The Human Immunodeficiency Virus (HIV) epidemic remains a major global public health problem, with sub-Saharan Africa (SSA) at its epicentre. Despite the use of antiretroviral therapy (ART) to reduce new infections and deaths, SSA reports the highest HIV incidence, constituting two-thirds of global new infections. Cameroon is one of SSA countries where HIV care decentralization is enforced as a national policy but follow up of people living with HIV (PLWH) is provider-oriented, with limited patient involvement in clinical monitoring. The purpose of this dissertation was to explore predominant barriers and facilitators influencing ART adherence and identify effective interventions enhancing ART adherence across SSA. Furthermore, we sought to assess the prevalence and predictors of ART non-adherence among PLWH, and factors influencing non-adherence among PLWH who have experienced ART non-adherence in Cameroon. We conducted a comprehensive systematic review and meta-analysis on studies examining barriers to ART adherence and interventions boosting adherence. Forty-five studies were selected (30 for narrative synthesis and 15 for meta-analysis). Identified barriers and facilitators to ART adherence were categorized into seven principal factors: patient-related, health system-related, medication-related, stigma, poor mental health, socioeconomic and socio-cultural-related factors. Adherence-enhancing interventions encompassed counselling, incentives, mobile phone short message service, peer delivered behavioral intervention, community ART delivery, electronic adherence service monitoring device, lay health worker lead group intervention and food assistance. The meta-analysis revealed a statistically significant difference in ART adherence between intervention and control groups (pooled OR=1.56, 95%CI:1.35 - 1.80, p=<0.01). Using a cross-sectional study of adult PLWH in HIV treatment centres in Cameroon, we explored the prevalence and predictors of ART non-adherence. A total of 451 participants with mean age 43.42 years (SD: 10.42), were enrolled. Overall, ART non-adherence was 37.78%. Reasons for missing ART include forgetfulness, business and traveling without drugs. Significant factors associated with ART non-adherence include age, education, and alcohol consumption. In a qualitative study of 43 adult PLWH who had experienced ART non-adherence, adherence barriers included those related to patient, medication, health service, stigma, use of alternative treatment, resource limitation, environmental/social, and political instability. Adherence facilitators included social support, aligning treatment with patient’s daily routines, use of reminders, health sector/caregiver support, and awareness of HIV status/ART knowledge. To harness full potential of ART and mitigate HIV burden in SSA countries, stakeholders engaged in HIV management must recognize and integrate barriers, facilitators, and adherence-enhancing interventions when formulating policies or crafting treatment strategies. Continuous information provision and unflinching support both from patients’ families and caregivers are needed to improve adherence. Future studies focusing on specific underrepresented demographics - HIV-infected children, adolescents, and pregnant women in SSA are needed to uncover appropriate barriers, facilitators and interventions tailored to each group’s unique needs. Other studies focusing on assessing long-term non-adherence trends and determinants using larger samples of PLWH in many regions are necessary. Also, studies using both in-depth and focused group discussions, and quantitative approaches are required to uncover the ART non-adherence-related burden.

Thesis advisor: Liane Young / Thesis advisor: Hiram Brownell / When (moral) psychologists make a claim (e.g., “Participants judged X as morally worse than Y”), how many participants are represented? Such claims are often based exclusively on group-level analyses; here, psychologists often fail to report, or perhaps even investigate, how many participants judged X as morally worse than Y. More troubling, group-level analyses do not necessarily generalize to the person-level. This dissertation first investigates a moral cognition hypothesis about the relation between perceptions of relationship obligations and moral evaluations of helping behavior. It is found that people, on average, judge agents who help strangers as more morally good than agents who help family members, but people also judge agents who help strangers instead of family members as less morally good than agents who help family members instead of strangers. Second, methodological issues with these studies are assessed, fixed, and thus the original psychological effect is retested with better experimental designs, measures, and analyses. Third, it is discovered that the moral cognition hypothesis consistently describes the psychology of only a minority of participants. Moreover, it is discovered that most psychologists misinterpret typical group-level analyses as revealing how prevalent a psychological phenomenon is. Finally, a set of simple and flexible methodological and statistical options are offered to better align typical psychological hypotheses with appropriate analyses, enabling researchers to confront this “group-to-person generalizability” problem in their own work. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Psychology.

Yes / Child undernutrition is a key public health issue that both causes and contributes to disease and death. Undernutrition accounts for 45% of under-five deaths globally most of which occur in Low- and Middle-income countries (LMIC). Malnutrition has a substantial and long-lasting effect on individuals, families, communities and the entire nation. This study aimed to assess the prevalence and determinants of undernutrition in under-five children in Nigeria. Methodology: This systematic review was done following the Cochrane library guidelines. A search of literature written in English language and published between 2000 and 2022 was done using PubMed, CINAHL, MEDLINE and ProQuest databases. The initial search resulted in 760 studies. These were exported to End note version 9 to remove duplicates. Titles and s were screened for studies that met the inclusion criteria. Finally, 11 studies that met the inclusion criteria were thoroughly assessed and data that were relevant to this systematic review were captured. The study findings were analyzed using descriptive statistics. Results: The prevalence of undernutrition was between 1.0% and 43.3%. The highest prevalence of underweight, wasting and stunting were 43.3%, 29.3% and 41%, respectively. Factors associated with undernutrition were age, sex, birth order, recent acute diarrhoea and acute respiratory infection, maternal literacy level, maternal income <$20 and socio-economic class among others. Conclusion: Under-five undernutrition is a huge public health issue in Nigeria. Prevalence of undernutrition varies widely across geo-political zone with a myriad of associated risk factors. Multi-level and multidisciplinary interventions are required to sustainably address the determinants of under-five undernutrition.

No / Background  Vitiligo is an acquired, idiopathic, and worldwide common depigmentation disorder with an estimated prevalence from 0.1 to 8%. These numbers are based on clinical population studies and field research examining inhabitants of geographically enclosed areas. Our aim was to collect all available data on the prevalence of vitiligo in the general population, paying particular attention to children/adolescent groups and adults. Materials and methods  Screening of available literature and online databases using several key words. Results  We found more than 50 studies that used several methods and subgroups of the general population. The prevalence of vitiligo ranges from 0.06 to 2.28%, whereas this was 0.0–2.16% in children/adolescents populations. Conclusions  The often cited prevalence of 8% could not be confirmed after excluding clinical patient populations. Accordingly, the worldwide prevalence of vitiligo ranges between 0.5 and 2%.

The main aim of this thesis is to analyse the impact of HIV/AIDS on the reproductive behaviour of population of South Africa, its four racial groups and its nine provinces since the half of 1980's. Before the analysis of the impact of HIV/AIDS on reproductive behaviour was made, it was shown how big the problem of HIV/AIDS is in South Africa. The HIV incidence and prevalence were used for this purpose. The impact of HIV/AIDS was noticeable from the comparison of levels of fertility between HIV positive and negative women. The impact of HIV/AIDS on reproductive behaviour was further assessed using the decomposition methods and the statistical and epidemiological indicator called population attributable change. The results of analyses revealed the exceptional position of South Africa between other African countries that suffer from HIV/AIDS as well. A regression analysis showed that the growing prevalence of HIV increases the overall level of fertility. At the end of the thesis the projection of fertility till 2030 was made to illustrate the theoretical development of fertility provided that nobody become infected with HIV since the beginning of 2010.

La résistance aux antibiotiques demeure un problème majeur de santé publique particulièrement dans les pays en voie de développement (PVD) où les conditions d’hygiène sont encore précaires et où l’utilisation des antibiotiques est souvent abusive et très peu contrôlée. Cette thèse a pour objectif principal d’étudier la prévalence, la circulation et la caractérisation génétique des bactéries multirésistantes (BMR) dans un PVD, le Burkina Faso. Ce travail permet de mieux comprendre la propagation de ces BMR dans ce pays et de donner des informations indispensables pour les services de santé publique. Dans cette région, c’est la première étude du genre et cette thèse représente donc un travail original et informatif. A partir d’une revue de la littérature réalisée sur la problématique de l’émergence des BMR en Afrique de l’ouest, les objectifs spécifiques sont : i) d’étudier la prévalence et la caractérisation phénotypique et génotypique des bêta-lactamases à spectre élargi (BLSE) chez les entérobactéries isolées en portage et dans les processus infectieux ; ii) d’évaluer la sensibilité des entérobactéries aux carbapénèmes ; iii) de documenter la prévalence du portage nasal de Staphylococcus aureus (SAUR) résistant à la méticilline (SARM) ainsi que d’effectuer la caractérisation moléculaire les isolats de SAUR. Les isolats ont été prélevés par les services de santé publique au sein des 3 CHU du Burkina et ont été remis en culture au laboratoire de bactériologie du CHU de Montpellier [un total de 594 souches, 522 entérobactéries (214 en portage et 308 dans les processus infectieux) et 72 SAUR]. L’identification des espèces bactériennes repose sur la spectrométrie de masse MALDI-TOF. L’évaluation de la sensibilité aux antibiotiques s’appuie sur la méthode de diffusion en milieu gélosé. Les BLSE et les carbapénémases chez les entérobactéries sont identifiées par méthodes moléculaires (PCR et séquençage) et la caractérisation génétique des isolats de SAUR par une technique de puce à ADN. Au Burkina Faso, les points importants sont : des taux très élevés en portage et dans les infections d’entérobactéries sécrétrices de BLSE en hospitalier et en communautaire; les antécédents de consommation d’antibiotiques ou d’hospitalisation sont des facteurs de risque de portage ; par les isolats BLSE, Escherichia coli est l’espèce prédominante ; la majorité des BLSE sont des CTX-M-15, suivi de CTX-M-14, 27 et SHV-12 ; l’étude des phylogroupes d’E. coli suggère une expansion des gènes CTX-M-15 d’origine plasmidique et non liée à une épidémie de clone ; des isolats d’E. coli producteurs de carbapénémase OXA-181 avec un support génétique plasmidique de type IncX3 sont identifiés. On observe un taux de portage nasal de SAUR classique avec une très faible prévalence de SARM ; on note dans une forte proportion des gènes de virulence (Leucocidine de Panton Valentin et du facteur EDIN) parmi les SAUR en portage constituant des facteurs de risques de gravité lors des infections ; l’analyse génétique des isolats de SAUR montre une grande diversité de clones. Les études de prévalence et de génétiques apportent des informations fondamentales pour l’épidémiologie des BMR, base indispensable pour appréhender la lutte et le contrôle de ces organismes pathogènes résistants. En conclusion, ces premières études réalisées au Burkina permettent de définir les perspectives de recherche et les stratégies à développer pour le contrôle l’émergence et la diffusion de ces BMR. / Antibiotic resistance is a major public health issue, particularly in developing countries where health conditions are still inadequate and antibiotic use is often unjustified and not properly regulated. The main objective of this thesis was to study the prevalence, spread and genetic features of multi-resistant bacteria (MRB) in Burkina Faso, a developing country. This work allows better understanding MRB spread in this country and gives essential information for the development of public health policies. This is the first study in this region and this thesis is therefore an original and informative work. Starting from a review of the literature data on the issue of MRB emergence in West Africa, the specific objectives are: i) to study the prevalence and to characterize phenotypically and genotypically the extended-spectrum beta lactamases (ESBL) in enterobacterial samples isolated from healthy carriers and during the clinical phase of infection; ii) to assess the sensitivity of such enterobacterial samples to carbapenem drugs; iii) to document the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and to molecularly characterize all S. aureus isolates. Samples were collected by the public health services of three Burkina Faso University Hospital Centers (UHC) and were then cultured at the Laboratory of Bacteriology of Montpellier UHC [total n= 594 isolates of which 522 were Enterobacteriaceae isolates (214 from healthy carriers and 308 from patients with clinical infection) and 72 S. aureus isolates]. Bacterial species were identified by MALDI-TOF mass spectrometry. Antibiotic sensitivity was tested using the agar diffusion method. ESBL and carbapenemases in enterobacterial isolates were identified using molecular methods (PCR amplification and sequencing). S. aureus isolates were genetically characterized by using DNA arrays. This work shows that in Burkina Faso, ESBL-producing enterobacterial strains are frequent both in healthy carriers and hospitalized patients and that previous antibiotic use or hospitalizations are risk factors for colonization. Among the ESBL-producing enterobacterial strains, Escherichia coli was the predominant species and most ESBL-producing isolates were CTX-M-15, followed by CTX-M-14, 27 and SHV-12. The analysis of the E. coli phylogenetic groups suggests a plasmid-mediated spread of CTX-M-15 genes and not linked to an epidemic clone. Moreover, E. coli strains that produce the carbapenemase OXA-181 and with an IncX3-type plasmid have been identified. Concerning S. aureus, the rate of nasal carriage was classical with a low prevalence of MRSA. Among the S. aureus nasal samples, a high proportion of virulence genes (Panton Valentin leukocidin and EDIN) was detected. This constitutes an important risk of severe disease during clinical infection. The genetic analysis of the S. aureus isolates showed great clone diversity. These data are essential for understanding MRB epidemiology in Burkina Faso and represent a base for fighting and controlling resistant pathogens. In conclusion, these first studies carried out in Burkina Faso allow defining the future research perspectives and strategies to be developed for controlling the emergence and spread of these MRB.

This diploma thesis is based on the fifth round of the Childhood Obesity Surveillance Initiative (COSI). This study is lead by World Health Organisation and on this study cooperate European countries including the Czech republic. In the Czech republic the study lead by Institute of Endocrinology in collaboration with practical paediatricians since the year 2008. The fifth round of this study took place in the Czech republic in 2019. We collected anthropometric data and characteristic of family and school enviroment from 2289 children 6,5-7,99 years old. Prevalence of underweight according to cut offs of WHO was 2,88% (2,74-3,02), according to National Anthropological Survey (NAS) was 2,27% (1,84- 2,7) and according to International Obesity Task Force was 1,35% (1,13-1,57). Prevalence of underweight was compared with prevalence of underweight in the last rounds of this study and with prevalence of overweight and obesity. Decrease of prevalence of underweight (WHO) in comparsion with last round of COSI study (2016) was significant in boys. We found non- significant increase in underweight prevalence in girls. A mild non-significant decrease of underweight in all children.. Prevalence of overweight and obesity according to cut offs of WHO was 22,24% (22,16-22,32), according to NAS was 18,92%...

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Master of Science in Biomedical Sciences / Department of Diagnostic Medicine/Pathobiology / Natalia Cernicchiaro / David G. Renter / Cattle shed Shiga toxin-producing Escherichia coli (STEC) in their feces. Therefore, cattle pose a risk to contaminate produce, water, and beef products intended for human consumption. The United States Department of Agriculture Food Safety and Inspection Service consider seven STEC serogroups (O26, O45, O103, O111, O121, O145, and O157) as adulterants in raw, non-intact beef products. Contrary to O157, the frequency and distribution of non-O157 serogroups and virulence genes have not been well-established in cattle. Therefore, the objectives of my thesis research were: 1) to appraise and synthesize data from peer-reviewed literature on non-O157 serogroup and virulence gene prevalence, and 2) to determine the prevalence of seven STEC in feedlot cattle feces across seasons. A systematic review and meta-analysis of published literature were conducted to gather, summarize, and interpret the existent data regarding non-O157 serogroup and virulence gene prevalence in cattle. Random-effects meta-analyses were used to obtain pooled non-O157 fecal prevalence estimates for continents worldwide and meta-regression analyses were conducted to evaluate effects of specific factors on between-study heterogeneity. Results indicated that non-O157 serogroup and virulence gene fecal prevalence significantly differed (P < 0.05) by geographic region, with North America yielding the highest pooled prevalence estimate worldwide. While previous research has demonstrated a strong seasonal shedding pattern of STEC O157, data regarding the seasonality of non-O157 STEC shedding in cattle is very limited. A repeated cross-sectional study was conducted to obtain serogroup and virulence gene prevalence data for the seven STEC in pre-harvest cattle feces, in summer and winter. We found that non-O157 serogroups were recovered in fecal samples collected in both seasons but virulence genes, thus STEC, were rarely detected in summer and undetected in winter. In conclusion, non-O157 STEC are present in cattle feces at very low frequencies, but STEC O103 and O157 significantly differed (P < 0.05) between seasons. Overall, the research described in this thesis greatly contributes to the limited body of data regarding non-O157 serogroup and virulence gene distribution in cattle and provides a better understanding of two major risk factors, season and geographic distribution, associated with STEC fecal shedding in cattle.