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1.
Trop Biomed ; 38(3): 360-365, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1404405

ABSTRACT

COVID-19, caused by the SARS-CoV-2 virus, can lead to massive inflammation in the gastrointestinal tract causing severe clinical symptoms. SARS-CoV-2 infects lungs after binding its spike proteins with alveolar angiotensin-converting enzyme 2 (ACE2), and it also triggers inflammation in the gastrointestinal tract. SARS-CoV-2 invades the gastrointestinal tract by interacting with Toll-like receptor-4 (TLR4) that induces the expression of ACE2. The influx of ACE2 facilitates cellular binding of more SARS-CoV-2 and causes massive gastrointestinal inflammation leading to diarrhea. Diarrhea prior to COVID-19 infection or COVID-19-induced diarrhea reportedly ends up in a poor prognosis for the patient. Flavonoids are part of traditional remedies for gastrointestinal disorders. Preclinical studies show that flavonoids can prevent infectious diarrhea. Recent studies show flavonoids can inhibit the multiplication of SARS-CoV-2. In combination with vitamin D, flavonoids possibly activate nuclear factor erythroid-derived-2-related factor 2 that downregulates ACE2 expression in cells. We suggest that flavonoids have the potential to prevent SARS-CoV-2 induced diarrhea.


Subject(s)
COVID-19/complications , Diarrhea/prevention & control , Flavonoids/therapeutic use , SARS-CoV-2 , Angiotensin-Converting Enzyme 2/physiology , Diarrhea/etiology , Humans
2.
East Mediterr Health J ; 27(7): 665-671, 2021 Jul 29.
Article in English | MEDLINE | ID: covidwho-1348835

ABSTRACT

BACKGROUND: Under-5 mortality remains high in developing nations despite decades of multilateral cooperation to reduce it. Diarrhoea contributes up to 15% of all mortality in this age group. Frequently reported barriers include poor hygiene, lack of sanitation facilities, and negligible public health education on the issue. Interventions such as Water, Sanitation, and Hygiene (WASH) could complement modern public health approaches with renewed vigour in wake of SARS-CoV-II (COVID-19). AIMS: We sought to assess maternal hand hygiene and ability to prepare oral rehydration solution at home. METHODS: In addition to the ability to prepare oral rehydration solution at home, this cross-sectional study, carried out at the Sughra Shafi Medical Complex, Narowal during 2017, compared knowledge, attitudes and behaviours of mothers of children with diarrhoea to those shoes children did not have diarrhoea. RESULTS: 511 (48%) children < 5 years were diagnosed with diarrhoea irrespective of household location. Among 1065 accompanying mothers recruited for this study, only 130 (12%) were able to prepare ORS at home and 288 (27%) qualified as regular hand-washers according to the criteria. Just over half of the respondents consumed untreated water supplied via a nearby canal. Almost 80% of neighbourhoods lacked waste collection. CONCLUSION: These findings informed management of frequent child diarrhoea cases presented at the hospital with locally relevant preventive knowledge. They are also expected to be useful in educating mothers on regular handwashing and the preparation of ORS as home-based interventions.


Subject(s)
COVID-19 , Hand Disinfection , Child , Cross-Sectional Studies , Diarrhea/epidemiology , Diarrhea/prevention & control , Female , Hospitals, Rural , Humans , Infant , Pakistan , SARS-CoV-2 , Sanitation , Self Report
3.
BMJ Glob Health ; 6(3)2021 03.
Article in English | MEDLINE | ID: covidwho-1148159

ABSTRACT

We have worked to develop a Clinical Information Network (CIN) in Kenya as an early form of learning health systems (LHS) focused on paediatric and neonatal care that now spans 22 hospitals. CIN's aim was to examine important outcomes of hospitalisation at scale, identify and ultimately solve practical problems of service delivery, drive improvements in quality and test interventions. By including multiple routine settings in research, we aimed to promote generalisability of findings and demonstrate potential efficiencies derived from LHS. We illustrate the nature and range of research CIN has supported over the past 7 years as a form of LHS. Clinically, this has largely focused on common, serious paediatric illnesses such as pneumonia, malaria and diarrhoea with dehydration with recent extensions to neonatal illnesses. CIN also enables examination of the quality of care, for example that provided to children with severe malnutrition and the challenges encountered in routine settings in adopting simple technologies (pulse oximetry) and more advanced diagnostics (eg, Xpert MTB/RIF). Although regular feedback to hospitals has been associated with some improvements in quality data continue to highlight system challenges that undermine provision of basic, quality care (eg, poor access to blood glucose testing and routine microbiology). These challenges include those associated with increased mortality risk (eg, delays in blood transfusion). Using the same data the CIN platform has enabled conduct of randomised trials and supports malaria vaccine and most recently COVID-19 surveillance. Employing LHS principles has meant engaging front-line workers, clinical managers and national stakeholders throughout. Our experience suggests LHS can be developed in low and middle-income countries that efficiently enable contextually appropriate research and contribute to strengthening of health services and research systems.


Subject(s)
Child Health Services/standards , Delivery of Health Care/standards , Health Services Accessibility/standards , Health Services Research , Quality Improvement , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child, Preschool , Developing Countries , Diarrhea/epidemiology , Diarrhea/prevention & control , Humans , Infant , Infant, Newborn , Kenya/epidemiology , Malaria/epidemiology , Malaria/prevention & control , Pandemics , Pneumonia/epidemiology , Pneumonia/prevention & control , SARS-CoV-2
5.
Benef Microbes ; 11(5): 477-488, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-740509

ABSTRACT

Neonatal calf diarrhoea is one of the challenges faced by intensive farming, and probiotics are considered a promising approach to improve calves' health. The objective of this study was to evaluate the effect of potential probiotic lactobacilli on new-born dairy calves' growth, diarrhoea incidence, faecal score, cytokine expression in blood cells, immunoglobulin A (IgA) levels in plasma and faeces, and pathogen abundance in faeces. Two in vivo assays were conducted at the same farm in two annual calving seasons. Treated calves received one daily dose of the selected lactobacilli (Lactobacillus reuteri TP1.3B or Lactobacillus johnsonii TP1.6) for 10 consecutive days. A faecal score was recorded daily, average daily gain (ADG) was calculated, and blood and faeces samples were collected. Pathogen abundance was analysed by absolute qPCR in faeces using primers directed at Salmonella enterica, rotavirus, coronavirus, Cryptosporidium parvum and three Escherichia coli virulence genes (eae, clpG and Stx1). The faecal score was positively affected by the administration of both lactobacilli strains, and diarrhoea incidence was significantly lower in treated calves. No differences were found regarding ADG, cytokine expression, IgA levels and pathogen abundance. Our findings showed that oral administration of these strains could improve gastrointestinal health, but results could vary depending on the calving season, which may be related to pathogen seasonality and other environmental effects.


Subject(s)
Cattle Diseases/therapy , Diarrhea , Lactobacillus johnsonii/metabolism , Lactobacillus reuteri/metabolism , Probiotics/therapeutic use , Animals , Animals, Newborn , Cattle , Cattle Diseases/microbiology , Cattle Diseases/prevention & control , Coronavirus Infections/prevention & control , Coronavirus Infections/veterinary , Cryptosporidiosis/prevention & control , Cytokines/blood , Dairying , Diarrhea/prevention & control , Diarrhea/therapy , Diarrhea/veterinary , Escherichia coli Infections/prevention & control , Escherichia coli Infections/veterinary , Feces/virology , Gastrointestinal Tract/microbiology , Immunoglobulin A/blood , Rotavirus Infections/prevention & control , Rotavirus Infections/veterinary , Salmonella Infections, Animal/prevention & control
7.
Lancet Glob Health ; 9(12): e1707-e1718, 2021 12.
Article in English | MEDLINE | ID: covidwho-1516469

ABSTRACT

BACKGROUND: Diarrhoeal diseases are an important cause of mortality in children younger than 5 years in sub-Saharan Africa. We aimed to evaluate the effect of three handwashing interventions on handwashing with soap (HWWS) after toilet use. METHODS: In this cluster randomised trial in Abidjan, Côte d'Ivoire, we randomly assigned communal housing compounds (1:1:1) to receive one of three interventions: a theory of normative social behaviour (TNSB) intervention, including provision of handwashing stations; handwashing stations only; and no intervention. The TNSB intervention was designed to shift the outcome expectation associated with HWWS from health to riddance of faeces-related disgust, and to increase the perceived descriptive norm and perceived handwashing publicness. Participants and fieldworkers were masked to the study objectives. The primary outcome was HWWS after toilet use, assessed at 1 month and 5 months follow-ups. Analysis was by intention to treat. This trial is registered at the Pan African Clinical Trial Registry, PACTR201501000892239. FINDINGS: Between April 10 and May 22, 2014, we identified 92 eligible compounds, of which 75 compounds were included. Follow-up data on HWWS were available for 23 compounds for the TNSB group, 25 compounds for the handwashing station-only group, and 25 compounds for the control group. The study ended in April, 2017. Compared with a frequency of 5% (29 of 604 occasions) in the control group, HWWS after toilet use increased to 9% (49 of 557 occasions; adjusted risk ratio 1·89, 95% CI 1·16-3·08) in the handwashing station-only group, and 24% (143 of 588 occasions; 4·82, 3·06-7·59) in the TNSB group, at the 1-month follow-up. The intervention effect was only sustained in the TNSB group (98 [22%] of 450 compounds; 2·68, 1·65-4·34). INTERPRETATION: A social norm-based handwashing intervention combined with disgust-inducing messages, with provision of handwashing stations, was effective at increasing HWWS after toilet use. The provision of handwashing stations alone had little effect. Future studies should investigate whether the same approach, when delivered via mass media, can have a similar effect to the face-to-face delivery used in this study. FUNDING: None.


Subject(s)
Diarrhea/prevention & control , Hand Disinfection/methods , Health Education/methods , Soaps/therapeutic use , Child , Child, Preschool , Cote d'Ivoire , Humans , Male , Sanitation/methods
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