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Description of a Mass Poisoning in a Rural District in Mozambique: The First Documented Bongkrekic Acid Poisoning in Africa.

ABSTRACT: Background:On 9 January 2015, in a rural town in Mozambique, >230 persons became sick and 75 died of an illness linked to drinking pombe, a traditional alcoholic beverage. Methods:An investigation was conducted to identify case patients and determine the cause of the outbreak. A case patient was defined as any resident of Chitima who developed any new or unexplained neurologic, gastrointestinal, or cardiovascular symptom from 9 January at 6:00 am through 12 January at 11:59 pm. We conducted medical record reviews, healthcare worker and community surveys, anthropologic and toxicologic investigations of local medicinal plants and commercial pesticides, and laboratory testing of the suspect and control pombe. Results:We identified 234 case patients; 75 (32%) died and 159 recovered. Overall, 61% of case patients were female (n = 142), and ages ranged from 1 to 87 years (median, 30 years). Signs and symptoms included abdominal pain, diarrhea, vomiting, and generalized malaise. Death was preceded by psychomotor agitation and abnormal posturing. The median interval from pombe consumption to symptom onset was 16 hours. Toxic levels of bongkrekic acid (BA) were detected in the suspect pombe but not the control pombe. Burkholderia gladioli pathovar cocovenenans, the bacteria that produces BA, was detected in the flour used to make the pombe. Conclusions:We report for the first time an outbreak of a highly lethal illness linked to BA, a deadly food-borne toxin in Africa. Given that no previous outbreaks have been recognized outside Asia, our investigation suggests that BA might be an unrecognized cause of toxic outbreaks globally.

SUBMITTER: Gudo ES

PROVIDER: S-EPMC5908738 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Description of a Mass Poisoning in a Rural District in Mozambique: The First Documented Bongkrekic Acid Poisoning in Africa.

Gudo Eduardo Samo ES Cook Kyla K Kasper Amelia M AM Vergara Alfredo A Salomão Cristolde C Oliveira Fernanda F Ismael Hamida H Saeze Cristovão C Mosse Carla C Fernandes Quinhas Q Viegas Sofia Omar SO Baltazar Cynthia S CS Doyle Timothy J TJ Yard Ellen E Steck Alaina A Serret Mayda M Falconer Travis M TM Kern Sara E SE Brzezinski Jennifer L JL Turner James A JA Boyd Brian L BL Jani Ilesh V IV

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20180401 9

<h4>Background</h4>On 9 January 2015, in a rural town in Mozambique, >230 persons became sick and 75 died of an illness linked to drinking pombe, a traditional alcoholic beverage.<h4>Methods</h4>An investigation was conducted to identify case patients and determine the cause of the outbreak. A case patient was defined as any resident of Chitima who developed any new or unexplained neurologic, gastrointestinal, or cardiovascular symptom from 9 January at 6:00 am through 12 January at 11:59 pm. We ...[more]

PMID: 29155976

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Project description:IntroductionIntentional self-poisoning is a significant part of the toxicological burden experienced by emergency centres. The aim of this study was to describe all adults presenting with intentional self-poisoning over a six-month period to the resuscitation unit of Khayelitsha Hospital, Cape Town.MethodsAdult patients with a diagnosis of intentional self-poisoning between 1 November 2014 and 30 April 2015 were retrospectively analysed after eligible patients were obtained from the Khayelitsha Hospital Emergency Centre database. Missing data and variables not initially captured in the database were retrospectively collected by means of a chart review. Summary statistics were used to describe all variables.ResultsA total of 192 patients were included in the analysis. The mean age was 27.3 years with the majority being female (n = 132, 68.8%). HIV-infection was a comorbidity in 39 (20.3%) patients, while 13 (6.8%) previously attempted suicide. Presentations per day of the week were almost equally distributed while most patients presented after conventional office hours (n = 152, 79.2%), were transported from home (n = 124, 64.6%) and arrived by ambulance (n = 126, 65.6%). Patients spend a median time of 3h37m in the resuscitation unit (interquartile range 1 h 45 m-7 h 00 m; maximum 65 h 49 m). Patient acuity on admission was mostly low according to both the Triage Early Warning Score (non-urgent n = 100, 52.1%) and the Poison Severity Score (minor severity n = 107, 55.7%). Pharmaceuticals were the most common type of toxin ingested (261/343, 76.1%), with paracetamol the most frequently ingested toxin (n = 48, 25.0%). Eleven patients (5.7%) were intubated, 27 (14.1%) received N-acetylcysteine, and 18 (9.4%) received benzodiazepines. Fourteen (7.3%) patients were transferred to a higher level of care and four deaths (2%) were reported.DiscussionIntentional self-poisoning patients place a significant burden on emergency centres. The high percentage of low-grade acuity patients managed in a high-acuity area is of concern and should be investigated further.

Project description:BackgroundTreatment and control of hypertension are associated with a substantial reduction in adverse cardiovascular disease outcomes. Although South Africa aims to reduce the burden of cardiovascular diseases, there is limited evidence on the hypertension care cascade (HCC) performance in rural areas where stroke and hypertension are high. This study estimated HCC performance and identified predictors of hypertension screening among adults in the Ingwavuma community of KwaZulu-Natal, South Africa.MethodsThis was a cross-sectional study. Data were collected using the WHO STEPwise approach to surveillance (STEPS) questionnaire from 400 adult participants, excluding pregnant women and those with physical or cognitive impairments. Three hundred and ninety-three participants had complete data, and 131 had high blood pressure. We calculated progression rates for screening, diagnosis, treatment and control of hypertension from the sub-sample of participants with high blood pressure and assessed the bivariate association between HCC stages and participant characteristics and their effect sizes. We used binary and multivariable logistic regression to identify predictors of hypertension screening.ResultsEighty-eight per cent of participants reported prior screening for hypertension. However, only 53.5% of patients under pharmacological treatment for hypertension had controlled blood pressure. In bivariate regression, employed participants were 80.3% (COR = 0.197, 95% CI [0.042-0.921]) more likely to be screened. In multivariable regression, the likelihood of hypertension screening was 82.4% (AOR = 0.176, 95% CI [0.047-0.655]) lower among participants in a cohabiting union than single participants. Similarly, employed participants were 87.4% (AOR = 0.129, 95% CI [0.017-0.952]) less likely to be screened than their unemployed counterparts.ConclusionsThe considerable attrition from the HCC across socio-demographic categories indicates a need for community-wide interventions. Empowering health care workers for community-based health promotion and hypertension management through point-of-care diagnostic tools could improve HCC performance. Efforts to improve the HCC should also focus on social determinants of health, notably gender and formal educational attainment.

Project description:Physical activity, among others, confers cardiovascular, mental, and skeletal health benefits to people of all age-groups and health states. It reduces the risks associated with cardiovascular disease and therefore, could be useful in rural South Africa where cardiovascular disease (CVD) burden is increasing. The objective of this study was to examine levels and correlates of physical activity among adults in the Ingwavuma community in KwaZulu-Natal (KZN). Self-reported data on physical activity from 392 consenting adults (female, n = 265; male, n = 127) was used. We used the one-sample t-test to assess the level of physical activity and a two-level multiple linear regression to investigate the relationship between total physical activity (TPA) and independent predictors. The weekly number of minutes spent on all physical activities by members of the Ingwavuma community was 912.2; standard deviation (SD) (870.5), with males having 37% higher physical activity (1210.6 min, SD = 994.2) than females (769.2, SD = 766.3). Livelihood activities constituted 65% of TPA, and sport and recreation contributed 10%. Participants without formal education (20%), those underweight (27%), and the obese (16%) had low physical activity. Notwithstanding this, in general, the Ingwavuma community significantly exceeded the recommended weekly time on physical activity with a mean difference of 762.1 (675.8-848.6) minutes, t (391) = 17.335, p < 0.001. Gender and age were significant predictors of TPA in level 1 of the multiple regression. Males were significantly more active than females by 455.4 min (β = -0.25, p < 0.001) and participants of at least 60 years were significantly less active than 18-29-year-olds by 276.2 min (β = -0.12, p < 0.05). Gender, marital status, and health awareness were significant predictors in the full model that included education level, employment status, body mass index (BMI), and physical activity related to health awareness as predictors. The high prevalence of insufficient physical activity in some vulnerable groups, notably the elderly and obese, and the general poor participation in sport and recreation activities are worrisome. Hence we recommend health education interventions to increase awareness of and reshape sociocultural constructs that hinder participation in leisure activities. It is important to promote physical activity as a preventive health intervention and complement the pharmacological treatment of CVDs in rural South Africa. Physical activity interventions for all sociodemographic groups have potential economic gains through a reduction in costs related to the treatment of chronic CVD.

Project description:BackgroundBovine tuberculosis (bTB), caused by Mycobacterium bovis, is an infectious disease of cattle that also affects other domestic animals, free-ranging and farmed wildlife, and also humans. In Mozambique, scattered surveys have reported a wide variation of bTB prevalence rates in cattle from different regions. Due to direct economic repercussions on livestock and indirect consequences for human health and wildlife, knowing the prevalence rates of the disease is essential to define an effective control strategy.Methodology/principal findingsA cross-sectional study was conducted in Govuro district to determine bTB prevalence in cattle and identify associated risk factors. A representative sample of the cattle population was defined, stratified by livestock areas (n = 14). A total of 1136 cattle from 289 farmers were tested using the single comparative intradermal tuberculin test. The overall apparent prevalence was estimated at 39.6% (95% CI 36.8-42.5) using a diagnostic threshold cut-off according to the World Organization for Animal Health. bTB reactors were found in 13 livestock areas, with prevalence rates ranging from 8.1 to 65.8%. Age was the main risk factor; animals older than 4 years were more likely to be positive reactors (OR = 3.2, 95% CI: 2.2-4.7). Landim local breed showed a lower prevalence than crossbred animals (Landim × Brahman) (OR = 0.6, 95% CI: 0.4-0.8).Conclusions/significanceThe findings reveal an urgent need for intervention with effective, area-based, control measures in order to reduce bTB prevalence and prevent its spread to the human population. In addition to the high prevalence, population habits in Govuro, particularly the consumption of raw milk, clearly may potentiate the transmission to humans. Thus, further studies on human tuberculosis and the molecular characterization of the predominant strain lineages that cause bTB in cattle and humans are urgently required to evaluate the impact on human health in the region.

Project description:BACKGROUND:Skin-related diseases affect every individual irrespective of age, gender or social status. Since time immemorial, humans have explored natural resources from their environment for the maintenance of the skin. This explorative survey was conducted to document the natural resources (plant and non-plant materials) used for folk cosmeceuticals by rural communities in Vhembe district municipality, Limpopo province, South Africa. METHODS:The research was conducted in six communities namely: Tshakuma, Shigalo, Tshamutilikwa, Luvhimbi (Masikhwa), Khakhanwa, and Folovhodwe in Vhembe district. Random and convenient sampling was used to access the target population. Semi-structured questionnaires were used to interview 71 participants that comprised traditional practitioners, herbalists and laypeople from the study area. Collected data were analysed using both quantitative (for e.g. frequency, use-value and relative frequency of citation) and qualitative (thematic) analytical methods. RESULTS:A total of 52 plants from 27 families and 22 non-plant materials were used as folk cosmeceuticals in the study area. The most cited plants included Dicerocaryum zanguebarium (Pedaliaceae), Ricinus communis (Euphorbiaceae) and Helinus integrifolius (Rhamnaceae). Trees and shrubs were the most common plant-life form while leaves were the most popular plant part. Pig fats, red ochre (Luvhundi soil) and ashes were the most cited non-plant materials. These documented natural resources are frequently prepared by crushing and mostly used to heal wounds. CONCLUSION:Traditional knowledge concerning folk cosmeceuticals is mostly held by elders. The high number of natural resources documented is an indication that Vhembe district is rich in ethnopharmacological knowledge. Scientific investigation of the efficacies and safety of these natural resources is highly recommended as a drive aimed at innovations with benefits to the rural communities who are the custodians of this valuable knowledge.

Dataset Information

Description of a Mass Poisoning in a Rural District in Mozambique: The First Documented Bongkrekic Acid Poisoning in Africa.

Publications

Description of a Mass Poisoning in a Rural District in Mozambique: The First Documented Bongkrekic Acid Poisoning in Africa.

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