Momodou Jasseh

Adult Mortality in Sub-Saharan Africa: Evidence From Demographic and Health Surveys

This article reports levels, trends, and age patterns of adult mortality in 23 sub-Saharan Africa countries, based on the sibling histories and orphanhood data collected by the countries’ Demographic and Health Surveys. Adult mortality has risen sharply since HIV became prevalent, but the size and speed of the mortality increase varies greatly among countries. Excess mortality is concentrated among women aged 25–39 and among men aged 30–44. These data suggest that the increase in the number of men who die each year has exceeded somewhat the increase for women. It is time for a systematic attempt to reconcile the demographic and epidemiological evidence concerning AIDS in Africa.

Two strategies for the delivery of IPTc in an area of seasonal malaria transmission in the Gambia: a randomised controlled trial.

Bojang and colleagues report a randomized trial showing that delivery of intermittent preventive treatment for malaria in children by village health workers is more effective than delivery by reproductive and child health trekking clinics.

Fertility in Kenya and Uganda: A Comparative Study of Trends and Determinants

Between 1980 and 2000 total fertility in Kenya fell by about 40 per cent, from some eight births per woman to around five. During the same period, fertility in Uganda declined by less than 10 per cent. An analysis of the proximate determinants shows that the difference was due primarily to greater contraceptive use in Kenya, though in Uganda there was also a reduction in pathological sterility. The Demographic and Health Surveys show that women in Kenya wanted fewer children than those in Uganda, but that in Uganda there was also a greater unmet need for contraception. We suggest that these differences may be attributed, in part at least, first, to the divergent paths of economic development followed by the two countries after Independence; and, second, to the Kenya Governments active promotion of family planning through the health services, which the Uganda Government did not promote until 1995.

Effect of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease in The Gambia: a population-based surveillance study

Summary Background Little information is available about the effect of pneumococcal conjugate vaccines (PCVs) in low-income countries. We measured the effect of these vaccines on invasive pneumococcal disease in The Gambia where the 7-valent vaccine (PCV7) was introduced in August, 2009, followed by the 13-valent vaccine (PCV13) in May, 2011. Methods We conducted population-based surveillance for invasive pneumococcal disease in individuals aged 2 months and older who were residents of the Basse Health and Demographic Surveillance System (BHDSS) in the Upper River Region, The Gambia, using standardised criteria to identify and investigate patients. Surveillance was done between May, 2008, and December, 2014. We compared the incidence of invasive pneumococcal disease between baseline (May 12, 2008–May 11, 2010) and after the introduction of PCV13 (Jan 1, 2013–Dec 31, 2014), adjusting for changes in case ascertainment over time. Findings We investigated 14 650 patients, in whom we identified 320 cases of invasive pneumococcal disease. Compared with baseline, after the introduction of the PCV programme, the incidence of invasive pneumococcal disease decreased by 55% (95% CI 30–71) in the 2–23 months age group, from 253 to 113 per 100 000 population. This decrease was due to an 82% (95% CI 64–91) reduction in serotypes covered by the PCV13 vaccine. In the 2–4 years age group, the incidence of invasive pneumococcal disease decreased by 56% (95% CI 25–75), from 113 to 49 cases per 100 000, with a 68% (95% CI 39–83) reduction in PCV13 serotypes. The incidence of non-PCV13 serotypes in children aged 2–59 months increased by 47% (−21 to 275) from 28 to 41 per 100 000, with a broad range of serotypes. The incidence of non-pneumococcal bacteraemia varied little over time. Interpretation The Gambian PCV programme reduced the incidence of invasive pneumococcal disease in children aged 2–59 months by around 55%. Further surveillance is needed to ascertain the maximum effect of the vaccine in the 2–4 years and older age groups, and to monitor serotype replacement. Low-income and middle-income countries that introduce PCV13 can expect substantial reductions in invasive pneumococcal disease. Funding GAVIs Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP), Bill & Melinda Gates Foundation, and the UK Medical Research Council.

Reaching millennium development goal 4 - the Gambia.

Objective  To describe how, through a DSS in a rural area of The Gambia, it has been possible to measure substantial reductions in child mortality rates and how we investigated whether the decline paralleled the registered fall in malaria incidence in the country.

Monitoring the introduction of pneumococcal conjugate vaccines into West Africa: design and implementation of a population-based surveillance system.

Philip Campbell Hill and colleagues describe how they set up a population-based surveillance system to assess the impact of pneumococcal conjugate vaccines on invasive pneumococcal disease (IPD) and radiological pneumonia in children in The Gambia.

Coverage and timing of children's vaccination: an evaluation of the expanded programme on immunisation in The Gambia.

Objective To evaluate the coverage and timeliness of the Expanded Programme on Immunisation (EPI) in The Gambia. Methods Vaccination data were obtained between January 2005 and December 2012 from the Farafenni Health and Demographic Surveillance System (FHDSS), the Basse Health and Demographic Surveillance System (BHDSS), the Kiang West Demographic surveillance system (KWDSS), a cluster survey in the more urban Western Health Region (WR) and a cross sectional study in four clinics in the semi-urban Greater Banjul area of WR. Kaplan-Meier survival function was used to estimate the proportion vaccinated by age and to assess timeliness to vaccination. Findings BCG vaccine uptake was over 95% in all regions. Coverage of DPT1 ranged from 93.2% in BHDSS to 99.8% in the WR. Coverage decreased with increasing number of DPT doses; DPT3 coverage ranged from 81.7% in BHDSS to 99.0% in WR. Measles vaccination coverage ranged from 83.3% in BHDSS to 97.0% in WR. DPT4 booster coverage was low and ranged from 43.9% in the WR to 82.8% in KWDSS. Across all regions, delaying on previous vaccinations increased the likelihood of being delayed for the subsequent vaccination. Conclusions The Gambia health system achieves high vaccine coverage in the first year of life. However, there continues to be a delay to vaccination which may impact on the introduction of new vaccines. Examples of effectively functioning EPI programmes such as The Gambia one may well be important models for other low income countries struggling to achieve high routine vaccination coverage.

Risk factors for house-entry by culicine mosquitoes in a rural town and satellite villages in The Gambia.

BackgroundScreening doors, windows and eaves of houses should reduce house entry by eusynanthropic insects, including the common African house mosquito Culex pipiens quinquefasciatus and other culicines. In the pre-intervention year of a randomized controlled trial investigating the protective effects of house screening against mosquito house entry, a multi-factorial risk factor analysis study was used to identify factors influencing house entry by culicines of nuisance biting and medical importance. These factors were house location, architecture, human occupancy and their mosquito control activities, and the number and type of domestic animals within the compound.Results40,407 culicines were caught; the dominant species were Culex thalassius, Cx. pipiens s.l., Mansonia africanus, M. uniformis and Aedes aegypti. There were four times more Cx. pipiens s.l. in Farafenni town (geometric mean/trap/night = 8.1, 95% confidence intervals, CIs = 7.2–9.1) than in surrounding villages (2.1, 1.9–2.3), but over five times more other culicines in the villages (25.1, 22.1–28.7) than in town (4.6, 4.2–5.2). The presence of Cx. pipiens s.l. was reduced in both settings if the house had closed eaves (odds ratios, OR town = 0.62, 95% CIs = 0.49–0.77; OR village = 0.49, 0.33–0.73), but increased per additional person in the trapping room (OR town = 1.16, 1.09–1.24; OR village = 1.10, 1.02–1.18). In the town only, Cx. pipiens s.l. numbers were reduced if houses had a thatched roof (OR = 0.70, 0.51–0.96), for each additional cow tethered near the house (OR = 0.73, 0.65–0.82) and with increasing distance from a pit latrine (OR = 0.97, 0.95–0.99). In the villages a reduction in Cx. pipiens s.l. numbers correlated with increased horses in the compound (OR = 0.90, 0.82–0.99). The presence of all other culicines was reduced in houses with closed eaves (both locations), with horses tethered outside (village only) and with increasing room height (town only), but increased with additional people in the trapping room and where cows were tethered outside (both locations).ConclusionThe findings of this study advocate eave closure and pit latrine treatment in all locations, and zooprophylaxis using horses in rural areas, as simple control measures that could reduce the number of culicines found indoors.

Social Acceptability and Durability of Two Different House Screening Interventions against Exposure to Malaria Vectors, Plasmodium falciparum Infection, and Anemia in Children in The Gambia, West Africa

The social acceptability and durability of two house screening interventions were addressed using focus group discussions, questionnaires, indoor climate measurements, and durability surveys. Participants recognized that screening stopped mosquitoes (79-96%) and other insects (86-98%) entering their houses. These and other benefits were appreciated by significantly more recipients of full screening than users of screened ceilings. Full screened houses were 0.26°C hotter at night (P = 0.05) than houses with screened ceilings and 0.51°C (P < 0.001) hotter than houses with no screening (28.43°C), though only 9% of full screened house users and 17% of screened ceiling users complained about the heat. Although 71% of screened doors and 85% of ceilings had suffered some damage after 12 months, the average number of holes of any size was < 5 for doors and < 7 for ceilings. In conclusion, house screening is a well-appreciated and durable vector control tool.

Serogroup W135 meningococcal disease, The Gambia, 2012.

In 2012, an outbreak of Neisseria meningitidis serogroup W135 occurred in The Gambia. The attack rate was highest among young children. The associated risk factors were male sex, contact with meningitis patients, and difficult breathing. Enhanced surveillance facilitates early epidemic detection, and multiserogroup conjugate vaccine could reduce meningococcal epidemics in The Gambia.