Field investigation with real-time virus genetic characterisation support of a cluster of Ebola virus disease cases in Dubréka, Guinea, April to June 2015

On 11 May 2015, the Dubréka prefecture, Guinea, reported nine laboratory-confirmed cases of Ebola virus disease (EVD). None could be epidemiologically linked to cases previously reported in the prefecture. We describe the epidemiological and molecular investigations of this event. We used the Dubréka EVD registers and the Ebola treatment centre’s (ETC) records to characterise chains of transmission. Real-time field Ebola virus sequencing was employed to support epidemiological results. An epidemiological cluster of 32 cases was found, of which 27 were laboratory confirmed, 24 were isolated and 20 died. Real-time viral sequencing on 12 cases demonstrated SL3 lineage viruses with sequences differing by one to three nt inside a single phylogenetic cluster. For isolated cases, the average time between symptom onset and ETC referral was 2.8 days (interquartile range (IQR): 1–4). The average time between sample collection and molecular results’ availability was 3 days (IQR: 2–5). In an area with scarce resources, the genetic characterisation supported the outbreak investigations in real time, linking cases where epidemiological investigation was limited and reassuring that the responsible strain was already circulating in Guinea. We recommend coupling thorough epidemiological and genomic investigations to control EVD clusters.Peer Reviewe

Influence of the Service Delivery Environment on Family Planning Outcomes in Nigeria

Using linked data from a 2009 health facility and household survey and multilevel logit models, this paper examined the association of the service delivery environment with contraceptive outcomes in Nigeria. The findings showed significant positive associations of the number of modern contraceptive methods provided and quality assurance systems used by health facilities in the Local Government Area (LGA) with the odds of knowing three or more modern methods. These odds were significantly higher among rural than urban residents. The LGA indices of provider training in FP and provider-client interaction had significant positive associations, while a perceived need for more staff in FP health facilities had a significant negative association with the odds of current use of a modern method. The positive association between the index of FP provider-client interaction and current use of a modern method was significantly stronger among women than men and in semi-urban than urban areas