Journal Article > CommentaryFull Text
PLoS Negl Trop Dis. 13 December 2012; Volume 6 (Issue 12); DOI:10.1371/journal.pntd.0001950
Hasker E, Lutumba P, Chappuis F, Kande V, Potet J, et al.
PLoS Negl Trop Dis. 13 December 2012; Volume 6 (Issue 12); DOI:10.1371/journal.pntd.0001950
Journal Article > CommentaryFull Text
Lancet. 7 January 2006; Volume 367 (Issue 9504); 7-9.; DOI:10.1016/S0140-6736(06)67900-2
Depoortere E, Checchi F
Lancet. 7 January 2006; Volume 367 (Issue 9504); 7-9.; DOI:10.1016/S0140-6736(06)67900-2
Journal Article > ResearchFull Text
Trop Med Int Health. 1 February 2005; Volume 10 (Issue 2); DOI:10.1111/j.1365-3156.2004.01363.x
Depoortere E, Guthmann JP, Presse J, Sipilanyambe N, Nkandu E, et al.
Trop Med Int Health. 1 February 2005; Volume 10 (Issue 2); DOI:10.1111/j.1365-3156.2004.01363.x
In the Maheba Refugee Settlement, in the clinics supported by Medecins Sans Frontieres, all children aged up to 5 years with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulfadoxine/pyrimethamine (SP) and artesunate (AS). We compared the treatment's efficacy and effectiveness. Patients were randomized in order to receive the treatment supervised (efficacy) or unsupervised (effectiveness). Therapeutic response was determined after 28 days of follow up. The difference between recrudescence and re-infection was ascertained by polymerase chain reaction (PCR). We also assessed genetic markers associated to SP resistance (dhfr and dhps). Eighty-five patients received treatment under supervision and 84 received it unsupervised. On day 28, and after PCR adjustment, efficacy was found to be 83.5% (95% CI: 74.1-90.5), and effectiveness 63.4% (95% CI: 52.6-73.3) (P < 0.01). Point mutations on dhfr (108) and dhps (437) were found for 92.0% and 44.2% respectively of the PCR samples analysed. The significant difference in therapeutic response after supervised and unsupervised treatment intake can only be explained by insufficient patient adherence. When implementing new malaria treatment policies, serious investment in ensuring patient adherence is essential to ascertain the effectiveness of the new treatment schedules.
Journal Article > ResearchFull Text
Trop Med Int Health. 1 June 2004; Volume 9 (Issue 6); DOI:10.1111/j.1365-3156.2004.01253.x
Depoortere E, Kavle J, Keus K, Zeller H, Murri S, et al.
Trop Med Int Health. 1 June 2004; Volume 9 (Issue 6); DOI:10.1111/j.1365-3156.2004.01253.x
An atypical outbreak of West Nile virus (WNV) occurred in Ngorban County, South Kordophan, Sudan, from May to August 2002. We investigated the epidemic and conducted a case-control study in the village of Limon. Blood samples were obtained for cases and controls. Patients with obvious sequelae underwent cerebrospinal fluid (CSF) sampling as well. We used enzyme-linked immunosorbent assay (ELISA) and neutralization tests for laboratory diagnosis and identified 31 cases with encephalitis, four of whom died. Median age was 36 months. Bivariate analysis did not reveal any significant association with the risk factors investigated. Laboratory analysis confirmed presence of IgM antibodies caused by WNV in eight of 13 cases, indicative of recent viral infection. The unique aspects of the WNW outbreak in Sudan, i.e. disease occurrence solely among children and the clinical domination of encephalitis, involving severe neurological sequelae, demonstrate the continuing evolution of WNV virulence. The spread of such a virus to other countries or continents cannot be excluded.
Journal Article > ResearchFull Text
Trop Med Int Health. 1 January 2004; Volume 9 (Issue 1); 62-67.; DOI:10.1046/j.1365-3156.2003.01157.x
Depoortere E, Guthmann JP, Sipilanyambe N, Nkandu E, Fermon F, et al.
Trop Med Int Health. 1 January 2004; Volume 9 (Issue 1); 62-67.; DOI:10.1046/j.1365-3156.2003.01157.x
Artemisinin-based combination therapy (ACT) is one strategy recommended to increase cure rates in malaria and to contain resistance to Plasmodium falciparum. In the Maheba refugee settlement, children aged 5 years or younger with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulphadoxine-pyrimethamine (1 day) and artesunate (3 days). To measure treatment adherence, home visits were carried out the day after the last treatment dose. Patients who had any treatment dose left were considered certainly non-adherent. Other patients' classification was based on the answers to the questionnaire: patients whose caretakers stated the child had received the treatment regimen exactly as prescribed were considered probably adherent; all other patients were considered probably non-adherent. Reasons for non-adherence were assessed. We found 21.2% (95% CI [15.0-28.4]) of the patients to be certainly non-adherent, 39.4% (95% CI [31.6-47.6]) probably non-adherent, and 39.4% (95% CI [31.6-47.6]) probably adherent. Insufficient explanation by the dispenser was identified as an important reason for non-adherence. When considering the use of ACT, the issue of patient adherence remains challenging. However, it should not be used as an argument against the introduction of ACT. For these treatment regimens to remain efficacious on a long-term basis, specific and locally adapted strategies need to be implemented to ensure completion of the treatment.
Journal Article > ResearchFull Text
Lancet. 14 October 2004; Volume 364 (Issue 9442); DOI:10.1016/S0140-6736(04)17187-0
Depoortere E, Checchi F, Broillet F, Gerstl S, Minetti A, et al.
Lancet. 14 October 2004; Volume 364 (Issue 9442); DOI:10.1016/S0140-6736(04)17187-0
BACKGROUND: Violence in Darfur, Sudan, has rendered more than one million people internally displaced. An epidemiological study of the effect of armed incursions on mortality in Darfur was needed to provide a basis for appropriate assistance to internally displaced people. METHODS: Between April and June, 2004, we did retrospective cluster surveys among 215?400 internally displaced people in four sites of West Darfur (Zalingei, Murnei, Niertiti, El Geneina). Mortality recall periods covered both the pre-displacement and post-displacement periods in Zalingei, Murnei, and Niertiti, but not in El Geneina. Heads of households provided dates, causes, and places of deaths, and described the family structure. FINDINGS: Before arrival at displacement sites, mortality rates (expressed as deaths per 10?000 per day), were 5.9 (95% CI 2.2-14.9) in Zalingei, 9.5 (6.4-14.0) in Murnei, and 7.3 (3.2-15.7) in Niertiti. Violence caused 68-93% of these deaths. People who were killed were mostly adult men (relative risk 29.1-117.9 compared with children younger than 15 years), but included women and children. Most households fled because of direct village attacks. In camps, mortality rates fell but remained above the emergency benchmark, with a peak of 5.6 in El Geneina. Violence persisted even after displacement. Age and sex pyramids of surviving populations were skewed, with a deficit in men. INTERPRETATION: This study, which was done in a difficult setting, provides epidemiological evidence of this conflict's effect on civilians, confirming the serious nature of the crisis, and reinforcing findings from other war contexts.
Journal Article > CommentaryFull Text
PLoS Negl Trop Dis. 22 June 2017; Volume 11 (Issue 6); e0005545.; DOI:10.1371/journal.pntd.0005545
Carazo Perez S, Folkesson E, Anglaret X, Beavogui A, Berbain E, et al.
PLoS Negl Trop Dis. 22 June 2017; Volume 11 (Issue 6); e0005545.; DOI:10.1371/journal.pntd.0005545
During the large Ebola outbreak that affected West Africa in 2014 and 2015, studies were launched to evaluate potential treatments for the disease. A clinical trial to evaluate the effectiveness of the antiviral drug favipiravir was conducted in Guinea. This paper describes the main challenges of the implementation of the trial in the Ebola treatment center of Guéckédou. Following the principles of the Good Clinical Research Practices, we explored the aspects of the community's communication and engagement, ethical conduct, trial protocol compliance, informed consent of participants, ongoing benefit/risk assessment, record keeping, confidentiality of patients and study data, and roles and responsibilities of the actors involved. We concluded that several challenges have to be addressed to successfully implement a clinical trial during an international medical emergency but that the potential for collaboration between research teams and humanitarian organizations needs to be highlighted.