Haitian Child

Haitian Child

Thursday, December 3, 2015

Articles on Haiti in the New England Journal of Medicine

In preparation for my trip to Haiti I reviewed articles on Haiti published in the New England Journal of Medicine since the earthquake in January 2010. The notes below summarize the information I found pertinent to my trip.

2013 - The island of Hispaniola (Haiti and the Dominican Republic) is the only remaining foci of endemic malaria among the Caribbean islands and accounts for more than 90% of all cases of lymphatic filariasis in the Western Hemisphere

2013 Shattuck Lecture Dr. Paul Farmer

Five salient lessons can be derived from the history of tuberculosis control. 
1. drug resistance is here to stay but the rate of emergence can be slowed. 
2. development of robust delivery platforms will lead to improved clinical outcomes if what is being delivered is clinically effective. 
3. care for patients who do not require inpatient care should shift from hospitals to clinics and community based care. 
4. therapeutic innovations need to be linked more rapidly to equitable delivery, which requires new financing mechanisms. 
5. it is not clear that any disease is helpfully termed "untreatable." 

2013 - During the first two years of the cholera epidemic in Haiti, the cumulative attack rate was 6.1%. The 14-day case fatality rate was 1.0% or less. 

2011 - The source of the cholera epidemic was probably the result of the introduction, through human activity, of a V. cholerae strain from a distant geographic source. The Haiti strain has a close relationship with strains isolated from Bangladesh. 

2011 - The strain of cholera in Haiti is susceptible to tetracycline and azithromycin but resistant to nalidixic acid, sulfisoxazole, and trimethoprim-sultamethoxazole. The WHO recommend antibiotics only for "severe" cholera. The authors recommend therapy for moderate and severe cholera. With effective antibiotic therapy, the purging rate is lessened by about 50%, the illness is shortened by about 50%, and the duration of excretion of Vibrio cholerae in the stool is shortened to 1 to 2 days. Vomiting usually subsides within a few hours of rehydration and antibiotic therapy should be delayed until the vomiting resolves. 

2010 - Early antiretroviral therapy for HIV-infected adults in Haiti reduced the mortality and rate of incident TB. The authors recommend starting therapy when the CD4+ T-cell count is greater than 200 per cubic millimeter. 

2010 - Children constitute almost half of Haiti's population of 9 million. Before the earthquake an estimated 350,000 children lived in "orphanages." Desperately poor families felt compelled to place children in residential care facilities (restaveks - Creole/Kreyole for "stay with").  

2010 - February 18. A month and a week after the earthquake. This was a international medical "Call to Arms." The "dispatch" announced that the country needed water, latrines, and security. 

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