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Effect of bedaquiline on mortality in South African patients with drug-resistant tuberculosis: a retrospective cohort study
No full textAddition of bedaquiline to treatment for multidrug-resistant tuberculosis was associated with an increased risk of death in a phase 2b clinical trial, resulting in caution from WHO. Following a compassionate access programme and local regulatory approval, the South African National Tuberculosis Programme began widespread use of bedaquiline in March, 2015, especially among patients with extensively drug resistant tuberculosis for whom no other effective treatment options were available. We aimed to compare mortality in patients on standard regimens with that of patients on regimens including bedaquiline
Unreported cases in the 2014-2016 Ebola epidemic: Spatiotemporal variation, and implications for estimating transmission
No full textIn the recent 2014-2016 Ebola epidemic in West Africa, non-hospitalized cases were an important component of the chain of transmission. However, non-hospitalized cases are at increased risk of going unreported because of barriers to access to healthcare. Furthermore, underreporting rates may fluctuate over space and time, biasing estimates of disease transmission rates, which are important for understanding spread and planning control measures. We performed a retrospective analysis on community deaths during the recent Ebola epidemic in Sierra Leone to estimate the number of unreported non-hospitalized cases, and to quantify how Ebola reporting rates varied across locations and over time. We then tested if variation in reporting rates affected the estimates of disease transmission rates that were used in surveillance and response. We found significant variation in reporting rates among districts, and district-specific rates of increases in reporting over time. Correcting time series of numbers of cases for variable reporting rates led, in some instances, to different estimates of the time-varying reproduction number of the epidemic, particularly outside the capital. Future analyses that compare Ebola transmission rates over time and across locations may be improved by considering the impacts of differential reporting rates
Long term follow up of Noma patients after surgical, nutritional and mental health interventions at the Noma Children’s Hospital in northwest Nigeria, 2018
No full textResearch ProtocolBackground\ud
Noma is a little understood, rapidly progressing gangrenous infection of the oral cavity, associated with a reported 90% mortality rate [1]. Noma mostly affects children under the age of five, and those who survive have severe facial disfigurements (2) and multiple physical impairments such as difficulty eating, seeing and breathing. Noma can also cause stigmatization due to these impairments [2]. The incidence of Noma is estimated to be 6.4 per 1000 children [3], and the World Health Organisation estimate that 140 000 children contract Noma each year [4]. Noma is thought to be most prevalent along the Noma belt which stretches from Senegal to Ethiopia [2], however Noma cases have recently been reported in the United Kingdom[5], United States [6], Afghanistan [7], South Korea [8] and Laos [9]. Little is known about Noma as the majority of cases live in underserved areas, difficult to reach locations, the mortality rate is high and the disease often goes undiagnosed. \ud
Noma starts as an inflammation of the gums, similar to a mouth ulcer, which then leads to the rapid destruction (one week [4]) of the jaw, lip, cheek, nose and sometimes eye [10]. During the first active stages of the disease, antibiotic treatment and wound dressing are effective forms of care, once Noma becomes inactive, patients can survive into adulthood but require extensive reconstructive surgery. The pathogenic cause of Noma is unknown [4]. Noma typifies the complex interactions between extreme poverty, severe malnutrition, poor oral hygiene practices, limited access to high quality health care [7] and co-morbidities with infections such as measles [1,2,7,11–18], malignancies, particularly leukaemia [4,11–13,16,17,19], Human Immunodeficiency Virus (HIV) [2,4–7,9,13,17–20] and Crohn’s Disease [8]. \ud
Long term outcomes of Noma treatment are difficult to ascertain due to inconsistent follow up because of the remote locations of home villages of patients and difficulties with access to health care assessments. A 2010 paper on the outcome of trismus release in Noma patients in northwest Nigeria (patients from the Noma Children’s Hospital), showed that the long term results of trismus release were poor with only 39% of patients showing improvement in mouth opening [21]. This shows a need to carefully monitor outcomes to try to ascertain what factors favour positive outcomes so that these can be the focus of treatment plans. \ud
Médecins Sans Frontières (MSF) runs programs at the Noma Children’s Hospital (NCH) in Sokoto, northern Nigeria, and currently assists with surgical interventions for the patients who have survived and sought care at the hospital. Community outreach, active case finding, follow up assessments and prevention programming are also supported by MSF. These projects place MSF in a unique position to study Noma, and to add to the scant body of knowledge around the disease. \ud
In 2017, MSF conducted a comprehensive descriptive study of the Noma patients treated since 2015 in the project in addition to a case control study for Noma patients. Results from these studies indicated that current routine data collection was sub-optimal. In order to be able to track clinical outcomes of Noma patients, more robust data collection and longer term follow up is needed. \ud
The current study aims to address one of the highlighted gaps from the 2017 case review which is the absence of comprehensive information on surgeries performed (including techniques) and clinical outcomes of Noma patients after surgery (in terms of surgical, anaesthesia-related and post-surgical complications, including infections) and outcome information after discharge from the hospital. Additionally, it will aim to establish better ways in which to ensure that current medical data on previous medical and vaccination history of each individual Noma patient are being accurately collected and analysed. Only by implementing a systematic and controlled method of data collection in conjunction with systematic follow up will our medical teams learn from current interventions and be able to use these recommendations for improved clinical management
Mental health literacy of internally displaced Iraqi young people and their parents in Iraq: paving the way for mental health education and promotion in vulnerable communities.
No full textResearch Protocol4. Objectives \ud
4.1 Primary objectives\ud
To determine levels of MHL relating to trauma related mental health disorders, namely posttraumatic stress disorder (PTSD) and depression among the displaced Iraqi young people in northern Iraq (see study population). \ud
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4.2 Specific objectives \ud
1. To estimate MHL relating to PTSD (and Depression) in a group of displaced Iraqi young people (13-17 years old) and the parents of children (8-12 years old) pertaining to:\ud
a. Problem recognition (including “self-recognition”)\ud
b. Beliefs about the severity of the problem described and its prevalence in the target population\ud
c. Beliefs about causes and risk factors\ud
d. Beliefs about how best to support someone with PTSD/depression\ud
e. Beliefs about the helpfulness of specific treatments and treatment providers\ud
f. Beliefs about likely outcome with and without treatment\ud
g. Beliefs about possible barriers to treatment\ud
h. Stigma and perceived discrimination towards someone with PTSD/depression\ud
2. To determine associations between specific aspects of MHL as outlined above, and individuals’ demographic characteristics (age, gender, religion, ethnicity, lengthen of displacement etc.) and symptom levels.\ud
3. To estimate the prevalence of mental health distress (major depression, anxiety disorders or suicidality ) using the Self Reporting Questionnaire (SRQ-20) in care takers of children 8-12 years old;\ud
4. To estimate the prevalence of constructs of intrusion, avoidance and arousal in children 8-17 years of age in the study population;\ud
5. To estimate the prevalence of self-reported depression in children 8-17 years old. \ud
The categories specified in objective 1 above were chosen because they were considered to be the aspects of MHL most likely to be of interest in informing the determinants of mental health in the proposed population. Objective 2 which seeks to examine the associations between specific aspects of MHL and individuals’ demographic characteristics and symptoms levels is important because associations of this kind can indicate specific targets for health promotion programs
Micro-hotspots of Risk in Urban Cholera Epidemics
No full textTargeted interventions have been delivered to neighbors of cholera cases in major epidemic responses globally despite limited evidence for the impact of such targeting. Using data from urban epidemics in Chad and D.R. Congo we estimate the extent of spatiotemporal zones of increased cholera risk around cases. In both cities, we found zones of increased risk of at least 200-meters during the 5-days immediately following case presentation to a clinic. Risk was highest for those living closest to cases and diminished in time and space similarly across settings. These results provide a rational basis for rapidly delivering targeting interventions
Compliance to follow up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: comparison of three models of care
No full textTo determine and compare, among three models of care, compliance to scheduled clinic appointments and adherence to anti-hypertensive medication of patients in an informal settlement of Kibera, Kenya
Near real-time forecasting for cholera decision making in Haiti after Hurricane Matthew
No full textComputational models of cholera transmission can provide objective insights into the course of an ongoing epidemic and aid decision making on allocation of health care resources. However, models are typically designed, calibrated and interpreted post-hoc. Here, we report the efforts of a team from academia, field research and humanitarian organizations to model in near real-time the Haitian cholera outbreak after Hurricane Matthew in October 2016, to assess risk and to quantitatively estimate the efficacy of a then ongoing vaccination campaign. A rainfall-driven, spatially-explicit meta-community model of cholera transmission was coupled to a data assimilation scheme for computing short-term projections of the epidemic in near real-time. The model was used to forecast cholera incidence for the months after the passage of the hurricane (October-December 2016) and to predict the impact of a planned oral cholera vaccination campaign. Our first projection, from October 29 to December 31, predicted the highest incidence in the departments of Grande Anse and Sud, accounting for about 45% of the total cases in Haiti. The projection included a second peak in cholera incidence in early December largely driven by heavy rainfall forecasts, confirming the urgency for rapid intervention. A second projection (from November 12 to December 31) used updated rainfall forecasts to estimate that 835 cases would be averted by vaccinations in Grande Anse (90% Prediction Interval [PI] 476-1284) and 995 in Sud (90% PI 508-2043). The experience gained by this modeling effort shows that state-of-the-art computational modeling and data-assimilation methods can produce informative near real-time projections of cholera incidence. Collaboration among modelers and field epidemiologists is indispensable to gain fast access to field data and to translate model results into operational recommendations for emergency management during an outbreak. Future efforts should thus draw together multi-disciplinary teams to ensure model outputs are appropriately based, interpreted and communicated
"I feel like I am less than other people": Health-related vulnerabilities of male migrants travelling alone on their journey to Europe
No full textDuring 2015 and 2016, an unprecedented flow of approximately 800,000 migrants coming from Turkey towards Western Europe crossed the Balkans. Male migrants are perceived as being less vulnerable compared to other migrants and they are not given priority in service and support provision. This qualitative study examines the self-perceived vulnerabilities of male migrants travelling alone along the Balkan route to Europe. Twenty-four individual in-depth interviews, two group interviews and participant observation were conducted with male migrants in Belgrade, Serbia in 2017. Data was coded manually, and analysed thematically. Male migrants traveling alone face the cumulative vulnerability of various traumatic events and migration-related contextual circumstances. Three main themes emerged: the ongoing desperate journey, the better treatment of 'traditionally' well recognised vulnerable sub-groups and the impact of the continuous stress on mental health. Deterrence measures imposed for border control purposes in the form of push-backs, expulsions, detention and degrading, inhumane treatment amplify the psychological distress of male migrants. Feelings of hopelessness, desperation, lack of self-value and self-esteem were reported. 'Traditionally vulnerable' populations were said to have had better treatment throughout the journey from smugglers, border state authorities, governmental officials, civil society and international organizations. The devastating experiences of male migrants, as well as the better treatment offered to other groups of migrants like women and children, results in a perceived neglect of the needs of men in humanitarian response, rendering them vulnerable and exposing them to further health and protection risks. In a context where needs are unmet and people's dignity and health are at risk, specific strategies should be developed to include men in the assistance and protection offered, particularly in relation to exposure to violence
A Nosocomial Outbreak of Clinical Sepsis in a Neonatal Care Unit (NCU) in Port-Au-Prince Haiti, July 2014 - September 2015
No full textBetween July 2014 and September 2015, a neonatal care unit (NCU) in Port Au Prince, Haiti, experienced an outbreak of sepsis, most probably due to nosocomial transmission of Extended Beta Lactamase (ESBL) producing gram negative bacteria, included Klebsiella pneumoniae
Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study
No full textThe emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance