Journal Article > ResearchFull Text
BMJ Glob Health. 2022 December 1; Volume 7 (Issue 12); e009674.; DOI:10.1136/bmjgh-2022-009674
Van Bortel W, Mariën J, Jacobs BKM, Sinzinkayo D, Sinarinzi P, et al.
BMJ Glob Health. 2022 December 1; Volume 7 (Issue 12); e009674.; DOI:10.1136/bmjgh-2022-009674
BACKGROUND
Long-lasting insecticidal nets (LLINs) are one of the key interventions in the global fight against malaria. Since 2014, mass distribution campaigns of LLINs aim for universal access by all citizens of Burundi. In this context, we assess the impact of LLINs mass distribution campaigns on malaria incidence, focusing on the endemic highland health districts. We also explored the possible correlation between observed trends in malaria incidence with any variations in climate conditions.
METHODS
Malaria cases for 2011—2019 were obtained from the National Health Information System. We developed a generalised additive model based on a time series of routinely collected data with malaria incidence as the response variable and timing of LLIN distribution as an explanatory variable to investigate the duration and magnitude of the LLIN effect on malaria incidence. We added a seasonal and continuous-time component as further explanatory variables, and health district as a random effect to account for random natural variation in malaria cases between districts.
RESULTS
Malaria transmission in Burundian highlands was clearly seasonal and increased non-linearly over the study period. Further, a fast and steep decline of malaria incidence was noted during the first year after mass LLIN distribution (p<0.0001). In years 2 and 3 after distribution, malaria cases started to rise again to levels higher than before the control intervention.
CONCLUSION
This study highlights that LLINs did reduce the incidence in the first year after a mass distribution campaign, but in the context of Burundi, LLINs lost their impact after only 1 year.
Long-lasting insecticidal nets (LLINs) are one of the key interventions in the global fight against malaria. Since 2014, mass distribution campaigns of LLINs aim for universal access by all citizens of Burundi. In this context, we assess the impact of LLINs mass distribution campaigns on malaria incidence, focusing on the endemic highland health districts. We also explored the possible correlation between observed trends in malaria incidence with any variations in climate conditions.
METHODS
Malaria cases for 2011—2019 were obtained from the National Health Information System. We developed a generalised additive model based on a time series of routinely collected data with malaria incidence as the response variable and timing of LLIN distribution as an explanatory variable to investigate the duration and magnitude of the LLIN effect on malaria incidence. We added a seasonal and continuous-time component as further explanatory variables, and health district as a random effect to account for random natural variation in malaria cases between districts.
RESULTS
Malaria transmission in Burundian highlands was clearly seasonal and increased non-linearly over the study period. Further, a fast and steep decline of malaria incidence was noted during the first year after mass LLIN distribution (p<0.0001). In years 2 and 3 after distribution, malaria cases started to rise again to levels higher than before the control intervention.
CONCLUSION
This study highlights that LLINs did reduce the incidence in the first year after a mass distribution campaign, but in the context of Burundi, LLINs lost their impact after only 1 year.
Journal Article > ResearchFull Text
PLOS One. 2014 October 20; Volume 9 (Issue 10); e111096.; DOI:10.1371/journal.pone.0111096
Loko Roka J, Van der Bergh R, Au S, de Plecker E, Zachariah R, et al.
PLOS One. 2014 October 20; Volume 9 (Issue 10); e111096.; DOI:10.1371/journal.pone.0111096
BACKGROUND
Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).
METHODS
A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.
RESULTS
In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13–17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20–35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.
CONCLUSION
This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.
Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).
METHODS
A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.
RESULTS
In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13–17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20–35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.
CONCLUSION
This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.
Journal Article > Short ReportFull Text
F1000Research. 2024 August 28; Volume 13 (Issue 642); DOI:10.12688/f1000research.150755.2
Lampaert E, Nsio JM, Nair D, Mashako M, De Weggheleire A, et al.
F1000Research. 2024 August 28; Volume 13 (Issue 642); DOI:10.12688/f1000research.150755.2
BACKGROUND
Traditionally in the Democratic Republic of the Congo (DRC), centralised Ebola treatment centres (ETCs) have been set exclusively for Ebola virus disease (EVD) case management during outbreaks. During the 2020 EVD outbreak in DRC’s Equateur Province, existing health centres were equipped as decentralised treatment centres (DTC) to improve access for patients with suspected EVD. Between ETCs and DTCs, we compared the time from symptom onset to admission and diagnosis among patients with suspected EVD.
METHODS
This was a cohort study based on analysis of a line-list containing demographic and clinical information of patients with suspected EVD admitted to any EVD health facility during the outbreak.
RESULTS
Of 2359 patients with suspected EVD, 363 (15%) were first admitted to a DTC. Of 1996 EVD-suspected patients initially admitted to an ETC, 72 (4%) were confirmed as EVD-positive. Of 363 EVD-suspected patients initially admitted to a DTC, 6 (2%) were confirmed and managed as EVD-positive in the DTC. Among all EVD-suspected patients, the median (interquartile range) duration between symptom onset and admission was 2 (1-4) days in a DTC compared to 4 (2-7) days in an ETC (p<0.001). Similarly, time from symptom onset to admission was significantly shorter among EVD-suspected patients ultimately diagnosed as EVD-negative.
CONCLUSIONS
Since <5% of the EVD-suspected patients admitted were eventually diagnosed with EVD, there is a need for better screening to optimise resource utilization and outbreak control. Only one in seven EVD-suspected patients were admitted to a DTC first, as the DTCs were piloted in a limited and phased manner. However, there is a case to be made for considering decentralized care especially in remote and hard-to-reach areas in places like the DRC to facilitate early access to care, contain viral shedding by patients with EVD and ensure no disrupted provision of non-EVD services.
Conference Material > Slide Presentation
Leclair C, Marien J, Sinzinkayo D, Abdelrahman A, Lampaert E, et al.
MSF Scientific Days International 2021: Research. 2021 May 19
Conference Material > Abstract
Leclair C, Marien J, Sinzinkayo D, Abdelrahman A, Lampaert E, et al.
MSF Scientific Days International 2021: Research. 2021 May 19
INTRODUCTION
In Burundi, malaria continues to be a major public health issue as the leading cause of health facility attendance, high levels of mortality and devastating malaria epidemics in highland areas. Since 2004, Burundi’s National Malaria Control Programme (PNILP) has developed an integrated malaria control strategy. Since 2016, Médecins Sans Frontières (MSF), in collaboration with the PNILP, has implemented integrated malaria control interventions within two malaria endemic health districts located in the central highlands and eastern border regions.
METHODS
We re-assessed epidemiological trends for malaria in Burundi to: (1) evaluate spatial heterogeneity and seasonality; (2) longitudinally describe trends in disease incidence for three epidemiological strata; and (3) assess the association between long-lasting insecticidal net (LLIN) mass distribution campaigns (MDC) and disease incidence. Analysis used malaria case data, routinely collected and reported weekly by PNILP from 2011- 2019. Malaria cases were converted into incidence rates, using existing population data, and expressed per 1000 population at risk. Health districts (n=47) were categorized into three different strata based upon geographic elevation and endemic channels, using the quartile method. A generalized additive mixed model (GAMM) was implemented in R to analyze time-series data.
ETHICS
This work met the requirements for exemption from MSF Ethics Review Board review, and was conducted with permission from Sebastian Spencer, Medical Director, Operational Centre Brussels, MSF.
RESULTS
From 2011-2016, seasonality and intensity of malaria transmission was heterogeneous across the three epidemiological strata. The median incidence (cases/1000 population) for health districts <1200m elevation was 6.0 (interquartile range, IQR, 4.3-8.5); for those 1200-1850m, incidence was 12.3 (IQR 8.0-17.6); and for those >1850m, incidence was 2.1 (IQR 1.1-6.3). In contrast to the observed incidence rates for health districts within the endemic channels at <1200m and >1850m, health districts within the endemic
channel at 1200-1850m showed marked seasonality, with a bimodal distribution. Health districts in these endemic channels, had peaks in median incidence of 17.6 cases/1000 and 15.1cases/1000 population in weeks 26 and 52, respectively. GAMM analysis suggested an increasing trend in malaria incidence over the period 2011—2019. The analysis further revealed that LLIN-MDC campaigns were associated with a rapid reduction in malaria incidence, but the epidemiological impact was attenuated after one year. Specifically, comparing malaria incidence in three health districts adjacent to MSF’s intervention area (1200-1850m channel), the 2017 LLIN-MCD was associated with a 44% reduction in clinical incidence one year post-distribution (RR 0.56, 95%CI 0.556-0.56), but no evidence for a reduction two years post-distribution was observed RR 1.10 (95%CI 1.092-1.099).
CONCLUSION
These findings highlight the effectiveness of LLIN as a malaria control intervention across different epidemiological strata in Burundi. However, the duration of functional effectiveness of LLIN is most definitely less than 3 years and may be shorter than one year in Burundi. The reasons underlying these finding are legion. Further operational research is needed to disentangle the dynamic interplay between operational, human behavioural, sociological, and entomological factors.
In Burundi, malaria continues to be a major public health issue as the leading cause of health facility attendance, high levels of mortality and devastating malaria epidemics in highland areas. Since 2004, Burundi’s National Malaria Control Programme (PNILP) has developed an integrated malaria control strategy. Since 2016, Médecins Sans Frontières (MSF), in collaboration with the PNILP, has implemented integrated malaria control interventions within two malaria endemic health districts located in the central highlands and eastern border regions.
METHODS
We re-assessed epidemiological trends for malaria in Burundi to: (1) evaluate spatial heterogeneity and seasonality; (2) longitudinally describe trends in disease incidence for three epidemiological strata; and (3) assess the association between long-lasting insecticidal net (LLIN) mass distribution campaigns (MDC) and disease incidence. Analysis used malaria case data, routinely collected and reported weekly by PNILP from 2011- 2019. Malaria cases were converted into incidence rates, using existing population data, and expressed per 1000 population at risk. Health districts (n=47) were categorized into three different strata based upon geographic elevation and endemic channels, using the quartile method. A generalized additive mixed model (GAMM) was implemented in R to analyze time-series data.
ETHICS
This work met the requirements for exemption from MSF Ethics Review Board review, and was conducted with permission from Sebastian Spencer, Medical Director, Operational Centre Brussels, MSF.
RESULTS
From 2011-2016, seasonality and intensity of malaria transmission was heterogeneous across the three epidemiological strata. The median incidence (cases/1000 population) for health districts <1200m elevation was 6.0 (interquartile range, IQR, 4.3-8.5); for those 1200-1850m, incidence was 12.3 (IQR 8.0-17.6); and for those >1850m, incidence was 2.1 (IQR 1.1-6.3). In contrast to the observed incidence rates for health districts within the endemic channels at <1200m and >1850m, health districts within the endemic
channel at 1200-1850m showed marked seasonality, with a bimodal distribution. Health districts in these endemic channels, had peaks in median incidence of 17.6 cases/1000 and 15.1cases/1000 population in weeks 26 and 52, respectively. GAMM analysis suggested an increasing trend in malaria incidence over the period 2011—2019. The analysis further revealed that LLIN-MDC campaigns were associated with a rapid reduction in malaria incidence, but the epidemiological impact was attenuated after one year. Specifically, comparing malaria incidence in three health districts adjacent to MSF’s intervention area (1200-1850m channel), the 2017 LLIN-MCD was associated with a 44% reduction in clinical incidence one year post-distribution (RR 0.56, 95%CI 0.556-0.56), but no evidence for a reduction two years post-distribution was observed RR 1.10 (95%CI 1.092-1.099).
CONCLUSION
These findings highlight the effectiveness of LLIN as a malaria control intervention across different epidemiological strata in Burundi. However, the duration of functional effectiveness of LLIN is most definitely less than 3 years and may be shorter than one year in Burundi. The reasons underlying these finding are legion. Further operational research is needed to disentangle the dynamic interplay between operational, human behavioural, sociological, and entomological factors.