A cluster of paediatric hydrocephalus in Mohale’s Hoek district of Lesotho, 2013-2016

Background: In 2016, an unusual increase of paediatric hydrocephalus was observed in Mohale’s Hoek (MH) district, Lesotho. This study describes the epidemiology of paediatric hydrocephalus, and review the management of case-patients in MH district. Methods: We defined a case-patient as a child ≤12 years diagnosed with hydrocephalus either radiologically (i.e. by CT or MRI scan) or clinically by a medical officer. We reviewed registries and medical records of children diagnosed or treated with hydrocephalus at national referral hospital in Maseru and in MH district. We also conducted a household survey among case-patients identified in MH. Results: A cumulative total of 75 case-patients with paediatric hydrocephalus were identified in Lesotho, giving an overall prevalence of 87/100,000 live births over the 2-years. Thirty-seven (49.3%) were diagnosed with congenital hydrocephalus, and 5 (6.7%) were acquired hydrocephalus post-meningitis. Overall, 11 case-patients were identified in MH district, giving an overall 4-years prevalence of 211/100,000 live births; case fatality of 4/11 (36.4%). The median age at the time of diagnosis was 3 weeks (range: 1 week - 12 months) and five of the 11 case-patients were diagnosed in 2015. Two (18.2%) were diagnosed with congenital hydrocephalus, 2 (18.2%) with acquired hydrocephalus post meningitis and 7 (63.6%) had hydrocephalus of unspecified origin. Five children had shunts inserted in South Africa with an average delay of about 3 months from diagnosis. All five shunts developed complications that resulted in their removal. Conclusion: Our findings provided an insight into the burden of hydrocephalus in Lesotho and highlight sub-optimal post-surgery follow-up of children treated for hydrocephalus. We recommend that the Lesotho government implement a national surveillance system for congenital abnormalities and strengthen capacity for neurosurgical procedures at the national hospital

Evaluation of the meningitis surveillance system in Luanda Province, Angola, March 2017

Introduction: Meningitis due to Neisseria meningitidis is a priority public health disease given its high epidemic potential and associated mortality. Angola is not one of the countries in the African meningitis belt and frequent outbreaks are uncommon. This might affect the preparedness and capacity of the surveillance system to promptly detect and effectively respond, should a meningitis outbreak occur. From 2014 to 2015, there was an increase in the number of meningitis cases identified in Angola, partly due to heightened disease surveillance. We evaluated the meningitis surveillance system to establish if the surveillance system was meeting its set objectives and made recommendations for improvement. Methods: A cross-sectional study was conducted among health workers in Luanda province in March 2017. Using a pretest structured questionnaire, we obtained information on the participants’ demographic characteristics, work experience, training and their knowledge about the meningitis surveillance system. Participants’ knowledge was graded poor (<50%), reasonable (50 – 69%), good (70 – 90%) and excellent (> 90%). We assessed the key system attributes using the updated CDC guidelines for evaluating public health surveillance systems. Results: Of the 52 operators interviewed, 51.9% were (27/52) nurses, 61.5% (32/52) had >5years work experience and 85.6% (45/52) had not been trained in public health surveillance in the last 5 years. Doctors and nurses had knowledge score of <20%, disease specific focal points and the program coordinator scored 85.7% and 100% respectively. Overall scores for the system’s attributes were as follows; simplicity-(33.3%), data quality-69.2 % and timeliness 33.3%. There was no evidence to suggest that data from the surveillance system was analysed at the source. Conclusion: Knowledge of surveillance system among doctors and nurses was very poor. Overall, the system was complex, with poor data quality, not timely and of low utility. We recommend periodic training of health workers, simplifying operation of the system, compliance with reporting timelines and regular data analysis and use for action at the sourc

Uptake of HIV testing and its associated factors among long-distance truck drivers in Zambia, 2015

Introduction: Globally, long distance truckers have been reported to have an important role in the spread of sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV). Evidence on the uptake of HIV testing among this key population is not well established. We analysed the 2015 Behavioral Surveillance Survey (BSS) data to determine the uptake of HIV testing and assess factors associated with HIV testing among Long Distance Truck Drivers (LDTDs) in Zambia. Methods: We analysed secondary data from the 2015 BSS. The BSS was carried out in five of the 10 Corridors of Hope (COH) III project sites (Kazungula, Solwezi, KapiriMposhi, Chipata and Chirundu) among male LDTDs. The Zambian Corridors of Hope HIV and AIDS Prevention Initiative project was formed to address rising rates of HIV and other sexually transmitted infections. The BSS study included LDTDs from truck depots, border sites, Zambia Revenue Authority offices and those parked along the road side. Association between independent variables and history of HIV testing was determined by bivariate logistic analysis. Multivariable logistic regression was done to control for confounders. Results: Overall, 1,386 male LDTDs were included in the study, with mean age of 38 years. Over 75% reported being currently married and living with a spouse while 82% reported having only one wife. Uptake for ever having tested for HIV among LDTDs was 83%. Having a relative or friend who was infected or who had succumbed to HIV/AIDS (adjusted OR: 0.61, 95%CI: 0.40 – 0.92) and having two or more wives (adjusted OR: 0.4, 95%CI: 0.2 – 0.6) were independent inhibitory factors for uptake of HIV testing. Conclusion: Knowledge of someone infected or died of HIV and having at least two wives were drivers for HIV testing. These findings suggest the need to implement focused Behavioral Change interventions and messages to increase uptake of HIV testing among LDTDs

Spatio-temporal distribution of under-five malaria morbidity and mortality hotspots in Ghana, 2012 – 2017: a case for evidence-based targeting of malaria interventions

Introduction: The spatiotemporal variation in malaria burden underpins the need for targeted malaria interventions. Despite the scale-up of malaria control interventions in Ghana, malaria remains the leading cause of hospital admissions and deaths among children below 5 years (U5). We described spatiotemporal distribution of U5 malaria morbidity and mortality from 2012 to 2017 to provide evidence for deployment of specific malaria interventions to regions of hotspots in Ghana. Methods: We conducted a retrospective review of district-level malaria surveillance data from 2012 to 2017. We obtained confirmed U5 malaria case and population data for all districts in Ghana, and computed yearly smoothed malaria incidence and mortality rates. Hotspot analysis was performed using GeoDa’s Global and Local Moran I tests of spatial autocorrelation. Results: Overall, 8,132,769 U5 malaria cases and 5,932 deaths were reported, with case fatality rate of 0.1%. Under-five malaria incidence increased from 16.4% in 2012 to 31.3% in 2017, and the mortality rate per 100,000 decreased from 30.2 in 2012 to 6.1 in 2017. We found variation in morbidity hotspots from 8 to 23 in the western, south-western and north-eastern areas of the country each year, and six persistent mortality hotspots in the north-eastern areas. Conclusion: Over the review period, U5 malaria morbidity increased while mortality decreased. Variability in morbidity hotspots occurred across the western and northern regions unlike persistence of mortality hotspots in the north-eastern region. We recommend that the National Malaria Control Program systematically deploys preventive and case management interventions to areas of hotspots and also conduct a further evaluation to identify the causes of high mortality in the northeastern areas

Prevalence of non-fatal injuries and associated factors in Mbarara Municipality, Western Uganda, December 2016-June 2017

Background: Injuries are a significant public health problem but poorly quantified especially in low and middle-income countries. In Uganda, the burden of injuries is poorly quantified with most of the data reported being facility and mortality based. Many non-fatal injuries, therefore, remain unreported in communities. We conducted a household survey in Mbarara Municipality to identify and describe all non-fatal injury events and the associated factors. Methods: We conducted a cross-sectional study of non-fatal injuries among 966 household members in Mbarara Municipality, from May to June 2017. The most recent non-fatal injury (within a six-month recall period; December 2016 to June 2017) resulting in loss of at least one day of usual daily operating activity was considered. We conducted a descriptive statistical analysis to estimate the counts and frequencies of non-fatal injuries. We identified factors associated with non-fatal injuries using a modified Poisson regression model. Results: The prevalence of non-fatal injuries was 18.2% (176/966) with 92% (162/176) of the non-fatal injuries being unintentional. Falls 27.3% (48/176) were the most common cause of injury followed by road traffic injuries (RTI), 26.7% (47/176), burns 16.5% (29/176) and the least being poisoning 2.8% (5/176). Occupation as casual laborer (Adjusted PR=2.1, 95% CI: 1.2 - 3.7), urban residency (Adjusted PR=1.5, 95% CI: 1.1 - 1.9) and being a non-native of the study area (Adjusted PR=1.7, 95% CI: 1.3 - 2.3) were independently associated with non-fatal injuries. Conclusion: Almost one out of five people had suffered a non-fatal injury in the past six months in Mbarara Municipality. Majority of the non-fatal injuries were unintentional, caused by falls and RTIs, and were amongst casual labourers and urban residents. These findings reveal a gap in injury prevention in Uganda that needs to be addressed to improve the quality of life