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Background: This serological study conducted between March and July 2015 investigated the status of onchocerciasis in Ogun State, Nigeria after a decade of mass drug administration (MDA) with ivermectin. Baseline information from the rapid epidemiological mapping of onchocerciasis (REMO) prior to MDA had indicated that Ogun State was meso-endemic to onchocerciasis. Following years of treatment with ivermectin, it has become important to investigate the current status of the disease using more sensitive diagnostic methods.Methods: The study was conducted in 32 communities in eight onchocerciasis-endemic local government areas (LGAs). Using the Ov16 rapid diagnostic test (Ov16 RDT), finger-prick whole blood was obtained from 3 895 consented participants from age five and above. Skin snips were obtained from a subset of 481 corresponding participants as the majority of community members did not consent to skin snipping.Results: Study revealed a cumulative seroprevalence of 9.3% (CI 9.29–9.31%) by RDT and 17.3% (CI 16.73–18.34%) microfilaridermia prevalence by the skin snip subset. Seroprevalence among children between the ages of five and nine was 2.9% (CI 1.74–3.53%) across all LGAs. A community microfilaria load (CMFL) between 0 and 1.21 MF/skin snip was recorded in the different communities studied. Among the studied LGAs, children in Odeda LGA recorded the highest seroprevalence by RDT (14.9%) followed by Abeokuta North (5.1%), Abeokuta South (4.8%) and Imeko-Afon (0.6%), while Ewekoro, Ifo, Obafemi-Owode and Yewa North LGAs recorded zero prevalence.Conclusion: It appears that the elimination of onchocerciasis in some LGAs is possible considering the lack of new infection among children and the hypo-endemicity among the adult population. However, the microfilaria prevalence observed among adults is of concern as it may imply that mass treatment has not been effective. Increased therapeutic coverage is advised to fully maximise the potential of ivermectin treatment to achieve the disease elimination.

IntroductionPneumonia is the leading cause of death from infection in children worldwide. Despite global treatment recommendations that call for children with pneumonia to receive amoxicillin dispersible tablets, only one-third of children with pneumonia receive any antibiotics and many do not complete the full course of treatment. Poor adherence to antibiotics may be driven in part by a lack of user-friendly treatment instructions.ObjectiveIn order to optimise childhood pneumonia treatment adherence at the community level, we developed a user-friendly product presentation for caregivers and a job aid for healthcare providers (HCPs). This paper aims to document the development process and offers a model for future health communication tools.MethodsWe employed an iterative design process that included document review, key stakeholder interviews, engagement with a graphic designer and pre-testing design concepts among target users in India and Kenya. The consolidated criteria for reporting qualitative research were used in the description of results.ResultsThough resources for pneumonia treatment are available in some countries, their content is incomplete and inconsistent with global recommendations. Document review and stakeholder interviews provided the information necessary to convey to caregivers and recommendations for how to present this information. Target users in India and Kenya confirmed the need to support better treatment adherence, recommended specific modifications to design concepts and suggested the development of a companion job aid. There was a consensus among caregivers and HCPs that these tools would be helpful and improve adherence behaviours.ConclusionsThe development of user-friendly instructions for medications for use in low-resource settings is a critically important but time-intensive and resource-intensive process that should involve engagement with target audiences.

BACKGROUND: Even though the WHO-endorsed, non-commercial MODS assay offers rapid, reliable TB liquid culture and phenotypic drug susceptibility testing (DST) at lower cost than any other diagnostic, uptake has been patchy. In part this reflects misperceptions about in-house assay quality assurance, but user convenience of one-stop procurement is also important. A commercial MODS kit was developed by Hardy Diagnostics (Santa Maria, CA, USA) with PATH (Seattle, WA, USA) to facilitate procurement, simplify procedures through readymade media, and enhance safety with a sealing silicone plate lid. Here we report the results from a large-scale field evaluation of the MODS kit in a government service laboratory. METHODS & FINDINGS: 2446 sputum samples were cultured in parallel in Lowenstein-Jensen (LJ), conventional MODS and in the MODS kit. MODS kit DST was compared with conventional MODS (direct) DST and proportion method (indirect) DST. 778 samples (31.8%) were Mycobacterium tuberculosis culture-positive. Compared to conventional MODS the sensitivity, specificity, positive, and negative predictive values (95% confidence intervals) of the MODS Kit were 99.3% (98.3-99.8%), 98.3% (97.5-98.8%), 95.8% (94.0-97.1%), and 99.7% (99.3-99.9%). Median (interquartile ranges) time to culture-positivity (and rifampicin and isoniazid DST) was 10 (9-13) days for conventional MODS and 8.5 (7-11) for MODS Kit (p

Introduction Maternal infections continue to be a major contributor to maternal, perinatal, and neonatal morbidity and mortality. The use of diagnostic technologies for maternal infections in the developing world is poorly researched. The current study aimed to elucidate the provider- and patient-level factors that may act to inhibit or encourage timely and effective provision of diagnostic technologies during the pregnancy, intrapartum, and early postpartum periods for infections linked with poor outcomes for mothers and infants in the developing world. Methodology This was an exploratory study that employed a socio-ecological framework. Using qualitative data collection methods, including focus group discussions (FGDs) with pregnant women, new mothers and their families, and in-depth interviews (IDIs) with lower-level providers, we examined health-seeking behaviours and perceptions of diagnostic testing during pregnancy with the aim of obtaining an in-depth understanding of factors related to the potential for uptake of new diagnostic technologies in two developing country settings (Bangladesh and Uganda). Results Diagnostic testing during ANC was generally viewed positively. Findings suggest that women and their families would prefer any proposed diagnostic tests be administered by skilled and trained providers. Communities expressed reservations in providing biological specimens during labour and the immediate postpartum period with discomfort and pain during labour and postpartum confinement cited as reasons for these preferences. Blood and urine were deemed the most acceptable specimens, and vaginal swabs were generally not viewed favourably. While providers were familiar with the concept of diagnostic testing, there is limited use of diagnostics in maternal health care, with HIV testing in Uganda being a notable exception. While providers saw definite advantages of diagnostic testing in terms of patient management, they also expressed reservations about the additional work load this would necessitate. Conclusions There are high levels of receptivity for diagnostic testing among providers and communities with certain caveats regarding specimens and timing.

Background Diagnostics provide a means to measure progress toward disease elimination. Many countries in Africa are approaching elimination of onchocerciasis after successful implementation of mass drug administration programs as well as vector control. An understanding of how markers for infection such as skin snip microfilaria and Onchocerca volvulus-specific seroconversion perform in near-elimination settings informs how to best use these markers. Methods All-age participants from 35 villages in Togo were surveyed in 2013 and 2014 for skin snip Onchocerca volvulus microfilaria and IgG4 antibody response by enzyme-linked immunosorbent assay (ELISA) to the Onchocerca volvulus-specific antigen Ov16. A Gaussian mixture model applying the expectation-maximization (EM) algorithm was used to determine seropositivity from Ov16 ELISA data. For a subset of participants (n = 434), polymerase chain reaction (PCR) was performed on the skin snips taken during surveillance. Results Within the 2,005 participants for which there was Ov16 ELISA data, O. volvulus microfilaremia prevalence and Ov16 seroprevalence were, 2.5 and 19.7 %, respectively, in the total population, and 1.6 and 3.6 % in children under 11. In the subset of 434 specimens for which ELISA, PCR, and microscopy data were generated, it was found that in children under 11 years of age, the anti-Ov16 IgG4 antibody response demonstrate a sensitivity and specificity of 80 and 97 %, respectively, against active infections as determined by combined PCR and microscopy on skin snips. Further analysis was performed in 34 of the 35 villages surveyed. These villages were stratified by all-age seroprevalence into three clusters: < 15 %; 15–20 %; and > 20 %. Age-dependence of seroprevalence for each cluster was best reflected by a two-phase force-of-infection (FOI) catalytic model. In all clusters, the lower of the two phases of FOI was associated with a younger age group, as reflected by the seroconversion rates for each phase. The age at which transition from lower to higher seroconversion, between the two phases of FOI, was found to be highest (older) for the cluster of villages with