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Bolo A, Ochira P, Hakim AJ, Katoro J, Bunga S, Lako R, Anib V, Arkangelo GC, Lobojo BN, Okiria AG. Limited awareness of HIV Status hinders uptake of treatment among female sex workers and sexually exploited adolescents in Wau and Yambio, South Sudan. BMC Public Health 2023; 23:692. [PMID: 37059971 PMCID: PMC10103365 DOI: 10.1186/s12889-023-15593-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Several factors determine uptake of HIV testing services (HTS) by female sex workers (FSW), including their knowledge of HIV and their awareness of services supporting people who are HIV-positive. HTS provided entry into the UNAIDS 90-90-90 cascade of care. We conducted a cross-sectional biobehavioural survey (BBS) to determine HIV prevalence and progress towards UNAIDS 90-90-90 cascade targets among this population in South Sudan. METHODS Respondent-driven sampling (RDS) was used to recruit women and sexually exploited girls aged 13-18 years who exchanged sex for goods or money in the past 6 months and resided in the town for at least 1 month. Consenting participants were interviewed and tested for HIV and, if positive, they were also tested for their viral load (VL). Data were weighted in RDS Analyst and analyzed with Stata 13. RESULTS A total of 1,284 participants were recruited. The overall HIV cascade coverages were 64.8% aware of their HIV-positive status; 91.0% of those aware of their positive status were on ART; and VL suppression among those on ART was 93.0%. CONCLUSION Being unaware of their HIV-positive status limits, the uptake of HIV treatment among FSW in South Sudan. This underscores the importance of optimized case-finding approaches to increase HTS among FSW and sexually exploited minors.
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Affiliation(s)
- Alex Bolo
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan.
| | | | - Avi J Hakim
- United States Centers for Disease Control and Prevention, DGHT, Atlanta, GA, USA
| | - Joel Katoro
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan
| | - Sudhir Bunga
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Juba, South Sudan
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Lewis HC, Marcato AJ, Meagher N, Valenciano M, Villanueva‐Cabezas J, Spirkoska V, Fielding JE, Karahalios A, Subissi L, Nardone A, Cheng B, Rajatonirina S, Okeibunor J, Aly EA, Barakat A, Jorgensen P, Azim T, Wijesinghe PR, Le L, Rodriguez A, Vicari A, Van Kerkhove MD, McVernon J, Pebody R, Price DJ, Bergeri I, Alemu MA, Alvi Y, Bukusi EA, Chung PS, Dambadarjaa D, Das AK, Dub T, Dulacha D, Ebrahim F, González‐Duarte MA, Guruge D, Heraud J, Heredia‐Melo DC, Herman‐Roloff A, Herring BL, Inbanathan FY, Islam F, Jeewandara KC, Kant S, Khan W, Lako R, Leite J, Malavige GN, Mandakh U, Mariam W, Mend T, Mize VA, Musa S, Nohynek H, Olu OO, Osorio‐Merchán MB, Pereyaslov D, Randremanana RV, de Dieu Randria MJ, Ransom J, Saxena S, Sharma P, Sreedevi A, Satheesh M, Subhashini KJ, Tippet‐Barr BA, Usha A, Wamala JF, Watare SH, Yadav K. Transmission of SARS-CoV-2 in standardised first few X cases and household transmission investigations: A systematic review and meta-analysis. Influenza Other Respir Viruses 2022; 16:803-819. [PMID: 36825117 PMCID: PMC9343340 DOI: 10.1111/irv.13002] [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: 04/12/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
We aimed to estimate the household secondary infection attack rate (hSAR) of SARS-CoV-2 in investigations aligned with the WHO Unity Studies Household Transmission Investigations (HHTI) protocol. We conducted a systematic review and meta-analysis according to PRISMA 2020 guidelines. We searched Medline, Embase, Web of Science, Scopus and medRxiv/bioRxiv for "Unity-aligned" First Few X cases (FFX) and HHTIs published 1 December 2019 to 26 July 2021. Standardised early results were shared by WHO Unity Studies collaborators (to 1 October 2021). We used a bespoke tool to assess investigation methodological quality. Values for hSAR and 95% confidence intervals (CIs) were extracted or calculated from crude data. Heterogeneity was assessed by visually inspecting overlap of CIs on forest plots and quantified in meta-analyses. Of 9988 records retrieved, 80 articles (64 from databases; 16 provided by Unity Studies collaborators) were retained in the systematic review; 62 were included in the primary meta-analysis. hSAR point estimates ranged from 2% to 90% (95% prediction interval: 3%-71%; I 2 = 99.7%); I 2 values remained >99% in subgroup analyses, indicating high, unexplained heterogeneity and leading to a decision not to report pooled hSAR estimates. FFX and HHTI remain critical epidemiological tools for early and ongoing characterisation of novel infectious pathogens. The large, unexplained variance in hSAR estimates emphasises the need to further support standardisation in planning, conduct and analysis, and for clear and comprehensive reporting of FFX and HHTIs in time and place, to guide evidence-based pandemic preparedness and response efforts for SARS-CoV-2, influenza and future novel respiratory viruses.
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Affiliation(s)
- Hannah C. Lewis
- World Health OrganizationGenevaSwitzerland,World Health Organization, Regional Office for AfricaBrazzavilleRepublic of Congo
| | - Adrian J. Marcato
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Niamh Meagher
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - Marta Valenciano
- World Health OrganizationGenevaSwitzerland,EpiconceptParisFrance
| | - Juan‐Pablo Villanueva‐Cabezas
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,The Nossal Institute for Global HealthThe University of MelbourneMelbourneAustralia
| | - Violeta Spirkoska
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Victorian Infectious Diseases Reference LaboratoryRoyal Melbourne Hospital, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - James E. Fielding
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia,Victorian Infectious Diseases Reference LaboratoryRoyal Melbourne Hospital, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | - Anthony Nardone
- World Health OrganizationGenevaSwitzerland,EpiconceptParisFrance
| | - Brianna Cheng
- World Health OrganizationGenevaSwitzerland,School of Population and Global HealthMcGill UniversityMontrealQuebecCanada
| | | | - Joseph Okeibunor
- World Health Organization, Regional Office for AfricaBrazzavilleRepublic of Congo
| | - Eman A. Aly
- World Health Organization, Regional Office for the Eastern MediterraneanCairoEgypt
| | - Amal Barakat
- World Health Organization, Regional Office for the Eastern MediterraneanCairoEgypt
| | | | - Tasnim Azim
- World Health Organization, Regional Office for South‐East AsiaNew DelhiIndia
| | | | - Linh‐Vi Le
- World Health Organization, Regional Office for the Western PacificManilaPhilippines
| | - Angel Rodriguez
- World Health Organization, Regional Office for the Americas (Pan American Health Organization)WashingtonDCUSA
| | - Andrea Vicari
- World Health Organization, Regional Office for the Americas (Pan American Health Organization)WashingtonDCUSA
| | | | - Jodie McVernon
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia
| | - Richard Pebody
- World Health Organization Regional Office for EuropeCopenhagenDenmark
| | - David J. Price
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | | | | | - Yasir Alvi
- Department of Community Medicine Hamdard Institute of Medical Sciences and Research New Delhi India
| | | | - Pui Shan Chung
- World Health Organization, Regional Office for the Western Pacific Manila Philippines
| | - Davaalkham Dambadarjaa
- School of Public Health Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Ayan K. Das
- Department of Microbiology Hamdard Institute of Medical Science and Research New Delhi India
- Hakeem Abdul Hameed Centenary Hospital New Delhi India
| | - Timothée Dub
- Department of Health Security Finnish Institute for Health and Welfare Helsinki Finland
| | | | - Faiqa Ebrahim
- World Health Organization Country Office Addis Ababa Ethiopia
| | | | | | | | | | | | - Belinda L. Herring
- World Health Organization, Regional Office for Africa Brazzaville Republic of Congo
| | | | - Farzana Islam
- Hamdard Institute of Medical Sciences and Research (HIMSR) New Delhi India
| | - Kamal Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura Nugegoda Sri Lanka
| | - Shashi Kant
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
| | - Wasiq Khan
- World Health Organization, Regional Office for the Eastern Mediterranean Cairo Egypt
| | | | - Juliana Leite
- World Health Organization, Regional Office for the Americas (Pan American Health Organization) Washington DC USA
| | | | - Undram Mandakh
- Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Warisha Mariam
- Department of Community Medicine Maulana Azad Medical College New Delhi India
| | - Tsogt Mend
- National Center for Communicable Diseases Ulaanbaatar Mongolia
| | | | - Sanjin Musa
- Institute for Public Health of the Federation of Bosnia and Herzegovina Sarajevo Bosnia and Herzegovina
- Sarajevo School of Science and Technology Sarajevo Bosnia and Herzegovina
| | - Hanna Nohynek
- Department of Health Security Finnish Institute for Health and Welfare Helsinki Finland
| | | | | | | | | | | | - James Ransom
- Centers for Disease Control and Prevention Juba South Sudan
| | - Sonal Saxena
- Department of Microbiology Maulana Azad Medical College New Delhi India
| | - Pragya Sharma
- Department of Community Medicine Maulana Azad Medical College New Delhi India
| | - Aswathy Sreedevi
- Department of Community Medicine Amrita Institute of Medical Sciences Kochi Kerala India
| | - Mini Satheesh
- Kerala University of Health Sciences Kerala India
- Government Medical College Thiruvananthapuram Kerala India
| | - K. J. Subhashini
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
| | - Beth A. Tippet‐Barr
- U.S. Centers for Disease Control and Prevention Nairobi Kenya
- Nyanja Health Research Institute Salima Malawi
| | - Anuja Usha
- Regional Prevention of Epidemic and Infectious Disease Cell Government of Kerala Kerala India
| | | | | | - Kapil Yadav
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
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3
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Hakim AJ, Bolo A, Coy KC, Achut V, Katoro J, Caesar G, Lako R, Taban AI, Sleeman K, Wesson J, Okiria AG. Progress toward the UNAIDS 90–90-90 targets among female sex workers and sexually exploited female adolescents in Juba and Nimule, South Sudan. BMC Public Health 2022; 22:132. [PMID: 35045854 PMCID: PMC8767749 DOI: 10.1186/s12889-022-12533-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Little is known about HIV in South Sudan and even less about HIV among female sex workers (FSW). We characterized progress towards UNAIDS 90–90-90 targets among female sex workers (FSW) and sexually exploited female adolescents in Juba and Nimule, South Sudan.
Methods
We conducted a biobehavioral survey of FSW and sexually exploited female adolescents using respondent-driven sampling (RDS) in Juba (November 2015–March 2016) and in Nimule (January–March 2017) to estimate achievements toward the UNAIDS 90–90-90 targets (90% of HIV-positive individuals know their status; of these, 90% are receiving antiretroviral therapy [ART]; and of these, 90% are virally suppressed). Eligibility criteria were girls and women who were aged ≥15 years; spoke English, Juba Arabic, or Kiswahili; received money, goods, or services in exchange for sex in the past 6 months; and resided, worked, or socialized in the survey city for ≥1 month. Data were weighted for RDS methods.
Results
We sampled 838 FSW and sexually exploited female adolescents in Juba (HIV-positive, 333) and 409 in Nimule (HIV-positive, 108). Among HIV-positive FSW and sexually exploited female adolescents living in Juba, 74.8% self-reported being aware of their HIV status; of these, 73.3% self-reported being on ART; and of these, 62.2% were virally suppressed. In Nimule, 79.5% of FSW and sexually exploited female adolescents living with HIV self-reported being aware of their HIV status; of these, 62.9% self-reported being on ART; and of these, 75.7% were virally suppressed.
Conclusions
Although awareness of HIV status is the lowest of the 90–90-90 indicators in many countries, treatment uptake and viral suppression were lowest among FSW and sexually exploited female adolescents in South Sudan. Differentiated service delivery facilitate linkage to and retention on treatment in support of attainment of viral suppression.
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Lopez VK, Shetty S, Kouch AT, Khol MT, Lako R, Bili A, Ayuen AD, Jukudu A, Kug AA, Mayen AD, Nyawel E, Berta K, Olu O, Clarke K, Bunga S. Lessons learned from implementation of a national hotline for Ebola virus disease emergency preparedness in South Sudan. Confl Health 2021; 15:27. [PMID: 33858478 PMCID: PMC8047513 DOI: 10.1186/s13031-021-00360-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/24/2020] [Accepted: 03/31/2021] [Indexed: 01/02/2023] Open
Abstract
Background The world’s second largest Ebola outbreak occurred in the Democratic Republic of Congo from 2018 to 2020. At the time, risk of cross-border spread into South Sudan was very high. Thus, the South Sudan Ministry of Health scaled up Ebola preparedness activities in August 2018, including implementation of a 24-h, toll-free Ebola virus disease (EVD) hotline. The primary purpose was the hotline was to receive EVD alerts and the secondary goal was to provide evidence-based EVD messages to the public. Methods To assess whether the hotline augmented Ebola preparedness activities in a protracted humanitarian emergency context, we reviewed 22 weeks of call logs from January to June 2019. Counts and percentages were calculated for all available data. Results The hotline received 2114 calls during the analysis period, and an additional 1835 missed calls were documented. Callers used the hotline throughout 24-h of the day and were most often men and individuals living in Jubek state, where the national capital is located. The leading reasons for calling were to learn more about EVD (68%) or to report clinical signs or symptoms (16%). Common EVD-related questions included EVD signs and symptoms, transmission, and prevention. Only one call was documented as an EVD alert, and there was no documentation of reported symptoms or whether the person met the EVD case definition. Conclusions Basic surveillance information was not collected from callers. To trigger effective outbreak investigation from hotline calls, the hotline should capture who is reporting and from where, symptoms and travel history, and whether this information should be further investigated. Electronic data capture will enhance data quality and availability of information for review. Additionally, the magnitude of missed calls presents a major challenge. When calls are answered, there is potential to provide health communication, so risk communication needs should be considered. However, prior to hotline implementation, governments should critically assess whether their hotline would yield actionable data and if other data sources for surveillance or community concerns are available.
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Affiliation(s)
- Velma K Lopez
- Division of Global Health Protection, Center for Global Health, CDC, Atlanta, Georgia, USA.
| | - Sharmila Shetty
- Division of Global Health Protection, Center for Global Health, CDC, Atlanta, Georgia, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Kevin Clarke
- Division of Global Health Protection, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Sudhir Bunga
- Division of Global HIV and TB, Center for Global Health, CDC, Juba, South Sudan
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5
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Waya JLL, Lako R, Bunga S, Chun H, Mize V, Ambani B, Wamala JF, Guyo AG, Gray JH, Gai M, Maleghemi S, Kol M, Rumunu J, Tukuru M, Olu OO. The first sixty days of COVID-19 in a humanitarian response setting: a descriptive epidemiological analysis of the outbreak in South Sudan. Pan Afr Med J 2020; 37:384. [PMID: 33796197 PMCID: PMC7992418 DOI: 10.11604/pamj.2020.37.384.27486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction the coronavirus disease 2019 (COVID-19) was declared a pandemic on March 11, 2020. South Sudan, a low-income and humanitarian response setting, reported its first case of COVID-19 on April 5, 2020. We describe the socio-demographic and epidemiologic characteristics of COVID-19 cases in this setting. Methods we conducted a cross-sectional descriptive analysis of data for 1,330 confirmed COVID-19 cases from the first 60 days of the outbreak. Results among the 1,330 confirmed cases, the mean age was 37.1 years, 77% were male, 17% were symptomatic with 95% categorized as mild, and the case fatality rate was 1.1%. Only 24.7% of cases were detected through alerts and sentinel site surveillance, with 95% of the cases reported from the capital, Juba. Epidemic doubling time averaged 9.8 days (95% confidence interval [CI] 7.7 - 13.4), with an attack rate of 11.5 per 100,000 population. Test positivity rate was 18.2%, with test rate per 100,000 population of 53 and mean test turn-around time of 9 days. The case to contact ratio was 1: 2.2. Conclusion this 2-month initial period of COVID-19 in South Sudan demonstrated mostly young adults and men affected, with most cases reported as asymptomatic. Systems´ limitations highlighted included a small proportion of cases detected through surveillance, low testing rates, low contact elicitation, and long collection to test turn-around times limiting the country´s ability to effectively respond to the outbreak. A multi-pronged response including greater access to testing, scale-up of surveillance, contact tracing and community engagement, among other interventions are needed to improve the COVID-19 response in this setting.
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Affiliation(s)
- Joy Luba Lomole Waya
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Richard Lako
- National COVID-19 Incident Management System, Ministry of Health, Juba, Republic of South Sudan
| | - Sudhir Bunga
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Helen Chun
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Valerie Mize
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Boniface Ambani
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | | | - Argata Guracha Guyo
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - John Henry Gray
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Malick Gai
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Sylvester Maleghemi
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Matthew Kol
- National Public Health Emergency Operations Centre, Juba, Republic of South Sudan
| | - John Rumunu
- Ministry of Health, Directorate of Preventive Health Services, Juba, Republic of South Sudan
| | - Michael Tukuru
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Olushayo Oluseun Olu
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
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6
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Olu OO, Lako R, Bunga S, Berta K, Kol M, Ramadan PO, Ryan C, Udenweze I, Guyo AG, Conteh I, Huda Q, Gai M, Saulo D, Papowitz H, Gray HJ, Chimbaru A, Wangdi K, Grube SM, Barr BT, Wamala JF. Analyses of the performance of the Ebola virus disease alert management system in South Sudan: August 2018 to November 2019. PLoS Negl Trop Dis 2020; 14:e0008872. [PMID: 33253169 PMCID: PMC7728195 DOI: 10.1371/journal.pntd.0008872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/29/2020] [Revised: 12/10/2020] [Accepted: 10/10/2020] [Indexed: 12/02/2022] Open
Abstract
South Sudan implemented Ebola virus disease preparedness interventions aiming at preventing and rapidly containing any importation of the virus from the Democratic Republic of Congo starting from August 2018. One of these interventions was a surveillance system which included an Ebola alert management system. This study analyzed the performance of this system. A descriptive cross-sectional study of the Ebola virus disease alerts which were reported in South Sudan from August 2018 to November 2019 was conducted using both quantitative and qualitative methods. As of 30 November 2019, a total of 107 alerts had been detected in the country out of which 51 (47.7%) met the case definition and were investigated with blood samples collected for laboratory confirmation. Most (81%) of the investigated alerts were South Sudanese nationals. The alerts were identified by health workers (53.1%) at health facilities, at the community (20.4%) and by screeners at the points of entry (12.2%). Most of the investigated alerts were detected from the high-risk states of Gbudwe (46.9%), Jubek (16.3%) and Torit (10.2%). The investigated alerts commonly presented with fever, bleeding, headache and vomiting. The median timeliness for deployment of Rapid Response Team was less than one day and significantly different between the 6-month time periods (K-W = 7.7567; df = 2; p = 0.0024) from 2018 to 2019. Strengths of the alert management system included existence of a dedicated national alert hotline, case definition for alerts and rapid response teams while the weaknesses were occasional inability to access the alert toll-free hotline and lack of transport for deployment of the rapid response teams which often constrain quick response. This study demonstrates that the Ebola virus disease alert management system in South Sudan was fully functional despite the associated challenges and provides evidence to further improve Ebola preparedness in the country. The Democratic Republic of Congo announced its tenth outbreak of the Ebola virus disease on 1st August 2018. As part of the preparedness measures to prevent and rapidly contain any importation of the virus, South Sudan, a neighbouring country to the Democratic Republic of Congo implemented a surveillance system which included an Ebola alert management system. We analyzed the performance of this system with a view to provide information to inform planning and allocation of resources to the other components of Ebola virus disease preparedness and to understand the key issues and challenges with the system. Our findings show that more than half of the reported alerts did not meet the case definition of the disease, alerts were mainly detected in the high-risk states, the commonest source of alert detection were from health facilities and the community and the most common symptoms presented by the alerts were fever, bleeding, headache, vomiting and weakness/fatigue. This study demonstrates that the Ebola virus disease alert management system in South Sudan was fully functional despite the associated challenges and provided evidence to further improve Ebola preparedness in the country. We recommend that the observed challenges should be urgently addressed.
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Affiliation(s)
- Olushayo Oluseun Olu
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Richard Lako
- National Ebola virus disease Incident Management Team Ministry of Health, Republic of South Sudan
| | - Sudhir Bunga
- United States Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Kibebu Berta
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Matthew Kol
- National Ebola virus disease Incident Management Team Ministry of Health, Republic of South Sudan
| | - Patrick Otim Ramadan
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Caroline Ryan
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Ifeanyi Udenweze
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Argata Guracha Guyo
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Ishata Conteh
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Qudsia Huda
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Malick Gai
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Dina Saulo
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Heather Papowitz
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Henry John Gray
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Alex Chimbaru
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Kencho Wangdi
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
| | - Steven M Grube
- United States Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Beth Tippett Barr
- United States Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Joseph Francis Wamala
- Ebola virus disease preparedness team, World Health Organization, Juba, Republic of South Sudan
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7
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Hakim AJ, Bolo A, Werner M, Achut V, Katoro J, Caesar G, Lako R, Taban AI, Wesson J, Okiria AG. High HIV and syphilis prevalence among female sex workers in Juba, South Sudan. PLoS One 2020; 15:e0239543. [PMID: 32986767 PMCID: PMC7521730 DOI: 10.1371/journal.pone.0239543] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Abstract
HIV prevalence is estimated to be 2.7% in South Sudan; however, little is known about the young country’s epidemic. We conducted a respondent-driven sampling biobehavioral survey in Juba of female sex workers (FSW) aged ≥15 years who sold or exchanged sex in the last 6 months to learn more about this population. We enrolled 838 FSW from November 2015 to March 2016 and estimated HIV prevalence to be 37.8%. Prevalence of active syphilis was 7.3%. FSW were from South Sudan and most neighboring countries. Comprehensive knowledge of HIV was 11.1% and 64.2% of FSW had never spoken with an outreach worker. In multivariable analysis, HIV was associated with being from Uganda (aOR: 3.3, 95% CI: 1.7–6.1) or Kenya (aOR: 4.3, 95% CI: 1.5–13.0) versus from South Sudan. Our survey suggests that FSW may play a critical role in South Sudan’s HIV epidemic and highlights the importance of tailoring services to the unique needs of FSW of all nationalities in Juba.
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Affiliation(s)
- Avi J. Hakim
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Alex Bolo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Margaret Werner
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Joel Katoro
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Golda Caesar
- South Sudan Ministry of Health, Juba, South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Juba, South Sudan
| | | | - Jennifer Wesson
- IntraHealth International, Chapel Hill, NC, United States of America
| | - Alfred G. Okiria
- IntraHealth International, Chapel Hill, NC, United States of America
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Benedek G, Abed El Latif M, Miller K, Rivkin M, Ramadhan Lasu AA, Riek LP, Lako R, Edvardson S, Alon SA, Galun E, Levite M. Protection or susceptibility to devastating childhood epilepsy: Nodding Syndrome associates with immunogenetic fingerprints in the HLA binding groove. PLoS Negl Trop Dis 2020; 14:e0008436. [PMID: 32639997 PMCID: PMC7371228 DOI: 10.1371/journal.pntd.0008436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/27/2020] [Revised: 07/20/2020] [Accepted: 05/30/2020] [Indexed: 12/26/2022] Open
Abstract
Nodding syndrome (NS) is a devastating and enigmatic childhood epilepsy. NS is accompanied by multiple neurological impairments and neuroinflammation, and associated with the parasite Onchocerca volvulus (Ov) and other environmental factors. Moreover, NS seems to be an ‘Autoimmune Epilepsy’ since: 1. ~50% of NS patients have neurotoxic cross-reactive Ov/Leimodin-I autoimmune antibodies. 2. Our recently published findings: Most (~86%) of NS patients have glutamate-receptor AMPA-GluR3B peptide autoimmune antibodies that bind, induce Reactive Oxygen Species, and kill both neural cells and T cells. Furthermore, NS patient’s IgG induce seizures, brain multiple damage alike occurring in brains of NS patients, and elevation of T cells and activated microglia and astrocytes, in brains of normal mice. Human Leukocyte antigen (HLA) class I and II molecules are critical for initiating effective beneficial immunity against foreign microorganisms and contributing to proper brain function, but also predispose to detrimental autoimmunity against self-peptides. We analyzed seven HLA loci, either by next-generation-sequencing or Sequence-Specific-Oligonucleotide-Probe, in 48 NS patients and 51 healthy controls from South Sudan. We discovered that NS associates significantly with both protective HLA haplotype: HLA-B*42:01, C*17:01, DRB1*03:02, DQB1*04:02 and DQA1*04:01, and susceptible motif: Ala24, Glu63 and Phe67, in the HLA-B peptide-binding groove. These amino acids create a hydrophobic and sterically closed peptide-binding HLA pocket, favoring proline residue. Our findings suggest that immunogenetic fingerprints in HLA peptide-binding grooves tentatively associate with protection or susceptibility to NS. Accordingly, different HLA molecules may explain why under similar environmental factors, only some children, within the same families, tribes and districts, develop NS, while others do not. Nodding syndrome (NS) is a devastating and mysterious neurological disorder affecting 5–15 years old children, primarily in Sudan, Uganda and Tanzania. NS strongly associates with an infection with the parasitic worm Oncocherca Volvulus (Ov), transmitted by the black fly, affecting many people worldwide. Moreover, NS is most probably an 'Autoimmune Epilepsy', especially in view of our recent findings that NS patient’s autoimmune GluR3B antibodies induce ROS and kill both neural cells and T cells. NS patient’s IgG also induce seizures, multiple brain damage and inflammation-inducing cells in the brain. HLA class I genes are expressed on the surface of all nucleated cells and present peptides to cytotoxic CD8+ T cells. HLA class II genes are expressed mainly on the surface of antigen presenting cells and present peptides to helper CD4+ T cells. Analysis of HLA of South-Sudanese NS patients and healthy controls revealed that that few amino acids in HLA peptide-binding grooves associate with either protection or susceptibility to NS. Theses amino acids could be critical in NS by affecting beneficial immunity and/or detrimental autoimmunity.
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Affiliation(s)
- Gil Benedek
- Tissue Typing and Immunogenetics Laboratory, Department of Genetics, Hadassah Hebrew University Hospital, Jerusalem, Israel
- * E-mail:
| | - Mahmoud Abed El Latif
- Tissue Typing and Immunogenetics Laboratory, Department of Genetics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Keren Miller
- Tissue Typing and Immunogenetics Laboratory, Department of Genetics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Mila Rivkin
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | - Lul P. Riek
- External Coordination & Research, Ministry of Health, Juba, Republic of South Sudan
| | - Richard Lako
- Ministry of Health South Sudan, Juba, Republic of South Sudan
| | - Shimon Edvardson
- Department of Pediatrics, Neurology Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Sagit-Arbel Alon
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Eithan Galun
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Mia Levite
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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Olu OO, Lako R, Wamala JF, Ramadan PO, Ryan C, Udenweze I, Berta K, Guyo AG, Sokemawu A, Tukuru M, Gray HJ, Chimbaru A. What did we learn from preparing for cross-border transmission of Ebola virus disease into a complex humanitarian setting - The Republic of South Sudan? Infect Dis Poverty 2020; 9:40. [PMID: 32312320 PMCID: PMC7170723 DOI: 10.1186/s40249-020-00657-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022] Open
Abstract
Background Following the West Africa Ebola virus disease (EVD) outbreak (2013–2016), WHO developed a preparedness checklist for its member states. This checklist is currently being applied for the first time on a large and systematic scale to prepare for the cross border importation of the ongoing EVD outbreak in the Democratic Republic of Congo hence the need to document the lessons learnt from this experience. This is more pertinent considering the complex humanitarian context and weak health system under which some of the countries such as the Republic of South Sudan are implementing their EVD preparedness interventions. Main text We identified four main lessons from the ongoing EVD preparedness efforts in the Republic South Sudan. First, EVD preparedness is possible in complex humanitarian settings such as the Republic of South Sudan by using a longer-term health system strengthening approach. Second, the Republic of South Sudan is at risk of both domestic and cross border transmission of EVD and several other infectious disease outbreaks hence the need for an integrated and sustainable approach to outbreak preparedness in the country. Third, a phased and well-prioritized approach is required for EVD preparedness in complex humanitarian settings given the costs associated with preparedness and the difficulties in the accurate prediction of outbreaks in such settings. Fourth, EVD preparedness in complex humanitarian settings is a massive undertaking that requires effective and decentralized coordination. Conclusion Despite a very challenging context, the Republic of South Sudan made significant progress in its EVD preparedness drive demonstrating that it is possible to rapidly scale up preparedness efforts in complex humanitarian contexts if appropriate and context-specific approaches are used. Further research, systematic reviews and evaluation of the ongoing preparedness efforts are required to ensure comprehensive documentation and application of the lessons learnt for future EVD outbreak preparedness and response efforts.
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Affiliation(s)
- Olushayo Oluseun Olu
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan.
| | - Richard Lako
- National Ebola virus disease preparedness Incident Manager, Ministry of Health, Juba, Republic of South Sudan
| | - Joseph Francis Wamala
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Patrick Otim Ramadan
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Caroline Ryan
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Ifeanyi Udenweze
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Kibebu Berta
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Argata Guracha Guyo
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Alex Sokemawu
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Michael Tukuru
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Henry John Gray
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Alex Chimbaru
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
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Valadez JJ, Berendes S, Odhiambo J, Vargas W, Devkota B, Lako R, Jeffery C. Is development aid to strengthen health systems during protracted conflict a useful investment? The case of South Sudan, 2011-2015. BMJ Glob Health 2020; 5:e002093. [PMID: 32377402 PMCID: PMC7199709 DOI: 10.1136/bmjgh-2019-002093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Is achievement of Sustainable Development Goal (SDG) 16 (building peaceful societies) a precondition for achieving SDG 3 (health and well-being in all societies, including conflict-affected countries)? Do health system investments in conflict-affected countries waste resources or benefit the public’s health? To answer these questions, we examine the maternal, newborn, child and reproductive health (MNCRH) service provision during protracted conflicts and economic shocks in the Republic of South Sudan between 2011 (at independence) and 2015. Methods We conducted two national cross-sectional probability surveys in 10 states (2011) and nine states (2015). Trained state-level health workers collected data from households randomly selected using probability proportional to size sampling of villages in each county. County data were weighted by their population sizes to measure state and national MNCRH services coverage. A two-sample, two-sided Z-test of proportions tested for changes in national health service coverage between 2011 (n=11 800) and 2015 (n=10 792). Results Twenty-two of 27 national indicator estimates (81.5%) of MNCRH service coverage improved significantly. Examples: malaria prophylaxis in pregnancy increased by 8.6% (p<0.001) to 33.1% (397/1199 mothers, 95% CI ±2.9%), institutional deliveries by 10.5% (p<0.001) to 20% (230/1199 mothers, ±2.6%) and measles vaccination coverage in children aged 12–23 months by 11.2% (p<0.001) to 49.7% (529/1064 children, ±2.3%). The largest increase (17.7%, p<0.001) occurred for mothers treating diarrhoea in children aged 0–59 months with oral rehydration salts to 51.4% (635/1235 children, ±2.9%). Antenatal and postnatal care, and contraceptive prevalence did not change significantly. Child vitamin A supplementation decreased. Despite significant increases, coverage remained low (median of all indicators = 31.3%, SD = 19.7). Coverage varied considerably by state (mean SD for all indicators and states=11.1%). Conclusion Health system strengthening is not a uniform process and not necessarily deterred by conflict. Despite the conflict, health system investments were not wasted; health service coverage increased.
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Affiliation(s)
- Joseph James Valadez
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sima Berendes
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jackline Odhiambo
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - William Vargas
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Baburam Devkota
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Richard Lako
- Division of Research, Monitoring and Evaluation, Government of the Republic of South Sudan Ministry of Health, Juba, South Sudan
| | - Caroline Jeffery
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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11
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Odhiambo J, Jeffery C, Lako R, Devkota B, Valadez JJ. Measuring health system resilience in a highly fragile nation during protracted conflict: South Sudan 2011-15. Health Policy Plan 2020; 35:313-322. [PMID: 31876921 PMCID: PMC7152724 DOI: 10.1093/heapol/czz160] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 12/31/2022] Open
Abstract
Health systems resilience (HSR) is defined as the ability of a health system to continue providing normal services in response to a crisis, making it a critical concept for analysis of health systems in fragile and conflict-affected settings (FCAS). However, no consensus for this definition exists and even less about how to measure HSR. We examine three current HSR definitions (maintaining function, improving function and achieving health system targets) using real-time data from South Sudan to develop a data-driven understanding of resilience. We used 14 maternal, newborn and child health (MNCH) coverage indicators from household surveys in South Sudan collected at independence (2011) and following 2 years of protracted conflict (2015), to construct a resilience index (RI) for 9 of the former 10 states and nationally. We also assessed health system stress using conflict-related indicators and developed a stress index. We cross tabulated the two indices to assess the relationship of resilience and stress. For maintaining function for 80% of MNCH indicators, seven state health systems were resilient, compared with improving function for 50% of the indicators (two states were resilient). Achieving the health system national target of 50% coverage in half of the MNCH indicators displayed no resilience. MNCH coverage levels were low, with state averages ranging between 15% and 44%. Central Equatoria State displayed high resilience and high system stress. Lakes and Northern Bahr el Ghazal displayed high resilience and low stress. Jonglei and Upper Nile States had low resilience and high stress. This study is the first to investigate HSR definitions using a resilience metric and to simultaneously measure health system stress in FCAS. Improving function is the HSR definition detecting the greatest variation in the RI. HSR and health system stress are not consistently negatively associated. HSR is highly complex warranting more in-depth analyses in FCAS.
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Affiliation(s)
- Jackline Odhiambo
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Caroline Jeffery
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Richard Lako
- Directorate of Policy, Planning, Budgeting and Research, Ministry of Health, Juba, South Sudan
| | - Baburam Devkota
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Joseph J Valadez
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Medley AM, Mavila O, Makumbi I, Nizeyemana F, Umutoni A, Balisanga H, Manoah YK, Geissler A, Bunga S, MacDonald G, Homsy J, Ojwang J, Ewetola R, Raghunathan PL, MacGurn A, Singler K, Ward S, Roohi S, Brown V, Shoemaker T, Lako R, Kabeja A, Muruta A, Lubula L, Merrill R. Case Definitions Used During the First 6 Months of the 10th Ebola Virus Disease Outbreak in the Democratic Republic of the Congo - Four Neighboring Countries, August 2018-February 2019. MMWR Morb Mortal Wkly Rep 2020; 69:14-19. [PMID: 31917783 PMCID: PMC6973343 DOI: 10.15585/mmwr.mm6901a4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Colebunders R, Y Carter J, Olore PC, Puok K, Bhattacharyya S, Menon S, Abd-Elfarag G, Ojok M, Ensoy-Musoro C, Lako R, Logora MY. High prevalence of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan: A community-based survey. Seizure 2018; 63:93-101. [PMID: 30468964 PMCID: PMC6291739 DOI: 10.1016/j.seizure.2018.11.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine the prevalence and incidence of epilepsy in an onchocerciasis endemic region of South Sudan. METHODS In May 2018, a door-to-door household survey was conducted in 8 study sites in an onchocerciasis endemic area in Maridi County. RESULTS A total of 2511 households agreed to participate in the study, corresponding to 17,652 individuals. An epilepsy screening questionnaire identified 799 persons suspected to have epilepsy (4.5%); in 736 of the 766 persons (96.1%) seen by a clinical officer the diagnosis of epilepsy was confirmed. Adding 38 persons who were not seen but with a positive answer to a combination of screening questions, 774 persons (4.4%) had epilepsy. Epilepsy prevalence was highest in the 11-20 age group (10.5%); 66 persons with epilepsy (PWE) developed their first seizures in the year preceding the survey (annual incidence = 373.9/100.000). Neurocysticercosis cannot explain the high epilepsy prevalence since no pigs are kept in the area. Independent risk factors for epilepsy included male gender, belonging to a "permanent household" and a farming family, and living in a village bordering the Maridi River. Only 7209 (40.8%) of the population took ivermectin in 2017. CONCLUSION A very high prevalence and incidence of epilepsy was observed in several villages in Maridi County located close to the Maridi River and the Maridi dam. Urgent action is needed to prevent children in Maridi County from developing OAE by strengthening the onchocerciasis elimination program.
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Affiliation(s)
- Robert Colebunders
- Global Health Institute, University of Antwerp, Kinsbergen Centrum Doornstraat 331, 2610, Antwerp, Belgium.
| | - Jane Y Carter
- FRCC Amref International University, Nairobi, Kenya.
| | | | - Kai Puok
- Maridi Health Sciences Institute, Maridi, South Sudan.
| | - Samit Bhattacharyya
- Department of Mathematics, School of Natural Sciences, Shiv Nadar University, Dadri, Uttar Pradesh, India.
| | - Sonia Menon
- Global Health Institute, University of Antwerp, Kinsbergen Centrum Doornstraat 331, 2610, Antwerp, Belgium.
| | | | | | | | - Richard Lako
- Policy, Planning, Budgeting and Research, Ministry of Health, Juba, South Sudan.
| | - Makoy Yibi Logora
- Neglected Tropical Diseases Unit, Ministry of Health, Juba, South Sudan.
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Abd-Elfarag G, Logora MY, Carter JY, Ojok M, Songok J, Menon S, Wit F, Lako R, Colebunders R. The effect of bi-annual community-directed treatment with ivermectin on the incidence of epilepsy in onchocerciasis endemic villages in South Sudan: a study protocol. Infect Dis Poverty 2018; 7:112. [PMID: 30424817 PMCID: PMC6234538 DOI: 10.1186/s40249-018-0496-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/18/2018] [Accepted: 10/19/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Nodding syndrome (NS) is a devastating epileptic illness of unknown aetiology mainly affecting children 5-15 years of age. Head nodding distinguishes NS from other forms of epilepsy. Other manifestations of the illness include mental and physical growth retardation. Many children die as a result of falling in fires or drowning. Recently, it was shown that NS is only one of the phenotypic presentations of onchocerciasis associated epilepsy (OAE). Despite the strong epidemiological association between epilepsy and onchocerciasis, the causal mechanism is unknown. After implementation of bi-annual community directed treatment with ivermectin (CDTi) and larviciding of rivers in northern Uganda, new cases of NS have ceased, while new cases continue to emerge in South Sudanese onchocerciasis-endemic areas with an interrupted CDTi programme. This study is designed to evaluate the potential effects of bi-annual CDTi on reducing the incidence of NS/OAE in onchocerciasis-endemic areas in South Sudan. METHODS A pre-intervention door-to-door population-based household survey will be conducted in selected onchocerciasis-endemic villages in Mundri and Maridi Counties, which have a high prevalence of epilepsy. Using a validated questionnaire, the entire village will be screened by community research assistants for suspected epilepsy cases. Suspected cases will be interviewed and examined by a trained clinical officer or medical doctor who will confirm or reject the diagnosis of epilepsy. Bi-annual CDTi will be implemented in the villages and a surveillance system for epilepsy set up. By implementing an epilepsy onchocerciasis awareness campaign we expect to obtain > 90% CDTi coverage of eligible individuals. The door-to-door survey will be repeated two years after the baseline survey. The incidence of NS/OAE will be compared before and after bi-annual CDTi. DISCUSSION Our study is the first population-based study to evaluate the effect of bi-annual CDTi to reduce the incidence of NS/OAE. If the study demonstrates such a reduction, these findings are expected to motivate communities in onchocerciasis-endemic regions to participate in CDTi, and will encourage policy makers, funders and other stakeholders to increase their efforts to eliminate onchocerciasis.
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Affiliation(s)
- Gasim Abd-Elfarag
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Makoy Yibi Logora
- Neglected Tropical Diseases Unit, Ministry of Health, Juba, Republic of South Sudan
| | | | | | | | - Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Ferdinand Wit
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Richard Lako
- Policy, Planning, Budgeting and Research, Ministry of Health, Juba, Republic of South Sudan
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, Kinsbergen Centrum, Doornstraat 331, 2610 Antwerp, Belgium
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Colebunders R, Abd-Elfarag G, Carter JY, Olore PC, Puok K, Menon S, Fodjo Siewe JN, Bhattacharyya S, Ojok M, Lako R, Logora MY. Clinical characteristics of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan. Seizure 2018; 62:108-115. [PMID: 30340162 DOI: 10.1016/j.seizure.2018.10.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 09/24/2018] [Revised: 09/30/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To describe the clinical manifestations of persons with epilepsy (PWE) in onchocerciasis endemic villages in South Sudan. METHODS During a survey in Maridi County in May 2018, PWE were interviewed and examined in their households by a clinical officer or medical doctor. Onchocerciasis-associated epilepsy (OAE) was defined as ≥2 seizures without any obvious cause, starting between the ages of 3-18 years in previously healthy persons who had resided for at least 3 years in the onchocerciasis endemic area. RESULTS Seven hundred and thirty-six PWE were included in the study; 315 (42.8%) were females; median age was 18 years. A variety of seizure types were reported: generalized tonic-clonic seizures in 511 PWE (69.4%), absences in 15 (2.0%), focal motor seizures with full awareness in 7 (1.0%), focal motor seizures with impaired awareness in 25 (3.4%), brief episodes of hallucinations in 316 (43.9%) and nodding seizures in 335 (45.5%). The median age of onset of all seizures was 10 years, and 8 years for nodding seizures. PWE with nodding seizures presented with more cognitive disabilities. The diagnostic criteria for OAE were met by 414 (85.2%) of the 486 PWE with complete information. Eighty (11.0%) PWE presented with Nakalanga features. Only 378 (51.4%) PWE were taking anti-epileptic treatment. CONCLUSION PWE presented with a wide spectrum of seizures. The high percentage of PWE who met the diagnostic criteria for OAE suggests that better onchocerciasis control could prevent new cases. Urgent action is needed to close the anti-epileptic treatment gap.
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Affiliation(s)
| | - Gasim Abd-Elfarag
- Department of Global Health, Academic Medical Center, University of Amsterdam, the Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.
| | | | | | - Kai Puok
- Maridi Health Sciences Institute, Maridi, Sudan.
| | - Sonia Menon
- Global Health Institute, University of Antwerp, Belgium.
| | | | - Samit Bhattacharyya
- Department of Mathematics, School of Natural Sciences, Shiv Nadar University, Dadri, Uttar Pradesh, India.
| | | | - Richard Lako
- Policy, Planning, Budgeting and Research, Ministry of Health, Juba, Sudan.
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Colebunders R, Carter J, Olore PC, Biel Chuong KP, Bhattacharyya S, Menon S, Abd-Elfarag G, Ojok M, Lako R. High Prevalence of Onchocerciasis-Associated Epilepsy in Villages in Maridi County, Republic of South Sudan. SSRN Journal 2018. [DOI: 10.2139/ssrn.3252676] [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: 09/02/2023]
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Harding E, Beckworth C, Fesselet JF, Lenglet A, Lako R, Valadez JJ. Using lot quality assurance sampling to assess access to water, sanitation and hygiene services in a refugee camp setting in South Sudan: a feasibility study. BMC Public Health 2017; 17:643. [PMID: 28789627 PMCID: PMC5549393 DOI: 10.1186/s12889-017-4656-2] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 07/31/2017] [Indexed: 11/23/2022] Open
Abstract
Background Humanitarian agencies working in refugee camp settings require rapid assessment methods to measure the needs of the populations they serve. Due to the high level of dependency of refugees, agencies need to carry out these assessments. Lot Quality Assurance Sampling (LQAS) is a method commonly used in development settings to assess populations living in a project catchment area to identify their greatest needs. LQAS could be well suited to serve the needs of refugee populations, but it has rarely been used in humanitarian settings. We adapted and implemented an LQAS survey design in Batil refugee camp, South Sudan in May 2013 to measure the added value of using it for sub-camp level assessment. Methods Using pre-existing divisions within the camp, we divided the Batil catchment area into six contiguous segments, called ‘supervision areas’ (SA). Six teams of two data collectors randomly selected 19 respondents in each SA, who they interviewed to collect information on water, sanitation, hygiene, and diarrhoea prevalence. These findings were aggregated into a stratified random sample of 114 respondents, and the results were analysed to produce a coverage estimate with 95% confidence interval for the camp and to prioritize SAs within the camp. Results The survey provided coverage estimates on WASH indicators as well as evidence that areas of the camp closer to the main road, to clinics and to the market were better served than areas at the periphery of the camp. This assumption did not hold for all services, however, as sanitation services were uniformly high regardless of location. While it was necessary to adapt the standard LQAS protocol used in low-resource communities, the LQAS model proved to be feasible in a refugee camp setting, and program managers found the results useful at both the catchment area and SA level. Conclusions This study, one of the few adaptations of LQAS for a camp setting, shows that it is a feasible method for regular monitoring, with the added value of enabling camp managers to identify and advocate for the least served areas within the camp. Feedback on the results from stakeholders was overwhelmingly positive.
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Affiliation(s)
- Elizabeth Harding
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, Netherlands.,Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, Merseyside, L3 5QA, UK
| | - Colin Beckworth
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, Merseyside, L3 5QA, UK.
| | | | - Annick Lenglet
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, Netherlands
| | | | - Joseph J Valadez
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, Merseyside, L3 5QA, UK
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Sanders AM, Stewart AEP, Makoy S, Chebet JJ, Magok P, Kuol A, Blauvelt C, Lako R, Rumunu J, Callahan EK, Nash SD. Burden of trachoma in five counties of Eastern Equatoria state, South Sudan: Results from population-based surveys. PLoS Negl Trop Dis 2017; 11:e0005658. [PMID: 28614375 PMCID: PMC5484542 DOI: 10.1371/journal.pntd.0005658] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/26/2017] [Accepted: 05/23/2017] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND In order to decrease the prevalence of trachoma within the country, the Republic of South Sudan has implemented components of the SAFE strategy in various counties since 2001. Five counties in Eastern Equatoria state were surveyed in order to monitor progress of programmatic interventions and determine if additional rounds of Mass Drug Administration with azithromycin were needed. METHODOLOGY/ PRINCIPAL FINDINGS Five counties (Budi, Lafon, Kapoeta East, Kapoeta South and Kapoeta North) were surveyed from April to October 2015. A cross-sectional, multi-stage, cluster-random sampling was used. All present, consenting residents of selected households were examined for all clinical signs of trachoma using the World Health Organization (WHO) simplified grading system. 14,462 individuals from 3,446 households were surveyed. The prevalence of trachomatous inflammation-follicular (TF) in children ages one to nine years ranged from 17.4% (95% Confidence Interval (CI): 11.4%, 25.6%) in Budi county to 47.6%, (95% CI: 42.3%, 53.0%) in Kapoeta East county. Trachomatous trichiasis (TT) was also highly prevalent in those 15 years and older, ranging between 2.6% (95% CI: 1.6%, 4.0%) in Kapoeta South to 3.9% (95% CI: 2.4%, 6.1%) in Lafon. The presence of water and sanitation were low in all five counties, including two counties which had a complete absence of latrines in all surveyed clusters. CONCLUSIONS/ SIGNIFICANCE To our knowledge, these were the first trachoma surveys conducted in the Republic of South Sudan since their independence in 2011. The results show that despite years of interventions, four of the five surveyed counties require a minimum of five additional years of SAFE strategy implementation, with the fifth requiring at minimum three more years.
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Affiliation(s)
- Angelia M. Sanders
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
- * E-mail:
| | - Aisha E. P. Stewart
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Samuel Makoy
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - Joy J. Chebet
- The Carter Center-South Sudan, The Carter Center, Juba, Republic of South Sudan
| | - Peter Magok
- The Carter Center-South Sudan, The Carter Center, Juba, Republic of South Sudan
| | - Aja Kuol
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - Carla Blauvelt
- The Carter Center-South Sudan, The Carter Center, Juba, Republic of South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - John Rumunu
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - E. Kelly Callahan
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Scott D. Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
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Valadez JJ, Berendes S, Lako R, Gould S, Vargas W, Milner S. Finding the gap: revealing local disparities in coverage of maternal, newborn and child health services in South Sudan using lot quality assurance sampling. Trop Med Int Health 2015; 20:1711-21. [PMID: 26432978 DOI: 10.1111/tmi.12613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We adapted a rapid monitoring method to South Sudan, a new nation with one of the world's highest maternal and child mortality rates, aiming to assess coverage of maternal, neonatal and child health (MNCH) services at the time of independence, and introducing a monitoring and evaluation system (M&E) for equity-sensitive tracking of progress related to Millennium Development Goals (MDG) 4 and 5 at national, state and county levels to detect local variability. METHODS We conducted a national cross-sectional household survey among women from six client populations in all, but six of South Sudan's 79 counties. We used lot quality assurance sampling (LQAS) to measure coverage with diverse MNCH indicators to obtain information for national-, state- and county-level health system management decision-making. RESULTS National coverage of MNCH services was low for all maternal and neonatal care, child immunisation, and child care indicators. However, results varied across states and counties. Central Equatoria State (CES), where the capital is located, showed the highest coverage for most indicators (e.g. ≥4 antenatal care visits range: 4.5% in Jonglei to 40.1% in CES). Urban counties often outperformed rural ones. CONCLUSIONS This adaptation of LQAS to South Sudan demonstrates how it can be used in the future as an M&E system to track progress of MDGs at national, state and county levels to detect local disparities. Overall, our data reveal a desperate need for improving MNCH service coverage in all states.
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Affiliation(s)
- Joseph J Valadez
- Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK
| | - Sima Berendes
- Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK
| | - Richard Lako
- Ministry of Health of the Republic of South Sudan, Directorate of Policy, Planning, Budgeting and Research, Juba, South Sudan
| | - Simon Gould
- Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK
| | - William Vargas
- Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK
| | - Susan Milner
- Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK
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