Combined Epidemiologic and Entomologic Survey to Detect Urban Malaria Transmission, Guinea, 2018.

Malaria incidence is generally lower in cities than rural areas. However, reported urban malaria incidence may not accurately reflect the level of ongoing transmission, which has potentially large implications for prevention efforts. To guide mosquito net distribution, we assessed the extent of malaria transmission in Conakry, Guinea, in 2018. We found evidence of active malaria transmission.

Beyond will: the empowerment conditions needed to abandon female genital mutilation in Conakry (Guinea), a focused ethnography.

BACKGROUND: Female genital mutilation (FGM) can give rise to immediate and long-term health problems for girls/women. Numerous studies have identified the sociocultural determinants of this tradition, but so far, in a national context where FGM is highly practiced, virtually none have focused on people refusing to have their daughters cut. We therefore aimed to understand the sociocultural dynamics underlying the non-practice of FGM in Guinea, a country which has one of the most prevalent rates of this practice in the world. This research explored the demographic and sociocultural profiles of Guineans who do not practice FGM, as well as their non-practice experience in a context of high FGM prevalence and social pressure. METHODS: We used a "focused ethnography" methodology and conducted semi-structured individual interviews with 30 women and men from different generations (young adults, parents, grandparents) living in Conakry, Guinea. RESULTS: We found that participants 1) do not disclose their non-practicing status in the same way, and 2) have different experiences with social pressure. A typology was created to describe participants as per their various profiles and experiences, which we named as: 1) the "activists", 2) the "discrete", 3) the "courageous", 4) the "strategists". DISCUSSION: Wanting to stop practicing FGM is not enough. The main empowering conditions allowing people to enact their decision not to have their daughters undergo FGM are: benefiting from social support (positive social capital), or being financially independent from the traditional solidarity network (sufficient economic capital). We therefore recommend finding ways to increase women's/families' empowerment to enact their decision not to practice FGM, mainly by: 1) providing them with new sources of social support, and 2) supporting them to gain more financial independence, including through schooling and improved access to better-paid employment. CONCLUSIONS: This study was the first to explore the experience of people who do not practice FGM in a context of high FGM prevalence and social pressure. The results and recommendations of this research can inform strategies for FGM abandonment and therefore contribute to improving or developing intervention strategies that promote the health and well-being of girls and women.

RéSUMé: CONTEXTE: Les mutilations génitales féminines (MGF) peuvent nuire à la santé des filles/femmes. Plusieurs études ont identifié les déterminants socioculturels de cette tradition, or aucune n'a focalisé sur des personnes vivant dans un contexte où les MGF sont hautement pratiquées et qui refusent de faire exciser leurs filles. En Guinée, la prévalence des MGF est très élevée et la pression sociale pour faire exciser les filles est forte. Cette recherche a donc exploré les profils démographiques et socioculturels, et l'expérience de Guinéens qui ne pratiquent pas les MGF. MéTHODES: Nous avons utilisé une méthodologie « d'ethnographie focalisée ¼, et mené des entretiens individuels semi-structurés avec 30 femmes et hommes de différentes générations (jeunes adultes, parents, grands-parents) vivant à Conakry, en Guinée. RéSULTATS: Nous avons constaté que les participants 1) ne divulguent pas tous leur statut de non-pratique, et 2) ont différentes expériences de pression sociale. Nous avons créé une typologie pour les décrire selon leurs différents profils et expériences, et les avons surnommés ainsi: 1) « activistes ¼, 2) « discrets ¼, 3) « courageux ¼, 4) « stratèges ¼. DISCUSSION: Vouloir abandonner la pratique des MGF ne suffit pas. Les principales conditions permettant aux participants de mettre en oeuvre leur décision de ne pas faire exciser leurs filles sont: bénéficier de soutien social (capital social positif), ou être financièrement indépendant du réseau de solidarité traditionnel (capital économique suffisant). Nous recommandons donc de trouver des moyens pour accroître l'autonomisation des femmes/familles pour qu'elles puissent mettre en œuvre leur décision de ne pas faire exciser leurs filles, principalement en les soutenant pour accéder à 1) du soutien social, et 2) l'indépendance financière, y compris par la scolarisation et l'accès à des emplois mieux rémunérés. CONCLUSIONS: Cette étude a été la première à explorer l'expérience de personnes qui ne pratiquent pas les MGF dans un contexte de forte prévalence des MGF et de pression sociale. Les résultats et recommandations de cette recherche peuvent éclairer les stratégies d'abandon des MGF et ainsi contribuer à améliorer ou à développer des stratégies d'intervention qui favorisent la santé et le bien-être des filles/femmes.

Occupational Exposures to Ebola Virus in Ebola Treatment Center, Conakry, Guinea.

We report 77 cases of occupational exposures for 57 healthcare workers at the Ebola Treatment Center in Conakry, Guinea, during the Ebola virus disease outbreak in 2014-2015. Despite the high incidence of 3.5 occupational exposures/healthcare worker/year, only 18% of workers were at high risk for transmission, and no infections occurred.

Transmission of Drug-Resistant Leprosy in Guinea-Conakry Detected Using Molecular Epidemiological Approaches.

Molecular drug susceptibility testing was performed on skin biopsies from 24 leprosy patients from Guinea-Conakry for the first time. We identified primary drug resistance in 4 cases and a dapsone-resistant cluster caused by the same strain. Primary transmission of drug-resistant Mycobacterium leprae, including a rifampicin-resistant strain, is reported.

Post-Ebola Measles Outbreak in Lola, Guinea, January-June 2015(1).

During public health crises such as the recent outbreaks of Ebola virus disease in West Africa, breakdowns in public health systems can lead to epidemics of vaccine-preventable diseases. We report here on an outbreak of measles in the prefecture of Lola, Guinea, which started in January 2015.

Factors associated with loss to follow-up in women undergoing repair for obstetric fistula in Guinea.

OBJECTIVES: To analyse the trend of loss to follow-up over time and identify factors associated with women being lost to follow-up after discharge in three fistula repair hospitals in Guinea. METHODS: This retrospective cohort study used data extracted from medical records of fistula repairs conducted from 1 January 2007 to 30 September 2013. A woman was considered lost to follow-up if she did not return within 4 months post-discharge. Factors associated with loss to follow-up were identified using a subsample of the data covering the period 2010-2013. RESULTS: Over the study period, the proportion of loss to follow-up was 21.5% (448/2080) and varied across repair hospitals and over time with an increase from 2% in 2009 to 52% in 2013. After adjusting for other variables in a multivariate logistic regression model, women who underwent surgery at Labe hospital and at Kissidougou hospital were more likely to be lost to follow-up than women operated at Jean Paul II hospital (OR: 50.6; 95% CI: 24.9-102.8) and (OR: 11.5; 95% CI: 6.1-22.0), respectively. Women with their fistula closed at hospital discharge (OR: 3.2; 95% CI: 2.1-4.8) and women admitted for repair in years 2011-2013 showed higher loss to follow-up as compared to 2010. Finally, loss to follow-up increased by 2‰ for each additional kilometre of distance a client lived from the repair hospital (OR: 1.002; 95% CI: 1.001-1.003). CONCLUSION: Reimbursement of transport was the likely reason for change over time of LTFU. Reducing geographical barriers to care for women with fistula could sustain fistula care positive outcomes.

Ischemic strokes revealing neurosyphilis: Study of six (6) observations at the neurology Department of the University Hospital of Conakry.

Introduction: In sub-Saharan Africa (SSA), stroke is a major public health problem and the etiological aspects are poorly studied and documented because of under-medicalization; the syphilitic etiology is rarely mentioned. Patients and methods: We performed a retrospective study of 472 patients hospitalized for ischemic stroke between 2016 and 2021 in the Neurology Department of the University Hospital of Conakry, confirmed by neuroradiological explorations (brain CT, MRI-Angio) and a biological workup including VDRL-TPHA serological reactions in blood and CSF. Results: Syphilitic etiology was retained for six (6) patients (4 men and 2 women) with a mean age of 43 years (extremes 36 and 49 years). The clinical picture was dominated by carotid syndromes: superficial and deep sylvian syndrome, anterior cerebral artery syndrome and vertebro-basilar syndromes and one case of lacunar syndrome.The diagnosis was based on the positivity of serological reactions (VDRL-TPHA) in blood and cerebrospinal fluid (CSF) and the presence of a predominantly lymphocytic hypercellularity and a hyperproteinorachy in the CSF in the absence of any other etiology. Conclusion: These neurological vascular syndromes consecutive to a cerebral treponematous attack are often the result of a still poorly conducted management of primary and secondary syphilis in our country.

Post-stroke Chorea in the Neurology Department of Ignace Deen Hospital of Conakry, Guinea.

INTRODUCTION: Chorea is an uncommon complication of stroke. The pathophysiology, the exact location of the lesions, and the evolution of this type of chorea are still poorly understood. The objective was to describe the epidemiological, clinical, and imaging profile of post-stroke chorea in a tropical environment in the context of a stroke epidemic. MATERIAL AND METHODS: We conducted a five-year retrospective observational study from 2015 to 2020 on stroke patients who presented with chorea in our department. Epidemiological, clinical, and imaging data were registered. RESULTS: Fourteen patients presented with chorea after their stroke, a frequency of 0.6%. The average age was 57.1 years with a male predominance. Hypertension was the cardiovascular risk factor in half of the patients; three patients (21.4) were diabetic. Chorea was the initial manifestation of the stroke in eight patients (57.1%). Thirteen patients (92.9%) had an ischaemic stroke and one had a cerebral haemorrhage. The middle cerebral artery (MCA) was involved in nine patients (64.3%), the anterior cerebral artery (ACA) in three patients (21.4%), and two patients (14.3%) had posterior cerebral artery (PCA) involvement. The lesions were cortical in five patients (35.7%), five other patients (35.7%) had a deep location, and four patients (28.6%) had both deep and cortical locations of their lesions. The structures affected were the lentiform nucleus (50%), the insula (35.7%), the caudate nucleus (14.3%), and the thalamus (14.3%). CONCLUSION: Post-stroke chorea is poorly studied in the tropics. In the presence of any acute abnormal movement associated with cardiovascular risk factors, post-stroke chorea should be considered. Recovery is rapid when treated early.

Current clinical presentations of AIDS dementia in a tropical environment: study of 26 observations in the neurology department of the University Hospital of Conakry.

INTRODUCTION: In sub-Saharan Africa (SSA), the clinical and progressive diagnostic certainty of AIDS dementia is difficult to establish due to under-medicalization and delays in consultation and especially the diversity of etiologies of demented states. MATERIAL AND METHODS: We carried out a retrospective study of 196 patients hospitalized for dementia syndrome between 2016 and 2021 in the neurology department of the University Hospital of Conakry. The criteria labeled in this study are those retained by the DSM-IV and the classification of the American Academy of Neurology (AAN) developed in accordance with the WHO. RESULTS: HIV etiology was identified in patients aged 44-67 years (17 women and 19 men). The clinical picture was dominated by severe cognitive disorders, slowed ideation, memory disorders and reduced motor skills associated with personality changes. Neurological examination revealed dysphoric disorders in most patients, sphincter abnormalities in 13 cases and labio-lingual tremor in 11 cases. Diagnosis was based on positive serological tests for HIV1 antibodies (25 cases) and HIV2 antibodies (1 case) using the Elisa and Western blot techniques, and the presence of discretely hypercellular CSF. Magnetic resonance imaging contributed to the diagnosis, showing diffuse white matter abnormalities with hyper signals on T2-weighted or FLAIR sequences. CONCLUSION: This study shows a non-stereotype clinical picture of AIDS dementia requiring a differential diagnosis with other infectious dementias. These results are important for the therapeutic and prognostic discussion.

Knowledge, Attitude and Practice Toward COVID-19: A Cross-Sectional Study of Staff in China-Guinea Friendship Hospital, Guinea.

Background: The purpose of this study was to assess the level of knowledge, attitude and practice of COVID-19 among staff in China-Guinea Friendship Hospital, and to confirm the effect of nosocomial infection management. Methods: This cross-sectional study was conducted in December 2021. Information on socio demographic data, knowledge, attitude and practices related to COVID-19 was collected through a self-administered questionnaire. Results: A total of 143 employees participated in the survey, with a response rate of 99.31% and a vaccination rate of 95.10%. The average knowledge score of COVID-19 was 8.39 ± 1.3 points (10 points in total), without significant differences between subgroups with different demographic variables (P > 0.05); more than 80% of the participants had a positive attitude, and 72.03-93.01% of the participants could take appropriate preventive practices in different environments such as hospital, outdoor or home. Conclusion: The staff of the China-Guinea Friendship Hospital has good knowledge of COVID-19, a positive attitude and appropriate preventive practices. It can be concluded that the current nosocomial infection management is active and effective. Therefore, this study suggests that comprehensive activities such as training, promotion and supervision of COVID-19-related knowledge and countermeasures should be widely and continuously implemented in healthcare facilities, which will continuously improve the overall KAP level of hospital staff and play an important role in curbing the COVID-19 pandemic.

[Knowledge, attitudes and practices related to cataract and glaucoma in the population of Conakry, Guinea]. / Connaissances, attitudes et pratiques relatives à la cataracte et au glaucome dans la population de Conakry en Guinée.

Introduction: the purpose of this study was to evaluate the knowledge, attitudes and practices (KAP) related to cataract and glaucoma in the population of Conakry Guinea. Methods: we conducted a prospective descriptive and analytical study at the Bartimée Clinic over a period of three months. All patients who agreed to answer our questionnaire and having an age ≥18 years were included. KAP questions related to cataract and glaucoma were asked. Knowledge levels were correlated with age, gender and education. Results: a total of 1000 people participated in the study. Sex-ratio was 1.10 and the mean age was 42.41 years ± 21.74. Male occupations were found to be more represented 21.80%; illiterate persons accounted for 45.10%, those with a very good level of knowledge 47.50%, patients knowing that the treatment of cataract was surgical 59.10%. For glaucoma: 55.80% of patients thought that the treatment was surgical. In the case of cataract and glaucoma 51.90% said they would go to hospital, 38,80% would go to a traditional healer and 9,30% practiced self-medication. There was a significant link between age, gender and education level and knowledge about cataract and glaucoma. Conclusion: in Conakry, Guinea, KAP related to cataract and glaucoma are less than satisfactory. Awareness-raising strategies should be undertaken to improve results.

Evaluation of Three Blended Learning Courses to Strengthen Health Professionals' Capacity in Primary Health Care, Management of Sexual and Reproductive Health Services and Research Methods in Guinea.

Background: Three blended courses on Primary Health Care (eSSP), Management of Sexual and Reproductive Health Services (eSSR), and Research Methods (eMR) were developed and implemented between 2017 and 2021 by the Maferinyah National Training and Research Center in Rural Health, a training and research institution of the Ministry of Health in Guinea. The study objectives were to evaluate the reasons for dropout and abstention, the learners' work behavior following the training, and the impact of the behavior change on the achievements of learners' organizations or services. Methods: We evaluated the three implemented courses in 2021, focusing on levels 3 and 4 of the Kirkpatrick training evaluation model. Quantitative and qualitative data were collected through an open learning platform (Moodle), via an electronic questionnaire, during the face-to-face component of the courses (workshops), and at learners' workplaces. Descriptive statistics and thematic analysis were performed for quantitative and qualitative data, respectively. Results: Out of 1,016 applicants, 543 including 137 (25%) women were enrolled in the three courses. Over the three courses, the completion rates were similar (67-69%) along with 20-29% dropout rates. Successful completion rates were 72% for eSSP, 83% for eMR and 85% for eSSR. Overall success rate (among all enrollees) ranged from 50% (eSSP) to 58% (eSSR). The majority (87%) of the learners reported applying the knowledge and skills they acquired during the courses through activities such as supervision (22%), service delivery (20%), and training workshops (14%). A positive impact of the training on utilization/coverage of services and increased revenues for their health facilities were also reported by some trainees. Conclusion: These findings showed fair success rates and a positive impact of the training on learners' work behavior and the achievements of their organizations.

Sjögren's syndrome in children: about 15 cases in Guinea Conakry.

OBJECTIVES: Sjögren's syndrome is rare in children and most often secondary. It frequently affects girls and is characterized by dry eye syndrome, mouth and sometimes systemic involvement. Its diagnosis is difficult to establish in children. We report a series of 15 cases of Sjögren's syndrome in order to clarify the peculiarities of this condition in children. PATIENTS AND METHODS: This retrospective study was carried out over a 2-year period focused on children under 16 years of age who had been followed for Sjögren's syndrome in the rheumatology and pediatric departments. Patient data were collected and then analyzed by STATA/SE version 11.2 software. Anonymity and respect for ethical rules were the norm. There was no connection between the patients and the researchers. DESCRIPTION OF CASES: The mean age of the patients was 11 years with extremes of 5-15 years. History reveals that a dry mouth was found in more than half of the cases, or in 10 (66.7%) patients. Clinical examination found oral ulceration and periodontitis in equal proportions, 6 (40%). The immunological workup and the biopsy of the accessory salivary glands served as diagnostic evidence in the 15 patients according to the US-European criteria of 2002. CONCLUSION: Sjögren's syndrome is a rare entity in pediatrics. Its diagnosis is difficult to establish in pediatrics and its severity is linked to the occurrence of late visceral and lymphomatous sicca syndrome. Rapid diagnosis and initiation of a synthetic antimalarial (hydroxychloroquine) increases the hope of a cure.

Lupus Pernio in Chronic Sarcoidosis.

Lupus pernio (LP) is characterized by the association between insidious purpuric or purplish blue lesions localized in the nose, cheeks, lips, and ears and swelling of the fingers and toes. We report a case of chronic sarcoidosis with lupus pernio in a 34-year-old male. The diagnosis of sarcoidosis was made on the basis of clinical data and imaging results and confirmed by skin biopsy, which showed numerous epithelioid granulomas surrounded by a non-caseous inflammatory crown. Treatment with prednisolone was started. It is important to make an early diagnosis to avoid a delay in treatment and worsening of the functional and psychological prognosis.

Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO) Syndrome: Clinical and Therapeutic Aspects.

Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare entity. It is frequently under-detected. We report the case of SAPHO syndrome in a 38-year-old woman, seen in consultation for pain and swelling of the anterior chest wall affecting the sternoclavicular and sternocostal joints predominantly on the right, and low back pain with an inflammatory appearance with peripheral damage, especially in the legs. We also found in our patient episodes of palmoplantar pustulosis. The diagnosis of SAPHO syndrome was retained in accordance with Kahn's diagnostic criteria, and the osteitis was confirmed by morphological examinations (CT scan, MRI, and bone scintigraphy). The patient was treated with non-steroidal anti-inflammatory drugs and methotrexate with good clinical improvement.

Evaluation of the Impact of Noise Pollution on the Workers of the Bottling Line of the Limited Company of Breweries of Guinea (SOBRAGUI).

Introduction Noise or noise pollution is a phenomenon that causes an auditory sensation considered unpleasant, undesirable, and annoying, which may present a danger to health in general and the auditory system in particular. The objective of this study was to evaluate the impact of noise pollution among workers in a brewery in the city of Conakry. Patient and methods This is a prospective descriptive study, of two months' duration (November 11, 2019, to January 10, 2020) carried out in the industrial unit of the Limited Company of Breweries of Guinea (SOBRAGUI). We included all the workers of the company exposed to noise pollution in their workplaces, after their informed consent. Results The age of the workers varied between 22 and 70 years, with a mean age of 44.14 ± 8.07 years. We noted a male predominance of 99.22% (n=128) cases. The average duration of exposure was 14.28 ± 6.78 years, with variations ranging from one year to 35 years. Among the auditory disorders, we noted tinnitus in 63.8% (n=74), hypoacusis in 56.9% (n=66), and auditory fatigue in 52.6% (n=61) of cases. These signs were often associated with each other and with other extra-auditory symptoms in the same worker. Audiometry revealed a moderate to severe hearing loss in 13.8% (n=16) and profound deafness in 0.9% (n=1) of cases. The impact of noise pollution on workers' performance was reflected in concentration difficulties in 57.7% (n=67) of cases. Conclusion Noise pollution is present in the SOBRAGUI bottling line. It has a negative impact on the health of workers and alters their work performance.

[The missions of Biologie Sans Frontières (BSF)]. / Les missions de Biologie Sans Frontières (BSF).

« Biologie sans Frontières ¼ (BSF) is a non-governmental organisation whose mission is to develop medical biology where it is most needed, particularly in French-speaking Africa. In Guinea Conakry, with Fondation Mérieux and the Guinean Ministry of Health, BSF is in charge of training "trainers/teachers" of technicians. This training will take place at the National Health School of Kindia, a school that has been completely rehabilitated and re-equipped thanks to the support of Fondation Mérieux. This project is supported by the French Development Agency. BSF has an in-depth knowledge of the local needs in medical biology training. After an audit carried out by two BSF members, the findings were alarming: these trainers had no experience in medical biology and their theoretical knowledge was still of low level. Three training courses were then provided by BSF, the first in biochemistry, sero-immunology and immuno-hematology, the second in cyto-hematology and the last one in bacteriology-parasitology. The basic techniques have been acquired, the "student trainers" have shown great assiduity, but the level remains fragile and will require new training, which is essential to help these future teachers to provide structured, functional and above all useful practical work adapted to local practices and needs.

[Locoregional Anaesthesia in a Country with Limited Resources: Lidocaine 1.5% Adrenaline, Alternative to Ropivacaine 0.5% for Ultrasound-Guided Axillary Block]. / Anesthésie Locorégionale dans un Pays à Ressources Limitées: La Lidocaïne 1,5% Adrenalinée, Alternative à la Ropivacaine 0,5% Pour le Bloc Axillaire Échoguidé.

Objective: The aim of this study was to evaluate lidocaine 1.5% adrenaline as an alternative to ropivacaine 0.5% for the echo guided axillary block. Methode: We conducted a 28-month prospective and randomized study (January 15, 2017 to May 15, 2019) conducted in the anesthesia department of the Ignace Deen National Hospital in Conakry, Guinea. Results: A total of 38 patients were enrolled: 19 in each group. Their average age was 46 ± 17 years in the lidocaine group compared to 44 ± 20 years in the ropivacaine group. The average time to fix the block in the lidocaine group was 6.8 ± 2.1 minutes compared to 8.3 ± 2.4 minutes in the ropivacaine group (p = 0.04). The average duration of action was 233 ± 57 minutes in the lidocaine group versus 260 ± 74 minutes in the ropivacaine group (p= 0.21). The block efficiency rate was identical in both groups with 89.5% of effective blocks in the lidocaine group and in the ropivacaine group (p =1). The cost of consumables for the lidocaine group was 15 euros compared to 60 euros for the ropivacaine group. Conclusion: 1.5% adrenaline lidocaine is a good alternative to ropivacaine 0.5% for the production of echoguided axillary blocks in resource-limited countries.

[Evolution of Uterine Ruptures at the Maternity of Ignace Deen National Hospital (Chu of Conakry)]. / Évolution des Ruptures Utérines à la Maternité de L'hôpital National Ignace Deen (Chu de Conakry).

Uterine rupture is a common obstetrical drama in our delivery rooms that has become exceptional in developed countries. In developing countries including Guinea, this tragedy is one of the major concerns of the obstetrician. The objectives of this work were: to evaluate the frequency of uterine rupture in the department, to describe the socio-demographic and clinical characteristics of the patients, to identify the factors favoring the occurrence of uterine rupture, to evaluate the maternal-fetal prognosis and propose a prevention strategy to reduce maternal and fetal morbidity and mortality by uterine rupture. This was a descriptive study with data collection in two phases, one retrospective lasting 18 months from July 1, 2017 to December 31, 2018 and the other prospective, lasting 18 months also from January 1, 2019 to June 30, 2020 both carried out at the maternity ward of the Ignace Deen National Hospital. We collected 84 cases of uterine rupture out of 18,790 deliveries, i.e. a frequency of 0.44%. During the same time 10,067 cesarean sections were realized, i.e. one laparotomy for uterine rupture for 120 cesarean sections. The average age of the patients was 28.14 years with a standard deviation of 2 years and the average profile is that of a housewife (51.8%), multiparous (44.6%), evacuated from peripheral maternity (85.5%) and having an insufficient number of antenatal consultations (82.6%). In 93.1% of cases, the uterine rupture had occurred in delivery centers, peripheral maternity hospitals and on the way, the uterine ruptures were mostly spontaneous (65.1%), and occurred in a healthy uterus (59.0%). Uterine rupture was more frequently complete (83.33%). Surgical treatment was more frequently conservative with hysterorrhaphy (88.1%). We recorded 12 maternal deaths, i.e. a case fatality rate of 14.6%. On admission, almost all of the women showed no signs of fetal life. To reduce the frequency of uterine ruptures, better organization of emergency obstetric and neonatal care and better screening for risk factors for obstructed labor during prenatal consultations should be encouraged.

Implementation of DHIS2 for Disease Surveillance in Guinea: 2015-2020.

A robust epidemic-prone disease surveillance system is a critical component of public health infrastructure and supports compliance with the International Health Regulations (IHR). One digital health platform that has been implemented in numerous low- and middle-income countries is the District Health Information System Version 2 (DHIS2). In 2015, in the wake of the Ebola epidemic, the Ministry of Health in Guinea established a strategic plan to strengthen its surveillance system, including adoption of DHIS2 as a health information system that could also capture surveillance data. In 2017, the DHIS2 platform for disease surveillance was piloted in two regions, with the aim of ensuring the timely availability of quality surveillance data for better prevention, detection, and response to epidemic-prone diseases. The success of the pilot prompted the national roll-out of DHIS2 for weekly aggregate disease surveillance starting in January 2018. In 2019, the country started to also use the DHIS2 Tracker to capture individual cases of epidemic-prone diseases. As of February 2020, for aggregate data, the national average timeliness of reporting was 72.2%, and average completeness 98.5%; however, the proportion of individual case reports filed was overall low and varied widely between diseases. While substantial progress has been made in implementation of DHIS2 in Guinea for use in surveillance of epidemic-prone diseases, much remains to be done to ensure long-term sustainability of the system. This paper describes the implementation and outcomes of DHIS2 as a digital health platform for disease surveillance in Guinea between 2015 and early 2020, highlighting lessons learned and recommendations related to the processes of planning and adoption, pilot testing in two regions, and scale up to national level.