AT innovation ecosystem design – a kenyan case study

Innovations within the AT space frequently fail to get to market and therefore to the people who could benefit from the products. The Scoping Report which underpins the AT2030 programme identified the need to test and develop “what works” for AT innovation to ensure new products, services and approaches are able to scale and reach people, especially people living in low- and middle-income countries. This paper sets out the initial thinking for an East Africa Innovation Ecosystem. We present the emerging thinking from initial scoping exercises and product trials which have helped to shape the newly launched Innovate Now ecosystem. We outline the ecosystem including the core elements – the accelerator programmes and Live Labs. Live labs will allow for rapid innovation testing and user feedback. Thus, increasing user-involvement in the design and development process, and reducing the time to market. The Innovate Now ecosystem is growing and is being led by AMREF. Successful graduates of innovate Now will be connected into the Innovation Scale Fund which will be launched by AT2030 next year (2020)

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

BACKGROUND Chronic kidney disease (CKD) is an important but insufficiently recognized public health problem. Unprecedented advances in delaying progression of CKD and reducing kidney failure and death have been made in recent years, with the addition of the sodium-glucose cotransporter 2 inhibitors and other newer medication to the established standard of care with inhibitors of the renin-angiotensin system. Despite knowledge of these effective therapies, their prescription and use remain suboptimal globally, and more specially in low resource settings. Many challenges contribute to this gap between knowledge and translation into clinical care, which is even wider in lower resource settings across the globe. Implementation of guideline-directed care is hampered by lack of disease awareness, late or missed diagnosis, clinical inertia, poor quality care, cost of therapy, systemic biases, and lack of patient empowerment. All of these are exacerbated by the social determinants of health and global inequities. SUMMARY CKD is a highly manageable condition but requires equitable and sustainable access to quality care supported by health policies, health financing, patient and health care worker education, and affordability of medications and diagnostics. KEY MESSAGES The gap between the knowledge and tools to treat CKD and the implementation of optimal quality kidney care should no longer be tolerated. Advocacy, research and action are required to improve equitable access to sustainable quality care for CKD everywhere

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Polymeric Nanoparticles for Brain Drug Delivery - A Review

Background: Blood-brain barrier (BBB) is playing a most hindering role in drug delivery to the brain. Recent research comes out with the nanoparticles approach, is continuously working towards improving the delivery to the brain. Currently, polymeric nanoparticle is extensively involved in many therapies for spatial and temporal targeted areas delivery. Methods: We did a non-systematic review, and the literature was searched in Google, Science Direct and PubMed. An overview is provided for the formulation of polymeric nanoparticles using different methods, effect of surface modification on the nanoparticle properties with types of polymeric nanoparticles and preparation methods. An account of different nanomedicine employed with therapeutic agent to cross the BBB alone with biodistribution of the drugs

21st century research in urban WASH and health in sub-Saharan Africa: methods and outcomes in transition

Tackling global inequalities in access to Water, Sanitation and Hygiene (WASH) remains an urgent issue - 58% of annual diarrhoeal deaths are caused by inadequate WASH provision. A global context of increasing urbanisation, changing demographics and health transitions demands an understanding and impact of WASH on a broad set of health outcomes. We examine the literature, in terms of health outcomes, considering WASH access and interventions in urban sub-Saharan Africa from 2000 to 2017. Our review of studies which evaluate the effectiveness of specific WASH interventions, reveals an emphasis of WASH research on acute communicable diseases, particularly diarrhoeal diseases. In contrast, chronic communicable and non-communicable health outcomes were notable gaps in the literature as well as a lack of focus on cross-cutting issues, such as ageing, well-being and gender equality. We recommend a broader focus of WASH research and interventions in urban Africa to better reflect the demographic and health transitions happening. Abbreviations: CBA: Controlled Before and After; GSD: Government Service Delivery; IWDSSD: International Drinking-Water, Supply and Sanitation Decade (IDWSSD); KAP: Knowledge, Attitudes and Practices; IBD: Irritable Bowel Diseases; MDG: Millennium Development Goals; NTD: Neglected Tropical Diseases; PSSD: Private Sector Service Delivery; SDG: Sustainable Development Goals; SSA: Sub Saharan Africa; SODIS: Solar Disinfection System; STH: Soil Transmitted Helminths; RCT: Randomised Control Trial; WASH: Water Sanitation and Hygiene; WHO: World Health Organization

Breaking the Access to Education Barrier: Enhancing HPLC Learning with Virtual Reality

This research focuses on an innovative approach to the practical teaching of High Performance Liquid Chromatography (HPLC), specifically exploring the application of Virtual Reality (VR) in undergraduate education. Traditionally, the exposure to HPLC instrumentation for undergraduates has been limited due to a substantial student population and the prohibitively high costs of these systems. To overcome these challenges, we developed our own in-house multi-user VR software, as well as a VR digital twin model of HPLC instruments in our laboratory and placed multiple copies of these in a training environment, aiming to simulate a realistic, interactive, and immersive learning HPLC environment. The investigation of its effectiveness included a group of first year undergraduate students with no previous HPLC experience, aiming to assess the reception of the VR learning environment among a student cohort. The use of the VR software positively influenced student engagement with HPLC training. Survey results indicate that the majority of students greatly enjoyed the VR sessions, with many students reporting a heightened interest in practicals and self-reporting that they learned better than they would have using text or PowerPoints, though formal assessment is needed to quantify its impact on learning outcomes. Notably, students reported a heightened confidence in their operational understanding of the instrument and exhibited a more profound grasp of the underlying theoretical concepts. In light of these findings, we propose that VR learning environments equipped with digital twins of laboratory equipment can greatly enhance practical teaching, particularly in areas constrained by equipment accessibility. This work, therefore, offers compelling insights into the potential of VR learning environments in reshaping HPLC practical teaching in undergraduate education

Institutional capacity for health systems research in East and Central African Schools of Public Health: strengthening human and financial resources

BACKGROUND: Despite its importance in providing evidence for health-related policy and decision-making, an insufficient amount of health systems research (HSR) is conducted in low-income countries (LICs). Schools of public health (SPHs) are key stakeholders in HSR. This paper, one in a series of four, examines human and financial resources capacities, policies and organizational support for HSR in seven Africa Hub SPHs in East and Central Africa. METHODS: Capacity assessment done included document analysis to establish staff numbers, qualifications and publications; self-assessment using a tool developed to capture individual perceptions on the capacity for HSR and institutional dialogues. Key informant interviews (KIIs) were held with Deans from each SPH and Ministry of Health and non-governmental officials, focusing on perceptions on capacity of SPHs to engage in HSR, access to funding, and organizational support for HSR. RESULTS: A total of 123 people participated in the self-assessment and 73 KIIs were conducted. Except for the National University of Rwanda and the University of Nairobi SPH, most respondents expressed confidence in the adequacy of staffing levels and HSR-related skills at their SPH. However, most of the researchers operate at individual level with low outputs. The average number of HSR-related publications was only <1 to 3 per staff member over a 6-year period with most of the publications in international journals. There is dependency on external funding for HSR, except for Rwanda, where there was little government funding. We also found that officials from the Ministries of Health often formulate policy based on data generated through ad hoc technical reviews and consultancies, despite their questionable quality. CONCLUSIONS: There exists adequate skilled staff for HSR in the SPHs. However, HSR conducted by individuals, fuelled by Ministries’ of Health tendency to engage individual researchers, undermines institutional capacity. This study underscores the need to form effective multidisciplinary teams to enhance research of immediate and local relevance. Capacity strengthening in the SPH needs to focus on knowledge translation and communication of findings to relevant audiences. Advocacy is needed to influence respective governments to allocate adequate funding for HSR to avoid donor dependency that distorts local research agenda.DFI

Spatial variation of fine particulate matter levels in nairobi before and during the covid-19 curfew: Implications for environmental justice

Abstract The temporary decrease of fine particulate matter (PM2.5) concentrations in many parts of the world due to the COVID-19 lockdown spurred discussions on urban air pollution and health. However there has been little focus on sub-Saharan Africa, as few African cities have air quality monitors and if they do, these data are often not publicly available. Spatial differentials of changes in PM2.5 concentrations as a result of COVID also remain largely unstudied. To address this gap, we use a serendipitous mobile air quality monitoring deployment of eight Sensirion SPS 30 sensors on motorbikes in the city of Nairobi starting on 16 March 2020, before a COVID-19 curfew was imposed on 25 March and continuing until 5 May 2020. We developed a random-forest model to estimate PM2.5 surfaces for the entire city of Nairobi before and during the COVID-19 curfew. The highest PM2.5 concentrations during both periods were observed in the poor neighborhoods of Kariobangi, Mathare, Umoja, and Dandora, located to the east of the city center. Changes in PM2.5 were heterogeneous over space. PM2.5 concentrations increased during the curfew in rapidly urbanizing, the lower-middle-class neighborhoods of Kahawa, Kasarani, and Ruaraka, likely because residents switched from LPG to biomass fuels due to loss of income. Our results indicate that COVID-19 and policies to address it may have exacerbated existing air pollution inequalities in the city of Nairobi. The quantitative results are preliminary, due to sampling limitations and measurement uncertainties, as the available data came exclusively from low-cost sensors. This research serves to highlight that spatial data that is essential for understanding structural inequalities reflected in uneven air pollution burdens and differential impacts of events like the COVID pandemic. With the help of carefully deployed low-cost sensors with improved spatial sampling and at least one reference-quality monitor for calibration, we can collect data that is critical for developing targeted interventions that address environmental injustice in the African context.</jats:p

The cardioprotective effect of whey protein against thioacetamide-induced toxicity through its antioxidant, anti-inflammatory, and anti-apoptotic effects in male albino rats

IntroductionThioacetamide (TAA) is widely used as an experimental drug in liver disease studies and has been shown to exert toxicity across multiple organs. It has been linked to oxidative stress, inflammation, apoptosis, fibrosis, and epigenetic modifications. Whey protein (WP) provides an abundant supply of essential and non-essential amino acids that are vital for the human body. It is highly valued for its nutritional and biological properties, benefiting the immune, digestive, cardiovascular, neurological, and endocrine systems. This research sought to evaluate the possible protective effects of WP against TAA-induced cardiotoxicity in rats, emphasizing its antioxidant, anti-inflammatory, and anti-apoptotic mechanisms.MethodsA total of forty male rats were randomly divided into four groups, with each group containing ten rats: the control group, the TAA-treated group (100 mg/kg body weight), the WP-treated group (300 mg/kg body weight), and the WP + TAA group. The treatments were administered for three consecutive weeks.ResultsThe findings revealed that TAA exposure significantly reduced cardiac tissue activities of glutathione, superoxide dismutase, and catalase while markedly increasing malondialdehyde and nitric oxide activities. Additionally, TAA administration led to a significant elevation in inflammatory markers (TNF-α and IL-1β) and apoptotic markers (Bax and Bcl-2), along with increased caspase-3 gene expression in heart tissue. Serum levels of lactate dehydrogenase were also notably higher in the TAA-intoxicated group, accompanied by significant histopathological alterations, increased collagen fiber deposition, and a pronounced immunopositive reaction for TGF-β1 and NF-κB in heart tissue. However, pre-treatment with WP significantly alleviated TAA-induced cardiotoxicity by reducing oxidative stress, inflammatory response, and apoptotic markers in cardiac tissue.DiscussionThe results indicate that WP supplementation offers protective effects and mitigates the cardiotoxicity triggered by TAA