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Glossary of Diseases and Activities
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 triatomine bugs, 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.
A person with Chagas often feels no symptoms in the first, acute, stage of the disease. Then the chronic stage is asymptomatic for years. Ultimately, however, debilitating complications develop in approximately 30 per cent of people infected, shortening life expectancy by an average of 10 years. Heart failure is the most common cause of death for adults.
Diagnosis is complicated, requiring laboratory analysis of blood samples. There are currently only two medicines available to treat the disease: benznidazole and nifurtimox, which were both developed over 35 years ago. The cure rate is almost 100 percent in newborns and infants, but as the gap between the date of infection and the beginning of treatment lengthens, the cure rate declines.
The treatment currently used can be toxic and can take longer than two months to complete. Despite the clear need for more efficient and safer medication, there are few new drugs in development.
MSF admitted 2,500 new patients to Chagas treatment programs in 2011.
Cholera is a water-borne, acute gastrointestinal infection caused by the Vibrio cholerae bacterium. It is transmitted by contaminated water or food, or direct contact with contaminated feces. Large outbreaks can occur suddenly and the infection can spread rapidly. Most people will suffer only a mild infection, but the illness can be very severe, causing profuse watery diarroea 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 centers to prevent the transmission of the disease. Outside the centers , 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 130,800 people for cholera in 2011.
Health promotion activities aim to improve health and encourage the effective use of health services. Health promotion is a two-way process: understanding the culture and practices of a community is as important as providing information.
During serious outbreaks of disease or epidemics, MSF provides people with information on how the disease is transmitted and how to prevent it, what signs to look for, and what to do if someone becomes ill. If MSF is responding to an outbreak of cholera, for example, teams work to explain the importance of good hygiene practices, because the disease is transmitted through contaminated water.
The human immunodeficiency virus (HIV) is transmitted through blood and body fluids and gradually breaks down the immune system – usually over a three- to ten-year period – leading to acquired immunodeficiency syndrome, or AIDS.
As the virus progresses, people begin to suffer from opportunistic infections. The most common opportunistic infection that leads to death is tuberculosis. 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 (ARVs) help combat the virus, and enable people to live longer, healthier lives without their immune systems deteriorating rapidly. ARVs also significantly reduce the likelihood of the virus being transmitted.
As well as treatment, MSF’s comprehensive HIV/AIDS programs generally include education and awareness activities, condom distribution, HIV testing, counseling and prevention of mother-to-child transmission (PMTCT) services. PMTCT involves the administration of ARV treatment to the mother during pregnancy and labour, and to the infant just after birth.
MSF provided care for 228,700 people living with HIV/AIDS, and antiretroviral treatment for 205,000 people in 2011.
Kala azar (visceral leishmaniasis)
Largely unknown in wealthy countries, kala azar – Hindi for ‘black fever’ – is a tropical, parasitic disease transmitted through bites from certain types of sand fly. It is endemic in 76 countries, and of the estimated 250,000-300,000 annual cases, 90 percent occur in Bangladesh, India, Nepal, South Sudan, Sudan and Brazil.
Kala azar is characterised by fever, weight loss, enlargement of the liver and spleen, anaemia and immune-system deficiencies. Without treatment, kala azar is almost always fatal.
In Asia, rapid diagnostic tests can be used for diagnosis of the disease. However, these tests are not sensitive enough for use in Africa, where diagnosis often requires microscopic examination of samples taken from the spleen, bone marrow or lymph nodes. These are invasive procedures requiring resources that are not readily available in developing countries.
Treatment options for kala azar have evolved over recent years. Liposomal amphotericin B is in the process of becoming the primary treatment used in Asia, either alone or as part of a combination therapy. This is safer and involves a shorter course of treatment than previously used medication. However, it requires intravenous administration, which remains an obstacle to its use in local clinics.
In Africa, the best available treatment is a combination of pentavalent antimonials and paromomycin, which requires a number of painful injections. Co-infection of kala azar and HIV is a major challenge, as both diseases influence each other in a vicious spiral as they attack and weaken the immune system.
MSF registered 7,600 new patients for kala azar treatment in 2011.
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 over artemether for the treatment of severe malaria in children.
Long-lasting 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 1,422,800 people for malaria in 2011.
A lack of essential 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.
Malnutrition in children can be diagnosed in two ways: it can be calculated from measurements of weight and height, or by measurement of the mid-upper arm circumference. According to these measurements, undernourished children are diagnosed with moderate or severe acute malnutrition.
MSF uses ready-to-use food (RUF) to treat malnutrition. RUF 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, these nutritional products can be used in all kinds of settings and allow patients to be treated at home, unless they are suffering severe complications.
In situations where malnutrition is likely to become severe, MSF takes a preventive approach, distributing nutritional supplements to at-risk children to prevent their condition from further deteriorating.
MSF admitted 348,000 malnourished patients to nutrition programmes in 2011.
Measles is a highly contagious viral disease. 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 with vitamin A, and for any complications: these can include eye-related problems, stomatitis (a viral mouth infection), dehydration, protein deficiencies and respiratory tract infections.
While most people infected with measles recover within two to three weeks, between 5 and 20 per cent die, usually due to complications such as diarrhea, dehydration, encephalitis (inflammation of the brain) or severe respiratory infection.
A safe and cost-effective vaccine against measles exists, and large-scale vaccination campaigns have drastically decreased the number of cases and deaths. However, coverage remains low in countries with weak health systems, or among people with limited access to health services, leaving large numbers of people susceptible to the disease.
MSF treated 126,500 people for measles and vaccinated more than 5,000,000 people in 2011.
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. Six strains of the bacteria Neisseria meningitidis are known (A, B, C, W135, Y and X), but only two (A and W135) are the cause of most epidemics.
People can be infected without showing symptoms and transmit the bacteria when they cough or sneeze. Suspected cases are diagnosed through the examination of a sample of spinal fluid and treatment consists of specific antibiotics. However, even with treatment, five to ten percent of patients will die and as many as one in five survivors may suffer from after effects, including 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 vaccine against this strain provides protection for 10 years and even prevents healthy carriers from transmitting the infection. Preventive vaccination campaigns have now been implemented in Burkina Faso, Mali and Niger and are planned to cover the entire meningitis belt.
MSF treated 5,900 patients for meningitis and vaccinated 952,600 people against he disease in 2011.
Traumatizing events – suffering or witnessing violence, the death of loved ones or the destruction of livelihoods – are likely to affect a person’s mental wellbeing. MSF provides psychosocial support to victims of trauma in an effort to reduce the likelihood of long-term psychological problems.
Psychosocial care focuses on supporting a community in developing its own coping strategies after trauma. Counselors help groups to talk about their experiences and process their feelings so that general stress levels are reduced. This approach fosters mutual support and allows a community to rebuild itself according to its own cultural beliefs, taking back control of the situation as soon as it is able. MSF complements psychosocial care with individual counseling and psychiatric care for those who need it.
MSF staff held 189,000 individual and group counseling sessions in 2011.
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 materials, cooking utensils and fuel.
In many emergencies, relief items are distributed as kits – cooking kits contain a stove, pots, plates, cups, cutlery and a jerrycan so that people can prepare meals, while a washing kit includes soap, shampoo, toothbrushes, toothpaste and laundry soap.
Where people are without shelter, and materials are not locally available, MSF distributes emergency supplies – rope and plastic sheeting or tents – with the aim of ensuring a roof, and some level of security and protection. In cold climates more substantial tents are provided, or teams try to find more permanent structures.
MSF distributed 225,500 relief kits in 2011.
Comprehensive emergency obstetric and neonatal care form part of MSF’s response to any emergency. Medical staff assist births and perform caesarean sections where necessary, and sick newborns and babies with a low birth weight receive medical care.
Many of MSF’s longer-term programs offer more extensive maternal healthcare. Several antenatal visits are recommended, so that medical needs during pregnancy are met and potentially complicated deliveries can be identified. After delivery, postnatal care includes family planning counseling, and information and education on sexually transmitted infections.
Good antenatal and obstetric care can prevent obstetric fistulas. Obstetric fistulas are injuries to the birth canal, and are most often a result of prolonged, obstructed labour. They cause incontinence, which can lead to social stigma. Around two million women are estimated to have obstetric fistulas, and a number of MSF programs carry out specialist obstetric fistula repair surgery.
MSF held more than 821,800 antenatal consultations in 2011.
MSF offers patients who have suffered sexual violence medical care, treatment to prevent the development of sexually transmitted infections, and psychological, social and legal support. In settings where the rate of sexual violence is high, such as in conflict zones or refugee camps, dedicated teams provide assistance, and staff work with the community to raise awareness of the problem of sexual violence, provide information about the care that MSF provides, and promote social and legal support.
MSF treated more than 14,900 patients for sexual violence-related injuries in 2011.
Sleeping sickness (human African trypanosomiasis)
Generally known as sleeping sickness, human African trypanosomiasis is a parasitic infection that occurs in sub-Saharan Africa and is transmitted by tsetse flies. It attacks the central nervous system, causing severe neurological disorders or even death.
More than 90 percent of reported cases are caused by the parasite Trypanosoma brucei gambiense, which is found in western and central Africa. The other 10 percent 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 World Health Organization’s recommended protocol. NECT is much safer than melarsoprol, the drug that was previously used to treat the disease, and which is a derivative of arsenic. Melarsoprol causes many side effects and can even kill the patient. New molecules are currently under clinical trial in the hope of developing a safe, effective treatment for both stages of the disease that can be administered orally.
MSF admitted 1,400 new patients for sleeping sickness treatment in 2011.
One-third of the world’s population is currently infected with the tuberculosis (TB) bacillus. Every year, nine million people develop active TB and 1.5 million die from it.
TB is spread through the air when infected people cough or sneeze. Not everyone infected with TB becomes ill, but 10 percent will develop active TB at some point in their lives. The disease most often affects the lungs. Symptoms include a persistent cough, fever, weight loss, chest pain and breathlessness in the lead-up to death. TB incidence is much higher and is a leading cause of death among people with HIV.
Diagnosis of TB depends on a phlegm sample, which can be difficult to obtain from children. There is a new molecular test that can give results after just two hours, and detect a certain level of drug resistance, but it is costly, depends on a reliable power supply, and still requires a phlegm sample.
A course of treatment for uncomplicated TB takes a minimum of six months. When patients are resistant to the two most powerful first-line antibiotics, they are considered to have multidrug-resistant TB (MDR-TB). MDR-TB is not impossible to treat, but the drug regime is arduous, taking up to two years and causing many side effects.
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 30,700 people for tuberculosis, and 1,060 for MDR-TB, in 2011.
Immunization is one of the most costeffective 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 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, pneumococcal conjugate, polio, rotavirus and rubella – although not all vaccines are recommended everywhere.
In countries where vaccination coverage is generally low, MSF strives to offer routine vaccinations for all children under five as part of its basic healthcare program. Vaccination also forms a key part of MSF’s response to outbreaks of measles, yellow fever or meningitis. Large-scale vaccination campaigns involve awareness-raising activities regarding the benefits of immunization and the set-up of vaccination posts in places where a community is likely to gather. A typical campaign lasts between two and three weeks and can reach hundreds of thousands of people.
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 facilities where MSF works.
In emergencies, MSF assists in the provision of safe water and adequate sanitation. Drinking water and waste disposal are the first priorities. Latrines are built at a convenient 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 2011, MSF distributed more than 96,000,000 liters of safe water.