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Nielsen J.,Bandim Health Project | Prudhon C.,Health and Nutrition Tracking Service | de Radigues X.,Health and Nutrition Tracking Service
International Journal of Epidemiology | Year: 2011

Background: The humanitarian response to the crisis in Darfur is the largest humanitarian operation in the world. To investigate the evolution of the conditions of the affected population, we analysed trends in malnutrition and mortality, the most widely accepted indicators for assessing the degree of severity of a crisis. Methods: We did a meta-analysis of 164 publicly available surveys taking into account changes in the contextual situation and humanitarian aid; type of population [residents and internally displaced persons (IDPs)]; and seasonal variations. Data on global acute malnutrition (GAM), severe acute malnutrition (SAM), crude death rate (CDR) and under-five death rate (U5DR) were analysed using a random effect model. Results: GAM and SAM decreased by 16% and 28%, respectively, in 2004- 05, whereas CDR dropped by 44-75% per year depending on state and type of population and U5DR decreased by an overall 50% yearly. Both security and the humanitarian contexts became increasingly complex after 2005, but levels of malnutrition stabilized in North and South Darfur. In West Darfur, GAM remained stable but SAM tended to increase for IDPs, although mortality rates remained constant. Mortality increased slightly for residents in South Darfur after 2005, even though nutritional status was stable. GAM, SAM, CDR and U5DR fluctuated markedly with seasons. Conclusion: A meta-analysis of myriads of surveys permitted us to draw an overall picture of the situation in Darfur and to identify some of its influencing factors. The large humanitarian operation, which gained momentum through 2004-05, was able to contain the crisis despite huge difficulties, but did not compensate for seasonal variations. The situation has remained fragile with some negative patterns tending to emerge. It is crucial that the humanitarian situation continues to be closely monitored. Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2011; all rights reserved. Source

Aage S.,Statens Serum Institute | Kiraly N.,Murdoch Childrens Research Institute | Da Costa K.,Bandim Health Project | Byberg S.,Statens Serum Institute | And 6 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2015

Background Neonatal vitamin A supplementation (NVAS) is currently being considered as policy in countries at risk of deficiency. A previous study suggested that NVAS may be associated with increased atopy. We examined the effect of NVAS on atopy by conducting long-term follow-up of a previous randomized controlled trial in Guinea-Bissau. Methods In 2002-2004, we randomized 4345 normal birthweight neonates to NVAS (50 000 IU retinyl palmitate) or placebo together with their Bacillus Calmette-Guérin vaccination. In 2013, we visited the 1692 (39%) children now aged 8-10 years who were still living in the study area, and 1478 (87%) were found at home. Provided consent, a skin prick test was performed, and history of allergic symptoms was recorded. Associations of NVAS and atopy (defined as skin prick test reaction of ≥3 mm) were analysed using binomial regression. Results Of the 1430 children with a valid skin prick test, 228 (16%) were positive (more boys (20%) than girls (12%), P-value < 0.0001). NVAS did not increase the overall risk of atopy (RR 1.10 [95% CI 0.87-1.40]). However, NVAS was associated with significantly increased risk among females (RR 1.78 [1.17-2.72]) but not among males (0.86 [0.64-1.15], P-value for interaction between NVAS and gender = 0.005). Furthermore, NVAS was associated with increased risk of wheezing among females (RR 1.80 [1.03-3.17], but not among males, P-value for interaction = 0.05). Conclusion The study corroborated previous observations; NVAS was associated with increased risk of atopy and wheezing, in this study only among females. Further studies on NVAS and atopy are warranted. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Source

Roman V.R.G.,Statens Serum Institute | Roman V.R.G.,Korean International Vaccine Institute | Jensen K.J.,Statens Serum Institute | Jensen S.S.,Statens Serum Institute | And 12 more authors.
AIDS Research and Human Retroviruses | Year: 2013

We have designed a therapeutic HIV-1 vaccine concept based on peptides together with the adjuvant CAF01. Peptides represented 15 HLA-supertype- restricted subdominant and conserved CD8 T cell epitopes and three CD4 T-helper cell epitopes. In this phase I clinical trial, safety and immunogenicity were assessed in untreated HIV-1-infected individuals in Guinea-Bissau, West Africa. Twenty-three HIV-1-infected individuals were randomized to receive placebo (n=5) or vaccine (n=18). Safety was appraised by clinical follow-up combined with monitoring of biochemistry, hematology, CD4 T cell counts, and HIV-1 viral loads. T cell immunogenicity was monitored longitudinally by interferon (IFN)-γ ELISpot. New vaccine-specific T cell responses were induced in 6/14 vaccinees for whom ELISpot data were valid. CD4 T cell counts and viral loads were stable. The study shows that therapeutic immunization is feasible and safe in Guinea-Bissau and that it is possible to redirect T cell immunity with CAF01-adjuvanted HIV-1 peptide vaccine during untreated HIV-1 infection in some patients. However, relatively few preexisting and vaccine-induced HIV-1 T cell responses to CD8 T cell epitopes were detected against HIV-1 using IFN-γ ELISpot in this chronically infected African population. © Copyright 2013, Mary Ann Liebert, Inc. 2013. Source

Nwakanma D.C.,Medical Research Council Laboratories | Neafsey D.E.,Cambridge Broad Institute | Jawara M.,Medical Research Council Laboratories | Adiamoh M.,Medical Research Council Laboratories | And 12 more authors.
Genetics | Year: 2013

Understanding genetic causes and effects of speciation in sympatric populations of sexually reproducing eukaryotes ischallenging, controversial, and of practical importance for controlling rapidly evolving pests and pathogens. The major African malariavector mosquito Anopheles gambiae sensu stricto (s.s.) is considered to contain two incipient species with strong reproductiveisolation, hybrids between the M and S molecular forms being very rare. Following recent observations of higher proportions of hybridforms at a few sites in West Africa, we conducted new surveys of 12 sites in four contiguous countries (The Gambia, Senegal, Guinea-Bissau, and Republic of Guinea). Identification and genotyping of 3499 A. gambiae s.s. revealed high frequencies of M/S hybrid formsat each site, ranging from 5 to 42%, and a large spectrum of inbreeding coefficient values from 0.11 to 0.76, spanning most of therange expected between the alternative extremes of panmixia and assortative mating. Year-round sampling over 2 years at one of thesites in The Gambia showed that M/S hybrid forms had similar relative frequencies throughout periods of marked seasonal variation inmosquito breeding and abundance. Genome-wide scans with an Affymetrix high-density single-nucleotide polymorphism (SNP) microarrayenabled replicate comparisons of pools of different molecular forms, in three separate populations. These showed strongdifferentiation between M and S forms only in the pericentromeric region of the X chromosome that contains the molecular formspecificmarker locus, with only a few other loci showing minor differences. In the X chromosome, the M/S hybrid forms were moredifferentiated from M than from S forms, supporting a hypothesis of asymmetric introgression and backcrossing. © 2013 by the Genetics Society of America. Source

Isendahl J.,Karolinska Institutet | Manjuba C.,Hospital Nacional Simao Mendes | Rodrigues A.,Bandim Health Project | Xu W.,Karolinska Institutet | And 6 more authors.
BMC Infectious Diseases | Year: 2014

Background: The burden of bloodstream infections is insufficiently studied in children in Africa and many healthcare facilities lack the capacity to identify invasive disease. Often studies have been limited to febrile patients or patients admitted to hospital. Methods: Blood cultures and malaria diagnostics was performed on 372 consecutive children presenting with tachycardia and/or fever to a referral paediatric emergency department in Bissau, Guinea-Bissau. Bacterial species detection, antimicrobial susceptibility testing and molecular typing were performed. The capacity of clinical parameters to identify bacteraemia was evaluated. Results: The prevalence of bloodstream infection was 12% (46/372) and in 46% (21/46) of the infections the child was non-febrile at presentation to the hospital. The predictive value for bacteraemia was poor for all assessed clinical parameters. Staphylococcus aureus accounted for 54% (26/48) of the isolates followed by non-typhoidal Salmonella, 10% (5/48), Streptococcus pneumoniae, 8% (4/48), and Salmonella Typhi, 6% (3/48). Among S. aureus there was a large diversity of spa types and 38% produced Pantone-Valentine leukocidin. Antibiotic resistance was low, however two out of three Klebsiella pneumoniae isolates produced extended-spectrum beta-lactamases. Malaria was laboratory confirmed in only 5% of the children but 64% (237/372) received a clinical malaria diagnosis. Conclusions: Bacteraemia was common irrespective of the presence of fever among children presenting to the hospital. The high prevalence of Staphylococcus aureus may be due to contamination. There is an imminent need to improve microbiological diagnostic facilities and to identify algorithms that can identify children at risk of bloodstream infections in Africa. © 2014 Isendahl et al.; licensee BioMed Central. Source

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