World Health Organization - Egypt

Abstract Small‐scale fisheries (SSF) make important but undervalued contributions to the economies of some of the world’s poorest countries. They also provide much of the animal protein needed by societies in which food security remains a pressing issue. Assessment and management of these fisheries is usually inadequate or absent and they continue to fall short of their potential as engines for development and social change. In this study, we bring together existing theory and methods to suggest a general scheme for diagnosing and managing SSF. This approach can be adapted to accommodate the diversity of these fisheries in the developing world. Many threats and solutions to the problems that beset SSF come from outside the domain of the fishery. Significant improvements in prospects for fisheries will require major changes in societal priorities and values, with consequent improvements in policy and governance. Changes in development policy and science reflect these imperatives but there remains a need for intra‐sectoral management that builds resilience and reduces vulnerability to those forces beyond the influence of small‐scale fishers.

A key determinant of breast cancer outcome in any population is the degree to which cancers are detected at early stages of disease. Populations in which cancers are detected at earlier stages have lower breast cancer mortality rates. The Breast Health Global Initiative (BHGI) held its third Global Summit in Budapest, Hungary in October 2007, bringing together internationally recognized experts to address the implementation of breast healthcare guidelines for early detection, diagnosis, and treatment in low- and middle-income countries (LMCs). A multidisciplinary panel of experts specifically addressed the implementation of BHGI guidelines for the early detection of disease as they related to resource allocation for public education and awareness, cancer detection methods, and evaluation goals. Public education and awareness are the key first steps, because early detection programs cannot be successful if the public is unaware of the value of early detection. The effectiveness and efficiency of screening modalities, including screening mammography, clinical breast examination (CBE), and breast self-examination, were reviewed in the context of resource availability and population-based need by the panel. Social and cultural barriers should be considered when early detection programs are being established, and the evaluation of early detection programs should include the use of well developed, methodologically sound process metrics to determine the effectiveness of program implementation. The approach and scope of any screening program will determine the success of any early detection program as measured by cancer stage at diagnosis and will drive the breadth of resource allocation needed for program implementation.

BACKGROUND: In war-torn Yemen, reports of confirmed cholera started in late September, 2016. The disease continues to plague Yemen today in what has become the largest documented cholera epidemic of modern times. We aimed to describe the key epidemiological features of this epidemic, including the drivers of cholera transmission during the outbreak. METHODS: . Finally, we estimated the association between rainfall and the daily cholera incidence during the increasing phase of the second epidemic wave by fitting a spatiotemporal regression model. FINDINGS: of more than 2 in 13 of 23 governorates. Microbiological analyses suggested that the same Vibrio cholerae O1 Ogawa strain circulated in both waves. We found a positive, non-linear, association between weekly rainfall and suspected cholera incidence in the following 10 days; the relative risk of cholera after a weekly rainfall of 25 mm was 1·42 (95% CI 1·31-1·55) compared with a week without rain. INTERPRETATION: Our analysis suggests that the small first cholera epidemic wave seeded cholera across Yemen during the dry season. When the rains returned in April, 2017, they triggered widespread cholera transmission that led to the large second wave. These results suggest that cholera could resurge during the ongoing 2018 rainy season if transmission remains active. Therefore, health authorities and partners should immediately enhance current control efforts to mitigate the risk of a new cholera epidemic wave in Yemen. FUNDING: Health Authorities of Yemen, WHO, and Médecins Sans Frontières.

In this paper, we review some highlights from the String theory, the black hole physics and the doubly special relativity and some thought experiments which were suggested to probe the shortest distances and/or maximum momentum at the Planck scale. Furthermore, all models developed in order to implement the minimal length scale and/or the maximum momentum in different physical systems are analyzed and compared. They entered the literature as the generalized uncertainty principle (GUP) assuming modified dispersion relation, and therefore are allowed for a wide range of applications in estimating, for example, the inflationary parameters, Lorentz invariance violation, black hole thermodynamics, Saleker–Wigner inequalities, entropic nature of gravitational laws, Friedmann equations, minimal time measurement and thermodynamics of the high-energy collisions. One of the higher-order GUP approaches gives predictions for the minimal length uncertainty. A second one predicts a maximum momentum and a minimal length uncertainty, simultaneously. An extensive comparison between the different GUP approaches is summarized. We also discuss the GUP impacts on the equivalence principles including the universality of the gravitational redshift and the free fall and law of reciprocal action and on the kinetic energy of composite system. The existence of a minimal length and a maximum momentum accuracy is preferred by various physical observations. The concern about the compatibility with the equivalence principles, the universality of gravitational redshift and the free fall and law of reciprocal action should be addressed. We conclude that the value of the GUP parameters remain a puzzle to be verified.

Abstract An index of economic vulnerability is developed and used with a more conventional measure of income poverty to explore vulnerability and chronic poverty in isolated rural communities. The method is applied to data from remote rural fishing–farming communities in Congo. The analysis highlights the high vulnerability of full-time fisherfolk and identifies mobility as a key factor increasing vulnerability. In line with other recent economic research, our work also shows that households can remain highly vulnerable even when their incomes lie well above the average local income. These different results are consistent with the more specialised literature on small-scale fisheries, confirming the robustness of the analysis proposed in this paper.

OBJECTIVES: We examined major issues associated with sharing of individual clinical trial data and developed a consensus document on providing access to individual participant data from clinical trials, using a broad interdisciplinary approach. DESIGN AND METHODS: This was a consensus-building process among the members of a multistakeholder task force, involving a wide range of experts (researchers, patient representatives, methodologists, information technology experts, and representatives from funders, infrastructures and standards development organisations). An independent facilitator supported the process using the nominal group technique. The consensus was reached in a series of three workshops held over 1 year, supported by exchange of documents and teleconferences within focused subgroups when needed. This work was set within the Horizon 2020-funded project CORBEL (Coordinated Research Infrastructures Building Enduring Life-science Services) and coordinated by the European Clinical Research Infrastructure Network. Thus, the focus was on non-commercial trials and the perspective mainly European. OUTCOME: We developed principles and practical recommendations on how to share data from clinical trials. RESULTS: The task force reached consensus on 10 principles and 50 recommendations, representing the fundamental requirements of any framework used for the sharing of clinical trials data. The document covers the following main areas: making data sharing a reality (eg, cultural change, academic incentives, funding), consent for data sharing, protection of trial participants (eg, de-identification), data standards, rights, types and management of access (eg, data request and access models), data management and repositories, discoverability, and metadata. CONCLUSIONS: The adoption of the recommendations in this document would help to promote and support data sharing and reuse among researchers, adequately inform trial participants and protect their rights, and provide effective and efficient systems for preparing, storing and accessing data. The recommendations now need to be implemented and tested in practice. Further work needs to be done to integrate these proposals with those from other geographical areas and other academic domains.

Breeding programmes described as community-based (CBBP) typically relate to low-input systems with farmers having a common interest to improve and share their genetic resources. CBBPs are more frequent with keepers of small ruminants, in particular smallholders of local breeds, than with cattle, pigs or chickens with which farmers may have easier access to alternative programmes. Constraints that limit the adoption of conventional breeding technologies in low-input systems cover a range of organizational and technical aspects. The analysis of 8 CBBPs located in countries of Latin-America, Africa and Asia highlights the importance of bottom-up approaches and involvement of local institutions in the planning and implementation stages. The analysis also reveals a high dependence of these programmes on organizational, technical and financial support. Completely self-sustained CBBPs seem to be difficult to realize. There is a need to implement and document formal socio-economic evaluations of CBBPs to provide governments and other development agencies with the information necessary for creating sustainable CBBPs at larger scales.

Warm water aquaculture is widely practiced in Kenya and is dominated by the culture of Nile tilapia (Oreochromis niloticus) (75% of total production) followed by African catfish (Clarias gariepinus) at 18%. Aquaculture started in Kenya in 1920’s and has been on upward trend until 2014 when it peaked at 24,096 MT. However, production reduced drastically in the past 3 years, with 14,952 metric tonnes (MT) reported in 2016. Most farmers practice earthen pond based semi-intensive culture system. Commercial intensive culture of Nile tilapia (O. niloticus) in cages in Lake Victoria has grown significantly in the last five years with a production of 12 million kg of fish every cycle (about 8 months). Recirculation aquaculture system (RAS) is also gaining popularity mainly in intensive hatcheries. The freshwater cages have been marred by increasing frequencies of fish kills with obvious financial and environmental implications. Although limited information exists on fish disease outbreaks across the country, certain well known diseases in farmed fish have been reported. These include; fungal, mainly saprolegniasis, bacterial, mainly hemorrhagic disease and pop-eye diseases. Parasites have also been documented in farmed O. niloticus and C. gariepinus. Although prophylactic treatments are used in some hatcheries in order to prevent infections, limited biosecurity measures are in place to prevent diseases in farmed fish. This is because of inadequate knowledge of the economics of fish diseases, poor infrastructure and inadequate human resource specialized in fish diseases. This review describes the aquaculture production and health mangement practices of farmed fish in Kenya in order to document actions required for effective monitoring and regulation of future fish health problems across the country.

OBJECTIVE: The Middle East and North Africa (MENA) region continues to be perceived as a region with very limited HIV epidemiological data, raising many controversies about the status of the epidemic in this part of the world. The objective of this review and synthesis was to address the dearth of strategic interpretable data on HIV in MENA by delineating a data-driven overview of HIV epidemiology in this region. METHODS: A comprehensive systematic review of HIV, sexually transmitted infections (STIs) and risk behavior studies in MENA, irrespective of design, was undertaken. Sources of data included Medline for peer-reviewed publications, Google Scholar for other scientific literature published in nonindexed local and regional journals, international organizations reports and databases, country-level reports and database including governmental and nongovernmental organizations publications, as well as various other institutional documents. RESULTS: Over 5000 sources of data related to HIV and STIs were identified and reviewed. The quality of data and nature of study designs varied substantially. There was no evidence for a sustainable HIV epidemic in the general population in any of the MENA countries, except possibly for southern Sudan. The general pattern in different countries in MENA points towards emerging epidemics in high-risk populations including injecting drug users, men who have sex with men (MSM) and to a lesser extent female sex workers, with heterogeneity between countries on the relative role of each of these high-risk groups. Exogenous HIV exposures among nationals linked to travel abroad appeared to be the dominant HIV transmission pattern in a few MENA countries with no evidence for much epidemic or endemic transmission. The role of bridging populations in bridging the HIV infection to the general population was found to be very limited. CONCLUSION: Although they do not provide complete protection against HIV spread, near universal male circumcision and possibly the prevailing sexually conservative cultural norms seemed to have played so far a protective role in slowing and limiting HIV transmission in MENA relative to other regions. If the existing social and epidemiological context remains largely the same, HIV epidemic transmission is likely to remain confined to high-risk populations and their sexual partners, in addition to exogenous exposures. HIV prevention efforts in this region, which continue to be stymied by stigma associated with HIV/AIDS and related risk behaviors, need to be aggressively expanded with a focus on controlling HIV spread along the contours of risk and vulnerability. There is still a window of opportunity to control further HIV transmission among high-risk groups in MENA that, if missed, may entail a health and socioeconomic burden that the region, in large part, is unprepared for.

Despite the fact that eflornithine was considered as the safer drug to treat human African trypanosomiasis (HAT) and has been freely available since 2001, the difficulties in logistics and cost burden associated with this drug meant that the toxic melarsoprol remained the drug of choice. The World Health Organization responded to the situation by designing a medical kit containing all the materials needed to use eflornithine, and by implementing a training and drugs distribution programme which has allowed a transition to this much safer treatment. The introduction of the combination of nifurtimox and eflornithine (NECT) has accelerated the shift from melarsoprol to the best treatment available, due to reduced dosage and treatment time for eflornithine that has significantly lessened the cost and improved the burden of logistics encountered during treatment and distribution. The decrease in the use of more dangerous but cheaper melarsoprol has meant a rise in the per patient cost of treating HAT. Although NECT is cheaper than eflornithine monotherapy, an unexpected consequence has been a continuing rise in the per patient cost of treating HAT. The ethical decision of shifting to the best available treatment imposes a financial burden on HAT control programmes that might render long-term application unsustainable. These factors call for continuing research to provide new safer and more effective drugs that are simple to administer and cheaper when compared to current drugs.

Objective. The objective was to evaluate the capacity of primary care (PC) facilities to implement basic interventions for prevention and management of major noncommunicable diseases (NCDs), including cardiovascular diseases and diabetes. Methods. A cross-sectional survey was done in eight low- and middle-income countries (Benin, Bhutan, Eritrea, Sri Lanka, Sudan, Suriname, Syria, and Vietnam) in 90 PC facilities randomly selected. The survey included questions on the availability of human resources, equipment, infrastructure, medicines, utilization of services, financing, medical information, and referral systems. Results and Conclusions. Major deficits were identified in health financing, access to basic technologies and medicines, medical information systems, and the health workforce. The study has provided the foundation for strengthening PC to address noncommunicable diseases. There are important implications of the findings of this study for all low- and middle-income countries as capacity of PC is fundamental for equitable prevention and control of NCDs.

The NEJM Image Challenge app brings a popular online feature to the smartphone. Optimized for viewing on the iPhone and iPod Touch, the Image Challenge app lets you test your diagnostic skills anytime, anywhere. The Image Challenge app randomly selects from 300 challenging clinical photos published in NEJM, with a new image added each week. View an image, choose your answer, get immediate feedback, and see how others answered. The Image Challenge app is available at the iTunes App Store.

BACKGROUND: Oral cholera vaccines represent a new effective tool to fight cholera and are licensed as two-dose regimens with 2-4 weeks between doses. Evidence from previous studies suggests that a single dose of oral cholera vaccine might provide substantial direct protection against cholera. During a cholera outbreak in May, 2015, in Juba, South Sudan, the Ministry of Health, Médecins Sans Frontières, and partners engaged in the first field deployment of a single dose of oral cholera vaccine to enhance the outbreak response. We did a vaccine effectiveness study in conjunction with this large public health intervention. METHODS: We did a case-cohort study, combining information on the vaccination status and disease outcomes from a random cohort recruited from throughout the city of Juba with that from all the cases detected. Eligible cases were those aged 1 year or older on the first day of the vaccination campaign who sought care for diarrhoea at all three cholera treatment centres and seven rehydration posts throughout Juba. Confirmed cases were suspected cases who tested positive to PCR for Vibrio cholerae O1. We estimated the short-term protection (direct and indirect) conferred by one dose of cholera vaccine (Shanchol, Shantha Biotechnics, Hyderabad, India). FINDINGS: Between Aug 9, 2015, and Sept 29, 2015, we enrolled 87 individuals with suspected cholera, and an 898-person cohort from throughout Juba. Of the 87 individuals with suspected cholera, 34 were classified as cholera positive, 52 as cholera negative, and one had indeterminate results. Of the 858 cohort members who completed a follow-up visit, none developed clinical cholera during follow-up. The unadjusted single-dose vaccine effectiveness was 80·2% (95% CI 61·5-100·0) and after adjusting for potential confounders was 87·3% (70·2-100·0). INTERPRETATION: One dose of Shanchol was effective in preventing medically attended cholera in this study. These results support the use of a single-dose strategy in outbreaks in similar epidemiological settings. FUNDING: Médecins Sans Frontières.

Lumpy skin disease (LSD) virus (LSDV) was isolated for the first time from cattle in Egypt in 2 disease outbreaks. Bovine herpesvirus-4 (BHV-4) and LSDV were detected in a pooled sample from the first outbreak (Suez). Only LSDV was isolated from the second outbreak (Ismalia). The capripoxviruses were identified as LSDV by neutralization with specific antiserum and by their ability to produce generalized LSD in experimentally inoculated cattle.

This study was carried out to evaluate the value chain performance of the aquaculture feed sector in Egypt, in terms of value addition, employment and profitability. The strengths and weaknesses of each link of the value chain were assessed and appropriate upgrading, management and development strategies were suggested. Quantitative data were collected for each link in the value-chain through structured questionnaires that were drafted and distributed to the key players in the sector; 25 fish feed mills and 34 fish farms covering different geographical and production regions. The results indicated that the Egyptian aquafeed value-chain is relatively simple; including only four main stakeholder groups. These are feed input suppliers, aquafeed producers, aquafeed marketers and traders and fish farmers. Between 50 and 99% of feed ingredients used in aquafeed production in Egypt are imported. About 90% of Egyptian aquafeeds are produced by the private sector in the form of conventionally pressed, pelleted feeds (80–85%) and extruded feeds (15–20%). About 85% of those producers sell their feeds directly to farmers with payment either in cash or on credit, while the remaining 15% sell through intermediaries such as traders. State-owned mills produced only 10% of total commercial fish feed production in 2012, exclusively in the form of pressed, pelleted feeds. Employment generation in private sector feed mills was 29.2 full-time equivalent (FTE) jobs per mill, with an average of 3.9 jobs per 1000 tonnes of feed produced. Employment generation in state-owned mills was much higher; with an average of 90.3 FTE per mill. Males represented 90% of the full-time employment in the state-owned mills and 96.6% in the private sector. Feed costs represent 75–90% of the total operating costs of the fish farms. The major factors impacting on the performance of the value-chain relate to inputs, to feed production, to fish farmers and to marketing and financial services. The study recommends actions to mitigate these issues including the local production of more feed raw materials, strengthening quality control and inspection, providing training for feed mills, better organization of fish farmers and improving the legal and policy environment.

Aquaculture has experienced spectacular growth in the past decades, during which continuous innovation has played a significant role, but it faces increasing criticism regarding its ecological and social sustainability practices and the resulting challenges for future innovation processes. However, in the aquaculture literature, there is limited systematic knowledge of how innovation has been approached in terms of how the focus and the scope of aquaculture innovation processes are understood and managed. The objective of this paper is therefore to analyse the different approaches to innovation used in aquaculture development. We conducted a systematic review of the aquaculture literature, using an analytical lens derived from three main bodies of literature on approaches to conceptualize and manage innovation: Technology-driven, Systemic, and Business and Managerial approaches to innovation. One hundred publications were selected from the aquaculture literature covering the topic of aquaculture innovation. Analysis identified the Transfer of Technology approach as still the predominant approach to aquaculture innovation; and, even with the integration of elements of Systemic approaches, most studies remain focused on the farm level and are technology driven. Multi-dimensional studies, integrating technical, biophysical, political, and institutional dimensions of innovation in aquaculture were found, but studies analysing interactions between levels remain scarce, have a strong emphasis on the institutional dimension, and lack focus on the management of the innovation process. Studies with cross-fertilizations between different approaches to aquaculture innovation are limited but address specific research questions regarding the extent to which specific target groups are included in interventions and the need to incorporate diverse dimensions in analysing innovation processes. Our analysis suggests that aquaculture research and technology design that feeds into aquaculture innovation could benefit from innovation management approaches that integrate constant feedback from users, especially when specific groups are being targeted for better inclusiveness, and thus could better foster multi-directional interactions between multiple actors connected to aquaculture systems. This would help to elevate the analysis from just the farm and improve the integration of institutional, political, economic, and socio-cultural dimensions for better management of the innovation process. The study of aquaculture innovation needs to take into consideration the important role of private sector actors and make better use of systemic approaches to further elucidate the multi-dimensional and multi-level interplays in complex aquaculture systems. Ultimately, interdisciplinary research on aquaculture innovation could deliver significant insights supporting the development of a resilient and sustainable aquaculture sector.

Mapping of lacustrine aquaculture and socio-economic assessment of cage farmers operations can be employed as decision support tools in an integrated fashion for fisheries management. We simultaneously mapped and reported the location of cages and characterized socio-economic and indicators of cage farming in Lake Victoria, Kenya. Structured questionnaires and interviews from cage farmers generated socio-economic data and management information. Vital water quality parameters were analyzed in selected sampling sites. Cage culture was found to be a male-dominated activity with the majority of owners aged <45 years (n = 23; 59%). Siaya County had the highest cage establishments (n = 20) and number (n = 1,343). Proximity to Dominion Farm, pioneers of cage culture, as well as decreased presence of water hyacinth (Eichhornia crassipes) coverage may have contributed to high cage numbers in Siaya County. The only species cultured was Oreochromis niloticus. Most cage establishments (n = 30; 76%) were located within 200 m from the shoreline. Total operational costs for a cycle (8 months) amounted to USD 465,250 worth a total production value of USD 8,827,000, farmers often realizing a mark-up of >100%, indicative of its robust viability within “The Blue Economy” concept. With the increasing number of cages in the lake, there is the need for policy and regulations to guide its investment, both to protect local economies through improved business practices and to ensure sustainability for the lake ecosystem due to the likelihood of exacerbation in water quality deterioration in cage culture sites.

Fishing communities are often recognised as being amongst the poorest in developing countries, and interventions targeted at improving resource status seen as central in the fight against poverty. A series of field assessments focusing on vulnerability conducted in two communities in Mali and Nigeria revealed some counterintuitive results. Despite fishing being the primary livelihood, vulnerabilities relating directly to the state of the resource were ranked lower than those relating to basic human needs. Those results challenge the conventional view and suggest that non-sectoral interventions can have more effective impacts on the livelihood of those communities than interventions targeting the resources. Copyright © 2009 John Wiley & Sons, Ltd.

Abstract Despite the large economic and social benefits fisheries can offer to address Africa’s development needs, investment in African fisheries and aquaculture has been remarkably low. However, if fisheries and aquaculture are to meet the challenges of technological change, institutional reforms and resource mobilization needed in support of the sector’s development potential, fisheries stakeholders must make the case for investment much more clearly within the context of wider socioeconomic development. In this paper, we argue that the global consensus around the Millennium Development Goals (MDGs) offers an important opportunity to pursue this agenda in Africa. In particular the MDGs’ human development focus provides a compelling framework for articulating the comprehensive value of fisheries for poverty reduction and long‐term socioeconomic development. The paper has two objectives. The first is to examine the direct and indirect links between fisheries and the individual MDGs, drawing together findings and lessons learnt from recent African case studies with relevant examples from elsewhere. The second is to translate these findings into recommendations for action in support of improved investments in fisheries aimed at increasing the overall development value of the sector.

The current study was designed to optimize the dietary levels of Spirulina platensis in Oreochromis niloticus; this was tested via graded levels. Six isonitrogenous and isocaloric rations containing graded levels of dried spirulina 0, 5, 7.5, 10, 15 and 20 g/kg diet were fed separately to six equal groups of O. niloticus fingerlings for 3 months. Growth performance, non-specific immune parameters, tissue reactions and resistance of tilapias post challenge infection with Pseudomonas fluorescens were estimated monthly. There were significant increase in growth performance parameters and survival rates in spirulina-supplemented groups at concentration level of 10 g/kg for 2 months. Significant increases in hematocrit, nitroblue tetrazolium and lysozyme activity were observed in most of the supplemented groups. Bacterial challenge infections resulted in significantly lower mortality rate in all Spirulina groups with remarkable increase in protection of fish received 10 g/kg. In sum, it advisable to incorporate 10 g/kg diet of spirulina for 2 months for maximum growth performance, immunity and disease resistance in O. niloticus.