Children are largely exposed to air pollution in low- and middle-income countries, yet data on exposure and respiratory effects of air pollution remain limited. This study aimed to assess the feasibility and outcomes of joint ambulatory monitoring of exposure to fine particulate matter (particles with a diameter of less than 2.5 µm (PM2.5)) and spirometry in children living in Abidjan, Côte d’Ivoire.
We did a cross-sectional observational study among children aged 7–17 years. After a baseline spirometry, children were asked to wear portable PM2.5 sensors and to perform 2x3 daily flow–volume curves using a portable spirometer for 7 days. We described the proportion of acceptable measurements, per cent predicted forced expiratory volume (ppFEV1), and hourly geometric mean PM2.5 concentrations, and analysed the cumulative delayed effects of PM2.5 on ppFEV1 using distributed lag non-linear models.
Of 29 children enrolled, 18 (62.1%) were female, median age 12 years, all performed spirometry with 1101 (90.4%) of 1218 expected flow-volume curves obtained. Of these, 625 (51.3%) acceptable curves were received and 313 valid, non-duplicate curves were analysed. The median ppFEV1 was 79.6% (71.5–87.4), with lower values in the morning than in the evening (p2.5 measurements, 93 689 (64.1%) were obtained; 6328 aberrant data were excluded. The median hourly PM2.5 concentrations were 164.2 (107.0–272.2) µg/m3. PM2.5 levels varied throughout the day, with pollution peaks observed in the morning. A significant decrease in ppFEV1 was observed between 0 and 2 hours post-exposure, after an IQR increase of 120.9 µg/m3 in PM2.5 exposure (β=–2.21; CI –3.74 to –0.69).
Ambulatory spirometry and PM2.5 measurements are feasible with portable devices in African children. High PM2.5 exposure and individual variability in lung function highlight the need for further research on the respiratory effects of air pollution in children.
There is a global rise in the burden of childhood obesity, increasing the risk of early onset adult obesity. Most developing countries face the double burden of malnutrition; overnutrition as overweight/obesity and undernutrition.
To determine the current burden and determinants of childhood thinness, overweight and obesity using national survey data.
Data from a cross-sectional survey conducted in 2022 were used.
Data from the seventh Demographic Health Survey conducted in Ghana were used.
The participants included 4417 children ≤59 months.
The seventh Ghana Demographic Health Survey in 2022 employed a two-stage stratified cluster sampling design, selecting 618 clusters to create a nationally representative sample. Weight and height were measured using the SECA 874U scale and Shorrboard, respectively. Children’s heights were measured recumbent (24 months). Multivariate logistic regression was used to assess the relationship between thinness and obesity, as well as the independent factors.
The outcome variable was obesity, determined by a WHZ of >+2SD.
The weighted prevalence of overweight/obesity and thinness in children under 5 years is 9.9% and 5.2%, respectively. Children who were overweight or obese had a mean age of 23.11 months, those who were thin or severely thin had a lower mean age of 21.02 months, and those with normal nutritional status were relatively older, with a mean age of 28.41 months. The Upper West, Northeast and Northern regions had the lowest densities of obesity. In the multivariate logistic regression model, children residing in Ashanti, Oti, Northern, North East and Upper East regions had significantly reduced odds of being obese compared with those in the Ahafo region. The average haemoglobin for those overweight/obese was 10.8 g/dL, and 10.7 g/dL for those who were normal and marginally reduced, 10.5 g/dL for those who were thin.
Regional disparities, maternal nutritional status, socioeconomic conditions and unsafe water sources were significant determinants of child nutrition outcomes. These findings call for targeted, multipronged interventions that integrate maternal-child nutrition, safe water, sanitation and regional context.
by Emelia Konadu Danso, Prince Asare, Amanda Yaa Tetteh, Phillip Tetteh, Augustine Asare Boadu, Ivy Naa Koshie Lamptey, Augustina Angelina Sylverken, Kwasi Obiri-Danso, Jane Sandra Afriyie-Mensah, Abraham Adjei, Dorothy Yeboah-Manu
Drug-resistant (DR) tuberculosis (TB) and diabetes mellitus (DM) are intersecting epidemics that complicate management of both diseases and worsen patient outcomes. We conducted a prospective cohort study of 758 GeneXpert-confirmed pulmonary TB patients, of whom 75 had DM. Demographic, clinical, radiographic, and anthropometric data were collected at baseline. Sputum samples were cultured for mycobacterial isolation, and the obtained isolates were characterized for Mycobacterium tuberculosis complex (MTBC) lineage and drug-susceptibility testing using spoligotyping and microplate alamar blue assay. The TB-diabetes (TB-DM) comorbid cohort was older [TB-DM: 53/75 (70.7%) vs. 241/683 (35.3%) aged 41–60 years) (pby Michele Letitia Tchabou Tientcheu, Pierre Marie Kaktcham, Edith Marius Foko Kouam, Laverdure Tchamani Piame, Lysette Chabrone Djodjeu Kamega, Aarzoo , Agnihotri Shekhar, Singh Bhim Pratap, François Zambou Ngoufack
Conventional culture media such as de Man, Rogosa and Sharpe are essential for the growth of lactic acid bacteria and the production of metabolites used in the food and pharmaceutical industries. However, their high cost limits their application, particularly in low and middle-income countries. This study aimed to develop a cost-effective and efficient culture medium based on agro-industrial and environmental by-products, pineapple peels, sugarcane molasses, and black soldier fly larvae cake. After physico-chemical analysis of the by-products, excluding sugarcane molasses, a statistical mixture design was used to determine the optimal proportions for supporting lactic acid bacteria growth and bacteriocin production. Growth and metabolite production were monitored via plate count and agar well diffusion assays respectively. The strains tested belonged to the genera Lactobacillus, Bifidobacterium, Streptococcus, Lactococcus, and Bacillus as an out taxa group. The larvae cake showed high protein (48.47 ± 0.14%) and amino acid (17 types) content, while pineapple peels and molasses were rich in carbohydrates (89.52 ± 0.16% and 86.86 ± 0.07%). Based on regression models, the compromise formulation was defined as 55.15% larvae cake hydrolysate, 19.85% pineapple peel hydrolysate, and 25.00% sugarcane molasses. This medium highly supported lactic acid bacteria growth (9.43–9.86 log CFU/mL) compared to MRS and M17 (9.20–9.69 log CFU/mL), with Lactobacillus strains performing better. It also supported bacteriocin activity (11.0–14.5 mm inhibition zones), higher or similar to MRS and M17, with Lactococcus lactis subsp. lactis MA2 exhibiting the strongest effect. These results highlight the potential of this formulation as a sustainable, low-cost alternative for microbiology and biotechnology, particularly in resource-limited settings. The determination of its formula will allow its manufacture once the proximate compositions of the ingredients are known, regardless their origin. Future investigations will focus on optimisation of culture conditions, powder form formulation, and cost evaluation.To assess the level of knowledge, attitudes and practices (KAP) among patients with type 2 diabetes mellitus (T2DM) regarding cardiovascular risk factors (CVRF) and diabetes-related complications in two hospitals in the West Region of Cameroon during the COVID-19 pandemic.
This was a prospective cross-sectional study conducted over 5 months from April to September 2022.
This study was conducted in two tertiary hospitals in the West Region of Cameroon, in Central Africa.
It included all patients with T2DM receiving care at these two hospitals, having agreed to participate and followed up in both hospitals for at least 3 months.
Sociodemographic, clinical and treatment data were collected using a data sheet, and KAP scores were based on the Essi and Njoya framework. Data collection and analysis were performed using SPSS V.23.0 software. Logistic regression was used to identify the factors associated with unacceptable KAP (p
A total of 140 participants (71 women) with an average age of 63 years and an average diabetes duration of 6.14±5.7 years were included. Most (55%) were managed by general practitioners. The main CVRFs identified were hypertension (11%) and overweight (6%), while the leading complications included visual disorders (10.7%), hypoglycaemia (6.4%) and erectile dysfunction (2.1%). Knowledge was good in 34.3% of participants, only 25.7% demonstrated correct attitudes, and merely 15.7% engaged in adequate practices. Unacceptable knowledge was associated with diabetes duration between 3 months and 5 years (OR: 0.34 (95% CI 0.14 to 0.85), p=0.021), follow-up by a specialist (OR: 0.31 (95% CI 0.13 to 0.74), p=0.009), the presence of at least one CVRF (OR: 0.03 (95% CI 0.00 to 0.23), p
Few people with T2DM presented good knowledge, right attitudes and adequate practices. Enhanced patient education and increasing specialist numbers are essential to promote self-management of the condition and to decrease the incidence of complications and mortality.
by Evelyn Aboagye Addae, Moses Adjei, Uchechi Shirley Anaduaka, David Kyetuo Wuollah-Dire, Regobert Bondong
Though the impact of COVID-19 pandemic’s effects on individuals’ life domains and quality of life has been widely researched, there remains unanswered questions on the mechanisms that explain the impact of fear of COVID-19 on different measurements of adolescents’ subjective well-being (SWB) particularly in the sub-Saharan African context. In a mediation model, we employed data collected during the pandemic to examine the mediating mechanisms that links fear of COVID-19 and COVID-19-induced changes in multiple life domains (subjective feelings of unsafety, positive affect and peer relationships) to different measurements of adolescents’ SWB (overall life satisfaction, overall happiness, subjective happiness, and composite SWB). Findings revealed significant negative correlations between fear of COVID-19 and all employed measurements of SWB as well as between the proposed mediating variables – changes in peer relationship, positive affect, subjective feelings of unsafety and the different measurements of SWB. Adolescents who reported negative changes in peer relationship, positive affect and subjective feelings of unsafety were more likely to report poorer SWB including lower life satisfaction and happiness. For instance, adolescents who experienced increase in peer relationship were more likely to experience higher overall life satisfaction (B = .169, p B = .172, p B = .056, p B = .416, p B = .381, p B = −1.350, pResearch on modelling geographical accessibility to healthcare services has witnessed rapid methodological advancement and refinement. One of the contributing factors is the increasing availability of big data detailing the link between the population in need of care and the health facility such as infrastructure, travel modes and speeds, traffic congestion and the quality of road network. This has allowed more granular computation of geographic access metrics, particularly in low-and-middle income countries where data are scarce. However, there are no reviews providing a comprehensive overview of the availability and use of big data for assessing geographical accessibility to healthcare. This protocol aims to describe a methodological approach that will be used to review the existing literature on the application of big data (past or potential) in evaluating geographical accessibility to healthcare.
To characterise the big data that can be used to model geographical accessibility to healthcare, a scoping review will be undertaken and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extensions for Scoping Reviews guidelines. We will search seven scientific databases (PubMed, Scopus, Web of Science, EBSCOhost-CINAHL, Cochrane, Embase and MEDLINE via Ovid), grey literature, reference lists of identified publications and conference proceedings. Search engines will be used to identify relevant big data services not yet used in published academic literature. All literature published in English or French will be included, regardless of publication type, geographical location or year of publication provided it describes or mentions big data that may be useful for evaluating geographical accessibility to healthcare. Study selection and data extraction will be performed independently by two researchers with a third resolving any discrepancies. Analysis will be conducted to summarise big data providers, their characteristics and their usefulness in terms of types of spatial accessibility metrics that can be derived.
Formal ethical approval is not required, as primary data will not be collected in this review. Findings will be disseminated through peer-reviewed publication in a journal, conference presentation and condensed summaries for stakeholders through professional networks and social media summaries.
Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/S496F.
Giant cell arteritis (GCA) is a large-vessel vasculitis occurring in people aged over 50 years. Recent studies have shown that tocilizumab (TCZ), an anti-IL-6 receptor monoclonal antibody, is remarkably effective in treating GCA and allows significant dose sparing of glucocorticoids. However, it makes it difficult to monitor disease activity. Furthermore, treatment is often prolonged over 1 year due to the fear of relapse after stopping TCZ and/or the absence of an optimal discontinuation scheme.
This study aims at comparing two discontinuation regimens in a population of GCA patients who have been treated with TCZ for 12–36 months and have discontinued glucocorticoids for at least 12 weeks. Patients will be randomised with a 1:1 ratio between two arms: immediate discontinuation (cessation) versus gradual discontinuation of TCZ (162 mg subcutaneously every 2 weeks for 12 weeks and then every 4 weeks for 12 additional weeks). Patients will be followed up for 78 weeks. The primary endpoint is relapse-free survival after 26 weeks of follow-up. A total of 120 patients will be randomised (60 in each group) for a period of 3 years.
The trial was approved by an independent ethics committee (CPP Sud Ouest et Outre Mer IV) and the French health authority (French National Agency for Medicines and Health Products Safety—ANSM) through the Clinical Trials Information System (CTIS) provided by the European Medicines Agency (EMA). The informed consent complies with the ICH GCP guideline and regulatory requirements. Eligible patients may only be included in the study after providing informed consent. Findings will be published in peer-reviewed journals and conference presentations.
HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool, reducing infection risk by up to 99% when used as prescribed. Despite its proven efficacy, PrEP uptake remains suboptimal, particularly among high-risk populations in Canada. Barriers to access and uptake, including stigma, financial constraints and healthcare accessibility, persist, highlighting the need for targeted interventions. The objective of this scoping review is to identify and map the extent and types of interventions, programmes, practices and policies aimed at increasing the acceptance, access, uptake and sustained use of HIV PrEP in Canada.
This review will use the Joanna Briggs Institute (JBI) Scoping Review methodology. Databases to be searched are MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Scopus and Web of Science from 2016 onwards. Two independent reviewers will screen studies, based on the inclusion criteria. The search results will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Data will be extracted from relevant studies by two independent reviewers and summarised to inform future research and policy development. This review will include studies focusing on individuals in Canada who are eligible for or using PrEP for HIV prevention. The interventions considered will address the awareness, acceptance, access, uptake and sustained use of PrEP. Studies must be set within the Canadian context, considering geographic, cultural and systemic factors. Exclusions include studies conducted outside Canada or those not addressing HIV prevention interventions.
This research will rely exclusively on previously published data and will not include human participants. Therefore, ethics approval is not required. For further clarification, please contact Stephen Hwang, Director, MAP Centre for Urban Health Solutions, Unity Health Toronto, at
The protocol has been registered with Open Science Framework at https://doi.org/10.17605/OSF.IO/C7S4Z.