Vétérinaires Sans Frontières Suisse

There was a protracted measles outbreak in Kismayo, Somalia between 2020–2021. The outbreak persisted despite availability of measles containing vaccine (MCV) through Expanded Program on Immunization (EPI) services and reactive vaccination campaigns. We sought to estimate measles burden and MCV coverage during the outbreak while further identifying barriers and facilitators to care and vaccinations. We adopted a cross-sectional, sequential mixed-method approach with a retrospective household survey followed by key informant interviews (KIIs) and focus group discussions (FGDs). We used proxy-reported interview data from a household survey with a two-year recall period to estimate attack rates (ARs), case fatality ratios (CFRs), measles-specific mortality and MCV coverage. We performed thematic analysis on qualitative data from 12 KIIs and 8 FGDs. We surveyed 1,050 households representing 6,664 individuals and estimated an urban population of 405,181 (95%CI: 389,335–422,331). We identified 338 measles cases (AR: 5.1% [95%CI: 4.6-5.6]) and 11 measles deaths (CFR: 3.3% [95%CI: 1.4-5.2]). During the outbreak, we interpolated that 20,664 (95%CI: 17,909–21,651) measles cases and 682 (95%CI: 251–1230) deaths occurred across Kismayo. At start of recall, 49.5% (95%CI: 46.5-52.6) aged 6–59 months had one-or-more doses of MCV and this increased to 69.6% (95%CI: 66.9-72.2) by end of recall. Thematic analysis produced qualitative insights on barriers to accessing medical care, barriers to routine vaccination through EPI, barriers to vaccination through mass campaigns and facilitating factors for care and vaccination. We show an unacceptably high burden of measles due to limited access to medical care and low MCV coverage despite a widespread willingness to be vaccinated. To mitigate the problem of protracted outbreaks, we suggest adopting a consistent, community-centered approach to risk communication and community engagement, reducing non-healthcare costs associated with accessing care, ensuring daily availability of EPI vaccinations in all public facilities and overhauling the ways in which mass vaccination campaigns are implemented.

BackgroundBangladesh has the second highest burden of child labour in South Asia. The informal sector employs most of the children however, data on health including injuries and place of work for children are limited. As the deadline for the Sustainable Development Goals to end child labour is upon us, it is paramount to document the impact of child labour on health. This study aims to contribute to this knowledge gap by presenting medical data from occupational health clinics (OHCs) set up by Médecins Sans Frontières (MSF) in a peri-urban area of Dhaka, Bangladesh.MethodsWe did a retrospective analysis of health care records of children attending MSF OHCs between February 2014 and December 2023. We stratified the analysis by sex and age (< 14 years and ≥ 14- < 18 years). We looked at morbidities according to type of factory, whether children reported working with machinery, and examined nutritional and mental health (2018–2023) status.ResultsOver the study period, there were 10,200 occupational health consultations among children < 18 years, of which 4945 were new/first time consultations. The average age of children attending their first consultation was 14.7 years, of which 61% were male. Fifteen percent reported living inside the factory. Children worked in all prohibited categories of the informal sector. Almost all children reported operating machinery. Musculoskeletal (26%) and dermatological (20%) were the most identified conditions, and 7.5% of consultations were for work-related injuries. A higher proportion of male children had injuries (11% vs 2.5% in girls). Children working in metal factories accounted for most injuries (65%). Mood-related disorders accounted for 86% of the 51 mental health consultations. Half of all children were malnourished with higher levels in boys and those < 14 years.ConclusionsFindings suggest that children face hazardous realities; engaged in the worst form of labour, bearing important morbidity and injury burden, with vulnerabilities varying by sex and age. Despite their economic contributions to the informal sector, they remain largely invisible and exploited. This study highlights the urgent need for child rights-based research and cross-sectoral approaches that actively involve children to develop sustainable, targeted solutions to eliminate child labour.

BackgroundAntibiotics hold the promise of mitigating the spread of livestock diseases while enhancing productivity. However, there is global concerns surrounding the improper handling and administration of antibiotics, which has led to an alarming rise in antimicrobial resistance (AMR). Kenya is currently listed as an AMR hotspot. This study assesses farmers’ knowledge and practices on antibiotics in livestock production, knowledge on AMR as well as factors influencing farmers’ knowledge of antibiotic safety and resistance, and antibiotics use.MethodsA across-sectional, quantitative survey was employed with 319 farming households in five counties in Kenya. Multivariate regression analysis was used to identify explanatory factors.ResultsAbout 80% of households use antibiotics in their livestock, and 58% administer the antibiotics themselves. The vast majority of farmers buy antibiotics without a prescription. Antibiotics are used for both therapeutic and non-therapeutic purposes, the latter mainly in form of growth promoters and feed enhancers in poultry. The withdrawal periods reported by farmers are shorter than the officially recommended periods. Although the majority of farmers reported risky antibiotic practices, most (76%) were well aware of bacterial AMR. Nineteen of 21 knowledge statements on AMR and safe use of antibiotics were answered correctly by 55–89% of respondents, indicating considerable farmer knowledge on different aspects of antibiotics risk, while certain knowledge gaps remain. Number of livestock owned was the factor most positively influencing farmers’ knowledge on AMR and safe use.ConclusionKenya has made notable progress towards creating knowledge and awareness of farming communities on the risks and requirements associated with antibiotic use in livestock. Nonetheless, farmers’ antibiotics practices continue to constitute considerable risk of further AMR development. This shows that knowledge is not enough to ensure fundamental behavioral change. There needs to be an enabling environment driven by (1) effective policy interventions and enforcement to ensure compliance with set guidelines for antibiotic use; (2) research on and deployment of alternatives, such as probiotics, vaccinations and disease prevention measures, (3) continued public awareness raising and education using multiple channels to reach farmers and, (4) strengthened cross-sector, multi-stakeholder collaboration to address the multi-dimensional complexities of AMR.

Pfhrp2 and pfhrp3 gene deletions threaten the use of Plasmodium falciparum malaria rapid diagnostic tests globally. In South Sudan, deletion frequencies were 15.6% for pfhrp2, 20.0% for pfhrp3, and 7.5% for double deletions. Deletions were approximately twice as prevalent in monoclonal infections than in polyclonal infections.

Improving animal welfare is a human responsibility and influenced by a person's values and experiences. Thus, it is critical to have an in-depth understanding of the knowledge, attitudes, and practices (KAP) of animal welfare among animal owners. For livestock in Ethiopia, the greatest proportion of livestock are reared by pastoral and mixed crop-livestock communities. A cross-sectional survey covering a range of species and animal welfare aspects was carried out on a total of 197 household (117 pastoral and 80 crop-livestock owners) and recorded information on 34 animal welfare KAP items. Item response theory models (IRT) were fitted to the data from KAP items to estimate the probability of correctly answering an item. This was used as a function of the respondents' KAP level. Overall, the highest percentage of desirable scores was recorded for the knowledge scale (35.7%) and the lowest was for the practice scale (24.6%). A significant correlation (P < 0.01) was found between knowledge of the farmers and their attitude toward animal welfare and self-reported practices. Generally, households practicing mixed crop-livestock farming system had better animal welfare knowledge, attitude, and practice than pastoralist. Mixed crop-livestock farmers had better knowledge on items related to observing the nutrition condition of the animal, animal-human relationship, the importance of water, and health inspection compared to pastoralists. In contrast, pastoralists had better knowledge of items related to natural behavior expression, animal care, and animal suffering than mixed crop-livestock farmers. Pastoralists had 3.3-times higher odds than mixed crop-livestock farmers to have a positive attitude to train their animals without beating. KAP scores demonstrate the need for targeted training to improve animal well-being (i.e., housing, management, nutrition, disease prevention and treatment, responsible care, humane handling) across livestock holding communities in Ethiopia.

To assess mortality and clinical outcomes in children treated with antiretroviral therapy (ART) in four African vertical programmes between 2001 and 2010. Cohort analysis of data from HIV-infected children (<15years old) initiating ART in four sub-Saharan HIV programmes in Kenya, Uganda and Malawi, between December 2001 and December 2010. Rates of mortality, programme attrition and first-line clinico-immunological failure were calculated by age group (<2, 2-4 and 5-14years), 1 or 2years after ART initiation, and risk factors were examined. A total of 3949 children, 22.7% aged <2years, 32.2% 2-4years and 45.1% 5-14years, were included. At ART initiation, 60.8% had clinical stage 3 or 4, and 46.5% severe immunosuppression. Overall mortality, attrition and 1-year failure rates were 5.1, 10.8 and 9.0 per 100 person-years, respectively. Immunosuppression, stage 3 or 4, and underweight were associated with increased rates of mortality, attrition and treatment failure. Adjusted estimates showed lower mortality hazard ratios (HR) among children aged 2-4years (HR=0.57, 95% CI 0.42-0.77 than children aged 5-14years). One-year treatment failure incidence rate ratios (IRR) were similar regardless of age (IRR=0.91, 95% CI 0.67-1.25 for <2years; 1.01, 95% CI 0.83-1.23 for 2-4years, vs. 5-14years). Good treatment outcomes were achieved during the first decade of HIV paediatric care despite the late start of therapy. Encouraging early HIV infant diagnosis in and outside prevention of mother-to-child transmission programmes, and linkage to care services for early ART initiation, is needed to reduce mortality and delay treatment failure.

Internal parasites are a significant determinant of the productivity of ruminant species in the tropics. Provision of anthelmintics has become a predominant part of animal health interventions in emergency drought responses, aiming to maintain the food conversion efficiency of livestock when pasture is scarce. This study aimed to assess the owner-perceived impact of anthelmintic provision on the health and productivity of small ruminants in the drought-prone counties of Isiolo and Marsabit, northern Kenya. Participatory approaches were used to retrospectively measure differences in key indicators of livestock output before and after anthelmintic administration. Results showed that there was no perceived impact of anthelmintic administration during droughts on small ruminant health and productivity, but some benefit of anthelmintic administration during rainy season was perceived. The study also provided some evidence of potential differences in the epidemiology of internal parasites between the counties. These findings may be utilised to inform future livestock intervention programmes in drought-prone areas.

We report the genome of a Staphylococcus aureus strain (ILRI_Eymole1/1) isolated from a nasal swab of a dromedary camel (Camelus dromedarius) in North Kenya. The complete genome sequence of this strain consists of a circular chromosome of 2,874,302 bp with a GC-content of 32.88 %. In silico annotation predicted 2755 protein-encoding genes and 76 non-coding genes. This isolate belongs to MLST sequence type 30 (ST30). Phylogenetic analysis based on a subset of 283 core genes revealed that it falls within the human clonal complex 30 (CC30) S. aureus isolate cluster but is genetically distinct. About 79 % of the protein encoding genes are part of the CC30 core genome (genes common to all CC30 S. aureus isolates), ~18 % were within the variable genome (shared among multiple but not all isolates) and ~ 3 % were found only in the genome of the camel isolate. Among the 85 isolate-specific genes, 79 were located within putative phages and pathogenicity islands. Protein encoding genes associated with bacterial adhesion, and secretory proteins that are essential components of the type VII secretion system were also identified. The complete genome sequence of S. aureus strain ILRI_Eymole1/1 has been deposited in the European Nucleotide Archive under the accession no LN626917.1.Electronic supplementary materialThe online version of this article (doi:10.1186/s40793-015-0098-6) contains supplementary material, which is available to authorized users.

Using routine data from HIV-positive adult patients eligible for antiretroviral therapy (ART), we report on routinely collected demographic characteristics and opportunistic diseases associated with pre-ART attrition (deaths and loss to follow-up). Among 2471 ART eligible patients, enrolled between January 2005 and November 2008, 446 (18%) were lost to attrition pre-ART. Adjusted risk factors significantly associated with pre-ART attrition included age <35 years (Odds Ratio, OR 1.4, 95% Confidence Interval, CI 1.1-1.8), severe malnutrition (OR 1.5, 95% CI 1.1-2.0), active pulmonary tuberculosis (OR 1.6, 95% CI 1.1-2.4), severe bacterial infections including severe bacterial pneumonia (OR 1.9, 95% CI 1.2-2.8) and prolonged unexplained fever (>1 month), (OR 2.6, 95% CI 1.3-5.2). This study highlights a number of clinical markers associated with pre-ART attrition that could serve as 'pointers' or screening tools to identify patients who merit fast-tracking onto ART and/or closer clinical attention and follow-up.