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1.
PLoS One ; 17(8): e0265299, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35947593

RESUMO

BACKGROUND: The introduction in many countries of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited. METHODS: Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators. RESULTS: We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the <2-month age group, 56 per 100,000 in the 2-23-month age group, but lower at 5 per 100,000 in the 5-14-year age group. The most common causes of ABM were Streptococcus pneumoniae (n = 44), Neisseria meningitidis (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49/169) and was highest in the <2-month age group 37% (10/27). The case fatality ratio was 8.6% (18/209) for suspected non-bacterial meningitis and 12.8% (134/1049) for clinically suspected meningitis cases. CONCLUSIONS: Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care.


Assuntos
Meningites Bacterianas , Neisseria meningitidis , Criança , Gâmbia/epidemiologia , Bactérias Gram-Negativas , Humanos , Lactente , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/epidemiologia , Streptococcus pneumoniae , Vacinas Conjugadas
2.
PLoS One ; 17(7): e0271464, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35830461

RESUMO

OBJECTIVE: To assess whether an adapted Demographic and Health Survey (DHS) like cross-sectional household survey with full pregnancy histories can demonstrate the validity of health and demographic surveillance (HDSS) data by producing similar population structural characteristics and childhood mortality indicators at two HDSS sites in The Gambia-Farafenni and Basse. METHODS: A DHS-type survey was conducted of 2,580 households in the Farafenni HDSS, and 2,907 in the Basse HDSS. Household members were listed and pregnancy histories obtained for all women aged 15-49. HDSS datasets were extracted for the same households including residency episodes for all current and former members and compared with the survey data. Neonatal (0-28 days), infant (<1 year), child (1-4 years) and under-5 (< 5 years) mortality rates were derived from each source by site and five-year periods from 2001-2015 and by calendar year between 2011 and 2015 using Kaplan-Meier failure probabilities. Survey-HDSS rate ratios were determined using the Mantel-Haenszel method. RESULTS: The selected households in Farafenni comprised a total population of 27,646 in the HDSS, compared to 26,109 captured in the household survey, implying higher coverage of 94.4% (95% CI: 94.1-94.7; p<0.0001) against a hypothesised proportion of 90% in the HDSS. All population subgroups were equally covered by the HDSS except for the Wollof ethnic group. In Basse, the total HDSS population was 49,287, compared to 43,538 enumerated in the survey, representing an undercount of the HDSS by the survey with a coverage of 88.3% (95% CI: 88.0-88.6; p = 1). All sub-population groups were also under-represented by the survey. Except for the neonatal mortality rate for Farafenni, the childhood mortality indicators derived from pregnancy histories and HDSS data compare reasonably well by 5-year periods from 2001-2015. Annual estimates from the two data sources for the most recent quinquennium, 2011-2015, were similar in both sites, except for an excessively high neonatal mortality rate for Farafenni in 2015. CONCLUSION: Overall, the adapted DHS-type survey has reasonably represented the Farafenni HDSS database using population size and structure; and both databases using childhood mortality indicators. If the hypothetical proportion is lowered to 85%, the survey would adequately validate both HDSS databases in all considered aspects. The adapted DHS-type sample household survey therefore has potential for validation of HDSS data.


Assuntos
Mortalidade Infantil , Vigilância da População , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Gâmbia/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Vigilância da População/métodos , Gravidez
3.
PLoS Negl Trop Dis ; 16(6): e0010222, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35767572

RESUMO

BACKGROUND: Tsetse flies (Glossina) transmit Trypanosoma brucei gambiense which causes Gambian human African trypanosomiasis (gHAT) in Central and West Africa. Several countries use Tiny Targets, comprising insecticide-treated panels of material which attract and kill tsetse, as part of their national programmes to eliminate gHAT. We studied how the scale and arrangement of target deployment affected the efficacy of control. METHODOLOGY AND PRINCIPAL FINDINGS: Between 2012 and 2016, Tiny Targets were deployed biannually along the larger rivers of Arua, Maracha, Koboko and Yumbe districts in North West Uganda with the aim of reducing the abundance of tsetse to interrupt transmission. The extent of these deployments increased from ~250 km2 in 2012 to ~1600 km2 in 2015. The impact of Tiny Targets on tsetse populations was assessed by analysing catches of tsetse from a network of monitoring traps; sub-samples of captured tsetse were dissected to estimate their age and infection status. In addition, the condition of 780 targets (~195/district) was assessed for up to six months after deployment. In each district, mean daily catches of tsetse (G. fuscipes fuscipes) from monitoring traps declined significantly by >80% following the deployment of targets. The reduction was apparent for several kilometres on adjacent lengths of the same river but not in other rivers a kilometre or so away. Expansion of the operational area did not always produce higher levels of suppression or detectable change in the age structure or infection rates of the population, perhaps due to the failure to treat the smaller streams and/or invasion from adjacent untreated areas. The median effective life of a Tiny Target was 61 (41.8-80.2, 95% CI) days. CONCLUSIONS: Scaling-up of tsetse control reduced the population of tsetse by >80% across the intervention area. Even better control might be achievable by tackling invasion of flies from infested areas within and outside the current intervention area. This might involve deploying more targets, especially along smaller rivers, and extending the effective life of Tiny Targets.


Assuntos
Tripanossomíase Africana , Moscas Tsé-Tsé , Animais , Gâmbia , Humanos , Controle de Insetos/métodos , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/prevenção & controle , Uganda/epidemiologia
4.
Front Public Health ; 10: 786071, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35747777

RESUMO

Background: The coexistence of under- and overnutrition is of increasing public health concern in The Gambia. Fruits, vegetables and pulses are essential to healthy and sustainable diets, preventing micronutrient deficiencies and non-communicable diseases, while cereals significantly contribute to energy intake. However, environmental changes are predicted to intensify, reducing future yields of these crops if agricultural productivity and resilience are not improved. The Gambia is highly climate-vulnerable and import-dependent, but the extent of its reliance on other climate-vulnerable countries for its supply of nutritionally important crops is currently unknown. Methods: We used United Nations Food and Agriculture Organization data, with novel origin-tracing algorithms applied, to analyse The Gambia's supply of cereals, fruits, vegetables and pulses between 1988 and 2018. The climate vulnerability of countries was assessed using Notre Dame Global Adaptation Initiative (ND-GAIN) index scores, and projected water stress (2040) assessed using World Resources Institute (WRI) scores. Multilevel generalized linear mixed-effects models were used to identify changes in the overall climate vulnerability and projected water stress of supply. Results: Between 1988 and 2018, The Gambia's supply of cereals, fruits, vegetables and pulses diversified, with the proportion domestically produced falling (Cereals: 61.4%-27.7%; Fruits: 93.0%-55.7%; Vegetables: 24.6%-16.3%; Pulses: 100.0%-76.0%). The weighted-average ND-GAIN scores improved (indicating less climate vulnerability) for supply of all crops except cereals, but the weighted-average WRI score for supply deteriorated (indicating increased projected water stress) for all crops except vegetables. When just considering imports, weighted-average ND-GAIN scores deteriorated for fruits and cereals while showing no significant change for other food groups, and the WRI score deteriorated for cereals only. Conclusions: Despite some notable improvements in the environmental vulnerability of The Gambia's supply of nutritionally important crops (particularly vegetables), considerable, and in some cases increasing, proportions of their supply are produced in countries that are vulnerable to climate change and future water stress. This may have implications for the availability, affordability, and hence consumption of these crops in The Gambia, ultimately exacerbating existing nutritional challenges. Exploring the options to strengthen supply resilience-such as altering trade patterns, agricultural techniques and diets-should be prioritized.


Assuntos
Desidratação , Abastecimento de Alimentos , Agricultura/métodos , Produtos Agrícolas , Gâmbia
5.
BMJ Open ; 12(6): e057607, 2022 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-35697441

RESUMO

OBJECTIVES: To examine the prevalence of and risk factors associated with tobacco smoking in the Gambia. DESIGN: A nationwide cross-sectional study. SETTING: The Gambia. PARTICIPANTS: The study participants were both women and men aged between 15 and 49 years old. We included 16,066 men and women in our final analysis. DATA ANALYSIS: We analysed data from the Gambia Demographic and Health Survey (DHS), 2019-2020. DHS collected nationally stratified data from local government areas and rural-urban areas. The outcome variable was the prevalence of tobacco smoking. Descriptive analysis, prevalence and logistic regression methods were used to analyse data to identify the potential determinants of tobacco smoking. RESULTS: The response rate was 93%. The prevalence of current tobacco smoking was 9.92% in the Gambia in 2019-2020, of which, 81% of the consumers smoked tobacco daily. Men (19.3%) smoked tobacco much higher than women (0.65%) (p<0.001). People aged 40-49 years, with lower education, and manual workers were the most prevalent group of smoking in the Gambia (p<0.001).Men were 33 times more likely to smoke tobacco than women. The chance of consuming smoked tobacco increased with the increase of age (adjusted OR (AOR) 9.08, 95% CI 5.08 to 16.22 among adults aged 40-49 years, p<0.001). The strength of association was the highest among primary educated individuals (AOR 5.35, 95% CI 3.35 to 8.54).Manual workers (AOR 2.73) and people from the poorest households (AOR 1.86) were the risk groups for smoking. However, place of residency and region were insignificantly associated with smoking in the Gambia. CONCLUSIONS: Men, older people, manual workers, individuals with lower education and lower wealth status were the vulnerable groups to tobacco smoking in the Gambia. Government should intensify awareness programmes on the harmful effects of smoking, and introduce proper cessation support services among tobacco smoking users prioritising these risk groups.


Assuntos
Fumar , Fumar Tabaco , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Gâmbia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fumar/epidemiologia , Fatores Socioeconômicos , Fumar Tabaco/epidemiologia , Adulto Jovem
6.
Malar J ; 21(1): 171, 2022 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-35672850

RESUMO

BACKGROUND: Subclinical infection with Plasmodium falciparum remains highly prevalent, yet diagnosing these often low-density infections remains a challenge. Infections can be subpatent, falling below the limit of detection for conventional thick-film microscopy and rapid diagnostic testing (RDT). In this study, the prevalence of subclinical P. falciparum infections in school-aged children was characterised at the start of the dry season in the Upper River Region of The Gambia in 2017/2018, with a goal to also compare the utility of different diagnostic tools. METHODS: In a cross-sectional survey of children living in 29 villages on the south bank of the Gambia river (median age of 10 years), matched microscopy, rapid diagnostic test (RDT, detecting histidine-rich protein 2) and polymerase chain reaction (PCR, targeting either 18S rRNA or var gene acidic terminal sequence) were used to determine the prevalence of patent and subpatent infections and to compare the performance of the different diagnostic methods. RESULTS: The prevalence of var gene acidic terminal sequence (varATS) qPCR-detectable infections was 10.2% (141/1381) with a median density of 3.12 parasites/µL. Malaria prevalence was highly heterogeneous across the region, ranging from < 1% to ~ 40% prevalence in different village clusters. Compared to varATS, 18S rRNA PCR detected fewer low-density infections, with an assay sensitivity of 50% and specificity of 98.8%. Parasite prevalence in the cohort was 2.9% by microscopy and 1.5% by RDT. Compared to varATS qPCR, microscopy and RDT had sensitivities of 11.5% and 9.2%, respectively, although both methods were highly specific (> 98%). Samples that were positive by all three tests (varATS qPCR, RDT and microscopy) had significantly higher parasite densities (median = 1705 parasites/µL) than samples that were positive by varATS qPCR only (median = 2.4 parasites/µL). CONCLUSIONS: The majority of subclinical malaria infections in school-aged children were of extremely low parasite density and detectable only by ultra-sensitive PCR analysis. Understanding the duration of these low density infections, their physiological impact and their contribution to sustained parasite transmission is necessary to inform malaria elimination strategies.


Assuntos
Malária Falciparum , Malária , Parasitos , Animais , Infecções Assintomáticas/epidemiologia , Criança , Estudos Transversais , Testes Diagnósticos de Rotina/métodos , Gâmbia/epidemiologia , Humanos , Malária Falciparum/diagnóstico , Malária Falciparum/epidemiologia , Malária Falciparum/parasitologia , Plasmodium falciparum/genética , Prevalência , RNA Ribossômico 18S/genética , Reação em Cadeia da Polimerase em Tempo Real , Estações do Ano , Sensibilidade e Especificidade
7.
Acta Trop ; 232: 106520, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35588781

RESUMO

To improve understanding of African Animal Trypanosomosis (AAT) and associated host-parasite relationship's challenges on cow and milk, The Gambia was examined given its enzootic status. Based on an integrated assessment framework, semi-structured questionnaires which were pre-tested and then administered in five regions were used. Relationships among the investigated variables were statistically explored with Pearson chi-square test and strength of association quantified with Phi or Cramer's V coefficient. Rough coat, eye and nose discharge, loss of appetite and weight were more consistently observed as signs of AAT in infected lactating cows. Older cows with more than three calving (75.8%) were indicated as the most susceptible and there is no fixed number of times (85.2%) a cow is treated for AAT in a year. The most commonly recognized effect (91.7%) of AAT is milk reduction. Statistically significant positive but moderate relationship exist between milk reduction and late dry season (phi coefficient of 0.221), between milk contamination and early dry season (phi coefficient of 0.226), and also between wateriness and rainy season (phi coefficient of 0.220). Milk discolouration is not statistically related to any season with highest AAT infection rates. The need for integrated assessment of veterinary challenges based on factors such as herd affiliation status, ethnic affiliation, and farmers' objectives before preventive veterinary and production interventions are designed or implemented is implied. Useful information to advance research in this direction are presented.


Assuntos
Tripanossomíase Africana , Tripanossomíase , Animais , Bovinos , Fazendeiros , Feminino , Gâmbia/epidemiologia , Humanos , Lactação , Leite , Estações do Ano
8.
Artigo em Inglês | MEDLINE | ID: mdl-35457730

RESUMO

Voluntary counselling and testing for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has always been one of the key policy interventions in the management and control of HIV/AIDS transmission. However, the prevalence of HIV testing among reproductive women in the Gambia remains low despite near universal information about HIV and Sexually Transmitted Infections (STIs) in the Gambia. Understanding factors influencing HIV testing uptake provides empirical data for the development of targeted evidenced-based strategies aimed at enhancing HIV testing uptake. Therefore, this study examined the factors associated with HIV testing among reproductive women aged 15-49 years in the Gambia. Data on weighted sample of 11,865 women from the 2019-2020 Gambia Demographic and Health Survey were analyzed in this study. Chi square, bivariate and multivariate logistic regression models were fitted and analysis conducted through Complex Samples Analysis in Statistical Package for Social Sciences (SPSS). Level of significance was set at p < 0.05 and 95% CI. Further analysis was conducted to determine the variability in HIV testing among women stratified by rural and urban centers. Prevalence of HIV testing among reproductive women was 42.1% (95% CI = 40.1-44.2%) in the Gambia. Women aged 20-24 years and 25-29 years (aOR = 3.10, 95% CI = 2.51-3.83) and (aOR = 4.52, 95% CI = 3.61-5.54) were more likely to test for HIV than those aged 15-19 years, respectively. Married women (aOR = 5.90, 95% CI = 4.84-7.02) were more likely to test for HIV compared to those who were not in any union. Respondents with higher education in urban centers (aOR = 2.65, 95% CI = 2.08-3.86) were likely to test for HIV compared to those in rural areas. HIV testing in the Gambia among reproductive women is low. Age, marital status, wealth index, place of residence, educational level, recent sexual activity, previous history of risky sexual behaviors, and history of an STI were associated with HIV testing. Health interventions targeted at increasing HIV testing uptake should factor in these.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Infecções Sexualmente Transmissíveis , Feminino , Gâmbia/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Teste de HIV , Humanos , Masculino , Casamento , Comportamento Sexual
9.
Front Public Health ; 10: 784915, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35462834

RESUMO

Climate change and environmental degradation are among the greatest threats to human health. Youth campaigners have very effectively focused global attention on the crisis, however children from the Global South are often under-represented (sometimes deliberately) in the dialogue. In The Gambia, West Africa, the impacts of climate change are already being directly experienced by the population, and this will worsen in coming years. There is strong government and community commitment to adapt to these challenges, as evidenced by The Gambia currently being the only country on target to meet the Paris agreement according to the Nationally Determined Contributions, but again children's voices are often missing-while their views could yield valuable additional insights. Here, we describe a "Climate Change Solutions Festival" that targeted and engaged school children from 13 to 18 years, and is to our knowledge, the first peer-to-peer (and student-to-professional) learning festival on climate change solutions for students in The Gambia. The event gave a unique insight into perceived climate change problems and scalable, affordable and sometimes very creative solutions that could be implemented in the local area. Logistical and practical methods for running the festival are shared, as well as details on all solutions demonstrated in enough detail to be duplicated. We also performed a narrative review of the most popular stalls to explore the scientific basis of these solutions and discuss these in a global context. Overall, we find extremely strong, grass-roots and student engagement in the Gambia and clear evidence of learning about climate change and the impacts of environmental degradation more broadly. Nevertheless, we reflect that in order to enact these proposed local solutions further steps to evaluate acceptability of adoption, feasibility within the communities, cost-benefit analyses and ability to scale solutions are needed. This could be the focus of future experiential learning activities with students and partnering stakeholders.


Assuntos
Mudança Climática , Estudantes , Adolescente , Criança , Gâmbia , Humanos , Aprendizagem
10.
J Relig Health ; 61(4): 2975-2991, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35478306

RESUMO

This article describes and analyses the religious justifications for the life satisfaction reported by two groups of Muslim women. Approximately, twenty Somali women and twenty Gambian women, living in Norway, who had experienced trauma and pain due to female genital mutilation/cutting as well as other traumas and hardships, were interviewed. While the Somali women adhere to conservative Islam and try to cope with their life through endurance and patience, the Gambians belong to a Sufi tradition and verbalise their dissatisfaction in order to receive help from Sufi saints. Therefore, there are two religious codes, here called emotionologies, within the Muslim tradition that have different impacts on the expression of life satisfaction and women's ways of coping with pain and suffering.


Assuntos
Satisfação Pessoal , Religião , Feminino , Gâmbia , Humanos , Islamismo , Dor , Somália
11.
BMC Cardiovasc Disord ; 22(1): 145, 2022 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-35366807

RESUMO

BACKGROUND: Diabetes is increasingly becoming a public health problem in developing countries like The Gambia. Prevention of diabetes and appropriate management of the disease largely depends on correct knowledge of the risk factors and signs and symptoms of the condition. However, studies that have assessed knowledge of diabetes at population level are limited. We examined the knowledge of diabetes risk factors, and signs and symptoms among Gambian adults. METHODS: The 2019-2020 Gambia demographic and health survey data was used to analyze 4, 436 men and 6, 186 women. Knowledge of diabetes was assessed two-fold: (1) diabetes risk factors and (2) diabetes signs and symptoms. Several sociodemographic factors were considered for analysis. A generalized estimating equation model was fitted to test the association between the selected sociodemographic factors and diabetes knowledge. RESULTS: Among the men, 7.6% and 3.1% had knowledge about diabetes risk factors, and signs and symptoms, respectively. Approximately 3.1% and 1.2% of the women included in the analysis had knowledge of diabetes risk factors, and signs and symptoms, respectively. Men who were aged ≥ 35 years were more likely to have knowledge regarding diabetes risk factors (adjusted odds ratio (AOR) = 1.90, 95% confidence interval (CI) = 1.12-3.22), and signs and symptoms (AOR = 2.59, 95% CI = 1.08-6.17). Having access to media was associated with increased odds of having knowledge regarding diabetes risk factors (AOR = 1.61, 95% CI = 1.09-2.37) and signs and symptoms (AOR = 2.04, 95% CI = 1.07-3.88) among men. Among other factors, educational level was positively associated with having diabetes knowledge among both men and women. Heterogeneities regarding diabetes knowledge were observed among different regions and areas of residence. CONCLUSION: There is a need to improve awareness regarding diabetes in The Gambia as low knowledge has been observed. Programs aimed to improve diabetes knowledge should consider regional and area of residence variations in their designs. The use of mass media and strengthening the education sector in The Gambia may be of importance in raising diabetes knowledge among Gambian adults.


Assuntos
Diabetes Mellitus , Adulto , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Escolaridade , Feminino , Gâmbia/epidemiologia , Humanos , Masculino , Razão de Chances
12.
Artigo em Inglês | MEDLINE | ID: mdl-35329020

RESUMO

Poor knowledge and management of menstruation impacts girls' school attendance and academic performance. This paper aims to explore how menstrual hygiene management practices and related factors influence school absenteeism and drop-out among primary and secondary school girls in rural Gambia. Mixed-method studies were conducted among students and key informants from 19 schools from July 2015-December 2017. Focus group discussions, in-depth interviews, cross-sectional surveys, menstrual diaries, and school water, sanitation and hygiene (WASH) facility observations were used. Key findings from the interviews were that menstrual pain, cultural beliefs, fear of peers knowing menstrual status, and poor school WASH facilities led to school absenteeism, however, they had no impact on school drop-out. Of the 561 girls surveyed, 27% reported missing at least one school day per month due to menses. Missing school during the most recent menstrual period was strongly associated with menstrual pain (extreme pain adjusted odds ratio (AOR) = 16.8 (95% CI: 7.29-38.74)), as was having at least one symptom suggestive of urinary tract infection (AOR = 1.71 (95% CI: 1.16-2.52)) or reproductive tract infection (AOR = 1.99 (95% CI: 1.34-2.94)). Clean toilets (AOR = 0.44 (95% CI: 0.26-75)), being happy using school latrines while menstruating (AOR = 0.59 (95% CI: 0.37-0.93)), and soap availability (AOR = 0.46 (95% CI: 0.3-0.73)) were associated with reduced odds of school absenteeism. This study suggests menstrual pain, school WASH facilities, urogenital infections, and cultural beliefs affected school attendance among menstruating girls in rural Gambia.


Assuntos
Higiene , Menstruação , Absenteísmo , Adolescente , Estudos Transversais , Dismenorreia , Feminino , Gâmbia/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Higiene/educação , Masculino , Instituições Acadêmicas
13.
BMJ Open ; 12(3): e056706, 2022 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-35273059

RESUMO

OBJECTIVES: To determine the causes of lobar pneumonia in rural Gambia. DESIGN AND SETTING: Population-based pneumonia surveillance at seven peripheral health facilities and two regional hospitals in rural Gambia. 7-valent pneumococcal conjugate vaccine (PCV7) was introduced routinely in August 2009 and replaced by PCV13 from May 2011. METHODS: Prospective pneumonia surveillance was undertaken among all ages with referral of suspected pneumonia cases to the regional hospitals. Blood culture and chest radiographs were performed routinely while lung or pleural aspirates were collected from selected, clinically stable patients with pleural effusion on radiograph and/or large, dense, peripheral consolidation. We used conventional microbiology, and from 8 April 2011 to 17 July 2012, used a multiplex PCR assay on lung and pleural aspirates. We calculated proportions with pathogens, associations between coinfecting pathogens and PCV effectiveness. PARTICIPANTS: 2550 patients were admitted with clinical pneumonia; 741 with lobar pneumonia or pleural effusion. We performed 181 lung or pleural aspirates and multiplex PCR on 156 lung and 4 pleural aspirates. RESULTS: Pathogens were detected in 116/160 specimens, the most common being Streptococcus pneumoniae(n=68), Staphylococcus aureus (n=26) and Haemophilus influenzae type b (n=11). Bacteria (n=97) were more common than viruses (n=49). Common viruses were bocavirus (n=11) and influenza (n=11). Coinfections were frequent (n=55). Moraxella catarrhalis was detected in eight patients and in every case there was coinfection with S. pneumoniae. The odds ratio of vaccine-type pneumococcal pneumonia in patients with two or three compared with zero doses of PCV was 0.17 (95% CI 0.06 to 0.51). CONCLUSIONS: Lobar pneumonia in rural Gambia was caused primarily by bacteria, particularly S. pneumoniae and S. aureus. Coinfection was common and M. catarrhalis always coinfected with S. pneumoniae. PCV was highly efficacious against vaccine-type pneumococcal pneumonia.


Assuntos
Coinfecção , Derrame Pleural , Infecções Pneumocócicas , Pneumonia Pneumocócica , Vírus , Coinfecção/epidemiologia , Gâmbia/epidemiologia , Humanos , Lactente , Pulmão , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/epidemiologia , Pneumonia Pneumocócica/prevenção & controle , Estudos Prospectivos , Staphylococcus aureus , Streptococcus pneumoniae/genética
14.
Anim Sci J ; 93(1): e13699, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35247008

RESUMO

We have clarified the microbiological characterization of Gambian traditional fermented milk (FM), "Kosam." Two samples of FM were collected at two regions in The Gambia in 2019. The microbiota of these samples was analyzed by culture-dependent methods and Illumina sequencing. The number of lactic acid bacteria (LAB) in FM from Central River Region (CRR) and Lower River Region (LRR) was 8.27 ± 0.08 log CFU/ml and 7.21 ± 0.09 log CFU/ml, respectively. While no coliforms and Escherichia coli were detected in CRR-FM, LRR-FM contained 5.73 ± 0.17 log CFU/ml of coliforms and 4.82 ± 0.13 log CFU/ml of E. coli. The dominant viable LAB in FM from CRR was Lactobacillus delbrueckii, followed by Streptococcus lutetiensis, while that from LRR was Lactococcus lactis. The metagenomic analysis also revealed that these species were dominant in these Gambian traditional FM. Furthermore, it also revealed the possibility of the presence of pathogens such as Klebsiella spp. This study enhanced the knowledge of Gambian FM and contributed to the elucidation of microbial communities.


Assuntos
Produtos Fermentados do Leite , Leite , Animais , Bactérias , Produtos Fermentados do Leite/microbiologia , Escherichia coli , Fermentação , Microbiologia de Alimentos , Gâmbia , Leite/microbiologia
15.
BMC Public Health ; 22(1): 520, 2022 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-35296298

RESUMO

BACKGROUND: Every year, vaccination averts about 3 million deaths from vaccine-preventable diseases (VPDs). However, despite that immunization coverage is increasing globally, many children in developing countries are still dropping out of vaccination. Thus, the present study aimed to identify determinants of vaccination dropouts among children aged 12-23 months in The Gambia. METHODS: The study utilized cross-sectional data obtained from the Gambia Demographic and Health Survey 2019-20 (GDHS). The percentage of children aged 12-23 months who dropped out from pentavalent and measles vaccination were calculated by (1) subtracting the third dose of pentavalent vaccine from the first dose of Pentavalent vaccine, and (2) subtracting the first dose of measles vaccine from the first dose Pentavalent vaccine. Generalized Estimating Equation models (GEE) were constructed to examine the risk factors of pentavalent and measles vaccinations dropout. RESULTS: Approximately 7.0% and 4.0% of the 1,302 children aged 12-23 months had dropped out of measles and pentavalent vaccination respectively. The multivariate analyses showed that when caregivers attended fewer than four antenatal care sessions, when children had no health card or whose card was lost, and resided in urban areas increased the odds of pentavalent dropout. On the other hand, when women gave birth in home and other places, when children had no health card, and being an urban areas dweller increased the odds of measles dropout. CONCLUSION: Tailored public health interventions towards urban residence and health education for all women during ANC are hereby recommended.


Assuntos
Programas de Imunização , Sarampo , Criança , Estudos Transversais , Feminino , Gâmbia , Humanos , Lactente , Sarampo/prevenção & controle , Vacina contra Sarampo , Gravidez , Vacinação , Vacinas Combinadas
16.
Microb Genom ; 8(3)2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35302932

RESUMO

Non-typhoidal Salmonella associated with multidrug resistance cause invasive disease in sub-Saharan Africa. Specific lineages of serovars Typhimurium and Enteritidis have been implicated. Here we characterized the genomic diversity of 100 clinical non-typhoidal Salmonella collected from 93 patients in 2001 from the eastern, and in 2006-2018 from the western regions of The Gambia respectively. A total of 93 isolates (64 invasive, 23 gastroenteritis and six other sites) representing a single infection episode were phenotypically tested for antimicrobial susceptibility using the Kirby-Bauer disc diffusion technique. Whole genome sequencing of 100 isolates was performed using Illumina, and the reads were assembled and analysed using SPAdes. The Salmonella in Silico Typing Resource (SISTR) was used for serotyping. SNP differences among the 93 isolates were determined using Roary, and phylogenetic analysis was performed in the context of 495 African strains from the European Nucleotide Archive. Salmonella serovars Typhimurium (26/64; 30.6 %) and Enteritidis (13/64; 20.3 %) were associated with invasive disease, whilst other serovars were mainly responsible for gastroenteritis (17/23; 73.9 %). The presence of three major serovar Enteritidis clades was confirmed, including the invasive West African clade, which made up more than half (11/16; 68.8 %) of the genomes. Multidrug resistance was confined among the serovar Enteritidis West African clade. The presence of this epidemic virulent clade has potential for spread of resistance and thus important implications for systematic patient management. Surveillance and epidemiological investigations to inform control are warranted.


Assuntos
Gastroenterite , Infecções por Salmonella , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/genética , Gâmbia/epidemiologia , Gastroenterite/epidemiologia , Genômica , Humanos , Filogenia , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/epidemiologia , Salmonella typhimurium/genética
17.
Front Public Health ; 10: 785254, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35237548

RESUMO

BACKGROUND: The expected increase in heat in The Gambia is one of the most significant health threats caused by climate change. However, little is known about the gendered dynamics of exposure and response to heat stress, including women's perceived health risks, their adaptation strategies to heat, and their perceptions of climate change. This research project aims to answer the question of whether and how pregnant farmers in The Gambia perceive and act upon occupational heat stress and its health impacts on both themselves and their unborn children, against the backdrop of current and expected climatic changes. METHOD: In-depth semi-structured interviews were conducted with 12 women who practice subsistence farming and were either pregnant or had delivered within the past month in West Kiang, The Gambia. Participants were selected using purposive sampling. Translated interview transcripts were coded and qualitative thematic content analysis with an intersectional lens was used to arrive at the results. RESULTS: All women who participated in the study experience significant heat stress while working outdoors during pregnancy, with symptoms often including headache, dizziness, nausea, and chills. The most common adaptive techniques included resting in the shade while working, completing their work in multiple shorter time increments, taking medicine to reduce symptoms like headache, using water to cool down, and reducing the amount of area they cultivate. Layered identities, experiences, and household power structures related to age, migration, marital situation, socioeconomic status, and supportive social relationships shaped the extent to which women were able to prevent and reduce the effects of heat exposure during their work whilst pregnant. Women who participated in this study demonstrated high awareness of climate change and offered important insights into potential values, priorities, and mechanisms to enable effective adaptation. CONCLUSION: Our findings reveal many intersecting social and economic factors that shape the space within which women can make decisions and take adaptive action to reduce the impact of heat during their pregnancy. To improve the health of pregnant working women exposed to heat, these intersectionalities must be considered when supporting women to adapt their working practices and cope with heat stress.


Assuntos
Mudança Climática , Fazendeiros , Agricultura , Feminino , Gâmbia , Cefaleia , Humanos , Masculino , Gravidez
18.
PLoS Negl Trop Dis ; 16(3): e0010282, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35344553

RESUMO

Trachoma is the leading infectious cause of blindness in the world and has been known to be a major public health problem in The Gambia for over 60 years. Nationwide blindness surveys, including trachoma, in 1986 and 1996 provided the foundation for a comprehensive plan to implement a trachoma elimination strategy. Impact and pre-validation surveillance surveys in 2011-13 demonstrated that active trachoma was below WHO threshold for elimination but trichiasis remained a public health problem. Trichiasis-only surveys in 2019 demonstrated that trichiasis was below WHO thresholds for elimination and in 2020 the Government of The Gambia completed and submitted its dossier for validation of elimination as a public health problem. Challenges that The Gambia faced on the pathway to elimination included effective use of data for decision making, poor trichiasis surgical outcomes, lack of access to antibiotic treatment for low prevalence districts, high attrition of ophthalmic nurses trained as trichiasis surgeons, unexpected active trachoma in madrassas, the misalignment of elimination of active trachoma and trichiasis, trichiasis in urban settings, and maintaining the quality of surgery post-elimination when trichiasis cases are rare. Elimination of trachoma does not end with the submission of an elimination dossier; The Gambia will need to sustain monitoring and support over the coming years.


Assuntos
Doenças do Recém-Nascido , Tracoma , Triquíase , Cegueira/epidemiologia , Cegueira/etiologia , Cegueira/prevenção & controle , Estudos Transversais , Gâmbia/epidemiologia , Humanos , Lactente , Recém-Nascido , Prevalência , Saúde Pública , Tracoma/tratamento farmacológico , Tracoma/epidemiologia , Tracoma/prevenção & controle , Triquíase/epidemiologia , Triquíase/prevenção & controle , Triquíase/cirurgia
19.
BMJ Glob Health ; 7(2)2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35190459

RESUMO

INTRODUCTION: The need to rapidly identify safe and efficacious drug therapies for COVID-19 has resulted in the implementation of multiple clinical trials investigating potential treatment options. These are being undertaken in an unprecedented research environment and at a higher speed than ever before. It is unclear how West African communities perceive such activities and how such perceptions influence participation in COVID-19 clinical trials. This qualitative study was conducted to assess the level of acceptability of a clinical trial on the prevention and treatment of COVID-19 in The Gambia and identify strategies to better engage communities in participating in such a trial. METHODS: Data were collected using digitally recorded semistructured interviews (SSIs) and focus group discussions (FGDs) in Brikama and Kanifing local government areas. These are two of the most densely populated administrative subdivisions in The Gambia, where the clinical trial was to be implemented by the MRC Unit The Gambia. 26 men and 22 women aged between 19 and 70 years, with diverse socioeconomic profiles, participated in 8 FGDs (n=36) and 12 SSIs (n=12). Thematic analysis was used to analyse the data. RESULTS: Fear of stigmatisation of patients with COVID-19 was a recurring theme in most FGDs and SSIs, with detrimental effects on willingness to accept COVID-19 testing and home visits to follow up patients with COVID-19 and their household contacts. Preserving the privacy of individuals enrolled in the study was key to potentially increase trial participation. Trust in the implementing institution and its acknowledged expertise were facilitators to accepting the administration of investigational products to sick individuals and their close contacts. CONCLUSION: COVID-19 is a stigmatising disease. Developing a research-participant collaboration through an ongoing engagement with community members is crucial to a successful enrolment in COVID-19 clinical trials. Trust and acknowledged expertise of the implementing institution are key facilitators to foster such collaboration.


Assuntos
COVID-19 , Ensaios Clínicos como Assunto , Adulto , Idoso , COVID-19/prevenção & controle , Teste para COVID-19 , Feminino , Gâmbia , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/psicologia , Participação do Paciente/estatística & dados numéricos , Pesquisa Qualitativa , SARS-CoV-2 , Adulto Jovem
20.
Front Immunol ; 13: 780525, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35154104

RESUMO

Recent malaria is associated with an increased risk of systemic bacterial infection. The aetiology of this association is unclear but malaria-related haemolysis may be one contributory factor. To characterise the physiological consequences of persistent and recently resolved malaria infections and associated haemolysis, 1650 healthy Gambian children aged 8-15 years were screened for P. falciparum infection (by 18sRNA PCR) and/or anaemia (by haematocrit) at the end of the annual malaria transmission season (t1). P. falciparum-infected children and children with moderate or severe anaemia (haemoglobin concentration < 11g/dl) were age matched to healthy, uninfected, non-anaemic controls and screened again 2 months later (t2). Persistently infected children (PCR positive at t1 and t2) had stable parasite burdens and did not differ significantly haematologically or in terms of proinflammatory markers from healthy, uninfected children. However, among persistently infected children, IL-10 concentrations were positively correlated with parasite density suggesting a tolerogenic response to persistent infection. By contrast, children who naturally resolved their infections (positive at t1 and negative at t2) exhibited mild erythrocytosis and concentrations of pro-inflammatory markers were raised compared to other groups of children. These findings shed light on a 'resetting' and potential overshoot of the homeostatic haematological response following resolution of malaria infection. Interestingly, the majority of parameters tested were highly heterogeneous in uninfected children, suggesting that some may be harbouring cryptic malaria or other infections.


Assuntos
Anemia/epidemiologia , Malária Falciparum/diagnóstico , Malária Falciparum/epidemiologia , Plasmodium falciparum/genética , Policitemia/epidemiologia , Adolescente , Anemia/sangue , Estudos de Casos e Controles , Criança , Comorbidade , Estudos Transversais , Citocinas/sangue , Feminino , Seguimentos , Gâmbia/epidemiologia , Hemoglobinas/análise , Humanos , Inflamação/sangue , Inflamação/diagnóstico , Inflamação/epidemiologia , Inflamação/parasitologia , Malária Falciparum/sangue , Malária Falciparum/parasitologia , Masculino , Plasmodium falciparum/isolamento & purificação , Policitemia/sangue , Reação em Cadeia da Polimerase/métodos
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