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Zanetta A, Bulfaro I, Faini F, Manzi M, Pica G, De Bastiani M, Bellani S, Zappia MI, Bianca G, Gabatel L, Panda JK, Del Rio Castillo AE, Prato M, Lauciello S, Bonaccorso F, Grancini G. Enhancing charge extraction in inverted perovskite solar cells contacts via ultrathin graphene:fullerene composite interlayers. J Mater Chem A Mater 2023; 11:12866-12875. [PMID: 37346737 PMCID: PMC10281336 DOI: 10.1039/d2ta07512a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/29/2022] [Indexed: 06/23/2023]
Abstract
Improving the perovskite/electron-transporting layer (ETL) interface is a crucial task to boost the performance of perovskite solar cells (PSCs). This is utterly fundamental in an inverted (p-i-n) configuration using fullerene-based ETLs. Here, we propose a scalable strategy to improve fullerene-based ETLs by incorporating high-quality few-layer graphene flakes (GFs), industrially produced through wet-jet milling exfoliation of graphite, into phenyl-C61-butyric acid methyl ester (PCBM). Our new composite ETL (GF:PCBM) can be processed into an ultrathin (∼10 nm), pinhole-free film atop the perovskite. We find that the presence of GFs in the PCBM matrix reduces defect-mediated recombination, while creating preferential paths for the extraction of electrons towards the current collector. The use of our GF-based composite ETL resulted in a significant enhancement in the open circuit voltage and fill factor of triple cation-based inverted PSCs, boosting the power conversion efficiency from ∼19% up to 20.8% upon the incorporation of GFs into the ETL.
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Affiliation(s)
- Andrea Zanetta
- Department of Chemistry & INSTM, University of Pavia Via T. Taramelli 14 27100 Pavia Italy
| | - Isabella Bulfaro
- Department of Chemistry & INSTM, University of Pavia Via T. Taramelli 14 27100 Pavia Italy
| | - Fabiola Faini
- Department of Chemistry & INSTM, University of Pavia Via T. Taramelli 14 27100 Pavia Italy
| | - Matteo Manzi
- Department of Chemistry & INSTM, University of Pavia Via T. Taramelli 14 27100 Pavia Italy
| | - Giovanni Pica
- Department of Chemistry & INSTM, University of Pavia Via T. Taramelli 14 27100 Pavia Italy
| | - Michele De Bastiani
- Department of Chemistry & INSTM, University of Pavia Via T. Taramelli 14 27100 Pavia Italy
| | | | | | - Gabriele Bianca
- Graphene Labs, Istituto Italiano di Tecnologia Via Morego 30 16163 Genova Italy
- Dipartimento di Chimica e Chimica Industriale, Università degli Studi di Genova Via Dodecaneso 31 16146 Genoa Italy
| | - Luca Gabatel
- BeDimensional S.p.A Via Lungotorrente Secca 30R 16163 Genova Italy
- Department of Mechanical Engineering - DIME, University of Genoa Via Opera Pia 15 16145 Genova Italy
| | - Jaya-Kumar Panda
- BeDimensional S.p.A Via Lungotorrente Secca 30R 16163 Genova Italy
| | | | - Mirko Prato
- Materials Characterization Facility, Istituto Italiano di Tecnologia Via Morego 30 16163 Genova Italy
| | - Simone Lauciello
- Electron Microscopy Facility, Istituto Italiano di Tecnologia Via Morego 30 16163 Genova Italy
| | | | - Giulia Grancini
- Department of Chemistry & INSTM, University of Pavia Via T. Taramelli 14 27100 Pavia Italy
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2
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Abstract
Ferroelectric ceramics such as PbZrxTi1-xO3 (PZT) are widely applied in many fields, from medical to aerospace, because of their dielectric, piezoelectric, and pyroelectric properties. In the past few years, hybrid organic-inorganic halide perovskites have gradually attracted attention for their optical and electronic properties, including ferroelectricity, and for their low fabrication costs. In this Review, we first describe techniques that are used to quantify ferroelectric figures of merit of a material. We then discuss ferroelectricity in hybrid perovskites, starting from controversies in methylammonium iodoplumbate perovskites and then focusing on low-dimensional perovskites that offer an unambiguous platform to obtain ferroelectricity. Finally, we provide examples of the application of perovskite ferroelectrics in solar cells, LEDs, and X-ray detectors. We conclude that the vast structure-property tunability makes low-dimensional hybrid perovskites promising, but they have yet to offer ferroelectric figures of merit (e.g., saturated polarization) and thermal stability (e.g., Curie temperature) competitive with those of conventional oxide perovskite ferroelectric materials.
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Affiliation(s)
| | - Giovanni Pica
- Department of Chemistry, University of Pavia, Via T. Taramelli 14, 27100 Pavia, Italy
| | - Michele De Bastiani
- Department of Chemistry, University of Pavia, Via T. Taramelli 14, 27100 Pavia, Italy
| | | | - Giulia Grancini
- Department of Chemistry & INSTM, University of Pavia, Via T. Taramelli 14, 27100 Pavia, Italy
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Mbonyinshuti F, Takarinda KC, Ade S, Manzi M, Iradukunda PG, Kabatende J, Habiyaremye T, Kayumba PC. Evaluating the availability of essential drugs for hypertension, diabetes and asthma in rural Rwanda, 2018. Public Health Action 2021; 11:5-11. [PMID: 33777715 DOI: 10.5588/pha.20.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022] Open
Abstract
SETTING Hypertension, diabetes mellitus and asthma are on the rise in developing countries, including Rwanda; there is thus a need to ensure uninterrupted drug availability. OBJECTIVES To assess 1) the frequency and duration of drug stock-outs; 2) lead time duration 3) monthly stock levels; and 4) drug quantities requested vs. quantity delivered for captopril, metformin and inhaled salbutamol between January and December 2018 Kirehe District, Rwanda. DESIGN This was a cross-sectional study using secondary programme data. RESULTS The median annual stock-outs for captopril, metformin and inhaled salbutamol were respectively 4 (IQR 3-4), 3 (IQR 2-3) and 4 (IQR 4-5) at rural health facilities (RHCs); no stock-outs occurred at the district hospital. For all three drugs, the median lead time was 7.5 days (IQR 5.5-11.5) at the hospital vs. 5 days (IQR 3-6) in RHCs. Stock status for captopril was below the 4-week minimum stock level for 2/12 months at the hospital vs. 7/12 months at the RHCs, while metformin and inhaled salbutamol were below the 4-week minimum stock levels for respectively 1/12 and 4/12 months at both hospital and RHCs. Total drug quantities delivered were less than the combined total quantities requested in respectively 8/12, 5/12 and 8/12 months for captopril, metformin and inhaled salbutamol. CONCLUSION There is a need to regularly and effectively monitor drug stock levels and ensure timely and sufficient stock replenishment to avert stock-outs.
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Affiliation(s)
- F Mbonyinshuti
- Human Resource for Health Secretariat, Ministry of Health, Kigali, Rwanda.,College of Business and Economics, African Centre of Excellence in Data Science, University of Rwanda, Kigali, Rwanda.,University of Global Health Equity, Kigali, Rwanda
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France.,AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Faculté de Médecine, Université de Parakou, Parakou, Bénin
| | - M Manzi
- Medical Department, Médecins Sans Frontières, Operational Centre Brussels, MSF-Luxembourg (LuxOR), Luxembourg, Belgium
| | - P G Iradukunda
- Rwanda Food and Drugs Authority, Kigali, Rwanda.,University of London, London School of Hygiene & Tropical Medicine, London, UK
| | - J Kabatende
- Rwanda Food and Drugs Authority, Kigali, Rwanda.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - T Habiyaremye
- Human Resource for Health Secretariat, Ministry of Health, Kigali, Rwanda.,Department of Clinical and Public Health Services, Ministry of Health, Kigali, Rwanda
| | - P C Kayumba
- College of Business and Economics, African Centre of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
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Habimana R, Ngeno K, Mahoro J, Ntawubizi M, Shumbusho F, Manzi M, Hirwa CA, Okeno TO. Morphobiometrical characteristics of indigenous chicken ecotype populations in Rwanda. Trop Anim Health Prod 2020; 53:24. [PMID: 33219485 DOI: 10.1007/s11250-020-02475-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
The rational of conservation and sustainable use of indigenous chicken (IC) resources requires their morphobiometrical characterisation. This study morphobiometrically characterised the IC ecotypes in Rwanda. The morphological features and zoometric measurement data were randomly collected on 1670 mature IC of both sexes from five ecotypes of Rwanda. The nonparametric Kruskal-Wallis and Mann-Whitney U test were used in evaluating the effect of ecotypes on the qualitative morphological variables. Zoometric measurements were analysed with the PROC GLM of SAS. The findings showed that the feather morphology and distribution were mainly normal (98.3 and 84.40%, respectively) while feather colour was dominated with multicoloured (38.10%). The majority of the birds had red earlobe (49.20%), yellow shanks (53.80%) and single comb-type (71.70%). These parameters were different (p < 0.05) between the ecotypes. Bodyweight and linear body measurements were highly different (P < 0.001) between ecotypes. Differences associated with sex (P < 0.001) were observed in body weight and linear body measurements. The interaction between ecotype and sex significantly (P < 0.001) influenced body weight, body length, shank length, comb length, comb height, wattle length, chest circumference, neck length and wingspan. The IC ecotypes in Rwanda were found to be diverse morphobiometrically both in quantitative and qualitative traits. These variations provide a foundation for classification of the chicken into breeds.
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Affiliation(s)
- R Habimana
- School of Veterinary Medicine, College of Agriculture, Animal Science and Veterinary Medicine, University of Rwanda, PO. Box 57, Nyagatare, Rwanda. .,Animal Breeding and Genomics Group, Department of Animal Science, Egerton University, P.O. Box 536, Egerton, 20115, Kenya.
| | - K Ngeno
- Animal Breeding and Genomics Group, Department of Animal Science, Egerton University, P.O. Box 536, Egerton, 20115, Kenya
| | - J Mahoro
- School of Veterinary Medicine, College of Agriculture, Animal Science and Veterinary Medicine, University of Rwanda, PO. Box 57, Nyagatare, Rwanda
| | - M Ntawubizi
- School of Veterinary Medicine, College of Agriculture, Animal Science and Veterinary Medicine, University of Rwanda, PO. Box 57, Nyagatare, Rwanda
| | - F Shumbusho
- Rwanda Agricultural and Animal Resources Development Board, P.O. Box 5016, Kigali, Rwanda
| | - M Manzi
- Rwanda Agricultural and Animal Resources Development Board, P.O. Box 5016, Kigali, Rwanda
| | - C A Hirwa
- Rwanda Agricultural and Animal Resources Development Board, P.O. Box 5016, Kigali, Rwanda
| | - T O Okeno
- Animal Breeding and Genomics Group, Department of Animal Science, Egerton University, P.O. Box 536, Egerton, 20115, Kenya
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Makelele JPK, Ade S, Takarinda KC, Manzi M, Cuesta JG, Acma A, Yépez MM, Mashako M. Outcomes of cholera and measles outbreak alerts in the Democratic Republic of Congo. Public Health Action 2020; 10:124-130. [PMID: 33134127 DOI: 10.5588/pha.19.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
Setting In 1995, a rapid response project for humanitarian and medical emergencies, including outbreak responses, named 'Pool d'Urgence Congo' (PUC), was implemented in the Democratic Republic of Congo by Médecins Sans Frontières. Objective To assess the outcomes of cholera and measles outbreak alerts that were received in the PUC surveillance system between 2016 and 2018. Design This was a retrospective cross-sectional study. Results Overall, 459 outbreak alerts were detected, respectively 69% and 31% for cholera and measles. Of these, 32% were actively detected and 68% passively detected. Most alerts (90%) required no intervention and 10% of alerts had an intervention. There were 25% investigations that were not carried out despite thresholds being met; 17% interventions were not performed, the main reported reason being PUC operational capacity was exceeded. Confirmed cholera and measles outbreaks that met an investigation threshold comprised respectively 90% and 76% of alerts; 59% of measles investigations were followed by a delayed outbreak response of ⩾14 days (n = 10 outbreaks). Conclusion Some alerts for cholera and measles outbreaks that were detected in the PUC system did not lead to a response even when required; the main reported reason was limited operational capacity to respond to all of them.
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Affiliation(s)
- J P K Makelele
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
| | - S Ade
- Faculté de Médecine, Université de Parakou, Parakou, Bénin.,Center for Operational Research, International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - K C Takarinda
- Center for Operational Research, International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - M Manzi
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, Operational Research Unit (LuOR), MSF Luxembourg
| | - J Gil Cuesta
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, Operational Research Unit (LuOR), MSF Luxembourg
| | - A Acma
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
| | - M M Yépez
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
| | - M Mashako
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
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Obopile M, Segoea G, Waniwa K, Ntebela DS, Moakofhi K, Motlaleng M, Mosweunyane T, Edwards JK, Namboze J, Butt W, Manzi M, Takarinda KC, Owiti P. Did microbial larviciding contribute to a reduction in malaria cases in eastern Botswana in 2012-2013? Public Health Action 2018; 8:S50-S54. [PMID: 29713595 DOI: 10.5588/pha.17.0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 09/17/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Larviciding has potential as a component of integrated vector management for the reduction of malaria transmission in Botswana by complementing long-lasting insecticide nets and indoor residual sprays. Objective: To evaluate the susceptibility of local Anopheles to commonly used larvicides. Design: This field test of the efficacy of Bacillus thuringiensis subsp. israliensis vs. Anopheles was performed by measuring larval density before treatment and 24 h and 48 h after treatment in seven sites of Bobirwa district, eastern Botswana, in 2012 and 2013. Vector density and malaria cases were compared between Bobirwa and Ngami (northwestern Botswana), with no larviciding in the control arm. Results: Larviciding reduced larval density by 95% in Bobirwa in 2012, with two cases of malaria, while in 2013 larval density reduction was 81%, with 11 cases. Adult mosquito density was zero for both years in Robelela village (Bobirwa), compared to respectively four and 26 adult mosquitoes per room in Shorobe village (Ngami) in 2012 and 2013. There were no cases of malaria in Robelela in either year, but in Shorobe there were 20 and 70 cases, respectively, in 2012 and 2013. Conclusion: Larviciding can reduce the larval density of mosquitoes and reduce malaria transmission in Botswana. Large-scale, targeted implementation of larviciding in districts at high risk for malaria is recommended.
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Affiliation(s)
- M Obopile
- Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - G Segoea
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - K Waniwa
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - D S Ntebela
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - K Moakofhi
- World Health Organization (WHO) Country Office for Botswana, Gaborone, Botswana
| | - M Motlaleng
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - T Mosweunyane
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | | | - J Namboze
- Inter-Country Support Team, WHO, Harare, Zimbabwe
| | - W Butt
- Inter-Country Support Team, WHO, Harare, Zimbabwe
| | - M Manzi
- Médecins Sans Frontières, Brussels, Belgium
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Moakofhi K, Edwards JK, Motlaleng M, Namboze J, Butt W, Obopile M, Mosweunyane T, Manzi M, Takarinda KC, Owiti P. Advances in malaria elimination in Botswana: a dramatic shift to parasitological diagnosis, 2008-2014. Public Health Action 2018; 8:S34-S38. [PMID: 29713592 DOI: 10.5588/pha.17.0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 08/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Malaria elimination requires infection detection using quality assured diagnostics and appropriate treatment regimens. Although Botswana is moving towards malaria elimination, reports of unconfirmed cases may jeopardise this effort. This study aimed to determine the proportion of cases treated for malaria that were confirmed by rapid diagnostic testing (RDT) and/or microscopy. Methods: This was a retrospective descriptive study using routine national data from the integrated disease surveillance and case-based surveillance systems from 2008 to 2014. The data were categorised into clinical and confirmed cases each year. An analysis of the data on cases registered in three districts that reported approximately 70% of all malaria cases was performed, stratified by year, type of reporting health facilities and diagnostic method. Results: During 2008-2014, 50 487 cases of malaria were reported in Botswana, and the proportion of RDT and/or blood microscopy confirmed cases improved from 6% in 2008 to 89% in 2013. The total number of malaria cases decreased by 97% in the same period, then increased by 41% in 2013. Conclusion: This study shows that malaria diagnostic tests dramatically improved malaria diagnosis and consequently reduced the malaria burden in Botswana. The study identified a need to build capacity on microscopy for species identification, parasite quantification and guiding treatment choices.
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Affiliation(s)
- K Moakofhi
- World Health Organization (WHO) Botswana Country Office, Gaborone, Botswana
| | | | - M Motlaleng
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - J Namboze
- Inter-Country Support Team, WHO, Harare, Zimbabwe
| | - W Butt
- Inter-Country Support Team, WHO, Harare, Zimbabwe
| | - M Obopile
- Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - T Mosweunyane
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - M Manzi
- Médecins Sans Frontières, Brussels, Belgium
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Motlaleng M, Edwards J, Namboze J, Butt W, Moakofhi K, Obopile M, Manzi M, Takarinda KC, Zachariah R, Owiti P, Oumer N, Mosweunyane T. Driving towards malaria elimination in Botswana by 2018: progress on case-based surveillance, 2013-2014. Public Health Action 2018; 8:S24-S28. [PMID: 29713590 DOI: 10.5588/pha.17.0019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Reliable information reporting systems ensure that all malaria cases are tested, treated and tracked to avoid further transmission. Botswana aimed to eliminate malaria by 2018, and surveillance is key. This study focused on assessing the uptake of the new malaria case-based surveillance (CBS) system introduced in 2012, which captures information on malaria cases reported in the Integrated Disease Surveillance and Response (IDSR) system. Methods: This was a retrospective descriptive study based on routine data focusing on Ngami, Chobe and Okavango, three high-risk districts in Botswana. Aggregated data variables were extracted from the IDSR and compared with data from the CBS. Results: The IDSR reported 456 malaria cases in 2013 and 1346 in 2014, of which respectively only 305 and 884 were reported by the CBS. The CBS reported 34% fewer cases than the IDSR system, indicating substantial differences between the two systems. The key malaria indicators with the greatest variability among the districts included in the study were case identification number and date of diagnosis. Conclusion: The IDSR and CBS systems are essential for malaria elimination, as shown by the significant gaps in reporting between the two systems. These findings highlight the need for further investigation into these discrepancies. Strengthening the CBS system will help to reach the objective of malaria elimination in Botswana.
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Affiliation(s)
- M Motlaleng
- National Malaria Programme, Ministry of Health, Gaborone, Botswana
| | - J Edwards
- Operational Centre Brussels, Médecins Sans Frontières (MSF), Luxembourg City, Luxembourg
| | - J Namboze
- Inter-Country Support Team, World Health Organization (WHO), Harare, Zimbabwe
| | - W Butt
- Inter-Country Support Team, World Health Organization (WHO), Harare, Zimbabwe
| | - K Moakofhi
- WHO Country Office for Botswana, Gaborone, Botswana
| | - M Obopile
- Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - M Manzi
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R Zachariah
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Operational Centre Brussels, MSF, Luxembourg City, Luxembourg
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - N Oumer
- National Malaria Programme, Ministry of Health, Gaborone, Botswana
| | - T Mosweunyane
- National Malaria Programme, Ministry of Health, Gaborone, Botswana
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Butler J, Fonseca E, Yang M, Rhodes T, Patel M, Manzi M, Hess G, Givertz M. P4368Characteristics and treatment of worsening chronic heart failure: real world evidence from linked PINNACLE Registry and claims data. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gerdts E, Izzo R, Mancusi C, Losi M, Manzi M, Canciello G, De Luca N, Trimarco B, De Simone G. 2897Sex difference in cardiovascular risk is offset by presence of left ventricular hypertrophy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.2897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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van den Boogaard W, Zuniga I, Manzi M, Van den Bergh R, Lefevre A, Nanan-N'zeth K, Duchenne B, Etienne W, Juma N, Ndelema B, Zachariah R, Reid A. How do low-birthweight neonates fare 2 years after discharge from a low-technology neonatal care unit in a rural district hospital in Burundi? Trop Med Int Health 2017; 22:423-430. [PMID: 28142216 DOI: 10.1111/tmi.12845] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES As neonatal care is being scaled up in economically poor settings, there is a need to know more on post-hospital discharge and longer-term outcomes. Of particular interest are mortality, prevalence of developmental impairments and malnutrition, all known to be worse in low-birthweight neonates (LBW, <2500 g). Getting a better handle on these parameters might justify and guide support interventions. Two years after hospital discharge, we thus assessed: mortality, developmental impairments and nutritional status of LBW children. METHODS Household survey of LBW neonates discharged from a neonatal special care unit in Rural Burundi between January and December 2012. RESULTS Of 146 LBW neonates, 23% could not be traced and 4% had died. Of the remaining 107 children (median age = 27 months), at least one developmental impairment was found in 27%, with 8% having at least five impairments. Main impairments included delays in motor development (17%) and in learning and speech (12%). Compared to LBW children (n = 100), very-low-birthweight (VLBW, <1500 g, n = 7) children had a significantly higher risk of impairments (intellectual - P = 0.001), needing constant supervision and creating a household burden (P = 0.009). Of all children (n-107), 18% were acutely malnourished, with a 3½ times higher risk in VLBWs (P = 0.02). CONCLUSIONS Reassuringly, most children were thriving 2 years after discharge. However, malnutrition was prevalent and one in three manifested developmental impairments (particularly VLBWs) echoing the need for support programmes. A considerable proportion of children could not be traced, and this emphasises the need for follow-up systems post-discharge.
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Affiliation(s)
- W van den Boogaard
- Médecins Sans Frontières, Brussels Operational Centre - Operational Research Unit (LuxOR), Luxembourg City, Luxembourg
| | - I Zuniga
- Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium
| | - M Manzi
- Médecins Sans Frontières, Brussels Operational Centre - Operational Research Unit (LuxOR), Luxembourg City, Luxembourg
| | - R Van den Bergh
- Médecins Sans Frontières, Brussels Operational Centre - Operational Research Unit (LuxOR), Luxembourg City, Luxembourg
| | - A Lefevre
- Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium
| | | | - B Duchenne
- Médecins Sans Frontières, Bujumbura, Burundi
| | - W Etienne
- Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium
| | - N Juma
- Ministry of Health, Bujumbura, Burundi
| | - B Ndelema
- Ministry of Health, Bujumbura, Burundi
| | - R Zachariah
- Médecins Sans Frontières, Brussels Operational Centre - Operational Research Unit (LuxOR), Luxembourg City, Luxembourg
| | - A Reid
- Médecins Sans Frontières, Brussels Operational Centre - Operational Research Unit (LuxOR), Luxembourg City, Luxembourg
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De Plecker E, Zachariah R, Kumar AMV, Trelles M, Caluwaerts S, van den Boogaard W, Manirampa J, Tayler-Smith K, Manzi M, Nanan-N’zeth K, Duchenne B, Ndelema B, Etienne W, Alders P, Veerman R, Van den Bergh R. Emergency obstetric care in a rural district of Burundi: What are the surgical needs? PLoS One 2017; 12:e0170882. [PMID: 28170398 PMCID: PMC5295715 DOI: 10.1371/journal.pone.0170882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 01/13/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes. METHODS A retrospective analysis of EmOC data (2011 and 2012). RESULTS A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%). A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by 'general practitioners with surgical skills' and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died. CONCLUSION Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.
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Affiliation(s)
- E. De Plecker
- Medecins sans Frontieres, Medical department, Brussels Operational Centre, Brussels, Belgium
- * E-mail:
| | - R. Zachariah
- Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - A. M. V. Kumar
- International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi India
| | - M. Trelles
- Medecins sans Frontieres, Medical department, Brussels Operational Centre, Brussels, Belgium
| | - S. Caluwaerts
- Medecins sans Frontieres, Medical department, Brussels Operational Centre, Brussels, Belgium
| | | | | | - K. Tayler-Smith
- Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - M. Manzi
- Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | | | - B. Duchenne
- Medecins sans Frontieres, Bujumbura, Burundi
| | - B. Ndelema
- Medecins sans Frontieres, Bujumbura, Burundi
| | - W. Etienne
- Medecins sans Frontieres, Operational department, Brussels Operational Centre, Brussels, Belgium
| | - P. Alders
- Medecins sans Frontieres, Operational department, Brussels Operational Centre, Brussels, Belgium
| | - R. Veerman
- Medecins sans Frontieres, Operational department, Brussels Operational Centre, Brussels, Belgium
| | - R. Van den Bergh
- Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
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van den Boogaard W, Manzi M, De Plecker E, Caluwaerts S, Nanan-N'zeth K, Duchenne B, Etienne W, Juma N, Ndelema B, Zachariah R. Caesarean sections in rural Burundi: how well are mothers doing two years on? Public Health Action 2016; 6:72-6. [PMID: 27358799 DOI: 10.5588/pha.15.0075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 02/09/2016] [Indexed: 11/10/2022] Open
Abstract
SETTING A caesarean section (C-section) is a life-saving emergency intervention. Avoiding pregnancies for at least 24 months after a C-section is important to prevent uterine rupture and maternal death. OBJECTIVES Two years following an emergency C-section, in rural Burundi, we assessed complications and maternal death during the post-natal period, uptake and compliance with family planning, subsequent pregnancies and their maternal and neonatal outcomes. METHODS A household survey among women who underwent C-sections. RESULTS Of 156 women who underwent a C-section, 116 (74%) were traced; 1 had died of cholera, 8 had migrated and 31 were untraceable. Of the 116 traced, there were no post-operative complications and no deaths. At hospital discharge, 83 (72%) women accepted family planning. At 24 months after hospital discharge (n = 116), 23 (20%) had delivered and 17 (15%) were pregnant. Of the remaining 76 women, 48 (63%) were not on family planning. The main reasons for this were religion or husband's non-agreement. Of the 23 women who delivered, there was one uterine rupture, no maternal deaths and three stillbirths. CONCLUSIONS Despite encouraging maternal outcomes, this study raises concerns around the effectiveness of current approaches to promote and sustain family planning for a minimum of 24 months following a C-section. Innovative ways of promoting family planning in this vulnerable group are urgently needed.
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Affiliation(s)
- W van den Boogaard
- Médecins Sans Frontières (MSF), Operational Research Medical Department, Luxembourg City, Luxembourg
| | - M Manzi
- Médecins Sans Frontières (MSF), Operational Research Medical Department, Luxembourg City, Luxembourg
| | - E De Plecker
- MSF, Brussels Operational Centre, Brussels, Belgium
| | - S Caluwaerts
- MSF, Brussels Operational Centre, Brussels, Belgium
| | | | | | - W Etienne
- MSF, Brussels Operational Centre, Brussels, Belgium
| | - N Juma
- Ministry of Health, Bujumbura, Burundi
| | - B Ndelema
- Ministry of Health, Bujumbura, Burundi
| | - R Zachariah
- Médecins Sans Frontières (MSF), Operational Research Medical Department, Luxembourg City, Luxembourg
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Benedetti G, Mossoko M, Nyakio Kakusu JP, Nyembo J, Mangion JP, Van Laeken D, Van den Bergh R, Van den Boogaard W, Manzi M, Kibango WK, Hermans V, Beijnsberger J, Lambert V, Kitenge E. Sparks creating light? Strengthening peripheral disease surveillance in the Democratic Republic of Congo. Public Health Action 2016; 6:54-9. [PMID: 27358796 DOI: 10.5588/pha.15.0080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 03/24/2016] [Indexed: 11/10/2022] Open
Abstract
SETTING The Democratic Republic of Congo suffers from an amalgam of disease outbreaks and other medical emergencies. An efficient response to these relies strongly on the national surveillance system. The Pool d'Urgence Congo (PUC, Congo Emergency Team) of Médecins Sans Frontières is a project that responds to emergencies in highly remote areas through short-term vertical interventions, during which it uses the opportunity of its presence to reinforce the local surveillance system. OBJECTIVE To investigate whether the ancillary strengthening of the peripheral surveillance system during short-term interventions leads to improved disease notification. DESIGN A descriptive paired study measuring disease notification before and after 12 PUC interventions in 2013-2014. RESULTS A significant increase in disease notification was observed after seven mass-vaccination campaigns and was sustained over 6 months. For the remaining five smaller-scaled interventions, no significant effects were observed. CONCLUSION The observed improvements after even short-term interventions underline, on the one hand, how external emergency actors can positively affect the system through their punctuated actions, and, on the other hand, the dire need for investment in surveillance at peripheral level.
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Affiliation(s)
- G Benedetti
- Médecins Sans Frontières (MSF), Kinshasa, Democratic Republic of Congo
| | - M Mossoko
- Ministère de la Santé Publique, Secrétariat Général à la Santé, Direction de Lutte contre la Maladie, Kinshasa, Democratic Republic of Congo
| | - J P Nyakio Kakusu
- Médecins Sans Frontières (MSF), Kinshasa, Democratic Republic of Congo
| | - J Nyembo
- Médecins Sans Frontières (MSF), Kinshasa, Democratic Republic of Congo
| | - J P Mangion
- Médecins Sans Frontières (MSF), Kinshasa, Democratic Republic of Congo
| | - D Van Laeken
- Médecins Sans Frontières (MSF), Kinshasa, Democratic Republic of Congo
| | - R Van den Bergh
- MSF, Medical Department (Operational Research), Operational Centre Brussels (OCB), Luxembourg, Luxembourg
| | - W Van den Boogaard
- MSF, Medical Department (Operational Research), Operational Centre Brussels (OCB), Luxembourg, Luxembourg
| | - M Manzi
- MSF, Medical Department (Operational Research), Operational Centre Brussels (OCB), Luxembourg, Luxembourg
| | | | - V Hermans
- Médecins Sans Frontières (MSF), Kinshasa, Democratic Republic of Congo
| | - J Beijnsberger
- Médecins Sans Frontières (MSF), Kinshasa, Democratic Republic of Congo
| | | | - E Kitenge
- Ministère de la Santé Publique, Secrétariat Général à la Santé, Direction de Lutte contre la Maladie, Kinshasa, Democratic Republic of Congo
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Mchunu G, van Griensven J, Hinderaker SG, Kizito W, Sikhondze W, Manzi M, Dlamini T, Harries AD. High mortality in tuberculosis patients despite HIV interventions in Swaziland. Public Health Action 2016; 6:105-10. [PMID: 27358803 PMCID: PMC4913672 DOI: 10.5588/pha.15.0081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 12/12/2022] Open
Abstract
SETTING All health facilities providing tuberculosis (TB) care in Swaziland. OBJECTIVE To describe the impact of human immunodeficiency virus (HIV) interventions on the trend of TB treatment outcomes during 2010-2013 in Swaziland; and to describe the evolution in TB case notification, the uptake of HIV testing, antiretroviral therapy (ART) and cotrimoxazole preventive therapy (CPT), and the proportion of TB-HIV co-infected patients with adverse treatment outcomes, including mortality, loss to follow-up and treatment failure. DESIGN A retrospective descriptive study using aggregated national TB programme data. RESULTS Between 2010 and 2013, TB case notifications in Swaziland decreased by 40%, HIV testing increased from 86% to 96%, CPT uptake increased from 93% to 99% and ART uptake among TB patients increased from 35% to 75%. The TB-HIV co-infection rate remained around 70% and the proportion of TB-HIV cases with adverse outcomes decreased from 36% to 30%. Mortality remained high, at 14-16%, over the study period, and anti-tuberculosis treatment failure rates were stable over time (<5%). CONCLUSION Despite high CPT and ART uptake in TB-HIV patients, mortality remained high. Further studies are required to better define high-risk patient groups, understand the reasons for death and design appropriate interventions.
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Affiliation(s)
- G. Mchunu
- National TB Control Programme, Ministry of Health, Manzini, Swaziland
| | | | | | - W. Kizito
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Kenya Mission, Nairobi, Kenya
| | - W. Sikhondze
- National TB Control Programme, Ministry of Health, Manzini, Swaziland
| | - M. Manzi
- MSF, Medical Department, Operational Research Unit, Luxembourg
| | - T. Dlamini
- National TB Control Programme, Ministry of Health, Manzini, Swaziland
| | - A. D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
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16
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Bissell K, Viney K, Brostrom R, Gounder S, Khogali M, Kishore K, Kool B, Kumar AMV, Manzi M, Marais B, Marks G, Linh NN, Ram S, Reid S, Roseveare C, Tayler-Smith K, Van den Bergh R, Harries AD. Building operational research capacity in the Pacific. Public Health Action 2015; 4:S2-S13. [PMID: 26477282 DOI: 10.5588/pha.13.0091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.
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Affiliation(s)
- K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, the University of Auckland, Auckland, New Zealand
| | - K Viney
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - R Brostrom
- Division of TB Elimination, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S Gounder
- National Tuberculosis Programme, Fiji Ministry of Health, Suva, Fiji
| | - M Khogali
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - K Kishore
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - B Kool
- School of Population Health, the University of Auckland, Auckland, New Zealand
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - M Manzi
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - B Marais
- Marie Bashir Institute for Emerging Infections and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - G Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - N N Linh
- Global TB Programme, World Health Organization, Geneva, Switzerland ; Division of Pacific Technical Support, WHO Representative Office in the South Pacific, Suva, Fiji
| | - S Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - S Reid
- Australian Centre for International and Tropical Health, School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| | - C Roseveare
- Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - K Tayler-Smith
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - R Van den Bergh
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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17
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Ramsay A, Harries AD, Zachariah R, Bissell K, Hinderaker SG, Edginton M, Enarson DA, Satyanarayana S, Kumar AMV, Hoa NB, Tweya H, Reid AJ, Van den Bergh R, Tayler-Smith K, Manzi M, Khogali M, Kizito W, Ali E, Delaunois P, Reeder JC. The Structured Operational Research and Training Initiative for public health programmes. Public Health Action 2015; 4:79-84. [PMID: 26399203 DOI: 10.5588/pha.14.0011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In 2009, the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins sans Frontières Brussels-Luxembourg (MSF) began developing an outcome-oriented model for operational research training. In January 2013, The Union and MSF joined with the Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO) to form an initiative called the Structured Operational Research and Training Initiative (SORT IT). This integrates the training of public health programme staff with the conduct of operational research prioritised by their programme. SORT IT programmes consist of three one-week workshops over 9 months, with clearly-defined milestones and expected output. This paper describes the vision, objectives and structure of SORT IT programmes, including selection criteria for applicants, the research projects that can be undertaken within the time frame, the programme structure and milestones, mentorship, the monitoring and evaluation of the programmes and what happens beyond the programme in terms of further research, publications and the setting up of additional training programmes. There is a growing national and international need for operational research and related capacity building in public health. SORT IT aims to meet this need by advocating for the output-based model of operational research training for public health programme staff described here. It also aims to secure sustainable funding to expand training at a global and national level. Finally, it could act as an observatory to monitor and evaluate operational research in public health. Criteria for prospective partners wishing to join SORT IT have been drawn up.
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Affiliation(s)
- A Ramsay
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland ; Bute Medical School, University of St Andrews, Fife, Scotland, UK
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - R Zachariah
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, The University of Auckland, New Zealand
| | - S G Hinderaker
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Center for International Health, University of Bergen, Bergen, Norway
| | - M Edginton
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; The Union South-East Asia Regional Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; The Union South-East Asia Regional Office, New Delhi, India
| | - N B Hoa
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - H Tweya
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A J Reid
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - R Van den Bergh
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - K Tayler-Smith
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - M Manzi
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - M Khogali
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - W Kizito
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - E Ali
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - P Delaunois
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - J C Reeder
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
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18
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Tamura M, Hinderaker SG, Manzi M, Van Den Bergh R, Zachariah R. Severe acute maternal morbidity and associated deaths in conflict and post-conflict settings in Africa. Public Health Action 2015; 2:122-5. [PMID: 26392969 DOI: 10.5588/pha.12.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/04/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING Five hospitals in four conflict and post-conflict countries (Democratic Republic of Congo, Somaliland, Sierra Leone and Burundi). OBJECTIVES To report among hospital deliveries: 1) the proportion of severe acute maternal morbidity (SAMM), 2) the pattern of SAMM, and 3) maternal deaths according to type of SAMM. METHODS An audit of data from a standardised database implemented in all the sites in the study. RESULTS Of the 18 675 deliveries, there were 6314 (34%) known SAMM cases with 63 associated deaths, implying that for every 100 SAMM cases there was one maternal death. In descending order, the death-to-SAMM ratios per 1000 deliveries were: 1:7 for sepsis, 6 for haemorrhage 1:70 for hypertensive disorder and 1:398 for obstructed labour. A substantial proportion of deaths (38%) that occurred in hospitals could not be categorised into the standardised SAMM conditions available in the database. CONCLUSION As this is the first study using multi-centre data from conflict and post-conflict countries, these findings are relevant to improving maternal health in such settings. Findings, implications and possible ways forward in addressing various challenges are discussed.
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Affiliation(s)
- M Tamura
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Brussels, Belgium
| | - S G Hinderaker
- International Union Against Tuberculosis and Lung Disease, Paris, France ; The Centre for International Health, University of Bergen, Norway
| | - M Manzi
- Medical Department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - R Van Den Bergh
- Medical Department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - R Zachariah
- Medical Department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
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19
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van den Boogaard W, Manzi M, Harries AD, Reid AJ. Causes of pediatric mortality and case-fatality rates in eight Médecins Sans Frontières-supported hospitals in Africa. Public Health Action 2015; 2:117-21. [PMID: 26392968 DOI: 10.5588/pha.12.0038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/01/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING Eight pediatric hospital in-patient wards in remote, rural and/or insecure areas in Africa. OBJECTIVES To describe, in children aged <5 years, 1) overall and individual mortality rates, 2) the 10 most common causes of mortality, and 3) their case-fatality rates. DESIGN Retrospective analysis of routinely collected standardized program data for 2010. RESULTS During 2010, 21 357 children aged <5 years were admitted and 1520 died, resulting in an overall in-patient mortality rate among under-fives of 7%. This remained the same after considering the three most common causes of mortality per hospital. One hospital with a neonatal unit showed a mortality rate of 14%. Of the 10 most common causes of mortality in the eight hospitals, severe malaria, acute lower respiratory tract infection and neonatal infection counted for about 77% of total deaths. Ranking the 10 most common causes of mortality according to case-fatality rates, septicemia, meningitis, low birth weight with pathology, neonatal infection and neonatal asphyxia were the most common (case-fatality rates 15-40%). CONCLUSION Despite widely different contexts, mortality rates for pediatric in-patients were consistently under 10%. To further reduce mortality, emphasis should be placed on treating sepsis and introducing implementable and/or adapted care packages for neonatal-related pathologies.
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Affiliation(s)
- W van den Boogaard
- Médecins Sans Frontières, Medical Department (Operational Research), Operational Centre Brussels, Luxembourg
| | - M Manzi
- Médecins Sans Frontières, Medical Department (Operational Research), Operational Centre Brussels, Luxembourg
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - A J Reid
- Médecins Sans Frontières, Medical Department (Operational Research), Operational Centre Brussels, Luxembourg
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20
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Ali E, Zachariah R, Dahmane A, Van den Boogaard W, Shams Z, Akter T, Alders P, Manzi M, Allaouna M, Draguez B, Delchevalerie P, Harries AD. Peanut-based ready-to-use therapeutic food: acceptability among malnourished children and community workers in Bangladesh. Public Health Action 2015; 3:128-35. [PMID: 26393015 DOI: 10.5588/pha.12.0077] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To assess the acceptability of a ready-to-use therapeutic food (Plumpy'nut(®) [PPN]) among 1) care givers of malnourished children and 2) community health workers (CHWs) at a nutrition rehabilitation centre in an urban slum in Dhaka, Bangladesh. METHODS This was a cross-sectional semi-structured questionnaire survey conducted between April and June 2011 as part of a nutritional programme run by Médecins Sans Frontières. The study population included care givers of malnourished children aged 6-59 months who received PPN for at least 3 weeks, and CHWs. RESULTS Of the 149 care givers (93% female) interviewed, 60% expressed problems with PPN acceptability. Overall, 43% perceived the child's dissatisfaction with the taste, 31% with consistency and 64% attributed side effects to PPN (nausea, vomiting, loose motion, diarrhoea, abdominal distension and pain). It is to be noted that 47% of children needed encouragement or were forced to eat PPN, while 5% completely rejected it after 3 weeks. Of the 29 CHWs interviewed, 48% were dissatisfied with PPN's taste and consistency, and 55% with its smell. However, 91% of the care givers and all CHWs still perceived a therapeutic benefit of PPN for malnourished children. CONCLUSION Despite a therapeutic benefit, only 4 in 10 care givers perceived PPN as being acceptable as a food product, which is of concern.
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Affiliation(s)
- E Ali
- Medical Department (Operational Research), Médecins Sans Frontières (MSF), Luxembourg, Luxembourg
| | - R Zachariah
- Medical Department (Operational Research), Médecins Sans Frontières (MSF), Luxembourg, Luxembourg
| | - A Dahmane
- Medical Department (Operational Research), Médecins Sans Frontières (MSF), Luxembourg, Luxembourg
| | - W Van den Boogaard
- Medical Department (Operational Research), Médecins Sans Frontières (MSF), Luxembourg, Luxembourg
| | | | | | - P Alders
- Brussels Operational Centre, MSF, Brussels, Belgium
| | - M Manzi
- Medical Department (Operational Research), Médecins Sans Frontières (MSF), Luxembourg, Luxembourg
| | - M Allaouna
- Brussels Operational Centre, MSF, Brussels, Belgium
| | - B Draguez
- Brussels Operational Centre, MSF, Brussels, Belgium
| | | | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Shams Z, Zachariah R, Enarson DA, Satyanarayana S, Van den Bergh R, Ali E, Alders P, Manzi M, Allaouna M, Draguez B, Delchevalerie P, Vernaeve L, Harries AD. Severe malnutrition in children presenting to health facilities in an urban slum in Bangladesh. Public Health Action 2015; 2:107-11. [PMID: 26392966 DOI: 10.5588/pha.12.0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 09/20/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING An urban slum in Kamrangirchar, Bangladesh. OBJECTIVES Among children aged 6-59 months seeking medical care from the two Médecins Sans Frontières-supported primary health centres, to determine 1) the prevalence of severe acute malnutrition (SAM) and severe chronic malnutrition (SCM), and 2) the extent of overlap between SAM and SCM. DESIGN In a retrospective record review, data were analysed from out-patient registers on age, sex, height, weight and mid-upper arm circumference (MUAC) of children attending for medical care from April to September 2011. SAM was defined as weight for height < -3 Z scores of the median and/or MUAC <115 mm. SCM was defined as height for age < -3 Z scores of the median. World Health Organization growth standards were used as reference. RESULTS Data were complete in the records of 7318 (98%) children, of whom 322 (4%) had SAM and 1698 (23%) had SCM. Among the 322 children with SAM, 162 (50%) also had SCM. CONCLUSION In an urban Bangladesh slum, SAM and SCM co-exist, with a predominance of SCM. The current national guidelines for severe malnutrition, which focus on identification and management only for SAM, urgently need to be expanded to include SCM if substantial childhood morbidity and mortality are to be reduced.
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Affiliation(s)
- Z Shams
- Médecins Sans Frontières (MSF), Kamrangirchar, Dhaka, Bangladesh
| | - R Zachariah
- MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S Satyanarayana
- The Union, South-East Asia Regional Office, New Delhi, India
| | - R Van den Bergh
- MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg
| | - E Ali
- MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg
| | - P Alders
- MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg
| | - M Manzi
- MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg
| | - M Allaouna
- MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg
| | - B Draguez
- MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg
| | - P Delchevalerie
- MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg
| | - L Vernaeve
- Médecins Sans Frontières (MSF), Kamrangirchar, Dhaka, Bangladesh
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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22
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Davtyan K, Zachariah R, Davtyan H, Ramsay A, Denisiuk O, Manzi M, Khogali M, Van den Bergh R, Hayrapetyan A, Dara M. Performance of decentralised facilities in tuberculosis case notification and treatment success in Armenia. Public Health Action 2015; 4:S13-6. [PMID: 26393091 DOI: 10.5588/pha.14.0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
We assessed the performance of decentralised tuberculosis (TB) out-patient centres in tuberculosis (TB) case notification and treatment success in Armenia. An average threshold case notification of ⩾37/100 000 was seen in centres that had higher numbers of presumptive TB patients, where more TB was diagnosed by in-patient facilities and where TB contacts were examined. The number of doctors and/or TB specialists at centres did not influence case notification. Onsite smear microscopy was significantly associated with a treatment success rate of ⩾85% for new TB patients. Addressing specific characteristics of TB centres associated with lower case notification and treatment success and optimising their location may improve performance.
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Affiliation(s)
- K Davtyan
- National Tuberculosis Control Programme, Ministry of Health of Armenia, Yerevan, Armenia
| | - R Zachariah
- Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - H Davtyan
- National Tuberculosis Control Programme, Ministry of Health of Armenia, Yerevan, Armenia
| | - A Ramsay
- University of St Andrews Medical School, Fife, Scotland, United Kingdom
| | - O Denisiuk
- International HIV/AIDS Alliance in Ukraine, Kiev, Ukraine
| | - M Manzi
- Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - M Khogali
- Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - R Van den Bergh
- Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - A Hayrapetyan
- National Tuberculosis Control Programme, Ministry of Health of Armenia, Yerevan, Armenia
| | - M Dara
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Zuniga I, Van den Bergh R, Ndelema B, Bulckaert D, Manzi M, Lambert V, Zachariah R, Reid AJ, Harries AD. Characteristics and mortality of neonates in an emergency obstetric and neonatal care facility, rural Burundi. Public Health Action 2015; 3:276-81. [PMID: 26393046 DOI: 10.5588/pha.13.0050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/05/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING A Médecins Sans Frontières emergency obstetric and neonatal care facility specialising as a referral centre for three districts for women with complications during pregnancy or delivery in rural Burundi. OBJECTIVE To describe the characteristics and in-facility mortality rates of neonates born in 2011. DESIGN Descriptive study involving a retrospective review of routinely collected facility data. RESULTS Of 2285 women who delivered, the main complications were prolonged labour 331 (14%), arrested labour 238 (10%), previous uterine intervention 203 (9%), breech 171 (8%) and multiple gestations 150 (7%). There were 175 stillbirths and 2110 live neonates, of whom 515 (24%) were of low birth weight, 963 (46%) were delivered through caesarean section and 267 (13%) required active birth resuscitation. Overall, there were 102 (5%) neonatal deaths. A total of 453 (21%) neonates were admitted to dedicated neonatal special services for sick and low birth weight babies. A high proportion of these neonates were delivered by caesarean section and needed active birth resuscitation. Of 67 (15%) neonatal deaths in special services, 85% were due to conditions linked to low birth weight and birth asphyxia. CONCLUSION Among neonates born to women with complications during pregnancy or delivery, in-facility deaths due to low birth weight and birth asphyxia were considerable. Sustained attention is needed to reduce these mortality rates.
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Affiliation(s)
- I Zuniga
- Médecins Sans Frontières Operational Centre Brussels, Brussels, Belgium
| | - R Van den Bergh
- Médecins Sans Frontières Operational Centre Brussels, Brussels, Belgium
| | - B Ndelema
- Ministry of Health, Bujumbura, Burundi
| | - D Bulckaert
- Médecins Sans Frontières Operational Centre Brussels, Brussels, Belgium
| | - M Manzi
- Médecins Sans Frontières Operational Centre Brussels, Brussels, Belgium
| | - V Lambert
- Médecins Sans Frontières Operational Centre Brussels, Brussels, Belgium
| | - R Zachariah
- Médecins Sans Frontières Operational Centre Brussels, Brussels, Belgium
| | - A J Reid
- Médecins Sans Frontières Operational Centre Brussels, Brussels, Belgium
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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24
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Lytvynenko N, Cherenko S, Feschenko Y, Pogrebna M, Senko Y, Barbova A, Manzi M, Denisiuk O, Ramsay A, Zachariah R. Management of multi- and extensively drug-resistant tuberculosis in Ukraine: how well are we doing? Public Health Action 2015; 4:S67-72. [PMID: 26393102 DOI: 10.5588/pha.14.0035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/07/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING A tertiary care facility in Ukraine, a high multi- and extensively drug-resistant tuberculosis (MDR/XDR-TB) burden country. OBJECTIVES To assess the management and treatment outcomes of MDR, pre-XDR-TB and XDR-TB. DESIGN Cohort study using programme data, 2006-2011. RESULTS Of 484 individuals with drug-resistant TB, 217 (45%) had MDR-, 153 (32%) pre-XDR- and 114 (24%) XDR-TB. Of all resistant types completing the intensive phase of treatment, 322 (67%) were alive and had culture converted. This included 157 (72%) with MDR- and 61 (54%) with XDR-TB. At the end of the continuation phase of treatment, 106 (22%) had treatment success and 378 (78%) had unfavourable outcomes, including 110 (23%) failures, 21 (4%) deaths, 71 (15%) losses to follow-up and 176 (36%) with an unknown outcome. This was associated with more than one lung cavity being affected, a history of treatment with second-line anti-tuberculosis drugs, poor adherence and XDR-TB. A total of 226 (47%) patients reported at least one adverse drug reaction, the most common being gastrointestinal and vestibular toxicity. CONCLUSION Outcomes of MDR- and XDR-TB were satisfactory in the intensive phase; however, this was not sustained during the ambulatory period. If we are to do better, urgent measures are needed to improve ambulatory management, including making safer, shorter and more effective drug regimens available.
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Affiliation(s)
- N Lytvynenko
- F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - S Cherenko
- F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Y Feschenko
- F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - M Pogrebna
- F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Y Senko
- F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - A Barbova
- F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - M Manzi
- Brussels Operational Center, Médecins Sans Frontières (MSF), MSF Luxembourg, Luxembourg
| | | | - A Ramsay
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland ; University of St Andrews Medical School, North Haugh, Scotland, United Kingdom
| | - R Zachariah
- Brussels Operational Center, Médecins Sans Frontières (MSF), MSF Luxembourg, Luxembourg
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25
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Dolgusev O, Obevzenco N, Padalco O, Pankrushev S, Ramsay A, Van den Bergh R, Manzi M, Denisiuk O, Zachariah R. Pattern of primary tuberculosis drug resistance and associated treatment outcomes in Transnistria, Moldova. Public Health Action 2014; 4:S64-6. [DOI: 10.5588/pha.14.0043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 07/26/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- O. Dolgusev
- TB Coordination, TB Control Programme, Bendery, Transnistria, Republic of Moldova
| | - N. Obevzenco
- Republican Tuberculosis Hospital, TB Control Programme, Bendery, Transnistria, Republic of Moldova
| | - O. Padalco
- Republican TB Dispensary, TB Control Programme, Bendery, Transnistria, Republic of Moldova
| | - S. Pankrushev
- TB Control Programme, Tiraspol, Transnitria, Republic of Moldova
| | - A. Ramsay
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland, University of St Andrews Medical School, Fife, Scotland, United Kingdom
| | - R. Van den Bergh
- Operational Centre Brussels, Operational Research Unit (LuxOR), Médecins Sans Frontières (MSF) Luxembourg, Luxembourg
| | - M. Manzi
- Operational Centre Brussels, Operational Research Unit (LuxOR), Médecins Sans Frontières (MSF) Luxembourg, Luxembourg
| | - O. Denisiuk
- International HIV/AIDS Alliance in Ukraine, Kiev, Ukraine
| | - R. Zachariah
- Operational Centre Brussels, Operational Research Unit (LuxOR), Médecins Sans Frontières (MSF) Luxembourg, Luxembourg
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26
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Aiello A, Anichini R, Brocco E, Caravaggi C, Chiavetta A, Cioni R, Da Ros R, De Feo ME, Ferraresi R, Florio F, Gargiulo M, Galzerano G, Gandini R, Giurato L, Graziani L, Mancini L, Manzi M, Modugno P, Setacci C, Uccioli L. Treatment of peripheral arterial disease in diabetes: a consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE). Nutr Metab Cardiovasc Dis 2014; 24:355-369. [PMID: 24486336 DOI: 10.1016/j.numecd.2013.12.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/31/2013] [Accepted: 12/01/2013] [Indexed: 02/07/2023]
Abstract
Diabetic foot (DF) is a chronic and highly disabling complication of diabetes. The prevalence of peripheral arterial disease (PAD) is high in diabetic patients and, associated or not with peripheral neuropathy (PN), can be found in 50% of cases of DF. It is worth pointing out that the number of major amputations in diabetic patients is still very high. Many PAD diabetic patients are not revascularised due to lack of technical expertise or, even worse, negative beliefs because of poor experience. This despite the progress obtained in the techniques of distal revascularisation that nowadays allow to reopen distal arteries of the leg and foot. Italy has one of the lowest prevalence rates of major amputations in Europe, and has a long tradition in the field of limb salvage by means of an aggressive approach in debridement, antibiotic therapy and distal revascularisation. Therefore, we believe it is appropriate to produce a consensus document concerning the treatment of PAD and limb salvage in diabetic patients, based on the Italian experience in this field, to share with the scientific community.
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Affiliation(s)
- A Aiello
- P.O. Campobasso - ASReM, Campobasso, Italy
| | - R Anichini
- Servizi di Diabetologia, USL 3, Pistoia, Italy
| | - E Brocco
- Policlinico Abano Terme, Presidio Ospedaliero ULSS 16, Veneto, Italy
| | - C Caravaggi
- Istituto Clinico "Città Studi", Milan, Italy
| | | | - R Cioni
- Dipartimento Radiologia Diagnostica, interventistica e medicina nucleare, Azienda Ospedaliera Universitaria Pisana, Pisa, italy
| | - R Da Ros
- Centro Diabetologico Monfalcone (GO) - Ass2, Gorizia, Italy
| | - M E De Feo
- U.O.S. Diabetologia A.O.R.N. "A. Cardarelli", Naples, Italy
| | - R Ferraresi
- Emodinamica Interventistica Cardiovascolare, Istituto Clinico Città Studi, Milan, Italy
| | - F Florio
- IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - M Gargiulo
- Chirurgia Vascolare, Azienda Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - G Galzerano
- Department of Surgery Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - R Gandini
- Dipartimento Diagnostica per immagini, Imaging molecolare, radioterapia e radiologia interventistica, Policlinico Universitario Tor Vergata, Rome, Italy
| | - L Giurato
- Diabetic Foot Unit, Dept of Internal Medicine, Policlinico Universitario Tor Vergata, Rome, Italy
| | - L Graziani
- Unità Operativa di Cardiologia Invasiva, Istituto Clinico "Città di Brescia", Brescia, Italy
| | - L Mancini
- Istituto Dermatologico Immacolata IRCCS, Rome, Italy
| | - M Manzi
- Radiologia Interventistica, Policlinico Abano Terme, Presidio Ospedaliero ULSS 16, Veneto, Italy
| | - P Modugno
- Dipartimento Malattie Cardiovascolari Fondazione Giovanni Paolo II, Università Cattolica Sacro Cuore, Campobasso, Italy
| | - C Setacci
- Department of Surgery Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - L Uccioli
- Diabetic Foot Unit, Dept of Internal Medicine, Policlinico Universitario Tor Vergata, Rome, Italy.
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Ferraresi R, Palena LM, Mauri G, Manzi M. Tips and tricks for a correct "endo approach". J Cardiovasc Surg (Torino) 2013; 54:685-711. [PMID: 24126507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The world is facing an epidemic of diabetes, consequently in the next years critical limb ischemia due to diabetic artery disease will become a major issue for vascular and endovascular operators. Revascularization is a key therapy in these patients because reestablishing an adequate blood supply to the wound is essential for healing avoiding a major amputation. In this paper, we summarize our experience in endovascular treatment of diabetic critical limb ischemia, focusing of the main technical challenges in treating below-the-knee vessels. We describe the following topics: 1) targets of the revascularization therapy: "complete" versus "partial" revascularization and the concept of wound related artery. Every procedure must be tailored on technically realistic strategies and on the general patient status; 2) the antegrade femoral access using both, the X-ray and the ultrasound guided techniques; 3) the chronic total occlusions crossing strategy proposing a step-by-step approach: endoluminal, subintimal, retrograde approaches. Particular attention has been given to the different retrograde approaches: pedal-plantar loop technique, trans-collateral approaches and the different types of retrograde puncture. For each step we provide a complete description of the technical details and of the suitable devices. Eventually we in brief describe: 3) acute result optimization and 4) prevention of restenosis.
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Affiliation(s)
- R Ferraresi
- Peripheral Interventional Cathlab, Diabetic Foot Clinic Istituto Clinico Città Studi, Milan, Italy -
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28
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Palena LM, Brocco E, Ninkovic S, Volpe A, Manzi M. Ischemic Charcot foot: different disease with different treatment? J Cardiovasc Surg (Torino) 2013; 54:561-566. [PMID: 24002384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM Aim of the study was to describe the presence of peripheral arterial disease in combination with Charcot neuroarthropathy in diabetic patients, and to evaluate the role of revascularization supporting surgical and orthopedic treatment. METHODS We retrospectively collected and analyzed data of all diabetic patients affected by Charcot neuroarthropathy in combination with critical limb ischemia, which arrived to our care for the presence of foot lesions and underwent endovascular revascularization, followed by surgical and orthopedic treatment between January 2010 and January 2012. The primary end point was to assess the limb salvage rate. The secondary end point was to evaluate the healing time of the lesions. RESULTS Ten diabetic patients (10 men; mean age 69.1±8.5 years), affected by ischemic Charcot neuroarthropathy underwent endovascular revascularization, surgical debridement and orthopedic correction. The limb salvage rate was 90%, avoiding major amputation in 9 patients. In one patient (10%) the infection could not be controlled and below-the-knee amputation was carried out. The required time to heal the lesion was in mean 197.4±22.4 days, after revascularization, surgical and orthopedic treatment. CONCLUSION Patients with Charcot foot deformity can be affected by critical limb ischemia and revascularization therapy is necessary, to support surgical and orthopedic treatment, avoiding amputation and leading to limb and foot salvage.
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Affiliation(s)
- L M Palena
- Interventional Radiology Unit, Policlinico Abano Terme Abano Terme, Padua, Italy.
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29
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Mlilo N, Sandy C, Harries AD, Kumar AMV, Masuka N, Nyathi B, Edginton M, Isaakidis P, Manzi M, Siziba N. Does the type of treatment supporter influence tuberculosis treatment outcomes in Zimbabwe? Public Health Action 2013; 3:146-8. [PMID: 26393018 DOI: 10.5588/pha.13.0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 04/26/2013] [Indexed: 11/10/2022] Open
Abstract
Zimbabwe National Tuberculosis Guidelines advise that direct observation of anti-tuberculosis treatment (DOT) can be provided by a family member/relative as a last resort. In 2011, in Nkayi District, of 763 registered tuberculosis (TB) patients, 59 (8%) received health facility-based DOT, 392 (51%) received DOT from a trained community worker and 306 (40%) from a family member/relative. There were no differences in TB treatment outcomes between the three DOT groups, apart from a higher frequency rate of 'no reported outcomes' for those receiving family-based DOT. Family members should be trained to use a suitable DOT support package.
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Affiliation(s)
- N Mlilo
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe
| | - C Sandy
- National Tuberculosis Control Programme, Harare, Zimbabwe
| | - A D Harries
- The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - N Masuka
- Ministry of Health and Child Welfare, Matabeleland, North Province, Zimbabwe
| | - B Nyathi
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe
| | - M Edginton
- Ethics Advisory Group, The Union, Paris, France
| | - P Isaakidis
- Médecins Sans Frontières-Luxembourg, Luxembourg
| | - M Manzi
- Médecins Sans Frontières-Luxembourg, Luxembourg
| | - N Siziba
- National Tuberculosis Control Programme, Harare, Zimbabwe
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30
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Ngoy BB, Zachariah R, Hinderaker SG, Khogali M, Manzi M, van Griensven J, Ayada L, Jemmy JP, Maalim A, Amin H. Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality? [Short communication]. Public Health Action 2013; 3:125-7. [DOI: 10.5588/pha.12.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 03/11/2013] [Indexed: 11/10/2022] Open
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31
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Zachariah R, Reid T, Van den Bergh R, Dahmane A, Kosgei RJ, Hinderaker SG, Tayler-Smith K, Manzi M, Kizito W, Khogali M, Kumar AMV, Baruani B, Bishinga A, Kilale AM, Nqobili M, Patten G, Sobry A, Cheti E, Nakanwagi A, Enarson DA, Edginton ME, Upshur R, Harries AD. Applying the ICMJE authorship criteria to operational research in low-income countries: the need to engage programme managers and policy makers. Trop Med Int Health 2013; 18:1025-8. [DOI: 10.1111/tmi.12133] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Zachariah
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - T. Reid
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - R. Van den Bergh
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
- Department of Molecular and Cellular Interactions; Flemish Institute of Biotechnology; Brussels Belgium
- Department of Microbiology; Institute of Tropical Medicine; Antwerp Belgium
| | - A. Dahmane
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - R. J. Kosgei
- Department of Obstetrics and Gynecology; University of Nairobi; Nairobi Kenya
| | - S. G. Hinderaker
- Centre for International Health; University of Bergen; Bergen Norway
- Center for Operational Research; International Union Against Tuberculosis and Lung Disease; Paris France
| | - K. Tayler-Smith
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - M. Manzi
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - W. Kizito
- International Union Against TB and Lung Disease; Kampala Uganda
| | - M. Khogali
- Medecins Sans Frontieres; Addis Ababa Ethiopia
| | - A. M. V. Kumar
- International Union Against Tuberculosis and Lung Disease; South East Asia office; New Delhi India
| | - B. Baruani
- Medecins Sans Frontieres; Somali Mission; Somalia
| | | | - A. M. Kilale
- National Institute for Medical Research; Dar Es Salaam Tanzania
| | - M. Nqobili
- National Tuberculosis Control Programme; Harare Zimbabwe
| | - G. Patten
- Medecins Sans Frontieres; Capetown South Africa
| | - A. Sobry
- Medecins Sans Frontieres; Nairobi Kenya
| | - E. Cheti
- Medecins Sans Frontieres; Nairobi Kenya
| | - A. Nakanwagi
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - D. A. Enarson
- Center for Operational Research; International Union Against Tuberculosis and Lung Disease; Paris France
| | - M. E. Edginton
- Center for Operational Research; International Union Against Tuberculosis and Lung Disease; Paris France
| | - R. Upshur
- Joint Center for Bioethics; University of Toronto; Toronto Canada
| | - A. D. Harries
- Center for Operational Research; International Union Against Tuberculosis and Lung Disease; Paris France
- London School of Hygiene and Tropical Medicine; London UK
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32
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Tayler-Smith K, Zachariah R, Manzi M, Van den Boogaard W, Nyandwi G, Reid T, De Plecker E, Lambert V, Nicolai M, Goetghebuer S, Christiaens B, Ndelema B, Kabangu A, Manirampa J, Harries AD. An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality. Trop Med Int Health 2013; 18:993-1001. [PMID: 23682859 DOI: 10.1111/tmi.12121] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections. METHODS Data were collected for the period January to December 2011, using ambulance log books, patient registers and logistics records. RESULTS In 2011, there were 1478 ambulance call-outs. The median referral time (time from maternity calling for an ambulance to the time the patient arrived at the MSF referral facility) was 78 min (interquartile range, 52-130 min). The total annual cost of the referral system (comprising 1.6 ambulances linked with nine maternity units) was € 85 586 (€ 61/obstetric case transferred or € 0.43/capita/year). Referral times exceeding 3 h were associated with a significantly higher risk of early neonatal deaths (OR, 1.9; 95% CI, 1.1-3.2). MSF coverage of complicated obstetric cases and caesarean sections was estimated to be 80% and 92%, respectively. CONCLUSION This study demonstrates that it is possible to implement an effective communication and transport system to ensure access to EmONC and also highlights some of the important operational factors to consider, particularly in relation to minimising referral delays.
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Affiliation(s)
- K Tayler-Smith
- Medical department Operational Research, Medecins sans Frontieres, Luxembourg.
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Ali E, Zachariah R, Shams Z, Vernaeve L, Alders P, Salio F, Manzi M, Allaouna M, Draguez B, Delchevalerie P, Harries AD. Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh? Trans R Soc Trop Med Hyg 2013; 107:319-23. [DOI: 10.1093/trstmh/trt018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tayler-Smith K, Zachariah R, Manzi M, Van den Boogaard W, Nyandwi G, Reid T, Van den Bergh R, De Plecker E, Lambert V, Nicolai M, Goetghebuer S, Christaens B, Ndelema B, Kabangu A, Manirampa J, Harries AD. Achieving the millennium development goal of reducing maternal mortality in rural Africa: an experience from Burundi. Trop Med Int Health 2012; 18:166-74. [PMID: 23163431 DOI: 10.1111/tmi.12022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality. METHODS The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this estimate, the resulting theoretical maternal mortality ratio in Kabezi was calculated and compared to the Millennium Development Goal for Burundi. RESULTS In 2011, 1385 women from Kabezi were transferred to the MSF facility, of whom 55% had a severe acute maternal morbidity. We estimated that the MSF intervention averted 74% (range 55-99%) of maternal deaths in Kabezi district, equating to a district maternal mortality rate of 208 (range 8-360) deaths/100,000 live births. This lies very near to the 2015 MDG 5 target for Burundi (285 deaths/100,000 live births). CONCLUSION Provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve Millennium Development Goal 5 in rural Africa.
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Affiliation(s)
- K Tayler-Smith
- Medecins sans Frontieres, Medical Department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
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Tayler-Smith K, Zachariah R, Hinderaker SG, Manzi M, De Plecker E, Van Wolvelaer P, Gil T, Goetghebuer S, Ritter H, Bawo L, Davis-Worzi C. Sexual violence in post-conflict Liberia: survivors and their care. Trop Med Int Health 2012; 17:1356-60. [PMID: 22882628 DOI: 10.1111/j.1365-3156.2012.03066.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Using routine data from three clinics offering care to survivors of sexual violence (SV) in Monrovia, Liberia, we describe the characteristics of SV survivors and the pattern of SV and discuss how the current approach could be better adapted to meet survivors' needs. There were 1500 survivors seeking SV care between January 2008 and December 2009. Most survivors were women (98%) and median age was 13 years (Interquartile range: 9-17 years). Sexual aggression occurred during day-to-day activities in 822 (55%) cases and in the survivor's home in 552 (37%) cases. The perpetrator was a known civilian in 1037 (69%) SV events. Only 619 (41%) survivors sought care within 72 h. The current approach could be improved by: effectively addressing the psychosocial needs of child survivors, reaching male survivors, targeting the perpetrators in awareness and advocacy campaigns and reducing delays in seeking care.
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Affiliation(s)
- K Tayler-Smith
- Medecins sans Frontieres, Medical Department, Operational Center Brussels, Luxembourg, Luxembourg Centre for International Health, University of Bergen, Bergen, Norway International Union against Tuberculosis and Lung Disease, Paris, France Medecins sans Frontieres, Operational Center Brussels, Brussels, Belgium Medecins sans Frontieres, Monrovia, Liberia Ministry of Health and Social Welfare, Monrovia, Liberia Ministry of Gender and Development, Monrovia, Liberia
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Zachariah R, Bienvenue B, Ayada L, Manzi M, Maalim A, Engy E, Jemmy JP, Ibrahim Said A, Hassan A, Abdulrahaman F, Abdulrahman O, Bseiso J, Amin H, Michalski D, Oberreit J, Draguez B, Stokes C, Reid T, Harries AD. Practicing medicine without borders: tele-consultations and tele-mentoring for improving paediatric care in a conflict setting in Somalia? Trop Med Int Health 2012; 17:1156-62. [PMID: 22845678 DOI: 10.1111/j.1365-3156.2012.03047.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In a district hospital in conflict-torn Somalia, we assessed (i) the impact of introducing telemedicine on the quality of paediatric care, and (ii) the added value as perceived by local clinicians. METHODS A 'real-time' audio-visual exchange of information on paediatric cases (Audiosoft Technologies, Quebec, Canada) took place between clinicians in Somalia and a paediatrician in Nairobi. The study involved a retrospective analysis of programme data, and a perception study among the local clinicians. RESULTS Of 3920 paediatric admissions, 346 (9%) were referred for telemedicine. In 222 (64%) children, a significant change was made to initial case management, while in 88 (25%), a life-threatening condition was detected that had been initially missed. There was a progressive improvement in the capacity of clinicians to manage complicated cases as demonstrated by a significant linear decrease in changes to initial case management for meningitis and convulsions (92-29%, P = 0.001), lower respiratory tract infection (75-45%, P = 0.02) and complicated malnutrition (86-40%, P = 0.002). Adverse outcomes (deaths and lost to follow-up) fell from 7.6% in 2010 (without telemedicine) to 5.4% in 2011 with telemedicine (30% reduction, odds ratio 0.70, 95% CI: 0.57-0.88, P = -0.001). The number needed to be treated through telemedicine to prevent one adverse outcome was 45. All seven clinicians involved with telemedicine rated it to be of high added value. CONCLUSION The introduction of telemedicine significantly improved quality of paediatric care in a remote conflict setting and was of high added value to distant clinicians.
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Affiliation(s)
- R Zachariah
- Medecins sans Frontieres, Brussels Operational Centre, Luxembourg, Belgium.
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Chu KM, Manzi M, Zuniga I, Biot M, Ford NP, Rasschaert F, Zachariah R. Nevirapine- and efavirenz-associated hepatotoxicity under programmatic conditions in Kenya and Mozambique. Int J STD AIDS 2012; 23:403-7. [DOI: 10.1258/ijsa.2009.009328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To describe the frequency, risk factors, and clinical signs and symptoms associated with hepatotoxicity (HT) in patients on nevirapine- or efavirenz-based antiretroviral therapy (ART), we conducted a retrospective cohort analysis of patients attending the ART clinic in Kibera, Kenya, from April 2003 to December 2006 and in Mavalane, Mozambique, from December 2002 to March 2007. Data were collected on 5832 HIV-positive individuals who had initiated nevirapine- or efavirenz-based ART. Median baseline CD4+ count was 125 cells/μL (interquartile range [IQR] 55–196). Over a median follow-up time of 426 (IQR 147–693) days, 124 (2.4%) patients developed HT. Forty-one (54.7%) of 75 patients with grade 3 HT compared with 21 (80.8%) of 26 with grade 4 had associated clinical signs or symptoms ( P = 0.018). Four (5.7%) of 124 patients with HT died in the first six months compared with 271 (5.3%) of 5159 patients who did not develop HT ( P = 0.315). The proportion of patients developing HT was low and HT was not associated with increased mortality. Clinical signs and symptoms identified 50% of grade 3 HT and most cases of grade 4 HT. This suggests that in settings where alanine aminotransferase measurement is not feasible, nevirapine- and efavirenz-based ART may be given safely without laboratory monitoring.
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Affiliation(s)
- K M Chu
- South African Medical Unit, Médecins Sans Frontières Johannesburg, PO Box 32117, Braamfontein 2017, South Africa
| | - M Manzi
- Médecins Sans Frontières, Medical Department (Operational Research), Brussels, Belgium
| | - I Zuniga
- Médecins Sans Frontières, Maputo, Mozambique
| | - M Biot
- Médecins Sans Frontières, Maputo, Mozambique
| | - N P Ford
- South African Medical Unit, Médecins Sans Frontières Johannesburg, PO Box 32117, Braamfontein 2017, South Africa
| | - F Rasschaert
- Médecins Sans Frontières, Medical Department (Operational Research), Brussels, Belgium
| | - R Zachariah
- Médecins Sans Frontières, Medical Department (Operational Research), Brussels, Belgium
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Manzi M, Palena LM, Brocco E. Is digital arteries recanalization useful to preserve the foot functionality and avoid toes amputation, after pedal recanalization? Clinical results. J Cardiovasc Surg (Torino) 2012; 53:61-68. [PMID: 22231531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The authors aimed to assess clinical results following percutaneous transluminal angioplasty (PTA) of pedal arteries and digital branches in order to avoid minor amputations or support surgical skin incisions, in patients with CLI and distal wounds on the toes. METHODS Baseline, procedural and mid-term outcome data of all consecutive patients with CLI and ulcerative lesion on the toes, in which endovascular treatment of the foot arteries and digital branches was attempted, were prospectively collected between January 2010 and January 2011. The primary end-point was acute success (i.e. technical, angiographic and procedural success). Secondary end-points included limb, foot and toes salvage rates, minor amputations, reocclusion/restenosis and repeat treatment. RESULTS 1057 consecutive patients with CLI were treated and in 24 cases (2.3%), after tibial and foot arteries PTA, related to the presence of arterial lesion (stenosis/occlusion) in the digital branches, the recanalization of the target vessel was performed. Acute technical success was achieved in 100% of cases, with adequate angiographic results without peri-procedural complications. Clinical improvement was obtained and maintained after an average of 9 months. Amputation was avoided in 9 patients (37.5%), in 8 patients (29.6%) amputation involved only a distal phalange, in 5 patients (20.8%) toe amputations was necessary, in 2 patients (8.4%) trans-metatarsal amputation was performed. No below the ankle (BTA) or major amputations were performed. CONCLUSION Endovascular recanalization of digital branches in patients with CLI and distal wounds on the toes is feasible and safe; represent a support to avoid minor amputations or surgical skin lesion healing.
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Affiliation(s)
- M Manzi
- Unit of Interventional Radiology, Foot and Ankle Clinic, Policlinico Abano Terme, Abano Terme, Padua, Italy
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Ferraresi R, Palloshi A, Aprigliano G, Caravaggi C, Centola M, Sozzi F, Danzi G, Manzi M. Angioplasty of Below-the-elbow Arteries in Critical Hand Ischaemia. Eur J Vasc Endovasc Surg 2012; 43:73-80. [DOI: 10.1016/j.ejvs.2011.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022]
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Tayler-Smith K, Zachariah R, Manzi M, Kizito W, Vandenbulcke A, Sitienei J, Chakaya J, Harries AD. Antiretroviral treatment uptake and attrition among HIV-positive patients with tuberculosis in Kibera, Kenya. Trop Med Int Health 2011; 16:1380-3. [PMID: 21831116 DOI: 10.1111/j.1365-3156.2011.02863.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Using data of human immunodeficiency virus-positive patients with tuberculosis from three primary care clinics in Kibera slums, Nairobi, Kenya, we report on the proportion that started antiretroviral treatment (ART) and attrition (deaths, lost to follow-up and stopped treatment) before and while on ART. Of 427 ART eligible patients, enrolled between January 2004 and December 2008, 70% started ART, 19% were lost to attrition and 11% had not initiated ART. Of those who started ART, 14% were lost to attrition, making a cumulative pre-ART and ART attrition of 33%. ART uptake among patients with TB was relatively good, but programme attrition was high and needs urgent addressing.
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Affiliation(s)
- K Tayler-Smith
- Medical Department, Operational Center Brussels, MSF-Luxembourg, Luxembourg
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Manzi M, Palena L, Cester G. Endovascular techniques for limb salvage in diabetics with crural and pedal disease. J Cardiovasc Surg (Torino) 2011; 52:485-492. [PMID: 21792156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Diabetics with critical limb ischemia (CLI) usually have significant multilevel arterial disease, very often with compromised outflow on the foot arteries. The combination of severe peripheral arterial occlusion with the increased blood flow requirement, necessary to achieve the healing of the skin lesions or surgical incisions, makes this population particularly challenging. Additionally, diabetics and CLI patients have a high rate of comorbities, that increase the surgical risks or contraindicate surgical by-pass. Since its initial applications, endovascular recanalization for tibial vessels and foot arteries has proven to be feasible and safe, especially in diabetics with CLI. Actually, it is an established treatment option for limb salvage, avoiding amputation in lot of cases and improving lesions healing. The development of new technologies, such as dedicated guidewire's or low profile catheter balloons helps the interventionists, but the knowledge of most important techniques could be indispensable to obtain the procedural success and clinical outcomes.
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Affiliation(s)
- M Manzi
- Foot and Ankle Clinic, Interventional Radiology Unit, Policlinico Abano Terme, Abano Terme, Padua, Italy.
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Zachariah R, Tayler-Smith K, Manzi M, Massaquoi M, Mwagomba B, van Griensven J, van Engelgem I, Arnould L, Schouten EJ, Chimbwandira FM, Harries AD. Retention and attrition during the preparation phase and after start of antiretroviral treatment in Thyolo, Malawi, and Kibera, Kenya: implications for programmes? Trans R Soc Trop Med Hyg 2011; 105:421-30. [PMID: 21724219 DOI: 10.1016/j.trstmh.2011.04.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 04/19/2011] [Accepted: 04/19/2011] [Indexed: 11/26/2022] Open
Abstract
Among adults eligible for antiretroviral therapy (ART) in Thyolo (rural Malawi) and Kibera (Nairobi, Kenya), this study (a) reports on retention and attrition during the preparation phase and after starting ART and (b) identifies risk factors associated with attrition. 'Retention' implies being alive and on follow-up, whilst 'attrition' implies loss to follow-up, death or stopping treatment (if on ART). There were 11,309 ART-eligible patients from Malawi and 3633 from Kenya, of whom 8421 (74%) and 2792 (77%), respectively, went through the preparation phase and started ART. In Malawi, 2649 patients (23%) were lost to attrition in the preparation phase and 2189 (26%) after starting ART. Similarly, in Kenya 546 patients (15%) were lost to attrition in the ART preparation phase and 647 (23%) while on ART. Overall programme attrition was 43% (4838/11,309) for Malawi and 33% (1193/3633) for Kenya. Restricting cohort evaluation to 'on ART' (as is usually done) underestimates overall programme attrition by 38% in Malawi and 36% in Kenya. Risk factors associated with attrition in the preparation phase included male sex, age <35 years, advanced HIV/AIDS disease and increasing malnutrition. Considerable attrition occurs during the preparation phase of ART, and programme evaluations confined to on-treatment analysis significantly underestimate attrition. This has important operational implications, which are discussed here.
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Affiliation(s)
- R Zachariah
- Médecins sans Frontières, Medical Department (Operational Research), Brussels Operational Center, 68 Rue de Gasperich, L-1617, Luxembourg, Luxembourg.
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Tayler-Smith K, Zachariah R, Manzi M, Kizito W, Vandenbulcke A, Dunkley S, von Rege D, Reid T, Arnould L, Suleh A, Harries AD. Demographic characteristics and opportunistic diseases associated with attrition during preparation for antiretroviral therapy in primary health centres in Kibera, Kenya. Trop Med Int Health 2011; 16:579-84. [DOI: 10.1111/j.1365-3156.2011.02740.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chiara M, Rony Z, Homa M, Bhanumati V, Ladomirska J, Manzi M, Wilson N, Alaka D, Harries A. Characteristics, immunological response & treatment outcomes of HIV-2 compared with HIV-1 & dual infections (HIV 1/2) in Mumbai. Indian J Med Res 2010; 132:683-9. [PMID: 21245615 PMCID: PMC3102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Information available on HIV-2 and dual infection (HIV-1/2) is limited. This study was carried out among HIV positive individuals in an urban referral clinic in Khar, Mumbai, India, to report on relative proportions of HIV-1, HIV-2 and HIV-1/2 and baseline characteristics, response to and outcomes on antiretroviral treatment (ART). METHODS Retrospective analysis of programme data (May 2006-May 2009) at Khar HIV/AIDS clinic at Mumbai, India was done. Three test algorithm was used to diagnose HIV-1 and -2 infection. Standard ART was given to infected individuals. Information was collected on standardized forms. RESULTS A total of 524 individuals (male=51%; median age=37 yr) were included in the analysis over a 3 year period (2006-2009) - 489 (93%) with HIV-1, 28 (6%) with HIV-2 and 7(1%) with dual HIV-1/2 infection. HIV-2 individuals were significantly older than HIV-1 individuals (P<0.001). A significantly higher proportion of HIV-2 patients and those with dual infections had CD4 counts <200 cells/μl compared to HIV-1. HIV-2 individuals were more likely to present in WHO Clinical Stage 4. Of the 443 patients who were started on ART, 358 (81%) were still alive and on ART, 38 (8.5%) died and 3 were transferred out. CD4 count recovery at 6 and 12 months was satisfactory for HIV-1 and HIV-2 patients on protease inhibitor based regimens while this was significantly lower in HIV-2 individuals receiving 3 nucleoside reverse transcriptase inhibitors. INTERPRETATION AND CONCLUSIONS In an urban HIV clinic in Mumbai, India, HIV-2 and dual infections are not uncommon. Adaptation of the current national diagnostic and management protocols to include discriminatory testing for HIV types and providing access to appropriate and effective ART regimens will prevent the development of viral resistance and preserve future therapeutic options.
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Affiliation(s)
| | - Zachariah Rony
- Medecins sans Frontiéres, Medical Department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | | | | | | | - M. Manzi
- Medecins sans Frontiéres, Medical Department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - N. Wilson
- International Union against Tuberculosis & Lung Disease, South East Asia Office, New Delhi, India
| | | | - A.D. Harries
- International Union against Tuberculosis & Lung Disease, Paris, France & Tropical Medicine, London, UK
- London School of Hygiene & Tropical Medicine, London, UK
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Manzi M, Cester G, Palena LM. Paclitaxel-coated balloon angioplasty for lower extremity revascularization: a new way to fight in-stent restenosis. J Cardiovasc Surg (Torino) 2010; 51:567-571. [PMID: 20671641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In the last years the development of new techniques and technologies for the endovascular treatment of peripheral arterial occlusive disease has allowed to treat a vast array of lesions with high technical success and low complications. Despite these advances, restenosis, and in particular in-stent restenosis, is a problem that significantly affects middle and long-term results and remains to be solved. Drug-eluting balloons (DEB) have shown good results in the treatment of coronary in-stent restenosis in experimental and clinical trials, but only few experimental and clinical trials focus on the peripheral district. This review summarizes the available experimental and clinical data in support of DEB in the treatment of ISR in the peripheral district. Larger clinical trials focused on paclitaxel-coated balloon in the treatment of ISR in the peripheral arteries will be necessary to provide definitive evidence of clinical benefit.
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Affiliation(s)
- M Manzi
- Interventional Radiology Unit, Policlinico Abano Terme, Abano Terme, Padua, Italy.
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Moses M, Zachariah R, Tayler-Smith K, Misinde D, Foncha C, Manzi M, Bauerfeind A, Mwagomba B, Kwanjana J, Harries AD. Outcomes and safety of concomitant nevirapine and rifampicin treatment under programme conditions in Malawi. Int J Tuberc Lung Dis 2010; 14:197-202. [PMID: 20074411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
SETTING Thyolo District Hospital, rural Malawi. OBJECTIVES To report on 1) clinical, immunological and virological outcomes and 2) safety among human immunodeficiency virus (HIV) infected patients with tuberculosis (TB) who received concurrent nevirapine (NVP) and rifampicin (RMP) based treatment. DESIGN Retrospective cohort study. METHODS Analysis of programme data, June-December 2007. RESULTS Of a total of 156 HIV-infected TB patients who started NVP-based antiretroviral treatment, 136 (87%) completed TB treatment successfully, 16 (10%) died and 5 (4%) were transferred out. Mean body weight and CD4 gain (adults) were respectively 4.4 kg (95%CI 3.3-5.4) and 140 cells/mm(3) (95%CI 117-162). Seventy-four per cent of patients who completed TB treatment and had a viral load performed (n = 74) had undetectable levels (<50 copies/ml), while 17 (22%) had a viral load of 50-1000 copies/ml. Hepatotoxicity was present in 2 (1.3%) patients at baseline. Two patients developed Grade 2 and one developed Grade 3 alanine transaminase enzyme elevations during TB treatment (incidence rate per 10 years of follow-up 4.2, 95%CI 1.4-13.1). There were no reported deaths linked to hepatotoxicity. CONCLUSIONS In a rural district in Malawi, concomitant NVP and RMP treatment is associated with good TB treatment outcomes and appears safe. Further follow-up of patients would be useful to ascertain the longer-term effects of this concurrent treatment.
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Affiliation(s)
- M Moses
- Médecins sans Frontières, Thyolo District, Thyolo, Malawi
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Manzi M, Fusaro M, Ceccacci T, Erente G, Dalla Paola L, Brocco E. Clinical results of below-the knee intervention using pedal-plantar loop technique for the revascularization of foot arteries. J Cardiovasc Surg (Torino) 2009; 50:331-337. [PMID: 19543193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM Recent registries and randomized trials support the role of percutaneous revascularization in patients with critical limb ischemia (CLI) due to below-the-knee (BTK) atherosclerotic disease, as percutaneous transluminal angioplasty (PTA) for BTK disease has shown to be feasible and safe in this setting. Nonetheless, succes rates remain suboptimal with current techniques. The authors aimed to appraise clinical results following PTA of foot vessels exploiting a novel technique, based on the recanalization of both pedal and plantar arteries and their anatomical anastomosis in order to restore direct arterial in-flow from both anterior and posterior tibial vessels, defined as the pedal-plantar loop technique. METHODS Baseline, procedural and mid-term outcome data of all consecutive patients with CLI due to BTK disease in which PTA was attempted using the pedal-plantar loop technique were prospectively collected between January 2007 and September 2008. The primary end-point was acute success (i.e. the composite of technical, angiographic and procedural success). Secondary end-points included limb salvage rate, major (above the ankle) and minor (below the ankle) amputation, change in Rutherford class and transcutaneous oxygen tension, reocclusion/restenosis, rehospitalization, and repeat revascularization after 12 months. RESULTS A total of 1331 consecutive patients with CLI were treated using BTK PTA and 135 (10.1%) were approached with the pedal-plantar loop technique in order to recanalize the foot arteries. Target lesions were mostly occlusive and diffusely diseased, involving in most cases the tibial arteries as well as the in-flow and out-flow vessels. Acute success was achieved for tibial PTA in 100% of the cases, with ability to position and inflate the balloon and achieve adequate angiographic results without peri-procedural complications in all, whereas acute success for the pedal-plantar loop technique was 85%. Clinical improvement in functional status was obtained and maintained after an average of 12 months, with a significant improvement of transcutaneous oxygen tension after 15 days, 59+/-16 mmHg in the group of patients in which the foot arteries revascularization was successfully feasible, versus 42+/-12 mmHg in patients achieving patency of two BTK vessels at the ankle level with partial out-flow in the foot (P<0.001). CONCLUSIONS Percutaneous revascularization of foot arteries in patients with CLI is feasible and safe, and appears to provide positive clinical results at both acute and mid-term follow-up.
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Affiliation(s)
- M Manzi
- Interventional Radiology Unit, Foot and Ankle Clinic, Abano Terme Clinic, Abano Terme, Padua, Italy.
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Massaquoi M, Zachariah R, Manzi M, Pasulani O, Misindi D, Mwagomba B, Bauernfeind A, Harries AD. Patient retention and attrition on antiretroviral treatment at district level in rural Malawi. Trans R Soc Trop Med Hyg 2009; 103:594-600. [DOI: 10.1016/j.trstmh.2009.02.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 02/16/2009] [Accepted: 02/16/2009] [Indexed: 11/26/2022] Open
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Federici M, Guarna T, Manzi M, Della Longa G, Di Renzi P, Bellelli A. Swelling of the submandibular glands after administration of low-osmolarity contrast agent: Ultrasound findings. J Ultrasound 2008; 11:85-8. [PMID: 23396309 DOI: 10.1016/j.jus.2008.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Swelling of the salivary glands occurring after injection of iodine based contrast agent is a rare late adverse reaction. Only a few cases in the literature report such diagnostic findings. We present our color Doppler ultrasound findings in a case of swelling of both submandibular glands occurring after administration of iodinated contrast agent.
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Affiliation(s)
- M Federici
- Hospital Fatebenefratelli Isola Tiberina Rome, Department of Diagnostic and Interventional Radiology, Rome, Italy
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Manzi M, Zachariah R, Teck R, Buhendwa L, Kazima J, Bakali E, Firmenich P, Humblet P. High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting. Trop Med Int Health 2005; 10:1242-50. [PMID: 16359404 DOI: 10.1111/j.1365-3156.2005.01526.x] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
SETTING Thyolo District Hospital, rural Malawi. OBJECTIVES In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district. DESIGN Cohort study. METHODS Review of routine antenatal, VCT and PMTCT registers. RESULTS Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95-97] were pre-test counselled, 2965 (95%, CI: 94-96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n=646) was 358 (55%, CI: 51-59) by the 36-week antenatal visit, 440 (68%, CI: 64-71) by delivery, 450 (70%, CI: 66-73) by the first postnatal visit and 524 (81%, CI: 78-84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16-22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available. CONCLUSIONS In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a 'different way of acting' if PMTCT is to be scaled up in our setting.
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Affiliation(s)
- M Manzi
- Médecins sans Frontières-Luxembourg, Thyolo district, Luxembourg, Malawi.
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