Journal Article > ResearchFull Text
Int J Infect Dis. 2022 September 1; Volume 122; 215-221.; DOI:10.1016/j.ijid.2022.05.039
Zheng Q, Luquero FJ, Ciglenecki I, Wamala JF, Abubakar A, et al.
Int J Infect Dis. 2022 September 1; Volume 122; 215-221.; DOI:10.1016/j.ijid.2022.05.039
BACKGROUND
Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology.
METHODS
From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics.
RESULTS
We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks.
CONCLUSIONS
This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.
Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology.
METHODS
From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics.
RESULTS
We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks.
CONCLUSIONS
This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.
Conference Material > Abstract
Croft LA, Puig-García M, Silver C, Pearlman J, Stellmach DUS, et al.
MSF Scientific Days International 2022. 2022 May 9; DOI:10.57740/b641-d608
INTRODUCTION
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Technical Report > Survey
Ouedraogo P, Simons E, Grellety E
2023 November 1
English
Français
INTRODUCTION
Since April 15, 2023, fighting erupted in Sudan between the army led by General Abdel Fattah al-Burhan and the paramilitary Rapid Support Forces (RSF) under the command of General Mohamed Hamdan Dogolo, known as Hemeti. This war has caused a major humanitarian crisis in Sudan, with violent fighting spreading throughout the country, particularly in Darfur, and aggravating pre-existing inter-community tensions.
By the end of March, almost 30,000 civilians had fled to Chad in search of safety. By September 2023, according to data from the United Nations High Commissioner for Refugees (UNHCR), clashes between military and paramilitary forces had driven more than 420,000 people to flee to Chad in successive waves, of whom around 327,000 had settled in the Ouaddaï province. Chadian refugees and returnees live in very precarious conditions, with limited access to primary healthcare, water and food. Little recent data is available on the mortality, nutritional status, and vaccination coverage of refugee populations in camps in eastern Chad, particularly in Toumtouma, Ourang and Arkoum camps. The results of these surveys are essential for Médecins Sans Frontières (MSF) to better plan its humanitarian interventions, coordinate effectively with other actors, and communicate about the refugee crisis in eastern Chad.
METHODOLOGY
Three cross-sectional surveys were carried out, the first with systematic random sampling in Toumtouma camp from August 7 to 13, and the next two with cluster random geospatial sampling in Ourang camp from August 17 to 22 and Arkoum camp from August 30 to September 4, 2023. Each survey covered retrospective mortality, frequency and type of violent events experienced, nutritional status of children aged 6 to 59 months, and measles vaccination coverage among children aged 6 months to 14 years. The recall period ran from January 1 to the day of the survey, i.e., a minimum of 210, 228 and 241 days respectively. Two phases were considered: 1) the pre-crisis phase (Toumtouma: January 1 - March 14, 2023 / Ourang and Arkoum: January 1 - April 14, 2023) and 2) the crisis phase (Toumtouma: March 15 - day of survey / Ourang and Arkoum: April 15 - day of survey). In Toumtouma camp, the crisis phase started earlier due to inter-community tensions that erupted end of March in West Darfur and drove important population displacements towards Chad.
RESULTS
Retrospective mortality: In Toumtouma camp, of the 1,032 households included (i.e., 6,372 people), 59.7% were refugees, 35.9% returnees and 4.4% displaced persons. The crude mortality rate (CMR) was significantly higher in phase 2 (CMR: 0.58 deaths/10,000 people/day [95% CI: 0.43 - 0.74]) than in phase 1 (CMR: 0.20 deaths/10,000 people/day [95% CI: 0.07 - 0.33]). Eighty-nine percent of those who died were men. Violence (77%; n=48) was the main cause of death reported, followed by diarrhea (6%; n=4) and respiratory infection (5%; n=3). Among the deaths, 68% occurred in their town or village of origin, 21% during displacement and 11% in an unknown location. Most people who died came from El Geneina (40%), Tandulti (35%) and Umm Dam (16%) in Darfur.
In Ourang camp, of the 1032 households included (i.e., 6302 people), 99.0% were refugees and 1.0% returnees. The CMR was significantly higher in phase 2 (CMR: 2.25 deaths/10,000 people/day [95% CI: 1.77 - 2.74]) than in phase 1 (CMR: 0.11 deaths/10,000 people/day [95% CI: 0.02 - 0.20]). Eighty-three percent of those who died were men (3.88 deaths/10,000 people/day [95% CI: 3.01 - 4.76] in phase 2). Violence (82%; n=147) was the main cause of death reported, followed by measles (5%; n=9). Among the deaths, 69% occurred in their town or village of origin, 25% during displacement and 6% in Adre, Chad. Most people who died came from El Geneina (96%) in Darfur.
In Arkoum camp, of the 1029 households included (i.e., 5324 people), 98.4% were refugees, 1.3% displaced and 0.4% returnees. The CMR was significantly higher in phase 2 (CMR: 0.67 deaths/10,000 people/day [95% CI: 0.46 - 0.89]) than in phase 1 (CMR: 0.15 deaths/10,000 people/day [95% CI: 0.03 - 0.26]). Seventy-seven percent of those who died were men; the mortality rate among men was 1.14 [95% CI: 0.72 - 1.55] in the second phase. Violence (50%; n=28) was the main cause of death reported, followed by diarrhea (16%; n=9). Among the deaths, 52% occurred in their town or village of origin, 27% during displacement, 5% after their arrival in Chad and 16% in an unknown location. Most people who died came from Mistre (54%) and Kongu (29%) in Darfur.
Frequency and main causes of violence: Among households in Toumtouma, Ourang and Arkoum camps, the overall frequency of violence was 3.3%, 11.7% and 4.4% respectively. The main types of violence were beatings (71.0% in Toumtouma, 71.1% in Ourang, and 79.7% in Arkoum), and shootings (27.1% in Toumtouma, 34.7% in Ourang, and 15.1% in Arkoum).
Prevalence of acute malnutrition: Among children aged 6-59 months, the prevalence of global acute malnutrition (GAM) according to MUAC and/or bilateral oedema was 5.5% [95% CI: 4.1 - 7.5] in Toumtouma, 11.3% [95% CI: 9.2 - 13.8] in Ourang, and 11.6% [95% CI: 9.5 - 14.5] in Arkoum camp. Rates of severe acute malnutrition (SAM) were 2.3% [95% CI: 1.4 - 3.6] in Toumtouma, 4.8% [95% CI: 3.6 - 6.4] in Ourang, and 4.6% [95% CI: 3.4 - 6.3] in Arkoum.
Measles vaccination: Measles vaccination coverage among children aged 6 months to 14 years was estimated at 58.6% [95% CI: 56.9 - 60.3] in Toumtouma, 75.9% [95% CI: 71.3 - 79.9] in Ourang, and 63.6% [95% CI: 58.2 - 68.7] in Arkoum.
CONCLUSIONS
In the three camps investigated, excess mortality was observed among households during the crisis phase (phase 2), with a significant difference in CMR due to deaths from violence among men. Among households living in Toumtouma camp, the CMR more than doubled and among households in Arkoum camp, it more than tripled. The population in Ourang camp seems to have been particularly affected by the violence, with CMR 20 times higher than in the pre- crisis period and mortality rates exceeding the standard emergency threshold (1 death/10,000 people/day). The vast majority of deaths occurred on the sites of origin or during displacement towards Chad (89% in Toutouma, 94% in Ourang and 79% in Arkoum). GAM and SAM prevalences among 6-59-month-olds were high in Ourang and Arkoum camps, with an alarming SAM prevalence of over 4%. In addition, the measles vaccination coverage, which ranged from 59% to 76% across the camps surveyed, was insufficient to prevent outbreaks.
Since April 15, 2023, fighting erupted in Sudan between the army led by General Abdel Fattah al-Burhan and the paramilitary Rapid Support Forces (RSF) under the command of General Mohamed Hamdan Dogolo, known as Hemeti. This war has caused a major humanitarian crisis in Sudan, with violent fighting spreading throughout the country, particularly in Darfur, and aggravating pre-existing inter-community tensions.
By the end of March, almost 30,000 civilians had fled to Chad in search of safety. By September 2023, according to data from the United Nations High Commissioner for Refugees (UNHCR), clashes between military and paramilitary forces had driven more than 420,000 people to flee to Chad in successive waves, of whom around 327,000 had settled in the Ouaddaï province. Chadian refugees and returnees live in very precarious conditions, with limited access to primary healthcare, water and food. Little recent data is available on the mortality, nutritional status, and vaccination coverage of refugee populations in camps in eastern Chad, particularly in Toumtouma, Ourang and Arkoum camps. The results of these surveys are essential for Médecins Sans Frontières (MSF) to better plan its humanitarian interventions, coordinate effectively with other actors, and communicate about the refugee crisis in eastern Chad.
METHODOLOGY
Three cross-sectional surveys were carried out, the first with systematic random sampling in Toumtouma camp from August 7 to 13, and the next two with cluster random geospatial sampling in Ourang camp from August 17 to 22 and Arkoum camp from August 30 to September 4, 2023. Each survey covered retrospective mortality, frequency and type of violent events experienced, nutritional status of children aged 6 to 59 months, and measles vaccination coverage among children aged 6 months to 14 years. The recall period ran from January 1 to the day of the survey, i.e., a minimum of 210, 228 and 241 days respectively. Two phases were considered: 1) the pre-crisis phase (Toumtouma: January 1 - March 14, 2023 / Ourang and Arkoum: January 1 - April 14, 2023) and 2) the crisis phase (Toumtouma: March 15 - day of survey / Ourang and Arkoum: April 15 - day of survey). In Toumtouma camp, the crisis phase started earlier due to inter-community tensions that erupted end of March in West Darfur and drove important population displacements towards Chad.
RESULTS
Retrospective mortality: In Toumtouma camp, of the 1,032 households included (i.e., 6,372 people), 59.7% were refugees, 35.9% returnees and 4.4% displaced persons. The crude mortality rate (CMR) was significantly higher in phase 2 (CMR: 0.58 deaths/10,000 people/day [95% CI: 0.43 - 0.74]) than in phase 1 (CMR: 0.20 deaths/10,000 people/day [95% CI: 0.07 - 0.33]). Eighty-nine percent of those who died were men. Violence (77%; n=48) was the main cause of death reported, followed by diarrhea (6%; n=4) and respiratory infection (5%; n=3). Among the deaths, 68% occurred in their town or village of origin, 21% during displacement and 11% in an unknown location. Most people who died came from El Geneina (40%), Tandulti (35%) and Umm Dam (16%) in Darfur.
In Ourang camp, of the 1032 households included (i.e., 6302 people), 99.0% were refugees and 1.0% returnees. The CMR was significantly higher in phase 2 (CMR: 2.25 deaths/10,000 people/day [95% CI: 1.77 - 2.74]) than in phase 1 (CMR: 0.11 deaths/10,000 people/day [95% CI: 0.02 - 0.20]). Eighty-three percent of those who died were men (3.88 deaths/10,000 people/day [95% CI: 3.01 - 4.76] in phase 2). Violence (82%; n=147) was the main cause of death reported, followed by measles (5%; n=9). Among the deaths, 69% occurred in their town or village of origin, 25% during displacement and 6% in Adre, Chad. Most people who died came from El Geneina (96%) in Darfur.
In Arkoum camp, of the 1029 households included (i.e., 5324 people), 98.4% were refugees, 1.3% displaced and 0.4% returnees. The CMR was significantly higher in phase 2 (CMR: 0.67 deaths/10,000 people/day [95% CI: 0.46 - 0.89]) than in phase 1 (CMR: 0.15 deaths/10,000 people/day [95% CI: 0.03 - 0.26]). Seventy-seven percent of those who died were men; the mortality rate among men was 1.14 [95% CI: 0.72 - 1.55] in the second phase. Violence (50%; n=28) was the main cause of death reported, followed by diarrhea (16%; n=9). Among the deaths, 52% occurred in their town or village of origin, 27% during displacement, 5% after their arrival in Chad and 16% in an unknown location. Most people who died came from Mistre (54%) and Kongu (29%) in Darfur.
Frequency and main causes of violence: Among households in Toumtouma, Ourang and Arkoum camps, the overall frequency of violence was 3.3%, 11.7% and 4.4% respectively. The main types of violence were beatings (71.0% in Toumtouma, 71.1% in Ourang, and 79.7% in Arkoum), and shootings (27.1% in Toumtouma, 34.7% in Ourang, and 15.1% in Arkoum).
Prevalence of acute malnutrition: Among children aged 6-59 months, the prevalence of global acute malnutrition (GAM) according to MUAC and/or bilateral oedema was 5.5% [95% CI: 4.1 - 7.5] in Toumtouma, 11.3% [95% CI: 9.2 - 13.8] in Ourang, and 11.6% [95% CI: 9.5 - 14.5] in Arkoum camp. Rates of severe acute malnutrition (SAM) were 2.3% [95% CI: 1.4 - 3.6] in Toumtouma, 4.8% [95% CI: 3.6 - 6.4] in Ourang, and 4.6% [95% CI: 3.4 - 6.3] in Arkoum.
Measles vaccination: Measles vaccination coverage among children aged 6 months to 14 years was estimated at 58.6% [95% CI: 56.9 - 60.3] in Toumtouma, 75.9% [95% CI: 71.3 - 79.9] in Ourang, and 63.6% [95% CI: 58.2 - 68.7] in Arkoum.
CONCLUSIONS
In the three camps investigated, excess mortality was observed among households during the crisis phase (phase 2), with a significant difference in CMR due to deaths from violence among men. Among households living in Toumtouma camp, the CMR more than doubled and among households in Arkoum camp, it more than tripled. The population in Ourang camp seems to have been particularly affected by the violence, with CMR 20 times higher than in the pre- crisis period and mortality rates exceeding the standard emergency threshold (1 death/10,000 people/day). The vast majority of deaths occurred on the sites of origin or during displacement towards Chad (89% in Toutouma, 94% in Ourang and 79% in Arkoum). GAM and SAM prevalences among 6-59-month-olds were high in Ourang and Arkoum camps, with an alarming SAM prevalence of over 4%. In addition, the measles vaccination coverage, which ranged from 59% to 76% across the camps surveyed, was insufficient to prevent outbreaks.
Journal Article > ResearchFull Text
Trans R Soc Trop Med Hyg. 2008 March 1; Volume 102 (Issue 3); DOI:10.1016/j.trstmh.2007.10.015
Alberti KP, Guthmann JP, Fermon F, Nargaye KD, Grais RF
Trans R Soc Trop Med Hyg. 2008 March 1; Volume 102 (Issue 3); DOI:10.1016/j.trstmh.2007.10.015
Inadequate evaluation of vaccine coverage after mass vaccination campaigns, such as used in national measles control programmes, can lead to inappropriate public health responses. Overestimation of vaccination coverage may leave populations at risk, whilst underestimation can lead to unnecessary catch-up campaigns. The problem is more complex in large urban areas where vaccination coverage may be heterogeneous and the programme may have to be fine-tuned at the level of geographic subunits. Lack of accurate population figures in many contexts further complicates accurate vaccination coverage estimates. During the evaluation of a mass vaccination campaign carried out in N'Djamena, the capital of Chad, Lot Quality Assurance Sampling was used to estimate vaccination coverage. Using this method, vaccination coverage could be evaluated within smaller geographic areas of the city as well as for the entire city. Despite the lack of accurate population data by neighbourhood, the results of the survey showed heterogeneity of vaccination coverage within the city. These differences would not have been identified using a more traditional method. The results can be used to target areas of low vaccination coverage during follow-up vaccination activities.
Conference Material > Abstract
Simons E, Grellety E
Epicentre Scientific Day 2024. 2024 May 23
BACKGROUND
Fighting erupted on 15 April 2023 in Sudan between the army and the paramilitary Rapid Support Forces. By September 2023, more than 420,000 people had fled to Chad. To describe the health status of the displaced populations in camps in eastern Chad, several surveys were realised. We describe retrospective crude and under five mortality rates, reported causes of death and frequency and type of violence events experienced by displaced populations in three camps in eastern Chad.
METHODS
Cross-sectional surveys were carried out in August and September 2023 in Toumtouma, Ourang and Arkoum camps. Each survey included retrospective mortality and frequency and type of violent events experienced. All surveys considered a pre-crisis and crisis phase.
RESULTS
In all sites, the crude mortality rate (CMR) was significantly higher in the crisis phase than in the pre-crisis phase. The CMR was particularly elevated in Ourang camp (CMR: 2.25 deaths/10,000 people/day [95% CI: 1.77 - 2.74] in the crisis phase versus CMR: 0.11 deaths/10,000 people/day [95% CI: 0.02 - 0.20] in the pre-crisis phase). Violence was the leading self-reported cause of death in all sites. Among households in Ourang, more than 90 percent originating from El Geneina, more than 1 in 10 of all men aged 30 and over died of violent causes. In Toumtouma, Ourang and Arkoum camps, the overall frequency of violence among households was 3.3%, 11.7% and 4.4% respectively, with beatings and shooting most frequently cited.
CONCLUSIONS
In the three camps investigated, excess mortality was observed among households during the crisis phase, with excess mortality primarily linked to violence among men. The population in Ourang camp, largely from El Geneina, appears to have been particularly affected by the violence, with CMR 20 times higher than in the pre-crisis period and mortality rates exceeding the standard emergency threshold (1 death/10,000 people/day).
KEY MESSAGE
Several cross-sectional surveys were carried out among displaced populations arriving in Chad. We provide epidemiological evidence of the high rates of mortality and violence since the start of the conflict in Sudan.
Conference Material > Video (talk)
Lasmi K
MSF Paediatric Days 2022. 2022 November 29; DOI:10.57740/qxex-ae08
English
Français
Journal Article > ResearchFull Text
BMC Infect Dis. 2018 June 26; Volume 18 (Issue 1); DOI:10.1186/s12879-018-3194-6
Vernier L, Lenglet AD, Hogema B, Moussa AM, Ariti C, et al.
BMC Infect Dis. 2018 June 26; Volume 18 (Issue 1); DOI:10.1186/s12879-018-3194-6
From September 2016-April 2017, Am Timan, Chad, experienced a large HEV outbreak in an urban setting with a limited impact in terms of morbidity and mortality. To better understand HEV epidemiology in this context, we estimated the seroprevalence of anti-HEV antibodies (IgM and IgG) and assessed the risk factors for recent HEV infections (positive anti-HEV IgM) during this outbreak.
Journal Article > ResearchFull Text
J Med Virol. 2005 December 1; Volume 77 (Issue 4); DOI:10.1002/jmv.20487
Nicand E, Armstrong GL, Enouf V, Guthmann JP, Guerin JP, et al.
J Med Virol. 2005 December 1; Volume 77 (Issue 4); DOI:10.1002/jmv.20487
The within-outbreak diversity of hepatitis E virus (HEV) was studied during the outbreak of hepatitis E that occurred in Sudan in 2004. Specimens were collected from internally displaced persons living in a Sudanese refugee camp and two camps implanted in Chad. A comparison of the sequences in the ORF2 region of 23 Sudanese isolates and five HEV samples from the two Chadian camps displayed a high similarity (>99.7%) to strains belonging to Genotype 1. But four isolates collected in one of the Chadian camps were close to Genotype 2. Circulation of divergent strains argues for possible multiple sources of infection.
Journal Article > ResearchFull Text
Vaccine. 2014 September 23; Volume 32 (Issue 47); DOI:10.1016/j.vaccine.2014.09.027
Juan-Giner A, Domicent C, Langendorf C, Roper M, Baoundoh P, et al.
Vaccine. 2014 September 23; Volume 32 (Issue 47); DOI:10.1016/j.vaccine.2014.09.027
In resource-poor settings, cold chain requirements present barriers for vaccine delivery. We evaluated the immunogenicity and safety of tetanus toxoid (TT) vaccine in "Controlled Temperature Chain" (CTC; up to 40°C for <30 days before administration), compared to standard cold chain (SCC; 2-8°C). Prior to the study, stability parameters of TT-CTC were shown to meet international requirements.
Journal Article > ResearchAbstract
Int Health. 2011 May 19; Volume 3 (Issue 2); 91-100.; DOI:10.1016/j.inhe.2011.01.002
Ponsar F, Tayler-Smith K, Philips M, Gerard S, Van Herp M, et al.
Int Health. 2011 May 19; Volume 3 (Issue 2); 91-100.; DOI:10.1016/j.inhe.2011.01.002
Although user fees are a common form of healthcare financing in resource-poor countries, there is growing consensus that their use compromises health service utilisation and population health. Between 2003 and 2006, Médecins sans Frontières (MSF) conducted population-based surveys in Burundi, Sierra Leone, Democratic Republic of Congo, Chad, Haiti and Mali to determine the impact of user fees on healthcare-seeking behaviour and access. For general and disease-specific conditions, MSF also measured the impact of (i) reduced payment systems in Chad, Mali, Haiti and Burundi and (ii) user fee abolition for certain population groups in Burundi and Mali. User fees were found to result in low utilisation of public health facilities, exclusion from health care and exacerbation of impoverishment, forcing many to seek alternative care. Financial barriers affected 30-60% of people requiring health care. Exemption systems targeting vulnerable individuals proved ineffective, benefiting only 1-3.5% of populations. Alternative payment systems, requiring 'modest' fees from users (e.g. low flat fees), did not adequately improve coverage of essential health needs, especially for the poorest and most vulnerable. Conversely, user fee abolition for large population groups led to rapid increases in utilisation of health services and coverage of essential healthcare needs. Abolition of user fees appears crucial in helping to reduce existing barriers to health care. The challenge for health authorities and donor agencies is around working creatively to remove the fees while addressing the financial consequences of improved access and providing quality care.