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1.
Health Res Policy Syst ; 19(Suppl 2): 44, 2021 Aug 11.
Artículo en Inglés | MEDLINE | ID: mdl-34380491

RESUMEN

BACKGROUND: One Health approaches such as the Joint human and animal vaccination programmes (JHAVP) are shown to be feasible and to increase health care access to hard-to-reach communities such as mobile pastoralists. However, the financial sustainability and the integration into the public health systems at the district level of such programmes are still challenging. The main objective of the present study was to give insight to the feasibility and financial sustainability of JHAVP integrated as part of the public health system in Chad. METHODS: We conducted a mixed methods study using semi-structured key informant interviews, focus group discussions and budget impact analysis. Strengths, weaknesses, opportunities, and threats were analysed regarding the feasibility and sustainability of the implementation of JHAVP in Danamadji health district in Chad. Feasibility was further analysed using three dimensions: acceptability, implementation, and adaptation. Financial sustainability of JHAVP was analysed through budget impact analysis of implementation of the programme at district level. RESULTS: The acceptability of this approach was regularly assessed by immunization campaign teams through evaluation meetings which included pastoralists. The presence of authorities in the meetings and workshops of the programme had an incentive effect since they represent a mark of consideration these populations generally declared to be lacking. The coordination between the public health and veterinary services at central and decentralized level seemed to be a key element in the success of the implementation of the programme. Regarding financial sustainability, the total incremental budget impact was 27% slightly decreasing to 26% after five years, which accounts for up to one third of the total budget of the district health office. Also, given that most of the costs for each round are recurrent costs, efficiency gains from scale effects over time are limited. CONCLUSION: Based on these findings, we conclude that for JHAVP to be routinely delivered at the district health level, a considerable increase in financial resources would be required. The district could benefit from joint immunization to maintain contact with mobile pastoralists to promote the use of available immunization services at district level.


Asunto(s)
Inmunización , Salud Pública , Animales , Chad , Estudios de Factibilidad , Humanos , Vacunación
2.
PLoS Negl Trop Dis ; 15(7): e0009609, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34310598

RESUMEN

BACKGROUND: Guinea worm (Dracunculus medinensis) was detected in Chad in 2010 after a supposed ten-year absence, posing a challenge to the global eradication effort. Initiation of a village-based surveillance system in 2012 revealed a substantial number of dogs infected with Guinea worm, raising questions about paratenic hosts and cross-species transmission. METHODOLOGY/PRINCIPAL FINDINGS: We coupled genomic and surveillance case data from 2012-2018 to investigate the modes of transmission between dog and human hosts and the geographic connectivity of worms. Eighty-six variants across four genes in the mitochondrial genome identified 41 genetically distinct worm genotypes. Spatiotemporal modeling revealed worms with the same genotype ('genetically identical') were within a median range of 18.6 kilometers of each other, but largely within approximately 50 kilometers. Genetically identical worms varied in their degree of spatial clustering, suggesting there may be different factors that favor or constrain transmission. Each worm was surrounded by five to ten genetically distinct worms within a 50 kilometer radius. As expected, we observed a change in the genetic similarity distribution between pairs of worms using variants across the complete mitochondrial genome in an independent population. CONCLUSIONS/SIGNIFICANCE: In the largest study linking genetic and surveillance data to date of Guinea worm cases in Chad, we show genetic identity and modeling can facilitate the understanding of local transmission. The co-occurrence of genetically non-identical worms in quantitatively identified transmission ranges highlights the necessity for genomic tools to link cases. The improved discrimination between pairs of worms from variants identified across the complete mitochondrial genome suggests that expanding the number of genomic markers could link cases at a finer scale. These results suggest that scaling up genomic surveillance for Guinea worm may provide additional value for programmatic decision-making critical for monitoring cases and intervention efficacy to achieve elimination.


Asunto(s)
Dracunculiasis/epidemiología , Dracunculus/genética , Vigilancia de la Población/métodos , Animales , Chad/epidemiología , ADN de Helmintos/genética , Marcadores Genéticos , Genoma de los Helmintos , Genoma Mitocondrial , Humanos
3.
Pan Afr Med J ; 38: 331, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34285754

RESUMEN

Introduction: the neighboring Republics of Chad and Cameroon have respectively one of the lowest and highest HIV prevalence rates in central Africa at 1.3% and 4.5%, respectively. We conducted a comparative description of social behaviors and HIV risk factors among heterosexual men and explored the baseline of the first UNAIDS target (by 2020, 90% of people living with HIV will know their status) in the two countries. Methods: this was a retrospective cross-sectional study using Demographic and Health Survey data. We fitted a separate multilevel logistic model for each country. In total, 5248 men were interviewed in Chad and 7191 men in Cameroon. Results: Cameroonian men have a higher level of education, higher HIV testing rate, and are more knowledgeable about HIV than Chadian men. However, Chadian men have a lower number of lifetime sexual partners (2 interquartile range (IQR), 1-4) compared to Cameroonian men (6 IQR 3-15) and 86.96% of Chadian versus 57.30% of Cameroonian men reported fidelity to their domestic partners in the last twelve months. Conclusion: there is a crucial need to encourage HIV screening and testing among Chadian men, especially in rural areas. Testing also needs to be increased in Cameroon to meet the first UNAIDS target. Government and partners in Cameroon could support more research and campaigns that aim at reducing multiple sexual partnerships among the communities in Cameroon.


Asunto(s)
Infecciones por VIH/epidemiología , Conducta Sexual/estadística & datos numéricos , Parejas Sexuales , Conducta Social , Adolescente , Adulto , Camerún/epidemiología , Chad/epidemiología , Estudios Transversales , Infecciones por VIH/diagnóstico , Prueba de VIH/estadística & datos numéricos , Heterosexualidad , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Población Rural/estadística & datos numéricos , Adulto Joven
4.
PLoS Negl Trop Dis ; 15(6): e0009323, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34106914

RESUMEN

BACKGROUND: African trypanosomes are parasites mainly transmitted by tsetse flies. They cause trypanosomiasis in humans (HAT) and animals (AAT). In Chad, HAT/AAT are endemic. This study investigates the diversity and distribution of trypanosomes in Mandoul, an isolated area where a tsetse control campaign is ongoing, and Maro, an area bordering the Central African Republic (CAR) where the control had not started. METHODS: 717 human and 540 cattle blood samples were collected, and 177 tsetse flies were caught. Trypanosomal DNA was detected using PCR targeting internal transcribed spacer 1 (ITS1) and glycosomal glyceraldehyde-3 phosphate dehydrogenase (gGAPDH), followed by amplicon sequencing. RESULTS: Trypanosomal DNA was identified in 14 human samples, 227 cattle samples, and in tsetse. Besides T. b. gambiense, T. congolense was detected in human in Maro. In Mandoul, DNA from an unknown Trypanosoma sp.-129-H was detected in a human with a history of a cured HAT infection and persisting symptoms. In cattle and tsetse samples from Maro, T. godfreyi and T. grayi were detected besides the known animal pathogens, in addition to T. theileri (in cattle) and T. simiae (in tsetse). Furthermore, in Maro, evidence for additional unknown trypanosomes was obtained in tsetse. In contrast, in the Mandoul area, only T. theileri, T. simiae, and T. vivax DNA was identified in cattle. Genetic diversity was most prominent in T. vivax and T. theileri. CONCLUSION: Tsetse control activities in Mandoul reduced the tsetse population and thus the pathogenic parasites. Nevertheless, T. theileri, T. vivax, and T. simiae are frequent in cattle suggesting transmission by other insect vectors. In contrast, in Maro, transhumance to/from Central African Republic and no tsetse control may have led to the high diversity and frequency of trypanosomes observed including HAT/AAT pathogenic species. Active HAT infections stress the need to enforce monitoring and control campaigns. Additionally, the diverse trypanosome species in humans and cattle indicate the necessity to investigate the infectivity of the unknown trypanosomes regarding their zoonotic potential. Finally, this study should be widened to other trypanosome hosts to capture the whole diversity of circulating trypanosomes.


Asunto(s)
Enfermedades de los Bovinos/parasitología , Trypanosoma/clasificación , Tripanosomiasis Africana/parasitología , Zoonosis/parasitología , Animales , Bovinos , Enfermedades de los Bovinos/sangre , Enfermedades de los Bovinos/epidemiología , Chad/epidemiología , Humanos , Especificidad de la Especie , Tripanosomiasis Africana/sangre , Tripanosomiasis Africana/epidemiología
5.
Pan Afr Med J ; 38: 248, 2021.
Artículo en Francés | MEDLINE | ID: mdl-34104296

RESUMEN

Yellow fever (YF) is a viral haemorrhagic fever caused by yellow fever virus transmitted by Aedes mosquitoes. Since 2013, in Chad, four cases of yellow fever have been detected and confirmed as part of the national fever surveillance program. We here report the last clinical case confirmed in the health district of Lai. The patient was a 57-year-old man with no significant medical and surgical history and unknown immunisation status. He consulted on April 21st, 2020 for fever, moderate to low abundance jaundice and epistaxis (nosebleed) and painful hepatomegaly. Paraclinical examinations, such as RT-PCR, objectified yellow fever virus in post-mortem tissue sample. Thus, confirmed yellow fever cases in this district, the low level of vaccination coverage, the circulation of the virus and the presence of vector in the country should warn of a real threat of reemergence of yellow fever in Chad.


Asunto(s)
Fiebre Amarilla/diagnóstico , Virus de la Fiebre Amarilla/aislamiento & purificación , Aedes/virología , Animales , Chad , Humanos , Masculino , Persona de Mediana Edad , Mosquitos Vectores/virología , Recurrencia , Fiebre Amarilla/transmisión , Fiebre Amarilla/virología , Vacuna contra la Fiebre Amarilla/administración & dosificación
6.
PLoS Genet ; 17(5): e1009506, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33956822

RESUMEN

Identifying the molecular underpinnings of the neural specializations that underlie human cognitive and behavioral traits has long been of considerable interest. Much research on human-specific changes in gene expression and epigenetic marks has focused on the prefrontal cortex, a brain structure distinguished by its role in executive functions. The cerebellum shows expansion in great apes and is gaining increasing attention for its role in motor skills and cognitive processing, including language. However, relatively few molecular studies of the cerebellum in a comparative evolutionary context have been conducted. Here, we identify human-specific methylation in the lateral cerebellum relative to the dorsolateral prefrontal cortex, in a comparative study with chimpanzees (Pan troglodytes) and rhesus macaques (Macaca mulatta). Specifically, we profiled genome-wide methylation levels in the three species for each of the two brain structures and identified human-specific differentially methylated genomic regions unique to each structure. We further identified which differentially methylated regions (DMRs) overlap likely regulatory elements and determined whether associated genes show corresponding species differences in gene expression. We found greater human-specific methylation in the cerebellum than the dorsolateral prefrontal cortex, with differentially methylated regions overlapping genes involved in several conditions or processes relevant to human neurobiology, including synaptic plasticity, lipid metabolism, neuroinflammation and neurodegeneration, and neurodevelopment, including developmental disorders. Moreover, our results show some overlap with those of previous studies focused on the neocortex, indicating that such results may be common to multiple brain structures. These findings further our understanding of the cerebellum in human brain evolution.


Asunto(s)
Cerebelo/metabolismo , Metilación de ADN , Epigénesis Genética , Proteínas ADAM , Animales , Autoantígenos , Proteínas Portadoras , Chad , Islas de CpG , Femenino , Regulación de la Expresión Génica , Humanos , Péptidos y Proteínas de Señalización Intracelular , Macaca mulatta/genética , Masculino , Proteínas de Microfilamentos , Proteínas del Tejido Nervioso , Pan troglodytes/genética , Fosfoinositido Fosfolipasa C , Proteínas Serina-Treonina Quinasas , Proteínas , Proteínas Asociadas a SAP90-PSD95 , Especificidad de la Especie , Sitio de Iniciación de la Transcripción
7.
Acta Trop ; 221: 105984, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34058158

RESUMEN

Better surveillance is desperately needed to guide rabies prevention and control to achieve the goal of zero dog-mediated human rabies by 2030, defined by the World Health Organization (WHO) and partners in 2015. With the help of funding from the Vaccine Alliance (GAVI) learning agenda, we implemented animal rabies surveillance based on One Health communication, improved accessibility of diagnostic testing and facilitated sample transport to increase case detection in three regions of Chad. Through the project, rabies surveillance, previously only available in N'Djaména, was extended to selected provincial rural and urban areas. Nine decentralized diagnostic units (DDU) were established, hosted by veterinary district agencies (VDA) in four different administrative regions. Four additional VDAs in the study area were reinforced with facilitation of sample collection and transport. Staff from all these 13 veterinary facilities were trained in sample collection and diagnostics. DDUs performed Rapid Immunodiagnostic Tests (RIDT) providing a preliminary result before samples were sent to the central laboratory in N'Djamena for confirmation with the standard Florescent Antibody Test (FAT). Within the project period from June 2016 to March 2018, 115 samples were reported by veterinary facilities in the study areas compared to 63 samples received from outside the study area, the vast majority of them originating from the capital city N'Djaména (N=61). Eighty nine percent of all 178 samples reported to IRED during the project period tested positive. Most of the samples originated from dogs (92%). Other confirmed rabies positive animals observed were cats, a donkey and a pig. Although surveillance of animal rabies was the focus, four human saliva samples were also submitted for diagnosis. We observed high differences in reporting rates between the four study regions. This could be attributable to differences in rabies epidemiology but are also influenced by the distance to the central laboratory in N'Djaména, the cultural background and the level of public awareness. The possibility for local testing through RIDT was very welcomed by local veterinary staff and preliminary insights suggest a positive influence on One Health communication and PEP initiation. However, these aspects as well as the relative impact of local testing on sample collection in comparison to reinforcement of sample collection and transport alone, need to be further investigated. Challenges encountered related to poor infrastructure (buildings, appliances, materials) and low logistic capacity (lacking means and material for transport and communication) of veterinary services in Chad. In addition, veterinary personnel lack experience in data management. Together with staff turnover, this leads to a need for repeated training. Major shortcoming of the approach was the high cost per sample and limited sustainability beyond the project timeframe.


Asunto(s)
Salud Única , Vacunas Antirrábicas , Rabia , Animales , Gatos , Chad/epidemiología , Perros , Equidae , Humanos , Rabia/diagnóstico , Rabia/epidemiología , Rabia/prevención & control , Porcinos
8.
BMC Public Health ; 21(1): 951, 2021 05 20.
Artículo en Inglés | MEDLINE | ID: mdl-34016072

RESUMEN

BACKGROUND: The heavy and ever rising burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) warrants interventions to reduce their underlying risk factors, which are often linked to lifestyles. To effectively supplement nationwide policies with targeted interventions, it is important to know how these risk factors are distributed across socioeconomic segments of populations in LMICs. This study quantifies the prevalence and socioeconomic inequalities in lifestyle risk factors in LMICs, to identify policy priorities conducive to the Sustainable Development Goal of a one third reduction in deaths from NCDs by 2030. METHODS: Data from 1,278,624 adult respondents to Demographic & Health Surveys across 22 LMICs between 2013 and 2018 are used to estimate crude prevalence rates and socioeconomic inequalities in tobacco use, overweight, harmful alcohol use and the clustering of these three in a household. Inequalities are measured by a concentration index and correlated with the percentage of GDP spent on health. We estimate a multilevel model to examine associations of individual characteristics with the different lifestyle risk factors. RESULTS: The prevalence of tobacco use among men ranges from 59.6% (Armenia) to 6.6% (Nigeria). The highest level of overweight among women is 83.7% (Egypt) while this is less than 12% in Burundi, Chad and Timor-Leste. 82.5% of women in Burundi report that their partner is "often or sometimes drunk" compared to 1.3% in Gambia. Tobacco use is concentrated among the poor, except for the low share of men smoking in Nigeria. Overweight, however, is concentrated among the better off, especially in Tanzania and Zimbabwe (Erreygers Index (EI) 0.227 and 0.232). Harmful alcohol use is more concentrated among the better off in Nigeria (EI 0.127), while Chad, Rwanda and Togo show an unequal pro-poor distribution (EI respectively - 0.147, - 0.210, - 0.266). Cambodia exhibits the largest socioeconomic inequality in unhealthy household behaviour (EI - 0.253). The multilevel analyses confirm that in LMICs, tobacco and alcohol use are largely concentrated among the poor, while overweight is concentrated among the better-off. The associations between the share of GDP spent on health and the socioeconomical distribution of lifestyle factors are multidirectional. CONCLUSIONS: This study emphasizes the importance of lifestyle risk factors in LMICs and the socioeconomic variation therein. Given the different socioeconomic patterns in lifestyle risk factors - overweight patters in LMICs differ considerably from those in high income countries- tailored interventions towards specific high-risk populations are warranted to supplement nationwide policies.


Asunto(s)
Países en Desarrollo , Estilo de Vida , Adulto , Armenia , Burundi , Cambodia , Chad , Egipto , Femenino , Gambia , Humanos , Masculino , Nigeria , Prevalencia , Factores de Riesgo , Rwanda , Factores Socioeconómicos , Tanzanía , Timor Oriental , Togo , Zimbabwe
9.
Int J Infect Dis ; 108: 461-464, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34051363

RESUMEN

BACKGROUND: Syphilis is endemic in the Sub-Saharan zone and disproportionately affects at-risk populations such as men who have sex with men, sex workers and HIV infected individuals. In this study, we measure the impact of syphilis among people living with HIV in the Republic of Chad, where no data are currently available. METHOD: Outpatients attending 2 HIV clinics in N'Djamena, Republic of Chad, were tested for syphilis. Subjects who tested positive for both non-treponemal (VDRL) and treponemal (TPHA) received a single dose of Benzathine Penicillin G, 2.4 MU. An additional VDRL test was performed 6 months after treatment to ensure appropriate serological response. RESULTS: Of 207 patients included, 29 (14%) tested positive for VDRL at the first visit, with moderate/low antibody titers (ranging from 1/2 to 1/8); 24 (82.6%) of these had treponemal immunization confirmed by TPHA test. Six months after Benzathine Penicillin treatment, 22/24 of the patients (91.6%) tested negative for VDRL, and 2 showed a 4-fold titer decline. CONCLUSION: This first study in the Republic of Chad suggests that syphilis infection is frequent among people living with HIV in this country. Systematic screening of syphilis should be considered in this population.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por VIH/complicaciones , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anticuerpos Antibacterianos/sangre , Chad/epidemiología , Coinfección , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Seroepidemiológicos , Sífilis/diagnóstico , Sífilis/epidemiología , Sífilis/inmunología , Adulto Joven
10.
J Theor Biol ; 521: 110683, 2021 07 21.
Artículo en Inglés | MEDLINE | ID: mdl-33744311

RESUMEN

Guinea-worm disease (GWD) was thought to be almost eliminated in Chad when it reemerged in 2010. The disease now shows a peculiar pattern of spreading along Chari River and its tributaries, rather than clustering around a particular drinking water source. We create a mathematical model of GWD that includes the population dynamics of the parasite as well as the dynamics of its hosts (copepods, fish, humans, and domestic dogs). We calibrate our model based on data from the literature and validate it on the recent GWD annual incidence data from Chad. The effective reproduction number predicted by our model agrees well with the empirical value of roughly 1.25 derived directly from the data. Our model thus supports the hypothesis that the parasite now uses fish as intermediate transport hosts. We predict that GWD transmission can be most easily interrupted by avoiding eating uncooked fish and by burying the fish entrails to prevent transmission through dogs. Increasing the mortality of copepods and even partially containing infected dogs to limit their access to water sources is another important factor for GWD eradication.


Asunto(s)
Dracunculiasis , Animales , Chad/epidemiología , Erradicación de la Enfermedad , Perros , Dracunculiasis/epidemiología , Dracunculiasis/prevención & control , Dracunculiasis/veterinaria , Dracunculus , Modelos Teóricos
11.
PLoS Negl Trop Dis ; 15(3): e0009285, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33735242

RESUMEN

BACKGROUND: Guinea worm is a debilitating parasitic infection targeted for eradication. Annual human cases have dropped from approximately 3,500,000 in 1986 to 54 in 2019. Recent identification of canine cases in Chad threatens progress, and therefore detection, prevention, and containment of canine cases is a priority. We investigated associations between disease knowledge, community engagement, and canine cases in Chad to identify opportunities to improve active surveillance. METHODS: We surveyed 627 respondents (villagers, local leaders, community volunteers, and supervisors) across 45 villages under active surveillance. Descriptive statistics were analyzed by respondent category. Logistic regression models were fitted to assess the effects of volunteer visit frequency on villager knowledge. RESULTS: Knowledge increased with respondents' associations with the Guinea worm program. Household visit frequency by community volunteers was uneven: 53.0% of villagers reported visits at least twice weekly and 21.4% of villagers reported never being visited. Villagers visited by a volunteer at least twice weekly had better knowledge of Guinea worm symptoms (OR: 1.71; 95% CI: 1.04-2.79) and could name more prevention strategies (OR: 2.04; 95% CI: 1.32-3.15) than villagers visited less frequently. The primary motivation to report was to facilitate care-seeking for people with Guinea worm. Knowledge of animal "containment" to prevent contamination of water, knowledge of rewards for reporting animal cases, and ability to name any reasons to report Guinea worm were each positively correlated with village canine case counts. CONCLUSIONS: Community volunteers play crucial roles in educating their neighbors about Guinea worm and facilitating surveillance. Additional training and more attentive management of volunteers and supervisors could increase visit frequency and further amplify their impact. Emphasizing links between animal and human cases, the importance of animal containment, and animal rewards might improve surveillance and canine case detection. The surveillance system should be evaluated routinely to expand generalizability of data and monitor changes over time.


Asunto(s)
Enfermedades de los Perros/epidemiología , Dracunculiasis/epidemiología , Dracunculiasis/veterinaria , Conocimientos, Actitudes y Práctica en Salud , Prevención Primaria/métodos , Adulto , Animales , Chad/epidemiología , Enfermedades de los Perros/parasitología , Perros , Dracunculus/aislamiento & purificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Prevención Primaria/educación , Encuestas y Cuestionarios
12.
BMC Public Health ; 21(1): 286, 2021 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541311

RESUMEN

BACKGROUND: Chad is one of the African countries with high prevalence of female genital mutilation (FGM). The aim of this study was to examine the factors associated with FGM among women aged 15-49 and girls aged 0-14 in Chad. METHODS: Data for the study were obtained from the 2014-2015 Chad Demographic and Health Survey. FGM among women aged 15-49 and girls aged 0-14 were the outcome variables. The prevalence of FGM among women and girls were presented using percentages while a mixed-effects multilevel multivariable logistic regression analysis was carried out to assess the factors associated with FGM. The results were presented using adjusted odds ratio with associated 95% confidence intervals. RESULTS: The results indicate that more than half (50.2%) of the women and 12.9% of girls in Chad had been circumcised. Among women aged 15-49, level of education, employment status, ethnicity, religion, wealth quintile and community literacy level were significant predictors of FGM. Age, partner's level of education, marital status, employment status, ethnicity, religion and mother's FGM status were associated with FGM among girls aged 0-14. CONCLUSION: This study has identified several individual and contextual factors as predictors of FGM among women and girls in Chad. The findings imply the need to adopt strategies aimed at addressing these factors in order to help eliminate the practice of FGM. Government and non-governmental organisations in Chad need to implement policies that enhance media advocacy and community dialogue to help deal with FGM in the country.


Asunto(s)
Circuncisión Femenina , Adolescente , Adulto , África , Chad/epidemiología , Niño , Preescolar , Escolaridad , Femenino , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Análisis Multinivel , Adulto Joven
13.
Acta Trop ; 215: 105808, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33385360

RESUMEN

Rabies is a fatal but preventable disease that remains notoriously underreported. Weak data availability hampers advocacy, constitutes a barrier to resource allocation and inhibits effective prevention and control. To gain better insight into the global rabies burden and human vaccine demand several studies were funded through the Vaccine Alliance (GAVI) learning agenda. With the help of this funding, Swiss TPH and local in country partner organizations implemented a One Health research project in Chad, Côte d'Ivoire and Mali to collect data at household, public health facility and veterinary level. This paper describes the implementation of this research project and evaluates its success on amount of information gained, achieved capacity building, impact on knowledge creation and influence on national and international policies. The project was based on the One Health concept and guided by the principles of transboundary research partnerships formulated by the Swiss Academy of Sciences. Data was collected on bite incidents and health seeking from over 24'000 households, on access to treatment of over 8'800 bite cases registered in public health facilities and on the status of over 1'800 rabies suspect animals. Selected country specific datasets have contributed to more than 10 scientific articles so far. On the international level, the multi-level data collection provided a unique set of indicators to inform, along with results from other studies, new WHO rabies immunization recommendations and a vaccine investment case scenario to prevent human rabies. New rabies burden estimates based on the data gathered are published for Mali and will be modelled for the whole West and Central African region. On the national level, the project facilitated communication between animal health and human health workers catalyzing creation of local and national committees and formulation of national action plans for Mali and Côte D'Ivoire. Major challenges arose from lack of data collection and documentation experience of human health and veterinary workers and weak infrastructural capacities of the veterinary and human health systems of the project countries. Through adherence to the principles of transboundary research partnerships, project team members acquired valuable research and networking skills despite language barriers, enabling them to play key roles in the future agenda towards national, regional and global canine rabies elimination. Project external collaborations with local public institutions was facilitated through long-term local partnerships. Both factors enabled success in project implementation and outcomes by identifying and mitigating risks in advance, resolving challenges amiably and enabling mutual knowledge creation as a fructuous ground for sustained commitment. Lack of immediate follow-up funding did not allow to maintain activities beyond the project timeframe. However, the national and international policy changes triggered, as well as the strengthened local disease control and research capacities provides sustainable basis for the elimination of dog transmitted human rabies.


Asunto(s)
Salud Única , Rabia/prevención & control , Animales , Chad , Costa de Marfil , Perros , Humanos , Malí , Vacunas Antirrábicas/inmunología , Vacunación
14.
J Community Health ; 46(2): 259-266, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33484402

RESUMEN

The first African COVID-19 case was reported in Egypt in February 2020. Since then, Sub-Saharan countries have struggled to respond to the pandemic. Among them, Chad is characterized by a high rate of poverty and mortality, a high burden of infectious diseases, insufficient epidemiological surveillance and underdeveloped infrastructure. In this study, we explore the knowledge, attitudes and practices (KAPs) regarding COVID-19 within the Chadian population, to determine whether there are more vulnerable groups of the population that require greater attention from authorities. This study was designed as a cross-sectional survey conducted in N'Djamena, Chad, using a convenience sampling technique that included 2269 participants. The study was conducted in May and August 2020. Questions regarding technical concepts were answered incorrectly by most participants (83.65%). The population had better knowledge about concrete aspects of the pandemics, such as prevention measures and contagion. Regarding attitudes, 34.55% participants were very concerned about the possibility of being infected, 81.27% were unsatisfied/very unsatisfied with their social relationships after the pandemic began, and 68.44% thought that the pandemic was a disturbing/very disturbing issue. As for practices, 49.41% of men followed all preventive measures compared to 32.07% of women, and 3.04% of people with vulnerable jobs did not respect any of preventive measures compared to 1.19% of people without this condition. Gender, job conditions and educational level impact KAPs within the Chadian population. It is suggested that local authorities in Chad should consider these variables when developing health strategies.


Asunto(s)
COVID-19/psicología , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Salud Mental/estadística & datos numéricos , Adulto , COVID-19/epidemiología , Chad/epidemiología , Estudios Transversales , Escolaridad , Femenino , Humanos , Masculino , Pandemias/estadística & datos numéricos , Satisfacción Personal , SARS-CoV-2
15.
Am J Trop Med Hyg ; 104(1): 303-312, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33124546

RESUMEN

Increased levels of guinea worm (GW) disease transmission among dogs in villages along the Chari River in Chad threaten the gains made by the GW Eradication Program. Infected dogs with preemergent worm blisters are difficult to proactively identify. If these dogs are not contained, blisters can burst upon submersion in water, leading to the contamination of the water supply with L1 larvae. Guinea worm antigens previously identified using sera from human dracunculiasis patients were coupled to polystyrene beads for multiplex bead assay analysis of 41 non-endemic (presumed negative) dog sera and 39 sera from GW-positive dogs from Chad. Because commercially available anti-dog IgG secondary antibodies did not perform well in the multiplex assay, dog IgGs were partially purified, and a new anti-dog IgG monoclonal antibody was developed. Using the new 4E3D9 monoclonal secondary antibody, the thioredoxin-like protein 1-glutathione-S-transferase (GST), heat shock protein (HSP1)-GST, and HSP2-GST antigen multiplex assays had sensitivities of 69-74% and specificities of 73-83%. The domain of unknown function protein 148 (DUF148)-GST antigen multiplex assay had a sensitivity of 89.7% and a specificity of 85.4%. When testing samples collected within 1 year of GW emergence (n = 20), the DUF148-GST assay had a sensitivity of 90.0% and a specificity of 97.6% with a receiver-operating characteristic area under the curve of 0.94. Using sera from two experimentally infected dogs, antibodies to GW antigens were detected within 6 months of exposure. Our results suggest that, when used to analyze paired, longitudinal samples collected 1-2 months apart, the DUF148/GST multiplex assay could identify infected dogs 4-8 months before GW emergence.


Asunto(s)
Anticuerpos Antihelmínticos/sangre , Enfermedades de los Perros/parasitología , Dracunculiasis/veterinaria , Inmunoglobulina G/sangre , Animales , Anticuerpos Monoclonales , Chad/epidemiología , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/epidemiología , Perros , Dracunculiasis/sangre , Dracunculiasis/diagnóstico , Dracunculus , Ensayo de Inmunoadsorción Enzimática , Reproducibilidad de los Resultados , Pruebas Serológicas/veterinaria
16.
Environ Sci Pollut Res Int ; 28(10): 12300-12320, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32876822

RESUMEN

The urban groundwater of the Quaternary aquifer of the Lake Chad basin in N'Djamena has been subject to many hydrochemical studies. However, the results are often not presented in a way that enables water quality managers to make an appropriate decisions, which restrict development and poverty reduction efforts. The objective of the present study was to contribute the improved management of the local groundwater resources. A total of 85 groundwater samples were interpreted using hydrochemical techniques associated with integrated numerical indices and multivariate statistical analysis. The hydrochemical results coupled with the relative residence time of water have shown that the chemical composition of these waters is linked to geogenic and anthropogenic factors and to their proximity to the Chari-Logone rivers. These investigations showed that the groundwater quality in N'Djamena is characterized by a high spatial variability. This study also assessed the suitability of groundwater for user needs and identified areas which are more/less favorable for a specific use. The evaluation of water quality and its suitability for human consumption is also a problem of optimizing data acquisition strategy, and this study used the correlation between water quality index (WQI) and electrical conductivity (EC) to orientate future data acquisition strategies. This parametrization can assist the decision makers and water management professionals in evaluating groundwater availability and setting up a robust water quality management plan in areas with similar hydrogeological and climatic conditions.


Asunto(s)
Agua Subterránea , Lagos , Chad , Monitoreo del Ambiente , Humanos , Análisis Multivariante
17.
BMC Public Health ; 20(1): 1873, 2020 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-33287797

RESUMEN

BACKGROUND: Under-five mortality in Chad reached a minimum value of 119 deaths per 1000 live births in 2018, compared with a maximum of 250 in 1972. Despite this decline in the  mortality trend, for every six children in Chad, one dies before the age of five. This study, therefore, investigated the proximate, intermediate, and distal determinants of under-five mortality in Chad. METHODS: We used data from the 2014-15 Chad's Demographic and Health Survey. Data of 7782 children below 5 years were used for the study. Both descriptive and multivariable hierarchical logistic regression analyses were performed. Statistical significance was declared at p < 0.05. RESULTS: Under-five mortality was found to be 130 deaths per 1000 live births in Chad, with variations across the various population sub-groups. For distal predictors, the likelihood of death was higher in children born in the FChari Baguirmi region (AOR = 3.83, 95% CI: 1.81-8.14). Children whose mothers belonged to the Baguirmi/Barma ethnic group (AOR = 8.04, 95% CI: 1.75-36.99) were more likely to die before the age of five. On the contrary, the likelihood of under-five mortality was low among children born in rural areas (AOR = 0.73, 95% CI: 0.55-0.97). With the intermediate predictors, the likelihood of under-five deaths was higher among children whose mothers had no formal education (AOR = 1.72, 95% CI: 1.06-2.77). Regarding the proximate predictors, the odds of under-five deaths was higher among male children (AOR = 1.03, 95% CI: 1.05-1.63) and first rank children (AOR = 1.58, 95% CI: 1.13-2.21). CONCLUSION: The study found that the determinants of under-five mortality in Chad are region of residence, place of residence, ethnicity, education, sex of child, and birth rank. These findings show that both socio-economic and proximate factors explain the disparities in under-five mortality in Chad. The identification of these factors can be pivotal towards the design of evidence-based interventions intended to improve child survival. Therefore, improving maternal education while refocusing and re-packaging existing strategies to target selected sub-regional populations with high under-five mortality is urgently required.


Asunto(s)
Mortalidad del Niño , Mortalidad Infantil , Chad/epidemiología , Preescolar , Escolaridad , Femenino , Humanos , Lactante , Masculino , Madres , Embarazo
18.
PLoS Negl Trop Dis ; 14(11): e0008738, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33180776
19.
Parasite ; 27: 63, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33206595

RESUMEN

Human African trypanosomiasis (HAT) has been targeted for zero transmission to humans by 2030. Animal reservoirs of gambiense-HAT could jeopardize these elimination goals. This study was undertaken to identify potential host reservoirs for Trypanosoma brucei gambiense by detecting its natural infections in domestic animals of Chadian HAT foci. Blood samples were collected from 267 goats, 181 sheep, 154 dogs, and 67 pigs. Rapid diagnostic test (RDT) and capillary tube centrifugation (CTC) were performed to search for trypanosomes. DNA was extracted from the buffy coat, and trypanosomes of the subgenus Trypanozoon as well as T. b. gambiense were identified by PCR. Of 669 blood samples, 19.4% were positive by RDT and 9.0% by CTC. PCR revealed 150 animals (22.4%) with trypanosomes belonging to Trypanozoon, including 18 (12%) T. b. gambiense. This trypanosome was found in all investigated animal species and all HAT foci. Between animal species or villages, no significant differences were observed in the number of animals harboring T. b. gambiense DNA. Pigs, dogs, sheep and goats appeared to be potential reservoir hosts for T. b. gambiense in Chad. The identification of T. b. gambiense in all animal species of all HAT foci suggests that these animals should be considered when designing new control strategies for sustainable elimination of HAT. Investigations aiming to decrypt their specific role in each epidemiological setting are important to achieve zero transmission of HAT.


Asunto(s)
Animales Domésticos , Reservorios de Enfermedades , Trypanosoma brucei gambiense , Tripanosomiasis Africana , Animales , Animales Domésticos/parasitología , Chad/epidemiología , Perros/parasitología , Cabras/parasitología , Ovinos/parasitología , Porcinos/parasitología , Trypanosoma brucei gambiense/genética , Tripanosomiasis Africana/epidemiología , Tripanosomiasis Africana/parasitología , Tripanosomiasis Africana/veterinaria
20.
J Parasitol ; 106(5): 616-622, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33009554

RESUMEN

The prevalence and diversity of parasitic nematodes in wildlife have been well studied for certain species, yet for others considerable gaps in knowledge exist. The parasitic nematode Dracunculus insignis infects North American wildlife, and past research on this species has led to an increased understanding of the potential host diversity and transmission of the closely related human Guinea worm, Dracunculus medinensis (which is currently the focus of a global eradication program). Many definitive hosts have been documented for D. insignis; however, the life cycle has been studied only in laboratories, and only a single phylogenetic study has been conducted on D. insignis (from Canada). The goals of the present study were to investigate the prevalence of infections with Dracunculus species among wildlife at a single site (Di-Lane plantation) in the southeastern United States, evaluate the genetic diversity of parasites at this site, and investigate potential paratenic hosts that may be involved in transmission. Over 3 yr, we sampled 228 meso-mammals, reporting an overall prevalence of infection with Dracunculus insignis of 20% (46/228). Amphibians and fish were sampled in the same geographic area as infected meso-mammals. Dracunculus insignis third-stage larvae were recovered from 2 different species of amphibians, but all fish sampled were negative. Phylogenetic analysis of the partial cytochrome c oxidase I (COI) gene showed very little diversity of Dracunculus at Di-Lane; however, we did recover a single nematode from a Virginia opossum (Didelphis virginiana) that falls outside of the D. insignis clade, more closely aligns with Dracunculus lutrae, and may represent an undescribed species. This work documents the occurrence of D. insignis in frogs, a potential transmission pathway for D. insignis at a single geographic site in nature. When applied to the global Guinea Worm Eradication Program, and Chad, Africa, in particular, this work increases our knowledge of the potential role of aquatic animals in the transmission of Dracunculus species and informs on potential intervention strategies that may be applied to the eradication of Guinea worm in Africa.


Asunto(s)
Animales Salvajes/parasitología , Dracunculiasis/veterinaria , Dracunculus/clasificación , Mamíferos/parasitología , Anfibios/parasitología , Animales , Armadillos/parasitología , Chad , Coyotes/parasitología , Dracunculiasis/epidemiología , Dracunculiasis/prevención & control , Dracunculiasis/transmisión , Dracunculus/genética , Dracunculus/crecimiento & desarrollo , Dracunculus/aislamiento & purificación , Femenino , Peces/parasitología , Variación Genética , Georgia/epidemiología , Estadios del Ciclo de Vida , Masculino , Zarigüeyas/parasitología , Filogenia , Estanques , Prevalencia , Mapaches/parasitología
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