RESUMEN
We describe the results of a molecular epidemiological survey of 15 carbapenemase-encoding genes from a recent collection of clinical isolates from Mercy Hospital in Bo, Sierra Leone. The most salient findings revealed that (i) 60% of the isolates harbored multiple carbapenemase genes; (ii) the blaDIM-1 gene, which has previously only been reported in The Netherlands, is also circulating in this environment; and (iii) blaOXA-51-like and blaOXA-58 genes, which were thought to reside exclusively in Acinetobacter species, can also be found in members of the Enterobacteriaceae.
Asunto(s)
Proteínas Bacterianas/genética , Infecciones por Enterobacteriaceae/epidemiología , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/enzimología , beta-Lactamasas/genética , Enterobacteriaceae/genética , Enterobacteriaceae/aislamiento & purificación , Genotipo , Humanos , Epidemiología Molecular , Datos de Secuencia Molecular , Análisis de Secuencia de ADN , Sierra Leona/epidemiologíaRESUMEN
Human health depends on reliable access to safe drinking water, but in many developing countries only a limited number of wells and boreholes are available. Many of these water resources are contaminated with biological or chemical pollutants. The goal of this study was to examine water access and quality in urban Bo, Sierra Leone. A health census and community mapping project in one neighborhood in Bo identified the 36 water sources used by the community. A water sample was taken from each water source and tested for a variety of microbiological and physicochemical substances. Only 38.9% of the water sources met World Health Organization (WHO) microbial safety requirements based on fecal coliform levels. Physiochemical analysis indicated that the majority (91.7%) of the water sources met the requirements set by the WHO. In combination, 25% of these water resources met safe drinking water criteria. No variables associated with wells were statistically significant predictors of contamination. This study indicated that fecal contamination is the greatest health risk associated with drinking water. There is a need to raise hygiene awareness and implement inexpensive methods to reduce fecal contamination and improve drinking water safety in Bo, Sierra Leone.
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Estado de Salud , Contaminación del Agua/análisis , Abastecimiento de Agua/estadística & datos numéricos , Agua Potable/química , Monitoreo del Ambiente , Humanos , Medición de Riesgo , Sierra Leona , Contaminantes del Agua/análisis , Contaminación del Agua/estadística & datos numéricosRESUMEN
BACKGROUND: Resource-limited tropical countries are home to numerous infectious pathogens of both human and zoonotic origin. A capability for early detection to allow rapid outbreak containment and prevent spread to non-endemic regions is severely impaired by inadequate diagnostic laboratory capacity, the absence of a "cold chain" and the lack of highly trained personnel. Building up detection capacity in these countries by direct replication of the systems existing in developed countries is not a feasible approach and instead requires "leapfrogging" to the deployment of the newest diagnostic systems that do not have the infrastructure requirements of systems used in developed countries. METHODS: A laboratory for molecular diagnostics of infectious agents was established in Bo, Sierra Leone with a hybrid solar/diesel/battery system to ensure stable power supply and a satellite modem to enable efficient communication. An array of room temperature stabilization and refrigeration technologies for reliable transport and storage of reagents and biological samples were also tested to ensure sustainable laboratory supplies for diagnostic assays. RESULTS: The laboratory demonstrated its operational proficiency by conducting an investigation of a suspected avian influenza outbreak at a commercial poultry farm at Bo using broad range resequencing microarrays and real time RT-PCR. The results of the investigation excluded influenza viruses as a possible cause of the outbreak and indicated a link between the outbreak and the presence of Klebsiella pneumoniae. CONCLUSIONS: This study demonstrated that by application of a carefully selected set of technologies and sufficient personnel training, it is feasible to deploy and effectively use a broad-range infectious pathogen detection technology in a severely resource-limited setting.
Asunto(s)
Brotes de Enfermedades/prevención & control , Gripe Aviar/diagnóstico , Laboratorios/organización & administración , Análisis por Micromatrices/métodos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Animales , Comunicación , Países en Desarrollo , Brotes de Enfermedades/veterinaria , Estabilidad de Medicamentos , Diagnóstico Precoz , Suministros de Energía Eléctrica , Indicadores y Reactivos , Gripe Aviar/epidemiología , Infecciones por Klebsiella/diagnóstico , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/veterinaria , Personal de Laboratorio/educación , Análisis por Micromatrices/veterinaria , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/veterinaria , Aves de Corral , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/veterinaria , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/veterinaria , Sierra Leona/epidemiología , Manejo de EspecímenesRESUMEN
BACKGROUND: Spatial epidemiology is useful but difficult to apply in developing countries due to the low availability of digitized maps and address systems, accurate population distributions, and computational tools. A community-based mapping approach was used to demonstrate that participatory geographic information system (PGIS) techniques can provide information helpful for health and community development. RESULTS: The PGIS process allowed for the rapid determination of sectional (neighborhood) boundaries within the city of Bo, Sierra Leone. When combined with data about hospital laboratory visits, a catchment area for one hospital in Bo could be established. A survey of households from within the catchment area determined that the average population per household (about 6 individuals) was similar to that found in the 2004 census. However, we also found that the average house was inhabited by more than one household, for an average of 17.5 inhabitants per residential building, which is critical information to know when estimating population size using remote imagery that can detect and enumerate buildings. CONCLUSIONS: The methods developed in this paper serve as a model for the involvement of communities in the generation of municipal maps and their application to community and health concerns.
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Áreas de Influencia de Salud/estadística & datos numéricos , Participación de la Comunidad/métodos , Mapas como Asunto , Países en Desarrollo , Métodos Epidemiológicos , Composición Familiar , Sistemas de Información Geográfica , Humanos , Laboratorios de Hospital/estadística & datos numéricos , Sierra LeonaRESUMEN
OBJECTIVES: To examine the diversity of the health-care providers in urban Bo, Sierra Leone, identify the types of health-care facilities preferred by women for fevers, and analyze the road network distances from homes to preferred health-care providers. METHODS: A population-based random sampling method was used to recruit 2419 women from Bo. A geographic information system was used to measure the road distance from each woman's home to her preferred provider. RESULTS: Preferred health-care providers for acute febrile illnesses (commonly referred to as "malaria" in the study communities) were hospitals (62.3 %), clinics (12.6 %), and pharmacies (12.4 %). Participants lived a median distance of 0.6 km from the nearest provider, but on average each woman lived 2.2 km one-way from her preferred provider. Women living farther from the city center had preferred providers significantly farther from home than women living downtown. CONCLUSIONS: The diverse health-care marketplace in Bo allows women to select clinical facilities from across the city. Most women prefer a malaria care provider farther from home than they could comfortably walk when ill.
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Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Prioridad del Paciente/estadística & datos numéricos , Viaje/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Femenino , Sistemas de Información Geográfica , Personal de Salud/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Malaria/terapia , Persona de Mediana Edad , Servicios Farmacéuticos/estadística & datos numéricos , Sierra Leona , Adulto JovenRESUMEN
The factors that influence the selection of a healthcare provider once the decision to seek care has been made can be summarized using a triad of cost, location and reputation. The goal of this study was to identify which of these factors is the primary consideration when women in urban Bo, Sierra Leone, select a healthcare provider for themselves or their children. We interviewed 1091 mothers during a household census of two neighbourhoods of Bo in April 2010. Reputation was the top consideration for about half of the women, cost was the second most common priority, and the location of the healthcare facility was the primary consideration for less than 7% of the participants. The majority of women said they would select a new provider if cost was not a barrier. Socioeconomic characteristics were not significant predictors of whether cost, location or reputation was selected as the highest-ranked consideration. This evidence for the importance of reputation in healthcare decision-making even in low-resource areas highlights the need for health systems to address issues of quality and responsiveness, and not just cost, in order to increase access to and utilization of health services.