• Antibiotic use in a district hospital in Kabul, Afghanistan: are we overprescribing?

      Bajis, S; Van den Bergh, R; De Bruycker, M; Mahama, G; Van Overloop, C; Satyanarayana, S; Bernardo, R S; Esmati, S; Reid, A J (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.
    • Do incentives improve tuberculosis treatment outcomes in the Republic of Moldova?

      Ciobanu, A; Domente, L; Soltan, V; Bivol, S; Severin, L; Plesca, V; Van den Bergh, R; Kumar, A M V; de Colombani, P (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Early Physical and Functional Rehabilitation of Trauma Patients in the Médecins Sans Frontières Trauma Centre in Kunduz, Afghanistan: Luxury or Necessity?

      Gohy, B; Ali, E; Van den Bergh, R; Schillberg, E; Nasim, M; Naimi, MM; Cheréstal, S; Falipou, P; Weerts, E; Skelton, P; et al. (Oxford University Press, 2016-10-13)
      In Afghanistan, Médecins Sans Frontières provided specialised trauma care in Kunduz Trauma Centre (KTC), including physiotherapy. In this study, we describe the development of an adapted functional score for patient outcome monitoring, and document the rehabilitation care provided and patient outcomes in relation to this functional score.
    • 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)
    • Intensive-Phase Treatment Outcomes among Hospitalized Multidrug-Resistant Tuberculosis Patients: Results from a Nationwide Cohort in Nigeria

      Oladimeji, O; Isaakidis, P; Obasanya, O J; Eltayeb, O; Khogali, M; Van den Bergh, R; Kumar, A M V; Hinderaker, S G; Abdurrahman, S T; Lawson, L; et al. (Public Library of Science, 2014-04)
      Nigeria is faced with a high burden of Human Immunodeficiency Virus (HIV) infection and multidrug-resistant tuberculosis (MDR-TB). Treatment outcomes among MDR-TB patients registered across the globe have been poor, partly due to high loss-to-follow-up. To address this challenge, MDR-TB patients in Nigeria are hospitalized during the intensive-phase(IP) of treatment (first 6-8 months) and are provided with a package of care including standardized MDR-TB treatment regimen, antiretroviral therapy (ART) and cotrimoxazole prophylaxis (CPT) for HIV-infected patients, nutritional and psychosocial support. In this study, we report the end-IP treatment outcomes among them.
    • Knockdown and recovery of malaria diagnosis and treatment in Liberia during and after the 2014 Ebola outbreak

      Dunbar, NK; Richards, EE; Woldeyohannes, D; Van den Bergh, R; Wilkinson, E; Tamang, D; Owiti, P (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
      Setting: The malaria-endemic country of Liberia, before, during and after the 2014 Ebola outbreak. Objective: To describe the consequences of the Ebola outbreak on Liberia's National Malaria Programme and its post-Ebola recovery. Design: A retrospective cross-sectional study using routine countrywide programme data. Results: Malaria caseloads decreased by 47% during the Ebola outbreak and by 11% after, compared to the pre-Ebola period. In those counties most affected by Ebola, a caseload reduction of >20% was sustained for 12 consecutive months, while this lasted for only 4 consecutive months in the counties least affected by Ebola. Linear regression of monthly proportions of confirmed malaria cases-as a proxy indicator of programme performance-over the pre- and post-Ebola periods indicated that the malaria programme could require 26 months after the end of the acute phase of the Ebola outbreak to recover to pre-Ebola levels. Conclusions: The differential persistence of reduced caseloads in the least- and most-affected counties, all of which experienced similar emergency measures, suggest that factors other than Ebola-related security measures played a key role in the programme's reduced performance. Clear guidance on when to abandon the emergency measures after an outbreak may be needed to ensure faster recovery of malaria programme performance.
    • Management of previously treated tuberculosis patients in Kalutara district, Sri Lanka: how are we faring?

      Abeygunawardena, S C; Sharath, B N; Van den Bergh, R; Naik, B; Pallewatte, N; Masaima, M N N (The Union, 2014-06-21)
    • 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)
    • 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)
    • Pattern of primary tuberculosis drug resistance and associated treatment outcomes in Transnistria, Moldova

      Dolgusev, O; Obevzenco, N; Padalco, O; Pankrushev, S; Ramsay, A; Van den Bergh, R; Manzi, M; Denisiuk, O; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Performance of decentralised facilities in tuberculosis case notification and treatment success in Armenia

      Davtyan, K; Zachariah, R; Davtyan, H; Ramsay, A; Denisiuk, O; Manzi, M; Khogali, M; Van den Bergh, R; Hayrapetyan, A; Dara, M (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • Picking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after study

      Maini, R; Van den Bergh, R; van Griensven, J; Tayler-Smith, K; Ousley, J; Carter, D; Mhatre, S; Ho, L; Zachariah, R (BioMed Central, 2014-11-05)
      BackgroundUser fees have been shown to constitute a major barrier to the utilisation of health-care, particularly in low-income countries such as the Democratic Republic of Congo (DRC). Importantly, such barriers can lead to the exclusion of vulnerable individuals from health-care. In 2008, a donor-funded primary health-care programme began implementing user fee subsidisation in 20 health zones of the DRC. In this study, we quantified the short and long-term effects of this policy on health-care utilisation.MethodsSixteen health zones were included for analysis. Using routinely collected health-care utilisation data before and after policy implementation, interrupted time series regression was applied to quantify the temporal impact of the user fee policy in the studied health zones. Payment of salary supplements to health-care workers and provision of free drugs - the other components of the programme - were controlled for where possible.ResultsFourteen (88%) health zones showed an immediate positive effect in health-care utilisation rates (overall median increase of 19%, interquartile range 11 to 43) one month after the policy was introduced, and the effect was significant in seven zones (P <0.05). This initial effect was sustained or increased at 24 months in five health zones but was only significant in one health zone at P <0.05. Utilisation reduced over time in the remaining health zones (overall median increase of 4%, interquartile range ¿10 to 33). The modelled mean health-care utilisation rate initially increased significantly from 43 consultations/1000 population to 51 consultations/1000 population during the first month following implementation (P <0.01). However, the on-going effect was not significant (P =0.69).ConclusionsOur research brings mixed findings on the effectiveness of user fee subsidisation as a strategy to increase the utilisation of services. Future work should focus on feasibility issues associated with the removal or reduction of user fees and how to sustain its effects on utilisation in the longer term.
    • Procurement and Supply Management System for MDR-TB in Nigeria: Are the Early Warning Targets for Drug Stock Outs and Over Stock of Drugs Being Achieved?

      Jatau, B; Avong, Y; Ogundahunsi, O; Shah, S; Tayler Smith, K; Van den Bergh, R; Zachariah, R; van Griensven, J; Ekong, E; Dakum, P (Public Library of Science, 2015-06-22)
      The World Health Organisation (WHO) introduced the twelve early warning indicators for monitoring and evaluating drug Procurement and Supply management (PSM) systems, intended to prevent drug stock-outs and overstocking. Nigeria- one of the high Multi Drug Resistant Tuberculosis (MDR-TB) burden countries, scaled-up treatment in 2012 with the concurrent implementation of a PSM system.
    • Providing a gateway to prevention and care for the most at-risk populations in Bhutan: is this being achieved?

      Khandu, L; Zachariah, R; Van den Bergh, R; Wangchuk, D; Tshering, N; Wangmo, D; Ananthakrishnan, R; Dorji, T; Satyanarayana, S (International Union Against Tuberculosis and Lung Disease, 2014-03)
      Setting: Two free-standing urban human immunodeficiency virus (HIV) testing and counselling (HCT) centres in Bhutan offering services to the general population and targeting the most at-risk populations (MARPs). Objectives: To assess the trend in testing for HIV, hepatitis B and syphilis in both the general population and MARPs, and to determine if sociodemographic and risk behaviour characteristics are associated with HIV, hepatitis B and syphilis seropositivity. Design: Cross-sectional study using client records, 2009–2012. Results: Of 7894 clients, 3009 (38%) were from the general population, while 4885 (62%) were from MARPs. Over the 4-year period, testing declined progressively among the general population, while it increased or remained static for MARPs. Of 4885 MARPs, seropositivity was respectively 0.7%, 1.3% and 1.2% for HIV, hepatitis B and syphilis. Female sex workers (FSWs) (relative risk[RR] 4.4, P=0.03) and partners of person living with HIV(RR 25.9, P<0.001) had a higher risk of being HIV-positive. FSWs had also a greater risk of being syphilis-positive(RR 9.1, P<0.001). Conclusion: The increase in uptake of HCT services by MARPs is a welcome finding; however, the relatively static trends call for the introduction of community outreach approaches. The critical gateway being provided to MARPs is an ‘opportunity’ for the expansion of the current service package.
    • 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)
    • 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)
    • Tuberculosis in health care workers in Belarus

      Klimuk, D; Hurevich, H; Harries, A D; Babrukevich, A; Kremer, K; Van den Bergh, R; Acosta, C D; Astrauko, A; Skrahina, A (International Union Against Tuberculosis and Lung Disease, 2014-10-21)