Journal Article > ReviewAbstract
Lancet. 2015 April 27; Volume 385; DOI:10.1016/S0140-6736(15)60826-1
Sharma DB, Hayman K, Stewart BT, Dominguez LB, Trelles M, et al.
Lancet. 2015 April 27; Volume 385; DOI:10.1016/S0140-6736(15)60826-1
Journal Article > ResearchFull Text
Public Health Action. 2019 September 1; 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. 2019 September 1; Volume 9 (Issue 3); 107-112.; DOI:10.5588/pha.18.0045
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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 > ResearchAbstract
Surg Infect (Larchmt). 2015 July 31 (Issue 6)
Sharma DB, Hayman K, Stewart BT, Dominguez LB, Trelles M, et al.
Surg Infect (Larchmt). 2015 July 31 (Issue 6)
Surgery for infection represents a substantial, although undefined, disease burden in low- and middle-income countries (LMICs). Médecins Sans Frontières-Operations Centre Brussels (MSF-OCB) provides surgical care in LMICs and collects data useful for describing operative epidemiology of surgical need otherwise unmet by national health services. This study aimed to describe the experience of MSF-OCB operations for infections in LMICs. By doing so, the results might aid effective resource allocation and preparation of future humanitarian staff.
Journal Article > ResearchFull Text
PLoS Curr. 2015 March 27; Volume 7; ecurrents.dis.5e30807568eaad09a3e23282ddb41da6.; DOI:10.1371/currents.dis.5e30807568eaad09a3e2328
Stewart BT, Wong EG, Papillon-Smith J, Trelles Centurion M, Dominguez LB, et al.
PLoS Curr. 2015 March 27; Volume 7; ecurrents.dis.5e30807568eaad09a3e23282ddb41da6.; DOI:10.1371/currents.dis.5e30807568eaad09a3e2328
Surgical capacity assessments in low-income countries have demonstrated critical deficiencies. Though vital for planning capacity improvements, these assessments are resource intensive and impractical during the planning phase of a humanitarian crisis. This study aimed to determine cesarean sections to total operations performed (CSR) and emergency herniorrhaphies to all herniorrhaphies performed (EHR) ratios from Médecins Sans Frontières Operations Centre Brussels (MSF-OCB) projects and examine if these established metrics are useful proxies for surgical capacity in low-income countries affected by crisis.
Journal Article > ResearchFull Text
J Burn Care Res. 2016 November 1; Volume 37 (Issue 6); e519–e524.; DOI:10.1097/BCR.0000000000000305
Stewart BT, Trelles M, Dominguez LB, Wong EG, Fiozounam HT, et al.
J Burn Care Res. 2016 November 1; Volume 37 (Issue 6); e519–e524.; DOI:10.1097/BCR.0000000000000305
OBJECTIVE
Humanitarian organisations care for burns during crisis and while supporting healthcare facilities in low- and middle-income countries. This study aimed to define the epidemiology of burn-related procedures to aid humanitarian response. In addition, operational data collected from humanitarian organisations are useful for describing surgical need otherwise unmet by national health systems.
METHOD
Procedures performed in operating theatres run by MSF Operations Centre Brussels (MSF-OCB) from July 2008 through June 2014 were reviewed. Surgical specialist missions were excluded. Burn procedures were quantified, related to demographics and reason for humanitarian response and described.
RESULTS
A total of 96,239 operations were performed at 27 MSF-OCB projects in 15 countries between 2008 – 2014. Of the 33,947 general surgical operations, 4,280 (11%) were for burns. This proportion steadily increased from 3% in 2008 to 24% in 2014. People receiving surgical care from conflict relief missions had nearly twice the odds of having a burn operation compared to people requiring surgery in communities affected by natural disaster (aOR 1.94, 95%CI 1.46 – 2.58). Nearly 70% of burn procedures were planned serial visits to the theatre. A diverse skill-set was required.
CONCLUSION
Unmet humanitarian assistance needs increased US$ 400 million dollars in 2013 in the face of an increasing number of individuals affected by crisis and a growing surgical burden. Given the high volume of burn procedures performed at MSF-OCB projects and the resource intensive nature of burn management, requisite planning and reliable funding are necessary to ensure quality for burn care in humanitarian settings.
Humanitarian organisations care for burns during crisis and while supporting healthcare facilities in low- and middle-income countries. This study aimed to define the epidemiology of burn-related procedures to aid humanitarian response. In addition, operational data collected from humanitarian organisations are useful for describing surgical need otherwise unmet by national health systems.
METHOD
Procedures performed in operating theatres run by MSF Operations Centre Brussels (MSF-OCB) from July 2008 through June 2014 were reviewed. Surgical specialist missions were excluded. Burn procedures were quantified, related to demographics and reason for humanitarian response and described.
RESULTS
A total of 96,239 operations were performed at 27 MSF-OCB projects in 15 countries between 2008 – 2014. Of the 33,947 general surgical operations, 4,280 (11%) were for burns. This proportion steadily increased from 3% in 2008 to 24% in 2014. People receiving surgical care from conflict relief missions had nearly twice the odds of having a burn operation compared to people requiring surgery in communities affected by natural disaster (aOR 1.94, 95%CI 1.46 – 2.58). Nearly 70% of burn procedures were planned serial visits to the theatre. A diverse skill-set was required.
CONCLUSION
Unmet humanitarian assistance needs increased US$ 400 million dollars in 2013 in the face of an increasing number of individuals affected by crisis and a growing surgical burden. Given the high volume of burn procedures performed at MSF-OCB projects and the resource intensive nature of burn management, requisite planning and reliable funding are necessary to ensure quality for burn care in humanitarian settings.
Journal Article > ResearchAbstract
J Pediatr Surg. 2015 September 15; Volume 51 (Issue 4); DOI:10.1016/j.jpedsurg.2015.08.063
Flynn- O Brien KT, Trelles M, Dominguez LB, Hassani GH, Akemani C, et al.
J Pediatr Surg. 2015 September 15; Volume 51 (Issue 4); DOI:10.1016/j.jpedsurg.2015.08.063