Journal Article > ResearchFull Text
BMC Public Health. 2019 August 22; Volume 19 (Issue 1); DOI:10.1186/s12889-019-7500-z
Keating P, Carrion Martin AI, Blake A, Lechevalier P, Uzzeni F, et al.
BMC Public Health. 2019 August 22; Volume 19 (Issue 1); DOI:10.1186/s12889-019-7500-z
BACKGROUND:
Measles continues to circulate in the Democratic Republic of Congo, and the country suffered from several important outbreaks over the last 5 years. Despite a large outbreak starting in the former province of Katanga in 2010 and the resulting immunization activities, another outbreak occurred in 2015 in this same region. We conducted measles seroprevalence surveys in four health zones (HZ) in the former Katanga Province in order to assess the immunity against measles in children 6 months to 14 years after the 2015 outbreak.
METHODS:
We conducted multi-stage cluster surveys stratified by age group in four HZs, Kayamba, Malemba-Nkulu, Fungurume, and Manono. The age groups were 6-11 months, 12-59 months, and 5-14 years in Kayamba and Malemba-Nkulu, 6-59 months and 5-14 years in Manono and Fungurume. The serological status was measured on dried capillary blood spots collected systematically along with vaccination status (including routine Extended Program of Immunization (EPI), and supplementary immunization activities (SIAs)) and previous self-reported history of suspected measles.
RESULTS:
Overall seroprevalence against measles was 82.7% in Kayamba, 97.6% in Malemba-Nkulu, 83.2% in Manono, and 74.4% in Fungurume, and it increased with age in all HZs. It was 70.7 and 93.8% in children 12-59 months in Kayamba and Malemba-Nkulu, and 49.8 and 64.7% in children 6-59 months in Fungurume and Manono. The EPI coverage was low but varied across HZ. The accumulation of any type of vaccination against measles resulted in an overall vaccine coverage (VC) of at least 85% in children 12-59 months in Kayamba and Malemba-Nkulu, 86.1 and 74.8% in children 6-59 months in Fungurume and Manono. Previous measles infection in 2015-early 2016 was more frequently reported in children aged 12-59 months or 6-59 months (depending on the HZ).
CONCLUSION:
The measured seroprevalence was consistent with the events that occurred in these HZs over the past few years. Measles seroprevalence might prove a valuable source of information to help adjust the timing of future SIAs and prioritizing support to the EPI in this region as long as the VC does not reach a level high enough to efficiently prevent epidemic flare-ups.
Measles continues to circulate in the Democratic Republic of Congo, and the country suffered from several important outbreaks over the last 5 years. Despite a large outbreak starting in the former province of Katanga in 2010 and the resulting immunization activities, another outbreak occurred in 2015 in this same region. We conducted measles seroprevalence surveys in four health zones (HZ) in the former Katanga Province in order to assess the immunity against measles in children 6 months to 14 years after the 2015 outbreak.
METHODS:
We conducted multi-stage cluster surveys stratified by age group in four HZs, Kayamba, Malemba-Nkulu, Fungurume, and Manono. The age groups were 6-11 months, 12-59 months, and 5-14 years in Kayamba and Malemba-Nkulu, 6-59 months and 5-14 years in Manono and Fungurume. The serological status was measured on dried capillary blood spots collected systematically along with vaccination status (including routine Extended Program of Immunization (EPI), and supplementary immunization activities (SIAs)) and previous self-reported history of suspected measles.
RESULTS:
Overall seroprevalence against measles was 82.7% in Kayamba, 97.6% in Malemba-Nkulu, 83.2% in Manono, and 74.4% in Fungurume, and it increased with age in all HZs. It was 70.7 and 93.8% in children 12-59 months in Kayamba and Malemba-Nkulu, and 49.8 and 64.7% in children 6-59 months in Fungurume and Manono. The EPI coverage was low but varied across HZ. The accumulation of any type of vaccination against measles resulted in an overall vaccine coverage (VC) of at least 85% in children 12-59 months in Kayamba and Malemba-Nkulu, 86.1 and 74.8% in children 6-59 months in Fungurume and Manono. Previous measles infection in 2015-early 2016 was more frequently reported in children aged 12-59 months or 6-59 months (depending on the HZ).
CONCLUSION:
The measured seroprevalence was consistent with the events that occurred in these HZs over the past few years. Measles seroprevalence might prove a valuable source of information to help adjust the timing of future SIAs and prioritizing support to the EPI in this region as long as the VC does not reach a level high enough to efficiently prevent epidemic flare-ups.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2021 February 12; Volume 15 (Issue 2); e0009023.; DOI:10.1371/journal.pntd.0009023
Alcoba G, Ochoa C, Martins SB, Ruiz de Castañeda R, Bolon I, et al.
PLoS Negl Trop Dis. 2021 February 12; Volume 15 (Issue 2); e0009023.; DOI:10.1371/journal.pntd.0009023
BACKGROUND
Worldwide, it is estimated that snakes bite 4.5-5.4 million people annually, 2.7 million of which are envenomed, and 81,000-138,000 die. The World Health Organization reported these estimates and recognized the scarcity of large-scale, community-based, epidemiological data. In this context, we developed the "Snake-Byte" project that aims at (i) quantifying and mapping the impact of snakebite on human and animal health, and on livelihoods, (ii) developing predictive models for medical, ecological and economic indicators, and (iii) analyzing geographic accessibility to healthcare. This paper exclusively describes the methodology we developed to collect large-scale primary data on snakebite in humans and animals in two hyper-endemic countries, Cameroon and Nepal.
METHODOLOGY/PRINCIPAL FINDINGS
We compared available methods on snakebite epidemiology and on multi-cluster survey development. Then, in line with those findings, we developed an original study methodology based on a multi-cluster random survey, enhanced by geospatial, One Health, and health economics components. Using a minimum hypothesized snakebite national incidence of 100/100,000/year and optimizing design effect, confidence level, and non-response margin, we calculated a sample of 61,000 people per country. This represented 11,700 households in Cameroon and 13,800 in Nepal. The random selection with probability proportional to size generated 250 clusters from all Cameroonian regions and all Nepalese Terai districts. Our household selection methodology combined spatial randomization and selection via high-resolution satellite images. After ethical approval in Switerland (CCER), Nepal (BPKIHS), and Cameroon (CNERSH), and informed written consent, our e-questionnaires included geolocated baseline demographic and socio-economic characteristics, snakebite clinical features and outcomes, healthcare expenditure, animal ownership, animal outcomes, snake identification, and service accessibility.
CONCLUSIONS/SIGNIFICANCE
This novel transdisciplinary survey methodology was subsequently used to collect countrywide snakebite envenoming data in Nepal and Cameroon. District-level incidence data should help health authorities to channel antivenom and healthcare allocation. This methodology, or parts thereof, could be easily adapted to other countries and to other Neglected Tropical Diseases.
Worldwide, it is estimated that snakes bite 4.5-5.4 million people annually, 2.7 million of which are envenomed, and 81,000-138,000 die. The World Health Organization reported these estimates and recognized the scarcity of large-scale, community-based, epidemiological data. In this context, we developed the "Snake-Byte" project that aims at (i) quantifying and mapping the impact of snakebite on human and animal health, and on livelihoods, (ii) developing predictive models for medical, ecological and economic indicators, and (iii) analyzing geographic accessibility to healthcare. This paper exclusively describes the methodology we developed to collect large-scale primary data on snakebite in humans and animals in two hyper-endemic countries, Cameroon and Nepal.
METHODOLOGY/PRINCIPAL FINDINGS
We compared available methods on snakebite epidemiology and on multi-cluster survey development. Then, in line with those findings, we developed an original study methodology based on a multi-cluster random survey, enhanced by geospatial, One Health, and health economics components. Using a minimum hypothesized snakebite national incidence of 100/100,000/year and optimizing design effect, confidence level, and non-response margin, we calculated a sample of 61,000 people per country. This represented 11,700 households in Cameroon and 13,800 in Nepal. The random selection with probability proportional to size generated 250 clusters from all Cameroonian regions and all Nepalese Terai districts. Our household selection methodology combined spatial randomization and selection via high-resolution satellite images. After ethical approval in Switerland (CCER), Nepal (BPKIHS), and Cameroon (CNERSH), and informed written consent, our e-questionnaires included geolocated baseline demographic and socio-economic characteristics, snakebite clinical features and outcomes, healthcare expenditure, animal ownership, animal outcomes, snake identification, and service accessibility.
CONCLUSIONS/SIGNIFICANCE
This novel transdisciplinary survey methodology was subsequently used to collect countrywide snakebite envenoming data in Nepal and Cameroon. District-level incidence data should help health authorities to channel antivenom and healthcare allocation. This methodology, or parts thereof, could be easily adapted to other countries and to other Neglected Tropical Diseases.
Conference Material > Abstract
Moser W, Hassan Fahal MA, Abualas E, Bedri S, Elsir MT, et al.
MSF Scientific Days International 2022. 2022 May 9; DOI:10.57740/m8zq-4v79
INTRODUCTION
In Sudan, since the first Covid-19 case was declared on 13 March 2020, 32,846 confirmed cases were recorded through 10 April 2021. Of these, 72% were registered in Khartoum State alone. A convenience sample of more than 1,000 individuals from 22 neighbourhoods of Khartoum City found that between March and July 2020, 35% of sampled individuals tested positive using RT-PCR for SARS-CoV-2; 18% had anti–SARS-CoV-2 antibodies. Similar discrepancies between clinically confirmed cases and infection rates assessed by serology or PCR testing independent of symptoms have been described elsewhere in Africa.
METHODS
Omdurman, the largest among the three cities composing Sudan’s capital Khartoum, was chosen as the study site. Study design comprised two surveys: i) a retrospective mortality survey using two–stage cluster sampling methodology based on random geo–points with two recall periods: pre-pandemic (1 January 2019–29 February 2020) and pandemic (1 March 2020–day of the survey); and ii) a nested SARS-CoV-2 antibody prevalence survey. An adult household representative answered a standardised questionnaire for the mortality survey; all members of a sub-set of the household, regardless of age, were invited to participate in the seroprevalence study. Capillary blood was collected on dry blood spot cards and directly tested with the STANDARD Q COVID-19 IgM/IgG Combo, SD–Biosensor rapid test. Dry blood spot cards were transferred to the National Public Health Laboratory, Khartoum, for further analysis using enzyme- linked immunosorbent assay (ELISA; EUROIMMUN Anti–SARS-CoV-2). Differences between pre–and pandemic periods were assessed using Fisher’s exact test, and test performance was adjusted with a random effect and Bayesian latent class model.
ETHICS
This study was approved by the MSF Ethics Review Board and the Ethics Review Board, Sudan.
RESULTS
From 1 March until 10 April 2021, data from 27,315 people (3,716 households) for the entire recall period showed a 67% (95% confidence interval (CI) 32–110) increase in death rate between pre–pandemic (0.12 deaths/10000 people/day; 95%CI 0.10–0.14) and pandemic periods (0.20 deaths/10000 people/ day; 95%CI 0.16–0.23). 2,374 people participated in the seroprevalence survey. Adjusted SARS-CoV-2 seroprevalence was 54.6% (95%CI 51.4–57.8). Seroprevalence was significantly associated with age, increasing up to 80.7% (95%CI 71.7–89.7) for the oldest age group (≥50 years). We estimated that the number of infections were 50 times higher than the number of cases reported.
CONCLUSION
This population-based cross-sectional survey in Omdurman, Sudan, demonstrated significantly higher mortality in the pandemic period, compared to pre-pandemic; particularly affecting individuals aged 50 years and over. We also found elevated seropositivity in Omdurman with older populations being the most affected. Our results suggest that Omdurman was severely impacted by the COVID-19 pandemic.
CONFLICTS OF INTEREST
None declared.
In Sudan, since the first Covid-19 case was declared on 13 March 2020, 32,846 confirmed cases were recorded through 10 April 2021. Of these, 72% were registered in Khartoum State alone. A convenience sample of more than 1,000 individuals from 22 neighbourhoods of Khartoum City found that between March and July 2020, 35% of sampled individuals tested positive using RT-PCR for SARS-CoV-2; 18% had anti–SARS-CoV-2 antibodies. Similar discrepancies between clinically confirmed cases and infection rates assessed by serology or PCR testing independent of symptoms have been described elsewhere in Africa.
METHODS
Omdurman, the largest among the three cities composing Sudan’s capital Khartoum, was chosen as the study site. Study design comprised two surveys: i) a retrospective mortality survey using two–stage cluster sampling methodology based on random geo–points with two recall periods: pre-pandemic (1 January 2019–29 February 2020) and pandemic (1 March 2020–day of the survey); and ii) a nested SARS-CoV-2 antibody prevalence survey. An adult household representative answered a standardised questionnaire for the mortality survey; all members of a sub-set of the household, regardless of age, were invited to participate in the seroprevalence study. Capillary blood was collected on dry blood spot cards and directly tested with the STANDARD Q COVID-19 IgM/IgG Combo, SD–Biosensor rapid test. Dry blood spot cards were transferred to the National Public Health Laboratory, Khartoum, for further analysis using enzyme- linked immunosorbent assay (ELISA; EUROIMMUN Anti–SARS-CoV-2). Differences between pre–and pandemic periods were assessed using Fisher’s exact test, and test performance was adjusted with a random effect and Bayesian latent class model.
ETHICS
This study was approved by the MSF Ethics Review Board and the Ethics Review Board, Sudan.
RESULTS
From 1 March until 10 April 2021, data from 27,315 people (3,716 households) for the entire recall period showed a 67% (95% confidence interval (CI) 32–110) increase in death rate between pre–pandemic (0.12 deaths/10000 people/day; 95%CI 0.10–0.14) and pandemic periods (0.20 deaths/10000 people/ day; 95%CI 0.16–0.23). 2,374 people participated in the seroprevalence survey. Adjusted SARS-CoV-2 seroprevalence was 54.6% (95%CI 51.4–57.8). Seroprevalence was significantly associated with age, increasing up to 80.7% (95%CI 71.7–89.7) for the oldest age group (≥50 years). We estimated that the number of infections were 50 times higher than the number of cases reported.
CONCLUSION
This population-based cross-sectional survey in Omdurman, Sudan, demonstrated significantly higher mortality in the pandemic period, compared to pre-pandemic; particularly affecting individuals aged 50 years and over. We also found elevated seropositivity in Omdurman with older populations being the most affected. Our results suggest that Omdurman was severely impacted by the COVID-19 pandemic.
CONFLICTS OF INTEREST
None declared.
Journal Article > ResearchFull Text
PLOS One. 2021 December 17; Volume 16 (Issue 12); e0260989.; DOI:10.1371/journal.pone.0260989
Gignoux EM, Athanassiadis F, Garat Yarrow A, Jimale A, Mubuto N, et al.
PLOS One. 2021 December 17; Volume 16 (Issue 12); e0260989.; DOI:10.1371/journal.pone.0260989
BACKGROUND
Camps of forcibly displaced populations are considered to be at risk of large COVID-19 outbreaks. Low screening rates and limited surveillance led us to conduct a study in Dagahaley camp, located in the Dadaab refugee complex in Kenya to estimate SARS-COV-2 seroprevalence and, mortality and to identify changes in access to care during the pandemic.
METHODS
To estimate seroprevalence, a cross-sectional survey was conducted among a sample of individuals (n = 587) seeking care at the two main health centres and among all household members (n = 619) of community health workers and traditional birth attendants working in the camp. A rapid immunologic assay was used (BIOSYNEX® COVID-19 BSS [IgG/IgM]) and adjusted for test performance and mismatch between the sampled population and that of the general camp population. To estimate mortality, all households (n = 12860) were exhaustively interviewed in the camp about deaths occurring from January 2019 through March 2021.
RESULTS
In total 1206 participants were included in the seroprevalence study, 8% (95% CI: 6.6%-9.7%) had a positive serologic test. After adjusting for test performance and standardizing on age, a seroprevalence of 5.8% was estimated (95% CI: 1.6%-8.4%). The mortality rate for 10,000 persons per day was 0.05 (95% CI 0.05-0.06) prior to the pandemic and 0.07 (95% CI 0.06-0.08) during the pandemic, representing a significant 42% increase (p<0.001). Médecins Sans Frontières health centre consultations and hospital admissions decreased by 38% and 37% respectively.
CONCLUSION
The number of infected people was estimated 67 times higher than the number of reported cases. Participants aged 50 years or more were among the most affected. The mortality survey shows an increase in the mortality rate during the pandemic compared to before the pandemic. A decline in attendance at health facilities was observed and sustained despite the easing of restrictions.
Camps of forcibly displaced populations are considered to be at risk of large COVID-19 outbreaks. Low screening rates and limited surveillance led us to conduct a study in Dagahaley camp, located in the Dadaab refugee complex in Kenya to estimate SARS-COV-2 seroprevalence and, mortality and to identify changes in access to care during the pandemic.
METHODS
To estimate seroprevalence, a cross-sectional survey was conducted among a sample of individuals (n = 587) seeking care at the two main health centres and among all household members (n = 619) of community health workers and traditional birth attendants working in the camp. A rapid immunologic assay was used (BIOSYNEX® COVID-19 BSS [IgG/IgM]) and adjusted for test performance and mismatch between the sampled population and that of the general camp population. To estimate mortality, all households (n = 12860) were exhaustively interviewed in the camp about deaths occurring from January 2019 through March 2021.
RESULTS
In total 1206 participants were included in the seroprevalence study, 8% (95% CI: 6.6%-9.7%) had a positive serologic test. After adjusting for test performance and standardizing on age, a seroprevalence of 5.8% was estimated (95% CI: 1.6%-8.4%). The mortality rate for 10,000 persons per day was 0.05 (95% CI 0.05-0.06) prior to the pandemic and 0.07 (95% CI 0.06-0.08) during the pandemic, representing a significant 42% increase (p<0.001). Médecins Sans Frontières health centre consultations and hospital admissions decreased by 38% and 37% respectively.
CONCLUSION
The number of infected people was estimated 67 times higher than the number of reported cases. Participants aged 50 years or more were among the most affected. The mortality survey shows an increase in the mortality rate during the pandemic compared to before the pandemic. A decline in attendance at health facilities was observed and sustained despite the easing of restrictions.
Conference Material > Slide Presentation
Lau DK, Seebacher S, Abdi AM, Bishar S, Nur MB, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/ld1iLMav4
Journal Article > ResearchFull Text
N Engl J Med. 2016 January 7; Volume 374 (Issue 1); 23-32.; DOI:10.1056/NEJMoa1504605
Gignoux EM, Azman AS, de Smet M, Azuma P, Massaquoi M, et al.
N Engl J Med. 2016 January 7; Volume 374 (Issue 1); 23-32.; DOI:10.1056/NEJMoa1504605
BACKGROUND
Malaria treatment is recommended for patients with suspected Ebola virus disease (EVD) in West Africa, whether systematically or based on confirmed malaria diagnosis. At the Ebola treatment center in Foya, Lofa County, Liberia, the supply of artemether–lumefantrine, a first-line antimalarial combination drug, ran out for a 12-day period in August 2014. During this time, patients received the combination drug artesunate–amodiaquine; amodiaquine is a compound with anti–Ebola virus activity in vitro. No other obvious change in the care of patients occurred during this period.
METHODS
We fit unadjusted and adjusted regression models to standardized patient-level data to estimate the risk ratio for death among patients with confirmed EVD who were prescribed artesunate–amodiaquine (artesunate–amodiaquine group), as compared with those who were prescribed artemether–lumefantrine (artemether–lumefantrine group) and those who were not prescribed any antimalarial drug (no-antimalarial group).
RESULTS
Between June 5 and October 24, 2014, a total of 382 patients with confirmed EVD were admitted to the Ebola treatment center in Foya. At admission, 194 patients were prescribed artemether–lumefantrine and 71 were prescribed artesunate–amodiaquine. The characteristics of the patients in the artesunate–amodiaquine group were similar to those in the artemether–lumefantrine group and those in the no-antimalarial group. A total of 125 of the 194 patients in the artemether–lumefantrine group (64.4%) died, as compared with 36 of the 71 patients in the artesunate–amodiaquine group (50.7%). In adjusted analyses, the artesunate–amodiaquine group had a 31% lower risk of death than the artemether–lumefantrine group (risk ratio, 0.69; 95% confidence interval, 0.54 to 0.89), with a stronger effect observed among patients without malaria.
CONCLUSIONS
Patients who were prescribed artesunate–amodiaquine had a lower risk of death from EVD than did patients who were prescribed artemether–lumefantrine. However, our analyses cannot exclude the possibility that artemether–lumefantrine is associated with an increased risk of death or that the use of artesunate–amodiaquine was associated with unmeasured patient characteristics that directly altered the risk of death.
Malaria treatment is recommended for patients with suspected Ebola virus disease (EVD) in West Africa, whether systematically or based on confirmed malaria diagnosis. At the Ebola treatment center in Foya, Lofa County, Liberia, the supply of artemether–lumefantrine, a first-line antimalarial combination drug, ran out for a 12-day period in August 2014. During this time, patients received the combination drug artesunate–amodiaquine; amodiaquine is a compound with anti–Ebola virus activity in vitro. No other obvious change in the care of patients occurred during this period.
METHODS
We fit unadjusted and adjusted regression models to standardized patient-level data to estimate the risk ratio for death among patients with confirmed EVD who were prescribed artesunate–amodiaquine (artesunate–amodiaquine group), as compared with those who were prescribed artemether–lumefantrine (artemether–lumefantrine group) and those who were not prescribed any antimalarial drug (no-antimalarial group).
RESULTS
Between June 5 and October 24, 2014, a total of 382 patients with confirmed EVD were admitted to the Ebola treatment center in Foya. At admission, 194 patients were prescribed artemether–lumefantrine and 71 were prescribed artesunate–amodiaquine. The characteristics of the patients in the artesunate–amodiaquine group were similar to those in the artemether–lumefantrine group and those in the no-antimalarial group. A total of 125 of the 194 patients in the artemether–lumefantrine group (64.4%) died, as compared with 36 of the 71 patients in the artesunate–amodiaquine group (50.7%). In adjusted analyses, the artesunate–amodiaquine group had a 31% lower risk of death than the artemether–lumefantrine group (risk ratio, 0.69; 95% confidence interval, 0.54 to 0.89), with a stronger effect observed among patients without malaria.
CONCLUSIONS
Patients who were prescribed artesunate–amodiaquine had a lower risk of death from EVD than did patients who were prescribed artemether–lumefantrine. However, our analyses cannot exclude the possibility that artemether–lumefantrine is associated with an increased risk of death or that the use of artesunate–amodiaquine was associated with unmeasured patient characteristics that directly altered the risk of death.
Conference Material > Abstract
Gignoux EM
Epicentre Scientific Day 2024. 2024 May 23
BACKGROUND
Hepatitis E was first identified in the 1990s, but major epidemics date back to the 1950s. There is no specific treatment, and it can be fatal especially for pregnant women, causing spontaneous abortion and stillbirths. In 2011, the first vaccine was made available, and in 2015, the WHO recommended its use during epidemics, including for pregnant women. However, several major epidemics occurred without vaccine use. The first mass reactive vaccination took place in 2022 at the Bentiu camp in South Sudan, alongside operational research.
METHODS
We assessed vaccination feasibility and acceptance through coverage surveys and conducted focus group discussions on acceptance. We monitored adverse events following immunization (AEFI) for pharmacovigilance. To assess safety in pregnancy, we monitored the pregnancy outcomes of all women identified as pregnant during the vaccination campaign through a census. Despite the significant efficacy shown in a phase 3 clinical trial after three doses, we aimed to evaluate the vaccine's efficacy in South Sudan during an epidemic after administering two doses through a case-control study.
RESULTS
Coverage of at least one dose of the Hecolin vaccine after three rounds was estimated at 86% (95% CI: 84-88), with no cases of severe AEFI. Focus groups revealed strong concern about hepatitis E and high confidence and demand for the vaccine. An emulated target trial showed a relative risk of foetal loss between vaccinated and unvaccinated pregnant women at 1.1 (95% CI: 0.7-1.8). Vaccine effectiveness after two doses was estimated at 88.3% (95% CI: 53.8-97.6) using a test-negative design.
CONCLUSION
We found high vaccine coverage, good acceptance, and demand from the population. There was no evidence of increased risk of foetal loss among vaccinated pregnant women. Despite the small number of cases, the reduced dose regimen appeared effective in reducing disease risk in this highly exposed population.
KEY MESSAGE
Studies from the first mass reactive vaccination against hepatitis E demonstrated high coverage and acceptance, no safety issues among pregnant women, and good effectiveness after two doses.
Conference Material > Abstract
Sterk E, Newport T, Mahamat TA, Gitahi P, Mandagot JJ, et al.
MSF Scientific Days International 2021: Research. 2021 May 19
INTRODUCTION
Conflict in DRC’s northeast has led to large-scale displacement. MSF has supported around 50,000 internally displaced people, together with the host community, in Angumu health zone, within the region, since 2019. Work there has focused on supporting health facilities, community treatment sites, and distribution of long-lasting insecticidally-treated nets. WHO’s recommendations for malaria in extreme complex emergencies include provision of mass drug administration (MDA). Angumu is a highly malaria-endemic area, with displaced people having relocated from an area with lower exposure to malaria. In Angumu, there are high levels of mortality linked with malaria, and crude and under-5 mortality rates have been shown to be above the emergency threshold in 2020 population survey data. In addition, healthcare systems are over-burdened due to population displacement, together with deterioration in access to healthcare caused by the COVID-19 pandemic. DRC’s Ministry of Health, together with MSF, have implemented MDA with the goal of rapidly reducing malaria morbidity and mortality. We describe the intervention’s feasibility, data on pharmacovigilance, and associations with reported malaria morbidity.
METHODS
We implemented 3 MDA rounds spaced at least 28 days apart, for adults and children aged over 2 months, living in four health areas, covering a total population of 56,353. MDA involved delivery of two rounds of amodiaquine-artesunate and one round of artesunate-pyronaridine (Pyramax). Door-to-door distribution was chosen to reduce risk of COVID-19 transmission, with teams using COVID-19 protection measures. FIrst doses were directly observed, and notification of adverse events (AE’s) was implemented. We calculated administrative coverage, and estimated the number and reduction in weekly confirmed malaria cases reported from MSF-supported health Facilities before (weeks 1-40/2020) and after (weeks 41-53/2020) MDA delivery, as well as comparing the difference between targeted (6 facilities) and non-targeted health areas (14 facilities).
ETHICS
This abstract describes the evaluation of an implementation of an MSF programme. It was conducted with oversight from Monica Rull, Medical Director, Operational Centre Geneva, MSF.
RESULTS
227 teams, involving two community health workers each, carried out MDA. The first MDA round, carried out between 24 September and 13 October 2020, reached 74,847 people (133%), and the second was executed between 9 and 27 November 2020, reaching 75,487 people (134%). The third MDA round ran between 17 December 2020 and 7 January 2021, reaching 78,227 people (139%). There were 679 mild and three severe (0.9%, of all those receiving MDA) AE’s reported during the first round, and 425 mild and three severe (0.57%) AE’s during the second round. None of the severe AE’s reported were causally linked with MDA, after investigation. The average weekly number of malaria cases decreased by 81% (151 vs. 29) in MDA-targeted areas, as compared with a drop of 33% (139 vs 93) in non-targeted areas.
CONCLUSION
This was the first large-scale MDA of which we are aware, delivered in a highly malaria-endemic rural area, and the first MDA delivered using Pyramax. We faced delays with approvals and provision of anti-malarials; MDA rounds took longer to implement than planned, with delays between rounds. We successfully provided three rounds of MDA using two different anti-malarials, in a complex emergency setting. Implementation was during the COVID-19 pandemic yet reached high levels of coverage, and was linked with a reduction in reported malaria cases in MDA-targeted areas. Currently, the analysis of morbidity data and a retrospective mortality survey are ongoing.
CONFLICTS OF INTEREST
None declared
Conflict in DRC’s northeast has led to large-scale displacement. MSF has supported around 50,000 internally displaced people, together with the host community, in Angumu health zone, within the region, since 2019. Work there has focused on supporting health facilities, community treatment sites, and distribution of long-lasting insecticidally-treated nets. WHO’s recommendations for malaria in extreme complex emergencies include provision of mass drug administration (MDA). Angumu is a highly malaria-endemic area, with displaced people having relocated from an area with lower exposure to malaria. In Angumu, there are high levels of mortality linked with malaria, and crude and under-5 mortality rates have been shown to be above the emergency threshold in 2020 population survey data. In addition, healthcare systems are over-burdened due to population displacement, together with deterioration in access to healthcare caused by the COVID-19 pandemic. DRC’s Ministry of Health, together with MSF, have implemented MDA with the goal of rapidly reducing malaria morbidity and mortality. We describe the intervention’s feasibility, data on pharmacovigilance, and associations with reported malaria morbidity.
METHODS
We implemented 3 MDA rounds spaced at least 28 days apart, for adults and children aged over 2 months, living in four health areas, covering a total population of 56,353. MDA involved delivery of two rounds of amodiaquine-artesunate and one round of artesunate-pyronaridine (Pyramax). Door-to-door distribution was chosen to reduce risk of COVID-19 transmission, with teams using COVID-19 protection measures. FIrst doses were directly observed, and notification of adverse events (AE’s) was implemented. We calculated administrative coverage, and estimated the number and reduction in weekly confirmed malaria cases reported from MSF-supported health Facilities before (weeks 1-40/2020) and after (weeks 41-53/2020) MDA delivery, as well as comparing the difference between targeted (6 facilities) and non-targeted health areas (14 facilities).
ETHICS
This abstract describes the evaluation of an implementation of an MSF programme. It was conducted with oversight from Monica Rull, Medical Director, Operational Centre Geneva, MSF.
RESULTS
227 teams, involving two community health workers each, carried out MDA. The first MDA round, carried out between 24 September and 13 October 2020, reached 74,847 people (133%), and the second was executed between 9 and 27 November 2020, reaching 75,487 people (134%). The third MDA round ran between 17 December 2020 and 7 January 2021, reaching 78,227 people (139%). There were 679 mild and three severe (0.9%, of all those receiving MDA) AE’s reported during the first round, and 425 mild and three severe (0.57%) AE’s during the second round. None of the severe AE’s reported were causally linked with MDA, after investigation. The average weekly number of malaria cases decreased by 81% (151 vs. 29) in MDA-targeted areas, as compared with a drop of 33% (139 vs 93) in non-targeted areas.
CONCLUSION
This was the first large-scale MDA of which we are aware, delivered in a highly malaria-endemic rural area, and the first MDA delivered using Pyramax. We faced delays with approvals and provision of anti-malarials; MDA rounds took longer to implement than planned, with delays between rounds. We successfully provided three rounds of MDA using two different anti-malarials, in a complex emergency setting. Implementation was during the COVID-19 pandemic yet reached high levels of coverage, and was linked with a reduction in reported malaria cases in MDA-targeted areas. Currently, the analysis of morbidity data and a retrospective mortality survey are ongoing.
CONFLICTS OF INTEREST
None declared
Journal Article > ResearchFull Text
Confl Health. 2020 November 30; Volume 14; DOI:10.1186/s13031-020-00327-4
Gignoux EM, Sontsa OT, Mudasiru A, Eyong J, Ntone R, et al.
Confl Health. 2020 November 30; Volume 14; DOI:10.1186/s13031-020-00327-4
Background
In 2017, Field access was considerably limited in the Far North region of Cameroon due to the conflict. Médecins Sans Frontieres (MSF) in collaboration with Ministry of health needed to estimate the health situation of the populations living in two of the most affected departments of the region: Logone-et-Chari and Mayo-Sava.
Methods
Access to health care and mortality rates were estimated through cell phone interviews, in 30 villages (clusters) in each department. Local Community Health Workers (CHWs) previously collected all household phone numbers in the selected villages and nineteen were randomly selected from each of them. In order to compare telephone interviews to face-to-face interviews for estimating health care access, and mortality rates, both methods were conducted in parallel in the town of Mora in the mayo Sava department. Access to food was assessed through push messages sent by the three main mobile network operators in Cameroon. Additionally, all identified legal health care facilities in the area were interviewed by phone to estimate attendance and services offered before the conflict and at the date of the survey.
Results
Of a total of 3423 households called 43% were reached. Over 600,000 push messages sent and only 2255 were returned. We called 43 health facilities and reached 34 of them. In The town of Mora, telephone interviews showed a Crude Mortality Rate (CMR) at 0.30 (CI 95%: 0.16–0.43) death per 10,000-person per day and home visits showed a CMR at 0.16 (0.05–0.27), most other indicators showed comparable results except household composition (more Internally Displaced Persons by telephone).
Phone interviews showed a CMR at 0.63 (0.29–0.97) death per 10,000-person per day in Logone-et-Chari, and 0.30 (0.07–0.50) per 10,000-person per day in Mayo-Sava. Among 86 deaths, 13 were attributed to violence (15%), with terrorist attacks being explicitly mentioned for seven deaths. Among 29 health centres, 5 reported being attacked and vandalized; 3 remained temporally closed; Only 4 reported not being affected.
Conclusion
Telephone interviews are feasible in areas with limited access, although special attention should be paid to the initial collection of phone numbers. The use of text messages to collect data was not satisfactory is not recommended for this purpose. Mortality in Logone-et-Chari and Mayo-Sava was under critical humanitarian thresholds although a considerable number of deaths were directly related to the conflict.
In 2017, Field access was considerably limited in the Far North region of Cameroon due to the conflict. Médecins Sans Frontieres (MSF) in collaboration with Ministry of health needed to estimate the health situation of the populations living in two of the most affected departments of the region: Logone-et-Chari and Mayo-Sava.
Methods
Access to health care and mortality rates were estimated through cell phone interviews, in 30 villages (clusters) in each department. Local Community Health Workers (CHWs) previously collected all household phone numbers in the selected villages and nineteen were randomly selected from each of them. In order to compare telephone interviews to face-to-face interviews for estimating health care access, and mortality rates, both methods were conducted in parallel in the town of Mora in the mayo Sava department. Access to food was assessed through push messages sent by the three main mobile network operators in Cameroon. Additionally, all identified legal health care facilities in the area were interviewed by phone to estimate attendance and services offered before the conflict and at the date of the survey.
Results
Of a total of 3423 households called 43% were reached. Over 600,000 push messages sent and only 2255 were returned. We called 43 health facilities and reached 34 of them. In The town of Mora, telephone interviews showed a Crude Mortality Rate (CMR) at 0.30 (CI 95%: 0.16–0.43) death per 10,000-person per day and home visits showed a CMR at 0.16 (0.05–0.27), most other indicators showed comparable results except household composition (more Internally Displaced Persons by telephone).
Phone interviews showed a CMR at 0.63 (0.29–0.97) death per 10,000-person per day in Logone-et-Chari, and 0.30 (0.07–0.50) per 10,000-person per day in Mayo-Sava. Among 86 deaths, 13 were attributed to violence (15%), with terrorist attacks being explicitly mentioned for seven deaths. Among 29 health centres, 5 reported being attacked and vandalized; 3 remained temporally closed; Only 4 reported not being affected.
Conclusion
Telephone interviews are feasible in areas with limited access, although special attention should be paid to the initial collection of phone numbers. The use of text messages to collect data was not satisfactory is not recommended for this purpose. Mortality in Logone-et-Chari and Mayo-Sava was under critical humanitarian thresholds although a considerable number of deaths were directly related to the conflict.
Conference Material > Video (talk)
Gignoux EM
Epicentre Scientific Day Paris 2021. 2021 June 10