Distribution of hygiene kits during a cholera outbreak in Kasaï-Oriental, Democratic Republic of Congo: a process evaluation.

Background: Cholera remains a leading cause of infectious disease outbreaks globally, and a major public health threat in complex emergencies. Hygiene kits distributed to cholera case-households have previously shown an effect in reducing cholera incidence and are recommended by Médecins Sans Frontières (MSF) for distribution to admitted patients and accompanying household members upon admission to health care facilities (HCFs). Methods: This process evaluation documented the implementation, participant response and context of hygiene kit distribution by MSF during a 2018 cholera outbreak in Kasaï-Oriental, Democratic Republic of Congo (DRC). The study population comprised key informant interviews with seven MSF staff, 17 staff from other organisations and a random sample of 27 hygiene kit recipients. Structured observations were conducted of hygiene kit demonstrations and health promotion, and programme reports were analysed to triangulate data. Results and conclusions: Between Week (W) 28-48 of the 2018 cholera outbreak in Kasaï-Oriental, there were 667 suspected cholera cases with a 5% case fatality rate (CFR). Across seven HCFs supported by MSF, 196 patients were admitted with suspected cholera between W43-W47 and hygiene kit were provided to patients upon admission and health promotion at the HCF was conducted to accompanying household contacts 5-6 times per day. Distribution of hygiene kits was limited and only 52% of admitted suspected cholera cases received a hygiene kit. The delay of the overall response, delayed supply and insufficient quantities of hygiene kits available limited the coverage and utility of the hygiene kits, and may have diminished the effectiveness of the intervention. The integration of a WASH intervention for cholera control at the point of patient admission is a growing trend and promising intervention for case-targeted cholera responses. However, the barriers identified in this study warrant consideration in subsequent cholera responses and further research is required to identify ways to improve implementation and delivery of this intervention

Identifying transferable lessons from cholera epidemic responses by Médecins Sans Frontières in Mozambique, Malawi and the Democratic Republic of Congo, 2015-2018: a scoping review.

BACKGROUND: Cholera epidemics occur frequently in low-income countries affected by concurrent humanitarian crises. Evaluations of these epidemic response remains largely unpublished and there is a need to generate evidence on response efforts to inform future programmes. This review of MSF cholera epidemic responses aimed to describe the main characteristics of the cholera epidemics and related responses in these three countries, to identify challenges to different intervention strategies based on available data; and to make recommendations for epidemic prevention and control practice and policy. METHODS: Case studies from the Democratic Republic of Congo, Malawi and Mozambique were purposively selected by MSF for this review due to the documented burden of cholera in each country, frequency of cholera outbreaks, and risk of humanitarian crises. Data were extracted on the characteristics of the epidemics; time between alert and response; and, the delivery of health and water, sanitation and hygiene interventions. A Theory of Change for cholera response programmes was built to assess factors that affected implementation of the responses. RESULTS AND CONCLUSIONS: 20 epidemic response reports were identified, 15 in DRC, one in Malawi and four in Mozambique. All contexts experienced concurrent humanitarian crises, either armed conflict or natural disasters. Across the settings, median time between the date of alert and date of the start of the response by MSF was 23 days (IQR 14-41). Almost all responses targeted interventions community-wide, and all responses implemented in-patient treatment of suspected cholera cases in either established health care facilities (HCFs) or temporary cholera treatment units (CTUs). In three responses, interventions were delivered as case-area targeted interventions (CATI) and four responses targeted households of admitted suspected cholera cases. CATI or delivery of interventions to households of admitted suspected cases occurred from 2017 onwards only. Overall, 74 factors affecting implementation were identified including delayed supplies of materials, insufficient quantities of materials and limited or lack of coordination with local government or other agencies. Based on this review, the following recommendations are made to improve cholera prevention and control efforts: explore improved models for epidemic preparedness, including rapid mobilisation of supplies and deployment of trained staff; invest in and strengthen partnerships with national and local government and other agencies; and to standardise reporting templates that allow for rigorous and structured evaluations within and across countries to provide consistent and accessible data

A Randomized Controlled Trial of Folate Supplementation When Treating Malaria in Pregnancy with Sulfadoxine-Pyrimethamine

OBJECTIVES: Sulfadoxine-pyrimethamine (SP) is an antimalarial drug that acts on the folate metabolism of the malaria parasite. We investigated whether folate (FA) supplementation in a high or a low dose affects the efficacy of SP for the treatment of uncomplicated malaria in pregnant women. DESIGN: This was a randomized, placebo-controlled, double-blind trial. SETTING: The trial was carried out at three hospitals in western Kenya. PARTICIPANTS: The participants were 488 pregnant women presenting at their first antenatal visit with uncomplicated malaria parasitaemia (density of ≥ 500 parasites/μl), a haemoglobin level higher than 7 g/dl, a gestational age between 17 and 34 weeks, and no history of antimalarial or FA use, or sulfa allergy. A total of 415 women completed the study. INTERVENTIONS: All participants received SP and iron supplementation. They were randomized to the following arms: FA 5 mg, FA 0.4 mg, or FA placebo. After 14 days, all participants continued with FA 5 mg daily as per national guidelines. Participants were followed at days 2, 3, 7, 14, 21, and 28 or until treatment failure. OUTCOME MEASURES: The outcomes were SP failure rate and change in haemoglobin at day 14. RESULTS: The proportion of treatment failure at day 14 was 13.9% (19/137) in the placebo group, 14.5% (20/138) in the FA 0.4 mg arm (adjusted hazard ratio [AHR], 1.07; 98.7% confidence interval [CI], 0.48 to 2.37; p = 0.8), and 27.1% (38/140) in the FA 5 mg arm (AHR, 2.19; 98.7% CI, 1.09 to 4.40; p = 0.005). The haemoglobin levels at day 14 were not different relative to placebo (mean difference for FA 5 mg, 0.17 g/dl; 98.7% CI, −0.19 to 0.52; and for FA 0.4 mg, 0.14 g/dl; 98.7% CI, −0.21 to 0.49). CONCLUSIONS: Concomitant use of 5 mg FA supplementation compromises the efficacy of SP for the treatment of uncomplicated malaria in pregnant women. Countries that use SP for treatment or prevention of malaria in pregnancy need to evaluate their antenatal policy on timing or dose of FA supplementation

Assessment of factors associated with complete immunization coverage in children aged 12-23 months: a cross-sectional study in Nouna district, Burkina Faso

This study identifies specific factors associated with immunization status in Nouna health district (Burkina Faso) in order to advance improved intervention strategies in this district and in those with similar environmental and social contexts. While comprehensive communication may improve understanding about immunization, local interventions should also take into account religious specificities and critical economic periods. Communication problems need to be examined; for instance, many respondents did not understand what the health workers wanted; and or they assumed their child was already totally immunized. Particular approaches that take into consideration local distinctions need to be applied

Hepcidin, Serum Iron, and Transferrin Saturation in Full-Term and Premature Infants during the First Month of Life: A State-of-the-Art Review of Existing Evidence in Humans.

Neonates regulate iron at birth and in early postnatal life. We reviewed literature from PubMed and Ovid Medline containing data on umbilical cord and venous blood concentrations of hepcidin and iron, and transferrin saturation (TSAT), in human neonates from 0 to 1 mo of age. Data from 59 studies were used to create reference ranges for hepcidin, iron, and TSAT for full-term-birth (FTB) neonates over the first month of life. In FTB neonates, venous hepcidin increases 100% over the first month of life (to reach 61.1 ng/mL; 95% CI: 20.1, 102.0 ng/mL) compared with umbilical cord blood (29.7 ng/mL; 95% CI: 21.1, 38.3 ng/mL). Cord blood has a high concentration of serum iron (28.4 μmol/L; 95% CI: 26.0, 31.1 μmol/L) and levels of TSAT (51.7%; 95% CI: 46.5%, 56.9%). After a short-lived immediate postnatal hypoferremia, iron and TSAT rebounded to approximately half the levels in the cord by the end of the first month. There were insufficient data to formulate reference ranges for preterm neonates

The adoption of strategic planning practices by retail SMEs in Johannesburg

M.Com. (Business Management)Abstract: Small and Medium Enterprises (SMEs) are the main pillar of economies around the world. Some evidence exists to prove the important and crucial role played by SMEs in economic growth. Among the multiple types of SMEs, there is one that specialises in retailing activities. Retailing involves all business activities involved in the selling of goods or services to the final consumer for a personal use. One advantage of retailing is that it makes products and services available to customers and clients in terms of distance. However, despite the incontestable importance of SMEs and the numerous roles they play in economic development, they face several constraints that negatively affect their success to perform in a business environment. These constraints include financial difficulties, lack of managerial skills, and lack of access to the international markets. Although SMEs are essential to the economy, many struggle to survive and to develop themselves. Nonetheless, one of the best management tools to face this dilemma has proven to be strategic planning. Such planning helps an organisation to face all the above-mentioned challenges, and allows it to be more proactive. Strategic planning helps as well appropriately allocate important resources and more. The aim of this study was to explore different factors that retail SMEs consider important for the adoption of strategic planning practices in Johannesburg CBD. A deductive approach and a survey strategy were used in this study followed by a quantitative method. Data were collected from 230 entrepreneurs and managers using a self-administered questionnaire from which a data analysis was conducted ranging from descriptive analysis, factor analysis, correlation analysis to regression analysis. The results revealed that there are five factors that retail SMEs operating in Johannesburg CBD consider important in the practice of strategic planning, namely: monitoring and evaluation, competitiveness, staff involvement, financial resources, and technology

Profil clinique et déterminants de l’ictère nucléaire du nouveau-né à l’hôpital provincial du Nord-Kivu, en République Démocratique du Congo: Clinical profile and determinants for nuclear jaundice in newborns at North-Kivu provincial hospital in Democratic Republic of Congo

Context and objective. Neonatal jaundice remains a major concern but paradoxically, related data are scarce in rural Africa. This study aimed to describe the frequency and clinical features of jaundice in neonates, and the determinants of kernicterus. Methods. Using a cross-sectional approach, 54 jaundiced newborns were studied at the North Kivu Provincial Hospital between January 1, 2015 and December 31, 2016. The parameters of interest included: clinical data (age, sex, weight of birth, mode of admission, time of onset of jaundice, mode of disease expression, causes of jaundice), biological data (total bilirubinemia, free and conjugated fraction, positive co-test, CRP > 10 mg / dL, positive blood culture) and imaging data (ultrasound or hepatic CT scan). We used the Chisquare test for the comparison of proportions and the odd ratio to calculate the risks at the 95% confidence interval. The statistical significance level was set at P <0.05. Results. The intra-hospital frequency of neonatal jaundice was 9.6%, ie an annual incidence of 27 cases per year. The sex ratio was 1.4 in favor of the male sex (59.3%). All these newborns clinically presented with jaundice and pallor. The relevant determinants of kernicterus were: biliary atresia (OR 4.0, 95% CI: 1.487-31) followed by rapid increase in free bilirubin; delayed care (OR 3.387, 95% CI 1.381-30.086) and the rhesus incompatibility (OR 3.2, 95% CI 1.39-25.35). Conclusion. Jaundice of infectious origin is the first cause of neonatal jaundice in our environment. Quality antenatal care would reduce these cases of neonatal pathological jaundice.  Contexte et objectif. L’ictère néonatal reste une préoccupation majeure mais les données y relatives sont paradoxalement rares en milieu rural africain. L’objectif de la présente étude était décrire la fréquence, le profil clinique de l’ictère chez les nouveau-nés ainsi que les déterminants de l’ictère nucléaire. Méthodes. Par une approche transversale, 54 nouveau-nés ictériques ont été étudiés à l’hôpital provincial du Nord-Kivu entre le 1er janvier 2015 et le 31 décembre 2016. Les paramètres d’intérêt comprenaient : les données cliniques (âge, sexe, poids de naissance, mode d’admission, moment d’apparition de l’ictère, signes de l’expression cliniques, causes de l’ictère), les données biologiques (taux de bilirubinémie totale, fraction libre et conjuguée, test de coombs positif, CRP > 10 mg/dL, hémoculture positive) et les données d’imagerie (échographie ou scanner hépatique). Nous avons recouru au test de Khi-carré pour la comparaison des proportions et l’Odd ratio pour calculer les risques à l’intervalle de confiance à 95%. Le seuil de signification statistique était fixé a P<0,05. Résultats. La fréquence intra hospitalière de l’ictère néonatal était de 9,6% soit une incidence annuelle de 27 cas par an. Le sex-ratio était de 1,4 en faveur du sexe masculin (59,3%). Tous ces nouveau-nés ont présenté cliniquement un ictère franc et une pâleur. Les déterminants de l’ictère nucléaire les plus retrouves étaient : l’atrésie des voies biliaires (OR 4,0 ; IC 95% : 1,487-31) suivi d’accroissement rapide de taux de bilirubine libre ; retard de soins (OR 3,387 ; IC 95% : (1,381-30,086) et en fin l’incompatibilité rhésus OR : 3,200, IC 95% (1,39-25,35). En conclusion. Les ictères d’origines infectieuses sont les premières causes des ictères néonatals dans notre milieu. Un suivi prénatal de qualité réduirait ces cas d’ictères pathologique néonatal