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Examples of Bedaquiline Introduction for the Management of Multidrug-Resistant Tuberculosis in Five Countries
No full textAbstract available only, full article is not open access. To access this article click on "additional links".For the first time in almost 50 years, there are new drugs available for the treatment of tuberculosis (TB), including bedaquiline (BDQ) and delamanid (DLM). The rate of introduction, however, has not kept pace with patient needs. It is estimated that as many as 23% of multidrug-resistant TB (MDR-TB) patients have an indication for receiving BDQ. As this is the first time the MDR-TB community is introducing new medications, it is important to understand how implementation can be developed in a variety of settings
Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe
No full textAge-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown
Different Challenges, Different Approaches and Related Expenditures of Community-Based Tuberculosis Activities by International Non-Governmental Organizations in Myanmar
No full textInternational non-governmental organizations (INGOs) have been implementing community-based tuberculosis (TB) care (CBTBC) in Myanmar since 2011. Although the National TB Programme (NTP) ultimately plans to take over CBTBC, there have been no evaluations of the models of care or of the costs of providing CBTBC in Myanmar by INGOs
Efficacy of a Low-Cost, Heat-Stable Oral Rotavirus Vaccine in Niger
No full textBackground Each year, rotavirus gastroenteritis is responsible for about 37% of deaths from diarrhea among children younger than 5 years of age worldwide, with a disproportionate effect in sub-Saharan Africa. Methods We conducted a randomized, placebo-controlled trial in Niger to evaluate the efficacy of a live, oral bovine rotavirus pentavalent vaccine (BRV-PV, Serum Institute of India) to prevent severe rotavirus gastroenteritis. Healthy infants received three doses of the vaccine or placebo at 6, 10, and 14 weeks of age. Episodes of gastroenteritis were assessed through active and passive surveillance and were graded on the basis of the score on the Vesikari scale (which ranges from 0 to 20, with higher scores indicating more severe disease). The primary end point was the efficacy of three doses of vaccine as compared with placebo against a first episode of laboratory-confirmed severe rotavirus gastroenteritis (Vesikari score, ≥11) beginning 28 days after dose 3. Results Among the 3508 infants who were included in the per-protocol efficacy analysis, there were 31 cases of severe rotavirus gastroenteritis in the vaccine group and 87 cases in the placebo group (2.14 and 6.44 cases per 100 person-years, respectively), for a vaccine efficacy of 66.7% (95% confidence interval [CI], 49.9 to 77.9). Similar efficacy was seen in the intention-to-treat analyses, which showed a vaccine efficacy of 69.1% (95% CI, 55.0 to 78.7). There was no significant between-group difference in the risk of adverse events, which were reported in 68.7% of the infants in the vaccine group and in 67.2% of those in the placebo group, or in the risk of serious adverse events (in 8.3% in the vaccine group and in 9.1% in the placebo group); there were 27 deaths in the vaccine group and 22 in the placebo group. None of the infants had confirmed intussusception. Conclusions Three doses of BRV-PV, an oral rotavirus vaccine, had an efficacy of 66.7% against severe rotavirus gastroenteritis among infants in Niger. (Funded by Médecins sans Frontières Operational Center and the Kavli Foundation; ClinicalTrials.gov number, NCT02145000 .)
Health Care Workers' Perceptions of Point-of-Care Testing in a Low-Income Country-A Qualitative Study in Southwestern Uganda
No full textPoint-of-care (POC) tests have become increasingly available and more widely used in recent years. They have been of particular importance to low-income settings, enabling them with clinical capacities that had previously been limited. POC testing programs hold a great potential for significant improvement in low-income health systems. However, as most POC tests are developed in high-income countries, disengagement between developers and end-users inhibit their full potential. This study explores perceptions of POC test end-users in a low-income setting, aiming to support the development of novel POC tests for low-income countries
How Do Low Birth Weight Neonates Fare Two Years After Discharge from a Low-Technology Neonatal Care Unit in a Rural District Hospital in Burundi?
No full textAbstract available only, full article is not Open Access. To access this article click on "additional links".As neonatal care is being scaled up in economically poor settings, there is a need to know more on post-hospital discharge and longer-term outcomes. Of particular interest are mortality, prevalence of developmental impairments and malnutrition, all known to be worse in low-birth-weight neonates (LBW, <2500 grams). Getting a better handle on these parameters might justify and guide support interventions. Two years after hospital discharge, we thus assessed: mortality, developmental impairments, and nutritional status of LBW children
A Live Term Intra-Abdominal Pregnancy in a Field Hospital: a Case Report
No full textAbdominal pregnancy is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be challenging, especially in a resource-limited setting. We report a case of abdominal pregnancy that presented to Médecins Sans Frontières field hospital in Agok, South Sudan, with abdominal pain. Examination revealed a term pregnancy and a live fetus in transverse lie. The diagnosis of abdominal pregnancy was made intraoperatively, with successful management and delivery of a healthy baby
The Evolving Role of CSR in International Development: Evidence from Canadian Extractive Companies’ Involvement in Community Health Initiatives in Low-Income Countries
No full textOverseas development agencies and international finance organisations view the exploitation of minerals as a strategy for alleviating poverty in low-income countries. However, for local communities that are directly affected by extractive industry projects, economic and social benefits often fail to materialise. By engaging in Corporate Social Responsibility (CSR), transnational companies operating in the extractive industries ‘space’ verbally commit to preventing environmental impacts and providing health services in low-income countries. However, the actual impacts of CSR initiatives can be difficult to assess.\ud
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We help to bridge this gap by analysing the reach of health-related CSR activities financed by Canadian mining companies in the low-income countries where they operate. We found that in 2015, only 27 of 102 Canadian companies disclosed information on their websites concerning health-related CSR activities for impacted communities. Furthermore, for these 27 companies, there is very little evidence that alleged CSR activities may substantially contribute to the provision of comprehensive health services or more broadly to the sustainable development of the health sector
Challenges in Preparing and Implementing a Clinical Trial at Field Level in an Ebola Emergency: A Case Study in Guinea, West Africa
No full textDuring the large Ebola outbreak that affected West Africa in 2014 and 2015, studies were launched to evaluate potential treatments for the disease. A clinical trial to evaluate the effectiveness of the antiviral drug favipiravir was conducted in Guinea. This paper describes the main challenges of the implementation of the trial in the Ebola treatment center of Guéckédou. Following the principles of the Good Clinical Research Practices, we explored the aspects of the community's communication and engagement, ethical conduct, trial protocol compliance, informed consent of participants, ongoing benefit/risk assessment, record keeping, confidentiality of patients and study data, and roles and responsibilities of the actors involved. We concluded that several challenges have to be addressed to successfully implement a clinical trial during an international medical emergency but that the potential for collaboration between research teams and humanitarian organizations needs to be highlighted
HIV Misdiagnosis in Sub-Saharan Africa: Performance of Diagnostic Algorithms at Six Testing Sites
No full textWe evaluated the diagnostic accuracy of HIV testing algorithms at six programmes in five sub-Saharan African countries