Journal Article > ResearchAbstract
Trop Med Int Health. 2012 October 11; Volume 17 (Issue 12); DOI:10.1111/j.1365-3156.2012.03095.x
Mueller YK, Bastard M, Ehounou G, Itama J, Quere M, et al.
Trop Med Int Health. 2012 October 11; Volume 17 (Issue 12); DOI:10.1111/j.1365-3156.2012.03095.x
Objective To assess the effectiveness of blood transfusions in a hospital of north-eastern Democratic Republic of the Congo. Methods Prospective study of children admitted for severe anaemia. During admission, data were collected on clinical condition and haemoglobin levels, before and after blood transfusion. A linear regression model was built to explore factors associated with haemoglobin level after transfusion. Risk factors for mortality were explored through multivariate logistic regression. Results Haemoglobin level (Hb) was below 4 g/dl in 35% (230/657), between 4 and 6 g/dl in 58% (348/657) and at least 6 g/dl in another 6% (43/657) of the transfused children. A transfusion of 15 ml/kg of whole blood increased the Hb from 4.4 to 7.8 g/dl. Haemoglobin level after transfusion was associated with baseline Hb, quantity of delivered blood and history of previous transfusions. Overall case-fatality rate was 5.6% (37/657). Risk factors for deaths were co-morbidities such as chest infection, meningitis or malnutrition, Hb ≥ 6 g/dl, impaired consciousness or jugular venous distention on admission, and provenance. Conclusion Transfusion was a frequent practice, the use of which could clearly have been rationalised. While indications should be restricted, quantities of transfused blood should be adapted to needs.
Journal Article > ResearchFull Text
Confl Health. 2018 October 24; Volume 12 (Issue 1); 42.; DOI:10.1186/s13031-018-0177-6
El-Khatib, Shah M, Zallappa SN, Nabeth P, Guerra J, et al.
Confl Health. 2018 October 24; Volume 12 (Issue 1); 42.; DOI:10.1186/s13031-018-0177-6
BACKGROUND
It is a challenge in low-resource settings to ensure the availability of complete, timely disease surveillance information. Smartphone applications (apps) have the potential to enhance surveillance data transmission.
METHODS
The Central African Republic (CAR) Ministry of Health and Médecins Sans Frontières (MSF) conducted a 15-week pilot project to test a disease surveillance app, Argus, for 20 conditions in 21 health centers in Mambéré Kadéi district (MK 2016). Results were compared to the usual paper-based surveillance in MK the year prior (MK 2015) and simultaneously in an adjacent health district, Nana-Mambére (NM 2016). Wilcoxon rank sum and Kaplan-Meier analyses compared report completeness and timeliness; the cost of the app, and users' perceptions of its usability were assessed.
RESULTS
Two hundred seventy-one weekly reports sent by app identified 3403 cases and 63 deaths; 15 alerts identified 28 cases and 4 deaths. Median completeness (IQR) for MK 2016, 81% (81-86%), was significantly higher than in MK 2015 (31% (24-36%)), and NM 2016 (52% (48-57)) (p < 0.01). Median timeliness (IQR) for MK 2016, 50% (39-57%) was also higher than in MK 2015, 19% (19-24%), and NM 2016 29% (24-36%) (p < 0.01). Kaplan-Meier Survival Analysis showed a significant progressive reduction in the time taken to transmit reports over the 15-week period (p < 0.01). Users ranked the app's usability as greater than 4/5 on all dimensions. The total cost of the 15-week pilot project was US$40,575. It is estimated that to maintain the app in the 21 health facilities of MK will cost approximately US$18,800 in communication fees per year.
CONCLUSIONS
The app-based data transmission system more than doubled the completeness and timeliness of disease surveillance reports. This simple, low-cost intervention may permit the early detection of disease outbreaks in similar low-resource settings elsewhere.
It is a challenge in low-resource settings to ensure the availability of complete, timely disease surveillance information. Smartphone applications (apps) have the potential to enhance surveillance data transmission.
METHODS
The Central African Republic (CAR) Ministry of Health and Médecins Sans Frontières (MSF) conducted a 15-week pilot project to test a disease surveillance app, Argus, for 20 conditions in 21 health centers in Mambéré Kadéi district (MK 2016). Results were compared to the usual paper-based surveillance in MK the year prior (MK 2015) and simultaneously in an adjacent health district, Nana-Mambére (NM 2016). Wilcoxon rank sum and Kaplan-Meier analyses compared report completeness and timeliness; the cost of the app, and users' perceptions of its usability were assessed.
RESULTS
Two hundred seventy-one weekly reports sent by app identified 3403 cases and 63 deaths; 15 alerts identified 28 cases and 4 deaths. Median completeness (IQR) for MK 2016, 81% (81-86%), was significantly higher than in MK 2015 (31% (24-36%)), and NM 2016 (52% (48-57)) (p < 0.01). Median timeliness (IQR) for MK 2016, 50% (39-57%) was also higher than in MK 2015, 19% (19-24%), and NM 2016 29% (24-36%) (p < 0.01). Kaplan-Meier Survival Analysis showed a significant progressive reduction in the time taken to transmit reports over the 15-week period (p < 0.01). Users ranked the app's usability as greater than 4/5 on all dimensions. The total cost of the 15-week pilot project was US$40,575. It is estimated that to maintain the app in the 21 health facilities of MK will cost approximately US$18,800 in communication fees per year.
CONCLUSIONS
The app-based data transmission system more than doubled the completeness and timeliness of disease surveillance reports. This simple, low-cost intervention may permit the early detection of disease outbreaks in similar low-resource settings elsewhere.
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
Journal Article > ResearchFull Text
Malar J. 2021 October 24; Volume 20 (Issue 1); 419.; DOI: 10.1186/s12936-021-03953-2
Coldiron ME, Assao B, Guindo O, Sayinzoga-Makombe N, Koskalova A, et al.
Malar J. 2021 October 24; Volume 20 (Issue 1); 419.; DOI: 10.1186/s12936-021-03953-2
BACKGROUND
Malaria transmission is highly seasonal in Niger. Despite the introduction of seasonal malaria chemoprevention (SMC) in the Magaria District, malaria incidence remains high, and the epidemiology of malaria in the community is not well-understood.
METHODS
Four cross-sectional, household-based malaria prevalence surveys were performed in the Magaria District of Niger between October 2016 and February 2018. Two occurred during the peak malaria season and two during the low malaria season. Individuals in each of three age strata (3-59 months, 5-9 years, and 10 years and above) were sampled in randomly-selected households. Capillary blood was collected by fingerprick, thick and thin blood films were examined. Microscopy was performed at Epicentre, Maradi, Niger, with external quality control. The target sample size was 396 households during the high-season surveys and 266 households during the low-season surveys.
RESULTS
Prevalence of parasitaemia was highest in children aged 5-9 years during all four surveys, ranging between 53.6% (95%CI 48.8-63.6) in February 2018 and 73.2% (66.2-79.2) in September 2017. Prevalence of parasitaemia among children aged 3-59 months ranged between 39.6% (33.2-46.4) in February 2018 and 51.9% (45.1-58.6) in October 2016. Parasite density was highest in children aged 3-59 months during all four surveys, and was higher in high season surveys than in low season surveys among all participants. The prevalence of gametocytaemia in children aged 3-59 months ranged between 9.9% (6.5-14.8) in February 2018 and 19.3% (14.6-25.2) in October 2016. The prevalence of gametocytaemia in children aged 5-9 years ranged between 6.3% (3.5-11.1) in February 2018 and 18.5% (12.7-26.1) in October 2016.
CONCLUSIONS
Asymptomatic malaria infection is highly prevalent in this area, even during the season with low incidence of clinical malaria. The high prevalence of parasitaemia in children aged 5-9 years warrants considering their inclusion in SMC programmes in this context.
Malaria transmission is highly seasonal in Niger. Despite the introduction of seasonal malaria chemoprevention (SMC) in the Magaria District, malaria incidence remains high, and the epidemiology of malaria in the community is not well-understood.
METHODS
Four cross-sectional, household-based malaria prevalence surveys were performed in the Magaria District of Niger between October 2016 and February 2018. Two occurred during the peak malaria season and two during the low malaria season. Individuals in each of three age strata (3-59 months, 5-9 years, and 10 years and above) were sampled in randomly-selected households. Capillary blood was collected by fingerprick, thick and thin blood films were examined. Microscopy was performed at Epicentre, Maradi, Niger, with external quality control. The target sample size was 396 households during the high-season surveys and 266 households during the low-season surveys.
RESULTS
Prevalence of parasitaemia was highest in children aged 5-9 years during all four surveys, ranging between 53.6% (95%CI 48.8-63.6) in February 2018 and 73.2% (66.2-79.2) in September 2017. Prevalence of parasitaemia among children aged 3-59 months ranged between 39.6% (33.2-46.4) in February 2018 and 51.9% (45.1-58.6) in October 2016. Parasite density was highest in children aged 3-59 months during all four surveys, and was higher in high season surveys than in low season surveys among all participants. The prevalence of gametocytaemia in children aged 3-59 months ranged between 9.9% (6.5-14.8) in February 2018 and 19.3% (14.6-25.2) in October 2016. The prevalence of gametocytaemia in children aged 5-9 years ranged between 6.3% (3.5-11.1) in February 2018 and 18.5% (12.7-26.1) in October 2016.
CONCLUSIONS
Asymptomatic malaria infection is highly prevalent in this area, even during the season with low incidence of clinical malaria. The high prevalence of parasitaemia in children aged 5-9 years warrants considering their inclusion in SMC programmes in this context.
Journal Article > ResearchFull Text
Malar J. 2023 February 6; Volume 22 (Issue 1); 44.; DOI:10.1186/s12936-023-04469-7
Grout L, Katuala Givo Y, Newport T, Mahamat TA, Gitahi P, et al.
Malar J. 2023 February 6; Volume 22 (Issue 1); 44.; DOI:10.1186/s12936-023-04469-7
BACKGROUND
Angumu health zone in Ituri, Democratic Republic of Congo, is a highly malaria-endemic area with an overburdened health system and hosting internally displaced persons (IDP). The World Health Organization recommends mass drug administration (MDA) for malaria in complex emergencies. Therefore, three MDA rounds were implemented by Ministry of Public Health and Médecins sans Frontières from September 2020 to January 2021 in four health areas selected for epidemiological (high malaria incidence) and logistic reasons. Reported mortality and morbidity were compared in locations where MDA has been performed and locations where it has not.
METHODS
A non-randomized controlled population-based retrospective mortality survey was conducted in March 2021. Two-stage cluster sampling was used in villages; all IDP sites were surveyed with systematic random sampling. The main (mortality rates) and secondary (morbidity) outcomes were estimated and compared between locations where MDA had been conducted and where it had not, using mixed Poisson and binomial regression models respectively.
RESULTS
Data was collected for 2554 households and 15470 individuals, of whom 721 died in the 18-month recall period. The under-five mortality rate (U5MR) decreased in the locations where MDA had been implemented from 2.32 [1.48–3.16] “before” the MDA to 1.10 [0.5–1.71] deaths/10,000 children under 5 years/day “after”, whereas it remained stable from 2.74 [2.08–3.40] to 2.67 [1.84–3.50] deaths/10,000 children/day in the same time periods in locations where MDA had not been implemented. The U5MR and malaria-specific mortality was significantly higher in non-MDA locations after MDA was implemented (aRR = 2.17 [1.36–3.49] and 2.60 [1.56–4.33], respectively, for all-cause and malaria-specific mortality among children < 5 years). Morbidity (all age and < 5 years, all cause or malaria-specific) appeared lower in MDA locations 2.5 months after last round: reported malaria-specific morbidity was 14.7% [11–18] and 25.0% [19–31] in villages and IDP sites where MDA had been implemented, while it was 30.4% [27–33] and 49.3% [45–54] in villages and IDP sites with no MDA.
CONCLUSIONS
Despite traditional limitations associated with non-randomized controlled retrospective surveys, the documented sharp decrease of under-5 mortality and morbidity shows that MDA has the potential to become an important malaria-control tool in emergency settings. Based on these results, new MDA rounds, along with indoor residual spraying campaigns, have been planned in the health zone in 2022. A set of surveys will be conducted before, during and after these rounds to confirm the effect observed in 2021 and assess its duration.
Angumu health zone in Ituri, Democratic Republic of Congo, is a highly malaria-endemic area with an overburdened health system and hosting internally displaced persons (IDP). The World Health Organization recommends mass drug administration (MDA) for malaria in complex emergencies. Therefore, three MDA rounds were implemented by Ministry of Public Health and Médecins sans Frontières from September 2020 to January 2021 in four health areas selected for epidemiological (high malaria incidence) and logistic reasons. Reported mortality and morbidity were compared in locations where MDA has been performed and locations where it has not.
METHODS
A non-randomized controlled population-based retrospective mortality survey was conducted in March 2021. Two-stage cluster sampling was used in villages; all IDP sites were surveyed with systematic random sampling. The main (mortality rates) and secondary (morbidity) outcomes were estimated and compared between locations where MDA had been conducted and where it had not, using mixed Poisson and binomial regression models respectively.
RESULTS
Data was collected for 2554 households and 15470 individuals, of whom 721 died in the 18-month recall period. The under-five mortality rate (U5MR) decreased in the locations where MDA had been implemented from 2.32 [1.48–3.16] “before” the MDA to 1.10 [0.5–1.71] deaths/10,000 children under 5 years/day “after”, whereas it remained stable from 2.74 [2.08–3.40] to 2.67 [1.84–3.50] deaths/10,000 children/day in the same time periods in locations where MDA had not been implemented. The U5MR and malaria-specific mortality was significantly higher in non-MDA locations after MDA was implemented (aRR = 2.17 [1.36–3.49] and 2.60 [1.56–4.33], respectively, for all-cause and malaria-specific mortality among children < 5 years). Morbidity (all age and < 5 years, all cause or malaria-specific) appeared lower in MDA locations 2.5 months after last round: reported malaria-specific morbidity was 14.7% [11–18] and 25.0% [19–31] in villages and IDP sites where MDA had been implemented, while it was 30.4% [27–33] and 49.3% [45–54] in villages and IDP sites with no MDA.
CONCLUSIONS
Despite traditional limitations associated with non-randomized controlled retrospective surveys, the documented sharp decrease of under-5 mortality and morbidity shows that MDA has the potential to become an important malaria-control tool in emergency settings. Based on these results, new MDA rounds, along with indoor residual spraying campaigns, have been planned in the health zone in 2022. A set of surveys will be conducted before, during and after these rounds to confirm the effect observed in 2021 and assess its duration.
Journal Article > ResearchFull Text
Clin Infect Dis. 2013 January 1; Volume 56 (Issue 2); 195-203.; DOI: 10.1093/cid/cis886
Alirol E, Schrumpf D, Amici Heradi J, Riedel A, de Patoul C, et al.
Clin Infect Dis. 2013 January 1; Volume 56 (Issue 2); 195-203.; DOI: 10.1093/cid/cis886
BACKGROUND
Existing diagnostic and treatment tools for human African trypanosomiasis (HAT) are limited. The recent development of nifurtimox-eflornithine combination therapy (NECT) has brought new hopes for patients in the second stage. While NECT has been rolled out in most endemic countries, safety data are scarce and derive only from clinical trials. The World Health Organization (WHO) coordinates a pharmacovigilance program to collect additional data on NECT safety and efficacy. We report here the results of 18 months of experience of NECT use in treatment centers run by Médecins Sans Frontières in the Democratic Republic of the Congo (DRC).
METHODS
This cohort study included 684 second-stage HAT patients (including 120 children) treated with NECT in Doruma and Dingila hospitals, northeastern DRC, between January 2010 and June 2011. All treatment-emergent adverse events (AEs) were recorded and graded according to the Common Terminology Criteria for Adverse Events version 3.0. Safety and efficacy data were retrieved from the WHO pharmacovigilance forms and from Epitryps, a program monitoring database.
RESULTS
Eighty-six percent of the patients experienced at least 1 AE during treatment. On average, children experienced fewer AEs than adults. Most AEs were mild (37.9%) or moderate (54.7%). Severe AEs included vomiting (n = 32), dizziness (n = 16), headache (n = 11), and convulsions (n = 11). The in-hospital case fatality rate was low (0.15%) and relapses were rare (n = 14).
CONCLUSIONS
In comparison with previous treatments, NECT was effective, safe, and well tolerated in nontrial settings in DRC, further supporting the roll-out of NECT as first-line treatment in second-stage Trypanosoma brucei gambiense HAT. Tolerance was particularly good in children.
Existing diagnostic and treatment tools for human African trypanosomiasis (HAT) are limited. The recent development of nifurtimox-eflornithine combination therapy (NECT) has brought new hopes for patients in the second stage. While NECT has been rolled out in most endemic countries, safety data are scarce and derive only from clinical trials. The World Health Organization (WHO) coordinates a pharmacovigilance program to collect additional data on NECT safety and efficacy. We report here the results of 18 months of experience of NECT use in treatment centers run by Médecins Sans Frontières in the Democratic Republic of the Congo (DRC).
METHODS
This cohort study included 684 second-stage HAT patients (including 120 children) treated with NECT in Doruma and Dingila hospitals, northeastern DRC, between January 2010 and June 2011. All treatment-emergent adverse events (AEs) were recorded and graded according to the Common Terminology Criteria for Adverse Events version 3.0. Safety and efficacy data were retrieved from the WHO pharmacovigilance forms and from Epitryps, a program monitoring database.
RESULTS
Eighty-six percent of the patients experienced at least 1 AE during treatment. On average, children experienced fewer AEs than adults. Most AEs were mild (37.9%) or moderate (54.7%). Severe AEs included vomiting (n = 32), dizziness (n = 16), headache (n = 11), and convulsions (n = 11). The in-hospital case fatality rate was low (0.15%) and relapses were rare (n = 14).
CONCLUSIONS
In comparison with previous treatments, NECT was effective, safe, and well tolerated in nontrial settings in DRC, further supporting the roll-out of NECT as first-line treatment in second-stage Trypanosoma brucei gambiense HAT. Tolerance was particularly good in children.
Journal Article > LetterFull Text
Lancet Global Health. 2017 February 5; Volume 5 (Issue 2); DOI:10.1016/S2214-109X(16)30287-X
Peyraud N, Rafael F, Parker LA, Quere M, Alcoba G, et al.
Lancet Global Health. 2017 February 5; Volume 5 (Issue 2); DOI:10.1016/S2214-109X(16)30287-X
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