Household and community variations and nested risk factors for diarrhoea prevalence in southern Malawi: a binary logistic multi-level analysis.

This paper examines household and community-level influences on diarrhoeal prevalence in southern Malawi. A Bayesian multi-level modelling technique is used in the estimation of hierarchically built data from a survey of individuals nested within households nested within communities. Households have strong unobserved influence on diarrhoeal illness (sigma(2)(u) = 4.476; 95% CI: 2.081, 6.871). A joint Wald test of significance shows that an individual's age [chi(2)(4) = 55.921, p = 0.000] and school [chi(2)(2) = 18.203, p = 0.000] have strong influence on an individual's diarrhoeal prevalence. An individual's history of malarial-like illness also has a strong positive relationship with diarrhoeal prevalence [beta = 0.606, p = 0.000]. Household factors that influence diarrhoea include employment status of head of household [beta = -0.619, p < 0.021], maternal age [beta = -0.013, p < 0.003], and size of household [beta = -0.669, p = 0.000]. The positive relationship between diarrhoea and malaria-like episodes highlights common risk factors hence the need for common approaches to combat the diseases. Significant household effects underline the importance of household considerations in policy issues.

Care-Seeking Behaviour and Implications for Malaria Control in Southern Malawi

Although malaria is a controllable and preventable disease; it remains among the leading causes of mortality and morbidity in southern Malawi. The importance of early diagnosis and prompt treatment with hospital prescribed drugs and effective home management to control malaria is well established; however; these in part depend on how households make their decisions when family members have suffered from malaria. This study examines the behaviour of households with regard to decisions they make in managing malaria illness. Using hierarchically built data from a survey of 1;400 mothers nested within 33 communities; a series of two-level logistic regression models with Bayesian estimation was used to determine predictors of care-seeking behaviour towards malaria when a family member or a child was perceived to have malaria. The results show that most families normally visit or use medication prescribed at health facilities for both adult (80) and child (86) members when they are perceived to have malaria. The main obstacle to accessing the nearest health facility was distance and transport costs (73) and the main problems encountered at health facilities were long waiting time or absence of health workers (73) and shortage of drugs (35). Among the main predictor variables for choices of treatment for childhood malaria was the absence of a health surveillance assistant for those that visited hospitals [Beta=0.56; 95CI:-0.86;-0.26]; bought medication from open markets [Beta=0.51; 95CI:0.20;0.82]; and those that used other traditional methods or did nothing [Beta=0.70; 95CI:-0.04;1.44; p=0.06].. The results have an important role to play in the control and prevention of malaria in Malawi. The results reveal the need for increased awareness about the dangers of purchasing drugs from non-medical and/or uncertified private institutions and sources such as those found in open markets. They also show the important role of community health workers in the delivery of health systems. The study recommends empowerment of community health workers through rigorous and relevant health promotion programmes to update both their knowledge and their skills in communication and counselling

Care-Seeking Behaviour and Implications for Malaria Control in Southern Malawi

Abstract:Although malaria is a controllable and preventable disease; it remains among the leading causes of mortality and morbidity in southern Malawi. The importance of early diagnosis and prompt treatment with hospital prescribed drugs and effective home management to control malaria is well established; however; these in part depend on how households make their decisions when family members have suffered from malaria. This study examines the behaviour of households with regard to decisions they make in managing malaria illness. Using hierarchically built data from a survey of 1;400 mothers nested within 33 communities; a series of two-level logistic regression models with Bayesian estimation was used to determine predictors of care-seeking behaviour towards malaria when a family member or a child was perceived to have malaria. The results show that most families normally visit or use medication prescribed at health facilities for both adult (80) and child (86) members when they are perceived to have malaria. The main obstacle to accessing the nearest health facility was distance and transport costs (73) and the main problems encountered at health facilities were long waiting time or absence of health workers (73) and shortage of drugs (35). Among the main predictor variables for choices of treatment for childhood malaria was the absence of a health surveillance assistant for those that visited hospitals [?=0.56; 95 CI:-0.86;-0.26]; bought medication from open markets [?=0.51; 95 CI:0.20;0.82]; and those that used other traditional methods or did nothing [?=0.70; 95

In vitro digestibility techniques to predict apparent total tract energy digestibility of wheat in grower pigs.

In vitro digestibility techniques have been developed to predict the apparent total tract digestibility (ATTD) of energy and DE content of mixed diets and feedstuffs including barley grain in swine. However, the techniques have not been tested properly for their accuracy in predicting the variation in ATTD of energy and DE content within wheat grain. The objectives were 1) to compare two 3-step in vitro digestibility techniques with either cellulase (IVD-CEL) or Viscozyme (a multienzyme complex to digest fiber; Novozymes, Bagsvaerd, Denmark; IVD-VIS) as the third step, and differing in the amount of enzymes used and the duration of digestion, for their accuracy in predicting ATTD of energy and DM of wheat in grower pigs; and 2) to develop equations to predict ATTD of energy of different batches of wheat. Wheat grain samples (n = 20) with a wide range in quality were collected; the ADF and CP content ranged from 3.3 to 6.2% and from 11.2 to 20.8% (DM basis), respectively. The ATTD of energy was determined using barrows (n = 60, 30.7 +/- 4.7 kg of initial BW) in 2 periods with 6 observations per sample, and ranged from 73.3 to 84.5%. In IVD-CEL, 1 g of ground wheat was digested sequentially in digestion solutions containing pepsin (10 mg/36.5 mL) for 6 h, pancreatin (150 mg/54.5 mL) for 18 h, and cellulase (75 mg/55.5 mL) for 24 h. In IVD-VIS, 0.5 g of ground wheat sample was digested sequentially in solutions containing pepsin (25 mg/36.5 mL) for 2 h, 3 mL of pancreatin (100 mg/54.5 mL) for 6 h, and Viscozyme (0.5 mL/65.3 mL) for 18 h. The in vitro energy and DM digestibility ranged from 79.8 to 91.0% and from 82.0 to 91.5% for IVD-CEL, and ranged from 76.2 to 87.0% and from 79.1 to 89.4% for IVD-VIS, respectively. The R(2) between ATTD of energy and in vitro DM and energy digestibility for IVD-VIS (0.82 and 0.73, respectively) was greater than for IVD-CEL (0.55 and 0.54, respectively). The equation y = 1.05x - 8.85 using the in vitro DM digestibility value from IVD-VIS can predict the ATTD of the energy of wheat in swine with an SE of prediction of 1.2. The relationship between in vitro DM digestibility and grain characteristics such as ADF was stronger for the IVD-VIS than for the IVD-CEL technique (R(2) = 0.89 vs. 0.70). In conclusion, the IVD-VIS, but not the IVD-CEL, technique can accurately (R(2) = 0.82) predict the ATTD of energy in wheat in grower pigs. Therefore, the IVD-VIS technique might be useful as the reference analysis to calibrate analytical equipment to predict the ATTD of energy rapidly in wheat.

Food sampling practice in the United Kingdom.

As an integral part of the UK food surveillance scheme, routine food sampling is undertaken by officers at local councils. One of the main purposes of the food sampling programme is to detect food contaminants before they are sold to the public. This paper investigated the current UK food sampling activity undertaken by the local Environmental Health Departments and examined the effectiveness of the food programme. A national survey was undertaken by means of a questionnaire sent to 439 UK local authorities and a response rate of 39.2% (172 LAs) was achieved. Thirty-nine per cent of replies indicated that ensuring food safety and hygiene was the most important aim of sampling. Less than half of the returns suggested that their food programmes contributed to the prevention of foodborne illness. However, over three-quarters agreed that the current food sampling system could be improved upon. This study concluded that current UK food sampling is marginalized by financial constraints. In order to design an effective routine food programme, it should be based on an overall co-ordinated approach from local to European levels. Future work towards a statistically validated approach to the design will improve the effectiveness of food sampling programme.

Modelling the Brain for Rotational Loading: Shear Effects and Other Complications.

This study considers modelling the brain due to rotation of the skull where, at lower frequencies, the shear property of the material is important. Investigations reported here cover the effect of elastic and viscoelastic (lossy) cerebral material, the effect of the Falx protruding into the brain, the gap around the Falx and the brain filled with non viscous fluid in addition to different models of the Falx with bending or membrane stiffness. Analytical benchmark formulations are also described for the simple 2D plane strain in a cylinder produced by a half-sine rotation on the outer periphery which allows numerical (Finite Element) models to be validated. The results show the importance of the material properties, duration of loading and amplitude of loading as well as the influence of the partition. The results are shown for predicted maximum Principal strains in the models, as this may well be indicative of whether damage of the brain tissue occurs.

The effect of dietary crude protein on growth, ammonia concentration, and litter composition in broilers.

An experiment was conducted to determine the effect of diets with reduced CP and supplemental amino acids on broiler performance, N excretion, litter characteristics, and equilibrium NH3 gas concentration. Results suggest that reducing CP (and lysine) below 241 g/kg (13.7 g/kg lysine) in the diets fed during the first 3 wk may slightly increase feed:gain and therefore may not be advisable. During the period 22 to 43 d of age there were no significant differences in weight gain and BW at 6 wk of age when reducing CP from 215 g/kg (11.5 g/kg lysine) to 196 g/kg (11.3 g/kg lysine), but feed intake and feed:gain ratio increased. However, reducing CP did cause equilibrium NH3 gas concentration and litter N to decline by 31 and 16.5%, respectively. Both of these advantages will improve air quality within the housing facility and possibly reduce heating costs during winter associated with higher ventilation rates required to reduce elevated NH3 gas concentrations.

The effect of dietary protein and phosphorus on ammonia concentration and litter composition in broilers.

An experiment was conducted to determine whether broiler litter concentration of N and P and equilibrium NH3 gas concentration can be reduced by reducing dietary CP and P levels and supplementing with amino acids and phytase, respectively, without adversely affecting bird performance. Equilibrium NH3 gas concentration above the litter was measured. The experiment was divided into a starter period (1 to 21 d) and grower period (22 to 42 d), each having two different CP and P levels in a 2 x 2 factorial arrangement. The CP treatments consisted of a control with a mean CP of 204 and 202 g/kg for starter and grower periods, respectively, and a low CP diet with means of 188 and 183 g/kg, respectively, but with similar amino acid levels as the control. The P treatments comprised starter and grower control diets containing means of 6.7 and 6.3 g/kg P, respectively, and low P treatment means of 5.8 and 5.4 g/kg P supplemented with 1.0 g/kg phytase. Reducing starter diet CP by 16 g/kg reduced weight gain by 3.5% and, hence, body weight at 21 d of age, but did not affect feed intake or feed efficiency. Reducing P did not affect feed intake and weight gain, but improved feed efficiency by 2.0%. Responses in feed intake and efficiency to CP depended on the level of dietary P. For the grower period there were no significant differences in feed intake, weight gain, and feed efficiency, nor in body weight at 42 d of age, after correcting for 21-d body weight, between CP and P treatments. There were significant (P < 0.001) reductions in litter N and P concentrations, but not equilibrium NH3 gas concentration, moisture content, or pH, for low CP and P diets. Mean equilibrium NH3 gas concentration was 63 ppm. Litter N concentration was reduced 16.3% with the low CP diets, and litter P by 23.2% in low P treatments. The results suggest that dietary manipulation shows merit for reducing litter N and P concentrations while maintaining acceptable production performance from broilers.