Arboviral infections have repeatedly been reported in the republic of Djibouti, consistent with the fact that essential vectors for arboviral diseases are endemic in the region. However, there is a limited recent information regarding arbovirus circulation, and the associated risk predictors to human exposure are largely unknown. We performed, from November 2010 to February 2011 in the Djibouti city general population, a cross-sectional ELISA and sero-neutralisation-based sero-epidemiological analysis nested in a household cohort, which investigated the arboviral infection prevalence and risk factors, stratified by their vectors of transmission. Antibodies to dengue virus (21.8%) were the most frequent. Determinants of infection identified by multivariate analysis pointed to sociological and environmental exposure to the bite of Aedes mosquitoes. The population was broadly naïve against Chikungunya (2.6%) with risk factors mostly shared with dengue. The detection of limited virus circulation was followed by a significant Chikungunya outbreak a few months after our study. Antibodies to West Nile virus were infrequent (0.6%), but the distribution of cases faithfully followed previous mapping of infected Culex mosquitoes. The seroprevalence of Rift valley fever virus was 2.2%, and non-arboviral transmission was suggested. Finally, the study indicated the circulation of Toscana-related viruses (3.7%), and a limited number of cases suggested infection by tick-borne encephalitis or Alkhumra related viruses, which deserve further investigations to identify the viruses and vectors implicated. Overall, most of the arboviral cases' predictors were statistically best described by the individuals' housing space and neighborhood environmental characteristics, which correlated with the ecological actors of their respective transmission vectors' survival in the local niche. This study has demonstrated autochthonous arboviral circulations in the republic of Djibouti, and provides an epidemiological inventory, with useful findings for risk mapping and future prevention and control programs.

Abstract. Of 49 workers at a Djiboutian abattoir, eight (16%, 95% confidence interval [CI]: 9-29) were seropositive against spotted fever group rickettsiae (SFGR), two (4%, 95% CI: 1-14) against typhus group rickettsiae, and three (6%, 95% CI: 2-17) against orientiae. One worker (9%, 95% CI: 2-38) seroconverted against orientiae during the study period. This is the first evidence of orientiae exposure in the Horn of Africa. SFGR were also identified by polymerase chain reaction in 32 of 189 (11%, 95% CI: 8-15) tick pools from 26 of 72 (36%) cattle. Twenty-five (8%, 95% CI: 6-12) tick pools were positive for Rickettsia africae, the causative agent of African tick-bite fever. Health-care providers in Djibouti should be aware of the possibility of rickettsiae infections among patients, although further research is needed to determine the impact of these infections in the country.Rickettsiae, obligate intracellular Gram-negative bacteria primarily transmitted to vertebrate hosts by arthropod vectors, are divided into four groups, two of which were examined in this study: spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR).1 The closely related Orientia spp. causes scrub typhus, a disease similar to rickettsioses. 2Although rickettsiae are found globally, orientiae are mainly endemic in the Asia-Australia-Pacific region, with limited evidence of infections in Africa, 3 the Middle East, 4 and South America. 5 As part of a broader study examining exposure to vector-borne and zoonotic pathogens in a high-risk environment in Djibouti, human samples were analyzed for evidence of exposure to and infection with rickettsiae and orientiae, and tick samples were examined for infection with rickettsiae.Before study initiation, the research protocol was reviewed by the institutional review boards (IRBs) and Institutional Animal Care and Use Committees at U. IRB protocol no. 911) and the U.S. Centers for Disease Control and Prevention (IRB protocol no. 5901), and by the Ministry of Health (MOH) and the Ministry of Agriculture, Livestock and the Sea in Djibouti. Samples were then collected at the Abattoir Frigorifique de Djibouti.In September 2010, participating abattoir workers completed baseline questionnaires and provided blood samples. Every 4 weeks, for a total of 20 weeks, an additional blood sample and questionnaire were collected from workers who self-reported a recent history of acute febrile illness (AFI); no subsequent samples were collected from workers who did not report recent AFI. Serum was stored at −20°C at MOH, transferred to NAMRU-3 in Cairo, Egypt, on dry ice, and stored at −40°C. Aliquots of 49 baseline and 11 follow-up samples were sent to the Naval Medical Research Center (NMRC) in Silver Spring, Maryland, on dry ice. Serum samples were screened for IgG antibodies against whole-cell antigens of SFGR, TGR, and orientiae by enzyme-linked immunosorbent assays (ELISAs), as described previously. 6,7 An ELISA titer procedure was performed on all screenpositive samples. Western blot assays us...

Crimean Congo hemorrhagic fever virus and Alkhumra virus, not previously reported in Djibouti, were detected among 141 (infection rate =15.7 per 100, 95% CI: 13.4–18.1) tick pools from 81 (37%) cattle and 2 (infection rate = 0.2 per 100, 95% CI: 0.0–0.7) tick pools from 2 (1%) cattle, respectively, collected at an abattoir in 2010 and 2011.

Historically, native populations in the Republic of Djibouti have experienced only low and unstable malaria transmission and intermittent epidemics. In recent years, efforts at malaria control have been aggressively pursued. This study was performed to inform revised malaria prevention recommendations for military service members and international travelers to the country. Laboratory-confirmed cases of malaria documented at large medical facilities and within military and civilian health care systems in the Republic of Djibouti from 1998 to 2009 were reviewed. In recent years, fewer than 5% of febrile cases among the three largest passive surveillance systems were laboratory-confirmed as malaria, and incidence of confirmed malaria was well below 1/1,000 persons/year. As efforts in the Republic of Djibouti progress toward elimination, and in conjunction with continued efforts at surveillance, emphasizing mosquito-avoidance measures and standby emergency treatment will become reasonable recommendations for malaria prevention.

This article aims to understand the impact of gender diversity on a firm’s equity volatility along with the moderating effect of chief executive officer (CEO) pay–performance sensitivity, institutional activism, and corporate social responsibility (CSR) activities. The sample consists of 200 South Asian health care firms over the period 2010 to 2018. After confirming the prevalence of endogeneity, we rely on the results of system generalized method of moments (GMM) rather than any static model. The results show that a higher representation of women on the board can mitigate the firm’s equity volatility. The findings of the study also purport that CEOs with higher pay–performance sensitivity exploit female directors to take the excessive risk, whereas institutional investors support the risk-averse behavior of these directors. However, we find no statistical evidence that CSR activities moderate the relationship between gender diversity and firm’s equity volatility. Our results theoretically support both stakeholder and agency perspectives that South Asian capital markets should enhance the representation of women on board to mitigate agency conflicts and to improve long-term firm’s sustainability.