Lipid profile among diabetes patients in Gaborone, Botswana

A cross-sectional study was undertaken to determine the serum lipid profile of diabetes mellitus (DM) patients receiving treatment at Gaborone City Council clinics. A total of 401 patients were studied over a 3-month period. It was found that 33.5% had hypercholesterolaemia and 38.9% hypertriglyceridaemia. The mean low-density lipoprotein (LDL) levels were higher in females than in males, but there was no difference in LDL levels between type 1 and 2 DM patients. There was no difference in cholesterol, triglyceride and highdensity lipoprotein (HDL) levels between genders or between type 1 and 2 patients. Hyperlipidaemia was associated with high body mass index. Only hypertriglyceridaemia was associated with high blood pressure. Hyperlipidaemia was not associated with exercise, smoking or alcohol consumption in the DM patients studied. Journal of Endocrinology, Metabolism and Diabetes of South Africa Vol. 11(1) 2006: 32-3

Podoconiosis and soil-transmitted helminths (STHs): double burden of neglected tropical diseases in Wolaita zone, rural southern Ethiopia

Background Both podoconiosis and soil-transmitted helminth (STH) infections occur among barefoot people in areas of extreme poverty; however, their co-morbidity has not previously been investigated. We explored the overlap of STH infection and podoconiosis in Southern Ethiopia and quantified their separate and combined effects on prevalent anemia and hemoglobin levels in podoconiosis patients and health controls from the same area. Methods and Principal Findings A two-part comparative cross-sectional study was conducted in Wolaita zone, southern Ethiopia. Data were collected from adult patients presenting with clinically confirmed podoconiosis, and unmatched adult neighborhood controls living in the same administrative area. Information on demographic and selected lifestyle factors was collected using interviewer-administered questionnaires. Stool samples were collected and examined qualitatively using the modified formalin-ether sedimentation method. Hemoglobin level was determined using two different methods: hemoglobinometer and automated hematology analyzer. A total of 913 study subjects (677 podoconiosis patients and 236 controls) participated. The prevalence of any STH infection was 47.6% among patients and 33.1% among controls (p<0.001). The prevalence of both hookworm and Trichuris trichiura infections was significantly higher in podoconiosis patients than in controls (AOR 1.74, 95% CI 1.25 to2.42, AOR 6.53, 95% CI 2.34 to 18.22, respectively). Not wearing shoes and being a farmer remained significant independent predictors of infection with any STH. There was a significant interaction between STH infection and podoconiosis on reduction of hemoglobin level (interaction p value = 0.002). Conclusions Prevalence of any STH and hookworm infection was higher among podoconiosis patients than among controls. A significant reduction in hemoglobin level was observed among podoconiosis patients co-infected with hookworm and ‘non-hookworm STH’. Promotion of consistent shoe-wearing practices may have double advantages in controlling both podoconiosis and hookworm infection in the study area

Predictors of Treatment Seeking Intention among People with Cough in East Wollega, Ethiopia Based on the Theory of Planned Behavior: A Community Based Cross -Sectional Study

Background: Early treatment seeking for cough is crucial in the prevention and control of Tuberculosis. This study was intended to assess treatment seeking intention of people with cough of more than two weeks, and to identify its predictors.Methods: A community based cross-sectional study was conducted among 763 individuals with cough of more than two weeks in East Wollega Zone from March 10 to April 16, 2011. Study participants were selected from eighteen villages by cluster sampling method. Data collection instruments were developed according to the standard guideline of the theory of planned behavior. The data were analyzed with SPSS 16.0. Multiple linear regression was used to identify predictors.Results: Mean score of intention was found to be 12.6 (SD=2.8) (range of possible score=3-15). Knowledge (β=0.14, 95%CI: 0.07-0.2), direct attitude (β=0.31, 95%CI: 0.25-0.35), belief-based attitude (β=0.03, 95%CI: 0.02-0.06) and perceived subjective norm (β=0.22, 95%CI: 0.13 -0.31) positively predicted treatment seeking intention. However, perceived behavioral control and control belief were not significantly associated with treatment seeking intention (p&gt;0.05). Being smoker (β=-0.97, 95%CI:-1.65- (-0.37)) and higher family income (β=-0.06, 95%CI:-0.07-(-0.01) were significantly associated with lower treatment seeking intention.Conclusion: TPB significantly predicted treatment seeking intention among the study participants. Attitude and silent beliefs held by the respondents play an important role and should be given emphasize in prevention and control of Tuberculosis.Keywords: Tuberculosis, Cough, Intention, Treatment, Theory of Planned Behavio

Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to$24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and$195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential

Future and potential spending on health 2015-40 : development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Background The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings We estimated that global spending on health will increase from US$9.21 trillion in 2014 to$24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and$195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential.Peer reviewe

The impact of water hyacinth biochar on maize growth and soil properties: The influence of pyrolysis temperature

Introduction: Options for managing water hyacinths (WHs) include converting the biomass into biochar for soil amendment. However, less has been known about the impact of WH‐based biochar developed in varying pyrolysis temperatures on plant growth and soil qualities. Materials and Methods: A pot experiment was undertaken in a factorial combination of WH biochars (WHBs) developed at three temperatures (350°C, 550°C and 750°C) and two application rates (5 and 20 t ha−1), plus a control without biochar. Maize was grown as a test crop for 2 months under natural conditions. Results: Our study showed that applying WHB developed between 350°C and 750°C at 20 t ha−1 increased maize shoot and root dry biomass by 47.7% to 17.6% and 78.4% to 54.1%, respectively. Nevertheless, raising the biochar pyrolysis temperature decreased maize growth, whereas increasing the application rate displayed a positive effect. The application of WHB generated at 350°C and 550°C at 20 t ha−1 resulted in significant improvements in soil total nitrogen (17.9% to 25%), cation exchange capacity (27.3% to 20.2%), and ammonium‐nitrogen (60.7% to 59.6%), respectively, over the control. Additionally, applying WHB produced from 350°C to 750°C at 20 t ha−1 enhanced soil carbon by 38.5%–56.3%, compared to the control. Conversely, applying biochar produced at 750°C resulted in higher soil pH (6.3 ± 0.103), electrical conductivity (0.23 ± 0.01 dSm−1) and available phosphorus (21.8 ± 2.53 mg kg−1). Conclusion: WHBs developed at temperatures of 350°C and 550°C with an application rate of 20 t ha−1 were found to be optimal for growing maize and improving soil characteristics. Our study concludes that pyrolysis temperature significantly governs the effectiveness of biochar produced from a specific biomass source

Sustainable weed management and soil enrichment with water hyacinth composting and mineral fertilizer integration

Composting water hyacinth (Eichhornia crassipes) presents a promising approach for managing the weed and the aquatic environment while increasing agricultural production and soil fertility. However, limited research reported on the impact of water hyacinth compost on soil properties and crop production under field conditions. This study aimed to evaluate impact of water hyacinth compost and its combined application with mineral fertilizer on soil properties and crop production. Before field experiments, the compost's phytotoxicity was assessed through bioassays, confirming it was safe for agricultural use with a seed germination index exceeding 80 %. Field trials were conducted using a factorial design with four application rates of water hyacinth compost (0, 8, 16, and 24 t ha-1) and three rates of the recommended mineral fertilizer for teff production (0/0, 40/23, and 80/46 kg N/P2O5 ha-1). The results indicated that compared to the control group, applying water hyacinth compost increased soil pH by up to 0.69 units and reduced bulk density by 10.3 %. Soil organic carbon, total nitrogen, available phosphorus, cation exchange capacity, and exchangeable potassium increased by 24.3 %, 28.6 %, 80.2 %, 26.2 %, and 112.7 %, respectively. Furthermore, exchangeable acidity and aluminum were reduced by 72.5 % and 78.6 %, respectively. The maximum grain yield (1826 kg ha-1) and total biomass (8020 kg ha-1) of teff were achieved by applying 24 t ha-1 of water hyacinth compost coupled with the full rate of mineral fertilizer. However, compared to adding only full fertilizer, the grain yield that resulted from applying water hyacinth compost at 16 and 24 t ha-1 along with half of the suggested mineral fertilizer was superior. This implies that water hyacinth compost could substitute 50 % of the mineral fertilizer required. In conclusion, composting water hyacinth offers a dual benefit of weed management and soil enrichment. This could be a sustainable strategy to mitigate weed proliferation while improving soil quality and crop production

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk outcome pairs, and new data on risk exposure levels and risk outcome associations. Methods: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings: In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) DALYs were attributable to GBD risk factors. Globally, 61.0% (59.6-62.4) of deaths and 48.3% (46.3-50.2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million (9.39-11.5) deaths and 218 million (198-237) DALYs, followed by smoking (7.10 million [6.83-7.37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6.53 million [5.23-8.23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4.72 million [2.99-6.70] deaths and 148 million [98.6-202] DALYs), and short gestation for birthweight (1.43 million [1.36-1.51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4.9% (3.3-6.5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23.5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18.6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning