Association between multivitamin supplementation and mortality among patients with Ebola virus disease: an international multisite cohort study

Introduction: Micronutrient supplementation is recommended in Ebola Virus Disease (EVD) care; however, there is limited data on its therapeutic effects. Methods: This retrospective cohort study included patients with EVD admitted to five Ebola Treatment Units (ETU) in Sierra Leone and Liberia during September 2014 to December 2015. A uniform protocol was used to guide ETU care, however, due to supply limitations, only a subset of patients received multivitamins. Data on demographics, clinical characteristics, and laboratory testing was collected. The outcome of interest was facility based mortality and the primary predictor was multivitamin supplementation initiated within 48 h of admission. The multivitamin formulations included: thiamine, riboflavin, niacin and vitamins A, C, and D3. Propensity score models (PSM) were used to match patients based on covariates associated with multivitamin administration and mortality. Mortality between cases treated and untreated within 48 h of admission were compared using generalized estimating equations to calculate relative risk with bootstrap methods employed to assess statistical significance. Results: There were 424 patients with EVD who had sufficient treatment data for analysis, of which 261 (61.6%) had daily multivitamins initiated within 48 h of admission. The mean age of the cohort was 30.5 years and 59.4% were female. In the propensity score matched analysis, mortality was 53.5% among patients receiving multivitamins and 66.2% among patients not receiving multivitamins, resulting in a relative risk for mortality of 0.81 (p=0.03) for patients receiving multivitamins. Conclusion: Early multivitamin supplementation was associated with lower overall mortality. Further research on the impact of micronutrient supplementation in EVD is warranted

Maxillofacial injuries sustained during military peace keeping mission in Liberia: The Nigerian Experience (1990-1997)

Objective: Armed conflicts often cause maxillofacial injuries that could be challenging to manage. These injuries are often disproportionate to the relationship between the maxillofacial region and the entire body. Between 1990 and 1997, Nigerian soldiers were involved in military operations during the Liberian Civil War as part of a subregional intervention force. The aim of this paper is to review some characteristics of the maxillofacial injuries sustained by Nigerian soldiers as seen at a tertiary referral hospital with a view to drawing lessons for future management of maxillofacial and other casualties in the West African subregion. Methods: Retrospective review of hospital records of patients evacuated from Liberia from 1991 to 1997 was undertaken. Data was collected on demographics, sites of injuries, treatment received and discharge details. Results: Sixty one patients were seen, all males, between age 21-53years, most (57.4%) were between 21-29years of age. There were more soft tissue and dentoalveolar injuries (60.6%) than facial bone fractures (39.4%). Soft tissue injuries were debrided with secondary suturing while most fractures were treated by closed reduction and immobilisation. Most patients (98.4%) were successfully treated while one patient died. Conclusion: Maxillofacial injuries sustained during the conflict were mostly of soft tissues and most were treated successfully, This study showed the need for the deployment of maxillofacial trauma registries during armed conflicts for proper documentation victims and for maxillofacial surgeons to be included in combat surgical teams to ensure prompt and adequate treatment of patients closer to the point of wounding

Pattern of limb amputations in Liberia

Background: Amputation is one of the oldest known surgical procedures. It has been one of the modalities of applying judgment and treatment. Its method and indications has evolved over time. Modern amputation is regarded as a part of treatment rather than failure of treatment. Amputation is the removal of a limb or part of a limb through on or more bone. When through a joint is referred to as disarticulation. Data on the profile and pattern of amputation in Liberia will add to the body of knowledge. Aim and Objectives: Is to describe the pattern of limb of amputations in Liberia. Also to describe the anatomical variations of limb amputations in Liberia. Patients and Method: A retrospective study of all patients that underwent limb amputation surgeries in the John F Kennedy Memorial (JFK M), Hospital , Monrovia Liberia between January 2010 to December 2015. Results: 100 patients had limb amputations between 2010 and 2015. Males(73) to female(27) ratio were 2.4:1. The age range was 9 - 91 years. Mean age was 42.9 years. The indications for amputations were Trauma 24%, Diabetes 29%, Gangrene (6%), Chronic ulcer (25%), Tumour (5%). Below knee(47%), Above Knee(45%), Below elbow(2%), Above Elbow(2%), Knee Disarticulation(2%), and Big Toe Disarticulation(2%). Conclusion: The profile of Limb amputation in Liberia is not very different from what is obtaining in the region. However the limitations of histology and other investigative procedure have affected the accurate diagnosis of certain conditions like tumours

Strengthening healthcare workforce capacity during and post Ebola outbreaks in Liberia : an innovative and effective approach to epidemic preparedness and response

Introduction: the 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017.Methods: data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained.Results: the ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events.Conclusion: no infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings

Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017

Introduction: measles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia.Methods: we conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017.Results: from January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown.Conclusion: revitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible

Rapid response to meningococcal disease cluster in Foya district, Lofa County, Liberia January to February 2018

Introduction: early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods: the county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis.Results: sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered.Conclusion: this cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis

Surgical outcomes for perforated peptic ulcer: a prospective case series at an academic hospital in Monrovia, Liberia

Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant; and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes.Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia; Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality.Results Median age was 33 years and 85 were males. A majority of the patients (70) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5 days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35. Median length of stay among survivors was 16 days; and death occurred at median 1 day after admission. Long symptom duration and age 30 years of age were significantly associated with in-hospital mortality on univariate (? = 2.60 [0.18-5.03]; p = 0.035) and multivariate testing (? = 2.95 [0.02-5.88]; p =0.049). Conclusion Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series; surgical treatment for perforated peptic ulcer disease carried a high mortality; and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries

Factors associated with unmet need for modern contraception in post-conflict Liberia

We examined the association between intimate partner violence and unmet need for modern contraception in post-conflict Liberia. This is a secondary analysis of data collected using the Priorities for Local AIDS Control Efforts (PLACE) method. Data from 499 sexually experienced young women (aged 14-25) in Montserrado County, Liberia were examined. Intimate partner violence (55.7%), unintended pregnancy (83.2%), and abortion (45.3%) were pervasive in the study population. An estimated 35.9% of respondents had an unmet need for modern contraception. However, multivariate logistic regression results did not reveal an association between intimate partner violence and unmet need (OR 1.11; 95% CI 0.70-1.75). Among covariates examined, only contraceptive use at sexual debut (26.1%) was significantly associated with unmet need (OR 0.27; 95% CI 0.14-0.52). Liberian youth need information about and access to modern contraceptive methods besides condoms. Interventions to identify and treat victims of violence are also needed. Afr J Reprod Health 2014; 18[2]: 58-67)

Availability of essential health services in post-conflict Liberia

Objective:To assess the availability of essential health services in northern Liberia in 2008; five years after the end of the civil war. Methods We carried out a population-based household survey in rural Nimba county and a health facility survey in clinics and hospitals nearest to study villages. We evaluated access to facilities that provide index essential services: artemisinin combination therapy for malaria; integrated management of childhood illness; human immunodeficiency virus (HIV) counselling and testing; basic emergency obstetric care and treatment of mental illness. Findings Data were obtained from 1405 individuals (98response rate) selected with a three-stage population- representative sampling method; and from 43 of Nimba county's 49 health facilities selected because of proximity to the study villages. Respondents travelled an average of 136 minutes to reach a health facility. All respondents could access malaria treatment at the nearest facility and 55.9could access HIV testing. Only 26.8; 14.5; and 12.1could access emergency obstetric care; integrated management of child illness and mental health services; respectively. Conclusion Although there has been progress in providing basic services; rural Liberians still have limited access to life-saving health care. The reasons for the disparities in the services available to the population are technical and political. More frequently available services (HIV testing; malaria treatment) were less complex to implement and represented diseases favoured by bilateral and multilateral health sector donors. Systematic investments in the health system are required to ensure that health services respond to current and future health priorities

Prevalence of Intestinal Helminthes among Children in Selected Communities in Monrovia; Liberia

The present study was carried out among children below 15 years in 10 communities in Monrovia. Out of the 646 children recruited in the study; 216 (33.4) were positive for at least one intestinal helminth parasite. Children between 11 - 15 years had the highest prevalence of intestinal helminthes. Ascaris lumbricoides was the most common intestinal helminth parasite encountered (79.6); followed by Trichuris trichura (19.0). Strongyloides stercoralis and Enterobius vermicularis were the least prevalent helminth parasites encountered among the study population (1each). The population in these communities depended largely on poorly built latrines and buckets for faecal disposal although some (49) used flush toilets despite their being in poor conditions. Only 23.45 of the 646 children surveyed used pipe borne water for drinking and other domestic purposes. The high prevalence rates of helminth infection obtained could be due to persistent infection and re-infection of the study population as a result of the constant seeding of the soil with parasite eggs and larvae in these communities

Susceptibility of Plasmodium falciparum to different doses of quinine in vivo and to quinine and quinidine in vitro in relation to chloroquine in Liberia

Chloroquine-resistant Plasmodium falciparum has been spreading rapidly after its emergence in 1988 in Yekepa. The in vivo and in vitro susceptibilities to quinine and quinidine, compared to chloroquine, were studied by investigating the number of treatment days required for radical cure and estimating the quinine concentrations concomitantly. The minimal inhibitory concentrations (MIC) for schizont maturation in all successful in vitro tests were 5.12 x 10(-6) mol/l for quinine and 1.28 x 10(-6) mol/l for quinidine, indicating that all 50 isolates were sensitive to the two drugs. The IC50 and IC90 values were 0.22 and 0.78 x 10(-6) mol/l for quinine and 0.07 and 0.26 x 10(-6) mol/l for quinidine, respectively. In vitro inhibition of parasites by 1.6 x 10(-6) mol/l of chloroquine was obtained in 31 out of 47 isolates, 16 (34%) being resistant. The IC50, IC90 and geometrical mean MIC for quinine were all about two times higher for the chloroquine-resistant than for the chloroquine-sensitive isolates (P = 0.006). P. falciparum infected children (n = 64) were randomly allocated to four groups and treated with quinine (10 mg/kg body weight twice daily) for 1 day (3 doses), 2, and 7 days, respectively. All cleared their parasitaemias by day 4 but 5 out of 15 of those treated with only three doses showed a recurrence of parasitaemia between days 7 and 14; these were considered to be recrudescences. In the other groups, recurrent parasitaemias only occurred between days 17 and 28 and were considered to be reinfections