Conference Material > Poster
Olaleye M, Farley ES, Karinja MN, Lawal AM, Muhammad S, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/dhIP6SLTf8
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2023 October 27; Volume 17 (Issue 10); e0011508.; DOI:10.1371/journal.pntd.0011508
Farley ES, Karinja MN, Lawal AM, Olaleye M, Muhammad S, et al.
PLoS Negl Trop Dis. 2023 October 27; Volume 17 (Issue 10); e0011508.; DOI:10.1371/journal.pntd.0011508
INTRODUCTION
Noma is a rapidly spreading infection of the oral cavity which mainly affects young children. Without early treatment, it can have a high mortality rate. Simple gingivitis is a warning sign for noma, and acute necrotizing gingivitis is the first stage of noma. The epidemiology of noma is not well understood. We aimed to understand the prevalence of all stages of noma in hospitalised children.
METHODS
We conducted a prospective observational study from 1st June to 24th October 2021, enrolling patients aged 0 to 12 years who were admitted to the Anka General Hospital, Zamfara, northwest Nigeria. Consenting parents/ guardians of participants were interviewed at admission. Participants had anthropometric and oral exams at admission and discharge.
FINDINGS
Of the 2346 patients, 58 (2.5%) were diagnosed with simple gingivitis and six (n = 0.3%) with acute necrotizing gingivitis upon admission. Of those admitted to the Inpatient Therapeutic Feeding Centre (ITFC), 3.4% (n = 37, CI 2.5–4.7%) were diagnosed with simple gingivitis upon admission compared to 1.7% of those not admitted to the ITFC (n = 21, CI 1.1–2.6%) (p = 0.008). Risk factors identified for having simple gingivitis include being aged over two years (2 to 6 yrs old, odds ratio (OR) 3.4, CI 1.77–6.5; 7 to 12 yrs OR 5.0, CI 1.7–14.6; p = <0.001), being admitted to the ITFC (OR 2.1; CI 1.22–3.62) and having oral health issues in the three months prior to the assessment (OR 18.75; CI 10.65, 33.01). All (n = 4/4) those aged six months to five years acute necrotizing gingivitis had chronic malnutrition.
CONCLUSION
Our study showed a small proportion of children admitted to the Anka General Hospital had simple or acute necrotizing gingivitis. Hospital admission with malnutrition was a risk factor for both simple and acute necrotizing gingivitis The lack of access to and uptake of oral health care indicates a strong need for oral exams to be included in routine health services. This provision could improve the oral status of the population and decrease the chance of patients developing noma.
Noma is a rapidly spreading infection of the oral cavity which mainly affects young children. Without early treatment, it can have a high mortality rate. Simple gingivitis is a warning sign for noma, and acute necrotizing gingivitis is the first stage of noma. The epidemiology of noma is not well understood. We aimed to understand the prevalence of all stages of noma in hospitalised children.
METHODS
We conducted a prospective observational study from 1st June to 24th October 2021, enrolling patients aged 0 to 12 years who were admitted to the Anka General Hospital, Zamfara, northwest Nigeria. Consenting parents/ guardians of participants were interviewed at admission. Participants had anthropometric and oral exams at admission and discharge.
FINDINGS
Of the 2346 patients, 58 (2.5%) were diagnosed with simple gingivitis and six (n = 0.3%) with acute necrotizing gingivitis upon admission. Of those admitted to the Inpatient Therapeutic Feeding Centre (ITFC), 3.4% (n = 37, CI 2.5–4.7%) were diagnosed with simple gingivitis upon admission compared to 1.7% of those not admitted to the ITFC (n = 21, CI 1.1–2.6%) (p = 0.008). Risk factors identified for having simple gingivitis include being aged over two years (2 to 6 yrs old, odds ratio (OR) 3.4, CI 1.77–6.5; 7 to 12 yrs OR 5.0, CI 1.7–14.6; p = <0.001), being admitted to the ITFC (OR 2.1; CI 1.22–3.62) and having oral health issues in the three months prior to the assessment (OR 18.75; CI 10.65, 33.01). All (n = 4/4) those aged six months to five years acute necrotizing gingivitis had chronic malnutrition.
CONCLUSION
Our study showed a small proportion of children admitted to the Anka General Hospital had simple or acute necrotizing gingivitis. Hospital admission with malnutrition was a risk factor for both simple and acute necrotizing gingivitis The lack of access to and uptake of oral health care indicates a strong need for oral exams to be included in routine health services. This provision could improve the oral status of the population and decrease the chance of patients developing noma.
Conference Material > Abstract
Briskin E, Smith JS, Caleo GNC, Lenglet AD, Pearlman J, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
INTRODUCTION
In April 2020, “shielding” (separate living spaces with enhanced infection control support for groups at high risk of severe COVID-19 disease) was proposed for COVID-19 prevention in settings where lockdown is not feasible (i.e. displaced persons camps). MSF used qualitative methods to explore community perceptions of shielding and other potential COVID-19 prevention measures applicable in settings where it works. Nigeria and Sierra Leone served as initial pilot sites for this multi-site study that ultimately included 13 countries.
METHODS
We carried out qualitative assessments between April and August 2020 within 9 MSF-supported sites in Nigeria and Sierra Leone, with the aim of exploring community perceptions of potential COVID-19 prevention measures. Sites in Nigeria included internally displaced camps in two states, and in Sierra Leone, an open village setting. We conducted multiple rounds of participant-led individual in-depth qualitative interviews in the study sites between April-August 2020. We recruited participants purposively, ensuring participants recruited were representative of underlying demographic and ethnic diversity. Data were coded by hand on paper copies of transcripts and in NVivo12 and analyzed for key themes. Findings were built on through iteration with participants.
ETHICS
This study was approved by the MSF Ethics Review Board and by the Ethical Review Boards of Benue State, Nigeria, Zamfara State, Nigeria, and the District Health Management team,
Tonkolilli, Sierra Leone.
RESULTS
Participants reported that access to both COVID-19 and non- COVID-19 care was challenging due to fear of infection and practical difficulties attending care facilities. Key priorities noted
by participants included obtaining food, masks and handwashing, and continuing to get access to non-COVID-19 healthcare. In Nigeria, shielding (providing separate dwellings for high-risk
people) was described as a challenge.
Reasons for this included close living conditions affecting practicality, its impact on mental health, and the community’s inter-generational reliance. Shielding was only seen as feasible
with sustained provision of resources for shielded persons including COVID testing, food from the family, mobile phones, and socially distanced visitation. For Sierra Leone, previous
experiences (e.g. war, Ebola) influenced fears of separation and the possibility of infection from contact with strangers and health workers or health facilities. Lockdowns and school
closures have a negative effect on support networks and local economies, and in Sierra Leone increased the perceived risk of sexual and gender-based violence and exploitation. Participants reported the desire for self-management of contact tracing and transmission prevention activities within their communities. Context-specific activities to address these priorities were implemented in response.
CONCLUSION
The community-based feedback provided a better understanding of attitudes towards and feasibility of COVID-19 control measures. Commonalities were reported across sites, while
differences in findings across sites highlighted the importance of context-specific engagement. Early and continued community engagement allowed context-specific activities to address these priorities to be implemented in partnership with communities in response. Implemented activities included enhancement of handwashing points, subsidizing locally-produced cloth masks, and reinforcement of prevention and control for non-COVID diseases such as malaria.
CONFLICTS OF INTEREST
None declared.
In April 2020, “shielding” (separate living spaces with enhanced infection control support for groups at high risk of severe COVID-19 disease) was proposed for COVID-19 prevention in settings where lockdown is not feasible (i.e. displaced persons camps). MSF used qualitative methods to explore community perceptions of shielding and other potential COVID-19 prevention measures applicable in settings where it works. Nigeria and Sierra Leone served as initial pilot sites for this multi-site study that ultimately included 13 countries.
METHODS
We carried out qualitative assessments between April and August 2020 within 9 MSF-supported sites in Nigeria and Sierra Leone, with the aim of exploring community perceptions of potential COVID-19 prevention measures. Sites in Nigeria included internally displaced camps in two states, and in Sierra Leone, an open village setting. We conducted multiple rounds of participant-led individual in-depth qualitative interviews in the study sites between April-August 2020. We recruited participants purposively, ensuring participants recruited were representative of underlying demographic and ethnic diversity. Data were coded by hand on paper copies of transcripts and in NVivo12 and analyzed for key themes. Findings were built on through iteration with participants.
ETHICS
This study was approved by the MSF Ethics Review Board and by the Ethical Review Boards of Benue State, Nigeria, Zamfara State, Nigeria, and the District Health Management team,
Tonkolilli, Sierra Leone.
RESULTS
Participants reported that access to both COVID-19 and non- COVID-19 care was challenging due to fear of infection and practical difficulties attending care facilities. Key priorities noted
by participants included obtaining food, masks and handwashing, and continuing to get access to non-COVID-19 healthcare. In Nigeria, shielding (providing separate dwellings for high-risk
people) was described as a challenge.
Reasons for this included close living conditions affecting practicality, its impact on mental health, and the community’s inter-generational reliance. Shielding was only seen as feasible
with sustained provision of resources for shielded persons including COVID testing, food from the family, mobile phones, and socially distanced visitation. For Sierra Leone, previous
experiences (e.g. war, Ebola) influenced fears of separation and the possibility of infection from contact with strangers and health workers or health facilities. Lockdowns and school
closures have a negative effect on support networks and local economies, and in Sierra Leone increased the perceived risk of sexual and gender-based violence and exploitation. Participants reported the desire for self-management of contact tracing and transmission prevention activities within their communities. Context-specific activities to address these priorities were implemented in response.
CONCLUSION
The community-based feedback provided a better understanding of attitudes towards and feasibility of COVID-19 control measures. Commonalities were reported across sites, while
differences in findings across sites highlighted the importance of context-specific engagement. Early and continued community engagement allowed context-specific activities to address these priorities to be implemented in partnership with communities in response. Implemented activities included enhancement of handwashing points, subsidizing locally-produced cloth masks, and reinforcement of prevention and control for non-COVID diseases such as malaria.
CONFLICTS OF INTEREST
None declared.
Conference Material > Slide Presentation
Briskin E, Smith JS, Caleo GNC, Lenglet AD, Pearlman J, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
Journal Article > ResearchFull Text
Sci Rep. 2021 October 21; Volume 11 (Issue 1); 20814.; DOI:10.1038/s41598-021-00149-1
Chukwumeze F, Lenglet AD, Olubiyo R, Lawal AM, Oluyide B, et al.
Sci Rep. 2021 October 21; Volume 11 (Issue 1); 20814.; DOI:10.1038/s41598-021-00149-1
Pediatric community-acquired bloodstream infections (CA-BSIs) in sub Saharan African humanitarian contexts are rarely documented. Effective treatment of these infections is additionally complicated by increasing rates of antimicrobial resistance. We describe the findings from epidemiological and microbiological surveillance implemented in pediatric patients with suspected CA-BSIs presenting for care at a secondary hospital in the conflict affected area of Zamfara state, Nigeria. Any child (> 2 months of age) presenting to Anka General Hospital from November 2018 to August 2020 with clinical severe sepsis at admission had clinical and epidemiological information and a blood culture collected at admission. Bacterial isolates were tested for antibiotic susceptibility. We calculated frequencies of epidemiological, microbiological and clinical parameters. We explored risk factors for death amongst severe sepsis cases using univariable and multivariable Poisson regression, adjusting for time between admission and hospital exit. We included 234 severe sepsis patients with 195 blood culture results. There were 39 positive blood cultures. Of the bacterial isolates, 14 were Gram positive and 18 were Gram negative; 5 were resistant to empiric antibiotics: methicillin-resistant Staphylococcus aureus (MRSA; n = 2) and Extended Spectrum Beta-Lactamase positive enterobacterales (n = 3). We identified no significant association between sex, age-group, ward, CA-BSI, appropriate intravenous antibiotic, malaria positivity at admission, suspected focus of sepsis, clinical severity and death in the multivariable regression. There is an urgent need for access to good clinical microbiological services, including point of care methods, and awareness and practice around rational antibiotic in healthcare staff in humanitarian settings to reduce morbidity and mortality from sepsis in children.