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In 2016, invasive bacterial diseases accounted for one quarter of the 5.6 million childhood deaths worldwide (1). Most invasive bacterial diseases occur in sub-Saharan Africa and other low- and middle-income [...]

Objective To compare oxygen supply options for health facilities in the Gambia and develop a decision-making algorithm for choosing oxygen delivery systems in Africa and the rest of the developing world. Methods Oxygen cylinders and concentrators were compared in terms of functionality and cost. Interviews with key informants using locally developed and adapted WHO instruments, operational assessments, cost-modelling and cost measurements were undertaken to determine whether oxygen cylinders or concentrators were the better choice. An algorithm and a software tool to guide the choice of oxygen delivery system were constructed. Findings In the Gambia, oxygen concentrators have significant advantages compared to cylinders where power is reliable; in other settings, cylinders are preferable as long as transporting them is feasible. Cylinder costs are greatly influenced by leakage, which is common, whereas concentrator costs are affected by the cost of power far more than by capital costs. Only two of 12 facilities in the Gambia were found suitable for concentrators; at the remaining 10 facilities, cylinders were the better option. Conclusion Neither concentrators nor cylinders are well suited to every situation, but a simple options assessment can determine which is better in each setting. Nationally this would result in improved supply and lower costs by comparison with conventional cylinders alone, although ensuring a reliable supply would remain a challenge. The decision algorithm and software tool designed for the Gambia could be applied in other developing countries. Objectif Comparer les options d'approvisionnement en oxygene qui s'offrent aux etablissements de soins de Gambie et developper un algorithme de prise de decisions pour guider le choix des systemes d'approvisionnement en oxygene en Afrique et dans le reste du monde en developpement. Methodes Les auteurs ont compare en termes de fonctionnalite et de cout les bouteilles et les concentrateurs d'oxygene. Ils ont interroge des informateurs cles en utilisant des instruments d'evaluation OMS mis au point et adaptes localement et realise des evaluations operationnelles, ainsi qu'une modelisation et des mesures des couts pour determiner le meilleur choix entre les bouteilles et les concentrateurs d'oxygene, lis ont elabore un algorithme et un outil logiciel pour guider la selection du systeme d'approvisionnement en oxygene. Resultats En Gambie, les concentrateurs d'oxygene presentent des avantages notables par rapport aux bouteilles lorsque I'alimentation electrique est fiable ; dans d'autres contextes, il est preferable de faire appel aux bouteilles dans la mesure ou leur transport est praticable. La presence de fuites, phenomene courant, influe fortement sur le cout des bouteilles, tandis que pour les concentrateurs, les couts energetiques sont de loin plus importants que les couts en capital. Sur les 12 etablissements gambiens, 2 seulement avaient interet d'apres l'etude a utiliser des concentrateurs ; pour les 10 autres, les bouteilles constituaient une meilleure option. Conclusion Ni les concentrateurs, ni les bouteilles ne conviennent a toutes les situations, mais une evaluation simple des options permet de determiner pour chaque contexte la meilleure solution. A l'echelle nationale, cette evaluation devrait conduire a une amelioration de I'approvisionnement et a une baisse des couts par rapport a la situation ou I'on utilise uniquement des bouteilles d'oxygene classiques, mais assurer un approvisionnement fiable devrait rester un defi. L'algorithme decisionnel et l'outil logiciel concus pour la Gambie devraient etre applicables dans d'autres pays en developpement. Objetivo Comparar las opciones de suministro de oxigeno para centros de salud en Gambia y desarrollar un algoritmo decisional para elegir los sistemas de suministro de oxigeno en Africa y en el resto del mundo en desarrollo. Metodos Se compararon la funcionalidad y el costo de las bombonas y los concentradores de oxigeno. Se Ilevaron a cabo entrevistas con informantes clave mediante instrumentos desarrollados localmente o adaptados a partir de otros de la OMS, evaluaciones operacionales, modelizaciones de costos y mediciones de costos a fin de determinar la mejor opcion entre las bombonas y los concentradores de oxigeno. Se desarrollo asi un algoritmo y un instrumento de software para fundamentar la eleccion dei sistema de suministro de oxigeno. Resultados En Gambia, los concentradores de oxigeno presentan ventajas importantes en comparacion con las bombonas alli donde el suministro electrico es fiable; en caso contrario, la opcion preferible son las bombonas, siempre y cuando sea factible transportarlas. El costo de las bombonas depende considerablemente de las fugas, un problema frecuente, mientras que el de los concentradores depende mucho mas del costo de la electricidad que de los gastos de infraestructura. Solo dos de los 12 centros de Gambia analizados reunian las condiciones idoneas para usar concentradores; en los otros diez centros, la mejor opcion eran las bombonas. Conclusion Ni los concentradores ni las bombonas son soluciones ideales para cualquier situacion, pero una simple evaluacion de esas dos opciones permite determinar cual es preferible en cada entorno. A nivel nacional, esa diferenciacion se traduciria en mejoras del suministro y menores costos en comparacion con el uso exclusivo de las bombonas convencionales, pero seguiria habiendo problemas para garantizar un suministro fiable. El algoritmo decisional y el instrumento de software concebidos para Gambia podrian aplicarse en otros paises en desarrollo., Introduction Acute respiratory infection, principally pneumonia, remains the leading cause of death in young children worldwide. (1-3) Case management of pneumonia is a key component of the WHO Integrated Management [...]

Objective To assess whether traditional measures of access to health care (distance and travel time to a facility) and non-traditional measures (social and financial support indicators) are associated with mortality among children under 5 years of age in the Gambia. Methods We conducted a case-control study in a population under demographic surveillance. Cases (n = 140) were children under 5 years of age who died between 31 December 2003 and 30 April 2006. Each case was matched in age and sex to five controls (n = 700). Information was gathered by interviewing primary caregivers. The data were analysed using conditional logistic regression. Findings Of traditional measures of access, only rural versus urban/periurban residence was important: children from rural areas were more likely to die (OR: 4.9; 95% confidence interval, Ch 1.2-20.2). For non-traditional measures, children were more likely to die if their primary caregivers lacked help with meal preparation (OR: 2.3; 95% Ch 1.2-4.1), had no one to relax with (OR: 1.8; 95% Ch 1.1-2.9), had no one who could offer good advice (OR: 23.1; 95% Ch 4.3-123.4), had little say over how earned money was spent (OR: 12.7; 95% Ch 1.3-127.6), were unable to cut spending for health care (OR: 2.5; 95% Ch 1.5-4.2) or had to carry out odd jobs to pay for the care (OR: 3.4; 95% Ch 2.1-5.5). A protective effect was observed when the caregiver had other children to care for (OR: 0.2; 95% Cl: 0.1-0.5). Conclusion Improving access to health-care for children in the Gambia and similar settings is not simply a matter of reducing travel time and distance to a health facility, but requires improvements in caregivers&apos; support networks and their access to the financial resources they need. Objectif Evaluer les eventuelles associations entre les mesures classiques de l&apos;acces aux soins (distance et duree du trajet jusqu&apos;a l&apos;etablissement) ou les mesures non conventionnelles (indicateurs de soutien social et financier) et la mortalito des enfants de moins de 5 ans en Gambie. Methodes Nous avons mene une etude cas-tomoins dans une population sous surveillance demographique. Les cas (n = 140) etaient des enfants de moins de 5 ans, decedes entre le 31 decembre 2003 et le 30 avril 2006. Chaque cas etait apparie selon l&apos;age et le sexe a 5 tomoins (n = 700). Des informations ont eto recueillies en interrogeant les aidants principaux. Les donnees ont ete analysees par regression logistique classique. Resultats Parmi les mesures classiques de l&apos;acces aux soins, seule la distinction entre residence en milieu rural et residence en milieu urbain ou periurbain etait importante :les enfants provenant de zones rurales avaient une plus grande probabilito de mourir (OR: 4,9; IC a 95 % 1,2-20,2). S&apos;agissant des mesures non conventionnelles, la probabilito de deces des enfants etait plus forte si leur aidant principal manquait d&apos;aide pour la preparation des repas (OR : 2,3 ;IC a 95 % : 1,2-4,1), n&apos;avait personne avec qui se detendre (OR : 1,8 ; IC a 95 % : 1,1-2,9), n&apos;avait personne pour lui prodiguer de bons conseils (OR: 23,1 ; IC a 95 % : 4,3-123,4), n&apos;avait pas son mot a dire sur la facon dont l&apos;argent gagne etait depense (OR: 12,7 ; IC a 95 % : 1,3-127,6), etait dans l&apos;incapacito de reduire les depenses de santo (OR :2,5 ;IC a 95% : 1,5-4,2) ou devait effectuer des << petits boulots >> pour payer ces depenses (OR : 3,4 ;IC a 95 % : 2,1-5,5). Un effet protecteur a ete observe lorsque l&apos;aidant principal devait egalement s&apos;occuper d&apos;autres enfants (OR : 0,2 ; IC a 95 % : 0,1-0,5). Conclusion Ameliorer l&apos;acces aux soins des enfants en Gambie ou dans d&apos;autres contextes similaires ne signifie pas seulement reduire le temps de trajet et la distance jusqu&apos;a l&apos;etablissement de soins, mais suppose un renforcement des reseaux de soutien aux aidants et un meilleur acces pour eux aux ressources financieres dont ils ont besoin. Objetivo Determinar si las medidas tradicionales (distancia y tiempo de viaje hasta un establecimiento) y no tradicionales (indicadores de apoyo social y financiero) de acceso a la atencion de salud guardan relacion con la mortalidad entre les menores de 5 anos en Gambia. Metodos Llevamos a cabo un estudio de casos y controles en una poblacion sometida a vigilancia demografica. Les casos (n = 140) fueron ninos menores de 5 anos fallecidos entre el 31 de diciembre de 2003 y e130 de abril de 2006. Cada case se emparejo por edad y sexo con cinco controles (n = 700). Se entrevisto a les cuidadores principales para reunir la informacion pertinente, analizandose luego les datos mediante regresion Iogistica condicional. Resultados De las medidas tradicionales de acceso, solo la residencia rural frente a la urbana/periurbana tenia un efecto importante: los ninos de las zonas rurales tenian mas probabilidades de morir (OR: 4,9; intervalo de confianza (IC) del 95%: 1,2-20,2). En cuanto a las medidas no tradicionales, los ninos tenian mas probabilidades de morir cuando sus cuidadores principales carecian de ayuda para preparar las comidas (OR: 2,3; IC95%: 1,2-4,1), no disponian de nadie con quien distenderse (OR: 1,8; IC95%: 1,1-2,9), no tenian a nadie que pudiera ofrecerles buenos consejos (OR: 23,1; IC95%: 4,3-123,4), no podian influir apenas en las decisiones de gasto det dinero ganado (OR: 12,7; IC95%: 1,3-127,6), no podian reducir el gasto en atencion de salud (OR: 2,5; IC95%: 1,5-4,2) o tenian que desempenar trabajos poco corrientes para pagar la atencion (OR: 3,4; IC95%: 2,1-5,5). Un efecto protector rue que el cuidador tuviera que ocuparse tambien de otros ninos (OR: 0,2; IC95%: 0,1-0,5). Conclusion La mejora del acceso a la atencion sanitaria para les ninos de Gambia y entornos similares no estriba simplemente en reducir el tiempo de viaje y la distancia a les centros de salud. Es preciso mejorar las redes de apoyo a les cuidadores y su acceso a les recursos financieros que necesitan., Une traduction en francais de ce resume figure a, la fin de l'article. Al final de/articulo se facilita una traduccion al espanol Introduction Every year approximately 10 million children under [...]

Background Tuberculous sputum provides a sample of bacilli that must be eliminated by chemotherapy and that may go on to transmit infection. A preliminary observation that Mycobacterium tuberculosis cells contain triacylglycerol lipid bodies in sputum, but not when growing in vitro, led us to investigate the extent of this phenomenon and its physiological basis. Methods and Findings Microscopy-positive sputum samples from the UK and The Gambia were investigated for their content of lipid body-positive mycobacteria by combined Nile red and auramine staining. All samples contained a lipid body-positive population varying from 3% to 86% of the acid-fast bacilli present. The recent finding that triacylglycerol synthase is expressed by mycobacteria when they enter in vitro nonreplicating persistence led us to investigate whether this state was also associated with lipid body formation. We found that, when placed in laboratory conditions inducing nonreplicating persistence, two M. tuberculosis strains had lipid body levels comparable to those found in sputum. We investigated these physiological findings further by comparing the M. tuberculosis transcriptome of growing and nonreplicating persistence cultures with that obtained directly from sputum samples. Although sputum has traditionally been thought to contain actively growing tubercle bacilli, our transcript analyses refute the hypothesis that these cells predominate. Rather, they reinforce the results of the lipid body analyses by revealing transcriptional signatures that can be clearly attributed to slowly replicating or nonreplicating mycobacteria. Finally, the lipid body count was highly correlated ([R.sup.2] = 0.64, p < 0.03) with time to positivity in diagnostic liquid cultures, thereby establishing a direct link between this cytological feature and the size of a potential nonreplicating population. Conclusion As nonreplicating tubercle bacilli are tolerant to the tidal action of antibiotics and resistant to multiple stresses, identification of this persister-like population of tubercle bacilli in sputum presents exciting and tractable new opportunities to investigate both responses to chemotherapy and the transmission of tuberculosis., Introduction Mycobacterium tuberculosis infects one in three worldwide and kills more people each year than any other bacterial pathogen. Routine treatment of tuberculosis requires combination antibiotic therapy for a minimum [...]

Objective In 2000, a referral hospital in the Gambia accepted a donation of oxygen concentrators to help maintain oxygen supplies. The concentrators broke down and were put into storage. A case study was done to find the reasons for the problem and to draw lessons to help improve both oxygen supplies and the success of future equipment donations. Methods A technical assessment of the concentrators was carried out by a biomedical engineer with relevant expertise. Semistructured interviews were undertaken with key informants, and content analysis and inductive approaches were applied to construct the history of the episode and the reasons for the failure. Findings Interviews confirmed the importance of technical problems with the equipment. They also revealed that the donation process was flawed, and that the hospital did not have the expertise to assess or maintain the equipment. Technical assessment showed that all units had the wrong voltage and frequency, leading to overheating and breakdown. Subsequently a hospital donations committee was established to oversee the donations process. On-site biomedical engineering expertise was arranged with a nongovernmental organization (NGO) partner. Conclusion Appropriate donations of medical equipment, including oxygen concentrators, can be of benefit to hospitals in resource-poor settings, but recipients and donors need to actively manage donations to ensure that the donations are beneficial. Success requires planning, technical expertise and local participation. Partners with relevant skills and resources may also be needed. In 2002, WHO produced guidelines for medical equipment donations, which address problems that might be encountered. These guidelines should be publicized and used. Resume Objectif En 2000, un hopital specialise de Gambie a accepte un don de concentrateurs d&apos;oxygene destine a I&apos;aider a maintenir ses approvisionnements en oxygene. Ces concentrateurs sont tombes en panne et ont ete ensuite entreposes. On a alors realise une etude de cas pour trouver les raisons de ce probleme et en tirer des lecons en vue d&apos;un meilleur approvisionnement en oxygene et d&apos;un plus grand succes des dons d&apos;equipements futurs. Methodes Une evaluation technique des concentrateurs a ete realisee par un ingenieur biomedical disposant des competences necessaires. Des entretiens semi-structures ont ete menes avec des informateurs cles, suivis d&apos;une analyse de leur contenu et de I&apos;application d&apos;une demarche inductive visant a reconstituer I&apos;histoire de I&apos;episode et les raisons de son echec. Resultats Les entretiens ont confirme I&apos;importance des problemes techniques affectant les equipements. lis ont aussi revele que le processus de don avait ete mal organise et que I&apos;hopital ne disposait pas des competences necessaires pour evaluer et entretenir ces equipements. L&apos;evaluation technique a aussi montre qu&apos;aucune des unites hospitalieres n&apos;avait la tension et la frequence de reseau voulues, d&apos;ou des surchauffes et des pannes. Par la suite, un comite sur les dons a ete mis en place au sein de I&apos;hopital pour surveiller les processus de donation. Des competences en ingenierie biomedicale ont ete mises en place dans I&apos;hopital par une organisation non gouvernementale (ONG). Conclusion Des dons appropries d&apos;equipements, et notamment de concentrateurs d&apos;oxygene, peuvent etre tres utiles aux hopitaux des pays a faible revenu, mais les destinataires et les donateurs doivent gerer activement ces operations pour s&apos;assurer qu&apos;elles soient benefiques. Pour reussir, ces operations necessitent une planification, des competences techniques et une participation locale. On peut egalement avoir besoin de partenaires apportant des competences et des ressources appropriees. En 2002, I&apos;OMS a elabore des recommandations a propos des dons d&apos;equipements medicaux, qui traitent des problemes pouvant se presenter. Ces recommandations doivent etre publiees et utilisees. Resumen Objetivo En 2000, un hospital de referencia de Gambia acepto una donacion de concentradores de oxigeno para poder garantizar mejor el suministro de oxigeno, pero los aparatos se averiaron y tuvieron que ser almacenados. Se realizo un estudio de casos para determinar las razones del problema y extraer lecciones a fin de ayudar a mejorar tanto el suministro de oxigeno como la eficacia de las futuras donaciones de equipo. Metodos Un ingeniero biomedico dotado de los conocimientos tecnicos pertinentes realizo una evaluacion tecnica de los concentradores. Se Ilevaron a cabo entrevistas semiestructuradas con informantes clave, y se aplicaron tecnicas de analisis del contenido y enfoques inductivos para reconstruir la historia del episodio y las razones del fracaso. Resultados Las entrevistas confirmaron la importancia de los problemas tecnicos que presentaba el equipo, pero tambien revelaron que habia habido fallos en el proceso de donacion y que el hospital carecia de los conocimientos tecnicos necesarios para evaluar y mantener el equipo. La evaluacion tecnica mostro que en todas las unidades el voltaje y la frecuencia habian sido incorrectos, con el consiguiente recalentamiento y averia de los aparatos. Posteriormente se establecio un comite de donaciones hospitalarias para supervisar el proceso de las donaciones, y se organizo un sistema de asesoramiento especializado de ingenieria biomedica in situ con una organizacion no gubernamental (ONG) asociada. Conclusion Las donaciones de equipo medico, incluidos los concentradores de oxigeno, pueden ser una opcion muy util para los hospitales de los entornos con recursos escasos, pero tanto los beneficiarios como los donantes han de saber gestionar activamente las donaciones para garantizar que sean provechosas, y eso exige planificacion, conocimientos especializados y participacion local. A veces se necesitan tambien asociados que posean las aptitudes y los recursos oportunos. En 2002 la OMS elaboro unas directrices para la donacion de equipo medico, en las que se abordan los problemas que pueden plantearse. Dichas directrices deberian ser divulgadas y utilizadas. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction Health services in developing countries often struggle to meet the demands of a high burden of illness in their communities. (1) Health facilities conspicuously lack technology and it is [...]

ABSTRACT Background Very little longitudinal information is available regarding the performance of T cell-based tests for Mycobacterium tuberculosis infection. To address this deficiency, we conducted a longitudinal assessment of the [...]

OBJECTIVE. To compare the enzyme-linked immunospot (ELISPOT) assay with the tuberculin skin test (TST) in children for the diagnosis of Mycobacterium tuberculosis infection in the Gambia. METHODS. We divided child contacts of sputum smear-positive tuberculosis cases into 3 age categories ( RESULTS. In child contacts of 287 cases, 225 (32.5%) of 693 were positive by TST and 232 (32.3%) of 718 by ELISPOT. The overall agreement between tests was 83% and the discordance was not significant. Both tests responded to the M tuberculosis exposure gradient in each age category. The percentage of those who were TST positive/ELISPOT negative increased with increasing exposure. At the lowest exposure level, the percentage of ELISPOT-positive children who were TST negative was increased compared with the highest exposure level. Neither test had evidence of false positive results because of BCG. CONCLUSIONS. In Gambian children, the ELISPOT is slightly less sensitive than the TST in the diagnosis of M tuberculosis infection from recent exposure, and neither test is confounded by prior BCG vaccination. Evidence of reduced TST sensitivity in subjects with the lowest known recent M tuberculosis exposure suggests that, when maximal sensitivity is important, the 2 tests may be best used together. Key Words tuberculin skin test, ELISPOT, tuberculosis, Mycobacterium tuberculosis, Abbreviations TST--tuberculin skin test BCG--Bacille Calmette Guerin ESAT-6--early secretory antigenic target 6 CFP-10--culture filterate protein 10 ELISPOT--enzyme-linked immunospot MRC--Medical Research Council SFU--spot forming units OR--odds ratio CI--confidence interval TUBERCULOSIS IN [...]

Research has been conducted on the intracellular lipophilic inclusions in Mycobacterium smegmatis. The factors affecting these inclusions and the hypothesis that these factors could be formed via fatty acid uptake either directly or biosynthetically have been investigated and the results are reported.

Introduction and Rationale The introduction of routine immunisation with pneumococcal conjugate vaccines (PCVs) in developing countries is expected to significantly reduce childhood deaths [1]. The 7-valent pneumococcal conjugate vaccine (PCV-7), [...]

Background: Introduction of pneumococcal conjugate vaccines (PCVs) of limited valency is justified in Africa by the high burden of pneumococcal disease. Long-term beneficial effects of PCVs may be countered by serotype replacement. We aimed to determine the impact of PCV-7 vaccination on pneumococcal carriage in rural Gambia. Methods and Findings: A cluster-randomized (by village) trial of the impact of PCV-7 on pneumococcal nasopharyngeal carriage was conducted in 21 Gambian villages between December 2003 to June 2008 (5,441 inhabitants in 2006). Analysis was complemented with data obtained before vaccination. Because efficacy of PCV-9 in young Gambian children had been shown, it was considered unethical not to give PCV-7 to young children in all of the study villages. PCV-7 was given to children below 30 mo of age and to those born during the trial in all study villages. Villages were randomized (older children and adults) to receive one dose of PCV-7 (11 vaccinated villages) or meningococcal serogroup C conjugate vaccine (10 control villages). Cross-sectional surveys (CSSs) to collect nasopharyngeal swabs were conducted before vaccination (2,094 samples in the baseline CSS), and 4-6, 12, and 22 mo after vaccination (1,168, 1,210, and 446 samples in CSS-1, -2, and -3, respectively). A time trend analysis showed a marked fall in the prevalence of vaccine-type pneumococcal carriage in all age groups following vaccination (from 23.7% and 26.8% in the baseline CSS to 7.1% and 8.5% in CSS-1, in vaccinated and control villages, respectively). The prevalence of vaccine-type pneumococcal carriage was lower in vaccinated than in control villages among older children (5 y to Conclusions: Vaccination of Gambian children reduced vaccine-type pneumococcal carriage across all age groups, indicating a 'herd effect' in non-vaccinated older children and adults. No significant serotype replacement was detected., Introduction The prevention of pneumococcal disease is a major international public health priority, especially in children in developing countries [1]. On the basis of a trial conducted in California in [...]

The genetic variability at six polymorphic loci was examined within a global collection of 502 isolates of subgroup III, serogroup A Neisseria meningitidis. Nine 'genoclouds' were identified, consisting of genotypes that were isolated repeatedly plus 48 descendent genotypes that were isolated rarely. These genoclouds have caused three pandemic waves of disease since the mid-1960s, the most recent of which was imported from East Asia to Europe and Africa in the mid-1990s. Many of the genotypes are escape variants, resulting from positive selection that we attribute to herd immunity. Despite positive selection, most escape variants are less fit than their parents and are lost because of competition and bottlenecks during spread from country to country. Competition between fit genotypes results in dramatic changes in population composition over short time periods.