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1. Predicting mortality in febrile adults: comparative performance of the MEWS, qSOFA, and UVA scores using prospectively collected data among patients in four health-care sites in sub-Saharan Africa and South-Eastern AsiaResearch in context

Author

Sham Lal, Manophab Luangraj, Suzanne H. Keddie, Elizabeth A. Ashley, Oliver Baerenbold, Quique Bassat, John Bradley, John A. Crump, Nicholas A. Feasey, Edward W. Green, Kevin C. Kain, Ioana D. Olaru, David G. Lalloo, Chrissy h. Roberts, David C.W. Mabey, Christopher C. Moore, Heidi Hopkins, Sara Ajanovic, Benjamin Amos, Stéphanie Baghoumina, Núria Balanza, Tsitsi Bandason, Tapan Bhattacharyya, Stuart D. Blacksell, Zumilda Boca, Christian Bottomley, Justina M. Bramugy, Clare IR. Chandler, Vilada Chansamouth, Mabvuto Chimenya, Joseph Chipanga, Anelsio Cossa, Ethel Dauya, Catherine Davis, Xavier de Lamballerie, Justin Dixon, Somyoth Douangphachanh, Audrey Dubot-Pérès, Michelle M. Durkin, Rashida A. Ferrand, Colin Fink, Elizabeth JA. Fitchett, Alessandro Gerada, Stephen R. Graves, Edward Green, Becca L. Handley, Coll D. Hutchison, Risara Jaksuwan, Jessica Jervis, Jayne Jones, Khamxeng Khounpaseuth, Katharina Kranzer, Khamfong Kunlaya, Pankaj Lal, Yoel Lubell, David CW. Mabey, Eleanor MacPherson, Forget Makoga, Sengchanh Manichan, Tegwen Marlais, Florian Maurer, Mayfong Mayxay, Michael Miles, Polycarp Mogeni, Campos Mucasse, Paul N. Newton, Chelsea Nguyen, Vilayouth Phimolsarnnousith, Mathieu Picardeau, Chrissy H. Roberts, Amphone Sengduangphachanh, Siho Sengsavang, Molly Sibanda, Somvai Singha, John Stenos, Ampai Tanganuchitcharnchai, Hira Tanvir, James E. Ussher, Marta Valente, Marie A. Voice, Manivanh Vongsouvath, Msopole Wamaka, L Joseph Wheat, and Shunmay Yeung

Subjects
Severity scores, Prognostic scores, Mortality, qSOFA, MEWS, UVA, Medicine (General), R5-920
Abstract

Summary: Background: Clinical severity scores can identify patients at risk of severe disease and death, and improve patient management. The modified early warning score (MEWS), the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and the Universal Vital Assessment (UVA) were developed as risk-stratification tools, but they have not been fully validated in low-resource settings where fever and infectious diseases are frequent reasons for health care seeking. We assessed the performance of MEWS, qSOFA, and UVA in predicting mortality among febrile patients in the Lao PDR, Malawi, Mozambique, and Zimbabwe. Methods: We prospectively enrolled in- and outpatients aged ≥ 15 years who presented with fever (≥37.5 °C) from June 2018–March 2021. We collected clinical data to calculate each severity score. The primary outcome was mortality 28 days after enrolment. The predictive performance of each score was determined using area under the receiver operating curve (AUC). Findings: A total of 2797 participants were included in this analysis. The median (IQR) age was 32 (24–43) years, 38% were inpatients, and 60% (1684/2797) were female. By the time of follow-up, 7% (185/2797) had died. The AUC (95% CI) for MEWS, qSOFA and UVA were 0.67 (0.63–0.71), 0.68 (0.64–0.72), and 0.82 (0.79–0.85), respectively. The AUC comparison found UVA outperformed both MEWS (p

Published
2024
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2. Antibiotic Arrivals in Africa: A Case Study of Yaws and Syphilis in Malawi, Zimbabwe and Uganda

Author

Paula Palanco Lopez, Salome Manyau, Justin Dixon, Eleanor MacPherson, Susan Nayiga, John Manton, Claas Kirchhelle, and Clare I. R. Chandler

Subjects
antibiotics, syphilis, eastern africa, colonialism, public health, Anthropology, GN1-890, Medicine (General), R5-920
Abstract

The mass production of antibiotics in the 1940s enabled their travel beyond Europe and America, but to date the significance of the ways in which these medicines co-constituted colonial regimes at the time has not been systematically described. Through a case study of yaws and syphilis, this research article traces arrivals of antibiotics in three countries of Eastern Africa—Malawi, Zimbabwe, and Uganda. We draw attention to the emergent roles of antibiotics at the intersection of colonial governance and humanitarianism in these different settings. Through this analysis of archival and ethnographic materials, we explore how antibiotics became ‘infrastructural’ in material, affective, and political ways. Achieving a better understanding of the entanglement of antibiotics with human systems and lives is crucial to address the pressing issue of antimicrobial resistance (AMR). With this article we join in the global multidisciplinary efforts to tackle AMR, pointing out the often-overlooked role of colonial history in the circulation of antibiotic drugs, and opening a line of research that will provide valuable insights for the development of effective measures to prevent and reduce the spread of antibiotic resistance.

Published
2022
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3. Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe

Author

Justin Dixon, Shunmay Yeung, John Bradley, Laurie Denyer Willis, Susan Nayiga, Clare I R Chandler, Rashida Abbas Ferrand, Sham Lal, Miriam Kayendeke, Christine Nabirye, Sarah G Staedke, Eleanor Elizabeth MacPherson, Edward Green, Salome Manyau, Esnart Sanudi, Alex Nkaombe, Portia Mareke, Kenny Sitole, Coll de Lima Hutchison, and Chrissy Roberts

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Background As concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-based research. Few studies to date have used comparative, mixed-methods approaches to render visible patterns of use within and between settings as well as wider points of context shaping these patterns.Design This article analyses findings from mixed-methods anthropological studies of antibiotic use in a range of rural and urban settings in Zimbabwe, Malawi and Uganda between 2018 and 2020. All used a ‘drug bag’ survey tool to capture the frequency and types of antibiotics used among 1811 households. We then undertook observations and interviews in residential settings, with health providers and key stakeholders to better understand the stories behind the most-used antibiotics.Results The most self-reported ‘frequently used’ antibiotics across settings were amoxicillin, cotrimoxazole and metronidazole. The stories behind their use varied between settings, reflecting differences in the configuration of health systems and antibiotic supplies. At the same time, these stories reveal cross-cutting features and omissions of contemporary global health programming that shape the contours of antibiotic (over)use at national and local levels.Conclusions Our findings challenge the predominant focus of stewardship frameworks on the practices of antibiotic end users. We suggest future interventions could consider systems—rather than individuals—as stewards of antibiotics, reducing the need to rely on these medicines to fix other issues of inequity, productivity and security.

Published
2021
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4. Opening up ‘fever’, closing down medicines

Author

Justin Dixon and Clare Chandler

Subjects
antimicrobial resistance, child health, algorithms, classification, diagnostics, pharmaceuticalisation, Anthropology, GN1-890, Medicine (General), R5-920
Abstract

Rising concerns about antimicrobial resistance have sparked a renewed push to rationalise and ration the use of medicines. This article explores the case of the Integrated Management of Childhood Illness (IMCI) guideline, a periodically updated ‘global’ algorithm that shapes and normalises the centrality of medicines to care in low- and middle-income countries and, increasingly, the imperative to ration them. Using ‘classification work’ as analytic frame, we firstly consider the IMCI algorithm as a blueprint for global health that classifies illnesses, patients, and care in particular ways relative to available medicines. Zooming in on this blueprint, we then offer a classificatory reading of ‘fever’ over time, tracing ‘nonmalarial fever’ from being malaria’s residual ‘other’ category to becoming increasingly legible through attention to diagnostics and antibiotic (over)use. Our reading suggests that an apparent refinement of the ‘fever’ category may concurrently entail the closing down of medicine options. This raises the possibility that an increasingly high-tech but ‘empty’ form of pharmaceuticalised care is being incidentally worked into the infrastructure of weak health systems.

Published
2019
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5. Action to protect the independence and integrity of global health research

Author

David Sanders, Lu Gram, Benjamin Tsofa, Johanne Sundby, Tolib Mirzoev, Kristine Bærøe, Ole Frithjof Norheim, Ejemai Eboreime, Valéry Ridde, Kristine Husøy Onarheim, Emily Mendenhall, Vladimir S Gordeev, Tanya Doherty, Stephen Taylor, David Peters, Shariful Islam, Madhukar Pai, Elysée Nouvet, Francesca L Cavallaro, Shafiu Mohammed, Sassy Molyneux, Karl Blanchet, Janice E Graham, Kayvan Bozorgmehr, David McCoy, Joel Lexchin, Anna-Karin Hurtig, Asha George, Rachel Chapman, Loveday Penn-Kekana, Katerini T Storeng, Dina Balabanova, Veronique Filippi, Sidsel Roalkvam, Grace Akello, Melissa Parker, Jennifer Palmer, Ibukun Abejirinde, Babatope Adebiyi, Clara Affun-Adegbulu, Jhon Álvarez Ahlgren, Ayesha Ahmad, Sameh Al-Awlaqi, Zongo Aloys, Gianna Gayle Amul, Muhammad Asaduzzaman, Akeza Awealom Asgedom, Bouchra Assarag, Nicole Atchessi, Salla Atkins, Okikiolu Badejo, Bailah Molleh, Alessandra Bazzano, Dominique P Béhague, Uli Beisel, Loubna Belaid, Sarah Bernays, Shafi Bhuiyan, Olivia Biermann, Harriet Birungi, Astrid Blystad, Oriane Bodson, Emmanuel Bonnet, Shibaji Bose, Michelle Brear, Rochelle Burgess, Jens Byskov, Séverine Carillon, Sophie Chabeda, Clare Chandler, Francis F Chikuse, Juliana Iwu Chinwe, Beniamino Cislaghi, Svea Closser, Christopher J Colvin, Jenny Cresswell, Fabiana da Cunha Saddi, Judith Daire, Sarah Dalglish, Vincent de Brouwere, Jean-Pierre Olivier de Sardan, Thérèse Delvaux, Annabel Desgrées du Loû, Brahima A Diallo, Aïssa Diarra, Justin Dixon, Alexandre Dumont, Beth Engelbrecht, Susan Erikson, Adama Faye, Sara Fischer, Florence Fournet, Ashley M Fox, Joel Msafiri Francis, Lara Gautier, Lucy Gilson, Sarah Gimbel, Jeff Glenn, Unni Gopinathan, Christoph Gradmann, Giulia Greco, Karen Grepin, Anne Guichard, Pragya Tiwari Gupta, Viveka Guzman, Marte E S Haaland, Anna Häggblom, Amy Hagopian, Karin Hammarberg, Pascal Handschumacher, Katrina Hann, Marie Hasselberg, Natasha Howard, Sameera Hussain, Eleanor Hutchinson, Ezirim Idoteyin, Jennifer J Infanti, Rachel Irwin, Taufique Joarder, Preethi John, Ermel Johnson, Mira Johri, Judith Justice, Charles Kaboré, Kadidiatou Kadio, Matthieu Kamwa, Ann H Kelly, Nora Kenworthy, Sonja Kittelsen, Maren Olene Kloster, Emily Kocsis, Pratap Kumar, Arush Lal, Isabelle Lange, Heather Lanthorn, Frederic Le Marcis, Shelley Lees, Ann Louise Lie, Gojjam Limenih, Isabel Litwin-Davies, Charles Clarke Lodda, Knut Lönnroth, John Manton, Anatole Manzi, Mehr Manzoor, Robert Marten, Mitsuaki Matsui, Allan Mbewe, Esther Mc Sween-Cadieux, Linsey McGoey, Desmond McNeill, Claudio A Méndez, Karen Marie Moland, Zubia Mumtaz, Susan Fairley Murray, Devaki Nambiar, Erica Nelson, Claudia Nieto-Sanchez, Francis Obare, Vincent Okungu, Marit Tolo Østebø, Fatoumata Ouattara, Sachiko Ozawa, Ligia Paina, Rakesh Parashar, Elisabeth Paul, Koen Peeters, Cédric Pennetier, James Pfeiffer, Hanneke Pot, N S Prashanth, Robyn Preston, Antoine de Bengy Puyvallee, Annisa Rahmalia, Simon Reid-Henry, Daniela C Rodríguez, Maya Ronse, Emma Sacks, Oumar Mallé Samb, Eric Sarriot, Inger Brummenæs Scheel, Thomas Schwarz, Kerry Scott, Janet Seeley, Nadine Seward, Geordan Shannon, Jessica Shearer, Katharine Shelley, Kenneth Sherr, Jeremey Shiffman, Frédéric Simard, Neha S Singh, Werner Soors, Rusla Anne Springer, Adrienne Strong, Moses Tetui, Stephanie M Topp, Anne-Marie Turcotte-Tremblay, Chi-Chi Undie, Sara Van Belle, Godelieve Van Heteren, André Janse van Rensburg, Veena Sriram, Sridhar Venkatapuram, Bradley H Wagenaar, Lauren Wallace, David R Walugembe, Oghenebrume Wariri, Alan OBE Whiteside, Bereket Yakob, Scholastica Zakayo, Tony Zitti, and Anthony Zwi

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Published
2019
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