Maternal deaths in rural Gambia

Abstract

The objective of this study was to determine causes and contributing factors to maternal deaths in a poor rural setting. We included all maternal deaths (N =42), identified from January to September 2002, in a remote area of The Gambia. To gain a comprehensive picture of medical causes and contributing factors a combination of audit procedure and verbal autopsy was applied. The results showed that anaemia (n =12) was the leading cause of death followed by haemorrhage (n =10), eclampsia (n =8) and obstructed labour (n =8). Placental abruption accounted for 9 of the 10 haemorrhage cases. Substandard obstetric care was identified for the majority of deaths. Substantial inadequacies were revealed at the hospital, characterized by operational difficulties and an uncoordinated emergency preparedness, including malfunction of the blood transfusion service, failure to obtain operative delivery, poor birth monitoring and lack of trained personnel, electricity, medical equipment and drugs. Substandard primary care and logistic difficulties within the referral process further complicated the situation. Delay in seeking care by the cases themselves played a less important role. It was concluded that interventions, addressing the profound deficiencies within the health care system and increasing access to emergency obstetric care, are warranted to reduce maternal deaths in a poor setting such as rural Gambia.     

Determinants of provider choice for malaria treatment: experiences from The Gambia

Malaria is responsible for an estimated one million deaths per year, the vast majority in sub-Saharan Africa. Many of these deaths are attributed to delays in seeking treatment and poor adherence to drug regimes. While there are a growing number of studies describing the factors influencing treatment seeking for malaria, far less is known about the relative weight given to these factors in different settings. This study estimates two models of demand for malaria treatment in the Farafenni region of The Gambia. The first examines the determinants of seeking malaria treatment outside the home versus no treatment or self-care while the second identifies the determinants of provider choice conditional on having decided to seek malaria treatment outside the home. Providers included hospital; health centre; and 'other' which included pharmacies, kiosks; petty traders; neighbours; and traditional healers. Results show that older people were more likely to opt for self-care, or no treatment. The longer the time spent ill or the more severe the fever, the more likely a treatment was sought outside the home. Time of the year and availability of community infrastructure played a key role in both models. Poorer households and those from the Fula ethnic group were much more likely to visit an 'other' provider than a hospital. The policy and methodological implications of these findings are discussed.     

Sustainability and acceptability of latrine provision in The Gambia

All households in 32 villages were provided with improved pit latrines as part of a trachoma control programme in a rural part of The Gambia. Latrine provision was externally driven and was not in response to a request from the communities involved. Materials were provided for free and labour was paid for. To assess durability and acceptability we conducted a follow-up study 25-47 months after construction. Before the intervention only 32% of households in these villages had access to any type of latrine; at follow-up this had risen to 95%. On visual inspection 585/666 latrines (87.3%) were usable and 510 (87.2% of those usable) were currently used. During interviews 566/637 latrine owners (89%) said they were either happy or very happy with their latrines, and 620 (97.3%) reported that they would make a new latrine of some kind when the current one was full or unusable. We interpret these data to suggest that externally driven latrine provision, without additional health education, to an area with poor latrine coverage can result in high, sustainable levels of uptake and generate future demand for sanitation.     

Factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal

BackgroundVaccination during pregnancy can protect pregnant women and their babies from infectious diseases. Tetanus vaccine, also known as tetanus toxoid, is the only vaccine given to pregnant women in The Gambia and Senegal, where it is given by antenatal care providers as part of the Expanded Programme on Immunization. A qualitative study was undertaken to explore factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal.MethodsFocus group discussions and in-depth interviews were conducted across urban and rural settlements of The Gambia and Senegal. We explored the knowledge, attitudes, and perceptions of 152 women who were either pregnant or with an infant. NVivo 11 Qualitative Data Analysis Software was used for management and thematic analysis of the data.ResultsWomen had sufficient knowledge of the need for tetanus vaccine from different information sources but insufficient knowledge of tetanus causes, signs and symptoms. Tetanus vaccine was perceived to be safe and side effects such as pain and swelling at site of injection did not deter uptake of future doses. Women overall had confidence in their sources of vaccine information and the health care workers who administered maternal vaccinations. Their willingness to accept vaccination during pregnancy was particularly influenced by their husbands and trusted healthcare workers. Women across all sites mentioned they would accept new maternal vaccines if they are sensitized beforehand about any potential risks and benefits to them and their babies.ConclusionVaccine acceptance can be influenced by several factors including contextual, individual or group influences and vaccine or vaccination-specific issues. Women across The Gambia and Senegal are generally vaccine acceptors with confidence in the health care workers who vaccinate them and few concerns about maternal vaccines. Women’s acceptance of vaccination during pregnancy is based on previous vaccination experiences and individual weighing of risks and benefits.     

农药暴露对女性生殖健康的影响

目的：研究不同程度农药暴露对女性生殖健康的影响。方法选择长期接触农药的育龄期女性319人为观察组,其中低暴露强度104人,中暴露强度112人,高暴露强度103人;以未长期接触农药的育龄期女性109人为对照组,通过问卷调查的方式搜集资料并进行数据之间的比较。结果不同强度的农药暴露对女性的月经功能、性功能状况、乳腺疾病、阴道炎、不良妊娠结局的差异有统计学意义（P＜0.05）,且与农药暴露的相关系数分别是0.257,0.113,0.127,0.125和0.119,其中长期农药暴露对月经功能和乳腺疾病影响显著（ P＜0.01）,但不同农药暴露对子宫疾病、孕期并发症影响较小（P＞0.05）。结论长期农药暴露对女性生殖系统健康有一定影响,其中对月经功能、性功能状况、阴道炎、乳腺病、不良妊娠结局等方面影响比较显著。应增强农药使用者的安全意识,促进女性农药使用者的生殖健康。     

Depression and Pesticide Exposures among Private Pesticide Applicators Enrolled in the Agricultural Health Study

Background

We evaluated the relationship between diagnosed depression and pesticide exposure using information from private pesticide applicators enrolled in the Agricultural Health Study between 1993 and 1997 in Iowa and North Carolina.

Methods

There were 534 cases who self-reported a physician-diagnosed depression and 17,051 controls who reported never having been diagnosed with depression and did not feel depressed more than once a week in the past year. Lifetime pesticide exposure was categorized in three mutually exclusive groups: low (< 226 days, the reference group), intermediate (226–752 days), and high (> 752 days). Two additional measures represented acute high-intensity pesticide exposures: an unusually high pesticide exposure event (HPEE) and physician-diagnosed pesticide poisoning. Logistic regression analyses were performed relating pesticide exposure to depression.

Results

After adjusting for state, age, education, marital status, doctor visits, alcohol use, smoking, solvent exposure, not currently having crops or animals, and ever working a job off the farm, pesticide poisoning was more strongly associated with depression [odds ratio (OR) = 2.57; 95% confidence interval (CI), 1.74–3.79] than intermediate (OR = 1.07; 95% CI, 0.87–1.31) or high (OR = 1.11; 95% CI, 0.87–1.42) cumulative exposure or an HPEE (OR = 1.65; 95% CI, 1.33–2.05). In analysis of a subgroup without a history of acute poisoning, high cumulative exposure was significantly associated with depression (OR = 1.54; 95% CI, 1.16–2.04).

Conclusion

These findings suggest that both acute high-intensity and cumulative pesticide exposure may contribute to depression in pesticide applicators. Our study is unique in reporting that depression is also associated with chronic pesticide exposure in the absence of a physician-diagnosed poisoning.     

‘Like sugar and honey’: The embedded ethics of a larval control project in The Gambia

This paper describes a malaria research project in The Gambia to provoke thinking on the social value of transnational research. The Larval Control Project (LCP) investigated the efficacy of a microbial insecticide to reduce vector density and, ultimately, clinical malaria in Gambian children. The LCP’s protocol delineated a clinical surveillance scheme that involved Village Health Workers (VHWs) supported by project nurses. Combining insights from ethnographic fieldwork conducted at the Medical Research Council (MRC) Laboratories in Farafenni from 2005 to 2009, open-ended interviews with project nurses, and eight focus group discussions held with participant mothers in October 2007, we consider the social impact of the LCP’s investigative method against the backdrop of several years of research activity. We found that while participants associated the LCP with the clinical care it provided, they also regarded the collaboration between the nurses and VHWs added additional benefits. Organised around the operational functions of the trial, small-scale collaborations provided the platform from which to build local capacity. While ethical guidelines emphasise the considerations that must be added to experimental endeavour in southern countries (e.g. elaborating processes of informed consent, developing strategies of community engagement or providing therapeutic access to participants after the trial concludes), these findings suggest that shifting attention from supplementing ethical protocols to the everyday work of research – embedding ethics through scientific activity – may provide a sounder basis to reinforce the relationship between scientific rigour and social value.     

Identifying the determinants of tuberculosis control in resource-poor countries: insights from a qualitative study in The Gambia

Despite the availability of effective treatment, tuberculosis (TB) remains a major cause of death from an infectious disease in the world, particularly in resource-poor countries. Among the chief reasons for this are deficiencies in case tracing and in adherence to treatment. In order to investigate the contribution of non-biological factors to these deficiencies, we carried out a qualitative study in The Gambia, West Africa, from October 2000 to March 2001. The methods used were focus group discussions, interviews, participant and non-participant observation, and case histories. Four domains were distinctively investigated: the TB patients, the community, the health care providers (including programme staff), and the donors and policy makers. Analysis of the data from all these sources indicated the contribution of a wide range of socio-anthropological factors which influence the success or otherwise of the TB control programme in The Gambia, i.e. gender, urban/rural residence, recourse to traditional healers, adherence to national health policies, knowledge about TB, migration, and socio-economic factors. It is concluded that all these factors must be taken into account in formulating interventions to improve detection of TB cases and patient adherence to treatment within the framework of the national TB control programmes, and proposals have been made for targeted interventions.     

Prevalence and factors associated with intimate partner violence against women in The Gambia: a population-based analysis

ABSTRACT

Although intimate partner violence (IPV) against women is prevalent in sub-Saharan Africa, studies that investigated factors associated with IPV among Gambian women are limited. In this study, we examined the prevalence and factors associated with the different forms of IPV against Gambian women. We used a sample of 3,116 currently married women age (15 ~ 49 years) from The Gambia Demographic and Health Survey 2013. Logistic regression models were used to examine factors associated with Physical Violence (PV), Sexual Violence (SV), and Emotional Violence (EV). Over 40% (n = 1,248) of women reported at least one form of IPV. The prevalence of PV, SV and EV was 20.6%, 4.3%, and 15.1% respectively. Women married at age 18 ~ 24 (adjusted Odds Ratio [aOR]_SV = 1.55), lived with 3 ~ 4 (aOR_PV = 1.69; aOR_EV = 2.10) and ≥5 (aOR_PV = 1.77; aOR_EV = 2.64) children, witnessed parental violence (aOR_PV = 1.66; aOR_SV = 2.75; aOR_EV = 2.25), partner’s primary education (aOR_PV = 1.76), accused of unfaithfulness (aOR_PV = 2.42; aOR_SV = 3.62; aOR_EV4.10), and partner’s alcohol consumption (aOR_PV = 2.56; OR_SV = 3.91; aOR_EV = 2.82) are more likely to report IPV. Conversely, women who lived in Kerewan area (aOR_PV = 0.43; aOR_SV = 0.38; aOR_EV = 0.50), had high income (aOR_PV = 0.65), Wolof (aOR_PV = 0.68) and Jola (aOR_PV = 0.65) ethnicity and unemployed (aOR_PV = 0.59; aOR_SV = 0.56) were less likely to report IPV. Interventions to prevent IPV should focus on education on its effects, and programs that reject sociocultural practices as determinants of IPV.     

Occupational Noise Exposures Among Three Farm Families in Northwest Ohio

ABSTRACT

A pilot project was conducted to evaluate occupational noise exposures of three families living and working on farms in Northwest Ohio. Noise exposures were measured continuously for 7 consecutive days for each participant for 1 week each during planting, growing, and harvesting seasons. The dosimeters were programmed to evaluate noise exposures using both the Occupational Safety and Health Administration (OSHA) action level and the National Institute for Occupational Safety and Health (NIOSH)/American Conference of Governmental Industrial Hygienists (ACGIH) guidelines. One family was evaluated per year and a total of nine family members (six adults and three children) participated. Adult noise exposures for on-farm activities (occupational exposures) ranged from 46.1 to 89.6 decibels on the A-weighted scale (dBA) as an 8-hour time-weighted average (8HR TWA) using the OSHA action level and from 62.6 to 92.1 dBA 8HR TWA using the NIOSH/ACGIH guidelines. Occupational noise exposures for the children ranged from 15.4 to 81.2 dBA 8HR TWA using the OSHA action level and from 42.4 to 85.5 dBA 8HR TWA using the NIOSH/ACGIH guidelines. Six of 45 exposures among the adults and none of the 11 exposures among the children exceeded the OSHA action level. In addition, 10 of 45 exposures among the adults and 1 of 11 exposures among the children exceeded the NIOSH/ACGIH guidelines. The results of this pilot project indicate noise exposures among farm families can exceed recommended levels.     

Pesticide/Environmental Exposures and Parkinson's Disease in East Texas

ABSTRACT

Epidemiological evidence suggests that pesticides and other environmental exposures may have a role in the etiology of idiopathic Parkinson's disease (PD). However, there is little human data on risk associated with specific pesticide products, including organic pesticides such as rotenone with PD. Using a case-control design, this study examined self-reports of exposure to pesticide products, organic pesticides such as rotenone, and other occupational and environmental exposures on the risk of PD in an East Texas population. The findings demonstrated significantly increased risk of PD with use of organic pesticides such as rotenone in the past year in gardening (OR = 10.9; 95% CI = 2.5–48.0) and any rotenone use in the past (OR = 10.0; 95% CI = 2.9–34.3). Use of chlorpyrifos products (OR = 2.0; 95% CI = 1.02–3.8), past work in an electronics plant (OR = 5.1; 95% CI = 1.1–23.6), and exposure to fluorides (OR = 3.3; 95% CI = 1.03–10.3) were also associated with significantly increased risk. A trend of increased PD risk was observed with work history in paper/lumber mill (OR = 6.35; 95% CI = 0.7–51.8), exposure to cadmium (OR = 5.3; 95% CI = 0.6–44.9), exposure to paraquat (OR = 3.5; 95% CI = 0.4–31.6), and insecticide applications to farm animals/animal areas and agricultural processes (OR = 4.4; 95% CI = 0.5–38.1). Cigarette smoking, alcohol use, and fish intake were associated with reduced risk. In summary, this study demonstrates an increased risk of PD associated with organic pesticides such as rotenone and certain other pesticides and environmental exposures in this population.     

Aflatoxin Exposure and Viral Hepatitis in the Etiology of Liver Cirrhosis in The Gambia,West Africa

Background

Cirrhosis of the liver is thought to be a major cause of morbidity and mortality in sub-Saharan Africa, but few controlled studies on the etiology of cirrhosis have been conducted in this region.

Objectives

We aimed to elucidate the association between environmental and infectious exposures and cirrhosis in The Gambia.

Methods

Ninety-seven individuals were diagnosed with cirrhosis using a validated ultrasound scoring system and were compared with 397 controls. Participants reported demographic and food frequency information. Blood samples were tested for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis C virus (HCV) antibody, HCV RNA, and the aflatoxin-associated 249^ser TP53 mutation.

Results

HBsAg seropositivity was associated with a significant increase in risk of cirrhosis [odds ratio (OR) = 8.0; 95% confidence interval (CI), 4.4–14.7] as was the presence of HBeAg (OR = 10.3; 95% CI, 2.0–53.9) and HCV infection (OR = 3.3; 95% CI, 1.2–9.5). We present novel data that exposure to aflatoxin, as assessed both by high lifetime groundnut (peanut) intake and by the presence of the 249^ser TP53 mutation in plasma, is associated with a significant increase in the risk for cirrhosis (OR = 2.8; 95% CI, 1.1–7.7 and OR = 3.8; 95% CI, 1.5–9.6, respectively). Additionally, aflatoxin and hepatitis B virus exposure appeared to interact synergistically to substantially increase the risk of cirrhosis, although this was not statistically significant.

Conclusions

Our results suggest that the spectrum of morbidity associated with aflatoxin exposure could include cirrhosis.     

Acceptance of multiple injectable vaccines in a single immunization visit in The Gambia pre and post introduction of inactivated polio vaccine

BackgroundAs the World Health Organization (WHO) currently recommends that children be protected against 11 different pathogens, it is becoming increasingly necessary to administer multiple injectable vaccines during a single immunization visit. In this study we assess Gambian healthcare providers’ and infant caregivers’ attitudes and practices related to the administration of multiple injectable vaccines to a child at a single immunization visit before and after the 2015 introduction of inactivated polio vaccine (IPV). IPV introduction increased the number of injectable vaccines recommended for the 4-month immunization visit from two to three in The Gambia.MethodsWe conducted a cross-sectional questionnaire-based survey before and after the introduction of IPV at 4 months of age in a representative sample of all health facilities providing immunizations in The Gambia. Healthcare providers who administer vaccines at the selected health facilities and caregivers who brought infants for their 4 month immunization visit were surveyed.FindingsPrior to IPV introduction, 9.9% of healthcare providers and 35.7% of infant caregivers expressed concern about a child receiving more than 2 injections in a single visit. Nevertheless, 98.8% and 90.9% of infants received all required vaccinations for the visit before and after IPV introduction, respectively. The only reason why vaccines were not received was vaccine stock-outs. Infant caregivers generally agreed that vaccinators could be trusted to provide accurate information regarding the number of vaccines that a child needed.ConclusionHealthcare providers and infant caregivers in this resource limited setting accepted an increase in the number of injectable vaccines administered at a single visit even though some expressed concerns about the increase.     

Screening for tuberculosis among 2381 household contacts of sputum-smear-positive cases in The Gambia

Contact investigation is a key component of tuberculosis (TB) control in developed, but not developing, countries. We aimed to measure the prevalence of TB among household contacts of sputum-smear-positive TB cases in The Gambia and to assess the sensitivity of an enzyme-linked immunospot (ELISPOT) assay in this regard. Household contacts of adult smear-positive TB patients were assessed by questionnaire, purified protein derivative (PPD) skin test, ELISPOT assay, physical examination, chest X-ray and sputum/gastric aspirate. Thirty-three TB cases were identified from 2174 of 2381 contacts of 317 adult smear-positive pulmonary TB patients, giving a prevalence of 1518/100000. The cases identified tended to have milder disease than those passively detected. The sensitivity of ESAT-6/CFP-10 ELISPOT test as a screening test for TB disease was estimated as 71%. Fifty-six per cent of contacts with a PPD skin test result >or=10mm induration had detectable responses to ESAT-6/CFP-10 by ELISPOT; 11% with a negative PPD skin test (<10mm) had a positive ESAT-6/CFP-10 response. Active screening for TB among contacts of TB patients may have a role in TB control in The Gambia. These individuals are a high-risk group, and the disease identified is less advanced than that found through passive case detection. An ELISPOT assay was relatively insensitive as a screening test for TB.     

The social shaping of childhood vaccination practice in rural and urban Gambia

Improving childhood vaccination coverage is a key health policyobjective in Africa, and as availability increases, it willdepend on addressing issues of demand and timely schedule completion.This paper explores vaccination demand in urban and rural areasof The Gambia as shaped by prevailing local vaccination cultures(comprising maternal knowledge and understandings, socio-culturalcontexts and interactions with health providers). A survey of1600 mothers constructed on the basis of prior ethnography findsa high level of social demand for vaccination, based on laytheories of the general value of immunization in complementingtraditional child protection practices. For most rural mothers,strong social networks encourage routine clinic attendance andvaccination ‘default’ arises only through day-to-dayproblems and contingencies. However, more pervasive patternsof schedule non-completion are found amongst poorer urban mothers,including recent immigrants, who experience social exclusionat infant welfare clinics. These findings point to the needfor health education dialogue grounded in mothers’ ownunderstandings and for particular policy attention to improvingthe clinic experiences of vulnerable social groups in rapidlyexpanding urban areas.     

Suicide Among Farmers in France: Occupational Factors and Recent Trends

Numerous studies have found agricultural workers, including farmers, at elevated risk of suicide, and socioeconomic conditions have been suggested as one of the important determinants of this mortality cause. The real agricultural income per worker in Europe increased steadily from 2005 to 2007 and then fell by 1.8% in 2008 and by 11.6% in 2009. This drop was particularly pronounced in France. Repeated cross-sectional studies were conducted to investigate suicide mortality rates among French farmers in 2007–2009. The study population included all French farmers enrolled yearly in the compulsory Agricultural Social Security and Health Insurance (CCMSA). Most of the mean of 500,164 subjects per year were men (68%). National cause-specific mortality rates were used to calculate standardized mortality ratios (SMRs) and associated 95% confidence intervals (95% CIs) for both genders and for each of the 3 years. During the 3-year study period, 2,769 men and 997 women died. Suicide accounted for 417 of the men’s (15%) and 68 of the women’s (6.8%) deaths. Hanging was the most frequent method of suicide for both. Compared with the general population, the increased rate of suicide deaths among male farmers was 28% in 2008 and 22% in 2009. This increased rate was particularly high among those aged 45–54 years (31%) and 55–64 years (47%) in 2008 (and in the 55–64-year-old group in 2009 (64%). Two specific types of farming activity were associated with increased suicide mortality rates in both 2008 and 2009: dairy cattle farming (SMR = 1.56 [95% CI: 1.09–2.15] and SMR=1.47 [95% CI: 1.01–2.04]) and beef cattle farming (SMR = 2.27 [95% CI: 1.59–3.10] and SMR = 1.57 [95% CI: 1.01–2.27]). These results may be useful for a better understanding of the situation from an epidemiological standpoint and for improving suicide prevention policies in this particular population.     

Pesticide Use and Self-Reported Health Symptoms Among Rice Farmers in Zanzibar

The agrarian population in low- and middle-income countries suffers from a number of adverse health effects due to pesticide exposure. In Zanzibar, the government subsidizes pesticides to enhance local rice production. The objectives of this study were to assess Zanzibar smallholder rice farmers’ pesticide use and self-reported health symptoms in relation to pesticide exposure, training, and use of protective measures and to raise awareness for future local policy formulation. An exploratory cross-sectional interviewer-administered study was conducted among 99 rice farmers. Participants were selected based on convenience sampling and stratified by expected exposure category. The study participants reported using pesticides in World Health Organization (WHO) Class II. Of pesticide users, 61% reported one or more symptoms of possible acute pesticide poisoning. Only 50% of pesticide users had received training in safe handling and application of pesticides, but those who had displayed a higher use of protective measures. Farmers who did not use protective measures were more likely to have reported skin irritation and headache, which, together with eye irritation, were the most commonly reported acute symptoms. The main sociodemographic differences between the expected exposure categories of pesticide users and nonusers were in gender and education level. Scaling up of training in safe handling and application of pesticides is needed. Further studies are required to better understand the mechanisms behind the choice to use pesticides or not.     

Acceptability of intranasal live attenuated influenza vaccine,influenza knowledge and vaccine intent in The Gambia

BackgroundThe burden of influenza is increasingly recognised in Africa. The WHO recommends introducing influenza vaccination to high-risk groups: pregnant women, children <5 years, and the elderly. The Gambia currently has no influenza vaccination policy, but the NASIMMUNE study, a clinical trial of intranasal live attenuated influenza vaccines (LAIV) in young children provided an opportunity to study maternal attitudes towards LAIV for the first time in sub-Saharan Africa. We assess acceptability of LAIV, influenza knowledge and attitudes towards influenza vaccination in Gambian women. Additionally, we investigate predictors of willingness to receive influenza vaccine (intent) in pregnancy or seasonally for children <5.MethodsA cross-sectional survey was conducted in Gambian women at two urban health facilities. To assess LAIV acceptability, the exposure group (women whose children had received LAIV during the NASIMMUNE study) were compared to a control group (women whose children were not enrolled in the NASIMMUNE study). Demographics and health belief constructs were analysed as predictors of influenza knowledge and vaccine intent.FindingsThe exposure group (n = 150) expressed a higher preference for a nasal spray vaccine than an injection compared to the control group (n = 304) (93.3% vs. 34.9%, OR = 26.15, p < 0.0001). Those in the exposure group who preferred the nasal spray found it less distressing, safer or equally safe, and easier or equally easy to give (all p < 0.001) than injections. Influenza knowledge increased with education level (p = 0.006 for higher education vs. none), and varied between sites (p = 0.0005). Vaccine intent was >98%, but no association with influenza knowledge or difference between groups was observed. Various health belief constructs were associated with vaccine intent.ConclusionLAIV acceptability was higher in those with first-hand experience. Influenza vaccine intent was also high. Incorporation of seasonal LAIV into the childhood immunisation schedule in The Gambia would be feasible, particularly if combined with community-based health education.     

Transmission of Armillifer armillatus ova at snake farm, The Gambia, West Africa

Visceral pentastomiasis caused by Armillifer armillatus larvae was diagnosed in 2 dogs in The Gambia. Parasites were subjected to PCR; phylogenetic analysis confirmed relatedness with branchiurans/crustaceans. Our investigation highlights transmission of infective A. armillatus ova to dogs and, by serologic evidence, also to 1 human, demonstrating a public health concern.     

棉麻纺织工人死因研究

应用回顾性队列方法对一个棉纺厂和一个亚麻厂生产工人的死因进行调查。在1469名亚麻工人中,男女性全死因及全肿瘤的死亡人数均低于预期值,但男性肝癌和肺癌以及女性胃癌的死亡人数均高于预期值,虽然其SMR_?增高没有统计学意义。同时,男女性中脑血管疾病以及男性心血管疾病尤其是肺心病(SMR420,P<0.01)的死亡人数均高于预期值。在2915名棉纺工人中,男性全死因、脑血管病及急性心肌梗塞的死亡率显著增高,P<0.01;慢性肾炎和肝硬化死亡率也明显增高,P<0.05。此外,男性肺癌、肝癌的死亡人数也高于预期值,但无统计学显著性。女性不吸烟者慢性肾炎和肝硬化的死亡率显著增高(P<0.01),脑血管病在女性也明显增高(P<0.05)。