Disease Surveillance Networks Initiative Africa: Final Evaluation

The overall objective of the Foundation's Disease Surveillance Networks (DSN) Initiative is to strengthen technical capacity at the country level for disease surveillance and to bolster response to outbreaks through the sharing of technical information and expertise. It supports formalizing collaboration, information sharing and best practices among established networks as well as trans-national, interdisciplinary and multi-sectoral efforts, and is experienced in developing and fostering innovative partnerships. In order to more effectively address disease threats, the DSN has four key outcome areas:(1) forming and sustaining trans-boundary DSN;(2) strengthening and applying technical and communication skills by local experts and institutions;(3) increasing access and use of improved tools and methods on information sharing, reporting and monitoring; and(4) emphasizing One Health and transdisciplinary approaches to policy and practice at global, regional and local levels

Children's stress-related reports and stress biomarkers interact in their association with metabolic syndrome risk

The purpose was to examine the cross-sectional associations of stress-related reports and stress biomarkers with metabolic syndrome (MetS) risk in children while also testing the interaction between stress biomarkers and stress reports. In 353 children (5-10years old, 7.9% overweight/obese), MetS risk was measured by blood pressure, waist circumference, glucose homeostasis, triglycerides, and high-density cholesterol. Stress was measured by stress-related reports (events, emotions, and internalizing/externalizing problems) and two biomarkers: salivary cortisol (total-day and morning output) and heart rate variability (percentage of consecutive normal RR intervals differing more than 50ms and low-to-high-frequency ratio). Cross-sectional regression analyses with z scored total MetS risk as outcome were adjusted for age, sex, and socio-economic status. Only internalizing problems were directly related to a higher MetS risk score (=0.236). Cortisol and heart rate variability were significant moderators: High cortisol morning output resulted in a positive (unfavourable) report-MetS relationship (=0.259-0.552), whereas low percentage of consecutive normal RR intervals differing more than 50ms resulted in a negative (favourable) report-MetS relationship (=-0.298) and low low-to-high-frequency ratio in a positive (unfavourable) report-MetS relationship (=0.478). In conclusion, stress can sometimes be a disadvantageous factor in metabolic health of otherwise healthy children. The cortisol biomarker seems relevant because metabolic risk was highest when stress-related reports were accompanied by high morning cortisol output

FLOTAC for the diagnosis of Hymenolepis spp. infection: proof-of-concept and comparing diagnostic accuracy with other methods

Hymenolepis nana is the most common cestode parasitizing humans, yet it is under-diagnosed. We determined the optimal flotation solution (FS) for the diagnosis of this intestinal parasite with the FLOTAC method, and compared its diagnostic accuracy with an ether-concentration technique and the Kato-Katz method. Zinc sulphate (specific gravity 1.20) proved to be the best-performing FS. Using this FS, we detected 65 H. nana infections among 234 fixed fecal samples from Tajik and Sahrawi children (prevalence 27.8%). The ether-concentration technique detected 40 infections (prevalence 17.1%) in the same samples. Considering the combined results as a reference, the sensitivities of FLOTAC and ether-concentration were 95.6% and 58.8%, respectively. The Kato-Katz method resulted in a prevalence of only 8.7%. In terms of eggs per gram of stool, a significantly (P <0.05) higher value was obtained with the FLOTAC and Kato-Katz techniques compared to ether-concentration. In another study carried out in China, the FLOTAC method detected six Hymenolepis diminuta infections in 302 fecal samples, whereas five samples were found positive with the Kato-Katz technique. We conclude that FLOTAC is an accurate coprodiagnostic technique for H. nana and H. diminuta, two species which join a growing list of intestinal parasites that can be reliably diagnosed by this techniqu

Prior selfing and the selfing syndrome in animals: an experimental approach in the freshwater snail Biomphalaria pfeifferi

Inbreeding species of hermaphroditic animals practising copulation have been characterized by few copulations, no waiting time (the time that an isolated individual waits for a partner before initiating reproduction compared with paired individuals) and limited inbreeding (self-fertilization) depression. This syndrome, which has never been fully studied before in any species, is analysed here in the highly selfing freshwater snail Biomphalaria pfeifferi. We conducted an experiment under laboratory conditions over two generations (G1 and G2) using snails sampled from two populations (100 individuals per population). G1 individuals were either isolated or paired once a week (potentially allowing for crosses), and monitored during 29 weeks for growth, fecundity and survival. Very few copulations were observed in paired snails, and there was a positive correlation in copulatory activity (e.g. number of copulations) between the male and female sexual roles. The waiting time was either null or negative, meaning that isolated individuals initiated reproduction before paired ones. G2 offspring did not differ in hatching rate and survival (to 28 days) between treatments, but offspring from paired individuals grew faster than those from isolated individuals. On the whole, the self-fertilization depression was extremely low in both populations. Another important result is that paired G1 individuals began laying (selfed) eggs several weeks prior to initiating copulation: this is the first characterization of prior selfing (selfing initiated prior to any outcrossing) in a hermaphroditic animal. A significant population effect was observed on most traits studied. Our results are discussed with regard to the maintenance of low outcrossing rates in highly inbreeding specie

Multiple parasite infections and their relationship to self-reported morbidity in a community of rural Côte d'Ivoire

Background Concomitant parasitic infections are common in the developing world, yet most studies focus on a single parasite in a narrow age group. We investigated the extent of polyparasitism and parasite associations, and related these findings to self-reported morbidity. Methods Inhabitants of 75 randomly selected households from a single village in western Côte d'Ivoire provided multiple faecal specimens and a single finger prick blood sample. The Kato-Katz technique and a formol-ether concentration method were employed to screen faecal samples for Schistosoma mansoni, soil-transmitted helminths and intestinal protozoa. Giemsa-stained blood smears were analysed for malaria parasites. A questionnaire was administered for collection of demographic information and self-reported morbidity indicators. Results Complete parasitological data were obtained for 500/561 (89.1%) participants, similarly distributed among sex, with an age range from 5 days to 91 years. The prevalences of Plasmodium falciparum, hookworms, Entamoeba histolytica/E. dispar, and S. mansoni were 76.4%, 45.0%, 42.2%, and 39.8%, respectively. Three-quarters of the population harboured three or more parasites concurrently. Multivariate analysis revealed significant associations between several pairs of parasites. Some parasitic infections and the total number of parasites were significantly associated with self-reported morbidity indicators. Conclusions Our data confirm that polyparasitism is very common in rural Côte d'Ivoire and that people have clear perceptions about the morbidity caused by some of these parasitic infections. Our findings can be used for the design and implementation of sound intervention strategies to mitigate morbidity and co-morbidit

Health Planning Approach Integrating a Health Literacy Concept and Using Community Health Teams in Tajikistan: ‘Work for the Sake of my Health and the Health of the Community’

The Enhancing Primary Health Care Services project supported the Ministry of Health and Social Protection in nine pilot health districts in Tajikistan to strengthen family medicine-oriented primary health care services. The project actively involved the community in this process by implementing a participatory health business planning process and health promotion approach. This study evaluated the degree of communities’ involvement in health planning processes and its effect on the population’s health literacy regarding risk factors of cardiovascular disease. The mixed-method longitudinal cross-sectional study design included a repeated community-based survey targeting Community Health Team representatives on their involvement in health business planning and health promotion activities and a health literacy survey on knowledge and behavior related to cardiovascular disease and risk factors among adults. The studies were conducted in four project districts in 2015 (only health literacy survey), 2017 and 2020, whereby rural communities were selected and then repeatedly visited. In each community, three community health team representatives were interviewed and 20 eligible adult women and men from randomly selected households. A total of 121 community health team representatives from 40 communities participated in the health business planning and health promotion surveys in 2017, and 154 from 55 communities in 2020. We analyzed complete data from 1,183 adult women and men from 60 communities participating in the health literacy surveys in 2015, 1,418 from 71 communities in 2017, and 1,111 from 55 communities in 2020. We found that the health business planning and promotion approach fostered the collaboration between the primary health care services, community authorities and the population through actively involving community health team representatives in these processes. The population’s overall knowledge of cardiovascular risk factors rated as ’good’ increased from 31% in the baseline to 46% in the endline. The respondent’s belief that changing their lifestyle affects their health increased from 60% to 86%, respectively. The health business planning and health literacy approaches empowered communities to successfully shape health planning by putting forward their health needs. This contributed to increasing people’s trust in primary health care services and enhanced the primary health care team’s accountability for progress towards the communities. Keywords: community health planning, community health team, health promotion, health literacy, cardiovascular diseases, primary health care ______________________________________________________________________________  Approche de planification sanitaire intégrant un concept de littératie en santé et recours aux équipes de santé communautaires au Tadjikistan : « Travailler pour le bien de ma santé et la santé de la communauté » RésuméLe projet d'amélioration des services de soins de santé primaires a aidé le ministère de la santé et de la protection sociale à renforcer les services de soins de santé primaires axés sur la médecine familiale, dans neuf districts sanitaires pilotes du Tadjikistan. Le projet a activement impliqué la communauté dans ce processus en mettant en oeuvre un processus participatif de planification des activités de santé et une approche de promotion de la santé. Cette étude a évalué le degré de participation des communautés aux processus de planification sanitaire et son effet sur les connaissances de la population en matière de santé en ce qui concerne les facteurs de risque des maladies cardiovasculaires. La conception de l'étude transversale longitudinale à méthode mixte comprenait une enquête communautaire répétée ciblant les représentants des équipes de santé communautaire sur leur participation à la planification des activités de santé et aux activités de promotion de la santé, ainsi qu'une enquête sur la littératie en matière de santé portant sur les connaissances et les comportements liés aux maladies cardiovasculaires et aux facteurs de risque chez les adultes. Les études ont été menées dans quatre districts du projet en 2015 (uniquement l'enquête sur les connaissances en matière de santé), 2017 et 2020, période au cours de laquelle des communautés rurales ont été sélectionnées, puis visitées à plusieurs reprises. Dans chaque communauté, trois représentants de l'équipe de santé communautaire ont été interrogés, ainsi que 20 femmes et hommes adultes éligibles et issus de ménages sélectionnés au hasard. Au total, 121 représentants d'équipes de santé communautaire de 40 communautés ont participé aux enquêtes sur la planification des activités de santé et à la promotion de la santé en 2017, et 154 de 55 communautés en 2020. Nous avons analysé les données complètes de 1 183 femmes et hommes adultes de 60 communautés ayant participé aux enquêtes sur la littératie en santé en 2015, de 1 418 personnes de 71 communautés en 2017 et de 1 111 personnes de 55 communautés en 2020. Nous avons constaté que l'approche de la planification et de la promotion des activités de santé favorisait la collaboration entre les services de soins de santé primaires, les autorités communautaires et la population en impliquant activement les représentants de l'équipe de santé communautaire dans ces processus. Les connaissances générales de la population sur les facteurs de risque cardiovasculaire, jugées "bonnes", sont passées de 31 % lors de l'enquête de référence à 46 % lors de l'enquête finale. La conviction des personnes interrogées que le changement de leur mode de vie a une incidence sur leur santé est passée de 60 % à 86 %, respectivement. Les approches de planification des activités de santé et de littératie en matière de santé ont permis aux communautés de façonner avec succès la planification de la santé en mettant en avant leurs besoins dans ce domaine. Cela a contribué à accroître la confiance des gens dans les services de soins de santé primaires et à renforcer la responsabilité de l'équipe de soins de santé primaires à l'égard des progrès réalisés auprès des communautés. Mots clés : planification de la santé communautaire, équipe de santé communautaire, promotion de la santé, littératie en matière de santé, maladies cardiovasculaires, soins de santé primaires

Impact of Group Formation on Women’s Empowerment and Economic Resilience in Rural Tajikistan

The overall aim of the Women’s Wealth and Influence (WW&I) project was to improve the economic situation and empowerment of women through the formation of groups as a platform for joint activities, savings and solidarity. In 17 districts of Khatlon Province in South Tajikistan, active female community members were trained as ‘coaches’ and mobilised women to form some 3,000 groups with a total membership of approximately 65,000. Using mixed methods, a study was undertaken to monitor processes of change initiated by this approach. This study set out to determine the extent of change associated with the implementation over two years of the WW&I model on the lives of participating women. In particular, it examines changes and stasis in women’s income and prosperity, access to and control over assets, personal empowerment as well a broader interpersonal and household change. Findings revealed that WW&I group members engaged in paid labour more frequently (20%) than non-members (12%), although the overall proportion of women involved in waged labour remained low throughout the project’s lifespan. Nonetheless, savings accumulated by the women’s groups provided a new means for women to access and control cash. Although there is no indication of group funds contributing to improved household wealth, there is evidence that it provided a buffer in times of acute financial stress, thereby strengthening the economic resilience of group members and their families. Group members also became more able to move freely outside their households: as only 8% had to be accompanied by a family member, compared with 15% of women who were not members of a group. Members of women’s groups also reported greater decision-making power in their daily lives compared to non-members. Moreover, through their group actions, women exercised leadership and decision-making in two arenas: organising social events and improving community infrastructure and amenities. This, in turn, raised their reputation for solving community challenges and marks an important step towards broader female empowerment. This indicates that the WW& I approach has potential for adaptation to address broader issues of female social and economic development in rural Tajikistan. Keywords: women’s groups; female empowerment; economic resilience; social capital Résumé L'objectif principal du projet de Women's Wealth and Influence (WW&I) était d'améliorer la situation et l'émancipation économiques des femmes à travers la formation de groupes comme plateforme d'activités conjointes, d'épargne et de solidarité. Dans les 17 districts de la Province de Khatlon, au sud du Tadjikistan, des femmes participant activement à la communauté ont été formées comme 'mentors' et ont mobilisé d'autres femmes pour former quelques 3000 groupes ainsi qu'un total d'adhésions d'environ 65 000 personnes. Selon une méthodologie mixte, une étude a été menée afin de surveiller les processus de changements initiés par cette approche. Cette étude vise à déterminer l'ampleur des changements associés à la mise en œuvre du modèle de WW&I, pendant deux ans, dans les vies des femmes participantes. En particulier, elle examine les changements et stagnations dans le revenu des femmes, leur prospérité, l'accès à leurs actifs, leur émancipation économique ainsi que de multiples changements interpersonnels et domestiques. Les conclusions montrent que les membres du groupe de WW&I sont engagés dans le marché du travail plus fréquemment (20%) que les non-membres (12%), bien que la proportion totale de femmes impliquée dans le travail rémunéré demeure faible tout au long de la durée du projet. Toutefois, les épargnes accumulées par les femmes des groupes ont fourni de nouveaux moyens pour les femmes d'accéder et de contrôler l'argent. Bien qu'il n'y ait pas d'indication de fonds collectifs contribuant à l'amélioration de la richesse des ménages, des preuves montrent que cette épargne a servi de coussin financier dans des situations de difficulté monétaire grave, renforçant ainsi la solidité économique de membres et de leurs familles. Les membres du groupe ont acquis plus d'autonomie pour se déplacer librement à l'extérieur du foyer: seulement 8% doivent être accompagnés par un membre de la famille, comparativement à 15% pour les femmes qui ne sont pas membres du groupe. Les membres des groupes de femmes ont aussi reporté un accroissement du pouvoir décisionnel dans leurs vies quotidiennes en comparaison à celles des non-membres. De plus, par leurs actions collectives, les femmes ont exercé leadership et prise de décisions sur deux scènes: l'organisation sociale d'évènements et l'amélioration des infrastructures et des équipements communautaires. Cela, en retour, a accru leur renommée en matière de résolution des défis communautaires et marque une étape fondamentale vers une plus grande autonomie des femmes. Cela indique que l'approche de WW& I a le potentiel de s'adapter pour traiter d'enjeux plus vastes concernant le développement social et économique des femmes en milieu rural Tadjik

History of malaria control in Tajikistan and rapid malaria appraisal in an agro-ecological setting

10.1186/1475-2875-7-217Malaria Journal721

Prevalence and risk factors of helminths and intestinal protozoa infections among children from primary schools in western Tajikistan

BACKGROUND: Intestinal parasitic infections represent a public health problem in Tajikistan, but epidemiological evidence is scarce. The present study aimed at assessing the extent of helminths and intestinal protozoa infections among children of 10 schools in four districts of Tajikistan, and to make recommendations for control. METHODS: A cross-sectional survey was carried out in early 2009. All children attending grades 2 and 3 (aged 7-11 years) from 10 randomly selected schools were invited to provide a stool sample and interviewed about sanitary situation and hygiene behaviour. A questionnaire pertaining to demographic and socioeconomic characteristics was addressed to the heads of households. On the spot, stool samples were subjected to duplicate Kato-Katz thick smear examination for helminth diagnosis. Additionally, 1-2 g of stool was fixed in sodium acetate-acetic acid formalin, transferred to a specialized laboratory in Europe and examined for helminths and intestinal protozoa. The results from both methods combined served as diagnostic 'gold' standard. RESULTS: Out of 623 registered children, 602 participated in our survey. The overall prevalence of infection with helminths and pathogenic intestinal protozoa was 32.0% and 47.1%, respectively. There was pronounced spatial heterogeneity. The most common helminth species was Hymenolepis nana (25.8%), whereas the prevalences of Ascaris lumbricoides, hookworm and Enterobius vermicularis were below 5%. The prevalence of pathogenic intestinal protozoa, namely Giardia intestinalis and Entamoeba histolytica/E. dispar was 26.4% and 25.9%, respectively. Almost half of the households draw drinking water from unimproved sources, such as irrigation canals, rivers and unprotected wells. Sanitary facilities were pit latrines, mostly private, and a few shared with neighbours. The use of public tap/standpipe as a source of drinking water emerged as a protective factor for G. intestinalis infection. Protecte spring water reduced the risk of infection with E. histolytica/E. dispar and H. nana. CONCLUSIONS: Our data obtained from the ecological 'lowland' areas in western Tajikistan call for school-based deworming (recommended drugs: albendazole and metronidazole), combined with hygiene promotion and improved sanitation. Further investigations are needed to determine whether H. nana represents a public health problem

Trends in reported malaria cases and the effects of malaria control in the Democratic Republic of the Congo

Considerable upscaling of malaria control efforts have taken place over the last 15 years in the Democratic Republic of Congo, the country with the second highest malaria case load after Nigeria. Malaria control interventions have been strengthened in line with the Millenium Development Goals. We analysed the effects of these interventions on malaria cases at health facility level, using a retrospective trend analysis of malaria cases between 2005 and 2014. Data were collected from outpatient and laboratory registers based on a sample of 175 health facilities that represents all eco-epidemiological malaria settings across the country.; We applied a time series analysis to assess trends of suspected and confirmed malaria cases, by health province and for different age groups. A linear panel regression model controlled for non-malaria outpatient cases, rain fall, nightlight intensity, health province and time fixed effects, was used to examine the relationship between the interventions and malaria case occurrences, as well as test positivity rates.; Overall, recorded suspected and confirmed malaria cases in the DRC have increased. The sharp increase in confirmed cases from 2010 coincides with the introduction of the new treatment policy and the resulting scale-up of diagnostic testing. Controlling for confounding factors, the introduction of rapid diagnostic tests (RDTs) was significantly associated with the number of tested and confirmed cases. The test positivity rate fluctuated around 40% without showing any trend.; The sharp increase in confirmed malaria cases from 2010 is unlikely to be due to a resurgence of malaria, but is clearly associated with improved diagnostic availability, mainly the introduction of RDTs. Before that, a great part of malaria cases were treated based on clinical suspicion. This finding points to a better detection of cases that potentially contributed to improved case management. Furthermore, the expansion of diagnostic testing along with the increase in confirmed cases implies that before 2010, cases were underreported, and that the accuracy of routine data to describe malaria incidence has improved