Dog rabies control in West and Central Africa: A review.

Rabies is a neglected but preventable zoonotic disease that predominantly affects the most vulnerable populations living in remote rural areas of resource-limited countries. To date, every country on the African mainland is considered endemic for dog-mediated rabies with an estimated 21'500 human rabies deaths occurring each year. In 2018, the United Against Rabies collaboration launched the Global Strategic Plan to end human deaths from dog-mediated rabies by 2030. The epidemiology of rabies from most Western and Central African countries remains poorly defined, making it difficult to assess the overall rabies situation and progress towards the 2030 goal. In this review, we attempt to provide an overview of the current rabies situation in 22 West and Central African countries based on published scientific literature and information obtained from rabies focal points. To this end, information was collected on i) established surveillance, ii) diagnostic capacity, iii) post-exposure prophylaxis (PEP) availability and coverage, iv) dog population estimates, v) dog vaccination campaigns, vi) animal and human health communication (One Health), vii) molecular studies, viii) Knowledge, Attitude and Practices (KAP), ix) cost estimates and x) national control strategies. Although rabies is a notifiable disease in the majority of the studied countries, national surveillance systems do not adequately capture the disease. A general lack of rabies diagnostic capacity has an additional negative impact on rabies surveillance and attempts to estimate rabies burden. Recurrent shortages of human rabies vaccine are reported by all of the countries, with vaccine availability usually limited to major urban centers but no country has yet adopted the new WHO-recommended 1-week intradermal vaccination regimen. Most countries carry out subsidized mass dog vaccination campaigns on World Rabies Day. Such activities are indispensable to keep rabies in the public consciousness but are not of the scale and intensity that is required to eliminate rabies from the dog population. Countries will need to scale up the intensity of their campaigns, if they are to progress towards the 2030 goal. But more than half of the countries do not yet have reliable figures on their dog populations. Only two countries reached stage 2 on the Stepwise Approach towards Rabies Elimination ladder - indicating that their national governments have truly prioritized rabies elimination and are thus providing the necessary support and political buy-in required to achieve success. In summary, the sub-region of West and Central Africa seems to be divided into countries which have accepted the challenge to eliminate rabies with governments committed to pushing forward rabies elimination, while other countries have achieved some progress, but elimination efforts remain stuck due to lacking government commitment and financial constraints. The possibility to meet the 2030 goal without international solidarity is low, because more than two-thirds of the countries rank in the low human development group (HDI ≤ 152). Leading countries should act as role models, sharing their experiences and capacities so that no country is left behind. Unified and with international support it is possible to reach the common goal of zero human rabies deaths by 2030.

Prevalence, risk factors and health consequences of soil-transmitted helminth infection on the Bijagos Islands, Guinea Bissau: A community-wide cross-sectional study.

Soil-transmitted helminths (STH) are endemic and widespread across Sub-Saharan Africa. A community wide soil-transmitted helminth (STH) prevalence survey was performed on the island of Bubaque in Guinea-Bissau using both Kato-katz microscopy and qPCR methodology. Predictors of infection and morbidity indicators were identified using multivariable logistic regression, and diagnostic methods were compared using k statistics. Among 396 participants, prevalence of STH by microscopy was 23.2%, hookworm was the only species identified by this method and the mean infection intensity was 312 eggs per gram. qPCR analysis revealed an overall prevalence of any STH infection of 47.3%, with the majority A. duodenale (32.3%), followed by N. americanus (15.01%) and S. stercoralis (13.2%). A. lumbricoides, and T. trichiura infections were negligible, with a prevalence of 0.25% each. Agreement between diagnostic tests was k = 0.22, interpreted as fair agreement, and infection intensity measured by both methods was only minimally correlated (Rs = -0.03). STH infection overall was more common in females and adults aged 31-40. STH infection was associated with open defaecation, low socio-economic status and further distance to a water-source. The prevalence of anaemia (defined as a binary outcome by the WHO standards for age and sex) was 69.1%, and 44.2% of children were malnourished according to WHO child growth standards. Hookworm infection intensity by faecal egg count showed no statistically significant association with age (Rs 0.06) but S. Stercoralis infection intensity by qPCR cycle threshold was higher in pre-school aged children (Rs = 0.30, p-value 0.03) There was no statistically significant association between STH infection and anaemia (OR 1.0 p = 0.8), stunting (OR 1.9, p-value 0.5) and wasting (OR 2.0, p-value 0.2) in children. This study reveals a persistent reservoir of STH infection across the community, with high rates of anaemia and malnutrition, despite high-coverage of mebendazole mass-drug administration in pre-school children. This reflects the need for a new strategy to soil-transmitted helminth control, to reduce infections and ultimately eliminate transmission.

The prevalence of scabies, pyoderma and other communicable dermatoses in the Bijagos Archipelago, Guinea-Bissau.

INTRODUCTION: Skin diseases represent a significant public health problem in most low and middle income settings. Nevertheless, there is a relative paucity of high-quality epidemiological data on the prevalence of these conditions. MATERIALS/METHODS: We conducted two cross-sectional population-based skin-surveys of children (6 months to 9 years old) in the Bijagós Archipelago of Guinea-Bissau during the dry season (February-March 2018) and the wet season (June-July 2018). Following a period of training, a nurse performed a standardised examination for communicable dermatoses for each participant. We calculated the prevalence of each skin condition and investigated demographic associations. RESULTS: 1062 children were enrolled in the dry season survey of whom 318 (29.9%) had at least one skin diseases. The most common diagnosis was tinea capitis (154/1062, 14.5% - 95% CI 12.5-16.8%) followed by tinea corporis (84/1062, 7.9% - 95% CI 6.4-9.7%), pyoderma (82/1062, 7.7% - 95% CI 6.2-9.5%) and scabies (56/1062. 5.2% - 95%CI 4.0-6.8%). 320 children were enrolled in the wet season survey of whom 121 (37.8%) had at least one skin problem. Tinea capitis remained the most common diagnosis (79/320, 24.7% - 95% CI 20.1-29.9%), followed by pyoderma (38/320, 11.9% - 95% CI 8.6-16.1%), tinea corporis (23/320, 7.2% - 95% 4.7-10.7%) and scabies (6/320, 1.9% - 95% CI 0.8-4.2%). CONCLUSIONS: Our study, which utilised robust population-based cluster random sampling methodology, demonstrates the substantial disease burden caused by common communicable dermatoses in this setting. Given these findings, there is a need to consider common dermatoses as part of Universal Health Coverage to deliver 'skin-health for all'.

Prevalence of community-acquired bacteraemia in Guinea-Bissau: an observational study.

BACKGROUND: The burden of bloodstream infections is insufficiently studied in children in Africa and many healthcare facilities lack the capacity to identify invasive disease. Often studies have been limited to febrile patients or patients admitted to hospital. METHODS: Blood cultures and malaria diagnostics was performed on 372 consecutive children presenting with tachycardia and/or fever to a referral paediatric emergency department in Bissau, Guinea-Bissau. Bacterial species detection, antimicrobial susceptibility testing and molecular typing were performed. The capacity of clinical parameters to identify bacteraemia was evaluated. RESULTS: The prevalence of bloodstream infection was 12% (46/372) and in 46% (21/46) of the infections the child was non-febrile at presentation to the hospital. The predictive value for bacteraemia was poor for all assessed clinical parameters. Staphylococcus aureus accounted for 54% (26/48) of the isolates followed by non-typhoidal Salmonella, 10% (5/48), Streptococcus pneumoniae, 8% (4/48), and Salmonella Typhi, 6% (3/48). Among S. aureus there was a large diversity of spa types and 38% produced Pantone-Valentine leukocidin. Antibiotic resistance was low, however two out of three Klebsiella pneumoniae isolates produced extended-spectrum beta-lactamases. Malaria was laboratory confirmed in only 5% of the children but 64% (237/372) received a clinical malaria diagnosis. CONCLUSIONS: Bacteraemia was common irrespective of the presence of fever among children presenting to the hospital. The high prevalence of Staphylococcus aureus may be due to contamination. There is an imminent need to improve microbiological diagnostic facilities and to identify algorithms that can identify children at risk of bloodstream infections in Africa.

Fecal carriage of ESBL-producing E. coli and K. pneumoniae in children in Guinea-Bissau: a hospital-based cross-sectional study.

BACKGROUND: In recent years, the world has seen a surge in extended-spectrum ß-lactamase (ESBL)-producing bacteria. However, data on the dissemination of ESBL-producing Enterobacteriaceae in the community from systematically enrolled study subjects in Africa remains limited. To determine the prevalence, phenotypic resistance patterns and genetic characteristics of ESBL-producing E. coli and K. pneumoniae in fecal carriage and to analyze associated risk factors in children attending a pediatric emergency department in Guinea-Bissau. METHODOLOGY/PRINCIPAL FINDINGS: From June to September 2010, children <5 years of age with fever or tachycardia attending a pediatric emergency ward during the day was screened for ESBL carriage in feces. Socio-demographic and health seeking behavior data was collected. Antibiotic susceptibility was tested with VITEK2 and EUCAST disk diffusion method, molecular characterization of ESBL-encoding genes was performed with multiplex PCR and clonal relatedness was established by automated rep-PCR. Of 408 enrolled children 133 (32.6%) were ESBL carriers. In total, 83 E. coli and 91 K. pneumoniae ESBL-producing isolates were obtained. Nearly all isolates were multidrug-resistant. Co-resistance to ciprofloxacin, trimethoprim-sulfamethoxazole and aminoglycosides was common. Of the isolates, 38.5% were co-resistant to these classes plus extended-spectrum cephalosporins, which infers resistance to all easily available antibiotic agents for treatment of gram-negative sepsis in Guinea-Bissau. The predominant resistance-encoding gene subgroup was bla(CTX-M-1) and epidemiologic typing showed that the bacterial ESBL population was highly diverse both for E. coli and K. pneumoniae. Bed sharing with another child <5 years of age was a risk factor for ESBL carriage, indicating crowding as a potential risk factor for transmission of ESBL-producing bacteria. CONCLUSIONS/SIGNIFICANCE: Prevalence of ESBL-producing bacteria in this population was high and clonally diverse. This is alarming considering the limited diagnostic and treatment possibilities in Guinea-Bissau and other resource-poor countries.

A situação epidemiológica da tuberculose na República da Guiné-Bissau, 2000 - 2005 / The epidemiological situation of tuberculosis in the Republic of Guinea-Bissau, 2000-2005

INTRODUÇÃO: A tuberculose na República da Guiné-Bissau não apresenta bons indicadores de saúde, assim como na maioria dos países em vias de desenvolvimento. OBJETIVO: Estudar na República da Guiné-Bissau e nas suas Províncias, a situação epidemiológica da doença no período de 2000 a 2005. MÉTODO: Realizou-se levantamento de dados secundários junto ao Programa Nacional de Luta Contra Lepra e Tuberculose, no período de 2000 a 2005, e análise de relatórios anuais da Capital e das Províncias da Guiné-Bissau, para o cálculo de coeficientes e taxas dos indicadores. RESULTADOS: O número de casos de tuberculose manteve-se estável no período de 2000 (1.959 casos) a 2005 (1.888 casos). O percentual de casos pulmonares variou de 96,0 a 98,8 por cento, dos quais 55 por cento eram bacilíferos. Em 2005 o coeficiente de prevalência foi de 142,4/100.000, o de incidência 131,3/100.000 e o de mortalidade, 16,8/100.000 habitantes. A maior concentração de casos ocorreu na região da Capital. A taxa de cura variou entre 46,5 por cento em 2000 e 69,6 por cento em 2005, e a de abandono de tratamento de 29,8 por cento em 2000 para 12,1 por cento em 2005. CONCLUSÃO: Os indicadores do Plano Estratégico Nacional devem ser melhorados, sobretudo no que diz respeito à busca ativa de casos, à descentralização do atendimento aos doentes, à implantação da estratégia DOTS e à necessidade de um sistema de informação e notificação eficientes.

INTRODUCTION: Tuberculosis does not present good health indicators in the Republic of the Guinea-Bissau, like most other developing countries. OBJECTIVE: To study the epidemiological status of the illness in the 2000-2005 period in the Republic of the Guinea-Bissau and its Provinces. METHOD: Secondary data were collected from the National Fight Against Leprosy and Tuberculosis Program, in the period from 2000 to 2005, and annual reports of the Capital and the Provinces were analyzed to calculate coefficients and indicators. RESULTS: The number of tuberculosis cases remained stable in the period from 2000 (1,959 cases) to 2005 (1,888 cases). The percentage of pulmonary cases ranged from 96.0 to 98.8 percent, of which 55 percent had positive smears. The coefficients of prevalence, incidence and mortality, in 2005 were 142.4/100,000, 131.3/100,000 and 16.8/100,000 inhabitants, respectively. The main concentration of cases occurred in the region of the Capital. Cure rates varied between 46.5 percent in 2000 and 69.6 percent in 2005 and treatment interruption rates were 29.8 percent in 2000 and 12.1 percent in 2005. CONCLUSION: The indicators of the National Strategic Plan must improve, particularly with regard to active case search, decentralization of patient care, implementation of the DOTS strategy, and the need for an efficient information and reporting system.

Vigilância epidemiológica da tuberculose na República da Guiné-Bissau / Epidemiological monitoring of tuberculosis in the Republic of Guinea-Bissau

Introdução: A tuberculose é uma doença milenar, constituindo um problema de saúde pública, desde sua descoberta até hoje em dia. Recentemente, com o surgimento da HIV/AIDS, a doença ganhou outros contornos e dimensões, nos países desenvolvidos e, sobretudo, nos países em desenvolvimento. Objetivo: Análise das ações da Luta Contra Tuberculose na República da Guiné-Bissau e do fluxo do sistema de notificação e de informação de dados, dentro do Sistema Nacional de Saúde. Metodologia: trata-se de um estudo exploratório descritivo que consiste no diagnóstico da situação de tuberculose no país, no período de 2000 a 2005, mediante levantamento das informações secundárias dos principais indicadores epidemiológicos e operacionais mais utilizados no país. Foram feitos cálculosde coeficientes e taxas, assim como padronização pelo método direito de coeficientes de incidência de casos bacilíferos, para comparação. Resultados: No período de estudo, foram registrados 10.623 casos de tuberculose. O menor coeficiente de incidência de tuberculose foi de 116,4/100.000 habitantes, no ano de 2003, e o mais alto foi de 131,3/100.000 habitantes, em 2005. O maior coeficiente de mortalidade registrado foi de 16,8/100.000 habitantes, em 2005. A maior taxa de letalidade foi de 11,8 por cento, em 2005, e a mais baixa, de 5,1 por cento, em 2003. Conclusão: É de notar que a busca ativa de sintomáticos respiratórios ainda é baixa, assim como a cobertura da estratégia DOTS, por possíveis problemas técnicos operacionais. Há necessidade da melhoria do diagnóstico no país, sobretudo da forma clínica extrapulmonar, e de um sistema de notificação e informação eficiente em todos os níveis.

Estudo das patologias ocupacionais benignas da coluna vertebral. Sistema de vigilância de acidentes de trabalho na Secretaria Municipal de Saúde de São Paulo / Study of occupational benign diseases of the spine. Surveillance system of occupational accidents in the Municipal Health Secretariat of São Paulo

Dentre as patologias ocupacionais da coluna vertebral as lombalgias e lombociatalgias benignas são umas das patologias ocupacionais mais frequentes e de causa de afastamento ou de incapacidade ao trabalho de 85% de trabalhadores economicamente ativos. Com isso acarretando a gastos altos com a previdência dos segurados; assim como problemas de saúde e sociais ao trabalhador e de geração de possíveis conflitos entre o Empregador, Governo e Trabalhador dos problemas decorrentes dentro do processo de produção. Posto isso, o estudo tem como objetivo mostrar a situação ocupacional e a prevalência das doenças benignas músculo-esqueléticas da coluna lombar entre as diferentes categorias profissionais de trabalhadores e as respectivas consequências no campo da saúde do trabalhador. Mediante ficha de notificação de acidente de trabalho da Secretaria Municipal de Saúde de São Paulo, foram levantados bancos de dados de registros de trabalhadores no ano de 2002. O modelo até agosto de 2005 que foram alimentados pelo sistema de notificação. O modelo de estudo é descritivo, abrangendo ambos os sexos, e independentemente da classe social, nível de escolaridade e de posto que ocupe na empresa,s erviço público e outros. Do total de 1579 pacientes avaliados, a prevalência quanto ao sexo foi de 81% dos homens contra 19% das mulheres, sendo a maioria dos trabalhadores com grau de escolaridade entre 4a e 11a série de escolaridade.