Population Enumeration and Household Utilization Survey Methods in the Enterics for Global Health (EFGH): Shigella Surveillance Study

Background

Accurate estimation of diarrhea incidence from facility-based surveillance requires estimating the population at risk and accounting for case patients who do not seek care. The Enterics for Global Health (EFGH) Shigella surveillance study will characterize population denominators and healthcare-seeking behavior proportions to calculate incidence rates of Shigella diarrhea in children aged 6-35 months across 7 sites in Africa, Asia, and Latin America.

Methods

The Enterics for Global Health (EFGH) Shigella surveillance study will use a hybrid surveillance design, supplementing facility-based surveillance with population-based surveys to estimate population size and the proportion of children with diarrhea brought for care at EFGH health facilities. Continuous data collection over a 24 month period captures seasonality and ensures representative sampling of the population at risk during the period of facility-based enrollments. Study catchment areas are broken into randomized clusters, each sized to be feasibly enumerated by individual field teams.

Conclusions

The methods presented herein aim to minimize the challenges associated with hybrid surveillance, such as poor parity between survey area coverage and facility coverage, population fluctuations, seasonal variability, and adjustments to care-seeking behavior.

The Enterics for Global Health (EFGH) Shigella Surveillance Study in The Gambia

Background

The Gambia, located in West Africa, is one of 7 country sites conducting the Enterics for Global Health (EFGH) Shigella Surveillance Study to establish incidence and consequence of Shigella-associated medically attended diarrhea among children 6-35 months old.

Methods

Here we describe the study site and research experience, sociodemographic characteristics of the study catchment area, facilities of recruitment for diarrhea case surveillance, and known care-seeking behavior for diarrheal illness. We also describe The Gambia's healthcare system and financing, current vaccine schedule and Shigella vaccine adaptation, local diarrhea management guidelines and challenges, and antibiotic resistance patterns in the region.

Conclusions

The EFGH study in The Gambia will contribute to the multisite network of Shigella surveillance study and prepare the site for future vaccine trials. In addition, the data produced will inform policy makers about prevention strategies and upcoming Shigella vaccine studies among children in this setting.

[Undesirable Events During Anesthesia For Programmed Digestive Surgery]

OBJECTIVES

to study the morbidity operative peri in digestive surgery.

PATIENT AND METHOD

It was about a prospective and descriptive survey in the services of digestive surgery and anesthesia resuscitation from February to August 2014. The population of survey was constituted of the whole patients having benefitted an anesthesia for programmed digestive surgery. The statistical test used for the comparison of the qualitative variables was CHI2 with p <0,05 considered meaningful.

RESULTS

during the period 125 files have been collected. The patients having presented at least an undesirable event were of 86 either 68,8%. These events had occurred in 77.9% of cases during the interview. The middle age was of 47.46±15, 68years with extremes of 18years. and 85 years. Sex ratio was of 1, 55. Patients were classified ASA I in 83.2%. The predominant operative indication was the gastric tumor in 26.4 % of the cases. General anesthesia was practiced in 82.4% of the cases. Anesthesia were achieved in 55.2% of the cases by male nurses' anesthetists and 44,8% by the students in diploma of studies specials(DES).Main recovered undesirable events were of cardiovascular, respiratory and digestive nature (nausea and vomiting). Intervening of the undesirable events was bound to the technique of anesthesia, Anesthetic time length of intervention, used narcotic and to the antecedents of the patients with p <0, 05.

CONCLUSION

Factors of avoidable operative morbidity peri are nearly present in all our acts for digestive surgery. The formation of the staff and the setting to disposition of products better tolerated will permit to reduce these factors.

[Variability of skin test on both tuberculosis and co infected patients with HIV under tuberculosis treatment]

To evaluate the variability of tuberculin skin test (TST), we did a prospective study in the pneumology unit of the teaching hospital at Point G and in the tuberculosis unit of the health district II at Bamako, Mali TST was applied two times to every patient more than 18 years old: at the beginning before the tuberculosis treatment (tst1) and after 2 months (tst2). For all 113 patients followed in both units, 41 were enrolled in this study (36, 2%). The mean age of patients was 37.9 years and 73.2% were male.(sex proportion was 2.72 for male). The different forms of Tuberculosis were: 63.4% of tuberculosis with smear positive(TSP); 7.3% of tuberculosis with smear negative(TSN); and 29,3% of disseminated tuberculosis. 22% of the patients were HIV positive. The tst1 was positive for 58.5% of the patients(11.11% of the HIV positive patients and 78.13% of the HIV negative). The diameter of indurations of the TST increased considerably during the treatment mainly with patients infected by HIV. The TST test can be an indicator of follow op for these patients who had less AFB most of time?

[Knowledge of the Bamako general population of tuberculosis]

The hope of the World Health Organization (WHO) in the fight against tuberculosis rests today on the implementation of the strategy DOTS. The success of this strategy passes obligatorily by an implication of the parents, neighbors in one word of the population living with the patient; this is why we fixed our objective to study knowledge on the tuberculosis of the people of more than 18 years of the district of Bamako. We carried out a cross-sectional study supplemented by focus-groups in 3 districts of Bamako near the general population (socio-medical personnel, old tuberculous, and helping natural) for the period from the 1st of June to July 15, 2004. Our sample was composed of 246 people for the individual questionnaires and of 47 per 8 meetings of focus group: the sex ratio was 2,5 in favour of the men and 60,2% of our subjects had less than 30 years. In the general population of Bamako 24,8% had a good knowledge, 49,0% an average knowledge and 26,2% a bad knowledge. 48,8 % of those which had a good knowledge were the pupils, students and civils servant. So in general the population had a good knowledge on symptomatology (90,2 %), it on the other hand had the knowledge very limited on the etiology (only 10,6% of the subject knew that tuberculosis is caused by a mycobactery) or on the modes of transmission (cigarettes, soap, meat). The population of Bamako has a very passable level of knowledge on tuberculosis. If this level is good with regard to symptomatology, it is very insufficient on the etiology or on the transmission of the disease. To improve this knowledge one needs a sensitizing supported for television and the radio in the dialects and national languages.

Male circumcision and HIV in the Malian military

In the goal of determine the impact of circumcision in transmission of HIV in military area. A retrospective study has been carried out from January 2000 to December 2005 at the infirmary of Genie military garrison about all HIV positive serology registered in that structure. It was a study of circumcised militaries and uncircumcised militaries as control group. Among 1183 militaries, 1102 were men (93.2%). Among these 1102, 57 were HIV positive (5.1%). Among 1102 military, 154 were uncircumcised and among them 20 were HIV positive (12.9 %). Among 948 of circumcised militaries 37 were HIV positive (3.9%). Circumcision reduces the risk of infection by HIV; however it has to be considered as supplement among other prevention methods.

[Extension of cervix cancer screening by visual methods to the community health centres in the district of Bamako]

Cervix cancer remains a public health problem in developing countries. These results are an assessment for multicentric study based on visual inspection of the cervix after application of acetiq acid (VIA) and lugol's iodine (VILI). The aim of this study is to determine the feasibility and the impact of this screening in the community health centres "CSCOM" in the district of Bamako. It was a prospective and multicentric study through 8 CSCOM, 3 Reference Centres "CSRéf", Hôpital Gabriel Touré (HGT) and National Institute of Public Health (INRSP) in Bamako. During 28 months, 5016 women aged through 25-49 years were screened. After their consent and questionnaire filling, the patient is comfortably settled for visual test. The repartition of screened patients by health level is: CSCOM (19.24% : 965/5016), CSRéf (48.64% : 2440/5016), HGT (32.12% : 1611/5016). In general, the positivity of tests was: 5.2% (VIA) and 6.8% (VILI). The positive women at the CSCOM level were oriented to the CSRéf or the HGT for the colposcopy, possible biopsy or care. At all 177 biopsies were done, and histological diagnosis were: 67 dysplasias, 3 early invasive carcinomas, 69 invasive carcinomas and 38 inflammatory metaplasic lesions or nonconclusives aspects. Patients with dysplasias or cancers were treated by cryotherapy, loop electrosurgical excision procedure (LEEP), cold-knife conization or surgery. This study showed that screening of cervical cancer by visual inspection is workable at CSCOM level. We wish a large diffusion of the method to the whole of the country.

[HIV/AIDS impact in pulmonary tuberculosis with negative microscopy in pneumology service at Point "G" hospital]

This study was opened and conducted from colligated patient folders during 5 years (from January 1999 to December 2003). The main objective was the description of epidemiological, diagnostically and prise and prise of charge aspects of microscopy negative pulmonary tuberculosis. Patients were enrolled in this study in accordance to WHO criteria. During these 5 years, pulmonary tuberculosis has constituted 72.2% on all froms of tuberculosis with 20.2% of microscopy negative pulmonary tuberculosis. The BCG vaccine scar has been observed in 50.8% of cases. The IDR was negative in 21.3% of cases; this rate was about 68.1% in HIV positive patients. More than 60% of the patients have more than 3 negative bacilloscopy. The 69.4% of our patients have been hospitalized and 64% have been treated with III category system.

Implementation of asthma guidelines in health centres of several developing countries

SETTING

Nine selected out-patient clinics caring for asthma patients in Algeria, Guinea, Ivory Coast, Kenya, Mali, Morocco, Syria, Turkey and Vietnam.

DESIGN

Prospective enrolment of consecutive patients considered by the practitioner to have asthma with evaluation of adherence of the practitioner with recommended standard case management, including proportion of patients confirmed to have asthma, proportion in whom severity was correctly graded and proportion in whom treatment with inhaled corticosteroids corresponded to severity grade.

RESULTS

Of 499 consecutive patients, 456 (91%) were enrolled and evaluated. The diagnosis was confirmed in 263 (58%). Agreement between the practitioner and the guidelines in assigning grade of severity was moderate overall (kappa = 0.42). It was higher for assignment of grade using symptoms (K = 0.51), but poor for assignment of grade using peak expiratory flow (PEF) rate (kappa = 0.29), with practitioners tending to underestimate the severity. Agreement between the practitioners' assessment of severity and treatment with inhaled corticosteroids was poor (kappa = 0.18), with underutilisation of inhaled corticosteroids.

CONCLUSIONS

Practitioners caring for asthma patients in this study tended to underutilise the PEF rate in assessing their patients and underutilised treatment of patients with inhaled corticosteroids.

Trilacunary Heteropolytungstates Functionalized by Organometallic Ruthenium(II), [(RuC6H6)2XW9O34]6- (X = Si, Ge)

The benzene-Ru(II)-supported trilacunary heteropolytungstates [(RuC6H6)2XW9O34]6- (X = Si, 1; Ge, 2) have been synthesized and characterized by multinuclear solution NMR (183W, 13C, 1H, 29Si), UV-vis and IR spectroscopy, electrochemistry, and elemental analysis. Single-crystal X-ray analysis was carried out on Rb2Na4[(RuC6H6)2SiW9O34].21H2O (RbNa-1), which crystallizes in the triclinic system, space group P, with a = 11.9415(2) A, b = 13.3123(2) A, c = 19.4927(4) A, alpha = 96.6460(10) degrees , beta = 95.1570(10) degrees , gamma = 98.2560(10) degrees , and Z = 2 and on Cs2Na4[(RuC6H6)2GeW9O34].19.5H2O (CsNa-2), which crystallizes also in the triclinic system, space group P, with a = 11.930(4) A, b = 13.353(4) A, c = 19.586(6) A, alpha = 95.982(5) degrees , beta = 95.414(6) degrees , gamma = 98.142(5) degrees , and Z = 2. The novel polyanion structure consists of two (RuC6H6) units linked to a trilacunary (XW9O34) Keggin fragment via Ru-O(W) and Ru-O(X) bonds resulting in an assembly with Cs symmetry. Polyanions 1 and 2 were synthesized by reaction of [RuC6H6Cl2]2 with [A-alpha-XW9O34]10- in aqueous buffer medium (pH 6.0). Both 1 and 2 are stable in solution as indicated by the expected 5-line pattern (2:1:2:2:2) in the 183W NMR and the expected (3C, 1H, and 29Si spectra. Descriptions of the respective electrochemical behaviors of the W centers and the Ru centers in 1 and 2 are given in media where these processes are clearly defined. In a pH = 3 acetate medium, the cyclic voltammetry of the W centers shows the known fingerprint of the trilacunary alpha-[XW9O34]n- (X = Ge, Si) moieties. The presence of the (RuC6H6) substituents imparts a good stability to these fragments in solution. Stepwise oxidation of the Ru centers was suspected in pH = 5 acetate medium, but only the first step was well-separated from a large current composite wave. The stepwise oxidation was finally observed clearly in a DMF-water (90/10 v/v) mixture and shows two well-behaved Ru oxidation processes. A short comparison is made with DMSO-bearing Ru polyoxometalates.

Affordability of inhaled corticosteroids as a potential barrier to treatment of asthma in some developing countries

SETTING

The cost and availability of the medications required for the treatment of asthma may represent potential barriers to effective management.

METHOD

A survey of prices and policies for components of asthma treatment in 1998, in Algeria, Burkina Faso, Ivory Coast, Guinea, Mali, Syria, Turkey and Vietnam.

RESULTS

Medications were consistently available in only four of the eight countries studied. The cost of essential medications for standard case management varied by over five times for beclomethasone and by over three times for inhaled salbutamol. In all but two countries, the cost of one year of drugs for treatment of a moderate, persistent case exceeded the monthly salary of a nurse in that country. The essential drugs list included inhaled salbutamol in five of eight countries and beclomethasone in three of eight. The costs of medications were lower where generic preparations were available and, to a lesser extent, where the medications are on the essential drugs list.

CONCLUSIONS

The cost and availability of medications vary widely, and may represent an important barrier to effective management in some low and middle income countries.

Electrochemical and esr spin trap studies of a new iron tetra-catecholamide complex

A new siderophore, N5,N6-thiodipropanoyl-bis[N1,N10-bis(2,3-dihydroxy benzoyl-spermidine)]-Fe (III) complex or H2LFe has been synthesised. The reaction of the reduced form of this complex with dioxygen has been investigated through electrochemical study and revealed the formation of a new species assumed to be H2O2. This species has been confirmed by esr spectroscopy using the diamagnetic compound 5-deutero-2,2,5-trimethylpyrrolidine-1-hydroxyl as spin trap. The resulting persistent radical is 5-deutero-2,2,5-trimethylpyrrolidine-1-yloxy (aN = 16.58 G, aD = 3.49 G).

Synthesis and electrochemical studies of a new iron tetra-catecholamide complex

A new tetra-catecholamide compound N5,N6-thiodipropanoyl-bis[N1,N10-bis(2,3-dihydroxybenzoyl-spermidi ne)] (H8L) has been synthesised as an iron chelator of Fe (III). Cyclic voltammogram of the iron complex H2LFe run under an argon atmosphere shows a quasi-reversible redox process with E0 = -430 mV vs. SCE in CH3OH/H20 (60/40). This value approaches the range of biological reductants and consequently the complex may mimic the release of iron from enterobactin to the agents which are directly involved in cell metabolism.

[Cardiac tolerance of a beta 2-sympathomimetic spray in 37 asthmatic adults monitored by Holter recording]

Thirty-seven asthmatic adults (27 women, 10 men), aged 28 to 70 yrs (mean 50. yrs), in a stable condition, were studied to assess the cardiac tolerance of B2SM sprays. These patients had no cardiac arrhythmia (checked by echocardiography), no hypertension and no hyperthyroidism. Two thirds had severe asthma, and 16 suffered from chronic asthma. After their condition was stabilized, they continued their previous treatment, consisting of theophylline (34 cases), moderate corticotherapy (19 cases), atropine spray (14 cases). Holter monitoring was performed before and 3 days after the institution of treatment by Fenoterol spray at 1,600 micrograms per day in 4 doses at fixed times. Gasometry was tested immediately before and during the protocol. Before B2SM treatment, 26 patients had a normal Holter, 11 had an abnormal first recording (4 important atrial ectopic beats (EBs), 5 ventricular EBs, 1 associating the two), 1 patient had an episode of ventricular tachycardia (VT). With Fenoterol, we observed (with no clinical manifestation) the aggravation of 1 pre-existing atrial EBs and 2 ventricular EBs. Two patients had a short episode of tachycardia but the role of Fenoterol was uncertain: one case was an elderly hypoxaemic patient and in the second a high theophylline level (20 mg/l) was found. The arrhythmogenic property peculiar to B2SM in spray form seems low at the dose we used. However in this study and in certain circumstances, such as hypoxemia, metabolic acidosis, or theophylline overload, the use B2SM may have contributed, together with other factors, to induce disquieting infraclinical cardiac dysrhythmia. We stress that this short-term study involved stable asthmatic patients under surveillance in hospital conditions.(ABSTRACT TRUNCATED AT 250 WORDS)