Improving standard of pediatric surgical care in a low resource setting: the key role of academic partnership.

BACKGROUND: An epidemiological transition is interesting Sub-Saharan Africa increasing the burden of non-communicable diseases most of which are of surgical interest. Local resources are far from meeting needs and, considering that 50% of the population is less than 14 years of age, Pediatric surgical coverage is specially affected. Efforts are made to improve standards of care and to increase the number of Pediatric surgeons through short-term specialist surgical Missions, facilities supported by humanitarian organization, academic Partnership, training abroad of local surgeons. This study is a half term report about three-years Partnership between the University of Chieti- Pescara, Italy and the University of Gezira, Sudan to upgrade standard of care at the Gezira National Centre for Pediatric Surgery (GNCPS) of Wad Medani. Four surgical Teams per year visited GNCPS. The Program was financed by the Italian Agency for Development Cooperation. METHODS: The state of local infrastructure, current standard of care, analysis of caseload, surgical activity and results are reported. Methods utilized to assess local needs and to develop Partnership activities are described. RESULTS: Main surgical task of the visiting Team were advancements in Colorectal procedures, Epispadias/Exstrophy Complex management and Hypospadias surgery (20% of major surgical procedures at the GNCPS). Intensive care facilities and staff to assist more complex cases (i.e. neonates) are still defective. Proctoring, training on the job of junior surgeons, anaesthetists and nurses, collaboration in educational programs, advisorship in hospital management, clinical governance, maintenance of infrastructure together with training opportunities in Italy were included by the Program. Despite on-going efforts, actions have not yet been followed by the expected results. More investments are needed on Healthcare infrastructures to increase health workers motivation and prevent brain drain. CONCLUSIONS: The key role that an Academic Partnership can play, acting through expatriated Teams working in the same constrained contest with the local workforce, must be emphasized. Besides clinical objectives, these types of Global Health Initiatives address improvement in management and clinical governance. The main obstacles to upgrade standard of care and level of surgery met by the Visiting Team are scarce investments on health infrastructure and a weak staff retention policy, reflecting in poor motivation and low performance.

Studies on West Nile virus infection in Egypt.

We conducted a prospective cohort study to determine prevalence and incidence of West Nile virus (WNV) in Egypt. Cohorts were established in Upper (UE), Middle (ME), and Lower (LE) Egypt. Additionally, a cross-sectional serosurvey was performed in the North (NS) and South (SS) Sinai. Cohorts were bled initially and 1 year later. Sera were tested for WNV-IgG by ELISA and positive sera were confirmed by plaque reduction neutralization test (PRNT). Sentinel chicken flocks placed in the above sites were bled monthly for virus isolation and serology. Mosquitoes were collected monthly from the above sites and tested for WNV. Human seroprevalence rates were 35%, 27%, 14%, 1% and 7% in UE, ME, LE, NS and SS, respectively. Seroconversion rates were 18%, 17% and 7% in UE, ME and LE, respectively; 49% of the seroconverters reported undiagnosed febrile illness. Sentinel chickens showed seroconversion in all study sites. WNV was isolated from both sentinel chickens and mosquitoes in cohort sites. This study demonstrates that WNV was actively circulating during the study period in different areas in Egypt and causing febrile illness in a considerable proportion of individuals in the study sites.

Adverse response of non-indigenous cattle of European breeds to live attenuated Smithburn Rift Valley fever vaccine.

Three hundred eighteen European cows and 115 buffaloes were vaccinated with locally prepared Smithburn vaccine, of which, 100 cows and 20 buffaloes were pregnant. Twenty-eight cows aborted within 72 days post-vaccination, buffaloes did not abort. Blood samples collected 77 days post-vaccination from aborted cows, 17 pregnant cows, 5 pregnant buffaloes, and 32 non-pregnant cows. Sera were tested by ELISA for anti-RVF IgM and IgG. All aborted cows were strongly positive for IgG. Five of 17 cows and two of five buffaloes that did not abort were IgG positive. The percentage of IgM positives in aborted cows was 25% and 0% in non-aborted cows. The percentage of IgG positives in pregnant non-aborted cows was lower than in non-pregnant cows. The percentage of IgG positives of non-pregnant cows was lower than pregnant aborted cows. Virus was isolated from one aborted fetus. The nucleotide sequence of fetus virus was compared to Smithburn of Onderstepoort, local Smithburn and virus isolates from 1993 to 1994 and 1977 RVF outbreaks. The nucleotide sequences of Onderstepoort and Egyptian Smithburn vaccines were almost identical. The sequences of 1993-1994 isolates were identical to 1977 outbreak virus. Virus from the fetus had two mutations; it is apparently a variant that is genetically distant from local Smithburn and Onderstepoort vaccines. Fetus virus was genetically distant from virus of 1993/1994 and 1977 outbreaks. In conclusion, antibody response to vaccination with local Smithburn had occurred in some, but not all the cows and buffaloes. Virus isolation from the fetus suggests in utero transmission of used vaccine virus, which resulted in high abortions in European cows.