• 2018-07
  • 2019-04
  • 2019-05
  • 2019-06
  • Findings children from households were enrolled either at ba


    Findings 5254 children from 3376 households were enrolled either at baseline or during the trial period. Mean 20-h kitchen concentration of PM2.5was reduced from 1386 μg/m3 to 930 μg/m3 There was a strong secular decline in the incidence of ALRI over the period of the study. The intervention was associated with a 13% decline in the incidence of ALRI but the strength of evidence was weak (0·87, 95% CI 0·67–1·13). There were statistically significant reductions in persistent cough (0·91, 0·85–0·97), wheeze (0·87, 0·78–0·97) and burn injury (0·68, 0·48–0·95) but not for fever, severe ALRI, or ear discharge. Interpretation There was weak evidence for a modest decline in the incidence of ALRI. Post-installation PM2.5 concentrations remained well above current indoor air standards of 25 μg/m3. Better performing buy leptomycin b stoves or cleaner fuels such as liquid petroleum gas or ethanol are needed to reduce concentrations enough to estimate the impact on ALRI incidence. Funding National Institutes of Health, Thrasher Research Fund. Declaration of interest
    Abstract Background Humans and animals living in close proximity may share microbiome constituents at the household level because of daily domestic contact. Such sharing could affect enteric and metabolic functions of the gut microbiome of humans and livestock living in such households. We sought to characterise the microbiome of children, cattle, chickens, and environmental surfaces within households in western Kenya to determine the degree of microbiome sharing. Methods We randomly selected households that were part of ongoing syndromic disease surveillance programme with at least one child under 5 years, one cow, and one chicken in the Lwak region of western Kenya. Trained field teams obtained informed consent and during household visits they took samples of stools from up to two children aged 5 years or younger, a healthy cow belonging to the household, a cloacal swab from a household chicken, and environmental swabs of living areas and kitchen surfaces. Samples were refrigerated immediately after collection and transported to a laboratory where they were frozen and subsequently had DNA extracted. DNA from samples was sequenced for 16S ribosomal RNA and 16S rRNA sequences were clustered into operational taxonomic units (OTUs). We analysed and compared the microbial community profiles of human, cow, chicken, and environmental samples to determine their composition and relationship. Findings A principal coordinates analysis of taxonomic profiles showed that each sample type (ie, human, cow, chicken, and environmental samples) was associated with a distinct microbial composition. Children who shared a household had greater similarity in their microbiome compositions than did children from different households. We also noted a slightly greater degree of similarity in the microbiome composition of children and cows sharing a household than in children and cows from different households, but this pattern did not reach statistical significance. We also noted that the diversity of gut microbiomes in children increased with age. Interpretation Exchange of microbiome components may occur at the household level, but the extent to which this takes place remains poorly understood. Further investigation should focus on the role of shared pathogens or non-pathogenic microbes and implications for growth, development, and disease status across species. Funding This research was funded by a Grand Challenges grant from the Bill & Melinda Gates Foundation. Declaration of interests
    Abstract Background A rise in global temperatures is known to reduce calorie and nutrient availability through diminished yields and shifts in crop nutrient content. Insufficient calorie and nutrient intake can adversely affect nervous-system development in children. To quantify the effect of rising temperatures on paediatric neurological development in east Africa, we analysed total intake of calories, iron, and zinc in Kenya, Rwanda, Tanzania, and Uganda. We then used a model to predict the effect of rising temperatures on incidences of factors important for neurological development in children younger than 5 years.