International Health
Volume 6 Issue 4 December 2014
http://inthealth.oxfordjournals.org/content/6/3.toc

Addressing the global health burden of sickle cell disease
Peter J. Carey*
Author Affiliations
Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
Received April 1, 2014.
Revision received June 13, 2014.
Accepted June 16, 2014.
Abstract
A review of the clinical manifestations of sickle cell disease (SCD), available therapeutic interventions and a necessarily limited assessment of progress with their implementation in Nigeria (the country with the largest number of affected individuals worldwide) was recently published in this journal. Despite a disappointing dearth of targeted therapy for a condition whose molecular basis has been well understood for half a century, there is a wealth of evidence-based supportive interventions, including antibiotic and vaccination prophylaxis against early bacteraemic mortality, childhood stroke risk prevention, patient and population education and screening and community care provision that are simple and inexpensive to implement. There is a real opportunity for international collaboration to drive an improvement in healthcare provision for this condition.

Time is (still) of the essence: quantifying the impact of emergency meningitis vaccination response in Katsina State, Nigeria
Matthew J. Ferraria, Florence Fermonb, Fabienne Nackersc, Augusto Llosac, Claire Magonec and
Rebecca F. Graisc,*
Author Affiliations
aCenter for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA 16802 USA
bEpicentre, Paris, France
cMédecins Sans Frontières, Paris, France
Received March 19, 2014.
Revision received July 28, 2014.
Accepted July 29, 2014.
Abstract
Background
In 2009, a large meningitis A epidemic affected a broad region of northern Nigeria and southern Niger, resulting in more than 75 000 cases and 4000 deaths. In collaboration with state and federal agencies, Médecins Sans Frontières (MSF) intervened with a large-scale vaccination campaign using polysaccharide vaccine. Here the authors analyze the impact (cases averted) of the vaccination response as a function of the timing and coverage achieved.
Methods
Phenomenological epidemic models were fitted to replicate meningitis surveillance data from the Nigerian Ministry of Health/WHO surveillance system and from reinforced surveillance conducted by MSF in both vaccinated and unvaccinated areas using a dynamic, state–space framework to account for under-reporting of cases.
Results
The overall impact of the vaccination campaigns (reduction in meningitis cases) in Katsina State, northern Nigeria, ranged from 4% to 12%. At the local level, vaccination reduced cases by as much as 50% when campaigns were conducted early in the epidemic.
Conclusions
Reactive vaccination with polysaccharide vaccine during meningitis outbreaks can significantly reduce the case burden when conducted early and comprehensively. Introduction of the conjugate MenAfriVac vaccine has reduced rates of disease caused by serogroup A Neisseria meningitidis in the region. Despite this, reactive campaigns with polysaccharide vaccine remain a necessary and important tool for meningitis outbreak response.

Perceptions of foreign health aid in East Africa: an exploratory baseline study
Shannon L. Lövgrena,1, Trisa B. Tarob and Heather L. Wipflib,*
Author Affiliations
aDivision of Global Health/IHCAR, Department of Public Health Science, Karolinska Institutet, Widerströmsa Huset, Tomtebodavägen 18A, 171 76 Stockholm, Sweden
bUSC Institute of Global Health, University of Southern California, Suite #318K, Los Angeles, CA 90032, USA
Received December 13, 2013.
Revision received March 6, 2014.
Accepted March 12, 2014.
Abstract
Background
There is insufficient literature on the perceptions of aid recipients with respect to foreign health aid administration and impact. This study sought to identify perceptions of foreign health aid among individuals, health care workers (HCWs), and policymakers in three East African countries: Kenya, Uganda, and Ethiopia. Each country receives substantial foreign aid and shares regional proximity.
Methods
A qualitative exploratory study design was adopted and 81 questionnaires were administered to individuals, HCWs and policymakers. Questionnaires ascertained perceptions of foreign aid, health aid and the USA. Responses were compared between groups and across countries.
Results
Perceptions of how much foreign aid a community receives varied between individuals (‘a little’), HCWs (‘some’) and policymakers (‘a lot’). Respondents were positive towards the USA irrespective of the level of aid they perceived came from the USA. Opinions regarding the impact of aid varied by country and by profession. Aid priorities were similar among all countries and participants, with health care, education and economic development among the primary sectors reported.
Conclusions
More research is needed on perceptions of aid recipients. The findings of this pilot study highlight the need for inclusion of these stakeholders in order to better inform decisions regarding foreign aid.