Ebola Virus Disease: epidemiology, management, prevention and control

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Household air pollution and childhood pneumonia in South Sudan: Will clean cooking stoves reduce the incidence and mortality?

Pneumonia causes more childhood deaths compared to other infectious diseases. Studies have showed that young children exposed to household air pollution (smoke) caused by burning of unprocessed solid fuels such as wood, charcoal, crop waste, animal dung and coal had double the risk of pneumonia infections compared to children who are not exposed or those from families using cleaner fuels such as electricity or gas. In 2012, more than half a million children below the age of 5 years died as a result of exposure to household air pollution worldwide. Based on studies which have indicated that reduction of household air pollution also reduces its health risks such as pneumonia, the World Health Organization recommended the use of cleaner fuels and/or technologies that offer significant health benefits, including the use of clean cooking stoves. Around 99% or all households in South Sudan use solid fuels for cooking in both rural and urban areas. This puts children in South Sudan at risk of pneumonia related deaths attributed to household air pollution. Therefore, promoting the use of clean/improved cook stoves such as the Uga Cooking Stove (locally made in Uganda, using charcoal) is critical to reduce the risk of childhood pneumonia and pneumonia related death in South Sudan.Keywords:  Household air pollution, childhood pneumonia, South Sudan, clean cooking stove

Treatment and prevention of epilepsy in onchocerciasis-endemic areas is urgently needed.

Background There is increasing epidemiological evidence supporting the association between onchocerciasis and seizures, reinforcing the concept of onchocerciasis-associated epilepsy (OAE). The aim of this paper is to provide an update on the new knowledge about OAE and to propose recommendations to the World Health Organization how to address this public health problem. Main text During the 2nd International Workshop on OAE held on 19-21 September, 2023, in Antwerp, Belgium, participants recognised OAE as a substantial yet neglected public health problem, particularly in areas of sub-Saharan Africa where onchocerciasis remains hyperendemic. Evidence from prospective population-based studies suggest that strengthening onchocerciasis elimination efforts leads to a significant reduction of OAE incidence. There is a need to validate an OAE case definition to estimate the burden of disease and identify onchocerciasis-endemic areas requiring intensification of onchocerciasis elimination programmes and integration of epilepsy care. It is expected that raising awareness about OAE will boost the population uptake of ivermectin. The implementation of a community-based epilepsy treatment programme offering free anti-seizure medications (ASMs) has shown high effectiveness in reducing the frequency of seizures and improving the overall quality of life of people with epilepsy. Conclusions To reduce OAE burden, enhanced collaboration between onchocerciasis and mental health programmes at community, national, and international levels is required. Urgent efforts are needed to ensure the uninterrupted provision of free ASMs in onchocerciasis-endemic areas. Furthermore, OAE should be included in the quantification of the onchocerciasis disease burden

Parasitic, bacterial, viral, immune-mediated, metabolic, and nutritional factors associated with Nodding syndrome

Nodding syndrome is a neglected, disabling and potentially fatal epileptic disorder of unknown aetiology affecting thousands of individuals mostly confined to Eastern sub-Saharan Africa. Previous studies have identified multiple associations – including O. volvulus, antileiomodin-1 antibodies, vitamin B6 deficiency, and measles virus infection – yet none is proven causal. We conducted a case-control study of children with early-stage Nodding syndrome (symptom onset <1 year). Cases and controls were identified through a household survey in the Greater Mundri area in South Sudan. A wide range of parasitic, bacterial, viral, immune-mediated, metabolic, and nutritional risk factors was investigated using conventional and state-of-the-art untargeted assays. Associations were examined by multiple logistic regression analysis and a hypothetical causal model was constructed using structural equation modelling. From 607 children with Nodding syndrome, 72 with early-stage disease were included as cases and matched to 65 household- and 44 community controls. Mansonella perstans infection (odds ratio [OR] 7.04, 95% confidence interval [CI] 2.28-21.7), Necator americanus infection (OR 2.33, 95% CI 1.02-5.3), higher antimalarial seroreactivity (OR 1.75, 95% CI 1.20-2.57), higher vitamin E concentration (OR 1.53 per standard deviation [SD] increase, 95% CI 1.07-2.19) and lower vitamin B12 concentration (OR 0.56 per SD increase, 95% CI 0.36-0.87) were associated with higher odds of NS. In a structural equation model, we hypothesized that M. perstans infection, higher vitamin E concentration and fewer viral exposures increased the risk of Nodding syndrome while lower vitamin B12 concentration, N. americanus and malaria infections resulted from having Nodding syndrome. We found no evidence that O. volvulus, antileiomodin-1 antibodies, vitamin B6 and other factors were associated with Nodding syndrome. Our results argue against several previous causal hypotheses including O. volvulus. Instead, Nodding syndrome may be caused by a complex interplay between multiple pathogens and nutrient levels. Further studies need to confirm these associations and determine the direction of effect

Quinolone resistance in Salmonella enterica serovar Typhi: Mechanisms, factors driving the spread of resistance, current epidemiological trends and clinical significance

The human restricted bacteria,Salmonella enterica serovar Typhi is the major cause of typhoid fever (or enteric fever), a characteristic severe systemic illness. In 2010, typhoid fever accounted for an estimated global burden of 27 million new cases and 200,000 deaths. For over two decades, S. enterica serovar Typhi and other serovars have developed resistance to the first line antimicrobials (ampicillin, chloramphenicol, and co-trimoxazole). As a result of this multidrug resistance (MDR), quinolones became key antibiotics for treatment of Salmonella Typhi disease. Quinolones are a group of antimicrobials with a 4-quinolone nucleus. Quinolones target the bacterial enzymes DNA gyrase and topoisomerase IV, which are essential for DNA replication and transcription

Nodding Syndrome: The Unresolved Mystery of a Pediatric Disease in Sub-Saharan Africa

Nodding syndrome is a mysterious neurologic illness of unknown etiology, presenting with distinctive clinical features often at early age. Currently, it affects children in restricted geographical areas in South Sudan, Northern Uganda and Southern Tanzania and is associated with high mortality and morbidity, especially in the children with severe disease. In this paper, we will give an outline of what is known about nodding syndrome with respect to epidemiology, clinical presentation, etiology and treatment. In addition, a possible approach to resolving the mystery is presented

Household air pollution and childhood pneumonia in South Sudan: will clean cooking stoves reduce the incidence and mortality?

Pneumonia causes more childhood deaths compared to other infectious diseases. Studies have showed that young children exposed to household air pollution (smoke) caused by burning of unprocessed solid fuels such as wood, charcoal, crop waste, animal dung and coal had double the risk of pneumonia infections compared to children who are not exposed or those from families using cleaner fuels such as electricity or gas. In 2012, more than half a million children below the age of 5 years died as a result of exposure to household air pollution worldwide. Based on studies which have indicated that reduction of household air pollution also reduces its health risks such as pneumonia, the World Health Organization recommended the use of cleaner fuels and/or technologies that offer significant health benefits, including the use of clean cooking stoves. Around 99% or all households in South Sudan use solid fuels for cooking in both rural and urban areas. This puts children in South Sudan at risk of pneumonia related deaths attributed to household air pollution. Therefore, promoting the use of clean/improved cook stoves such as the Uga Cooking Stove (locally made in Uganda, using charcoal) is critical to reduce the risk of childhood pneumonia and pneumonia related death in South Sudan

Hepatocellular carcinoma in South Sudan: possible aetiologies, presentation, diagnostic challenges and ways forward

Hepatocellular carcinoma is one of the common malignancies in both the developed and developing worlds. This is most likely due to its wide variety of causes. The aetiologies vary from one part of the world to another determined by many factors ranging from geography, life style, availability of advanced medical care etc among many others. Though the presentation and diagnosis of hepatocellular carcinoma is straight forward in many developed countries, the reality is different in many resource-constrained regions and countries such as South Sudan which has only one Computer-Tomography machine country wide, lack of most of the non-invasive liver screening tests as well as coupled with lack of medical personnel. However, in spite of these challenges, the authors of this article believe that the diagnosis of hepatocellular carcinoma can be reasonably made considering the clinical presentation of this condition and maximizing the use of available diagnostic tools

Nodding Syndrome: A Scoping Review

Nodding syndrome (NS) is a debilitating yet often neglected neurological disease affecting thousands of children in several sub-Saharan African countries. The cause of NS remains unknown, and effective treatment options are lacking. Moreover, knowledge regarding NS is scarce and is based on a limited number of publications, with no comprehensive overview published to date. Therefore, the aim of this scoping review was to summarise the current evidence and identify existing knowledge gaps in order to help clinicians, scientists, and policymakers develop guidelines for prioritising this severe condition. We searched the Medline (Ovid), Embase (Ovid), Scopus, and Global Health Library databases in accordance with the PRISMA extension for scoping review guidance and in accordance with the Joanna Briggs Institute guidelines and methodology for a scoping review, using keywords describing NS. We then extracted and presented the original data regarding the epidemiology, aetiology, pathophysiology, clinical features, diagnosis, management, and outcomes of NS, as well as community perceptions and the psychosocial and economic impact of NS. Out of 1470 identified articles, a total of 69 were included in this scoping review. Major gaps exist in understanding the aetiology and pathogenesis of NS. Future research is urgently needed not only to address these gaps, but also to study the treatment options, epidemiology, and psychosocial and economic impacts of NS. Innovative interventions and rehabilitation programmes designed to address the psychosocial and economic burdens associated with NS are also urgently needed