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Precision medicine for drug-resistant tuberculosis in high-burden countries: is individualised treatment desirable and feasible?
No full textTreatment for drug-resistant tuberculosis is largely delivered through standardised, empirical combination regimens in low-resource, high-burden settings. However, individualised treatment, guided by detailed drug susceptibility testing, probably results in improved individual outcomes and is the standard of care in well-resourced settings. Driven by the urgent need to scale up treatment provision, new tuberculosis drugs, incorporated into standardised regimens, are being tested. Although standardised regimens are expected to improve access to treatment in high-burden settings, they are also likely to contribute to the emergence of resistance, even with good clinical management. We argue that a balance is required between the need to improve treatment access and the imperative to minimise resistance amplification and provide the highest standard of care, through a precision medicine approach. In tuberculosis, as in other diseases, we should aim to reduce the entrenched inequalities that manifest as different standards of care in different settings
Understanding the health status and humanitarian impact of the recent events in the internally displaced population (IDPs) in Tal Abyad and Manbij districts, northern Syria, 2017
No full textResearch ProtocolAims and objectives\ud
2.1. Primary objective\ud
To estimate the prevalence of current illnesses (self-reported), vaccination coverage, and mental health distress related symptoms in the IDP population in order to obtain a baseline that can guide MSF response activities in Raqqa as well as in Tal Abyad and Manbij districts. \ud
2.2. Secondary objectives\ud
1) To estimate the vaccination coverage for key vaccine preventable diseases in children aged 6-59 months among the new IDP population;\ud
2) To describe the demographic characteristics of the IDP population; \ud
3) To describe the displacement routes and experiences of the IDP population; \ud
4) To estimate the prevalence of self-reported morbidities in the previous two weeks; \ud
5) To estimate the global acute malnutrition (GAM) rate of in children aged 6-59 months and pregnant women;\ud
6) To estimate the prevalence of self-reported major chronic diseases; \ud
7) To estimate the prevalence of symptoms commonly associated with mental health distress; \ud
8) To estimate the prevalence of conflict-related violence/trauma experienced during the recall period (365 days);\ud
9) To estimate the retrospective mortality since the beginning of Ar-Raqqa offensive in northern Syria (12 June 2016);\ud
10) To gain more understanding related to the concerns, challenges and priority needs of the IDPs in the community
Determining sero-prevalence of antibodies against Hepatitis E during an acute outbreak scenario.
No full textResearch ProtocolOBJECTIVES\ud
\ud
3.1 PRIMARY OBJECTIVES\ud
To estimate sero prevalence of anti-HEV antibodies (IgG and IgM) in different age groups in Am Timam, Chad\ud
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3.2 SECONDARY OBJECTIVES\ud
• To determine individual risk factors associated with different anti-HEV antibody status during an acute outbreak;\ud
• To determine household level risk factors associated with different anti-HEV antibody status during an acute outbreak;\ud
• To compare the sero prevalence of anti-HEV antibodies (IgG and IgM) in different age groups at two different time periods during an acute HEV outbreak to inform our understanding of viral transmission dynamics in a population in this context;\ud
• To determine sero prevalence in different age groups of other jaundice causing agents (malaria, hepatitis A, B and C, leptospirosis and arboviral diseases such as yellow fever, viral haemorrhagic fever, Dengue and Rift valley fever;\ud
• To compare dried blood spots (DBS) with blood samples for detection of HEV IgM and IgG and HEV RNA through PCR;\ud
• To compare oral swabs with blood samples for the detection of HEV IgM and IgG and HEV RNA through PCR
Case management of malaria in Swaziland, 2011-2015: on track for elimination?
No full textObjective: To assess adherence to malaria diagnosis and treatment guidelines (2010 and 2014) in all health care facilities in Swaziland between 2011 and 2015. Methods: This was a cross-sectional descriptive study involving all health care facilities that diagnosed and managed malaria cases in Swaziland. Patients' age, sex, diagnosis method and type of treatment were analysed. Results: Of 1981 records for severe and uncomplicated malaria analysed, 56% of cases were uncomplicated and 14% had severe malaria. The type of malaria was not recorded for 30% of cases. Approximately 71% of cases were confirmed by rapid diagnostic tests (RDT) alone, 3% by microscopy alone and 26% by both RDT and microscopy. Of the uncomplicated cases, 93% were treated with artemether-lumefantrine (AL) alone, 5% with quinine alone and 2% with AL and quinine. Amongst the severe cases, 11% were treated with AL alone, 44% with quinine alone and 45% with AL and quinine. For severe malaria, clinics and health centres prescribed AL alone more often than hospitals (respectively 13%, 12% and 4%, P = 0.03). Conclusion: RDTs and/or microscopy results are used at all facilities to inform treatment. Poor recording of malaria type causes difficulties in assessing the prescription of antimalarial drugs
Wishful thinking versus operational commitment: is the international guidance on priority sexual and reproductive health interventions in humanitarian settings becoming unrealistic?
No full textTwenty-one years ago, a global consortium of like-minded institutions designed the landmark Minimum Initial Service Package (MISP) for sexual and reproductive health (SRH) to guide national and international humanitarian first responders in preventing morbidity and mortality at the onset of chaos, destruction, and high insecurity caused by disasters or conflicts. Since then, the MISP has undergone limited change and has become an international reference in humanitarian response. This article discusses our perspectives regarding the 2018 changes to the MISP that have created division among humanitarian field practitioners, academics, advocates, and development agencies. With more than 50 pages, the new MISP chapter dilutes key guidance and messages on the most life-saving activities, leaving actors with excessive room for interpretation as to which priority activities need to be first implemented. Consequently, non-life-saving interventions may take precedence over essential ones. Insecurity, scarce human and financial resources, logistics constrains, and other limitations imposed by field reality at the onset of a crisis must be considered. We strongly recommend that an institution with the mandate, legitimacy, and technical expertise in the review of guidelines reexamines the 2018 edition of the MISP. We urge experienced first-line responders, national actors, and relevant agencies to join efforts to ensure that the MISP remains focused on a very limited set of essential activities and supplies that are pragmatic, field-oriented, and, most importantly, immediately life-saving for people in need
Oral cholera vaccine in cholera prevention and control, Malawi
No full textWith limited global supplies of oral cholera vaccine, countries need to identify priority areas for vaccination while longer-term solutions, such as water and sanitation infrastructure, are being developed
For Family-Centered Differentiated Service Delivery for HIV
No full textDifferentiated care, or differentiated service delivery (DSD), is increasingly being promoted as one of the possible ways to address and improve access, quality, and efficiency of HIV prevention, care, and treatment. Family-centered care has long been promoted within the provision of HIV services, but the full benefits have not necessarily been realized. In this article, we bring together these two approaches and make the case for how family-centered DSD can offer benefits to both people affected by HIV and the health system. Family-centered DSD approaches are presented for HIV testing and antiretroviral therapy (ART) delivery, referencing policies, best practice examples, and evidence from the field. With differentiated family-centered ART delivery, the potential efficiencies gained by extending ART refills can both benefit clients by reducing the frequency and intensity of contact with the health service and lead to health system gains by not requiring multiple providers to care for one family. A family-centered DSD approach should also be leveraged along the HIV care cascade in the provision of prevention technologies and mobilizing family members to receive regular HIV testing. Furthermore, a family-centered lens should be applied wherever DSD is implemented to ensure that, for example, adolescents who are pregnant receive an adapted package of quality care
Treatment and outcomes in children with multidrug-resistant tuberculosis: A systematic review and individual patient data meta-analysis
No full textAn estimated 32,000 children develop multidrug-resistant tuberculosis (MDR-TB; Mycobacterium tuberculosis resistant to isoniazid and rifampin) each year. Little is known about the optimal treatment for these children
