Modelling to infer the role of animals in gambiense human African trypanosomiasis transmission and elimination in DRC

Gambiense human African trypanosomiasis (gHAT) has been targeted for elimination of transmission (EoT) to humans by 2030. Whilst this ambitious goal is rapidly approaching, there remain fundamental questions about the presence of non-human animal transmission cycles and their potential role in slowing progress towards, or even preventing, EoT. In this study we focus on the country with the most gHAT disease burden, the Democratic Republic of Congo (DRC), and use mathematical modelling to assess whether animals may contribute to transmission in specific regions, and if so, how their presence could impact the likelihood and timing of EoT. By fitting two model variants – one with, and one without animal transmission – to the human case data from 2000–2016 we estimate model parameters for 158 endemic health zones of DRC. We evaluate the statistical support for each model variant in each health zone and infer the contribution of animals to overall transmission and how this could impact predicted time to EoT. We conclude that there are 24/158 health zones where there is moderate or high statistical support for some animal transmission. However, – even in these regions – we estimate that animals would be extremely unlikely to maintain transmission on their own. Animal transmission could hamper progress towards EoT in some settings, with projections under continuing interventions indicating that the number of health zones expected to achieve EoT by 2030 reduces from 68 to 61 if animals are included in the model. With supplementary vector control (at a modest 60% tsetse reduction) added to medical screening and treatment interventions, the predicted number of health zones meeting the goal increases to 147/158 for the model including animals. This is due to the impact of vector reduction on transmission to and from all hosts.

Contextual factors influencing a training intervention aimed at improved maternal and newborn healthcare in a health zone of the Democratic Republic of Congo

Background Maternal and neonatal mortality and morbidity in the Democratic Republic of Congo (DRC) are among the highest worldwide. As part of a quality improvement programme in a health zone in the DRC aimed at contributing to reduced maternal and neonatal mortality and morbidity, a three-pillar training intervention around childbirth was developed and implemented in collaboration between Swedish and Congolese researchers and healthcare professionals. The aim of this study is to explore contextual factors influencing this intervention. Methods A qualitative research design was used, with data collected through focus group discussions (n = 7) with healthcare professionals involved in the intervention before and at the end (n = 9). Transcribed discussions were inductively analysed using content analysis. Results Three generic categories describe the contextual factors influencing the intervention: i) Incentives motivated participants’ efforts to begin a training programme; ii) Involving the local health authorities was important; and (iii) Having physical space, electricity, and equipment in place was crucial. Conclusions This study and similar ones highlight that incentives of various types are crucial contextual factors that influence training interventions, and have to be considered already in the planning of such interventions. One such factor is expectations of monetary incentives. To meet this in a small research project like ours would require a reduction of the scale and thus limit the implementation of new evidence-based knowledge into practice aimed at reducing maternal mortality and morbidity.

Contraintes d’acces aux Soins de Sante Face a la Croissance Demographique de la Zone Sanitaire Ouidah/Kpomasse/Tori-Bossito

La nécessité, voire l’exigence de disposer des services de santé de qualité, accessibles géographiquement s’impose à une population sans cesse en croissance. Les infrastructures sanitaires, les équipements médicaux, la disponibilité du personnel soignant nécessaire pour accueillir et prendre en charge cette population font toujours défaut. La présente étude aborde les contraintes d’accès aux soins de santé face à l’explosion démographique de la zone sanitaire Ouidah/Kpomassè/Tori-Bossito. Les observations, la recherche documentaire et les travaux de terrain sont les principales étapes de la méthodologie adoptée. Les données utilisées ont été collectées auprès de 900 ménages et 78 personnes ressources. L’Indice de Confort Matériel (ICM) a été calculé pour déterminer le confort des enquêtés. Les Analyse Factorielle des Composantes (AFC) ont été réalisées pour évaluer le lien entre l’accès aux soins de santé et les différentes variables indépendantes. Le modèle SWOT (Strenght, Weaknesses, Opportunities, Threats) a permis d’évaluer les contraintes liées à l’accessibilité aux soins face à la croissance démographique observée dans la zone sanitaire Ouidah/Kpomassè/Tori-Bossito (OKT). Les résultats ont révélé que la disponibilité, la répartition des infrastructures sanitaires et du personnel soignant, le confort matériel du ménage, l’état de praticabilité des voies d’accès aux centres de santé conditionnent l’accessibilité aux soins des ménages. Malgré les efforts fournis par l’Etat et les collectivités territoriales, l’offre de soins de santé est insuffisante au regard du croît démographique. The need, indeed the requirement, to have quality health services that are geographically accessible is imposed on an ever-growing population. Health infrastructure, medical equipment and the availability of the nursing staff necessary to welcome and take care of this population are still lacking. This study addresses the constraints of access to healthcare in the face of the demographic explosion in the Ouidah/Kpomassè/Tori-Bossito health zone. Observations, documentary research and fieldwork are the main stages of the methodology adopted. The data used was collected from 900 households and 78 resource persons. The Material Comfort Index (ICM) was calculated to determine the comfort of the respondents. The Component Factor Analysis (AFC) was carried out to assess the link between access to health care and the various independent variables. The SWOT model (Strength, Weaknesses, Opportunities, Threats) made it possible to assess the constraints related to access to care in the face of the demographic growth observed in the Ouidah/Kpomassè/Tori-Bossito (OKT) health zone. The results revealed that the availability and distribution of health infrastructure and nursing staff, the material comfort of the household, the state of practicability of access routes to health centers condition access to household care. Despite the efforts made by the State and local authorities, the supply of health care is insufficient in view of the demographic growth.

Epidemiology and risk factors for pyogenic liver abscess in the Calgary Health Zone revisited: a population-based study

Background Pyogenic liver abscess (PLA), although uncommon in North America, is associated with significant morbidity and mortality. We sought to re-examine the epidemiology, risk factors, and outcomes of PLA in a large, diverse Canadian health zone. Methods All Calgary Health Zone (CHZ) residents aged ≥20 with PLA between 2015 and 2017 were identified. Incidence and mortality rates were calculated using census data. Risk factors for PLA were identified using a multivariate analysis. Data was compared to 1999–2003 data, also collected in the CHZ. Results There were 136 patients diagnosed with PLA between 2015 and 2017. Incidence rate during this period increased significantly relative to 1999–2003 (3.7 vs 2.3 cases/100,000 population, p < 0.01), however, mortality rates remained similar. The microbiological composition of PLA did not change over this 15-year time period but the number of antimicrobial resistant isolates did increase (8% vs 1%, p = 0.04). The greatest risk factors for PLA relative to general populations included current malignancy, liver-transplant, end-stage renal disease, and cirrhosis. Thirty-day mortality was 7.4% and independent risk factors included polymicrobial bacteremia, absence of abscess drainage, congestive-heart failure, a history of liver disease, and admission bilirubin. Conclusions Pyogenic liver abscess is a health concern with rising incidence rate. The increasing prevalence of comorbidities in our population and factors that are associated with risk of PLA suggests this will continue to be an emerging diagnosis of concern. Increasing prevalence of antibiotic resistant organisms compounding unclear optimal treatment regimens is an issue that requires urgent study.

Does admission order form design really matter? A reduction in urea blood test ordering

IntroductionLaboratory blood testing is one of the most high-volume medical procedures and continues to increase steadily with instances of inappropriate testing resulting in significant financial implications. Studies have suggested that the design of a standard hospital admission order form and laboratory request forms influence physician test ordering behaviour, reducing inappropriate ordering and promoting resource stewardship.Aim/methodTo redesign the standard medicine admission order form-laboratory request section to reduce inappropriate blood urea nitrogen (BUN) testing.ResultsA redesign of the standard admission order form used by general internal medicine physicians and residents in two large teaching hospitals in one health zone in Alberta, Canada led to a significant step reduction in the ordering of the BUN test on hospital admission.ConclusionsRedesigning the standard medicine admission order form-laboratory request section can have a beneficial effect on the reduction in BUN ordering altering physician ordering patterns and behaviour.

Perimeter Confinements of Basic Health Zones and COVID-19 Incidence in Madrid, Spain

Background: A unique policy of perimeter closures of Basic Health Zones (small administrative health units) was implemented in the Autonomous Region of Madrid from September 21st 2020 to May 23rd 2021 to face the COVID-19 pandemic.Aim: To assess the impact of local perimeter confinements on the 14-days cumulative incidence of SARS-CoV-2 during the second wave of the pandemic in Madrid, Spain.Methods: We compare the errors in estimation of two families of mathematical models: ones that include the perimeter closures as explanatory covariables and ones that do not, in search of a significant improvement in estimation of one family over the other. We incorporate leave-one-out cross-validation and the choice of the best over 15 models at each step in our analysis for statistical signification.Results: The two families of models provided very similar estimations (correlation of the errors > 0.95 (±10-3 95% CI), difference in means of the errors < 1.2 (±0.7 95% CI) 14-days cumulative incidence), both for a 2 weeks and 3 weeks delay in observed cumulative incidence and also when restricting the analysis to only those Basic Health Zones that were subject to at least one closure during the time under study.Conclusion: Our analysis suggests that the perimeter closures by Basic Health Zone did not have a significant effect on the epidemic curve in Madrid, either 2 or 3 weeks after their activation.

Risk Factors for TB/HIV Coinfection and Consequences for Patient Outcomes: Evidence from 241 Clinics in the Democratic Republic of Congo

(1) Background: In resource-limited countries, patients with tuberculosis (TB)/HIV coinfection commonly face economic, sociocultural, and behavioral barriers to effective treatment. These barriers manifest from low treatment literacy, poverty, gender inequality, malnutrition, societal stigmas regarding HIV, and an absence of available care. It is critical for intervention programs to understand and assist in overcoming these barriers and any additional risks encountered by patients with TB/HIV coinfection. This study analyzes variation in TB/HIV coinfection and risks of negative outcomes among patients with TB/HIV coinfection compared to those without coinfection. (2) Methods: This quantitative study used data from 49,460 patients receiving ART from 241 HIV/AIDS clinics in Haut-Katanga and Kinshasa, two provinces in the Democratic Republic of Congo. Chi-square and logistic regression analysis were performed. (3) Results: Significantly higher proportions of patients with TB/HIV coinfection were men (4.5%; women, 3.3%), were new patients (3.7%; transferred-in, 1.6%), resided in the Kinshasa province (4.0%; Haut-Katanga, 2.7%), and were in an urban health zone (3.9%) or semi-rural health zone (3.1%; rural, 1.2%). Logistic regression analysis showed that after controlling for demographic and clinical variables, TB/HIV coinfection increased the risk of death (adjusted odds ratio (AOR), 2.26 (95% confidence interval (CI): 1.94–2.64)) and LTFU (AOR, 2.06 (95% CI: 1.82–2.34)). TB/HIV coinfection decreased the odds of viral load suppression (AOR, 0.58 (95% CI: 0.46–0.74)). (4) Conclusions: TB/HIV coinfection raises the risk of negative outcomes such as death, LTFU, and lack of viral load suppression. Our findings can help HIV clinics in Democratic Republic of Congo and other African countries to customize their interventions to improve HIV care and reduce care disparities among patients.