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Mattia Fattorini
Post Graduate School of Public Health, Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy

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Journal article
Published: 19 November 2019 in International Journal of Environmental Research and Public Health
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In May 2018, the non-governmental organization (NGO) Doctors with Africa CUAMM began to implement an intervention to strengthen Chiulo Hospital’s public health section to deliver immunization services in Mucope Comuna, Ombadja District. We aimed to evaluate the effect of this intervention. During the intervention period, actions such as staff training, improvement in the monitoring of vaccine stockpile, and the involvement of Community Health Workers were performed. The effects of the intervention on the number of vaccine doses administered were examined using negative binomial regression. Doses administered were 14,221 during the intervention period and 11,276 in the pre-intervention one. The number of administered doses was 26% higher (95% CI 9%–45%) in the intervention period than in the pre-intervention period. This was driven by vaccine doses administered during outreach sessions, where a statistically significant increase of 62% (95% CI 28%–107%) was observed. Regarding individual vaccines, statistically significant increases in the number of doses were observed for OPV2 (76%), OPV3 (100%), Penta3 (53%), PCV3 (53%), and Rota2 (43%). The NGO interventions led to improved delivery of immunization services in the study area. Greater increases were observed for vaccine doses that are more likely to be missed by children.

ACS Style

Mattia Fattorini; Calistus Wilunda; Gloria Raguzzoni; Cecilia Quercioli; Gabriele Messina; Maria Pia Fantini; Giovanni Putoto. Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era. International Journal of Environmental Research and Public Health 2019, 16, 4572 .

AMA Style

Mattia Fattorini, Calistus Wilunda, Gloria Raguzzoni, Cecilia Quercioli, Gabriele Messina, Maria Pia Fantini, Giovanni Putoto. Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era. International Journal of Environmental Research and Public Health. 2019; 16 (22):4572.

Chicago/Turabian Style

Mattia Fattorini; Calistus Wilunda; Gloria Raguzzoni; Cecilia Quercioli; Gabriele Messina; Maria Pia Fantini; Giovanni Putoto. 2019. "Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era." International Journal of Environmental Research and Public Health 16, no. 22: 4572.

Review
Published: 01 November 2019 in European Journal of Public Health
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Background Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug resistant organism (MDRO) frequently involved in skin, soft tissue and bone infections. Moreover, it is one of the most frequently isolated pathogen in bloodstream infections in European countries. Because of its capacity to survive on inanimate surfaces, this microorganism could be detected not only on hospital environment, but also in other healthcare settings such as ambulances. We performed a systematic review in order to study the level of MRSA contamination in ambulances (vehicle surfaces and medical equipment). Methods In March 2019 we searched studies in PubMed using the key search terms “MRSA, ambulance”. We included different designs of studies in English. Results The research yielded 18 publications: after title, abstract and full text’s analysis, 9 manuscripts were included in this review. Studies were conducted from 2007 to 2018 in USA, Egypt, Poland, Germany and South Korea. Overall, the number of ambulances sampled for MRSA was 511 (min. 3-max. 150), and 64 (12.5%) resulted contaminated by MRSA. Sampling points examined for each vehicle varied from 5 to 33, for a total of 5872 (min. 39-max. 2136) samplings performed. The amount of MRSA positive samplings was 145/5872 (2.5%) (min. 1-max. 43). Stretcher resulted the most frequently contaminated fomite (29 of the 145 MRSA positive samplings, 20%). Conclusions Despite MRSA prevalence is decreasing in Europe, recent studies showed how this MDRO could still be responsible of a remarkable burden in terms of attributable deaths and costs. Implementing effective sanitation procedures with a continuative monitoring of the processes is highly recommended in all the healthcare settings, including ambulances. Automated terminal disinfection of these vehicles, adopting technologies such as ultraviolet germicidal irradiation or hydrogen peroxide aerosol, could reduce bacterial contamination hosted on surfaces and medical equipment. Key messages Although the percentage of isolates of MRSA in European countries is decreasing, the burden this multidrug resistant organism in terms of mortality and costs remains remarkable. Ambulances must be considered as a potential reservoir of MRSA because of its ability to survive on inanimate surfaces, and adequate sanitation procedures should be frequently performed.

ACS Style

M Fattorini; C Quercioli; G Messina; N Nante. MRSA contamination in ambulances: a systematic review. European Journal of Public Health 2019, 29, 1 .

AMA Style

M Fattorini, C Quercioli, G Messina, N Nante. MRSA contamination in ambulances: a systematic review. European Journal of Public Health. 2019; 29 (Supplement):1.

Chicago/Turabian Style

M Fattorini; C Quercioli; G Messina; N Nante. 2019. "MRSA contamination in ambulances: a systematic review." European Journal of Public Health 29, no. Supplement: 1.

Journal article
Published: 01 November 2019 in European Journal of Public Health
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Background Maternity Waiting Homes (MWHs) are structures usually located close to health facilities able to provide emergency obstetric care. Women can decide to be hosted in MWHs and when labour begins they move to the health facility for the delivery. Although the effectiveness of MWHs is debated, literature shows increasing findings about their importance. Aim of the study is to describe a one-year activity of a MWH located in Angola. Methods Since 2000, Italian Non-Governmental Organization (NGO) Doctors with Africa CUAMM supports the activities of the hospital of Chiulo in the district of Ombadja (Cunene province). Among the implemented projects, the NGO supports the local MWH (in Portuguese, “casa de espera”), providing dedicated staff and food for all the women hosted in the MWH. The MWH team routinely performs antenatal care visits and brief talks regarding maternal health. In case of pregnancy complications, the staff promptly refers women to the nearby hospital. The MHW team is also involved in routine data collection. Results In 2018, 703 women were admitted in the MWH. Three-hundred and forty-two (48.6%) were between 18 and 24 years of age. Four-hundred and eighty-two (68.6%) were invited to join the MWH by personnel of local health facilities, while 160 (22.8%) by family members and 61 (8.7%) by community health workers/traditional birth attendants. Age less than 18, previous abortion and/or caesarean were the most assessed factors for high risk pregnancy. In 2018, 1364 deliveries were performed in the hospital, and 593 (43.5%) concerned women hosted in the MWH. Conclusions To achieve the 2030 Sustainable Development Goals targets regarding maternal and neonatal mortality, the implementation of MHWs could represent an effective tool, especially in countries such as Angola where these indicators show a weak annual reduction. Regarding Chiulo’s MWH, an improvement of data collection could lead to a better comprehension of the efficacy of the facility. Key messages In the SDGs era, countries with a high burden of maternal and neonatal mortality should implement various and integrated approaches to achieve significant reductions of these indicators. Although the effectiveness of maternity waiting homes is still debated, increasing findings suggest that they could represent an effective tool to contain mother and child mortality.

ACS Style

M Fattorini; G Raguzzoni; C Cuccaro; N Nante; G Messina; J M N Ndilimondjo; W Ndapandula; G Tuitileni; C Caresia; G Putoto. One-year activity of a “Casa de Espera” (Maternity Waiting Home) in the south of Angola. European Journal of Public Health 2019, 29, 1 .

AMA Style

M Fattorini, G Raguzzoni, C Cuccaro, N Nante, G Messina, J M N Ndilimondjo, W Ndapandula, G Tuitileni, C Caresia, G Putoto. One-year activity of a “Casa de Espera” (Maternity Waiting Home) in the south of Angola. European Journal of Public Health. 2019; 29 (Supplement):1.

Chicago/Turabian Style

M Fattorini; G Raguzzoni; C Cuccaro; N Nante; G Messina; J M N Ndilimondjo; W Ndapandula; G Tuitileni; C Caresia; G Putoto. 2019. "One-year activity of a “Casa de Espera” (Maternity Waiting Home) in the south of Angola." European Journal of Public Health 29, no. Supplement: 1.

Journal article
Published: 01 November 2019 in European Journal of Public Health
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Background Reduction of maternal mortality ratio (MMR), a key indicator contained in the Sustainable Development Goals (SDGs), is strictly related to maternal empowerment and to an increasing access to skilled care in pregnancy, childbirth and postpartum. The WHO recommends to define alternative roles for Traditional Birth Attendants (TBAs) in the transition from birth with TBAs to birth with Skilled Birth Attendants (SBAs), in particular in countries where maternal care services still do not meet recommended standards. Objectives In 2018, the Italian Non-Governmental Organization Doctors with Africa CUAMM and the District Health Department of Ombadja (a 350000 inhabitants district in Cunene province, south of Angola) started a three-year multifaceted project to support and strengthen local health services. Aim of this work is to describe the first six months of an implemented activity involving 120 local TBAs, identified and trained to perform basic educational talks in the district territory regarding topical issues of mother and child health. TBAs were also engaged in the referral of pregnant women to health facilities with SBAs. Results From June to November 2018, TBAs performed 2272 talks about maternal and child health issues: healthy pregnancy (551 talks, 24.3%), nutrition (404, 17.8%) and malaria (370, 16.3%) were the most debated topics. The total of women’s presences during these educational talks was 57504, and 15379 of them (26.7%) were pregnant. TBAs referred to health facilities 226 pregnant women for a delivery assisted by SBAs. Conclusions Angolan estimated MMR in 2015 was 477/100000 live births: therefore, more efforts should be made to contribute to the achievement of 2030 SDGs target of 70/100000 globally. Moreover, the country percentage of deliveries assisted by SBAs is less than 50%. Promoting alternative roles for TBAs into the mother and child health framework could represent an effective way to improve maternal and neonatal outcomes. Key messages According to the World Health Organization, defining alternative roles for traditional birth attendants could represent an effective way to support the health of women and children. Traditional Birth Attendants can play an important role in providing basic health education and in the “referral chain” of pregnant women to health facilities with skilled birth attendants.

ACS Style

M Fattorini; G Raguzzoni; C Cuccaro; N Nante; C Quercioli; F Ileni; M C Kaunawoye; C Caresia; G Putoto. Finding alternative roles for Traditional Birth Attendants: an experience from the south of Angola. European Journal of Public Health 2019, 29, 1 .

AMA Style

M Fattorini, G Raguzzoni, C Cuccaro, N Nante, C Quercioli, F Ileni, M C Kaunawoye, C Caresia, G Putoto. Finding alternative roles for Traditional Birth Attendants: an experience from the south of Angola. European Journal of Public Health. 2019; 29 (Supplement):1.

Chicago/Turabian Style

M Fattorini; G Raguzzoni; C Cuccaro; N Nante; C Quercioli; F Ileni; M C Kaunawoye; C Caresia; G Putoto. 2019. "Finding alternative roles for Traditional Birth Attendants: an experience from the south of Angola." European Journal of Public Health 29, no. Supplement: 1.

Journal article
Published: 01 November 2019 in European Journal of Public Health
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Background Immunization represents one of the most effective intervention in public health. In the Sustainable Development Goals era, adequate vaccination services are still crucial for the prevention of infectious diseases and the reduction of under-5 mortality. However, in 2017 WHO estimated that children <1 year who did not receive the third dose of Diphtheria-Tetanus-Pertussis (DTP3) vaccine were 19.2 million globally, and 600000 of these were located in Angola, a Sub-Saharan country with an estimated DTP3 coverage of 52%. Since 2000, Italian Non-Governmental Organization (NGO) Doctors with Africa CUAMM supports the activity of the hospital of Chiulo in the commune of Mucope (district of Ombadja, south of Angola). Aim of the study is to describe the interventions implemented to strengthen the immunization services performed by the hospital Public Health Staff (PHS). Methods In May 2018 the NGO started to implement multiple interventions to enhance the number of vaccine doses administered. Firstly, outreach immunization sessions were reorganized and reinforced, for example involving local Community Health Workers in the identification of villages with a high burden of unvaccinated children. Other actions were the continuous training of the PHS in data collection and the increased collaboration with the Ombadja District Health Department in order to develop a more efficient vaccine supply chain at local level. Results In 2018, among children <1 year the PHS administered 19746 doses, with a 22.3% growth compared to 2017 (15349 doses). Doses administered during outreach sessions increased by 35.4% (6597 versus 4259 doses). Estimated DTP3 coverage in Mucope commune was 71% (2017, 59%). Conclusions The WHO “Reaching Every Community” strategy emphasizes the importance of high quality immunization services in hard-to-reach areas. The organisation of well-functioning immunization services requires a multifaceted approach by the involved stakeholders. Key messages In 2017, globally 19.2 million of children <1 year did not receive the recommended three DTP doses. Six-hundred thousand were located in Angola. To obtain and sustain an adequate vaccination coverage, especially in hard-to-reach areas, multiple and well-coordinated actions should be implemented by all the involved stakeholders.

ACS Style

M Fattorini; G Raguzzoni; C Cuccaro; N Nante; C Quercioli; J M N Ndilimondjo; C Caresia; G Putoto. Multiple interventions to strengthen immunization services in an Angolan district. European Journal of Public Health 2019, 29, 1 .

AMA Style

M Fattorini, G Raguzzoni, C Cuccaro, N Nante, C Quercioli, J M N Ndilimondjo, C Caresia, G Putoto. Multiple interventions to strengthen immunization services in an Angolan district. European Journal of Public Health. 2019; 29 (Supplement):1.

Chicago/Turabian Style

M Fattorini; G Raguzzoni; C Cuccaro; N Nante; C Quercioli; J M N Ndilimondjo; C Caresia; G Putoto. 2019. "Multiple interventions to strengthen immunization services in an Angolan district." European Journal of Public Health 29, no. Supplement: 1.

Journal article
Published: 01 November 2018 in European Journal of Public Health
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ACS Style

M Fattorini; D Rosadini; S Cresti; A De Luca; L Cubattoli; G Messina; C Basagni; A Tinturini; Mf De Marco. An educational programme for prevention and control of multidrug resistant organism outbreaks. European Journal of Public Health 2018, 28, 1 .

AMA Style

M Fattorini, D Rosadini, S Cresti, A De Luca, L Cubattoli, G Messina, C Basagni, A Tinturini, Mf De Marco. An educational programme for prevention and control of multidrug resistant organism outbreaks. European Journal of Public Health. 2018; 28 (suppl_4):1.

Chicago/Turabian Style

M Fattorini; D Rosadini; S Cresti; A De Luca; L Cubattoli; G Messina; C Basagni; A Tinturini; Mf De Marco. 2018. "An educational programme for prevention and control of multidrug resistant organism outbreaks." European Journal of Public Health 28, no. suppl_4: 1.

Journal article
Published: 01 August 2018 in Journal of Hospital Infection
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Nosocomial outbreaks due to multidrug-resistant Gram-negative bacteria (MDR-GNB) represent a serious concern for healthcare facilities worldwide. The European Antimicrobial Resistance Surveillance Network (EARS-Net) in 2016 reported combined resistance to multiple antimicrobial groups for Klebsiellla pneumoniae [1]. Moreover, despite a low European percentage of surveillance isolates resistant to carbapenems, countries like Italy and Greece showed an alarming diffusion of carbapenem-resistant Klebsiella pneumoniae (CRKP): in these scenarios, few therapeutic drugs such as colistin remain available, but even for this antibiotic the emergence of resistant strains represent a serious threat.

ACS Style

M. Fattorini; D. Rosadini; G. Messina; C. Basagni; A. Tinturini; M.F. De Marco. A multi-disciplinary educational programme for the management of a carbapenem-resistant Klebsiella pneumoniae outbreak: an Italian experience. Journal of Hospital Infection 2018, 99, 427 -428.

AMA Style

M. Fattorini, D. Rosadini, G. Messina, C. Basagni, A. Tinturini, M.F. De Marco. A multi-disciplinary educational programme for the management of a carbapenem-resistant Klebsiella pneumoniae outbreak: an Italian experience. Journal of Hospital Infection. 2018; 99 (4):427-428.

Chicago/Turabian Style

M. Fattorini; D. Rosadini; G. Messina; C. Basagni; A. Tinturini; M.F. De Marco. 2018. "A multi-disciplinary educational programme for the management of a carbapenem-resistant Klebsiella pneumoniae outbreak: an Italian experience." Journal of Hospital Infection 99, no. 4: 427-428.

Journal article
Published: 20 October 2017 in The European Journal of Public Health
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ACS Style

M Fattorini; S Burgassi; Mr Cardaci; D Lenzi; G Buonocore; K P Biermann; G Cevenini; G Messina. Public Health from the very beginning: neonatal incubators safety in a clinical setting. The European Journal of Public Health 2017, 27, 1 .

AMA Style

M Fattorini, S Burgassi, Mr Cardaci, D Lenzi, G Buonocore, K P Biermann, G Cevenini, G Messina. Public Health from the very beginning: neonatal incubators safety in a clinical setting. The European Journal of Public Health. 2017; 27 (suppl_3):1.

Chicago/Turabian Style

M Fattorini; S Burgassi; Mr Cardaci; D Lenzi; G Buonocore; K P Biermann; G Cevenini; G Messina. 2017. "Public Health from the very beginning: neonatal incubators safety in a clinical setting." The European Journal of Public Health 27, no. suppl_3: 1.

Evaluation study
Published: 23 September 2016 in International Journal of Environmental Research and Public Health
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Today it is well demonstrated that stethoscopes can be as contaminated as hands, which are a recognized source of Health-Care Associated Infections (HCAIs). Ultraviolet C (UVC) light has proven disinfection capacity and the innovative UVC technology of Light Emitting Diode (LED) shows several potential benefits. To verify whether the use of UVC LEDs is effective and reliable in stethoscope membrane disinfection after prolonged use, a pre-post intervention study was conducted. A total of 1668 five-minute cycles were performed on two UVC LEDs to simulate their use; thereafter, their disinfection capacity was tested on stethoscope membranes used on a previously auscultated volunteer. Then, a further 1249 cycles were run and finally the LEDs were tested to assess performance in reducing experimental contamination by Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli on the stethoscope membrane. Baseline volunteer contamination identified 104 Colony Forming Units (CFUs) while treated Petri dishes had 12 and 15 CFUs (p < 0.001). Statistically significant differences (p < 0.001) were also found relating to the reduction of specific bacteria: in particular, after treatment no CFU were observed for S. aureus and E. coli. UVC LEDs demonstrated the capacity to maintain high levels of disinfection after more than 240 h of use and they were effective against common microorganisms that are causative agents of HCAIs.

ACS Style

Gabriele Messina; Mattia Fattorini; Nicola Nante; Daniele Rosadini; Andrea Serafini; Marco Tani; Gabriele Cevenini. Time Effectiveness of Ultraviolet C Light (UVC) Emitted by Light Emitting Diodes (LEDs) in Reducing Stethoscope Contamination. International Journal of Environmental Research and Public Health 2016, 13, 940 .

AMA Style

Gabriele Messina, Mattia Fattorini, Nicola Nante, Daniele Rosadini, Andrea Serafini, Marco Tani, Gabriele Cevenini. Time Effectiveness of Ultraviolet C Light (UVC) Emitted by Light Emitting Diodes (LEDs) in Reducing Stethoscope Contamination. International Journal of Environmental Research and Public Health. 2016; 13 (10):940.

Chicago/Turabian Style

Gabriele Messina; Mattia Fattorini; Nicola Nante; Daniele Rosadini; Andrea Serafini; Marco Tani; Gabriele Cevenini. 2016. "Time Effectiveness of Ultraviolet C Light (UVC) Emitted by Light Emitting Diodes (LEDs) in Reducing Stethoscope Contamination." International Journal of Environmental Research and Public Health 13, no. 10: 940.