One in 25 deaths worldwide is related to liver disease, and often with multiple hepatosplenic conditions. Yet, little is understood of the risk factors for hepatosplenic multimorbidity, especially in the context of chronic infections. We present a novel Bayesian multitask learning framework to jointly model 45 hepatosplenic conditions assessed using point-of-care B-mode ultrasound for 3155 individuals aged 5-91 years within the SchistoTrack cohort across rural Uganda, where chronic intestinal schistosomiasis is endemic. We identify distinct and shared biomedical, socioeconomic, and spatial risk factors for individual conditions and hepatosplenic multimorbidity, and introduce methods for measuring condition dependencies as risk factors. Notably, for gastro-oesophageal varices, we discover key risk factors of older age, lower haemoglobin concentration, and schistosomal periportal fibrosis. Our findings provide a compendium of risk factors to inform surveillance, triage, and follow-up, while our model enables improved prediction of hepatosplenic multimorbidity, and if validated on other anatomical systems, general multimorbidity.

The global burden of multimorbidity is increasing yet poorly understood, owing to insufficient methods for modelling complex systems of conditions. In particular, hepatosplenic multimorbidity has been inadequately investigated. From 17 January to 16 February 2023, we examined 3186 individuals aged 5-92 years from 52 villages across Uganda within the SchistoTrack Cohort. Point-of-care B-mode ultrasound was used to assess 45 hepatosplenic conditions within the context of schistosomiasis (Schistosoma mansoni). Three graph learning methods for representing hepatosplenic multimorbidity were compared. Thresholds for including graph edges were found using graph kernels and tested with graph neural networks to assess predictive utility for unobserved conditions. Clinical validity was assessed by identifying medically relevant condition inter-dependencies for portal hypertension. 54.65% (1741/3186) of individuals were multimorbid with two or more hepatosplenic conditions. Thresholds were 50.16 and 64.46% for graphical lasso and signed distance correlation, respectively, but could not be inferred for co-occurrence. Co-occurrence graphs were clinically uninformative with low predictive capacity. Graph learning algorithms with statistical assumptions, e.g. graphical lasso, enabled accurate and clinically valid multimorbidity representations. Severe conditions related to portal hypertension were predicted with high sensitivity and specificity. This work presents a generalizable framework for understanding multimorbidity to enable more accurate diagnoses of complex diseases.

BACKGROUND:WHO guidelines for schistosomiasis-related morbidity control and elimination rely on current infection as a proxy indicator for morbidity. We evaluated these guidelines within the context of repeated mass drug administration and periportal fibrosis attributable to chronic intestinal schistosomiasis. METHODS:We examined 1442 households randomly sampled from 38 villages in Buliisa, Pakwach, and Mayuge districts of Uganda within the SchistoTrack cohort. Periportal fibrosis was diagnosed in 2834 individuals aged 5-90 years using ultrasound and image patterns C-F from the Niamey protocol. Schistosoma mansoni status and intensity were diagnosed by Kato-Katz microscopy and point-of-care circulating cathodic antigen tests. Schistosome infection, co-infections, and comorbidities were examined as exposures for periportal fibrosis. Multivariable logistic regressions were run with SEs clustered by household. FINDINGS:Between Jan 6 and Feb 3, 2022, 342 (12·1%) of 2834 participants were diagnosed with periportal fibrosis. By Kato-Katz microscopy, 1229 (43·4%) of 2834 participants were infected. 1863 (65·7%) of 2834 participants had trace positive point-of-care circulating cathodic antigen tests, which was higher than prevalence by Kato-Katz microscopy, and 1158 (40·9%) of 2834 participants had trace negative point-of-care circulating cathodic antigen tests. Individual schistosome status, intensity, and prevalence of heavy intensity infections of less than 1% and less than 5% were not correlated with periportal fibrosis likelihood or village prevalence. Periportal fibrosis likelihood linearly increased with age from age 5 years to age 25 years, non-linearly increased from age 26 years to age 45 years, attenuated or remained unchanged from age 46 years to age 60 years, and steadily decreased past 60 years of age. History of liver diseases, HIV, and ultrasound-detected chronic hepatitis or early cirrhosis-like disease were associated with more than two-times increased periportal fibrosis likelihood. INTERPRETATION:WHO guidelines reliant on current schistosome status and intensity are uninformative for identifying probable cases or communities with periportal fibrosis. History of HIV and underlying chronic hepatitis or early cirrhosis-like disease are risk factors that could be investigated for periportal fibrosis surveillance and management. FUNDING:NDPH Pump Priming Fund, Wellcome Trust, John Fell Fund, Robertson Foundation, and UK Research and Innovation Engineering and Physical Sciences Research Council.

Budd-Chiari syndrome is a rare disease characterized by the obstruction of hepatic venous outflow. Stepwise treatment options aimed to relieve obstruction and prevent complications of Budd-Chiari syndrome are medical therapy, interventional recanalization, and surgery. Aggressive interventions for complicated Budd-Chiari syndrome are placement of a transjugular intrahepatic portosystemic shunt, surgical shunting, or liver transplantation. Although literature suggests differences in the presentation and management between Europe and Asia, cases documenting successful use of stepwise management of Budd-Chiari syndrome in Sub-Saharan Africa are scarce. A 47-year-old male on treatment for chronic hepatitis B presented with abdominal pain and distension for 2 weeks and findings of gross ascites without stigmata of chronic liver disease. Laboratory investigations performed showed anemia, elevated transaminases, coagulopathy, and renal dysfunction. Abdominal ultrasound and computed tomography abdominal scan revealed filling defects in intrahepatic veins and inferior vena cava extending to bilateral renal and external iliac veins. Extensive workup for thrombophilia and myeloproliferative disorders was negative. The diagnosis was hepatic dysfunction secondary to inferior vena cava obstruction due to a thrombus in the setting of extensive inferior vena cava thrombosis, and heparin was initiated. However, due to lack of recanalization with anticoagulation, we performed aspiration thrombectomy, balloon angioplasty, and local thrombolysis. Transjugular intrahepatic portosystemic shunt procedure was subsequently done due to hepatic venous congestion and refractory ascites. He was discharged on oral anticoagulation. Imaging exams performed 4 months later showed patent inferior vena cava and transjugular intrahepatic portosystemic shunt, good flows in the portal vein and resolution of ascites.

ABSTRACT Background Intestinal schistosome infections are known to cause periportal fibrosis (PPF). Yet, the epidemiology of PPF remains poorly understood, especially in settings endemic with Schistosoma mansoni . Methods We randomly sampled 1442 households from 38 villages in Mayuge, Buliisa, and Pakwach Districts of Uganda within the SchistoTrack Cohort to examine 2834 individuals aged 5-90 years. PPF was diagnosed using ultrasound and image patterns C-F from the Niamey Protocol. S. mansoni infection status/intensity was diagnosed by Kato-Katz microscopy and point-of-care circulating cathodic antigens (POC-CCA). Schistosome infection, coinfections, and comorbidities were examined as exposures for PPF. Logistic regressions were run with standard errors clustered by household. Findings PPF prevalence was 12·10% (343/2834), varying from 5·00-19·46% across districts. S. mansoni prevalence by Kato-Katz, and POC-CCA trace negative and positive was 43·37% (1229/2834), 40·86% (1158/2834), and 65·73% (1863/2834) respectively. Individual schistosome infection status/intensity was not correlated with the likelihood of PPF. Living in a village where adults had <5% prevalence of heavy intensity infections (400+ eggs per gram of stool) was associated with 30.2% decreased odds of PPF. The likelihood of PPF with age linearly increased from 5-25, exponentially changed from 26-45, remain unchanged from 45- 60, and steadily decreased past 60 years. History of liver diseases, human immunodeficiency virus positivity (HIV+), and ultrasound-detected chronic hepatitis/early cirrhosis-like disease were associated with >2-fold increased PPF likelihood. Interpretation Current individual schistosome infections alone are uninformative for PPF. History of HIV+ and underlying chronic hepatitis/early cirrhosis-like disease were risk factors and could be investigated for PPF surveillance and management. Funding Nuffield Department of Population Health Pump Priming Fund, Wellcome Trust Institutional Strategic Support Fund (204826/Z/16/Z), John Fell Fund, Robertson Foundation Fellowship, and UKRI EPSRC Award (EP/X021793/1). Research in context Evidence before this study Morbidity due to parasitic infection is a complex interplay of current and past exposures. World Health Organization (WHO) guidelines for elimination of schistosomiasis as a public health problem assume current infection is a reliable proxy indicator of prevalent morbidity. Community infection thresholds are defined in guidelines and, when met, the assumption is there is no schistosomiasis-related morbidity. There is a lack of evidence for the association of infection with prevalent morbidity in the context of repeated treatment from routine mass drug administration. To evaluate WHO guidelines, there is a need for large-scale population- based, cross-sectional studies in endemic areas where current infection is compared with current morbidity at the same timepoint. A cross-sectional design also enables the investigation of a wide range of risk factors to assess the relative importance of current schistosome infection. Periportal fibrosis is a schistosomiasis-associated severe morbidity with clinical consequences such as portal hypertension, upper gastrointestinal tract bleeding, and ultimately premature death. Yet, little is known about the distribution of this disease; no information is available on its most basic epidemiology including age and gender-specific likelihoods. It is schistosomiasis-specific or attributable to schistosome pathology unlike more subtle conditions with complex aetiologies (e.g. anaemia). Hence, investigating periportal fibrosis serves as a first line, conservative approach to evaluating World Health Organization guidelines for elimination of schistosomiasis-related morbidity as a public health problem. A systematic literature search as part of an ongoing metanalysis was prospectively registered on PROSPERO (CRD42022333919). Databases were searched on 18 th May 2022 and included the Cochrane Central Register of Controlled Trials, Embase, Global Health, Global Index Medicus, and Medline. The following general terms were used: “Schistosoma” AND “fibrosis” AND “intensity” AND “infection” AND “periportal OR liver”. Studies were included that considered Schistosoma mansoni , S. japonicum, or S. mekongi species. Only original research articles in English were considered. No restriction on date of publication, age, gender, or region was applied. Infection was required to be diagnosed as opposed to self-reported. Periportal fibrosis was defined by the study authors. Added value of this study No population-wide or adjusted analyses were found to characterize the age-specific likelihood of periportal fibrosis. Studies focused on unadjusted associations in nonrandomly sampled populations of narrow age groups. In a single case (Weigand et al 2021) where adjusted analyses were completed (with age and gender considered), national programmatic data was used with sparsely nonrandomly sampled schoolchildren and limited frequency of the outcome of periportal fibrosis. Ultrasound data collection protocols and validation across studies were poorly reported. There was a lack of investigations on coinfections and comorbidities with only eight studies initiated (or published) from 2003 onwards after the start of mass drug administration in sub-Saharan Africa. Implications of all available evidence To our knowledge, this study is the first to characterize the epidemiology of periportal fibrosis with respect to the most common intestinal schistosome pathogen ( S. mansoni ). We conducted a comprehensive, population-based study of all ages (5+ years) eligible for mass drug administration in an area that has received at least 13 rounds of treatment. Here we provide clear evidence for the lack of association of current S. mansoni infection status and intensity with periportal fibrosis irrespective of the diagnostic for schistosome infection. No support was found for current WHO elimination guidelines despite using arguably the most biologically specific and severe morbidity associated with schistosomiasis. We also characterized the age-specific likelihood of periportal fibrosis, identifying a transitional age as young as 25 years. We identified future avenues for research into coinfections such as HIV and hepatitis B that appear to influence periportal fibrosis status even after controlling for a wide range of biosocial determinants of schistosome infection, treatment, and unrelated liver fibrosis. Future work is needed to understand if/how coinfections alter the pathogenesis of periportal fibrosis. Importantly, World Health Organization guidelines should be differentiated for schistosomiasis morbidities to discourage the use of infection status/intensity/prevalence as a proxy indicator for monitoring the elimination of periportal fibrosis as a public health problem.

Background: Contextual factors, including knowledge, attitudes, and practice of medical doctors, can influence prevention and management of colorectal cancer(CRC) in Uganda. To inform practices and improve care, we studied the knowledge, attitudes and practice of medical doctors in Uganda regarding prevention and management of CRC in Uganda.Methods: This was an online survey with questions on prevention and management of CRC. It included closed-ended and open-ended questions. All questions had an opt-out option. Respondents were registered medical doctors in Uganda. Group performance scores of each structured question (based on the level of correctness of the response to each question) were graded on a Likert scale as; below average (≤50%), average (51-60%), good (61-70%), very good (71-80%) excellent (81-90%), and outstanding (≥91%).Results: Four hundred and eighty-eight responded with an overall median opt-out rate of 39%. The overall performance from 27 knowledge questions was average. Questions about obesity, exercise/activity, diet, polypectomy, family history of CRC, principles of management /treatment were well answered (very good to outstanding). Questions about infections linked to CRC, aspirin or metformin chemoprophylaxis, diet, and screening tests for CRC were poorly answered (graded as below average). Less than one-third of the respondents thought they were adequately prepared to prevent or manage CRC.Three quarters of respondents identified limited individual clinical knowledge/ skills and poor health infrastructure as major barriers to the prevention and management of CRC in their work environment. Respondents also identified four key areas that could lead to improved prevention and management of CRC in Uganda. These included improved training and supervision, appropriate policy and advocacy, access to health resources, and improvement of the health system.Conclusion: There is a need to improve the doctor’s knowledge on the prevention and management of colorectal cancer in Uganda. This could be achieved through continuous training and health systems support.Funding Information: Support for this work was through the Dr Freda Omaswa Ssemaganda Health and Education (FOSHE) Foundation, Uganda.Declaration of Interests: None of the authors have any conflict of interest to declare regarding this work.Ethics Approval Statement: The Research and Ethics Committee of the Uganda Cancer Institute and the Uganda National Council for Science and Technology approved the study.

Today, most patients chronically infected with hepatitis C virus (HCV) can comfortably clear their infection after a 12-week course of direct-acting antivirals, which are easy to administer, well tolerated, and effective when administered as combination therapies.1 However, treatment failure after the use of direct-acting antivirals for HCV infection, which can be recurrent, is an emerging worldwide problem and a threat to the global elimination of chronic HCV infection. Predictors of failure of direct-acting antiviral treatment include HCV genotypes, subtypes, and viral adaptations.

Dietary exposure to 2-amino-1-methyl-6-phenylimidazo [4,5-b] pyridine (PhIP) in cooked meats maybe responsible for the high burden of Esophageal squamous cell carcinoma (ESCC) in southwestern Uganda. We conducted a pilot case-control study among 31 histologically confirmed ESCC cases and 54 age, gender, and residence matched healthy community controls sampled from the general population at the time of accrual of each case in southwestern Uganda. We collected data including smoking, alcohol consumption, diet, and scalp hair samples analyzed for normalized PhlP (adjusted per gram of melanin). We used logistic regression to determine the association of PhlP and ESCC. Overall, the mean normalized PhIP (ng/g melanin) was 44.79 (SD 148.08), higher among women compared to men (130.68 vs. 9.00, p = 0.03), lowest among healthy men [8.31 (SD 8.52) ng/g melanin] and highest among healthy women 158.39 (SD 288.75) ng/g melanin. In fully adjusted models, covariates associated with greater odds of ESCC included ever smoking 2 to 3 pack years of cigarettes (aOR 7.75 (95% CI 1.90, 31.50) and those 3 or more pack years (aOR5.82, 95%CI 1.25, 27.11), drinking 3 to 4 alcoholic drinks daily (aOR8.00, 95%CI 2.31, 27.74), and normalized PhIP above 75th percentile (8.65 ng/g of melanin) (aOR4.27, 95%CI 1.12, 16.24). In conclusion, high PhIP levels maybe associated with ESCC in a rural Uganda, a high ESCC burden setting. Further study with larger sample with a wider geographical representation is needed to validate scalp hair PhIP for assessment of ESCC risk.

Abstract Background Health related quality of life measurements are vital elements of public health surveillance that uncover unmet health needs and predict the success of health interventions. We described health related quality of life measurements using the EuroQoL 5-dimension (EQ-VAS/EQ-5D) instrument and associated factors among patients with upper gastrointestinal bleeding (UGIB) and hepatic schistosomiasis at a rural health facility in the Albert Nile Basin, Uganda. Methods and materials This was a cross-sectional study at Pakwach Health Centre IV. Participants included adult inpatients and outpatients with a history of UGIB and ultrasound evidence of hepatic schistosomiasis. We evaluated and recorded each participant’s medical history, physical examination, laboratory tests results, ultrasound results, and endoscopy findings. We also recorded health related quality of life measurements using the EuroQoL 5-dimension instrument and derived disability weights from EQ-VAS and EQ-5D measurements. These were our dependent variables. Descriptive and inferential statistics were generated summarizing our findings. Results We found 103 participants had a history of upper gastrointestinal bleeding and hepatosplenic schistosomiasis. Sixty percent were between the ages of 30–49 years, 59% were females, 74% were farmers, 92% had splenomegaly, 88% had varices at endoscopy, 22% were medical emergencies with acute variceal upper gastrointestinal bleeding, and 62% had anemia. Measures of the different dimensions of health from 101 participants with patient reported outcomes revealed 77 (76%) participants experienced problems in self-care, 89 (88%) participants reported anxiety or depression, and 89 (88%) participants experienced pain or discomfort. The median EQ-VAS derived disability weights and median EQ-5D index-derived disability weights were 0.3 and 0.34, respectively. Acute upper gastrointestinal bleeding, praziquantel drug treatment, and age by decade predicted higher EQ-VAS derived disability weights (p value < 0.05). Under weight (Body mass index ≤ 18.5), acute upper gastrointestinal bleeding, ascites, age by decade, female gender, and praziquantel drug treatment predicted higher EQ-5D index- derived disability weights (p value < 0.05). Conclusion Adult patients with upper gastrointestinal bleeding and hepatic schistosomiasis from this primary health facility experience poor health and considerable health loss. Several factors predicted increased health loss. These factors probably represent key areas of health intervention towards mitigating increased health loss in this population.

The development of direct-acting antivirals against hepatitis C virus (HCV) has transformed the treatment landscape and underpinned the WHO goal of HCV elimination by 2030. However, as of 2021, few countries remain on track to achieve this goal. Reliable data remain scarce, especially those on national plans for HCV elimination in many regions of the world and particularly in sub-Saharan Africa, which accounts for around 11 million of 71 million people estimated to be living with HCV. 1 Blach S Zeuzem S Manns M et al. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017; 2: 161-176 Summary Full Text Full Text PDF PubMed Scopus (1179) Google Scholar

Forest cover loss and fragmentation have increased in recent years due to the increasing anthropogenic land use. Whereas previous studies have focused mostly on forest cover change from other disturbances (e.g., insects, diseases, and forest fires), little is known regarding how land uses are increasing at the expense of forest cover. Thus, we fill this research gap by assessing forest cover change and fragmentation with an emphasis on how competing anthropogenic land uses are increasing at the expense of the coniferous forests using empirical evidence from northeastern British Columbia (BC). We classified Landsat images from 1985, 2000, and 2015 using the Random Forests (RF) classification algorithm. The study finds an annual net loss of 2.3% (gain: 6.9%, loss: 9.2%) in the coniferous forest cover, but the timber harvest land base’s (THLB) share of the coniferous forest gain and loss is higher than that of the area outside the THLB. We find that the period with a lower amount of fragmentation has a lesser amount of coniferous forest cover loss and vice versa. We show that coniferous forest cover is more likely to recover from barren land. In forest areas where anthropogenic land uses are on the rise, land managers could use knowledge from our study as ancillary information in assessing the sustainability and potential cumulative impacts of anthropogenic land uses. We conclude that the rate of forest recovery from anthropogenic-induced land categories is likely to account for the amount of forest fragmentation.

Background: Little is known about the survival of patients with esophageal squamous cell cancer in resource limited settings. Objectives: We sought to determine the incidence of one-year all-cause mortality and age-standardized mortality rates for esophageal squamous cell carcinoma in Uganda. Methods: Prospective cohort of 92 participants with histologically confirmed esophageal squamous cell cancer at Mbarara Regional Referral Hospital, southwestern Uganda. Participants were enrolled between January 2018 and March 2020 and followed until death. We used Kaplan-Meier methods to determine all-cause mortality and median survival time; Cox regression to determine predictors of survival; and determined age-standardized mortality rates (SMR) using the WHO standard population. Results: All 92 participants contributed a total 353.8 months at risk, 89 (96.7%) died representing an incidence rate of 251.5 (95% CI 204.3, 309.6) per 1000 person-months. The difference in the one-year risk of all-cause mortality among men and women was negative 6.4 percentage points. The overall SMR was 9.96 (95%CI 7.63, 12.29) per 100,000 and median survival time was 3.03 (95% CI 2.60, 3.47), shortest (1.77 months) among men younger than 45 and longest (7.77 months) among women aged 75 years or greater. In a fully adjusted model, high socioeconomic status predicted longer survival while increasing age and low socioeconomic status predicted shorter survival. Conclusion: After diagnosis, the one-year incidence rates of all-cause mortality and age-standardized mortality rates among ESCC patients in rural Uganda are high. Initiatives to improve access to oncology care for diagnosis and treatment should be prioritized to improve overall survival.

Liver fibrosis may be assessed noninvasively with transient electrography (TE). Data on the performance of TE for detecting liver fibrosis in sub‐Saharan Africa are limited. We evaluated the diagnostic accuracy of TE by performing liver biopsies on persons with liver fibrosis indicated by TE. We enrolled HIV‐infected and HIV‐uninfected participants with TE scores consistent with at least minimal disease (liver stiffness measurement [LSM]≥7.1 kPa). Biopsies were performed and staged using the Ishak scoring system. A concordant result was defined using accepted thresholds for significant fibrosis by TE (LSM ≥ 9.3 kPa) and liver biopsy (Ishak score ≥ 2). We used modified Poisson regression methods to quantify the univariate and adjusted prevalence risk ratios (PRR) of the association between covariates and the concordance status of TE and liver biopsy in defining the presence of liver fibrosis. Of 131 participants with valid liver biopsy and TE data, only 5 participants (3.8%) had Ishak score ≥ 2 of whom 4 had LSM ≥ 9.3 kPa (sensitivity = 80%); of the 126 (96.2%) with Ishak score < 2, 76 had LSM < 9.3 kPa (specificity = 61%). In multivariable analysis, discordance was associated with female gender (adjPRR = 1.80, 95%CI 1.1‐2.9; P = .019), herbal medicine use (adjPRR 1.64, 95% CI = 1.0‐2.5; P = .022), exposure to lake or river water (adjPRR 2.05, 95% CI = 1.1‐3.7; P = .016), and current smoking (adjPRR 1.72, 95%CI 1.0‐2.9; P = .045). These data suggest that TE among rural Ugandans has low specificity for detection of histologically confirmed liver fibrosis. Caution should be exercised when using this tool to confirm significant liver fibrosis.

In the original article publication, the affiliation of the author Ana Coutinho is incorrect.

Understanding the interconnection between land use processes and land change patterns is yet to be fully achieved. Land change researchers have posited that the lack of understanding is not due to lack of effort but rather the difficulty in the task of seeking understanding, theoretically and practically. In this study, to understand forest change patterns from shale oil and gas (SOG) land use, we combine geospatial approach with metrics from landscape ecology to compare and contrast forest change from SOG infrastructure development in the four shale gas plays in British Columbia (BC). The study finds that cumulatively, between 1975 and 2017, the Cordova, Horn, Liard, and Montney shale gas plays have lost 0.30%, 0.25%, 0.14%, and 0.36% of forest cover, respectively, due to the construction of SOG well pads, access roads, and pipelines. Also, we find that the shale gas plays with the largest quantity of forest cover loss from SOG infrastructure construction have the highest amount of forest fragmentation and the vice versa. The results, however, suggest that differences in the intensity of forest cover change from shale gas land use is likely to create different ecologically significant forest fragmentation patterns. From a broader perspective, this study demonstrates how different levels of human-environment interactions yield different levels of anthropogenic land use impacts on the environment. The study provides land managers with a context for understanding the land use intensities and forest change pattern, which is relevant for sustainable land management in the shale gas plays in British Columbia.

There is a general consensus that widespread use of praziquantel in populations where schistosomiasis is endemic prevents development of hepatic schistosomiasis and its complications. However, a few studies have reported discordant findings linking praziquantel to the occurrence of upper gastrointestinal bleeding (UGIB) in some patients with hepatic schistosomiasis and varices. We explored if there was any causal association between recent praziquantel use (rPZQ) and upper gastrointestinal bleeding in hepatic schistosomiasis in rural Africa. A quasi-experimental, retrospective case-controlled study was performed. It involved adult patients with past or acute UGIB, varices, periportal fibrosis, and/or cirrhosis. Cases had acute variceal bleeding while controls did not. The outcome was the frequency of lifetime episodes of UGIB and exposure was rPZQ (received praziquantel in the last 11 months from the date of enrollment). The data analysis included 2 × 2 tables, logistic regression, and propensity-score matching. Odds ratios (ORs), average treatment effects (ATEs), and their 95% confidence intervals (CIs) were used for inference. Over 6 weeks, we enrolled 19 cases with 92 lifetime episodes of UGIB, and 66 controls with 192 lifetime episodes of UGIB. Cases were more likely to experience UGIB than controls following rPZQ (92% vs. 62%; OR 7.6; 95% CI 3.4–17). Factors predictive of more lifetime episodes of UGIB at multivariable analysis included rPZQ (adjusted OR 13; 95% CI 2.9–53), relative leukocytosis (adjusted OR 26; 95% CI 7.6–89), large varices (adjusted OR 5.0; 95% CI 1.7–15), a family member with hepatosplenic schistosomiasis (adjusted OR 19; 95% CI 7.4–51), advanced periportal fibrosis (adjusted OR 8.0; 95% CI 2.6–22), ascites (adjusted OR 14; 95% CI 4.3–47), and jaundice (adjusted OR 32; 95% CI 7.8–128). While the ATE following rPZQ among the treated was 0.40 (95% CI 0.33–0.48). Our findings suggest the presence of a plausible causal association between recent praziquantel use and increased frequency of UGIB in our study population.

Information about forest change patterns from oil and gas (OG) activities could improve our understanding of the land use–land cover change nexus, aid in predicting future forest changes, and prompt the need for more mitigation measures in reducing impacts from the activities. However, little is known about forest change patterns from OG infrastructure development in northeastern British Columbia (BC). In this study, we assess forest change from the impacts of OG infrastructure development using a geospatial approach. The study finds that forest cover was reduced by 0.234% between 1975 and 2017. However, we show that forest cover change (− 0.182%) from OG infrastructure development between 1995 and 2017 was faster compared to that of the two decades before 1995. The faster change, however, coincides with the period of the OG boom in BC. Between time points and locations, we measured a larger amount of forest fragmentation in the land cover for the year and location with larger quantities of human-induced land classes. The differences in the quantity of human-induced land cover types between time points and locations could account for the differences in the amount of fragmentation. Our findings suggest that forest fragmentation is likely to reduce if land managers would make relentless effort to reduce the quantity of anthropogenic-induced land cover classes and increase forest recovery programs in the forest areas.

BackgroundThe link between use of solid biomass fuel (wood, charcoal, coal, dung, and crop residues) for cooking and/or heating and esophageal squamous cell carcinoma (ESCC) is inconclusive.ObjectiveWe systematically reviewed the literature and performed a meta-analysis to determine whether cooking fuel type influences esophageal squamous cell carcinoma.MethodsWe searched MEDLINE, EMBASE, Web of Knowledge and Cochrane Database of Systematic Reviews for studies investigating cooking fuel and ESCC from 2000 until March 2019. We performed random effects meta-analysis stratified by the continent, World Bank's country income classifications and fuel type and calculated pooled odds ratios and 95% CIs for the risk of esophageal squamous cell carcinoma in biomass fuel users compared with non-users.ResultsOur analysis included 16 studies (all case-control) with 16,189 participants (5233 cases and 10,956 controls) that compared risk of ESCC among those using nonsolid fuels and biomass fuels. We found use of biomass fuel was associated with Esophageal squamous cell carcinoma with a pooled odds ratio (OR) 3.02 (95% CI 2.22, 4.11, heterogeneity (I-2)=79%). In sub-group analyses by continent, Africa (OR 3.35, 95%CI 2.34, 4.80, I-2=73.4%) and Asia (OR 3.08, 95%CI 1.27, 7.43, I-2=81.7%) had the highest odds of ESCC. Use of wood as fuel had the highest odds of 3.90, 95% CI 2.25, 6.77, I-2=63.5%). No significant publication bias was detected.ConclusionsBiomass fuel is associated with increased risk of Esophageal squamous cell carcinoma. Biomass fuel status should be considered in the risk assessment for Esophageal squamous cell carcinoma.

Many countries in sub-Saharan Africa face increasing poverty among the poor, rapid population growth, inadequate access to safe drinking water, environmental degradation, weak institutional support, and cultural practices that impede development. These factors negatively affect human well-being at the household, community, and national levels, which affects the capacity of individuals to contribute effectively to economic activities, including those related to forestry, and leads to food insecurity. This study investigated the relationships between improvement of human well-being, economic activity, and food security. Using a case-study method, the authors performed a strengths, weaknesses, opportunities, and threats (SWOT) analysis to evaluate the efforts of a women's group in northern Uganda to build and manage a tree nursery. The analysis identified the key factors in the success of the group's tree-nursery project, which could be used as a model for the successful development of forestry-related sources of income, thereby contributing to improved food security in sub-Saharan Africa.

Background The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate viral hepatitis by 2030. Although no virological cure exists for hepatitis B virus (HBV) infection, existing therapies to control viral replication and prophylaxis to minimise mother-to-child transmission make elimination of HBV feasible. We aimed to estimate the national, regional, and global prevalence of HBsAg in the general population and in the population aged 5 years in 2016, as well as coverage of prophylaxis, diagnosis, and treatment. Methods In this modelling study, we used a Delphi process that included a literature review in PubMed and Embase, followed by interviews with experts, to quantify the historical epidemiology of HBV infection. We then used a dynamic HBV transmission and progression model to estimate the country-level and regional-level prevalence of HBsAg in 2016 and the effect of prophylaxis and treatment on disease burden. Findings We developed models for 120 countries, 78 of which were populated with data approved by experts. Using these models, we estimated that the global prevalence of HBsAg in 2016 was 3.9% (95% uncertainty interval [UI] 3.4-4.6), corresponding to 291 992 000 (251 513 000-341 114 000) infections. Of these infections, around 29 million (10%) were diagnosed, and only 4.8 million (5%) of 94 million individuals eligible for treatment actually received antiviral therapy. Around 1.8 (1.6-2.2) million infections were in children aged 5 years, with a prevalence of 1.4% (1.2-1.6). We estimated that 87% of infants had received the three-dose HBV vaccination in the first year of life, 46% had received timely birth-dose vaccination, and 13% had received hepatitis B immunoglobulin along with the full vaccination regimen. Less than 1% of mothers with a high viral load had received antiviral therapy to reduce mother-to-child transmission. Interpretation Our estimate of HBV prevalence in 2016 differs from previous studies, potentially because we took into account the effect of infant prophylaxis and early childhood vaccination, as well as changing prevalence over time. Although some regions are well on their way to meeting prophylaxis and prevalence targets, all regions must substantially scale-up access to diagnosis and treatment to meet the global targets. Funding John C Martin Foundation. Copyright (c) 2018 Elsevier Ltd. All rights reserved.