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Essouma M, Noubiap JJ. Lupus and other autoimmune diseases: Epidemiology in the population of African ancestry and diagnostic and management challenges in Africa. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100288. [PMID: 39282618 PMCID: PMC11399606 DOI: 10.1016/j.jacig.2024.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/15/2024] [Accepted: 02/23/2024] [Indexed: 09/19/2024]
Abstract
Autoimmune diseases are prevalent among people of African ancestry living outside Africa. However, the burden of autoimmune diseases in Africa is not well understood. This article provides a global overview of the current burden of autoimmune diseases in individuals of African descent. It also discusses the major factors contributing to autoimmune diseases in this population group, as well as the challenges involved in diagnosing and managing autoimmune diseases in Africa.
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Affiliation(s)
- Mickael Essouma
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Cameroon
| | - Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, Calif
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Mboowa G, Tessema SK, Christoffels A, Ndembi N, Kebede Tebeje Y, Kaseya J. Africa in the era of pathogen genomics: Unlocking data barriers. Cell 2024; 187:5146-5150. [PMID: 39303683 DOI: 10.1016/j.cell.2024.08.032] [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: 08/17/2023] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/22/2024]
Abstract
Rapid expansion of pathogen sequencing capacity in Africa has led to a paradigm shift from relying on others to locally generating genomic data and sharing it with the global community. However, several barriers remain to be unlocked for timely processing, analysis, dissemination, and effective use of pathogen sequence data for pandemic prevention, preparedness, and response.
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Affiliation(s)
- Gerald Mboowa
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Sofonias K Tessema
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia.
| | - Alan Christoffels
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Nicaise Ndembi
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Yenew Kebede Tebeje
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Jean Kaseya
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
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Ashenafi A, Sule O, Peter T, Mashate S, Otieno O, Kebede A, Oio J, Kao K, Carter J, Whistler T, Ndlovu N, Kebede Y. Diagnostics for detection and surveillance of priority epidemic-prone diseases in Africa: an assessment of testing capacity and laboratory strengthening needs. Front Public Health 2024; 12:1438334. [PMID: 39360262 PMCID: PMC11445050 DOI: 10.3389/fpubh.2024.1438334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 08/29/2024] [Indexed: 10/04/2024] Open
Abstract
In 2023, Africa experienced 180 public health emergencies, of which 90% were infectious diseases and 75% were related to zoonotic diseases. Testing capacity for epidemic-prone diseases is essential to enable rapid and accurate identification of causative agents, and for action to prevent disease spread. Moreover, testing is pivotal in monitoring disease transmission, evaluating public health interventions and informing targeted resource allocation during outbreaks. An online, self-assessment survey was conducted in African Union Member States to identify major challenges in testing for epidemic-prone diseases. The survey assessed current capacity for diagnosing priority epidemic-prone diseases at different laboratory levels. It explored challenges in establishing and maintaining testing capacity to improve outbreak response and mitigate public health impact. Survey data analysed diagnostic capacity for priority infectious diseases, diagnostic technologies in use, existing surveillance programmes and challenges limiting diagnostic capacity, by country. The survey result from 15 Member States who responded to the survey, showed high variability in testing capacity and technologies across countries and diverse factors limiting testing capacity for certain priority diseases like dengue and Crimean-Congo haemorrhagic fever. At the same time diagnostic capacity is better for coronavirus disease 2019 (COVID-19), polio, and measles due to previous investments. Unfortunately, many countries are not utilizing multiplex testing, despite its potential to improve diagnostic access. The challenges of limited laboratory capacity for testing future outbreaks are indeed significant. Recent disease outbreaks in Africa have underscored the urgent need to strengthen diagnostic capacity and introduce cost-effective technologies. Small sample sizes and differing disease prioritisation within each country limited the analysis. These findings suggest the benefits of evaluating laboratory testing capacity for epidemic-prone diseases and highlight the importance of effectively addressing challenges to detect diseases and prevent future pandemics.
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Affiliation(s)
- Aytenew Ashenafi
- Centre of Laboratory Systems Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Olajumoke Sule
- International Health Regulations Strengthening Project, Health Protection Operations, United Kingdom Health Security Agency, London, United Kingdom
| | - Trevor Peter
- Clinton Health Access Initiative, Boston, MA, United States
| | - Silver Mashate
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Osborn Otieno
- Technical Advice and Partnerships Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Abebaw Kebede
- Centre of Laboratory Systems Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - John Oio
- Centre of Laboratory Systems Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Kekeletso Kao
- Diagnostic System Strengthening Unit, FIND, Geneva, Switzerland
| | - Jane Carter
- Clinical and Diagnostics Programme, Amref Health Africa, Nairobi, Kenya
| | - Toni Whistler
- Technical Advice and Partnerships Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Nqobile Ndlovu
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Yenew Kebede
- Centre of Laboratory Systems Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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Moh’d AZ, Coetzer A, Malan AJ, Scott TP, Ramadhan RJ, Wright N, Nel LH. Investigating the Impact That Diagnostic Screening with Lateral Flow Devices Had on the Rabies Surveillance Program in Zanzibar, Tanzania. Microorganisms 2024; 12:1314. [PMID: 39065083 PMCID: PMC11279036 DOI: 10.3390/microorganisms12071314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
With the global impetus for the elimination of canine-mediated human rabies, the need for robust rabies surveillance systems has become ever more important. Many countries are working to improve their rabies surveillance programs and, as a result, the reported use of lateral flow devices (LFDs) is increasing. Despite their known diagnostic limitations, previous studies have hypothesised that the benefits associated with LFDs could make them potentially quite useful towards improving the overall robustness of surveillance programs. To test this, a best practice standard operating procedure was developed which was used to guide the implementation of the ADTEC LFD as a diagnostic screening tool in Zanzibar. Over the course of the first 22 months of this investigation, 83 samples were subjected to in-field diagnostic screening, coupled with subsequent laboratory confirmation, and only one false-negative result was detected. Furthermore, the findings of our investigation indicated that the routine use of LFDs as a diagnostic screening tool resulted in a four-fold increase in the number of samples subjected to rabies diagnosis per month and a three-fold increase in the number of wards where samples were collected per year. Our findings suggest that LFDs could play a noteworthy role in improving the robustness of surveillance systems by increasing the number of samples tested and promoting diagnostic screening in areas distant from laboratories. Their implementation would, however, need to be carefully controlled through standardised protocols that align with the international best practices to ensure their judicious use.
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Affiliation(s)
- Ali Z. Moh’d
- Department of Livestock Development, Ministry of Agriculture, Irrigation, Natural Resources and Livestock, Zanzibar P.O. Box 159, Tanzania
| | - Andre Coetzer
- Global Alliance for Rabies Control, Manhattan, KS 66502, USA; (A.C.); (T.P.S.)
| | - Ayla J. Malan
- Department of Biochemistry, Genetics and Microbiology, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0002, South Africa
| | - Terence P. Scott
- Global Alliance for Rabies Control, Manhattan, KS 66502, USA; (A.C.); (T.P.S.)
| | - Ramadhan J. Ramadhan
- Department of Livestock Development, Ministry of Agriculture, Irrigation, Natural Resources and Livestock, Zanzibar P.O. Box 159, Tanzania
| | - Nicolette Wright
- Department of Biochemistry, Genetics and Microbiology, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0002, South Africa
| | - Louis H. Nel
- Global Alliance for Rabies Control, Manhattan, KS 66502, USA; (A.C.); (T.P.S.)
- Department of Biochemistry, Genetics and Microbiology, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0002, South Africa
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Renneker KK, Mtuy TB, Kabona G, Mbwambo SG, Mosha P, Mollel JM, Hooper PJ, Emerson PM, Hollingsworth TD, Butcher R, Solomon AW, Harding-Esch EM. Acceptability and feasibility of tests for infection, serological testing, and photography to define need for interventions against trachoma. PLoS Negl Trop Dis 2024; 18:e0011941. [PMID: 38843285 PMCID: PMC11185441 DOI: 10.1371/journal.pntd.0011941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/18/2024] [Accepted: 05/13/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Trachoma causes blindness due to repeated conjunctival infection by Chlamydia trachomatis (Ct). Transmission intensity is estimated, for programmatic decision-making, by prevalence of the clinical sign trachomatous inflammation-follicular (TF) in children aged 1-9 years. Research into complementary indicators to field-graded TF includes work on conjunctival photography, tests for ocular Ct infection, and serology. The perceived acceptability and feasibility of these indicators among a variety of stakeholders is unknown. METHODOLOGY Focus group discussions (FGDs) with community members and in-depth interviews (IDIs) with public health practitioners in Tanzania were conducted. FGDs explored themes including participants' experience with, and thoughts about, different diagnostic approaches. The framework method for content analysis was used. IDIs yielded lists of perceived strengths of, and barriers to, implementation for programmatic use of each indicator. These were used to form an online quantitative survey on complementary indicators distributed to global stakeholders via meetings, mailing lists, and social media posts. RESULTS Sixteen FGDs and 11 IDIs were conducted in October-November 2022. In general, all proposed sample methods were deemed acceptable by community members. Common themes included not wanting undue discomfort and a preference for tests perceived as accurate. Health workers noted the importance of community education for some sample types. The online survey was conducted in April-May 2023 with 98 starting the questionnaire and 81 completing it. Regarding barriers to implementing diagnostics, the highest agreement items related to feasibility, rather than acceptability. No evidence of significant differences was found in responses pertaining to community acceptability based on participant characteristics. CONCLUSIONS All of the indicators included were generally deemed acceptable by all stakeholders in Tanzania, although community education around the benefits and risks of different sample types, as well as addressing issues around feasibility, will be key to successful, sustainable integration of these indicators into trachoma programs.
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Affiliation(s)
- Kristen K. Renneker
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Tara B. Mtuy
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - George Kabona
- National Neglected Tropical Diseases Control Programme, Preventive Services Department, Ministry of Health, Dodoma, Tanzania
| | - Stephen Gabriel Mbwambo
- National Neglected Tropical Diseases Control Programme, Preventive Services Department, Ministry of Health, Dodoma, Tanzania
| | - Patrick Mosha
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Jeremiah Mepukori Mollel
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - PJ Hooper
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Paul M. Emerson
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - T. Deirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Robert Butcher
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W. Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Olatunji E, Patel S, Graef K, Joseph A, Lasebikan N, Mallum A, Chigbo C, Jaffee E, Ngwa W. Utilization of cancer immunotherapy in sub-Saharan Africa. Front Oncol 2023; 13:1266514. [PMID: 38179176 PMCID: PMC10765613 DOI: 10.3389/fonc.2023.1266514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction The Lancet Oncology Commission for sub-Saharan Africa (SSA) predicts that cancer deaths will double from 520,158 per year to more than 1 million per year by the year 2040. These striking figures indicate a need to urgently evaluate cancer treatment infrastructure and resources in the region. Studies have found immunotherapy to be effective for the treatment of advanced-stage cancer, which almost 70% of patients in SSA present with. Despite immunotherapy's significant therapeutic potential, its utilization in SSA is not well documented. The purpose of this study was to evaluate the landscape of immunotherapy in SSA. Methods A Qualtrics survey assessing the existing infrastructure and training for safe immunotherapy administration was developed and distributed online via email and WhatsApp to 3,231 healthcare providers across SSA, with a target audience of healthcare providers serving patients with cancer. The survey contained 22 questions evaluating the accessibility, use, knowledge, and training on immunotherapy in SSA. Responses were collected between January and February 2023. Microsoft Excel was used to summarize and visually present the distribution of responses as counts and proportions. Results 292 responses were included from 28 countries in SSA. 29% of all respondents indicated their clinic has easy access to cancer immunotherapy and 46% indicated their clinic currently practices it. Of clinics that practiced immunotherapy (n = 133), 12% used genomic sequencing to assess the tumor mutational burden biomarker, and 44% assessed expression of the PD-L1 biomarker prior to immunotherapy administration. 46% of all respondents were familiar with immunotherapy. 11% indicated being adequately trained to administer it. Of these (n=33), 52% indicated also being trained to manage immune-related adverse events related to immunotherapy administration. Conclusion Immunotherapy utilization and training is low in SSA and insufficient for the rising cancer burden. Increased accessibility and usage of biomarker testing to predict immunotherapy response, incorporation of immunotherapy training into continuous medical education, and increased access to immunotherapy drugs may be prerequisites for expanded utilization of immunotherapy in SSA.
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Affiliation(s)
- Elizabeth Olatunji
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Saloni Patel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA, United States
| | - Adedayo Joseph
- Nigeria Sovereign Investment Authority-Lagos University Teaching Hospital (NSIA-LUTH) Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nwamaka Lasebikan
- Oncology Center, University of Nigeria Teaching Hospital Enugu, Enugu, Nigeria
| | - Abba Mallum
- Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban, South Africa
- Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Chinelo Chigbo
- Oncology Center, University of Nigeria Teaching Hospital Enugu, Enugu, Nigeria
| | - Elizabeth Jaffee
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD, United States
| | - Wil Ngwa
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
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