Treatment of a cohort of tuberculosis patients using the Manyatta regimen in a conflict zone in South Sudan

Abstract

This is a descriptive report of a pilot project of tuberculosis (TB) treatment in a conflict zone. A TB programme was implemented by Médecins Sans Frontières(MSF)-Holland in a semi-nomadic population in a very insecure and underdeveloped area of Upper Nile province in Southern Sudan. Outcome measures were operational feasibility, default rate, and sputum smear conversion at 4 months. A cohort of TB patients was admitted over a 10-week period (July-September 2001). Adherence strategy, project implementation, and and contingency planning were adapted to local conditions. The treatment regimen (4 HRZE [4-month daily supervised regimen] followed by 3EH or 3TH [3-month unsupervised regimen]: isoniazid (H), rifampicin (R), pyrazinamide (Z), ethambutol (E) and thiacetazone (T)) was a variant on the Manyatta regimen developed for semi-nomads in Kenya. Of 163 patients, 84 (52%) were children aged < 15 years. Lymph node TB comprised 34% and spinal TB 15% of all patients. Among adults, 41% had smear-positive pulmonary disease. Only 1 patient (0.6%) defaulted. All sputum smear-positive patients who completed 4 months of therapy converted to smear-negative, although 2 were subsequently found to have relapsed. TB in complex emergency situations is an underrecognized priority. Using an approach adapted especially to this setting, TB treatment was successfully implemented with minimal risk of promoting drug resistance, in an unstable setting.

Editorial: Health of nomadic pastoralists: new approaches towards equity effectiveness

“…An adaptation of the DOTS strategy to nomadic pastoralists should consider, besides massive information education communication (IEC) campaigns, the presence and influence of traditional healers together with specific contacts with modern health services which should be strategically placed following the calendar of livestock transhumance. Moreover, recent approaches in Sudan, Kenya and Ethiopia (MSF TB control in the Afar region) adapt TB control centres to the nomadic pastoralist way of life by constructing traditional housing, termed the 'Manyatta' system (Keus et al 2003). This approach has also been successfully used for long-term albendazole drug treatment of cystic echinococcosis in Turkana nomads (E. Zeyhle, African Medical Research Foundation).…”

Preparation and antitubercular activities in vitro and in vivo of novel Schiff bases of isoniazid

“…As a practical matter, drugs for combination therapy are most efficacious when their achievable serum concentration levels permit this restriction of amplification, given concomitant low toxicity. Advancement of these important drug characteristics may make it possible to shorten the current lengthy therapeutic regimens and to address the physiologically-controlled underdosing of certain patient groups, both of which have been identified as pivotal factors in the rise of acquired and primary drug resistance in the clinic [14, 15]. …”

The experience of implementing a 'TB village' for a pastoralist population in Cherrati, Ethiopia

“…15 Furthermore, the offer of free food in a context where food insecurity is a problem provided a strong incentive for patients to remain in one place for the entire duration of their treatment. 16 Interestingly, after treatment completion, we did not face any problems sending patients away.…”

“…Third, with the SRS a confl ict-prone area, there were the usual challenges of feasibility and sustainability of interventions, as well as programme quality. 16 During confl ict periods, MSF expatriate staff were often evacuated and general standards of supervision and management fell in their absence. This highlights the importance of increased emphasis on national staff capacity development.…”