Thinking outside of the [cold] box: implementing a human-centered design approach to understand barriers and craft solutions to cold chain equipment maintenance in Niger.

BACKGROUND: Vaccines require cold chain equipment (CCE) to ensure quality and potency, yet the risk of CCE failing is well-documented, often due to lack of equipment maintenance. While general barriers to a reliable CCE maintenance system are known, little has been done to understand the barriers from the cold chain technician's perspective. This human-centered design (HCD) study in Niger sought to better understand the gap in the current maintenance approaches from the technicians' perspectives and to collaboratively identify forward-thinking solutions. METHODS: The research team collected data through semi-structured and open-ended in-depth consultations. Rapid qualitative research was followed by co-creation workshops with study participants to identify solutions. RESULTS: The research team conducted 20 in-depth consultations in two regions with participants directly involved in the management of the cold chain. Fourteen people participated in the online co-creation workshop, and 20 people participated in the in-person workshop. Insights were organized in three main areas: (1) the lack of system agility and ability to optimize resources constrain performance of the maintenance system; (2) cold chain is often an afterthought within the overall context of immunization services and should instead be prioritized; and (3) knowledge sharing across the system and key stakeholders is ad hoc with limited understanding of roles and responsibilities. During the co-creation workshop, participants identified four main concepts as potential solutions: (1) create an on-line platform to connect people and to share knowledge across regions; (2) develop practical CCE technical resources; (3) use gamification and friendly competition to motivate staff to value maintenance; and (4) create a real-time maintenance tracking system. DISCUSSION: This study took a unique HCD approach to engage people directly involved in CCE maintenance to more deeply understand challenges with the current system and create space to identify innovative solutions that are tailored to the context. The results demonstrate that stakeholders can identify potential solutions that have not been part of the typical approaches to a maintenance system. This HCD approach has implications for all global health challenges and demonstrates a methodology that can encourage key stakeholders to think about problems and solutions differently.

Innovations et gestion des déchets médicaux : le cas du nouvel hôpital de référence de Niamey, Niger.

INTRODUCTION: Public hospitals in Africa are experiencing major organizational dysfunctions, which are particularly acute in waste management. The opening of a new reference hospital in Niamey offers the opportunity to study the implementation of an innovative waste management system. PURPOSE OF RESEARCH: The objective of this study was to document the agents’ representations, practices, and construction of waste management standards in a new tertiary hospital in Niamey. We sought to study the implementation of innovative materials in waste management and the progressive construction of protocols, habits, and levers of adaptation. This research was carried out using a socio-spatial approach and essentially mobilized the tools of qualitative investigation. RESULTS: Our study highlighted that a hospital waste management culture is progressively established, thanks to an effort to plan activities, to promote the sector, the activities and the emergence of a profession organized around waste management. However, the distinct waste management sectors are struggling to stabilize due to the differentiated statuses and perceptions of the agents. Finally, the success of hospital waste management depends on waste collection at the city level. CONCLUSIONS: The Niamey referral hospital is intended to be an infrastructure of excellence, a showcase for neighboring countries. In this respect, our study shows that it is crucial to invest in planning, the enhancement of the profession and the recognition of all the agents involved in waste management.

[Malaria infection during pregnancy in Niamey, Niger]. / Infection palustre de la femme enceinte à Niamey au Niger.

INTRODUCTION: malaria during pregnancy is a major public health problem in Africa. It can have serious consequences for mother, fetus and newborn. It is associated with high maternal and infant mortality rate. The purpose of our study was to determine the prevalence of plasmodium infection in pregnant women, describe their clinical signs and potential complications, analyze associated factors, and propose preventive measures. METHODS: we conducted a cross-sectional study at the Issaka Gazobi Maternity Ward (MIG), Niamey, from 1 June to 30 November 2017. Diagnosis was based on microscopic examination. RESULTS: two hundred and forty-nine (249) women were included in this study. The prevalence of plasmodium infection was 36.5% (IC95%; [30.6; 42.9]). Mean parasite density was 177 P/µl (SD: 121; [40; 800]). All infections were due to P. falciparum. Seventy-three point six percent (67/91) of infected women were asymptomatic. Only 26.4% (24/91) of them had uncomplicated malaria; 9.6% (6/91) had miscarriage; 38.4% of newborns were low birthweight; 26.51% (66/249) developed congenital malaria. Mortality rate was 1.1% (1/ 91). Intermittent preventive treatment (IPT) significantly protected patients against gestational malaria (p=0.01). CONCLUSION: in Niger, P. falciparum infection very commonly affects pregnant women. It is most often asymptomatic but it can lead to uncomplicated or even severe malaria. Main consequences include abortion, low birth weight, intrauterine growth retardation, congenital malaria and maternal death. IPT and the use of long-lasting insecticide-treated mosquito nets (LLINs) can prevent infection.

Transfusional Malaria and Associated Factors at the National Blood Transfusion Center of Niamey-Niger.

SUMMARY: Problem. Transfusional malaria is an accidental transmission of Plasmodium via a blood transfusion. Its magnitude is underestimated and very little data on the assessment of this risk are available in Niger. OBJECTIVE: This study aimed to determine the prevalence of plasmodial infection of blood bags at the National Blood Transfusion Center of Niamey (NBTC). METHODOLOGY: A cross-sectional study to diagnose Plasmodium infection by microscopy and Rapid Diagnostic Test (RDT) was carried out during the rainy season (September to November 2015). Blood grouping was performed by the BETH-VINCENT technique. RESULTS: One thousand three hundred and fifty-seven (1357) blood bags were collected. One hundred and fifty-seven (11.6%) of the donors were infected with Plasmodium by microscopy and 2.4% (9/369) by rapid diagnostic test. All infections were with P. falciparum (100%). The mean parasite density was 197 parasites/µL (SD=281; [80: 2000]). There were no significant differences in infection prevalence between the ABO blood groups (p = 0.3) or the rhesus positivity (p=08). There is also no significant difference in temporal (p = 0.1) and spatial (p = 0.6) distribution. CONCLUSION: The transmission of transfusional malaria during the rainy season is a fact in Niger. Such risks were independent of the ABO blood type and positivity for the rhesus antigen. Pretransfusion diagnosis or posttransfusion therapy should be instituted to prevent it.

Risk factors for in-hospital maternal mortality in the region of Maradi, Niger (2008-2010: A retrospective study of 7 regional maternity units.

In the Maradi region, despite multiple efforts to reduce maternal mortality the in-hospital maternal mortality ratio (HMMR) remains high. We sought to determine the factors related to maternal mortality in seven maternity units in this region. A retrospective study reviewed records of deliveries from January, 2008, through December, 2010. Data for all maternal deaths were collected. The Chi2 test was used to determine the significance of differences between groups for the different variables. Statistical significance was defined as P < 0.05. Data were analyzed with Epi Info© 3.5.1. The in-hospital maternal mortality ratio (HMMR) was 2,512 per 100,000 live births. Women aged 14 to 19 years were most affected, accounting for 27.1 % of deaths. In all, 93 (27.4 %) women died during their pregnancy. Direct obstetric causes accounted for 53.61 % of these deaths, and indirect causes 46.39 %. The bivariate analysis showed that age 14 to19 years (Chi2 = 64.69; P = 0.00000178); great multiparity (Chi2 = 64.69; P = 0.00000124), primiparity (Chi2 = 18.82; P = 0.000016), the third trimester of pregnancy (Chi2 = 10.43; P = 0.0054) were significantly associated with maternal death. It is therefore necessary to strengthen women's awareness about the risks of early pregnancy and the immediate use of health services.

Flambée épidémique d'hépatite virale à forte létalité dans la région de Diffa (Niger) en 2017

Introduction. En 2017, la région de Diffa a notifié une hausse des cas de syndrome ictérique à huit cas dont 6 (75%) décès. Suite à la confirmation, une équipe multidisciplinaire a investigué cette flambée épidémique. L'objectif était de caractériser la population à risque, d'identifier la source de l'infection et de mettre en place des mesures de contrôle et de prévention. Méthodes. Nous avons conduit une étude descriptive des cas d'HVE survenus dans la région de Diffa, du 23 avril au 4 juin 2017. Une recherche active des cas a été menée dans les villages et les camps des réfugiés et des déplacés internes. Nous avons effectué des entretiens avec les malades et une revue documentaire. Une liste linéaire a été établie. Des prélèvements ont été collectés. Epi Info 7.2 pour l'analyse. Résultats. 329 cas dont 26 (7,90%) décès ont été enregistrés. Le sexe féminin représentait 63,1%. L'âge médian était de 26 ans (2 à 75 ans). La tranche d'âge ≥15 ans représentait 85,41%. Les femmes enceintes ou allaitantes représentaient 38,16% de l'effectif. Les signes cliniques étaient une fièvre, des céphalées, ictère, d'asthénies, de myalgies, d'arthralgies. Les populations se ravitaillaient en eau de boisson au niveau des abreuvoirs destinés aux animaux. La défécation se faisait à l'air libre dans les camps de réfugiés et des déplacés. Conclusion. L'investigation de l'épidémie a permis de décrire les cas et mettre en place des mesures de contrôle et de prévention. Nous recommandons de sensibiliser les populations sur l'hygiène et assainissement

Emergence of epidemic Neisseria meningitidis serogroup C in Niger, 2015: an analysis of national surveillance data.

BACKGROUND: To combat Neisseria meningitidis serogroup A epidemics in the meningitis belt of sub-Saharan Africa, a meningococcal serogroup A conjugate vaccine (MACV) has been progressively rolled out since 2010. We report the first meningitis epidemic in Niger since the nationwide introduction of MACV. METHODS: We compiled and analysed nationwide case-based meningitis surveillance data in Niger. Cases were confirmed by culture or direct real-time PCR, or both, of cerebrospinal fluid specimens, and whole-genome sequencing was used to characterise isolates. Information on vaccination campaigns was collected by the Niger Ministry of Health and WHO. FINDINGS: From Jan 1 to June 30, 2015, 9367 suspected meningitis cases and 549 deaths were reported in Niger. Among 4301 cerebrospinal fluid specimens tested, 1603 (37·3%) were positive for a bacterial pathogen, including 1147 (71·5%) that were positive for N meningitidis serogroup C (NmC). Whole-genome sequencing of 77 NmC isolates revealed the strain to be ST-10217. Although vaccination campaigns were limited in scope because of a global vaccine shortage, 1·4 million people were vaccinated from March to June, 2015. INTERPRETATION: This epidemic represents the largest global NmC outbreak so far and shows the continued threat of N meningitidis in sub-Saharan Africa. The risk of further regional expansion of this novel clone highlights the need for continued strengthening of case-based surveillance. The availability of an affordable, multivalent conjugate vaccine may be important in future epidemic response. FUNDING: MenAfriNet consortium, a partnership between the US Centers for Disease Control and Prevention, WHO, and Agence de Médecine Preventive, through a grant from the Bill & Melinda Gates Foundation.