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BACKGROUND: In Haiti, reported incidence and mortality rates for COVID-19 were lower than expected. We aimed to analyze factors at communal and individual level that might lead to an underestimation of the true burden of the COVID-19 epidemic in Haiti during its first two years. METHODS: We analyzed national COVID-19 surveillance data from March 2020 to December 2021, to describe the epidemic using cluster detection, time series, and cartographic approach. We performed multivariate Quasi-Poisson regression models to determine socioeconomic factors associated with incidence and mortality. We performed a mixed-effect logistic regression model to determine individual factors associated with the infection. RESULTS: Among the 140 communes of Haiti, 57 (40.7%) had a COVID-19 screening center, and the incidence was six times higher in these than in those without. Only 22 (15.7%) communes had a COVID-19 care center, and the mortality was five times higher in these than in those without. All the richest communes had a COVID-19 screening center while only 30.8% of the poorest had one. And 75% of the richest communes had a COVID-19 care center while only 15.4% of the poorest had one. Having more than three healthcare workers per 1000 population in the commune was positively associated with the incidence (SIR: 3.31; IC95%: 2.50, 3.93) and the mortality (SMR: 2.73; IC95%: 2.03, 3.66). At the individual level, male gender (adjusted OR: 1.11; IC95%: 1.01, 1.22), age with a progressive increase of the risk compared to youngers, and having Haitian nationality only (adjusted OR:2.07; IC95%: 1.53, 2.82) were associated with the infection. CONCLUSIONS: This study highlights the weakness of SARS-CoV-2 screening and care system in Haiti, particularly in the poorest communes, suggesting that the number of COVID-19 cases and deaths were probably greatly underestimated.
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COVID-19 , Programas de Rastreamento , Humanos , Haiti/epidemiologia , COVID-19/epidemiologia , COVID-19/mortalidade , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Incidência , Programas de Rastreamento/estatística & dados numéricos , Adulto Jovem , SARS-CoV-2 , Adolescente , Idoso , Fatores Socioeconômicos , Teste para COVID-19/estatística & dados numéricosRESUMO
BACKGROUND: In Haiti, patient's adherence to treatment and compliance with medical appointments are very challenging due to different local factors. We aimed to assess the effectiveness of a reminder system implemented in health facilities in Haiti in a context of socio-political crisis. METHODS: We used appointment data from patients aged 15 years and older between January 2021 and November 2023 from four healthcare centers in the Port-au-Prince metropolitan area. We performed descriptive analysis, crossing covariates with appointment attendance. We performed Pearson's Chi-squared test, and multivariate regression analysis using a mixed-effect logistic regression model in order to explore the association between sending reminders and appointment attendance, with and without adjustment for other patient-level covariates. RESULTS: A total of 14 108 appointments were registered on the reminder systems, with 2 479 (17.6%) attendances. Among those to whom reminders were sent, the number of attendances was 167 (17.4%) for email recipients only, 199 (36.7%) for SMS recipients only, and 19 (42.2%) for both SMS and email recipients - versus 2 094 (16.7%) for non-reminders. After adjusting on all other covariates, we found that patients to whom a reminder was sent via email (aOR: 1.45; CI: 1.08, 1.94), SMS (aOR: 2.95; CI: 2.41, 3.60), and both SMS and email (aOR: 2.86, CI: 1.37, 5.96) were more likely to show up on their appointment day compared to those who did not receive any reminder. Other socio-demographic factors such as being 50 years and older (aOR: 1.31; CI: 1.10, 1.56) compared to under 30 years, living as couple (aOR: 1.23; CI: 1.10, 1.37), and not having children (aOR: 1.21; CI: 1.07, 1.37) were significantly associated with appointment attendance. CONCLUSIONS: Our study suggests that patient reminder systems may be used to reduce non-attendance in Haiti, even in a context of socio-political crisis.
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Agendamento de Consultas , Sistemas de Alerta , Humanos , Haiti , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adolescente , Cooperação do Paciente/estatística & dados numéricos , Adulto Jovem , Política , IdosoRESUMO
BACKGROUND: The novel coronavirus disease 2019 (COVID-19) epidemic has spread from China to 25 countries. Local cycles of transmission have already occurred in 12 countries after case importation. In Africa, Egypt has so far confirmed one case. The management and control of COVID-19 importations heavily rely on a country's health capacity. Here we evaluate the preparedness and vulnerability of African countries against their risk of importation of COVID-19. METHODS: We used data on the volume of air travel departing from airports in the infected provinces in China and directed to Africa to estimate the risk of importation per country. We determined the country's capacity to detect and respond to cases with two indicators: preparedness, using the WHO International Health Regulations Monitoring and Evaluation Framework; and vulnerability, using the Infectious Disease Vulnerability Index. Countries were clustered according to the Chinese regions contributing most to their risk. FINDINGS: Countries with the highest importation risk (ie, Egypt, Algeria, and South Africa) have moderate to high capacity to respond to outbreaks. Countries at moderate risk (ie, Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya) have variable capacity and high vulnerability. We identified three clusters of countries that share the same exposure to the risk originating from the provinces of Guangdong, Fujian, and the city of Beijing, respectively. INTERPRETATION: Many countries in Africa are stepping up their preparedness to detect and cope with COVID-19 importations. Resources, intensified surveillance, and capacity building should be urgently prioritised in countries with moderate risk that might be ill-prepared to detect imported cases and to limit onward transmission. FUNDING: EU Framework Programme for Research and Innovation Horizon 2020, Agence Nationale de la Recherche.
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Defesa Civil , Infecções por Coronavirus , Epidemias/prevenção & controle , Recursos em Saúde , Modelos Teóricos , Pneumonia Viral , Vigilância da População , Populações Vulneráveis , África/epidemiologia , COVID-19 , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Planejamento em Saúde , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Medição de Risco , ViagemRESUMO
BACKGROUND: The emergence and re-emergence of viral haemorrhagic fevers (VHFs) is a growing concern worldwide. They are associated with major epidemics with an estimated 51-101 million cases each year, of which around 67 000 are fatal. In 2007, 13 countries in the Eastern Mediterranean Region reported VHF cases. AIMS: The main purpose of the study was to review the epidemiological situation in the Region vis-à-vis VHFs to obtain baseline epidemiological information for the establishment of the Emerging Dangerous Pathogen Laboratory Network (EDPLN). METHODS: A literature search was performed using PubMed, ProMED-Mail and GIDEON databases. Reported data included disease burden (reported cases and deaths), human prevalence (general population, high-risk groups), vectors and reservoirs. A scoring method was employed to divide countries into 4 groups (very highly, highly, medium and low affected countries). RESULTS: Very highly affected countries were Afghanistan, Egypt, Islamic Republic of Iran, Saudi Arabia and Sudan. Highly affected countries were Djibouti, Morocco, Oman, Pakistan, Tunisia and Yemen. Medium affected countries were Iraq, Somalia and United Arab Emirates. Low affected countries were Bahrain, Jordan, Lebanon, Libya, Palestine, Qatar and Syrian Arab Republic. CONCLUSIONS: This study contributes in prioritizing countries to be part of EDPLN and in addressing specific needs related to outbreak investigations, surveillance and research.
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Doenças Transmissíveis Emergentes/epidemiologia , Febres Hemorrágicas Virais/epidemiologia , Animais , Doenças Transmissíveis Emergentes/mortalidade , Reservatórios de Doenças/virologia , Vetores de Doenças , Epidemias/estatística & dados numéricos , Febres Hemorrágicas Virais/mortalidade , Humanos , Região do Mediterrâneo/epidemiologia , Oriente Médio/epidemiologia , Vigilância da População/métodos , PrevalênciaRESUMO
BACKGROUND: Nutritional surveillance remains generally weak and early warning systems are needed in areas with high burden of acute under-nutrition. In order to enhance insight into nutritional surveillance, a community-based sentinel sites approach, known as the Listening Posts (LP) Project, was piloted in Burkina Faso by Action Contre la Faim (ACF). This paper presents ACF's experience with the LP approach and investigates potential selection and observational biases. METHODS: Six primary sampling units (PSUs) were selected in each livelihood zone using the centric systematic area sampling methodology. In each PSU, 22 children aged between 6 and 24 months were selected by proximity sampling. The prevalence of GAM for each month from January 2011 to December 2013 was estimated using a Bayesian normal-normal conjugate analysis followed by PROBIT estimation. To validate the LP approach in detecting changes over time, the time trends of MUAC from LP and from five cross-sectional surveys were modelled using polynomial regression and compared by using a Wald test. The differences between prevalence estimates from the two data sources were used to assess selection and observational biases. RESULTS: The 95 % credible interval around GAM prevalence estimates using LP approach ranged between +6.5 %/-6.0 % on a prevalence of 36.1 % and +3.5 %/-2.9 % on a prevalence of 10.8 %. LP and cross-sectional surveys time trend models were well correlated (p = 0.6337). Although LP showed a slight but significant trend for GAM to decrease over time at a rate of -0.26 %/visit, the prevalence estimates from the two data sources showed good agreement over a 3-year period. CONCLUSIONS: The LP methodology has proved to be valid in following trends of GAM prevalence for a period of 3 years without selection bias. However, a slight observational bias was observed, requiring a periodical reselection of the sentinel sites. This kind of surveillance project is suited to use in areas with high burden of acute under-nutrition where early warning systems are strongly needed. Advocacy is necessary to develop sustainable nutrition surveillance system and to support the use of surveillance data in guiding nutritional programs.
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OBJECTIVES: In low-income settings with limited access to diagnosis, COVID-19 information is scarce. In September 2020, after the first COVID-19 wave, Mali reported 3086 confirmed cases and 130 deaths. Most reports originated from Bamako, with 1532 cases and 81 deaths (2.42 million inhabitants). This observed prevalence of 0.06% appeared very low. Our objective was to estimate SARS-CoV-2 infection among inhabitants of Bamako, after the first epidemic wave. We assessed demographic, social and living conditions, health behaviours and knowledges associated with SARS-CoV-2 seropositivity. SETTINGS: We conducted a cross-sectional multistage household survey during September 2020, in three neighbourhoods of the commune VI (Bamako), where 30% of the cases were reported. PARTICIPANTS: We recruited 1526 inhabitants in 3 areas, that is, 306 households, and 1327 serological results (≥1 years), 220 household questionnaires and collected answers for 962 participants (≥12 years). PRIMARY AND SECONDARY OUTCOME MEASURES: We measured serological status, detecting SARS-CoV-2 spike protein antibodies in blood sampled. We documented housing conditions and individual health behaviours through questionnaires among participants. We estimated the number of SARS-CoV-2 infections and deaths in the population of Bamako using the age and sex distributions. RESULTS: The prevalence of SARS-CoV-2 seropositivity was 16.4% (95% CI 15.1% to 19.1%) after adjusting on the population structure. This suggested that ~400 000 cases and ~2000 deaths could have occurred of which only 0.4% of cases and 5% of deaths were officially reported. Questionnaires analyses suggested strong agreement with washing hands but lower acceptability of movement restrictions (lockdown/curfew), and mask wearing. CONCLUSIONS: The first wave of SARS-CoV-2 spread broadly in Bamako. Expected fatalities remained limited largely due to the population age structure and the low prevalence of comorbidities. Improving diagnostic capacities to encourage testing and preventive behaviours, and avoiding the spread of false information remain key pillars, regardless of the developed or developing setting. ETHICS: This study was registered in the registry of the ethics committee of the Faculty of Medicine and Odonto-Stomatology and the Faculty of Pharmacy, Bamako, Mali, under the number: 2020/162/CA/FMOS/FAPH.
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COVID-19 , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , Estudos Soroepidemiológicos , Estudos Transversais , Mali/epidemiologia , Condições Sociais , Controle de Doenças Transmissíveis , Anticorpos AntiviraisRESUMO
We conducted a nationwide hospital-based prospective study in Germany of influenza A(H1N1)pdm09 cases among children <15 years of age admitted to pediatric intensive care units and related deaths during the 2009-10 pandemic and the 2010-11 postpandemic influenza seasons. We identified 156 eligible patients: 112 in 2009-10 and 44 in 2010-11. Although a shift to younger patients occurred in 2010-11 (median age 3.2 vs. 5.3 years), infants <1 year of age remained the most affected. Underlying immunosuppression was a risk factor for hospital-acquired infections (p = 0.013), which accounted for 14% of cases. Myocarditis was predictive of death (p = 0.006). Of the 156 case-patients, 17% died; the difference between seasons was not significant (p = 0.473). Our findings stress the challenge of preventing severe postpandemic influenza infection in children and the need to prevent nosocomial transmission of influenza virus, especially in immunosuppressed children.
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Influenza Humana/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Alemanha , História do Século XXI , Humanos , Lactente , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/história , Pandemias , Vigilância da População , Estudos Prospectivos , Fatores de Risco , Estações do AnoRESUMO
BACKGROUND: With ageing of the HIV-infected population, long-term exposure to treatment, varying adherence, emerging resistance and complications to therapies, effectiveness of Highly Active Antiretroviral Therapy (HAART) needs to be monitored continuously at the population level. The German HIV-1 Seroconverter Cohort is a multi-centre, open, long-term observational cohort including patients with a known or reliably estimated date of HIV-infection i.e. last negative and first positive HIV antibody test within a maximum three-year interval or laboratory evidence of seroconversion. Our study aims to investigate survival improvements and changes in AIDS risk over calendar periods in the German HIV-1 Seroconverter Cohort. METHODS: Retrospective (for the pre-1997 period) and prospective (since 1997) data from the German HIV-1 Seroconverter Cohort were used. Time from seroconversion to first AIDS-defining event over calendar periods was analysed by using Cox models adjusting for age at seroconversion, sex, transmission groups and short HIV test interval. Kaplan-Meier methods were used to determine expected survival (remaining AIDS-free) by calendar period. RESULTS: 2162 seroconverters with 8976 person-years of observation were included in our analysis (up to 31.12.2010). A total of 196 first AIDS defining events were reported. Two periods i.e. 19972000 and 2007-2010 were statistically associated with a reduction in the risk of AIDS, accounting for an overall reduction of 80%. Compared to1997-2000, hazard ratios were 2.6 (95%CI, 1.6-4.8; p=0.000) in pre-1997 and 0.5 (95%CI, 0.3-0.8; p=0.007) in 20072010. Independent risk factor for AIDS progression was age at seroconversion (HR, 1.3 per 10 year-increase; p=0.001). CONCLUSION: HAART effectiveness has improved in the German HIV-1-Seroconverter Cohort. The risk to develop AIDS decreased significantly in 19972000 and in 20072010. However, elderly may require particular monitoring in view of their faster progression to AIDS.
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Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/mortalidade , Síndrome da Imunodeficiência Adquirida/virologia , Adulto , Fármacos Anti-HIV/administração & dosagem , Terapia Antirretroviral de Alta Atividade , Estudos de Coortes , Feminino , Alemanha/epidemiologia , HIV-1/patogenicidade , Humanos , Incidência , Estudos Longitudinais , Masculino , Análise de Sobrevida , Fatores de TempoRESUMO
In a hospital-based observational study in Germany, we investigated children admitted to pediatric intensive care units and deaths caused by confirmed pandemic (H1N1) 2009 to identify risk factors and outcomes in critically ill children. Ninety-three children were eligible for our study, including 9 with hospital-acquired infections. Seventy-five percent had underlying chronic medical conditions; neurodevelopmental disorders were most prevalent (57%). The proportion of patients having ≥1 risk factor increased with age in years (odds ratio 1.21, p = 0.007). Of 15 deaths, 11 occurred in a pediatric intensive care unit (case-fatality rate 12%, 95% confidence interval 6%-21%). Only 9% of the children had been vaccinated against pandemic (H1N1) 2009; all survived. Our results stress the role of underlying risk factors, especially neurodevelopmental disorders, and the need for improving preventive measures to reduce severe disease and adverse outcomes of pandemic (H1N1) 2009 in children.
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Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/epidemiologia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pandemias , Índice de Gravidade de Doença , Adolescente , Criança , Pré-Escolar , Alemanha/epidemiologia , Humanos , Lactente , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/mortalidade , Influenza Humana/fisiopatologia , Influenza Humana/virologia , Prevalência , Fatores de RiscoRESUMO
In the context of a large outbreak of Shiga toxin-producing Escherichia coli O104:H4 in Germany, we quantified the timeliness of the German surveillance system for hemolytic uremic syndrome and Shiga toxin-producing E. coli notifiable diseases during 2003-2011. Although reporting occurred faster than required by law, potential for improvement exists at all levels of the information chain.
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Surtos de Doenças , Infecções por Escherichia coli/epidemiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Escherichia coli Shiga Toxigênica/isolamento & purificação , Notificação de Doenças , Infecções por Escherichia coli/diagnóstico , Alemanha/epidemiologia , Síndrome Hemolítico-Urêmica/diagnóstico , Humanos , Fatores de TempoRESUMO
A major forthcoming sanitary issue concerns the apparition and spreading of drug-resistant microorganisms, potentially threatening millions of humans. In low-income countries, polluted urban runoff and open sewage channels are major sources of microbes. These microbes join natural microbial communities in aquatic ecosystems already impacted by various chemicals, including antibiotics. These composite microbial communities must adapt to survive in such hostile conditions, sometimes promoting the selection of antibiotic-resistant microbial strains by gene transfer. The low probability of exchanges between planktonic microorganisms within the water column may be significantly improved if their contact was facilitated by particular meeting places. This could be specifically the case within biofilms that develop on the surface of the myriads of floating macroplastics increasingly polluting urban tropical surface waters. Moreover, as uncultivable bacterial strains could be involved, analyses of the microbial communities in their whole have to be performed. This means that new-omic technologies must be routinely implemented in low- and middle-income countries to detect the appearance of resistance genes in microbial ecosystems, especially when considering the new 'plastic context.' We summarize the related current knowledge in this short review paper to anticipate new strategies for monitoring and surveying microbial communities.
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Antibacterianos/análise , Bactérias/isolamento & purificação , Biofilmes , Microbiota , Esgotos/microbiologia , Urbanização , Microbiologia da Água , Países em Desenvolvimento , Monitoramento Ambiental/métodos , Humanos , Pobreza , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Mortality of children under the age of five remains one of the most important public health challenges in developing countries. In rural settings, the promotion of household and community health practices through community health workers (CHWs) is among the key strategies to improve child health. The objective of this study was to assess the performance of CHWs in the promotion of basic child heath services in rural Mali. METHODS: A community-based cross-sectional survey was undertaken using multi-stage cluster sampling of wards and villages. Data was collected through questionnaires among 401 child-caregivers and registers of 72 CHWs. RESULTS: Of 401 households suppose to receive a visit by a CHW, 219 (54.6%; confidence interval 95%; 49.6-59.5) had received at least one visit in the last three months before the survey. The mother is the most important caregiver (97%); high percentage being illiterate. Caregivers treat fever and diarrhoea with the correct regimen in 40% and 11% of cases respectively. Comparative analysis between households with and without CHW visits showed a positive influence of CHWs on family health practices: knowledge on the management of child fever (p = < 0.001), non-utilization of antibiotics in home treatment of diarrhoea (p = 0.003), presence of cloroquine in the household (p = 0.002), presence (p = 0.001) and use (p = < 0.001) of bed nets. A total of 27 (38%) CHWs had not received supervision at all, against 45 (63%) who have been followed regularly each month during the last six months. CONCLUSION: Continuous training, transport means, adequate supervision and motivation of CHWs through the introduction of financial incentives and remuneration are among key factors to improve the work of CHWs in rural communities. Poor performance of basic household health practices can be related to irregular supply of drugs and the need of appropriate follow-up by CHWs.
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We would like to thank the authors Sunanda Gupta and Kiran Goswami for their interest in our article "Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad: a matched case-control study". In this response we aim to address their criticisms.
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After publication of the original article [1], the authors have notified us of an additional acknowledgement they wish to bring for their paper.
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BACKGROUND: Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad. The reasons behind persistently high prevalence of SAM in the Kanem region are still poorly understood, leaving national and international partners without clearly identified drivers to address. Current knowledge of SAM determinants in this context is largely based on very limited data. The aim of this study was thus to investigate individual and household-level risk factors for SAM among under-five children in Mao health district. METHODS: A matched case-control study was conducted on 411 (137 cases and 274 controls) children aged 6-59 months with their caretakers from mid-February to August 2017. Data were collected by using a structured interviewer administered questionnaire, anthropometric measurements and through direct observations of household environment. Controls were matched to their cases on place of residence and on age (± 3 months). Data were double-entered, processed and analysed using Epi Info 7.2.0.1. Conditional logistic regression was used to analyse the association of independent variables with SAM. For multivariable analysis, two models were constructed to investigate risk factors for SAM, at individual and household level. A stepwise backwards elimination approach with a significance level of p = 0.05 was used to build the final models. RESULTS: At the individual level, SAM was significantly associated with diarrhoea [AOR (95% CI) = 10.7 (4.2-27.3)], fever [AOR (95% CI) = 8.4 (3.1-22.8)], vomiting [AOR (95% CI) = 7.6 (3.0-19.7)], being stunted [AOR (95% CI) = 5.3 (1.7-16.3)], and type of complementary meal [AOR (95% CI) = 4.4 (1.0-19.6)]. At the household level, SAM was significantly associated with undernourished caretaker [AOR (95% CI) = 2.6 (1.2-5.5)], caretaker's hand washing habits [AOR (95% CI) = 1.9 (1.2-3.1)], absence of toilet [AOR (95% CI) = 1.9 (1.1-3.6)], caretaker's marriage status [AOR (95% CI) = 7.7 (2.0-30.1)], and low household food diversity [AOR (95% CI) = 1.8 (1.0-3.1)]. CONCLUSION: The present study identified the need to address both treatment and prevention of infections in children through an integrated approach. Well-organized efforts to improve child feeding practices, household hygiene and sanitation conditions, women's nutritional status, along with increasing household food diversity are likely to lead to improved nutritional status of children in this setting.
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BACKGROUND: During the Ebola virus disease (EVD) epidemic in Liberia, contact tracing was implemented to rapidly detect new cases and prevent further transmission. We describe the scope and characteristics of contact tracing in Liberia and assess its performance during the 2014-2015 EVD epidemic. METHODOLOGY/PRINCIPAL FINDINGS: We performed a retrospective descriptive analysis of data collection forms for contact tracing conducted in six counties during June 2014-July 2015. EVD case counts from situation reports in the same counties were used to assess contact tracing coverage and sensitivity. Contacts who presented with symptoms and/or died, and monitoring was stopped, were classified as "potential cases". Positive predictive value (PPV) was defined as the proportion of traced contacts who were identified as potential cases. Bivariate and multivariate logistic regression models were used to identify characteristics among potential cases. We analyzed 25,830 contact tracing records for contacts who had monitoring initiated or were last exposed between June 4, 2014 and July 13, 2015. Contact tracing was initiated for 26.7% of total EVD cases and detected 3.6% of all new cases during this period. Eighty-eight percent of contacts completed monitoring, and 334 contacts were identified as potential cases (PPV = 1.4%). Potential cases were more likely to be detected early in the outbreak; hail from rural areas; report multiple exposures and symptoms; have household contact or direct bodily or fluid contact; and report nausea, fever, or weakness compared to contacts who completed monitoring. CONCLUSIONS/SIGNIFICANCE: Contact tracing was a critical intervention in Liberia and represented one of the largest contact tracing efforts during an epidemic in history. While there were notable improvements in implementation over time, these data suggest there were limitations to its performance-particularly in urban districts and during peak transmission. Recommendations for improving performance include integrated surveillance, decentralized management of multidisciplinary teams, comprehensive protocols, and community-led strategies.
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Busca de Comunicante , Transmissão de Doença Infecciosa , Epidemias , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/transmissão , Feminino , Humanos , Libéria/epidemiologia , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The aim of this open-label, randomized controlled trial conducted in four African countries (Madagascar, Niger, Central African Republic, and Senegal) is to compare three strategies of renutrition for moderate acute malnutrition (MAM) in children based on modulation of the gut microbiota with enriched flours alone, enriched flours with prebiotics or enriched flours coupled with antibiotic treatment. METHODS: To be included, children aged between 6 months and 2 years are preselected based on mid-upper-arm circumference (MUAC) and are included based on a weight-for-height Z-score (WHZ) between - 3 and - 2 standard deviations (SD). As per current protocols, children receive renutrition treatment for 12 weeks and are assessed weekly to determine improvement. The primary endpoint is recovery, defined by a WHZ ≥ - 1.5 SD after 12 weeks of treatment. Data collected include clinical and socioeconomic characteristics, side effects, compliance and tolerance to interventions. Metagenomic analysis of gut microbiota is conducted at inclusion, 3 months, and 6 months. The cognitive development of children is evaluated in Senegal using only the Developmental Milestones Checklist II (DMC II) questionnaire at inclusion and at 3, 6, and 9 months. The data will be correlated with renutrition efficacy and metagenomic data. DISCUSSION: This study will provide new insights for the treatment of MAM, as well as original data on the modulation of gut microbiota during the renutrition process to support (or not) the microbiota hypothesis of malnutrition. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03474276 Last update 28 May 2018.
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Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Farinha , Alimentos Fortificados , Microbioma Gastrointestinal/efeitos dos fármacos , Transtornos da Nutrição do Lactente/terapia , Fenômenos Fisiológicos da Nutrição do Lactente , Desnutrição/terapia , Estado Nutricional , Prebióticos/administração & dosagem , Doença Aguda , África , Fatores Etários , Albendazol/administração & dosagem , Antibacterianos/efeitos adversos , Antiparasitários/administração & dosagem , Azitromicina/efeitos adversos , Desenvolvimento Infantil , Pré-Escolar , Feminino , Farinha/efeitos adversos , Alimentos Fortificados/efeitos adversos , Humanos , Lactente , Transtornos da Nutrição do Lactente/diagnóstico , Transtornos da Nutrição do Lactente/microbiologia , Transtornos da Nutrição do Lactente/fisiopatologia , Masculino , Desnutrição/diagnóstico , Desnutrição/microbiologia , Desnutrição/fisiopatologia , Estudos Multicêntricos como Assunto , Prebióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do TratamentoRESUMO
Water, sanitation and hygiene (WASH) interventions have a small but measurable benefit on stunting, but not on wasting. Our objective was to assess the effectiveness of a household WASH package on the performance of an Outpatient Therapeutic feeding Program (OTP) for severe acute malnutrition (SAM). We conducted a cluster-randomized controlled trial embedded in a routine OTP. The study population included 20 health centers (clusters) from Mao and Mondo districts in Chad. Both arms received the OTP. The intervention arm received an additional household WASH package (chlorine, soap, water storage container, and promotion on its use). The primary objective measures were the relapse rates to SAM at 2 and 6 months post-recovery. The secondary objectives included the recovery rate from SAM, the time-to-recovery, the weight gain, and the diarrhea longitudinal prevalence in OTP. The study lasted from April 2015 to May 2016. Among the 1,603 recruited children, 845 were in the intervention arm and 758 in the control arm. No differences in the relapse rates were noticed at 2 (-0.4%; P = 0.911) and 6 (-1.0%; P = 0.532) months. The intervention decreased the time-to-recovery (-4.4 days; P = 0.038), improved the recovery rate (10.5%; P = 0.034), and the absolute weight gain (3.0 g/d; P = 0.014). No statistical differences were noticed for the diarrhea longitudinal prevalence (-1.7%; P = 0.223) and the weight gain velocity (0.4 g/kg/d; P = 0.086). Our results showed that adding a household WASH package did not decrease post-recovery relapse rates but increased the recovery rate among children admitted in OTP. We recommend further robust trials in other settings to confirm our results.
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Transtornos do Crescimento/prevenção & controle , Higiene , Saneamento , Desnutrição Aguda Grave/prevenção & controle , Água/normas , Chade/epidemiologia , Pré-Escolar , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/patologia , Humanos , Lactente , Estudos Longitudinais , Pacientes Ambulatoriais , Desnutrição Aguda Grave/epidemiologia , Desnutrição Aguda Grave/patologia , Aumento de PesoRESUMO
INTRODUCTION: Although cases were reported only in 2010 and 2011, cholera is probably endemic in Yemen. In the context of a civil war, a cholera outbreak was declared in different parts of the country October 6th, 2016. This paper describes the ACF outbreak response in Hodeidah city from October 28th, 2016 to February 28th, 2017 in order to add knowledge to this large outbreak. METHODS: The ACF outbreak response in Hodeidah city included a case management component and prevention measures in the community. In partnership with the Ministry of Public Health and Population of Yemen (MoPHP), the case management component included a Cholera Treatment Center (CTC) implemented in the Al Thoraw hospital, 11 Oral Rehydration Therapy Corners (ORTCs) and an active case finding system. In partnership with other stakeholders, prevention measures in the community, including access to safe water and hygiene promotion, were implemented in the most affected communities of the city. RESULTS: From October 28th, 2016 until February 28th, 2017, ACF provided care to 8,270 Acute Watery Diarrhea (AWD) cases, of which 5,210 (63%) were suspected cholera cases, in the CTC and the 11 ORTCs implemented in Hodeidah city. The attack rate was higher among people living in Al Hali district, with a peak in November 2016. At the CTC, 8% of children under 5 years-old also presented with Severe Acute Malnutrition (SAM). The Case-Fatality Rate (CFR) was low (0.07%) but 15% of admitted cases defaulted for cultural and security reasons. Environmental management lacked the information to appropriately target affected areas. Financial resources did not allow complete coverage of the city. CONCLUSION: Response to the first wave of a large cholera outbreak in Hodeidah city was successful in maintaining a CFR <1% in the CTC. However, considering the actual context of Yemen and its water infrastructure, much more efforts are needed to control the current outbreak resurgence.
RESUMO
BACKGROUND AND PURPOSE: Central retinal artery occlusion (CRAO) is most often indirectly diagnosed by lack of retinal perfusion. Direct embolus characterization may help to understand the natural course and low response to treatment. In a previous study we identified a hyperechoic signal within the optic nerve and in the central retinal artery ("spot sign"). METHODS: In this study we performed a follow-up investigation in 7 patients with CRAO and positive spot sign indicating the embolic cause of the occlusion after a median interval of 17 months (range 11-38 months) using a battery of tests (ocular color-coded sonography, optic coherence tomography [OCT], fundoscopy, amongst others). RESULTS: The spot sign persisted in all patients, none had high-grade internal carotid artery stenosis, stroke or transient ischemic attacks. Four patients were completely blind, 3 patients were able to recognize hand movements. OCT demonstrated retinal atrophy, and fundoscopy revealed only minimal arterial perfusion. CONCLUSIONS: The hyperechoic spot sign may be an important predictive prognostic marker for persistent loss of vision. Its persistence may indicate calcified or cholesterol emboli and may explain the low therapeutic success rate to thrombolysis. Further studies on their origin and significance in atherosclerotic disease are warranted.