International Activity Report 2010 - Glossary of diseases and MSF activities

Chagas disease

Chagas disease is found almost exclusively in Latin America, although increased global travel and migration have led to more cases being reported in North America, Europe, Australia and Japan.  

Chagas is a parasitic disease transmitted by vinchuca beetles, which live in cracks in the walls and roofs of mud and straw housing. It can also be transmitted through blood transfusions, to the foetus during pregnancy and, less frequently, through organ transplants.  

Some people can have the disease but show no sign of it for years. Ultimately, debilitating chronic symptoms develop in approximately 30 per cent of people infected, shortening life expectancy by an average of ten years, with heart failure being the most common cause of death for adults.

Diagnosis is complicated, as doctors need to perform two or three blood tests. There are currently only two medicines to combat the disease: benznidazole and nifurtimox, both developed over 35 years ago. The cure rate is almost 100 per cent in newborns and infants, but in older children, adolescents and adults, treatment is only around 60 or 70 per cent effective.  

The treatment currently used can be toxic and can take one to two months to complete. Despite the clear need for more efficient and safer medication, there are few new drugs in development.

MSF admitted 1,254 new patients to Chagas treatment programmes in 2010.

Cholera

Cholera is a water-borne, acute gastrointestinal infection caused by the Vibrio cholerae bacterium and spread by contaminated water or food. The infection can spread rapidly and large outbreaks can occur suddenly.

Most people will suffer only a mild infection, but the illness can be very severe, causing profuse watery diarrhoea and vomiting that can lead to severe dehydration and death.

Treatment consists of a rehydration solution – administered orally or intravenously – which replaces fluids and salts.

As soon as an outbreak is suspected, patients are isolated in specialised treatment centres to prevent the spread of the disease. Outside the centres, strict hygiene practices must be implemented and a safe water supply must be assured. Cholera is most common in densely populated settings where sanitation is poor and water supplies are not safe.

MSF treated 174,220 people for cholera in 2010.

Health promotion

When MSF opens a project, the local community needs to know what services are available and how these services can improve their health. Informing people and communicating about when and where staff will be available and what they can do is one of the first tasks for a team setting up a new clinic or programme.

During serious outbreaks of disease or epidemics, MSF provides communities with information on how the disease is transmitted and how to prevent it, what signs to look for in case someone becomes ill, and what to do. If MSF is responding to an outbreak of cholera, for example, teams work to explain the importance of good hygiene practices as the disease is transmitted through contaminated water.

HIV/AIDS

The human immunodeficiency virus (HIV) is transmitted through blood and body fluids and gradually weakens the immune system – usually over a three- to ten-year period – leading to acquired immunodeficiency syndrome or AIDS. A number of opportunistic infections are able to develop as the immune system weakens. Tuberculosis is the most common opportunistic infection that leads to death.

A simple blood test can confirm HIV status, but many people live for years without symptoms and may not know they have been infected with HIV. Combinations of drugs known as antiretrovirals (ARV s) help combat the virus, reduce the spead of the infection, and enable people to live longer, healthier lives without their immune systems deteriorating rapidly. As well as treatment, MSF’s comprehensive HIV/AIDS programmes generally include education and awareness activities, condom distribution, HIV testing, counselling and prevention of mother-tochild transmission (PMTCT) of the virus.

PMTCT services involve the administration of ARV treatment during pregnancy and labour, and to the infant just after birth.

MSF provided care for over 210,000 people living with HIV/AIDS, and antiretroviral treatment.

Human African trypanosomiasis (sleeping sickness)

Generally known as sleeping sickness, human African trypanosomiasis is a parasitic infection that occurs in sub-Saharan Africa and is transmitted by tsetse flies. More than 90 per cent of reported cases are caused by the parasite Trypanosoma brucei gambiense, which is found in west and central Africa. It attacks the central nervous system, causing severe neurological disorders or even death.

The other ten per cent of cases are caused by Trypanosoma brucei rhodesiense, which is found in eastern and southern Africa.

During the first stage, the disease is relatively easy to treat but difficult to diagnose, as symptoms such as fever and weakness are non-specific.  

The second stage begins when the parasite invades the central nervous system and the infected person begins to show neurological or psychiatric symptoms, such as poor coordination, confusion, convulsions and sleep disturbance. At this stage, accurate diagnosis of the illness requires a sample of spinal fluid.

Nifurtimox-eflornithine combination therapy, or NECT, is now the internationally recommended treatment. NECT is safer than melarsoprol, the drug that was used to treat the disease before, which is a derivative of arsenic, causes many side effects and can even kill the patient.

MSF admitted 1,293 new patients for treatment for human African trypanosomiasis in 2010.

Malaria

Malaria is transmitted by infected mosquitoes.

Symptoms include fever, pain in the joints, headaches, repeated vomiting, convulsions and coma. Severe malaria, most often caused by the Plasmodium falciparum parasite, causes organ damage and leads to death if left untreated.  

MSF field research has helped prove that artemisinin-based combination therapy (ACT) is currently the most effective treatment for malaria caused by Plasmodium falciparum. In 2010 World Health Organization guidelines were altered to recommend the use of artesunate, a derivative of artemisinin, for the treatment of severe malaria in children.

Longlasting insecticide-treated bed nets are one important means of controlling malaria.

In endemic areas, MSF systematically distributes nets to pregnant women and children under the age of five, who are most vulnerable to severe malaria, and staff advise people on how to use the nets.

MSF treated 1,622,721 people for malaria in 2010.

Malnutrition

A lack of esssential nutrients causes malnutrition: growth will falter and a child’s susceptibility to common diseases increases.

The critical age for malnutrition is from six months – when mothers generally start supplementing breast milk – to 24 months.

However children under five, adolescents, pregnant or breastfeeding women, the elderly and the chronically ill are also vulnerable.

“Wasting”, when a malnourished person begins to consume his or her own tissues to obtain needed nutrients, is a sign of acute malnutrition. Severe acute malnutrition is defined by very low weight for a person’s height or visible severe wasting. Over a quarter of children suffering from severe malnutrition will die if they do not receive treatment.

MSF uses ready-to-use food (RU F) to treat malnutrition. RU F contains fortified milk powder and delivers all the nutrients that a malnourished child needs to reverse deficiencies and gain weight. With a long shelf-life and requiring no preparation, RU F can be used in all kinds of settings and allows patients to be treated at home, unless they are suffering severe complications. Where malnutrition is likely to become severe, MSF takes a preventive approach, distributing supplementary RU F to at-risk children.

MSF admitted more than 300,000 malnourished patients to feeding centres in 2010.

Measles

Measles is a highly contagious viral disease, and one of the leading causes of death among young children. Symptoms appear between 10 and 14 days after exposure to the virus and include a runny nose, cough, eye infection, rash and high fever. There is no specific treatment for measles – patients are isolated and treated for a lack of vitamin A, eye-related complications, stomatitis (a viral mouth infection), dehydration, protein deficiencies and respiratory tract infections.

Most people recover within two to three weeks, but between 5 and 20 per cent of people infected with measles die, usually because of complications such as diarrhoea, dehydration, encephalitis (inflammation of the brain) or respiratory infections.

A safe and cost-effective vaccine against measles exists, and large-scale vaccination campaigns have drastically decreased the number of cases and deaths from measles.

However, coverage remains low in countries with weak health structures, or among people with limited access to health services, and large outbreaks still occur.

In 2010 MSF treated 188,704 people for measles and vaccinated more than 4,500,000 people.

Meningococcal meningitis

Meningococcal meningitis is an infection of the thin membranes surrounding the brain and spinal cord. Meningitis can cause sudden and intense headaches, fever, nausea, vomiting, sensitivity to light and stiffness of the neck. Death can follow within hours of the onset of symptoms.

Five strains of the bacteria Neisseria meningitidis (A, B, C, W135, and X) can cause epidemics. People can be infected without showing symptoms and spread the bacteria when they cough or sneeze.

Suspected cases are properly diagnosed through the examination of a sample of spinal fluid and are treated with specific antibiotics. However, even with treatment, five to ten per cent of patients will die and as many as one in five survivors may suffer from after effects that can include hearing loss and learning disabilities.

Meningitis occurs throughout the world, but the majority of infections and deaths are in Africa, particularly across the “meningitis belt”, an east–west geographical strip from Ethiopia to Senegal, where epidemics are most likely to be caused by meningitis A. A new vaccination against this strain provides protection for 10 years and even prevents healthy carriers from transmitting the infection. Such long-term protection means that preventive vaccination campaigns are now a possibility, potentially changing the lives of millions of people living in the meningitis belt.

MSF treated 5,911 cases and vaccinated more than 1,330,000 people against meningitis in 2010, participating in the campaign introducing the new vaccine in Mali and Niger.

Mental healthcare

Traumatising events – suffering or witnessing violence, the death of loved ones, the destruction of livelihoods – can generate intense fear and horror, and are likely to affect a person’s mental wellbeing. MSF provides early psychosocial support to victims of trauma in an effort to reduce the possibility of long-term psychological problems developing.

Psychosocial care focuses on supporting a community to build its own coping strategies after trauma. Counsellors help groups to talk about their experiences and process their feelings so that general stress levels are reduced. This approach fosters mutual support and enables a community to rebuild itself according to its own cultural beliefs, taking back control of the situation as soon as it is able. It is complemented with individual counselling and psychiatric care for those who need it.

MSF staff held more than 188,000 individual and group counselling sessions in 2010.

Relief items distribution

MSF’s primary focus is on providing medical care, but in an emergency teams often distribute relief items that contribute to psychological and physical survival. Such items include clothing, blankets, bedding, shelter, cleaning and hygiene materials, cooking utensils, and fuel. In many emergencies, relief items are distributed as kits – cooking kits containing a stove, pots, plates, cups, cutlery and a jerrycan so that a family can prepare meals, or a hygiene kit with soap, shampoo, toothbrushes, toothpaste, and laundry soap for a family to be able to wash themselves and clean their clothes.

A shelter provides both protection from the elements and a measure of security. Where materials are not locally available, MSF distributes emergency supplies – rope and plastic sheeting or tents – with the aim of ensuring a roof for each family. A minimum standard of 3.5m2 is allocated per person, with 2 metres between shelters to help prevent fires. In cold climates more substantial tents are provided or teams try to find more permanent structures.

MSF distributed 341,507 relief kits in 2010.

Reproductive healthcare

Comprehensive emergency and neonatal obstetric care is part of MSF’s emergency response, and many of MSF’s longer-term programmes offer more extensive maternal healthcare. Medical staff assist births and perform caesarean sections where necessary, perinatal care is provided and sick newborns and babies with a low birth weight receive medical care.

Several antenatal visits are recommended to meet medical needs during the pregnancy and to identify potentially complicated deliveries.

Family planning counselling is provided as part of postnatal care, as is information and education on sexually transmitted infections (STIs).

Around two million women are estimated to have fistulas, which are injuries to the birth canal. Fistulas cause incontinence, which can lead to social stigma. They are often the result of a long, obstructed labour, and can be prevented by good antenatal and obstetric care. Fistulas can also be repaired.

In 2010 specialist MSF teams operated on about 1,000 women with obstetric fistulas.

MSF held more than 700,000 antenatal consultations in 2010.

Sexual violence

MSF offers medical care, treatment to prevent the development of sexually transmitted infections, and psychological, social and legal support to patients who have suffered sexual violence. In settings where the incidence of sexual violence is higher, such as conflict zones or refugee or displaced persons camps, dedicated teams care for people who have experienced sexual violence.

Staff work with the community to raise awareness of the problem of sexual violence, to inform them of the care that MSF provides, and to promote social and legal support.

MSF treated more than 10,000 patients for sexual violence-related injuries in 2010.

Tuberculosis

One-third of the world’s population is currently infected with the tuberculosis (TB) bacillus. Every year, nine million people develop active TB and close to two million die from it. Ninety-five per cent of these people live in low-income countries.

TB mainly affects the lungs and is spread through the air when infected people cough or sneeze. Symptoms include a persistent cough, fever, weight loss, chest pain and breathlessness in the lead-up to death. Not everyone becomes ill, but 10 per cent of people will develop active TB at some point in their lives. The incidence is much higher among people with HIV, for whom TB is a leading cause of death.

The drugs used to treat TB were developed in the 1950s, and a course for uncomplicated TB takes six months. Multidrug-resistant TB (MDR-TB) is identified when patients are resistant to the two most powerful first-line antibiotics. MDR-TB is not impossible to treat, but the required regimen causes many side effects and takes up to two years. A newer strain, extensively drug-resistant tuberculosis (XDR-TB), is identified when resistance to second-line drugs develops on top of MDR-TB.

The treatment options for XDR-TB are limited.

MSF treated over 30,090 people for tuberculosis, and 1,159 for MDR-TB, in 2010.
 

Vaccinations

The use of immunisation to prevent infectious diseases is one of the most cost-effective medical interventions in public health.

However, it is estimated that approximately two million people die every year from diseases that are preventable by a series of vaccines recommended for all children by the World Health Organization. Currently, these are DTP (diphtheria, tetanus, pertussis), hepatitis B, Haemophilius influenzae type b (Hib), BCG (against tuberculosis), human papillomavirus, measles, polio and rotavirus.

In countries where vaccination coverage is generally low, MSF strives to offer routine vaccinations for all children under five as part of the basic healthcare programme.

Immunisation also forms a key part of MSF’s response to outbreaks of measles, yellow fever or meningitis. Teams often take part in large-scale vaccination campaigns. Staff work to raise awareness in the community about the benefits of immunisation, and vaccination posts are set up in places where the community is likely to gather. A typical campaign lasts between two and three weeks and can reach hundreds of thousands of people.

Visceral leishmaniasis (kala azar)

Largely unknown in the developed world, kala azar – Hindi for “black fever” – is a tropical, parasitic disease that is transmitted through bites from certain types of sand fly. It is endemic in 62 countries, and of the estimated 500,000 annual cases, 90 per cent occur in Bangladesh, India, Nepal, Sudan and Brazil. It is characterised by fever, weight loss, enlargement of the liver and spleen, anaemia and immune-system deficiencies. Without treatment, nearly all patients will die.

Very suitable rapid diagnostic field tests are available, although backup confirmation testing – involving microscopic examination of samples taken from the spleen, bone marrow or lymph nodes – is invasive and requires resources not readily available in developing countries. Current treatment options include pentavalent antimonials. Although expensive, and evolving to become more simplified – studies showing the efficacy and safety of liposomal amphotericin B in the Indian subcontinent are promising – treatment options have significant limitations. The anticipated combination therapies intend to reduce the risk of the parasite developing resistance to the drugs, optimise the efficacy and safety of treatment, and reduce costs and hospitalisation time.

Co-infection of kala azar and HIV is a major challenge. Both diseases influence each other in a vicious spiral as they attack and weaken the immune system, making the person less resistant to the other disease and the treatment less effective.

MSF admitted 8,128 new patients for kala azar treatment in 2010.

Water and sanitation

Safe water and good sanitation are essential to medical activities. MSF teams make sure there is a clean water supply and a waste management system in all the health structures where MSF works.

In emergencies, MSF assists in the provision of safe water and adequate sanitation to people displaced by natural disasters or armed conflict. Drinking water and waste disposal are the first priorities. Latrines are built at a convenient, yet secure, distance from camps.

Where a safe water source cannot be found close by, water will be trucked in containers.

Staff conduct information campaigns to promote the use of facilities and ensure good hygiene practices.

In 2010, MSF distributed more than 577,000,000 litres of safe water and built or rehabilitated 1,986 latrines.