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Knudsen JB, Pinder M, Jatta E, Jawara M, Yousuf MA, Søndergaard AT, Lindsay SW. Measuring ventilation in different typologies of rural Gambian houses: a pilot experimental study. Malar J 2020; 19:273. [PMID: 32736629 PMCID: PMC7393878 DOI: 10.1186/s12936-020-03327-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND African houses are frequently too hot and uncomfortable to use a bed net at night. Indoor thermal comfort is often evaluated by measuring temperature and humidity, ignoring ventilation. This study explored ways to measure ventilation in single-roomed rural Gambian houses during the malaria transmission season and evaluated building designs that could increase airflow at night and help keep the occupants comfortable. METHODS Two identical mud-walled houses were constructed with a metal roof, three doors and closed eaves. Experiment 1 compared five methods for measuring ventilation in a building: (1) using a blower door, (2) increasing carbon dioxide (CO2) levels indoors using an artificial source of CO2 and then measuring the rate of gas decay, (3) using a similar approach with a natural source of CO2, (4) measuring the rise of CO2 when people enter a building and (5) using hot-wire anemometers. Experiment 2 used CO2 data loggers to compare ventilation in a reference metal-roofed house with closed eaves and badly-fitting doors with a similar house with (1) thatched roof and open eaves, (2) eaves tubes, (3) screened doors and (4) screened doors and windows. RESULTS In experiment 1, CO2 data loggers placed indoors in two identical houses showed similar changes in airflow (p > 0.05) for all three methods recording either decreasing or increasing CO2. Blower doors were unable to measure airflow in houses with open eaves or screened windows and the anemometers broke down under field conditions. In experiment 2, open eaves in thatched houses, screened doors alone, and screened doors and windows increased indoor ventilation compared to the reference metal-roofed house with closed eaves and badly fitting doors (p < 0.05). Eaves tubes did not increase ventilation in comparison to the reference house. CONCLUSION CO2 data loggers proved to be a simple and efficient method for measuring ventilation in rural houses at night. Ventilation of metal-roofed houses can be improved by adding two screened doors and windows on opposite walls. Improved ventilation will result in increased thermal comfort making it more likely that people will sleep under a bed net.
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Affiliation(s)
- Jakob B Knudsen
- Schools of Architecture, Design and Conservation, The Royal Danish Academy of Fine Arts, Philip de Langes Allé 10, 1435, Copenhagen K, Denmark.
| | - Margaret Pinder
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.,Department of Biosciences, Durham University, Durham, UK
| | - Ebrima Jatta
- Department of Biosciences, Durham University, Durham, UK.,National Malaria Control Programme, Banjul, The Gambia
| | - Musa Jawara
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Mahamed A Yousuf
- Schools of Architecture, Design and Conservation, The Royal Danish Academy of Fine Arts, Philip de Langes Allé 10, 1435, Copenhagen K, Denmark
| | - Amalie T Søndergaard
- Schools of Architecture, Design and Conservation, The Royal Danish Academy of Fine Arts, Philip de Langes Allé 10, 1435, Copenhagen K, Denmark
| | - Steve W Lindsay
- Department of Biosciences, Durham University, Durham, UK.,London School of Hygiene & Tropical Medicine, London, UK
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Outcomes of Community-Based Systematic Screening of Household Contacts of Patients with Multidrug-Resistant Tuberculosis in Myanmar. Trop Med Infect Dis 2019; 5:tropicalmed5010002. [PMID: 31881646 PMCID: PMC7157714 DOI: 10.3390/tropicalmed5010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 01/17/2023] Open
Abstract
Screening of household contacts of patients with multidrug-resistant tuberculosis (MDR-TB) is a crucial active TB case-finding intervention. Before 2016, this intervention had not been implemented in Myanmar, a country with a high MDR-TB burden. In 2016, a community-based screening of household contacts of MDR-TB patients using a systematic TB-screening algorithm (symptom screening and chest radiography followed by sputum smear microscopy and Xpert-MTB/RIF assays) was implemented in 33 townships in Myanmar. We assessed the implementation of this intervention, how well the screening algorithm was followed, and the yield of active TB. Data collected between April 2016 and March 2017 were analyzed using logistic and log-binomial regression. Of 620 household contacts of 210 MDR-TB patients enrolled for screening, 620 (100%) underwent TB symptom screening and 505 (81%) underwent chest radiography. Of 240 (39%) symptomatic household contacts, 71 (30%) were not further screened according to the algorithm. Children aged <15 years were less likely to follow the algorithm. Twenty-four contacts were diagnosed with active TB, including two rifampicin- resistant cases (yield of active TB = 3.9%, 95% CI: 2.3%-6.5%). The highest yield was found among children aged <5 years (10.0%, 95% CI: 3.6%-24.7%). Household contact screening should be strengthened, continued, and scaled up for all MDR-TB patients in Myanmar.
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Hamada Y, Glaziou P, Sismanidis C, Getahun H. Prevention of tuberculosis in household members: estimates of children eligible for treatment. Bull World Health Organ 2019; 97:534-547D. [PMID: 31384072 PMCID: PMC6653819 DOI: 10.2471/blt.18.218651] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 02/08/2023] Open
Abstract
Objective To estimate of the number of children younger than 5 years who were household contacts of people with tuberculosis and were eligible for tuberculosis preventive treatment in 2017. Methods To estimate the number of eligible children, we obtained national values for the number of notified cases of bacteriologically confirmed pulmonary tuberculosis in 2017, the proportion of the population younger than 5 years in 2017 and average household size from published sources. We obtained global values for the number of active tuberculosis cases per household with an index case and for the prevalence of latent tuberculosis infection among children younger than 5 years who were household contacts of a tuberculosis case through systematic reviews, meta-analysis and Poisson regression models. Findings The estimated number of children younger than 5 years eligible for tuberculosis preventive treatment in 2017 globally was 1.27 million (95% uncertainty interval, UI: 1.24–1.31), which corresponded to an estimated global coverage of preventive treatment in children of 23% at best. By country, the estimated number ranged from less than one in the Bahamas, Iceland, Luxembourg and Malta to 350 000 (95% UI: 320 000–380 000) in India. Regionally, the highest estimates were for the World Health Organization (WHO) South-East Asia Region (510 000; 95% UI: 450 000–580 000) and the WHO African Region (470 000; 95% UI: 440 000–490 000). Conclusion Tuberculosis preventive treatment in children was underutilized globally in 2017. Treatment should be scaled up to help eliminate the pool of tuberculosis infection and achieve the End TB Strategy targets.
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Affiliation(s)
- Yohhei Hamada
- Global Tuberculosis Programme, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | - Philippe Glaziou
- Global Tuberculosis Programme, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | - Charalambos Sismanidis
- Global Tuberculosis Programme, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | - Haileyesus Getahun
- Global Tuberculosis Programme, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
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Nagaraja SB, Satyanarayana S, Bansal AK. Can ventilation oust tuberculosis bacilli? Dare to plug the unpluggable. Public Health Action 2018; 8:28. [PMID: 29581941 DOI: 10.5588/pha.17.0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- S B Nagaraja
- Employees State Insurance Corporation Medical College, Post Graduate Institute of Medical Science and Research (PGIMSR), Bangalore, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease South East Asia Office, New Delhi, India
| | - A K Bansal
- National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, India
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Taylor JG, Yates TA, Mthethwa M, Tanser F, Abubakar I, Altamirano H. Measuring ventilation and modelling M. tuberculosis transmission in indoor congregate settings, rural KwaZulu-Natal. Int J Tuberc Lung Dis 2018; 20:1155-61. [PMID: 27510239 PMCID: PMC4978153 DOI: 10.5588/ijtld.16.0085] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
SETTING: Molecular epidemiology suggests that most Mycobacterium tuberculosis transmission in high-burden settings occurs outside the home. OBJECTIVE: To estimate the risk of M. tuberculosis transmission inside public buildings in a high TB burden community in KwaZulu-Natal, South Africa. DESIGN: Carbon dioxide (CO2) sensors were placed inside eight public buildings. Measurements were used with observations of occupancy to estimate infection risk using an adaptation of the Wells-Riley equation. Ventilation modelling using CONTAM was used to examine the impact of low-cost retrofits on transmission in a health clinic. RESULTS: Measurements indicate that infection risk in the church, classroom and clinic waiting room would be high with typical ventilation, occupancy levels and visit durations. For example, we estimated that health care workers in a clinic waiting room had a 16.9–24.5% annual risk of M. tuberculosis infection. Modelling results indicate that the simple addition of two new windows allowing for cross-ventilation, at a cost of US$330, would reduce the annual risk to health care workers by 57%. CONCLUSIONS: Results indicate that public buildings in this community have a range of ventilation and occupancy characteristics that may influence transmission risks. Simple retrofits may result in dramatic reductions in M. tuberculosis transmission, and intervention studies should therefore be considered.
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Affiliation(s)
- J G Taylor
- University College London (UCL) Institute for Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, UCL, London, UK
| | - T A Yates
- Wellcome Trust Africa Centre for Population Health, Mtubatuba, South Africa; Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, UCL, London, UK
| | - M Mthethwa
- Wellcome Trust Africa Centre for Population Health, Mtubatuba, South Africa
| | - F Tanser
- Wellcome Trust Africa Centre for Population Health, Mtubatuba, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of Kwa-Zulu Natal, Congella, South Africa
| | - I Abubakar
- Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, UCL, London, UK, Institute for Global Health, UCL, London, UK
| | - H Altamirano
- University College London (UCL) Institute for Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, UCL, London, UK
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Mathema B, Andrews JR, Cohen T, Borgdorff MW, Behr M, Glynn JR, Rustomjee R, Silk BJ, Wood R. Drivers of Tuberculosis Transmission. J Infect Dis 2017; 216:S644-S653. [PMID: 29112745 PMCID: PMC5853844 DOI: 10.1093/infdis/jix354] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Measuring tuberculosis transmission is exceedingly difficult, given the remarkable variability in the timing of clinical disease after Mycobacterium tuberculosis infection; incident disease can result from either a recent (ie, weeks to months) or a remote (ie, several years to decades) infection event. Although we cannot identify with certainty the timing and location of tuberculosis transmission for individuals, approaches for estimating the individual probability of recent transmission and for estimating the fraction of tuberculosis cases due to recent transmission in populations have been developed. Data used to estimate the probable burden of recent transmission include tuberculosis case notifications in young children and trends in tuberculin skin test and interferon γ-release assays. More recently, M. tuberculosis whole-genome sequencing has been used to estimate population levels of recent transmission, identify the distribution of specific strains within communities, and decipher chains of transmission among culture-positive tuberculosis cases. The factors that drive the transmission of tuberculosis in communities depend on the burden of prevalent tuberculosis; the ways in which individuals live, work, and interact (eg, congregate settings); and the capacity of healthcare and public health systems to identify and effectively treat individuals with infectious forms of tuberculosis. Here we provide an overview of these factors, describe tools for measurement of ongoing transmission, and highlight knowledge gaps that must be addressed.
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Affiliation(s)
- Barun Mathema
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, California
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Martien W Borgdorff
- Centers for Disease Control and Prevention, Kisumu, Kenya
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Marcel Behr
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal,Canada
| | - Judith R Glynn
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Roxana Rustomjee
- Tuberculosis Clinical Research Branch, Therapeutics Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland
| | - Benjamin J Silk
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robin Wood
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
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Mbugi EV, Katale BZ, Lupindu AM, Keyyu JD, Kendall SL, Dockrell HM, Michel AL, Matee MI, van Helden PD. Tuberculosis Infection: Occurrence and Risk Factors in Presumptive Tuberculosis Patients of the Serengeti Ecosystem in Tanzania. East Afr Health Res J 2017; 1:19-30. [PMID: 34308155 PMCID: PMC8279301 DOI: 10.24248/eahrj-d-16-00319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/01/2017] [Indexed: 11/20/2022] Open
Abstract
Background Cross-species tuberculosis (TB) transmission between humans and animals has been reported for quite a long time in sub-Saharan Africa. Because humans and animals coexist in the same ecosystem, exploring their potential for cross-species transmission and the impact the disease may have on the health of humans, animals, and their products is critical. Objectives This study aimed to identify risk factors for transmission of TB (Mycobacterium tuberculosis) and to assess the potential for zoonotic TB (Mycobacterium bovis) transmission in the Serengeti ecosystem where humans and animals are in intense contact. Our aim is to create a base for future implementation of appropriate control strategies to limit infection in both humans and animals. Methodology We administered a semi-structured questionnaire to 421 self-reporting patients to gather information on risk factors and TB occurrence. In a parallel study, researchers screened sputum smears using Ziehl-Neelsen staining and confirmed by mycobacterial culture. We then performed descriptive statistics (Pearson's chi-square test) and logistic regression analysis to establish frequencies, association, and quantification of the risk factors associated with TB cases. Results Our findings showed 44% (95% confidence interval [CI], 0.40-0.49) of the results were positive from sputum samples collected over a 1-year duration in areas with a high TB burden, particularly the Bunda district, followed by the Serengeti and Ngorongoro districts. Of the culture-positive patients who also had infections other than TB (43/187 patients), 21 (49%) were HIV positive. Contact with livestock products (odds ratio [OR] 6.0; 95% CI, 1.81-19.9), infrequent milk consumption (OR 2.5; 95% CI, 1.42-4.23), cigarette smoking (OR 2.9; 95% CI, 1.19-7.1.2), and alcohol consumption (OR 2.3; 95% CI, 1.22-4.23) were associated with a higher likelihood of TB infection. Conclusion There was no evidence of direct cross-species transmission of either M tuberculosis or M bovis between humans and animals using the study methods. The absence of cross-species TB transmission could be due to limited chances of contact rather than an inability of cross-species disease transmission. In addition, not all people with presumptive TB are infected with TB, and therefore control strategies should emphasise confirming TB status before administering anti-TB drugs.
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Affiliation(s)
- Erasto V Mbugi
- Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Departments of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bugwesa Z Katale
- Departments of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Tanzania Wildlife Research Institute, Arusha, Tanzania
| | - Athumani M Lupindu
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | | | | | - Hazel M Dockrell
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anita L Michel
- Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria, South Africa
| | - Mecky I Matee
- Departments of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul D van Helden
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/Medical Research Council, Centre for Molecular and Cellular Biology, Stellenbosch University, Tygerberg, South Africa
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Dowdy DW, Azman AS, Kendall EA, Mathema B. Transforming the fight against tuberculosis: targeting catalysts of transmission. Clin Infect Dis 2014; 59:1123-9. [PMID: 24982034 DOI: 10.1093/cid/ciu506] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The global tuberculosis control community has committed itself to ambitious 10-year targets. To meet these targets, biomedical advances alone will be insufficient; a more targeted public health tuberculosis strategy is also needed. We highlight the role of "tuberculosis transmission catalysts," defined as variabilities in human behavior, bacillary properties, and host physiology that fuel the propagation of active tuberculosis at the local level. These catalysts can be categorized as factors that increase contact rates, infectiousness, or host susceptibility. Different catalysts predominate in different epidemiological and sociopolitical settings, and public health approaches are likely to succeed only if they are tailored to target the major catalysts driving transmission in the corresponding community. We argue that global tuberculosis policy should move from a country-level focus to a strategy that prioritizes collection of data on key transmission catalysts at the local level followed by deployment of "catalyst-targeted" interventions, supported by strengthened health systems.
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Affiliation(s)
- David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Emily A Kendall
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barun Mathema
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Albuquerque T, Isaakidis P, Das M, Saranchuk P, Andries A, Misquita DP, Khan S, Dubois S, Peskett C, Browne M. Infection control in households of drug-resistant tuberculosis patients co-infected with HIV in Mumbai, India. Public Health Action 2014; 4:35-41. [PMID: 26423759 PMCID: PMC4479090 DOI: 10.5588/pha.13.0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/30/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mumbai has a population of 21 million, and an increasingly recognised epidemic of drug-resistant tuberculosis (DR-TB). OBJECTIVE To describe TB infection control (IC) measures implemented in households of DR-TB patients co-infected with the human immunodeficiency virus (HIV) under a Médecins Sans Frontières programme. METHODS IC assessments were carried out in patient households between May 2012 and March 2013. A simplified, standardised assessment tool was utilised to assess the risk of TB transmission and guide interventions. Administrative, environmental and personal protective measures were tailored to patient needs. RESULTS IC assessments were carried out in 29 houses. Measures included health education, segregating sleeping areas of patients, improving natural ventilation by opening windows, removing curtains and obstacles to air flow, installing fans and air extractors and providing surgical masks to patients for limited periods. Environmental interventions were carried out in 22 houses. CONCLUSIONS TB IC could be a beneficial component of a comprehensive TB and HIV care programme in households and communities. Although particularly challenging in slum settings, IC measures that are feasible, affordable and acceptable can be implemented in such settings using simplified and standardised tools. Appropriate IC interventions at household level may prevent new cases of DR-TB, especially in households of patients with a lower chance of cure.
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Affiliation(s)
| | | | - M. Das
- Médecins Sans Frontières, Mumbai, India
| | - P. Saranchuk
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | | | - D. P. Misquita
- School of Health System Studies, Tata Institute of Social Sciences, Mumbai, India
| | - S. Khan
- Médecins Sans Frontières, Mumbai, India
| | - S. Dubois
- Médecins Sans Frontières, Mumbai, India
| | | | - M. Browne
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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