Strengthen Surveillance Systems Research Articles

Resistance to Antimalarial Drugs in Uganda: Current Status and Future Directions

Antimalarial drug resistance posed a significant challenge to malaria control in Uganda, where Plasmodium falciparum remains the predominant strain. This review examined the current status of antimalarial drug resistance in Uganda, focusing on the mechanisms underlying resistance, epidemiological trends, and the impact on malaria control programs. Chloroquine and sulfadoxine-pyrimethamine resistance have been well-documented, and recent concerns about reduced efficacy of artemisinin-based combination therapies (ACTs) highlight ongoing challenges. The review identified key mechanisms of resistance, including genetic mutations, drug efflux, metabolic pathway alterations, and potential biofilm formation. The implications of resistance on treatment efficacy, healthcare costs, and policy adjustments are discussed. Future directions included strengthening surveillance systems, optimizing combination therapies, investing in research and development, implementing integrated vector management strategies, and enhancing public education and community engagement. Related published literatures were reviewed and analysis of recent data on drug resistance patterns in Uganda was carried out and utilised in compiling this paper. By exploring these dimensions, the review aims to provide actionable insights for policymakers, healthcare providers, and researchers to effectively address drug resistance and advance malaria control efforts in Uganda. Keywords: Antimalarial Drug Resistance, Plasmodium falciparum, Chloroquine Resistance, Artemisinin-Based Combination Therapies (ACTs), Surveillance and Monitoring.

Urgent Response Needed: Addressing the Dengue Crisis in the Andean and Southern Cone Latin American Regions.

The dengue crisis in the Latin American region is currently intensifying, exacerbated by heavy rains, widespread flooding, and the onset of the El Niño-Southern Oscillation. The indirect consequences of the COVID-19 pandemic, which weakened healthcare systems, have further compounded the situation. Comparing the first 15 weeks of 2023 with the same period in 2024, we observed a significant average increase of 600% in the number of new cases. This translates to a 536% rise in the composite rate per 100,000 inhabitants across all countries. Brazil experienced a staggering surge from 1,425,000 cases in the initial 15 weeks of 2023 to 5,177,989 cases in the corresponding period of 2024. Similarly, Paraguay witnessed a notable escalation, with cases soaring from 12,497 in 2023 to more than 240,000 thus far in 2024, marking an increase of more than 1,825%. Bolivia, however, witnessed a reduction in cases, though the cause remains unclear. Urgent action is imperative to address this escalating crisis. Strengthening surveillance systems, enhancing vector control programs, and implementing effective public health campaigns are critical. Immediate and coordinated action by regional governments and health authorities is essential to mitigate the growing dengue crisis and safeguard public health in the region.

Intersecting realities: Exploring the nexus between armed conflicts in eastern Democratic Republic of the Congo and Global Health

The eastern Democratic Republic of the Congo (DRC) grapples with entrenched armed conflicts, creating a complex humanitarian crisis with far-reaching implications for global health. This paper explores the intersection between armed conflict in the region and the risks of zoonotic disease transmission, shedding light on interconnected challenges and proposing integrated strategies for mitigation. Armed conflict disrupts healthcare systems, affecting healthcare facilities (HCF) and healthcare workers (HCW), destroying millions of lives, impoverishing communities, and weakening surveillance systems. This deleterious situation is a bottleneck to achieving the Sustainable Development Goals (SDGs), especially Universal Health Coverage (UHC), as it prevents millions of Congolese from accessing healthcare services. The direct impact of armed insecurity undermines Global Health Security (GHS) by fostering natural habitat degradation and biodiversity loss, exacerbating vulnerabilities to zoonotic disease outbreaks. Forced population displacement and encroachment on natural habitats amplify human-wildlife interaction, facilitating zoonotic disease spillover and increasing the risk of regional and global spread. Biodiversity loss and poaching further compound these challenges, underscoring the need for holistic approaches that address both conservation and public health concerns. Mitigating zoonotic disease risks requires strengthening surveillance systems, promoting community engagement, and integrating conservation efforts with conflict resolution initiatives. By adopting a comprehensive approach, including the incorporation of One Health considerations in all peace-seeking and humanitarian efforts, stakeholders can enhance Global Health Security, scale up UHC, and promote sustainable development in conflict-affected regions. Creativity and strategic foresight are essential to safeguarding the well-being of human, livestock, plant, and wildlife populations in the Eastern DRC.

Roles of Wildlife Reservoirs in the Maintenance and Transmission of Zoonotic Diseases in Nigeria

Purpose: The aim of the study was to examine roles of wildlife reservoirs in the maintenance and transmission of zoonotic diseases in Nigeria. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study revealed that wildlife populations serve as reservoirs for a diverse array of pathogens, including viruses, bacteria, and parasites, many of which have the potential to spill over into human populations and cause disease outbreaks. Factors such as habitat destruction, encroachment into wildlife habitats, wildlife trade, and climate change contribute to increased interactions between humans and wildlife, facilitating the transmission of zoonotic pathogens. Unique Contribution to Theory, Practice and Policy: Ecological niche theory & Host-Pathogen Coevolution Theory may be used to anchor future studies on roles of wildlife reservoirs in the maintenance and transmission of zoonotic diseases in Nigeria. Strengthen surveillance systems to monitor wildlife populations, identify emerging zoonotic pathogens, and assess the risk of spillover events. This includes implementing targeted surveillance programs in high-risk regions and species known to harbor zoonotic pathogens. Develop and implement wildlife conservation policies that prioritize the protection of biodiversity and ecosystem health while considering the potential risks associated with zoonotic disease transmission.

Study of Mosquito Borne Deasease Found in Yavatmal Region

Abstract: Mosquito-borne diseases are a significant public health concern in the Yavatmal region of Maharashtra, India. Malaria, dengue fever, and Japanese encephalitis are among the prominent diseases transmitted by mosquitoes in this region. Malaria, caused by the Plasmodium parasite, is endemic in Yavatmal, with transmission occurring mainly during the monsoon and post-monsoon seasons. Dengue fever, caused by the dengue virus and transmitted by Aedes mosquitoes, has seen periodic outbreaks in the region, with increased incidence during the rainy season. Japanese encephalitis, caused by the Japanese encephalitis virus and transmitted by Culex mosquitoes, poses a threat to the population, particularly in rural areas. Several factors contribute to the spread of mosquito-borne diseases in the Yavatmal region, including inadequate sanitation, stagnant water bodies, deforestation, and climate change. Socioeconomic factors such as poverty and limited access to healthcare further exacerbate the problem. Control and prevention efforts in the region primarily focus on vector control measures, including insecticide spraying, larval source management, and the use of bed nets. Community education and awareness campaigns play a crucial role in promoting preventive behaviors such as the use of insect repellents and proper waste disposal. Challenges in addressing mosquito-borne diseases in Yavatmal include inadequate healthcare infrastructure, insufficient funding, and the emergence of insecticide resistance among mosquito populations. Collaborative efforts involving government agencies, healthcare providers, researchers, and community organizations are essential to effectively combat these diseases. Strengthening surveillance systems, improving access to diagnostic and treatment facilities, and implementing integrated vector management strategies are necessary steps towards reducing the burden of mosquito-borne diseases in the Yavatmal region and improving public health outcomes.

Measles outbreak investigation in Tocha district, southwestern Ethiopia: an unmatched case-control study.

Measles continues to be a public health challenge in Ethiopia. Rumors of suspected measles were notified on April 8, 2023 from Tocha district. We conducted an assessment to describe measles outbreak and determine risk factors for measles infection in the Tocha district of the Dawuro zone, Southwest Ethiopia. We conducted a 1:2 unmatched case-control studies from April to May 2023. We took all 147 cases registered on line list for descriptive analyses. We used a total of 74 randomly selected cases and 147 controls for case-control part. Any person in Tocha district with laboratory-confirmed measles IgM antibody; or any suspected person epidemiologically linked to confirmed measles cases from March 23 to April 26 2023, were included in the case. Neighborhood who did not fulfill this standard case definition were included in controls. Data were collected using standardized questionnaires deployed on Kobo Collect. Descriptive analyses were conducted using Epi info version 7.2.5.0. The analyses were performed using Statistical Package for Social Science (SPSS) version 26. Binary logistic regression analyses were utilized to select candidate variables. We conducted multiple logistic regression analysis to identify determinants of measles infection at a p value ≤0.05 with 95% confidence interval. The overall attack rate of 22.64/10,000 for general population and 104.59/10,000 among under-five children were attributed to the outbreak with a case fatality rate of 2.72%. Vaccine coverage in the last year and this year were 73.52 and 53.88%, respectively, while vaccine effectiveness in the district was 79%. Poor house ventilation (AOR = 3.540, 95% CI: 1.663-7.535) and having contact history with the case (AOR = 2.528, 95% CI: 1.180-4.557) were positively related to measles infection while being previously vaccinated for measles (AOR = 0.209, 95% CI: 0.180-4.577) reduce risk of measles infections. The highest attack rate was observed among children under 5 years of age, with a case fatality rate of 2.72%. Vaccination coverage was less than what expected to develop herd immunity. Strategies to increase vaccination coverage and strengthening surveillance systems for rumor identification and early responses to prevent person to person transmission are recommended.

Sepsis, Antimicrobial Resistance, and Alternative Therapies

Sepsis, a life-threatening condition caused by the body's excessive response to an infection, has emerged as a global health menace. Around 20% of all global deaths are attributable to sepsis. Conversely, the presence of antimicrobial resistance (AMR) poses a significant peril to the health system. AMR constitutes an escalating pandemic that we must not disregard, as the absence of effective antibiotics would compromise the treatment of even commonplace bacterial infections. Therefore, the increasing prevalence of AMR further adds complexity to the management and outcomes of individuals with sepsis. AMR plays a contributory role in aggravating the consequences of sepsis, ranging from prolonged hospitalization to mortality. The World Health Organization (WHO) has prioritized AMR as a major concern necessitating immediate action to prevent dire consequences in the future. Though, One Health approach, infection prevention, rational use of antibiotics, strengthening surveillance systems, as well as research and development, are crucial strategies in combating antimicrobial resistance, alternative therapies, such as phage therapy and immunotherapeutics, are being explored for the management of AMR infections. Advances in these therapies show promise in addressing the challenges posed by antibiotic resistance in treating sepsis. In this critical assessment, we succinctly delineate the existing challenges of AMR in managing sepsis cases, and we provide an overview of the advancements in treating sepsis through alternative therapeutic modalities.

Comparative Molecular Virulence Typing and Antibiotic Resistance of Campylobacter Species at the Human-Animal-Environment Interface.

This study holds significant importance due to its focus on Campylobacter, the leading bacterial cause of gastroenteritis worldwide, responsible for ∼96 million cases each year. By investigating the prevalence of both Campylobacter jejuni and Campylobacter coli in humans, animals, and the environment, this research sheds light on the broader impact of these pathogens, which can harm both human and animal populations. Traditional microbiological methods were implemented followed by optimized multiplex polymerase chain reaction targeting 16S rDNA and virulence gene markers by using specific primers. The findings revealed that a total of 219 Campylobacter isolates were recovered from 528 collected specimens from human, animal, and environmental sources. Campylobacter species showed a prevalence of 41.5%, with C. jejuni accounting for 53% and C. coli for 47%. Antimicrobial resistance rates were high, with tetracycline at 89%, ceftriaxone at 75%, cefotaxime at 70%, erythromycin at 69%, nalidixic acid at 54%, ciprofloxacin at 39%, and gentamicin at 23%. Commonly prevalent virulence-associated genes observed in the Campylobacter were cadF at 93%, flaA at 91%, cdtB at 88%, cheY at 86%, sodB at 78%, and iamA at 32%. The study confirmed multidrug-resistant Campylobacter prevalence at the human-animal-environment interface, harboring virulence-associated genes with potential harm to humans. Data analysis showed a nonsignificant (p ≥ 0.05) correlation between virulence genes and antibiotic susceptibility. To effectively manage Campylobacter infections, a multifaceted strategy incorporating preventative interventions at different levels is required. This strategy should take into account practicability, effectiveness, and sustainability while strengthening surveillance systems and addressing the economics of disease prevention.

Evaluation of the malaria case surveillance system in KwaZulu-Natal Province, South Africa, 2022: a focus on DHIS2

BackgroundSouth Africa set a target to eliminate malaria by 2023, with KwaZulu-Natal (KZN) Province the malaria-endemic province closest to achieving this goal. Objective two of the National Malaria Elimination Strategic Plan (NMESP) focused on strengthening surveillance systems to support the country’s elimination efforts. Regular evaluations of the malaria surveillance systems against the targets of the NMESP objective are crucial in improving their performance and impact. This study aimed to assess whether the malaria surveillance system in KwaZulu-Natal Province meets the NMESP surveillance objective and goals.MethodsA mixed-methods cross-sectional study design was used to evaluate the malaria surveillance system, focusing on the District Health Information System 2 (DHIS2). The study assessed the data quality, timeliness, simplicity, and acceptability of the system. Key personnel from KZN’s Provincial malaria control programme were interviewed using self-administered questionnaires to evaluate their perception of the system's simplicity and acceptability. Malaria case data from January 2016 to December 2020 were extracted from the DHIS2 and evaluated for data quality and timeliness.ResultsThe survey respondents generally found the DHIS2-based surveillance system acceptable (79%, 11/14) and easy to use (71%, 10/14), stating that they could readily find, extract, and share data (64%, 9/14). Overall data quality was good (88.9%), although some variables needed for case classification had low completeness and data availability. However, case notifications were not timely, with only 61% (2 622/4 329) of cases notified within 24 h of diagnosis. During the 5-year study period, the DHIS2 captured 4 333 malaria cases. The majority of cases (81%, 3 489/4 330) were categorized as imported, and predominately in males (67%, 2 914/4 333).ConclusionWhile the malaria surveillance system in KZN Province largely met the NMESP surveillance strategic goals, it failed to achieve the overarching surveillance objective of 100% notification of cases within 24 h of diagnosis. The majority of reported cases in KZN Province were classified as imported, emphasizing the importance of complete data for accurate case classification. Engaging with healthcare professionals responsible for case notification and disseminating aggregated data back to them is needed to encourage and improve notification timeliness.

Antimicrobial resistance profile of Pseudomonas aeruginosa clinical isolates from healthcare-associated infections in Ethiopia: A systematic review and meta-analysis.

Antimicrobial-resistant (AMR) bacterial infection is a significant global threat to the healthcare systems. Pseudomonas aeruginosa, the leading infectious agent in the healthcare setting is now one of the major threats due to AMR. A comprehensive understanding of the magnitude of AMR, particularly highly public health important pathogens such as P. aeruginosa, is necessary for the management of infections based on local information. This systematic review and meta-analysis aimed to determine the country-wide AMR of P. aeruginosa. Systematic searches were performed to retrieve articles from PubMed, Scopus, Web of Science, ScienceDirect electronic databases, Google Scholar search engine, and repository registrars from 2015 to 31st December 2023. Twenty-three studies that provided important data on AMR in P. aeruginosa were systematically reviewed and analyzed to determine the country-wide magnitude of P. aeruginosa AMR profile from healthcare-associated infections. AMR of P. aeruginosa to 10 different antibiotics were extracted separately into Microsoft Excel and analyzed using STATA 17.0. Cohen's kappa was computed to determine the agreement between reviewers, the Inverse of variance (I2) was used to evaluate heterogeneity across studies, and Egger's test to identify publication bias. A random effect model was used to determine the pooled resistance to each antibiotic. Subgroup analysis was performed by infection type and year of publication. This systematic review and meta-analysis revealed that the pooled prevalence of P. aeruginosa in clinical specimens associated with HAI was 4.38%(95%CI: 3.00-5.76). The pooled prevalence of AMR in P. aeruginosa for different antibiotics varies, ranging from 20.9% (95%CI: 6.2-35.8) for amikacin to 98.72% (95%CI: 96.39-101.4) for ceftriaxone. The pooled resistance was higher for ceftriaxone (98.72%), Trimethoprim-sulfamethoxazole (75.41), and amoxicillin-clavulanic acid (91.2). In contrast relatively lower AMR were observed for amikacin (20.9%) and meropenem (28.64%). The pooled multi-drug resistance (MDR) in P. aeruginosa was 80.5% (95%CI: 66.25-93.84). Upon subgroup analysis by infection types and year of publication, P. aeruginosa isolated from healthcare-associated infections exhibited higher resistance to ceftazidime (94.72%) compared to isolates from mixed types of healthcare-associated infections (70.84%) and surgical site infections (57.84%). Antimicrobial resistance in gentamicin was higher during the periods of 2018-2020 (73.96%), while comparatively lower during 2021-2023 (42.69%) and 2015-2017 (29.82%). Significantly high AMR and MDR were observed from this systematic review and meta-analysis. AMR obtained from this systematic review and meta-analysis urges the need for improved infection control, antimicrobial stewardship practices, and strengthened surveillance systems to control the spread of AMR and ensure effective treatment of P. aeruginosa infections. This systematic review and meta-analysis was registered on PROSPERO (Registration ID: CRD42024518145).

Addressing the Dengue fever challenges in Nigeria: A narrative review and recommendations for control.

Dengue fever is a mosquito-borne viral infection that continues to pose a significant public health threat globally, including Nigeria. Here, we provided a review of dengue fever outbreaks in Nigeria from 1972 to 2023, examining the epidemiology, prevention strategies, challenges faced in combating the disease, and recommendations to mitigate its spread and transmission. We utilized scholarly databases such as PubMed and Google Scholar in writing this paper. The search keywords like, "dengue fever", "break-bone fever", "dengue fever virus" "outbreak", "Nigeria", "prevalence", and "epidemiology", were used to get appropriate published articles about the subject areas. Over the past five decades, Nigeria has experienced intermittent outbreaks of dengue fever, with varying degrees of severity and geographic distribution. Factors such as urbanization, climate change, and inadequate healthcare infrastructure have contributed to the resurgence and spread of the disease in the country. Despite efforts to control dengue transmission through vector control measures and public health interventions, challenges persist, including limited surveillance capacity, diagnostic delays, and gaps in vector control strategies. The emergence of new dengue virus serotypes and the potential for co-circulation with other arboviruses further complicate control efforts. This review highlights the importance of strengthening surveillance systems, enhancing vector control measures, improving diagnostic capabilities, and increasing public awareness to effectively mitigate the burden of dengue fever in Nigeria. Collaboration between government agencies, healthcare providers, researchers, and international partners is crucial in addressing the growing threat of dengue fever and reducing its impact on public health in Nigeria.

Spatial heterogeneity in relationship between district patterns of HIV incidence and covariates in Zimbabwe: a multi-scale geographically weighted regression analysis.

A study was conducted to investigate the district-level patterns of incidence of the human immunodeficiency virus (HIV) in Zimbabwe in the period 2005-2015 and explore variations in the relationship between covariates and HIV incidence across different districts. Demographic health survey data were analysed using hotspot analysis, spatial autocorrelation, and multi-scale geographically weighted regression (MGWR) techniques. The analysis revealed hotspots of the HIV epidemic in the southern and western regions of Zimbabwe in contrast to the eastern and northern regions. Specific districts in Matabeleland South and Matabeleland North provinces showed clusters of HIV incidence in 2005-2006, 2010-2011 and 2015. Variables studied were multiple sex partners and sexually transmitted infections (STI) condom use and being married. Recommendations include implementing targeted HIV prevention programmes in identified hotspots, prioritising interventions addressing the factors mentioned above as well as enhancing access to HIV testing and treatment services in high-risk areas, strengthening surveillance systems, and conducting further research to tailor interventions based on contextual factors. The study also emphasizes the need for regular monitoring and evaluation at the district level to inform effective responses to the HIV epidemic over time. By addressing the unique challenges and risk factors in different districts, significant progress can be made in reducing HIV transmission and improving health outcomes in Zimbabwe. These findings should be valuable for policymakers in resource allocation and designing evidence-based interventions.

Costs and control strategies of healthcare-associated infections in an Italian university hospital

Abstract Backgrounds Healthcare-associated infections (HAIs) increase morbidity, mortality, and costs, necessitating effective prevention strategies. This study estimates the additional costs of HAIs in a university hospital in Rome, Italy Policlinico Tor Vergata (PTV), to inform policymakers, healthcare professionals, and researchers. Methods We conducted a retrospective cohort study, including all patients admitted or discharged in 2018. We applied propensity score matching (PSM) to balance study groups and then we analysed cost differences using the average treatment effect on the treated (ATT) approach. Costs were calculated using the Diagnosis Related Groups (DRGs) system. Outcome measures included the real reimbursement cost in euros and the relative cost increment using adjusted logarithmic transformation. Results 12,033 patients were included: 6,653(55%) female, 5,380 (45%) male, with a median age of 67. In total, 1,212 (10.1%) infected patients were compared to 10,821 (89.9%) non-infected patients. Predominant infections were urinary tract infections (UTI) (48.8%) and blood stream infections (BSI) (34.4%), while Staphylococcus spp. (37.5%) and Enterococcus spp. (36.4%) were the most common pathogens. The propensity score analysis showed a 59.7% (95% CI: 48.8% to 71.3%) cost increase for infected patients. They incurred an additional €4,988 (95% CI: €4,173 to €5,804) in costs. Subgroup analyses revealed cost variations across infection sites and pathogens, with Klebsiella P. having the greatest economic impact at €7,586 (95% CI: €5,301 to €9,871) and BSI also at €9,719 (95% CI: €8,137 to €11,307). Conclusions This study highlights the significant additional cost burden of HAIs in the PTV. Interventions with an equal or lower cost per HAI averted can be considered cost-effective. Public health actions, including enhancing infection prevention, developing or revising policies, and strengthening surveillance systems, should be prioritised to address ongoing HAI challenges. Key messages • Our study reveals a significant 59.7% cost increase (€4,988in our hospital) for HAI patients, highlighting the need for cost-effective prevention strategies in healthcare settings. • Findings emphasise the importance of enhancing infection prevention measures, policy development, and strengthening surveillance systems to reduce HAI-associated costs.

Preparing for future outbreaks in Ghana: An overview of current COVID-19, monkeypox, and Marburg disease outbreaks.

Amidst the ongoing COVID-19 pandemic, Ghana is currently grappling with simultaneous outbreaks of Marburg virus disease and human monkeypox virus. The coexistence of these outbreaks emphasizes the imperative for a collaborative and global approach to enhance surveillance and expedite case detection. While Ghana has made efforts to respond to these outbreaks, this paper outlines the lessons learned and proposes recommendations in this regard. It is crucial to intensify response efforts at the local, regional, and national levels to effectively contain the spread of these infectious diseases. Therefore, this paper suggests prioritizing the following recommendations as crucial for assisting Ghana in adequately preparing for future outbreaks and safeguarding global public health: strengthening surveillance system through digitization, rapid and effective response; risk communication and community engagement; healthcare system readiness; and research and collaboration. Also, prioritizing building healthy public policies and developing personal skills of health personnel across the country is key for future outbreak response.

A review of current trends in HIV epidemiology, surveillance, and control in Nigeria.

The HIV epidemic remains a public health challenge in Nigeria, with about 1.9 million people living with the virus in 2020. Despite progress in controlling the epidemic, challenges remain, including inadequate funding and limited access to prevention and treatment services for key populations. This article provides an overview of the HIV control system in Nigeria and the current state of the HIV control system in Nigeria. It provides recommendations for strengthening the response to the epidemic. Contributions of government agencies, international partners, and civil society organizations are required to reduce this epidemic. This article highlights the need to strengthen surveillance systems, increase access to testing and treatment, enhance prevention strategies, address stigma and discrimination, increase funding, and expand research and development. The impact of antiretroviral therapy on HIV management is also discussed. Over the last decade, Nigeria has made significant progress in controlling the HIV epidemic, with a decline in new infections and increased treatment coverage. However, more work is needed to achieve the 95-95-95 targets set by the joint united nations programme on HIV/acquired immunodeficiency syndrome for 2030, and a multi-pronged approach is required to address the social and structural determinants of health that drive the epidemic. By implementing the recommendations outlined in this article, Nigeria can make significant progress towards ending the HIV epidemic and improving the quality of life for those living with the virus.

Human Arboviral Infections in Italy: Past, Current, and Future Challenges.

Arboviruses represent a public health concern in many European countries, including Italy, mostly because they can infect humans, causing potentially severe emergent or re-emergent diseases, with epidemic outbreaks and the introduction of endemic circulation of new species previously confined to tropical and sub-tropical regions. In this review, we summarize the Italian epidemiology of arboviral infection over the past 10 years, describing both endemic and imported arboviral infections, vector distribution, and the influence of climate change on vector ecology. Strengthening surveillance systems at a national and international level is highly recommended to be prepared to face potential threats due to arbovirus diffusion.

Health System Resilience in the Eastern Mediterranean Region: Perspective on the Recent Lessons Learned.

Public health has a pivotal role in strengthening resilience at individual, community, and system levels as well as building healthy communities. During crises, resilient health systems can effectively adapt in response to evolving situations and reduce vulnerability across and beyond the systems. To engage national, regional, and international public health entities and experts in a discussion of challenges hindering achievement of health system resilience (HSR) in the Eastern Mediterranean Region, the Eastern Mediterranean Public Health Network (EMPHNET) held its seventh regional conference in Amman, Jordan, between November 15 and 18, 2021, under the theme "Towards Resilient Health Systems in the Eastern Mediterranean: Breaking Barriers." This viewpoint paper portrays the roundtable discussion of experts on the core themes of that conference. Our aim was to provide insights on lessons learned from the past and explore new opportunities to attain more resilient health systems to break current barriers. The roundtable brought together a panel of public health experts representing Field Epidemiology Training Programs (FETPs), Centers for Disease Control and Prevention in Atlanta, World Health Organization, EMPHNET, universities or academia, and research institutions at regional and global levels. To set the ground, the session began with four 10-12-minute presentations introducing the concept of HSR and its link to workforce development with an overall reflection on the matter and lessons learned through collective experiences. The presentations were followed by an open question and answer session to allow for an interactive debate among panel members and the roundtable audience. The panel discussed challenges faced by health systems and lessons learned in times of the new public health threats to move toward more resilient health systems, overcome current barriers, and explore new opportunities to enhance the HSR. They presented field experiences in building resilient health systems and the role of FETPs with an example from Yemen FETP. Furthermore, they debated the lessons learned from COVID-19 response and how it can reshape our thinking and strategies for approaching HSR. Finally, the panel discussed how health systems can effectively adapt and prosper in the face of challenges and barriers to recover from extreme disruptions while maintaining the core functions of the health systems. Considering the current situation in the region, there is a need to strengthen both pandemic preparedness and health systems, through investing in essential public health functions including those required for all-hazards emergency risk management. Institutionalized mechanisms for whole-of-society engagement, strengthening primary health care approaches for health security and universal health coverage, as well as promoting enabling environments for research, innovation, and learning should be ensured. Investing in building epidemiological capacity through continuous support to FETPs to work toward strengthening surveillance systems and participating in regional and global efforts in early response to outbreaks is crucial.

Monkeypox outbreak: a perspective on Africa's diagnostic and containment capacity

Since the first monkeypox (MPX) case was reported in humans in 1970, there have been several outbreaks of the disease. MPX is endemic in central and western Africa. MPX virus infection is confirmed using the conventional polymerase chain reaction, which detects the viral DNA in samples from the rash. Of concern is that the current outbreak has affected five regions of the world. Although MPX confirmatory tests are available worldwide, there are concerns about Africa's capacity to diagnose and contain the disease. The challenges faced by Africa include a lack of adequate laboratory infrastructure and health care workers, weak disease surveillance systems, and a lack of MPX knowledge among health care workers and communities. These challenges can be addressed by mobilizing resources for MPX virus testing, strengthening surveillance systems, collaboration among countries, training health care workers, task shifting, and engaging communities.

Epidemiology of Newcastle disease in poultry in Africa: systematic review and meta-analysis.

The present study intended to determine the prevalence of Newcastle disease in unvaccinated backyard poultry in Africa. Using the PRISMA approach, a systematic review and meta-analysis of 107 epidemiological studies was conducted. The meta-analysis identified significant variation of both seroprevalence (I2 = 99.38, P = 0.00) and Newcastle disease virus prevalence (I2 = 99.52, P = 0.00) reported in various studies included in this review. Publication bias was not detected in either case. Seroprevalence of Newcastle disease was 40.2 (95%CI 32.9-47.8). Seroprevalence was significantly influenced by sampling frame and the African region where the studies were conducted. The prevalence of Newcastle disease virus (NDV) was 12% (95%CI 7.3-17.8), and the variation was influenced by sampling frame, diagnostic test, and regions where the studies were conducted. Also, Newcastle disease (ND) accounted for 33.1% (95%CI 11.9-58.1) of sick chickens. Results also indicated that genotypes VI and VII are widely distributed in all countries included in the study. However, genotype V is restricted in East Africa, and genotypes XIV, XVII, and XVIII are restricted in West and Central Africa. On the other hand, genotype XI occurs in Madagascar only. In addition, virulent genotypes were isolated from apparently healthy and sick birds. It is concluded that several genotypes of NDV are circulating and maintained within the poultry population. African countries should therefore strengthen surveillance systems, be able to study the viruses circulating in their territories, and establish control programs.

P16 Strengthening surveillance systems for antimicrobial resistance in urinary tract infections in Kenya

BackgroundUrinary tract infections (UTIs) are amongst the most common conditions leading to outpatient visits and are also one of the most common causes of inappropriate antibiotic usage. Addressing antimicrobial resistance (AMR) requires strengthening surveillance system in Kenya where UTI is a problem with health systems having limited capacity for accurate laboratory identification of UTI pathogens. Empirical treatment to manage UTIs is the most common problem due to limited microbiology capacity. These include shortages of suitable training, equipment, quality control procedures and professional expertise to make an accurate clinical interpretation of urine cultures. This leads to reporting normal flora as pathogens.ObjectivesTo deliver training on the identification and antibiotic susceptibility testing of bacterial isolates from urine infections at participating hospitals in the Kenyan AMR surveillance network and measure competency levels in staff participating in the training with the aim of strengthening the Kenyan surveillance system.MethodsA 1 day baseline visit to the five sites was made between October and November 2021 using a standardized checklist to assess laboratory capacity. This was followed by urine processing training conducted between November 2021 and January 2022 in Malindi, Jaramogi, Kitale, Nakuru and Nyeri County Hospitals. Training materials were developed with the input of Aga Khan University Hospital. A 5 day in-person training course was delivered at each of the five hospitals, which targeted an average of 2–3 laboratory staff per hospital. The competencies of the laboratory staff were assessed by written pre-assessment and post-assessment tests. A standardized practical assessment was achieved by use of five different control organisms. The scores were done by doing an average performance score at each hospital laboratory.ResultsOut of 13 trainees, 8 were male and 5 were female. The median number of years since qualification for these staff was 6 (IQR 2–9). The median number of total months of microbiology training time was 2.3 (IQR 1–7). The median pre-training and post-training scores were 46% and 90%, respectively; non-parametric Wilcoxon rank test showed statistical difference (P < 0.0001) between pre-training and post-training. All participants improved from pre-to post- training assessment from the 5 day training with marked improvement amongst from staff with lowest previous level of laboratory training.ConclusionsTraining microbiology staff in the accurate processing of urine sample will be an important activity for a Kenyan AMR surveillance system. These training materials, if delivered by an experienced trainer, can achieve a clear improvement in knowledge levels and practical competence for real-life microbiology identifications.