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Field Evaluation of Capillary Blood Samples as a Collection…

June 01, 2016

Reliable reverse transcription polymerase chain reaction (RT-PCR)–based diagnosis of Ebola virus infection currently requires a blood sample obtained by intravenous puncture. During the Ebola outbreak in Guinea, we evaluated the usability of capillary blood samples collected from finger sticks of patients suspected of having Ebola virus disease (EVD) for field diagnostics during an outbreak emergency.

 

Monitoring treatment outcomes in patients with chronic disease: lessons…

Chronic disease, communicable or non-communicable, that requires lifelong treatment has to be reported differently as patients cannot be cured. For instance, in relation to HIV, the two essential pieces of information are how many new patients are being initiated and registered for ART each quarter and how many cumulatively are retained alive and on therapy, stratified by type of ART regimen. Similarly, ever since the ‘DOTS TB Strategy Framework’ was launched in 1994, tuberculosis control programmes all over the world have monitored, recorded and reported on the treatment outcomes of patients registered for treatment. The study focuses on the significance of monitoring treatment outcomes of chronic diseases such as HIV and TB to evaluate facility based programme outcomes, clinic performance and cohort survival overtime. 

 

Pregnant women in war zones

Death from violent conflict is a little acknowledged cause of maternal mortality. An estimated 140 000 women die in conflict every year and an unknown proportion of these women are pregnant at the time of death, adding to the estimated 303, 000 women already expected to die annually worldwide in pregnancy and childbirth. This study talks about how war aggravates an existing high maternal mortality rate by destroying health services and preventing access to them. 

 

Intensified tuberculosis case finding amongst vulnerable communities in southern…

India mainly uses passive case finding to detect tuberculosis (TB) patients through the Revised National Tuberculosis Control Programme (RNTCP). An intensified case finding (ICF) intervention was conducted among vulnerable communities in two districts of Karnataka during July– December 2013; 658 sputum smear-positive TB cases were detected. The study shows that the number of smear-positive cases detected increased by 8.8% relative to the pre-intervention period (July–December 2012) in intervention communities as compared to an 8.6% decrease in communities without the ICF intervention. ICF activities brought TB services closer to vulnerable communities, moderately increasing TB case detection rates. 

 

Shedding of Ebola Virus in an Asymptomatic Pregnant Woman

April 01, 2016

A 31-year-old woman in the late stage of a fifth pregnancy who had no history of coexisting illnesses or use of long-term medications presented to the hospital with suspected premature rupture of membranes. She was referred to the ELWA3 Ebola treatment unit (ETU) in Monrovia, Liberia, as was common practice in Monrovia for patients who potentially presented a hospital- exposure risk, such as during delivery. On admittance to the ETU, she had mild lower abdominal pain and sparse contractions and reported fetal movements (Fig. 1). She was afebrile and reported having had no contact with patients with EVD and did not meet the Ebola virus case definition. She underwent routine EBOV testing for anticipated transfer to the delivery clinic. The unique immunologic status of pregnant women might alter disease presentation and progression. This case highlights the challenges that clinicians may face in assessing pregnant women for possible infections, including EVD, and the potential risk for health care staff.

 

Orthopaedic surgery in natural disaster and conflict settings: how…

Médecins sans Frontières (MSF) is one of the main providers of orthopaedic surgery in natural disaster and conflict settings and strictly imposes a minimum set of context specific standards before any surgery can be performed. Based on MSF’s experience of performing orthopaedic surgery in a number of such settings, we describe: (a) whether it was possible to implement the minimum standards for one of the more rigorous orthopaedic procedures—internal fixation—and when possible, the time frame, (b) the volume and type of interventions performed and (c) the intra-operative mortality rates and postoperative infection rates. We conducted a retrospective review of routine programme data collected between 2007 and 2014 from three MSF emergency surgical interventions in Haiti (following the 2010 earthquake) and three ongoing MSF projects in Kunduz (Afghanistan), Masisi (Democratic Republic of the Congo) and Tabarre (Haiti). 

It was concluded that in settings affected by natural disaster or conflict, a high volume and wide repertoire of orthopaedic surgical procedures can be performed with good outcomes when minimum standards are in place. More demanding procedures like internal fixation may not always be feasible.

 

“They Know, They Agree, but They Don’t Do”- The…

Despite being a recognized standard of tuberculosis (TB) care internationally, mandatory TB case notification brings forth challenges from the private sector. Only three TB cases were notified in 2013 by private practitioners compared to 2000 TB cases notified yearly from the public sector in Alappuzha district. The study objective was to explore the knowledge, opinion and barriers regarding TB Notification among private practitioners offering TB services in Alappuzha, Kerala state, India. This was a mixed-methods study with quantitative (survey) and qualitative components conducted between December 2013 and July 2014. The study concluded that communication strategies like training, timely dissemination of information of policy changes and one-to-one dialogue with private practitioners to dispel misconceptions may enhance TB notification. Trust building strategies like providing feedback about referred cases from private sector, health personnel visit or a liaison private doctor may ensure compliance to public health activities.

 

Reframing HIV care: putting people at the centre of…

The delivery of HIV care in the initial rapid scale-up of HIV care and treatment was based on existing clinic-based models, which are common in highly resourced settings and largely undifferentiated for individual needs. A new framework for treatment based on variable intensities of care tailored to the specific needs of different groups of individuals across the cascade of care is proposed here. Service intensity is characterised by four delivery components: (i) types of services delivered, (ii) location of service delivery, (iii) provider of health services and (iv) frequency of health services. How these components are developed into a service delivery framework will vary across countries and populations, with the intention being to improve acceptability and care outcomes. The goal of getting more people on treatment before they become ill will necessitate innovative models of delivering both testing and care. As HIV programmes expand treatment eligibility, many people entering care will not be ‘patients’ but healthy, active and productive members of society [1]. To take the framework to scale, it will be important to: (i) define which individuals can be served by an alternative delivery framework; (ii) strengthen health systems that support decentralisation, integration and task shifting; (iii) make the supply chain more robust; and (iv) invest in data systems for patient tracking and for programme monitoring and evaluation.

 

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