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Soil-Transmitted Helminth Infections and Nutritional Status in School-age Children from Rural Communities in Honduras
Ana Lourdes Sanchez ,
* E-mail: ana.sanchez@brocku.ca
Affiliation Department of Community Health Sciences, Brock University, St. Catharines, Ontario, Canada
Jose Antonio Gabrie,
Mary-Theresa Usuanlele,
Maria Mercedes Rueda,
Affiliation School of Microbiology, National Autonomous University of Honduras, Tegucigalpa, Honduras
Maritza Canales,
Theresa W. Gyorkos
Affiliation Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Ana Lourdes Sanchez,
https://doi.org/10.1371/journal.pntd.0002378
Ana Lourdes Sanchez Jose Antonio Gabrie ... Theresa W. Gyorkos
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Soil-transmitted helminth (STH) infections are endemic in Honduras and efforts are underway to decrease their transmission. However, current evidence is lacking in regards to their prevalence, intensity and their impact on children's health.
To evaluate the prevalence and intensity of STH infections and their association with nutritional status in a sample of Honduran children.
A cross-sectional study was done among school-age children residing in rural communities in Honduras, in 2011. Demographic data was obtained, hemoglobin and protein concentrations were determined in blood samples and STH infections investigated in single-stool samples by Kato-Katz. Anthropometric measurements were taken to calculate height-for-age (HAZ), BMI-for-age (BAZ) and weight-for-age (WAZ) to determine stunting, thinness and underweight, respectively.
Among 320 children studied (48% girls, aged 7–14 years, mean 9.76±1.4) an overall STH prevalence of 72.5% was found. Children >10 years of age were generally more infected than 7–10 year-olds (p = 0.015). Prevalence was 30%, 67% and 16% for Ascaris, Trichuris and hookworms, respectively. Moderate-to-heavy infections as well as polyparasitism were common among the infected children (36% and 44%, respectively). Polyparasitism was four times more likely to occur in children attending schools with absent or annual deworming schedules than in pupils attending schools deworming twice a year (p<0.001). Stunting was observed in 5.6% of children and it was associated with increasing age. Also, 2.2% of studied children were thin, 1.3% underweight and 2.2% had anemia. Moderate-to-heavy infections and polyparasitism were significantly associated with decreased values in WAZ and marginally associated with decreased values in HAZ.
STH infections remain a public health concern in Honduras and despite current efforts were highly prevalent in the studied community. The role of multiparasite STH infections in undermining children's nutritional status warrants more research.
Soil-transmitted helminth (STH) infections are endemic in Honduras but their impact on children's health is not well studied. With the purpose of determining the prevalence and intensity of STH infections and their association with nutritional status in a sample of Honduran children, a cross-sectional study was undertaken in 2011. School-age children were enrolled, and in addition to demographic data, blood and stool samples and anthropometric measurements were obtained to determine nutritional status and STH infection. The overall STH prevalence among 320 studied children was 72.5% and almost half of the infected children harboured multiple parasites. Polyparasitism was more likely to occur in children attending schools with absent or annual deworming schedules than in pupils attending schools deworming twice a year. Prevalence by species was 30%, 67% and 16% for Ascaris, Trichuris and hookworms, respectively. Infections of moderate to heavy intensity as well as multiparasite infections were significant predictors of decreased weight-for-age scores in children ages 7–10 years after controlling for key confounders. Sustainable efforts to control STH infections in Honduras are required. Future research providing more insight on the nutritional impact of polyparasitic STH infections in childhood is necessary.
Citation: Sanchez AL, Gabrie JA, Usuanlele M-T, Rueda MM, Canales M, Gyorkos TW (2013) Soil-Transmitted Helminth Infections and Nutritional Status in School-age Children from Rural Communities in Honduras. PLoS Negl Trop Dis 7(8): e2378. https://doi.org/10.1371/journal.pntd.0002378
Editor: Hélène Carabin, University of Oklahoma Health Sciences Center, United States of America
Received: December 21, 2012; Accepted: July 7, 2013; Published: August 8, 2013
Copyright: © 2013 Sanchez et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: Funding for the parent study was received from the Canadian Institutes for Health Research, CIHR (TWG, Principal Investigator). Additional funding was provided by a Teasdale-Corti grant from the Global Health Research Initiative, GHRI (ALS, Principal Investigator). Graduate research fellowships were awarded by Brock University to JAG and MTU and by the Teasdale-Corti project to MMR. The funding agencies had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Honduras is among 30 countries in the Americas that are endemic for soil-transmitted helminth (STH) infections, which are caused by four species of intestinal nematodes: the common roundworm, Ascaris lumbricoides; the whipworm, Trichuris trichiura; and the hookworms, Necator americanus and Ancylostoma duodenale [1]. The health impact of these infections is more dramatic in children, for whom STH show a particular predilection [2] partly due to their differential exposure to contaminated soil. Health adverse effects such as anemia, growth stunting, protein-calorie malnutrition, fatigue, and poor cognitive development tend to occur and persist in populations affected by STH [3], and all too often, helminth infections are seen as normal and unavoidable part of life in endemic populations [4].
According to the World Health Organization (WHO), two thirds of Honduran children aged 1–14 years require preventive chemotherapy (PC) for STH [1]. In fact, the Preventive Chemotherapy and Transmission Control (PCT) databank of the WHO estimates that 2.6 million Honduran children (769,405 pre-school and 1,832,476 school-age children) are at risk for STH transmission therefore requiring regular administration of anthelminthic drugs [5]. Organized STH control activities in the country began in 1998 with the establishment of the Healthy Schools Program, a collaborative effort between the ministry of health, the ministry of education and the World Food Program [6]. By 2001, Honduras had started subnational control activities [1], [7] and these soon evolved into a national program guided by the recommendations outlined in the World Health Assembly resolution 54.19 [6], [8]. Although the goal of providing anthelminthic medication in a regular manner to at least 75% of all school-age children at risk has yet to be attained [1], [5], [6], [7], Honduras' efforts of tackling STH transmission are, nevertheless, commendable. An important complement to these efforts would be to undertake a complete situation analysis at subnational levels; one that would establish baseline data in terms of prevalence as well as transmission risk factors so priority areas can be identified and intervention efforts tailored to specific populations [9]. Additionally, to effectively monitor the success of PC and other interventions, studies assessing STH-associated morbidity in infected children are needed in Honduras.
Based on scientific evidence linking STH morbidity with worm burden (i.e., the number of adult parasites inhabiting the intestine [10]), the elimination of moderate and heavy infections is the target of PC programs [1]. In addition to worm burden, polyparasitism -the concurrent infection with multiple parasite species- has also been associated with children's malnutrition [11], [12]. As well, even when recent data is scarce, some studies have reported that even light infections may impose a threat to children's health [13], especially if living in endemic communities with poor nutritional status [10], [11], [14]. Hence, the overlap of poverty, malnutrition and STH endemicity in some populations may obscure the true effect of these helminthiases in childhood health and accordingly, more research is needed to fully appreciate the burden of these infections on people living in these areas [15].
With this in mind, the aim of this study was to investigate the prevalence and intensity of STH infections in a sample of Honduran school-aged children and examine whether STH are negatively associated with malnutrition and anemia.
The present study was nested within a parent study entitled 'Gender and parasitic diseases: Integrating gender analysis in epidemiological research on parasitic diseases to optimize the impact of prevention and control measures' (principal investigator, T. W. Gyorkos, McGill University, Canada) and both received ethics clearance from McGill University Health Centre, Montreal, QC (file number MUHC 10 -175 – PED Nov. 23rd 2010) and Brock University, St. Catharines, ON (file number - BU 10–161 – Sanchez/Gyorkos Jan 13th 2011). In the absence of an institutional ethics board in the participating academic unit of the Honduran university, the Ethics Officer of the Masters Program in Infectious and Zoonotic Diseases (MEIZ) of the School of Microbiology, National Autonomous University of Honduras, reviewed the protocol and provided clearance (file number OF-MEIZ- 001-2011).
As the study population comprised minors, both parental consent and children's assent were required prior to enrolment of children. Parents and guardians of children in grades 3–5 were invited to an information session in which the study's objectives, benefits and risks were fully explained. Parents and guardians who gave oral consent were presented with an information package containing a detailed lay description of the study, an invitation to participate and a consent form for their signature. All parents or guardians consenting for their children to participate signed the informed consent form. Children whose parents consented were invited to participate in the study during sessions held at the schools and those who expressed assent in responding to a questionnaire, providing a stool and blood sample and allowing the collection of anthropometric measurements were then enrolled in the study. Children assents were obtained verbally and documented through a child assent form. Also, since the study was undertaken during class time at participating schools, authorizations from schools' Principals were sought in advance and only schools with such authorizations were approached for enrolment. Laboratory reports were issued with accompanying lay interpretations and recommendations. Also, parents of children with STH infections were offered anti-parasitic treatment for their child. If agreed, albendazole tablets (400 mg) were administered to the child by the school teacher or parent. A "deworming tracking card" was issued for each child. Parents and teachers were encouraged to keep track of the children's deworming treatment in order to either avoid missing the school's annual or bi-annual treatment or prevent excessive treatments in case deworming was offered by third parties (e.g., international or national medical brigades, faith-based missions, etc.).
Study design and determination of sample size
Both the parent study and present study were school-based, cross-sectional studies, designed as explorative and hypothesis generating studies.
For the parent study, power and sample size determination were performed utilizing the PS software (version 3.0, January 2009, by William D. DuPont and Walton D. Plummer Jr.). This was based on a two-sided chi-square test to compare STH infection between boys and girls. Using previous studies in Peru as a reference [16] it was assumed that half of the children in this school-age group will be male and that the prevalence of any STH would be 50% in males (a conservative estimate). An estimated design effect of 2.7 was used with a significance level of 0.05. A total of 314 participants were therefore needed to detect a minimum risk ratio of 1.5 with 80% power. The present study was bound by this sample size determination.
Study area and population
This study was implemented during February and March 2011 with the collaboration of the National University of Agriculture (UNA) located in the city Catacamas, in the municipality of the same name (14°51′35.46″; N 85°53′58.19″W) in the Department of Olancho, about 210 km north-east of the capital of Honduras, Tegucigalpa. Geographically, Catacamas is the largest municipality in the country and is nested in a fertile valley at approximately 450 m above sea level. Catacamas municipality consists of the urban core (Catacamas proper) and 14 main villages which in turn are comprised of smaller 339 hamlets. Catacamas human development index (HDI) value for 2009 was 0.675 [17], slightly over to that of Honduras (0.625 for 2011) [18]. However, 60% of Catacamas' population resides in rural areas, the majority lacking public services such as electricity, potable water and indoor plumbing. As means of livelihood inhabitants engage in mixed agricultural farming, rearing animals such as cattle, pigs and poultry and growing crops such as corn, beans, coffee and vegetables. Others work as traders or labourers while a few work in public or private service [19].
The following nine surrounding rural communities (most between 2–3 hour driving distance from the city) were visited as potential study-sites: Colonia de Poncaya, Las Lomas de Poncaya, Las Parcelas, Corosito de Poncaya, El Cerro del Vigía, El Hormiguero, Santa Clara, Los Lirios and Campamento Viejo. The combined eligible school population was 445 children. Schools located in those communities were identified and principals contacted by UNA's personnel to inform them about the study and obtain authorization to approach the school and potentially enrol their pupils. As well, information was obtained in regards to school enrolment and status of their deworming program, if any. Schools which had provided deworming treatment within the last three months were not eligible for the study.
Study sample
The target participants for the study were children in grades 3–5 (aged 9–11) since STH infections, especially A. lumbricoides and T. trichiura tend to peak at this age [1]. Also, at this age children are old enough to understand survey questions and provide basic information.
Using a pre-tested, 30-minute, face-to-face standardized questionnaire in Spanish, the Gender Study collected demographic and epidemiological data as well as children's living conditions and knowledge regarding STH infections. From these data, the present study extracted children's general demographics (name, date of birth, age, and sex of the child), STH and deworming history, self-reported living conditions (household's type of floor, water access and type and use of sanitary facilities), and the possession of major home appliances.
Assessment of nutritional status
Body weight and height measurements were taken for each child to calculate anthropometric indicators. Weights were taken using a digital electronic balance to the nearest 0.1 kg while children were wearing school uniforms and without shoes. Height was taken to the nearest 0.1 cm using a height pole mounted on the wall. In order to minimize intra-individual errors, all measurements were taken twice by different researchers and the average value calculated and used thereof.
Age, height and weight were then used to calculate the following indicators: a) height-for-age Z-score (HAZ) to assess stunting; b) weight-for-age Z-score (WAZ) to assess underweight; and c) body-mass-index-for-age Z-score (BAZ) to assess thinness. Calculations were done with the WHO AnthroPlus software version 1.04 (WHO, Geneva, Switzerland) using the WHO international reference values (available at http://www.who.int/growthref/tools/en/). Because of its inability to differentiate between relative height and body mass, WAZ is not recommended for the assessment of growth beyond childhood (>10 years of age) [19]. Therefore, BAZ was used as a complement to HAZ. These indicators are recommended by the WHO as they provide an assessment of the child's nutritional status in comparison with a healthy reference population [20], [21]. According to the 2007 WHO growth reference for school-aged children and adolescents, stunting, underweight and thinness are defined as <−2 standard deviations (SD) HAZ, WAZ and BAZ, respectively [20].
Stool collection and parasite determination
A single fecal sample was collected from each child and samples were taken to UNA's laboratory for analysis on the same day using the Kato-Katz technique [22] with a template of 41.7 mg, as recommended by the WHO [23]. Kato-Katz templates were obtained from Vestergaard-Frandsen Disease Control Textiles (Vestergaard Frandsen SA, Aarhus, Denmark). Kato–Katz slides were examined microscopically in a systematic manner within 30–60 min of preparation; helminth eggs counted for each parasite species and the number thus obtained multiplied by a factor of 24 in order to get the number of eggs per gram of feces (epg). Egg counts were utilized to classify infection intensities into light, moderate, or heavy infections as follows, respectively: for A. lumbricoides, 1–4,999 epg, 5,000 – 49,999 epg and ≥50,000 epg; for T. trichiura, 1–999 epg, 1,000–9,999 epg and ≥10,000 epg; and for hookworms, 1–1,999 epg, 2,000–3,999 epg and ≥4,000 epg [1], [24].
Haematological and protein analysis
Haematological analyses were done using the BC – 3000Plus AutoHematology Analyzer (Mindray Medical Instrumentation, USA) in a private medical laboratory contracted in Catacamas. Anemia was determined when children aged 6–11 years had hemoglobin (Hb) values <11.5 g/dL or hematocrit (Hct) <34%. For children aged 12–14 years, these values were Hb <12 g/dL or Hct <36% [25]. Total serum protein concentrations were measured by the Biuret method and children were considered within the reference values if concentrations were within 6–8.5 g/dL [26].
Data were entered by a researcher into Microsoft office Excel spreadsheet 2007 (Microsoft) and verified for accuracy (compared with data in questionnaires) by a different researcher. Data were cleaned by checking for errors and missing values. Statistical analyses were done using IBM, SPSS Statistics ver. 20 (IBM. Somers, NY). Descriptive statistics for continuous variables and frequency (proportions) for categorical variables were used to describe the characteristics of the study population. Weight and height measurements were subjected to a reliability test and the inter observer technical error of measurements was assessed using the Mueller and Martorell method [27]. Differences in proportions for categorical variables (e.g., age group, sex of the child, stunting, thinness, underweight and anemia) were calculated using Chi square test of independence. Differences in mean values for continuous variables (e.g., HAZ, WAZ, BAZ, total proteins, Hb and Hct) were assessed using the student t-test analysis.
Since STH clinical importance is generally associated with increased worm burden, infections of moderate and heavy intensity were merged into one category "moderate-to-heavy". This was also useful for computational reasons since those infections were in minority among studied children. Also, to assess polyparasitism, a category termed "infection status" was created to denote conditions of non-infected, monoparasitism or polyparasitism (co-infections with 2 or 3 STH). One-way ANOVA was used to analyze differences in anthropometric mean Z-scores of the study population by infection status and by infection intensity (negative, light and moderate-to-heavy) of each parasite species.
A generalized estimating equations (GEE) approach was used to construct both multivariable linear and logistic regression models to account for possible within-school data correlation (clustering at the school level). For these models, intensity of infection was not analyzed by parasite species. Rather, infection categories "negative-to-light" and "moderate-to-heavy" were created to denote individuals with such infections by any of the three parasites under study. Linear regression models to test for associations between anthropometric indicators and intensity of infection categories were constructed adjusting for age, sex, socio-economic status (SES) and anemia. Similar models were done to test for association between those indicators and infection status. Using principal component analysis (PCA), the SES variable was constructed from five factors: type of floor, access to tap water, having a toilet, having a television set and having a fridge. Separate logistic regression models were constructed to assess associations between stunting and thinness odds and STH intensity of infection and infection status adjusting for age stratum (7–10 or >10 years of age), sex and SES. Odds ratios (OR) were determined with 95% confidence intervals (CI = 95%).
Study participation and characteristics of the study population
Of the nine visited, seven schools were enrolled in the study: Colonia de Poncaya, Las Lomas de Poncaya, Las Parcelas, Corosito de Poncaya, El Cerro del Vigía, El Hormiguero, and Campamento Viejo. The reasons for not including the two remaining were: recent deworming treatment (Santa Clara n = 26) and time-constraints to complete questionnaires and measurements (Los Lirios n = 19). (Los Lirios' children, however, were examined for STH and treatment provided if needed). Thus, the number of eligible participants in grades 3 to 5 among participating schools was 400 children. The parents of 368 (92%) children provided written informed consent for their children to participate and almost all (357, 97%) children assented to be enrolled. After enrolment, 37 participants were dropped from the study due to insufficient or no stool sample (n = 20), or unreliable Kato-Katz results that could not be repeated (n = 17). Also, five children declined blood collection but they were kept in the study since their remaining data was complete. The final study sample was 320 children aged 7–14 years (mean 9.76±1.4) and 154 (48%) were girls. Demographic, household and nutritional characteristics of the study sample are shown in Table 1. Additionally, habitual or occasional open defecation was reported by 15.6% and 12.8% of the children, respectively. As for STH history, 58.1% of the children reported having expelled 'worms' in the past and 85.9% recalled having received deworming treatment sometime in the past but not recently.
Table 1. Demographic, household and nutritional characteristics of the study sample according to STH infection.
https://doi.org/10.1371/journal.pntd.0002378.t001
Five of the seven schools enrolled in the study had ongoing deworming programs, some starting as far back as 2007. Frequency of deworming was twice a year for two schools and once a year for three schools. The last deworming treatment had been within the last 4–6 months for four schools and two years for the remaining one. There was no statistical difference between overall infection with any STH and schools' deworming schedule (p = 0.767).
Parasitic profile of the studied children
Prevalence of STH infections.
A total of 232 of 320 children studied were infected with one or more intestinal helminths, for an overall point STH prevalence of 72.5% (95% CI = 67.6–77.4). Specifically, the prevalence for T. trichiura, A. lumbricoides, and hookworms was 66.9%, 30.3% and 15.9%, respectively. Children >10 years of age had twice the odds of being infected with any of the three STH than younger children (OR = 2.146, 95% CI = 1.2–4.0, p = 0.016). A statistical difference was not observed in terms of overall STH positivity and the sex of the children (p = 0.708). However, a closer look at infection by species revealed that boys of any age were twice as likely as girls to be infected by hookworms (OR = 2.076, 95% CI = 1.1–3.9, p = 0.022).
Intensity of STH infections.
The majority of T. trichiura and hookworm infections were light intensity (73.4% and 94.1%, respectively) whereas for Ascaris the proportion of such infections was 40.2%. Overall, over one third of all infections (84 of 232, 36.2%) were moderate-to-heavy. Specifically, infections of heavy intensity accounted for 6.2%, 1.9% and 3.9% of the cases of ascariasis, trichuriasis and hookworm infection, respectively.
Polyparasitism.
As shown in Table 2, of 232 infected children, 103 (44.4%) were polyparasitized. Of the latter, 27 (26.2%) harboured triple infections. T. trichiura prevailed across all combinations and it was found more frequently associated with A. lumbricoides than with hookworms.
Table 2. Proportion of cases with monoparasitism or polyparasitism among 232 infected children.
A statistical difference between schools' deworming schedule and polyparasitism was observed (Table 1). Children attending schools with absent or once-a-year deworming schedule were almost four times as likely to be polyparasitized (OR = 3.85, 95% CI = 1.97–7.50, p<0.001). Indeed, only 10% of children attending schools providing deworming twice a year harboured multiparasite infections.
Children's nutritional status
Replicate weight and height measurements showed high reliability when tested for the inter-observer technical error of measurements. The reliability coefficient (R) was 0.962 for weight and 0.973 for height. Nutritional indicators of the study population are presented in Table 1. The nutritional status of most children was within healthy parameters but a few cases of stunting (n = 18, 5.6%), thinness (n = 7, 2.2%) and underweight (n = 3, 1.3%) were observed. Of the children who were stunted, thin or underweight, girls accounted for 50%, 43% and 67% of the cases, respectively.
No child had a total protein value below the normal range and of 315 children examined, 7 (57% girls) were anemic.
Overall, of 320 children, 33 (10.3%) had at least a form of nutritional deficit. Five of these children (15.2%) were negative for any STH, while 28 (84.8%) were infected with one or more STH. Among the latter, 15 children were monoparasitized, while 13 were polyparasitized.
Associations between STH infections and nutritional status
Results of the one-way ANOVA analysis revealed that mean values for WAZ scores were significantly lower in children with moderate-to-heavy infections by either T. trichiura (p = 0.020) or A. lumbricoides (p = 0.015) compared to children with no or light infections. This was not observed in the case of hookworm infections, likely due to the fact that the vast majority (94%) of such infections were light. On the other hand, the scores for the other two indicators (HAZ and BAZ) did not differ significantly across the various infection intensities of any of the helminth species.
However, as depicted in Figure 1, a negative trend –although not always significant- between infection intensity and the mean values of all anthropometric indicators was identified. In other words, the heavier the intensity, the lower the HAZ, BAZ and WAZ mean values (Figure 1, plots A, B and C). A similar trend was observed in terms of infection status: as polyparasitism increased, the mean values of all anthropometric indicators decreased (Figure 1, plot D). As data in Table 1 show, this trend was significant in terms of WAZ scores (p = 0.012), marginally significant for HAZ scores (p = 0.071) but not significant for BAZ scores (p = 0.202).
Figure 1. Plots of Z-scores for anthropometric indicators vs. STH intensity of infection/infection status.
A decreasing trend in Z-scores was observed as intensity of infection increased (plots A–C) and as the number of species parasitizing increased (plot D). HAZ: height-for-age Z-score; BAZ: BMI-for-age Z-score; WAZ: weight-for-age Z-score. Mod-Heavy: infections of moderate-to-heavy intensity.
https://doi.org/10.1371/journal.pntd.0002378.g001
Estimated coefficients (β) from multivariable GEE linear models are shown in Table 3. Compared to no or light infections, moderate-to-heavy infections with any STH were significantly correlated with a decrease in WAZ scores (β = −0.34, 95% CI = −0.62 to −0.06, p = 0.018). This correlation was only marginally significant for HAZ scores (β = −0.20, 95% CI = −0.44 to 0.04, p = 0.108) but not significant for BAZ (p = 0.622). Polyparasitism was found inversely correlated with both WAZ and HAZ scores. For WAZ, this correlation was significant (β = −0.37, 95% CI = −0.66 to −0.08, p = 0.012) whereas for HAZ, it was only marginally significant (β = −0.24, 95% CI = −0.50 to 0.02, p = 0.074). However, no evidence for association between polyparasitism and BAZ scores was found (p = 0.446). With respect to age, there was a strong negative correlation between age and HAZ and BAZ scores (β = −0.16, 95% CI = −0.24 to −0.09, p<0.001 and β = −0.12, 95% CI = −0.21 to −0.03, p = 0.008, respectively). Conversely, WAZ scores were not correlated with age (p = 0.428).
Table 3. Adjusted coefficients (β) from multivariable GEE linear models of anthropometric indicators, accounting for within-school clustering.
Multivariable GEE logistic models revealed that age of the studied population was significantly associated with stunting. Children >10 years old were three times more likely to be stunted (OR = 3.31; 95% CI = 1.23–8.90, p = 0.018) than younger children. Age, on the other hand, was only marginally significantly associated with thinness (p<0.15).
Neither infection intensity nor infection status (polyparasitism) was found associated with stunting or thinness. Finally, since only three children were underweight (WAZ <−2SD) no statistical model was produced for this nutritional indicator.
In a little more than a decade, moderate economic progress alongside dedicated efforts for STH control –mainly through national deworming campaigns- have contributed to the decrease of Honduras' national STH prevalence [1]. Yet, as the data from our study show, some rural communities have persistently high STH transmission and perhaps they face greater struggles in overcoming poverty and inequities [17]. Indeed, considering that five of the seven participating schools reported some form of mass-deworming during the past year, a prevalence of 72.5% for any STH among these children is remarkably high. According to the work of Hall and colleagues, a prevalence of 70% or greater carries a high probability of disease [12]. Moreover, 36% of infected children were harbouring moderate-to-heavy infections. The new vision for a world free of childhood morbidity due to these helminths, according to the WHO, is reducing the prevalence of STH infection of moderate and heavy intensity to ≤1% [1]. Therefore, these data alone underscore the need for Honduras to continue and sustain its deworming program, and more importantly, to implement and monitor integrated control efforts [28], [29].
The predominance of T. trichiura over A. lumbricoides (66.9% versus 30.3%) may indicate that the single-dose albendazole schedule currently used for deworming has been less effective for reducing trichuriasis as this parasite is less susceptible to this drug [30], [31]. Even though it might not be feasible to implement a different PC regimen in Honduras at the moment, it is important to be vigilant of the different patterns of transmission of individual STH species. At the same time, it would be useful to conduct baseline studies to measure reinfection rates [32] and drug efficacy [33], as well as to make efforts to detect potential emergence of resistance to benzimidazoles [34], [35], [36].
In terms of prevalence, our study shows that children older than 10 years of age were more likely to be infected with any STH than younger children, underscoring the importance of deworming children throughout their primary school years [1]. The fact that in our study boys were more likely than girls to harbour hookworm infection warrants further investigation as there might be gender-related factors playing an important role in exposure to hookworms, as previously suggested [37], [38]. Along with high prevalence, we also found a high proportion of polyparasitism with almost half of those infected (44%) harbouring 2 or 3 helminths. This finding is consistent with the epidemiological profile of endemic countries [16], [39], [40], [41] and although already observed in Honduras [6], [42], [43], it has not received sufficient attention in the country. The impact of infections by multiple parasite species has been subject to some attention in the last decade [44] and studies show that concurrent infections may have additive or synergistic detrimental effects, especially in childhood [11], [45]. Given that regular PC interventions will eventually result in reduced infection intensity, light polyparasitic infections will become more relevant [45]. Therefore, addressing polyparasitism in future WHO recommendations merits consideration.
In terms of nutritional status, the majority of studied children were within the WHO reference values for growth and nutrition. This is uncommon for a Honduran rural population [46]. In fact, the proportion of children suffering chronic undernutrition (as measured by stunting) identified in this study was 5.6% well below current national urban (13.7%) or rural (32%) figures. On the other hand, the proportion of global undernutrition (as measured by thinness) was 2.2%, below the national urban (6.2%) or rural (14.8%) averages [47] and very close to the expected value (in a healthy population, approximately 2.1% of individuals will fall either above or below 2SD of the HAZ, BAZ and WAZ reference values). Although assessing food-security was beyond the scope of this study, a possible explanation for this finding is that Catacamas valley and surrounding areas are situated in fertile lands and food insecurity is not as dramatic as in other parts of the country [19], [48].
We found that the risk of stunting increased with age, a phenomenon also found in similar studies conducted in Peru in both school-age children [16] and in pre-schoolers [49], as well as in Malaysia [50], Colombia [51] and Guatemala [39]. It appears, therefore, that once stunted, children continue to be so, even when more acute indicators such as WAZ and BAZ fall within healthy parameters. Longitudinal studies could help elucidate the most favourable moment for children to prevent growth faltering that may lead to stunting.
As mentioned, we aimed to ascertain potential associations of STH infections with the children's nutritional status (stunting, underweight and thinness) but our data did not support such associations. It is recognized that studying the impact of intestinal helminths on child growth and nutrition in endemic populations is not an easy endeavour as it is difficult to control for other environmental or socio-economic factors or seasonal changes in the food supply [4], [12]. It is worth mentioning, however, that SES status (as we measured it) was not found associated with either increased odds of stunting or thinness or with a decrease in anthropometric indicators Z-scores.
Notwithstanding this lack of association in our study, when looking at the distribution of the actual Z-scores for these indicators in the multivariable analyses, we found that both moderate-to-heavy infections with any STH and polyparasitism were significantly associated with lower WAZ scores. Additionally, at the species level, negative trends (albeit not all significant) were observed between STH infection and WAZ, BAZ and HAZ mean scores; namely, as intensity of infection or the number of species parasitizing increased, Z-score mean values for the three measured anthropometric indicators decreased. A similar finding was reported by Ordoñez and Angulo (2002) in a cross-sectional study in which polyparasitized children had lower HAZ and WAZ scores [51]. Thus, examining anthropometric Z-scores values might be useful in providing additional insight into the impact of STH on children's nutritional status as they may reveal subtle changes missed when focusing only on end outcomes (i.e., stunting, thinness and underweight). By the same token, Z-score values may be able to pin-point improvements in children's nutrition after anthelminthic treatment even if significant changes in end outcomes cannot be demonstrated.
Limitations of this study arise from its cross-sectional nature as direct causal relationship between STH and nutritional status cannot be determined. This is why large-scale prospective studies with rigorous design and the corresponding funding are necessary to investigate neglected tropical diseases including helminthiases. Another potential limitation stems from the fact that our investigation was part of a parent study with a sample size calculation based on being able to detect an important difference in sex-specific STH prevalences instead of nutritional indicators and this may limit the precision of our results. We trust that our findings will shed light into the design of future studies in Honduras.
In terms of our parasitological findings, the analysis of a single stool sample may have underestimated STH prevalence in our study but by the high prevalence obtained, this underestimation might be minimal. Further, recent work suggests that Kato-Katz is reasonably accurate for A. lumbricoides and T. trichiura although less so for hookworms [52]. Likewise, intensity of infection may have been underestimated although recent publications suggest that Kato-Katz results are fairly reliable for the three STH investigated in the present study [52], [53]. Malaria, other intestinal parasites or gastrointestinal infections were not determined and a role for these on children's nutritional status cannot be ruled out. Finally, an important limitation in identifying undernutrition factors is that this study did not entail an exhaustive investigation of underlying causes of malnutrition (e.g., social determinants, food security, dietary intake and expenditure, etc). Future research should address this gap although cross-sectional studies might not be able to reveal concrete answers, as shown by Gray et al. (2006) [46].
Strengths of this study are: including a design effect in the sample size estimation to take into account clustering by school, obtaining a high participation rate, and that our sample is likely representative of the communities' school children as in Honduras 95% children attend primary school [47]. Also, by utilizing laboratory protocols and anthropometric measurements recommended by the WHO, our results permit comparisons with other studies both nationally and internationally.
In conclusion, the prevalence data obtained in this study contribute with accurate and updated information to map out the situation of STH infections in Honduras. Further, this study provides a unique insight into the nutritional status of a cohort of school children living in rural Honduras and, very importantly, it is to our knowledge, the first in the country to explore the potential impact of STH infections on children's nutritional status. Our results also underscore the need for more research into the health effects of polyparasitism in children. It is hoped that the findings presented here will be useful in informing current STH control efforts in Honduras and encourage future investigations that take into account the social and geographical differences across the country.
Checklist S1.
STROBE Checklist.
https://doi.org/10.1371/journal.pntd.0002378.s001
(DOC)
We wish to thank our colleagues at the National University of Agriculture of Honduras for their invaluable collaboration, in particular to Rober Rubí, coordinator of "Escuelas de Campo", and Kenny Nájera. Thanks also are indebted to the faculty and students of the School of Microbiology and the Masters Program in Infectious and Zoonotic Diseases at UNAH, for volunteering their time and assisting with field and laboratory work. We are grateful to the study communities, schools' principals and teachers and research participants are also thanked for their enthusiastic participation. We also thank Mr. Amidu Raifu, MSc, CStat (Brock University), for his valuable statistical advice, and the three anonymous reviewers for their insightful comments and suggestions.
Conceived and designed the experiments: ALS TWG MC. Performed the experiments: ALS MC MMR MTU JAG. Analyzed the data: ALS JAG. Contributed reagents/materials/analysis tools: ALS TWG MC. Wrote the paper: ALS JAG.
1. WHO (2012) Soil-transmitted helminthiases: eliminating soil-transmitted helminthiases as a public health problem in children: progress report 2001–2010 and strategic plan 2011–2020. Geneva: World Health Organization. WHO/HTM/NTD/PCT/2012.4 WHO/HTM/NTD/PCT/2012.4.
2. Hotez P (2008) "The Unholy Trinity": the soil-transmitted helminth infections ascariasis, trichuriasis, and hookworm infection. Forgotten people and forgetten diseases, the neglected tropical diseases and their impact on global health and development. Washington DC: American Society for Microbiology. pp. 215.
3. Hotez PJ, Brindley PJ, Bethony JM, King CH, Pearce EJ, et al. (2008) Helminth infections: the great neglected tropical diseases. J Clin Invest 118: 1311–1321.
4. Tanner S, Leonard WR, McDade TW, Reyes-Garcia V, Godoy R, et al. (2009) Influence of helminth infections on childhood nutritional status in lowland Bolivia. Am J Hum Biol 21: 651–656.
5. WHO PCT databank (2012) Preventive chemotherapy and transmission control: Soil-transmitted helminthiases.
6. Ministry of Health Honduras (2011) Prevalence of soil-transmitted helminths and malaria and infection intensity for geohelminths; characterizing socio-cultural and environmental risk factors for infection in school-age children in Honduras, 2011.
7. WHO (2012) Soil-transmitted helminthiases: number of children treated in 2010. Weekly epidemiological record No. 23: 225–232.
8. WHO (2001) Fifty-fourth World Health Assembly. 2001. Resolution WHA 54.19. Schistosomiasis and soil-transmitted helminth infections. Geneva: WHO.
9. Brooker S, Hotez PJ, Bundy DA (2010) The global atlas of helminth infection: mapping the way forward in neglected tropical disease control. PLoS Negl Trop Dis 4: e779.
10. Stephenson LS, Latham MC, Ottesen EA (2000) Malnutrition and parasitic helminth infections. Parasitology 121(Suppl): S23–38.
11. Ezeamama AE, Friedman JF, Olveda RM, Acosta LP, Kurtis JD, et al. (2005) Functional significance of low-intensity polyparasite helminth infections in anemia. J Infect Dis 192: 2160–2170.
12. Hall A, Hewitt G, Tuffrey V, de Silva N (2008) A review and meta-analysis of the impact of intestinal worms on child growth and nutrition. Matern Child Nutr 4(Suppl 1): 118–236.
13. Stoltzfus RJ, Albonico M, Tielsch JM, Chwaya HM, Savioli L (1997) School-based deworming program yields small improvement in growth of Zanzibari school children after one year. J Nutr 127: 2187–2193.
14. Crompton DW, Nesheim MC (2002) Nutritional impact of intestinal helminthiasis during the human life cycle. Annu Rev Nutr 22: 35–59.
15. King CH (2010) Health metrics for helminthic infections. Adv Parasitol 73: 51–69.
16. Casapia M, Joseph SA, Nunez C, Rahme E, Gyorkos TW (2006) Parasite risk factors for stunting in grade 5 students in a community of extreme poverty in Peru. Int J Parasitol 36: 741–747.
17. PNUD (2012) Informe sobre Desarrollo Humano, Honduras 2011. Reducir la inequidad: un desafío impostergable. Costa Rica: PNUD Honduras.
18. UNDP (2011) Human Development Report 2011. Sustainability and equity: A better future for all. New York.NY.
19. COFINSA (2005) [Institutional and financial diagnosis of the Municipality of Catacamas, Department of Olancho]. Tegucigalpa: Consultores Financieros Internacionales, S.A. 84 p.
20. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, et al. (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85: 660–667.
21. de Onis M, Monteiro C, Akre J, Glugston G (1993) The worldwide magnitude of protein-energy malnutrition: An overview from the WHO global database on child growth. Bull World Health Organ 71: 703–712.
22. Katz N, Chaves A, Pellegrino J (1972) A simple device for quantitative stool thick-smear technique in Schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 14: 397–400.
23. WHO (1991) Basic laboratory methods in medical parasitology. Geneva: WHO. pp. 25–29.
24. WHO (2002) Prevention and control of schistosomiasis and soil transmitted helminthiasis. Geneva, Switzerland: WHO Expert Committee.
25. WHO (2001) Iron deficiency anaemia assessment, prevention and control. A guide for programme managers. Geneva, Switzerland: World Health Organization.
26. WHO (2000) Guidelines on standard operating procedures for clinical chemistry. Geneva: WHO.
27. Mueller WH, Martorell R (1988) Reliability and accuracy of measurement. In: TG Lohman ARaRM, editor. Anthropometric Standardisation Reference Manual. Champaign, IL.: Human Kinetics Books. pp. 83–86.
28. Knopp S, Stothard JR, Rollinson D, Mohammed KA, Khamis IS, et al. (2011) From morbidity control to transmission control: time to change tactics against helminths on Unguja Island, Zanzibar. Acta Trop 56 10.1016/j.actatropica.2011.04.010.
29. Kabatereine NB, Malecela M, Lado M, Zaramba S, Amiel O, et al. (2010) How to (or not to) integrate vertical programmes for the control of major neglected tropical diseases in sub-Saharan Africa. PLoS Negl Trop Dis 4: e755.
30. Prichard RK, Basanez MG, Boatin BA, McCarthy JS, Garcia HH, et al. (2012) A research agenda for helminth diseases of humans: intervention for control and elimination. PLoS Negl Trop Dis 6: e1549.
31. Keiser J, Utzinger J (2008) Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. JAMA 299: 1937–1948.
32. Halpenny CM, Paller C, Koski KG, Valdes VE, Scott ME (2013) Regional, household and individual factors that influence soil transmitted helminth reinfection dynamics in preschool children from rural indigenous Panama. PLoS Negl Trop Dis 7: e2070.
33. Albonico M, Engels D, Savioli L (2004) Monitoring drug efficacy and early detection of drug resistance in human soil-transmitted nematodes: a pressing public health agenda for helminth control. Int J Parasitol 34: 1205–1210.
34. Diawara A, Schwenkenbecher JM, Kaplan RM, Prichard RK (2013) Molecular and biological diagnostic tests for monitoring benzimidazole resistance in human soil-transmitted helminths. Am J Trop Med Hyg
35. Diawara A, Drake LJ, Suswillo RR, Kihara J, Bundy DA, et al. (2009) Assays to detect beta-tubulin codon 200 polymorphism in Trichuris trichiura and Ascaris lumbricoides. PLoS Negl Trop Dis 3: e397.
36. Geerts S, Gryseels B (2001) Anthelmintic resistance in human helminths: A review. Trop Med Int Health 6: 915–921.
37. Brooker S, Bethony J, Hotez PJ (2004) Human hookworm infection in the 21st century. Adv Parasitol 58: 197–288.
38. Behnke JM, De Clercq D, Sacko M, Gilbert FS, Ouattara DB, et al. (2000) The epidemiology of human hookworm infections in the southern region of Mali. Trop Med Int Health 5: 343–354.
39. Sorensen WC, Cappello M, Bell D, Difedele LM, Brown MA (2011) Poly-helminth Infection in East Guatemalan school children. J Glob Infect Dis 3: 25–31.
40. Quihui-Cota L, Valencia ME, Crompton DW, Phillips S, Hagan P, et al. (2004) Prevalence and intensity of intestinal parasitic infections in relation to nutritional status in Mexican schoolchildren. Trans R Soc Trop Med Hyg 98: 653–659.
41. Lustigman S, Prichard RK, Gazzinelli A, Grant WN, Boatin BA, et al. (2012) A research agenda for helminth diseases of humans: the problem of helminthiases. PLoS Negl Trop Dis 6: e1582.
42. Ministry of Health Honduras (2001) Profile of soil- transmitted helminthiases and taeniasis in schools. 2000–2001. Honduras. 41 p.
43. Ministry of Health Honduras (2006) Profile of soil-transmitted helminths conducted in national sentinel municipalities. 2005–2006. Honduras.
44. Steinmann P, Utzinger J, Du ZW, Zhou XN (2010) Multiparasitism a neglected reality on global, regional and local scale. Adv Parasitol 73: 21–50.
45. Pullan R, Brooker S (2008) The health impact of polyparasitism in humans: are we under-estimating the burden of parasitic diseases? Parasitology 135: 783–794.
46. Gray VB, Cossman JS, Powers EL (2006) Stunted growth is associated with physical indicators of malnutrition but not food insecurity among rural school children in Honduras. Nutrition Research 26: 549–555.
47. United Nations (2010) Millennium Development Goals, Honduras 2010. Third Country Report.
48. Henry PJ (2009) [Final Report. Characterization Catacamas business sector]. Catacamas: ADEL Catacamas, AHMON. 56 p.
49. Gyorkos TW, Gilbert NL, Larocque R, Casapia M (2011) Trichuris and hookworm infections associated with anaemia during pregnancy. Trop Med Int Health 16: 531–537.
50. Ahmed A, Al-Mekhlafi HM, Al-Adhroey AH, Ithoi I, Abdulsalam AM, et al. (2012) The nutritional impacts of soil-transmitted helminths infections among Orang Asli schoolchildren in rural Malaysia. Parasit Vectors 5: 119.
51. Ordóñez LE, Angulo ES (2002) Malnutrition and its association with intestinal parasitism among children from a village in the Colombian Amazonian region. Biomédica 22: 486–498.
52. Tarafder MR, Carabin H, Joseph L, Balolong E Jr, Olveda R, et al. (2010) Estimating the sensitivity and specificity of Kato-Katz stool examination technique for detection of hookworms, Ascaris lumbricoides and Trichuris trichiura infections in humans in the absence of a 'gold standard'. Int J Parasitol 40: 399–404.
53. Krauth SJ, Coulibaly JT, Knopp S, Traore M, N'Goran EK, et al. (2012) An in-depth analysis of a piece of shit: distribution of Schistosoma mansoni and hookworm eggs in human stool. PLoS Negl Trop Dis 6: e1969.
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2017 Annual Dinner — Buy Tickets Now!
Site: Arlington Community Church, 52 Arlington Avenue in Kensington.
Our speaker will be past State Superintendent of Public Instruction, and Gubernatorial candidate, Delaine Eastin! The menu will be superb Thai food (rigorously sampled by volunteers from your diligent ECDC Executive Board) catered by Larb Thai Food and Tapas, 10166 San Pablo, between Lincoln and Central. This is one of the most exciting restaurants to open recently in El Cerrito!
Purchase your tickets here at this year's attractive price of $25 per person! Download a reminder flyer here.


Yuppie Socks welcomes you to 2017! We are excited as ever to continue our momentum into the new year. You folks have been kind to us since our December launch and we greatly appreciate your support. Our inventory will continue to update daily with plenty of new designs to keep your sock drawer fresh.
Two weeks into January, which means nearly 33% of you have already fallen off the resolution train. But don't fret, there's always next year.
Amazon is just unstoppable. No literally, they cannot stop, or millions of Americans would be disappointed when their package arrives a day late. And forget about the drone delivery excitement (that's so 2016), they are currently working on a floating warehouse patent – the e-commerce giant calls this logistics technology "airborne fulfillment centers" or AFC for short. I mean what's next? Football helmets that dispense beer?! At least I know my $99 Prime membership is going to good use.
Who needs human friends when you can have robot friends!


text:
Алтинто́бинський сільський округ (, ) — адміністративна одиниця у складі Казигуртського району Туркестанської області Казахстану. Адміністративний центр — село Алтинтобе.

Населення — 7311 осіб (2009; 6883 в 1999).

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До складу округу входять такі населені пункти:

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Сільські округи Казигуртського району

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Over the last 20 years there have been more than 200 scientific research papers published in peer-reviewed medical journals highlighting ECP therapy as a non-invasive, safe, low-cost, and highly effective treatment for patients with coronary artery disease. The European Society of Cardiology reviewed ECP technology and in 2013 upgraded its recommendation, stating the treatment should be offered to certain heart patients.
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Each Clinic offering Renew ECP treatments offer different treatment packages. Find out more directly from our Partners.
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Currently ECP technology is only private funded treatment however Renew Health Ltd is working with leading NHS facilities to make the treatment more widely available.
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Q : Can I have Renew ECP if I have high blood pressure??
Pregnant women, those with a severe aneurysm (thinned & bulging vessel walls) in their aorta requiring surgical repair, and patients with active blood clots in their legs. A full list of contraindications are available from Renew Health.
Most people often feel revitalised after a treatment session similar to how they would feel after a workout at the gym. However, just like exercise, if you have been inactive for a while, you may feel slightly light-headed due to the increase in blood circulation however, this usually passes in a few moments. You may feel somewhat tired at the end of the first week, due to the "passive exercise" effect of ECP.
The minimum age for receiving Renew ECP therapy is 18 years old. There are no upper age restrictions.
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You can find a list of Authorised Renew Service Providers on our Operator Locator page. During your personal consultation, you will discuss your current health status, fitness levels, sleep patterns and other lifestyle related questions. As part of the consultation process, you will also receive a Cardiac Pre-Treatment Assessment.
Renew ECP therapy is a relaxing experience and 100% pain free. Your trained Renew Operator will carefully increase the air pressure of the cuffs to a level of comfort to suit you. It feels like a firm massage with squeezing of the legs at regular intervals. The intensity of the pressure is adjustable to ensure a comfortable and effective treatment. Most people fall asleep during treatment!
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The increased blood flow during the Renew ECP treatment naturally widens the arteries throughout the body. This makes your cardiovascular system stronger and more efficient.
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Renew Therapy gives everyone the opportunity to enhance their blood circulation through the introduction of ECP (external counter pulsation) Technology. Widely regarded as an effective method to increase blood flow, ECP Therapy can aid in improving quality of life, cardiovascular efficiency and sports recovery. ECP is a medically founded treatment that is non-invasive, pain free and with no significant side effects.
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We have a full service provider based in the UK that can provide fast, efficient support when required.
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The Renew ECP devices are under warranty for one year.
Over the last 20 years there have been more than 200 scientific research papers published in peer-reviewed medical journals highlighting ECP therapy as a non-invasive, safe, low-cost, and highly effective treatment for patients with coronary artery disease.
The European Society of Cardiology reviewed ECP technology and in 2013 upgraded its recommendation, stating the treatment should be offered to patients diagnosed with heart disease and angina, whose condition has not improved with medication, and who are unable to undergo surgery or wish to try a non-invasive alternative to standard treatment options.
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text:
BioInvent signed new deal for antibody production for pharma client
by Ben Adams |
Sep 1, 2016 3:54am
BioInvent International has penned an extended deal with one of its major pharma clients (the name of which is not being disclosed) for one of the company's key products.
The deal is expected to see the Swedish antibody manufacturer, which has several I/O candidates, gain a SEK8 million ($930,000) boost in revenue.
Michael Oredsson, president and CEO of BioInvent, said: "We are pleased that we have been contracted to provide additional manufacturing services to this major global pharmaceutical client.
"The extension of our relationship reflects BioInvent's world-leading expertise in antibody production based around our cGMP-certified facilities, which meet EU and standards. This new agreement is expected to generate about SEK 8 million in revenue, with the majority occurring in 2016."
This builds on the firm's recent resolve to boost its ability to produce antibodies on its own after it stumped up more cash for its single use bioreactor.
The company said in a statement that this will "benefit the development of our internal projects, and will also generate revenue from external companies."
Its current facility creates antibodies for its clients' research and trials up to Phase III testing. Its portfolio contains a number of programs aiming to treat different severe forms of cancer using its immuno-oncology antibodies.
This includes candidates for multiple myeloma, medulloblastoma, chronic lymphatic leukemia and non-Hodgkin lymphoma.
The company, which has a market cap of $607 million and trades on the Stockholm Stock Exchange, was up 1% this morning after having a downward trend for the past two weeks.
In July, the company released its interim half-year report showing net sales for January-June 2016 amounted to SEK40 million, although after tax this turned out to be a loss of: SEK27 million.
CDMO antibody BioInvent
GSK bets on tech to help boost lagging R&D
As GlaxoSmithKline looks to start a 23andMe-partnered test this year, the Big Pharma is increasingly looking to tech for its R&D.
by Ben Adams Jan 21, 2020 7:25am
LabCorp's CRO unit Covance doubles down on cell, gene therapies
LabCorp has unveiled a new suite of cell and gene therapy development offerings from Covance as it looks to get into this burgeoning area.
JPM: Execs on where the industry should look beyond cancer
Oncology is clearly a major medical and societal issue, but one that sees too much focus from biopharmas at the expense of other killers.
by Ben Adams, by Amirah Al Idrus Jan 17, 2020 10:05am

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Freeview, the UK's biggest TV platform, has jumped in to the mobile world with the launch of its new app. The Freeview app is now available on the App Store, ready for iOS users to download on to their devices.
Users of the app will be able to stream shows live from the BBC, ITV and Channel 4 and also play on-demand content on the go from BBC iPlayer, ITV Hub, All 4, My5 and UKTV Play – all for free.
The Freeview app has a number of features available to give you the best viewing experience possible. Of note is On Demand Recommendations which helpfully takes note of what entertainment you lean towards and suggests content just for you. It could be your longstanding go-to show or the new favourite that you are yet to discover but whatever it is, with thousands of hours of content and ten genres, the Freeview app will have something for every user. Bring on the TV binge!
For those who like to plan their TV-watching schedules, you'll be pleased to know that Freeview has included their trusty TV guide in the app. The TV guide will span 15 days showing content from both the previous week and the week ahead so that users will be able to plan both their live and on-demand viewing.
The Freeview app is currently available on the App Store. In keeping with its name, it's free to use as neither a download fee or subscription is required. Android users, don't worry the Android version will launch later this year.


text:
Q: XML into curly braces statement Is there any mechanism to represent XML as curly braces statement . How  achieve this using C# ?
For example, I have such XML:
<protocols>
  <bgp>
    <group>
      <name>23</name>
      <import>policy1</import>
    </group>
   </bgp>
</protocols>

Represented as Cli configuration statement:
protocols {
  bgp {
    group 23 {
      import policy1;
     }
    }
   }

redpajama_set_name: RedPajamaStackExchange


This past weekend, I had the unfortunate pleasure of using a utility pump to get water out of my basement. It was a good pump, but did not come with any instructions or trouble shooting so I was mostly wandering around blindly while inches of water came in through my basement. I thought it might help some people if I wrote about how to use it.
Sometimes the pump would not spin. This was because of silt that had gotten into the mechanism. By drilling the screws out and wiping each part down, I was able to get most of the silt out. Always make sure that the pump is turned off when you do that and try it out before you put the screws back in.
Sometimes that even doesn't work. The only way I figured out how to make the pump start working was to turn it out, put it on the floor, and then unscrew the hose until it started taking in water. Then you have to move very fast, angle the pump on its side and screw the hose back on. This way, it will start taking water up and through the hose.
Make sure to give it time to cool down. It has a little engine and it is doing a lot of work, so put it in a cool place.
Clean it completely after you are done with it.
Hopefully I won't have to use this again anytime soon. However, we need to get a few contractors out to fix things in the house and yard.
I bought my pump at Lowes. It was located in the back behind the fridge/sink/toilet display against the back wall.
Oddly enough, the most popular posts on here have to do with living in East Boston and my costume choice for last year, a German Beer Wench. People are interested in the weirdest things.
Not sure what I am going to be this year…maybe Rosie the Riveter…or a '50s Vamp. It all depends on if I can find a costume for the boy since we've never dressed up together but probably should one of these days to get it over with.


text:
In Rahul Gandhi asking PM to support Women's Reservation Bill, BJP sees Congress' double standardshttps://indianexpress.com/article/india/bjp-questions-cong-commitment-over-women-reservation-bill-blames-rahul-gandhi-of-adopting-double-standard-5262181/
In Rahul Gandhi asking PM to support Women's Reservation Bill, BJP sees Congress' double standards
In 2017, then Congress president Sonia Gandhi urged PM Modi to take advantage of the majority enjoyed by the BJP in Lok Sabha and pass the long-pending bill. The Bill was passed in the Rajya Sabha in 2010 when the Congress was in power.
By Express Web Desk |New Delhi | Updated: July 16, 2018 10:08:41 pm
Post 2019 election win, Congress will pass Women's Reservation Bill: Jyotiraditya Scindia
Rahul Gandhi promises passage of women's quota Bill if Congress voted to power
Rahul Gandhi to Punjab CM: Pass resolution in Assembly in support of Women's Reservation Bill
Congress president Rahul Gandhi.
Reacting to Rahul Gandhi's letter to Prime Minister Narendra Modi asking for support to Women's Reservation Bill, the BJP on Monday attacked the Congress for adopting double standards on the bill saying the party supports the bill on one side while it joins hands with those who are opposed to it. Union minister Prakash Javadekar sought to know whether the Congress could ensure letters of support for the bill from its own allies.
"This shows the double standard of Congress as it is in alliance with those who opposed the legislation," Javadekar said.
Referring to the Congress' grand alliance with the RJD, who has been opposing the bill, Javadekar said, "It is Congress which is sitting with those opposed to the bill. It is Congress which is in alliance with those who had opposed the Women Reservation Bill. So will now Congress come out of the alliance or will it get the letters of support from those parties?"
Our PM says he's a crusader for women's empowerment? Time for him to rise above party politics, walk-his-talk & have the Women's Reservation Bill passed by Parliament. The Congress offers him its unconditional support.
Attached is my letter to the PM. #MahilaAakrosh pic.twitter.com/IretXFFvvK
— Rahul Gandhi (@RahulGandhi) July 16, 2018
The development comes just hours after the Congress president Rahul Gandhi wrote to prime minister Narendra Modi seeking his support for the bill in the upcoming Monsoon Session of the Parliament. "I write to you to request your support to ensure the passage of the women's reservation bill in the upcoming Monsoon session of Parliament," Gandhi wrote in his letter to the prime minister.
The bill has been stalled in the Lok Sabha for over eight years on one pretext or the other, Gandhi wrote. He added that the BJP appeared to have second thoughts about the bill, though it was one of its key promises in its 2014 election manifesto.
Women Reservation Bill
In Rahul Gandhi asking PM to support Women's Reservation Bill, BJP sees Congress' double standards
1 J&K: Policeman dies after militants attack security team outside NC leader's house
2 Madhya Pradesh: Three tribals stripped naked, beaten up for alleged diesel 'theft'
3 Rajasthan: Woman thrashes man for allegedly defaming her


Because You are my Shepherd, I have everything I need!
You let me rest in the meadow grass and lead me beside the quiet streams. You give me new strength. You help me do what honors you the most.
Restore to me and my family line all that the enemy has stolen.
Restore health. Restore finances. Restore godly authority. Restore relationships.
I surrender my rights to follow Jesus Christ.
I will walk in your protective armor.
I will be a leader of grace, humbleness and mercy.
I will walk in unity with my brothers and sisters.
I will bless those who persecute me.
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I will let all wrongs roll off of me.
I will rejoice in truth.
I will protect, trust, hope and persevere.
Abba Father, I declare that I am your child.


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Shot in near darkness, lit only by a single bulb about 30 feet away, the F200 had no problem focusing and producing a good clear photo.
The F200 is great for parties and gigs, capturing clear low-noise pictures in aby lighting conditions. The band is local ska/reggae act Melosa, and they're brilliant.


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text:
Cadidavid is a borough in the municipality of Verona with 7800 inhabitants.

History

The first mention of the village is found in 1251, as Domus illorum de Davijs and was an independent municipality until 1927 when it was included in the larger city of Verona, with the name Cà di David ( Borgo Roma ).

During the Middle Ages, the village is first called Ca' dei Davi (Domus Daviorum or House of  Davi, the founding family). There are still two streets named in honour of the first inhabitants, Gerardo and Belobono.

Later, in the 15th century, a "d" is added in the end and the village is then called Cà di David ( Casa dei David), but the original spelling was also used until 1792. Even today, however, the village is still called Ca' di Dai (or Ca i Dai) in Venetian dialect / language.

Notable people
Famous persons from Cadidavid are:

Luciano Albertini, painter ( 1910 - 1985)
Aldo Sala, Mayor of Verona 1990 - 1993

References

^Comune di Verona. I quartieri della città di Verona. Differenze e similarità. Anno 2002
^https://web.archive.org/web/20141020223344/http://www.cadidavid.it/foto.html

Verona


text:
Royal Mint unveils new Beatrix Potter 50p coins with colour designs
By Telegraph Reporters 3 April 2017 • 11:42pm
Beatrix Potter's mischievous Peter Rabbit is to be joined by three other children's favourites in a roll-out of new colour coins.
The Royal Mint is bolstering the coin collection it issued last year to mark the 150th anniversary of the author's birth with a special UK release featuring Peter Rabbit followed by Benjamin Bunny, Tom Kitten and Jeremy Fisher.
The printed colour designs on the silver proof 50p coins have been created to capture the hand-painted style of Potter's original illustrations.
The coins reflect Potter's illustrations Credit: Royal Mint/PA
These will include the intense red of Jeremy Fisher's jacket, the blue of Tom Kitten's pyjamas and the green of Benjamin Bunny's hat, according to the Royal Mint.
They were created by designer Emma Noble who has previously worked on pieces commemorating the Diamond Jubilee and Remembrance Sunday.
The coins are in colour Credit: Mikael Buck/Royal Mint/PA
Anne Jessopp, of The Royal Mint, said: "While we always knew that the Beatrix Potter characters would be a huge hit, the enormous popularity of the 2016 set exceeded everyone's expectations.
"The coins sold out almost instantly as people raced to collect a complete set of the four friends. We're delighted to be able to present another group of her exquisite characters, giving them a new lease of life on our specially-designed coloured commemorative coins."
Credit: Mikael Buck/Royal Mint/PA
All four designs will find their way into people's pockets and purses later this year.
The limited edition coins Credit: Mikael Buck/Royal Mint/PA
Potter's children's book The Tale Of Peter Rabbit, the first to feature the character, was an instant success after being picked up in 1902 by British children's publisher Frederick Warne & Co.
The story has never been out of print since then and more than 45 million copies have been sold worldwide.
Potter died in 1943 aged 77.
We copy the French fetish for municipal government at our peril
Ross Clark 16 Jan 2022, 11:00am
By Raven Saunt 16 Jan 2022, 10:44am
Joe Biden's presidency is lurching from crisis to catastrophe
Freddy Gray 16 Jan 2022, 10:00am


text:
Mastochilus australasicus es una especie de coleóptero de la familia Passalidae.

Distribución geográfica
Habita en Australia.

Referencias

Australasicus
Coleópteros de Australia


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text:
Eva Roberta Coles Boone (1880 - 1902) was an African-American teacher and Baptist missionary from Charlottesville, Virginia, who served with her husband Clinton Caldwell Boone in what was then the Congo Free State, now the Congo.

Early life
Eva Roberta Coles was born January 8, 1880, in Charlottesville, Virginia. Coles attended Hartshorn Memorial College, the first college in the world for women of color. She graduated in 1899.

Career and family

After graduation, Coles returned to Charlottesville to teach. In 1901, Coles married Clinton Caldwell Boone, who had attended seminary at Virginia Union University, located a block north of Hartshorn, and earned his divinity degree in 1900. The son of a minister, he was born and grew up in Hertford County, North Carolina.

Boone and her husband received an appointment to the mission field, supported by the American Baptist Missionary Union and the Lott Carey Foreign Mission Convention. They arrived at the Palabala station in the Katanga province of the Congo Free State on May 24, 1901.

At this time, it was unusual and controversial for American religious organizations to offer people of color missionary opportunities to serve in Africa. At the Palabala station, she taught kindergarten, administered medical treatment, and organized a sewing circle for the women of the village. She tried to teach women to sew, but in the culture of the Kongo people, men traditionally dominated this work. She gradually worked to change cultural taboos against women sewing. The women of the village called her "Mama Bunu".

Coles died of a venomous bite on December 8, 1902 in Palaballa, Congo Free State (now part of the Democratic Republic of the Congo). She and her husband had already suffered the death of their child as an infant.

References

1880 births
1902 deaths
American women educators
African-American educators
African-American missionaries
20th-century African-American people
20th-century African-American women


text:
List of MPs elected in the 1761 British general election

This is a list of the 558 MPs or Members of Parliament elected to the 314 constituencies of the Parliament of Great Britain in 1761, the 12th Parliament of Great Britain and their replacements returned at subsequent by-elections, arranged by constituency.

By-elections
List of Great Britain by-elections (1754–74)

See also
1761 British general election
List of parliaments of Great Britain
Unreformed House of Commons

References

 The House of Commons 1754–1790, by Sir Lewis Namier and John Brooke (HMSO 1964)

External links
 History of Parliament: Members 1754–1790
 History of Parliament: Constituencies 1754–1790

1761
1761
1761 in Great Britain
Lists of Members of the Parliament of Great Britain


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As modern consumers, we can purchase an incredible variety of foods packaged in durable metal containers. Alternatively, we can grow (or purchase) fresh foods and "can" them ourselves in glass jars with relatively simple equipment. Both options are good, depending upon your skills, interests, and funding.
Commercial canned foods will be labeled with a date that the food should be "best" before. That doesn't mean the food is inedible after that date, it only means that the manufacturer doesn't stand by the appearance or flavor after that date. With most commercially canned foods, if they look edible and they smell edible, they are edible. However, throw out any cans which are bulging or leaking — without attempting to smell them.
Manufacturers normally label canned foods to be eaten within 1 to 5 years. Sir John Franklin abandoned some canned food in the Arctic during Franklin's Lost Expedition in 1845. The contents were edible and nutritious when they were opened in 1939, and that was with the primitive solder-sealing methods of the 19th century. The steamboat Bertrand sank in the Missouri River in 1865. When canned food from the wreck was tested in 1974, it was still safe and nutritious — though it's smell and flavor had deteriorated.
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With these highly acidic foods, all you need to do is to heat the food to the boiling temperature of water (212°F/100°C at sea level) to kill off the lesser bacteria, yeasts, and molds.


Posted on May 21, 2016 by Saurabh Agarwal.
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We have been very busy lately. Both with dogs and cats. Thank you to all my loyal customers and welcome to new ones too. On a personal note sadly I had to say a tearful farewell to my beloved pony Norman. We had him for 19 years. He was my little driving pony, teaching me the art of driving the harness horse. He will never be forgotten. Run free my special friend with Millie and Seren.


Churchill Brothers will face Real Kashmir at their stadium to play the next game of the Indian I-League.
Churchill Brothers possess the second place in the table. The hosts earned twenty-eight points after fourteen games.
Real Kashmir are third here. The guests have the same stats with worse additional parameters.
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