Impact of mass distribution of free long-lasting insecticidal nets on childhood malaria morbidity: The Togo National Integrated Child Health Campaign

<p>Abstract</p> <p>Background</p> <p>An evaluation of the short-term impact on childhood malaria morbidity of mass distribution of free long-lasting insecticidal nets (LLINs) to households with children aged 9-59 months as part of the Togo National Integrated Child Health Campaign.</p> <p>Methods</p> <p>The prevalence of anaemia and malaria in children aged zero to 59 months was measured during two cross-sectional household cluster-sample surveys conducted during the peak malaria transmission, three months before (Sept 2004, n = 2521) and nine months after the campaign (Sept 2005, n = 2813) in three districts representative of Togo's three epidemiological malaria transmission regions: southern tropical coastal plains (Yoto), central fertile highlands (Ogou) and northern semi-arid savannah (Tone).</p> <p>Results</p> <p>In households with children <5 years of age, insecticide-treated net (ITN) ownership increased from <1% to >65% in all 3 districts. Reported ITN use by children during the previous night was 35.9%, 43.8% and 80.6% in Yoto, Ogou and Tone, respectively. Rainfall patterns were comparable in both years. The overall prevalence of moderate to severe anaemia (Hb < 8.0 g/dL) was reduced by 28% (prevalence ratio [PR] 0.72, 95% CI 0.62-0.84) and mean haemoglobin was increased by 0.35 g/dL (95% CI 0.25-0.45).</p> <p>The effect was predominantly seen in children aged 18-59 months and in the two southern districts: PR (95% CI) for moderate to severe anaemia and clinical malaria: Yoto 0.62 (0.44-0.88) and 0.49 (0.35-0.75); Ogou 0.54 (0.37-0.79) and 0.85 (0.57-1.27), respectively. Similar reductions occurred in children <18 months in Ogou, but not in Yoto. No effect was seen in the semi-arid northern district despite a high malaria burden and ITN coverage.</p> <p>Conclusions</p> <p>A marked reduction in childhood malaria associated morbidity was observed in the year following mass distribution of free LLINs in two of the three districts in Togo. Sub-national level impact evaluations will contribute to a better understanding of the impact of expanding national malaria control efforts.</p

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Performance d’Hemocue Hb 201+ dans le diagnostic de l’anémie de l’enfant dans les structures sanitaires du niveau périphérique au Togo

Contexte: L’anémie est un problème de santé publique dans le monde entier, et notamment dans les pays en développement. Elle a des répercussions majeures sur la santé et sur ledéveloppement économique et social d’un pays. La prise en charge des patients anémiés étant nécessaire, il faut un diagnostic biologique précis, et donc un dosage du taux d’hémoglobine par des méthodes fiables. Objectif: Évaluer les performances diagnostiques du test Hemocue Hb201+®. Méthodes: Étude comparative de la mesure du taux d’hémoglobine à partir du photomètre Hemocue Hb 201+® et d’analyseurs d’hématologie chez 213 enfants de 6 à 59 mois souffrant d’un paludisme simple; la détermination du taux d’hémoglobine par les analyseurs est retenue comme méthode de référence pour évaluer Hemocue Hb201+®. Résultats: 72.8% des valeurs obtenues par Hemocue Hb201+® étaient à ±1 g/dl de celles de la méthode de référence. Le coefficient de corrélation de Pearson était de 0.80. La prévalence de l’anémie était de 79.3% pour la méthode de référence et de 77.9% pour Hemocue Hb201+®. La sensibilité et la spécificité de l’analyseur Hemocue Hb201+® étaient respectivement de 95.1% et de 65.3%. Conclusion: Les résultats de l’étude ont montré que le test Hemocue Hb201+® présentait une bonne sensibilité, une spécificité moyenne et une exactitude moyenne dans le diagnostic del’anémie et dans le dosage de l’hémoglobine. Son utilisation peut être recommandée dans les structures périphériques afin de faciliter le diagnostic biologique de l’anémie et sa prise encharge dans les populations vivant dans les zones difficiles d’accès. Performance of HemoCue Hb201+ in the diagnosis of anaemia in children in health facilitiesat the peripheral level in Togo Background: Anaemia is a global public health problem, especially in developing countries. Anaemia has major repercussions on health status, as well as on the economic and social development of a country. Effective care of anaemic patients requires a reliable and precisediagnostic test that can determine haemoglobin levels. Objective: To evaluate the diagnostic performance of the Hemocue test Hb201+®. Method: This study compared haemoglobin levels measured using the photometer Hemocue Hb201+® with those measured by analysers of haematology. Children aged 6 to 59 months who suffered from uncomplicated malaria were eligible for inclusion. Haemoglobin levels determined by the analysers were considered the reference for evaluation of the levels measured using Hemocue Hb201+®. Results: 72.8% of the values obtained by Hemocue Hb201® were within ±1g/dl of the reference value. The Pearson correlation coefficient was 0.80. The prevalence of anaemia was 79.3% using the reference method and 77.9% using Hemocue 201+®. The sensitivity and the specificity of Hemocue Hb201+® were 95.1% and 65.3% respectively. Conclusion: The study results showed that the Hemocue Hb201 test+® provided good sensitivity, average specificity and average precision, both for the diagnosis of anaemia and for the determination of haemoglobin levels. It may be used in peripheral centres to facilitate the laboratory diagnosis of anaemia and its management in populations that live in areas with difficult accessibility

Physico-chemical quality of ashes post-incineration and waste from laboratory automaton biochemistry, hematology and serology in Togo

Biochemistry, hematology and serology laboratories produce very heterogeneous discharges capable of polluting water, soil and the environment. The aim of this study is to evaluate the physico-chemical quality of the ashes, effluents and the range of equipment that produce the much effluent and pollutions.This is a descriptive and cross-sectional study of 82 laboratories followed by the sampling of effluents from automatons. The physico-chemical parameters and trace elements are determined according to French Standardization Association (AFNOR) standards and used atomic absorption spectrometers and molecular absorption spectrometers. The Mindray hematology automaton is used for 64.7% and 81.5% of the cans are used to collect waste. Semehow 77.8% of discharges are released into sinks without adequate treatment in 42.6% of cases. Chemical analyses show that trace elements (TE) levels in effluents range from 5.89 ± 0.21 to 105.80 ± 0.96 μg/L for Arsenic; from 5.62 ± 0.34 to 6.53 ± 0.49 μg/L for Cadmium; 0.70 ± 0.01 to 10.63 ± 1.17 μg/L for Mercure and 35.72 ± 1.88 to 61.98 ± 5.15 μg/L for Plomb. pH ranges from 7.17 ± 0.65 to 8.3 ± 1.35 with total dissolved salts (TDS) range from 3260.20 ± 401.68 to 17117.41 ± 265.37 mg/L. All averages of contamination indices (CI) and polymetallic contamination indices (PCI) for post-incineration ashes are greater than 1.5 with the exception of Hg (0.22). For effluents, in addition to polymetallic contamination indices (PCI), CI in hematology effluents (1.09), all CI are less than 1. Hematology effluents have a lower pH and are much more mineralized and concentrated in trace elements while those from biochemistry and serology appear to be similar. However, the effluents of Biochemistry and Serology are more basic and concentrated in Suspended Solids with higher values obtained in Biochemistry. Although the physico-chemical parameters comply with WHO standards, discharges from automatons deserve appropriate treatment before their disposal

The associations between water and sanitation and hookworm infection using cross-sectional data from Togo's national deworming program.

Sustainable control of soil-transmitted helminths requires a combination of chemotherapy treatment and environmental interventions, including access to safe drinking water, sufficient water for hygiene, use of clean sanitation facilities, and handwashing (WASH). We quantified associations between home-, school-, and community-level WASH characteristics and hookworm infection-both prevalence and eggs per gram of stool (intensity)-among Togolese school children in the context of community-based chemotherapy treatments administered in the country from 2010 through 2014.We analyzed data from two surveys conducted by the Togo Ministry of Health: a school-based survey of students aged 6-9 years across Togo conducted in 2009 and a follow-up survey in 2015, after four to five years of preventive chemotherapy. Data were available for 16,473 students attending 1,129 schools in 2009 and for 16,890 students from 1,126 schools in 2015. Between surveys, children in study schools received 0 to 8 rounds of deworming chemotherapy treatments. Few WASH conditions (only unimproved drinking water) were found to be significantly associated with the presence or absence of hookworms in an individual; however, quantitative eggs per gram of feces was associated with availability of unimproved drinking water, availability of improved drinking water either on or off school grounds, having a handwashing station with water available, and access to a sex-separate non-private or private latrine. The association between school WASH conditions and hookworm infection or burden often depended on the 2009 prevalence of infection, as more WASH characteristics were found to be significant predictors of infection among schools with high underlying endemicity of hookworm.Our findings emphasize the complex and often inconsistent or unpredictable relationship between WASH and hookworm. Specifically, we found that while preventive chemotherapy appeared to dramatically reduce hookworm infection, WASH was associated with infection intensity

Prevalence and factors associated with trichomonas vaginalis infection among female sex workers in Togo, 2017

International audienceBackground: The aim of this study was to estimate the prevalence and factors associated with Trichomonas vaginalis (T. vaginalis) among female sex workers (FSW) in Togo in 2017. A cross-sectional bio-behavioral study was conducted from August to October 2017 using a respondent-driven sampling method in four cities in Togo. Method: A standardized questionnaire was used to record socio-demographic data and sexual behavior patterns. T. vaginalis detection by molecular biology tests was performed using Allplex STI Essential Assay which detect also 6 others microorganisms. A blood sample was drawn and serological test using SD Bioline Duo VIH/Syphilis rapid test was performed for Human immunodeficiency virus (HIV) and syphilis testing. Results: A total of 310 FSW with median age 25 years, interquartile range (IQR) [21-32 years] were included. The prevalence of T. vaginalis was 6.5% (95%CI = [4.1-9.9]) and, overall, prevalence of other STI ranged from 4.2% (95%CI = [2.3-7.2]) for N. gonorrhoeae to 10.6% (95% CI = [7.5-14.7]) for HIV. Binary logistic regression was conducted to assess factors associated with T. vaginalis infection. Living in Lomé (aOR = 3.19; 95%CI = [1.11-11.49]), having had sexual intercourse before the age of 18 (aOR = 5.72; 95%CI = [1.13-10.89]), and being infected with C. trachomatis (aOR = 3.74; 95%CI = [2.95-12.25]) were factors associated with T. vaginalis among FSW. Conclusion: The prevalence of T. vaginalis infection using molecular test was low among FSW in Togo. Extensive studies are needed to confirm and to better understand the epidemiology of T. vaginalis among this population and in other populations in Togo

Multivariable associations between WASH conditions and prevalence/intensity of hookworm infection.

<p>Multivariable associations between WASH conditions and prevalence/intensity of hookworm infection.</p

Prevalence and intensity of hookworm infections in 2009 and 2015 and number of treatments.

<p>Prevalence and intensity of hookworm infections in 2009 and 2015 and number of treatments.</p

School and home WASH conditions.

<p>School and home WASH conditions.</p