Spatial analysis of Schistosoma Haematobium infection among school children in a rural sub-district of South Africa: an application of geographical information systems (2009)

M.Sc. (Med.), Faculty of Health Sciences, University of the Witwatersrand, 2009Background Assessing risk of schistosomiasis requires knowledge of the spatial distribution of the disease and its association with demographic, socioeconomic, behavioural, and environmental factors over time and space. The objective of this study was to advance such knowledge by analyzing the spatial distribution of schistosoma haematobium infections in relation to the demographic attributes and environmental covariates of the Africa centre Demographic Surveillance Areas (DSA) in rural KwaZulu-Natal. The study also examined the association between household socio-economic conditions and rates of S. haematobium infection with particular emphasis on the impact of pipe water on rates of infection. Methods The study is a crosses sectional study, involving all 33 primary schools in Africa Centre DSA. 2110 grade five and six children took part in the study. Statistical analysis was done using chi square tests to compare statistical significant differences between sex and age groups. Bivariate and multivariate logistic regression models were used to explore factors that are significantly associated with infection. Spatial analysis was done to examine the spatial distribution of the disease using geographical information systems techniques. Microscopic analysis of the urine samples was done using the filtration technique. Results Of the 2110 school children who were screened for infection, 347 tested positive for the presence of iv S. haematobium, representing an overall prevalence of 16.6%. Prevalence levels were higher in boys (20.8%) than females (8.5%) (P<0.001). 57.6% were heavily infected (eggs ≥50 eggs per 10ml urine) as compared to 42.5% who had light infection (eggs<50 eggs/10ml of urine). Whereas, prevalence was significantly age-dependent (Pearson chi2 (3) = 28.4184, P< 0.001), intensity of infection was not significantly age dependent (Pearson chi2 (3) = 3.2579, P<0.354). Altitudinal variation, access to portable water, toilet, and distance to water bodies were significantly associated with infection. Prevalence of infection was clustered around the Eastern part of the study area. Conclusion While there may be several factors associated with schistosoma infection in the study area's school children; age, sex, water contact behaviour, homestead altitude and distance to permanent water bodies, were the most significant risk factors explaining the spatial distribution of S. haematobium infection in the Africa Centre DSA. Selective Mass treatment of S. haematobium infection in 7 clustered areas is recommended for the control of the disease

Is the decline in neonatal mortality in northern Ghana, 1996-2012, associated with the decline in the age of BCG vaccination? An ecological study

OBJECTIVE: To examine the association between early Bacille Calmette-Guerin (BCG) vaccination and neonatal mortality in northern Ghana.METHODS: This ecological study used vaccination and mortality data from the Navrongo Health and Demographic Surveillance System. First, we assessed and compared changes in neonatal mortality rates (NMRs) and median BCG vaccination age from 1996 to 2012. Second, we compared the changes in NMR and median BCG vaccination age from 2002 to 2012 by delivery place when data on delivery place were available.RESULTS: Neonatal mortality rates declined from 46 to 12 per 1000 live births between 1996 and 2012 (trend test: p&lt;0.001). Within the same period, median BCG vaccination age declined from 46 to 4 days (trend test: p&lt;0.001). Among home deliveries, BCG vaccination age declined from 39 days in 2002 to 7 days in 2012 (trend test: p&lt;0.001) and neonatal mortality declined by 24/1000 (trend test: p&lt;0.001). Among health facility deliveries, BCG vaccination age was stable around 3 days from 2002 to 2012 (trend test: p=0.49) and neonatal mortality declined by 9/1000 (trend test: p=0.04). In a small study of children whose vaccination cards were inspected within the first 28 days of life, the HR for BCG-vaccinated compared with BCG-unvaccinated children was 0.55 (95% CI 0.12 to 2.40).CONCLUSION: The data support the hypothesis that early BCG vaccination may be associated with a decrease in neonatal mortality. However, as suggested by WHO, randomised control trials are required to address the question of whether there is indeed a causal association between early BCG vaccination and neonatal mortality.</p

Road traffic fatalities - a neglected epidemic in rural northern Ghana: evidence from the navrongo demographic surveillance system

Globally, road traffic fatalities have been on the increase, particularly in low-and-middle income countries. Much of this is attributed to increases in the acquisition, and use of motorized vehicles. However, there is very little empirical research to understand the causes and determinants of this threat. This paper investigates time trends and determinants of road traffic accidents in the Kasena-Nankana district of northern Ghana. First, we utilized causes of death data gathered by the Health and Demographic Surveillance System in Navrongo, to examine trends in deaths due to injury, particularly those related to road traffic crashes. Subsequently, we employed multivariate logistic regression to examine factors associated with deaths due to all injuries and road traffic crashes among adults 15–59 years of age. Results show a three-fold increase in mortality (18%) due to injuries in the Kasena-Nankana district in about a decade. Fatalities resulting from road traffic crashes constitute the greatest share of the burden of mortality resulting from injuries. Increases in road traffic fatalities have coincided with recent increases in motor and vehicular traffic in the region. Several factors are associated with the increased risk of deaths from road traffic accidents, principal among which include urban residence (OR = 1.74 95% CI 1.09-2.78), being male and in the prime adult ages of between 20–29 years old (OR = 4.85 95% CI 2.65-8.89), as well as people with higher levels of education (OR = 3.21 95% CI 1.75-5.87) and those in higher socioeconomic status categories (OR = 2.43 95% CI 1.21-4.88). Results suggest that road traffic fatalities have become a major cause of morbidity and mortality and brings into focus the need for measures to curb this looming crisis. There is need for strategic interventions to be adopted to avert what is sure to become one of the leading causes of death in this impoverished locality

Safety of RTS,S/AS01&lt;sub&gt;E&lt;/sub&gt; malaria vaccine up to 1 year after the third dose in Ghana, Kenya, and Malawi (EPI-MAL-003): a phase 4 cohort event monitoring study.

BackgroundRTS,S/AS01E has been successfully administered to over two million children since 2019 through the Malaria Vaccine Implementation Programme (MVIP). In this Article, we report the safety results of a study evaluating RTS,S/AS01E safety and effectiveness in real-world settings.MethodsEPI-MAL-003 is an ongoing phase 4 disease surveillance study with prospective cohort event monitoring and hospital-based surveillance, done in the setting of routine health-care practice in Ghana, Kenya, and Malawi and fully embedded in the MVIP. The study design was dependent on the cluster-randomised vaccine implementation. In active surveillance, we enrolled children younger than 18 months from exposed (where RTS,S/AS01E was offered) and unexposed clusters. The coprimary endpoints were the occurrence of predefined adverse events of special interest and aetiology-confirmed meningitis. We report primary and secondary safety results up to 1 year after the primary vaccine schedule (three doses). The study is registered with ClinicalTrials.gov, NCT03855995.FindingsThe first participant was enrolled on March 21, 2019. The cutoff date for the current analysis was 1 year after the third RTS,S/AS01E dose for each participant. In total, 44 912 children (19 993 in Ghana, 11 990 in Kenya, and 12 929 in Malawi) were included in the analysis set for the cluster-randomised comparison: 22 508 from exposed clusters and 22 404 from unexposed clusters. Incidence rates (expressed per 100 000 person-years) for generalised convulsive seizures and intussusception were similar between vaccinated and unvaccinated children. Aetiology-confirmed meningitis was reported in two children: one case of bacterial meningitis due to Streptococcus pneumoniae in an RTS,S/AS01E-vaccinated child in the exposed clusters, and one case of viral meningitis due to human herpesvirus 6 in an unvaccinated child in the unexposed clusters. Both cases occurred within 12 months after vaccination in children in the cluster-design analysis set, leading to incidence rates of 4·1 (95% CI 0·1-23·0) per 100 000 person-years in RTS,S/AS01E-vaccinated children and 4·0 (0·1-22·6) per 100 000 person-years in unvaccinated children, and a country-adjusted incidence rate ratio (IRR) of 0·96 (95% CI 0·06-15·34; p=0·98). Cerebral malaria cases were reported for four (E-vaccinated children in the exposed clusters and two (E-vaccinated children and unvaccinated children, respectively (IRR 1·43, 95% CI 0·24-8·58, p=0·70). Incidence rates for all-cause mortality were 659·7 (95% CI 561·5-770·3) in vaccinated children versus 724·5 (622·3-838·8) in unvaccinated children, with similar incidence rates for boys and girls.InterpretationWe found no evidence of vaccination being associated with an increased risk of meningitis, cerebral malaria, or mortality among vaccinated children, and no new safety risks were identified.FundingGSK

BETTEReHEALTH

BETTEReHEALTH aimed to inform e-health policymaking towards better health outcomes through a bottom-up evidence-based holistic approach in African LLMICs. We are working to address three aspects related to successful e-health: human, technical and public policy factors. BETTEReHEALTH will set up four Regional Hubs based in Tunisia, Ghana, Ethiopia and Malawi, already endorsed by each country’s Ministry of Health. Each hub will organize coordination and networking activities (including two regional workshops) involving national and regional actors. We will also organise two international workshops to promote the cooperation and networking between Europe and Africa. Additionally, BETTEReHEALTH creates open access registries by collecting information from African countries regarding eHealth policies and existing eHealth solutions. The registries will be used to identify best-practices and produce useful knowledge regarding e-health implementation. The knowledge produced in registries, together with the input from the other activities will be synthesized into e-health policy roadmaps and strategic implementation plans for better e-health services. The strengths of BETTEReHEALTH are the diversity of the involved partners, which will contribute to an interdisciplinary approach (including health, technical and policymaking actors), the evidence-based approach guaranteed by the academic and research partners, and the strong local involvement ensured by the four Regional Hubs

BETTEReHEALTH

All pre-registration documents are in the pre-registration folde