Strengthening National Immunization Technical Advisory Groups in resource-limited settings: current and potential linkages with polio national certification committees.

BACKGROUND: Countries are transitioning assets and functions from polio eradication to integrated immunization and surveillance activities. We assessed the extent of linkages between and perceptions of National Immunization Technical Advisory Groups (NITAGs) and National Certification Committees (NCCs) for polio eradication to understand how linkages can be leveraged to improve efficiencies of these expert bodies. METHODS: During May 2017 to May 2018, we administered a 15-question survey to a NITAG chair or member and an NCC counterpart in all countries of the WHO Regions for Africa (AFR) and for the Eastern Mediterranean (EMR) that had both a NITAG and an NCC. Data were analysed using frequency distributions. RESULTS: Of countries with both a NITAG and an NCC (n = 44), the response rate was 92% (22/24) in AFR and 75% (15/20) in EMR. Some respondents reported being very familiar with the functions of the other technical bodies, 36% (8/22) for NITAG members and 38% (14/37) for NCC members. Over 85% (51/59) of respondents felt it was somewhat useful or very useful to strengthen ties between bodies. Nearly all respondents (98%, 58/59) felt that NCC expertise could inform measles and rubella elimination programmes. CONCLUSIONS: We observed a broad consensus that human resource assets of NCCs may serve an important technical role to support national immunization policy-making. At this stage of the polio eradication initiative, countries should consider how to integrate the technical expertise of NCC members to reinforce NITAGs and maintain the polio essential functions, beginning in countries that have been polio-free for several years.

Dietary diversity and associated factors among infants and young children in three West African countries.

Providing children healthy diversified diets is important for their optimal growth and development. The high prevalence of under-nourishment during the critical early life period is of serious concern in West Africa. We assessed the level of dietary diversity and associated factors for children aged 6-23 months in Côte d'Ivoire, Niger and Senegal. Prior 24 h dietary intake was assessed for 3,528 children (Côte d'Ivoire: N = 118; Niger: N = 763; Senegal: N = 2,647) using the Diet Quality Questionnaire survey tool administered to primary caregivers. Cluster random sampling was conducted for urban and rural areas in Niger and Senegal and simple random sampling was used in Côte d'Ivoire, where only rural households were selected. Survey data were analyzed to determine children's intake of items from eight food groups: breast milk; grains, roots, tubers and plantains; pulses, nuts and seeds; dairy products; flesh foods; eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables. Minimum Dietary Diversity (MDD) was assessed based on the consumption of ≥5 of the 8 food groups. In all countries, the majority of children were ≥ 12 months of age and from rural households. Children from poor/very poor households ranged from 32.4 to 41.9%. MDD prevalence was 54.2% in Côte d'Ivoire, 33.3% in Niger and 30.8% in Senegal. In all three countries, children 12-23 months had significantly higher consumption of six of the food groups, compared to those 6-11 months, and children ≥12 months had a higher likelihood of MDD, compared to infants, in Niger (aOR = 4.25; 95% CI: 2.46, 7.36) and Senegal (aOR = 2.69; 95% CI: 2.15, 3.35). MDD prevalence was higher among children in urban, compared to rural, areas in Niger (p = 0.020) and Senegal (p < 0.001) and significantly higher in the wealthiest, compared to poorest, households. This study suggests most young children in Côte d'Ivoire, Niger and Senegal are not receiving an adequately diversified diet, with a reliance on starchy staples and lower intake of high-quality protein sources. Our results highlight socio-economic barriers to attaining dietary diversity in these settings and stress the urgent and continuing need for investments in strategies that support optimal complementary feeding practices.

Dietary Quality and Associated Factors among Women of Reproductive Age in Six Sub-Saharan African Countries.

The burden of micronutrient malnutrition is high among women of reproductive age (WRA) in sub-Saharan Africa. We examined the dietary quality and associated factors for WRA in Cameroon, Côte d'Ivoire, Kenya, Nigeria, Senegal, and Tanzania. Data were collected from women aged 15-49 years using representative Diet Quality Questionnaire surveys. The Minimum Dietary Diversity for Women (MDD-W), All-5 (key food group) consumption, noncommunicable disease risk (NCD-Risk), and Global Dietary Recommendation (GDR) indicators were assessed. Participants included N = 16,584 women [Cameroon: N = 2073; Côte d'Ivoire: N = 242; Kenya: N = 864; Adamawa State (Nigeria): N = 1283; Benue State (Nigeria): N = 1047; Nasarawa State (Nigeria): N = 1151; Senegal: N = 7232; Tanzania: N = 2692]. The MDD-W ranged from 43.0% in Tanzania to 81.4% in Côte d'Ivoire and was higher in urban, compared to rural, areas in Cameroon, Kenya, Nasarawa, Senegal, and Tanzania (p < 0.001). Increased education and wealth were positively associated with MDD-W in Kenya, Benue, Senegal, and Tanzania. Fewer than half of all women attained All-5 consumption. NCD-Risk scores ranged from 1.13 (95% CI: 1.08, 1.17) in Tanzania to 2.28 (95% CI: 2.16, 2.40) in Nasarawa, and women's GDR scores ranged from 10.47 (95% CI: 10.40, 10.54) in Cameroon to 11.45 (95% CI: 11.25, 11.64) in Côte d'Ivoire. Our findings highlight key aspects of women's diets in sub-Saharan African settings to enable greater awareness and more targeted responses to the specific areas needing the most improvement.

Tsetse fly ecology and risk of transmission of African trypanosomes related to a protected forest area at a military base in the city of Abidjan, Côte d'Ivoire.

African trypanosomoses, whose pathogens are transmitted by tsetse flies, are a threat to animal and human health. Tsetse flies observed at the military base of the French Forces in Côte d'Ivoire (FFCI base) were probably involved in the infection and death of military working dogs. Entomological and parasitological surveys were carried out during the rainy and dry seasons using "Vavoua" traps to identify tsetse fly species, their distribution, favorable biotopes and food sources, as well as the trypanosomes they harbor. A total of 1185 Glossina palpalis palpalis tsetse flies were caught, corresponding to a high average apparent density of 2.26 tsetse/trap/day. The results showed a heterogeneous distribution of tsetse at the FFCI base, linked to more or less favorable biotopes. No significant variation in tsetse densities was observed according to the season. The overall trypanosomes infection rate according to microscopic observation was 13.5%. Polymerase chain reaction (PCR) analyses confirmed the presence of Trypanosoma vivax and T. congolense forest type, responsible for African animal trypanosomosis. Our findings suggest that there is a risk of introduction and transmission of T. brucei gambiense, responsible for human African trypanosomiasis, on the study site. This risk of transmission of African trypanosomes concerns not only the FFCI base, but also inhabited peripheral areas. Our study confirmed the need for vector control adapted to the eco-epidemiological context of the FFCI base.

Title: Écologie des mouches tsé-tsé et risque de transmission des trypanosomes africains lié à une zone forestière protégée dans une base militaire de la ville d'Abidjan, Côte d'Ivoire. Abstract: Les trypanosomoses africaines, dont les agents pathogènes sont transmis par les mouches tsé-tsé, constituent une contrainte pour la santé animale et humaine. Des mouches tsé-tsé observées dans la base militaire des Forces françaises en Côte d'Ivoire (base FFCI) ont probablement été impliquées dans l'infection et la mort de chiens militaires. Des enquêtes entomologiques et parasitologiques ont été menées pendant la saison pluvieuse et la saison sèche à l'aide de pièges "Vavoua" afin d'identifier les espèces de mouches tsé-tsé, leur distribution, les biotopes favorables et leur source de nourriture ainsi que les trypanosomes qu'elles hébergent. Au total 1185 mouches tsé-tsé de l'espèce Glossina palpalis palpalis ont été capturées, ce qui correspond à une densité apparente moyenne élevée de 2,26 tsé-tsé/piège/jour. Les résultats ont montré une distribution hétérogène des tsé-tsé dans la base FFCI en lien avec des biotopes plus ou moins favorables. Aucune variation significative des densités de tsé-tsé n'a été observée en fonction de la saison. Le taux d'infection global par les trypanosomes était de 13,5 % selon l'observation microscopique. Les analyses PCR ont confirmé la présence de Trypanosoma vivax et T. congolense type forêt, responsable de la trypanosomose animale africaine. Nos résultats suggèrent qu'il existe un risque potentiel d'introduction et de transmission de T. brucei gambiense responsable de la trypanosomiase humaine africaine dans la zone d'étude. Ce risque de transmission des trypanosomes africains concerne non seulement l'intérieur de la base FFCI, mais aussi les espaces périphériques habités. Notre étude a confirmé la nécessité de mener une lutte antivectorielle adaptée au contexte éco-épidémiologique de la base FFCI.

Use of vector control to protect people from sleeping sickness in the focus of Bonon (Côte d'Ivoire).

BACKGROUND: Gambian human African trypanosomiasis (gHAT) is a neglected tropical disease caused by Trypanosoma brucei gambiense transmitted by tsetse flies (Glossina). In Côte d'Ivoire, Bonon is the most important focus of gHAT, with 325 cases diagnosed from 2000 to 2015 and efforts against gHAT have relied largely on mass screening and treatment of human cases. We assessed whether the addition of tsetse control by deploying Tiny Targets offers benefit to sole reliance on the screen-and-treat strategy. METHODOLOGY AND PRINCIPAL FINDINGS: In 2015, we performed a census of the human population of the Bonon focus, followed by an exhaustive entomological survey at 278 sites. After a public sensitization campaign, ~2000 Tiny Targets were deployed across an area of 130 km2 in February of 2016, deployment was repeated annually in the same month of 2017 and 2018. The intervention's impact on tsetse was evaluated using a network of 30 traps which were operated for 48 hours at three-month intervals from March 2016 to December 2018. A second comprehensive entomological survey was performed in December 2018 with traps deployed at 274 of the sites used in 2015. Sub-samples of tsetse were dissected and examined microscopically for presence of trypanosomes. The census recorded 26,697 inhabitants residing in 331 settlements. Prior to the deployment of targets, the mean catch of tsetse from the 30 monitoring traps was 12.75 tsetse/trap (5.047-32.203, 95%CI), i.e. 6.4 tsetse/trap/day. Following the deployment of Tiny Targets, mean catches ranged between 0.06 (0.016-0.260, 95%CI) and 0.55 (0.166-1.794, 95%CI) tsetse/trap, i.e. 0.03-0.28 tsetse/trap/day. During the final extensive survey performed in December 2018, 52 tsetse were caught compared to 1,909 in 2015, with 11.6% (5/43) and 23.1% (101/437) infected with Trypanosoma respectively. CONCLUSIONS: The annual deployment of Tiny Targets in the gHAT focus of Bonon reduced the density of Glossina palpalis palpalis by >95%. Tiny Targets offer a powerful addition to current strategies towards eliminating gHAT from Côte d'Ivoire.

Apport de la technique combinée gingivectomie-frénectomie dans la prise en charge d'un accroissement gingival associé à un frein pathologique: à propos d'un cas / contribution of the combined gingivectomy-frenectomy technique in the management of gingival growth associated with a pathological frenulum: about a case

Introduction : La prise en charge de l'accroissement gingival repose sur un entretien médical bien mené, un examen clinique rigoureux, un diagnostic bien posé et une exérèse chirurgicale. Cependant, une récidive de la lésion peut être observée avec un rendu gingival souvent inesthétique. L'objectif de ce travail était d'illustrer, à travers un cas clinique, l'apport de la gingivectomie et de la frénectomie dans la prise en charge d'un accroissement gingival associé à un frein pathologique. Observation : Il s'agissait d'un patient âgé de 27 ans, venu consulter pour un problème esthétique lié à une excroissance gingivale. L'examen exo-buccal a mis en évidence, une asymétrie faciale dans le sens horizontal. La lésion gingivale était visible au sourire et évoluant depuis plus de 5 ans. L'examen endo-buccal a relevé la présence d'une gingivite induite par le biofilm, d'un frein de type 4 de Placek associés à un accroissement gingival pédonculé saignant au contact et siégeant entre la 11 et la 21. Après la thérapeutique initiale et une réévaluation, une gingivectomie à biseau interne (GBI) associée à une frénectomie ont été réalisées. L'examen anatomo-pathologique a mis en évidence un épulis fibreux ou fibrome périphérique avec absence de signes histologiques de malignité. L'évolution après 6 mois est marquée par une muqueuse gingivale cliniquement saine avec absence de récidive. Conclusion : L'apport de la gingivectomie et de la frénectomie est un atout important en termes de résultat clinique et de limitation de récidives dans l'exérèse des excès gingivaux combinés à un frein labial pathologique.

Introduction: Gingival growth is a change in the size and/or multiplication of cells, the gingival vascular system and the extracellular matrix. Management is based on a wellconducted medical interview, a rigorous clinical examination, a well-made diagnosis and surgical excision. However, a recurrence of the lesion can be observed with an often unsightly gingival rendering. The objective of this work was to illustrate, through a clinical case, the contribution of gingivectomy and frenectomy in the management of gingival growth associated with a pathological frenulum. Observation: It was a patient aged 27 who came to consult for an aesthetic problem related to a gingival growth. The exo-oral examination highlighted, a facial asymmetry in the horizontal direction. The gum lesion was visible on the smile and had been evolving for more than 5 years. The endooral examination noted the presence of biofilm-induced gingivitis, a type 4 Placek frenulum associated with pedunculate gingival growth bleeding on contact and sitting between 11 and 21. After initial therapy and reassessment, an internal bevel gingivectomy (IGG) combined with frenectomy was performed. The anatomo-pathological examination revealed fibrous epulis or peripheral fibroid with absence of histological signs of malignancy. The evolution after 6 months is marked by a clinically healthy gingival mucosa with no recurrence. Conclusion: The contribution of gingivectomy and frenectomy is an important asset in terms of clinical outcome and limitation of recurrence in the excision of excess gingival combined with a pathological labial frenulum.

Polio eradication in the African Region on course despite public health emergencies.

The World Health Organization, African Region is heading toward eradication of the three types of wild polio virus, from the Region. Cases of wild poliovirus (WPV) types 2 and 3 (WPV2 and WPV3) were last reported in 1998 and 2012, respectively, and WPV1 reported in Nigeria since July 2014 has been the last in the entire Region. This scenario in Nigeria, the only endemic country, marks a remarkable progress. This significant progress is as a result of commitment of key partners in providing the much needed resources, better implementation of strategies, accountability, and innovative approaches. This is taking place in the face of public emergencies and challenges, which overburden health systems of countries and threaten sustainability of health programmes. Outbreak of Ebola and other diseases, insecurity, civil strife and political instability led to displacement of populations and severely affected health service delivery. The goal of eradication is now within reach more than ever before and countries of the region should not relent in their efforts on polio eradication. WHO and partners will redouble their efforts and introduce better approaches to sustain the current momentum and to complete the job. The carefully planned withdrawal of oral polio vaccine type II (OPV2) with an earlier introduction of one dose of inactivated poliovirus vaccine (IPV), in routine immunization, will boost immunity of populations and stop cVDPVs. Environmental surveillance for polio viruses will supplement surveillance for AFP and improve sensitivity of detection of polio viruses.

Polio infrastructure strengthened disease outbreak preparedness and response in the WHO African Region.

INTRODUCTION: The continuous deployments of polio resources, infrastructures and systems for responding to other disease outbreaks in many African countries has led to a number of lessons considered as best practice that need to be documented for strengthening preparedness and response activities in future outbreaks. METHODS: We reviewed and documented the influence of polio best practices in outbreak preparedness and response in Angola, Nigeria and Ethiopia. Data from relevant programmes of the WHO African Region were also analyzed to demonstrate clearly the relative contributions of PEI resources and infrastructure to effective disease outbreak preparedness and response. RESULTS: Polio resources including, human, financial, and logistic, tool and strategies have tremendously contributed to responding to diseases outbreaks across the African region. In Angola, Nigeria and Ethiopia, many disease epidemics including Marburg Hemorrhagic fever, Dengue fever, Ebola Virus Diseases (EVD), Measles, Anthrax and Shigella have been controlled using existing polio Eradication Initiatives resources. Polio staffs are usually deployed in occasions to supports outbreak response activities (coordination, surveillance, contact tracing, case investigation, finance, data management, etc.). Polio logistics such vehicles, laboratories were also used in the response activities to other infectious diseases. Many polio tools including micro planning, dashboard, guidelines, SOPs on preparedness and response have also benefited to other epidemic-prone diseases. The Countries' preparedness and response plan to WPV importation as well as the Polio Emergency Operation Center models were successfully used to develop, strengthen and respond to many other diseases outbreak with the implication of partners and the strong leadership and ownership of governments. This review has important implications for WHO/AFRO initiative to strengthening and improving disease outbreak preparedness and responses in the African Region in respect to the international health regulations core capacities.

Epidemiological and Surveillance Response to Ebola Virus Disease Outbreak in Lofa County, Liberia (March-September, 2014); Lessons Learned.

Ebola Virus Disease (EVD) outbreak was confirmed in Liberia on March 31st 2014. A response comprising of diverse expertise was mobilized and deployed to the country to contain transmission of Ebola and give relief to a people already impoverished from protracted civil war. This paper describes the epidemiological and surveillance response to the EVD outbreak in Lofa County in Liberia from March to September 2014. Five of the 6 districts of Lofa were affected. The most affected districts were Voinjama/Guardu Gbondi and Foya. By 26th September, 2014, a total of 619 cases, including 19.4% probable cases, 20.3% suspected cases and 44.2% confirmed cases were recorded by the Ebola Emergency Response Team (EERT) of Lofa County. Adults (20-50 years) were the most affected. Overall fatality rate was 53.3%.  Twenty two (22) cases were reported among the Health Care Workers with a fatality rate of 81.8%. Seventy eight percent (78%) of the contacts successfully completed 21 days follow-up while 134 (6.15%) that developed signs and symptoms of EVD were referred to the ETU in Foya. The contributions of the weak health systems as well as socio-cultural factors in fueling the epidemic are highlighted. Importantly, the lessons learnt including the positive impact of multi-sectorial and multidisciplinary and coordinated response led by the government and community.  Again, given that the spread of infectious disease can be considered a security threat every effort has to put in place to strengthen the health systems in developing countries including the International Health Regulation (IHR)'s core capacities. Key words:  Ebola virus disease, outbreak, epidemiology and surveillance, socio-cultural factors, health system, West Africa.