Now showing items 21-40 of 2577

    • Access to Care for Non-Communicable Diseases in Mosul, Iraq Between 2014 and 2017: A Rapid Qualitative Study.

      Baxter, LM; Eldin, MS; Al Mohammed, A; Saim, M; Checchi, F (BioMed Central, 2018-12-29)
      During June 2014 to April 2017, the population of Mosul, Iraq lived in a state of increasing isolation from the rest of Iraq due to the city's occupation by the Islamic State group. As part of a study to develop a generalisable method for estimating the excess burden of non-communicable diseases (NCDs) in conflict-affected settings, in April-May 2017 we conducted a brief qualitative study of self-reported care for NCDs among 15 adult patients who had fled Mosul and presented to Médecins Sans Frontières clinics in the Kurdistan region with hypertension and/or diabetes. Participants reported consistent barriers to NCD care during the so-called Islamic State period, including drug shortages, insecurity and inability to afford privately sold medication. Coping strategies included drug rationing. By 2016, all patients had completely or partially lost access to care. Though limited, this study suggests a profound effect of the conflict on NCD burden.
    • From Risk to Care: The Hepatitis C Screening and Diagnostic Cascade in a Primary Health Care Clinic in Karachi, Pakistan—a Cohort Study

      Khalid, GG; Kyaw, KWY; Bousquet, C; Auat, R; Donchuk, D; Trickey, A; Hamid, S; Qureshi, H; Mazzeo, V; Aslam, K; Khowaja, S; Van den Bergh, R; Operational Center Brussels, Médecins Sans Frontières, Islamabad, Pakistan; Department of Operational Research, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar; Operational Center Brussels, Médecins Sans Frontières, Islamabad, Pakistan; Operational Center Brussels, Brussels, Belgium; Operational Center Brussels, Brussels, Belgium; School of Social and Population Sciences, University of Bristol, Bristol, UK; Department of Medicine, Agha Khan Medical University, Karachi, Pakistan; Pakistan Health Research Council, Islamabad, Pakistan; Operational Center Brussels, Médecins Sans Frontières, Islamabad, Pakistan; Operational Center Brussels, Médecins Sans Frontières, Islamabad, Pakistan; Operational Center Brussels, Médecins Sans Frontières, Islamabad, Pakistan; Operational Center Brussels, Brussels, Belgium (Oxford University Press, 2018-12-28)
      Background In the high-prevalence setting of Pakistan, screening, diagnosis and treatment services for chronic hepatitis C (CHC) patients are commonly offered in specialized facilities. We aimed to describe the cascade of care in a Médecins Sans Frontières primary health care clinic offering CHC care in an informal settlement in Karachi, Pakistan. Methods This was a retrospective cohort analysis using routinely collected data. Three different screening algorithms were assessed among patients with one or more CHC risk factors. Results Among the 87 348 patients attending the outpatient clinic, 5003 (6%) presented with one or more risk factors. Rapid diagnostic test (RDT) positivity was 38% overall. Approximately 60% of the CHC patients across all risk categories were in the early stage of the disease, with an aspartate aminotransferase:platelet ratio index score <1. The sequential delays in the cascade differed between the three groups, with the interval between screening and treatment initiation being the shortest in the cohort tested with GeneXpert onsite. Conclusions Delays between screening and treatment can be reduced by putting in place more patient-centric testing algorithms. New strategies, to better identify and treat the hidden at-risk populations, should be developed and implemented.
    • Field Evaluation of Near Point of Care Cepheid GeneXpert HIV-1 Qual for Early Infant Diagnosis

      Opollo, VS; Nikuze, A; Ben-Farhat, J; Anyango, E; Humwa, F; Oyaro, B; Wanjala, S; Omwoyo, W; Majiwa, M; Akelo, V; Zeh, C; Maman, D (Public Library of Science, 2018-12-27)
      Access to point-of-care HIV testing shortens turn-around times, time to diagnosis and reduces loss to follow-up hence minimizing barriers to early linkage to care and treatment among HIV infected infants. Currently samples for early infant HIV diagnosis are sent to centralized testing facilities which are few and located only at specific regions in Kenya. However, there are Point of Care (POC) early infant diagnosis [EID] technologies elsewhere such as SAMBA and ALERE-Q that are yet to be evaluated in Kenya despite the urgent need for data to inform policy formulation regarding EID. The Cepheid GeneXpert HIV-1 Qual (GeneXpert) technology for POC EID offers a great opportunity to minimize HIV associated morbidity, mortality and loss to follow-up through decentralization of early infant HIV testing to the clinics. This technology also allows for same-day results thus facilitating prompt linkage to care.
    • Dual Screen and Confirm Rapid Test Does Not Reduce Overtreatment of Syphilis in Pregnant Women Living in a Non-venereal treponematoses Endemic Region: a Field Evaluation Among Antenatal Care Attendees in Burkina Faso

      Langendorf, C; Lastrucci, C; Sanou-Bicaba, I; Blackburn, K; Koudika, MH; Crucitti, T (BMJ Publishing Group, 2018-12-22)
      In resource-limited settings, screening pregnant women for syphilis using rapid diagnostic tests (RDTs) is a key tool in the prevention of congenital syphilis. However, most syphilis RDTs detect only treponemal antibodies (T-RDT), meaning antibiotics may be provided unnecessarily to previously treated pregnant women, particularly in non-venereal treponematoses endemic regions. We estimated the potential reduction in overtreatment when comparing T-RDT (SD Bioline) to a newer rapid test (Dual Path Platform (DPP) Screen and Confirm Assay, Chembio) detecting both treponemal and non-treponemal antibodies.
    • Increased Hepatitis C Virus Co-infection and Injection Drug Use in HIV-infected Fishermen in Myanmar

      Ousley, J; Nesbitt, R; Kyaw, NTT; Bermudez, E; Soe, KP; Anicete, R; Mon, PE; Le Shwe Sin Ei, W; Christofani, S; Fernandez, M; Ciglenecki, I (BioMed Central, 2018-12-14)
      In Southeast Asia, though fishermen are known to be a key population at high risk of HIV, little is known about their co-infection rates with Hepatitis C virus (HCV), or how illness and risk behaviors vary by occupation or type of fishermen. In Myanmar, this lack of knowledge is particularly acute, despite the fact that much of the country's border is coastline.
    • High Prevalence of Infection and Low Incidence of Disease in Child Contacts of Patients with Drug-resistant Tuberculosis: a Prospective Cohort Study

      Huerga, H; Sanchez-Padilla, E; Melikyan, N; Atshemyan, H; Hayrapetyan, A; Ulumyan, A; Bastard, M; Khachatryan, N; Hewison, C; Varaine, F; Bonnet, M (BMJ, 2018-12-06)
      We aimed to measure the prevalence and incidence of latent tuberculosis infection (LTBI) and tuberculosis (TB) disease in children in close contact with patients with drug-resistant TB (DR-TB) in a country with high DR-TB prevalence.
    • Field evaluation of GeneXpert® (Cepheid) HCV performance for RNA quantification in a genotype 1 and 6 predominant patient population in Cambodia.

      Iwamoto, M; Calzia, A; Dublineau, A; Rouet, F; Nouhin, J; Yann, S; Pin, S; Sun, C; Sann, K; Dimanche, C; Lastrucci, C; Coulborn, R; Maman, D; Dousset, JP; Loarec, A (Wiley-Blackwell, 2018-12-03)
      GeneXpert® (Cepheid) is the only WHO prequalified platform for hepatitis C virus (HCV) nucleic acid amplification testing that is suitable for point-of-care use in resource-limited contexts. However, its application is constrained by the lack of evidence on genotype 6 (GT6) HCV. We evaluated its field performance among a patient population in Cambodia predominantly infected with GT6. Between August and September 2017, we tested plasma samples obtained from consenting patients at Médecins Sans Frontières' HCV clinic at Preah Kossamak Hospital for HCV viral load (VL) using GeneXpert® and compared its results to those obtained using COBAS® AmpliPrep/Cobas® TaqMan® HCV Quantitative Test, v2.0 (Roche) at the Institut Pasteur du Cambodge. Among 769 patients, 77% of the seropositive patients (n = 454/590) had detectable and quantifiable VL using Roche and 43% (n = 195/454) were GT6. The sensitivity and specificity of GeneXpert® against Roche were 100% (95% CI 99.2, 100.0) and 98.5% (95% CI 94.8, 99.8). The mean VL difference was -0.01 (95% CI -0.05, 0.02) log10  IU/mL for 454 samples quantifiable on Roche and -0.07 (95% CI -0.12, -0.02) log10  IU/mL for GT6 (n = 195). The limit of agreement (LOA) was -0.76 to 0.73 log10  IU/mL for all GTs and -0.76 to 0.62 log10 IU/mL for GT6. Twenty-nine GeneXpert® results were outside the LOA. Frequency of error and the median turnaround time (TAT) for GeneXpert® were 1% and 0 days (4 days using Roche). We demonstrated that the GeneXpert® HCV assay has good sensitivity, specificity, quantitative agreement, and TAT in a real-world, resource-limited clinical setting among GT6 HCV patients.
    • Real-Time PCR for the Evaluation of Treatment Response in Clinical Trials of Adult Chronic Chagas Disease: Usefulness of Serial Blood Sampling and qPCR Replicates

      Parrado, R; Ramirez, JC; de la Barra, A; Alonso-Vega, C; Juiz, N; Ortiz, L; Illanes, D; Torrico, F; Gascon, J; Alves, F; Flevaud, L; Garcia, L; Schijman, AG; Ribeiro, I (American Society for Microbiology, 2018-12-03)
      This work evaluated a serial blood sampling procedure to enhance the sensitivity of duplex real-time PCR (qPCR) for baseline detection and quantification of parasitic loads and post-treatment identification of failure in the context of clinical trials for treatment of chronic Chagas disease, namely DNDi-CH-E1224-001 (NCT01489228) and MSF-DNDi PCR sampling optimization study (NCT01678599). Patients from Cochabamba (N= 294), Tarija (N= 257), and Aiquile (N= 220) were enrolled. Three serial blood samples were collected at each time-point and qPCR triplicates were tested per sample. The first two samples were collected during the same day and the third one seven days later.A patient was considered PCR positive if at least one qPCR replicate was detectable. Cumulative results of multiple samples and qPCR replicates enhanced the proportion of pre-treatment sample positivity from 54.8 to 76.2%, 59.5 to 77.8%, and 73.5 to 90.2% in Cochabamba, Tarija, and Aiquile cohorts, respectively. This strategy increased the detection of treatment failure from 72.9 to 91.7%, 77.8 to 88.9%, and 42.9 to 69.1% for E1224 low, short, and high dosage regimens, respectively; and from 4.6 to 15.9% and 9.5 to 32.1% for the benznidazole arm in the DNDi-CH-E1224-001 and MSF-DNDi studies, respectively. The addition of the third blood sample and third qPCR replicate in patients with non-detectable PCR results in the first two samples, gave a small, non-statistically significant improvement in qPCR positivity. No change in clinical sensitivity was seen with a blood volume increase from 5 to 10 ml. The monitoring of patients treated with placebo in the DNDi-CH-E1224-001 trial revealed fluctuations in parasitic loads and occasional non-detectable results. In conclusion, serial sampling strategy enhanced PCR sensitivity to detecting treatment failure during follow-up and has the potential for improving recruitment capacity in Chagas disease trials, which require an initial positive qPCR result for patient admission.
    • Oral cholera vaccination in hard-to-reach communities, Lake Chilwa, Malawi

      Grandesso, F; Rafael, F; Chipeta, S; Alley, I; Saussier, C; Nogareda, F; Burns, M; Lechevalier, P; Page, AL; Salumu, L; Pezzoli, L; Mwesawina, M; Cavailler, P; Mengel, M; Luquero, FJ; Cohuet, S (The World Health Organization, 2018-12-01)
      To evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak.
    • The role of pediatric nursing in the provision of quality care in humanitarian settings: a qualitative study in Tonkolili District, Sierra Leone

      Gilday, J; Chantler, T; Gray, N; Treacy-Wong, V; Yillia, J; Pascal Gbla, A; Howard, N; Stringer, B (Innovational Publishers, 2018-12)
    • Perceptions of Healthcare-Associated Infection and Antibiotic Resistance among Physicians Treating Syrian Patients with War-Related Injuries

      Älgå, A; Karlow Herzog, K; Alrawashdeh, M; Wong, S; Khankeh, H; Stålsby Lundborg, C (MDPI, 2018-12-01)
      Healthcare-associated infections (HAIs) constitute a major contributor to morbidity and mortality worldwide, with a greater burden on low- and middle-income countries. War-related injuries generally lead to large tissue defects, with a high risk of infection. The aim of this study was to explore how physicians in a middle-income country in an emergency setting perceive HAI and antibiotic resistance (ABR). Ten physicians at a Jordanian hospital supported by Médecins Sans Frontières were interviewed face-to-face. The recorded interviews were transcribed verbatim and analyzed by qualitative content analysis with an inductive and deductive approach. The participants acknowledged risk factors of HAI and ABR development, such as patient behavior, high numbers of injured patients, limited space, and non-compliance with hygiene protocols, but did not express a sense of urgency or any course of action. Overuse and misuse of antibiotics were reported as main contributors to ABR development, but participants expressed no direct interrelationship between ABR and HAI. We conclude that due to high patient load and limited resources, physicians do not see HAI as a problem they can prioritize. The knowledge gained by this study could provide insights for the allocation of resources and development of hygiene and wound treatment protocols in resource-limited settings.
    • Defining priority medical devices for cancer management: a WHO initiative

      Velazquez Berumen, A; Jimenez Moyao, G; Rodriguez, NM; Ilbawi, AM; Migliore, A; Shulman, LN (The Lancet, 2018-12)
    • The Role of Pediatric Nursing in the Provision of Quality Care in Humanitarian Settings: a Qualitative Study in Tonkolili District, Sierra Leone

      Gilday, J; Chantler, T; Gray, N; Treacy-Wong, V; Yillia, J; Gbla, AP; Howard, N; Stringer, B (Innovational Publishers, 2018-12)
      Purpose: Evaluate nurses' and caretakers' perspectives of quality care, barriers to its delivery, and its study in a humanitarian setting. Methods: A qualitative study using semi-structured interviews and direct observation was conducted in the pediatric department of Magburaka Hospital, Tonkolili district, Sierra Leone. Interviews were recorded, transcribed, and inductive coding was used to identify prevalent themes. The observation was used to compare and elaborate on interview findings. Results: Three themes emerged holistic care; the nursing community; and organization and systems of care. For caretakers, holistic care related to their child‟s survival, with quality care described as the availability of free medication, provision for basic needs (food, water, shelter, sanitation), hospital cleanliness, and psychosocial support. For nurses, this involved medication administration, cleanliness, and carrying out nursing tasks (e.g., taking vital signs). Observation revealed caretakers, without nursing involvement, performed the majority of “activities of daily living” (e.g., bathing, toileting). The nursing community describes nursing employment types, attitudes, and how a lack of teamwork impacted quality nursing care. The third theme outlines the importance of organization and systems of care, in which training and a good salary were perceived as prerequisites for quality nursing care, whilst a lack of resources and inadequate operational systems were barriers. Conclusion: Caretakers play an integral role in the delivery of quality care. This and important quality care components outlined by nurses and caretakers identified a patient and family-centered approach could contribute to improving quality nursing care in humanitarian settings.
    • Assessing the performance of real-time epidemic forecasts: A case study of Ebola in the Western Area Region of Sierra Leone, 2014-15

      Funk, S; Camacho, A; Kucharski, AJ; Lowe, R; Eggo, RM; Edmunds, WJ (London School Hygiene and Tropical Medicine, 2018-11-23)
    • Extremely Low Hepatitis C prevalence among HIV co-infected individuals in 4 countries in sub-Saharan Africa

      Loarec, A; Carnimeo, V; Molfino, L; Kizito, W; Muyindike, W; Andrieux-Meyer, I; Balkan, S; Nzomukunda, Y; Mwanga-Amumpaire, J; Ousley, J; Bygrave, H; Maman, D (Lippincott, Williams & Wilkins, 2018-11-16)
      : A multicentric, retrospective case-series analysis (facility-based) in five sites across Kenya, Malawi, Mozambique, and Uganda screened HIV-positive adults for hepatitis C virus (HCV) antibodies using Oraquick rapid testing and viral confirmation (in three sites). Results found substantially lower prevalence than previously reported for these countries compared with previous reports, suggesting that targeted integration of HCV screening in African HIV programs may be more impactful than routine screening.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.
    • Field suitability and diagnostic accuracy of the Biocentric open real-time PCR platform for plasma-based HIV viral load quantification in Swaziland

      Kerschberger, B; Mpala, Q; Uribe, PAD; Maphalala, G; de la Tour, R; Kalombola, S; Bekele, A; Chawinga, T; Mliba, M; Ntshalintshali, N; Phugwayo, N; Kabore, SM; Goiri, J; Dlamini, S; Ciglenecki, I; Fajardo, E (BMC, 2018-11-14)
      Viral load (VL) testing is being scaled up in resource-limited settings. However, not all commercially available VL testing methods have been evaluated under field conditions. This study is one of a few to evaluate the Biocentric platform for VL quantification in routine practice in Sub-Saharan Africa.
    • This is not a drill

      Carenzo, L (Springer Link, 2018-11-14)
    • Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study

      Coulborn, RM; Gebrehiwot, TG; Schneider, M; Gerstl, S; Adera, C; Herrero, M; Porten, K; den Boer, M; Ritmeijer, K; Alvar, J; Hassen, A; Mulugeta, A (PLoS, 2018-11-08)
      Ethiopia bears a high burden of visceral leishmaniasis (VL). Early access to VL diagnosis and care improves clinical prognosis and reduces transmission from infected humans; however, significant obstacles exist. The approximate 250,000 seasonal mobile workers (MW) employed annually in northwestern Ethiopia may be particularly disadvantaged and at risk of VL acquisition and death. Our study aimed to assess barriers, and recommend interventions to increase access, to VL diagnosis and care among MWs.
    • Retention in care among clinically stable antiretroviral therapy patients following a six-monthly clinical consultation schedule: findings from a cohort study in rural Malawi

      Wringe, A; Cawley, C; Szumilin, E; Salumu, L; Amoros Quiles, I; Pasquier, E; Masiku, C; Nicholas, S (Wiley Open Access, 2018-11)
      Longer intervals between clinic consultations for clinically stable antiretroviral therapy (ART) patients may improve retention in care and reduce facility workload. We assessed long-term retention among clinically stable ART patients attending six-monthly clinical consultations (SMCC) with three-monthly fast-track drug refills, and estimated the number of consultations "saved" by this model of ART delivery in rural Malawi.
    • Complex interactions between malaria and malnutrition: a systematic literature review

      Das, D; Grais, R F; Okiro, E A; Stepniewska, K; Mansoor, R; van der Kam, S; Terlouw, D J; Tarning, J; Barnes, K I; Guerin, P J (BMC, 2018-10-29)
      Despite substantial improvement in the control of malaria and decreased prevalence of malnutrition over the past two decades, both conditions remain heavy burdens that cause hundreds of thousands of deaths in children in resource-poor countries every year. Better understanding of the complex interactions between malaria and malnutrition is crucial for optimally targeting interventions where both conditions co-exist. This systematic review aimed to assess the evidence of the interplay between malaria and malnutrition.