• A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe

      Machekera, Shepherd; Wilkinson, Ewan; Hinderaker, Sven G.; Mabhala, Mzwandile A.; Zishiri, Christopher; Ncube, Ronald; Sandy, Charles; Timire, Collins; Takarinda, Kudakwashe; Sengai, Tonderai; et al. (International Union Against Tuberculosis and Lung Disease, 2019-06-21)
      Setting: 10 districts and 3 cities in Zimbabwe Objective: To compare the yield and relative cost of identifying a case of tuberculosis (TB) if the National TB Programme (NTP) used one of three World Health Organisation (WHO)-recommended algorithms (2c,2d,3b) instead of Zimbabwe’s active case finding (ACF) algorithm Design: Cross-sectional study using data from the Zimbabwe ACF project. Results: 38,574 people were screened from April-December 2017 and 488 (1.3%) were diagnosed with TB. WHO-2d had the least number of people needing a chest X-ray (CXR) at 13,710 (35.5%) and bacteriological confirmation at 2,595 (6.7%). If the NTP had used the WHO recommended algorithms, fewer TB cases would have been diagnosed - 18% (88 cases) with algorithm 2b, 25% (122 cases) algorithm 2d, and only 7% (34 cases) with algorithm 3b. The relative cost-per-case of TB diagnosed for the Zimbabwe algorithm at $565 was over three times that of WHO 3b algorithm ($180) which was the cheapest. Conclusion: The Zimbabwe ACF algorithm had the highest yield but at a considerable cost when compared to WHO algorithms. The trade-off between cost and yield needs to be reviewed by the NTP and changing to use algorithm 3d considered.
    • Sexual violence against migrants and asylum seekers. The experience of the MSF clinic on Lesvos Island, Greece.

      Mabhala, Mzwandile; Belanteri, Rea; Hinderaker, Sven Gudmund; Wilkinson, Ewan; Episkopou, Maria; Timire, Collins; De Plecker, Eva; Takarinda, Kudakwashe; Van den Bergh, Rafael; Médecins Sans Frontières-Operational Centre Brussels; University of Bergen; University of Chester; International Union Against Tuberculosis and Lung Disease; AIDS and TB Department, Harare;
      Sexual violence can have destructive impact on the lives of people. It is more common in unstable conditions such as during displacement. On the Greek island of Lesvos, Médecins Sans Frontières provided medical care to survivors of sexual violence among the population of asylum seekers arriving there. This study aimed to describe the patterns of sexual violence reported by migrants and asylum seekers and the clinical care provided to them. Methods This is s a descriptive study using routine program data. The study population consisted of migrants and asylum seekers treated for conditions related to sexual violence at the Médecins Sans Frontières clinic on Lesvos Island (September 2017-January 2018). Results We enrolled 215 survivors of sexual violence who reported and were treated, of whom 60 (28%) were male. The majority of incidents reported (90%) were cases of rape; 174 (81%) of survivors were from Africa and 185 (86%) occurred over a month before presentation. Half the incidents (118) occurred in transit, mainly in Turkey, and 76 (35%) in the country of origin; 10 cases (5%) on Lesvos were also observed. The perpetrator was known in 23% of the cases. Only XXX received mental health care, and the need exceeded the capacity of available mental care services. Conclusion Even though the majority of cases delayed seeking medical care after the incident, it is crucial that access to mental health services is guaranteed for those in need. Such access and protection measures for people in transit need to be put in place along migration routes, including in countries nominally considered safe, and secure routes need to be developed.