Innovations 2014

 

Read more about the three proposals which got funding from the Innovations Fund in 2014:

1. Development of a small-scale basic and autonomous diagnostic bacteriology laboratory (click for full proposal)

To develop a small-scale basic and autonomous diagnostic bacteriology laboratory (‘mini bacterio lab’)based on appropriate and feasible, existing or adapted techniques, at affordable cost, high accessibility and ease of use and responding to clinical needs at MSF field sites. Specific objectives: 

  • To define and validate the most appropriate techniques, material and consumables and for sampling, bacterial diagnosis (culture), pathogen identification and antibiotic susceptibility testing (AST). 
  • To standardize techniques and materials and design/validate standardized kits to facilitate procurement, supply, training and quality  assurance (QA) 
  • To develop a basic diagnostic bacteriology manual including standard operating procedures. 
  • To develop training materials on technical procedures (lab tech) and appropriate indications for and -interpretation of bacteriological diagnostics (clinicians) 
  • To estimate implementation cost and cost per analysis (running costs)

​Study hypothesis: Access to diagnostic bacteriology in MSF can be expanded and speeded up at low cost using simplified and customized technics within a kit- based approach. y creating a kit called “mini bacterio lab” we expect (i) to improve individual patient care, (ii) to contribute to diagnostic issues about proportions, identity and antibiotic susceptibility of bacterial pathogens in specific patients and syndromes to which MSF teams are confronted (i.e. acute ill children with danger signs, malnourished children requiring hospitalization, etc.), (iii) to support infection control policies.

2. A better oral rehydration solution for severely malnourished children (click for full proposal)

Comparison of outcomes in dehydration treatment between low osmolarity ORS and ReSoMal in children with Severe Acute Malnutrition (SAM) and proposition of new formulation. 

Phase 1: Description of severe electrolyte abnormalities (severe hyponatremia and severe hypokalemia) before, and after treatment with low osmolarity ORS (ORS-LowOsm) versus ReSoMal rehydration solutions in children with severe acute malnutrition. SAM children receive normally ReSoMal for rehydration except under suspicion of cholera or when diarrhoea is watery and profuse, in those situations current recommendation is to give ORS-LowOsm. 

Phase 2: Comparison of outcomes with the use of low osmolarity ORS versus ReSoMal rehydration solutions (as per WHO protocol) versus new formulation (ORS-SAM-MSF) in the treatment of mild and moderate dehydration in severely malnourished children (marasmic and kwashiorkor). Here we do not take into account the type of diarrhoea to decide which oral rehydration solution to use. 
 
Main hypothesis:  Current formulation of rehydration solution for severely malnourished children (ReSoMal) does not meet requirements for sodium and can lead to severe hyponatremia, seizures and death in a significant proportion of cases. On the other hand current formulation of low osmolarity oral rehydration solution (ORS-LowOsm) does not meet requirements of malnourished children for potassium and zinc. With hard/objective laboratory data results we can propose a better hydration solution for SAM children taking into account their malnutrition type (kwashiorkor and marasmus) and reducing the risk for hyponatremia without increasing the risk for hypokalemia. 
 
Phase 1 and 2 hypothesis:
  1. Treatment of mild to moderate dehydration with either ORSLowOsm or ReSoMal can cause significant electrolyte disturbances.
  2. ORS-LowOsm might be safer than ReSoMal for most cases. 

Study sub hypothesis: 

  1. The use of ReSoMal in SAM children with mild to moderate dehydration significantly increases the risk of severe hyponatremia
  2. The use of ORS-LowOsm in SAM children with mild to moderate dehydration significantly increases the risk of severe hypokalemia.
  3. The risk of hyponatremia by using ReSoMal is higher than the risk of hypokalemia by using ORS-LowOsm. 
  4. A new formulation adjusting the sodium and potassium content can be safer than both solutions existing currently.

3. The Clean Kids Trial (click for full proposal)

MSF has prioritized responding to antibiotic resistance and reducing hospital-acquired infections (HI) is a critical part of this effort.

  • Reducing HI involves improving hygiene but any additional measures would ideally not rely upon on overburdened hospital staff but be put in hands of caretakers.
  • Hospitalized children, especially those with malnutrition or prolonged hospitalizations, are vulnerable to multidrug-resistant HI, including the most lethal manifestation, hospitalacquired bloodstream infections.
  • A recent landmark study showed a 30% reduction in risk of serious HI in children –notably bloodstream infections – as well as a reduction in acquisition of multidrug resistant organisms (MDROs) through daily bathing using chlorhexidine (CHG)-impregnated washcloths. Adverse skin reaction rates were extremely low.
  • CHG is used widely in poor settings for umbilical cord care and is both effective and safe.
  • While the cost of CHG washcloths would be greater than the standard approach to personal hygiene in MSF inpatient structure – unsupervised soap and water (S&W) bath by a caretaker – the potential advantages of CHG over the standard approach in reducing IPD HI, length of stay and mortality, make it an attractive potential tool for the field.

Main study hypothesis:

  • The use of CHG daily baths in hospitalized children – compared with standard S&W bathing – will reduce HI and overall late in-hospital mortality (combined endpoint). 
  • CHG daily baths will be associated with a very low rate of adverse skin reactions.

 Secondary study hypothesis:

  • A reduction in the acquisition of gut-colonizing MDROs during hospital stay is also hypothesized and will be tested if microbiology services are available at study site.
     
By: Rebecca Cederholm