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Challenges and opportunities of developing bioinformatics platforms in Africa: the case of BurkinaBioinfo at Joseph Ki-Zerbo University, Burkina Faso.
Get PDFBioinformatics, an interdisciplinary field combining biology and computer science, enables meaningful information to be extracted from complex biological data. The exponential growth of biological data, driven by high-throughput omics technologies and advanced sequencing methods, requires robust computational resources. Worldwide, bioinformatics skills and computational clusters are essential for managing and analysing large-scale biological datasets across health, agriculture, and environmental science, which are crucial for the African continent. In Burkina Faso, the establishment of bioinformatics infrastructure has been a gradual process. Initial training initiatives between 2015-2016, including bioinformatics courses and the establishment of the BurkinaBioinfo (BBi) platform, marked significant progress. Over 250 scientists have been trained at diverse levels in bioinformatics, 105 user accounts have been created for high-performance computing access. Operational since 2019, this platform has significantly facilitated training programs for scientists and system administrators in west Africa, covering data production, introductory bioinformatics, phylogenetic analysis, and metagenomics. Financial and technical support from various sources has facilitated the rapid development of the platform to meet the growing need for bioinformatics analysis, particularly in conjunction with local 'wet labs'. Establishing a bioinformatics cluster in Burkina Faso involved identifying the needs of researchers, selecting appropriate hardware and installing the necessary bioinformatics tools. At present, the main challenges for the BBi platform include ongoing staff training in bioinformatics skills and high-level IT infrastructure management in the face of growing infrastructure demands. Despite these challenges, the establishment of a bioinformatics platform in Burkina Faso offers significant opportunities for scientific research and economic development in the country
Comparative Effectiveness of Antivirals and Monoclonal Antibodies for Treating COVID-19 Patients Infected With Omicron Variant: A Systematic Review and Network Meta-Analysis.
Get PDFAntiviral drugs likely remain effective against the SARS-CoV-2 Omicron variant, while monoclonal antibody (mAb) therapies have experienced drops in neutralizing ability. This systematic review and network meta-analysis aims to estimate the comparative effectiveness of antivirals and mAb therapies for treating COVID-19 patients infected with Omicron, capturing primarily acute outcomes. We searched multiple databases from July 4 to July 19, 2022, with updates through November 4, 2022. Studies comparing the effectiveness of antivirals or mAb to either nonuser controls or other treatments were included. Risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. Data extraction and verification involved five independent researchers. Among 39 studies (727,893 individuals with COVID-19, including 38 nonrandomized trials), nirmatrelvir/ritonavir and sotrovimab were associated with lower risks of mortality (HR = 0.317, 95% credible intervals [CrI] = 0.144-0.678; HR = 0.176, 95%CrI = 0.052-0.527) and hospitalization (HR = 0.479, 95%CrI = 0.319-0.711; HR = 0.489, 95%CrI = 0.293-0.797) compared with nonuser controls. Remdesivir users were associated with a lower risk of hospitalization (HR = 0.367, 95%CrI = 0.147-0.868) but not mortality. Molnupiravir and bebtelovimab showed no significant benefits for these outcomes. In conclusion, among individuals infected with COVID-19 during the Omicron wave, mortality risk was lower with nirmatrelvir/ritonavir or sotrovimab use, whereas hospitalization was reduced with nirmatrelvir/ritonavir, remdesivir, or sotrovimab. Sotrovimab and nirmatrelvir/ritonavir were effective against Omicron B.1.1.529/BA.1 and BA.2/BA.4/BA.5 subvariants, respectively. A key limitation is that findings rely on data from the last search and may be impacted by potential changes in mortality risk due to immune evasion by emerging variants, highlighting the need for ongoing randomized trials across variants and populations. TRIAL REGISTRATION: The study was registered on PROSPERO, CRD42022351508
Insights into the biology and insecticide susceptibility of the secondary malaria vector Anopheles parensis in an area with long-term use of insecticide-treated nets in northwestern Tanzania.
Get PDFBACKGROUND: The Anopheles funestus group includes at least 11 sibling species, with Anopheles funestus Giles being the most studied and significant malaria vector. Other species, like Anopheles parensis, are understudied despite their potential role in transmission. This article provides insights into the biology and insecticide susceptibility of An. parensis, with observations of its densities in northwestern Tanzania. METHODS: Mosquitoes were collected in three villages in Misungwi district, northwestern Tanzania, using CDC light traps and battery-powered aspirators indoors and human-baited double net traps outdoors. Female Anopheles adults were morphologically sorted and identified by PCR, and a subset was tested by ELISA for vertebrate blood meal sources and Plasmodium sporozoite infections. Insecticide susceptibility was assessed using the WHO protocol (2nd edition, 2018). Unfed females were dissected to assess parity, gonotrophic status and insemination status, while blood-fed females were monitored for oviposition to estimate egg counts. The prevalence of An. parensis was generally < 24% across all sites, except in Ngaya village, where it unexpectedly constituted 84% of PCR-amplified An. funestus sensu lato. This species was present in both indoor and outdoor collections, yet the females exclusively fed on non-human vertebrates, with no human blood meals detected. Parity rates were approximately 49% for resting and 46% for host-seeking females, with slightly higher percentages of both parous and inseminated females in the dry season compared to the wet season. Most parous females had oviposited once or twice, with those in the dry season ovipositing significantly more eggs. The average wing length of female An. parensis was 2.93 mm, and there was no significant impact of body size on parity, fecundity or insemination. The An. parensis mosquitoes were fully susceptible to pyrethroids, carbamates, organophosphates and organochlorides. RESULTS: The prevalence of An. parensis was generally < 24% across all sites, except in Ngaya village, where it unexpectedly constituted 84% of PCR-amplified An. funestus sensu lato. This species was present in both indoor and outdoor collections, yet the females exclusively fed on non-human vertebrates, with no human blood meals detected. Parity rates were approximately 49% for resting and 46% for host-seeking females, with slightly higher percentages of both parous and inseminated females in the dry season compared to the wet season. Most parous females had oviposited once or twice, with those in the dry season ovipositing significantly more eggs. The average wing length of female An. parensis was 2.93 mm, and there was no significant impact of body size on parity, fecundity or insemination. The An. parensis mosquitoes were fully susceptible to pyrethroids, carbamates, organophosphates and organochlorides.. CONCLUSION: This study offers insights into the behaviours and insecticide susceptibility of An. parensis. Primarily feeding on non-human hosts, An. parensis is less significant in malaria transmission than more anthropophilic vectors. Unlike the pyrethroid-resistant An. funestus sensu stricto, An. parensis remains fully susceptible to public health insecticides despite the use of insecticidal bed nets. These findings provide a foundation for future research and may inform control strategies targeting residual malaria transmission involving An. parensis
Vaccination strategies to identify and reach zero-dose and under-immunized children in crisis-affected states in Sudan: a qualitative study.
Get PDFBACKGROUND: Globally, 21 million children were un- or under-vaccinated with Diphtheria-Tetanus-Pertussis (DTP)-containing vaccines in 2023. Around 20% of zero-dose children, those who had not received any DTP doses, live in conflict-affected settings in low and middle-income countries. There is insufficient evidence on vaccination interventions to identify and reach zero-dose children in these settings. This study aimed to map and assess current vaccination strategies to identify and reach zero-dose and under-vaccinated children in the crisis-affected states of South Kordofan, South Darfur and Blue Nile in Sudan. METHODS: We conducted a cross-sectional qualitative study guided by the (Identify-Reach-Monitor-Measure-Advocate (IRMMA) framework, developed by Gavi, the Vaccine Alliance. We conducted 20 individual semi-structured interviews during November and December 2022. We interviewed governmental and non-governmental vaccination stakeholders at federal, state and locality levels. We used the IRMMA framework to analyze the interview transcripts. RESULTS: Zero-dose and under-immunized children in the study sites were concentrated in opposition-controlled areas, nomadic communities, and remote rural areas. Zero-dose and under-immunized children in accessible areas were identified through routine vaccination strategies and surveillance reports. Various strategies were used in inaccessible areas. This includes tasking local institutions and individuals trusted by communities to identify and reach children, and infrequent integration and co-delivery of routine vaccines with other health interventions such as COVID-19 vaccination and insecticidal net distribution. There are inaccurate population estimates and a lack of guidance from ministries of health for measuring and monitoring zero-dose and under-immunized children. Respondents conflated advocacy with mobilization, and advocacy was broadly characterized as an ad hoc activity mostly connected to immunization campaigns. CONCLUSIONS: Our study underscored the complexity of vaccinating zero-dose and under-immunized children in crisis-affected states of Sudan. Further research is needed to evaluate these practices and the role of non-governmental organizations (NGOs) and community engagement in improving vaccination coverage. Furthermore, exploring alternative funding methods and using geographic information systems (GIS) could enhance vaccination data and address funding limitations
Delivering insecticide-treated nets (ITNs) through a digitized single-phase door-to-door strategy: lessons from Ondo state, Nigeria.
Get PDFBackground The use of insecticide-treated nets (ITNs) is a strategy recommended by the World Health Organization (WHO) for malaria prevention. In Nigeria, ITNs have been periodically distributed since 2007 through campaigns. Campaign activities and assets are typically tracked using either a paper-based or digital system. In 2017, a digital approach was introduced in Ondo state for tracking attendance at training sessions as part of the ITN campaign. Following the success of the 2017 introduction, subsequent campaigns planned to digitise other aspects of the campaign to improve accountability and efficiency of the ITN distribution. The COVID-19 pandemic posed additional challenges for the ITN distribution planned for 2021 and adaptations were made to the programme strategy to ensure the campaign could go ahead safely. This article presents lessons and experiences from the 2021 ITN distribution campaign in Ondo state, Nigeria. Methods The campaign used RedRose, a customised mobile application, to monitor the planning and delivery of the campaign, collect household information including training personnel and tracking the transfer of ITNs between distribution hubs and households. ITNs were delivered through a single-phase door-to-door distribution strategy. Results The campaign distributed 2,965,125 ITNs covering 1,057,577 households across Ondo state. The digital application was beneficial for monitoring the quality of implementation and tracking assets and staff to ensure safety. The single-phase door-to-door approach was more convenient for households compared to fixed-point distribution but increased the workload for mobilization and distribution teams. Conclusions Single phase door-to-door strategy using digital tools was an effective method to increase coverage of ITNs while closely tracking the progress of distribution campaigns. High-quality population data are needed to further improve the planning and implementation of ITN campaigns and other health interventions
Understanding Viral Haemorrhagic Fevers: Virus Diversity, Vector Ecology, and Public Health Strategies.
Get PDFViral haemorrhagic fevers encompass a diverse group of severe, often life-threatening illnesses caused by viruses from multiple families, including Arenaviridae, Filoviridae, Flaviviridae, Hantaviridae, Nairoviridae, Peribunyaviridae, and Phenuiviridae. Characterised by fever and haemorrhagic symptoms, these diseases challenge public health systems by overwhelming healthcare facilities, complicating diagnostic processes, and requiring extensive resources for containment and treatment, especially in resource-limited settings. This discussion explores the intricate relationships between VHFs and their transmission vectors-both animal and arthropod-and examines the impact of ecological and geographic factors on disease spread. The primary transmission of VHFs typically occurs through direct contact with infected animals or via bites from haematophagous arthropods, facilitating zoonotic and, at times, human-to-human transmission. With an emphasis on the role of diverse wildlife, domesticated animals, and vectors such as mosquitoes and ticks in the epidemiology of VHFs, there is a recognised need for robust surveillance and strategic public health responses to manage outbreaks. This review discusses the necessity of interdisciplinary approaches that integrate virology, ecology, and public health to enhance diagnostic capabilities, develop vaccines and antivirals, and improve outbreak interventions. Exploring the ecological and biological dynamics of VHFs will help bolster a deeper understanding of these emerging viruses and underpin preparation for future outbreaks. The importance of enhanced global cooperation, continuous research, and collaboration to mitigate the public health threats posed by these complex infections is a central theme, serving as a foundational strategy to reinforce worldwide preparedness and response efforts. Future directions include addressing gaps in vaccine development and tailoring public health strategies to the unique challenges of managing VHFs, such as the rapid mutation rates of viruses, the need for cold chain logistics for vaccine distribution, and socio-economic barriers to healthcare access, in order to ensure readiness for and effective response to emerging threats worldwide
Protecting infants against RSV disease: an impact and cost-effectiveness comparison of long-acting monoclonal antibodies and maternal vaccination.
Get PDFBACKGROUND: Two new products for preventing Respiratory Syncytial Virus (RSV) in young children have been licensed: a single-dose long-acting monoclonal antibody (la-mAB) and a maternal vaccine (MV). To facilitate the selection of new RSV intervention programmes for large-scale implementation, this study provides an assessment to compare the costs of potential programmes with the health benefits accrued. METHODS: Using an existing dynamic transmission model, we compared maternal vaccination to la-mAB therapy against RSV in England and Wales by calculating the impact and cost-effectiveness. We calibrated a statistical model to the efficacy trial data to accurately capture their immune waning and estimated the impact of seasonal and year-round programmes for la-mAB and MV programmes. Using these impact estimates, we identified the most cost-effective programme across pricing and delivery cost assumptions. FINDINGS: For infants under six months old in England and Wales, a year-round MV programme with 60% coverage would avert 32% (95% CrI 22-41%) of RSV hospital admissions and a year-round la-mAB programme with 90% coverage would avert 57% (95% CrI 41-69%). The MV programme has additional health benefits for pregnant women, which account for 20% of the population-level health burden averted. A seasonal la-mAB programme could be cost-effective for up to £84 for purchasing and administration (CCPA) and a seasonal MV could be cost-effective for up to £80 CCPA. INTERPRETATION: This modelling and cost-effectiveness analysis has shown that both the long-acting monoclonal antibodies and the maternal vaccine could substantially reduce the burden of RSV disease in the infant population. Our analysis has informed JCVI's recommendations for an RSV immunisation programme to protect newborns and infants. FUNDING: National Institute for Health Research
Implementing (and evaluating) peer support with people living with noncommunicable diseases in humanitarian settings.
Get PDFIn line with the peer reviewers comments, the authors have added highlights in stead of an abstract. It was felt that it was better able to capture the findings and is more in line with the paper's target audience
Stigma experiences, effects and coping among individuals affected by Buruli ulcer and yaws in Ghana.
Get PDFBACKGROUND: Stigma related to skin neglected tropical diseases like Buruli ulcer (BU) and yaws has remained underexplored and existing studies are limited to individual diseases despite the WHO call for integration in disease management. Within two districts in central Ghana, we explored stigma associated with BU and yaws to understand overlaps and disease-specific nuances to help guide integrated interventions. METHODOLOGY/PRINCIPAL FINDINGS: In-depth interviews were conducted with 31 current or formerly affected individuals to assess the experiences, effects and coping strategies adopted to manage disease related stigma. Data were analysed along broad themes based on the sociological construct of macro and micro interaction and Goffman's treatise on stigma. Disapproving community labels fueled by misconceptions were noted among BU participants which contributed to macro stigma experiences, including exclusion, discrimination and avoidance. In contrast, a high level of social acceptance was reported among yaws participants although some micro-level stigma (anticipated, felt and self-stigma) were noted by individuals with both diseases. While younger participants experienced name-calling and use of derogatory words to address affected body parts, older participants and caregivers discussed the pain of public staring. Stigma experiences had negative consequences on psychosocial well-being, schooling, and social relations, particularly for BU affected people. Problem-focused strategies including confrontation, selective disclosure and concealment as well as emotion-focused strategies (religious coping and self-isolation) were noted. CONCLUSIONS AND SIGNIFICANCE: The types and levels of stigma varied for BU and yaws. Stigma experiences also differed for adults and children in this setting and these differences should be accounted for in integrated interventions for these skin NTDs. School health programs need to prioritize educating school teachers about skin NTDs and the negative impact of stigma on the wellbeing of children
Improving the efficiency in spending for health: A systematic review of evidence
Get PDFBackground: Addressing inefficiencies in the way healthcare is financed has been identified as an important source of fiscal space for health systems. The WHO, for example, has argued that up to 40% of resources spent in health are wasted. Which reforms to focus on, their impact on fiscal space, and their feasibility have seldom been documented, however. The aim of this paper is to synthesise the evidence on these points, ascertaining the extent of fiscal space that has, to date, been created by implementing reforms aimed at addressing inefficiencies in health financing. Methods: systematic review of peer-reviewed literature in global databases (Medline, Embase, Global Health, Econlit, Africa-Wide information, Web of Science Core Collection and SciELO citation index). 20 articles were included for narrative analysis. Data extracted included: type of study; countries where the reform was implemented; the specific inefficiency discussed; the specific reform to tackle inefficiency; the efficiency indicator used; the baseline information given; the impact of the reform on health spending; and the feasibility and timing of the reform. Findings: Inefficiencies in health financing exist across the world, and reforms to address these remain important. Yet the empirical evidence on savings that can be created through addressing these inefficiencies is limited, mixed, and suggests that potential savings are more modest than indicated by the WHO. The feasibility of these reforms is seldom documented. The process of implementation of these reforms is similarly poorly documented, although the available evidence suggests that it takes three to ten years for these efficiency-enhancing health financing reforms to translate into actual results. Interpretation: Further research is needed to understand how to translate identified inefficiencies in the way healthcare is financed into additional fiscal space. Engaging with the political economy of designing and implementing these reforms will be key. Rooting fiscal space analysis projections in country-specific analysis of inefficiencies is also key, as the expectations of financial savings will otherwise be unrealistic