1
|
Amisu BO, Okesanya OJ, Adigun OA, Manirambona E, Ukoaka BM, Lawal OA, Idris NB, Olaleke NO, Okon II, Ogaya JB, Prisno DEL. Cholera resurgence in Africa: assessing progress, challenges, and public health response towards the 2030 global elimination target. LE INFEZIONI IN MEDICINA 2024; 32:148-156. [PMID: 38827826 PMCID: PMC11142410 DOI: 10.53854/liim-3202-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/14/2024] [Indexed: 06/05/2024]
Abstract
Global efforts to combat epidemic cholera outbreaks have witnessed tremendous feats over the decades. However, sporadic outbreaks in regions, particularly across African states, mask these advancements. This regressive trend is frequently fuelled by factors retarding efforts towards optimal environmental sanitation and personal hygiene, which include ingesting infected food, drinking contaminated waters, and engaging in unhealthy environmental practices such as indiscriminate waste and sewage disposal and poor toilet practices. The ongoing efforts to achieve the Global Taskforce on Cholera Control (GTFCC) targets of a 90% reduction in cases and deaths by 2030, even in the wake of continuous outbreaks across various African regions, as reported by the World Health Organization (WHO) face a significant threat. One such effort, among others, is the AFRICHOL project, an enhanced cholera surveillance consortium launched in Africa over a decade ago as part of the GTFCC at WHO to monitor and fast-track the GTFCC's 2030 targets. It is tasked with supporting the implementation of research-based strategies for combating cholera in Africa. The prequalified oral cholera vaccines - Dukoral, Shanchol, and Euvichol - and those with recombinant DNA technology have also emerged as remarkable strides. In the face of this progress, challenges persist. Climate change, including extreme weather events and the lack of safe water, sanitation, and hygiene facilities, acts as a multiplier, amplifying existing challenges and hindering progress. Porous borders with inefficient disease surveillance networks among member states also facilitate the inter-territorial spread of the disease. Despite ongoing challenges, global targets are achievable provided strong institutional infrastructure and additional evidence-based public health initiatives are promulgated and enacted. The Global Roadmap to Ending Cholera Outbreaks by 2030 is a resourceful tool for advancing this fight and eradicating cholera.
Collapse
Affiliation(s)
- Blessing Olawunmi Amisu
- Department of Medical Laboratory Science, Uniosun Teaching Hospital, Osogbo, Osun state, Nigeria
| | - Olalekan John Okesanya
- Department of Public Health and Maritime Transport, University of Thessaly, Volos, Greece
| | | | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Okikiola Azeez Lawal
- Department of Medical Laboratory Sciences, Kwara State University, Kwara State, Nigeria
| | - Nimat Bola Idris
- Department of Public Health, Al-Hikmah University, Ilorin, Kwara State, Nigeria
| | - Noah Olabode Olaleke
- Department of Medical Laboratory Science, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Osun State, Nigeria
| | - Inibehe Ime Okon
- Department of Neurosurgery, Hospital of the Babcock University, Ogun State, Nigeria
| | | | - Don Eliseo Lucero Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
2
|
Altare C, Kostandova N, Basadia LM, Petry M, Gankpe GF, Crockett H, Morfin NH, Bruneau S, Antoine C, Spiegel PB. COVID-19 epidemiology, health services utilisation and health care seeking behaviour during the first year of the COVID-19 pandemic in Mweso health zone, Democratic Republic of Congo. J Glob Health 2024; 14:05016. [PMID: 38665056 PMCID: PMC11047223 DOI: 10.7189/jogh.14.05016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background Although the evidence about coronavirus disease 2019 (COVID-19) has increased exponentially since the beginning of the pandemic, less is known about the direct and indirect effects of the pandemic in humanitarian settings. In the Democratic Republic of the Congo (DRC), most studies occurred in Kinshasa and other cities. Limited research was conducted in remote conflict-affected settings. We investigated the COVID-19 epidemiology, health service utilisation, and health care-seeking behaviour during the first year of the pandemic (March 2020-March 2021) in the Mweso health zone, North Kivu, DRC. Methods This mixed-methods study includes a descriptive epidemiological analysis of reported COVID-19 cases data extracted from the provincial line list, interrupted time series analysis of health service utilisation using routine health service data, qualitative perceptions of health care workers about how health services were affected, and community members' health care seeking behaviour from a representative household survey and focus group discussions. Results The COVID-19 epidemiology in North Kivu aligns with evidence reported globally, yet case fatality rates were high due to underreporting. Testing capacity was limited and initially mainly available in the province's capital. Health service utilisation showed different patterns - child measles vaccinations experienced a decrease at the beginning of the pandemic, while outpatient consultations, malaria, and pneumonia showed an increase over time. Such increases might have been driven by insecurity and population displacements rather than COVID-19. Community members continued seeking care during the first months of the COVID-19 pandemic and visited the same health facilities as before COVID-19. Financial constraints, not COVID-19, were the main barrier reported to accessing health care. Conclusions The first year of the COVID-19 pandemic in the Mweso health zone was characterised by low testing capacity and an underestimation of reported COVID-19 infections. The increase in health care utilisation should be further explored to understand the role of factors unrelated to COVID-19, such as insecurity, population displacement, and poverty, which remain major challenges to successfully providing health services and improving the population's health. Measles vaccination coverage dropped, which exacerbated the ongoing measles outbreak. Improved decentralised testing capacity will be crucial for future epidemics and enhanced efforts to maintain child vaccination coverage.
Collapse
Affiliation(s)
- Chiara Altare
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, USA
| | - Natalya Kostandova
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Linda Matadi Basadia
- Health and Nutrition Department, Action Contre la Faim, Kinshasa, Democratic Republic of Congo
| | - Marie Petry
- Health and Nutrition Department, Action Contre la Faim, Kinshasa, Democratic Republic of Congo
| | - Gbètoho Fortuné Gankpe
- Health and Nutrition Department, Action Contre la Faim, Kinshasa, Democratic Republic of Congo
| | - Hannah Crockett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Natalia Hernandez Morfin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sophie Bruneau
- Operations Department, Action Contre la Faim, Paris, France
| | - Caroline Antoine
- Technical and Advocacy Department, Action Contre la Faim, Paris, France
| | - Paul B Spiegel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, USA
| | - IMPACT DRC TeamMullafirozeRoxanaLinkeJasperCecchiOlivierDasNayanaRickardKatieMushamalirwaJean-PaulRuhindaDestinLehmannNadiaAmandineMarieHenzlerElioraGallecierAudreyBesnardeauBenoitGerritsmaNoortje
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, USA
- Health and Nutrition Department, Action Contre la Faim, Kinshasa, Democratic Republic of Congo
- Operations Department, Action Contre la Faim, Paris, France
- Technical and Advocacy Department, Action Contre la Faim, Paris, France
| |
Collapse
|
3
|
Abbara A, Abu Shomar R, Daoudy M, Abu Sittah G, Zaman MH, Zeitoun M. Water, health, and peace: a call for interdisciplinary research. Lancet 2024; 403:1427-1429. [PMID: 38522451 DOI: 10.1016/s0140-6736(24)00588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Aula Abbara
- Department of Infection, Imperial College London, St Mary's Hospital, London W2 1NY, UK.
| | - Reem Abu Shomar
- Islamic University of Gaza and Al-Azhar University, occupied Palestinian territory
| | - Marwa Daoudy
- Department of International Relations, Georgetown University, Washington, DC, USA
| | | | - Muhammad H Zaman
- Department of Biomedical Engineering and Center on Forced Displacement, Boston University, Boston, MA USA
| | - Mark Zeitoun
- Geneva Water Hub and Geneva Graduate Institute, Geneva, Switzerland
| |
Collapse
|
4
|
Altare C, Kostandova N, Hasan MA, Agbogan JA, Miah ML, Crockett H, Bates M, Leslie S, Tonon B, Antoine C, Spiegel P. Health care utilisation in Cox's Bazar district, Bangladesh, during the first year of the COVID-19 pandemic: A mixed-methods study among host communities. Glob Public Health 2024; 19:2305364. [PMID: 38252791 DOI: 10.1080/17441692.2024.2305364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
To respond to the COVID-19 pandemic, countries introduced public health and social measures that had indirect societal, economic consequences. Concerns during epidemics include continuity of routine health services. We investigate how healthcare utilisation and healthcare seeking behaviour changed during the first year of the COVID-19 pandemic among host communities in Cox's Bazar, Bangladesh. This mixed-methods study combines quantitative analyses of routine health data and population-based findings about healthcare seeking behaviours. Trends in consultations changed according to facility level (higher-level facilities included Upazila Health Complexes and District Hospitals; lower-level facilities included Community Clinics and Union Health and Family Welfare Centers). At the pandemic's beginning, drops were seen at higher-level health facilities for outpatient department (OPD) consultations, respiratory infections, and antenatal care. Minor reductions or increases were seen at lower-level facilities for the same services. Half of the subdistricts reported a cumulative increase in OPD and respiratory tract infection consultations. Most subdistricts reported a cumulative decrease in antenatal care. Child vaccinations dropped in all subdistricts, half of which did not catch-up, resulting in a cumulative decrease of delivered doses. Fear of contracting COVID-19 and financial constraints were the main reasons for decreased access. Drivers of healthcare seeking behaviours should be better understood to guide preparedness and service delivery modalities at primary and secondary levels.
Collapse
Affiliation(s)
- Chiara Altare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | | | | | | | | | - Hannah Crockett
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | - Madison Bates
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | - Sharon Leslie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | | | | | - Paul Spiegel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| |
Collapse
|
5
|
Abdelmagid N, Southgate RJ, Alhaffar M, Ahmed M, Bani H, Mounier-Jack S, Dahab M, Checchi F, Sabahelzain MM, Nor B, Rao B, Singh NS. The Governance of Childhood Vaccination Services in Crisis Settings: A Scoping Review. Vaccines (Basel) 2023; 11:1853. [PMID: 38140257 PMCID: PMC10747651 DOI: 10.3390/vaccines11121853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
The persistence of inadequate vaccination in crisis-affected settings raises concerns about decision making regarding vaccine selection, timing, location, and recipients. This review aims to describe the key features of childhood vaccination intervention design and planning in crisis-affected settings and investigate how the governance of childhood vaccination is defined, understood, and practised. We performed a scoping review of 193 peer-reviewed articles and grey literature on vaccination governance and service design and planning. We focused on 41 crises between 2010 and 2021. Following screening and data extraction, our analysis involved descriptive statistics and applying the governance analysis framework to code text excerpts, employing deductive and inductive approaches. Most documents related to active outbreaks in conflict-affected settings and to the mass delivery of polio, cholera, and measles vaccines. Information on vaccination modalities, target populations, vaccine sources, and funding was limited. We found various interpretations of governance, often implying hierarchical authority and regulation. Analysis of governance arrangements suggests a multi-actor yet fragmented governance structure, with inequitable actor participation, ineffective actor collaboration, and a lack of a shared strategic vision due to competing priorities and accountabilities. Better documentation of vaccination efforts during emergencies, including vaccination decision making, governance, and planning, is needed. We recommend empirical research within decision-making spaces.
Collapse
Affiliation(s)
- Nada Abdelmagid
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Health in Humanitarian Crises Centre, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Mervat Alhaffar
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Syria Research Group (SYRG), Co-Hosted by the London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Matab Ahmed
- School of Health Sciences, Ahfad University for Women (AUW), Omdurman P.O. Box 167, Sudan
| | - Hind Bani
- School of Health Sciences, Ahfad University for Women (AUW), Omdurman P.O. Box 167, Sudan
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, The London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Maysoon Dahab
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Health in Humanitarian Crises Centre, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Health in Humanitarian Crises Centre, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Majdi M. Sabahelzain
- School of Health Sciences, Ahfad University for Women (AUW), Omdurman P.O. Box 167, Sudan
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Barni Nor
- Department of Women’s and Children’s Health, Uppsala University, 751 23 Uppsala, Sweden
| | - Bhargavi Rao
- Department of Global Health and Development, Faculty of Public Health and Policy, The London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Neha S. Singh
- Health in Humanitarian Crises Centre, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, The London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| |
Collapse
|
6
|
Baličević SA, Elimian KO, King C, Diaconu K, Akande OW, Ihekweazu V, Trolle H, Gaudenzi G, Forsberg B, Alfven T. Influences of community engagement and health system strengthening for cholera control in cholera reporting countries. BMJ Glob Health 2023; 8:e013788. [PMID: 38084475 PMCID: PMC10711916 DOI: 10.1136/bmjgh-2023-013788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
The 2030 Global Task Force on Cholera Control Roadmap hinges on strengthening the implementation of multistranded cholera interventions, including community engagement and health system strengthening. However, a composite picture of specific facilitators and barriers for these interventions and any overlapping factors existing between the two, is lacking. Therefore, this study aims to address this shortcoming, focusing on cholera-reporting countries, which are disproportionately affected by cholera and may be cholera endemic. A scoping methodology was chosen to allow for iterative mapping, synthesis of the available research and to pinpoint research activity for global and local cholera policy-makers and shareholders. Using the Arksey and O'Malley framework for scoping reviews, we searched PubMed, Web of Science and CINAHL. Inclusion criteria included publication in English between 1990 and 2021 and cholera as the primary document focus in an epidemic or endemic setting. Data charting was completed through narrative descriptive and thematic analysis. Forty-four documents were included, with half relating to sub-Saharan African countries, 68% (30/44) to cholera endemic settings and 21% (9/44) to insecure settings. We identified four themes of facilitators and barriers to health systems strengthening: health system cooperation and agreement with external actors; maintaining functional capacity in the face of change; good governance, focused political will and sociopolitical influences on the cholera response and insecurity and targeted destruction. Community engagement had two themes: trust building in the health system and growing social cohesion. Insecurity and the community; cooperation and agreement; and sociopolitical influences on trust building were themes of factors acting at the interface between community engagement and health system. Given the decisive role of the community-health system interface for both sustained health system strengthening and community engagement, there is a need to advocate for conflict resolution, trust building and good governance for long-term cholera prevention and control in cholera reporting countries.
Collapse
Affiliation(s)
| | - Kelly Osezele Elimian
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Exhale Health Foundation, Abuja, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Diaconu
- Institute of Global Health, Queen Margaret University, Edinburgh, UK
| | - Oluwatosin Wuraola Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Hanna Trolle
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Gaudenzi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Protein Science, SciLifeLab, Stockholm, Sweden
| | - Birger Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| |
Collapse
|
7
|
Tarnas MC, Al-Dheeb N, Zaman MH, Parker DM. Association between air raids and reported incidence of cholera in Yemen, 2016-19: an ecological modelling study. Lancet Glob Health 2023; 11:e1955-e1963. [PMID: 37973343 DOI: 10.1016/s2214-109x(23)00272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Yemen continues to endure cholera outbreaks during ongoing conflict and destructive environmental events. Air raids have been used throughout the conflict to target military and civilian infrastructure. We aimed to assess the association between air raids and cholera incidence while taking into account geographical, environmental, economic, and demographic factors that drive outbreaks. METHODS In this ecological modelling study, we used data from Sept 12, 2016, to Dec 29, 2019, for the number of air raids, vegetation coverage, surface water, precipitation, temperature, economic variables, and cholera case and population data to model the association between conflict and the weekly incidence of cholera (per 100 000 people) in Yemen. Data were transformed into weekly intervals and governorates were categorised according to air raid severity (the number of raids in the previous 3 months). We used a negative binomial generalised additive model that accounted for geographical location and environmental, temporal, economic, and demographic variables to estimate incidence rate ratios for the association between air raid severity and cases of cholera. FINDINGS During the study period, 2 107 912 cases of cholera were reported in Yemen, and a minimum of 11 366 air raids were recorded. After controlling for relevant factors, compared with no air raids, all other levels of air raid severity were significantly associated with cholera incidence. The largest effect was noted in governorates with severe air raid levels (ie, ≥76 during the previous 3 months), which had an incidence rate ratio of 2·06 (95% CI 1·59-2·69; p<0·0001) for cholera compared with governorates with no air raids in the previous 3 months. Economic factors were also significantly associated with increased cholera incidence. INTERPRETATION Air raids were significantly associated with the burden of cholera in Yemen, even after controlling for other relevant factors. Quantification of this relationship further shows that the cholera outbreak is largely a result of human action rather than a natural occurrence, and demonstrates the conflict's devastating effects on health. Our findings highlight the need for ceasefire and peacebuilding efforts, as well as infrastructure and economic restoration, to reduce Yemen's cholera burden. FUNDING None. TRANSLATION For the Arabic translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Maia C Tarnas
- Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, CA, USA.
| | | | - Muhammad H Zaman
- Department of Biomedical Engineering, Boston University, Boston, MA, USA; Center on Forced Displacement, Boston University, Boston, MA, USA
| | - Daniel M Parker
- Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, CA, USA; Department of Epidemiology & Biostatistics, University of California, Irvine, Irvine, CA, USA
| |
Collapse
|
8
|
Percival V, Thoms OT, Oppenheim B, Rowlands D, Chisadza C, Fewer S, Yamey G, Alexander AC, Allaham CL, Causevic S, Daudelin F, Gloppen S, Guha-Sapir D, Hadaf M, Henderson S, Hoffman SJ, Langer A, Lebbos TJ, Leomil L, Lyytikäinen M, Malhotra A, Mkandawire P, Norris HA, Ottersen OP, Phillips J, Rawet S, Salikova A, Shekh Mohamed I, Zazai G, Halonen T, Kyobutungi C, Bhutta ZA, Friberg P. The Lancet Commission on peaceful societies through health equity and gender equality. Lancet 2023; 402:1661-1722. [PMID: 37689077 DOI: 10.1016/s0140-6736(23)01348-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Valerie Percival
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada; The Wilson Center, Washington DC, USA.
| | - Oskar T Thoms
- Department of Political Science, University of Toronto, Mississauga, ON, Canada
| | - Ben Oppenheim
- Ginkgo Bioworks, Boston, MA, USA; New York University Center on International Cooperation, New York, NY, USA
| | - Dane Rowlands
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Carolyn Chisadza
- Department of Economics, University of Pretoria, Pretoria, South Africa
| | - Sara Fewer
- Department of Global Public Health, Stockholm, Sweden; Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Amy C Alexander
- Quality of Government Institute, Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Chloe L Allaham
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Sara Causevic
- Department of Global Public Health, Stockholm, Sweden; Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - François Daudelin
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siri Gloppen
- University of Bergen, Bergen, Norway; LawTransform, CMI-UiB Centre on Law and Social Transformation, Bergen, Norway
| | - Debarati Guha-Sapir
- Institute of Health and Society, UC Louvain, Brussels, Belgium; Johns Hopkins Center for Humanitarian Health, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maseh Hadaf
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Samuel Henderson
- Department of Political Science, University of Toronto, Toronto, ON, Canada
| | | | - Ana Langer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Toni Joe Lebbos
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Luiz Leomil
- Department of Political Science, Carleton University, Ottawa, ON, Canada
| | | | - Anju Malhotra
- Center for Women's Health and Gender Equality, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Paul Mkandawire
- Human Rights and Social Justice Program, Carleton University, Ottawa, ON, Canada
| | - Holly A Norris
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Ole Petter Ottersen
- Office of the President, Karolinska Institutet, Stockholm, Sweden; University of Oslo, Oslo, Norway
| | - Jason Phillips
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Sigrún Rawet
- Department for Multilateral Development Banks, Sustainability and Climate, Ministry for Foreign Affairs, Stockholm, Sweden
| | | | - Idil Shekh Mohamed
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
| | - Ghazal Zazai
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | | | | | - Zulfiqar A Bhutta
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; The Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan; SickKids Centre for Global Child Health, Toronto, ON, Canada
| | - Peter Friberg
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden; School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
9
|
Hraib M, Alaidi S, Jouni S, Saad S, Muna M, Alaidi N, Alshehabi Z. Cholera: An Overview with Reference to the Syrian Outbreak. Avicenna J Med 2023; 13:199-205. [PMID: 38144913 PMCID: PMC10736186 DOI: 10.1055/s-0043-1775762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
Cholera is an acute type of diarrheal disease caused by intestinal infection with the toxin-producing bacteria Vibrio cholerae. The disease is still endemic in almost 69 countries, accounting for around 2.86 million cases and 95,000 deaths annually. Cholera is associated with poor infrastructure, and lack of access to sanitation and clean drinking water. The current cholera outbreak in Syria is associated with more than 10 years of conflict, which has devastated infrastructures and health services. There were 132,782 suspected cases reported between August 25, 2022 and May 20, 2023 in all 14 governorates, including 104 associated deaths. The recent earthquake in the region has complicated the situation, with an increase in cholera cases, and hindrance to a response to the disease. Climate change has driven a number of large cholera outbreaks around the world this year. The World Health Organization prequalifies three oral cholera vaccines. Cholera treatment mainly depends on rehydration, with the use of antibiotics in more severe infections. This review gives an overview of cholera bacteriology, pathogenesis, epidemiology, clinical manifestations, diagnosis, management, and prevention in light of global climate change and the ongoing outbreak in Syria, which poses a significant public health threat that requires urgent attention.
Collapse
Affiliation(s)
- Munawar Hraib
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Sara Alaidi
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Sarah Jouni
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Sana Saad
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Mohammad Muna
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Nour Alaidi
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Zuheir Alshehabi
- Department of Pathology, Tishreen University Hospital, Latakia, Syria
| |
Collapse
|
10
|
Alhaffar MHDBA, Gomez MDMM, Sigua JA, Eriksson A. The cholera outbreak in Syria: a call for urgent actions. IJID REGIONS 2023; 8:71-74. [PMID: 37521106 PMCID: PMC10372181 DOI: 10.1016/j.ijregi.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023]
Abstract
The ongoing cholera outbreak in Syria poses a significant public health threat that requires immediate and comprehensive attention. The spread of the outbreak is attributed to a combination of factors, including displacement due to armed conflict, chronic water insecurity, inadequate water, sanitation, and hygiene infrastructure, climate change-induced droughts, weakened health system capacity, and political instability. The recent earthquake in the region has further complicated the situation, potentially leading to a surge in cholera cases. The limited capacity of the Syrian health system to handle the cholera outbreak, especially after the earthquake, highlights the urgent need for external support. The political instability in the country has hampered effective responses to the outbreak, contributing to the spread of the disease beyond Syria's borders. It is imperative to prioritize aid to address the fragmented response and provide the necessary resources for comprehensive and effective cholera prevention and control measures. The situation calls for an integrated, multi-sectoral approach that prioritizes economic development, universal access to sustainable safe drinking water, and adequate sanitation. Additionally, community engagement and education are essential for effective disease prevention and control. In conclusion, the ongoing cholera outbreak in Syria is a complex issue that requires urgent attention and action. The combination of armed conflict, water insecurity, climate change, and political instability have contributed to the spread of the disease, further compounded by the recent earthquake. To effectively address the outbreak and prevent its further spread, a comprehensive and integrated approach is needed, with support from the international community.
Collapse
Affiliation(s)
| | | | - Jemar Anne Sigua
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Anneli Eriksson
- Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
11
|
Marzouk M, Durrance-Bagale A, Lam ST, Nagashima-Hayashi M, Ung M, Aribou ZM, Zaseela A, Ibrahim NM, Agarwal S, Omar M, Newaz S, Mkhallalati H, Howard N. Health system evaluation in conflict-affected countries: a scoping review of approaches and methods. Confl Health 2023; 17:30. [PMID: 37337225 DOI: 10.1186/s13031-023-00526-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/26/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Strengthening health systems in conflict-affected settings has become increasingly professionalised. However, evaluation remains challenging and often insufficiently documented in the literature. Many, particularly small-scale health system evaluations, are conducted by government bodies or non-governmental organisations (NGO) with limited capacity to publish their experiences. It is essential to identify the existing literature and main findings as a baseline for future efforts to evaluate the capacity and resilience of conflict-affected health systems. We thus aimed to synthesise the scope of methodological approaches and methods used in the peer-reviewed literature on health system evaluation in conflict-affected settings. METHODS We conducted a scoping review using Arksey and O'Malley's method and synthesised findings using the WHO health system 'building blocks' framework. RESULTS We included 58 eligible sources of 2,355 screened, which included examination of health systems or components in 26 conflict-affected countries, primarily South Sudan and Afghanistan (7 sources each), Democratic Republic of the Congo (6), and Palestine (5). Most sources (86%) were led by foreign academic institutes and international donors and focused on health services delivery (78%), with qualitative designs predominating (53%). Theoretical or conceptual grounding was extremely limited and study designs were not generally complex, as many sources (43%) were NGO project evaluations for international donors and relied on simple and lower-cost methods. Sources were also limited in terms of geography (e.g., limited coverage of the Americas region), by component (e.g., preferences for specific components such as service delivery), gendered (e.g., limited participation of women), and colonised (e.g., limited authorship and research leadership from affected countries). CONCLUSION The evaluation literature in conflict-affected settings remains limited in scope and content, favouring simplified study designs and methods, and including those components and projects implemented or funded internationally. Many identified challenges and limitations (e.g., limited innovation/contextualisation, poor engagement with local actors, gender and language biases) could be mitigated with more rigorous and systematic evaluation approaches.
Collapse
Affiliation(s)
- Manar Marzouk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Anna Durrance-Bagale
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sze Tung Lam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore.
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Michiko Nagashima-Hayashi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Mengieng Ung
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Zeenathnisa Mougammadou Aribou
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Ayshath Zaseela
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Nafeesah Mohamed Ibrahim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Sunanda Agarwal
- Distinguished Careers Institute, Stanford University, Stanford, CA, USA
| | - Maryam Omar
- Chelsea and Westminster Hospital NHS Foundation Trust, Fulham Road, London, SW10 9NH, UK
| | - Sanjida Newaz
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada
| | - Hala Mkhallalati
- Research for Health System Strengthening in North-West of Syria, King's College London, Strand, London, WC2R 2LS, UK
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| |
Collapse
|
12
|
Attal B, Dureab F, Abbara A. Yemen: current peace talks must also prioritise health. BMJ 2023; 381:p1242. [PMID: 37277135 DOI: 10.1136/bmj.p1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Bothaina Attal
- The Healthcare Improvement Studies (THIS) Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fekri Dureab
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Aula Abbara
- Imperial College, Department of Infection, London, UK
| |
Collapse
|
13
|
Altare C, Kostandova N, Gankpe GF, Nalimo P, Almoustapha Abaradine AA, Bruneau S, Antoine C, Spiegel PB. The first year of the COVID-19 pandemic in humanitarian settings: epidemiology, health service utilization, and health care seeking behavior in Bangui and surrounding areas, Central African Republic. Confl Health 2023; 17:24. [PMID: 37210535 DOI: 10.1186/s13031-023-00523-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/16/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Despite increasing evidence on COVID-19, few studies have been conducted in humanitarian settings and none have investigated the direct and indirect effects of the pandemic in the Central African Republic. We studied the COVID-19 epidemiology, health service utilization, and health care seeking behavior in the first year of the pandemic in Bangui and surrounding areas. METHODS This mixed-methods study encompasses four components: descriptive epidemiological analysis of reported COVID-19 cases data; interrupted time series analysis of health service utilization using routine health service data; qualitative analysis of health care workers' perceptions of how health services were affected; and health care seeking behavior of community members with a household survey and focus group discussions. RESULTS The COVID-19 epidemiology in CAR aligns with that of most other countries with males representing most of the tested people and positive cases. Testing capacity was mainly concentrated in Bangui and skewed towards symptomatic cases, travelers, and certain professions. Test positivity was high, and many cases went undiagnosed. Decreases in outpatient department consultations, consultations for respiratory tract infections, and antenatal care were found in most study districts. Cumulative differences in districts ranged from - 46,000 outpatient department consultations in Begoua to + 7000 in Bangui 3; - 9337 respiratory tract infections consultations in Begoua to + 301 in Bangui 1; and from - 2895 antenatal care consultations in Bimbo to + 702 in Bangui 2. Consultations for suspected malaria showed mixed results while delivery of BCG vaccine doses increased. Fewer community members reported seeking care at the beginning of the pandemic compared to summer 2021, especially in urban areas. The fear of testing positive and complying with related restrictions were the main obstacles to seeking care. CONCLUSIONS A large underestimation of infections and decreased health care utilization characterized the first year of the COVID-19 pandemic in Bangui and surrounding area. Improved decentralized testing capacity and enhanced efforts to maintain health service utilization will be crucial for future epidemics. A better understanding of health care access is needed, which will require strengthening the national health information system to ensure reliable and complete data. Further research on how public health measures interact with security constraints is needed.
Collapse
Affiliation(s)
- Chiara Altare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA.
| | - Natalya Kostandova
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | | | | | | | | | | | - Paul B Spiegel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| |
Collapse
|
14
|
Al Waziza R, Sheikh R, Ahmed I, Al-Masbhi G, Dureab F. Analyzing Yemen's health system at the governorate level amid the ongoing conflict: a case of Al Hodeida governorate. DISCOVER HEALTH SYSTEMS 2023; 2:15. [PMID: 37520515 PMCID: PMC10169293 DOI: 10.1007/s44250-023-00026-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/27/2023] [Indexed: 08/01/2023]
Abstract
Background Yemen is regarded as one of the Middle East's poorest countries. Decades of political, economic, and social difficulties have culminated in the current protracted conflict. As a result, the globe experienced its worst humanitarian catastrophe. The ongoing war has affected several public services, notably the health sector, which is operating at less than half its capacity. This study aims to examine Yemen's health system at the governorate level (Al Hodeida) amidst the current conflict. It analyzes current challenges and produces suggestions for enhancement. Methods The study used qualitative research methods such as Key Informant Interviews (KIIs) and document analysis. The study used WHO's health systems framework to measure health system performance. Twelve KIIs were conducted via Skype with several health stakeholders. In addition, documents were analyzed to inform the subject guide, generate themes, and aid in the triangulation of results. Results According to the study findings, the governorate health system managed to offer a minimum level of healthcare services while making some advances in outbreak control jointly with other partners. One of the main difficulties confronting the governorate's health system is a severe lack of financial resources forcing it to rely entirely on external aid. Furthermore, other significant deficiencies include inadequate health system organogram, low reporting capacities, insufficient funding, and scarcity of health professionals. Conclusion Yemen's frail health system has been weakened by almost eight years of insecurity and conflict. If the current scenario continues, most of Yemen's health system's operations and indicators will likely deteriorate. On the other hand, progress in some areas, such as primary healthcare (PHC) services and disease management, is remarkable. However, for better performance, Yemen's health system leadership and stakeholders should seek a holistic strategy to improve the entire dimensions of the health system.
Collapse
Affiliation(s)
- Raof Al Waziza
- Institute for Research in International Assistance (IRIA), Akkon Hochschule für Humanwissenschaften, Berlin, Germany
| | | | - Iman Ahmed
- World Health Organization, Gaziantep, Turkey
| | | | - Fekri Dureab
- Institute for Research in International Assistance (IRIA), Akkon Hochschule für Humanwissenschaften, Berlin, Germany
- Heidelberg Institute of Global Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
| |
Collapse
|
15
|
Buliva E, Elnossery S, Okwarah P, Tayyab M, Brennan R, Abubakar A. Cholera prevention, control strategies, challenges and World Health Organization initiatives in the Eastern Mediterranean Region: A narrative review. Heliyon 2023; 9:e15598. [PMID: 37153427 PMCID: PMC10160509 DOI: 10.1016/j.heliyon.2023.e15598] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/01/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
The resurgence of cholera is presenting unusual challenges in the Eastern Mediterranean Region (EMR), where it is considered endemic in nine-member states. The risk of a cholera outbreak spreading to non-endemic countries remains high. We discuss the regional trends of cholera, regional burden, and challenges with a focus on World Health Organization (WHO) initiatives in the region that could be useful in preventing and controlling the disease in similar contexts. Despite significant progress in the control of cholera worldwide, the disease continues to be a major public health problem across the region, where it constitutes both an emerging and re-emerging threat. Recurring cholera outbreaks are an indication of deprived water and sanitation conditions as well as weak health systems, contributing to the transmission and spread of the cholera infection. We note that despite the challenges in eliminating cholera in the region, effective implementation of the proposed WHO EMR Strategic framework, among other measures, could sustain the region's cholera prevention, preparedness, and response needs.
Collapse
Affiliation(s)
- Evans Buliva
- World Health Organization (WHO) Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Sherein Elnossery
- World Health Organization (WHO) Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Patrick Okwarah
- Amref International University (AMIU), School of Public Health, Nairobi, Kenya
| | - Muhammad Tayyab
- World Health Organization (WHO) Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Richard Brennan
- World Health Organization (WHO) Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Abdinasir Abubakar
- World Health Organization (WHO) Regional Office for the Eastern Mediterranean, Cairo, Egypt
| |
Collapse
|
16
|
Ouamba JP, Mbarga NF, Ciglenecki I, Ratnayake R, Tchiasso D, Finger F, Peyraud N, Mounchili I, Boyom T, Yonta C, Nwatchok L, Mouhamadou M, Ekedi C, Marcel J, Luquero F, Ekah F, Amani A, Tamakloe M, Boum Y, Esso L. Implementation of targeted cholera response activities, Cameroon. Bull World Health Organ 2023; 101:170-178. [PMID: 36865607 PMCID: PMC9948504 DOI: 10.2471/blt.22.288885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 03/04/2023] Open
Abstract
Objective To describe the implementation of case-area targeted interventions to reduce cholera transmission using a rapid, localized response in Kribi district, Cameroon. Methods We used a cross-sectional design to study the implementation of case-area targeted interventions. We initiated interventions after rapid diagnostic test confirmation of a case of cholera. We targeted households within a 100-250 metre perimeter around the index case (spatial targeting). The interventions package included: health promotion, oral cholera vaccination, antibiotic chemoprophylaxis for nonimmunized direct contacts, point-of-use water treatment and active case-finding. Findings We implemented eight targeted intervention packages in four health areas of Kribi between 17 September 2020 and 16 October 2020. We visited 1533 households (range: 7-544 per case-area) hosting 5877 individuals (range: 7-1687 per case-area). The average time from detection of the index case to implementation of interventions was 3.4 days (range: 1-7). Oral cholera vaccination increased overall immunization coverage in Kribi from 49.2% (2771/5621 people) to 79.3% (4456/5621 people). Interventions also led to the detection and prompt management of eight suspected cases of cholera, five of whom had severe dehydration. Stool culture was positive for Vibrio cholerae O1 in four cases. The average time from onset of symptoms to admission of a person with cholera to a health facility was 1.2 days. Conclusion Despite challenges, we successfully implemented targeted interventions at the tail-end of a cholera epidemic, after which no further cases were reported in Kribi up until week 49 of 2021. The effectiveness of case-area targeted interventions in stopping or reducing cholera transmission needs further investigation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Christine Ekedi
- Kribi District Hospital, Regional Delegation of the South, Kribi, Cameroon
| | - Johne Marcel
- Kribi District Hospital, Regional Delegation of the South, Kribi, Cameroon
| | | | - Faustin Ekah
- United Nations International Children's Emergency Fund, Yaounde, Cameroon
| | - Adidja Amani
- Sub-direction of Vaccination, Ministry of Public Health, Yaounde, Cameroon
| | | | | | - Linda Esso
- Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaounde, Cameroon
| |
Collapse
|
17
|
Tabor R, Almhawish N, Aladhan I, Tarnas M, Sullivan R, Karah N, Zeitoun M, Ratnayake R, Abbara A. Disruption to water supply and waterborne communicable diseases in northeast Syria: a spatiotemporal analysis. Confl Health 2023; 17:4. [PMID: 36739427 PMCID: PMC9898953 DOI: 10.1186/s13031-023-00502-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In Syria, disruption to water and sanitation systems, together with poor access to vaccination, forced displacement and overcrowding contribute to increases in waterborne diseases (WBDs). The aim of this study is to perform a spatiotemporal analysis to investigate potential associations between interruptions to water, sanitation, and hygiene (WASH) and WBDs in northeast Syria using data collected by the Early Warning Alert and Response Network (EWARN) from Deir-ez-Zor, Raqqa, Hassakeh and parts of Aleppo governorates. METHODS We reviewed the literature databases of MEDLINE and Google Scholar and the updates of ReliefWeb to obtain information on acute disruptions and attacks against water infrastructure in northeast Syria between January 2015 and June 2021. The EWARN weekly trends of five syndromes representing waterborne diseases were plotted and analysed to identify time trends and the influence of these disruptions. To investigate a potential relationship, the Wilcoxon rank sum test was used to compare districts with and without disruptions. Time series analyses were carried out on major disruptions to analyse their effect on WBD incidence. RESULTS The literature review found several instances where water infrastructure was attacked or disrupted, suggesting that water has been deliberately targeted by both state and non-state actors in northeast Syria throughout the conflict. Over time, there was an overall upwards trend of other acute diarrhoea (OAD, p < 0.001), but downwards trends for acute jaundice syndrome, suspected typhoid fever and acute bloody diarrhoea. For the major disruption of the Alouk water plant, an interrupted time series analysis did not find a strong correlation between the disruption and changes in disease incidence in the weeks following the incident, but long-term increases in WBD were observed. CONCLUSIONS While no strong immediate correlation could be established between disruptions to WASH and WBDs in northeast Syria, further research is essential to explore the impact of conflict-associated damage to civil infrastructure including WASH. This is vital though challenging given confounding factors which affect both WASH and WBDs in contexts like northeast Syria. As such, research which includes exploration of mitigation after damage to WASH is essential to improve understanding of impacts on quantity and quality of WASH. More granular research which explores the origin of cases of WBDs and how such communities are affected by challenges to WASH is needed. One step towards research on this, is the implementation of adequate reporting mechanisms for real time tracking of the WASH attacks, damages, direct effects, and likely impact in conjunction with environmental and public health bodies and surveillance systems.
Collapse
Affiliation(s)
- Ruby Tabor
- London School of Tropical Medicine and Hygiene, London, UK ,Syria Public Health Network, London, UK
| | - Naser Almhawish
- Assistance Coordination Unit, Gaziantep, Turkey ,Syria Public Health Network, London, UK
| | - Ibrahim Aladhan
- Syrian Environmental Protection Agency, Gaziantep, Turkey ,Syria Public Health Network, London, UK
| | - Maia Tarnas
- grid.266093.80000 0001 0668 7243University of California Irvine, Irvine, USA ,Syria Public Health Network, London, UK
| | - Richard Sullivan
- grid.13097.3c0000 0001 2322 6764King’s College, London, UK ,Syria Public Health Network, London, UK
| | - Nabil Karah
- grid.12650.300000 0001 1034 3451Umea University, Umeå, Sweden ,Syria Public Health Network, London, UK
| | - Mark Zeitoun
- grid.8273.e0000 0001 1092 7967University of East Anglia, Norwich, UK ,Geneva Water Hub, Geneva, Switzerland ,Syria Public Health Network, London, UK
| | - Ruwan Ratnayake
- London School of Tropical Medicine and Hygiene, London, UK ,Syria Public Health Network, London, UK
| | - Aula Abbara
- Geneva Water Hub, Geneva, Switzerland ,grid.7445.20000 0001 2113 8111Department of Infectious Diseases, Imperial College, London, W2 1NY UK ,Syria Public Health Network, London, UK
| |
Collapse
|
18
|
Shalash A, Abu-Rmeileh NME, Kelly D, Elmusharaf K. The need for standardised methods of data collection, sharing of data and agency coordination in humanitarian settings. BMJ Glob Health 2022; 7:bmjgh-2021-007249. [PMID: 36210070 PMCID: PMC9540843 DOI: 10.1136/bmjgh-2021-007249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/15/2022] [Indexed: 11/03/2022] Open
Abstract
Humanitarian crises and emergencies are prevalent all over the world. With a surge in crises in the last decade, humanitarian agencies have increased their presence in these areas. Initiatives such as the Sphere Project and the Minimum Initial Service Package known as MISP were formed to set standards and priorities for humanitarian assistance agencies. MISP was initiated to coordinate and standardise data and collection methods and involve locals for programme sustainability. Developing policies and programmes based on available data in humanitarian crises is necessary to make evidence-based decisions. Data sharing between humanitarian agencies increases the effectiveness of rapid responses and limits duplication of services and research. In addition, standardising data collection methods helps alleviate the risk of inaccurate information and allows for comparison and estimates among different settings. Big data is a new collection method that can help assemble timely data if resources are available and turn the data into information. Further research on setting priority indicators for humanitarian situations can help guide agencies to collect quality data.
Collapse
Affiliation(s)
- Aisha Shalash
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine, State of,School of Medicine, University of Limerick, Limerick, Ireland
| | - Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine, State of
| | - Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland
| | | |
Collapse
|
19
|
A blueprint for eliminating cholera by 2030. Nat Med 2022; 28:1747-1749. [DOI: 10.1038/s41591-022-01898-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
20
|
Falconer J, Diaconu K, O’May F, Gummaraju A, Victor-Uadiale I, Matragrano J, Njanpop-Lafourcade BM, Ager A. Cholera diagnosis in human stool and detection in water: A systematic review and meta-analysis. PLoS One 2022; 17:e0270860. [PMID: 35793330 PMCID: PMC9258865 DOI: 10.1371/journal.pone.0270860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 06/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cholera continues to pose a problem for low-resource, fragile and humanitarian contexts. Evidence suggests that 2.86 million cholera cases and 95,000 deaths due to cholera are reported annually. Without quick and effective diagnosis and treatment, case-fatality may be 50%. In line with the priorities of the Global Task Force on Cholera Control, we undertook a systematic review and meta-analysis of diagnostic test accuracy and other test characteristics of current tests for cholera detection in stool and water. Methods We searched 11 bibliographic and grey literature databases. Data was extracted on test sensitivity, specificity and other product information. Meta-analyses of sensitivity and specificity were conducted for tests reported in three or more studies. Where fewer studies reported a test, estimates were summarised through narrative synthesis. Risk of Bias was assessed using QUADAS-2. Results Searches identified 6,637 records; 41 studies reporting on 28 tests were included. Twenty-two tests had both sensitivities and specificities reported above 95% by at least one study, but there was, overall, wide variation in reported diagnostic accuracy across studies. For the three tests where meta-analyses were possible the highest sensitivity meta-estimate was found in the Cholera Screen test (98.6%, CI: 94.7%-99.7%) and the highest specificity meta-estimate in the Crystal VC on enriched samples (98.3%, CI: 92.8%-99.6%). There was a general lack of evidence regarding field use of tests, but where presented this indicated trends for lower diagnostic accuracy in field settings, with lesser-trained staff, and without the additional process of sample enrichment. Where reported, mean test turnaround times ranged from over 50% to 130% longer than manufacturer’s specification. Most studies had a low to unclear risk of bias. Conclusions Currently available Rapid Diagnostic Tests can potentially provide high diagnostic and detection capability for cholera. However, stronger evidence is required regarding the conditions required to secure these levels of accuracy in field use, particularly in low-resource settings. Registration PROSPERO (CRD42016048428).
Collapse
Affiliation(s)
- Jennifer Falconer
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
- * E-mail:
| | - Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
| | - Fiona O’May
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
| | - Advaith Gummaraju
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| |
Collapse
|
21
|
Simpson RB, Babool S, Tarnas MC, Kaminski PM, Hartwick MA, Naumova EN. Dynamic mapping of cholera outbreak during the Yemeni Civil War, 2016-2019. J Public Health Policy 2022; 43:185-202. [PMID: 35614203 PMCID: PMC9192410 DOI: 10.1057/s41271-022-00345-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/03/2022]
Abstract
Widespread destruction from the Yemeni Civil War (2014-present) triggered the world's largest cholera outbreak. We compiled a comprehensive health dataset and created dynamic maps to demonstrate spatiotemporal changes in cholera infections and war conflicts. We aligned and merged daily, weekly, and monthly epidemiological bulletins of confirmed cholera infections and daily conflict events and fatality records to create a dataset of weekly time series for Yemen at the governorate level (subnational regions administered by governors) from 4 January 2016 through 29 December 2019. We demonstrated the use of dynamic mapping for tracing the onset and spread of infection and manmade factors that amplify the outbreak. We report curated data and visualization techniques to further uncover associations between infectious disease outbreaks and risk factors and to better coordinate humanitarian aid and relief efforts during complex emergencies.
Collapse
Affiliation(s)
- Ryan B. Simpson
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Sofia Babool
- Neuroscience Department, The University of Texas at Dallas, Richardson, TX USA
| | - Maia C. Tarnas
- Community Health Department, Tufts University School of Arts and Sciences, Medford, MA USA
| | - Paulina M. Kaminski
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Meghan A. Hartwick
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Elena N. Naumova
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| |
Collapse
|
22
|
Nair S, Attal-Juncqua A, Reddy A, Sorrell EM, Standley CJ. Assessing barriers, opportunities and future directions in health information sharing in humanitarian contexts: a mixed-method study. BMJ Open 2022; 12:e053042. [PMID: 35379617 PMCID: PMC8981313 DOI: 10.1136/bmjopen-2021-053042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Health information sharing continues to play a crucial yet underappreciated role in humanitarian settings, to guide evidence-based disease prevention, detection and response. We conducted a mixed-methods study to investigate and analyse existing approaches and practices to health information sharing across humanitarian settings over the past 20 years. SETTING We sought to identify studies from any self-described humanitarian setting worldwide, and also targeted experts familiar with refugee settings, specifically long-term camps in Kenya, Jordan and Bangladesh, for key informant interviews. PARTICIPANTS The systematic review did not directly involve participants. The identified reports were largely retrospective and observational, and focused on populations affected by humanitarian crises worldwide. Participants in the key informant interviews were experts with either broad geographical expertise or direct experience in refugee camp settings. PRIMARY AND SECONDARY OUTCOME MEASURES Our study was qualitative, and both the systematic review and analysis of key informant interview responses focused on identifying themes related to barriers, tools and recommendations used between stakeholders to share health information, with a particular emphasis on infectious disease and surveillance data. RESULTS We identified logistical challenges, difficulties with data collection and a lack of health information sharing frameworks as the most significant barriers to health information sharing. The most important tools to health information sharing included the use of third-party technologies for data collection and standardisation, formalised health information sharing frameworks, establishment of multilevel coordination mechanisms and leadership initiatives which prioritised the sharing of health information. CONCLUSIONS We conclude that health information sharing can be strengthened in humanitarian settings with improvements to existing frameworks, coordination and leadership tools, in addition to promotion of health information communication. Furthermore, specific recommendations for improving health information sharing should be pursued according to the nature of the humanitarian setting and the efficacy of the health system present.
Collapse
Affiliation(s)
- Shuait Nair
- Walsh School of Foreign Service, Georgetown University, Washington, District of Columbia, USA
| | - Aurelia Attal-Juncqua
- Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
| | - Aashna Reddy
- School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Erin M Sorrell
- Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
- Department of Microbiology & Immunology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Claire J Standley
- Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
| |
Collapse
|
23
|
Leach M, MacGregor H, Ripoll S, Scoones I, Wilkinson A. Rethinking Disease Preparedness: Incertitude and the Politics of Knowledge. CRITICAL PUBLIC HEALTH 2022; 32:82-96. [PMID: 36618759 PMCID: PMC7614024 DOI: 10.1080/09581596.2021.1885628] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This paper argues for a rethinking of disease preparedness that puts incertitude and the politics of knowledge at the centre. Through examining the experiences of Ebola, Nipah, cholera and COVID-19 across multiple settings, the limitations of current approaches are highlighted. Conventional approaches assume a controllable, predictable future, which is responded to by a range of standard interventions. Such emergency preparedness planning approaches assume risk - where future outcomes can be predicted - and fail to address uncertainty, ambiguity and ignorance - where outcomes or their probabilities are unknown. Through examining the experiences of outbreak planning and response across the four cases, the paper argues for an approach that highlights the politics of knowledge, the constructions of time and space, the requirements for institutions and administrations and the challenges of ethics and justice. Embracing incertitude in disease preparedness responses therefore means making contextual social, political and cultural dimensions central.
Collapse
Affiliation(s)
- Melissa Leach
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Hayley MacGregor
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Santiago Ripoll
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Ian Scoones
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Annie Wilkinson
- Institute of Development Studies, University of Sussex, Brighton, UK
| |
Collapse
|
24
|
Simpson RB, Babool S, Tarnas MC, Kaminski PM, Hartwick MA, Naumova EN. Signatures of Cholera Outbreak during the Yemeni Civil War, 2016-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010378. [PMID: 35010649 PMCID: PMC8744546 DOI: 10.3390/ijerph19010378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
Abstract
The Global Task Force on Cholera Control (GTFCC) created a strategy for early outbreak detection, hotspot identification, and resource mobilization coordination in response to the Yemeni cholera epidemic. This strategy requires a systematic approach for defining and classifying outbreak signatures, or the profile of an epidemic curve and its features. We used publicly available data to quantify outbreak features of the ongoing cholera epidemic in Yemen and clustered governorates using an adaptive time series methodology. We characterized outbreak signatures and identified clusters using a weekly time series of cholera rates in 20 Yemeni governorates and nationally from 4 September 2016 through 29 December 2019 as reported by the World Health Organization (WHO). We quantified critical points and periods using Kolmogorov–Zurbenko adaptive filter methodology. We assigned governorates into six clusters sharing similar outbreak signatures, according to similarities in critical points, critical periods, and the magnitude of peak rates. We identified four national outbreak waves beginning on 12 September 2016, 6 March 2017, 28 May 2018, and 28 January 2019. Among six identified clusters, we classified a core regional hotspot in Sana’a, Sana’a City, and Al-Hudaydah—the expected origin of the national outbreak. The five additional clusters differed in Wave 2 and Wave 3 peak frequency, timing, magnitude, and geographic location. As of 29 December 2019, no governorates had returned to pre-Wave 1 levels. The detected similarity in outbreak signatures suggests potentially shared environmental and human-made drivers of infection; the heterogeneity in outbreak signatures implies the potential traveling waves outwards from the core regional hotspot that could be governed by factors that deserve further investigation.
Collapse
Affiliation(s)
- Ryan B. Simpson
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA; (P.M.K.); (M.A.H.)
- Correspondence: (R.B.S.); (E.N.N.); Tel.: +1-978-697-1037 (R.B.S.); +1-617-636-2927 (E.N.N.)
| | - Sofia Babool
- Department of Neuroscience, The University of Texas at Dallas, 800 W Campbell Road, Richardson, TX 75080, USA;
| | - Maia C. Tarnas
- Department of Community Health, School of Arts and Sciences, Tufts University, 574 Boston Avenue, Medford, MA 02155, USA;
| | - Paulina M. Kaminski
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA; (P.M.K.); (M.A.H.)
| | - Meghan A. Hartwick
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA; (P.M.K.); (M.A.H.)
| | - Elena N. Naumova
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA; (P.M.K.); (M.A.H.)
- Correspondence: (R.B.S.); (E.N.N.); Tel.: +1-978-697-1037 (R.B.S.); +1-617-636-2927 (E.N.N.)
| |
Collapse
|
25
|
Sikder M, Altare C, Doocy S, Trowbridge D, Kaur G, Kaushal N, Lyles E, Lantagne D, Azman AS, Spiegel P. Case-area targeted preventive interventions to interrupt cholera transmission: Current implementation practices and lessons learned. PLoS Negl Trop Dis 2021; 15:e0010042. [PMID: 34919551 PMCID: PMC8719662 DOI: 10.1371/journal.pntd.0010042] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/31/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cholera is a major cause of mortality and morbidity in low-resource and humanitarian settings. It is transmitted by fecal-oral route, and the infection risk is higher to those living in and near cholera cases. Rapid identification of cholera cases and implementation of measures to prevent subsequent transmission around cases may be an efficient strategy to reduce the size and scale of cholera outbreaks. METHODOLOGY/PRINCIPLE FINDINGS We investigated implementation of cholera case-area targeted interventions (CATIs) using systematic reviews and case studies. We identified 11 peer-reviewed and eight grey literature articles documenting CATIs and completed 30 key informant interviews in case studies in Democratic Republic of Congo, Haiti, Yemen, and Zimbabwe. We documented 15 outbreaks in 12 countries where CATIs were used. The team composition and the interventions varied, with water, sanitation, and hygiene interventions implemented more commonly than those of health. Alert systems triggering interventions were diverse ranging from suspected cholera cases to culture confirmed cases. Selection of high-risk households around the case household was inconsistent and ranged from only one case to approximately 100 surrounding households with different methods of selecting them. Coordination among actors and integration between sectors were consistently reported as challenging. Delays in sharing case information impeded rapid implementation of this approach, while evaluation of the effectiveness of interventions varied. CONCLUSIONS/SIGNIFICANCE CATIs appear effective in reducing cholera outbreaks, but there is limited and context specific evidence of their effectiveness in reducing the incidence of cholera cases and lack of guidance for their consistent implementation. We propose to 1) use uniform cholera case definitions considering a local capacity to trigger alert; 2) evaluate the effectiveness of individual or sets of interventions to interrupt cholera, and establish a set of evidence-based interventions; 3) establish criteria to select high-risk households; and 4) improve coordination and data sharing amongst actors and facilitate integration among sectors to strengthen CATI approaches in cholera outbreaks.
Collapse
Affiliation(s)
- Mustafa Sikder
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Chiara Altare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Shannon Doocy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Daniella Trowbridge
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Gurpreet Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Natasha Kaushal
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Emily Lyles
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Daniele Lantagne
- Consultant, Public Health Engineer, Boston, Massachusetts, United States of America
| | - Andrew S. Azman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Paul Spiegel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America
- * E-mail:
| |
Collapse
|
26
|
Pediatric Infectious Diseases Encountered During Wartime-Part 1: Experiences and Lessons Learned From Armed Conflict in the Modern Era. Curr Infect Dis Rep 2021; 23:27. [PMID: 34903952 PMCID: PMC8656442 DOI: 10.1007/s11908-021-00770-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
Purpose of Review Armed conflicts occur globally, with some regions experiencing heightened instability for many years. A better understanding of the infectious disease impact on children in armed conflict will allow aid organizations to anticipate and mitigate the most serious problems. Recent Findings Armed conflicts are estimated to have caused approximately 30 million civilian deaths during the past 27 years, with two-thirds occurring in women and children. Children are extremely vulnerable to the mass population displacements, experiencing a combined loss of safety, nutrition, shelter, hygiene, and health care. Under these circumstances, the emergence and prevalence of multiple infectious diseases can result in heightened morbidity and mortality long after active conflict ceases. Summary Factors leading to increased infectious diseases in populations in crisis due to armed conflict and lessons learned from recent outbreaks are discussed in detail. Acute respiratory infections, diphtheria, measles, varicella, and cholera are a few of the more common infectious diseases that take advantage of populations displaced or disrupted by conflict. Key issues include the ability of countries or non-governmental organizations (NGOs) to keep up with basic childhood immunizations, and how rapidly disease outbreaks are recognized and addressed with disease-specific interventions.
Collapse
|
27
|
Al Serouri AA, Ghaleb YA, Al Aghbari LA, Al Amad MA, Alkohlani AS, Almoayed KA, Jumaan AO. Field Epidemiology Training Program Response to COVID-19 During a Conflict: Experience From Yemen. Front Public Health 2021; 9:688119. [PMID: 34881214 PMCID: PMC8646099 DOI: 10.3389/fpubh.2021.688119] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
COVID-19 pandemic has underscored the need for a well-trained public health workforce to save lives through timely outbreaks detection and response. In Yemen, a country that is entering its seventh year of a protracted war, the ongoing conflict severely limited the country's capacity to implement effective preparedness and response measures to outbreaks including COVID-19. There are growing concerns that the virus may be circulating within communities undetected and unmitigated especially as underreporting continues in some areas of the country due to a lack of testing facilities, delays in seeking treatment, stigma, difficulty accessing treatment centers, the perceived risks of seeking care or for political issues. The Yemen Field Epidemiology Training Program (FETP) was launched in 2011 to address the shortage of a skilled public health workforce, with the objective of strengthening capacity in field epidemiology. Thus, events of public health importance can be detected and investigated in a timely and effective manner. During the COVID-19 pandemic, the Yemen FETP's response has been instrumental through participating in country-level coordination, planning, monitoring, and developing guidelines/standard operating procedures and strengthening surveillance capacities, outbreak investigations, contact tracing, case management, infection prevention, and control, risk communication, and research. As the third wave is circulating with a steeper upward curve than the previous ones with possible new variants, the country will not be able to deal with a surge of cases as secondary care is extremely crippled. Since COVID-19 prevention and control are the only option available to reduce its grave impact on morbidity and mortality, health partners should support the Yemen FETP to strengthen the health system's response to future epidemics. One important lesson learned from the COVID-19 pandemic, especially in the Yemen context and applicable to developing and war-torn countries, is that access to outside experts becomes limited, therefore, it is crucial to invest in building national expertise to provide timely, cost-effective, and sustainable services that are culturally appropriate. It is also essential to build such expertise at the governorate and district levels, as they are normally the first respondents, and to provide them with the necessary tools for immediate response in order to overcome the disastrous delays.
Collapse
Affiliation(s)
| | - Yasser Ahmed Ghaleb
- Field Epidemiology Training Program, Ministry of Public Health and Population, Sana'a, Yemen
| | - Labiba Anam Al Aghbari
- Field Epidemiology Training Program, Ministry of Public Health and Population, Sana'a, Yemen
| | | | | | - Khaled Abdullah Almoayed
- General Directorate for Disease Surveillance and Control, Ministry of Public Health and Population, Sana'a, Yemen
| | | |
Collapse
|
28
|
Erdem R, Ambler G, Al-Ibrahim M, Fraczek K, Dong SD, Gast C, Mercer LD, Raine M, Tennant SM, Chen WH, de Hostos EL, Choy RKM. A Phase 2a randomized, single-center, double-blind, placebo-controlled study to evaluate the safety and preliminary efficacy of oral iOWH032 against cholera diarrhea in a controlled human infection model. PLoS Negl Trop Dis 2021; 15:e0009969. [PMID: 34793441 PMCID: PMC8639072 DOI: 10.1371/journal.pntd.0009969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/02/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
Cholera remains a major cause of infectious diarrhea globally. Despite the increased availability of cholera vaccines, there is still an urgent need for other effective interventions to reduce morbidity and mortality. Furthermore, increased prevalence of antibiotic-resistant Vibrio cholerae threatens the use of many drugs commonly used to treat cholera. We developed iOWH032, a synthetic small molecule inhibitor of the cystic fibrosis transmembrane conductance regulator chloride channel, as an antisecretory, host-directed therapeutic for cholera. In the study reported here, we tested iOWH032 in a Phase 2a cholera controlled human infection model. Forty-seven subjects were experimentally infected with V. cholerae El Tor Inaba strain N16961 in an inpatient setting and randomized to receive 500 mg iOWH032 or placebo by mouth every 8 hours for 3 days to determine the safety and efficacy of the compound as a potential treatment for cholera. We found that iOWH032 was generally safe and achieved a mean (± standard deviation) plasma level of 4,270 ng/mL (±2,170) after 3 days of oral dosing. However, the median (95% confidence interval) diarrheal stool output rate for the iOWH032 group was 25.4 mL/hour (8.9, 58.3), compared to 32.6 mL/hour (15.8, 48.2) for the placebo group, a reduction of 23%, which was not statistically significant. There was also no significant decrease in diarrhea severity and number or frequency of stools associated with iOWH032 treatment. We conclude that iOWH032 does not merit future development for treatment of cholera and offer lessons learned for others developing antisecretory therapeutic candidates that seek to demonstrate proof of principle in a cholera controlled human infection model study. Trial registration: This study is registered with ClinicalTrials.gov as NCT04150250. Cholera, a disease caused by infection with the bacterium Vibrio cholerae, remains a major cause of diarrheal illness and death, particularly in settings with poor sanitation and hygiene. We developed a synthetic chemical, named “iOWH032,” as a potential treatment for cholera, which is administered as oral tablets. The chemical acts by blocking secretions from cells in the intestine, and thereby was expected to prevent fluid loss and dehydration caused by cholera illness. We tested iOWH032 in a clinical study using a cholera human challenge model. Study volunteers were intentionally infected with V. cholerae in an inpatient clinic setting to better study the effects of iOWH032 on infected individuals. This challenge model had been used previously to test cholera vaccine candidates, but this study represents the first test of a potential cholera treatment using the model. We found that treatment of individuals with iOWH032 was safe, but did not result in a significant reduction of cholera illness, based on several different measurements of diarrheal symptoms and severity. This study demonstrates how human challenge models incorporating a relatively small number of subjects can help support decision-making about potential new therapeutics and other interventions for infectious diseases.
Collapse
Affiliation(s)
- Rahsan Erdem
- PATH, Seattle, Washington, United States of America
| | - Gwen Ambler
- PATH, Seattle, Washington, United States of America
| | | | | | | | | | | | | | - Sharon M. Tennant
- Center for Vaccine Development and Global Health, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Wilbur H. Chen
- Center for Vaccine Development and Global Health, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | | | | |
Collapse
|
29
|
D'Mello-Guyett L, Cumming O, Bonneville S, D'hondt R, Mashako M, Nakoka B, Gorski A, Verheyen D, Van den Bergh R, Welo PO, Maes P, Checchi F. Effectiveness of hygiene kit distribution to reduce cholera transmission in Kasaï-Oriental, Democratic Republic of Congo, 2018: a prospective cohort study. BMJ Open 2021; 11:e050943. [PMID: 34649847 PMCID: PMC8522665 DOI: 10.1136/bmjopen-2021-050943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Household contacts of cholera cases are at a greater risk of Vibrio cholerae infection than the general population. There is currently no agreed standard of care for household contacts, despite their high risk of infection, in cholera response strategies. In 2018, hygiene kit distribution and health promotion was recommended by Médecins Sans Frontières for admitted patients and accompanying household members on admission to a cholera treatment unit in the Democratic Republic of Congo. METHODS To investigate the effectiveness of the intervention and risk factors for cholera infection, we conducted a prospective cohort study and followed household contacts for 7 days after patient admission. Clinical surveillance among household contacts was based on self-reported symptoms of cholera and diarrhoea, and environmental surveillance through the collection and analysis of food and water samples. RESULTS From 94 eligible households, 469 household contacts were enrolled and 444 completed follow-up. Multivariate analysis suggested evidence of a dose-response relationship with increased kit use associated with decreased relative risk of suspected cholera: household contacts in the high kit-use group had a 66% lower incidence of suspected cholera (adjusted risk ratio (aRR) 0.34, 95% CI 0.11 to 1.03, p=0.055), the mid-use group had a 53% lower incidence (aRR 0.47, 95% CI 0.17 to 1.29, p=1.44) and low-use group had 22% lower incidence (aRR 0.78, 95% CI 0.24 to 2.53, p=0.684), compared with household contacts without a kit. Drinking water contamination was significantly reduced among households in receipt of a kit. There was no significant effect on self-reported diarrhoea or food contamination. CONCLUSION The integration of a hygiene kit intervention to case-households may be effective in reducing cholera transmission among household contacts and environmental contamination within the household. Further work is required to evaluate whether other proactive localised distribution among patients and case-households or to households surrounding cholera cases can be used in future cholera response programmes in emergency contexts.
Collapse
Affiliation(s)
- Lauren D'Mello-Guyett
- London School of Hygiene & Tropical Medicine, London, UK
- Médecins Sans Frontières, Brussels, Belgium
| | - Oliver Cumming
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Yates T, Zannat H, Khandaker N, Porteaud D, Bouvet F, Lantagne D. Evidence summary of water, sanitation, and hygiene (WASH) coordination in humanitarian response. DISASTERS 2021; 45:913-938. [PMID: 32845023 DOI: 10.1111/disa.12463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Providing water, sanitation, and hygiene (WASH) to emergency-affected populations is necessary for reasons of dignity and disease control. Such a (humanitarian) response is coordinated via the 'cluster approach'. This study utilises a literature review, an appraisal of and analysis of Global WASH Cluster (GWC) documentation, and key informant interviews to summarise the outcomes and impacts of GWC coordination. Across these three datasets, consistent themes were identified, including: the cluster approach evolving into a cost-effective 'best-fit' model; cluster staff requiring technical and coordination skills; and cluster members facing participation-related trade-offs. Consistent intractable difficulties were pinpointed, too, such as: accountability to beneficiaries; cross-cluster and subnational cluster coordination; and working with national governments. Previous research was found to be largely subjective and not to address future cluster challenges. An analysis of cluster outcomes and impacts, including member and beneficiary perspectives, is needed. To facilitate this work, a theory of change for cluster coordination was also developed.
Collapse
Affiliation(s)
- Travis Yates
- Postdoctoral Scholar at Tufts University, United States
| | - Hur Zannat
- Research Assistant at Tufts University, United States
| | | | - Dominique Porteaud
- Global WASH Cluster Coordinator at the United Nations Children's Fund (UNICEF), Switzerland
| | - Franck Bouvet
- Deputy Global WASH Cluster Coordinator at UNICEF, Switzerland
| | | |
Collapse
|
31
|
Islam MT, Khan AI, Khan ZH, Tanvir NA, Ahmmed F, Afrad MMH, Begum YA, Kim M, Hasan ASMM, Vandenent M, Uzzaman MS, Shirin T, Clemens JD, Qadri F. Acute watery diarrhea surveillance during the Rohingya Crisis 2017-2019 in Cox's Bazar, Bangladesh. J Infect Dis 2021; 224:S717-S724. [PMID: 34528689 PMCID: PMC8687071 DOI: 10.1093/infdis/jiab453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Forcibly Displaced Myanmar Nationals fled into Cox's Bazar, Bangladesh due to internal conflict. Considering the public health situation, a surveillance network was established to identify the enteric pathogens and early detection of cholera epidemics. Purpose of this manuscript is to report the clinical, epidemiological determinants of cholera and other enteric pathogens among hospitalized diarrhoeal patients from FDMNs and host community. METHODOLOGY A total of 11 sentinel surveillance sites were established around the camps in Ukhia and Teknaf Upazila, Cox's Bazar. Rapid diagnostic testing was conducted for immediate detection of cholera cases. Stool samples were transferred to the icddr,b laboratory for culture. RESULT A total of 8134 participants with diarrhea were enrolled from 2017- 2019: 4881 were FDMNs and 3253 from the Bangladeshi host community. Among the FDMNs, the proportion of V. cholerae 0.7%, ETEC 4.9% and Shigella 1.5%. The distributions from host community were 1.2% V. cholerae, 1.8% ETEC and 1.1% Shigella. Similar risk factors have been identified for the diarrhoeal pathogens for both communities. CONCLUSION This surveillance helped to monitor the situation of diarrheal diseases including cholera in refugee camps as well as in the neighboring host community. These findings lead policy makers to take immediate preventive measures.
Collapse
Affiliation(s)
- Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.,School of Medical Science, Griffith University, Gold Coast, Australia
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zahid Hasan Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nabid Anjum Tanvir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Faisal Ahmmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Mokibul Hassan Afrad
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Yasmin Ara Begum
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Minjoon Kim
- Health section, The United Nations Children's Fund (UNICEF), Dhaka, Bangladesh
| | - A S M Mainul Hasan
- Health section, The United Nations Children's Fund (UNICEF), Dhaka, Bangladesh
| | - Maya Vandenent
- Health section, The United Nations Children's Fund (UNICEF), Dhaka, Bangladesh
| | - M Salim Uzzaman
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - John D Clemens
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.,International Vaccine Institute, Seoul, Republic of Korea.,UCLA Fielding School of Public Health, Los Angeles, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
32
|
Baaees MSO, Naiene JD, Al-Waleedi AA, Bin-Azoon NS, Khan MF, Mahmoud N, Musani A. Community-based surveillance in internally displaced people's camps and urban settings during a complex emergency in Yemen in 2020. Confl Health 2021; 15:54. [PMID: 34225760 PMCID: PMC8256204 DOI: 10.1186/s13031-021-00394-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/29/2021] [Indexed: 12/28/2022] Open
Abstract
Background The need for early identification of coronavirus disease (COVID-19) cases in communities was high in Yemen during the first wave of the COVID-19 epidemic because most cases presenting to health facilities were severe. Early detection of cases would allow early interventions to interrupt the transmission chains. This study aimed to describe the implementation of community-based surveillance (CBS) in in internally displaced people (IDP) camps and urban settings in Yemen from 15 April 2020 to 30 September 2020. Methods Following the Centers for Disease Control and Prevention guidance for evaluation of surveillance systems, we assessed the usefulness and acceptability of CBS. For acceptability, we calculated the proportion of trained volunteers who reported disease alerts. To assess the usefulness, we compared the alerts reported through the electronic diseases early warning system (eDEWS) with the alerts reported through CBS and described the response activities implemented. Results In Al-Mukalla City, 18% (14/78) of the volunteers reported at least one alert. In IDP camps, 58% (18/31) of volunteers reported at least one alert. In Al-Mukalla City, CBS detected 49 alerts of influenza-like illness, whereas health facilities detected 561 cases of COVID-19. In IDP camps, CBS detected 91 alerts of influenza-like illness, compared to 10 alerts detected through eDEWS. In IDP camps, CBS detected three other syndromes besides influenza-like illness (febrile illness outbreak suspicion, acute diarrhoea, and skin disease). In IDP camps, public health actions were implemented for each disease detected and no further cases were reported. Conclusions In Yemen, CBS was useful for detecting suspected outbreaks in IDP camps. CBS implementation did not yield expected results in general communities in urban areas in the early stage of the COVID-19 pandemic when little was known about the disease. In the urban setting, the system failed to detect suspected COVID-19 cases and other diseases despite the ongoing outbreaks reported through eDEWS. In Yemen, as in other countries, feasibility and acceptability studies should be conducted few months before CBS expansion in urban communities. The project should be expanded in IDP camps, by creating COVID-19 and other disease outbreak reporting sites. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00394-1.
Collapse
|
33
|
Abbara A, Zakieh O, Rayes D, Collin SM, Almhawish N, Sullivan R, Aladhan I, Tarnas M, Whalen-Browne M, Omar M, Tarakji A, Karah N. Weaponizing water as an instrument of war in Syria: Impact on diarrhoeal disease in Idlib and Aleppo governorates, 2011-2019. Int J Infect Dis 2021; 108:202-208. [PMID: 34010668 PMCID: PMC9972299 DOI: 10.1016/j.ijid.2021.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Investigate the weaponization of water during the Syrian conflict and the correlation of attacks on water, sanitation, and hygiene (WASH) infrastructure in Idlib and Aleppo governorates with trends in waterborne diseases reported by Early Warning and Response surveillance systems. METHODS We reviewed literature and databases to obtain information on attacks on WASH in Aleppo and Idlib governorates between 2011 and 2019. We plotted weekly trends in waterborne diseases from two surveillance systems operational in Aleppo and Idlib governorates between 2015 and early 2020. RESULTS The literature review noted several attacks on water and related infrastructure in both governorates, suggesting that WASH infrastructure was weaponized by state and non-state actors. Most interference with WASH in the Aleppo governorate occurred before 2019 and in the Idlib governorate in the summer of 2020. Other acute diarrhea represented >90% of cases of diarrhea; children under 5 years contributed 50% of cases. There was substantial evidence (p < 0.001) of an overall upward trend in cases of diarrheal disease. CONCLUSIONS Though no direct correlation can be drawn between the weaponization of WASH and the burden of waterborne infections due to multiple confounders, this research introduces important concepts on attacks on WASH and their potential impacts on waterborne diseases.
Collapse
Affiliation(s)
- Aula Abbara
- Imperial College, London, UK; Syria Public Health Network, UK.
| | | | - Diana Rayes
- Syria Public Health Network, UK,Johns Hopkins, USA
| | | | | | | | | | - Maia Tarnas
- Community Research Initiative, Charlestown, MA, USA
| | | | | | | | | |
Collapse
|
34
|
Bragança Lima MV, Hinderaker SG, Ogundipe OF, Owiti PO, Kadai B, Maikere J. Association between cholera treatment outcome and nutritional status in children aged 2-4 years in Nigeria. Public Health Action 2021; 11:80-84. [PMID: 34159067 DOI: 10.5588/pha.20.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Cholera can aggravate or precipitate malnutrition, and children with severe acute malnutrition (SAM) have a higher incidence and longer duration of diarrhoea. OBJECTIVE To describe 1) characteristics of and treatment outcomes in children aged 2-4 years with cholera, 2) the case fatality rate (CFR) in all children treated, and 3) the associations between nutritional status, hydration status, treatment administered and hospital outcomes. DESIGN An observational cohort study of children admitted to one cholera treatment centre in Maiduguri, Nigeria, with a focus on children aged 2-4 years. CFRs were examined by cross tabulation and mean length of stay (LOS) using analysis of variance. RESULTS SAM was identified in 24% of children aged 2-4 years. The CFR for children aged 2-4 years was 1.4%. As the sample size was small, we did not find any association between nutritional status and death due to cholera. The proportion of children discharged within 2 days was 79%, and the longest stay was 8 days. In general, health facility LOS increased with severity of malnutrition. CONCLUSION Our study found that nutritional status affected the LOS, but was unable to find an association between malnutrition and fatality among children aged 2-4 years.
Collapse
Affiliation(s)
- M V Bragança Lima
- Operational Centre Brussels, Médecins sans Frontières, Brussels, Belgium
| | | | - O F Ogundipe
- Operational Centre Brussels, Médecins sans Frontières, Brussels, Belgium
| | - P O Owiti
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - B Kadai
- Planning, Research & Statistics Department, Ministry of Health, Borno State, Maiduguri, Nigeria
| | - J Maikere
- Operational Centre Brussels, Médecins sans Frontières, Brussels, Belgium
| |
Collapse
|
35
|
Wise PH, Shiel A, Southard N, Bendavid E, Welsh J, Stedman S, Fazal T, Felbab-Brown V, Polatty D, Waldman RJ, Spiegel PB, Blanchet K, Dayoub R, Zakayo A, Barry M, Martinez Garcia D, Pagano H, Black R, Gaffey MF, Bhutta ZA. The political and security dimensions of the humanitarian health response to violent conflict. Lancet 2021; 397:511-521. [PMID: 33503458 DOI: 10.1016/s0140-6736(21)00130-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
The nature of armed conflict throughout the world is intensely dynamic. Consequently, the protection of non-combatants and the provision of humanitarian services must continually adapt to this changing conflict environment. Complex political affiliations, the systematic use of explosive weapons and sexual violence, and the use of new communication technology, including social media, have created new challenges for humanitarian actors in negotiating access to affected populations and security for their own personnel. The nature of combatants has also evolved as armed, non-state actors might have varying motivations, use different forms of violence, and engage in a variety of criminal activities to generate requisite funds. New health threats, such as the COVID-19 pandemic, and new capabilities, such as modern trauma care, have also created new challenges and opportunities for humanitarian health provision. In response, humanitarian policies and practices must develop negotiation and safety capabilities, informed by political and security realities on the ground, and guidance from affected communities. More fundamentally, humanitarian policies will need to confront a changing geopolitical environment, in which traditional humanitarian norms and protections might encounter wavering support in the years to come.
Collapse
Affiliation(s)
- Paul H Wise
- Department of Pediatrics, Stanford University, CA, USA; Center for Innovation in Global Health, Stanford University, CA, USA; Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA.
| | - Annie Shiel
- Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA; Center for Civilians in Conflict, Washington DC, USA
| | - Nicole Southard
- Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | - Eran Bendavid
- Center for Innovation in Global Health, Stanford University, CA, USA; Department of Medicine, Stanford University, CA, USA; Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | - Jennifer Welsh
- Department of Political Science, McGill University, Montreal, QC, Canada
| | - Stephen Stedman
- Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | - Tanisha Fazal
- Department of Political Science, University of Minnesota, Minneapolis, MN, USA
| | - Vanda Felbab-Brown
- The Initiative on Nonstate Armed Actors, Foreign Policy Program, The Brookings Institution, Washington DC, USA
| | - David Polatty
- Civilian-Military Humanitarian Response Program, United States Naval War College, Newport, RI, USA
| | - Ronald J Waldman
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Paul B Spiegel
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karl Blanchet
- Geneva Centre for Education and Research in Humanitarian Action, University of Geneva, Geneva, Switzerland; Health and Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Rita Dayoub
- Centre on Global Health Security, Chatham House, London, UK
| | | | - Michele Barry
- Center for Innovation in Global Health, Stanford University, CA, USA; Department of Medicine, Stanford University, CA, USA; Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | | | | | - Robert Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
| |
Collapse
|
36
|
Ratnayake R, Finger F, Edmunds WJ, Checchi F. Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes. BMC Med 2020; 18:397. [PMID: 33317544 PMCID: PMC7737284 DOI: 10.1186/s12916-020-01865-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Cholera epidemics continue to challenge disease control, particularly in fragile and conflict-affected states. Rapid detection and response to small cholera clusters is key for efficient control before an epidemic propagates. To understand the capacity for early response in fragile states, we investigated delays in outbreak detection, investigation, response, and laboratory confirmation, and we estimated epidemic sizes. We assessed predictors of delays, and annual changes in response time. METHODS We compiled a list of cholera outbreaks in fragile and conflict-affected states from 2008 to 2019. We searched for peer-reviewed articles and epidemiological reports. We evaluated delays from the dates of symptom onset of the primary case, and the earliest dates of outbreak detection, investigation, response, and confirmation. Information on how the outbreak was alerted was summarized. A branching process model was used to estimate epidemic size at each delay. Regression models were used to investigate the association between predictors and delays to response. RESULTS Seventy-six outbreaks from 34 countries were included. Median delays spanned 1-2 weeks: from symptom onset of the primary case to presentation at the health facility (5 days, IQR 5-5), detection (5 days, IQR 5-6), investigation (7 days, IQR 5.8-13.3), response (10 days, IQR 7-18), and confirmation (11 days, IQR 7-16). In the model simulation, the median delay to response (10 days) with 3 seed cases led to a median epidemic size of 12 cases (upper range, 47) and 8% of outbreaks ≥ 20 cases (increasing to 32% with a 30-day delay to response). Increased outbreak size at detection (10 seed cases) and a 10-day median delay to response resulted in an epidemic size of 34 cases (upper range 67 cases) and < 1% of outbreaks < 20 cases. We estimated an annual global decrease in delay to response of 5.2% (95% CI 0.5-9.6, p = 0.03). Outbreaks signaled by immediate alerts were associated with a reduction in delay to response of 39.3% (95% CI 5.7-61.0, p = 0.03). CONCLUSIONS From 2008 to 2019, median delays from symptom onset of the primary case to case presentation and to response were 5 days and 10 days, respectively. Our model simulations suggest that depending on the outbreak size (3 versus 10 seed cases), in 8 to 99% of scenarios, a 10-day delay to response would result in large clusters that would be difficult to contain. Improving the delay to response involves rethinking the integration at local levels of event-based detection, rapid diagnostic testing for cluster validation, and integrated alert, investigation, and response.
Collapse
Affiliation(s)
- Ruwan Ratnayake
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. .,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK. .,Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - W John Edmunds
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
37
|
Ratnayake R, Finger F, Azman AS, Lantagne D, Funk S, Edmunds WJ, Checchi F. Highly targeted spatiotemporal interventions against cholera epidemics, 2000-19: a scoping review. THE LANCET. INFECTIOUS DISEASES 2020; 21:e37-e48. [PMID: 33096017 DOI: 10.1016/s1473-3099(20)30479-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/27/2020] [Accepted: 05/19/2020] [Indexed: 01/12/2023]
Abstract
Globally, cholera epidemics continue to challenge disease control. Although mass campaigns covering large populations are commonly used to control cholera, spatial targeting of case households and their radius is emerging as a potentially efficient strategy. We did a Scoping Review to investigate the effectiveness of interventions delivered through case-area targeted intervention, its optimal spatiotemporal scale, and its effectiveness in reducing transmission. 53 articles were retrieved. We found that antibiotic chemoprophylaxis, point-of-use water treatment, and hygiene promotion can rapidly reduce household transmission, and single-dose vaccination can extend the duration of protection within the radius of households. Evidence supports a high-risk spatiotemporal zone of 100 m around case households, for 7 days. Two evaluations separately showed reductions in household transmission when targeting case households, and in size and duration of case clusters when targeting radii. Although case-area targeted intervention shows promise for outbreak control, it is critically dependent on early detection capacity and requires prospective evaluation of intervention packages.
Collapse
Affiliation(s)
- Ruwan Ratnayake
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Andrew S Azman
- Department of Epidemiology and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Médecins Sans Frontières, Geneva, Switzerland
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
38
|
Ratnayake R, Tammaro M, Tiffany A, Kongelf A, Polonsky JA, McClelland A. People-centred surveillance: a narrative review of community-based surveillance among crisis-affected populations. Lancet Planet Health 2020; 4:e483-e495. [PMID: 33038321 PMCID: PMC7542093 DOI: 10.1016/s2542-5196(20)30221-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
Outbreaks of disease in settings affected by crises grow rapidly due to late detection and weakened public health systems. Where surveillance is underfunctioning, community-based surveillance can contribute to rapid outbreak detection and response, a core capacity of the International Health Regulations. We reviewed articles describing the potential for community-based surveillance to detect diseases of epidemic potential, outbreaks, and mortality among populations affected by crises. Surveillance objectives have included the early warning of outbreaks, active case finding during outbreaks, case finding for eradication programmes, and mortality surveillance. Community-based surveillance can provide sensitive and timely detection, identify valid signals for diseases with salient symptoms, and provide continuity in remote areas during cycles of insecurity. Effectiveness appears to be mediated by operational requirements for continuous supervision of large community networks, verification of a large number of signals, and integration of community-based surveillance within the routine investigation and response infrastructure. Similar to all community health systems, community-based surveillance requires simple design, reliable supervision, and early and routine monitoring and evaluation to ensure data validity. Research priorities include the evaluation of syndromic case definitions, electronic data collection for community members, sentinel site designs, and statistical techniques to counterbalance false positive signals.
Collapse
Affiliation(s)
- Ruwan Ratnayake
- International Rescue Committee, New York, NY, USA; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Meghan Tammaro
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Jonathan A Polonsky
- World Health Organization, Geneva, Switzerland; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Amanda McClelland
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| |
Collapse
|
39
|
Kimball AM, Jumaan A. Yemen: the challenge of delivering aid in an active conflict zone. GLOBAL SECURITY: HEALTH, SCIENCE AND POLICY 2020. [DOI: 10.1080/23779497.2020.1814162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Ann Marie Kimball
- School of Public Health, University of Washington, Seattle, Washington, USA
- Chatham House, London, UK
- Yemen Relief and Reconstruction Foundation, Mercer Island, WA, USA
| | - Aisha Jumaan
- Yemen Relief and Reconstruction Foundation, Mercer Island, WA, USA
| |
Collapse
|
40
|
Horizontal Coordination of I-LNGOs in the Humanitarian Supply Chain: An Evolutionary Game Approach. SUSTAINABILITY 2020. [DOI: 10.3390/su12155953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Disasters accompanied by heavy casualties and huge economic losses directly result in the disruption or delay of economic development. Considering the urgent need for reducing losses and accelerating the process of social recovery, international nongovernment organizations (INGOs) and local NGOs (LNGOs) with different resource endowments should achieve organizational coordination to improve the relief efficiency and sustainability of the humanitarian supply chain. Due to conflicting interests and expectations, this coordination is hard to achieve. In this study, we first establish an evolutionary game model between INGOs and LNGOs to determine the influencing factors and explore the interaction of NGOs in a dynamic way. Our results show that: (1) coordination by resource sharing can improve the sustainability of the humanitarian supply chain; (2) coordination willingness is affected by the behavior of other players, which can nevertheless achieve equilibrium under certain conditions; and (3) the important factors and optimal strategies of players are highlighted in the dynamic model. This study provides several insights into the theory of organizational coordination in the humanitarian supply chain regarding sustainability.
Collapse
|
41
|
Ngwa MC, Wondimagegnehu A, Okudo I, Owili C, Ugochukwu U, Clement P, Devaux I, Pezzoli L, Ihekweazu C, Jimme MA, Winch P, Sack DA. The multi-sectorial emergency response to a cholera outbreak in Internally Displaced Persons camps in Borno State, Nigeria, 2017. BMJ Glob Health 2020; 5:e002000. [PMID: 32133173 PMCID: PMC7042583 DOI: 10.1136/bmjgh-2019-002000] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 01/24/2023] Open
Abstract
Introduction In August 2017, a cholera outbreak started in Muna Garage Internally Displaced Persons camp, Borno state, Nigeria and >5000 cases occurred in six local government areas. This qualitative study evaluated perspectives about the emergency response to this outbreak. Methods We conducted 39 key informant interviews and focus group discussions, and reviewed 21 documents with participants involved with surveillance, water, sanitation, hygiene, case management, oral cholera vaccine (OCV), communications, logistics and coordination. Qualitative data analysis used thematic techniques comprising key words in context, word repetition and key sector terms. Results Authorities were alerted quickly, but outbreak declaration took 12 days due to a 10-day delay waiting for culture confirmation. Outbreak investigation revealed several potential transmission channels, but a leaking latrine around the index cases' house was not repaired for more than 7 days. Chlorine was initially not accepted by the community due to rumours that it would sterilise women. Key messages were in Hausa, although Kanuri was the primary local language; later this was corrected. Planning would have benefited using exercise drills to identify weaknesses, and inventory sharing to avoid stock outs. The response by the Rural Water Supply and Sanitation Agency was perceived to be slow and an increased risk from a religious festival was not recognised. Case management was provided at treatment centres, but some partners were concerned that their work was not recognised asking, 'Who gets the glory and the data?' Nearly one million people received OCV and its distribution benefited from a robust infrastructure for polio vaccination. There was initial anxiety, rumour and reluctance about OCV, attributed by many to lack of formative research prior to vaccine implementation. Coordination was slow initially, but improved with activation of an emergency operations centre (EOC) that enabled implementation of incident management system to coordinate multisectoral activities and meetings held at 16:00 hours daily. The synergy between partners and government improved when each recognised the government's leadership role. Conclusion Despite a timely alert of the outbreak, delayed laboratory confirmation slowed initial response. Initial responses to the outbreak were not well coordinated but improved with the EOC. Understanding behaviours and community norms through rapid formative research should improve the effectiveness of the emergency response to a cholera outbreak. OCV distribution was efficient and benefited from the polio vaccine infrastructure.
Collapse
Affiliation(s)
- Moise Chi Ngwa
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Ifeanyi Okudo
- World Health Organisation, Nigeria Country Office, Abuja, Nigeria
| | - Collins Owili
- World Health Organisation, Nigeria Country Office, Abuja, Nigeria
| | - Uzoma Ugochukwu
- World Health Organisation, Nigeria Country Office, Abuja, Nigeria
| | - Peter Clement
- World Health Organisation, Nigeria Country Office, Abuja, Nigeria
| | | | | | | | - Mohammed Abba Jimme
- Geography, University of Maiduguri Faculty of Social Science, Maiduguri, Nigeria
| | - Peter Winch
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David A Sack
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|