Determining the effects of wind-aided midge movement on the outbreak and coexistence of multiple bluetongue virus serotypes in patchy environments.

Bluetongue virus (BTV) has 27 serotypes with some of them coexisting in different environments which make its control difficult. Wind-aided midge movement is a known mechanism in the spread of BTV. However, its effects on the dynamics of multiple BTV serotypes are not clear. Ordinary differential equation (ODE) and continuous-time Markov chain (CTMC) models for two BTV serotypes in an environment divided into two patches depending on the risk of infection are formulated and analysed. By approximating the CTMC model with a multitype branching process, an estimate for the probability of a major outbreak of two BTV serotypes is obtained. It is shown that without movement a major outbreak occurs in the high-risk patch, but with cattle or midge movement it occurs in both patches. When a major outbreak occurs, numerical simulations of the ODE model illustrate possible coexistence in both patches if the patches are connected by midge or cattle movement. Sensitivity analysis, based on the Latin hypercube sampling method, identified midge mortality and biting rates as being the most important in determining the magnitude of the probability of a major outbreak. These results indicate the significance of wind-aided midge movement on the outbreak and coexistence of multiple BTV serotypes in patchy environments.

Perceptions on preeclampsia and eclampsia among senior, older women, in rural Southwestern Uganda.

BACKGROUND: Eclampsia is among the leading causes of maternal mortality. It is a serious hypertensive complication of pregnancy and increases the risk of cardiovascular disease in later life. Pregnancy-related hypertension complications predispose to chronic hypertension and premature heart attacks. A significant proportion of women with preeclampsia/eclampsia does not reach the formal healthcare system or arrive too late because of certain traditional or cultural beliefs about the condition. The older, senior women in the community are knowledgeable and play a significant role in decision making regarding where mothers should seek maternal health care. Therefore, the purpose of this study was to explore the perceptions of older and senior women regarding the manifestation of, risk factors and possible causes of preeclampsia/eclampsia. METHODS: We conducted a qualitative study in rural Southwestern Uganda. The key informants were senior, older women including community elders, village health team members and traditional birth attendants who were believed to hold local knowledge and influence on birth and delivery. We purposively selected key informants and data were collected till we reached saturation point. We analyzed data using an inductive thematic approach to identify themes. RESULTS: We interviewed 20 key informants with four themes identified. The 'causes' theme emerged from the subthemes of confusion with other conditions, spiritual beliefs and high blood pressure. The 'risk factors' theme emerged from the subthemes of oedema-related illnesses, poverty-induced malnutrition, and strained relationships. The 'remedies' theme emerged from the consistent mention of traditional herbal treatment, seek medical help, spiritual healing, emotional healing and corrective nutrition as potential solutions. The theme 'effects of preeclampsia/eclampsia' emerged from the mention of pregnancy complications like premature delivery, child loss, operative delivery like caesarian section delivery as well as death. There was no identifiable local name from the interviews. Women carried several myths regarding the cause and these included little blood, witchcraft, ghost attacks and stress from strained relationships including marital tension. Women were generally aware of the outcomes of eclampsia, mainly that it kills. CONCLUSIONS: Eclampsia is associated with significant myths and misconceptions in this rural community. We recommend interventions to increase awareness and dispel these myths and misconceptions, increase access to antenatal preeclampsia surveillance, and facilitate timely referral for basic maternity care as means for early detection and management of preeclampsia.

The Joint Mobile Emerging Disease Clinical Capability (JMEDICC) laboratory approach: Capabilities for high-consequence pathogen clinical research.

Following the 2013-2016 Ebola virus outbreak in West Africa, numerous groups advocated for the importance of executing clinical trials in outbreak settings. The difficulties associated with obtaining reliable data to support regulatory approval of investigational vaccines and therapeutics during that outbreak were a disappointment on a research and product development level, as well as on a humanitarian level. In response to lessons learned from the outbreak, the United States Department of Defense established a multi-institute project called the Joint Mobile Emerging Disease Intervention Clinical Capability (JMEDICC). JMEDICC's primary objective is to establish the technical capability in western Uganda to execute clinical trials during outbreaks of high-consequence pathogens such as the Ebola virus. A critical component of clinical trial execution is the establishment of laboratory operations. Technical, logistical, and political challenges complicate laboratory operations, and these challenges have been mitigated by JMEDICC to enable readiness for laboratory outbreak response operations.