Suchergebnisse

BackgroundAmong people living with HIV/AIDS, nutritional support is increasingly recognized as a critical part of the essential package of care, especially for patients in sub‐Saharan Africa. The objectives of the study were to evaluate the outcomes of HIV‐positive malnourished adults treated with ready‐to‐use therapeutic food and to identify factors associated with nutrition programme failure.MethodsWe present results from a retrospective cohort analysis of patients aged 15 years or older with a body mass index of less than 17 kg/m2 enrolled in three HIV/AIDS care programmes in Africa between March 2006 and August 2008. Factors associated with nutrition programme failure (patients discharged uncured after six or more months of nutritional care, defaulting from nutritional care, remaining in nutritional care for six or more months, or dead) were investigated using multiple logistic regression.ResultsOverall, 1340 of 8685 (15.4%) HIV‐positive adults were enrolled in the nutrition programme. At admission, median body mass index was 15.8 kg/m2 (IQR 14.9‐16.4) and 12% received combination antiretroviral therapy (ART). After a median of four months of follow up (IQR 2.2‐6.1), 524 of 1106 (47.4%) patients were considered cured. An overall total of 531 of 1106 (48.0%) patients failed nutrition therapy, 132 (11.9%) of whom died and 250 (22.6%) defaulted from care. Men (OR = 1.5, 95% CI 1.2‐2.0), patients with severe malnutrition at nutrition programme enrolment (OR = 2.2, 95% CI 1.7‐2.8), and those never started on ART (OR = 4.5, 95% CI 2.7‐7.7 for those eligible; OR = 1.6, 95% CI 1.0‐2.5 for those ineligible for ART at enrolment) were at increased risk of nutrition programme failure. Diagnosed tuberculosis at nutrition programme admission or during follow up, and presence of diarrhoeal disease or extensive candidiasis at admission, were unrelated to nutrition programme failure.ConclusionsConcomitant administration of ART and ready‐to‐use therapeutic food increases the chances of nutritional recovery in these high‐risk patients. While adequate nutrition is necessary to treat malnourished HIV patients, development of improved strategies for the management of severely malnourished patients with HIV/AIDS are urgently needed.

Abstract Background The Democratic Republic of Congo experiences regular measles outbreaks. From September 2010, the number of suspected measles cases increased, especially in Katanga province, where Medecins sans Frontieres supported the Ministry of Health in responding to the outbreak by providing free treatment, reinforcing surveillance and implementing non-selective mass vaccination campaigns. Here, we describe the measles outbreak in Katanga province in 2010–2011 and the results of vaccine coverage surveys conducted after the mass campaigns. Methods The surveillance system was strengthened in 28 of the 67 health zones of the province and we conducted seven vaccination coverage surveys in 2011. Results The overall cumulative attack rate was 0.71% and the case fatality ratio was 1.40%. The attack rate was higher in children under 4 and decreased with age. This pattern was consistent across districts and time. The number of cases aged 10 years and older barely increased during the outbreak. Conclusions Early investigation of the age distribution of cases is a key to understanding the epidemic, and should guide the vaccination of priority age groups.