Protocol > Research Study
Lenglet AD, Farley ES, Trienekens S, Amirtharajah M, Bil K, et al.
2018 July 1
BACKGROUND
Noma is an orofacial gangrene that rapidly eats away at the hard and soft tissue as well as the bones in the face. Noma has a 90% mortality rate, and the disease affects mostly children under the age of 5. Little is known about Noma as the majority of cases live in underserved, difficult to reach locations. MSF runs projects at the Noma Children’s Hospital in Sokoto, northern Nigeria and currently assists with surgical interventions for the patients who have survived and sought care at the hospital. Community outreach and active case finding are also taking place. These projects place MSF in a unique position to study Noma, and to add to the scant body of knowledge around the disease.
AIM
To identify risk factors for Noma in northwest Nigeria in terms of epidemiological (demographic characteristics, medical history), socio-economic-behavioural aspects and access to health care in order to better guide existing prevention strategies.
SPECIFIC OBJECTIVES
1. To understand concepts and perceptions of Noma within the population of northwestern Nigeria, specifically those affected (caretakers of Noma cases) by the disease, and controls matching these cases. To describe the epidemiological profile of all cases of Noma that have been treated at the MSF Noma Children’s Hospital from August 2015 until June 2016;
2. To describe the current Noma patient’s clinical history before the onset of the disease, the start of the disease and the care/treatment sought as well as the impact of Noma on the patient;
3. To assess Noma risk factors by comparing cases enrolled at the Noma Children’s Hospital and controls matched to cases by sex, age, and village of residence;
All of these objectives are in order to assess if there are intervention opportunities in the unique Nigerian setting that could prevent further Noma case development.
METHODS
1) Qualitative phase: focus groups will take place with care takers (guardians or parents) of cases as well as key informant interviews with health care workers to better understand the local concepts, vocabulary and expressions used to describe Noma in this part of Nigeria.
2) Descriptive epidemiology: description of all available medical, nutritional and mental health data associated with the Noma patients operated on at the Noma Children’s Hospital over the last year.
3) Case control study: assessing risk factors for Noma using care takers of cases recruited from the Noma Children’s Hospital and care takers of controls that are recruited from cases village of residence and matched by age and sex.
OUTCOMES
• Initiate the MSF operational research agenda around Noma in Nigeria;
• Improved understanding of local beliefs, traditions and language used to describe Noma;
• Improved understanding of Noma patients at the Sokoto Children’s hospital;
• Identification of preventable risk factors for Noma development in our patients;
• Integration of information obtained into outreach programming, improved community engagements, options for preventative campaigns and overall improved clinical and mental health care of Noma patients and caretakers in the MSF project.
Noma is an orofacial gangrene that rapidly eats away at the hard and soft tissue as well as the bones in the face. Noma has a 90% mortality rate, and the disease affects mostly children under the age of 5. Little is known about Noma as the majority of cases live in underserved, difficult to reach locations. MSF runs projects at the Noma Children’s Hospital in Sokoto, northern Nigeria and currently assists with surgical interventions for the patients who have survived and sought care at the hospital. Community outreach and active case finding are also taking place. These projects place MSF in a unique position to study Noma, and to add to the scant body of knowledge around the disease.
AIM
To identify risk factors for Noma in northwest Nigeria in terms of epidemiological (demographic characteristics, medical history), socio-economic-behavioural aspects and access to health care in order to better guide existing prevention strategies.
SPECIFIC OBJECTIVES
1. To understand concepts and perceptions of Noma within the population of northwestern Nigeria, specifically those affected (caretakers of Noma cases) by the disease, and controls matching these cases. To describe the epidemiological profile of all cases of Noma that have been treated at the MSF Noma Children’s Hospital from August 2015 until June 2016;
2. To describe the current Noma patient’s clinical history before the onset of the disease, the start of the disease and the care/treatment sought as well as the impact of Noma on the patient;
3. To assess Noma risk factors by comparing cases enrolled at the Noma Children’s Hospital and controls matched to cases by sex, age, and village of residence;
All of these objectives are in order to assess if there are intervention opportunities in the unique Nigerian setting that could prevent further Noma case development.
METHODS
1) Qualitative phase: focus groups will take place with care takers (guardians or parents) of cases as well as key informant interviews with health care workers to better understand the local concepts, vocabulary and expressions used to describe Noma in this part of Nigeria.
2) Descriptive epidemiology: description of all available medical, nutritional and mental health data associated with the Noma patients operated on at the Noma Children’s Hospital over the last year.
3) Case control study: assessing risk factors for Noma using care takers of cases recruited from the Noma Children’s Hospital and care takers of controls that are recruited from cases village of residence and matched by age and sex.
OUTCOMES
• Initiate the MSF operational research agenda around Noma in Nigeria;
• Improved understanding of local beliefs, traditions and language used to describe Noma;
• Improved understanding of Noma patients at the Sokoto Children’s hospital;
• Identification of preventable risk factors for Noma development in our patients;
• Integration of information obtained into outreach programming, improved community engagements, options for preventative campaigns and overall improved clinical and mental health care of Noma patients and caretakers in the MSF project.
Journal Article > ResearchFull Text
BMJ Open. 2022 January 11; Volume 12 (Issue 1); e053661.; DOI:10.1136/bmjopen-2021-053661
Van Boetzelaer E, Fotso A, Angelova I, Huisman G, Thorson T, et al.
BMJ Open. 2022 January 11; Volume 12 (Issue 1); e053661.; DOI:10.1136/bmjopen-2021-053661
OBJECTIVES
This study will contribute to the systematic epidemiological description of morbidities among migrants, refugees and asylum seekers when crossing the Mediterranean Sea.
SETTING
Since 2015, Médecins sans Frontières (MSF) has conducted search and rescue activities on the Mediterranean Sea to save lives, provide medical services, to witness and to speak out.
PARTICIPANTS
Between November 2016 and December 2019, MSF rescued 22 966 migrants, refugees and asylum seekers.
PRIMARY AND SECONDARY OUTCOME MEASURES
We conducted retrospective data analysis of data collected between January 2016 and December 2019 as part of routine monitoring of the MSF's healthcare services for migrants, refugees and asylum seekers on two search and rescue vessels.
RESULTS
MSF conducted 12 438 outpatient consultations and 853 sexual and reproductive health consultations (24.9% of female population, 853/3420) and documented 287 consultations for sexual and gender-based violence (SGBV). The most frequently diagnosed health conditions among children aged 5 years or older and adults were skin conditions (30.6%, 5475/17 869), motion sickness (28.6%, 5116/17 869), headache (15.4%, 2 748/17 869) and acute injuries (5.7%, 1013/17 869). Of acute injuries, 44.7% were non-violence-related injuries (453/1013), 30.1% were fuel burns (297/1013) and 25.4% were violence-related injuries (257/1013).
CONCLUSION
The limited testing and diagnostics capacity of the outpatient department, space limitations, stigma and the generally short length of stay of migrants, refugees and asylum seekers on the ships have likely led to an underestimation of morbidities, including mental health conditions and SGBV. The main diagnoses on board were directly related to journey on land and sea and stay in Libya. We conclude that this population may be relatively young and healthy but displays significant journey-related illnesses and includes migrants, refugees and asylum seekers who have suffered significant violence during their transit and need urgent access to essential services and protection in a place of safety on land.
This study will contribute to the systematic epidemiological description of morbidities among migrants, refugees and asylum seekers when crossing the Mediterranean Sea.
SETTING
Since 2015, Médecins sans Frontières (MSF) has conducted search and rescue activities on the Mediterranean Sea to save lives, provide medical services, to witness and to speak out.
PARTICIPANTS
Between November 2016 and December 2019, MSF rescued 22 966 migrants, refugees and asylum seekers.
PRIMARY AND SECONDARY OUTCOME MEASURES
We conducted retrospective data analysis of data collected between January 2016 and December 2019 as part of routine monitoring of the MSF's healthcare services for migrants, refugees and asylum seekers on two search and rescue vessels.
RESULTS
MSF conducted 12 438 outpatient consultations and 853 sexual and reproductive health consultations (24.9% of female population, 853/3420) and documented 287 consultations for sexual and gender-based violence (SGBV). The most frequently diagnosed health conditions among children aged 5 years or older and adults were skin conditions (30.6%, 5475/17 869), motion sickness (28.6%, 5116/17 869), headache (15.4%, 2 748/17 869) and acute injuries (5.7%, 1013/17 869). Of acute injuries, 44.7% were non-violence-related injuries (453/1013), 30.1% were fuel burns (297/1013) and 25.4% were violence-related injuries (257/1013).
CONCLUSION
The limited testing and diagnostics capacity of the outpatient department, space limitations, stigma and the generally short length of stay of migrants, refugees and asylum seekers on the ships have likely led to an underestimation of morbidities, including mental health conditions and SGBV. The main diagnoses on board were directly related to journey on land and sea and stay in Libya. We conclude that this population may be relatively young and healthy but displays significant journey-related illnesses and includes migrants, refugees and asylum seekers who have suffered significant violence during their transit and need urgent access to essential services and protection in a place of safety on land.
Journal Article > ResearchFull Text
J Immigr Minor Health. 2022 October 22; Online ahead of print; DOI:10.1007/s10903-022-01408-7
Carrion-Martin AI, Alrawashdeh A, Karapanagos G, Mahmoud R, Ta’anii N, et al.
J Immigr Minor Health. 2022 October 22; Online ahead of print; DOI:10.1007/s10903-022-01408-7
Non-communicable diseases (NCDs) are high-prevalence health problems among Syrian refugees. In 2014, Médecins Sans Frontières (MSF) identified unmet NCD care needs and began providing free-of-charge services for Syrian refugees in Irbid, Jordan. This study aimed to describe current socioeconomic and medical vulnerabilities among MSF Irbid Syrian refugee patients and their households and raise awareness of their ongoing health needs that must be addressed. A cross-sectional survey among Syrian refugees attending MSF NCD services in Irbid Governorate, Jordan was conducted by telephone interviews in January 2021 to query sociodemographic characteristics, economic situation, self-reported NCD prevalence, and Ministry of Health (MoH) policy awareness. Descriptive analysis of indicators included proportions or means presented with 95% confidence intervals. The survey included 350 patient-participants in 350 households and 2157 household members. Mean age was 28.3 years. Only 13.5% of household members had paid or self-employed work; 44% of households had no working members. Mean monthly income was 258.3 JOD (95%CI: 243.5–273.1) per household. Mean expenditures were 320.0 JOD (95%CI: 305.1–334.9). Debt was reported by 93% of households. NCD prevalence among adults was 42% (95%CI: 40–45). Hypertension was most prevalent (31.1%, 95%CI: 28.7–33.7), followed by diabetes (21.8%, 95%CI: 19.7–24.1) and cardiovascular diseases (14.4%, 95%CI: 12.6–16.4). Only 23% of interviewees were aware of subsidized MoH rates for NCD care. Twenty-nine percent stated they will not seek MoH care, mainly due to the unaffordable price. Our findings highlight increased vulnerability among MSF Irbid Syrian refugee NCD patients and their households, including: an older population; a high percentage of unemployment and reliance on cash assistance; higher proportion of households in debt and a high number of households having to resort to extreme coping mechanisms when facing a health emergency; and a higher proportion of people with multiple comorbid NCDs and physical disability. Their awareness of subsidised MoH care was low. MoH care is expected to be unaffordable for many. These people are at increased risk of morbidity and mortality. It is vital that health actors providing care for Syrian refugees take action to reduce their risk, including implementing financial support mechanisms and free healthcare.
Protocol > Research Study
Hadera A, Huisman G, Kaur G, Oluyide B, Greig J, et al.
2018 July 1