TB treatment in a chronic complex emergency: treatment outcomes and experiences in Somalia

Liddle, K.; Elema, Riekje; Thi, Sein Sein; Greig, Jane; Venis, Sarah

doi:10.1093/trstmh/trt090

Cited by 23 publications

(35 citation statements)

References 13 publications

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“…The results from the first questionnaire, regarding the selection of risk factors, confirm that, as suggested in the wider literature, WASH (39)(40)(41)(42), health care (36,43), nutrition (1,36,37) and emergency specific risk factors such as poverty (44)(45)(46), displacement and overcrowding (1,24,28,47), and (ongoing) armed conflict or war (48) are among the primary factors influencing communicable disease outbreaks in humanitarian emergencies and disasters. These results are further confirmed by the outcomes of the third questionnaire which indicates the high importance of the selected risk factors across all types of humanitarian emergencies.…”

Section: Discussionsupporting

confidence: 69%

Risk factors for communicable diseases in humanitarian emergencies and disasters: Results from a three-stage expert elicitation

Hammer¹,

Brainard²,

Hunter

2019

Global Biosecurity

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Background: Humanitarian emergencies including disasters associated with natural hazards, conflict, complex emergencies and famines can pose significant risks to public health, especially when they lead to population displacement into inadequate conditions. To reduce the risk of communicable disease outbreaks in such situations it is necessary to know the key risk factors, their thresholds (quantitative risk factors only) and their relative importance in different types of emergencies. Methods: We conducted a three-stage structured expert elicitation. Experts from the fields of health protection and humanitarian assistance were invited to complete three successive online questionnaires. Experts were asked to choose the 20 most critical risk factors and in subsequent rounds to determine thresholds for urgent (yellow threshold level) and critical action (red threshold level). Additionally, experts were asked to assign weights for the risk factors in different emergency types. Results: We identified 20 key risk factors, which include factors related to water, sanitation and hygiene, access to health care, vaccination, nutrition, political will and others. Nine out of the 20 risk factors were quantifiable, for those risk factors yellow and red thresholds are given. 11 risk factors were qualitative. All risk factors scored highly when weighted in different emergency types and differences between risk factor weights in different types of emergencies were limited. Conclusion: Communicable disease risks in humanitarian emergencies are a nexus of complex and often interrelated individual issues. Knowing key risk factors and their thresholds and weight in different types of emergencies can help guide emergency response and risk reduction efforts.

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Section: Discussionsupporting

confidence: 69%

Risk factors for communicable diseases in humanitarian emergencies and disasters: Results from a three-stage expert elicitation

Hammer¹,

Brainard²,

Hunter

2019

Global Biosecurity

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“…Our colleagues have reported experiences of an MSF tuberculosis treatment programme in Somalia where the need for DOT led the teams to create “TB villages” and “DOT corners” to ensure continuous provision of treatment [16]. We think that this was an interesting alternative to DOT.…”

Section: Discussionmentioning

confidence: 99%

Directly-Observed and Self-Administered Tuberculosis Treatment in a Chronic, Low-Intensity Conflict Setting in India

Das¹,

Isaakidis²,

Armstrong³

et al. 2014

PLoS ONE

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BackgroundLimited data are available about tuberculosis treatment models of care for internally displaced populations in chronic, low-intensity conflict zones. This study aimed to detail experiences of a Médecins Sans Frontières tuberculosis programme in Andhra Pradesh-Chhattisgarh border area, India, from January to December 2012.MethodsThe study was a description of two retrospective, observational cohorts receiving category I tuberculosis treatment, either intermittent directly observed treatment (DOT) or daily self-administered therapy (SAT) depending on the security of the area and access to health care services.ResultsA total of 55 and 17 new tuberculosis patients under DOT and SAT respectively, with complete outcomes were included in the study. Most patients registered were new cases suffering from pulmonary, smear-positive tuberculosis. More than half of the patients in both cohorts were cured or completed treatment: 38/55 (69%) patients were successfully treated under DOT compared to 9/17 (53%) under SAT. Of the patients with adverse outcomes, the ratios of loss to follow up: failure: died were 10∶4:3 under DOT and 7∶0:1 under SAT. A much smaller proportion of patients under DOT (18%) were lost to follow up than under SAT (41%).DiscussionMaximum efforts are required to implement successful tuberculosis control programmes for internally displaced populations in conflict zones. Our study suggests that complete tuberculosis treatment can be given to patients using either intermittent DOT or daily SAT, depending on security and access to health services. National TB programmes should include SAT strategies for tuberculosis treatment as these may be an alternative feasible option in conflict settings.

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“…High LTFU rates can lead to increased disease transmission, greater rates of smear positivity, drug resistance, chronic pulmonary impairment and increased mortality rates [25]. These findings are supported by the study from Galkayo, which found a correlation between the 10% LTFU rate in Somalia and weak health system management [3]. …”

Section: Discussionmentioning

confidence: 76%

“…In addition, conflicts cause the displacement of populations and impair access to healthcare. This can increase TB transmission, worsen patient outcomes and lead to increasing rates of drug resistance [3, 4]. A study conducted in Nepal found that the poor uptake of TB services was due to war-associated factors [1].…”

Section: Introductionmentioning

confidence: 99%

Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014

Hassanain¹,

Edwards

Venables

et al. 2018

Confl Health

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BackgroundSudan is a fragile developing country, with a low expenditure on health. It has been subjected to ongoing conflicts ever since 1956, with the Darfur crisis peaking in 2004. The conflict, in combination with the weak infrastructure, can lead to poor access to healthcare. Hence, this can cause an increased risk of infection, greater morbidity and mortality from tuberculosis (TB), especially amongst the poor, displaced and refugee populations. This study will be the first to describe TB case notifications, characteristics and outcomes over a ten-year period in Darfur in comparison with the non-conflict Eastern zones within Sudan.MethodsA cross-sectional review of the National Tuberculosis Programme (NTP) data from 2004 to 2014 comparing the Darfur conflict zone with the non-conflict eastern zone.ResultsNew case notifications were 52% lower in the conflict zone (21,131) compared to the non-conflict zone (43,826). Smear-positive pulmonary TB (PTB) in the conflict zone constituted 63% of all notified cases, compared to the non-conflict zone of 32% (p < 0.001). Extrapulmonary TB (EPTB) predominated the TB notified cases in the non-conflict zone, comprising 35% of the new cases versus 9% in the conflict zone (p < 0.001). The loss to follow up (LTFU) was high in both zones (7% conflict vs 10% non-conflict, p < 0.001) with a higher rate among re-treatment cases (12%) in the conflict zone. Average treatment success rates of smear-positive pulmonary TB (PTB), over ten years, were low (65-66%) in both zones. TB mortality among re-treatment cases was higher in the conflict zone (8%) compared to the non-conflict zone (6%) (p < 0.001).ConclusionA low TB case notification was found in the conflict zone from 2004 to 2014. High loss to follow up and falling treatment success rates were found in both conflict and non-conflict zones, which represents a significant public health risk. Further analysis of the TB response and surveillance system in both zones is needed to confirm the factors associated with the poor outcomes. Using context-sensitive measures and simplified pathways with an emphasis on displaced persons may increase access and case notification in conflict zones, which can help avoid a loss to follow up in both zones.

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TB treatment in a chronic complex emergency: treatment outcomes and experiences in Somalia

Abstract: Despite the challenges, a high percentage of patients were successfully treated. Treatment outcomes were not adversely affected by withdrawal of international supervisory staff.

Cited by 23 publications

References 13 publications

Risk factors for communicable diseases in humanitarian emergencies and disasters: Results from a three-stage expert elicitation

Risk factors for communicable diseases in humanitarian emergencies and disasters: Results from a three-stage expert elicitation

Directly-Observed and Self-Administered Tuberculosis Treatment in a Chronic, Low-Intensity Conflict Setting in India

Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014

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