Refugios masivos: inapropiados en el desplazamiento

Los refugios masivos no parecen ser una solución de alojamiento adecuada ni siquiera durante el repentino estallido de una crisis, ya que provocan problemas de dignidad y seguridad y conllevan graves consecuencias para la salud

Vulnérabilités urbaines à Conakry, Guinée

L’évaluation des vulnérabilités urbaines dans la ville de Conakry a été commissionnée par MSF-CH pour identifier les populations les plus vulnérables et mieux comprendre les facteurs sanitaires de vulnérabilité afin de proposer des pistes de réflexion pour un futur projet.\ud \ud Cette évaluation qualitative a été réalisée par l’Unité d’évaluation de MSF à Vienne. Elle a été menée dans les cinq (5) communes de la ville de Conakry entre août et septembre 2012. Les recommandations et le rapport final sont présentés en octobre 2012. Le manque de temps était la contrainte majeure de cette évaluation

Las poblaciones desplazadas fuera de los campos

Las actuales herramientas de evaluación y estrategias de intervención se basan principalmente en experiencias de situaciones en los campos; lo que se necesita son respuestas innovadoras para abordar problemas específicos en entornos abiertos

Evaluation of three parasite lactate dehydrogenase-based rapid diagnostic tests for the diagnosis of falciparum and vivax malaria

BACKGROUND: In areas where non-falciparum malaria is common rapid diagnostic tests (RDTs) capable of distinguishing malaria species reliably are needed. Such tests are often based on the detection of parasite lactate dehydrogenase (pLDH). METHODS: In Dawei, southern Myanmar, three pLDH based RDTs (CareStart Malaria pLDH (Pan), CareStart Malaria pLDH (Pan, Pf) and OptiMAL-IT)were evaluated in patients presenting with clinically suspected malaria. Each RDT was read independently by two readers. A subset of patients with microscopically confirmed malaria had their RDTs repeated on days 2, 7 and then weekly until negative. At the end of the study, samples of study batches were sent for heat stability testing. RESULTS: Between August and November 2007, 1004 patients aged between 1 and 93 years were enrolled in the study. Slide microscopy (the reference standard) diagnosed 213 Plasmodium vivax (Pv) monoinfections, 98 Plasmodium falciparum (Pf) mono-infections and no malaria in 650 cases. The sensitivities (sens) and specificities (spec), of the RDTs for the detection of malaria were- CareStart Malaria pLDH (Pan) test: sens 89.1% [CI95 84.2-92.6], spec 97.6% [CI95 96.5-98.4]. OptiMal-IT: Pf+/- other species detection: sens 95.2% [CI95 87.5-98.2], spec 94.7% [CI95 93.3-95.8]; non-Pf detection alone: sens 89.6% [CI95 83.6-93.6], spec 96.5% [CI95 94.8-97.7]. CareStart Malaria pLDH (Pan, Pf): Pf+/- other species: sens 93.5% [CI95 85.4-97.3], spec 97.4% [95.9-98.3]; non-Pf: sens 78.5% [CI95 71.1-84.4], spec 97.8% [CI95 96.3-98.7]. Inter-observer agreement was excellent for all tests (kappa > 0.9). The median time for the RDTs to become negative was two days for the CareStart Malaria tests and seven days for OptiMAL-IT. Tests were heat stable up to 90 days except for OptiMAL-IT (Pf specific pLDH stable to day 20 at 35 degrees C). CONCLUSION: None of the pLDH-based RDTs evaluated was able to detect non-falciparum malaria with high sensitivity, particularly at low parasitaemias. OptiMAL-IT performed best overall and would perform best in an area of high malaria prevalence among screened fever cases. However, heat stability was unacceptable and the number of steps to perform this test is a significant drawback in the field. A reliable, heat-stable, highly sensitive RDT, capable of diagnosing all Plasmodium species has yet to be identified

VACCELERATE Site Network: Real-time definition of clinical study capacity in Europe

Background: The inconsistent European vaccine trial landscape rendered the continent of limited interest for vaccine developers. The VACCELERATE consortium created a network of capable clinical trial sites throughout Europe. VACCELERATE identifies and provides access to state-of-the-art vaccine trial sites to accelerate clinical development of vaccines. Methods: Login details for the VACCELERATE Site Network (vaccelerate.eu/site-network/) questionnaire can be obtained after sending an email to. Interested sites provide basic information, such as contact details, affiliation with infectious disease networks, main area of expertise, previous vaccine trial experience, site infrastructure and preferred vaccine trial settings. In addition, sites can recommend other clinical researchers for registration in the network. If directly requested by a sponsor or sponsor representative, the VACCELERATE Site Network pre-selects vaccine trial sites and shares basic study characteristics provided by the sponsor. Interested sites provide feedback with short surveys and feasibility questionnaires developed by VACCELERATE and are connected with the sponsor to initiate the site selection process. Results: As of April 2023, 481 sites from 39 European countries have registered in the VACCELERATE Site Network. Of these, 137 (28.5 %) sites have previous experience conducting phase I trials, 259 (53.8 %) with phase II, 340 (70.7 %) with phase III, and 205 (42.6 %) with phase IV trials, respectively. Infectious diseases were reported as main area of expertise by 274 sites (57.0 %), followed by any kind of immunosuppression by 141 (29.3 %) sites. Numbers are super additive as sites may report clinical trial experience in several indications. Two hundred and thirty-one (47.0 %) sites have the expertise and capacity to enrol paediatric populations and 391 (79.6 %) adult populations. Since its launch in October 2020, the VACCELERATE Site Network has been used 21 times for academic and industry trials, mostly interventional studies, focusing on different pathogens such as fungi, monkeypox virus, Orthomyxoviridae/influenza viruses, SARS-CoV-2, or Streptococcus pneumoniae/pneumococcus. Conclusions: The VACCELERATE Site Network enables a constantly updated Europe-wide mapping of experienced clinical sites interested in executing vaccine trials. The network is already in use as a rapid-turnaround single contact point for the identification of vaccine trials sites in Europe.The VACCELERATE Site Network has received funding from the European Union’s Horizon 2020 research and innovation pro gramme (grant agreement No 101037867) and the German Federal Ministry of Education and Research (Bundesministerium für Bil dung und Forschung [BMBF]) (grant agreement No BMBF01KX2040).S

Capitalisation de la mise en œuvre de la chimio-prévention du paludisme saisonnier au Niger

La chimio-prévention du paludisme saisonnier (CPS) a été mise en œuvre au Niger depuis 2013, conformément aux recommandations de l'Organisation mondiale de la Santé (OMS) et à la politique nationale de lutte contre le paludisme. Elle se déroule sous la forme d’une campagne de masse qui consiste en l’administration de doses curatives de sulphadoxine-pyriméthamine (SP) et d'amodiaquine (AQ) durant trois jours, à 28 jours d’intervalle entre juillet et novembre, aux enfants de 3 à 59 mois.\ud \ud Les résultats de ce travail de capitalisation montrent que la mise en œuvre de la CPS dans le contexte du Niger a été réussite et ceci même avec une population cible qui a plus que doublé par rapport à l’année 2013. Cependant, nous ne constatons pas de simplification attendue du mode opératoire qui pourtant pourrait se traduire par une diminution des ressources humaines déployées et ainsi par une réduction considérable du coût de la CPS. Nous tenons à souligner que pour alléger de manière concrète l’implémentation de la CPS, MSF devrait envisager de tester des modes opératoires plus « osés » (p.ex. la distribution de plaquettes entières via les structures sanitaires), et ceci notamment dans les zones où la population est déjà habituée à la CPS et adhère bien à cette stratégie préventive. MSF a démontré la faisabilité de combiner la CPS avec d’autres activités préventives, notamment avec la distribution de Plumpy’Doz™, d’Albendazole, de moustiquaires imprégnés, ainsi qu’avec la vaccination de routine

Mass shelters: inappropriate in displacement

Mass shelters appear to be an inappropriate shelter solution even in the acute onset of a crisis, creating problems of dignity and security and having significant health consequences

Outside camp settings

Current assessment tools and intervention strategies are based mainly on experience of camp-like situations; what is needed are innovative responses to address problems specific to open settings

Qualitative study of antibiotic prescription patterns and associated drivers in Sudan, Guinea-Bissau, Central African Republic and Democratic Republic of Congo

Objectives The objective of this study was to address the knowledge gap regarding antibiotic use in Medecins Sans Frontiéres (MSF) projects located in Africa by exploring antibiotic prescription and consumption habits and their drivers at different healthcare levels.Design This study used an exploratory study design through thematic analysis of semistructured, in-depth interviews, focus group discussions (FGDs) and field observations in order to understand the main drivers influencing current antibiotics prescription habits and consumption habits of patients in different geographical settings.Setting The study took place in MSF centres and towns across four countries: Guinea-Bissau, Central African Republic (CAR), Democratic Republic of Congo (DRC) and Sudan.Participants 384 respondents participated in the study, which includes project staff, prescribers, community members, patients, among other groups.Results Treatment protocols were physically present in all countries except DRC, but compliance to protocols varied across contexts. A failing health system and barriers to accessing healthcare were perceived as major drivers of overuse and inconsistent prescription practices. Patient demands influenced prescription decisions, and self-medication was commonly reported in the context of failing health systems. Additionally, there was a strong demand for quick cures and communities preferred injections over pills. Patients tended to stop antibiotic treatment once symptoms abated and had major gaps in understanding antibiotic intake instructions and functions.Conclusions While there were specific findings in each context, the larger trend from these four MSF projects in Africa indicates widespread use of antibiotics based on unclear assumptions, which are often influenced by patient demands. There needs to be a broader focus on the balance between access and excess, especially in such fragile contexts where access to healthcare is a real challenge