Oxygen for treatment of severe pneumonia in The Gambia, West Africa: a situational analysis.

SETTING: Health facilities in The Gambia, West Africa. OBJECTIVES: Oxygen treatment is vital in pneumonia, the leading cause of death in children globally. There are shortages of oxygen in developing countries, but little information is available on the extent of the problem. We assessed national oxygen availability and use in The Gambia, a sub-Saharan African country. METHODS: A government-led team visited 12 health facilities in The Gambia. A modified World Health Organization assessment tool was used to determine oxygen requirements, current provision and capacity to support effective oxygen use. RESULTS: Eleven of the 12 facilities managed severe pneumonia. Oxygen was reliable in three facilities. Requirement and supply were often mismatched. Both oxygen concentrators and oxygen cylinders were used. Suboptimal electricity and maintenance made using concentrators difficult, while logistical problems and cost hampered cylinder use. Children were usually triaged by trained nurses who reported lack of training in oxygen use. Oxygen was given typically by nasal prongs; pulse oximetry was available in two facilities. CONCLUSIONS: National data showed that oxygen availability did not meet needs in most Gambian health facilities. Remedial options must be carefully assessed for real costs, reliability and site-by-site usability. Training is needed to support oxygen use and equipment maintenance.

Equine trypanosomosis in the Central River Division of The Gambia: a study of veterinary gate-clinic consultation records.

The objective of this study was to provide epidemiological information of equine trypanosomosis in the Central River Division (CRD) of The Gambia. Therefore, 2285 consultations records of equines, admitted in a gate-clinic at Sololo in CRD, were studied retrospectively. The data were recorded in the period between September 1995 and July 2002 and comprised consultations of 2113 horses and 172 donkeys. 'Trypanosome infection' was the most frequently diagnosed condition and accounted for 61% of the cases. Horses were more frequently diagnosed with trypanosome infections than donkeys (p<0.001), with an occurrence of 63% compared to 43% in donkeys. In both horses and donkeys, trypanosome infections were mainly due to Trypanosoma congolense (64%) and T. vivax (32%). There was no difference observed in the occurrence of trypanosome infections in male or female donkeys (p=0.585), but there were more female (67.8%) horses observed with trypanosome infections than male horses (60.7%; p=0.003). There was no difference observed in the occurrence of trypanosome infections in donkeys older or younger than 1 year (p=0.130), but more older horses (63.2% >1 year) were observed with trypanosome infections than young horses (54.5% <1 year; p=0.033). The number of donkeys and horses with trypanosome infections decreased during the rainy season (June-September). The majority of equines that were admitted with trypanosome infections were severely anaemic. The average packed cell volume (PCV) declined with increasing parasitaemia (p=0.006). Seventy-four percent of the farmers' predictions of trypanosome infections in their equines were confirmed by darkground-microscopy. That proved that farmers had a fairly accurate knowledge of the diseases affecting their equines. The treatments executed at the gate-clinic were generally effective. The few (0.4%) relapses of the T. vivax infections that were previously treated with diminazene aceturate in this study were not sufficient to prove drug resistance. The study showed that the analysis of consultation records at a gate-clinic can provide complementary information to conventional epidemiological studies in the same research area.

Susceptibility of West African Dwarf goats and WAD x Saanen crosses to experimental infection with Trypanosoma congolense.

West African Dwarf goats (WADs) and their Saanen crosses were experimentally infected with Trypanosoma congolense. No significant differences were found between trypanosome parasitaemia and antibody response of the crossbred and WAD goats. Neither the WAD goats nor the Saanen crosses were able to control the drop in PCV following trypanosome infection. The level of anaemia caused by the trypanosome infection was similar in the two breeds during the trial. Based on these findings, no difference in tolerance or susceptibility to T. congolense could be demonstrated between the WAD goats and their Saanen crosses. Although the weight of all goats increased during the trial, the crosses gained significantly more weight than the WAD goats. The trypanosome infection reduced the growth rate of both breeds, but this reduction was not statistically significant. Crossbreeding trypanotolerant WADs with trypanosusceptible Saanen goats might, therefore, be an effective means of increasing productivity.

Molecular epidemiology of respiratory syncytial virus in The Gambia.

Respiratory syncytial virus (RSV) infection in The Gambia occurs seasonally in association with the rainy season. This study examined the genetic variability of RSV isolates from four consecutive epidemics from 1993-6. Each epidemic was made up of a number of variants which were replaced in subsequent epidemics. Analysis of attachment (G) protein gene sequences showed that isolates were closely related to those observed in the rest of the world. However, many isolates from 1993 and 1994 were unlike other isolates observed in the developed world during this period and were more similar to isolates from 1984 in Europe. In addition, the most commonly observed genotype in the UK in the 1990s was not detected in The Gambia during this period.