Future Directions for Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Sub-Saharan Africa

Abstract In sub-Saharan Africa, bacterial meningitis remains a significant public health problem, especially in the countries of the meningitis belt, where Neisseria meningitidis serogroup A historically caused large-scale epidemics. In 2014, MenAfriNet was established as a consortium of partners supporting strategic implementation of case-based meningitis surveillance to monitor meningitis epidemiology and impact of meningococcal serogroup A conjugate vaccine (MACV). MenAfriNet improved data quality through use of standardized tools, procedures, and laboratory diagnostics. MenAfriNet surveillance and study data provided evidence of ongoing MACV impact, characterized the burden of non-serogroup A meningococcal disease (including the emergence of a new epidemic clone of serogroup C), and documented the impact of pneumococcal conjugate vaccine. New vaccines and schedules have been proposed for future implementation to address the remaining burden of meningitis. To support the goals of “Defeating Meningitis by 2030,” MenAfriNet will continue to strengthen surveillance and support research and modeling to monitor the impact of these programs on meningitis burden in sub-Saharan Africa.

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The prevalence of scabies in Monrovia, Liberia: a population-based survey

10.1101/2020.06.25.20139808 ◽

2020 ◽

Author(s):

Shelui Collinson ◽

Joseph Timothy ◽

Samuel K Zayay ◽

Karsor K Kollie ◽

Eglantine Lebas ◽

...

Keyword(s):

Public Health ◽

Quality Of Life ◽

Health Problem ◽

Public Health Problem ◽

Sub Saharan Africa ◽

Quality Data ◽

Local Health ◽

Sub Saharan ◽

The Impact

AbstractBackgroundScabies is known to be a public health problem in many settings but the majority of recent data is from rural settings in the Pacific. There is a need for high quality data from sub-Saharan Africa and peri-Urban settings to inform scale up of scabies control efforts. There have been anecdotal reports of scabies being a public health problem in Liberia but robust data are lacking.MethodsWe conducted a cross-sectional cluster-randomised prevalence survey for scabies in a peri-urban community in Monrovia, Liberia in February-March 2020. Participants underwent a standardised examination conducted by trained local health care workers. Health related quality of life (HRQoL) was assessed using age-appropriate dermatology life quality indices (DLQIs). Prevalence estimates were calculated accounting for clustering at community and household levels and associations with key demographic variables assessed through multivariable random-effects logistic regression.Results1,318 participants from 477 households were surveyed. The prevalence of scabies prevalence was 9.3% (95% CI: 6.5-13.2%), across 75 (19.7%) households; impetigo or infected scabies prevalence was 0.8% (95% CI: 0.4-1.9%). The majority (52%) of scabies cases were classified as severe. Scabies prevalence was lower in females and higher in the youngest age group; no associations were found with other collected demographic or socio-economic variables. DLQI scores indicated a very or extremely large effect on HRQoL in 29% of adults and 18% of children diagnosed with scabies.ConclusionsOur study indicates a substantial burden of scabies in this peri-Urban population in Liberia. This was associated with significant impact on quality of life, highlighting the need for action to control scabies in this population. Further work is needed to assess the impact of interventions in this context on both the prevalence of scabies and quality of life.Plain English summaryScabies is an infestation with a microscopic mite which affects many people living in low-resource tropical countries. It causes intense itching, which can lead to complications through bacterial infection and poor quality of life. To help develop global scabies control programmes, we need a better understanding of how common it is across different tropical settings. We conducted a survey to assess the burden of scabies and bacterial skin infection in a random sample of people living in a community in Monrovia, Liberia. Information about participants and their household were collected and their skin was examined; those with skin conditions were asked about its impact on quality of life.We examined 1,318 participants and found that almost 10% of people had scanies. Scabies was more common in young children, and was more common in male children than female children. We found that there was a large impact on quality of life due mostly to the itching that scabies causes and to people feeling embarrassed or sad because of their skin condition. This scabies survey is one of the first conducted across all age groups in recent years in sub-Saharan Africa and indicates a substantial burden and impact on quality of life. More work is needed to understand how common scabies is in different settings and the impact that different treatment strategies may have.

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HIV/AIDS

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0098 ◽

2020 ◽

pp. 901-933

Author(s):

Sarah Fidler ◽

Timothy E.A. Peto ◽

Philip Goulder ◽

Christopher P. Conlon

Keyword(s):

Large Scale ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

African Countries ◽

Global Pandemic ◽

The People ◽

Reduce Life Expectancy ◽

Sub Saharan ◽

Living With Hiv ◽

The Impact

Since its discovery in 1983, the human immunodeficiency virus (HIV) has been associated with a global pandemic that has affected more than 78 million people and caused more than 39 million deaths. Globally, 36.9 million (34.3–41.4 million) people were living with HIV at the end of 2013. An estimated 0.8% of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of the people living with HIV worldwide. The impact of HIV in some African countries has been sufficient to reverse population growth and reduce life expectancy into the mid-30s, although HIV incidence has declined in some of these high-prevalence countries. However, there are large-scale HIV epidemics elsewhere (e.g. India, the Russian Federation, and Eastern Europe).

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Global Patterns of Prostate Cancer Incidence, Aggressiveness, and Mortality in Men of African Descent

Prostate Cancer ◽

10.1155/2013/560857 ◽

2013 ◽

Vol 2013 ◽

pp. 1-12 ◽

Cited By ~ 81

Author(s):

Timothy R. Rebbeck ◽

Susan S. Devesa ◽

Bao-Li Chang ◽

Clareann H. Bunker ◽

Iona Cheng ◽

...

Keyword(s):

Prostate Cancer ◽

African Descent ◽

Public Health Problem ◽

Tumor Stage ◽

Sub Saharan Africa ◽

Incidence And Mortality ◽

African Caribbean ◽

Significant Public Health ◽

The Usa ◽

Sub Saharan

Prostate cancer (CaP) is the leading cancer among men of African descent in the USA, Caribbean, and Sub-Saharan Africa (SSA). The estimated number of CaP deaths in SSA during 2008 was more than five times that among African Americans and is expected to double in Africa by 2030. We summarize publicly available CaP data and collected data from the men of African descent and Carcinoma of the Prostate (MADCaP) Consortium and the African Caribbean Cancer Consortium (AC3) to evaluate CaP incidence and mortality in men of African descent worldwide. CaP incidence and mortality are highest in men of African descent in the USA and the Caribbean. Tumor stage and grade were highest in SSA. We report a higher proportion of T1 stage prostate tumors in countries with greater percent gross domestic product spent on health care and physicians per 100,000 persons. We also observed that regions with a higher proportion of advanced tumors reported lower mortality rates. This finding suggests that CaP is underdiagnosed and/or underreported in SSA men. Nonetheless, CaP incidence and mortality represent a significant public health problem in men of African descent around the world.

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Methylene blue inhibits lumefantrine-resistant Plasmodium berghei

The Journal of Infection in Developing Countries ◽

10.3855/jidc.7556 ◽

2016 ◽

Vol 10 (06) ◽

pp. 635-642 ◽

Cited By ~ 4

Author(s):

Victor Irungu Mwangi ◽

Ruth Mwende Mumo ◽

Daniel Muthui Kiboi ◽

Sabah Ahmed Omar ◽

Zipporah Waithera Ng'ang'a ◽

...

Keyword(s):

Methylene Blue ◽

Combination Therapy ◽

Large Scale ◽

Public Health Problem ◽

Drug Repurposing ◽

Sub Saharan Africa ◽

Major Public Health Problem ◽

Resistant Strains ◽

Sub Saharan ◽

Emergence Of Resistance

Introduction: Chemotherapy still is the most effective way to control malaria, a major public health problem in sub-Saharan Africa. The large-scale use of the combination therapy artemether-lumefantrine for malaria treatment in Africa predisposes lumefantrine to emergence of resistance. There is need to identify drugs that can be used as substitutes to lumefantrine for use in combination therapy. Methylene blue, a synthetic anti-methemoglobinemia drug, has been shown to contain antimalarial properties, making it a candidate for drug repurposing. The present study sought to determine antiplasmodial effects of methylene blue against lumefantrine- and pyrimethamine-resistant strains of P. berghei. Methodology: Activity of methylene blue was assessed using the classical four-day test on mice infected with lumefantrine-resistant and pyrimethamine-resistant P. berghei. A dose of 45 mg/kg/day was effective for testing ED90. Parasitemia and mice survival was determined. Results: At 45 mg/kg/day, methylene blue sustained significant parasite inhibition, over 99%, for at least 6 days post-treatment against lumefantrine-resistant and pyrimethamine-resistant P. berghei (p = 0.0086 and p = 0.0191, respectively). No serious adverse effects were observed. Conclusions: Our results indicate that methylene blue at a concentration of 45 mg/kg/day confers over 99% inhibition against lumefantrine- and pyrimethamine-resistant P. berghei for six days. This shows the potential use methylene blue in the development of antimalarials against lumefantrine- and pyrimethamine-resistant parasites.

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COVID-19 in South Africa: outbreak despite interventions

Scientific Reports ◽

10.1038/s41598-021-84487-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Malte Schröder ◽

Andreas Bossert ◽

Moritz Kersting ◽

Sebastian Aeffner ◽

Justin Coetzee ◽

...

Keyword(s):

South Africa ◽

Large Scale ◽

Virus Disease ◽

Sub Saharan Africa ◽

African Countries ◽

Nelson Mandela ◽

Intervention Measures ◽

Before And After ◽

Sub Saharan ◽

The Impact

AbstractThe future dynamics of the Corona Virus Disease 2019 (COVID-19) outbreak in African countries is largely unclear. Simultaneously, required strengths of intervention measures are strongly debated because containing COVID-19 in favor of the weak health care system largely conflicts with socio-economic hardships. Here we analyze the impact of interventions on outbreak dynamics for South Africa, exhibiting the largest case numbers across sub-saharan Africa, before and after their national lockdown. Past data indicate strongly reduced but still supracritical growth after lockdown. Moreover, large-scale agent-based simulations given different future scenarios for the Nelson Mandela Bay Municipality with 1.14 million inhabitants, based on detailed activity and mobility survey data of about 10% of the population, similarly suggest that current containment may be insufficient to not overload local intensive care capacity. Yet, enduring, slightly stronger or more specific interventions, combined with sufficient compliance, may constitute a viable option for interventions for South Africa.

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Household Food Insecurity, Dietary Diversity, and Stunting in Sub-Saharan Africa: A Systematic Review

Nutrients ◽

10.3390/nu13124401 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4401

Author(s):

Goudja Gassara ◽

Jihua Chen

Keyword(s):

Food Insecurity ◽

Dietary Diversity ◽

Public Health Problem ◽

Sub Saharan Africa ◽

Bibliographic Databases ◽

Household Food Insecurity ◽

Household Food ◽

Significant Public Health Problem ◽

Significant Public Health ◽

Sub Saharan

Background: The significant public health problem in Sub-Saharan Africa of household food insecurity is an underlying cause of malnutrition in Sub-Saharan Africa. This study aims to systematically study the association between household food insecurity, dietary diversity, and stunting. Methods: This review was carried out based on the recommendations of PRISMA (2015). We searched the literature in six bibliographic databases: PubMed, EMBASE, Science Direct, Web of Science, Google Scholar, and Scopus. The research was based on studies conducted in Sub-Saharan Africa about household food insecurity, dietary diversity, and stunting and was published between 2009 and 2020. Results: Out of 2398 original articles identified, only 21 articles met the specific requirements of this review. Two-thirds of the articles selected showed that stunting was linked to household food insecurity and dietary diversity. Conclusions: This study found that household food insecurity and dietary diversity are significantly associated with stunting in Sub-Saharan Africa. This review recommends that in order to yield a sustainable fight against childhood malnutrition in Sub-Saharan Africa, reliable guidelines and strategies are needed to address these factors related to malnutrition.

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The Health Impact of Water and Sanitation Utilities Privatization and Regulation in Sub-Saharan Africa

Oxford Research Encyclopedia of Global Public Health ◽

10.1093/acrefore/9780190632366.013.315 ◽

2021 ◽

Author(s):

Lisa Bagnoli ◽

Salvador Bertomeu-Sanchez ◽

Antonio Estache

Keyword(s):

Large Scale ◽

Health Impact ◽

Sub Saharan Africa ◽

Water And Sanitation ◽

Middle Income ◽

Imperfect Data ◽

High Population Growth ◽

Sub Saharan ◽

Rural Access ◽

The Impact

As of 2017, the urban access rate to safe water sources in 2017 stood at 84% while rural access was still around 45%. The rates for sanitation were 44% and 22%, respectively. Since the 1980s many high-profile reforms supported by international organizations have been implemented in the region in an attempt to close the access gaps in the water and sanitation sector (WSS). Two recommendations with high international exposure were an increased role for large-scale private sector participation in the management and financing of national or regional utilities and the creation of separate sector regulatory agencies to increase the independence of regulation. Both reforms seemed to contribute to improved water access rates, at least for the urban population, but not enough to catch up with the demands of a fast-growing population; and both failed to deliver on sanitation. The progress these initiatives allowed was correlated with improvements in the average health outcomes for some indicators (i.e., under-five mortality associated to diarrhea) but once again, it was not enough and was not fairly distributed. Indeed, improvements seem to have mostly benefited upper- and middle-income groups. Unfortunately, an evaluation of the health effects of these two reforms have not yet been fully established empirically, which is why it seems prudent to talk about correlations rather than causal effects. Most of the statistically robust evidence on the impact of utilities and regulatory reforms on health is incomplete because details of several dimensions of these reforms and their context are not measured consistently across countries or within countries. In addition, the small amount of econometric evidence available is based on pre-2010 data for SSA. The imperfect data is however solid enough to suggest that without further governance changes in the region, the health risks are likely to increase. This is because due to the high population growth rate of the region, closing the access gaps is likely to get tougher considering current investment levels and technological choices. The necessary changes require improving the match between policy and technological choices, including service delivery technologies that are consistent with the ability to pay and the tariff and subsidy levels adopted to ensure cost recovery without excluding any category of users.

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Epidemic cerebrospinal meningitis in children at Federal Medical Centre, Gusau, Zamfara state, Nigeria

Nigerian Journal of Paediatrics ◽

10.4314/njp.v40i2.12 ◽

2013 ◽

Vol 40 (2) ◽

pp. 169-171

Author(s):

SM Mado ◽

U Abubakar ◽

SO Onazi ◽

GO Adeoye

Keyword(s):

Neisseria Meningitidis ◽

Large Scale ◽

Medical Centre ◽

Sub Saharan Africa ◽

Treatment Modalities ◽

Major Public Health Problem ◽

Tropical Countries ◽

Young Infants ◽

Meningitis Belt ◽

Sub Saharan

Epidemic meningococcal meningitis is a major public health problem still affecting tropical countries, particularly in Sub-Saharan Africa, which lieswithin African meningitis belt. Repeated large scale epidemics of CSM have been reported in northern Nigeria for the past four decades. It is one of the important causes of morbidity and mortality in these regions. Mortality from the CSM remains high despite advances in treatment modalities. Neisseria meningitidis serogroup A have been the major cause of large scale epidemics in tropical countries, while serogroups B, C, Y and W-135 are responsible for most of invasive disease in America and other developed countries.Objective: To determine the pattern of epidemic CSM in children atFederal Medical Centre, Gusau.Method: The study was a retrospective one carried out in children agedsix months to 12 years admitted into Emergency Paediatrics Unit (EPU) with a diagnosis of CSM within the period January to May, 2009.Results: Seventy- seven children with epidemic CSM were admittedand managed in EPU from January-May 2009.Conclusion: Neisseria meningitidis serogroup A CSM is becoming thedisease of young infants, and stresses the need for inclusion ofCSM vaccine in early infancy in routine immunization policy, in areas within the meningitis belt in Sub-Saharan Africa.

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Modelling meningococcal meningitis in the African meningitis belt

Epidemiology and Infection ◽

10.1017/s0950268811001385 ◽

2011 ◽

Vol 140 (5) ◽

pp. 897-905 ◽

Cited By ~ 26

Author(s):

T. J. IRVING ◽

K. B. BLYUSS ◽

C. COLIJN ◽

C. L. TROTTER

Keyword(s):

Disease Incidence ◽

Public Health Problem ◽

Meningococcal Meningitis ◽

Sub Saharan Africa ◽

Major Public Health Problem ◽

Large Area ◽

Population Immunity ◽

Complex Interactions ◽

Meningitis Belt ◽

Sub Saharan

SUMMARYMeningococcal meningitis is a major public health problem in a large area of sub-Saharan Africa known as the meningitis belt. Disease incidence increases every dry season, before dying out with the first rains of the year. Large epidemics, which can kill tens of thousands of people, occur frequently but unpredictably every 6–14 years. It has been suggested that these patterns may be attributable to complex interactions between the bacteria, human hosts and the environment. We used deterministic compartmental models to investigate how well simple model structures with seasonal forcing were able to qualitatively capture these patterns of disease. We showed that the complex and irregular timing of epidemics could be caused by the interaction of temporary immunity conferred by carriage of the bacteria together with seasonal changes in the transmissibility of infection. This suggests that population immunity is an important factor to include in models attempting to predict meningitis epidemics.

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Peptides derived of kunitz-type serine protease inhibitor as potential vaccine against experimental schistosomiasis

10.1101/634360 ◽

2019 ◽

Cited By ~ 1

Author(s):

Juan Hernández-Goenaga ◽

Julio López-Abán ◽

Anna V. Protasio ◽

Belén Vicente Santiago ◽

Esther del Olmo ◽

...

Keyword(s):

Protease Inhibitor ◽

B Cell ◽

Serine Protease ◽

Protective Efficacy ◽

Public Health Problem ◽

Sub Saharan Africa ◽

Peptide Epitopes ◽

Significant Public Health ◽

Kunitz Type ◽

Sub Saharan

AbstractSchistosomiasis is a significant public health problem in sub-Saharan Africa, China, South-East Asia and regions of South and central America affecting about 189 million people. Kunitz-type serine protease inhibitors have been identified as important players in the interaction of other flatworm parasites with their mammalian hosts. Here, we evaluate the protective efficacy of chemically synthesized of T- and B-cell peptide epitopes derived from a kunitz protein from Schistosoma mansoni. Putative kunitz-type protease inhibitor proteins were identified in the S. mansoni genome and their expression analyzed by RNA-seq. Gene expression analyses showed that the kunitz protein Smp_147730 (Syn. Smp_311670) was dramatically and significantly up-regulated in schistosomula and adult worms when compared to the invading cercariae. T- and B-cell epitopes were predicted using bioinformatics tools, chemically synthesized and formulated in the Adjuvant Adaptation (ADAD) vaccination system. BALB/c mice were vaccinated and challenged with S. mansoni cercariae. Kunitz peptides were highly protective in vaccinated BALB/c mice showing significant reductions in recovery of adult females (89-91%), and in the numbers of eggs trapped in the livers (77-81%) and guts (57-77%) of mice. Moreover, liver lesions were significantly reduced in vaccinated mice (64-65%) compared to infected control mice. The vaccination regime was well tolerated with both peptides. We propose the use of these peptides, alone or in combination, as reliable candidates for vaccination against schistosomiasis.

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