Department of Environmental Health Sciences
Permanent URI for this collectionhttps://dspace.njala.edu.sl/handle/20.500.144402/168
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Item Regression Modelling and Analysis of Cell phone-Based Syndromic Surveillance Data for Ebola in Sierra Leone(OMICS Publishing Group, 2016) Kangbai, Jia Bainga**Aim:** To determine the out degree centrality for multivariate analysis, examine the demographic differences and characteristics of callers who make more calls, and determine callers who are more likely to make at least one positive Ebola call.Methods: Surveillance data for 393 suspected Ebola cases (192 males, 201 females) were collected from October 23, 2014 to June 28, 2015 using cell phone technology.UCINET and Net Draw software were used to determine the out degree centrality used for multivariate analysis.Poisson and logistic regression analyses were used to do multivariable analysis.Result: Women (AOR=0.33,95% CI \[0.14, 0.81\]) was associated with decreased odds of making at least one positive Ebola surveillance call compared to men.Women (IR= 0.63, 95% CI \[0.49, 0.82\]) was also associated with making fewer Ebola surveillance calls compared to men. **Conclusion:** This study shows that the combination of cell phone technology with user-friendly and open-source social network software such as UCINET and Net draw will provide an important adjunct to the traditional measures of epidemiologic surveillance.Item Virologic Response and Survival Analysis of 281 HbsAg Treatment Naive Patients on Lamivudine Monotherapy in Sierra Leone(2017-10-06) Kangbai, Jia BaingaMore than 350 million people are infected with Hepatitis B Virus (HBV) globally. The main aim of any chronic hepatitis B therapy is to prevent liver cirrhosis and its sequelae, including Hepatocellular Carcinoma (HCC). This is a cross sectional study that analysed medical records of 281 HBsAg seropositive patients in order to determine those factors that are associated with the reduction in the HBV viral load and the duration of HBV lamivudine monotherapy in order to attain a virological response.Item Tracking Ebola through cellphone, internet of things and Blockchain technology(OMICS Publishing Group, 2018) Kangbai, Jia Bainga**Objective:** In the absence of any approved therapeutics and vaccines to treat or prevent Ebola infection, managing Ebola outbreak largely depends on early case detection and surveillance, real-time communication of surveillance data, and Ebola case management. Here we assessed the possibility of uploading data obtained by Internet of Internet device that monitors cellphone company’s Call Data Records (CDR), national demographic census, national transportation system and Ebola vaccine production databases on a Blockchain platform to conduct real-time Ebola contact tracing, transmission pattern surveillance and vaccine delivery. **Results:** Mobility data obtained by Internet of Things (IoT) from CDR from cellphone companies, national transportation system, and census demographic data can be integrated into a Blockchain platform to provide real-time Ebola surveillance and contact-tracing. While cellphone data provides a unique opportunity to quantify human mobility, Blockchain system magnifies such opportunity by making the data accessible to many actors in real-time. By mounting data from CDR, national population census, national transport system and Ebola vaccine production database on a Blockchain platform will provide additional lens in our understanding of the role played by human population dynamics in the spread as well and containment of Ebola during outbreaksItem Health Care Facility Network Efficiency and Location Crucial for Ebola Treatment Outcome(OMICS Publishing Group, 2018) Kangbai, Jia Bainga**Background:** The application of network analysis in public health research is gaining popularity with the belief that health problems are a product of complex social, political and economic causes.Organisational networks can be used in public health to design and evaluate public health programs.There have been multiple studies in the past relating to public health organisations and HIV/AIDS using organisational networking method.Here we use social network analysis to analyse the association between the network positions of health care facilities and the treatment outcome of Ebola patients from these health care facilities in Sierra Leone. **Methods:** We extracted and later analysed treatment outcome data obtained from the Case Report Forms (CRF) of 117 Ebola patients who sought Ebola treatment at the Kenema Government Hospital from June 2014 to April 2015.For ego network purpose, we considered each Ebola referral health care facility as an ego.Poisson regression analysis was used to determine the association between Ebola mortality rates in a health care facility and the ego's structural holes.Results: The median age, length of stay during Ebola treatment, and the period it takes an Ebola patient to survive treatment following from onset of signs and symptoms were 20 (IQR=17.5 years), 15 (IQR=11 days) and 7 (IQR=5.3days) respectively.There were differences in ego, network efficiency, effective size and constraint for the factors associated with mortality rates for Ebola patients treated at the Kenema Government Hospital.Conclusion: Establishing non-redundant contacts within a health care facility network and expanding their locations can reduce Ebola mortality rates during outbreak.Item Epidemiological Markers for HIV Infection among First-Time Antenatal Attendees in Sierra Leone: 2012-2015 Longitudinal Study(2018-03-31) Kangbai, Jia BaingaGlobally it is estimated that 10% of Human Immunodeficiency Virus (HIV) infected patients are coinfected with Hepatitis B Virus (HBV) which is the leading cause of chronic liver diseases including liver cirrhosis and hepatocellular carcinoma. In countries with high HBV endemicity the seroprevalence rate can be as high as 25% with approximately 10% of the HIV infected population coinfected with HBV. HIV and HBV shares similar transmission route and co-infection is common.Item Epidemiological characteristics, clinical manifestations, and treatment outcome of 139 paediatric Ebola patients treated at a Sierra Leone Ebola treatment center(BioMed Central, 2019-01-24) Kangbai, Jia BaingaBACKGROUND: The West Africa Ebola Virus Disease (EVD) outbreak in 2014-2016 was declared by the World Health Organization (WHO) a public health emergency of international concern. Most of the previous studies done in Sierra Leone relating to the clinical and epidemiological features of EVD during the 2014-2016 West African outbreak focused on adult EVD patients. There have been conflicting reports about the effects of EVD on children during previous outbreaks. METHODS: This is an observational retrospective analysis of medical data of all laboratory confirmed paediatric EVD patients below 15 years of age who were admitted at the 34 Military Hospital Ebola Treatment Center (ETC) in Wilberforce, Sierra Leone between June 2014 to April 2015. We analyzed the sociodemographic and clinical characteristics of paediatric EVD cases contained in case report forms that were collected by Ebola surveillance officers and clinicians at the 34 Military Hospital ETC. Both univariate and multivariate logistic regression models were used to determine the sociodemographic and clinical characteristics of paediatric EVD patients that were associated with EVD facility-based mortality. RESULTS: The majority of the paediatric EVD cases in this study were female (56.1%), pupils (51.1%), and 43.2% belonged to the age group between 10 years and below 15 years. The median age of the paediatric EVD cases was 9 years (interquartile range = 4 to 11 years). Adjusting for other covariates in the model, male paediatric EVD patient (AOR = 13.4, 95% CI = \[2.07-156-18\], p < 0.05), EVD patient with abdominal pain (AOR = 11.0, 95% CI = \[1.30-161.81\], p < 0.05), vomiting (AOR = 35.7, 95% CI = \[3.43-833.73\], p < 0.05), signs of conjunctivitis (AOR = 17.4, 95% CI = \[1.53-342.21\], p < 0.05) and difficulty in breathing (AOR = 23.3, 95% CI = \[1.92-713.01\], p < 0.05) at the time of admission had increased odds of dying during EVD treatment. CONCLUSIONS: We recommend the adoption of case definitions currently in vigour to cater for specific characteristics of paediatric patients. Subgroups that can be identified by applying the model developed in this study may require special attention and intensified care.Item Sociodemographic and clinical determinants of in-facility case fatality rate for 938 adult Ebola patients treated at Sierra Leone Ebola treatment center(BioMed Central, 2020-04-21) Kangbai, Jia BaingaBACKGROUND: The 2013-2016 West Africa Ebola Virus Disease (EVD) outbreak recorded the highest incidence and mortality since the discovery of the virus in Zaire in 1976; with more than 28,000 probable and confirmed EVD cases and 11,000 deaths. Studies relating to previous outbreaks usually involved small sample sizes. In this study we are set to identify those sociodemographic and clinical features that predict in-facility mortality among EVD patients using a large sample size. METHODS: We analysed the anonymized medical records of 938 laboratory-confirmed EVD patients 15 years old and above who received treatment at The 34 Military Hospital and The Police Training School EVD Treatment Centers in Sierra Leone in the period June 2014 to April 2015. We used both univariable and multivariable logistic regression to determine the predictors for in-facility mortality of these patients based on their sociodemographic and clinical characteristics. RESULTS: The median age of the EVD cases was 33 years (interquartile range = 25 to 40 years). The majority of the EVD cases were male (59.0%) and had secondary level education (79.3%). We reported a low overall in-facility case fatality rate of 26.4%. The associations between case fatality rates and EVD patients who reported fever, abdominal pain, cough, diarrhoea, vomiting, fatigue, haemorrhage, dysphagia, conjunctival injection, dyspnea, and skin rash at the time of admission were all statistically significant (p < 0.05). Our preferred model with the age group 65 years and above alongside the following clinical symptoms; diarrhoea, vomiting, fatigue, dysphagia, conjunctival injection, dyspnea and cough produced a receiver operating characteristic (ROC) curve with an AUC (area under the curve) value of 0.93. CONCLUSIONS: We constructed a simple model that can be optimally used alongside other rapid EVD diagnostic tools to identify EVD in-facility treatment mortality predictors based on the sociodemographic characteristics and clinical symptoms of adult EVD patients. We also reported low EVD cases among patients with secondary and tertiary education. These subpopulations of our patients who are generally informed about the signs and symptoms of EVD, alongside our treatment regimen may have been responsible for our comparatively lower case fatality rate.Item Severity score for predicting in-facility Ebola treatment outcome(Elsevier BV, 2020-08-04) Kangbai, Jia BaingaPurpose Sierra Leone recorded the highest incidence rate for the 2013-2016 West African Ebola outbreak. In this investigation, we used the medical records of Ebola patients with different sociodemographic and clinical features to determine the factors that are associated with Ebola treatment outcome during the 2013-2016 West African Ebola outbreak in Sierra Leone and constructed a predictive in-facility mortality score. Methods We used the anonymized medical records of 1077 laboratory-confirmed pediatric and adult patients with EVD who received treatment at the 34 Military Hospital and the Police Training School Ebola Treatment Centers in Sierra Leone between the period of June 2014 and April 2015. We later determined the in-facility case fatality rates for Ebola, the odds of dying during Ebola treatment, and later constructed a predictive in-facility mortality score for these patients based on their clinical and sociodemographic characteristics. Results We constructed a model that partitioned the study population into three mortality risk groups of equal patient numbers, based on risk scoring: low (score ≤ -5), medium (score -4 to 1), and high-risk group (score ≥ 2). The CFR of patients with EVD belonging to the low- (≤-5), medium (-4 to 1), and high- (≥2) risk groups were 0.56%, 9.75%, and 67.41%, respectively. Conclusions We succeeded in designing an in-facility mortality risk score that reflects EVD clinical severity and can assist in the clinical prioritization of patients with EVD.Item Re-reading ACT, BCG, and Low COVID-19 in Africa(Springer Nature, 2021) Kangbai, Jia BaingaOctober 11, 2020, marks the seventh month since the World Health Organization (WHO) officially declared COVID-19 a pandemic. Unlike other coronavirus diseases, there is a geographically disproportionate distribution of the incidence of COVID-19 cases around the world. We observed a significantly high COVID-19 cases and deaths in countries and territories with no or very small number of malaria cases or no or low national TB cases in 2018. We speculate that the high incidence of COVID-19 cases and deaths in countries less affected by malaria is partly due to overexposure to malaria which led to the regular use of the artemisinin anti-malaria drugs as well as the regular use of bacillus Calmette-Guérin (BCG) vaccine for TB prevention. The vaccine produced an almost life-long immunity to TB and meningitis to its recipients. We are thus calling for a COVID-19 containment and clinical management protocol that will incorporate the use of the anti-malaria ACT drug cocktail and BCG vaccine on compassionate ground.Item Factors associated with length of stay and treatment outcome of Ebola patients treated at an Ebola treatment center in Sierra Leone during the peak period of the West African Ebola outbreak 2013–2016(BioMed Central, 2021-07-12) Kangbai, Jia BaingaBACKGROUND: The World Health Organization (WHO) declared the West Africa Ebola epidemic as a Public Health Emergency of International Concern in August 2014. During the outbreak period, there were calls for the affected countries to construct Ebola treatment centres and reliable diagnostic laboratories closer to areas of transmission in order to improve the quality care of Ebola Virus Disease (EVD) patients. Delay in seeking treatment has been reported to have led to poor treatment outcome of EVD patients. Sierra Leone recorded more than 8000 probable and confirmed cases and more than 4000 EVD -related deaths nation-wide. METHODS: In this retrospective study, we investigated the effects of treatment delay, length of symptomatic period, EVD patients' sex, age, occupation, region of residence, and clinical characteristics on the treatment outcome of 205 laboratory-confirmed EVD patients who were admitted at the Kenema Government Hospital Ebola Treatment Center (KGHETC) from 13/09/2014-26/11/2014; i.e. during the peak of 2013-2016 EVD outbreak in Sierra Leone. Specifically also, we determined the factors that were associated with the length of stay for EVD treatment for patients who were discharged alive. RESULTS: Majority (66.3%, n = 205/309) of the 309 suspected EVD patients with medical records at the KGHETC triage during the period under review were tested positive for EVD using reverse-transcriptase-polymerase chain reaction (RT-PCR) and had a definitive treatment outcome. Few (33.7%, n = 104/309) suspected EVD patients were not included in our analysis and were classified thus: 29.1% (n = 90/309) suspect EVD cases with negative RT-PCR results, 4.5% (n = 14/309) suspect cases with non-available RT-PCR result. Of the 205 patients, 99 (48.3%) had a fatal outcome. For EVD patients that survived, we recorded a significant association (- 0.06, 95% Confidence Interval (CI) = - 0.14 - - 0.02, p = 0.004) between the Length of Stay (LOS) and for each kilometer travelled to seek treatment at the KGHETC. However, the association between EVD patients that were low skilled workers (- 5.91, 95% CI = - 24.60 - 12.79, p = 0.73), EVD patients who were children and pupils in junior school (- 0.86, 95% CI = - 12.86 - 11.14, p = 0.73), health seeking delay for EVD patients who resided in Kenema District where the KGHETC was located (- 0.49, 95% CI = - 0.12 - 1.09, p = 0.24), sex (- 1.77, 95% CI = - 8.75 - 5.21, p = 0.50), age (0.21, 95% CI = - 0.36 - 0.77, p = 0.57), referral status (1.21, 95% CI = - 17.67 - 20.09, p = 0.89) and the LOS in surviving patients were not statistically significant. CONCLUSION: The high LOS for either treatment outcome for EVD patients that resided in the district in which the EVD treatment facility was located compared to those patients from other districts implies that health authorities should consider intensive health education with high priority given to seeking early EVD treatment, and the construction of strategic ETCs as important components in their response strategy.