Journal Article > ResearchFull Text
Trop Med Int Health. 2000 May 1; Volume 5 (Issue 5); 312-317.; DOI:10.1046/j.1365-3156.2000.00555.x
Veeken H, Ritmeijer KKD, Seaman J, Davidson RN
Trop Med Int Health. 2000 May 1; Volume 5 (Issue 5); 312-317.; DOI:10.1046/j.1365-3156.2000.00555.x
OBJECTIVE
To compare the outcome of treatment of Sudanese kala-azar patients treated under field conditions with either branded sodium stibogluconate (SSG) (Pentostam GlaxoWellcome) or generic SSG (Albert David Ltd, Calcutta, supplied by International Dispensary Association, Amsterdam).
METHOD
Randomised comparison. 271 patients were treated with Pentostam and 245 with generic SSG.
RESULTS
No statistically significant differences in cure rate or mortality were detected between Pentostam and generic SSG. No differences in side-effects between the two drugs were noted. The initial cure rate at the time of discharge was 93.7 and 97.6%, respectively; the death rate during treatment 5.9 and 2.4%. Six months follow up was achieved in 88.5% of the discharged patients. Two patients had died in the Pentostam group and two had died in the generic SSG group, giving a final death rate of 7.5 and 3.7%. The number of relapses in the Pentostam and generic SSG groups were 3 and 1, respectively. The final cure rates, calculated at 6 months after discharge, were 91.3% and 95.9%.
CONCLUSION
No difference was observed in the performance of generic SSG compared to Pentostam for the treatment of visceral leishmaniasis in Sudan. Generic SSG can be routinely and safely used for the treatment of kala-azar. Generic SSG costs only 1/14 of the price of Pentostam. The use of generic SSG may make treatment of kala-azar affordable for national governments in Africa.
To compare the outcome of treatment of Sudanese kala-azar patients treated under field conditions with either branded sodium stibogluconate (SSG) (Pentostam GlaxoWellcome) or generic SSG (Albert David Ltd, Calcutta, supplied by International Dispensary Association, Amsterdam).
METHOD
Randomised comparison. 271 patients were treated with Pentostam and 245 with generic SSG.
RESULTS
No statistically significant differences in cure rate or mortality were detected between Pentostam and generic SSG. No differences in side-effects between the two drugs were noted. The initial cure rate at the time of discharge was 93.7 and 97.6%, respectively; the death rate during treatment 5.9 and 2.4%. Six months follow up was achieved in 88.5% of the discharged patients. Two patients had died in the Pentostam group and two had died in the generic SSG group, giving a final death rate of 7.5 and 3.7%. The number of relapses in the Pentostam and generic SSG groups were 3 and 1, respectively. The final cure rates, calculated at 6 months after discharge, were 91.3% and 95.9%.
CONCLUSION
No difference was observed in the performance of generic SSG compared to Pentostam for the treatment of visceral leishmaniasis in Sudan. Generic SSG can be routinely and safely used for the treatment of kala-azar. Generic SSG costs only 1/14 of the price of Pentostam. The use of generic SSG may make treatment of kala-azar affordable for national governments in Africa.
Journal Article > ResearchFull Text
Trop Med Int Health. 2003 February 1; Volume 8 (Issue 2); 164-167.; DOI:10.1046/j.1365-3156.2003.00996.x
Veeken H, Ritmeijer KKD, Seaman J, Davidson RN
Trop Med Int Health. 2003 February 1; Volume 8 (Issue 2); 164-167.; DOI:10.1046/j.1365-3156.2003.00996.x
We compared an rK39 dipstick rapid test (Amrad ICT, Australia) with a direct agglutination test (DAT) and splenic aspirate for the diagnosis of kala-azar in 77 patients. The study was carried out under field conditions in an endemic area of north-east Sudan. The sensitivity of the rK39 test compared with splenic aspiration was 92% (46/50), the specificity 59% (16/27), and the positive predictive value 81% (46/57). Compared with the diagnostic protocol used by Médecins sans Frontières, the sensitivity of the rK39 test was 93% (50/54), the specificity 70% (16/23), and the positive predictive value 88% (50/57). Compared with splenic aspirates, the sensitivity of a DAT with a titre > or =1:400 was 100% (50/50), but its specificity only 55% (15/27) and the positive predictive value was 80% (50/62). Using a DAT titre > or =1:6400, the sensitivity was 84% (42/50), the specificity 85% (23/27) and the positive predictive value 91% (42/46). All four patients with DAT titre > or =1:6400 but negative splenic aspirate were also rK39 positive; we consider these are probably 'true' cases of kala-azar, i.e. false negative aspirates, rather than false DAT and rK39 seropositives. There were no false negative DATs (DAT titre < or =1:400 and aspirate positive), but there were four false negative rK39 tests (rK39 negative and aspirate positive). The rK39 dipstick is a good screening test for kala-azar; but further development is required before it can replace the DAT as a diagnostic test in endemic areas of the Sudan.
Journal Article > ResearchFull Text
BMJ. 1993 July 31
Veeken H
BMJ. 1993 July 31
Haiti, one of the world's five poorest nations, gets international attention because of the number of refugees who leave by boat in search of a better future. The 80,000 inhabitants of Ile de la Gonave are neglected, even in Haiti--there is no government medical post, and facilities in the health posts run by missions are minimal. Typhoid and cholera epidemics threaten the island. Médecins Sans Frontières plans to send staff and supplies and train local health workers.
Journal Article > CommentaryFull Text
BMJ. 1998 December 12; Volume 317 (Issue 7173); 1649-1650.; DOI:10.1136/bmj.317.7173.1649
Veeken H
BMJ. 1998 December 12; Volume 317 (Issue 7173); 1649-1650.; DOI:10.1136/bmj.317.7173.1649
Journal Article > CommentaryFull Text
BMJ. 1993 May 8; Volume 306 (Issue 6887); 1263-1264.; DOI:10.1136/bmj.306.6887.1263
Veeken H
BMJ. 1993 May 8; Volume 306 (Issue 6887); 1263-1264.; DOI:10.1136/bmj.306.6887.1263
Journal Article > CommentaryFull Text
BMJ. 1998 January 10; Volume 316; 138.; DOI:10.1136/bmj.316.7125.138
Veeken H
BMJ. 1998 January 10; Volume 316; 138.; DOI:10.1136/bmj.316.7125.138
SUMMARY POINTS
-- Russia is finding it increasingly difficult to look after all its citizens. Alcohol misusers and homeless and elderly people fight to survive.
-- A recent problem is the rapid rise in the number of injecting drug misusers. In Moscow an estimated 100 000 users form an important core group for HIV transmission.
-- With the health system in a state of collapse and sexually transmitted diseases on the rise, all the ingredients for a HIV epidemic are present. By the turn of the century the Ministry of Health forecasts there will be 800 000 people who are HIV positive.
-- Médecins Sans Frontières has started an HIV prevention campaign in cooperation with the government.
-- Russia is finding it increasingly difficult to look after all its citizens. Alcohol misusers and homeless and elderly people fight to survive.
-- A recent problem is the rapid rise in the number of injecting drug misusers. In Moscow an estimated 100 000 users form an important core group for HIV transmission.
-- With the health system in a state of collapse and sexually transmitted diseases on the rise, all the ingredients for a HIV epidemic are present. By the turn of the century the Ministry of Health forecasts there will be 800 000 people who are HIV positive.
-- Médecins Sans Frontières has started an HIV prevention campaign in cooperation with the government.
Journal Article > ResearchFull Text
Trans R Soc Trop Med Hyg. 2008 January 31
Ritmeijer KKD, Veeken H, Melaku Y, Leal G, Amsalu R, et al.
Trans R Soc Trop Med Hyg. 2008 January 31
We evaluated generic sodium stibogluconate (SSG) (International Dispensary Association, Amsterdam) versus Pentostam (sodium stibogluconate, GlaxoWellcome, London) under field conditions in Ethiopian patients with visceral leishmaniasis (VL; kala-azar). The 199 patients were randomly assigned to Pentostam (n = 104) or SSG (n = 95) in 1998/99; both drugs were given at 20 mg/kg intra-muscularly for 30 days. A clinical cure after 30-days treatment was achieved in 70.2% (Pentostam) and 81.1% (SSG). There were no significant differences between the 2 drugs for the following parameters: frequency of intercurrent events (vomiting, diarrhoea, bleeding or pneumonia) or main outcome (death during treatment and death after 6-month follow-up; relapse or post kala-azar dermal leishmaniasis at 6-months follow-up). Twenty-seven patients had confirmed co-infection with HIV. On admission, HIV co-infected VL patients were clinically indistinguishable from HIV-negative VL patients. The HIV co-infected VL patients had a higher mortality during treatment (33.3% vs 3.6%). At 6-month follow-up, HIV-positive patients had a higher relapse rate (16.7% vs 1.2%), a higher death rate during the follow-up period (14.3% vs 2.4%), and more frequent moderate or severe post kala-azar dermal leishmaniasis (27.3% vs 13.3%). Only 43.5% of the HIV-positive patients were considered cured at 6-months follow-up vs 92.1% of the HIV-negative patients. HIV-positive patients relapsing with VL could become a reservoir of antimonial-resistant Leishmania donovani.
Journal Article > ResearchFull Text
BMJ. 1995 October 7
Veeken H
BMJ. 1995 October 7
The health system in Cuba guarantees accessibility to the entire population, is free of charge, and covers the spectrum from vaccinations to sophisticated interventions. The results are impressive: Cuba's health figures are on a par with developed countries that have 20 times the budget. The country is experiencing a difficult period because of the collapse and loss of support from the Soviet Union; over 30 years' trade embargo by the United States; and the gradual change from a centrally planned economy towards more of a free market system. Shortages are experienced in every sector, and maintaining health care services at the current level is too expensive. Doctors and nurses continue to work towards the goal of health for all Cubans, even though their salaries are minimal. Signs of negligence or corruption, often seen in other socialist countries where incentives for output are lacking, are unknown. Topics such as family planning and AIDS deserve immediate attention.
Journal Article > CommentaryFull Text
BMJ. 2000 January 15; Volume 320 (Issue 7228); 173-175.; DOI:10.1136/bmj.320.7228.173
Veeken H
BMJ. 2000 January 15; Volume 320 (Issue 7228); 173-175.; DOI:10.1136/bmj.320.7228.173
Journal Article > CommentaryFull Text
BMJ. 1998 May 9; Volume 316 (Issue 7142); 1446-1447.; DOI: doi: 10.1136/bmj.316.7142.1446
Veeken H
BMJ. 1998 May 9; Volume 316 (Issue 7142); 1446-1447.; DOI: doi: 10.1136/bmj.316.7142.1446
"Do not worry, she will survive; she has meningitis and is on treatment. You'll see it tomorrow when it is light.” William smiles confidently, sweeps his stethoscope round his neck, bends his back, and crawls out of the hut. I'm not convinced and examine the girl once more; I'm glad I brought my torch. She lies naked in the sand, obviously stiff necked, unconscious, and breathing superficially. The hut is pitch dark, and I can just see the shadows of some five relatives who cook and sleep in the same place. Except for nasogastric feeding, I have not much more to offer. I decide to follow the health worker and to re-examine the girl first thing next morning. William has received primary school education and upgraded himself to health assistant through “hands on” teaching for several years by our doctors. I feel proud but also a bit embarrassed at the ease with which he diagnoses severe illnesses so seldom seen in my home country, the Netherlands.