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Antibiotic prescribing for upper respiratory infections among children in…

May 15, 2017

Overuse of antibiotics contributes to the development of antimicrobial resistance. This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China. The authors conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2–14 years with upper respiratory infections (URI).  The study concludes that inappropriate use of antibiotics was high for outpatient childhood URI in the four counties of Guangxi, China, with the highest rate found in township hospitals. A significantly high proportion of prescriptions containing antibiotics were broad-spectrum, by intravenous infusion or with multiple antibiotics, especially at county hospitals. Urgent attention is needed to address this challenge.

Management of chronic hepatitis C at a primary health…

May 14, 2017

The burden of hepatitis C (HCV) infection in Pakistan is among the highest in the world, with a reported national HCV prevalence of 6.7% in 2014. In specific populations, such as in urban communities in Karachi, the prevalence is suspected to be higher. Interferon-free treatment for chronic HCV infection (CHC) could allow scale up, simplification and decentralisation of treatment to such communities. This study presents an interim analysis over the course of February-December 2015 of an interferon-free, decentralised CHC programme in the community clinic in Machar Colony, Karachi, Pakistan. It was concluded that the outcomes of HCV treatment with all oral combination in an integrated, decentralised model of care for CHC in a primary care setting, using simplified diagnostic and treatment algorithms, are comparable to the outcomes achieved in clinical trial settings for Sofosbuvir-based regimens. The study suggests the feasibility and the pertinence if interferon-free treatment regimens are included in the national programme, at both provincial and national levels.

Antimicrobial-resistant infections among postpartum women at a Ugandan referral…

May 13, 2017

Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology, and antimicrobial resistance are lacking. This is a prospective cohort study of 4,231 Ugandan women presenting to a regional referral hospital for delivery or postpartum care. It was found that women in rural Uganda with postpartum fever have a high rate of antibiotic resistance among cultured urinary and bloodstream infections. Increasing availability of microbiology testing to inform appropriate antibiotic use, development of antimicrobial stewardship programs, and strengthening infection control practices should be high priorities.

Efficacy of a low-cost, heat-stable oral rotavirus vaccine in…

April 15, 2017

Each year, rotavirus gastroenteritis is responsible for about 37% of deaths from diarrhea among children younger than 5 years of age worldwide, with a disproportionate effect in sub-Saharan Africa. MSF conducted a randomized, placebo-controlled trial in Niger to evaluate the efficacy of a live, oral bovine rotavirus pentavalent vaccine (BRV-PV, Serum Institute of India) to prevent severe rotavirus gastroenteritis. It was found that three doses of BRV-PV, an oral rotavirus vaccine, had an efficacy of 66.7% against severe rotavirus gastroenteritis among infants in Niger.

International non-governmental organisations’ provision of community-based tuberculosis care for…

April 14, 2017

National tuberculosis (TB) programs engage with international non-governmental organisations (INGOs), especially to provide TB care in complex settings where community involvement might be required. In Myanmar, however, there is limited data on how such INGO community-based programs are organised and how effective they are. In this study, MSF describes four INGO strategies for providing community-based TB care to hard-to-reach populations in Myanmar, and assess their contribution to TB case detection. This is a descriptive study using program data from four INGOs and the National TB Program (NTP) in 2013–2014. The study concludes that community-based TB care supported by INGOs successfully achieved TB case detection in hard-to-reach and vulnerable populations. Strategies to ensure sustainability of the programs should be explored, including the need for longer-term commitment of INGOs.

Visceral Leishmaniasis in Somalia: A review of epidemiology and…

April 13, 2017

Somalia, ravaged by conflict since 1991, has areas endemic for visceral leishmaniasis (VL), a deadly parasitic disease affecting the rural poor, internally displaced, and pastoralists. Very little is known about VL burden in Somalia, where the protracted crisis hampers access to health care. We reviewed evidence about VL epidemiology in Somalia and appraised control options within the context of this fragile state’s health system. VL has been reported in Somalia since 1934 and has persisted ever since in foci in the southern parts of the country. The only feasible VL control option is early diagnosis and treatment, currently mostly provided by non-state actors. The availability of VL care in Somalia is limited and insufficient at best, both in coverage and quality. Precarious security remains a major obstacle to reach VL patients in the endemic areas, and the true VL burden and its impact remain unknown. Locally adjusted, innovative approaches in VL care provision should be explored, without undermining ongoing health system development in Somalia. Ensuring VL care is accessible is a moral imperative, and the limitations of the current VL diagnostic and treatment tools in Somalia and other endemic settings affected by conflict should be overcome.

Local constraints to access appropriate malaria treatment in the…

April 12, 2017

Despite emerging drug resistance in Cambodia, artemisinin-based combination therapy (ACT) is still the most efficacious therapy. ACT is available free of charge in the Cambodian public sector and at a subsidised rate in the private sector. However, un- and mistreated cases in combination with population movements may lead to the further spread of resistant parasites, stressing the importance of understanding how the perceived aetiology of malaria and associated health-seeking behaviour may delay access to appropriate treatment. A qualitative study explored these factors after an epidemiological survey confirmed parasite resistance in Preah Vihear province. It was concluded that Cambodian perceptions of illness that focus on single symptoms and their perceived severity may lead to the identification of one or multiple illnesses at the same time, rarely suspecting malaria from the start and implying different patterns of health seeking behaviour and treatment choice. However, decisions to self-diagnose and treat at home are also pragmatic and must be understood in the context of poverty, a major barrier to seeking prompt and appropriate care for malaria in an area characterised by parasite resistance

 

Women's knowledge and perception of male circumcision before and…

April 11, 2017

The roll-out of medical male circumcision (MC) is progressing in Southern and Eastern Africa. Little is known about the effect of this roll-out on women. The objective of this study was to assess the knowledge and perceptions of women regarding MC in a setting before and after the roll-out. This study was conducted in the South African township of Orange Farm where MC prevalence among men increased from 17% to 53% in the period 2008± 2010. This study shows that the favourable perception of women and relatively correct knowledge regarding Voluntary Medical MC (VMMC) had increased during the rollout of VMMC. When possible, women should participate in the promotion of VMMC although further effort should be made to improve their knowledge.

Modelling the effect of short-course multidrug-resistant tuberculosis treatment in…

March 18, 2017

Multidrug-resistant tuberculosis (MDR-TB) is a major threat to global TB control. MDR-TB treatment regimens typically last 20 months or more, require a patient to take a high number of pills, and often lead to unsatisfactory results. This research conclusively proves that a 9–11-month regimen with seven antibiotics can demonstrate high success rates among selected MDR-TB patients in different settings. It further states that greater gains may be possible in contexts where the regimen is more widely applicable.

Multidrug-resistant tuberculosis

Optimal health and disease management using spatial uncertainty: A…

March 17, 2017

Artemisinin-resistant Plasmodium falciparum malaria parasites are now present across much of mainland Southeast Asia, where ongoing surveys are measuring and mapping their spatial distribution. These efforts require substantial resources. Here we propose a generic ‘smart surveillance’ methodology to identify optimal candidate sites for future sampling and thus map the distribution of artemisinin resistance most efficiently. The study uses ‘uncertainty’ map generated iteratively by a geostatistical model to determine optimal locations for subsequent sampling. It was concluded that this methodology, which has broader application to geostatistical mapping in general, could improve the quality and efficiency of drug resistance mapping and thereby guide practical operations to eliminate malaria in affected areas.

Effectiveness of one dose of oral cholera vaccine in…

March 16, 2017

During a cholera outbreak in May 2015, in Juba, South Sudan, the Ministry of Health, Doctors Without Borders/Médecins Sans Frontières (MSF) and partners engaged in the first field deployment of a single dose of oral cholera vaccine to enhance the outbreak response. This is a case-cohort study, combining information on the vaccination status and disease outcomes from a random cohort recruited from throughout the city of Juba with that from all the cases detected. It was concluded that one dose of Shanchol was effective in preventing medically attended cholera in this study. These results support the use of a single-dose strategy in outbreaks in similar epidemiological settings.

Introducing an antibiotic stewardship program in a humanitarian surgical…

March 15, 2017

Antibiotic stewardship program (ASP) implementation in humanitarian settings is a new endeavour – Doctors Without Borders/Médecins Sans Frontières (MSF) introduced an ASP within a hospital in Amman, Jordan, where patients from Iraq, Syria, and Yemen with chronic, often multidrug-resistant, infections related to war are managed. Antibiotics were reviewed, and real-time recommendations were made to optimise choice, dose, duration, and route by a small team. Over the first year of implementation, acceptance of the ASP’s recommendations improved. When compared with the year prior to implementation, antibiotic cost in 2014 declined considerably from approximately $252,077 (average, $21,006/month) to

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