Subsequent mortality in survivors of Ebola virus disease in Guinea: a nationwide retrospective cohort study.

BACKGROUND: A record number of people survived Ebola virus infection in the 2013-16 outbreak in west Africa, and the number of survivors has increased after subsequent outbreaks. A range of post-Ebola sequelae have been reported in survivors, but little is known about subsequent mortality. We aimed to investigate subsequent mortality among people discharged from Ebola treatment units. METHODS: From Dec 8, 2015, Surveillance Active en ceinture, the Guinean national survivors' monitoring programme, attempted to contact and follow-up all survivors of Ebola virus disease who were discharged from Ebola treatment units. Survivors were followed up until Sept 30, 2016, and deaths up to this timepoint were recorded. Verbal autopsies were done to gain information about survivors of Ebola virus disease who subsequently died from their closest family members. We calculated the age-standardised mortality ratio compared with the general Guinean population, and assessed risk factors for mortality using survival analysis and a Cox proportional hazards regression model. FINDINGS: Of the 1270 survivors of Ebola virus disease who were discharged from Ebola treatment units in Guinea, information was retrieved for 1130 (89%). Compared with the general Guinean population, survivors of Ebola virus disease had a more than five-times increased risk of mortality up to Dec 31, 2015 (age-standardised mortality ratio 5·2 [95% CI 4·0-6·8]), a mean of 1 year of follow-up after discharge. Thereafter (ie, from Jan 1-Sept 30, 2016), mortality did not differ between survivors of Ebola virus disease and the general population. (0·6 [95% CI 0·2-1·4]). Overall, 59 deaths were reported, and the cause of death was tentatively attributed to renal failure in 37 cases, mostly on the basis of reported anuria. Longer stays (ie, equal to or longer than the median stay) in Ebola treatment units were associated with an increased risk of late death compared with shorter stays (adjusted hazard ratio 2·62 [95% CI 1·43-4·79]). INTERPRETATION: Mortality was high in people who recovered from Ebola virus disease and were discharged from Ebola treatment units in Guinea. The finding that survivors who were hospitalised for longer during primary infection had an increased risk of death, could help to guide current and future survivors' programmes and in the prioritisation of funds in resource-constrained settings. The role of renal failure in late deaths after recovery from Ebola virus disease should be investigated. FUNDING: WHO, International Medical Corps, and the Guinean Red Cross

Resurgence of Ebola virus in 2021 in Guinea suggests a new paradigm for outbreaks

These authors contributed equally: Alpha K. Keita, Fara R. Koundouno, Martin Faye, Ariane Düx, Julia Hinzmann.International audienc

New therapeutic landscapes in Africa: parental categories and practices in seeking infant health in the Republic of Guinea

In considering African health care practice, it is usual to draw strong distinctions between biomedical and traditional practices, and between public and private health institutions. Whilst distinctions between traditional and biomedical, and between public and private medicine make sense from the vantage point of health professionals, we question how far these distinctions are pertinent in shaping health-seeking behaviour given experience of them. This paper argues that other distinctions are becoming far more important to African therapeutic landscapes to the ways that people evaluate the salience of different health providers to their problems. We draw on ethnographic research and illustrative evidence from 1550 `infant health biographies from rural and urban areas in the Republic of Guinea, where 93% of health expenditure takes place outside the state sector. We outline the distinctions that inform parents' health-seeking practices here. These include distinctions between women's and children's health providers (at state health centres), and those that men frequent (private pharmacies); between familiar ailments with known therapies (whether self-treatment, biomedical or herbal), and unfamiliar ones requiring expert diagnostics (whether from Islamic healers, diviners or doctors); between illnesses treatable by injection, and those aggravated by injection; between types of payment; and between high quality/strong medicines, and poor quality/weak ones. As people engage with emergent therapeutic landscapes, relations of knowledge and expertise, and forms of social solidarity, are emerging with significant implications for potential pathways of health system development, how these are conceptualised, and the forms of citizenship and partnership they might involve

New therapeutic landscapes in Africa: Parental categories and practices in seeking infant health in the Republic of Guinea

In considering African health care practice, it is usual to draw strong distinctions between biomedical and traditional practices, and between public and private health institutions. Whilst distinctions between traditional and biomedical, and between public and private medicine make sense from the vantage point of health professionals, we question how far these distinctions are pertinent in shaping health-seeking behaviour given experience of them. This paper argues that other distinctions are becoming far more important to African therapeutic landscapes to the ways that people evaluate the salience of different health providers to their problems. We draw on ethnographic research and illustrative evidence from 1550 'infant health biographies' from rural and urban areas in the Republic of Guinea, where 93% of health expenditure takes place outside the state sector. We outline the distinctions that inform parents' health-seeking practices here. These include distinctions between women's and children's health providers (at state health centres), and those that men frequent (private pharmacies); between familiar ailments with known therapies (whether self-treatment, biomedical or herbal), and unfamiliar ones requiring expert diagnostics (whether from Islamic healers, diviners or doctors); between illnesses treatable by injection, and those aggravated by injection; between types of payment; and between high quality/strong medicines, and poor quality/weak ones. As people engage with emergent therapeutic landscapes, relations of knowledge and expertise, and forms of social solidarity, are emerging with significant implications for potential pathways of health system development, how these are conceptualised, and the forms of citizenship and partnership they might involve.Guinea West Africa Therapeutic pluralism Therapeutic landscapes Health services utilisation Health system development

All SPSS Tables and Outputs from Assessments of Ebola knowledge, attitudes and practices in Forécariah, Guinea and Kambia, Sierra Leone, July–August 2015

The border region of Forécariah (Guinea) and Kambia (Sierra Leone) was of immense interest to the West Africa Ebola response. Cross-sectional household surveys with multi-stage cluster sampling procedure were used to collect random samples from Kambia (<i>n</i> = 635) in July 2015 and Forécariah (<i>n</i> = 502) in August 2015 to assess public knowledge, attitudes and practices related to Ebola. Knowledge of the disease was high in both places, and handwashing with soap and water was the most widespread prevention practice. Acceptance of safe alternatives to traditional burials was significantly lower in Forécariah compared with Kambia. In both locations, there was a minority who held discriminatory attitudes towards survivors. Radio was the predominant source of information in both locations, but those from Kambia were more likely to have received Ebola information from community sources (mosques/churches, community meetings or health workers) compared with those in Forécariah. These findings contextualize the utility of Ebola health messaging during the epidemic and suggest the importance of continued partnership with community leaders, including religious leaders, as a prominent part of future public health protection.This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’

Abstracts of the 1st International Colloquium in Mine & Society

This book presents the abstracts of the selected contributions to the First International Colloquium on Mines and Society (CIMS) organized by The Higher Institute of Mining and Geology of Boke. The theme of this colloquium was "Mining and Sustainable Development, a major challenge for an Emerging Africa" which aims to bring together teachers, researchers, and Professionals from different backgrounds in order to exchange the results of their research work, share their points of view on the issue of mining and sustainable development. It also aims to define, in a collaborative and inclusive manner, research prospects or future projects between all the actors involved in this field. Colloquium Title: 1st International Colloquium in Mine &amp; SocietyTheme: Mining and Sustainable Development, A Major Challenge for an Emerging AfricaColloquium Date: 20-22 May 2022Colloquium Location: A L’Hôtel Rio Nunez de BokeColloquium Organizer: The Higher Institute of Mining and Geology of Bok

Maintenance darunavir/ritonavir monotherapy to prevent perinatal HIV transmission, ANRS-MIE 168 MONOGEST study

International audienceObjectives: Because NRTIs can have fetal toxicities, we evaluated a perinatal NRTI-sparing strategy to prevent perinatal HIV transmission. Our primary objective was to determine the proportion maintaining a viral load (VL) of 50 copies/mL. Neonates received nevirapine prophylaxis for 14 days.Results: Of 89 patients switching to darunavir/ritonavir monotherapy, 4 miscarried before 22 weeks' gestation, 2 changed treatment for elevated liver enzymes without virological failure, and 83 were evaluable for the main outcome. Six had virological failure confirmed on a repeat sample (median VL=193 copies/mL; range 78-644), including two before switching to monotherapy. In these six cases, ART was intensified with tenofovir disoproxil fumarate/emtricitabine. The success rate was 75/83, 90.4% (95% CI, 81.9%-95.7%) considering two patients with VL missing at delivery as failures, and 77/83, 92.8% (95% CI, 84.9%-97.3%) when considering them as successes since both had undetectable VL on darunavir/ritonavir throughout pregnancy. In ITT, the last available VL before delivery was <50 copies/mL in all of the patients. There was no case of perinatal HIV transmission.Conclusions: Darunavir/ritonavir maintenance monotherapy required intensification in nearly 10% of cases. This limits its widespread use, thus other regimens should be evaluated in order to limit exposure to antiretrovirals, particularly NRTIs, during pregnancy