Rudi Coninx

Prioritization of themes and research questions for health outcomes in natural disasters, humanitarian crises or other major healthcare emergencies

PLoS Curr, 2013

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Tuberculosis in prisons

The Lancet, 1995

10000 to 100000 times more sensitive than double immunodiffusion (DID) and 100 to 1000 times less... more 10000 to 100000 times more sensitive than double immunodiffusion (DID) and 100 to 1000 times less sensitive than PCR. However, in contrast to PCR, RHA detects only those virions which can bind to the receptor molecule. In the early recovering phase of erythema infectiosum, 2 patient samples bearing antibodies against B19 were positive by PCR but negative by RHA. When we examined donor samples by PCR, we did not find any PCR-positive and RHA-negative samples. To determine the specificity and sensitivity of RHA, we tested 329 of selected donor samples (table). These findings suggests that RHA has enough sensitivity and specificity to detect viraemic blood donors. In 1992, when erythema infectiosum was prevalent in Japan, we found 13 cases of viraema among 187 187 blood donors (0-007%) with DID. In 1993, when erythema infectiosum was not prevalent, we found 2 cases of viraemia among 181003 (0°001%) donors. From April to July 1995, when erythema infectiosum was again not prevalent, we screened 45 735 blood donor samples with both DID and RHA. We detected no viraemic samples by DID, whereas 27 samples were positive by RHA; of which seven were confirmed to be positive by PCR (0-015%). The rate of nonspecific reaction of RHA was calculated to be 0-044% in random donor samples. Donors with the B19 virus should be identified by a method such as RHA to prevent bloodborne infection.

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The mystery of the wooden leg: vitamin C deficiency in East African prisons

Tropical doctor, 2005

Vitamin C deficiency (scurvy) is an uncommon disease in modern times, and therefore easily misdia... more Vitamin C deficiency (scurvy) is an uncommon disease in modern times, and therefore easily misdiagnosed when it appears. While visiting prisoners in East Africa, health delegates of the International Committee of the Red Cross (ICRC) encountered prisoners suffering from a hitherto undiagnosed 'mysterious' illness, consisting mainly of swollen and hard legs, that had not responded to various treatments given by the local health centre or hospital. The ICRC set out to investigate the nature of this disease and examined 133 prisoners with the suspected clinical symptoms described as 'wooden leg' syndrome in 10 different prisons. Serum ascorbic acid levels were measured and a food basket analysis done. The diagnosis of scurvy was confirmed. All patients responded to standard treatment with oral ascorbic acid. The clinical presentation of scurvy in these East African prisons seems to be somewhat different from the classic descriptions, but is in line with historic records of the disease. Treatment is easy and cheap, and response to treatment is quick. Scurvy remains a problem in prisons in Africa and clinicians working in prisons need to be aware of its presence and its presentations.

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Strongyloidiasis on the Thai-Cambodian border

Transactions of The Royal Society of Tropical Medicine and Hygiene, 1992

A series of children's deaths at a Cambodian refugee camp in Thailand prompted an investigation o... more A series of children's deaths at a Cambodian refugee camp in Thailand prompted an investigation of children suffering from bloody diarrhoea and severe abdominal pain. Microscopical stool and blood examinations of 15 cases aged 1-7 years revealed hyperinfective strongyloidiasis as the cause of illness. Nine of 14 cases were infected with Strongyloides stercoralis, and 6 (42%) had concurrent infection with hookworm. Examination of 958 outpatients at the camp's daily clinic showed that mixed infections of S. stercoralis and hookworm were present in only 4.8% of the outpatients of the same age group.

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Pitfalls of tuberculosis programmes in prisons

BMJ, 1997

Directly observed therapy is designed to ensure, by means of direct observation, that patients ac... more

Humanitarian Practice Network Managed by Humanitarian Policy Group

independent forum where field workers, managers and policymakers in the humanitarian sector share... more

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4 Direct and indirect estimates of mortality changes : A case study in Mozambique

The paper compares direct and indirect estimates of mortality changes in Maringue, a district of ... more The paper compares direct and indirect estimates of mortality changes in Maringue, a district of central Mozambique. Direct estimates based on the maternity histories of 1503 women aged 15-60 years showed complex changes in q(5), the probability of dying of children from birth to their fifth birthday. During the colonial period (19551974), q(5) declined from 373 to 270 per 1,000. During the civil war period (19751991), it increased rapidly to reach a peak of 473 per 1,000 in 1986. It declined again thereafter and reached a plateau of 380 in 1991. A health intervention conducted by the International Committee of the Red Cross since 1992 reduced mortality to 269 per 1,000 in 1994. Most of the decline was attributable to vaccinations, in particular measles vaccination, and to Vitamin A supplementation. Indirect estimates based on the same data appeared very biased. Although they did also reveal an increase in mortality, followed by a decrease, they tended to smooth out the rapid change...

The effects of the civil war in central Mozambique and an evaluation of the intervention of the Red Cross

Results are presented of a retrospective study of mortality undertaken in the central Mozambique ... more Results are presented of a retrospective study of mortality undertaken in the central Mozambique province of Maringue in October 1994. The study involved 1503 women aged 15-60. The focus of this monograph is on changes over time in the levels of mortality of children under five years of age. "During the colonial period (1955-1974) mortality declined from 373 to 270 per 1000. During the civil war period (1975-1991) mortality increased rapidly to reach a peak of 473 per 1000 in 1986. It declined again thereafter and reached a plateau of 380 in 1991. A health intervention conducted by the International Red Cross Committee since the end of 1991 further reduced mortality to 269 per 1000 in 1994. Most of the 1992-1994 decline was attributable to vaccinations in particular measles and tetanus immunizations and to Vitamin `A supplementation." (SUMMARY IN ENG) (EXCERPT)

Effets de la guerre civile au centre-Mozambique et évaluation d'une intervention de la Croix Rouge

ABSTRACT Afin de mesurer l&#39;évolution de la mortalité avant, pendant et après la guerre ci... more ABSTRACT Afin de mesurer l&#39;évolution de la mortalité avant, pendant et après la guerre civile, une enquête a été conduite dans le district de Maringué, au Mozambique, en octobre 1994. L&#39;enquête a porté sur les histoires des maternités de 1503 femmes de 15 à 60 ans. Les résultats de l&#39;analyse révèlent une évolution complexe de la mortalité des enfants. Au cours de la fin de la période coloniale, la mortalité des moins de 5 ans baisse de 373 pour mille (1955-1959) à 270 pour mille (1970-1974). Puis elle passe par une période de stagnation entre 1975 et 1979. A partir de 1980, début de la guerre civile, la mortalité augmente rapidement pour atteindre un pic de 473 pour mille en 1986, à un niveau près du double de l&#39;étiage des annnées 1965-1969. Puis la mortalité baisse à nouveau pour atteindre un plateau en 1990-1991 (380 pou mille). Ce sont surtout les maladies infectieuses et parasitaires, principales causes de décès dans la population, qui expliquent l&#39;augmentation pendant la période de crise, les morts violentes ne représentant que moins de 1% du total. Une intervention conduite par la Croix Rouge depuis la fin de l&#39;année 1991 a permis de réduire la mortalité à 269 pour mille en 1994. La baisse récente de la mortalité s&#39;explique essentiellement par la diminution de quatre causes de décès seulement : la rougeole, la diarrhée, le tétanos et la malnutrition. Ces maladies étaient les principales cibles du programme d&#39;intervention de la Croix Rouge, qui portaient notamment sur les vaccinations et sur la supplémentation en vitame &quot;A&quot;. (Résumé d&#39;auteur)

Guidelines for the control of tuberculosis in prisons

Tuberculosis (TB) is common in many prisons worldwide and treatment is often ill-informed and ina... more Tuberculosis (TB) is common in many prisons worldwide and treatment is often ill-informed and inadequate. In this perspective the WHO and the International Committee of the Red Cross (ICRC) have joined forces to produce guidelines for the control of TB in prisons. This document presents the results of the collaborative effort of WHO and ICRC. The guidelines based on recent experience outline the many obstacles to effective diagnosis and treatment and it gives useful guidance as to how to overcome these obstacles. Outlined into three parts these guidelines are primarily for prison authorities policy- makers and decision-makers in relevant ministries nongovernmental organizations (NGOs) and donor agencies and National TB Program staff. Part I provides background information on TB and prisons of particular relevance to prison authorities and decision-makers in relevant ministries. Part II provides guidelines for the control of TB in prisons of particular relevance to prison health staf...

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Tuberculosis in Complex emergencies/Tuberculose Dans Lens Situations D'urgence complexes/La Tuberculosis En Las Emergencias Complejas

In 2004 there were 9 million new cases and approximately 2 million deaths from tuberculosis (TB).... more In 2004 there were 9 million new cases and approximately 2 million deaths from tuberculosis (TB). Control programmes are difficult at the best of times, but the direct and indirect health and health system effects of complex emergencies complicate these programmes to such an extent that many organizations choose not to implement them. However, as TB is recognized as a major cause of mortality in long-term complex emergencies, several agencies have taken up the challenge of establishing control programmes in these circumstances. They have met the WHO targets for successful programmes (to detect at least 70% of estimated new smear-positive cases and successfully treat at least 85% of all detected smear-positive cases) without increasing the rates of multi-drug-resistant TB (MDR-TB). This paper describes the key factors and the remaining challenges for successful tuberculosis control programmes in complex emergencies. A complex emergency is defined as "a humanitarian crisis in a c...

Overwhelming Consumption In Prisons: Human Rights and Tuberculosis Control

Health and Human Rights, 1999

De part le monde, la tuberculose est consideree comme la cause principale de mortalite chez les i... more

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Tuberculosis in prisons in countries with high prevalence

BMJ: British Medical …, 2000

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Medicine in Cambodian refugee camps

Annals of Internal Medicine, 1986

... 6 1 8 Annals of Internal Medicine. 1986;105:618-621. Page 2. ... Although the Royal Thai Arme... more

Drug resistant tuberculosis in prisons in Azerbaijan: case study

Bmj, 1998

Objectives: To document the existence of drug resistance in a tuberculosis treatment programme th... more

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Outbreak of Beri-Beri In a Prison In West Africa

Tropical doctor, 2002

The International Committee of the Red Cross investigated an outbreak of beri-beri in a prison in... more

Attacks on Health Care in Emergency Settings: What is the Extent of the Problem, Based on Open Source Data from 2014 to 2015?

Prehospital and Disaster Medicine

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Guidelines for the control of tuberculosis in prisons

The World Health Organization (WHO) and the International Committee of the Red Cross (ICRC) have ... more

Effects of the Civil War in Central Mozambique and Evaluation of the Intervention of the International Committee of the Red Cross

by Michel GARENNE and Rudi Coninx

Journal of Tropical Pediatrics, 1997

In October 1994, a retrospective study of mortality of children was conducted in Maringué, a dist... more In October 1994, a retrospective study of mortality of children was conducted in Maringué, a district of central Mozambique. Estimates based on maternity histories of 1503 women aged 15-60 years revealed complex changes in the under-5 death rate. During the colonial period (1955-1974), mortality declined from 373 to 270 per 1000. During the civil war period (1975-1991), mortality increased rapidly to reach a peak of 473 per 1000 in 1986. It declined again thereafter and reached a plateau of 380 in 1991. A health intervention conducted by the International Red Cross Committee since 1992 further reduced mortality to 269 per 1000 in 1994. Most of the 1992-1994 decline was attributable to vaccinations, in particular measles and tetanus immunizations, and to Vitamin A supplementation.

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Growing challenge of chronic diseases in disasters

In 2005, chronic diseases were the leading cause of mortality in six out of seven WHO regions, bu... more In 2005, chronic diseases were the leading cause of mortality in six out of seven WHO regions, but to date disaster and humanitarian response has not fully addressed chronic diseases. Several factors are contributing to changing needs in humanitarian relief efforts worldwide, among them the aging population and an increasing prevalence of chronic diseases worldwide. Further, seemingly unrelated topics such as the HIV epidemic and child feeding programs, are contributing to the growing numbers of chronic diseases worldwide, compounding the importance of this initiative. Yet, in our current model of humanitarian relief, targeted response has not included those with chronic disease. In an effort to address this need, an emerging NGO, ChronAid, is dedicated to advocating for the inclusion of chronic diseases and related disabilities and dependence in disaster and emergency preparedness and response. An example of ChronAid's initiatives is a novel proposal of a Supplementary Unit for...

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