Prediction of coccidiosis prevalence in extensive backyard chickens in countries and regions of the Horn of Africa.

Coccidiosis is one of the leading morbidity causes in chickens, causing a reduction of body weight and egg production. Backyard chickens are at risk of developing clinical and subclinical coccidiosis due to outdoor housing and scavenging behaviour, jeopardizing food security in households. The objectives of this study were to estimate clinical prevalence of coccidiosis at country and regional levels in the Horn of Africa in extensive backyard chickens. A binomial random effects model was developed to impute prevalence of coccidiosis. Previously gathered prevalence data (n = 40) in backyard chickens was used to define the model. Precipitation (OR: 1.09 (95% CI: 1.05-1.13) and the presence of seasonal rainfall (OR: 1.85, 95% CI: 1.27-2.70) significantly increase prevalence. Results showed an overall prevalence of coccidiosis in the Horn of Africa of 0.21 (95% CI: 0.15-0.29). Ethiopia, the Republic of South Sudan and Kenya showed the highest prevalence and Djibouti the lowest. Significant differences between Djibouti and the countries with highest prevalence were found. However, no evidence of a significant difference between the rest of the countries. Kenya and Ethiopia showed larger prevalence differences between regions. Results could assist with the targeting of testing for coccidiosis, the observation for clinical disease of chickens living in specific regions and as a baseline for the evaluation of future control measures.

One Health in Somalia: Present status, opportunities, and challenges.

One Health (OH) is an integrated approach aiming at improving the health of people, animals, and ecosystems. It recognizes the interconnectedness of human health with the health of animals, plants, and the environment. Since Somali people's livelihoods are mainly based on livestock, agriculture, marine resources, and their shared environment, OH-oriented initiatives could significantly impact the country toward reducing complex problems affecting the health of humans, animals, and the environment. The term "One Health" was first introduced into the global scientific community in September 2004 and in 2013 in Somalia. After ten years, there is still a long road ahead for implementing the OH approach in the country. Herein, we present the status, opportunities, and challenges of OH in Somalia and recommend ways to promote and institutionalize it. The country has been involved in various OH initiatives solely driven by external funding, focusing on research, capacity development, and community interventions, apart from university-led initiatives such as Somali One Health Centre. In Somalia, OH initiatives face numerous challenges, ranging from limited infrastructure and resources to weak governance and institutional capacity. We urge the Somali government to address these challenges and prioritize OH as the main approach to tackling critical health issues. We suggest the Somali government institutionalize and implement OH actions at all administrative levels, including Federal, State, District, and community, through a mechanism to improve multisectoral coordination and collaboration to predict, prevent, detect, control, and respond to communicable and non-communicable diseases at the human-animal-ecosystem interface for improving health outcomes for all.

The Pattern of COVID-19 in Horn of Africa countries, from March-December 2020.

Background: Coronavirus-19 (COVID-19) is a novel, highly infectious, and potentially fatal communicable pandemic disease. It has taken longer to reach Africa than the other continents. Objective: To examine the pattern of COVID-19 in the Horn of Africa countries from March to December 2020. Methods: A prospective cross-sectional study in which the total number of daily reported cases and deaths were collected from the official website of the World Health Organization (WHO) and Worldometer. Data were standardized based on the total population provided by World Population Prospects 2020 per million. Data sources of WHO reports and governmental reports from March to December 2020 were analyzed in this study. Data extraction was done using the microsoft excel spreadsheet tool, variables relating to the countries were computed in terms of frequencies and percentages. Results: The findings revealed that as of 31st December 2020, 136,129 (7590 per million) cases were reported from the four countries in the Horn of Africa. The overall case fatality rate (CFR) in the Horn of Africa was 1.14%. The majority of the cases were reported from Djibouti (77.20%), followed by Ethiopia (14.07%), Eritrea (4.87%), and Somalia (3.86%). The highest case fatality rate (0.81%) was from Djibouti, and the lowest (0.01%) was from Eritrea. Conclusions: The epidemiological pattern of COVID-19 among the Horn of African countries seems to have slow progress, given the prevalence of the new infections remains low, and the death toll seems stable throughout the study periods, except for Djibouti. Hence, the prevention control measures implemented in the countries should be further strengthened and supported. It is recommended that relevant stakeholders responsible for tackling the COVID-19 pandemic should put up measures to curb the spread of the virus in the region and set up a crisis management system to combat future pandemics.

Capacity for One Health research in the Horn of Africa.

Introduction: In low-and-middle-income countries, many people live near livestock. Rural livelihoods need improvement, however livestock-sector growth is a 'wicked' problem, needing careful management and One Health approaches which balance positive aspects of livestock ownership against deleterious impacts. Materials and methods: A Key Informant survey was delivered to higher education and research institute Units in Horn of Africa, to quantify baseline estimates for One Health research, understand characteristics, and risk factors for usage. Principal results: Four-fifths of Units acknowledged some One Health research; however, this was biased towards human-focused dimensions including at the human/animal/environment-interface and human/animal-interface; One Health approaches were also more often reported when all or the animal/environment dimensions were examined. We detected subject-bias impacting environment-focus in research; only research-focused Units had staff with higher environmental science degrees. Our work suggested good national research buy-in, and Units engaging with national policy-makers most often; local policy-makers were least engaged. Four-fifths of Units had laboratories, with two-thirds processing either human or animal samples and half processing both. Funding for equipment purchase, supplies and maintenance, staff training on technical/safety issues was nearly half that previously identified. Major conclusions: The necessity for One Health research approaches is acknowledged, however our results suggest persistent and systemic neglect of the environment in approaches and research staff education, and a lack of integration across government hierarchies during policy-development, potentially driven by international organisation domination. Further, Units lack funding for laboratory equipment purchase/supplies/maintenance, and staff training on technical/safety issues.

On the verge of domestication: Early use of C4 plants in the Horn of Africa.

The earliest evidence of agriculture in the Horn of Africa dates to the Pre-Aksumite period (ca. 1600 BCE). Domesticated C3 cereals are considered to have been introduced from the Near East, whereas the origin (local or not) and time of domestication of various African C4 species such as sorghum, finger millet, or t'ef remain unknown. In this paper, we present the results of the analysis of microbotanical residues (starch and phytoliths) from grinding stones recovered from two archaeological sites in northeastern Tigrai (Ethiopia), namely Mezber and Ona Adi. Together, both sites cover a time period that encompasses the earliest evidence of agriculture in the region (ca. 1600 BCE) to the fall of the Kingdom of Aksum (ca. 700 CE). Our data indicate that these communities featured complex mixed economies which included the consumption of both domestic and wild plant products since the Initial Pre-Aksumite Phase (ca. 1600 to 900 BCE), including C3 crops and legumes, but also C4 cereals and geophytes. These new data expand the record of C4 plant use in the Horn of Africa to over 1,000 y. It also represents the first evidence for the consumption of starchy products in the region. These results have parallels in the wider northeastern African region where complex food systems have been documented. Altogether, our data represent a significant challenge to our current knowledge of Pre-Aksumite and Aksumite economies, forcing us to rethink the way we define these cultural horizons.

Entyposisfrici (Coleoptera, Scarabaeidae, Melolonthinae), a new species from Somaliland.

Entyposisfrici Bezdek & Sehnal, sp. nov., from Somaliland is described and relevant diagnostic characters are illustrated. The new species is compared with the morphologically closely similar Entyposis Kolbe, 1894 species. An updated checklist and an identification key to northeastern African Entyposis species are provided.

Ticks and tick-borne pathogens of domestic animals in Somalia and neighbouring regions of Ethiopia and Kenya.

Ticks and tick-borne pathogens (TBPs) of domestic animals in Somalia and neighbouring regions of Ethiopia and Kenya are reviewed to identify knowledge gaps in these regions, where unrestricted livestock movements across borders are common. Major scientific databases, such as PubMed, Web of Science, Scopus, CABI, and Google Scholar were searched, to retrieve articles based on papers published between 1960 and March 2023. Thirty-one tick species representing six genera (Rhipicephalus, Hyalomma, Amblyomma, Haemaphysalis, Ornithodoros and Argas) were reported to infest domestic animals, mainly livestock. Overall, the most represented species were Rhipicephalus pulchellus (up to 60% of specimens identified), followed by Hyalomma dromedarii (up to 57%), Hyalomma truncatum (up to 57%), Amblyomma lepidum (up to 21%), Amblyomma variegatum (up to 21%) and Amblyomma gemma (up to 19%), with morphological characterization being the principal method of tick identification. In addition, 18 TBPs, including zoonotic pathogens (e.g., Crimean-Congo haemorrhagic fever virus), were detected, with Babesia spp., Theileria spp., and Rickettsia spp. being the most commonly reported. Half of the pathogens documented were detected using molecular techniques, while the other half were detected by serology and microscopic techniques. Generally, ticks and TBPs in the region are under-studied, particularly, data relating to pet animals and equines is lacking. Further, the infection intensity and herd prevalence of ticks and TBPs is unclear because of insufficient data and poor approaches to quantitative analysis, making it difficult to propose management policies in the region. There is an urgent need, therefore, for more and better studies, particularly those that take a 'One Health' perspective, focusing on the prevalence and socioeconomic impact of ticks and TBPs in animals as well as in humans, so that sustainable control strategies against them can be planned.

Epidemiological Dynamics of Foot-and-Mouth Disease in the Horn of Africa: The Role of Virus Diversity and Animal Movement.

The Horn of Africa is a large area of arid and semi-arid land, holding about 10% of the global and 40% of the entire African livestock population. The region's livestock production system is mainly extensive and pastoralist. It faces countless problems, such as a shortage of pastures and watering points, poor access to veterinary services, and multiple endemic diseases like foot-and-mouth disease (FMD). Foot-and-mouth disease is one of the most economically important livestock diseases worldwide and is endemic in most developing countries. Within Africa, five of the seven serotypes of the FMD virus (FMDV) are described, but serotype C is not circulating anymore, a burden unseen anywhere in the world. The enormous genetic diversity of FMDV is favored by an error-prone RNA-dependent RNA polymerase, intra-typic and inter-typic recombination, as well as the quasi-species nature of the virus. This paper describes the epidemiological dynamics of foot-and-mouth disease in the Horn of Africa with regard to the serotypes and topotypes distribution of FMDV, the livestock production systems practiced, animal movement, the role of wildlife, and the epidemiological complexity of FMD. Within this review, outbreak investigation data and serological studies confirm the endemicity of the disease in the Horn of Africa. Multiple topotypes of FMDV are described in the literature as circulating in the region, with further evolution of virus diversity predicted. A large susceptible livestock population and the presence of wild ungulates are described as complicating the epidemiology of the disease. Further, the husbandry practices and legal and illegal trading of livestock and their products, coupled with poor biosecurity practices, are also reported to impact the spread of FMDV within and between countries in the region. The porosity of borders for pastoralist herders fuels the unregulated transboundary livestock trade. There are no systematic control strategies in the region except for sporadic vaccination with locally produced vaccines, while literature indicates that effective control measures should also consider virus diversity, livestock movements/biosecurity, transboundary trade, and the reduction of contact with wild, susceptible ungulates.

Knowledge, attitudes and practices towards suicide among immigrants from the horn of Africa in Victoria, Australia.

This study explored suicide risks and protective factors in the first generation-immigrants to Victoria, Australia, from five countries of the Horn of Africa. The aim was to contribute towards an effective and culturally sensitive interventions to prevent suicide. The research used a survey study of knowledge, attitudes and practices towards suicide, in representative samples recruited from each community using snowball sampling. The results identified three major risk factors including, (1) lack of interface between community resources and support services, (2) prevalent negative attitudes towards suicide, and (3) gaps in suicide awareness. The roles of religious and community leaders and spiritual healers were identified as protective factors providing the communities with support to deal with suicide and other mental health issues. In conclusion, the overall impact of these risk factors was that they lead to delayed lifesaving interventions, thus contributing to an increased likelihood of suicide incidents or other adverse outcomes. These protective factors have a key role to serve as a link between the communities and health services, to address issues of delay in accessing services as well as to address negative attitudes towards suicide and the gaps in suicide literacy.

Review of maternal death audits in refugee camps in UNHCR East and Horn of Africa and Great Lakes Region, 2017-2019.

OBJECTIVES: To review the quality of maternal death audits and identify factors contributing to refugee maternal deaths in the East and Horn of Africa. METHODS: Maternal death audits submitted to The UN Refugee Agency (UNHCR) from 2017 to 2019 in 43 refugee camps in eight countries were analyzed for completeness, obstetric history, cause of death, and contributing factors. RESULTS: A total of 191 refugee maternal death audits were retrieved. The mean age of the deceased was 28 years (range, 15-45 years), and 13% were adolescents and 17% were of advanced maternal age. Most patients (55%) were grand multigravida (≥5 pregnancies). The majority (86%) attended antenatal care visits, with 51% attending four or more visits. Among women who delivered (n = 140), 91% were facility-based deliveries. Most (68%) deaths occurred postpartum. Obstetric hemorrhage (49%) was the leading direct cause of death (with 77 cases of postpartum hemorrhage), followed by hypertensive disorder (19%) and infection (15%). Delays in care were identified in 185 (97%) cases. Delays in receiving care were more prevalent (81%) than in seeking (61%) and reaching (26%) care. CONCLUSION: Factors contributing to delays in receiving care highlight the capacity gaps in provision of emergency obstetric care, including management of postpartum hemorrhage, requiring urgent additional investments. Audit findings also show the need for attention and action towards family planning, contraception, and adolescent sexual and reproductive health services.

Outbreak of Middle East Respiratory Syndrome Coronavirus in Camels and Probable Spillover Infection to Humans in Kenya.

The majority of Kenya's > 3 million camels have antibodies against Middle East respiratory syndrome coronavirus (MERS-CoV), although human infection in Africa is rare. We enrolled 243 camels aged 0−24 months from 33 homesteads in Northern Kenya and followed them between April 2018 to March 2020. We collected and tested camel nasal swabs for MERS-CoV RNA by RT-PCR followed by virus isolation and whole genome sequencing of positive samples. We also documented illnesses (respiratory or other) among the camels. Human camel handlers were also swabbed, screened for respiratory signs, and samples were tested for MERS-CoV by RT-PCR. We recorded 68 illnesses among 58 camels, of which 76.5% (52/68) were respiratory signs and the majority of illnesses (73.5% or 50/68) were recorded in 2019. Overall, 124/4692 (2.6%) camel swabs collected from 83 (34.2%) calves in 15 (45.5%) homesteads between April−September 2019 screened positive, while 22 calves (26.5%) recorded reinfections (second positive swab following ≥ 2 consecutive negative tests). Sequencing revealed a distinct Clade C2 virus that lacked the signature ORF4b deletions of other Clade C viruses. Three previously reported human PCR positive cases clustered with the camel infections in time and place, strongly suggesting sporadic transmission to humans during intense camel outbreaks in Northern Kenya.

Anopheles stephensi in Africa requires a more integrated response.

There are increasing reports of the Asian malaria mosquito, Anopheles stephensi invading and spreading in Eastern Africa. We discuss the importance of these invasions in the context of broader challenges facing malaria control in Africa and argue against addressing it as an isolated problem. Anopheles stephensi is only one of multiple biological threats facing malaria control in the region-and is itself an indication of wide-ranging weaknesses in vector surveillance and control programs. Expanded investigations are needed in both urban and rural areas, especially in countries serviced by the Indian Ocean trade routes, to establish the full extent and future trajectories of the problem. More importantly, instead of tackling this vector species as a stand-alone threat, affected countries should adopt more integrated and multi-sectorial initiatives that can sustainably drive and keep out malaria.

Wolbachia 16S rRNA haplotypes detected in wild Anopheles stephensi in eastern Ethiopia.

BACKGROUND: About two out of three Ethiopians are at risk of malaria, a disease caused by the parasites Plasmodium falciparum and Plasmodium vivax. Anopheles stephensi, an invasive vector typically found in South Asia and the Middle East, was recently found to be distributed across eastern and central Ethiopia and is capable of transmitting both P. falciparum and P. vivax. The detection of this vector in the Horn of Africa (HOA) coupled with widespread insecticide resistance requires that new methods of vector control be investigated in order to control the spread of malaria. Wolbachia, a naturally occurring endosymbiotic bacterium of mosquitoes, has been identified as a potential vector control tool that can be explored for the control of malaria transmission. Wolbachia could be used to control the mosquito population through suppression or potentially decrease malaria transmission through population replacement. However, the presence of Wolbachia in wild An. stephensi in eastern Ethiopia is unknown. This study aimed to identify the presence and diversity of Wolbachia in An. stephensi across eastern Ethiopia. METHODS: DNA was extracted from An. stephensi collected from eastern Ethiopia in 2018 and screened for Wolbachia using a 16S targeted PCR assay, as well as multilocus strain typing (MLST) PCR assays. Haplotype and phylogenetic analysis of the sequenced 16S amplicons were conducted to compare with Wolbachia from countries across Africa and Asia. RESULTS: Twenty out of the 184 mosquitoes screened were positive for Wolbachia, with multiple haplotypes detected. In addition, phylogenetic analysis revealed two superclades, representing Wolbachia supergroups A and B (bootstrap values of 81 and 72, respectively) with no significant grouping of geographic location or species. A subclade with a bootstrap value of 89 separates the Ethiopian haplotype 2 from other sequences in that superclade. CONCLUSIONS: These findings provide the first evidence of natural Wolbachia populations in wild An. stephensi in the HOA. They also identify the need for further research to confirm the endosymbiotic relationship between Wolbachia and An. stephensi and to investigate its utility for malaria control in the HOA.

A reference database of forensic autosomal and gonosomal STR markers in the Tigray population of Ethiopia.

Allele frequencies of 21 autosomal STR markers (AmpF/STR GlobalFiler) and haplotype frequencies of 27 Y- and 12 X-STR markers (AmpF/STR YFiler Plus and Investigator Argus X-12, respectively) were investigated in the Tigray population of Ethiopia, representing the main population group in the Tigray regional state of Ethiopia and neighboring Eritrea. For autosomal STR allele frequencies, the average random match probability in the Tigray sample was 2.1 × 10-27. The average locus by locus FST distance calculated comparing autosomal STR allele frequencies from Tigray and from a broad regional reference dataset currently available for the Horn of Africa was 0.003. The Tigray male sample displayed high Y-STR diversity, with complete individualization of haplotypes using the AmpF/STR YFiler Plus panel. Analysis of molecular variance did not detect significant heterogeneity between Y-STR haplotypes observed in the present study and those previously reported in the literature for other Tigray population samples from Ethiopia and Eritrea. Study of the X-STR landscape in Tigray evidenced several distinctive features including: the molecular characterization of a novel null allele at locus DXS10146 with frequency > 1%; allele dependency between loci within linkage groups I and III; significant differences in haplotype distribution compared to other Horn of Africa populations, that should be taken into account in kinship analysis. The collected data can be used as a reference STR database by local forensic genetics services and in genetic identification procedures of victims of human trafficking in the Mediterranean Sea, which frequently involve individuals originating from the Horn of Africa.

Genetic diversity of Anopheles stephensi in Ethiopia provides insight into patterns of spread.

BACKGROUND: The recent detection of the South Asian malaria vector Anopheles stephensi in the Horn of Africa (HOA) raises concerns about the impact of this mosquito on malaria transmission in the region. Analysis of An. stephensi genetic diversity and population structure can provide insight into the history of the mosquito in the HOA to improve predictions of future spread. We investigated the genetic diversity of An. stephensi in eastern Ethiopia, where detection suggests a range expansion into this region, in order to understand the history of this invasive population. METHODS: We sequenced the cytochrome oxidase subunit I (COI) and cytochrome B gene (CytB) in 187 An. stephensi collected from 10 sites in Ethiopia in 2018. Population genetic, phylogenetic, and minimum spanning network analyses were conducted for Ethiopian sequences. Molecular identification of blood meal sources was also performed using universal vertebrate CytB sequencing. RESULTS: Six An. stephensi COI-CytB haplotypes were observed, with the highest number of haplotypes in the northeastern sites (Semera, Bati, and Gewana towns) relative to the southeastern sites (Kebridehar, Godey, and Degehabur) in eastern Ethiopia. We observed population differentiation, with the highest differentiation between the northeastern sites compared to central sites (Erer Gota, Dire Dawa, and Awash Sebat Kilo) and the southeastern sites. Phylogenetic and network analysis revealed that the HOA An. stephensi are more genetically similar to An. stephensi from southern Asia than from the Arabian Peninsula. Finally, molecular blood meal analysis revealed evidence of feeding on cows, goats, dogs, and humans, as well as evidence of multiple (mixed) blood meals. CONCLUSION: We show that An. stephensi is genetically diverse in Ethiopia and with evidence of geographical structure. Variation in the level of diversity supports the hypothesis for a more recent introduction of An. stephensi into southeastern Ethiopia relative to the northeastern region. We also find evidence that supports the hypothesis that HOA An. stephensi populations originate from South Asia rather than the Arabian Peninsula. The evidence of both zoophagic and anthropophagic feeding support the need for additional investigation into the potential for livestock movement to play a role in vector spread in this region.

Comment on: Emergence of the invasive malaria vector Anopheles stephensi in Khartoum State, Central Sudan.

This letter comments on the article "Emergence of the invasive malaria vector Anopheles stephensi in Khartoum State, Central Sudan" published in Parasites and Vectors 2021, 14:511. Here we aim of provide a response to this paper in the broader context of the invasion and spread of An. stephensi in the Horn of Africa, and the required response to it. We agree with the authors that the arrival of this invasive vector in Khartoum State is of high public health concern. Equally concerning, however, we found that the detection of the vector by the authors in 2018 seemingly took 3 years to communicate to the Ministry of Health and World Health Organization (WHO), and was reliant on an academic journal. We consider that this short report sets a poor example of how public health threats should be reported. Suitable communication alternatives to alert public health authorities to such threats have been put in place by the WHO and its Member States, and are well known to at least some of the authors of the short report. We would like to encourage all readers not to follow the example of Ahmed et al. but instead act as responsible public health professionals by drawing on the established reporting mechanisms and escalate potential threats as soon as they are identified.

Polio Outbreak Investigation and Response in The Horn of Africa: 2013-2016.

BACKGROUND: There has been civil strife, spanning more than two decades in some countries and recurrent natural disasters in the Horn of Africa (HoA). This has consistently maintained these countries in chronic humanitarian conditions. More important however is the fact that these crises have also denied populations of these countries access to access to lifesaving health services. Children in the difficult terrains and security compromised areas are not given the required immunization services to build their immunity against infectious diseases like the poliovirus. This was the situation in 2013 when the large outbreaks of poliovirus occurred in the HoA. This article reviews the epidemiology, risk, and programme response to what is now famed as the 2013-204 poliovirus outbreaks in the HoA and highlights the challenges that the programme faced in interrupting poliovirus transmission here. METHODS: A case of acute flaccid paralysis (AFP) was defined as a child <15 years of age with sudden onset of fever and paralysis. Polio cases were defined as AFP cases with stool specimens positive for WPV. RESULTS: Between 2013 and 2016, when transmission was interrupted 20,266 polio viruses were in the Horn of Africa region. In response to the outbreak, several supplementary immunization activities were conducted with oral polio vaccine (OPV) The trivalent OPV was used initially, followed subsequently by bivalent OPV, and targeting various age groups, including children aged <5 years, children aged <10 years, and individuals of any age. Other response activities were undertaken to supplement the immunization in controlling the outbreak. Some of these activities included the use of various communication strategies to create awareness, sensitize and mobilize the populations against poliovirus transmission. CONCLUSIONS: The outbreaks were attributed to the existence of clusters of unvaccinated children due to inaccessibility to them by the health system, caused by poor geographical terrain and conflicts. The key lesson therefore is that the existence of populations with low immunity to infections will necessary constitutes breeding grounds for disease outbreak and of course reservoirs to the vectors. Though brought under reasonable control, the outbreaks indicate that the threat of large polio outbreaks resulting from poliovirus importation will remain constant unless polio transmission is interrupted in the remaining polio-endemic countries of the world.

Establishment and Use of Polio Communication Network in Response to Polio in Outbreak Countries of the Horn of Africa: 2013-2014.

BACKGROUND: Between 2013 and 2014, the Horn of Africa countries experienced a severe and prolonged outbreak of polio viruses. It started in one district in Somalia but quickly became a national and even international disaster, crossing international boundaries into Kenya and Ethiopia. This paper documents experiences in the establishment and contributions of the Polio Communication Network (PCN) to the polio outbreak response in the outbreak countries of Somalia, Kenya and Ethiopia from 2013 to 2015. PROCESS: The establishment of the PCN network of partnerships and technical assistance was designed to implement a strategic communication response. Various strategies were used to establish the PCN. Some of these strategies included partnerships with faith-based organizations; involvement of local leaders in microplanning; social mobilization committees and research, monitoring, evaluation and documentation structures. MAJOR OUTCOMES: PCN contributions through sustained high levels of community awareness of polio rounds were demonstrated. The contributions of the context-sensitive approaches included significant gains in reaching traditionally missed, hard-to-reach, pastoral communities with polio information, improved communication capacity, and successful closure of the outbreak within the expected timeline. This PCN experience provides important communication lessons relevant to polio eradication and other public health programmes. The focus on building capacity in areas such as monitoring, and data collection generated social data that led to the communication approaches making a significant impact. PCN contributed to a better understanding of the behavioral and environmental factors affecting the demand for, and uptake of, health services in the HoA which can be extended to most of the countries in the HoA with the same demographic and epidemiological realities. CONCLUSION: The use of the PCN helped bring the 2013-2014 polio outbreak under control and illustrates how the PCN can help drive progress towards the realization of the agenda of the universal health coverage and vision 2030 agenda in the African Region and elsewhere.

Surveillance Review System to Track Progress Towards Polio Eradication in the Horn of Africa.

BACKGROUND: The risk for importation and reintroduction wild poliovirus in areas that have been cleared of the wild poliovirus in the Horn of Africa will remain if the surveillance systems are weak and porous. METHODS: Consequently, the Horn of Africa Polio Coordinating Office in Nairobi, together with partners conducted surveillance reviews for some of the countries in the Horn of Africa, especially Ethiopia, Kenya and Somalia to identify gaps in the polio surveillance and provided recommendations for improved surveillance. Structured questionnaires collected information about acute flaccid paralysis (AFP) surveillance resources, training, data monitoring, and supervision at provincial, district, and health facility levels. Other information collected included resource availability, management and monitoring of AFP surveillance. RESULTS: The result revealed that although AFP surveillance systems were well established in these countries, a number of gaps and constraints existed. Widespread deficiencies and inefficient resource flow systems were observed and reported at all levels. There were also deficiencies related to provider knowledge, funding, training, and supervision, and were particularly evident at the health facility level. These weaknesses were corroborated with the sustained transmission of polioviruses in the region, where the surveillance systems were not sensitive enough to pick the viruses. CONCLUSION: The review teams made useful recommendations that led to strengthening of the surveillance systems in these countries, including the formation and use of village polio volunteers in the south and central zones of Somalia, where security was heavily compromised and surveillance officers lacked regular access to the communities.

Integrative transnational analysis to dissect tuberculosis transmission events along the migratory route from Africa to Europe.

BACKGROUND: Growing international migration has increased the complexity of tuberculosis transmission patterns. Italy's decision to close its borders in 2018 made of Spain the new European porte entrée for migration from the Horn of Africa (HA). In one of the first rescues of migrants from this region at the end of 2018, tuberculosis was diagnosed in eight subjects, mainly unaccompanied minors. METHODS: Mycobacterium tuberculosis isolates from these recently arrived migrants were analysed by Mycobacterial Interspersed Repetitive-Unit/Variable-Number of Tandem Repeat (MIRU-VNTR) and subsequent whole genome sequencing (WGS) analysis. Data were compared with those from collections from other European countries receiving migrants from the HA and a strain-specific PCR was applied for a fast searching of common strains. Infections in a cellular model were performed to assess strain virulence. RESULTS: MIRU-VNTR analysis allowed identifying an epidemiological cluster involving three of the eight cases from Somalia (0 single-nucleotide polymorphisms between isolates, HA cluster). Following detailed interviews revealed that two of these cases had shared the same migratory route in most of the trip and had spent a long time at a detention camp in Libya. To confirm potential en route transmission for the three cases, we searched the same strain in collections from other European countries receiving migrants from the HA. MIRU-VNTR, WGS and a strain-specific PCR for the HA strain were applied. The same strain was identified in 12 cases from Eritrea diagnosed soon after their arrival in 2018 to the Netherlands, Belgium and Italy. Intracellular replication rate of the strain did not reveal abnormal virulence. CONCLUSIONS: Our study suggests a potential en route transmission of a pan-susceptible strain, which caused at least 15 tuberculosis cases in Somalian and Eritrean migrants diagnosed in four different European countries.