Invasive bacterial infections in Gambians with sickle cell anaemia in an era of widespread Pneumococcal and Haemophilus influenzae type B vaccination

Background: There is relatively little data on the aetiology of bacterial infections in patients with sickle cell anaemia (SCA) in West Africa, and no data from countries that have implemented conjugate vaccines against both Streptococcus pneumoniae and Haemophilus influenzae type b (Hib). Methods: We conducted a retrospective analysis of SCA patients admitted to the Medical Research Council Unit, The Gambia during a five-year period when there was high coverage of Hib and Pneumococcal conjugate vaccination. We evaluated 161 admissions of 126 patients between April 2010 and April 2015. Results: Pathogenic bacteria were identified in blood cultures from 11 of the 131 admissions that had cultures taken (8.4%, 95% CI 4.5-14.1%). The most frequent isolate was Salmonella Typhimurium (6/11; 54.5%), followed by Staphylococcus aureus (2/11; 18.2%) and other enteric Gram-negative pathogens (2/11; 18.2%) and there was one case of H. influenzae non-type b bacteraemia (1/11; 9.1%). There were no episodes of bacteraemia caused by S. pneumoniae or Hib. Conclusions: The low prevalence of S. pneumoniae and Hib, and the predominance of non-typhoidal Salmonella as a cause of bacteraemia suggest the need to reconsider optimal antimicrobial prophylaxis and the empirical treatment regimens for patients with SCA

Factors that influenced utilization of antenatal and immunization services in two local government areas in The Gambia during COVID-19: An interview-based qualitative study.

INTRODUCTION: Evidence is being consolidated that shows that the utilization of antenatal and immunization services has declined in low-income countries (LICs) during the COVID-19 pandemic. Very little is known about the effects of the pandemic on antenatal and immunization service utilization in The Gambia. We set out to explore the COVID-19-related factors affecting the utilization of antenatal and immunization services in two Local Government Areas (LGAs) in The Gambia. METHODS: A qualitative methodology was used to explore patients' and providers' experiences of antenatal and immunization services during the pandemic in two LGAs in The Gambia. Thirty-one study participants were recruited from four health facilities, applying a theory-driven sampling framework, including health workers as well as female patients. Qualitative evidence was collected through theory-driven semi-structured interviews, and was recorded, translated into English, transcribed, and analysed thematically, applying a social-ecological framework. RESULTS: In our interviews, we identified themes at five different levels: individual, interpersonal, community, institutional and policy factors. Individual factors revolved around patients' fear of being infected in the facilities, and of being quarantined, and their anxiety about passing on infections to family members. Interpersonal factors involved the reluctance of partners and family members, as well as perceived negligence and disrespect by health workers. Community factors included misinformation within the community and mistrust of vaccines. Institutional factors included the shortage of health workers, closures of health facilities, and the lack of personal protective equipment (PPEs) and essential medicines. Finally, policy factors revolved around the consequences of COVID-19 prevention measures, particularly the shortage of transport options and mandatory wearing of face masks. CONCLUSIONS: Our findings suggest that patients' fears of contagion, perceptions of poor treatment in the health system, and a general anxiety around the imposing of prevention measures, undermined the uptake of services. In future emergencies, the government in The Gambia, and governments in other LICs, will need to consider the unintended consequences of epidemic control measures on the uptake of antenatal and immunization services

The gravity duals of SO/USp superconformal quivers

We study the gravity duals of SO/USp superconformal quiver gauge theories realized by M5-branes wrapping on a Riemann surface ("G-curve") together with a Z_2-quotient. When the G-curve has no punctures, the gravity solutions are classified by the genus g of the G-curve and the torsion part of the four-form flux G_4. We also find that there is an interesting relation between anomaly contributions from two mysterious theories: T_{SO(2N)} theory with SO(2N)^3 flavor symmetry and \tilde{T}_{SO(2N)} theory with SO(2N) x USp(2N-2)^2 flavor symmetry. The dual gravity solutions for various SO/USp-type tails are also studied.Comment: 27 pages, 13 figures; v2 minor corrections, typos corrected, Figure 13 replaced, references adde

Technical efficiency of primary health units in Kailahun and Kenema districts of Sierra Leone

<p>Abstract</p> <p>Background</p> <p>The objectives of the study reported in this paper were to (i) estimate the technical efficiency of samples of community health centres (CHCs), community health posts (CHPs) and maternal and child health posts (MCHPs) in Kailahun and Kenema districts of Sierra Leone, (ii) estimate the output increases needed to make inefficient MCHPs, CHCs and CHPs efficient, and (iii) explore strategies for increasing technical efficiency of these institutions.</p> <p>Methods</p> <p>This study applies the data envelopment analysis (DEA) approach to analyse technical efficiency of random samples of 36 MCHPs, 22 CHCs and 21 CHPs using input and output data for 2008.</p> <p>Results</p> <p>The findings indicate that 77.8% of the MCHPs, 59.1% of the CHCs and 66.7% of the CHPs were variable returns to scale technically inefficient. The average variable returns to scale technical efficiency was 68.2% (SD = 27.2) among the MCHPs, 69.2% (SD = 33.2) among the CHCs and 59% (SD = 34.7) among the CHPs.</p> <p>Conclusion</p> <p>This study reveals significant technical inefficiencies in the use of health system resources among peripheral health units in Kailahun and Kenema districts of Sierra Leone. There is need to strengthen national and district health information systems to routinely track the quantities and prices of resources injected into the health care systems and health service outcomes (indicators of coverage, quality and health status) to facilitate regular efficiency analyses.</p

Evaluation de la productivité et de la mortalité de la poule locale sur le plateau du Sankaran, Faranah, Guinée, en 1993-1994

Cet article traite de la productivité et de la mortalité de la poule de race locale en milieu villageois (plateau du Sankaran). La productivité de cette poule était très modeste, caractérisée par le nombre d'œufs par couvée (10,05 + ou - 0,15) et le nombre de couvées par an (3,8 + ou - 0,07). Le taux d'éclosion des œufs a varié de 42 à 100 %. Le poids moyen des œufs était de 30,7 + ou - 0,03 g. Le poids moyen des poussins éclos était de 22,8 + ou - 0,23 g. Le taux de fertilité s'est élevé à 87,5 % et le taux de viabilité des poussins d'un jour était de 89,31 %. La maladie de Newcastle et la typhose pullorose étaient les principales causes de mortalité chez les poules et les poussins (plus de 60 % des pertes). Le taux de mortalité brut annuel s'est élevé à 80 % chez les poules et à 73,16 % chez les poussins. Le taux de mortalité brut saisonnier s'est élevé notamment pendant les saisons humide et froide. L'effet de la saison sur la mortalité des poules et des poussins observé au moyen du test du chi2 était très significatif (P 0,05) et étaient respectivement de -0,639 et 0,4081. L'intervalle de confiance du coefficient de corrélation était de -0,639 + ou - 1,7384. L'effet des saisons sur le taux d'éclosion n'était pas significatif (P > 0,05). Les effets des saisons, des maladies et leur interaction étaient très significatifs (P < 0,005) sur le taux de mortalité des poussins. Le sex-ratio coq/poule était de 38 %. Les éleveurs ont gardé 28 % des volailles pour le renouvellement du cheptel

serological markers of pulmonary tuberculosis and of response to anti tuberculosis treatment in a patient population in guinea

The aim of the study was to evaluate serological correlates of active tuberculosis and of response to antituberculosis treatment in a cohort of HIV-negative patients with pulmonary tuberculosis studied at diagnosis and during treatment at the Service de Pneumo-Phtisiologie, Centre Hospitalier-Universitaire Ignace Deen, Conakry, Republic of Guinea. Two similar cohorts of HIV-negative healthy households of patients and healthy community controls were included in the study. Plasma samples were obtained from 168 untreated tuberculosis patients, 167 healthy household controls, and 168 healthy community controls. Serial plasma samples were also obtained from the tuberculosis patients at 2 and 8 months after initiation of chemotherapy. IgG antibody levels were measured by an enzyme-linked immunosorbent assay (ELISA) using ten purified M. tuberculosis antigens. ELISA results were analysed by comparing geometric means of data. Of the ten antigens tested, five (14kDa Ag, 19kDa Ag, AlaDH, MS, and MPT83) elicited similar antibody responses in untreated TB patients and controls. In contrast, levels of three antibodies (ESAT-6, LAM, and 38kDa Ag) were higher in untreated TB patients than in household or community controls (p<0.0001). Levels were higher in untreated patients than in community controls also for the anti-Rv2626c antibody (p = 0.0001) and, at a lower significance level, for the anti-FdxA antibody (p<0.025). Antibody levels against ESAT-6 and Rv2626c decreased during therapy, while antibody levels to the 38 kDa antigen and LAM increased during therapy; FdxA antibody levels did not vary with treatment. Neither severity of presentation nor chest X-ray patterns affected levels of these antibodies before treatment. In contrast, after the 8-month therapeutic course, patients who presented with moderate/severe disease had higher levels of anti-ESAT-6, anti-FdxA, and anti-38kDa antibodies than those of patients with mild disease onset. Patients with bilateral lung lesions had significantly higher anti-38kDa and anti-LAM levels, both at diagnosis and after 8-month treatment, than patients with lesions involving only one lung. Antibodies to alanine dehydrogenase and malate synthetase measured at initiation of treatment were higher in tuberculosis patients who subsequently failed therapy than in those who were cured. The main conclusions of the study are: a) plasma levels of antibodies to a number of M. tuberculosis represent serological correlates of active disease; b) these correlates are affected in an antigen-specific fashion by anti-tuberculosis treatment; c) particular serological markers may be predictive of treatment outcome

DIFFICULTÉS DE LA PARTICIPATION EN RECHERCHE- ACTION : retour d'expériences de modélisation d'accompagnement en appui à l'aménagement du territoire au Sénégal et à la Réunion

International audienceComment aider les institutions et acteurs locaux à investir davantage les processus d'affectation des terres pour aménager leur territoire ? La décentralisation de l'aménagement du territoire engagée à la Réunion et au Sénégal est inachevée. Malgré l'arsenal législatif, les populations locales semblent peu impliquées dans les décisions les concernant en raison notamment de la difficulté à appréhender la complexité des systèmes d'interactions entre dynamiques sociales et environnementales. Le projet Domino vise à accompagner les processus de décision en proposant aux acteurs de construire et d'explorer des scenarii prospectifs d'affectation des terres. Cette expérience de modélisation participative repose sur une dynamique partenariale complexe sur chaque terrain, source de difficultés. Conscients des dérives potentielles, nous discutons la nécessité de construire une démarche qualité de notre recherche-action. Mots clés : montage de partenariat, démarche qualité, modèle, changement social, ComMod, interdisciplinarité, décentralisation, foncier, Sénégal, Réunio

Dipole Coupling Effect of Holographic Fermion in the Background of Charged Gauss-Bonnet AdS Black Hole

We investigate the holographic fermions in the charged Gauss-Bonnet $AdS_{d}$ black hole background with the dipole coupling between fermion and gauge field in the bulk. We show that in addition to the strength of the dipole coupling, the spacetime dimension and the higher curvature correction in the gravity background also influence the onset of the Fermi gap and the gap distance. We find that the higher curvature effect modifies the fermion spectral density and influences the value of the Fermi momentum for the appearance of the Fermi surface. There are richer physics in the boundary fermion system due to the modification in the bulk gravity.Comment: 16 pages, accepted for publication in JHE