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Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita and the local annual mean level of ambient particulate matter (PM2.5) using negative binomial regression. The prevalence of CAO was not independently associated with PM2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improved understanding of the link between CAO and poverty should be prioritised.

IntroductionWe investigated whether the forced expiratory volume in 6 s (FEV6) can be used as a surrogate for the forced vital capacity (FVC).MethodsThe Burden of Obstructive Lung Disease is a multinational cohort study. At baseline, data were collected from adults, aged 40 years or older, from 41 sites across 34 countries. Participants from 18 sites were followed-up after a median of 8.3 years. Participants who completed the study core questionnaire and had acceptable post-bronchodilator spirometry were included. We performed receiver operating characteristic analyses to measure the ability of FEV1/FEV6 less than the lower limit of normal (LLN) to correctly classify FEV1/FVC less than the LLN, and FEV6 less than the LLN to correctly classify FVC less than the LLN. We used multilevel regression analyses to assess the association of discordant measurements with respiratory symptoms, quality of life and lung function decline.ResultsAt baseline, 28 604 participants were included. 53% were female (15 060). 10% (2876) had chronic airflow obstruction for FEV1/FVC, compared with 9% (2704) for FEV1/FEV6. 37% (10 637) had spirometric restriction for FVC, compared with 35% (9978) for FEV6. The FEV1/FEV6 had excellent accuracy in identifying FEV1/FVC less than the LLN (area under the curve (AUC): 0.90, 95% CI, 0.89 to 0.91, κ coefficient 0.82). The FEV6 also had excellent agreement in identifying FVC less than the LLN (AUC: 0.95, 95% CI, 0.94 to 0.95, κ coefficient 0.90). Discordant reductions in FEV1/FEV6 (1%, 345) and FEV6 (1%, 309) were associated with greater odds of having respiratory symptoms and a lower physical quality of life. 3870 participants were followed up. Those with discordant reductions in FEV1/FEV6 and FEV6 were more likely to have chronic airflow obstruction and spirometric restriction at follow-up.ConclusionsThere is strong agreement between the FVC and FEV6 in the identification of chronic airflow obstruction and spirometric restriction.

IntroductionPrevious population-based studies, mainly from high-income countries, have shown that a higher forced vital capacity (FVC) is associated with a lower risk of developing cardiometabolic diseases. The aim of this study was to assess the longitudinal association between spirometry measures and the onset of cardiometabolic diseases across sites in low-income, middle-income and high-income countries.MethodsThe study population comprised 5916 individuals from 15 countries participating in the Burden of Obstructive Lung Disease baseline and follow-up assessments. Postbronchodilator forced expiratory volume in 1 s (FEV1), FVC and FEV1/FVC were measured at baseline. Participants who reported having doctor-diagnosed hypertension, diabetes, heart disease and stroke at follow-up but not at baseline were considered new cases of these diseases. The association between lung function and the onset of participant-reported cardiometabolic diseases was assessed in each site using regression models, and estimates were combined using random effects meta-analysis. Models were adjusted for sex, age, smoking, body mass index and educational level.ResultsParticipants with greater per cent predicted FVC were less likely to have new-onset diabetes (OR per 10%=0.91, 95% CI 0.84 to 0.99), heart disease (OR per 10%=0.86, 95% CI 0.80 to 0.92) and stroke (OR per 10%=0.81, 95% CI 0.73 to 0.89) during the follow-up period (mean±SD 9.5±3.6 years). A greater percentage of FEV1 was associated with a lower risk of onset of heart disease and stroke. No significant association was found between FEV1/FVC and onset of reported cardiometabolic diseases, except for a higher risk of diabetes (OR per 10%=1.21, 95% CI 1.08 to 1.35) in participants with higher FEV1/FVC.ConclusionsThe findings of this study suggest that a low FVC is more important than a low FEV1/FVC as a risk factor for developing cardiometabolic diseases. The value of including FVC in risk score models to improve their precision in predicting the onset of cardiometabolic diseases should be explored.

Since 2016, the invasive fall armyworm (FAW), Spodoptera frugiperda, has been one of the most rapidly spreading and highly devastating maize pests across Africa and Asia. Although several studies have estimated the effect of FAW on maize yield, little is known about its impact on broader welfare outcomes. Using data from smallholder maize‐growing households in Zimbabwe, this article aimed to measure the impact of FAW on household income and food security, as well as the extent to which the adoption of a control strategy can help mitigate the negative welfare impacts due to FAW invasion. Regression results showed that households affected by FAW were 12% more likely to experience hunger, as measured by the household hunger scale. A disaggregated analysis indicated that minor FAW infestation did not exert significant impacts on incomes and food security, but severe level of infestation reduced per capita household income by 44% and increased a household's likelihood of experiencing hunger by 17%. We also found that compared to unaffected households, the FAW‐affected households who failed to implement a control strategy had a 50% lower per capita household income, while their counterparts that implemented a control strategy did not suffer a significant income loss. These findings point to the need to promote strategies to prevent high infestation levels of FAW so as to mitigate its detrimental welfare effects. The impact of fall armyworm invasion on smallholder welfare is estimated. Farm households affected by fall armyworm are 12% more likely to experience hunger. Sustainable and safe fall armyworm control strategies are required.

Background Legumes enhance food security in developing countries, necessitating an understanding of their properties. This study examined the nutritional, functional, and microbial qualities of legume-based flour blends from Small and Medium Enterprises (SMEs) in Malawi and Zambia. SMEs were chosen for their key role in local food production, distribution, and complementary food supply. Method A total of 36 legume-based flour blend samples were collected using snowball sampling, consisting of 21 samples (7 sets of 3 similar samples) from SMEs in Zambia and 15 samples (5 sets of 3 similar samples) from SMEs in Malawi. Samples were analyzed for proximate composition, energy, iron, and zinc content. The nutritional contributions to the Recommended Dietary Allowances (RDA) for children aged 1–3 years were assessed. Additionally, functional properties such as water-holding and oil-holding capacities were measured. Microbial analysis was performed, and the data were statistically analyzed to determine significance ( p  ≤ 0.05). Results Our findings revealed substantial variability in the nutritional content of these flour blends. Protein content ranged from 9.4% to 41.5%, carbohydrates from 8.1% to 71.3%, crude fat from 2.3% to 26.8%, and crude fiber from 6.2% to 35.2%. Iron and zinc levels also varied significantly, from 2.9 to 21.9 mg/100 g and 2.2 to 5.2 mg/100 g, respectively. These inconsistencies highlight a lack of standardization in nutrient content for blends intended for infant feeding. When prepared as 96 g porridge servings for children aged 1–3 years, the blends provided notable contributions to the Recommended Dietary Allowance (RDA). However, their nutrient levels were generally lower compared to the standard Corn-Soy Blend Plus (CSB +). The flour blends also showed variations in physico-functional properties, and some had microbial loads exceeding 250 cfu/g, reflecting inadequate hygiene practices during processing. Conclusion To enhance their products, SMEs should ensure that their flour blends meet both nutritional and safety standards while striving to match or surpass the nutrient content of CSB + to remain competitive in the market.

Background The Fall Army Worm (FAW) radio campaign was implemented between November 2018 and April 2019 in key maize growing areas and locations with reported high severity of fall armyworm as identified by national stakeholders. We evaluated the effectiveness of radio mass extension campaign in achieving scale, and effect on farmers’ knowledge and uptake of management practices for fall armyworm (FAW). We also assessed the factors determining farmers’ participation in radio campaign, to inform future and similar campaigns. Methods Data were gathered through a household survey targeting locations where the campaign was implemented; and 250 male and 215 female farmers were surveyed. The study was conducted in four of the seven provinces where the campaign took place—Eastern, Luapula, Copperbelt and Southern provinces. Selection of the sample provinces was based on reported rainfall distribution during the season and severity of FAW infestation, radio coverage areas and maize growing intensities. Results The radio campaign reached an estimated 1.4 million farmers. Survey results show that both male and female radio listeners were significantly more aware of fall armyworm, and more likely to adopt management practices than non-radio listeners, in particular preventive measures such as frequent monitoring, intercropping and crop rotation. This means that participation in the radio-based extension campaign significantly increased farmers’ knowledge and stimulated uptake of management practices for FAW. However, the survey showed that only 49% of the respondents listened to at least one FAW radio episode. Predictors of farmer participation in radio campaign were; gender, education level, and maize farm size. Conclusions The results imply that deliberate promotion of such programs would enhance listenership and improve interactivity while at the same time integrating other extension approaches. The integration also provides opportunities for equally reaching women as men, given the observed digital divide.