Promoting hygienic weaning food handling practices through a community-based programme: intervention implementation and baseline characteristics for a cluster randomised controlled trial in rural Gambia.

OBJECTIVE: Contamination of weaning food leads to diarrhoea in children under 5 years. Public health interventions to improve practices in low-income and middle-income countries are rare and often not evaluated using a randomised method. We describe an intervention implementation and provide baseline data for such a trial. DESIGN: Clustered randomised controlled trial. SETTING: Rural Gambia. PARTICIPANTS: 15 villages/clusters each with 20 randomly selected mothers with children aged 6-24 months per arm. INTERVENTION: To develop the public health intervention, we used: (A) formative research findings to determine theoretically based critical control point corrective measures and motivational drives for behaviour change of mothers; (B) lessons from a community-based weaning food hygiene programme in Nepal and a handwashing intervention programme in India; and (C) culturally based performing arts, competitions and environmental clues. Four intensive intervention days per village involved the existing health systems and village/cultural structures that enabled per-protocol implementation and engagement of whole villager communities. RESULTS: Baseline village and mother's characteristics were balanced between the arms after randomisation. Most villages were farming villages accessing health centres within 10 miles, with no schools but numerous village committees and representing all Gambia's three main ethnic groups. Mothers were mainly illiterate (60%) and farmers (92%); 24% and 10% of children under 5 years were reported to have diarrhoea and respiratory symptoms, respectively, in the last 7 days (dry season). Intervention process engaged whole village members and provided lessons for future implementation; culturally adapted performing arts were an important element. CONCLUSION: This research has potential as a new low-cost and broadly available public health programme to reduce infection through weaning food. The theory-based intervention was widely consulted in the Gambia and with experts and was well accepted by the communities. Baseline analysis provides socioeconomic data and confirmation of Unicefs Multiple Indicator Cluster Survey (MICS) data on the prevalence of diarrhoea and respiratory symptoms in the dry season in the poorest region of Gambia. TRIAL REGISTRATION NUMBER: PACTR201410000859336; Pre-results

Maternal colonization and early-onset neonatal bacterial sepsis in the Gambia, West Africa: a genomic analysis of vertical transmission

OBJECTIVES: To define bacterial aetiology of neonatal sepsis and estimate the prevalence of neonatal infection from maternal genital tract bacterial carriage among mother-newborn pairs. METHODS: We carried out a cross-sectional study of newborns with clinical sepsis admitted to three hospitals in the Gambia neonatal wards. Neonatal blood cultures and maternal genital swabs were obtained at recruitment. We used whole-genome sequencing to explore vertical transmission for neonates with microbiologically confirmed bloodstream infection by comparing phenotypically-matched paired neonatal blood cultures and maternal genital tract bacterial isolates. RESULTS: We enrolled 203 maternal-newborn pairs. Two-thirds (67%; 137/203) of neonates presented with early-onset sepsis (days 0-6 after birth) of which 26% (36/137) were because of a clinically-significant bacterial pathogen. Blood culture isolates from newborns with early-onset sepsis because of Staphylococcus aureus (n = 5), Klebsiella pneumonia (n = 2), and Enterococcus faecalis (n = 1), phenotypically matched their maternal genital tract isolates. Pairwise single-nucleotide variants comparisons showed differences of 12 to 52 single-nucleotide variants only between maternal and newborn S. aureus isolates, presumably representing vertical transmission with a transmission rate of 14% (5/36). CONCLUSIONS: We found a low prevalence of vertical transmission of maternal genital tract colonization in maternal-newborn pairs for early-onset neonatal sepsis in the West African context. Identifying infection acquisition pathways among newborns is essential to prioritize preventive interventions, which could be targeted at the mother or infection control in the hospital environment, depending on the major pathways of transmission

COVID-19 reinfections in The Gambia by phylogenetically distinct SARS-CoV-2 variants-first two confirmed events in west Africa.

At the beginning of the COVID-19 pandemic, in early 2020, the scientific community hypothesised that SARS-CoV-2 transmission would eventually be hindered by herd immunity, conferred by natural infection, vaccination, or both.1 However, essential questions about whether infection with SARS-CoV-2 confers protection against reinfection and the length of time the protection lasts after either infection or vaccination remain open. These answers are crucial for the development of appropriate health control measures worldwide and become more important as new viral variants spread

A instabilidade crónica da Guiné-Bissau : do Golpe de Estado de 1980 a 2018

A República da Guiné-Bissau nasceu num contexto particularmente violento, nomeadamente a luta pela libertação nacional. Esta teve consequências desastrosas na vida futura do novo Estado. De facto, o conflito começou no seio da guerrilha entre Cabo Verdianos e Guineenses. Logo depois da proclamação unilateral da independência em 1973, a Guiné-Bissau passou por sucessivos golpes de Estado e contragolpes e viveu durante duas décadas uma ditadura sangrenta. A pressão internacional prevaleceu e o país abriu-se ao multipartidarismo em 1994. Entretanto, os guineenses nunca conheceram uma estabilidade governativa. Na verdade, o país experimentou uma guerra civil, golpes e a eliminação física de um presidente em pleno exercício. Há quem diga que esta instabilidade ocorre devido ao sistema político escolhido, logo na abertura à democracia liberal e à composição étnica do país. O objetivo desta dissertação é apresentar as causas de instabilidade crónica da Guiné-Bissau desde o golpe de Estado de 1980 até 2018. Assim, pretende-se analisar as razões, motivos, causas e origens deste fenómeno num país rico em termos de recursos naturais.The Republic of Guinea-Bissau was born in a violent particular context, namely the National Struggle for Independence. This had disastrous consequences on the future life of the new State. In fact, the conflict started in the mid of the freedom fighters, between Cape Verdians and Bissau Guineans. Immediately after gaining its Independence in 1973, Guinea-Bissau has been experiencing coup d’états and counter coup and lived for two decades in a bloody dictatorship. The international pressure prevailed over it and the country finally was open to the multiparty system in 1994. Since then to date, the country has never known a governing stability and has experienced a civil war, coup d’états and an assassination of a President of the Republic in full exercise. Some did believe that this instability is due to the choice of the political system during the adoption of the liberal democracy and to the ethnical composition of the country. The objective of this thesis is to show what are the causes of chronical instability of Guinea-Bissau since the 1980 coup d´état, to 2018. It intends to analyze the reasons, motives, causes or origins of this phenomenon in a natural resource enriched country

Sequestration of organic carbon in West African soils by Aménagement en Courbes de Niveau

A recent Intergovernmental Panel on Climate Change (IPPC) report concludes that global warming, while already a global crisis, is likely to become even more devastating. The scientific consensus is that global warming is caused by increases in greenhouse gases including carbon dioxide. The Sahel of West Africa seems to be more adversely affected by such climate changes, leading to reduced and more sporadic rainfall. In addition, food security in the region is tenuous and fragile, due to adverse climate change, but also due to the historical mining of nutrients and carbon. With the adoption of the Kyoto accords, at least by some countries, sequestered carbon (C) has become a tradable commodity. This provides a double incentive to increase soil organic carbon in the C-depleted and degraded soils of West Africa – return C to improve soil quality and assist in removing CO$_{2}$ from the atmosphere to assist in mitigating climate change. A challenge, however, remains to determine which agricultural systems can actually sequester C. The technology called Aménagement en courbes de niveau (ACN), which can be roughly translated as `Ridge-tillage', has given crop yield increases of 30 to 50%. To date, there has only been anecdotal evidence suggesting that Aménagement en courbes de niveau leads to increased soil organic C. The objectives of the study reported here were to determine whether the technology has the potential to sequester C in West African soils, and, if so, how much. In this study, soil organic C was measured by combustion methods in soils sampled at 0–20 and 20–40 cm depths in a series of experiments in Mali, Senegal and The Gambia. Soil organic C was measured in three very different types of experiments, all including Aménagement en courbes de niveau technology, resulting in three methods of measuring C sequestration. Our results indicate that the Aménagement en courbes de niveau technology significantly increased maize yields by 24% by weight in the Gambia experiment while soil organic C was increased by 26% in The Gambia, by 12% in Siguidolo, Mali, and by 14% in peanut systems of Nioro, Senegal. These increases in soil organic C are likely due to three factors: (1) reduced erosion and movement of soil, (2) increased crop growth resulting from the greater capture of rainfall, and (3) increased growth and density of shrubs and trees resulting from the increased subsoil water, resulting in turn from the increased capture of rainfall, and reduced runoff. Measuring soil C on fields that were successively placed under Aménagement en courbes de niveau management and the use of replicated experimental plots appear to be the best methods to quantify the C sequestration potential of the practice. These results indicate that this soil and water conservation technology not only harvests water and increases food production, but also increases soil organic carbon. This technology thus is a successful technique to sequester C in soils and if carried out in a large region may both offset CO$_{2}$ emissions and help mitigate climate change

Shigella Detection and Molecular Serotyping With a Customized TaqMan Array Card in the Enterics for Global Health (EFGH): Shigella Surveillance Study.

BACKGROUND: Quantitative polymerase chain reaction (qPCR) targeting ipaH has been proven to be highly efficient in detecting Shigella in clinical samples compared to culture-based methods, which underestimate Shigella burden by 2- to 3-fold. qPCR assays have also been developed for Shigella speciation and serotyping, which is critical for both vaccine development and evaluation. METHODS: The Enterics for Global Health (EFGH) Shigella surveillance study will utilize a customized real-time PCR-based TaqMan Array Card (TAC) interrogating 82 targets, for the detection and differentiation of Shigella spp, Shigella sonnei, Shigella flexneri serotypes, other diarrhea-associated enteropathogens, and antimicrobial resistance (AMR) genes. Total nucleic acid will be extracted from rectal swabs or stool samples, and assayed on TAC. Quantitative analysis will be performed to determine the likely attribution of Shigella and other particular etiologies of diarrhea using the quantification cycle cutoffs derived from previous studies. The qPCR results will be compared to conventional culture, serotyping, and phenotypic susceptibility approaches in EFGH. CONCLUSIONS: TAC enables simultaneous detection of diarrheal etiologies, the principal pathogen subtypes, and AMR genes. The high sensitivity of the assay enables more accurate estimation of Shigella-attributed disease burden, which is critical to informing policy and in the design of future clinical trials

<i>Shigella</i> Detection and Molecular Serotyping With a Customized TaqMan Array Card in the Enterics for Global Health (EFGH): <i>Shigella</i> Surveillance Study.

BackgroundQuantitative polymerase chain reaction (qPCR) targeting ipaH has been proven to be highly efficient in detecting Shigella in clinical samples compared to culture-based methods, which underestimate Shigella burden by 2- to 3-fold. qPCR assays have also been developed for Shigella speciation and serotyping, which is critical for both vaccine development and evaluation.MethodsThe Enterics for Global Health (EFGH) Shigella surveillance study will utilize a customized real-time PCR-based TaqMan Array Card (TAC) interrogating 82 targets, for the detection and differentiation of Shigella spp, Shigella sonnei, Shigella flexneri serotypes, other diarrhea-associated enteropathogens, and antimicrobial resistance (AMR) genes. Total nucleic acid will be extracted from rectal swabs or stool samples, and assayed on TAC. Quantitative analysis will be performed to determine the likely attribution of Shigella and other particular etiologies of diarrhea using the quantification cycle cutoffs derived from previous studies. The qPCR results will be compared to conventional culture, serotyping, and phenotypic susceptibility approaches in EFGH.ConclusionsTAC enables simultaneous detection of diarrheal etiologies, the principal pathogen subtypes, and AMR genes. The high sensitivity of the assay enables more accurate estimation of Shigella-attributed disease burden, which is critical to informing policy and in the design of future clinical trials