• Beauty and the beast.

      Cox, H; Isles, S; Médecins Sans Frontières, 7 Ganges Street, Maitama, Abuja, Nigeria. helenscox@yahoo.com.au (Elsevier, 2003-01)
    • 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.
    • Benznidazole Treatment Safety: The Médecins Sans Frontières Experience in a Large Cohort of Bolivian Patients with Chagas' Disease

      Sperandio da Silva, G; Felix Mediano, M; Hasslocher-Moreno, A; Holanda, M; Silvestre de Sousa, A; Sangenis, L; Brasil, P; Mejía, R; Fux, C; Cubides, J; et al. (2017-06-22)
      Up to half of patients with Chagas' disease under benznidazole treatment present adverse drug reactions (ADRs) and up to one-third do not complete standard treatment.
    • Biological diagnosis of meningococcal meningitis in the African meningitis belt: current epidemic strategy and new perspectives.

      Chanteau, S; Rose, A; Djibo, S; Nato, F; Boisier, P; CERMES, Réseau International Institut Pasteur, PO Box 10887, Niamey, Niger. schanteau@cermes.org (Elsevier, 2007-09-03)
      Laboratory diagnosis is an essential component in surveillance of meningococcal epidemics, as it can inform decision-makers of the Neisseria meningitidis serogroup(s) involved and the most appropriate vaccine to be selected for mass vaccination. However, countries most affected face real limitations in laboratory diagnostics, due to lack of resources. We describe current diagnostic tools and examine their cost-effectiveness for use in an epidemic context. The conclusion is that current WHO recommendations to use only the latex agglutination assay (Pastorex) at epidemic onset is cost-effective, but recently developed rapid diagnostic tests for the major epidemic-causing meningococcal serogroups may prove a breakthrough for the future.
    • Brain injury: Iraq's unseen burden of wounded civilians

      Guerrier, Gilles; Baron, Emmanuel; Fakri, Rasheed; Mouniaman, Isabelle; Epicentre, Paris, France; Médecins Sans Frontières, Amman, Jordan; Médecins Sans Frontières, Paris, France (Nature Publishing Group, 2011-10-27)
      The burden of war-related mental disorders is well documented among US veterans (Nature 477, 390–393; 2011), but not among civilians in Iraq. This oversight must be rectified so that adequate medical support can be provided to the Iraqi people. US combat troops will soon depart Iraq, leaving Iraqis to cope with the consequences of the 2003 invasion. Although the number of violent deaths is falling, civilians have been killed almost every day this year, most of them in coordinated bomb attacks. Roadside blasts cause long-term disabilities and societal effects among injured civilians. However, these have been largely neglected by the media and no systematic surveillance has been undertaken.
    • Burden of disease and circulating serotypes of rotavirus infection in sub-Saharan Africa: systematic review and meta-analysis.

      Sanchez-Padilla, Elisabeth; Grais, RFebecca F; Guerin, Philippe J; Steele, Andrew D; Burny, Marie-Eve; Luquero, Francisco J; Epicentre, Research Unit, Paris, France. elisabeth.sanchez@epicentre.msf.org (2009-09-09)
      Two new rotavirus vaccines have recently been licensed in many countries. However, their efficacy has only been shown against certain serotypes commonly circulating in Europe, North America, and Latin America, but thought to be globally important. To assess the potential impact of these vaccines in sub-Saharan Africa, where rotavirus mortality is high, knowledge of prevalent types is essential because an effective rotavirus vaccine is needed to protect against prevailing serotypes in the community. We did two systematic reviews and two meta-analyses of the most recent published data on the burden of rotavirus disease in children aged under 5 years and rotavirus serotypes circulating in countries in sub-Saharan Africa. Eligible studies were selected from PubMed/Medline, Cochrane Library, EmBase, LILACS, Academic Search Premier, Biological Abstracts, ISI Web of Science, and the African Index Medicus. Depending on the heterogeneity, DerSimonian-Laird random-effects or fixed-effects models were used for meta-analyses. Geographical variability in rotavirus burden within countries in sub-Saharan Africa is substantial, and most countries lack information on rotavirus epidemiology. We estimated that annual mortality for this region was 243.3 (95% CI 187.6-301.7) deaths per 100,000 under 5 years (ie, a total of 300,000 children die of rotavirus infection in this region each year). The most common G type detected was G1 (34.9%), followed by G2 (9.1%), and G3 (8.6%). The most common P types detected were P[8] (35.5%) and P[6] (27.5%). Accurate information should be collected from surveillance based on standardised methods in these countries to obtain comparable data on the burden of disease and the circulating strains to assess the potential impact of vaccine introduction.
    • Buruli et VIH: une interaction complexe et peu etudiee

      Christinet V, Di Benedetto C, Comte E, Calmy A; MSF Suisse (2012-09)
    • The case for improved diagnostic tools to control Ebola Virus Disease in West Africa and how to get there

      Chua, Arlene C; Cunningham, Jane; Moussy, Francis; Perkins, Mark D; Formenty, Pierre (Public Library of Science, 2015-06-11)
    • Case-Fatality Rates and Sequelae Resulting from Neisseria Meningitidis Serogroup C Epidemic, Niger, 2015

      Coldiron, ME; Salou, H; Sidikou, F; Goumbi, K; Djibo, A; Lechevalier, P; Compaoré, I; Grais, RFF (Center for Disease Control, 2016-10-01)
      We describe clinical symptoms, case-fatality rates, and prevalence of sequelae during an outbreak of Neisseria meningitidis serogroup C infection in a rural district of Niger. During home visits, we established that household contacts of reported case-patients were at higher risk for developing meningitis than the general population.
    • Case-Fatality Rates and Sequelae Resulting from Neisseria Meningitidis Serogroup C Epidemic, Niger, 2015

      Coldiron, ME; Salou, H; Sidikou, F; Goumbi, K; Djibo, A; Lechevalier, P; Compaore, I; Grais, RFF (Center for Disease Control, 2016-10-01)
      We describe clinical symptoms, case-fatality rates, and prevalence of sequelae during an outbreak of Neisseria meningitidis serogroup C infection in a rural district of Niger. During home visits, we established that household contacts of reported case-patients were at higher risk for developing meningitis than the general population.
    • Caseload, management and treatment outcomes of patients with hypertension and/or diabetes mellitus in a primary health care programme in an informal setting

      Sobry, Agnes; Kizito, Walter; Van den Bergh, Rafael; Tayler-Smith, Katie; Isaakidis, Petros; Cheti, Erastus; Kosgei, Rose J.; Vandenbulcke, Alexandra; Ndegwa, Zacharia; Reid, Tony (John Wiley & Sons Ltd, 2013-10-23)
    • CE: Inside an Ebola Treatment Unit: A Nurse's Report

      Wilson, D (Lippincott Williams & Wilkins, 2015-11-10)
      : A firsthand account of combating Ebola in West Africa.
    • Ceftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study.

      Nathan, N; Borel, T; Djibo, A; Evans, D; Djibo, S; Corty, J F; Guillerm, M; Alberti, K P; Pinoges, L; Guerin, P J; et al. (Elsevier, 2008-04-14)
      BACKGROUND: In sub-Saharan Africa in the 1990s, more than 600,000 people had epidemic meningococcal meningitis, of whom 10% died. The current recommended treatment by WHO is short-course long-acting oily chloramphenicol. Continuation of the production of this drug is uncertain, so simple alternatives need to be found. We assessed whether the efficacy of single-dose treatment of ceftriaxone was non-inferior to that of oily chloramphenicol for epidemic meningococcal meningitis. METHODS: In 2003, we undertook a randomised, open-label, non-inferiority trial in nine health-care facilities in Niger. Participants with suspected disease who were older than 2 months were randomly assigned to receive either chloramphenicol or ceftriaxone. Primary outcome was treatment failure (defined as death or clinical failure) at 72 h, measured with intention-to-treat and per-protocol analyses. FINDINGS: Of 510 individuals with suspected disease, 247 received ceftriaxone, 256 received chloramphenicol, and seven were lost to follow-up. The treatment failure rate at 72 h for the intention-to-treat analysis was 9% (22 patients) for both drug groups (risk difference 0.3%, 90% CI -3.8 to 4.5). Case fatality rates and clinical failure rates were equivalent in both treatment groups (14 [6%] ceftriaxone vs 12 [5%] chloramphenicol). Results were also similar for both treatment groups in individuals with confirmed meningitis caused by Neisseria meningitidis. No adverse side-effects were reported. INTERPRETATION: Single-dose ceftriaxone provides an alternative treatment for epidemic meningococcal meningitis--its efficacy, ease of use, and low cost favour its use. National and international health partners should consider ceftriaxone as an alternative first-line treatment to chloramphenicol for epidemic meningococcal meningitis.
    • Chagas Disease: Review of Needs, Neglect, and Obstacles to Treatment Access in Latin America

      Pinheiro, E; Brum-Soares, L; Reis, R; Cubides, J; Consultora em Saúde Pública, Brasil; Médicos Sem Fronteiras, Brasil; Médicos Sem Fronteiras, Brasil; Médicos Sem Fronteiras, Brasil (Sociedade Brasileira de Medicina Tropical, 2017-06)
    • Challenges in mass drug administration for treating lymphatic filariasis in Papua, Indonesia.

      Bhullar, Navneet; Maikere, Jacob (2010-08-11)
      ABSTRACT: BACKGROUND: The World Health Organization (WHO) Global Program to Eliminate Lymphatic Filariasis relies on mass drug administration (MDA) of two drugs annually for 4 to 6 years. The goal is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector. In 2008, the international medical aid organization Medecins Sans Frontieres (MSF) performed the first round of a MDA in the high-burden area of Asmat district, in Papua, Indonesia. We report the challenges faced in this MDA on a remote Indonesian island and propose solutions to overcome these hurdles in similar future contexts. RESULTS: During the MDA, we encountered difficult challenges in accessing as well as persuading the patient population to take the antifilarial drugs. Health promotion activities supporting treatment need to be adapted and repetitive, with adequate time and resources allocated for accessing and communicating with local, seminomadic populations. Distribution of bednets resulted in an increase in MDA coverage, but it was still below the 80-85% target. CONCLUSIONS: MDA for lymphatic filariasis is how the WHO has planned to eliminate the disease from endemic areas. Our programmatic experience will hopefully help inform future campaign planning in difficult-to-access, high-burden areas of the world to achieve target MDA coverage for elimination of lymphatic filariasis.
    • Challenges in measuring measles case fatality ratios in settings without vital registration.

      Cairns, K Lisa; Nandy, Robin; Grais, RFebecca F; Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-05, Atlanta, GA 30333, USA. kfc4@cdc.gov. (2010)
      ABSTRACT: Measles, a highly infectious vaccine-preventable viral disease, is potentially fatal. Historically, measles case-fatality ratios (CFRs) have been reported to vary from 0.1% in the developed world to as high as 30% in emergency settings. Estimates of the global burden of mortality from measles, critical to prioritizing measles vaccination among other health interventions, are highly sensitive to the CFR estimates used in modeling; however, due to the lack of reliable, up-to-date data, considerable debate exists as to what CFR estimates are appropriate to use. To determine current measles CFRs in high-burden settings without vital registration we have conducted six retrospective measles mortality studies in such settings. This paper examines the methodological challenges of this work and our solutions to these challenges, including the integration of lessons from retrospective all-cause mortality studies into CFR studies, approaches to laboratory confirmation of outbreaks, and means of obtaining a representative sample of case-patients. Our experiences are relevant to those conducting retrospective CFR studies for measles or other diseases, and to those interested in all-cause mortality studies.
    • Challenges in Preparing and Implementing a Clinical Trial at Field Level in an Ebola Emergency: A Case Study in Guinea, West Africa

      Carazo Perez, S; Folkesson, E; Anglaret, X; Beavogui, A; Berbain, E; Camara, A; Depoortere, E; Lefevre, A; Maes, P; Malme, K; et al. (Public Library of Science, 2017-06-22)
      During the large Ebola outbreak that affected West Africa in 2014 and 2015, studies were launched to evaluate potential treatments for the disease. A clinical trial to evaluate the effectiveness of the antiviral drug favipiravir was conducted in Guinea. This paper describes the main challenges of the implementation of the trial in the Ebola treatment center of Guéckédou. Following the principles of the Good Clinical Research Practices, we explored the aspects of the community's communication and engagement, ethical conduct, trial protocol compliance, informed consent of participants, ongoing benefit/risk assessment, record keeping, confidentiality of patients and study data, and roles and responsibilities of the actors involved. We concluded that several challenges have to be addressed to successfully implement a clinical trial during an international medical emergency but that the potential for collaboration between research teams and humanitarian organizations needs to be highlighted.
    • Changes in Health-Seeking Behavior Did Not Result in Increased All-Cause Mortality During the Ebola Outbreak in Western Area, Sierra Leone

      Vygen, S; Tiffany, A; Rull, M; Ventura, A; Wolz, A; Jambai, A; Porten, K (American Society of Tropical Medicine and Hygiene, 2016-07-25)
      Little is known about the residual effects of the west African Ebola virus disease (Ebola) epidemic on non-Ebola mortality and health-seeking behavior in Sierra Leone. We conducted a retrospective household survey to estimate mortality and describe health-seeking behavior in Western Area, Sierra Leone, between May 25, 2014, and February 16, 2015. We used two-stage cluster sampling, selected 30 geographical sectors with probability proportional to population size, and sampled 30 households per sector. Survey teams conducted face-to-face interviews and collected information on mortality and health-seeking behavior. We calculated all-cause and Ebola-specific mortality rates and compared health-seeking behavior before and during the Ebola epidemic using χ(2) and Fisher's exact tests. Ninety-six deaths, 39 due to Ebola, were reported in 898 households. All-cause and Ebola-specific mortality rates were 0.52 (95% confidence interval [CI] = 0.29-0.76) and 0.19 (95% CI = 0.01-0.38) per 10,000 inhabitants per day, respectively. Of those households that reported a sick family member during the month before the survey, 86% (73/85) sought care at a health facility before the epidemic, compared with 58% (50/86) in February 2015 (P = 0.013). Reported self-medication increased from 4% (3/85) before the epidemic to 23% (20/86) during the epidemic (P = 0.013). Underutilization of health services and increased self-medication did not show a demonstrable effect on non-Ebola-related mortality. Nevertheless, the residual effects of outbreaks need to be taken into account for the future. Recovery efforts should focus on rebuilding both the formalized health system and the population's trust in it.
    • Characteristics of a cholera outbreak, patterns of Vibrio cholerae and antibiotic susceptibility testing in rural Malawi.

      Zachariah, R; Harries, A D; Arendt, V; Nchingula, D; Chimtulo, F; Courteille, O; Kirpach, P; Department of Infectious Diseases, Reference Centre, Central Hospital, Rue Barble, Luxembourg. msflblantyre@malawi.net (2002)
      The cumulative cholera attack rate in an epidemic in Malawi in 1999/2000 was 59/100,000 population, case-fatality rate 4%, and 98% of all cases presenting to health facilities required intravenous therapy. Microbiological studies showed high resistance of Vibrio cholerae to commonly recommended antibiotics, predominant Ogawa serotypes and no O139 isolates.
    • Characteristics of human encounters and social mixing patterns relevant to infectious diseases spread by close contact: a survey in Southwest Uganda

      le Polain de Waroux, O; Cohuet, S; Ndazima, D; Kucharski, AJ; Juan-Giner, A; Flasche, S; Tumwesigye, E; Arinaitwe, R; Mwanga-Amumpaire, J; Boum, Y; et al. (BioMed Central, 2018-04-11)
      Quantification of human interactions relevant to infectious disease transmission through social contact is central to predict disease dynamics, yet data from low-resource settings remain scarce.