Matt Cleary Who are we 1990 PP Founded in France in 2009 by a team of former Médecins Sans Frières Doctors Without Borders senior executives ALIMA the Alliance for International Medical Action is an independent medical NGO ID: 809103
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Slide1
ALIMA
Susan Shepherd &
Matt Cleary
Slide2Who
are
we?
(1990)PPFounded in France in 2009 by a team of former Médecins Sans Frières/Doctors Without Borders senior executives, ALIMA, the Alliance for International Medical Action, is an independent medical NGON (1999)Projets pilotes (2000). Des innovations par des scientifiques utilisés essentiellement par des ex Sud Soudan 1998, Angola 2002) à faible échelle compte tenu des limites techniques.
Slide3Three Principal Areas of Action / Expertise
Slide4In 2015 we treated:
607,000 consultations
42,000 hospitalisations
1,500 surgical interventionsThat Includes:92,000 severely malnourished children308,000 malaria cases50,000 ANC consultation9,000 deliveries50,000 MUAC Mothers129,000 children in SMC
Our Activity
Slide5ALIMA Historical Growth
Slide6Where we work
Current Emergency Missions:
Tanzania
CameroonGuniea (Ebola)
Planned opening 2016:
Nigeria
Slide7Delauche
MC, Blackwell N, Le
Perff
H, et al. A Prospective Study of the Outcome of Patients with Limb Trauma following the Haitian Earthquake in 2010 at One- and Two- Year (The SuTra2 Study) . PLoS Currents. 2013;5:ecurrents.Port au Prince, Haiti: SuTra2 StudyALIMAUniversité de Lille
Centre National de la
Recherche
Scientifique
Slide8Alima’s
Commitment to Operational Research
6 Peer-reviewed publications
Traumatology (1)Paediatrics and Malnutrition (3)Ebola (2)More in submissionPaediatrics and Malnutrition (3)Ebola (1)Current PartnershipsUniversity of Copenhagen: TreatFOODINSERM and NIH: JIKI and PrevailMalaria Research & Training Centre, Univ of BamakoEpicentre: 1000 Days
Slide9Current Research Projects –
Focus on Prevention
1000 Days (Niger)
maternal-infant care package
DiDiMAS
(Chad)
Automated PCR
infectious causes of diarrhoea in malnourished
MUAC-only (BF)
Simplifying treatment of SAM
CPS + LNS (Mali)
Simultaneous prevention of Malaria and Malnutrition
Slide10END
Slide11Alima: Malaria & Malnutrition
Countries today where we confront Malaria & Malnutrition co-morbidity in our projects:
Niger
MaliBurkina FasoCameroonDRCPlanned 2016NigeriaOur approach:TreatmentCommunity programsHospitalisationPreventionSMC: sulfadoxine-pyrimethamine plus amodiaquineMosquito net distributionSupplementary Feeding1000 Days (Niger)Clinical Research/Delivery Science
Treatfood
MUAC Mothers
MUAC Only
1000 Days (Niger)
Slide12Overlap in Malaria and Malnutrition
Niger 2015
34.5%
(13,084/37,916) of ‘uncomplicated’ SAM children in 2 projects were malaria RDT(+)46% of children with severe malaria were SAM in-patients (2,485/5,402)
Slide13Seasonal malaria chemoprevention (SMC):
potential to impact SAM incidence in Burkina Faso
BOUSSE, Burkina Faso
July to December
2013
2014
% reduction from 2013 to 2014
Total
nb
SAM admitted to project
1188
816
31,31%
Total
nb
SAM admitted to hospital
270
101
62,59%
Total nb pediatric hosp admissions
674
356
47,18%
Total nb of transfusions
327
126
61,47%
SMC for 32,756 children 3-59 m Aug-Nov 2014
Slide14LNS –
data suggesting influence on malaria mortality
From:
Effect of Preventive Supplementation With Ready-to-Use Therapeutic Food on the Nutritional Status, Mortality, and Morbidity of Children Aged 6 to 60 Months in Niger: A Cluster Randomized Trial. JAMA. 2009;301(3):277-285. doi:10.1001/jama.2008.1018
Slide151000 Days Package of Care -
~4,000 children 6-23 m enrolled in Niger
Slide16Malaria-Malnutrition-Measles:
DRC 2015
153,258 children 6 m – 10 y vaccinated against measles
6,313 children treated for malaria3.416 children treated for measles< 500 children treated for acute malnutrition
Epicenter of 2015 Measles epidemic
Slide17The Alliance for International Medical Action
L’importance
de
l’ionogramme
Documentation de troubles
ioniques
CRENI
Mirriah
73
enfants
admis
août-oct
2015
Test
selon
avis
du
médecin
Age
moyen
= 18.6
mois
28% d’enfants avec hyponatrémie sévère (Na < 125
mmol/L)87% décès – hypokaliémie
profondeDélai moyen entre admission et test = 2 j (mode = 1 j, range 1-10 j)
Slide18Operational Issues related to Malaria and Malnutrition Prevention in the SAHEL
Cost:
approx. 4 Euro per child per season (1 € drug cost, 3 € distribution cost): How to reduce
It is possible to make the CPS more efficient but also more efficient by combining distribution of anti-malarial drugs to other medical activities as screening for malnutrition, immunization catch-up, the distribution of vitamin A, deworming; orReduce the number of distributions to once or bi-monthly: requires greater community participationCost of SQ-LNS: approximately US$ 3.00/monthAccessibility of Amodiaquine:Limited number of Company pre-qualified for production.Supply is less than demand, Taste of drug
Slide19Research / Operational Questions Related to SMC
Study the impact of combined SMC & LNS distributions on rates of Malaria, febrile illness and acute malnutrition and potentially stunting
Drug resistance related to SMC activity
Are antimalarial pharmacokinetics altered with LNS co-administration?How to achieve the best SMC distribution planning EffectivenessCommunity participationTimingCost
Slide20Research / Operational Questions Related to Malnutrition & Malaria Prevention
Increasing incidence of malaria morbidity and mortality in Eastern DRC?
Role for malaria vaccine trial?
Advantages to associating LNS with malaria vaccine trial?