Conference Material > Poster
Al Laham D, Ali E, Moussally K, Nahas N, Alameddine A, et al.
MSF Scientific Days International 2020. 2020 May 13; DOI:10.7490/f1000research.1117937.1
• Since 2011, the conflict in Syria has had a huge impact on its population, many of whom are now displaced
• The Syrian crisis has not only affected the physical health of refugees, but has also had a drastic effect on their mental health
• Wadi Khaled, a rural district in the north of Lebanon, hosts about 36,000 displaced Syrians, and is one of most under-served and marginalized areas of Lebanon
• Médecins Sans Frontières (MSF) has been providing mental health services to Syrian refugees and the Lebanese host population in Akkar, Wadi Khaled since 2016.
• The Syrian crisis has not only affected the physical health of refugees, but has also had a drastic effect on their mental health
• Wadi Khaled, a rural district in the north of Lebanon, hosts about 36,000 displaced Syrians, and is one of most under-served and marginalized areas of Lebanon
• Médecins Sans Frontières (MSF) has been providing mental health services to Syrian refugees and the Lebanese host population in Akkar, Wadi Khaled since 2016.
Conference Material > Slide Presentation
Schittecatte G, Pellechia U, Meudec M, Vanlerberghe V
MSF Scientific Days International 2022. 2022 May 12; DOI:10.57740/79m2-8h12
Conference Material > Slide Presentation
Ansbro E, Masri S, Prieto-Merino D, Bahous SA, Molfino L, et al.
MSF Scientific Days International 2022. 2022 May 11; DOI:10.57740/mzsh-8t29
Conference Material > Video (talk)
Al Kady C
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/6cdv-9f90
Conference Material > Slide Presentation
Rapoud D, Cramer E, Al Asmar M, Sagara F, Ndiaye B, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/2acXDPpuix
Conference Material > Video (talk)
Masri S
MSF Scientific Days International 2020: Innovation. 2020 May 14
Journal Article > Meta-AnalysisFull Text
Bianchi S
2014 June 23; Volume 33 (Issue 3); DOI:10.1093/rsq/hdu007
The 2010 reform of the legal regime regulating Palestinians’ access to the labour market in Lebanon ignited a heated debate among Lebanese, Palestinians, and international political actors. This article analyses the advocacy initiatives preceding the reform to answer the following question: what signifiers of Palestinian-ness have Palestinian political entrepreneurs mobilised? In a nutshell, it shows how a group of non-governmental organizations working with Palestinian refugees in Lebanon re-shaped the references to “Return” and “Dignity” in order to create an intellectual environment favourable to their demands for legal reform. However, these two signifiers not only concern the issue of the work-related rights of Lebanon’s Palestinians, but they also envisage a specific form of emplacement of the Palestinian community in that country. From this perspective, they are the constitutive elements of a “diasporic project” of emplacement in which Palestinians collectively exist in an in-between (imagined) space situated somewhere between their host society and their homeland.
Journal Article > ResearchFull Text
BMC Psychiatry. 2017 January 18; Volume 17 (Issue 1); 28.; DOI:10.1186/s12888-016-1154-5
Llosa AE, van Ommeren M, Kolappa K, Ghantous Z, Souza R, et al.
BMC Psychiatry. 2017 January 18; Volume 17 (Issue 1); 28.; DOI:10.1186/s12888-016-1154-5
BACKGROUND
Time and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms for the detection of moderate and severe mental disorders in a refugee setting.
METHODS
Lay interviewers applied a screening algorithm to detect individuals with severe distress or mental disorders in randomly selected households in a Palestinian refugee camp in Beirut, Lebanon. The method included household informant and individual level interviews using a Vignettes of Local Terms and Concepts for mental disorders (VOLTAC), individual and household informant portions of the field-test version of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) and the WHO Self Reporting Questionnaire (SRQ-20). A subset of participants were then reappraised utilizing the Mini International Neuropsychiatric Interview (MINI), WHO Disability Assessment Schedule II, and the Global Assessment of Functioning. The study constitutes a secondary analysis of interview data from 283 randomly selected households (n = 748 adult residents) who participated in a mental health disorders prevalence study in 2010.
RESULTS
The 5-item household informant portion of WASSS was the most efficient instrument among those tested. It detected adults with severe mental disorders with 95% sensitivity and 71% specificity (Area Under Curve (AUC) = 0.85) and adults with moderate or severe mental disorder with 85.1% sensitivity and 74.8% specificity (AUC = 0.82). The complete screening algorithm demonstrated 100% sensitivity and 58% specificity.
CONCLUSIONS
Our results suggest that a two phase, screen-confirm approach is likely a useful strategy to detect incapacitating mental disorders in humanitarian contexts where mental health specialists are scarce, and that in the context of a multi-step screen confirm mechanism, the household informant portion of field-test version of the WASSS may be an efficient screening tool to identify adults in greatest need for mental health care in humanitarian settings.
Time and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms for the detection of moderate and severe mental disorders in a refugee setting.
METHODS
Lay interviewers applied a screening algorithm to detect individuals with severe distress or mental disorders in randomly selected households in a Palestinian refugee camp in Beirut, Lebanon. The method included household informant and individual level interviews using a Vignettes of Local Terms and Concepts for mental disorders (VOLTAC), individual and household informant portions of the field-test version of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) and the WHO Self Reporting Questionnaire (SRQ-20). A subset of participants were then reappraised utilizing the Mini International Neuropsychiatric Interview (MINI), WHO Disability Assessment Schedule II, and the Global Assessment of Functioning. The study constitutes a secondary analysis of interview data from 283 randomly selected households (n = 748 adult residents) who participated in a mental health disorders prevalence study in 2010.
RESULTS
The 5-item household informant portion of WASSS was the most efficient instrument among those tested. It detected adults with severe mental disorders with 95% sensitivity and 71% specificity (Area Under Curve (AUC) = 0.85) and adults with moderate or severe mental disorder with 85.1% sensitivity and 74.8% specificity (AUC = 0.82). The complete screening algorithm demonstrated 100% sensitivity and 58% specificity.
CONCLUSIONS
Our results suggest that a two phase, screen-confirm approach is likely a useful strategy to detect incapacitating mental disorders in humanitarian contexts where mental health specialists are scarce, and that in the context of a multi-step screen confirm mechanism, the household informant portion of field-test version of the WASSS may be an efficient screening tool to identify adults in greatest need for mental health care in humanitarian settings.
Conference Material > Abstract
Schittecatte G, Pellechia U, Meudec M, Vanlerberghe V
MSF Scientific Days International 2022. 2022 May 12; DOI:10.57740/w55h-9b93
INTRODUCTION
Community engagement (CE) rose to prominence with the Alma Ata Declaration in 1978, and remains a concept lauded by global health actors, including MSF. CE is often described as being linked with accountability, ownership, and sustainability of health programmes. It is also linked with social determinants of health through its empowering principles. Despite the recognition of its importance, challenges remain in incorporating
CE into programmes.
METHODS
We used a qualitative, case-based approach to explore how community engagement is defined, perceived, and evaluated in MSF contexts. Our aim was to identify challenges and opportunities in truly integrating communities into humanitarian health interventions. Three projects were purposively selected, in Democratic Republic of the Congo, Lebanon, and Venezuela, aiming to represent a variety of health programmes, as well as societal diversity. Document review and 55 semi-structured interviews were conducted. Participants represented different institutional levels and positions, as well as national and international staff. Interviews were transcribed and coded iteratively, as were the operational and technical documents, institutional policies, and reports included in the document reviews. The themes that emerged in the iterative coding were
then analysed.
ETHICS
This study was approved by the MSF Ethics Review Board, and by the Institutional Review Board at the Institute of Tropical Medicine, Antwerp, Belgium.
RESULTS
We found disparity between MSF institutional policy, operational documents, and incorporation of CE at programme level. While there is policy acceptance of CE as essential, interviews show that MSF barely engages with communities in a participatory process. There is little prioritisation of CE, and lack of guidance on the processes needed to involve communities in decision making. Our results also show that despite shared claims of the importance of CE, definitions, objectives, and evaluation all vary significantly. Tensions emerge between seeing communities as active participants or as passive beneficiaries. Additional tensions appeared around whether CE was perceived as an approach for promotion of quality of care and accountability of operations, or purely as an activity to reach the organisation’s goals. Finally, while field projects may establish links with communities, MSF remains the sole decision-maker on the overall medical-humanitarian strategy. Interviewees questioned the capability of MSF to work within this community engagement approach, due to inherent power asymmetries and the predominant use of western-centred biomedical approaches. Inequalities and misconceptions between international and national staff created an additional barrier to bridging with
local communities.
CONCLUSION
If MSF is interested in improving its approach to CE, there should be a concerted effort to change the way communities are viewed with respect to the organisation‘s interventions. While a single model of CE is not possible, MSF needs to set up training on CE approaches and develop frameworks and clear objectives for CE, through dedicated resources at headquarters and field levels.
CONFLICTS OF INTEREST
None declared.
Community engagement (CE) rose to prominence with the Alma Ata Declaration in 1978, and remains a concept lauded by global health actors, including MSF. CE is often described as being linked with accountability, ownership, and sustainability of health programmes. It is also linked with social determinants of health through its empowering principles. Despite the recognition of its importance, challenges remain in incorporating
CE into programmes.
METHODS
We used a qualitative, case-based approach to explore how community engagement is defined, perceived, and evaluated in MSF contexts. Our aim was to identify challenges and opportunities in truly integrating communities into humanitarian health interventions. Three projects were purposively selected, in Democratic Republic of the Congo, Lebanon, and Venezuela, aiming to represent a variety of health programmes, as well as societal diversity. Document review and 55 semi-structured interviews were conducted. Participants represented different institutional levels and positions, as well as national and international staff. Interviews were transcribed and coded iteratively, as were the operational and technical documents, institutional policies, and reports included in the document reviews. The themes that emerged in the iterative coding were
then analysed.
ETHICS
This study was approved by the MSF Ethics Review Board, and by the Institutional Review Board at the Institute of Tropical Medicine, Antwerp, Belgium.
RESULTS
We found disparity between MSF institutional policy, operational documents, and incorporation of CE at programme level. While there is policy acceptance of CE as essential, interviews show that MSF barely engages with communities in a participatory process. There is little prioritisation of CE, and lack of guidance on the processes needed to involve communities in decision making. Our results also show that despite shared claims of the importance of CE, definitions, objectives, and evaluation all vary significantly. Tensions emerge between seeing communities as active participants or as passive beneficiaries. Additional tensions appeared around whether CE was perceived as an approach for promotion of quality of care and accountability of operations, or purely as an activity to reach the organisation’s goals. Finally, while field projects may establish links with communities, MSF remains the sole decision-maker on the overall medical-humanitarian strategy. Interviewees questioned the capability of MSF to work within this community engagement approach, due to inherent power asymmetries and the predominant use of western-centred biomedical approaches. Inequalities and misconceptions between international and national staff created an additional barrier to bridging with
local communities.
CONCLUSION
If MSF is interested in improving its approach to CE, there should be a concerted effort to change the way communities are viewed with respect to the organisation‘s interventions. While a single model of CE is not possible, MSF needs to set up training on CE approaches and develop frameworks and clear objectives for CE, through dedicated resources at headquarters and field levels.
CONFLICTS OF INTEREST
None declared.
Conference Material > Abstract
Al Kady C, Moussally K, Caluwaerts S, Chreif W, Dibiasi J, et al.
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/73jr-dg45
INTRODUCTION
Inappropriate use of antibiotics is widespread, and one of the main drivers for antimicrobial resistance (AMR). In pregnant women with suspected urinary tract infection (UTI), studies have suggested antibiotic over-use in up to 96%; use may be particularly high in settings with limited diagnostic resources and where reliant on symptomatic approaches. In south Beirut, specifically within camps where refugees settle and living conditions are poor, MSF has been operational since 2014 as the main provider of free primary healthcare services as well as sexual and reproductive health (SRH) care. Current MSF protocols operational in this setting recommend the use of urine dipsticks for UTI screening in pregnant women, followed by empirical antibiotic treatment for those with a positive result (positive for nitrites and/or leucocytes).
METHODS
In 2021, around 6,300 (24%) of the total 26,300 antenatal care (ANC) consultations conducted had a suspected UTI, based on urine dipstick results, and all those suspected with UTI were prescribed antibiotics. A prospective study was conducted between April and July 2022, to determine if adding urine
culture, following positive urine dipstick, to the protocol would reduce the use of unnecessary antibiotics. We used descriptive statistics to describe the population and compare positive and negative urine cultures. We calculated the proportion of patients receiving appropriate or inappropriate antibiotics.
ETHICS
This study was approved by the MSF Ethics Review Board, and by the ethics committee of the Lebanese American University.
RESULTS
A total of 449 pregnant women with suspected UTI were included in this study; all received urine culture. 81 (18%) were culture-positive. Under usual practice, 368 women (82%) would have been overprescribed antibiotics, based solely on urine dipstick results. 197 (44%) of the cohort were symptomatic, and were given empirical antibiotic treatment, with cefixime administered to 42 (21%) women and fosfomycin to 155 (79%). Escherichia coli (79%) was the most common bacterial species isolated, followed by Proteus (11%). In addition, among the 81 positive cultures, 4 (5%) were found resistant to fosfomycin and 39 (48%) to cefixim
CONCLUSION
These study findings reinforce concern around potential over prescription of unnecessary antibiotics in such populations, which could contribute to a potential rise in AMR. In addition, resistance to cefixime, one of the recommended antibiotics to treat UTI’s, is relatively high in this community. In contexts where urine culture is feasible, not costly, accessible, and results rapidly available, particularly with large cohorts of patients, urine culture should be the main method used to diagnose UTI; treatment should be based on microbiology/antibiotic sensitivity results.
CONFLICTS OF INTEREST
None declared.
Inappropriate use of antibiotics is widespread, and one of the main drivers for antimicrobial resistance (AMR). In pregnant women with suspected urinary tract infection (UTI), studies have suggested antibiotic over-use in up to 96%; use may be particularly high in settings with limited diagnostic resources and where reliant on symptomatic approaches. In south Beirut, specifically within camps where refugees settle and living conditions are poor, MSF has been operational since 2014 as the main provider of free primary healthcare services as well as sexual and reproductive health (SRH) care. Current MSF protocols operational in this setting recommend the use of urine dipsticks for UTI screening in pregnant women, followed by empirical antibiotic treatment for those with a positive result (positive for nitrites and/or leucocytes).
METHODS
In 2021, around 6,300 (24%) of the total 26,300 antenatal care (ANC) consultations conducted had a suspected UTI, based on urine dipstick results, and all those suspected with UTI were prescribed antibiotics. A prospective study was conducted between April and July 2022, to determine if adding urine
culture, following positive urine dipstick, to the protocol would reduce the use of unnecessary antibiotics. We used descriptive statistics to describe the population and compare positive and negative urine cultures. We calculated the proportion of patients receiving appropriate or inappropriate antibiotics.
ETHICS
This study was approved by the MSF Ethics Review Board, and by the ethics committee of the Lebanese American University.
RESULTS
A total of 449 pregnant women with suspected UTI were included in this study; all received urine culture. 81 (18%) were culture-positive. Under usual practice, 368 women (82%) would have been overprescribed antibiotics, based solely on urine dipstick results. 197 (44%) of the cohort were symptomatic, and were given empirical antibiotic treatment, with cefixime administered to 42 (21%) women and fosfomycin to 155 (79%). Escherichia coli (79%) was the most common bacterial species isolated, followed by Proteus (11%). In addition, among the 81 positive cultures, 4 (5%) were found resistant to fosfomycin and 39 (48%) to cefixim
CONCLUSION
These study findings reinforce concern around potential over prescription of unnecessary antibiotics in such populations, which could contribute to a potential rise in AMR. In addition, resistance to cefixime, one of the recommended antibiotics to treat UTI’s, is relatively high in this community. In contexts where urine culture is feasible, not costly, accessible, and results rapidly available, particularly with large cohorts of patients, urine culture should be the main method used to diagnose UTI; treatment should be based on microbiology/antibiotic sensitivity results.
CONFLICTS OF INTEREST
None declared.