Prevention of violence against women and girls: A cost-effectiveness study across 6 low- and middle-income countries

BackgroundViolence against women and girls (VAWG) is a human rights violation with social, economic, and health consequences for survivors, perpetrators, and society. Robust evidence on economic, social, and health impact, plus the cost of delivery of VAWG prevention, is critical to making the case for investment, particularly in low- and middle-income countries (LMICs) where health sector resources are highly constrained. We report on the costs and health impact of VAWG prevention in 6 countries.Methods and findingsWe conducted a trial-based cost-effectiveness analysis of VAWG prevention interventions using primary data from 5 randomised controlled trials (RCTs) in sub-Saharan Africa and 1 in South Asia. We evaluated 2 school-based interventions aimed at adolescents (11 to 14 years old) and 2 workshop-based (small group or one to one) interventions, 1 community-based intervention, and 1 combined small group and community-based programme all aimed at adult men and women (18+ years old). All interventions were delivered between 2015 and 2018 and were compared to a do-nothing scenario, except for one of the school-based interventions (government-mandated programme) and for the combined intervention (access to financial services in small groups). We computed the health burden from VAWG with disability-adjusted life year (DALY). We estimated per capita DALYs averted using statistical models that reflect each trial’s design and any baseline imbalances. We report cost-effectiveness as cost per DALY averted and characterise uncertainty in the estimates with probabilistic sensitivity analysis (PSA) and cost-effectiveness acceptability curves (CEACs), which show the probability of cost-effectiveness at different thresholds. We report a subgroup analysis of the small group component of the combined intervention and no other subgroup analysis. We also report an impact inventory to illustrate interventions’ socioeconomic impact beyond health. We use a 3% discount rate for investment costs and a 1-year time horizon, assuming no effects post the intervention period. From a health sector perspective, the cost per DALY averted varies between US$222 (2018), for an established gender attitudes and harmful social norms change community-based intervention in Ghana, to US$17,548 (2018) for a livelihoods intervention in South Africa. Taking a societal perspective and including wider economic impact improves the cost-effectiveness of some interventions but reduces others. For example, interventions with positive economic impacts, often those with explicit economic goals, offset implementation costs and achieve more favourable cost-effectiveness ratios. Results are robust to sensitivity analyses. Our DALYs include a subset of the health consequences of VAWG exposure; we assume no mortality impact from any of the health consequences included in the DALYs calculations. In both cases, we may be underestimating overall health impact. We also do not report on participants’ health costs.ConclusionsWe demonstrate that investment in established community-based VAWG prevention interventions can improve population health in LMICs, even within highly constrained health budgets. However, several VAWG prevention interventions require further modification to achieve affordability and cost-effectiveness at scale. Broadening the range of social, health, and economic outcomes captured in future cost-effectiveness assessments remains critical to justifying the investment urgently required to prevent VAWG globally.

In a cost-effectiveness study, Dr. Giulia Ferrari and colleagues examine the costs and health impact of prevention of violence against women and girls in six low- and middle-income countries.     

Microsomal triglyceride transfer protein and its role in apoB-lipoprotein assembly

Apolipoprotein B (apoB) and microsomal triglyceride transfer protein (MTP) are necessary for lipoprotein assembly. ApoB consists of five structural domains, betaalpha(1)-beta(1)-alpha(2)-beta(2)-alpha(3). We propose that MTP contains three structural motifs (N-terminal beta-barrel, central alpha-helix, and C-terminal lipid cavity) and three functional domains (lipid transfer, membrane associating, and apoB binding). MTP's lipid transfer activity is required for the assembly of lipoproteins. This activity renders nascent apoB secretion-competent and may be involved in the import of triglycerides into the lumen of endoplasmic reticulum. In addition, MTP binds to apoB with high affinity involving ionic interactions. MTP interacts at multiple sites in the N-terminal betaalpha(1) structural domain of apoB. A novel antagonist that inhibits apoB-MTP binding decreases apoB secretion. Furthermore, site-directed mutagenesis and deletion analyses that inhibit apoB-MTP binding decrease apoB secretion. Lipids modulate protein-protein interactions between apoB and MTP. Lipids associated with MTP increase apoB-MTP binding whereas lipids associated with apoB decrease this binding. Thus, specific antagonist, site-directed mutagenesis, deletion analyses, and modulation studies support the notion that apoB-MTP binding plays a role in lipoprotein biogenesis. However, specific steps in lipoprotein assembly that require apoB-MTP binding have not been identified. ApoB-MTP binding may be important for the prevention of degradation and lipidation of nascent apoB.     

Putative Virulence Genes and Biofilm Production Among Typical Enteroaggregative Escherichia coli Isolates from Diarrhoeic Children in Kashmir and Andhra Pradesh

Fifty-eight typical EAEC isolates from children with diarrhoea were examined for HEp-2 cell adherence assay, presence of dispersin (aap), yersiniabactin (irp2), plasmid encoded toxins (pet), Shigella enterotoxin1 (set1A) and cryptic open reading frame (shf) putative virulence genes by polymerase chain reaction as well as for biofilm production. All the isolates showed aggregative adherence pattern on HEp-2 cells. All but five isolates (91.3 %) carried aap gene. While irp2, pet, set1A and shf genes were detected in 68.9, 5.1, 39.6, and 60.3 % isolates, respectively. Thirty-three (64.7 %) isolates out of 51 tested were found to produce biofilm which was found to be significantly associated only with set1A virulence gene (P = 0.025). Highest amount of biofilm was produced by a strain that possessed all the genes studied. Out of 14 isolates in which the most frequent gene combination (aap, irp2 and shf) was observed, only six produced biofilm. It is concluded that there is significant heterogeneity in putative virulence genes of EAEC isolates from diarrhoeic children and biofilm formation is associated with multiple genes.     

Rearing, reproductive behaviour and gamma sterilization of fruit fly, Dacus zonatus (Diptera: Tephritidae)

Investigations were made on rearing, reproductive behaviour and gamma sterilization of one-day old male adults of Dacus zonatus. The larvae were successfully reared on an artificial diet based on wheat shorts. Adult emergence ranged from 89–99% with a sex ratio of about 1:1. Mating occurred at dusk and its duration ranged from 8–13 hours. Males mated a second time with the same female but preferred mating if the already mated female was replaced with a sexually mature virgin female. The optimum dosage for inducing sterility amongst one-day old male adults was 12 kR.

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Zusammenfassung Zucht und Fortpflanzungsverhalten von Dacus zonatus (Saunders) wurde untersucht. Die Larven wurden vier Generationen lang an einer Diät aus Weizenkleie, Bierhefe, granuliertem Zucker, Agar, Nipagin, Salzsäure und Wasser gehalten. Die Arbeit gibt Daten über Verpuppungsprozentsatz (69,3%), Puppengewicht, Dauer der Ei + Larvenperiode, Schlüpfen der Adulten, Präovipositionszeit, Fruchtbarkeit, Fertilität und Lebensdauer der Adulten. Die Schlüpfrate der Adulten betrug 89–99%, das Geschlechtsverhältnis lag etwa bei 1:1. Die Kopulation findet während der Abenddämmerung statt, sie dauert 8–13 Stunden. Maximum der Kopulationen zwischen dem 10. und 15. Tag nach dem Schlüpfen. Männchen paarten sich ein zweites Mal mit dem gleichen Weibchen, bevorzugten jedoch geschlechtsreife jung-fräuliche Weibchen. Die Eiablage begann am 2.–7. Tag nach der Paarung, die Eizahl betrug bei gepaarten Weibchen 91–564.Die optimale Dosis zur Erzeugung von 99,3% Sterilität bei Bestrahlung von einem Tag alten Männchen war 12 kR. Die Lebensdauer der Bestrahlten war vermindert.

     

Ethnobotanical studies of plants of Charkotli Hills, Batkhela District, Malakand, Pakistan

A survey was conducted with the aim to document the indigenous information of Charkotli Hills, Batkhela District, Malakand, Pakistan. The area has rich vegetation and a high potential for ethnobotanical utilization. Information was collected on various traditional uses of 100 plants distributed over 49 families, of which 43 families were of dicot, 2 of monocot, 2 of pteridophyta, and 1 of gymnosperms. Most plants have more than one local use. Sixty-six plants were found to be medicinal species, 21 fruit and edible seed species, 11 furniture species, 18 fodder or forage species, 12 vegetable species, 12 fuel species, 11 thatching and building species, 5 hedge or fencing species, 5 timber wood species, 5 poisonous plants, 3 species used in ketchup, 2 fixed oil yielding species, 2 miswak species, 2 species for making sticks for cattle and defense purposes, 2 species cultivated for ornamental purposes, 2 species used as mehindi by girls, 1 irritant species, 1 species for the making of Salai (a little stick for applying ‘surma’ to the eyes), 1 species for tanning, 1 species used as refresher in milk pots, 1 species giving gum used as chewing gum, and 1 species used as insect repellent. The area is under heavy pressure of deforestation and overgrazing, which have reduced the regeneration of woody plants. Proper ecological management is required to protect the wildlife and ethnobotanical resources for the coming generations.     

Engineering novel traits in plants through RNA interference

RNA interference (RNAi) is a homology-dependent gene silencing technology that involves double-stranded RNA directed against a target gene or its promoter region. Using hairpin constructs, double-stranded RNA can be expressed in plants relatively easily, enabling this technology to be applied to a wide range of species to silence the expression of both specific endogenous genes and genes of invading pathogens. RNAi has also been used to engineer metabolic pathways to overproduce secondary products with health, yield or environmental benefits. The application of tissue-specific or inducible gene silencing, with the use of appropriate promoters, and the ability to silence several genes simultaneously should enhance our ability to create novel traits in plants.     

Identification of drought tolerant Chickpea genotypes through multi trait stability index

Drought is a major and constantly increasing abiotic stress factor, thus limiting chickpea production. Like other crops, Kabuli Chickpea genotypes are screened for drought stress through Multi-environment trials (METs). Although, METs analysis is generally executed taking into account only one trait, which provides less significant reliability for the recommendation of genotypes as compared to multi trait-based analysis. Multi trait-based analysis could be used to recommend genotypes across diverse environments. Hence, current research was conducted for selection of superior genotypes through multi-trait stability index (MTSI) by using mixed and fixed effect models under six diverse environments. The genotypic stability was computed for all traits individually using the weighted average of absolute scores from the singular value decomposition of the matrix of best linear unbiased predictions for the genotype vs environment interaction (GEI) effects produced by a linear mixed-effect model index. A superiority index, WAASBY was measured to reflect the MPS (Mean performance and stability). The selection differential for the WAASBY index was 11.2%, 18.49% and 23.30% for grain yield (GY), primary branches per plant (PBP) and Stomatal Conductance (STOMA) respectively. Positive selection differential (0.80% ≤ selection differential ≤ 13.00%) were examined for traits averaged desired to be increased and negative (-0.57% ≤ selection differential ≤ -0.23%) for those traits desired to be reduced. The MTSI may be valuable to the plant breeders for the selection of genotypes based on many characters as being strong and simple selection process. Analysis of MTSI for multiple environments revealed that, the genotypes G20, G86, G31, G28, G116, G12, G105, G45, G50, G10, G30, G117, G81, G48, G85, G17, G32, G4, and G37 were the most stable and high yielding out of 120 chickpea genotypes, probably due to high MPS of selected traits under various environments. It is concluded that identified traits can be utilized as genitors in hybridization programs for the development of drought tolerant Kabuli Chickpea breeding material.