• 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.
    • The Ebola Outbreak and Staffing in Public Health Facilities in Rural Sierra Leone: Who is Left to do the Job?

      Sylvester Squire, J; Hann, K; Denisiuk, O; Kamara, M; Tamang, D; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
      Setting: The 82 public health facilities of rural Kailahun District, Sierra Leone. Objective: The 2014-2015 Ebola virus disease outbreak in Sierra Leone led the Ministry of Health and Sanitation and stakeholders to set minimum standards of staffing (medical/non-medical) for a basic package of essential health services (BPEHS). No district-level information exists on staffing levels in relation to the Ebola outbreak. We examined the staffing levels before the Ebola outbreak, during the last month of the outbreak and 4 months after the outbreak, as well as Ebola-related deaths among health care workers (HCWs). Design: This was a retrospective cross-sectional study. Results: Of 805 recommended medical staff (the minimum requirement for 82 health facilities), there were deficits of 539 (67%) pre-Ebola, 528 (65%) during the Ebola outbreak and 501 (62%) post-Ebola, hovering at staff shortages of >50% at all levels of health facilities. Of the 569 requisite non-medical staff, the gap remained consistent, at 92%, in the three time periods. Of the 1374 overall HCWs recommended by the BPEHS, the current staff shortage is 1026 (75%). Of 321 facility-based HCWs present during Ebola, there were 15 (14 medical and one non-medical staff) Ebola-related and three non-Ebola related deaths among HCWs. Conclusion: The post-Ebola health-related human resource deficit is alarmingly high, with very few staff available to work. We call for urgent political will, resources and international collaboration to address this situation.
    • Effect of Previous Utilization and Out-Of-Pocket Expenditure on Subsequent Utilization of a State Led Public-Private Partnership Scheme "Chiranjeevi Yojana" to Promote Facility Births in Gujarat, India

      Yasobant, S; Shewade, HD; Vora, KS; Annerstedt, KS; Isaakidis, P; Dholakia, NB; Mavalankar, DV (BioMed Central, 2017-04-25)
      In Gujarat, India, a state led public private partnership scheme to promote facility birth named Chiranjeevi Yojana (CY) was implemented in 2005. Institutional birth is provided free of cost at accredited private health facilities to women from socially disadvantaged groups (eligible women). CY has contributed in increasing facility birth and providing substantially subsidized (but not totally free) birth care; however, the retention of mothers in this scheme in subsequent child birth is unknown. Therefore, we conducted a study aimed to determine the effect of previous utilization of the scheme and previous out of pocket expenditure on subsequent child birth among multiparous eligible women in Gujarat.
    • Effect of the 2014/2015 Ebola Outbreak on Reproductive Health Services in a Rural District of Guinea: an Ecological Study

      Camara, BS; Delamou, A; Diro, E; Béavogui, AH; El Ayadi, AM; Sidibé, S; Grovogui, FM; Takarinda, KC; Bouedouno, P; Sandouno, SD; et al. (Oxford University Press, 2017-03-18)
      The 2014/2015 Ebola outbreak was the most sustained in history. In Guinea, we compared trends in family planning, antenatal care, and institutional deliveries over the period before, during and after the outbreak.
    • Effects of the 2014 Ebola outbreak on antenatal care and delivery outcomes in Liberia: a nationwide analysis

      Shannon, FQ; Horace-Kwemi, E; Najjemba, R; Owiti, P; Edwards, J; Shringarpure, K; Bhat, P; Kateh, F N (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
      Setting: All health facilities, public and private, in Liberia, West Africa. Objectives: To determine access to antenatal care (ANC), deliveries and their outcomes before, during and after the 2014-2015 Ebola outbreak. Design: This was a descriptive cross-sectional study. Result: During the Ebola outbreak in Liberia, overall monthly reporting from health facilities plunged by 43%. Access to ANC declined by 50% and reported deliveries fell by one third during the outbreak. Reported deliveries by skilled attendants and Caesarian section declined by respectively 32% and 60%. Facility-based deliveries dropped by 35% and reported community deliveries fell by 47%. There was an overall decline in reported stillbirths, maternal and neonatal deaths, by 50%, during the outbreak. ANC, reported deliveries and related outcomes returned to pre-outbreak levels within one year following the outbreak. Conclusion: The Liberian health system was considerably weakened during the Ebola outbreak and had difficulties providing basic maternal health services. In the light of the major reporting gaps during the Ebola period, and the reduced use of health facilities for maternal care, these findings highlight the need for measures to avoid such disruptions during future outbreaks.
    • Engagement of Public and Private Medical Facilities in Tuberculosis Care in Myanmar: Contributions and Trends Over an Eight-Year Period

      Nwe, T; Saw, S; Le Win, L; Mon, M; van Griensven, J; Zhou, S; Chinnakali, P; Shah, S; Thein, S; Aung, S (BioMed Central, 2017-09-01)
      As part of the WHO End TB strategy, national tuberculosis (TB) programs increasingly aim to engage all private and public TB care providers. Engagement of communities, civil society organizations and public and private care provider is the second pillar of the End TB strategy. In Myanmar, this entails the public-public and public-private mix (PPM) approach. The public-public mix refers to public hospital TB services, with reporting to the national TB program (NTP). The public-private mix refers to private general practitioners providing TB services including TB diagnosis, treatment and reporting to NTP. The aim of this study was to assess whether PPM activities can be scaled-up nationally and can be sustained over time.
    • Factors associated with death and loss to follow-up in children on antiretroviral care in Mingalardon Specialist Hospital, Myanmar, 2006-2016

      Kaung Nyunt, KK; Han, WW; Satyanarayana, S; Isaakidis, P; Hone, S; Khaing, AA; Nguyen Binh, H; Oo, HN (Public Library of Science, 2018-04-05)
      Myanmar National AIDS programme's priority is to improve the survival of all people living with HIV by providing anti-retroviral therapy (ART) care. More than 7200 children (aged <15 years) have been enrolled into ART care from 2005 to 2016. A previous study showed that ~11% children on ART care had either died or were lost to follow-up by 60 months. Factors associated with death and lost-to follow-up (adverse outcomes) have not been previously studied.
    • Factors Associated with Unfavorable Treatment Outcomes in New and Previously Treated TB Patients in Uzbekistan: A Five Year Countrywide Study

      Gadoev, J; Asadov, D; Tillashaykhov, M; Tayler-Smith, K; Isaakidis, P; Dadu, A; Colombani, P d; Gudmund Hinderaker, S; Parpieva, N; Ulmasova, D; et al. (Public Library of Science, 2015-06-15)
      TB is one of the main health priorities in Uzbekistan and relatively high rates of unfavorable treatment outcomes have recently been reported. This requires closer analysis to explain the reasons and recommend interventions to improve the situation. Thus, by using countrywide data this study sought to determine trends in unfavorable outcomes (lost-to-follow-ups, deaths and treatment failures) and describe their associations with socio-demographic and clinical factors.
    • Fostering interest in research: evaluation of an introductory research seminar at hospitals in rural Rwanda

      Iribagiza, M K; Manikuzwe, A; Aquino, T; Amoroso, C; Zachariah, R; van Griensven, J; Schneider, S; Finnegan, K; Cortas, C; Kamanzi, E; et al. (International Union Against Tuberculosis and Lung Disease, 2014-12-21)
    • 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)
    • From diagnosis to case investigation for malaria elimination in Swaziland: is reporting and response timely?

      Dlamini, N; Zulu, Z; Kunene, S; Geoffroy, E; Ntshalintshali, N; Owiti, P; Sikhondze, W; Makadzange, K; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Background: Swaziland is one of the southern African countries that aim to eliminate malaria by 2020. In 2010, the country introduced an Immediate Disease Notification System (IDNS) for immediate reporting of notifiable diseases, including malaria. Health facilities are to report malaria cases within 24 h through a toll-free telephone number (977), triggering an alert for case investigation at the patient's household within 48 h. We assessed the completeness of reporting in the IDNS, the subsequent case investigation, and whether it was done within the stipulated timelines. Methods: A cross-sectional study using routine country-wide data. Results: Of 1991 malaria cases notified between July 2011 and June 2015, 76% were reported in the IDNS, of which 68% were investigated-a shortfall of 24% in reporting and 32% in case investigations. Of the 76% of cases reported through the IDNS, 62% were reported within 24 h and 20% were investigated within 48 h. These shortcomings were most pronounced in hospitals and private facilities. Investigated cases (n = 1346) were classified as follows: 60% imported, 35% local and 5% undetermined. Conclusion: The utilisation of the IDNS for case reporting to trigger investigation is crucial for active surveillance. There is a need to address the reporting and investigation gaps identified to ensure that malaria cases receive appropriate interventions.
    • Hidden dangers-prevalence of blood borne pathogens, hepatitis B, C, HIV and syphilis, among blood donors in Sierra Leone in 2016: opportunities for improvement: a retrospective, cross-sectional study.

      Yambasu, EE; Reid, A; Owiti, P; Manzi, M; Murray, MJS; Edwin, AK (African Field Epidemiology Network, 2018-05-18)
      INTRODUCTION: Transmissible blood-borne infections are a serious threat to blood transfusion safety in West African countries; and yet blood remains a key therapeutic product in the clinical management of patients. Sierra Leone screens blood donors for blood-borne infections but has not implemented prevention of mother-to-child transmission for hepatitis B. This study aimed to describe the overall prevalence of hepatitis B and C, HIV and syphilis among blood donors in Sierra Leone in 2016 and to compare the differences between volunteer versus family replacement donors, as well as urban versus rural donors. METHODS: Retrospective, cross-sectional study from January-December 2016 in five blood bank laboratories across the country. Routinely-collected programme data were analyzed; blood donors were tested with rapid diagnostic tests-HBsAg for HBV, anti-HCV antibody for HCV, antibodies HIV1&2 for HIV and TPHA for syphilis. RESULTS: There were 16807 blood samples analysed, with 80% from males; 2285 (13.6%) tested positive for at least one of the four pathogens. Overall prevalence was: 9.7% hepatitis B; 1.0% hepatitis C; 2.8% HIV; 0.8% syphilis. Prevalence was higher among samples from rural blood banks, the difference most marked for hepatitis C. The proportion of voluntary donors was 12%. Family replacement donors had a higher prevalence of hepatitis B, C and HIV than volunteers. CONCLUSION: A high prevalence of blood-borne pathogens, particularly hepatitis B, was revealed in Sierra Leone blood donors. The study suggests the country should implement the prevention of mother-to-child transmission of hepatitis B and push to recruit more volunteer, non-remunerated blood donors.
    • 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)
    • High quit rate among smokers with tuberculosis in a modified smoking cessation programme in Dhaka, Bangladesh

      Siddiquea, B N; Islam, M A; Bam, T S; Satyanarayana, S; Enarson, D A; Reid, A J; Husain, Md A; Ahmed, S M; Ferdous, S; Ishikawa, N (2013-08)
    • High time to use rapid tests to detect multidrug resistance in sputum smear-negative tuberculosis in Belarus

      Rusovich, V; Kumar, A M V; Skrahina, A; Hurevich, H; Astrauko, A; de Colombani, P; Tayler-Smith, K; Dara, M; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2014-12-21)
    • HIV Testing, Antiretroviral Therapy, and Treatment Outcomes in New Cases of Tuberculosis in Brazil, 2011

      Torrens, A; Bartholomay, P; Silva, S; Khogali, M; Verdonck, K; Bissell, K (Scielo Public Health, 2016-01-01)
      Objective To assess the implementation of HIV-related interventions for patients with tuberculosis (TB), as well as TB treatment outcomes in patients coinfected with HIV in Brazil in 2011. Methods This was a cross-sectional, operational research study of HIV-related interventions among TB cases and the sociodemographic and clinical characteristics of TB-HIV coinfected patients. It also used a retrospective cohort design to determine the association between antiretroviral therapy (ART) and favorable TB treatment outcomes. The source of data was a linkage of 2011 administrative health databases used by the National TB and HIV/AIDS Programs. Results Of 73 741 new cases of TB reported, 63.6% (46 865 patients) were tested for HIV; 10.3% were positive. Of patients with HIV, 45.9% or 3 502 were on ART. TB favorable outcome was achieved in 63.1% or 2 205 coinfected patients on ART and in only 35.4% or 1 459 of those not on ART. On multivariate analysis, the relative risk for the association between ART and TB treatment success was 1.72 (95% Confidence Interval = 1.64-1.81). Conclusions The linkage between national TB and HIV datasets has created a convenient baseline for ongoing monitoring of HIV testing, ART use, and TB treatment outcomes among coinfected patients. The low rates of HIV screening and ART use in 2011 need to be improved. The association between ART and treatment success adds to the evidence supporting timely initiation of ART for all patients with TB-HIV coinfection.
    • How effective is the integration of facility and community-based management of severe acute malnutrition in India?

      Kumar, B; Shrivastava, J; Satyanarayana, S; Reid, A J; Ali, E; Zodpey, S; Agnani, M (2013-12-21)
    • How has the Zimbabwe mycobacterial culture and drug sensitivity testing system among re-treatment tuberculosis patients functioned during the scale-up of the Xpert MTB/RIF assay?

      Timire, C; Takarinda, KC; Harries, AD; Mutunzi, H; Manyame-Murwira, B; Kumar, AMV; Sandy, C (Oxford University Press, 2018-06-01)
      In Zimbabwe, while the Xpert MTB/RIF assay is being used for diagnosing tuberculosis and rifampicin-resistance, re-treatment tuberculosis (TB) patients are still expected to have culture and drug sensitivity testing (CDST) performed at national reference laboratories for confirmation. The study aim was to document the Xpert MTB/RIF assay scale-up and assess how the CDST system functioned for re-treatment TB patients.
    • How well are asthma treatment cards filled out in public health centres in Gazeera State, Sudan?

      Kodouda, S F; Zachariah, R; Khogali, M; van Grievensen, J; Saeed, M; Ibrahim, E H; Schneider, S; Adulazeem, S; El Sadig, H A; Atta, R; et al. (The Union, 2014-06-21)
    • I have heard about it for the first time from you! Implementation of tobacco control law by police personnel in India.

      Ahuja, N; Kathiresan, J; Anand, T; Isaakidis, P; Bajaj, D (International Union Against Tuberculosis and Lung Disease, 2018-12-21)
      Setting and Objetives: Police personnel, alongside other key stakeholders, are responsible for implementing the Cigarettes and Other Tobacco Products Act (COTPA) in India. This study aimed to assess knowledge and attitudes about COTPA among police personnel and explore enablers and barriers in implementing it. Design: This convergent parallel mixed-methods study used a self-administered questionnaire (quantitative) and key informant interviews (qualitative). Of 300 police personnel across all eight police stations in Daman, 155 participated. Quantitative data were analysed using descriptive statistics and the χ2 test. Qualitative data from in-depth interviews of six key informants from all coordinating departments were analysed thematically. Results: Overall, 63.2% of responders were aware of any tobacco control law in India, and only 12.9% were trained in its implementation. One person had conducted inspections for COTPA compliance in the last 12 months. The majority (78.1%) of the police personnel, and significantly more tobacco non-users than users (81.2% vs. 52.9%, P = 0.016), felt that enforcing anti-tobacco regulations is one of their most important functions. Perceived benefits of the act and formal authority to act were the two main enablers of COTPA implementation. Lack of awareness and coordination, competing priorities, concentration of authority with higher-ranking officials and evasion of the law by retailers and the public hampered effective implementation of the law. Conclusion: Knowledge about the COTPA was average and implementation poor. Sensitisation and training of implementers, systematic transparent reporting and creating awareness among public are recommended for effective implementation.