Measles in Democratic Republic of Congo: an outbreak description from Katanga, 2010--2011

BACKGROUND: The Democratic Republic of Congo experiences regular measles outbreaks. From September 2010, the number of suspected measles cases increased, especially in Katanga province, where Medecins sans Frontieres supported the Ministry of Health in responding to the outbreak by providing free treatment, reinforcing surveillance and implementing non-selective mass vaccination campaigns. Here, we describe the measles outbreak in Katanga province in 2010--2011 and the results of vaccine coverage surveys conducted after the mass campaigns. METHODS: The surveillance system was strengthened in 28 of the 67 health zones of the province and we conducted seven vaccination coverage surveys in 2011. RESULTS: The overall cumulative attack rate was 0.71% and the case fatality ratio was 1.40%.The attack rate was higher in children under 4 and decreased with age. This pattern was consistent across districts and time. The number of cases aged 10 years and older barely increased during the outbreak. CONCLUSIONS: Early investigation of the age distribution of cases is a key to understanding the epidemic, and should guide the vaccination of priority age groups

Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies

Background: The 2016 Dar Es Salaam Call to Action on Diabetes and Other non-communicable diseases (NCDs) advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. We estimated trends from 1980 to 2014 in age-standardized mean body mass index (BMI) and diabetes prevalence in these countries, in order to assess the co-progression and assist policy formulation. Methods: We pooled data from African and worldwide population-based studies which measured height, weight and biomarkers to assess diabetes status in adults aged ≥ 18 years. A Bayesian hierarchical model was used to estimate trends by sex for 200 countries and territories including 53 countries across five African regions (central, eastern, northern, southern and western), in mean BMI and diabetes prevalence (defined as either fasting plasma glucose of ≥ 7.0 mmol/l, history of diabetes diagnosis, or use of insulin or oral glucose control agents). Results: African data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. Countries with the highest number of data sources for BMI were South Africa (n = 17), Nigeria (n = 15) and Egypt (n = 13); and for diabetes estimates, Tanzania (n = 8), Tunisia (n = 7), and Cameroon, Egypt and South Africa (all n = 6). The age-standardized mean BMI increased from 21.0 kg/m2 (95% credible interval: 20.3–21.7) to 23.0 kg/m2 (22.7–23.3) in men, and from 21.9 kg/m2 (21.3–22.5) to 24.9 kg/m2 (24.6–25.1) in women. The age-standardized prevalence of diabetes increased from 3.4% (1.5–6.3) to 8.5% (6.5–10.8) in men, and from 4.1% (2.0–7.5) to 8.9% (6.9–11.2) in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association (correlation coefficient ≃ 0.9) was observed between mean BMI and diabetes prevalence in both sexes in 1980 and 2014. Conclusions: These estimates, based on limited data sources, confirm the rapidly increasing burden of diabetes in Africa. This rise is being driven, at least in part, by increasing adiposity, with regional variations in observed trends. African countries’ efforts to prevent and control diabetes and obesity should integrate the setting up of reliable monitoring systems, consistent with the World Health Organization’s Global Monitoring System Framework

Restore, ensure, address, and guarantee security in the African Great Lakes Region: which coherence for which efficiency in post-conflict contexts?

It is no longer denied that security, in its multiple dimensions, constitute a major challenge for development. Yet, donor States seem to act in a somewhat schizophrenic way on this matter: on one hand, the nexus between security and development has been regularly re-asserted for about two decades; but on the other hand security issues are still linked to the more general political field and distinguished from cooperation – then more technical – activities. This fallacious and recurrent need for a strict differentiation leads to the expurgation of any frank talk on security matters between donors and partners. Nevertheless, insecurity, that is broadly depicted to go from incivility to armed conflict, remains a reality – or a threatening shade – for post-conflict States. In this context, donors’ initiatives are numerous and include, for example, multifaceted support to DDR/DDR processes and setting up of peacekeeping international forces, etc. Aid provision or « peace support » is thus materialized at various levels, through international (among them UN ones), and European missions, or again through bilateral partnerships, etc. From now on, the donors’ objectives aim at countering some well-identified weaknesses. However, what about the security segments that are disposed off or inadequately tackled by those donors, whether intentionally or not? « Forgotten » or neglected fields of security – at domestic level for instance – seem to be out of reach for any kind of external intervention, and even sometimes for the local partner itself. Can these “forgotten” segments be intentionally kept out of the external donors’ intervention scope by domestic elites? Do the latter aim at preserving peculiar dynamics of power and wealth captation that are hitherto anchored in the socio-economic structure? To what extent a jealous sovereignty over the security sector is considered to be a way to gain power and autonomy? This proposed panel aims at questioning the relevance and coherence of external intervention – or the relevance of its end goals – when operationalizing the security-development nexus, both from the donor’s and partner’s side/perspective. Proposals of communications or papers addressing the following aspects were paid particular attention during selection: - Review of bilateral and multilateral Belgium security commitment results (both civil and military) in African Great Lakes Region; - European Union "Security" missions - EUSEC RD Congo (civilian/military), EUPOL RD Congo (civilian): objectives, expectations, and achievements, particularly when considering their contribution to the partner country’s improved autonomy (nature, scope) and the population’s perception of this contribution. - Security in the African Great Lakes since the end of the conflict from a domestic or daily perspective. - The progressive "Africanization of peacekeeping" (via programs such as AFRICAP, bilateral partnerships of training, etc.): impact and/or profits on the homeland security of the States (in terms of constraints, trade capacities, and lessons learnt)