Conference Material > Abstract
Ajamah S, Tanaka M, De Vore K, Vogiazou Y, Joseph S, et al.
MSF Paediatric Days 2022. 2022 November 26; DOI:10.57740/142a-kn28
BACKGROUND AND AIMS
The Noma hospital in Sokoto State, Nigeria, provides specialised care for noma, a rapidly progressive and often fatal necrotising bacterial disease, which continues to be neglected. This project was initiated and is led by the Noma project team in collaboration with the Sapling Nursery fund (MSF UK) who provide resources and support. Through community-based exploratory assessments, it was found that caregivers do not have enough resources, knowledge and overall capacity to continue with the necessary treatment and care after discharge. Patients are too often re-admitted in worse condition than before. This highlights a serious gap in the continuity of care, which the Noma Discharge Toolkit (NDT) aims to improve.
METHODS
Person-centered design methodologies aiming to improve quality of care were central to toolkit development. Individual interviews and group sessions led to the identification of needs and challenges, while also exploring potential solutions. The resulting NDT contains four components to support care after discharge:
--Locally sourced food items (Kwash-pap) and RUTF (Plumpy-nut);
--Non-food items for hygiene and transport/storage;
--Medication and treatment;
--Knowledge/engagement booklet.
The feasibility of the NDT was investigated using qualitative data collection methods to understand the perceived benefit by caregivers and hospital staff.
RESULTS
The pilot is in an early stage and distribution data will be gathered and analysed in autumn 2022, but the NDT’s preliminary results are promising. It has been welcomely integrated within the team’s regular processes. Initial feedback is positive, highlighting how the kit gives necessary resources, while increasing engagement, knowledge and focus on quality of care. For the upcoming distribution data collection and analysis, formal ethics approval will be sought.
CONCLUSIONS
The process is this project’s strength – it demonstrates what can be accomplished when co-designing with community and hospital staff, while concretely showing the potential of person-centred design methodologies.
The Noma hospital in Sokoto State, Nigeria, provides specialised care for noma, a rapidly progressive and often fatal necrotising bacterial disease, which continues to be neglected. This project was initiated and is led by the Noma project team in collaboration with the Sapling Nursery fund (MSF UK) who provide resources and support. Through community-based exploratory assessments, it was found that caregivers do not have enough resources, knowledge and overall capacity to continue with the necessary treatment and care after discharge. Patients are too often re-admitted in worse condition than before. This highlights a serious gap in the continuity of care, which the Noma Discharge Toolkit (NDT) aims to improve.
METHODS
Person-centered design methodologies aiming to improve quality of care were central to toolkit development. Individual interviews and group sessions led to the identification of needs and challenges, while also exploring potential solutions. The resulting NDT contains four components to support care after discharge:
--Locally sourced food items (Kwash-pap) and RUTF (Plumpy-nut);
--Non-food items for hygiene and transport/storage;
--Medication and treatment;
--Knowledge/engagement booklet.
The feasibility of the NDT was investigated using qualitative data collection methods to understand the perceived benefit by caregivers and hospital staff.
RESULTS
The pilot is in an early stage and distribution data will be gathered and analysed in autumn 2022, but the NDT’s preliminary results are promising. It has been welcomely integrated within the team’s regular processes. Initial feedback is positive, highlighting how the kit gives necessary resources, while increasing engagement, knowledge and focus on quality of care. For the upcoming distribution data collection and analysis, formal ethics approval will be sought.
CONCLUSIONS
The process is this project’s strength – it demonstrates what can be accomplished when co-designing with community and hospital staff, while concretely showing the potential of person-centred design methodologies.
Conference Material > Abstract
Briskin E, Smith JS, Caleo GNC, Lenglet AD, Pearlman J, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
INTRODUCTION
In April 2020, “shielding” (separate living spaces with enhanced infection control support for groups at high risk of severe COVID-19 disease) was proposed for COVID-19 prevention in settings where lockdown is not feasible (i.e. displaced persons camps). MSF used qualitative methods to explore community perceptions of shielding and other potential COVID-19 prevention measures applicable in settings where it works. Nigeria and Sierra Leone served as initial pilot sites for this multi-site study that ultimately included 13 countries.
METHODS
We carried out qualitative assessments between April and August 2020 within 9 MSF-supported sites in Nigeria and Sierra Leone, with the aim of exploring community perceptions of potential COVID-19 prevention measures. Sites in Nigeria included internally displaced camps in two states, and in Sierra Leone, an open village setting. We conducted multiple rounds of participant-led individual in-depth qualitative interviews in the study sites between April-August 2020. We recruited participants purposively, ensuring participants recruited were representative of underlying demographic and ethnic diversity. Data were coded by hand on paper copies of transcripts and in NVivo12 and analyzed for key themes. Findings were built on through iteration with participants.
ETHICS
This study was approved by the MSF Ethics Review Board and by the Ethical Review Boards of Benue State, Nigeria, Zamfara State, Nigeria, and the District Health Management team,
Tonkolilli, Sierra Leone.
RESULTS
Participants reported that access to both COVID-19 and non- COVID-19 care was challenging due to fear of infection and practical difficulties attending care facilities. Key priorities noted
by participants included obtaining food, masks and handwashing, and continuing to get access to non-COVID-19 healthcare. In Nigeria, shielding (providing separate dwellings for high-risk
people) was described as a challenge.
Reasons for this included close living conditions affecting practicality, its impact on mental health, and the community’s inter-generational reliance. Shielding was only seen as feasible
with sustained provision of resources for shielded persons including COVID testing, food from the family, mobile phones, and socially distanced visitation. For Sierra Leone, previous
experiences (e.g. war, Ebola) influenced fears of separation and the possibility of infection from contact with strangers and health workers or health facilities. Lockdowns and school
closures have a negative effect on support networks and local economies, and in Sierra Leone increased the perceived risk of sexual and gender-based violence and exploitation. Participants reported the desire for self-management of contact tracing and transmission prevention activities within their communities. Context-specific activities to address these priorities were implemented in response.
CONCLUSION
The community-based feedback provided a better understanding of attitudes towards and feasibility of COVID-19 control measures. Commonalities were reported across sites, while
differences in findings across sites highlighted the importance of context-specific engagement. Early and continued community engagement allowed context-specific activities to address these priorities to be implemented in partnership with communities in response. Implemented activities included enhancement of handwashing points, subsidizing locally-produced cloth masks, and reinforcement of prevention and control for non-COVID diseases such as malaria.
CONFLICTS OF INTEREST
None declared.
In April 2020, “shielding” (separate living spaces with enhanced infection control support for groups at high risk of severe COVID-19 disease) was proposed for COVID-19 prevention in settings where lockdown is not feasible (i.e. displaced persons camps). MSF used qualitative methods to explore community perceptions of shielding and other potential COVID-19 prevention measures applicable in settings where it works. Nigeria and Sierra Leone served as initial pilot sites for this multi-site study that ultimately included 13 countries.
METHODS
We carried out qualitative assessments between April and August 2020 within 9 MSF-supported sites in Nigeria and Sierra Leone, with the aim of exploring community perceptions of potential COVID-19 prevention measures. Sites in Nigeria included internally displaced camps in two states, and in Sierra Leone, an open village setting. We conducted multiple rounds of participant-led individual in-depth qualitative interviews in the study sites between April-August 2020. We recruited participants purposively, ensuring participants recruited were representative of underlying demographic and ethnic diversity. Data were coded by hand on paper copies of transcripts and in NVivo12 and analyzed for key themes. Findings were built on through iteration with participants.
ETHICS
This study was approved by the MSF Ethics Review Board and by the Ethical Review Boards of Benue State, Nigeria, Zamfara State, Nigeria, and the District Health Management team,
Tonkolilli, Sierra Leone.
RESULTS
Participants reported that access to both COVID-19 and non- COVID-19 care was challenging due to fear of infection and practical difficulties attending care facilities. Key priorities noted
by participants included obtaining food, masks and handwashing, and continuing to get access to non-COVID-19 healthcare. In Nigeria, shielding (providing separate dwellings for high-risk
people) was described as a challenge.
Reasons for this included close living conditions affecting practicality, its impact on mental health, and the community’s inter-generational reliance. Shielding was only seen as feasible
with sustained provision of resources for shielded persons including COVID testing, food from the family, mobile phones, and socially distanced visitation. For Sierra Leone, previous
experiences (e.g. war, Ebola) influenced fears of separation and the possibility of infection from contact with strangers and health workers or health facilities. Lockdowns and school
closures have a negative effect on support networks and local economies, and in Sierra Leone increased the perceived risk of sexual and gender-based violence and exploitation. Participants reported the desire for self-management of contact tracing and transmission prevention activities within their communities. Context-specific activities to address these priorities were implemented in response.
CONCLUSION
The community-based feedback provided a better understanding of attitudes towards and feasibility of COVID-19 control measures. Commonalities were reported across sites, while
differences in findings across sites highlighted the importance of context-specific engagement. Early and continued community engagement allowed context-specific activities to address these priorities to be implemented in partnership with communities in response. Implemented activities included enhancement of handwashing points, subsidizing locally-produced cloth masks, and reinforcement of prevention and control for non-COVID diseases such as malaria.
CONFLICTS OF INTEREST
None declared.
Conference Material > Slide Presentation
Briskin E, Smith JS, Caleo GNC, Lenglet AD, Pearlman J, et al.
MSF Scientific Days International 2021: Research. 2021 May 18