Microbiological parameters that influence the treatment outcomes of monodrug and multidrug-resistant tuberculosis

Magister Pharmaceuticae - MpharmPrevious studies have reported microbiological parameters such as HIV infection, resistance to anti-TB drugs such as fluoroquinolones, resistance to previous treatment with anti-TB drugsand extrapulmonary TB, causing poor treatment outcomes in patients with monodrug and multidrugresistant tuberculosis. However, little is known about the time to sputum culture conversion in HIV-positive patients infected with monodrug and multidrug-resistant tuberculosis in South Africa, and currently there is no information on the effects of inappropriate (i.e. low and high) anti-tuberculosis drug-dose on the time to sputum culture conversion in monodrug and multidrug-resistant TB patients. The aim of the study was to investigate whether or not there is a difference between the time to sputum culture conversion in drug-resistant tuberculosis patients with HIV, and those without HIV infection. It also aimed to find out whether inappropriate (i.e. low and high) anti-tuberculosis drug dose could affect the time to sputum culture conversion in drug-resistant TB patients. In addition, the influence of HIV infection (CD4 count and viral load), drug resistance type, impact of antiretroviral duration before TB treatment, the replacement of ofloxacin by moxifloxacin and DR-TB localization were assessed on drugresistant TB treatment outcomes

Monkeypox during Covid-19 era in Africa: Current challenges and recommendations

In May 2022, monkeypox virus (MPXV) outbreak was confirmed amid the coronavirus disease 2019 (COVID-19) pandemic in many parts of the world including Africa. This is the largest outbreak since monkeypox (MPX) was first detected in humans in 1970. The MPX outbreak in Africa is an added burden to the fragile healthcare systems that are already overburdened with several reoccurring epidemics. Although several efforts are in place to effectively contained the outbreak. Several measures such as improved surveillance and diagnostic are necessary to contain the spread of the disease in Africa. This commentary highlights the challenges with the MPX outbreak in Africa and discusses the measures that can be taken to limit the spread of the disease, particularly in high-risk countries

Marburg virus disease outbreak amidst COVID-19 in the Republic of Guinea: A point of contention for the fragile health system?

In August 2021, the Marburg virus disease (MVD) outbreak was confirmed amid the coronavirus disease 2019 (COVID-19) pandemic in the Republic of Guinea. This is the first time it is detected in Guinea and West Africa. Marburg virus is one of the world’s most threatening diseases, causing severe haemorrhagic fever, with a case fatality rate of 90%. Currently, there are no vaccines and specific antiviral drugs for MVD. Technical teams and community health care workers that were set up as part of the recent Ebola virus disease (EVD) outbreak that was declared over on June 19, 2021, are now redeployed to support governments response activities of the MVD outbreak in the country. The MVD is an added burden to the fragile healthcare systems that are already overburdened with multiple reoccurring epidemics and the COVID-19 pandemic. Previous epidermic strategies are needed to contain the spread of the disease, amid the COVID-19 pandemic, so the health care systems are not overwhelmed. This commentary discusses the available evidence regarding the epidemic of MVD in Guinea amid the COVID-19 pandemic, and highlights the efforts, challenges to be prioritized, and provides evidence-based recommendations

Understanding varying COVID-19 mortality rates reported in Africa compared to Europe, Americas and Asia

The SARS-CoV-2 infection, which causes the COVID-19 disease, has impacted every nation on the globe, albeit disproportionately. African countries have seen lower infection and mortality rates than most countries in the Americas Europe and Asia. In this commentary, we explore some of the factors purported to be responsible for the low COVID-19 infection and case fatality rates in Africa: low testing rate, poor documentation of cause of death, younger age population, good vitamin D status as a result of exposure to sunlight, cross-immunity from other viruses including coronaviruses, and lessons learnt from other infectious diseases such as HIV and Ebola. With the advent of a new variant of COVID-19 and inadequate roll-out of vaccines, an innovative and efficient response is needed to ramp up testing, contact tracing and accurate reporting of infection rates and cause of death in order to mitigate the spread of the infection

Time trends in Tuberculosis mortality across the BRICS: An age-period-cohort analysis for the GBD 2019

There were 549,522 tuberculosis deaths across the BRICS in 2019, accounting for 39.3% of global deaths. Among HIV-negative populations, the age-standardised mortality rate (ASMR) of tuberculosis in BRICS remained far higher than that of high-income Asia Pacific countries, especially in India (36.1 per 100 000 in 2019, 95% UI [30.7, 42.6]) and South Africa (40.1 per 100 000 in 2019, 95% UI [36.8, 43.7]). China had the fastest ASMR reduction across the BRICS, while India maintained the largest tuberculosis death numbers with an annual decrease much slower than China’s (-4.1 vs -8.0%). Among HIV-positive populations, the ASMR in BRICS surged from 0.24 per 100 000 in 1990 to 5.63 per 100 000 in 2005, and then dropped quickly to 1.70 per 100 000 in 2019. Brazil was the first country to reverse the upward trend of HIV/AIDS-tuberculosis (HIV-TB) mortality in 1995, and achieved the most significant reduction (-3.32% per year). The HIV-TB mortality in South Africa has realised much progress since 2006, but still has the heaviest HIV-TB burden across the BRICS (ASMR: 70.0 per 100 000 in 2019). We also found unfavourable trends among HIV-negative middle-aged (35-55) adults of India, men over 50 in the HIV-negative population and whole HIV-positive population of South Africa, and women aged 45-55 years of Russia. China had little progress in its HIV-positive population with worsening period risks from 2010 to 2019, and higher risks in the younger cohorts born after 1980

Challenges faced by African healthcare workers during the third wave of the pandemic

Africa experienced the third wave of the coronavirus disease in 2019, which caused an 18% rise in cases in most parts of the continent. As of January 2022, the region had an estimated 10.4 million cumulative cases and more than 233,000 deaths, which add up to the burden on the fragile healthcare system, which continues to face a shortage of staff and resources. In addition, the progression of the pandemic further threatens the supply of healthcare workers in Africa due to the increased risk of infection and death, where more than 10,000 healthcare workers in 40 countries have been infected with the virus. This is amid low vaccination coverage, with only 27% of healthcare workers in Africa being fully vaccinated against the disease

Strategies for malaria vaccination during the Covid-19 pandemic in African countries

Since October 2021, the World Health Organization (WHO) recommends the use of RTS,S/AS01 (RTS,S) malaria vaccine for children in areas of moderate to high transmission of Plasmodium falciparum in Africa.1 The vaccine can reduce the 241 million cases of malaria and 627 000 malaria deaths worldwide;2,3 it is much needed in the WHO African Region, which accounts for 228 million cases of malaria (95% of global cases) and about 96% of global malaria deaths.2 However, an effective vaccine roll-out in Africa can only be achieved when region-specific challenges can be overcome; intraregional inequality, health-care systems strengthening and lessons from community engagement in previous public health crises

Inequalities in the prevalence of stunting, anemia and exclusive breastfeeding among African children

Childhood stunting and anemia are on the increase in many resource-constrained settings, without a counter increase in proper feeding practices such as exclusive breastfeeding. The objective of this study was to explore the prevalence of stunting, anemia and exclusive breastfeeding across African countries. Demographic and Health Survey (DHS) data from 39 African countries was analyzed. Data from under 5 children were analyzed. Forest plot was used to determine inequalities in the prevalence of the outcome variables. The prevalence of stunting was highest in Burundi (56%), Madagascar (50%) and Niger (44%). In addition, Burkina Faso (88%), Mali (82%), Cote d’Ivoire and Guinea (75% each) and Niger (73%) had the highest prevalence of anemia. Furthermore, Burundi (83%), Rwanda (81%) and Zambia (70%) had the highest exclusive breastfeeding. We found statistical significant difference in the prevalence of stunting, anemia and exclusive breastfeeding (p < 0.001). Higher prevalence of stunting and anemia were estimated among the male, rural residents, those having mothers with low education and from poor household wealth

Marburg virus disease amid Covid-19 in West Africa: An emerging and re-emerging zoonotic epidemic threat, future implications and way forward

Amid the coronavirus 2019 (COVID-19) pandemic, several African countries including Ghana and Equatorial Guinea have reported several zoonotic outbreaks. The COVID-19 pandemic has added more strain on the already fragile healthcare system, and consequently increasing the impact of both emerging and re-emerging diseases such as the current outbreak of Marburg virus disease (MVD) in Ghana and Equatorial Guinea.1–4 On 28 June 2022, the health authorities in Ghana received reports of two fatal cases of MVD;1 by 29 July 2022, four confirmed case of MVD were reported with three deaths (case fatality ratio of 75%)

COVID-19, measles, and yellow fever: The need to reinforce vaccination in the Democratic Republic of Congo

The immunization programs have been jeopardized all over the world due to the stay-at-home constraints imposed, to mitigate the ongoing COVID-19 pandemic. This has directly or indirectly placed the global health care system in peril, resulting in an overlapping public health crisis. With this commentary, we aim to accentuate the need to reinforce vaccination in the Democratic Republic of Congo, in lieu of the intersecting COVID-19, measles, and yellow fever outbreak, besides, providing recommendations so as to help alleviate the situation