Etiology and management of hospitalized and outpatient diarrhea among children less than 5 years of age in Lambaréné, Gabon

Objectives: Diarrhea remains a significant cause of global under-5 mortality, particularly in SubSaharan Africa (SSA). To reduce morbidity and mortality, the World Health Organization (WHO) recommends oral rehydration salts (ORS), zinc supplementation, and continued feeding or breastfeeding for all children with diarrhea to prevent dehydration and malnutrition; antibiotics only for bloody diarrhea (i.e. probable shigellosis), suspected cholera, or severe non-intestinal infections (e.g. pneumonia or sepsis); and avoidance of antidiarrheals and antiemetics owing to lack of benefit and potential for harm in young children. Gabon is an upper-middle income country in SSA for which there is a lack of recent, high quality data on the etiology and management of childhood diarrhea. This prospective study aimed to describe the etiology and management of hospitalized and outpatient cases of diarrhea in Gabonese children under five years of age. Methods: Children ≤ 59 months presenting to the Albert Schweitzer or George Rawiri Regional hospitals (February-July 2017) in Lambaréné, Gabon were included if they had ≥ 3 liquid stools per day within the past 3 days. Data was obtained via medical records and standardized questionnaires with caregivers. Diarrheaogenic Escherichia coli, Salmonella enterica, and Shigella spp. were detected using conventional culture techniques. Rotavirus, adenovirus, and Cryptosporidium spp. antigens were detected with commercial rapid immunoassays. Multiplex PCR was used for Cryptosporidium spp., Giardia intestinalis, and Cyclospora cayetanensis detection. Results: Forty-five children were included, 34 of whom were hospitalized. Mean age was 12.2 months; 58% were female. 49% were infected with one or more sought-for pathogens, most commonly with Giardia intestinalis (28.9%) or Cryptosporidium spp. (24.4%). 33% and 36% of hospitalized and outpatient children, respectively, received ORS. Zinc was given to one (3%) hospitalized patient and zero outpatients. Antidiarrheals were frequently given to hospitalized (48%) and outpatient (73%) children. Antibiotics were prescribed in 85% and 36% of hospitalized and outpatient cases, respectively, while only 8 children (18%) presented with bloody stools. 79% of children presented with severe acute malnutrition; 21% had never been breastfed. Conclusions: Ongoing education of healthcare workers and communities regarding WHO-recommended management of childhood diarrhea is needed. The overuse of antibiotics observed in this study is consistent with previous reports and is concerning given high levels of antimicrobial resistance in SSA. Strategies to increase provider awareness of indicated uses of antimicrobials in the setting of childhood diarrhea may help limit the spread of resistance

Genetic Diversity of Enteric Viruses in Children under Five Years Old in Gabon

Enteric viruses are the leading cause of diarrhea in children globally. Identifying viral agents and understanding their genetic diversity could help to develop effective preventive measures. This study aimed to determine the detection rate and genetic diversity of four enteric viruses in Gabonese children aged below five years. Stool samples from children <5 years with (n = 177) and without (n = 67) diarrhea were collected from April 2018 to November 2019. Norovirus, astrovirus, sapovirus, and aichivirus A were identified using PCR techniques followed by sequencing and phylogenetic analyses. At least one viral agent was identified in 23.2% and 14.9% of the symptomatic and asymptomatic participants, respectively. Norovirus (14.7%) and astrovirus (7.3%) were the most prevalent in children with diarrhea, whereas in the healthy group norovirus (9%) followed by the first reported aichivirus A in Gabon (6%) were predominant. The predominant norovirus genogroup was GII, consisting mostly of genotype GII.P31-GII.4 Sydney. Phylogenetic analysis of the 3CD region of the aichivirus A genome revealed the presence of two genotypes (A and C) in the study cohort. Astrovirus and sapovirus showed a high diversity, with five different astrovirus genotypes and four sapovirus genotypes, respectively. Our findings give new insights into the circulation and genetic diversity of enteric viruses in Gabonese children.Peer Reviewe

Molecular surveillance and genetic divergence of rotavirus A antigenic epitopes in Gabonese children with acute gastroenteritis

Background Rotavirus A (RVA) causes acute gastroenteritis in children <5 years of age in sub-Saharan Africa. In this study, we described the epidemiology and genetic diversity of RVA infecting Gabonese children and examined the antigenic variability of circulating strains in relation to available vaccine strains to maximize the public health benefits of introducing rotavirus vaccine through the Expanded Programme on Immunization (EPI) in Gabon. Methods Stool samples were collected consecutively between April 2018 and November 2019 from all hospitalized children <5 years with gastroenteritis and community controls without gastroenteritis. Children were tested for rotavirus A by quantitative RT-PCR and subsequently sequenced to identify circulating rotavirus A genotypes in the most vulnerable population. The VP7 and VP4 (VP8*) antigenic epitopes were mapped to homologs of vaccine strains to assess structural variability and potential impact on antigenicity. Findings Infections were mostly acquired during the dry season. Rotavirus A was detected in 98/177 (55%) hospitalized children with gastroenteritis and 14/67 (21%) of the control children. The most common RVA genotypes were G1 (18%), G3 (12%), G8 (18%), G9 (2%), G12 (25%), with G8 and G9 reported for the first time in Gabon. All were associated either with P[6] (31%) or P[8] (38%) genotypes. Several non-synonymous substitutions were observed in the antigenic epitopes of VP7 (positions 94 and 147) and VP8* (positions 89, 116, 146 and 150), which may modulate the elicited immune responses. Interpretation This study contributes to the epidemiological surveillance of rotavirus A required before the introduction of rotavirus vaccination in the EPI for Gabonese children.Peer Reviewe

Computational Design and Preliminary Serological Analysis of a Novel Multi-Epitope Vaccine Candidate Against Onchocerciasis and Related Filarial Diseases

Onchocerciasis is a skin and eye disease that exerts a heavy socio-economic burden, particularly in sub-Saharan Africa, a region which harbours greater than 96% of either infected or at-risk populations. The elimination plan for the disease is currently challenged by many factors including amongst others; the potential emergence of resistance to the main chemotherapeutic agent, ivermectin (IVM). Novel tools, including preventative and therapeutic vaccines, could provide additional impetus to the disease elimination tool portfolio. Several observations in both humans and animals have provided evidence for the development of both natural and artificial acquired immunity. In this study, immuno-informatics tools were applied to design a filarial-conserved multi-epitope subunit vaccine candidate, (designated Ov-DKR-2) consisting of B-and T-lymphocyte epitopes of eight immunogenic antigens previously assessed in pre-clinical studies. The high-percentage conservation of the selected proteins and epitopes predicted in related nematode parasitic species hints that the generated chimera may be instrumental for cross-protection. Bioinformatics analyses were employed for the prediction, refinement, and validation of the 3D structure of the Ov-DKR-2 chimera. In-silico immune simulation projected significantly high levels of IgG1, T-helper, T-cytotoxic cells, INF-γ, and IL-2 responses. Preliminary immunological analyses revealed that the multi-epitope vaccine candidate reacted with antibodies in sera from both onchocerciasis-infected individuals, endemic normals as well as loiasis-infected persons but not with the control sera from European individuals. These results support the premise for further characterisation of the engineered protein as a vaccine candidate for onchocerciasis

Impact of training on employee performance.

The dismissals, sanctions and punishments given to employees at their work place prompted the researcher to find out what was happening. In doing so, the researcher found out, the employees were lacking in some areas of their work and it made the researcher come up with this study of the impact of training on employees’ performance. To achieve this, the researcher came up with the main objective of the study which was to find out how training will have an impact on employees’ performance. From this main objective, the researcher was able to come up with some research questions such as, what training techniques, theories and training delivery methods organizations put in place for a better training for their employees to help them get the required knowledge and skills they need. To get answers to these questions, the researcher used both primary and secondary ways to collect data for the study and used some sampling techniques. The researcher took a sample of thirty workers from the organization and administered a questionnaire to them. Though faced with difficulties during the process of acquiring necessary information needed, the researcher still managed to get various responses from the employees when the questionnaires were administered, and the researcher was able to come up with the conclusion that, training does have a positive impact on employees' performance. The researcher noticed that organizations could not meet up with the various changes in the market environment, the technology, population growth, demands, taste and fashion of customers. To meet up with all these changes, training is involved. Also, the researcher noticed that, some employees are instead kicked out of organizations when they fail to give out the required skills needed for the job. The researcher decided to find out how far and how deep organizations take and consider training for their employees and how it will affect their performance at work

Indigenous culture and nascent tourism in Muanenguba, Cameroon

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Brand Reputation in International Marketing Case of Mobile Telephone Companies

This thesis is concerned with measuring the extent to which the market of mobile telephone companies is influenced by their brand reputation in international marketing. The analysis investigates the relative importance of brand reputation in the marketing of products in the mobile telephone industry. The work comprises a study within the context of a quantitative survey of marketing information analysis. A survey is carried out by administering questionnaires on a sample of mobile telephone users within the ages of 18 and above from an international student environment at Halmstad University. Watching over your brand reputation is rationally the ideal means of benefiting from a companies brand equity management. The findings provided useful information that may serve mobile telephone companies to strategically position themselves in the competitive international market, thereby improving their overall sales as well as market share. It can equally serve as decision guidelines to brand managers while making meaningful contributions to their companies

Brand Reputation in International Marketing Case of Mobile Telephone Companies

This thesis is concerned with measuring the extent to which the market of mobile telephone companies is influenced by their brand reputation in international marketing. The analysis investigates the relative importance of brand reputation in the marketing of products in the mobile telephone industry. The work comprises a study within the context of a quantitative survey of marketing information analysis. A survey is carried out by administering questionnaires on a sample of mobile telephone users within the ages of 18 and above from an international student environment at Halmstad University. Watching over your brand reputation is rationally the ideal means of benefiting from a companies brand equity management. The findings provided useful information that may serve mobile telephone companies to strategically position themselves in the competitive international market, thereby improving their overall sales as well as market share. It can equally serve as decision guidelines to brand managers while making meaningful contributions to their companies

Traditional and Local Knowledge Practices for Disaster Risk Reduction in Northern Ghana

In order to deal with recurrent disasters, like floods and droughts coupled with the limited adaptive capacity, in the semiarid regions of Northern Ghana, local communities have no choice but to apply traditional and local knowledge practices. This study seeks to identify such practices employed in selected rural communities in Northern Ghana and to investigate their effectiveness. Data were collected through key informant interviews, household questionnaire surveys, focus group discussions, and participant observations. The findings indicated that although diverse practices were applied to predict and manage local disaster events, skepticism prevailed among locals toward these practices regarding their effectiveness. Due to the lack of science-based tools and systems for disaster prediction and management, local communities continually depended on these knowledge systems and practices. Integrating local and traditional disaster risk reduction (DRR) efforts into modern scientific knowledge should be encouraged in order to reduce the vulnerability of local communities to disasters with thorough effectiveness evaluation protocols