World Health Organization African Region Research Articles

Simulation exercises and after action reviews \u2013 analysis of outputs during 2016\u20132019 to strengthen global health emergency preparedness and response

BackgroundUnder the International Health Regulations (2005) [IHR (2005)] Monitoring and Evaluation Framework, after action reviews (AAR) and simulation exercises (SimEx) are two critical components which measure the functionality of a country’s health emergency preparedness and response under a “real-life” event or simulated situation. The objective of this study was to describe the AAR and SimEx supported by the World Health Organization (WHO) globally in 2016–2019.MethodsIn 2016–2019, WHO supported 63 AAR and 117 SimEx, of which 42 (66.7%) AAR reports and 56 (47.9%) SimEx reports were available. We extracted key information from these reports and created two central databases for AAR and SimEx, respectively. We conducted descriptive analysis and linked the findings according to the 13 IHR (2005) core capacities.ResultsAmong the 42 AAR and 56 SimEx available reports, AAR and SimEx were most commonly conducted in the WHO African Region (AAR: n = 32, 76.2%; SimEx: n = 32, 52.5%). The most common public health events reviewed or tested in AAR and SimEx, respectively, were epidemics and pandemics (AAR: n = 38, 90.5%; SimEx: n = 46, 82.1%). For AAR, 10 (76.9%) of the 13 IHR core capacities were reviewed at least once, with no AAR conducted for food safety, chemical events, and radiation emergencies, among the reports available. For SimEx, all 13 (100.0%) IHR capacities were tested at least once. For AAR, the most commonly reviewed IHR core capacities were health services provision (n = 41, 97.6%), risk communication (n = 39, 92.9%), national health emergency framework (n = 39, 92.9%), surveillance (n = 37, 88.1%) and laboratory (n = 35, 83.3%). For SimEx, the most commonly tested IHR core capacity were national health emergency framework (n = 56, 91.1%), followed by risk communication (n = 48, 85.7%), IHR coordination and national IHR focal point functions (n = 45, 80.4%), surveillance (n = 31, 55.4%), and health service provision (n = 29, 51.8%). For AAR, the median timeframe between the end of the event and AAR was 125 days (range = 25–399 days).ConclusionsWHO has recently published guidance for the planning, execution, and follow-up of AAR and SimEx. Through the guidance and the simplified reporting format provided, we hope to see more countries conduct AAR and SimEx and standardization in their methodology, practice, reporting and follow-up.

Review of measles cases, surveillance indicators and predictors from case-based laboratory data over five years (2014–2018) in Bayelsa State, Nigeria

Background: Measles is a vaccine preventable, highly transmissible viral infection that affects mostly children under five years. It has been ear marked for eradication and Nigeria adopted the measles elimination strategies of the World Health Organization (WHO) African region to reduce cases and deaths. This study was done to determine trends in measles cases in Bayelsa state, to describe cases in terms of person and place, identify gaps in the case-based surveillance data collection system and identify risk factors for measles infection. Methods and materials: We carried out a secondary data analysis of measles case-based surveillance data for the period of January 2014 to December 2018 obtained in Microsoft Excel from the State Ministry of Health. Cases were defined according the World Health Organization (WHO) standard case definitions. We calculated frequencies, proportions, estimated odds ratios (OR), 95% confidence intervals (CI) and multivariate analysis. Results: A total of 449 cases of measles were reported. There were 245 (54.6%) males and the most affected age group was 1–4 years with 288 (64.1%) cases. Of all cases, 289 (9.35%) were confirmed and 70 (48.27%) had received at least one dose of measles vaccine. There was an all year transmission with increased cases in the 4th quarter of the year. Yenegoa local government area had the highest number of cases. Timeliness of specimen reaching the laboratory and the proportion of specimens received at the laboratory with results sent to the national level timely was below WHO recommended 80% respectively. Predictors of measles infection were, age less than 5 years (AOR: 0.57, 95% CI: 0.36–0.91) and residing in an urban area (AOR: 1.55, 95% CI: 1.02–2.34). Conclusion: Measles infection occurred all year round, with children less than 5 years being more affected. Measles case-based surveillance system showed high levels of case investigation with poor data quality and poor but improving indicators. Being less than 5 years was protective of measles while living in urban areas increased risk for infection. We recommended to the federal government to prioritize immunization activities in the urban centers, start campaigns by the 4th quarter and strengthen regional laboratory capacities while the State government to continue to support measles surveillance activities.

Measuring Timeliness of Outbreak Response in the World Health Organization African Region, 2017-2019.

Large-scale protracted outbreaks can be prevented through early detection, notification, and rapid control. We assessed trends in timeliness of detecting and responding to outbreaks in the African Region reported to the World Health Organization during 2017–2019. We computed the median time to each outbreak milestone and assessed the rates of change over time using univariable and multivariable Cox proportional hazard regression analyses. We selected 296 outbreaks from 348 public reported health events and evaluated 184 for time to detection, 232 for time to notification, and 201 for time to end. Time to detection and end decreased over time, whereas time to notification increased. Multiple factors can account for these findings, including scaling up support to member states after the World Health Organization established its Health Emergencies Programme and support given to countries from donors and partners to strengthen their core capacities for meeting International Health Regulations.

How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization's African regional targets.

In Africa, mortality due to non-communicable diseases (NCDs) is projected to overtake the combined mortality from communicable, maternal, neonatal, and nutritional diseases by 2030. To address this growing NCD burden, primary health care (PHC) systems will require substantial re-orientation. In this study, we reviewed the progress of African countries towards integrating essential NCD services into PHC. A review of World Health Organization (WHO) reports was conducted for all 47 countries in the WHO African Region. To report each country's progress, we used an a priori framework developed by the WHO regional office for Africa (AFRO). Twelve indicators were used to measure countries' progress. The proportion of countries meeting each indicator was tabulated using a heat map. Correlation between country income status and attainment of each indicator was also assessed. No country met all the recommended indicators to integrate NCD services into PHC and seven countries met none of the indicators. Few countries (30%) had nationally approved guidelines for NCD management and very few reported availabilities of all essential NCD medicines (13%) and technologies (11%) in PHC facilities. There was no overall correlation between a country's GDP per capita and the aggregate of targets being met (rho = 0.23; P = .12). There was, however, a modestly negative correlation between out-of-pocket expenditure and overall country progress (rho = -0.58; P < .001). Progress by AFRO Member States in integrating NCD care into PHC is variable across the region. Enhanced government commitment and judicious resource allocation to prioritize NCDs are needed. Particular areas of focus include increasing the uptake of simplified guidelines for NCDs; increasing workforce capacity to manage NCDs; and removing access barriers to essential medicines and basic diagnostic technologies.

Novel Approach to Support Rapid Data Collection, Management, and Visualization During the COVID-19 Outbreak Response in the World Health Organization African Region: Development of a Data Summarization and Visualization Tool.

BackgroundThe COVID-19 pandemic has created unprecedented challenges to the systematic and timely sharing of COVID-19 field data collection and management. The World Health Organization (WHO) is working with health partners on the rollout and implementation of a robust electronic field data collection platform. The delay in the deployment and rollout of this electronic platform in the WHO African Region, as a consequence of the application of large-scale public health and social measures including movement restrictions and geographical area quarantine, left a gap between data collection and management. This lead to the need to develop interim data management solutions to accurately monitor the evolution of the pandemic and support the deployment of appropriate public health interventions.ObjectiveThe aim of this study is to review the design, development, and implementation of the COVID-19 Data Summarization and Visualization (DSV) tool as a rapidly deployable solution to fill this critical data collection gap as an interim solution.MethodsThis paper reviews the processes undertaken to research and develop a tool to bridge the data collection gap between the onset of a COVID-19 outbreak and the start of data collection using a prioritized electronic platform such as Go.Data in the WHO African Region.ResultsIn anticipation of the implementation of a prioritized tool for field data collection, the DSV tool was deployed in 18 member states for COVID-19 outbreak data management. We highlight preliminary findings and lessons learned from the DSV tool deployment in the WHO African Region.ConclusionsWe developed a rapidly deployable tool for COVID-19 data collection and visualization in the WHO African Region. The lessons drawn on this experience offer an opportunity to learn and apply these to improve future similar public health informatics initiatives in an outbreak or similar humanitarian setting, particularly in low- and middle-income countries.

DANGER TO PUBLIC HEALTH PROGRAMS IN THE WAKE OF COVID-19

The time when the world is dealing with corona disaster, there is this fear that we might not forget about other communicable diseases. There are multiple international and national programs in place to prevent these communicable diseases. The fear is these programs might not get the attention it deserves at the time when all the attention is toward Covid-19. Currently more than 180 countries/regions have reported Covid-19 cases.1 The highly contagious measles cases have continued to increase. World Health Organization (WHO) data shows that globally measles cases rose by 300 percent in the first three months of 2019, compared to the same time period of 2018. The WHO African region has recorded a 700% increase, the Region of the Americas 60%, the European region 300%, the Eastern Mediterranean 100%, with 40% increases in Southeast Asia and the Western Pacific. According to statistics, it caused approximately 110,000 deaths worldwide in 2017.1,2 The point of concern is that even countries with high overall vaccination coverage like USA and Israel noted spikes in cases. United States recorded 1,282 individual cases of measles, greatest number since 1992.3 Speaking about polio, countries are still struggling with its eradication. Afghanistan, Nigeria and Pakistan are still endemic recording total of 29, 18 and 146 cases respectively in 2019.4 These are the countries currently dealing with the COVD-19 pandemic too. As of March 15, 2020, the Khyber Pakhtunkhwa Province of Pakistan reported 13 new circulating vaccine derived poliovirus (cVDP2) cases, the largest number of cases the province has ever seen in a day.5 According to WHO, Lower respiratory tract infections remained the deadliest communicable disease, causing 3.0 million deaths globally in 2016. Diarrheal diseases caused 1.4 million deaths in 2016. Similarly, Tuberculosis (TB) was responsible for 1.3 million deaths globally. Lower respiratory tract infections, Diarrhea diseases and Tuberculosis are among the top ten global causes of deaths. The situation at hand demands extra measures on the part of authorities and public health experts. With the Covid-19 pandemic, trend has been observed where there is diversion of all human and budgetary resources toward Covid -19 pandemic. This pandemic and helplessness of many nations to deal with it alarms us that we are not capable of dealing with another pandemic at this time. Therefore, it is important that all those programs i.e. Immunization programs, TB, HIV, Hepatitis control programs etc. must continue at the same time. Otherwise, more deaths might result associated with these communicable diseases than the overall endeavor would save from Covid -19.

COVID-19 and the HIV care continuum in Uganda: minimising collateral damage

The novel coronavirus, SARS-CoV-2, has spread across the world within months of its first description in Wuhan, China in December 2019, resulting in an unprecedented global health emergency. Whilst Europe and North America are the current epicentres of infection, the global health community are preparing for the potential effects of this new disease on the African continent. Modelling studies predict that factors such as a youthful and rural population may be protective in mitigating the spread of COVID-19 in the World Health Organisation (WHO) African Region, however, with 220 million infections and 4.6 million hospitalisations predicted in the first year of the pandemic alone, fragile health systems could still be placed under significant strain. Furthermore, subsequent disruptions to the provision of services for people living with HIV, or at risk of acquiring HIV, are predicted to lead to an extra 500,000 adult HIV deaths and a 2-fold increase in mother to child transmission of HIV in sub-Saharan Africa in 2020-2021. Ignoring these predictions may have severe consequences and we risk “stepping back in time” in AIDS-related deaths to numbers seen over a decade ago. Reflecting on our current experience of the COVID-19 pandemic in Uganda, we explore the potential impact of public health measures implemented to mitigate spread of COVID-19 on the HIV care continuum, and suggest areas of focus for HIV services, policy makers and governments to urgently address in order to minimise the collateral damage.

EVALUATING SOCIO-CULTURAL BARRIERS TO ANTENATAL CARE UTILIZATION AMONG REPRODUCTIVE AGE WOMEN IN WUSHISHI AND ZUNGERU COMMUNITIES IN NIGER STATE, NIGERIA: A LOGISTIC REGRESSION APPROACH

More than 33% of Nigerian pregnant women do not use the Antenatal Care service during pregnancy. In 2015, for instance, World Health Organization (WHO) revealed that only 61% of Nigerian pregnant women had attended ANC at least once during their pregnancy period. Only 51% of these women met the WHO standard of a minimum of 4 visits. This ANC rate is, without doubt, lower than the WHO African region average of 77%. The situation in Wushishi and Zungeru communities of Niger State may not be different. Despite the number of health facilities available in these communities, some women of childbearing age do not access antenatal care. Most times, many of them lose their lives during delivery at home, some end up with complications or lose their babies at births. This situation raised concern why pregnant women do not attend antenatal care in health facilities around them? This paper examined the socio-cultural impediments to accessing antenatal care services among reproductive-aged women in Wushishi and Zungeru Communities of Niger State. We used a Multivariate Logistic Analysis. A total of 150 subjects were involved in this study comprising 83 from Zungeru and 67 from Wushishi. The questionnaire used for data collection was a structured consist of 17 items. The results indicated that ethnicity and preference for traditional birth attendant are major influences to accessing ANC in these communities

Trends in measles cases in Bayelsa state, Nigeria: a five-year review of case-based surveillance data (2014\u20132018)

BackgroundMeasles is a vaccine preventable, highly transmissible viral infection that affects mostly children under five years. It has been ear marked for elimination and Nigeria adopted the measles elimination strategies of the World Health Organization (WHO) African region to reduce cases and deaths. This study was done to determine trends in measles cases in Bayelsa state, to describe cases in terms of person and place, identify gaps in the case-based surveillance data collection system and identify risk factors for measles infection.MethodsWe carried out a secondary data analysis of measles case-based surveillance data for the period of January 2014 to December 2018 obtained in Microsoft Excel from the State Ministry of Health. Cases were defined according to WHO standard case definitions. We calculated frequencies, proportions, estimated odds ratios (OR), 95% confidence intervals (CI) and multivariate analysis.ResultsA total of 449 cases of measles were reported. There were 245(54.6%) males and the most affected age group was 1–4 years with 288(64.1%) cases. Of all cases, 289(9.35%) were confirmed and 70 (48.27%) had received at least one dose of measles vaccine. There was an all-year transmission with increased cases in the 4th quarter of the year. Yenegoa local government area had the highest number of cases. Timeliness of specimen reaching the laboratory and the proportion of specimens received at the laboratory with results sent to the national level timely were below WHO recommended 80% respectively. Predictors of measles infection were, age less than 5 years (AOR: 0.57, 95% CI: 0.36–0.91) and residing in an urban area (AOR: 1.55, 95% CI:1.02–2.34).ConclusionsMeasles infection occurred all-year round, with children less than 5 years being more affected. Measles case-based surveillance system showed high levels of case investigation with poor data quality and poor but improving indicators. Being less than 5 years was protective of measles while living in urban areas increased risk for infection. We recommended to the state government to prioritize immunization activities in the urban centers, start campaigns by the 4th quarter and continue to support measles surveillance activities and the federal government to strengthen regional laboratory capacities.

The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African Region: a predictive model

The spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been unprecedented in its speed and effects. Interruption of its transmission to prevent widespread community transmission is critical because its...

A review of policies and programmes for human organ and tissue donations and transplantations, WHO African Region.

Several resolutions, endorsed by the World Health Assembly and the United Nations General Assembly, articulate the need to improve the availability, quality and safety of organ and tissue donation and transplantation, as well as to prevent and combat trafficking in human organs. Here we assessed the implementation of these resolutions pertaining to organ and tissue donations and transplantations by sending out a questionnaire to all 47 countries in the World Health Organization African Region. From 33 countries that provided data, we identified several obstacles and challenges. Compared to other regions, there are very limited data on organ donation and transplantation. Most countries are lacking legal and regulatory frameworks, since they did not yet establish a specific or comprehensive legislation covering donation and transplantation of human organs and tissues. Countries also have a poor national capacity to perform organ and tissue transplantations and the organization and management of national programmes are weak. Funding, both from domestic and external sources, is insufficient to implement effective transplantations programmes and patients have inadequate financial protection. To address these challenges, we propose that countries and partners should develop and implement policies, strategies, plans and regulatory frameworks for all aspects of organ and tissue donations and transplantations, including fighting against organ trafficking and transplant tourism. Where donation and transplantation programmes exist, stakeholders should develop the skills of human resources, adopt technical standards and quality management procedures to improve donation and transplantation of human organs and tissues.

International Cooperation in the Fight against Infectious Diseases: a Case for Legal Epidemiology in Kenya

As of May 21, more than 323,256 people worldwide have died and counting of COVID-19, the highly infectious respiratory disease caused by the coronavirus. The number of people, who have tested positive for COVID-19, has exceeded 4.9 million and counting, according to data compiled by the World Health Organization (WHO).The coronavirus disease 2019 (COVID-19) outbreak in the WHO African Region has rapidly evolved over the past few weeks, as reflected by the significant upsurge in the number of cases, and the rapid geographical expansion of the disease. Since the last situation report by the Johns Hopkins University on 18 March 2020 (External Situation Report 3), 11 new countries in the WHO African Region including Angola, Cape Verde, Chad, Eritrea, Niger, Madagascar, Mali, Mauritius, Mozambique, Uganda, and Zimbabwe have confirmed 1 371 and counting COVID-19 cases. As of 25 March 2020, a cumulative total of 1 716 confirmed cases have been reported across 38 countries in the region, bringing the total number of reported deaths to 30, which corresponds to a case fatality ratio of 1.8% among reported confirmed cases.The most affected countries in the WHO African Region are: South Africa (5647 cases and counting), Algeria (4006 cases and counting), Burkina Faso (645 cases and counting), Senegal (933 cases and counting), Cameroon (1832 cases and counting), and Cote d’Ivoire (1275 and counting) [13].This paper seeks to lay a theoretical foundation for a broader intellectual discourse on the emerging challenges presented by pandemics while discussing and examining how law as a social determinant of health and a factor in the cause, distribution and prevention of disease and injury in populations within Africa and Kenya in particular can be utilized in understanding trends in health laws, study the impact and effectiveness of laws in health, informing and supporting best practices and developing an evidence base of what works in the prevention of infectious diseases and in particular COVID – 19 in Africa (Kenya).

Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals?

ABSTRACT Reducing child mortality is a key global health challenge. We examined reasons for greater or lesser success in meeting under-five mortality rate reductions, i.e. Millennium Development Goal #4, between 1990 and 2015 in Sub-Saharan Africa where child mortality remains high. We first examined factors associated with child mortality from all World Health Organization African Region nations during the Millennium Development Goal period. This analysis was followed by case studies of the facilitators and barriers to Millennium Development Goal #4 in four countries – Kenya, Liberia, Zambia, and Zimbabwe. Quantitative indicators, policy documents, and qualitative interviews and focus groups were collected from each country to examine factors within and across countries related to child mortality. We found familiar themes that highlighted the need for both specific services (e.g. primary care access, emergency obstetric and neonatal care) and general management (e.g. strong health governance and leadership, increasing community health workers, quality of care). We also identified methodological opportunities and challenges to assessing progress in child health, which can provide insights to similar efforts during the Sustainable Development Goal period. Specifically, it is important for countries to adapt general international goals and measurements to their national context, considering baseline mortality rates and health information systems, to develop country-specific goals. It will also be critical to develop more rigorous measurement tools and indicators to accurately characterize maternal, neonatal, and child health systems, particularly in the area of governance and leadership. Valuable lessons can be learned from Millennium Development Goal successes and failures, as well as how they are evaluated. As countries seek to lower child mortality further during the Sustainable Development Goal period, it will be necessary to prioritize and support countries in quantitative and qualitative data collection to assess and contextualize progress, identifying areas needing improvement.

Measles antibody levels among vaccinated and unvaccinated children 6–59 months of age in the Democratic Republic of the Congo, 2013–2014

BackgroundMeasles is endemic in the Democratic Republic of the Congo (DRC), and 89–94% herd immunity is required to halt its transmission. Much of the World Health Organization African Region, including the DRC, has vaccination coverage below the 95% level required to eliminate measles, heightening concern of inadequate measles immunity. MethodsWe assessed 6706 children aged 6–59 months whose mothers were selected for interview in the 2013–2014 DRC Demographic and Health Survey. History of measles was obtained by maternal report, and classification of children who had measles was completed using maternal recall and measles immunoglobulin G serostatus obtained from a multiplex chemiluminescent automated immunoassay dried blood spot analysis. A logistic regression model was used to identify associations of covariates with measles and seroprotection, and vaccine effectiveness (VE) was calculated. ResultsOut of our sample, 64% of children were seroprotected. Measles vaccination was associated with protection against measles (OR: 0.15, 95% CI: 0.03, 0.81) when administered to children 12 months of age or older. Vaccination was predictive of seroprotection at all ages. VE was highest (88%) among children 12–24 months of age. ConclusionOur results demonstrated lower than expected seroprotection against measles among vaccinated children. Understanding the factors that affect host immunity to measles will aid in developing more efficient and effective immunization programs in DRC.

Progress towards measles elimination in Eritrea: 2003 - 2018.

IntroductionThe Expanded Program on Immunisation (EPI) has been operational in Eritrea since 1980. Eritrea has endorsed the resolution of the Regional Committee of the World Health Organisation African region, committing to a measles elimination goal for 2020 in the African Region. The country is implementing the recommended strategies.MethodsWe reviewed administrative coverage and WHO UNICEF coverage estimates for Diphtheria-Pertussis-Tetanus (DPT) and measles routine vaccination, as well as for measles supplemental immunization activities. We reviewed national surveillance performance and analyzed the epidemiological trends of measles as reported in the case-based surveillance database.ResultsEritrea has maintained more than 90% coverage with the first dose of measles vaccine at national level since 2001 and 88% MCV2 coverage from 2015 - 2017 according to the WHO-UNICEF coverage estimates. Since 2011, the country has not met the surveillance performance target of at least 80% districts reporting suspected measles cases with blood specimen. Measles incidence was between 16.8 - 24.7 cases per million population in the period 2015 - 2018. The mean and median age of confirmed measles cases was more than 10 years in 8 of the 14 years covered by the analysis. In 2017, Eritrea reported 1,199 cases of measles which differs significantly from the 185 suspected cases in the case based surveillance database for the same year. Eritrea has maintained high coverage for MCV1 and MCV2 and made progress towards measles elimination. However, the country has gaps in surveillance performance which may mask the true incidence of measles.ConclusionIn order to attain elimination of measles, Eritrea needs to implement measures to improve surveillance quality, to conduct regular risk assessment and implement targeted measures to close immunity gaps. In addition, setting up a national committee for the verification of measles elimination will help the country document progress and also to highlight and advocate for addressing issues related to data quality and performance gaps.

Hepatitis B vaccination and immunotherapies: an update.

World Health Organization (WHO) estimates that 257 million people were living with chronic hepatitis B virus (HBV) infection. Highest HBV prevalence was found in the WHO Western Pacific Region (6.2%) and in the WHO African Region (6.1%). The HBV vaccine is the best protection against chronic HBV infection and its complications. Globally, routine infant immunization against HBV has increased with an estimated coverage of 84% in 2017. Nevertheless, in many countries further efforts are needed to implement this coverage and ensure national immunization programs for people at major risk for HBV infection. Therapeutic vaccination in chronic HBV infected patients can cause anti-HBV immune responses able to remove and/or cure infected hepatocytes. It shows promising results in murine model and human trials, but these results need to be consolidated by further multicenter clinical studies. In particular, the efficacy of therapeutic vaccine seems to improve by combination therapies.

Infectious disease outbreak preparedness and response in Nigeria: history, limitations and recommendations for global health policy and practice.

Effective disease outbreak response has historically been a challenging accomplishment for the Nigerian health system due to an array of hurdles not unique to Nigeria but also found in other African nations which share its large size and complexity. However, the efficiency of the response mounted against the Ebola Virus Disease (EVD) outbreak of 2014 proved that indeed, though challenging, proactive and effective outbreak response is not impossible. With over 20 public health emergencies and infectious disease outbreaks between 2016 and 2018 alone, Nigeria is one of only five members of the World Health Organization (WHO) African Region to report five or more public health events per annum. There are many lessons that can be drawn from Nigeria's experience in handling outbreaks of infectious diseases. In this review, we discuss the history of emerging and re-emerging infectious disease outbreaks in Nigeria and explore the response strategies mounted towards each. We also highlight the significant successes and note-worthy limitations, which we have then utilized to proffer policy recommendations to strengthen the Nigerian public health emergency response systems.

Medical laboratory accreditation in a resource-limited district health centre laboratory, Addis Ababa, Ethiopia.

BackgroundImproving the quality of medical laboratory services is a high priority in many countries. However, quality management systems for laboratories in resource-limited settings are often inadequate.ObjectivesThis article shares the experiences, benefits and challenges of the laboratory journey towards accreditation in a primary healthcare laboratory in Addis Ababa, Ethiopia.MethodsA retrospective review of laboratory records in Addis Ketema Health Center was conducted from 2012 to 2015. The study was supplemented by observations from some of the authors of this article who worked in the laboratory.ResultsThe laboratory journey towards accreditation began with a baseline assessment in 2012 using the World Health Organization African Region Stepwise Laboratory Quality Improvement Process Towards Accreditation; the baseline score was 78 points (0 stars). After mentorship support, the laboratory improved to 198 points (3 stars) in 2013 and 249 points (5 stars) in 2014. The laboratory scaled up to International Organization for Standardization 15189 requirements and received limited-scope accreditation for tuberculosis sputum microscopy and hematology tests in 2015. After adopting and implementing the standards, steady improvement was observed in the reliability of the laboratory services. Lack of resources was the major challenge the laboratory encountered.ConclusionEven though a remarkable quality performance improvement was observed over the entire process, inadequate skilled personnel was the major challenge identified in the road towards accreditation. Therefore, an appropriate, workload-based staffing structure should be developed to improve and sustain medical laboratory quality standards in resource-limited settings.

Prevention of tuberculosis in household members: estimates of children eligible for treatment.

ObjectiveTo estimate of the number of children younger than 5 years who were household contacts of people with tuberculosis and were eligible for tuberculosis preventive treatment in 2017.MethodsTo estimate the number of eligible children, we obtained national values for the number of notified cases of bacteriologically confirmed pulmonary tuberculosis in 2017, the proportion of the population younger than 5 years in 2017 and average household size from published sources. We obtained global values for the number of active tuberculosis cases per household with an index case and for the prevalence of latent tuberculosis infection among children younger than 5 years who were household contacts of a tuberculosis case through systematic reviews, meta-analysis and Poisson regression models.FindingsThe estimated number of children younger than 5 years eligible for tuberculosis preventive treatment in 2017 globally was 1.27 million (95% uncertainty interval, UI: 1.24–1.31), which corresponded to an estimated global coverage of preventive treatment in children of 23% at best. By country, the estimated number ranged from less than one in the Bahamas, Iceland, Luxembourg and Malta to 350 000 (95% UI: 320 000–380 000) in India. Regionally, the highest estimates were for the World Health Organization (WHO) South-East Asia Region (510 000; 95% UI: 450 000–580 000) and the WHO African Region (470 000; 95% UI: 440 000–490 000).ConclusionTuberculosis preventive treatment in children was underutilized globally in 2017. Treatment should be scaled up to help eliminate the pool of tuberculosis infection and achieve the End TB Strategy targets.

Tuberculosis decline in populations affected by HIV: a retrospective study of 12 countries in the WHO African Region.

ObjectiveTo investigate which of the World Health Organization recommended methods for tuberculosis control have had the greatest effect on case incidence in 12 countries in the World Health Organization (WHO) African Region that carry high burdens of tuberculosis linked to human immunodeficiency virus (HIV) infection.MethodsWe obtained epidemiological surveillance, survey and treatment data on HIV and tuberculosis for the years 2003 to 2016. We used statistical models to examine the effects of antiretroviral therapy (ART) and isoniazid preventive therapy in reducing the incidence of tuberculosis among people living with HIV. We also investigated the role of tuberculosis case detection and treatment in preventing Mycobacterium tuberculosis transmission and consequently reducing tuberculosis incidence.FindingsBetween 2003 and 2016, ART provision was associated with the decline of tuberculosis in each country, and with differences in tuberculosis decline between countries. Inferring that ART was a cause of tuberculosis decline, ART prevented 1.88 million (95% confidence interval, CI: 1.65 to 2.11) tuberculosis cases in people living with HIV, or 15.7% (95% CI: 13.8 to 17.6) of the 11.96 million HIV-positive tuberculosis cases expected. Population coverage of isoniazid preventive therapy was too low (average 1.0% of persons eligible) to have a major effect on tuberculosis decline, and improvements in tuberculosis detection and treatment were either weakly associated or not significantly associated with tuberculosis decline.ConclusionART provision is associated with tuberculosis decline in these 12 countries. ART should remain central to tuberculosis control where rates of tuberculosis–HIV coinfection are high, but renewed efforts to treat tuberculosis are needed.