A look back at the millenium development goal of reducing #maternal mortality - studies from 2004 and 2009 - African Population Studies Vol.19 No.12 & Journal of Postgraduate Medicine Vol.55 No.1

The Guardian recently published an article on a new report compiled by a number of health organizations such as WaterAID and WHO that calls for action on water sanitation and hygiene care that could greatly reduce maternal deaths in Africa. The article notes that goal number 5 of the United Nation's millenium goals between 1990 and 2015 was to reduce the maternal mortality ratio. The Guardian notes that although rates have been improving in some countries, low-income and middle-income countries have yet to succeed in reaching this goal. The Guardian notes that among these countries are Tanzania and South Sudan.

Several articles on Bioline have discussed this issue in relation to different countries. Among them is an article from ten years ago in African Population Studies vol.19 no.12 named: "Maternal and Child Health among the Urban Poor in Nairobi, Kenya" by Monica Magadi. This study takes a look at the health care provided to infants and their mothers in the slums of Nairobi, and Kenya. Magadi notes that although it is important to consider the care and quality of services provided to the infants and their mothers, their overall health prior is equally as important. Unfortunately, many of these deaths occur as a direct result of diseases and malnutrition from lack of services and necessities such as food, shelter, health care, nutrition and water sanitation. Diarrhea is also prevalent in Nairobi, especially for people living in slums. Only 53 per cent of slum residents have access to safe drinking water. In the three major slums in Nairobi, it was reported that most water does not go directly to their houses but instead is purchased from informal traders or taken from communal water points. These conditions make for poor health of both the children and their mothers, and Magadi notes that they require urgent attention.

Another article, "An autopsy study of maternal mortality: A tertiary healthcare perspective" by Panchabhai et al. in the Journal of Postgraduate Medicine vol.55 no.1, discusses this millenium goal in relation to India. Panchabhai et al. note that many maternal deaths in India are attributable to sepsis, infection and hemorrhage. This study evaluates the maternal deaths that occurred between January 1998 to December 2006. Tuberculosis, malaria and meningitis were amongst the cases of deaths.

These articles highlight the need for action to be taken in preventing more maternal deaths, particularly in developing countries.

You can find more articles on Bioline on maternal mortality here.

Traumatic Events and Symptoms of Post-traumatic Stress Disorder Amongst Sudanese Nationals, Refugees and Ugandans in the West Nile- African Health Sciences, Vol. 4, No. 2, 2004

While some might find the juxtaposition between pen and conflict abnormal, others such as the five Sudanese writers in the article: "I write to expel my fear - storytelling in the Sudans", published by The Guardian, would argue it to be the norm. It is suggested by the author of the article, Bhakti Shringarpure, that the use of writing is not only a way of connecting with others that are feeling the mental anguish of war, however, writing is also - in a sense - therapeutic. It allows for one to "expel [...their] fears" and connect with others feeling the emotional burden of a conflict-ridden society.

On the other hand, while it is important to understand the grieving process of such individuals and not to take lightly, Karunakara et al. study the issue of mental illness and conflict within Sudan, Africa, in their article "Traumatic Events and Symptoms of Post-Traumatic Stress Disorder Amongst Sudanese Nationals, Refugees and Ugandans in The West Nile" vol. 2 no. 4 of African Health Sciences, in hopes of better understanding how conflict and mental illness are connected. Further, they compare the traumatic experiences of Sudanese nationals and the association it has with post-traumatic stress disorder (PTSD) in three population groups in Northern Uganda and Southern Sudan.

The methods used in this study were that of both household and individual level data that was collected through a single-round cross-sectional demographic survey within the sub-countries of Yivu, Odupi and Midia, in the Northern Uganda District Arua, and Otogo, in the Yei River district of Southern Sudan. The residents were then categorized on the basis of citizenship and refugee status (read: Ugandan nationals, Sudanese nationals, or Sudanese refugees). The random sample population consisted of 3,323 adults, with a mean age of 30 years, 75 percent of which were females from 1,831 national and refugee households.

Results indicated that Sudanese refugees experienced and witnessed the highest number of traumatic events. While the witnessing of traumatic events significantly increased the chances of the establishment of PTSD in surveyed populations. Gender, age, education, as well as occupation played a significant role in the development of PTSD symptoms in patients studied. The population prevalence of PTSD was estimated to be 48% for Sudanese nationals, 46% for Sudanese refugees, and only 18% for Ugandan nationals--significantly lower than the Sudanese.

In summary, symptoms of PTSD in war-effected Sudanese populations can partly be explained by the exposure of traumatic events. While the prevalence of violence and symptoms of PTSD in refugee populations concretize the need for better overall protection and security in refugee settlements. The need is at its greatest for humanitarian agencies working in these re-settlement populations to consider the provision for mental services.

For this journal and others from this issue, click here. 

Oral mouthwashes could degrade acrylic resin used in orthodontic appliances such as braces - Brazilian Journal of Oral Sciences Vol.13 No.3

The latest issue of the Brazilian Journal of Oral Sciences includes "Influence of mouthwashes on the physical properties of orthodontic acrylic resin" by Collares et al. This article could be of particular interest to both people in the orthodontics industry and consumers of orthodontics products. Collares et al. say that mouthwash could help remove biofilm on removable orthodontic appliances such as wires, clasps and springs, as well as acrylic baseplates. But how does mouthwash affect the acrylic resin in these parts in the long-term? This is the question that Collares et al. aim to answer in their study.

Orto Clas brand acrylic resin was used in this experiment. It was self-cured according to the manufacturer's instructions. All samples used in the study were ensured to have a smooth and flat surface, without roughness or tested for microhardness. Five brands of mouthwash were tested: Plax Classic, Plax alcohol-free, Listerine Cool Mint, Periogard and Periogard alcohol free were used. The Knoop microhardness of each acrylic resin was measured using a hardness test in which a 15 gram load was used on each acrylic resin sample for 10 seconds. Afterward, they were immersed in the different mouthwashes for several different time periods. They were then washed with distilled water for 10 seconds each and dried with compressed air for one minute. The hardness test was performed again, and the measurements of the softening of acrylic resin were recorded as the percent difference between the final and initial Knoop hardness.

Roughness, colorimetric analysis, mouthwash pH and statistical analysis were also measured in the test. Among the results indicated, Collares et al. found that after 7 days, all the mouthwashes decreased the surface microhardness. Plax alcohol-free mouthwash was found to have no difference on acrylic resin that was immersed between 1 hour and 7 days. The results also suggest that acrylic resin immersed in Listerine showed decreased microhardness after all time periods. In terms of surface roughness, the results indicated that all mouthwashes increased surface roughness. However, acrylic resins immersed in Plax alcohol-free mouthwash and Listerine mouthwash showed significantly higher measurements of surface roughness after 12 hours than the other mouthwashes.

Collares et al. conclude that in order for biofilm to form on orthodontic appliances, a minimum measurement of 0.2mm of surface roughness has to occur on the appliances. Listerine and Plax alcohol-free were shown to increase surface roughness past this measurement. This roughness could cause discomfort in the patient and allow biofilm and microorganism colonization to occur. Collares et al. also note that acrylic resin immersed in Periogard had the highest softening values over time, potentially due to its alcohol base. The alcohol could be absorbed by the resin over time and change the structure of the polymer. It was also noted that Listerine caused high values of softening on acrylic resin over time. Collares et al. note that this could be because of the essential oils in Listerine that are said to help antibacterial activity. However, after 7 days of immersion in Listerine, acrylic resin was shown to have an increase in hardness and decrease in softening. Collares et al. suggest that this may be because of the ethanol in the Listerine.

The study concludes that hardness, colour and roughness affects the acrylic resin in orthodontic appliances, therefore it is important for orthodontists to notify their patients of these possible changes when establishing a hygiene care routine.

You can find more articles from this issue here.

A Ricardian Analysis Of The Impact Of Climate Change On South American Farms - Chilean Journal of Agricultural Research, Vol. 68 No. 1

"Some people said it was the end of the world...", said Wenceslao Mamio, chief of the Capiana community (Jones, Sam, The Guardian). While it was not the end of humanity, it was the beginning of lost dreams, lost lives, and lost hope for the people that reside along the river Beni, Bolivia, in South America. 

Recently, Bolivia has witnessed an immense amount of rain - breaking the previous record from more than 60 years prior. The Guardian has published an article called "Bolivia after the floods: the climate is changing; we are living that change" by Sam Jones, which links the torrential downpours to climate change, with emphasis on the socioeconomic impact it has had, and in effect, has "marginaliz[ed]" the indigenous peoples even further. 

To understand this issue of global warming and the overall socioeconomic impact it has on residents, not just within Bolivia, but in all of South America, S. Niggol Seo and Robert Mendelsohn in their article "A Ricardian Analysis of The Impact of Climate Change On south American Farms", break the numbers down more extensively. Specifically, the purpose of the study was to gather data in order to estimate the severity climate change has had on South American agriculture, taking into account farmer adaptations. 

The methods used was a Ricardian analysis of 2300 farms to dig further into the effects climate change has had on land values. In order to predict climate change for this century, Seo and Mendelsohn used three Atmospheric Oceanic General Circulation Models (AOGCM): the Canadian Climate Centre, the Centre For Climate Research, and the Parallel Climate Model. Several econometric specifications were tested and five separate regressions were run for all farm types: small household farms,large commercial farms, rain-fed farms, as well as irrigated farms.

Results of the study were staggering: Seo and Mendelsohn found that the increase in temperature and rainfall would predictably decrease land values over time. Under the Canadian Climate Centre scenario, South American farmers will lose on average 14% of their income by the year 2020, 20% by 2060, and 53% by 2100. While using the less severe Centre for Climate System Research scenario, the loss of income was recorded to be only half the above percentages. 

Yet, while viewing the farms using the mild and wet Parallel Climate Model scenario, it is estimated that they will lose only small amounts of income. Further, both small household farms and large commercial farms are under extreme vulnerability to global warming. Small farms are vulnerable to warming, whereas the latter is vulnerable to the increase in rainfall. It is suggested that both rain-fed and irrigated farms will lose their incomes by more than 50% by 2100, with slightly more damaged being done to irrigated farms. 

For this journal and others from this issue, click here.

Soil characterization in contrasting cropping systems under the fast track land reform programme in Zimbabwe - African Journal of Food, Agriculture and Development Vol.11 No.3

A recent article by The Guardian on land management in sub-saharan Africa specifically addresses the need for adequate soil care in order to better overall agricultural crop yields in the long-term. What's interesting is that the author underscores the total economic losses regionally by the improper care of soil within this region to gain a more fluid insight as to the need of a more established land management system altogether.

To understand this issue further, Shoko and Moyo in their article "Soil Characterization In Contrasting Cropping Systems Under The Fast Track Land Reform Programme In Zimbabwe", study the the soil found in Zimbabwe (sub-sarahan Africa) at the molecular level in hopes of better understanding the health of the soil via the levels of molecules found within. The article is in the African Journal of Food, Agriculture and Development vol.11 no.3. 

The research was conducted by studying three contrasting cropping systems in Zimbabwe: communal areas, large-scale resettlement (A2) and small-scale systems (A1), and all systems were found within the province of Manicaland. 

The soil samples were collected during the off seasons of 2006 to 2008 and the following soil sample characteristics were as follows: Ca, Mg, K, Zn, pH were tested to be in the soil, as well as variants of organic matter. Yet there were significant differences between the soil chemical properties and production systems. Calcium, magnesium, and potassium levels were generally low in all three production systems, due to overall lower than normal pH levels found in the soil. 

A2 farms were found to have the highest (p< 0.05) Ca, Mg, and K, while the communal area had the lowest levels of soil organic matter content. That said, the soil organic content in A2 (large-scale) farms are very much able to sustain plant growth. The reason for this could be, as suggested by Shoko and Moyo, because of better land management practices, such as liming and fertilization. Suggesting that there may be a need for both the communal and A1 (small-scale) farmers to apply organic matter to boost SOM in their fields. 

With that said, the most optimum levels of organic matter for the region of Zimbabwe are between 1.5% - 5%, with results of the study showing the pH of the soil measuring between 5.0 - 6.8 (slightly acidic) in all three production systems. Yet, the acidity of the soil being significantly stronger in communal areas at the depth of 0-30cm, resulting in a negative yield of maize and groundnut within those areas. In both the A1 and A2 farms, it is suggested that the soil acidity levels could sustain the production of tobacco and sunflower and generally, there is a need for farmers in all three production systems to lime their soils and improve their organic matter through the application of crop residues and cattle manure. 

For this journal and others from this issue, click here.

Predicting small mammal and flea abundance using landform and soil properties in a plague endemic area in Lushoto District, Tanzania - Tanzania Journal of Health Research Vol. 16 No. 3

Recently, the World Health Organization (WHO) has reported a concentrated outbreak of Bubonic Plague centred off the coast of Africa in Madagascar. While there are only 40 confirmed cases, WHO has stated that it has the potential of spreading rapidly, and that two cases have already been confirmed in the regions capital of Antananarivo. Since the population of Antananarivo is so dense, this creates a problematic situation for overall containment of the outbreak, creating higher than average risks of contraction and overall rapid spread of infection. 


Prior articles such as: "Predicting small mammal and flea abundance using landform and soil properties in a plague endemic area in Lushoto District, Tanzania" by Meliyo et al. have included studies related to the contraction of Bubonic Plague that may help gain more insight into the life cycle of this illness. More specifically, the purpose of this study was to investigate the correlations between landforms and associated soil properties, and small mammals and fleas in the West Usambara Mountains, Tanzania, to determine whether plague persistence in natural foci has a root cause in soils. 

The methods used in this study were of standard field surveys, paired with Geographical Information Systems (GIS) techniques, in order to examine landforms and soil characteristics. Soil samples were analyzed more closely in a laboratory for physico- chemical properties, and the small mammals were trapped on pre-established landform positions, for which they were identified at genus/species level. Fleas were then meticulously picked off the mammal and counted accordingly. 

It is important to note that the relation between landforms and soil data was done using ArcGIS Toolbox functions. Descriptive statistical analysis and the correlation between landforms, soils, small mammals, and fleas were gathered and established by the use a generalized linear regression model (GLM), operated in R statistics software. 

Results showed that landforms and soils influenced the abundance of small mammals and fleas and their overall spatial distribution and that the increase of overall population of small mammals and fleas increased with altitude and elevation. The landform-soil model shows that phosphorus found within the soil, slope and elevation were significant predictors in explaining abundance in small mammals. Fleas' abundance and spatial distribution were strongly linked and influenced by hill-shade, phosphorus, and base saturation. 

In summary, this study suggests that there is a strong correlation between landforms and soils, and small mammals and fleas' overall abundance and could help explain further the dynamics associated with bubonic plague in the region. 

For this journal and others from this issue, click here.

For more on the plague epidemic in Madagascar, click here. 

Ninety-five per cent of women in Hatcliffe, Zimbabwe have faced gender-based violence - African Journal of Reproductive Health Vol.18 No.1 #WHO

On November 21, 2014, the World Health Organization (WHO) released a story on the worldwide need to address violence against females, both young and old.

The African Journal of Reproductive Health, in particular, has several articles addressing physical and sexual abuse against women and girls, as well as issues on child brides and spousal abuse. A recent article in vol.18 no.1 called "Gender Based Violence and its Effects on Women’s Reproductive Health: The Case of Hatcliffe, Harare, Zimbabwe" by Mukanangana et al. explores how violence against women can affect their reproductive health. According to Mukanagana et al. in their article, gender-based violence (GBV) is caused by existing traditional power norms and ways of thinking towards women that can prove to be detrimental to a woman's health. 

WHO says that one in three women globally will experience sexual violence by partners and non-partners in their lifetime. Yet, how will GBV affect women's health? Mukanagana et al. aim to uncover this by conducting a study in Zimbabwe. Women from Hatcliffe in Harare Province in Zimbabwe, between the ages of 15 and 49 were included in the study. This is because of their reproductive age and their vulnerability at this age to GBV. Both qualitative and quantitative research was conducted with group discussions and surveys.

The results indicated that 95 per cent of women in Hatcliffe have faced physical abuse in their lifetime. 66 per cent of abused women were between the ages of 25 and 39 years old. 47 per cent of women who were physically abused were married. Results also indicated that education level was related to the vulnerability of physical abuse. 77 per cent of women who were physically abused had primary education, while 20 per cent of abused women had secondary education, and three per cent of abused women had higher education levels. The study also provides qualitative interviews and statements from participant and "Victim Friendly" officers.

Mukanagana et al. conclude that GBV is prevalent in Hatcliffe, however there is minimal reporting of these cases and victims are silenced due to economic, cultural and religious factors, as well as factors related to current policies. Counselling and education, as well as information provided to both men and women about gender-based violence could help break this culture of silence. The introduction and implementation of policies are needed in order to protect women and their reproductive health from gender-based violence.    

Dec.1 is #WorldAIDSDay - HIV/AIDS-related stigma and HIV test uptake in Ghana: evidence from the 2008 Demographic and Health Survey

Dec.1 is World AIDS Day. This blog post will be highlighting a recent article on Bioline from African Population Studies called "HIV/AIDS-related stigma and HIV test uptake in Ghana: evidence from the 2008 Demographic and Health Survey" by Novignon et al. in African Population Studies vol.28 no.3.

The researchers note that the effectiveness of the Ghana AIDS commission (GAC)'s testing and counselling policies could be hindered due to stigma, but since the GAC was created in 2001, HIV/AIDS in Ghana has is on a downward trend. For example, the percentage of people diagnosed with HIV/AIDS in 2003 was 3.6 per cent, and in 2005 it dropped to 2.7 per cent.

This study aims to uncover the stigma surrounding HIV/AIDS and whether this stigma affects HIV testing, and whether testing is affected by socio-economics such as education level, sexual behaviour and wealth status.

For this study, data from the 2008 Ghana Demographic and Health Survey was used. The survey is part of population and health surveys done in Ghana in part of a global demographic survey program. Ghana Statistical Service and Ghana Health Service collaborated to administer the survey.

6141 households were surveyed. Participants were men between the ages of 15 and 59 and women between the ages of 15 and 49. The final sample included 1635 men and 1676 women who were sexually active in the past 12 months.

The results indicated that over 69 per cent of women and almost 77 per cent of men knew what HIV/AIDS was and where to get tested. However, only 26.2 per cent of women and 16.8 per cent of men had ever been tested. 

The results also indicated that the majority of survey participants (74.2 per cent of women and 80.3 per cent of men) were willing to care for a relative with HIV/AIDS, but 59.7 per cent of men and 73.1 per cent of women would stop buying from a vendor if they found out the vendor had HIV/AIDS.

Some of the other findings in this study were that the majority of respondents who said they would not care for a relative living with HIV/AIDS had also never been tested for HIV/AIDS themselves. Both men and women participants who had no formal education were less likely to get testing for HIV/AIDS.

The study concludes that despite knowledge of HIV/AIDS in Ghana, testing for the disease is low. Although it is important that people are made aware of the disease, further knowledge and education must be provided in the treatment, prevention and transmission. Accessibility and affordability is needed. Community engagement through campaigns and free counselling is also recommended.