• 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; Shulman, L N (The Union, 2014-06-21)
    • Case management of malaria in Swaziland, 2011-2015: on track for elimination?

      Dlamini, SV; Kosgei, RJ; Mkhonta, N; Zulu, Z; Makadzange, K; Zhou, S; Owiti, P; Sikhondze, W; Namboze, J; Reid, A; Kunene, S (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Objective: To assess adherence to malaria diagnosis and treatment guidelines (2010 and 2014) in all health care facilities in Swaziland between 2011 and 2015. Methods: This was a cross-sectional descriptive study involving all health care facilities that diagnosed and managed malaria cases in Swaziland. Patients' age, sex, diagnosis method and type of treatment were analysed. Results: Of 1981 records for severe and uncomplicated malaria analysed, 56% of cases were uncomplicated and 14% had severe malaria. The type of malaria was not recorded for 30% of cases. Approximately 71% of cases were confirmed by rapid diagnostic tests (RDT) alone, 3% by microscopy alone and 26% by both RDT and microscopy. Of the uncomplicated cases, 93% were treated with artemether-lumefantrine (AL) alone, 5% with quinine alone and 2% with AL and quinine. Amongst the severe cases, 11% were treated with AL alone, 44% with quinine alone and 45% with AL and quinine. For severe malaria, clinics and health centres prescribed AL alone more often than hospitals (respectively 13%, 12% and 4%, P = 0.03). Conclusion: RDTs and/or microscopy results are used at all facilities to inform treatment. Poor recording of malaria type causes difficulties in assessing the prescription of antimalarial drugs.
    • Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

      Prasanna, T; Jeyashree, K; Chinnakali, P; Bahurupi, Y; Vasudevan, K; Das, M (Taylor & Francis Open, 2018)
      The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016-2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India.
    • Changing distribution and abundance of the malaria vector Anopheles merus in Mpumalanga Province, South Africa

      Mbokazi, F; Coetzee, M; Brooke, B; Govere, J; Reid, A; Owiti, P; Kosgei, R; Zhou, S; Magagula, R; Kok, G; Namboze, J; Tweya, H; Mabuza, A (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Background: The malaria vector Anopheles merus occurs in the Mpumalanga Province of South Africa. As its contribution to malaria transmission in South Africa has yet to be ascertained, an intensification of surveillance is necessary to provide baseline information on this species. The aim of this study was therefore to map An. merus breeding sites in the Ehlanzeni District of Mpumalanga Province and to assess qualitative trends in the distribution and relative abundance of this species over a 9-year period. Methods: The study was carried out during the period 2005-2014 in the four high-risk municipalities of Ehlanzeni District. Fifty-two breeding sites were chosen from all water bodies that produced anopheline mosquitoes. The study data were extracted from historical entomological records that are captured monthly. Results: Of the 15 058 Anopheles mosquitoes collected, 64% were An. merus. The abundance and distribution of An. merus increased throughout the four municipalities in Ehlanzeni District during the study period. Conclusion: The expanded distribution and increased abundance of An. merus in the Ehlanzeni District may contribute significantly to locally acquired malaria in Mpumalanga Province, likely necessitating the incorporation of additional vector control methods specifically directed against populations of this species.
    • Characteristics and Treatment Outcomes of New Pulmonary Tuberculosis Patients with Comorbidities in the Samarkand Region, Uzbekistan

      Yusupova, S; Nurullayeva, S; Sadikov, U; Gadoev, J; Alikhanova, N; Zachariak, R; Harries, A (World Health Organization, 2016-03)
    • 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.
    • Childhood Tuberculosis in Dushanbe, Tajikistan

      Pirov, K; Sirojiddinova, U; Bobokhojaev, O; Zachariah, R; Lucenko, I; Mirzoev, A; Suleimenov, S; Dustmatova, Z; Rajabov, A; van den Boom, M; Acosta, C (The World Health Organization, 2016-03)
    • Childhood tuberculosis in Mauritania, 2010-2015: diagnosis and outcomes in Nouakchott and the rest of the country

      Aw, B; Ade, S; Hinderaker, SG; Dlamini, N; Takarinda, KC; Chiaa, K; Feil, A; Traoré, A; Reid, T (International Union Against Tuberculosis and Lung Disease, 2017-09-21)
      Setting: The National Tuberculosis Programme, Mauritania. Objective: To compare the diagnosis and treatment outcomes of childhood tuberculosis (TB) cases (aged <15 years) registered between 2010 and 2015 inside and outside Nouakchott, the capital city. Design: This was a retrospective comparative cohort study. Results: A total of 948 children with TB were registered. The registration rate was 10 times higher in Nouakchott. The proportion of children among all TB cases was higher inside than outside Nouakchott (7.5% vs. 4.6%, P < 0.01). Under-fives represented 225 (24%) of all childhood TB cases, of whom 204 (91%) were registered in Nouakchott. Extra-pulmonary TB was more common in Nouakchott, while smear-negative TB was less common. Treatment success was similar inside and outside Nouakchott (national rate 61%). The principal unsuccessful outcomes were loss to follow-up outside Nouakchott (21% vs. 11%, P < 0.01) while transfers out were more common in the city (25% vs. 14%, P = 0.01). Being aged <5 years (OR 1.2, 95%CI 1.1-1.5) was associated with an unsuccessful outcome. Conclusion: This study indicates problems in the diagnosis and treatment of childhood TB in Mauritania, especially outside the city of Nouakchott. We suggest strengthening clinical diagnosis and management, improving communications between TB treatment centres and health services and pressing the TB world to develop more accurate and easy-to-use diagnostic tools for children.
    • Closing the gap: decentralising mental health care to primary care centres in one rural district of Rwanda

      Nyirandagijimana, B; Edwards, JK; Venables, E; Ali, E; Rusangwa, C; Mukasakindi, H; Borg, R; Fabien, M; Tharcisse, M; Nshimyiryo, A; Park, PH; Raviola, GJ; Smith, SL (International Union Against Tuberculosis and Lung Disease, 2017-09-21)
      Setting: Programmes that integrate mental health care into primary care settings could reduce the global burden of mental disorders by increasing treatment availability in resource-limited settings, including Rwanda. Objective: We describe patient demographics, service use and retention of patients in care at health centres (HC) participating in an innovative primary care integration programme, compared to patients using existing district hospital-based specialised out-patient care. Design: This was a retrospective cohort study using routinely collected data from six health centres and one district hospital from October 2014 to March 2015. Results: Of 709 patients, 607 were cared for at HCs; HCs accounted for 88% of the total visits for mental disorders. Patients with psychosis used HC services more frequently, while patients with affective disorders were seen more frequently at the district hospital. Of the 68% of patients who returned to care within 90 days of their first visit, 76% had a third visit within a further 90 days. There were no significant differences in follow-up rates between clinical settings. Conclusion: This study suggests that a programme of mentorship for primary care nurses can facilitate the decentralisation of out-patient mental health care from specialised district hospital mental health services to HCs in rural Rwanda.
    • Comparing Yield and Relative Costs of WHO TB Screening Algorithms in Selected Risk Groups Among People Aged 65 Years and Over in China, 2013

      Zhang, C; Ruan, Y; Cheng, J; Zhao, F; Xia, Y; Zhang, H; Wilkinson, E; Das, M; Li, J; Chen, W; Hu, D; Jeyashree, K; Wang, L (Public Library of Science, 2017-06-08)
      To calculate the yield and cost per diagnosed tuberculosis (TB) case for three World Health Organization screening algorithms and one using the Chinese National TB program (NTP) TB suspect definitions, using data from a TB prevalence survey of people aged 65 years and over in China, 2013.
    • Compliance to follow up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: comparison of three models of care

      Kuria, N; Reid, A; Owiti, P; Tweya, H; Kibet, CK; Mbau, L; Manzi, M; Murunga, V; Namusonge, T; Kibachio, J (Wiley-Blackwell, 2018-05-19)
      To determine and compare, among three models of care, compliance to scheduled clinic appointments and adherence to anti-hypertensive medication of patients in an informal settlement of Kibera, Kenya.
    • Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014.

      Hassanain, SA; Edwards, JK; Venables, E; Ali, E; Adam, K; Hussien, H; Elsony, A (BioMed Central, 2018-05-16)
      Sudan is a fragile developing country, with a low expenditure on health. It has been subjected to ongoing conflicts ever since 1956, with the Darfur crisis peaking in 2004. The conflict, in combination with the weak infrastructure, can lead to poor access to healthcare. Hence, this can cause an increased risk of infection, greater morbidity and mortality from tuberculosis (TB), especially amongst the poor, displaced and refugee populations. This study will be the first to describe TB case notifications, characteristics and outcomes over a ten-year period in Darfur in comparison with the non-conflict Eastern zones within Sudan.
    • Countrywide audit of multidrug-resistant tuberculosis and treatment outcomes in Mongolia

      Ganzaya, S; Naranbat, N; Bissell, K; Zachariah, R (2013-12-21)
    • 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; Kapur, A; Shaikh, I; Seita, A (International Union Against Tuberculosis and Lung Disease, 2014-03-25)
    • Did microbial larviciding contribute to a reduction in malaria cases in eastern Botswana in 2012-2013?

      Obopile, M; Segoea, G; Waniwa, K; Ntebela, DS; Moakofhi, K; Motlaleng, M; Mosweunyane, T; Edwards, JK; Namboze, J; Butt, W; Manzi, M; Takarinda, KC; Owiti, P (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Setting: Larviciding has potential as a component of integrated vector management for the reduction of malaria transmission in Botswana by complementing long-lasting insecticide nets and indoor residual sprays. Objective: To evaluate the susceptibility of local Anopheles to commonly used larvicides. Design: This field test of the efficacy of Bacillus thuringiensis subsp. israliensis vs. Anopheles was performed by measuring larval density before treatment and 24 h and 48 h after treatment in seven sites of Bobirwa district, eastern Botswana, in 2012 and 2013. Vector density and malaria cases were compared between Bobirwa and Ngami (northwestern Botswana), with no larviciding in the control arm. Results: Larviciding reduced larval density by 95% in Bobirwa in 2012, with two cases of malaria, while in 2013 larval density reduction was 81%, with 11 cases. Adult mosquito density was zero for both years in Robelela village (Bobirwa), compared to respectively four and 26 adult mosquitoes per room in Shorobe village (Ngami) in 2012 and 2013. There were no cases of malaria in Robelela in either year, but in Shorobe there were 20 and 70 cases, respectively, in 2012 and 2013. Conclusion: Larviciding can reduce the larval density of mosquitoes and reduce malaria transmission in Botswana. Large-scale, targeted implementation of larviciding in districts at high risk for malaria is recommended.
    • Different Challenges, Different Approaches and Related Expenditures of Community-Based Tuberculosis Activities by International Non-Governmental Organizations in Myanmar

      Han, WW; Saw, S; Isaakidis, P; Khogali, M; Reid, A; Hoa, N; Zaw, KK; Aung, ST (BioMed Central, 2017-03-24)
      International non-governmental organizations (INGOs) have been implementing community-based tuberculosis (TB) care (CBTBC) in Myanmar since 2011. Although the National TB Programme (NTP) ultimately plans to take over CBTBC, there have been no evaluations of the models of care or of the costs of providing CBTBC in Myanmar by INGOs.
    • 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)
    • Do Incentivised Community Workers in Informal Settlements Influence Maternal and Infant Health in Urban India?

      Verma, H; Sagili, K; Zachariah, R; Aggarwal, A; Dongre, A; Gupte, H (International Union Against Tuberculosis and Lung Disease, 2017-03-21)
      Setting: The introduction of accredited social health activists (ASHAs, community workers) in the community is encouraged by the Government of India as being of universal benefit for maternal and infant health. Objectives: In two informal settlements in Chandigarh, India, one with ASHAs and the other without, we assessed 1) whether ASHAs influenced certain selected maternal and infant health indicators, and 2) perceptions among women who did not contact the ASHAs. Design: This was a mixed-methods study conducted from April 2013 to March 2016 using quantitative (retrospective programme data) and qualitative (free-listing) components. Results: The increase in institutional deliveries from 2013 to 2015 was marginal, and was similar in both areas (86-99% in the settlement with ASHAs and 88-97% in the settlement without). Bacille Calmette-Guérin and pentavalent vaccination coverage were close to 100% in both areas during the 3 years of the study. Antenatal registration in the first trimester increased from 49% to 52% in the settlement with ASHAs and from 53% to 71% in the settlement without. Between 18% and 35% of women did not complete at least three antenatal visits. 'Not knowing ASHAs' and 'not feeling a need for ASHAs' were the main reasons for not using their services. Conclusion: While success has been achieved for institutional deliveries and immunisation coverage even without the ASHAs, their presence plays an important role in improving antenatal indicators.
    • Does an Isoniazid Prophylaxis Register Improve Tuberculosis Contact Management in South African Children?

      van Soelen, N; du Preez, K; van Wyk, S S; Mandalakas, A M; Enarson, D A; Reid, A J; Hesseling, A C (Public Library of Science, 2013)
      We compared the change in child household contact management of pulmonary tuberculosis (TB) cases before and after the implementation of an isoniazid preventive therapy (IPT) register in an urban clinic setting in Cape Town, South Africa.
    • Does Research Through Structured Operational Research and Training (SORT IT) Courses Impact Policy and Practice?

      Kumar, AMV; Shewade, HD; Tripathy, JP; Guillerm, N; Tayler-Smith, K; Dar Berger, S; Bissell, K; Reid, AJ; Zachariah, R; Harries, AD (Cambridge University Press, 2016-03-21)