Conference Material > Poster
Sheikh Mohamed A, Ilyas A, Abbas A, Avochi S, Kihara M, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/fDNraEM
Conference Material > Slide Presentation
Lau DK, Seebacher S, Abdi AM, Bishar S, Nur MB, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/ld1iLMav4
Conference Material > Abstract
Lau DK, Seebacher S, Abdi AM, Bishar S, Nur MB, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/eyJwVt4rop
BACKGROUND AND OBJECTIVES
Kismayo is a city in southern Somalia and the capital of Jubaland State. In 2020, the Jubaland State Ministry of Health (MoH) recorded 1094 measles cases: an 8.2-fold increase from 2019. This study sought to estimate measles disease burden and measles vaccination coverage during the 2020-2021 outbreak, while further identifying key barriers and facilitators to measles vaccination and care.
METHODS
We utilised a sequential mixed-method approach with two phases of data collection. Phase one involved a cross-sectional household survey with a standard questionnaire while phase two included key informant interviews and focus group discussions with community members, health care workers and vaccination program administrators.
RESULTS
Of 6664 individuals, 338 measles cases were recorded during the two-year recall period, giving an attack rate of 5% (95%CI:4-5). 17 measles deaths were reported, giving a case fatality ratio of 4% (95%CI:2-6). Measles-specific mortality was 0.04 deaths/day/10000 population (95%CI:0.02-0.05). Initially, 50% of vaccine-eligible children had one or more doses of measles containing vaccine (MCV) and this rose to 69% by the end of the recall period. Thematic analysis led to the grouping of qualitative data into two overarching themes: sociocultural factors and health system factors. Regarding sociocultural factors, respondents gave insights on community measles knowledge and care practices, social responsibility for prevention, security challenges and measles-related rumours. Regarding health system factors, respondents spoke about challenges with health service management and shortcomings in the implementation of the expanded programme on immunisation (EPI) and mass vaccination campaigns.
CONCLUSIONS
Our results show that measles represents a serious health burden for the Kismayo population and that MCV coverage is well below the 95% target for herd immunity. We recommend developing a population-specific approach to risk communication and community engagement, expanding measles care, increasing accessibility for EPI services in health facilities and mobile clinics, and developing improved programmatic strategies for mass vaccination campaigns.
Kismayo is a city in southern Somalia and the capital of Jubaland State. In 2020, the Jubaland State Ministry of Health (MoH) recorded 1094 measles cases: an 8.2-fold increase from 2019. This study sought to estimate measles disease burden and measles vaccination coverage during the 2020-2021 outbreak, while further identifying key barriers and facilitators to measles vaccination and care.
METHODS
We utilised a sequential mixed-method approach with two phases of data collection. Phase one involved a cross-sectional household survey with a standard questionnaire while phase two included key informant interviews and focus group discussions with community members, health care workers and vaccination program administrators.
RESULTS
Of 6664 individuals, 338 measles cases were recorded during the two-year recall period, giving an attack rate of 5% (95%CI:4-5). 17 measles deaths were reported, giving a case fatality ratio of 4% (95%CI:2-6). Measles-specific mortality was 0.04 deaths/day/10000 population (95%CI:0.02-0.05). Initially, 50% of vaccine-eligible children had one or more doses of measles containing vaccine (MCV) and this rose to 69% by the end of the recall period. Thematic analysis led to the grouping of qualitative data into two overarching themes: sociocultural factors and health system factors. Regarding sociocultural factors, respondents gave insights on community measles knowledge and care practices, social responsibility for prevention, security challenges and measles-related rumours. Regarding health system factors, respondents spoke about challenges with health service management and shortcomings in the implementation of the expanded programme on immunisation (EPI) and mass vaccination campaigns.
CONCLUSIONS
Our results show that measles represents a serious health burden for the Kismayo population and that MCV coverage is well below the 95% target for herd immunity. We recommend developing a population-specific approach to risk communication and community engagement, expanding measles care, increasing accessibility for EPI services in health facilities and mobile clinics, and developing improved programmatic strategies for mass vaccination campaigns.
Journal Article > CommentaryFull Text
Journal of Humanitarian Affairs. 23 November 2023; Volume 5 (Issue 2); 24-29.; DOI:10.7227/JHA.107
Leyland J, Tiller S, Bhattacharya B
Journal of Humanitarian Affairs. 23 November 2023; Volume 5 (Issue 2); 24-29.; DOI:10.7227/JHA.107
While health misinformation is important to address in humanitarian settings, over-focusing on it can obfuscate a more holistic understanding of a community’s needs in a crisis. Through Médecins Sans Frontières’ experience of deploying a platform to tackle health misinformation during the COVID-19 pandemic, this field report argues that, while important, health misinformation became a diversionary topic during COVID-19, which represented a lack of trust between communities, humanitarian organisations and health institutions, rather a fundamental obstacle to effective humanitarian interventions.
From our practitioners’ viewpoint, we reflect on the deployment of the ‘MSF Listen’ platform in our programmes and how it evolved from a purely misinformation-focused digital tool to a broader workflow and approach to understanding community needs in crises through accountable management of community feedback.
From our practitioners’ viewpoint, we reflect on the deployment of the ‘MSF Listen’ platform in our programmes and how it evolved from a purely misinformation-focused digital tool to a broader workflow and approach to understanding community needs in crises through accountable management of community feedback.
Conference Material > Slide Presentation
Ilyas A
MSF Paediatric Days 2022. 1 December 2022; DOI:10.57740/48P1-N928
Conference Material > Video
Ibrahim AI
MSF Paediatric Days 2022. 1 December 2022; DOI:10.57740/3n8y-wc55
English
Français
Conference Material > Slide Presentation
Ilyas A, Valori AV, Tamannai M, Aderie EM, Isak YA, et al.
MSF Paediatric Days 2022. 1 December 2022; DOI:10.57740/521y-tt84
Conference Material > Abstract
Ibrahim AI, Valori AV, Aderie EM
MSF Paediatric Days 2022. 26 November 2022; DOI:10.57740/v0ej-8d09
INTRODUCTION
Immunobullous disorders include several uncommon skin disorders rarely seen in infants. They typically present with bullae, erosions and surrounding erythema, although many variants and clinical presentations exist. We report the case of an infant with extended skin lesions who was diagnosed clinically and successfully treated after remote support from a dermatologist.
CASE DESCRIPTION (Download PDF for photos accompanying this description)
A 4-month-old boy arrived at our hospital with his mother presenting with diffuse, irregular skin erosions on the face, chest, shoulder and scalp. The condition started when the infant was 40 days old with flaccid, clear blisters on his left cheek. These ruptured to produce itchy, irregular-shaped erosions with thick crusts, and pustules at the edges. The lesions extended to the present locations including mucous membranes of the mouth and conjunctiva. There was no history of maternal skin disease or pregnancy complications. He was delivered at home and was previously healthy. Family history revealed that two older siblings had exhibited similar symptoms at 2 months, and 40 days old, and died at 8 and 4 months old respectively. The case was discussed remotely with a dermatologist using telemedicine, and the diagnosis of immunobullous disorder was made on clinical suspicion. In addition to IV cloxacillin and nutritional support, oral prednisone 2mg/kg and wound care were started. After 14 days he improved clinically, and the lesions started to heal.
DISCUSSION
We report a case of an infant with a clinical diagnosis of immunobullous disorder, successfully treated with oral corticosteroids. Differential diagnosis of skin disorders in settings without laboratory capacity for histopathology is challenging, but subspecialist support via telemedicine allowed the team to start empiric treatment resulting in clinical improvement and discharge of a complicated case. Remote health advice platforms are important tools to improve quality of care for patients in low resource settings.
Immunobullous disorders include several uncommon skin disorders rarely seen in infants. They typically present with bullae, erosions and surrounding erythema, although many variants and clinical presentations exist. We report the case of an infant with extended skin lesions who was diagnosed clinically and successfully treated after remote support from a dermatologist.
CASE DESCRIPTION (Download PDF for photos accompanying this description)
A 4-month-old boy arrived at our hospital with his mother presenting with diffuse, irregular skin erosions on the face, chest, shoulder and scalp. The condition started when the infant was 40 days old with flaccid, clear blisters on his left cheek. These ruptured to produce itchy, irregular-shaped erosions with thick crusts, and pustules at the edges. The lesions extended to the present locations including mucous membranes of the mouth and conjunctiva. There was no history of maternal skin disease or pregnancy complications. He was delivered at home and was previously healthy. Family history revealed that two older siblings had exhibited similar symptoms at 2 months, and 40 days old, and died at 8 and 4 months old respectively. The case was discussed remotely with a dermatologist using telemedicine, and the diagnosis of immunobullous disorder was made on clinical suspicion. In addition to IV cloxacillin and nutritional support, oral prednisone 2mg/kg and wound care were started. After 14 days he improved clinically, and the lesions started to heal.
DISCUSSION
We report a case of an infant with a clinical diagnosis of immunobullous disorder, successfully treated with oral corticosteroids. Differential diagnosis of skin disorders in settings without laboratory capacity for histopathology is challenging, but subspecialist support via telemedicine allowed the team to start empiric treatment resulting in clinical improvement and discharge of a complicated case. Remote health advice platforms are important tools to improve quality of care for patients in low resource settings.
Conference Material > Abstract
Ibrahim AI, Valori AV, Tamannai M, Aderie EM, Isak YA, et al.
MSF Paediatric Days 2022. 26 November 2022; DOI:10.57740/0r1d-n351
INTRODUCTION
Measles is a highly contagious viral infection preventable by vaccination. It can be a serious health problem and is one of Somalia´s public health concerns, with a vaccination coverage of 23% according to the Somali Health and Demographic Survey (SHDS, 2020). Common complications of measles include diarrhoea and respiratory complications such as otitis and pneumonia. We report a case of measles complicated by subcutaneous emphysema and pneumomediastinum seen in our hospital.
CASE DESCRIPTION (Download PDF for photos accompanying this description)
An 8-year-old boy diagnosed with measles presented to hospital with fever, respiratory distress (tachypnoea: respiratory rate 65/min, intercostal retractions, bilateral crepitations on auscultation, oxygen saturation in room air 94%), neck swelling and eyelid oedema a week after the appearance of the skin rash. The swelling progressed, involving the face, upper limbs, chest and scrotum. Subcutaneous crepitations were felt on palpation and chest X-ray showed extensive subcutaneous emphysema and signs of pneumomediastinum. He had no signs of malnutrition. He was not vaccinated against measles and two siblings were diagnosed with measles during his admission. The patient received percutaneous catheterisation in the Emergency Room and was hospitalised with supplemental oxygen (increasing saturations to 100%) plus ampicillin 150 mg/kg/day and cloxacillin 200 mg/kg/day for 2 weeks. He improved progressively and was discharged on day 14 after admission.
DISCUSSION
We report a case of measles with subcutaneous emphysema successfully treated in the Paediatric Ward. Over a period of three months, 80 cases of measles were treated at our hospital. Only this case deteriorated with bronchopneumonia and persistent cough, and eventually pneumomediastinum and subcutaneous emphysema. These are rare complications of measles, commonly associated with malnutrition and age under 5 years old, neither of which was the case for our patient. During outbreaks, in low coverage vaccination areas, rare complications of measles should still be considered.
Measles is a highly contagious viral infection preventable by vaccination. It can be a serious health problem and is one of Somalia´s public health concerns, with a vaccination coverage of 23% according to the Somali Health and Demographic Survey (SHDS, 2020). Common complications of measles include diarrhoea and respiratory complications such as otitis and pneumonia. We report a case of measles complicated by subcutaneous emphysema and pneumomediastinum seen in our hospital.
CASE DESCRIPTION (Download PDF for photos accompanying this description)
An 8-year-old boy diagnosed with measles presented to hospital with fever, respiratory distress (tachypnoea: respiratory rate 65/min, intercostal retractions, bilateral crepitations on auscultation, oxygen saturation in room air 94%), neck swelling and eyelid oedema a week after the appearance of the skin rash. The swelling progressed, involving the face, upper limbs, chest and scrotum. Subcutaneous crepitations were felt on palpation and chest X-ray showed extensive subcutaneous emphysema and signs of pneumomediastinum. He had no signs of malnutrition. He was not vaccinated against measles and two siblings were diagnosed with measles during his admission. The patient received percutaneous catheterisation in the Emergency Room and was hospitalised with supplemental oxygen (increasing saturations to 100%) plus ampicillin 150 mg/kg/day and cloxacillin 200 mg/kg/day for 2 weeks. He improved progressively and was discharged on day 14 after admission.
DISCUSSION
We report a case of measles with subcutaneous emphysema successfully treated in the Paediatric Ward. Over a period of three months, 80 cases of measles were treated at our hospital. Only this case deteriorated with bronchopneumonia and persistent cough, and eventually pneumomediastinum and subcutaneous emphysema. These are rare complications of measles, commonly associated with malnutrition and age under 5 years old, neither of which was the case for our patient. During outbreaks, in low coverage vaccination areas, rare complications of measles should still be considered.
Journal Article > ResearchFull Text
Int J Infect Dis. 1 September 2022; 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. 1 September 2022; 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.