• Access to Essential Drugs in Poor Countries: A Lost Battle?

      Pécoul, B; Chirac, P; Trouiller, P; Pinel, J; Fondation Médecins Sans Frontières, Paris, France. office@paris.msf.org (1999-01-27)
      Drugs offer a simple, cost-effective solution to many health problems, provided they are available, affordable, and properly used. However, effective treatment is lacking in poor countries for many diseases, including African trypanosomiasis, Shigella dysentery, leishmaniasis, tuberculosis, and bacterial meningitis. Treatment may be precluded because no effective drug exists, it is too expensive, or it has been withdrawn from the market. Moreover, research and development in tropical diseases have come to a near standstill. This article focuses on the problems of access to quality drugs for the treatment of diseases that predominantly affect the developing world: (1) poor-quality and counterfeit drugs; (2) lack of availability of essential drugs due to fluctuating production or prohibitive cost; (3) need to develop field-based drug research to determine optimum utilization and remotivate research and development for new drugs for the developing world; and (4) potential consequences of recent World Trade Organization agreements on the availability of old and new drugs. These problems are not independent and unrelated but are a result of the fundamental nature of the pharmaceutical market and the way it is regulated.
    • Evaluation of Three Rapid Tests for Diagnosis of P. Falciparum and P. Vivax Malaria in Colombia.

      van den Broek, I; Hill, O; Gordillo, F; Angarita, B; Hamade, P; Counihan, H; Guthmann, J P; Médecins sans Frontières (MSF), London, UK. ingrid_vandenbroek@yahoo.com (2006-12)
      The diagnostic capacity of three malaria rapid diagnostic tests (RDTs), NOW-Malaria-ICT, OptiMAL-IT, and Paracheck-Pf, was evaluated against expert microscopy in Colombia. We tested 896 patients, of whom microscopy confirmed 139 P. falciparum, 279 P. vivax, and 13 mixed P.f/P.v infections and 465 negatives. Paracheck-Pf and NOW-malaria-ICT were more accurate in detecting P. falciparum (sensitivities 90.8% and 90.1%, respectively) in comparison with Optimal-IT (83.6%). NOW showed an acceptable Pf detection rate at low densities (< 500/microL), but resulted in a higher proportion of false positives. For P. vivax diagnosis, Optimal-IT had a higher sensitivity than NOW (91.0% and 81.4%, respectively). The choice between the two Pf/Pv detecting RDTs balances P. falciparum and P. vivax detection rates. Considering some degree of P. falciparum overtreatment and failure to detect all P. vivax cases as more acceptable than missing some cases of P. falciparum, we recommend careful implementation of NOW-malaria-ICT in areas where microscopy is lacking. The price is however still a constraint.
    • Internal quality control of the malaria microscopy diagnosis for 10 laboratories on the Thai-Myanmar border.

      Hemme, F; Gay, F; Medecins Sans Frontières, French Section, Mae Sot, Thailand. (1998-09)
      On the Thai-Myanmar border, where multidrug resistance to anti-malaria medications is a major problem, a quality control program for diagnostic laboratories has been set up. This study examines the "passive" screening performed in 10 laboratories. Monthly evaluation of the quality of thick and thin smear practice, Giemsa staining and microscopy took place during the year 1994. Considering the general context and the methodology applied, the evaluation of performance and strategy of the malaria diagnostic test showed satisfactory results for all 10 laboratories. Performance of technics = 64% (62-66) to 96% (95-97); Sensitivity = 92.6 (91.5-95.5) to 96.6% (95.8-99.0); Specificity = 93.5% (91.4-95.5) to 98.3% (97.6-99.0); Predictive Positive Value = 92.0% (90.9-93.1) to 98.3% (97.6-99.0); Predictive Negative Value = 94.3% (93.0-95.6) to 98.5% (98.0-99.0). The study underlines the importance of a reliable quality control method for microscopy diagnosis of malaria in hyperendemic areas, with Plasmodium falciparum as the main species. A high level of input from the international laboratory technician, performing training, follow-up and evaluation was required. The need for adequate training of national technicians and supervisors, especially regarding long-term sustainability, is stressed. The type of program presented can be used as a model for similar projects in developing countries.
    • Microscopy quality control in Médecins Sans Frontières programs in resource-limited settings

      Klarkowski, D B; Orozco, J D; Médecins Sans Frontières, Amsterdam, Amsterdam, The Netherlands (2010-01-26)
    • The Efficacy of Chloroquine for the Treatment of Acute, Uncomplicated, Plasmodium Falciparum Malaria in Laos.

      Guthmann, J P; Kasparian, S; Phetsouvanh, R; Nathan, N; Garcia, M; Phompida, S; Brockman, A; Gastellu-Etchegorry, M; Legros, D; Epicentre, 8 rue Saint Sabin, 75011 Paris, France. jguthmann@epicentre.msf.org (Published by: Maney Publishing, 2002-09)
      To assess the local efficacy of chloroquine for the treatment of acute, uncomplicated, Plasmodium falciparum malaria, children and adults from Sekong province (an area of Laos with a low intensity of transmission) were tested in a 28-day, in-vivo study. Complete data were collected from 88 of the 102 subjects enrolled between October 1999 and September 2000. After genotypic analysis to distinguish recrudescing infections from re-infections, 35 (39.7%, with a 95% confidence interval of 29.5%-50.7%) of these 88 patients were considered treatment failures. These results seriously question the use of chloroquine as the first-line treatment for P. falciparum malaria in the study area.
    • Trypanosoma Brucei Gambiense Trypanosomiasis in Terego County, Northern Uganda, 1996: A Lot Quality Assurance Sampling Survey.

      Hutin, Y; Legros, D; Owini, V; Brown, V; Lee, E; Mbulamberi, D; Paquet, C; Epicentre Office in Uganda, Kampala, Uganda. (Published by: American Society of Tropical Medicine and Hygiene, 2004-04)
      We estimated the pre-intervention prevalence of Trypanosoma brucei gambiense (Tbg) trypanosomiasis using the lot quality assurance sampling (LQAS) methods in 14 parishes of Terego County in northern Uganda. A total of 826 participants were included in the survey sample in 1996. The prevalence of laboratory confirmed Tbg trypanosomiasis adjusted for parish population sizes was 2.2% (95% confidence interval =1.1-3.2). This estimate was consistent with the 1.1% period prevalence calculated on the basis of cases identified through passive and active screening in 1996-1999. Ranking of parishes in four categories according to LQAS analysis of the 1996 survey predicted the prevalences observed during the first round of active screening in the population in 1997-1998 (P < 0.0001, by chi-square test). Overall prevalence and ranking of parishes obtained with LQAS were validated by the results of the population screening, suggesting that these survey methods may be useful in the pre-intervention phase of sleeping sickness control programs.