Journal Article > CommentaryFull Text
PLOS Med. 2014 April 22; Volume 11 (Issue 4); DOI:10.1371/journal.pmed.1001632
Gerdin M, Clarke M, Allen C, Kayabu B, Summerskill W, et al.
PLOS Med. 2014 April 22; Volume 11 (Issue 4); DOI:10.1371/journal.pmed.1001632
Journal Article > CommentaryFull Text
Trop Med Int Health. 2010 November 1; Volume 15 (Issue 11); DOI:10.1111/j.1365-3156.2010.02630.x
Zachariah R, Tayler-Smith K, Ngamvithayapong-Yana J, Ota M, Murakami K, et al.
Trop Med Int Health. 2010 November 1; Volume 15 (Issue 11); DOI:10.1111/j.1365-3156.2010.02630.x
Journal Article > ResearchFull Text
Trans R Soc Trop Med Hyg. 2007 August 1; Volume 101 (Issue 8); DOI:10.1016/j.trstmh.2007.02.020
van Griensven J, De Naeyer L, Mushi T, Ubarijoro S, Gashumba D, et al.
Trans R Soc Trop Med Hyg. 2007 August 1; Volume 101 (Issue 8); DOI:10.1016/j.trstmh.2007.02.020
This study was conducted among individuals placed on WHO-recommended first-line antiretroviral therapy (ART) at two urban health centres in Kigali, Rwanda, in order to determine (a) the overall prevalence of lipodystrophy and (b) the risk factors for lipoatropy. Consecutive individuals on ART for >1 year were systematically subjected to a standardised case definition-based questionnaire and clinical assessment. Of a total of 409 individuals, 370 (90%) were on an ART regimen containing stavudine (d4T), whilst the rest were receiving a zidovudine (AZT)-containing regimen. Lipodystrophy was apparent in 140 individuals (34%), of whom 40 (9.8%) had isolated lipoatrophy, 20 (4.9%) had isolated lipohypertrophy and 80 (19.6%) had mixed patterns. Fifty-six percent of patients reported the effects as disturbing. The prevalence of lipoatrophy was more than three times higher when taking d4T compared with AZT-containing regimens (31.4% vs. 10.3%). Being female, d4T-based ART, baseline body mass index >or=25 kg/m(2) or baseline CD4 count >or=150 cells/microl and increasing duration of ART were all significantly associated with lipoatrophy. Lipoatrophy appears to be an important long-term complication of WHO-recommended first-line ART regimens. These data highlight the urgent need for access to more affordable and less toxic ART regimens in resource-limited settings.
Journal Article > ResearchFull Text
Int J STD AIDS. 2003 March 1; Volume 14 (Issue 3); DOI:10.1258/095646203762869197
Zachariah R, Spielmann M P, Harries AD, Nkhoma W, Chantulo A, et al.
Int J STD AIDS. 2003 March 1; Volume 14 (Issue 3); DOI:10.1258/095646203762869197
In Thyolo District, Malawi, a study was conducted among commercial sex workers (CSWs) attending mobile clinics in order to; determine the prevalence and pattern of sexually transmitted infections (STIs), describe sexual behaviour among those who have an STI and identify risk factors associated with 'no condom use'. There were 1817 CSWs, of whom 448 (25%) had an STI. Of these, the commonest infections included 237 (53%) cases of abnormal vaginal discharge, 109 (24%) cases of pelvic inflammatory disease and 95 (21%) cases of genital ulcer disease (GUD). Eighty-seven per cent had sex while symptomatic, 17% without condoms. Having unprotected sex was associated with being married, being involved with commercial sex outside a known rest-house or bar, having a GUD, having fewer than two clients/day, alcohol intake and having had no prior medication for STI. The high levels of STIs, particularly GUDs, and unprotected sex underlines the importance of developing targeted interventions for CSWs and their clients.
Journal Article > ResearchAbstract
Trop Med Int Health. 2012 July 29; Volume 17 (Issue 9); 1163-1170.; DOI:10.1111/j.1365-3156.2012.03048
Khader A, Zachariah R
Trop Med Int Health. 2012 July 29; Volume 17 (Issue 9); 1163-1170.; DOI:10.1111/j.1365-3156.2012.03048
Recording and reporting systems borrowed from the DOTS framework for tuberculosis control can be used to record, monitor and report on chronic disease. In a primary healthcare clinic run by UNRWA in Amman, Jordan, serving Palestine refugees with hypertension, we set out to illustrate the method of cohort reporting for persons with hypertension by presenting on quarterly and cumulative case finding, cumulative and 12-month analysis of cohort outcomes and to assess how these data may inform and improve the quality of hypertension care services.
Journal Article > CommentaryFull Text
Public Health Action. 2014 September 21; Volume 4 (Issue 3); DOI:10.5588/pha.14.0028
Zachariah R, Kumar AMV, Reid A, Van der Bergh R, Isaakidis P, et al.
Public Health Action. 2014 September 21; Volume 4 (Issue 3); DOI:10.5588/pha.14.0028
Journal Article > CommentaryFull Text
Public Health Action. 2012 September 21; Volume 2 (Issue 3); DOI:10.5588/pha.12.0022
Bissell K, Harries AD, Reid A, Edginton ME, Hinderaker SG, et al.
Public Health Action. 2012 September 21; Volume 2 (Issue 3); DOI:10.5588/pha.12.0022
Journal Article > LetterFull Text
Trop Med Int Health. 2013 May 30; Volume 18 (Issue 8); DOI:10.1111/tmi.12133
Zachariah R, Reid AJ, Van der Bergh R, Dahmane A, Kosgei RJ, et al.
Trop Med Int Health. 2013 May 30; Volume 18 (Issue 8); DOI:10.1111/tmi.12133
Journal Article > ResearchFull Text
Obstetric fistula in Burundi: a comprehensive approach to managing women with this neglected disease
BMC Pregnancy Childbirth. 2013 August 21; Volume 13 (Issue 1); 164.
Tayler-Smith K, Zachariah R, Manzi M, van den Boogaard W, Vandeborne A, et al.
BMC Pregnancy Childbirth. 2013 August 21; Volume 13 (Issue 1); 164.
BACKGROUND
In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000-2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.
METHODS
Descriptive study using routine programme data.
RESULTS
Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31-51 days).
CONCLUSION
In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed.
In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000-2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.
METHODS
Descriptive study using routine programme data.
RESULTS
Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31-51 days).
CONCLUSION
In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed.
Journal Article > ResearchFull Text
PLOS One. 2017 February 7; Volume 12 (Issue 2); e0170882.; DOI:10.1371/journal.pone.0170882
de Plecker E, Zachariah R, Kumar AMV, Trelles M, Caluwaerts C, et al.
PLOS One. 2017 February 7; Volume 12 (Issue 2); e0170882.; DOI:10.1371/journal.pone.0170882
OBJECTIVES
In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.
METHODS
A retrospective analysis of EmOC data (2011 and 2012).
RESULTS
A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%).
A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died.
CONCLUSION
Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.
In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.
METHODS
A retrospective analysis of EmOC data (2011 and 2012).
RESULTS
A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%).
A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died.
CONCLUSION
Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.