Using Andersen's model of health care utilization to assess factors associated with COVID-19 testing among adults in nine low-and middle-income countries: an online survey.

BACKGROUND: This study aimed to investigate, using Andersen's model of health care utilization, factors associated with COVID-19 testing among adults in nine low- and middle- income countries. METHODS: In between 10 December 2020 and 9 February 2021, an online survey was organized in nine low- and middle-income countries. In total 10,183 adults (median age 45 years, interquartile range 33-57 years, range 18-93 years), including 6470 from Brazil, 1738 Malaysia, 1124 Thailand, 230 Bangladesh, 219 DR Congo, 159 Benin, 107 Uganda, 81 Malawi and 55 from Mali participated in the study. COVID-19 testing/infection status was assessed by self-report. RESULTS: Of the 10,183 participants, 40.3% had ever tested for COVID-19, 7.3% tested positive, and 33.0% tested negative. In an adjusted logistic regression model, predisposing factors (residing in Brazil, postgraduate education), enabling/disabling factors (urban residence, higher perceived economic status, being a student or worker in the health care sector, and moderate or severe psychological distress), and need factors (having at least one chronic condition) increased the odds of COVID-19 testing. Among those who were tested, participants residing in Bangladesh, those who had moderate to severe psychological distress were positively associated with COVID-19 positive diagnosis. Participants who are residing in Malaysia and Thailand, and those who had higher education were negatively associated with a COVID-19 positive diagnosis. Considering all participants, higher perceived economic status, being a student or worker in the health sector, and moderate or severe psychological distress were positively associated with a COVID-19 positive diagnosis, and residing in Malaysia, Thailand or five African countries was negatively associated with a COVID-19 positive diagnosis. CONCLUSION: A high rate of COVID-19 testing among adults was reported in nine low-and middle-income countries. However, access to testing needs to be increased in Africa. Moreover, COVID-19 testing programmes need to target persons of lower economic status and education level who are less tested but most at risk for COVID-19 infection.

Comparative analyses of the bacterial communities present in the spontaneously fermented milk products of Northeast India and West Africa.

Introduction: Spontaneous fermentation of raw cow milk without backslopping is in practice worldwide as part of the traditional food culture, including "Doi" preparation in earthen pots in Northeast India, "Kindouri" of Niger and "Fanire" of Benin prepared in calabash vessels in West Africa. Very few reports are available about the differences in bacterial communities that evolved during the spontaneous mesophilic fermentation of cow milk in diverse geographical regions. Methods: In this study, we used high throughput amplicon sequencing of bacterial 16S rRNA gene to investigate 44 samples of naturally fermented homemade milk products and compared the bacterial community structure of these foods, which are widely consumed in Northeast India and Western Africa. Results and discussion: The spontaneous milk fermentation shared the lactic acid bacteria, mainly belonging to Lactobacillaceae (Lactobacillus) and Streptococcaceae (Lactococcus) in these two geographically isolated regions. Indian samples showed a high bacterial diversity with the predominance of Acetobacteraceae (Gluconobacter and Acetobacter) and Leuconostoc, whereas Staphylococcaceae (Macrococcus) was abundant in the West African samples. However, the Wagashi cheese of Benin, prepared by curdling the milk with proteolytic leaf extract of Calotrophis procera followed by natural fermentation, contained Streptococcaceae (Streptococcus spp.) as the dominant bacteria. Our analysis also detected several potential pathogens, like Streptococcus infantarius an emerging infectious foodborne pathogen in Wagashi samples, an uncultured bacterium of Enterobacteriaceae in Kindouri and Fanire samples, and Clostridium spp. in the Doi samples of Northeast India. These findings will allow us to develop strategies to address the safety issues related to spontaneous milk fermentation and implement technological interventions for controlled milk fermentation by designing starter culture consortiums for the sustainable production of uniform quality products with desirable functional and organoleptic properties.

Prevalence, antibiotic resistance, and virulence gene profile of Escherichia coli strains shared between food and other sources in Africa: A systematic review.

Background and Aim: Foodborne diseases caused by Escherichia coli are prevalent globally. Treatment is challenging due to antibiotic resistance in bacteria, except for foodborne infections due to Shiga toxin-producing E. coli, for which treatment is symptomatic. Several studies have been conducted in Africa on antibiotic resistance of E. coli isolated from several sources. The prevalence and distribution of resistant pathogenic E. coli isolated from food, human, and animal sources and environmental samples and their virulence gene profiles were systematically reviewed. Materials and Methods: Bibliographic searches were performed using four databases. Research articles published between 2000 and 2022 on antibiotic susceptibility and virulence gene profile of E. coli isolated from food and other sources were selected. Results: In total, 64 articles were selected from 14 African countries: 45% of the studies were conducted on food, 34% on animal samples, 21% on human disease surveillance, and 13% on environmental samples. According to these studies, E. coli is resistant to ~50 antimicrobial agents, multidrug-resistant, and can transmit at least 37 types of virulence genes. Polymerase chain reaction was used to characterize E. coli and determine virulence genes. Conclusion: A significant variation in epidemiological data was noticed within countries, authors, and sources (settings). These results can be used as an updated database for monitoring E. coli resistance in Africa. More studies using state-of-the-art equipment are needed to determine all resistance and virulence genes in pathogenic E. coli isolated in Africa.

Hygiene practices of food of animal origin operators in primary schools in the Mono Department of Benin. A cross-sectional study.

Food of animal origin is an important source of proteins for human beings. However, they are subject to microbial contamination. It is essential to ensure the safety of food products intended for school children regarding their vulnerability to food poisoning. Good sanitary quality of these products requires the respect of good practices during their processing and distribution. This study aims to evaluate the conditions of processing and sale of food of animal origin to school children in public schools, with or without canteens, in the Department of Mono in southern Benin. In the Department of Mono in the Republic of Benin, 137 operators were interviewed in public schools, with one operator per school, using a questionnaire created on the Epicollect5 platform. The interview showed that the operators involved in the processing and sale of food to school children were women. Most of these operators had primary education and did not undergo a medical examination. They transported food of animal origin mixed with other types of food. Frying and cooking were used to prepare or process the food. Direct observation revealed that food is produced in an unhealthy environment. The operators did not wear gloves during food processing but some wore aprons. All the operators washed their hands with soap and water (tap or well water) after using the toilet. There was not an adequate handwashing facility. The majority of operators used wooden cutting boards. Overall, food operators especially in schools without a canteen do not follow good hygiene and manufacturing practices in the kitchen. To guarantee food safety for school children, training should be organized to make operators aware of good hygiene and manufacturing practices in kitchens.

Prevalence of antibiotic-resistant bacteria amongst dogs in Africa: A meta-analysis review.

Antimicrobial resistance (AMR) is a global public health threat for both human and veterinary medicine. Increasing evidence suggests that animals are important sources of AMR to humans; however, most of these studies focus on production animals. In order to determine the pattern of AMR in pets, mainly in dogs in Africa, a meta-analysis was performed with AMR studies conducted in African countries and published between January 2000 and January 2021 in four databases: Medline (PubMed), Scopus, Cab abstract and Google Scholar. Seven bacterial strains, namely Staphylococcus aureus, Escherichia coli, Salmonella spp., Pseudomonas aeruginosa, Streptococcus pyogenes, coagulase-negative Staphylococcus (SNC) and Staphylococcus pseudintermedius were included in this study. A total of 18 out of 234 indexed articles met the study criteria. The results revealed that multiple bacteria were resistant to various commonly used antibiotics including enrofloxacin, ciprofloxacin, gentamicin, amoxicillin, clavulanic acid, cotrimoxazole, streptomycin, tetracycline and chloramphenicol. Concerning multidrug resistance, E. coli strains came first with the highest prevalence of 98%, followed by P. aeroginosa (92%) and Salmonella spp. (53%). In contrast, the overall prevalence of multidrug resistance was low for S. aureus (18%) and S. pseudintermedius (25%). It is therefore urgent to find, as soon as possible, alternatives to replace these antibiotics, which have become ineffective in controlling these bacteria in dogs in Africa. Moreover, further metagenomic studies are needed to describe the full resistome and mobilome in dogs regardless of the bacteria.

Hygienic quality of raw and fermented cow milk in the local milk sector of the Liptako-Gourma area in Niger.

Background and Aim: Milk is a food of high nutritional value, which occupies an undeniable place in the human food ration, but is an ideal medium for microbial growth. This study aims to assess the hygienic quality of local raw and fermented milk from the Liptako-Gourma region in Niger. Materials and Methods: We performed physical and bacteriological analyses on 330 samples of bovine milk from local breeds, including 110 individual milk samples (per cow), 110 fermented milk samples, and 110 blended milk samples. The microbiological parameters were determined using standard methods. Results: The physical analysis revealed temperatures during sample collection for all milk types between 35.2°C and 37.8°C. The average pH of fermented milk varied between 3.16 and 4.92 and those of individual and blended raw milks between 5.42 and 6.98. The titratable acidity varied from 15° to 18.1°D for raw milk and between 59° and 122°D for fermented milk. The average density of individual and blended milks ranged between 1.028 and 1.035. Regionally, milk samples from Tillaberi had a significantly higher aerobic mesophilic germ (GAM) load (7.42 ± 0.53 × 107 Colony-forming unit/mL; p = 0.0025) compared to the Dosso and Niamey regions. The prevalence of Staphylococcus aureus, Escherichia coli, and Salmonella spp. were 86.36%, 12.73%, and 20.91%, respectively, in fermented milk. Phenotypic identification pointed toward three genera: E. coli (30.76% ± 0.25%), S. aureus (20.58% ± 0.14%), and Salmonella spp. (2.74 ± 0.04%). Conclusion: The present data suggest that milk samples collected from three regions in Liptako-Gourma had low quality; further, some of the bacteria identified (E. coli, S. aureus, and Salmonella spp.) could be potential foodborne pathogens.

Adherence to COVID-19 preventive measures in Sub-Saharan Africa during the 1st year of the pandemic: Pooled analysis of the International Citizen Project on COVID-19 (ICPCovid) surveys.

Introduction: While most governments instituted several interventions to stall the spread of COVID-19, little is known regarding the continued observance of the non-pharmaceutical COVID-19 preventive measures particularly in Sub-Saharan Africa (SSA). We investigated adherence to these preventive measures during the initial 6 months of the COVID-19 outbreak in some SSA countries. Methods: Between March and August 2020, the International Citizen Project on COVID-19 consortium (www.icpcovid.com) conducted online surveys in six SSA countries: Benin, Cameroon, Democratic Republic of Congo, Mozambique, Somalia, and Uganda. A five-point individual adherence score was constituted by scoring respondents' observance of the following measures: mask use, physical distancing, hand hygiene, coughing hygiene, and avoiding to touch one's face. Community behaviors (going to public places, traveling during the pandemic) were also assessed. Data were analyzed in two time periods: Period 1 (March-May) and Period 2 (June-August). Results: Responses from 26,678 respondents were analyzed (mean age: 31.0 ± 11.1 years; 54.1% males). Mean individual adherence score decreased from 3.80 ± 1.37 during Period 1, to 3.57 ± 1.43 during Period 2; p < 0.001. At the community level, public events/places were significantly more attended with increased travels during Period 2 compared to Period 1 (p < 0.001). Using linear mixed models, predictors of increased individual adherence included: higher age (Coef = 0.005; 95% CI: 0.003-0.007), female gender (Coef = 0.071; 95% CI: 0.039-0.104), higher educational level (Coef = 0.999; 95% CI: 0.885-1.113), and working in the healthcare sector (Coef = 0.418; 95% CI: 0.380-0.456). Conclusion: Decreasing adherence to non-pharmaceutical measures over time constitutes a risk for the persistence of COVID-19 in SSA. Younger persons and those with lower education levels constitute target groups for improving adherence to such measures.

Psychosocial Factors Associated With Adherence to COVID-19 Preventive Measures in Low-Middle- Income Countries, December 2020 to February 2021.

Objectives: To investigate psychosocial factors associated with adherence to COVID-19 preventive measures in low- and middle-income countries (LMICs). Methods: This online cross-sectional survey included 10,183 adults (median age 45 years) from nine LMICs. Participants were asked about adhering to four COVID-19 preventive measures (physical distancing, wearing a face mask, hand, and cough hygiene); a composite adherence score was calculated, ranging from 0-4 positive responses. Psychosocial measures included worry, anxiety, depression, social and demographic, and COVID-19 related factors. Results: Factors associated with adherence to more preventive measures included being a participant from Malaysia or Bangladesh, older age, higher education, belonging to the healthcare sector (either as or worker), having health personnel as a trusted source of COVID-19 information/advice, possessing correct COVID-19 knowledge, worry or fear about being (re)infected with COVID-19, and screening negative for general anxiety symptoms. Conclusion: Moderate to high adherence to COVID-19 preventive measures was found, with significant variations across countries. Psychosocial factors (worry, anxiety, knowledge, education, age, and country) seemed determinant in predicting the number of measures to which participants adhered.

Evaluation of the knowledge, attitudes and practices of students at the University of Abomey-Calavi on rabies in Benin Republic, West Africa.

INTRODUCTION: rabies is a vaccine-preventable viral zoonotic disease. Once clinical symptoms appear, rabies is fatal in almost 100% of cases. The objective of this study was to evaluate the knowledge, attitudes and practices of students at the University of Abomey-Calavi in Benin on rabies in order to explore the factors that promote the occurrence of this zoonosis. METHODS: for this purpose, a descriptive cross-sectional survey was conducted among 263 randomly-selected students. The collected data were analyzed by R software with logistic regression. RESULTS: out of all the 263 respondents, 53.2% (n=140) of the students claimed to have heard of canine rabies, compared to 47.5% (n=125) for human rabies. Stray dogs were recognized by 49.0% (n=129) as a prevailing source of rabies infection in people; bites from these dogs were considered as a means of rabies contagion (41.4%; n=109) and vaccination of dogs was considered by 32.7% (n=86) as a means of rabies control in both people and dogs. In case of a dog bite, 60.5% (n=159) of respondents would visit a western medicine human clinic first. For the fate of the biting dog, 18.6% (n=49) and 27.4% (n=72) of respondents, respectively, prefer to euthanize the dog or take the dog to the veterinarian for observation. Regarding the perceived consequences of inaction after a dog bite, 58.2% (n=140) mentioned the risk of rabies. Students in human or animal health were 3 times more aware on rabies. CONCLUSION: this study identifies the gaps in students´ knowledge, attitudes and practices about effective rabies prevention and control. It will therefore be necessary to intensify awareness and education campaigns among students who could be a good relay of information to other members in their communities.

Assessment of adherence to public health measures and their impact on the COVID-19 outbreak in Benin Republic, West Africa.

INTRODUCTION: following the global COVID-19 outbreak, the government of Benin implemented preventive measures to stall viral transmission. We sought to evaluate adherence of the Beninese people to these preventive measures, in order to identify predictors of poor adherence and adapt the national response to COVID-19. METHODS: two consecutive online surveys were conducted between May and August 2020. Four hundred and sixty two and 507 adult participants aged 18 years and above responded to the first and second survey respectively, with >70% being males. RESULTS: more than 98% of respondents reported wearing face masks. A five-point adherence score was constituted by scoring observance to key preventive measures (mask use, physical distancing, hand hygiene, coughing hygiene and avoiding to touch one´s face). We observed that the mean adherence scores were fairly stable over time, respectively 4.08 and 4.03 during the first and second survey (p=0.439). Increasing age (aOR=1.043, 95% CI: 1.026 - 1.061; p<0.001) and obtaining COVID-19 information from official sources (aOR=1.628, 95% CI: 1.275 - 2.081; p<0.001) were significantly associated with higher adherence scores in a multivariable model. CONCLUSION: these findings suggest that a wide dissemination of adequate information about COVID-19 would increase adherence, and that targeted efforts should be directed towards increasing the compliance to preventive measures among the younger age groups.

Factors Affecting COVID-19 Vaccine Acceptance: An International Survey among Low- and Middle-Income Countries.

Vaccination is fast becoming a key intervention against the ongoing COVID-19 pandemic. We conducted cross-sectional online surveys to investigate COVID-19 vaccine acceptance across nine Low- and Middle-Income Countries (LMICs; N = 10,183), assuming vaccine effectiveness at 90% and 95%. The prevalence of vaccine acceptance increased from 76.4% (90% effectiveness) to 88.8% (95% effectiveness). Considering a 90% effective vaccine, Malaysia, Thailand, Bangladesh, and five African countries (Democratic Republic of Congo, Benin, Uganda, Malawi, and Mali) had lower acceptance odds compared to Brazil. Individuals who perceived taking the vaccine as important to protect themselves had the highest acceptance odds (aOR 2.49) at 95% effectiveness.Vaccine acceptance was also positively associated with COVID-19 knowledge, worry/fear regarding COVID-19, higher income, younger age, and testing negative for COVID-19. However, chronic disease and female gender reduced the odds for vaccine acceptance. The main reasons underpinning vaccine refusal were fear of side effects (41.2%) and lack of confidence in vaccine effectiveness (15.1%). Further research is needed to identify country-specific reasons for vaccine hesitancy in order to develop mitigation strategies that would ensure high and equitable vaccination coverage across LMICs.

Adults' Acceptance of COVID-19 Vaccine for Children in Selected Lower- and Middle-Income Countries.

Since emergency approval of COVID-19 vaccines for children aged between 12 and 15 years old was recently obtained in the United States and Europe, we aimed to assess the willingness to vaccinate children with a COVID-19 vaccine in lower- and middle-income countries (LMICs). Therefore, we launched an online cross-sectional survey in several LMICs. Questions relating to socio-demographic information, knowledge of COVID-19, level of fear/worry of being infected with COVID-19, and willingness to vaccinate children with the COVID-19 vaccine at 50%, 75% and 95% effectiveness levels, were asked. Of the 6571 participants (mean age = 39 ± 14 years), 64.0%, 72.6%, and 92.9% were willing to vaccinate children at 50%, 75%, and 95% effectiveness levels, respectively. Respondents who were undergraduates, who were more worried/fearful about COVID-19, had higher knowledge scores regarding COVID-19, and a higher belief that COVID-19 vaccination is important to protect others, were more willing to accept COVID-19 vaccination of children. COVID-19 vaccination of children will limit the spread of the virus, especially in schools; it may decrease the need for school closures which has a negative effect on child development. Findings from this study are useful for health promotion strategies during COVID-19 vaccination implementation among children in LMICs.

High-Throughput Illumina MiSeq Amplicon Sequencing of Yeast Communities Associated With Indigenous Dairy Products From Republics of Benin and Niger.

Traditional Wagashi cheese and fermented cow milk are among the most popular dairy products appreciated by people from Benin, Niger, and the neighboring region. These products are the main source of protein in the diet of the low-income population in the region. The fermented milk is prepared by spontaneous fermentation without back-slopping. Whereas, the leaf extract of Calotropis procera is used for curdling the milk to prepare the soft Wagashi cheese. The present study aims to provide in-depth analysis of yeast communities associated with these traditional milk products by high-throughput Illumina MiSeq amplicon sequencing of internal transcribed spacer (ITS) region of fungal rRNA genes. A total of 60 samples, 20 samples of fermented milk each from Benin and Niger, and 20 samples of Wagashi cheese from Benin were used for analysis. The metagenomic investigation revealed that Kluyveromyces marxianus, Saccharomyces cerevisiae, Candida parapsilosis, and Sagenomella keratitidis were the predominant yeast species present in the traditional milk products. Furthermore, we noticed a high presence of K. marxianus (61.1% relative abundance) in the Wagashi cheese and S. cerevisiae (28.4% relative abundance) in the fermented milk of Niger. The presence of potential pathogenic yeast C. parapsilosis and S. keratitidis in these African milk products calls for further investigation to assess their safety. The predominant yeast K. marxianus and S. cerevisiae, recognized with generally regarded as safe (GRAS) status, could be further selected as starter culture along with lactic acid bacteria for developing controlled fermentation processes with enhanced product quality and safety.

A serological survey of Toxoplasma gondii infection in sheep and goat from Benin, West-Africa.

Toxoplasma gondii is a parasitic protozoan, the etiological agent of toxoplasmosis, a worldwide zoonosis responsible for abortion and congenital malformation in animal and human. The present study reports, for the first time, the occurrence of T. gondii infection among sheep and goats from Benin. A total of 368 small ruminants: 215 serum samples from sheep raised in Sahelian area of North Benin and 153 serum samples from goats raised in a family farm from South-Benin, were collected and screened for anti-T. gondii IgG antibodies by the ELISA-indirect method. The results show the presence of anti-T. gondii IgG in 53% (83/153) of goats and 1.4% of sheep (3/215). Age, sex and breed did not seem to affect the frequency of this infection. Among goats, T. gondii infection was higher in animals reared in the coastal zone (Cotonou municipality) than those raised on the island (Allada municipality) [odds ratio (OR) = 4, 95% confidence interval (CI) = 1.07-15.002, p = 0.032, (χ2) test]. Humidity would be the determining factor in the disparity of recorded infection rates among sheep and goat. The high prevalence of caprine toxoplasmosis observed in southern Benin shows strong environmental contamination. Sensitization campaigns should therefore be undertaken by the public health authorities to inform the inhabitants of this area about risks and preventive measures of this zoonose.

Correction to: A serological survey of Toxoplasma gondii infection in sheep and goat from Benin, West-Africa.

[This corrects the article DOI: 10.1007/s12639-018-01076-1.].

Toxoplasma gondii infection in meat animals from Africa: Systematic review and meta-analysis of sero-epidemiological studies.

AIM: Toxoplasma gondii is an ubiquitous apicomplexan parasite which causes toxoplasmosis in humans and animals. Felids especially cats are definitive hosts and almost all warm-blooded mammals, including livestock and human can serve as intermediate hosts. Food animals can be reservoirs for T. gondii and act as one of the sources for parasite transmission to humans. The objective of this study is to collect serological data on the prevalence of anti-T. gondii antibody, and risk factors for certain food animals from Africa to provide a quantitative estimate of T. gondii infection among these species from different African countries. MATERIALS AND METHODS: Four databases were used to search seroepidemiological data on the prevalence of anti-T. gondii antibody in food animals between 1969 and 2016 from African countries. The search focused on data obtained by serologic test in food animals and meta-analyses were performed per species. RESULTS: A total of 30,742 individual samples from 24 countries, described in 68 articles were studied. The overall estimated prevalence for toxoplasmosis in chicken, camel, cattle, sheep, goat, pig were 37.4% (29.2-46.0%), 36% (18-56%), 12% (8-17%), 26.1% (17.0-37.0%), 22.9% (12.3-36.0%), and 26.0% (20-32.0%), respectively. Moreover, major risk factor of infection was age, farming system, and farm location. CONCLUSIONS: A significant variation in the seroepidemiological data was observed within each species and country. The results can aid in an updated epidemiological analysis but also can be used as an important input in quantitative microbial risk assessment models. Further studies are required for a better and continual evaluation of the occurrence of this zoonotic infection.