T-Cell Subsets Predict Mortality in Malnourished Zambian Adults Initiating Antiretroviral Therapy.

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedTo estimate the prognostic value of T-cell subsets in Zambian patients initiating antiretroviral therapy (ART), and to assess the impact of a nutritional intervention on T-cell subsets.This work was supported by European and Developing Countries Clinical Trials Partnership grant # IP.2009.33011.004; trial foods were prepared and supplied by Nutriset, Malauney, Franc

T cell subset profile in healthy Zambian adults at the University Teaching Hospital.

INTRODUCTION: Symptom-free human immunodeficiency virus antibody-negative Zambian adults (51 subjects, aged 20 to 62 years, 33.3% women and 66.7% men) were studied to establish T cell subset reference ranges. METHODS: We carried out across sectional study at the University Teaching Hospital, Lusaka. Blood samples were collected from healthy donor volunteers from hospital health care staff, between February and March 2015. Immunopheno typing was undertaken to characterize Tcell subsets using the markers CD3, CD4, CD8, α4β7, Ki67, CD25, CCR7, CD54RA, CD57, CD28, CD27 and HLA-DR. RESULTS: Among 51 volunteers, Women had significantly higher absolute CD4 count (median 1042; IQR 864, 1270) than in men (671; 545, 899) (p=0.003). Women also had more CD4 cells expressing homing, naïve, effector and effector memory T cell subsets compared to men. However, in the CD8 population, only the effector cells were significantly different with women expressing more than the males. CONCLUSION: We provide early reference range for T cell subsets in Zambian adults and conclude that among the African women some T cell subsets are higher than men

Guidelines for developing agricultural information portals in the Southern African Development Community Region (SADC)

The Internet and the Web have become a source of agricultural information for many people, including researchers working in agricultural research organizations. According to Besemer, Addison and Ferguson (2003:2), the Web has changed the information landscape in the field of agriculture and natural resources. The relatively small investment required to set up a Web site enables a great many institutions to become instant information providers

Growth and health outcomes at school age in HIV-exposed, uninfected Zambian children: follow-up of two cohorts studied in infancy.

BACKGROUND: Early growth and health of HIV-exposed, uninfected (HEU) children is poorer than that of their HIV-unexposed, uninfected (HUU) counterparts but there is little information about longer term effects of early HIV exposure. We previously recruited two cohorts of HEU and HUU Zambian infants and documented the poorer infant growth and health of the HEU compared to the HUU children. We followed up HEU and HUU children from these cohorts when they were school-aged and compared their growth, health, biochemical markers of acute or chronic disease, and school grades. METHODS: We recruited 111 HEU and 279 HUU children aged 6-12 years. We measured anthropometry, determined health by questionnaire and clinical examination, viewed the child's most recent school report, and measured blood pressure, haemoglobin (Hb), HbA1c, glucose, cholesterol, and C-reactive protein (CRP). RESULTS: Anthropometric measures were lower among HEU than HUU children, significantly so for hip circumference (age- and sex-adjusted difference -1.74 cm; 95% confidence interval (CI) -3.24, -0.24; P = 0.023) and mid-upper-arm circumference (adjusted difference -0.63 cm, 95% CI -1.23, -0.04; P = 0.037) and with borderline effects for body mass index, thigh circumference and subscapular skinfolds. HEU children had significantly lower total, trunk, and limb fat percentages. All anthropometric and body composition differences became non-significant after adjustment for sociodemographic variables which differed between HEU and HUU children. More HEU than HUU children reported minor illnesses and were prescribed medication at the time of visit. There were no differences in biochemical markers between groups. HEU children had lower math grades than HUU children even after adjustment for socioeconomic variables. CONCLUSIONS: Although HEU children were smaller and had lower percent fat than HUU children, this appeared to be due mainly to their poorer socioeconomic status. Reasons for lower school grades require further research

Appetite testing in HIV-infected African adults recovering from malnutrition and given antiretroviral therapy.

OBJECTIVE: The Nutritional Support for Africans Starting Antiretroviral Therapy (NUSTART) trial was designed to determine whether nutritional support for malnourished HIV-infected adults starting antiretroviral therapy (ART) can improve early survival. Appetite is related to health outcomes in this population, but the optimal appetite metric for field use is uncertain. We evaluated two measures of appetite with the goal of improving understanding and treatment of malnutrition in HIV-infected adults. DESIGN: Longitudinal cohort study embedded in a clinical trial of vitamin and mineral-fortified, v. unfortified, lipid-based nutritional supplements. SETTING: HIV clinics in Mwanza, Tanzania and Lusaka, Zambia. SUBJECTS: Malnourished (BMI<18.5 kg/m2) HIV-infected adults starting ART. RESULTS: Appetite measurements, by short questionnaire and by weight of maize porridge consumed in a standardized test, were compared across time and correlated with changes in weight. Appetite questionnaire scores, from polychoric correlation, and porridge test results were normally distributed for Tanzanians (n 187) but clustered and unreliable for Zambians (n 297). Among Tanzanian patients, the appetite score increased rapidly from referral for ART, plateaued at the start of ART and then increased slowly during the 12-week follow-up. Change in appetite questionnaire score, but not porridge test, correlated with weight change in the corresponding two-week intervals (P=0.002) or over the whole study (P=0.05) but a point estimate of hunger did not predict weight change (P=0.4). CONCLUSIONS: In Tanzania change in appetite score correlated with weight change, but single point measurements did not. Appetite increases several weeks after the start of ART, which may be an appropriate time for nutritional interventions for malnourished HIV-infected adults

Using discrete element modelling (DEM) and breakage experiments to model the comminution action in a tumbling mill

Includes abstract.Includes bibliographical references (leaves 147-153).The Discrete Element Method (DEM) is a powerful modelling tool that characterises the system at the individual particle level. This makes it particularly well suited for simulating tumbling mills whose charge is principally individual particles (steel balls, rocks and fines). The use of DEM to simulate tumbling mills has proliferated since the early 1990s and been successfully employed to predict important milling parameters such as charge motion, power draw, liner wear and impact energy distribution. The ultimate aim of any model of the tumbling mill is to predict the product of the milling process. Current DEM simulations of the tumbling mill however do not simulate the breakage of the particles and as such can not directly predict the product. In order to predict the performance of industrial-scale tumbling mills, laboratory-scale mills are used to experimentally obtain data, which is then scaled up using black box mathematical models. In this thesis a tumbling mill model that utilises the power of DEM to provide the mechanical environment and the energies available for breakage is proposed. The incorporation of DEM eliminates the need to scale up because DEM is able to simulate the actual industrial-scale device. Data from breakage experiments on the ore being treated is also incorporated into the model to determine the breakage functions. Population balance techniques are applied in the mathematical framework of the model to predict the product of the comminution process. In order to test the proposed tumbling mill model, DEM simulations of a 1.695m diameter pilot SAG mill using charge based on actual operation data were performed and analysed. Results from the DEM simulation and Drop Weight Tester breakage experiments were then used in the proposed tumbling mill model to predict the evolution of the product size distribution

Socio-economic factors associated with the adoption of conservation agriculture among women farmers in Balaka District, Malawi

The study was conducted in Balaka District, Malawi among women farmers. The study focused on three research questions: What socio-economic factors are associated with the rate of adoption of conservation agriculture among women farmers in Balaka District, Malawi? What are the levels of adoption of conservation agriculture among women farmers in Balaka District, Malawi? What are the main sources of information for conservation agriculture among women farmers in Balaka District, Malawi that lead to adoption of CA? Quantitative data were collected using a door-to-door survey. The survey was verbally administered to 60 women farmers. ^ Qualitative data were collected through informal interviews with five women farmers, which provided more in-depth data. ^ Findings revealed availability of farm labor, access to farmer trainings on CA, farm size, source of information, education level, access to farm inputs, age, membership to a farmer group and visits by the Extension worker are positively associated with adoption of CA. Conversely, inadequate knowledge on CA, inadequate number of Extension workers in the area, inadequate resources to buy farm inputs and small land holding sizes are negatively associated with adoption of CA. Among these women farmers, 47% adopted CA with the major sources of information on CA being Extension workers, village meetings, friends and the radio. The six major themes that emerged from the informal interviews were grouped into two categories of factors that are positively associated with adoption of CA and those that are negatively associated with adoption of CA. It was found that the qualitative results were related to those found quantitatively. It was found that regarding adoption of conservation agriculture an inadequate number of Extension workers and lack of inputs affect women farmers negatively. ^ Four recommendations were made. First, the Malawi government should recruit more Extension workers to reduce the knowledge gap present among farmers. Second, there is a need for subsidizing the price of the inputs package for CA in order to increase its adoption. Third, the Malawi government should help communities gain access to loan facilities. Fourth, Extension workers should increase utilization of the farmers\u27 groups in order to facilitate dissemination of information about new technologies. More training on CA should be provided to the farmers through their groups in order to increase the adoption rate

Micro-insurance: a proposed practical solution to mitigate hand-pump maintenance challenges in Malawi

As part of the grant offer, stakeholder end-users in low- income or ultra- poverty regions are encouraged to contribute 5% of the total hand-pump asset cost in a form of labour or household financing, as set by IMF/ World Bank who is the main project investor. This model also outlines that stakeholder end-users take up the maintenance role when the project sponsors leave the scene, yet there are challenges to successfully maintain the assets. This study attempts to identify end-users efforts and challenges in hand-pump project maintenance and propose a strategy to overcome the gap. Data collection was done using 12 Convergence Interviews, 36 Individual Case Interviews and two sets of Focus Groups in operational as well as non-operational hand-pumps in rural Malawi. Results show that end-users financing is inadequate to cover maintenance of a major hand-pump breakdown and/or overhaul. To address the gap, a risk management plan in form of micro insurance maintenance subsidy is proposed as part of the project design

Micronutrient Adequacy and Dietary Diversity Exert Positive and Distinct Effects on Linear Growth in Urban Zambian Infants.

BACKGROUND: In the monitoring of infant and young child feeding, dietary diversity is used as an indicator of micronutrient adequacy; however, their relation may have weakened with the increasing use of fortified complementary foods. OBJECTIVE: The objectives were to assess the relation between dietary diversity and micronutrient adequacy in an urban infant population with a high consumption of fortified foods and to investigate whether dietary diversity and micronutrient adequacy were independently associated with subsequent growth. METHODS: We used longitudinal data on 811 infants in the Chilenje Infant Growth, Nutrition, and Infection Study conducted in Lusaka, Zambia. The relation between mean micronutrient adequacies and dietary diversity scores derived from 24-h diet recalls at 6 mo of age was investigated with the use of Spearman rank correlation. Multiple linear regression was used to assess the association between micronutrient adequacy, dietary diversity, and subsequent growth to 18 mo of age. RESULTS: Overall mean micronutrient density adequacy (MMDA) and MMDA of "problem micronutrients," defined as those micronutrients (calcium, iron, zinc) with mean density adequacies less than half of estimated needs, were correlated with dietary diversity scores (ρ = 0.36 and 0.30, respectively, both P < 0.0001). Consumption of "sentinel foods" (iron rich, fortified, animal source, dairy) showed better correlation with MMDA than with dietary diversity (ρ = 0.58-0.69, all P < 0.0001). In fully adjusted analyses, MMDA calcium, iron, zinc, and dietary diversity, but not overall MMDA, were associated with linear growth to 18 mo (both P ≤ 0.028). CONCLUSIONS: Micronutrient adequacy in infants consuming fortified foods may be more accurately assessed using locally specific sentinel food indicators rather than dietary diversity scores. Nonetheless, dietary diversity has a positive effect on subsequent linear growth apart from that of micronutrient adequacy, warranting its continued monitoring and further investigation into the mechanisms underlying this finding. This trial was registered at www.controlled-trials.com as ISRCTN37460449

Effects on mortality of a nutritional intervention for malnourished HIV-infected adults referred for antiretroviral therapy: a randomised controlled trial.

Malnourished HIV-infected African adults are at high risk of early mortality after starting antiretroviral therapy (ART). We hypothesized that short-course, high-dose vitamin and mineral supplementation in lipid nutritional supplements would decrease mortality