Conference Material > Abstract
Juma H, Worku DT, Evboumwan PE, Katuala Y, Mbuyi Y, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/Sh2BIQ8FOl
BACKGROUND AND OBJECTIVES
Diphtheria is a vaccine preventable disease caused by toxicogenic Corynebacterium diphtheriae. Since declaration of an outbreak in Nigeria in December 2022, Kano state has been its epicentre, with 77% of the 12,581 confirmed cases nationally. In response, a Decentralised Model of Care (DMC) for delivering proximal, fast, and easily accessible curative and preventive community-based health care was introduced in Kano. Here, we describe implementation of this DMC and assess its impact in reducing mortality from diphtheria during this outbreak.
METHODS
Components of DMC:
• OPD for the triaging and management of mild cases
• Contact clinic (mobile and fixed) to improve access to preventative care for close contacts
Main packages of DMC:
• Health and Infection Prevention and Control promotion
• Chemoprophylaxis and vaccination for close contacts
• Identification and management of simple cases
• Referral of complicated cases
• Training of health workers
DMC was implemented within existing public health facilities for outpatient services, and in the community for the management of close contacts. The selection of facilities was guided by epidemiological data analysis and mapping.
Chi-square testing was used for analysing statistical significance on mortality before and after the implementation of DMC.
RESULTS
Between weeks 2 and 48 of 2023, the health facilities included in this study managed a total of 12,662 suspected diphtheria cases. From this, 1,987 cases (136 deaths; CFR 6.84%) were managed before implementation of DMC (before week 34), and 10,675 cases (611 deaths; CFR 5.72%) were managed after its implementation (from week 34 to 48). One-tailed Chi-square testing showed a statistically significant difference in mortality before and after implementation (p-value 0.02).
CONCLUSIONS
DMC may have contributed to the reduction of mortality in healthcare facilities. Upon in-depth analysis of the impact of DMC, it may be recommended for implementation in large outbreaks. Further studies, however, need to be conducted to assess the role of DMC in improving patients’ access to healthcare and reducing the burden on healthcare facilities during massive outbreaks.
Diphtheria is a vaccine preventable disease caused by toxicogenic Corynebacterium diphtheriae. Since declaration of an outbreak in Nigeria in December 2022, Kano state has been its epicentre, with 77% of the 12,581 confirmed cases nationally. In response, a Decentralised Model of Care (DMC) for delivering proximal, fast, and easily accessible curative and preventive community-based health care was introduced in Kano. Here, we describe implementation of this DMC and assess its impact in reducing mortality from diphtheria during this outbreak.
METHODS
Components of DMC:
• OPD for the triaging and management of mild cases
• Contact clinic (mobile and fixed) to improve access to preventative care for close contacts
Main packages of DMC:
• Health and Infection Prevention and Control promotion
• Chemoprophylaxis and vaccination for close contacts
• Identification and management of simple cases
• Referral of complicated cases
• Training of health workers
DMC was implemented within existing public health facilities for outpatient services, and in the community for the management of close contacts. The selection of facilities was guided by epidemiological data analysis and mapping.
Chi-square testing was used for analysing statistical significance on mortality before and after the implementation of DMC.
RESULTS
Between weeks 2 and 48 of 2023, the health facilities included in this study managed a total of 12,662 suspected diphtheria cases. From this, 1,987 cases (136 deaths; CFR 6.84%) were managed before implementation of DMC (before week 34), and 10,675 cases (611 deaths; CFR 5.72%) were managed after its implementation (from week 34 to 48). One-tailed Chi-square testing showed a statistically significant difference in mortality before and after implementation (p-value 0.02).
CONCLUSIONS
DMC may have contributed to the reduction of mortality in healthcare facilities. Upon in-depth analysis of the impact of DMC, it may be recommended for implementation in large outbreaks. Further studies, however, need to be conducted to assess the role of DMC in improving patients’ access to healthcare and reducing the burden on healthcare facilities during massive outbreaks.
Journal Article > CommentaryFull Text
Lancet Infect Dis. 18 October 2018; Volume 19 (Issue 4); DOI:10.1016/S1473-3099(18)30493-6
Loyse A, Burry J, Cohn J, Ford NP, Chiller T, et al.
Lancet Infect Dis. 18 October 2018; Volume 19 (Issue 4); DOI:10.1016/S1473-3099(18)30493-6
In 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-income countries (LMICs): optimised combination therapies for confirmed meningitis cases and cryptococcal antigen screening programmes for ambulatory people living with HIV who access care. WHO's preferred therapy for the treatment of HIV-related cryptococcal meningitis in LMICs is 1 week of amphotericin B plus flucytosine, and the alternative therapy is 2 weeks of fluconazole plus flucytosine. In the ACTA trial, 1-week (short course) amphotericin B plus flucytosine resulted in a 10-week mortality of 24% (95% CI -16 to 32) and 2 weeks of fluconazole and flucytosine resulted in a 10-week mortality of 35% (95% CI -29 to 41). However, with widely used fluconazole monotherapy, mortality because of HIV-related cryptococcal meningitis is approximately 70% in many African LMIC settings. Therefore, the potential to transform the management of HIV-related cryptococcal meningitis in resource-limited settings is substantial. Sustainable access to essential medicines, including flucytosine and amphotericin B, in LMICs is paramount and the focus of this Personal View.