Non-cases are suspect Ebola Virus Disease (EVD) cases testing negative by EVD RT-PCR after admission to an Ebola Treatment Centre (ETC). Admitting non-cases to an ETC prompts concerns on case- and workload in the ETC, risk for nosocomial EVD infection, and delays in diagnosis and disease-specific treatment. We retrospectively analysed characteristics, outcomes and determinants of death of EVD cases and non-cases admitted to the Conakry ETC in Guinea between 03/2014 and 09/2015. Of the 2362 admitted suspects who underwent full confirmatory PCR testing, 1540 (65.2%) were non-cases; among them 727 needed repeated confirmatory PCR testing resulting in 2.5 days (average) in the ETC isolation ward. Twenty-one patients tested positive on the repeat test, most in a period of flawed sampling for the initial test and none after introduction of PCR confirmation with geneXpert. No readmissions following nosocomial EVD infection were recorded. No combination of symptoms yielded acceptable sensitivity and specificity to allow differentiating confirmed from non-cases. Symptoms as ocular bleeding/redness have high specificity, but limited usefulness as not common. Admission delay and age distribution were not different for both groups. In total, 98 (20.6%) of 475 deaths in the ETC were non-cases. Most died within 24 hours after admission. Living in Conakry (aOR 1.78 (1.08–2.96)) was the strongest risk factor for death. Weeks with higher admission load had lower case fatality among non-cases, probably because more acute (and treatable) illnesses of contacts of known cases were admitted. These findings show high numbers of potentially critically ill non-cases need to be considered when setting up triage and referral of EVD suspect cases. Symptoms and risk factors alone do not allow differentiating the non-cases. Integration of highly-sensitive EVD diagnostic methods with short turnaround time in the triage of peripheral hospitals and dropping the systematic 2nd PCR for symptomatic early presenters could limit delays in access to adapted care of cases and seriously ill non-cases. Whether feasible without compromising outbreak control, and under which conditions, should be further assessed.
Introduction: Since the declaration of the first case of Covid-19 on March 12, 2020, in Guinea, the number of COVID-19 cases has been increasing day by day despite the state of health emergency and the barrier measures decreed by the Guinean government. This present study aimed to assess the early impact of COVID-19 on vaccine activities by comparing current trends to trends over the past year when vaccine coverage of major antigens (BCG, OPV, DTP-HepB-Hib, MMR, IPV, and Td) had improved considerably. Methods: The study was carried out at the Expanded Vaccination Program (EPI) of the Republic of Guinea from February 2019 to June 2019. It was a comparative retrospective cohort study on the trends in administrative coverage of the different antigens used in the framework of vaccination. We performed interrupted time series (STI) analysis using the delayed dependent variable model ANCOVA type II Sum Squares with significance for a p-value less than 0.05 to confirm the link between the occurrence of Covid-19 and the collapse of vaccine coverage. These analyzes were performed on global vaccine-preventable disease surveillance data extracted from the District Immunization Data Management Tool (DVD-MT) designed by WHO. Estimates of the target population were obtained from the National Health Information System (SNIS), and surveillance data for Covid-19 patients were obtained from the National Health Security Agency (ANSS). Results: Overall, the EPI recorded a median vaccination coverage of less than 80% for all the vaccines introduced and the analysis of the interrupted time series shows that the interruption of the vaccination program was significant for all the vaccines. This finding is factual at both the national and district levels. However, there are disparities at this level, even though some districts have yet to report cases of COVID-19 but have experienced drop-in vaccination coverage. The comparison of vaccination coverage for DTP3, for example, shows a sharp drop in the prefectures of Yomou, N'Nzêrêkorê, Macenta, Kankan, Mandiana, Dinguiraye, Mamou, Koubia, Mali, and Conakry, where it varies between 0 and 80% compared to 2019 where it was above 80%. Conclusion: Our results demonstrate the need for a resilient health system that could adapt quickly and effectively to pandemics and which in turn makes it possible to strengthen EPI activities in Guinea during this period of a health crisis, in particular for children. Keywords: Vaccine covers, Covid-19, EPI, Guinea
The benchmark for evaluating the training of education inspectors is the training plan implemented since the start of the 1999-2000 academic year. Beyond the strict application of Kirkpatrick's model which established a hierarchy and causal links between its four stages, this evaluation revealed others, with different objects and methods of achievement (evaluation of skills, evaluation of training system, selfevaluation, external evaluation). Strengthening professionalization, the main suggestion resulting from this evaluation refers to the evaluation that generates professional development for its purpose and to the evaluation-advice for its implementation.
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