Lyme borreliosis (LB) caused by spirochetes of the Borrelia burgdorferi sensu lato complex is the most common tick-borne disease in the northern hemisphere. Data on the distribution and on risk ...factors in Germany are sketchy.
Blood samples of a nationwide population-based cross-sectional study from 2003-2006 in children and adolescents aged 1 to 17 years in Germany (KiGGS) were analysed (n = 12,614) to assess the seroprevalence of anti-Borrelia antibodies. Data from standardized interviews were used to assess potential risk factors. First, sera were screened for anti-Borrelia antibodies by ELISA. The overall prevalence was 4.8% (95% confidence interval (CI) 4.3-5.4%). Positive and borderline ELISA test results were confirmed by a line blot revealing a combined prevalence of 4.0% (95% CI 3.6-4.5%). Seroprevalence of ELISA was significantly higher in males (odds ratio (OR) = 1.37; CI 1.15-1.63) and in the southern part of Germany (OR = 1.41; CI 1.09-1.83), but significantly lower in children and adolescents with migration background (OR = 0.33; CI 0.24-0.44). Study participants from households with cats had a higher chance of seropositivity (OR = 6.7; CI 5.6-8.0). In a multivariable model the odds of seropositivity increases by 11% for every year of age for boys and 6% for girls.
This survey is the first nationwide, representative seroprevalence survey of LB in children and young adolescents. The study shows that infections with Borrelia burgdorferi are endemic in all parts of Germany despite regional differences. Even at a young age children are exposed to tick bites including seropositivity. Encouraging a thorough check for ticks and promptly removal of ticks are the key public health strategies to reduce the risk of LB and other tick-borne diseases in children and adolescents. Further epidemiological studies are warranted to better understand the burden of disease related to LB.
Close to 800 million people in the world are at risk of schistosomiasis, 85 per cent of whom live in Africa. Recent studies have indicated that female genital schistosomiasis might increase the risk ...of human immunodeficiency virus (HIV) infection. The aim of this study is to quantify and analyse the characteristics of the vasculature surrounding Schistosoma haematobium ova in the female genital mucosa.
Cervicovaginal biopsies with S. haematobium ova (n=20) and control biopsies (n=69) were stained with immunohistochemical blood vessel markers CD31 and von Willebrand Factor (vWF), which stain endothelial cells in capillary buds and established blood vessels respectively. Haematoxylin and eosin (HE) were applied for histopathological assessment. The tissue surrounding S. haematobium ova had a higher density of established blood vessels stained by vWF compared to healthy controls (p=0.017). Immunostain to CD31 identified significantly more granulation tissue surrounding viable compared to calcified ova (p=0.032), and a tendency to neovascularisation in the tissue surrounding viable ova compared to healthy cervical mucosa (p=0.052).
In this study female genital mucosa with S. haematobium ova was significantly more vascularised compared to healthy cervical tissue. Viable parasite ova were associated with granulation tissue rich in sprouting blood vessels. Although the findings of blood vessel proliferation in this study may be a step to better understand the implications of S. haematobium infection, further studies are needed to explore the biological, clinical and epidemiological features of female genital schistosomiasis and its possible influence on HIV susceptibility.
Schistosomiasis affects the reproductive health of women. Described sequelae are ectopic pregnancy, infertility, abortion, and cervical lesions and symptoms mimicking cervical cancer and STIs. There ...are indications that cervical schistosomiasis lesions could become co-factors for viral infection such as HIV and HPV.
In a retrospective descriptive histopathological study clinical specimens sent between 1999 and 2005 to the pathology department of a consultant hospital in Tanzania were reviewed to analyse the occurrence and features of schistosomiasis in female genital organs.
During the study period, schistosomiasis was histopathologically diagnosed in 423 specimens from different organs (0.7% of all specimens examined in the study period), out of those 40% were specimens from female and male organs. The specimens were sent from 24 hospitals in 13 regions of mainland Tanzania. Female genital schistosomiasis was diagnosed in 125 specimens from 111 patients. The main symptoms reported were bleeding disorders (48%), ulcer (17%), tumor (20%), lower abdominal pain (11%) and infertility (7%). The majority of cases with genital schistosomiasis were diagnosed in cervical tissue (71 cases). The confirmation of cervical cancer was specifically requested for 53 women, but the diagnosis could only be verified for 13 patients (25%), in 40 cases only severe cervical schistosomiasis was diagnosed. Vulval/labial schistosomiasis was seen in specimens from young women. Infertility was reported in four patients with schistosomiasis of the Fallopian tubes.
Genital schistosomiasis adds to the disease burden of women in all age groups. Pathological consequences due to the involvement of different genital organs can be damaging for the affected women. Clinical unawareness of genital schistosomiasis can lead to misdiagnosis and therefore false and ineffective therapy. In endemic areas cervical schistosomiasis should be considered as differential diagnosis of cancer.
Objective
Healthcare workers (HCWs) play pivotal roles in outbreak responses. Ebola virus disease (EVD) outbreak spread to Lagos, Nigeria, in July 2014, infecting 11 HCWs (case fatality rate of 45%). ...This study was conducted during the outbreak to assess HCWs' EVD‐related knowledge and practices.
Methods
A health facility‐based cross‐sectional study was conducted among HCWs across Lagos State using stratified sampling technique. An interviewer‐administered questionnaire was administered to elicit respondents' socio‐demographic characteristics, knowledge and practices. A checklist assessing health facility's level of preparedness and HCWs' EVD‐related training was employed. HCWs' knowledge and practices were scored and classified as either good or poor. Multivariate analysis was performed with confidence interval set at 95%.
Results
A total of 112 health facilities with 637 HCWs were recruited. Mean age of respondents was 40.1 ± 10.9 years. Overall, 72.5% had good knowledge; doctors knew most. However, only 4.6% of HCWs reported good practices. 16.6% reported having been trained in identifying suspected EVD patient(s); 12.2% had a triaging area for febrile patients in their facilities. Higher proportions of HCWs with good knowledge and training reported good practices. HCWs with EVD‐related training were three times more likely to adopt good practices.
Conclusion
Lagos State HCWs had good knowledge of EVD without a corresponding level of good practices. Training was a predictor of good practices.
Objectif
Les agents de la santé (AS) jouent un rôle essentiel dans les réponses aux épidémies. L’épidémie de la maladie du virus Ebola (MVE) s'est propagée à Lagos, au Nigeria, en juillet 2014, infectant 11 AS (taux de létalité de 45%). Cette étude a été menée au cours de l’épidémie pour évaluer les connaissances et les pratiques des AS liées à la MVE.
Méthodes
Une étude transversale basée sur les établissements de santé a été menée chez les AS dans l'Etat de Lagos, en utilisant la technique d’échantillonnage stratifié. Un questionnaire administré par un intervieweur a été appliqué pour obtenir les caractéristiques sociodémographiques, les connaissances et les pratiques des répondants. Une liste d’évaluation de l’état d'apprêtement de l’établissement de santé et de la formation des AS liée à la MVE a été employée. Les connaissances et les pratiques des AS ont été inscrites sur une échelle et classées comme bonnes ou mauvaises. L'analyse multivariée a été effectuée avec un intervalle de confiance fixé à 95%.
Résultats
Un total de 112 établissements de santé avec 637 AS ont été recrutés. L’âge moyen des répondants était de 40,1 ± 10,9 ans. Dans l'ensemble, 72,5% avaient une bonne connaissance; les médecins en savaient plus. Toutefois, seuls 4,6% des AS faisaient état de bonnes pratiques. 16,6% ont déclaré avoir été formés à l'identification des patients suspectés de la MVE; 12,2% disposaient dans leurs établissements d'une zone de triage pour les patients fébriles. Des proportions plus élevées d’AS ayant de bonnes connaissances et formations, rapportaient de bonnes pratiques. Les AS avec une formation liée à la MVE étaient trois fois plus susceptibles d'adopter de bonnes pratiques.
Conclusion
Les AS de l'Etat de Lagos avaient de bonnes connaissances sur la MVE sans avoir un niveau correspondant de bonnes pratiques. La formation était un prédicteur de bonnes pratiques.
Objetivo
Los trabajadores sanitarios (TS) juegan un papel primordial en las respuestas a los brotes epidémicos. Los primeros brotes de enfermedad por el virus del Ébola (EVE) aparecieron en Lagos, Nigeria, en Julio del 2014, infectando 11 TS (tasa de letalidad del 45%). Este estudio se realizó durante el brote, para evaluar los conocimientos y prácticas de los TS sobre la EVE.
Métodos
Se realizó un estudio croseccional en centros sanitarios y entre los TS, a lo largo del estado de Lagos, utilizando una técnica de muestreo estratificada. Un entrevistador administró un cuestionario sobre las características demográficas, conocimientos y prácticas del entrevistado. Mediante una lista de verificación se evaluó en nivel de preparación del centro de atención sanitaria y el entrenamiento recibido por los TS sobre la EVE. Los conocimientos y prácticas de los TS se puntuaron y clasificaron como “buenos” o “pobres”. Se realizó un análisis multivariado con intervalos de confianza del 95%.
Resultados
Se reclutaron 112 centros sanitarios con 637 TS. La edad media de quienes respondieron era de 40.1±10.9 años. En total, un 72.5% tenía un buen nivel de conocimientos; los médicos eran quienes más sabían. Sin embargo, solo un 4.6% de los TS reportaron buenas prácticas. Un 16.6% reportó haber sido entrenado en la identificación de pacientes con sospecha de EVE; un 12.2% tenía, en sus centros, un área de triaje para pacientes febriles. Una mayor proporción de TS con un buen nivel de conocimientos y entrenamiento reportó buenas prácticas. Los TS con entrenamiento sobre la EVE tenían tres veces más probabilidad de adoptar unas buenas prácticas.
Conclusión
Los trabajadores sanitarios del Estado de Lagos tenían un buen nivel de conocimientos sobre la EVE, sin un nivel correspondiente de buenas prácticas. El entrenamiento era un vaticinador de buenas prácticas.
Maternal mortality defined as deaths due to complications of pregnancy or childbirth remains a public health concern. Although statistics show a decline in maternal mortality ratio from 380 deaths to ...210 deaths per 100,000 live births from1990 to 2013, in Sub-Saharan Africa, maternal mortality rates remain unacceptably high. Maternal mortality In Nigeria is currently 560/100,000 live births. This study was conducted to identify the associated risk factors and perceptions of adverse pregnancy outcomes among reproductive age women in Soba local government area (LGA).
A 1:1 unmatched case control study with 138 respondents was used. Cases were women aged 15-49 years with a history of adverse pregnancy outcome. Controls: 15-49 years without a history of adverse outcomes. Adverse outcomes were: pregnancy induced hypertension and spontaneous abortions. Anthropometric measurements and blood pressure were taken. Six focus group discussions (FGDs) with grandmothers, mothers and teenagers were used to explore perceptions. Quantitative data was analyzed using Epi-info version 3.5.3. Qualitative data analyzed by thematic approach.
The median age of cases was: 25 years (Range: 16-44years), Median age of controls: 27 years (Range: 16-43years). Commencement of Antenatal care (ANC) attendance <4months (adjusted odds ratio (AOR): 0.32; 95% CI: 0.12-0.81) and Number of pregnancies ≥4 (AOR: 5.02; 95% CI: 1.97-12.82) were found to be associated with adverse outcomes.
Risk factors associated with outcomes are multiple pregnancies and delayed commencement of antenatal care. There was poor perception of adverse pregnancy outcomes. We recommended frequent community health talks, early commencement of antenatal and Utilization of Family planning services.
The first ever outbreak of Ebola virus disease (EVD) in Nigeria was declared in July, 2014. Level of public knowledge, perception and adequacy of information on EVD were unknown. We assessed the ...public preparedness level to adopt disease preventive behavior which is premised on appropriate knowledge, perception and adequate information.
We enrolled 5,322 respondents in a community-based cross-sectional study. We used interviewer-administered questionnaire to collect data on socio-demographic characteristics, EVD-related knowledge, perception and source of information. We performed univariate and bivariate data analysis using Epi-Info software setting p-value of 0.05 as cut-off for statistical significance.
Mean age of respondents was 34 years (± 11.4 years), 52.3% were males. Forty one percent possessed satisfactory general knowledge; 44% and 43.1% possessed satisfactory knowledge on mode of spread and preventive measures, respectively. Residing in EVD cases districts, male respondents and possessing at least secondary education were positively associated with satisfactory general knowledge (p-value: 0.01, 0.001 and 0.000004, respectively). Seventy one percent perceived EVD as a public health problem while 61% believed they cannot contract the disease. Sixty two percent and 64% of respondents will not shake hands and hug a successfully treated EVD patient respectively. Only 2.2% of respondents practice good hand-washing practice. Television (68.8%) and radio (55.0%) are the most common sources of information on EVD.
Gaps in EVD-related knowledge and perception exist. Targeted public health messages to raise knowledge level, correct misconception and discourage stigmatization should be widely disseminated, with television and radio as media of choice.
Objective: Leprosy is a chronic, infectious disease complicated with blindness and loss of fingers/toes in some cases. Though the disease is targeted for eradication in Nigeria, the country had the ...6th highest prevalence globally in 2013. This study was conducted to evaluate the leprosy surveillance system in Kwara State, assessing its operations, attributes and determining its usefulness. Method: The 2001 updated guidelines for evaluating public health systems of Centers for Disease Control and Prevention was used. Key informant interviews were done with the State Tuberculosis and Leprosy (TBL) Control Officer, and the State Epidemiologists to assess the importance of the public health, purpose and operation of the surveillance system, resources used to operate it as well as the attributes of the system. Questionnaires were administered to Local Government Area TBL supervisors to assess the attributes of the surveillance system. Surveillance data from 2010 to 2014 was analyzed and data quality determined. Results: Incidence of leprosy over the five year period 2010 - 2014 was 62.0%, 59.0%, 54.0%, 67.0%, and 42.0% respectively, with occurrence of the multi-bacillary type in 83.1% to 90.7% newly detected cases. The system was found to be 51.0% sensitive(most hospitals do not have treatment forms for health workers use, community awareness programmes was done in 53.0% of local government areas in last 3 months, contact tracing was however always done), 90.0% simple, 93.0% acceptable and 95.0% timely. Data system was both paper and electronics, based on collection, collation, analysis and reporting done quarterly in a year. The surveillance system is donor-driven and fully integrated with that of tuberculosis and buruli ulcer. Annual surveillance expenditure was about $2 500. Conclusion: Kwara State Leprosy Surveillance System has a low sensitivity with delayed case detection. Training of health workers on early case detection, provision of treatment forms and more community awareness will improve the surveillance system's sensitivity.
Clinical schistosomiasis in endemic countries is treated with a single dose of praziquantel per 40 mg/kg body weight. Treating according to weight, in resource-poor settings when thousands of doses ...are to be administered in mass treatment campaigns, is considered problematic. A calibrated dose-pole based on height was developed and is now used in mass treatment campaigns for determining the doses for schoolchildren. The dose-pole will generate dose errors since every child population contains individuals that are either short or tall for weight. The aim of this study is to explore whether the WHO praziquantel pole is a satisfactory dose instrument for mass treatment of S. haematobium.
In 1996 and 2002, 1,694 children were surveyed in the Kilimanjaro Region, Tanzania. We compared doses given by weight to doses given by height using descriptive statistics and regression.
The WHO dose-pole for praziquantel is based on height of the patient; however, children with the same height will differ in weight. Our study shows that children with the same weight could qualify for up to four different dose levels based on their height. The largest variation of doses based on the WHO dose-pole will be found in children below 20 kg of bodyweight. Using bodyweight and tablet halves as the smallest tablet division unit to determine the doses of praziquantel, one only has to identify every 6th kilogram of bodyweight; the doses will then vary a lot less than when using the WHO dose-pole.
The first imported case of pandemic influenza (H1N1) 2009 in Germany was confirmed in April 2009. However, the first wave with measurable burden of disease started only in October 2009. The basic ...epidemiological and clinical characteristics of the pandemic were analysed in order to understand the course of the pandemic in Germany.
The analysis was based on data from the case-based, mandatory German surveillance system for infectious diseases. Cases notified between 27 April and 11 November 2009 and fulfilling the case definition were included in the study.
Two time periods with distinct epidemiologic characteristics could be determined: 23,789 cases (44.1%) occurred during the initiation period (IP, week 18 to 41), and 30,179 (55.9%) during the acceleration period (AP, week 42 to 45). During IP, coinciding with school summer holidays, 61.1% of cases were travel-related and one death occurred. Strict containment efforts were performed until week 32. During AP the majority of cases (94.3%) was autochthonous, 12 deaths were reported. The main affected age group shifted from 15 to 19 years in IP to 10 to 14 years in AP (median age 19 versus 15 years; p < 0.001). The proportion of cases with underlying medical conditions increased from 4.7% to 6.9% (p < 0.001). Irrespective of the period, these cases were more likely to be hospitalised (OR = 3.6 95% CI: 3.1; 4.3) and to develop pneumonia (OR = 8.1 95% CI: 6.1; 10.7). Furthermore, young children (0 to 2 years) (OR = 2.8 95% CI: 1.5; 5.2) and persons with influenza-like illness (ILI, OR = 1.4 95% CI: 1.0; 2.1) had a higher risk to develop pneumonia compared to other age groups and individuals without ILI.
The epidemiological differences we could show between summer and autumn 2009 might have been influenced by the school summer holidays and containment efforts. The spread of disease did not result in change of risk groups or severity. Our results show that analyses of case-based information can advise future public health measures.
The development of an educational concept of a training programme for infection prevention and control (IPC) was seen as a key issue to successfully address the complexity of change processes of ...professional IPC routines in clinical procedures. Therefore, the Nigeria Centre for Disease Control (NCDC), Nigeria, and the Robert Koch Institute (RKI), Germany established an interdisciplinary project framework, involving knowledge and competences from different disciplines and professions like health professionals, epidemiologists and educators (MAURICE project). A multi-module training programme for health care workers to improve IPC standards was developed and implemented based on the participatory approach and a systemic view for organizational change.The development of an educational concept of a training programme for infection prevention and control (IPC) was seen as a key issue to successfully address the complexity of change processes of professional IPC routines in clinical procedures. Therefore, the Nigeria Centre for Disease Control (NCDC), Nigeria, and the Robert Koch Institute (RKI), Germany established an interdisciplinary project framework, involving knowledge and competences from different disciplines and professions like health professionals, epidemiologists and educators (MAURICE project). A multi-module training programme for health care workers to improve IPC standards was developed and implemented based on the participatory approach and a systemic view for organizational change.
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