• Face to Face with Ebola - An Emergency Care Center in Sierra Leone.

      Wolz, Anja (Massachusetts Medical Society, 2014-08-27)
      At 6 a.m., our medical team arrives at the Ebola case-management center in the Kailahun district of Sierra Leone to take blood samples. At our 80-bed center here near the borders of Liberia and Guinea, 8 new patients were admitted yesterday, 9 need to have a repeat test 72 hours after their symptoms began, and some we hope to discharge today: at least 18 blood samples to obtain. The center currently houses 64 patients in all, 4 of them children less than 5 years of age. We have already seen 2 patients die today. I have been here for 7 . . .
    • 'Face Up to the Truth': Helping Gay Men in Vietnam Protect Themselves from AIDS.

      Wilson, D; Cawthorne, P; Médecins Sans Frontières, Belgium. msfbthai@asianet.co.th (1999-01)
      Appropriate AIDS prevention information is not available in Vietnam for men who have sex with men. Current AIDS prevention messages can be misunderstood with potentially dangerous results. We outline some features of gay culture in a provincial city in Vietnam. We describe the activities of a peer educator who made contact with a small group of young gay men during 1996 and 1997. All the young men were ill-informed about AIDS. Their attitudes and sexual practices made them vulnerable to AIDS. The peer educator provided clear information and emotional support. The peer education was done without government endorsement and on a very low budget.
    • Factors affecting continued use of ceramic water purifiers distributed to Tsunami-affected Communities in Sri Lanka

      Casanova, L M; Walters, A; Naghawatte, A; Sobsey, M D; Institute of Public Health, Georgia State University, Atlanta, GA, USA  Medecins Sans Frontieres, New York, NY, USA  Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka  Department of Environmental Sciences and Engineering, University of North Carolina Chapel Hill, Chapel Hill, NC, USA. (2012-09-24)
      Objectives  There is little information about continued use of point-of-use technologies after disaster relief efforts. After the 2004 tsunami, the Red Cross distributed ceramic water filters in Sri Lanka. This study determined factors associated with filter disuse and evaluate the quality of household drinking water. Methods  A cross-sectional survey of water sources and treatment, filter use and household characteristics was administered by in-person oral interview, and household water quality was tested. Multivariable logistic regression was used to model probability of filter non-use. Results  At the time of survey, 24% of households (107/452) did not use filters; the most common reason given was breakage (42%). The most common household water sources were taps and wells. Wells were used by 45% of filter users and 28% of non-users. Of households with taps, 75% had source water Escherichia coli in the lowest World Health Organisation risk category (<1/100 ml), vs. only 30% of households reporting wells did. Tap households were approximately four times more likely to discontinue filter use than well households. Conclusion  After 2 years, 24% of households were non-users. The main factors were breakage and household water source; households with taps were more likely to stop use than households with wells. Tap water users also had higher-quality source water, suggesting that disuse is not necessarily negative and monitoring of water quality can aid decision-making about continued use. To promote continued use, disaster recovery filter distribution efforts must be joined with capacity building for long-term water monitoring, supply chains and local production.
    • The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone

      Caleo, G; Duncombe, J; Jephcott, F; Lokuge, K; Mills, C; Looijen, E; Theoharaki, F; Kremer, R; Kleijer, K; Squire, J; et al. (BioMed Central, 2018-02-13)
      Little is understood of Ebola virus disease (EVD) transmission dynamics and community compliance with control measures over time. Understanding these interactions is essential if interventions are to be effective in future outbreaks. We conducted a mixed-methods study to explore these factors in a rural village that experienced sustained EVD transmission in Kailahun District, Sierra Leone.
    • Factors Affecting Perceived Stigma in Leprosy Affected Persons in Western Nepal

      Adhikari, Bipin; Kaehler, Nils; Chapman, Robert S.; Raut, Shristi; Roche, Paul; Akogun, Oladele B. (Public Library of Science, 2014-06-05)
      Background There are various factors which construct the perception of stigma in both leprosy affected persons and unaffected persons. The main purpose of this study was to determine the level of perceived stigma and the risk factors contributing to it among leprosy affected person attending the Green Pastures Hospital, Pokhara municipality of western Nepal. Methods A cross-sectional study was conducted among 135 people affected by leprosy at Green Pastures Hospital and Rehabilitation Centre. Persons above the age of 18 were interviewed using a set of questionnaire form and Explanatory Model Interview Catalogue (EMIC). In addition, two sets of focused group discussions each containing 10 participants from the ward were conducted with the objectives of answering the frequently affected EMIC items. Results Among 135 leprosy affected persons, the median score of perceived stigma was 10 while it ranged from 0–34. Higher perceived stigma score was found in illiterate persons (p = 0.008), participants whose incomes were self-described as inadequate (p = 0.014) and who had changed their occupation due to leprosy (p = 0.018). Patients who lacked information on leprosy (p = 0.025), knowledge about the causes (p = 0.02) and transmission of leprosy (p = 0.046) and those who had perception that leprosy is a severe disease (p<0.001) and is difficult to treat (p<0.001) had higher perceived stigma score. Participants with disfigurement or deformities (p = 0.014), ulcers (p = 0.022) and odorous ulcers (p = 0.043) had higher perceived stigma score. Conclusion The factors associated with higher stigma were illiteracy, perceived economical inadequacy, change of occupation due to leprosy, lack of knowledge about leprosy, perception of leprosy as a severe disease and difficult to treat. Similarly, visible deformities and ulcers were associated with higher stigma. There is an urgent need of stigma reduction strategies focused on health education and health awareness programs in addition to the necessary rehabilitation support.
    • Factors associated with Condom Use Problems during Vaginal Sex with main and non-main partners

      DʼAnna, L H; Korosteleva, O; Warner, L; Douglas, J; Paul, S; Metcalf, C; McIlvaine, E; Malotte, C K; California State University, Long Beach, Center for Health Care Innovation, and Department of Math and Statistics, LongBeach, CA 90840, USA. laura.d’anna@csulb.edu (2012-09-01)
      Incorrect condom use is a common problem that can undermine their prevention impact. We assessed the prevalence of 2 condom use problems, breakage/slippage and partial use, compared problems by partnership type, and examined associations with respondent, partner, and partnership characteristics.
    • Factors associated with death and loss to follow-up in children on antiretroviral care in Mingalardon Specialist Hospital, Myanmar, 2006-2016

      Kaung Nyunt, KK; Han, WW; Satyanarayana, S; Isaakidis, P; Hone, S; Khaing, AA; Nguyen Binh, H; Oo, HN (Public Library of Science, 2018-04-05)
      Myanmar National AIDS programme's priority is to improve the survival of all people living with HIV by providing anti-retroviral therapy (ART) care. More than 7200 children (aged <15 years) have been enrolled into ART care from 2005 to 2016. A previous study showed that ~11% children on ART care had either died or were lost to follow-up by 60 months. Factors associated with death and lost-to follow-up (adverse outcomes) have not been previously studied.
    • Factors Associated with HIV Status Awareness and Linkage to Care Following Home Based Testing in Rural Malawi

      Maman, D; Ben-Farhat, J; Chilima, B; Masiku, C; Salumu, L; Ford, N; Mendiharat, P; Szumilin, E; Masson, S; Etard, JF; et al. (Wiley-Blackwell, 2016-10)
    • Factors Associated with Marburg Hemorrhagic Fever:

      Roddy, Paul; Sara L Thomas; Benjamin Jeffs; Pascoal Nascimento Folo; Pedro Pablo Palma; Bengi Moco Henrique; Luis Villa; Fernando Paixao Damiao Machado; Oscar Bernal; Steven M. Jones; et al. (Infectious Disease Society of America, 2010-06-15)
      Background. Reliable on-site polymerase chain reaction (PCR) testing for Marburg hemorrhagic fever (MHF) is not always available. Therefore, clinicians triage patients on the basis of presenting symptoms and contact history. Using patient data collected in Uige, Angola, in 2005, we assessed the sensitivity and specificity of these factors to evaluate the validity of World Health Organization (WHO)–recommended case definitions for MHF. Methods. Multivariable logistic regression was used to identify independent predictors of PCR confirmation of MHF. A data-derived algorithm was developed to obtain new MHF case definitions with improved sensitivity and specificity. Results. A MHF case definition comprising (1) an epidemiological link or (2) the combination of myalgia or arthralgia and any hemorrhage could potentially serve as an alternative to current case definitions. Our dataderived case definitions maintained the sensitivity and improved the specificity of current WHO-recommended case definitions. Conclusions. Continued efforts to improve clinical documentation during filovirus outbreaks would aid in the refinement of case definitions and facilitate outbreak control.
    • Factors associated with severe preeclampsia and eclampsia in Jahun, Nigeria

      Guerrier, G; Oluyide, B; Keramarou, M; Grais, R (DovePress, 2013)
      To explore traditional herbal medicines as potential risk factors of severe preeclampsia and eclampsia in Nigeria.
    • Factors Associated with Unfavorable Treatment Outcomes in New and Previously Treated TB Patients in Uzbekistan: A Five Year Countrywide Study

      Gadoev, J; Asadov, D; Tillashaykhov, M; Tayler-Smith, K; Isaakidis, P; Dadu, A; Colombani, P d; Gudmund Hinderaker, S; Parpieva, N; Ulmasova, D; et al. (Public Library of Science, 2015-06-15)
      TB is one of the main health priorities in Uzbekistan and relatively high rates of unfavorable treatment outcomes have recently been reported. This requires closer analysis to explain the reasons and recommend interventions to improve the situation. Thus, by using countrywide data this study sought to determine trends in unfavorable outcomes (lost-to-follow-ups, deaths and treatment failures) and describe their associations with socio-demographic and clinical factors.
    • Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland

      Jobanputra, Kiran; Parker, Lucy Anne; Azih, Charles; Okello, Velephi; Maphalala, Gugu; Kershberger, Bernard; Khogali, Mohammed; Lujan, Johnny; Antierens, Annick; Teck, Roger; et al. (Public Library of Science, 2015-02-19)
      This study explores factors associated with virological detectability, and viral re-suppression after enhanced adherence counselling, in adults and children on antiretroviral therapy (ART) in Swaziland.
    • Factors influencing participation in an Ebola vaccine trial among front-line workers in Guinea

      Grantz, KH; Claudot, C; Kambala, M; Kouyate, M; Soumah, A; Boum, Y; Juan-Giner, A; Jemmy, JP; Cummings, DAT; Grais, RF (Elsevier, 2019-10-14)
      Background Alongside the clinical aspects of the immunogenicity and safety trial of an Ebola vaccine deployed among front-line workers, a qualitative study was conducted to describe motivations behind individuals’ decisions to participate – or not to participate – in the study. Methods In July and August 2015, focus group discussions and semi-structured individual interviews were conducted in Conakry, Guinea. Individuals were eligible for the qualitative study if they met the inclusion criteria of the immunogenicity and safety study irrespective of their participation. Surveys were also conducted among several institution and department heads of staff included in the study as well as vaccine trial staff members. Discussion and interview transcripts were analyzed using content thematic analysis. Results Interviews and focus groups were conducted among 110 persons, of whom about two-thirds (67%) participated in the vaccine trial. There was at least one group interview conducted at each participating trial site, along with numerous formal and informal interviews and conversations through the enrollment period. Participants were often motivated by a desire to save and protect themselves and others, contribute to scientific progress, or lead by example. Non-participants expressed concerns regarding the risk and costs of participation, particularly the fear of unknown side effects following vaccination, and distrust or fear of stigmatization. Conclusions Despite the unique nature of the 2014–2015 Ebola outbreak, front-line workers employed much of the same logic when choosing to participate as in other clinical trials in similar settings. Special consideration should be given to addressing perceived inequity, misunderstanding, and mistrust among the target populations in future trials.
    • Factors Related to Fetal Death in Pregnant Women with Cholera, Haiti, 2011-2014

      Schillberg, E; Ariti, C; Bryson, L; Delva-Senat, R; Price, D; GrandPierre, R; Lenglet, A (Center for Disease Control, 2016-01-01)
      We assessed risk factors for fetal death during cholera infection and effect of treatment changes on these deaths. Third trimester gestation, younger maternal age, severe dehydration, and vomiting were risk factors. Changes in treatment had limited effects on fetal death, highlighting the need for prevention and evidence-based treatment.
    • Failure of an Innovative Low-Cost, Noninvasive Thermotherapy Device for Treating Cutaneous Leishmaniasis Caused by in Pakistan.

      Kamink, S; Abdi, A; Kamau, C; Ashraf, S; Ansari, MA; Qureshi, NA; Schallig, H; Grobusch, MB; Fernhout, J; Ritmeijer, K (The American Society of Tropical Medicine and Hygiene, 2019-10-07)
      Cutaneous leishmaniasis (CL), a neglected parasitic skin disease, is endemic in Pakistan, where Leishmania tropica and Leishmania major are the causative protozoan species. Standard treatment with antimonial injections is long, painful, and costly; has toxic side effects; and is not always available in public hospitals. Small pilot studies have previously evaluated a low-cost and noninvasive hand-held exothermic crystallization thermotherapy (HECT-CL) device. We aimed to further establish the effectiveness, safety, and feasibility of HECT-CL in L. tropica. In a prospective observational study, patients with parasitological confirmation of CL were treated using the HECT-CL heat pack for 3 minutes with an initial temperature of 52-53°C for 7 consecutive days. Dried blood spot samples were taken for species identification by PCR. Effectiveness was assessed by using medical photographs and measurements of the lesion size at baseline and subsequent follow-up visits, for up to 180 days. We intended to enroll 317 patients. The HECT-CL treatment was easy to apply and well tolerated. Species identification demonstrated the presence of L. tropica. Interim analysis of 56 patients showed a failure rate of 91% at follow-up (median 45 days after treatment, interquartile range 30-60 days). Enrollment of patients was prematurely suspended because of futility. This study showed a high failure rate for HECT-CL thermotherapy in this setting. Leishmania tropica is known to be less sensitive to antileishmanial drugs, more temperature-resistant, and spontaneous healing is slower than that in L. major. More research is needed to identify low-cost, effective, and more patient-friendly treatment for L. tropica.
    • A fairer deal for pneumococcal vaccination.

      Ford, N; Berman, D; Frigati, L; Medecins Sans Frontieres, Johannesburg, South Africa; Access to Essential Medicines Campaign, Medecins Sans Frontieres, Geneva, Switzerland; Red Cross Memorial Children's Hospital, Cape Town, South Africa. (2009-12-07)
    • Falciparum Malaria and Climate Change in the Northwest Frontier Province of Pakistan.

      Bouma, M J; Dye, C; van der Kaay, H J; Medecins Sans Frontieres-Holland, Amsterdam, The Netherlands. (Published by: American Society of Tropical Medicine and Hygiene, 1996-08)
      Following a striking increase in the severity of autumnal outbreaks of Plasmodium falciparum during the last decade in the Northwest Frontier Province (NWFP) of Pakistan, the role of climatologic variables was investigated. A multivariate analysis showed that during the transmission season of P. falciparum, the amount of rainfall in September and October, the temperature in November and December, and the humidity in December were all correlated (r2 = 0.82) with two measures of P. falciparum, the falciparum rate (percent of slides examined positive for P. falciparum) since 1981 and the annual P. falciparum proportion (percent of all malaria infections diagnosed as P. falciparum) since 1978. Climatologic records since 1876 show an increase in mean November and December temperatures by 2 degrees C and 1.5 degrees C, respectively, and in October rainfall. Mean humidity in December has also been increasing since 1950. These climatologic changes in the area appear to have made conditions for transmission of P. falciparum more favorable, and may account for the increase in incidence observed in the NWFP in recent years.
    • False positive HIV diagnoses in resource limited settings: operational lessons learned for HIV programmes

      Shanks, Leslie; Klarkowski, Derryck; O'Brien, Daniel P; Médecins Sans Frontières, Amsterdam, The Netherlands. (Public Library of Science, 2013-03-20)
      Access to HIV diagnosis is life-saving; however the use of rapid diagnostic tests in combination is vulnerable to wrongly diagnosing HIV infection when both screening tests give a false positive result. Misclassification of HIV patients can also occur due to poor quality control, administrative errors and lack of supervision and training of staff. Médecins Sans Frontières discovered in 2004 that HIV negative individuals were enrolled in some HIV programmes. This paper describes the result of an audit of three sites to review testing practices, implement improved testing algorithms and offer re-testing to clients enrolled in the HIV clinic.
    • False-positive Xpert(®) MTB/RIF assays and previous treatment

      Boyles, T H; Hughes, J; Cox, V; Burton, R; Meintjes, G; Mendelson, M (International Union Against Tuberculosis and Lung Disease, 2015-04)