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Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection

Title: Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection Authors: Kemigisha, E; Nanjebe, D; Boum, Y; Langendorf, Céline; Aberrane, S; Nyehangane, D; Nackers, F; Mueller, Y; Charrel, R; Murphy, RA; Page, AL; Mwanga-Amumpaire, J Abstract: Acute central nervous system (CNS) infections in children in sub-Saharan Africa are often fatal. Potential contributors include late presentation, limited diagnostic capacity and inadequate treatment. A more nuanced understanding of treatment practices with a goal of optimizing such practices is critical to prevent avoidable case fatality. We describe empiric antimicrobial treatment, antibiotic resistance and treatment adequacy in a prospective cohort of 459 children aged two months to 12 years hospitalised for suspected acute CNS infections in Mbarara, Uganda, from 2009 to 2012. Among these 459 children, 155 had a laboratory-confirmed diagnosis of malaria (case-fatality rate [CFR] 14%), 58 had bacterial infections (CFR 24%) and 6 children had mixed malaria and bacterial infections (CFR 17%). Overall case fatality was 18.1% (n = 83). Of 219 children with laboratory-confirmed malaria and/or bacterial infections, 182 (83.1%) received an adequate antimalarial and/or antibiotic on the day of admission and 211 (96.3%) within 48 hours of admission. The proportion of those receiving adequate treatment was similar among survivors and non-survivors. All bacterial isolates were sensitive to ceftriaxone except one Escherichia coli isolate with extended-spectrum beta-lactamase (ESBL). The observed high mortality was not a result of inadequate initial antimicrobial treatment at the hospital. The epidemiology of CNS infection in this setting justifies empirical use of a third-generation cephalosporin, however antibiotic resistance should be monitored closely.

Typhoid fever outbreak in the Democratic Republic of Congo: Case control and ecological study

Title: Typhoid fever outbreak in the Democratic Republic of Congo: Case control and ecological study Authors: Brainard, J; D’hondt, R; Ali, E; Van den Bergh, R; De Weggheleire, A; Baudot, Y; Patigny, F; Lambert, V; Zachariah, R; Maes, P; Kuma-Kuma Kenge, D; Hunter, PR Abstract: During 2011 a large outbreak of typhoid fever affected an estimated 1430 people in Kikwit, Democratic Republic of Congo. The outbreak started in military camps in the city but then spread to the general population. This paper reports the results of an ecological analysis and a case-control study undertaken to examine water and other possible transmission pathways. Attack rates were determined for health areas and risk ratios were estimated with respect to spatial exposures. Approximately 15 months after the outbreak, demographic, environmental and exposure data were collected for 320 cases and 640 controls residing in the worst affected areas, using a structured interview questionnaire. Unadjusted and adjusted odds ratios were estimated. Complete data were available for 956 respondents. Residents of areas with water supplied via gravity on the mains network were at much greater risk of disease acquisition (risk ratio = 6.20, 95%CI 3.39–11.35) than residents of areas not supplied by this mains network. In the case control study, typhoid was found to be associated with ever using tap water from the municipal supply (OR = 4.29, 95% CI 2.20–8.38). Visible urine or faeces in the latrine was also associated with increased risk of typhoid and having chosen a water source because it is protected was negatively associated. Knowledge that washing hands can prevent typhoid fever, and stated habit of handwashing habits before cooking or after toileting was associated with increased risk of disease. However, observed associations between handwashing or plate-sharing with disease risk could very likely be due to recall bias. This outbreak of typhoid fever was strongly associated with drinking water from the municipal drinking water supply, based on the descriptive and analytic epidemiology and the finding of high levels of faecal contamination of drinking water. Future outbreaks of potentially waterborne disease need an integrated response that includes epidemiology and environmental microbiology during early stages of the outbreak.

Health Seeking Behaviour in Kamrangirchar

Title: Health Seeking Behaviour in Kamrangirchar Authors: Jeroen van der Heijden Description: The perceptions and experiences of health and health seeking behaviour for the community living in the slum areas of Kamrangirchar and Hazaribagh, Dhaka, Bangladesh: a qualitative study

Outbreak of Pneumococcal Meningitis, Paoua Subprefecture, Central African Republic, 2016-2017

Title: Outbreak of Pneumococcal Meningitis, Paoua Subprefecture, Central African Republic, 2016-2017 Authors: Coldiron, Me; Touré, O; Frank, T; Bouygues, N; Grais, RF Abstract: We report a pneumococcal meningitis outbreak in the Central African Republic (251 suspected cases; 60 confirmed by latex agglutination test) in 2016-2017. Case-fatality rates (10% for confirmed case-patients) were low. In areas where a recent pneumococcal conjugate vaccine campaign was conducted, a smaller proportion of cases was seen in youngest children.

Leishmaniasis

Title: Leishmaniasis Authors: Burza, S; Croft, SL; Boelaert, M Abstract: Leishmaniasis is a poverty-related disease with two main clinical forms: visceral leishmaniasis and cutaneous leishmaniasis. An estimated 0·7-1 million new cases of leishmaniasis per year are reported from nearly 100 endemic countries. The number of reported visceral leishmaniasis cases has decreased substantially in the past decade as a result of better access to diagnosis and treatment and more intense vector control within an elimination initiative in Asia, although natural cycles in transmission intensity might play a role. In east Africa however, the case numbers of this fatal disease continue to be sustained. Increased conflict in endemic areas of cutaneous leishmaniasis and forced displacement has resulted in a surge in these endemic areas as well as clinics across the world. WHO lists leishmaniasis as one of the neglected tropical diseases for which the development of new treatments is a priority. Major evidence gaps remain, and new tools are needed before leishmaniasis can be definitively controlled.

For Family-Centered Differentiated Service Delivery for HIV

Title: For Family-Centered Differentiated Service Delivery for HIV Authors: Grimsrud, A; Bygrave, H; Wilkinson, L Abstract: Differentiated 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.

Does the Structured Operational Research and Training Initiative (SORT IT) continue to influence health policy and/or practice?

Title: Does the Structured Operational Research and Training Initiative (SORT IT) continue to influence health policy and/or practice? Authors: Tripathy, JP; Kumar, AM; Guillerm, N; Berger, SD; Bissell, K; Reid, A; Zachariah, R; Ramsay, A; Harries, AD Abstract: The Structured Operational Research and Training Initiative (SORT IT) is a successful model of integrated operational research and capacity building with about 90% of participants completing the training and publishing in scientific journals.

Retrospective mortality survey in the MSF catchment area in Fizi health zone, South Kivu, Democratic Republic of Congo

Title: Retrospective mortality survey in the MSF catchment area in Fizi health zone, South Kivu, Democratic Republic of Congo Authors: Lenglet, Annick; Bil, Karla; Mandelkow, Jantina Abstract: . OBJECTIVES 2.1. PRIMARY OBJECTIVES 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. 2.2. SECONDARY OBJECTIVES  To determine the prevalence of self-reported morbidities in the two weeks preceding the survey in household members;  To determine the frequency and reasons for displacement;  To assess access to health care;  To determine the main causes of deaths during the recall period;  To measure the incidence and types of direct violence experienced by the civilian population;  To evaluate household ownership of basic non-food items; Description: Research Protocol

Prevalence and vaccination coverage of Hepatitis B among healthcare workers in Cameroon: A national seroprevalence survey

Title: Prevalence and vaccination coverage of Hepatitis B among healthcare workers in Cameroon: A national seroprevalence survey Authors: Bilounga Ndongo, C; Eteki, L; Siedner, M; Mbaye, R; Chen, J; Ntone, R; Donfack, O; Bongwong, B; Essaka, RE; Zeh, F; Njouom, R; Nguefack-Tsague, Georges; Etoundi, GAM; Biwole Sida, M; Boum, Y Abstract: Hepatitis B virus (HBV) infection is hyperendemic in Cameroon, and health care workers (HCWs) are at high-risk of infection. We aimed to assess prevalence, risk factors and vaccine coverage of HBV infection among HCWs in Cameroon. We conducted a cross-sectional study in 16 hospitals across all regions of Cameroon. HCWs were tested for HBV using rapid diagnostic tests (RDT). We collected data on socio-demographics and HBV vaccination status. We estimated prevalence of HBV and used Poisson regression models with robust standard errors to model the prevalence ratios of HBV positivity between covariates. We enrolled 1,824 of 1,836 eligible HCWs (97.5%). The mean age was 34 (SD: 10) years, 65.3% (n=1787) were women, and 11.4% (n=1747) had three or more doses of the HBV vaccine. Overall, we found a HBV prevalence of 8.7% (95% CI: 5.2 - 14.3%). Patient transporters had the highest crude prevalence (14.3%; 95%CI: 5.4-32.9%), whereas medical doctors had the lowest (3.2%; 95%CI: 0.8%-12.1%). The Far North Region had the highest prevalence of HBV (24.0%; 95%CI: 18.3%-30.8%). HBV prevalence decreased with increasing doses of the HBV vaccine (10.3% for no doses vs 3.5% for three or more doses; P<0.001). In conclusion, approximately 1 in 12 HCWs in Cameroon have evidence of HBV infection, yet fewer than 1 in 6 have been fully vaccinated. Our results illustrate the urgent need to scale up systematic HBV screening and targeted vaccination of HCWs in the region. This article is protected by copyright. All rights reserved.

Body and mind: retention in antiretroviral treatment care is improved by mental health training of care providers in Ethiopia

Title: Body and mind: retention in antiretroviral treatment care is improved by mental health training of care providers in Ethiopia Authors: Berheto, TM; Hinderaker, SG; Senkoro, M; Tweya, H; Deressa, T; Getaneh, Y; Gezahegn, G Abstract: Ethiopia has achieved a high coverage of antiretroviral treatment (ART), but maintaining lifelong care is still a great challenge. Mental illnesses often co-exist with HIV/AIDS and may compromise the retention on ART. In order to improve prolonged retention in ART care, basic training in mental health care was introduced for ART providers, but this hasn't been evaluated yet. The aim of this study was to examine if this training has improved patient retention in care.

MSF OCA NCD Guidelines version 4

Title: MSF OCA NCD Guidelines version 4 Authors: MSF Description: Non-communicable diseases (NCDs) make the largest contribution to mortality both globally and in the majority of low- and middle- income countries (LMICs). Worldwide, NCDs account for 60% (35 million) of global deaths. The major NCDs used to be diseases of affluence; however, the changing epidemiology of NCDs (increasingly affecting low- and middle-income countries) and the changing patterns of refugee crises (away from settings where infectious disease represents the main burden of disease) mean that they now represent an increasing proportion of the cases we see in many MSF projects.

Field Research Survey

Title: Field Research Survey Authors: MSF USA; LuxOR Description: To access the survey, click on Additional Links.

Estimating program coverage in the treatment of severe acute malnutrition: a comparative analysis of the validity and operational feasibility of two methods

Title: Estimating program coverage in the treatment of severe acute malnutrition: a comparative analysis of the validity and operational feasibility of two methods Authors: Isanaka, S; Hedt-Gauthier, BL; Grais, RF; Allen, BGS Abstract: Many health programs can assess coverage using standardized cluster survey methods, but estimating the coverage of nutrition programs presents a special challenge due to low disease prevalence. Used since 2012, the Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) employs both qualitative and quantitative methods to identify key barriers to access and estimate coverage of therapeutic feeding programs. While the tool has been increasingly used in programs, the validity of certain methodological elements has been the subject of debate.

Is 6 months of bedaquiline enough? Results from the compassionate use of bedaquiline in Armenia and Georgia

Title: Is 6 months of bedaquiline enough? Results from the compassionate use of bedaquiline in Armenia and Georgia Authors: Hewison, C; Bastard, M; Khachatryan, N; Kotrikadze, T; Hayrapetyan, A; Avaliani, Z; Kiria, N; Yegiazaryan, L; Chumburidze, N; Kirakosyan, O; Atshemyan, H; Qayyum, S; Lachenal, N; Varaine, F; Huerga, H Abstract: Bedaquiline (BDQ) was initially only available through compassionate use programmes.