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Livestock mobility exacerbates infectious disease risks across sub-Saharan Africa, but enables critical access to grazing and water resources, and trade. Identifying locations of high livestock traffic offers opportunities for targeted control. We focus on Tanzanian agropastoral and pastoral communities that account respectively for over 75% and 15% of livestock husbandry in eastern Africa. We construct networks of livestock connectivity based on participatory mapping data on herd movements reported by village livestock keepers as well as data from trading points to understand how seasonal availability of resources, land-use and trade influence the movements of livestock. In communities that practise agropastoralism, inter- and intra-village connectivity through communal livestock resources (e.g. pasture and water) was 1.9 times higher in the dry compared to the wet season suggesting greater livestock traffic and increased contact probability. In contrast, livestock from pastoral communities were 1.6 times more connected at communal locations during the wet season when they also tended to move farther (by 3 km compared to the dry season). Trade-linked movements were twice more likely from rural to urban locations. Urban locations were central to all networks, particularly those with potentially high onward movements, for example to abattoirs, livestock holding grounds, or other markets, including beyond national boundaries. We demonstrate how livestock movement information can be used to devise strategic interventions that target critical livestock aggregation points (i.e. locations of high centrality values) and times (i.e. prior to and after the wet season in pastoral and agropastoral areas, respectively). Such targeted interventions are a cost-effective approach to limit infection without restricting livestock mobility critical to sustainable livelihoods. [ABSTRACT FROM AUTHOR]

Warm and humid climatic conditions coupled with poor agricultural practices in sub-Saharan Africa favor the contamination of food and feed by Aspergillus flavus and Fusarium verticillioides fungi, which subsequently may produce aflatoxins (AFs) and fumonisins (FBs), respectively. The growth of fungi and the production of mycotoxins are influenced by physical (temperature, pH, water activity, light and aeration), nutritional, and biological factors. This study aimed at optimizing the conditions for the laboratory production of large quantities of AFs and FBs for use in the animal experiments. A. flavus and F. verticillioides strains, previously isolated from maize in Kenya, were used. Levels of AFB1 and total FBs (FB1, FB2, and FB3) in different growth substrates were screened using ELISA methods. Maize kernels inoculated with three different strains of A. flavus simultaneously and incubated at 29 °C for 21 days had the highest AFB1 level of 12,550 ± 3397 μg/kg of substrate. The highest level of total FBs (386,533 ± 153,302 μg/kg of substrate) was detected in cracked maize inoculated with three different strains of F. verticillioides and incubated for 21 days at temperatures of 22–25 °C in a growth chamber fitted with yellow light. These two methods are recommended for the mass production of AFB1 and FBs for animal feeding trials. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) recommends prompt malaria diagnosis with either microscopy or malaria rapid diagnostic tests (RDTs) and treatment with an effective anti-malarial, as key interventions to control malaria. However, in sub-Saharan Africa, malaria diagnosis is still often influenced by clinical symptoms, with patients and care providers often interpreting all fevers as malaria. The Ministry of Health in Uganda defines suspected malaria cases as those with a fever. A target of conducting testing for at least 75% of those suspected to have malaria was established by the National Malaria Reduction Strategic Plan 2014–2020. Methods: This study investigated factors that affect malaria testing at health facilities in Uganda using data collected in March/April 2017 in a cross-sectional survey of health facilities from the 52 districts that are supported by the US President's Malaria Initiative (PMI). The study assessed health facility capacity to provide quality malaria care and treatment. Data were collected from all 1085 public and private health facilities in the 52 districts. Factors assessed included supportive supervision, availability of malaria management guidelines, laboratory infrastructure, and training health workers in the use of malaria rapid diagnostic test (RDT). Survey data were matched with routinely collected health facility malaria data obtained from the district health information system Version-2 (DHIS2). Associations between testing at least 75% of suspect malaria cases with several factors were examined using multivariate logistic regression. Results: Key malaria commodities were widely available; 92% and 85% of the health facilities reported availability of RDTs and artemether–lumefantrine, respectively. Overall, 933 (86%) of the facilities tested over 75% of patients suspected to have malaria. Predictors of meeting the testing target were: supervision in the last 6 months (OR: 1.72, 95% CI 1.04–2.85) and a health facility having at least one health worker trained in the use of RDTs (OR: 1.62, 95% CI 1.04–2.55). Conclusion: The study findings underscore the need for malaria control programmes to provide regular supportive supervision to health facilities and train health workers in the use of RDTs. [ABSTRACT FROM AUTHOR]

: Atypical bacteria cause 10–40% of all childhood pneumonia.. Data on the burden of atypical pneumonia in sub-Saharan Africa are limited. : To determine the prevalence, associated factors, and outcome of Mycoplasma pneumoniae infection in children with respiratory symptoms at Mulago National Referral Hospital, Kampala. : Children aged 2 months to 12 years with cough and/or difficult breathing and fast breathing were recruited. A clinical history and physical examination were undertaken. Blood samples for Mycoplasma pneumoniae IgM antibodies were taken at enrolment and Day 21 and induced sputum for DNA-PCR. Admitted participants were followed for a maximum of 7 days or until discharge or death, whichever came first. : A total of 385 children were enrolled, and, of these, 368 (95.6%) were <5 years. Overall, 60/385 (15.6%) participants tested positive for M. pneumoniae IgM and/or DNA-PCR. Of these, 56/60 (93.3%) were <5 years of age. Wheezing was present in 21/60 (35.0%) of the children with atypical pneumonia and in 128/325 (39.4%) with typical pneumonia. The factors associated with M. pneumonia were female sex (AOR 1.94, 95% CI 1.22–3.08, p < 0.001), age ≥12 months (AOR 2.73, 95% CI 1.53–4.87, p = 0.01) and a history of prematurity (AOR 2.07, 95% CI 1.23–3.49, p = 0.01). Mortality was 17/352 (4.8%) and, of these, 4/17 (23.5%) had M. pneumonia. : M. pneumonia is common in young children , especially females above 2 years and those with history of prematurity. It presents with severe symptoms. The results of the study highlight the importance of considering atypical bacteria in under-5s with the symptoms of pneumonia. [ABSTRACT FROM AUTHOR]

Biochar produced in cookstoves has the potential to contribute to negative carbon emissions through sequestration of biomass carbon while also providing other benefits for sustainable development, including provision of clean renewable energy and increased yields in tropical agriculture. The aim of the reported research was to estimate effects on food production, household energy access and life cycle climate impact from introduction of biochar-producing cookstoves on smallholder farms in Kenya. Participatory research on biochar production and use was undertaken with 150 Kenyan smallholder farming households. Gasifier cookstove functionality, fuel efficiency and emissions were measured, as well as biochar effects on agricultural yields after application to soil. Cookstoves provided benefits through reduced smoke, fuel wood savings and char production, but challenges were found related to labour for fuel preparation, lighting and refilling. On-farm trials with varying rates of biochar inputs, in combination with and without mineral fertilizers, have led to a sustained increase of maize yields following one-time application. The climate impact in a life cycle perspective was considerably lower for the system with cookstove production of biochar and use of biochar in agriculture than for current cooking practices. Climate benefits from biochar production and use are thus possible on smallholder farms in sub-Saharan Africa, through reduced use of biomass in cooking, reduced emissions of products of incomplete combustion and sequestration of stable biochar carbon in soils. Biochar-producing cookstoves can be implemented as a climate change mitigation method in rural sub-Saharan Africa. Successful implementation will require changes in cooking systems including fuel supply, as well as farming systems, which, in turn, requires an understanding of local socio-cultural conditions, including power relations and gender aspects. [ABSTRACT FROM AUTHOR]

Background: Mortality among children under 5 years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda's National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under 5 years of age admitted to the NRH for routine care of SAM.Methods: This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14.Results: Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2% (95% CI 19.9-30.4%) died. In-hospital mortality was 20.7% (95% CI15.9-25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2-4.2), p = 0.014), bacteraemia (AHR 9 (95% CI 3.4-23.0), p < 0.001, and low glomerular filtration rate (eGFR), AHR 3.2; (95% CI 1.7-6.3), p = 0.001).Conclusions: A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have eGFR below 60 mL/min/1.73m2 or have bacteraemia, are more likely to die. Further studies to explore the relationship between eGFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM. [ABSTRACT FROM AUTHOR]

Eradicating poverty and achieving food and nutrition security in a sustainable environment is difficult to achieve without adequate access to affordable cooking fuel. It is therefore important to understand the common sources of cooking energy used by people in rural areas and the challenges faced in making fuel sources economically viable, socially acceptable and ecologically sustainable. In the sub-Saharan Africa (SSA) region, more than 90% of the population relies on firewood and charcoal (wood fuel, collectively) as a primary source of domestic energy. Wood fuel sustainability is challenged by unsustainable harvesting and inefficient methods of converting wood into energy. The use of inefficient cook stoves contributes to wood wastage and smoke exposure associated with severe illnesses. Households often abandon traditional nutritious diets that take a long time to cook, reduce the number of meals, and spend income on fuel at the expense of food costs. Innovations exist that have the potential to provide affordable and cleaner tree-based cooking fuel. Pruning trees on the farm as a fuel source brings firewood closer to women, lightens their workload, saves time and reduces income spent on cooking fuel. Using briquettes or gas cook stoves can reduce health risks associated with food preparation and reduce income spent on cooking fuel due to increased fuel efficiency. The development of these innovations indicates the need for a multi-disciplinary approach to increase awareness of the benefits of cooking fuel innovations, encourage further research on product quality enhancement and standardization, to understand cultural and behavioral issues influencing adoption, and integrate innovations into bioenergy policy frameworks. [ABSTRACT FROM AUTHOR]

Background In this multi-country cluster-randomized behavioural intervention trial promoting exclusive breastfeeding (EBF) in Africa, we compared growth of infants up to 6 months of age living in communities where peer counsellors promoted EBF with growth in those infants living in control communities. Methods A total of 82 clusters in Burkina Faso, Uganda and South Africa were randomised to either the intervention or the control arm. Feeding data and anthropometric measurements were collected at visits scheduled 3, 6, 12 and 24 weeks post-partum. We calculated weight-forlength (WLZ), length-for-age (LAZ) and weight-for-age (WAZ) z-scores. Country specific adjusted Least Squares Means with 95% confidence intervals (CI) based on a longitudinal analysis are reported. Prevalence ratios (PR) for the association between peer counselling for EBF and wasting (WLZ < -2), stunting (LAZ < -2) and underweight (WAZ < -2) were calculated at each data collection point. Results The study included a total of 2,579 children. Adjusting for socio-economic status, the mean WLZ at 24 weeks were in Burkina Faso -0.20 (95%CI -0.39 to -0.01) and in Uganda -0.23 (95%CI -0.43 to -0.03) lower in the intervention than in the control arm. In South Africa the mean WLZ at 24 weeks was 0.23 (95%CI 0.03 to 0.43) greater in the intervention than in the control arm. Differences in LAZ between the study arms were small and not statistically significant. In Uganda, infants in the intervention arm were more likely to be wasted compared to those in the control arm at 24 weeks (PR 2.36; 95%CI 1.11 to 5.00). Differences in wasting in South Africa and Burkina Faso and stunting and underweight in all three countries were small and not significantly different. Conclusions There were small differences in mean anthropometric indicators between the intervention and control arms in the study, but in Uganda and Burkina Faso, a tendency to slightly lower ponderal growth (weight-for-length z-scores) was found in the intervention arms. [ABSTRACT FROM AUTHOR]

The poultry industry in sub-Saharan Africa (SSA) is faced with feed insecurity, associated with high cost of feeds, and feed safety, associated with locally produced feeds often contaminated with mycotoxins. Mycotoxins, including aflatoxins (AFs), fumonisins (FBs), trichothecenes, and zearalenone (ZEN), are common contaminants of poultry feeds and feed ingredients from SSA. These mycotoxins cause deleterious effects on the health and productivity of chickens and can also be present in poultry food products, thereby posing a health hazard to human consumers of these products. This review summarizes studies of major mycotoxins in poultry feeds, feed ingredients, and poultry food products from SSA as well as aflatoxicosis outbreaks. Additionally reviewed are the worldwide regulation of mycotoxins in poultry feeds, the impact of major mycotoxins in the production of chickens, and the postharvest use of mycotoxin detoxifiers. In most studies, AFs are most commonly quantified, and levels above the European Union regulatory limits of 20 μg/kg are reported. Trichothecenes, FBs, ZEN, and OTA are also reported but are less frequently analyzed. Co-occurrences of mycotoxins, especially AFs and FBs, are reported in some studies. The effects of AFs on chickens' health and productivity, carryover to their products, as well as use of mycotoxin binders are reported in few studies conducted in SSA. More research should therefore be conducted in SSA to evaluate occurrences, toxicological effects, and mitigation strategies to prevent the toxic effects of mycotoxins. [ABSTRACT FROM AUTHOR]

Mycotoxins are common in grains in sub-Saharan Africa and negatively impact human and animal health and production. This study assessed occurrences of mycotoxins, some plant, and bacterial metabolites in 16 dairy and 27 poultry feeds, and 24 feed ingredients from Machakos town, Kenya, in February and August 2019. We analyzed the samples using a validated multi-toxin liquid chromatography-tandem mass spectrometry method. A total of 153 mycotoxins, plant, and bacterial toxins, were detected in the samples. All the samples were co-contaminated with 21 to 116 different mycotoxins and/or metabolites. The commonly occurring and EU regulated mycotoxins reported were; aflatoxins (AFs) (70%; range 0.2–318.5 μg/kg), deoxynivalenol (82%; range 22.2–1037 μg/kg), ergot alkaloids (70%; range 0.4–285.7 μg/kg), fumonisins (90%; range 32.4–14,346 μg/kg), HT-2 toxin (3%; range 11.9–13.8 μg/kg), ochratoxin A (24%; range 1.1–24.3 μg/kg), T-2 toxin (4%; range 2.7–5.2 μg/kg) and zearalenone (94%; range 0.3–910.4 μg/kg). Other unregulated emerging mycotoxins and metabolites including Alternaria toxins, Aspergillus toxins, bacterial metabolites, cytochalasins, depsipeptides, Fusarium metabolites, metabolites from other fungi, Penicillium toxins, phytoestrogens, plant metabolites, and unspecific metabolites were also detected at varying levels. Except for total AFs, where the average contamination level was above the EU regulatory limit, all the other mycotoxins detected had average contamination levels below the limits. Ninety-six percent of all the samples were contaminated with more than one of the EU regulated mycotoxins. These co-occurrences may cause synergistic and additive health effects thereby hindering the growth of the Kenyan livestock sector. [ABSTRACT FROM AUTHOR]

Mycotoxins are secondary metabolites of fungi that contaminate food and feed and have a significant negative impact on human and animal health and productivity. The tropical condition in Sub-Saharan Africa (SSA) together with poor storage of feed promotes fungal growth and subsequent mycotoxin production. Aflatoxins (AF) produced by Aspergillus species, fumonisins (FUM), zearalenone (ZEN), T-2 toxin (T-2), and deoxynivalenol (DON) produced by Fusarium species, and ochratoxin A (OTA) produced by Penicillium and Aspergillus species are well-known mycotoxins of agricultural importance. Consumption of feed contaminated with these toxins may cause mycotoxicoses in animals, characterized by a range of clinical signs depending on the toxin, and losses in the animal industry. In SSA, contamination of dairy feed with mycotoxins has been frequently reported, which poses a serious constraint to animal health and productivity, and is also a hazard to human health since some mycotoxins and their metabolites are excreted in milk, especially aflatoxin M1. This review describes the major mycotoxins, their occurrence, and impact in dairy cattle diets in SSA highlighting the problems related to animal health, productivity, and food safety and the up-to-date post-harvest mitigation strategies for the prevention and reduction of contamination of dairy feed. [ABSTRACT FROM AUTHOR]

Biomass fuels dominate the household energy mix in sub-Saharan Africa. Much of it is used inefficiently in poorly ventilated kitchens resulting in indoor air pollution and consumption of large amounts of wood fuel. Micro-gasification cookstoves can improve fuel use efficiency and reduce indoor air pollution while producing char as a by-product. This study monitored real-time concentrations of carbon monoxide (CO), carbon dioxide (CO2) and fine particulate matter (PM2.5), and amount of firewood used when households were cooking dinner. Twenty-five households used the gasifier cookstove to cook and five repeated the same test with three-stone open fire on a different date. With the gasifier, the average corresponding dinner time CO, CO2, and PM2.5 concentrations were reduced by 57%, 41%, and 79% respectively compared to three-stone open fire. The gasifier had average biomass-to-char conversion efficiency of 16.6%. If the produced char is used as fuel, households could save 32% of fuel compared to use of three-stone open fire and 18% when char is used as biochar, for instance. Adoption of the gasifier can help to reduce the need for firewood collection, hence reducing impacts on the environment while saving on the amount of time and money spent on cooking fuel. [ABSTRACT FROM AUTHOR]

Background: Strategies to prevent postnatal mother-to-child transmission of HIV-1 in Africa, including infant prophylaxis, have never been assessed past 6 months of breastfeeding, despite breastfeeding being recommended up to 12 months after birth. We aimed to compare the efficacy and safety of infant prophylaxis with the two drug regimens (lamivudine or lopinavir-ritonavir) to prevent postnatal HIV-1 transmission up to 50 weeks of breastfeeding.Methods: We did a randomised controlled trial in four sites in Burkina Faso, South Africa, Uganda, and Zambia in children born to HIV-1-infected mothers not eligible for antiretroviral therapy (CD4 count >350 cells per μL). An independent researcher electronically generated a randomisation schedule; we then used sequentially numbered envelopes to randomly assign (1:1) HIV-1-uninfected breastfed infants aged 7 days to either lopinavir-ritonavir or lamivudine (paediatric liquid formulations, twice a day) up to 1 week after complete cessation of breastfeeding or at the final visit at week 50. We stratified the randomisation by country and used permuted blocks of four and six. We used a study label on drug bottles to mask participants, study physicians, and assessors to the treatment allocation. The primary outcome was infant HIV-1 infection between age 7 days and 50 weeks, diagnosed every 3 months with HIV-1 DNA PCR, in the modified intention-to-treat population (all who attended at least one follow-up visit). This trial is registered with ClinicalTrials.gov, number NCT00640263.Findings: Between Nov 16, 2009, and May 7, 2012, we enrolled and randomised 1273 infants and analysed 1236; 615 assigned to lopinavir-ritonavir or 621 assigned to lamivudine. 17 HIV-1 infections were diagnosed in the study period (eight in the lopinavir-ritonavir group and nine in the lamivudine group), resulting in cumulative HIV-1 infection of 1.4% (95% CI 0.4-2.5) and 1.5% (0.7-2.5), respectively. Infection rates did not differ between the two drug regimens (hazard ratio [HR] of lopinavir-ritonavir versus lamivudine of 0.90, 95% CI 0.35-2.34; p=0.83). Clinical and biological severe adverse events did not differ between groups; 251 (51%) infants had a grade 3-4 event in the lopinavir-ritonavir group compared with 246 (50%) in the lamivudine group.Interpretation: Infant HIV-1 prophylaxis with lopinavir-ritonavir was not superior to lamivudine and both drugs led to very low rates of HIV-1 postnatal transmission for up to 50 weeks of breastfeeding. Infant pre-exposure prophylaxis should be extended until the end of HIV-1 exposure and mothers should be informed about the persistent risk of transmission throughout breastfeeding.Funding: INSERM/National Agency for Research on AIDS and Viral Hepatitis (including funds from the Total Foundation), European Developing Countries Clinical Trials Partnership, Research Council of Norway. [ABSTRACT FROM AUTHOR]

Background: Neonatal hypoglycemia is the most common endocrine abnormality in children, which is associated with increased morbidity and mortality. The burden and risk factors of neonatal hypoglycemia in rural communities in sub-Saharan Africa are unknown. Objective: To determine the prevalence and risk factors for neonatal hypoglycemia in Lira District, Northern Uganda. Methods: This was a community-based cross-sectional study, nested in a cluster randomized controlled trial designed to promote health facility births and newborn care practices in Lira District, Northern Uganda. This study recruited neonates born to mothers in the parent study. Random blood glucose was measured using an On Call® Plus glucometer (ACON Laboratories, Inc., 10125 Mesa Road, San Diego, CA, USA). We defined hypoglycemia as a blood glucose of < 47 mg/dl. To determine the factors associated with neonatal hypoglycemia, a multivariable linear regression mixed-effects model was used. Results: We examined 1416 participants of mean age 3.1 days (standard deviation (SD) 2.1) and mean weight of 3.2 kg (SD 0.5). The mean neonatal blood glucose level was 81.6 mg/dl (SD 16.8). The prevalence of a blood glucose concentration of < 47 mg/dl was 2.2% (31/1416): 95% CI 1.2%, 3.9%. The risk factors for neonatal hypoglycemia were delayed breastfeeding initiation [adjusted mean difference, − 2.6; 95% CI, − 4.4, − 0.79] and child age of 3 days or less [adjusted mean, − 12.2; 95% CI, − 14.0, − 10.4]. Conclusion: The incidence of neonatal hypoglycemia was low in this community and was predicted by delay in initiating breastfeeding and a child age of 3 days or less. We therefore suggest targeted screening and management of neonatal hypoglycemia among neonates before 3 days of age and those who are delayed in the onset of breastfeeding. [ABSTRACT FROM AUTHOR]