Surveillance on pediatric bacterial meningitis in Gondar University Hospital, Ethiopia from 2012 to 2021: Retrospective analysis

Introduction: Acute Bacterial meningitis is still a major cause of death in under-five children. Surveillance on Pediatric Bacterial Meningitis has been set up by the World Health Organization to generate data on vaccine preventable causes of Meningitis in under-five children. Ethiopia is one of the countries conducting the surveillance and Gondar University Hospital is one of the sentinel surveillance sites. In this study we described the epidemiological data on Bacterial meningitis in under-five children at Gondar University Hospital from 2012-2021. Methods: Data were extracted directly from Gondar University Hospital surveillance database collected from under-five children admitted to the Hospital with suspected meningitis from January 1st, 2012 to December 31st , 2021. Socio-demographic and clinical characteristics were collected using standard pretested questioners. All under-five children with suspected meningitis over the 10-years period were included and descriptive statistics like frequency, percentage, mean, median and standard deviations were used for the characteristics of under-five Children with Suspected Bacterial Meningitis. Results: In this study, a total of 4311 under-five admitted with suspected bacterial meningitis from 2012 to 2021 were enrolled. The majority, 71% of suspected meningitis were reported in infants. The mortality rate in suspected meningitis during the study period was 1%. The majority (92.4 %) had fever at presentation followed by seizure (62.7 %), altered consciousness (58.9 %) and bulged fontanel in 48.3 %, respectively. The commonest bacteria identified by CSF culture and Polymerase Chain Reaction was Streptococcus pneumonia (SPN). There was a reduction of confirmed meningitis cases from 2012 to 2021 (26 cases in 2012 and 6cases in 2021). Conclusions: Streptococcus pneumoniae was the commonest cause of PBM. Bacterial detection by culture was low which showed that Polymerase Chain Reaction (PCR) test should be encouraged to improve bacterial detection.

Prevalence and antimicrobial resistance profiles of Neisseria gonorrhea and Chlamydia trachomatis isolated from individuals attending STD clinics in Kampala, Uganda

Background: Sexually transmitted diseases (STDs) management in sub-Saharan Africa is syndromic but molecular diagnostics provide quicker, sensitive diagnosis and treatment. Effective STD control hinges on identification and treatment of infected persons and sexual partner contact tracing. Objectives: This study assessed feasibility of using the Xpert CT/NG test to identify prevalent Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) infections among STD clinic attendees and their sexual partners and tested for antimicrobial resistance for N. gonorrhea. Methods: A cross-sectional study was conducted at 4 outpatient STD clinics in Kampala, Uganda from February 2019 to October 2019. Participants received a syndromic diagnosis, were tested for NG and CT, as well as their sexual partners. Urine (men) and high vaginal swabs (women) were collected, examined using Xpert CT/NG assay. A total of 79 participants were enrolled at baseline of whom 25 had CT/NG. 21 partners of infected baseline participants and 7 partners of the 21 primary partners were enrolled. Results: The mean age of the reported sexual partners was 26 (18-43) years. The prevalence of NG was 25% at baseline and 18 % for CT. Nine (11.4%) people were dually infected. Men were more likely to have NG (p<0.001) at multivariable level. Two participants tested HIV-1 positive. On microbiological culture, 8 samples (2.5%) grew NG, and all were resistant to penicillin, ciprofloxacin. For CT, we found a preponderance of the F-serovar in this population. Conclusion: The most prevalent organism was Neisseria gonorrhea. Generally, the prevalence of CT and NG was high. Infection proportions increased among primary partners, particularly women. Etiologic testing without partner tracing and treatment may underestimate burden of CT/NG in this population and contribute to re-infection

An evaluation of the perinatal mortality surveillance system in Gwanda District, Matabeleland South Province, Zimbabwe

Background. A preliminary review of perinatal mortality surveillance data (January - August 2017) suggested an under-reporting of perinatal deaths in Gwanda District, Matabeleland South.Objective. To evaluate the effectiveness of the perinatal mortality surveillance system in Gwanda District, Matabeleland South, Zimbabwe.Methods. This descriptive cross-sectional study interviewed 50 healthcare workers employed in the district using pretested intervieweradministered questionnaires. The sample was drawn from 16 randomly selected healthcare facilities. Records for perinatal mortality cases were reviewed and data were analysed.Results. Only 32% of healthcare workers knew the case definition of perinatal death. Approximately two-thirds of participants (68%) knew who should complete notification forms and ~half (52%) of the respondents cited fear of blame as the reason for a low perinatal death report rate in the district. Although 50% of participants reporting having participated in perinatal death reviews and 78% reporting using the data for planning community health programmes, there was no recorded evidence in support. Perinatal mortality case notification forms were not in stock at 13 of the 16 sampled healthcare facilities.Conclusion. Poor knowledge of the perinatal mortality surveillance system was found among participants. The low reporting rate suggests that the system does not function effectively in the district. Healthcare workers feared blame, which suggests management intervention is required to create a trusted reporting environment

Evaluation of the influenza sentinel surveillance system in Madagascar, 2009­2014

Problem:Evaluation of influenza surveillance systems is poor, especially in Africa.ApproachIn 2007, the Institut Pasteur de Madagascar and the Malagasy Ministry of Public Health implemented a countrywide system for the prospective syndromic and virological surveillance of influenza-like illnesses. In assessing this system's performance, we identified gaps and ways to promote the best use of resources. We investigated acceptability, data quality, flexibility, representativeness, simplicity, stability, timeliness and usefulness and developed qualitative and/or quantitative indicators for each of these attributes.Local settingUntil 2007, the influenza surveillance system in Madagascar was only operational in Antananarivo and the observations made could not be extrapolated to the entire country.Relevant changes By 2014, the system covered 34 sentinel sites across the country. At 12 sites, nasopharyngeal and/or oropharyngeal samples were collected and tested for influenza virus. Between 2009 and 2014, 177718 fever cases were detected, 25 809 (14.5%) of these fever cases were classified as cases of influenza-like illness. Of the 9192 samples from patients with influenza-like illness that were tested for influenza viruses, 3573 (38.9%) tested positive. Data quality for all evaluated indicators was categorized as above 90% and the system also appeared to be strong in terms of its acceptability, simplicity and stability. However, sample collection needed improvement.Lessons learnt:The influenza surveillance system in Madagascar performed well and provided reliable and timely data for public health interventions. Given its flexibility and overall moderate cost, this system may become a useful platform for syndromic and laboratory-based surveillance in other low-resource settings

Active Surveillance of Hospital-Acquired Infections in South Africa: Implementation; Impact and Challenges

BACKGROUND:Hospital-acquired infections (HAIs) are a significant although unquantified burden in South Africa. Lack of adequate surveillance compounds this problem.OBJECTIVE:To report on the establishment and outcomes of a unit-specific surveillance system for hospital-acquired infections; based on international standards; in a private academic hospital. METHODS: Active unit-specific surveillance of device-associated infections (DAIs) was introduced over a 2-year period. The surveillance system was based on the US National Healthcare Safety Network (NHSN) utilising standardised definitions. Analysis of DAI rates and device utilisation was done according to Centers for Disease Control and Prevention methods. Comparative analysis using study-derived annualised data and existing NHSN data was done.RESULTS:Surveillance results of DAI rates showed significant reductions in intensive care unit-related ventilator-associated pneumonia (42%) and central line-associated bloodstream infections (100%) over a 3-year period. Substantial variations in DAI rates and utilisation ratios between wards highlight the importance of unit-specific surveillance.CONCLUSIONS:Active surveillance requires a significant investment in resources and is a sustained operational challenge; although equally significant benefits are derived from a better understanding of HAIs with more targeted interventions and efficient use of resources. A robust surveillance system is an essential component of any healthcare infection prevention and control programme and is a prerequisite to contextualising the HAI burden of hospitals

Surveillance for Diseases Targeted by new Vaccines: Progress; Challenges and Way Forward

Thirteen years ago; WHO-AFRO proposed the establishment of a sentinel disease surveillance network as part of efforts to improve surveillance for invasive bacterial diseases (IBD) including paediatric pneumonia and meningitis and rotavirus diarrhoea in all Member States as part of surveillance for vaccine-preventable diseases and in line with the regional strategy integrated disease surveillance and response (IDSR). This was prompted by the eminent availability of new and prospective vaccines against Haemophilus influenzae type b (Hib); Streptococcus pneumoniae (S. pneum); Neisseria meningitides (Nm) and rotavirus vaccines. The Regional Office for Africa developed guidelines and tools and standardized methodology; including cases definitions to be used to recruit eligible cases. This article outlines the challenges and results of this initiative to date and aims for the future

Community-Based Surveillance on Polio Eradication in the Horn of Africa

Community-based surveillance complements the existing surveillance systems in the mission to control and eradicate polioviruses. It is a cost effective method and has a number of benefits. It was introduced in Ethiopia in 2003 and in the South Sudan CORE Group Polio Project areas in 2010. As well as the results obtained from this initiative; the report looks at the challenges; lessons learned and suggests some ways to strengthen the programme

Immunization Monitoring and Vaccine-Preventable Diseases Surveillance Data Management in the African Region

Countries in the WHO African Regionhave well-established national immunization programmes and disease control programmes working towards the different goals for the control of vaccine-preventable diseases; and generating coverage and surveillance data. WHO provides technical support to standardize the approaches; methodology; and tools used for data management. The datasets are shared with WHO for purposes of monitoring the coverage and disease trends across the Region. This article reviews the methods WHO employs to build capacity in this field of data management across the Region and the resultant achievements and gaps. Despite the recent improvements in some aspects of data quality; important policy; technical and managerial gaps remain; which need to be addressed in order to ensure that the data coming out of these national programmes are of optimal quality

Cross-Border Initiative on Polio Eradication in the Horn of Africa

Community-based surveillance complements the existing surveillance systems in the mission to control and eradicate polioviruses. It is a cost effective method and has a number of benefits. It was introduced in Ethiopia in 2003 and in the South Sudan CORE Group Polio Project areas in 2010. As well as the results obtained from this initiative; the report looks at the challenges; lessons learned and suggests some ways to strengthen the programme

The National Stop Transmission of Polio (STOP) Programme in Uganda 2012-2014

In 2012 Uganda established a pool of national STOP (Stop Transmission of Polio) volunteers who assist subnational staff in strengthening surveillance - detection and reporting. In addition to surveillance activities; the volunteers have built capacity of operational health workers in basic skills for routine immunization. This article gives a brief overview of the initiative and the impressive achievements it is making

HIV Prevalence in South Sudan: Data from the ANC Sentinel Surveillance 2009

Data on the prevalence of HIV and syphilis was collected from 24 ante-natal care clinic (ANC) sentinel sites in all 10 states of South Sudan during the three months September to December 2009. The overall sample size was 6175 pregnant women; however; only 5913 samples were tested for HIV of which 176 (3) were positive. Interestingly; the age groups 15-24 years accounted for almost half (49.5) of the overall sample size of this ANC 2009 Survey distributed between the age group 15-19 years with 18.6of the overall sample and the age group 20-24 years accounting for 30.9of the total sample size. The prevalence of HIV was 2.3(n=25) in the 15-19 year age group and 3.3(n=59) in the 20-24 year age group. The prevalence of syphilis was 7.6(n=74) in the) in the 15-19 year age group and 9.6(n=183) in the 20-24 year age group. The HIV prevalence among the young women aged 15-24 years was 2.9compared to the overall HIV prevalence among all age groups of 3. Similarly the syphilis prevalence among 15-24 year old women was 28.4compared to the overall survey syphilis prevalence of 9.9. In conclusion; the post conflict ANC surveillance showed an HIV prevalence of 3and the experience had shed some light; proved and disregarded a wide range of assumptions with regards to HIV distribution in the country. Despite all challenges; the routine ANC surveillance system; in the context of South Sudan; is very promising in provision of timely relevant information and can be used to monitor the trend over time

Monitoring and evaluation of Integrated Disease Surveillance and Response in selected districts in Tanzania

Integrated Disease Surveillance and Response (IDSR) is a strategy developed by the World Health Organization. Regional Office for Africa in 1998. The Ministry of Health; Tanzania has adopted this strategy for strengthening communicable diseases surveillance in the country. In order to improve the effectiveness of the implementation of IDSRmonitoring and evaluating the performance of the surveillance system; identifying areas that require strengthening and taking action is important. This paper presents the findings of baseline data collection for the period October - December 2003 in 12 districts representing eight regions of Tanzania. The districts involved were Mbulu; Babati; odoma Rural; Mpwapwa; Igunga; Tabora Urban; Mwanza Urban; Muleba; Nkasi; Sumbawanga Rural; Tunduru and Masasi. Results are grouped into three key areas: surveillance reporting; use of surveillance data and management of the IDSR system. In general; reporting systems are weak; both in terms of receiving all reports from all acilities in a timely manner; and in managing those reports at the district level. Routine analysis of surveillance data is not being done at facility or district levels; and districts do not monitor the performance of their surveillance system. There was also good communication and coordination with other sectors in terms of sharing information and resources. It is important that districts' capacity on IDSR is strengthened to enable them monitor and evaluate their own performance using established indicators

Paludisme sur les Hautes Terres Centrales de Madagascar : strategies de lutte

Le present article presente le paludisme sur les Hautes Terres Centrales de Madagascar et les strategies pour ameliorer les composantes du programme national de lutte contre le paludisme. Pour la prise en charge du patient suspect d'acces palustre; l'utilisation des bandelettes de diagnostic rapide; la prise en charge precoce a domicile par la chloroquine pre-emballee et les reflexions sur les nouvelles combinaisons therapeutiques a base d'artemisinine sont discutees. Pour les mesures de prevention; l'alternance des pulverisations intra domiciliaires ciblees et generalisees dans la lutte antivectorielle; l' utilisation de moustiquaires impregnees d'insecticides; le passage au traitement preventif intermittent pour les groupes a risque; l'amelioration du systeme de surveillance et d'alerte epidemique par l'utilisation de la methode de Lot Quality Assurance Sampling pour l'investigation epidemiologique en cas de depassement du seuil d'alerte et la mise a disposition des bandelettes de diagnostic rapide sont etudies

Surveillance epidemiologique et virologique de la grippe a Antananarivo de 1995 a 2002

"Influenza epidemiologic and virologic surveillance in Antananarivo from 1995 to 2002"" : The ""Institut Pasteur de Madagascar"" virology laboratory is the National WHOCentre for Influenza surveillance in Madagascar. On this surveillance collaborate the Ministry of Health with 9 sentinel centres. In the present article; the authors relate the results of influenza surveillance in Antananarivo between 1995 and 2002. Among 6341 patients with nasal and/or pharyngeal swabs; influenza virus were isolated from 427 patients (6.7"