Conference Material > Slide Presentation
Ali Dubad B, Baertlein L, Piening T, Chindong I, Sahelie B, et al.
MSF Scientific Days International 2022. 12 May 2022; DOI:10.57740/8bp2-4234
Conference Material > Poster
Steegemans IM, Sisay K, Nshimiyimana E, Gebrewold G, Piening T, et al.
MSF Scientific Days International 2021: Research. 18 May 2021
Conference Material > Abstract
Ali Dubad B, Baertlein L, Piening T, Chindong I, Sahelie B, et al.
MSF Scientific Days International 2022. 12 May 2022; DOI:10.57740/s9dr-mf76
INTRODUCTION
The Somali Region is one of the least developed regions of Ethiopia, with low coverage of healthcare services and recurrent disease outbreaks, floods, and malnutrition emergencies. MSF has been providing medical assistance in the Doolo Zone, Somali Region, since 2007. Following multiple disease outbreaks in 2017, MSF shifted focus to work primarily on early outbreak detection and provision of a timely response. In 2019, MSF established a “Tea Team surveillance team”; this combines health facility data with that from community indicator- and event-based surveillance systems. Data are collected from 32 locations (17 surveillance only and 15 non-permanent mobile clinic sites), as well as alerts from other actors in Doolo Zone. We aimed to evaluate the usefulness of the data generated by these different components.
METHODS
We used a mixed methods approach. Description of the surveillance system, quantitative analysis of retrospective data between February 2019 and January 2021, and focus group discussions were the main methods used to evaluate usefulness, acceptability, and other surveillance attributes. Quantitative analyses were done using R software (R Core Team, 2014) while qualitative data analysis was performed with NVivo software (QSR International Pty Ltd, Australia).
ETHICS
Permission to conduct the study was obtained from the Somali Regional Health Bureau. This study was approved by the MSF Ethics Review Board.
RESULTS
Over 1200 signals were reported to the Tea Team surveillance system over the evaluation period, with the majority being reported via the community event-based surveillance (CEBS) component. There were a total of 31 responses conducted between February 2019 and January 2021. 22 (84.6%) originated from CEBS system signals, one (3.8%) was from the community indicator-based surveillance (CIBS) system, 2 (7.7%) were from health facility indicator-based surveillance (HFIBS), and 6 (23.1%) came from other event-based surveillance systems. Most responses were triggered by population movements, suspected measles, and suspected acute watery diarrhoea. No responses arose from acute jaundice syndrome signals. MSF staff found the “Tea Team surveillance system” to have higher acceptability in non-emergency situations, but indicated lower acceptability during a crisis, due to data processing times and rigidity of the HFIBS online database. The surveillance system has complex data management procedures leading to potential underreporting of signals and difficulties with routine data quality monitoring. Project staff considered the CEBS and CIBS components to be more flexible than HFIBS. The system was sufficiently flexible to integrate with Covid-19 surveillance.
CONCLUSION
The Tea Team surveillance system is a comprehensive and useful system to detect and respond to public health events in a pastoralist population. Simplification of the surveillance system and greater standardisation of the data management processes will increase the utility of the system.
CONFLICTS OF INTEREST
None declared
The Somali Region is one of the least developed regions of Ethiopia, with low coverage of healthcare services and recurrent disease outbreaks, floods, and malnutrition emergencies. MSF has been providing medical assistance in the Doolo Zone, Somali Region, since 2007. Following multiple disease outbreaks in 2017, MSF shifted focus to work primarily on early outbreak detection and provision of a timely response. In 2019, MSF established a “Tea Team surveillance team”; this combines health facility data with that from community indicator- and event-based surveillance systems. Data are collected from 32 locations (17 surveillance only and 15 non-permanent mobile clinic sites), as well as alerts from other actors in Doolo Zone. We aimed to evaluate the usefulness of the data generated by these different components.
METHODS
We used a mixed methods approach. Description of the surveillance system, quantitative analysis of retrospective data between February 2019 and January 2021, and focus group discussions were the main methods used to evaluate usefulness, acceptability, and other surveillance attributes. Quantitative analyses were done using R software (R Core Team, 2014) while qualitative data analysis was performed with NVivo software (QSR International Pty Ltd, Australia).
ETHICS
Permission to conduct the study was obtained from the Somali Regional Health Bureau. This study was approved by the MSF Ethics Review Board.
RESULTS
Over 1200 signals were reported to the Tea Team surveillance system over the evaluation period, with the majority being reported via the community event-based surveillance (CEBS) component. There were a total of 31 responses conducted between February 2019 and January 2021. 22 (84.6%) originated from CEBS system signals, one (3.8%) was from the community indicator-based surveillance (CIBS) system, 2 (7.7%) were from health facility indicator-based surveillance (HFIBS), and 6 (23.1%) came from other event-based surveillance systems. Most responses were triggered by population movements, suspected measles, and suspected acute watery diarrhoea. No responses arose from acute jaundice syndrome signals. MSF staff found the “Tea Team surveillance system” to have higher acceptability in non-emergency situations, but indicated lower acceptability during a crisis, due to data processing times and rigidity of the HFIBS online database. The surveillance system has complex data management procedures leading to potential underreporting of signals and difficulties with routine data quality monitoring. Project staff considered the CEBS and CIBS components to be more flexible than HFIBS. The system was sufficiently flexible to integrate with Covid-19 surveillance.
CONCLUSION
The Tea Team surveillance system is a comprehensive and useful system to detect and respond to public health events in a pastoralist population. Simplification of the surveillance system and greater standardisation of the data management processes will increase the utility of the system.
CONFLICTS OF INTEREST
None declared
Protocol > Research Protocol
Doyle K, Isidro Carrion Martin A, Piening T, Ramirez A, Fesselet JF, et al.
1 July 2018
These materials can be used, adapted and copied as long as citation of the source is given including the direct URL to the material. This work is licensed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0/ https://i.creativecommons.org/l/by/4.0/88x31.png
Journal Article > ResearchFull Text
Clin Infect Dis. 19 October 2011; Volume 53 (Issue 12); DOI:10.1093/cid/cir674
Ritmeijer KKD, ter Horst R, Chane S, Aderie EM, Piening T, et al.
Clin Infect Dis. 19 October 2011; Volume 53 (Issue 12); DOI:10.1093/cid/cir674
Due to unacceptably high mortality with pentavalent antimonials, Médecins Sans Frontières in 2006 began using liposomal amphotericin B (AmBisome) for visceral leishmaniasis (VL) patients in Ethiopia who were severely ill or positive for human immunodeficiency virus (HIV).
Conference Material > Poster
Sahelie B, Ali Dubad B, Piening T, Chindong I, Osman M, et al.
MSF Scientific Days International 2022. 9 May 2022; DOI:10.57740/63dm-5748
Journal Article > ResearchFull Text
PLOS One. 17 October 2018; Volume 13 (Issue 10); e0205601.; DOI:10.1371/journal.pone.0205601
Verdecchia M, Keus K, Blankley S, Vambe D, Ssonko C, et al.
PLOS One. 17 October 2018; Volume 13 (Issue 10); e0205601.; DOI:10.1371/journal.pone.0205601
INTRODUCTION
Since 2011 Médecins sans Frontières together with the eSwatini Ministry of Health have been managing patients with multi-drug resistant tuberculosis (MDR-TB) at Matsapha and Mankayane in Manzini region. This analysis describes the model of care and outcomes of patients receiving a 20 months MDR-TB treatment regimen between 2011 and 2013.
METHOD
We conducted a retrospective observational cohort study of MDR-TB patients enrolled for treatment between May 2011 and December 2013. An extensive package of psychological care and socio-economic incentives were provided including psychological support, paid treatment supporters, transport fees and a monthly food package. Baseline demographic details and treatment outcomes were recorded and for HIV positive patient's univariate analysis as well as a cox regression hazard model were undertaken to assess risk factors for unfavorable outcomes.
RESULTS
From the 174 patients enrolled, 156 (89.7%) were HIV co-infected, 102 (58.6%) were female, median age 33 years old (IQR: 28-42), 55 (31.6%) had a BMI less than 18 and 86 (49.4%) had not been previously treated for any form of TB. Overall cohort outcomes revealed a 75.3% treatment success rate, 21.3% mortality rate, 0.6% failure and 0.6% lost to follow-up rate. In the adjusted multivariate analysis, low BMI and low CD4 count at treatment initiation were associated with an increased risk of unfavorable outcome.
CONCLUSIONS
A model of care that included psychosocial support and patient's enablers led to a high level of treatment success with a very low lost to follow up rate. Limiting the overall treatment success was a high mortality rate which was associated with advanced HIV and a low BMI at presentation. These factors will need to be addressed in order to improve upon the overall treatment success rate in future.
Since 2011 Médecins sans Frontières together with the eSwatini Ministry of Health have been managing patients with multi-drug resistant tuberculosis (MDR-TB) at Matsapha and Mankayane in Manzini region. This analysis describes the model of care and outcomes of patients receiving a 20 months MDR-TB treatment regimen between 2011 and 2013.
METHOD
We conducted a retrospective observational cohort study of MDR-TB patients enrolled for treatment between May 2011 and December 2013. An extensive package of psychological care and socio-economic incentives were provided including psychological support, paid treatment supporters, transport fees and a monthly food package. Baseline demographic details and treatment outcomes were recorded and for HIV positive patient's univariate analysis as well as a cox regression hazard model were undertaken to assess risk factors for unfavorable outcomes.
RESULTS
From the 174 patients enrolled, 156 (89.7%) were HIV co-infected, 102 (58.6%) were female, median age 33 years old (IQR: 28-42), 55 (31.6%) had a BMI less than 18 and 86 (49.4%) had not been previously treated for any form of TB. Overall cohort outcomes revealed a 75.3% treatment success rate, 21.3% mortality rate, 0.6% failure and 0.6% lost to follow-up rate. In the adjusted multivariate analysis, low BMI and low CD4 count at treatment initiation were associated with an increased risk of unfavorable outcome.
CONCLUSIONS
A model of care that included psychosocial support and patient's enablers led to a high level of treatment success with a very low lost to follow up rate. Limiting the overall treatment success was a high mortality rate which was associated with advanced HIV and a low BMI at presentation. These factors will need to be addressed in order to improve upon the overall treatment success rate in future.
Journal Article > ResearchFull Text
Wellcome Open Res. 19 October 2018; Volume 3; DOI:10.12688/wellcomeopenres.14868.1
Crellen T, Rao VB, Piening T, Zeydner J, Siddqui MR
Wellcome Open Res. 19 October 2018; Volume 3; DOI:10.12688/wellcomeopenres.14868.1
A high incidence of bacterial meningitis was observed in the Central African Republic (CAR) from December 2015 to May 2017 in three hospitals in the northwest of the country that are within the African meningitis belt. The majority of cases were caused by Streptococcus pneumoniae (249/328; 75.9%), which occurred disproportionately during the dry season (November-April) with a high case-fatality ratio of 41.6% (95% confidence interval [CI] 33.0, 50.8%). High rates of bacterial meningitis during the dry season in the meningitis belt are typically caused by Neisseria meningitidis (meningococcal meningitis), and our observations suggest that the risk of contracting S. pneumoniae (pneumococcal) meningitis is increased by the same environmental factors. Cases of meningococcal meningitis (67/328; 20.4%) observed over the same period were predominantly type W and had a lower case fatality rate of 9.6% (95% CI 3.6, 21.8%). Due to conflict and difficulties in accessing medical facilities, it is likely that the reported cases represented only a small proportion of the overall burden and that there is high underlying prevalence of S. pneumoniae carriage in the community. Nationwide vaccination campaigns in the CAR against meningitis have been limited to the use of MenAfriVac, which targets only meningococcal meningitis type A. We therefore highlight the need for expanded vaccine coverage to prevent additional causes of seasonal outbreaks.
Journal Article > ResearchFull Text
Confl Health. 14 November 2019; Volume 13; 52.; DOI:10.1186/s13031-019-0236-7
Crellen T, Ssonko C, Piening T, Simaleko MM, Geiger K, et al.
Confl Health. 14 November 2019; Volume 13; 52.; DOI:10.1186/s13031-019-0236-7
BACKGROUND
Provision of antiretroviral therapy (ART) during conflict settings is rarely attempted and little is known about the expected patterns of mortality. The Central African Republic (CAR) continues to have a low coverage of ART despite an estimated 110,000 people living with HIV and 5000 AIDS-related deaths in 2018. We present results from a cohort in Zemio, Haut-Mboumou prefecture. This region had the highest prevalence of HIV nationally (14.8% in a 2010 survey), and was subject to repeated attacks by armed groups on civilians during the observed period.
METHODS
Conflict from armed groups can impact cohort mortality rates i) directly if HIV patients are victims of armed conflict, or ii) indirectly if population displacement or fear of movement reduces access to ART. Using monthly counts of civilian deaths, injuries and abductions, we estimated the impact of the conflict on patient mortality. We also determined patient-level risk factors for mortality and how the risk of mortality varies with time spent in the cohort. Model-fitting was performed in a Bayesian framework, using logistic regression with terms accounting for temporal autocorrelation.
RESULTS
Patients were recruited and observed in the HIV treatment program from October 2011 to May 2017. Overall 1631 patients were enrolled and 1628 were included in the analysis giving 48,430 person-months at risk and 145 deaths. The crude mortality rate after 12 months was 0.92 (95% CI 0.90, 0.93). Our model showed that patient mortality did not increase during periods of heightened conflict; the odds ratios (OR) 95% credible interval (CrI) for i) civilian fatalities and injuries, and ii) civilian abductions on patient mortality both spanned unity. The risk of mortality for individual patients was highest in the second month after entering the cohort, and declined seven-fold over the first 12 months. Male sex was associated with a higher mortality (odds ratio 1.70 [95% CrI 1.20, 2.33]) along with the severity of opportunistic infections (OIs) at baseline (OR 2.52; 95% CrI 2.01, 3.23 for stage 2 OIs compared with stage 1).
CONCLUSIONS
Our results show that chronic conflict did not appear to adversely affect rates of mortality in this cohort, and that mortality was driven predominantly by patient-specific risk factors. The risk of mortality and recovery of CD4 T-cell counts observed in this conflict setting are comparable to those in stable resource poor settings, suggesting that conflict should not be a barrier in access to ART.
Provision of antiretroviral therapy (ART) during conflict settings is rarely attempted and little is known about the expected patterns of mortality. The Central African Republic (CAR) continues to have a low coverage of ART despite an estimated 110,000 people living with HIV and 5000 AIDS-related deaths in 2018. We present results from a cohort in Zemio, Haut-Mboumou prefecture. This region had the highest prevalence of HIV nationally (14.8% in a 2010 survey), and was subject to repeated attacks by armed groups on civilians during the observed period.
METHODS
Conflict from armed groups can impact cohort mortality rates i) directly if HIV patients are victims of armed conflict, or ii) indirectly if population displacement or fear of movement reduces access to ART. Using monthly counts of civilian deaths, injuries and abductions, we estimated the impact of the conflict on patient mortality. We also determined patient-level risk factors for mortality and how the risk of mortality varies with time spent in the cohort. Model-fitting was performed in a Bayesian framework, using logistic regression with terms accounting for temporal autocorrelation.
RESULTS
Patients were recruited and observed in the HIV treatment program from October 2011 to May 2017. Overall 1631 patients were enrolled and 1628 were included in the analysis giving 48,430 person-months at risk and 145 deaths. The crude mortality rate after 12 months was 0.92 (95% CI 0.90, 0.93). Our model showed that patient mortality did not increase during periods of heightened conflict; the odds ratios (OR) 95% credible interval (CrI) for i) civilian fatalities and injuries, and ii) civilian abductions on patient mortality both spanned unity. The risk of mortality for individual patients was highest in the second month after entering the cohort, and declined seven-fold over the first 12 months. Male sex was associated with a higher mortality (odds ratio 1.70 [95% CrI 1.20, 2.33]) along with the severity of opportunistic infections (OIs) at baseline (OR 2.52; 95% CrI 2.01, 3.23 for stage 2 OIs compared with stage 1).
CONCLUSIONS
Our results show that chronic conflict did not appear to adversely affect rates of mortality in this cohort, and that mortality was driven predominantly by patient-specific risk factors. The risk of mortality and recovery of CD4 T-cell counts observed in this conflict setting are comparable to those in stable resource poor settings, suggesting that conflict should not be a barrier in access to ART.
Conference Material > Abstract
Genovese GOM, Woudenberg T, Kamau C, Beko P, Miaka EM, et al.
MSF Scientific Days International 2020: Research. 26 May 2020; DOI:10.7490/f1000research.1117908.1
INTRODUCTION
Human African trypanosomiasis (HAT) is a parasitic disease that can be fatal if left untreated. MSF conducted an active screening campaign for HAT, deploying mobile teams in remote areas of the Democratic Republic of Congo (DRC) between February 2018 and June 2019. We aimed to identify village-level risk factors associated with the presence of HAT cases, to better inform future targeted screening activities.
METHODS
Between Jan 2018 and June 2019, 170 villages were included in an exploratory phase of the study, with activities involving information, education and communication, population counts, collection of global positioning system coordinates, and assessment of risk factors. Risk factors were identified based on literature review and interviews with HAT experts, and included distances between village and water, presence of specific land types, tsetse flies, and hunting and fishing activities. 152 villages were included in the later active screening phase. Screening involved lymph node palpation, card agglutination test for trypanosomes (CATT) done on whole blood for all villagers, CATT dilutions, as well as parasitological testing and confirmation should patients test 1:16 CATT positive. Serological suspect cases were defined as those CATT 1:16 positive. Treatment with pentamidine was given to all suspect cases. Univariable and multivariable Poisson regression models were used to examine the association between at least one positive case in a village and risk factors.
ETHICS
This work fulfilled the exemption criteria set by the MSF Ethics Review Board (ERB) for a posteriori analyses of routinely collected clinical data, and thus did not require MSF ERB review. It was conducted with permission from Sidney Wong, Medical Director, Operational Centre Amsterdam, MSF.
RESULTS
Of 33,147 screened individuals, from a population of 41,764 (79%) in 152 villages, 46 suspect cases were diagnosed (1.4 cases per 1000). Suspect cases came from 33 villages (22%), of which nine villages (6%) had more than one suspect case. The highest incidence was in Otanga, with 5.6 suspect cases per 1000 screened population. Limited sample size prevented us from conducting a multivariable Poisson regression, and reduced power to find statistically significant effects. Incidence rate ratios (IRR) for relevant risk factors were: presence of hunters in a village (IRR 1.7; 95%CI 0.9-3.8), village screened more than 5 years ago (IRR 2.0; 95%CI 1.0–4.7), tsetse fly observed on visit (IRR 1.3; 95%CI 0.4 –3.3), and absence of forests within 1000m of village (IRR 0.2; 95%CI 0.0–1.0).
CONCLUSION
We detected small numbers of HAT suspect cases, preventing predictive algorithm development. However our data suggest that where HAT prevalence is low, active screening campaigns might not be effective; risk factors are not likely predictive enough to enable development of targeted screening programmes. Integrating passive screening into health posts and reactionary responses, when parasitological confirmed cases are detected, may be a better alternative. This will require training of medical staff, and reformed strategies within MSF.
CONFLICTS OF INTEREST
None declared.
Human African trypanosomiasis (HAT) is a parasitic disease that can be fatal if left untreated. MSF conducted an active screening campaign for HAT, deploying mobile teams in remote areas of the Democratic Republic of Congo (DRC) between February 2018 and June 2019. We aimed to identify village-level risk factors associated with the presence of HAT cases, to better inform future targeted screening activities.
METHODS
Between Jan 2018 and June 2019, 170 villages were included in an exploratory phase of the study, with activities involving information, education and communication, population counts, collection of global positioning system coordinates, and assessment of risk factors. Risk factors were identified based on literature review and interviews with HAT experts, and included distances between village and water, presence of specific land types, tsetse flies, and hunting and fishing activities. 152 villages were included in the later active screening phase. Screening involved lymph node palpation, card agglutination test for trypanosomes (CATT) done on whole blood for all villagers, CATT dilutions, as well as parasitological testing and confirmation should patients test 1:16 CATT positive. Serological suspect cases were defined as those CATT 1:16 positive. Treatment with pentamidine was given to all suspect cases. Univariable and multivariable Poisson regression models were used to examine the association between at least one positive case in a village and risk factors.
ETHICS
This work fulfilled the exemption criteria set by the MSF Ethics Review Board (ERB) for a posteriori analyses of routinely collected clinical data, and thus did not require MSF ERB review. It was conducted with permission from Sidney Wong, Medical Director, Operational Centre Amsterdam, MSF.
RESULTS
Of 33,147 screened individuals, from a population of 41,764 (79%) in 152 villages, 46 suspect cases were diagnosed (1.4 cases per 1000). Suspect cases came from 33 villages (22%), of which nine villages (6%) had more than one suspect case. The highest incidence was in Otanga, with 5.6 suspect cases per 1000 screened population. Limited sample size prevented us from conducting a multivariable Poisson regression, and reduced power to find statistically significant effects. Incidence rate ratios (IRR) for relevant risk factors were: presence of hunters in a village (IRR 1.7; 95%CI 0.9-3.8), village screened more than 5 years ago (IRR 2.0; 95%CI 1.0–4.7), tsetse fly observed on visit (IRR 1.3; 95%CI 0.4 –3.3), and absence of forests within 1000m of village (IRR 0.2; 95%CI 0.0–1.0).
CONCLUSION
We detected small numbers of HAT suspect cases, preventing predictive algorithm development. However our data suggest that where HAT prevalence is low, active screening campaigns might not be effective; risk factors are not likely predictive enough to enable development of targeted screening programmes. Integrating passive screening into health posts and reactionary responses, when parasitological confirmed cases are detected, may be a better alternative. This will require training of medical staff, and reformed strategies within MSF.
CONFLICTS OF INTEREST
None declared.