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
Conference Material > Abstract
Danno K, Worku DT, Adjaho I, Ale F, Katuala Y, et al.
MSF Paediatric Days 2024. 2024 May 4; DOI:10.57740/OMKnX6
BACKGROUND AND OBJECTIVES
Hypothermia is a major risk factor for high neonatal mortality. In January, night-time temperatures in Kano State can drop below 20°C. We conducted a study to elucidate the incidence of neonatal hypothermia at Garan Gamawa maternal and child health (MCH) clinic in Kano City, with an aim to improve midwifery care and reduce hypothermia-related neonatal mortality.
METHODS
The data of neonates born in January 2022 were collected retrospectively in February 2022. Hypothermia was defined as “axillary temperature below 35.5°C” in accordance with MSF Essential Obstetric and Newborn Care guidelines, 2019. Statistical analysis was done using a one-sided test for binomial proportions. Qualitative data was garnered by non-participatory observation (NPO) in the delivery room and postnatal care (PNC) ward to observe the warm chain and the interactions between staff and mothers. Individual semi-structured in-depth interviews were also conducted with eight MCH staff.
RESULTS
Amongst the 206 newborns included, 55 (26.69%, Wilson confidence interval 21.13- 33.13%, p value < 0.00001) developed hypothermia. From the NPO, contributing factors to hypothermia included: absence of skin-to-skin at birth; a delay of 40 minutes between birth and baby being put to the breast for their first feed; constant draught of outside air into delivery room; absence of heating system in delivery room and PNC ward; and the need to go outside during transfer between the delivery room and PNC ward. In-depth interviews illustrated that midwives prioritised dressing the babies rather than encouraging Kangaroo Mother Care (KMC), and that the warm chain was prone to interruption during a complicated delivery and when there were multiple labouring mothers. Additionally, some midwives were not aware of the definition of neonatal hypothermia.
CONCLUSIONS
The proportion of hypothermic neonates was significant, and several contributing factors were identified. Recommendations include the installation of a door into the delivery room and appropriate heating systems in both the delivery room and PNC ward. Training of MCH staff is required to build knowledge and skills regarding the maintenance of the warm chain, and highlighting the importance of immediate skin-to-skin at birth and KMC, which have an important role in preventing hypothermia and must be encouraged.
Hypothermia is a major risk factor for high neonatal mortality. In January, night-time temperatures in Kano State can drop below 20°C. We conducted a study to elucidate the incidence of neonatal hypothermia at Garan Gamawa maternal and child health (MCH) clinic in Kano City, with an aim to improve midwifery care and reduce hypothermia-related neonatal mortality.
METHODS
The data of neonates born in January 2022 were collected retrospectively in February 2022. Hypothermia was defined as “axillary temperature below 35.5°C” in accordance with MSF Essential Obstetric and Newborn Care guidelines, 2019. Statistical analysis was done using a one-sided test for binomial proportions. Qualitative data was garnered by non-participatory observation (NPO) in the delivery room and postnatal care (PNC) ward to observe the warm chain and the interactions between staff and mothers. Individual semi-structured in-depth interviews were also conducted with eight MCH staff.
RESULTS
Amongst the 206 newborns included, 55 (26.69%, Wilson confidence interval 21.13- 33.13%, p value < 0.00001) developed hypothermia. From the NPO, contributing factors to hypothermia included: absence of skin-to-skin at birth; a delay of 40 minutes between birth and baby being put to the breast for their first feed; constant draught of outside air into delivery room; absence of heating system in delivery room and PNC ward; and the need to go outside during transfer between the delivery room and PNC ward. In-depth interviews illustrated that midwives prioritised dressing the babies rather than encouraging Kangaroo Mother Care (KMC), and that the warm chain was prone to interruption during a complicated delivery and when there were multiple labouring mothers. Additionally, some midwives were not aware of the definition of neonatal hypothermia.
CONCLUSIONS
The proportion of hypothermic neonates was significant, and several contributing factors were identified. Recommendations include the installation of a door into the delivery room and appropriate heating systems in both the delivery room and PNC ward. Training of MCH staff is required to build knowledge and skills regarding the maintenance of the warm chain, and highlighting the importance of immediate skin-to-skin at birth and KMC, which have an important role in preventing hypothermia and must be encouraged.
Conference Material > Slide Presentation
Danno K, Worku DT, Adjaho I, Ale F, Katuala Y, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/MyxnLeH
Conference Material > Abstract
Juma H, Worku DT, Evboumwan PE, Katuala Y, Mbuyi Y, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/Sh2BIQ8FOl
BACKGROUND AND OBJECTIVES
Diphtheria is a vaccine preventable disease caused by toxicogenic Corynebacterium diphtheriae. Since declaration of an outbreak in Nigeria in December 2022, Kano state has been its epicentre, with 77% of the 12,581 confirmed cases nationally. In response, a Decentralised Model of Care (DMC) for delivering proximal, fast, and easily accessible curative and preventive community-based health care was introduced in Kano. Here, we describe implementation of this DMC and assess its impact in reducing mortality from diphtheria during this outbreak.
METHODS
Components of DMC:
• OPD for the triaging and management of mild cases
• Contact clinic (mobile and fixed) to improve access to preventative care for close contacts
Main packages of DMC:
• Health and Infection Prevention and Control promotion
• Chemoprophylaxis and vaccination for close contacts
• Identification and management of simple cases
• Referral of complicated cases
• Training of health workers
DMC was implemented within existing public health facilities for outpatient services, and in the community for the management of close contacts. The selection of facilities was guided by epidemiological data analysis and mapping.
Chi-square testing was used for analysing statistical significance on mortality before and after the implementation of DMC.
RESULTS
Between weeks 2 and 48 of 2023, the health facilities included in this study managed a total of 12,662 suspected diphtheria cases. From this, 1,987 cases (136 deaths; CFR 6.84%) were managed before implementation of DMC (before week 34), and 10,675 cases (611 deaths; CFR 5.72%) were managed after its implementation (from week 34 to 48). One-tailed Chi-square testing showed a statistically significant difference in mortality before and after implementation (p-value 0.02).
CONCLUSIONS
DMC may have contributed to the reduction of mortality in healthcare facilities. Upon in-depth analysis of the impact of DMC, it may be recommended for implementation in large outbreaks. Further studies, however, need to be conducted to assess the role of DMC in improving patients’ access to healthcare and reducing the burden on healthcare facilities during massive outbreaks.
Diphtheria is a vaccine preventable disease caused by toxicogenic Corynebacterium diphtheriae. Since declaration of an outbreak in Nigeria in December 2022, Kano state has been its epicentre, with 77% of the 12,581 confirmed cases nationally. In response, a Decentralised Model of Care (DMC) for delivering proximal, fast, and easily accessible curative and preventive community-based health care was introduced in Kano. Here, we describe implementation of this DMC and assess its impact in reducing mortality from diphtheria during this outbreak.
METHODS
Components of DMC:
• OPD for the triaging and management of mild cases
• Contact clinic (mobile and fixed) to improve access to preventative care for close contacts
Main packages of DMC:
• Health and Infection Prevention and Control promotion
• Chemoprophylaxis and vaccination for close contacts
• Identification and management of simple cases
• Referral of complicated cases
• Training of health workers
DMC was implemented within existing public health facilities for outpatient services, and in the community for the management of close contacts. The selection of facilities was guided by epidemiological data analysis and mapping.
Chi-square testing was used for analysing statistical significance on mortality before and after the implementation of DMC.
RESULTS
Between weeks 2 and 48 of 2023, the health facilities included in this study managed a total of 12,662 suspected diphtheria cases. From this, 1,987 cases (136 deaths; CFR 6.84%) were managed before implementation of DMC (before week 34), and 10,675 cases (611 deaths; CFR 5.72%) were managed after its implementation (from week 34 to 48). One-tailed Chi-square testing showed a statistically significant difference in mortality before and after implementation (p-value 0.02).
CONCLUSIONS
DMC may have contributed to the reduction of mortality in healthcare facilities. Upon in-depth analysis of the impact of DMC, it may be recommended for implementation in large outbreaks. Further studies, however, need to be conducted to assess the role of DMC in improving patients’ access to healthcare and reducing the burden on healthcare facilities during massive outbreaks.
Conference Material > Poster
Usman K, Suwaid SA, Fix M, Evbuomwan PE, Worku DT, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/kX6Njdggl
Conference Material > Poster
Gignoux EM, Katuala Y, Tagoto N, Wega N, Nkemenang P, et al.
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/05y5-hg11
Conference Material > Slide Presentation
Sterk E, Newport T, Mahamat TA, Gitahi P, Mandagot JJ, et al.
MSF Scientific Days International 2021: Research. 2021 May 19