Journal Article > ReviewFull Text
Lancet Infect Dis. 1 December 2024; Online ahead of print; DOI:10.1016/S1473-3099(24)00673-X
Rojek A, Fieggen J, Apiyo P, Caluwaerts S, Fowler RA, et al.
Lancet Infect Dis. 1 December 2024; Online ahead of print; DOI:10.1016/S1473-3099(24)00673-X
The west Africa Ebola disease epidemic (2014-16) marked a historic change of course for patient care during emerging infectious disease outbreaks. The epidemic response was a failure in many ways-a slow, cumbersome, and disjointed effort by a global architecture that was not fit for purpose for a rapidly spreading outbreak. In the most affected countries, health-care workers and other responders felt helpless-dealing with an overwhelming number of patients but with few, if any, tools at their disposal to provide high-quality care. These inadequacies, however, led to attention and innovation. The decade since then has seen remarkable achievements in clinical care for Ebola disease, including the approval of the first vaccines and treatments. In this paper, the first in a two-part Series, we reflect on this progress and provide expert summary of the modern landscape of Ebola disease, highlighting the priorities and ongoing activities aimed at further improving patient survival and wellbeing in the years ahead.
Journal Article > ResearchFull Text
Bull World Health Organ. 1 June 2024; Volume 102 (Issue 06); 389-399.; DOI:10.2471/BLT.23.291235
Al Kady C, Moussally K, Chreif W, Farra A, Caluwaerts S, et al.
Bull World Health Organ. 1 June 2024; Volume 102 (Issue 06); 389-399.; DOI:10.2471/BLT.23.291235
English
Français
Español
عَرَبِيّ
中文
Русский
OBJECTIVE
To determine whether adding urine culture to urinary tract infection diagnosis in pregnant women from refugee camps in Lebanon reduced unnecessary antibiotic use.
METHODS
We conducted a prospective, cross-sectional study between April and June 2022 involving pregnant women attending a Médecins Sans Frontières sexual reproductive health clinic in south Beirut. Women with two positive urine dipstick tests (i.e. a suspected urinary tract infection) provided urine samples for culture. Bacterial identification and antimicrobial sensitivity testing were conducted following European Committee on Antimicrobial Susceptibility Testing guidelines. We compared the characteristics of women with positive and negative urine culture findings and we calculated the proportion of antibiotics overprescribed or inappropriately used. We also estimated the cost of adding urine culture to the diagnostic algorithm.
FINDINGS
The study included 449 pregnant women with suspected urinary tract infections: 18.0% (81/449) had positive urine culture findings. If antibiotics were administered following urine dipstick results alone, 368 women would have received antibiotics unnecessarily: an overprescription rate of 82% (368/449). If administration was based on urine culture findings plus urinary tract infection symptoms, 144 of 368 women with negative urine culture findings would have received antibiotics unnecessarily: an overprescription rate of 39.1% (144/368). The additional cost of urine culture was 0.48 euros per woman.
CONCLUSION
A high proportion of pregnant women with suspected urinary tract infections from refugee camps unnecessarily received antibiotics. Including urine culture in diagnosis, which is affordable in Lebanon, would greatly reduce antibiotic overprescription. Similar approaches could be adopted in other regions where microbiology laboratories are accessible.
To determine whether adding urine culture to urinary tract infection diagnosis in pregnant women from refugee camps in Lebanon reduced unnecessary antibiotic use.
METHODS
We conducted a prospective, cross-sectional study between April and June 2022 involving pregnant women attending a Médecins Sans Frontières sexual reproductive health clinic in south Beirut. Women with two positive urine dipstick tests (i.e. a suspected urinary tract infection) provided urine samples for culture. Bacterial identification and antimicrobial sensitivity testing were conducted following European Committee on Antimicrobial Susceptibility Testing guidelines. We compared the characteristics of women with positive and negative urine culture findings and we calculated the proportion of antibiotics overprescribed or inappropriately used. We also estimated the cost of adding urine culture to the diagnostic algorithm.
FINDINGS
The study included 449 pregnant women with suspected urinary tract infections: 18.0% (81/449) had positive urine culture findings. If antibiotics were administered following urine dipstick results alone, 368 women would have received antibiotics unnecessarily: an overprescription rate of 82% (368/449). If administration was based on urine culture findings plus urinary tract infection symptoms, 144 of 368 women with negative urine culture findings would have received antibiotics unnecessarily: an overprescription rate of 39.1% (144/368). The additional cost of urine culture was 0.48 euros per woman.
CONCLUSION
A high proportion of pregnant women with suspected urinary tract infections from refugee camps unnecessarily received antibiotics. Including urine culture in diagnosis, which is affordable in Lebanon, would greatly reduce antibiotic overprescription. Similar approaches could be adopted in other regions where microbiology laboratories are accessible.
Journal Article > ResearchFull Text
Public Health Action. 1 August 2023; Volume 13 (Issue 2(Suppl 1)); 13-18.; DOI:10.5588/pha.23.0004
Huyghe S, Telo S, Danwesse E, Ali E, van den Boogaard W, et al.
Public Health Action. 1 August 2023; Volume 13 (Issue 2(Suppl 1)); 13-18.; DOI:10.5588/pha.23.0004
CONTEXTE
Le taux de mortalité maternelle reste élevé (882/100 000 naissances) en République Centrafricaine (RCA), du fait de la survenue de fréquentes complications obstétricales. Médecins Sans Frontières y soutient une maternité de référence à la capitale, Bangui.
OBJECTIFS
Décrire la prévalence, les facteurs associés et la létalité, de l’une des plus sévères, la rupture utérine (RU), ainsi que l’influence d’un antécédent de chirurgie utérine.
MÉTHODES
Ceci est une étude transversale sur des données collectées rétrospectivement entre janvier 2018 et décembre 2021 pour les femmes accouchées d’un nouveau-né plus de 1 000 g.
RÉSULTATS
Sur 38 782 accouchements, 229 (0,6%) de RU étaient enregistrés. Les facteurs associés à la RU étaient : une parité =5 (ORb 7,5 ; IC 95% 4,6–12,2), une présentation fœtale non occipitale (ORb 2,8 ; IC 95% 2,1–3,7) et une macrosomie (OR 4 ; IC 95% 2,6–6,4). La létalité était de 4,4% et la mortinatalité de 64%. La RU était survenue sur utérus non cicatriciel chez 150 (66,1%) femmes. L’issue était plus défavorable en cas de survenue sur utérus non cicatriciel que cicatriciel avec plus de décès maternel (6% vs 0% ; P = 0,023) et un Apgar du nouveau-né < 2 (69,1% vs 45,8% ; P < 0,001).
CONCLUSION
La RU reste un problème majeur de santé maternelle et périnatale en RCA et des efforts sont nécessaires pour détecter précocement les facteurs de risque et d’augmenter la couverture des Soins Obstétricaux et Néonataux d’Urgence Complets.
Le taux de mortalité maternelle reste élevé (882/100 000 naissances) en République Centrafricaine (RCA), du fait de la survenue de fréquentes complications obstétricales. Médecins Sans Frontières y soutient une maternité de référence à la capitale, Bangui.
OBJECTIFS
Décrire la prévalence, les facteurs associés et la létalité, de l’une des plus sévères, la rupture utérine (RU), ainsi que l’influence d’un antécédent de chirurgie utérine.
MÉTHODES
Ceci est une étude transversale sur des données collectées rétrospectivement entre janvier 2018 et décembre 2021 pour les femmes accouchées d’un nouveau-né plus de 1 000 g.
RÉSULTATS
Sur 38 782 accouchements, 229 (0,6%) de RU étaient enregistrés. Les facteurs associés à la RU étaient : une parité =5 (ORb 7,5 ; IC 95% 4,6–12,2), une présentation fœtale non occipitale (ORb 2,8 ; IC 95% 2,1–3,7) et une macrosomie (OR 4 ; IC 95% 2,6–6,4). La létalité était de 4,4% et la mortinatalité de 64%. La RU était survenue sur utérus non cicatriciel chez 150 (66,1%) femmes. L’issue était plus défavorable en cas de survenue sur utérus non cicatriciel que cicatriciel avec plus de décès maternel (6% vs 0% ; P = 0,023) et un Apgar du nouveau-né < 2 (69,1% vs 45,8% ; P < 0,001).
CONCLUSION
La RU reste un problème majeur de santé maternelle et périnatale en RCA et des efforts sont nécessaires pour détecter précocement les facteurs de risque et d’augmenter la couverture des Soins Obstétricaux et Néonataux d’Urgence Complets.
Conference Material > Abstract
Al Kady C, Moussally K, Caluwaerts S, Chreif W, Dibiasi J, et al.
MSF Scientific Day International 2023. 7 June 2023; 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.
Conference Material > Slide Presentation
Al Kady C, Moussally K, Caluwaerts S, Chreif W, Dibiasi J, et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/hymf-1a27
Journal Article > CommentaryFull Text
BMJ. 20 April 2016; DOI:10.1136/bmj.i2037
Akol AD, Caluwaerts S, Weeks AD
BMJ. 20 April 2016; DOI:10.1136/bmj.i2037
Journal Article > ResearchFull Text
Public Health Action. 1 September 2019; Volume 9 (Issue 3); 107-112.; DOI:10.5588/pha.18.0045
Gil Cuesta J, Trelles M, Naseer A, Momin A, Ngabo Mulamira L, et al.
Public Health Action. 1 September 2019; Volume 9 (Issue 3); 107-112.; DOI:10.5588/pha.18.0045
English
Français
Español
INTRODUCTION
Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings.
OBJECTIVE
To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections.
METHODS
We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care.
RESULTS
During 2008–2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38).
CONCLUSIONS
Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.
Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings.
OBJECTIVE
To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections.
METHODS
We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care.
RESULTS
During 2008–2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38).
CONCLUSIONS
Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.
Journal Article > ResearchFull Text
Int Health. 1 March 2016; Volume 8 (Issue 2); 89-95.; DOI:10.1093/inthealth/ihv051
Shah SK, Van der Bergh R, Prinsloo JR, Rehman G, Bibi A, et al.
Int Health. 1 March 2016; Volume 8 (Issue 2); 89-95.; DOI:10.1093/inthealth/ihv051
BACKGROUND
In developing countries such as Pakistan, poor training of mid-level cadres of health providers, combined with unregulated availability of labour-inducing medication can carry considerable risk for mother and child during labour. Here, we describe the exposure to labour-inducing medication and its possible risks in a vulnerable population in a conflict-affected region of Pakistan.
METHODS
A retrospective cohort study using programme data, compared the outcomes of obstetric risk groups of women treated with unregulated oxytocin, with those of women with regulated treatment.
RESULTS
Of the 6379 women included in the study, 607 (9.5%) received labour-inducing medication prior to reaching the hospital; of these, 528 (87.0%) received unregulated medication. Out of 528 labour-inducing medication administrators, 197 (37.3%) traditional birth attendants (also known as dai) and 157 (29.7%) lady health workers provided unregulated treatment most frequently. Women given unregulated medication who were diagnosed with obstructed/prolonged labour were at risk for uterine rupture (RR 4.1, 95% CI 1.7–9.9) and severe birth asphyxia (RR 3.9, 95% CI 2.5–6.1), and those with antepartum haemorrhage were at risk for stillbirth (RR 1.8, 95% CI 1.0–3.1).
CONCLUSIONS
In a conflict-affected region of Pakistan, exposure to unregulated treatment with labour-inducing medication is common, and carries great risk for mother and child. Tighter regulatory control of labour-inducing drugs is needed, and enhanced training of the mid-level cadres of healthcare workers is required
In developing countries such as Pakistan, poor training of mid-level cadres of health providers, combined with unregulated availability of labour-inducing medication can carry considerable risk for mother and child during labour. Here, we describe the exposure to labour-inducing medication and its possible risks in a vulnerable population in a conflict-affected region of Pakistan.
METHODS
A retrospective cohort study using programme data, compared the outcomes of obstetric risk groups of women treated with unregulated oxytocin, with those of women with regulated treatment.
RESULTS
Of the 6379 women included in the study, 607 (9.5%) received labour-inducing medication prior to reaching the hospital; of these, 528 (87.0%) received unregulated medication. Out of 528 labour-inducing medication administrators, 197 (37.3%) traditional birth attendants (also known as dai) and 157 (29.7%) lady health workers provided unregulated treatment most frequently. Women given unregulated medication who were diagnosed with obstructed/prolonged labour were at risk for uterine rupture (RR 4.1, 95% CI 1.7–9.9) and severe birth asphyxia (RR 3.9, 95% CI 2.5–6.1), and those with antepartum haemorrhage were at risk for stillbirth (RR 1.8, 95% CI 1.0–3.1).
CONCLUSIONS
In a conflict-affected region of Pakistan, exposure to unregulated treatment with labour-inducing medication is common, and carries great risk for mother and child. Tighter regulatory control of labour-inducing drugs is needed, and enhanced training of the mid-level cadres of healthcare workers is required
Journal Article > EditorialFull Text
BMJ. 20 December 2021; Volume 375; n3126.; DOI:10.1136/bmj.n3126
Caluwaerts S
BMJ. 20 December 2021; Volume 375; n3126.; DOI:10.1136/bmj.n3126
Journal Article > ResearchFull Text
Confl Health. 22 January 2018; Volume 12 (Issue 1); DOI:10.1186/s13031-018-0137-1
Lagrou D, Zachariah R, Bissel K, Van Overloop C, Nasim M, et al.
Confl Health. 22 January 2018; Volume 12 (Issue 1); DOI:10.1186/s13031-018-0137-1
Provision of Emergency Obstetric and Neonatal Care (EmONC) reduces maternal mortality and should include three components: Basic Emergency Obstetric and Neonatal Care (BEmONC) offered at primary care level, Comprehensive EmONC (CEmONC) at secondary level and a good referral system in-between. In a conflict-affected province of Afghanistan (Khost), we assessed the performance of an Médecins Sans Frontières (MSF) run CEmONC hospital without a primary care and referral system. Performance was assessed in terms of hospital utilisation for obstetric emergencies and quality of obstetric care.