Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda

YesSETTING: In 2005, in response to the increasing prevalence of rifampicin-resistant tuberculosis (RR-TB) and poor treatment outcomes, Rwanda initiated the programmatic management of RR-TB, including expanded access to systematic rifampicin drug susceptibility testing (DST) and standardised treatment.OBJECTIVE: To describe trends in diagnostic and treatment delays and estimate their effect on RR-TB mortality.DESIGN: Retrospective analysis of individual-level data including 748 (85.4%) of 876 patients diagnosed with RR-TB notified to the World Health Organization between 1 July 2005 and 31 December 2016 in Rwanda. Logistic regression was used to estimate the effect of diagnostic and therapeutic delays on RR-TB mortality.RESULTS: Between 2006 and 2016, the median diagnostic delay significantly decreased from 88 days to 1 day, and the therapeutic delay from 76 days to 3 days. Simultaneously, RR-TB mortality significantly decreased from 30.8% in 2006 to 6.9% in 2016. Total delay in starting multidrug-resistant TB (MDR-TB) treatment of more than 100 days was associated with more than two-fold higher odds for dying. When delays were long, empirical RR-TB treatment initiation was associated with a lower mortality.CONCLUSION: The reduction of diagnostic and treatment delays reduced RR-TB mortality. We anticipate that universal testing for RR-TB, short diagnostic and therapeutic delays and effective standardised MDR-TB treatment will further decrease RR-TB mortality in Rwanda

Community mobilization for malaria elimination: application of an open space methodology in Ruhuha sector, Rwanda

Background Despite the significant reduction of malaria transmission in Rwanda, Ruhuha sector is still a highly endemic area for malaria. The objective of this activity was to explore and brainstorm the potential roles of various community stakeholders in malaria elimination. Methods Horizontal participatory approaches such as ‘open space’ have been deployed to explore local priorities, stimulate community contribution to project planning, and to promote local capacity to manage programmes. Two open space meetings were conducted with 62 and 82 participants in years 1 and 2, respectively. Participants included purposively selected community and local organizations’ representatives. Results Malaria was perceived as a health concern by the respondents despite the reported reduction in prevalence from 60 to 20% for cases at the local health centre. Some misconceptions of the cause of malaria and misuse of preventive strategies were noted. Poverty was deemed to be a contributing factor to malaria transmission, with suggestions that improvement of living conditions for poor families might help malaria reduction. Participants expressed willingness to contribute to malaria elimination and underscored the need for constant education, sensitization and mobilization towards malaria control in general. Active diagnosis, preventative strategies and prompt treatment of malaria cases were all mentioned by participants as ways to reduce malaria. Participants suggested that partnership of stakeholders at various levels could speed up programme activities. A community rewards system was deemed important to motivate engaged participants, i.e., community health workers and households. Establishment of malaria clubs in schools settings was also suggested as crucial to speed up community awareness and increase skills towards further malaria reduction. Conclusions This bottom-up approach was found useful in engaging the local community, enabling them to explore issues related to malaria in the area and suggest solutions for sustainable malaria elimination gains

Community-based biological control of malaria mosquitoes using Bacillus thuringiensis var. israelensis (Bti) in Rwanda: Community awareness, acceptance and participation

Contains fulltext : 184206.pdf (publisher's version ) (Open Access)Background: Targeting the aquatic stages of malaria vectors via larval source management (LSM) in collaboration with local communities could accelerate progress towards malaria elimination when deployed in addition to existing vector control strategies. However, the precise role that communities can assume in implementing such an intervention has not been fully investigated. This study investigated community awareness, acceptance and participation in a study that incorporated the socio-economic and entomological impact of LSM using Bacillus thuringiensis var. israelensis (Bti) in eastern Rwanda, and identified challenges and recommendations for future scale-up. Methods: The implementation of the community-based LSM intervention took place in Ruhuha, Rwanda, from February to July 2015. The intervention included three arms: control, community-based (CB) and project-supervised (PS). Mixed methods were used to collect baseline and endline socio-economic data in January and October 2015. Results: A high perceived safety and effectiveness of Bti was reported at the start of the intervention. Being aware of malaria symptoms and perceiving Bti as safe on other living organisms increased the likelihood of community participation through investment of labour time for Bti application. On the other hand, the likelihood for community participation was lower if respondents: (1) perceived rice farming as very profitable; (2) provided more money to the cooperative as a capital; and, (3) were already involved in rice farming for more than 6 years. After 6 months of implementation, an increase in knowledge and skills regarding Bti application was reported. The community perceived a reduction in mosquito density and nuisance biting on treated arms. Main operational, seasonal and geographical challenges included manual application of Bti, long working hours, and need for transportation for reaching the fields. Recommendations were made for future scale-up, including addressing above-mentioned concerns and government adoption of LSM as part of its vector control strategies. Conclusions Community awareness and support for LSM increased following Bti application. A high effectiveness of Bti in terms of reduction of mosquito abundance and nuisance biting was perceived. The study confirmed the feasibility of community-based LSM interventions and served as evidence for future scale-up of Bti application and adoption into Rwandan malaria vector control strategies.13 p

Sputum Concentration Improves Diagnosis Of Pulmonary Tuberculosis Cases In Children At A Tertiary Care Institution In Rwanda

Background: Pulmonary tuberculosis diagnosis by direct sputum smear microscopy is still questionable because of its low sensitivity and this technique is not sufficient to diagnose pulmonary tuberculosis especially in people who are not able to spit out properly like children and old people; therefore another more sensitive conventional technique like concentrated sputum smear microscopy is needed in patients suspected of having pulmonary tuberculosis. We aimed to find out if the sputum concentration technique can be more sensitive than direct smear microscopy in the diagnosis of pulmonary tuberculosis according to age groups. Methods: This study was a cross-sectional, conducted on 70 participants at CHUK. The sputa were examined microscopically on direct and concentrated smears and result compared to culture. Finally the data were analyzed with MS excel and SPSS. Results: A total of 210 sputa were analyzed by direct and concentration methods with culture as a gold standard. In patients under 15 years both methods were different in sensitivity (25% vs. 75%, CI= 95%, P= 0.047), in patients of 15 years of age and more, both methods had the same sensitivity (75% vs. 75%, CI= 95%, P = 0, 87). Regardless of age groups both methods were different in sensitivity (80% vs.90.9%, C.I= 95%, P = 0.001). Conclusion: Sputum concentration is more sensitive than direct technique especially in children under 15 years. We would recommend all researchers involved in tuberculosis to increase the sample size and use different study sites to validate this method before its implementation universally.Introduction: Le diagnostic de la tuberculose pulmonaire par examen microscopique des frottis direct est encore discutable en raison de sa faible sensibilité et ne permet pas elle seule de poser le diagnostic de la tuberculose pulmonaire. Ceci est surtout le cas chez les malades qui ne sont pas en mesure de trouver le crachat à savoir les enfants et les personnes âgées. Par conséquent, une autre technique classique plus sensible comme le frottis concentré est nécessaire dans ce groupe des patients. Ce travail avait pour but de déterminer l’apport réel de la technique de concentration des crachats comparé à celui de l’examen microscopique de frottis direct dans le diagnostic de la tuberculose pulmonaire selon les groupes d’âge. Méthodes: Il s’agissait d’une étude prospective, transversale portant sur 70 patients suspect de tuberculose pulmonaire vue au CHUK. Les résultats de l’examen microscopique direct; et après concentration du crachat ont été comparés aux résultats de la culture. Les données ont été saisies et analysées avec MS Excel et SPSS. Résultats: Sur un total de 210 crachats examinés, l’approche d’examen microscopique basées sur la concentration du crachat a détecté un nombre significativement plus élevé chez les patients de moins de 15 ans (25% vs 75%, IC = 95%, P = 0,047). Chez les patients de 15 ans et plus, les deux méthodes ont détectée de façon égale avec une même sensibilité (75% contre 75%, IC = 95%, P = 0, 87). Quel que soit e le groupe d’âge, la méthode d’examen microscopique après concentration du crachat aune sensibilité légèrement supérieur qu’ à celle dont l’approche utilise un examen direct (80% vs.90.9%, IC = 95%, P = 0,001). Conclusion: L’examen microscopique basé sur la concentration du crachat est plus sensible que la technique directe surtout chez les enfants de moins de 15 ans. Nos résultats font appel à des recherches portant sur grande taille de l’échantillon et impliquant différents sites d’étude pour valider cette méthode avant sa mise en oeuvre

Sensory motor learning : developing a kinaesthetic sense in the throws

Améliorer le contrôle des mouvements dynamiques par un sens kinesthésique développé (la capacité de sentir le mouvement du corps et des membres) : la condition pour la réussite au plus haut niveau dans les lancers. Illustration par des exercices généraux et spécifiques en lancer du martea

Le militaire et l'orienteur : contribution des Armées à l'implantation et à la diffusion d'un sport (1967-1987)

Rôle joué par les militaires dans l'implantation, l'institutionnalisation et la propagation de la course d'orientation en France, entre 1967, moment de l'intervention de l'Ecole Interarmées des sports (EIS) dans les destinées de la jeune activité sportive , et 1987, date symbolique d'une rupture affichée par la structure fédérale civile avec le parrainage de l'armée