National plan of action for coordination and response against alerts and emergencies for infectious diseases in Congo Brazzaville

Aparicio Azcarraga, Pilar, cotutoraEste Trabajo Final de Máster tiene como objetivo desarrollar un Plan Nacional de Acción para la coordinación y respuesta ante emergencias y alertas relacionadas con enfermedades infecciosas en el país de Congo Brazzaville. Para ello, se analiza en primer lugar la situación basal del estado de salud de la población, las prestaciones y la estructura del sistema sanitario de Congo Brazzaville, incluyendo los brotes de enfermedades infecciosas ocurridos en los últimos años. La realización de esta propuesta de Plan Nacional de Acción se ha realizado siguiendo los estándares del Reglamento Sanitario Internacional (RSI) del año 2005 y profundizando en los distintos componentes esenciales que lo conforman, todo ello teniendo en cuenta las características y singularidades de esta región africana. Se propone además la creación de un Centro Nacional de coordinación y se definen sus objetivos, recursos y funcionamiento interno. También se identifican herramientas que ayuden a su implementación como son la tecnología mHealth y los comités distritales de vigilancia epidemiológica. Además, se revisan los posibles mecanismos de financiación, incluyendo la realización de un mapeo de donantes. Se concluye con recomendaciones generales enfocadas en las debilidades encontradas.This final master's project aims to develop Action National Plan for coordination and response against alerts and emergencies of infectious diseases in the country of Congo Brazzaville. In order to do this, the baseline status of the health status of the population, benefits and structure of the Congo Brazzaville health system will be analyzed, including the outbreaks of infectious diseases that have occurred in recent years. The implementation of this Action National Plan has been carried out following the standards of the International Health Regulations (IHR) of the year 2005 and deepening in the different essential components that compose according to the characteristics and singularities of this African region. The creation of a National Coordination Center is also proposed and its objectives, resources and internal functioning are defined. In addition, the possible financing mechanisms are reviewed, including the realization of a donor mapping. It concludes with general recommendations focused on the weaknesses found.Máster Universitario en Acción Humanitaria Sanitaria (M161

Imported cases of malaria in Spain: observational study using nationally reported statistics and surveillance data, 2002-2015

BACKGROUND: Malaria was eliminated in Spain in 1964. Since then, more than 10,000 cases of malaria have been reported, mostly in travellers and migrants, making it the most frequently imported disease into this country. In order to improve knowledge on imported malaria cases characteristics, the two main malaria data sources were assessed: the national surveillance system and the hospital discharge database (CMBD). METHODS: Observational study using prospectively gathered surveillance data and CMBD records between 2002 and 2015. The average number of hospitalizations per year was calculated to assess temporal patterns. Socio-demographic, clinical and travel background information were analysed. Bivariate and multivariable statistical methods were employed to evaluate hospitalization risk, fatal outcome, continent of infection and chemoprophylaxis failure and their association with different factors. RESULTS: A total of 9513 malaria hospital discharges and 7421 reported malaria cases were identified. The number of reported cases was below the number of hospitalizations during the whole study period, with a steady increase trend in both databases since 2008. Males aged 25-44 were the most represented in both data sources. Most frequent related co-diagnoses were anaemia (20.2%) and thrombocytopaenia (15.4%). The risks of fatal outcome increased with age and were associated with the parasite species (Plasmodium falciparum). The main place of infection was Africa (88.9%), particularly Equatorial Guinea (33.2%). Most reported cases were visiting friends and relatives (VFRs) and immigrants (70.2%). A significant increased likelihood of hospitalization was observed for children under 10 years (aOR:2.7; 95% CI 1.9-3.9), those infected by Plasmodium vivax (4.3; 95% CI 2.1-8.7) and travellers VFRs (1.4; 95% CI 1.1-1.7). Only 4% of cases reported a correct regime of chemoprophylaxis. Being male, over 15 years, VFRs, migrant and born in an endemic country were associated to increased risk of failure in preventive chemotherapy. CONCLUSIONS: The joint analysis of two data sources allowed for better characterization of imported malaria profile in Spain. Despite the availability of highly effective preventive measures, the preventable burden from malaria is high in Spain. Pre-travel advice and appropriately delivered preventive messages needs to be improved, particularly in migrants and VFRs.This study has been funded by Instituto de Salud Carlos III through the project “PI15/01398” (Co-funded by European Regional Development Fund/European Social Fund “Investing in your future”).S