scholarly journals Environmental surveillance for Salmonella Typhi as a tool to estimate the incidence of typhoid fever in low-income populations

2021 ◽  
Author(s):  
Christopher B Uzzell ◽  
Catherine M Troman ◽  
Jonathan Rigby ◽  
Venkata Raghava Mohan ◽  
Jacob John ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Low Income ◽  
Low Cost ◽  
World Health ◽  
Low Income Countries ◽  
Environmental Surveillance ◽  
Sample Collection ◽  
Conjugate Vaccines ◽  
Clinical Surveillance ◽  
The Impact

Background: The World Health Organisation recommends prioritised use of recently prequalified typhoid conjugate vaccines in countries with the highest incidence of typhoid fever. However, representative typhoid surveillance data are lacking in many low-income countries because of the costs and challenges of diagnostic clinical microbiology. Environmental surveillance (ES) of Salmonella Typhi in sewage and wastewater using molecular methods may offer a low-cost alternative, but its performance in comparison with clinical surveillance has not been assessed. Methodology/Principal Findings: We developed a harmonised protocol for typhoid ES and its implementation in communities in India and Malawi where it will be compared with findings from hospital-based surveillance for typhoid fever. The protocol includes methods for ES site selection based on geospatial analysis, grab and trap sample collection at sewage and wastewater sites, and laboratory methods for sample processing, concentration and quantitative PCR to detect Salmonella Typhi. The optimal locations for ES sites based on digital elevation models and mapping of sewage and river networks are described for each community and their suitability confirmed through field investigation. We will compare the prevalence and abundance of Salmonella Typhi in ES samples collected each month over a 12-month period to the incidence of blood culture confirmed typhoid estimated from cases recorded at referral hospitals serving the study areas and community surveys of healthcare seeking for individuals with fever. Significance: If environmental detection of Salmonella Typhi correlates with the incidence of typhoid fever estimated through clinical surveillance, typhoid ES may be a powerful and low-cost tool to estimate the local burden of typhoid fever and support the introduction of typhoid conjugate vaccines. Typhoid ES could also allow the impact of vaccination to be assessed and rapidly identify circulation of drug resistant strains.

scholarly journals Adaptation and validation for Colombia of the WHO safe childbirth checklist

2018 ◽  
Vol 49 (3) ◽  
pp. 201-212
Author(s):  
Ana Carolina Amaya Arias ◽  
Óscar Zuluaga ◽  
Douglas Idárraga ◽  
Javier Hernando Eslava Schmalbach
Keyword(s):  
Low Income ◽  
Health Workers ◽  
Low Cost ◽  
Neonatal Morbidity ◽  
Neonatal Care ◽  
World Health ◽  
Low Income Countries ◽  
Safe Childbirth Checklist ◽  
Health Organization ◽  
Safe Childbirth

Introduction: Most maternal deaths that occur in developing countries are considered unfair and can be avoided. In 2008, The World Health Organization (WHO) proposed a checklist for childbirth care, in order to assess whether a simple, low-cost intervention had an impact on maternal and neonatal mortality in low-income countries. Objective: To translate, adapt and validate the content of the WHO Safe Childbirth Checklist (SCC) for its use in Colombia Methods: The checklist was translated and adapted to the Colombian context. It was subsequently validated by a panel of experts composed of 17 health workers with experience in maternal and neonatal care and safety. Reliability among judges was estimated (Rwg) and items were modified or added to each section of the list according to the results. Results: Modifications were made to 28 items, while 19 new items were added, and none was removed. The most important modifications were made to the management guidelines included in each item, and the items added refer to risks inherent to our environment. Conclusion: The Colombian version of the SCC will be a useful tool to improve maternal and neonatal care and thereby contribute to reducing maternal and neonatal morbidity and mortality in our country.

Development of improved low-cost ceramic water filters for viral removal in the Haitian context

2014 ◽  
Vol 5 (1) ◽  
pp. 28-38 ◽  
Author(s):  
L. Guerrero-Latorre ◽  
M. Rusiñol ◽  
A. Hundesa ◽  
M. Garcia-Valles ◽  
S. Martinez ◽  
...  
Keyword(s):  
Low Income ◽  
Low Cost ◽  
World Health ◽  
Low Income Countries ◽  
Virus Removal ◽  
Ceramic Water Filters ◽  
Removal Efficiencies ◽  
Reductive Atmosphere ◽  
Health Organization ◽  
Water Filters

Household-based water treatment (HWT) is increasingly being promoted to improve water quality and, therefore, health status in low-income countries. Ceramic water filters (CWFs) are used in many regions as sustainable HWT and have been proven to meet World Health Organization (WHO) microbiological performance targets for bacterial removal (2–4 log); however, the described viral removal efficiencies are insufficient to significantly reduce the associated risk of viral infection. With the objective of improving the viral removal efficiencies of ceramic water filters, new prototypes with different oxide compositions and firing atmospheres have been developed and evaluated. For removal efficiencies human adenoviruses, MS2 bacteriophage and Escherichia coli were quantified in all prototypes. A new model of CWF that was fired in a reductive atmosphere presented virus and bacteria removal efficiencies greater than 3.0 log and 2.5 log, respectively, which would fulfill the viral targets that are recommended by the WHO. Ceramic characterization of the selected filters, which were fired in a reductive atmosphere, showed that a larger specific surface area than those of control filters and higher fraction of a positive Z-potential fraction are the most likely explanations for this increase in virus removal.

scholarly journals Reducing preterm mortality in eastern Uganda: The impact of introducing low-cost bubble CPAP on neonates <1500g

2019 ◽  
Author(s):  
Emmanuel Egiru ◽  
Francis Okello ◽  
Juliet Ikiror ◽  
Linda Acom ◽  
Kate SM Loe ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Low Income ◽  
Low Cost ◽  
Treatment Options ◽  
Neonatal Unit ◽  
Low Income Countries ◽  
Preterm Neonates ◽  
Healthcare Provision ◽  
The Impact ◽  
Eastern Uganda

Abstract Background Complications of prematurity are the leading cause of deaths in children under the age of five. The predominant reason for these preterm deaths is respiratory distress syndrome (RDS). In low-income countries (LICs) there are limited treatment options for RDS. Due to their simplicity and affordability, low-cost bubble continuous positive airway pressure (bCPAP) devices have been introduced in neonatal units in LICs to treat RDS. This study is the first observational study from a LIC to compare outcomes of preterm neonates in pre- and post-CPAP periods. Methods This was a retrospective study in Mbale Regional Referral Hospital Neonatal Unit (MRRH-NNU), a government hospital in eastern Uganda. Two study periods were identified. A 14-month study period beginning at the opening of MRRH-NNU and covering the period until bCPAP was introduced (pre-bCPAP) and an 18-month period after bCPAP was introduced (post-bCPAP). After the introduction of bCPAP, it was applied to preterm neonates with RDS when clinically indicated and if a device was available. Clinical features and outcomes of all neonates <1500g were compared before and after the introduction of bCPAP. Results The admission records of 377 preterm neonates <1500g were obtained. 158 were admitted in pre-bCPAP period and 219 after. The mortality rate in pre- bCPAP period was 39.2% (62/158) compared with 26.5% (58/219, P=0.012) in post-bCPAP period. There were no differences in birthweight, sex, presence of signs of respiratory distress or apnoea between the two groups. Conclusion Specialized and resource-appropriate neonatal care that appropriately addresses the challenges of healthcare provision in LICs has the potential to reduce neonatal deaths. The use of a low-cost bCPAP to treat RDS in preterm neonates <1500g resulted in a significant improvement in their survival in a neonatal unit in eastern Uganda. Implementing bCPAP with adequate training and supervision could significantly reduce preterm mortality in LICs.

scholarly journals Antibiotic Prescribing Patterns for Childhood infections in Ambulatory Settings

2021 ◽  
Author(s):  
Samah Al-Shatnawi ◽  
Sanabel Alhusban ◽  
Shoroq Altawalbeh ◽  
Rawand Khasawneh
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Action Plan ◽  
Prescribing Patterns ◽  
World Health ◽  
Low Income Countries ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Tract Infections ◽  
The Impact

Background: Antibiotics’ rational prescribing is a major goal of the World Health Organization’s (WHO) global action-plan to tackle antimicrobial resistance. Evaluation of antibiotic prescribing patterns is necessary to guide simple, globally applicable stewardship interventions. The impact of antimicrobial resistance is devastating, especially in low-income countries. We aimed to introduce ambulatory data on patterns of pediatric antibiotic prescribing in Jordan, which could be used to guide local stewardship interventions. Methods: A cross-sectional retrospective study was conducted by selecting a random sample of pediatric patients, who attended ambulatory settings in 2018. Records of outpatients (age 18 years) receiving at least one antibiotic were included. The WHO’s model of drug utilization was applied, and all prescribing indicators were included. Multiple linear regression was performed to examine factors influencing the ratio of prescribed antibiotics to overall medications per encounter. Results: A total of 20,494 prescriptions, containing 45,241 prescribed drugs, were obtained. Average number of prescribed drugs per prescription was (2.21  0.98). 77.5% of overall ambulatory prescriptions accounted for antimicrobials. Only 0.6% of total prescriptions were for injectables. All antimicrobials (100%) were prescribed by generic-names and from essential drug list. Antibiotics were most commonly prescribed for respiratory tract infections. Age, gender, season, and facility type were significant predictors of prescribed antibiotics to overall medications ratio. Conclusions: This is the first study of antibiotic prescribing patterns among outpatient pediatrics that covers wide regions in Jordan. Results indicate high rates of antibiotics use among outpatient pediatrics. Such findings necessitate more focused efforts and regulations that support rational utilization of drugs.

scholarly journals Dose-specific efficacy of Haemophilus influenzae type b conjugate vaccines: a systematic review and meta-analysis of controlled clinical trials

2012 ◽  
Vol 140 (8) ◽  
pp. 1343-1355 ◽  
Author(s):  
U. K. GRIFFITHS ◽  
A. CLARK ◽  
B. GESSNER ◽  
A. MINERS ◽  
C. SANDERSON ◽  
...  
Keyword(s):  
Haemophilus Influenzae ◽  
Low Income ◽  
Meta Analysis ◽  
Analytical Models ◽  
Low Income Countries ◽  
Haemophilus Influenzae Type ◽  
Type B ◽  
Conjugate Vaccines ◽  
Large Numbers ◽  
The Impact

SUMMARYGlobal coverage of infant Haemophilus influenzae type b (Hib) vaccination has increased considerably during the past decade, partly due to GAVI Alliance donations of the vaccine to low-income countries. In settings where large numbers of children receive only one or two vaccine doses rather than the recommended three doses, dose-specific efficacy estimates are needed to predict impact. The objective of this meta-analysis is to determine Hib vaccine efficacy against different clinical outcomes after receiving one, two or three doses of vaccine. Studies were eligible for inclusion if a prospective, controlled design had been used to evaluate commercially available Hib conjugate vaccines. Eight studies were included. Pooled vaccine efficacies against invasive Hib disease after one, two or three doses of vaccine were 59%, 92% and 93%, respectively. The meta-analysis provides robust estimates for use in decision-analytical models designed to predict the impact of Hib vaccine.

scholarly journals Reducing preterm mortality in eastern Uganda: The impact of introducing low-cost bubble CPAP on neonates <1500g

2019 ◽  
Author(s):  
Francis Okello ◽  
Emmanuel Egiru ◽  
Juliet Ikiror ◽  
Linda Acom ◽  
Kate SM Loe ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Low Income ◽  
Very Low Birth Weight ◽  
Low Cost ◽  
Neonatal Unit ◽  
Low Income Countries ◽  
Preterm Neonates ◽  
The Impact ◽  
Eastern Uganda

Abstract Background: Complications of prematurity are the leading cause of deaths in children under the age of five.The predominant reason for these preterm deaths is respiratory distress syndrome (RDS). In low-income countries (LICs) there are limited treatment options for RDS. Due to their simplicity and affordability, low-cost bubble continuous positive airway pressure (bCPAP) devices have been introduced in neonatal units in LICs to treat RDS. This study is the first observational study from a LIC to compare outcomes of very-low-birth-weight (VLBW) neonates in pre- and post-CPAP periods. Methods: This was a retrospective study of VLBW neonates (weight <1500 grams) in Mbale Regional Referral Hospital Neonatal Unit (MRRH-NNU), a government hospital in eastern Uganda. It aimed to measure the outcome of VLBW neonates in two distinct study periods: A 14-month period beginning at the opening of MRRH-NNU and covering the period until bCPAP was introduced (pre-bCPAP) and an 18-month period following the introduction of bCPAP (post-bCPAP). After the introduction of bCPAP, it was applied to preterm neonates with RDS when clinically indicated and if a device was available. Clinical features and outcomes of all neonates <1500g were compared before and after the introduction of bCPAP. Results: The admission records of 377 VLBW neonates <1500g were obtained. 158 were admitted in the pre-bCPAP period and 219 in the post-bCPAP period. The mortality rate in the pre- bCPAP period was 39.2% (62/158) compared with 26.5% (58/219, P =0.012) in the post-bCPAP period. Overall, there was a 44% reduction in mortality (OR 0.56, 95%CI 0.36-0.86, P = 0.01).There were no differences in birthweight, sex, presence of signs of respiratory distress or apnoea between the two groups. Conclusion: Specialized and resource-appropriate neonatal care, that appropriately addresses the challenges of healthcare provision in LICs, has the potential to reduce neonatal deaths.The use of a low-cost bCPAP to treat RDS in VLBW neonates resulted in a significant improvement in their survival in a neonatal unit in eastern Uganda. Since RDS is one of the leading causes of neonatal mortality, it is possible that this relatively simple and affordable intervention could have a huge impact on global neonatal mortality.

scholarly journals Reducing preterm mortality in eastern Uganda: The impact of introducing low-cost bubble CPAP on neonates <1500g

2019 ◽  
Author(s):  
Francis Okello ◽  
Emmanuel Egiru ◽  
Juliet Ikiror ◽  
Linda Acom ◽  
Kate SM Loe ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Low Income ◽  
Very Low Birth Weight ◽  
Low Cost ◽  
Neonatal Unit ◽  
Low Income Countries ◽  
Preterm Neonates ◽  
The Impact ◽  
Eastern Uganda

Abstract Background: Complications of prematurity are the leading cause of deaths in children under the age of five.The predominant reason for these preterm deaths is respiratory distress syndrome (RDS). In low-income countries (LICs) there are limited treatment options for RDS. Due to their simplicity and affordability, low-cost bubble continuous positive airway pressure (bCPAP) devices have been introduced in neonatal units in LICs to treat RDS. This study is the first observational study from a LIC to compare outcomes of very-low-birth-weight (VLBW) neonates in pre- and post-CPAP periods. Methods: This was a retrospective study of VLBW neonates (weight <1500 grams) in Mbale Regional Referral Hospital Neonatal Unit (MRRH-NNU), a government hospital in eastern Uganda. It aimed to measure the outcome of VLBW neonates in two distinct study periods: A 14-month period beginning at the opening of MRRH-NNU and covering the period until bCPAP was introduced (pre-bCPAP) and an 18-month period following the introduction of bCPAP (post-bCPAP). After the introduction of bCPAP, it was applied to preterm neonates with RDS when clinically indicated and if a device was available. Clinical features and outcomes of all neonates <1500g were compared before and after the introduction of bCPAP. Results: The admission records of 377 VLBW neonates <1500g were obtained. 158 were admitted in the pre-bCPAP period and 219 in the post-bCPAP period. The mortality rate in the pre- bCPAP period was 39.2% (62/158) compared with 26.5% (58/219, P =0.012) in the post-bCPAP period. Overall, there was a 44% reduction in mortality (OR 0.56, 95%CI 0.36-0.86, P = 0.01).There were no differences in birthweight, sex, presence of signs of respiratory distress or apnoea between the two groups. Conclusion: Specialized and resource-appropriate neonatal care, that appropriately addresses the challenges of healthcare provision in LICs, has the potential to reduce neonatal deaths.The use of a low-cost bCPAP to treat RDS in VLBW neonates resulted in a significant improvement in their survival in a neonatal unit in eastern Uganda. Since RDS is one of the leading causes of neonatal mortality, it is possible that this relatively simple and affordable intervention could have a huge impact on global neonatal mortality.

scholarly journals Low-Cost Polyester-Tipped Three-Dimensionally Printed Nasopharyngeal Swab for the Detection of Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV-2)

2020 ◽  
Vol 58 (11) ◽  
Author(s):  
Mohammad Alghounaim ◽  
Sulaiman Almazeedi ◽  
Sarah Al Youha ◽  
Jesse Papenburg ◽  
Osama Alowaish ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Polylactic Acid ◽  
Low Income ◽  
Low Cost ◽  
Positive Control ◽  
Low Income Countries ◽  
Contact Tracing ◽  
Nasopharyngeal Swab ◽  
Sample Collection ◽  
3D Printed

ABSTRACT Case identification, isolation, and contact tracing are fundamental strategies used to control the spread of coronavirus disease 2019 (COVID-19). This has led to widespread testing that interrupted the supply chain for testing materials around the world. A prospective study was conducted to compare inexpensive and easily sourced 3-dimensionally (3D)-printed polylactic acid and polyester nasopharyngeal swabs to commercially manufactured swabs for the detection of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2). During the study period, 287 laboratory-confirmed hospitalized COVID-19 patients, at multiple stages of their illness, were enrolled. The median age for the study population was 47.6 years (interquartile range [IQR], 34.4 to 56.6 years), and two-thirds (67.6%) of the subjects were male. The median duration of hospitalization, at the time of sampling, was 13 days (IQR, 10 to 16 days). Overall concordance between the prototype and control swabs was 80.8% (Cohen’s kappa coefficient, 0.61). Most discrepant results were due to prototype-positive control-negative results. When considering all positive results to be true positives, the prototype swab had a higher sensitivity (90.6% versus 80.8%; 95% confidence interval [CI], 85.7% to 94.0% and 74.7% to 85.7%, respectively; P < 0.015). The cost to produce the prototype swab was estimated to be $0.05 per swab. Polylactic acid 3D-printed polyester-tipped swabs were shown to be effective for nasopharyngeal sample collection. We believe that this design can easily be adopted in countries where commercial swabs are not readily available and can play a vital role in public health efforts for disease control in low-income countries.

COVID-19 health research in low-income countries

Impact ◽  
2021 ◽  
Vol 2021 (6) ◽  
pp. 4-5
Author(s):  
Lucy Annette
Keyword(s):  
Low Income ◽  
Health Research ◽  
Quality Of Healthcare ◽  
World Health ◽  
Hiv Care ◽  
Low Income Countries ◽  
Infection Prevention And Control ◽  
Middle Income ◽  
Research And Innovation ◽  
The Impact

The COVID-19 pandemic has affected different countries in different ways and to varying extents. Differences in geography and population, as well as the different health response of respective governments, are factors that play a role in the impact of the virus. Unfortunately, the quality of healthcare systems also plays a key role and there are disparities in healthcare quality across countries. In an initiative led by the National Institute for Health Research (NIHR), in partnership with UK Research and Innovation (UKRI), 12 health research projects across more than 18 countries are seeking to reduce the impacts of the COVID-19 pandemic across low- and middle-income countries. Topics include transmission and infection control, how people in different settings are affected by the virus and long-term outcomes, including the risk of neurological problems. The projects have been informed by the World Health Organization COVID-19 Global Research Roadmap, which features four priority research topics relating to the virus: 'epidemiology, clinical management, infection prevention and control, and health system responses'. One project is looking at the impact of COVID-19 on the mental health of older adults in Peru and another is looking at how the virus affected the brain. A project called the DOMINO Study is investigating the indirect effects of COVID-19 on tuberculosis and HIV care in Indonesia and a project based in a low-resource community in Rio de Janeiro, Brazil, is working to better understand SARS-CoV-2 in children.

scholarly journals Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2439
Author(s):  
Brendon Stubbs ◽  
Kamran Siddiqi ◽  
Helen Elsey ◽  
Najma Siddiqi ◽  
Ruimin Ma ◽  
...  
Keyword(s):  
Health Survey ◽  
Low Income ◽  
World Health ◽  
Low Income Countries ◽  
Multivariable Logistic Regression Analysis ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

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