Journal Article > ResearchFull Text
Trans R Soc Trop Med Hyg. 2004 November 1; Volume 98 (Issue 11); DOI:10.1016/j.trstmh.2004.01.005
Guerin PJ, Brasher C, Baron E, Mic D, Grimont F, et al.
Trans R Soc Trop Med Hyg. 2004 November 1; Volume 98 (Issue 11); DOI:10.1016/j.trstmh.2004.01.005
From December 1999 to the end of February 2000, 4218 cases of dysentery were reported in Kenema district, southeastern Sierra Leone, by a Médecins Sans Frontières team operating in this region. Shigella dysenteriae serotype 1 was isolated from the early cases. The overall attack rate was 7.5% but higher among children under 5 years (11.2%) compared to the rest of the population (6.8%) (RR = 1.6; 95% CI 1.5-1.8). The case fatality ratio was 3.1%, and higher for children under 5 years (6.1% vs. 2.1%) (RR = 2.9; 95% CI 2.1-4.1). A case management strategy based on stratification of affected cases was chosen in this resource-poor setting. Patients considered at higher risk of death were treated with a 5 day ciprofloxacin regimen in isolation centres. Five hundred and eighty-three cases were treated with a case fatality ratio of 0.9%. Patients who did not have signs of severity when seen by health workers were given hygiene advice and oral rehydration salts. This strategy was effective in this complex emergency.
Journal Article > ResearchFull Text
Lancet. 2003 August 30
Guerin PJ, Brasher C, Baron E, Mic D, Grimont F, et al.
Lancet. 2003 August 30
In November 1999, a Médecins Sans Frontières team based in the southeastern part of Sierra Leone reported an increased number of cases of bloody diarrhoea. Shigella dysenteriae serotype 1 (Sd1) was isolated in the early cases. A total of 4218 cases of dysentery were reported in Kenema district from December, 1999, to March, 2000. The overall attack rate was 7.5%. The attack rate was higher among children younger than 5 years than in the rest of the population (11.2% vs 6.8%; relative risk=1.6; 95% CI 1.5-1.8). The case fatality was 3.1%, also higher for children younger than 5 years (6.1% vs 2.1%; relative risk=2.9; 95% CI 2.1-4.1]). Among 583 patients regarded at increased risk of death who were treated with ciprofloxacin in isolation centres, case fatality was 0.9%. A 5-day ciprofloxacin regimen, targeted to the most severe cases of bloody diarrhoea, was highly effective. This is the first time a large outbreak caused by Sd1 has been reported in west Africa.
Journal Article > ResearchFull Text
Lancet. 2006 April 22; Volume 367 (Issue 9519); DOI:10.1016/S0140-6736(06)68580-2
Ferradini LLF, Jeannin A, Pinoges LLP, Izopet J, Odhiambo D, et al.
Lancet. 2006 April 22; Volume 367 (Issue 9519); DOI:10.1016/S0140-6736(06)68580-2
BACKGROUND: The recording of outcomes from large-scale, simplified HAART (highly active antiretroviral therapy) programmes in sub-Saharan Africa is critical. We aimed to assess the effectiveness of such a programme held by Médecins Sans Frontières (MSF) in the Chiradzulu district, Malawi. METHODS: We scaled up and simplified HAART in this programme since August, 2002. We analysed survival indicators, CD4 count evolution, virological response, and adherence to treatment. We included adults who all started HAART 6 months or more before the analysis. HIV-1 RNA plasma viral load and self-reported adherence were assessed on a subsample of patients, and antiretroviral resistance mutations were analysed in plasma with viral loads greater than 1000 copies per mL. Analysis was by intention to treat. FINDINGS: Of the 1308 patients who were eligible, 827 (64%) were female, the median age was 34.9 years (IQR 29.9-41.0), and 1023 (78%) received d4T/3TC/NVP (stavudine, lamivudine, and nevirapine) as a fixed-dose combination. At baseline, 1266 individuals (97%) were HAART-naive, 357 (27%) were at WHO stage IV, 311 (33%) had a body-mass index of less than 18.5 kg/m2, and 208 (21%) had a CD4 count lower than 50 cells per muL. At follow-up (median 8.3 months, IQR 5.5-13.1), 967 (74%) were still on HAART, 243 (19%) had died, 91 (7%) were lost to follow-up, and seven (0.5%) discontinued treatment. Low body-mass index, WHO stage IV, male sex, and baseline CD4 count lower than 50 cells per muL were independent determinants of death in the first 6 months. At 12 months, the probability of individuals still in care was 0.76 (95% CI 0.73-0.78) and the median CD4 gain was 165 (IQR 67-259) cells per muL. In the cross-sectional survey (n=398), 334 (84%) had a viral load of less than 400 copies per mL. Of several indicators measuring adherence, self-reported poor adherence (<80%) in the past 4 days was the best predictor of detectable viral load (odds ratio 5.4, 95% CI 1.9-15.6). INTERPRETATION: These data show that large numbers of people can rapidly benefit from antiretroviral therapy in rural resource-poor settings and strongly supports the implementation of such large-scale simplified programmes in Africa.