Laboratory Capacity Research Articles

Aspergillus Contamination in Healthcare Facilities: An Ever-Present Issue—Prevention and Control Measures

Aspergillus spp. are ubiquitous fungi present in soil, organic debris, water, decaying vegetation and dust produced in renovation and/or building work. Several studies have shown the presence of aspergilli in various healthcare environments. Typically, thousands of fungal spores are inhaled every day, but if spore clearance fails (typically in immunocompromised patients), fungi can grow and invade lung tissue, causing invasive aspergillosis (IA) which is one of the most frequent infections in highly immunocompromised patients. Aspergillus fumigatus is the most common species involved; this species can be attributed to about 80% of the cases of aspergillosis. According to the WHO, Aspergillus fumigatus is one of four critical priority fungi. The first-line treatment of diseases caused by Aspergillus, in particular IA, is based on triazole antimycotics. Unfortunately, resistance to antimycotics is increasing, partly due to their widespread use in various areas, becoming a significant concern to clinicians who are charged with caring for patients at high risk of invasive mycoses. A recent WHO report emphasised the need for strategies to improve the response, and in particular strengthen laboratory capacity and surveillance, support investment in research and strengthen public health interventions for the prevention and control of fungal infections through a One Health approach.

Assessment of the Public Health Laboratory Capacity - Sierra Leone, 2021.

Public health laboratories (PHLs) are critical for effectively identifying, detecting, preventing, and responding to emerging and reemerging infectious diseases. Following the 2014 Ebola outbreak, Sierra Leone implemented a national laboratory strategic plan (2015-2020) aimed at creating, strengthening, and maintaining laboratory capacities for detecting, assessing, notifying, and reporting incidents, with a requirement to review PHL capabilities every five years. This study assessed the comprehensive capacity and personnel status of PHLs in Sierra Leone using a standardized assessment tool following the implementation of the 2015 National Laboratory Strategic Plan. Among 11 indicators evaluated, laboratory infrastructure and equipment, data and information management, experimental technical training, and laboratory performance received low scores. The assessment revealed critical personnel gaps, including limited staff with extensive work experience and advanced education. Additionally, laboratory staff demonstrated limited capabilities in specialized areas such as gene library creation, primer design, sequencing, surveillance, and field epidemiology and laboratory-related training. Continued investment and capacity building are essential for PHLs to deliver high-quality testing services and effectively support public health functions. The identified gaps across various indicators must be systematically addressed to strengthen PHL capacity in Sierra Leone.

Tackling the Burden of Substandard and Falsified Medicines and Health Technologies in Somaliland and Somalia

Background: The problem posed by the substandard and falsified (SF) medicines is a rising global challenge. WHO estimates that sales of SF medical products in low- and middle-income countries is around US$ 30 billion whereby 1 in 10 medical is substandard or falsified. Objectives: The purpose of this article was to enlighten the actions by the Somali NRA to tackle the scourge of SF medicines in Somalia. Methods: The literature was reviewed on the topic and evidence from other sources were incorporated including reports of post-marketing surveillance surveys, assessments at national and regional levels, as well as author’s experiences. Findings: The medicines regulatory capacity is weak in Somaliland and Somalia, where only 16% of total indicators for the regulatory system was in place as per WHO/IGAD rapid benchmarking of the National Regulatory Authority (NRA) in 2017, increasing the risk of circulation of SF medicines in the local private sector dominated and exclusively import relied pharmaceutical supply chain. Key actions by the NRA to address this problem include: regulatory reliance mechanisms such as using the WHO PQ/EUL for emergency authorization of vaccines, i.e. COVID-19 vaccines, enhanced licensing procedures, information exchange with NRAs in the region as well as technical collaboration with WHO. Conclusion & Recommendation: However, a lot has to be done and considering the weak laboratory capacity and the porous national borders, the risk of local circulation of SF medicines is high and swift actions are needed to ensure access to safe and quality medicines and health technologies in Somaliland and Somalia.

Schistosoma mansoni and soil-transmitted helminth infections among schoolchildren living along the shore of Lake Hawassa, southern Ethiopia

BackgroundSchistosoma mansoni and soil-transmitted helminth (STH) infections are major public health problems in areas with poor sanitation and limited access to water. In Ethiopia, there is limited data available for monitoring the efficacy of interventions aimed at reducing helminth infections. Therefore, we assessed the prevalence of S. mansoni and STH infections, as well as factors associated with this prevalence, among schoolchildren and compared the findings with those of earlier studies. We also evaluated the diagnostic agreement between two parasitological methods.MethodsA cross-sectional study involving 363 schoolchildren from three rural primary schools located along the shore of Lake Hawassa, Sidama Regional State, southern Ethiopia, was conducted in October and November 2023. The schoolchildren were selected using a systematic random sampling technique. Socio-demographic data were collected using pre-structured questionnaires. A single stool sample was collected from each study participant and processed using direct wet mount (DM) microscopy and the formol-ether concentration technique (FECT) to detect helminth ova.ResultsThe overall prevalence of helminths was 59.8%, with 36.6% of participating children having a single infection and 23.1% having multiple infections. Schistosoma mansoni and STHs were present in 33.9% and 38.8% of children, respectively. The STHs included Ascaris lumbricoides (28.9% of children), Trichuris trichiura (10.7%), hookworms (5.2%) and Strongyloides stercoralis (2.8%). Diagnostic agreement between the DM microscopy method and FECT was substantial [kappa (κ) = 0.710] for the detection of Hymenolepis nana and almost perfect (κ = 0.827) for the dection of A. lumbricoides, but only fair for the detection of other detected helminths. Children at Finchawa primary school had a lower prevalence of S. mansoni infection [adjusted odds ratio (AOR) 0.31; 95% confidence interval (CI) 0.13–0.76] than those at St Paul’s Tullo Catholic primary school. STH infections were more common among children who sometimes (vs. always) washed their hands before meals (AOR 1.89; 95% CI 1.01–3.54) and those who regularly played with soil (AOR 2.56; 95% CI 1.47–4.46).ConclusionsThis study showed a reduction in STH infections from a high prevalence in 2015 to a moderate prevalence at the present time, despite a similar moderate prevalence of S. mansoni infection. Thus, it is crucial to intensify deworming interventions to reduce the burden of helminths in the study area. Additionally, there is a need to enhance the capacity of clinical laboratories to perform FECT in Ethiopian clinical settings where DM is often employed to diagnose helminths.Graphical

India’s Consensus Statement Tobacco Control Priorities: Review of Current Strategies and the Way Forward

IntroductionTobacco consumption remains a significant global public health challenge, causing over 8 million preventable deaths annually, with India bearing a substantial burden as second largest producer and consumer of tobacco products. Despite some advanced tobacco control policies, there are certain gaps, which requires effective implementation. To address these challenges, a national consultation was organized, bringing together experts to identify priorities in tobacco control in India and formulate an action plan. Design/MethodsA national consultation on ‘tobacco control priorities in India- challenges and way forward’ was organised where a total of 40 experts from the government, developmental organizations, and academia participated to formulate Short, Intermediate and Long-term priorities for tobacco control in India. Preceding the consultation, an extensive literature review and policy analysis were conducted to establish initial priorities. Subsequently, a consensus statement was developed to assist policymakers in identifying tobacco control priorities in India with agoal to achieve SDG 3a, aiming to strengthen the implementation of the WHO FCTC. ResultsThe proposed short-term priorities focused on promoting anti-tobacco curricula in health educational institutions, expanding cessation services, creating a national task force for Tobacco Control, training, monitoring and evaluation, and strengthening Tobacco Control Act. The intermediate priorities focused on advancing tobacco taxation, creating Tobacco-Free environments, adopting and implementing FCTC Article 5.3, building the capacity of National Tobacco Testing Laboratories and implementating Tobacco Vendor Licensing. The development of a comprehensive, multi-sectoral strategy to address the policy gaps and maintain resources to support the sustainability of tobacco control efforts to reach the goal of tobacco-free India were long-term priorities. ConclusionsNational policies and legislation play a crucial role in strengthening the comprehensive tobacco control framework. The collaborative formulation of short, intermediate, and long-term priorities for tobacco control in India is essential for their phased implementation toward achieving a Tobacco-Free Generation, emphasizing a holistic approach for addressing challenges and leading the way ahead.

Bacteriology testing and antimicrobial resistance detection capacity of national tiered laboratory networks in sub-Saharan Africa: an analysis from 14 countries

Accurate detection of antimicrobial resistance (AMR) depends on adequate laboratory capacity. We aimed to document key weaknesses hindering AMR detection at various tiers of laboratory networks in 14countries in sub-Saharan Africa, and analyse their significance in AMR surveillance and policies. In this analysis, we obtained retrospective data on AMR and antimicrobial consumption from 14countries participating in the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership between May 1, 2019, and June 30, 2020. We established the number, capacity for AMR detection, and other characteristics from all bacteriology laboratories within the national network from existing national health system compendiums, combined with a self-applied scored survey tool. We calculated AMR detection readiness scores at a facility and country level and analysed the pertinence of national strategies to address system gaps for AMR detection and surveillance. Of the 53 770listed laboratories, 675 (1%) were formally assigned to deliver bacterial testing and invited to complete the survey tool. Of the 504 (75%) facilities that returned the completed survey, 393 (78%) reported antimicrobial susceptibility testing (AST) capacity and collectively provided geographical access to less than 50% of the general population in seven countries. Continuous access to water was reported by 347 (88%) laboratories, power sources by 341 (87%) laboratories, and the presence of qualified laboratory scientist or technologist by 377 (96%) laboratories. By contrast, ISO15189 accreditation was reported by 90 (23%) laboratories and use of an electronic laboratory information system by 54 (13%). Reference laboratories were associated with higher AMR detection readiness scores than were district laboratories (odds ratio 4·7 [95% CI 1·3-10·2; p=0·014). Private, not-for-profit laboratories were associated with higher scores than were government-affiliated facilities (9·2 [1·6-53·8; p=0·014). Designated national AMR sentinel sites were associated with higher scores than were non-sentinel sites (5·8[2·9-11·8; p<0·001). Laboratories processing between 1001and 3000bacterial cultures annually were associated with higher scores than were those processing less than 200cultures annually (4·8 [1·7-13·7]; p=0·0040). Strengthening bacterial testing and capacity for AMR detection represented less than 20% of the proposed interventions in 12of the 14national AMR action plans. AMR action plans and other relevant national strategies should prioritise the scale-up of bacterial testing services to improve access to care and promote quality AMR surveillance. Interventions that democratise AST to lower laboratory tiers, formally designate AMR sentinel sites, and implement whole-of-network laboratory information and quality management systems are urgently needed. Fleming Fund, UK Aid, and US Centers for Disease Control and Prevention through the Training Programs in Epidemiology and Public Health Intervention Networks.

Improved cholera control in Kenya: A retrospective analysis of 2017-2019 in Nairobi and Homabay.

Kenya has recorded at least 38 678 cases and 695 deaths over the last decade, and costing on average $2.2 million annually. From 2014 to 2016, the country experienced one of the deadliest and largest outbreak. However, between 2017 and 2020, there was a decline in the number of reported cases and deaths. This study seeks to reveal the investments made post the 2014-2016 outbreak and highlight existing gaps that need to be addressed to stop the resurgence of cholera outbreaks in Kenya. The study was conducted in two counties: Homabay and Nairobi. We used an observational study. Data were collected from 20 health facilities (involved in cholera control, during the study), 9 key informant interviews (KII) and 6 focus group discussions (FGDs). We found improvement such as: dissemination of standard operating procedures, aligned reporting system, field epidemiology programme, establishment of a public health emergency operating centre and improved partner coordination. On the other hand, 12 of the selected 20 (60%) facilities had no prior training before government financing and laboratory capacity was sub-optimal: 13 (65%) facilities had no prior training, 16 (20%) had no operational laboratory plan and 10 (50%) had inadequate laboratory test kits and reagents. This study highlights that Kenya has experienced an improvement in specific core capacities. For Kenya to completely flatten the curve, there is need for more sustainable investment and government's commitment in health system strengthening.

High pertussis circulation among infants, children and adolescents in Abidjan, Côte d'Ivoire.

Whooping cough due to Bordetella pertussis (BP) and/or B. parapertussis (BPP) is a highly contagious infection sometimes fatal for infants. Africa accounts for the largest share of cases and deaths worldwide. To evaluate pertussis circulation, we conducted a hospital-based prospective study (PS) including household contact-cases investigation (CCS) and a sero-epidemiological cross-sectional study (SECS). The PS, in which Bordetella diagnostics (qPCR) were performed, included infants aged ≤6 months presenting with ≥5 days of cough associated with one pertussis-like symptom. CCS was performed using qPCR and serology regardless of clinical signs. In the SECS, serology was performed in children aged 3-15 years with primary pertussis immunization. Study took place in Abidjan between April 2019 and July 2021. In the PS, 187 infants with median age of 2.8 months were enrolled. A total of 42 (22.5%) were confirmed as positive, including 29 (15.5%), 4 (2.1%) and 9 (4.8%) of BP, BPP and BP/BPP coinfections respectively. Age <3 months, low BMI, apnea and inclusion period were identified as risk factors of infection. In the CCIS, 36 households were investigated, representing 158 people with median age of 21.4 years. BP and/or BPP infection was confirmed for 77/157 (49.0%). Twenty-nine households (81%) had at least one positive case. Sixty-seven (42.7%) contact cases were categorized as possibly contaminated, mainly siblings older than five years (25.4%). Twenty-seven contact cases were considered as possible contaminators, primarily mothers (26%). In the SECS, 444 people were enrolled. Two hundred and thirty-eight (53.6%) and nine (2.0%) children had received one and two boosters, respectively. A positive serology was observed in 96 (21.7%) of children and adolescents. Our study highlighted high circulation of pertussis. Barriers to accessing boosters recommended by WHO need to be overcome. Laboratory capacities are key at individual level and to build an effective surveillance system.

Performance evaluation of the introduction of full sample traceability system within the specimen collection process.

To evaluate the efficacy, safety and efficiency performances related to the introduction of innovative traceability platforms and integrated blood collection systems, for the improvement of a total testing process, thus also assessing the economic and organizational sustainability of these innovative technologies. A mixed-method approach was utilized. A key-performance indicators dashboard was created based on a narrative literature review and expert consensus and was assessed through a real-life data collection from the University Hospital of Padova, Italy, comparing three scenarios over time(2013, 2016, 2019) with varying levels of technological integration. The economic and organizational sustainability was determined considering all the activities performed from the tube check-in to the validation of the results, with the integration of the management of the prevalent errors occurred during the process. The introduction of integrated venous blood collection and full sample traceability systems resulted in significant improvements in laboratory performance. Errors in samples collected in inappropriate tubes decreased by 42 %, mislabelled samples by 47 %, and samples with irregularities by 100 %. Economic analysis revealed a cost saving of 12.7 % per tube, equating to a total saving of 447,263.80 € over a 12-month period. Organizational efficiency improved with a reduction of 13,061.95 h in time spent on sample management, allowing for increased laboratory capacity and throughput. Results revealed the strategic relevance of introducing integrated venous blood collection and full sample traceability systems, within the Laboratory setting, with a real-life demonstration of TLA economic and organizational sustainability, generating an overall improvement of the process efficiency.

Integrated fuzzy decision-making methodology with intuitionistic fuzzy numbers: An application for disaster preparedness in clinical laboratories

Society is on constant alert due to the increasing frequency and severity of Seasonal Respiratory Diseases (SRDs), posing significant challenges from both a humanitarian and public health perspective. The recent COVID-19 pandemic has tested the capacity of clinical laboratories to address seasonal infections, epidemic outbreaks, and critical emergencies. This scenario has led to operational burdens, primarily from resource limitations, a lack of proactive planning, and the low adaptation to unforeseen circumstances. Coupling different data-driven approaches considering multi-criteria weighting, interdependence assessment, and outranking are critical for devising effective interventions upgrading the operability of clinical labs during SRDs. Nonetheless, a deep literature review revealed there are no studies using these hybridized approaches when addressing this problem. Consequently, this article proposes the application of an innovative hybrid Multicriteria Decision-Making (MCDM) methodology that integrates the Intuitionistic Fuzzy Analytic Hierarchy Process (IF-AHP), Intuitionistic Fuzzy Decision Making Trial and Evaluation Laboratory (IF-DEMATEL), and Combined Compromise Solution (CoCoSo) to assess the disaster preparedness of clinical laboratories during SRDs. Initially, we applied IF-AHP to assign the relative weights to criteria and sub-criteria, considering the inherent hesitation and uncertainty in decision-making. Subsequently, IF-DEMATEL was utilized to analyze the interrelationships between criteria, providing insights into the interrelations among clinical lab disaster management drivers. Finally, the CoCoSo method was applied to estimate each lab’s Preparedness Index (PI) and detect response gaps when coping with SRDs. The suggested methodology was validated across nine clinical laboratories in Colombia during the most recent respiratory pandemic. This study contributes to the healthcare sector authorities by identifying key criteria and sub-criteria affecting the response of clinical labs, the elicitation of main response drivers in clinical labs when facing SRDs, and the calculation of a multidimensional indicator representing the preparedness of the labs. This work also enriches the literature by applying the IF-AHP, IF-DEMATEL, and CoCoSo approach to a challenging case study requiring a multi-method data-driven application. Furthermore, it suggests future directions to improve the proposed framework in other related contexts.

Characterizing Escherichia coli carrying plasmid-mediated AmpC β-lactamases to optimize detection in a diagnostic laboratory setting.

Plasmid-mediated AmpC β-lactamases are a cause of acquired cephalosporin resistance in Gram-negative bacteria. However, consensus regarding the optimal detection method is yet to be achieved and varies depending on local epidemiology and laboratory capacity. We determined the acquired genotypic resistance mechanisms of 250 Escherichia coli isolates with a positive AmpC screen, defined as cefoxitin MIC ≥ 8 mg/L and a positive AmpC double- disc diffusion test, using in-house designed high-resolution melt PCR, detecting plasmid-acquired genes from the CIT and DHA families. A proportion of these isolates (n = 170, 68%) underwent further genotypic characterization using whole- genome sequencing (WGS). Of 250 isolates with a positive screening test, 72 (28.8%) were determined to carry an acquired AmpC gene. There was 100% concordance between PCR and WGS in the identification of acquired AmpC genes. The phenotypic criteria were then assessed to determine their utility in predicting acquired AmpC gene carriage. Criteria 1 (cefoxitin MIC > 8 mg/L plus ceftriaxone MIC > 1 mg/L and/or ceftazidime MIC > 1 mg/L) yielded a sensitivity of 93.1% and a specificity of 47.8%. Criteria 2 (cefoxitin MIC > 16 mg/L plus ceftriaxone MIC > 4 mg/L) had a sensitivity of 33.3% and a specificity of 98.9%. DHA genes, whose expression may be induced following antibiotic exposure, were present in 19% of isolates testing susceptible to ceftriaxone (MIC ≤ 1 mg/L) and were significantly more likely than CIT genes to be detected in susceptible isolates (P < 0.0001). These findings highlight the importance of using genotypic methods to detect acquired AmpC resistance in E. coli isolates that meet phenotypic screening criteria.IMPORTANCEDetection of transmissible AmpC resistance remains a challenging problem for diagnostic laboratories, especially in Escherichia coli where the expression of its intrinsic AmpC gene can result in phenotypic resistance patterns indistinguishable from plasmid-mediated resistance. In conjunction with whole- genome sequencing (WGS), we describe the development and performance of a novel melt-curve PCR to identify the two most prevalent plasmid-mediated AmpC gene families: CIT and DHA. We then describe phenotypic testing algorithms that incorporate this PCR and can differentiate these from non-acquired resistance in E. coli. It is important to distinguish these, not only to spare patients from unnecessarily being treated with infection control precautions, but also to identify plasmid-mediated genes, especially of the DHA family, that have been associated with inducible drug resistance to third- generation cephalosporins.

Strengthening the Application of the DAIDS GCLP Guidelines: The Implementation of an Integrated Laboratory Oversight Framework.

The Division of AIDS (DAIDS) Good Clinical Laboratory Practice (GCLP) Guidelines establish a framework to guide the oversight of laboratories supporting DAIDS-sponsored clinical research or trials. Compliance with these guidelines promotes data reliability, validity, and safety of the clinical research or trial participants and laboratory staff and ensures adherence to regulatory requirements. Acknowledgment and adoption of the DAIDS GCLP Guidelines are critical in building laboratory capacity and preparedness for conducting clinical trials. In collaboration with DAIDS, laboratory experts support the implementation of the DAIDS Integrated Laboratory Oversight Framework (Framework) activities. This article describes the implementation of the GCLP Guidelines, the Framework activities, and the coordinated efforts to strengthen laboratory performance. The Framework activities include four components: Quality Assurance Oversight, GCLP Audits, GCLP Training, and Laboratory Quality Improvement. Comparison of GCLP Guidelines with other regulations or standards, including U.S. Clinical Laboratory Improvement Amendments regulation 42 CFR 493, College of American Pathologists, World Health Organization GCLP, and International Organization for Standardization, ISO 15189:2012 standards, highlighted the differences and similarities to guide integration and harmonization efforts. Processes related to the Framework activities are outlined in detail, including key data derived from the managed activities of over 175 laboratories worldwide. Via the evolution of the DAIDS GCLP Guidelines and laboratory oversight workflows, the laboratories participating in DAIDS-sponsored clinical research and trials have successfully participated in internal and external regulatory audits. The collaborative and integrated oversight approach promotes knowledge-sharing and accountability to support the implementation of the DAIDS GCLP Guidelines and compliance monitoring. Lessons learned have helped with the implementation of the DAIDS integrated laboratory oversight approach and quality oversight programs at multiple laboratories worldwide.

Large scale system transformation: Ukraine

Abstract In the context of the EU-Ukraine Accession agreement, Ukraine started large scale public health systems reform back in 2015. The COVID-19 pandemic tested the response capacity of the national public health system and led to some improvement during the pandemic such as on laboratory capacity. It also generated lessons for strengthening national and subnational health emergency preparedness and response. Multiple interventions, including a Joint External Evaluation led to the adoption of the Public Health System Law in 2022, laying the foundation to bolster health promotion, disease prevention, and health protection. The Ukrainian Public Health Centre was substantially strengthened, partly oriented on models in other European countries. Corresponding centers for diseases control and prevention at the oblast level were reformed and a subnational network of these centers was created. While the war has a significant impact on the public health system, infrastructure, people and more, decision makers and professionals keep working on sustaining and moving forward the achievements on public health reforms, for example with the adoption of the National Health Strategy 2030 and the adoption of the National Health Security Plan. Further legal and strategic preparations are afoot to strengthen public health services governance capacity, financing, institutional innovation and development, and public health workforce development.

Large scale public health system transformation: Germany

Abstract The COVID-19 pandemic was a stress test for public health services in Germany. Decision making was complex (party lengthy and inconsistent) due to the divided responsibilities within the federal system. Some improvements on the public health system were already enacted during the pandemic. A “pandemic radar” was established to bundle up relevant infectious disease indicators with indicators of health services use. The national electronic notification and information system for infectious diseases was extended. Digital improvements were made in the public health offices. Laboratory capacity was strengthened, so was inter-science modelling to forecast pathogen spread. A nation-wide collaborative mechanism, the cloverleaf system, was introduced between regions to avoid the overburdening of hospitals. It is now established for times of excess need for inpatient services. In 2020, a 4 billion euros investment program, the “Pact of Public Health Services”, was adopted to strengthen and modernize the German public health service institutions. The pact is implemented until 2026. The human resources component is the largest. Further priorities include digitalization, improvement of the infrastructure (of designated ports and airports) for the implementation of the International Health Regulations, research and the creation of agile and resilient public health structures. Outputs so far include the establishment of more than 4800 new public health positions, the appointment of new professorships for public health services, the initiation of several research projects, and the roll-out of more than 300 digitalization projects. A new federal institute for prevention is planned. It aims to foster networking between public health services, strengthen health communication, data use, and evidence for public health services. In this process, WHO advised the federal ministry e.g. on behavioral insights; heat health action; prevention on noncommunicable diseases and others. Many public health actors have provided opinions. However, consensus building on how Germany can overcome fragmentation in public health is ongoing.

Strengthening anthrax outbreak response and preparedness: simulation and stakeholder education in Namisindwa district, Uganda

BackgroundAnthrax is a zoonotic disease caused by Bacillus anthracis that poses a significant threat to both human health and livestock. Effective preparedness and response to anthrax outbreak at the district level is essential to mitigate the devastating impact of the disease to humans and animals. The current diseaae surveillance in animals and humans uses two different infrastructure systems with online platform supported by established diagnostic facilities. The differences in surveillance systems affect timely outbreak response especially for zoonotic diseases like anthrax. We therefore aimed to assess the feasibility of implementing a simulation exercise for a potential anthrax outbreak in a local government setting and to raise the suspicion index of different district stakeholders for a potential anthrax outbreak in Namisindwa District, Uganda.MethodsWe conducted a field-based simulation exercise and a health education intervention using quantitative data collection methods. The study participants mainly members of the District Taskforce (DTF) were purposively selected given their role(s) in disease surveillance and response at the sub-national level. We combined 26 variables (all dichotomized) assessing knowledge on anthrax and knowledge on appropriate outbreak response measures into an additive composite index. We then dichotomized overall score based on the 80% blooms cutoff i.e. we considered those scoring at least 80% to have high knowledge, otherwise low. We then assessed the factors associated with knowledge using binary logistic regression with time as a proxy for the intervention effect. Odds ratios (ORs) and 95% Confidence intervals (95%CI) have been reported.ResultsThe overall district readiness score was 35.0% (24/69) and was deficient in the following domains: coordination and resource mobilization (5/16), surveillance (5/11), laboratory capacity (3/10), case management (4/7), risk communications (4/12), and control measures (4/13). The overall community readiness score was 7 out of 32 (22.0%). We noted poor scores of readiness in all domains except for case management (2/2). The knowledge training did not have an effect on the overall readiness score, but improved specific domains such as control measures. Instead tertiary education was the only independent predictor of higher knowledge on anthrax and how to respond to it (OR = 1.57, 95% CI = 1.07–2.31). Training did not have a significant association with overall knowledge improvement but had an effect on several individual knowledge aspects.ConclusionWe found that the district’s preparedness to respond to a potential anthrax outbreak was inadequate, especially in coordination and mobilisation, surveillance, case management, risk communication and control measures. The health education training intervention showed increased knowledge levels compared to the pre-test and post-test an indicator that the health education sessions could increase the index of suspicion. The low preparedness underscores the urgency to strengthen anthrax preparedness in the district and could have implications for other districts. We deduce that trainings of a similar nature conducted regularly and extensively would have better effects. This study’s insights are valuable for improving anthrax readiness and safeguarding public and animal health in similar settings.

A comprehensive study on the production of potassium sorbate and sodium benzoate reference material in orange juice

Controlling the content of preservatives in soft drinks is of paramount important for assessing their quality during production and consumption, as well as for ensuring consumer health. To effectively enhance laboratory capacity in preservatives analysis, the requirement for reference materials (RMs) of non-alcoholic beverages containing common preservatives such as potassium sorbate and sodium benzoate is fundamentally essential. This research was conducted to provide a procedure for the production of reference materials for potassium sorbate and sodium benzoate in orange juice. The concentration of potassium sorbate and sodium benzoate in the reference materials complied with Circular No.24/2019/TT-BYT which regulates the management and use of food additives. The two RMs of natural and flavored orange juice were homogeneous and stable, however, their quality and stability were strongly affected by the storage temperature. At a particular condition of 5&amp;deg;C, synthetic orange juice witnessed a higher stability than natural at 532 days and 318 days, respectively. Furthermore, an accelerated aging study demonstrated that at -20&amp;deg;C, the integrity of potassium sorbate and sodium benzoate in natural orange juice was identically maintained for a substantial period of almost 3 years (expected shelf life 1,049 days).

The home-based breathing and chest mobility exercise improves cardiorespiratory functional capacity in long COVID with cardiovascular comorbidities: a randomized study

BackgroundBeyond the acute phase, a considerable proportion of patients recovering from the coronavirus disease 2019 (COVID-19) experience long-term sequelae that profoundly impact their quality of life, particularly their physical fitness. This study aims to assess the effect of home-based breathing and chest mobility exercise on the cardiorespiratory functional capacity of long COVID with cardiovascular comorbidity.MethodsIn this randomized, controlled, single-blind clinical trial, 46 long COVID with cardiovascular comorbidities were randomly assigned to either intervention or control group. The intervention group (n = 23) received additional home-based breathing and chest mobility exercise 3x/week for 12 weeks supervised by attending physicians, whereas the control group only received a home-based cardiac rehabilitation program. Baseline and post-intervention assessments consisted of laboratory (D-Dimer and CRP levels) and functional capacity, assessed through 6-minute walking test (6-MWT), exercise stress test’s metabolic equivalents (METS), and predicted peak oxygen consumption (VO2 peak), peak expiratory flow rate (PEFR), peak cough flow (PCF), chest expansion, and EuroQoL’s quality of life. Intention to treat analysis was performed.ResultsAt the 12th week, intervention subjects had significantly greater functional capacity with higher mean PEFR (p = .031) and PCF (p = .016). Similarly, 6-MWT was higher in the group receiving home-based breathing and chest mobility training (p = .032). The bottom part of the chest circumference was statistically different between the two groups (p = .01). METS and predicted VO2 peak were also higher in the intervention group. However, laboratory parameters and quality of life did not differ markedly (p > .05).ConclusionsHome-based respiratory and chest mobility exercise could be an adjunct to cardiac rehabilitation in long COVID with cardiovascular comorbidities for improving cardiorespiratory functional capacity.Trial registrationThe study protocol was registered at http://ClinicalTrial.gov.id NCT05077943 (14/10/2021).

Exploring antibiotic prescribing practices in multidisciplinary hospitals in the Republic of Moldova

Antimicrobial resistance (AMR) represents a major global challenge, amplified by the excessive and incorrect use of antibiotics. Th is study conducted in the Republic of Moldova investigated antibiotic prescribing practices in multidisciplinary hospitals to identify correlations between these practices and the increase in AMR. Th e study included a sample of 222 patients from four hospitals, selected based on the availability of a bacteriological laboratory and bed capacity. Data were collected using standardized questionnaires, which evaluated the type, duration, and changes in antibiotic therapy, as well as the results of bacteriological tests. Th e analysis revealed a high prevalence of antibiotic prescriptions, at 86.5%, with higher rates in urology (96%) and intensive care (92%) departments. Approximately 70% of patients hospitalized for 3-5 days received an antibiotic, while those hospitalized for more than 10 days were three times more likely to receive two or more antibiotics. The justification for these prescriptions was missing in most cases, signaling an urgent need for improvement in prescribing practices. Third-generation cephalosporins were the most frequently prescribed antibiotics (44.9%), followed by fluoroquinolones and aminoglycosides. Th e majority of the prescribed antibiotics were classified as „Watch” according to the WHO AWARe classification, indicating a need for intensive monitoring due to the risk of AMR. Th e results underscore the importance of implementing effective antimicrobial management programs and enhancing the monitoring of antibiotic use to combat the rise in AMR.

Diagnostics for detection and surveillance of priority epidemic-prone diseases in Africa: an assessment of testing capacity and laboratory strengthening needs.

In 2023, Africa experienced 180 public health emergencies, of which 90% were infectious diseases and 75% were related to zoonotic diseases. Testing capacity for epidemic-prone diseases is essential to enable rapid and accurate identification of causative agents, and for action to prevent disease spread. Moreover, testing is pivotal in monitoring disease transmission, evaluating public health interventions and informing targeted resource allocation during outbreaks. An online, self-assessment survey was conducted in African Union Member States to identify major challenges in testing for epidemic-prone diseases. The survey assessed current capacity for diagnosing priority epidemic-prone diseases at different laboratory levels. It explored challenges in establishing and maintaining testing capacity to improve outbreak response and mitigate public health impact. Survey data analysed diagnostic capacity for priority infectious diseases, diagnostic technologies in use, existing surveillance programmes and challenges limiting diagnostic capacity, by country. The survey result from 15 Member States who responded to the survey, showed high variability in testing capacity and technologies across countries and diverse factors limiting testing capacity for certain priority diseases like dengue and Crimean-Congo haemorrhagic fever. At the same time diagnostic capacity is better for coronavirus disease 2019 (COVID-19), polio, and measles due to previous investments. Unfortunately, many countries are not utilizing multiplex testing, despite its potential to improve diagnostic access. The challenges of limited laboratory capacity for testing future outbreaks are indeed significant. Recent disease outbreaks in Africa have underscored the urgent need to strengthen diagnostic capacity and introduce cost-effective technologies. Small sample sizes and differing disease prioritisation within each country limited the analysis. These findings suggest the benefits of evaluating laboratory testing capacity for epidemic-prone diseases and highlight the importance of effectively addressing challenges to detect diseases and prevent future pandemics.

Multidisciplinary Collaboration in Combatting Antimicrobial Resistance: Insights and Outcomes From the National Alliance of Medical Professionals on Antimicrobial Resistance (NAMP-AMR) Initiative.

Antimicrobial resistance (AMR) poses a critical global health challenge, requiring a coordinated and vigorous response. Despite numerous global and national efforts, a unified multidisciplinary approach has been missing. The National Alliance of Medical Professionals on Antimicrobial Resistance (NAMP-AMR), led by the Indian Medical Association in collaboration with key stakeholders such as NITI Aayog and the Ministry of Health, seeks to address this gap. This alliance unites 52 medical specialty organizations and associations to enhance efforts across various sectors, developing comprehensive strategies for awareness, surveillance, infection control, and optimization of antimicrobial use. The foundational meeting of NAMP-AMR on July 7, 2024, established a collaborative roadmap, promising to bolster India's efforts against AMR and support the forthcoming National Action Plan on AMR 2.0. The meeting concentrated on six key areas: improving AMR awareness and advocacy; strengthening laboratory capacities and surveillance; enhancing infection prevention and control (IPC); optimizing antimicrobial use through stricter regulations and stewardship programs; advancing AMR research and innovation; and fostering strong national and international collaborations. This initiative marks a significant advancement in combating AMR and positions India as a leader in global health efforts against this critical issue.