One of the most urgent global public health needs is the development of a safe, effective, and accessible HIV vaccine. The ethical imperative demands that the situation of those people and population most vulnerable to exposure of HIV infection be addressed, especially women who are disproportionately affected by the infection. Participation of women in testing appropriate products is imperative and therefore the need for the recruitment and retention of African women in HIV vaccine clinical trials is of significance. The recruitment and retention of women in sub Saharan Africa who are vulnerable due to some factors beyond their control such as Biological, socio-cultural and socio-economic factors are further entangled in a number of challenges. These challenges include but not limited to Community participation consideration which vary within and between cultures. Other challenges are consent issues which should be freely given but could be influenced by coercion from husbands. Confidentiality that should be absolute for men and women is a more critical issue for women in Africa since they may need the permission of their husbands to participate in the study. Enrolment and retention of women in HIV vaccine clinical trials is an important challenge to the successful development of an effective vaccine. Therefore there is need for researchers to identify the various challenges and retention strategies through community involvement and representation before inception of clinical trials and ensure that the needs of this population are respected. Full article

Globally, concerns over information security vulnerabilities are growing exponentially, fuelled by several headline reports of data breach incidents, which increase in size with each occurrence. On the Africa continent, South Africa is ranked among the most ‘at-risk’ countries for information security vulnerabilities, having lost approximately fifty billion rands to cybercrime in 2014. South Africa is currently considered to be the most cybercrime-targeted country in Africa. Worldwide, cyber vulnerability incidents greatly affect the education sector, due to the fact that this sector holds more Personal Identifiable Information (PII) than many other sectors. The PII ranges from (but is not limited to) ID numbers and financial account numbers to biomedical research data. In response to growing threats in South Africa, a similar regulation strategy to the European Union General Data Protection Regulation (GDPR), called the Protection of Personal Information Act (POPIA) will be implemented, with a view to mitigating cybercrime and information security vulnerabilities. The extent to which African institutions, and specifically the South African universities, have embraced and respond to these two information security regulations (GDPR and POPIA) is not yet clear and will be a matter of great importance for biomedical researchers. This research study aims to conduct a qualitative exploratory analysis of information security management across three universities in South Africa, by using a Technology, Organizational, and Environmental (TOE) model to investigate the factors which may influence the effectiveness of information security measures. This study is poised to make a significant contribution to the development of a Management Model for security practitioners and a framework for information management of biomedical data. Full article

Background: Prior to the 2009 pandemic H1N1, and the unprecedented outbreak of Highly Pathogenic Avian Influenza (HPAI) caused by the H5N1 virus, the World Health Organization (WHO) called upon its Member States to develop preparedness plans in response to a new pandemic in humans. The WHO Member States responded to this call by developing national pandemic plans in accordance with the International Health Regulations (IHR) to strengthen the capabilities of Member States to respond to different pandemic scenarios. In this study, we aim to evaluate the quality of the preparedness plans in the WHO African region since their inception in 2005. Methods: A standard checklist with 61 binary indicators (“yes” or “no”) was used to assess the quality of the preparedness plans. The checklist was categorised across seven thematic areas of preparedness: preparation (16 indicators); coordination and partnership (5 indicators); risk communication (8 indicators); surveillance and monitoring (7 indicators); prevention and containment (10 indicators); case investigation and treatment (10 indicators) and ethical consideration (5 indicators). Four assessors independently scored the plans against the checklist. Results: Of the 47 countries in the WHO African region, a total of 35 national pandemic plans were evaluated. The composite score for the completeness of the pandemic plans across the 35 countries was 36%. Country-specific scores on each of the thematic indicators for pandemic plan completeness varied, ranging from 5% in Côte d'Ivoire to 79% in South Africa. On average, preparation and risk communication scored 48%, respectively, while coordination and partnership scored the highest with an aggregate score of 49%. Surveillance and monitoring scored 34%, while prevention and containment scored 35%. Case investigation and treatment scored 25%, and ethical consideration scored the lowest of 14% across 35 countries. Overall, our assessment shows that pandemic preparedness plans across the WHO African region are inadequate. Conclusions: Moving forward, these plans must address the gaps identified in this study and demonstrate clarity in their goals that are achievable through drills, simulations and tabletop exercises. Full article

The impacts of climate change on livelihood and natural ecosystems have made it imperative to support health leadership in Africa to integrate health into national climate change planning. This paper analyses Rabies as a pressing issue for developing countries like Nigeria to build climate-resilient health systems. Rabies remains a public health problem in Nigeria despite regulations on rabies, dog movement and population control. Most of the reported cases of rabies deaths in man and canines are associated with unvaccinated dogs sharing space with human beings; this can be prevented if appropriate measures are taken. The aim of the study was to assess the risk rabies constitute to the public in the selected study area, Nyanya, Abuja, the Federal Capital Territory. This is a retrospective study on reported cases of dog bite in humans at the General Hospital in Nyanya, Abuja, FCT. Past medical records of patients for a period of 5 years which were randomly selected for the study. Data collected were analysed using descriptive and inferential statistical methods. 100% of the cases were due to dog exposure. Children between the ages 0–19 years accounted for 98% of the reported cases while only 2% occurred in adult. Male children had highest cases of 76%, female children; 22% and male adult case of 2%. Climate-resilient health systems should include the strengthening of governance and policy, integration of health information systems, preventive and curative service delivery with adaptation options such as morbidity and mortality attributed to rabies and other emerging diseases. Full article

Background: Malaria is invariably one of the most perplexing problems of public health importance all over the world affecting mainly tropical and sub-tropical regions of the world. The study determined the influence of environmental conditions on malaria morbidity. Methods: The study was descriptive in design. Structured household questionnaire with three sections was administered to heads of households and on the spot assessment of the environment was carried out. Twelve households from each of the 8 villages that consist of Ihiagwa community were randomly selected. Data was analyzed using IBM SPSS Statistics for Windows version 20.0, Armonk, NY, USA. Results: Findings from the study revealed that 47.9% of the 96 household heads had attained tertiary education although 45.85% of them were self-employed and only 8.3% were civil servants. Majority (59.4%) had a family size of less than 4 while 40.6% had a family size above 4. Among the study participants, 77.3% confirmed having suffered malaria in the last three months though 44.6% of them were diagnosed by their family members and majority (52.7%) were unable to carry out their duties for about 7 days. Generally, the people lived in a clean environment, 97.8% of them claimed that they cleared their bushes in their environment weekly. Majority (57%) lived in an environment without stagnant water, poorly draining gutters and exposed septic tanks. There was no statistically significant relationship between environmental conditions and reported malaria cases (P = 1.0). Conclusion: This is in contrast with some other studies however the result does not affirm that malaria morbidity has no relationship with the environment of people rather a need for certain factors to be controlled. Full article

The increasing health threat arising from emerging infectious disease requires an urgent global response. The accelerated development of vaccines, diagnostics and treatments requires facilitated access to and timely transfer of pertinent research reagents between scientists, especially those from low- and middle-income countries (LMICs) which are frequently the worst affected. To meet this global need, we propose to establish a Centre for Emerging Disease Research Reagents (CEDRR) which will support research on those emerging diseases that pose the greatest threat. This initiative will be based on the model of the Centre for AIDS Reagents, a not-for-profit repository based at the National Institute for Biological Standards and Control (NIBSC), UK, which has been providing a sustained HIV research reagent resource to scientists worldwide for 30 years. CEDRR will encourage leading scientists to donate research materials under an established transfer agreement, that will enable onward supply of samples to requesting laboratories in a manner that protects intellectual property. In addition, we will prepare and commission novel research materials including non-infectious subgenomic clones, recombinant proteins, peptides and antibodies. All the reagents will be characterized and provided individually or as all-in-one packages for specific assays along with detailed data sheets and corresponding standard operating procedures. They will be available globally and access will be prioritized with the objective to help build research capacity in LMICs. In order to provide a service that will meet the scientific community need, CEDRR will actively participate in existing networks and consortia on emerging pathogens, provide frequent newsletters and held regular meetings to discuss reagent requirements. By building an infrastructure that will provide quality research reagents to scientists worldwide, CEDRR hopes to speed up the development of much needed vaccines, diagnostics and treatments to fight emerging pathogens. Full article

The Sahel region faces many complex and interconnected challenges including food crisis, poverty, and political instability as well as recurring epidemics. Recently, the region has been affected by outbreaks of Ebola (Mali), Rift Valley Fever (Mauritania/Niger), Dengue (Burkina Faso/Mali), and Hepatitis E (Chad/Niger). In addition, the region is threatened by terrorism, including the potential risk of bioterrorism. In order to mitigate natural and intentional biological threats in the region, the development of a G5 Sahel biosecurity network seemed essential. In 2014, as part of the response to the Ebola outbreak, Germany had provided a mobile laboratory and trained a local team in Mali. This mobile laboratory, hosted by the Charles Mérieux Infectiology Center (CICM), now belongs to the Malian Ministry of Health. Since mid-2016, Germany has extended its initiative to the other G5 Sahel (G5S) countries. In November 2017, a biosafety network was established between G5S public health institutions, which is currently chaired by CICM Mali. It aims to strengthen cooperation between the G5S countries in the area of biosafety and biosecurity by capacity building for the diagnosis of dangerous pathogens. Methodology: Network activities include: (i) workshops between heads of institutions; (ii) theoretical and practical training of biologists and use of the mobile laboratory; (iii) internships in Germany and (iv) mobile laboratory field exercises. Results: Up to now, more than ten biologists from all G5S countries participated in trainings and field exercises, including the identification of hemorrhagic fever viruses and other infectious viral and bacterial agents. An initial response capability for outbreaks of dangerous pathogens is now available within the Sahel region. Conclusion: Maintaining skills in the G5S Mobile Lab Network is critical and procedures for deploying and tools for its cross-border functionality need to be developed. The official recognition of the Network by the G5S Permanent Secretariat is expected. Full article

Introduction: The EBOVAC-Salone trial of a candidate Ebola two-dose vaccine regimen (Ad.ZEBOV/MVA-BN-Filo) was conducted in a research-naïve setting in rural northern Sierra Leone, where no local laboratory reference values (LRV) had been established. In the first stage (n = 43) of the trial, laboratory screening was based on internationally-derived protocol LRV (PLRV). For postrecruitment participant care, LRV derived from a West African population (WALRV) were used. We assessed what difference using WALRV rather than PLRV for screening might have made to the eligibility of volunteers. METHODS: We reviewed the laboratory screening results of study volunteers. Red blood cells (RBC), white blood cells (WBC), platelets (PTT), haemoglobin, haematocrit, creatinine, and alanine (ALT) and aspartate (AST) transaminases were measured. Overall and for each parameter, we compared the actually eligible proportion of volunteers using PLRV with the potentially eligible proportion using WALRV. Results: Of 102 (82 males, 20 females) volunteers, overall 55 (53.9% males) met PLRV eligibility criteria for inclusion, compared with 91 (89.2% males) who were within WALRV normal limits (p < 0.0001). Thus, 36 volunteers who failed laboratory screening using PLRV (76.6% of screening failures) might have been eligible if WALRV had been applied. Parameters with significant effect were haemoglobin (33 ineligible by PLRV, vs. 2 ineligible by WALRV; p < 0.0001); RBC (27 vs. 1; p < 0.0001); and PTT (18 vs. 6; p = 0.0093). Levels of creatinine and ALT did not present any differences. Discussion: Use of WALRV in eligibility assessment would potentially have led to considerable differences in the baseline laboratory characteristics of enrolled volunteers. Clinical trials are increasingly common and crucial in emerging infectious disease research. Our findings underscore the importance of locally-derived LRV in clinical trials in sub-Saharan Africa, to avoid excluding potentially eligible study volunteers, and to better support routine clinical care and safety assessments. Appropriately designed studies are needed in each region to establish local LRV. Full article

Introduction: Lassa fever disease (LFD) is an acute viral haemorrhagic fever caused by Lassa virus. It is a disease of public health importance in West Africa and a global health threat. It is endemic in some West African countries like Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria, where an estimated 300,000 to 500,000 cases occur every year with an estimated 5000 annual deaths. Persons living in rural areas and health care workers are at greatest risk. Public awareness and knowledge of the LFD and its risk factors are some of the important factors that determine disease transmission and success of preventive/control efforts. This study was therefore conducted to assess LFD-related awareness and knowledge in Gangara, a rural agrarian community in Giwa Local Government Area of Kuduna State, NorthWest Nigeria. Methods: A cross-sectional, community based descriptive study conducted in Gangara community. An interviewer- administered questionnaire was used to collect data from 556 adult respondents, selected using systematic random sampling technique. Data was analyzed using SPSS (version 20). Results: A majority of the respondents were females (52.9%) with a mean age of 37.0 ± 15.2. The level of awareness of LFD was high (66.7%) among respondents and there was a statistically significant association between awareness of LFD and not having any form of education (P < 0.00). However, most of the respondents (79.0%) have poor knowledge of LFD. Knowledge of risk factors for LFD was also poor with 59.4% not knowing that drying grains and foodstuffs on the ground is a risk factor for LFD. Conclusions: Awareness of the disease was quite high but knowledge of the disease and its risk factors was poor. For effective prevention of future outbreaks, the community needs to be properly educated on LFD and its risk factors. Full article

A country’s ability to prepare for, detect, and respond to infectious disease outbreaks such as the Ebola outbreaks in West Africa and the Democratic Republic of the Congo, and the recent Zika outbreak in the Latin American and Caribbean region, depends greatly on its competency in mobilizing skilled staff, and in providing and resupplying its health system with essential infection prevention and control commodities during public health emergencies. Health systems in most developing countries suffer from fragmentation; limited coordination and leadership; lack of national health security policies and legislation; low staff capacity and competency; and inadequate information systems necessary for decision making. The global health security agenda (GHSA) has stepped up efforts to build the capacity of such countries to effectively respond to health emergencies by strengthening health systems preparedness and ability to respond to outbreaks and epidemics. Chemonics International leads the implementation of multiple efforts to strengthen health systems across the world in support of the GHSA mission, both through the implementation of USAID funded activities and through its membership in the GHSA Private Sector Roundtable. Under the USAID Global Health Supply Chain—Technical Assistance Francophone Task Order, Chemonics developed a framework of essential competencies for emergency supply chain (ESC) management to help countries prepare and respond to outbreaks and epidemics. This framework has been piloted in Cameroon, and has wide-ranging applications for ministries of health, central medical stores, and regional level logistics units. Additionally, Chemonics, through the USAID funded Human Resources for Health in 2030 (HRH2030) program, supports the efforts of National One Health Platforms to ensure efficient multisectoral coordination; support integrated surveillance, preparedness, and response systems; and develop emerging diseases preparedness and response plans as well as prevention and control strategies, including leading the first ever simulation exercise in Ethiopia focused on Highly Pathogenic Avian Influenza. Full article

Introduction: The West African Ebola outbreak of 2014–2016 necessitated clinical trials in communities with limited health data. The EBOVAC-Salone Ebola vaccine trial is ongoing in the largely rural Kambia District in northern Sierra Leone. To gain a baseline insight into our local noncommunicable disease (NCD) epidemiology, we examined screening blood pressure (BP) measurements in trial volunteers. Methods: BP involved taking multiple readings using an Omron M6 sphygmomanometer in rested individuals. We classified BP by the European 2018 ESC/ESH guidelines: optimal BP, normal or high-normal BP, or hypertension (systolic ≥ 140 mmHg ± diastolic ≥ 90 mmHg) with Grade 1, 2, or 3 (G1HT, G2HT, G3HT) severity levels. Results: Of 870 volunteers, 220 (25.3%) had optimal BP, 236 (27.13%) had normal BP, and 250 (28.7%) had high-normal BP. The remaining 164 (18.9%) were hypertensive. By gender, 16.5% (109/668) of males and 27.2% (55/202) of females were hypertensive. Among hypertensives, 62.2% had G1HT, 18.3% had G2HT, and 19.5% had G3HT. Twenty-two (13.4%) were previously diagnosed, with eight on treatment. Forty-one had isolated systolic hypertension. The prevalence significantly increased with age (p < 0.0001), with 5.3% (27/514) in the age-category 18–29 y, 18.6% (29/156) in 30–39 y, 49.4% (84/170) in 40–59 y, and 80% (24/30) in ≥60 y. The severity also increased with age, with 54.9% of G1HT, 76.7% of G2HT, and 90.7% of G3HT being aged ≥ 40 y. In total, 36.6% (60/164) of hypertensives were overweight or obese. Discussion: In an economically disadvantaged, Ebola-affected rural West African community where NCD might not traditionally be thought prevalent, almost one in five adults were found to be hypertensive and were mostly unaware. Additionally, nearly one in three had high-normal BP. Together, these findings portend a potent, largely silent, and potentially growing NCD threat, and illustrate that infectious disease (ID) studies could provide opportunities for pragmatic NCD data. As both ID and NCD are putatively promoted by overlapping pro-inflammatory and poverty-driven factors, a cross-paradigmatic “multiplex” approach, whereby ID studies prospectively incorporate NCD-related sub-studies (and vice versa), might optimize limited research resources for enhanced public health benefit. Full article

Background: Good laboratory practices in terms of biosecurity and biosafety are essential for the protection of laboratory personnel, the populations and the environment. If not implemented, the risk of pathogen spreading from the laboratory is conceivable. In addition, in current African geopolitical context, the reliable practices such as the protection, control and tracking of valuable biological material will prevent their loss, theft, uncontrolled access and potential misuse. WAHO, with the support of KfW is implementing trainings of trainers on biosecurity in the ECOWAS region in a project called PROALAB. PROALAB team realized that many partners were aiming at implementing in parallel quite similar non internationally certified programs in the ECOWAS region. Therefore, PROALAB decided to organize a meeting of key stakeholders in order to pool efforts, avoid duplication, and harmonize strategies and procedures. Objective: Develop a harmonized strategy and harmonized procedures for the training of health professionals in biosecurity/biosafety and biohazard risk management in ECOWAS member countries to pass internationally certified biosafety and biosecurity examinations. Methods: Programs of each of the institutions were presented and discussed. A regional program on biosecurity/biosafety training was elaborated during group working and a regional program of certification of trainers was discussed and validated. A work plan and timeline were developed through group working. Results: In the ECOWAS region, some countries are more advanced in biosecurity training. Training is generally organized by national biosecurity associations with the support of the IFBA or other partners (WHO, FMx, PHE, etc.). Côte d’Ivoire, Nigeria and Mali seem more advanced and could be solicited to organize training for less-advanced countries. The IFBA certification covers five domains: (1) Biorisk management, (2) biosecurity, (3) biosafety cabinet, (4) biological waste management and (5) biocontainment facility. The technical working group decided consensually that basic training for biosecurity managers in the laboratories should cover the first two domains. More advanced experts advising governments should be trained in the other domains progressively. Progressive training could be built on the 3 levels Nigerian/Ivoirian system of “basic-advanced-consolidated (or expert)” system. Existing module from WHO, FMx, IPD, IPCI and other ECOWAS countries should be adapted to match the international certification needs. Practical training should also be organized in the laboratory by the same institutions that will be allowed to deliver a practical certificate on behalf of WAHO. Conclusion: With the extension of laboratory activities in the context of strengthening the surveillance programs in the ECOWAS region, more expertise on biosecurity is needed. With the support of national biosecurity associations, WAHO could play a role in harmonizing reinforcing training on biosecurity and legislation. Full article

Background: The goal of the health system is to improve health by providing an integrated set of services. The vaccination program is set up for it. Evaluation results revealed low coverage and many key factors involved in the decision to vaccinate. Vaccination has been integrated into primary health care and is free. WHO has initiated a strategy to reach every district and UNICEF’s Baby Friendly Community Approach. All this for meeting each target child in the community and in health facilities. The purpose of the study is to analyze the factors that interact to or against access to vaccination for all in three areas: system response and community. Methodology: The approach is participatory and consisted of a literature review and in-depth interviews with target (n = 88). Results: The results in three areas: understanding the motivations, the dynamic impact of change and challenges: knowledge and perception of preventable diseases through vaccination, vaccines & administration, time and frequency, rumors attitudes and behaviors community perceptions of vaccination vs. stakeholder views on social norms and community involvement Leadership district management teams acceptability by the community agents communication activities to increase the level of knowledge about immunization, promotion of good practices to improve social mobilization, assessments, management rumors and distrust. Conclusions: Factors hampering access to vaccination. To fill the gaps strengthening improvement plan is essential. The measures envisaged are: communication, promotion and use of data for action. Full article

Background: Studies have shown that Guinea is a natural reservoir for many serious infectious diseases: cholera, Lassa, Ebola, measles. The analysis that underlies the emergence and spread of infectious diseases are dominated by a certain ecosystem, favorable customs, the fragility of the health system resilience: warning, surveillance, adequate response or lack of research and biosafety. The objective is to analyze the links between disease and community commitment for action. Methodology qualitative, participatory and focused on the triangulation of the literature review, in-depth interviews with target and comments. Results: In Guinea, a strategy “Active Monitoring belt around Heal Ebola” (SA-Ceint) was implemented to ensure enhanced oversight and assurance á their medical and psychosocial needs. Monitoring is implemented by “National Safety Agency” in collaboration with various partners. Community-based monitoring is required to prevent new outbreaks of Ebola in the country and bring them to life and health events. The Ebola outbreak (2013–2016) reveals that in a context of vulnerability, mistrust and rumors, the management deserves a preparation. Thus, the incentive mechanisms at the community commitment of the response including surveillance have enabled side. Lessons learned have pushed the country to engage in a process of implementation of ERARE, separates, the platform “One Health” and institutionalization of community health strategies preservation of human health, animal health and protection of the environment. Conclusion: Without communication that improves knowledge and helps in solving health and biosecurity issues, it is illusory to imagine that the prevention and response programs against infectious diseases will be successful long term. Community involvement is critical to the prevention, detection, monitoring, response. Full article

Aeromonas hydrophila, Escherichia coli and Vibrio cholerae are among a myriad of bacteria pathogen commonly found in natural water bodies that cause serious waterborne infection while antibiotic resistance genes are emerging contaminants posing potential worldwide human health risk. This study was designed to determined genetic determinants involved in antimicrobial resistance in bacteria isolates from aquatic environments. A total of 372 water samples, comprising of 111, 144 and 117 ponds, rivers and streams were collected from three local governments areas (Abakaliki, Ebonyi and Ikwo) of Ebonyi State Nigeria over a period of twelve (12) months. Bacteria Isolates obtained from water bodies were identified and characterized by polymerase chain reaction (PCR) analysis using 16S rRNA specific primers. The susceptibility of the isolates to different antibiotics was determined using disc diffusion technique. Total DNA was extracted and sequenced on Genetic Analyzer 3130 xl sequencer and the amplified 16S rRNA gene sequence. The presence of antibiotic resistance genes was determined by PCR using specific primers. Bacteria isolated were Aeromonas hydrophila (103), Escherichia coli (118) and Vibrio cholera (87). The isolates were susceptibility to gentamicin (96.12%), meropenem (94.17%), ciprofloxacin (89.32%) imipenem (85.44%) and chloramphenicol (84.47%) while they showed 94.17%, 93.20%, 90.29%, 89.32%, 88.35%, 86.41% and 83.5% resistance to penicillin, sulphamethoxazole, kanamycin, azithromycin, streptomycin cephalothin and cefuroxime respectively. The isolates were found to harbor the following antibiotic resistance genes, blaCTXM, blaSHV, class 1 Integron Ac, Intl1, blaTEM and TetB. These findings deserve serious attention, as the presence of bacteria coliforms in water harbouring antibiotic resistance genes are potential risk to the health of people. Keywords: aquatic environment resistant genes characterization. Full article