3 research outputs found
Translating drug resistant tuberculosis treatment guidelines to reality in war-torn Kandahar, Afghanistan: a retrospective cohort study
Introduction
Afghanistan is affected by one of the world’s longest protracted armed conflicts, frequent natural disasters, disease outbreaks and large population movements and it suffers from a high burden of tuberculosis (TB), including rifampicin-resistant TB (RR-TB). The study shows Médecins Sans Frontières’ experiences with care for patients with RR-TB in Kandahar Province. We describe the uptake of RR-TB treatment, how World Health Organisation criteria for the choice between the short and an individualized regimen were implemented, and treatment outcomes.
Methods
This is a retrospective cohort analysis of routinely collected data from RR-TB patients enrolled in care from 2016 until 2019. Descriptive analysis was performed to present characteristics of patients and treatment outcomes. Multivariable Cox analysis was performed to identify risk factors for having an unfavourable treatment outcome.
Results
Out of 146 enrolled RR-TB patients, 112 (76.7%) started treatment: 41 (36.6%) and 71 (63.4%) with the short and individualized treatment regimen, respectively. Of 82 with results for fluoroquinolone susceptibility, 39 (47.6%) had fluoroquinolone-resistant TB. Seven patients with initially fluoroquinolone-resistant TB and three pregnant women started the short regimen and 18 patients eligible for the short regimen started the injectable-free individualized regimen. Overall, six-month smear and culture conversion were 98.7% and 97.1%, respectively; treatment success was 70.1%. Known initial fluoroquinolone resistance (aHR 3.77, 95%CI:1.53–9.27) but not choice of regimen predicted having an unfavourable outcome.
Conclusion
Even though criteria for the choice of treatment regimen were not applied strictly, we have achieved acceptable outcomes in this cohort. To expand RR-TB care, treatment regimens should fit provision at primary health care level and take patient preferences into account
Traumatic Brain Injury in Myanmar: Preliminary Results and Development of an Adjunct Electronic Medical Record
BACKGROUND: The treatment of traumatic brain injury (TBI) in Myanmar is a major health issue. Comprehensive appreciation of the pathology is limited given the lack of granular metadata available. In this proof-of-concept study, we analyzed demographic data on TBI generated from a novel prospective, online database in a low-to-middle income country (LMIC).
METHODS: Neurosurgery residents were given an electronic tablet for data entry onto an online database. Metadata-driven data capture was carried prospectively by the trained residents and the information was reviewed weekly by the supervising team in the United States.
RESULTS: Complete data was available on 242/253 (96%) patients. Age at admission was 37 years (range 16-85) and length of stay was 3.53 days (1-21). Etiologies included motorcycle accidents, falls, assaults, pedestrian vehicular injuries and industrial accidents. Dispositions were primarily to home (211). Average Glasgow Coma Score (GCS) at admission was 12.97. There was a 68% mortality rate of patients directly admitted to NOGH with GCS75% for patients transferred in from other facilities. Surgery was performed on 30 patients (12.4%).
CONCLUSIONS: Despite a lack of formal training in electronic medical records or research, the resident team was able to capture the majority of admissions with granular-level data. This helped shed light on the etiology and severity of TBI in Myanmar. As a result, more effective transport systems and access to trauma care must be achieved. Accessible regional trauma centers with investment in intensive care units, operative care, anesthesia, and imaging resources is necessary