Explore the vast range of titles available.

Antimicrobial consumption (AMC) measures the level and types of antibiotics consumed in a specific setting. Monitoring AMC is critical component of antimicrobial resistance (AMR) containment strategies. However, AMC data at both facility and national-levels are scarce in Africa, which limits our understanding of the rate, patterns and drivers of antibiotic consumption, and prevents the establishment of evidence-based antimicrobial stewardship. We determined facility and national-level rates and patterns of AMC from data retrospectively collected between 2016 and 2019 in 327 pharmacies from 14 countries AMC data collection followed a backfilling strategy leveraging from public and private central medical stores, wholesalers, distributors or import services as data sources. Participating hospital and community pharmacies were selected based on their location in or proximity to hospitals capable of producing AMR data. Levels of AMC were determined as defined daily dose (DDD) and DDD per inhabitant (DID). AMC patterns were analysed according to the WHO Access, Watch, and Reserve (AWaRe) Categories, the Anatomical Therapeutic Chemical (ATC) classes and the individual antibiotic molecules included in the Drug Utilisation 75% (DU75). The availability of antibiotics was examined against the WHO and the National Essential Medicine Lists (EML). National AMC data was available in 11 of the 14 participating countries, revealing a collective AMC of 8.42 DID varying from 2.8 to 115.5 at individual country level. AMC was also determined in 327 hospital and community pharmacies. Nine of 11 (82%) countries with national data available, and 219 of the 327 (72%) participating pharmacies achieved the WHO AWaRe target of at least 60% of antibiotic consumption from Access drugs. Eighty percent of country-level AMC was accounted for by five ATC sub-classes classes of antibacterial for systemic use. Facility-level antibiotic consumption was dominated by a narrow scope of less than five drugs, taking advantage of only 10% of all possible WHO-recommended Access drugs within ATC classes. Collectively, the 14 national EML included 70% of Access, 60% of Watch and less than 5% of Reserve antibiotics listed in the WHO EML. Forty-eight uncategorized and 50 categorized non-WHO-recommended drugs were included in national EMLs or documented to be circulating in countries. The relatively low AMC and the poorly diversified subset of antibiotics available in countries underscores that strategies to expand equitable access to adequate treatment of bacterial infections should complement current efforts to promote the judicious use of antimicrobials. Interventions to increase the volume of analysable data on AMU, AMC and AMR, should be prioritized in national AMR action plans as well as in wider infrastructural and economic development plans.

Background Kenya is faced with a triple burden of malnutrition which is multi-faceted with health and socio-economic implications. Huge geographical disparities exist, especially, in the arid and semi-arid lands exacerbated by inadequate resource allocation to the nutrition sector and challenges in multi-sectoral coordination and nutrition governance. UNICEF’s Maternal and Child Nutrition Programme is a four-year (2018–2022) resilience-building, multi-sectoral program focused on pregnant and lactating women, mothers of children under five years and children under five years. The objective of the mid-term evaluation was to establish the relevance, effectiveness, efficiency, and sustainability of the programme. Methods The field evaluation conducted between June and July 2021, adopted a concurrent mixed-methods approach, where qualitative information was gathered through 29 key informant interviews and 18 focus group discussions (6 FGDs per population group; women of reproductive age, adolescent girls and men). Quantitatively, data were obtained through desk review of secondary data from programme reports, budgets, and project outputs where descriptive analysis was undertaken using Excel software. Qualitative information was organized using Nvivo software and analyzed thematically. Results The findings provide evidence of the relevance of the Maternal and Child Nutrition Programme II to the nutrition situation in Kenya and its alignment with the Government of Kenya and donor priorities. Most planned programme targets were achieved despite operating in a COVID-19 pandemic environment. The use of innovative approaches such as family mid-upper arm circumference, integrated management of acute malnutrition surge model, Malezi bora and Logistic Management Information Management System contributed to the realization of effective outputs and outcomes. Stringent financial management strategies contributed toward programme efficiencies; however, optimal utilization of the resources needs further strengthening. The programme adopted strategies for strengthening local capacity and promoting ownership and long-term sustainability. Conclusion The programme is on track across the four evaluation criteria. However, a few suggestions are recommended to improve relevance, effectiveness, efficiency, and sustainability. A formal transition strategy needs to be developed in consultation with multi-stakeholder groups and implemented in phases. UNICEF Nutrition section should explore a more integrated  programming mode of delivery through joint initiatives with other agencies under the Delivery as One UN agenda, along the more gender transformative approaches with more systematic involvement of males and females in gender-based discussions.

KM3NeT/ORCA is a water Cherenkov neutrino detector under construction and anchored at the bottom of the Mediterranean Sea. The detector is designed to study oscillations of atmospheric neutrinos and determine the neutrino mass ordering. This paper focuses on an initial configuration of ORCA, referred to as ORCA6, which comprises six out of the foreseen 115 detection units of photo-sensors. A high-purity neutrino sample was extracted, corresponding to an exposure of 433 kton-years. The sample of 5828 neutrino candidates is analysed following a binned log-likelihood method in the reconstructed energy and cosine of the zenith angle. The atmospheric oscillation parameters are measured to be \\(\\sin^2\\theta_{23}= 0.51^{+0.04}_{-0.05}\\), and \\( \\Delta m^2_{31} = 2.18^{+0.25}_{-0.35}\\times 10^{-3}~\\mathrm{eV^2} \\cup \\{-2.25,-1.76\\}\\times 10^{-3}~\\mathrm{eV^2}\\) at 68\\% CL. The inverted neutrino mass ordering hypothesis is disfavoured with a p-value of 0.25.

Gamma-ray bursts are promising candidate sources of high-energy astrophysical neutrinos. The recent GRB 221009A event, identified as the brightest gamma-ray burst ever detected, provides a unique opportunity to investigate hadronic emissions involving neutrinos. The KM3NeT undersea neutrino detectors participated in the worldwide follow-up effort triggered by the event, searching for neutrino events. In this letter, we summarize subsequent searches, in a wide energy range from MeV up to a few PeVs. No neutrino events are found in any of the searches performed. Upper limits on the neutrino emission associated with GRB 221009A are computed.