• A Drug Dosage Table is a Useful Tool to Facilitate Prescriptions of Antiretroviral Drugs for Children in Thailand.

      Ponnet, M; Frederix, K; Petdachai, W; Wilson, D; Eksaengsri, A; Zachariah, R; Médecins Sans Frontières, Bangkok, Thailand. (2005-06)
      Scaling up of antiretroviral treatment (ART) for children in countries like Thailand will require decentralization and management by non-specialist doctors. We describe (a) the formulation of a standardized drug dosage table to facilitate antiretroviral drug (ARV) prescriptions for children, (b) the acceptability of such a table among doctors and (c) the safety and efficacy of drug doses in the table. Acceptability was assessed using a questionnaire. Safety and efficacy were assessed on the basis of incidence of adverse effects and virological response to treatment, respectively. Of all doctors (n=18), 17 (94%) found that the table was practical to use, avoided miscalculations and made them more confident with prescriptions. Of 49 children prescribed ARVs, less than 5% had adverse side-effects. All ARV-naïve children achieved undetectable viral loads within six months of ART. In our setting, a standardized drug dosage table provided a simple and reliable tool that facilitated ARV prescriptions for children.
    • Acceptability and technical problems of the female condom amongst commercial sex workers in a rural district of Malawi.

      Zachariah, R; Harries, A D; Buhendwa, L; Spielmann, M P; Chantulo, A; Bakali, E; Médecins Sans Frontières - Luxembourg, Thyolo district, Thyolo, Malawi. zachariah@internet.lu (2003-10)
      A study was conducted among commercial sex workers (CSWs) in rural southern Malawi, in order to (a) assess the acceptability of the female condom and (b) identify common technical problems and discomforts associated with its use. There were 88 CSWs who were entered into the study with a total of 272 female condom utilizations. Eighty-six (98%) were satisfied with the female condom, 80% preferred it to the male condom and 92% were ready to use the device routinely. Of all the utilizations, the most common technical problem was reuse of the device with consecutive clients, 6% after having washed it, and 2% without any washing or rinsing. The most common discomfort that were reported included too much lubrication (32%), device being too large (16%), and noise during sex (11%). This study would be useful in preparing the introduction of the female condom within known commercial sex establishments in Malawi.
    • Acceptance of anti-retroviral therapy among patients infected with HIV and tuberculosis in rural Malawi is low and associated with cost of transport.

      Zachariah, R; Harries, A D; Manzi, M; Gomani, P; Teck, R; Philips, M; Firmenich, P; Medecins sans Frontieres, Medical Department (Operational Research), Brussels Operational Center, Brussels, Belgium. zachariah@internet.lu (Public Library of Science, 2006)
      BACKGROUND: A study was conducted among newly registered HIV-positive tuberculosis (TB) patients systematically offered anti-retroviral treatment (ART) in a district hospital in rural Malawi in order to a) determine the acceptance of ART b) conduct a geographic mapping of those placed on ART and c) examine the association between "cost of transport" and ART acceptance. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cross-sectional analysis was performed on routine program data for the period of February 2003 to July 2004. Standardized registers and patient cards were used to gather data. The place of residence was used to determine road distances to the Thyolo district hospital. Cost of transport from different parts of the district was based on the known cost for public transport to the road-stop closest to the patient's residence. Of 1,290 newly registered TB patients, 1,003(78%) underwent HIV-testing of whom 770 (77%) were HIV-positive. 742 of these individuals (pulmonary TB = 607; extra-pulmonary TB = 135) were considered eligible for ART of whom only 101(13.6%) accepted ART. Cost of transport to the hospital ART site was significantly associated with ART acceptance and there was a linear trend in association between cost and ART acceptance (chi(2) for trend = 25.4, P<0.001). Individuals who had to pay 50 Malawi Kwacha (1 United States Dollar = 100 Malawi Kwacha, MW) or less for a one-way trip to the Thyolo hospital were four times more likely to accept ART than those who had to pay over 100 MW (Adjusted Odds ratio = 4.0, 95% confidence interval: 2.0-8.1, P<0.001). CONCLUSIONS/SIGNIFICANCE: ART acceptance among TB patients in a rural district in Malawi is low and associated with cost of transport to the centralized hospital based ART site. Decentralizing the ART offer from the hospital to health centers that are closer to home communities would be an essential step towards reducing the overall cost and burden of travel.
    • Achieving the Millennium Development Goal of reducing maternal mortality in rural Africa: an experience from Burundi.

      Tayler-Smith, K; Zachariah, R; Manzi, M; Van den Boogaard, W; Nyandwi, G; Reid, T; Van den Bergh, R; De Plecker, E; Lambert, V; Nicolai, M; et al. (2012-11-20)
      OBJECTIVES: To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality. METHODS: The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this estimate, the resulting theoretical maternal mortality ratio in Kabezi was calculated and compared to the Millennium Development Goal for Burundi. RESULTS: In 2011, 1385 women from Kabezi were transferred to the MSF facility, of whom 55% had a severe acute maternal morbidity. We estimated that the MSF intervention averted 74% (range 55-99%) of maternal deaths in Kabezi district, equating to a district maternal mortality rate of 208 (range 8-360) deaths/100 000 live births. This lies very near to the 2015 MDG 5 target for Burundi (285 deaths/100 000 live births). CONCLUSION: Provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve Millennium Development Goal 5 in rural Africa.
    • Active and passive case detection strategies for the control of leishmaniasis in Bangladesh

      Das, A. K.; Harries, A. D.; Hinderaker, S. G.; Zachariah, R; Ahmad, B; Shah, G. N.; Khogali, M. A.; Das, G. I.; Ahmed, E. M.; Ritmeijer, K (The Union, 2014-03-21)
    • Adapting the DOTS framework for tuberculosis control to the management of non-communicable diseases in sub-Saharan Africa

      Harries, A D; Jahn, A; Zachariah, R; Enarson, D; Clinical HIV Unit, Ministry of Health, Lilongwe, Malawi; Family Health International, Malawi Country Office, Lilongwe, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom; Lighthouse Trust, Lilongwe, Malawi; International Training and Education Center on HIV, University of Washington, Seattle, WA; Médecins Sans Frontières, Operational Research Medical Department, Luxembourg; International Union against Tuberculosis and Lung Disease, Paris, France (Public Library of Science (PLoS), 2008-06-10)
    • Addressing Diabetes Mellitus as Part of the Strategy for Ending TB

      Harries, A D; Kumar, A M; Satyanarayana, S; Lin, Y; Zachariah, R; Lönnroth, K; Kapur, A (Oxford University Press, 2016-03-01)
      As we enter the new era of Sustainable Development Goals, the international community has committed to ending the TB epidemic by 2030 through implementation of an ambitious strategy to reduce TB-incidence and TB-related mortality and avoiding catastrophic costs for TB-affected families. Diabetes mellitus (DM) triples the risk of TB and increases the probability of adverse TB treatment outcomes such as failure, death and recurrent TB. The rapidly escalating global epidemic of DM means that DM needs to be addressed if TB-related milestones and targets are to be achieved. WHO and the International Union Against Tuberculosis and Lung Disease's Collaborative Framework for Care and Control of Tuberculosis and Diabetes, launched in 2011, provides a template to guide policy makers and implementers to combat the epidemics of both diseases. However, more evidence is required to answer important questions about bi-directional screening, optimal ways of delivering treatment, integration of DM and TB services, and infection control. This should in turn contribute to better and earlier TB case detection, and improved TB treatment outcomes and prevention. DM and TB collaborative care can also help guide the development of a more effective and integrated public health approach for managing non-communicable diseases.
    • AIDS Review

      Harries, A D; Zachariah, R (2010-01)
    • An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality

      Tayler-Smith, K; Zachariah, R; Manzi, M; Van den Boogaard, W; Nyandwi, G; Reid, T; De Plecker, E; Lambert, V; Nicolai, M; Goetghebuer, S; et al. (2013-08)
      In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections.
    • Antibiotic Prescribing for Upper Respiratory Infections Among Children in Rural China: a Cross-Sectional Study of Outpatient Prescriptions

      Zhang, Z; Hu, Y; Zou, G; Lin, M; Zeng, J; Deng, S; Zachariah, R; Walley, J; Tucker, JD; Wei, X (Taylor & Francis, 2017-05-02)
      Overuse of antibiotics contributes to the development of antimicrobial resistance.
    • Antiretroviral therapy for HIV prevention: many concerns and challenges, but are there ways forward in sub-Saharan Africa?

      Zachariah, R; Harries, A D; Philips, M; Arnould, L; Sabapathy, K; O'Brien, D P; Ferreyra, C; Balkan, S; Médecins Sans Frontières, Medical Department (Operational Research), Brussels Operational Centre, Belgium. (2010-01-28)
      Scientists from the WHO have presented a theoretical mathematical model of the potential impact of universal voluntary HIV testing and counselling followed by immediate antiretroviral therapy (ART). The results of the model suggests that, in a generalised epidemic as severe as that in sub-Saharan Africa (SSA), HIV incidence may be reduced by 95% in 10 years and that this approach may be cost effective in the medium term. This offers a 'ray of hope' to those who have thus far only dreamed of curbing the HIV/AIDS epidemic in SSA, as until now the glaring truth has been pessimistic. When it comes to ART, approximately 7 of 10 people who clinically need ART still do not receive it. From an epidemic point of view, for every person placed on ART an estimated four to six others acquire HIV. The likelihood of achieving the targets of the Millennium Development Goals for 2015 and universal ART access by 2010 are thus extremely low. A new window of opportunity may have now opened, but there are many unanswered feasibility and acceptability issues. In this paper, we highlight four key operational challenges linked to acceptability and feasibility and discuss possible ways forward to address them.
    • Applying the ICMJE authorship criteria to operational research in low-income countries: the need to engage programme managers and policy makers [letter]

      Zachariah, R; Reid, T; Van den Bergh, R; Dahmane, A; Kosgei, R J; Hinderaker, S G; Tayler-Smith, K; Manzi, M; Kizito, W; Khogali, M; et al. (Wiley-Blackwell, 2013-05-30)
    • Are sputum samples of retreatment tuberculosis reaching the reference laboratories? A 9-year audit in Tanzania

      Kilale, A M; Ngowi, B J; Mfinanga, G S; Egwaga, S; Doulla, B; Kumar, A M V; Khogali, M; van Griensven, J; Harries, A D; Zachariah, R; et al. (2013-06-21)
    • Are tuberculosis patients in a tertiary care hospital in Hyderabad, India being managed according to national guidelines?

      Kondapaka, K K; Prasad, S V; Satyanarayana, S; Kandi, S; Zachariah, R; Harries, A D; Nagaraja, S B; Tetali, S; Anchala, R; Kannuri, N K; et al. (Public Library of Science (PLoS), 2012-01-17)
      A tertiary health care facility (Government General and Chest hospital) in Hyderabad, India.
    • Assessment of household ownership of bed nets in areas with and without artemisinin resistance containment measures in Myanmar

      Maung, TM; Oo, T; Wai, KT; Hlaing, T; Owiti, P; Kumar, B; Shewade, HD; Zachariah, R; Thi, A (BioMed Central, 2018-03-23)
      Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria. As the artemisinin compound is the pillar of effective antimalarial therapies, containing the spread of artemisinin resistance is a national and global priority. The use of insecticide-treated bed nets/long-lasting insecticidal nets (ITNs/LLINs) is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains, and for eventually eliminating malaria. This study aimed at assessing household ownership of, access to, and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment measures.
    • Behavioural characteristics, prevalence of Chlamydia trachomatis and antibiotic susceptibility of Neisseria gonorrhoeae in men with urethral discharge in Thyolo, Malawi.

      Zachariah, R; Harries, A D; Nkhoma, W; Arendt, V; Nchingula, D; Chantulo, A; Chimtulo, F; Kirpach, P; Médecins sans Frontières-Luxembourg, Thyolo District, Malawi. zachariah@internet.lu (Elsevier, 2008-01-25)
      A study was carried out in 2000/2001 in a rural district of Malawi among men presenting with urethral discharge, in order to (a) describe their health-seeking and sexual behaviour, (b) determine the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis, and (c) verify the antibiotic susceptibility of N. gonorrhoeae. A total of 114 patients were entered into the study; 61% reported having taken some form of medication before coming to the sexually transmitted infections clinic. The most frequent alternative source of care was traditional healers. Sixty-eight (60%) patients reported sexual encounters during the symptomatic period, the majority (84%) not using condoms. Using ligase chain reaction on urine, N. gonorrhoeae was detected in 91 (80%) and C. trachomatis in 2 (2%) urine specimens. Forty five of 47 N. gonorrhoeae isolates produced penicillinase, 89% showing multi-antimicrobial resistance. This study emphasizes the need to integrate alternative care providers and particularly traditional healers in control activities, and to encourage their role in promoting safer sexual behaviour. In patients presenting with urethral discharge in our rural setting, C. trachomatis was not found to be a major pathogen. Antimicrobial susceptibility surveillance of N. gonorrhoeae is essential in order to prevent treatment failures and control the spread of resistant strains.
    • Blended SORT-IT for operational research capacity building: the model, its successes and challenges.

      Decroo, T; Van den Bergh, R; Kumar, AMV; Zachariah, R; Schillberg, E; Owiti, P; van den Boogaard, W; Benedetti, G; Shah, S; Ali, E; et al. (Taylor & Francis, 2018-05-10)
      The Structured Operational Research Training Initiative (SORT-IT) has been shown to be very effective in strengthening capacity for conducting operational research, publishing in scientific journals and fostering policy and practice change. The ‘classic’ model includes three face-to-face modules during which, respectively, a study protocol, a data analysis plan, and a manuscript are elaborated. Meanwhile, the lectures of the SORT-IT are available online as YouTube videos. Given the availability of this online material and the experiences with online mentorship of the faculty, we piloted a first blended distance/residential SORT-IT. To inform future implementers of our experience with blended operational research courses, we summarize the model, successes, and challenges of this approach in this perspective paper. The blended SORT-IT consisted of an online phase, covering modules 1 and 2, followed by a face-to-face writing module 3. Four out of six participants successfully completed the course, and submitted a manuscript to a peer-reviewed journal within four weeks of completing module 3. A blended approach may make the SORT-IT course more accessible to future participants and may favour the adoption of the course by other institutions, such as national Ministries of Health.
    • Brief Report: Decentralizing ART Supply for Stable HIV Patients to Community-Based Distribution Centers: Program Outcomes From an Urban Context in Kinshasa, DRC

      Vogt, F; Kalenga, L; Lukela, J; Salumu, F; Diallo, I; Nico, E; Lampart, E; Van den Bergh, R; Shah, S; Ogundahunsi, O; et al. (Lippincott Williams & Wilkins, 2017-02-14)
    • Building Global Capacity for Conducting Operational Research Using the SORT IT Model: Where and Who?

      Zachariah, R; Rust, S; Berger, SD; Guillerm, N; Bissell, K; Delaunois, P; Reid, AJ; Kumar, AM; Olliaro, PL; Reeder, JC; et al. (Public Library of Science, 2016)
      Research capacity is weakest in low and middle-income countries (LMICs) where operational research is highly relevant and needed. Structured Operational Research and Training Initiative (SORT IT) courses have been developed to train participants to conduct and publish operational research and influence policy and practice. Twenty courses were completed in Asia, Africa, Europe and the South Pacific between 2009 and 2014.