Home treatment and use of informal market of pharmaceutical drugs for the management of paediatric malaria in Cotonou, Benin

Factors influencing fever care-seeking for children under five years of age in The Gambia: a secondary analysis of 2019-20 DHS data

BACKGROUND

Malaria contributes to excess child mortality in The Gambia. Children under five are at risk of severe malaria and death if not treated promptly and appropriately. It is crucial that a child with fever receive appropriate care from a trained provider. The aim was to identify influences on child fever care-seeking in The Gambia to inform malaria control strategies.

METHODS

This cross-sectional analysis of The Gambia 2019-20 Demographic and Health Survey used logistic regression analysis to identify associations between source of care for a child with fever (public or private healthcare provider, other, or no treatment) and mother, child, and household characteristics.

RESULTS

Only 52.0% of mothers sought care from a trained healthcare provider for a child with fever-45.1% from a public facility and 7.0% from the private sector. 35.2% of mothers did not seek treatment. Mothers in urban households were 2.67 times as likely (aOR, 95% CI 1.504-4.736) as mothers in rural households to seek care from an informal source (e.g., pharmacy) versus not seeking treatment, and 0.29 times as likely (aOR, 95% CI 0.165-0.515) as mothers in rural households to seek care from a public provider versus informal source. Mothers in wealthier households were 2.30 times as likely (aOR, 95% CI 1.274-4.164) as mothers in poorer households to seek care from an informal source versus no treatment and half as likely as mothers in poorer households to seek care from a public provider versus informal source (aOR 0.53, 95% CI 0.291-0.959).

CONCLUSIONS

Maintaining The Gambia's malaria control achievements will require the active engagement and oversight of private pharmacies along with continued integrated community case management to reach mothers who do not seek care for a child with fever, and remove challenges to seeking appropriate care from trained providers. Whether influenced by convenience, costs, perceived urgency, or other factors, given the likelihood of urban mothers and mothers in wealthier households to seek care from private pharmacies, it will be necessary to incorporate private pharmacies into malaria control strategies while building public sector capacity and workforce, and initiating more effective attitude and behavioural change among mothers and households.

Susceptibility antibiotic screening reveals high rates of multidrug resistance of Salmonella, Shigella and Campylobacter in HIV infected and uninfected patients from Mozambique

BACKGROUND

Antibacterial resistance is a growing concern worldwide, including in Mozambique. Diarrhea is an important cause of mortality in Mozambique, yet few local studies have reported on the resistance of bacterial pathogens in this context. Therefore, this study aims to characterize antibiotic susceptibility patterns of Salmonella, Shigella and Campylobacter spp. among patients with diarrhea, including those who are HIV-infected and-uninfected.

METHODS

We conducted antibiotic susceptibility testing on 157 stool isolates recovered from 129 patients aged between 0 and 80 years with diarrhea, including HIV infected (n = 68) and-uninfected individuals (n = 61), assisted at two health centers in Maputo city. The isolates comprised of 99 Salmonella, 45 Shigella and 13 Campylobacter strains. The Kirby-Bauer disk diffusion method was used on Mueller-Hinton II agar for Salmonella and Shigella spp., while Mueller-Hinton II agar with 5% defibrinated sheep blood was used for Campylobacter spp. We tested six antibiotics listed on the national essential medicines list, including ciprofloxacin, erythromycin, azithromycin, trimethoprim-sulfamethoxazole, gentamicin, and tetracycline.

RESULTS

All isolates were resistant to at least one antibiotic. A high percentage of Salmonella spp. isolates were found to be resistant to trimethoprim-sulfamethoxazole (89.9%, n = 89), erythromycin (88.9%, n = 88) and tetracycline (76.8%, n = 76). In addition, 86.6% (n = 39) and 68.9% (n = 31) of Shigella isolates were resistant to trimethoprim-sulfamethoxazole and tetracycline, respectively. The majority of Campylobacter isolates (92.3%, n = 12) were resistant to erythromycin, azithromycin and tetracycline. Multidrug resistance (MDR) was observed in 79.8% of Salmonella spp., 76.9% of Campylobacter spp., and 57.8% of Shigella spp. Drug susceptibility profiles for Salmonella spp. and Campylobacter were similar in both HIV-1 infected and uninfected patients. However, Shigella spp. isolates obtained from patients without HIV infection were significantly more likely to be resistant to erythromycin, azithromycin or to exhibit multidrug resistance than those obtained from patients with HIV-1 infection (p < 0.05). All Shigella spp. and Campylobacter spp. isolates were susceptible to gentamicin.

CONCLUSION

Our study highlights concerning rates of antibiotic resistance and MDR among diarrheal bacterial pathogens in Mozambique. Further research is needed to understand the impact of HIV, ART therapy and immunosuppression on antibiotic resistance. Urgent interventions are essential to prevent the spread of resistant strains.

Household Factors of Foodborne Diarrhea in Children under Five in Two Districts of Maputo, Mozambique

Household factors involved in the disease of diarrhea are multifaceted. This study aimed to explore and describe the household factors affecting foodborne diarrhea in children younger than 5 years old using structured questionnaire data based on quantitative tools. The sample size was calculated based on a binomial distribution. A total of 300 children, together with their caregivers, participated, and the data were descriptively and mathematically analyzed using Epi Info modelling. The caregivers were mostly female and included 93.3% rural and 84% urban dwellers of ages between 18 and 38, who were single but living with someone. Of the children who were under six months of age, 23.3% in rural areas and 16.6% in urban areas had diarrhea, while of the children between 12 and 23 months of age, 36.6% in urban areas and 30% in rural areas had diarrhea. The relatives had similar symptoms before the child became ill, with 12.6% of relatives in rural areas and 13.3% in urban areas reporting this. Before receiving medical assistance, 51.3% of children in rural areas and 16% of children in urban areas were treated with traditional medication. Water was not treated before drinking in 48% of rural cases and 45.3% of urban cases. A total of 24.6% of infants in urban areas and 12.6% of infants in rural areas used a bottle for feeding. The factors affecting foodborne diarrhea were the use of traditional medication in rural areas, bottle feeding in urban areas and untreated water used for drinking in both areas.

Treatment-seeking and uptake of malaria prevention strategies among pregnant women and caregivers of children under-five years during COVID-19 pandemic in rural communities in South West Uganda: a qualitative study

Background

Despite efforts to avert the negative effects of malaria, there remain barriers to the uptake of prevention measures, and these have hindered its eradication. This study explored the factors that influence uptake of malaria prevention strategies among pregnant women and children under-five years and the impact of COVID-19 in a malaria endemic rural district in Uganda.

Methods

This was a qualitative case study that used focus group discussions, in-depth interviews, and key informant interviews involving pregnant women, caregivers of children under-five years, traditional birth attendants, village health teams, local leaders, and healthcare providers to explore malaria prevention uptake among pregnant women and children under-five years. The interviews were audio-recorded, transcribed and data were analyzed using thematic content approach.

Results

Seventy-two participants were enrolled in the Focus Group Discussions, 12 in the in-depth interviews, and 2 as key informants. Pregnant women and caregivers of children under-five years were able to recognize causes of malaria, transmission, and symptoms. All participants viewed malaria prevention as a high priority, and the use of insecticide-treated mosquito bed nets (ITNs) was upheld. Participants' own experiences indicated adverse effects of malaria to both pregnant women and children under-five. Home medication and the use of local herbs were a common practice. Some participants didn’t use any of the malaria prevention methods due to deliberate refusal, perceived negative effects of the ITNs, and family disparity. The Corona Virus Disease-2019 (COVID-19) control measures did not abate the risk of malaria infection but these were deleterious to healthcare access and the focus of malaria prevention.

Conclusions

Although pregnant women and caregivers of children under-five years recognized symptoms of malaria infection, healthcare-seeking was not apt as some respondents used alternative approaches and delayed seeking formal healthcare. It is imperative to focus on the promotion of malaria prevention strategies and address drawbacks associated with misconceptions about these interventions, and promotion of health-seeking behaviors. As COVID-19 exacerbated the effect of malaria prevention uptake and healthcare seeking, it’s critical to recommit and integrate COVID-19 prevention measures in normative living and restrict future barriers to healthcare access.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12771-3.

Characterization of Escherichia coli from Water and Food Sold on the Streets of Maputo: Molecular Typing, Virulence Genes, and Antibiotic Resistance

The aim of this study was to investigate the pathogenic potential and antibiotic resistance of 59 Escherichia coli isolates from ready-to-eat (RTE) street food (n = 31) and drinking water (n = 28) sold in the city of Maputo, Mozambique. The isolates were characterized by XbaI subtyping analysis via pulsed field gel electrophoresis. Multiplex PCRs were performed targeting five virulence genes (stx, lt, st, astA, and eae) and three groups of antibiotic-resistant genes, namely ß-lactamases (extended-spectrum ß-lactamase and AmpC), tetracycline (tetA, tetB, and tetM) and sulfamethoxazole/trimethoprim (sul1, sul2, and sul3). The stx virulence gene, encoding the Shiga/Vero (VT) toxin produced by the verotoxin-producing E. coli (VTEC), was identified with similar frequency in isolates from food (5/31) and water (6/28). The highest percentages of resistant isolates from food and water were found for ß-lactams imipenem (35.5 and 39.3%, respectively) and ampicillin (39.3 and 46.4%, respectively). Multidrug resistance was observed in 31.3% of the isolates, being higher in E. coli isolates from water (45.5%) compared to RTE street food isolates (19.2%). Virulence genes were detected in 73% of the multidrug-resistant isolates. Concerning antibiotic-resistant genes, ESBL was the most frequent (57.7%) among β-lactamases while tetA was the most frequent (50%) among non-β-lactamases.

I Buy Medicines From the Streets Because I Am Poor: A Qualitative Account on why the Informal Market for Medicines Thrive in Ivory Coast

The informal market for medicines has been growing. In Ivory Coast, this informal market is an unofficial core part of the health system. Given the risks associated with the informal market for medicines, it is important to understand why this market continues to grow. It becomes even more important in the context of COVID-19, as a huge chunk of falsified medical products end up at the informal market. A qualitative case study design was chosen for this study, with in-depth interviews (IDIs) and focus group discussions (FGDs) being the methods for data collection. 20 IDIs and 3 FGDs were conducted. Participants in this study are sellers, buyers, and pharmaceutical experts. We found out that the informal market for medicines thrives because it is highly accessible, convenient, affordable, and that it is used for various social, cultural, and religious reasons. The study concludes that although this informal market presents a clear danger to public health, it is thriving. For authorities to address this public health challenge, there is need for a holistic and multi-pronged approach, which includes addressing health systems factors and strengthening regulatory framework.

High Fecal Contamination and High Levels of Antibiotic-Resistant Enterobacteriaceae in Water Consumed in the City of Maputo, Mozambique

Simple Summary

The high number of diarrheal disease cases in developing countries is related to sanitation conditions, consumption of untreated water, and poor individual and collective hygiene. In this study, the microbiological quality of water sold and consumed in the city of Maputo, Mozambique, and the antibiotic resistance profile of Enterobacteriaceae isolated from these samples were evaluated. The results showed the occurrence of microorganisms that indicate fecal contamination with enterococci, fecal coliforms, and Escherichia coli above the limit legally allowed for drinking water. The antibiotic resistance profile revealed the existence of antibiotic-resistant bacteria. These results show the need to improve the water supply system in the city of Maputo and to educate the population on hygiene to reduce health risks and promote well-being.

Abstract

In the city of Maputo, Mozambique, food and water are often sold on the streets. Street water is packaged, distributed, and sold not paying attention to good hygienic practices, and its consumption is often associated with the occurrence of diarrheal diseases. Coincidentally, the increase of diarrheal diseases promotes the inappropriate use of antibiotics that might cause the emergence of antibiotic-resistant bacterial strains. In this context, the present study aimed to assess the microbiological quality of water sold on the streets of Maputo, as well as the antibiotic resistance profile of selected Enterobacteriaceae isolates. The 118 water samples analyzed were from street home-bottled water (n = 81), municipal water distribution systems (tap water) (n = 25), and selected supply wells in several neighborhoods (n = 12). The samples were analyzed for total mesophilic microorganisms, fecal enterococci, fecal coliforms, Escherichia coli, and Vibrio spp. The results showed a high level of fecal contamination in all types of water samples. In home-bottled water, fecal coliforms were found in 88% of the samples, and E. coli in 66% of the samples. In tap water, fecal coliforms were found in 64%, and E. coli in 28% of the samples. In water from supply wells, fecal coliforms and E. coli were found in 83% of the samples. From 33 presumptive Vibrio spp. colonies, only three were identified as V. fluvialis. The remaining isolates belonged to Aeromonas spp. (n = 14) and Klebsiella spp. (n = 16). Of 44 selected Enterobacteriaceae isolates from water samples (28 isolates of E. coli and 16 isolates of Klebsiella spp.), 45.5% were not susceptible to the beta-lactams ampicillin and imipenem, 43.2% to amoxicillin, and 31.8% to amoxicillin/clavulanic acid. Regarding non-beta-lactam antibiotics, there was a high percentage of isolates with tolerance to tetracycline (52.3%) and azithromycin (31.8%). In conclusion, water in Maputo represents a risk for human health due to its high fecal contamination. This situation is made more serious by the fact that a relatively high percentage of isolates with multidrug resistance (40%) were found among Enterobacteriaceae. The dissemination of these results can raise awareness of the urgent need to reduce water contamination in Maputo and other cities in Mozambique.

Household sampling through geocoded points and satellite view: A step-by-step approach to implement a spatial sampling method for demographic and health surveys in areas without population sampling frame and with limited resource settings

INTRODUCTION

Spatial sampling is increasingly used in health surveys as it provides a simple way to randomly select target populations on sites where reliable and complete data on the general population are not available. However, the previously implemented protocols have been poorly detailed, making replication difficult or even impossible. To our knowledge, ours is the first document describing step-by-step an efficient spatial sampling method for health surveys. Our objective is to facilitate the rapid acquisition of the technical skills and know-how necessary for its deployment.

METHODS

The spatial sampling design is based on the random generation of geocoded points in the study area. Afterwards, these points were projected on the satellite view of Google Earth Pro™ software and the identified buildings were selected for field visits. A detailed formula of the number of points required, considering non-responses, is proposed. Density of buildings was determined by drawing circles around points and by using a replacement strategy when interviewing was unachievable. The method was implemented for a cross-sectional study during the April-May 2016 period in Cotonou (Bénin). The accuracy of the collected data was assessed by comparing them to those of the Cotonou national census.

RESULT

This approach does not require prior displacement in the study area and only 1% of identified buildings with Google Earth Pro™ were no longer extant. Most of the measurements resulting from the general census were within the confidence intervals of those calculated with the sample data. Furthermore, the range of measurements resulting from the general census was similar to those calculated with the sample data. These include, for example, the proportion of the foreign population (unweighted 8.9%/weighted 9% versus 8.5% in census data), the proportion of adults over 17 years of age (56.7% versus 57% in census data), the proportion of households whose head is not educated (unweighted 21.9%/weighted 22.8% versus 21.1% in census data).

CONCLUSION

This article illustrates how an epidemiological field survey based on spatial sampling can be successfully implemented at low cost, quickly and with little technical and theoretical knowledge. While statistically similar to simple random sampling, this survey method greatly simplifies its implementation.

Between traditional remedies and pharmaceutical drugs: prevention and treatment of "Palu" in households in Benin, West Africa

BACKGROUND

In Benin, malaria clinical cases, including the larger popular entity called "Palu" are evoked when people get fever. "Palu" is often self-diagnosed and self-medicated at home. This study aimed to describe the use of herbal medicine, and/or pharmaceutical medicines for prevention and treatment of malaria at home and the factors associated with this usage.

METHODS

A cross-sectional survey was conducted in Benin in an urban and in a rural area in 2016. Around 600 households in each place were selected by using a random sampling of houses GPS coordinates of the families. The association between socio demographic characteristics and the use of herbal medicine was tested by using logistic regression models.

RESULTS

In Cotonou (urban), 43.64% of households reported using herbal or pharmaceutical medicine to prevent "Palu", while they were 53.1% in Lobogo (rural). To treat "Palu" in Cotonou, 5.34% of households reported using herbal medicine exclusively, 33.70% pharmaceutical medicine exclusively and 60.96% reported using both. In Lobogo, 4% reported using herbal medicine exclusively, 6.78% pharmaceutical medicine exclusively and 89.22% reported using both. In Cotonou, the factors "age of respondent", "participation to a traditional form of savings" and "low socioeconomic level of the household" were associated with the use of herbal medicine.

CONCLUSIONS

This study shows the strong use of herbal medicine to prevent "Palu" or even treat it, and in this case it is mostly associated with the use of pharmaceutical medicine. It also highlights the fact that malaria control and care seeking behaviour with herbal medicine remain closely linked to household low-income status but also to cultural behaviour. The interest of this study is mostly educational, with regards to community practices concerning "Palu", and to the design of adapted behaviour change communication strategies. Finally, there is a need to take into account the traditional habits of populations in malaria control and define a rational and risk-free use of herbal medicine as WHO-recommended.