Achieving comprehensive childhood immunization: an analysis of obstacles and opportunities in The Gambia

INTRODUCTION: Immunization is a vital component in the drive to decrease global childhood mortality, yet challenges remain in ensuring wide coverage of immunization and full immunization, particularly in low- and middle-income countries. This study assessed immunization coverage and the determinants of immunization in a semi-rural area in The Gambia. METHODS: Data were drawn from the Farafenni Health and Demographic Surveillance System. Children born within the surveillance area between January 2000 and December 2010 were included. Main outcomes assessed included measles, BCG and DTP vaccination status and full immunization by 12 months of age as reported on child healthcards. Predictor variables were evaluated based on a literature review and included gender, ethnicity, area of residence, household wealth and mother's age. RESULTS: Of the 7363 children included in the study, immunization coverage was 73% (CI 72-74) for measles, 86% (CI 86-87) for BCG, 79% (CI 78-80) for three doses of DTP and 52% (CI 51-53) for full immunization. Coverage was significantly associated with area of residence and ethnicity, with children in urban areas and of Mandinka ethnicity being least likely to be fully immunized. CONCLUSIONS: Despite high levels of coverage of many individual vaccines, delivery of vaccinations later in the schedule and achieving high coverage of full immunization remain challenges, even in a country with a committed childhood immunization programme, such as The Gambia. Our data indicate areas for targeted interventions by the national Expanded Programme of Immunization

Prosecuting International Crimes in Africa: Lessons from Rwanda and Reflections on the Future

In this article the former Chief Prosecutor of the International Criminal Tribunal for Rwanda reflects on his experiences to respond to the question: what options are available for Africa in dealing with mass atrocity crimes based on the ICTR experience? The article notes the pedigree of Africa in terms of international criminal justice and the contributions this allows it to bring to the broad questions of ensuring justice for mass atrocities and building peace and reconciliation after such incidences

Discovery and Validation of Biomarkers to Guide Clinical Management of Pneumonia in African Children

Background Pneumonia is the leading cause of death in children globally. Clinical algorithms remain suboptimal for distinguishing severe pneumonia from other causes of respiratory distress such as malaria or distinguishing bacterial pneumonia and pneumonia from others causes, such as viruses. Molecular tools could improve diagnosis and management. Methods We conducted a mass spectrometry–based proteomic study to identify and validate markers of severity in 390 Gambian children with pneumonia (n = 204) and age-, sex-, and neighborhood-matched controls (n = 186). Independent validation was conducted in 293 Kenyan children with respiratory distress (238 with pneumonia, 41 with Plasmodium falciparum malaria, and 14 with both). Predictive value was estimated by the area under the receiver operating characteristic curve (AUC). Results Lipocalin 2 (Lpc-2) was the best protein biomarker of severe pneumonia (AUC, 0.71 [95% confidence interval, .64–.79]) and highly predictive of bacteremia (78% [64%–92%]), pneumococcal bacteremia (84% [71%–98%]), and “probable bacterial etiology” (91% [84%–98%]). These results were validated in Kenyan children with severe malaria and respiratory distress who also met the World Health Organization definition of pneumonia. The combination of Lpc-2 and haptoglobin distinguished bacterial versus malaria origin of respiratory distress with high sensitivity and specificity in Gambian children (AUC, 99% [95% confidence interval, 99%–100%]) and Kenyan children (82% [74%–91%]). Conclusions Lpc-2 and haptoglobin can help discriminate the etiology of clinically defined pneumonia and could be used to improve clinical management. These biomarkers should be further evaluated in prospective clinical studies

Seasonal variability of carbon dioxide in the rivers and lagoons of Ivory Coast (West Africa)

We report partial pressure of CO2 (pCO2) and ancillary data in three rivers (Bia, Tanoé, and Comoé) and five lagoons (Tendo, Aby, Ebrié, Potou, and Grand-Lahou) in Ivory Coast (West Africa), during four cruises covering the main climatic seasons. The three rivers were oversaturated in CO2 with respect to atmospheric equilibrium, and the seasonal variability of pCO2 was due to dilution during the flooding period. Surface waters of the Potou, Ebrié, and Grand-Lahou lagoons were oversaturated in CO2 during all seasons. These lagoons behaved similarly to the oligohaline regions of macrotidal estuaries that are CO2 sources to the atmosphere due to net ecosystem heterotrophy and inputs of riverine CO2 rich waters. The Aby and Tendo lagoons were undersaturated in CO2 with respect to the atmosphere because of their permanent haline stratification (unlike the other lagoons) that seemed to lead to higher phytoplankton production and export of organic carbon below the pycnocline

Clinical features of severe malaria associated with death: a 13-year observational study in the Gambia

BACKGROUND: Severe malaria (SM) is a major cause of death in sub-Saharan Africa. Identification of both specific and sensitive clinical features to predict death is needed to improve clinical management. METHODS: A 13-year observational study was conducted from 1997 through 2009 of 2,901 children with SM enrolled at the Royal Victoria Teaching Hospital in The Gambia to identify sensitive and specific predictors of poor outcome in Gambian children with severe malaria between the ages 4 months to 14 years. We have measured the sensitivity and specificity of clinical features that predict death or development of neurological sequelae. FINDINGS: Impaired consciousness (odds ratio {OR} 4.4 [95% confidence interval {CI}, 2.7-7.3]), respiratory distress (OR 2.4 [95%CI, 1.7-3.2]), hypoglycemia (OR 1.7 [95%CI, 1.2-2.3]), jaundice (OR 1.9 [95%CI, 1.2-2.9]) and renal failure (OR 11.1 [95%CI, 3.3-36.5]) were independently associated with death in children with SM. The clinical features that showed the highest sensitivity and specificity to predict death were respiratory distress (area under the curve 0.63 [95%CI, 0.60-0.65]) and impaired consciousness (AUC 0.61[95%CI, 0.59-0.63]), which were comparable to the ability of hyperlactatemia (blood lactate>5 mM) to predict death (AUC 0.64 [95%CI, 0.55-0.72]). A Blantyre coma score (BCS) of 2 or less had a sensitivity of 74% and specificity of 67% to predict death (AUC 0.70 [95% C.I. 0.68-0.72]), and sensitivity and specificity of 74% and 69%, respectively to predict development of neurological sequelae (AUC 0.72 [95% CI, 0.67-0.76]).The specificity of this BCS threshold to identify children at risk of dying improved in children less than 3 years of age (AUC 0.74, [95% C.I 0.71-0.76]). CONCLUSION: The BCS is a quantitative predictor of death. A BCS of 2 or less is the most sensitive and specific clinical feature to predict death or development of neurological sequelae in children with SM

Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis.

The criteria for defining severe malaria have evolved over the last 20 years. We aimed to assess the strength of association of death with features currently characterizing severe malaria through a systematic review and meta-analysis. Electronic databases (Medline, Embase, Cochrane Database of Systematic Reviews, Thomson Reuters Web of Knowledge) were searched to identify publications including African children with severe malaria. PRISMA guidelines were followed. Selection was based on design (epidemiological, clinical and treatment studies), setting (Africa), participants (children < 15 years old with severe malaria), outcome (survival/death rate), and prognostic indicators (clinical and laboratory features). Quality assessment was performed following the criteria of the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Odds ratios (ORs) were calculated for each study and prognostic indicator, and, when a test was assessed in at least two studies, pooled estimates of ORs were computed using fixed- or random-effects meta-analysis. A total of 601 articles were identified and screened and 30 publications were retained. Features with the highest pooled ORs were renal failure (5.96, 95% CI 2.93-12.11), coma score (4.83, 95% CI 3.11-7.5), hypoglycemia (4.59, 95% CI 2.68-7.89), shock (4.31, 95% CI 2.15-8.64), and deep breathing (3.8, 95% CI 3.29-4.39). Only half of the criteria had an OR > 2. Features with the lowest pooled ORs were impaired consciousness (0.58, 95% CI 0.25-1.37), severe anemia (0.76, 95% CI 0.5- 1.13), and prostration (1.12, 95% CI 0.45-2.82). The findings of this meta-analysis show that the strength of association between the criteria defining severe malaria and death is quite variable for each clinical and/or laboratory feature (OR ranging from 0.58 to 5.96). This ranking allowed the identification of features weakly associated with death, such as impaired consciousness and prostration, which could assist to improve case definition, and thus optimize antimalarial treatment

Intergenerational Peacebuilding Among Women: Leveraging the Power of Collaboration (Executive Summary)

Compounding crises related to inequalities and violence, health, the environment and food and water insecurity affect people across generations, and solutions to build lasting peace require the involvement and leadership of people of all generations. This report focuses on how generation and age differences affect peacebuilding work among women by analyzing how women and women’s organizations are using intergenerational strategies and partnerships to build peace. Intergenerational Peacebuilding Among Women: Leveraging the Power of Collaboration argues that women’s and women’s organizations’ intergenerational peacebuilding efforts and potential must be better recognized, supported, developed and encouraged at the national and international levels alike. Through the case studies, the report shows examples of existing efforts, opportunities and challenges, with the goal of shaping and influencing how decision-makers and funders approach intergenerational partnerships and strategies as part of peacebuilding work.https://digital.sandiego.edu/ipj-research/1061/thumbnail.jp

Intergenerational Peacebuilding Among Women: Leveraging the Power of Collaboration

Compounding crises related to inequalities and violence, health, the environment and food and water insecurity affect people across generations, and solutions to build lasting peace require the involvement and leadership of people of all generations. This report focuses on how generation and age differences affect peacebuilding work among women by analyzing how women and women’s organizations are using intergenerational strategies and partnerships to build peace. Intergenerational Peacebuilding Among Women: Leveraging the Power of Collaboration argues that women’s and women’s organizations’ intergenerational peacebuilding efforts and potential must be better recognized, supported, developed and encouraged at the national and international levels alike. Through the case studies, the report shows examples of existing efforts, opportunities and challenges, with the goal of shaping and influencing how decision-makers and funders approach intergenerational partnerships and strategies as part of peacebuilding work.https://digital.sandiego.edu/ipj-research/1060/thumbnail.jp