• Kashin-Beck Disease and Drinking Water in Central Tibet.

      La Grange, M; Mathieu, F; Begaux, F; Suetens, C; Durand, M C; Médecins Sans Frontiéres, Brussels, Belgium. (Springer, 2001)
      A cross-sectional survey was carried out in order to study the relationship between Kashin-Beck disease and drinking water. The average volume of the water containers was larger in families unaffected by the disease. Organic material was measured by ultraviolet (UV) spectroscopy. The UV absorbency was significantly lower in drinking water of unaffected families. Thus, the organic material in drinking water may play a role in the pathogenesis of Kashin-Beck disease.
    • Kashin-Beck disease and iodine deficiency in Tibet.

      Moreno-Reyes, R; Suetens, C; Mathieu, F; Begaux, F; Zhu, D; Rivera, M; Boelaert, M; Nève, J; Perlmutter, N; Vanderpas, J; et al. (2001)
      We evaluated iodine and selenium status in 575 children between 5 and 15 years with Kashin-Beck disease from endemic and non-endemic areas. Of these 267 (46%) children had goiter. The proportion of subjects with goiter was higher in the villages with Kashin-Beck disease than in the control village. In the villages with Kashin-Beck disease, 105 (23%) of the subjects had a serum thyrotropin greater than 10 mU/l as compared with 3 (4%) in the control village. The percentages of low serum thyroxine values and low serum tri-iodothyronine were greater in the villages where Kashin-Beck disease was endemic than in the control village. The percentages of low urinary iodine concentration were significantly greater in the subjects with Kashin-Beck disease. The results suggest that in areas where severe selenium deficiency is endemic, iodine deficiency is a risk factor for Kashin-Beck disease.
    • Kashin-Beck osteoarthropathy in rural Tibet in relation to selenium and iodine status.

      Moreno-Reyes, R; Suetens, C; Mathieu, F; Begaux, F; Zhu, D; Rivera, M; Boelaert, M; Nève, J; Perlmutter, N; Vanderpas, J; et al. (Massachusetts Medical Society, 1998-10-15)
      BACKGROUND AND METHODS: Kashin-Beck disease is a degenerative osteoarticular disorder that is endemic to certain areas of Tibet, where selenium deficiency is also endemic. Because selenium is involved in thyroid hormone metabolism, we studied the relation among the serum selenium concentration, thyroid function, and Kashin-Beck disease in 575 subjects 5 to 15 years of age in 12 villages around Lhasa, Tibet, including 1 control village in which no subject had Kashin-Beck disease. Clinical, radiologic, and biochemical data were collected. RESULTS: Among the 575 subjects, 280 (49 percent) had Kashin-Beck disease, 267 (46 percent) had goiter, and 7 (1 percent) had cretinism. Of the 557 subjects in whom urinary iodine was measured, 66 percent had a urinary iodine concentration of less than 2 microg per deciliter (157 nmol per liter; normal, 5 to 25 microg per deciliter [394 to 1968 nmol per liter]). The mean urinary iodine concentration was lower in subjects with Kashin-Beck disease than in control subjects (1.2 vs. 1.8 microg per deciliter [94 vs. 142 nmol per liter], P<0.001) and hypothyroidism was more frequent (23 percent vs. 4 percent, P=0.01). Severe selenium deficiency was documented in all villages; 38 percent of subjects had serum concentrations of less than 5 ng per milliliter (64 nmol per liter; normal, 60 to 105 ng per milliliter [762 to 1334 nmol per liter]). When age and sex were controlled for in a multivariate analysis, low urinary iodine, high serum thyrotropin, and low serum thyroxine-binding globulin values were associated with an increased risk of Kashin-Beck disease, but a low serum selenium concentration was not. CONCLUSIONS: In areas where severe selenium deficiency is endemic, iodine deficiency is a risk factor for Kashin-Beck disease.
    • Knowledge, attitude and practices of snakebite management amongest health workers in Cameroon: Need for continuous training and capacity building

      Taieb, F; Dub, T; Madec, Y; Tondeur, L; Chippaux, JP; Lebreton, M; Medang, R; Foute, FNN; Tchoffo, D; Potet, J; et al. (Public Library of Science, 2018-10-25)
      Snakebite has only recently been recognized as a neglected tropical disease by the WHO. Knowledge regarding snakebites and its care is poor both at the population level, and at the health care staff level. The goal of this study was to describe the level of knowledge and clinical practice regarding snakebite among health care staff from Cameroon.
    • Knowledge, Awareness and Practices of Incident Cases of Dengue in Chandigarh

      Kaur, R; Rajvanshi, H (Advanced Research Publications, 2019-12-23)
      Introduction: Dengue is an endemic disease in India. Epidemics occur every year with incidence rising every year. Since 2010, Chandigarh has seen Dengue epidemics every year but the toll of reported confirmed cases has been very low. A study was undertaken to assess knowledge, awareness and practices among those who had already been diagnosed with dengue and followed up multiple times by Multipurpose Health Workers (MPHWs) at their homes. This study was conducted when both authors were post-graduate scholars at the Department of Public Health at Manipal Academy of Higher Education.Objective: To ascertain knowledge, awareness and practices regarding dengue among incident dengue cases of 2016 in Chandigarh. Methods: Retrospective Cohort study was conducted among the incident cases of dengue reported in 2016. The line list of cases was obtained from health department. Each household was visited once and face to face interviews were conducted with those willing to participate from January 2017 to March 2017. Using a modified WHO (World Health Organisation) questionnaire, 149 interviews were completed and analysed using descriptive analytical tools. Results: Data from the 149 interviews (57 males and 92 females) was used for primary analysis. Only 58.4% respondents were aware about dengue before diagnosis and 63.1% knew of its vector while only 10.1% were aware of the national programme and services available to them. Use of mosquito net was negligible (3.4%), even in rural areas. Screens on doors and windows were more common in urban area of Chandigarh. Conclusion: Since the study was conducted among incident cases, even after multiple visits conducted by MPHWs to the houses of these respondents, the knowledge regarding dengue was lower than expected.
    • Konzo Outbreak Among Refugees From Central African Republic in Eastern region, Cameroon

      Ciglenečki, I; Eyema, R; Kabanda, C; Taafo, F; Mekaoui, H; Urbaniak, V; Médecins Sans Frontières, Geneva, Switzerland; Médecins Sans Frontières, Yaounde, Cameroon (2010-06)
      Konzo is a spastic paraparesis of sudden onset, linked to the exclusive consumption of insufficiently processed bitter cassava as staple food combined with low protein intake. Around 60,000 refugees from the Central African Republic sought refuge in villages in eastern Cameroon between 2005 and 2007. Médecins Sans Frontières was providing nutritional and medical assistance in the villages affected by displacement. We describe cases of konzo seen at the mobile clinics organized in these villages. Basic information including demographic data, history and clinical presentation was recorded for each konzo patient. All patients were given nutritional supplements, and selected cases were referred for physiotherapy to a rehabilitation center. A total of 469 patients were diagnosed with konzo. The majority (80%) were refugees. Children and women of reproductive age predominated. Most of the patients developed symptoms after 2007 in a seasonal pattern with most of the cases occurring during the dry winter season. Most of the patients complained about walking difficulties and weight loss and had exaggerated lower limb reflexes and muscle wasting on observation. Eastern Cameroon is an area with konzo. More effort needs to be put into preventive and educational measures. In addition, timely balanced food rations have to be provided to refugees.
    • Konzo Outbreak, in the South-West of the Democratic Republic of Congo, 1996.

      Bonmarin, I; Nunga, M; Perea, W; Epicentre, 8 rue St Sabin, Paris, France. i.bonmarin@invs.sante.fr (Published by Oxford University Press, 2002-08)
      In August 1996, cases of poliomyelitis were reported in Kahemba zone, in the south-west of the Democratic Republic (DR) of Congo. The diagnosis was reviewed and charged to Konzo, a spastic paraparesis attributed to food cyanide intoxication. In order to describe the phenomena, a community-based survey took place and found 237 people affected. The highest prevalence was found in the most isolated part of the zone. The patients suffered from an isolated non-progressive spastic paraparesis of abrupt onset. Children and women were the most affected groups, especially women after childbirth. Most of the patients developed the disease after 1990 with 101 cases in 1996. Cassava processing was the same over time and in all the villages. The study did not fully explain the increased number of cases in 1996 but suggested that complementary investigations regarding micronutrient intakes, especially vitamin A, would be necessary.
    • A Large Outbreak of Hepatitis E Among a Displaced Population in Darfur, Sudan, 2004: The Role of Water Treatment Methods.

      Guthmann, J P; Klovstad, H; Boccia, D; Hamid, N; Pinoges, L; Nizou, J Y; Tatay, M; Diaz, F; Moren, A; Grais, RF; et al. (Published by: Infectious Diseases Society of America, 2006-06-15)
      BACKGROUND: The conflict in Darfur, Sudan, was responsible for the displacement of 1.8 million civilians. We investigated a large outbreak of hepatitis E virus (HEV) infection in Mornay camp (78,800 inhabitants) in western Darfur. METHODS: To describe the outbreak, we used clinical and demographic information from cases recorded at the camp between 26 July and 31 December 2004. We conducted a case-cohort study and a retrospective cohort study to identify risk factors for clinical and asymptomatic hepatitis E, respectively. We collected stool and serum samples from animals and performed a bacteriological analysis of water samples. Human samples were tested for immunoglobulin G and immunoglobulin M antibody to HEV (for serum samples) and for amplification of the HEV genome (for serum and stool samples). RESULTS: In 6 months, 2621 hepatitis E cases were recorded (attack rate, 3.3%), with a case-fatality rate of 1.7% (45 deaths, 19 of which involved were pregnant women). Risk factors for clinical HEV infection included age of 15-45 years (odds ratio, 2.13; 95% confidence interval, 1.02-4.46) and drinking chlorinated surface water (odds ratio, 2.49; 95% confidence interval, 1.22-5.08). Both factors were also suggestive of increased risk for asymptomatic HEV infection, although this was not found to be statistically significant. HEV RNA was positively identified in serum samples obtained from 2 donkeys. No bacteria were identified from any sample of chlorinated water tested. CONCLUSIONS: Current recommendations to ensure a safe water supply may have been insufficient to inactivate HEV and control this epidemic. This research highlights the need to evaluate current water treatment methods and to identify alternative solutions adapted to complex emergencies.
    • A large outbreak of Hepatitis E virus genotype 1 infection in an urban setting in Chad likely linked to household level transmission factors, 2016-2017.

      Spina, A; Lenglet, A; Beversluis, D; de Jong, M; Vernier, L; Spencer, C; Andayi, F; Kamau, C; Vollmer, S; Hogema, B; et al. (Public Library of Science, 2017-11-27)
      In September 2016, three acutely jaundiced (AJS) pregnant women were admitted to Am Timan Hospital, eastern Chad. We described the outbreak and conducted a case test-negative study to identify risk factors for this genotype of HEV in an acute outbreak setting.
    • Learning Without Borders: A Review of the Implementation of Medical Error Reporting in Médecins Sans Frontières

      Shanks, Leslie; Bil, Karla; Fernhout, Jena (Public Library of Science, 2015-09-18)
      To analyse the results from the first 3 years of implementation of a medical error reporting system in Médecins Sans Frontières-Operational Centre Amsterdam (MSF) programs.
    • Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries

      Loyse, A; Burry, J; Cohn, J; Ford, N; Chiller, T; Ribeiro, I; Koulla-Shiro, S; Mghamba, J; Ramadhani, A; Nyirenda, R; et al. (The Lancet, 2018-10-18)
      In 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-income countries (LMICs): optimised combination therapies for confirmed meningitis cases and cryptococcal antigen screening programmes for ambulatory people living with HIV who access care. WHO's preferred therapy for the treatment of HIV-related cryptococcal meningitis in LMICs is 1 week of amphotericin B plus flucytosine, and the alternative therapy is 2 weeks of fluconazole plus flucytosine. In the ACTA trial, 1-week (short course) amphotericin B plus flucytosine resulted in a 10-week mortality of 24% (95% CI -16 to 32) and 2 weeks of fluconazole and flucytosine resulted in a 10-week mortality of 35% (95% CI -29 to 41). However, with widely used fluconazole monotherapy, mortality because of HIV-related cryptococcal meningitis is approximately 70% in many African LMIC settings. Therefore, the potential to transform the management of HIV-related cryptococcal meningitis in resource-limited settings is substantial. Sustainable access to essential medicines, including flucytosine and amphotericin B, in LMICs is paramount and the focus of this Personal View.
    • Leaving no one behind: Towards equitable global elimination of hepatitis C

      Dahl, EH; Zahid, H; Aslam, K; Jafri, W (Edinburgh University Global Health Society, 2020-03-14)
    • Lessons and challenges for measles control from unexpected large outbreak, Malawi

      Minetti, Andrea; Kagoli, Matthew; Katsulukuta, Agnes; Huerga, Helena; Featherstone, Amber; Chiotcha, Hazel; Noel, Delphine; Bopp, Cameron; Sury, Laurent; Fricke, Renzo; et al. (Center for Disease Control and Prevention, 2013-02-01)
      Despite high reported coverage for routine and supplementary immunization, in 2010 in Malawi, a large measles outbreak occurred that comprised 134,000 cases and 304 deaths. Although the highest attack rates were for young children (2.3%, 7.6%, and 4.5% for children <6, 6-8, and 9-11 months, respectively), persons >15 years of age were highly affected (1.0% and 0.4% for persons 15-19 and >19 years, respectively; 28% of all cases). A survey in 8 districts showed routine coverage of 95.0% for children 12-23 months; 57.9% for children 9-11 months; and 60.7% for children covered during the last supplementary immunization activities in 2008. Vaccine effectiveness was 83.9% for 1 dose and 90.5% for 2 doses. A continuous accumulation of susceptible persons during the past decade probably accounts for this outbreak. Countries en route to measles elimination, such as Malawi, should improve outbreak preparedness. Timeliness and the population chosen are crucial elements for reactive campaigns.
    • Lessons Learned about Pneumonic Plague Diagnosis from 2 Outbreaks, Democratic Republic of the Congo

      Bertherat, Eric; Thullier, Philippe; Shako, Jean Christophe; England, Kathleen; Kone, Mamadou Lamine; Arntzen, Lorraine; Tomaso, Herbert; Koyange, Louis; Formenty, Pierre; Ekwanzala, Florent; et al. (2011-04-25)
      Pneumonic plague is a highly transmissible infectious disease for which fatality rates can be high if untreated; it is considered extremely lethal. Without prompt diagnosis and treatment, disease management can be problematic. In the Democratic Republic of the Congo, 2 outbreaks of pneumonic plague occurred during 2005 and 2006. In 2005, because of limitations in laboratory capabilities, etiology was confirmed only through retrospective serologic studies. This prompted modifications in diagnostic strategies, resulting in isolation of Yersinia pestis during the second outbreak. Results from these outbreaks demonstrate the utility of a rapid diagnostic test detecting F1 antigen for initial diagnosis and public health management, as well as the need for specialized sampling kits and trained personnel for quality specimen collection and appropriate specimen handling and preservation for plague confirmation and Y. pestis isolation. Efficient frontline management and a streamlined diagnostic strategy are essential for confirming plague, especially in remote areas.
    • Limited effectiveness of high-dose liposomal amphotericin B (AmBisome) for treatment of visceral leishmaniasis in an Ethiopian population with high HIV prevalence.

      Ritmeijer, Koert; ter Horst, Rachel; Chane, Solomon; Aderie, Endashaw Mengistu; Piening, Turid; Collin, Simon M; Davidson, Robert N; Public Health Department, Médecins Sans Frontières, Amsterdam, the Netherlands. koert.ritmeijer@amsterdam.msf.org (2011-12)
      Due to unacceptably high mortality with pentavalent antimonials, Médecins Sans Frontières in 2006 began using liposomal amphotericin B (AmBisome) for visceral leishmaniasis (VL) patients in Ethiopia who were severely ill or positive for human immunodeficiency virus (HIV).
    • Localised transmission hotspots of a typhoid fever outbreak in the Democratic Republic of Congo

      Ali, E; Bergh, RVD; D'hondt, R; Kuma-Kuma, D; Weggheleire, AD; Baudot, Y; Lambert, V; Hunter, P; Zachariah, R; Maes, P (PAMJ-Center for Public Health Research and Information, 2017)
      In a semi-urban setting in the Democratic Republic of Congo, this study aims to understand the dynamic of a typhoid fever (TF) outbreak and to assess: a) the existence of hot spots for TF transmission and b) the difference between typhoid cases identified within those hot spots and the general population in relation to socio-demographic characteristics, sanitation practice, and sources of drinking water.
    • Long-acting chloramphenicol versus intravenous ampicillin for treatment of bacterial meningitis.

      Pécoul, B; Varaine, F; Keita, M; Soga, G; Djibo, A; Soula, G; Abdou, A; Etienne, J; Rey, M; Epicentre, Paris, France. (Elsevier, 1991-10-05)
      In most developing countries, bacterial meningitis (BM) is associated with a high case-fatality rate. The search for a simple, convenient, and inexpensive antibiotic treatment remains a priority. In this study, a non-blinded, multicentre, randomised clinical trial of 528 cases of BM was done in two hospitals in Mali and Niger, between March, 1989, and May, 1990, to see whether a double injection of long-acting chloramphenicol (on admission to hospital and 48 h later) is as effective as a course of intravenous ampicillin (8 days, 4 times a day). The cumulative case-fatality rate on day 4 (principal end-point) among the chloramphenicol (254 patients) and ampicillin (274) groups were, respectively, 28% and 24.5% (relative risk 1.14, 95% confidence interval 0.86-1.52). No outbreak occurred during the study period. The hospital case-fatality rate was 33.1%. Main risk factors for death were associated with clinical condition on admission--ie, altered consciousness, convulsions, or dehydration. The case-fatality rates were 13% (21/161) for Neisseria meningitidis, 36.1% (48/133) for Haemophilus influenzae, and 67% (77/115) for Streptococcus pneumoniae. In a multiple logistic regression model, controlling for the differential distribution of potential risk factors (including bacterial species), there was no difference between treatment groups. Our findings suggest that long-acting chloramphenicol is a useful first-line presumptive treatment for BM in high-incidence countries.
    • A long-lasting measles epidemic in Maroua, Cameroon 2008-2009: mass vaccination as response to the epidemic.

      Luquero, Francisco J; Pham-Orsetti, Heloise; Cummings, D A T; Ngaunji, Philippe E; Nimpa, Marcelino; Fermon, Florence; Ngoe, Ndong; Sosler, Stephen; Strebel, Peter; Grais, RFebecca F; et al. (2011-07)
      A measles outbreak occurred in Maroua, Cameroon, from January 2008 to April 2009. In accordance with recent World Health Organization guidelines, an outbreak-response immunization (ORI) was conducted in January 2009. The aim of this study was to investigate the causes of the epidemic in order to guide vaccination strategies.
    • A look back at an ongoing problem: Shigella dysenteriae type 1 epidemics in refugee settings in Central Africa (1993-1995).

      Kernéis, Solen; Guerin, Philippe J; von Seidlein, Lorenz; Legros, Dominique; Grais, RFebecca F; Epicentre, Paris, France. (2009-02)
      BACKGROUND: Shigella dysenteriae type 1 (Sd1) is a cause of major dysentery outbreaks, particularly among children and displaced populations in tropical countries. Although outbreaks continue, the characteristics of such outbreaks have rarely been documented. Here, we describe the Sd1 outbreaks occurring between 1993 and 1995 in 11 refugee settlements in Rwanda, Tanzania and Democratic Republic of the Congo (DRC). We also explored the links between the different types of the camps and the magnitude of the outbreaks. METHODOLOGY/PRINCIPAL FINDINGS: Number of cases of bloody diarrhea and deaths were collected on a weekly basis in 11 refugee camps, and analyzed retrospectively. Between November 1993 and February 1995, 181,921 cases of bloody diarrhea were reported. Attack rates ranged from 6.3% to 39.1% and case fatality ratios (CFRs) from 1.5% to 9.0% (available for 5 camps). The CFRs were higher in children under age 5. In Tanzania where the response was rapidly deployed, the mean attack rate was lower than in camps in the region of Goma without an immediate response (13.3% versus 32.1% respectively). CONCLUSIONS/SIGNIFICANCE: This description, and the areas where data is missing, highlight both the importance of collecting data in future epidemics, difficulties in documenting outbreaks occurring in complex emergencies and most importantly, the need to assure that minimal requirements are met.
    • Maculopapular lesions in the Central African Republic

      Berthet, Nicolas; Nakouné, Emmanuel; Whist, Eline; Selekon, Benjamin; Burguière, Ana-Maria; Manuguerra, Jean-Claude; Gessain, Antoine; Kazanji, Mirdad; Institut Pasteur, Epidemiology and Physiopathology of Oncogenic Viruses Unit, CNRS URA 3015; Institut Pasteur, Laboratory for Urgent Responses to Biological Threats, Paris, France; Institut Pasteur in Bangui, Department of Virology, Bangui, Central African Republic d Médecins Sans Frontières, Paris, France (Elservier, 2011-10-08)