Ebola virus disease in West Africa — the first 9 Months of the epidemic and forward projections

BACKGROUND On March 23, 2014, the World Health Organization (WHO) was notified of an outbreak of Ebola virus disease (EVD) in Guinea. On August 8, the WHO declared the epidemic to be a "public health emergency of international concern." METHODS By September 14, 2014, a total of 4507 probable and confirmed cases, including 2296 deaths from EVD (Zaire species) had been reported from five countries in West Africa - Guinea, Liberia, Nigeria, Senegal, and Sierra Leone. We analyzed a detailed subset of data on 3343 confirmed and 667 probable Ebola cases collected in Guinea, Liberia, Nigeria, and Sierra Leone as of September 14. RESULTS The majority of patients are 15 to 44 years of age (49.9% male), and we estimate that the case fatality rate is 70.8% (95% confidence interval [CI], 69 to 73) among persons with known clinical outcome of infection. The course of infection, including signs and symptoms, incubation period (11.4 days), and serial interval (15.3 days), is similar to that reported in previous outbreaks of EVD. On the basis of the initial periods of exponential growth, the estimated basic reproduction numbers (R-0) are 1.71 (95% CI, 1.44 to 2.01) for Guinea, 1.83 (95% CI, 1.72 to 1.94) for Liberia, and 2.02 (95% CI, 1.79 to 2.26) for Sierra Leone. The estimated current reproduction numbers (R) are 1.81 (95% CI, 1.60 to 2.03) for Guinea, 1.51 (95% CI, 1.41 to 1.60) for Liberia, and 1.38 (95% CI, 1.27 to 1.51) for Sierra Leone; the corresponding doubling times are 15.7 days (95% CI, 12.9 to 20.3) for Guinea, 23.6 days (95% CI, 20.2 to 28.2) for Liberia, and 30.2 days (95% CI, 23.6 to 42.3) for Sierra Leone. Assuming no change in the control measures for this epidemic, by November 2, 2014, the cumulative reported numbers of confirmed and probable cases are predicted to be 5740 in Guinea, 9890 in Liberia, and 5000 in Sierra Leone, exceeding 20,000 in total. CONCLUSIONS These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from EVD are expected to continue increasing from hundreds to thousands per week in the coming months

Evaluation of mid-level management training in immunisation in the African Region

Objective: The Mid-Level Management (MLM) training course provides managers of immunisation programmes with new, advanced skills in planning, management, monitoring and evaluation. An evaluation was conducted of the MLM training courses held between 2000 and 2004 in the African Region, in order to assess its effectiveness and impact, and its contribution to the management of the Extended Programme on Immunisation (EPI) at country level.Methods: Evaluation methods included: a desk review of the MLM course reports, WHO/AFRO MLM modules and reference documents; interviews with MLM course participants, facilitators, supervisors, Ministry of Health officials and country-based partners; focus group discussions; and questionnaires.Results: During 2000-2004, eleven MLM courses were held and 642 participants were trained. Of the 151 course participants interviewed, 85% rated the course as very useful and 15% as useful. Modules on new vaccines, immunisation safety, cold chain and vaccine management, communication and problem solving were most appreciated. According to supervisors, the MLM training has contributed to significant improvements in the performance of the staff after attending the MLM course. Using DTP3 as an indicator, immunisation coverage in the African Region increased from 49% in 1991 to 53% in 2001 and 69% in 2004.Conclusions: The MLM training has increased the performance of the trained staff and therefore contributed to the improvement of EPI coverage in the African Region. However, MLM training remains a predominantly vertical event and should be harmonised with other health training programmes for various levels of the health system

The clinical presentations, etiology and factors associated with foot mycoses among patients attending dermatology clinic at Mbarara Regional Referral Hospital, Mbarara, Uganda

Background: Foot mycosis is one of the most common fungal infections of the skin worldwide. The magnitude of the problem in terms of clinical presentations, etiology and associated factors remain as poorly established in low-income countries especially in Uganda.Objective: To study the clinical presentations, etiology and factors associated with foot mycoses among patients attending Mbarara Regional Referral Hospital, Mbarara, Uganda (MRRH). Materials and methods: This was a cross-sectional study that recruited 110 patients attending the skin clinic at MRRH between November 2018 and May 2019. The subjects were examined physically, and skin scrapings of suspected lesions were collected for laboratory processing.Results: Out of 110 suspects for foot mycoses 101 (91.8%) were diagnosed with a fungal. Fungal culture confirmed foot mycosis in 67 (60.9%) of the cases. Of the 67 fungal culture growth, dermatophytes were 39.5%, followed by yeasts with 32.6% and non-dermatophyte molds (NDMs) with 27.9%. The commonest associated factors were age and wearing occlusive shoes.Conclusion: The study reveals that foot mycosis is a common clinical entity at our dermatology clinic and interdigital was the most common clinical presentation, highlighting dermatophytes as the commonest etiological agents. Age and shoe design remain the most significant associated factors of the infection

What 1st metatarsal cortical thickness distribution reveals about locomotion of Sterkfontein and Swartkrans hominins

Two first metatarsals from Sterkfontein (StW562, StW595) and two from Swartkrans (SKX5017, SK1813) are analyzed. Early work demonstrated a mosaic nature of morphological traits on these metatarsals, complicating functional interpretations: these hominins were unquestionably bipedal, but likely possessed a toe-off mechanism different from modern humans. Here we analyzed cortical thickness patterns in first metatarsal shafts of African apes. Fossil hominin metatarsals were analysed similarly and patterns of thicknesses compared to the extant sample. We ask whether each of the four hominin metatarsals is most similar to one extant species, and if so, is it the same extant species in each case. First metatarsals of chimpanzees, gorillas, modern humans, and fossils were CT scanned. For each metatarsal, we measured 17 cross sections from 25% to 65% of diaphyseal mechanical length. In each cross section, we measured cortical thickness along radii separated by one degree increments. Cortical thicknesses were size standardized, after which they were used in a penalised discriminant analysis (PDA) to assess species-specific or fossil patterns. The first function of the PDA discriminates modern humans from chimpanzees and gorillas. The second function of the PDA discriminates chimpanzees from gorillas. SK1813 and StW562 metatarsals have patterns of thickness distribution most similar to gorillas. SKX5017 and StW595 metatarsals patterns occupy a space in the PDA between humans and chimpanzees. Thus, the fossils can be divided into two “morphs”, showing different diaphyseal structure, possibly the result of different locomotor repertoires. Interestingly, both Plio-Pleistocene sites contain the two “morphs”

Epidemiology of Pediatric Surgical Conditions Observed in a First-Level Hospital in Burundi

Background: Little is known about the surgical conditions affecting the pediatric population in low-income countries. In this article we describe the epidemiology of pediatric surgical diseases observed in Mutoyi hospital, a first-level hospital in Burundi. Methods and Findings: We retrospectively reviewed the records of all children (0–14 years) admitted to the Surgery ward from January 2017 to December 2017. We also reviewed the records of all the patients admitted to the Neonatology ward in 2017 and among them we selected the ones in which a surgical diagnosis was present. Five hundred twenty-eight children were admitted to the surgical ward during the study period. The most common conditions requiring hospitalization were abscesses (29.09%), fractures (13.59%), osteomyelitis (9.76%), burns (5.40%) and head injuries (4.36%). The average length of stay was 16 days. Fifty-six newborns were admitted to the Neonatology ward for a surgical condition; 29% of them had an abscess. Conclusions: Conditions requiring surgical care are frequent in Burundian children and have a completely different spectrum from the western ones. This is due on one side to an under-diagnosis of certain conditions caused by the lack of diagnostic tools and on the other to the living conditions of the population. This difference should lead to intervention plans tailored on the actual necessities of the country and not on the western ones