Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study.

BACKGROUND: In the African region, 5.6% of pregnancies are estimated to be complicated by preeclampsia and 2.9% by eclampsia, with almost one in ten maternal deaths being associated with hypertensive disorders. In Sierra Leone, representing one of the countries with the highest maternal mortality rates in the world, 16% of maternal deaths were caused by pregnancy-induced hypertension in 2016. In the light of the high burden of preeclampsia and eclampsia (PrE/E) in Sierra Leone, we aimed at assessing population-based risk factors for PrE/E to offer improved management for women at risk. METHODS: A facility-based, unmatched observational case-control study was conducted in Princess Christian Maternity Hospital (PCMH). PCMH is situated in Freetown and is the only health care facility providing 'Comprehensive Emergency Obstetric and Neonatal Care services' throughout the entire country. Cases were defined as pregnant or postpartum women diagnosed with PrE/E, and controls as normotensive postpartum women. Data collection was performed with a questionnaire assessing a wide spectrum of factors influencing pregnant women's health. Statistical analysis was performed by estimating a binary logistic regression model. RESULTS: We analyzed data of 672 women, 214 cases and 458 controls. The analysis yielded several independent predictors for PrE/E, including family predisposition for PrE/E (AOR = 2.72, 95% CI: 1.46-5.07), preexisting hypertension (AOR = 3.64, 95% CI: 1.32-10.06), a high mid-upper arm circumflex (AOR = 3.09, 95% CI: 1.83-5.22), presence of urinary tract infection during pregnancy (AOR = 2.02, 95% CI: 1.28-3.19), presence of prolonged diarrhoea during pregnancy (AOR = 2.81, 95% CI: 1.63-4.86), low maternal assets (AOR = 2.56, 95% CI: 1.63-4.02), inadequate fruit intake (AOR = 2.58, 95% CI: 1.64-4.06), well or borehole water as the main source of drinking water (AOR = 2.05, 95% CI: 1.31-3.23) and living close to a waste deposit (AOR = 1.94, 95% CI: 1.15-3.25). CONCLUSION: Our findings suggest that systematic assessment of identified PrE/E risk factors, including a family predisposition for PrE/E, preexisting hypertension, or obesity, should be performed early on in ANC, followed by continued close monitoring of first signs and symptoms of PrE/E. Additionally, counseling on nutrition, exercise, and water safety is needed throughout pregnancy as well as education on improved hygiene behavior. Further research on sources of environmental pollution in Freetown is urgently required.

Characterization of a hospital-based gastroenteritis outbreak caused by GII.6 norovirus in Jinshan, China.

An acute gastroenteritis (AGE) outbreak caused by a norovirus occurred at a hospital in Shanghai, China, was studied for molecular epidemiology, host susceptibility and serological roles. Rectal and environmental swabs, paired serum samples and saliva specimens were collected. Pathogens were detected by real-time polymerase chain reaction and DNA sequencing. Histo-blood group antigens (HBGA) phenotypes of saliva samples and their binding to norovirus protruding proteins were determined by enzyme-linked immunosorbent assay. The HBGA-binding interfaces and the surrounding region were analysed by the MegAlign program of DNAstar 7.1. Twenty-seven individuals in two care units were attacked with AGE at attack rates of 9.02 and 11.68%. Eighteen (78.2%) symptomatic and five (38.4%) asymptomatic individuals were GII.6/b norovirus positive. Saliva-based HBGA phenotyping showed that all symptomatic and asymptomatic cases belonged to A, B, AB or O secretors. Only four (16.7%) out of the 24 tested serum samples showed low blockade activity against HBGA-norovirus binding at the acute phase, whereas 11 (45.8%) samples at the convalescence stage showed seroconversion of such blockade. Specific blockade antibody in the population played an essential role in this norovirus epidemic. A wide HBGA-binding spectrum of GII.6 supports a need for continuous health attention and surveillance in different settings.

Maternal caesarean section infection (MACSI) in Sierra Leone: a case-control study.

Sierra Leone is the country with highest maternal mortality and infections are the underlying cause in 11% of maternal deaths, but the real burden remains unknown. This study aims to determine the incidence and risk factors of surgical site infection (SSI) post-caesarean section (CS) in women admitted to Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. A prospective case-control (1:3 ratio) study was implemented from 1 May 2018 to 30 April 2019 and 11 women presenting with suspected or confirmed infection post-CS were screened for inclusion as a case. For each case, three patients undergoing CS on the same day and admitted to the same ward, but not presenting with SSI, were selected as controls. The post-CS infection rate was 10.9%. Two hundred and fifty-four clinically confirmed cases were enrolled and matched with 762 control patients. By multivariable analysis, the risk factors for SSI were: being single (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.36-1.66), low education level (OR 1.68, 95% CI 1.55-1.84), previous CS (OR 1.27, 95% CI 1.10-1.52), presenting with premature membranes rupture (OR 1.49, 95% CI 1.18-1.88), a long decision-incision time (OR 2.08, 95% CI 1.74-2.24) and a high missing post-CS antibiotic doses rate (OR 2.52, 95% CI 2.10-2.85).

The Ebola outbreak: effects on HIV reporting, testing and care in Bonthe district, rural Sierra Leone.

Setting: All public health facilities in Bonthe District, rural Sierra Leone. Objective: To compare, in the periods before and during the Ebola virus disease outbreak, 1) the submission and completeness of monthly human immunodeficiency virus (HIV) reports, and 2) the uptake of HIV testing and care for pregnant women and the general population. Design: A cross-sectional study using routine programme data. Results: Of the 627 HIV reports expected in each period, 406 (65%) were submitted in the pre-Ebola period and 376 (60%) during the Ebola outbreak (P = 0.08), of which respectively 318 (78%) and 335 (89%) had complete information (P < 0.001). In the pre-Ebola period, 5012 pregnant women underwent testing for HIV, of whom 25 were HIV-positive, compared to 4254 during the Ebola period, of whom 21 were HIV-positive (P < 0.001). Of those who were HIV-positive, respectively 14 (56%) and 21 (100%) received antiretroviral prophylaxis or antiretroviral therapy (ART) (P < 0.001). In the general population, 5770 persons underwent HIV testing pre-Ebola vs. 3095 in the Ebola period (P < 0.001); of those who tested positive for HIV, respectively 62% (33/53) and 81% (33/41) were started on ART (P = 0.06). Conclusion: There was suboptimal reporting on HIV/acquired immune-deficiency disease syndrome activities before and during the Ebola virus disease outbreak. HIV testing decreased during the Ebola outbreak, while the uptake of prevention of mother-to-child transmission and ART increased. Pre-emptive actions are needed to maintain the levels of HIV testing in any future outbreak.

Contexte : Toutes les structures de santé publiques du district de Bonthe, Sierra Leone rurale.Objectif : Au cours des périodes avant et pendant l'épidémie d'Ebola, comparer 1) la soumission et la complétude des rapports mensuels du virus de l'immunodéficience humaine (VIH), et 2) la couverture du test VIH et les soins des femmes enceintes et de la population générale.Schéma : Étude transversale grâce à des données de routine du programme.Résultats : Sur les 627 rapports relatifs au VIH attendus pour chaque période, 406 (65%) ont été soumis avant Ebola et 376 (60%) pendant l'épidémie d'Ebola (P = 0,08) ; 318 (78%) des rapports pré Ebola et 335 (89%) des rapports de la période Ebola comportaient des informations complètes (P < 0,001). Dans la période pré-Ebola, 5012 femmes enceintes ont eu un test VIH (dont 25 VIH positives) comparées aux 4254 (dont 21 VIH positives) pendant Ebola (P < 0,001), et parmi les femmes VIH positives, respectivement 14 (56%) et 21 (100%) ont reçu une prophylaxie antirétrovirale ou un traitement antirétroviral (TAR) (P < 0,001). Dans la population générale, 5770 personnes ont été testées pour le VIH avant Ebola et 3095 pendant Ebola (P < 0,001). Parmi les personnes VIH positives, respectivement 62% (33/53) et 81% (33/41) ont mis en route un TAR avant et pendant Ebola (P = 0,06).Conclusion : Les rapports relatifs aux activités VIH/SIDA (syndrome de l'immunodéficience acquise) avant et après l'épidémie d'Ebola ont été sous-optimaux. La couverture du test VIH a diminué pendant l'épidémie d'Ebola, tandis que la couverture de la prévention de la transmission mère-enfant et TAR a augmenté. Des efforts de prévention sont requis pour maintenir l'utilisation du test VIH dans toute épidémie à venir.

Marco de referencia: Todos los establecimientos públicos de atención de salud del distrito Bonthe en una zona rural de Sierra Leona.Objetivo: Al analizar el período anterior a la epidemia de fiebre hemorrágica del Ébola y el período epidémico, se compararon los siguientes aspectos: 1) la rendición de informes mensuales sobre el virus de la inmunodeficiencia humana (VIH) y su integridad; y 2) la aceptación de las pruebas diagnósticas de la infección por el VIH y la adhesión al tratamiento por parte de las embarazadas y la población general.Método: Un estudio transversal a partir de los datos corrientes del programa.Resultados: De los 627 informes sobre el VIH previstos en cada período, antes de la epidemia del Ébola se enviaron 406 informes (65%) y durante la misma 376 (60%; P = 0,08); la información transmitida fue completa en 318 informes anteriores a la epidemia (78%) y en 335 de los informes presentados durante el brote (89%; P < 0,001). Antes de la epidemia del Ébola se practicó la prueba del VIH a 5012 embarazadas (25 resultados positivos), en comparación con 4254 durante la epidemia (21 resultados positivos; P < 0,001); antes del brote, de las pacientes con resultado positivo, 14 recibieron profilaxis o tratamiento con medicamentos antirretrovíricos (TAR) (56%) y 21 pacientes durante epidemia (100%; P < 0,001). En la población general, antes del brote del Ébola se practicó la prueba del VIH a 5770 personas y durante la epidemia a 3095 personas (P < 0,001). De las personas positivas frente al VIH antes del brote, el 62% inició el TAR (33 de 53) y el 81% durante la epidemia (33 de 41; P = 0,06).Conclusión: Se constató una deficiencia en la notificación de las actividades de atención del VIH/sida antes del brote epidémico y durante el mismo. La realización de pruebas diagnósticas del VIH disminuyó durante la epidemia, pero aumentó la administración del TAR y la prevención de la transmisión madre al niño. Se precisan medidas anticipatorias que permitan conservar la tasa de utilización de la prueba del VIH durante todo episodio epidémico futuro.

Failure mode and effects analysis of the universal anaesthesia machine in two tertiary care hospitals in Sierra Leone.

BACKGROUND: Anaesthesia care in developed countries involves sophisticated technology and experienced providers. However, advanced machines may be inoperable or fail frequently when placed into the austere medical environment of a developing country. Failure mode and effects analysis (FMEA) is a method for engaging local staff in identifying real or potential breakdowns in processes or work systems and to develop strategies to mitigate risks. METHODS: Nurse anaesthetists from the two tertiary care hospitals in Freetown, Sierra Leone, participated in three sessions moderated by a human factors specialist and an anaesthesiologist. Sessions were audio recorded, and group discussion graphically mapped by the session facilitator for analysis and commentary. These sessions sought to identify potential barriers to implementing an anaesthesia machine designed for austere medical environments-the universal anaesthesia machine (UAM)--and also engaging local nurse anaesthetists in identifying potential solutions to these barriers. RESULTS: Participating Sierra Leonean clinicians identified five main categories of failure modes (resource availability, environmental issues, staff knowledge and attitudes, and workload and staffing issues) and four categories of mitigation strategies (resource management plans, engaging and educating stakeholders, peer support for new machine use, and collectively advocating for needed resources). CONCLUSIONS: We identified factors that may limit the impact of a UAM and devised likely effective strategies for mitigating those risks.

Cerebral vasculitis and Cardiobacterium valvarum endocarditis.

We present a case of aortic and tricuspid native valve endocarditis in which Cardiobacterium valvarum was isolated from the blood culture of a 65-year-old man. Cardiobacterium valvarum is a fastidious, Gram-negative bacillus. The genus Cardiobacterium encompasses two species - Cardiobacterium valvarum and Cardiobacterium hominis. Although both species rarely feature as the aetiological agent of endocarditis, Cardiobacterium hominis has a higher incidence than Cardiobacterium valvarum. For this causative organism, we believe this is the first report of fatality prior to surgical intervention and the first clinical course to be complicated by cerebral vasculitis. Native valve endocarditis caused by Gram-negative bacilli is extremely rare and identification of isolates may require the use of reference laboratories with molecular identification techniques.

Comparison of albendazole and levamisole chemotherapy on prevalence and intensity of common soil-transmitted helminth infections in school children, Sierra Leone.

A comparison of two studies performed in Sierra Leone on the effect of anthelmintic, chemotherapy, levamisole, albendazole or a placebo in children aged 6 to 10 years on the prevalence and intensity of common soil transmitted helminths (S-THs) infections is presented. In total 501 children were screened, and 394 successfully follow-up. At baseline their overall prevalence and intensity (epg) of Ascaris, Necator and Trichuris were 34% (2,877), 22% (284) and 39% (266) respectively. At baseline there was no significant difference in the intensity of S-THs infections in the different treatment groups but the prevalence of Necator was significantly higher in the levamisole than the albendazole group (p < 0.05). At follow-up both albendazole and levamisole significantly reduced prevalence and intensity of Ascaris and Trichuris. Only albendazole significantly reduced those of Necator. The placebo group had no significant change in prevalence but a significant increase in intensity of all S-THs.