• Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007–2013

      Kihara, A-B; Harries, A D; Bissell, K; Kizito, W; Van Den Berg, R; Mueke, S; Mwangi, A; Sitene, J C; Gathara, D; Kosgei, R J; et al. (International Union Against Tuberculosis and Lung Disease, 2015-03-21)
    • Bringing care to the community: expanding access to health care in rural Malawi through mobile health clinics

      Geoffroy, E; Harries, A D; Bissell, K; Schell, E; Bvumbwe, A; Tayler-Smith, K; Kizito, W (International Union Against Tuberculosis and Lung Disease, 2014-12-21)
    • Building operational research capacity in the Pacific

      Bissel, K; Viney, K; Brostrom, R; Gounder, S; Khogali, M; Kishore, K; Kool, B; Kumar, A M V; Manzi, M; Marais, B; et al. (The Union, 2014-06-21)
      Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.
    • Caring for patients with surgically resectable cancers: experience from a specialised centre in rural Rwanda

      Mubiligi, J M; Hedt-Gauthier, B; Mpunga, T; Tapela, N; Okao, P; Harries, A D; Edginton, M E; Driscoll, C; Mugabo, L; Riviello, R; et al. (The Union, 2014-06-21)
    • Childhood immunization in Bungoma County, Kenya, from 2008 to 2011: need for improved uptake

      Mbuthia, G W; Harries, A D; Obala, A A; Nyamogoba, H D N; Simiyu, C; Edginton, M E; Khogali, M; Hedt-Gauthier, B L; Otsyla, B K (International Union Against Tuberculosis and Lung Disease, 2014-03)
      Uptake of immunisations in children aged 1–2 years in Bungoma County, Kenya, was determined as part of the 6-monthly Health and Demographic Surveillance System surveys. A total of 2699 children were assessed between 2008 and 2011. During this time period, full immunisation declined significantly from 84% to 58%,and measles vaccine declined uptake from 89% to 60%(P<0.001). Each year there was a significant fall-off for the third doses of the oral polio and pentavalent vaccines(P<0.001). These findings are of concern, as low immunisation coverage may lead to vaccine-preventable disease outbreaks. Further investigations into the reasons for declining immunisation trends are required.
    • Diabetes mellitus and treatment outcomes in Palestine refugees in UNRWA primary health care clinics in Jordan

      Khader, A; Ballout, G; Shahin, Y; Hababeh, M; Farajallah, L; Zeiden, W; Abu-Zayed, I; Kochi, A; Harries, A D; Zachariah, R; et al. (International Union Against Tuberculosis and Lung Disease, 2014-03-25)
    • A four-year nationwide molecular epidemiological study in Estonia: risk factors for tuberculosis transmission

      Toit, K; Altraja, A; Acosta, C D; Viiklepp, P; Kremer, K; Kummik, T; Danilovitš, M; Van den Bergh, R; Harries, A D; Supply, P (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • High Mortality in Tuberculosis Patients Despite HIV Interventions in Swaziland

      Mchunu, G; van Griensven, J; Hinderaker, S G; Kizito, W; Sikhondze, W; Manzi, M; Dlamini, T; Harries, A D (International Union Against TB and Lung Disease, 2016-06-21)
    • The journey to antiretroviral therapy in Karnataka, India: who was lost on the road?

      Shastri, S; Sathyanarayna, S; Nagaraja, S B; Kumar, A M V; Rewari, B; Harries, A D; Zachariah, R (International AIDS Society, 2013)
      One important operational challenge facing antiretroviral treatment (ART) programmes in low- and middle-income countries is the loss to follow-up between diagnosis of human immunodeficiency virus (HIV) and initiation of ART. This is a major obstacle to achieving universal access to ART. This study from Karnataka, India, tried to measure such losses by determining the number of HIV-positive individuals diagnosed, the number of them reaching ART centres, the number initiated on ART and the reasons for non-initiation of ART.
    • Managing and Monitoring Chronic Non-Communicable Diseases in a Primary Health Care Clinic, Lilongwe, Malawi

      Manjomo, RC; Mwagomba, B; Ade, S; Ali, E; Ben-Smith, A; Khomani, P; Bondwe, P; Nkhoma, D; Douglas, GP; Tayler-Smith, K; et al. (International Union Against Tuberculosis and Lung Disease, 2016-06-21)
      Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi.
    • Managing and Monitoring Chronic Non-Communicable Diseases in a Primary Health Care Clinic, Lilongwe, Malawi

      Manjomo, R C; Mwagomba, B; Ade, S; Ali, E; Ben-Smith, A; Khomani, P; Bondwe, P; Nkhoma, D; Douglas, G P; Tayler-Smith, K; et al. (International Union Against TB and Lung Disease, 2016-06-21)
      Setting: Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi. Objective: Using an electronic medical record monitoring system, to describe the quarterly and cumulative disease burden, management and outcomes of patients registered between March 2014 and June 2015. Design: A cross-sectional study. Results: Of 1135 patients, with new registrations increasing each quarter, 66% were female, 21% were aged 65 years, 20% were obese, 53% had hypertension alone, 18% had diabetes alone, 12% had asthma, 10% had epilepsy and 7% had both hypertension and diabetes. In every quarter, about 30% of patients did not attend the clinic and 19% were registered as lost to follow-up (not seen for 1 year) in the last quarter. Of those attending, over 90% were prescribed medication, and 80–90% with hypertension and/or diabetes had blood pressure/blood glucose measured. Over 85% of those with epilepsy had no seizures and 60–75% with asthma had no severe attacks. Control of blood pressure (41–51%) and diabetes (15–38%) was poor. Conclusion: It is feasible to manage patients with non-communicable diseases in a primary health care setting in Malawi, although more attention is needed to improve clinic attendance and the control of hypertension and diabetes.
    • Mass Treatment to Eliminate Tuberculosis from an Island Population

      Hill, P C; Dye, C; Viney, K; Tabutoa, K; Kienene, T; Bissell, K; Williams, B G; Zachariah, R; Marais, B J; Harries, A D (International Union Against Tuberculosis and Lung Disease, 2014-08-01)
      The global target of tuberculosis (TB) elimination by 2050 requires new approaches. Active case finding plus mass prophylactic treatment has been disappointing. We consider mass full anti-tuberculosis treatment as an approach to TB elimination in Kiribati, a Pacific Island nation, with a persistent epidemic of high TB incidence.
    • Multi- and extensively drug-resistant tuberculosis in Latvia: trends, characteristics and treatment outcomes

      Kuksa, L; Riekstina, V; Leimane, V; Ozere, I; Skenders, G; Van den Bergh, R; Kremer, K; Acosta, C D; Harries, A D (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Non-monetary incentives for pregnant women and antenatal attendance among Ethiopian pastoralists

      Zachariah, R; De Smet, M; Etienne, W; Khogali, M; van Den Bergh, R; Veerman, R; Harries, A D (International Union Against Tuberculosis and Lung Disease, 2014-06-21)
    • Open access for operational research publications from low- and middle-income countries: who pays?

      Zachariah, R; Kumar, A M V; Reid, A J; Van den Bergh, R; Isaakidis, P; Draguez, B; Delaunois, P; Nagaraja, S B; Ramsay, A; Reeder, J C; et al. (International Union Against Tuberculosis and Lung Disease, 2014-09-21)
    • Provider-initiated HIV testing and counselling for TB in low HIV prevalence settings: is it worthwhile?

      Nagai, S; Robinson, R; Rahamefy, J R; Randriambeloson, S J; Ranaivomanana, D A; Razafindranaivo, T; Rakotobe, L; Ranaivo, A; Hinderaker, S G; Harries, A D; et al. (Oxford University Press, 2014-01-23)
      We assessed the HIV-positive yield of offering provider-initiated HIV testing and counselling (PITC) for TB and the costs, in Madagascar, which has a low HIV prevalence and a high TB burden.
    • Providing emergency care and assessing a patient triage system in a referral hospital in Somaliland: a cross-sectional study

      Sunyoto, T; Van den Bergh, R; Valles, P; Gutierrez, R; Ayada, L; Zachariah, R; Yassin, A; Hinderaker, S; Harries, A D (2014-11-06)
      BackgroundIn resource-poor settings, where health systems are frequently stretched to their capacity, access to emergency care is often limited. Triage systems have been proposed as a tool to ensure efficiency and optimal use of emergency resources in such contexts. However, evidence on the practice of emergency care and the implementation of triage systems in such settings, is scarce. This study aimed to assess emergency care provision in the Burao district hospital in Somaliland, including the application of the South African Triage Scale (SATS) tool.MethodsA cross-sectional descriptive study was undertaken. Routine programme data of all patients presenting at the Emergency Department (ED) of Burao Hospital during its first year of service (January to December 2012) were analysed. The American College of Surgeons Committee on Trauma (ACSCOT) indicators were used as SATS targets for high priority emergency cases (¿high acuity¿ proportion), overtriage and undertriage (with thresholds of >25%, <50% and <10%, respectively).ResultsIn 2012, among 7212 patients presented to the ED, 41% were female, and 18% were aged less than five. Only 21% of these patients sought care at the ED within 24 hours of developing symptoms. The high acuity proportion was 22.3%, while the overtriage (40%) and undertriage (9%) rates were below the pre-set thresholds. The overall mortality rate was 1.3% and the abandon rate 2.0%. The outcomes of patients corresponds well with the color code assigned using SATS.ConclusionThis is the first study assessing the implementation of SATS in a post-conflict and resource-limited African setting showing that most indicators met the expected standards. In particular, specific attention is needed to improve the relatively low rate of true emergency cases, delays in patient presentation and in timely provision of care within the ED. This study also highlights the need for development of emergency care thresholds that are more adapted to resource-poor contexts. These issues are discussed.
    • Public Health Action for public health action

      Harries, A D; Bianchi, L; Jensen, P M; Pantages, M; Bissell, K; Kumar, A M V; Hinderaker, S G; Tayler-Smith, K; Van den Bergh, R; van den Boogaard, W; et al. (International Union Against Tuberculosis and Lung Disease, 2014-09-21)
    • Scale-Up of ART in Malawi Has Reduced Case Notification Rates in HIV-Positive and HIV-Negative Tuberculosis

      Kanyerere, H; Girma, B; Mpunga, J; Tayler-Smith, K; Harries, A D; Jahn, A; Chimbwandira, FM (International Union Against Tuberculosis and Lung Disease, 2016-12-21)
      Setting: For 30 years, Malawi has experienced a dual epidemic of human immunodeficiency virus (HIV) infection and tuberculosis (TB) that has recently begun to be attenuated by the scale-up of antiretroviral therapy (ART). Objective: To report on the correlation between ART scale-up and annual national TB case notification rates (CNR) in Malawi, stratified by HIV-positive and HIV-negative status, from 2005 to 2015. Design: A retrospective descriptive ecological study using aggregate data from national reports. Results: From 2005 to 2015, ART was scaled up in Malawi from 28 470 to 618 488 total patients, with population coverage increasing from 2.4% to 52.2%. During this time, annual TB notifications declined by 35%, from 26 344 to 17 104, and the TB CNR per 100 000 population declined by 49%, from 206 to 105. HIV testing uptake increased from 51% to 92%. In known HIV-positive TB patients, the CNR decreased from a high of 1247/100 000 to 710/100 000, a 43% decrease. In known HIV-negative TB patients, the CNR also decreased, from a high of 66/100 000 to 49/100 000, a 26% decrease. Conclusion: TB case notifications have continued to decline in association with ART scale-up, with the decline seen more in HIV-positive than HIV-negative TB. These findings have programmatic implications for national TB control efforts.
    • The Structured Operational Research and Training Initiative for public health programmes

      Ramsay, A; Harries, A D; Zachariah, R; Bissel, K; Hinderaker, S G; Edginton, M; Enarson, D A; Satyanarayana, S; Kumar, A M V; Hoa, N B; et al. (The Union, 2014-06-21)