bluuebunny/crossref_metadata_2025 huggingface dataset:
MEETING FIELD-BASED CHALLENGES: INNOVATIVE APPROACHES TO COLLECTING DRY BLOOD SPOT SAMPLES IN THE COMMUNITY
Authors: Sikombe Kombatende , Hantuba Cardinal , Czaicki Nancy , Geng Elvin , Holmes Charles , Musukuma Kalo , Simbeza Sandra , Somwe Paul , Sikazwe Izukanji
Published: February 2017

Background

Community collection of dry blood spots (DBS) is ideal to capture viral load results from HIV-positive, patients lost to follow-up (LFTU) in order to monitor their health. We sought to optimise protocols for high-quality community-based DBS collection in resource-constrained settings such as Zambia.

Methods

As part of a nested case-control study, we trained 23 non-medical interviewers who collected DBS from LTFU patients in rural and urban Lusaka. We visited another Zambian community-based DBS study improving upon their approach through team-based problem solving methods. We evaluated our innovation through field observations, bi-weekly meetings, interviewer reports, and two debriefing meetings. The laboratory assessed DBS quality for testing validity.

Results

We transformed a first-aid box into a phlebotomy box to keep DBS contamination free and in ambient temperature. A styrofoam partition separated the DBS drying rack glued to one side of the box from phlebotomy supplies and kept DBS cards horizontal during transportation. Interviewers collected 229 DBS (60.6%) in participant homes or place of their choice with 149 refusals. DBS was air-dried in an area free of direct sunlight, water, insects and dust for a few minutes so blood was not flowing when placed on the rack. DBS was taken to the nearest health facility for further drying using public transport, or study motorbikes fitted with a custom made carrier to hold the box horizontal. The laboratory did not report any blotted or double spotted DBS cards. Barriers included privacy, visibility and awkward box size.

Conclusions

We optimised community-based DBS collection in Zambia using non-medical staff and an innovative, low-cost light-weight phlebotomy box to transport DBS without contamination at ambient temperature. While we successfully collected DBS from 60.6% of found LTFU patients, concerted efforts are needed to re-engage LTFU patients who refuse HIV-related procedures even when made conveniently available.
CHANGES IN VAGINAL PRACTICES AFTER CONTRACEPTIVE VAGINAL RING USE AMONG WOMEN IN KIGALI, RWANDA
Authors: Umulisa Michele , Ilo Jennifer , Kestelyn Evelyne , Uwineza Mireille , Agaba Stephen , Delvaux Therese , Wijgert Janneke
Published: February 2017

Background

Recent developments in HIV prevention, including the dapivirine vaginal ring, have shown promising results in protecting women from HIV. Additionally, a healthy vagina is protective against HIV/STIs but vaginal practices can disturb the vaginal environment. The objective of this study was to explore vaginal practices and assess the changes during contraceptive vaginal ring (CVR) use among Rwandan women.

Methods

Rinda Ubuzima, a research site in Kigali, Rwanda, collected data on vaginal practices using mixed methods (in-depth interviews, observations, focus group discussions, surveys) during a safety and acceptability study of CVRs. Education about safe vaginal practices was provided at study visits after baseline. Descriptive and thematic analyses were conducted.

Results

At baseline, 57% of the 289 participants reported washing inside and outside the vagina while 124 (43%) reported washing outside only. 65% of those washing inside and outside the vagina reported doing so once a day. Participants reported washing inside the vagina while bathing (93%), after sex (63%), and during menses (54%). A total of 157 (96%) participants reported inserting water and/or soap with fingers into the vagina. Qualitative data suggested that vaginal practices went beyond those listed in the survey and included herbs, stones, gels, and food in order to increase vaginal lubrication and tightness, treat vaginal symptoms, and clean the vagina. Only 14 of the 120 (12%) women reported a reduction/increase in their vaginal practices following ring insertion. However, after triangulation of data, over 25% of the participants reported changes in their vaginal practices resulting from study participation.

Conclusions

Vaginal cleaning is frequent among the study population and increased education from the research site about vaginal practices encouraged some women to change their behaviour during the short duration of the study. Additionally, there are more vaginal practices that may need consideration for ring development and rollout in Rwanda.
AGREEMENT OF QUANTIFERON TEST AND TUBERCULIN SKIN TEST IN DIAGNOSING LATENT TUBERCULOSIS INFECTION AMONG HIV-INFECTED PEOPLE IN KISUMU COUNTY, KENYA
Authors: Oduor Patience , Gethi Dickson , Odeny Lazarus , Agaya Janet , Wandiga Steve
Published: February 2017

Background

HIV-infected people are at greatest risk of progression from latent tuberculosis infection (LTBI) to development of active tuberculosis (TB) disease. Accurate diagnosis and treatment of LTBI in this group is an essential component of the WHO TB control strategy. Interferon-gamma assays have emerged as novel alternatives to the tuberculin skin test (TST) for the diagnosis of LTBI. Comparable performance for these two tests is not fully evaluated in regions with high incidence of HIV and TB. We compared the performance of QuantiFERON TB-Gold In-tube® assay (QFT) and TST tests for LTBI.

Methods

Newly diagnosed HIV patients older than 7 years were enrolled from HIV clinics. Blood was drawn for QFT assay, thereafter TST was placed into the volar surface of the forearm. The TST was read at 48–72 hours and deemed positive at >or=5 mm. Statistical analyses were performed using SAS 9.2. Agreement evaluated using kappa (k) statistic.

Results

Of the 650 HIV-infected participants, 62% were females; median age (IQR) was 32 (26–39). Among 592 (91%) who received TST, 88 (17%) were positive; QFT positives were 274 (42%). Indeterminate QFT results were 22 (3%). Overall agreement between QFT and TST was 37% (95% CI: 30–45%). Agreement was 56% (95% CI: 30–45%) and 15% (95% CI: 30–45%) for negative and positive QFT and TST results.

Conclusions

Low prevalence of LTBI was found; however, agreement between the 2 tests was moderate. This lack of agreement calls for a search for a better diagnostic test for LTBI among HIV-infected persons in TB endemic regions since TST positivity is associated with better response to INH in LTBI patients.
INSTITUTIONAL BARRIERS TO IMPROVE ACCESS TO DRY BLOOD SAMPLE COLLECTION IN NORTH-WESTERN NIGERIA: A 12-MONTH RETROSPECTIVE DATA REVIEW OF PARTNERSHIP WITH NIGERIA POSTAL SERVICE FOR SAMPLE TRANSPORTATION
Authors: Adepoju Abiola , Magana Musa , Etsetowaghan Andrew
Published: February 2017

Background

Institutional challenges still limit access of exposed infants to dried blood spot (DBS) sampling at 6 weeks in Nigeria. There is a paucity of data to evaluate the impact of multiple interventions in addressing these challenges. The objective of the study was to review institutional barriers and issues regarding access of exposed infants to DBS sampling in 6 general hospitals. The study was supported by Management Science for Health and funded by USAID in Kebbi State, Nigeria.

Methods

Review of the partnership with Nigeria Postal Service for DBS transportation (6 months after the take-off in October 2014) was conducted in April 2015. It revealed that 34% of exposed infants had access to DBS sampling at 6 weeks. This led to key informant interviews with 36 healthcare workers across 6 hospitals with identification of 5 major institutional challenges limiting access to DBS collection. Targeted interventions included: strengthening of Intra-facility referral; incorporation of adherence and tracking into PMTCT/Early Infant Diagnosis service, development of the capacity of hospital staff on the DBS collection process and documentation in PMTCT service tools. The outcome was then evaluated at 6 months.

Results

By October 2015, the repeat evaluation showed that the number of DBS samples collected increased from 42 to 138 and results received increased from 31 to 112. The average turnaround time improved from 70 days to 43 days, and DBS sampling access increased from 32% to 86%, all within 6 months of the interventions.

Conclusions

Multiple structured interventions have the potential to improve access of exposed infants to DBS sampling for early infant diagnosis. The study will inform implementers on how best to improve early infant diagnosis in poor-resource settings through interventions aimed at institutional barriers. Point-of-care testing for DBS needs to be scaled up.
FUNCTIONAL AND PHENOTYPIC CHARACTERISATION OF REGULATORY T (TREG) CELLS IN ANTIRETROVIRAL NAïVE HIV-1 INFECTED PEOPLE
Authors: Ndzengue Georgia , Loveline Ngu , Sake Carol , Lissom Abel , Tchadji Jules , Flaurent Tchouangueu , Nji Nadesh , Sosso Samuel , Essomba Claudine , Etoa François-Xavier , Nchinda Godwin
Published: February 2017

Background

Regulatory T cells (Tregs) function in dampening excessive immune activation in steady state. However during HIV-1 infection there is sustained immune activation and it is not known how Tregs function in this context. To optimise immunotherapeutic strategies based on Tregs for HIV-1 infected people we assessed the phenotypic and functional properties of these cells from antiretroviral naïve HIV-1 infected adults in Cameroon.

Methods

Tregs were purified by magnetic sorting from PBMCs obtained from adults aged 21 to 65 years using microbeads according to the manufacturer's protocol (Miltenyi Biotec). The phenotypic properties of the purified Tregs were then determined by multiparametric flow cytometry. Tregs functions were assessed by measuring inflammatory cytokine formation by monocytes following co-culture with autologous Tregs in the presence of either polyICLC or CLO97. Samples were acquired on BD Fortessa X5 cytometer using BDFACS Diva Software and data analysed with FlowJo version 9.8.5. Graph Pad Prism 5 was used for statistical analysis.

Results

Tregs were defined as CD4+CD25+CD127LoFoxP3+ cells. However, the strong correlation between Foxp3 with the combination of CD25+CD127Lo (r=0,965; p< 0,001, Pearson's correlation) allowed us to use these surface markers as previously reported for tracking Tregs in subsequent experiments. With respect to surface expression there was a significant elevation of HLA-DR /CD38 in Tregs from HIV-1-infected people when compared to HIV-participants. When purified Tregs were co-cultured with autologous monocytes in the presence polyICLC (a TLR 3 agonist) and CLO97 (TLR7/8 agonist) they escalated the intracellular formation of both TNF-α and IL-6 by monocytes. The escalation was significantly higher in co-cultures of cells from antiretroviral naïve HIV-1-infected people relative to seronegative participants.

Conclusions

Dysregulation in Tregs function can exacerbate inflammatory cytokine formation.
DRUG RESISTANCE AND GENETIC PROFILE OF BACTERIAL SPECIES ASSOCIATED WITH BURULI ULCER WOUND INFECTIONS IN TWO DISTRICTS OF GHANA
Authors: Kpeli Grace , Otchere Isaac , Lamelas Araceli , Buultjens Andrew , Bulach Dieter , Baines Sarah , Seemann Torsten , Giulieri Stefano , Nakobu Zuliehatu , Aboagye Samuel , Owusu-Mireku Evelyn , Danso Emelia , Hauser Julia , Hinic Vladimira , Pluschke Gerd , Stinear Timothy , Yeboah-Manu Dorothy
Published: February 2017

Background

We identified secondary infection of Buruli ulcer (BU) wounds as a cause of healing delay. In order to contribute to the improvement of wound management and reduction of healing delay, we initiated a study to gain understanding of the possible routes of infection and also characterised the resistant profiles of Gram negative bacteria isolated from the wounds of patients attending two health facilities in Ghana.

Methods

Staphylococcus aureusisolates were characterised by thespagene,mecAand the Pantone Valentine Leukocidin (PVL) toxin followed byspasequencing and whole genome sequencing of a subset of isolates. Phenotypic antibiotic susceptibility testing of Gram negative clinical isolates was performed and multidrug-resistantPseudomonas aeruginosaidentified. TheEnterobacteriaceaewere further investigated for ESBL and carbapenem production, and some resistance conferring genes were analysed by PCR.

Results

Twenty-four isolates were identified as methicillin-resistantS. aureus(MRSA), andlukFSgenes encoding PVL were identified in 67 isolates. Typing and sequencing of thespagene from 91 isolates identified 29 differentspatypes with t355 (ST152), t186 (ST88), and t346 dominating. While many distinct strains were isolated from both health centres, genotype clustering was identified within centres pointing to possible health care-associated transmission. Phylogenomic analysis confirmed these clusters. Among the GNB, phenotype screening showed widespread resistance to ampicillin, chloramphenicol, ticarcillin-clavulanic acid, cefuroxime and sulphamethoxazole-trimethoprim. ESBL production was confirmed in 15 isolates phenotypically while 61.5% of screen-positive isolates harboured at least one ESBL-conferring gene. Carbapenem encoding genes were detected in 41% of the isolates.

Conclusions

Our findings indicate that the health-care environment likely contributes to superinfection of BU wounds and calls for training in wound management and infection control techniques. The observed frequency of ESBL and carbapenem resistance indicates the need to set up surveillance networks and strictly enforce policies which guide the rational use of antibiotics.
ANTIBIOTIC RESISTANCE PATTERNS OF POTENTIAL PATHOGENS ISOLATED FROM TWO MAJOR HOSPITALS IN LUSAKA AND NDOLA
Authors: Chibwe Bertha , Simuyandi Michelo , Ojok David , Chilengi Roma , Kruuner Annika
Published: February 2017

Background

This study was conducted as part of an assessment of the effectiveness of existing hygiene and sanitation practices in two first-level hospitals in Lusaka and two central clinics in Ndola to determine the drug resistance patterns of potential pathogens in health care facilities in Zambia.

Methods

In this cross-sectional study, the samples analysed were collected from health care workers' hands, touch surfaces, disinfectant buckets in delivery rooms, post-natal and paediatric wards, operation theatre, post-operation wards and outpatient departments. The swabs in Cary-Blair transport media were used for sample collection and inoculated to 3 (Blood-, Chocolate- and MacConkey agar) primary plates. For species identification and drug susceptibility testing BD Crystal ID System and disk diffusion method with panel of 20 antibiotics was used.

Results

A total of 132 swabs were collected resulting in isolation of 275 Gram negative and positive bacteria. 65 bacterial isolates were successfully identified as the following species:Acinetobacter, Enterobacter, Klebsiella, Pseudomonas, Staphylococcus, Streptococcusspp. All identified bacteria were tested for drug resistance. Among thePseudomonasspp, the highest level of resistance was detected to cephalosporins, amoxicillin and carbenicillin and was up to 70%, 90% and 60%, respectively.Staphylococcusspp had high resistance to penicillin, ampicillin, azithromycin and cephalosporins, up to 86%, 76%, 57% and 95%, respectively. Vancomycin resistance amongStaphylococcusspp was 19%.

Conclusions

High drug-resistance levels among potential pathogens isolated in health care facilities reflect the long-term empiric use of antibiotics in Zambia. For better understanding of the scale of this problem a more comprehensive study including all central private and government health care facilities should be conducted. A large number of isolated bacteria (35%) remained unknown indicating that more than one identification method should be used in order to capture the full spectrum of potential pathogens colonising the health care facilities in Africa.
HARNESSING THE DIGITAL SHARING REVOLUTION TO DRIVE GLOBAL HEALTH RESEARCH: SHOWING SIGNIFICANT IMPACT THAT SHOULD SUPPORT EDCTP CAPACITY DEVELOPMENT
Authors: Loggerenberg François Van , Furtado Tamzin , Boggs Liam , Segrt Alexis , Lang Trudie
Published: February 2017

Background

The Global Health Network is a platform for research capacity development and improving evidence generation and quality, especially in low- and middle-income countries. This is achieved by delivering training and career development (through an on-line professional membership and training scheme as well as face-to-face workshops). The platform is also a mechanism for sharing research skills knowledge, experience and tools.

Methods

The Network has been consistently monitored using web analytics data and targeted surveys which combine quantitative and qualitative data, including 600 user interviews to evaluate impact. The data have been compiled by four researchers working in collaboration; each researcher was responsible for analysing specific datasets, which were later combined for the overall evaluation to ensure a fully comprehensive and in-depth assessment.

Results

The Global Health Network is made up of over 30 interconnected research communities, with over 770,000 visits, over 73,000 individual site memberships and more than 30,000 tools or document downloads. It is clear that this is a much needed, trusted and well-used resource. In all, 89.5% of users indicated the quality of information provided on the Network is of high quality. Importantly, over 130,000 online eLearning modules have been taken. Ninety-six percent of users indicated they would recommend the training courses to others, and 82% had greater course-specific skills confidence after taking a course.

Conclusions

The Network has a broad user base, from individual frontline research staff through to large collaborative groups who make use of the platform to disseminate their activities, and is viewed as a high-quality, cost-effective and trustworthy community. However, more needs to be done to ensure that the capacity development initiatives of key groups, like EDCTP, make greater and more effective use of this free and impactful resource.
ACHIEVEMENTS AND PRIMED PROSPECTS OF INCREASING CAPABILITIES FOR MULTISITE CLINICAL TRIALS IN THE EASTERN AFRICA NETWORK OF EXCELLENCE
Authors: Miiro George , Mbidde Edward , Peshu Norbert , Kivaya Esther , Mfinanga Godfrey , Ngowi Bernard , Kavishe Reginald , Maowia Mukhtar , Lang Trudie , Sandstrom Eric , Ayuo Elizabeth , Nanvubya Annet , Mmbaga Blandina , Kaleebu Pontiano
Published: February 2017

Background

In May 2009, EDCTP supported the establishment of the East African Consortium for Clinical Research (EACCR) involving 35 regional institutions and 6 northern partners to promote capacity development for collaborative multi-site clinical trials and research. EACCR aims to contribute to overcoming a situation of: under-funded, fragmented and uncoordinated regional health research; too few African scientists; inadequate infrastructure; insufficient networking and knowledge-sharing. We present updates on achievements and lessons learnt on increased preparedness to conduct globally-competitive research and clinical trials on poverty-related, neglected and emerging infectious diseases.

Methods

Retrospectively, we conducted a quasi-purposive summative evaluation through document review, participatory appraisal, direct observation and case studies of the EACCR work packages for governance, research, training and mentoring, infrastructure, and networking between November 2015 and February 2016.

Results

In the past five years, the Eastern Africa-led consensus-driven consortium has contributed to the following results (at least): 15 new research and capacity-strengthening grants; 150 peer-reviewed publications; 15 trials monitored; 531 scientists and associates mentored; 12 electronic training modules on research and bio-ethics; 2 newly ISO-accredited laboratories; 24 research sites upgraded; 20 partnerships harnessed; 2 knowledge-sharing platforms of the East African Health Research Commission; an interactive website (www. eaccr.org); and an additional 2 million euros leveraged.

Conclusions

EACCR has increased its capacity and partnerships for on-going and planned multisite clinical trials; we can sustain coordinated collaborative GCP-compliant multisite trials and health research. We can intensify high-level advocacy and resource mobilisation in Eastern Africa in partnership with policy makers, other consortia and development partners. We stand firm on the shoulders of current and promising giants of EACCR, other consortia, EDCTP and other like-minded partners and are thus prepared to conduct and disseminate more African-led health research and capacity-strengthening initiatives on poverty-related, neglected and emerging infectious diseases in Africa during the second programme of EDCTP.
BLENDED-LEARNING USING THE GLOBAL HEALTH NETWORK ONLINE RESOURCES: A PILOT STUDY
Authors: Allen Elizabeth , Leisegang Cordelia , Furtado Tamzin , Loggerenberg François Van , Lang Trudie
Published: February 2017

Background

Enhancing The Global Health Network's online offerings (TGHN eLearning, www.theglobalhealthnetwork. org) through local facilitation of its outputs may enable its uptake by clinical research staff. To explore this issue, we aimed to design and pilot a blended-learning programme in collaboration with South African research team members.

Methods

A participatory research design was used, with purposively-selected support staff and their line managers. Formative semi-structured interviews with the former and focus group discussions with the latter sought reflection on current learning opportunities and career development experiences and needs. Staff then helped design and pilot a practical, feasible blended-learning programme over an approximately 6-month period. The pilot was assessed on reflections of its value that were elicited in follow-up discussions with participants.

Results

Forty-five clinical research field workers, nurses, co-ordinators, data managers and laboratory personnel (and their respective line managers) took part. Formative discussions suggested staff generally had the necessary skills for their jobs, however they often lacked time and finances to develop a career path. The blended-learning menu of options for staff that they then co-designed and piloted included: facilitated one-to-one or group TGHN eLearning sessions followed by a discussion forum hosted by a volunteer content-expert; job shadows; guidance in accessing training opportunities/ resources; twinning with other research groups or staff; and a skills-sharing workshop. Feedback on their experience of the programme was very positive from those who got ‘hooked’, particularly as regards the non-threatening learning environment, building of IT competence and networking opportunities. However, staff's personal time constraints, and our challenges in supporting remote teams, were evident for some despite the pragmatic design.

Conclusions

This flexible, practical and feasible blended-learning program catalysed the self-development of many research staff in the pilot, and supported their busy line managers. As some challenges remain, the programme may require further modification when implemented in different contexts.
THE EFFICACY OF ALBENDAZOLE AGAINST SOIL-TRANSMITTED HELMINTHS AND THE IMPACT OF MASS DRUG ADMINISTRATION OF ALBENDAZOLE AND IVERMECTIN ON HEALTH STATUS
Authors: Hamidu Buhari Adamu , Jenner Tettevi Edward , Asiedu Larbi John , Osei-Atweneboana Mike
Published: February 2017

Background

The lymphatic filariasis (LF) control programme has been on-going in Ghana since 2000 with mass drug administration (MDA) of ivermectin (IVM) and albendazole (ALB). Soil-transmitted helminth (STH) infections control is augmented within this programme. Therefore this study aimed to determine the efficacy of ALB against STH infections and impact of MDA on study participants.

Methods

This was a twelve months longitudinal study. A total of 412 subjects including school children (between the ages of 2–17 years) and pregnant women were randomly selected from four endemic communities in Kpandai district of the Northern region. Coprological assessment for parasites was based on the Kato–Katz technique in both dry and rainy seasons at baseline, 21 days and 3 months post treatment. Single dose albendazole treatment was administered to all patients at baseline.

Results

Of all the parasites found (hookworm,Trichuris trichiura,Hymenolepis nana, andTaenia sp.), hookworm was the most prevalent. In the dry season, the overall STHs prevalence at pre-treatment was 29%, while 9% and 13% prevalence was recorded at 21 days, and three months after treatment, respectively. However, in the rainy season, the overall STHs prevalence was 8%, while 4% and 12% was recorded at 21 days and three months respectively after ALB treatment. In general, ALB treatment resulted in an overall hookworm egg count reduction rate of 89% in the dry season and 93% in the rainy season, while theT. trichiuraegg count reduction rate was 100% in both seasons.

Conclusions

STH infections still remain a significant public health burden in Ghana. Hookworm infection seems to respond poorly or suboptimally to ALB, raising concerns of possible emergence of resistance which may lead to a major setback for the control and elimination of STH infections, especially hookworm infections.
CULTIVATION OF TWO IS2404 POSITIVEMYCOBACTERIUM SPP.FROM THE ENVIRONMENT OF ASANTE AKIM DISTRICT OF GHANA
Authors: Afeke Innocent , Addo Phyllis , Newman Mercy , Durnez Lies , Eddyani Miriam , Ammisah Nana , Abas Mona , Quartey Maxwell , Ablordey Anthony
Published: February 2017

Background

Buruli ulcer (BU) is one of the neglected tropical diseases.Mycobacterium ulceransis the aetiologic agent of Buruli ulcer. Many extensive studies have failed to isolateM. ulceransin pure culture from the environment, even in highly endemic areas of BU. We investigated the role of macro-invertebrates as possible hosts or vectors forM. ulceransby attempting to cultivateM. ulceransfrom these organisms.

Methods

The study was conducted in 5 villages in the Asante Akim District of Ghana for 10 months. Primary detection ofM. ulceranswas done by real-time PCR targeting insertion sequence IS2404coupled with the detection of IS2606and Ketone reductase genes for increased sensitivity and specificity. Primary cultures were done using routine bacteriological media for culturing mycobacteria, L-J and special enrichment liquid broth, BACTEC®.

Results

The overall rate of detection of IS2404in the general macro-invertebrate population was 12.8%. Cluster of CT-values was observed around a mean value of 35.88 and range values of 28.35–38.61. Statistically, there were no significant differences between the various CT-values obtained,p>0.05. The difference in ∆CT values (IS2606-IS2404) for homogenate sample obtained from Naucoridae which was positive for the three targets onM. ulceransgenome was estimated to be 1.77. The present study reports the cultivation of two IS2404positiveMycobacteria spp.from two aquatic macro-invertebrates of the families Belostomidae and Notonectidae both of the order Hemiptera. The isolate from Belostomidae was identified as eitherM. ulceransorM. marinumwith 98% identities that from Notonectidae was 98% identical toM. neoaurum. The organisms are yet to be passaged through mice footpad and fully characterised.

Conclusions

For the first timeM. neoaurumspecies was reported to have harboured IS2404element. Aquatic Hemiptera are highly suspected to be vectors or hosts forM. ulceransand they may transmit the pathogen to humans through biting.
EFFECT OF SCHISTOSOMA HAEMATOBIUM INFECTION ONPLASMODIUM FALCIPARUMMALARIA BURDEN IN LAMBARÉNÉ, GABON
Authors: Agobé Jean Claude Dejon , Zinsou Frejus Jeannot , Honkpehedji J , Ngoa Ulysse Ateba , Kremsner Peter , Adegnika Ayola
Published: February 2017

Background

Malaria remains the first cause of death in Africa. In endemic area, it overlaps with other infections including helminths infections. It has been shown that there are interactions between the two parasites infection. Lambarene is the endemic area for urogenital schistosomiasis, which co-exist withP. falciparummalaria. Therefore, we decide to assess for the first time the effect of schistosomiasis infection on malaria infection burden.

Methods

In order to assess the effect ofS. haematobiumon malaria infection burden, a cross-sectional study was conducted in school children aged 6–16 years old. One blood smear was performed and 3 urine samples were obtained to assess the presence of infections. Chi-square test and generalised linear model were used to compare the risk to be infected byP. falciparumparasite and Mann-Whitney-Wilcoxon test to compare the parasitaemia ofP. falciparum. Demographic data was also collected.

Results

A total of 741 children were included. The overall prevalence was 20% and 31% forP. falciparummicroscopic carriage andS. haematobiuminfection, respectively. Co-infection of both was found in 65 (9%) participants.S. haematobiumandP. falciparumare highly prevalent in PK compared to Bindo and Makouké areas. At univariable analysis, schistosomiasis-infected subjects have an odd of 2.11 [1.46–3.07] to be infected byP. falciparumparasite compared to non-infected subjects. Locality was found to confound the association which remains significant after adjustment for age, gender and locality (aOR=1.69, [1.13–2.59]). The effect ofS. haematobiumon theP. falciparumparasitaemia outcome was also assessed. There is no effect of Schistosoma infection on malaria parasite density (p-value=0.92).

Conclusions

S. haematobiuminfection increases the risk of being infected withP. falciparumbut doesn't affect the parasitaemia density ofP. falciparummalaria in our study population.
MOLECULAR BACTERIAL LOAD ASSAY: A FAST AND ACCURATE MEANS FOR MONITORING TUBERCULOSIS TREATMENT RESPONSE
Authors: Sabiiti Wilber , Ntinginya Nyanda , Kuchaka Davis , Azam Khalide , Kampira Elizabeth , Mtafya Bariki , Bowness Ruth , Bhatt Nilesh , Davies Gerry , Kibiki Gibson , Gillespie Stephen
Published: February 2017

Background

Tuberculosis is a difficult disease to treat. We report a multi-centre performance evaluation of the molecular bacterial load assay (MBLA) that monitors change in patient bacterial load (BL) as they respond to TB therapy.

Methods

Smear or Xpert MTB/RIF-positive patients were prospectively monitored for treatment response using MBLA and culture at four sites in Southeast Africa. Treatment response was defined as decline in BL and or rise in time to culture positivity (TTP) or conversion to negative culture status. Positive culture at 5 or 6 months confirmed treatment failure. MBLA-MGIT correlation and association with treatment outcome were determined by Spearman's ρ and logistic regression, respectively.

Results

A total of 1764 serial samples from 178 patients were assessed for treatment response of which 91% were treatment success. Of those who failed treatment (n=17), MBLA detected TB in 82% at 2 months of treatment compared to MGIT 24% and LJ 6%. Mean BL at baseline was 6±1.3log10 CFU/ml falling to zero in 59% of the patients by 3 months of treatment. A corresponding rise in MGIT TTP, 5±3 to 22±11 was observed, r=–0.5, p<0.0001. The rate of sputum clearance (SLOPE) was high among high-burden patients – 1.0log10C-FU/ml than low-burden patients, –0.7log10CFU/ml in the first 2 weeks of treatment. Despite higher rates of clearance, high-burden patients were more likely to be TB-positive at 2 months of treatment, p=0.01(OR 2.5). Response was generally slower among the MDR than susceptible TB patients. Time to result was 4h with MBLA and 5–22 days for MGIT. Contamination was 25% in MGIT and 4% on solid culture.

Inter-site testing revealed that MBLA was reproducible, ANOVA p >0.05.

Conclusions

MBLA is a contamination-insensitive, reproducible method capable of giving results in real-time. Direct quantification of bacterial load from uncultured sputum demonstrates considerable potential for application in resource-limited settings where TB culture facilities are scarce.
NONTYPHOIDALSALMONELLAIN THE FOODSTUFFS AND THE HUMAN DIARRHOEAL STOOLS IN OUAGADOUGOU, BURKINA FASO
Authors: Nikiema Marguerite , Ky-Ba Absatou , Comapore Kiswendsida Abdou Muller , Traore Alfred , Sangare Lassana
Published: February 2017

Background

The sanitary quality of food is a global concern.Salmonellainfections are a major health problem in developing countries. Each year, food poisoning is affecting thousands of consumers. The objective of this study was to isolate strains of nontyphoidalSalmonellain food and in human diarrhoeal stools in Ouagadougou.

Methods

Sixty-one samples of sandwiches bought in Ouagadougou and 177 diarrhoeic stools specimen collected at the University Hospital Yaldao Ouedraogo and the Medical Centre Schiphra from May to October 2015 to detectSalmonella. The antibiotic susceptibility testing ofSalmonellastrains was done by the disk diffusion method using 14 antibiotics. Statistical analysis of data was done with Epi Info 7.3.

Results

From the overall samples analysed, 23 strains ofSalmonellawere identified including14/177 (7.9%) clinical strains, 9/61 (14.75% ) food strains. After antigenic identification 15 isolates (6 from foods, 9 from stools) belonged to known serotypes including 9 typhoidal and 6 nontyphoidal stains. Eight strains (3 from foods, 5 from stools) could not be serotyped by the reagents available. All the serotypes identified were found in stools (2S.typhi, 1S. paratyphiB, 1S. paratyphiC, 1S. enteritidis, 3S. typhimuriumand 1S. dublin) whileS. paratyphiB (4),S. paratyphiC (1) andS. enteritidis(1) only were identified in foods. Eleven (47.83%) strains were resistant to cotrimoxazole (2/11), tetracycline (8/11), nalidixic acid (##) and ciprofloxacine (2/11).

Conclusions

The overall frequency ofSalmonellais higher in the foods than in the diarrhoeic stools. However, the serotype diversity of the clinical strains is more important than that of the food strains. The street sandwiches would not be the main sources of contamination bySalmonella. The high rate of theSalmonellaresistance to antibiotics requires a more steady surveillance of the use of these antimicrobials.
PREVALENCE OF GASTROINTESTINAL PARASITES IN SOUTHERN MOZAMBIQUE USING A NOVEL MULTIPARALLEL QUANTITATIVE REAL-TIME PCR
Authors: Cuamba Inocencia , Grau-Pujol Berta , Nhabomba Augusto , Gutiérrez Jose , Lázaro Carlota , Mejia Rojelio
Published: February 2017

Background

Intestinal parasitic infections are distributed worldwide presenting high prevalence in low-income countries. Gastrointestinal parasites in children are associated to inhibition of normal growth, low intellectual development, vitamin deficiency by malabsorption, chronic diarrhoea and dysentery. Available data point to global prevalence in Mozambique (2005–2007) of 65.8% for soil-transmitted helminthiasis. Diagnosis of gastrointestinal parasites relies on stool microscopy which has a lower sensitivity and specificity than molecular biology methods. Consequently, researchers have developed a novel multi-parallel quantitative real-time PCR to detect protozoa and helminths in stool. This technique was used in the current study to determine the prevalence of gastrointestinal parasites in the Manhiça district.

Methods

Stool samples (10 g) for the detection of gastrointestinal parasites were collected from 175 children, aged 2 to 10 years, recruited at the Manhiça District Hospital. Clinical and laboratory data were obtained for all participants. Helminths and protozoa were detected through microscopy, the gold standard method, and through multi-parallel quantitative real-time PCR.

Results

High prevalence was found forGiardia lamblia(61%). Other prevalent parasites wereAscaris lumbricoides(10.2%),Strongyloides stercoralis(8.6%),Cryptosporidium(4%) andNecator americanus(2.8%).Ancylostoma duodenaleandEntamoeba histolyticawere not detected in any samples studied. More than 60% of children withA. lumbricoidespresented high egg burden that was correlated with increasedGiardiaburden co-infection (p=0.01).

Conclusions

The preliminary results point to a high prevalence ofG. lamblia. In our sample, a highGiardiaburden was associated with higherA. lumbricoidesegg count. Further analysis will allow us to correlate findings with clinical data and to evaluate the effect of the presence of gastrointestinal parasites on the immunological response to malaria.
SOIL-TRANSMITTED HELMINTH INFECTIONS AND RISK FACTORS AMONG PRIMARY SCHOOL PUPILS IN LAGOS, NIGERIA
Authors: Adewale Babatunde , Adedeji Abimbola , Folorunsho Sola , Demehin Pelumi , Akinsanya Bamidele
Published: February 2017

Background

A survey of prevalence of soil-transmitted helminth infections and associated risk factors among pupils of primary schools carried out between June and July 2015.

Methods

Four primary schools were purposely selected for the survey (2 public and 2 private). All the pupils that consented to participate were given sterile universal containers for the collection of stool samples which were processed for examination using Kato Katz technique. Structured questionnaires were administered to the pupils to obtain demographic and risk factors information.

Results

A total of 243 pupils aged 5–15 years were recruited for the study while 207 (85.2%) complied and returned stool samples suitable for examination. The overall prevalence of infection was 34.8% (males 36.8%; females 33%). There was no significant difference between the male and female infection rate (p=0.6) and there was also no significant difference among the different age groups (p=0.7). About a quarter (24.2%) of the population studied had single infection ofAscaris lumbricoidesand 1% had hookworm infection while 4.3% had multiple infections ofAscaris lumbricoidesandTrichuris trichiura. Multiple infections ofAscaris lumbricoides, Trichuris trichiura,andTaeniaspp. occurred in 0.5%. Large proportion of pupils engaged in risk factors such as cutting of finger nails with teeth (58.5%), unhygienic eating habits (41.4%), and irregular hand washing (28.5%). Majority (71.5%) of the pupils were not aware of school deworming programme among which 35.8% of them were positive for infection. Also 39.3% of the total number of pupils (56) who engage in open defaecation and use of pit latrines were positive for infection.

Conclusions

This showed that unhygienic habits practiced by pupils predisposed them to infection and the need to combine the school deworming programme with health education to reduce the burden of infection among pupils.
DIAGNOSTIC TOOLS FOR HUMAN AFRICAN TRYPANOSOMIASIS ELIMINATION AND CLINICAL TRIALS: THE DITECT-HAT PROJECT
Authors: Lejon Veerle , Ilboudo Hamidou , Mumba Dieudonné , Camara Mamady , Kaba Dramane , Lumbala Crispin , Fèvre Eric , Jamonneau Vincent , Bucheton Bruno , Büscher Philippe
Published: February 2017

Background

Trypanosoma brucei gambiense(Tbg) causes human African trypanosomiasis (HAT), one of the neglected tropical diseases targeted for elimination. Integration of diagnosis and case management into the general health system, sustainable monitoring of eliminated foci and development of safe and efficacious drugs, remain important challenges.

Methods

The DiTECT-HAT project tackles these challenges. For passive case detection, we will determine the diagnostic performance and cost of rapid diagnostic tests (RDTs) performed on clinical suspects in peripheral health centres, whether or not combined with serological and/or molecular tests on filter paper done at regional reference centres. Cost-effective diagnostic algorithms with high positive predictive values might allow test-and-treat scenarios without the need for complicated parasitological confirmations. Secondly, health workers performing house to house visits in foci with very low HAT prevalence can easily collect blood on filter paper and send it to regional HAT reference centres for analysis. The feasibility and cost of diagnostic algorithms with RDTs, serological and molecular high-throughput tests for post-elimination monitoring will be determined. An appropriate threshold will be established to trigger active case finding to avoid re-emergence of HAT, without unnecessarily raising the alarm. Finally, the accuracy of neopterin and RNA detection as early test-of-cure will be determined in therapeutic trials.

Earlier treatment outcome assessment will speed up the development of new drugs for HAT, and improve management of relapses in routine care.

Results

An update of ongoing and planned activities is given. The passive case detection sub-project is being set up in DR Congo, Côte d'Ivoire and Guinea. The inclusions for the early test-of-cure sub-project are ongoing in DR Congo.

Conclusions

The proposed research will provide evidence to support policies for improved HAT diagnosis and patient management within a context of disease elimination, and will contribute to successful and sustainable HAT elimination.
ACTIVE PHARMACOVIGILANCE IN CôTE D'IVOIRE
Authors: Djima Mariam Mama
Published: February 2017

Background

In Africa, pharmacovigilance (PV) is a relatively new science. Yet the African context is favourable to the irrational use of medicines, the circulation of counterfeit drugs, and a high consumption of traditional medicine. This should make PV in African countries a critical and crucial issue to ensure the safe use of treatments available. The collection system used in pharmacovigilance in Africa is predominantly passive. This passive system suffers from significant underreporting because it detects only 1–10% of adverse events. The limit in the passive detection and the growing concerns about security in the long term of drugs widely used in health programs, have stimulated in many countries the implementation of active systems such as actively seeking to improve the development of PV in their countries. In Côte d'Ivoire, pharmacovigilance at the regulatory level started in 1988. What is actually the state of pharmacovigilance and the impact of active research in the development of pharmacovigilance?

Methods

This is an observational descriptive study using a qualitative analysis of interviews in order to provide answers to these questions. The interview guides are constructed from a questionnaire already used in the monitoring of pharmacovigilance activities by the Uppsala Monitoring Center in countries with limited resources.

Results

Active surveillance has several sources. A well-known source is the pharmaceutical industry in the conduct of clinical trials and the risk management plans. The pharmaceutical industry accounts for over 80% of reports of adverse effects at national level. The second data source are research centres, but the reporting of adverse effects is not made at national level. The last source of data comes from active operational research studies which as a source are weak and this should be strengthened.

Conclusions

Active pharmacovigilance is to be encouraged in Côte d'Ivoire because it will collect data to improve the safety of medicines consumed by the population.
SCHISTOSOMIASIS, PRAZIQUANTEL AND FOOD: THE CONTROL OF A MALADY AMONG SCHOOL-AGE CHILDREN IN UGANDA
Authors: Muhumuza Simon , Katahoire Anne , Nuwaha Fred , Olsen Annette
Published: February 2017

Background

Annual school-based mass treatment with praziquantel is the cornerstone for schistosomiasis control among school-age children in Uganda. However, uptake of treatment is low. We evaluated strategies for improved uptake of mass treatment and the effects on the prevalence and mean intensity ofS. mansoniinfection

Methods

Through serial cross-sectional surveys conducted in 2011 and 2012 in 12 primary schools in Jinja district and a cluster randomised trial conducted in 2013, the levels of uptake of praziquantel and the prevalence and mean intensity ofS. mansoniinfection among school children were determined. Additionally, in 2012, the effect of increased teacher motivation to distribute treatment was assessed. In 2013, the effectiveness of provision of a pre-treatment snack in improving uptake was evaluated.

Results

A total of 1010, 1020 and 1284 randomly selected children were enrolled in 2011, 2012 and 2013, respectively. Uptake of praziquantel was 28.2% (95% CI: 22.9%–33.6%) in 2011. Prevalence and intensity ofS. mansoniinfection was 35.0% (95% CI: 25.4%–37.9%) and 116.1 eggs per gram of stool (epg) (95% CI 98.3–137.1), respectively. With increased teacher motivation in 2012, uptake increased to 48.9% (95% CI: 45.8%–52.0%). The prevalence and intensity ofS. mansoniinfection was 32.6% (95% CI: 29.6%–35.5%) and 133.1 epg (95% CI: 99.0%–167.2%), respectively. Provision of a pre-treatment snack in 2013 increased uptake to 85.5% (95% CI: 82.5%–91.7%) and reduced the prevalence and intensity ofS. mansoniinfection to 8.2% (5.6%–12.2%) and 15.9 epg (95% CI: 12.3%–19.2%), respectively.

Conclusions

Although teacher motivation increased uptake of mass treatment, the realised uptake was too low to affect the prevalence and intensity of schistosomiasis among school children. Conversely, provision of a pre-treatment snack achieved a high uptake. The increased uptake significantly reduced the prevalence and intensity ofS. mansoniinfection in this age group.
SAFETY OF RVSV EBOLA VACCINE, AFTER 6 MONTHS FOLLOW-UP, IN ADULTS: A PHASE 1 TRIAL CONDUCTED IN LAMBARÉNÉ, GABON
Authors: Fernandes José , Bache Emmanuel B. , Mba Régis M Obiang , Kabwende Anita L. , Mordmüller Benjamin , Krishna Sanjeev , Kremsner Peter G. , Grobusch Martin P. , Todagbe Agnandji Selidji
Published: February 2017

Introduction

The Centre de Recherches Médicales de Lambaréné (CERMEL) in Gabon, member of the ‘VSV-EBola CONsortium’ (VEBCON), evaluated safety and immunogenicity of the rVSV∆G-ZEBOV-GP vaccine in African volunteers from an area with previous Ebola outbreaks before its use during the last outbreak in West Africa.

Methods

From November 2014 to April 2015 we performed an open-label, dose escalation phase 1 trial to assess safety, side-effect profile, and immunogenicity of rVSV-ZEBOV. A total of 115 healthy adults both male and non-pregnant or lactating female volunteers aged 18–50 years old living in Lambaréné (Gabon) were included. Participants were allocated to five vaccine dose groups: 3×103PFU (n=20), 3×104PFU (n=20), 3×105PFU (n=20), 3×106PFU (n=39) and 2×107PFU (n=16). Here, we present data on adverse events (AE) and serious adverse events (SAE) between days 180 and 365 after vaccine injection (Day 0).

Results

From Month six to Month 12, the proportion of volunteers with AE as well as number and grade of AEs per volunteer were similar in the five groups. A higher total number of events occurred in the cohort 3×106PFU, the largest group. Most symptoms were mild to moderate. No clinically significant laboratory changes were observed. Three events - two episodes ofP. falciparummalaria and one snake bite - were graded as serious, because they required hospitalizations. Both SAE were judged as non-related to the vaccine and resolved without sequelae. None of the adverse events was related to rVSV-ZEBOV vaccine.

Conclusions

Our results confirmed an acceptable profile of safety and tolerability of rVSV-ZEBOV up to 12 months of follow-up. In order to investigate possible late-stage safety signals follow-up period of the study was extended to five years. Integrating data (assessment until 60 months) from all the VEBCON study sites is the next key step allowing a final conclusion about safety of rVSV-ZEBOV. The trial was registered on the Pan African Clinical Trials Network website with the number PACTR201411000919191