Dynamics of Socioeconomic Risk Factors for Neglected Tropical Diseases and Malaria in an Armed Conflict

Armed conflict and war and infectious diseases are globally among the leading causes of human suffering and premature death. Moreover, they are closely interlinked, as an adverse public health situation may spur violent conflict, and violent conflict may favor the spread of infectious diseases. The consequences of this vicious cycle are increasingly borne by civilians, often as a hidden and hence neglected burden. We analyzed household data that were collected before and after an armed conflict in a rural part of western Côte d'Ivoire, and investigated the dynamics of socioeconomic risk factors for neglected tropical diseases (NTDs) and malaria. We identified a worsening of the sanitation infrastructure, decreasing use of protective measures against mosquito bites, and increasing difficulties to reach public health care infrastructure. In contrast, household crowding, the availability of soap, and the accessibility of comparatively simple means of health care provision (e.g., traditional healers and community health workers) seemed to be more stable. Knowledge about such dynamics may help to increase crisis-proofness of critical infrastructure and public health systems, and hence mitigate human suffering due to armed conflict and war

New Antenatal Model in Africa and India (NAMAI) study: implementation research to improve antenatal care using WHO recommendations

Background: In 2020, an estimated 287 000 women died globally from pregnancy‐related causes and 2 million babies were stillborn. Many of these outcomes can be prevented by quality healthcare during pregnancy and childbirth. Within the continuum of maternal health, antenatal care (ANC) is a key moment in terms of contact with the health system, yet it remains an underutilized platform. This paper describes the protocol for a study conducted in collaboration with Ministries of Health and country research partners that aims to employ implementation science to systematically introduce and test the applicability of the adapted WHO ANC package in selected sites across four countries. Methods: Study design is a mixed methods stepped-wedge cluster randomized implementation trial with a nested cohort component (in India and Burkina Faso). The intervention is composed of two layers: (i) the country- (or state)-specific ANC package, including evidence-based interventions to improve maternal and newborn health outcomes, and (ii) the co-interventions (or implementation strategies) to help delivery and uptake of the adapted ANC package. Using COM-B model, co-interventions support behaviour change among health workers and pregnant women by (1) training health workers on the adapted ANC package and ultrasound (except in India), (2) providing supplies, (3) conducting mentoring and supervision and (4) implementing community mobilization strategies. In Rwanda and Zambia, a fifth strategy includes a digital health intervention. Qualitative data will be gathered from health workers, women and their families, to gauge acceptability of the adapted ANC package and its components, as well as experience of care. The implementation of the adapted ANC package of interventions, and their related costs, will be documented to understand to what extent the co-interventions were performed as intended, allowing for iteration. Discussion: Results from this study aim to build the global evidence base on how to implement quality ANC across different settings and inform pathways to scale, which will ultimately lead to stronger health systems with better maternal and perinatal outcomes. On the basis of the study results, governments will be able to adopt and plan for national scale-up, aiming to improve ANC nationally. This evidence will inform global guidance. Trial registration number: ISRCTN, ISRCTN16610902. Registered 27 May 2022. https://www.isrctn.com/ISRCTN16610902

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

Caractérisation physique, chimique et microbiologique de trois sols acides tropicaux du Rwanda sous jachères naturelles et contraintes à leur productivité

Physical, chemical and microbiological characterization of three tropical acidic soils of Rwanda under natural fallows and productivity constraints. Three acidic soils of highland (HL), middle land (ML) and lowland (LL) from Rwanda were sampled respectively in the experimental stations of Gakuta, Tonga and Cyabayaga for a physical, chemical and microbiological characterization in order to determine their productivity constraints. Soils are strongly acidic in the HL and ML (pH 4.1 and 4.7) and moderately acidic in LL (pH 5.5). The rate of total organic carbon (Corg) is acceptable in Gakuta (4.5%), but decreases with altitude. The total nitrogen (Ntot), the phosphorus and the effective cation exchange capacity follow the same trend, their levels remaining nevertheless weak. Base saturation and Bray2-P content are weak in the HL and ML, but also they are negatively correlated with Corg content. The Al3+ ion occupies 32 and 18% of the exchange complex at Gakuta and Tonga, and is non-existent in Cyabayaga soils. Carbon microbial biomass (Cmic : Corg) and nitrogen microbial biomass (Nmic : Ntot) ratios indicate a weak mineralization/immobilization rate in the highly acidic soils, and are positively correlated with soil pH. Cmic : Nmic ratio values obtained indicate a soil microbial population dominated by fungi, which predicts a poor organic matter (OM) quality. The small proportion of the assimilate carbon fraction at Gakuta (5% of Corg) testifies also to the OM poor quality. Basal respiration rate is very low (0.30 - 0.37 μg CO2 .h-1.g-1). The addition of glucose for the substrate inducedrespiration has considerably stimulated the metabolic activity, which results in low values of respiratory activation quotient(QR = 0.4-0.5). Dehydrogenase and acidic phosphatase activities are very low but positively correlated with Corg. The soil acidity remains the principal constraint to land productivity in the HL and ML regions while low soil OM and N contents would constitute a limitation in LL zone if appropriate land management practices are not used

Contribution à l'épidémiologie de la malaria et à son contrôle en Côte d'Ivoire

En Côte-d'Ivoire, le développement de la culture de riz dans les bas-fonds n'a pas d'effet ni sur l'infection ni sur la maladie palustre, en zone de savane comme en zone de forêt. Le parasite Plasmodium falciparum a été trouvé très résistant au traitement par la chloroquine en zone forestière alors qu'il y était sensible en zone de savane. Inversement, le vecteur Anopheles gambiae s.l. a été trouvé résistant aux insecticides pyréthrinoïdes en zone de savane alors qu'il y était sensible en zone forestière. Cette résistance est liée à une mutation du gène kdr. La mise en place au niveau national des combinaisons thérapeutiques à base d'artémisinine a permis de résoudre le problème de la résistance des parasites à la chloroquine. Par ailleurs, il a été démontré que les moustiquaires imprégnées de pyréthrinoïdes utilisées dans la lutte antivectorielle ont conservé leur efficacité contre la morbidité de la malaria dans les zones où An. gambiae s.l. a été trouvé résistant à ces insecticides