Ebola virus disease outbreak in Nigeria: Transmission dynamics and rapid control.

International air travel has already spread Ebola virus disease (EVD) to major cities as part of the unprecedented epidemic that started in Guinea in December 2013. An infected airline passenger arrived in Nigeria on July 20, 2014 and caused an outbreak in Lagos and then Port Harcourt. After a total of 20 reported cases, including 8 deaths, Nigeria was declared EVD free on October 20, 2014. We quantified the impact of early control measures in preventing further spread of EVD in Nigeria and calculated the risk that a single undetected case will cause a new outbreak. We fitted an EVD transmission model to data from the outbreak in Nigeria and estimated the reproduction number of the index case at 9.0 (95% confidence interval [CI]: 5.2-15.6). We also found that the net reproduction number fell below unity 15 days (95% CI: 11-21 days) after the arrival of the index case. Hence, our study illustrates the time window for successful containment of EVD outbreaks caused by infected air travelers.

Socio-demographic determinants of aflatoxin B1-lysine adduct levels among pregnant women in Kumasi, Ghana.

OBJECTIVES: Aflatoxins are fungal metabolites that contaminate staple food crops in many developing countries. Although studies have linked these toxins to adverse birth outcomes and poor infant development, no study has investigated the socio-demographic and economic determinants of aflatoxin levels among pregnant women living in sub-Saharan Africa. DESIGN: A cross-sectional study was conducted among 785 pregnant women in Kumasi. Aflatoxin B1 lysine adduct levels (AF-ALB) were determined by High Performance Liquid Chromatography. Analysis of variance was used to determine mean log AF-ALB levels and significance of differences in these levels according to socio-demographic variables. Logistic regression was used to identify independent associations of socio-demographics with having AF-ALB levels (≥ 11.34 pg/mg; upper quartile). RESULTS: AF-ALB levels ranged from 0.44 pg/mg to 268.73 pg/mg albumin with a median level of 5.0 pg/mg. Bivariate analyses indicates that mean ln AF-ALB as well as the percent of women having high AF-ALB levels (≥ 11.34 pg/mg; upper quartile) were inversely associated with indices of higher socioeconomic status: higher education and income, being employed and having a flush toilet. Higher income, being employed, having one child (verses no children) and having a flush toilet (verses no toilet facilities) were each independently associated with a 30-40% reduced odds of high AF-ALB levels. CONCLUSIONS: Additional research is needed to investigate how socio-demographic and economic factors interact to influence aflatoxin ingestion by individuals in regions with high aflatoxin crop contamination. This knowledge can be used to formulate and implement policies that will reduce exposure of women and their unborn children to these toxins.

Association of high viral load and abnormal liver function with high aflatoxin B1-albumin adduct levels in HIV-positive Ghanaians: preliminary observations.

We examined the association between certain clinical factors and aflatoxin B(1)-albumin adduct (AF-ALB) levels in HIV-positive people. Plasma samples collected from 314 (155 HIV-positive and 159 HIV-negative) people were tested for AF-ALB levels, viral load, CD4+ T-cell count, liver function profile, malaria parasitaemia, and hepatitis B and C virus infections. HIV-positive participants were divided into high and low groups based on their median AF-ALB of 0.93 pmol mg(-1) albumin and multivariable logistic and linear regression methods used to assess relationships between clinical conditions and AF-ALB levels. Multivariable logistic regression showed statistically significant increased odds of having higher HIV viral loads (OR=2.84; 95% CI=1.17-7.78) and higher direct bilirubin levels (OR=5.47; 95% CI=1.03-22.85) among HIV-positive participants in the high AF-ALB group. There were also higher levels of total bilirubin and lower levels of albumin in association with high AF-ALB. Thus, aflatoxin exposure may contribute to high viral loads and abnormal liver function in HIV-positive people and so promote disease progression.

Knowledge, attitudes and practices regarding dengue infection in Westmoreland, Jamaica.

BACKGROUND: Dengue virus infection causes significant morbidity and mortality in most tropical and sub-tropical countries of the world. Dengue fever is endemic in Jamaica and continues to be a public health concern. There is a paucity of information on knowledge, attitudes and practices (KAP) of Jamaicans regarding dengue infection. OBJECTIVE: To describe dengue-related knowledge, attitudes and practices (KAP) of residents of Westmoreland, Jamaica. METHODS: A cross-sectional questionnaire survey of 192 parents attending child health clinics in the Parish of Westmoreland was conducted. RESULTS: More than half of the parents (54%) had good knowledge about signs, symptoms and mode of transmission of dengue. Approximately 47% considered dengue to be a serious but preventable disease to which they are vulnerable. Nevertheless, a majority (77%) did not use effective dengue preventive methods such as screening of homes and 51% did not use bed nets. Educational attainment (OR, 2.98; CI, 1.23, 7.23) was positively associated with knowledge of dengue. There was no correlation between knowledge about dengue and preventive practices (p = 0.34). Radio and TV were the predominant sources of information about dengue fever. CONCLUSION: Findings suggest that the good knowledge about dengue fever among residents of Westmoreland did not translate to adoption of preventive measures. Health programme planners and practitioners need to identify and facilitate removal of barriers to behaviour change related to control of dengue fever among the population. Future campaigns should focus on educating and encouraging individuals and families to adopt simple, preventive actions, such as, use of insecticide treated bed nets and screening of homes.

Knowledge, attitudes and practices regarding dengue infection in Westmoreland, Jamaica / Conocimientos, actitudes y prácticas con respecto a la infección de Dengue en Westmoreland, Jamaica

BACKGROUND: Dengue virus infection causes significant morbidity and mortality in most tropical and sub-tropical countries of the world. Dengue fever is endemic in Jamaica and continues to be a public health concern. There is a paucity of information on knowledge, attitudes and practices (KAP) of Jamaicans regarding dengue infection. OBJECTIVE: To describe dengue-related knowledge, attitudes and practices (KAP) of residents of Westmoreland, Jamaica. METHODS: A cross-sectional questionnaire survey of 192 parents attending child health clinics in the Parish of Westmoreland was conducted. RESULTS: More than half of the parents (54%) had good knowledge about signs, symptoms and mode of transmission of dengue. Approximately 47% considered dengue to be a serious but preventable disease to which they are vulnerable. Nevertheless, a majority (77%) did not use effective dengue preventive methods such as screening of homes and 51% did not use bed nets. Educational attainment (OR, 2.98; CI, 1.23, 7.23) was positively associated with knowledge of dengue. There was no correlation between knowledge about dengue and preventive practices (p = 0.34). Radio and TV were the predominant sources of information about dengue fever. CONCLUSION: Findings suggest that the good knowledge about dengue fever among residents of Westmoreland did not translate to adoption of preventive measures. Health programme planners and practitioners need to identify and facilitate removal of barriers to behaviour change related to control of dengue fever among the population. Future campaigns should focus on educating and encouraging individuals and families to adopt simple, preventive actions, such as, use of insecticide treated bed nets and screening of homes.

ANTECEDENTES: La infección del virus del dengue causa morbosidad y mortalidad en un grado significativo en los países más tropicales y sub-tropicales del mundo. La fiebre de dengue es endémica en Jamaica y sigue siendo una preocupación para la salud pública. Hay escasez de información sobre el conocimiento, actitudes y prácticas (KAP) de los jamaicanos con respecto a la infección de dengue. OBJETIVO: Describir los conocimientos, actitudes y prácticas (CAP) de los residentes de Westmoreland, Jamaica, en relación con el dengue. MÉTODOS: Se realizó un cuestionario transversal a 192 padres y madres que asisten a las clínicas de salud infantil en la provincia de Westmoreland. RESULTADOS: Más de la mitad de los padres y las madres (54%) poseían un buen conocimiento acerca de los síntomas, señales, y modo de transmisión del dengue. Aproximadamente 47% veían al dengue como una enfermedad seria pero evitable, a la cual eran vulnerables. Sin embargo, una mayoría (77%) no usaba métodos efectivos para la prevención del dengue, tales como el uso de mallas de protección en las casas y el 51% no usaba mosquiteros. El logro educativo (OR, 2.98; CI, 1.23, 7.23) estuvo positivamente asociado con el conocimiento del dengue. No hubo correlación entre el conocimiento sobre el dengue y las prácticas preventivas (p = 0.34). La radio y la televisión fueron las fuentes predominantes de información sobre la fiebre del dengue. CONCLUSIÓN: Los hallazgos sugieren que el buen conocimiento sobre la fiebre del dengue entre los residentes de Westmoreland no se traduce en adopción de medidas preventivas. Los planificadores y médicos generales a cargo de programas de salud necesitan buscar formas de identificar y eliminar las barreras que obstaculizan el cambio de conducta en relación con el control de la fiebre del dengue entre la población. Las campañas futuras deben estar encaminadas a educar y estimular a individuos y familias a fin de que adopten acciones preventivas simples y económicas, tales como el uso de mosquiteros de cama tratados con insecticida y el uso de mallas de protección en las casas.

Factors associated with incomplete childhood immunization among residents in St. Mary, Jamaica.

AIM: To investigate factors associated with caregiver failure to complete immunizations for their children in the parish of St. Mary, Jamaica. METHODS: A case-control study was conducted with 50 cases defined as caregivers who failed to immunize their children and 179 controls defined as caregivers of children who were properly immunized. The cases were caregivers of children who were randomly selected from clinic records of children who failed to complete their immunization within the study period. Controls were caregivers of children who were identified to have completed their immunization from a similar list. Cases and controls were visited at home and interviewed using a validated questionnaire. Cases and controls were compared in terms of socio-demographic, economic and other variables. RESULTS: Participants with less than secondary school education were more likely to be non-compliant (odds ratio [OR], 2.51, 95% confidence interval [CI], 1.06- 5.97), while participants who were aware of legislation against non-compliance with immunization (OR, 0.35; 95% CI, 0.17, 0.69) were less likely to fail to immunize their children. CONCLUSION: Policy-makers and programme managers need to use established educational and communication channels to increase awareness of childhood immunization especially among families with lower educational levels in the parish.