Title: Real-Time PCR for the Evaluation of Treatment Response in Clinical Trials of Adult Chronic Chagas Disease: Usefulness of Serial Blood Sampling and qPCR Replicates Authors: Parrado, R; Ramirez, JC; de la Barra, A; Alonso-Vega, C; Juiz, N; Ortiz, L; Illanes, D; Torrico, F; Gascon, J; Alves, F; Flevaud, L; Garcia, L; Schijman, AG; Ribeiro, I Abstract: This work evaluated a serial blood sampling procedure to enhance the sensitivity of duplex real-time PCR (qPCR) for baseline detection and quantification of parasitic loads and post-treatment identification of failure in the context of clinical trials for treatment of chronic Chagas disease, namely DNDi-CH-E1224-001 (NCT01489228) and MSF-DNDi PCR sampling optimization study (NCT01678599). Patients from Cochabamba (N= 294), Tarija (N= 257), and Aiquile (N= 220) were enrolled. Three serial blood samples were collected at each time-point and qPCR triplicates were tested per sample. The first two samples were collected during the same day and the third one seven days later.A patient was considered PCR positive if at least one qPCR replicate was detectable. Cumulative results of multiple samples and qPCR replicates enhanced the proportion of pre-treatment sample positivity from 54.8 to 76.2%, 59.5 to 77.8%, and 73.5 to 90.2% in Cochabamba, Tarija, and Aiquile cohorts, respectively. This strategy increased the detection of treatment failure from 72.9 to 91.7%, 77.8 to 88.9%, and 42.9 to 69.1% for E1224 low, short, and high dosage regimens, respectively; and from 4.6 to 15.9% and 9.5 to 32.1% for the benznidazole arm in the DNDi-CH-E1224-001 and MSF-DNDi studies, respectively. The addition of the third blood sample and third qPCR replicate in patients with non-detectable PCR results in the first two samples, gave a small, non-statistically significant improvement in qPCR positivity. No change in clinical sensitivity was seen with a blood volume increase from 5 to 10 ml. The monitoring of patients treated with placebo in the DNDi-CH-E1224-001 trial revealed fluctuations in parasitic loads and occasional non-detectable results. In conclusion, serial sampling strategy enhanced PCR sensitivity to detecting treatment failure during follow-up and has the potential for improving recruitment capacity in Chagas disease trials, which require an initial positive qPCR result for patient admission.
Title: The role of pediatric nursing in the provision of quality care in humanitarian settings: a qualitative study in Tonkolili District, Sierra Leone Authors: Gilday, J; Chantler, T; Gray, N; Treacy-Wong, V; Yillia, J; Pascal Gbla, A; Howard, N; Stringer, B
Title: Perceptions of Healthcare-Associated Infection and Antibiotic Resistance among Physicians Treating Syrian Patients with War-Related Injuries Authors: Älgå, A; Karlow Herzog, K; Alrawashdeh, M; Wong, S; Khankeh, H; Stålsby Lundborg, C Abstract: Healthcare-associated infections (HAIs) constitute a major contributor to morbidity and mortality worldwide, with a greater burden on low- and middle-income countries. War-related injuries generally lead to large tissue defects, with a high risk of infection. The aim of this study was to explore how physicians in a middle-income country in an emergency setting perceive HAI and antibiotic resistance (ABR). Ten physicians at a Jordanian hospital supported by Médecins Sans Frontières were interviewed face-to-face. The recorded interviews were transcribed verbatim and analyzed by qualitative content analysis with an inductive and deductive approach. The participants acknowledged risk factors of HAI and ABR development, such as patient behavior, high numbers of injured patients, limited space, and non-compliance with hygiene protocols, but did not express a sense of urgency or any course of action. Overuse and misuse of antibiotics were reported as main contributors to ABR development, but participants expressed no direct interrelationship between ABR and HAI. We conclude that due to high patient load and limited resources, physicians do not see HAI as a problem they can prioritize. The knowledge gained by this study could provide insights for the allocation of resources and development of hygiene and wound treatment protocols in resource-limited settings.
Title: Oral cholera vaccination in hard-to-reach communities, Lake Chilwa, Malawi Authors: Grandesso, F; Rafael, F; Chipeta, S; Alley, I; Saussier, C; Nogareda, F; Burns, M; Lechevalier, P; Page, AL; Salumu, L; Pezzoli, L; Mwesawina, M; Cavailler, P; Mengel, M; Luquero, FJ; Cohuet, S Abstract: To evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak.
Title: Assessing the performance of real-time epidemic forecasts: A case study of Ebola in the Western Area Region of Sierra Leone, 2014-15 Authors: Funk, S; Camacho, A; Kucharski, AJ; Lowe, R; Eggo, RM; Edmunds, WJ
Title: Extremely Low Hepatitis C prevalence among HIV co-infected individuals in 4 countries in sub-Saharan Africa Authors: Loarec, A; Carnimeo, V; Molfino, L; Kizito, W; Muyindike, W; Andrieux-Meyer, I; Balkan, S; Nzomukunda, Y; Mwanga-Amumpaire, J; Ousley, J; Bygrave, H; Maman, D Abstract: : A multicentric, retrospective case-series analysis (facility-based) in five sites across Kenya, Malawi, Mozambique, and Uganda screened HIV-positive adults for hepatitis C virus (HCV) antibodies using Oraquick rapid testing and viral confirmation (in three sites). Results found substantially lower prevalence than previously reported for these countries compared with previous reports, suggesting that targeted integration of HCV screening in African HIV programs may be more impactful than routine screening.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.
Title: Field suitability and diagnostic accuracy of the Biocentric open real-time PCR platform for plasma-based HIV viral load quantification in Swaziland Authors: Kerschberger, B; Mpala, Q; Uribe, PAD; Maphalala, G; de la Tour, R; Kalombola, S; Bekele, A; Chawinga, T; Mliba, M; Ntshalintshali, N; Phugwayo, N; Kabore, SM; Goiri, J; Dlamini, S; Ciglenecki, I; Fajardo, E Abstract: Viral load (VL) testing is being scaled up in resource-limited settings. However, not all commercially available VL testing methods have been evaluated under field conditions. This study is one of a few to evaluate the Biocentric platform for VL quantification in routine practice in Sub-Saharan Africa.
Title: This is not a drill Authors: Carenzo, L
Title: Complex interactions between malaria and malnutrition: a systematic literature review Authors: Das, D; Grais, R F; Okiro, E A; Stepniewska, K; Mansoor, R; van der Kam, S; Terlouw, D J; Tarning, J; Barnes, K I; Guerin, P J Abstract: Despite substantial improvement in the control of malaria and decreased prevalence of malnutrition over the past two decades, both conditions remain heavy burdens that cause hundreds of thousands of deaths in children in resource-poor countries every year. Better understanding of the complex interactions between malaria and malnutrition is crucial for optimally targeting interventions where both conditions co-exist. This systematic review aimed to assess the evidence of the interplay between malaria and malnutrition.
Title: Removal of user fees and system strengthening improves access to maternity care, maternal and neonatal mortality in a district hospital in Lesotho Authors: Steele, SJ; Sugianto, H; Baglione, Q; Sedlimaier, S; Niyibizi, AA; Duncan, K; Hill, J; Brix, J; Philips, M; Van Cutsem, G; Shroufi, A Abstract: Lesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co-payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho.
Title: High treatment success rate for multidrug-resistant and extensively drug-resistant tuberculosis using a bedaquiline-containing treatment regimen Authors: Ndjeka, N; Schnippel, K; Master, I; Meintjes, G; Maartens, G; Romero, R; Padanilam, X; Enwerem, M; Chotoo, S; Singh, N; Hughes, J; Variava, E; Ferreira, H; Te Riele, J; Ismail, N; Mohr, E; Bantubani, N; Conradie, F Abstract: Background: South African patients with rifampicin-resistant tuberculosis and resistance to fluoroquinolones and/or injectables (pre/XDR-TB) were granted access to bedaquiline through a Clinical Access Programme with strict inclusion and exclusion criteria.Methods: Pre/XDR-TB and XDR-TB patients were treated with 24 weeks bedaquiline within an optimised, individualised background regimen that could include levofloxacin, linezolid and clofazimine as needed.Results: 200 patients were enrolled: 87 (43.9%) with XDR-TB, 99 (49.3%) were female, median age 34 years (IQR 27, 42). 134 (67.0%) were living with HIV; median CD4+ 281 (IQR 130; 467) and all on antiretroviral therapy.16/200 patients (8.0%) did not complete 6 months of bedaquiline of which 8 were lost to follow up, 6 died, 1 stopped for side effects and 1 patient was diagnosed with drug-sensitive TB.146/200 (73.0%) patients had favourable outcomes: 139/200 were cured (69.5%) and 7 completed treatment (3.5%). 25 died (12.5%), were lost from treatment (10.0%), 9 had treatment failure (4.5%).22 adverse events were attributed to bedaquiline: including QTcF >500 ms (n=5), QTcF increase >50 ms from baseline (n=11), paroxysmal atrial flutter (n=1).Conclusion: Bedaquiline added to an optimised background regimen was associated with a high rate of successful treatment outcomes for this MDR-TB and XDR-TB cohort. Description: We regret that this article is behind a paywall.
Title: Uncharted territory of the epidemiological burden of cutaneous leishmaniasis in sub-Saharan Africa-A systematic review Authors: Sunyoto, T; Verdonck, K; El Safi, S; Potet, J; Picado, A; Boelaert, M Abstract: Cutaneous leishmaniasis (CL) is the most frequent form of leishmaniasis, with 0.7 to 1.2 million cases per year globally. However, the burden of CL is poorly documented in some regions. We carried out this review to synthesize knowledge on the epidemiological burden of CL in sub-Saharan Africa.
Title: Knowledge, attitude and practices of snakebite management amongest health workers in Cameroon: Need for continuous training and capacity building Authors: Taieb, F; Dub, T; Madec, Y; Tondeur, L; Chippaux, JP; Lebreton, M; Medang, R; Foute, FNN; Tchoffo, D; Potet, J; Alcoba, G; Comte, E; Einterz, EM; Nkwescheu, AS Abstract: Snakebite has only recently been recognized as a neglected tropical disease by the WHO. Knowledge regarding snakebites and its care is poor both at the population level, and at the health care staff level. The goal of this study was to describe the level of knowledge and clinical practice regarding snakebite among health care staff from Cameroon.
Title: SMS-based smartphone application for disease surveillance has doubled completeness and timeliness in a limited-resource setting – evaluation of a 15-week pilot program in Central African Republic (CAR) Authors: El-Khatib, Z; Shah, M; Zallappa, SN; Nabeth, P; Guerra, J; Manengu, CT; Yao, M; Philibert, A; Massina, L; Staiger, CP; Mbailao, R; Kouli, JP; Mboma, H; Duc, G; Inagbe, D; Barry, AB; Dumont, T; Cavailler, P; Quere, M; Willett, B; Reaiche, S; de Ribaucourt, H; Reeder, B
Title: Field safety and effectiveness of new visceral leishmaniasis treatment regimens within public health facilities in Bihar, India Authors: Goyal, Vi; Mahajan, R; Pandey, K; Singh, SN; Singh, RS; Strub-Wourgaft, N; Alves, F; Rabi Das, VN; Topno, RK; Sharma, B; Balasegaram, M; Bern, C; Hightower, A; Rijal, S; Ellis, S; Sunyoto, T; Burza, S; Lima, N; Das, P; Alvar, J Abstract: In 2010, WHO recommended the use of new short-course treatment regimens in kala-azar elimination efforts for the Indian subcontinent. Although phase 3 studies have shown excellent results, there remains a lack of evidence on a wider treatment population and the safety and effectiveness of these regimens under field conditions.
Title: Antibiotic resistance in Palestine: an emerging part of a larger crisis Authors: Kanapathipillai, R; Malou, N; Baldwin, K; Marty, P; Rodaix, C; Mills, C; Herard, P; Saim, M
Title: Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection Authors: Kemigisha, E; Nanjebe, D; Boum, Y; Langendorf, Céline; Aberrane, S; Nyehangane, D; Nackers, F; Mueller, Y; Charrel, R; Murphy, RA; Page, AL; Mwanga-Amumpaire, J Abstract: Acute central nervous system (CNS) infections in children in sub-Saharan Africa are often fatal. Potential contributors include late presentation, limited diagnostic capacity and inadequate treatment. A more nuanced understanding of treatment practices with a goal of optimizing such practices is critical to prevent avoidable case fatality. We describe empiric antimicrobial treatment, antibiotic resistance and treatment adequacy in a prospective cohort of 459 children aged two months to 12 years hospitalised for suspected acute CNS infections in Mbarara, Uganda, from 2009 to 2012. Among these 459 children, 155 had a laboratory-confirmed diagnosis of malaria (case-fatality rate [CFR] 14%), 58 had bacterial infections (CFR 24%) and 6 children had mixed malaria and bacterial infections (CFR 17%). Overall case fatality was 18.1% (n = 83). Of 219 children with laboratory-confirmed malaria and/or bacterial infections, 182 (83.1%) received an adequate antimalarial and/or antibiotic on the day of admission and 211 (96.3%) within 48 hours of admission. The proportion of those receiving adequate treatment was similar among survivors and non-survivors. All bacterial isolates were sensitive to ceftriaxone except one Escherichia coli isolate with extended-spectrum beta-lactamase (ESBL). The observed high mortality was not a result of inadequate initial antimicrobial treatment at the hospital. The epidemiology of CNS infection in this setting justifies empirical use of a third-generation cephalosporin, however antibiotic resistance should be monitored closely.
Title: Delivering paediatric critical care in humanitarian settings Authors: Umphrey, L; Brown, A; Hiffler, L; Lafferty, N; Garcia, DM; Morton, N; Ogundipe, O
Title: Typhoid fever outbreak in the Democratic Republic of Congo: Case control and ecological study Authors: Brainard, J; D’hondt, R; Ali, E; Van den Bergh, R; De Weggheleire, A; Baudot, Y; Patigny, F; Lambert, V; Zachariah, R; Maes, P; Kuma-Kuma Kenge, D; Hunter, PR Abstract: During 2011 a large outbreak of typhoid fever affected an estimated 1430 people in Kikwit, Democratic Republic of Congo. The outbreak started in military camps in the city but then spread to the general population. This paper reports the results of an ecological analysis and a case-control study undertaken to examine water and other possible transmission pathways. Attack rates were determined for health areas and risk ratios were estimated with respect to spatial exposures. Approximately 15 months after the outbreak, demographic, environmental and exposure data were collected for 320 cases and 640 controls residing in the worst affected areas, using a structured interview questionnaire. Unadjusted and adjusted odds ratios were estimated. Complete data were available for 956 respondents. Residents of areas with water supplied via gravity on the mains network were at much greater risk of disease acquisition (risk ratio = 6.20, 95%CI 3.39–11.35) than residents of areas not supplied by this mains network. In the case control study, typhoid was found to be associated with ever using tap water from the municipal supply (OR = 4.29, 95% CI 2.20–8.38). Visible urine or faeces in the latrine was also associated with increased risk of typhoid and having chosen a water source because it is protected was negatively associated. Knowledge that washing hands can prevent typhoid fever, and stated habit of handwashing habits before cooking or after toileting was associated with increased risk of disease. However, observed associations between handwashing or plate-sharing with disease risk could very likely be due to recall bias. This outbreak of typhoid fever was strongly associated with drinking water from the municipal drinking water supply, based on the descriptive and analytic epidemiology and the finding of high levels of faecal contamination of drinking water. Future outbreaks of potentially waterborne disease need an integrated response that includes epidemiology and environmental microbiology during early stages of the outbreak.
Title: Health Seeking Behaviour in Kamrangirchar Authors: Jeroen van der Heijden Description: The perceptions and experiences of health and health seeking behaviour for the community living in the slum areas of Kamrangirchar and Hazaribagh, Dhaka, Bangladesh: a qualitative study