Journal Article > Commentary
PLOS Glob Public Health. 30 December 2022; Volume 2 (Issue 12); e0001431.; DOI:10.1371/journal.pgph.0001431
Martinez Garcia D, Amsalu R, Harkensee C, Janet S, Kadir A, et al.
PLOS Glob Public Health. 30 December 2022; Volume 2 (Issue 12); e0001431.; DOI:10.1371/journal.pgph.0001431
Journal Article > CommentaryFull Text
BMC Pediatr. 1 October 2020; Volume 146 (Issue Suppl 2); S208-S217.; DOI:10.1542/peds.2020-016915L
Amsalu R, Schulte-Hillen C, Garcia DM, Lafferty N, Morris CN, et al.
BMC Pediatr. 1 October 2020; Volume 146 (Issue Suppl 2); S208-S217.; DOI:10.1542/peds.2020-016915L
Humanitarian crises, driven by disasters, conflict, and disease epidemics, have profound effects on society, including on people's health and well-being. Occurrences of conflict by state and nonstate actors have increased in the last 2 decades: by the end of 2018, an estimated 41.3 million internally displaced persons and 20.4 million refugees were reported worldwide, representing a 70% increase from 2010. Although public health response for people affected by humanitarian crisis has improved in the last 2 decades, health actors have made insufficient progress in the use of evidence-based interventions to reduce neonatal mortality. Indeed, on average, conflict-affected countries report higher neonatal mortality rates and lower coverage of key maternal and newborn health interventions compared with non-conflict-affected countries. As of 2018, 55.6% of countries with the highest neonatal mortality rate (≥30 per 1000 live births) were affected by conflict and displacement. Systematic use of new evidence-based interventions requires the availability of a skilled health workforce and resources as well as commitment of health actors to implement interventions at scale. A review of the implementation of the Helping Babies Survive training program in 3 refugee responses and protracted conflict settings identify that this training is feasible, acceptable, and effective in improving health worker knowledge and competency and in changing newborn care practices at the primary care and hospital level. Ultimately, to improve neonatal survival, in addition to a trained health workforce, reliable supply and health information system, community engagement, financial support, and leadership with effective coordination, policy, and guidance are required.
Journal Article > ResearchFull Text
Trans R Soc Trop Med Hyg. 31 January 2008
Ritmeijer KKD, Veeken H, Melaku Y, Leal G, Amsalu R, et al.
Trans R Soc Trop Med Hyg. 31 January 2008
We evaluated generic sodium stibogluconate (SSG) (International Dispensary Association, Amsterdam) versus Pentostam (sodium stibogluconate, GlaxoWellcome, London) under field conditions in Ethiopian patients with visceral leishmaniasis (VL; kala-azar). The 199 patients were randomly assigned to Pentostam (n = 104) or SSG (n = 95) in 1998/99; both drugs were given at 20 mg/kg intra-muscularly for 30 days. A clinical cure after 30-days treatment was achieved in 70.2% (Pentostam) and 81.1% (SSG). There were no significant differences between the 2 drugs for the following parameters: frequency of intercurrent events (vomiting, diarrhoea, bleeding or pneumonia) or main outcome (death during treatment and death after 6-month follow-up; relapse or post kala-azar dermal leishmaniasis at 6-months follow-up). Twenty-seven patients had confirmed co-infection with HIV. On admission, HIV co-infected VL patients were clinically indistinguishable from HIV-negative VL patients. The HIV co-infected VL patients had a higher mortality during treatment (33.3% vs 3.6%). At 6-month follow-up, HIV-positive patients had a higher relapse rate (16.7% vs 1.2%), a higher death rate during the follow-up period (14.3% vs 2.4%), and more frequent moderate or severe post kala-azar dermal leishmaniasis (27.3% vs 13.3%). Only 43.5% of the HIV-positive patients were considered cured at 6-months follow-up vs 92.1% of the HIV-negative patients. HIV-positive patients relapsing with VL could become a reservoir of antimonial-resistant Leishmania donovani.
Journal Article > ReviewFull Text
Lancet. 6 February 2021; Volume 397 (Issue 10273); DOI:10.1016/s0140-6736(21)00133-1
Gaffey MF, Waldman RJ, Blanchet K, Amsalu R, Capobianco E, et al.
Lancet. 6 February 2021; Volume 397 (Issue 10273); DOI:10.1016/s0140-6736(21)00133-1
Journal Article > ResearchFull Text
Confl Health. 7 May 2022; Volume 16; 23.; DOI:10.1186/s13031-022-00440-6
Russell N, Tappis H, Mwanga JP, Black B, Thapa K, et al.
Confl Health. 7 May 2022; Volume 16; 23.; DOI:10.1186/s13031-022-00440-6
BACKGROUND
Maternal and perinatal death surveillance and response (MPDSR) is a system of identifying, analyzing and learning lessons from such deaths in order to respond to and prevent future deaths, and has been recommended by WHO and implemented in many low-and-middle-income settings in recent years. However, there is limited documentation of experience with MPDSR in humanitarian settings. A meeting on MPDSR in humanitarian settings was convened by WHO, UNICEF, CDC and Save the Children, UNFPA, and UNHCR on 17th–18th October 2019, informed by semi-structured interviews with a range of professionals, including experts attendees.
CONSULTATION FINDINGS
Interviewees revealed significant obstacles to the full implementation of the MPDSR process in humanitarian settings. Many obstacles were familiar to low resource settings in general but were amplified in the context of a humanitarian crisis, such as overburdened services, disincentives to reporting, accountability gaps, a blame approach, and politicization of mortality. Factors more unique to humanitarian contexts included concerns about health worker security and moral distress. There are varying levels of institutionalization and implementation capacity for MPDSR within humanitarian organizations. It is suggested that if poorly implemented, particularly with a punitive or blame approach, MPDSR may be counterproductive. Nevertheless, successes in MPDSR were described whereby the process led to concrete actions to prevent deaths, and where death reviews have led to an improved understanding of complex and rectifiable contextual factors leading to deaths in humanitarian settings.
CONCLUSIONS
Despite the challenges, examples exist where the lessons learned from MPDSR processes have led to improved access and quality of care in humanitarian contexts, including successful advocacy. An adapted approach is required to ensure feasibility, with varying implementation being possible in different phases of crises. There is a need for guidance on MPDSR in humanitarian contexts, and for greater documentation and learning from experiences.
Maternal and perinatal death surveillance and response (MPDSR) is a system of identifying, analyzing and learning lessons from such deaths in order to respond to and prevent future deaths, and has been recommended by WHO and implemented in many low-and-middle-income settings in recent years. However, there is limited documentation of experience with MPDSR in humanitarian settings. A meeting on MPDSR in humanitarian settings was convened by WHO, UNICEF, CDC and Save the Children, UNFPA, and UNHCR on 17th–18th October 2019, informed by semi-structured interviews with a range of professionals, including experts attendees.
CONSULTATION FINDINGS
Interviewees revealed significant obstacles to the full implementation of the MPDSR process in humanitarian settings. Many obstacles were familiar to low resource settings in general but were amplified in the context of a humanitarian crisis, such as overburdened services, disincentives to reporting, accountability gaps, a blame approach, and politicization of mortality. Factors more unique to humanitarian contexts included concerns about health worker security and moral distress. There are varying levels of institutionalization and implementation capacity for MPDSR within humanitarian organizations. It is suggested that if poorly implemented, particularly with a punitive or blame approach, MPDSR may be counterproductive. Nevertheless, successes in MPDSR were described whereby the process led to concrete actions to prevent deaths, and where death reviews have led to an improved understanding of complex and rectifiable contextual factors leading to deaths in humanitarian settings.
CONCLUSIONS
Despite the challenges, examples exist where the lessons learned from MPDSR processes have led to improved access and quality of care in humanitarian contexts, including successful advocacy. An adapted approach is required to ensure feasibility, with varying implementation being possible in different phases of crises. There is a need for guidance on MPDSR in humanitarian contexts, and for greater documentation and learning from experiences.
Journal Article > ResearchFull Text
Trop Med Int Health. 1 February 2006; Volume 11 (Issue 2); DOI:10.1111/j.1365-3156.2005.01550.x
Gerstl S, Amsalu R, Ritmeijer KKD
Trop Med Int Health. 1 February 2006; Volume 11 (Issue 2); DOI:10.1111/j.1365-3156.2005.01550.x
OBJECTIVE: To evaluate the accessibility of visceral leishmaniasis (VL) treatment. METHOD: Community-based study using in-depth qualitative interviews and focus group discussions with key informants, as well as quantitative questionnaires with 448 randomly selected heads of households in nine representative villages in three geographical sub-regions. RESULTS: Despite the high incidence of the disease, most people in Gedaref State know little about VL, and help at a treatment centre is usually sought only after traditional remedies and basic allopathic drugs have failed. Factors barring access to treatment are: lack of money for treatment and transport, impassability of roads, work priorities, severe cultural restrictions of women's decision-making power and distance to the next health center. CONCLUSIONS: To provide more VL patients with access to treatment in this highly endemic area, diagnostic and treatment services should be decentralized. Health education would be a useful tool to rationalise people's health-seeking behaviour.