Adolescent Nutritional Status and its Association with Village-level Factors in Tanzania Undernutrition is associated with multiple risk factors operating at different levels, from the individual level to household and community levels. Empirical research has shown that contextual or environmental factors influence nutritional status, but very few studies have examined association between these factors and undernutrition among adolescents. This cross-sectional study used a two-level hierarchical nonlinear model to investigate the association between village-level factors and undernutrition (BMI for Age < 5th percentile of the WHO reference) among a sample of adolescents, (n=670) from 28 villages in Kilosa District, Tanzania. Our hypothesis that contextual factors are associated with undernutrition was supported. The odds of undernutrition were more than twice as high among adolescents from villages with low income expenditure values compared to villages with middle or high income expenditure values (OR: 2.28; CI: 1.429,3.645). Similarly, community food insecurity was a significant predictor of undernutrition (OR: 0.63; CI: 0.467, 0.847; p < 0.05). We also observed a positive association between improved nutritional status and dietary diversity. The multilevel analytic framework employed in this study has demonstrated that both individual-level and community-level characteristics are important predictors of undernutrition in adolescents. Our findings have important policy implications in relation to developing targeted intervention strategies that improve village SES and diversified diets, which in turn may contribute to improved nutritional health for adolescents and their household members.

The purpose of this study on Mormon missionaries was to determine the effect of health on missionary activity time, age, sex, months in field, laboring city population, monthly mission cost, living conditions, diet, pre-existing conditions, adequacy of medical care, nativity, effectiveness, emotional health, interpersonal relationships, and motivation and enthusiasm. In addition the research attempted to ascertain the effect of the selected independent factors on ill missionary lost time.As an outcome of the statistical analysis performed on this study's sample the following results were obtained. Respiratory disorders, gastrointestinal difficulties and orthopedic injuries were the most common health problems. Well missionaries were generally older, spent more money, had been out longer in the field and were judged in better emotional health than were ill missionaries. Ill missionaries rated the adequacy of medical care higher than their counterparts. Sex, activity time over a three month period, and laboring city population were not found to be significantly related to missionary health. The average amount of lost proselyting time per missionary over a four-month period was 9.3 hours.

Severe liver and kidney dysfunction are prevalent in 10%-30% of the Southeast Asian population. Dengue virus infection has been reported as a modifiable risk factor for liver and kidney dysfunction, especially among children in Southeast Asia. Epidemiologic studies assessing this relationship are sparse, often failed to include children, and did not adjust for important covariates. Therefore, we evaluated the relationship between dengue virus infection and liver and kidney dysfunction among hospitalized children in Cambodia (n=551). Participants with a serologically confirmed dengue virus infection were categorized according to increasing severity of infection (i.e. dengue fever, dengue hemorrhagic fever, or dengue shock syndrome) using clinical assessment. Laboratory assays were used to assess liver (i.e. albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total protein) and kidney protein levels (i.e. creatinine and urea). Descriptive statistics were used to assess the impact of severity of dengue virus infection on kidney dysfunction. Additionally, descriptive statistics and linear mixed modeling were used to assess the impact of severity of dengue virus infection on liver dysfunction while adjusting for important risk factors. Approximately 75% of all participants had abnormal liver or kidney protein level(s) over the first four days of follow-up. Overall, a negative association was observed between increasing dengue disease severity and albumin (ßadj = -0.08, 95% CI = -0.45 to 0.29), ALT (ßadj = -18.02, 95% CI = -51.59 to 15.55), and AST (ßadj = -7.18, 95% CI = -49.57 to 35.21) protein levels. A positive association was observed between increasing dengue disease severity and total protein levels (ßadj = 7.14, 95% CI = 1.15 to 13.13). While abnormal liver function (increases in ALT and/or AST levels and decreases in albumin and/or total protein levels) is a common clinical finding in dengue infections, we did not find evidence for a significant association with more severe forms of dengue virus infection (i.e. dengue hemorrhagic fever or dengue shock syndrome) and greater liver dysfunction as compared to patients with dengue fever in pediatric populations in Cambodia.

Background: Maternal malnutrition in developing countries is associated with adverse pregnancy and birth outcomes. Malnourished mothers are often faced with additional risk factors as a circumstance of poverty. Supplementary nutrition can improve the outcomes of both mother and infant. Identifying maternal nutritional and socioeconomic risk factors is critical for developing effective interventions. Objective: A secondary analysis to evaluate maternal risk factors associated with poor birth outcomes including pregnancy loss, low birth weight, stunting, and preterm delivery among moderately malnourished pregnant women in Sierra Leone. Maternal risk factors in the analysis are age, education, parity, BMI, MUAC, gestational weight gain, and recent exposure to malaria infection. Methods: Pregnant women were enrolled into a randomized controlled trial when presenting with a MUAC ≤ 23cm (N=1475). Demographic information was collected and women were randomly assigned two receive either a ready-to-use supplementary food (RUSF) or a corn-soy blended flour with an iron and folic acid supplement (CSB +IFA). Anthropometric measurements of height, weight, MUAC, and fundal height were measured every two weeks during pregnancy. Upon delivery the infant was measured for length, weight, MUAC, and head circumference and the mother was measured for MUAC. Infant outcomes of interest included stunting (length-for-age z-score Results: The mean age of enrolled pregnant women was 21.2 years with a mean BMI of 19.78 kg/m2. A total of 33.2% had never attended school. Controlling for weeks on treatment and BMI at enrollment, mothers receiving the RUSF treatment gained a mean 0.49 kg (p2 produced infants that were significantly smaller than women with a BMI ≥ 18.5 kg/cm2 . Similarly, infants born to women with a MUAC(p=0.004) and had a 0.26 cm smaller MUAC (p=0.008) compared to women with a MUAC ≤23. Additionally, for every one unit decrease in maternal MUAC, women has 1.2 greater odds of preterm delivery (p=0.022). Also, women with adequate weekly weight gain gave birth to infants with a 0.37 cm greater mean length (p=0.012), 7.0 g greater mean weight (p=0.030), and 0.08 cm greater mean MUAC (p=0.045) than women with inadequate weight gain. No association was found between recent exposure to malaria at enrollment and poor infant outcomes. Conclusion: In resource poor settings like Sierra Leone with high rates of maternal malnutrition and a high burden of stunting, LBW, and preterm delivery, use of RUSF improved maternal nutritional status but did not impact infant outcomes. The youngest adolescents had the most adverse infant outcomes. Education did not have the expected outcome, indicating other risk factors in this population may play a greater role in infant outcomes. Maternal risk factors of malnutrition such as BMI2and MUACpregnancy, women should be encouraged to gain adequate weight. Young primiparous adolescent are at the highest risk and interventions to postpone motherhood should be priority.

Background: Public health interventions are any activity with the objective of improving human health such as preventing or curing disease, reducing the severity or duration of a disease, or assisting in regaining function after a disease or injury. These interventions are known to be impactful; however, those living with the highest burden of disease such as individuals in low- and middle-income countries have limited money and resources to successfully implement these interventions. Southeast Asian countries are among some of the middle-income countries effected by the lack of affordable interventions. The aims of this study were to assess cost saving and resource limited interventions and understand how sociodemographic and housing characteristics predict knowledge and attitudes of health and social issues. Methods: A scoping review was completed to synthesize literature regarding cost saving and resource limited global public health interventions following the PRISMA ScR guidelines. Data from the Demographic and Health Survey were used to conduct multivariable linear and logistic regression to assess the association of knowledge and attitudes of different health outcomes. Lastly, a pre- post- intervention analysis was conducted to assess the effectiveness of a solar light distribution program in a rural area of the Philippines. Results: The results from the scoping literature review highlighted the importance of handwashing as a cost saving and resource limited Water and Sanitation Hygiene intervention and that more researched should be conducted on interventions associated with access to light and women’s safety. The Demographic and Health Survey study found that there were statistically significant differences in people’s attitudes and knowledge chronic and infectious disease, water and sanitation hygiene and women’s safety based on their sociographic and housing characteristics. Finally, while the study sample size was too small to determine statistical significance of the overall program, participants did report improved outcomes after the solar light intervention in the Philippines. Implications: The findings from these studies highlight the need for additional cost saving and resource limited interventions in Southeast Asia. Continued research needs to be conducted to advance public health in underserved countries and communities.

Ebola virus (EBOV) is a re-emerging zoonotic virus (it is transmitted between animals and humans) that causes acute hemorrhagic fever and a high fatality rate in humans. First reported in 1976 in the Democratic Republic of the Congo (formerly Zaire), the virus is transmitted between humans through direct contact with body fluids of an infected person, causing fever, weakness, diarrhea, abdominal pain, cramping, nausea and vomiting in those affected. There is neither a licensed vaccine nor an approved treatment for Ebola virus in human patients. The reservoir species for Ebola virus is similarly unknown, as many studies have attempted yet failed to isolate living virus from potential candidates. The widely accepted and circulated hypothesis based on preliminary findings of outbreaks past is that bat species, specifically the fruit bat species Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata are potential reservoirs. Recent reports, especially concerning findings from the 2014 Ebola outbreak, have determined that insectivorous bats could similarly be reservoir species. Successful isolation of a live virus from a bat species found through a widened sampling of a variety of bat species would confirm the hypothesis that bats, either fruit or insectivorous, are the reservoir species for Ebola virus.

Disaster, community-wide trauma, and epidemics can have devastating effects on a child’s emotional and psychological wellbeing (Wethington, Hahn, Fuqua-Whitley et al., 2008). The 2014-2015 Liberian Ebola epidemic was detrimental to a country still recovering from a 14-year war. In Liberia alone there were 10,678 confirmed cases and 4,810 Ebola deaths (CDC, 2016). The physical, emotional, and psychological toll of this epidemic was extraordinary. An United States non-profit, Playing to Live (PTL), worked alongside the Liberian government, ministries and local and international organizations to find an innovative solution to the psychological and emotional healing of children and families most affected. This solution used best practices in expressive arts therapy, mental health, and train the trainer models. The purposes of these studies were to evaluate the process of the PTL programming, the outcome effects based on pre-and posttests of child participants psychological stress symptoms (PSS), and explore lessons learned and implications for future programming. Process evaluation results indicated positive reactions to programming from both facilitators and child participants. Results also brought forth considerations for future programming. Outcome data from the pre-and post PSS symptoms showed a significant decrease for both 5-months and 3-months of PTL programming. In addition, a significant difference on pre-and post-symptoms for the 5-month and 3-month treatment groups was found, indicating that longer treatment yields greater results. A review of best practices and lessons learned was discussed for future implications for PTL and similar programs.

Cervical cancer, caused by oncogenic (high risk [hr]) human papillomavirus (HPV) subtypes, is the most common cancer in women in Guatemala and the most common cause of cancer mortality in women aged 15-44 years. Visual inspection with acetic acid (VIA) with onsite cryotherapy “test-and-treat” is recommended for underserved Guatemalan indigenous rural women. This research assessed: 1) hrHPV infection prevalence in women screened by VIA; 2) Sensitivity and specificity of VIA in detecting hrHPV infection and cytologically identified precancerous and cancerous lesions; and 3) Factors associated with hrHPV infection. Analysis of anonymous data collected during VIA clinics in 2013 (N = 205) and 2017 (N = 234) for indigenous women aged 21-65 years in six villages showed 22.6% (95% confidence interval [CI]=18.7%-27.2%) had hrHPV cervical infection. VIA results were abnormal in 5.9% (95%CI=3.8%-8.8%). Only nine VIA exams in 89 women with hrHPV were abnormal (Sensitivity=10.1%, 95%CI=4.7%-18.3%), although abnormal VIA was associated with hrHPV (Prevalence Ratio [PR])=1.8; 95%CI=1.1-3.1; P=.05). Of 221 women who had VIA, hrHPV nucleic acid testing and liquid preparation cytology (equivalent to Papanicolaou or “Pap”) testing, 10 (4.7% [95%CI=2.3%-8.5%]) had abnormal cytological results, including one cancer, four high- and five low-grade squamous intraepithelial lesions. VIA sensitivity and specificity for detection of precancerous cytological abnormalities and cancerous lesions were 20.0% (95%CI=2.5%-55.6%) and 96.0% (95%CI=92.3%-98.3%) respectively. In contrast, hrHPV sensitivity and specificity were 100% (95%CI=71.7%-100%) and 88.7% (95%CI: 83.9%-92.7%). In both years combined, women aged fewer than 29 years or reporting fewer than four pregnancies were more likely to have hrHPV cervical infection (36.8%, 27.3%, respectively) than those who were older or reported more pregnancies (18.7; P=.025, respectively); 60.0% reported some form of modern contraception. Progesterone injections or implant users were more likely to have hrHPV infection (31.9%) than women using other or no contraceptives (19.5%); PR=1.6; 95%CI=1.1-2.4; P=.01). These data suggest that VIA may not be sufficiently sensitive for use in cervical cancer screening. “Test-and-treat” screening using hrHPV real-time testing, as recommended by the World Health Organization may be preferable to VIA, and may be acceptable using self-collected specimens.

The state of global health and wellbeing is threatened by the pervasive and dangerous decision to engage in unprotected sex. Only male or female condoms can prevent the spread of both sexually transmitted infections and unintended pregnancies. Despite this, condoms remain dangerously underused because of the perception that they diminish sexual pleasure. The pleasure gap in the design and promotion of condoms cripples sexual health outcomes. Acknowledging and harnessing the power of pleasure in sexual-decision making is key to increasing condom use.

Human norovirus (HuNoVs) are the most common enteric pathogen around the world that cause ~50% of foodborne illness of disease outbreaks annually. HuNoVs are the member of the Caliciviridae family, which consist of small (38 nm), unenveloped, single stranded RNA (ssRNA) viruses. Norovirus are divided into 5 genogroup (GI, GII, GIII, GIV, GV, GVI and GVII). The GI, GII, and GIV cause human illness, in addition, GII.4 genotype cause the most human disease. Due to HuNoVs are difficult cultured in vitro, the cultivable HuNoVs surrogates have been widely studied. Recently, some studies have been conducted with HuNoVs surrogates, for example bacteriophage MS2. MS2 is conservative surrogate for nonenveloped viruses which there is a close relationship to the behavior of HuNoVs, thus we can examine the infection control measures for HuNoVs. Despite plenty of treatment method been done on testing antiviral effect on bacteriophage MS2, for example UV inactivation, steam ultrasound and antimicrobial etc., plant-based nanoemulsion treatment has yet to be explored. Carvacrol is a major component of oregano essential oil and is responsible for their antimicrobial activity on the growth of various microorganism. In this study, carvacrol nanoemulsions were formed by using the spontaneous emulsification for testing the nanoemulsion stability (14 days shelf life study on its droplet size and particle charge) and antimicrobial activity. In carvacrol nanoemulsion 14 days shelf life test, the droplet size and particle charge stay stable at three different treatment environments (4°C, 20°C and 37°C). The results proved that nanoemulsion (was formed with surfactant agents and medium-chain triglycerides) is stable system that gives consistent droplet size and charge. Although, the low antimicrobial activity was investigated at carvacrol nanoemulsion, the strong antimicrobial effects have been found when carvacrol or carvacrol combined with ionic surfactant of treatment on MS2 and Escherichia coli. Taken together, in the wake of growing consumer demand for different “natural” products in a number of industries, our study broadly informs the development and study of functionalized carvacrol active compound that can not only provide beneficial health for human but can also examine antimicrobial efficacy of control measures for public health.