Publications (7)16.11 Total impact
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Article: Deploying artemether‐lumefantrine with rapid testing in Ethiopian communities: impact on malaria morbidity, mortality and healthcare resources
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ABSTRACT: Objective To assess the impact and feasibility of artemether-lumefantrine deployment at community level, combined with phased introduction of rapid diagnostic tests (RDTs), on malaria transmission, morbidity, and mortality and health service use in a remote area of Ethiopia.Methods Two-year pilot study in two districts: artemether-lumefantrine was prescribed after parasitological confirmation of malaria in health facilities in both districts. In the intervention district, artemether-lumefantrine was also made available through 33 community health workers (CHWs); of these, 50% were equipped with RDTs in the second year.Results At health facilities; 54 774 patients in the intervention and 100 535 patients in the control district were treated for malaria. In the intervention district, 75 654 patients were treated for malaria by community health workers. Use of RDTs in Year 2 excluded non-Plasmodium falciparumin 89.7% of suspected cases. During the peak of malaria transmission in 2005, the crude parasite prevalence was 7.4% (95% CI: 6.1–8.9%) in the intervention district and 20.8% (95% CI: 18.7–23.0%) in the control district. Multivariate modelling indicated no significant difference in risk of all-cause mortality between the intervention and the control districts [adjusted incidence rate ratio (aIRR) 1.03, 95%CI 0.87–1.21, P = 0.751], but risk of malaria-specific mortality was lower in the intervention district (aIRR 0.60, 95%CI 0.40–0.90, P = 0.013).Conclusions Artemether-lumefantrine deployment through a community-based service in a remote rural population reduced malaria transmission, lowered the malaria case burden for health facilities and reduced malaria morbidity and mortality during a 2-year period which included a major malaria epidemic.Déploiement de l’artéméther-luméfantrine et du test rapide dans des communautés éthiopiennes: impact sur la morbidité, la mortalité et les ressources de la santé pour la malariaObjectif: Evaluer l’impact et la faisabilité du déploiement de l’artéméther-luméfantrine à l’échelle communautaire, combinée avec l’introduction progressive de tests rapides de diagnostic, sur la morbidité et la mortalité de la malaria et sur l’utilisation des services de santé dans une région reculée d’Éthiopie.Méthodes: Etude pilote de 2 ans an dans deux districts: l’artéméther-luméfantrine a été prescrit après confirmation parasitologique de la malaria dans les services de santé dans les deux districts. Dans le district d’intervention, l’artéméther-luméfantrine a été rendu disponible chez 33 agents de santé communautaires; 50% de ceux-ci étaient équipés de tests rapides de diagnostic durant la deuxième année.Résultats: 54.774 patients atteints de malaria ont été soignés dans les services de santé dans le district d’intervention et 100.535 dans le district témoins. 75.654 patients atteints de malaria ont été traités par des agents de santé communautaires dans le district d’intervention. L’utilisation de tests rapides de diagnostic dans l’année 2 a permis d’exclure les non P. falciparum dans 89,7% des cas suspects. Durant le pic de transmission de la malaria en 2005, la prévalence parasitaire brute était de 7,4% (IC95%: 6,1-8,9%) dans le district d’intervention et de 20,8% (IC95%: 18,7-23,0%) dans le district témoins. L’analyse multivariée n’a indiqué aucune différence significative du risque de mortalité de toutes causes confondues entre les districts d’intervention et témoins (ratio ajusté des taux d’incidence [AIRr]: 1,03; IC95% : 0, 87-1,21 ; p = 0,751), mais le risque de mortalité spécifique à la malaria était plus faible dans le district d’intervention (AIRr : 0,60, IC95%: 0,40-0,90 ; p = 0, 013).Conclusions: Le déploiement de l’artéméther-luméfantrine à travers un service basé sur la communauté dans une population rurale a réduit la transmission de la malaria, a diminué la charge liées aux cas de malaria pour les services de santé et a réduit la morbidité et la mortalité de la malaria au cours d’une période de deux ans couvrant une épidémie majeure de malaria.Desplegando la artemeter-lumefantrina con pruebas rápidas en comunidades Etiopes: impacto sobre la morbilidad de malaria, mortalidad y recursos sanitarios.Objetivo: Evaluar el impacto y la viabilidad del despliegue a nivel comunitario de artemeter-lumefantrina, combinado con la introducción por fases de pruebas de diagnóstico rápido, sobre la morbilidad de malaria, mortalidad y uso de servicios sanitarios en un área remota de Etiopía.Métodos: Estudio piloto de 2-años en dos distritos: se prescribió artemeter-lumefantrina después de la confirmación parasitológica de malaria en centros sanitarios de ambos distritos. En el distrito de la intervención, el artemeter-lumefantrina también estaba disponible a través de 33 trabajadores sanitarios comunitarios; de estos, 50% estaban equipados con pruebas diagnósticas rápidas en el segundo año.Resultados: Se trataron 54,774 pacientes con malaria en los centros sanitarios del distrito intervenido y 100,535 en el distrito control. 75,654 pacientes con malaria fueron tratados por trabajadores sanitarios comunitarios en el distrito de intervención. El uso de pruebas diagnósticas rápidas en el Año 2 excluyó no-P. falciparum en 89·7% de los casos sospechosos. Durante el pico de transmisión de la malaria en el 2005, la prevalencia parasitaria cruda era 7.4% (95% IC: 6.1-8.9%) en el distrito de la intervención y 20.8% (95% IC: 18.7-23.0%) en el distrito control. Los modelos multivariados indicaban que no había diferencias significativas en el riesgo de mortalidad por cualquier causa entre los distritos de intervención y control (razón de tasas de la incidencia ajustado [aIRR] 1·03, 95%IC 0·87-1·21, p = 0·751), pero el riesgo de mortalidad específica por malaria era menor en el distrito de la intervención (aIRR 0·60, 95%CI 0·40-0·90, p = 0·013).Conclusiones: El despliegue de artemeter-lumefantrina mediante un servicio basado en la comunidad en una población rural remota, redujo la transmisión de malaria, disminuyó la carga por casos de malaria en los centros sanitarios, y redujo la morbilidad y mortalidad por malaria durante un periodo de dos años que incluyeron una gran epidemia de malaria.Tropical Medicine & International Health 12/2009; 15(2):241 - 250. · 2.80 Impact Factor -
Article: Deploying artemether-lumefantrine with rapid testing in Ethiopian communities: impact on malaria morbidity, mortality and healthcare resources.
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ABSTRACT: To assess the impact and feasibility of artemether-lumefantrine deployment at community level, combined with phased introduction of rapid diagnostic tests (RDTs), on malaria transmission, morbidity, and mortality and health service use in a remote area of Ethiopia. Two-year pilot study in two districts: artemether-lumefantrine was prescribed after parasitological confirmation of malaria in health facilities in both districts. In the intervention district, artemether-lumefantrine was also made available through 33 community health workers (CHWs); of these, 50% were equipped with RDTs in the second year. At health facilities; 54 774 patients in the intervention and 100 535 patients in the control district were treated for malaria. In the intervention district, 75 654 patients were treated for malaria by community health workers. Use of RDTs in Year 2 excluded non-Plasmodium falciparumin 89.7% of suspected cases. During the peak of malaria transmission in 2005, the crude parasite prevalence was 7.4% (95% CI: 6.1-8.9%) in the intervention district and 20.8% (95% CI: 18.7-23.0%) in the control district. Multivariate modelling indicated no significant difference in risk of all-cause mortality between the intervention and the control districts [adjusted incidence rate ratio (aIRR) 1.03, 95%CI 0.87-1.21, P = 0.751], but risk of malaria-specific mortality was lower in the intervention district (aIRR 0.60, 95%CI 0.40-0.90, P = 0.013). Artemether-lumefantrine deployment through a community-based service in a remote rural population reduced malaria transmission, lowered the malaria case burden for health facilities and reduced malaria morbidity and mortality during a 2-year period which included a major malaria epidemic.Tropical Medicine & International Health 12/2009; 15(2):241-50. · 2.80 Impact Factor -
Article: Reply to comment on: Cutaneous and mucocutaneous leishmaniasis in Tigray, northern Ethiopia: clinical aspects and therapeutic concerns.
Transactions of the Royal Society of Tropical Medicine and Hygiene 10/2009; · 2.16 Impact Factor -
Article: Cutaneous and mucocutaneous leishmaniasis in Tigray, northern Ethiopia: clinical aspects and therapeutic concerns.
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ABSTRACT: Leishmaniasis is a worldwide disease, but due to the absence of surveillance systems is under-reported from low- and middle-income countries. In Ethiopia, the disease is found in the rural highlands and the incidence of Leishmania/HIV co-infection is increasing. Although some studies have been carried out in areas of the country with a similar disease/ecological profile this report is, to our knowledge, the first aimed at elucidating the clinical-epidemiological features of cutaneous and mucocutaneous leishmaniasis in Tigray, northern Ethiopia. This study enrolled 167 patients presenting different forms of cutaneous leishmaniasis over an 18 month period, of which 5.6% tested HIV positive. Patients were initially treated with meglumine antimonate and resistant cases with pentamidine isethionate. There was a high rate of resistance to meglumine antimonate (28%) and a less than optimal response to prolonged systemic treatment in relapsed cases. Eight patients affected by severe and resistant forms were treated with pentamidine isethionate, with a cure rate of 87.5% after 6 months. Many atypical and severe presentations were seen, and a poor response to first-line antileishmanial drugs was observed. Resistance to antimonials is of concern and cost-effective therapeutic schemes need to be developed. The cost-effectiveness of pentamidine isethionate has to be determined in a larger population.Transactions of the Royal Society of Tropical Medicine and Hygiene 05/2009; 103(7):707-11. · 2.16 Impact Factor -
Article: Skin diseases highlighting essential global public health priorities.
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ABSTRACT: Which are the essential global public health activities that should be carried out in order to attain the largest impact on poverty reduction and health improvement in the world? Since its foundation in 2001 the Human Mobile Population Committee (HMPC) has continued to devote its efforts to finding answers to this question, with a particular focus on the skin diseases of the Human Mobile Population (HMP) and other groups of disadvantaged people. In this article we present the model of socio-sanitary activity in the field of Migration, Poverty and Health of the Department of Preventive Medicine of Migration, Tourism and Tropical Dermatology (Dept.) at San Gallicano Institute--Research Institute for Hospitalization and Treatment (IRCCS)--in Rome (Italy). The activities of this dermatological centre are in the spirit of the HMPC's aims and we are of the opinion that this model is not only ethically valid, but also practically and economically convenient, and that there is evidence that our experience is worth repeating, in as many situations as possible, in the interest of public health.International Journal of Dermatology 06/2005; 44(5):384-90. · 1.14 Impact Factor -
Article: Vulvar lymphangiectases mimicking genital warts in female genital mutilation.
European journal of dermatology: EJD 16(5):587-8. · 2.53 Impact Factor -
Article: Early development of disseminated nocardiosis during immunosuppressive treatment for pemphigus vulgaris.
European journal of dermatology: EJD 17(4):346-7. · 2.53 Impact Factor
