Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa.

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

Did the Ebola outbreak disrupt immunisation services? A case study from Liberia.

Setting: All health facilities providing routine immunisation services in Liberia. Objective: To compare the number of routine facility-based and outreach immunisations and measles cases before, during and after the Ebola outbreak. Design: A descriptive cross-sectional study. Results: Immunisation coverage for fully immunised children before the Ebola outbreak was 73%. Immunisation coverage for all antigens declined by half compared to baseline during the outbreak. These findings were similar in facility-based and outreach immunisations. During the outbreak, the proportion of fully immunised children dropped by respectively 58%, 33% and 39% in the most, moderately and least Ebola-affected counties. Immunisation rate of recovery in the post-Ebola period was respectively 82%, 21% and 9% in the most, moderately and least affected counties compared to the Ebola-outbreak period. Outreach immunisation recovered slowly compared to facility-based immunisation. The mean number of measles cases reported per month was 12 pre-Ebola, 16 Ebola and 60 post-Ebola. Conclusion: This study provides insights into the possible impact of an Ebola outbreak on countrywide immunisation. The outbreak weakened a struggling national immunisation programme, and post-outbreak recovery took significant time, which likely contributed to the measles epidemic. Recommendations for the improvement of immunisation services that could limit further preventable epidemics in Liberia and similar contexts at risk for Ebola are provided.

Contexte : Toutes les structures de santé offrant des services de vaccination de routine au Liberia.Objectif : Comparer le nombre de vaccinations de routine dans des structures de santé et en stratégies avancées et le nombre de cas de rougeole avant, pendant et après l'épidémie d'Ebola.Schéma : Étude descriptive transversale.Résultats : La couverture vaccinale des enfants complètement immunisés avant l'épidémie d'Ebola était de 73%. La couverture vaccinale pour tous les antigènes a décliné de moitié pendant la flambée comparée à la période précédente. Ces résultats ont été similaires pour les vaccinations dans les structures de santé et les vaccinations périphériques. Pendant la flambée, la proportion d'enfants complètement immunisés a chuté de 58%, 33% et 39%, respectivement, dans les contés gravement, moyennement et faiblement affectés par Ebola. Le taux de vaccination de récupération dans la période post Ebola a été de 82%, 21% et 9%, respectivement, dans les comtés gravement, moyennement et faiblement affectés par Ebola comparés à la période de la flambée d'Ebola. Les vaccinations dans la communauté ont récupéré plus lentement que les vaccinations en structures de santé. Le nombre moyen mensuel de cas de rougeole rapporté a été de 12 avant Ebola, 16 Ebola et 60 après Ebola.Conclusion : Cette étude permet de mieux comprendre l'impact possible d'une épidémie d'Ebola sur le programme de vaccination dans le pays. La flambée a affaibli un programme national de vaccination déjà en difficulté et après la flambée la récupération a pris du temps, ce qui a sans doute contribué à l'épidémie de rougeole. Des recommandations pour une amélioration des services de vaccination qui pourraient limiter les épidémies évitables à l'avenir au Liberia et dans des contextes similaires à risque d'Ebola sont proposées.

Marco de referencia: Todos los establecimientos de salud que prestan servicios corrientes de vacunación en Liberia.Objetivo: Comparar el número de vacunaciones corrientes institucionales y extrainstitucionales practicadas y de casos de sarampión antes de la epidemia de fiebre hemorrágica del Ébola, durante el brote y después del mismo.Método: Fue este un estudio transversal descriptivo.Resultados: La cobertura de los niños con un esquema completo de vacunación antes de la epidemia del Ébola era 73%. La cobertura con todos los antígenos disminuyó un 50% durante el brote epidémico en comparación con los datos preepidémicos. Esta proporción fue equivalente en la vacunación institucional y periférica. Durante el brote, la proporción de niños con un esquema completo de vacunación disminuyó según la intensidad alta, moderada o baja de la epidemia en un 58%, un 33% y un 39%, respectivamente. La tasa correspondiente de recuperación de la vacunación después del período epidémico fue de 82%, 21% y 9% con respecto al período epidémico. La vacunación periférica se recuperó más lentamente que la vacunación practicada en los establecimientos de salud. El promedio mensual de casos de sarampión notificados fue 12 antes del brote del Ébola, 16 durante la epidemia y 60 después de la misma.Conclusión: Los resultados del presente estudio enriquecen la percepción de las repercusiones que puede provocar una epidemia de fiebre hemorrágica del Ébola en el sistema de vacunación a escala del país. El brote epidémico debilitó aun más el programa nacional de vacunación y su recuperación precisó un tiempo considerable; es probable que este factor haya contribuido al surgimiento de la epidemia de sarampión. Se aportan recomendaciones encaminadas a mejorar los servicios de vacunación, que pueden limitar mejor las epidemias prevenibles en Liberia y en otros entornos comparables donde existe un riesgo de aparición de la fiebre del Ébola.

Coverage and use of insecticide-treated bed nets in households with children aged under five years in Liberia.

SETTING: St John's District, Grand Bassa County, Liberia. OBJECTIVES: In households with children aged <5 years, to examine the coverage and use of long-lasting insecticide-treated bed nets (LLINs), factors associated with non-use and the characteristics and conditions of bed nets. DESIGN: Cross-sectional study involving interviews with mothers and visual inspection of LLINs. RESULTS: Of 663 households visited, 492 (74%) had no LLIN and 135 (20%) had one LLIN. Of 171 households with LLINs, these were consistently used by 73 (43%) children. The main reasons for inconsistent use included LLINs being old or damaged, and LLINs generating too much heat for 20-30% of children. Visual inspection of LLINs in 130 households showed that 98% of LLINs were white, 20% were not hung above the child's sleeping place, 30% had holes, 84% were double-bed sized and 82% had been washed in the previous 6 months. CONCLUSION: Despite reports of 100% LLIN coverage in St John's District, this study showed that only a quarter of households had an LLIN, over half of the children used LLINs inconsistently and the LLINs had several deficiencies. More surveys should be conducted to determine the true coverage of LLINs in Liberia, and measures must be taken to improve the use of LLINs.