Disparities in Risks of Malaria Associated with Climatic Variability among Women, Children and Elderly in the Chittagong Hill Tracts of Bangladesh.

Malaria occurrence in the Chittagong Hill Tracts in Bangladesh varies by season and year, but this pattern is not well characterized. The role of environmental conditions on the occurrence of this vector-borne parasitic disease in the region is not fully understood. We extracted information on malaria patients recorded in the Upazila (sub-district) Health Complex patient registers of Rajasthali in Rangamati district of Bangladesh from February 2000 to November 2009. Weather data for the study area and period were obtained from the Bangladesh Meteorological Department. Non-linear and delayed effects of meteorological drivers, including temperature, relative humidity, and rainfall on the incidence of malaria, were investigated. We observed significant positive association between temperature and rainfall and malaria occurrence, revealing two peaks at 19 °C (logarithms of relative risks (logRR) = 4.3, 95% CI: 1.1-7.5) and 24.5 °C (logRR = 4.7, 95% CI: 1.8-7.6) for temperature and at 86 mm (logRR = 19.5, 95% CI: 11.7-27.3) and 284 mm (logRR = 17.6, 95% CI: 9.9-25.2) for rainfall. In sub-group analysis, women were at a much higher risk of developing malaria at increased temperatures. People over 50 years and children under 15 years were more susceptible to malaria at increased rainfall. The observed associations have policy implications. Further research is needed to expand these findings and direct resources to the vulnerable populations for malaria prevention and control in the Chittagong Hill Tracts of Bangladesh and the region with similar settings.

Effects of time-lagged meteorological variables on attributable risk of leishmaniasis in central region of Afghanistan.

BACKGROUND: Leishmaniasis remains one of the world's most neglected vector-borne diseases, affecting predominantly poor communities mainly in developing countries. Previous studies have shown that the distribution and dynamics of leishmaniasis infections are sensitive to environmental factors, however, there are no studies on the burden of leishmaniasis attributable to time-varying meteorological variables. METHODS: This study used data from 3 major leishmaniosis afflicted provinces of Afghanistan, between 2003 and 2009, to provide empirical analysis of change in heat/cold-leishmaniosis association. Non-linear and delayed exposure-lag-response relationship between meteorological variables and leishmaniasis were fitted with a distributed lag non-linear model applying a spline function which describes the dependency along the range of values with a lag of up to 12 months. We estimated the risk of leishmaniasis attributable to high and low temperature. RESULTS: The median monthly mean temperature and rainfall were 16.1 °C and 0.6 in., respectively. Seasonal variations of leishmaniasis were consistent between males and females, however significant differences were observed among different age groups. Temperature effects were immediate and persistent (lag 0-12 months). The cumulative risks were highest at cold temperatures. The cumulative relative risks (logRR) for leishmaniasis were 6.16 (95% CI: 5.74-6.58) and 1.15 (95% CI: 1.32-1.31) associated with the 10th percentile temperature (2.16 °C) and the 90th percentile temperature (28.46 °C). The subgroup analysis showed increased risk for males as well as young and middle aged people at cold temperatures, however, higher risk was observed for the elderly in heat. The overall leishmaniasis-temperature attributable fractions was estimated to be 7.6% (95% CI: 7.5%-7.7%) and mostly due to cold. CONCLUSION: Findings in this study highlight the non-linearity, delay of effects and magnitude of leishmaniasis risk associated with temperature. The disparity of risk between different subgroups can hopefully advise policy makers and assist in leishmaniasis control program.

Analysis of Presentations and Outcomes of Care of Children with Disorders of Sexual Development in a Nigerian Hospital.

STUDY OBJECTIVE: To describe the presentation, diagnosis, management, and short-term outcome of children with disorders of sexual development (DSD) in the context of multidisciplinary team care. DESIGN: Prospective descriptive study. SETTING: University Teaching Hospital. PARTICIPANTS: All children who presented with genital ambiguity. INTERVENTIONS AND MAIN OUTCOME MEASURES: Records of all patients diagnosed and managed for DSD between January 2011 and December 2016 were reviewed. The care pathway included clinical, laboratory, internal genitalia evaluation, and panel (including parents) meeting. RESULTS: Fifteen children presented with DSD at a median age of 20 months. Only 5/15 (33.3%) presented in the neonatal period. Ten of fifteen patients (66.7%) presented with genital ambiguity. Ovotesticular DSD was the most common diagnosis (9/15; 60%). Seven of the patients were genetically female (46, XX), 1 was genetically male (46, XY) and 1 without genetic diagnosis. Six patients were assigned male gender and they underwent male genitoplasty. Five of them had excision of Müllerian structures with gonadectomy. Three of fifteen patients (20%) were diagnosed as 46, XX DSD, at a median age of 7 years. All of them were due to congenital adrenal hyperplasia and underwent female genitoplasty. Two patients were diagnosed as XY, DSD. They were both raised as female at presentation and were reassigned male sex. Both had urethroplasty done. Four patients had postoperative urethrocutaneous fistula and 1 had partial wound dehiscence. The median follow-up period was 21 months (interquartile range, 2-26 months). CONCLUSION: The frequency of ovotesticular DSD is high in our setting. The decision of sex assignment was finally made at a median age of 7.5 months in most of our patients with satisfactory short-term surgical outcome.

Individual and network characteristic associated with hospital-acquired Middle East Respiratory Syndrome coronavirus.

BACKGROUND: During outbreaks of infectious diseases, transmission of the pathogen can form networks of infected individuals connected either directly or indirectly. METHODS: Network centrality metrics were used to characterize hospital-acquired Middle East Respiratory Syndrome Coronavirus (HA-MERS) outbreaks in the Kingdom of Saudi Arabia between 2012 and 2016. Covariate-adjusted multivariable logistic regression models were applied to assess the effect of individual level risk factors and network level metrics associated with increase in length of hospital stay and risk of deaths from MERS. RESULTS: About 27% of MERS cases were hospital acquired during the study period. The median age of healthcare workers and hospitalized patients were 35 years and 63 years, respectively, Although HA-MERS were more connected, we found no significant difference in degree centrality metrics between HA-MERS and non-HA-MERS cases. Pre-existing medical conditions (adjusted Odds ratio (aOR)=2.43, 95% confidence interval: (CI) [1.11-5.33]) and hospitalized patients (aOR=29.99, 95% CI [1.80-48.65]) were the strongest risk predictors of death from MERS. The risk of death associated with 1-day increased length of stay was significantly higher for patients with comorbidities. CONCLUSION: Our investigation also revealed that patients with an HA-MERS infection experienced a significantly longer hospital stay and were more likely to die from the disease. Healthcare worker should be reminded of their potential role as hubs for pathogens because of their proximity to and regular interaction with infected patients. On the other hand, this study has shown that while healthcare workers acted as epidemic attenuators, hospitalized patients played the role of an epidemic amplifier.

Knowledge, awareness and practice of infection control by health care workers in the intensive care units of a tertiary hospital in Nigeria.

BACKGROUND: Hospital-acquired infections (HAIs), one of the leading causes of, morbidity and mortality, are common in developing countries. Methicillin-resistant staphylococcus aureus (MRSA), commonest cause of HAIs, has been isolated from the hands of more than half of health care workers. Practice of hand hygiene may help in the control of nosocomial infections. We evaluated the practice of infection control among health care workers in the intensive care unit (ICU) of our hospital. MATERIALS AND METHODS: This is a descriptive cross-sectional study. Information on knowledge, awareness and practice of infection control in the ICU were obtained from health care workers with the aid of a structured questionnaire. RESULTS: Sixty nine out of the 80 (86%) respondents had good knowledge that a hand is the most common vehicle of transmission of infection. However, 53.8% and 32.5% of the respondents had knowledge of movement of hand hygiene and practiced six steps of the hand washing technique respectively. Though, physicians accounted for 68 (85%) of the respondents, only 28% of them practiced the six steps of the hand washing technique with resident doctors constituting a large proportion of hand washing technique defaulters. Only 13.9% of non-physician and 7.5% of physician respondents had ever attended a training program on infection control respectively. CONCLUSION: Knowledge and awareness of infection control among the health care workers in our ICU is good but the practice is poor. Training workshop on infection control should be organized for all ICU health care workers to reduce noso-comial infections.

Goitre-Related Factors for Predicting Difficult Intubation in Patients Scheduled for Thyroidectomy in a Resource-Challenged Health Institution in North Central Nigeria.

BACKGROUND: Airway management problems may arise when intubating patients with goitre scheduled for thyroidectomy. Goitres are not uncommon in sub-Saharan Africa, thyroidectomy being the main treatment. The aim of this study was to determine incidences of difficult intubation (DI), failed intubation (FI) and predictors of DI using a modified intubation difficulty score (IDS). METHODS: One hundred and twenty-five consenting patients with goitre scheduled for thyroidectomy were recruited. Goitre-related factors (GRF) of duration of illness, diagnosis, neck circumference, tracheal deviation and narrowing and retrosternal extension were recorded as well as Mallampati classification and BMI. At intubation, modified IDS was determined for each patient. Patients with modified IDS ≤ 5 were categorized as easy intubation group (E), and those with modified IDS >5 were categorized as difficult intubation group (D). The GRF of all patients in group D were compared with matched patients in group E. RESULTS: Incidence of DI was 13.6% with 2 (1.6%) cases of failed intubation. Comparing groups D and E, duration of illness was 4.28 ± 3.78 years in group D versus 7.44 ± 7.63 years group E, p = 0.1353. Neck circumference was 41.42 ±5.30 cm in group D versus 37.43±2.68 cm in group E, p = 0.0200. Tracheal deviation, narrowing and retrosternal extension, and surgical diagnosis were not significantly different among both groups. CONCLUSION: Incidence of DI was 13.6% and that of FI was 1.6%. Neck circumference was found to be a predictor of difficult intubation in goitre patients scheduled for thyroidectomy using the modified IDS.

Spatially Correlated Time Series and Ecological Niche Analysis of Cutaneous Leishmaniasis in Afghanistan.

Leishmaniasis is the third most common vector-borne disease and a very important protozoan infection. Cutaneous leishmaniasis is one of the most common types of leishmaniasis infectious diseases with up to 1.2 million occurrences of new cases each year worldwide. A dynamic transmission multivariate time series model was applied to the data to account for overdispersion and evaluate the effects of three environmental layers as well as seasonality in the data. Furthermore, ecological niche modeling was used to study the geographically suitable conditions for cutaneous leishmaniasis using temperature, precipitation and altitude as environmental layers, together with the leishmaniasis presence data. A retrospective analysis of the cutaneous leishmaniasis spatial data in Afghanistan between 2003 and 2009 indicates a steady increase from 2003 to 2007, a small decrease in 2008, and then another increase in 2009. An upward trend and regularly repeating patterns of highs and lows were observed related to the months of the year, which suggests seasonality effect in the data. Two peaks were observed in the disease occurrence-January to March and September to December-which coincide with the cold period. Ecological niche modelling indicates that precipitation has the greatest contribution to the potential distribution of leishmaniasis.