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1.
MMWR Morb Mortal Wkly Rep ; 69(1): 14-19, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31917783

RESUMO

On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its 10th Ebola virus disease (Ebola) outbreak in an area with a high volume of cross-border population movement to and from neighboring countries. The World Health Organization (WHO) designated Rwanda, South Sudan, and Uganda as the highest priority countries for Ebola preparedness because of the high risk for cross-border spread from DRC (1). Countries might base their disease case definitions on global standards; however, historical context and perceived risk often affect why countries modify and adapt definitions over time, moving toward or away from regional harmonization. Discordance in case definitions among countries might reduce the effectiveness of cross-border initiatives during outbreaks with high risk for regional spread. CDC worked with the ministries of health (MOHs) in DRC, Rwanda, South Sudan, and Uganda to collect MOH-approved Ebola case definitions used during the first 6 months of the outbreak to assess concordance (i.e., commonality in category case definitions) among countries. Changes in MOH-approved Ebola case definitions were analyzed, referencing the WHO standard case definition, and concordance among the four countries for Ebola case categories (i.e., community alert, suspected, probable, confirmed, and case contact) was assessed at three dates (2). The number of country-level revisions ranged from two to four, with all countries revising Ebola definitions by February 2019 after a December 2018 peak in incidence in DRC. Case definition complexity increased over time; all countries included more criteria per category than the WHO standard definition did, except for the "case contact" and "confirmed" categories. Low case definition concordance and lack of awareness of regional differences by national-level health officials could reduce effectiveness of cross-border communication and collaboration. Working toward regional harmonization or considering systematic approaches to addressing country-level differences might increase efficiency in cross-border information sharing.


Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/epidemiologia , Vigilância em Saúde Pública/métodos , República Democrática do Congo/epidemiologia , Humanos , Ruanda/epidemiologia , Sudão do Sul/epidemiologia , Fatores de Tempo , Uganda/epidemiologia
3.
Disasters ; 43(3): 534-554, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31206227

RESUMO

This paper2 provides a snapshot of the mental health situation in South Sudan between 2013 and 2016, taking account of the personal reflections of both authors who were engaged in mental health and psychosocial support (MHPSS)3 programming in the country at this time.4 It begins by presenting an overview of MHPSS activities from this period, including governmental and non-governmental organisation (NGO) services, and relevant research and coordination mechanisms. It goes on to illustrate the challenges to the provision of support, as well as the overarching structural, governance, and human resource constraints faced by the sector. Finally, recommendations are put forward for improving services and care for people suffering from psychosocial and mental health issues, as well as suggestions for areas of focus in the future. The importance of an integrated, community-based model is emphasised, and opportunities for organisations engaged in reconciliation efforts and mental health service provision to collaborate are proposed.


Assuntos
Transtornos Mentais/epidemiologia , Serviços Comunitários de Saúde Mental/organização & administração , Humanos , Transtornos Mentais/terapia , Sudão do Sul/epidemiologia
4.
BMC Infect Dis ; 19(1): 450, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31113372

RESUMO

BACKGROUND: Brucellosis is an infectious zoonotic disease and is common especially among pastoral communities in most low and middle-income countries. The aim of this study was to determine sero-prevalence, and risk factors of Brucella infection among Slaughterhouse workers, in Bahr el Ghazal region, South Sudan. METHODS: A cross sectional study was conducted among Slaughterhouse workers in Bahr el Ghazal region, South Sudan from December 2015 to May 2016. A pre-tested questionnaire was used in data collection. Each randomly selected participant was interviewed and a venous blood sample collected. The blood samples were screened for Brucellosis infection using Rose Bengal Plate Test (RBPT) and confirmed using Competitive Enzyme link Immuno Sorbet Assay (c-ELISA). Data was analyzed using Stata version 13 at 95% level of confidence. RESULTS: A total of 234 Slaughterhouse workers were screen for Brucella infection. Overall, a third, 32.1% (75/234) of the participants were sero-positive for brucellosis. The prevalence of brucellosis was higher, 17.1% (40/234) in Wau state compared to other states. There was high prevalence among males, 28.6% (67/234) compared to females 3.4% (8/234). The mean age of study participants was 34.4 ± 9.6 years. A high proportion, 12.8% (30/234) of participants with confirmed brucellosis infection were 31-40 years of age. Brucellosis prevalence was high among butchers, 14.5% (34/234), and meat handlers, 9.0% (21/234). CONCLUSIONS: Brucellosis is common among animal slaughterhouse workers in Bahr el Ghazal region, South Sudan. There is need for public awareness campaigns and educational programs to help sensitize communities on Brucella infection.


Assuntos
Brucelose/epidemiologia , Matadouros/estatística & dados numéricos , Adolescente , Adulto , Animais , Brucella , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Carne , Exposição Ocupacional/efeitos adversos , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , Sudão do Sul/epidemiologia , Zoonoses/epidemiologia
6.
Math Biosci ; 310: 13-23, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30711479

RESUMO

Malaria is endemic in South Sudan and it is one of the most severe diseases in the war-torn nation. There has been much concern about whether the severity of its transmission might depend upon climatic conditions that are related to the reproduction of the single-cell parasite attaching to female mosquitoes, especially in high altitude areas. The country experiences two different climatic conditions; namely one tropical and the other hot and semi-arid. In this study, we aim to assess the potential impact of climatic conditions on malaria prevalence in these two climatically distinct regions of South Sudan. We develop and analyze a host-mosquito disease-based model that includes temperature and rainfall. The model has also been parameterized in a Bayesian framework using Bayesian Markov Chain Monte Carlo (MCMC). The mathematical analysis for this study has included equilibria, stability and a sensitivity index on the basic reproduction number R0. The threshold R0 is also used to provide a numerical basis for further refinement and prediction of the impact of climate variability on malaria transmission intensity over the study region. The study highlights the impact of various temperature values on the population dynamics of the mosquito.


Assuntos
Número Básico de Reprodução , Malária/transmissão , Modelos Biológicos , Modelos Estatísticos , Estações do Ano , Teorema de Bayes , Humanos , Cadeias de Markov , Método de Monte Carlo , Sudão do Sul/epidemiologia
7.
BMC Infect Dis ; 19(1): 4, 2019 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-30606126

RESUMO

BACKGROUND: On 18th May 2017, State Ministry of Health of former Warrap State received a report from Tonj East County of an outbreak of acute watery diarrhoea and vomiting in Makuac payam. We conducted this investigation to confirm the causative organism and describe the epidemiology of the outbreak in order to support evidence-based control measures. METHODS: We defined a suspected case as a resident of Tonj East or Tonj North County with sudden onset of acute watery diarrhoea and vomiting between May 1 and October 15, 2017. A probable case was defined as a suspected case with a positive rapid test for Vibrio cholerae; a confirmed case was a probable case with a positive stool culture for V. cholerae. We conducted systematic case finding by visiting health facilities and villages in the affected payams. We reviewed patient records from 1 May 2017 to 15 October 2017, to identify suspected cholera case-patients. We conducted a descriptive epidemiologic study, examining the distribution of the cases. We computed the attack rates by age, sex, and payam of residence. Case fatality rate was calculated as the ratio of the total number of suspected cholera death to the total number of cholera case-patients. We conducted an oral cholera vaccination campaign after the peak of the outbreak to control and prevent the spread to other payams. RESULTS: We identified 1451 suspected cholera cases between May and October 2017. Of these, 81% (21/26) had a positive rapid diagnostic test for V. cholerae; out of the 16 rectal swabs transported to the National Public Laboratory, 88% (14/16) were confirmed to be V. cholerae O1 serotype Inaba. The epidemic curve shows continuous common source outbreak with several peaks. The mean age of the case-patients was 24 years (Range: 0.2-75y). The clinical presentations of the case-patients were consistent with cholera. Males had an attack rate of 9.9/10000. The highest attack rate was in ≥30y (14 per 10,000). Among the six payams affected, Makuac had the highest attack rate of 3/100. The case fatality rate (CFR) was 3.0% (44/1451). Paliang and Wunlit had an oral cholera vaccination coverage of ≥100%, while 4 payams had a vaccination coverage of < 90%. CONCLUSION: This was a continuous common source cholera outbreak caused by V. cholerae 01 sero type Inaba. We recommended strengthening of the surveillance system to improve early detection and effective response.


Assuntos
Cólera/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Cólera/etiologia , Cólera/microbiologia , Vacinas contra Cólera/uso terapêutico , Diarreia/epidemiologia , Diarreia/microbiologia , Surtos de Doenças , Feminino , Humanos , Programas de Imunização , Lactente , Masculino , Sudão do Sul/epidemiologia , Vibrio cholerae/patogenicidade , Vômito/epidemiologia , Vômito/microbiologia , Adulto Jovem
8.
Travel Med Infect Dis ; 28: 34-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30553046

RESUMO

BACKGROUND: . Diarrhea is a well-established problem in travellers, with military personnel at especially high risk. This study aimed to characterise the spectrum of pathogens causing diarrhea in UK military personnel in South Sudan, and assess the utility of culture-independent testing for etiology and antimicrobial resistance in a logistically challenging and austere environment. METHODS: . All military personnel presenting with diarrhea were admitted to the UK Level 2 Medical Treatment Facility in Bentiu, South Sudan. Samples were tested for etiology utilising multiplex PCR-based diagnostics (BioFire FilmArray). In addition, the presence of carbapenemase resistance genes was determined using the geneXpert Carba-R platform. RESULTS: . Over 5 months, 127 samples were tested. The vast majority of pathogens detected were diarrheagenic Escherichia coli. The presence of either enterotoxigenic (ETEC) or enteropathogenic (EPEC) E. coli was a significant predictor of the other being present. In this study patients presenting with vomiting were 32 times more likely to have norovirus than not (p < 0.001). No carbapenem resistance was detected. CONCLUSIONS: . Diarrhea in UK military personnel in South Sudan was determined to be predominantly bacterial, with norovirus presenting a distinct clinical and epidemiological pattern. Multiplex PCR and molecular resistance point of care testing were robust and effective in this environment.


Assuntos
Infecções por Caliciviridae/complicações , Diarreia/epidemiologia , Diarreia/etiologia , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Militares , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Estudos de Coortes , Escherichia coli Enteropatogênica/genética , Escherichia coli Enterotoxigênica/genética , Feminino , Humanos , Masculino , Norovirus/fisiologia , Estudos Prospectivos , Sudão do Sul/epidemiologia , Reino Unido/epidemiologia , Nações Unidas
9.
Seizure ; 63: 93-101, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30468964

RESUMO

PURPOSE: To determine the prevalence and incidence of epilepsy in an onchocerciasis endemic region of South Sudan. METHODS: In May 2018, a door-to-door household survey was conducted in 8 study sites in an onchocerciasis endemic area in Maridi County. RESULTS: A total of 2511 households agreed to participate in the study, corresponding to 17,652 individuals. An epilepsy screening questionnaire identified 799 persons suspected to have epilepsy (4.5%); in 736 of the 766 persons (96.1%) seen by a clinical officer the diagnosis of epilepsy was confirmed. Adding 38 persons who were not seen but with a positive answer to a combination of screening questions, 774 persons (4.4%) had epilepsy. Epilepsy prevalence was highest in the 11-20 age group (10.5%); 66 persons with epilepsy (PWE) developed their first seizures in the year preceding the survey (annual incidence = 373.9/100.000). Neurocysticercosis cannot explain the high epilepsy prevalence since no pigs are kept in the area. Independent risk factors for epilepsy included male gender, belonging to a "permanent household" and a farming family, and living in a village bordering the Maridi River. Only 7209 (40.8%) of the population took ivermectin in 2017. CONCLUSION: A very high prevalence and incidence of epilepsy was observed in several villages in Maridi County located close to the Maridi River and the Maridi dam. Urgent action is needed to prevent children in Maridi County from developing OAE by strengthening the onchocerciasis elimination program.


Assuntos
Epilepsia/epidemiologia , Epilepsia/etiologia , Oncocercose/epidemiologia , Oncocercose/etiologia , Adolescente , Adulto , Antiparasitários/uso terapêutico , Criança , Pré-Escolar , Doenças Endêmicas , Feminino , Geografia Médica , Humanos , Incidência , Lactente , Recém-Nascido , Ivermectina/uso terapêutico , Masculino , Oncocercose/tratamento farmacológico , Prevalência , Fatores de Risco , Rios , Sudão do Sul/epidemiologia , Adulto Jovem
10.
Infect Dis Poverty ; 7(1): 112, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30424817

RESUMO

BACKGROUND: Nodding syndrome (NS) is a devastating epileptic illness of unknown aetiology mainly affecting children 5-15 years of age. Head nodding distinguishes NS from other forms of epilepsy. Other manifestations of the illness include mental and physical growth retardation. Many children die as a result of falling in fires or drowning. Recently, it was shown that NS is only one of the phenotypic presentations of onchocerciasis associated epilepsy (OAE). Despite the strong epidemiological association between epilepsy and onchocerciasis, the causal mechanism is unknown. After implementation of bi-annual community directed treatment with ivermectin (CDTi) and larviciding of rivers in northern Uganda, new cases of NS have ceased, while new cases continue to emerge in South Sudanese onchocerciasis-endemic areas with an interrupted CDTi programme. This study is designed to evaluate the potential effects of bi-annual CDTi on reducing the incidence of NS/OAE in onchocerciasis-endemic areas in South Sudan. METHODS: A pre-intervention door-to-door population-based household survey will be conducted in selected onchocerciasis-endemic villages in Mundri and Maridi Counties, which have a high prevalence of epilepsy. Using a validated questionnaire, the entire village will be screened by community research assistants for suspected epilepsy cases. Suspected cases will be interviewed and examined by a trained clinical officer or medical doctor who will confirm or reject the diagnosis of epilepsy. Bi-annual CDTi will be implemented in the villages and a surveillance system for epilepsy set up. By implementing an epilepsy onchocerciasis awareness campaign we expect to obtain > 90% CDTi coverage of eligible individuals. The door-to-door survey will be repeated two years after the baseline survey. The incidence of NS/OAE will be compared before and after bi-annual CDTi. DISCUSSION: Our study is the first population-based study to evaluate the effect of bi-annual CDTi to reduce the incidence of NS/OAE. If the study demonstrates such a reduction, these findings are expected to motivate communities in onchocerciasis-endemic regions to participate in CDTi, and will encourage policy makers, funders and other stakeholders to increase their efforts to eliminate onchocerciasis.


Assuntos
Antiparasitários/uso terapêutico , Epilepsia/epidemiologia , Ivermectina/uso terapêutico , Oncocercose/tratamento farmacológico , Oncocercose/epidemiologia , Adolescente , Criança , Pré-Escolar , Doenças Endêmicas , Epilepsia/etiologia , Feminino , Humanos , Incidência , Masculino , Síndrome do Cabeceio/epidemiologia , Síndrome do Cabeceio/etiologia , Oncocercose/complicações , Prevalência , Saúde Pública , Sudão do Sul/epidemiologia
11.
Seizure ; 62: 108-115, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30340162

RESUMO

PURPOSE: To describe the clinical manifestations of persons with epilepsy (PWE) in onchocerciasis endemic villages in South Sudan. METHODS: During a survey in Maridi County in May 2018, PWE were interviewed and examined in their households by a clinical officer or medical doctor. Onchocerciasis-associated epilepsy (OAE) was defined as ≥2 seizures without any obvious cause, starting between the ages of 3-18 years in previously healthy persons who had resided for at least 3 years in the onchocerciasis endemic area. RESULTS: Seven hundred and thirty-six PWE were included in the study; 315 (42.8%) were females; median age was 18 years. A variety of seizure types were reported: generalized tonic-clonic seizures in 511 PWE (69.4%), absences in 15 (2.0%), focal motor seizures with full awareness in 7 (1.0%), focal motor seizures with impaired awareness in 25 (3.4%), brief episodes of hallucinations in 316 (43.9%) and nodding seizures in 335 (45.5%). The median age of onset of all seizures was 10 years, and 8 years for nodding seizures. PWE with nodding seizures presented with more cognitive disabilities. The diagnostic criteria for OAE were met by 414 (85.2%) of the 486 PWE with complete information. Eighty (11.0%) PWE presented with Nakalanga features. Only 378 (51.4%) PWE were taking anti-epileptic treatment. CONCLUSION: PWE presented with a wide spectrum of seizures. The high percentage of PWE who met the diagnostic criteria for OAE suggests that better onchocerciasis control could prevent new cases. Urgent action is needed to close the anti-epileptic treatment gap.


Assuntos
Epilepsia/complicações , Epilepsia/epidemiologia , Oncocercose/complicações , Oncocercose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Transtornos Cognitivos/etiologia , Gerenciamento Clínico , Epilepsia/diagnóstico , Epilepsia/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Oncocercose/terapia , Sudão do Sul/epidemiologia , Adulto Jovem
12.
Int Health ; 10(6): 490-494, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30165402

RESUMO

Introduction: In Sudan, echinococcosis (EC) is a chronic neglected zoonotic parasitic disease caused by Echinococcus granulosus. Studies have shown high prevalence rates in dogs (50-70%), camels (35%) and sheep, goats and cattle (10-11%). In total, 0.3-1.0% of humans in Central and South Sudan are infected with the G6 camel strain. This strain is almost exclusively the cause of human infections. The objective of this study was to explore knowledge, attitudes and practices (KAP) regarding the disease among people living around Tambool city, Central Sudan. Methods: A cross-sectional survey was conducted in three villages around the city of Tambool in Central Sudan. Three-hundred-and-twelve households were selected from the administrative unit of the area for participation in the study, of which 300 agreed to partake. A standardized questionnaire was designed to collect data on EC in animals, humans and the environment. The questionnaire domains were socio-demographic characteristics, KAP regarding echinococcosis. Results: The population surveyed showed that 68.7% (206/300) had never heard of the disease, while 31.3% (94/300) had heard about it. The level of knowledge among the 31.3% of those that had heard about the disease was excellent (69/94; 73.4%); so were their attitudes (76/94; 80.9%). However, the majority of the participants (64/94; 68%) showed poor practice regarding this disease, enhancing the odds for further propagation of parasite circulation in the animal and human populations at risk. Knowledge was found to be significantly associated with marital status. Practice was found to be significantly associated with occupation. Conclusions: There is a need for the implementation of a multidisciplinary program using the One Health approach to effectively control and prevent EC.


Assuntos
Doenças dos Animais/epidemiologia , Equinococose/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Estudos Transversais , Echinococcus granulosus , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , Sudão do Sul/epidemiologia , Adulto Jovem
13.
BMC Pregnancy Childbirth ; 18(1): 278, 2018 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-29970038

RESUMO

BACKGROUND: Reducing Maternal Mortality Rate (MMR) is considered by the international community as one of the eight Millennium Development Goals. Based on previous studies, Skilled Assistant at Birth (SAB), General Fertility Rate (GFR) and Gross Domestic Product (GDP) have been identified as the most significant predictors of MMR in South Sudan. This paper aims for the first time to develop profile limits for the MMR in terms of significant predictors SAB, GFR, and GDP. The paper provides the optimal values of SAB and GFR for a given MMR level. METHODS: Logarithmic multi- regression model is used to model MMR in terms of SAB, GFR and GDP. Data from 1986 to 2015 collected from Juba Teaching Hospital was used to develop the model for predicting MMR. Optimization procedures are deployed to attain the optimal level of SAB and GFR for a given MMR level. MATLAB was used to conduct the optimization procedures. The optimized values were then used to develop lower and upper profile limits for yearly MMR, SAB and GFR. RESULTS: The statistical analysis shows that increasing SAB by 1.22% per year would decrease MMR by 1.4% (95% CI (0.4-5%)) decreasing GFR by 1.22% per year would decrease MMR by 1.8% (95% CI (0.5-6.26%)). The results also indicate that to achieve the UN recommended MMR levels of minimum 70 and maximum 140 by 2030, the government should simultaneously reduce GFR from the current value of 175 to 97 and 75, increase SAB from the current value of 19 to 50 and 76. CONCLUSIONS: This study for the first time has deployed optimization procedures to develop lower and upper yearly profile limits for maternal mortality rate targeting the UN recommended lower and upper MMR levels by 2030. The MMR profile limits have been accompanied by the profile limits for optimal yearly values of SAB and GFR levels. Having the optimal level of predictors that significantly influence the maternal mortality rate can effectively aid the government and international organizations to make informed evidence-based decisions on resources allocation and intervention plans to reduce the risk of maternal death.


Assuntos
Parto Obstétrico , Necessidades e Demandas de Serviços de Saúde/organização & administração , Morte Materna , Mortalidade Materna/tendências , Serviços Preventivos de Saúde/estatística & dados numéricos , Adulto , Coeficiente de Natalidade , Causas de Morte , Parto Obstétrico/efeitos adversos , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Morte Materna/etiologia , Morte Materna/prevenção & controle , Modelos Organizacionais , Mortalidade/tendências , Gravidez , Melhoria de Qualidade/organização & administração , Sudão do Sul/epidemiologia
14.
PLoS Negl Trop Dis ; 12(6): e0006456, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29924843

RESUMO

BACKGROUND: Brucellosis is a worldwide recognized bacterial zoonotic disease. There is currently no information on bovine brucellosis sero-prevalence in South Sudan regardless of the economic, social and public health impact on populations. Therefore, for the first time in 33 years, we report the sero-prevalence of brucellosis in cattle and their herders. Furthermore, we characterize the drivers associated with the disease at the human-animal interface in Bahr el Ghazal region, South Sudan. METHODS: A total of 893 and 87 animal and human sera respectively were examined between December 2015 and May 2016. Rose Bengal Plate Test (RBPT) and Competitive Enzyme Linked Immuno Sorbent Assay (c-ELISA) were used in parallel to detect anti-Brucella antibodies. Questionnaires were administered to collect relevant metadata used for the association analysis in R version 3.2.3. Odds Ratio (OR) and Confidence Intervals (CI) were determined. RESULTS: Overall bovine brucellosis prevalence was 31% (95%CI = 28.0-34.2), with the highest 63% (95%CI = 53-70) and lowest 10% (95%CI = 4.5-20.1) prevalence estimates in Wau and Gogrial states respectively. The bovine sero-prevalence was approximately equally distributed among the male 30.4% (26.9-34.2) and the females 32.5% (26.8-38.7). Poor body condition (OR = 0.22; 95%CI = 0.07-0.54) and larger herd sizes (OR = 0.05; 95%CI = 0.008-0.173) were protective factors for brucellosis, while the opposite was true for the second (OR = 1.70; 95%CI = 1.08-2.67) and third (OR = 2.5; 95%CI = 1.46-4.47) lactation stage. The overall brucellosis sero-prevalence in herders was estimated at 33.3% (23.9-44.3). CONCLUSION: We report a high prevalence of anti-Brucella antibodies in cattle and their herders in Bahr el Ghazal, indicating an enzootic status in the cattle population being an important source of infection for humans. This represents a genuine public health challenge. Therefore, there is need to raise awareness and build capacity and infrastructure in this fragile state to underwrite future public health strategies for brucellosis.


Assuntos
Anticorpos Antibacterianos/sangue , Brucella/imunologia , Brucelose Bovina/epidemiologia , Brucelose/epidemiologia , Estudos Soroepidemiológicos , Adolescente , Adulto , Animais , Brucelose/imunologia , Brucelose/microbiologia , Bovinos , Criança , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sudão do Sul/epidemiologia , Inquéritos e Questionários , Adulto Jovem , Zoonoses
15.
PLoS One ; 13(6): e0198280, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29879166

RESUMO

A campaign for malaria control, using Long Lasting Insecticide Nets (LLINs) was launched in South Sudan in 2009. The success of such a campaign often depends upon adequate available resources and reliable surveillance data which help officials understand existing infections. An optimal allocation of resources for malaria control at a sub-national scale is therefore paramount to the success of efforts to reduce malaria prevalence. In this paper, we extend an existing SIR mathematical model to capture the effect of LLINs on malaria transmission. Available data on malaria is utilized to determine realistic parameter values of this model using a Bayesian approach via Markov Chain Monte Carlo (MCMC) methods. Then, we explore the parasite prevalence on a continued rollout of LLINs in three different settings in order to create a sub-national projection of malaria. Further, we calculate the model's basic reproductive number and study its sensitivity to LLINs' coverage and its efficacy. From the numerical simulation results, we notice a basic reproduction number, [Formula: see text], confirming a substantial increase of incidence cases if no form of intervention takes place in the community. This work indicates that an effective use of LLINs may reduce [Formula: see text] and hence malaria transmission. We hope that this study will provide a basis for recommending a scaling-up of the entry point of LLINs' distribution that targets households in areas at risk of malaria.


Assuntos
Malária/epidemiologia , Malária/transmissão , Controle de Mosquitos/instrumentação , Humanos , Mosquiteiros Tratados com Inseticida , Malária/prevenção & controle , Cadeias de Markov , Modelos Teóricos , Método de Monte Carlo , Vigilância da População , Prevalência , Sudão do Sul/epidemiologia
16.
Lancet ; 391(10121): 647, 2018 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-29617255
17.
Emerg Infect Dis ; 24(5): 883-887, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29664387

RESUMO

Combining the official cholera line list data and outbreak investigation reports from the ministries of health in Uganda and South Sudan with molecular analysis of Vibrio cholerae strains revealed the interrelatedness of the epidemics in both countries in 2014. These results highlight the need for collaboration to control cross-border outbreaks.


Assuntos
Cólera/epidemiologia , Cólera/prevenção & controle , Epidemias , Cooperação Internacional , Humanos , Sudão do Sul/epidemiologia , Fatores de Tempo , Uganda/epidemiologia
18.
PLoS Negl Trop Dis ; 12(2): e0006257, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29489815

RESUMO

BACKGROUND: Oral cholera vaccination is an approach to preventing outbreaks in at-risk settings and controlling cholera in endemic settings. However, vaccine-derived herd immunity may be short-lived due to interactions between human mobility and imperfect or waning vaccine efficacy. As the supply and utilization of oral cholera vaccines grows, critical questions related to herd immunity are emerging, including: who should be targeted; when should revaccination be performed; and why have cholera outbreaks occurred in recently vaccinated populations? METHODS AND FINDINGS: We use mathematical models to simulate routine and mass oral cholera vaccination in populations with varying degrees of migration, transmission intensity, and vaccine coverage. We show that migration and waning vaccine efficacy strongly influence the duration of herd immunity while birth and death rates have relatively minimal impacts. As compared to either periodic mass vaccination or routine vaccination alone, a community could be protected longer by a blended "Mass and Maintain" strategy. We show that vaccination may be best targeted at populations with intermediate degrees of mobility as compared to communities with very high or very low population turnover. Using a case study of an internally displaced person camp in South Sudan which underwent high-coverage mass vaccination in 2014 and 2015, we show that waning vaccine direct effects and high population turnover rendered the camp over 80% susceptible at the time of the cholera outbreak beginning in October 2016. CONCLUSIONS: Oral cholera vaccines can be powerful tools for quickly protecting a population for a period of time that depends critically on vaccine coverage, vaccine efficacy over time, and the rate of population turnover through human mobility. Due to waning herd immunity, epidemics in vaccinated communities are possible but become less likely through complementary interventions or data-driven revaccination strategies.


Assuntos
Vacinas contra Cólera/imunologia , Cólera/imunologia , Imunidade Coletiva , Dinâmica Populacional , Potência de Vacina , Criança , Cólera/epidemiologia , Vacinas contra Cólera/provisão & distribução , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Humanos , Imunização Secundária/métodos , Vacinação em Massa , Modelos Teóricos , Campos de Refugiados , Sudão do Sul/epidemiologia , Vacinação , Cobertura Vacinal
19.
Ticks Tick Borne Dis ; 9(4): 806-813, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29534988

RESUMO

Theileria parva is a parasitic protozoan that causes East Coast fever (ECF), an economically important disease of cattle in eastern, central and southern Africa. In South Sudan, ECF is considered a major constraint for livestock development in regions where the disease is endemic. To obtain insights into the dynamics of T. parva in South Sudan, population genetic analysis was performed. Out of the 751 samples included in this study, 178 blood samples were positive for T. parva by species-specific PCR, were collected from cattle from four regions in South Sudan (Bor = 62; Juba = 45; Kajo keji = 41 and Yei = 30) were genotyped using 14 microsatellite markers spanning the four chromosomes. The T. parva Muguga strain was included in the study as a reference. Linkage disequilibrium was evident when populations from the four regions were treated as a single entity, but, when populations were analyzed separately, linkage disequilibrium was observed in Bor, Juba and Kajo keji. Juba region had a higher multiplicity of infection than the other three regions. Principal components analysis revealed a degree of sub-structure between isolates from each region, suggesting that populations are partially distinct, with genetic exchange and gene flow being limited between parasites in the four geographically separated populations studied. Panmixia was observed within individual populations. Overall T. parva population genetic analyses of four populations in South Sudan exhibited a low level of genetic exchange between the populations, but a high level of genetic diversity within each population.


Assuntos
Variação Genética , Theileria parva/genética , Theileriose/epidemiologia , Animais , Bovinos/parasitologia , Fluxo Gênico , Genótipo , Técnicas de Genotipagem , Desequilíbrio de Ligação , Repetições de Microssatélites , Reação em Cadeia da Polimerase , Sudão do Sul/epidemiologia , Theileria parva/isolamento & purificação , Theileriose/sangue , Theileriose/parasitologia
20.
BMJ Open ; 8(2): e018739, 2018 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-29444779

RESUMO

OBJECTIVE: To determine the met need for emergency obstetric care (EmOC) services in three Payams of Torit County, South Sudan in 2015 and to determine the frequency of each major obstetric complication. DESIGN: This was a retrospective cross-sectional study. SETTING: Four primary healthcare centres (PHCCs) and one state hospital in three payams (administrative areas that form a county) in Torit County, South Sudan. PARTICIPANTS: All admissions in the obstetrics and gynaecology wards (a total of 2466 patient admission files) in 2015 in all the facilities designated to conduct deliveries in the study area were reviewed to identify obstetric complications. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was met need for EmOC, which was defined as the proportion of all women with direct major obstetric complications in 2015 treated in health facilities providing EmOC services. The frequency of each complication and the interventions for treatment were the secondary outcomes. RESULTS: Two hundred and fifty four major obstetric complications were admitted in 2015 out of 390 expected from 2602 pregnancies, representing 65.13% met need. The met need was highest (88%) for Nyong Payam, an urban area, compared with the other two rural payams, and 98.8% of the complications were treated from the hospital, while no complications were treated from three PHCCs. The most common obstetric complications were abortions (45.7%), prolonged obstructed labour (23.2%) and haemorrhage (16.5%). Evacuation of the uterus for retained products (42.5%), caesarean sections (32.7%) and administration of oxytocin for treatment of postpartum haemorrhage (13.3%) were the most common interventions. CONCLUSION: The met need for EmOC in Torit County is low, with 35% of women with major obstetric complications not accessing care, and there is disparity with Nyong Payam having a higher met need. We suggest more support supervision to the PHCCs to increase access for the rural population.


Assuntos
Parto Obstétrico , Serviços Médicos de Emergência , Tratamento de Emergência , Instalações de Saúde , Acesso aos Serviços de Saúde/normas , Serviços de Saúde Materna , Complicações na Gravidez/terapia , Adolescente , Adulto , Cesárea , Estudos Transversais , Feminino , Humanos , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/terapia , Obstetrícia , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Sudão do Sul/epidemiologia , Adulto Jovem
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