Traditional remedies and other characteristics among human snakebite survivors in Baringo county, Kenya, 2010-2020: a case series.

BACKGROUND: Seeking traditional remedies following snakebites leads to avoidable deaths in rural settings in developing countries. METHODS: In this case series study, we identified and recruited 169 snakebite survivors in Baringo county, a hard-to-reach region in northwestern Kenya, who experienced snakebites from 2010 to 2020 using a snowballing technique. We explored associations between traditional and hospital care in managing snakebites and other characteristics. χ2 tests assessed these categorical differences. RESULTS: Fifty-four (33%) of the survivors used traditional remedies to manage snakebites. The majority (56%) were men and aged >18 y (72%); 59% had low education levels and income. They sourced water from rivers or lakes (93%) and used charcoal as an energy source (74%). These survivors (>67%) resided in households practicing free-range and stall-feeding animal husbandry systems and in houses with thatch roofing or an earthen floor structure. Also, >62% reported muscle tremors, fever and chills, while 80% visited health facilities for further treatment. CONCLUSION: Community sensitization covering the risks of non-effective remedies and escalation of training to traditional healers could improve the speed of referrals in hard-to-reach snakebite hotspots. Medical anthropology studies could explore the enablers of continued use of traditional remedies in snakebite management in rural communities.

Tax incentives for preceptors of nurse practitioner students in Massachusetts: A potential solution.

With a growing population, there is an increasing need for nurse practitioners to improve access to health care. There is currently a shortage of nurse practitioner (NP) preceptors across Massachusetts, making clinical placements difficult and at times unachievable. The lack of NP preceptors has a direct impact on student outcomes, educational programs, and ultimately access to care. The authors explored lessons learned about the national scale of this problem and whether Massachusetts should entertain legislative initiatives similar to other states as a solution. Data were collected from the boards of nursing and the national and state chapters of the American Association of Nurse Practitioners regarding current and pending legislation. State and federal sources and the Massachusetts Association of Colleges of Nursing provided statistical and qualitative data on current and future needs for NP preceptors. States that have successfully passed legislation have awarded tax incentives to NP preceptors, although none of the existing regulations have assessed for their effectiveness in improving preceptor availability. Massachusetts may benefit from legislation to improve NP student access to preceptors; however, incentives related to geographical location may best serve both students and the greater population.

Respiratory viruses, such as 2009 H1N1 influenza virus, could trigger temporal trends in serotypes causing pneumococcal disease.

In order to determine if the novel influenza A(H1N1)pdm09 was associated with temporal trends of main serotypes causing invasive pneumococcal disease (IPD), we studied 384 episodes of IPD in <18-year-old patients from 2007 to 2012. The number of IPD episodes diagnosed during the 2009 pandemic period meant almost one-third of all the episodes diagnosed in the five included influenza periods (51/156). The number of IPD episodes diagnosed during the 2009 pandemic period meant almost one-third of all the episodes diagnosed in the five included influenza periods. Most of them occurred in <5-year-old children. Serotype 1 was the main serotype detected over the period, except for the 2009 pandemic, when it practically disappeared. Seasonality and viral infections could trigger temporal trends of serotypes causing IPD.

Plasmodium infection, anaemia and mosquito net use among school children across different settings in Kenya.

OBJECTIVE: To investigate risk factors, including reported net use, for Plasmodium infection and anaemia among school children and to explore variations in effects across different malaria ecologies occurring in Kenya. METHODS: This study analysed data for 49 975 school children in 480 schools surveyed during a national school malaria survey, 2008-2010. Mixed effects logistic regression was used to investigate factors associated with Plasmodium infection and anaemia within different malaria transmission zones. RESULTS: Insecticide-treated net (ITN) use was associated with reduction in the odds of Plasmodium infection in coastal and western highlands epidemic zones and among boys in the lakeside high transmission zone. Other risk factors for Plasmodium infection and for anaemia also varied by zone. Plasmodium infection was negatively associated with increasing socio-economic status in all transmission settings, except in the semi-arid north-east zone. Plasmodium infection was a risk factor for anaemia in lakeside high transmission, western highlands epidemic and central low-risk zones, whereas ITN use was only associated with lower levels of anaemia in coastal and central zones and among boys in the lakeside high transmission zone. CONCLUSIONS: The risk factors for Plasmodium infection and anaemia, including the protective associations with ITN use, vary according to malaria transmission settings in Kenya, and future efforts to control malaria and anaemia should take into account such heterogeneities among school children.

The effect of nitrogen enrichment on c(1)-cycling microorganisms and methane flux in salt marsh sediments.

Methane (CH(4)) flux from ecosystems is driven by C(1)-cycling microorganisms - the methanogens and the methylotrophs. Little is understood about what regulates these communities, complicating predictions about how global change drivers such as nitrogen enrichment will affect methane cycling. Using a nitrogen addition gradient experiment in three Southern California salt marshes, we show that sediment CH(4) flux increased linearly with increasing nitrogen addition (1.23 µg CH(4) m(-2) day(-1) for each g N m(-2) year(-1) applied) after 7 months of fertilization. To test the reason behind this increased CH(4) flux, we conducted a microcosm experiment altering both nitrogen and carbon availability under aerobic and anaerobic conditions. Methanogenesis appeared to be both nitrogen and carbon (acetate) limited. N and C each increased methanogenesis by 18%, and together by 44%. In contrast, methanotrophy was stimulated by carbon (methane) addition (830%), but was unchanged by nitrogen addition. Sequence analysis of the sediment methylotroph community with the methanol dehydrogenase gene (mxaF) revealed three distinct clades that fall outside of known lineages. However, in agreement with the microcosm results, methylotroph abundance (assayed by qPCR) and composition (assayed by terminal restriction fragment length polymorphism analysis) did not vary across the experimental nitrogen gradient in the field. Together, these results suggest that nitrogen enrichment to salt marsh sediments increases methane flux by stimulating the methanogen community.

Implementing school malaria surveys in Kenya: towards a national surveillance system.

OBJECTIVE: To design and implement surveys of malaria infection and coverage of malaria control interventions among school children in Kenya in order to contribute towards a nationwide assessment of malaria. METHODS: The country was stratified into distinct malaria transmission zones based on a malaria risk map and 480 schools were visited between October 2008 and March 2010. Surveys were conducted in two phases: an initial opportunistic phase whereby schools were selected for other research purposes; and a second phase whereby schools were purposively selected to provide adequate spatial representation across the country. Consent for participation was based on passive, opt-out consent rather than written, opt-in consent because of the routine, low-risk nature of the survey. All children were diagnosed for Plasmodium infection using rapid diagnostic tests, assessed for anaemia and were interviewed about mosquito net usage, recent history of illness, and socio-economic and household indicators. Children's responses were entered electronically in the school and data transmitted nightly to Nairobi using a mobile phone modem connection. RDT positive results were corrected by microscopy and all results were adjusted for clustering using random effect regression modelling. RESULTS: 49,975 children in 480 schools were sampled, at an estimated cost of US$ 1,116 per school. The overall prevalence of malaria and anaemia was 4.3% and 14.1%, respectively, and 19.0% of children reported using an insecticide-treated net (ITN). The prevalence of infection showed marked variation across the country, with prevalence being highest in Western and Nyanza provinces, and lowest in Central, North Eastern and Eastern provinces. Nationally, 2.3% of schools had reported ITN use >60%, and low reported ITN use was a particular problem in Western and Nyanza provinces. Few schools reported having malaria health education materials or ongoing malaria control activities. CONCLUSION: School malaria surveys provide a rapid, cheap and sustainable approach to malaria surveillance which can complement household surveys, and in Kenya, show that large areas of the country do not merit any direct school-based control, but school-based interventions, coupled with strengthened community-based strategies, are warranted in western and coastal Kenya. The results also provide detailed baseline data to inform evaluation of school-based malaria control in Kenya.

Air pollution in Sibenik before and after the shutdown of major local industries.

This study compares the values of the critical air pollution indicators (including-sulphur dioxide, smoke, total deposited matter, gaseous fluorides, fluorides, and manganese in suspended particulates and deposited matter) measured in Sibenik for years 1989/90 when the industry was working with full capacity, and for years 1994/95 and 1995/96 when most plants were shut down due to Serbian aggression. The purpose of this study was to assess the influence of industrial air pollution sources on the air quality in Sibenik. The pollution indicators show that the air in Sibenik was excessively polluted until the major industries were shut down as a result of Serbian aggression in Croatia, while it is only slightly polluted today. These findings prove the dominant influence of industrial emissions on the air quality in Sibenik.