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An evaluation of dog bite mitigation strategies aimed at reducing the health and economic burden of rabies in Nepal- an effectiveness trial involving in-school children and adolescentsBackground: Dog bites pose a significant public health concern, particularly in regions with high stray dog populations. In Nepal, the incidence of dog bites has remained high, affecting children and adolescents the most. Previous studies have suggested that interventions such as sterilization and education may help reduce bite rates, but their combined effectiveness had not been systematically assessed. Rationale: This study sought to evaluate the effectiveness of dog bite mitigation strategies through a Cluster-Randomized Control Trial (cRCT), focusing on school-based education and mass dog sterilization. Given the high burden of dog bites, particularly among children aged 11-17 years, understanding which interventions yield the greatest reduction in exposure is essential for shaping public health policy. Aim: The primary objective was to assess the impact of targeted interventions—sterilisation and education—on reducing dog bite incidents, with an emphasis on children and adolescents in Kathmandu. Design & Methods: The study was conducted across four municipality clusters, involving 2,427 children and 9,610 dogs. Baseline and post-intervention data were collected through canine population surveys and hospital records. Two interventions were applied: (1) sterilization of free-roaming dogs and (2) school-based education on dog behavior and bite prevention. The effectiveness of these interventions was measured by analyzing hospital-reported dog bite cases before and after the intervention. Findings: The study found a 7.82% overall reduction in dog bite cases over 12 months, with the most severe bite cases (requiring vaccination, wound care, immunoglobulin, and surgery) decreasing by over 60%. The strongest effect was seen among the target age group (11-17 years), where bite incidents significantly declined (p=0.017). Education proved to be the most effective standalone intervention, leading to behavioral changes that reduced exposure risk. Regression analysis highlighted key risk factors, including past exposure, fear of dogs, and lack of knowledge about canine behavior. Interestingly, sterilization alone had a moderate effect, but its impact was less immediate compared to education. Combined interventions did not demonstrate a significantly greater effect than individual interventions. Conclusion: This study provides strong evidence that school-based education is the most effective strategy for reducing dog bite exposure among children. While sterilization contributes to long-term risk reduction, it should be implemented alongside education rather than as a standalone intervention. These findings emphasize the need for multi-sectoral approaches to dog bite prevention, integrating behavioral education into public health initiatives to achieve sustainable impact.
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Epilepsy-related stigma in Nigeria: A systematic review of manifestations, impacts, and socio-cultural driversBackground: Stigma poses significant challenges to the overall quality of life of people living with epilepsy (PLWE) in Nigeria; yet, there remains a limited understanding of the stigmatisation of PLWE. Objectives: Guided by critical theory, the purpose of this systematic review is to synthesise evidence on the nature, impact, and socio-cultural drivers of epilepsy-related stigma in Nigeria. This review attempts to provide insights that could be useful for informing interventions to empower PLWE, reduce their burdens, improve their outcomes, and foster their inclusion in the Nigerian society. Method: Literature search was conducted using six electronic databases – APA PsycINFO, Google Scholar, JSTOR, MEDLINE, PubMed, and Scopus – to identify relevant studies published between 2011 and 2024. Qualitative and quantitative studies were included. A total of 10 studies met the inclusion criteria and were analysed using thematic and narrative syntheses. Results: The findings revealed that stigma is a multi-dimensional issue encompassing perceived, enacted, and internalised forms. Cultural misconceptions such as beliefs associating epilepsy with witchcraft, curses, and contagion were found to be the primary drivers of stigma. Economic barriers, gender-specific vulnerabilities, and social exclusion further perpetuate discrimination and healthcare disparities. Stigma is associated with social determinants of health, such as education, employment, and gender, to limit opportunities and quality of life for PLWE. Conclusion: This study highlights that stigma adversely affects PLWE, perpetuating marginalisation, social isolation, and healthcare inequalities. Contribution: Urgent action is required to implement culturally sensitive interventions, enhance healthcare policies, and increase awareness to address stigmatisation, ensuring equitable treatment and access.
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Deep learning–enhanced prediction of microstructure and porosity evolution in additive-manufactured membrane coatings for harsh environmentsThis study investigates the capability of additive manufacturing (AM) to produce thick coatings functioning as multifunctional membranes with enhanced barrier, transport, and mechanical properties for harsh operating environments. The primary objective was to evaluate how deposition technique and microstructural optimisation influence porosity, diffusion resistance, corrosion protection, and thermal stability. A combined methodology was implemented, integrating experimental testing of laser cladding, thermal spraying, and direct energy deposition (DED) with mathematical models for permeability, diffusion, and thermal conductivity. Laser cladding demonstrated the densest structures, achieving porosity levels below 2% and reducing gas permeability to 1.2 × 10⁻¹⁵ m², nearly an order of magnitude lower than thermal spraying (1.1 × 10⁻¹⁴ m²). Corrosion testing showed nickel-based cladded coatings reached rates as low as 0.0025 mm/year, representing a 90% reduction compared to uncoated substrates (0.026 mm/year). Thermal barrier evaluation of YSZ coatings indicated a conductivity of 0.95 W/m·K at 1200 °C, corresponding to a 38% reduction in heat flux across 1.2 mm-thick layers. Ultrasonic spray post-treatment reduced surface roughness by up to 55% and biofilm accumulation by nearly half. Error analysis confirmed deviations within ± 6%. These results confirm that AM thick coatings function as functional membranes, offering selective transport regulation, structural durability, and sustainability across the aerospace, energy, and marine sectors.
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The way forward for assessing the human health safety of cosmetics in the EU: Proceedings of Workshop 2Under the European Cosmetic Regulation, safety assessments of cosmetics and their ingredients must be conducted without the use of animals. This regulatory requirement poses a number of challenges, as validated alternative methods are only available for some of the toxicological endpoints that are typically considered in standard human health risk assessments. Despite significant progress since the ban in 2013, particularly in the development of New Approach Methodologies (NAMs) for local and acute toxicity, and for mutagenicity/genotoxicity, there remains an urgent need for non-animal test methods to assess systemic toxicity, which often becomes evident after repeated or long-term exposure. Currently, no validated animal-free alternatives are available for assessing sub-acute, sub-chronic and chronic toxicity, carcinogenicity, developmental/reproductive toxicity, or for a major part of toxicokinetics. In response to these challenges, the Methodology Working Group of the Scientific Committee on Consumer Safety organised a dedicated workshop in December 2024 to discuss advances in the application of Next Generation Risk Assessment (NGRA) as a strategic animal-free approach for the safety assessment of cosmetic ingredients. The workshop focused on a number of important key issues for the practical application of NAMs and NGRA, their regulatory acceptance and identification of possible (partial) solutions to overcome existing limitations. [Abstract copyright: © 2025. The Author(s).]
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The efficacy and safety of Asciminib in the treatment of Chronic Myeloid Leukemia: A systematic review and meta-analysisChronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm characterized by the presence of the BCR :ABL1 fusion gene, which drives leukemogenesis through aberrant tyrosine kinase activity. While first- and second-generation tyrosine kinase inhibitors (TKIs) have transformed the management of CML, treatment failure due to resistance or intolerance—especially in patients with the T315I mutation—remains a critical concern. Asciminib, a first-in-class STAMP inhibitor targeting the myristoyl pocket of ABL1, offers a novel therapeutic approach distinct from ATP-competitive TKIs. This systematic review summarizes current evidence on the efficacy and safety of Asciminib in adults with CML who have failed at least two prior TKIs. Data from eight clinical trials involving 1,093 patients revealed that Asciminib demonstrated superior major molecular response rates compared to Bosutinib and Ponatinib in patients without the T315I mutation, along with a favorable safety profile marked by fewer grade ≥3 adverse events and treatment discontinuations. However, its efficacy in T315I-mutant CML remains inconclusive and warrants further investigation. The unique mechanism of Asciminib and its tolerability profile support its clinical utility as a third-line agent in CML, with potential future applications in combination therapies and treatment-free remission strategies.
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An investigation of the use and delivery of mesenchymal stem cells and their secretome to treat skin woundsSkin damage can be caused by cuts, burns, abrasions and ulcers. Wound healing is a complex process involving coordination between multiple biological pathways and is classified into four stages: haemostasis, inflammation, proliferation, and tissue remodeling. Chronic wounds such as burn injuries and diabetic foot ulcer are under-appreciated injuries that are prevalent and life-threatening forms that contribute to mortality rates due to high rates of wound infections. Managing chronic wounds presents challenges and development of new therapeutics are required. Stem cells, specifically mesenchymal stem cells (MSCs), and their conditioned medium (CM) are known for their regenerative ability in skin wounds. However, there has been a need to search for an efficient delivery system for MSCs and its secretome for skin wounds. This thesis focused on using MySkinTM scaffolds as a delivery system for MSCs and MSC CM as these scaffolds were previously used in delivering keratinocytes for burn wounds. Initial experiments focused on an in vitro animal model using murine cells i.e., murine MSCs (ST2) and murine dermal fibroblasts (L929) where the results suggested that MSC CM helps accelerate dermal fibroblast adhesion/spreading, proliferation and migration. Furthermore, the animal model also suggested that it is possible to use culture MSCs on MySkinTM scaffolds and generate MSC CM on the scaffold. Additionally, the results also suggested that it is possible to deliver MSCs and MSC CM onto a wound site. The same set of experiments were conducted using human cells, i.e., human MSCs, dermal fibroblasts and endothelial cells. The results supported the findings from the animal model along with MSC CM supporting angiogenesis. Due to these results, the CM was analyzed for presence of growth factors, cytokines, chemokines, and extra cellular matrix (ECM) proteins which may have played a role in observing these results. The experiments suggest that it is possible to use and deliver MSCs and MSC CM using MySkinTM scaffolds and may help accelerate the wound healing process.
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Evaluating the feasibility of a co-produced, bespoke dementia education programme for formal caregivers of individuals with intellectual disabilityBackground: This study aimed to evaluate a multi-component anxiety management programme for individuals with intellectual disability, focusing on its feasibility, acceptability, and effectiveness in supporting development of self-management skills and reducing anxiety. Design: A mixed methods quasi-experimental design was used, with participants recruited and allocated to either the anxiety intervention or treatment as usual group (TAU). Participants’ anxiety symptoms and quality of life were measured at baseline, midpoint and 20 week follow up. Qualitative feedback was collected through interviews with participants and clinicians. Results: High engagement levels demonstrated intervention acceptability, with strong retention rates highlighting feasibility. Participants in the intervention group reported improvements in self-management skills with quantitative data suggesting small reductions in anxiety symptoms compared to TAU. Conclusion: The findings provide promising preliminary evidence for the interventions feasibility, acceptability and its potential to reduce anxiety symptoms. However, its potential value in supporting anxiety self management remains to be fully tested.
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florio HAEMO—A digital medical device for monitoring of treatment, symptoms and physical activities for people living with haemophiliaIntroduction: Despite therapeutic achievements in haemophilia care, there is still the need to monitor and define personal treatment outcomes and document results to achieve the best possible care. Hence, a need for unbiased, timely and comprehensive real‐world information exists to support informed shared decision‐making regarding treatment and care. Aim: To describe a medical device for people living with haemophilia (PLWH) supporting an active involvement to achieve a near to normal life. Methods: Florio HAEMO was developed as haemophilia monitoring platform to support PLWH and their care teams in documenting, interpreting and analysing personal reported outcomes. The tool was created partnering closely with PLWH and healthcare professionals to address previously unmet needs compared to existing applications. Results: Florio HAEMO was launched in March 2020. Currently, it is available in 25 countries and 24 languages; 1558 PLWH (86% with haemophilia A) are registered users in 121 treatment centres across 20 countries. All users included are on a prophylactic treatment regimen. Conclusion: Florio HAEMO allows the collection of contemporaneous data to monitor treatment, like factor level, adherence and consumption as well as monitoring treatment outcomes, including pain, bleeds, wellbeing and levels of physical activity to support self‐management, shared decision‐making and to enable better care for PLWH. Data collected over time may help to show the impact of individualised prophylaxis and may support the definition of factor levels required for good bleed and joint protection in a real world setting from daily life to physical activities.
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The Eat-Out-to-Help-Out incentive: A trigger for gastrointestinal infections in England, 2020?Our study assessed the link between gastrointestinal (GI) infections in England and the Eat Out to Help Out scheme (EOHO), a government subsidy created to encourage people to eat out during COVID-19 pandemic (03–30 August 2020). We studied national laboratory data between January 2015 and December 2020. We used time series change point analysis to see if there were shifts in reported cases of specific GI infections (Campylobacter spp., Escherichia coli O157, and non-typhoidal Salmonella spp.) associated with the timing of the scheme. Our analysis uniquely applied the Pruned Exact Linear Time method, with generalized linear models to a national dataset of GI infections. This revealed increases in cases closely aligned to the timing of the easing of COVID-19 restrictions, prior to the introduction of the EOHO scheme. Our study showed the scheme had no measurable impact, as there was no significant change on reported cases. Substantial reductions in cases after the first lockdown, followed by an increase as restrictions were phased out, show the wider impact of COVID-19 control measures, for example, public information campaigns aimed at improving hand-hygiene. These findings highlight the complicated interactions between COVID-19 control measures, the public’s behaviour, and the spread of GI infections.
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Using theories of power and place to evaluate community health promotionThere is some consensus that better ways of evaluating complex public health programmes are needed as experimental methods are limited in explaining the 'how' and 'why' of change. Methods like 'theory-of-change,' 'realist evaluation,' and 'systems evaluation' try to give a more complete picture of change by looking at the context of the programme. However, when these methods are used to study programmes that aim to reduce health inequalities, they often miss a crucial issue: how power affects people's health and engagement with programmes. This paper addresses that gap by reporting an ethnographic study of a community health promotion programme that was informed by a social theory of power (figurational sociology). When looking at how power dynamics played out in the targeted community, we could see why residents often did not trust the people running the programme, and why local status was so important to them. When programme staff understood these power dynamics, they were better able to connect with residents and help them improve their wellbeing. We argue that combining this way of looking at power with our observational approach gives us a much clearer understanding of how complex public health programmes work and why they succeed or fail in their aims.
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Impact of dietary patterns on skeletal health: A systematic review and meta-analysis of bone mineral density, fracture, bone turnover markers, and nutritional statusBackground/Objectives: Dietary patterns play a crucial role in musculoskeletal health; however, the effects of different diets on bone mineral density (BMD), fracture risk, and bone metabolism remain inconsistent across studies. This systematic review and meta-analysis aimed to evaluate the impact of Mediterranean, calorie restriction, high-protein, low-carbohydrate, and ketogenic diets on skeletal outcomes in adults. Methods: A comprehensive search of PubMed/MEDLINE, CENTRAL, and Web of Science was conducted for studies published between January 2000 and June 2025. Eligible randomised controlled trials (RCTs) and cohort studies involving adults (≥18 years) and reporting outcomes related to BMD, fractures, bone turnover markers, and vitamin D or calcium status were included. Risk of bias was assessed using the Cochrane’s Risk of Bias tool for RCTs and the Joanna Briggs Institute checklist for observational studies. Random-effects meta-analyses were performed for outcomes reported by ≥3 comparable studies, presenting standardised mean differences (SMDs) for BMD and hazard ratios (HRs) for fractures. Results: Thirty studies met inclusion criteria, comprising 14 RCTs and 16 observational studies with over 500,000 participants. Pooled analyses showed no significant differences in BMD at the femoral neck (SMD = 0.12, 95% CI −0.80 to 1.04), lumbar spine (SMD = 0.04, 95% CI: −1.12 to 1.03), total hip (SMD = −0.07, 95% CI −0.36 to 0.21), or whole body (SMD = 0.03, 95% CI −0.07 to 0.14) across diet categories. However, adherence to a Mediterranean diet was associated with a significantly reduced hazard of hip and overall fractures (pooled HR = 0.95, 95% CI 0.93–0.96). Calorie restriction consistently increased bone resorption markers, whereas Mediterranean and high-protein diets showed neutral or modestly favourable effects. Vitamin D and calcium status were minimally affected across interventions. Conclusions: While dietary patterns exert diverse effects on skeletal health, consistent evidence supports Mediterranean-style diets as protective against fractures. Calorie restriction may elevate bone turnover, whereas ketogenic and high-protein diets show mixed effects on bone. However, across all analyses, high heterogeneity was observed. Further high-quality RCTs are warranted to clarify these relationships and inform dietary guidance for bone health.
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An investigation into differences in general intelligence and coaches' subjective assessment of players' decision-making skills across different playing positions in EPPP association football academiesWith developments in tactical complexity in association football (soccer) general intelligence and decision-making are becoming increasingly important attributes for players at all levels. However, an absence of evidence regarding general intelligence and decision-making across different positions within English Academy soccer indicates that it is unknown how specific intelligence in soccer needs to be for successful performance. This study aimed to 1) examine differences in general intelligence scores between different playing positions, 2) investigate differences in coach assessed decision-making ability between different playing positions and 3) assess differences between general intelligence test score ranks and decision-making ranks awarded by coaches to each player per position. One hundred and one participants, aged 16–18 years were recruited from eight clubs in the English Football League. Participants completed an established psychometric test of general intelligence and the lead development phase coach at each club ranked players' decision-making ability. There were 99 outfield players who participated: 37 defenders, 34 midfielders and 28 attackers. No difference was found in general intelligence scores between playing positions. However, a significant difference was found in decision-making ranks, with coaches determining attacker's decision-making to be lower than midfielders and defenders. Likewise, no difference was found between general intelligence and decision-making ranks for either defenders or midfielders, but a difference was observed between attackers' general intelligence and decision-making ranks. In conclusion, attacker's game intelligence appears to be underestimated by coaches. Consequently, utilisation of a psychometric test of general intelligence could enhance identification of talented players in Academy soccer.
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Organisational contextual drivers of evidence-based practice across acute and primary careBackground: Evidence based practice (EBP) is widely recognised as fundamental to high quality nursing care, yet implementation remains uneven across healthcare settings in England. Attention has shifted from individual barriers to organisational context. Leadership, team dynamics, access to resources, and social capital shape how nurses engage with EBP. Despite national policies promoting research active environments, how these ambitions are realised at the frontline is unclear. This study examined how organisational factors influence nurses’ implementation of evidence across acute and primary care. Methods: A cross-sectional design was used with registered nurses working in acute and primary care settings. Two validated instruments, the Evidence Based Practice Implementation Scale and the Alberta Context Tool, were administered. A nonprobability sampling strategy targeted the acute and general practice nursing workforce. Response distributions were monitored across pre specified strata and fieldwork closed once coverage and precision criteria were met. Descriptive statistics summarised participant and organisational characteristics. Inferential analyses compared settings, mediation modelling tested the role of social capital in the leadership to EBP pathway, and cluster analysis identified implementation profiles. Results: Engagement with EBP was moderate overall (M = 3.16, SD = 0.88) with no significant difference between sectors (p = 0.38). Acute care nurses reported higher leadership support (M = 4.01 versus 3.78, p = 0.008) and better access to structural resources (M = 3.35 vs. 3.10, p = 0.004). Within acute care, leadership differed across specialties, with higher scores in ICU or CCU and general medicine, F (4, 636) = 4.12, p = 0.003. Social capital significantly mediated the association between leadership and EBP implementation (β = 0.15, 95% CI 0.10–0.21). Three engagement clusters were identified, high 32%, moderate 45%, and low 23%, each with distinct organisational profiles. Conclusion: Organisational context, particularly leadership and social capital, is central to nurses’ capacity to implement evidence. Variation across specialties and sectors indicates that a one size fits all approach is unlikely to succeed. Policy relevant levers include formalising protected time, resourcing embedded facilitation, investing in knowledge infrastructure, and expanding clinical academic pathways, to create environments where evidence use is routine and supported.
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A situation analysis of diagnostic and management strategies for gestational Urinary Tract Infections (UTIs) in Kisumu County, Kenya: Maternal health implications and opportunities for diagnostic improvementUrinary tract infections (UTIs) are linked to adverse pregnancy outcomes, yet epidemiological data on gestational UTIs in Kenya are limited. This study assessed diagnostic and management practices in Kisumu County to inform diagnostic and antimicrobial stewardship. A hospital-based retrospective study was conducted from February 2020 to February 2021 among 416 records of pregnant women at Chulaimbo and Nyahera Sub-County Hospitals. Socio-demographic, laboratory, and clinical history data were collected using structured forms and analysed in STATA 16.0. Statistical methods included chi-square, multivariate logistic regression, and Spearman’s rank correlation (p ≤ 0.05). Dipstick-based presumptive proportion of UTIs was 57.9% (241/416). Only 1.4% (6/416) had microbiological confirmation despite infections being recorded. The mean maternal age was 23.92 years, parity two, mean antenatal visits two, and mean haemoglobin 10.73 ± 1.8 g/dL. The first antenatal care attendance occurred at varying gestational ages in 56% (233/416). Antibiotics prescribed were 60% from WHO ‘Access’ group and 40% from ‘Watch’ group. Gestational UTI’s in Kisumu County were frequently managed without confirmatory diagnosis, increasing antimicrobial resistance risk. Strengthening management requires better laboratory capacity, sustained financial investment, improved antibiotic access, and adherence to WHO AWaRe guidelines to protect maternal and neonatal health.
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Cardiovascular disease in the context of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A comprehensive narrative reviewMetabolic dysfunction-associated steatotic liver disease (MASLD) is a chronic hepatic disease with a rising global prevalence (25–38% of the general population). As a new term, MASLD was introduced in 2023 to replace the previous nomenclature of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD). This new term/definition introduced changes in the diagnostic criteria and underscores the direct link between cardio-metabolic risk and this prevalent liver disease. In this context, the present review examines the clinical and pathophysiological links between MASLD and cardiovascular disease (CVD), providing a robust evidence synthesis of primarily systematic review data on the association between MASLD and coronary artery disease (CAD), atrial fibrillation (AF), and heart failure (HF). This association appears to be not only synergistic, but also independent of other known CVD risk factors, highlighting MASLD as a key cardio-metabolic risk factor that merits prompt diagnosis and treatment. The development of MASLD-related cardiovascular morbidity increases with the severity of the underlying hepatic pathology, particularly with progression to steatohepatitis and fibrosis. Notably, growing evidence highlights the links between MASLD and CVD through cardiac structural, electrical, and functional alterations that can progress to CAD, AF, and new-onset HF. Recognizing these links in clinical practice underscores the importance of early detection and multi-disciplinary management of MASLD to prevent disease progression and CVD complications.
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Eating well when living with an intellectual disability—Exploring the carer: client relationship in residential settingsBackground: Individuals with intellectual disabilities face increased risks of obesity and health issues. Carers in residential settings play a crucial role in shaping their dietary habits. This study explores how carers influence eating behaviours to identify strategies for healthy eating. Method: Seventeen semi-structured interviews were conducted with carers from three community homes. Thematic analysis identified three key themes: (i) whose responsibility is it?; (ii) food autonomy and choice in the context of caring relationships; (iii) opportunities for working together to support dietary choices. Results: Carers strive to encourage healthy eating while respecting residents' autonomy, particularly in those with cognitive impairments or on psychotropic medications. They use strategies like rapport-building, personalised care, and nutrition education. However, these efforts are limited by gaps in knowledge, time constraints, and variation in application and impact. Conclusions: Findings highlight the practice gap and the need for better training and resources to support carers in promoting healthy food choices while respecting residents' autonomy.
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Organ wide toxicological assessment of common edible herbs and their mixtures as used in home remediesThe use of home remedies for medicinal purposes, most of which are edible plants has continued to be a practice in many homes. However, there has been an increasing report of chronic use with lethal effect. Among the commonly used herbal/ medicinal plants were ginger, garlic and lemon. These were seen to be prevalent across continents with brewing and crude extraction being the most means of consumption. This study investigated the organ wide toxicity of this extract following chronic consumption of crude extract. Twenty-five albino Wister rats, five in each group were used for this experiment. Each animal received 0.5ml/kg body weight of either ginger extract, garlic extract, lemon juice, or a mixture of equal volumes of all three extract (v/v) respectively twice daily for seven (7) days. Statistics were represented as ±SE; P≤0.05 was considered significant. Previous studies have shown that moderate consumption of these medicinal plants were beneficial and have shown no deleterious effect. This study observed no change in the weight of the experimental animals. The weight of the animals continued to increase except for the group that received lemon and the mixture, but these were not significant. It was observed that chronic consumption induced organ wide toxicity to include the liver, kidney, intestinal epithelium, stomach, and pancreas. These were shown to alter tissue architecture and the cell morphology. Packed cell volume was reduced in the lemon and the group that received a combination of all extracts (p=o.03). Blood differentials showed changes in levels. An elevated basophil level was observed in ginger and garlic (p<0.0001; p=0.0006). Monocyte levels increased progressively across each group when compared to the control with the most elevated level seen in the group that received the mixture (p<0.0001). Lymphocyte count was reduced across all the groups that received the extract except for animals that received ginger. This study suggests the application of caution among users of these medicinal plants and continues to draw attention to the need for harmonization and standardization of safe use doses.
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Awareness and Knowledge of Antimicrobial Resistance, Antimicrobial Stewardship and Barriers to Implementing Antimicrobial Susceptibility Testing among Medical Laboratory Scientists in Nigeria: A Cross-Sectional StudyBackground: Antimicrobial resistance (AMR) is now considered one of the greatest global health threats. This is further compounded by a lack of new antibiotics in development. Antimicrobial stewardship programmes can improve and optimize the use of antibiotics, thereby increasing the cure rates of antibiotic treatment and decreasing the problem of AMR. In addition, diagnostic and antimicrobial stewardships in the pathology laboratories are useful tools to guide clinicians on patient treatment and to stop the inappropriate use of antibiotics in empirical treatment or narrow antibiotics. Medical Laboratory Scientists are at the forefront of performing antibiotics susceptibility testing in pathology laboratories, thereby helping clinicians to select the appropriate antibiotics for patients suffering from bacterial infections. Methods: This cross-sectional study surveyed personal antimicrobial usage, the knowledge and awareness on AMR, and antimicrobial stewardship, as well as barriers to antimicrobial susceptibility testing among medical laboratory scientists in Nigeria using pre-tested and validated questionnaires administered online. The raw data were summarized and exported in Microsoft Excel and further analyzed using IBM SPSS version 26. Results: Most of the respondents were males (72%) and 25–35 years old (60%). In addition, the BMLS degree was the highest education qualification most of the respondents (70%) achieved. Of the 59.2% of the respondents involved in antibiotics susceptibility testing, the disc diffusion method was the most commonly used (67.2%), followed by PCR/Genome-based detection (5.2%). Only a small percentage of respondents used the E-test (3.4%). The high cost of testing, inadequate laboratory infrastructure, and a lack of skilled personnel are the major barriers to performing antibiotics susceptibility testing. A higher proportion of a good AMR knowledge level was observed in male respondents (75%) than females (42.9%). The knowledge level was associated with the respondent’s gender (p = 0.048), while respondents with a master’s degree were more likely to possess a good knowledge level of AMR (OR: 1.69; 95% CI: 0.33, 8.61). Conclusion: The findings of this study indicate that Nigerian medical laboratory scientists had moderate awareness of AMR and antibiotic stewardship. It is necessary to increase investments in laboratory infrastructure and manpower training, as well as set up an antimicrobial stewardship programme to ensure widespread antibiotics susceptibility testing in hospitals, thereby decreasing empirical treatment and the misuse of antibiotics.
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A generic theory of change-based framework with core indicators for monitoring the effectiveness of large-scale food fortification programs in low- and middle-income countriesLarge-scale food fortification (LSFF) programs are widely implemented in low- and middle-income countries (LMIC) to alleviate micronutrient deficiencies. However, these programs may not achieve the desired impact due to poor design or bottlenecks in program implementation. Monitoring and evaluation (M&E) frameworks and a set of agreed indicators can help to benchmark progress and to strengthen the evidence-base of effectiveness in a standardized way. We aimed to formulate recommendations towards core indicators for evaluating the effectiveness of LSFF programs with their associated metrics, methods, and tools (IMMT). For this, we used a multi-method iterative approach, including a mapping review of the literature, semi-structured interviews with international experts, compilation of a generic Theory of Change (ToC) framework for LSFF program delivery, and selection of IMMT for M&E of LSFF programs at key stages along the ToC delivery framework. Lastly, we conducted exploratory, qualitative interviews with key informants in Nigeria to explore experiences and perceptions related to the implementation of LSFF programs in Nigeria's context, and their opinion towards the proposed set of core IMMT. The literature search resulted in 14 published and 15 grey literature documents, from which we extracted a total of 41 indicators. Based on the available literature and interviews with international experts, we mapped a ToC delivery framework and selected nine core indicators at the output, outcome and impact level for M&E of the effectiveness of LSFF programs. Key informants in Nigeria revealed that the main bottlenecks for implementation of the proposed IMMT are related to the lack of technical capacity, equipment, laboratory infrastructure, and financial resources. In conclusion, we propose a set of nine core indicators for enabling comprehensive M&E of the effectiveness of LSFF programs in LMIC. This proposed set of core indicators can be used for further evaluation, harmonization and integration in national and international protocols for M&E of LSFF programs.
