Michel Quere

Nifurtimox-Eflornithine Combination Therapy for Second-Stage Gambiense Human African Trypanosomiasis: Médecins Sans Frontières Experience in the Democratic Republic of the Congo

BACKGROUND Existing diagnostic and treatment tools for human African trypanosomiasis (HAT) are limited. The recent development of nifurtimox-eflornithine combination therapy (NECT) has brought new hopes for patients in the second stage. While NECT has been rolled out in most endemic countries, safety data are scarce and derive only from clinical trials. The World Health Organization (WHO) coordinates a pharmacovigilance program to collect additional data on NECT safety and efficacy. We report here the results of 18 months of experience of NECT use in treatment centers run by Médecins Sans Frontières in the Democratic Republic of the Congo (DRC). METHODS This cohort study included 684 second-stage HAT patients (including 120 children) treated with NECT in Doruma and Dingila hospitals, northeastern DRC, between January 2010 and June 2011. All treatment-emergent adverse events (AEs) were recorded and graded according to the Common Terminology Criteria for Adverse Events version 3.0. Safety and efficacy data were retrieved from the WHO pharmacovigilance forms and from Epitryps, a program monitoring database. RESULTS Eighty-six percent of the patients experienced at least 1 AE during treatment. On average, children experienced fewer AEs than adults. Most AEs were mild (37.9%) or moderate (54.7%). Severe AEs included vomiting (n = 32), dizziness (n = 16), headache (n = 11), and convulsions (n = 11). The in-hospital case fatality rate was low (0.15%) and relapses were rare (n = 14). CONCLUSIONS In comparison with previous treatments, NECT was effective, safe, and well tolerated in nontrial settings in DRC, further supporting the roll-out of NECT as first-line treatment in second-stage Trypanosoma brucei gambiense HAT. Tolerance was particularly good in children.

An epidemic of dystonic reactions in central Africa

www.thelancet.com/lancetgh Vol 5 February 2017 e137 bought in a pharmacy or procured at a government health centre. The evidence suggests that this large outbreak of dystonic reactions, in a remote area of central Africa, was caused by the consumption of tablets labelled as diazepam but which in fact contained undeclared haloperidol. No alternative explanation was found to explain the clinical features observed. It is most likely that these were falsifi ed medicines, deliberately and fraudulently mislabelled. This case emphasises the importance of investi gating atypical clinical presentations and the need for multidisciplinary approaches. Meningitis was a reasonable working diagnosis, in a remote community, by primary health-care workers unfamiliar with dystonia. Further investigations revealed that, in this area of DRC, patients frequently receive diazepam over the counter to treat a wide range of illnesses for which diazepam should not have been used according to rational prescribing. Although dystonic reactions are rarely life-threatening, they often cause distress, panic, and shame for patients and their families. Local public perceptions of the outbreak were not linked to the consumption of medication, but rather to meningitis or “evil spells/spirits”. Joint action led to the posting of an international WHO alert about the circulation of falsifi ed diazepam in sub-Saharan Africa. Two types of falsifi ed diazepam have been identifi ed to date. Both products have tablets that are embossed with the mark “AGOG”: falsifi ed diazepam sold in bottles marked “Centaur Solina An epidemic of dystonic reactions in central Africa

Effectiveness of blood transfusions and risk factors for mortality in children aged from 1 month to 4 years at the Bon Marché Hospital, Bunia, Democratic Republic of the Congo

Objective  To assess the effectiveness of blood transfusions in a hospital of north‐eastern Democratic Republic of the Congo.

SMS-based smartphone application for disease surveillance has doubled completeness and timeliness in a limited-resource setting – evaluation of a 15-week pilot program in Central African Republic (CAR)

BackgroundIt is a challenge in low-resource settings to ensure the availability of complete, timely disease surveillance information. Smartphone applications (apps) have the potential to enhance surveillance data transmission.MethodsThe Central African Republic (CAR) Ministry of Health and Médecins Sans Frontières (MSF) conducted a 15-week pilot project to test a disease surveillance app, Argus, for 20 conditions in 21 health centers in Mambéré Kadéi district (MK 2016). Results were compared to the usual paper-based surveillance in MK the year prior (MK 2015) and simultaneously in an adjacent health district, Nana-Mambére (NM 2016). Wilcoxon rank sum and Kaplan-Meier analyses compared report completeness and timeliness; the cost of the app, and users’ perceptions of its usability were assessed.ResultsTwo hundred seventy-one weekly reports sent by app identified 3403 cases and 63 deaths; 15 alerts identified 28 cases and 4 deaths. Median completeness (IQR) for MK 2016, 81% (81–86%), was significantly higher than in MK 2015 (31% (24–36%)), and NM 2016 (52% (48–57)) (p < 0.01). Median timeliness (IQR) for MK 2016, 50% (39–57%) was also higher than in MK 2015, 19% (19–24%), and NM 2016 29% (24–36%) (p < 0.01). Kaplan-Meier Survival Analysis showed a significant progressive reduction in the time taken to transmit reports over the 15-week period (p < 0.01). Users ranked the app’s usability as greater than 4/5 on all dimensions. The total cost of the 15-week pilot project was US

MSFeCARE: an electronic algorithm to improve antibiotic prescription in the management of childhood illness in primary health care

40,575. It is estimated that to maintain the app in the 21 health facilities of MK will cost approximately US

Protective effectiveness of seasonal malaria chemoprevention in Niger: a prospective case-control study

18,800 in communication fees per year.ConclusionsThe app-based data transmission system more than doubled the completeness and timeliness of disease surveillance reports. This simple, low-cost intervention may permit the early detection of disease outbreaks in similar low-resource settings elsewhere.

A post-conflict vaccination campaign, Central African Republic

INTRODUCTION: MSFeCARE is an electronic clinical decision support system designed to improve quality of care and rational use of antibiotics for childhood illnesses in children 50% reduction in antibiotic prescriptions and provided valuable information to guide clinical supervision. The tool holds immense potential to improve the quality of care and reduce irrational antibiotic prescription. Plans are underway for further implementation and continued monitoring.