Now showing items 61-80 of 85

    • Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality? [Short communication]

      Ngoy, B B; Zachariah, R; Hinderaker, S G; Khogali, M; Manzi, M; van Griensven, J; Ayada, L; Jemmy, J P; Maalim, A; Amin, H (2013-06)
    • Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh?

      Ali, E; Zachariah, R; Shams, Z; Vernaeve, L; Alders, P; Salio, F; Manzi, M; Allaouna, M; Draguez, B; Delchevalerie, P; et al. (Oxford University Press, 2013-05)
      Mid-upper arm circumference (MUAC) and weight-for-height Z-score (WHZ) identify different populations of children with severe acute malnutrition (SAM) with only some degree of overlap. In an urban slum in Bangladesh, we conducted a prospective cohort study on children assessed as being severely malnourished by WHZ (<-3) but not by MUAC (>115 mm), to: 1. Assess their nutritional outcomes, and 2. Report on morbidity and mortality.
    • Effectiveness of blood transfusions and risk factors for mortality in children aged from 1 month to 4 years at the Bon Marche Hospital, Bunia, Democratic Republic of Congo

      Mueller, Y; Bastard, M; Ehounou, G; Itama, J; Quéré, M; de la Tour, R; Vala, L; Etard, J-F; Bottineau, M-C; Epicentre, Paris, France  Médecins Sans Frontières, Geneva, Switzerland  National Program for Blood Transfusion, Bunia, Democratic Republic of the Congo. (2012-10-11)
      Objective  To assess the effectiveness of blood transfusions in a hospital of north-eastern Democratic Republic of the Congo. Methods  Prospective study of children admitted for severe anaemia. During admission, data were collected on clinical condition and haemoglobin levels, before and after blood transfusion. A linear regression model was built to explore factors associated with haemoglobin level after transfusion. Risk factors for mortality were explored through multivariate logistic regression. Results  Haemoglobin level (Hb) was below 4 g/dl in 35% (230/657), between 4 and 6 g/dl in 58% (348/657) and at least 6 g/dl in another 6% (43/657) of the transfused children. A transfusion of 15 ml/kg of whole blood increased the Hb from 4.4 to 7.8 g/dl. Haemoglobin level after transfusion was associated with baseline Hb, quantity of delivered blood and history of previous transfusions. Overall case-fatality rate was 5.6% (37/657). Risk factors for deaths were co-morbidities such as chest infection, meningitis or malnutrition, Hb ≥ 6 g/dl, impaired consciousness or jugular venous distention on admission, and provenance. Conclusion  Transfusion was a frequent practice, the use of which could clearly have been rationalised. While indications should be restricted, quantities of transfused blood should be adapted to needs.
    • Practicing medicine without borders: tele-consultations and tele-mentoring for improving paediatric care in a conflict setting in Somalia?

      Zachariah, R; Bienvenue, B; Ayada, L; Manzi, M; Maalim, A; Engy, E; Jemmy, J P; Ibrahim Said, A; Hassan, A; Abdulrahaman, F; et al. (2012-09)
    • Bridging the gap from knowledge to delivery in the control of Childhood Diarrhoea

      Isanaka, S; Elder, G; Schaefer, M; Vasset, B; Baron, E; Grais, RF (2012-09-01)
    • A rapid screening tool for Psychological Distress in children 3-6 years old: results of a Validation Study

      Marquer, C; Barry, C; Mouchenik, Y; Hustache, S; Djibo, D; Manzo, M; Falissard, B; Révah-Lévy, A; Grais, RF; Moro, M-R; et al. (2012-08-16)
      The mental health needs of young children in humanitarian contexts often remain unaddressed. The lack of a validated, rapid and simple tool for screening combined with few mental health professionals able to accurately diagnose and provide appropriate care mean that young children remain without care. Here, we present the results of the principle cross-cultural validation of the "Psychological Screening for Young Children aged 3 to 6" (PSYCAa3-6). The PSYCa 3-6 is a simple scale for children 3 to 6 years old administered by non-specialists, to screen young children in crises and thereby refer them to care if needed.
    • Mortality after fluid bolus in children with shock due to sepsis or severe infection: a systematic review and meta-analysis.

      Ford, N; Hargreaves, S; Shanks, L; 1 Medecins Sans Frontieres, Geneva, Switzerland, 2 Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa, 3 The (2012-08)
      Sepsis is one of the leading causes of childhood mortality, yet controversy surrounds the current treatment approach. We conducted a systematic review to assess the evidence base for fluid resuscitation in the treatment of children with shock due to sepsis or severe infection.
    • Massive Increase, Spread, and Exchange of Extended Spectrum {beta}-Lactamase-Encoding Genes Among Intestinal Enterobacteriaceae in Hospitalized Children With Severe Acute Malnutrition in Niger.

      Woerther, P-L; Angebault, C; Jacquier, H; Hugede, H-C; Janssens, A-C; Sayadi, S; El Mniai, A; Armand-Lefèvre, L; Ruppé, E; Barbier, F; et al. (2011-10)
      Background. From the time of CTX-M emergence, extended-spectrum β-lactamase-producing enterobacteria (ESBL-E) have spread worldwide in community settings as well as in hospitals, particularly in developing countries. Although their dissemination appears linked to Escherichia coli intestinal carriage, precise paths of this dynamic are largely unknown. Methods. Children from a pediatric renutrition center were prospectively enrolled in a fecal carriage study. Antibiotic exposure was recorded. ESBL-E strains were isolated using selective media from fecal samples obtained at admission and, when negative, also at discharge. ESBL-encoding genes were identified, their environments and plasmids were characterized, and clonality was assessed with polymerase chain reaction-based methods and pulsed-field gel electrophoresis for E. coli and Klebsiella pneumoniae. E. coli strains were subjected to multilocus sequence typing. Results. The ESBL-E carriage rate was 31% at admission in the 55 children enrolled. All children enrolled received antibiotics during hospitalization. Among the ESBL-E-negative children, 16 were resampled at discharge, and the acquisition rate was 94%. The bla(CTX-M-15) gene was found in >90% of the carriers. Genetic environments and plasmid characterization evidenced the roles of a worldwide, previously described, multidrug-resistant region and of IncF plasmids in CTX-M-15 E. coli dissemination. Diversity of CTX-M-15-carrying genetic structures and clonality of acquired ESBL E. coli suggested horizontal genetic transfer and underlined the potential of some ST types for nosocomial cross-transmission. Conclusions. Cross-transmission and high selective pressure lead to very high acquisition of ESBL-E carriage, contributing to dissemination in the community. Strict hygiene measures as well as careful balancing of benefit-risk ratio of current antibiotic policies need to be reevaluated.
    • Paediatric radiology seen from Africa. Part I: providing diagnostic imaging to a young population

      Andronikou, S; McHugh, K; Abdurahman, N; Khoury, B; Mngomezulu, V; Brant, W E; Cowan, I; McCulloch, M; Ford, N; Radiology Department, University of Witwatersrand, Johannesburg Gauteng, South Africa; Radiology Department, Great Ormond Street Hospital for Children, London, UK; Radiology Department, University of Cape Town, Cape Town, South Africa; Radiology Department, University of Virginia, Charlottesville, VA, USA; Radiology Department, Christchurch Hospital, Christchurch, New Zealand; Evelyna Children's Hospital, London, UK; Public Health/Access, Medecins Sans Frontieres, Cape Town, South Africa (Springer, 2011-06-09)
      Paediatric radiology requires dedicated equipment, specific precautions related to ionising radiation, and specialist knowledge. Developing countries face difficulties in providing adequate imaging services for children. In many African countries, children represent an increasing proportion of the population, and additional challenges follow from extreme living conditions, poverty, lack of parental care, and exposure to tuberculosis, HIV, pneumonia, diarrhoea and violent trauma. Imaging plays a critical role in the treatment of these children, but is expensive and difficult to provide. The World Health Organisation initiatives, of which the World Health Imaging System for Radiography (WHIS-RAD) unit is one result, needs to expand into other areas such as the provision of maintenance servicing. New initiatives by groups such as Rotary and the World Health Imaging Alliance to install WHIS-RAD units in developing countries and provide digital solutions, need support. Paediatric radiologists are needed to offer their services for reporting, consultation and quality assurance for free by way of teleradiology. Societies for paediatric radiology are needed to focus on providing a volunteer teleradiology reporting group, information on child safety for basic imaging, guidelines for investigations specific to the disease spectrum, and solutions for optimising imaging in children.
    • Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey.

      Page, A-L; Hustache, S; Luquero, F J; Djibo, A; Manzo, M L; Grais, RF; Epicentre, Paris, France. anne-laure.page@epicentre.msf.org (2011-05-25)
      Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases.
    • Cholera in Haiti: please do not forget zinc.

      Rossi, G; Zachariah, R; Draguez, B; Van Herp, M (2011-05-21)
    • Outcomes For Street Children and Youth Under Multidisciplinary Care in a Drop-In Centre in Tegucigalpa, Honduras

      Souza, R; Porten, K; Nicholas, S; Grais, RF; Médecins Sans Frontières, Geneva, Switzerland; Epicentre, Paris, France (2010-09-14)
      BACKGROUND: There is little evidence to describe the feasibility and outcomes of services for the care of street children and youth in low-income countries. AIMS: To describe the outcomes of a multidisciplinary case management approach delivered in a drop-in centre for street children and youth. METHODS: A longitudinal study of street children and youth followed in an urban drop-in centre. Four hundred (400) street children and youth received a multidisciplinary case management therapeutic package based on the community reinforcement approach. The main outcomes were changes in psychological distress, substance abuse and social situation scores. RESULTS: The median follow-up time for the cohort was 18 months. There were reductions in the levels of psychological distress (p = 0.0001) and substance abuse (p ≤ 0.0001) in the cohort as well as an improvement in the social situation of street children and youth (p = 0.0001). There was a main effect of gender (p < 0.001) and a significant interaction of gender over time (p < 0.001) on improvements in levels of psychological distress. Survival analysis showed that the probability of remaining on substances at 12 months was 0.76 (95% CI: 0.69-0.81) and 0.51 (95% CI: 0.42-0.59) at 24 months. At 12 months, fewer female patients remained using substances compared to male (p < 0.01). CONCLUSION: To be most effective, programmes and strategies for children and youth in street situations in developing countries should target both their health and social needs.
    • Antiretroviral therapy outcomes in resource-limited settings for HIV-infected children <5 years of age.

      Sauvageot, D; Schaefer, M; Olson, D; Pujades-Rodriguez, M; O'Brien, D P; Epicentre, Paris, France. delphsauvageot@hotmail.com (2010-05)
      OBJECTIVE: We describe medium-term outcomes for young children receiving antiretroviral therapy (ART) in resource-limited countries. METHODS: Analyses were conducted on surveillance data for children <5 years of age receiving ART (initiated April 2002 to January 2008) in 48 HIV/AIDS treatment programs in Africa and Asia. Primary outcome measures were probability of remaining in care, probability of developing World Health Organization stage 4 clinical events, rate of switching to second-line ART, and drug toxicity, compared at 6, 12, 24, and 36 months of ART. RESULTS: Of 3936 children (90% in Africa) initiating ART, 9% were <12 months, 50% were 12 to 35 months, and 41% were 36 to 59 months of age. The median time of ART was 10.5 months. Probabilities of remaining in care after 12, 24, and 36 months of ART were 0.85, 0.80, and 0.75, respectively. Compared with children 36 to 59 months of age at ART initiation, probabilities of remaining in care were significantly lower for children <12 months of age. Overall, 55% and 69% of deaths and losses to follow-up occurred in the first 3 and 6 months of ART, respectively. Probabilities of developing stage 4 clinical events after 12, 24, and 36 months of ART were 0.03, 0.06, and 0.09, respectively. Only 33 subjects (0.8%) switched to second-line regimens, and 151 (3.8%) experienced severe drug toxicities. CONCLUSIONS: Large-scale ART for children <5 years of age in resource-limited settings is feasible, with encouraging clinical outcomes, but efforts should be increased to improve early HIV diagnosis and treatment.
    • Excellent outcomes among HIV+ children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia.

      Raguenaud, M-E; Isaakidis, P; Zachariah, R; Te, V; Soeung, S; Akao, K; Kumar, V; Médecins Sans Frontières, 72, Street 592, Phnom Penh, Cambodia. eve_raguenaud@hotmail.com (2009-08-20)
      BACKGROUND: Although HIV program evaluations focusing on mortality on ART provide important evidence on treatment effectiveness, they do not asses overall HIV program performance because they exclude patients who are eligible but not started on ART for whatever reason. The objective of this study was to measure mortality that occurs both pre-ART and during ART among HIV-positive children enrolled in two HIV-programs in Cambodia. METHODS: Retrospective cohort study on 1168 HIV-positive children <15 years old registered in two HIV-programs over a four-year period. Mortality rates were calculated for both children on treatment and children not started on ART. RESULTS: Over half (53%) of children were 5 years or above and only 69(6%) were <18 months. Overall, 9% (105/1168) of children died since the set-up of the programs. By the end of the observation period, 66(14.5%) patients not on ART had died compared to 39(5.5%) of those under treatment, and 100(22%) who did not start ART were lost-to-follow-up compared to 13(2%) on ART. 66/105 (62.8%) of all in-program deaths occurred before starting ART, of which 56% (37/66) and 79% (52/66) occurred within 3 and 6 months of enrollment respectively. Mortality rate ratio between children not on ART and children on ART was 4.1 (95%CI: 2.7-6.2) (P < 0.001). The most common contributing cause of death in first 3 months of treatment and in first 3 months of program enrollment was tuberculosis. 41/52 (79%) children who died within 6 months of enrollment had met the ART eligibility criteria before death. CONCLUSION: HIV-positive children experienced a high mortality and loss-to-follow-up rates before starting ART. These program outcomes may be improved by a more timely ART initiation. Measuring overall in-program mortality as opposed to only mortality on ART is recommended in order to more accurately evaluate pediatric HIV-programs performance.
    • Success with antiretroviral treatment for children in Kigali, Rwanda: experience with health center/nurse-based care.

      van Griensven, J; De Naeyer, L; Uwera, J; Asiimwe, A; Gazille, C; Reid, T; Médecins Sans Frontières, Kigali, Rwanda. jvgrie@yahoo.com (BMC, 2008-10)
      BACKGROUND: Although a number of studies have shown good results in treating children with antiretroviral drugs (ARVs) in hospital settings, there is limited published information on results in pediatric programs that are nurse-centered and based in health centers, in particular on the psychosocial aspects of care. METHODS: Program treatment and outcome data were reported from two government-run health centers that were supported by Médecins Sans Frontières (MSF) in Kigali, Rwanda between October 2003 and June 2007. Interviews were held with health center staff and MSF program records were reviewed to describe the organization of the program. Important aspects included adequate training and supervision of nurses to manage ARV treatment. The program also emphasized family-centered care addressing the psychosocial needs of both caregivers and children to encourage early diagnosis, good adherence and follow-up. RESULTS: A total of 315 children (< 15 years) were started on ARVs, at a median age of 7.2 years (range: 0.7-14.9). Sixty percent were in WHO clinical stage I/II, with a median CD4% of 14%. Eighty-nine percent (n = 281) started a stavudine-containing regimen, mainly using the adult fixed-dose combination. The median follow-up time after ARV initiation was 2 years (interquartile range 1.2-2.6). Eighty-four percent (n = 265) of children were still on treatment in the program. Thirty (9.5%) were transferred out, eight (2.6%) died and 12 (3.8%) were lost to follow-up. An important feature of the study was that viral loads were done at a median time period of 18 months after starting ARVs and were available for 87% of the children. Of the 174 samples, VL was < 400 copies/ml in 82.8% (n = 144). Two children were started on second-line ARVs. Treatment was changed due to toxicity for 26 children (8.3%), mainly related to nevirapine. CONCLUSION: This report suggests that providing ARVs to children in a health center/nurse-based program is both feasible and very effective. Adequate numbers and training of nursing staff and an emphasis on the psychosocial needs of caregivers and children have been key elements for the successful scaling-up of ARVs at this level of the health system.
    • Different methodological approaches to the assessment of in vivo efficacy of three artemisinin-based combination antimalarial treatments for the treatment of uncomplicated falciparum malaria in African children.

      Ashley, E A; Pinoges, L; Turyakira, E; Dorsey, G; Checchi, F; Bukirwa, H; van den Broek, I; Zongo, I; Urruta, P P P; van Herp, M; et al. (2008-08-09)
      BACKGROUND: Use of different methods for assessing the efficacy of artemisinin-based combination antimalarial treatments (ACTs) will result in different estimates being reported, with implications for changes in treatment policy. METHODS: Data from different in vivo studies of ACT treatment of uncomplicated falciparum malaria were combined in a single database. Efficacy at day 28 corrected by PCR genotyping was estimated using four methods. In the first two methods, failure rates were calculated as proportions with either (1a) reinfections excluded from the analysis (standard WHO per-protocol analysis) or (1b) reinfections considered as treatment successes. In the second two methods, failure rates were estimated using the Kaplan-Meier product limit formula using either (2a) WHO (2001) definitions of failure, or (2b) failure defined using parasitological criteria only. RESULTS: Data analysed represented 2926 patients from 17 studies in nine African countries. Three ACTs were studied: artesunate-amodiaquine (AS+AQ, N = 1702), artesunate-sulphadoxine-pyrimethamine (AS+SP, N = 706) and artemether-lumefantrine (AL, N = 518).Using method (1a), the day 28 failure rates ranged from 0% to 39.3% for AS+AQ treatment, from 1.0% to 33.3% for AS+SP treatment and from 0% to 3.3% for AL treatment. The median [range] difference in point estimates between method 1a (reference) and the others were: (i) method 1b = 1.3% [0 to 24.8], (ii) method 2a = 1.1% [0 to 21.5], and (iii) method 2b = 0% [-38 to 19.3].The standard per-protocol method (1a) tended to overestimate the risk of failure when compared to alternative methods using the same endpoint definitions (methods 1b and 2a). It either overestimated or underestimated the risk when endpoints based on parasitological rather than clinical criteria were applied. The standard method was also associated with a 34% reduction in the number of patients evaluated compared to the number of patients enrolled. Only 2% of the sample size was lost when failures were classified on the first day of parasite recurrence and survival analytical methods were used. CONCLUSION: The primary purpose of an in vivo study should be to provide a precise estimate of the risk of antimalarial treatment failure due to drug resistance. Use of survival analysis is the most appropriate way to estimate failure rates with parasitological recurrence classified as treatment failure on the day it occurs.
    • Maternal common mental disorder and infant growth--a cross-sectional study from Malawi

      Stewart, R C; Umar, E; Kauye, F; Bunn, J; Vokhiwa, M; Fitzgerald, M; Tomenson, B; Rahman, A; Creed, F; Department of Community Health, College of Medicine, Blantyre, Malawi; Zomba Mental Hospital, Zomba, Malawi; Médecins Sans Frontières, Thyolo, Malawi; Population Health Service Executive, Dr Stevens Hospital, Dublin, Ireland; Department of Psychiatry, University of Manchester, Manchester, UK (2008-07-01)
      The objective of the study was to investigate the association between maternal common mental disorder (CMD) and infant growth in rural Malawi. A cross-sectional study was conducted at a district hospital child health clinic. Participants were consecutive infants due for measles vaccination, and their mothers. Mean infant weight-for-age and length-for-age z-scores were compared between infants of mothers with and without CMD as measured using the self-reporting questionnaire (SRQ). Of 519 eligible infants/mothers, 501 were included in the analysis. Median infant age was 9.9 months. 29.9% of mothers scored 8 or above on the SRQ indicating CMD. Mean length-for-age z-score for infants of mothers with CMD (-1.50 SD 1.24) was significantly lower than for infants of mothers without CMD (-1.11 SD 1.12) Student's t-test: P = 0.001. This association was confirmed in multivariate analysis. Mean weight-for-age z-score for infants of mothers with CMD (-1.77 SD 1.16) was lower than for infants of mothers without CMD (-1.59 SD 1.09) but this difference was not significant on univariate (Student's t-test: P = 0.097) or multivariate analysis. The study demonstrates an association between maternal CMD and infant growth impairment in rural sub-Saharan Africa.
    • Reasons for loss to follow-up among mothers registered in a prevention-of-mother-to-child transmission program in rural Malawi

      Bwirire, L; Fitzgerald, M; Zachariah, R; Chikafa, V; Massaquoi, M; Moens, M; Kamoto, K; Schouten, E (Elsevier, 2008-05-16)
    • The dynamics of measles in sub-Saharan Africa.

      Ferrari, M J; Grais, RF; Bharti, N; Conlan, A J K; Bjørnstad, O N; Wolfson, L J; Guerin, P J; Djibo, A; Grenfell, B T; Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park, Pennsylvania 16802, USA. mferrari@psu.edu (Macmillan, 2008-02-07)
      Although vaccination has almost eliminated measles in parts of the world, the disease remains a major killer in some high birth rate countries of the Sahel. On the basis of measles dynamics for industrialized countries, high birth rate regions should experience regular annual epidemics. Here, however, we show that measles epidemics in Niger are highly episodic, particularly in the capital Niamey. Models demonstrate that this variability arises from powerful seasonality in transmission-generating high amplitude epidemics-within the chaotic domain of deterministic dynamics. In practice, this leads to frequent stochastic fadeouts, interspersed with irregular, large epidemics. A metapopulation model illustrates how increased vaccine coverage, but still below the local elimination threshold, could lead to increasingly variable major outbreaks in highly seasonally forced contexts. Such erratic dynamics emphasize the importance both of control strategies that address build-up of susceptible individuals and efforts to mitigate the impact of large outbreaks when they occur.