• Malaria profiles and challenges in artemisinin resistance containment in Myanmar

      Nwe, TW; Oo, T; Wai, KT; Zhou, S; van Griensven, J; Chinnakali, P; Shah, S; Thi, A (BioMed Central, 2017-04-25)
      This study examined evolving malaria profiles from January, 2010 to December, 2014 to evaluate achievements and challenges of implementing measures to prevent and control spread of artemisinin resistance in Myanmar.
    • Management and Treatment Outcomes of Patients Enrolled in MDR-TB Treatment in Viet Nam

      Phuong, NTM; Nhung, NV; Hoa, NB; Thuy, HT; Takarinda, KC; Tayler-Smith, K; Harries, AD (International Union Against Tuberculosis and Lung Disease, 2016-03-21)
      The programmatic management of drug-resistant tuberculosis (TB) in Viet Nam has been rapidly scaled up since 2009.
    • Management of malaria in children with fever in rural Sierra Leone in relation to the 2014-2015 Ebola outbreak

      Moses, FL; Tamang, D; Denisiuk, O; Dumbuya, U; Hann, K; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
      Setting: Sixty-eight primary health facilities, Koinadugu District, rural Sierra Leone. Objectives: Sierra Leone, a country with one of the highest burdens of malaria, was severely affected by the 2014-2015 Ebola virus disease outbreak. In under-five children, we compared trends in the completeness of malaria reports sent to the district office during the pre-Ebola, Ebola and post-Ebola periods, including the number of children with reported fever, malaria diagnostic testing performed and treatment for malaria initiated with artemisinin-based combination therapy (ACT). Design: A cross-sectional study. Results: Of 1904 expected malaria reports, 1289 (68%) were received. Completeness of reporting was 61% pre-Ebola, increased to 88% during the outbreak and dropped to 44% post-Ebola (P = 0.003). Total malaria testing (n = 105 558) exceeded the number of fever cases (n = 105 320). Pre-Ebola, 75% (n = 43 245) of all reported fever cases received malaria treatment, dropping to 34% (n = 50 453) during the Ebola outbreak. Of 36 804 confirmed malaria cases during Ebola, 17 438 (47%) were treated, significantly fewer than in the pre-Ebola period (96%, P < 0.001). Of the fever cases, 95% in both the pre- and post-Ebola periods received ACT, a rate that increased to 99% during the Ebola outbreak. Conclusion: Pre-existing gaps in malaria reporting worsened after the Ebola outbreak. Reassuringly, malaria testing matched fever cases, although only half of all confirmed cases received treatment during the outbreak, possibly explained by outbreak-related operational difficulties. These findings could be useful to guide health systems strengthening and recovery.
    • Management of multi- and extensively drug-resistant tuberculosis in Ukraine: how well are we doing?

      Lytvynenko, N; Cherenko, S; Feschenko, Y; Pogrebna, M; Senko, Y; Barbova, A; Manzi, M; Denisiuk, O; Ramsay, A; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • 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)
    • 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.
    • Moving towards malaria elimination: trends and attributes of cases in Kavango region, Namibia, 2010-2014

      Nghipumbwa, H; Ade, S; Kizito, W; Takarinda, KC; Uusiku, P; Mumbegegwi, DR (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Setting: Kavango, a 'moderate' transmission risk region located in north-eastern Namibia, borders Angola, a country with higher malaria transmission levels. Objective: To determine 1) the trends in malaria incidence between 2010 and 2014 in Kavango, 2) the socio-demographic and clinical characteristics of confirmed cases in 2014, and 3) associated risk factors of cases classified as imported. Design: This was a retrospective study of malaria case investigation forms conducted in all 52 public health facilities in 2014. Incidence was derived from aggregate routine surveillance data from the Health Information System (HIS). Results: During the 5-year study, incidence fell from 53.6 to 3.6 cases per 1000 population, then increased again to 47.3/1000. Fifty-five per cent of cases were males, and 49% were aged between 5 and 17 years. Of the 2014 cases, 23% were imported, and were associated with higher odds of severe malaria (adjusted odds ratio [aOR] 1.8; 95%CI 1.01-3.29), not having long-lasting insecticide treated nets (aOR 2.1, 95%CI, 1.3-3.4) and not receiving insecticide residual spraying (aOR 3.2, 95%CI, 2.1-5.1). Conclusion: Sporadic outbreaks in the 5-year period posed a threat to malaria elimination. Better targeting of vector control interventions, strong cross-border collaboration and robust health promotion will be key to achieving malaria elimination.
    • 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)
    • Notified tuberculosis among Singapore residents by ethnicity, 2002–2011

      Lim, L K-Y; Enarson, D A; Reid, A J; Satyanarayana, S; Cutter, J; Kyi Win, K M; Chee, C B-E; Wang, Y T (2013-12-21)
    • A 'one-stop shop' approach in antenatal care: does this improve antiretroviral treatment uptake in Zimbabwe?

      Gunguwo, H; Zachariah, R; Bissell, K; Ndebele, W; Moyo, J; Mutasa-Apollo, T (International Union Against Tuberculosis and Lung Disease, 2014-03-25)
    • 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)
    • Outcomes of Antiretroviral Therapy Among Younger Versus Older Adolescents and Adults in an Urban Clinic, Zimbabwe

      Matyanga, C M J; Takarinda, K C; Owiti, P; Mutasa-Apollo, T; Mugurungi, O; Buruwe, L; Reid, A J (International Union Against TB and Lung Disease, 2016-06-21)
      Setting: A non-governmental organisation-supported clinic offering health services including antiretroviral therapy (ART). Objective: To compare ART retention between younger (age 10–14 years) vs. older (age 15–19 years) adolescents and younger (age 20–29 years) vs. older (age 30 years) adults and determine adolescent- and adult-specific attrition-associated factors among those initiated on ART between 2010 and 2011. Design: Retrospective cohort study. Results: Of 110 (7%) adolescents and 1484 (93%) adults included in the study, no differences in retention were observed between younger vs. older adolescents at 6, 12 and 24 months. More younger adolescents were initiated with body mass index 16 kg/m2 compared with older adolescents (64% vs. 47%; P = 0.04). There were more females (74% vs. 52%, P  0.001) and fewer patients initiating ART with CD4 count 350 cells/mm3 (77% vs. 81%, P = 0.007) among younger vs. older adults. Younger adults demonstrated more attrition than older adults at all time-points. No attrition risk factors were observed among adolescents. Attrition-associated factors among adults included being younger, having a lower CD4 count and advanced human immunodeficiency virus disease at initiation, and initiation on a stavudine-based regimen. Conclusion: Younger adults demonstrated greater attrition and may require more attention. We were unable to demonstrate differences in attrition among younger vs. older adolescents. Loss to follow-up was the main reason for attrition across all age groups. Overall, earlier presentation for ART care appears important for improved ART retention among adults.
    • Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality?

      Ngoy, B B; Zachariah, R; Hinderaker, S G; Khogali, M; Manzi, M; van Griensven, J; Ayada, L; Jemmy, J P; Maalim, A; Amin, H (International Union Against Tuberculosis and Lung Disease, 2014-03-25)
    • 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.
    • Poor treatment outcomes among multidrug-resistant tuberculosis patients in Gomel Region, Republic of Belarus

      Khaliaukin, A; Kumar, A M V; Skrahina, A; Hurevich, H; Rusovich, V; Gadoev, J; Falzon, D; Khogali, M; de Colombani, P (International Union Against Tuberculosis and Lung Disease, 2014-10-21)