Background: Despite the recognition of the importance of indoor microbial exposures on children’s health, the role of different microbial agents in development and aggravation of respiratory symptoms and diseases is only poorly understood. This study aimed to assess whether exposure to microbial aerosols within the indoor environment are associated with respiratory symptoms among children under-5 years of age.Methods: A systematic literature search was conducted on PubMed, Web of Science, GreenFILE, ScienceDirect, EMBASE and Cochrane library through February 2020. Studies that investigated the exposure–response relationship between components of the indoor microbial communities and respiratory symptoms among under-five children were eligible for inclusion. A random-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI) for study specific high versus low microbial exposures. The potential effect of individual studies on the overall estimate was evaluated using leave-one-out analysis, while heterogeneity was evaluated byI²statistics using RevMan 5.3.Results: Fifteen studies were eligible for inclusion in a meta-analysis. The pooled risk estimate suggested that increased microbial exposure was associated with an increased risk of respiratory symptoms [pooled relative risk (RR): 1.24 (1.09, 1.41),P = 0.001]. The association was strongest with exposure to a combination ofAspergillus,Penicillium, Cladosporium and Alternariaspecies [pooled RR: 1.73 (1.30, 2.31),P = 0.0002]. Stratified analysis revealed an increased risk of wheeze [pooled RR: 1.20 (1.05, 1.37),P = 0.007 and allergic rhinitis [RR: 1.18 (0.94, 1.98),P = 0.16] from any microbial exposure.Conclusions: Microbial exposures are, in general, associated with risk of respiratory symptoms. Future studies are needed to study the indoor microbiome more comprehensively, and to investigate the mechanism of these associations.

Background: Using tailored mobile health interventions to improve global vascular risk awareness and control is yet to be investigated for primary stroke prevention in Africa. Methods: This 2-arm pilot randomized controlled trial involved 100 stroke-free adults with at least 2 vascular risk factors for stroke. Eligible participants were assigned randomly to a control arm offering 1-time counseling (n=50) or a 2-month educational intervention arm (n=50) comprising a stroke video and riskometer app aimed at improving stroke risk factor awareness and health-seeking behavioral modification to control total vascular risk. Reduction in total stroke risk score was the primary outcome while feasibility and process measures were secondary outcomes. Results: All enrolled participants completed the 2-month follow-up (retention rate=100%). The mean (SD) age of participants was 59.5 (±12.5) years, 38% were males. The mean change in stroke risk score at 2 months was −11.9% (±14.2) in the intervention arm versus −1.2% (±9.1) in the control arm, P =0.0001. Stroke risk awareness improved by 16.1% (±24.7) in the intervention arm versus 8.9% (±24.7) in the control arm, P =0.08. The intervention arm had 11.1 mm Hg reduction in systolic blood pressure compared with 4.8 mm Hg reduction in the control arm. Conclusions: The intervention demonstrated a positive signal of effect over a 2-month period. A definitive clinical trial with a longer duration of follow-up is warranted on the premise of these promising findings from this pilot randomized clinical trial. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05619406.

Acute respiratory infection is the fourth major cause of morbidity and mortality among children under five globally. However, information on housing characteristics that could predispose children under five to these infections is scanty in Nigeria. Therefore, this study assessed the quality of housing and its contribution to the acquisition of acute respiratory infections among children under five in Ibadan. A prospective case–control design was employed for this study. Two hundred and twenty children under five each with acute respiratory infection (cases) and without acute respiratory infection (controls) were selected from children visiting Oni-memorial Children Hospital and University College Hospital, Ibadan. A survey of 66 consented cases and controls each was carried out using a checklist to assess indoor housing indicators. Data were analysed using descriptive statistics, Chi-square and logistic regression at p < 0.05. More cases (43, 65.2%) than controls (28, 42.4%) reside in houses with poor housing quality (OR 2.5; 95% CI = 1.3–5.1). Presence of damp roof (OR 2.9; 95% CI = 1.1–8.1), mould growth on walls (OR 6.3; 95% CI = 2.0–19.6) and high indoor air relative humidity (OR 10.2; 95% CI = 3.0–35.2) were significant risk factors for acute respiratory infections in children under five. Inadequate housing conditions play an important role in the acquisition of acute respiratory infections. Therefore, considerable effort should be made to educate mothers of children under five on improved housing and hygiene conditions in order to reduce childhood morbidity and mortality risks associated with acute respiratory infections.

Background: Baseline stroke severity is probably partly responsible for poor stroke outcomes in sub‐Saharan Africa. However, there is a paucity of information on determinants of stroke severity among indigenous Africans. We sought to identify the factors associated with stroke severity among West Africans in the SIREN (Stroke Investigative Research and Educational Networks) study. Methods and Results: Stroke was diagnosed clinically and confirmed with brain neuroimaging. Severe stroke was defined as a Stroke Levity Scale score of ≤5. A multivariate logistic regression model was constructed to identify factors associated with stroke severity at 95% CI and a nominal cutoff of 5% type 1 error. A total of 3660 stroke cases were included. Overall, 50.7%% had severe stroke, including 47.6% of all ischemic strokes and 56.1% of intracerebral hemorrhage. Factors independently associated with severe stroke were meat consumption (adjusted odds ratio [aOR], 1.97 [95% CI, 1.43–2.73]), low vegetable consumption (aOR, 2.45 [95% CI, 1.93–3.12]), and lesion volume, with an aOR of 1.67 (95% CI, 1.03–2.72) for lesion volume of 10 to 30 cm ³ and aOR of 3.88 (95% CI, 1.93–7.81) for lesion volume >30 cm ³ . Severe ischemic stroke was independently associated with total anterior circulation infarction (aOR, 3.1 [95% CI, 1.5–6.9]), posterior circulation infarction (aOR, 2.2 [95% CI, 1.1–4.2]), and partial anterior circulation infarction (aOR, 2.0 [95% CI, 1.2–3.3]) compared with lacunar stroke. Increasing age (aOR, 2.6 [95% CI, 1.3–5.2]) and lesion volume >30 cm ³ (aOR, 6.2 [95% CI, 2.0–19.3]) were independently associated with severe intracerebral hemorrhage. Conclusions: Severe stroke is common among indigenous West Africans, where modifiable dietary factors are independently associated with it. These factors could be targeted to reduce the burden of severe stroke.