Global Epidemic of Ebola Virus Disease and the Importation Risk into China: An Assessment Based on the Risk Matrix Method / 生物医学与环境科学（英文）

OBJECTIVE@#To analyze the global epidemic status of the Ebola virus disease (EVD) and assess the importation risk into China.@*METHODS@#Data from World Health Organization reports were used. We described the global epidemic status of EVD from 1976-2021, and assessed and ranked the importation risk of EVD from the disease-outbreaking countries into China using the risk matrix and Borda count methods, respectively.@*RESULTS@#From 1976-2021, EVD mainly occurred in western and central Africa, with the highest cumulative number of cases (14,124 cases) in Sierra Leone, and the highest cumulative fatality rate (85%) in the Congo. Outbreaks of EVD have occurred in the Democratic Republic of the Congo and Guinea since 2018. The importation risk into China varies across countries with outbreaks of disease. The Democratic Republic of the Congo had an extremely high risk (23 Borda points), followed by Guinea and Liberia. Countries with a moderate importation risk were Nigeria, Uganda, Congo, Sierra Leone, Mali, and Gabon, while countries with a low importation risk included Sudan, Senegal, and Co

The outpatient management of hypertension at two Sierra Leonean health centres: a mixed-method investigation of follow-up compliance and patient-reported barriers to care

Background: Sub-Saharan Africa faces an increasing burden of non-communicable diseases. In particular, hypertension and its therapeutic control present a challenge and opportunity for health practitioners and health systems within the region. Aim: This study sought to assess an initiative conducted by two health clinics to begin treatment of hypertension amongst their patient populations by reviewing medication possession rates and documenting patient-reported barriers to care in the provision of chronic hypertension management. Setting: Two private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives. Methods: A retrospective chart review identified 487 records of patients with diagnosed hypertension and assessed for medication adherence through calculation of medication possession ratios from pharmacy refill data. Surveys were conducted on a convenience sample of 68 patients of the hypertension treatment programme to discern patient-reported barriers of care. Results: Medication possession rates were found to be less than 40% in 82% (399/487) of patients, between 40% and 79% in 12% (60/487) of patients and 80% or greater in 6% (28/487) of patients. In surveys of individuals being treated by the programme, patients were most likely to cite transportation (81%, 55/68), financial burden (69%, 47/68) and schedule conflicts with work or other prior commitments (25%, 17/68) as barriers to care. Conclusions: In this newly instituted outpatient hypertensive management initiative, 82% of patients had medication possession ratios under 40%, which is likely to impact the clinical effectiveness of the initiative. The most frequent patient-reported barriers to care in surveys included transportation, financial burden and schedule conflicts

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

Caracterización clínico epidemiológica de pacientes con ébola en un centro de tratamiento de Sierra Leona / Clinical-epidemiological characterization of Ebola disease in patients at a treatment center in Sierra Leone

Introducción: La enfermedad del ébola se dio a conocer por primera vez en 1976, con una letalidad muy elevada en todos los brotes detectados. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes portadores de la enfermedad por el virus del Ébola. Métodos: Se realizó un estudio observacional, descriptivo y transversal en 424 pacientes ingresados en un centro de tratamiento de ébola en la República de Sierra Leona, África occidental, con el diagnóstico confirmado mediante la técnica de reacción en cadena de la polimerasa para virus Ébola, durante el período de noviembre de 2014 hasta marzo de 2015. Resultados: Se muestra que el grupo etario más afectado fue el de 25 a 34 con un 25,9 por ciento. La mayor letalidad se presentó en los pacientes con más de 65 años de edad con un 44,4 por ciento. El síntoma que prevaleció fue la fiebre para un 61,8 por ciento, y el hipo se presentó en el 88,8 por ciento de los fallecidos. Conclusión: Se concluye que la enfermedad no tuvo distinción significativa con el sexo. La mayor letalidad se presentó en las edades geriátricas. Los síntomas más frecuentes fueron la fiebre, diarrea y el decaimiento. El hipo fue el signo que más se presentó en los pacientes que fallecieron(AU)

Introduction: Ebola disease was first reported in 1976 with a very high lethality in all outbreaks. Objective: To clinically and epidemiologically characterize the patients carriers of Ebola virus disease. Methods: we conducted an observational, descriptive and cross-sectional study in 424 patients admitted to an Ebola Treatment Center in the Republic of Sierra Leone, West Africa from November 2014 to March 2015. The polymerase chain reaction technique for Ebola virus confirmed the diagnosis. Medical records provided all data. Results: The age group most affected was 25 to 34 (25.9 percent). The highest lethality occurred in those over 65 years of age (44.4 percent ). Fever was the prevailing symptom (61.8 percent) and hiccups occurred in 88.8 percent of the deceased. Conclusion: Clinical manifestations were variable, although fever was the main symptom. Hiccup was a sign of poor prognosis when associated with a higher percentage of mortality. Lethality was high(AU)

Next-generation Sequencing Study of Pathogens in Serum from Patients with Febrile Jaundice in Sierra Leone / 生物医学与环境科学（英文）

OBJECTIVE@#People in Western Africa suffer greatly from febrile jaundice, which is caused by a variety of pathogens. However, yellow fever virus (YFV) is the only pathogen under surveillance in Sierra Leone owing to the undeveloped medical and public health system there. Most of the results of YFV identification are negative. Elucidation of the pathogen spectrum is required to reduce the prevalence of febrile jaundice.@*METHODS@#In the present study, we used Ion Torrent semiconductor sequencing to profile the pathogen spectrum in archived YFV-negative sera from 96 patients in Sierra Leone who presented with unexplained febrile jaundice.@*RESULTS@#The most frequently identified sequencing reads belonged to the following pathogens: cytomegalovirus (89.58%), Epstein-Barr virus (55.21%), hepatitis C virus (34.38%), rhinovirus (28.13%), hepatitis A virus (20.83%), coxsackievirus (10.42%), Ebola virus (8.33%), hepatitis E virus (8.33%), lyssavirus (4.17%), leptospirosis (4.17%), chikungunya virus (2.08%), Crimean-Congo hemorrhagic fever virus (1.04%), and hepatitis B virus (1.04%).@*CONCLUSION@#The distribution of sequencing reads suggests a broader spectrum of pathogens for consideration in clinical diagnostics and epidemiological surveillance in Sierra Leone.

A comprehensive district-level laboratory intervention after the ebola epidemic in Sierra Leone

Background: The 2014­2016 Ebola outbreak exposed the poor laboratory systems in Sierra Leone. Immense needs were recognised across all areas, from facilities, diagnostic capacity, supplies, trained personnel to quality assurance mechanisms.Objective: We aimed to describe the first year of a comprehensive intervention, which started in 2015, in a public hospital's general laboratory serving a population of over 500 000 in a rural district.Methods: The intervention focused on (1)supporting local authorities and healthcare workers in policy implementation and developing procedures to enhance access to services, (2) addressing gaps by investing in infrastructure, supplies, and equipment, (3) development of quality assurance mechanisms via mentorship, bench-side training, and the introduction of quality control and information systems. All work was performed alongside counterparts from the Ministry of Health and Sanitation.Results: We observed a strong increase in patient visits and inpatient and outpatient testing volumes. Novel techniques and procedures were taken up well by staff, leading to improved and expanded service and safety, laying foundations for further improvements.Conclusion: This comprehensive approach was successful and the results suggest an increase in trust from patients and healthcare workers

Antinutritional factors, toxic elements and phytochemicals present in jatropha curcas fruits, kernels, seeds and ethanol seed extract

Jatropha curcas (J. curcas) seeds have been exploited as a source of biodiesel and for its ethnomedicinal uses and agro feed potential, however, toxic properties have been associated with the seeds. The study was aimed at determining the toxic constituents present in J. curcas fruits, seeds and kernels and ethanol seed extract. Standard methods were employed in the investigations, including those of the Association of Analytical Chemists and Trease and Evans. J. curcas fruits, seeds and kernels from Sierra Leone contained cyanogenic glycosides (in mg/100g) of 7.10, 5.10 and 16.96 while the corresponding values for the Nigeria samples were 11.60, 10.15 and 15.92; all greatly above the maximum permissible limits of 0.05-0.35. Similarly, the tannin contents of the fruits, seeds and kernels from Sierra Leone (1.66, 1.46, and 1.80) and of the seeds and kernels from Nigeria (1.40, 1.48) approximated the maximum permissible limits of 1.5 mg/100g or were higher. In contrast, the phytates and saponins which ranged from 1.78-2.14 and 1.64-2.42 for both sources of J. curcas were significantly below the maximum permissible levels of 500 mg/100g (for phytates) and 100 mg/100g (for saponins). Heavy metals like cadmium, copper, chromium and lead were also detected, but their concentrations were below the maximum permissible limits. These constituents were mostly similar regardless of the country source of Jatropha. Ethanol extract of J. curcas seeds was found to contain toxic phytochemicals and heavy metals. J. curcas as food cannot be ruled out especially for animals since cooking, fermentation and heat treatment can significantly reduce some of these antinutritional factors

Disproportionate HBsAg seroprevalence rates among healthy blood donors in six health care facilities in Sierra Leone, 2012-2016

Background: Viral hepatitis is a disease condition caused by five distinct types of hepatitis viruses including hepatitis B Virus (HBV). HBV causes a range of acute and chronic liver diseases that sometimes lead to death. There are about 400 million HBV infected people worldwide many of them in Asia and Africa where the infection is endemic. Methods: We collected and later analyzed anonymized laboratory results from blood banks at Connaught Hospital, PCMH, 34th Regiment Military Hospital, Aberdeen Women Hospital, Lumley Government Hospital and the Emergency Surgical Hospital of healthy blood donors. All persons whose data were used in this study were healthy blood donors between the ages of 18-55 years and had only gone to these blood bank facilities to donate blood. Results: Out of 43,163 persons screened for various blood infections, 6,564 persons were positive for HBsAg with a seroprevalence rate of 15.2% (95% CI: 14.87-15.55). There were 37,060 males tested and 6103 females tested and 5735 males (15.5%) and 829 females (13.6%) were positive for HBsAg. There was gender, yearly and health care facility difference (P<0.0001) for HBsAg seroprevalence cases recorded in this study. The highest HBsAg seroprevalence rate for the period under review was recorded in 2013. We observed disproportionate differences in HBsAg seroprevalence rates for gender, yearly and health care facility (P<0.0001) for the period under review. Conclusion: A seroprevalence of 15.2% among healthy volunteers indicate that HBV is a serious problem in Sierra Leone. There is a need for an urgent HBV vaccination coverage in Sierra Leone. A randomized population-based study with healthy volunteers is recommended for future seroprevalence studies on HBV

Seroprevalence of Ebola virus infection in Bombali District, Sierra Leone

A serosurvey of anti-Ebola Zaire virus nucleoprotein IgG prevalence was carried out among Ebola virus disease survivors and their Community Contacts in Bombali District, Sierra Leone. Our data suggest that the specie of Ebola virus (Zaire) responsible of the 2013-2016 epidemic in West Africa may cause mild or asymptomatic infection in a proportion of cases, possibly due to an efficient immune response

Establishment of Quality Control System of Nucleic Acid Detection for Ebola Virus in Sierra Leone-China Friendship Biological Safety Laboratory / 病毒学报

The quality control process throughout the Ebola virus nucleic acid detection in Sierra Leone-China Friendship Biological Safety Laboratory (SLE-CHN Biosafety Lab) was described in detail, in order to comprehensively display the scientific, rigorous, accurate and efficient practice in detection of Ebola virus of first batch detection team in SLE-CHN Biosafety Lab. Firstly, the key points of laboratory quality control system was described, including the managements and organizing, quality control documents and information management, instrument, reagents and supplies, assessment, facilities design and space allocation, laboratory maintenance and biosecurity. Secondly, the application of quality control methods in the whole process of the Ebola virus detection, including before the test, during the test and after the test, was analyzed. The excellent and professional laboratory staffs, the implementation of humanized management are the cornerstone of the success; High-level biological safety protection is the premise for effective quality control and completion of Ebola virus detection tasks. And professional logistics is prerequisite for launching the laboratory diagnosis of Ebola virus. The establishment and running of SLE-CHN Biosafety Lab has landmark significance for the friendship between Sierra Leone and China, and the lab becomes the most important base for Ebola virus laboratory testing in Sierra Leone.

Anesthetic management of urgent cesarean delivery in a parturient with acute malaria infection: a case report / 대한마취과학회지

Malaria is associated with high rates of morbidity and mortality worldwide, particularly in Africa, Southeast Asia and South America. Nonetheless, several cases of malaria have been reported in Western countries involving travelers from endemic areas, though very few involve pregnant women. In this article, we report a case of a young woman born in Sierra Leone who had been living in Italy for two years. She was admitted to our hospital with malaise; worsening of her condition led to Plasmodium falciparum infection diagnosis early during her hospital stay, as well as an urgent cesarean delivery. We briefly discuss the features of malaria in pregnancy, the difficulties associated with early diagnosis, and the possible fetal and maternal implications, and also consider how the disease may affect anesthetic management.

Genetic variants associated with fetal hemoglobin levels show the diverse ethnic origin in Colombian patients with sickle cell anemia / Las variantes genéticas asociadas con niveles de hemoglobina fetal señalan diversos orígenes étnicos en pacientes colombianos con anemia falciforme.

Introduction: Fetal hemoglobin is an important factor in modulating the severity of sickle cell anemia. Its level in peripheral blood underlies strong genetic determination. Associated loci with increased levels of fetal hemoglobin display population-specific allele frequencies. Objective: We investigated the presence and effect of known common genetic variants promoting fetal hemoglobin persistence (rs11886868, rs9399137, rs4895441, and rs7482144) in 60 Colombian patients with sickle cell anemia. Materials and methods: Four single nucleotide polymorphisms (SNP) were genotyped by restriction fragment length polymorphisms (RFLP) and the use of the TaqMan procedure. Fetal hemoglobin (HbF) from these patients was quantified using the oxyhemoglobin alkaline denaturation technique. Genotype frequencies were compared with frequencies reported in global reference populations. Results: We detected genetic variants in the four SNPs, reported to be associated with higher HbF levels for all four SNPs in the Colombian patients. Genetic association between SNPs and HbF levels did not reach statistical significance. The frequency of these variants reflected the specific ethnic make-up of our patient population: A high prevalence of rs7482144-'A' reflects the West-African origin of the sickle cell mutation, while high frequencies of rs4895441-'G' and rs11886868-'C' point to a significant influence of an Amerindian ethnic background in the Colombian sickle cell disease population. Conclusion: These results showed that in the sickle cell disease population in Colombia there is not a unique genetic background, but two (African and Amerindian). This unique genetic situation will provide opportunities for a further study of these loci, such as fine-mapping and molecular-biological investigation. Colombian patients are expected to yield a distinctive insight into the effect of modifier loci in sickle cell disease.

Introducción. La hemoglobina fetal es un importante factor modulador de la gravedad de la anemia falciforme, cuya expresión está muy condicionada por el factor genético. Los loci asociados con el incremento de la hemoglobina fetal pueden presentar frecuencias alélicas específicas para cada población. Objetivo. Investigar la presencia y el efecto de las variantes genéticas rs11886868, rs9399137, rs4895441 y rs7482144 asociadas con la persistencia de hemoglobina fetal, en 60 pacientes colombianos con anemia falciforme. Materiales y métodos. Se hizo la genotipificación de los polimorfismos de nucleótido simple ( Single Nucleotide Polymorphisms, SNP) mediante la técnica de polimorfismos de longitud de fragmentos de restricción ( Restriction Fragment Length Polymorphisms, RFLP) y el procedimiento TaqMan. La hemoglobina fetal (HbF) se cuantificó utilizando la técnica de desnaturalización alcalina de la oxihemoglobina. Las frecuencias genotípicas se compararon con las reportadas en poblaciones de referencia global. Resultados. Se observaron variantes genéticas ya reportadas para aumento de HbF en los cuatro SNP. La asociación genética entre los SNP y el incremento de la HbF no alcanzó significancia estadística. La frecuencia de estos alelos reflejó la siguiente composición específica en esta muestra de pacientes colombianos: una gran prevalencia de rs7482144-'A', lo que indica que el origen de la mutación para la anemia falciforme es África occidental, y una gran frecuencia de rs4895441-'G' y rs11886868-'C', lo que denota la influencia significativa del origen genético amerindio. Conclusión. Los resultados evidenciaron que la población con anemia falciforme de Colombia no tiene un único origen genético, sino que existen dos (africano y amerindio). Esta situación genética única ofrece la oportunidad de llevar a cabo un estudio más amplio de estos loci a nivel molecular. Se espera que el estudio de pacientes colombianos permita una visión diferente del efecto de los loci modificadores en esta enfermedad.

Western area surge for controlling Ebola hemorrhagic fever outbreak in Sierra Leone and evaluation of its effect / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the Western Area Surge (WAS) program in the Ebola outbreak of Sierra Leone, and to analyze its implementing effect.</p><p><b>METHODS</b>The subject of this study was 3,813 laboratory confirmed Ebola hemorrhagic fever (EHF) cases reported in Sierra Leone from November 19, 2014 through January 27, 2015, a period before and after the implementation of the WAS program. To analyze and make conclusions according to the working experience of China Mobile Laboratory Reponses Team in the fight of Ebola outbreak, using WHO published EHF case definition to make diagnosis and compare the number of bed numbers, confirmed EHF cases, samples tested, and positive rates before and after implementation of WAS program.</p><p><b>RESULTS</b>From the implementation of WAS program on 17th December 2014 to half a month later, the total numbers of Ebola holding and treatment centers increased from 640 to 960, six additional laboratories were established. On January, 2015, another two laboratories from America and The Netherlands were established. The numbers of samples tested one month before and after WAS program were 7,891 and 9,783, respectively, with an increase of 24.0 percent, while the positive rate of Ebola virus decreased from 22.2% (1,752/7,891) to 11.0% (1,077/9,783). The positive rate of blood samples decreased from 39.6% (248/626) in the month before WAS program to 27.4% (131/478) (χ2=17.93, P<0.001) in the mother after WAS program, the positive rate of blood samples 22.7% (103/454) to 10% (62/609) (χ2=31.03, P<0.001), accordingly. After 3 weeks of WAS program, in addition to Western Area, another four hotspots in Sierra Leone had also reported a significant decrease of the numbers of confirmed EVD cases. Forty-two days after implementation of WAS program, the daily number of laboratory confirmed EHF cases decreased from 63 to 10.</p><p><b>CONCLUSION</b>WAS program played a vital role in controlling the EHF outbreak rapidly in Sierra Leone. It could also provide guidance for the control similar large infectious diseases outbreak in the future.</p>

The 2013-2015 Ebola outbreak in West Africa

Zaire Ebola virus (EBOV) is a fatal human pathogen, with a high case fatality rate (CFR) averaging up to 78%. In March 2014, the World Health Organization (WHO) was made aware of a ZEBOV outbreak in rural Guinea, West Africa. Epidemiologic investigation linked the clinical and laboratory confirmed cases with the presumed first fatality of the outbreak in December 2013. EBOV from Guinea is a separate clade from other ZEBOV strains reported from the Democratic Republic of Congo (DRC) and Gabon. Since the outbreak in March, ZEBOV was also reported in Conakry, Guinea's capital and spread to other neighboring countries. In its largest outbreak, ZEBOV disease expanded through Guinea, Liberia, Sierra Leone, and Nigeria and to Spain, the USA, and the UK. The WHO declared the 2013-2015 West African Ebola epidemic a public health emergency of international concern considering its presumable capacity for further international spread. Early manifestations of EVD (Ebola virus disease) include a high fever, body aches, malaise, and fatigue. Severe diarrhea and other gastrointestinal manifestations such as vomiting were common, while bleeding was a more sporadic finding. The fatality rate was 43% and highest in patients aged > or = 45 years and the overall fitted mean incubation period was 10.3 days (95% CI 9.9~10.7). We present a review of the literature on the emergence of Ebola, and the epidemiologic, clinical, and laboratory records of patients in whom EVD was diagnosed in Sierra Leone, Guinea, Liberia, Mali, the USA, and Spain, its zoonotic origin, and the transmission of ZEBOV, as well as presenting original literature on the current Ebola outbreak.

Seroprevalence of human immunodeficiency and hepatitis b viruses among patients at a health facility in Freetown; Sierra Leone

Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) constitute serious public health problems worldwide. In Sierra Leone; information on both viral infections remains scanty. This study estimated the seroprevalence of HIV and HBV infections and a possible co-infection in one hundred and ninety-eight (198) patients seeking diagnosis at a private laboratory in Freetown; Sierra Leone. Blood plasma was collected from each patient after informed consent was obtained. The samples were assayed for antibodies to HIV virus and HBV antigen using appropriate assays. Male patient accounts for 52of the population examined. Thirty-one (31) of the 198 patients examined (15.7) were positive for HIV. Hepatitis B surface antigen (HbsAg) was present in 17 (39.5) females and 26 (60.5) males. Thirteen (13) (6.6) patients were co-infected with HIV and HBsAg. This is the first documented evidence of HBsAg and HIV co-infection in Sierra Leoneans. Larger population based studies are however needed to confirm the findings

Plasmodium falciparum-induced kidney and liver dysfunction in malaria patients in Freetown; Sierra Leone

This study was undertaken to investigate the effect of Plasmodium falciparum infection on kidney and liver function parameters in malaria patients in Freetown; Sierra Leone. Blood samples taken from 64 malaria patients and 64 non-malaria volunteers at Abanita and Blue Shield Hospitals; Freetown Sierra Leone between January to April; 2009 were examined. Changes in serum biochemical parameters were analysed using normal range values as baseline. Serum bilirubin; alkaline phosphatase (ALP); alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentrations were significantly elevated in falciparum malaria patients compared to their non-malaria counterparts which is an indication of defective liver function. Most of patients with falciparum malaria also have significantly high serum concentrations of urea; creatinine; sodium and potassium showing alteration in kidney function. This study suggests that malaria parasites could be responsible for derangement of kidney and liver functions in patients and could therefore contribute to organ damage in affected individuals if not treated

Nasal carriage of staphylococcus aureus and antibiotic susceptibility pattern among children in Freetown; Sierra Leone

Nasal carriage of Staphylococcus aureus has been demonstrated to be a major risk factor for invasive S. aureus infections in various population including children. The extent of S. aureus carriage in Sierra Leonean children is largely unknown. To determine the prevalence and pattern of antibiotic susceptibility of nasal S. aureus among children in Freetown; Sierra Leone; samples were collected from anterior nares of children less than two years at the Ola During Children's Hospital between October 2008 and April 2009. Of the 116 children screened during the study period; S. aureus isolates were found in the nasal specimens of 40 (34.5) of the children. Antimicrobial susceptibility testing to norfloxacin; gentamycin; erythromycin; trimethoprim-sulfamethazole; doxycycline; tetracycline and amoxycillin-clavulanic acid were observed to be 95; 35; 30; 20; 15; 7.5 and 2.5respectively. All the isolates were susceptible to oxacillin and resistant to chloramphenicol; penicillin G; amoxycillin and ampiclox. Regular monitoring of antimicrobial susceptibility pattern may be useful

Avian and human influenza pandemic; how prepared is the developing world?

The history of avian and human influenza pandemics showed a high case fatality and devastating socioeconomic impact on the developing world. The global epidemiology of the human influenza of 1918; 1957 and 1968 pandemics had few similarities. One of which was mass human migration; whether it being troop deployment or trade routes. How much the perennial flight patterns of wild bird had on its spread is another question for consideration? The avian influenza virus does not readily cross the species barrier; though there is a potential for genetic re-assortment and cross infection. The main finding of this review suggest a lack of historic epidemiological data from the developing world on previous influenza pandemics; a poorly developed surveillance system and lack of health service delivery capacity to effectively combat an outbreak of influenza; should it occur. The developing world already heavily burdened with endemic diseases such as malaria; HIV; Tuberculosis and other respiratory tract infections will find it difficult to cope with an influenza pandemic. A preparedness plan for developing countries should include health systems strengthening especially that providing expertise and improved surveillance tools

Knowledge; perception of risk and attitude of Sierra Leone military personnel towards colleagues with HIV/AIDS

The aim of this survey was to gain an insight into the level of knowledge; perception of risk and attitude of Sierra Leone Military personnel towards colleagues with HIV/AIDS. Four hundred and fifty (450) randomly selected male and female military personnel including officers and other ranks from six battalions were surveyed with a standard questionnaire. Results of this survey demonstrated a relatively low level of knowledge of HIV and AIDS amongst the survey population as evidenced by the 40and 52of participants stating that HIV is transmitted by mosquito bites and from public toilets respectively. An equally low perception of risk of the infection was demonstrated from the responses of the participants about attitude towards HIV infected colleagues. Three-fourth of the participants indicated that nobody should be informed if a colleague is HIV positive; with almost all the participants expressing their willingness to take care of an HIV/AIDS person in their household. Varying responses obtained demonstrate the necessity for scaling-up HIV education within the Republic of Sierra Leone Armed Forces. More resources most therefore be made available to the HIV/AIDS office of the Republic of Sierra Leone Armed Forces so that HIV education activities can be extended to all the brigades and battalions