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

Prevalence and Intensity of Intestinal Helminth Parasites and Their Response to Treatment with Albendazole in a Rural Community in Sierra Leone

Helminth infections can be an important public health problem in most developing countries. Stool samples from 514 participants in Gbondapi village were examined to determine the prevalence and intensity of intestinal helminths using the Kato-Katz method. The efficacy of a single dose of 200mg and 400mg albendazole in adults and subjects below and above 2 years respectively was also assessed. Seventy-nine (15.4) of the 514 subjects were infected with at least one intestinal helminth. Data collected was analysed using Epi info statistical package. The most prevalent intestinal helminth was Hookworm (7.6) followed by Ascaris lumbricoides (5.3) and Strongyloides stercoralis (3.9). The least prevalent helminth was Schistosoma mansoni (1.6). The worm burden was generally light with mean egg counts ranging between 83 - 927eggs/gram of stool. Albendazole had an excellent safety record and found to be highly effective against Ascaris lumbricoides. In order to break the cycle of infection and re-infection in rural communities; programs embracing health education; mass treatment with albendazole; improved sanitation and the provision of protected water sources must be implemented