Journal Article > ReviewAbstract Only
BMJ Sex Reprod Health. 2022 November 7; Volume 49 (Issue 2); 118-128.; DOI:10.1136/bmjsrh-2022-201526
Nicholls EJ, McGowan CR, Miles S, Baxter LM, Dix L, et al.
BMJ Sex Reprod Health. 2022 November 7; Volume 49 (Issue 2); 118-128.; DOI:10.1136/bmjsrh-2022-201526
BACKGROUND
Most cervical cancer can be prevented through routine screening. Disparities in uptake of routine screening therefore translate into disparities in cervical cancer incidence and outcomes. Transmasculine people including transgender men experience multiple barriers to cervical screening and their uptake of screening is low compared with cisgender women. Comprehensive evidence-based guidelines are needed to improve cervical screening for this group.
METHODS
We searched for and synthesised clinical and programmatic guidelines for the provision of cervical screening for transmasculine patients.
FINDINGS
The guidelines offer recommendations addressing: (1) reception, check-in and clinic facilities; (2) patient data and invitation to screening; (3) improving inclusion in screening programmes; and (4) sexual history taking, language and identity. Guidelines offer strategies for alleviating physical and psychological discomfort during cervical screening and recommendations on what to do if the screening procedure cannot be completed. Most of the guidelines were from and for high-income countries.
DISCUSSION
The evidence base is limited, but existing guidelines provide recommendations to ensure life-saving screening services are available to all who need them. We were only able to identify one set of guidelines for a middle-income country, and none for low-income countries. We encourage the involvement of transmasculine people in the development of future guidelines.
Most cervical cancer can be prevented through routine screening. Disparities in uptake of routine screening therefore translate into disparities in cervical cancer incidence and outcomes. Transmasculine people including transgender men experience multiple barriers to cervical screening and their uptake of screening is low compared with cisgender women. Comprehensive evidence-based guidelines are needed to improve cervical screening for this group.
METHODS
We searched for and synthesised clinical and programmatic guidelines for the provision of cervical screening for transmasculine patients.
FINDINGS
The guidelines offer recommendations addressing: (1) reception, check-in and clinic facilities; (2) patient data and invitation to screening; (3) improving inclusion in screening programmes; and (4) sexual history taking, language and identity. Guidelines offer strategies for alleviating physical and psychological discomfort during cervical screening and recommendations on what to do if the screening procedure cannot be completed. Most of the guidelines were from and for high-income countries.
DISCUSSION
The evidence base is limited, but existing guidelines provide recommendations to ensure life-saving screening services are available to all who need them. We were only able to identify one set of guidelines for a middle-income country, and none for low-income countries. We encourage the involvement of transmasculine people in the development of future guidelines.
Technical Report > Policy Brief
Baxter LM, Cowan K, Devine C, Guevara M, Kalub D, et al.
2022 October 27
As an independent international medical humanitarian organisation responding to health crises in more than 70 countries, Médecins Sans Frontières/Doctors Without Borders (MSF) is seeing first-hand the suffering caused or exacerbated by climate change and environmental degradation, most often experienced by the most vulnerable people. We are witnessing how climate change directly threatens health – for example, through death and injury due to extreme weather – and how climate change impacts health indirectly, through food insecurity and shifting patterns of climate-sensitive infectious diseases.
Recognising the role of the climate crisis in amplifying humanitarian needs, MSF is adapting its operations to be more responsive to the populations it serves while also facing up to the challenges of measuring and reducing its own environmental footprint.
Recognising the role of the climate crisis in amplifying humanitarian needs, MSF is adapting its operations to be more responsive to the populations it serves while also facing up to the challenges of measuring and reducing its own environmental footprint.
Journal Article > CommentaryFull Text
Confl Health. 2020 November 4; Volume 14 (Issue 1); 72.; DOI:10.1186/s13031-020-00319-4
McGowan CR, Baxter LM, DuBois M, Sheather J, Khondaker R, et al.
Confl Health. 2020 November 4; Volume 14 (Issue 1); 72.; DOI:10.1186/s13031-020-00319-4
Infectious disease outbreaks represent potentially catastrophic threats to those affected by humanitarian crises. High transmissibility, crowded living conditions, widespread co-morbidities, and a lack of intensive care capacity may amplify the effects of the outbreak on already vulnerable populations and present humanitarian actors with intense ethical problems. We argue that there are significant and troubling gaps in ethical awareness at the level of humanitarian praxis. Though some ethical guidance does exist most of it is directed at public health experts and fails to speak to the day-to-day ethical challenges confronted by frontline humanitarians. In responding to infectious disease outbreaks humanitarian workers are likely to grapple with complex dilemmas opening the door to moral distress and burnout.
Journal Article > ResearchFull Text
Confl Health. 2020 November 25; Volume 14; 80.; DOI:10.1186/s13031-020-00325-6
Garry S, Abdelmagid N, Baxter LM, Roberts N, de Waroux OL, et al.
Confl Health. 2020 November 25; Volume 14; 80.; DOI:10.1186/s13031-020-00325-6
The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.
Journal Article > ResearchFull Text
Eur J Pediatr. 2017 December 19; Volume 177 (Issue 3); 371-380.; DOI:10.1007/s00431-017-3057-y
Meigari L, Hoetjes M, Baxter LM, Lenglet AD
Eur J Pediatr. 2017 December 19; Volume 177 (Issue 3); 371-380.; DOI:10.1007/s00431-017-3057-y
Few data are available to evaluate the impact of Syrian war on civilian population; to describe this impact on child health, this article uses data from Médecins Sans Frontières-Operational Centre Amsterdam's activities in Tal-Abyad and Kobane cities, northern Syria (2013-2016). Data were obtained from routine medical datasets and narrative reports, for out-patient clinics, immunisation, nutritional monitoring and assessments, and in-patient care, and were analysed quantitatively and qualitatively. Infections were the largest contributor to morbidity. The proportion of < 5 year out-patient consultations of infectious diseases that are listed for outbreak monitoring in emergencies was 15% in 2013, 51% in 2014, 75% in 2015 and 70% in 2016. Thalassemia was recorded in 0.5% of 2014 < 5 year out-patient consultations and 3.4% of 2013-2014 < 18-year in-patient admissions. Measles immunisation activities and routine Extended Programme for Immunisation were re-activated across northern Syria; however, immunisation coverage could not be calculated. Results from our routine data must be compared cautiously, due to differences in settings and disease categories.
Journal Article > ResearchFull Text
Confl Health. 2018 December 29; Volume 12 (Issue 1); 48.; DOI:10.1186/s13031-018-0183-8
Baxter LM, Eldin MS, Al Mohammed A, Saim M, Checchi F
Confl Health. 2018 December 29; Volume 12 (Issue 1); 48.; DOI:10.1186/s13031-018-0183-8
During June 2014 to April 2017, the population of Mosul, Iraq lived in a state of increasing isolation from the rest of Iraq due to the city's occupation by the Islamic State group. As part of a study to develop a generalisable method for estimating the excess burden of non-communicable diseases (NCDs) in conflict-affected settings, in April-May 2017 we conducted a brief qualitative study of self-reported care for NCDs among 15 adult patients who had fled Mosul and presented to Médecins Sans Frontières clinics in the Kurdistan region with hypertension and/or diabetes. Participants reported consistent barriers to NCD care during the so-called Islamic State period, including drug shortages, insecurity and inability to afford privately sold medication. Coping strategies included drug rationing. By 2016, all patients had completely or partially lost access to care. Though limited, this study suggests a profound effect of the conflict on NCD burden.
Journal Article > CommentaryFull Text
Lancet. 2022 November 5; Volume 400 (Issue 10363); 1561-1563.; DOI:10.1016/S0140-6736(22)01991-2
Baxter LM, McGowan CR, Smiley S, Palacios L, Devine C, et al.
Lancet. 2022 November 5; Volume 400 (Issue 10363); 1561-1563.; DOI:10.1016/S0140-6736(22)01991-2
The climate emergency is a humanitarian and health crisis. Extreme weather events, heat stress, declining air quality, changes in water quality and quantity, declining food security and safety, and changes in vector distribution and ecology threaten all of us. As the planet heats, climate risks are increasingly complex, frequent, and unpredictable, compounding existing vulnerabilities and inequities within populations and causing emergencies that cascade across different systems and sectors. Humanitarian agencies are now seeing how these problems are putting millions of people across the world at immediate risk of famine and death.
Journal Article > ResearchFull Text
Confl Health. 2020 November 4; Volume 14 (Issue 1); DOI:10.1186/s13031-020-00319-4
McGowan CR, Baxter LM, DuBois M, Sheather J, Khondaker R, et al.
Confl Health. 2020 November 4; Volume 14 (Issue 1); DOI:10.1186/s13031-020-00319-4
Infectious disease outbreaks represent potentially catastrophic threats to those affected by humanitarian crises. High transmissibility, crowded living conditions, widespread co-morbidities, and a lack of intensive care capacity may amplify the effects of the outbreak on already vulnerable populations and present humanitarian actors with intense ethical problems. We argue that there are significant and troubling gaps in ethical awareness at the level of humanitarian praxis. Though some ethical guidance does exist most of it is directed at public health experts and fails to speak to the day-to-day ethical challenges confronted by frontline humanitarians. In responding to infectious disease outbreaks humanitarian workers are likely to grapple with complex dilemmas opening the door to moral distress and burnout.