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Irfan B, Sultan MJ, Khawaja H, Wajahath M, Nasser E, Hasan AI, Fawaz M, Nasser M, Saleh KJ. Infection control in conflict zones: practical insights from recent medical missions to Gaza. J Hosp Infect 2024:S0195-6701(24)00235-4. [PMID: 38992842 DOI: 10.1016/j.jhin.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 07/13/2024]
Affiliation(s)
- B Irfan
- Center for Bioethics, Harvard Medical School, Boston, MA, USA; University of Michigan Medical School, Ann Arbor, NY, USA; FAJR Scientific, Houston, TX, USA.
| | - M J Sultan
- Department of Vascular Surgery, Hull University Hospitals, Hull, UK; FAJR Scientific, Houston, TX, USA
| | - H Khawaja
- Canton Medical Clinic, Canton, OH, USA; FAJR Scientific, Houston, TX, USA
| | - M Wajahath
- Michigan State University College of Human Medicine, Lansing, MI, USA; FAJR Scientific, Houston, TX, USA
| | - E Nasser
- The University of Texas Southwestern Medical Center, Dallas, TX, USA; FAJR Scientific, Houston, TX, USA
| | - A I Hasan
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA; FAJR Scientific, Houston, TX, USA
| | - M Fawaz
- University of Michigan Medical School, Ann Arbor, NY, USA; FAJR Scientific, Houston, TX, USA
| | - M Nasser
- FAJR Scientific, Houston, TX, USA
| | - K J Saleh
- Michigan State University College of Human Medicine, Lansing, MI, USA; FAJR Scientific, Houston, TX, USA.
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Wagnew F, Alene KA, Kelly M, Gray D. Undernutrition increases the risk of unsuccessful treatment outcomes of patients with tuberculosis in Ethiopia: A multicenter retrospective cohort study. J Infect 2024; 89:106175. [PMID: 38729526 DOI: 10.1016/j.jinf.2024.106175] [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: 12/06/2023] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND While undernutrition has been identified as a common risk factor for tuberculosis (TB), its impact on treatment outcomes has yet to be investigated in high TB burden and low-income countries such as Ethiopia. Therefore, this study aimed to investigate the effect of undernutrition on treatment outcomes among patients with TB in northwest Ethiopia. METHODS A retrospective cohort study was conducted using data from different hospitals in northwest Ethiopia, for the period from July 2017 to August 2023. A Cox proportional hazard model was performed to determine the effect of undernutrition on TB treatment outcomes, which were defined as a composite of death, treatment failure, or loss to follow-up. RESULTS A total of 602 patients with TB were included in the analysis. Of these, 367 (60.9%) were male, and 344 (57.1%) were undernourished. Upon completion of the follow-up period, 65 (10.8%) adults with TB had unsuccessful treatment outcomes. After adjusting for potential confounders, patients with undernutrition had a two times higher risk of experiencing unsuccessful treatment outcomes compared to well-nourished patients (AHR: 2.0, 95% CI: 1.2, 3.6). In addition, patients residing in rural areas (AHR: 3.1, 95% CI: 1.7, 5.4), having a history of prior TB treatment (AHR: 2.2, 95%CI: 1.1, 4.1), and the presence of diabetes comorbidity (AHR: 2.4, 95% CI: 1.1, 5.2) were at higher risk of unsuccessful treatment outcomes. CONCLUSIONS Undernutrition increases the risk of unsuccessful treatment outcomes in Ethiopia. This finding suggests that nutritional support during TB treatment can improve successful treatment outcomes in high TB burden and low-income countries such as Ethiopia.
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Affiliation(s)
- Fasil Wagnew
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia; College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia; Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.
| | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Darren Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Tigabu E, Melese A, Mekonen F, Siraj Y. Bullet-related bacterial wound infections among injured personnel at emergency site hospitals in Bahir Dar: prevalence, antimicrobial susceptibility and associated factors. BMC Microbiol 2024; 24:166. [PMID: 38755533 PMCID: PMC11097502 DOI: 10.1186/s12866-024-03324-2] [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: 11/20/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Bullet-related bacterial wound infection can be caused by high-velocity bullets and shrapnel injuries. In Ethiopia, significant injuries were reported that may cause severe wound infections, persistent systemic infections and may lead to amputation and mortality. The magnitude, antimicrobial susceptibility profiles, and factors associated with bacterial wound infections among patients with bullet-related injuries are not yet studied particularly at health facilities in Bahir Dar, Northwest Ethiopia. Therefore, this study was aimed to determine the prevalence, bacterial profiles, antimicrobial susceptibility profiles, and factors associated with bacterial infections among patients with bullet-related injuries at referral health facilities in Bahir Dar, Northwest Ethiopia. METHODS A Hospital-based cross-sectional study was conducted among patients with bullet-related injuries at three referral health facilities in Bahir Dar from May 25 to July 27, 2022. A total of 384 patients with bullet-related injuries were included in the study. Sociodemographic and clinical data were collected using a structured questionnaire. Wound swabs were collected aseptically and cultured on Blood and MacConkey agar following bacteriological standards. Biochemical tests were performed to differentiate bacteria for positive cultivation and antimicrobial susceptibility profiles of the isolates were done on Muller Hinton agar using the Kirby-Bauer disk diffusion technique according to the 2021 Clinical Laboratory Standard Institute (CLSI) guideline. The data were entered using Epi-Info version 7.3 and analyzed using SPSS version 25. Descriptive data were presented using frequency, percentages, figures, and charts. Logistic regression was carried out to identify factors associated with bacterial wound infections. P-value < 0.05 was considered statistically significant. RESULTS The prevalence of bullet-related bacterial wound infection among three referral hospitals in Bahir Dar city was 54.7%. The most commonly isolated Gram-negative organism was Klebsiella spps 49 (23.3%) while among Gram-positive organism, Staphylococcus aureus 58 (27.6%) and coagulase-negative staphylococci (CONS) 18 (8.6%). Contamination, hospitalization and smoking habit were significantly associated with the presence of bullet-related bacterial wound infections. Over 97% multidrug resistant (MDR) bacterial isolates were identified and of theses, E. coli, Proteus species, Citrobactor, and Staphylococcus aureus were highly drug resistant. CONCLUSION Increased prevalence of bullet-related bacterial wound infection was noticed in this study. S. aureus followed by Klebsiella species were most commonly isolated bacteria. High frequency of resistance to Ampicillin, Oxacillin, Cefepime, Ceftriaxone, Ceftazidime, Vancomycin, and Norfloxacin was observed. Therefore, proper handling of bullet injuries, prompt investigation of bacterial infections, monitoring of drug sensitivity patterns and antibiotic usage are critical.
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Affiliation(s)
- Enanu Tigabu
- Department of Medical Laboratory Sciences, GAMBY Medical and Business College, Bahir Dar, Ethiopia.
| | - Addisu Melese
- Department of Medical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Feleke Mekonen
- Department of Medical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yesuf Siraj
- Department of Medical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Marou V, Vardavas CI, Aslanoglou K, Nikitara K, Plyta Z, Leonardi-Bee J, Atkins K, Condell O, Lamb F, Suk JE. The impact of conflict on infectious disease: a systematic literature review. Confl Health 2024; 18:27. [PMID: 38584269 PMCID: PMC11000310 DOI: 10.1186/s13031-023-00568-z] [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: 05/25/2023] [Accepted: 12/28/2023] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Conflict situations, armed or not, have been associated with emergence and transmission of infectious diseases. This review aims to identify the pathways through which infectious diseases emerge within conflict situations and to outline appropriate infectious disease preparedness and response strategies. METHODS A systematic review was performed representing published evidence from January 2000 to October 2023. Ovid Medline and Embase were utilised to obtain literature on infectious diseases in any conflict settings. The systematic review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis). No geographical restrictions were imposed. FINDINGS Our review identified 51 studies covering AIDS, Hepatitis B, Tuberculosis, Cholera, Coronavirus 2, Ebola, Poliomyelitis, Malaria, Leishmaniasis, Measles, Diphtheria, Dengue and Acute Bacterial Meningitis within conflict settings in Europe, Middle East, Asia, and Africa since October 2023. Key factors contributing to disease emergence and transmission in conflict situations included population displacement, destruction of vital infrastructure, reduction in functioning healthcare systems and healthcare personnel, disruption of disease control programmes (including reduced surveillance, diagnostic delays, and interrupted vaccinations), reduced access by healthcare providers to populations within areas of active conflict, increased population vulnerability due to limited access to healthcare services, and disruptions in the supply chain of safe water, food, and medication. To mitigate these infectious disease risks reported preparedness and response strategies included both disease-specific intervention strategies as well as broader concepts such as the education of conflict-affected populations through infectious disease awareness programmes, investing in and enabling health care in locations with displaced populations, intensifying immunisation campaigns, and ensuring political commitment and intersectoral collaborations between governments and international organisations. CONCLUSION Conflict plays a direct and indirect role in the transmission and propagation of infectious diseases. The findings from this review can assist decision-makers in the development of evidence-based preparedness and response strategies for the timely and effective containment of infectious disease outbreaks in conflict zones and amongst conflict-driven displaced populations. FUNDING European Centre for Disease Prevention and Control under specific contract No. 22 ECD.13,154 within Framework contract ECDC/2019/001 Lot 1B.
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Affiliation(s)
- Valia Marou
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | | | - Zinovia Plyta
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kirsty Atkins
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Orla Condell
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Favelle Lamb
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden.
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5
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Gebreyohannes EA, Wolde HF, Akalu TY, Clements ACA, Alene KA. Impacts of armed conflicts on tuberculosis burden and treatment outcomes: a systematic review. BMJ Open 2024; 14:e080978. [PMID: 38453196 PMCID: PMC10921481 DOI: 10.1136/bmjopen-2023-080978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES This systematic review aimed to summarise existing literature on the impacts of armed conflicts on tuberculosis burden and treatment outcomes. DESIGN A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, ScienceDirect, Embase and medRxiv. DATA EXTRACTION AND SYNTHESIS Three reviewers independently screened, selected eligible studies and extracted data. A narrative review was undertaken to summarise the findings qualitatively. RESULTS Eleven studies were included in this review, reporting on tuberculosis incidence rates, prevalence and treatment outcomes, including mortality. Overall, the impact of armed conflicts on case notifications was variable. Six studies reported overall increases in tuberculosis case notifications following the onset of conflicts, while three studies reported overall decreases in tuberculosis case notifications. Factors, including limited access to healthcare services, challenges in surveillance and laboratory confirmation, the destruction of health systems and incapacitating the healthcare workforce, contributed to a decrease in the number of notified cases. The higher tuberculosis notification in some of the studies could be attributed to the disruption of tuberculosis prevention and control programmes as well as increased socioeconomic deprivation, including malnutrition, mass migration, poor living conditions and overcrowding that are worsened during conflicts. Armed conflicts without effective interventions were associated with worse tuberculosis treatment outcomes, including lower proportions of people with treatment success and higher proportions of people with loss to follow-up, mortality and treatment failure. However, implementing various interventions in conflict settings (such as establishing a National Tuberculosis Control Programme) led to higher tuberculosis notification rates and treatment success. CONCLUSION The impact of armed conflicts on tuberculosis notification is complex and is influenced by multiple factors. The findings of this review underscore the importance of concerted efforts to control tuberculosis in conflict settings using available resources.
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Affiliation(s)
- Eyob Alemayehu Gebreyohannes
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Haileab Fekadu Wolde
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Temesgen Yihunie Akalu
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Penninsula Medical School, University of Plymouth, Playmouth, UK
| | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Kearney JE, Thiel N, El-Taher A, Akhter S, Townes DA, Trehan I, Pottinger PS. Conflicts in Gaza and around the world create a perfect storm for infectious disease outbreaks. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002927. [PMID: 38324565 PMCID: PMC10849227 DOI: 10.1371/journal.pgph.0002927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- John E. Kearney
- University of Washington School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Natalie Thiel
- University of Washington School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Arian El-Taher
- University of Washington School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Sabreen Akhter
- Department of Pediatrics, University of Washington School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - David A. Townes
- Department of Global Health, University of Washington School of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Emergency Medicine, University of Washington School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Indi Trehan
- Department of Pediatrics, University of Washington School of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington School of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Paul S. Pottinger
- Department of Medicine, University of Washington School of Medicine, University of Washington, Seattle, Washington, United States of America
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Walker CP, Cramer ER. Contagion to unrest: Investigating the link between disease and civil unrest in Africa. Politics Life Sci 2024; 43:24-33. [PMID: 38567780 DOI: 10.1017/pls.2023.27] [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] [Indexed: 04/05/2024]
Abstract
Scholars, policymakers, and citizens alike remain invested in the impact of infectious diseases worldwide. Studies have found that emerging diseases and disease outbreaks burden global economies and public health goals. This article explores the potential link between measles outbreaks and various forms of civil unrest, such as demonstrations, riots, strikes, and other anti-government violence, in four central African countries from 1996 to 2005. Using a difference-in-differences model, we examine whether disease outbreaks have a discernible impact on the prevalence of civil unrest. While our findings indicate that the relationship between disease and civil unrest is not as strong as previously suggested, we identify a notable trend that warrants further investigation. These results have significant implications for health and policy officials in understanding the complex interplay between state fragility, civil unrest, and the spread of disease.
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Mohammed AA, Ahmed M. Veterinary services under siege: how the armed conflict in Sudan threatens animal and human health and how to respond. Infect Ecol Epidemiol 2023; 13:2281054. [PMID: 38187168 PMCID: PMC10769538 DOI: 10.1080/20008686.2023.2281054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Abdullah A.A. Mohammed
- Department of Biomedical Sciences, Faculty of Veterinary Sciences, University of Gadarif, Sudan
- Reproductive Health Sciences Program, Pan African University Life and Earth Sciences Institute (PAULESI), University of Ibadan, Ibadan, Nigeria
| | - Musa Ahmed
- Reproductive Health Sciences Program, Pan African University Life and Earth Sciences Institute (PAULESI), University of Ibadan, Ibadan, Nigeria
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, AL-Salam University, West Kordofan, Sudan
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Topluoglu S, Taylan-Ozkan A, Alp E. Impact of wars and natural disasters on emerging and re-emerging infectious diseases. Front Public Health 2023; 11:1215929. [PMID: 37727613 PMCID: PMC10505936 DOI: 10.3389/fpubh.2023.1215929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/17/2023] [Indexed: 09/21/2023] Open
Abstract
Emerging Infectious Diseases (EIDs) and Re-Emerging Infectious Diseases (REIDs) constitute significant health problems and are becoming of major importance. Up to 75% of EIDs and REIDs have zoonotic origin. Several factors such as the destruction of natural habitats leading humans and animals to live in close proximity, ecological changes due to natural disasters, population migration resulting from war or conflict, interruption or decrease in disease prevention programs, and insufficient vector control applications and sanitation are involved in disease emergence and distribution. War and natural disasters have a great impact on the emergence/re-emergence of diseases in the population. According to a World Bank estimation, two billion people are living in poverty and fragility situations. Wars destroy health systems and infrastructure, curtail existing disease control programs, and cause population movement leading to an increase in exposure to health risks and favor the emergence of infectious diseases. A total of 432 catastrophic cases associated with natural disasters were recorded globally in 2021. Natural disasters increase the risk of EID and REID outbreaks by damaging infrastructure and leading to displacement of populations. A Generic National Action Plan covering risk assessment, mechanism for action, determination of roles and responsibilities of each sector, the establishment of a coordination mechanism, etc. should be developed.
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Affiliation(s)
- Seher Topluoglu
- Provincial Health Directorate of Ankara, Republic of Türkiye Ministry of Health, Ankara, Türkiye
| | - Aysegul Taylan-Ozkan
- Department of Medical Microbiology, Medical Faculty, TOBB University of Economics and Technology, Ankara, Türkiye
| | - Emine Alp
- Department of Clinical Microbiology and Infectious Diseases, Medical Faculty, Ankara Yildirim Beyazit University, Ankara, Türkiye
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Solanke BL, Soladoye DA, Birsirka IA, Abdurraheem A, Salau OR. Utilization of insecticide-treated nets and associated factors among childbearing women in Northern Nigeria. Malar J 2023; 22:184. [PMID: 37328856 DOI: 10.1186/s12936-023-04620-4] [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: 02/08/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Studies have explored the correlates of insecticide-treated nets in Nigeria. The few studies that focused on Northern Nigeria mostly examined individual correlates, but largely ignored the community correlates. Also, the persistence of armed insurgencies in the region calls for more research attention. This study examines the utilization and the associated individual and community factors of insecticide-treated nets in Northern Nigeria. METHODS The study adopted a cross-sectional design. Data were extracted from the 2021 Nigeria Malaria Indicator Survey (NMIS). A weighted sample size of 6873 women was analysed. The outcome variable was the utilization of insecticide-treated nets. The explanatory variables selected at the individual/household level were maternal age, maternal education, parity, religion, sex of head of household, household wealth, and household size. The variables selected at the community level were the type of place of residence, geo-political zone of residence, the proportion of children under five who slept under a bed net, the proportion of women aged 15-49 who heard malaria media messages, and the community literacy level. Two variables, namely, the number of mosquito bed nets in the household, and the number of rooms used for sleeping were included for statistical control. Three multilevel mixed-effect regression models were fitted. RESULTS The majority of childbearing women (71.8%) utilized insecticide-treated nets. Parity and household size were the significant individual/household characteristics associated with the utilization of insecticide-treated nets. The proportion of under-five children in the community who slept under mosquito bed nets, and the geopolitical zone of residence were significant community correlates of the use of insecticide-treated nets. In addition, the number of rooms for sleeping, and the number of mosquito bed nets in the households were significantly associated with the utilization of insecticide-treated nets. CONCLUSION Parity, household size, number of sleeping rooms, number of treated bed nets, geo-political zone of residence, and proportion of under-five children sleeping under bed nets are important associated factors of the utilization of insecticide-treated nets in Northern Nigeria. Existing malaria preventive initiatives should be strengthened to target these characteristics.
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Affiliation(s)
- Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Daniel Alabi Soladoye
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | - Omowumi Romoke Salau
- Department of Clinical Nursing Services, UHD Trust, Royal Bournemouth Dorset, Bournemouth, UK
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Abstract
Infectious diseases and war are maleficent comrades. This reality applies equally well to the war in Ukraine and the current coronavirus disease 2019 (COVID-19) pandemic. Europe is facing a huge refugee crisis and potentially the conflict could worsen the COVID-19 pandemic. Initially, 2 major countries of concern are Poland, which has taken the majority of refugees, and Moldova, which has taken a very large number of refugees on a per capita basis. However, the concern extends to the rest of Europe because of the mobility of refugees beyond the first country they enter. Vaccinating, infection control, and boosting refugees should be a priority. However, complete prevention of COVID-19 is very complex because of other issues related to the success of prevention.
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12
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Tarnas MC, Desai AN, Parker DM, Almhawish N, Zakieh O, Rayes D, Whalen-Browne M, Abbara A. Syndromic surveillance of respiratory infections during protracted conflict: experiences from northern Syria 2016-2021. Int J Infect Dis 2022; 122:337-344. [PMID: 35688310 DOI: 10.1016/j.ijid.2022.06.003] [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: 03/15/2022] [Revised: 05/30/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Northern Syria faces a large burden of influenza-like illness (ILI) and severe acute respiratory illness (SARI). This study aimed to investigate the trends of Early Warning and Response Network (EWARN) reported ILI and SARI in northern Syria between 2016 and 2021 and the potential impact of SARS-CoV-2. METHODS We extracted weekly EWARN data on ILI/ SARI and aggregated cases and consultations into 4-week intervals to calculate case positivity. We conducted a seasonal-trend decomposition to assess case trends in the presence of seasonal fluctuations. RESULTS It was observed that 4-week aggregates of ILI cases (n = 5,942,012), SARI cases (n = 114,939), ILI case positivity, and SARI case positivity exhibited seasonal fluctuations with peaks in the winter months. ILI and SARI cases in individuals aged ≥5 years surpassed those in individuals aged <5 years in late 2019. ILI cases clustered primarily in Aleppo and Idlib, whereas SARI cases clustered in Aleppo, Idlib, Deir Ezzor, and Hassakeh. SARI cases increased sharply in 2021, corresponding with a severe SARS-CoV-2 wave, compared with the steady increase in ILI cases over time. CONCLUSION Respiratory infections cause widespread morbidity and mortality throughout northern Syria, particularly with the emergence of SARS-CoV-2. Strengthened surveillance and access to testing and treatment are critical to manage outbreaks among conflict-affected populations.
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Affiliation(s)
- Maia C Tarnas
- University of California, Population Health and Disease Prevention, Irvine, CA, USA.
| | - Angel N Desai
- University of California, Davis Medical Center, Sacramento, CA, USA
| | - Daniel M Parker
- University of California, Population Health and Disease Prevention, Irvine, CA, USA
| | | | - Omar Zakieh
- Imperial College, Department of Infection, London, UK
| | - Diana Rayes
- Syria Public Health Network, London, UK; Johns Hopkins University, Department of International Health, Baltimore, MD, USA
| | | | - Aula Abbara
- Imperial College, Department of Infection, London, UK; Syria Public Health Network, London, UK
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13
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Biselli R, Nisini R, Lista F, Autore A, Lastilla M, De Lorenzo G, Peragallo MS, Stroffolini T, D’Amelio R. A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health. Biomedicines 2022; 10:2050. [PMID: 36009598 PMCID: PMC9405556 DOI: 10.3390/biomedicines10082050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
The environmental conditions generated by war and characterized by poverty, undernutrition, stress, difficult access to safe water and food as well as lack of environmental and personal hygiene favor the spread of many infectious diseases. Epidemic typhus, plague, malaria, cholera, typhoid fever, hepatitis, tetanus, and smallpox have nearly constantly accompanied wars, frequently deeply conditioning the outcome of battles/wars more than weapons and military strategy. At the end of the nineteenth century, with the birth of bacteriology, military medical researchers in Germany, the United Kingdom, and France were active in discovering the etiological agents of some diseases and in developing preventive vaccines. Emil von Behring, Ronald Ross and Charles Laveran, who were or served as military physicians, won the first, the second, and the seventh Nobel Prize for Physiology or Medicine for discovering passive anti-diphtheria/tetanus immunotherapy and for identifying mosquito Anopheline as a malaria vector and plasmodium as its etiological agent, respectively. Meanwhile, Major Walter Reed in the United States of America discovered the mosquito vector of yellow fever, thus paving the way for its prevention by vector control. In this work, the military relevance of some vaccine-preventable and non-vaccine-preventable infectious diseases, as well as of biological weapons, and the military contributions to their control will be described. Currently, the civil-military medical collaboration is getting closer and becoming interdependent, from research and development for the prevention of infectious diseases to disasters and emergencies management, as recently demonstrated in Ebola and Zika outbreaks and the COVID-19 pandemic, even with the high biocontainment aeromedical evacuation, in a sort of global health diplomacy.
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Affiliation(s)
- Roberto Biselli
- Ispettorato Generale della Sanità Militare, Stato Maggiore della Difesa, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Roberto Nisini
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - Florigio Lista
- Dipartimento Scientifico, Policlinico Militare, Comando Logistico dell’Esercito, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Alberto Autore
- Osservatorio Epidemiologico della Difesa, Ispettorato Generale della Sanità Militare, Stato Maggiore della Difesa, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Marco Lastilla
- Istituto di Medicina Aerospaziale, Comando Logistico dell’Aeronautica Militare, Viale Piero Gobetti 2, 00185 Roma, Italy
| | - Giuseppe De Lorenzo
- Comando Generale dell’Arma dei Carabinieri, Dipartimento per l’Organizzazione Sanitaria e Veterinaria, Viale Romania 45, 00197 Roma, Italy
| | - Mario Stefano Peragallo
- Centro Studi e Ricerche di Sanità e Veterinaria, Comando Logistico dell’Esercito, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Tommaso Stroffolini
- Dipartimento di Malattie Infettive e Tropicali, Policlinico Umberto I, 00161 Roma, Italy
| | - Raffaele D’Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
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14
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Daw MA, El-Bouzedi AH, Ahmed MO. The Impact of Armed Conflict on the Prevalence and Transmission Dynamics of HIV Infection in Libya. Front Public Health 2022; 10:779778. [PMID: 35433583 PMCID: PMC9009867 DOI: 10.3389/fpubh.2022.779778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
The interrelationships between HIV/AIDS and armed conflict are a complex phenomenon, and studies are rarely devoted to this area of research. Libya is the second-largest country in Africa that has been evoked with war since the NATO intervention in 2011. The country has also experienced one of the largest HIV outbreaks associated with the Bulgarian nurse's saga. The effect of the armed conflict on the dynamic spread of HIV is not yet well-known. The objectives of this study were to determine the impact of armed conflict on the epidemiological situation of HIV infection in Libya and to analyze the transmission dynamics of HIV strains during the conflict. We investigated the movement of people with HIV during the Libyan armed conflict, analyzed the HIV subtypes reported from 2011 to 2020, and followed up the infected cases all over the country. The patterns of HIV spread within the Libyan regions were traced, and the risk factors were determined during the conflict period. A total of 4,539 patients with HIV/AIDS were studied from the four regions during the Libyan conflict. Our data analysis indicated that Benghazi, the biggest city in the Eastern region, was the significant exporter of the virus to the rest of the country. The viral dissemination changes were observed within the country, particularly after 2015. A major virus flows from the Eastern region during the armed conflict associated with internally displaced people. This resulted in the dissemination of new HIV strains and accumulations of HIV cases in western and middle regions. Although, there were no significant changes in the national prevalence of HIV/AIDS. Our data highlight the factors that complicated the spread and dissemination of HIV during the armed conflict, which provide a better understanding of the interaction between them. This could be used to plan for effective preventive measures in tackling the spread of HIV in conflict and post-conflict settings.
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Affiliation(s)
- Mohamed Ali Daw
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Mohamed Omar Ahmed
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli, Libya
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15
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Differences in Ethical Viewpoints among Civilian–Military Populations: A Survey among Practitioners in Two European Countries, Based on a Systematic Literature Review. SUSTAINABILITY 2022. [DOI: 10.3390/su14031085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Civilian–military collaboration in humanitarian crises has been encouraged globally; however, little is known about their diverse ethical viewpoints towards challenging and critical situations, which may cause difficulties in the partnership, and influence the outcomes of their mutual activities. The aim of this study was to identify the diversity of viewpoints and ethical decision-making during exceptional circumstances among civilian and military populations from two different countries, each with diverse background and healthcare organization structures. Possible scenarios, based on a systematic review of the literature, were introduced to Swedish and Polish civilian and military healthcare providers. Variations in the participants’ viewpoints and approaches to ethical decision-making were analyzed according to their characteristics, organizational belonging, and nationality. There were differences between both populations but also within the military and civilian groups, respectively. One significant factor influencing ethical viewpoints was participants’ nationality. Differences in ethical viewpoints between multiagency organizations should be considered in planning and implementation of future transdisciplinary and international collaboration in disaster and emergency management. Further studies and renewed educational initiatives are necessary to validate these differences and to navigate civilian–military as well as other multinational partnerships.
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