Toward Health System Recovery in the Aftermath of Ebola Outbreak in Guinea: New Approaches for Improved Knowledge of Target Populations at the Community Level.

BACKGROUND: Before the COVID-19 pandemic, Guinea has been the epicenter of the huge West Africa Ebola outbreak (2014-2016), that impact heavily the health system. Demographic information is one of the most basic data sources for health systems and services delivery, and yet can be very difficult to obtain with any accuracy. The objectives were to contribute among other to: (i) a determination of the catchment area (health coverage area and responsibility) of the Kirikilan health facility (PCM); (ii) geocoded mapping to find out exactly where these populations per sector of Kirikilan neighborhood lives; (iii) an approach for regular and systematic annual demographic follow up of target populations. METHODS: The study was a 3-year community-based survey with annual follow up of the population within the quartier of Kirikilan in Dubreka Prefecture in Guinea. It was an exhaustive enumeration of the population, sector by sector of the quartier, then there was no sampling size neither estimation. RESULTS: In October 2017 as a baseline of the study, the enumeration showed the total population was 8824 persons, 936 compounds, 1435 households, and the breakdown by sub quartier (sector) has been performed. It's showed the interest of the mapping of the target populations with geo-referenced localization. The annual follow up by demographic enumerus showed a dramatic increase of the size of the population, including strong migration of the evicted population due to urbanization purpose in some districts of Conakry, the capital. CONCLUSION: The study showed the importance of the enumeration and follow up of the target populations, but also of the setting up community data based to improve the district health information system (DHIS 2) in Guinea. The approach has a best practice could be an importunity to improve data sharing, mapping, health quality access, and affordability for a sustainable health toward universal health coverage.

Effectiveness of haemophilus influenzae type B conjugate vaccine for prevention of meningitis in Senegal.

A total of 24 cases of hospitalized, laboratory-confirmed Haemophilus influenzae type b (Hib) meningitis were identified through a regional pediatric bacterial meningitis surveillance system. Each case was matched by age and residence to 4 neighborhood controls. The adjusted vaccine effectiveness for ≥ 2 doses was 95.8% (95% confidence interval, 67.9%-99.4%). Hib vaccine appears to be highly effective in preventing Hib meningitis in Senegal.

Hospital surveillance of childhood bacterial meningitis in Senegal and the introduction of Haemophilus influenzae type b conjugate vaccine.

Bacterial meningitis is an important cause of morbidity and mortality in children living in low-resource settings. Pediatric bacterial meningitis cases < 5 years of age were identified through a regional hospital surveillance system for 3 years after introduction of routine immunization with Haemophilus influenzae type b (Hib) conjugate vaccine in Senegal in July 2005. Cases from the national pediatric hospital were also tracked from 2002 to 2008. The regional surveillance system recorded 1,711 suspected pediatric bacterial meningitis cases. Of 214 laboratory-confirmed cases, 108 (50%) were caused by Streptococcus pneumoniae, 42 (20%) to Hib, and 13 (6%) to Neisseria meningitidis. There was a 98% reduction in the number of hospitalized Hib meningitis cases from Dakar Region in 2008 compared with 2002. The surveillance system provides important information to the Ministry of Health as they consider self-funding Hib vaccine and introducing pneumococcal vaccine.

Prospective cohort study of disabling sequelae and quality of life in children with bacterial meningitis in urban Senegal.

BACKGROUND: No studies have prospectively examined disabling sequelae and quality of life in children with bacterial meningitis in Sub-Saharan Africa. METHODS: Objectives were to (i) follow-up pediatric bacterial meningitis surveillance system children from urban Dakar, Senegal; (ii) use standardized tools to classify disabling sequelae (Global Burden of Disease classification system) and quality of life (Pediatric Quality of Life Inventory tool); and (iii) compare these sequelae with an age- and community-matched control group. RESULTS: Sixty-six cases and 66 controls had follow-up examinations. The odds of a major sequelae was 3 times greater in the cases (65.1%, 43/66) than the age- and community-matched control group (40.9%, 27/66) (adjusted odds ratio, 3.24; 95% confidence interval, 1.25-8.38). Hearing loss was the most common major sequelae in the cases (51.8%, 29/56) followed by cognitive deficit (40.0%, 26/65), seizures (21.2%, 14/66), and motor deficit (21.2%, 14/66). Of these cases, 34.9% (23/66) had multiple impairments. The risk of major sequelae was 79.2% (17/22) in children with previous pneumococcal meningitis, 59.1% (14/24) in Haemophilus influenzae type b meningitis, and 54.6% (6/11) in meningococcal meningitis. Total quality of life scores were significantly lower in cases (mean, 69.7; standard deviation, 25.6) than controls (mean, 84.0; standard deviation,: 14.4) (weighted mean difference, 12.98; 95% confidence interval, 6.15-19.82). CONCLUSIONS: Children with bacterial meningitis are at high risk of complex multiple impairments and impaired quality of life. Many of these disabilities could have been averted with use of the new conjugate vaccines against Haemophilus influenzae type b, pneumococcus, and meningococcus.