The World Health Organisation (WHO) introduced the twelve early warning indicators for monitoring and evaluating drug Procurement and Supply management (PSM) systems, intended to prevent drug ...stock-outs and overstocking. Nigeria--one of the high Multi Drug Resistant Tuberculosis (MDR-TB) burden countries, scaled-up treatment in 2012 with the concurrent implementation of a PSM system.
We evaluated how well this system functioned using the WHO indicators, including all seven MDR-TB treatment centres in the country that were functional throughout 2013.
The quantity of MDR-TB drugs ordered for 2013 matched the annual forecast and all central orders placed during the year were delivered in full and on time. Drug consumption was 81%-106% of the quantity allocated for routine consumption. Timely submission of complete inventory reports ranged from 86-100%, late submissions being 5-15 days late. Forty to 71% of treatment centres placed a drug order when stock was below the minimum level of three months. The proportion of drug orders received at the treatment centres in full and on time ranged from 29-80%, late orders being 1-19 days late.
The PSM was found to be performing well in terms of forecasting and procurement of MDR-TB drugs, but there were shortcomings in drug distribution, reporting at treatment centre level and in drug order placements. Despite these gaps, there were no stock outs. These findings indicate that where it matters most, namely ensuring that no drug stock outs affect patient management, the PSM system is effective. Addressing the observed shortcomings will help to strengthen the existing PSM system in anticipation of a growing MDR-TB case burden in the country.
Objectives
Among patients with primary and relapse visceral leishmaniasis (VL) in eastern Sudan, we determined the proportion eligible for treatment with sodium stibogluconate and paromomycin ...(SSG/PM) and, of these, their demographic and clinical characteristics; initial treatment outcomes including adverse side effects requiring treatment discontinuation; treatment outcomes by 6 months; and risk factors associated with initial (slow responders) and late treatment failure (relapses and post‐kala‐azar dermal leishmaniasis, PKDL).
Methods
A retrospective cohort study in Tabarak Allah Hospital, Gedaref Province, eastern Sudan, from July 2011 to January 2014.
Results
Of 1252 individuals diagnosed with VL (1151 primary and 101 relapses), 65% were eligible for SSG/PM including 83% children, almost half of them malnourished and anaemic. About 4% of individuals discontinued treatment due to side effects; 0.7% died during treatment. Initial cure was achieved in 93% of 774 primary cases and 77% of 35 relapse cases (P < 0.001). Among the 809 patients eligible for SSG/PM, 218 (27%) were lost to follow‐up. Outcomes by six months among the 591 patients with available follow‐up data were: definitive cure (n = 506; 86%), relapse (n = 38; 6%), treatment discontinuation (n = 33; 6%), PKDL (n = 7; 1%) and death (n = 7; 1%). Among those completing a full course of SSG/PM, relapses and under‐fives were at significantly higher risk of early and late treatment failure, respectively.
Conclusion
Whether SSG/PM as a first‐line regimen is an undeniable progress compared to SSG monotherapy, it excluded a considerable proportion of VL patients due to drug safety concerns. We call for accelerated development of new drugs and treatment regimens to improve VL treatment in Sudan.
Objectifs
Parmi les patients ayant une leishmaniose viscérale (LV) primaire et de rechute dans l'est du Soudan, nous avons déterminé la proportion éligibles pour un traitement avec du stibogluconate de sodium et de la paromomycine (SGS/PM) et, de ceux‐ci, leurs caractéristiques démographiques et cliniques, les résultats des traitements initiaux, y compris les effets secondaires indésirables nécessitant l'arrêt du traitement, les résultats du traitement après six mois et les facteurs de risque associés à l’échec initial (répondeurs lents) et tardif (rechutes et leishmaniose cutanée post kala‐azar, PKDL) du traitement.
Méthodes
Etude de cohorte rétrospective à l'Hôpital Tabarak Allah, dans la Province de Gedaref, dans l'est du Soudan, de juillet 2011 à janvier 2014.
Résultats
Sur 1252 personnes diagnostiquées avec la LV (1151 primaires et 101 rechutes), 65% étaient éligibles pour SGS/PM dont 83% d'enfants; près de la moitié d'entre eux souffraient de malnutrition et d'anémie. 4% des individus ont abandonné le traitement à cause d'effets secondaires, 0,7% sont décédés au cours du traitement. La guérison initiale a été atteinte chez 93% des 774 cas primaires et 77% des 35 cas de rechute (p <0,001). Il y avait 2% des répondeurs lents parmi les cas primaires et 17% (P <0,001) parmi les cas de rechute. Parmi les 809 patients éligibles pour SGS/PM, les résultats à six mois étaient: 63% de guérisons définitives, 27% de pertes au suivi, 5% de rechutes, 4% d'abandons du traitement, 0,9% de PKDL et 0,9% de décès. Parmi ceux qui ont terminé un cycle complet d’SSG/PM, les cas de rechutes et ceux de moins de cinq ans étaient à risque significativement plus élevé d’échec précoce et tardif du traitement, respectivement.
Conclusion
SSG/PM en tant que traitement de première intention a exclu une proportion considérable de patients atteints de LV en raison de préoccupations sur la sécurité des médicaments. Nous appelons à un développement accéléré de nouveaux médicaments et régimes de traitement pour améliorer le traitement de la VL au Soudan.
Objetivos
Entre pacientes con leishmaniosis visceral (LV) primaria y recaídas en el este de Sudán, hemos determinado la proporción que cumplían criterios para ser tratados con estibugluconato de sodio y paromomicina (EGS/PM) y de estos, sus características demográficas y clínicas; los resultados iniciales del tratamiento incluyendo efectos adversos que requerían descontinuar el tratamiento; resultados de tratamiento después de seis meses; y factores de riesgo asociados con un fallo inicial (respondedores lentos) y fallo en el tratamiento tardío (recaídas y leishmaniosis dérmica post kala azar, LDPK).
Métodos
Estudio retrospectivo de cohortes en el Hospital Tabarak Allah, Provincia de Gedaref, Sudán, entre Julio 2011 y Enero 2014.
Resultados
De 1252 individuos diagnosticados con LV (1151 primarios y 101 recaídas), 65% eran elegibles para EGS/PM incluyendo 83% niños, casi la mitad de ellos desnutridos y anémicos. Un 4% de los individuos descontinuaron el tratamiento debido a sus efectos secundarios; 0.7% murieron durante el tratamiento. La curación inicial se alcanzó en un 93% de los 774 casos primarios y un 77% de 35 casos de recaída (P<0.001). Entre los casos primarios, un 2% eran respondedores lentos, y entre los casos de recaída, un 17% (P<0.001). Entre los 809 pacientes elegibles para recibir EGS/PM, los resultados a seis meses eran: curación definitiva 63%, pérdida durante el seguimiento 27%, recaída 5%, discontinuación del tratamiento 4%, PKDL 0.9% y muerte 0.9%. Entre aquellos que tomaron un tratamiento completo de EGS/PM, los pacientes con recaídas y los menores de cinco años tenían un mayor riesgo de fallo en el tratamiento temprano y tardío, respectivamente.
Conclusión
EGS/PM como régimen de primera línea excluía una proporción considerable por posibles problemas de seguridad del medicamento. Hacemos un llamado a un desarrollo acelerado de nuevos medicamentos y regímenes de tratamiento para mejorar el tratamiento de LV en Sudán.
National Institute of Tuberculosis and Respiratory Diseases (erstwhile Lala Ram Sarup Institute) in Delhi, India.
To evaluate before and after the introduction of the line Probe Assay (LPA) a) the ...overall time to MDR-TB diagnosis and treatment initiation; b) the step-by-step time lapse at each stage of patient management; and c) the lost to follow-up rates.
A retrospective cohort analysis was done using data on MDR-TB patients diagnosed during 2009-2012 under Revised National Tuberculosis Control Programme at the institute.
Following the introduction of the LPA in 2011, the overall median time from identification of patients suspected for MDR-TB to the initiation of treatment was reduced from 157 days (IQR 127-200) to 38 days (IQR 30-79). This reduction was attributed mainly to a lower diagnosis time at the laboratory. Lost to follow-up rates were also significantly reduced after introduction of the LPA (12% versus 39% pre-PLA).
Introduction of the LPA was associated with a major reduction in the delay between identification of patients suspected for MDR-TB and initiation of treatment, attributed mainly to a reduction in diagnostic time in the laboratory.
Atypical environmental conditions with drought followed by heavy rainfall and flooding in arid areas in sub-Saharan Africa can lead to explosive epidemics of malaria, which might be prevented through ...timely vector-control interventions.
Wajir County in Northeast Kenya is classified as having seasonal malaria transmission. The aim of this study was to describe in Wajir town the environmental conditions, the scope and timing of vector-control interventions and the associated resulting burden of malaria at two time periods (1996-1998 and 2005-2007).
This is a cross-sectional descriptive and ecological study using data collected for routine program monitoring and evaluation.
In both time periods, there were atypical environmental conditions with drought and malnutrition followed by massive monthly rainfall resulting in flooding and animal/human Rift Valley Fever. In 1998, this was associated with a large and explosive malaria epidemic (weekly incidence rates peaking at 54/1,000 population/week) with vector-control interventions starting over six months after the massive rainfall and when the malaria epidemic was abating. In 2007, vector-control interventions started sooner within about three months after the massive rainfall and no malaria epidemic was recorded with weekly malaria incidence rates never exceeding 0.5 per 1,000 population per week.
Did timely vector-control interventions in Wajir town prevent a malaria epidemic? In 2007, the neighboring county of Garissa experienced similar climatic events as Wajir, but vector-control interventions started six months after the heavy un-seasonal rainfall and large scale flooding resulted in a malaria epidemic with monthly incidence rates peaking at 40/1,000 population. In conclusion, this study suggests that atypical environmental conditions can herald a malaria outbreak in certain settings. In turn, this should alert responsible stakeholders about the need to act rapidly and preemptively with appropriate and wide-scale vector-control interventions to mitigate the risk.
Setting. A nationwide study in Fiji. Objective. To describe the incidence of congenital rubella syndrome (CRS) and its relationship to the incidence of notified cases of rubella in Fiji from 1995 to ...2010. Design. Descriptive, retrospective review of all recorded congenital abnormalities associated with live births in Fiji over 16 years. Results. There were 294 infants who met the criteria for CRS. Of these, 95% were classified as “suspected” cases, 5% were “clinically confirmed,” and none were “laboratory confirmed cases”. There was a significant linear increase over the study period in the incidence of CRS (odds ratio 1.045 per year, 95% CI 1.019 to 1.071, P≤0.001). There was no significant association between the incidence of CRS and the reported incidence of rubella (P=0.3). Conclusion. There is a rising trend in reports of suspected CRS cases in Fiji. This highlights the need to strengthen surveillance for CRS through improvements in clinical and laboratory diagnosis to confirm or exclude suspected cases. It is also important to ensure high coverage of rubella vaccination in Fiji.
Background
In Fiji, patients with suspected pulmonary tuberculosis (PTB) currently submit three sputum specimens for smear microscopy for acid-fast bacilli, but there is little information about how ...well this practice is carried out.
Methods
A cross-sectional retrospective review was carried out in all four TB diagnostic laboratories in Fiji to determine among new patients presenting with suspected PTB in 2011: the quality of submitted sputum; the number of sputum samples submitted; the relationship between quality and number of submitted samples to smear-positivity; and positive yield from first, second and third samples.
Results
Of 1940 patients with suspected PTB, 3522 sputum samples were submitted: 997 (51.4%) patients submitted one sample, 304 (15.7%) patients submitted two samples and 639 (32.9%) submitted three samples. Sputum quality was recorded in 2528 (71.8%) of samples, of which 1046 (41.4%) were of poor quality. Poor quality sputum was more frequent in females, inpatients and children (0-14 years). Good quality sputum and a higher number of submitted samples positively correlated with smear-positivity for acid-fast bacilli. There were 122 (6.3%) patients with suspected PTB who were sputum smear positive. Of those, 89 had submitted three sputum samples: 79 (89%) were diagnosed based on the first sputum sample, 6 (7%) on the second sample and 4 (4%) on the third sample.
Conclusion
This study shows that there are deficiencies in the practice of sputum smear examination in Fiji with respect to sputum quality and recommended number of submitted samples, although the results support the continued use of three sputum samples for TB diagnosis. Ways to improve sputum quality and adherence to recommended guidelines are needed.
Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package ...of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts.
A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014.
31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians' maximum working capacity was exceeded in both centres, and mainly during rush hours.
This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs.
Background
We describe an innovative strategy implemented to support national staff at Istarlin Hospital in the conflict setting of Somalia; and report on inpatient morbidities, mortality and adverse ...hospital exit outcomes.
Methods
This was a retrospective analysis of hospital data for 2011.
Results
Of 8584 admitted patients, the largest numbers were for lower respiratory tract infections (LRTI) (2114; 25%), normal deliveries (1355; 16%) and diarrhoeal diseases (715; 8%). The highest contributors to mortality were gunshot wounds in surgery (18/30; 60%), LRTIs in internal medicine (6/32; 19%) and malnutrition in paediatrics (30/81; 37%). Adverse hospital exit outcomes (deaths and absconded) were well within thresholds set by Médecins Sans Frontières.
Conclusions
With a support package, satisfactory standards of care were met for hospital care in Somalia.
Background Atypical environmental conditions with drought followed by heavy rainfall and flooding in arid areas in sub-Saharan Africa can lead to explosive epidemics of malaria, which might be ...prevented through timely vector-control interventions. Objectives Wajir County in Northeast Kenya is classified as having seasonal malaria transmission. The aim of this study was to describe in Wajir town the environmental conditions, the scope and timing of vector-control interventions and the associated resulting burden of malaria at two time periods (1996-1998 and 2005-2007). Methods This is a cross-sectional descriptive and ecological study using data collected for routine program monitoring and evaluation. Results In both time periods, there were atypical environmental conditions with drought and malnutrition followed by massive monthly rainfall resulting in flooding and animal/human Rift Valley Fever. In 1998, this was associated with a large and explosive malaria epidemic (weekly incidence rates peaking at 54/1,000 population/week) with vector-control interventions starting over six months after the massive rainfall and when the malaria epidemic was abating. In 2007, vector-control interventions started sooner within about three months after the massive rainfall and no malaria epidemic was recorded with weekly malaria incidence rates never exceeding 0.5 per 1,000 population per week. Discussion and Conclusion Did timely vector-control interventions in Wajir town prevent a malaria epidemic? In 2007, the neighboring county of Garissa experienced similar climatic events as Wajir, but vector-control interventions started six months after the heavy un-seasonal rainfall and large scale flooding resulted in a malaria epidemic with monthly incidence rates peaking at 40/1,000 population. In conclusion, this study suggests that atypical environmental conditions can herald a malaria outbreak in certain settings. In turn, this should alert responsible stakeholders about the need to act rapidly and preemptively with appropriate and wide-scale vector-control interventions to mitigate the risk.
The purpose of this study is to assess how the COVID-19 pandemic impacted various sexual behaviors and levels of sexual and relationship satisfaction by performing a content analysis of participants' ...(N = 1051 American adults) responses to open-ended survey questions. Results revealed a variety of impacts that increased, decreased, or otherwise qualitatively changed sexual behavior and satisfaction. Major themes included emotions and mental health, changes in routines, social distancing and fears related to COVID-19, and changes in romantic relationships. These findings are contextualized within the emerging quantitative research on COVID-19 and sexuality, and areas for future research based on these findings are discussed.
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