Suchergebnisse

Background: There is little evidence to describe the feasibility and outcomes of services for the care of street children and youth in low-income countries. Aims: To describe the outcomes of a multidisciplinary case management approach delivered in a drop-in centre for street children and youth. Methods: A longitudinal study of street children and youth followed in an urban drop-in centre. Four hundred (400) street children and youth received a multidisciplinary case management therapeutic package based on the community reinforcement approach. The main outcomes were changes in psychological distress, substance abuse and social situation scores. Results: The median follow-up time for the cohort was 18 months. There were reductions in the levels of psychological distress ( p = 0.0001) and substance abuse ( p ≤ 0.0001) in the cohort as well as an improvement in the social situation of street children and youth ( p = 0.0001). There was a main effect of gender ( p < 0.001) and a significant interaction of gender over time ( p < 0.001) on improvements in levels of psychological distress. Survival analysis showed that the probability of remaining on substances at 12 months was 0.76 (95% CI: 0.69–0.81) and 0.51 (95% CI: 0.42–0.59) at 24 months. At 12 months, fewer female patients remained using substances compared to male ( p < 0.01). Conclusion: To be most effective, programmes and strategies for children and youth in street situations in developing countries should target both their health and social needs.

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.

Abstract
Background
In 2017, Field access was considerably limited in the Far North region of Cameroon due to the conflict. Médecins Sans Frontieres (MSF) in collaboration with Ministry of health needed to estimate the health situation of the populations living in two of the most affected departments of the region: Logone-et-Chari and Mayo-Sava.

Methods
Access to health care and mortality rates were estimated through cell phone interviews, in 30 villages (clusters) in each department. Local Community Health Workers (CHWs) previously collected all household phone numbers in the selected villages and nineteen were randomly selected from each of them. In order to compare telephone interviews to face-to-face interviews for estimating health care access, and mortality rates, both methods were conducted in parallel in the town of Mora in the mayo Sava department. Access to food was assessed through push messages sent by the three main mobile network operators in Cameroon. Additionally, all identified legal health care facilities in the area were interviewed by phone to estimate attendance and services offered before the conflict and at the date of the survey.

Results
Of a total of 3423 households called 43% were reached. Over 600,000 push messages sent and only 2255 were returned. We called 43 health facilities and reached 34 of them. In The town of Mora, telephone interviews showed a Crude Mortality Rate (CMR) at 0.30 (CI 95%: 0.16–0.43) death per 10,000-person per day and home visits showed a CMR at 0.16 (0.05–0.27), most other indicators showed comparable results except household composition (more Internally Displaced Persons by telephone).
Phone interviews showed a CMR at 0.63 (0.29–0.97) death per 10,000-person per day in Logone-et-Chari, and 0.30 (0.07–0.50) per 10,000-person per day in Mayo-Sava. Among 86 deaths, 13 were attributed to violence (15%), with terrorist attacks being explicitly mentioned for seven deaths. Among 29 health centres, 5 reported being attacked and vandalized; 3 remained temporally closed; Only 4 reported not being affected.

Conclusion
Telephone interviews are feasible in areas with limited access, although special attention should be paid to the initial collection of phone numbers. The use of text messages to collect data was not satisfactory is not recommended for this purpose. Mortality in Logone-et-Chari and Mayo-Sava was under critical humanitarian thresholds although a considerable number of deaths were directly related to the conflict.

Targeted interventions have been delivered to neighbors of cholera cases in major epidemic responses globally despite limited evidence for the impact of such targeting. Using data from urban epidemics in Chad and Democratic Republic of the Congo, we estimate the extent of spatiotemporal zones of increased cholera risk around cases. In both cities, we found zones of increased risk of at least 200 meters during the 5 days immediately after case presentation to a clinic. Risk was highest for those living closest to cases and diminished in time and space similarly across settings. These results provide a rational basis for rapidly delivering targeting interventions.