As the ongoing Covid-19 pandemic grips the world, one of its most devastating indirect effects is the disruption to medical services for preventing and treating other life-threatening diseases—especially in countries with already-fragile health systems. For MSF and other global health actors this means not only responding to Covid-19 directly but also assessing its impact on other essential care and then adapting programs so they can keep serving patients despite the enormous obstacles.
In this Collection you will find a selection of published articles and conference content from this year’s MSF Scientific Days 2021 conference content, encompassing a range of approaches, settings and medical challenges—from malaria, TB and HIV/AIDS prevention and care to digital health promotion and sexual and reproductive health.
7 result(s)
Journal Article > ResearchFull Text
Confl Health. 2022 February 14; Volume 16 (Issue 1); 6.
Ibragimov K, Palma M, Keane G, Ousley J, Carreño C, et al.
Confl Health. 2022 February 14; Volume 16 (Issue 1); 6.
BACKGROUND
'Tele-Mental Health (MH) services' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format.
METHODS
From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred.
RESULTS
Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure.
CONCLUSION
Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
'Tele-Mental Health (MH) services' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format.
METHODS
From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred.
RESULTS
Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure.
CONCLUSION
Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
Conference Material > Video (talk)
Hossain FN
MSF Scientific Days Asia 2021. 2021 August 26
Conference Material > Slide Presentation
Daka M
MSF Scientific Days International 2021: Innovation. 2021 May 20
Conference Material > Slide Presentation
Hein J
MSF Scientific Days International 2021: Innovation. 2021 May 20
Conference Material > Abstract
Sterk E, Newport T, Mahamat TA, Gitahi P, Mandagot JJ, et al.
MSF Scientific Days International 2021: Research. 2021 May 19
INTRODUCTION
Conflict in DRC’s northeast has led to large-scale displacement. MSF has supported around 50,000 internally displaced people, together with the host community, in Angumu health zone, within the region, since 2019. Work there has focused on supporting health facilities, community treatment sites, and distribution of long-lasting insecticidally-treated nets. WHO’s recommendations for malaria in extreme complex emergencies include provision of mass drug administration (MDA). Angumu is a highly malaria-endemic area, with displaced people having relocated from an area with lower exposure to malaria. In Angumu, there are high levels of mortality linked with malaria, and crude and under-5 mortality rates have been shown to be above the emergency threshold in 2020 population survey data. In addition, healthcare systems are over-burdened due to population displacement, together with deterioration in access to healthcare caused by the COVID-19 pandemic. DRC’s Ministry of Health, together with MSF, have implemented MDA with the goal of rapidly reducing malaria morbidity and mortality. We describe the intervention’s feasibility, data on pharmacovigilance, and associations with reported malaria morbidity.
METHODS
We implemented 3 MDA rounds spaced at least 28 days apart, for adults and children aged over 2 months, living in four health areas, covering a total population of 56,353. MDA involved delivery of two rounds of amodiaquine-artesunate and one round of artesunate-pyronaridine (Pyramax). Door-to-door distribution was chosen to reduce risk of COVID-19 transmission, with teams using COVID-19 protection measures. FIrst doses were directly observed, and notification of adverse events (AE’s) was implemented. We calculated administrative coverage, and estimated the number and reduction in weekly confirmed malaria cases reported from MSF-supported health Facilities before (weeks 1-40/2020) and after (weeks 41-53/2020) MDA delivery, as well as comparing the difference between targeted (6 facilities) and non-targeted health areas (14 facilities).
ETHICS
This abstract describes the evaluation of an implementation of an MSF programme. It was conducted with oversight from Monica Rull, Medical Director, Operational Centre Geneva, MSF.
RESULTS
227 teams, involving two community health workers each, carried out MDA. The first MDA round, carried out between 24 September and 13 October 2020, reached 74,847 people (133%), and the second was executed between 9 and 27 November 2020, reaching 75,487 people (134%). The third MDA round ran between 17 December 2020 and 7 January 2021, reaching 78,227 people (139%). There were 679 mild and three severe (0.9%, of all those receiving MDA) AE’s reported during the first round, and 425 mild and three severe (0.57%) AE’s during the second round. None of the severe AE’s reported were causally linked with MDA, after investigation. The average weekly number of malaria cases decreased by 81% (151 vs. 29) in MDA-targeted areas, as compared with a drop of 33% (139 vs 93) in non-targeted areas.
CONCLUSION
This was the first large-scale MDA of which we are aware, delivered in a highly malaria-endemic rural area, and the first MDA delivered using Pyramax. We faced delays with approvals and provision of anti-malarials; MDA rounds took longer to implement than planned, with delays between rounds. We successfully provided three rounds of MDA using two different anti-malarials, in a complex emergency setting. Implementation was during the COVID-19 pandemic yet reached high levels of coverage, and was linked with a reduction in reported malaria cases in MDA-targeted areas. Currently, the analysis of morbidity data and a retrospective mortality survey are ongoing.
CONFLICTS OF INTEREST
None declared
Conflict in DRC’s northeast has led to large-scale displacement. MSF has supported around 50,000 internally displaced people, together with the host community, in Angumu health zone, within the region, since 2019. Work there has focused on supporting health facilities, community treatment sites, and distribution of long-lasting insecticidally-treated nets. WHO’s recommendations for malaria in extreme complex emergencies include provision of mass drug administration (MDA). Angumu is a highly malaria-endemic area, with displaced people having relocated from an area with lower exposure to malaria. In Angumu, there are high levels of mortality linked with malaria, and crude and under-5 mortality rates have been shown to be above the emergency threshold in 2020 population survey data. In addition, healthcare systems are over-burdened due to population displacement, together with deterioration in access to healthcare caused by the COVID-19 pandemic. DRC’s Ministry of Health, together with MSF, have implemented MDA with the goal of rapidly reducing malaria morbidity and mortality. We describe the intervention’s feasibility, data on pharmacovigilance, and associations with reported malaria morbidity.
METHODS
We implemented 3 MDA rounds spaced at least 28 days apart, for adults and children aged over 2 months, living in four health areas, covering a total population of 56,353. MDA involved delivery of two rounds of amodiaquine-artesunate and one round of artesunate-pyronaridine (Pyramax). Door-to-door distribution was chosen to reduce risk of COVID-19 transmission, with teams using COVID-19 protection measures. FIrst doses were directly observed, and notification of adverse events (AE’s) was implemented. We calculated administrative coverage, and estimated the number and reduction in weekly confirmed malaria cases reported from MSF-supported health Facilities before (weeks 1-40/2020) and after (weeks 41-53/2020) MDA delivery, as well as comparing the difference between targeted (6 facilities) and non-targeted health areas (14 facilities).
ETHICS
This abstract describes the evaluation of an implementation of an MSF programme. It was conducted with oversight from Monica Rull, Medical Director, Operational Centre Geneva, MSF.
RESULTS
227 teams, involving two community health workers each, carried out MDA. The first MDA round, carried out between 24 September and 13 October 2020, reached 74,847 people (133%), and the second was executed between 9 and 27 November 2020, reaching 75,487 people (134%). The third MDA round ran between 17 December 2020 and 7 January 2021, reaching 78,227 people (139%). There were 679 mild and three severe (0.9%, of all those receiving MDA) AE’s reported during the first round, and 425 mild and three severe (0.57%) AE’s during the second round. None of the severe AE’s reported were causally linked with MDA, after investigation. The average weekly number of malaria cases decreased by 81% (151 vs. 29) in MDA-targeted areas, as compared with a drop of 33% (139 vs 93) in non-targeted areas.
CONCLUSION
This was the first large-scale MDA of which we are aware, delivered in a highly malaria-endemic rural area, and the first MDA delivered using Pyramax. We faced delays with approvals and provision of anti-malarials; MDA rounds took longer to implement than planned, with delays between rounds. We successfully provided three rounds of MDA using two different anti-malarials, in a complex emergency setting. Implementation was during the COVID-19 pandemic yet reached high levels of coverage, and was linked with a reduction in reported malaria cases in MDA-targeted areas. Currently, the analysis of morbidity data and a retrospective mortality survey are ongoing.
CONFLICTS OF INTEREST
None declared
Journal Article > CommentaryFull Text
Lancet Child Adolesc Health. 2021 March 1; Volume 5 (Issue 3); 159-161.
Mohr-Holland E, Douglas-Jones B, Apolisi I, Ngambu N, Mathee S, et al.
Lancet Child Adolesc Health. 2021 March 1; Volume 5 (Issue 3); 159-161.
Journal Article > CommentaryFull Text
BMJ Glob Health. 2020 July 20; Volume 5 (Issue 7); e003175.
Kumar M, Daly M, de Plecker E, Jamet C, McRae M, et al.
BMJ Glob Health. 2020 July 20; Volume 5 (Issue 7); e003175.
SUMMARY BOX
• The COVID-19 pandemic has begun to severely limit access to sexual and reproductive healthcare, including contraception and safe abortion care (SAC), which have historically not been regarded as essential health services.
• Shutdown or delays of contraception and SAC during COVID-19 will disproportionately impact the most vulnerable populations, including women and girls in low-income and middle-income countries, and lead to considerable and preventable death and lifelong disability.
• Médecins Sans Frontières calls on the global health community to strengthen access to contraception and SAC for populations everywhere, and especially in poor and crisis settings, by engaging with women and their communities to develop self-managed models of care.
• The COVID-19 pandemic has begun to severely limit access to sexual and reproductive healthcare, including contraception and safe abortion care (SAC), which have historically not been regarded as essential health services.
• Shutdown or delays of contraception and SAC during COVID-19 will disproportionately impact the most vulnerable populations, including women and girls in low-income and middle-income countries, and lead to considerable and preventable death and lifelong disability.
• Médecins Sans Frontières calls on the global health community to strengthen access to contraception and SAC for populations everywhere, and especially in poor and crisis settings, by engaging with women and their communities to develop self-managed models of care.
