Safieh Shah

Bio: Safieh Shah is an academic researcher from Médecins Sans Frontières. The author has contributed to research in topics: Population & Mental health. The author has an hindex of 7, co-authored 14 publications receiving 163 citations.

Task shifting the management of non-communicable diseases to nurses in Kibera, Kenya: does it work?

Abstract: Background In sub-Saharan Africa there is an increasing need to leverage available health care workers to provide care for non-communicable diseases (NCDs). This study was conducted to evaluate adherence to Medecins Sans Frontieres clinical protocols when the care of five stable NCDs (hypertension, diabetes mellitus type 2, epilepsy, asthma, and sickle cell) was shifted from clinical officers to nurses. Methods Descriptive, retrospective review of routinely collected clinic data from two integrated primary health care facilities within an urban informal settlement, Kibera, Nairobi, Kenya (May to August 2014). Results There were 3,554 consultations (2025 patients); 733 (21%) were by nurses out of which 725 met the inclusion criteria among 616 patients. Hypertension (64%, 397/616) was the most frequent NCD followed by asthma (17%, 106/616) and diabetes mellitus (15%, 95/616). Adherence to screening questions ranged from 65% to 86%, with an average of 69%. Weight and blood pressure measurements were completed in 89% and 96% of those required. Laboratory results were reviewed in 91% of indicated visits. Laboratory testing per NCD protocols was higher in those with hypertension (88%) than diabetes mellitus (67%) upon review. Only 17 (2%) consultations were referred back to clinical officers. Conclusion Nurses are able to adhere to protocols for managing stable NCD patients based on clear and standardized protocols and guidelines, thus paving the way towards task shifting of NCD care to nurses to help relieve the significant healthcare gap in developing countries.

Brief Report: Decentralizing ART Supply for Stable HIV Patients to Community-Based Distribution Centers: Program Outcomes From an Urban Context in Kinshasa, DRC.

Abstract: Scale-up of antiretroviral therapy (ART) has increased the number of HIV-infected patients on treatment to 15 million in 2015, of which 11 million live in sub-Saharan Africa (SSA).1 The number of clinically stable patients accessing health services for ART collection without requiring medical care regularly has increased accordingly. This compounds existing problems in resource-low settings such as overcrowding and diverts scarce human resources needed to care for nonstable patients with HIV.2,3 In 2010, Medecins Sans Frontieres (MSF) started a decentralization project to provide ART for clinically stable HIV patients through community-based drug refill centers in Kinshasa, Democratic Republic of Congo (DRC). No evaluation of such a task-shifting model exists to date.3–6 We assessed outcomes and risk factors for attrition after decentralization in this project.

Sodium stibogluconate and paromomycin for treating visceral leishmaniasis under routine conditions in eastern Sudan

Abstract: Objectives Among patients with primary and relapse visceral leishmaniasis (VL) in eastern Sudan, we determined the proportion eligible for treatment with sodium stibogluconate and paromomycin (SSG/PM) and, of these, their demographic and clinical characteristics; initial treatment outcomes including adverse side effects requiring treatment discontinuation; treatment outcomes by 6 months; and risk factors associated with initial (slow responders) and late treatment failure (relapses and post-kala-azar dermal leishmaniasis, PKDL). Methods A retrospective cohort study in Tabarak Allah Hospital, Gedaref Province, eastern Sudan, from July 2011 to January 2014. Results Of 1252 individuals diagnosed with VL (1151 primary and 101 relapses), 65% were eligible for SSG/PM including 83% children, almost half of them malnourished and anaemic. About 4% of individuals discontinued treatment due to side effects; 0.7% died during treatment. Initial cure was achieved in 93% of 774 primary cases and 77% of 35 relapse cases (P < 0.001). Among the 809 patients eligible for SSG/PM, 218 (27%) were lost to follow-up. Outcomes by six months among the 591 patients with available follow-up data were: definitive cure (n = 506; 86%), relapse (n = 38; 6%), treatment discontinuation (n = 33; 6%), PKDL (n = 7; 1%) and death (n = 7; 1%). Among those completing a full course of SSG/PM, relapses and under-fives were at significantly higher risk of early and late treatment failure, respectively. Conclusion Whether SSG/PM as a first-line regimen is an undeniable progress compared to SSG monotherapy, it excluded a considerable proportion of VL patients due to drug safety concerns. We call for accelerated development of new drugs and treatment regimens to improve VL treatment in Sudan. Objectifs Parmi les patients ayant une leishmaniose viscerale (LV) primaire et de rechute dans l'est du Soudan, nous avons determine la proportion eligibles pour un traitement avec du stibogluconate de sodium et de la paromomycine (SGS/PM) et, de ceux-ci, leurs caracteristiques demographiques et cliniques, les resultats des traitements initiaux, y compris les effets secondaires indesirables necessitant l'arret du traitement, les resultats du traitement apres six mois et les facteurs de risque associes a l’echec initial (repondeurs lents) et tardif (rechutes et leishmaniose cutanee post kala-azar, PKDL) du traitement. Methodes Etude de cohorte retrospective a l'Hopital Tabarak Allah, dans la Province de Gedaref, dans l'est du Soudan, de juillet 2011 a janvier 2014. Resultats Sur 1252 personnes diagnostiquees avec la LV (1151 primaires et 101 rechutes), 65% etaient eligibles pour SGS/PM dont 83% d'enfants; pres de la moitie d'entre eux souffraient de malnutrition et d'anemie. 4% des individus ont abandonne le traitement a cause d'effets secondaires, 0,7% sont decedes au cours du traitement. La guerison initiale a ete atteinte chez 93% des 774 cas primaires et 77% des 35 cas de rechute (p <0,001). Il y avait 2% des repondeurs lents parmi les cas primaires et 17% (P <0,001) parmi les cas de rechute. Parmi les 809 patients eligibles pour SGS/PM, les resultats a six mois etaient: 63% de guerisons definitives, 27% de pertes au suivi, 5% de rechutes, 4% d'abandons du traitement, 0,9% de PKDL et 0,9% de deces. Parmi ceux qui ont termine un cycle complet d’SSG/PM, les cas de rechutes et ceux de moins de cinq ans etaient a risque significativement plus eleve d’echec precoce et tardif du traitement, respectivement. Conclusion SSG/PM en tant que traitement de premiere intention a exclu une proportion considerable de patients atteints de LV en raison de preoccupations sur la securite des medicaments. Nous appelons a un developpement accelere de nouveaux medicaments et regimes de traitement pour ameliorer le traitement de la VL au Soudan. Objetivos Entre pacientes con leishmaniosis visceral (LV) primaria y recaidas en el este de Sudan, hemos determinado la proporcion que cumplian criterios para ser tratados con estibugluconato de sodio y paromomicina (EGS/PM) y de estos, sus caracteristicas demograficas y clinicas; los resultados iniciales del tratamiento incluyendo efectos adversos que requerian descontinuar el tratamiento; resultados de tratamiento despues de seis meses; y factores de riesgo asociados con un fallo inicial (respondedores lentos) y fallo en el tratamiento tardio (recaidas y leishmaniosis dermica post kala azar, LDPK). Metodos Estudio retrospectivo de cohortes en el Hospital Tabarak Allah, Provincia de Gedaref, Sudan, entre Julio 2011 y Enero 2014. Resultados De 1252 individuos diagnosticados con LV (1151 primarios y 101 recaidas), 65% eran elegibles para EGS/PM incluyendo 83% ninos, casi la mitad de ellos desnutridos y anemicos. Un 4% de los individuos descontinuaron el tratamiento debido a sus efectos secundarios; 0.7% murieron durante el tratamiento. La curacion inicial se alcanzo en un 93% de los 774 casos primarios y un 77% de 35 casos de recaida (P<0.001). Entre los casos primarios, un 2% eran respondedores lentos, y entre los casos de recaida, un 17% (P<0.001). Entre los 809 pacientes elegibles para recibir EGS/PM, los resultados a seis meses eran: curacion definitiva 63%, perdida durante el seguimiento 27%, recaida 5%, discontinuacion del tratamiento 4%, PKDL 0.9% y muerte 0.9%. Entre aquellos que tomaron un tratamiento completo de EGS/PM, los pacientes con recaidas y los menores de cinco anos tenian un mayor riesgo de fallo en el tratamiento temprano y tardio, respectivamente. Conclusion EGS/PM como regimen de primera linea excluia una proporcion considerable por posibles problemas de seguridad del medicamento. Hacemos un llamado a un desarrollo acelerado de nuevos medicamentos y regimenes de tratamiento para mejorar el tratamiento de LV en Sudan.

Offering mental health services in a conflict affected region of Pakistan: who comes, and why?

Abstract: Background North West Pakistan is an area ravaged by conflict and population displacement for over three decades. Recently, drone attacks and military operations have aggravated underlying mental disorders, while access to care is limited. Among patients attending a mental health clinic integrated in district hospital conducted by psychologists; we describe service utilization, patient characteristics, presenting complaints, morbidity patterns, and follow-up details.

Engagement of public and private medical facilities in tuberculosis care in Myanmar: contributions and trends over an eight-year period

Abstract: As part of the WHO End TB strategy, national tuberculosis (TB) programs increasingly aim to engage all private and public TB care providers. Engagement of communities, civil society organizations and public and private care provider is the second pillar of the End TB strategy. In Myanmar, this entails the public-public and public-private mix (PPM) approach. The public-public mix refers to public hospital TB services, with reporting to the national TB program (NTP). The public-private mix refers to private general practitioners providing TB services including TB diagnosis, treatment and reporting to NTP. The aim of this study was to assess whether PPM activities can be scaled-up nationally and can be sustained over time. Using 2007–2014 aggregated program data, we collected information from NTP and non-NTP actors on 1) the number of TB cases detected and their relative contribution to the national case load; 2) the type of TB cases detected; 3) their treatment outcomes. The total number of TB cases detected per year nationally increased from 133,547 in 2007 to 142,587 in 2014. The contribution of private practitioners increased from 11% in 2007 to 18% in 2014, and from 1.8% to 4.6% for public hospitals. The NTP contribution decreased from 87% in 2007 to 77% in 2014. A similar pattern was seen in the number of new smear (+) TB cases (31% of all TB cases) and retreatment cases, which represented 7.8% of all TB cases. For new smear (+) TB cases, adverse outcomes were more common in public hospitals, with more patients dying, lost to follow up or not having their treatment outcome evaluated. Patients treated by private practitioners were more frequently lost to follow up (8%). Adverse treatment outcomes in retreatment cases were particularly common (59%) in public hospitals for various reasons, predominantly due to patients dying (26%) or not being evaluated (10%). In private clinics, treatment failure tended to be more common (8%). The contribution of non-NTP actors to TB detection at the national level increased over time, with the largest contribution by private practitioners involved in PPM. Treatment outcomes were fair. Our findings confirm the role of PPM in national TB programs. To achieve the End TB targets, further expansion of PPM to engage all public and private medical facilities should be targeted.

True Outcomes for Patients on Antiretroviral Therapy Who Are "Lost to Follow-Up" in Malawi/Veritables Issues Du Traitement Antiretroviral Pour Les Patients Consideres Comme « Perdus De Vue » Au Malawi/Evolucion Real De Los Pacientes Sometidos a Terapia Antirretroviral Y Perdidos En El Seguimiento En Malawi

Abstract: Introduction Many resource-poor countries with HIV epidemics are scaling up antiretroviral therapy (ART) By December 2005, an estimated 13 million people from low-and middle-income countries had been placed on treatment; 810 000 of these were in sub-Saharan Africa (1) Treatment outcomes reported from various clinics in sub-Saharan Africa, Haiti, Asia and South America have been good, comparable with those observed in countries with higher incomes (2-7) Patient outcomes are usually categorized as patients alive and on treatment, stopped treatment, transferred to another facility, dead or "lost to follow-up" Depending on the facility, patients are classified as lost to follow-up if they have missed two or more consecutive clinic appointments (2) or have not been seen for at least 2 or 3 months (4-6) The proportion of patients lost to follow-up differs between clinics, ranging from 5% in programmes supported by Medecins Sans Frontieres (5) to 25% in western Kenya (4) In 18 ART-delivery programmes in Africa, Asia and South America, 15% of 4810 patients were lost to follow-up in the first year of ART, with the average being 12% in programmes with active follow-up and 19% in those with no active follow-up (7) To our knowledge, there ate no published data from resource-poor countries on the true outcome status of these patients Malawi--a small resource-poor country in southern Africa--has been engaged in ART scale-up for nearly 3 years By 31 March 2006, 46 702 patients had ever started receiving ART in 66 facilities in the public sector; of these, 33 891 (73%) were registered as alive, 5131 (11%) were dead, 4226 (9%) were lost to follow-up, 3140 (7%) had transferred to another facility and 314 (1%) had stopped therapy (8) We hypothesized that many patients lost to follow-up may have died, and therefore conducted a study in northern Malawi to investigate this problem Methods Details on the delivery and monitoring of ART in Malawi have been described previously (9) When patients start ART, their details are entered on master cards and an ART register Patients attend the ART clinic each month, at which time their outcome status is entered on the master card and they are given another month's supply of ART drugs if a patient is not seen in the clinic for three consecutive months, the patient is registered as a "defaulter" (an abbreviated term for "lost to follow-up") on the master card and also on the register Four public-sector ART facilities in the northern region of Malawi were selected for the study These included one central hospital and three peripheral hospitals (two district hospitals and one mission hospital) Provision of free ART was initiated at the central and mission hospitals in July 2004, and at the two district hospitals in January and June 2005 respectively For the period between the date when each facility started to provide free ART and 31 March 2006, we identified all patients indicated on the master cards and registers as a defaulter Using contact details, ART facility staff visited the patients' homes to try to ascertain their true outcome status If patients were traced to the home, they were asked whether they were still taking ART and if not, why they had stopped If the patient had died, the relatives were asked when the patient had died If the patient had moved away, relatives or friends were asked when they had moved Ethical approval for the study was granted by the Malawi National Health Sciences Research Committee Informed consent was obtained from patients being interviewed, and staff took care not to disclose that the patient was receiving ART when interviewing relatives or friends in the event of the patient's death or transfer Data were collected, on Structured forms, and analysis was carried out using Epi Info version 60 Patients from the central and the peripheral hospitals were compared: the [chi square] test with relative risks (RR) and 95% confidence intervals (CI) were used for characteristics and outcomes, and the student's t-test was used for time periods between start of ART, default and patient tracing, with differences at the level Of 0 …

Chemotherapy of leishmaniasis: present challenges

Abstract: Cutaneous and visceral leishmaniasis are amongst the most devastating infectious diseases of our time, affecting millions of people worldwide. The treatment of these serious diseases rely on a few chemotherapeutic agents, most of which are of parenteral use and induce severe side-effects. Furthermore, rates of treatment failure are high and have been linked to drug resistance in some areas. Here, we reviewed data on current chemotherapy practice in leishmaniasis. Drug resistance and mechanisms of resistance are described as well as the prospects for applying drug combinations for leishmaniasis chemotherapy. It is clear that efforts for discovering new drugs applicable to leishmaniasis chemotherapy are essential. The main aspects on the various steps of drug discovery in the field are discussed.

Recent Development of Visceral Leishmaniasis Treatments: Successes, Pitfalls, and Perspectives.

Abstract: SUMMARY Research in visceral leishmaniasis in the last decade has been focused on how better to use the existing medicines as monotherapy or in combination Systematic research by geographical regions has shown that a universal treatment is far from today9s reality Substantial progress has been made in the elimination of kala-azar in South Asia, with a clear strategy on first- and second-line therapy options of single-dose liposomal amphotericin B and a combination of paromomycin and miltefosine, respectively, among other interventions In Eastern Africa, sodium stibogluconate (SSG) and paromomycin in combination offer an advantage compared to the previous SSG monotherapy, although not exempted of limitations, as this therapy requires 17 days of painful double injections and bears the risk of SSG-related cardiotoxicity In this region, attempts to improve the combination therapy have been unsuccessful However, pharmacokinetic studies have led to a better understanding of underlying mechanisms, like the underexposure of children to miltefosine treatment, and an improved regimen using an allometric dosage Given this global scenario of progress and pitfalls, we here review what steps need to be taken with existing medicines and highlight the urgent need for oral drugs Furthermore, it should be noted that six candidates belonging to five new chemical classes are reaching phase I, ensuring an optimistic near future