Journal Article > ResearchFull Text
BMJ. 2003 September 20; Volume 327 (Issue 7416); 650.; DOI:10.1136/bmj.327.7416.650
Grein T
BMJ. 2003 September 20; Volume 327 (Issue 7416); 650.; DOI:10.1136/bmj.327.7416.650
OBJECTIVE
To measure retrospectively mortality among a previously inaccessible population of former UNITA members and their families displaced within Angola, before and after their arrival in resettlement camps after ceasefire of 4 April 2002.
DESIGN
Three stage cluster sampling for interviews. Recall period for mortality assessment was from 21 June 2001 to 15-31 August 2002.
SETTING
Eleven resettlement camps over four provinces of Angola (Bié, Cuando Cubango, Huila, and Malange) housing 149 000 former UNITA members and their families. PARTICIPANTS: 900 consenting family heads of households, or most senior household members, corresponding to an intended sample size of 4500 individuals. MAIN
OUTCOME MEASURES
Crude mortality and proportional mortality, overall and by period (monthly, and before and after arrival in camps).
RESULTS
Final sample included 6599 people. The 390 deaths reported during the recall period corresponded to an average crude mortality of 1.5/10 000/day (95% confidence interval 1.3 to 1.8), and, among children under 5 years old, to 4.1/10 000/day (3.3 to 5.2). Monthly crude mortality rose gradually to a peak in March 2002 and remained above emergency thresholds thereafter. Malnutrition was the leading cause of death (34%), followed by fever or malaria (24%) and war or violence (18%). Most war victims and people who had disappeared were women and children.
CONCLUSIONS
This population of displaced Angolans experienced global and child mortality greatly in excess of normal levels, both before and after the 2002 ceasefire. Malnutrition deaths reflect the extent of the food crisis affecting this population. Timely humanitarian assistance must be made available to all populations in such conflicts.
To measure retrospectively mortality among a previously inaccessible population of former UNITA members and their families displaced within Angola, before and after their arrival in resettlement camps after ceasefire of 4 April 2002.
DESIGN
Three stage cluster sampling for interviews. Recall period for mortality assessment was from 21 June 2001 to 15-31 August 2002.
SETTING
Eleven resettlement camps over four provinces of Angola (Bié, Cuando Cubango, Huila, and Malange) housing 149 000 former UNITA members and their families. PARTICIPANTS: 900 consenting family heads of households, or most senior household members, corresponding to an intended sample size of 4500 individuals. MAIN
OUTCOME MEASURES
Crude mortality and proportional mortality, overall and by period (monthly, and before and after arrival in camps).
RESULTS
Final sample included 6599 people. The 390 deaths reported during the recall period corresponded to an average crude mortality of 1.5/10 000/day (95% confidence interval 1.3 to 1.8), and, among children under 5 years old, to 4.1/10 000/day (3.3 to 5.2). Monthly crude mortality rose gradually to a peak in March 2002 and remained above emergency thresholds thereafter. Malnutrition was the leading cause of death (34%), followed by fever or malaria (24%) and war or violence (18%). Most war victims and people who had disappeared were women and children.
CONCLUSIONS
This population of displaced Angolans experienced global and child mortality greatly in excess of normal levels, both before and after the 2002 ceasefire. Malnutrition deaths reflect the extent of the food crisis affecting this population. Timely humanitarian assistance must be made available to all populations in such conflicts.
Journal Article > ResearchFull Text
Am J Trop Med Hyg. 2016 October 3; 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. 2016 October 3; 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.
Protocol > Research Study
Price DJ, Lenglet AD, Thoulass J, Willrich N
2018 July 1
Aim
To identify the best method to monitor maternal mortality in MSF-OCA facilities prospectively.
Objectives/Research questions
Evaluate the current surveillance system for maternal mortality in MSF-OCA facilities
Estimate maternal mortality in MSF-OCA facilities for 2015
Identify contributing factors to maternal mortality in MSF-OCA facilities for 2015
To identify the best method to monitor maternal mortality in MSF-OCA facilities prospectively.
Objectives/Research questions
Evaluate the current surveillance system for maternal mortality in MSF-OCA facilities
Estimate maternal mortality in MSF-OCA facilities for 2015
Identify contributing factors to maternal mortality in MSF-OCA facilities for 2015
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
Technical Report > Study report
Ngwa W, Mupenda J, Nanan-N'Zeth K, Haba B, Keita K
2019 July 10
Français
Introduction
Médecins Sans Frontières (MSF) est présent Kouroussa depuis juin 2017 et a fourni des services de soutien aux structures de santé publiques (l'hôpital préfectoral de Kouroussa, les 13 centres de santé de la préfecture et 6 postes de santé), ainsi que des services de santé communautaires pour les enfants de 0 à 5 ans. Au niveau de l'hôpital préfectoral MSF, assure la prise en charge gratuite des cas de paludisme simple et grave, de la malnutrition et autres pathologies. Au niveau des centres de santé et des postes de santé, MSF assure le traitement gratuit des cas simples de paludisme, de la malnutrition, de la diarrhée et d'infections des voies respiratoires, mais aussi assure le transport des cas graves de ces structures vers l'hôpital préfectoral de la préfecture. Au niveau communautaire, MSF assure à travers des agents et relais communautaires, la prise en charge gratuite des cas simples de paludisme, le dépistage de la malnutrition, la prise en charge des cas de diarrhée, le suivi du calendrier de vaccination des enfants et le transfert des cas complexes vers les formations sanitaires. Afin d'améliorer et d'évaluer l'impact de ses activités dans la préfecture, MSF réalise chaque année une enquête rétrospective sur la mortalité avec un volet qui évalue le comportement par rapport à la recherche des soins dans la communauté. MSF mène également des activités de recherche opérationnelle visant à améliorer la santé des habitants de la préfecture.
Méthodologie
Une enquête de mortalité rétrospective (avec une composante sur la recherche des soins) en grappe à 2 degrés, a été réalisée dans les 12 sous-préfectures de Kouroussa du 7 au 14 Juin 2019. 45 grappes ont été enquêtées. La période de rappel s’étendait du 15 Juin 2018 (fête de Ramadan 2018) au jour de l’enquête. La population cible était constituée par l’ensemble des personnes résidant dans la préfecture de Kouroussa. L’évaluation de recherche de soins par rapport à la fièvre/paludisme a été réalisée pour les enfants de 0 à 5 ans.
Résultats
5 510 personnes ont été recensées dans 541 ménages, dont 5 283 étaient présentes et vivantes dans les ménages à la fin de l'enquête. La taille moyenne des ménages était 9,8 personnes et les enfants âgés de moins de 5 ans ont représenté 18,8% (95% IC : 17,3-20,3) de l’ensemble des personnes inclus. Pendant la période de rappel, 66 décès ont été rapportés : le taux brut de mortalité était estimé à 0,35 décès/10 000/jour [95% IC: 0,23-0,46; Deff : 1,20] et le taux de mortalité chez les enfants de moins de 5 ans était estimé à 0,81 décès/10 000/jour [95% IC: 0,40-1,20; Deff : 1,89]. Les
décès du a la fièvre/paludisme ont représenté 24,2% (IC 95%: 14,5-36,4) des décès rapportés. 68,2 % (IC 95%: 55,6-79,1) décès ont été survenus dans les ménages. 21,5% (IC 95%: 19,3-23,8) des
enfants de 0 à 5 ans ont eu de la fièvre au cours de deux semaines précèdent le jour de l’enquête. 85,7%(IC 95%: 80,9 - 89,6) d’enfants fiévreux ont eu à rechercher les soins avec 69,1% (IC 95%: 62,9-74,7) dans une structures de santé (y compris les agents/relais communautaires). « L'enfant n'est pas assez malade », a été identifié comme la principale raison de non recherche de soins chez les enfants de moins de 5 ans. 61,4% [95% IC: 54,8-67,7]) des enfants de 0 à 5 ans ont eu accès à des soins de santé gratuits. 66,5% (95% IC : 60,1-72,6) ont eu accès à un test de dépistage du paludisme avec 87,1% (95% IC : 80,8 – 91,9) de ces tests réalisés dans une structure sanitaire. 95,1% (IC 95%: 90,2-98,0) des enfants dont le test de dépistage du paludisme était positif avaient accès à un traitement antipaludique.
Conclusion
Nos résultats montrent une réduction de taux brut de mortalité et taux de mortalité chez les enfants de moins de 5 ans. Le recours aux soins chez les enfants âgés de 0 à 5 ans était élevé, mais les répondants étaient plus susceptibles de rechercher des soins quand ils percevaient la maladie comme «grave». L'accès aux tests de dépistage du paludisme a grandement influencé les chances de
recevoir un traitement de qualité. La majorité des décès sont survenus au sein des ménages, la fièvre/paludisme étant la principale cause de décès.
Technical Report > Survey
Ouedraogo P, Simons E, Grellety E
2023 November 1
English
Français
INTRODUCTION
Since April 15, 2023, fighting erupted in Sudan between the army led by General Abdel Fattah al-Burhan and the paramilitary Rapid Support Forces (RSF) under the command of General Mohamed Hamdan Dogolo, known as Hemeti. This war has caused a major humanitarian crisis in Sudan, with violent fighting spreading throughout the country, particularly in Darfur, and aggravating pre-existing inter-community tensions.
By the end of March, almost 30,000 civilians had fled to Chad in search of safety. By September 2023, according to data from the United Nations High Commissioner for Refugees (UNHCR), clashes between military and paramilitary forces had driven more than 420,000 people to flee to Chad in successive waves, of whom around 327,000 had settled in the Ouaddaï province. Chadian refugees and returnees live in very precarious conditions, with limited access to primary healthcare, water and food. Little recent data is available on the mortality, nutritional status, and vaccination coverage of refugee populations in camps in eastern Chad, particularly in Toumtouma, Ourang and Arkoum camps. The results of these surveys are essential for Médecins Sans Frontières (MSF) to better plan its humanitarian interventions, coordinate effectively with other actors, and communicate about the refugee crisis in eastern Chad.
METHODOLOGY
Three cross-sectional surveys were carried out, the first with systematic random sampling in Toumtouma camp from August 7 to 13, and the next two with cluster random geospatial sampling in Ourang camp from August 17 to 22 and Arkoum camp from August 30 to September 4, 2023. Each survey covered retrospective mortality, frequency and type of violent events experienced, nutritional status of children aged 6 to 59 months, and measles vaccination coverage among children aged 6 months to 14 years. The recall period ran from January 1 to the day of the survey, i.e., a minimum of 210, 228 and 241 days respectively. Two phases were considered: 1) the pre-crisis phase (Toumtouma: January 1 - March 14, 2023 / Ourang and Arkoum: January 1 - April 14, 2023) and 2) the crisis phase (Toumtouma: March 15 - day of survey / Ourang and Arkoum: April 15 - day of survey). In Toumtouma camp, the crisis phase started earlier due to inter-community tensions that erupted end of March in West Darfur and drove important population displacements towards Chad.
RESULTS
Retrospective mortality: In Toumtouma camp, of the 1,032 households included (i.e., 6,372 people), 59.7% were refugees, 35.9% returnees and 4.4% displaced persons. The crude mortality rate (CMR) was significantly higher in phase 2 (CMR: 0.58 deaths/10,000 people/day [95% CI: 0.43 - 0.74]) than in phase 1 (CMR: 0.20 deaths/10,000 people/day [95% CI: 0.07 - 0.33]). Eighty-nine percent of those who died were men. Violence (77%; n=48) was the main cause of death reported, followed by diarrhea (6%; n=4) and respiratory infection (5%; n=3). Among the deaths, 68% occurred in their town or village of origin, 21% during displacement and 11% in an unknown location. Most people who died came from El Geneina (40%), Tandulti (35%) and Umm Dam (16%) in Darfur.
In Ourang camp, of the 1032 households included (i.e., 6302 people), 99.0% were refugees and 1.0% returnees. The CMR was significantly higher in phase 2 (CMR: 2.25 deaths/10,000 people/day [95% CI: 1.77 - 2.74]) than in phase 1 (CMR: 0.11 deaths/10,000 people/day [95% CI: 0.02 - 0.20]). Eighty-three percent of those who died were men (3.88 deaths/10,000 people/day [95% CI: 3.01 - 4.76] in phase 2). Violence (82%; n=147) was the main cause of death reported, followed by measles (5%; n=9). Among the deaths, 69% occurred in their town or village of origin, 25% during displacement and 6% in Adre, Chad. Most people who died came from El Geneina (96%) in Darfur.
In Arkoum camp, of the 1029 households included (i.e., 5324 people), 98.4% were refugees, 1.3% displaced and 0.4% returnees. The CMR was significantly higher in phase 2 (CMR: 0.67 deaths/10,000 people/day [95% CI: 0.46 - 0.89]) than in phase 1 (CMR: 0.15 deaths/10,000 people/day [95% CI: 0.03 - 0.26]). Seventy-seven percent of those who died were men; the mortality rate among men was 1.14 [95% CI: 0.72 - 1.55] in the second phase. Violence (50%; n=28) was the main cause of death reported, followed by diarrhea (16%; n=9). Among the deaths, 52% occurred in their town or village of origin, 27% during displacement, 5% after their arrival in Chad and 16% in an unknown location. Most people who died came from Mistre (54%) and Kongu (29%) in Darfur.
Frequency and main causes of violence: Among households in Toumtouma, Ourang and Arkoum camps, the overall frequency of violence was 3.3%, 11.7% and 4.4% respectively. The main types of violence were beatings (71.0% in Toumtouma, 71.1% in Ourang, and 79.7% in Arkoum), and shootings (27.1% in Toumtouma, 34.7% in Ourang, and 15.1% in Arkoum).
Prevalence of acute malnutrition: Among children aged 6-59 months, the prevalence of global acute malnutrition (GAM) according to MUAC and/or bilateral oedema was 5.5% [95% CI: 4.1 - 7.5] in Toumtouma, 11.3% [95% CI: 9.2 - 13.8] in Ourang, and 11.6% [95% CI: 9.5 - 14.5] in Arkoum camp. Rates of severe acute malnutrition (SAM) were 2.3% [95% CI: 1.4 - 3.6] in Toumtouma, 4.8% [95% CI: 3.6 - 6.4] in Ourang, and 4.6% [95% CI: 3.4 - 6.3] in Arkoum.
Measles vaccination: Measles vaccination coverage among children aged 6 months to 14 years was estimated at 58.6% [95% CI: 56.9 - 60.3] in Toumtouma, 75.9% [95% CI: 71.3 - 79.9] in Ourang, and 63.6% [95% CI: 58.2 - 68.7] in Arkoum.
CONCLUSIONS
In the three camps investigated, excess mortality was observed among households during the crisis phase (phase 2), with a significant difference in CMR due to deaths from violence among men. Among households living in Toumtouma camp, the CMR more than doubled and among households in Arkoum camp, it more than tripled. The population in Ourang camp seems to have been particularly affected by the violence, with CMR 20 times higher than in the pre- crisis period and mortality rates exceeding the standard emergency threshold (1 death/10,000 people/day). The vast majority of deaths occurred on the sites of origin or during displacement towards Chad (89% in Toutouma, 94% in Ourang and 79% in Arkoum). GAM and SAM prevalences among 6-59-month-olds were high in Ourang and Arkoum camps, with an alarming SAM prevalence of over 4%. In addition, the measles vaccination coverage, which ranged from 59% to 76% across the camps surveyed, was insufficient to prevent outbreaks.
Since April 15, 2023, fighting erupted in Sudan between the army led by General Abdel Fattah al-Burhan and the paramilitary Rapid Support Forces (RSF) under the command of General Mohamed Hamdan Dogolo, known as Hemeti. This war has caused a major humanitarian crisis in Sudan, with violent fighting spreading throughout the country, particularly in Darfur, and aggravating pre-existing inter-community tensions.
By the end of March, almost 30,000 civilians had fled to Chad in search of safety. By September 2023, according to data from the United Nations High Commissioner for Refugees (UNHCR), clashes between military and paramilitary forces had driven more than 420,000 people to flee to Chad in successive waves, of whom around 327,000 had settled in the Ouaddaï province. Chadian refugees and returnees live in very precarious conditions, with limited access to primary healthcare, water and food. Little recent data is available on the mortality, nutritional status, and vaccination coverage of refugee populations in camps in eastern Chad, particularly in Toumtouma, Ourang and Arkoum camps. The results of these surveys are essential for Médecins Sans Frontières (MSF) to better plan its humanitarian interventions, coordinate effectively with other actors, and communicate about the refugee crisis in eastern Chad.
METHODOLOGY
Three cross-sectional surveys were carried out, the first with systematic random sampling in Toumtouma camp from August 7 to 13, and the next two with cluster random geospatial sampling in Ourang camp from August 17 to 22 and Arkoum camp from August 30 to September 4, 2023. Each survey covered retrospective mortality, frequency and type of violent events experienced, nutritional status of children aged 6 to 59 months, and measles vaccination coverage among children aged 6 months to 14 years. The recall period ran from January 1 to the day of the survey, i.e., a minimum of 210, 228 and 241 days respectively. Two phases were considered: 1) the pre-crisis phase (Toumtouma: January 1 - March 14, 2023 / Ourang and Arkoum: January 1 - April 14, 2023) and 2) the crisis phase (Toumtouma: March 15 - day of survey / Ourang and Arkoum: April 15 - day of survey). In Toumtouma camp, the crisis phase started earlier due to inter-community tensions that erupted end of March in West Darfur and drove important population displacements towards Chad.
RESULTS
Retrospective mortality: In Toumtouma camp, of the 1,032 households included (i.e., 6,372 people), 59.7% were refugees, 35.9% returnees and 4.4% displaced persons. The crude mortality rate (CMR) was significantly higher in phase 2 (CMR: 0.58 deaths/10,000 people/day [95% CI: 0.43 - 0.74]) than in phase 1 (CMR: 0.20 deaths/10,000 people/day [95% CI: 0.07 - 0.33]). Eighty-nine percent of those who died were men. Violence (77%; n=48) was the main cause of death reported, followed by diarrhea (6%; n=4) and respiratory infection (5%; n=3). Among the deaths, 68% occurred in their town or village of origin, 21% during displacement and 11% in an unknown location. Most people who died came from El Geneina (40%), Tandulti (35%) and Umm Dam (16%) in Darfur.
In Ourang camp, of the 1032 households included (i.e., 6302 people), 99.0% were refugees and 1.0% returnees. The CMR was significantly higher in phase 2 (CMR: 2.25 deaths/10,000 people/day [95% CI: 1.77 - 2.74]) than in phase 1 (CMR: 0.11 deaths/10,000 people/day [95% CI: 0.02 - 0.20]). Eighty-three percent of those who died were men (3.88 deaths/10,000 people/day [95% CI: 3.01 - 4.76] in phase 2). Violence (82%; n=147) was the main cause of death reported, followed by measles (5%; n=9). Among the deaths, 69% occurred in their town or village of origin, 25% during displacement and 6% in Adre, Chad. Most people who died came from El Geneina (96%) in Darfur.
In Arkoum camp, of the 1029 households included (i.e., 5324 people), 98.4% were refugees, 1.3% displaced and 0.4% returnees. The CMR was significantly higher in phase 2 (CMR: 0.67 deaths/10,000 people/day [95% CI: 0.46 - 0.89]) than in phase 1 (CMR: 0.15 deaths/10,000 people/day [95% CI: 0.03 - 0.26]). Seventy-seven percent of those who died were men; the mortality rate among men was 1.14 [95% CI: 0.72 - 1.55] in the second phase. Violence (50%; n=28) was the main cause of death reported, followed by diarrhea (16%; n=9). Among the deaths, 52% occurred in their town or village of origin, 27% during displacement, 5% after their arrival in Chad and 16% in an unknown location. Most people who died came from Mistre (54%) and Kongu (29%) in Darfur.
Frequency and main causes of violence: Among households in Toumtouma, Ourang and Arkoum camps, the overall frequency of violence was 3.3%, 11.7% and 4.4% respectively. The main types of violence were beatings (71.0% in Toumtouma, 71.1% in Ourang, and 79.7% in Arkoum), and shootings (27.1% in Toumtouma, 34.7% in Ourang, and 15.1% in Arkoum).
Prevalence of acute malnutrition: Among children aged 6-59 months, the prevalence of global acute malnutrition (GAM) according to MUAC and/or bilateral oedema was 5.5% [95% CI: 4.1 - 7.5] in Toumtouma, 11.3% [95% CI: 9.2 - 13.8] in Ourang, and 11.6% [95% CI: 9.5 - 14.5] in Arkoum camp. Rates of severe acute malnutrition (SAM) were 2.3% [95% CI: 1.4 - 3.6] in Toumtouma, 4.8% [95% CI: 3.6 - 6.4] in Ourang, and 4.6% [95% CI: 3.4 - 6.3] in Arkoum.
Measles vaccination: Measles vaccination coverage among children aged 6 months to 14 years was estimated at 58.6% [95% CI: 56.9 - 60.3] in Toumtouma, 75.9% [95% CI: 71.3 - 79.9] in Ourang, and 63.6% [95% CI: 58.2 - 68.7] in Arkoum.
CONCLUSIONS
In the three camps investigated, excess mortality was observed among households during the crisis phase (phase 2), with a significant difference in CMR due to deaths from violence among men. Among households living in Toumtouma camp, the CMR more than doubled and among households in Arkoum camp, it more than tripled. The population in Ourang camp seems to have been particularly affected by the violence, with CMR 20 times higher than in the pre- crisis period and mortality rates exceeding the standard emergency threshold (1 death/10,000 people/day). The vast majority of deaths occurred on the sites of origin or during displacement towards Chad (89% in Toutouma, 94% in Ourang and 79% in Arkoum). GAM and SAM prevalences among 6-59-month-olds were high in Ourang and Arkoum camps, with an alarming SAM prevalence of over 4%. In addition, the measles vaccination coverage, which ranged from 59% to 76% across the camps surveyed, was insufficient to prevent outbreaks.
Journal Article > ResearchSubscription Only
Pediatrics. 2023 March 23; Online ahead of print; DOI:10.1542/peds.2022-057912
Bonnet MMB, Nordholm AC, Ssekyanzi B, Byamukama O, Orikiriza P, et al.
Pediatrics. 2023 March 23; Online ahead of print; DOI:10.1542/peds.2022-057912
BACKGROUND AND OBJECTIVES:
Children experience high tuberculosis (TB)-related mortality but causes of death among those with presumptive TB are poorly documented. We describe the mortality, likely causes of death, and associated risk factors among vulnerable children admitted with presumptive TB in rural Uganda.
METHODS:
We conducted a prospective study of vulnerable children, defined as <2 years of age, HIV-positive, or severely malnourished, with a clinical suspicion of TB. Children were assessed for TB and followed for 24 weeks. TB classification and likely cause of death were assessed by an expert endpoint review committee, including insight gained from minimally invasive autopsies, when possible.
RESULTS:
Of the 219 children included, 157 (71.7%) were <2 years of age, 72 (32.9%) were HIV-positive, and 184 (84.0%) were severely malnourished. Seventy-one (32.4%) were classified as “likely tuberculosis” (15 confirmed and 56 unconfirmed), and 72 (32.9%) died. The median time to death was 12 days. The most frequent causes of death, ascertained for 59 children (81.9%), including 23 cases with autopsy results, were severe pneumonia excluding confirmed TB (23.7%), hypovolemic shock due to diarrhea (20.3%), cardiac failure (13.6%), severe sepsis (13.6%), and confirmed TB (10.2%). Mortality risk factors were confirmed TB (adjusted hazard ratio [aHR] = 2.84 [95% confidence interval (CI): 1.19–6.77]), being HIV-positive (aHR = 2.45 [95% CI: 1.37–4.38]), and severe clinical state on admission (aHR = 2.45 [95% CI: 1.29–4.66]).
CONCLUSIONS:
Vulnerable children hospitalized with presumptive TB experienced high mortality. A better understanding of the likely causes of death in this group is important to guide empirical management.
Children experience high tuberculosis (TB)-related mortality but causes of death among those with presumptive TB are poorly documented. We describe the mortality, likely causes of death, and associated risk factors among vulnerable children admitted with presumptive TB in rural Uganda.
METHODS:
We conducted a prospective study of vulnerable children, defined as <2 years of age, HIV-positive, or severely malnourished, with a clinical suspicion of TB. Children were assessed for TB and followed for 24 weeks. TB classification and likely cause of death were assessed by an expert endpoint review committee, including insight gained from minimally invasive autopsies, when possible.
RESULTS:
Of the 219 children included, 157 (71.7%) were <2 years of age, 72 (32.9%) were HIV-positive, and 184 (84.0%) were severely malnourished. Seventy-one (32.4%) were classified as “likely tuberculosis” (15 confirmed and 56 unconfirmed), and 72 (32.9%) died. The median time to death was 12 days. The most frequent causes of death, ascertained for 59 children (81.9%), including 23 cases with autopsy results, were severe pneumonia excluding confirmed TB (23.7%), hypovolemic shock due to diarrhea (20.3%), cardiac failure (13.6%), severe sepsis (13.6%), and confirmed TB (10.2%). Mortality risk factors were confirmed TB (adjusted hazard ratio [aHR] = 2.84 [95% confidence interval (CI): 1.19–6.77]), being HIV-positive (aHR = 2.45 [95% CI: 1.37–4.38]), and severe clinical state on admission (aHR = 2.45 [95% CI: 1.29–4.66]).
CONCLUSIONS:
Vulnerable children hospitalized with presumptive TB experienced high mortality. A better understanding of the likely causes of death in this group is important to guide empirical management.
Journal Article > ResearchFull Text
PLOS One. 2015 June 15; Volume 10 (Issue 6); e0128907.; DOI:10.1371/journal.pone.0128907
Gadoev J, Asadov D, Tillashaykhov M, Tayler-Smith K, Isaakidis P, et al.
PLOS One. 2015 June 15; Volume 10 (Issue 6); e0128907.; DOI:10.1371/journal.pone.0128907
BACKGROUND
TB is one of the main health priorities in Uzbekistan and relatively high rates of unfavorable treatment outcomes have recently been reported. This requires closer analysis to explain the reasons and recommend interventions to improve the situation. Thus, by using countrywide data this study sought to determine trends in unfavorable outcomes (lost-to-follow-ups, deaths and treatment failures) and describe their associations with socio-demographic and clinical factors.
METHODS
A countrywide retrospective cohort study of all new and previously treated TB patients registered in the National Tuberculosis programme between January 2006 and December 2010.
RESULTS
Among 107,380 registered patients, 67% were adults, with smaller proportions of children (10%), adolescents (4%) and elderly patients (19%). Sixty per cent were male, 66% lived in rural areas, 1% were HIV-infected and 1% had a history of imprisonment. Pulmonary TB (PTB) was present in 77%, of which 43% were smear-positive and 53% were smear-negative. Overall, 83% of patients were successfully treated, 6% died, 6% were lost-to-follow-up, 3% failed treatment and 2% transferred out. Factors associated with death included being above 55 years of age, HIV-positive, sputum smear positive, previously treated, jobless and living in certain provinces. Factors associated with lost-to-follow-up were being male, previously treated, jobless, living in an urban area, and living in certain provinces. Having smear-positive PTB, being an adolescent, being urban population, being HIV-negative, previously treated, jobless and residing in particular provinces were associated with treatment failure.
CONCLUSIONS
Overall, 83% treatment success rate was achieved. However, our study findings highlight the need to improve TB services for certain vulnerable groups and in specific areas of the country. They also emphasize the need to develop unified monitoring and evaluation tools for drug-susceptible and drug-resistant TB, and call for better TB surveillance and coordination between provinces and neighbouring countries.
TB is one of the main health priorities in Uzbekistan and relatively high rates of unfavorable treatment outcomes have recently been reported. This requires closer analysis to explain the reasons and recommend interventions to improve the situation. Thus, by using countrywide data this study sought to determine trends in unfavorable outcomes (lost-to-follow-ups, deaths and treatment failures) and describe their associations with socio-demographic and clinical factors.
METHODS
A countrywide retrospective cohort study of all new and previously treated TB patients registered in the National Tuberculosis programme between January 2006 and December 2010.
RESULTS
Among 107,380 registered patients, 67% were adults, with smaller proportions of children (10%), adolescents (4%) and elderly patients (19%). Sixty per cent were male, 66% lived in rural areas, 1% were HIV-infected and 1% had a history of imprisonment. Pulmonary TB (PTB) was present in 77%, of which 43% were smear-positive and 53% were smear-negative. Overall, 83% of patients were successfully treated, 6% died, 6% were lost-to-follow-up, 3% failed treatment and 2% transferred out. Factors associated with death included being above 55 years of age, HIV-positive, sputum smear positive, previously treated, jobless and living in certain provinces. Factors associated with lost-to-follow-up were being male, previously treated, jobless, living in an urban area, and living in certain provinces. Having smear-positive PTB, being an adolescent, being urban population, being HIV-negative, previously treated, jobless and residing in particular provinces were associated with treatment failure.
CONCLUSIONS
Overall, 83% treatment success rate was achieved. However, our study findings highlight the need to improve TB services for certain vulnerable groups and in specific areas of the country. They also emphasize the need to develop unified monitoring and evaluation tools for drug-susceptible and drug-resistant TB, and call for better TB surveillance and coordination between provinces and neighbouring countries.
Protocol > Research Study
Siddiqui R, White K, Guzek J
2018 July 1
2.1. PRIMARY OBJECTIVES
To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age
2.2. SECONDARY OBJECTIVES
To describe the population in terms of age, sex and household composition;
To determine the coverage of measles, polio, MenACWY, DPT-Hib-HepB (Pentavalent), cholera (OCV) and pneumococcal virus (PCV) vaccination in 6-59 month olds;
To determine the rate of severe and global acute malnutrition in 6-59 month olds;
To identify the most prevalent morbidities in the population in the two weeks preceding the survey;
To describe the health seeking behaviour in terms of access to primary and secondary care;
To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;
To identify major causes of death, by age group and sex;
To gain knowledge of violence-related events
2.1. PRIMARY OBJECTIVES
To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age
2.2. SECONDARY OBJECTIVES
To describe the population in terms of age, sex and household composition;
To determine the coverage of measles, polio, MenACWY, DPT-Hib-HepB (Pentavalent), cholera (OCV) and pneumococcal virus (PCV) vaccination in 6-59 month olds;
To determine the rate of severe and global acute malnutrition in 6-59 month olds;
To identify the most prevalent morbidities in the population in the two weeks preceding the survey;
To describe the health seeking behaviour in terms of access to primary and secondary care;
To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;
To identify major causes of death, by age group and sex;
To gain knowledge of violence-related events
To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age
2.2. SECONDARY OBJECTIVES
To describe the population in terms of age, sex and household composition;
To determine the coverage of measles, polio, MenACWY, DPT-Hib-HepB (Pentavalent), cholera (OCV) and pneumococcal virus (PCV) vaccination in 6-59 month olds;
To determine the rate of severe and global acute malnutrition in 6-59 month olds;
To identify the most prevalent morbidities in the population in the two weeks preceding the survey;
To describe the health seeking behaviour in terms of access to primary and secondary care;
To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;
To identify major causes of death, by age group and sex;
To gain knowledge of violence-related events
2.1. PRIMARY OBJECTIVES
To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age
2.2. SECONDARY OBJECTIVES
To describe the population in terms of age, sex and household composition;
To determine the coverage of measles, polio, MenACWY, DPT-Hib-HepB (Pentavalent), cholera (OCV) and pneumococcal virus (PCV) vaccination in 6-59 month olds;
To determine the rate of severe and global acute malnutrition in 6-59 month olds;
To identify the most prevalent morbidities in the population in the two weeks preceding the survey;
To describe the health seeking behaviour in terms of access to primary and secondary care;
To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;
To identify major causes of death, by age group and sex;
To gain knowledge of violence-related events
Conference Material > Abstract
Ostrowski JJ, Parikh K, Umar A
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/3mfOFt
BACKGROUND AND OBJECTIVES
Over 50,000 children in Nigeria’s Gombe state have moderate acute malnutrition (MAM) and are at risk of deteriorating to severe acute malnutrition (SAM). An effective strategy to reduce mortality is through a targeted supplementary feeding programme delivered within community-based management of acute malnutrition (CMAM) interventions. We present findings from an outpatient therapeutic programme (OTP) which used Tom Brown for treating children with MAM. Tom Brown is a locally produced flour blend of sorghum, soybeans, and groundnuts, consumed as a sweetened porridge.
METHODS
We conducted retrospective analysis of patient data from OTP sites in three local government areas between October 2022 and December 2023. Data were extracted for children aged 6-59 months diagnosed with MAM, defined as absence of oedema; weight-for- height z-score (WHZ) ≥-3 and <-2; and/or mid upper arm circumference (MUAC) ≥11.5 and <12.5 cm. Those enrolled for at least 14 days and receiving 1.5 kg per week of Tom Brown were included.
RESULTS
Of the 1,207 cases of MAM treated, 1,089 (90.2%) recovered i.e. had two consecutive visits with WHZ >-2 and MUAC >12.5 and no severe clinical complications; 91 (7.5%) defaulted; 21 (1.7%) did not improve; 4 (<1%) were transferred out; and 2 (<1%) died at the end of follow- up. During treatment, 197 (16.3%) deteriorated to SAM and were switched to ready-to-use therapeutic food. All deaths (n=2) deteriorated to SAM. For children who recovered without deterioration, average enrolment length was 36.3 (±15.8) days and average weight gain was 4.21 (±3.03) g/kg/day.
CONCLUSIONS
With acceptable recovery and low death rates, Tom Brown is a feasible alternative for treatment of MAM. Made with cheaper ingredients, it can potentially reach more children for the same cost, particularly when combined with frequent screening and early diagnosis in the community. Timely follow-up of defaulters may also improve adherence. Research is needed to understand Tom Brown’s effectiveness compared to commercial products or combination with cash-based assistance.
Over 50,000 children in Nigeria’s Gombe state have moderate acute malnutrition (MAM) and are at risk of deteriorating to severe acute malnutrition (SAM). An effective strategy to reduce mortality is through a targeted supplementary feeding programme delivered within community-based management of acute malnutrition (CMAM) interventions. We present findings from an outpatient therapeutic programme (OTP) which used Tom Brown for treating children with MAM. Tom Brown is a locally produced flour blend of sorghum, soybeans, and groundnuts, consumed as a sweetened porridge.
METHODS
We conducted retrospective analysis of patient data from OTP sites in three local government areas between October 2022 and December 2023. Data were extracted for children aged 6-59 months diagnosed with MAM, defined as absence of oedema; weight-for- height z-score (WHZ) ≥-3 and <-2; and/or mid upper arm circumference (MUAC) ≥11.5 and <12.5 cm. Those enrolled for at least 14 days and receiving 1.5 kg per week of Tom Brown were included.
RESULTS
Of the 1,207 cases of MAM treated, 1,089 (90.2%) recovered i.e. had two consecutive visits with WHZ >-2 and MUAC >12.5 and no severe clinical complications; 91 (7.5%) defaulted; 21 (1.7%) did not improve; 4 (<1%) were transferred out; and 2 (<1%) died at the end of follow- up. During treatment, 197 (16.3%) deteriorated to SAM and were switched to ready-to-use therapeutic food. All deaths (n=2) deteriorated to SAM. For children who recovered without deterioration, average enrolment length was 36.3 (±15.8) days and average weight gain was 4.21 (±3.03) g/kg/day.
CONCLUSIONS
With acceptable recovery and low death rates, Tom Brown is a feasible alternative for treatment of MAM. Made with cheaper ingredients, it can potentially reach more children for the same cost, particularly when combined with frequent screening and early diagnosis in the community. Timely follow-up of defaulters may also improve adherence. Research is needed to understand Tom Brown’s effectiveness compared to commercial products or combination with cash-based assistance.