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Mackenzie GA, Hossain I, Salaudeen R, Badji H, Manjang A, Usuf E, Bottomley C, Greenwood B, Hill PC. Impact of pneumococcal conjugate vaccination on pneumococcal nasopharyngeal carriage in the Gambia: Population-based cross-sectional surveys. Vaccine 2024; 42:2680-2686. [PMID: 38490820 PMCID: PMC11004668 DOI: 10.1016/j.vaccine.2024.02.066] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The introduction of pneumococcal conjugate vaccines (PCV) has reduced carriage of vaccine-type (VT) pneumococci in many settings. We determined the impact of The Gambia's national PCV programme on carriage of VT pneumococci in the population. METHODS Seven-valent PCV (PCV7) was introduced in August 2009 without catch-up and with doses scheduled at 2, 3, 4 months of age; it was replaced by PCV13 in May 2011. We did cross-sectional carriage surveys in 2009, 2015, and 2017 in age-stratified, population-based samples. Nasopharyngeal specimens were collected and processed according to WHO guidelines. We calculated observed and adjusted prevalence ratios (PR) of VT carriage before and after PCV introduction. FINDINGS We enrolled 2988, 3162, and 2709 participants in 2009, 2015, and 2017 respectively. The baseline (2009) prevalence of VT pneumococcal carriage among children aged 0-4 years was 42.6 %, which declined to 14.9 % and 17.5 % in 2015 and 2017 respectively (adjPR 0.32 [95 % CI 0.27, 0.38] and 0.38 [0.31, 0.46] respectively). VT prevalence among children aged 5-14 years was 16.6 %, 15.1 %, and 15.8 % in the three surveys (2017 vs 2009, adjPR 0.70 [0.58, 0.83]). VT prevalence among 15-44 year-olds was 6.4 %, 5.7 %, and 7.1 % in the three surveys (2017 vs 2009, adjPR 0.59 [0.46, 0.75]), while in those aged ≥ 45 years it was 4.5 %, 6.5 %, and 4.5 % respectively. Non-VT carriage increased in all age-groups. Prevalent residual serotypes were 34 and 15B (age 0-4 years), 3 and 34 (age 5-14 years), and 3 and 16F (age ≥ 15 years). CONCLUSIONS Introduction of PCV was associated with reduced VT pneumococcal carriage in young, and older children, although with substantial residual prevalence. Persisting VT, and non-VT, carriage indicate significant, persistent transmission of pneumococci in the population.
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Affiliation(s)
- Grant A Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia; Murdoch Children's Research Institute, Parkville, 3052 Melbourne, Victoria, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Department of Paediatrics, University of Melbourne, Parkville, 3052 Melbourne, Victoria, Australia.
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Henry Badji
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Ahmed Manjang
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Effua Usuf
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Christian Bottomley
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Philip C Hill
- Centre for International Health, University of Otago, McMillan Street, Dunedin 9010, New Zealand
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Wutor BM, Osei I, Sarwar G, Adefila WO, Galega LB, Hossain I, Abdulsalam Y, Lamin KM, Baldeh AM, Barry B, Ezeani E, Mackenzie G. Under-5 mortality surveillance in low-income and middle-income countries: insights from two Health and Demographic Surveillance Systems in rural Gambia. BMJ Glob Health 2024; 9:e014937. [PMID: 38569661 PMCID: PMC10989099 DOI: 10.1136/bmjgh-2023-014937] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Without complete data on under-5 mortality, tracking progress towards achieving Sustainable Development Goal 3.2 will be challenging. Such data are also needed to ensure proper planning and prioritisation of scarce resources in low-income and middle-income countries. However, most low-income and middle-income countries have weak Civil Registration and Vital Statistics (CRVS) systems, leaving a critical gap in understanding under-5 mortality dynamics. This paper outlines a community-based approach to enhance under-5 mortality surveillance in low-income countries, using The Gambia as a case study. The methodology involves Health and Demographic Surveillance Systems (HDSSs) in Basse and Fuladu West, employing unique identification numbers, periodical household visits and collaboration with communities, village reporters and project field workers to ensure comprehensive data collection. Verbal autopsies (VAs) are conducted by trained field workers, and causes of death are determined using the physician-certified VA method. Between 1 September 2019 and 1 September 2023, 1333 deaths were detected, for which causes of death were determined for 97.1% (1294 of 1333). The most common causes of death detected were acute respiratory infections including pneumonia, sepsis, diarrhoeal diseases and birth asphyxia. Challenges include the cost of maintaining the HDSSs, poor road infrastructure, Electronic Data Capture transition challenges, and the need for national integration of HDSS data into the CRVS system. The success of this model highlights its potential for scalable and adaptable under-5 mortality surveillance in resource-limited settings.
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Affiliation(s)
- Baleng Mahama Wutor
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Isaac Osei
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Golam Sarwar
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Williams Oluwatosin Adefila
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Lobga Babila Galega
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ilias Hossain
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Yusuf Abdulsalam
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Keita Modou Lamin
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Alhagie Muya Baldeh
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Basiru Barry
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Esu Ezeani
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Grant Mackenzie
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Adefila WO, Osie I, Keita ML, Wutor BM, Yusuf AO, Hossain I, Molfa M, Barjo O, Salaudeen R, Mackenzie G. Stenotrophomonas maltophilia neonatal sepsis: a case report. J Med Case Rep 2024; 18:180. [PMID: 38523318 PMCID: PMC10962140 DOI: 10.1186/s13256-024-04479-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Stenotrophomonas maltophilia is a gram-negative bacteria known for causing opportunistic and nosocomial infections in humans. S. maltophilia is an emerging pathogen of concern due to it's increasing prevalence, diverse disease spectrum, intrinsic multi-drug resistance and high mortality rates in immunocompromised individuals. S. maltophilia is a rare cause of neonatal sepsis associated with significant morbidity and mortality. The bacterium's multi-drug resistance poses a considerable challenge for treatment, with various mechanisms contributing to its resistance. CASE PRESENTATION We report a case involving a 40-h-old male African neonate who exhibited symptoms of neonatal sepsis. The blood culture revealed Stenotrophomonas maltophilia, which was sensitive to ciprofloxacin and gentamicin but resistant to other antibiotics. Lumbar puncture for CSF could not be done because the father declined. We treated the newborn with the empirical first-line antibiotics as per the national guideline intravenous ampicillin and gentamicin for six days, and the child recovered fully with a repeated negative blood culture. CONCLUSIONS This report describes a neonatal sepsis case caused by S. maltophilia, a multi-drug resistant bacteria and a rare cause of neonatal sepsis. We report that early detection of the bacterial and antimicrobial management based on local antibiogram data may be essential for successful patient's management.
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Affiliation(s)
- Williams Oluwatosin Adefila
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, West Africa, PO Box 273, Fajara, The Gambia.
| | - Isaac Osie
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, West Africa, PO Box 273, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Modou Lamin Keita
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, West Africa, PO Box 273, Fajara, The Gambia
| | - Baleng Mahama Wutor
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, West Africa, PO Box 273, Fajara, The Gambia
| | - Abdulsalam Olawale Yusuf
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, West Africa, PO Box 273, Fajara, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, West Africa, PO Box 273, Fajara, The Gambia
| | - Minteh Molfa
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, West Africa, PO Box 273, Fajara, The Gambia
| | - Ousman Barjo
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, West Africa, PO Box 273, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, West Africa, PO Box 273, Fajara, The Gambia
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia at London, School of Hygiene and Tropical Medicine, West Africa, PO Box 273, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Wutor BM, Osei I, Babila Galega L, Ezeani E, Adefila W, Hossain I, Sarwar G, Mackenzie G. Verbal autopsy analysis of childhood deaths in rural Gambia. PLoS One 2023; 18:e0277377. [PMID: 37410741 PMCID: PMC10325104 DOI: 10.1371/journal.pone.0277377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND In low-resource settings, it is challenging to ascertain the burden and causes of under-5 mortality as many deaths occur outside health facilities. We aimed to determine the causes of childhood deaths in rural Gambia using verbal autopsies (VA). METHODOLOGY We used WHO VA questionnaires to conduct VAs for deaths under-5 years of age in the Basse and Fuladu West Health and Demographic Surveillance Systems (HDSS) in rural Gambia between September 01, 2019, and December 31, 2021. Using a standardized cause of death list, two physicians assigned causes of death and discordant diagnoses were resolved by consensus. RESULTS VAs were conducted for 89% (647/727) of deaths. Of these deaths, 49.5% (n = 319) occurred at home, 50.1% (n = 324) in females, and 32.3% (n = 209) in neonates. Acute respiratory infection including pneumonia (ARIP) (33.7%, n = 137) and diarrhoeal diseases (23.3%, n = 95) were the commonest primary causes of death in the post-neonatal period. In the neonatal period, unspecified perinatal causes of death (34.0%, n = 71) and deaths due to birth asphyxia (27.3%, n = 57) were the commonest causes of death. Severe malnutrition (28.6%, n = 185) was the commonest underlying cause of death. In the neonatal period, deaths due to birth asphyxia (p-value<0.001) and severe anaemia (p-value = 0.03) were more likely to occur at hospitals while unspecified perinatal deaths (p-value = 0.01) were more likely to occur at home. In the post-neonatal period, deaths due to ARIP (p-value = 0.04) and diarrhoeal disease (p-value = 0.001) were more likely to occur among children aged 1-11 months and 12-23 months respectively. CONCLUSION According to VA analysis of deaths identified within two HDSS in rural Gambia, half of deaths amongst children under-5 in rural Gambia occur at home. ARIP and diarrhoea, and the underlying cause of severe malnutrition remain the predominant causes of child mortality. Improved health care and health-seeking behaviour may reduce childhood deaths in rural Gambia.
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Affiliation(s)
- Baleng Mahama Wutor
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Isaac Osei
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lobga Babila Galega
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Esu Ezeani
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Williams Adefila
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Golam Sarwar
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Hossain I, Osei I, Lobga G, Wutor BM, Olatunji Y, Adefila W, Adeshola B, Isa Y, Nguyen C, Sonko K, Ceesay L, Baldeh B, Barrow O, Young B, Ceesay S, Nyassi A, Sarwar G, Barjo O, M Drammeh M, Salaudeen R, Mackenzie G. Impact of the COVID-19 pandemic on a clinical trial of pneumococcal vaccine scheduling (PVS) in rural Gambia. Trials 2023; 24:271. [PMID: 37055788 PMCID: PMC10101732 DOI: 10.1186/s13063-023-07298-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
The COVID-19 pandemic represents an unprecedented challenge for clinical research. The Pneumococcal Vaccine Schedules (PVS) study is a non-inferiority, interventional trial in which infants resident in 68 geographic clusters are randomised to two different schedules for pneumococcal vaccination. From September 2019 onwards, all infants resident in the study area became eligible for trial enrolment at all Expanded Programme on Immunisation (EPI) clinics in the study area. Surveillance for clinical endpoints is conducted at all 11 health facilities in the study area. PVS is conducted as a collaboration between the Medical Research Council Unit The Gambia (MRCG) at LSHTM and the Gambian Ministry of Health (MoH). The COVID-19 pandemic caused many disruptions to PVS. MRCG instructed interventional studies that participant enrolment be suspended on 26 March 2020, and a public health emergency was declared in The Gambia on 28 March 2020. Enrolment in PVS restarted on 1 July 2020 and was suspended again on 5 August 2020 after The Gambia experienced a sharp increase in COVID-19 cases in late July 2020 and restarted again on 1 September 2020. During periods of suspended enrolment of infants at EPI clinics, PVS continued safety surveillance at health facilities, albeit with disruptions. During the periods of suspended enrolment, infants who had been enrolled before 26 March 2020 continued to receive the PCV schedule to which they had been randomly allocated based on their village of residence, whereas all other infants received the standard PCV schedule. Throughout 2020 and 2021, the trial faced numerous technical and operational challenges: disruption to MoH delivery of EPI services and clinical care at health facilities; episodes of staff illness and isolation; disruption of MRCG transport, procurement, communications and human resource management; and also a range of ethical, regulatory, sponsorship, trial monitoring and financial challenges. In April 2021, a formal review concluded that the pandemic had not compromised the scientific validity of PVS and that the trial should continue as per protocol. The continuing challenges that COVID-19 poses to PVS, and other clinical trials will persist for some time.
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Affiliation(s)
- Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia.
| | - Isaac Osei
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Galega Lobga
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Baleng M Wutor
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Yekini Olatunji
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Williams Adefila
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Banjo Adeshola
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Yasir Isa
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Cattram Nguyen
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Kemo Sonko
- Regional Health Directorate, Upper River Region, Ministry of Health, Basse, The Gambia
| | - Lamin Ceesay
- Regional Health Directorate, Upper River Region, Ministry of Health, Basse, The Gambia
| | - Bubacarr Baldeh
- Regional Health Directorate, Central River Region, Ministry of Health, Bansang, The Gambia
| | - Omar Barrow
- Regional Health Directorate, Central River Region, Ministry of Health, Bansang, The Gambia
| | - Benjamin Young
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Saidina Ceesay
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Abdoullah Nyassi
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Golam Sarwar
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Ousman Barjo
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Momodou M Drammeh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Fajara, Banjul, The Gambia
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Mohammed NI, Wason J, Mendy T, Nass SA, Ofordile O, Camara F, Baldeh B, Sanyang C, Jallow AT, Hossain I, Faria N, Powell JJ, Prentice AM, Pereira DI. A novel nano-iron supplement versus standard treatment for iron deficiency anaemia in children 6-35 months (IHAT-GUT trial): a double-blind, randomised, placebo-controlled non-inferiority phase II trial in The Gambia. EClinicalMedicine 2023; 56:101853. [PMID: 36880049 PMCID: PMC9985047 DOI: 10.1016/j.eclinm.2023.101853] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Iron deficiency anaemia (IDA) is the leading cause of years lost to disability in most sub-Saharan African countries and is especially common in young children. The IHAT-GUT trial assessed the efficacy and safety of a novel nano iron supplement, which is a dietary ferritin analogue termed iron hydroxide adipate tartrate (IHAT), for the treatment of IDA in children under 3 years of age. METHODS In this single-country, randomised, double-blind, parallel, placebo-controlled, non-inferiority Phase II study in The Gambia, children 6-35 months with IDA (7≤Hb < 11 g/dL and ferritin<30 μg/L) were randomly assigned (1:1:1) to receive either IHAT, ferrous sulphate (FeSO4) or placebo daily for 3 months (85 days). The daily iron dose was 12.5 mg Fe equivalent for FeSO4 and the estimated dose with comparable iron-bioavailability for IHAT (20 mg Fe). The primary efficacy endpoint was the composite of haemoglobin response at day 85 and correction of iron deficiency. The non-inferiority margin was 0.1 absolute difference in response probability. The primary safety endpoint was moderate-severe diarrhoea analysed as incidence density and prevalence over the 3 months intervention. Secondary endpoints reported herein include hospitalisation, acute respiratory infection, malaria, treatment failures, iron handling markers, inflammatory markers, longitudinal prevalence of diarrhoea and incidence density of bloody diarrhoea. Main analyses were per-protocol (PP) and intention-to-treat (ITT) analyses. This trial is registered with clinicaltrials.gov (NCT02941081). FINDINGS Between Nov 2017 and Nov 2018, 642 children were randomised into the study (214 per group) and included in the ITT analysis, the PP population included 582 children. A total of 50/177 (28.2%) children in the IHAT group achieved the primary efficacy endpoint, as compared with 42/190 (22.1%) in the FeSO4 group (OR 1.39, 80% CI 1.01-1.91, PP population) and with 2/186 (1.1%) in the placebo group. Diarrhoea prevalence was similar between groups, with 40/189 (21.2%) children in the IHAT group developing at least one episode of moderate-severe diarrhoea over the 85 days intervention, compared with 47/198 (23.7%) in the FeSO4 group (OR 1.18, 80% CI 0.86-1.62) and 40/195 (20.5%) in the placebo group (OR 0.96, 80% CI 0.7-1.33, PP population). Incidence density of moderate-severe diarrhoea was 2.66 in the IHAT group and 3.42 in the FeSO4 group (RR 0.76, 80% CI 0.59-0.99, CC-ITT population).There were 143/211 (67.8%) children with adverse events (AEs) in the IHAT group, 146/212 (68.9%) in the FeSO4 group and 143/214 (66.8%) in the placebo group. There were overall 213 diarrhoea-related AEs; 35 (28.5%) cases reported in the IHAT group compared with 51 (41.5%) cases in the FeSO4 group and 37 (30.1%) cases in the placebo group. INTERPRETATION In this first Phase II study conducted in young children with IDA, IHAT showed sufficient non-inferiority compared to standard-of-care FeSO4, in terms of ID correction and haemoglobin response, to warrant a definitive Phase III trial. In addition, IHAT had lower incidence of moderate-severe diarrhoea than FeSO4, with no increased adverse events in comparison with placebo. FUNDING The Bill & Melinda Gates Foundation (OPP1140952).
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Affiliation(s)
- Nuredin I. Mohammed
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - James Wason
- MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, NE2 4BN, UK
| | - Thomas Mendy
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Stefan A. Nass
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
- Medical Humanities, Amsterdam-UMC - VUmc Location, Vrije Universiteit, Amsterdam, the Netherlands
| | - Ogochukwu Ofordile
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Famalang Camara
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Bakary Baldeh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Chilel Sanyang
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Amadou T. Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Nuno Faria
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Jonathan J. Powell
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
- Corresponding author. MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, Gambia.
| | - Dora I.A. Pereira
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
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Osei I, Sarwar G, Hossain I, Sonko K, Ceesay L, Baldeh B, Secka E, Mackenzie GA. Attendance and vaccination at immunization clinics in rural Gambia before and during the COVID-19 pandemic. Vaccine 2022; 40:6367-6373. [PMID: 36180374 PMCID: PMC9468317 DOI: 10.1016/j.vaccine.2022.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has affected the delivery of essential health services, such as routine immunization. We assessed the impact of the pandemic on the uptake of routine immunization in rural Gambia. METHODS We collected real-time vaccine administration data in the Basse and Fuladu West Health & Demographic Surveillance Systems from September 01, 2019, to December 31, 2020. We assessed the monthly number of Expanded Program on Immunization (EPI) clinic attendances and vaccines administered, comparing data during the baseline period (September 01, 2019-March 31, 2020), COVID-19 interruption period (April 01-June 30, 2020), initial recovery period (Jul 01-September 30, 2020) and the late recovery period (October 01-December 31, 2020). RESULTS Compared to the baseline period, there was an overall average monthly decline of 13.4% in EPI attendance and 38.3% reduction in average monthly immunizations during the interruption period. This decrease was particularly noticeable for Bacille Calmette-Guérin (BCG) (47.2%), birth dose hepatitis B (Hep B) (46.9%), 1st dose pentavalent (Penta1) (43.1%), 1st dose pneumococcal conjugate vaccine (PCV1) (42.4%), and measles vaccines (15.5%). Comparing the late recovery to baseline period, average monthly EPI attendance was 5.3% higher, with 1.9% increase in average monthly immunizations. Monthly immunizations for BCG were 3.0% greater, 2.5% greater for Hep B, 22.7% greater for oral polio vaccine (OPV1), 2.0% less for Penta1, 19.2% less for Penta2, and 2.6% less for PCV1. CONCLUSION The reduced EPI attendance during the pandemic interruption period lasted only 3 months. Significant recovery in EPI attendance occurred during the late recovery period, while rates of monthly immunization returned to pre-pandemic levels for most antigens. EPI programmes should implement strategies to deliver missed antigens when infants do present to EPI clinics, aware that missed doses may be age dependent.
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Affiliation(s)
- Isaac Osei
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Golam Sarwar
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kemo Sonko
- Regional Health Directorate, Upper River Region, Ministry of Health, Basse, The Gambia
| | - Lamin Ceesay
- Regional Health Directorate, Upper River Region, Ministry of Health, Basse, The Gambia
| | - Bubacarr Baldeh
- Regional Health Directorate, Central River Region, Ministry of Health, Bansang, The Gambia
| | - Ebba Secka
- Regional Health Directorate, Central River Region, Ministry of Health, Bansang, The Gambia
| | - Grant A Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Ikumapayi UN, Hill PC, Hossain I, Olatunji Y, Ndiaye M, Badji H, Manjang A, Salaudeen R, Ceesay L, Adegbola RA, Greenwood BM, Mackenzie GA. Childhood meningitis in rural Gambia: 10 years of population-based surveillance. PLoS One 2022; 17:e0265299. [PMID: 35947593 PMCID: PMC9365145 DOI: 10.1371/journal.pone.0265299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background The introduction in many countries of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited. Methods Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators. Results We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the <2-month age group, 56 per 100,000 in the 2–23-month age group, but lower at 5 per 100,000 in the 5–14-year age group. The most common causes of ABM were Streptococcus pneumoniae (n = 44), Neisseria meningitidis (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49/169) and was highest in the <2-month age group 37% (10/27). The case fatality ratio was 8.6% (18/209) for suspected non-bacterial meningitis and 12.8% (134/1049) for clinically suspected meningitis cases. Conclusions Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care.
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Affiliation(s)
- Usman N. Ikumapayi
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- * E-mail:
| | - Philip C. Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Ilias Hossain
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yekini Olatunji
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ahmed Manjang
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Lamin Ceesay
- Ministry of Health, Gambia Government, Banjul, The Gambia
| | - Richard A. Adegbola
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- RAMBICON, Immunisation & Global Health Consulting, Lekki, Lagos, Nigeria
| | | | - Grant A. Mackenzie
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Murdoch Children’s Research Institute, Parkville, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Young B, Sarwar G, Hossain I, Mackenzie G. Risk factors associated with non-vaccination in Gambian children: a population-based cohort study. Trans R Soc Trop Med Hyg 2022; 116:1063-1070. [PMID: 35696088 PMCID: PMC9623738 DOI: 10.1093/trstmh/trac051] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/05/2022] [Accepted: 05/13/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We determined the risk factors associated with unvaccinated children in rural Gambia. METHODS We conducted prospective demographic surveillance and recorded immunisations in real time in the Upper River Region, The Gambia. Analysis included residents born from 1 January 2012 to 31 December 2016. Data included age, sex, household members and relationships, migrations, births, deaths, ethnicity, residential location and birth type. Children were defined as unvaccinated at 10, 15 and 24 mo of age if they missed all primary series doses (pentavalent, oral polio and pneumococcal conjugate vaccines), secondary series (first dose measles and yellow fever vaccines) or both vaccination series, respectively. Logistic regressions measured the association between risk factors and being unvaccinated. RESULTS In total, 5% (1567/30 832) of infants born during the study period and who were residents at the age of 10 mo were unvaccinated. Being unvaccinated at 10 mo of age was associated with children; who did not reside with either parent (adjusted OR 2.26, 95% CI 1.60 to 3.19), whose parents were not the head of household (1.29, 1.09 to 1.52), who had experienced immigration (2.78, 1.52 to 5.08) or who were not of Mandinka ethnicity (between 1.57 and 1.85 for other ethnicities). CONCLUSIONS Family characteristics are associated with unimmunised children in rural Gambia. Our findings may inform strategies to increase vaccine coverage.
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Affiliation(s)
- Benjamin Young
- Corresponding author: Present address: School of Public Health, University of Hong Kong, 7 Sassoon Road, Sandy Bay, Hong Kong SAR. Tel: +852-3917 9055; E-mail:
| | - Golam Sarwar
- MRC Unit The Gambia at LSHTM, Fajara, 00000, The Gambia,London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Ilias Hossain
- MRC Unit The Gambia at LSHTM, Fajara, 00000, The Gambia,London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Grant Mackenzie
- MRC Unit The Gambia at LSHTM, Fajara, 00000, The Gambia,London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom,Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia,Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
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10
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Evans B, Ellsmere J, Hossain I, Ennis M, O'Brien E, Bacque L, Ge M, Brodie J, Harnett J, Borgaonkar M, Pace D. Colonoscopy skills improvement training improves patient comfort during colonoscopy. Surg Endosc 2022; 36:4588-4592. [PMID: 34622297 DOI: 10.1007/s00464-021-08753-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION We aimed to assess the effect of Colonoscopy Skills Improvement (CSI) training on patient comfort and sedation-related complications during colonoscopy. METHODS This retrospective cohort study was performed on 19 endoscopists practicing in a Canadian tertiary care center who completed CSI training between October 2014 and May 2016. Data from 50 procedures immediately prior to, immediately after, and eight months following CSI training were included for each endoscopist. The primary outcome variable was intraprocedural comfort, and secondary outcomes included intraprocedural hypotension and hypoxia. Data were extracted from an electronic medical record and analyzed using SPSS version 20.0. Univariate analysis and stepwise multivariable logistic regression were performed to determine if there was an association between patient comfort and CSI training. Predictors of these outcomes including patient age, gender, sedation use and dosing, procedure completion, quality of bowel preparation, endoscopist experience, and specialty were included in the analysis. RESULTS 2533 colonoscopies were included in the study. The mean dose of sedatives was reduced immediately following CSI training and at 8 months for both Fentanyl (75.4 mcg v. 67.8 mcg v. 65.9 mcg, p < 0.001) and Midazolam (2.57 mg v. 2.27 mg v. 2.19 mg, p < 0.001). The percentage of patients deemed to have a comfortable exam improved following endoscopist participation in CSI training and remained improved at 8 months (55.1% v. 70.2% v. 69.8%, p < 0.001). No significant change in rates of intraprocedural hypoxia or hypotension were noted following CSI training. CONCLUSION CSI training is associated with improved patient comfort and reduced sedation requirements during colonoscopy.
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Affiliation(s)
- B Evans
- Department of Surgery, Dalhousie University, Halifax, NS, Canada. .,Department of Surgery, Memorial University, St. John's, NL, Canada.
| | - J Ellsmere
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - I Hossain
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - M Ennis
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - E O'Brien
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - L Bacque
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - M Ge
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - J Brodie
- Department of Surgery, Memorial University, St. John's, NL, Canada
| | - J Harnett
- Department of Medicine, Memorial University, St. John's, NL, Canada
| | - M Borgaonkar
- Department of Medicine, Memorial University, St. John's, NL, Canada
| | - D Pace
- Department of Surgery, Memorial University, St. John's, NL, Canada
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Bhattacharjee M, Hossain I, Roy S, Kamrul-Hasan AB, Ahmed F, Banerjee S, Bhuya SI, Losy SA, Biswas R, Mondal D. Post-Acute Covid Neurological Symptoms among Doctors and Nurses in A Tertiary Care Hospital: An Observational Study from Bangladesh. Mymensingh Med J 2022; 31:379-384. [PMID: 35383754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A good number of patients experience post-Covid complications. Doctors and nurses are the front liners who are at greater risk of having this disease. Neurological symptoms are frequent in patients with post-COVID-19 infection. The study aims to observe the post-acute neurological symptoms among doctors and nurses of Mymensingh Medical College Hospital, a tertiary care hospital in Bangladesh, after they recover from initial infection or among the asymptomatic cases. It was a retrospective observational study among the doctors and nurses who became RT PCR positive from late April to mid-September 2020. A total of 100 subjects were interviewed over the phone for the presence or absence of neurological symptoms four weeks post Covid-19 infection. Total 54 doctors and 46 nurses were evaluated; the male-female ratio was 1:1.77, the mean age was 35.6±7.6 years. Post-acute COVID neurological symptoms (PACNS) were present in 60% of respondents. Fatigue (51%) was the most common symptom, followed by sleep disturbance, headache, myalgia, loss of taste and smell. PACNS were more in symptomatic patients at the initial Covid infection than asymptomatic cases.
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Affiliation(s)
- M Bhattacharjee
- Dr Manabendra Bhattacharjee, Associate Professor, Department of Neurology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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12
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Mackenzie GA, McLellan J, Machuka E, Ndiaye M, Pathirana J, Fombah A, Abatan B, Hossain I, Manjang A, Greenwood B, Hill P. Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance. BMJ Open 2022; 12:e056706. [PMID: 35273059 PMCID: PMC8915295 DOI: 10.1136/bmjopen-2021-056706] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the causes of lobar pneumonia in rural Gambia. DESIGN AND SETTING Population-based pneumonia surveillance at seven peripheral health facilities and two regional hospitals in rural Gambia. 7-valent pneumococcal conjugate vaccine (PCV7) was introduced routinely in August 2009 and replaced by PCV13 from May 2011. METHODS Prospective pneumonia surveillance was undertaken among all ages with referral of suspected pneumonia cases to the regional hospitals. Blood culture and chest radiographs were performed routinely while lung or pleural aspirates were collected from selected, clinically stable patients with pleural effusion on radiograph and/or large, dense, peripheral consolidation. We used conventional microbiology, and from 8 April 2011 to 17 July 2012, used a multiplex PCR assay on lung and pleural aspirates. We calculated proportions with pathogens, associations between coinfecting pathogens and PCV effectiveness. PARTICIPANTS 2550 patients were admitted with clinical pneumonia; 741 with lobar pneumonia or pleural effusion. We performed 181 lung or pleural aspirates and multiplex PCR on 156 lung and 4 pleural aspirates. RESULTS Pathogens were detected in 116/160 specimens, the most common being Streptococcus pneumoniae(n=68), Staphylococcus aureus (n=26) and Haemophilus influenzae type b (n=11). Bacteria (n=97) were more common than viruses (n=49). Common viruses were bocavirus (n=11) and influenza (n=11). Coinfections were frequent (n=55). Moraxella catarrhalis was detected in eight patients and in every case there was coinfection with S. pneumoniae. The odds ratio of vaccine-type pneumococcal pneumonia in patients with two or three compared with zero doses of PCV was 0.17 (95% CI 0.06 to 0.51). CONCLUSIONS Lobar pneumonia in rural Gambia was caused primarily by bacteria, particularly S. pneumoniae and S. aureus. Coinfection was common and M. catarrhalis always coinfected with S. pneumoniae. PCV was highly efficacious against vaccine-type pneumococcal pneumonia.
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Affiliation(s)
- Grant Austin Mackenzie
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessica McLellan
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eunice Machuka
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Malick Ndiaye
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Jayani Pathirana
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Augustin Fombah
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Baderinwa Abatan
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Ilias Hossain
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Ahmed Manjang
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Brian Greenwood
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Philip Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
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Mackenzie GA, Osei I, Salaudeen R, Hossain I, Young B, Secka O, D'Alessandro U, Palmu AA, Jokinen J, Hinds J, Flasche S, Mulholland K, Nguyen C, Greenwood B. A cluster-randomised, non-inferiority trial of the impact of a two-dose compared to three-dose schedule of pneumococcal conjugate vaccination in rural Gambia: the PVS trial. Trials 2022; 23:71. [PMID: 35073989 PMCID: PMC8785014 DOI: 10.1186/s13063-021-05964-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/22/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCV) effectively prevent pneumococcal disease but the global impact of pneumococcal vaccination is hampered by the cost of PCV. The relevance and feasibility of trials of reduced dose schedules is greatest in middle- and low-income countries, such as The Gambia, where PCV has been introduced with good disease control but where transmission of vaccine-type pneumococci persists. We are conducting a large cluster-randomised, non-inferiority, field trial of an alternative reduced dose schedule of PCV compared to the standard schedule, the PVS trial. METHODS PVS is a prospective, cluster-randomised, non-inferiority, real-world field trial of an alternative schedule of one dose of PCV scheduled at age 6 weeks with a booster dose at age 9 months (i.e. the alternative '1 + 1' schedule) compared to the standard schedule of three primary doses scheduled at 6, 10, and 14 weeks of age (i.e. the standard '3 + 0' schedule). The intervention will be delivered for 4 years. The primary endpoint is the population-level prevalence of nasopharyngeal vaccine-type pneumococcal carriage in children aged 2 weeks to 59 months with clinical pneumonia in year 4 of the trial. Participants and field staff are not masked to group allocation while measurement of the laboratory endpoint will be masked. Sixty-eight geographic population clusters have been randomly allocated, in a 1:1 ratio, to each schedule and all resident infants are eligible for enrolment. All resident children less than 5 years of age are under continuous surveillance for clinical safety endpoints measured at 11 health facilities; invasive pneumococcal disease, radiological pneumonia, clinical pneumonia, and hospitalisations. Secondary endpoints include the population-level prevalence of nasopharyngeal vaccine-type pneumococcal carriage in years 2 and 4 and vaccine-type carriage prevalence in unimmunised infants aged 6-12 weeks in year 4. The trial includes components of mathematical modelling, health economics, and health systems research. DISCUSSION Analysis will account for potential non-independence of measurements by cluster, comparing the population-level impact of the two schedules with interpretation at the individual level. The non-inferiority margin is informed by the 'acceptable loss of effect' of the alternative compared to the standard schedule. The secondary endpoints will provide substantial evidence to support the interpretation of the primary endpoint. PVS will evaluate the effect of transition from a standard 3+ 0 schedule to an alternative 1 + 1 schedule in a setting of high pneumococcal transmission. The results of PVS will inform global decision-making concerning the use of reduced-dose PCV schedules. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number 15056916 . Registered on 15 November 2018.
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Affiliation(s)
- Grant A Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia.
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
- Murdoch Children's Research Institute, Melbourne, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Isaac Osei
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Benjamin Young
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Ousman Secka
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Arto A Palmu
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Jokinen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jason Hinds
- Institute for Infection and Immunity St George's University of London, London, UK
- BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | - Stefan Flasche
- Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kim Mulholland
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cattram Nguyen
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Brian Greenwood
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Pecenka C, Usuf E, Hossain I, Sambou S, Vodicka E, Atherly D, Mackenzie G. Pneumococcal conjugate vaccination in The Gambia: health impact, cost effectiveness and budget implications. BMJ Glob Health 2021; 6:bmjgh-2021-007211. [PMID: 34916274 PMCID: PMC8679103 DOI: 10.1136/bmjgh-2021-007211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/17/2021] [Accepted: 11/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Introducing pneumococcal conjugate vaccine (PCV) in many low-income countries has contributed to reductions in global childhood deaths caused by Streptococcus pneumoniae. Many low-income countries, however, will soon reach an economic status leading to transition from Gavi, the Vaccine Alliance vaccine funding support and then face increased expenditure to continue PCV programmes. Evaluating the cost-effectiveness of PCV in low-income countries will inform such country decisions. METHODS We used empiric data on the costs of vaccine delivery and pneumococcal disease and PCV programme impact on disease among children less than 5 years old in The Gambia. We used the UNIVAC cost-effectiveness modelling tool to compare the impact and cost-effectiveness of pneumococcal conjugate vaccination to no vaccination over 20 birth cohorts starting in 2011. We calculated costs per disability-adjusted-life-year (DALY) averted from government and societal perspectives and undertook scenario and probabilistic sensitivity analysis. RESULTS We projected that, over 20 years, PCV in The Gambia could avert 117 000 total disease episodes in children less than 5 years old, including outpatient and hospitalised pneumonia, pneumococcal sepsis and meningitis (including sequelae). Vaccination could avert 9000 outpatient pneumonia visits, 88 000 hospitalisations and 3300 deaths due to pneumonia, meningitis and sepsis. Approximately 100 000 DALYs are expected to be averted. Averted visits and hospitalisations represent US$4 million in healthcare costs expected to be saved by the government and US$7.3 million if household costs are included. The cost of the vaccination programme is estimated at US$2 million. In the base scenario, most alternative scenarios and nearly 90% of the probabilistic scenarios, pneumococcal vaccination is cost saving in The Gambia. CONCLUSION Pneumococcal conjugate vaccination is expected to generate substantial health gains and is likely to be cost saving in The Gambia. Policymakers in similar settings should be confident to maintain their PCV programmes.
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Affiliation(s)
- Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
| | - Effua Usuf
- Disease Control and Elimination, Medical Research Council The Gambia, Banjul, Gambia
| | - Ilias Hossain
- Disease Control and Elimination, Medical Research Council The Gambia, Banjul, Gambia
| | - Sana Sambou
- Ministry of Health, Government of the Gambia, Banjul, Gambia
| | - Elisabeth Vodicka
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
| | - Deborah Atherly
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
| | - Grant Mackenzie
- Disease Control and Elimination, MRC Unit The Gambia at LSHTM, Banjul, Gambia.,London School of Hygiene & Tropical Medicine, London, UK
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Hossain I, Hill P, Bottomley C, Jasseh M, Bojang K, Kaira M, Sankareh A, Sarwar G, Greenwood B, Howie S, Mackenzie G. Healthcare Seeking and Access to Care for Pneumonia, Sepsis, Meningitis, and Malaria in Rural Gambia. Am J Trop Med Hyg 2021; 106:446-453. [PMID: 34872061 PMCID: PMC8832889 DOI: 10.4269/ajtmh.21-0362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Children with acute infectious diseases may not present to health facilities, particularly in low-income countries. We investigated healthcare seeking using a cross-sectional community survey, health facility-based exit interviews, and interviews with customers of private pharmacies in 2014 in Upper River Region (URR) The Gambia, within the Basse Health & Demographic Surveillance System. We estimated access to care using surveillance data from 2008 to 2017 calculating disease incidence versus distance to the nearest health facility. In the facility-based survey, children and adult patients sought care initially at a pharmacy (27.9% and 16.7% respectively), from a relative (23.1% and 28.6%), at a local shop or market (13.5% and 16.7%), and on less than 5% of occasions with a community-based health worker, private clinic, or traditional healer. In the community survey, recent symptoms of pneumonia or sepsis (15% and 1.5%) or malaria (10% and 4.6%) were common in children and adults. Rates of reported healthcare-seeking were high with families of children favoring health facilities and adults favoring pharmacies. In the pharmacy survey, 47.2% of children and 30.4% of adults had sought care from health facilities before visiting the pharmacy. Incidence of childhood disease declined with increasing distance of the household from the nearest health facility with access to care ratios of 0.75 for outpatient pneumonia, 0.82 for hospitalized pneumonia, 0.87 for bacterial sepsis, and 0.92 for bacterial meningitis. In rural Gambia, patients frequently seek initial care at pharmacies and informal drug-sellers rather than community-based health workers. Surveillance underestimates disease incidence by 8-25%.
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Affiliation(s)
- Ilias Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Kombo, The Gambia
| | - Philip Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Momodou Jasseh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Kombo, The Gambia
| | - Kalifa Bojang
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Kombo, The Gambia
| | - Markieu Kaira
- Medicines Control Agency, Kairaba Avenue, Kombo, The Gambia
| | - Alhagie Sankareh
- Regional Health Team, Upper River Region, Basse, URR, The Gambia
| | - Golam Sarwar
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Kombo, The Gambia
| | - Brian Greenwood
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stephen Howie
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Kombo, The Gambia.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Kombo, The Gambia.,London School of Hygiene & Tropical Medicine, London, United Kingdom.,Murdoch Childrens Research Institute, Parkville, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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16
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Mackenzie GA, Hill PC, Jeffries DJ, Ndiaye M, Sahito SM, Hossain I, Uchendu U, Ameh D, Adeyemi O, Pathirana J, Olatunji Y, Abatan B, Muhammad BS, Ahameefula E, Fombah AE, Adeshola B, Lobga BG, Saha D, Mackenzie R, Odutola A, Plumb ID, Akano A, Ebruke BE, Ideh RC, Kuti B, Githua P, Olutunde E, Ofordile O, Green E, Usuf E, Badji H, Ikumapayi UN, Manjang A, Salaudeen R, Nsekpong ED, Jarju S, Antonio M, Sambou S, Ceesay L, Lowe-Jallow Y, Fofana S, Jasseh M, Mulholland K, Knoll M, Levine OS, Howie SR, Adegbola RA, Greenwood BM, Corrah T. Impact of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease and pneumonia in The Gambia: 10 years of population-based surveillance. Lancet Infect Dis 2021; 21:1293-1302. [PMID: 34280357 PMCID: PMC8384632 DOI: 10.1016/s1473-3099(20)30880-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 10/01/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022]
Abstract
Background The Gambia introduced seven-valent pneumococcal conjugate vaccine (PCV7) in August 2009, followed by PCV13 in May, 2011, using a schedule of three primary doses without a booster dose or catch-up immunisation. We aimed to assess the long-term impact of PCV on disease incidence. Methods We did 10 years of population-based surveillance for invasive pneumococcal disease (IPD) and WHO defined radiological pneumonia with consolidation in rural Gambia. The surveillance population included all Basse Health and Demographic Surveillance System residents aged 2 months or older. Nurses screened all outpatients and inpatients at all health facilities using standardised criteria for referral. Clinicians then applied criteria for patient investigation. We defined IPD as a compatible illness with isolation of Streptococcus pneumoniae from a normally sterile site (cerebrospinal fluid, blood, or pleural fluid). We compared disease incidence between baseline (May 12, 2008–May 11, 2010) and post-vaccine years (2016–2017), in children aged 2 months to 14 years, adjusting for changes in case ascertainment over time. Findings We identified 22 728 patients for investigation and detected 342 cases of IPD and 2623 cases of radiological pneumonia. Among children aged 2–59 months, IPD incidence declined from 184 cases per 100 000 person-years to 38 cases per 100 000 person-years, an 80% reduction (95% CI 69–87). Non-pneumococcal bacteraemia incidence did not change significantly over time (incidence rate ratio 0·88; 95% CI, 0·64–1·21). We detected zero cases of vaccine-type IPD in the 2–11 month age group in 2016–17. Incidence of radiological pneumonia decreased by 33% (95% CI 24–40), from 10·5 to 7·0 per 1000 person-years in the 2–59 month age group, while pneumonia hospitalisations declined by 27% (95% CI 22–31). In the 5–14 year age group, IPD incidence declined by 69% (95% CI −28 to 91) and radiological pneumonia by 27% (95% CI −5 to 49). Interpretation Routine introduction of PCV13 substantially reduced the incidence of childhood IPD and pneumonia in rural Gambia, including elimination of vaccine-type IPD in infants. Other low-income countries can expect substantial impact from the introduction of PCV13 using a schedule of three primary doses. Funding Gavi, The Vaccine Alliance; Bill & Melinda Gates Foundation; UK Medical Research Council; Pfizer Ltd.
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Affiliation(s)
| | - Grant A Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia; London School of Hygiene & Tropical Medicine, London, UK; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australi.
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - David J Jeffries
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Shah M Sahito
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Uchendu Uchendu
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - David Ameh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Oyedeji Adeyemi
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Jayani Pathirana
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yekini Olatunji
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Baderinwa Abatan
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Bilquees S Muhammad
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ebirim Ahameefula
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Augustin E Fombah
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Banjo Adeshola
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Babila G Lobga
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Debasish Saha
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Roslyn Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Aderonke Odutola
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ian D Plumb
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Aliu Akano
- The National Hospital, Garki, Abuja, Nigeria
| | - Bernard E Ebruke
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Readon C Ideh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Bankole Kuti
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Peter Githua
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Emmanuel Olutunde
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ogochukwu Ofordile
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Edward Green
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Effua Usuf
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Usman Na Ikumapayi
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ahmed Manjang
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - E David Nsekpong
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sheikh Jarju
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Martin Antonio
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; London School of Hygiene & Tropical Medicine, London, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Sana Sambou
- Ministry of Health, Gambia Government, The Gambia
| | - Lamin Ceesay
- Ministry of Health, Gambia Government, The Gambia
| | | | - Sidat Fofana
- Ministry of Health, Gambia Government, The Gambia
| | - Momodou Jasseh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kim Mulholland
- Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia; London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Knoll
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Orin S Levine
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen R Howie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Centre for International Health, University of Otago, Dunedin, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | | | | | - Tumani Corrah
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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17
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Zaman SM, Howie SR, Ochoge M, Secka O, Bah A, Baldeh I, Sanneh B, Darboe S, Ceesay B, Camara HB, Mawas F, Ndiaye M, Hossain I, Salaudeen R, Bojang K, Ceesay S, Sowe D, Hossain MJ, Mulholland K, Kwambana-Adams BA, Okoi C, Badjie S, Ceesay L, Mwenda JM, Cohen AL, Agocs M, Mihigo R, Bottomley C, Antonio M, Mackenzie GA. Impact of routine vaccination against Haemophilus influenzae type b in The Gambia: 20 years after its introduction. J Glob Health 2021; 10:010416. [PMID: 32509291 PMCID: PMC7243067 DOI: 10.7189/jogh.10.010416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background In 1997, The Gambia introduced three primary doses of Haemophilus influenzae type b (Hib) conjugate vaccine without a booster in its infant immunisation programme along with establishment of a population-based surveillance on Hib meningitis in the West Coast Region (WCR). This surveillance was stopped in 2002 with reported elimination of Hib disease. This was re-established in 2008 but stopped again in 2010. We aimed to re-establish the surveillance in WCR and to continue surveillance in Basse Health and Demographic Surveillance System (BHDSS) in the east of the country to assess any shifts in the epidemiology of Hib disease in The Gambia. Methods In WCR, population-based surveillance for Hib meningitis was re-established in children aged under-10 years from 24 December 2014 to 31 March 2017, using conventional microbiology and Real Time Polymerase Chain Reaction (RT-PCR). In BHDSS, population-based surveillance for Hib disease was conducted in children aged 2-59 months from 12 May 2008 to 31 December 2017 using conventional microbiology only. Hib carriage survey was carried out in pre-school and school children from July 2015 to November 2016. Results In WCR, five Hib meningitis cases were detected using conventional microbiology while another 14 were detected by RT-PCR. Of the 19 cases, two (11%) were too young to be protected by vaccination while seven (37%) were unvaccinated. Using conventional microbiology, the incidence of Hib meningitis per 100 000-child-year (CY) in children aged 1-59 months was 0.7 in 2015 (95% confidence interval (CI) = 0.0-3.7) and 2.7 (95% CI = 0.7-7.0) in 2016. In BHDSS, 25 Hib cases were reported. Nine (36%) were too young to be protected by vaccination and five (20%) were under-vaccinated for age. Disease incidence peaked in 2012-2013 at 15 per 100 000 CY and fell to 5-8 per 100 000 CY over the subsequent four years. The prevalence of Hib carriage was 0.12% in WCR and 0.38% in BHDSS. Conclusions After 20 years of using three primary doses of Hib vaccine without a booster Hib transmission continues in The Gambia, albeit at low rates. Improved coverage and timeliness of vaccination are of high priority for Hib disease in settings like Gambia, and there are currently no clear indications of a need for a booster dose.
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Affiliation(s)
- Syed Ma Zaman
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Education Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephen Rc Howie
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.,Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Magnus Ochoge
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ousman Secka
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Alasana Bah
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ignatius Baldeh
- National Public Health Laboratory, Ministry of Health & Social Welfare, Kotu, The Gambia
| | - Bakary Sanneh
- National Public Health Laboratory, Ministry of Health & Social Welfare, Kotu, The Gambia
| | - Saffiatou Darboe
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Buntung Ceesay
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Haddy Bah Camara
- Edward Francis Small Teaching Hospital, Ministry of Health & Social Welfare, Banjul, The Gambia
| | - Fatme Mawas
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, UK
| | - Malick Ndiaye
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kalifa Bojang
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Samba Ceesay
- Directorate of Health Services, Ministry of Health & Social Welfare, Banjul, The Gambia
| | - Dawda Sowe
- Directorate of Health Services, Ministry of Health & Social Welfare, Banjul, The Gambia
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kim Mulholland
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Brenda A Kwambana-Adams
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Catherine Okoi
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Siaka Badjie
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Lamin Ceesay
- Expanded Programme on Immunization, Ministry of Health & Social Welfare, Kotu, The Gambia
| | - Jason M Mwenda
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Adam L Cohen
- World Health Organization, Headquarters, Geneva, Switzerland
| | - Mary Agocs
- American Red Cross, Washington, D.C., USA
| | - Richard Mihigo
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Christian Bottomley
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin Antonio
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.,Dept. of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, London, UK.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Grant A Mackenzie
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Institut de Recherche en Sante, de Surveillance Epidemiologique et de Formation, Dakar, Senegal
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18
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Iaccarino C, Kolias A, Adelson PD, Rubiano AM, Viaroli E, Buki A, Cinalli G, Fountas K, Khan T, Signoretti S, Waran V, Adeleye AO, Amorim R, Bertuccio A, Cama A, Chesnut RM, De Bonis P, Estraneo A, Figaji A, Florian SI, Formisano R, Frassanito P, Gatos C, Germanò A, Giussani C, Hossain I, Kasprzak P, La Porta F, Lindner D, Maas AIR, Paiva W, Palma P, Park KB, Peretta P, Pompucci A, Posti J, Sengupta SK, Sinha A, Sinha V, Stefini R, Talamonti G, Tasiou A, Zona G, Zucchelli M, Hutchinson PJ, Servadei F. Consensus statement from the international consensus meeting on post-traumatic cranioplasty. Acta Neurochir (Wien) 2021; 163:423-440. [PMID: 33354733 PMCID: PMC7815592 DOI: 10.1007/s00701-020-04663-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
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19
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Nass SA, Hossain I, Sanyang C, Baldeh B, Pereira DIA. Hemoglobin point-of-care testing in rural Gambia: Comparing accuracy of HemoCue and Aptus with an automated hematology analyzer. PLoS One 2020; 15:e0239931. [PMID: 33002049 PMCID: PMC7529235 DOI: 10.1371/journal.pone.0239931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 09/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Anemia is one of the most impactful nutrient deficiencies in the world and disproportionately affects children in low-resource settings. Point-of-care devices (PoCDs) measuring blood hemoglobin (Hb) are widely used in such settings to screen for anemia due to their low cost, speed, and convenience. Here we present the first iteration of Aptus, a new PoCD which measures Hb and hematocrit (HCT). Aim To evaluate the accuracy of Aptus and HemoCue® Hb 301 against an automated hematology analyzer (Medonic®) in Gambian children aged 6–35 months and the Aptus’ usage in the field. Methods Aptus, HemoCue® and Medonic® were compared using venous blood (n = 180), and Aptus and HemoCue® additionally using capillary blood (n = 506). Agreement was estimated using Bland-Altman analysis and Lin’s concordance. Usage was assessed by error occurrence and user experience. Results Mean Hb values in venous blood did not significantly differ between Aptus and HemoCue® (10.44±1.05 vs 10.56±0.93g/dl, p>0.05), but both measured higher Hb concentrations than Medonic® (9.75±0.99g/dl, p<0.0001). Lin’s coefficient between Aptus and Medonic® was rc = 0.548, between HemoCue® and Medonic® rc = 0.636. Mean bias between the PoCDs venous measurements was -0.11g/dl with limits of agreement (LoA) -1.63 and 1.40g/dl. The bias was larger for the comparisons between the Medonic® and both Aptus (0.69g/dl, LoA 0.92 and 2.31g/dl) and HemoCue® (0.81g/dl, LoA 0.17 and 1.78g/dl). ROC curves showed an AUC of 0.933 in HemoCue® and 0.799 in Aptus. Capillary Hb was higher with Aptus than HemoCue® (10.33±1.11g/dl vs 10.01±1.07g/dl, p<0.0001). Mean bias was 0.32g/dl with LoA of -1.91 and 2.54g/dl. Aptus‘ usage proved intuitive, yet time-to-results and cuvettes could be improved. Conclusion Both PoCDs showed a relatively limited bias but large LoA. Aptus and HemoCue® showed similar accuracy, while both overestimated Hb levels. Aptus showed promise, with its operation unimpaired by field conditions as well as being able to show HCT values.
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Affiliation(s)
- Stefan A. Nass
- Medical Humanities, Amsterdam-UMC—VUmc Location, Vrije Universiteit, Amsterdam, The Netherlands
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- * E-mail:
| | - Ilias Hossain
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Chilel Sanyang
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bakary Baldeh
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Dora I. A. Pereira
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
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Yussuf NM, Saeed MA, Wagiran H, Hossain I. Soil-to-Plant Transfers Factor of Natural Radionuclides in Groundnut Crops Grown on Soils with Different Levels of Background Radioactivity. Proc Natl Acad Sci , India, Sect A Phys Sci 2020. [DOI: 10.1007/s40010-018-0580-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Dunne EM, Hua Y, Salaudeen R, Hossain I, Ndiaye M, Ortika BD, Mulholland EK, Hinds J, Manna S, Mackenzie GA, Satzke C. Insights into pneumococcal pneumonia using lung aspirates and nasopharyngeal swabs collected from pneumonia patients in The Gambia. J Infect Dis 2020; 225:1447-1451. [PMID: 32319524 PMCID: PMC9016440 DOI: 10.1093/infdis/jiaa186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/13/2020] [Accepted: 04/21/2020] [Indexed: 11/20/2022] Open
Abstract
Background We investigated the pathogenesis of pneumococcal pneumonia using clinical specimens collected for pneumonia surveillance in The Gambia. Methods Lung aspirates and nasopharyngeal swabs from 31 patients were examined by culture, quantitative polymerase chain reaction (qPCR), whole genome sequencing, serotyping, and reverse-transcription qPCR. Results Five lung aspirates cultured pneumococci, with a matching strain identified in the nasopharynx. Three virulence genes including ply (pneumolysin) were upregulated >20-fold in the lung compared with the nasopharynx. Nasopharyngeal pneumococcal density was higher in pediatric pneumonia patients compared with controls (P < .0001). Conclusions Findings suggest that changes in pneumococcal gene expression occurring in the lung environment may be important in pathogenesis.
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Affiliation(s)
- Eileen M Dunne
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Yinglei Hua
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Belinda D Ortika
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
| | - E Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jason Hinds
- Institute for Infection and Immunity, St. George's University of London, London, United Kingdom.,BUGS Bioscience, London Bioscience Innovation Centre, London, United Kingdom
| | - Sam Manna
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Grant A Mackenzie
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine Satzke
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Australia
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Odutola A, Bottomley C, Zaman SA, Lindsay J, Shah M, Hossain I, Ndiaye M, Osuorah CDI, Olatunji Y, Badji H, Ikumapayi UNA, Manjang A, Salaudeen R, Ceesay L, Jasseh M, Adegbola RA, Corrah T, Hill PC, Greenwood BM, Mackenzie GA. Staphylococcus aureus Bacteremia in Children of Rural Areas of The Gambia, 2008-2015. Emerg Infect Dis 2019; 25:701-709. [PMID: 30882307 PMCID: PMC6433015 DOI: 10.3201/eid2504.180935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Staphylococcus aureus bacteremia is a substantial cause of childhood disease and death, but few studies have described its epidemiology in developing countries. Using a population-based surveillance system for pneumonia, sepsis, and meningitis, we estimated S. aureus bacteremia incidence and the case-fatality ratio in children <5 years of age in 2 regions in the eastern part of The Gambia during 2008–2015. Among 33,060 children with suspected pneumonia, sepsis, or meningitis, we performed blood culture for 27,851; of 1,130 patients with bacteremia, 198 (17.5%) were positive for S. aureus. S. aureus bacteremia incidence was 78 (95% CI 67–91) cases/100,000 person-years in children <5 years of age and 2,080 (95% CI 1,621–2,627) cases/100,000 person-years in neonates. Incidence did not change after introduction of the pneumococcal conjugate vaccine. The case-fatality ratio was 14.1% (95% CI 9.6%–19.8%). Interventions are needed to reduce the S. aureus bacteremia burden in The Gambia, particularly among neonates.
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23
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Hamzah SA, Saeed MA, Hossain I, Wagiran H. Thermoluminescence of Dysprosium Doped Strontium Borate Glass for (NA, LI, CA) Modifiers Irradiated to High Dose 60CO. High Energy Chem 2019. [DOI: 10.1134/s0018143919030068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Pereira DI, Mohammed NI, Ofordile O, Camara F, Baldeh B, Mendy T, Sanyang C, Jallow AT, Hossain I, Wason J, Prentice AM. A novel nano-iron supplement to safely combat iron deficiency and anaemia in young children: The IHAT-GUT double-blind, randomised, placebo-controlled trial protocol. Gates Open Res 2018; 2:48. [PMID: 30569038 PMCID: PMC6266659 DOI: 10.12688/gatesopenres.12866.2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Iron deficiency and its associated anaemia (IDA) are the leading forms of micronutrient malnutrition worldwide. Here we describe the rationale and design of the first clinical trial evaluating the efficacy and safety of an innovative nano iron supplement, iron hydroxide adipate tartrate (IHAT), for the treatment of IDA in young children (IHAT-GUT trial). Oral iron is often ineffective due to poor absorption and/or gastrointestinal adverse effects. IHAT is novel since it is effectively absorbed whilst remaining nanoparticulate in the gut, therefore should enable supplementation with fewer symptoms. Methods: IHAT-GUT is a three-arm, double-blind, randomised, placebo-controlled phase II trial conducted in Gambian children 6-35 months of age. The intervention consists of a 12-week supplementation with either IHAT, ferrous sulphate (both at doses bioequivalent to 12.5 mg Fe/day) or placebo. The trial aims to include 705 children with IDA who will be randomly assigned (1:1:1) to each arm. The primary objectives are to test non-inferiority of IHAT in relation to ferrous sulphate at treating IDA, and to test superiority of IHAT in relation to ferrous sulphate and non-inferiority in relation to placebo in terms of diarrhoea incidence and prevalence. Secondary objectives are mechanistic assessments, to test whether IHAT reduces the burden of enteric pathogens, morbidity, and intestinal inflammation, and that it does not cause detrimental changes to the gut microbiome, particularly in relation to Lactobacillaceae, Bifidobacteriaceae and Enterobacteriaceae. Discussion: This trial will test the hypothesis that supplementation with IHAT eliminates iron deficiency and improves haemoglobin levels without inducing gastrointestinal adverse effects. If shown to be the case, this would open the possibility for further testing and use of IHAT as a novel iron source for micronutrient intervention strategies in resource-poor countries, with the ultimate aim to help reduce the IDA global burden. Registration: This trial is registered at clinicaltrials.gov ( NCT02941081).
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Affiliation(s)
- Dora I.A. Pereira
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Nuredin I. Mohammed
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ogochukwu Ofordile
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Famalang Camara
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bakary Baldeh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Thomas Mendy
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Chilel Sanyang
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Amadou T. Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - James Wason
- MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
- Institute of Health and Society, Newcastle University, Newcastle, NE2 4BN, UK
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
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25
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Pereira DIA, Mohammed NI, Ofordile O, Camara F, Baldeh B, Mendy T, Sanyang C, Jallow AT, Hossain I, Wason J, Prentice AM. A novel nano-iron supplement to safely combat iron deficiency and anaemia in young children: The IHAT-GUT double-blind, randomised, placebo-controlled trial protocol. Gates Open Res 2018. [PMID: 30569038 DOI: 10.12688/gatesopenres.12866.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Iron deficiency and its associated anaemia (IDA) are the leading forms of micronutrient malnutrition worldwide. Here we describe the rationale and design of the first clinical trial evaluating the efficacy and safety of an innovative nano iron supplement, iron hydroxide adipate tartrate (IHAT), for the treatment of IDA in young children (IHAT-GUT trial). Oral iron is often ineffective due to poor absorption and/or gastrointestinal adverse effects. IHAT is novel since it is effectively absorbed whilst remaining nanoparticulate in the gut, therefore should enable supplementation with fewer symptoms. Methods: IHAT-GUT is a three-arm, double-blind, randomised, placebo-controlled phase II trial conducted in Gambian children 6-35 months of age. The intervention consists of a 12-week supplementation with either IHAT, ferrous sulphate (both at doses bioequivalent to 12.5 mg Fe/day) or placebo. The trial aims to include 705 children with IDA who will be randomly assigned (1:1:1) to each arm. The primary objectives are to test non-inferiority of IHAT in relation to ferrous sulphate at treating IDA, and to test superiority of IHAT in relation to ferrous sulphate and non-inferiority in relation to placebo in terms of diarrhoea incidence and prevalence. Secondary objectives are mechanistic assessments, to test whether IHAT reduces the burden of enteric pathogens, morbidity, and intestinal inflammation, and that it does not cause detrimental changes to the gut microbiome, particularly in relation to Lactobacillaceae, Bifidobacteriaceae and Enterobacteriaceae. Discussion: This trial will test the hypothesis that supplementation with IHAT eliminates iron deficiency and improves haemoglobin levels without inducing gastrointestinal adverse effects. If shown to be the case, this would open the possibility for further testing and use of IHAT as a novel iron source for micronutrient intervention strategies in resource-poor countries, with the ultimate aim to help reduce the IDA global burden. Registration: This trial is registered at clinicaltrials.gov ( NCT02941081).
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Affiliation(s)
- Dora I A Pereira
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK.,Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Nuredin I Mohammed
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ogochukwu Ofordile
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Famalang Camara
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bakary Baldeh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Thomas Mendy
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Chilel Sanyang
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Amadou T Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - James Wason
- MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK.,Institute of Health and Society, Newcastle University, Newcastle, NE2 4BN, UK
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
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26
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Goemans N, Wong B, Signorovitch J, Sajeev G, Jenkins M, Dieye I, Yao Z, Hossain I, Ward S. DUCHENNE MUSCULAR DYSTROPHY - PHYSIOTHERAPY. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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Mackenzie GA, Hill PC, Sahito SM, Jeffries DJ, Hossain I, Bottomley C, Uchendu U, Ameh D, Ndiaye M, Osuorah CD, Adeyemi O, Pathirana J, Olatunji Y, Abatan B, Ahameefula E, Muhammad BS, Fombah AE, Saha D, Mackenzie R, Plumb I, Akano A, Ebruke B, Ideh RC, Kuti B, Githua P, Olutunde E, Ofordile O, Green E, Usuf E, Badji H, Ikumapayi UNA, Manjang A, Salaudeen R, Nsekpong ED, Jarju S, Antonio M, Sambou S, Ceesay L, Lowe-Jallow Y, Sowe D, Jasseh M, Mulholland K, Knoll M, Levine OS, Howie SR, Adegbola RA, Greenwood BM, Corrah T. Impact of the introduction of pneumococcal conjugate vaccination on pneumonia in The Gambia: population-based surveillance and case-control studies. Lancet Infect Dis 2017; 17:965-973. [PMID: 28601421 PMCID: PMC5589209 DOI: 10.1016/s1473-3099(17)30321-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/11/2017] [Accepted: 04/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCVs) are used in many low-income countries but their impact on the incidence of pneumonia is unclear. The Gambia introduced PCV7 in August, 2009, and PCV13 in May, 2011. We aimed to measure the impact of the introduction of these vaccines on pneumonia incidence. METHODS We did population-based surveillance and case-control studies. The primary endpoint was WHO-defined radiological pneumonia with pulmonary consolidation. Population-based surveillance was for suspected pneumonia in children aged 2-59 months (minimum age 3 months in the case-control study) between May 12, 2008, and Dec 31, 2015. Surveillance for the impact study was limited to the Basse Health and Demographic Surveillance System (BHDSS), whereas surveillance for the case-control study included both the BHDSS and Fuladu West Health and Demographic Surveillance System. Nurses screened all outpatients and inpatients at all health facilities in the surveillance area using standardised criteria for referral to clinicians in Basse and Bansang. These clinicians recorded clinical findings and applied standardised criteria to identify patients with suspected pneumonia. We compared the incidence of pneumonia during the baseline period (May 12, 2008, to May 11, 2010) and the PCV13 period (Jan 1, 2014, to Dec 31, 2015). We also investigated the effectiveness of PCV13 using case-control methods between Sept 12, 2011, and Sept 31, 2014. Controls were aged 90 days or older, and were eligible to have received at least one dose of PCV13; cases had the same eligibility criteria with the addition of having WHO-defined radiological pneumonia. FINDINGS We investigated 18 833 children with clinical pneumonia and identified 2156 cases of radiological pneumonia. Among children aged 2-11 months, the incidence of radiological pneumonia fell from 21·0 cases per 1000 person-years in the baseline period to 16·2 cases per 1000 person-years (23% decline, 95% CI 7-36) in 2014-15. In the 12-23 month age group, radiological pneumonia decreased from 15·3 to 10·9 cases per 1000 person-years (29% decline, 12-42). In children aged 2-4 years, incidence fell from 5·2 to 4·1 cases per 1000 person-years (22% decline, 1-39). Incidence of all clinical pneumonia increased by 4% (-1 to 8), but hospitalised cases declined by 8% (3-13). Pneumococcal pneumonia declined from 2·9 to 1·2 cases per 1000 person-years (58% decline, 22-77) in children aged 2-11 months and from 2·6 to 0·7 cases per 1000 person-years (75% decline, 47-88) in children aged 12-23 months. Hypoxic pneumonia fell from 13·1 to 5·7 cases per 1000 person-years (57% decline, 42-67) in children aged 2-11 months and from 6·8 to 1·9 cases per 1000 person-years (72% decline, 58-82) in children aged 12-23 months. In the case-control study, the best estimate of the effectiveness of three doses of PCV13 against radiological pneumonia was an adjusted odds ratio of 0·57 (0·30-1·08) in children aged 3-11 months and vaccine effectiveness increased with greater numbers of doses (p=0·026). The analysis in children aged 12 months and older was underpowered because there were few unvaccinated cases and controls. INTERPRETATION The introduction of PCV in The Gambia was associated with a moderate impact on the incidence of radiological pneumonia, a small reduction in cases of hospitalised pneumonia, and substantial reductions of pneumococcal and hypoxic pneumonia in young children. Low-income countries that introduce PCV13 with reasonable coverage can expect modest reductions in hospitalised cases of pneumonia and a marked impact on the incidence of severe childhood pneumonia. FUNDING GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan, Bill & Melinda Gates Foundation, and UK Medical Research Council.
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Affiliation(s)
- Grant A Mackenzie
- Medical Research Council Unit, The Gambia, Fajara, The Gambia,Murdoch Childrens Research Institute, Melbourne, VIC, Australia,London School of Hygiene & Tropical Medicine, London, UK,Correspondence to: Dr Grant A Mackenzie, Basse Field Station, MRC The Gambia Unit, PO Box 273, Banjul, The GambiaCorrespondence to: Dr Grant A MackenzieBasse Field StationMRC The Gambia UnitPO Box 273BanjulThe Gambia
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Shah M Sahito
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Ilias Hossain
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Uchendu Uchendu
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - David Ameh
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Oyedeji Adeyemi
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Yekini Olatunji
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Bade Abatan
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | | | | | - Debasish Saha
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Ian Plumb
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Bernard Ebruke
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Readon C Ideh
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Bankole Kuti
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Peter Githua
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | | | - Edward Green
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Effua Usuf
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Ahmad Manjang
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | | | - Sheikh Jarju
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Martin Antonio
- Medical Research Council Unit, The Gambia, Fajara, The Gambia,Microbiology and Infection Unit, Warwick Medical School, Coventry, UK
| | - Sana Sambou
- Ministry of Health and Social Welfare, Gambia Government, Kotu, The Gambia
| | - Lamin Ceesay
- Ministry of Health and Social Welfare, Gambia Government, Kotu, The Gambia
| | | | - Dawda Sowe
- Ministry of Health and Social Welfare, Gambia Government, Kotu, The Gambia
| | - Momodou Jasseh
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Kim Mulholland
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia,London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Knoll
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Orin S Levine
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen R Howie
- Medical Research Council Unit, The Gambia, Fajara, The Gambia,Centre for International Health, University of Otago, Dunedin, New Zealand,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | | | | | - Tumani Corrah
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
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Zaman K, Sack DA, Neuzil KM, Yunus M, Moulton LH, Sugimoto JD, Fleming JA, Hossain I, Arifeen SE, Azim T, Rahman M, Lewis KDC, Feller AJ, Qadri F, Halloran ME, Cravioto A, Victor JC. Effectiveness of a live oral human rotavirus vaccine after programmatic introduction in Bangladesh: A cluster-randomized trial. PLoS Med 2017; 14:e1002282. [PMID: 28419095 PMCID: PMC5395158 DOI: 10.1371/journal.pmed.1002282] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 11/10/2016] [Accepted: 03/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rotavirus vaccines are now globally recommended by the World Health Organization (WHO), but in early 2009 WHO's Strategic Advisory Group of Experts on Immunization reviewed available data and concluded that there was no evidence for the efficacy or effectiveness of a two-dose schedule of the human rotavirus vaccine (HRV; Rotarix) given early at 6 and 10 wk of age. Additionally, the effectiveness of programmatic rotavirus vaccination, including possible indirect effects, has not been assessed in low-resource populations in Asia. METHODS AND FINDINGS In Bangladesh, we cluster-randomized (1:1) 142 villages of the Matlab Health and Demographic Surveillance System to include two doses of HRV with the standard infant vaccines at 6 and 10 wk of age or to provide standard infant vaccines without HRV. The study was initiated November 1, 2008, and surveillance was conducted concurrently at Matlab Diarrhoea Hospital and two community treatment centers to identify children less than 2 y of age presenting with acute rotavirus diarrhea (ARD) through March 31, 2011. Laboratory confirmation was made by enzyme immunoassay detection of rotavirus antigen in stool specimens. Overall effectiveness of the HRV vaccination program (primary objective) was measured by comparing the incidence rate of ARD among all children age-eligible for vaccination in villages where HRV was introduced to that among such children in villages where HRV was not introduced. Total effectiveness among vaccinees and indirect effectiveness were also evaluated. In all, 6,527 infants were age-eligible for vaccination in 71 HRV villages, and 5,791 in 71 non-HRV villages. In HRV villages, 4,808 (73.7%) infants received at least one dose of HRV. The incidence rate of ARD was 4.10 cases per 100 person-years in non-HRV villages compared to 2.8 per 100 person-years in HRV villages, indicating an overall effectiveness of 29.0% (95% CI, 11.3% to 43.1%). The total effectiveness of HRV against ARD among vaccinees was 41.4% (95% CI, 23.2% to 55.2%). The point estimate for total effectiveness was higher against ARD during the first year of life than during the second (45.2% versus 28.9%), but estimates for the second year of life lacked precision and did not reach statistical significance. Indirect effects were not detected. To check for bias in presentation to treatment facilities, we evaluated the effectiveness of HRV against acute diarrhea associated with enterotoxigenic Escherichia coli; it was 4.0% (95% CI, -46.5% to 37.1%), indicating that bias likely was not introduced. Thirteen serious adverse events were identified among recipients of HRV, but none were considered related to receipt of study vaccine. The main limitation of this study is that it was an open-label study with an observed-only control group (no placebo). CONCLUSIONS The two-dose HRV rotavirus vaccination program significantly reduced medically attended ARD in this low-resource population in Asia. Protection among vaccinees was similar to that in other low-resource settings. In low-resource populations with high rotavirus incidence, large-scale vaccination across a wide population may be required to obtain the full benefit of rotavirus vaccination, including indirect effects. TRIAL REGISTRATION ClinicalTrials.gov NCT00737503.
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Affiliation(s)
- K. Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - David A. Sack
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Mohammad Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Lawrence H. Moulton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jonathan D. Sugimoto
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | | | - Ilias Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tasnim Azim
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Andrea J. Feller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - M. Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Biostatistics Department, University of Washington, Seattle, Washington, United States of America
| | - Alejandro Cravioto
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - John C. Victor
- PATH, Seattle, Washington, United States of America
- * E-mail:
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Hossain I, Jiang J, Matras M, Trociewitz UP, Lu J, Kametani F, Larbalestier D, Hellstrom E. Effect of sheath material and reaction overpressure on Ag extrusions into the TiO 2 insulation coating of Bi-2212 round wire. IOP Conf Ser Mater Sci Eng 2017; 279. [PMID: 30197666 DOI: 10.1088/1757-899x/279/1/012021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to develop a high current density in coils, Bi-2212 wires must be electrically discrete in tight winding packs. It is vital to use an insulating layer that is thin, fulfils the dielectric requirements, and can survive the heat treatment whose maximum temperature reaches 890 °C. A thin (20-30 µm) ceramic coating could be better as the insulating layer compared to alumino-silicate braided fiber insulation, which is about 100 μm thick and reacts with the Ag sheath during heat treatment, degrading the critical current density (Jc). At present, TiO2 seems to be the most viable ceramic material for such a thin insulation because it is chemically compatible with Ag and Bi-2212 and its sintering temperature is lower than the maximum temperature used for the Bi-2212 heat treatment. However, recent tests of a large Bi-2212 coil insulated only with TiO2 showed severe electrical shorting between the wires after over pressure heat treatment (OPHT). The origin of the shorting was frequent silver extrusions that penetrated the porous TiO2 layer and electrically connected adjacent Bi-2212 wires. To understand the mechanism of this unexpected behaviour, we investigated the effect of sheath material and hydrostatic pressure on the formation of Ag extrusions. We found that Ag extrusions occur only when TiO2-insulated Ag-0.2%Mg sheathed wire (Ag(Mg) wire) undergoes OPHT at 50 bar. No Ag extrusions were observed when the TiO2-insulated Ag(Mg) wire was processed at 1 bar. The TiO2-insulated wires sheathed with pure Ag that underwent 50 bar OPHT were also free from Ag extrusions. A key finding is that the Ag extrusions emanating from the Ag(Mg) sheath actually contain no MgO, suggesting that local depletion of MgO facilitates local, heterogeneous deformation of the sheath under hydrostatic overpressure. Our study also suggests that predensifying the Ag(Mg) wire before insulating it with TiO2 and doing the final OPHT can potentially prevent Ag extrusion.
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Affiliation(s)
- I Hossain
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA.,Materials Science and Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - J Jiang
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - M Matras
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA.,Materials Science and Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - U P Trociewitz
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - J Lu
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - F Kametani
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA.,Department of Mechanical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - D Larbalestier
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA.,Materials Science and Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA.,Department of Mechanical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA
| | - E Hellstrom
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, FL 32310, USA.,Materials Science and Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA.,Department of Mechanical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, FL 32310, USA
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Refaei A, Wagiran H, Saeed MA, Hossain I. Thermoluminescence characteristics of neodymium-doped silicon dioxide optical fibers subjected to X-ray. High Energy Chem 2016. [DOI: 10.1134/s0018143916040032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hossain I, H. Kassim H, I. Sharrad F, Ahmed A. Nuclear structure of yrast bands of 180Hf, 182W, and 184Os nuclei by means of interacting boson model-1. ScienceAsia 2016. [DOI: 10.2306/scienceasia1513-1874.2016.42.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Saeed MA, Abdul Pattah NF, Hossain I, Wagiran H. Thermoluminescence response of ytterbium-doped silicon dioxide fiber. High Energy Chem 2015. [DOI: 10.1134/s001814391504013x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Saeed MA, Hossain I, Nursyazwanie R, Wagiran H, Mubarak AA. Thermoluminescence response of multimode fluorine-doped SiO2 optical fibers and TLD 100 with 6 mega volt photon irradiation. High Energy Chem 2015. [DOI: 10.1134/s0018143915030133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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34
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Nahar B, Hossain I, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson LA. Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh. Child Care Health Dev 2015; 41:483-93. [PMID: 25040164 DOI: 10.1111/cch.12176] [Citation(s) in RCA: 15] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Maternal depression is associated with poor child development and growth in low-income countries. This paper evaluates the effect of a community-based trial providing psychosocial stimulation and food supplements to severely malnourished children on maternal depressive symptoms in Bangladesh. METHODS Severely underweight (weight-for-age Z-score < -3) hospitalized children aged 6-24 months (n = 507), were randomly assigned to: psychosocial stimulation (PS), food supplementation (FS), PS+FS, clinic control (CC) and hospital control (CH) at discharge. PS included play sessions with children and parental counselling to mothers during fortnightly follow-up visit at community clinics, conducted by trained play leaders for 6 months. FS involved cereal-based supplements (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplements and growth monitoring. We used Bayley scales, Home Observation for Measurement of Environment (HOME) inventory and a parenting questionnaire to assess child development, home stimulation and mothers' child-rearing practices, respectively. We assessed mothers' depressive symptoms using a modified version of Centre for Epidemiologic Studies Depression Scale at baseline and at 6 months post intervention. RESULTS Maternal depressive symptoms were significantly lower in the CH group at baseline (P = 0.014). After 6 months of intervention there was no significant effect of intervention after adjusting for baseline scores and all possible confounders. Maternal depressive symptoms were higher among poorer (P = 0.06), older (P = 0.057) and less educated (P = 0.019) mothers, who were housewives (P = 0.053), and whose husbands had more unstable jobs (P = 0.058). At 6 months post intervention, children's cognitive (P = 0.045) and motor (P = 0.075) development, HOME (P = 0.012) and mother's parenting score (P = 0.057) were higher among mothers with lower depressive symptoms. CONCLUSION The study did not show a significant effect of the intervention on the level of maternal depressive symptoms. Interventions with higher intensity and/or of longer duration focusing directly on maternal psychosocial functioning are probably needed to reduce maternal depressive symptoms.
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Affiliation(s)
- B Nahar
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Sahini MH, Hossain I, Wagiran H, Saeed MA, Ali H. Thermoluminescence responses of the Yb- and Yb-Tb-doped SiO2 optical fibers to 6-MV photons. Appl Radiat Isot 2014; 92:18-21. [PMID: 24973463 DOI: 10.1016/j.apradiso.2014.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/27/2014] [Accepted: 05/27/2014] [Indexed: 11/26/2022]
Abstract
Characteristics of the thermoluminescence (TL) responses of Yb- and Yb-Tb-doped optical fibers irradiated with 6MV photons are reported. The concentration of Yb in the Yb-doped optical fiber was 0.26mol%; the concentrations of Yb and Tb in the Yb-Tb-doped optical fiber were 0.62 and 0.2mol%, respectively. The TL dose responses are linear in the dose range 0.5-4Gy. The radiation sensitivity of the Yb-Tb material is almost two orders of magnitude higher than the sensitivity of the material doped with Yb alone.
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Affiliation(s)
- M H Sahini
- Department of Physics, Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia
| | - I Hossain
- Department of Physics, Rabigh College of Science & Arts, King Abdulaziz University, 21911 Rabigh, Saudi Arabia.
| | - H Wagiran
- Department of Physics, Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia
| | - M A Saeed
- Department of Physics, Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia
| | - H Ali
- Department of Oncology and Radiation Therapy, Hospital Sultan Ismail, Johor Barhu, Malaysia
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Hossain I, Hoque A. Factors influencing the success of home modification in paraplegic spinal cord injured individuals in Bangladesh. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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37
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Hossain I, Hossain S. Post-rehabilitation participation restriction of spinal cord injured patient at Centre for the Rehabilitation of the Paralysed (CRP). Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Md Khudzari J, Wagiran H, Hossain I, Ibrahim N. Screening heavy metals levels in hair of sanitation workers by X-ray fluorescence analysis. J Environ Radioact 2013; 115:1-5. [PMID: 22846873 DOI: 10.1016/j.jenvrad.2012.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 05/06/2012] [Accepted: 05/14/2012] [Indexed: 06/01/2023]
Abstract
This work presents a study of human hair as a bio-indicator for detection of heavy metals as part of environmental health surveillance programs project to develop a subject of interest in the biomedical and environmental sciences. A total of 34 hair samples were analyzed that consisting of 29 samples from sanitation workers and five samples from students. The hair samples were prepared and treated in accordance to the International Atomic Energy Agency (IAEA) recommendations. The concentrations of heavy metals were analyzed using the energy dispersive X-ray fluorescence (EDXRF) technique by X-50 Mobile X-ray Fluorescence (XRF) at Oceanography Institute, Universiti Malaysia Terengganu. The performance of EDXRF analyzer was tested by Standard Reference Material (SRM 2711) Montana Soil which was in good agreement with certified value within 14% deviations except for Hg. While seven heavy metals: Mn, Fe, Ni, Cu, Zn, Se, and Sb were detected in both groups, three additional elements, i.e. As, Hg and Pb, were detected only in sanitation workers group. For sanitation workers group, the mean concentration of six elements, Mn, Fe, Cu, Zn, Se, and Sb, shows elevated concentration as compared to the control samples concentration. Results from both groups were compared and discussed in relation to their respective heavy metals concentrations.
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Affiliation(s)
- Jauharah Md Khudzari
- Department of Science and Mathematics, Faculty of Science, Technology and Human Development, Universiti Tun Hussein Onn Malaysia, 86400 Parit Raja, Batu Pahat, Johor, Malaysia
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Akhter MQ, Authoy F, Nabi J, Rahman MR, Hossain I, Hossain MM, Mamun AA, Chakrabarty P. Wandering spleen associated with β-Thalassemia: a case report. Mymensingh Med J 2013; 22:186-191. [PMID: 23416830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The clinical entity 'Wandering spleen' is an uncommon presentation and it is more often diagnosed in children than in adults, mostly women of reproductive age. Here is a case of a young woman who presented with generalized weakness and fever, and a painless mobile lump in her central abdomen. The laboratory evaluation revealed a haemolytic state and Haemoglobin electrophoresis showed β-Thalassemia trait (Hb A2 5.1%). Ultrasonography and Computerized Tomography (CT) scan confirmed that the mass is spleen and spleen is not present in its normal anatomical location. Abdominal CT described a well-defined, homogenous pediculated mass with echo texture comparable to spleen. Radioisotope scanning could be used as an alternative for confirmation of diagnosis of this rare condition, but was not done in our case. Colour Doppler sonography of the splenic circulation revealed no infarction and intact splenic vasculature. Wandering spleen should be considered in the differential diagnosis of idiopathic abdominal or pelvic lumps. The authoritative opinion for the treatment of such a case is splenectomy or splenopexy especially in children and here, in this case splenectomy was done.
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Affiliation(s)
- M Q Akhter
- Department of Surgery, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh
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Zaman K, Yunus M, Arifeen SE, Azim T, Faruque A, Huq E, Hossain I, Luby SP, Victor JC, Dallas MJ, Lewis KD, Rivers SB, Steele AD, Neuzil KM, Ciarlet M, Sack DA. Methodology and lessons-learned from the efficacy clinical trial of the pentavalent rotavirus vaccine in Bangladesh. Vaccine 2012; 30 Suppl 1:A94-100. [DOI: 10.1016/j.vaccine.2011.07.117] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/13/2011] [Accepted: 07/25/2011] [Indexed: 11/30/2022]
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King MT, Viney R, Smith DP, Hossain I, Street D, Savage E, Fowler S, Berry MP, Stockler M, Cozzi P, Stricker P, Ward J, Armstrong BK. Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer. Br J Cancer 2012; 106:638-45. [PMID: 22274410 PMCID: PMC3324299 DOI: 10.1038/bjc.2011.552] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Men diagnosed with localised prostate cancer (LPC) face difficult choices between treatment options that can cause persistent problems with sexual, urinary and bowel function. Controlled trial evidence about the survival benefits of the full range of treatment alternatives is limited, and patients' views on the survival gains that might justify these problems have not been quantified. Methods: A discrete choice experiment (DCE) was administered in a random subsample (n=357, stratified by treatment) of a population-based sample (n=1381) of men, recurrence-free 3 years after diagnosis of LPC, and 65 age-matched controls (without prostate cancer). Survival gains needed to justify persistent problems were estimated by substituting side effect and survival parameters from the DCE into an equation for compensating variation (adapted from welfare economics). Results: Median (2.5, 97.5 centiles) survival benefits needed to justify severe erectile dysfunction and severe loss of libido were 4.0 (3.4, 4.6) and 5.0 (4.9, 5.2) months. These problems were common, particularly after androgen deprivation therapy (ADT): 40 and 41% overall (n=1381) and 88 and 78% in the ADT group (n=33). Urinary leakage (most prevalent after radical prostatectomy (n=839, mild 41%, severe 18%)) needed 4.2 (4.1, 4.3) and 27.7 (26.9, 28.5) months survival benefit, respectively. Mild bowel problems (most prevalent (30%) after external beam radiotherapy (n=106)) needed 6.2 (6.1, 6.4) months survival benefit. Conclusion: Emerging evidence about survival benefits can be assessed against these patient-based benchmarks. Considerable variation in trade-offs among individuals underlines the need to inform patients of long-term consequences and incorporate patient preferences into treatment decisions.
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Affiliation(s)
- M T King
- Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Room 148, Transient Building (F12), Sydney, NSW 2006, Australia.
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Jinghua Ge, Hutanu A, Toole C, Kooima R, Hossain I, Allen G. An Experimental Distributed Visualization System for Petascale Computing. Comput Sci Eng 2010. [DOI: 10.1109/mcse.2010.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Zaman K, Yunus M, Faruque ASG, El Arifeen S, Hossain I, Azim T, Rahman M, Podder G, Roy E, Luby S, Sack DA. Surveillance of rotavirus in a rural diarrhoea treatment centre in Bangladesh, 2000-2006. Vaccine 2010; 27 Suppl 5:F31-4. [PMID: 19931715 DOI: 10.1016/j.vaccine.2009.08.063] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Rotavirus was detected in 33% of 4519 children less than 5 years of age admitted with diarrhoea to treatment centres at Matlab in rural Bangladesh from 2000 to 2006. Highest rotavirus detection rates were in children aged 6-11 months with 56% being less than 1 year old. The peak seasonal detection was in July-September and December-February. The population-based incidence rates of rotavirus ranged from 10.8 to 19.6/1000 children less than 5 years of age. G1 serotype predominated between June 2002-May 2005 and June 2005-May 2006 the predominant type was G2 (41%) followed by G1 (22%) and G9 (22%). Rotavirus is an important cause of childhood diarrhoea in rural Bangladesh and this burden may be reduced with a rotavirus vaccination programme.
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Affiliation(s)
- K Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh.
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King MT, Viney R, Hossain I, Smith D, Savage E, Stockler MR, Armstrong B. Survival gains needed to justify the side effects of treatment for localized prostate cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5119 Background: Men diagnosed with localized prostate cancer face difficult treatment decisions. Evidence about the relative survival benefit of treatment options is lacking or piecemeal. Side-effects can vary widely with treatment, affecting some fundamental aspects of quality of life (QOL). Little is known about patients’ views of the relative tolerability of these side-effects or the survival gains needed to justify them. Methods: QOL data were collected prospectively 3 years post-diagnosis in a population-based cohort of men treated for localized prostate cancer (n=1642); these data were used to identify common side-effect profiles. A patient preference survey was conducted in a subset (n=357, stratified by treatment); hypothetical treatment alternatives were described in terms of side-effects and survival. Random parameter logit models were estimated. We adapted the concept of compensating variation from welfare economics to derive a parameter function for the value of changes in QOL in terms of survival time; i.e., the survival gains needed to justify persistent side-effects. Bootstrap confidence intervals (CI) were constructed. Results: The table shows the survival gains needed for a range of common treatment profiles, relative to the base case of active surveillance (in which men typically experienced mild loss of libido and mild fatigue). For example, radical prostatectomy often resulted in severe impotence and mild urinary leakage; men required an extra 8.0 months (95% CI 7.4–8.7) of life to make this worthwhile. Generally, urinary dysfunction and bowel symptoms were considered the least tolerable, hormonal symptoms and fatigue came next, and sexual dysfunction was considered relatively benign. This pattern was relatively consistent across treatment groups. Conclusions: These results highlight the need for better evidence about the actual survival benefits of alternative treatments. They also help to target supportive care to optimize patient QOL after treatment for localized prostate cancer. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. T. King
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - R. Viney
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - I. Hossain
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - D. Smith
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - E. Savage
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - M. R. Stockler
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
| | - B. Armstrong
- University of Sydney, Sydney, Australia; University of Technology, Sydney, Australia; Cancer Council New South Wales, Sydney, Australia; Sydney Cancer Centre, Camperdown, Australia
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Hossain I, Moussavi Z. Finding the lung sound-flow relationship in normal and asthmatic subjects. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:3852-5. [PMID: 17271136 DOI: 10.1109/iembs.2004.1404078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To investigate the relationship between lung sound (LS) and flow, we studied LS signals from 5 healthy adults (group I), 10 healthy children (group II) and 7 asthmatic children (group III). The LS signals were recorded on right upper lung lobe at different flow rates varied from 0.4 to 3.0 L/s and the flow signals were measured at mouth. The LS and flow signals were parsed into segments of 1024 data points with 50% overlap between successive segments. The mean LS amplitude (mean AMP) and mean flow (flow) were calculated for each segment. The average power (Pave) of each segment was calculated from LS spectrum for different frequency bands between 20-600 Hz. Four different types of models, representing the relationship between mean AMP or Pave and flow, were investigated using different percentage of flow signal in each inspiratory phase. The model coefficients were derived from either linear regression analysis or polynomial curve fitting between the data and model variables. The correlation coefficients (r) between the experimental data and data estimated from the model coefficients were calculated for each subject in each model and averaged between the subjects. The results showed much stronger correlation between Pave and flow than mean AMP and flow for all groups. The best model to describe Pave relationship with flow was found to be power relationship in both healthy adults and children whereas a third-order polynomial curve best fitted the Pave and flow data in asthmatic group. The optimum frequency band to calculate Pave was found to be 150-450 Hz for healthy subjects and 300-600 Hz for asthmatic children. The diminution of heart sound (HS) from LS recordings showed no change in the selected model in all three groups. The results of this study suggest the difference in Pave- flow relationship in healthy and asthmatic subjects may be used as a diagnostic tool for asthma.
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Affiliation(s)
- I Hossain
- Department of Electrical and Computer Engineering, University of Manitoba, Winnipeg, MB.
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Aminuzzaman FM, Hossain I. Evaluation of plant activator and chemical fungicides on leaf blight (Bipolaris sorokiniana) development and yield of wheat. Pak J Biol Sci 2007; 10:1797-803. [PMID: 19086540 DOI: 10.3923/pjbs.2007.1797.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bion 50 WG (Benzothiodiazole), Tilt-250 EC (Propiconazole) and Amistar (Azoxystrobin) either alone and some of their combinations were evaluated against leaf blight/spot (Bipolaris sorokiniana) development and yield of wheat. All the treatments significantly reduced leaf spot reaction of wheat over untreated control. But Bion in combination with Amistar resulted significantly highest reduction of leaf spot reaction of wheat (p = 0.05) against all the tested pathotypes inoculated at flag leaf stage. In the field, Bion reduced leaf spot severity at heading and flowering stage in 2000-2001 and at hard dough stage in 2001-2002. Number of grains/ear not significantly increased by treating seeds with Bion though 1000-grain weight is significantly increased (p = 0.05) in 2000-2001 by Bion. Statistically higher grain yield was obtained from the experimental plot by treating seeds with Bion and Amistar. Bion resulted 53.33% higher grain yield in compare to untreated control.
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Affiliation(s)
- F M Aminuzzaman
- Department of Plant Pathology, Sher-e-Bangla Agricultural University, Dhaka-1207, Bangladesh
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Ahsan S, Ahmed M, Islam T, Islam MS, Hossain I, Bashar A, Rahman SM. Bilateral giant angiomyolipoma of kidneys: a case report and review of literature. Bangladesh Med Res Counc Bull 2004; 30:125-7. [PMID: 16240983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Angiomyolipoma is uncommon benign tumor of the kidney. Bilateral and multiple lesions are associated with tuberous sclerosis. We report a case with bilateral giant angiomyolipomas in a patient who had no other features of tuberous sclerosis. In this case, the involvement of the kidneys was diffuse rather than usual well-circumscribed lesions.
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Affiliation(s)
- S Ahsan
- Deptt. of Radiology and Imaging, Bangabandhu Shiek Mujib Medical University (BSMMU), Dhaka
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Sarker SA, Casswall TH, Juneja LR, Hoq E, Hossain I, Fuchs GJ, Hammarström L. Randomized, placebo-controlled, clinical trial of hyperimmunized chicken egg yolk immunoglobulin in children with rotavirus diarrhea. J Pediatr Gastroenterol Nutr 2001; 32:19-25. [PMID: 11176319 DOI: 10.1097/00005176-200101000-00009] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hyperimmunized bovine colostrum containing antibodies has been shown to be effective in the treatment of rotavirus diarrhea. Antibodies derived from eggs of immunized hens may be a less expensive and more practical alternative. In this study, children with proven rotavirus diarrhea were treated with immunoglobulin extracted from eggs of chicken immunized with human rotavirus strains. METHODS In a randomized, double-blind study, 79 children with known rotavirus diarrhea were assigned to receive either 10 g hyperimmune egg yolk (HEY) daily in four equally divided doses for 4 days (HEY group) or a similar preparation obtained from nonimmunized chicken (placebo group). The daily stool frequency and amount, oral rehydration solution iORS) intake, and presence of rotavirus in the stool were monitored for 4 days. RESULTS In the HEY-treated group, there was significant reduction in stool output (in grams per kilogram per day; HEY vs. placebo; 87+/-59 vs. 120+/-75, P = 0.03), and significant reduction of ORS intake (in milliliters per kilogram per day) (HEY vs. placebo; 84+/-46 vs. 122+/-72, P = 0.008) on day 1 and clearance of virus on day 4 (HEY vs. placebo; 73% vs. 46%, P = 0.02). There was, however, no difference in diarrheal duration between the groups. CONCLUSIONS Treatment with HEY against four human rotavirus strains resulted in modest improvement of diarrhea associated with earlier clearance of rotavirus from stools. These results indicate an encouraging role of HEY in the treatment of rotavirus-induced diarrhea in children. Further studies are needed to optimize the dose and neutralization titer and thus improve the efficacy of egg yolk immunoglobulin IgY derived from immunized hens.
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Affiliation(s)
- S A Sarker
- Clinical Sciences Division, International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) Centre for Health and Population Research, Dhaka.
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Hynninen MS, Cheng DC, Hossain I, Carroll J, Aumbhagavan SS, Yue R, Karski JM. Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery. Can J Anaesth 2000; 47:1182-7. [PMID: 11132739 DOI: 10.1007/bf03019866] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Non-steroidal anti-inflammatory drugs (NSAIDs) are used as analgesic in postoperative pain to reduce opioid side effects, such as drowsiness and nausea. However, NSAIDs have not been used extensively in cardiac surgical patients due to the fear of untoward effects on gastric, renal, and coagulation parameters. This study will evaluate the efficacy and safety of three NSAIDs for pain control in CABG patients. METHODS One hundred and twenty patients scheduled for elective CABG surgery were enrolled in randomized, double blind, controlled study. Standardized fast track cardiac anesthesia was used. One dose of drug (75 mg diclofenac, 100 mg ketoprofen, 100 mg indomethacin, or placebo) was given pr one hour before tracheal extubation and a second dose 12 hr later. Pain was treated with morphine iv and acetaminophen po. Visual analogue pain scores were recorded at baseline, 3, 6, 12 and 24 hr after the first dose of drug. RESULTS There were no differences among the groups in pain scores. Only patients who received diclofenac required less morphine than patients in the control group (P < 0.05). When the total amounts of pain medications were computed to morphine equivalents, only patients in the diclofenac group received less pain medications than the placebo group (P < 0.05). Proportion of patients with postoperative increase of creatinine level (20% and over) did not differ between placebo and drug groups. CONCLUSION Non-steroidal anti-inflammatory drugs may be used for analgesia management post CABG surgery in selected patients. Diclofenac appears to have the best analgesic effects by reducing the morphine and other analgesic requirement postoperatively.
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Affiliation(s)
- M S Hynninen
- Division of Cardiac Anesthesia & Intensive Care, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada
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