Showing papers by "Mohamed F Jalloh published in 2021"

A review and agenda for integrated disease models including social and behavioural factors.

Abstract: Social and behavioural factors are critical to the emergence, spread and containment of human disease, and are key determinants of the course, duration and outcomes of disease outbreaks. Recent epidemics of Ebola in West Africa and coronavirus disease 2019 (COVID-19) globally have reinforced the importance of developing infectious disease models that better integrate social and behavioural dynamics and theories. Meanwhile, the growth in capacity, coordination and prioritization of social science research and of risk communication and community engagement (RCCE) practice within the current pandemic response provides an opportunity for collaboration among epidemiological modellers, social scientists and RCCE practitioners towards a mutually beneficial research and practice agenda. Here, we provide a review of the current modelling methodologies and describe the challenges and opportunities for integrating them with social science research and RCCE practice. Finally, we set out an agenda for advancing transdisciplinary collaboration for integrated disease modelling and for more robust policy and practice for reducing disease transmission.

Behaviour adoption approaches during public health emergencies: implications for the COVID-19 pandemic and beyond.

Abstract: Human behaviour will continue to play an important role as the world grapples with public health threats. In this paper, we draw from the emerging evidence on behaviour adoption during diverse public health emergencies to develop a framework that contextualises behaviour adoption vis-a-vis a combination of top-down, intermediary and bottom-up approaches. Using the COVID-19 pandemic as a case study, we operationalise the contextual framework to demonstrate how these three approaches differ in terms of their implementation, underlying drivers of action, enforcement, reach and uptake. We illustrate how blended strategies that include all three approaches can help accelerate and sustain protective behaviours that will remain important even when safe and effective vaccines become more widely available. As the world grapples with the COVID-19 pandemic and prepares to respond to (re)emerging public health threats, our contextual framework can inform the design, implementation, tracking and evaluation of comprehensive public health and social measures during health emergencies.

Trends in classifying vaccine hesitancy reasons reported in the WHO/UNICEF Joint Reporting Form, 2014-2017: Use and comparability of the Vaccine Hesitancy Matrix.

Abstract: Since 2014, the World Health Organization (WHO) member states have been annually reporting vaccine hesitancy reasons, using the WHO/UNICEF Joint Reporting Form (JRF). The Vaccine Hesitancy Matrix (VHM), developed by a WHO strategic advisory group of experts, can serve as an important tool to categorize vaccine hesitancy reasons reported in the JRF. We aimed to describe the reasons for vaccine hesitancy reported globally from 2014 to 2017 to ascertain trends over time and understand the comparability of using the VHM to classify hesitancy reasons from 2014 to 2016 based on previously published literature. We conducted a quantitative content analysis to code and categorize vaccine hesitancy reasons reported in the JRF from 2014 to 2017. Vaccine hesitancy trends were consistent from 2014 to 2017, where vaccine hesitancy reasons were mainly related to "individual and group level influences" (59%) followed by "contextual influences" (25%), and "vaccine- or vaccination-specific issues" (16%). Comparability of our approach to categorize vaccine hesitancy to the previously published JRF data showed that results were mostly but not entirely consistent. Major differences in categorizing vaccine hesitancy were noted between two specific reasons - "experience with past vaccination" (under "individual and group influences") and "risk/benefit- scientific evidence" (under "vaccine and vaccination-specific issues"); this was usually due to lack of clear definitions in some sub-categories and generic responses reported in the JRF. The JRF hesitancy module may benefit from modifications to improve the data quality. Understanding global vaccine hesitancy is crucial and JRF can serve as an important tool, especially with the potential introduction of a COVID-19 vaccine.

Engaging religious leaders to promote safe burial practices during the 2014-2016 Ebola virus disease outbreak, Sierra Leone.

Abstract: Objective To quantify the potential impact of engaging religious leaders in promoting safe burial practices during the 2014-2016 Ebola virus disease outbreak in Sierra Leone. Methods We analysed population-based household survey data from 3540 respondents collected around the peak of the outbreak in Sierra Leone, December 2014. Respondents were asked if in the past month they had heard an imam or pastor say that people should not touch or wash a dead body. We used multilevel logistic regression modelling to examine if exposure to religious leaders' messages was associated with protective burial intentions if a family member died at home and other Ebola protective behaviours. Findings Of the respondents, 3148 (89%) had been exposed to faith-based messages from religious leaders on safe Ebola burials and 369 (10%) were unexposed. Exposure to religious leaders' messages was associated with a nearly twofold increase in the intention to accept safe alternatives to traditional burials and the intention to wait ≥ 2 days for burial teams (adjusted odds ratio, aOR: 1.69; 95% confidence interval, CI: 1.23-2.31 and aOR: 1.84; 95% CI: 1.38-2.44, respectively). Exposure to messages from religious leaders was also associated with avoidance of traditional burials and of contact with suspected Ebola patients (aOR: 1.46; 95% CI: 1.14-1.89 and aOR: 1.65; 95% CI: 1.27-2.13, respectively). Conclusion Public health messages promoted by religious leaders may have influenced safe burial behaviours during the Ebola outbreak in Sierra Leone. Engagement of religious leaders in risk communication should be prioritized during health emergencies in similar settings.

Debunking highly prevalent health misinformation using audio dramas delivered by WhatsApp: evidence from a randomised controlled trial in Sierra Leone.

Abstract: INTRODUCTION: Infectious disease misinformation is widespread and poses challenges to disease control. There is limited evidence on how to effectively counter health misinformation in a community setting, particularly in low-income regions, and unsettled scientific debate about whether misinformation should be directly discussed and debunked, or implicitly countered by providing scientifically correct information. METHODS: The Contagious Misinformation Trial developed and tested interventions designed to counter highly prevalent infectious disease misinformation in Sierra Leone, namely the beliefs that (1) mosquitoes cause typhoid and (2) typhoid co-occurs with malaria. The information intervention for group A (n=246) explicitly discussed misinformation and explained why it was incorrect and then provided the scientifically correct information. The intervention for group B (n=245) only focused on providing correct information, without directly discussing related misinformation. Both interventions were delivered via audio dramas on WhatsApp that incorporated local cultural understandings of typhoid. Participants were randomised 1:1:1 to the intervention groups or the control group (n=245), who received two episodes about breast feeding. RESULTS: At baseline 51% believed that typhoid is caused by mosquitoes and 59% believed that typhoid and malaria always co-occur. The endline survey was completed by 91% of participants. Results from the intention-to-treat, per-protocol and as-treated analyses show that both interventions substantially reduced belief in misinformation compared with the control group. Estimates from these analyses, as well as an exploratory dose-response analysis, suggest that direct debunking may be more effective at countering misinformation. Both interventions improved people's knowledge and self-reported behaviour around typhoid risk reduction, and yielded self-reported increases in an important preventive method, drinking treated water. CONCLUSION: These results from a field experiment in a community setting show that highly prevalent health misinformation can be countered, and that direct, detailed debunking may be most effective. TRIAL REGISTRATION NUMBER: NCT04112680.

Overall and central obesity and prostate cancer risk in African men.

Abstract: African men are disproportionately affected by prostate cancer (PCa). Given the increasing prevalence of obesity in Africa, and its association with aggressive PCa in other populations, we examined the relationship of overall and central obesity with risks of total and aggressive PCa among African men. Between 2016 and 2020, we recruited 2,200 PCa cases and 1,985 age-matched controls into a multi-center, hospital-based case–control study in Senegal, Ghana, Nigeria, and South Africa. Participants completed an epidemiologic questionnaire, and anthropometric factors were measured at clinic visit. Multivariable logistic regression was used to examine associations of overall and central obesity with PCa risk, measured by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), respectively. Among controls 16.4% were obese (BMI ≥ 30 kg/m2), 26% and 90% had WC > 97 cm and WHR > 0.9, respectively. Cases with aggressive PCa had lower BMI/obesity in comparison to both controls and cases with less aggressive PCa, suggesting weight loss related to cancer. Overall obesity (odds ratio: OR = 1.38, 95% CI 0.99–1.93), and central obesity (WC > 97 cm: OR = 1.60, 95% CI 1.10–2.33; and WHtR > 0.59: OR = 1.68, 95% CI 1.24–2.29) were positively associated with D’Amico intermediate-risk PCa, but not with risks of total or high-risk PCa. Associations were more pronounced in West versus South Africa, but these differences were not statistically significant. The high prevalence of overall and central obesity in African men and their association with intermediate-risk PCa represent an emerging public health concern in Africa. Large cohort studies are needed to better clarify the role of obesity and PCa in various African populations.

Alternative Capture-Recapture Point and Interval Estimators Based on Two Surveillance Streams

Abstract: The capture-recapture approach is a common and potentially useful paradigm for estimating the total number (N) of cases or deaths via multiple registries in epidemiological studies. Using data on childhood deaths from two sources in a Sierra Leone chiefdom collected by the Child Health and Mortality Prevention Surveillance (CHAMPS) project team as a motivating example, we consider point and interval estimation in the two-capture case. We focus primarily on closed population scenarios under what we term and clarify as the LP conditions, i.e., assumptions that make the well-known Lincoln-Petersen (LP) and Chapman estimators valid. We clarify the unverifiable nature of assumptions about a key population-level parameter (akin to a relative risk of capture) implicitly made by popular alternatives such as loglinear models and the estimator of Chao (Biometrics. 43:783–791, 1987). We argue that the LP conditions remain the most central and useful given the possibility to defend them within strata of judiciously chosen covariates and/or to ensure them by design. We then propose two new multinomial distribution-based estimators that are valid under those conditions. The first adjusts for typical (mean) bias and provides a potentially preferable alternative to the Chapman estimator. The second targets reduced median bias, which is generally overlooked as a performance criterion in the capture-recapture setting. Finally, we develop an approach geared toward improved confidence intervals in this setting that utilizes refinements to the posterior distribution of the proposed mean bias-adjusted estimand within a Bayesian credible interval strategy. The proposed point and interval estimators are evaluated in comparison with others through simulation studies.

Evaluation of health system readiness and coverage of intermittent preventive treatment of malaria in infants (IPTi) in Kambia district to inform national scale-up in Sierra Leone

Abstract: Intermittent preventive treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a proven strategy to protect infants against malaria Sierra Leone is the first country to implement IPTi nationwide IPTi implementation was evaluated in Kambia, one of two initial pilot districts, to assess quality and coverage of IPTi services This mixed-methods evaluation had two phases, conducted 3 (phase 1) and 15–17 months (phase 2) after IPTi implementation Methods included: assessments of 18 health facilities (HF), including register data abstraction (phases 1 and 2); a knowledge, attitudes and practices survey with 20 health workers (HWs) in phase 1; second-generation sequencing of SP resistance markers (pre-IPTi and phase 2); and a cluster-sample household survey among caregivers of children aged 3–15 months (phase 2) IPTi and vaccination coverage from the household survey were calculated from child health cards and maternal recall and weighted for the complex sampling design Interrupted time series analysis using a Poisson regression model was used to assess changes in malaria cases at HF before and after IPTi implementation Most HWs (19/20) interviewed had been trained on IPTi; 16/19 reported feeling well prepared to administer it Nearly all HFs (17/18 in phase 1; 18/18 in phase 2) had SP for IPTi in stock The proportion of parasite alleles with dhps K540E mutations increased but remained below the 50% WHO-recommended threshold for IPTi (41% pre-IPTi [95%CI 2–7%]; 11% post-IPTi [95%CI 8–15%], p < 001) From the household survey, 299/459 (674%) children ≥ 10 weeks old received the first dose of IPTi (versus 804% for second pentavalent vaccine, given simultaneously); 274/444 (625%) children ≥ 14 weeks old received the second IPTi dose (versus 654% for third pentavalent vaccine); and 83/217 (364%) children ≥ 9 months old received the third IPTi dose (versus 522% for first measles vaccine dose) HF register data indicated no change in confirmed malaria cases among infants after IPTi implementation Kambia district was able to scale up IPTi swiftly and provide necessary health systems support The gaps between IPTi and childhood vaccine coverage need to be further investigated and addressed to optimize the success of the national IPTi programme

Prostate tumors of native men from West Africa show biologically distinct pathways—A comparative genomic study

Abstract: BACKGROUND Native African men (NAM) experience a disproportionate burden of prostate cancer (PCa) and have higher mortality rates compared to European American men (EAM). While socioeconomic status has been implicated as a driver of this disparity, little is known about the genomic mechanisms and distinct biological pathways that are associated with PCa of native men of African origin. METHODS To understand biological factors that contribute to this disparity we utilized a total of 406 multi-institutional localized PCa samples, collected by Men of African Descent and Carcinoma of the Prostate biospecimen network and Moffitt Cancer Center/University of Pennsylvania Health science system. We performed comparative genomics and immunohistochemistry to identify the biomarkers that are highly enriched in NAM from west Africa and compared them with African American Men (AAM) and EAM. Quantified messenger RNA expression and Median H scores based on immune reactivity of staining cells, were compared using Mann Whitney test. For gene expression analysis, p values were further adjusted for multiple comparisons using false discovery rates. RESULTS Immunohistochemical analysis on selected biomarkers showed a consistent association between ETS related gene (ERG) status and race with 83% of NAM exhibiting tumors that lacked TMPRSS2-ERG translocation (ERGnegative ) as compared to AAM (71%) and EAM (52%). A higher proportion of NAM (29%) were also found to be double negative (ERGnegative and PTENLoss ) as compared to AAM (6%) and EAM (7%). NAM tumors had significantly higher immunoreactivity (H-score) for PSMA, and EZH2, whereas they have lower H-score for PTEN, MYC, AR, RB and Racemase, (all p < .05). Comparative genomics revealed that NAM had significant transcriptomic variability in AR-activity score. In pathways enrichment analysis NAM tumors exhibited the enrichment of proinflammatory pathways including cytokine, interleukins, inflammatory response, and nuclear factor kappa B signaling. CONCLUSIONS Prostate tumors in NAM are genomically distinct and are characterized by the dysregulation of several biomarkers. Furthermore, these tumors are also highly enriched for the major proinflammatory pathways. These distinct biological features may have implications for diagnosis and response to targeted therapy among Black men, globally.

Barriers and facilitators to reporting deaths following Ebola surveillance in Sierra Leone: implications for sustainable mortality surveillance based on an exploratory qualitative assessment

Abstract: Objectives To understand the barriers contributing to the more than threefold decline in the number of deaths (of all causes) reported to a national toll free telephone line (1-1-7) after the 2014–2016 Ebola outbreak ended in Sierra Leone and explore opportunities for improving routine death reporting as part of a nationwide mortality surveillance system. Design An exploratory qualitative assessment comprising 32 in-depth interviews (16 in Kenema district and 16 in Western Area). All interviews were audio-recorded, transcribed and analysed using qualitative content analysis to identify themes. Setting Participants were selected from urban and rural communities in two districts that experienced varying levels of Ebola cases during the outbreak. All interviews were conducted in August 2017 in the post-Ebola-outbreak context in Sierra Leone when the Sierra Leone Ministry of Health and Sanitation was continuing to mandate reporting of all deaths. Participants Family members of deceased persons whose deaths were not reported to the 1-1-7 system. Results Death reporting barriers were driven by the lack of awareness to report all deaths, lack of services linked to reporting, negative experiences from the Ebola outbreak including prohibition of traditional burial rituals, perception that inevitable deaths do not need to be reported and situations where prompt burials may be needed. Facilitators of future willingness to report deaths were largely influenced by the perceived communicability and severity of the disease, unexplained circumstances of the death that need investigation and the potential to leverage existing death notification practices through local leaders. Conclusions Social mobilisation and risk communication efforts are needed to help the public understand the importance and benefits of sustained and ongoing death reporting after an Ebola outbreak. Localised practices for informal death notification through community leaders could be integrated into the formal reporting system to capture community-based deaths that may otherwise be missed.

Epidemiological and Diagnostic Aspects of Bladder Bilharziomas in the Urology Department of Idrissa Pouye General Hospital (HOGIP)

Abstract: Objective. The aim of our study is to assess the diagnostic aspects of bladder bilharzioma in the Urology Department of Idrissa Pouye General Hospital (Senegal). Materials and Methods. It is a descriptive study from January 2013 to December 2018. The patients included in the study were those who had anatomopathological examination of bladder biopsy that showed a schistosomiasis pseudotumor of the bladder. The variables studied were sociodemographic, clinical symptoms, imaging findings, histology, and treatment. The data have been saved and analyzed by the 2013 Excel software. Results. Thirteen patients were included in our study. The average age was 27 ± 12.1 years. Sex ratio was 1.6. The majority of the patients were from the northern part of Senegal. Hematuria was the main symptom for all the patients. Cystoscopy was performed for all the patients and showed 5 granulomas and 8 fibrocalcic polyps. A transurethral resection of the bladder was performed, and treatment with praziquantel (40 mg/kg of bodyweight) has been carried out. One patient presented precancerous lesions such as metaplasia and dysplasia of the bladder mucosa. After a median follow-up of 40 months (6–57 months), ten patients had a favorable clinical and endoscopic outcome. Conclusion. Granulomas and fibrocalcic polyps of the bladder mucosa are, respectively, confused with squamous cell carcinoma and bladder lithiasis in endemic areas of schistosomiasis. Good cystoscopy interpretation can provide the diagnosis of bladder bilharzioma and start the treatment.

The network epidemiology of an Ebola epidemic

Abstract: Connecting the different scales of epidemic dynamics, from individuals to communities to nations, remains one of the main challenges of disease modeling. Here, we revisit one of the largest public health efforts deployed against a localized epidemic: the 2014-2016 Ebola Virus Disease (EVD) epidemic in Sierra Leone. We leverage the data collected by the surveillance and contact tracing protocols of the Sierra Leone Ministry of Health and Sanitation, the US Centers for Disease Control and Prevention, and other responding partners to validate a network epidemiology framework connecting the population (incidence), community (local forecasts), and individual (secondary infections) scales of disease transmission. In doing so, we gain a better understanding of what brought the EVD epidemic to an end: Reduction of introduction in new clusters (primary cases), and not reduction in local transmission patterns (secondary infections). We also find that the first 90 days of the epidemic contained enough information to produce probabilistic forecasts of EVD cases; forecasts which we show are confirmed independently by both disease surveillance and contact tracing. Altogether, using data available two months before the start of the international support to the local response, network epidemiology could have inferred heterogeneity in local transmissions, the risk for superspreading events, and probabilistic forecasts of eventual cases per community. We expect that our framework will help connect large data collection efforts with individual behavior, and help reduce uncertainty during health emergencies and emerging epidemics.

Using immunisation caregiver journey interviews to understand and optimise vaccination uptake: lessons from Sierra Leone.

Abstract: Quantitative and qualitative assessments have revealed diverse factors that influence the uptake of childhood immunisation services and shed light on reasons for vaccination delays and refusals UNICEF and partner organisations developed the Immunisation Caregiver Journey Framework as a novel way to understand caregiver experiences in accessing and receiving immunisation services for children This framework aims to help immunisation programmes identify vaccination barriers and opportunities to improve vaccination uptake by enhancing the overall caregiver journey in a systems-focused manner, using human-centred design principles In this paper, we adapt the framework into a flexible qualitative inquiry approach with theoretical guidance from interpretative phenomenology We draw from the implementation experiences in Sierra Leone to inform methodological guidance on how to design and implement the Immunisation Caregiver Journey Interviews (ICJI) to understand the lived experiences of caregivers as they navigate immunisation services for their children Practical guidance is provided on sampling techniques, conducting interviews, data management, data analysis and the use of data to inform programmatic actions When properly implemented, the ICJI approach generates a rich qualitative understanding of how caregivers navigate household and community dynamics, as well as primary healthcare delivery systems We argue that understanding and improving the caregiver journey will enhance essential immunisation outcomes, such as the completion of the recommended vaccination schedule, timeliness of vaccination visits and reduction in dropouts between vaccine doses

A case of pyelo-ureteral junction bilharzioma.

Abstract: Bilharziomas are inflammatory tumour-like masses which often pose the problem of differential diagnosis with neoplastic processes. Its location at the pyelo-ureteral junction is very uncommon. The pre-operative diagnosis of bilharzia of the pyelo-ureteral junction is difficult. Indeed, the diagnosis is most often made on anatomo-pathological examination of the surgical specimen, which rarely allows for conservative treatment. We report one case of pyeloureteral junction bilharzioma in children living in bilharzia endemic areas and discuss the diagnostic and therapeutic issues of these cases.