Methodological issues raised from the coverage survey of the MSF nutritional programme. Madarounfa and Guidan Roumdji, Maradi region, Niger 2006.

Abstract Poster - Congress: Surveying Health in Complex Situations; Brussels; June 2007

Feasibility of engaging caregivers in at‐home surveillance of children with uncomplicated severe acute malnutrition

Abstract Many factors can contribute to low coverage of treatment for severe acute malnutrition (SAM), and a limited number of health facilities and trained personnel can constrain the number of children that receive treatment. Alternative models of care that shift the responsibility for routine clinical and anthropometric surveillance from the health facility to the household could reduce the burden of care associated with frequent facility‐based visits for both healthcare providers and caregivers. To assess the feasibility of shifting clinical surveillance to caregivers in the outpatient management of SAM, we conducted a pilot study to assess caregivers' understanding and retention of key concepts related to the surveillance of clinical danger signs and anthropometric measurement over a 28‐day period. At the time of a child's admission to nutritional treatment, a study nurse provided a short training to groups of caregivers on two topics: (a) clinical danger signs in children with SAM that warrant facility‐based care and (b) methods to measure and monitor their child's mid‐upper arm circumference. Caregiver understanding was assessed using standardized questionnaires before training, immediately after training, and 28 days after training. Knowledge of most clinical danger signs (e.g., convulsions, edema, poor appetite, respiratory distress, and lethargy) was low (0–45%) before training but increased immediately after and was retained 28 days after training. Agreement between nurse–caregiver mid‐upper arm circumference colour classifications was 77% (98/128) immediately after training and 80% after 28 days. These findings lend preliminary support to pursue further study of alternative models of care that allow for greater engagement of caregivers in the clinical and anthropometric surveillance of children with SAM

Hand hygiene compliance and environmental contamination with gram-negative bacilli in a rural hospital in Madarounfa, Niger

Abstract Background Healthcare-associated infections pose a major, yet often preventable risk to patient safety. Poor hand hygiene among healthcare personnel and unsanitary hospital environments may contribute to this risk in low-income settings. We aimed to describe hand hygiene behaviour and environmental contamination by season in a rural, sub-Saharan African hospital setting. Methods We conducted a concurrent triangulation mixed-methods study combining three types of data at a hospital in Madarounfa, Niger. Hand hygiene observations among healthcare personnel during two seasons contributed quantitative data describing hand hygiene frequency and its variability in relation to seasonal changes in caseload. Semistructured interviews with healthcare personnel contributed qualitative data on knowledge, attitudes and barriers to hand hygiene. Biweekly environmental samples evaluated microbial contamination from October 2016 to December 2017. Triangulation identified convergences, complements and contradictions across results. Results Hand hygiene compliance, or the proportion of actions (handrubbing or handwashing) performed out of all actions required, was low (11% during non-peak and 36% during peak caseload seasons). Interviews with healthcare personnel suggesting good general knowledge of hand hygiene contradicted the low hand hygiene compliance. However, compliance by healthcare activity was convergent with poor knowledge of precise hand hygiene steps and the motivation to prevent personal acquisition of infection identified during interviews. Contamination of environmental samples with gram-negative bacilli was high (45%), with the highest rates of contamination observed during the peak caseload season. Conclusion Low hand hygiene compliance coupled with high contamination rates of hospital environments may increase the risk of hospital-acquired infections in sub-Saharan African settings. </jats:sec

Carriage prevalence and serotype distribution of Streptococcus pneumoniae prior to 10-valent pneumococcal vaccine introduction: A population-based cross-sectional study in South Western Uganda, 2014.

BACKGROUND: Information on Streptococcus pneumoniae nasopharyngeal (NP) carriage before the pneumococcal conjugate vaccine (PCV) introduction is essential to monitor impact. The 10-valent PCV (PCV10) was officially introduced throughout Ugandan national childhood immunization programs in 2013 and rolled-out countrywide during 2014. We aimed to measure the age-specific Streptococcus pneumoniae carriage and serotype distribution across all population age groups in the pre-PCV10 era in South Western Uganda. METHODS: We conducted a two-stage cluster, age-stratified, cross-sectional community-based study in Sheema North sub-district between January and March 2014. One NP swab was collected and analyzed for each participant in accordance with World Health Organization guidelines. RESULTS: NP carriage of any pneumococcal serotype was higher among children <2years old (77%; n=387) than among participants aged ?15years (8.5%; n=325) (chi2 p<0.001). Of the 623 positive cultures, we identified 49 serotypes among 610 (97.9%) isolates; thirteen (2.1%) isolates were non-typeable. Among <2years old, serotypes 6A, 6B, 14, 15B, 19F and 23F accounted for half of all carriers. Carriage prevalence with PCV10 serotypes was 29.4% among individuals aged <2years (n=387), 23.4% in children aged 2-4years (n=217), 11.4% in 5-14years (n=417), and 0.4% among individuals ?15years of age (n=325). The proportion of carried pneumococci serotypes contained in PCV10 was 38.1% (n=291), 32.8% (n=154), 29.4% (n=156), and 4.4% (n=22) among carriers aged <2years, 2-4years, 5-14years and ?15years, respectively. DISCUSSION: In Sheema district, the proportion of PCV10 serotypes was low (<40%), across all age groups, especially among individuals aged 15years or older (<5%). PCV10 introduction is likely to impact transmission among children and to older individuals, but less likely to substantially modify pneumococcal NP ecology among individuals aged 15years or older

Mycobacterium ulcerans infection: control, diagnosis, and treatment.

The skin disease Buruli ulcer, caused by Mycobacterium ulcerans, is the third most common mycobacterial disease after tuberculosis and leprosy and mainly affects remote rural African communities. Although the disease is known to be linked to contaminated water, the mode of transmission is not yet understood, which makes it difficult to propose control interventions. The disease is usually detected in its later stages, when it has caused substantial damage and disability. Surgery remains the treatment of choice. Although easy and effective in the early stages of the disease, treatment requires extended excisions and long hospitalisation for the advanced forms of the disease. Currently, no antibiotic treatment has proven effective for all forms of M ulcerans infection and research into a new vaccine is urgently needed. While the scientific community works on developing non-invasive and rapid diagnostic tools, the governments of endemic countries should implement active case finding and health education strategies in their affected communities to detect the disease in its early stages. We review the diagnosis, treatment, and control of Buruli ulcer and list priorities for research and development

Performance of Small Cluster Surveys and the Clustered LQAS Design to estimate Local-level Vaccination Coverage in Mali

<p>Abstract</p> <p>Background</p> <p>Estimation of vaccination coverage at the local level is essential to identify communities that may require additional support. Cluster surveys can be used in resource-poor settings, when population figures are inaccurate. To be feasible, cluster samples need to be small, without losing robustness of results. The clustered LQAS (CLQAS) approach has been proposed as an alternative, as smaller sample sizes are required.</p> <p>Methods</p> <p>We explored (i) the efficiency of cluster surveys of decreasing sample size through bootstrapping analysis and (ii) the performance of CLQAS under three alternative sampling plans to classify local VC, using data from a survey carried out in Mali after mass vaccination against meningococcal meningitis group A.</p> <p>Results</p> <p>VC estimates provided by a 10 × 15 cluster survey design were reasonably robust. We used them to classify health areas in three categories and guide mop-up activities: i) health areas not requiring supplemental activities; ii) health areas requiring additional vaccination; iii) health areas requiring further evaluation. As sample size decreased (from 10 × 15 to 10 × 3), standard error of VC and ICC estimates were increasingly unstable. Results of CLQAS simulations were not accurate for most health areas, with an overall risk of misclassification greater than 0.25 in one health area out of three. It was greater than 0.50 in one health area out of two under two of the three sampling plans.</p> <p>Conclusions</p> <p>Small sample cluster surveys (10 × 15) are acceptably robust for classification of VC at local level. We do not recommend the CLQAS method as currently formulated for evaluating vaccination programmes.</p

Burden of visceral leishmaniasis in villages of eastern gedaref state, Sudan: an exhaustive cross-sectional survey.

Since December 2009, Médecins Sans Frontières has diagnosed and treated patients with visceral leishmaniasis (VL) in Tabarak Allah Hospital, eastern Gedaref State, one of the main endemic foci of VL in Sudan. A survey was conducted to estimate the VL incidence in villages around Tabarak Allah

Adherence to self-administered tuberculosis treatment in a high HIV-prevalence setting: a cross-sectional survey in Homa Bay, Kenya.

Good adherence to treatment is crucial to control tuberculosis (TB). Efficiency and feasibility of directly observed therapy (DOT) under routine program conditions have been questioned. As an alternative, Médecins sans Frontières introduced self-administered therapy (SAT) in several TB programs. We aimed to measure adherence to TB treatment among patients receiving TB chemotherapy with fixed dose combination (FDC) under SAT at the Homa Bay district hospital (Kenya). A second objective was to compare the adherence agreement between different assessment tools

Prevalence of Buruli Ulcer in Akonolinga Health District, Cameroon: Results of a Cross Sectional Survey

As long as there is no strategy to prevent Buruli ulcer, the early detection and treatment of cases remains the most promising control strategy. Buruli ulcer is most common in remote rural areas where people have little contact with health structures. Information on the number of existing cases in the population and where they go to seek treatment is important for project planning and evaluation. Health structure based surveillance systems cannot provide this information, and previous prevalence surveys did not provide information on spatial distribution and coverage. We did a survey using centric systematic area sampling in a Health District in Cameroon to estimate prevalence and project coverage. We found the method was easy to use and very useful for project planning. It identified priority areas with relatively high prevalence and low coverage and provided an estimate of the number of existing cases in the population of the health district. The active case finding component of the method used served as an awareness campaign and was an integrated part of the project, creating a network of health delegates trained on Buruli ulcer

Evaluation of possible determinants of Mycobacterium ulcerans disease BCG vaccination, environmental and health-related behaviours, haemoglobin variants S and C, HIV

Mycobacterium ulcerans (M. ulcerans) disease, commonly called Buruli ulcer, is an emergent skin and bone disease. In endemic West African countries, it causes public health concern in terms of morbidity, treatment, and functional disabilities. There is no specific vaccine against M. ulcerans disease and control strategies are limited due to lack of knowledge on its reservoir(s), mode(s) of transmission, and risk factors. Research into the determinants of M. ulcerans is essential in order to develop improved management and prevention strategies. The aim of the present work was to get a better understanding of four possible determinants of M. ulcerans disease i.e., (i) the BCG vaccine and its potential protective effect, (ii) environmental and health-related behaviours possibly linked to M. ulcerans exposure in endemic areas, (iii) the haemoglobin variants S and C whose associated physiopathological disorders may facilitate M. ulcerans growth in human tissues, (iv) the human immunodeficiency virus (HIV) which, by inducing immunosuppression, may increase patients’ susceptibility to M. ulcerans infection or lead to more severe clinical lesions. This work took place in southern Benin. We designed a case-control study using hospital cases and matched neighbourhood controls in order to evaluate, as the main objective, the protective effect of routine BCG vaccine against M. ulcerans disease. In the same study, as a secondary objective, we investigated several environmental and health-related behaviours using a questionnaire. Three other series of patients with M. ulcerans disease were also included in this project: One series with documented HIV status, one series with documented HbS/C genotype, and one series of patients with M. ulcerans osteomyelitis and documented HbS/C genotype. In an unmatched case-control design, we compared the HIV prevalence and the frequency of the haemoglobin variants in these last three series of patients with those of the control group of the “BCG study”. In our first publication, we reported that there was no evidence for a strong mid- to long-lasting protection of BCG vaccination against M. ulcerans disease. From a public health perspective, routine neonatal BCG appears of little value in controlling M. ulcerans disease in southern Benin. Effective prevention of M. ulcerans disease by immunoprophylaxis therefore requires further research on vaccine development. In our second publication, we suggested that simple hygiene measures (i.e. using soap for washing, treating injuries with soap or antibiotic powder, and frequent contact with flowing water) could play a role in preventing M. ulcerans disease. These findings could be of public health relevance. In our third publication, we excluded a strong association between the presence of haemoglobin variants S or C and M. ulcerans disease (all clinical forms). Haemoglobin variants S and C are thus unlikely to play a role in the burden of M. ulcerans disease in Benin. However, we suggested a positive association between sickling disorders and M. ulcerans osteomyelitis. Finally, in our fourth publication, we reported a possible strong positive association between HIV and M. ulcerans disease and this deserves further consideration. This work has contributed to the enhancement of knowledge of some determinants of M. ulcerans disease. However, further research efforts are required to develop effective tools to control this poorly understood pathogen.(MED 3) -- UCL, 201