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.
Conference Material > Abstract
Hadiuzzaman M, Yantzi R, van den Boogaard W, Lim SY, Gupta PS, et al.
MSF Scientific Days International 2022. 12 May 2022; DOI:10.57740/2hjs-zc19
INTRODUCTION
Maternal health indicators remain unacceptably poor within the densely populated Rohingya refugee camps in Cox’s Bazar, Bangladesh. With a high prevalence of home births, we sought to explore perceptions, experiences, and expectations around delivery care of women of reproductive age. We also examined the potential roles of family and key community members within Camp 22, a relatively isolated camp with 23,000 refugees where MSF is the only provider of facility-based maternity care.
METHODS
In 2021, we selected 45 participants from Camp 22 through purposive and snowball sampling for in-depth interviews. Participants included 36 Rohingya women and their family members, three traditional birth attendants (TBA’s) and six community and religious leaders. Interviews were recorded, translated and transcribed into English by trained staff fluent in Rohingya. Thematic-content analysis was performed, whereby codes and emerging themes were identified.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the ERB of Bangladesh University of Health Sciences.
RESULTS
Findings showed that delivery choices were made as a family, with husband and parents-in-law being primary decision makers. An uncomplicated birth was not perceived as requiring facility-based assistance; many women preferred to give birth at home assisted by TBA’s, family, or local healers, due to placing greater trust in their own community. Lack of security and transport were crucial determinants in repudiating facility-based care at night. Concerns about male staff and being undressed during facility-based births, as well as the possibility of onward referrals should surgery or episiotomies be required, drove hesitancy. Separation from family and children added more anxiety. Lack of understanding by facility staff towards Rohingya birthing practices and beliefs, and the Rohingya’s unfamiliarity with formally-trained midwives and medical procedures, featured heavily in decisions for home births. Factors such as utilising birthing ropes and guaranteed privacy at home were key influencers for choosing home births. Additionally, perceived inexperience of midwives and lack of autonomy while in the facility, were other common reasons for apprehension.
CONCLUSION
This study emphasizes community trust as a factor in collective decision-making regarding birth choices. Trust was higher in TBA’s than in formally-trained midwives and this negatively affected perceptions regarding competence. Perceptions may also be affected by rapid midwife turnover, a factor endemic to non-governmental organizations working in Cox’s Bazar. The persistent gap in cultural understanding and adaptation by facility-based staff, even after three years of presence, suggests the need for a more iterative, inclusive and reflective approach, with community engagement strategies founded on beneficiaries own explicitly stated needs, beliefs and practices.
CONFLICTS OF INTEREST
None declared
Maternal health indicators remain unacceptably poor within the densely populated Rohingya refugee camps in Cox’s Bazar, Bangladesh. With a high prevalence of home births, we sought to explore perceptions, experiences, and expectations around delivery care of women of reproductive age. We also examined the potential roles of family and key community members within Camp 22, a relatively isolated camp with 23,000 refugees where MSF is the only provider of facility-based maternity care.
METHODS
In 2021, we selected 45 participants from Camp 22 through purposive and snowball sampling for in-depth interviews. Participants included 36 Rohingya women and their family members, three traditional birth attendants (TBA’s) and six community and religious leaders. Interviews were recorded, translated and transcribed into English by trained staff fluent in Rohingya. Thematic-content analysis was performed, whereby codes and emerging themes were identified.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the ERB of Bangladesh University of Health Sciences.
RESULTS
Findings showed that delivery choices were made as a family, with husband and parents-in-law being primary decision makers. An uncomplicated birth was not perceived as requiring facility-based assistance; many women preferred to give birth at home assisted by TBA’s, family, or local healers, due to placing greater trust in their own community. Lack of security and transport were crucial determinants in repudiating facility-based care at night. Concerns about male staff and being undressed during facility-based births, as well as the possibility of onward referrals should surgery or episiotomies be required, drove hesitancy. Separation from family and children added more anxiety. Lack of understanding by facility staff towards Rohingya birthing practices and beliefs, and the Rohingya’s unfamiliarity with formally-trained midwives and medical procedures, featured heavily in decisions for home births. Factors such as utilising birthing ropes and guaranteed privacy at home were key influencers for choosing home births. Additionally, perceived inexperience of midwives and lack of autonomy while in the facility, were other common reasons for apprehension.
CONCLUSION
This study emphasizes community trust as a factor in collective decision-making regarding birth choices. Trust was higher in TBA’s than in formally-trained midwives and this negatively affected perceptions regarding competence. Perceptions may also be affected by rapid midwife turnover, a factor endemic to non-governmental organizations working in Cox’s Bazar. The persistent gap in cultural understanding and adaptation by facility-based staff, even after three years of presence, suggests the need for a more iterative, inclusive and reflective approach, with community engagement strategies founded on beneficiaries own explicitly stated needs, beliefs and practices.
CONFLICTS OF INTEREST
None declared
Conference Material > Slide Presentation
Hadiuzzaman M, Yantzi R, van den Boogaard W, Lim SY, Gupta PS, et al.
MSF Scientific Days International 2022. 12 May 2022; DOI:10.57740/qwgn-be73
Journal Article > ResearchFull Text
Clin Infect Dis. 19 October 2011; Volume 53 (Issue 12); DOI:10.1093/cid/cir674
Ritmeijer KKD, ter Horst R, Chane S, Aderie EM, Piening T, et al.
Clin Infect Dis. 19 October 2011; Volume 53 (Issue 12); DOI:10.1093/cid/cir674
Due to unacceptably high mortality with pentavalent antimonials, Médecins Sans Frontières in 2006 began using liposomal amphotericin B (AmBisome) for visceral leishmaniasis (VL) patients in Ethiopia who were severely ill or positive for human immunodeficiency virus (HIV).
Protocol > Research Protocol
BMJ Open. 25 January 2021; Volume 11 (Issue 1); e045826.; DOI:10.1136/bmjopen-2020-045826
Chandna A, Aderie EM, Ahmad R, Arguni E, Ashley EA, et al.
BMJ Open. 25 January 2021; Volume 11 (Issue 1); e045826.; DOI:10.1136/bmjopen-2020-045826
INTRODUCTION
In rural and difficult-to-access settings, early and accurate recognition of febrile children at risk of progressing to serious illness could contribute to improved patient outcomes and better resource allocation. This study aims to develop a prognostic clinical prediction tool to assist community healthcare providers identify febrile children who might benefit from referral or admission for facility-based medical care.
METHODS AND ANALYSIS
This prospective observational study will recruit at least 4900 paediatric inpatients and outpatients under the age of 5 years presenting with an acute febrile illness to seven hospitals in six countries across Asia. A venous blood sample and nasopharyngeal swab is collected from each participant and detailed clinical data recorded at presentation, and each day for the first 48 hours of admission for inpatients. Multianalyte assays are performed at reference laboratories to measure a panel of host biomarkers, as well as targeted aetiological investigations for common bacterial and viral pathogens. Clinical outcome is ascertained on day 2 and day 28.Presenting syndromes, clinical outcomes and aetiology of acute febrile illness will be described and compared across sites. Following the latest guidance in prediction model building, a prognostic clinical prediction model, combining simple clinical features and measurements of host biomarkers, will be derived and geographically externally validated. The performance of the model will be evaluated in specific presenting clinical syndromes and fever aetiologies.
ETHICS AND DISSEMINATION
The study has received approval from all relevant international, national and institutional ethics committees. Written informed consent is provided by the caretaker of all participants. Results will be shared with local and national stakeholders, and disseminated via peer-reviewed open-access journals and scientific meetings.
TRIAL REGISTRATION NUMBER NCT04285021.
In rural and difficult-to-access settings, early and accurate recognition of febrile children at risk of progressing to serious illness could contribute to improved patient outcomes and better resource allocation. This study aims to develop a prognostic clinical prediction tool to assist community healthcare providers identify febrile children who might benefit from referral or admission for facility-based medical care.
METHODS AND ANALYSIS
This prospective observational study will recruit at least 4900 paediatric inpatients and outpatients under the age of 5 years presenting with an acute febrile illness to seven hospitals in six countries across Asia. A venous blood sample and nasopharyngeal swab is collected from each participant and detailed clinical data recorded at presentation, and each day for the first 48 hours of admission for inpatients. Multianalyte assays are performed at reference laboratories to measure a panel of host biomarkers, as well as targeted aetiological investigations for common bacterial and viral pathogens. Clinical outcome is ascertained on day 2 and day 28.Presenting syndromes, clinical outcomes and aetiology of acute febrile illness will be described and compared across sites. Following the latest guidance in prediction model building, a prognostic clinical prediction model, combining simple clinical features and measurements of host biomarkers, will be derived and geographically externally validated. The performance of the model will be evaluated in specific presenting clinical syndromes and fever aetiologies.
ETHICS AND DISSEMINATION
The study has received approval from all relevant international, national and institutional ethics committees. Written informed consent is provided by the caretaker of all participants. Results will be shared with local and national stakeholders, and disseminated via peer-reviewed open-access journals and scientific meetings.
TRIAL REGISTRATION NUMBER NCT04285021.
Journal Article > ResearchFull Text
Trans R Soc Trop Med Hyg. 13 June 2017; Volume 111 (Issue 3); 107-116.; DOI:10.1093/trstmh/trx023
Aderie EM, Diro EGJ, Zachariah R, da Fonseca M, Abongomera C, et al.
Trans R Soc Trop Med Hyg. 13 June 2017; Volume 111 (Issue 3); 107-116.; DOI:10.1093/trstmh/trx023
BACKGROUND
Visceral leishmaniasis (VL) patients with HIV co-infection should receive antiretroviral treatment (ART). However, the best timing for initiation of ART is not known. Among such individuals, we assessed the influence of ART timing on VL outcomes.
METHODS
A retrospective cohort study was conducted in Northwest Ethiopia among VL patients starting ART between 2008 and 2015. VL outcomes were assessed by the twelfth month of starting ART, within 4 weeks of VL diagnosis or thereafter.
RESULTS
Of 213 VL-HIV co-infected patients with ART initiation, 96 (45.1%) had moderate to severe malnutrition, 53 (24.9%) had active TB and 128 (60.1%) had hemoglobin levels under 9 g/dL. Eighty-nine (41.8%) were already on ART before VL diagnosis, 46 (21.6%) started ART within 4 weeks, and 78 (36.6%) thereafter. Definitive cure in those starting ART within 4 weeks 59% (95% CI 43-75%) and those starting thereafter 56% (95% CI 44-68%) was not significantly different. Those starting ART before primary VL had higher 12-months mortality compared to those starting later (RR 0.6; 95% CI 0.4-0.9; p=0.012).
CONCLUSIONS
VL-HIV patients are severely ill and with serious additional comorbidities. Outcomes of HIV-VL management are unsatisfactory and early ART initiation was associated with higher mortality. Further research on the optimal timing of ART initiation, and ensuring earlier diagnosis of VL patients, with improved management of comorbidities are needed.
Visceral leishmaniasis (VL) patients with HIV co-infection should receive antiretroviral treatment (ART). However, the best timing for initiation of ART is not known. Among such individuals, we assessed the influence of ART timing on VL outcomes.
METHODS
A retrospective cohort study was conducted in Northwest Ethiopia among VL patients starting ART between 2008 and 2015. VL outcomes were assessed by the twelfth month of starting ART, within 4 weeks of VL diagnosis or thereafter.
RESULTS
Of 213 VL-HIV co-infected patients with ART initiation, 96 (45.1%) had moderate to severe malnutrition, 53 (24.9%) had active TB and 128 (60.1%) had hemoglobin levels under 9 g/dL. Eighty-nine (41.8%) were already on ART before VL diagnosis, 46 (21.6%) started ART within 4 weeks, and 78 (36.6%) thereafter. Definitive cure in those starting ART within 4 weeks 59% (95% CI 43-75%) and those starting thereafter 56% (95% CI 44-68%) was not significantly different. Those starting ART before primary VL had higher 12-months mortality compared to those starting later (RR 0.6; 95% CI 0.4-0.9; p=0.012).
CONCLUSIONS
VL-HIV patients are severely ill and with serious additional comorbidities. Outcomes of HIV-VL management are unsatisfactory and early ART initiation was associated with higher mortality. Further research on the optimal timing of ART initiation, and ensuring earlier diagnosis of VL patients, with improved management of comorbidities are needed.