behaviours of a subset of Australia's older population: 'grey nomads', many who live and travel with type 1 or 2 diabetes mellitus. Grey nomads are people aged more than 55 years, who travel in caravans or motorhomes for extended periods of time around rural and remote areas of Australia. Grey nomads are challenging the established view of ageing in Australia by their lifestyle choices, which include social and economic contribution, independence and furthering of personal fulfilment. However, some evidence suggests that grey nomads experience health issues while in rural locations, which exerts a significant burden on already under-resourced Australian rural health services. This review seeks knowledge on grey nomads' self-management of diabetes while travelling, with the aim of understanding their experiences and identifying support services and strategies that would facilitate improved self-management. Furthermore, this review seeks knowledge of how Australia's rural and remote health services support the nomads with diabetes and the influence of this burgeoning population on such services. METHODS: A scoping review methodology provided the methods to map the current evidence concerned with this broad and complex topic. A systematic six-step framework was adopted: identifying the research question; identifying relevant literature; selecting studies; charting the findings; collating, summarising and reporting results; and a final consultation. RESULTS: The grey nomads in this review travelled long distances through the often-harsh Australian countryside where they sought, privacy, isolation, self-sufficiency and a closeness with nature. Although their motivations included life- and health-enhancing experiences, most grey nomads travelled with at least one chronic health condition, which they did not consider as a barrier to adopting a grey nomad lifestyle. However, many were under-prepared for their health needs when in rural or remote Australia. Specific literature concerning grey nomads and self-management of diabetes was not found but salient aspects of diabetes self-management were identified and included a well-developed relationship with their diabetes healthcare provider; a relationship that relied on ongoing communication and support. When travelling, the ability to form or sustain supportive relationships with local health care providers was limited due to sparseness of rural services and the perceived transient nature of the relationship. Increasingly, grey nomads utilised digital technology via telemedicine or social media sites for information and advice on health issues. The local pharmacies in rural and remote locations were also identified as sources of support and services. CONCLUSION: The literature showed that the grey nomad population had a similar distribution of chronic illness, including diabetes, to that of the general Australian population, but very little was published about how they self-manage conditions when in remote locations where healthcare services were limited. The emerging roles of digital technology and development opportunities for pharmacists offer new and innovative avenues to support grey nomads with diabetes while travelling in rural and remote Australia.

Toxoplasmosis in Nomadic Communities: A Seroepidemiological Study in Southwestern Iran.

BACKGROUND: Toxoplasma gondii is the agent of a zoonotic protozoan infection with worldwide distribution. The rates of infection in different areas are depending on climatic conditions and also social and cultural habits of the people. This cross-sectional study aimed to find out the seroprevalence of toxoplasmosis in nomadic people in Boyer-Ahmad County, in the southwest of Iran. METHODS: Blood samples (5 mL) were collected from 1005 individuals of nomadic tribes of Boyer-Ahmad County in Kohgiluyeh and Boyer-Ahmad Province in 2016. A predesigned questionnaire, containing basic epidemiological information was filled out for each subject during the sampling. Sera were evaluated for anti-T. gondii antibodies (both IgG and IgM), using a commercial ELISA kit. Collected data were analyzed by SPSS, using descriptive statistics and Chi-square test. RESULTS: Out of the 1005 studied subjects, 227 (22.6%) were male and 778 (77.4%) were female. The mean age of participants was 41 years (SD: ±17). The most represented (24.4%) age class was 21-30 years and the least (1.9%) 1-10 years. Anti-T. gondii antibodies were detected in 174 (17.3%) of the cases. No statistically significant associations were found between seropositivity to T. gondii and area of residence, age, gender and educational levels of the participants. CONCLUSIONS: Findings of this study show that the seroprevalence of toxoplasmosis among the nomads of Kohgiluyeh and Boyer-Ahmad province is alike to other communities in our country. Further study is required to elucidate the genotype of T. gondii in this community.

Alu insertion polymorphisms in the African Sahel and the origin of Fulani pastoralists.

BACKGROUND: The origin of Western African pastoralism, represented today by the Fulani nomads, has been a highly debated issue for the past decades, and has not yet been conclusively resolved. AIM: This study focused on Alu polymorphisms in sedentary and nomadic populations across the African Sahel to investigate patterns of diversity that can complement the existing results and contribute to resolving issues concerning the origin of West African pastoralism. SUBJECTS AND METHODS: A new dataset of 21 Alu biallelic markers covering a substantial part of the African Sahel has been analysed jointly with several published North African populations. RESULTS: Interestingly, with regard to Alu variation, the relationship of Fulani pastoralists to North Africans is not as evident as was earlier revealed by studies of uniparental loci such as mtDNA and NRY. Alu insertions point rather to an affinity of Fulani pastoralists to Eastern Africans also leading a pastoral lifestyle. CONCLUSIONS: It is suggested that contemporary Fulani pastoralists might be descendants of an ancestral Eastern African population that, while crossing the Sahara in the Holocene, admixed slightly with a population of Eurasian (as evidenced by uniparental polymorphisms) ancestry. It seems that, in the Fulani pastoralists, Alu elements reflect more ancient genetic relationships than do uniparental genetic systems.

The persistence of cliques in the post-communist state. The case of deniability in drug reimbursement policy in Poland.

This article explores a key question in political sociology: Can post-communist policy-making be described with classical theories of the Western state or do we need a theory of the specificity of the post-communist state? In so doing, we consider Janine Wedel's clique theory, concerned with informal social actors and processes in post-communist transition. We conducted a case study of drug reimbursement policy in Poland, using 109 stakeholder interviews, official documents and media coverage. Drawing on 'sensitizing concepts' from Wedel's theory, especially the notion of 'deniability', we developed an explanation of why Poland's reimbursement policy combined suboptimal outcomes, procedural irregularities with limited accountability of key stakeholders. We argue that deniability was created through four main mechanisms: (1) blurred boundaries between different types of state authority allowing for the dispersion of blame for controversial policy decisions; (2) bridging different sectors by 'institutional nomads', who often escaped existing conflicts of interest regulations; (3) institutional nomads' 'flexible' methods of influence premised on managing roles and representations; and (4) coordination of resources and influence by elite cliques monopolizing exclusive policy expertise. Overall, the greatest power over drug reimbursement was often associated with lowest accountability. We suggest, therefore, that the clique theory can be generalized from its home domain of explanation in foreign aid and privatizations to more technologically advanced policies in Poland and other post-communist countries. This conclusion is not identical, however, with arguing the uniqueness of the post-communist state. Rather, we show potential for using Wedel's account to analyse policy-making in Western democracies and indicate scope for its possible integration with the classical theories of the state.

Herpes simplex virus type 2 among mobile pastoralists in northwestern Namibia.

BACKGROUND: Although herpes simplex virus type 2 (HSV-2) epidemiology has been described for many western and/or urban populations, disease burden has not been characterized for remote, non-western, under treated populations, where patterns of risk and vulnerability may be very different. AIMS: To understand demographic, behavioural and geographic influences on risk for HSV-2 in a population of mobile, rural pastoralists in northwestern Namibia. SUBJECTS AND METHODS: The authors conducted a cross-sectional survey of reproductively aged adults (n = 445) across 28 villages in Kaokoveld, Namibia. All participants completed a questionnaire of demographic data, ecological interactions and sexual behaviour, and a rapid test specific for HSV-2. RESULTS: HSV-2 status was significantly associated with being female (OR = 3.1, 95% CI = 2.00, 4.71), increasing age (men: OR = 7.5, 95% CI = 2.67, 20.85; women: OR = 6.2, 95% CI = 2.48, 15.50) and with higher wealth among men (OR = 5.1, 95% CI = 1.98, 13.09). CONCLUSIONS: Higher risk among women can be explained, in part, by local hygiene practices and a preference for "dry" sex. There was considerable variation in prevalence by region, which appears to be linked to geographic remoteness. Culturally contextualized epidemiologic studies of remote, vulnerable populations can provide essential information for limiting the introduction and spread of new infections.

The prevalence of dyspepsia symptoms and its correlation with the quality of life among Qashqai Turkish migrating nomads in Fars Province, Southern Iran.

OBJECTIVES: To determine the prevalence of dyspepsia and its correlation with quality of life in Fars Qashqai Turkish migrating nomads from Southern Iran. METHODS: During 2010 we enrolled 397 Qashqai migrating nomads from Southern Iran who were 25 years of age or older. Participants completed a questionnaire that consisted of demographic factors, lifestyle data, gastrointestinal symptoms, and the Short-Form 36 Health Survey (SF-36) questionnaire. RESULTS: There was a 48% prevalence of dyspepsia symptoms among participants. The prevalence was higher among females, those less than 35 years of age, married participants, and those with a low body mass index (BMI). The correlation between dyspepsia and quality of life was significant. Dyspeptic patients were classified into ulcer-like (27.9%), dysmotility-like (26.2%), and unspecified (45.9%) groups. A significant correlation existed between dyspepsia symptoms and consumption of dairy products, drinking water and tea before and after meals, smoking, dysphagia, reflux, heartburn, and use of non-steroid anti-inflammatory drugs and acetaminophen. CONCLUSION: The high prevalence of dyspepsia in Qashqai nomads necessitates educational health programs for the migrating tribes in order to decrease prevalence of this disease.

Using a Knowledge and Awareness Survey to Engage and Inform a Community-Based Tuberculosis Intervention among Nomads in Adamawa State, Nigeria.

BACKGROUND: Nomadic populations are frequently isolated and vulnerable to diseases including tuberculosis (TB) and human immunodeficiency virus (HIV) due to limited access to health-related information and services, poverty, and social exclusion. We designed and implemented community-driven and -based outreach for TB and HIV based on the results of a TB knowledge, attitude, and practices (KAP) survey in Adamawa, Nigeria. METHODS: We conducted a cross-sectional study on KAP among nomads using an adapted WHO survey. A TB and HIV community-level active case-finding intervention among nomadic populations was planned and delivered based on the KAP survey results. RESULTS: Among 81 respondents, 26 (32.1%) knew what caused TB. More than 60% reported no health facilities in their community. Radio and healthcare workers were primary sources of information on health. Using community input, we developed and broadcasted radio jingles to sensitize people to TB services. Outreach initiatives led to the verbal screening of 61,891 individuals and 306 were diagnosed with TB. Additionally, 4489 people underwent HIV testing, and 69 were HIV-positive, all of whom were linked to treatment. CONCLUSIONS: The results of KAP surveys can inform the design of evidence-based TB and HIV community-driven and -based case-finding interventions in rural Nigeria among nomadic populations.

Prevalence, serotype distribution, and antimicrobial susceptibility profile of Streptococcus pneumoniae in Sea Nomad children under 5 years of age in Wakatobi, Southeast Sulawesi, Indonesia: A cross-sectional study.

OBJECTIVE: Indonesia commenced the nationwide introduction of pneumococcal conjugate vaccine (PCV) in 2022. Pre-vaccine Streptococcus pneumoniae data from across the country could be critical to enable vaccine impact evaluation in the future. This study evaluates colonization prevalence, factors associated with colonization, serotype distribution, and the antimicrobial susceptibility profile of S. pneumoniae. METHODS: Children under 5 years of age were enrolled from Bajau tribe settlements in Wakatobi, southeast Sulawesi, Indonesia, from October 2018 to February 2019. Nasopharyngeal swab specimens were analysed by culture, and isolates were serotyped using sequential multiplex polymerase chain reaction. Antibiotic susceptibility was performed by the disk diffusion method. Multivariable logistic regression was performed for risk factor analysis. RESULTS: A total of 499 NP swab specimens were collected; 61.9% were colonized with S. pneumoniae and 48.9% of the isolates were of PCV13-vaccine type. The most common serotypes were 23F, 6B, 19F, and 6A at 13.2%, 9.8%, 8.9%, and 8.0%, respectively. Exposure to cigarette smoke in the household and runny nose were significant risk factors for colonization, with aORs of 1.6 (95% confidence interval: 1.1-2.3) and 2.1 (95% confidence interval: 1.4-3.3), respectively. CONCLUSIONS: The findings of this study may contribute to baseline pre-vaccine data in Indonesia that would be critical for the impact evaluation of vaccines.

Chronic household air pollution and exposure patterns among Himalayan nomads.

BACKGROUND: Household air pollution (HAP) is a major risk factor of non-communicable diseases, causing millions of premature deaths each year in developing nations. Populations living at high altitudes are particularly vulnerable to HAP and associated health outcomes. OBJECTIVES: This study aims to explore the relationships between activity patterns, HAP, and an HAP biomarker among 100 Himalayan nomadic households during both cooking and heating-only periods. METHODS: Household CO was monitored in 100 rural homes in Qinghai, China, at 3500 m on the Himalayan Plateau among Himalayan nomads. Carboxyhemoglobin (COHb) was used as a biomarker to assess exposure among 100 male and 100 female heads of household. Linear mixed-effects models were used to explore the relationship between COHb and activity patterns. RESULTS: Cooking periods were associated with 7 times higher household CO concentrations compared with heating periods (94 ± 56 ppm and 13 ± 11 ppm, respectively). Over the three-day biomarker-monitoring period in each house, 99% of subjects had at least one COHb measurement exceeding the WHO safety level of 2%. Cooking was associated with a 32% increase in COHb (p < 0.001). IMPACT STATEMENT: This study on household air pollution (HAP) in high-altitude regions provides important insights into the exposure patterns of nomadic households in Qinghai, China. The study found that cooking is the primary factor influencing acute carbon monoxide (CO) exposure among women, while heating alone is sufficient to elevate CO exposure above WHO guidelines. The results suggest that cooking-only interventions have the potential to reduce HAP exposure among women, but solutions for both cooking and heating may be required to reduce COHb to below WHO guidelines. This study's findings may inform future interventions for fuel and stove selection to reduce HAP and exposure among other populations.

Challenges and prospects of managing non-acute medical conditions among pastoral populations in sub-Saharan Africa.

In Africa, pastoral populations face several underrecognized health issues. The livelihoods of pastoralists revolve around possession of livestock and they are constantly moving in search of water and pasturage. They are predisposed to chronic zoonotic infections but may also suffer from non-acute non-zoonotic cosmopolitan infectious and non-infectious chronic medical conditions. Given their migratory lifestyle, livelihood, geographic inaccessibility, communication barriers, illiteracy and poverty, it is challenging for pastoralists to access lengthy inpatient clinical care and long-term periodic follow-up that may be required to achieve control or cure of subacute, chronic or lifelong diseases. The challenges and management modalities of complicated subacute bacterial endocarditis requiring critical clinical considerations, long-term medical and surgical interventions in a stateless Arab camel herder are described to highlight the plight of pastoralists. Innovative clinical and public health strategies are suggested to authorities and healthcare institutions to improve access to care for non-acute diseases among them.

In-service training policy during the COVID-19 pandemic: The case of the agents of the farmers, rural people, and nomads social insurance fund.

Introduction: The COVID-19 pandemic has posed the in-service training of agents of the Farmers, Rural People, Nomads Social Insurance Fund (hereafter the Fund) to many problems. In-service training is one of the most effective development factors for organizational goals. This sort of training will increase employees' skills and subsequently improve their job performance. Accordingly, the present research mainly aimed to shed light on the effect of in-service training policy on employees' capabilities and job performance. Methods: The research was conducted among the agents of the Fund in Fars province, Iran (N = 197) out of whom 127 agents were sampled by simple randomization. The research instrument was a standard questionnaire whose face and content validity was confirmed by a panel of experts and its reliability was determined by calculating Cronbach's alpha in a pilot study. The results showed that the indicators used to measure the research variables were acceptably consistent with the factor structure and the theoretical framework of the research. Results and discussion: Based on the findings, in-service training in the Fund during the COVID-19 pandemic has had a positive and significant effect on the agents' capabilities (communication and team-working skills, creativity and problem-solving skills, commitment and responsibility, technical information and knowledge, and technical and practical skills) and job performance at the individual, technical, and general levels. Also, the agents' capabilities have had a positive and significant influence on their job performance. It can be concluded that in-service training can influence the agents' capabilities and job performance and improve organizational performance during the COVID-19 pandemic. Thus, the enhancement of in-service training courses' quantity and quality during the COVID-19 pandemic can influence the job performance of the agents at the individual, general, and technical performance levels.

A comparative study of the proximity to nomadic travel routes and environmental factors on the occurrence of cutaneous leishmaniasis in Kohgiluyeh and Boyer-Ahmad province, southwestern Iran.

Cutaneous leishmaniasis (CL) is one of the most important health challenges in hyperendemic countries like Iran. Geospatial information systems-based studies have shown that factors, including land cover, altitude, slope temperature, rainfall and animal livestock, affect CL distribution in Kohgyloyeh and Boyerahmad province, southwestern Iran. However, the question of the influence of nomadic tribes, who travel with their goats and sheep, on CL is unanswered. We, therefore, investigated their role in CL epidemiology from 2008 to 2017 and compare them with geoclimatic factors. CL patient demographic data and their village/city addresses were retrieved from Provincial Health Center and mapped on the geographic information system (GIS) layer of the province's political divisions. Nomadic travel routes (NTRs) with a 2 km buffer were generated and their effect on CL was investigated together with the interpolated layers of rainfall, temperatures, humidity, slope, elevation, land covers, by binary regression. CL was significantly more common in villages/cities in the 2 km NTR zone (p value < .001; OR = 1.96; 95% CI = 1.4-2.745). Geoclimatic factors, including slope, elevation, rainfall, temperatures, humidity and most of the landcovers, were not significantly different inside and outside the NTR. Areas of irrigated farm were the only effective landcover on CL (p value = .049; OR = 2.717; 95% CI = 1.003-7.361) within the NTR versus non-NTR. Living within NTRs almost doubled the risk of acquiring CL. Several factors for this include passage through areas of high sand fly activity, increased contact between sandflies and humans, sheep and goats, and feeding on their blood and faeces, and low availability of health facilities that should be more investigated and considered in the future control programs.