Conference Material > Poster
Elsinga J, Sunyoto T, Di Stefano L, Giorgetti PF, Kyi HA, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/63l6oZ
Journal Article > ResearchFull Text
Clin Infect Dis. 2021 October 5; Volume 73 (Issue 7); e1713-e1718.; DOI:10.1093/cid/ciaa1718
Eisenberg N, Panunzi I, Wolz A, Burzio C, Cilliers A, et al.
Clin Infect Dis. 2021 October 5; Volume 73 (Issue 7); e1713-e1718.; DOI:10.1093/cid/ciaa1718
BACKGROUND
Diphtheria has re-emerged over the past several years. There is a paucity of data on the administration and safety of diphtheria antitoxin (DAT), the standard treatment for diphtheria. The 2017-2018 outbreak among Rohingya refugees in Bangladesh was the largest in decades. We determined the outcomes of DAT-treated patients and describe the occurrence and risk factors associated with adverse reactions to DAT.
METHODS
We conducted a retrospective study at the Médecins Sans Frontières Rubber Garden Diphtheria Treatment Center from December 2017-September 2018. Diphtheria was diagnosed based on the World Health Organization clinical case criteria. High-acuity patients were eligible for DAT. Safety precautions were meticulously maintained. We calculated the presence of adverse events by age, duration of illness, and DAT dosage using bivariate comparisons.
RESULTS
We treated 709 patients with DAT; 98% (n = 696) recovered and were discharged. One-fourth (n = 170) had at least 1 adverse reaction. Common reactions included cough (n = 115, 16%), rash (n = 66, 9%), and itching (n = 37, 5%). Three percent (n = 18) had severe hypersensitivity reactions. Five patients died during their DAT infusion or soon afterwards, but no deaths were attributed to DAT.
CONCLUSIONS
Outcomes for DAT-treated patients were excellent; mortality was <1%. Adverse reactions occurred in one-quarter of all patients, but most reactions were mild and resolved quickly. DAT can be safely administered in a setting with basic critical care, provided there is continuous patient monitoring during the infusion, staff training on management of adverse effects, and attention to safety precautions.
Diphtheria has re-emerged over the past several years. There is a paucity of data on the administration and safety of diphtheria antitoxin (DAT), the standard treatment for diphtheria. The 2017-2018 outbreak among Rohingya refugees in Bangladesh was the largest in decades. We determined the outcomes of DAT-treated patients and describe the occurrence and risk factors associated with adverse reactions to DAT.
METHODS
We conducted a retrospective study at the Médecins Sans Frontières Rubber Garden Diphtheria Treatment Center from December 2017-September 2018. Diphtheria was diagnosed based on the World Health Organization clinical case criteria. High-acuity patients were eligible for DAT. Safety precautions were meticulously maintained. We calculated the presence of adverse events by age, duration of illness, and DAT dosage using bivariate comparisons.
RESULTS
We treated 709 patients with DAT; 98% (n = 696) recovered and were discharged. One-fourth (n = 170) had at least 1 adverse reaction. Common reactions included cough (n = 115, 16%), rash (n = 66, 9%), and itching (n = 37, 5%). Three percent (n = 18) had severe hypersensitivity reactions. Five patients died during their DAT infusion or soon afterwards, but no deaths were attributed to DAT.
CONCLUSIONS
Outcomes for DAT-treated patients were excellent; mortality was <1%. Adverse reactions occurred in one-quarter of all patients, but most reactions were mild and resolved quickly. DAT can be safely administered in a setting with basic critical care, provided there is continuous patient monitoring during the infusion, staff training on management of adverse effects, and attention to safety precautions.
Journal Article > ResearchFull Text
Front Public Health. 2023 June 2; Volume 11; 1077068.; DOI:10.3389/fpubh.2023.1077068
Amat Camacho N, Chara A, Briskin E, Pellecchia U, Kyi HA, et al.
Front Public Health. 2023 June 2; Volume 11; 1077068.; DOI:10.3389/fpubh.2023.1077068
BACKGROUND
Breastfeeding (BF) should be protected, promoted, and supported for all infants in humanitarian settings. The re-establishment of exclusive BF is also a central part of the management of acutely malnourished infants under 6 months (<6 m). Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) perceptions of BF practice, promotion, and support among CGs with infants <6 m in this setting.
METHODS
We conducted a qualitative study using in-depth interviews and focus group discussions combined with non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programs or who attended health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data were collected involving a local translator and analyzed using reflexive thematic analysis directly from audio recordings.
RESULTS
Participants described how feeding practices are shaped by family, community, and traditional beliefs. The perception of breastmilk insufficiency was common and led to early supplementary feeding with inexpensive but unsuitable products. Participants often linked insufficient breastmilk production with poor maternal nutrition and stress, in a context shaped by conflict and food insecurity. BF promotion was generally well received but could be improved if tailored to address specific barriers to exclusive BF. Interviewed CGs positively valued BF support received as part of the comprehensive treatment for infant malnutrition. One of the main challenges identified was the length of stay at the facility. Some participants perceived that improvements in BF were at risk of being lost after discharge if CGs lacked an enabling environment for BF.
CONCLUSION
This study corroborates the strong influence of household and contextual factors on the practice, promotion, and support of BF. Despite identified challenges, the provision of BF support contributes to improvements in BF practice and was positively perceived by CGs in the studied setting. Greater attention should be directed toward providing support and follow-up for infants <6 m and their CGs in the community.
Breastfeeding (BF) should be protected, promoted, and supported for all infants in humanitarian settings. The re-establishment of exclusive BF is also a central part of the management of acutely malnourished infants under 6 months (<6 m). Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) perceptions of BF practice, promotion, and support among CGs with infants <6 m in this setting.
METHODS
We conducted a qualitative study using in-depth interviews and focus group discussions combined with non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programs or who attended health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data were collected involving a local translator and analyzed using reflexive thematic analysis directly from audio recordings.
RESULTS
Participants described how feeding practices are shaped by family, community, and traditional beliefs. The perception of breastmilk insufficiency was common and led to early supplementary feeding with inexpensive but unsuitable products. Participants often linked insufficient breastmilk production with poor maternal nutrition and stress, in a context shaped by conflict and food insecurity. BF promotion was generally well received but could be improved if tailored to address specific barriers to exclusive BF. Interviewed CGs positively valued BF support received as part of the comprehensive treatment for infant malnutrition. One of the main challenges identified was the length of stay at the facility. Some participants perceived that improvements in BF were at risk of being lost after discharge if CGs lacked an enabling environment for BF.
CONCLUSION
This study corroborates the strong influence of household and contextual factors on the practice, promotion, and support of BF. Despite identified challenges, the provision of BF support contributes to improvements in BF practice and was positively perceived by CGs in the studied setting. Greater attention should be directed toward providing support and follow-up for infants <6 m and their CGs in the community.
Conference Material > Abstract
Bigirimana T, Thind A, Hawa Diallo O, Kourouma A, Burzio C, et al.
MSF Paediatric Days 2024. 2024 May 4; DOI:10.57740/EFc46s
English
Français
BACKGROUND AND OBJECTIVES
In 2016, UNAIDS identified the Prevention of Mother-to-Child Transmission of HIV (PMTCT) as a significant challenge in the fight against HIV/AIDS in Guinea. This abstract presents the key findings of an evaluation conducted on the PMTCT component of MSF's HIV project in Guinea, implemented since the early 2000’s. The main objective of the evaluation was to assess its relevance, coherence, effectiveness, efficiency, impact, and sustainability.
METHODS
A mixed quantitative and qualitative methodology was applied, including a desk review of MSF project documents, field observations, and interviews with key stakeholders. The data were analysed by triangulation and benchmarking to ensure internal validity. Quantitative indicators provided information on the number of women receiving PMTCT treatment and the rate of HIV mother-to-child transmission (MTCT) in health facilities supported by MSF, allowing the measurement of the effectiveness of the intervention. The quality of data and the lack of primary data from 2011 to 2015 was the main limitation, hindering the calculation of statistical significance (p-value) for the observed change in the rate of MTCT of HIV.
RESULTS
MSF's PMTCT intervention was highly relevant and aligned with the country's needs. It demonstrated effectiveness through the significant number of women receiving PMTCT treatment, the establishment of a platform for viral load testing, drug supply support, and a reduction in the HIV MTCT rate. The rate of MTCT in health facilities supported by MSF decreased from 35.9% to 12% [7 – 12] between 2010 and 2021. The challenges relating to data accuracy, monitoring activities, the follow-up of babies born from HIV-infected mothers, and the readiness of the MoH to take over the programme were identified, highlighting the need for improvement to enhance the effectiveness and efficiency. Sustainability efforts remained low as the Guinean health system lacked enough funding to take over the programme.
CONCLUSIONS
The evaluation affirms the positive impact of the PMTCT intervention in reducing MTCT of HIV, even if project target (5%) was not achieved. Recommendations aim to strengthen investment in PMTCT and enhance the hand-over strategy to ensure sustainability after MSF exit.
In 2016, UNAIDS identified the Prevention of Mother-to-Child Transmission of HIV (PMTCT) as a significant challenge in the fight against HIV/AIDS in Guinea. This abstract presents the key findings of an evaluation conducted on the PMTCT component of MSF's HIV project in Guinea, implemented since the early 2000’s. The main objective of the evaluation was to assess its relevance, coherence, effectiveness, efficiency, impact, and sustainability.
METHODS
A mixed quantitative and qualitative methodology was applied, including a desk review of MSF project documents, field observations, and interviews with key stakeholders. The data were analysed by triangulation and benchmarking to ensure internal validity. Quantitative indicators provided information on the number of women receiving PMTCT treatment and the rate of HIV mother-to-child transmission (MTCT) in health facilities supported by MSF, allowing the measurement of the effectiveness of the intervention. The quality of data and the lack of primary data from 2011 to 2015 was the main limitation, hindering the calculation of statistical significance (p-value) for the observed change in the rate of MTCT of HIV.
RESULTS
MSF's PMTCT intervention was highly relevant and aligned with the country's needs. It demonstrated effectiveness through the significant number of women receiving PMTCT treatment, the establishment of a platform for viral load testing, drug supply support, and a reduction in the HIV MTCT rate. The rate of MTCT in health facilities supported by MSF decreased from 35.9% to 12% [7 – 12] between 2010 and 2021. The challenges relating to data accuracy, monitoring activities, the follow-up of babies born from HIV-infected mothers, and the readiness of the MoH to take over the programme were identified, highlighting the need for improvement to enhance the effectiveness and efficiency. Sustainability efforts remained low as the Guinean health system lacked enough funding to take over the programme.
CONCLUSIONS
The evaluation affirms the positive impact of the PMTCT intervention in reducing MTCT of HIV, even if project target (5%) was not achieved. Recommendations aim to strengthen investment in PMTCT and enhance the hand-over strategy to ensure sustainability after MSF exit.
Journal Article > Short ReportFull Text
J Infect Dis. 2017 January 15; DOI:10.1093/infdis/jiw493
Dornemann J, Burzio C, Ronsse A, Sprecher A, De Clerck H, et al.
J Infect Dis. 2017 January 15; DOI:10.1093/infdis/jiw493
A neonate born to an Ebola virus-positive woman was diagnosed with Ebola virus infection on her first day of life. The patient was treated with monoclonal antibodies (ZMapp), a buffy coat transfusion from an Ebola survivor, and the broad-spectrum antiviral GS-5734. On day 20, a venous blood specimen tested negative for Ebola virus by quantitative reverse-transcription polymerase chain reaction. The patient was discharged in good health on day 33 of life. Further follow-up consultations showed age-appropriate weight gain and neurodevelopment at the age of 12 months. This patient is the first neonate documented to have survived congenital infection with Ebola virus.
Conference Material > Slide Presentation
Bigirimana T, Thind A, Hawa Diallo O, Kourouma A, Burzio C, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/mZr9atns6
Français
Journal Article > ResearchFull Text
Lancet Infect Dis. 2024 September 1; Volume 24 (Issue 9); 1037-1044.; DOI:10.1016/S1473-3099(24)00184-1
Elsinga J, Sunyoto T, di Stefano L, Giorgetti PF, Kyi HA, et al.
Lancet Infect Dis. 2024 September 1; Volume 24 (Issue 9); 1037-1044.; DOI:10.1016/S1473-3099(24)00184-1
BACKGROUND
Lassa fever is a viral haemorrhagic fever with few options for diagnosis and treatment; it is also under-researched with knowledge gaps on its epidemiology. A point-of-care bedside test diagnosing Lassa fever, adhering to REASSURED criteria, is not currently available but is urgently needed in west African regions with high Lassa fever burden. We aimed to assess the validity and feasibility of a rapid diagnostic test (RDT) to confirm Lassa fever in people in Nigeria.
METHODS
We estimated the diagnostic performance of the ReLASV Pan-Lassa RDT (Zalgen Labs, Frederick, MD, USA) as a research-use-only test, compared to RT-PCR as a reference standard, in 217 participants at a federal tertiary hospital in Abakaliki, Nigeria. We recruited participants between Feb 17, 2022, and April 17, 2023. The RDT was performed using capillary blood at the patient bedside and using plasma at the laboratory. The performance of the test, based on REASSURED criteria, was assessed for user friendliness, rapidity and robustness, sensitivity, and specificity.
FINDINGS
Participants were aged between 0 and 85 years, with a median age of 33·0 years (IQR 22·0-44·3), and 24 participants were younger than 18 years. 107 (50%) participants were women and 109 (50%) were men; one participant had missing sex data. Although the specificity of the Pan-Lassa RDT was high (>90%), sensitivity at bedside using capillary blood was estimated as 4% (95% CI 1-14) at 15 min and 10% (3-22) at 25 min, far below the target of 90%. The laboratory-based RDT using plasma showed better sensitivity (46% [32-61] at 15 min and 50% [36-64] at 25 min) but did not reach the target sensitivity. Among the 52 PCR-positive participants with Lassa fever, positive RDT results were associated with lower cycle threshold values (glycoprotein precursor [GPC] gene mean 30·3 [SD 4·3], Large [L] gene mean 32·3 [3·7] vs GPC gene mean 24·5 [3·9], L gene mean 28·0 [3·6]). Personnel conducting the bedside test procedure reported being hindered by the inconvenient use of full personal protective equipment and long waiting procedures before a result could be read.
INTERPRETATION
The Pan-Lassa RDT is not currently recommended as a diagnostic or screening tool for suspected Lassa fever cases. Marked improvement in sensitivity and user friendliness is needed for the RDT to be adopted clinically. There remains an urgent need for better Lassa fever diagnostics to promote safety of in-hospital care and better disease outcomes in low-resource settings.
Lassa fever is a viral haemorrhagic fever with few options for diagnosis and treatment; it is also under-researched with knowledge gaps on its epidemiology. A point-of-care bedside test diagnosing Lassa fever, adhering to REASSURED criteria, is not currently available but is urgently needed in west African regions with high Lassa fever burden. We aimed to assess the validity and feasibility of a rapid diagnostic test (RDT) to confirm Lassa fever in people in Nigeria.
METHODS
We estimated the diagnostic performance of the ReLASV Pan-Lassa RDT (Zalgen Labs, Frederick, MD, USA) as a research-use-only test, compared to RT-PCR as a reference standard, in 217 participants at a federal tertiary hospital in Abakaliki, Nigeria. We recruited participants between Feb 17, 2022, and April 17, 2023. The RDT was performed using capillary blood at the patient bedside and using plasma at the laboratory. The performance of the test, based on REASSURED criteria, was assessed for user friendliness, rapidity and robustness, sensitivity, and specificity.
FINDINGS
Participants were aged between 0 and 85 years, with a median age of 33·0 years (IQR 22·0-44·3), and 24 participants were younger than 18 years. 107 (50%) participants were women and 109 (50%) were men; one participant had missing sex data. Although the specificity of the Pan-Lassa RDT was high (>90%), sensitivity at bedside using capillary blood was estimated as 4% (95% CI 1-14) at 15 min and 10% (3-22) at 25 min, far below the target of 90%. The laboratory-based RDT using plasma showed better sensitivity (46% [32-61] at 15 min and 50% [36-64] at 25 min) but did not reach the target sensitivity. Among the 52 PCR-positive participants with Lassa fever, positive RDT results were associated with lower cycle threshold values (glycoprotein precursor [GPC] gene mean 30·3 [SD 4·3], Large [L] gene mean 32·3 [3·7] vs GPC gene mean 24·5 [3·9], L gene mean 28·0 [3·6]). Personnel conducting the bedside test procedure reported being hindered by the inconvenient use of full personal protective equipment and long waiting procedures before a result could be read.
INTERPRETATION
The Pan-Lassa RDT is not currently recommended as a diagnostic or screening tool for suspected Lassa fever cases. Marked improvement in sensitivity and user friendliness is needed for the RDT to be adopted clinically. There remains an urgent need for better Lassa fever diagnostics to promote safety of in-hospital care and better disease outcomes in low-resource settings.