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 or 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 complications such as heart failure, arrhythmia and cardiomyopathy are 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 40 years ago. The cure rate is almost 100 per cent 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 treated 4,500 patients for Chagas disease in 2013.

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 surfaces. In non-endemic areas, 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 diarrhoea 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. Cholera is most common in densely populated settings where sanitation is poor and water supplies are not safe.

As soon as an outbreak is suspected, patients are treated in centres where infection control precautions are taken to avoid further transmission of the disease. Strict hygiene practices must be implemented and large quantities of safe water must be available.

MSF treated 27,900 people for cholera in 2013.

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 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 or food, or direct contact with contaminated surfaces.

The human immunodeficiency virus (HIV) is transmitted through blood and body fluids and gradually breaks down the immune system – usually over a three- to 15-year period, although 10 years is more usual – 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.

Simple blood tests 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 programmes generally include education and awareness activities, condom distribution, HIV testing, counselling and prevention of mother-to-child transmission (PMTCT) services. PMTCT involves the administration of ARV treatment to the mother during and after pregnancy, during labour and breastfeeding, and to the infant just after birth. MSF provided care for 341,600 people living with HIV/AIDS and antiretroviral treatment for 331,000 people in 2013.

Largely unknown in high-income countries (although it is present in the Mediterranean basin), kala azar – Hindi for 'black fever' – is a tropical, parasitic disease transmitted through bites from certain types of sandfly. It is endemic in 76 countries, and of the estimated 200,000–400,000 annual cases, 90 per cent occur in Bangladesh, India, Ethiopia, 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 and difficult procedures requiring resources that are not readily available in developing countries. Treatment options for kala azar have evolved during recent years. Liposomal amphotericin B is becoming the primary treatment 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 still a combination of pentavalent antimonials and paromomycin, which requires a number of painful injections. Research into a simpler treatment is underway and it is hoped it will soon be available.

Co-infection of kala azar and HIV is a major challenge, as the diseases influence each other in a vicious spiral as they attack and weaken the immune system.
MSF treated 5,300 patients for kala azar in 2013.

Malaria is transmitted by infected mosquitoes. Symptoms include fever, pain in the joints, headaches, repeated vomiting, convulsions and coma. Severe malaria, nearly always 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 injections 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 distributes nets to pregnant women and children under the age of five, who are most vulnerable and have the highest frequency of severe malaria. Staff advise people on how to use the nets.

In 2012, MSF used a seasonal chemoprevention strategy for the first time, in Chad and Mali. Children up to five years old took oral antimalarial treatment monthly over a period or three to four months during the peak season for the disease. In 2013, this was introduced in Niger. MSF treated 1,871,200 people for malaria in 2013.

A lack of food or essential nutrients causes malnutrition: children’s growth falters and their 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 deteriorating further.

MSF admitted 250,900 malnourished patients to nutrition programmes in 2013.

Measles is a highly contagious viral disease. Symptoms appear between eight and 13 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.

Most people infected with measles recover within two to three weeks, and mortality rates in high-income countries are low. In developing countries, however, the mortality rate can be between 3 and 15 per cent, rising to 20 per cent where people are more vulnerable. Death is usually due to complications such as diarrhoea, 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 significantly decreased the number of cases and deaths. However, coverage remains low in countries with weak health systems and in areas where there is limited access to health services, leaving large numbers of people susceptible to the disease.
MSF treated 129,900 patients for measles
and vaccinated 495,250 people in response
to outbreaks in 2013.

Meningococcal meningitis is a bacterial infection of the thin membranes surrounding the brain and spinal cord. It 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. Up to 50 per cent of people infected will die without treatment.

Six strains of the bacterium Neisseria meningitidis (A, B, C, W135, X and Y) are known to cause meningitis. People can be carriers without showing symptoms and transmit the bacteria when they cough or sneeze. Cases are diagnosed through the examination of a sample of spinal fluid and treatment consists of specific antibiotics. However, even with treatment, 10 per cent or more 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 meningococcus A.

A new vaccine against this strain provides protection for at least 10 years and even prevents healthy carriers from transmitting the infection. Large preventive vaccination campaigns have now been carried out in Benin, Burkina Faso, Cameroon, Chad, Ghana, Mali, Niger, Nigeria, Senegal and Sudan and have resulted in a decrease in the number of new cases.

MSF treated 1,750 patients for meningitis and vaccinated 162,400 people against the disease in response to outbreaks in 2013.

Traumatising events – such as 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 patients to develop their own coping strategies after trauma. Counsellors help people to talk about their experiences and process their feelings so that general stress levels are reduced. MSF also offers group counselling, as a complementary approach. MSF staff held 155,300 individual and group counselling sessions in 2013.

MSF's primary focus is on providing medical care, but in an emergency teams often distribute relief items that contribute to physical and psychological 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 shelter. In cold climates more substantial tents are provided, or teams try to find more permanent structures. MSF distributed 146,650 relief kits in 2013.

Comprehensive neonatal and obstetric care form part of MSF’s response to any emergency. Medical staff assist births and perform caesarean sections where necessary and feasible, and sick newborns and babies with a low birth weight receive medical care.

Many of MSF's longer-term programmes 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 medical treatment, counselling on family planning and information and education on sexually transmitted infections.

Good antenatal and obstetric care can prevent obstetric fistulas. An obstetric fistula is a hole between the vagina and rectum or bladder that is most often a result of prolonged, obstructed labour. It causes incontinence, which can lead to social stigma. Around two million women are estimated to have untreated obstetric fistulas; there are between 50,000 and 100,000 new cases each year. A number of MSF programmes carry out specialist obstetric fistula repair surgery. MSF held more than 703,900 antenatal consultations in 2013.

Sexual violence occurs in all societies and in all contexts at any time. Destabilisation of contexts often results in increased levels of violence, including sexual violence. Sexual violence is particularly complex and stigmatising and has long-lasting consequences and can result in important health risks.

MSF medical care for victims of sexual violence covers preventive treatment against sexually transmitted infections, including HIV, syphilis and gonorrhoea, and vaccinations for tetanus and hepatitis B. Treatment of physical injuries, psychological support and the prevention and management of unwanted pregnancy are also part of the systematic care. MSF provides a medical certificate to all victims of violence.

Medical care is central to MSF’s response to sexual violence, but stigma and fear may prevent many victims from coming forward. A proactive approach is necessary to raise awareness about the medical consequences of sexual violence and the availability of care. Where MSF sees large numbers of victims – especially in areas of conflict – advocacy action aims to raise awareness among local authorities, as well as the armed forces when they are involved in the assaults.

MSF medically treated 11,100 patients for sexual violence-related injuries in 2013.

Generally known as sleeping sickness, human African trypanosomiasis is a parasitic infection transmitted by tsetse flies that occurs in sub-Saharan Africa. In its latter stage, it attacks the central nervous system, causing severe neurological disorders and frequently death. More than 95 per cent of reported cases are caused by the parasite Trypanosoma brucei gambiense, which is found in western and central Africa. The other 5 per cent 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. Accurate diagnosis of the illness requires a sample of spinal fluid.

Nifurtimox-eflornithine combination therapy or NECT, developed by MSF, Drugs for Neglected Diseases initiative (DNDi) and Epicentre, is now the World Health Organization 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. It is hoped that the new molecules currently under clinical trial will lead to the development of a safe, effective treatment for both stages of the disease that can be administered orally. MSF admitted 1,800 patients for sleeping sickness treatment in 2013.

One-third of the world’s population is currently infected with the tuberculosis (TB) bacillus. Every year, about 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 per cent 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 sputum or gastric fluid sample, which can be difficult to obtain from children. A new molecular test that can give results after just two hours and detect a certain level of drug resistance is now being used, but it is costly and still requires a phlegm sample, as well as a reliable power supply.

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 regimen is arduous, taking up to two years and causing many side effects. Extensively drug-resistant tuberculosis (XDR-TB) is identified when patients show resistance to the second-line drugs administered for MDR-TB. The treatment options for XDR-TB are limited.

MSF treated 29,900 patients for TB and 1,950 for MDR-TB in 2013.

Immunisation is one of the most cost-effective 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, rubella and yellow fever – although not all vaccines are recommended everywhere.

In countries where vaccination coverage is generally low, MSF strives to offer routine vaccinations for children under five when possible as part of its basic healthcare programme. Vaccination also forms a key part of MSF’s response to outbreaks of measles, yellow fever and meningitis. Large-scale vaccination campaigns involve awareness-raising activities regarding the benefits of immunisation as well as the set-up of vaccination posts in places where people are likely to gather. A typical campaign lasts between two and three weeks and can reach hundreds of thousands of people.

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 it works.

In emergencies, MSF assists in the provision of safe water and adequate sanitation. Drinking water and waste disposal are among the first priorities. Where a safe water source cannot be found close by, water in containers is trucked in. Staff conduct information campaigns to promote the use of facilities and ensure good hygiene practices.