Resource-limited Countries Research Articles

Genomic surveillance of SARS-CoV-2 evolution by a centralised pipeline and weekly focused sequencing, Austria, January 2021 to March 2023

Background The COVID-19 pandemic was largely driven by genetic mutations of SARS-CoV-2, leading in some instances to enhanced infectiousness of the virus or its capacity to evade the host immune system. To closely monitor SARS-CoV-2 evolution and resulting variants at genomic-level, an innovative pipeline termed SARSeq was developed in Austria. Aim We discuss technical aspects of the SARSeq pipeline, describe its performance and present noteworthy results it enabled during the pandemic in Austria. Methods The SARSeq pipeline was set up as a collaboration between private and public clinical diagnostic laboratories, a public health agency, and an academic institution. Representative SARS-CoV-2 positive specimens from each of the nine Austrian provinces were obtained from SARS-CoV-2 testing laboratories and processed centrally in an academic setting for S-gene sequencing and analysis. Results SARS-CoV-2 sequences from up to 2,880 cases weekly resulted in 222,784 characterised case samples in January 2021–March 2023. Consequently, Austria delivered the fourth densest genomic surveillance worldwide in a very resource-efficient manner. While most SARS-CoV-2 variants during the study showed comparable kinetic behaviour in all of Austria, some, like Beta, had a more focused spread. This highlighted multifaceted aspects of local population-level acquired immunity. The nationwide surveillance system enabled reliable nowcasting. Measured early growth kinetics of variants were predictive of later incidence peaks. Conclusion With low automation, labour, and cost requirements, SARSeq is adaptable to monitor other pathogens and advantageous even for resource-limited countries. This multiplexed genomic surveillance system has potential as a rapid response tool for future emerging threats.

The HyperPed-COVID international registry: Impact of age of onset, disease presentation and geographical distribution on the final outcome of MIS-C

ObjectivesThe aim of the study was to establish an international multicenter registry to collect data on patients with Multisystem Inflammatory Syndrome in Children (MIS-C), in order to highlight a relationship between clinical presentation, age of onset and geographical distribution on the clinical outcome. Study designMulticenter retrospective study involving different international societies for rare immunological disorders.1009 patients diagnosed with MIS-C between March and September 2022, from 48 centers and 22 countries were collected. Five age groups (<1, 1–4, 5–11, 12–16, >16 years) and four geographic macro-areas, Western Europe, Central-Eastern Europe, Latin America, Asian-African resource-limited countries (LRC), were identified. ResultsTime to referral was significantly higher in LRC. Intensive anti-inflammatory treatment, including biologics, respiratory support and mechanic ventilation were more frequently used in older children and in European countries. The mortality rate was higher in very young children (<1 year), in older patients (>16 years of age) and in LRC. Multivariate analysis identified the residence in LRC, presence of severe cardiac involvement, renal hypertension, lymphopenia and non-use of heparin prophylaxis, as the factors most strongly associated with unfavorable outcomes. ConclusionsThe stratification of patients by age and geographic macro-area provided insights into the clinical presentation, treatment and outcome of MIS-C. The mortality and sequelae rates exhibited a correlation with the age and geographical areas. Patients admitted and treated in LRC displayed more severe outcomes, possibly due to delays in hospital admission and limited access to biologic drugs and to intensive care facilities.

Epidemiological analysis and overall survival of adrenal malignancies in a developing Middle Eastern country over 18 years.

e23067 Background: Adrenal cancer imposes a significant socioeconomic and health burden due to the resulting morbidity and mortality. Accordingly, assessment of the epidemiological characteristics of adrenal malignancies in the Middle East, where the epidemiology of adrenal malignancies is poorly evaluated, is of paramount importance in management tailoring and planning as it enables appropriate risk stratification, especially in limited resource countries. Methods: Extensive and thorough data on adrenal cancer for all individuals, both males and females, of various nationalities residing in Jordan who were diagnosed from 2000-2018 was retrieved from the Jordan Cancer Registry, the formal reporting institution for cancer epidemiology in Jordan with a total of 296 patients being included. Furthermore, comprehensive epidemiological analysis was performed with Kaplan-Meier analysis being performed to assess overall survival rates. Results: 296 patients with a mean age of 18.7 ± 22.6 years old and a male predominance of 55.4% were included in the analysis. The vast majority of the included patients were non-smokers (72.3%). Adrenal malignancy was found to be most commonly located in the left adrenal gland (41.6%), while only 7 patients (2.36%) had bilateral adrenal malignancies. 19.6% of the tumors were arising from the adrenal cortex while 70.9% of the patients had adrenal gland tumors with the origin being unknown at the time of reporting. A concerning 17.20% of the enrolled patients had poorly differentiated tumors, and 8 patients (2.70%) had undifferentiated malignancies. At the time of diagnosis, a staggering 51.0% of the patients had distant and systemic metastasis, while only 11.8% of the patients had localized malignancy. The overall 5-year survival rate was determined to be 66.8%. A statistically significant increase in the crude incidence of adrenal cancer in Jordan over 18 years was evident with a crude incidence estimated effect of 0.014 (p-value = 0.003). Conclusions: Despite that the 5-year survival is 66.8%, there is an alarmingly significant uptrend in the crude incidence of adrenal cancer in Jordan with the overwhelming majority presenting at an advanced stage, and thus the introduction of early interventions and advanced management is mandated to achieve better outcomes.

An Evaluation of the Sensitivity and Specificity of Three COVID-19 Rapid Immunochromatographic Test Kits Compared to Real-Time Reverse Transcriptase-Polymerase Chain Reaction (rRT-PCR) Among Clinical Samples.

Background and objective The coronavirus disease 2019 (COVID-19) pandemic has imposed a significant burden on healthcare systems worldwide. This highlights the need for simple, rapid, and affordable diagnostic tests that can serve as alternatives tothe existing costly and demanding polymerase chain reaction (PCR) assay, especially in resource-limited countries like Ghana. In light of this, we aimed to assess thediagnostic efficacy of threeCOVID-19 rapid immunochromatographic antigen test kits vs. real-time reverse transcriptase-PCR (rRT-PCR). Methods This study evaluated the sensitivity and specificity of threeCOVID-19 rapid immunochromatographic antigen test kits: DG Rapid, SD Rapid, and SS Rapid. They were compared with the gold standard RT-PCRfor the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid antigen in 75 randomly selected archived nasopharyngeal samples. Results Of the 75 samples tested, 38 (50.7%) were positive and 37 (49.3%) were negative for SARS-CoV-2 RNA by rRT-PCR assay. No false positives were recorded. On the other hand, the DG Rapid kit detected 30 (78.9%) true positives and eight (21.1%) false negatives. SD Rapid kit detected 28 (73.7%) true positives and 10 (26.3%) false negatives, while the SS Rapid kit detected 19 (50.0%) true positives and 19 (50.0%) false negatives. While the specificity of each test kit was 100% (95% CI),the sensitivity of the DG Rapid, SD Rapid, and SS Rapid kits was 79%, 74%, and 50% (95% CI), respectively. Higher sensitivitieswere recorded among samples with cycle threshold (Ct) values <29.99 for each kit. Also, the DG Rapid kit demonstrated 79% excellent agreement with rRT-PCR, while the SD Rapid and SS Rapid kits demonstrated good agreement with rRT-PCR with 73% and 50% Cohen's kappa values, respectively. Conclusions Based on our findings,DG Rapid and SD Rapid kits are reliable alternatives to rRT-PCR for the detection of SARS-CoV-2 infection, especially in resource-limited settings like Ghana.

Tetanus– a case report highlighting the challenges in diagnosis and treatment

Tetanus has become an increasingly rare infectious disease due to the development of successful vaccination programs in the mid-20th century. In resource-rich countries, mainly unvaccinated or partly vaccinated risk groups are affected, whereas tetanus still remains prevalent in resource-limited countries. The decreasing incidence in developed countries has hindered clinical trials evaluating the best treatment modalities for tetanus infections. Current guidelines are based on a small number of studies and case reports. So far, these studies have shown potential benefits of treating tetanus infections with benzodiazepines, magnesium sulfate and baclofen. Additionally, several treatments have been shown to be useful in stabilizing and supporting patients with tetanus. However, each treatment modality has limitations, from negative side effects to logistical challenges, especially in developing countries. Therefore, further knowledge is required to evaluate the best use of each treatment and to further optimize patient care. This knowledge can contribute to the reduction of the burden of disease in countries where tetanus remains prevalent and where resources are limited, though vaccination is the most effective method to achieve this. This case report describes the treatment of a Dutch patient with tetanus infection and illustrates the role of benzodiazepines as well as other key aspects of treating patients with tetanus.

Peaks, sources, and immediate health impacts of PM2.5 and PM1 exposure in Indonesia and Taiwan with microsensors.

Microsensors have been used for the high-resolution particulate matter (PM) monitoring. This study applies PM and health microsensors with the objective of assessing the peak exposure, sources, and immediate health impacts of PM2.5 and PM1 in two Asian countries. Exposure assessment and health evaluation were carried out for 50 subjects in 2018 and 2019 in Bandung, Indonesia and for 55 subjects in 2019 and 2020 in Kaohsiung, Taiwan. Calibrated AS-LUNG sets and medical-certified RootiRx® sensors were used to assess PM and heart-rate variability (HRV), respectively. Overall, the 5-min mean exposure of PM2.5 and PM1 was 30.4 ± 20.0 and 27.0 ± 15.7 µg/m3 in Indonesia and 14.9 ± 11.2 and 13.9 ± 9.8 µg/m3 in Taiwan, respectively. The maximum 5-min peak PM2.5 and PM1 exposures were 473.6 and 154.0 µg/m3 in Indonesia and 467.4 and 217.7 µg/m3 in Taiwan, respectively. Community factories and mosquito coil burning are the two most important exposure sources, resulting in, on average, 4.73 and 5.82 µg/m3 higher PM2.5 exposure increments for Indonesian subjects and 10.1 and 9.82 µg/m3 higher PM2.5 exposure for Taiwanese subjects compared to non-exposure periods, respectively. Moreover, agricultural waste burning and incense burning were another two important exposure sources, but only in Taiwan. Furthermore, 5-min PM2.5 and PM1 exposure had statistically significantly immediate impacts on the HRV indices and heart rates of all subjects in Taiwan and the scooter subjects in Indonesia with generalized additive mixed models. The HRV change for a 10 µg/m3 increase in PM2.5 and PM1 ranged from -0.9% to -2.5% except for ratio of low-high frequency, with greater impacts associated with PM1 than PM2.5 in both countries. This work highlights the ability of microsensors to capture high peaks of PM2.5 and PM1, to identify exposure sources through the integration of activity records, and to assess immediate changes in heart rate variability for a panel of approximately 50 subjects in Indonesia and Taiwan. This study stands out as one of the few to demonstrate the immediate health impacts of peak PM, complementing to the short-term (days or weeks) or long-term effects (months or longer) assessed in most epidemiological studies. The technology/methodology employed offer great potential for researchers in the resource-limited countries with high PM2.5 and PM1 levels.

Consensus Guideline on the Management of Epilepsy in Egypt: A National Delphi Consensus Study.

In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day-to-day practice in Egypt as well as several other resource-limited countries. Premature mortality, poor quality of life, socio-economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus. The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements. Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements. With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt. This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource-limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.

#1381 Economic evaluation of an integrated care program versus conventional care for chronic kidney disease patients in rural communities of Thailand

Abstract Background and Aims This study evaluates an integrated care program for chronic kidney disease (CKD), which has demonstrated effectiveness in delaying kidney function decline in the rural population of Thailand. Efficacy of the program was initially established through the ESCORT-1 study, a cluster-randomized controlled trial (doi: 10.1186/s12882-016-0414-4), and further demonstrated the effectiveness by the larger-scale prospective cohort study, ESCORT-2 (doi: 10.1111/nep.13849). The aim of this study is to assess the cost-effectiveness of incorporating this program into Thailand's public health benefit package, with the goal of establishing it as a model for similar rural areas in resource-limited settings. Method Following the Thailand's guideline for health technology assessment, a cost-utility analysis utilizing data from the ESCORT studies, local databases, and literatures. The integrated care program was tailored to primary healthcare system by using preexisting workforces. It involved a collaboration between Multi-Disciplinary Care Teams (MDCT) at district hospitals and Community Care Network (CCN) teams at Sub-District Health Centers (SDHC). The MDCT, comprising general practitioners, CKD nurse managers, pharmacists, a nutritionist, and a physical therapist, provided key patient education on diet, medication adherence, exercise, and avoiding certain medications and herbal remedies. The CCN teams, including community nurses and village health volunteers, conducted home visits for health monitoring and lifestyle guidance. Both MDCT and CCN personnel received training in CKD care based on the NKF-K/DOQI and KDIGO Clinical Practice Guidelines. A decision-analytic Markov model and Monte-Carlo simulation were applied to quantify and compare the lifetime costs and quality-adjusted life years (QALY) outcomes of the intervention and conventional-care from a societal perspective considering both direct and indirect costs. The analysis included extensive sensitivity analyses, incorporating a probabilistic model and scenario-analyses based on patient ages, CKD stages, and varying program efficacy. Additionally, a budget impact analysis from the payer's perspective assessed the financial impact and affordability over a five-year period. Results The integrated care program was found to dominate conventional care. The results indicated an incremental cost-effectiveness of (-)278,000 Thai Baht (∼7,267 EUR) per QALY for the base case analysis. Probabilistic analysis demonstrated consistent outcomes, with the integrated care program being cost-effective at almost 100% of the time during analysis at the 160,000 Thai Baht (∼4,182 EUR) willingness-to-pay threshold (Fig. 1). These results are driven by significant cost savings due to reduced time and overall costs in dialysis before death. The program is most cost-effective when provided early to patients, in terms of both age and CKD stages (Fig. 2). The budget impact analysis showed that introducing the intervention could save the payer 184 billion Thai Baht (4.76 billion EUR) over five years. (The exchange rate; 1 Thai Baht = 38.26 EUR) Conclusion The integrated care program for patients with stage 3-4 CKD is cost-effective and suitable for inclusion in Thailand's health benefit package, mainly due to its significant cost savings and enhanced health outcomes. The program's design, focusing on sustainability and feasibility by utilizing existing workforces, positions it as a viable model for similar economic and healthcare contexts, especially in resource-limited countries.

Characteristics and outcome of pregnancy-related acute kidney injury in a teaching hospital in a low-resource setting: a five-year retrospective review.

Pregnancy-related kidney injury contributes to a high burden of acute kidney injury in low-resource settings and causes maternal and perinatal morbidity and mortality. Few studies have examined the impact of acute kidney injury in resource-limited countries, with very limited research on pregnancy-specific disorders in Ethiopia. This study aimed to determine the characteristics of pregnancy-related acute kidney injury, outcomes and associated factors. A retrospective study was conducted to evaluate the clinical profile and maternal-fetal outcome of pregnancy-related acute kidney injury at Ayder Comprehensive Specialized Hospital in Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Maternal and fetal outcomes were analyzed using descriptive statistics. Multivariate logistic regression was used to determine the association between the dependent and independent variables. Of 27,350 mothers who delivered at Ayder Comprehensive Specialized Hospital between January 1, 2017, and December 31, 2021, a total of 187 women developed pregnancy-related acute kidney injury, a prevalence rate of 68 per 100,000 births. Preeclampsia, sepsis and pre-renal causes due to dehydration and hemorrhage were the most common causes of pregnancy-related acute kidney injury in this study. Hemodialysis was needed in 8.6% (n = 16) of patients. Of the 187 pregnancy-related acute kidney injuries, 143 (76.5%) recovered completely and 30 (16%) partially. The mortality rate was 7.5%. Preexisting chronic kidney disease (AOR = 30.13; 95% CI: 2.92, 310.84), use of vasoactive agents (AOR = 5.77; 95% CI: 1.47, 22.67), increase in creatinine per unit (AOR = 1.65; 95% CI: 1.11, 2.45) and complications related to acute kidney injury (AOR = 5.26; 95% CI: 1.73, 16.00) were determinants of the composite endpoints (partial renal recovery and death). This study emphasizes acute kidney injury in resource-limited settings is a significant cause of maternal and fetal morbidity and mortality. The vast majority of patients with pregnancy-related acute kidney injury recovered completely from kidney injury. The main causes of pregnancy-related acute kidney injury were preeclampsia, sepsis and pre-renal associated with hemorrhage and dehydration. Preexisting renal disease, use of vasopressors, increase in creatinine per unit and complications associated with acute kidney injury were determining factors for concomitant fetomaternal mortality. Appropriate preventive strategies during prenatal care and prompt treatment are needed for pregnancy-related acute kidney injury.

Comparing Mobile-Based to Group-Based Education for Weight Reduction in a Developing Country: A Randomized Study.

This study compared the impact of Short Message Service (SMS)-based education with traditional group-based education and the control group on body mass index, weight, and lifestyle in obese and overweight patients in a limited-resource country. It also compared the direct financial costs between the two intervention groups. In this controlled randomized educational study, 90 overweight or obese adults from four family physician clinics in Shiraz, Iran were randomly allocated to three training groups: SMS-based education, group-based education, and a control group. The participants' weight, body mass index (BMI), and waist circumference were measured at baseline, and the Physical Activity Scale questionnaire was completed. Group-based training was conducted in 1-hour weekly sessions. The SMS group received a text message each morning. The control group received routine care from a family physician. The intervention lasted 12 weeks. All participants were re-examined for the studied variables. Additionally, the direct costs were estimated, calculated, and compared. The mean weight, BMI, and waist circumference changed significantly after 3 months compared to baseline in each group. The mean weight change differed significantly among the three groups (P-value=0.04), and the mean BMI changes were near significant (P-value=0.06). A post hoc comparison of changes in weight and BMI showed a significant difference between the control and SMS groups. SMS education incurred much lower costs for patients and healthcare services than group-based education. The study showed that SMS is an effective and cost-saving educational method for weight loss compared to group-based education, especially in developing countries.

Diagnostic and treatment strategies for pediatric acute lymphoblastic leukemia in low- and middle-income countries.

The survival rate of children and adolescents with acute lymphoblastic leukemia (ALL), the most common pediatric cancer, has improved significantly in high-income countries (HICs), serving as an excellent example of how humans can overcome catastrophic diseases. However, the outcomes in children with ALL in low- and middle-income countries (LMICs), where approximately 80% of the global population live, are suboptimal because of limited access to diagnostic procedures, chemotherapeutic agents, supportive care, and financial assistance. Although the implementation of therapeutic strategies in resource-limited countries could theoretically follow the same path of improvement as modeled in HICs, intensification of chemotherapy may simply result in increased toxicities. With the advent of genetic diagnosis, molecular targeted therapy, and immunotherapy, the management of ALL is changing dramatically in HICs. Multidisciplinary collaborations between institutions in LMICs and HICs will provide access to strategies that are suitable for institutions in LMICs, enabling them to minimize toxicities while improving outcomes. This article summarizes important aspects of the diagnosis and treatment of pediatric ALL that were mostly developed in HICs but that can be realistically implemented by institutions in countries with limited resources through resource-adapted multidisciplinary collaborations.

PREDICTION OF FLUID RESPONSIVENESS WITH CRYSTALLOID MINI-FLUID CHALLENGE IN CRITICALLY ILL PATIENTS

Background: The mini-fluid challenge test is a good predictor and has minimal limitations in determining fluid responsiveness in the critically ill. However, it primarily relies on colloid infusion. The availability of colloids may vary among hospitals in resource-limited countries, and they can be more expensive than crystalloid fluids. Objective: The study aimed to use crystalloids instead of colloids to predict fluid responsiveness. Methods: This study was conducted from August 2022 to February 2023 among patients with shock in the medical ICU to assess fluid responsiveness. Arterial and central venous catheters were used for the intravenous infusion and monitoring. Data were collected during two consecutive crystalloid mini-fluid challenges of 50 mL each in 1 minute, 100 mL in 2 minutes, and a standard fluid challenge of 300 mL over 15 minutes. The objective was to predict a stroke volume index (SVI) increase of &gt; 10%. Diagnostic accuracy was evaluated using the Receiver Operating Characteristic (ROC) curve, and hemodynamic variables in the positive fluid challenge group were compared for different volume expansions. Results: Twenty-nine patients (62% males; median age, 75 years) were included, with 42 fluid challenge test events. Septic shock was the primary condition in 83% of the cases. The 50 mL crystalloid mini-fluid challenge showed an accuracy of 80% with a sensitivity of 69% and specificity of 100% at the cutoff level of SVI &gt; 5%, Area Under ROC (AUROC)=0.79. In comparison, the 100 mL crystalloid mini-fluid challenge demonstrated an accuracy of 85% (sensitivity of 79% and specificity of 100%) at the cutoff level of SVI &gt; 10% (AUROC= 0.89). In the positive fluid challenge group, administration of crystalloids led to a significant increase in mean arterial pressure and SVI, while other parameters remained comparable. Conclusions: A mini-fluid challenge test with 100 mL crystalloids can predict fluid responsiveness in critically ill patients. The best cutoff level was a change in SVI &gt; 10% from baseline.

Development and field evaluation in African and Asian countries of an hepatitis B virus PCR on open polyvalent platforms to determine treatment eligibility: results from the “Agence Nationale de Recherche sur le Sida et les hépatites” 12327 study

ObjectivesWidespread testing and treatment are essential to eliminate hepatitis B virus (HBV) infection as a public health concern. However, in resource-limited countries, access to HBV PCR is limited. In this study, we developed a quantitative HBV PCR assay on open molecular platforms and evaluate its performance in diagnosing clinically significant HBV DNA thresholds as defined by the WHO (2000 IU/mL, 20 000 IU/mL, and 200 000 IU/mL). MethodsWe implemented our HBV PCR test in seven African and Asian countries and France, using either an in-house laboratory method or a European conformity for in vitro diagnostic (CE-IVD) marked version of the PCR (Generic HBV Charge Virale, Biocentric). Results were compared with reference tests (Roche Cobas AmpliPrep/Cobas TaqMan and Abbott RealTime on Abbott m2000). ResultsThere was a good agreement between the HBV DNA results of 1015 samples tested by the PCR on open polyvalent platforms and the results from reference tests (mean difference (bias ± standard deviation [SD]): −0.3 ± 0.7 log10 IU/mL and −0.2 ± 0.9 log10 IU/mL when compared with Roche and Abbott tests, respectively). Kappa-Cohen agreements between the HBV PCR on open polyvalent platforms and the Roche/Abbott assays appeared almost perfect for HBV DNA levels ranged from >20 000 to 200 000 IU/mL and >200 000 IU/mL, substantial and moderate for HBV DNA levels ranged from 2000 to 20 000 IU/mL when compared with Abbott and Roche, respectively. The assay's performance was consistent across genotypes A, B, C, D, and E. DiscussionThis field evaluation showed that our HBV PCR test is a valuable alternative to proprietary PCR systems. PCR assays on open platforms contribute to expanding clinical laboratory solutions for diagnosing individuals who meet the viral load criteria for antiviral therapy (>20 000 IU/mL) and mother-to-child prophylaxis (>200 000 IU/mL).

The varying estimation of infertility in Ethiopia: the need for a comprehensive definition

BackgroundInfertility is a marginalized sexual and reproductive health issue in low-resource settings. Globally, millions are affected by infertility, but the lack of a universal definition makes it difficult to estimate the prevalence of infertility at the population level. Estimating the prevalence of infertility may inform targeted and accessible intervention, especially for a resource-limited country like Ethiopia. This study aims to estimate the prevalence of female infertility in Ethiopia using the Demographic and Health Survey (DHS) through two approaches: (i) the demographic approach and (ii) the current duration approach.MethodsData from 15,683 women were obtained through the 2016 Ethiopian DHS. The demographic approach estimates infertility among women who had been married/in a union for at least five years, had never used contraceptives, and had a fertility desire. The current duration approach includes women at risk of pregnancy at the time of the survey and determines their current length of time-at-risk of pregnancy at 12, 24, and 36 months. Logistic regression analysis estimated the prevalence of infertility and factors associated using the demographic approach. Parametric survival analysis estimated the prevalence of infertility using the current duration approach. All estimates used sampling weights to account for the DHS sampling design. STATA 14 and R were used to perform the statistical analysis.ResultsUsing the demographic definition, the prevalence of infertility was 7.6% (95% CI 6.6–8.8). When stratified as primary and secondary infertility, the prevalence was 1.4% (95% CI 1.0-1.9) and 8.7% (95% CI 7.5–10.1), respectively. Using the current duration approach definition, the prevalence of overall infertility was 24.1% (95% CI 18.8–34.0) at 12-months, 13.4% (95% CI 10.1–18.6) at 24-months, and 8.8% (95% CI 6.5–12.3) at 36-months.ConclusionThe demographic definition of infertility resulted in a lower estimate of infertility. The current duration approach definition could be more appropriate for the early detection and management of infertility in Ethiopia. The findings also highlight the need for a comprehensive definition of and emphasis on infertility. Future population-based surveys should incorporate direct questions related to infertility to facilitate epidemiological surveillance.

Rationalizing artemisinin-based combination therapies use for treatment of uncomplicated malaria: A situation analysis in health facilities and private pharmacies of Douala 5e-Cameroon.

Artemisinin-based combination therapies (ACTs) represent one of the mainstays of malaria control. Despite evidence of the risk of ACTs resistant infections in resource-limited countries, studies on the rational use of ACTs to inform interventions and prevent their emergence and/or spread are limited. The aim of this study was designed to analyze practices toward ACTs use for treating the treatment of uncomplicated malaria (UM) in an urban community. Between November 2015 and April 2016, a cross-sectional and prospective study was conducted in the 6 health facilities and all pharmacies in the Douala 5e subdivision, Cameroon. Anonymous interviews including both open- and closed-ended questions were conducted with selected participants among drug prescribers, patients attending the health facilities, and customers visiting the pharmacies. Data analysis was performed using StataSE11 software (version 11 SE). A total of 41 prescribers were included in the study. All were aware of national treatment guidelines, but 37.7% reported not waiting for test results before prescribing an antimalarial drug, and the main reason being stock-outs at health facilities. Likewise, artemether+lumefantrine/AL (81%) and dihydroartemisinin+piperaquine (63.5%) were the most commonly used first- and second-line drugs respectively. Biological tests were requested in 99.2% (128/129) of patients in health facilities, 60.0% (74) were performed and 6.2% were rationally managed. Overall 266 (35%) of 760 customers purchased antimalarial drugs, of these, 261 (98.1%) agreed to participate and of these, 69.4% purchased antimalarial drugs without a prescription. ACTs accounted for 90.0% of antimalarials purchased from pharmacies, of which AL was the most commonly prescribed antimalarial drug (67.1%), and only 19.5% of patients were appropriately dispensed. The current data suggest a gap between the knowledge and practices of prescribers as well as patients and customers misconceptions regarding the use of ACTs in Douala 5e subdivision. Despite government efforts to increase public awareness regarding the use of ACTs as first-line treatment for UM, our findings point out a critical need for the development, implementation and scaling-up of control strategies and continuing health education for better use of ACTs (prescription and dispensing) in Cameroon.

Management of communicable diseases in limited resources countries

Management of communicable diseases in limited resources countries

Role of Conventional Pap Smear in Current Times

Abstract Cervical cancer is the fourth most common malignancy among females after breast, colon, and lung cancers and a leading cause of mortality among gynecologic malignancies. Over 85% of new cases are diagnosed in resource-limited countries. Several screening techniques have been developed to detect precancerous changes timely. The most common of which is conventional Pap smear (CPS). It is based on the cytological and morphology assessment of exfoliated cervical cells to detect preinvasive lesions of the cervix. Despite high specificity, a single Pap test has a low-to-moderate sensitivity. CPS can have false-negative and false-positive results because of inadequate sampling and slide preparation and errors in laboratory detection and interpretation. To overcome these shortcomings, liquid-based cytology (LBC) was introduced. LBC can be a better alternative to CPS because of a lower rate of unsatisfactory smears. The liquid reserve can be used for ancillary testing, such as human papillomavirus DNA tests (as reflex test and co-test). The cost of this technique is a limiting factor. In most of the developed countries, CPS is replaced by the LBC. There are several studies with conflicting results, and no method has been shown to be superior in terms of all parameters. Relevant studies were searched using PubMed/MEDLINE and Google Scholar. This article puts forward the results of various studies comparing the efficacy of CPS and LBC and highlights the advantages and disadvantages of both methods.

Genetic Diversity and Detection of Respiratory Viruses Excluding SARS-CoV-2 during the COVID-19 Pandemic in Gabon, 2020-2021.

Acute respiratory infections are a major global burden in resource-limited countries, including countries in Africa. Although COVID-19 has been well studied since the pandemic emerged in Gabon, Central Africa, less attention has been paid to other respiratory viral diseases, and very little data are available. Herein, we provide the first data on the genetic diversity and detection of 18 major respiratory viruses in Gabon during the COVID-19 pandemic. Of 582 nasopharyngeal swab specimens collected from March 2020 to July 2021, which were SARS-CoV-2 negative, 156 were positive (26%) for the following viruses: enterovirus (20.3%), human rhinovirus (HRV) (4.6%), human coronavirus OC43 (1.2%), human adenovirus (0.9%), human metapneumovirus (hMPV) (0.5%), influenza A virus (IAV) (0.3%), and human parainfluenza viruses (0.5%). To determine the genetic diversity and transmission route of the viruses, phylogenetic analyses were performed using genome sequences of the detected viruses. The IAV strain detected in this study was genetically similar to strains isolated in the USA, whereas the hMPV strain belonging to the A2b subtype formed a cluster with Kenyan strains. This study provides the first complete genomic sequences of HRV, IAV, and hMPV detected in Gabon, and provides insight into the circulation of respiratory viruses in the country.

Holt-Oram Syndrome – A Case Report and a Short Review

Holt-Oram syndrome also known as the heart-hand syndrome type 1, is an autosomal dominant rare congenital disorder, manifested as a conglomeration of various skeletal and cardiac abnormalities. The list of differential diagnoses of such abnormalities is extensive but careful examination can point towards a specific diagnosis even without genetic testing in a resource-limited country. We present a sporadic case of Holt-Oram syndrome with OS-ASD highlighting the diagnostic problem without genetic testing and discussing differentiating salient features of most of the syndromic associations.

Venomous Foes in Mediterranean Africa: Occurrence of Physalia physalis (Linnaeus, 1758), and First Records of Glaucus atlanticus Forster, 1777 for Algeria and Tunisia

Climate change can promote shifts in species’ biogeographical distribution, but their monitoring is a challenge in the hardly accessible marine environment. In such cases, citizen science allows collecting data on scales unattainable for researchers. This study uses a citizen science approach through social media platforms to describe a high-occurrence event of the siphonophore Physalia physalis in Tunisia during April 2021, which, in addition to literature records, add to more than 50 colonies recorded in 2021 in Algeria and Tunisia. This is the highest abundance ever reported in these countries. Moreover, 20 specimens of Glaucus atlanticus were recorded in August 2022 in Tunisia, and 1 specimen in June 2023 in Algeria, constituting the first record for the species in both countries. For P. physalis, the reported event could result from an increase of citizen science in these countries, driving an increase of reports uploaded to social media, along with a high occurrence of colonies in 2021. Finally, high occurrence events might be partially predicted by westerly wind prevalence in the Strait of Gibraltar and nearby areas, a geographic bottleneck for colony entrance in the Mediterranean Sea. Overall, this study illustrates the key role of citizen science in resource-limited countries and the need of reinforcing these networks to generate eco-environmental awareness and scientific knowledge towards the achievement of UN Sustainable Development Goals.