bluuebunny/crossref_metadata_2025_split huggingface dataset:
AETIOLOGY, ANTIBIOTIC RESISTANCE AND RISK FACTORS FOR NEONATAL SEPSIS IN A LARGE REFERRAL CENTRE IN ZAMBIA
Authors: Kabwe Mwila , Tembo John , Chilukutu Lophina , Chilufya Moses , Ngulube Francis , Lukwesa Chileshe , Enne Virve , Wexner Hannah , Mwananyanda Lawrence , Hamer Davidson , Sinyangwe Sylvester , Ahmed Yusuf , Klein Nigel , Maeurer Markus , Zumla Ali , Bates Matthew 
Published: February 2017

BackgroundIn sub-Saharan Africa there is scanty data on the causes of neonatal sepsis and antimicrobial resistance among common invasive pathogens, which might guide policy and practice.MethodsThis was a cross-sectional observational prevalence and aetiology study of neonates with suspected sepsis admitted to the neonatal intensive care unit, University Teaching Hospital, Lusaka, Zambia, between October 2013 and May 2014. Data from blood cultures and phenotypic antibiotic susceptibility testing were compared with multivariate analysis of risk factors for neonatal sepsis.ResultsOf 313 neonates with suspected sepsis, 54% (170/313) were male; 20% (62/313) were born to HIV-positive mothers; 33% (103/313) had positive blood cultures, of which 85% (88/103) were early onset sepsis (EOS).Klebsiellaspecies was the most prevalent isolate, accounting for 75% (77/103) of cases, followed by coagulase-negative staphylococci (6% (7/103)),Staphylococcus aureus(6% (6/103)),Escherichia coli(5% (5/103) andCandidaspecies (5% (5/103). ForKlebsiellaspecies, antibiotic resistance ranged from 96–99% for WHO-recommended first-line therapy (gentamicin and ampicillin/penicillin) to 94–97% for third generation cephalosporins. The prevalence of culture-confirmed sepsis increased from 0–39% from December 2013 to March 2014, during which time mortality increased 29–47%. 93% (14/15) neonates with late onset sepsis and 82% (37/45) with early-onset sepsis aged 4–7 days were admitted >2 days prior to onset of symptoms. Culture results for only 25% (26/103) of cases were available before discharge or death. Maternal HIV infection was associated with a reduced risk of neonatal sepsis (OR 0.46 [0.23–0.93], p=0.029).ConclusionsOutbreaks of nosocomial multi-antibiotic-resistant infections are an important cause of neonatal sepsis and associated mortality. Reduced risk of neonatal sepsis associated with maternal HIV infection is counterintuitive and requires further investigation.
RESISTANCE OF ENTEROPATHOGENS MAINLY ASSOCIATED WITH DIARRHOEA TO FREQUENTLY PRESCRIBED ANTIBIOTICS IN KOUSSERI (FAR NORTH, CAMEROON)
Authors: Beyala Landry , Etienne Guenou , Anthony Njimbia , Benjamin Azike , Ateudjieu Jerome 
Published: February 2017

BackgroundThe resistance of diarrhoea-causing enteropathogens to antibiotics is a global concern.MethodsA cross-sectional descriptive study that had as objective to test the sensitivity of these pathogens to antibiotics frequently prescribed in the Logone and Chari Division was carried out in Kousseri from 24 July to 23 October 2015. Stool samples were collected from patients (children and adults) presenting at the Kousseri Annex Regional Hospital, in sterile containers and analysed as required by SOPs in the cholera detection laboratory of the NGO ‘Better Access to Health Care’ (BAHCARE) in Kousseri. Microbial isolation and identification was done using Hektoen and EMB culture media and API 20E pack (Biomerieux). Antibiotic susceptibility testing was done using the Kirby Bauer method with Muller Hinton medium.ResultsA total of 150 stool samples were analysed, out of which 45 enteropathogens were isolated (66% of isolated microbes wereEscherichia coli), identified and tested with antibiotic discs. The rate of resistance ofEscherichia coliwas 83.33% to cotrimoxazole and 43.33% to both ceftriaxone and ciprofloxacin. Salmonella species had a resistance rate of 71.42%, 42.86%, and 28.57% to cotrimoxazole, ceftriaxone and ciprofloxacine, respectively.Shigella sppwere 100% resistant to cotrimoxazole, ciprofloxacine and the combination of amoxicillin with clavulanic acid.ConclusionsThese results underscore the need to systematically assess the sensitivity of enteropathogens to antibiotics so as to guide health workers on the prescription of antibiotics in the Lake Chad area, Cameroon.
LOCALLY DRIVEN RESEARCH IS BETTER FOR INFECTIOUS DISEASES OUTBREAK PREPAREDNESS: AN EDCTP CAPACITY-BUILDING PROJECT IN POST-EBOLA LIBERIA
Authors: Tarr Christine Attia , Perez Guillermo Martinez , Omeonga Senga , Kibungu Fanta , Meyer Ana , Lansana Peter , Mayor Alfredo 
Published: February 2017

BackgroundLiberia is recovering from an Ebola outbreak. Liberia suffers from brain drain and a low gross enrolment ratio in tertiary education alongside a dearth of institutions, skilled investigators and funds for research. Liberia needs to rebuild its capacity in epidemiological research. The Saint Joseph's Catholic Hospital (SJCH) in Monrovia –in collaboration with ISGlobal and the Juan Ciudad Foundation, received an EDCTP grant to strengthen its staff capacities to lead research in infectious diseases.MethodsIn March 2016, a participatory planning process started. The hospital management team and medical department staff were engaged. The process was guided by scientists from ISGlobal. Thirty-two trainees were identified among staff of the Ministry of Health and SJCH; community leaders were sought to build a Community Advisory Board; and trainees' suggestions informed the design of a 6-months Moodle-based eLearning program.ResultsTwo workshops on Good Clinical and Laboratory Practices (GCLP) were conducted. In preparation for the SJCH to conduct biomedical research and clinical trials, another workshop to design Standard Operating Procedures was done. All trainees joined the eLearning program and received a certificate of completion. Furthermore, the SJCH defined its own institutional research program, submitted a research proposal to a local ethics board, and is pooling resources to undertake further research on infectious diseases in 2017.ConclusionsA collaborative multi-disciplinary framework that promoted participation of the community was an approach that fuelled the successful completion of all training activities of this EDCTP-awarded project. The trainees capitalised on their experiences during the Ebola epidemic to ensure all activities were planned as per best quality standards. All trainees were motivated to prevent that planning and implementation-related errors they witnessed during the Ebola outbreak, were repeated in new education and research initiatives. In addressing global health challenges today, these motivational driving forces need a responsible and prompt response from Northern countries.
THE ROLE OF LOCAL CONTRACT RESEARCH ORGANISATIONS IN BUILDING GCP-COMPLIANT CLINICAL RESEARCH IN POVERTY-RELATED DISEASES IN AFRICA: A CASE OF CLINWIN RESEARCH SERVICES
Authors: Onyango Peter 
Published: February 2017

BackgroundAfrica carries the largest burden of the poverty-related diseases in the world. Most of her populations live in resource-limited settings. These act as catalysts for poverty-related diseases in those populations. There is urgent need for affordable, safe and effective health technologies to reduce the economic burden of those diseases. Clinical research provides an opportunity for access to new and improved health technologies, which have undergone evaluation in clinical trial settings, in compliance with Good Clinical Practice (GCP) and local regulatory requirements. The local Contract Research Organisations offer cost-effective solutions, human resource capacity and experience in poverty-related diseases research, regulatory affairs, culture and politics.MethodsClinWin provides clinical development services for poverty-related diseases. It has partnered with industry, not-for-profits and academic sponsors to provide a suite of trial and site management, and sponsor oversight services to local clinical research programs. These services include: training, trial monitoring, quality assurance, ethical and regulatory expertise; contract negotiation and trial coordination among others. Leveraging its indigenous knowledge of the clinical trial landscape in the region, it has developed a database of potential and current local investigators capable of conducting registration trials. The lessons learnt in each project are documented and shared with investigator staff at new sites.ResultsWe conducted 23 monitoring visits at an academic site for a phase Ib HIV vaccine study and malaria phase IV drug trial monitoring visits in Kenya and Tanzania. Academic epidemiological tuberculosis studies were also conducted and we developed partnerships with professional development programs in industry and academia.ConclusionsAfrica is the next frontier for clinical research enterprise, and the need for developing local human resource capacity is critical. This will make the region attractive for industry sponsored trials for poverty-related diseases and other indications.
PERFORMANCE OF XPERT MTB/RIF AND DETERMINE LAM IN HIV-INFECTED ADULTS IN PERI-URBAN SITES IN ZAMBIA (CDC OP-X STUDY)
Authors: Kasaro Margaret Phiri , Muluka Brenda , Kaunda Kaunda , Morse Jill , Westfall Andrew , Kapata Nathan , Kruuner Annika , Henostroza German , Reid Stewart 
Published: February 2017

BackgroundTuberculosis (TB) mortality in HIV-infected patients remains high in sub-Saharan Africa. Inadequate diagnostic tools delay time to TB treatment.MethodsA two-phase TB diagnostic study was conducted among HIV-infected adult patients from 2014–2016. Patients underwent history/physical exam, chest x-ray, urine for lipoarabinomannan (LAM), sputum smear and culture. We evaluated sensitivity, specificity and time to appropriate treatment within 14 and 28 days of screening for culture-positive patients, comparing Xpert MTB/RIF assay (GXP), and LAM to standard-of-care (SOC) in 3 peri-urban clinics. chi-square and Wilcoxon Rank-Sum tests were used to test for differences between SOC and GXP for categorical variables and continuous variables, respectively.Results1353 patients were enrolled; 755 in the SOC arm and 598 in the GXP arm. Median age was 34.3 and 65.1% were male. TB was diagnosed by any method (smear, clinical, GXP, LAM, culture) in 237 (17.5%) and with positive MTB culture in 152 (11.2%); 84 and 68 in the SOC and GXP arms, respectively. The overall sensitivity and specificity (culture as reference standard) of SOC was 91.7% and 92.9% respectively while GXP was 50.8% and 99.2%, respectively. LAM, when used with SOC, did not improve sensitivity or specificity in any CD4 strata, however when used with GXP increased sensitivity from 20% to 50% at CD4<50. There was a marginally significant difference (p=0.08) at 14-day TB treatment initiation between the GXP and SOC phases but no difference at 28-days. Among those initiating therapy, the median time to TB treatment initiation was shorter for the GXP arm (4vs15 days).ConclusionsGXP did not significantly increase the number or accuracy of TB diagnoses compared to SOC but reduced median number of days to TB treatment by 11 days. GXP and LAM when used together have the potential to rapidly identify TB in patients with advanced HIV disease.
INTRODUCTION OF A NEW VACCINE INTO NATIONAL IMMUNISATION PROGRAMMES IN AFRICA: THE ROLE OF CAPACITY BUILDING
Authors: Dochez Carine , Burnett Rosemary , Mphahlele M. Jeffrey 
Published: February 2017

BackgroundMembers of National Immunisation Technical Advisory Groups, policy-makers, EPI managers and vaccinators are tasked with making evidence-based recommendations and decisions on whether a new vaccine merits introduction into national immunisation programmes; implementation of new vaccine introduction; and efficient management of immunisation programmes. Therefore it is paramount that they are equipped with the latest state-of-the-art information on vaccines and immunisation.MethodsCapacity building activities – such as high-level in-service vaccinology courses, other interactive courses and workshops (mid-level management training and experience exchange workshops) – address all steps required for decision-making on new vaccine introduction into national immunisation programmes. These include establishing: 1) burden of disease to be prevented; 2) existence of a good intervention (i.e. is the vaccine efficacious, safe and acceptable for the target population); 3) the cost of the new vaccine, its implementation and the comparative effectiveness with other vaccines/interventions in terms of health gains; 4) whether finances to pay for the new vaccine are available; and 5) programmatic implications. Interested parties are trained on this rational decision-making process to be followed before embarking on new vaccine introduction, on key implementation steps, and efficient management of immunisation programmes.ResultsSeveral inter-country vaccinology courses and interactive workshops, which were organised during the last years in the African region (e.g. Kenya and South Africa), will be presented in detail. These capacity building activities have contributed to successful introduction of new vaccines in the African region, key ones being rotavirus, pneumococcal and currently human papillomavirus vaccines. This concerted effort has contributed for example to the successful introduction of rotavirus vaccine in 29 African countries to date.ConclusionsCapacity building efforts, like high-level in-service courses and interactive workshops have enabled interested parties to make evidence-based recommendations and decisions on the introduction of any new vaccine, and to successfully implement new vaccine introduction.
DEVELOPING A GLOBAL CORE COMPETENCY FRAMEWORK FOR CLINICAL RESEARCH
Authors: Julé Amélie , Furtado Tamzin , Boggs Liam , Loggerenberg François Van , Lang Trudie 
Published: February 2017

BackgroundLack of recognition for working in clinical research is widely cited as an impediment to its conduct. There is a lack of career structure for the many roles involved (investigators, trial managers, nurses, etc.), and a lack of understanding of who does what. Competency frameworks exist for some individual job roles, but these are infrequent; thus the need for a global framework describing roles and responsibilities in a research team. This would facilitate appraisal of staff, promote career development by highlighting acquired skills, and illuminate areas where training opportunities are lacking.MethodsIn this project, we combine 28 frameworks created by external groups, with information from 116 job descriptions obtained from partners in clinical trial units worldwide, including input from the EDCTP Networks of Excellence, and from the web, to create a widely-encompassing framework derived from 11 different roles. Using qualitative analysis software, we systematically assess the activities performed by the clinical research team to categorise them and define underlying knowledge-, skill- or task-based competencies.ResultsThe resulting framework counts 50 competencies required throughout the research life cycle, from assessment of scientific literature to results dissemination via project management, public engagement or grant application. It is applicable to studies that may differ in design, geographical location, disease, etc., and can be adapted to the particular needs of specific projects or roles. The framework was subject to an initial validation through consultations with over 30 global health research experts in collaboration with WHO-TDR in September 2015, resulting in enhancements and its subsequent beta release.ConclusionsThe adaptable ‘Global Core Competency Framework for Clinical Research’ is now accessible via The Global Health Network, alongside a protocol for individuals who may wish to pilot test it in their work. The framework may be further refined before being finally approved and launched in collaboration with WHO-TDR.
EVALUATION OF CIRCULATING CATHODIC ANTIGEN (CCA) URINE-CASSETTE ASSAY AS A SURVEY TOOL FORSCHISTOSOMA MANSONIIN DIFFERENT TRANSMISSION SETTINGS WITHIN BUGIRI DISTRICT, UGANDA
Authors: Adriko Moses 
Published: February 2017

BackgroundDiagnosis of schistosomiasis at the point-of-care is a growing topic in neglected tropical disease research. There is a need for diagnostic tests which are affordable, sensitive, specific, user-friendly, rapid, equipment-free and delivered to those who need it, and point-of-care is an important tool for disease mapping and guiding mass deworming.MethodsOur study was conducted among 500 school children randomly selected across 5 schools within Bugiri district, adjacent to Lake Victoria in Uganda. Duplicate Kato-Katz thick smears were prepared in the field upon receipt of the faecal samples and were read under a microscope within 60 minutes of slide preparation to determine hookworm status. The slides were again read 24 hours later forAscaris lumbricoides,Trichuris trichiuraandS. mansoniand this was repeated for all subsequent stool samples.ResultsOf the 469 pupils who provided three stool samples for the six Kato-Katz smears, 293 (76%) children had no infection, 109 (23%) were in the light intensity category, while 42 (9%) and 25 (5%) were in the moderate and heavy intensity categories, respectively. Following performance analysis of CCA tests in terms of sensitivity, specificity, negative and positive predictive values, the overall performance of the commercially available CCA test was more informative than single Kato-Katz faecal smear microscopy, the current operational field standard for disease mapping.ConclusionsThe current CCA assay is a satisfactory method for surveillance ofS. mansoniin an area where disease endemicity is declining due to control interventions. The urine point-of-care CCA test is an attractive tool to augment and perhaps replace the Kato-Katz sampling within ongoing control programmes.
COMMUNITY KNOWLEDGE, ATTITUDES AND PRACTICES (KAP) DURING MDA INTEGRATED MALARIA ELIMINATION AND SCHISTOSOMIASIS AND SOIL-TRANSMITTED HELMINTHS CONTROL STUDY IN NGODHE ISLAND, LAKE VICTORIA, KENYA
Authors: Mwaura Peter , Kongere James , Omolloh Kevin , Gitaka Jesse 
Published: February 2017

BackgroundKnowledge, attitudes and practices (KAP) of communities where mass drug administration based integrated malaria elimination and control of schistosomiasis and soil transmitted helminths (STH) is targeted will be critical in adhering to intervention strategies. KAP surveys have the potential to reveal lessons that will inform implementation in similar settings. This study sought to assess knowledge, attitudes and practices of Ngodhe islanders in Lake Victoria Kenya during mass drug administration (MDA) with artemisinin-piperaquine and low dose primaquine for malaria; albendazole for STH and praziquantel for schistosomiasis.MethodsThe KAP study used a pre-tested interviewer questionnaire that was administered to 239 randomly selected adults. Additionally, 4 focus group discussions (each consisting of between 8–12 participants) was done with the elders, women, youth, and mixed group. Another 6 key informant interviews were also done.ResultsAll respondents (239) had heard about malaria and they acknowledged that it is preventable; 89.1% of respondents had heard about schistosomiasis; and another 87.4% had heard about STH. A high percentage of 96.2 had heard about the mass drug administration while 87% were aware of the integrated malaria, schistosomiasis, and STH strategy. 78.2% of participants favoured stopping MDA in case side effects were perceived to be common. Sanitation was a major challenge with only 41.3% of the respondents using latrines with the rest using bushes.ConclusionsThis study revealed huge awareness of the integrated strategy for malaria elimination and schistosomiasis and STH control using mass drug administration. Nonetheless, concerns on MDA drugs side effects and poor sanitation practices will require greater engagement with the community.
INTERRUPTED BANCROFTIAN FILARIASIS EXPOSURE RATES IN CHILDREN AFTER TWELVE ROUNDS OF MASS DRUG ADMINISTRATION AND USE OF LONG-LASTING INSECTICIDAL NETS IN RUFIJI DISTRICT, TANZANIA
Authors: Jones Clarer , Ngasala Billy , Malecela Mwelecele 
Published: February 2017

BackgroundTanzania started implementing the WHO strategy of mass drug administration (MDA) with ivermectin and albendazole to eliminate lymphatic filariasis (LF) in Rufiji District, which had a baseline prevalence of 49% in 2000. This study was conducted in April 2015, six months after the latest MDA to establish the impact of MDA and utilisation of long-lasting insecticidal nets on the exposure rates of LF among standard-one children born within the implementation period of the LF elimination programme after 12 rounds.MethodsA cross-sectional study for LF circulating filarial antigen (CFA) was performed in 5 primary schools from 5 different villages. A total of 659 standard-one pupils aged 6–9 years were recruited and screened for CFA using immunochromatographic test cards (ICT). Prior to blood sample collection, children were interviewed on their participation in the MDA. A finger prick whole blood sample (100 µl) drawn from each child was applied to ICT. Results were read after ten minutes for the presence of CFA. Also, the study involved 868 heads of household who were interviewed on their participation in MDA and utilisation of long-lasting insecticidal nets (LLINs).ResultsThe ICT results were negative for CFA and suggest that there has been an interruption of exposure of children to LF transmission in the study area. More than half of the screened children (54.3%) participated in 2014 MDA round. Household surveyed MDA coverage was 57.4% for the 2014 MDA, below the minimum effective coverage recommended by WHO. Majority (92.5%) of households possessed and utilised LLINs. Of those who did not take the drugs in the last round, 88.7% possessed and utilised LLINs suggesting its synergistic effect with ivermectin and albendazole on LF transmission.ConclusionsAdditional MDA rounds and utilisation of LLINs in areas of high-baseline prevalence may result in considerable decreased lymphatic filariasis infection transmission.