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BackgroundThe COVID-19 pandemic, caused by SARS-CoV-2, continues to impact health systems throughout the world with serious medical challenges being imposed on many African countries like Nigeria. Although emerging studies have identified lymphopenia as a driver of cytokine storm, disease progression, and poor outcomes in infected patients, its immunopathogenesis, as well as environmental and genetic determinants, remain unclear. Understanding the interplay of these determinants in the context of lymphopenia and COVID-19 complications in patients in Africa may help with risk stratification and appropriate deployment of targeted treatment regimens with repurposed drugs to improve prognosis. ObjectiveThis study is designed to investigate the role of vitamin D status, vasculopathy, apoptotic pathways, and vitamin D receptor (VDR) gene polymorphisms in the immunopathogenesis of lymphopenia among African people infected with SARS-CoV-2. MethodsThis cross-sectional study will enroll 230 participants, categorized as “SARS-CoV-2 negative” (n=69), “COVID-19 mild” (n=32), “hospitalized” (n=92), and “recovered” (n=37), from two health facilities in Lagos, Nigeria. Sociodemographic data, travel history, and information on comorbidities will be obtained from case files and through a pretested, interview-based structured questionnaire. Venous blood samples (5 mL) collected between 8 AM and 10 AM and aliquoted into EDTA (ethylenediaminetetraacetic acid) and plain tubes will be used for complete blood count and CD4 T cell assays to determine lymphopenia (lymphocyte count

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: Rare coexistence of disease or pathology Background: Bacterial Infections, especially, of the respiratory system, have been reported as one of the medical concerns in patients with the Coronavirus Disease-2019 (COVID-19), particularly those with multiple co-morbidities. We present a case of a diabetic patient with co-infection of multi-drug-resistant Kocuria rosea and methicillin-resistant Staphylococcus aureus (MRSA) who contracted COVID-19. Case Report: A 72-year-old man with diabetes presented with symptoms including cough, chest pain, urinary incontinence, respiratory distress, sore throat, fever, diarrhea, loss of taste, and anosmia and was confirmed to have COVID-19. At admission, he was also found to have sepsis. MRSA was isolated in conjunction with another organism, resembling coagulase-negative Staphylococcus, which was misidentified using commercial biochemical testing systems. The strain was finally confirmed to be Kocuria rosea by 16S rRNA gene sequencing. Both strains were highly resistant to multiple classes of antibiotics, but the Kocuria rosea was resistant to all the cephalosporins, fluoroquinolones, and macrolides tested. The use of ceftriaxone and ciprofloxacin did not improve his condition, which ultimately led to his death. Conclusions: This case report shows that the presence of multi-drug-resistant bacteria infections can be fatal in patients with COVID-19, especially in patients with other co-morbidities like diabetes. This case report also shows that biochemical testing may be inadequate in identifying emerging bacterial infections and there is a need to include proper bacterial screening and treatment in the management of COVID-19, especially in patients with other co-morbidities and with indwelling devices. [ABSTRACT FROM AUTHOR]

Data on spatiotemporal distribution of rotavirus diarrhea are limited in many endemic settings. This study determined the prevalence and seasonal distribution of rotavirus among Nigerian children with diarrhea. Here, a total of 406 fecal samples were collected from patients attending six health facilities in Lagos between January – December 2019. Socio-demographic data of each enrolled child were collected. Rotavirus VP6 antigen was detected by enzyme-linked immunoassay (ELISA) and confirmation by VP7 gene detection by reverse transcription polymerase-chain reaction. The overall rotavirus diarrhea prevalence was 16.3% by ELISA with children above 2 years having 29.2% of this prevalence and higher occurrence in females (59.1%) than males (40.9%) (P <.05). Rotavirus diarrhea diagnosis using RT-PCR showed 100% concordance with ELISA. Cases of rotavirus diarrhea were detected from March to July and from September to November with the highest number of cases detected in May and June (22.7% each), followed by July (21.2%). The prevalence of rotavirus diarrhea remains high in Lagos with an emerging higher disease activity in children above 2. A different rotavirus transmission dynamics compared to previous studies from Nigeria and other African countries was found. VP6 ELISA may reliably be used for continuous rotavirus surveillance in Nigeria. [ABSTRACT FROM AUTHOR]

Background Invasive bacterial diseases (IBD) cause significant mortality in young infants. There are limited population-based data on IBD in young infants in Sub-Saharan Africa. Methods We conducted population-based surveillance for IBD among infants aged 0-90 days in a demographic surveillance area in rural Gambia between 1 March 2011 and 31 December 2017. Infants admitted to health facilities within the study area had standardised clinical evaluation plus conventional microbiological investigation. We defined IBD as isolation of pathogenic bacteria from blood, cerebrospinal fluid, lung, or pleural aspirate. We determined incidence, aetiology and case-fatality of IBD. Results A total of 3794 infants were admitted and 3605 (95%) had at least one sample collected for culture. We detected 254 (8.0%) episodes of IBD (bacteraemia 241; meningitis 14; pneumonia seven). The incidence of IBD in infants aged 0-90 days was 25 episodes/1000 person-years (95% confidence interval (CI) = 22-28), the incidence in neonates was 50 episodes/1000 person-years (95% CI = 43-58) and the incidence in infants aged 29-90 days was 12 episodes/1000 person-years (95% CI = 9-15). The most common pathogens causing IBD were Staphylococcus aureus (n = 102, 40%), Escherichia coli (n = 37, 15%), Streptococcus pneumoniae (n = 24, 9%) and Klebsiella pneumoniae (n = 12, 5%). Case-fatality was 29% (95% CI = 23-37) in neonates and 19% (95% CI = 11-29) in infants aged 29-90 days. A minimum of 7.3% of all young infant deaths in the population were caused by IBD. Conclusions IBD are common in young infants in rural Gambia and have a high case-fatality. Strategies are needed to prevent IBD in young infants. Overcoming barriers to widespread implementation of existing vaccines and developing new vaccines against the most common pathogens causing IBD should be among top priorities for reducing the high mortality rate in young infants. [ABSTRACT FROM AUTHOR]

Invasive group A streptococcal (Strep A) infections occur when Streptococcus pyogenes , also known as beta-hemolytic group A Streptococcus , invades a normally sterile site in the body. This article provides guidelines for establishing surveillance for invasive Strep A infections. The primary objective of invasive Strep A surveillance is to monitor trends in rates of infection and determine the demographic and clinical characteristics of patients with laboratory-confirmed invasive Strep A infection, the age- and sex-specific incidence in the population of a defined geographic area, trends in risk factors, and the mortality rates and rates of nonfatal sequelae caused by invasive Strep A infections. This article includes clinical descriptions followed by case definitions, based on clinical and laboratory evidence, and case classifications (confirmed or probable, if applicable) for invasive Strep A infections and for 3 Strep A syndromes: streptococcal toxic shock syndrome, necrotizing fasciitis, and pregnancy-associated Strep A infection. Considerations of the type of surveillance are also presented, noting that most people who have invasive Strep A infections will present to hospital and that invasive Strep A is a notifiable disease in some countries. Minimal surveillance necessary for invasive Strep A infection is facility-based, passive surveillance. A resource-intensive but more informative approach is active case finding of laboratory-confirmed Strep A invasive infections among a large (eg, state-wide) and well defined population. Participant eligibility, surveillance population, and additional surveillance components such as the use of International Classification of Disease diagnosis codes, follow-up, period of surveillance, seasonality, and sample size are discussed. Finally, the core data elements to be collected on case report forms are presented. [ABSTRACT FROM AUTHOR]

Background: The introduction in many countries of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited. Methods: Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators. Results: We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the <2-month age group, 56 per 100,000 in the 2–23-month age group, but lower at 5 per 100,000 in the 5–14-year age group. The most common causes of ABM were Streptococcus pneumoniae (n = 44), Neisseria meningitidis (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49/169) and was highest in the <2-month age group 37% (10/27). The case fatality ratio was 8.6% (18/209) for suspected non-bacterial meningitis and 12.8% (134/1049) for clinically suspected meningitis cases. Conclusions: Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care. [ABSTRACT FROM AUTHOR]

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 [...]