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  • The STREAM trial: missed opportunities and lessons for future clinical trials.

    Loveday, M; Reuter, A; Furin, J; Seddon, JA; Cox, H (Elsevier, 2019-04-01)
    Final results of the STREAM trial were presented at the 2018, 49th Union World Conference on Lung Health, held in The Hague, The Netherlands. STREAM is a randomised controlled trial comparing the 18–24 month WHO-recommended multidrug-resistant tuberculosis (MDR-TB) treatment regimen with a 9–12 month regimen similar to that first described in Bangladesh. 1 Under programmatic conditions, the longer regimen results in treatment success for approximately 50% of patients, 2 whereas the shorter 9–12 month regimen improved treatment success to 80% or higher in selected countries. 3 , 4 Because these countries had relatively low HIV prevalence and relatively high percentages of treatment success with the longer regimens, questions around generalisability were raised. 4 STREAM was a multi-million dollar undertaking that took almost 10 years from the time of study design until the release of final results. Given the time and costs involved it is essential to reflect on lessons learned, and what the trial results tell us to inform how we accumulate future evidence to guide MDR-TB treatment.
  • SMS-based smartphone application for disease surveillance has doubled completeness and timeliness in a limited-resource setting – evaluation of a 15-week pilot program in Central African Republic (CAR)

    El-Khatib, Z; Shah, M; Zallappa, SN; Nabeth, P; Guerra, J; Manengu, CT; Yao, M; Philibert, A; Massina, L; Staiger, CP; Mbailao, R; Kouli, JP; Mboma, H; Duc, G; Inagbe, D; Barry, AB; Dumont, T; Cavailler, P; Quere, M; Willett, B; Reaiche, S; de Ribaucourt, H; Reeder, B (BMC, 2018-10-24)
  • Inter-rater and intrarater reliability of the South African Triage Scale in low-resource settings of Haiti and Afghanistan

    Dalwai, M; Tayler-Smith, K; Twomey, M; Nasim, M; Popal, AQ; Haqdost, WH; Gayraud, O; Cheréstal, S; Wallis, L; Valles, P (BMJ Publishing Group, 2018-03-16)
    The South African Triage Scale (SATS) has demonstrated good validity in the EDs of Médecins Sans Frontières (MSF)-supported sites in Afghanistan and Haiti; however, corresponding reliability in these settings has not yet been reported on. This study set out to assess the inter-rater and intrarater reliability of the SATS in four MSF-supported EDs in Afghanistan and Haiti (two trauma-only EDs and two mixed (including both medical and trauma cases) EDs).
  • Beyond Open Data: Realising the Health Benefits of Sharing Data

    Pisani, E; Aaby, P; Breugelmans, JG; Carr, D; Groves, T; Helinski, M; Kamuya, D; Kern, S; Littler, K; Marsh, V; Mboup, S; Merson, L; Sankoh, O; Serafini, M; Schneider, M; Schoenenberger, V; Guerin, Philippe J (BMJ Publishing Group, 2016-10-10)
  • Overlooking the Importance of Immunoassays - Authors' Reply

    Cnops, L; van Griensven, J; Honko, AN; Bausch, DG; Sprecher, A; Hill, CE; Colebunders, R; Johnson, JC; Griffiths, A; Palacios, GF; Kraft, CS; Kobinger, G; Hewlett, A; Norwood, DA; Sabeti, P; Jahrling, PB; Formenty, P; Kuhn, JH; Ariën, KK (Elsevier, 2016-10-01)
  • Open Source Software For Patient Data Management In Critical Care

    Massaut, J; Charretk, N; Gayraud, O; Van Den Bergh, R; Charles, A; Edema, N (IOS Press, 2015)
    We have previously developed a Patient Data Management System for Intensive Care based on Open Source Software. The aim of this work was to adapt this software to use in Emergency Departments in low resource environments. The new software includes facilities for utilization of the South African Triage Scale and prediction of mortality based on independent predictive factors derived from data from the Tabarre Emergency Trauma Center in Port au Prince, Haiti.
  • An alternative classification to mixture modeling for longitudinal counts or binary measures

    Subtil, F; Boussari, O; Bastard, M; Etard, J-F; Ecochard, R; Génolini, C (SAGE Publications, 2014-09-01)
    Classifying patients according to longitudinal measures, or trajectory classification, has become frequent in clinical research. The k-means algorithm is increasingly used for this task in case of continuous variables with standard deviations that do not depend on the mean. One feature of count and binary data modeled by Poisson or logistic regression is that the variance depends on the mean; hence, the within-group variability changes from one group to another depending on the mean trajectory level. Mixture modeling could be used here for classification though its main purpose is to model the data. The results obtained may change according to the main objective. This article presents an extension of the k-means algorithm that takes into account the features of count and binary data by using the deviance as distance metric. This approach is justified by its analogy with the classification likelihood. Two applications are presented with binary and count data to show the differences between the classifications obtained with the usual Euclidean distance versus the deviance distance.
  • Does research make a difference to public health? Time for scientific journals to cross the Rubicon

    Harries, A D; Zachariah, R; Ramsay, A; Kumar, A M V; Reid, A J; Terry, R F; Reeder, J C (International Union Against TB and Lung Disease, 2014-04-14)
  • Should mortality data for the elderly be collected routinely in emergencies? The practical challenges of age-disaggregated surveillance systems

    du Cros, P; Venis, S; Karunakara, U; Manson Unit, Médecins Sans Frontières, London, UK. (Oxford University Press, 2013-11)
    Data on the elderly are rarely collected in humanitarian emergencies. During a refugee crisis in South Sudan, Médecins Sans Frontières developed a prospective mortality surveillance system collecting data for those aged ≥50 years and found that the elderly were dying at five times the rate of those aged 5-49 years. Practical and ethical issues arose. Were reported ages accurate? Since no baseline exists, what does the mortality rate mean? Should programmatic changes be made without evidence that these would reduce the elderly mortality rate? We outline issues to be addressed to enable informed decisions on response to elderly populations in emergency settings.
  • The power of data: using routinely collected data to improve public health programmes and patient outcomes in low-and middle-income countries

    Harries, A D; Zachariah, R; Maher, D; International Union against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene and Tropical Medicine, London, UK. (John Wiley & Sons Ltd., 2013-09-18)
  • References for scientific papers: why not standardise to one global style? [Notes from the field]

    Harries, A D; Kumar, A M V; Satyanarayana, S; Bissell, K; Hinderaker, S G; Edginton, M; Reid, A J; Zachariah, R (2013-09)
  • Oops, what about ethics?

    Oladimeji, O; Isaakidis, P; Zachariah, R; Hinderaker, S G; Koghali, M; van Griensven, J; Harries, A D; Edginton, M E (2013-09)
  • Village registers for vital registration in rural Malawi

    Singogo, E; Kanike, E; van Lettow, M; Cataldo, F; Zachariah, R; Bissell, K; Harries, A D; Dignitas International, Zomba, Malawi. (John Wiley & Sons Ltd, 2013-08)
    Paper-based village registers were introduced 5 years ago in Malawi as a tool to measure vital statistics of births and deaths at the population level. However, usage, completeness and accuracy of their content have never been formally evaluated. In Traditional Authority Mwambo, Zomba district, Malawi, we assessed 280 of the 325 village registers with respect to (i) characteristics of village headmen who used village registers, (ii) use and content of village registers, and (iii) whether village registers provided accurate information on births and deaths. All village headpersons used registers. There were 185 (66%) registers that were regarded as 95% completed, and according to the registers, there were 115 840 people living in the villages in the catchment area. In 2011, there were 1753 births recorded in village registers, while 6397 births were recorded in health centre registers in the same catchment area. For the same year, 199 deaths were recorded in village registers, giving crude death rates per 100 000 population of 189 for males and 153 for females. These could not be compared with death rates in health centre registers due to poor and inconsistent recording in these registers, but they were compared with death rates obtained from the 2010 Malawi Demographic Health Survey that reported 880 and 840 per 100 000 for males and females, respectively. In conclusion, this study shows that village registers are a potential source for vital statistics. However, considerable inputs are needed to improve accuracy of births and deaths, and there are no functional systems for the collation and analysis of data at the traditional authority level. Innovative ways to address these challenges are discussed, including the use of solar-powered electronic village registers and mobile phones, connected with each other and the health facilities and the District Commissioner's office through the cellular network and wireless coverage.
  • Oh no! Power out, internet down! Two challenges in running training courses in low- and middle-income countries [Editorial]

    Demez, C; Zachariah, R; Reid, T; Harries, A D (International Union Against TB and Lung Disease, 2013-06)
  • Applying the ICMJE authorship criteria to operational research in low-income countries: the need to engage programme managers and policy makers [letter]

    Zachariah, R; Reid, T; Van den Bergh, R; Dahmane, A; Kosgei, R J; Hinderaker, S G; Tayler-Smith, K; Manzi, M; Kizito, W; Khogali, M; Kumar, A M V; Baruani, B; Bishinga, A; Kilale, A M; Nqobili, M; Patten, G; Sobry, A; Cheti, E; Nakanwagi, A; Enarson, D A; Edginton, M E; Upshur, R; Harries, A D; Medical Department (Operational Research Unit), Medecins sans Frontieres, Operational Centre Brussels, MSF-Luxembourg, Luxembourg, Luxembourg. (Wiley-Blackwell, 2013-05-30)
  • Too complicated for the field? Measuring quality of care in humanitarian aid settings

    Kersten, R; Bosse, G; Dörner, F; Slavuckij, A; Fernandez, G; Marx, M; Independent International Health Consultant, Berlin, Germany (Co-Action Publishing, 2013-05-16)
    While quality of care is a major concern in the western world, not many studies investigate this topic in low-income countries. Even less is known about the quality of care in humanitarian aid settings, where additional challenges from natural or manmade disasters contribute to additional challenges. This study tried to address this gap by introducing a new approach to systematically measure quality of care in a project of Médecins Sans Frontières (MSF) in Agok area, between South Sudan and Sudan. Our objective was to obtain a valid snapshot of quality of care for a MSF project in three weeks that has the potential to serve as a baseline for quality improvement strategies. The evaluation followed a cross-sectional study design to assess structural, process and outcome quality according to Donabedian's criteria of quality of care. A bundle of well-established methods for collection of quantitative and qualitative data was used to assess the project by following a triangulated mixed-methods approach. Mean structural quality scored 73% of expected performance level and mean process quality 59%. The overall mortality rate for the hospital was 3.6%. On average, less complicated cases got a better level of care than patients who were seriously ill. Significant motivational issues were discovered in staff interviews potentially affecting quality of care. The tool appeared to be quick, feasible and effective in judging quality of care in the selected project. To tap the whole potential of the approach a re-evaluation should be carried out to assess the effectiveness of implemented improvement strategies in Agok. To confirm the usefulness of the approach, more studies are needed covering the variety of different humanitarian aid settings.
  • Making sure that clinical trial results make a difference: Operational Research and the Hierarchy of Evidence.

    Ford, N; Maher, D; Médecins sans Frontiéres, Geneva, Switzerland. (2013-02-08)

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