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In the Lao People's Democratic Republic (Lao PDR), cervical cancer is the third leading cause of women cancer.The objective of this cross-sectional study was to compare the efficacy of careHPV™ test versus conventional Pap smear or Siriraj liquid-based cytology in the detection of cervical cancer in women living with human immunodeficiency virus type 1 (HIV-1).Overall, 631 women consented to participate. Four cervical specimens were taken for the purpose of conventional Pap smear, Siriraj liquid-based cytology, careHPV™ test, and HPV-16 genotyping. The exact McNemar test was used to compare the efficacy and diagnostic performance of the tests.Of the 631 women with follow-up, 331 were human papillomavirus (HPV) negative. High-grade squamous intraepithelial lesions were found in 37 women, biopsy-proven high-grade cervical intraepithelial neoplasia in 50 women, and invasive carcinoma in seven women. The proportion of women with high-grade cervical lesion or carcinoma detected after abnormal careHPV™ test was higher (6.02%; 95% confidence interval [CI]: 4.4-8.1) than that detected by conventional Pap smear (4.59%; 95% CI: 3.2-6.5). careHPV™ and HPV-16 genotyping had, respectively, the highest sensitivity (80.8%; 95% CI: 67.4-89.5) and specificity (92.2%; 95% CI: 89.8-94.2). HPV-16 was the most frequently detected genotype.careHPV™ test represents a screening option in Lao PDR, particularly in women living with HIV-1 because of higher prevalence of chronic HPV in this population.

Objective To better understand factors contributing to underutilization of laboratory services for health care delivery in sub-Saharan Africa, we conducted a study in Senegalese Antenatal Care clinics (ANC) and laboratories to determine the extent of underutilization, contributing factors, and bottlenecks in the cascade of care from first ANC visit, test uptake, to availability of test results and appropriate clinical management. Methods At 16 health facilities, pregnant women attending for their first ANC visit were consecutively recruited and information was prospectively collected on the request, execution, results and clinical management of seven nationally recommended laboratory screening tests for normal pregnancy: hemoglobin concentration (Hb), syphilis serology, HIV serology, determination of proteinuria (PU), determination of blood group and Rhesus factor, Emmel test to detect sickle cell disease, and glycaemia. Health facility staff were interviewed on human resource capacity, management of the ANC and the laboratory, and availability and use of guidelines. Results Of 1246 ANC attendants, 400 (32%) had complete results. Completeness varied between facilities from 0–99%. In multilevel logistic regression analysis of women nested in facilities, complete uptake was lower if women started ANC later in pregnancy; very low in rural ANC attendants who ever delivered compared to urban primigravidae (OR 0.064; 95%CI 0.00–0.52); and higher if the facility routinely recommended all seven tests. In the cascade from test request to clinical management, the most frequent bottleneck was non-execution of requested tests, while unavailability of results for executed test was uncommon (

UNSTRUCTURED Public health professionals in the Eastern Mediterranean region (EMR) have limited access to continuing education, including workshops and conferences in public health. Held under the theme Innovative Approaches: Adapting to the Current EMR Context, the Eastern Mediterranean Public Health Network (EMPHNET) organized and conducted the Sixth EMPHNET Regional Conference from March 26 to 29, 2018. This paper summarizes the key activities including workshops, roundtable discussions, oral and poster presentations, keynote speeches, and side meetings. Before the opening, 5 preconference workshops were held: “Field Epidemiology Training Program (FETP) Accreditation,” “Innovative Public Health Surveillance,” “Human and Animal Brucellosis,” “Rapid Response Teams,” and “Polio Transition and Routine Immunization.” The conference hosted 6 roundtable discussions: “Consolidation of the FETP Network,” “One Health to Achieve Global Health Security,” “Polio Eradication Efforts and Transition Planning for Measles Elimination,” “Mobile Data Collection and Other Innovative Tools to Enhance Decision Making,” “Confronting Candida auris: An Emerging Multidrug-resistant Global Pathogen,” and “Functioning and Sustainable Country Public Health Emergency Response Operation Framework.” One of the conference’s key objectives was to provide a space for FETP residents, graduates, and public health professionals to showcase achievements. A total of 421 abstracts were submitted and after professional review, 34.9% (147/421) were accepted (111 for oral presentations and 36 for poster presentations) and published by Iproceeding. The conference met the primary objectives of showcasing the public health accomplishments and contributions of the EMR, encouraging the exchange of ideas and coordination among stakeholders, and engaging cross-sectoral workforce in producing recommendations for approaching regional and global health concerns. Moreover, the conference presented a unique opportunity for FETPs and other public health professionals from the Mediterranean region to present their significant scientific work and also facilitated networking among professionals. EMPHNET strives to continue to present similar exchange opportunities for public health professionals in the region.

Background: Education is one of the most important drivers for helping people in developing countries lift themselves out of poverty. However, even when schooling is available absenteeism rates can be high. Recently, focus is being given on whether or not WASH interventions can help reduce absenteeism in developing countries. However, none has focused exclusively on the role of drinking water provision. We report a study on the association between absenteeism and provision of treated water in containers maintained in schools. Methods and Findings: We undertook a quasi-experimental longitudinal study of absenteeism rates in 8 schools, 4 of which received one 20 l container of treated drinking water per day. The water had been treated by filtration and ultraviolet disinfection. Weekly absenteeism rates were compared across all schools using the negative binomial model in generalized estimating equations. There was a strong association between the provision of free water and reduced absenteeism (Incidence rate ratio = 0.39 (95% confidence intervals 0.27-0.56)). However, there was also a strong association with season (wet versus dry) and a significant interaction between receiving free water and season. In one of the intervention schools, it was discovered that the water supplier was not fulfilling his contract and was not delivering sufficient water each week. In this school, we showed a significant association between the number of water containers delivered each week and absenteeism (IRR = 0.98 95% CI 0.96-1.00). Conclusion: There appears to be a strong association between providing free and safe drinking water and reduced absenteeism, although only in the dry season. The mechanism for this association is not clear but may be in part due to improved hydration leading to improved school experience for the children.

Joint paper of the INSERM Ethics Committee and the IRD Consultative Committee for Deontology and Ethics.

Background Interferon-release assays (IGRAs) for diagnosing active pulmonary tuberculosis (PTB) are not yet fully validated, particularly in high TB-endemic areas as the People's Republic of China (PRC). The aim of this report was to assess the performance of the QuantiFERON-TB Gold In-tube (QFT-GIT) and tuberculin skin test (TST), in addition to microbiological results, as contributors for diagnosing active PTB in the PRC. Methods/Principal Findings A total of 300 PTB patients, 41 disease controls (DC) and 59 healthy community controls (HCC) were included prospectively between May 2010 and April 2011 from two provinces of the PRC (Heilongjiang and Zhejiang). The QFT-GIT and TST yielded an overall sensitivity for active TB of 80.9% and 86.2%, and a specificity of 36.6% and 26.8%, respectively. The province of origin and smear microscopy status did not significantly impact the diagnostic values for PTB. However, using the TST with a 10 mm cut-off point, a significantly higher proportion of LTBI was observed in the DC than the HCC (p=0.01). Discordant results between the QFT-GIT and TST were found among 1/3 of the PTB, HCC and DC. Two-thirds of the individuals presented TST-positive/QFT-GIT-negative discordant results. The TST-negative/QFT-GIT-positive result was not associated with age or bacillary load. Cumulative QFT-GIT and TST positive results increased the overall sensitivity (95.9%), but it was associated with a dramatic decrease of the overall specificity (24.8%) leading to a suboptimal PPV (80.1%) and a low NPV (61.1%). Conclusions/Significance The usefulness of the QFT-GIT to diagnose active TB in high TB-endemic countries remains doubtful because like the TST, the QFT-GIT cannot distinguish between LTBI and active TB. Used as single stand-alone tests, both the QFT-GIT and TST have very limited roles in the diagnosis of active PTB. However, the combined use of SM, the TST and QFT-GIT may allow for the exclusion of ATB.

To assess the antibiotic prescribing practices of doctors working in the Lao People's Democratic Republic and their knowledge of local antibiotic resistance patterns.Doctors attending morning meetings in 25 public hospitals in four provinces were asked to complete a knowledge, attitude and practice survey. The questionnaire contained 43 multiple choice questions that the doctor answered at the time of the meeting.The response rate was 83.4% (386/463). Two hundred and seventy doctors (59.8%) declared that they had insufficient information about antibiotics. Only 14.0% (54/386) recognized the possibility of cephalosporin cross-resistance in methicillin-resistant Staphylococcus aureus. Most participants had no information about local antibiotic resistance for Salmonella Typhi (211/385, 54.8%) and hospital-acquired pneumonia (253/384, 65.9%). Unnecessary antibiotic prescriptions were considered as harmless by 115 participants and 148 considered locally-available generic antibiotics to be of poor quality. Nearly three-quarters (280/386) of participants agreed that it was difficult to select the correct antibiotics. Most participants (373/386) welcomed educational programmes on antibiotic prescribing and 65.0% (249/383) preferred local over international antibiotic guidelines.Doctors in the Lao People's Democratic Republic seem to favour antibiotic prescribing interventions. Health authorities should consider a capacity building programme that incorporates antibiotic prescribing and hospital infection control.الغرض تقييم ممارسات الأطباء العاملين في جمهورية لاو الديمقراطية الشعبية في وصف المضادات الحيوية ومعرفتهم بالأنماط المحلية لمقاومة المضادات الحيوية. الطريقة طُلب من الأطباء الذين حضروا الاجتماعات الصباحية في 25 مستشفى عمومي في أربع مقاطعات المشاركة في مسح عن المعرفة والاتجاه والممارسة. وتضمن المسح 43 سؤالاً متعدد الخيارات أجاب عنها الطبيب أثناء الاجتماع. النتائج كان معدل الاستجابة 83.4 % (386/463). وصرح مائتان وسبعون طبيباً (59.8 %) أنهم لا يمتلكون معلومات كافية عن المضادات الحيوية. وعرف 14.0 % فقط (54/386) إمكانية المقاومة المشتركة للسيفالوسبورين في البكتيريا العنقودية الذهبية المقاومة للميثيسيلين. ولم يكن لدى معظم المشاركين معلومات عن مقاومة المضادات الحيوية المحلية لبكتيريا السالمونيلا التيفية (211/385، 54.8 %) والالتهاب الرئوي الذي يحدث في المستشفيات (253/384، 65.9 %). واعتبر 115 مشاركاً وصفات المضادات الحيوية غير الضرورية آمنة واعتبر 148 مشاركاً المضادات الحيوية الجنيسة المتوفرة محلياً ذات جودة ضعيفة. واتفق ثلاثة أرباع المشاركين تقريباً (280/386) أنه كان من الصعب اختيار المضادات الحيوية المناسبة. ورحب معظم المشاركين (373/386) بالبرامج التثقيفية المعنية بوصف المضادات الحيوية وفضل 65.0 % (249/383) الدلائل الإرشادية المحلية للمضادات الحيوية عن الدلائل الإرشادية الدولية للمضادات الحيوية. الاستنتاج يبدو أن الأطباء في جمهورية لاو الديمقراطية الشعبية يؤيدون تدخلات وصف المضادات الحيوية. وينبغي أن تفكر السلطات الصحية في برنامج لبناء القدرات يدمج بين وصف المضادات الحيوية ومكافحة العدوى بالمستشفيات.评估老挝人民民主共和国医生的抗生素处方实务及其对当地抗生素耐药性模式的知识。.要求四个省25所公立医院参加晨会的医生完成知识、态度和实务调查。问卷包含43个多项选择题,医生在会议时间内完成回答。.响应率为83.4%(386/463)。其中270名医生(59.8%)称其了解足够的抗生素信息。只有14.0%医生(54/386)认识到在耐甲氧西林金黄色酿脓葡萄球菌中可能存在头孢菌素交叉耐药。大多数参与者对伤寒杆菌(211/385,54.8%)和院内肺炎(253/384,65.9%)的当地抗生素耐药性一无所知。115名参与者认为非必要的抗生素处方无害,148名认为当地可获得的一般抗生素质量较差。近四分之三(280/386)的参与者认为很难选择适合的抗生素。大多数参与者(373/386)对抗生素处方教育计划表示欢迎,65.0%(249/383)首选地方而非国际抗生素的指导方针。.老挝的医生似乎支持抗生素处方干预措施。卫生部门应该考虑推行包含抗生素处方和医院感染控制的能力建设计划。.Évaluer les pratiques de prescription d'antibiotiques des médecins travaillant en République démocratique populaire lao et leur connaissance des profils locaux de résistance aux antibiotiques.Les médecins participant aux réunions matinales dans 25 hôpitaux publiques dans 4 provinces ont été invités à répondre à une enquête sur leurs connaissances, leur attitude et leur pratique. Le questionnaire contenait 43 questions à choix multiples auxquelles les médecins répondaient au moment de la réunion.Le taux de réponse était de 83,4% (386/463). Deux cent soixante-dix médecins (59,8%) ont déclaré ne pas avoir suffisamment d'informations sur les antibiotiques. Seuls 14,0% des médecins (54/386) ont admis la possibilité d'une résistance croisée pour la céphalosporine chez la bactérieLes médecins en République démocratique populaire lao semblaient soutenir les interventions en matière de prescription d'antibiotiques. Les autorités de santé devraient envisager l'établissement d'un programme de renforcement des capacités qui intègre la prescription des antibiotiques et le contrôle des infections à l'hôpital.Оценить порядок назначения антибиотиков, которого придерживаются врачи, работающие в Лаосской Народно-Демократической Республике, а также осведомленность этих врачей о резистентности к антибиотикам местного действия.Присутствовавших на утренних совещаниях врачей в 25 государственных больницах четырех провинций попросили принять участие в исследовании осведомленности, отношения и практики. Им было предложено ответить на 43 вопроса с несколькими вариантами ответов во время совещания.Частота ответов составила 83,4% (386/463). Двести семьдесят докторов (59,8%) заявили, что у них отсутствует достаточная информация об антибиотиках. Только 14,0% (54/386) принимает во внимание вероятность перекрестной резистентности к цефалоспорину при лечении метициллин-резистентногоМожно заключить, что врачи в Лаосской Народно-Демократической Республике относятся к вмешательствам с назначением антибиотиков положительно. Органы здравоохранения должны рассмотреть возможность разработки программы по развитию и укреплению потенциала, включающей назначение антибиотиков и контроль за внутрибольничными инфекциями.Evaluar las prácticas de prescripción de antibióticos de los médicos que prestan servicio en la República Democrática Popular Lao y sus conocimientos de los patrones de resistencia a antibióticos locales.Se solicitó a los médicos que asistían a reuniones por la mañana en 25 hospitales públicos de cuatro provincias que completaran una encuesta sobre conocimientos, actitudes y prácticas. El cuestionario contenía 43 preguntas de opción múltiple que los médicos contestaron en la reunión.La tasa de respuesta fue del 83,4 % (386/463). 270 médicos (59,8 %) declararon que no disponían de información suficiente acerca de los antibióticos. Solo el 14,0 % (54/386) reconoció la posibilidad de resistencia cruzada con cefalosporina delLos médicos en la República Democrática Popular Lao parecen favorecer las intervenciones de prescripción de antibióticos. Las autoridades sanitarias deberían considerar un programa de capacitación que incorpore la prescripción de antibióticos y el control de las infecciones hospitalarias.

Background Cervical cancer is the first female cancer in Lao PDR, a low-income country with no national screening and prevention programs for this human papillomavirus (HPV) associated pathology. HIV-infected women have a higher risk of persistent oncogenic HPV infection. The purpose of this study was to determine the knowledge, awareness and attitudes about cervical cancer among Lao women attending or not an HIV treatment center, in order to understand if this attendance had offered an opportunity for information and prevention. Methods A cross-sectional case–control survey was conducted in three provinces of Lao PDR, Vientiane, Luang Prabang and Savannakhet. Cases were 320 women aged 25 to 65, living with HIV and followed in an HIV treatment center. Controls were 320 women matched for age and place of residence, not attending an HIV treatment center. Results Cases had a greater number of sexual partners and used condoms more often than controls. Only 36.6% of women had consulted a gynecologist (47.5% among cases and 25.6% among controls, p < 0.001) and 3.9% had benefited from at least one Pap smear screening (5.6% cases and 2.2% controls, p = 0.02). The average knowledge score was 3.5 on a 0 to 13 scale, significantly higher in cases than in controls (p < 0.0001). Despite having a lower education level and economic status, the women living with HIV had a better knowledge about cervical cancer and were more aware than the controls of the risk of developing such a cancer (35.9% vs. 8.4%, p = 0.0001). The main source of information was healthcare professionals. The main reasons for not undergoing Pap smear were the absence of symptoms and the default of medical injunction for cases, the lack of information and ignorance of screening usefulness for controls. Conclusion In Lao PDR, routine consultation in HIV treatment centers is not enough harnessed to inform women of their high risk of developing cervical cancer, and to perform screening testing and treatment of precancerous lesions. Implementing this cost-effective strategy could be the first step toward a national prevention program for cervical cancer.

Background The aim of this multi-centric prospective study in India was to assess the accuracy of a serological test as an additional tool for diagnosing active tuberculosis (ATB). In particular, an assay based on ELISA using a phenolic glycolipid (PGL-Tb1) or a fusion protein (ESAT-6/CFP10) was compared to the tuberculin skin test (TST) and the microbiological results according to HIV status. Methods Individuals with and without ATB and HIV infection were enrolled. Serology and TST results were analyzed per se and in combination with the microbiological data. Results Among the 778 ATB patients, 102 were HIV-infected, 316 HIV-uninfected and 360 had an HIV-unknown status. Of the 945 non-ATB subjects, 559 were at low risk (community adults) and 386 at high risk of M. tuberculosis exposure. Among those with ATB, the sensitivity of ELISA-PGL-Tb1 for ATB was higher than that of ELISA-ESAT-6/CFP10, both in HIV-infected (72.3% versus 63.7%, p = 0.29) and HIV-uninfected/HIV-unknown groups (40.5% versus 28.6%; p

Background Despite claims that the Millennium Development Goals (MDG) targets on access to safe drinking water have been met, many 100 s of millions of people still have no access. The challenge remains how to provide these people and especially young children with safe drinking water. Method We report a longitudinal study designed to assess the effectiveness of an intervention based on provided treated drinking water in containers on self-reported diarrhoea in children. The intervention was “1001 fontaines pour demain” (1001 F) is a non-governmental not for profit organization (created in 2004 and based in Caluire, France) that helps local entrepreneurs treat package, and sell safe drinking water. Cases and controls were chosen at village and household level by propensity score matching Participants were visited twice a month over six months and asked to complete a diarrhoea health diary. Results In total 4275 follow-up visits were completed on 376 participants from 309 homes. Diarrhoea was reported in 20.4% of children on each visit, equating to an incidence rate estimate of 5.32 episodes per child per year (95% confidence interval = 4.97 to 5.69). Compared to those drinking 1001 F water, children drinking surface water were 33% (95% CI -1 to 17%), those drinking protected ground water were 62% (95% CI 19 to 120%) and those drinking other bottled water 57% (95% CI 15 to 114%) more likely to report diarrhoea. Children drinking harvested rainwater had similar rates of diarrhoea to Children drinking 1001 F water. Conclusion Our study suggests that 1001 F water provides a safer alternative to groundwater or surface water. Furthermore, our study raises serious concerns about the validity of assuming protected groundwater to be safe water for the purposes of assessing the MDG targets. By contrast our study provides addition evidence of the relative safety of rainwater harvesting.

International audience; BACKGROUND: The aim of this multicentric prospective study in India was to assess the performance of the QuantiFERON TB-Gold in tube (QFT-GIT), Tuberculin Skin Test (TST) and microbiological results as additional tools for diagnosing active tuberculosis (TB) and latent infection (LTBI) according to Human Immunodeficiency Virus (HIV) status. METHODS: Individuals with and without active TB and HIV infection were enrolled between 2006-2008. QFT-GIT and TST results were analyzed per se and in combination with microbiological data. RESULTS: Among the 276 individuals (96 active pulmonary TB and 180 no active TB) tested by QFT-GIT, 18 indeterminate results (6.5%) were found, more significantly numerous in the HIV-infected (15/92; 16.3%) than the HIV-uninfected (3/184; 1.6%)(p

Sufficient laboratory capacity is essential to effective infectious disease surveillance and control. This is recognized in the current International Health Regulations (IHR), which identify laboratory services as a category of core capacities that all the World Health Organization (WHO) Member States are expected to develop and maintain ( 1 ). IHR Core Capacity 8 requires laboratory services for every phase of real-time event management (i.e., detection, investigation, and response), with sample analysis being performed either domestically or through collaboration centers ( 2 ). (Published: 25 January 2013) Citation: Emerg Health Threats J 2013, 6 : 19960 - http://dx.doi.org/10.3402/ehtj.v6i0.19960

BackgroundThe suboptimal sensitivity of Interferon (IFN)-γ-based in-vitro assays, especially in immunocompromised individuals, emphasizes the need for alternative markers for diagnosing tuberculosis (TB). The objective of this study was to evaluate whether interferon-inducible protein (IP)-10, monocyte chemotactic protein (MCP)-2 and interleukin (IL)-2 can be useful biomarkers for evaluating a specific response to RD1 antigens associated to active TB disease in HIV-infected individuals.Methodology/principal findingsThe study was carried out in India, the country with the highest TB burden in the world. Sixty-six HIV-infected individuals were prospectively enrolled, 28 with active-pulmonary-TB and 38 without. The whole blood assay based on RD1-selected peptides (experimental test) and QuantiFERON-TB Gold In tube (QFT-IT) was performed. Plasma was harvested at day-1-post-culture and soluble factors were evaluated by ELISA. The results indicate that by detecting IP-10, the sensitivity of the experimental test and QFT-antigen (75% and 85.7% respectively) for active TB was higher compared to the same assays based on IFN-γ (42.9% and 60.7% respectively) and was not influenced by the ability to respond to the mitogen. By detecting IP-10, the specificity of the experimental test and QFT-antigen (57.9% and 13.2% respectively) for active TB was lower than what was reported for the same assays using IFN-γ-detection (78.9% and 68.4% respectively). On the other side, in vitro IL-2 and MCP-2 responses were not significantly associated with active TB.ConclusionsHIV infection does not impair RD1-specific response detected by IP-10, while it significantly decreases IFN-γ-mediated responses. At the moment it is unclear whether higher detection is related to higher sensitivity or lower specificity of the assay. Further studies in high and low TB endemic countries are needed to elucidate this.