Conference Material > Slide Presentation
Finger F, Mimbu N, Ratnayake R, Meakin S, Bahati JB, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/tC1av3293
Conference Material > Abstract
Finger F, Mimbu N, Ratnayake R, Meakin S, Bahati JB, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/hfok99y
INTRODUCTION
The risk of cholera outbreaks spreading rapidly and extensively is substantial. Case-area targeted interventions (CATI) are based on the premise that early detection can trigger a rapid, localised response in the high-risk radius around case-households to reduce transmission sufficiently to extinguish the outbreak or reduce its spread, as opposed to relying on resource-intensive mass interventions. Current evidence supports intervention in a high-risk spatiotemporal zone of up to 200 m around case- households for 5 days after case presentation. Médecins Sans Frontières (MSF) started delivering CATI to people living within these high-risk rings during outbreaks in the Democratic Republic of the Congo in April 2022. We present the results of a prospective observational study designed to evaluate the CATI strategy, measuring effectiveness, feasibility, timeliness, and resource requirements, and we extract operational learnings.
METHODS
Between April 2022 and April 2023, MSF delivered the holistic CATI package in five cholera-affected regions. The package incorporated key interventions combining household-level water, sanitation, and hygiene measures, health promotion, antibiotic chemoprophylaxis, and single-dose oral cholera vaccination (OCV). We conducted a survey in each ring roughly 3 weeks after the intervention to estimate coverage and uptake of the different components. We measured effectiveness by comparing cholera incidence in the first 30 days between rings with different delays from primary case presentation to CATI implementation, using a Bayesian regression model and adjusting for covariates such as population density, age, and access to water and sanitation.
RESULTS
During the study, four MSF operational sections implemented 118 CATI rings in five sites. The median number of households per ring was 70, the median OCV coverage was 85%, and the median time from presentation of the primary case to CATI implementation and to vaccination was 2 days and 3 days, respectively. These characteristics varied widely across sites and between rings. No secondary cases were observed in 81 (78%) of 104 rings included in the analysis, and we noted a (non- significant) decreasing trend in the number of secondary cases with decreasing delay to CATI implementation, e.g. 1.3 cases [95% CrI 0.01–4.9] for CATI implementation starting within 5 days from primary case presentation, and 0.5 cases [0.03–2.0] for CATI starting within 2 days.
CONCLUSION
Our results show that rapid implementation of CATI with vaccination is feasible in complex contexts. The number of secondary cases was low when CATI was implemented promptly. This highly targeted approach may be an effective strategy to quickly protect people most at risk and is resource- efficient if implemented early to extinguish localised outbreaks before they require mass interventions.
The risk of cholera outbreaks spreading rapidly and extensively is substantial. Case-area targeted interventions (CATI) are based on the premise that early detection can trigger a rapid, localised response in the high-risk radius around case-households to reduce transmission sufficiently to extinguish the outbreak or reduce its spread, as opposed to relying on resource-intensive mass interventions. Current evidence supports intervention in a high-risk spatiotemporal zone of up to 200 m around case- households for 5 days after case presentation. Médecins Sans Frontières (MSF) started delivering CATI to people living within these high-risk rings during outbreaks in the Democratic Republic of the Congo in April 2022. We present the results of a prospective observational study designed to evaluate the CATI strategy, measuring effectiveness, feasibility, timeliness, and resource requirements, and we extract operational learnings.
METHODS
Between April 2022 and April 2023, MSF delivered the holistic CATI package in five cholera-affected regions. The package incorporated key interventions combining household-level water, sanitation, and hygiene measures, health promotion, antibiotic chemoprophylaxis, and single-dose oral cholera vaccination (OCV). We conducted a survey in each ring roughly 3 weeks after the intervention to estimate coverage and uptake of the different components. We measured effectiveness by comparing cholera incidence in the first 30 days between rings with different delays from primary case presentation to CATI implementation, using a Bayesian regression model and adjusting for covariates such as population density, age, and access to water and sanitation.
RESULTS
During the study, four MSF operational sections implemented 118 CATI rings in five sites. The median number of households per ring was 70, the median OCV coverage was 85%, and the median time from presentation of the primary case to CATI implementation and to vaccination was 2 days and 3 days, respectively. These characteristics varied widely across sites and between rings. No secondary cases were observed in 81 (78%) of 104 rings included in the analysis, and we noted a (non- significant) decreasing trend in the number of secondary cases with decreasing delay to CATI implementation, e.g. 1.3 cases [95% CrI 0.01–4.9] for CATI implementation starting within 5 days from primary case presentation, and 0.5 cases [0.03–2.0] for CATI starting within 2 days.
CONCLUSION
Our results show that rapid implementation of CATI with vaccination is feasible in complex contexts. The number of secondary cases was low when CATI was implemented promptly. This highly targeted approach may be an effective strategy to quickly protect people most at risk and is resource- efficient if implemented early to extinguish localised outbreaks before they require mass interventions.
Journal Article > CommentaryFull Text
Lancet. 5 November 2022; Volume 400 (Issue 10363); 1561-1563.; DOI:10.1016/S0140-6736(22)01991-2
Baxter LM, McGowan CR, Smiley S, Palacios L, Devine C, et al.
Lancet. 5 November 2022; Volume 400 (Issue 10363); 1561-1563.; DOI:10.1016/S0140-6736(22)01991-2
The climate emergency is a humanitarian and health crisis. Extreme weather events, heat stress, declining air quality, changes in water quality and quantity, declining food security and safety, and changes in vector distribution and ecology threaten all of us. As the planet heats, climate risks are increasingly complex, frequent, and unpredictable, compounding existing vulnerabilities and inequities within populations and causing emergencies that cascade across different systems and sectors. Humanitarian agencies are now seeing how these problems are putting millions of people across the world at immediate risk of famine and death.
Technical Report > Policy Brief
Baxter LM, Cowan K, Devine C, Guevara M, Kalub D, et al.
27 October 2022
As an independent international medical humanitarian organisation responding to health crises in more than 70 countries, Médecins Sans Frontières/Doctors Without Borders (MSF) is seeing first-hand the suffering caused or exacerbated by climate change and environmental degradation, most often experienced by the most vulnerable people. We are witnessing how climate change directly threatens health – for example, through death and injury due to extreme weather – and how climate change impacts health indirectly, through food insecurity and shifting patterns of climate-sensitive infectious diseases.
Recognising the role of the climate crisis in amplifying humanitarian needs, MSF is adapting its operations to be more responsive to the populations it serves while also facing up to the challenges of measuring and reducing its own environmental footprint.
Recognising the role of the climate crisis in amplifying humanitarian needs, MSF is adapting its operations to be more responsive to the populations it serves while also facing up to the challenges of measuring and reducing its own environmental footprint.
Journal Article > ResearchFull Text
Malar J. 19 October 2015; Volume 14 (Issue 1); 414.; DOI:10.1186/s12936-015-0933-7
Gerstl S, Namagana A, Palacios L, Mweshi F, Aprile S, et al.
Malar J. 19 October 2015; Volume 14 (Issue 1); 414.; DOI:10.1186/s12936-015-0933-7
BACKGROUND
In resource-poor settings, treatment adherence is a major determinant of response to anti-malarial drugs as most are taken at home without medical supervision. Evidence on adherence to artemisinin-based combination therapy (ACT) is limited. The study aimed to measure adherence and identify reasons for non-adherence to a 3-day, fixed-dose combination (FDC) of artesunate-amodiaquine (ASAQ), the first-line treatment for uncomplicated malaria in the Médecins Sans Frontières project in the Shabunda Health Zone, South Kivu, Democratic Republic of Congo, a highly malarious and conflict-affected area.
METHODS
The study took place in the health centres/outpatient departments of the Shabunda general hospital, the quarter Mbangayo, and participant households. Patients prescribed FDC ASAQ were visited at home on the day after their regimen finished and asked to complete an adherence questionnaire. Patients/caretakers were also interviewed when exiting the outpatient department to understand their attitude towards FDC ASAQ and assess the quality of the prescribing process.
RESULTS
148 patients/caretakers completed the adherence questionnaire: 11.5 % (17/148, 95 % CI 7-17) had ≥1 tablet left at the time of the home visit and were defined as certainly non-adherent; 13.5 % (20/148, 95 % CI 8-19) were probably non-adherent; thus total non-adherence was 25.0 % (37/148, 95 % CI 18-32). 75 % (111/148, 95 % CI 68-82) were defined as probably adherent. In exit interviews, 87.5 % (105/120) knew they had malaria or could name the correct signs/symptoms. 89 % (107/120) could identify FDC ASAQ as anti-malarials among all tablets given and correctly repeat the intake instructions given at the outpatient department.
CONCLUSIONS
This is the first study to assess adherence to an FDC of ACT under real treatment conditions in a context of high instability. High quality prescribing of anti-malarials at health centre level and patient adherence to the correct intake of ACT were possible in this setting. Adherence to treatment regimen requires careful and constant monitoring which might be better guaranteed at health centre rather than community level. It could, nevertheless, be a precondition to the successful introduction of home- or community based management of malaria.
In resource-poor settings, treatment adherence is a major determinant of response to anti-malarial drugs as most are taken at home without medical supervision. Evidence on adherence to artemisinin-based combination therapy (ACT) is limited. The study aimed to measure adherence and identify reasons for non-adherence to a 3-day, fixed-dose combination (FDC) of artesunate-amodiaquine (ASAQ), the first-line treatment for uncomplicated malaria in the Médecins Sans Frontières project in the Shabunda Health Zone, South Kivu, Democratic Republic of Congo, a highly malarious and conflict-affected area.
METHODS
The study took place in the health centres/outpatient departments of the Shabunda general hospital, the quarter Mbangayo, and participant households. Patients prescribed FDC ASAQ were visited at home on the day after their regimen finished and asked to complete an adherence questionnaire. Patients/caretakers were also interviewed when exiting the outpatient department to understand their attitude towards FDC ASAQ and assess the quality of the prescribing process.
RESULTS
148 patients/caretakers completed the adherence questionnaire: 11.5 % (17/148, 95 % CI 7-17) had ≥1 tablet left at the time of the home visit and were defined as certainly non-adherent; 13.5 % (20/148, 95 % CI 8-19) were probably non-adherent; thus total non-adherence was 25.0 % (37/148, 95 % CI 18-32). 75 % (111/148, 95 % CI 68-82) were defined as probably adherent. In exit interviews, 87.5 % (105/120) knew they had malaria or could name the correct signs/symptoms. 89 % (107/120) could identify FDC ASAQ as anti-malarials among all tablets given and correctly repeat the intake instructions given at the outpatient department.
CONCLUSIONS
This is the first study to assess adherence to an FDC of ACT under real treatment conditions in a context of high instability. High quality prescribing of anti-malarials at health centre level and patient adherence to the correct intake of ACT were possible in this setting. Adherence to treatment regimen requires careful and constant monitoring which might be better guaranteed at health centre rather than community level. It could, nevertheless, be a precondition to the successful introduction of home- or community based management of malaria.