Conference Material > Poster
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/ahq9-t438
Conference Material > Slide Presentation
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/Rcembdt4Bk
Journal Article > ResearchFull Text
Malar J. 2023 November 10; Volume 22 (Issue 1); 345.; DOI:10.1186/s12936-023-04740-x
Molina-de la Fuente I, Sagrado Benito MJ, Lasry E, Ousley J, García L, et al.
Malar J. 2023 November 10; Volume 22 (Issue 1); 345.; DOI:10.1186/s12936-023-04740-x
BACKGROUND
Seasonal malaria chemoprevention (SMC) using sulfadoxine-pyrimethamine plus amodiaquine (SP-AQ), is a community-based malaria preventive strategy commonly used in the Sahel region of sub-Saharan Africa. However, to date it has not been implemented in East Africa due to high SP resistance levels. This paper is a report on the implementation of SMC outside of the Sahel in an environment with a high level of presumed SP-resistance: five cycles of SMC using SPAQ were administered to children 3–59 months during a period of high malaria transmission (July–December 2019) in 21 villages in South Sudan.
METHODS
A population-based SMC coverage survey was combined with a longitudinal time series analysis of health facility and community health data measured after each SMC cycle. SMC campaign effectiveness was assessed by Poisson model. SPAQ molecular resistance markers were additionally analysed from dried blood spots from malaria confirmed patients.
RESULTS
Incidence of uncomplicated malaria was reduced from 6.6 per 100 to an average of 3.2 per 100 after SMC administration (mean reduction: 53%) and incidence of severe malaria showed a reduction from 21 per 10,000 before SMC campaign to a mean of 3.3 per 10,000 after each cycle (mean reduction: 84%) in the target group when compared to before the SMC campaign. The most prevalent molecular haplotype associated with SP resistance was the IRNGE haplotype (quintuple mutant, with 51I/59R/108N mutation in pfdhfr + 437G/540E in pfdhps). In contrast, there was a low frequency of AQ resistance markers and haplotypes resistant to both drugs combined (< 2%).
CONCLUSIONS
The SMC campaign was effective and could be used as an additional preventive tool in seasonal malaria settings outside of the Sahel, especially in areas where access to health care is unstable. Malaria case load reduction was observed despite the high level of resistance to SP.
Seasonal malaria chemoprevention (SMC) using sulfadoxine-pyrimethamine plus amodiaquine (SP-AQ), is a community-based malaria preventive strategy commonly used in the Sahel region of sub-Saharan Africa. However, to date it has not been implemented in East Africa due to high SP resistance levels. This paper is a report on the implementation of SMC outside of the Sahel in an environment with a high level of presumed SP-resistance: five cycles of SMC using SPAQ were administered to children 3–59 months during a period of high malaria transmission (July–December 2019) in 21 villages in South Sudan.
METHODS
A population-based SMC coverage survey was combined with a longitudinal time series analysis of health facility and community health data measured after each SMC cycle. SMC campaign effectiveness was assessed by Poisson model. SPAQ molecular resistance markers were additionally analysed from dried blood spots from malaria confirmed patients.
RESULTS
Incidence of uncomplicated malaria was reduced from 6.6 per 100 to an average of 3.2 per 100 after SMC administration (mean reduction: 53%) and incidence of severe malaria showed a reduction from 21 per 10,000 before SMC campaign to a mean of 3.3 per 10,000 after each cycle (mean reduction: 84%) in the target group when compared to before the SMC campaign. The most prevalent molecular haplotype associated with SP resistance was the IRNGE haplotype (quintuple mutant, with 51I/59R/108N mutation in pfdhfr + 437G/540E in pfdhps). In contrast, there was a low frequency of AQ resistance markers and haplotypes resistant to both drugs combined (< 2%).
CONCLUSIONS
The SMC campaign was effective and could be used as an additional preventive tool in seasonal malaria settings outside of the Sahel, especially in areas where access to health care is unstable. Malaria case load reduction was observed despite the high level of resistance to SP.
Conference Material > Abstract
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/utH6tREN
INTRODUCTION
Inpatient Therapeutic Feeding Centre (ITFC) in Abs General Hospital, Yemen, provides nutrition treatment and management of medical complications to children affected by the humanitarian crisis in Abs and surrounding areas. In the past 2 years, the monthly mortality rate for children younger than 14 years averaged at 2.5–5% during non-peak months (Médecins Sans Frontières [MSF] indicator threshold for ITFC is 5%), but it increased to 7% during the peak months. We aimed to describe ITFC patients’ demographic, anthropometric, and clinical variables, and assess their association with inpatient mortality.
METHODS
We conducted an unmatched case-control study with patients aged <14 years who attended IFTC between January and December 2022. Cases were patients for whom the ITFC exit was recorded as “death” (n=106), and controls were those with the exit recorded as “discharged”, selected via systematic random sampling (n=218). Descriptive statistics were performed for all variables. We assessed associations with mortality by calculating adjusted odds ratios (aORs) via multivariable logistic regression, controlling for factors significant in the univariable analysis.
RESULTS
About 77% of patients were aged ≥6 months (71/106 cases and 178/218 controls). Gender distribution was even in both groups. The median mid-upper arm circumference was 88 mm in patients aged <6 months and 104 mm in those aged ≥6 months; 89% of the patients had weight-for-height Z score of <–3. The most common diagnoses at death were pneumonia (38%), gastroenteritis (24%), and sepsis (23%). Patients who lived at the three districts to the north of Abs had significantly higher odds of death (crude ORs 3.47, 3.64, and 6.07) than patients from Abs districts. Having shock (aOR 29.2, 95% CI 6.61–151), hypoglycaemia (9.33, 2.98–32.2), and sepsis (7.52, 2.60–24.1) were strongly associated with inpatient mortality. Other significant risk factors for mortality included age (aOR 1.07, 1.03–1.11), high paediatric early warning score (1.14, 1.01–1.30), being given intravenous fluid without documented shock (3.64, 1.20–12.6), respiratory distress (4.36, 1.47–13.8), congenital heart disease (5.44, 1.42–22.5), and hepatomegaly (6.78, 1.45–36.0). Several medical complications were found exclusively among deceased patients (e.g., electrolyte disturbance, hypothermia, and coma). Among those who received rehydration treatment (n=280), plan B with ReSoMal was the least used plan (15%).
CONCLUSION
We identified important demographic and clinical factors associated with ITFC mortality. Geographical disparity suggests a need for healthcare gap and access evaluation to the affected regions. Prompt recognition of shock, hypoglycaemia, sepsis, and other significant clinical factors would enable early intervention and closer patient monitoring. Lastly, this study highlights the importance of adherence to fluid management guideline.
Inpatient Therapeutic Feeding Centre (ITFC) in Abs General Hospital, Yemen, provides nutrition treatment and management of medical complications to children affected by the humanitarian crisis in Abs and surrounding areas. In the past 2 years, the monthly mortality rate for children younger than 14 years averaged at 2.5–5% during non-peak months (Médecins Sans Frontières [MSF] indicator threshold for ITFC is 5%), but it increased to 7% during the peak months. We aimed to describe ITFC patients’ demographic, anthropometric, and clinical variables, and assess their association with inpatient mortality.
METHODS
We conducted an unmatched case-control study with patients aged <14 years who attended IFTC between January and December 2022. Cases were patients for whom the ITFC exit was recorded as “death” (n=106), and controls were those with the exit recorded as “discharged”, selected via systematic random sampling (n=218). Descriptive statistics were performed for all variables. We assessed associations with mortality by calculating adjusted odds ratios (aORs) via multivariable logistic regression, controlling for factors significant in the univariable analysis.
RESULTS
About 77% of patients were aged ≥6 months (71/106 cases and 178/218 controls). Gender distribution was even in both groups. The median mid-upper arm circumference was 88 mm in patients aged <6 months and 104 mm in those aged ≥6 months; 89% of the patients had weight-for-height Z score of <–3. The most common diagnoses at death were pneumonia (38%), gastroenteritis (24%), and sepsis (23%). Patients who lived at the three districts to the north of Abs had significantly higher odds of death (crude ORs 3.47, 3.64, and 6.07) than patients from Abs districts. Having shock (aOR 29.2, 95% CI 6.61–151), hypoglycaemia (9.33, 2.98–32.2), and sepsis (7.52, 2.60–24.1) were strongly associated with inpatient mortality. Other significant risk factors for mortality included age (aOR 1.07, 1.03–1.11), high paediatric early warning score (1.14, 1.01–1.30), being given intravenous fluid without documented shock (3.64, 1.20–12.6), respiratory distress (4.36, 1.47–13.8), congenital heart disease (5.44, 1.42–22.5), and hepatomegaly (6.78, 1.45–36.0). Several medical complications were found exclusively among deceased patients (e.g., electrolyte disturbance, hypothermia, and coma). Among those who received rehydration treatment (n=280), plan B with ReSoMal was the least used plan (15%).
CONCLUSION
We identified important demographic and clinical factors associated with ITFC mortality. Geographical disparity suggests a need for healthcare gap and access evaluation to the affected regions. Prompt recognition of shock, hypoglycaemia, sepsis, and other significant clinical factors would enable early intervention and closer patient monitoring. Lastly, this study highlights the importance of adherence to fluid management guideline.