Journal Article > ResearchFull Text
Public Health Action. 2020 September 21; Volume 10; DOI:10.5588/pha.19.0074
Makelele JPK, Ade S, Takarinda KC, Manzi M, Gil Cuesta J, et al.
Public Health Action. 2020 September 21; Volume 10; DOI:10.5588/pha.19.0074
Setting: In 1995, a rapid response project for humanitarian and medical emergencies, including outbreak responses, named ‘Pool d’Urgence Congo’ (PUC), was implemented in the Democratic Republic of Congo by Médecins Sans Frontières.
Objective: To assess the outcomes of cholera and measles outbreak alerts that were received in the PUC surveillance system between 2016 and 2018.
Design: This was a retrospective cross-sectional study.
Results: Overall, 459 outbreak alerts were detected, respectively 69% and 31% for cholera and measles. Of these, 32% were actively detected and 68% passively detected. Most alerts (90%) required no intervention and 10% of alerts had an intervention. There were 25% investigations that were not carried out despite thresholds being met; 17% interventions were not performed, the main reported reason being PUC operational capacity was exceeded. Confirmed cholera and measles outbreaks that met an investigation threshold comprised respectively 90% and 76% of alerts; 59% of measles investigations were followed by a delayed outbreak response of 14 days (n = 10 outbreaks).
Conclusion: Some alerts for cholera and measles outbreaks that were detected in the PUC system did not lead to a response even when required; the main reported reason was limited operational capacity to respond to all of them.
Objective: To assess the outcomes of cholera and measles outbreak alerts that were received in the PUC surveillance system between 2016 and 2018.
Design: This was a retrospective cross-sectional study.
Results: Overall, 459 outbreak alerts were detected, respectively 69% and 31% for cholera and measles. Of these, 32% were actively detected and 68% passively detected. Most alerts (90%) required no intervention and 10% of alerts had an intervention. There were 25% investigations that were not carried out despite thresholds being met; 17% interventions were not performed, the main reported reason being PUC operational capacity was exceeded. Confirmed cholera and measles outbreaks that met an investigation threshold comprised respectively 90% and 76% of alerts; 59% of measles investigations were followed by a delayed outbreak response of 14 days (n = 10 outbreaks).
Conclusion: Some alerts for cholera and measles outbreaks that were detected in the PUC system did not lead to a response even when required; the main reported reason was limited operational capacity to respond to all of them.
Journal Article > CommentaryFull Text
Afr Health. 2016 January 1
Harries AD, Takarinda KC, Zachariah R
Afr Health. 2016 January 1
Journal Article > ResearchFull Text
Trans R Soc Trop Med Hyg. 2018 June 1; Volume 112 (Issue 6); DOI:10.1093/trstmh/try054
Timire C, Takarinda KC, Harries AD, Mutunzi H, Manyame-Murwira B, et al.
Trans R Soc Trop Med Hyg. 2018 June 1; Volume 112 (Issue 6); DOI:10.1093/trstmh/try054
In Zimbabwe, while the Xpert MTB/RIF assay is being used for diagnosing tuberculosis and rifampicin-resistance, re-treatment tuberculosis (TB) patients are still expected to have culture and drug sensitivity testing (CDST) performed at national reference laboratories for confirmation. The study aim was to document the Xpert MTB/RIF assay scale-up and assess how the CDST system functioned for re-treatment TB patients.
Journal Article > ResearchFull Text
Public Health Action. 2017 September 1; Volume 7 (Issue 3); DOI:10.5588/pha.16.0123
Aw B, Ade S, Hinderaker SG, Dlamini N, Takarinda KC, et al.
Public Health Action. 2017 September 1; Volume 7 (Issue 3); DOI:10.5588/pha.16.0123
Setting: The National Tuberculosis Programme, Mauritania. Objective: To compare the diagnosis and treatment outcomes of childhood tuberculosis (TB) cases (aged <15 years) registered between 2010 and 2015 inside and outside Nouakchott, the capital city. Design: This was a retrospective comparative cohort study. Results: A total of 948 children with TB were registered. The registration rate was 10 times higher in Nouakchott. The proportion of children among all TB cases was higher inside than outside Nouakchott (7.5% vs. 4.6%, P < 0.01). Under-fives represented 225 (24%) of all childhood TB cases, of whom 204 (91%) were registered in Nouakchott. Extra-pulmonary TB was more common in Nouakchott, while smear-negative TB was less common. Treatment success was similar inside and outside Nouakchott (national rate 61%). The principal unsuccessful outcomes were loss to follow-up outside Nouakchott (21% vs. 11%, P < 0.01) while transfers out were more common in the city (25% vs. 14%, P = 0.01). Being aged <5 years (OR 1.2, 95%CI 1.1-1.5) was associated with an unsuccessful outcome. Conclusion: This study indicates problems in the diagnosis and treatment of childhood TB in Mauritania, especially outside the city of Nouakchott. We suggest strengthening clinical diagnosis and management, improving communications between TB treatment centres and health services and pressing the TB world to develop more accurate and easy-to-use diagnostic tools for children.
Journal Article > ResearchFull Text
Trop Med Infect Dis. 2021 May 19; Volume 6 (Issue 2); 83.; DOI:10.3390/tropicalmed6020083
Namugambe JS, Delamou A, Moses FL, Ali E, Hermans V, et al.
Trop Med Infect Dis. 2021 May 19; Volume 6 (Issue 2); 83.; DOI:10.3390/tropicalmed6020083
Antimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) and Joint Medical Stores (JMS) to 442 health facilities from 2017 to 2019. Data were analyzed using the World Health Organization methodology for AMC surveillance. Total quantity of antimicrobials in defined daily dose (DDD) were determined, classified into Access, Watch, Reserve (AWaRe) and AMC density was calculated. There was an increase in total DDDs distributed by NMS in 2019 by 4,166,572 DDD. In 2019, Amoxicillin (27%), Cotrimoxazole (20%), and Metronidazole (12%) were the most supplied antimicrobials by NMS while Doxycycline (10%), Amoxicillin (19%), and Metronidazole (10%) were the most supplied by JMS. The majority of antimicrobials supplied by NMS (81%) and JMS (66%) were from the Access category. Increasing antimicrobial consumption density (DDD per 100 patient days) was observed from national referral to lower-level health facilities. Except for NMS in 2019, total antimicrobials supplied by NMS and JMS remained the same from 2017 to 2019. This serves as a baseline for future assessments and monitoring of stewardship interventions.
Journal Article > ResearchFull Text
J Infect Dev Ctries. 2020 June 29; Volume 14 (Issue 6.1); 28S-35S.; DOI:10.3855/jidc.11701
Enbiale W, Baynie TB, Ayalew A, Gebrehiwot TG, Getanew T, et al.
J Infect Dev Ctries. 2020 June 29; Volume 14 (Issue 6.1); 28S-35S.; DOI:10.3855/jidc.11701
INTRODUCTION
In 2018, the Ethiopian Ministry of Health embarked on a Mass Drug Administration (MDA) campaign that involved over 9 million people in Ethiopia - the largest scabies MDA campaign ever conducted on a global level. We describe its implementation and report on a) numbers screened and identified with scabies, b) treatment category and drug type and c) human resources used, duration, and cost of the campaign.
METHODOLOGY
The MDA campaign was conducted according to national guidelines and activities including: planning and organization, engagement of local leaders, community mobilisation and advocacy, awareness-raising among health workers, field implementation, and monitoring and evaluation. The campaign was conducted between July and August 2018.
RESULTS
The MDA campaign was implemented by about 15,000 people, mostly from the community, over an average of 6 days and reached 9, 057, 427 people. A total of 875,890 (9.7%) scabies cases were detected and 995,471 (11.0%) contacts received treatment. (Contact-to-case ratio = 1.3). Scabies prevalence varied, the highest prevalence was seen in Central Gondar (39.2%), South Gondar (16.7%) and North Gondar (15.0%), these neighbouring zones contributing more than two third of all scabies cases in the region. Of 1,738,304 (93%) who received treatment, 94% received ivermectin, the rest topical permethrin and sulfur. The average coverage capacity of an MDA campaign staff member was 84 people per day. The total cost was 11,696,333 United States Dollars (USD). Cost per 100,000 population = 129,135 USD.
CONCLUSIONS
This experience of rapid-large scale implementation would be useful to scale up similar interventions and "stop the itch" in other regions of Ethiopia.
In 2018, the Ethiopian Ministry of Health embarked on a Mass Drug Administration (MDA) campaign that involved over 9 million people in Ethiopia - the largest scabies MDA campaign ever conducted on a global level. We describe its implementation and report on a) numbers screened and identified with scabies, b) treatment category and drug type and c) human resources used, duration, and cost of the campaign.
METHODOLOGY
The MDA campaign was conducted according to national guidelines and activities including: planning and organization, engagement of local leaders, community mobilisation and advocacy, awareness-raising among health workers, field implementation, and monitoring and evaluation. The campaign was conducted between July and August 2018.
RESULTS
The MDA campaign was implemented by about 15,000 people, mostly from the community, over an average of 6 days and reached 9, 057, 427 people. A total of 875,890 (9.7%) scabies cases were detected and 995,471 (11.0%) contacts received treatment. (Contact-to-case ratio = 1.3). Scabies prevalence varied, the highest prevalence was seen in Central Gondar (39.2%), South Gondar (16.7%) and North Gondar (15.0%), these neighbouring zones contributing more than two third of all scabies cases in the region. Of 1,738,304 (93%) who received treatment, 94% received ivermectin, the rest topical permethrin and sulfur. The average coverage capacity of an MDA campaign staff member was 84 people per day. The total cost was 11,696,333 United States Dollars (USD). Cost per 100,000 population = 129,135 USD.
CONCLUSIONS
This experience of rapid-large scale implementation would be useful to scale up similar interventions and "stop the itch" in other regions of Ethiopia.
Journal Article > ResearchFull Text
Public Health Action. 2018 April 25; Volume 8 (Issue 1); DOI:10.5588/pha.17.0076
Nghipumbwa MH, Ade S, Kizito W, Takarinda KC, Uusiku P, et al.
Public Health Action. 2018 April 25; Volume 8 (Issue 1); DOI:10.5588/pha.17.0076
Setting: Kavango, a 'moderate' transmission risk region located in north-eastern Namibia, borders Angola, a country with higher malaria transmission levels. Objective: To determine 1) the trends in malaria incidence between 2010 and 2014 in Kavango, 2) the socio-demographic and clinical characteristics of confirmed cases in 2014, and 3) associated risk factors of cases classified as imported. Design: This was a retrospective study of malaria case investigation forms conducted in all 52 public health facilities in 2014. Incidence was derived from aggregate routine surveillance data from the Health Information System (HIS). Results: During the 5-year study, incidence fell from 53.6 to 3.6 cases per 1000 population, then increased again to 47.3/1000. Fifty-five per cent of cases were males, and 49% were aged between 5 and 17 years. Of the 2014 cases, 23% were imported, and were associated with higher odds of severe malaria (adjusted odds ratio [aOR] 1.8; 95%CI 1.01-3.29), not having long-lasting insecticide treated nets (aOR 2.1, 95%CI, 1.3-3.4) and not receiving insecticide residual spraying (aOR 3.2, 95%CI, 2.1-5.1). Conclusion: Sporadic outbreaks in the 5-year period posed a threat to malaria elimination. Better targeting of vector control interventions, strong cross-border collaboration and robust health promotion will be key to achieving malaria elimination.
Journal Article > ResearchFull Text
J Infect Dev Ctries. 2020 June 30; Volume 14 (Issue 06.1); DOI:10.3855/jidc.11731
Tekalign S, Adera C, den Boer ML, Miecha H, Zewde A, et al.
J Infect Dev Ctries. 2020 June 30; Volume 14 (Issue 06.1); DOI:10.3855/jidc.11731
Introduction: In three health care facilities in the Oromia region, the aim of this study is to report on 1) the number of VL cases registered over time (2013-2018) and 2) the clinical profile, type of treatment used and response to treatment.
Methodology: A retrospective cohort study was conducted among all VL cases admitted with a diagnosis of VL.
Results: A total of 434 VL cases were registered at the three health facilities, but patient files were available for only 188. Most (51.6%) were children and only three presented with VL relapse. 78 (41.5%) of the 188 patients presented within one month of symptom onset. Concurrent severe acute malnutrition (27.1%), tuberculosis (6.4%) and malaria (6.4%) were common. There were only two cases with HIV coinfection. Fourty-three percent were treated with antimonials, 34% with antimonials combined with paromomycin and 23% with AmBisome. Amongst the 188 patients with patient files there were no deaths and one treatment failure. Six months outcome data were however missing for all. Aggregated data from the 434 VL cases reported three deaths, two treatment failures and one relapse.
Conclusions: Children were most commonly affected, suggesting long-term endemicity. While short-term outcomes are encouraging, long-term follow-up data are required.
Methodology: A retrospective cohort study was conducted among all VL cases admitted with a diagnosis of VL.
Results: A total of 434 VL cases were registered at the three health facilities, but patient files were available for only 188. Most (51.6%) were children and only three presented with VL relapse. 78 (41.5%) of the 188 patients presented within one month of symptom onset. Concurrent severe acute malnutrition (27.1%), tuberculosis (6.4%) and malaria (6.4%) were common. There were only two cases with HIV coinfection. Fourty-three percent were treated with antimonials, 34% with antimonials combined with paromomycin and 23% with AmBisome. Amongst the 188 patients with patient files there were no deaths and one treatment failure. Six months outcome data were however missing for all. Aggregated data from the 434 VL cases reported three deaths, two treatment failures and one relapse.
Conclusions: Children were most commonly affected, suggesting long-term endemicity. While short-term outcomes are encouraging, long-term follow-up data are required.
Journal Article > ResearchFull Text
Trends of reported outpatient malaria cases to assess the Test, Treat and Track (T3) policy in Kenya
East Afr Med J. 2016 October 1
Mbuli CW, Waqo E, Owiti P, Tweya H, Kizito W, et al.
East Afr Med J. 2016 October 1
Journal Article > ResearchFull Text
BMC Pediatr. 2019 August 15; Volume 19 (Issue 1); DOI:10.1186/s12887-019-1622-4
Ogundipe OF, Van der Bergh R, Thierry B, Takarinda KC, Muller CP, et al.
BMC Pediatr. 2019 August 15; Volume 19 (Issue 1); DOI:10.1186/s12887-019-1622-4
BACKGROUND:
In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns.
METHODS:
The study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization.
RESULTS:
Of 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04-0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00-1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing.
CONCLUSIONS:
This testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections.
In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns.
METHODS:
The study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization.
RESULTS:
Of 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04-0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00-1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing.
CONCLUSIONS:
This testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections.