Conference Material > Video
Roederer T
Epicentre Scientific Day 2024. 1 July 2024
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Conference Material > Abstract
Roederer T
Epicentre Scientific Day 2024. 23 May 2024
BACKGROUND
Haiti faces chronic instability for decades, but recent years have seen exacerbation following the assassination of president Juvenel Moise in 2021. Over 95 armed gangs are battling for control of Port-au-Prince and constant clashes paralyze infrastructure and medical assistance. Data on mortality and violence are virtually non-existent. To address this information gap, we conducted two retrospective mortality surveys, one among MSF national staff and another in the Cité Soleil commune population in Port-au-Prince.
METHODS
The first cross-sectional survey was conducted in April 2023 among the MSF-OCP, OCA and OCB national staff and their families. All 1545 MSF Haitian employees were eligible. The second took place in August 2023 in the Cité Soleil commune, where a spatial sample of 1400 households was randomly selected. Indicators included crude mortality rate, causes of death, and experiences of violence.
RESULTS
The MSF staff survey interviewed 819 members representing 3977 individuals, while the Cité Soleil survey interviewed 1669 households representing 8202 individuals. Mortality was low in the MSF staff, with only 6 deaths, in Cité Soleil, 176 deaths were reported, translating into a crude mortality rate of 0.63/10000/day [95% CI: 0.54- 0.73]. Violence accounted for 40% of deaths, with an estimated age-standardized number of homicides of 2,300. Nearly half of MSF Staff family members and Cité Soleil participants experienced some form of violence.
CONCLUSION
Our findings confirm the alarming levels of violence experienced by the Haitian population. In 2022-2023, Haiti was one of the most dangerous countries in the world for civilians. Urgent action is needed to strengthen humanitarian access, healthcare provision and civilian protection. Two surveys conducted by Epicentre/MSF in 2023 in Haiti confirm the extreme violence the population is suffering. Urgent action is needed to improve healthcare access and civilian protection.
KEY MESSAGE
Two surveys conducted by Epicentre/MSF in 2023 in Haiti confirm the extreme violence the population is suffering. Urgent action is needed to improve healthcare access and civilian protection.
Conference Material > Poster
Casera M, Lacan K, Camacho A, Augustin C, Métrailler F, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/Ln8HXfhD
Journal Article > ResearchFull Text
Ecancer medical science. 28 February 2024; Volume 18; 1675.; DOI:10.3332/ecancer.2024.1675
Bolous NS, Mercredi P, Bonilla M, Friedrich P, Bhakta N, et al.
Ecancer medical science. 28 February 2024; Volume 18; 1675.; DOI:10.3332/ecancer.2024.1675
Haiti is a low-income country with one of the lowest human development index rankings in the world. Its childhood cancer services are provided by a single hospital with the only dedicated paediatric oncology department in the country. Our objective was to assess the cost and cost-effectiveness of all types of childhood cancer in Haiti to help prioritise investments and to support national cancer control planning. All costing data were collected from the year 2017 or 2018 hospital records. Costs were classified into 11 cost categories, and the proportion of the overall budget represented by each was calculated and converted from Haitian Gourde to United States dollars. The 5-year survival rate was retrieved from hospital records and used to calculate the cost-effectiveness of disability-adjusted life year (DALY) averted, using a healthcare costing perspective. Additional sensitivity analyses were conducted accounting for late-effect morbidity and early mortality and discounting rates of 0%, 3% and 6%. The annual cost of operating a paediatric oncology unit in Haiti treating 74 patients with newly diagnosed cancer was $803,184 overall or $10,854 per patient. The largest cost category was pharmacy, constituting 25% of the overall budget, followed by medical personnel (20%) and administration (12%). The cost per DALY averted in the base-case scenario was $1,128, which is 76% of the gross domestic product per capita, demonstrating that treating children with cancer in Haiti is very cost-effective according to the World Health Organisation Choosing Interventions that are Cost-Effective (WHO-CHOICE) threshold. In the most conservative scenario, the cost per DALY averted was cost-effective by WHO-CHOICE criteria. Our data will add to the growing body of literature illustrating a positive return on investment associated with diagnosing and treating children with cancer in even the most resource-limited environments. We anticipate that these data will aid local stakeholders and policymakers when identifying cancer control priorities and making budgetary decisions.
Journal Article > CommentaryFull Text
Journal of Humanitarian Affairs. 23 November 2023; Volume 5 (Issue 2); 24-29.; DOI:10.7227/JHA.107
Leyland J, Tiller S, Bhattacharya B
Journal of Humanitarian Affairs. 23 November 2023; Volume 5 (Issue 2); 24-29.; DOI:10.7227/JHA.107
While health misinformation is important to address in humanitarian settings, over-focusing on it can obfuscate a more holistic understanding of a community’s needs in a crisis. Through Médecins Sans Frontières’ experience of deploying a platform to tackle health misinformation during the COVID-19 pandemic, this field report argues that, while important, health misinformation became a diversionary topic during COVID-19, which represented a lack of trust between communities, humanitarian organisations and health institutions, rather a fundamental obstacle to effective humanitarian interventions.
From our practitioners’ viewpoint, we reflect on the deployment of the ‘MSF Listen’ platform in our programmes and how it evolved from a purely misinformation-focused digital tool to a broader workflow and approach to understanding community needs in crises through accountable management of community feedback.
From our practitioners’ viewpoint, we reflect on the deployment of the ‘MSF Listen’ platform in our programmes and how it evolved from a purely misinformation-focused digital tool to a broader workflow and approach to understanding community needs in crises through accountable management of community feedback.
Journal Article > ResearchFull Text
Public Health Action. 1 August 2023; Volume 13 (Issue 2(Suppl 1)); 1-6.; DOI:10.5588/pha.23.0008
Baptiste SL, van den Boogaard W, Letoquart JP, NDong JG, Jonacé G, et al.
Public Health Action. 1 August 2023; Volume 13 (Issue 2(Suppl 1)); 1-6.; DOI:10.5588/pha.23.0008
CONTEXTE
Les traumatismes abdominaux (TA) semblent fréquents en Haïti confronté à des violences socio-politiques récurrents.
OBJECTIF
Etudier les patients admis pour TA au centre traumatologie Médecins Sans Frontières (MSF) Tabarre (Port-au-Prince), et les circonstances de survenue.
TYPE D’ETUDE
Ceci est une étude transversale sur des données rétrospectives de Janvier 2020 à Décembre 2021.
RÉSULTATS
Sur 3 211 patients admis pour traumatisme, 541 (17,3%) avaient un TA, dont 500 (91,4%) en lien avec des événements socio-politiques. Leur âge médian était de 30 ans (intervalle interquartile [IQR] 23–38) ; 429 (85,8%) étaient masculin. Une blessure par balle était notée chez 371 (74,2%). La distance médiane entre le lieu de violence et l’hôpital était de 11 km (IQR 7–15) ; cependant, 9 (1,8%) étaient venus dans l’heure après le traumatisme ; la transfusion était non faite ou insuffisante chez 169 (33,8%). Une issue défavorable (décès, référence, sortie contre-avis médical) était notée chez 57 (11,4%), avec 8,0% de décès. L’instabilité politique était la principale cause de violence. Une issue défavorable était associée à une transfusion insuffisante (rapport de risque [RR] 2,4 ; IC 95% 1,4–4,3 ; P = 0,006) ou à une blessure par balle (RR 2,4 ; IC 95% 1,1–5,2 ; P = 0,002).
CONCLUSION
Les TA par balle étaient fréquents durant la période des évènements socio-politiques 2020–2021. Le manque de produits sanguins a eu un impact négatif sur l’issue des patients. Les mesures de sécurité et la collecte de sang doivent toujours être maintenues et renforcées.
Les traumatismes abdominaux (TA) semblent fréquents en Haïti confronté à des violences socio-politiques récurrents.
OBJECTIF
Etudier les patients admis pour TA au centre traumatologie Médecins Sans Frontières (MSF) Tabarre (Port-au-Prince), et les circonstances de survenue.
TYPE D’ETUDE
Ceci est une étude transversale sur des données rétrospectives de Janvier 2020 à Décembre 2021.
RÉSULTATS
Sur 3 211 patients admis pour traumatisme, 541 (17,3%) avaient un TA, dont 500 (91,4%) en lien avec des événements socio-politiques. Leur âge médian était de 30 ans (intervalle interquartile [IQR] 23–38) ; 429 (85,8%) étaient masculin. Une blessure par balle était notée chez 371 (74,2%). La distance médiane entre le lieu de violence et l’hôpital était de 11 km (IQR 7–15) ; cependant, 9 (1,8%) étaient venus dans l’heure après le traumatisme ; la transfusion était non faite ou insuffisante chez 169 (33,8%). Une issue défavorable (décès, référence, sortie contre-avis médical) était notée chez 57 (11,4%), avec 8,0% de décès. L’instabilité politique était la principale cause de violence. Une issue défavorable était associée à une transfusion insuffisante (rapport de risque [RR] 2,4 ; IC 95% 1,4–4,3 ; P = 0,006) ou à une blessure par balle (RR 2,4 ; IC 95% 1,1–5,2 ; P = 0,002).
CONCLUSION
Les TA par balle étaient fréquents durant la période des évènements socio-politiques 2020–2021. Le manque de produits sanguins a eu un impact négatif sur l’issue des patients. Les mesures de sécurité et la collecte de sang doivent toujours être maintenues et renforcées.
Conference Material > Poster
Post N, Boobier L, Vyncke J, Tremblay LL
MSF Scientific Day International 2023. 7 June 2023
Journal Article > Case Report/SeriesFull Text
Rev Panam Salud Publica. 10 March 2023; Volume 47; e41.; DOI:10.26633/RPSP.2023.41
Lam CG, Vasquez L, Loggetto P, Fuentes-Alabi S, Gonzalez Ruiz A, et al.
Rev Panam Salud Publica. 10 March 2023; Volume 47; e41.; DOI:10.26633/RPSP.2023.41
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Working with PAHO/WHO to prioritize childhood cancer in the context of systems strengthening is central to St. Jude Children's Research Hospital (SJCRH)’s role as WHO Collaborating Centre for Childhood Cancer. This manuscript focuses on how SJCRH and PAHO/WHO have partnered to apply C5 (Country Collaboration for Childhood Cancer Control) to define and implement priority actions regionally, strengthening Ministry programs for childhood cancer, while implementing the Global Initiative for Childhood Cancer since 2018. Using C5, a tool developed by SJCRH, PAHO/WHO and SJCRH co-hosted regional/national workshops engaging authorities, clinicians and other stakeholders across 10 countries to map health systems needs and prioritize strategic activities (spanning Central America, Dominican Republic, Haiti, Brazil and Uruguay). SJCRH provided English/Spanish/Portuguese C5 versions/templates for analysis/prioritization exercises, and worked with PAHO/WHO and country teams to implement C5, analyze findings, and develop outputs. In an eight-country regional workshop, countries defined priorities within national/regional initiatives and ranked their value and political will, incorporating country-specific surveys and stakeholder dialogues. Each country prioritized one strategic activity for 2022-2023, exchanged insights via storytelling, and disseminated and applied results to inform country-specific and regional action plans. National workshops analyses have been incorporated into cancer control planning activities and collaborative work regionally. Implementation success factors include engaging actors beyond the clinic, enabling flexibility, and focusing on co-design with stakeholders. Joint implementation of C5 catalyzed prioritization and accelerated strategic activities to improve policies, capacity, and quality of care for children in the Americas, supporting Ministries to integrate childhood cancer interventions as part of systems strengthening.
Journal Article > ResearchFull Text
Int J Tuberc Lung Dis. 1 January 2023; Volume 27 (Issue 1); 34-40.; DOI:10.5588/ijtld.22.0324
Zeng C, Mitnick CD, Hewison CCH, Bastard M, Khan PY, et al.
Int J Tuberc Lung Dis. 1 January 2023; Volume 27 (Issue 1); 34-40.; DOI:10.5588/ijtld.22.0324
BACKGROUND
The WHO provides standardized outcome definitions for rifampicin-resistant (RR) and multidrug-resistant (MDR) TB. However, operationalizing these definitions can be challenging in some clinical settings, and incorrect classification may generate bias in reporting and research. Outcomes calculated by algorithms can increase standardization and be adapted to suit the research question. We evaluated concordance between clinician-assigned treatment outcomes and outcomes calculated based on one of two standardized algorithms, one which identified failure at its earliest possible recurrence (i.e., failure-dominant algorithm), and one which calculated the outcome based on culture results at the end of treatment, regardless of early occurrence of failure (i.e., success-dominant algorithm).
METHODS
Among 2,525 patients enrolled in the multi-country endTB observational study, we calculated the frequencies of concordance using cross-tabulations of clinician-assigned and algorithm-assigned outcomes. We summarized the common discrepancies.
RESULTS
Treatment success calculated by algorithms had high concordance with treatment success assigned by clinicians (95.8 and 97.7% for failure-dominant and success-dominant algorithms, respectively). The frequency and pattern of the most common discrepancies varied by country.
CONCLUSION
High concordance was found between clinician-assigned and algorithm-assigned outcomes. Heterogeneity in discrepancies across settings suggests that using algorithms to calculate outcomes may minimize bias.
The WHO provides standardized outcome definitions for rifampicin-resistant (RR) and multidrug-resistant (MDR) TB. However, operationalizing these definitions can be challenging in some clinical settings, and incorrect classification may generate bias in reporting and research. Outcomes calculated by algorithms can increase standardization and be adapted to suit the research question. We evaluated concordance between clinician-assigned treatment outcomes and outcomes calculated based on one of two standardized algorithms, one which identified failure at its earliest possible recurrence (i.e., failure-dominant algorithm), and one which calculated the outcome based on culture results at the end of treatment, regardless of early occurrence of failure (i.e., success-dominant algorithm).
METHODS
Among 2,525 patients enrolled in the multi-country endTB observational study, we calculated the frequencies of concordance using cross-tabulations of clinician-assigned and algorithm-assigned outcomes. We summarized the common discrepancies.
RESULTS
Treatment success calculated by algorithms had high concordance with treatment success assigned by clinicians (95.8 and 97.7% for failure-dominant and success-dominant algorithms, respectively). The frequency and pattern of the most common discrepancies varied by country.
CONCLUSION
High concordance was found between clinician-assigned and algorithm-assigned outcomes. Heterogeneity in discrepancies across settings suggests that using algorithms to calculate outcomes may minimize bias.
Journal Article > ResearchFull Text
PLOS Glob Public Health. 14 December 2022; Volume 2 (Issue 12); e0001334.; DOI:10.1371/journal.pgph.0001334
Gohy B, Opava CH, von Schreeb J, Van den Bergh R, Brus A, et al.
PLOS Glob Public Health. 14 December 2022; Volume 2 (Issue 12); e0001334.; DOI:10.1371/journal.pgph.0001334
A standardized set of measures to assess functioning after trauma in humanitarian settings has been called for. The Activity Independence Measure for Trauma (AIM-T) is a clinician-rated measure of independence in 20 daily activities among patients after trauma. Designed in Afghanistan, it has since been used in other contexts. Before recommending the AIM-T for wider use, its measurement properties required confirmation. This study aims at item reduction followed by content validity assessment of the AIM-T. Using a two-step revision process, first, routinely collected data from 635 patients at five facilities managing patients after trauma in Haiti, Burundi, Yemen, and Iraq were used for item reduction. This was performed by analyzing inter-item redundancy and distribution of the first version of the AIM-T (AIM-T1) item scores, resulting in a shortened version (AIM-T2). Second, content validity of the AIM-T2 was assessed by item content validity indices (I-CVI, 0–1) based on structured interviews with 23 health care professionals and 60 patients in Haiti, Burundi, and Iraq. Through the analyses, nine pairs of redundant items (r≥0.90) were identified in the AIM-T1, leading to the removal of nine items, and resulting in AIM-T2. All remaining items were judged highly relevant, appropriate, clear, feasible and representative by most of participants (I-CVI>0.5). Ten items with I-CVI 0.5–0.85 were revised to improve their cultural relevance or appropriateness and one item was added, resulting in the AIM-T3. In conclusion, the proposed 12-item AIM-T3 is overall relevant, clear, and representative of independence in daily activity after trauma and it includes items appropriate and feasible to be observed by clinicians across different humanitarian settings. While some additional measurement properties remain to be evaluated, the present version already has the potential to serve as a routine measure to assess patients after trauma in humanitarian settings.