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Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya.
We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999-2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies.
There were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81-0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels. Conclusions Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if sustained and efforts should continue to expand coverage.
Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya
Fredrick Ibinda, 1 ,* Evasius Bauni, 1 Symon M. Kariuki, 1 Greg Fegan, 1 , 2 Joy Lewa, 1 Monica Mwikamba, 1 Mwanamvua Boga, 1 Rachael Odhiambo, 1 Kiponda Mwagandi, 1 Anna C. Seale, 1 , 2 James A. Berkley, 1 , 2 Jeffrey R. Dorfman, 3 , 4 and Charles R. J. C. Newton 1 , 5
The epilepsy treatment gap is large in low‐ and middle‐income countries, but the reasons behind nonadherence to treatment with antiepileptic drugs (AEDs) across African countries remain unclear. We investigated the extent to which AEDs are not taken and associated factors in people with active convulsive epilepsy (ACE) identified in cross‐sectional studies conducted in five African countries.
We approached 2,192 people with a confirmed diagnosis of ACE for consent to give blood voluntarily. Participants were asked if they were taking AEDs, and plasma drug concentrations were measured using a fluorescence polarization immunoassay analyzer. Information about possible risk factors was collected using questionnaire‐based clinical interviews. We determined factors associated with nonadherence to AED treatment in children and adults, as measured by detectable and optimal levels, using multilevel logistic regression.
In 1,303 samples assayed (43.7% were children), AEDs were detected in 482, but only 287 had optimal levels. Of the 1,303 samples, 532 (40.8%) were from people who had reported they were on AEDs. The overall prevalence of nonadherence to treatment was 63.1% (95% confidence interval [CI] 60.5-65.6%) as measured by detectable AED levels and 79.1% (95% CI 73.3-84.3%) as measured by optimal AED levels; self‐reported nonadherence was 65.1% (95% CI 45.0-79.5%). Nonadherence was significantly (p < 0.001) more common among the children than among adults for optimal and detectable levels of AEDs, as was the self‐reported nonadherence. In children, lack of previous hospitalization and learning difficulties were independently associated with nonadherence to treatment. In adults, history of delivery at home, absence of burn marks, and not seeking traditional medicine were independently associated with the nonadherence to AED treatment. Significance Only about 20% of people with epilepsy benefit fully from antiepileptic drugs in sub‐Saharan Africa, according to optimum AEDs levels. Children taking AEDs should be supervised to promote compliance.
Antiepileptic drugs, Adherence, sub‐Saharan Africa, Epilepsy, Treatment gap
Magnitude and factors associated with nonadherence to antiepileptic drug treatment in Africa: A cross‐sectional multisite study
Fredrick Ibinda, 1 , 2 , † * Peter Odermatt, 2 , 3 , 4 Symon M. Kariuki,corresponding author 1 , 2 Angelina Kakooza‐Mwesige, 2 , 5 , 6 Ryan G. Wagner, 2 , 7 , 8 Seth Owusu‐Agyei, 2 , 9 Honorati Masanja, 2 , 10 Anthony K. Ngugi, 2 , 11 Caroline K. Mbuba, 12 Victor C. K. Doku, 2 , 13 Brian G. Neville, 2 , 14 , † Josemir W. Sander, 2 , 15 , 16 , 17 Charles R. J. C. Newton, 1 , 2 , 14 , 18 and the SEEDS writing group ‡
Pinaceae, the largest family of conifers, has a diversified organization of chloroplast (cp) genomes with two typical highly reduced inverted repeats (IRs). In the current study, we determined the complete sequence of the cp genome of an economically and ecologically important conifer tree, the loblolly pine (Pinus taeda L.), using Illumina paired-end sequencing and compared the sequence with those of other pine species. The results revealed a genome size of 121,531 base pairs (bp) containing a pair of 830-bp IR regions, distinguished by a small single copy (42,258 bp) and large single copy (77,614 bp) region. The chloroplast genome of P. taeda encodes 120 genes, comprising 81 protein-coding genes, four ribosomal RNA genes, and 35 tRNA genes, with 151 randomly distributed microsatellites. Approximately 6 palindromic, 34 forward, and 22 tandem repeats were found in the P. taeda cp genome. Whole cp genome comparison with those of other Pinus species exhibited an overall high degree of sequence similarity, with some divergence in intergenic spacers. Higher and lower numbers of indels and single-nucleotide polymorphism substitutions were observed relative to P. contorta and P. monophylla, respectively. Phylogenomic analyses based on the complete genome sequence revealed that 60 shared genes generated trees with the same topologies, and P. taeda was closely related to P. contorta in the subgenus Pinus. Thus, the complete P. taeda genome provided valuable resources for population and evolutionary studies of gymnosperms and can be used to identify related species.
Complete chloroplast genome sequence and comparative analysis of loblolly pine (Pinus taeda L.) with related species
Sajjad Asaf, Conceptualization, Data curation,1 Abdul Latif Khan, Conceptualization, Methodology,1 Muhammad Aaqil Khan, Validation, Writing - original draft,2 Raheem Shahzad, Conceptualization, Writing - original draft,2 Lubna, Data curation,3 Sang Mo Kang, Formal analysis, Methodology,2 Ahmed Al-Harrasi, Resources, Software,1 Ahmed Al-Rawahi, Conceptualization, Writing - review & editing,1 and In-Jung Lee, Supervision2,4,*