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High Seroconversion Rates in Trypanosoma Cruzi Chronic Infection Treated with Benznidazole in People Under 16 Years in Guatemala

Title: High Seroconversion Rates in Trypanosoma Cruzi Chronic Infection Treated with Benznidazole in People Under 16 Years in Guatemala Authors: Brum-Soares, L; Cubides, JC; Burgos, I; Monroy, C; Castillo, L; González, S; Viñas, PA; Urrutia, PP Abstract: Geographical, epidemiological, and environmental differences associated with therapeutic response to Chagas etiological treatment have been previously discussed. This study describes high seroconversion rates 72 months after benznidazole treatment in patients under 16 years from a project implemented by Doctors without Borders in Guatemala.

Diagnostic accuracy of VIKIA® Rota-Adeno and Premier™ Rotaclone® tests for the detection of Rotavirus in Niger

Title: Diagnostic accuracy of VIKIA® Rota-Adeno and Premier™ Rotaclone® tests for the detection of Rotavirus in Niger Authors: Lagare, A; Moumouni, A; Kaplon, J; Langendorf, C; Pothier, P; Grais, R; Issaka, B; Page, A Abstract: We conducted a parallel evaluation of the diagnostic accuracy of VIKIA® Rota-Adeno, a rapid diagnostic test (RDT) and Premier™ Rotaclone® an enzyme immunoassay (EIA) using reverse transcription polymerase chain reaction (RT-PCR) as the reference standard. The study was part of a rotavirus surveillance project in Niger.

A Novel Electronic Algorithm using Host Biomarker Point-of-Care tests for the Management of Febrile Illnesses in Tanzanian children (e-POCT): A randomized, controlled non-inferiority trial

Title: A Novel Electronic Algorithm using Host Biomarker Point-of-Care tests for the Management of Febrile Illnesses in Tanzanian children (e-POCT): A randomized, controlled non-inferiority trial Authors: Keitel, K; Kagoro, F; Samaka, J; Masimba, J; Said, Z; Temba, H; Mlaganile, T; Sangu, W; Rambaud-Althaus, C; Gervaix, A; Genton, B; D'Acremont, V Abstract: The management of childhood infections remains inadequate in resource-limited countries, resulting in high mortality and irrational use of antimicrobials. Current disease management tools, such as the Integrated Management of Childhood Illness (IMCI) algorithm, rely solely on clinical signs and have not made use of available point-of-care tests (POCTs) that can help to identify children with severe infections and children in need of antibiotic treatment. e-POCT is a novel electronic algorithm based on current evidence; it guides clinicians through the entire consultation and recommends treatment based on a few clinical signs and POCT results, some performed in all patients (malaria rapid diagnostic test, hemoglobin, oximeter) and others in selected subgroups only (C-reactive protein, procalcitonin, glucometer). The objective of this trial was to determine whether the clinical outcome of febrile children managed by the e-POCT tool was non-inferior to that of febrile children managed by a validated electronic algorithm derived from IMCI (ALMANACH), while reducing the proportion with antibiotic prescription.

A Clinical Severity Scoring System for Visceral Leishmaniasis in Immunocompetent Patients in South Sudan

Title: A Clinical Severity Scoring System for Visceral Leishmaniasis in Immunocompetent Patients in South Sudan Authors: Kämink, SS; Collin, SM; Harrison, T; Gatluak, F; Mullahzada, AW; Ritmeijer, K Abstract: South Sudan is one of the most endemic countries for visceral leishmaniasis (VL), and is frequently affected by large epidemics. In resource-limited settings, clinicians require a simple clinical tool to identify VL patients who are at increased risk of dying, and who need specialised treatment with liposomal amphotericin B and other supportive care. The aim of this study was to develop and validate a clinical severity scoring system based on risk factors for death in VL patients in South Sudan.

Missed Opportunities for Earlier Diagnosis of rifampicin-resistant Tuberculosis despite access to Xpert(®) MTB/RIF

Title: Missed Opportunities for Earlier Diagnosis of rifampicin-resistant Tuberculosis despite access to Xpert(®) MTB/RIF Authors: Mohr, E; Daniels, J; Muller, O; Furin, J; Chabalala, B; Steele, S J; Cox, V; Dolby, T; Ferlazzo, G; Shroufi, A; Duran, L T; Cox, H Abstract: To assess the proportion of rifampicin-resistant tuberculosis (RR-TB) patients with potential earlier RR-TB diagnoses in Khayelitsha, South Africa.

Off-Label Use of Bedaquiline in Children and Adolescents with Multidrug-Resistant Tuberculosis

Title: Off-Label Use of Bedaquiline in Children and Adolescents with Multidrug-Resistant Tuberculosis Authors: Achar, J; Hewison, C; Cavalheiro, AP; Skrahina, A; Cajazeiro, J; Nargiza, P; Herboczek, K; Rajabov, A; Hughes, J; Ferlazzo, G; Seddon, JA; du Cros, P Abstract: We describe 27 children and adolescents <18 years of age who received bedaquiline during treatment for multidrug-resistant tuberculosis. We report good treatment responses and no cessation attributable to adverse effects. Bedaquiline could be considered for use with this age group for multidrug-resistant tuberculosis when treatment options are limited.

Care Requirements for Clients Who Present After Rape and Clients Who Presented After Consensual Sex as a Minor at a Clinic in Harare, Zimbabwe, From 2011 to 2014

Title: Care Requirements for Clients Who Present After Rape and Clients Who Presented After Consensual Sex as a Minor at a Clinic in Harare, Zimbabwe, From 2011 to 2014 Authors: Harrison, R; Pearson, L; Vere, M; Chonzi, P; Hove, B; Mabaya, S; Chigwamba, M; Nhamburo, J; Gura, J; Vandeborne, A; Simons, S; Lagrou, D; De Plecker, E; Van den Bergh, R Abstract: To describe the differences between clients presenting after rape and clients who have consented to sex as a minor to an SGBV clinic in Harare, Zimbabwe, and how these differences affect their care requirements.

Survivors' Perceptions of Public Health Messages During an Ebola Crisis in Liberia and Sierra Leone: An Exploratory Study

Title: Survivors' Perceptions of Public Health Messages During an Ebola Crisis in Liberia and Sierra Leone: An Exploratory Study Authors: Schwerdtle, P; De Clerck, V; Plummer, V Abstract: The outbreak of Ebola virus disease in Guinea, Liberia, and Sierra Leone was the largest epidemic of Ebola ever recorded. The healthcare workforce was diminished and exhausted as the region emerged from civil war. Few qualitative, descriptive studies have been conducted to date that concentrate on the voices of Ebola survivors and their perceptions of health messages. In this study, we employed an interpretive, qualitative design to explore participant experiences. Twenty five survivors who had recovered from Ebola were recruited from three villages in Liberia and Sierra Leone in August 2015. Data were collected using semistructured interviews. Data analysis revealed four themes: (i) degrees of mistrust; (ii) messages conflicting with life and culture; (iii) seeing is believing; and (iv) recovery inspires hope. The findings were explored in the context of the relevant literature. The themes highlight the need to develop culturally-appropriate messages, underpinned by a sound understanding of the community and a willingness to work with the culture and trusted leaders. Description: We regret that this article is behind a paywall.

The 'Indirect Costs' of Underfunding Foreign Partners in Global Health Research: A Case Study

Title: The 'Indirect Costs' of Underfunding Foreign Partners in Global Health Research: A Case Study Authors: Crane, J; Andia B; Fouad, T; Boum, Y; R Bangsberg, D Abstract: This study of a global health research partnership assesses how U.S. fiscal administrative policies impact capacity building at foreign partner institutions. We conducted a case study of a research collaboration between Mbarara University of Science and Technology (MUST) in Mbarara, Uganda, and originally the University of California San Francisco (UCSF), but now Massachusetts General Hospital (MGH). Our case study is based on three of the authors' experiences directing and working with this partnership from its inception in 2003 through 2015. The collaboration established an independent Ugandan non-profit to act as a local fiscal agent and grants administrator and to assure compliance with the Ugandan labour and tax law. This structure, combined with low indirect cost reimbursements from U.S. federal grants, failed to strengthen institutional capacity at MUST. In response to problems with this model, the collaboration established a contracts and grants office at MUST. This office has built administrative capacity at MUST but has also generated new risks and expenses for MGH. We argue that U.S. fiscal administrative practices may drain rather than build capacity at African universities by underfunding the administrative costs of global health research, circumventing host country institutions, and externalising legal and financial risks associated with international work.

Evaluating a Mental Health Program for Palestinian Refugees in Lebanon

Title: Evaluating a Mental Health Program for Palestinian Refugees in Lebanon Authors: Yassin, N; Taha, A; Ghantous, Z; Atoui, M; Forgione, F Abstract: Medecins sans Frontière, an international non-governmental organization, initiated a mental health program for Palestinian refugees living in Lebanon. To evaluate the impact of the program after its completion, focus groups were conducted with three target groups: (1) patients, (2) staff, and (3) local community stakeholders. Participants voiced overall satisfaction with the program. The program provided easy access, good quality care, decreased stigma, as perceived by participants, and revealed a sense of community contentedness. In addition, several short-term outcomes were achieved, such as increasing the numbers of patients visiting the center/ receiving mental health treatment. However, lack of planning for sustainability and proper procedures for hand-over of the program constituted a major downfall. Program discontinuation posed ethical dilemmas, common in provisional interventions in underprivileged refugee communities. Description: We regret that this article is behind a paywall.

Knowledge, Access and Utilization of Bed-Nets Among Stable and Seasonal Migrants in an Artemisinin Resistance Containment Area of Myanmar

Title: Knowledge, Access and Utilization of Bed-Nets Among Stable and Seasonal Migrants in an Artemisinin Resistance Containment Area of Myanmar Authors: Phyo Than, W; Oo, T; Wai, K; Thi, A; Owiti, P; Kumar, B; Deepak Shewade, H; Zachariah, R Abstract: Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies (ACT). Migrant populations are more likely than others to spread ACT resistance. A vital intervention to reduce malaria transmission, resistance spread and eliminate malaria is the use of bed nets. Among seasonal and stable migrants in an artemisinin resistance containment region of Myanmar, we compared a) their household characteristics, b) contact with health workers and information material, and c) household knowledge, access and utilization of bed nets.

Thiamine Content of F-75 Therapeutic Milk for Complicated Severe Acute Malnutrition: Time for a Change?

Title: Thiamine Content of F-75 Therapeutic Milk for Complicated Severe Acute Malnutrition: Time for a Change? Authors: Hiffler, L; Adamolekun, B; Fischer, P; Fattal-Vavleski, A Abstract: Since community-based management of severe acute malnutrition has become the standard of care, the clinical profile of severe acutely malnourished patients admitted to hospitals or inpatient therapeutic feeding centers has changed significantly. These patients are usually very ill and often present with several comorbidities, such as shock, sepsis, and pneumonia. Complicated severe acute malnutrition patients are at risk of thiamine insufficiency, and critically ill patients have higher thiamine requirements. The thiamine content of F-75, the therapeutic milk formula used in the early stabilization phase of refeeding in patients with severe acute malnutrition, seems insufficient. Here, we discuss the need and rationale for a substantial increase in the thiamine content of F-75. Description: We regret that this article is behind a paywall.

Effectiveness of Food Supplements in Increasing Fat-Free Tissue Accretion in Children with Moderate Acute Malnutrition: A Randomised 2 × 2 × 3 Factorial Trial in Burkina Faso

Title: Effectiveness of Food Supplements in Increasing Fat-Free Tissue Accretion in Children with Moderate Acute Malnutrition: A Randomised 2 × 2 × 3 Factorial Trial in Burkina Faso Authors: Fabiansen, C; Yaméogo, C; Iuel-Brockdorf, A; Cichon, B; Rytter, M; Kurpad, A; Wells, J; Ritz, C; Ashorn, P; Filteau, S; Briend, A; Shepherd, S; Christensen, V; Michaelsen, K; Friis, H Abstract: Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion.

Engagement of Public and Private Medical Facilities in Tuberculosis Care in Myanmar: Contributions and Trends Over an Eight-Year Period

Title: Engagement of Public and Private Medical Facilities in Tuberculosis Care in Myanmar: Contributions and Trends Over an Eight-Year Period Authors: Nwe, T; Saw, S; Le Win, L; Mon, M; van Griensven, J; Zhou, S; Chinnakali, P; Shah, S; Thein, S; Aung, S Abstract: As part of the WHO End TB strategy, national tuberculosis (TB) programs increasingly aim to engage all private and public TB care providers. Engagement of communities, civil society organizations and public and private care provider is the second pillar of the End TB strategy. In Myanmar, this entails the public-public and public-private mix (PPM) approach. The public-public mix refers to public hospital TB services, with reporting to the national TB program (NTP). The public-private mix refers to private general practitioners providing TB services including TB diagnosis, treatment and reporting to NTP. The aim of this study was to assess whether PPM activities can be scaled-up nationally and can be sustained over time.

Adherence, Tolerability, and Outcome After 36 Months of Isoniazid-Preventive Therapy in 2 Rural Clinics of Swaziland: A Prospective Observational Feasibility Study

Title: Adherence, Tolerability, and Outcome After 36 Months of Isoniazid-Preventive Therapy in 2 Rural Clinics of Swaziland: A Prospective Observational Feasibility Study Authors: Mueller, Y; Mpala, Q; Kerschberger, B; Rusch, B; Mchunu, G; Mazibuko, S; Bonnet, M Abstract: Although efficacy of 36 months isoniazid preventive therapy (IPT) among HIV-positive individuals has been proven in trial settings, outcome, tolerance, and adherence have rarely been evaluated in real-life settings.This is a prospective observational cohort study conducted in 2 primary care rural clinics in Swaziland.After negative tuberculosis symptom screening, patients either with the positive tuberculin skin test (TST) or after tuberculosis treatment were initiated on IPT for 144 weeks. In addition to routine clinic visits, adherence was assessed every semester.Of 288 eligible patients, 2 patients never started IPT (1 refusal, 1 contraindication), and 253 (87.8%), 234 (81.3%), and 228 (79.2%) were still on IPT after 48, 96, and 144 weeks, respectively (chiP = .01). Of 41 patients who interrupted IPT before 144 weeks, 21 defaulted (of which 17 also defaulted HIV care); 16 stopped because of adverse drug reactions; 2 were discontinued by clinicians' mistake and 1 because of TB symptoms. Five patients (1.7%) died of causes not related to IPT, 5 (1.7%) developed TB of which 2 were isoniazid-resistant, and 9 (3.1%) were transferred to another clinic. As an indicator of adherence, isoniazid could be detected in the urine during 86.3% (302/350) and 73.6% (248/337) of patient visits in the 2 clinics, respectively (chiP < .001).The routine implementation of IPT 36 months was feasible and good patient outcomes were achieved, with low TB incidence, good tolerance, and sustained adherence.

[Orthopedic Surgery with Limited Resources After Mass Disasters and During Armed Conflicts : First International Guidelines for the Management of Limb Injuries and the Experience of Doctors Without Borders]

Title: [Orthopedic Surgery with Limited Resources After Mass Disasters and During Armed Conflicts : First International Guidelines for the Management of Limb Injuries and the Experience of Doctors Without Borders] Authors: Osmers, I Abstract: Disasters and armed conflicts are often the unfortunate basis for aid projects run by Doctors Without Borders/Médecins Sans Frontières (MSF). The nature of war and disasters means that surgery is an integral part of this medical emergency aid. In these situations, resources are usually limited. As a result, surgical work in these contexts differs significantly from the daily routine of a surgeon working in a highly resourced hospital. The principles of surgery do not change but surgeons must adapt their tactical approach to the changed context otherwise there is a high risk of failing to improve the health of patients and potentially jeopardizing their prospects for recovery. Every experienced war surgeon has learned new skills the hard way. The Field Guide to Manage Limb Injury in Disaster and Conflict has been written to help new surgeons who may face the challenges of disaster and war surgery and to avoid unnecessary suffering for patients ( https://icrc.aoeducation.org ). Under the guidance of the International Committee of the Red Cross (ICRC), with participation of the World Health Organization (WHO), financed by the AO Foundation, and featuring the experiences of experts from different organizations (amongst them MSF), the book details techniques and guidelines for surgery in low resource settings. The following article provides a short summary of some of the surgical challenges when working with limited resources and reflects on a few specific recommendations for so-called war surgery.