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1.
Genes (Basel) ; 12(9)2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34573296

RESUMO

Human immunodeficiency virus (HIV) drug resistance (HIVDR) is widespread in sub-Saharan Africa. Children and pregnant women are particularly vulnerable, and laboratory testing capacity remains limited. We, therefore, used a cross-sectional design and convenience sampling to characterize HIV subtypes and resistance-associated mutations (RAMs) in these groups in Sierra Leone. In total, 96 children (age 2-9 years, 100% ART-experienced), 47 adolescents (age 10-18 years, 100% ART-experienced), and 54 pregnant women (>18 years, 72% ART-experienced) were enrolled. Median treatment durations were 36, 84, and 3 months, respectively, while the sequencing success rates were 45%, 70%, and 59%, respectively, among children, adolescents, and pregnant women. Overall, the predominant HIV-1 subtype was CRF02_AG (87.9%, 95/108), with minority variants constituting 12%. Among children and adolescents, the most common RAMs were M184V (76.6%, n = 49/64), K103N (45.3%, n = 29/64), Y181C/V/I (28.1%, n = 18/64), T215F/Y (25.0%, n = 16/64), and V108I (18.8%, n = 12/64). Among pregnant women, the most frequent RAMs were K103N (20.6%, n = 7/34), M184V (11.8%, n = 4/34), Y181C/V/I (5.9%, n = 2/34), P225H (8.8%, n = 3/34), and K219N/E/Q/R (5.9%, n = 2/34). Protease and integrase inhibitor-RAMs were relatively few or absent. Based on the genotype susceptibility score distributions, 73%, 88%, and 14% of children, adolescents, and pregnant women, respectively, were not susceptible to all three drug components of the WHO preferred first-line regimens per 2018 guidelines. These findings suggest that routine HIVDR surveillance and access to better ART choices may improve treatment outcomes in Sierra Leone.

2.
Glob Health Action ; 14(1): 1947566, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34404330

RESUMO

BACKGROUND: There are limited data to help guide implementation of differentiated HIV service delivery (DSD) in resource-limited settings in sub-Saharan Africa. OBJECTIVES: This pre-implementation study sought to assess the proportion of patients eligible for DSD and HIV services utilization, as well as risk factor analysis of virologic failure in Sierra Leone. METHODS: We conducted a retrospective study of adult HIV-infected patients aged 18 years and older receiving care at the largest HIV treatment center in Sierra Leone 2019-2020. Multiple logistic regression was used to identify predictors of virologic failure. RESULTS: Of 586 unique patients reviewed, 210 (35.8%) qualified as 'stable' for antiretroviral therapy (ART) delivery. There was high utilization of certain HIV service programs (e.g. HIV status disclosure to partners (83%) and treatment 'buddy' program participation (62.8%)), while other service programs (e.g. partner testing and community HIV support group participation) had low utilization (<50%). Of 429 patients with available viral load, 277 (64.6%) were virologically suppressed. In the multivariate logistic regression analysis of risk factors of virologic failure, CD4 < 350 cells/mm3 (p = 0.009), atazanavir-based ART (p = 0.032), once monthly versus once two- or three-monthly ART dispensing (p = 0.028), history of ART switching (p = 0.02), poor adherence (p = 0.001) and not having received adherence support (p < 0.001) were independent predictors of virologic failure. CONCLUSION: Approximately one in three HIV-infected patients on ART were eligible for DSD. We identified gaps in HIV care (i.e. low partner testing, treatment 'buddy', program participation and a substantially high rate of virologic failure) that need to be addressed in preparation for full implementation of DSD in Sierra Leone.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Adulto , Fármacos Anti-HIV/uso terapêutico , Utilização de Instalações e Serviços , Infecções por HIV/tratamento farmacológico , Humanos , Estudos Retrospectivos , Serra Leoa , Carga Viral
3.
BMC Gastroenterol ; 21(1): 320, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372775

RESUMO

BACKGROUND: Hepatitis B virus (HBV) is a major global health problem. Although sub-Saharan Africa has a high proportion of the global burden of HBV, the epidemiology and clinical features of HBV in this region are poorly characterized, and access to diagnostic and treatment services remain limited. METHODS: We conducted a retrospective study of HBV-infected children and adults of all age groups who were evaluated at public and private health facilities in Freetown, Sierra Leone between January 2017 and January 2019. We assessed their clinical presentation, HBV sero-markers, stages of liver disease, prevalence of cirrhosis by non-invasive tools, and the proportion of treatment eligible patients using the criteria recommended by the World Health Organization's 2015 treatment guidelines for HBV. Logistic regression was used to identify predictors of liver cirrhosis. RESULTS: 163 HBV patients included in the study, with mean age 32.6 years and 65.0% (106) being males. Most (84.0%) were asymptomatic at presentation. The majority (69.9%) were classified as having HBeAg-negative chronic infection (or inactive HBsAg carrier phase), 24.5% were in the HBeAg-negative immune active phase, 3.1% had HBeAg positive hepatitis, and 2.5% were HBsAg negative. The median Aspartate aminotransferase to Platelet Ratio (APRI) and Fibrosis-4 (FIB-4) scores were 0.37 and 0.80, respectively. The prevalence of cirrhosis was 7.6% and 6.2%, estimated by the APRI and FIB-4 scores, respectively. About 20.0% of patients were eligible for treatment with antiviral agents. Based on APRI scores, the presence of any symptom [adjusted odds ratio (aOR) 20.0, 95% confidence interval (CI) (4.1-85.9); p < 0.001], elevated direct bilirubin [aOR 12.1, 95% CI (1.9-63.0); p = 0.003], and elevated total bilirubin [aOR 16.1, 95% CI (3.2-80.8); p = 0.001] were independent predictors of cirrhosis. CONCLUSION: Although most patients with HBV infection were asymptomatic, the prevalence of liver cirrhosis and proportion of patients requiring antiviral treatment were substantial. This small study from a hyperendemic setting in Sierra Leone suggests that routine population-based screening may increase early detection and linkage of HBV patients to care before development of complications. Larger studies are needed to confirm our findings.


Assuntos
Hepatite B Crônica , Hepatite B , Adulto , Criança , Estudos Transversais , Hepatite B/complicações , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Antígenos de Superfície da Hepatite B , Vírus da Hepatite B , Humanos , Cirrose Hepática/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Serra Leoa/epidemiologia
4.
Trop Med Infect Dis ; 6(3)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34449755

RESUMO

The COVID-19 pandemic has adversely affected tuberculosis (TB) care delivery in high burden countries. We therefore conducted a retrospective study to assess the impact of COVID-19 on TB case detection and treatment outcomes at the Chest Clinic at Connaught Hospital in Freetown, Sierra Leone. Overall, 2300 presumptive cases were tested during the first three quarters of 2020 (intra-COVID-19) versus 2636 in 2019 (baseline), representing a 12.7% decline. Testing declined by 25% in women, 20% in children and 81% in community-initiated referrals. Notwithstanding, laboratory-confirmed TB cases increased by 37.0% and treatment success rate was higher in 2020 (55.6% vs. 46.7%, p = 0.002). Multivariate logistic regression analysis found that age < 55 years (aOR 1.74, 95% CI (1.80, 2.56); p = 0.005), new diagnosis (aOR 1.69, 95% CI (1.16, 2.47); p = 0.007), pulmonary TB (aOR 3.17, 95% CI (1.67, 6.04); p < 0.001), HIV negative status (aOR 1.60, 95%CI (1.24, 2.06); p < 0.001) and self-administration of anti-TB drugs through monthly dispensing versus directly observed therapy (DOT) (aOR 1.56, 95% CI (1.21, 2.03); p = 0.001) independently predicted treatment success. These findings may have policy implications for DOTS in this setting and suggest that more resources are needed to reverse the negative impact of the COVID-19 pandemic on TB program activities in Sierra Leone.

5.
Pan Afr Med J ; 38: 412, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381556

RESUMO

Non-tuberculous mycobacteria are uncommon pathogens in immunocompetent individuals. We report an unusual case of pneumonia with pleural effusion caused by co-infection with two species of non-tuberculous mycobacteria in an immunocompetent man in Nigeria. The case highlights the possibility of the occurrence of a disease caused by these pathogens in an unusual host in a setting where they are rarely isolated as well as the challenges faced in diagnosis.


Assuntos
Infecções por Mycobacterium não Tuberculosas/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Derrame Pleural/diagnóstico , Pneumonia Bacteriana/diagnóstico , Adulto , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/microbiologia , Nigéria , Derrame Pleural/microbiologia , Pneumonia Bacteriana/microbiologia
7.
Int J Mycobacteriol ; 10(1): 1-7, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33707364

RESUMO

Introduction: Tuberculosis (TB) is a disease of public health importance globally. The incidence of pulmonary TB is rising in sub-Saharan Africa. Bilateral adrenal destruction and the use of medications such as rifampicin are possible mechanisms by which TB cause adrenal insufficiency. Failure to promptly recognize adrenal insufficiency may lead to a medical crisis causing death. This systematic review aimed to identify the frequency of adrenal insufficiency, the clinical presentation and its predictors in patients with pulmonary TB in sub-Saharan Africa. Methods: The study was a systematic review. Medical databases and the grey literature were searched. Literature search and studies selection were done following the PRISMA guidelines. Results: The total sample size was 809. The frequency of adrenal insufficiency among patients with pulmonary TB in sub-Saharan Africa was 0.9%-59.8%. Patients with adrenal insufficiency had symptoms such as nausea, vomiting, darkening of the skin, salt craving, and weight loss. Other symptoms were dry, itchy skin, abdominal pain, and muscle pain. The predictors of adrenal insufficiency among patients with pulmonary TB in sub-Saharan Africa were low blood pressure, low blood glucose, presence of multidrug-resistant TB, and low CD4 count. Other predictors were abdominal pain and generalized skin hyperpigmentation. Conclusion: The frequency of adrenal insufficiency in patients with pulmonary TB can be as high as 50%. The presence of low blood pressure, low blood glucose, multidrug-resistant TB, and generalized skin hyperpigmentation is a pointer to the possibility of adrenal insufficiency in these patients.

8.
Trans R Soc Trop Med Hyg ; 115(10): 1106-1113, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33772308

RESUMO

There are no comprehensive data on viral hepatitis from Sierra Leone; however, a huge disease burden has been observed in different subpopulations. This review summarizes available data on hepatitis B and C virus (HBV and HCV) prevalence in Sierra Leone and identifies knowledge gaps. Despite the non-uniformity of the studies and the lack of systematic case recording, different reports published in recent decades yielded a hepatitis B prevalence of 8.7% among healthcare workers, 11.3% among pregnant women, 15.2% among blood donors and 16.7% in school-age children. The actual HBV prevalence in the general population was reported as 21.7%; similar to what was reported for people living with human immunodeficiency virus (PLHIV). HCV prevalence is 8% and 7% in male and female blood donors, respectively, 4.1% in PLHIV and 2.0% in school children. There are significant knowledge gaps regarding the prevalence of viral hepatitis B and C in Sierra Leone, despite the high burden reported in a few studies. There are limited programmatic interventions on the control and prevention of viral hepatitis in the country. Therefore, well-structured representative studies should provide a solid understanding of the true prevalence of hepatitis B and C to inform best possible public health measures in Sierra Leone.

9.
BMJ Open ; 11(3): e043887, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33692181

RESUMO

INTRODUCTION: Very little is known about possible clinical sequelae that may persist after resolution of acute COVID-19. A recent longitudinal cohort from Italy including 143 patients followed up after hospitalisation with COVID-19 reported that 87% had at least one ongoing symptom at 60-day follow-up. Early indications suggest that patients with COVID-19 may need even more psychological support than typical intensive care unit patients. The assessment of risk factors for longer term consequences requires a longitudinal study linked to data on pre-existing conditions and care received during the acute phase of illness. The primary aim of this study is to characterise physical and psychosocial sequelae in patients post-COVID-19 hospital discharge. METHODS AND ANALYSIS: This is an international open-access prospective, observational multisite study. This protocol is linked with the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) and the WHO's Clinical Characterisation Protocol, which includes patients with suspected or confirmed COVID-19 during hospitalisation. This protocol will follow-up a subset of patients with confirmed COVID-19 using standardised surveys to measure longer term physical and psychosocial sequelae. The data will be linked with the acute phase data. Statistical analyses will be undertaken to characterise groups most likely to be affected by sequelae of COVID-19. The open-access follow-up survey can be used as a data collection tool by other follow-up studies, to facilitate data harmonisation and to identify subsets of patients for further in-depth follow-up. The outcomes of this study will inform strategies to prevent long-term consequences; inform clinical management, interventional studies, rehabilitation and public health management to reduce overall morbidity; and improve long-term outcomes of COVID-19. ETHICS AND DISSEMINATION: The protocol and survey are open access to enable low-resourced sites to join the study to facilitate global standardised, longitudinal data collection. Ethical approval has been given by sites in Colombia, Ghana, Italy, Norway, Russia, the UK and South Africa. New sites are welcome to join this collaborative study at any time. Sites interested in adopting the protocol as it is or in an adapted version are responsible for ensuring that local sponsorship and ethical approvals in place as appropriate. The tools are available on the ISARIC website (www.isaric.org). PROTOCOL REGISTRATION NUMBER: osf.io/c5rw3/ PROTOCOL VERSION: 3 August 2020 EUROQOL ID: 37035.


Assuntos
COVID-19/diagnóstico , COVID-19/psicologia , Colômbia , Gana , Humanos , Itália , Estudos Longitudinais , Noruega , Estudos Prospectivos , Fatores de Risco , Federação Russa , África do Sul , Reino Unido
10.
J Neurol Sci ; 421: 117311, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33493959

RESUMO

Ebolavirus disease (EVD) is a severe, highly contagious, and often fatal systemic disease in human and non-human primates. Zoonotic and human-to-human transmission have been well documented. Ebolaviruses are endemic to Equatorial and West Africa and there have been over 20 outbreaks in sub-Saharan Africa since 1976. The largest known outbreak of EVD occurred between 2013 and 2016 across several West African countries. It resulted in 28,646 suspected and confirmed cases and 11,323 deaths. There are 5 species within the genus Ebolavirus with 4 of them being clinically significant. In patients with EVD, neurologic manifestations range from mild symptoms such as confusion to severe neurologic diseases such as meningitis and encephalitis. Altered mental status, from mild confusion to delirium with hallucinations, may also occur. Rare neuropsychiatric manifestations of EVD include psychological or cognitive symptoms, including short-term memory loss, insomnia, and depression or anxiety. Although Ebolavirus RNA has been detected in cerebrospinal fluid, the body of knowledge around the pathogenic mechanisms of neurological disease is not yet fully understood. Studies are needed to understand the acute and chronic neuronal pathologic as well as biochemical cerebrospinal fluid changes in Ebolavirus infection.


Assuntos
Ebolavirus , Doença pelo Vírus Ebola , África ao Sul do Saara , África Ocidental , Surtos de Doenças , Doença pelo Vírus Ebola/epidemiologia , Humanos
11.
Int J Infect Dis ; 102: 45-52, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33002619

RESUMO

OBJECTIVE: To assess the prevalence of serological markers of HBV and endemic acute and chronic infections (HAV, HCV, CMV, HTLV-1/2 and syphilis) in HIV-infected children, adolescents and pregnant women in Sierra Leone. METHOD: We conducted a cross-sectional study at the national children's and women's hospitals in Freetown. Logistic regression was used to assess predictors of HBsAg positivity. RESULTS: 183 HIV-infected participants were enrolled, comprising children (n = 88), adolescents (n = 47) and pregnant women (n = 48). All participants (100%) were CMV IgG-positive, while 56.8%, 93.6% and 100% of children, adolescents and pregnant women, respectively, were HAV IgG-positive. The prevalence of HCV, HTLV-1/2 and syphilis were <4%. HBV markers were distributed as follows-children: HBsAg (2.3%), HBeAg (0%), anti-HBc (5.7%); adolescents: HBsAg (17.0%), HBeAg (6.4%), anti-HBc (27.7%); and pregnant women: HBsAg (18.8%), HBeAg (4.2%), anti-HBc (77.1%). Age >10 years, i.e., being born pre-2009 before implementation of routine hepatitis B immunization (aOR 5.05 [1.18-21.28]; p = 0.029) and CD4 count <350 cells/mm3 (aOR 3.97 [1.07-14.71]; p = 0.039) predicted HBsAg positivity. CONCLUSION: A high burden of chronic HBV and other endemic infections was observed among HIV-infected patients born pre-2009 before implementation of routine HBV immunization in Sierra Leone, warranting targeted screening and immunization of this high-risk population.


Assuntos
Infecções por HIV/epidemiologia , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Antígenos E da Hepatite B/sangue , Hepatite B/epidemiologia , Sífilis/epidemiologia , Adolescente , Adulto , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Estudos Transversais , Feminino , Infecções por HIV/complicações , Hepatite B/complicações , Humanos , Masculino , Gravidez , Gestantes , Prevalência , Serra Leoa/epidemiologia , Sífilis/complicações , Adulto Jovem
12.
Pan Afr Med J ; 36: 204, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32963670

RESUMO

Introduction: hand hygiene (HH) is an effective measure to reduce healthcare-associated infections and the growing burden of antimicrobial resistance. There is a need to understand the perceptions of healthcare workers towards its practice and the use of alcohol-based hand rubs (ABHR) to make recommendations to promote HH. Our study aimed to explore the perceptions of Nigerian healthcare workers towards HH and the use and availability of ABHR to suggest potential interventions to improve its practice as qualitative evidence in this field is limited in Nigeria. Methods: a qualitative study design was utilized to understand the perceptions of healthcare workers towards HH and the use of ABHR at Adeoyo Maternity Hospital, Ibadan, Nigeria. Purposive sampling was used to recruit nineteen healthcare workers who were interviewed. Thematic content analysis was used to analyze the data generated. Results: five themes emerged including discrepancies in what constitutes HH practice as participants, motivation for HH practice, a good knowledge of timing as regards practice, barriers to good practice and evidence of poor practice. Conclusion: while many healthcare workers know about HH and self-reported compliance towards it seems to be high, knowledge gaps, lack of resources, absence of regulations and poor working conditions were impediments to the successful implementation of HH practices. We recommend that hospitals institute well-articulated HH regulations, continuous education and training of healthcare workers. Hospitals should also ensure adequate provision of resources for hand hygiene and institute a continuous monitoring and feedback program to evaluate compliance with regulations.


Assuntos
Atitude do Pessoal de Saúde , Infecção Hospitalar/prevenção & controle , Higiene das Mãos/normas , Pessoal de Saúde/estatística & dados numéricos , Adulto , Feminino , Desinfecção das Mãos/normas , Maternidades , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria
13.
Int J Infect Dis ; 96: 112-118, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32339724

RESUMO

OBJECTIVE: To assess the diagnosis, treatment outcomes, and predictors of mortality in adult tuberculosis (TB) patients in an urban setting with a high HIV prevalence. METHODS: A retrospective study was conducted of adult TB patients aged ≥15 years who were treated at Connaught Hospital in Freetown, Sierra Leone from January through December 2017. Multivariate logistic regression was used to identify predictors of mortality. RESULTS: Of 1127 TB cases notified in 2017, 1105 (98%) were tested for HIV, yielding a TB/HIV co-infection rate of 32.0%. Only HIV-tested cases (n=1105) were included in the final analysis. The majority were male (69.3%), aged 25-34 years (29.2%), and had pulmonary TB (96.3%). Treatment outcomes were as follows: 29.0% cured, 29.0% completed, 0.5% treatment failure, 24.2% lost to follow-up, 12.8% transferred/not evaluated, and 4.5% died. The majority of deaths (80.0%, 40/50) occurred within 2 months of TB treatment initiation. Age 65 years or older (adjusted odds ratio 3.48, 95% confidence interval 1.15-10.56; p=0.027) and HIV-positive status (adjusted odds ratio 3.50, 95% confidence interval 1.72-7.12; p=0.001) were independent predictors of mortality. CONCLUSIONS: Suboptimal TB treatment outcomes were observed in Sierra Leone in 2017. More local and international action is warranted to help achieve the 2035 global TB elimination targets.


Assuntos
Tuberculose/diagnóstico , Tuberculose/terapia , Adolescente , Adulto , Idoso , Cidades , Coinfecção/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Serra Leoa/epidemiologia , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/mortalidade , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
14.
BMC Infect Dis ; 20(1): 141, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059703

RESUMO

BACKGROUND: The global annual estimate for cryptococcal disease-related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count < 100/µl. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone. METHODS: A prospective cohort study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm3 from January to April 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with 8 weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher's exact test was used to compare categorical variables. RESULTS: A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm3 (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days). Eight participants had a positive blood CrAg, giving a prevalence of 4.7% (95% CI: 2.4-9.2%). Of those with a positive CrAg, CSF CrAg was positive in five (62.5%). Five (62.5%) CrAg-positive participants died within the first month, while the remaining three were alive and established on ART at 8 weeks. CONCLUSION: A substantial prevalence of cryptococcal antigenaemia and poor outcome of cryptococcal disease were demonstrated in our study. The high mortality suggests a need for the HIV programme to formulate and implement policies on screening and pre-emptive fluconazole therapy for all adults with advanced HIV in Sierra Leone, and advocate for affordable access to effective antifungal therapies.


Assuntos
Antígenos de Fungos/sangue , Criptococose/epidemiologia , Infecções por HIV/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Adulto , Antifúngicos/uso terapêutico , Estudos Transversais , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/mortalidade , Cryptococcus , Feminino , Fluconazol/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/epidemiologia , Prevalência , Estudos Prospectivos , Estudos Soroepidemiológicos , Serra Leoa/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos
15.
Antimicrob Resist Infect Control ; 9(1): 38, 2020 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-32087751

RESUMO

BACKGROUND: Available data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research is needed to inform public health policies. Our study aimed to assess antibiotic resistance rates from isolates in the urine and sputum samples of patients with clinical features of HAIs. METHODOLOGY: We conducted a cross-sectional study of adult inpatients aged ≥18 years at Connaught Hospital, an urban tertiary care hospital in Freetown between February and June 2018. RESULTS: Over the course of the study, we enrolled 164 patients. Risk factors for HAIs were previous antibiotic use (93.3%), comorbidities (58.5%) and age (≥65 years) (23.9%). Of the 164 samples, 89.6% were urine. Bacterial growth was recorded in 58.8% of cultured specimens; the type of specimen was an independent predictor of bacterial growth (p < 0.021). The most common isolates were Escherichia coli and Klebsiella pneumoniae; 29.2% and 19.0% in urine samples and 18.8% and 31.3% in sputum samples, respectively. The overall resistance rates were 58% for all extended-spectrum beta-lactamase (ESBL)-producing organisms, 13.4% for carbapenem-resistant non-lactose fermenting gram-negative bacilli, 8.7% for carbapenem-resistant Acinetobacter baumannii (CRAB) and 1.3% for carbapenem-resistant Enterobacteriaceae (CRE). There were no carbapenem-resistant P. aeruginosa (CRPA) isolates but all Staphylococcus aureus isolates were methicillin-resistant S. aureus. CONCLUSION: We demonstrated a high prevalence rate of ESBL-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone. Urgent action is needed to strengthen microbiological diagnostic infrastructure, initiate surveillance on antibiotic resistance and develop and implement policy framework on antibiotic stewardship.


Assuntos
Antibacterianos/farmacologia , Bactérias/classificação , Bactérias/efeitos dos fármacos , Infecção Hospitalar/epidemiologia , Resistência a Medicamentos , Adulto , Fatores Etários , Idoso , Bactérias/isolamento & purificação , Comorbidade , Infecção Hospitalar/microbiologia , Estudos Transversais , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Serra Leoa/epidemiologia , Escarro/microbiologia , Centros de Atenção Terciária , Saúde da População Urbana , Urina/microbiologia
16.
Neurology ; 94(10): e998-e1012, 2020 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-32075893

RESUMO

OBJECTIVE: To characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans. METHODS: The Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors. RESULTS: Of 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78-213.72); dyslipidemia, 2.95 (1.84-4.74); meat consumption, 1.55 (1.01-2.38); family history of CVD, 2.22 (1.41-3.50); nonconsumption of green vegetables, 3.61 (2.07-6.31); diabetes mellitus, 2.11 (1.29-3.46); stress, 1.68 (1.03-2.77); and current tobacco use, 14.27 (2.09-97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43-2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00-1.01); presence of midline shift, 1.54 (1.11-2.13); lobar ICH, 1.72 (1.16-2.55); and supratentorial bleeds, 2.17 (1.06-4.46). CONCLUSIONS: Population-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.


Assuntos
Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/etiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Hemorragia Cerebral/complicações , Feminino , Gana/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/etiologia
17.
Int J Infect Dis ; 90: 71-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31655112

RESUMO

OBJECTIVES: Our study aimed to assess antibiotic use in adult inpatients in the context of limited laboratory services at the main tertiary hospital in Sierra Leone. DESIGN: A cross-sectional study of consecutive adult inpatients (≥18 years) between October 2017 and February 2018 at Connaught Hospital in Freetown. RESULTS: A total of 920 patients were interviewed, of which 753 (81.8%) had at least one antibiotic. Complete data was captured for 688 (91.0%) patients. The median age was 41 years and 52.8% were male. Fever was reported in 41.5% of patients, though 85.1% had no leukocyte count prior to antibiotic use and none had a bacterial culture. Indications for prescribing were surgical prophylaxis (15.7%), pneumonia (15.1%), and trauma (5.8%). Cephalosporins (25.9%), penicillins (23.2%), and imidazoles (20.8%) were commonly prescribed. CONCLUSION: We found high rates of antibiotic use, of which most was not based on laboratory evidence. Lack of oversight and microbiological support are drivers of poor prescribing in many developing countries, which lack financial resources and serve a sicker population. Greater investments are needed to establish antimicrobial stewardship programs and provide clinicians with diagnostic support to enable improvements in patient outcomes and curb the spread of antibiotic resistance.


Assuntos
Antibacterianos/uso terapêutico , Adulto , Cefalosporinas/uso terapêutico , Serviços de Laboratório Clínico , Estudos Transversais , Feminino , Hospitalização , Humanos , Imidazóis/uso terapêutico , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Serra Leoa , Adulto Jovem
18.
Pan Afr Med J ; 34: 74, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31819790

RESUMO

The report describes a 32-year-old man with dengue hemorrhagic fever presenting with acute onset high-grade intermittent fever with chills and rigors, headache, myalgia, abdominal pain, and vomiting. His laboratory results revealed neutrophilia, thrombocytopenia, microscopic hematuria, and a markedly elevated D-dimer. While on admission, he developed diarrhea, hypertension, and respiratory symptoms which evolved into respiratory distress with low oxygen saturation, eventually warranting his admission to the Intensive Care Unit (ICU). Despite his adverse prognostic indices, the patient made an uneventful recovery with conservative management after 16 days of admission. Thus illustrating how aggressive management could influence the outcome of dengue illness.


Assuntos
Unidades de Terapia Intensiva , Dengue Grave/terapia , Adulto , Humanos , Masculino , Prognóstico , Dengue Grave/fisiopatologia , Resultado do Tratamento
19.
BMC Public Health ; 19(1): 1320, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638941

RESUMO

BACKGROUND: HIV infection is a growing public health problem in Sierra Leone and the wider West Africa region. The countrywide HIV prevalence was estimated at 1.7% (67,000 people), with less than 30% receiving life-saving ART in 2016. Thus, HIV-infected patients tend to present to health facilities late, with high mortality risk. METHODS: We conducted a prospective study of HIV inpatients aged ≥15 years at Connaught Hospital in Freetown-the main referral hospital in Sierra Leone-from July through September 2017, to assess associated factors and predictors of HIV-related mortality. RESULTS: One hundred seventy-three HIV inpatients were included, accounting for 14.2% (173/1221) of all hospital admissions during the study period. The majority were female (59.5%, 70/173), median age was 34 years, with 51.4% (89/173) of them diagnosed with HIV infection for the first time during the current hospitalization. The most common admitting diagnoses were anemia (48%, 84/173), tuberculosis (24.3%, 42/173), pneumonia (17.3%, 30/173) and diarrheal illness (15.0%, 26/173). CD4 count was obtained in 64.7% (112/173) of patients, with median value of 87 cells/µL (IQR 25-266), and was further staged as severe immunosuppression: CD4 < 100 cells/µL (50%, 56/112); AIDS: CD4 < 200 cells/µL (69.6%, 78/112); and late-stage HIV disease: CD4 < 350 cells/µL (83%, 93/112). Fifty-two patients (30.1%, 52/173) died during hospitalization, 23% (12/52) of them within the first week. The leading causes of death were anemia (23.1%, 12/52), pneumonia (19.2%, 10/52), diarrheal illness (15.4%, 8/52) and tuberculosis (13.6%, 7/52). Neurological symptoms, i.e., loss of consciousness (p = 0.04) and focal limb weakness (p = 0.04); alcohol use (p = 0.01); jaundice (p = 0.02); cerebral toxoplasmosis (p = 0.01); and tuberculosis (p = 0.04) were significantly associated with mortality; however, only jaundice (AOR 0.11, 95% CI [0.02-0.65]; p = 0.01) emerged as an independent predictor of mortality. CONCLUSION: HIV-infected patients account for a substantial proportion of admissions at Connaught Hospital, with a high morbidity and in-hospital mortality burden. These findings necessitate the implementation of specific measures to enhance early HIV diagnosis and expand treatment access to all HIV-infected patients in Sierra Leone.


Assuntos
Infecções por HIV/mortalidade , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Encaminhamento e Consulta , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Serra Leoa/epidemiologia , Adulto Jovem
20.
BMC Res Notes ; 12(1): 629, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31551091

RESUMO

OBJECTIVE: Despite a 1.5% National HIV prevalence, less than 40% of people living with HIV in Sierra Leone know their status. Limited activities on testing partners of HIV patients could be contributory to this substantial unawareness of HIV status. We carried out a retrospective study aimed at assessing partner testing and HIV prevalence among adults (≥ 15 years) tested using Determine™ and SD Bioline as recorded in the HIV testing registers from January to December 2017 at Connaught Hospital, an urban tertiary hospital in Sierra Leone. RESULTS: Of the 3808 clients tested for HIV, 2048 (53.8%) were females. The median age was 31 (IQR 24-42) years and 2104 (55.3%) were single. While 3014 (79.1%) had Provider-Initiated Testing and Counseling (PITC), 794 (20.9%) had Client-Initiated Testing and Counseling (CITC). HIV test was positive in 925 (24.3%) {CI 22.9-25.6, P < 0.001} clients. Of the 17 (0.4%) partners tested for HIV, 9 (52.9%) were positive. PITC yielded more HIV positive cases (760, 25.2%) than CITC (165, 20.8%). Partner testing (P = 0.007), female sex (P < 0.001) and PITC (P = 0.006) were associated with a positive HIV diagnosis. With high HIV prevalence and low partner testing, activities on partner testing are needed to improve the response to the epidemic.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Parceiros Sexuais , Adulto , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Hospitais Urbanos , Humanos , Masculino , Programas de Rastreamento/métodos , Prevalência , Estudos Retrospectivos , Serra Leoa/epidemiologia , Centros de Atenção Terciária , Serviços Urbanos de Saúde/estatística & dados numéricos , Adulto Jovem
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