Study protocol for a type-II hybrid effectiveness-implementation trial to reach teenagers using mobile money shops to reduce unintended pregnancies in Uganda.

INTRODUCTION: Unintended teenage pregnancies have become a global public health challenge, particularly in sub-Saharan Africa. There is a notably high prevalence of unintended pregnancies among unmarried teenagers in Uganda. This study will develop an intervention programme using mobile money shops (vendors) as a platform to deliver sexual and reproductive health and rights (SRHR) services to teenagers and assess its effectiveness and scalability in Uganda. METHODS AND ANALYSES: This hybrid study comprises two integral components: an intervention study to assess the effectiveness of vendor-mediated intervention and implementation research to evaluate the implementation process. 30 vendors will be recruited for both intervention and control arms in 2 municipalities in Eastern Uganda, which have a high unintended pregnancy prevalence rate among unmarried teens aged 15-19 years. A preintervention and postintervention repeated survey involving 600 participants for each arm will be conducted over 4 months. The primary outcome is the rate of condom users among teenage vendor users. The secondary outcomes include the rate of preference for receiving SRHR services at vendors and knowledge regarding SRHR. A difference-in-differences analysis will be used to determine the effectiveness of the intervention. The Bowen model will be employed to evaluate the implementation design. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Ethics Review Committee of Uganda Christen University and JICA Ogata Sadako Research Institute for Peace and Development in Japan. The findings will be widely disseminated. This study was registered with the University Hospital Medical Information Network in Japan (UMIN000053332) on 12 January 2024. TRIAL REGISTRATION NUMBER: UMIN000053332.

Building a new platform to support public health emergency response in Africa: the AFENET Corps of Disease Detectives, 2018-2019.

Public health emergency (PHE) response in sub-Saharan Africa is constrained by inadequate skilled public health workforce and underfunding. Since 2005, the African Field Epidemiology Network (AFENET) has been supporting field epidemiology capacity development and innovative strategies are required to use this workforce. In 2018, AFENET launched a continental rapid response team: the AFENET Corps of Disease Detectives (ACoDD). ACoDD comprises field epidemiology graduates and residents and was established to support PHE response. Since 2018, AFENET has deployed the ACoDD to support response to several PHEs. The main challenges faced during ACoDD deployments were financing of operations, ACoDD safety and security, resistance to interventions and distrust of the responders by some communities. Our experience during these deployments showed that it was feasible to mobilise and deploy ACoDD within 48 hours. However, the sustainability of deployments will depend on establishing strong linkages with the employers of ACoDD members. PHEs are effectively controlled when there is a fast deployment and strong linkages between the stakeholders. There are ongoing efforts to strengthen PHE preparedness and response in sub-Saharan Africa. ACoDD members are a competent workforce that can effectively augment PHE response. ACoDD teams mentored front-line health workers and community health workers who are critical in PHE response. Public health emergence response in sub-Saharan Africa is constrained by inadequacies in a skilled workforce and underfunding. ACoDD can be utilised to overcome the challenges of accessing a skilled public health workforce. To improve health security in sub-Saharan Africa, more financing of PHE response is needed.

Predictors of incomplete immunization coverage among one to five years old children in Togo.

BACKGROUND: Incompleteness of vaccination coverage among children is a major public health concern because itcontinues to sustain a high prevalence of vaccine-preventable diseases in some countries. In Togo, very few data on the factors associated with incomplete vaccination coverage among children have been published. We determined the prevalence of incomplete immunization coverage in children aged one to five years in Togo and associated factors. METHODS: This was a cross-sectional study using secondary data from the 2010 Multiple Indicator Cluster Surveys (MICS4) conducted in 2010 among children aged 1 to 5 years in Togo. This survey was conducted over a period of two months from September to November, 2010. RESULTS: During Togo'sMICS4 survey, 2067 children met the inclusion criteria for our study. Female children accounted for 50.9 % (1051/2067) of the sample and 1372 (66.4 %) lived in rural areas. The majority of children (92.2 %; 1905/2067) lived with both parents and 30 % of the head of households interviewed were not schooled (620/2067). At the time of the survey, 36.2 % (750/2067) of the children had not received all vaccines recommended by Expanded Program on Immunization (EPI). In multivariate analysis, factors associated with incompleteness of immunization at 1 year were: health region of residences (Maritime aOR = 0.650; p = 0.043; Savanes: aOR = 0.324; p <0.001), non-schooled mother (aOR = 1.725; p = 0.002),standard of living (poor: aOR = 1.668; p = 0.013; medium: aOR = 1.393; p = 0.090) and the following characteristics of the household heads: sex (aOR = 1.465; p = 0.034), marital status (aOR = 1.591; p = 0.032), education level(non-educated: aOR = 1.435; p = 0.027. CONCLUSION: The incomplete immunization coverage among children in Togo remains high. It is necessary to strengthen health promotion among the population in order to improve the use of immunization services that are essential to reduce morbidity and mortality among under five years old children.

Proceedings of the African Field Epidemiology Network (AFENET) Scientific Conference 17-22 November 2013 Addis Ababa, Ethiopia: plenaries and oral presentations.

Biennially, trainees and graduates of Field Epidemiology and Laboratory Training Programs (FELTPs) are presented with a platform to share investigations and projects undertaken during their two-year training in Applied Epidemiology. The African Field Epidemiology Network (AFENET) Scientific Conference, is a perfect opportunity for public health professionals from various sectors and organizations to come together to discuss issues that impact on public health in Africa. This year's conference was organized by the Ethiopian Health and Nutrition Research Institute in collaboration with the Ethiopia Ministry of Health, Ethiopian Public Health Association (EPHA), Ethiopia Field Epidemiology Training Program (EFETP), Addis Ababa University (AAU), Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) and AFENET. Participants at this year's conference numbered 400 from over 20 countries including; Angola, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of the Congo, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Sudan, Tanzania, Uganda, Yemen and Zimbabwe. The topics covered in the 144 oral presentations included: global health security, emergency response, public health informatics, vaccine preventable diseases, immunization, outbreak investigation, Millennium Development Goals, Non-Communicable Diseases, and public health surveillance. The theme for the 5th AFENET Scientific Conference was; "Addressing Public Health Priorities in Africa through FELTPs." Previous AFENET Scientific conferences have been held in: Accra, Ghana (2005), Kampala, Uganda (2007), Mombasa, Kenya (2009) and Dar es Salaam, Tanzania (2011).

Implementation of infection control in health facilities in Arua district, Uganda: a cross-sectional study.

BACKGROUND: At least 1.4 million people are affected globally by nosocomial infections at any one time, the vast majority of these occurring in low-income countries. Most of these infections can be prevented by adopting inexpensive infection prevention and control measures such as hand washing. We assessed the implementation of infection control in health facilities and determined predictors of hand washing among healthcare workers (HCWs) in Arua district, Uganda. METHODS: We interviewed 202 HCWs that included 186 randomly selected and 16 purposively selected key informants in this cross-sectional study. We also conducted observations in 32 health facilities for compliance with infection control measures and availability of relevant supplies for their implementation. Quantitative data underwent descriptive analysis and multiple logistic regressions at 95 % confidence interval while qualitative data was coded and thematically analysed. RESULTS: Most respondents (95/186, 51 %) were aware of at least six of the eight major infection control measures assessed. Most facilities (93.8 %, 30/32) lacked infection control committees and adequate supplies or equipment for infection control. Respondents were more likely to wash their hands if they had prior training on infection control (AOR = 2.71, 95 % CI: 1.03-7.16), had obtained at least 11 years of formal education (AOR = 3.30, 95 % CI: 1.44-7.54) and had reported to have acquired a nosocomial infection (AOR = 2.84, 95 % CI: 1.03-7.84). CONCLUSIONS: Healthcare workers are more likely to wash their hands if they have ever suffered from a nosocomial infection, received in-service training on infection control, were educated beyond ordinary level, or knew hand washing as one of the infection control measures. The Uganda Ministry of Health should provide regular in-service training in infection control measures and adequate necessary materials.

Performance of an HRP-2 rapid diagnostic test in Nigerian children less than 5 years of age.

The diagnostic performance of histidine-rich protein 2 (HRP-2)-based malaria rapid diagnostic test (RDT) was evaluated in a mesoendemic area for malaria, Kaduna, Nigeria. We compared RDT results with expert microscopy results of blood samples from 295 febrile children under 5 years. Overall, 11.9% (35/295) tested positive with RDT compared with 10.5% (31/295) by microscopy: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100%, 98.5%, 88.6%, and 100%, respectively. The RDT sensitivity was not affected by transmission season, parasite density, and age. Specificity and positive PV decreased slightly during the high-transmission season (97.5% and 83.3%). The RDT test positivity rates in the low- and high-transmission seasons were 9.4% and 13.5%, respectively. Overall, the test performance of this RDT was satisfactory. The findings of a low proportion of RDT false positives, no invalid and no false-negative results should validate the performance of RDTs in this context.

Knowledge and beliefs on cervical cancer and practices on cervical cancer screening among women aged 20 to 50 years in Ouagadougou, Burkina Faso, 2012: a cross-sectional study.

INTRODUCTION: In Burkina Faso, 1230 women are diagnosed with cervical cancer every year and 838 die from the disease. Little is known about women's practices, knowledge and beliefs regarding cervical cancer. This study aims to describe women's practices regarding cervical cancer screening and to assess their knowledge and beliefs. METHODS: Cross-sectional study was carried out in Ouagadougou from 1st to 31st December 2012 interviewing 840 women aged 20 to 50 years about their knowledge, beliefs and practices regarding cervical cancer. Cluster sampling was used. Univariate and multivariate logistic regression analysis were performed. Chi square test was used and p-value < 0.05 was considered. RESULTS: Out of 840 women enrolled with mean age 29.5 ± 7.77 years, 66.31% were married, 59.28% have not been to school or left school at primary level. While 64.2% of participants heart about cervical cancer, 8.5% heart about Human papillomavirus, 69.05% don't know that cervical cancer is preventable. 90.4% of participants were worried to develop cervical cancer, 96.67% would accept to be screened and 11.07% were screened for cervical cancer. In multivariate analysis, heart about cervical cancer (OR = 5.7; 95% CI: 2.21-14.69), know contamination mode of HPV (OR = 3.81; 95% CI: 2.27-6.39), heart about HPV (OR = 2.05; 95% CI: 1.11-3.81) and use of oral contraceptive (OR = 2.06; 95% CI: 1.25-3.39) were independently associated with screening history with p < 0.05. CONCLUSION: Knowledge and belief regarding cervical cancer is limited among Ouagadougou women and screening rate is low. There is need to enhance health education regarding Human papillomavirus and cervical cancer.

Training and service in public health, Nigeria Field Epidemiology and Laboratory Training, 2008 - 2014.

The health workforce is one of the key building blocks for strengthening health systems. There is an alarming shortage of curative and preventive health care workers in developing countries many of which are in Africa. Africa resultantly records appalling health indices as a consequence of endemic and emerging health issues that are exacerbated by a lack of a public health workforce. In low-income countries, efforts to build public health surveillance and response systems have stalled, due in part, to the lack of epidemiologists and well-trained laboratorians. To strengthen public health systems in Africa, especially for disease surveillance and response, a number of countries have adopted a competency-based approach of training - Field Epidemiology and Laboratory Training Program (FELTP). The Nigeria FELTP was established in October 2008 as an inservice training program in field epidemiology, veterinary epidemiology and public health laboratory epidemiology and management. The first cohort of NFELTP residents began their training on 20th October 2008 and completed their training in December 2010. The program was scaled up in 2011 and it admitted 39 residents in its third cohort. The program has admitted residents in six annual cohorts since its inception admitting a total of 207 residents as of 2014 covering all the States. In addition the program has trained 595 health care workers in short courses. Since its inception, the program has responded to 133 suspected outbreaks ranging from environmental related outbreaks, vaccine preventable diseases, water and food borne, zoonoses, (including suspected viral hemorrhagic fevers) as well as neglected tropical diseases. With its emphasis on one health approach of solving public health issues the program has recruited physicians, veterinarians and laboratorians to work jointly on human, animal and environmental health issues. Residents have worked to identify risk factors of disease at the human animal interface for influenza, brucellosis, tick-borne relapsing fever, rabies, leptospirosis and zoonotic helminthic infections. The program has been involved in polio eradication efforts through its National Stop Transmission of Polio (NSTOP). The commencement of NFELTP was a novel approach to building sustainable epidemiological capacity to strengthen public health systems especially surveillance and response systems in Nigeria. Training and capacity building efforts should be tied to specific system strengthening and not viewed as an end to them. The approach of linking training and service provision may be an innovative approach towards addressing the numerous health challenges.

High concentration of blood lead levels among young children in Bagega community, Zamfara - Nigeria and the potential risk factor.

INTRODUCTION: In May 2010, lead poisoning (LP) was confirmed among children <5years (U5) in two communities in Zamfara state, northwest Nigeria. Following reports of increased childhood deaths in Bagega, another community in Zamfara, we conducted a survey to investigate the outbreak and recommend appropriate control measures. METHODS: We conducted a cross-sectional survey in Bagega community from 23rd August to 6th September, 2010. We administered structured questionnaires to parents of U5 to collect information on household participation in ore processing activities. We collected and analysed venous blood samples from 185 U5 with LeadCare II machine. Soil samples were analysed with X-ray fluorescence spectrometer for lead contamination. We defined blood lead levels (BLL) of >10ug/dL as elevated BLL, and BLL ≥45ug/dL as the criterion for chelation therapy. We defined soil lead levels (SLL) of ≥400 parts per million (ppm) as elevated SLL. RESULTS: The median age of U5 was 36 months (Inter-quartile range: 17-48 months). The median BLL was 71µg/dL (range: 8-332µg/dL). Of the 185 U5, 184 (99.5%) had elevated BLL, 169 (91.4%) met criterion for CT. The median SLL in tested households (n = 37) of U5 was 1,237ppm (range: 53-45,270ppm). Households breaking ore rocks within the compound were associated with convulsion related-children's death (OR: 5.80, 95% CI: 1.08 - 27.85). CONCLUSION: There was an LP outbreak in U5 in Bagega community possibly due to heavy contamination of the environment as a result of increased ore processing activities. Community-driven remediation activities are ongoing. We recommended support for sustained environmental remediation, health education, intensified surveillance, and case management.

Mycobacterium tuberculosis resistance to antituberculosis drugs in Mozambique.

OBJECTIVE: To determine the drug resistance profile of Mycobacterium tuberculosis in Mozambique. METHODS: We analyzed secondary data from the National Tuberculosis Referral Laboratory, in the city of Maputo, Mozambique, and from the Beira Regional Tuberculosis Referral Laboratory, in the city of Beira, Mozambique. The data were based on culture-positive samples submitted to first-line drug susceptibility testing (DST) between January and December of 2011. We attempted to determine whether the frequency of DST positivity was associated with patient type or provenance. RESULTS: During the study period, 641 strains were isolated in culture and submitted to DST. We found that 374 (58.3%) were resistant to at least one antituberculosis drug and 280 (43.7%) were resistant to multiple antituberculosis drugs. Of the 280 multidrug-resistant tuberculosis cases, 184 (65.7%) were in previously treated patients, most of whom were from southern Mozambique. Two (0.71%) of the cases of multidrug-resistant tuberculosis were confirmed to be cases of extensively drug-resistant tuberculosis. Multidrug-resistant tuberculosis was most common in males, particularly those in the 21-40 year age bracket. CONCLUSIONS: M. tuberculosis resistance to antituberculosis drugs is high in Mozambique, especially in previously treated patients. The frequency of M. tuberculosis strains that were resistant to isoniazid, rifampin, and streptomycin in combination was found to be high, particularly in samples from previously treated patients.

Mycobacterium tuberculosis resistance to antituberculosis drugs in Mozambique / Resistência de Mycobacterium tuberculosis aos tuberculostáticos em Moçambique

OBJECTIVE: To determine the drug resistance profile of Mycobacterium tuberculosis in Mozambique. METHODS: We analyzed secondary data from the National Tuberculosis Referral Laboratory, in the city of Maputo, Mozambique, and from the Beira Regional Tuberculosis Referral Laboratory, in the city of Beira, Mozambique. The data were based on culture-positive samples submitted to first-line drug susceptibility testing (DST) between January and December of 2011. We attempted to determine whether the frequency of DST positivity was associated with patient type or provenance. RESULTS: During the study period, 641 strains were isolated in culture and submitted to DST. We found that 374 (58.3%) were resistant to at least one antituberculosis drug and 280 (43.7%) were resistant to multiple antituberculosis drugs. Of the 280 multidrug-resistant tuberculosis cases, 184 (65.7%) were in previously treated patients, most of whom were from southern Mozambique. Two (0.71%) of the cases of multidrug-resistant tuberculosis were confirmed to be cases of extensively drug-resistant tuberculosis. Multidrug-resistant tuberculosis was most common in males, particularly those in the 21-40 year age bracket. CONCLUSIONS: M. tuberculosis resistance to antituberculosis drugs is high in Mozambique, especially in previously treated patients. The frequency of M. tuberculosis strains that were resistant to isoniazid, rifampin, and streptomycin in combination was found to be high, particularly in samples from previously treated patients. .

OBJETIVO: Avaliar o perfil de resistência de Mycobacterium tuberculosis aos tuberculostáticos em Moçambique. MÉTODOS: Foram analisados dados secundários do Laboratório Nacional de Referência da Tuberculose, em Maputo, Moçambique, e do Laboratório Regional de Referência da Tuberculose, na Beira, Moçambique. Os dados foram relativos a amostras positivas à cultura e submetidas ao teste de sensibilidade aos tuberculostáticos de primeira linha durante o período de janeiro a dezembro de 2011. Os resultados do teste de sensibilidade foram analisados, e sua frequência foi comparada com o tipo de paciente e sua proveniência. RESULTADOS: Foram analisadas 641 cepas, isoladas em cultura e submetidas ao teste de sensibilidade. Das 641 cepas, 374 (58,3%) foram resistentes a pelo menos um tuberculostático e 280 (43,7%) revelaram-se multirresistentes. Dos 280 casos de tuberculose multirresistente, 184 (65,7%) eram pacientes com tratamento prévio, a maioria dos quais era oriunda da zona sul do país. Confirmou-se que 2 (0,71%) dos casos de tuberculose multirresistente eram casos de tuberculose extensivamente resistente a drogas. O sexo masculino foi o mais afetado, particularmente na faixa etária de 21 a 40 anos. CONCLUSÕES: A resistência de M. tuberculosis aos tuberculostáticos é elevada em Moçambique, especialmente em indivíduos com tratamento prévio. A resistência de M. tuberculosis à combinação de isoniazida, rifampicina e estreptomicina foi elevada, especialmente em amostras provenientes de indivíduos com tratamento prévio. .

Cholera surveillance in Uganda: an analysis of notifications for the years 2007-2011.

INTRODUCTION: Cholera outbreaks have occurred periodically in Uganda since 1971. The country has experienced intervals of sporadic cases and localized outbreaks, occasionally resulting in prolonged widespread epidemics. METHODS: Cholera surveillance data reported to the Uganda Ministry of Health from 2007 through 2011 were reviewed to determine trends in annual incidence and case fatality rate. Demographic characteristics of cholera cases were analyzed from the national line list for 2011. Cases were analyzed by district and month of report to understand the geographic distribution and identify any seasonal patterns of disease occurrence. RESULTS: From 2007 through 2011, Uganda registered a total of 7615 cholera cases with 181 deaths (case fatality rate = 2.4%). The absolute number of cases and incidence per 100 000 varied from year to year with the highest incidence occurring in 2008 following heavy rainfall and flooding in eastern Uganda. For 2011, cholera cases occurred in 1.6 times more males than females. The geographical areas affected by the outbreaks shifted each year, with the exception of a few endemic districts. No clear seasonal trends in cholera occurrence were identified for this time period. CONCLUSIONS: We observed an overall decline in cases reported during the 5 years under review. During this period, concerted efforts were made by the Ugandan government and development partners to educate communities on proper sanitation and hygiene and provide safe water and timely treatment. Mechanisms to ensure timely and complete cholera surveillance data are reported to the national level should continue to be strengthened.

Perceptions of diabetes in rural areas of Eastern Uganda.

BACKGROUND: People diagnosed with diabetes mellitus are increasing in sub-Saharan Africa and prompt care seeking depends on perceptions of the illness. OBJECTIVE: The objective was to explore perceptions of diabetes in rural areas. METHOD: We conducted a qualitative, explorative and descriptive study in rural eastern Uganda. Eight focus group discussions with community members were conducted. Community members were presented with a story about a person with diabetes symptoms and their perceptions of the diagnosis and treatment elicited. Four focus group discussions with people with diabetes and seven key informant interviews with health workers were conducted. Respondents were asked how the community interpreted symptoms of diabetes, its causes and whether it was curable. Manifest content analysis was used. RESULTS: Some respondents thought people with diabetes symptoms had HIV or were bewitched. Causes of diabetes mentioned included consuming too much fatty food. Some respondents thought diabetes is transmitted through air, sharing utensils with or sitting close to people with diabetes. Some respondents thought that diabetes could heal fast whilst others thought it was incurable. CONCLUSION: Misdiagnosis may cause delay in seeking proper care. Preventive programmes could build on people's thinking that too much fatty food causes diabetes to promote diets with less fat. The perception of diabetes as a contagious disease leads to stigmatisation and affects treatment seeking. Seeing diabetes as curable could create patient expectations that may not be fulfilled in the management of diabetes. Rural communities would benefit from campaigns creating awareness of prevention, symptoms, diagnosis and management of diabetes.

Factors associated with obstetric fistulae occurrence among patients attending selected hospitals in Kenya, 2010: a case control study.

BACKGROUND: In Kenya, about 3000 fistula cases are estimated to occur every year with an incidence of 1/1000 women. This study sought to identify risk factors associated with developing obstetrics fistula in order to guide implementation of appropriate interventions. METHODS: An unmatched case control study was conducted in three major hospitals in Kenya between October and December 2010. Cases were patients who had fistula following delivery within the previous five years. Controls were systematically selected from women who attended obstetrics and gynecology clinics at these hospitals, and did not have present or past history of fistula. Odds ratio was used as measure of association with their corresponding 95% confidence interval. Factors with p value of <0.1 were included into forward additive logistic regression model to generate adjusted odds ratios. RESULTS: Seventy cases and 140 controls were included in the study. Independent risk factors associated with obstetrics fistula included duration of labour of >24 hours (OR = 4.7, 95% CI = 2.4 -9.2), seeking delivery services after 6 hours of labour onset (OR = 6.9, 95% CI = 2.2-21.3), taking more than 2 hours to reach a health facility (OR = 5.7, 95% CI = 2.9 -11.5), having none or primary education (OR = 9.6, 95% CI = 3.3 -27.9) and being referred to another facility for emergency obstetrics services (OR = 8.6, 95% CI = 2.7 -27). CONCLUSIONS: Risk factors for developing obstetrics fistula were delays in care seeking including delay in making decision to seek delivery servers after six hours of labour onset, taking more than two hours to reach a health facility, labour duration of more than 24 hours and having no formal or primary education. Efforts geared at strengthening all levels of the health system to reduce delays in access to emergency obstetric care are needed.

Orofacial manifestations in HIV positive children attending Mildmay Clinic in Uganda.

The aim of this study was to assess the orofacial manifestations and their influence on oral function in human immunodeficiency virus (HIV) positive children attending Mildmay Clinic in Uganda. This was a cross-sectional study based on clinical examination, medical records and a structured questionnaire of 368 children aged between 1.5 and 17 years. The clinical examination for dental caries was based on decayed, extracted and filled teeth (deft) and decayed, missing and filled teeth (DMFT) indices as defined by World Health Organisation. The soft tissue orofacial lesions were assessed using the classification and diagnostic criteria as described by the Collaborative Workgroup on the Oral Manifestations of Pediatric HIV Infections. Approximately 67.4% of the children were on highly active antiretroviral therapy (HAART). The majority (77.4%) of the children had at least one orofacial lesion associated with HIV, pseudomembranous candidiasis being the most prevalent. Overall, 61.7% of the children with orofacial lesions reported at least one form of discomfort in the mouth. Discomfort was particularly associated with swallowing. The prevalence of orofacial lesions was significantly higher in children with poor oral hygiene and lower in those on HAART than in their respective counterparts. The CD4+ cell count, age and gender of the children did not significantly influence the distribution of orofacial lesions. The mean deft and DMFT scores were 11.8 and 2.7, respectively. The d- and D-components contributed 54.7 and 42.1%, respectively. Consumption of sugary snacks was directly associated with dental caries. Despite these children attending an HIV care centre of excellence, they have a high prevalence of orofacial manifestations associated with HIV. The majority of the children experienced discomfort in the oral cavity, particularly during swallowing.

Morbidity and mortality due to malaria in Est Mono district, Togo, from 2005 to 2010: a times series analysis.

BACKGROUND: In 2004, Togo adopted a regional strategy for malaria control that made use of insecticide-treated nets (ITNs), followed by the use of rapid diagnostic tests (RDTs), artemisinin-based combination therapy (ACT). Community health workers (CHWs) became involved in 2007. In 2010, the impact of the implementation of these new malaria control strategies had not yet been evaluated. This study sought to assess the trends of malaria incidence and mortality due to malaria in Est Mono district from 2005 to 2010. METHODS: Secondary data on confirmed and suspected malaria cases reported by health facilities from 2005 to 2010 were obtained from the district health information system. Rainfall and temperature data were provided by the national Department of Meteorology. Chi square test or independent student's t-test were used to compare trends of variables at a 95% confidence interval. An interrupted time series analysis was performed to assess the effect of meteorological factors and the use of ACT and CHWs on morbidity and mortality due to malaria. RESULTS: From January 2005 to December 2010, 114,654 malaria cases (annual mean 19,109 ± 6,622) were reported with an increase of all malaria cases from 10,299 in 2005 to 26,678 cases in 2010 (p<0.001). Of the 114,654 malaria cases 52,539 (45.8%) were confirmed cases. The prevalence of confirmed malaria cases increased from 23.1 per 1,000 in 2005 to 257.5 per 1,000 population in 2010 (p <0.001). The mortality rate decreased from 7.2 per 10,000 in 2005 to 3.6 per 10,000 in 2010 (p <0.001), with a significant reduction of 43.9% of annual number of death due to malaria. Rainfall (ß-coefficient = 1.6; p = 0.05) and number of CHWs trained (ß-coefficient = 6.8; p = 0.002) were found to be positively correlated with malaria prevalence. CONCLUSION: This study showed an increase of malaria prevalence despite the implementation of the use of ACT and CHW strategies. Multicentre data analysis over longer periods should be carried out in similar settings to assess the impact of malaria control strategies on the burden of the disease. Integrated malaria vector control management should be implemented in Togo to reduce malaria transmission.

Risk factors for non-communicable diseases in rural Uganda: a pilot surveillance project among diabetes patients at a referral hospital clinic.

INTRODUCTION: Despite an increasing recognition of non- communicable diseases (NCDs) in sub-Saharan Africa, there is lack of well established surveillance systems for these diseases. In an effort to understand burden of NCDs in low-resource settings, the African Field Epidemiology Network launched a pilot project in 2009 to routinely capture patient data in the diabetes clinic of Mbarara Regional Referral Hospital. The objective of this study was to determine the prevalence and, the gender- and age- specific distributions of common NCD risk factors among diabetic patients attending a referral hospital in rural Uganda. METHODS: A relational Access database was designed to collect information on NCD risk factors. These included smoking, alcohol use, family history of diabetes, hypertension and body mass index. Univariate analyses were done and differences in proportions tested using chi-square P-values in STATA version 10.0. RESULTS: A total of 1,383 patient records were analyzed, with 61% being female and mean age of 39.6 years (SD 15.8). About 24% had a family history of diabetes. Smoking and alcohol use were more prevalent among males (16.6% vs. 8.3%; p<0.0001) and (30.7 vs. 13%; p<0.0001) respectively. Overweight, obesity and hypertension were more prevalent in women (18.6% vs. 9.7%, 8.6% vs. 2.6%; p<0.0001, and 40.3% vs. 33%, p=0.018) respectively. CONCLUSION: This pilot project shows that use of hospital-based data is a valuable initial step in setting up surveillance systems for NCDs in Uganda. Risk factors for NCDs were both age and gender-specific and predominantly related to lifestyle. This suggests the need to design gender-sensitive prevention interventions that target lifestyle modification in this setting.

The genesis and evolution of the African Field Epidemiology Network.

In an effort to contain the frequently devastating epidemics in sub-Saharan Africa, the World Health Organization (WHO) Regional Office for Africa launched the Integrated Disease Surveillance and Response (IDSR) strategy in an effort to strengthen surveillance and response. However, 36 sub-Saharan African countries have been described as experiencing a human resource crisis by the WHO. Given this human resource situation, the challenge remains for these countries to achieve, among others, the health-related Millennium Development Goals (MDGs). This paper describes the process through which the African Field Epidemiology Network (AFENET) was developed, as well as how AFENET has contributed to addressing the public health workforce crisis, and the development of human resource capacity to implement IDSR in Africa. AFENET was established between 2005 and 2006 as a network of Field Epidemiology Training Programs (FETPs) and Field Epidemiology and Laboratory Training Programs (FELTPs) in Africa. This resulted from an expressed need to develop a network that would advocate for the unique needs of African FETPs and FELTPs, provide service to its membership, and through which programs could develop joint projects to address the public health needs of their countries. A total of eight new programs have been developed in sub-Saharan Africa since 2006. Programs established after 2006 represent over 70% of current FETP and FELTP enrolment in Africa. In addition to growth in membership and programs, AFENET has recorded significant growth in external partnerships. Beginning with USAID, CDC and WHO in 2004-2006, a total of at least 26 partners have been added by 2011. Drawing from lessons learnt, AFENET is now a resource that can be relied upon to expand public health capacity in Africa in an efficient and practical manner. National, regional and global health actors can leverage it to meet health-related targets at all levels. The AFENET story is one that continues to be driven by a clearly recognized need within Africa to develop a network that would serve public health systems development, looking beyond the founders, and using the existing capacity of the founders and partners to help other countries build capacity for IDSR and the International Health Regulations (IHR, 2005).