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Nzietchueng S, Kitua A, Nyatanyi T, Rwego IB. Facilitating implementation of the one health approach: A definition of a one health intervention. One Health 2023; 16:100491. [PMID: 36755741 PMCID: PMC9900431 DOI: 10.1016/j.onehlt.2023.100491] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
The last two decades has witnessed a disruption of socio-economic, security and political foundation worldwide due to surging of health events arising at the ecosystem, animal and human interface. The unprecedent magnitude of these events has led to the adoption of One Health approach. Several theoretical definitions and an operational one were released to help common user to understand the approach. To provide evidence of the impact of implementing the One Health approach and to assess the process outputs, a definition of a One Health intervention is required. We are proposing a definition and characteristics of a One Health intervention which will complement the operational definition of the One Health approach by the One Health High-Level Expert Panel.
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Affiliation(s)
- Serge Nzietchueng
- Faculty of Veterinary Medicine, University of Liege, Belgium,Food and Agriculture Organization of United Nations, Kenya,Corresponding author at: Faculty of Veterinary Medicine, University of Liege, Belgium.
| | - Andrew Kitua
- Public Health and Environmental Interventions Enhancement (NGALAKERI NGO), Tanzania
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2
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Semakula M, Niragire F, Umutoni A, Nsanzimana S, Ndahindwa V, Rwagasore E, Nyatanyi T, Remera E, Faes C. The secondary transmission pattern of COVID-19 based on contact tracing in Rwanda. BMJ Glob Health 2021; 6:bmjgh-2020-004885. [PMID: 34103325 PMCID: PMC8189754 DOI: 10.1136/bmjgh-2020-004885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction COVID-19 has shown an exceptionally high spread rate across and within countries worldwide. Understanding the dynamics of such an infectious disease transmission is critical for devising strategies to control its spread. In particular, Rwanda was one of the African countries that started COVID-19 preparedness early in January 2020, and a total lockdown was imposed when the country had only 18 COVID-19 confirmed cases known. Using intensive contact tracing, several infections were identified, with the majority of them being returning travellers and their close contacts. We used the contact tracing data in Rwanda for understanding the geographic patterns of COVID-19 to inform targeted interventions. Methods We estimated the attack rates and identified risk factors associated to COVID-19 spread. We used Bayesian disease mapping models to assess the spatial pattern of COVID-19 and to identify areas characterised by unusually high or low relative risk. In addition, we used multiple variable conditional logistic regression to assess the impact of the risk factors. Results The results showed that COVID-19 cases in Rwanda are localised mainly in the central regions and in the southwest of Rwanda and that some clusters occurred in the northeast of Rwanda. Relationship to the index case, being male and coworkers are the important risk factors for COVID-19 transmission in Rwanda. Conclusion The analysis of contact tracing data using spatial modelling allowed us to identify high-risk areas at subnational level in Rwanda. Estimating risk factors for infection with SARS-CoV-2 is vital in identifying the clusters in low spread of SARS-CoV-2 subnational level. It is imperative to understand the interactions between the index case and contacts to identify superspreaders, risk factors and high-risk places. The findings recommend that self-isolation at home in Rwanda should be reviewed to limit secondary cases from the same households and spatiotemporal analysis should be introduced in routine monitoring of COVID-19 in Rwanda for policy making decision on real time.
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Affiliation(s)
- Muhammed Semakula
- Center for Excellence in Data Science, University of Rwanda - Kigali Campus, Kigali, Rwanda .,Centre for Statistics, Hasselt Biostatistics and statistical Bioinformatics Center, Diepenbeek, Limburg, Belgium
| | - FranÇois Niragire
- Applied Statistics, University of Rwanda College of Business and Economics - Gikondo Campus, Kigali, Rwanda
| | - Angela Umutoni
- Institute for HIV, Diseases Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Sabin Nsanzimana
- Institute for HIV, Diseases Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Vedaste Ndahindwa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Edison Rwagasore
- Rwanda Biomedical Center, Rwanda Ministry of Health, Kigali, Rwanda
| | - Thierry Nyatanyi
- Institute for HIV, Diseases Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Eric Remera
- Institute for HIV, Diseases Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Christel Faes
- BioStat, Hasselt Biostatistics and statistical Bioinformatics Center, Diepenbeek, Limburg, Belgium
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3
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Mutesa L, Ndishimye P, Butera Y, Souopgui J, Uwineza A, Rutayisire R, Ndoricimpaye EL, Musoni E, Rujeni N, Nyatanyi T, Ntagwabira E, Semakula M, Musanabaganwa C, Nyamwasa D, Ndashimye M, Ujeneza E, Mwikarago IE, Muvunyi CM, Mazarati JB, Nsanzimana S, Turok N, Ndifon W. A pooled testing strategy for identifying SARS-CoV-2 at low prevalence. Nature 2021; 589:276-280. [PMID: 33086375 DOI: 10.1038/s41586-020-2885-5] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/12/2020] [Indexed: 01/29/2023]
Abstract
Suppressing infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will probably require the rapid identification and isolation of individuals infected with the virus on an ongoing basis. Reverse-transcription polymerase chain reaction (RT-PCR) tests are accurate but costly, which makes the regular testing of every individual expensive. These costs are a challenge for all countries around the world, but particularly for low-to-middle-income countries. Cost reductions can be achieved by pooling (or combining) subsamples and testing them in groups1-7. A balance must be struck between increasing the group size and retaining test sensitivity, as sample dilution increases the likelihood of false-negative test results for individuals with a low viral load in the sampled region at the time of the test8. Similarly, minimizing the number of tests to reduce costs must be balanced against minimizing the time that testing takes, to reduce the spread of the infection. Here we propose an algorithm for pooling subsamples based on the geometry of a hypercube that, at low prevalence, accurately identifies individuals infected with SARS-CoV-2 in a small number of tests and few rounds of testing. We discuss the optimal group size and explain why, given the highly infectious nature of the disease, largely parallel searches are preferred. We report proof-of-concept experiments in which a positive subsample was detected even when diluted 100-fold with negative subsamples (compared with 30-48-fold dilutions described in previous studies9-11). We quantify the loss of sensitivity due to dilution and discuss how it may be mitigated by the frequent re-testing of groups, for example. With the use of these methods, the cost of mass testing could be reduced by a large factor. At low prevalence, the costs decrease in rough proportion to the prevalence. Field trials of our approach are under way in Rwanda and South Africa. The use of group testing on a massive scale to monitor infection rates closely and continually in a population, along with the rapid and effective isolation of people with SARS-CoV-2 infections, provides a promising pathway towards the long-term control of coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Leon Mutesa
- Centre for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Pacifique Ndishimye
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda.,African Institute for Mathematical Sciences, Kigali, Rwanda
| | - Yvan Butera
- Centre for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Jacob Souopgui
- Centre for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda.,Department of Molecular Biology, Institute of Biology and Molecular Medicine, IBMM, Université Libre de Bruxelles, Gosselies, Belgium
| | - Annette Uwineza
- Centre for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Robert Rutayisire
- Centre for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | | | - Emile Musoni
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Nadine Rujeni
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Thierry Nyatanyi
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Edouard Ntagwabira
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Muhammed Semakula
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Clarisse Musanabaganwa
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Daniel Nyamwasa
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Maurice Ndashimye
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda.,African Institute for Mathematical Sciences, Kigali, Rwanda
| | - Eva Ujeneza
- African Institute for Mathematical Sciences, Kigali, Rwanda
| | - Ivan Emile Mwikarago
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Claude Mambo Muvunyi
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Jean Baptiste Mazarati
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Sabin Nsanzimana
- Rwanda Joint Task Force COVID-19, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Neil Turok
- African Institute for Mathematical Sciences, Kigali, Rwanda. .,School of Physics and Astronomy, University of Edinburgh, Edinburgh, UK. .,Perimeter Institute for Theoretical Physics, Waterloo, Ontario, Canada.
| | - Wilfred Ndifon
- African Institute for Mathematical Sciences, Kigali, Rwanda.
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4
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Berrian AM, Wilkes M, Gilardi K, Smith W, Conrad PA, Crook PZ, Cullor J, Nyatanyi T, Smith MH, Kazwala R, Mazet JAK. Developing a Global One Health Workforce: The "Rx One Health Summer Institute" Approach. Ecohealth 2020; 17:222-232. [PMID: 32685999 PMCID: PMC7471195 DOI: 10.1007/s10393-020-01481-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 01/21/2020] [Accepted: 05/15/2020] [Indexed: 06/08/2023]
Abstract
The One Health approach has gained support across a range of disciplines; however, training opportunities for professionals seeking to operationalize the interdisciplinary approach are limited. Academic institutions, through the development of high-quality, experiential training programs that focus on the application of professional competencies, can increase accessibility to One Health education. The Rx One Health Summer Institute, jointly led by US and East African partners, provides a model for such a program. In 2017, 21 participants representing five countries completed the Rx One Health program in East Africa. Participants worked collaboratively with communities neighboring wildlife areas to better understand issues impacting human and animal health and welfare, livelihoods, and conservation. One Health topics were explored through community engagement and role-playing exercises, field-based health surveillance activities, laboratories, and discussions with local experts. Educational assessments reflected improvements in participants' ability to apply the One Health approach to health and disease problem solving, as well as anticipate cross-sectoral challenges to its implementation. The experiential learning method, specifically the opportunity to engage with local communities, proved to be impactful on participants' cultural awareness. The Rx One Health Summer Institute training model may provide an effective and implementable strategy by which to contribute to the development of a global One Health workforce.
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Affiliation(s)
- Amanda M Berrian
- One Health Institute, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Michael Wilkes
- One Health Institute, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
- School of Medicine, University of California, Davis, CA, USA
| | - Kirsten Gilardi
- One Health Institute, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
| | - Woutrina Smith
- One Health Institute, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
| | - Patricia A Conrad
- One Health Institute, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
- Global Programs, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Paulina Zielinska Crook
- One Health Institute, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
- Global Programs, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - James Cullor
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Thierry Nyatanyi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Martin H Smith
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA, USA
| | | | - Jonna A K Mazet
- One Health Institute, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA.
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5
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Nziza J, Goldstein T, Cranfield M, Webala P, Nsengimana O, Nyatanyi T, Mudakikwa A, Tremeau-Bravard A, Byarugaba D, Tumushime JC, Mwikarago IE, Gafarasi I, Mazet J, Gilardi K. Coronaviruses Detected in Bats in Close Contact with Humans in Rwanda. Ecohealth 2020; 17:152-159. [PMID: 31811597 PMCID: PMC7088394 DOI: 10.1007/s10393-019-01458-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/10/2019] [Indexed: 05/31/2023]
Abstract
Bats living in close contact with people in Rwanda were tested for evidence of infection with viruses of zoonotic potential. Mucosal swabs from 503 bats representing 17 species were sampled from 2010 to 2014 and screened by consensus PCR for 11 viral families. Samples were negative for all viral families except coronaviruses, which were detected in 27 bats belonging to eight species. Known coronaviruses detected included the betacorona viruses: Kenya bat coronaviruses, Eidolon bat coronavirus, and Bat coronavirus HKU9, as well as an alphacoronavirus, Chaerephon Bat coronavirus. Novel coronaviruses included two betacorona viruses clustering with SARS-CoV, a 2d coronavirus, and an alphacoronavirus.
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Affiliation(s)
| | - Tracey Goldstein
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | | | - Paul Webala
- Department of Forestry and Wildlife Management, Maasai Mara University, P.O. Box 861, Narok, 20500, Kenya
| | | | - Thierry Nyatanyi
- Department of Global Health and Social Medicine, School of Medicine, Harvard University, Boston, USA
| | | | - Alexandre Tremeau-Bravard
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Dennis Byarugaba
- Makerere University Walter Reed Project, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Ivan Emil Mwikarago
- National Reference Laboratory, Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda
| | | | - Jonna Mazet
- Gorilla Doctors, P.O. Box 115, Musanze, Rwanda
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Kirsten Gilardi
- Gorilla Doctors, P.O. Box 115, Musanze, Rwanda
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
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6
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Nyamusore J, Rukelibuga J, Mutagoma M, Muhire A, Kabanda A, Williams T, Mutoni A, Kamwesiga J, Nyatanyi T, Omolo J, Kabeja A, Koama JB, Mukarurangwa A, Umuringa JD, Granados C, Gasana M, Moen A, Tempia S. The national burden of influenza-associated severe acute respiratory illness hospitalization in Rwanda, 2012-2014. Influenza Other Respir Viruses 2017; 12:38-45. [PMID: 29197152 PMCID: PMC5818355 DOI: 10.1111/irv.12494] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 11/30/2022] Open
Abstract
Background Estimates of influenza‐associated hospitalization are severely limited in low‐ and middle‐income countries, especially in Africa. Objectives To estimate the national number of influenza‐associated severe acute respiratory illness (SARI) hospitalization in Rwanda. Methods We multiplied the influenza virus detection rate from influenza surveillance conducted at 6 sentinel hospitals by the national number of respiratory hospitalization obtained from passive surveillance after adjusting for underreporting and reclassification of any respiratory hospitalizations as SARI during 2012‐2014. The population at risk was obtained from projections of the 2012 census. Bootstrapping was used for the calculation of confidence intervals (CI) to account for the uncertainty associated with all levels of adjustment. Rates were expressed per 100 000 population. A sensitivity analysis using a different estimation approach was also conducted. Results SARI cases accounted for 70.6% (9759/13 813) of respiratory admissions at selected hospitals: 77.2% (6783/8786) and 59.2% (2976/5028) among individuals aged <5 and ≥5 years, respectively. Overall, among SARI cases tested, the influenza virus detection rate was 6.3% (190/3022): 5.7% (127/2220) and 7.8% (63/802) among individuals aged <5 and ≥5 years, respectively. The estimated mean annual national number of influenza‐associated SARI hospitalizations was 3663 (95% CI: 2930‐4395—rate: 34.7; 95% CI: 25.4‐47.7): 2637 (95% CI: 2110‐3164—rate: 168.7; 95% CI: 135.0‐202.4) among children aged <5 years and 1026 (95% CI: 821‐1231—rate: 11.3; 95% CI: 9.0‐13.6) among individuals aged ≥5 years. The estimates obtained from both approaches were not statistically different (overlapping CIs). Conclusions The burden of influenza‐associated SARI hospitalizations was substantial and was highest among children aged <5 years.
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Affiliation(s)
- José Nyamusore
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Joseph Rukelibuga
- Influenza Program, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Mwumvaneza Mutagoma
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Andrew Muhire
- Health Management Information System Division, Ministry of Health, Kigali, Rwanda
| | - Alice Kabanda
- National Reference Laboratory, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Thelma Williams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela Mutoni
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Julius Kamwesiga
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Thierry Nyatanyi
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Jared Omolo
- Influenza Program, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Adeline Kabeja
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Jean Baptiste Koama
- Influenza Program, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Agrippine Mukarurangwa
- National Reference Laboratory, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Jeanne d'Arc Umuringa
- National Reference Laboratory, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Carolina Granados
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michel Gasana
- Institute of HIV/AIDS, Disease Prevention and Control, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Ann Moen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
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7
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Nyatanyi T, Wilkes M, McDermott H, Nzietchueng S, Gafarasi I, Mudakikwa A, Kinani JF, Rukelibuga J, Omolo J, Mupfasoni D, Kabeja A, Nyamusore J, Nziza J, Hakizimana JL, Kamugisha J, Nkunda R, Kibuuka R, Rugigana E, Farmer P, Cotton P, Binagwaho A. Implementing One Health as an integrated approach to health in Rwanda. BMJ Glob Health 2017; 2:e000121. [PMID: 28588996 PMCID: PMC5335763 DOI: 10.1136/bmjgh-2016-000121] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 11/30/2022] Open
Abstract
It is increasingly clear that resolution of complex global health problems requires interdisciplinary, intersectoral expertise and cooperation from governmental, non-governmental and educational agencies. ‘One Health’ refers to the collaboration of multiple disciplines and sectors working locally, nationally and globally to attain optimal health for people, animals and the environment. One Health offers the opportunity to acknowledge shared interests, set common goals, and drive toward team work to benefit the overall health of a nation. As in most countries, the health of Rwanda's people and economy are highly dependent on the health of the environment. Recently, Rwanda has developed a One Health strategic plan to meet its human, animal and environmental health challenges. This approach drives innovations that are important to solve both acute and chronic health problems and offers synergy across systems, resulting in improved communication, evidence-based solutions, development of a new generation of systems-thinkers, improved surveillance, decreased lag time in response, and improved health and economic savings. Several factors have enabled the One Health movement in Rwanda including an elaborate network of community health workers, existing rapid response teams, international academic partnerships willing to look more broadly than at a single disease or population, and relative equity between female and male health professionals. Barriers to implementing this strategy include competition over budget, poor communication, and the need for improved technology. Given the interconnectedness of our global community, it may be time for countries and their neighbours to follow Rwanda's lead and consider incorporating One Health principles into their national strategic health plans.
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Affiliation(s)
- Thierry Nyatanyi
- Ministry of Health, Kigali, Rwanda
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Wilkes
- University of California Davis, Davis, California, USA
- University of Rwanda, Butare, Rwanda
- Harvard Medical School, Boston, Massachusetts, USA
| | - Haley McDermott
- University of California Davis, Davis, California, USA
- Partners in Health, Rwanda
| | - Serge Nzietchueng
- University of Minnesota, Minneapolis, Minnesota, USA
- USAID Preparedness and Response Project
| | | | | | | | | | - Jared Omolo
- Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
| | - Denise Mupfasoni
- Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
| | | | | | | | | | | | | | | | | | - Paul Farmer
- Harvard Medical School, Boston, Massachusetts, USA
- Partners in Health, Rwanda
- University of Global Health Equity
| | | | - Agnes Binagwaho
- Harvard Medical School, Boston, Massachusetts, USA
- University of Global Health Equity
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8
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Umulisa I, Omolo J, Muldoon KA, Condo J, Habiyaremye F, Uwimana JM, Muhimpundu MA, Galgalo T, Rwunganira S, Dahourou AG, Tongren E, Koama JB, McQuiston J, Raghunathan PL, Massung R, Gatei W, Boer K, Nyatanyi T, Mills EJ, Binagwaho A. A Mixed Outbreak of Epidemic Typhus Fever and Trench Fever in a Youth Rehabilitation Center: Risk Factors for Illness from a Case-Control Study, Rwanda, 2012. Am J Trop Med Hyg 2016; 95:452-6. [PMID: 27352876 DOI: 10.4269/ajtmh.15-0643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 05/05/2016] [Indexed: 11/07/2022] Open
Abstract
In August 2012, laboratory tests confirmed a mixed outbreak of epidemic typhus fever and trench fever in a male youth rehabilitation center in western Rwanda. Seventy-six suspected cases and 118 controls were enrolled into an unmatched case-control study to identify risk factors for symptomatic illness during the outbreak. A suspected case was fever or history of fever, from April 2012, in a resident of the rehabilitation center. In total, 199 suspected cases from a population of 1,910 male youth (attack rate = 10.4%) with seven deaths (case fatality rate = 3.5%) were reported. After multivariate analysis, history of seeing lice in clothing (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI] = 1.1-5.8), delayed (≥ 2 days) washing of clothing (aOR = 4.0, 95% CI = 1.6-9.6), and delayed (≥ 1 month) washing of beddings (aOR = 4.6, 95% CI = 2.0-11) were associated with illness, whereas having stayed in the rehabilitation camp for ≥ 6 months was protective (aOR = 0.20, 95% CI = 0.10-0.40). Stronger surveillance and improvements in hygiene could prevent future outbreaks.
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Affiliation(s)
- Irenee Umulisa
- Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda.
| | - Jared Omolo
- CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Katherine A Muldoon
- University of British Columbia, Vancouver, Canada. University of Ottawa, Ottawa, Canada
| | - Jeanine Condo
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Francois Habiyaremye
- Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Jean Marie Uwimana
- Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda
| | | | - Tura Galgalo
- CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Samuel Rwunganira
- Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda. Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Anicet G Dahourou
- CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Eric Tongren
- Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Jean Baptiste Koama
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Jennifer McQuiston
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pratima L Raghunathan
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Robert Massung
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wangeci Gatei
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Kimberly Boer
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Thierry Nyatanyi
- Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Edward J Mills
- University of British Columbia, Vancouver, Canada. University of Ottawa, Ottawa, Canada. Stanford University, Stanford, California
| | - Agnes Binagwaho
- Ministry of Health Rwanda, Kigali, Rwanda. Harvard Medical School, Boston, Massachusetts. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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9
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Lafond KE, Nair H, Rasooly MH, Valente F, Booy R, Rahman M, Kitsutani P, Yu H, Guzman G, Coulibaly D, Armero J, Jima D, Howie SRC, Ampofo W, Mena R, Chadha M, Sampurno OD, Emukule GO, Nurmatov Z, Corwin A, Heraud JM, Noyola DE, Cojocaru R, Nymadawa P, Barakat A, Adedeji A, von Horoch M, Olveda R, Nyatanyi T, Venter M, Mmbaga V, Chittaganpitch M, Nguyen TH, Theo A, Whaley M, Azziz-Baumgartner E, Bresee J, Campbell H, Widdowson MA. Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982-2012: A Systematic Analysis. PLoS Med 2016; 13:e1001977. [PMID: 27011229 PMCID: PMC4807087 DOI: 10.1371/journal.pmed.1001977] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 02/05/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The global burden of pediatric severe respiratory illness is substantial, and influenza viruses contribute to this burden. Systematic surveillance and testing for influenza among hospitalized children has expanded globally over the past decade. However, only a fraction of the data has been used to estimate influenza burden. In this analysis, we use surveillance data to provide an estimate of influenza-associated hospitalizations among children worldwide. METHODS AND FINDINGS We aggregated data from a systematic review (n = 108) and surveillance platforms (n = 37) to calculate a pooled estimate of the proportion of samples collected from children hospitalized with respiratory illnesses and positive for influenza by age group (<6 mo, <1 y, <2 y, <5 y, 5-17 y, and <18 y). We applied this proportion to global estimates of acute lower respiratory infection hospitalizations among children aged <1 y and <5 y, to obtain the number and per capita rate of influenza-associated hospitalizations by geographic region and socio-economic status. Influenza was associated with 10% (95% CI 8%-11%) of respiratory hospitalizations in children <18 y worldwide, ranging from 5% (95% CI 3%-7%) among children <6 mo to 16% (95% CI 14%-20%) among children 5-17 y. On average, we estimated that influenza results in approximately 374,000 (95% CI 264,000 to 539,000) hospitalizations in children <1 y-of which 228,000 (95% CI 150,000 to 344,000) occur in children <6 mo-and 870,000 (95% CI 610,000 to 1,237,000) hospitalizations in children <5 y annually. Influenza-associated hospitalization rates were more than three times higher in developing countries than in industrialized countries (150/100,000 children/year versus 48/100,000). However, differences in hospitalization practices between settings are an important limitation in interpreting these findings. CONCLUSIONS Influenza is an important contributor to respiratory hospitalizations among young children worldwide. Increasing influenza vaccination coverage among young children and pregnant women could reduce this burden and protect infants <6 mo.
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Affiliation(s)
- Kathryn E. Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- School of Health Sciences, University of Tampere, Tampere, Finland
- * E-mail: (KEL); (MAW)
| | - Harish Nair
- Centre for Global Health Research, University of Edinburgh, Edinburgh, United Kingdom
- Public Health Foundation of India, New Delhi, India
| | - Mohammad Hafiz Rasooly
- Afghanistan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | - Fátima Valente
- National Directorate of Public Health, Ministry of Health, Luanda, Angola
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Paul Kitsutani
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | | | | | - Julio Armero
- Ministerio de Salud de El Salvador, San Salvador, El Salvador
| | - Daddi Jima
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Stephen R. C. Howie
- Medical Research Council Unit, Fajara, The Gambia
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - William Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ricardo Mena
- Ministerio de Salud Publica y Asistencia Social, Guatemala City, Guatemala
| | | | - Ondri Dwi Sampurno
- National Institute of Health Research and Development, Jakarta, Indonesia
| | | | | | - Andrew Corwin
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jean Michel Heraud
- National Influenza Centre, Virology Unit, Institut Pasteur of Madagascar, Antananarivo, Madagascar
| | - Daniel E. Noyola
- Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Radu Cojocaru
- National Centre for Public Health, Chisinau, Republic of Moldova
| | | | - Amal Barakat
- Institut National d’Hygiène, Ministère de la Santé, Rabat, Morocco
| | | | - Marta von Horoch
- Ministerio de Salud Publica y Bienestar Social, Asunción, Paraguay
| | - Remigio Olveda
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Marietjie Venter
- National Institute for Communicable Diseases, Johannesburg, South Africa
- Zoonoses Research Unit, Department Medical Virology, University of Pretoria, Pretoria, South Africa
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | | | - Andros Theo
- Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Melissa Whaley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph Bresee
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Harry Campbell
- Centre for Global Health Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc-Alain Widdowson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail: (KEL); (MAW)
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10
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McMorrow ML, Wemakoy EO, Tshilobo JK, Emukule GO, Mott JA, Njuguna H, Waiboci L, Heraud JM, Rajatonirina S, Razanajatovo NH, Chilombe M, Everett D, Heyderman RS, Barakat A, Nyatanyi T, Rukelibuga J, Cohen AL, Cohen C, Tempia S, Thomas J, Venter M, Mwakapeje E, Mponela M, Lutwama J, Duque J, Lafond K, Nzussouo NT, Williams T, Widdowson MA. Severe Acute Respiratory Illness Deaths in Sub-Saharan Africa and the Role of Influenza: A Case Series From 8 Countries. J Infect Dis 2015; 212:853-60. [PMID: 25712970 PMCID: PMC4826902 DOI: 10.1093/infdis/jiv100] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
Background. Data on causes of death due to respiratory illness in Africa are limited. Methods. From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI)–associated deaths identified from influenza surveillance during 2009–2012. Results. Twenty-three countries (82%) responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37 714 SARI cases, and 3091 (8.2%; range by country, 5.1%–25.9%) tested positive for influenza virus. There were 1073 deaths (2.8%; range by country, 0.1%–5.3%) reported, among which influenza virus was detected in 57 (5.3%). Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting. The influenza-associated CFP was 1.8% (57 of 3091), compared with 2.9% (1016 of 34 623) for influenza virus–negative cases (P < .001). Among 834 deaths (77.7%) tested for other respiratory pathogens, rhinovirus (107 [12.8%]), adenovirus (64 [6.0%]), respiratory syncytial virus (60 [5.6%]), and Streptococcus pneumoniae (57 [5.3%]) were most commonly identified. Among 1073 deaths, 402 (37.5%) involved people aged 0–4 years, 462 (43.1%) involved people aged 5–49 years, and 209 (19.5%) involved people aged ≥50 years. Conclusions. Few African countries systematically collect data on outcomes of people hospitalized with respiratory illness. Stronger surveillance for deaths due to respiratory illness may identify risk groups for targeted vaccine use and other prevention strategies.
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Affiliation(s)
- Meredith L McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland
| | | | | | | | - Joshua A Mott
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland Centers for Disease Control and Prevention-Kenya, Nairobi
| | - Henry Njuguna
- Centers for Disease Control and Prevention-Kenya, Nairobi
| | - Lilian Waiboci
- Centers for Disease Control and Prevention-Kenya, Nairobi
| | | | | | | | - Moses Chilombe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | - Dean Everett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | | | - Thierry Nyatanyi
- Division of Epidemic Infectious Diseases, Rwanda Biomedical Center
| | | | - Adam L Cohen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland Centers for Disease Control and Prevention-South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Centers for Disease Control and Prevention-South Africa
| | - Juno Thomas
- Outbreak Response Unit, National Institute for Communicable Diseases
| | - Marietjie Venter
- Centers for Disease Control and Prevention-South Africa Zoonoses Research Unit, Department of Medical Virology, University of Pretoria Centre for Respiratory Diseases and Meningitis
| | - Elibariki Mwakapeje
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Ministry of Health and Social Welfare-Tanzania
| | - Marcelina Mponela
- Ministry of Health and Social Welfare-Tanzania Centers for Disease Control and Prevention-Tanzania, Dar es Salaam
| | - Julius Lutwama
- Centers for Disease Control and Prevention-Tanzania, Dar es Salaam Uganda Virus Research Institute, Entebbe
| | - Jazmin Duque
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Battelle, Atlanta, Georgia
| | - Kathryn Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Ndahwouh Talla Nzussouo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Thelma Williams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
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11
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Binagwaho A, Farmer PE, Nsanzimana S, Karema C, Gasana M, de Dieu Ngirabega J, Ngabo F, Wagner CM, Nutt CT, Nyatanyi T, Gatera M, Kayiteshonga Y, Mugeni C, Mugwaneza P, Shema J, Uwaliraye P, Gaju E, Muhimpundu MA, Dushime T, Senyana F, Mazarati JB, Gaju CM, Tuyisenge L, Mutabazi V, Kyamanywa P, Rusanganwa V, Nyemazi JP, Umutoni A, Kankindi I, Ntizimira C, Ruton H, Mugume N, Nkunda D, Ndenga E, Mubiligi JM, Kakoma JB, Karita E, Sekabaraga C, Rusingiza E, Rich ML, Mukherjee JS, Rhatigan J, Cancedda C, Bertrand-Farmer D, Bukhman G, Stulac SN, Tapela NM, van der Hoof Holstein C, Shulman LN, Habinshuti A, Bonds MH, Wilkes MS, Lu C, Smith-Fawzi MC, Swain JD, Murphy MP, Ricks A, Kerry VB, Bush BP, Siegler RW, Stern CS, Sliney A, Nuthulaganti T, Karangwa I, Pegurri E, Dahl O, Drobac PC. Rwanda 20 years on: investing in life. Lancet 2014; 384:371-5. [PMID: 24703831 PMCID: PMC4151975 DOI: 10.1016/s0140-6736(14)60574-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Two decades ago, the genocide against the Tutsis in Rwanda led to the deaths of 1 million people, and the displacement of millions more. Injury and trauma were followed by the effects of a devastated health system and economy. In the years that followed, a new course set by a new government set into motion equity-oriented national policies focusing on social cohesion and people-centred development. Premature mortality rates have fallen precipitously in recent years, and life expectancy has doubled since the mid-1990s. Here we reflect on the lessons learned in rebuilding Rwanda's health sector during the past two decades, as the country now prepares itself to take on new challenges in health-care delivery.
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Affiliation(s)
| | | | | | | | | | | | - Fidele Ngabo
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Cameron T Nutt
- Dartmouth Center for Health Care Delivery Science, Hanover, NH, USA
| | | | | | | | - Cathy Mugeni
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Joseph Shema
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Erick Gaju
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | | | | | | | | | | | | | | | | | | | - Agathe Umutoni
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | - Ida Kankindi
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Hinda Ruton
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | - Nathan Mugume
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | - Denis Nkunda
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | | | | | | | - Claude Sekabaraga
- Quality and Equity HealthCare-Social Health Enterprise, Kigali, Rwanda
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anne Sliney
- Clinton Health Access Initiative, Boston, MA, USA
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12
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Nyatanyi T, Nkunda R, Rukelibuga J, Palekar R, Muhimpundu MA, Kabeja A, Kabanda A, Lowrance D, Tempia S, Koama JB, McAlister D, Mukabayire O, Wane J, Raghunathan P, Katz M, Karema C. Influenza sentinel surveillance in Rwanda, 2008-2010. J Infect Dis 2013; 206 Suppl 1:S74-9. [PMID: 23169976 DOI: 10.1093/infdis/jis574] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 2008, Rwanda established an influenza sentinel surveillance (ISS) system to describe the epidemiology of influenza and monitor for the emergence of novel influenza A viruses. We report surveillance results from August 2008 to July 2010. METHODS We conducted ISS by monitoring patients with influenza-like illness (ILI) and severe acute respiratory infection (SARI) at 6 hospitals. For each case, demographic and clinical data, 1 nasopharyngeal specimen, and 1 oropharyngeal specimen were collected. Specimens were tested by real-time reverse-transcription polymerase chain reaction for influenza A and B viruses at the National Reference Laboratory in Rwanda. RESULTS A total of 1916 cases (945 ILI and 971 SARI) were identified. Of these, 29.2% (n = 276) of ILI and 10.4% (n = 101) of SARI cases tested positive for influenza. Of the total influenza-positive cases (n = 377), 71.8% (n = 271) were A(H1N1) pdm09, 5.6% (n = 21) influenza A(H1), 7.7% (n = 29) influenza A(H3), 1.6% (n = 6) influenza A (unsubtyped), and 13.3% (n = 50) influenza B. The percentage of positivity for influenza viruses was highest in October-November and February-March, during peaks in rainfall. CONCLUSIONS The implementation of ISS enabled characterization of the epidemiology and seasonality of influenza in Rwanda for the first time. Future efforts should determine the population-based influenza burden to inform interventions such as targeted vaccination.
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14
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Wane J, Nyatanyi T, Nkunda R, Rukelibuga J, Ahmed Z, Biedron C, Kabeja A, Muhimpundu MA, Kabanda A, Antara S, Briet O, Koama JB, Rusanganwa A, Mukabayire O, Karema C, Raghunathan P, Lowrance D. 2009 pandemic influenza A (H1N1) virus outbreak and response--Rwanda, October, 2009-May, 2010. PLoS One 2012; 7:e31572. [PMID: 22745652 PMCID: PMC3383749 DOI: 10.1371/journal.pone.0031572] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 01/11/2012] [Indexed: 11/18/2022] Open
Abstract
Background In October 2009, the first case of pandemic influenza A(H1N1)pdm09 (pH1N1) was confirmed in Kigali, Rwanda and countrywide dissemination occurred within several weeks. We describe clinical and epidemiological characteristics of this epidemic. Methods From October 2009 through May 2010, we undertook epidemiologic investigations and response to pH1N1. Respiratory specimens were collected from all patients meeting the WHO case definition for pH1N1, which were tested using CDC’s real time RT-PCR protocol at the Rwandan National Reference Laboratory (NRL). Following documented viral transmission in the community, testing focused on clinically severe and high-risk group suspect cases. Results From October 9, 2009 through May 31, 2010, NRL tested 2,045 specimens. In total, 26% (n = 532) of specimens tested influenza positive; of these 96% (n = 510) were influenza A and 4% (n = 22) were influenza B. Of cases testing influenza A positive, 96.8% (n = 494), 3% (n = 15), and 0.2% (n = 1) were A(H1N1)pdm09, Seasonal A(H3) and Seasonal A(non-subtyped), respectively. Among laboratory-confirmed cases, 263 (53.2%) were children <15 years and 275 (52%) were female. In total, 58 (12%) cases were hospitalized with mean duration of hospitalization of 5 days (Range: 2–15 days). All cases recovered and there were no deaths. Overall, 339 (68%) confirmed cases received oseltamivir in any setting. Among all positive cases, 26.9% (143/532) were among groups known to be at high risk of influenza-associated complications, including age <5 years 23% (122/532), asthma 0.8% (4/532), cardiac disease 1.5% (8/532), pregnancy 0.6% (3/532), diabetes mellitus 0.4% (2/532), and chronic malnutrition 0.8% (4/532). Conclusions Rwanda experienced a PH1N1 outbreak which was epidemiologically similar to PH1N1 outbreaks in the region. Unlike seasonal influenza, children <15 years were the most affected by pH1N1. Lessons learned from the outbreak response included the need to strengthen integrated disease surveillance, develop laboratory contingency plans, and evaluate the influenza sentinel surveillance system.
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Affiliation(s)
| | - Thierry Nyatanyi
- Center of Treatment and Research on HIV/AIDS, Malaria, Tuberculosis and Other Epidemic Diseases, Ministry of Health, Kigali, Rwanda
| | | | - Joseph Rukelibuga
- Influenza Division, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
| | - Zara Ahmed
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
| | - Caitlin Biedron
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
| | - Adeline Kabeja
- Center of Treatment and Research on HIV/AIDS, Malaria, Tuberculosis and Other Epidemic Diseases, Ministry of Health, Kigali, Rwanda
| | - Marie Aimée Muhimpundu
- Center of Treatment and Research on HIV/AIDS, Malaria, Tuberculosis and Other Epidemic Diseases, Ministry of Health, Kigali, Rwanda
| | | | - Simon Antara
- African Field Epidemiology Network, Kigali, Rwanda
| | - Olivier Briet
- Center of Treatment and Research on HIV/AIDS, Malaria, Tuberculosis and Other Epidemic Diseases, Ministry of Health, Kigali, Rwanda
| | - Jean Baptiste Koama
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
| | | | | | - Corine Karema
- Center of Treatment and Research on HIV/AIDS, Malaria, Tuberculosis and Other Epidemic Diseases, Ministry of Health, Kigali, Rwanda
| | - Pratima Raghunathan
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
| | - David Lowrance
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
- * E-mail:
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15
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Ntahobakurira I, Antara S, Galgalo TB, Kakoma JB, Karema C, Nyatanyi T, Theogene R, Mukabayire O, Lowrance D, Raghunathan P, Ayebazibwe N, Mukanga D, Nsubuga P, Binagwaho A. The Rwanda Field Epidemiology and Laboratory Training Program: training skilled disease detectives. Pan Afr Med J 2011; 10 Supp 1:7. [PMID: 22359695 PMCID: PMC3266676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 12/07/2011] [Indexed: 11/22/2022] Open
Abstract
Rwanda still suffers from communicable diseases which frequently lead to epidemics. In addition to other health workforce needs, Rwanda also lacks a public health workforce that can operate multi-disease surveillance and response systems at the national and sub-national levels.In 2009 and 2010 the Rwanda Ministry of Health and its partners from the Government of Rwanda (GOR) as well as the United States (US) Centers for Disease Control and Prevention, the African Field Epidemiology Network, and other partners embarked on a series of activities to develop a public health workforce that would be trained to operate disease surveillance and response systems at the national and district levels. The Rwanda Field Epidemiology and Laboratory Training Program (RFELTP) is a 2-year public health leadership development training program that provides applied epidemiology and public health laboratory training while the trainees provide public health service to the Ministry of Health. RFELTP is hosted at the National University of Rwanda School of Public Health for the didactic training. RFELTP is funded by GOR, the US Presidents Emergency Plan for AIDS Relief and the World Bank; it is managed by a multi-sectoral steering committee headed by the Minister of Health. The first RFELTP cohort has 15 residents who were recruited from key health programs in GOR. Over the first year of implementation, these 15 residents have conducted a variety of field investigations and responded to several outbreaks. RFELTP has also trained 145 frontline health workers through its two-week applied short courses. In the future, RFELTP plans to develop a veterinary track to address public health issues at the animal-human interface.
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Affiliation(s)
- Isaac Ntahobakurira
- National University of Rwanda School of Public Health, Kigali, Rwanda,Corresponding author: Isaac Ntahobakurira, National University of Rwanda School of Public Health, Kigali, Rwanda
| | - Simon Antara
- Rwanda Field Epidemiology and Laboratory Training Program, Kigali, Rwanda
| | | | | | | | | | | | | | - David Lowrance
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, USA
| | - Pratima Raghunathan
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, USA
| | | | | | - Peter Nsubuga
- Centers for Disease Control and Prevention, Center for Global Health, Division of Public Health Systems and Workforce Development, Atlanta, Georgia, USA
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