Comparing the Usefulness of the 1997 and 2009 WHO Dengue Case Classification: A Systematic Literature Review

The 1997 and 2009 WHO dengue case classifications were compared in a systematic review with 12 eligible studies (4 prospective). Ten expert opinion articles were used for discussion. For the 2009 WHO classification studies show: when determining severe dengue sensitivity ranges between 59–98% (88%/98%: prospective studies), specificity between 41–99% (99%: prospective study) - comparing the 1997 WHO classification: sensitivity 24.8–89.9% (24.8%/74%: prospective studies), specificity: 25%/100% (100%: prospective study). The application of the 2009 WHO classification is easy, however for (non-severe) dengue there may be a risk of monitoring increased case numbers. Warning signs validation studies are needed. For epidemiological/pathogenesis research use of the 2009 WHO classification, opinion papers show that ease of application, increased sensitivity (severe dengue) and international comparability are advantageous; 3 severe dengue criteria (severe plasma leakage, severe bleeding, severe organ manifestation) are useful research endpoints. The 2009 WHO classification has clear advantages for clinical use, use in epidemiology is promising and research use may at least not be a disadvantage

Conocimientos, actitudes y prácticas sobre el dengue en escuelas de Lambayeque, Perú

Introduction: dengue fever is a viral disease widely distributed in tropical areas, influenced by climatic factors and the presence of the Aedes aegypti mosquito. The economic burden on health services is a key factor in endemic locations.Objective: to describe the knowledge, attitudes and practices of schoolchildren concerning dengue fever in Lambayeque, Peru.Methods: an observational, descriptive cross-sectional study was conducted from April to June 2019 in secondary schools in the districts of Lambayeque, Peru. Fifty-two students were chosen through simple random sample. Each student was given a structured questionnaire previously validated.Results: thirty-eight valid surveys were selected, where 53,85 % of which were from rural schools; 94 % expressed knowledge of dengue, 47 % reported receiving the information by television; 28 % recognized fever, vomiting and diarrhea as the main symptoms. The 89 % reported water tanks as the main breeding ground, 86 % recognized the disease as a serious problem and 87 % said it could be prevented or controlled. While the 89 % agreed that it is people's responsibility to prevent dengue fever and 95 % agreed on the need to eliminate mosquito breeding sites.Conclusions: secondary school students in Lambayeque have a low level of knowledge regarding the causal agent, transmission route and symptoms of dengue fever. Knowledge about attitudes and practices regarding this disease was high.Introducción: el dengue es una enfermedad viral muy distribuida en zonas tropicales, influenciada por factores climáticos y la presencia del mosquito Aedes aegypti. La carga económica en los servicios sanitarios constituye un factor clave en lugares endémicos.Objetivo: describir los conocimientos, actitudes y prácticas de los escolares acerca del dengue en Lambayeque, Perú.Métodos: se realizó un estudio observacional, descriptivo de corte transversal en el periodo comprendido entre abril y junio de 2019 en colegios de educación secundaria de distritos de Lambayeque, Perú. Se seleccionaron 52 estudiantes mediante un muestreo aleatorio simple. A cada estudiante se le aplicó un cuestionario estructurado previamente validado.Resultados: Fueron seleccionadas 38 encuestas válidas, donde el 53,85 % provenía escolares de población rural. El 94 % expresó conocer que era el dengue, el 47 % refirió recibir los conocimientos por televisión. El 28 % reconoció la fiebre, el vómito y la diarrea como principales síntomas. El 89 % reportó los tanques con agua como principales criaderos, el 86 % reconoció la enfermedad como un problema grave y el 87 % expuso que se podía prevenir o combatir. El 89 % estuvo de acuerdo en que es responsabilidad de las personas prevenir el dengue y el 95 % en la necesidad de eliminar los sitios de reproducción del mosquito.Conclusiones: los estudiantes de secundaria de Lambayeque tienen bajo nivel de conocimientos con respecto al agente causal, vía de transmisión y sintomatología del dengue. Los conocimientos sobre actitudes y prácticas frente a esta enfermedad fueron altos

"It's the poverty"-Stakeholder perspectives on barriers to secondary education in rural Burkina Faso

Universal primary and secondary education is a key target of the Sustainable Development Goals. While substantial gains have been made at the primary school level, progress towards universal secondary education has slowed, particularly in sub-Saharan Africa. In this study, we aimed to determine perceived barriers of secondary schooling in rural Burkina Faso, where secondary school completion is among the lowest globally (<10%). We conducted a two-stage qualitative study using semi-structured interviews (N = 49). In the first stage, we sampled enrolled students (n = 10), out-of-school adolescents (n = 9), parents of enrolled students (n = 5), parents of out-of-school adolescents (n = 5) and teachers (n = 10) from a random sample of five secondary schools. In a second stage, we interviewed key informants knowledgeable of the school context using snowball sampling (n = 10). Systematic analysis of the pooled sample was based on a reading of interview transcripts and coding of the narratives in NVivo12 using the diathesis-stress model. Recurring themes were classified using a priori developed categories of hypothesized barriers to secondary schooling. Major reported barriers included school-related expenses and the lack of school infrastructure and resources. Insufficient and heterogeneous French language skills (the official language of instruction in Burkina Faso) were seen as a major barrier to secondary schooling. Forced marriages, adolescent pregnancies, and the low perceived economic benefits of investing in secondary schooling were reported as key barriers among young women. Our results guide future interventions and policy aimed at achieving universal secondary education and gender equity in the region

Dengue data and surveillance in Tanzania: a systematic literature review

Objective: Although there is evidence that dengue virus is circulating in Tanzania, the country lacks a dengue surveillance system. Consequently, the true estimate of dengue seroprevalence, as well as the incidence in the population, the frequency and magnitude of outbreaks is unknown. This study therefore sought to systematically review available dengue data from Tanzania. Methods: The systematic review was conducted and reported using the PRISMA tool. Five databases (PubMed, Embase, Web of Science, WHOLIS and Google Scholar) were searched for articles using various keywords on the illness, data and geographical location. Identified articles were assessed for inclusion based on predefined eligibility criteria. Data were extracted from included articles, analysed and reported. Results: Based on the 10 seroprevalence studies in defined populations with estimates of acute confirmed infections that were included in the review, the estimated seroprevalence of past dengue infection in Tanzania ranged from 50.6% in a health facility-based study to 11% in a population-based study. Acute confirmed infections of dengue were estimated to be as high as 38.2% of suspected cases. Only one study reported on an outbreak. Conclusions: It is evident that dengue needs to become part of regular disease surveillance in Tanzania. Control measures need to be instituted with a focus on building human resource capacity and integrating dengue control measures in ongoing health programmes, for both preventive and curative interventions. Systematic reviews are valuable in assessing health issues when surveillance data are not available

Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia

Background and objective: The haemodynamics of crystalloid and colloid fluid loading may depend on underlying disease, i.e. sepsis versus non-sepsis. Design and setting: A single-centre, single-blinded, randomized clinical trial was carried out on 24 critically ill sepsis and 24 non-sepsis patients with clinical hypovolaemia, assigned to loading with normal saline, gelatin 4%, hydroxyethyl starch 6% or albumin 5% in a 90-min (delta) central venous pressure (CVP)-guided fluid loading protocol. Transpulmonary thermodilution was done each 30 min, yielding, among others, global end-diastolic volume and cardiac indices (GEDVI, CI). Results: Sepsis patients had hyperdynamic hypotension in spite of myocardial depression and dilatation, and greater inotropic/vasopressor requirements than non-sepsis patients. Independent of underlying disease, CVP and GEDVI increased more after colloid than saline loading (P < 0.018), so that CI increased by about 2% after saline and 12% after colloid loading (P = 0.029). The increase in preload-recruitable stroke work was also greater with colloids and did not differ among conditions. Conclusion: Fluid loading with colloids results in a greater linear increase in cardiac filling, output and stroke work than does saline loading, in both septic and non-septic clinical hypovolaemia, in spite of myocardial depression and presumably increased vasopermeability potentially decreasing the effects of colloid fluid loading in the former. © The Author(s) 2010

Dengue contingency planning: from research to policy and practice

Background Dengue is an increasingly incident disease across many parts of the world. In response, an evidence-based handbook to translate research into policy and practice was developed. This handbook facilitates contingency planning as well as the development and use of early warning and response systems for dengue fever epidemics, by identifying decision-making processes that contribute to the success or failure of dengue surveillance, as well as triggers that initiate effective responses to incipient outbreaks. Methodology/Principal findings Available evidence was evaluated using a step-wise process that included systematic literature reviews, policymaker and stakeholder interviews, a study to assess dengue contingency planning and outbreak management in 10 countries, and a retrospective logistic regression analysis to identify alarm signals for an outbreak warning system using datasets from five dengue endemic countries. Best practices for managing a dengue outbreak are provided for key elements of a dengue contingency plan including timely contingency planning, the importance of a detailed, context-specific dengue contingency plan that clearly distinguishes between routine and outbreak interventions, surveillance systems for outbreak preparedness, outbreak definitions, alert algorithms, managerial capacity, vector control capacity, and clinical management of large caseloads. Additionally, a computer-assisted early warning system, which enables countries to identify and respond to context-specific variables that predict forthcoming dengue outbreaks, has been developed. Conclusions/Significance Most countries do not have comprehensive, detailed contingency plans for dengue outbreaks. Countries tend to rely on intensified vector control as their outbreak response, with minimal focus on integrated management of clinical care, epidemiological, laboratory and vector surveillance, and risk communication. The Technical Handbook for Surveillance, Dengue Outbreak Prediction/ Detection and Outbreak Response seeks to provide countries with evidence-based best practices to justify the declaration of an outbreak and the mobilization of the resources required to implement an effective dengue contingency plan

Defining Research to Improve Health Systems

Robert Terry and colleagues present working definitions of operational research, implementation research, and health systems research within the context of research to strengthen health systems

Effect of blood type on anti-a-Gal immunity and the incidence of infectious diseases

The identification of factors affecting the susceptibility to infectious diseases is essential toward reducing their burden on the human population. The ABO blood type correlates with susceptibility to malaria and other infectious diseases. Due to the structural similarity between blood antigen B and Gala1-3GalB1-(3)4GlcNAc-R (a-Gal), we hypothesized that self-tolerance to antigen B affects the immune response to a-Gal, which in turn affects the susceptibility to infectious diseases caused by pathogens carrying a-Gal on their surface. Here we found that the incidence of malaria and tuberculosis, caused by pathogens with a-Gal on their surface, positively correlates with the frequency of blood type B in endemic regions. However, the incidence of dengue fever, caused by a pathogen without a-Gal, was not related to the frequency of blood type B in these populations. Furthermore, the incidence of malaria and tuberculosis was negatively correlated with the anti-a-Gal antibody protective response. These results have implications for disease control and prevention.Peer reviewedVeterinary Pathobiolog