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Article ; Online: Cohort Profile Update: The Bissau HIV Cohort-a cohort of HIV-1, HIV-2 and co-infected patients.

Dutschke, Alexander / Jespersen, Sanne / Medina, Candida / Nanque, João Paulo / Rodrigues, Amabelia / Wejse, Christian / Hønge, Bo Langhoff / Jensen, Mads Mose

International journal of epidemiology

2023 Volume 52, Issue 4, Page(s) e232–e240

MeSH term(s)	Humans ; HIV-1 ; HIV Infections/epidemiology ; HIV-2 ; Coinfection/epidemiology ; HIV Seropositivity ; Guinea-Bissau
Language	English
Publishing date	2023-05-17
Publishing country	England
Document type	Journal Article
ZDB-ID	187909-1
ISSN	1464-3685 ; 0300-5771
ISSN (online)	1464-3685
ISSN	0300-5771
DOI	10.1093/ije/dyad065
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Article ; Online: Effect of distributing locally produced cloth facemasks on COVID-19-like illness and all-cause mortality-a cluster-randomised controlled trial in urban Guinea-Bissau.

Nanque, Line M / Jensen, Andreas M / Diness, Arthur / Nielsen, Sebastian / Cabral, Carlos / Cawthorne, Dylan / Martins, Justiniano S D / Ca, Elsi J C / Jensen, Kjeld / Martins, Cesario L / Rodrigues, Amabelia / Fisker, Ane B

PLOS global public health

2024 Volume 4, Issue 2, Page(s) e0002901

Abstract: Facemasks have been employed to mitigate the spread of SARS-CoV-2. The community effect of providing cloth facemasks on COVID-19 morbidity and mortality is unknown. In a cluster randomised trial in urban Bissau, Guinea-Bissau, clusters (geographical ... ...

Abstract	Facemasks have been employed to mitigate the spread of SARS-CoV-2. The community effect of providing cloth facemasks on COVID-19 morbidity and mortality is unknown. In a cluster randomised trial in urban Bissau, Guinea-Bissau, clusters (geographical areas with an average of 19 houses), were randomised to an intervention or control arm using computer-generated random numbers. Between 20 July 2020 and 22 January 2021, trial participants (aged 10+ years) living in intervention clusters (n = 90) received two 2-layer cloth facemasks, while facemasks were only distributed later in control clusters (n = 91). All participants received information on COVID-19 prevention. Trial participants were followed through a telephone interview for COVID-19-like illness (3+ symptoms), care seeking, and mortality for 4 months. End-of-study home visits ensured full mortality information and distribution of facemasks to the control group. Individual level information on outcomes by trial arm was compared in logistic regression models with generalised estimating equation-based correction for cluster. Facemasks use was mandated. Facemask use in public areas was assessed by direct observation. We enrolled 39,574 trial participants among whom 95% reported exposure to groups of >20 persons and 99% reported facemasks use, with no difference between trial arms. Observed use was substantially lower (~40%) with a 3%, 95%CI: 0-6% absolute difference between control and intervention clusters. Half of those wearing a facemask wore it correctly. Few participants (532, 1.6%) reported COVID-19-like illness; proportions did not differ by trial arm: Odds Ratio (OR) = 0.81, 95%CI: 0.57-1.15. 177 (0.6%) participants reported consultations and COVID-19-like illness (OR = 0.83, 95%CI: 0.56-1.24); 89 participants (0.2%) died (OR = 1.34, 95%CI: 0.89-2.02). Hence, though trial participants were exposed to many people, facemasks were mostly not worn or not worn correctly. Providing facemasks and messages about correct use did not substantially increase their use and had limited impact on morbidity and mortality. Trial registration: clinicaltrials.gov: NCT04471766.
Language	English
Publishing date	2024-02-13
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0002901
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Article: Can earlier BCG-Japan and OPV vaccination reduce early infant mortality? A cluster-randomised trial in Guinea-Bissau.

Thysen, Sanne Marie / da Silva Borges, Igualdino / Martins, Jailson / Stjernholm, Alexander Dahl / Hansen, Jesper Sloth / da Silva, Leontino Manuel Vieira / Martins, Justiniano Sebastião Durga / Jensen, Aksel / Rodrigues, Amabelia / Aaby, Peter / Stabell Benn, Christine / Fisker, Ane Baerent

BMJ global health

2024 Volume 9, Issue 2

Abstract: Objective: To assess the effect of providing BCG and oral polio vaccine (OPV) at an early home visit after delivery.: Design: Cluster-randomised trial, randomising 92 geographically defined clusters 1:1 to intervention/control arms.: Setting: ... ...

Abstract	Objective: To assess the effect of providing BCG and oral polio vaccine (OPV) at an early home visit after delivery. Design: Cluster-randomised trial, randomising 92 geographically defined clusters 1:1 to intervention/control arms. Setting: Bandim Health Project Health and Demographic Surveillance System, Guinea-Bissau. Participants: 2226 newborns enrolled between July 2016 and August 2019. Interventions: In both arms, newborns received a home visit within 72 hours after birth. In intervention clusters (n=46), BCG and OPV were provided at the home visit. Main outcome measure: Rates of non-accidental mortality were compared in Cox proportional hazards models from (last of) day 1 or enrolment, until (first of) day 60 or registration of non-trial vaccines. Results: A total of 35 deaths (intervention: 7, control: 28) were registered during the trial. Providing BCG and OPV reduced non-accidental early infant mortality by 59% (8-82%). The intervention also reduced non-accidental hospital admissions. The intervention had little impact on growth and BCG scarring and tended to increase the risk of consultations. Conclusions: The trial was stopped early due to lower-than-expected enrolment and event rates when 33% of the planned number of newborns had been enrolled. Despite the small size of the trial, the results support that early BCG and OPV vaccinations are beneficial and reduce early child mortality and morbidity. Trial registration number: ClinicalTrials.gov Registry (NCT02504203).
MeSH term(s)	Infant ; Child ; Humans ; Infant, Newborn ; BCG Vaccine ; Guinea-Bissau/epidemiology ; Japan ; Infant Mortality ; Vaccination ; Poliovirus Vaccine, Oral
Chemical Substances	BCG Vaccine ; Poliovirus Vaccine, Oral
Language	English
Publishing date	2024-02-12
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2023-014044
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Article ; Online: Chronic Political Instability and the HIV/AIDS Response in Guinea-Bissau from 2000 to 2015: A Systematic Review.

Galjour, Joshua / Havik, Philip / Aaby, Peter / Rodrigues, Amabelia / Mpinga, Emmanuel Kabengele

Tropical medicine and infectious disease

2021 Volume 6, Issue 1

Abstract: Guinea-Bissau suffers from political instability and an unusually high HIV/AIDS burden compared to other countries in the West Africa region. We conducted a systematic review on the HIV/AIDS epidemic in Guinea-Bissau during the Millennium Development ... ...

Abstract	Guinea-Bissau suffers from political instability and an unusually high HIV/AIDS burden compared to other countries in the West Africa region. We conducted a systematic review on the HIV/AIDS epidemic in Guinea-Bissau during the Millennium Development Goals (MDGs) period (2000-2015), which dovetailed with a period of chronic political instability in the country's history. We searched published works on the HIV/AIDS epidemic in Guinea-Bissau for references to chronic political instability. Six databases and the grey literature were searched, informed by expert opinion and manual research through reference tracing. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search yielded 122 articles about HIV/AIDS in Guinea-Bissau during the MDG years. Biomedical, clinical, or epidemiological research predominated public health research production on HIV/AIDS in Guinea-Bissau in this period. Six articles addressing themes related to chronic political instability, including how political instability has affected the HIV/AIDS disease response, were identified. The results suggest the importance of considering a broader political epidemiology that accounts for socio-political aspects such as governance, human rights, and community responses into which any national HIV/AIDS response is integrated.
Language	English
Publishing date	2021-03-16
Publishing country	Switzerland
Document type	Journal Article
ISSN	2414-6366
ISSN (online)	2414-6366
DOI	10.3390/tropicalmed6010036
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Article: The mortality effects of disregarding the strategy to save doses of measles vaccine: a cluster-randomised trial in Guinea-Bissau.

Byberg, Stine / Aaby, Peter / Rodrigues, Amabelia / Stabell Benn, Christine / Fisker, Ane Baerent

BMJ global health

2021 Volume 6, Issue 5

Abstract: Introduction: Measles vaccine (MV) may improve health beyond measles protection. To avoid wastage from multi-dose vials, children in Guinea-Bissau are only measles vaccinated when aged 9-11 months and when six or more children are present. We assessed ... ...

Abstract	Introduction: Measles vaccine (MV) may improve health beyond measles protection. To avoid wastage from multi-dose vials, children in Guinea-Bissau are only measles vaccinated when aged 9-11 months and when six or more children are present. We assessed health impacts of providing MV to all measles-unvaccinated children 9-35 months. Methods: We cluster-randomised 182 village clusters under demographic surveillance in rural Guinea-Bissau to an 'MV-for-all-policy' arm where we offered MV regardless of age and number of children present at our bi-annual village visits, or a 'Restrictive-MV-policy' arm where we followed national policy. Measles-unvaccinated children aged 9-35 months were eligible for enrolment and followed to 5 years of age. In intention-to-treat analyses, we compared mortality using Cox regression analyses with age as underlying timescale. The primary analysis was for children aged 12-35 months at eligibility assessment. Interactions with several background factors were explored. Results: Between 2011 and 2016, we followed 2778 children in the primary analysis. MV coverage by 3 years was 97% among children eligible for enrolment under the MV-for-all-policy, and 48% under the Restrictive-MV-policy. Mortality was 59% lower than anticipated and did not differ by trial arm (MV-for-all-policy: 45/1405: Restrictive-MV-policy: 44/1373; HR: 0.95 (95% CI 0.64 to 1.43)). The effect of MV-for-all changed over time: The HR was 0.53 (95% CI 0.27 to 1.07) during the first 1½ years of enrolment but 1.47 (95% CI 0.87 to 2.50) later (p=0.02, test of interaction). Explorative analyses indicated that the temporal change may be related to interactions with other childhood interventions. Conclusion: The MV-for-all-policy increased MV coverage but had no overall effect on overall mortality. Trial registration number: NCT01306006.
MeSH term(s)	Child ; Guinea-Bissau/epidemiology ; Humans ; Measles/epidemiology ; Measles/prevention & control ; Measles Vaccine
Chemical Substances	Measles Vaccine
Language	English
Publishing date	2021-05-04
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2020-004328
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Article: Monitoring and molecular profiling of contemporary insecticide resistance status of malaria vectors in Guinea–Bissau

Silva, Ronise / Mavridis, Konstantinos / Vontas, John / Rodrigues, Amabélia / Osório, Hugo Costa

Acta tropica. 2020 June, v. 206

2020

Abstract: Despite reduction in the prevalence of malaria, Guinea-Bissau (GB) is still widely affected by the disease that is primarily vectored by Anopheles gambiae s.l. mosquitoes. Monitoring mosquito susceptibility and investigating the insecticide resistance ... ...

Abstract	Despite reduction in the prevalence of malaria, Guinea-Bissau (GB) is still widely affected by the disease that is primarily vectored by Anopheles gambiae s.l. mosquitoes. Monitoring mosquito susceptibility and investigating the insecticide resistance status is an integral part of malaria control actions. Here, mosquito populations from five regions of GB: Bafatá, Bissau, Buba, Cacheu and Gabu were monitored for species ID and insecticide resistance, using diagnostic and intensity WHO bioassays, as well as molecular assays. Phenotypic and molecular identification of species showed the presence of An. gambiae s.s. (S form), An. coluzzii (M form) and An. arabiensis, as well as rare An. arabiensis/ An. gambiae hybrids. Resistance to permethrin and deltamethrin was found in all Anopheles populations assayed, with the intensity of resistance for permethrin being moderate to high, as confirmed by bioassays performed at concentration intensities of 5X and 10X. Consistent to these findings, molecular analysis showed a higher frequency of knock-down resistance (kdr) mutations (L1014F, L1014S, reaching > 90% in some areas) compared to previous studies in the same region, as well as detected for the first time the presence of the super kdr mutation (N1575Y) in GB. The “iAche” (G119S) resistance mutation was also found in GB in low frequencies (up to 12.41%). Additionally, the synergistic PBO-permethrin bioassays suggested partial involvement of non target (metabolic and/or reduced penetration) resistance mechanism. Expression analysis of known pyrethroid metabolisers indicated the slight overexpression and possible association of the cytochrome P450s CYP6Z1, CYP4G16 with the pyrethroid resistance phenotype. The findings should guide future evidence-based resistance management strategies in GB.
Keywords	Anopheles arabiensis ; Anopheles gambiae ; World Health Organization ; bioassays ; cytochrome P-450 ; deltamethrin ; gene overexpression ; hybrids ; insect vectors ; insecticide resistance ; malaria ; monitoring ; mutation ; permethrin ; phenotype ; pyrethrins ; rare species ; resistance management ; Guinea-Bissau
Language	English
Dates of publication	2020-06
Publishing place	Elsevier B.V.
Document type	Article
ZDB-ID	210415-5
ISSN	1873-6254 ; 0001-706X
ISSN (online)	1873-6254
ISSN	0001-706X
DOI	10.1016/j.actatropica.2020.105440
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Differences in barriers to birth and death registration in Guinea-Bissau: implications for monitoring national and global health objectives.

Fisker, Ane B / Rodrigues, Amabélia / Helleringer, Stéphane

Tropical medicine & international health : TM & IH

2018 Volume 24, Issue 2, Page(s) 166–174

Abstract: Objective: Improving civil registration and vital statistics (CRVS) systems is essential to monitoring health objectives locally and globally. The barriers to birth and particularly death registration in low- and middle-income countries are however ... ...

Abstract	Objective: Improving civil registration and vital statistics (CRVS) systems is essential to monitoring health objectives locally and globally. The barriers to birth and particularly death registration in low- and middle-income countries are however poorly understood. Methods: We conducted a survey among women of reproductive age in Bissau, the capital of Guinea-Bissau. We asked women with a birth in the past two years whether their child had been registered and had obtained a birth certificate. We elicited the sources of information about birth registration and asked respondents to list their reasons for (not) registering a birth. If their child had died, we asked similar questions about death registration. Results: Most women (86%) had received messages about birth registration, but few women whose child had died had heard about the need to register deaths (22%). The primary sources of information about birth registration were messages broadcast on the radio or displayed at health facilities. Information about death registration was primarily obtained through informal social networks. Only 16% of births, and 2% of deaths, had been registered. The main barriers to birth registration were administrative pre-requisites and paternal absence. The main reasons for not registering a death were lack of knowledge about death registration and lack of perceived benefits. Conclusion: Strengthening CRVS systems requires addressing the specific barriers preventing birth and death registration. In Bissau, interventions to improve knowledge about death registration are needed. Simplifying registration procedures, as well as providing additional incentives, might help improve the coverage of birth registration.
MeSH term(s)	Birth Certificates ; Birth Rate ; Death Certificates ; Female ; Guinea-Bissau ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Male ; Registries/statistics & numerical data ; Surveys and Questionnaires ; Vital Statistics
Language	English
Publishing date	2018-11-14
Publishing country	England
Document type	Journal Article
ZDB-ID	1314080-2
ISSN	1365-3156 ; 1360-2276
ISSN (online)	1365-3156
ISSN	1360-2276
DOI	10.1111/tmi.13177
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Article: Oral Polio Vaccine to Mitigate the Risk of Illness and Mortality During the Coronavirus Disease 2019 Pandemic: A Cluster-Randomized Trial in Guinea-Bissau.

Fisker, Ane B / Martins, Justiniano S D / Nanque, Line M / Jensen, Andreas M / Ca, Elsi J C / Nielsen, Sebastian / Martins, Cesario L / Rodrigues, Amabelia

Open forum infectious diseases

2022 Volume 9, Issue 9, Page(s) ofac470

Abstract: Background: Oral polio vaccine (OPV) may improve resistance to non-polio-infections. We tested whether OPV reduced the risk of illness and mortality before coronavirus disease 2019 (COVID-19) vaccines were available.: Methods: During the early COVID- ... ...

Abstract	Background: Oral polio vaccine (OPV) may improve resistance to non-polio-infections. We tested whether OPV reduced the risk of illness and mortality before coronavirus disease 2019 (COVID-19) vaccines were available. Methods: During the early COVID-19 pandemic, houses in urban Guinea-Bissau were randomized 1:1 to intervention or control. Residents aged 50+ years were invited to participate. Participants received bivalent OPV (single dose) or nothing. Rates of mortality, admissions, and consultation for infections (primary composite outcome) during 6 months of follow-up were compared in Cox proportional hazards models adjusted for age and residential area. Secondary outcomes included mortality, admissions, consultations, and symptoms of infection. Results: We followed 3726 participants (OPV, 1580; control, 2146) and registered 66 deaths, 97 admissions, and 298 consultations for infections. OPV did not reduce the risk of the composite outcome overall (hazard ratio [HR] = 0.97; 95% confidence interval [CI], .79-1.18). OPV reduced the risk in males (HR = 0.71; 95% CI, .51-.98) but not in females (HR = 1.18; 95% CI, .91-1.52) ( Conclusions: In line with previous studies, OPV had beneficial nonspecific effects in males.
Language	English
Publishing date	2022-09-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac470
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Article ; Online: Out-of-sequence DTP and measles vaccinations and child mortality in Guinea-Bissau: a reanalysis.

Thysen, Sanne M / Rodrigues, Amabelia / Aaby, Peter / Fisker, Ane B

BMJ open

2019 Volume 9, Issue 9, Page(s) e024893

Abstract: Objectives: To assess whether the sequence of diphtheria-tetanus-pertussis vaccine (DTP) and measles vaccine (MV) was associated with child survival in a dataset previously used to assess non-specific effects of vaccines with no consideration of ... ...

Abstract	Objectives: To assess whether the sequence of diphtheria-tetanus-pertussis vaccine (DTP) and measles vaccine (MV) was associated with child survival in a dataset previously used to assess non-specific effects of vaccines with no consideration of vaccination sequence. Design: Prospective cohort study analysed using the landmark approach. Setting: Bandim Health Project's Health and Demographic Surveillance System covering 100 village clusters in rural Guinea-Bissau. The recommended vaccination schedule was BCG and oral polio vaccine (OPV) at birth, DTP and OPV at 6, 10 and 14 weeks, MV at 9 months and booster DTP and OPV at 18 months of age. Participants: Children aged 9-17 months (main analysis) and 18-35 months (secondary analysis: age of booster DTP) with vaccination status assessed between April 1991 and April 1996. Methods: Survival during the 6 months after assessing vaccination status was compared by vaccination sequence in Cox-proportional hazards models with age as underlying time. Analyses were stratified by sex and village cluster. Main outcome measure: Mortality rate ratio (MRR) for out-of-sequence vaccinations compared with in-sequence vaccinations. Results: Among children aged 9-17 months, 60% of observations (3574/5937) were from children who had received both MV and DTP. Among these, 1590 observations were classified as in-sequence vaccinations (last DTP before MV), and 1984 observations were out-of-sequence vaccinations (1491: MV with DTP and 493: MV before DTP). Out-of-sequence vaccinations were associated with higher mortality than in-sequence vaccinations (MRR 2.10, 95% CI 1.07 to 4.11); the MRR was 2.30 (95% CI 1.15 to 4.58) for MV with DTP and 1.45 (95% CI 0.50 to 4.22) for DTP after MV. Associations were similar for boys and girls (p=0.77). Between 18 and 35 months the mortality rate increased among children vaccinated in-sequence and the differential effect of out-of-sequence vaccinations disappeared. Conclusion: Out-of-sequence vaccinations may increase child mortality. Hence, sequence of vaccinations should be considered when planning vaccination programmes or introducing new vaccines into the current vaccination schedule.
MeSH term(s)	Child ; Child Mortality ; Child, Preschool ; Diphtheria-Tetanus-Pertussis Vaccine/therapeutic use ; Female ; Guinea-Bissau ; Humans ; Immunization Schedule ; Immunization, Secondary/statistics & numerical data ; Infant ; Male ; Proportional Hazards Models ; Prospective Studies ; Vaccination/statistics & numerical data
Chemical Substances	Diphtheria-Tetanus-Pertussis Vaccine
Language	English
Publishing date	2019-09-05
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2747269-3
ISSN	2044-6055 ; 2044-6055 ; 2053-3624
ISSN (online)	2044-6055
ISSN	2044-6055 ; 2053-3624
DOI	10.1136/bmjopen-2018-024893
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Article ; Online: Genomic surveillance of Anopheles mosquitoes on the Bijagós Archipelago using custom targeted amplicon sequencing identifies mutations associated with insecticide resistance.

Moss, Sophie / Pretorius, Elizabeth / Ceesay, Sainey / Hutchins, Harry / da Silva, Eunice Teixeira / Ndiath, Mamadou Ousmane / Jones, Robert T / Vasileva, Hristina / Phelan, Jody / Acford-Palmer, Holly / Collins, Emma / Rodrigues, Amabelia / Krishna, Sanjeev / Clark, Taane G / Last, Anna / Campino, Susana

Parasites & vectors

2024 Volume 17, Issue 1, Page(s) 10

Abstract: Background: Insecticide resistance is reducing the efficacy of vector control interventions, consequently threatening efforts to control vector-borne diseases, including malaria. Investigating the prevalence of molecular markers of resistance is a ... ...

Abstract	Background: Insecticide resistance is reducing the efficacy of vector control interventions, consequently threatening efforts to control vector-borne diseases, including malaria. Investigating the prevalence of molecular markers of resistance is a useful tool for monitoring the spread of insecticide resistance in disease vectors. The Bijagós Archipelago (Bijagós) in Guinea-Bissau is a region of stable malaria transmission where insecticide-treated nets are the mainstay for malaria control. However, the prevalence of molecular markers of insecticide resistance in malaria vectors is not well understood. Methods: A total of 214 Anopheles mosquitoes were analysed from 13 islands across the Bijagós. These mosquitoes were collected using CDC light traps in November 2019, during the peak malaria transmission season. High-throughput multiplex amplicon sequencing was used to investigate the prevalence of 17 different molecular markers associated with insecticide resistance in four genes: vgsc, rdl, ace1 and gste2. Results: Of the 17 screened mutations, four were identified in mosquitoes from the Bijagós: vgsc L995F (12.2%), N1570Y (6.2%) and A1746S (0.7%) and rdl A269G (1.1%). This study is the first to report the L995F knock-down resistance (kdr)-west allele in Anopheles melas on the Archipelago. An additional eight non-synonymous single-nucleotide polymorphisms were identified across the four genes which have not been described previously. The prevalences of the vgsc L995F and N1570Y mutations were higher on Bubaque Island than on the other islands in this study; Bubaque is the most populous island in the archipelago, with the greatest population mobility and connection to continental Guinea-Bissau. Conclusions: This study provides the first surveillance data for genetic markers present in malaria vectors from islands across the Bijagós Archipelago. Overall prevalence of insecticide resistance mutations was found to be low. However, the identification of the vgsc L995F and N1570Y mutations associated with pyrethroid resistance warrants further monitoring. This is particularly important as the mainstay of malaria control on the islands is the use of pyrethroid insecticide-treated nets.
MeSH term(s)	Animals ; Anopheles/genetics ; Insecticide Resistance/genetics ; Insecticides/pharmacology ; Mosquito Vectors/genetics ; Pyrethrins/pharmacology ; Genomics ; Malaria ; Mutation
Chemical Substances	Insecticides ; Pyrethrins
Language	English
Publishing date	2024-01-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2409480-8
ISSN	1756-3305 ; 1756-3305
ISSN (online)	1756-3305
ISSN	1756-3305
DOI	10.1186/s13071-023-06085-5
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