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Use of MUAC as the sole discharge criterion from community-based management of severe acute malnutrition in Burkina Faso.
No full textThe use of mid upper arm circumference (MUAC) measurement to screen and determine eligibility for admission to therapeutic feeding programs has been established, but evidence and programmatic experience to inform guidance on the use of MUAC as a discharge criterion is limited. We present results from a large scale nutritional program using MUAC for admission and discharge and compare program outcomes and response to treatment when determining eligibility for discharge by proportional weight gain vs. discharge by MUAC. The study population included all children admitted to the Ministry of Health therapeutic feeding program supported by Médecins Sans Frontières in northern Burkina Faso from September 2007 to December 2011 (n = 50,841). Recovery was high overall using both discharge criteria, with low risks of death, non-response and transfer to inpatient care and high daily gains in weight, MUAC, WHZ and height. When discharge was made by MUAC only, recovery increased, while all adverse program outcomes and length of stay decreased, with increasing MUAC on admission. MUAC-based programming, where MUAC is integrated into program screening, admission, and discharge, is one of several new approaches that can be used to target resources to the most at-risk malnourished children and improve program efficiency and coherency. This analysis provides additional programmatic experience on the use of MUAC-based discharge criterion, but more work may be needed to inform optimal discharge thresholds across settings
Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries
No full textIn 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-income countries (LMICs): optimised combination therapies for confirmed meningitis cases and cryptococcal antigen screening programmes for ambulatory people living with HIV who access care. WHO's preferred therapy for the treatment of HIV-related cryptococcal meningitis in LMICs is 1 week of amphotericin B plus flucytosine, and the alternative therapy is 2 weeks of fluconazole plus flucytosine. In the ACTA trial, 1-week (short course) amphotericin B plus flucytosine resulted in a 10-week mortality of 24% (95% CI -16 to 32) and 2 weeks of fluconazole and flucytosine resulted in a 10-week mortality of 35% (95% CI -29 to 41). However, with widely used fluconazole monotherapy, mortality because of HIV-related cryptococcal meningitis is approximately 70% in many African LMIC settings. Therefore, the potential to transform the management of HIV-related cryptococcal meningitis in resource-limited settings is substantial. Sustainable access to essential medicines, including flucytosine and amphotericin B, in LMICs is paramount and the focus of this Personal View
HIV-associated Kaposi's sarcoma in Maputo, Mozambique: outcomes in a specialized treatment center, 2010-2015
No full textKaposi's sarcoma (KS) is a common HIV-associated malignancy associated with disability, pain and poor outcomes. The cornerstone of its treatment is antiretroviral therapy, but advanced disease necessitates the addition of chemotherapy. In high-income settings, this often consists of liposomal anthracyclines, but in Mozambique, the first line includes conventional doxorubicin, bleomycin and vincristine, which is poorly-tolerated. Médecins Sans Frontières supports the Ministry of Health (MOH) in a specialized HIV and KS treatment center at the Centro de Referencia de Alto Maé in Maputo
Safety and effectiveness of short-course AmBisome in the treatment of Post-Kala-azar Dermal Leishmaniasis (PKDL): a prospective cohort study in Bangladesh
No full textA safe and effective short-course treatment regimen for Post Kala Azar Dermal Leishmaniasis (PKDL) is considered essential for achieving and sustaining elimination of visceral leishmaniasis (VL) in the Indian subcontinent.(1, 2) Here, single dose liposomal amphotericin B (AmBisome) has been adopted as a first line regimen for VL; however the effectiveness and safety of AmBisome for PKDL has not been formally evaluated
'I could not join because I had to work for pay.': A qualitative evaluation of falciparum malaria pro-active case detection in three rural Cambodian villages
No full textPro-active case detection (Pro-ACD), in the form of voluntary screening and treatment (VSAT) following community mobilisation about 'asymptomatic malaria', is currently being evaluated as a tool for Plasmodium falciparum elimination in Preah Vihear Province, Cambodia
Morbidity, healthcare needs and barriers to access medical care amongst local and displaced populations in west Dar’a and Quneitra, Southern Syria.
No full textResearch ProtocolObjectives\ud
2.1 Primary objective\ud
To determine the health care needs for local population and IDP’s in west Dar’a and Quneitra by estimating the prevalence of underlying morbidities, vaccination coverage and identifying barriers to access to health care, in order to obtain a baseline that can guide MSF and actor response.\ud
2.2 Secondary objectives \ud
The relevance of subjects for the (secondary) objective(s) has been informed by insights from reports of, and explorative meetings with MSF and medical NGOs active in southern Syria (section 3.2.3). Of the secondary objectives identified, similar objectives are reflected in MSF-ERB approved protocols for surveys conducted in the region. We formulated the objectives (and related indicators on page 15) as much as possible on basis of these approved secondary objectives .\ud
I. To describe the socio-demographic characteristics of the surveyed population including age, gender and household characteristics. \ud
II. To estimate the prevalence of self-reported morbidities in previous two weeks, an estimate of the prevalence of non-communicable diseases, and the main reasons for requiring medical care.\ud
III. To estimate the vaccination coverage for key vaccine preventable diseases in children aged 6-59 months.\ud
IV. To characterise health care utilisation, the degree of access to healthcare for common morbidities in the population (health seeking behviour) and determine the most common barriers to access to health care.\ud
V. To estimate the global acute malnutrition [GAM] rate of in children aged 6-59 months.\ud
VI. To estimate the prevalence of conflict-related trauma experienced during the recall period.\ud
VII. To what extent maternal and reproductive health services are utilized by assessed crisis-affected women of 15-49 years of age in this area.\ud
VIII. To estimate the retrospective mortality and cause of mortality, over the past 6 months (since Ramadan 2017).\ud
IX. To better understand the configuration of the health system following the crisis, the characteristics of care-seeking and the quality of the services
Longitudinal cohort to evaluate Hepatitis C treatment effectiveness in HIV co-infected patients: Manipur, India
No full textResearch Protocol4. OBJECTIVES\ud
Primary objective\ud
The primary objective of this study is to assess the effectiveness of HCV curative treatments in\ud
patients with chronic hepatitis C (CHC), co-infected with HIV in Manipur, India.\ud
Secondary objectives\ud
a. To describe the demographic, clinical and biological characteristics of patients with chronic\ud
hepatitis C and HIV co-infection\ud
b. To assess the effectiveness of HCV curative strategies in patients with chronic HCV, co-infected\ud
with HIV stratified by regimen and by site\ud
c. To identify risk factors associated with differing virological responses\ud
d. To assess the safety of HCV treatment\ud
e. To monitor the safety of HCV treatment in HIV co-infected patients\ud
f. To document the clinical and biological tolerance of the HCV treatment\ud
g. To assess the feasibility of HCV treatment\ud
h. To assess comparative performance of elastography (Fibroscan®) and APRI (AST to Platelet\ud
Ration Index), to evaluate liver fibrosis among HIV/HCV co-infected individuals\ud
i. To describe causes of non-eligibility for treatment\ud
j. To describe the clinical and biological evolution of co-infected patients, not eligible for HCV\ud
treatment\ud
k. To assess treatment adherenc
Retrospective mortality survey in the MSF catchment area in Fizi health zone, South Kivu, Democratic Republic of Congo
No full textResearch Protocol. OBJECTIVES\ud
\ud
2.1. PRIMARY OBJECTIVES\ud
To estimate the crude mortality rate for the total population (host and IDP) and for children under five years of age in the health zone of Fizi, South Kivu, DRC, in order to understand the current health status of the population in this catchment area.\ud
\ud
2.2. SECONDARY OBJECTIVES\ud
To determine the prevalence of self-reported morbidities in the two weeks preceding the survey in household members;\ud
To determine the frequency and reasons for displacement;\ud
To assess access to health care;\ud
To determine the main causes of deaths during the recall period;\ud
To measure the incidence and types of direct violence experienced by the civilian population;\ud
To evaluate household ownership of basic non-food items