Search

Team Gambia EMPA 2023 Poster

Presentation The Gambia EMPA 2023

Background: The role of the germline in epigenetic transgenerational inheritance starts with environmental factors, acting on the first generation of a gestating mother. These factors influence the developing second-generation fetus by altering gonadal development, thereby reprogramming the primordial germ cell DNA methylation and leading to consequences that might be seen along generations. Objective: Despite these epigenetic factors now surfacing, the few available studies are on animal-based experiments, and conducting a follow-up on human intergenerational trials might take decades. To this response, this study aimed to determine the influence of parental energy, toxicant exposure, age, and nutrient restriction on the early life of offspring growth in Gambia. Method: This pilot study was based on population observation and combined both maternal and paternal factors across the country between August and October 2021. It captures the lifestyle and health detailed account of 339 reproductive parents and their last born (child under 5 years) using a structured interview questionnaire performed by nurses and public health officers. Results: This study showed that parents who worked in industrial areas were more likely to have offspring with poor psychosocial skills. In addition, mothers who are exposed to oxidative stress and high temperatures are more likely to have offspring with poor psychosocial skills. Mothers who consume a high-protein diet were almost three times more likely to have infants with good psychosocial skills in their offspring. Furthermore, there was a negative correlation between maternal stress during pregnancy and the psychosocial skills of offspring. Conclusion: This study was able to ascertain if the maternal diet during gestation, toxicant exposure, maternal stress, and parental smoking habits have an influence on the early life of offspring. While the study recommends a large sample size study to eliminate selection bias, there should be an increased level of awareness of mothers of their offspring’s health and their husbands’ lifestyles that might influence the adulthood health of their offspring.

Background Snakebites affect about 5.4 million people worldwide resulting in over 137,880 deaths per year. In Sub-Saharan Africa, the incidence of snakebite cases is generally underestimated despite the adverse effect of snakebite when it occurs. We therefore conducted this study to describe the incidence of snakebites in the North Bank West Region of the Gambia. Methods We reviewed snakebite surveillance data from 2017 to 2021 as recorded in health facility registers in North Bank West Region of The Gambia. Variables extracted were age, sex, date reported, health facility name, district of residence, and case outcome. We summarized the data by person, place, and time and results were presented using frequencies and proportions in tables, charts, graphs and maps. Results A total of 197 cases were reported, the median age was 20 (IQR:13–30) years, and males were 69.0% (136/197). 35.0% (69/197) of snakebite victims were between age group 10–19 years of age. The 5-year incidence rate was 31 snakebite cases per 100,000 population with a case fatality ratio of 4.1%. Jokadou District recorded the highest number of incidences (14 cases per 10,000) in 2017. 72.6% (143/197) of the snakebites occurred during the rainy season (June-October). The year 2020 recorded the highest incidence of snakebite in the region, 59 snakebite cases per 100,000 population. Conclusion There was a high incidence of snakebite cases recorded and Jokadou District recording the highest with the peak occurring during the rainy season. We recommend that the Regional Health Directorate work with health facilities to regularly organize health education activities for the communities, especially during the start of the rainy season.

Background: The trends in the role of the germline in epigenetic transgenerational inheritance starts with the environmental factors acting on the first generation of a gestating mother. These factors influence the developing second-generation fetus by altering gonadal development, thereby reprogramming the primordial germ cell DNA methylation and leading to consequences that would be seen along generations. Objective: Despite these epigenetic factors now surfacing, the few available studies are on animal-based experiments and to make follow up on human intergenerational trials might take decades. To this response, this study aimed to determine the influence of parental energy, toxicant exposure, age and nutrient restriction on the early life of offspring growth in Gambia. Method: The study was on population-based observational study on parental energy influence, toxicant exposure, age, and nutrient restriction on offspring growth in Gambia. Results: This study showed that parents who worked in industrial areas were more likely to have offspring with poor psychosocial skills. In addition, mothers who are exposed to oxidative stress and high temperature are more likely to have offspring with poor psychosocial skills. Mothers who consumed a high protein diet were almost three more likely to have infants with good psychosocial skills in their offspring. Furthermore, there was a negative correlation between maternal stress during pregnancy and psychosocial skills of offspring. Conclusion: This study was able ascertain if maternal diet during gestation, toxicant exposure, maternal stress and parental smoking habits have influence on the early life of offspring. While the study is recommending a large sample size study to eliminate selection bias, there should be an increased level of awareness of mothers on their offspring's health and their husbands' lifestyles that might influence the adulthood health of offspring.

Introduction:accurate and timely laboratory diagnosis of yellow fever (YF) is critical to the Eliminate Yellow Fever Epidemics (EYE) strategy. Gavi, the Vaccine Alliance recognized the need to support and build capacity in the national and regional laboratories in the Global YF Laboratory Network (GYFLN) as part of this strategy. Methods:to better understand current capacity, gaps and needs of the GYFLN laboratories in Africa, assessments were carried out in national and regional reference laboratories in the 25 African countries at high risk for YF outbreaks that were eligible for new financial support from Gavi. Results:the assessments found that the GYFLN in Africa has high capacity but 21% of specimens were not tested due to lack of testing kits or reagents and approximately 50% of presumptive YF cases were not confirmed at the regional reference laboratory due to problems with shipping. Conclusion:the laboratory assessments helped to document the baseline capacities of these laboratories prior to Gavi funding to support strengthening YF laboratories.

Background: Innovation has been recognized by most firms as critical for the development of novel or improved products, processes, and services to remain competitive. In light of the importance of Industry-University collaborations (IUCs) towards enhancing the competitive advantage of firms via innovation, it is vital to ensure successful outcomes of IUCs. Objectives: The objectives of this paper are: (i) to determine whether national cultural values impact the innovation performance of IUCs, (ii) to determine the effects of the differences in national cultural values between the industry and university partners on the innovation performance of IUCs, and (iii) to determine the effects of geographical proximity on the innovation performance of IUCs.

The introductions of advanced antibiotics have triggered complex versions of resistant genes in gram-negative bacteria. In a generation witness limited discovery of antibiotics makes this phenomenon a major public health threat. This study aims to establish the fecal carriage rate of multidrug-resistant Enterobacteriaceae strains among food handlers. Data was extracted from a prospective cross-sectional study – ‘Prevalence and risk factors of fecal carriage of Extended Spectrum β-Lactamase producing Enterobacteriaceae amongst food handlers in Lower Basic Schools in West Coast region of The Gambia. The study enrolled 600 randomly selected food handlers (565 of which had complete data set) from 60 lower basic schools in 7 districts in the West Coast Region of The Gambia. Stool samples were collected from the participants and screened for resistance to cefotaxim. Isolated organisms were further tested for susceptibility to cephalosporins, carbapenems, fluoroquinolones and other families of antimicrobials as per Clinical Standard Laboratory Institute guidelines. The association of risk factors to fecal carriage of resistant Enterobacteriacea was performed using Pearson Chi squared and fishers exact (P Results confirmed that the prevalence of Enterobacteriaceae by resistance to cefotaxime was 15.8%. 23 genus and 89 species of resistant strains were isolated. All isolates were 100% resistant to cephalosporins such as ceftriazone, cefotaxime and cefuroxime, except ceftazidime (92%). Resistance to ciprofloxacin (fluoroquinolone) was measured at 50%. Only 1.2% was resistant to imipenem (carbapenem). Most isolates were resistant to ampicillin, nitrofurantoine, erythromycin, tetracycline and cotrimaxole. Majority of the identified Enterobacteriaceae wereEnterobacter aerogene(14%),Klebsiella pneumoniea(12%) andEscherichia coli(7%). This study found a high prevalence of fecal carriage multi-drug resistant Enterobacteriaceae among food handlers, mostly women, in The Gambia. The irrational prescription and use of antibiotics is a major risk factor for the proliferation of antibiotic resistance. Well-conducted surveillance is essential to implement effective control measures for the spread of antibiotic resistance urgently receommended.

The COVID-19 pandemic poses risks to African trade. It has contributed to sharp falls in the prices of Africa’s top export products and reduced trade with the region’s top trading partners. Measures to contain it could impact the region’s trade finance market as well. Falling export revenues and deteriorating balance sheets due to the pandemic could limit access to foreign exchange liquidity. This has the potential to increase trade finance rejection rates, particularly for SMEs, and increase the trade finance gap. Because trade finance transactions are largely paper-based, limited in-person interactions could also hinder banks’ ability to better conduct due diligence. This could slow down trade finance approval rates and decrease the supply of bank-intermediated trade finance. The crisis calls for emergency facilities such as trade finance lines of credit and risk-mitigation instruments ear-marked for trade related transactions, particularly for SMEs. Regulators could also work with banks to put in place temporary measures to allow digital processing and transmission of trade finance transactions.

Full Bayes Markov Chain Multi Carlo (MCMC) and Penalised Structured Additive Regression (STAR) models were compared for an underenutrition (measured as stunting) study in Zambia. Spatial correlated effects were specified as a Markov random field prior, continuous covariates were modelled using Bayesian penalised splines and diffused priors were assigned to fixed effects. A Bayesian Structured Additive Regression Model was developed for the Zambia data. Model estimation and inference was based on both fully Bayesian MCMC and Empirical Bayes (based on mixed method methodology). In a frequentist setting, EB inference is closely related to penalized likelihood estimation. (Approximate) restricted maximum likelihood are used to estimate Variance components which correspond to inverse smoothing parameters. Both inference procedures were then compared based on the results from the Zambia study and were found to be very similar. The results indicate spatial variations in stunting among the districts of Zambia. Continuous covariates Age and BMI have a significant effect on stunting. There is also significant difference among the factors of all categorical variables except for mother's employment status where no difference was found in stunting between children of employed and unemployed mothers. Keywords: MCMC, STAR, Full Bayes, Empirical Bayes, spatial, continuous, categorical, model estimation, inference.

Enteroaggregative Escherichia coli (EAEC) cause acute and persistent diarrhea, mostly in children worldwide. Outbreaks of diarrhea caused by EAEC have been described, including a large outbreak caused by a Shiga toxin expressing strain. This study investigated the association of EAEC virulence factors with diarrhea in children less than 5 years. We characterized 428 EAEC strains isolated from stool samples obtained from moderate-to-severe diarrhea cases (157) and healthy controls (217) children aged 0–59 months recruited over 3 years as part of the Global Enteric Multicenter Study (GEMS) in The Gambia. Four sets of multiplex polymerase chain reaction were applied to detect 21 EAEC-virulence genes from confirmed EAEC strains that target pCVD432 (aatA) and AAIC (aaiC). In addition, Kirby-Bauer disc diffusion antimicrobial susceptibility testing was performed on 88 EAEC strains following Clinical Laboratory Standard Institute guidelines. We observed that the plasmid-encoded enterotoxin [odds ratio (OR): 6.9, 95% confidence interval (CI): 2.06–29.20, P < 0.001], aggregative adherence fimbriae/I fimbriae (aggA) [OR: 2.2, 95% CI: 1.16–4.29, P = 0.008], and hexosyltransferase (capU) [OR: 1.9, 95% CI 1.02–3.51, P = 0.028] were associated with moderate-to-severe diarrhea among children < 12 months old but not in the older age strata (> 12 months). Our data suggest that some EAEC-virulent factors have age-specific associations with moderate-to-severe diarrhea in infants. Furthermore, our study showed that 85% and 72% of EAEC strains tested were resistant to sulphamethoxazole-trimethoprim and ampicillin, respectively. Sulphamethoxazole-trimethoprim and ampicillin are among the first-line antibiotics used for the treatment of diarrhea in The Gambia.

Rotavirus is the leading cause of diarrhea in children5 years of age. In light of the implementation of rotavirus vaccines of limited valency, it is important to characterize the genotypic diversity of circulating rotavirus in sub-Saharan Africa.We collected stool samples from children 0-59 months of age who presented at the health centres as cases with moderate-to-severe diarrhea in the Upper River Region of The Gambia. Stool samples were also collected from age, sex and area-matched healthy controls. All stool samples were assayed for rotavirus antigens by enzyme-linked immunosorbent assay and genotyping was done using reverse transcriptase polymerase chain reaction.We enrolled 1029 cases and 1569 controls during the 3-year study period (2008-2010). The detection rate of rotavirus among the cases was 20% (204/1029) and 3% (42/1569) among controls. At least 18 genotypes were found and the predominant genotypes were G2P[6] (28%), G1P[8] (26%) and G1P[10] (10%). The rare identified genotypes (1%) were G2P[14], G8P[6], G9P[6] and G4P[10]. There was also a strong positive association between rotavirus infection and the dry season (odds ratio: 9.83, 95% confidence interval: 6.18-15.63, P0.001). A significant increase in the odds of rotavirus and G1P[8] detection with the use of untreated water and the presence of cats, rodents and cows in the child's residence was also found.This study provides important baseline data for the genotypes circulating before vaccine implementation. The wide diversity of genotypes circulating in The Gambia implies the need for vigilant effectiveness surveillance following the implementation of RotaTeq in August 2013.

BackgroundWith the endemic Mycobacterium africanum (Maf), West African laboratories use glycerol and pyruvate in separate LJ cultures (LJG and LJP) for isolation of MTBC. The aim of this work is to evaluate if combining both glycerol and pyruvate in a single LJ medium (LJGP) will lead to comparable growth characteristics and time to detection in comparison to LJG, LJP and MGIT 960.MethodTotal of 118 smear-positive sputum samples were processed using 4% NaOH-NALC decontamination method. The decontaminated samples were inoculated parallel on LJG, LGP, MGIT 960 and LJGP. Positive cultures were confirmed using Ziehl-Neelsen staining method. MTBC identification was done using the Capilia TBNeo kit and spoligotyping used for speciation.ResultsThe recovery rate for LJG, LJP, LJPG and MGIT was found to be 73.7% (87/118), 82.2% (96/118), 83.9% (99/118) and 93.2% (110/118) respectively. No significant agreement was observed between the LJPG and MGIT 960 with Kappa values of −0.105 (p-value=0.199). However, there was significant agreement between LJGP and LJG and LJP with Kappa value of 0736 (p-valueM. Bovis. LJGP have better Maf recovery rate, 85.3% (29/34) in comparison to MGIT 960, 79.4% (27/34), LJP, 76.5% (26/34) and LJG, 61.8% (21/34). Seven of the 8 MGIT negatives that were LJPG positive were M. africanum and 1 M. bovis.ConclusionLJPG has a better detection rate and time to positivity compared to LJG and LJP and was shown to have a better Maf recovery than other LJ methods and MGIT 960. It is evident that LJGP is a promising culture tool for Maf-endemic West African countries that will not only increase MTBC recovery rate in combination with MGIT, but also leads to better detection of Maf.

Introduction: Healthcare-associated infections (HAIs) are better documented in developed than in developing countries. There are emerging reports regarding the high frequency of HAIs in developing countries. We aimed to report an outbreak of an HAI caused by Serratia liquefaciens at a rural health center in The Gambia. Methodology: Following an abrupt increase in the isolation of S. liquefaciens in clinical samples, laboratory and clinical consumables, as well as staff, were screened for contamination with S. liquefaciens. Conventional microbiological techniques and biochemical identification tests were used. A phenotypic typing was achieved using the Kirby-Bauer antibiotic susceptibility method. Strategies to control the outbreak were implemented. Results: A total of 794 samples were processed during the outbreak; 44 (6%) grew S. liquefaciens. Five (25%) of the 20 suspected contaminated materials (hospital consumables and equipment) screened yielded growth of the organism. The primary source of the outbreak was hospital consumables. Three (7%) of the 44 infected children died with no other known cause than S. liquefaciens infection. Ninety-nine percent similarity of the antibiogram phenotypic typing suggests the isolates were from the same clonal origin. The outbreak was successfully controlled after the removal and sterilization of the respective contaminated fluids and equipment. Conclusions: This HAI was caused by poor practice in the preparation of medications for nebulization and intravenous infusion, hygiene practices, and a lack of awareness among staff about infection control. We recommend further studies to delineate the role played by HAIs in the developing world.