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Setting: All community health workers (CHWs) in rural Kenema District, Sierra Leone. Objective: CHW programmes provide basic health services to fill gaps in human health resources. We compared trends in the reporting and management of childhood malaria, diarrhoea and pneumonia by CHWs before, during and after the Ebola outbreak (2014-2016). Design: Retrospective cross-sectional study using programme data. Results: CHW reporting increased from 59% pre-outbreak to 95% during the outbreak (P < 0.001), and was sustained at 98% post-outbreak. CHWs stopped using rapid diagnostic tests for malaria mid-outbreak, and their use had not resumed post-outbreak. The average monthly number of presumptive treatments for malaria increased from 2931 pre-outbreak to 5013 during and 5331 post-outbreak (P < 0.001). The average number of monthly treatments for diarrhoea and pneumonia decreased from respectively 1063 and 511 pre-outbreak to 547 and 352 during the outbreak (P = 0.01 and P = 0.04). Post-outbreak pneumonia treatments increased (mean 1126 compared to pre-outbreak, P = 0.003), and treatments for diarrhoea returned to pre-outbreak levels (P = 0.2). Conclusion: The CHW programme demonstrated vulnerability, but also resilience, during and in the early period after the Ebola outbreak. Investment in CHWs is required to strengthen the health care system, as they can cover pre-existing gaps in facility-based health care and those created by outbreaks.

Summary box > “We must become bigger than we have been: more courageous, greater in spirit, larger in outlook.” > > Emperor Haile Selassie It was in the city of Gondar in Ethiopia, one of the highest burden countries for neglected tropical diseases (NTDs)1 and currently home to 16 to 20 recognised NTDs (table 1), that a unanimous desire was expressed by scientists, policy makers and health workers from around the world (the forum was an operational research training on NTDs organised by the Structured Operational Research and Training Initiative (SORT IT). SORT IT is a global partnership coordinated by the Special Programme for Research and Training in Tropical Diseases (TDR) hosted at the WHO. http://www.who.int/tdr/capacity/strengthening/sort/en), for urgent reflection on how to garner support and hasten the pace towards achieving the fast approaching Sustainable Development Goal (SDG) target of eliminating NTDs by 2030.2 Concerns, raised by the group are articulated below: View this table: Table 1 The 20 neglected tropical diseases recognised by the WHO* First, there is the term ‘Neglected Tropical Diseases’, coined by Peter Hotez and colleagues in 2003 with the noble intention of propelling political momentum, catalysing donor funding and making quantum shifts in research and development (R&D).3 The question today is whether designating a specific group of diseases as being ‘neglected’ does not carry with it a negative and disempowering connotation. Populations affected by NTDs already face neglect by being …

In the wake of the recent outbreak of Ebola virus disease (EVD) in several African countries, the World Health Organization prioritized the evaluation of treatment with convalescent plasma derived from patients who have recovered from the disease. We evaluated the safety and efficacy of convalescent plasma for the treatment of EVD in Guinea. : In this nonrandomized, comparative study, 99 patients of various ages (including pregnant women) with confirmed EVD received two consecutive transfusions of 200 to 250 ml of ABO-compatible convalescent plasma, with each unit of plasma obtained from a separate convalescent donor. The transfusions were initiated on the day of diagnosis or up to 2 days later. The level of neutralizing antibodies against Ebola virus in the plasma was unknown at the time of administration. The control group was 418 patients who had been treated at the same center during the previous 5 months. The primary outcome was the risk of death during the period from 3 to 16 days after diagnosis with adjustments for age and the baseline cycle-threshold value on polymerase-chain-reaction assay; patients who had died before day 3 were excluded. The clinically important difference was defined as an absolute reduction in mortality of 20 percentage points in the convalescent-plasma group as compared with the control group. : A total of 84 patients who were treated with plasma were included in the primary analysis. At baseline, the convalescent-plasma group had slightly higher cycle-threshold values and a shorter duration of symptoms than did the control group, along with a higher frequency of eye redness and difficulty in swallowing. From day 3 to day 16 after diagnosis, the risk of death was 31% in the convalescent-plasma group and 38% in the control group (risk difference, -7 percentage points; 95% confidence interval [CI], -18 to 4). The difference was reduced after adjustment for age and cycle-threshold value (adjusted risk difference, -3 percentage points; 95% CI, -13 to 8). No serious adverse reactions associated with the use of convalescent plasma were observed. : The transfusion of up to 500 ml of convalescent plasma with unknown levels of neutralizing antibodies in 84 patients with confirmed EVD was not associated with a significant improvement in survival. (Funded by the European Union's Horizon 2020 Research and Innovation Program and others; ClinicalTrials.gov number, NCT02342171.).

A district hospital in conflict-torn Somalia.To report on in-patient paediatric morbidity, case fatality and exit outcomes as indicators of quality of care.Cross-sectional study.Of 6211 children, lower respiratory tract infections (48%) and severe acute malnutrition (16%) were the leading reasons for admission. The highest case-fatality rate was for meningitis (20%). Adverse outcomes occurred in 378 (6%) children, including 205 (3.3%) deaths; 173 (2.8%) absconded.Hospital exit outcomes are good even in conflict-torn Somalia, and should boost efforts to ensure that such populations are not left out in the quest to achieve universal health coverage.Un hôpital de district dans la Somalie en conflit.Rapport sur la morbidité, la létalité et les résultats à la sortie de l’hôpital comme indicateurs de la qualité des soins chez des patients admis en pédiatrie.Etude transversale.Chez 6211 enfants, les infections du tractus respiratoire inférieur (48%) et une malnutrition aiguë grave (16%) ont été les causes principales d’admission. Le taux de létalité le plus élevé survient dans les cas de méningite (20%). Des effets indésirables sont survenus chez 378 enfants (6%), notamment 205 décès (3,3%) et 173 évasions (2,8%).Les résultats à la sortie de l’hôpital sont bons même dans une Somalie en conflit, ce qui devrait stimuler les efforts pour garantir que de telles populations ne soient pas abandonnées dans la recherche d’une couverture universelle de la santé.Un hospital distrital en Somalia, un país fracturado por el conflicto armado.Comunicar los datos sobre la morbilidad y la letalidad de los niños hospitalizados y el desenlace de alta hospitalaria como indicadores de la calidad de la atención de salud.Fue este un estudio transversal.Las principales causas de hospitalización de los 6211 niños fueron la infección de las vías respiratorias inferiores (48%) y la desnutrición grave aguda (16%). El índice más alto de letalidad fue por meningitis (20%). Ocurrieron desenlaces desfavorables en 378 casos (6%), de los cuales 205 muertes (3,3%) y 173 altas voluntarias (2,8%).Los desenlaces de la hospitalización de los niños en Somalia son buenos, pese a las divisiones que causa el conflicto armado, lo cual debe estimular las iniciativas encaminadas a evitar que estas poblaciones queden aisladas de la búsqueda de una cobertura universal de salud.

Where antiretroviral therapy is available, the primary source of mortality among HIV-infected people is the delay in starting treatment. Many of these delays occur in the context of care and are modifiable through changes in the protocols followed by healthcare providers for HIV testing, staging and preparation of patients for antiretroviral therapy. A number of potential evidence-based interventions are discussed in the context of sub-Saharan Africa. Included are decentralizing services, initiating counseling on antiretroviral therapy without delay, tracing patients that miss appointments, protecting patient confidentiality, reducing user fees, and providing point-of-care tests for CD4 cell counts, cryptococcal antigen, and for the diagnosis of TB.

BACKGROUND: The recombinant unglycosylated single chain urokinase-type plasminogen activator saruplase is cleared for a large part by the liver. A large interindividual variation in saruplase concentration is found in acute myocardial infarction (AMI) patients. The variable cardiac performance after an infarct may induce differences in liver blood flow that could explain the concentration diversity. This study was performed to investigate the relation between hepatic blood flow and the pharmacokinetic and pharmacodynamic properties of saruplase. METHODS AND RESULTS: Thirteen AMI patients were enrolled in this open label study. Patients received a bolus injection of 20 mg saruplase followed by a one-hour infusion of 60 mg saruplase. Concurrently 36 mg intravenous indocyanine green (ICG) was given over 1 h to measure hepatic blood flow. Blood samples were taken at regular time intervals to measure plasma levels of urokinase-type plasminogen activator (u-PA) antigen and activity, the two-chain form (tcu-PA) activity, indocyanine green, fibrinogen, fibrin and fibrin degradation products, alpha2-antiplasmin and thrombin antithrombin III complex. A correlation was seen between the clearance of ICG and both those of u-PA antigen (r = 0.62; p