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Introduction In 2011, member states of the World Health Organization (WHO) Africa Regional Office (AFRO) resolved to eliminate Measles by 2020. Our study aims to assess The Gambia’s progress towards the set AFRO measles elimination target and highlight surveillance and immunisation gaps to better inform future measles prevention strategies. Material and methods A retrospective review of measles surveillance data for the period 2011–2019, was extracted from The Gambia case-based measles surveillance database. WHO—UNICEF national coverage estimates were used for estimating national level MCV coverage. Measles post campaign coverage survey coverage estimates were used to estimate national measles campaign coverage. Results One hundred and twenty-five of the 863 reported suspected cases were laboratory confirmed as measles cases. More than half (53.6%) of the confirmed cases have unknown vaccination status, 24% of cases were vaccinated, 52.8% of cases occurred among males, and 72.8% cases were among urban residents. The incidence of measles cases per million population was lowest (0) in 2011–2012 and highest in 2015 and 2016 (31 and 23 respectively). The indicator for surveillance sensitivity was met in all years except in 2016 and 2019. Children aged 5–9 years (Incidence Rate Ratio—IRR = 0.6) and residents of Central River region (IRR = 0.21) had lower measles risk whilst unvaccinated (Adjusted IRR = 5.95) and those with unknown vaccination status (IRR 2.21) had higher measles risk. Vaccine effectiveness was 89.5%. Conclusion The Gambia’s quest to attain measles elimination status by 2020 has registered significant success but it is unlikely that all target indicators will be met. Vaccination has been very effective in preventing cases. There is variation in measles risk by health region, and it will be important to take it into account when designing prevention and control strategies. The quality of case investigations should be improved to enhance the quality of surveillance for decision making.

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.

Background The poliovirus has been targeted for eradication since 1988. Kenya reported its last case of indigenous Wild Poliovirus (WPV) in 1984 but suffered from an outbreak of circulating Vaccine-derived Poliovirus type 2 (cVDPV2) in 2018. We aimed to describe Kenya’s polio surveillance performance 2016–2018 using WHO recommended polio surveillance standards. Methods Retrospective secondary data analysis was conducted using Kenyan AFP surveillance case-based database from 2016 to 2018. Analyses were carried out using Epi-Info statistical software (version 7) and mapping was done using Quantum Geographic Information System (GIS) (version 3.4.1). Results Kenya reported 1706 cases of AFP from 2016 to 2018. None of the cases were confirmed as poliomyelitis. However, 23 (1.35%) were classified as polio compatible. Children under 5 years accounted for 1085 (63.6%) cases, 937 (55.0%) cases were boys, and 1503 (88.1%) cases had received three or more doses of Oral Polio Vaccine (OPV). AFP detection rate substantially increased over the years; however, the prolonged health workers strike in 2017 negatively affected key surveillance activities. The mean Non-Polio (NP-AFP) rate during the study period was 2.87/ 100,000 children under 15 years, and two adequate specimens were collected for 1512 (88.6%) AFP cases. Cumulatively, 31 (66.0%) counties surpassed target for both WHO recommended AFP quality indicators. Conclusions The performance of Kenya’s AFP surveillance system surpassed the minimum WHO recommended targets for both non-polio AFP rate and stool adequacy during the period studied. In order to strengthen the country’s polio free status, health worker’s awareness on AFP surveillance and active case search should be strengthened in least performing counties to improve case detection. Similar analyses should be done at the sub-county level to uncover underperformance that might have been hidden by county level analysis.

Background The isolation of Extended spectrum βlactamase (ESBLs) producing Enterobacteriaceae among food handlers and their implication as sources of food borne outbreaks are a public health concern. This study seeks to investigate the prevalence of faecal carriage of these bacteria among food handlers in the West Coast Region of The Gambia. Method This study enrolled 600 participants from 60 Lower Basic Schools in West Coast Region of the country. Stool samples collected from the participants were presumptively screened for the ESBLs producing Enterobacteriaceae, using Drigalski agar, supplemented with 2mg/L cefotaxime. The bacterial colonies that grew on each Drigalski agar were tested for ESBL production by the double disk synergy test as recommended by Clinical and Laboratory Standard Institute (CLSI-2015). The confirmatory analysis for ESBL was determined as the zone of inhibition of cefotaxime and/or ceftazidime to ≥5mm from that of cefotaxime /clavulanicacid and/or ceftazidime/clavulanic acid. The presumptive screening of isolates for AmpC phenotypes was done by testing the organism against cefoxitin. The prevalence of the ESBL carriage was presented in percentages. The association of risk factors to the faecal carriage of ESBLs producing Enterobacteriaceae was performed by Pearson Chi-squared and Fishers Exact at (p ≤ 0.05). Result The prevalence of faecal carriage ESBL producing Enterobacteriaceae among food handlers was 5.0% (28/565). We found50% (14/28) and3.57% (1/28) ESBL producing bacteria were presumptive AmpC and carbapenemase resistance phenotype. Themost abundant ESBL producing Enterobacteriaceae were Klebsiella spp 32.1% (9/28) and Escherichia spp 28.6% (8/28). The use of antibiotics in the last 3 months was found to be significantly associated (P = 0.012) with the faecal carriage of ESBLs producing Enterobacteriaceae. Conclusion The prevalence of faecal carriage of ESBLs producing Enterobacteriaceae among food handlers in the Gambia is low. The history to use of the antibiotics in the last three months was found to be significantly associated with this prevalence. Therefore, the institution of a robust antimicrobial surveillance and treatment of patients with such infections are necessary to curb the spread of these multidrug resistant bacteria in the country. Rational prescription and usage of the antibiotics especially cephalosporin should be advocated both in public and private health facilities.

This article addresses macroeconomic instabilities according to exchange rate regimes in Sub-Saharan Africa (SSA). Based on International Monetary Fund's exchange rate regimes de facto classification, the global sample, SSA, is first divided into two subsamples, which are countries within CFA franc zone (ZCFA) and those outside CFA franc zone (HZCFA), and then into four categories, which are the Western Economic and Monetary Union (WAEMU), the Central African Economic and Monetary Community, the countries CFA franc zone with fix exchange rate regimes(HZCFA-FIX), and the countries outside CFA franc zone with flexible exchange rate regimes(HZCFA-FLEX). By applying advanced statistical and econometric methods upon internal and external macroeconomic equilibrium conditions, we show that the inflation, the GDP (or the output) and the real exchange rate (RER) are very volatile in SSA. However, we found out that they are more volatile in the group HZCFA comparatively to the group ZCFA. We also found out that they are higher in the group HZCFA-FIX than the group HZCFA-FLEX. Moreover, we found out that a high instability of the inflation is combined with those of the output and the RER.

Background Studies in Sub Saharan Africa have shown that the Circulating Cathodic Antigen point-of-care-test (POC-CCA) is more accurate in the detections of S. mansoni than the microscopic Kato-Katz technique but less is known about the accuracy of this rapid test in detecting S. haematobium infections. This study was intended to evaluate the field accuracy of POC-CCA as a rapid test kit for schistosomiasis mapping in The Gambia. Methods This prospective study was conducted in 4 regions in the country. Ten schools were randomly selected from each region, and a total of 2018 participants whose ages range from 7 to 14 years were enrolled in the study. Stool and urine samples were collected from each participant from May to June 2015, and tested for S. haematobium and S. mansoni infections in field and laboratory settings. The tests conducted included POC-CCA, double Kato-Katz slides, urine filtration and dipstick for hematuria. Results Of the 1954 participants that had complete data, the mean age of participants was 9.9 years. The prevalence of children infected with S. haematobium, using urine filtration technique was 10.1% (95% CI: 8.87–11.55). Central River Region had the highest level of urinary schistosomiasis with a prevalence of 28.0% (24.13–32.12).The lowest urinary schistosomiasis prevalence of 0.6% (0.12–1.86) was found in Lower River Region and North Bank Region had no cases of schistosomiasis detected. Only 5 participants were infected with S. mansoni. Using urine filtration as reference standard for the detection of S. haematobium, the sensitivity and specificity of POC-CCA was 47.7% and 75.8%. Whilst sensitivity and specificity of POC-CCA for detecting S. mansoni were 60.0% and 71.2% using double Kato-Katz as reference standard. Conclusion This study showed lower sensitivity of POC-CCA in detecting S. haematobium. Therefore POC-CCA is less useful for rapid diagnosis of urinary schistosomiasis.

Background The Ministry of Health and Social Welfare, The Gambia with support from WHO and Task Force for Global Health (TFGH), conducted a national endemicity mapping survey for schistosomiasis (SCH) and soil-transmitted helminths (STH) to establish their endemicity status. The survey was meant to provide baseline information on endemicity in order to plan and implement strategic interventions. This is a critical step towards NTD elimination by 2020. Methods A cross-section of fifty school-aged children (SAC, 25 boys and 25 girls) per school was sampled in 209 schools countrywide. Eligible SAC of 7 to 14 years old were randomly selected using formula (n/50) where n=total eligible pupils per school. Stool, urine and finger prick samples provided, were examined for SCH and STH using Kato-Katz, urine filtration, dip-stick and CCA techniques. Results National prevalence of schistosomiasis and soil-transmitted helminthiasis were 4.3% and 2.5%, respectively. At district level, Niani had the highest prevalence of SCH, recording 22%. Whereas for STH, Banjul, the capital city, had the highest prevalence, recording 55%, followed by 22% prevalence in Kombo South. Schistosoma haematobium is the most dominant parasitic infection in The Gambia. Fourteen (38%) districts in the country are co-endemic for both STH and SCH. Generally, male pupils are more infected with urinary schistosomiasis than females. Conclusions It was established that 19 (45%) of districts mapped are endemic for schistosomiasis; thus the need for treatment with praziquantel. Twenty (47%) of districts mapped are endemic for soil-transmitted helminthiasis at varying rates. However, only two STH endemic districts, Banjul (55%), and Kombo South (22%), within the high and very high prevalence rates of endemicity, are eligible for treatment with albendazole.

Background: Salmonella spp are among the most common food borne pathogens. Food handlers play an important role in the production of food products, in which they can contribute to the transmission of salmonellosis. The probability of food contamination depends mainly on the health status and personal hygiene of the food handlers and their choice of managing their health could give rise to contamination of food by multi drug resistant bacteria. Multi Drug Resistance is of global concern and poses a public health threat in combating diseases. In the developing countries there is paucity on the prevalence of salmonella carriage among food handlers. This study aims to investigate the prevalence of salmonella and to determine their antimicrobial resistance pattern. Method: A total of 500 stool samples from different food handlers were collected and analyzed with completed questionnaires. For standard isolation and identification of salmonella isolates; stool samples were enriched in buffered peptone water, standard culture and biochemical tests were used. Antimicrobial susceptibility Test (AST) was carried out using Clinical Laboratory and Standard Institute (CLSI-2015) protocol disc diffusion method. The data were analyzed using SPSS version 16 and Microsoft excel version 2010 to determine the risk factors. Results: Of 500 participants with the mean age of 38.15, 497(99.4%) were all females. Most of the participants wash their hands under running water and 271(54.2%) were certified on food handling. Among the risk factors, consuming medicines/antibiotics from street vendors showed statistical significant of salmonella carriage with (P=0.011). It was found that 13(2.6%) were salmonella carriers. AST performed on the 13 isolates show that; 13(100%), 12(92.3%), 7(53.8%), 9(69.2%) and 9(69.2%) were resistant to Ampicillin, Erythromycin, and Tetracycline, ceftriaxone and cefotaxime respectively. And 13(100%), 12(92.3%) and 7(53.8) were sensitive to Imipenem, chloramphenicol and gentamycin respectively. Conclusion: This study had found multidrug resistant salmonella isolates carriers amongst food handlers who could serve as potential reservoirs for the transmission of these infections in the communities. Thus, it is crucial to implement regular screening of food handlers and health education on food safety.