Journal Article > ResearchFull Text
Lancet Global Health. 25 March 2025; Online ahead of print; DOI:10.1016/S2214-109X(25)00011-7
Barks PM, Camacho A, Newport T, Ribeiro F, Ahuka-Mundeke S, et al.
Lancet Global Health. 25 March 2025; Online ahead of print; DOI:10.1016/S2214-109X(25)00011-7
Conference Material > Abstract
Simons E, Grellety E
Epicentre Scientific Day 2024. 23 May 2024
BACKGROUND
Fighting erupted on 15 April 2023 in Sudan between the army and the paramilitary Rapid Support Forces. By September 2023, more than 420,000 people had fled to Chad. To describe the health status of the displaced populations in camps in eastern Chad, several surveys were realised. We describe retrospective crude and under five mortality rates, reported causes of death and frequency and type of violence events experienced by displaced populations in three camps in eastern Chad.
METHODS
Cross-sectional surveys were carried out in August and September 2023 in Toumtouma, Ourang and Arkoum camps. Each survey included retrospective mortality and frequency and type of violent events experienced. All surveys considered a pre-crisis and crisis phase.
RESULTS
In all sites, the crude mortality rate (CMR) was significantly higher in the crisis phase than in the pre-crisis phase. The CMR was particularly elevated in Ourang camp (CMR: 2.25 deaths/10,000 people/day [95% CI: 1.77 - 2.74] in the crisis phase versus CMR: 0.11 deaths/10,000 people/day [95% CI: 0.02 - 0.20] in the pre-crisis phase). Violence was the leading self-reported cause of death in all sites. Among households in Ourang, more than 90 percent originating from El Geneina, more than 1 in 10 of all men aged 30 and over died of violent causes. In Toumtouma, Ourang and Arkoum camps, the overall frequency of violence among households was 3.3%, 11.7% and 4.4% respectively, with beatings and shooting most frequently cited.
CONCLUSIONS
In the three camps investigated, excess mortality was observed among households during the crisis phase, with excess mortality primarily linked to violence among men. The population in Ourang camp, largely from El Geneina, appears to have been particularly affected by the violence, with CMR 20 times higher than in the pre-crisis period and mortality rates exceeding the standard emergency threshold (1 death/10,000 people/day).
KEY MESSAGE
Several cross-sectional surveys were carried out among displaced populations arriving in Chad. We provide epidemiological evidence of the high rates of mortality and violence since the start of the conflict in Sudan.
Conference Material > Poster
Mousset M, Grellety E
Epicentre Scientific Day 2024. 23 May 2024
Conference Material > Poster
Ouedraogo P, Simons E, Grellety E
Epicentre Scientific Day 2024. 23 May 2024
Français
Technical Report > Survey
Ouedraogo P, Simons E, Grellety E
1 November 2023
English
Français
INTRODUCTION
Since April 15, 2023, fighting erupted in Sudan between the army led by General Abdel Fattah al-Burhan and the paramilitary Rapid Support Forces (RSF) under the command of General Mohamed Hamdan Dogolo, known as Hemeti. This war has caused a major humanitarian crisis in Sudan, with violent fighting spreading throughout the country, particularly in Darfur, and aggravating pre-existing inter-community tensions.
By the end of March, almost 30,000 civilians had fled to Chad in search of safety. By September 2023, according to data from the United Nations High Commissioner for Refugees (UNHCR), clashes between military and paramilitary forces had driven more than 420,000 people to flee to Chad in successive waves, of whom around 327,000 had settled in the Ouaddaï province. Chadian refugees and returnees live in very precarious conditions, with limited access to primary healthcare, water and food. Little recent data is available on the mortality, nutritional status, and vaccination coverage of refugee populations in camps in eastern Chad, particularly in Toumtouma, Ourang and Arkoum camps. The results of these surveys are essential for Médecins Sans Frontières (MSF) to better plan its humanitarian interventions, coordinate effectively with other actors, and communicate about the refugee crisis in eastern Chad.
METHODOLOGY
Three cross-sectional surveys were carried out, the first with systematic random sampling in Toumtouma camp from August 7 to 13, and the next two with cluster random geospatial sampling in Ourang camp from August 17 to 22 and Arkoum camp from August 30 to September 4, 2023. Each survey covered retrospective mortality, frequency and type of violent events experienced, nutritional status of children aged 6 to 59 months, and measles vaccination coverage among children aged 6 months to 14 years. The recall period ran from January 1 to the day of the survey, i.e., a minimum of 210, 228 and 241 days respectively. Two phases were considered: 1) the pre-crisis phase (Toumtouma: January 1 - March 14, 2023 / Ourang and Arkoum: January 1 - April 14, 2023) and 2) the crisis phase (Toumtouma: March 15 - day of survey / Ourang and Arkoum: April 15 - day of survey). In Toumtouma camp, the crisis phase started earlier due to inter-community tensions that erupted end of March in West Darfur and drove important population displacements towards Chad.
RESULTS
Retrospective mortality: In Toumtouma camp, of the 1,032 households included (i.e., 6,372 people), 59.7% were refugees, 35.9% returnees and 4.4% displaced persons. The crude mortality rate (CMR) was significantly higher in phase 2 (CMR: 0.58 deaths/10,000 people/day [95% CI: 0.43 - 0.74]) than in phase 1 (CMR: 0.20 deaths/10,000 people/day [95% CI: 0.07 - 0.33]). Eighty-nine percent of those who died were men. Violence (77%; n=48) was the main cause of death reported, followed by diarrhea (6%; n=4) and respiratory infection (5%; n=3). Among the deaths, 68% occurred in their town or village of origin, 21% during displacement and 11% in an unknown location. Most people who died came from El Geneina (40%), Tandulti (35%) and Umm Dam (16%) in Darfur.
In Ourang camp, of the 1032 households included (i.e., 6302 people), 99.0% were refugees and 1.0% returnees. The CMR was significantly higher in phase 2 (CMR: 2.25 deaths/10,000 people/day [95% CI: 1.77 - 2.74]) than in phase 1 (CMR: 0.11 deaths/10,000 people/day [95% CI: 0.02 - 0.20]). Eighty-three percent of those who died were men (3.88 deaths/10,000 people/day [95% CI: 3.01 - 4.76] in phase 2). Violence (82%; n=147) was the main cause of death reported, followed by measles (5%; n=9). Among the deaths, 69% occurred in their town or village of origin, 25% during displacement and 6% in Adre, Chad. Most people who died came from El Geneina (96%) in Darfur.
In Arkoum camp, of the 1029 households included (i.e., 5324 people), 98.4% were refugees, 1.3% displaced and 0.4% returnees. The CMR was significantly higher in phase 2 (CMR: 0.67 deaths/10,000 people/day [95% CI: 0.46 - 0.89]) than in phase 1 (CMR: 0.15 deaths/10,000 people/day [95% CI: 0.03 - 0.26]). Seventy-seven percent of those who died were men; the mortality rate among men was 1.14 [95% CI: 0.72 - 1.55] in the second phase. Violence (50%; n=28) was the main cause of death reported, followed by diarrhea (16%; n=9). Among the deaths, 52% occurred in their town or village of origin, 27% during displacement, 5% after their arrival in Chad and 16% in an unknown location. Most people who died came from Mistre (54%) and Kongu (29%) in Darfur.
Frequency and main causes of violence: Among households in Toumtouma, Ourang and Arkoum camps, the overall frequency of violence was 3.3%, 11.7% and 4.4% respectively. The main types of violence were beatings (71.0% in Toumtouma, 71.1% in Ourang, and 79.7% in Arkoum), and shootings (27.1% in Toumtouma, 34.7% in Ourang, and 15.1% in Arkoum).
Prevalence of acute malnutrition: Among children aged 6-59 months, the prevalence of global acute malnutrition (GAM) according to MUAC and/or bilateral oedema was 5.5% [95% CI: 4.1 - 7.5] in Toumtouma, 11.3% [95% CI: 9.2 - 13.8] in Ourang, and 11.6% [95% CI: 9.5 - 14.5] in Arkoum camp. Rates of severe acute malnutrition (SAM) were 2.3% [95% CI: 1.4 - 3.6] in Toumtouma, 4.8% [95% CI: 3.6 - 6.4] in Ourang, and 4.6% [95% CI: 3.4 - 6.3] in Arkoum.
Measles vaccination: Measles vaccination coverage among children aged 6 months to 14 years was estimated at 58.6% [95% CI: 56.9 - 60.3] in Toumtouma, 75.9% [95% CI: 71.3 - 79.9] in Ourang, and 63.6% [95% CI: 58.2 - 68.7] in Arkoum.
CONCLUSIONS
In the three camps investigated, excess mortality was observed among households during the crisis phase (phase 2), with a significant difference in CMR due to deaths from violence among men. Among households living in Toumtouma camp, the CMR more than doubled and among households in Arkoum camp, it more than tripled. The population in Ourang camp seems to have been particularly affected by the violence, with CMR 20 times higher than in the pre- crisis period and mortality rates exceeding the standard emergency threshold (1 death/10,000 people/day). The vast majority of deaths occurred on the sites of origin or during displacement towards Chad (89% in Toutouma, 94% in Ourang and 79% in Arkoum). GAM and SAM prevalences among 6-59-month-olds were high in Ourang and Arkoum camps, with an alarming SAM prevalence of over 4%. In addition, the measles vaccination coverage, which ranged from 59% to 76% across the camps surveyed, was insufficient to prevent outbreaks.
Since April 15, 2023, fighting erupted in Sudan between the army led by General Abdel Fattah al-Burhan and the paramilitary Rapid Support Forces (RSF) under the command of General Mohamed Hamdan Dogolo, known as Hemeti. This war has caused a major humanitarian crisis in Sudan, with violent fighting spreading throughout the country, particularly in Darfur, and aggravating pre-existing inter-community tensions.
By the end of March, almost 30,000 civilians had fled to Chad in search of safety. By September 2023, according to data from the United Nations High Commissioner for Refugees (UNHCR), clashes between military and paramilitary forces had driven more than 420,000 people to flee to Chad in successive waves, of whom around 327,000 had settled in the Ouaddaï province. Chadian refugees and returnees live in very precarious conditions, with limited access to primary healthcare, water and food. Little recent data is available on the mortality, nutritional status, and vaccination coverage of refugee populations in camps in eastern Chad, particularly in Toumtouma, Ourang and Arkoum camps. The results of these surveys are essential for Médecins Sans Frontières (MSF) to better plan its humanitarian interventions, coordinate effectively with other actors, and communicate about the refugee crisis in eastern Chad.
METHODOLOGY
Three cross-sectional surveys were carried out, the first with systematic random sampling in Toumtouma camp from August 7 to 13, and the next two with cluster random geospatial sampling in Ourang camp from August 17 to 22 and Arkoum camp from August 30 to September 4, 2023. Each survey covered retrospective mortality, frequency and type of violent events experienced, nutritional status of children aged 6 to 59 months, and measles vaccination coverage among children aged 6 months to 14 years. The recall period ran from January 1 to the day of the survey, i.e., a minimum of 210, 228 and 241 days respectively. Two phases were considered: 1) the pre-crisis phase (Toumtouma: January 1 - March 14, 2023 / Ourang and Arkoum: January 1 - April 14, 2023) and 2) the crisis phase (Toumtouma: March 15 - day of survey / Ourang and Arkoum: April 15 - day of survey). In Toumtouma camp, the crisis phase started earlier due to inter-community tensions that erupted end of March in West Darfur and drove important population displacements towards Chad.
RESULTS
Retrospective mortality: In Toumtouma camp, of the 1,032 households included (i.e., 6,372 people), 59.7% were refugees, 35.9% returnees and 4.4% displaced persons. The crude mortality rate (CMR) was significantly higher in phase 2 (CMR: 0.58 deaths/10,000 people/day [95% CI: 0.43 - 0.74]) than in phase 1 (CMR: 0.20 deaths/10,000 people/day [95% CI: 0.07 - 0.33]). Eighty-nine percent of those who died were men. Violence (77%; n=48) was the main cause of death reported, followed by diarrhea (6%; n=4) and respiratory infection (5%; n=3). Among the deaths, 68% occurred in their town or village of origin, 21% during displacement and 11% in an unknown location. Most people who died came from El Geneina (40%), Tandulti (35%) and Umm Dam (16%) in Darfur.
In Ourang camp, of the 1032 households included (i.e., 6302 people), 99.0% were refugees and 1.0% returnees. The CMR was significantly higher in phase 2 (CMR: 2.25 deaths/10,000 people/day [95% CI: 1.77 - 2.74]) than in phase 1 (CMR: 0.11 deaths/10,000 people/day [95% CI: 0.02 - 0.20]). Eighty-three percent of those who died were men (3.88 deaths/10,000 people/day [95% CI: 3.01 - 4.76] in phase 2). Violence (82%; n=147) was the main cause of death reported, followed by measles (5%; n=9). Among the deaths, 69% occurred in their town or village of origin, 25% during displacement and 6% in Adre, Chad. Most people who died came from El Geneina (96%) in Darfur.
In Arkoum camp, of the 1029 households included (i.e., 5324 people), 98.4% were refugees, 1.3% displaced and 0.4% returnees. The CMR was significantly higher in phase 2 (CMR: 0.67 deaths/10,000 people/day [95% CI: 0.46 - 0.89]) than in phase 1 (CMR: 0.15 deaths/10,000 people/day [95% CI: 0.03 - 0.26]). Seventy-seven percent of those who died were men; the mortality rate among men was 1.14 [95% CI: 0.72 - 1.55] in the second phase. Violence (50%; n=28) was the main cause of death reported, followed by diarrhea (16%; n=9). Among the deaths, 52% occurred in their town or village of origin, 27% during displacement, 5% after their arrival in Chad and 16% in an unknown location. Most people who died came from Mistre (54%) and Kongu (29%) in Darfur.
Frequency and main causes of violence: Among households in Toumtouma, Ourang and Arkoum camps, the overall frequency of violence was 3.3%, 11.7% and 4.4% respectively. The main types of violence were beatings (71.0% in Toumtouma, 71.1% in Ourang, and 79.7% in Arkoum), and shootings (27.1% in Toumtouma, 34.7% in Ourang, and 15.1% in Arkoum).
Prevalence of acute malnutrition: Among children aged 6-59 months, the prevalence of global acute malnutrition (GAM) according to MUAC and/or bilateral oedema was 5.5% [95% CI: 4.1 - 7.5] in Toumtouma, 11.3% [95% CI: 9.2 - 13.8] in Ourang, and 11.6% [95% CI: 9.5 - 14.5] in Arkoum camp. Rates of severe acute malnutrition (SAM) were 2.3% [95% CI: 1.4 - 3.6] in Toumtouma, 4.8% [95% CI: 3.6 - 6.4] in Ourang, and 4.6% [95% CI: 3.4 - 6.3] in Arkoum.
Measles vaccination: Measles vaccination coverage among children aged 6 months to 14 years was estimated at 58.6% [95% CI: 56.9 - 60.3] in Toumtouma, 75.9% [95% CI: 71.3 - 79.9] in Ourang, and 63.6% [95% CI: 58.2 - 68.7] in Arkoum.
CONCLUSIONS
In the three camps investigated, excess mortality was observed among households during the crisis phase (phase 2), with a significant difference in CMR due to deaths from violence among men. Among households living in Toumtouma camp, the CMR more than doubled and among households in Arkoum camp, it more than tripled. The population in Ourang camp seems to have been particularly affected by the violence, with CMR 20 times higher than in the pre- crisis period and mortality rates exceeding the standard emergency threshold (1 death/10,000 people/day). The vast majority of deaths occurred on the sites of origin or during displacement towards Chad (89% in Toutouma, 94% in Ourang and 79% in Arkoum). GAM and SAM prevalences among 6-59-month-olds were high in Ourang and Arkoum camps, with an alarming SAM prevalence of over 4%. In addition, the measles vaccination coverage, which ranged from 59% to 76% across the camps surveyed, was insufficient to prevent outbreaks.
Journal Article > ResearchFull Text
Lancet Infect Dis. 1 January 2023; Volume 23 (Issue 1); 91-102.; DOI:10.1016/S1473-3099(22)00584-9
Nsio JM, Ardiet DL, Coulborn RM, Grellety E, Albela M, et al.
Lancet Infect Dis. 1 January 2023; Volume 23 (Issue 1); 91-102.; DOI:10.1016/S1473-3099(22)00584-9
BACKGROUND
In its earliest phases, Ebola virus disease's rapid-onset, high fever, and gastrointestinal symptoms are largely indistinguishable from other infectious illnesses. We aimed to characterise the clinical indicators associated with Ebola virus disease to improve outbreak response.
METHODS
In this retrospective analysis, we assessed routinely collected data from individuals with possible Ebola virus disease attending 30 Ebola health facilities in two provinces of the Democratic Republic of the Congo between Aug 1, 2018, and Aug 28, 2019. We used logistic regression analysis to model the probability of Ebola infection across 34 clinical variables and four types of possible Ebola virus disease exposures: contact with an individual known to have Ebola virus disease, attendance at any funeral, health facility consultation, or consultation with an informal health practitioner.
FINDINGS
Data for 24 666 individuals were included. If a patient presented to care in the early symptomatic phase (ie, days 0–2), Ebola virus disease positivity was most associated with previous exposure to an individual with Ebola virus disease (odds ratio [OR] 11·9, 95% CI 9·1–15·8), funeral attendance (2·1, 1·6–2·7), or health facility consultations (2·1, 1·6–2·8), rather than clinical parameters. If presentation occurred on day 3 or later (after symptom onset), bleeding at an injection site (OR 33·9, 95% CI 12·7–101·3), bleeding gums (7·5, 3·7–15·4), conjunctivitis (2·4, 1·7–3·4), asthenia (1·9, 1·5–2·3), sore throat (1·8, 1·3–2·4), dysphagia (1·8, 1·4–2·3), and diarrhoea (1·6, 1·3–1·9) were additional strong predictors of Ebola virus disease. Some Ebola virus disease-specific signs were less prevalent among vaccinated individuals who were positive for Ebola virus disease when compared with the unvaccinated, such as dysphagia (–47%, p=0·0024), haematemesis (–90%, p=0·0131), and bleeding gums (–100%, p=0·0035).
INTERPRETATION
Establishing the exact time an individual first had symptoms is essential to assessing their infection risk. An individual's exposure history remains of paramount importance, especially in the early phase. Ebola virus disease vaccination reduces symptom severity and should also be considered when assessing the likelihood of infection. These findings about symptomatology should be translated into practice during triage and should inform testing and quarantine procedures.
In its earliest phases, Ebola virus disease's rapid-onset, high fever, and gastrointestinal symptoms are largely indistinguishable from other infectious illnesses. We aimed to characterise the clinical indicators associated with Ebola virus disease to improve outbreak response.
METHODS
In this retrospective analysis, we assessed routinely collected data from individuals with possible Ebola virus disease attending 30 Ebola health facilities in two provinces of the Democratic Republic of the Congo between Aug 1, 2018, and Aug 28, 2019. We used logistic regression analysis to model the probability of Ebola infection across 34 clinical variables and four types of possible Ebola virus disease exposures: contact with an individual known to have Ebola virus disease, attendance at any funeral, health facility consultation, or consultation with an informal health practitioner.
FINDINGS
Data for 24 666 individuals were included. If a patient presented to care in the early symptomatic phase (ie, days 0–2), Ebola virus disease positivity was most associated with previous exposure to an individual with Ebola virus disease (odds ratio [OR] 11·9, 95% CI 9·1–15·8), funeral attendance (2·1, 1·6–2·7), or health facility consultations (2·1, 1·6–2·8), rather than clinical parameters. If presentation occurred on day 3 or later (after symptom onset), bleeding at an injection site (OR 33·9, 95% CI 12·7–101·3), bleeding gums (7·5, 3·7–15·4), conjunctivitis (2·4, 1·7–3·4), asthenia (1·9, 1·5–2·3), sore throat (1·8, 1·3–2·4), dysphagia (1·8, 1·4–2·3), and diarrhoea (1·6, 1·3–1·9) were additional strong predictors of Ebola virus disease. Some Ebola virus disease-specific signs were less prevalent among vaccinated individuals who were positive for Ebola virus disease when compared with the unvaccinated, such as dysphagia (–47%, p=0·0024), haematemesis (–90%, p=0·0131), and bleeding gums (–100%, p=0·0035).
INTERPRETATION
Establishing the exact time an individual first had symptoms is essential to assessing their infection risk. An individual's exposure history remains of paramount importance, especially in the early phase. Ebola virus disease vaccination reduces symptom severity and should also be considered when assessing the likelihood of infection. These findings about symptomatology should be translated into practice during triage and should inform testing and quarantine procedures.
Journal Article > ResearchFull Text
BMJ Open. 20 September 2022; Volume 12 (Issue 9); e060276.; DOI:10.1136/bmjopen-2021-060276
Dujmovic M, Roederer T, Frison S, Melki C, Lauvin T, et al.
BMJ Open. 20 September 2022; Volume 12 (Issue 9); e060276.; DOI:10.1136/bmjopen-2021-060276
INTRODUCTION
French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.
METHODS
A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.
RESULTS
The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.
CONCLUSION
Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.
French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.
METHODS
A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.
RESULTS
The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.
CONCLUSION
Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.
Journal Article > ResearchFull Text
PLOS One. 3 May 2013; Volume 8 (Issue 5); DOI:10.1371/journal.pone.0062767
Grellety E, Luquero FJ, Mambula C, Adamu HH, Elder G, et al.
PLOS One. 3 May 2013; Volume 8 (Issue 5); DOI:10.1371/journal.pone.0062767
The Sahel is subject to seasonal hungry periods with increasing rates of malnutrition. In Northern Nigeria, there is no surveillance system and surveys are rare. The objectives were to analyse possible observational bias in a sentinel surveillance system using repeated mixed longitudinal/cross-sectional data and estimate the extent of seasonal variation.
Journal Article > ResearchFull Text
Confl Health. 8 November 2010; Volume 4 (Issue 17); DOI:10.1186/1752-1505-4-17
Alberti KP, Grellety E, Lin YD, Polonsky JA, Coppens K, et al.
Confl Health. 8 November 2010; Volume 4 (Issue 17); DOI:10.1186/1752-1505-4-17
BACKGROUND
The province of North Kivu in the Democratic Republic of Congo has been afflicted by conflict for over a decade. After months of relative calm, offences restarted in September 2008. We did an epidemiological study to document the impact of violence on the civilian population and orient pre-existing humanitarian aid.
METHODS
In May 2009, we conducted three cross-sectional surveys among 200 000 resident and displaced people in North Kivu (Kabizo, Masisi, Kitchanga). The recall period covered an eight month period from the beginning of the most recent offensives to the survey date. Heads of households provided information on displacement, death, violence, theft, and access to fields and health care.
RESULTS
Crude mortality rates (per 10 000 per day) were below emergency thresholds: Kabizo 0.2 (95% CI: 0.1-0.4), Masisi 0.5 (0.4-0.6), Kitchanga 0.7 (0.6-0.9). Violence was the reported cause in 39.7% (27/68) and 35.8% (33/92) of deaths in Masisi and Kitchanga, respectively. In Masisi 99.1% (897/905) and Kitchanga 50.4% (509/1020) of households reported at least one member subjected to violence. Displacement was reported by 39.0% of households (419/1075) in Kitchanga and 99.8% (903/905) in Masisi. Theft affected 87.7% (451/514) of households in Masisi and 57.4% (585/1019) in Kitchanga. Access to health care was good: 93.5% (359/384) of the sick in Kabizo, 81.7% (515/630) in Masisi, and 89.8% (651/725) in Kitchanga received care, of whom 83.0% (298/359), 87.5% (451/515), and 88.9% (579/651), respectively, did not pay.
CONCLUSIONS
Our results show the impact of the ongoing war on these civilian populations: one third of deaths were violent in two sites, individuals are frequently subjected to violence, and displacements and theft are common. While humanitarian aid may have had a positive impact on disease mortality and access to care, the population remains exposed to extremely high levels of violence.
The province of North Kivu in the Democratic Republic of Congo has been afflicted by conflict for over a decade. After months of relative calm, offences restarted in September 2008. We did an epidemiological study to document the impact of violence on the civilian population and orient pre-existing humanitarian aid.
METHODS
In May 2009, we conducted three cross-sectional surveys among 200 000 resident and displaced people in North Kivu (Kabizo, Masisi, Kitchanga). The recall period covered an eight month period from the beginning of the most recent offensives to the survey date. Heads of households provided information on displacement, death, violence, theft, and access to fields and health care.
RESULTS
Crude mortality rates (per 10 000 per day) were below emergency thresholds: Kabizo 0.2 (95% CI: 0.1-0.4), Masisi 0.5 (0.4-0.6), Kitchanga 0.7 (0.6-0.9). Violence was the reported cause in 39.7% (27/68) and 35.8% (33/92) of deaths in Masisi and Kitchanga, respectively. In Masisi 99.1% (897/905) and Kitchanga 50.4% (509/1020) of households reported at least one member subjected to violence. Displacement was reported by 39.0% of households (419/1075) in Kitchanga and 99.8% (903/905) in Masisi. Theft affected 87.7% (451/514) of households in Masisi and 57.4% (585/1019) in Kitchanga. Access to health care was good: 93.5% (359/384) of the sick in Kabizo, 81.7% (515/630) in Masisi, and 89.8% (651/725) in Kitchanga received care, of whom 83.0% (298/359), 87.5% (451/515), and 88.9% (579/651), respectively, did not pay.
CONCLUSIONS
Our results show the impact of the ongoing war on these civilian populations: one third of deaths were violent in two sites, individuals are frequently subjected to violence, and displacements and theft are common. While humanitarian aid may have had a positive impact on disease mortality and access to care, the population remains exposed to extremely high levels of violence.
Journal Article > ResearchFull Text
BMC Public Health. 21 February 2014; Volume 14; DOI:10.1186/1471-2458-14-193
Grout L, Conan N, Giner AJ, Hurtado N, Fermon F, et al.
BMC Public Health. 21 February 2014; Volume 14; DOI:10.1186/1471-2458-14-193
Background: The World Health Organization recommends African children receive two doses of measles containing vaccine (MCV) through routine programs or supplemental immunization activities (SIA). Moreover, children have an additional opportunity to receive MCV through outbreak response immunization (ORI) mass campaigns in certain contexts. Here, we present the results of MCV coverage by dose estimated through surveys conducted after outbreak response in diverse settings in Sub-Saharan Africa.
Methods: We included 24 household-based surveys conducted in six countries after a non-selective mass vaccination campaign. In the majority (22/24), the survey sample was selected using probability proportional to size cluster-based sampling. Others used Lot Quality Assurance Sampling.
Results: In total, data were collected on 60,895 children from 2005 to 2011. Routine coverage varied between countries (>95% in Malawi and Kirundo province (Burundi) while <35% in N'Djamena (Chad) in 2005), within a country and over time. SIA coverage was <75% in most settings. ORI coverage ranged from >95% in Malawi to 71.4% [95% CI: 68.9-73.8] in N'Djamena (Chad) in 2005.In five sites, >5% of children remained unvaccinated after several opportunities. Conversely, in Malawi and DRC, over half of the children eligible for the last SIA received a third dose of MCV.
Conclusions: Control pre-elimination targets were still not reached, contributing to the occurrence of repeated measles outbreak in the Sub-Saharan African countries reported here. Although children receiving a dose of MCV through outbreak response benefit from the intervention, ensuring that programs effectively target hard to reach children remains the cornerstone of measles control.
Methods: We included 24 household-based surveys conducted in six countries after a non-selective mass vaccination campaign. In the majority (22/24), the survey sample was selected using probability proportional to size cluster-based sampling. Others used Lot Quality Assurance Sampling.
Results: In total, data were collected on 60,895 children from 2005 to 2011. Routine coverage varied between countries (>95% in Malawi and Kirundo province (Burundi) while <35% in N'Djamena (Chad) in 2005), within a country and over time. SIA coverage was <75% in most settings. ORI coverage ranged from >95% in Malawi to 71.4% [95% CI: 68.9-73.8] in N'Djamena (Chad) in 2005.In five sites, >5% of children remained unvaccinated after several opportunities. Conversely, in Malawi and DRC, over half of the children eligible for the last SIA received a third dose of MCV.
Conclusions: Control pre-elimination targets were still not reached, contributing to the occurrence of repeated measles outbreak in the Sub-Saharan African countries reported here. Although children receiving a dose of MCV through outbreak response benefit from the intervention, ensuring that programs effectively target hard to reach children remains the cornerstone of measles control.