Mortality In sub-Saharan Africa Research Articles

A novel locus in CSMD1 gene is associated with increased susceptibility to severe malaria in Malian children

BackgroundPlasmodium falciparum malaria is still a leading cause of child mortality in sub-Saharan Africa. The clinical manifestations of malaria range from asymptomatic infection to severe disease. The variation in clinical presentation is partly attributed to host genetic factors with estimated narrow-sense heritability of 23%. Here, we investigate the associations between candidate gene polymorphisms and the likelihood of severe malaria (SM) in a cohort of Malian children.MethodsBased on our previous genome-wide association studies (GWAS) analysis, candidate genes were selected for in-depth analysis using several criteria including gene-level GWAS scores, functional overlap with malaria pathogenesis, and evidence of association with protection or susceptibility to other infectious or inflammatory diseases. Single Nucleotide Polymorphisms (SNPs) residing within these genes were selected mainly based on p-values from previous severe malaria susceptibility GWAS studies and minor allele frequency (MAF) in West African populations.ResultsOf 182 candidate genes reported in our previous study, 11 genes and 22 SNPs residing in these genes were selected. The selected SNPs were genotyped using KASP technology in 477 DNA samples (87 SM and 390 controls). Logistic regression analysis revealed that a common intron variant, rs13340578 in CUB and Sushi Multi Domain (CSMD1) gene, is associated with increased odds of SM in recessive mode of inheritance (MAF = 0.42, OR = 1.8, 95% CI = [1.78, 1.84], p = 0.029). The SNP is in linkage disequilibrium (LD) with multiple variants with regulatory features.ConclusionTaken together, the current study showed that an intron variant rs13340578, residing in CSMD1 gene, is associated with increased susceptibility to malaria. This finding suggests that modified regulation of complement may contribute to malaria disease severity. Further studies are needed to identify the causal variants and the underlying molecular mechanisms.

Learning from Ethiopia’s success in reducing maternal and neonatal mortality through a health systems lens

BackgroundThis study aimed to enhance insights into the key characteristics of maternal and neonatal mortality declines in Ethiopia, conducted as part of a seven-country study on Maternal and Newborn Health...

Knowledge and factors associated with active management of the third stage of labor in sub-Saharan Africa: A systematic review and meta-analysis.

Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality in sub-Saharan Africa. Implementing active management in the third stage of labor has significantly reduced the incidence of PPH. Thus, understanding the level of healthcare providers' knowledge of active management in the third stage of labor can inform guidelines, policies, and practices for effectively preventing PPH. This review aimed to assess the level of healthcare providers' knowledge and associated factors of active management in the third stage of labor in sub-Saharan Africa. We conducted a search using PubMed, Scopus, Web of Science, Google Scholar, Cochrane Library, and the African Journals online international databases. The inclusion criteria were determined before the review of the articles and adhere to the criteria of population, intervention, comparison, and outcome. Statistical analysis was performed using STATA data analysis software version 14, while Microsoft Excel was utilized for data abstraction. We checked publication bias using a funnel plot and Egger and Begg regression tests. A P value less than 0.05 was considered statistically significant, suggesting the presence of presence publication bias. The I2 statistic was used to assess heterogeneity between studies. The study's overall effect was evaluated using the random effects model. The study included 20 studies to conduct a pooled prevalence analysis. The overall prevalence of healthcare providers' knowledge of active management of third-stage labor in sub-Saharan Africa was 47.975% (95% CI: 32.585, 63.365). Having pre- and in-service training (AOR: 2.25, 95% CI: 1.00, 5.08), having a higher degree (AOR: 1.98, 95% CI: 1.39, 2.82), and having good practices (AOR: 8.91, 95% CI: 4.58, 17.40) were significantly associated with healthcare provider's knowledge regarding active management third stage of labor. The overall healthcare providers' knowledge of active management of the third stage of labor (AMTSL) was low in sub-Saharan Africa. Obstetric healthcare providers should undertake comprehensive training covering all AMTSL components through pre- and in-service diploma training programs.

Effectiveness of kangaroo mother care before clinical stabilisation versus standard care among neonates at five hospitals in Uganda (OMWaNA): a parallel-group, individually randomised controlled trial and economic evaluation

Preterm birth is the leading cause of death in children younger than 5 years worldwide. WHO recommends kangaroo mother care (KMC); however, its effects on mortality in sub-Saharan Africa and its relative costs remain unclear. We aimed to compare the effectiveness, safety, costs, and cost-effectiveness of KMC initiated before clinical stabilisation versus standard care in neonates weighing up to 2000 g. We conducted a parallel-group, individually randomised controlled trial in five hospitals across Uganda. Singleton or twin neonates aged younger than 48 h weighing 700-2000 g without life-threatening clinical instability were eligible for inclusion. We randomly assigned (1:1) neonates to either KMC initiated before stabilisation (intervention group) or standard care (control group) via a computer-generated random allocation sequence with permuted blocks of varying sizes, stratified by birthweight and recruitment site. Parents, caregivers, and health-care workers were unmasked to treatment allocation; however, the independent statistician who conducted the analyses was masked. After randomisation, neonates in the intervention group were placed prone and skin-to-skin on the caregiver's chest, secured with a KMC wrap. Neonates in the control group were cared for in an incubator or radiant heater, as per hospital practice; KMC was not initiated until stability criteria were met. The primary outcome was all-cause neonatal mortality at 7 days, analysed by intention to treat. The economic evaluation assessed incremental costs and cost-effectiveness from a disaggregated societal perspective. This trial is registered with ClinicalTrials.gov, NCT02811432. Between Oct 9, 2019, and July 31, 2022, 2221 neonates were randomly assigned: 1110 (50·0%) neonates to the intervention group and 1111 (50·0%) neonates to the control group. From randomisation to age 7 days, 81 (7·5%) of 1083 neonates in the intervention group and 83 (7·5%) of 1102 neonates in the control group died (adjusted relative risk [RR] 0·97 [95% CI 0·74-1·28]; p=0·85). From randomisation to 28 days, 119 (11·3%) of 1051 neonates in the intervention group and 134 (12·8%) of 1049 neonates in the control group died (RR 0·88 [0·71-1·09]; p=0·23). Even if policy makers place no value on averting neonatal deaths, the intervention would have 97% probability from the provider perspective and 84% probability from the societal perspective of being more cost-effective than standard care. KMC initiated before stabilisation did not reduce early neonatal mortality; however, it was cost-effective from the societal and provider perspectives compared with standard care. Additional investment in neonatal care is needed for increased impact, particularly in sub-Saharan Africa. Joint Global Health Trials scheme of the Department of Health and Social Care, Foreign, Commonwealth and Development Office, UKRI Medical Research Council, and Wellcome Trust; Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Trapping and killing performance of a PermaNet 2.0 hybrid mosquito trapping bednet: an experimental hut evaluation

Background Despite the huge global effort , there has been an increase in malaria morbidity and mortality in sub-Saharan Africa since 2015, from 212 million cases and 429,000 deaths in 2015 to 241 million cases and 627,000 deaths in 2020 mainly because of resistance to insecticide. Therefore, advancing innovative approaches is the only sustainable way to fight malaria. Methods Taking advantage of the behavior of mosquitoes around the net, which is almost 70-90% concentrated on the roof, we have developed a two-compartment mosquito bednet, the so-called T-Net for mass mosquito trapping and killing. In the current study, we investigated in an experimental hut trial, the efficacy of trapping-long-lasting insecticide-treated nets (T-LLINs) against Anopheles gambiae s.l. in an insecticide resistance context. Five different arms have been considered in this study including three positive control arms e.g. PermaNet 2.0 LLIN, Tsara boost LLIN and Interceptor generation 2 (IG2) LLIN), one negative control arm using insecticide-free bednet, and one candidate arm using a hybrid-treated trapping bednet made with PermaNet 2.0 LLIN mounted with an insecticide-free compartment (T-LLIN). Results The highest average daily mortality was recorded with the T-LLIN. In total, 678 mosquitoes were killed by T-LLIN among the 760 collected, i.e. 89.2%. Out of these, 317 were found in the trap compartment, representing 46.75% of mortality directly attributable to the mechanical effect of this net. This added value made it possible to quantify the increased in the killing effect that this net would have over the positive control arms: this would be 58.5% higher than the killing effect of PN2.0, 38% higher than that of Tsara boost and 31.5% higher than that of IG2. Conclusion The current study shows potential to maximize the efficiency of the WHO-recommended LLINs by an addition of an insecticide-free trap compartment on top of the net.

Implementation strategies to build mental health-care capacity in Malawi: a health-economic evaluation

Depression is a major contributor to morbidity and mortality in sub-Saharan Africa. Due to low system capacity, three in four patients with depression in sub-Saharan Africa go untreated. Despite this, little attention has been paid to the cost-effectiveness of implementation strategies to scale up evidence-based depression treatment in the region. In this study, we investigate the cost-effectiveness of two different implementation strategies to integrate the Friendship Bench approach and measurement-based care in non-communicable disease clinics in Malawi. The two implementation strategies tested in this study are part of a trial, in which ten clinics were randomly assigned (1:1) to a basic implementation package consisting of an internal coordinator acting as a champion (IC-only group) or to an enhanced package that complemented the basic package with quarterly external supervision, and audit and feedback of intervention delivery (IC + ES group). We included material costs, training costs, costs related to project-wide meetings, transportation and medication costs, time costs related to internal champion activities and depression screening or treatment, and costs of external supervision visits if applicable. Outcomes included the number of patients screened with the patient health questionnaire 2 (PHQ-2), cases of remitted depression at 3 and 12 months, and disability-adjusted life-years (DALYs) averted. We compared the cost-effectiveness of both packages to the status quo (ie, no intervention) using a micro-costing-informed decision-tree model. Relative to the status quo, IC + ES would be on average US$10 387 ($1349-$17 365) more expensive than IC-only but more effective in achieving remission and averting DALYs. The cost per additional remission would also be lower with IC + ES than IC-only at 3 months ($119 vs $223) and 12 months ($210 for IC + ES; IC-only dominated by the status quo at 12 months). Neither package would be cost-effective under the willingness-to-pay threshold of $65 per DALY averted currently used by the Malawian Ministry of Health. However, the IC + ES package would be cost-effective in relation to the commonly used threshold of three times per-capita gross domestic product per DALY averted. Investing in supporting champions might be an appropriate use of resources. Although not currently cost-effective by Malawian willingness-to-pay standards compared with the status quo, the IC + ES package would probably be a cost-effective way to build mental health-care capacity in resource-constrained settings in which decision makers use higher willingness-to-pay thresholds. National Institute of Mental Health.

Analytical performances of a point-of-care loop-mediated isothermal amplification assay to detect Group B Streptococcus in intrapartum pregnant women living in the Democratic Republic of the Congo

ObjectivesGroup B Streptococcus (GBS) is the leading infectious cause of stillbirth and neonatal morbidity and mortality in sub-Saharan Africa. MethodsVaginal and rectovaginal swab samples were obtained from 274 intrapartum pregnant women in the Democratic Republic of the Congo to be analyzed for GBS DNA detection in parallel by the point-of-care BIOSYNEX AMPLIFLASH® GBS assay (Biosynex SA, Illkirch-Graffenstaden, France) and by reference quantitative polymerase chain reaction (qPCR). ResultsRectovaginal swabbing, nearly two-fold more positive for GBS than vaginal swabbing alone, showed a high prevalence of GBS DNA positivity in 20.1% of eligible intrapartum pregnant women. In the event of significant bacterial carriage (i.e., cycle threshold ≤33 by reference qPCR), the AMPLIFLASH® GBS assay with rectovaginal swabbing showed high sensitivity (98.1%) and specificity (100.0%) for GBS DNA detection, with excellent concordance, reliability, and accuracy with the reference qPCR, and positive predictive values and negative predictive values above 99.0%. ConclusionsThe study demonstrates a high rate of female rectogenital GBS colonization in pregnant Congolese women. The AMPLIFLASH® GBS assay harbored excellent analytical performances in the field, which makes it suitable to be used as point-of-care molecular assay in various hospital and non-hospital settings where rapid diagnosis of GBS is necessary.

Acceptability of IV iron treatment for iron deficiency anaemia in pregnancy in Nigeria: a qualitative study with pregnant women, domestic decision-makers, and health care providers

BackgroundAnaemia in pregnancy causes a significant burden of maternal morbidity and mortality in sub-Saharan Africa, with prevalence ranging from 25 to 45% in Nigeria. The main treatment, daily oral iron, is associated with suboptimal adherence and effectiveness. Among pregnant women with iron deficiency, which is a leading cause of anaemia (IDA), intravenous (IV) iron is an alternative treatment in moderate or severe cases. This qualitative study explored the acceptability of IV iron in the states of Kano and Lagos in Nigeria.MethodsWe purposively sampled various stakeholders, including pregnant women, domestic decision-makers, and healthcare providers (HCPs) during the pre-intervention phase of a hybrid clinical trial (IVON trial) in 10 healthcare facilities across three levels of the health system. Semi-structured topic guides guided 12 focus group discussions (140 participants) and 29 key informant interviews. We used the theoretical framework of acceptability to conduct qualitative content analysis.ResultsWe identified three main themes and eight sub-themes that reflected the prospective acceptability of IV iron therapy. Generally, all stakeholders had a positive affective attitude towards IV iron based on its comparative advantages to oral iron. The HCPs noted the effectiveness of IV iron in its ability to evoke an immediate response and capacity to reduce anaemia-related complications. It was perceived as a suitable alternative to blood transfusion for specific individuals based on ethicality. However, to pregnant women and the HCPs, IV iron could present a higher opportunity cost than oral iron for the users and providers as it necessitates additional time to receive and administer it. To all stakeholder groups, leveraging the existing infrastructure to facilitate IV iron treatment will stimulate coherence and self-efficacy while strengthening the existing trust between pregnant women and HCPs can avert misconceptions. Finally, even though high out-of-pocket costs might make IV iron out of reach for poor women, the HCPs felt it can potentially prevent higher treatment fees from complications of IDA.ConclusionsIV iron has a potential to become the preferred treatment for iron-deficiency anaemia in pregnancy in Nigeria if proven effective. HCP training, optimisation of information and clinical care delivery during antenatal visits, uninterrupted supply of IV iron, and subsidies to offset higher costs need to be considered to improve its acceptability.Trial registration ISRCTN registry ISRCT N6348 4804. Registered on 10 December 2020 Clinicaltrials.gov NCT04976179. Registered on 26 July 2021

Identifying neonates at risk for post-discharge mortality in Dar es Salaam, Tanzania, and Monrovia, Liberia: Derivation and internal validation of a novel risk assessment tool

IntroductionThe immediate period after hospital discharge carries a large burden of childhood mortality in sub-Saharan Africa. Our objective was to derive and internally validate a risk assessment tool to identify...

Salmonella enterica serovar Typhimurium ST313 sublineage 2.2 has emerged in Malawi with a characteristic gene expression signature and a fitness advantage.

Invasive non-typhoidal Salmonella (iNTS) disease is a serious bloodstream infection that targets immune-compromised individuals, and causes significant mortality in sub-Saharan Africa. Salmonella enterica serovar Typhimurium ST313 causes the majority of iNTS in Malawi. We performed an intensive comparative genomic analysis of 608 S. Typhimurium ST313 isolates dating between 1996 and 2018 from Blantyre, Malawi. We discovered that following the arrival of the well-characterized S. Typhimurium ST313 lineage 2 in 1999, two multidrug-resistant variants emerged in Malawi in 2006 and 2008, designated sublineages 2.2 and 2.3, respectively. The majority of S. Typhimurium isolates from human bloodstream infections in Malawi now belong to sublineages 2.2 or 2.3. To understand the emergence of the prevalent ST313 sublineage 2.2, we studied two representative strains, D23580 (lineage 2) and D37712 (sublineage 2.2). The chromosome of ST313 lineage 2 and sublineage 2.2 only differed by 29 SNPs/small indels and a 3kb deletion of a Gifsy-2 prophage region including the sseI pseudogene. Lineage 2 and sublineage 2.2 had distinctive plasmid profiles. The transcriptome was investigated in 15 infection-relevant in vitro conditions and within macrophages. During growth in physiological conditions that do not usually trigger S. Typhimurium SPI2 gene expression, the SPI2 genes of D37712 were transcriptionally active. We identified down-regulation of flagellar genes in D37712 compared with D23580. Following phenotypic confirmation of transcriptomic differences, we discovered that sublineage 2.2 had increased fitness compared with lineage 2 during mixed growth in minimal media. We speculate that this competitive advantage is contributing to the emergence of sublineage 2.2 in Malawi.

Birth asphyxia and its association with grand multiparity and referral among hospital births: A prospective cross-sectional study in Benin, Malawi, Tanzania and Uganda.

Birth asphyxia is a leading cause of neonatal mortality in sub-Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies. We investigated birth asphyxia and its association with GM and referral in Benin, Malawi, Tanzania and Uganda. This was a prospective cross-sectional study. Data were collected using a perinatal e-Registry in 16 hospitals (four per country). The study population consisted of 80 663 babies (>1000 g, >28 weeks' gestational age) delivered between July 2021 and December 2022. The primary outcome was birth asphyxia, defined by 5-minute appearance, pulse, grimace, activity and respiration score <7. A multilevel and stratified multivariate logistic regression was performed with GM (parity ≥5) as exposure, and birth asphyxia as outcome. An interaction between referral (none, prepartum, intrapartum) and GM was also evaluated as a secondary outcome. All models were adjusted for confounders. Pan African Clinical Trial Registry 202006793783148. Birth asphyxia was present in 7.0% (n = 5612) of babies. More babies with birth asphyxia were born to grand multiparous women (11.9%) than to other parity groups (≤7.6%). Among the 76 850 cases included in the analysis, grand multiparous women had a 1.34 times higher odds of birth asphyxia (95% confidence interval [CI] 1.17-1.54) vs para one to two. Grand multiparous women referred intrapartum had the highest probability of asphyxiation (13.02%, 95% CI 9.34-16.69). GM increased odds of birth asphyxia in Benin (odds ratio [OR] 1.37, 95% CI 1.13-1.68) and Uganda (OR 1.29, 95% CI 1.02-1.64), but was non-significant in Tanzania (OR 1.44, 95% CI 0.81-2.56) and Malawi (OR 0.98, 95% CI 0.67-1.44). There is some evidence of an increased risk of birth asphyxia for grand multiparous women having babies at hospitals, especially following intrapartum referral. Antenatal counseling should recognize grand multiparity as higher risk and advise appropriate childbirth facilities. Findings in Malawi suggest an advantage of health systems configuration requiring further exploration.

Locusts Fly, Babies Die: Desert Locusts and Infant Mortality in Sub-Saharan Africa

Locusts Fly, Babies Die: Desert Locusts and Infant Mortality in Sub-Saharan Africa

Frequency of Blood Donation and Malaria Occurrence among Blood Donors in a Tertiary Hospital, Nigeria

Context: Malaria is a significant cause of morbidity and mortality in Sub-Saharan Africa (SSA). Transfusion transmitted malaria contributes significantly to the burden of malaria in SSA. The safety of blood transfusion as it relates to frequency of blood donation and malaria occurrence on the part of donors is an aspect that has not been properly investigated hence this study.&#x0D; Objectives: This study was conducted to assess the frequency of blood donation and occurrence of malaria among blood donors at OAUTHC, Ile-Ife.&#x0D; Materials and methods: This was a cross-sectional study. Ethical approval was obtained. One hundred and thirty-three consenting blood donors aged between 18-50 years were recruited for the study. Two millilitres of blood were collected from each study participant and immediately transported to the laboratory for processing. Giemsa-stained films of the samples were viewed under the oil immersion objective of the microscope. Questionnaires were administered to the study participants to obtain relevant information. Data generated were analysed using descriptive and inferential statistics with SPSS software version 20. The level of significance was set at p &lt; 0.05.&#x0D; Results: The prevalence of malaria among the blood donors was 21.1% with the highest rate among commercial donors (33.3%) followed by family donors (12.9%) then voluntary donors (11.9%). Evaluation of the frequency of donation showed that malaria occurred more in recurring donors (77.78%) than first time donors (22.22%).&#x0D; Conclusion: Malaria is highly prevalent among blood donors and occurs more in recurring blood donors than first time donors.

Comparative Diagnostic Performance of Microscopy, SD-Bioline Rapid Diagnostic Test, and Polymerase Chain Reaction in the Detection of Malaria Infection among Pregnant Women at Delivery in Kumba Health District Area in the Southwest Region of Cameroon

Introduction. Malaria during pregnancy is a major cause of morbidity and mortality in sub-Saharan Africa. Microcopy and rapid diagnostic test (RDT) recommended by the World Health Organization for clinical diagnosis have poor sensitivity to detect individuals with very low levels of parasitemia. Previous studies have shown that malaria in pregnancy is associated with mastitis and excessive uterine blood loss during delivery. However, information evaluating the performance of these tools in detecting malaria in pregnancy at the national level is limited. This study therefore evaluates the performance of microscopy, RDT, and nested polymerase chain reaction (nPCR) in the detection of pregnancy-associated malaria at delivery. Methods. A total of 227 participants constituting of 201 pregnant women without and 26 with HIV were recruited from five health facilities within the Kumba health district area. Mother venous and cord blood were collected at delivery to test for malaria using the thick-film microscopy, SD-bioline RDT, and 18SrRNA-nested PCR. Results. The percentage of malaria-positive cases detected by thick-film microcopy (TFM), RDT, and PCR in pregnant women with and without HIV was 7.69%, 53.85%, and 50% and 3.48%, 23.38%, and 49.25%, respectively. Plasmodium falciparum was detected in 1.99% cord blood samples of women without HIV by PCR. The positivity rate in at least two of the test methods (composite positive) was 42.31% for women with and 19.90% for women without HIV. The sensitivity of TFM and RDT when using PCR as a reference was 7.21% and 49.00%, respectively, in all samples. The specificity was 99.14% and 90.55% with kappa values of 0.064 and 0.461, respectively. When using the composite test as a reference, the sensitivity of TFM, RDT, and nPCR was 15.69%, 94.12%, and 100%, respectively. Specificity was 99.43%, 93.18%, and 65.34% with kappa values of 0.213, 0.821, and 0.458, respectively. Conclusion. This study shows that PCR is more sensitive in the detection of malaria parasite followed by SD-bioline RDT kit. However, in resource-limited settings where access to molecular diagnosis of malaria is a problem, RDT should be considered as the first option to microscopy in the diagnosis of malaria.

The potential of provitamin A maize ( Zea mays L.) biofortification in sub-Saharan Africa: Current status, opportunities, challenges and perspectives: A review

Abstract Maize is a potential crop for improving food and nutritional security for over 300 million people in sub-Saharan Africa (SSA). It is the most preferred cereal crop in SSA because of its diversified uses, taste and higher grain yield potential compared to other cereals. However, overdependence on maize-based diets without vitamin A supplementation is associated with the highest rates of vitamin A deficiency (VAD) in SSA. Vitamin A deficiency mostly affects children under the age of 5 years, pregnant and lactating women, accounting for the worst disease burden, and infant mortality in SSA. To date provitamin A maize breeding programmes of HarvestPlus partnered with CIMMYT and IITA, private seed companies and national plant breeding programmes developed at least 70 elite varieties to curb VAD in SSA. This review summarizes the potential of provitamin A maize in SSA focusing on (1) reasons why maize is a good choice for provitamin A biofortification, (2) the prevalence of vitamin A deficiency in SSA, (3) the Global Hunger Index (GHI) and extent of hidden hunger, (4) possible interventions to curb vitamin A deficiency in SSA and their applicability, (5) status of the provitamin A maize varieties released, (6) level of adoption and consumer perception of provitamin A maize-based food, (7) the impact of climate change in maize productivity in SSA and (8) the breeding methods for developing provitamin A maize-resilient genotypes to mitigate the effects of climate change in SSA.

Trapping and killing performance of a PermaNet 2.0 hybrid mosquito trapping bednet: an experimental hut evaluation.

Despite the huge global effort , there has been an increase in malaria morbidity and mortality in sub-Saharan Africa since 2015, from 212 million cases and 429,000 deaths in 2015 to 241 million cases and 627,000 deaths in 2020 mainly because of resistance to insecticide. Therefore, advancing innovative approaches is the only sustainable way to fight malaria. Taking advantage of the behavior of mosquitoes around the net, which is almost 70-90% concentrated on the roof, we have developed a two-compartment mosquito bednet, the so-called T-Net for mass mosquito trapping and killing. In the current study, we investigated in an experimental hut trial, the efficacy of trapping-long-lasting insecticide-treated nets (T-LLINs) against Anopheles gambiae s.l. in an insecticide resistance context. Five different arms have been considered in this study including three positive control arms e.g. PermaNet 2.0 LLIN, Tsara boost LLIN and Interceptor generation 2 (IG2) LLIN), one negative control arm using insecticide-free bednet, and one candidate arm using a hybrid-treated trapping bednet made with PermaNet 2.0 LLIN mounted with an insecticide-free compartment (T-LLIN). The highest average daily mortality was recorded with the T-LLIN. In total, 678 mosquitoes were killed by T-LLIN among the 760 collected, i.e. 89.2%. Out of these, 317 were found in the trap compartment, representing 46.75% of mortality directly attributable to the mechanical effect of this net. This added value made it possible to quantify the increased in the killing effect that this net would have over the positive control arms: this would be 52% higher than the killing effect of PN2.0, 25.2% higher than that of Tsara boost and 23% higher than that of IG2. The current study shows potential to maximize the efficiency of the WHO-recommended LLINs by an addition of an insecticide-free trap compartment on top of the net.

Does bribery increase maternal mortality? Evidence from 135 Sub-Saharan African regions.

About 295,000 women died globally during and following pregnancy and childbirth in 2017. Two-thirds of these deaths occurred in Sub-Saharan Africa. By linking individual and regional data from 135 regions in 17 Sub-Saharan African countries over the period 2002-2018 this study explores how bribery affects maternal mortality in Sub-Saharan Africa. Our results show that the percentage of people who had first-hand experience in bribery is significantly and positively associated with pregnancy related deaths. We find that a 10 p.p. increase in the prevalence of bribery is associated with up to 41 [95% CI: 10-73] additional deaths for every 1,000 pregnancy-related deaths. However, the healthcare system quality appears to be an important moderator. To reduce maternal mortality, policy makers should not only increase investments in healthcare, they need also to implement measures to combat corruption.

Characterization of Beta-Lactamase and Fluoroquinolone Resistance Determinants in Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa Isolates from a Tertiary Hospital in Yola, Nigeria.

Infections due to antimicrobial resistant gram-negative bacteria cause significant morbidity and mortality in sub-Saharan Africa. To elucidate the molecular epidemiology of antimicrobial resistance in gram-negative bacteria, we characterized beta-lactam and fluoroquinolone resistance determinants in Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa isolates collected from November 2017 to February 2018 (Period 1) and October 2021 to January 2022 (Period 2) in a tertiary medical center in north-eastern Nigeria. Whole genome sequencing (WGS) was used to identify sequence types and resistance determinants in 52 non-duplicate, phenotypically resistant isolates. Antimicrobial susceptibility was determined using broth microdilution and modified Kirby-Bauer disk diffusion methods. Twenty sequence types (STs) were identified among isolates from both periods using WGS, with increased strain diversity observed in Period 2. Common ESBL genes identified included blaCTX-M, blaSHV, and blaTEM in both E. coli and K. pneumoniae. Notably, 50% of the E. coli in Period 2 harbored either blaCTX-M-15 or blaCTX-M-1 4 and phenotypically produced ESBLs. The blaNDM-7 and blaVIM-5 metallo-beta-lactamase genes were dominant in E. coli and P. aeruginosa in Period 1, but in Period 2, only K. pneumoniae contained blaNDM-7, while blaNDM-1 was predominant in P. aeruginosa. The overall rate of fluoroquinolone resistance was 77% in Period 1 but decreased to 47.8% in Period 2. Various plasmid-mediated quinolone resistance (PMQR) genes were identified in both periods, including aac(6')-Ib-cr, oqxA/oqxB, qnrA1, qnrB1, qnrB6, qnrB18, qnrVC1, as well as mutations in the chromosomal gyrA, parC and parE genes. One E. coli isolate in Period 2, which was phenotypically multidrug resistant, had ESBL blaCTX-M-15, the serine carbapenemase, blaOXA-181 and mutations in the gyrA gene. The co-existence of beta-lactam and fluoroquinolone resistance markers observed in this study is consistent with widespread use of these antimicrobial agents in Nigeria. The presence of multidrug resistant isolates is concerning and highlights the importance of continued surveillance to support antimicrobial stewardship programs and curb the spread of antimicrobial resistance.

Comparing cardiovascular outcomes and costs of perindopril-, enalapril- or losartan-based antihypertensive regimens in South Africa: real-world medical claims database analysis

Abstract Background Effective strategies for hypertension management are essential to reduce associated morbidity and mortality in sub-Saharan Africa, where blood pressure control rates are alarmingly low. Renin-angiotensin-aldosterone system (RAAS) inhibitors are recommended as first-line treatment; however, differences in class or molecule-specific effects have not been conclusively demonstrated. Purpose This real-world study analysed medical insurance claims data to assess clinical and cost outcomes of antihypertensive therapy based on the three most commonly prescribed RAAS inhibitors in South Africa: perindopril, losartan and enalapril. Methods Patients on standard doses of perindopril, enalapril or losartan (alone or in combination with other agents) for ≥12 months prior to January 2015 were identified from a large, South African private health insurance database. Anonymised patient-level claims over the next 5 years (January 2015 to December 2019) were analysed in patients with ≥80% adherence. The primary outcome was the risk-adjusted rate of the composite of myocardial infarction (MI), ischaemic heart disease (IHD), heart failure (HF) or stroke. The key secondary clinical outcome was the risk-adjusted all-cause mortality rate; risk-adjusted costs per life per month (PLPM) in South African Rands (ZAR) were also assessed. Results In total, 63,489 patients who received perindopril (n=32,857), losartan (n=16,693) or enalapril (n=13,939) were included. Within the 5-year study period, the risk-adjusted rate of ≥1 claim for MI, IHD, HF or stroke (primary outcome) was significantly lower with perindopril than losartan (205 vs 221 per 1000 patients; P&amp;lt;0.0001) or enalapril (205 vs 223 per 1000 patients; P&amp;lt;0.0001). The risk-adjusted all-cause mortality rate was also significantly lower with perindopril than enalapril (100 vs 139 deaths per 1000 patients; P=0.007), but similar to that with losartan (100 vs 94 deaths per 1000 patients; P=0.650). Perindopril was also associated with significantly lower overall risk-adjusted costs than the other agents, with mean (95% confidence interval) costs PLPM of ZAR 1342 (87–8973) for perindopril, ZAR 1466 (104–9365) for losartan (P=0.0044) and ZAR 1540 (77–10,546) for enalapril (P=0.0003). Conclusion In this real-world analysis of South African individuals with hypertension, perindopril-based regimens were associated with a lower rate of cardiovascular events (MI, IHD, HF and stroke) over 5 years than enalapril- or losartan-based regimens. Perindopril also provided considerably greater cost-saving benefits, both statistically and socioeconomically, compared with the other RAAS inhibitor agents. Although these observations need to be confirmed in a broader South African population, including those treated in the public health sector, they may have significant implications for the choice of antihypertensive therapy.Time to outcome event over 5 yearsRisk-adjusted cost in South African Rand

OTHER-04 FEASIBILITY STUDY ON BRAIN TUMOR BIOBANKING AND REGISTRY IN SUB-SAHARAN AFRICAN COUNTRIES: A QUESTIONNAIRE-BASED SURVEY

Abstract INTRODUCTION Brain tumors constitute significant morbidity and mortality in sub-Saharan Africa (SSA). Improvements in neuro-oncology practice and research have seen increased diagnosis of brain tumors. However, to our knowledge, there have been no previous projects on brain tumor genetics in SSA. To understand the feasibility of developing brain tumor biobanking and registries, this project aims to start by mapping out the current neuro-oncology capacity in terms of workforce and available services. METHODOLOGY We will conduct a descriptive questionnaire-based online survey among a cross section of neuro-oncology practitioners spread across SSA countries. The dissemination of the survey questionnaire will be facilitated by the Society for Neuro-oncology in SSA (SNOSSA). The Google designed questionnaire will capture information on the distribution, and number of available neuro-oncology care practitioners, capacity for brain tumor diagnosis and management, cancer registration, tumor biobanking, and research. CLINICAL IMPACT AND CONCLUSION This study will generate robust data from SSA, which can be used to improve future research and promote advocacy towards brain tumor diagnosis and management. This work will also serve as a pilot study for subsequent research that will focus on the development of brain tumor-specific registries and biorepositories in SSA.