Essential Medicines at the National Level : The Global Asthma Network's Essential Asthma Medicines Survey 2014

Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013-2020 sets an 80% target for essential NCD medicines' availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013-2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system's capacity to address NCDs.Peer reviewe

The management of severe malaria in children: a review.

We have attempted to summarise an approach to management of severe malaria from our experience and that of others from published data in this review. This represents our current state of knowledge and practices which may change as research continues in this field. It also represents what we feel should be the minimum aim in treating severe malaria even at district hospital level. It focuses on practical issues encountered when admitting such patients: initial assessment, immediate supportive management, use of transfusion, appropriate anti-malarial treatment and ongoing management

Pneumocystis carinii pneumonia in HIV/AIDS patients at an urban district hospital in Kenya

Background: Pneumocytis carinii pneumonia has generally been regarded to be an uncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa. The reason for this has not been clear but postulates included a lack of suitable pathogenic types in the African environment, diagnostic difficulties and the more commonly held belief that African HIV infected individuals were dying early from common non-opportunistic pathogens before severe degrees of immunosuppression occured. Recently a trend has emerged at the Mbagathi district hospital whereby an increasing number of HIV infected patients are empirically treated for Pneumocytis carinii pneumonia (PCP) based on clinical and radiological features. Objective: To determine the prevalence of PCP and clinical outcomes of HIV infected patients presenting at the Mbagathi District Hospital, Nairobi with the presumptive diagnosis of PCP. Setting: Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya. Methods: Patients presenting with a sub-acute onset of cough and dyspnoea were eligible for the study if they were found to have bilateral pulmonary shadows and had negative sputum smears for AFBS. Consenting patients who had no contraindication to fiberoptic bronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopy procedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF was examined for cysts of P. carinii using toluidine blue stain and immunofluorescent antibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteria using routine procedures. Standard treatment with high dose cotrimoxazole was offered to all patients who were then followed up until discharge from hospital or death whichever came first. Results: Between June 1999 and August 2000 a total of 63 patients were referred for bronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure, four died before the procedure could be done, one was judged too sick to undergo the procedure and three had been on cotrimoxazole for longer than five days. Thus 51 patients underwent bronchoscopy. Pneumocytis carinii stain was positive in 19 (37.2%) while death occured in 16 (31.4%) of the 51 patients. There were more deaths in those without PCP but this difference was not statistically significant (odds ratio 0.68 (95% CI 0.35-1.32; P=0.2). Conclusion: PCP was found to be common in HIV infected patients presenting with clinical and radiological features of the disease. The mortality rate for patients with a presumptive diagnosis of PCP is high. This study suggests that cotrimoxazole preventive therapy may be a useful intervention in symptomatic HIV infected patients in Kenya for the prevention of PCP and may avert deaths from this disease. (East African Medical Journal: 2003 80(1): 30-35

PNEUMOCYTIS CARINII PNEUMONIA IN HIV/AIDS PATIENTS AT AN URBAN DISTRICT HOSPITAL IN KENYA

ABSTRACTBackground: Pneumocytis carinii pneumonia has generally been regarded to be anuncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa.The reason for this has not been clear but postulates included a lack of suitablepathogenic types in the African environment, diagnostic difficulties and the morecommonly held belief that African HIV infected individuals were dying early fromcommon non-opportunistic pathogens before severe degrees of immunosuppressionoccured. Recently a trend has emerged at the Mbagathi district hospital whereby anincreasing number of HIV infected patients are empirically treated for Pneumocytiscarinii pneumonia (PCP) based on clinical and radiological features.Objective: To determine the prevalence of PCP and clinical outcomes of HIV infectedpatients presenting at the Mbagathi District Hospital, Nairobi with the presumptivediagnosis of PCP.Setting: Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya.Methods: Patients presenting with a sub-acute onset of cough and dyspnoea were eligiblefor the study if they were found to have bilateral pulmonary shadows and had negativesputum smears for AFBS. Consenting patients who had no contraindication to fiberopticbronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopyprocedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF wasexamined for cysts of P. carinii using toluidine blue stain and immunofluorescentantibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteriausing routine procedures. Standard treatment with high dose cotrimoxazole was offeredto all patients who were then followed up until discharge from hospital or deathwhichever came first.Results: Between June 1999 and August 2000 a total of 63 patients were referred forbronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure,four died before the procedure could be done, one was judged too sick to undergo theprocedure and three had been on cotrimoxazole for longer than five days. Thus 51patients underwent bronchoscopy. Pneumocytis carinii stain was positive in 19 (37.2%)while death occured in 16 (31.4%) of the 51 patients. There were more deaths in thosewithout PCP but this difference was not statistically significant (odds ratio 0.68 (95%CI 0.35-1.32; P=0.2).Conclusion: PCP was found to be common in HIV infected patients presenting withclinical and radiological features of the disease. The mortality rate for patients witha presumptive diagnosis of PCP is high. This study suggests that cotrimoxazolepreventive therapy may be a useful intervention in symptomatic HIV infected patientsin Kenya for the prevention of PCP and may avert deaths from this disease

A partially randomised trial of pretomanid, moxifloxacin and pyrazinamide for pulmonary TB

STAND was sponsored by TB Alliance with support from the UK Department for International Development, UK Department of Health (London, UK), Bill and Melinda Gates Foundation (Seattle, WA, USA), US Agency for International Development (Washington DC, USA), Directorate General for International Cooperation of the Netherlands (Amsterdam, The Netherlands), Irish Aid (Dublin, Ireland), Australia Department of Foreign Affairs and Trade (Canberra ACT, Australia) and the Federal Ministry for Education and Research of Germany (Berlin, Germany) through KfW (Kreditanstalt fur Wiederaufbau) and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (NIH; Bethesda, MD, USA) under Award Numbers UM1 AI068634 and UM1 AI068636. AMC and AJN are supported by Medical Research Council Grant: MC_UU_12023/27 Tuberculosis Treatment Trials.BACKGROUND: Treatment for TB is lengthy and toxic, and new regimens are needed. METHODS: Participants with pulmonary drug-susceptible TB (DS-TB) were randomised to receive: 200 mg pretomanid (Pa, PMD) daily, 400 mg moxifloxacin (M) and 1500 mg pyrazinamide (Z) for 6 months (6Pa200MZ) or 4 months (4Pa200MZ); 100 mg pretomanid daily for 4 months in the same combination (4Pa100MZ); or standard DS-TB treatment for 6 months. The primary outcome was treatment failure or relapse at 12 months post-randomisation. The non-inferiority margin for between-group differences was 12.0%. Recruitment was paused following three deaths and not resumed. RESULTS: Respectively 4/47 (8.5%), 11/57 (19.3%), 14/52 (26.9%) and 1/53 (1.9%) DS-TB outcomes were unfavourable in patients on 6Pa200MZ, 4Pa200MZ, 4Pa100MZ and controls. There was a 6.6% (95% CI –2.2% to 15.4%) difference per protocol and 9.9% (95%CI –4.1% to 23.9%) modified intention-to-treat difference in unfavourable responses between the control and 6Pa200MZ arms. Grade 3+ adverse events affected 68/203 (33.5%) receiving experimental regimens, and 19/68 (27.9%) on control. Ten of 203 (4.9%) participants on experimental arms and 2/68 (2.9%) controls died. CONCLUSION: PaMZ regimens did not achieve non-inferiority in this under-powered trial. An ongoing evaluation of PMD remains a priority.Publisher PDFPeer reviewe

Imported SARS-CoV-2 variants of concern drove spread of infections across Kenya during the second year of the pandemic

Using classical and genomic epidemiology, we tracked the COVID-19 pandemic in Kenya over 23 months to determine the impact of SARS-CoV-2 variants on its progression. SARS-CoV-2 surveillance and testing data were obtained from the Kenya Ministry of Health, collected daily from 306 health facilities. COVID-19-associated fatality data were also obtained from these health facilities and communities. Whole SARS-CoV-2 genome sequencing were carried out on 1241 specimens. Over the pandemic duration (March 2020–January 2022), Kenya experienced five waves characterized by attack rates (AR) of between 65.4 and 137.6 per 100,000 persons, and intra-wave case fatality ratios (CFR) averaging 3.5%, two-fold higher than the national average COVID-19 associated CFR. The first two waves that occurred before emergence of global variants of concerns (VoC) had lower AR (65.4 and 118.2 per 100,000). Waves 3, 4, and 5 that occurred during the second year were each dominated by multiple introductions each, of Alpha (74.9% genomes), Delta (98.7%), and Omicron (87.8%) VoCs, respectively. During this phase, government-imposed restrictions failed to alleviate pandemic progression, resulting in higher attack rates spread across the country. In conclusion, the emergence of Alpha, Delta, and Omicron variants was a turning point that resulted in widespread and higher SARS-CoV-2 infections across the country

Essential Medicines at the National Level: The Global Asthma Network's Essential Asthma Medicines Survey 2014

10.3390/ijerph16040605INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH16