Polio outbreak among nomads in Chad: outbreak response and lessons learned.

BACKGROUND: In response to the 2011 and 2012 polio epidemic in Chad, Chad's Ministry of Public Health, with support from Global Polio Eradication Initiative partners, took steps to increase vaccination coverage of nomadic children with targeted polio campaigns. This article describes the strategies we used to vaccinate nomads in 3 districts of Chad. METHODS: Our targeted interventions involved using mobile vaccination teams, recruiting local nomads to identify settlements, using social mobilization, and offering vaccinations to children, women, and animals. RESULTS: Vaccination coverage of nomadic children 0-59 months of age increased, particularly among those never before vaccinated against polio. These increases occurred mostly in the intervention districts of Dourbali, from 2956 to 8164 vaccinated children, and Kyabe, from 7319 to 15 868. The number of first-time vaccinated nomadic children also increased the most in these districts, from 60 to 131 in Dourbali and from 1302 to 2973 in Kyabe. Coverage in the Massaguet district was only 37.7%. CONCLUSIONS: Our success was probably due to (1) appointment of staff to oversee implementation, (2) engagement of the national government and its partners, (3) participation of nomadic community leaders, (4) intersectoral collaboration between human and animal health services, and (5) flexibility and capacity of vaccinators to vaccinate when and where nomads were available.

Hookworm infection and anemia in adult women in rural Chiapas, Mexico.

OBJECTIVE: To describe associations between anemia and hookworm (Necator americanus) infection in hospitalized women in rural Chiapas, Mexico. MATERIAL AND METHODS: We retrospectively reviewed the hospital records of 68 anemic women (defined as having a hemoglobin level < 10 mg/dl) or with intestinal parasitism, identified through hospital discharge and transfusion records for the calendar year 1999. The medical charts of 86 cases were located, 18 of which were not confirmed as anemia cases. The hospital is located in Altamirano, Chiapas. Characteristics of subjects were compared using Student's t-test (for continuous variables) and the chi 2 test (for categorical variables). A p-value < or = 0.01 was used for statistical significance. Chart review and data analysis took place during the year 2000. RESULTS: Fifty percent of women who had stool examinations were infected with N. americanus. Necator often coexisted with other potential causes of anemia, such as pregnancy and hemorrhage. Hemoglobin levels in hookworm-infected women (mean 4.1 g/dl) were significantly lower than in uninfected women (mean 7.0 gm/dl), and Necator prevalence was significantly higher in the anemic women (50%) than in the overall hospital population (1.9%). CONCLUSIONS: Anemic women should be offered stool testing where Necator is present, and should be considered for antihelminthic treatment even if pregnant. Further investigation is recommended among women in Chiapas, and probably elsewhere in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Hookworm infection and anemia in adult women in rural Chiapas, Mexico

OBJECTIVE: To describe associations between anemia and hookworm (Necator americanus) infection in hospitalized women in rural Chiapas, Mexico. MATERIAL AND METHODS: We retrospectively reviewed the hospital records of 68 anemic women (defined as having a hemoglobin level <10mg/dl) or with intestinal parasitism, identified through hospital discharge and transfusion records for the calendar year 1999. The medical charts of 86 cases were located, 18 of which were not confirmed as anemia cases. The hospital is located in Altamirano, Chiapas. Characteristics of subjects were compared using Student's t-test (for continuous variables) and the chi2 test (for categorical variables). A p-value <0.01 was used for statistical significance. Chart review and data analysis took place during the year 2000. RESULTS: Fifty percent of women who had stool examinations were infected with N. americanus. Necator often coexisted with other potential causes of anemia, such as pregnancy and hemorrhage. Hemoglobin levels in hookworm-infected women (mean 4.1 g/dl) were significantly lower than in uninfected women (mean 7.0 gm/dl), and Necator prevalence was significantly higher in the anemic women (50 percent) than in the overall hospital population (1.9 percent). CONCLUSIONS: Anemic women should be offered stool testing where Necator is present, and should be considered for antihelminthic treatment even if pregnant. Further investigation is recommended among women in Chiapas, and probably elsewhere in Mexico