Journal Article > Case Report/SeriesFull Text
Lancet Infect Dis. 1 August 2024; Online ahead of print; DOI:10.1016/S1473-3099(24)00419-5
Meakin S, Nsio J, Camacho A, Kitenge R, Coulborn RM, et al.
Lancet Infect Dis. 1 August 2024; Online ahead of print; DOI:10.1016/S1473-3099(24)00419-5
BACKRGOUND
The recombinant vesicular stomatitis virus-Zaire Ebola virus (rVSV-ZEBOV) vaccine is the only WHO prequalified vaccine recommended for use to respond to outbreaks of Ebola virus (species Zaire ebolavirus) by WHO's Strategic Advisory Group of Experts on Immunization. Despite the vaccine's widespread use during several outbreaks, no real-world effectiveness estimates are currently available in the literature.
METHODS
We conducted a retrospective test-negative analysis to estimate effectiveness of rVSV-ZEBOV vaccination against Ebola virus disease during the 2018-20 epidemic in the Democratic Republic of the Congo, using data on suspected Ebola virus disease cases collected from Ebola treatment centres. Those eligible for inclusion had an available Ebola virus RT-PCR result, available key data, were eligible for vaccination during the outbreak, and had symptom onset aligning with the period in which a ring-vaccination protocol was in use. After imputing missing data, each individual confirmed by RT-PCR to be Ebola virus disease-positive (defined as a case) was matched to one individual negative for Ebola virus disease (control) by sex, age, health zone, and month of symptom onset. Effectiveness was estimated from the odds ratio of being vaccinated (≥10 days before symptom onset) versus being unvaccinated among cases and controls, after adjusting for the matching factors. The imputation, matching and effectiveness estimation, was repeated 500 times.
FINDINGS
1273 (4·8%) of 26 438 eligible individuals were positive for Ebola virus disease (cases) and 25 165 (95·2%) were negative (controls). 40 (3·1%) cases and 1271 (5·1%) controls were reported as being vaccinated at least 10 days before symptom onset. After selecting individuals who reported exposure to an individual with Ebola virus disease within the 21 days before symptom onset and matching, the analysis datasets comprised a median of 309 cases and 309 controls. 10 days or more after vaccination, the effectiveness of rVSV-ZEBOV against Ebola virus disease was estimated to be 84% (95% credible interval 70-92).
INTERPRETATION
This analysis is the first to provide estimates of the real-world effectiveness of the rVSV-ZEBOV vaccine against Ebola virus disease, amid the widespread use of the vaccine during a large Ebola virus disease outbreak. Our findings confirm that rVSV-ZEBOV is highly protective against Ebola virus disease and support its use during outbreaks, even in challenging contexts such as in the eastern Democratic Republic of the Congo.
Conference Material > Abstract
Sterk E, Schramm B, Riccio E, Gabut M, Fontana L, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/Dz2BnS7
INTRODUCTION
The 2014 West Africa Ebola outbreak underlined inadequacies of current personal protective equipment (PPE), such as being uncomfortable and hot, causing excessive sweating and rapid exhaustion, and limiting interactions between health workers and patients. The smartPPE development project responded to the urgent need for a more comfortable, simpler, and sustainable PPE solution for filovirus-outbreak front-line workers. A one- piece, reusable smartPPE with ventilation system was developed to address these challenges. We assessed ease-of-use, comfort, functionality, and perceived doffing-safety of the smartPPE prototype compared with currently used PPE (current-PPE) under simulated field conditions.
METHODS
In June 2023, we conducted a mixed-methods crossover usability study in a controlled high-heat/high-humidity indoor site in Brindisi, Italy. Ten test users (three female, seven with filovirus-front-line experience) assessed smartPPE and current- PPE in four guided sessions covering donning, (emergency) doffing, clinical tasks, and heavy physical WATSAN activities. User feedback was collected through structured questionnaires. Temperature, humidity, session duration, and vital signs were measured, and perceived exertion was assessed using Borg- scores (scale 6–20).
RESULTS
Median temperature and humidity were higher inside current- PPE than inside smartPPE (difference: 2.3°C [IQR 1.8–3.0] and 12.6 percentage points [8.8–19.6], respectively). Users endured heavy work sessions for significantly longer in smartPPE than in current-PPE (80.0 min [IQR 75–84] vs 49.5 min [45–56]). Median increases in body temperature (1.1°C [IQR 0.7–1.6] vs 0.7°C [0.3–0.9]; p<0.001) and respiratory rate (3.5 rpm [1–5] vs 1.5 rpm [0–3]; p=0.034), and reductions in O2 saturation (–2% [–5 to –1] vs –1.5% [–3 to 0]; p=0.027) were higher with current-PPE than with smartPPE. Peripheral vision was similarly rated, but hearing was compromised with smartPPE at ≥5 m. Median exertion- scores were lower for smartPPE (clinical tasks 8.5 [IQR 7–11] vs 15.5 [14–16] p<0.01; heavy physical activities 14 [13–17] vs 18 [17–20] p=0.035). All users preferred smartPPE for overall and thermal comfort, breathing, and doffing-safety; nine (90%) favoured it for non-verbal communication, eight (80%) for vision or longer-interval heavy WATSAN activities, six (60%) for longer- interval patient care, six (60%) for short-term clinical activities, and six (60%) for emergency doffing. Reported concerns were airflow obstruction while bending, hearing difficulties attributed to ventilation noise, and adjustments for headgear, ventilation, and suit fitting.
CONCLUSION
Test users confirmed the usability of smartPPE and favoured it, especially for doffing-safety, longer-interval clinical or physical work, and improved non-verbal interactions, whereas hearing was challenged by the ventilation. Adjustments are currently underway before design freeze. Stakeholder commitment will be crucial to ensure production at scale.
The 2014 West Africa Ebola outbreak underlined inadequacies of current personal protective equipment (PPE), such as being uncomfortable and hot, causing excessive sweating and rapid exhaustion, and limiting interactions between health workers and patients. The smartPPE development project responded to the urgent need for a more comfortable, simpler, and sustainable PPE solution for filovirus-outbreak front-line workers. A one- piece, reusable smartPPE with ventilation system was developed to address these challenges. We assessed ease-of-use, comfort, functionality, and perceived doffing-safety of the smartPPE prototype compared with currently used PPE (current-PPE) under simulated field conditions.
METHODS
In June 2023, we conducted a mixed-methods crossover usability study in a controlled high-heat/high-humidity indoor site in Brindisi, Italy. Ten test users (three female, seven with filovirus-front-line experience) assessed smartPPE and current- PPE in four guided sessions covering donning, (emergency) doffing, clinical tasks, and heavy physical WATSAN activities. User feedback was collected through structured questionnaires. Temperature, humidity, session duration, and vital signs were measured, and perceived exertion was assessed using Borg- scores (scale 6–20).
RESULTS
Median temperature and humidity were higher inside current- PPE than inside smartPPE (difference: 2.3°C [IQR 1.8–3.0] and 12.6 percentage points [8.8–19.6], respectively). Users endured heavy work sessions for significantly longer in smartPPE than in current-PPE (80.0 min [IQR 75–84] vs 49.5 min [45–56]). Median increases in body temperature (1.1°C [IQR 0.7–1.6] vs 0.7°C [0.3–0.9]; p<0.001) and respiratory rate (3.5 rpm [1–5] vs 1.5 rpm [0–3]; p=0.034), and reductions in O2 saturation (–2% [–5 to –1] vs –1.5% [–3 to 0]; p=0.027) were higher with current-PPE than with smartPPE. Peripheral vision was similarly rated, but hearing was compromised with smartPPE at ≥5 m. Median exertion- scores were lower for smartPPE (clinical tasks 8.5 [IQR 7–11] vs 15.5 [14–16] p<0.01; heavy physical activities 14 [13–17] vs 18 [17–20] p=0.035). All users preferred smartPPE for overall and thermal comfort, breathing, and doffing-safety; nine (90%) favoured it for non-verbal communication, eight (80%) for vision or longer-interval heavy WATSAN activities, six (60%) for longer- interval patient care, six (60%) for short-term clinical activities, and six (60%) for emergency doffing. Reported concerns were airflow obstruction while bending, hearing difficulties attributed to ventilation noise, and adjustments for headgear, ventilation, and suit fitting.
CONCLUSION
Test users confirmed the usability of smartPPE and favoured it, especially for doffing-safety, longer-interval clinical or physical work, and improved non-verbal interactions, whereas hearing was challenged by the ventilation. Adjustments are currently underway before design freeze. Stakeholder commitment will be crucial to ensure production at scale.
Conference Material > Slide Presentation
Sterk E, Schramm B, Riccio E, Gabut M, Fontana L, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/9RSrgB
Journal Article > ResearchFull Text
Malar J. 6 February 2023; 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. 6 February 2023; 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 > Short ReportFull Text
Morbidity and Mortality Weekly Report. 14 November 2014; Volume 63; 1067-71.
Sharma A, Heijenberg N, Peter C, Bolongei J, Reeder B, et al.
Morbidity and Mortality Weekly Report. 14 November 2014; Volume 63; 1067-71.
WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?
Lofa County in Liberia has one of the highest numbers of reported cases of Ebola virus disease (Ebola) in West Africa. Government health offices, nongovernmental organizations, and technical agencies coordinated response activities to reduce transmission of Ebola in Lofa County. The intensity and thoroughness of activities increased in response to the resurgence of Ebola in early June.
WHAT IS ADDED BY THIS REPORT?
Trends in new reported cases, admissions to the dedicated Ebola treatment unit in the town of Foya, and test results of community decedents evaluated for Ebola virus suggest transmission of Ebola virus decreased in Lofa County as early as August 17, 2014, following rapid scale-up of response activities after a resurgence of Ebola in early June.
WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?
A comprehensive Ebola response strategy developed with participation from the local community and rapidly scaled up following resurgence of Ebola might have reduced the spread of Ebola virus in Lofa County. The strategy implemented in Lofa County might serve as a model for reducing transmission of Ebola virus in other affected areas.
Lofa County in Liberia has one of the highest numbers of reported cases of Ebola virus disease (Ebola) in West Africa. Government health offices, nongovernmental organizations, and technical agencies coordinated response activities to reduce transmission of Ebola in Lofa County. The intensity and thoroughness of activities increased in response to the resurgence of Ebola in early June.
WHAT IS ADDED BY THIS REPORT?
Trends in new reported cases, admissions to the dedicated Ebola treatment unit in the town of Foya, and test results of community decedents evaluated for Ebola virus suggest transmission of Ebola virus decreased in Lofa County as early as August 17, 2014, following rapid scale-up of response activities after a resurgence of Ebola in early June.
WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?
A comprehensive Ebola response strategy developed with participation from the local community and rapidly scaled up following resurgence of Ebola might have reduced the spread of Ebola virus in Lofa County. The strategy implemented in Lofa County might serve as a model for reducing transmission of Ebola virus in other affected areas.
Journal Article > ResearchFull Text
Am J Trop Med Hyg. 3 October 2016; Volume 95 (Issue 6); 1389–1397 .; DOI:10.4269/ajtmh.16-0376
Tiffany A, Moundekeno FP, Traore A, Haile M, Sterk E, et al.
Am J Trop Med Hyg. 3 October 2016; Volume 95 (Issue 6); 1389–1397 .; DOI:10.4269/ajtmh.16-0376
Multiple community-based approaches can aid in quantifying mortality in the absence of reliable health facility data. Community-based sentinel site surveillance that was used to document mortality and the systems utility for outbreak detection was evaluated. We retrospectively analyzed data from 46 sentinel sites in three sous-préfectures with a reinforced malaria control program and one sous-préfecture without (Koundou) in Guinea. Deaths were recorded by key informants and classified as due to malaria or another cause. Malaria deaths were those reported as due to malaria or fever in the 3 days before death with no other known cause. Suspect Ebola virus disease (sEVD) deaths were those due to select symptoms in the EVD case definition. Deaths were aggregated by sous-préfecture and analyzed by a 6-month period. A total of 43,000 individuals were monitored by the surveillance system; 1,242 deaths were reported from July 2011-June 2014, of which 55.2% (N = 686) were reported as due to malaria. Malaria-attributable proportional mortality decreased by 26.5% (95% confidence interval [CI] = 13.9-33.1, P < 0.001) in the program area and by 6.6% (95% CI = -17.3-30.5, P = 0.589) in Koundou. Sixty-eight deaths were classified as sEVD and increased by 6.1% (95% CI = 1.3-10.8, P = 0.021). Seventeen sEVD deaths were reported from November 2013 to March 2014 including the first two laboratory-confirmed EVD deaths. Community surveillance can capture information on mortality in areas where data collection is weak, but determining causes of death remains challenging. It can also be useful for outbreak detection if timeliness of data collection and reporting facilitate real-time data analysis.
Journal Article > ResearchFull Text
N Engl J Med. 7 January 2016; Volume 374 (Issue 1); 23-32.; DOI:10.1056/NEJMoa1504605
Gignoux EM, Azman AS, de Smet M, Azuma P, Massaquoi M, et al.
N Engl J Med. 7 January 2016; Volume 374 (Issue 1); 23-32.; DOI:10.1056/NEJMoa1504605
BACKGROUND
Malaria treatment is recommended for patients with suspected Ebola virus disease (EVD) in West Africa, whether systematically or based on confirmed malaria diagnosis. At the Ebola treatment center in Foya, Lofa County, Liberia, the supply of artemether–lumefantrine, a first-line antimalarial combination drug, ran out for a 12-day period in August 2014. During this time, patients received the combination drug artesunate–amodiaquine; amodiaquine is a compound with anti–Ebola virus activity in vitro. No other obvious change in the care of patients occurred during this period.
METHODS
We fit unadjusted and adjusted regression models to standardized patient-level data to estimate the risk ratio for death among patients with confirmed EVD who were prescribed artesunate–amodiaquine (artesunate–amodiaquine group), as compared with those who were prescribed artemether–lumefantrine (artemether–lumefantrine group) and those who were not prescribed any antimalarial drug (no-antimalarial group).
RESULTS
Between June 5 and October 24, 2014, a total of 382 patients with confirmed EVD were admitted to the Ebola treatment center in Foya. At admission, 194 patients were prescribed artemether–lumefantrine and 71 were prescribed artesunate–amodiaquine. The characteristics of the patients in the artesunate–amodiaquine group were similar to those in the artemether–lumefantrine group and those in the no-antimalarial group. A total of 125 of the 194 patients in the artemether–lumefantrine group (64.4%) died, as compared with 36 of the 71 patients in the artesunate–amodiaquine group (50.7%). In adjusted analyses, the artesunate–amodiaquine group had a 31% lower risk of death than the artemether–lumefantrine group (risk ratio, 0.69; 95% confidence interval, 0.54 to 0.89), with a stronger effect observed among patients without malaria.
CONCLUSIONS
Patients who were prescribed artesunate–amodiaquine had a lower risk of death from EVD than did patients who were prescribed artemether–lumefantrine. However, our analyses cannot exclude the possibility that artemether–lumefantrine is associated with an increased risk of death or that the use of artesunate–amodiaquine was associated with unmeasured patient characteristics that directly altered the risk of death.
Malaria treatment is recommended for patients with suspected Ebola virus disease (EVD) in West Africa, whether systematically or based on confirmed malaria diagnosis. At the Ebola treatment center in Foya, Lofa County, Liberia, the supply of artemether–lumefantrine, a first-line antimalarial combination drug, ran out for a 12-day period in August 2014. During this time, patients received the combination drug artesunate–amodiaquine; amodiaquine is a compound with anti–Ebola virus activity in vitro. No other obvious change in the care of patients occurred during this period.
METHODS
We fit unadjusted and adjusted regression models to standardized patient-level data to estimate the risk ratio for death among patients with confirmed EVD who were prescribed artesunate–amodiaquine (artesunate–amodiaquine group), as compared with those who were prescribed artemether–lumefantrine (artemether–lumefantrine group) and those who were not prescribed any antimalarial drug (no-antimalarial group).
RESULTS
Between June 5 and October 24, 2014, a total of 382 patients with confirmed EVD were admitted to the Ebola treatment center in Foya. At admission, 194 patients were prescribed artemether–lumefantrine and 71 were prescribed artesunate–amodiaquine. The characteristics of the patients in the artesunate–amodiaquine group were similar to those in the artemether–lumefantrine group and those in the no-antimalarial group. A total of 125 of the 194 patients in the artemether–lumefantrine group (64.4%) died, as compared with 36 of the 71 patients in the artesunate–amodiaquine group (50.7%). In adjusted analyses, the artesunate–amodiaquine group had a 31% lower risk of death than the artemether–lumefantrine group (risk ratio, 0.69; 95% confidence interval, 0.54 to 0.89), with a stronger effect observed among patients without malaria.
CONCLUSIONS
Patients who were prescribed artesunate–amodiaquine had a lower risk of death from EVD than did patients who were prescribed artemether–lumefantrine. However, our analyses cannot exclude the possibility that artemether–lumefantrine is associated with an increased risk of death or that the use of artesunate–amodiaquine was associated with unmeasured patient characteristics that directly altered the risk of death.
Conference Material > Abstract
Sterk E, Newport T, Mahamat TA, Gitahi P, Mandagot JJ, et al.
MSF Scientific Days International 2021: Research. 19 May 2021
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
Conference Material > Abstract
Wodon S, Voiret I, Acquarone A, Sterk E, Traore K, et al.
MSF Scientific Days International 2020: Innovation. 28 May 2020
INTRODUCTION
The Ebola outbreak in the Democratic Republic of Congo (DRC) has led to over 3300 confirmed cases and caused over 2250 deaths so far. Health promotion is a key component of the Ebola response, however, misconceptions about Ebola and the response are common. CHAMPIONS CONTRE EBOLA is a smartphone app for disseminating health promotion (HP) messages. It uses gamification to let people proactively identify adequate health behaviours. Players are asked simple questions about Ebola and asked to choose between two answers. For each correct answer, the player earns stars which unlocks avatars. Correct messages, consisting of a short text and two illustrations, and certificates showing successful game completion, can be shared on social media. The app, available in French, Swahili, and English, can be downloaded from Google Play or shared via Bluetooth. The game has been developed in a partnership between MSF and Pixel Impact.
METHODS
The first version of the app was tested in Bunia in October, 2019. 75 people in individual and group sessions gave feedback on the app’s messages and user interface. A second version, including a tutorial, improved coherency between stars, certificates, and avatars, and revised messages, was launched in January, 2020 in Bunia during MSF HP sessions. From these group sessions, 75 individuals, including medical team members, key community members, and other age and gender representative community members, agreed to test the application individually. Using a structured questionnaire, data were collected on app perception, understanding, and usability. An observer checklist was used by a supervisor to collect information on the technical reliability of the app during field use.
RESULTS
The app was positively perceived by 99% of respondents, for its capacity to facilitate knowledge improvement (51% of participants), to reach more people with health promotion messages (14%), to reinforce and affirm existing knowledge (14%), to support decision-making (16%), and as a user-friendly game (10%). The game’s design and pedagogical approach were appreciated and motivating for all participants, with 99% motivated to win stars, 97% appreciating the ability to choose avatars, and all participants agreeing with its utility to fight Ebola and likely acceptance by communities. Challenges were identified regarding usability, with 53% of people requiring assistance at the beginning of use, due to difficulty with game initiation (55% of those requiring assistance), fear regarding a new game (28%), and difficulty utilising the options in the game (18%). Additional factors were identified for improvement, including increased competitiveness and intuitiveness.
ETHICS
This innovation project did not involve human participants’ personal data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
CONCLUSION
CHAMPIONS CONTRE EBOLA generated a positive response and has potential as a complement to standard health promotion tools. It is designed to enable participants to engage actively in the learning process and to facilitate sharing of health messages within the community, rather than be passive recipients of health-care messages. Limitations include the lack of assessment of message retention and impact on behavior; further research would be needed to determine these effects. The app has been shared with other Ebola response actors and is available on Google Play.
Conflicts of interest
None declared.
The Ebola outbreak in the Democratic Republic of Congo (DRC) has led to over 3300 confirmed cases and caused over 2250 deaths so far. Health promotion is a key component of the Ebola response, however, misconceptions about Ebola and the response are common. CHAMPIONS CONTRE EBOLA is a smartphone app for disseminating health promotion (HP) messages. It uses gamification to let people proactively identify adequate health behaviours. Players are asked simple questions about Ebola and asked to choose between two answers. For each correct answer, the player earns stars which unlocks avatars. Correct messages, consisting of a short text and two illustrations, and certificates showing successful game completion, can be shared on social media. The app, available in French, Swahili, and English, can be downloaded from Google Play or shared via Bluetooth. The game has been developed in a partnership between MSF and Pixel Impact.
METHODS
The first version of the app was tested in Bunia in October, 2019. 75 people in individual and group sessions gave feedback on the app’s messages and user interface. A second version, including a tutorial, improved coherency between stars, certificates, and avatars, and revised messages, was launched in January, 2020 in Bunia during MSF HP sessions. From these group sessions, 75 individuals, including medical team members, key community members, and other age and gender representative community members, agreed to test the application individually. Using a structured questionnaire, data were collected on app perception, understanding, and usability. An observer checklist was used by a supervisor to collect information on the technical reliability of the app during field use.
RESULTS
The app was positively perceived by 99% of respondents, for its capacity to facilitate knowledge improvement (51% of participants), to reach more people with health promotion messages (14%), to reinforce and affirm existing knowledge (14%), to support decision-making (16%), and as a user-friendly game (10%). The game’s design and pedagogical approach were appreciated and motivating for all participants, with 99% motivated to win stars, 97% appreciating the ability to choose avatars, and all participants agreeing with its utility to fight Ebola and likely acceptance by communities. Challenges were identified regarding usability, with 53% of people requiring assistance at the beginning of use, due to difficulty with game initiation (55% of those requiring assistance), fear regarding a new game (28%), and difficulty utilising the options in the game (18%). Additional factors were identified for improvement, including increased competitiveness and intuitiveness.
ETHICS
This innovation project did not involve human participants’ personal data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
CONCLUSION
CHAMPIONS CONTRE EBOLA generated a positive response and has potential as a complement to standard health promotion tools. It is designed to enable participants to engage actively in the learning process and to facilitate sharing of health messages within the community, rather than be passive recipients of health-care messages. Limitations include the lack of assessment of message retention and impact on behavior; further research would be needed to determine these effects. The app has been shared with other Ebola response actors and is available on Google Play.
Conflicts of interest
None declared.
Journal Article > ResearchFull Text
PLOS One. 28 December 2012; Volume 7 (Issue 12); DOI:10.1371/journal.pone.0052986
Roddy P, Howard N, Van Kerkhove MD, Lutwama J, Wamala JF, et al.
PLOS One. 28 December 2012; Volume 7 (Issue 12); DOI:10.1371/journal.pone.0052986
A confirmed Ebola haemorrhagic fever (EHF) outbreak in Bundibugyo, Uganda, November 2007-February 2008, was caused by a putative new species (Bundibugyo ebolavirus). It included 93 putative cases, 56 laboratory-confirmed cases, and 37 deaths (CFR = 25%). Study objectives are to describe clinical manifestations and case management for 26 hospitalised laboratory-confirmed EHF patients. Clinical findings are congruous with previously reported EHF infections. The most frequently experienced symptoms were non-bloody diarrhoea (81%), severe headache (81%), and asthenia (77%). Seven patients reported or were observed with haemorrhagic symptoms, six of whom died. Ebola care remains difficult due to the resource-poor setting of outbreaks and the infection-control procedures required. However, quality data collection is essential to evaluate case definitions and therapeutic interventions, and needs improvement in future epidemics. Organizations usually involved in EHF case management have a particular responsibility in this respect.