Journal Article > CommentaryFull Text
Lancet Healthy Longev
Healthy longevity. 2024 January 1; Volume 5 (Issue 1); e76-e82.; DOI:10.1016/S2666-7568(23)00244-1
van Boetzelaer E, van de Kamp J, Keating P, Sharma SK, Pellecchia U, et al.
Lancet Healthy Longev
Healthy longevity. 2024 January 1; Volume 5 (Issue 1); e76-e82.; DOI:10.1016/S2666-7568(23)00244-1
Journal Article > ResearchFull Text
PLOS One. 2021 March 26; Volume 16 (Issue 3); e0249098.; DOI:10.1371/journal.pone.0249098
Kaelen S, van den Boogaard W, Pellecchia U, Spiers S, De Cramer C, et al.
PLOS One. 2021 March 26; Volume 16 (Issue 3); e0249098.; DOI:10.1371/journal.pone.0249098
BACKGROUND
Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly.
METHODS
A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020.
RESULTS
NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling ‘trapped’ between IPC and the residents’ wellbeing. They witnessed the detrimental effects of the measures imposed on their residents.
CONCLUSION
This study revealed the insights of residents’ and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents’ mental health impact and to enhance their quality of life.
Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly.
METHODS
A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020.
RESULTS
NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling ‘trapped’ between IPC and the residents’ wellbeing. They witnessed the detrimental effects of the measures imposed on their residents.
CONCLUSION
This study revealed the insights of residents’ and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents’ mental health impact and to enhance their quality of life.
Journal Article > ResearchAbstract
Anthropol Action. 2017 June 1; Volume 24 (Issue 2); DOI:10.3167/aia.2017.240203
Pellecchia U
Anthropol Action. 2017 June 1; Volume 24 (Issue 2); DOI:10.3167/aia.2017.240203
Technical Report > Policy Brief
Voûte C, Baker H, Baidjoe AY, Bartrem C, Charrier M, et al.
2024 October 29
At the time of writing, many people around the world are feeling the pain, disruption, and devastating health consequences driven by climate change. The world has been shocked by the widespread flooding in Europe and the consecutive catastrophic hurricanes in North America. Yet far less attention is given to the impacts of climate change in places where Médecins Sans Frontières (MSF) works, such as Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Myanmar, Niger, Nigeria, and South Sudan. In 2024, these populations have likewise been affected by devastating floods, many of them not for the first time.
Although immediate impacts like injury, displacement, and limited access to healthcare may be similar worldwide, the compounding crises that follow and the capacity to recover from these vary significantly. Individuals in low-resource and humanitarian settings face significant health threats while contributing the least to global emissions. These regions are often vulnerable to climate hazards and possess low adaptive capacity, increasing people’s susceptibility to the negative impacts of climate change.
In this brief, drawing on evidence from indicators in the 2024 report of the Lancet Countdown on Health and Climate Change, MSF teams present examples of how climate change and environmental degradation are making provision of assistance more difficult by amplifying health and humanitarian needs and by further complicating interventions. It also highlights activities that respond to the climate crisis using a three-pillar approach: mitigating MSF’s environmental footprint, adapting healthcare delivery and emergency response to the current and future realities of climate change, and advocating for those impacted.
The complexity of climate change and environmental degradation, coupled with highly politicised and siloed global response efforts often make it insufficiently clear to health and humanitarian implementing partners that every issue is part of a continuous process, where each component informs the others. In this brief, MSF staff outline six focus areas where teams are engaged in developing environmentally-informed health and humanitarian interventions, emphasising their interdependence, and how failure to act on one issue not only impedes progress on that specific component but also affects the entire sequence of subsequent actions.
Journal Article > CommentaryFull Text
PLOS Glob Public Health. 2023 July 17; Volume 3 (Issue 7); e0002142.; DOI:10.1371/journal.pgph.0002142
van Boetzelaer E, Browne JL, Vaid S, Pellecchia U, van de Kamp J, et al.
PLOS Glob Public Health. 2023 July 17; Volume 3 (Issue 7); e0002142.; DOI:10.1371/journal.pgph.0002142
Journal Article > ResearchFull Text
Int J Migr Health Soc Care. 2021 August 1; Volume 17 (Issue 3); 241-258.; DOI:10.1108/IJMHSC-08-2020-0082
Whitehouse K, Lambe E, Rodriguez S, Pellecchia U, Ponthieu A, et al.
Int J Migr Health Soc Care. 2021 August 1; Volume 17 (Issue 3); 241-258.; DOI:10.1108/IJMHSC-08-2020-0082
PURPOSE
Prolonged exposure to daily stressors can have long-term detrimental implications for overall mental health. For asylum seekers in European Union transit or destination countries, navigating life in reception centres can represent a significant burden. The purpose of this study was to explore post-migration stressors during residency in reception centres, and to formulate recommendations for adequate service provision in Belgium.
DESIGN/METHODOLOGY/APPROACH
Research was conducted in two reception centres in Belgium. A total of 41 in-depth interviews were carried out with asylum seeker residents (n = 29) and staff (n = 12). Purposive recruitment was used for asylum seekers (for variation in length of centre residency and family status) and staff (variation in job profiles). Interviews were conducted in English, French or with a translator in Arabic or Dari. Interviews were audio-recorded, transcribed verbatim and manually coded using thematic analysis.
FINDINGS
Asylum seekers face significant constraints with regard to their living conditions, including total absence of privacy, overcrowding and unhygienic conditions. These act as continuous and prolonged exposure to daily stressors. Several barriers to accessing activities or integration opportunities prevent meaningful occupation, contribute towards eroded autonomy and isolation of asylum seeker residents. Inadequate capacity and resources for the provision of psychosocial support in reception centres leads to a sense of abandonment and worthlessness.
ORIGINALITY/VALUE
Analysis indicates that structural and practical challenges to adequately support asylum seekers are rooted in policy failures necessary for appropriate resourcing and prioritization of preventative measures. Such deliberate decisions contribute towards state deterrence strategies, eroding both individual well-being and manufacturing a crisis in the systems of support for asylum seekers.
Prolonged exposure to daily stressors can have long-term detrimental implications for overall mental health. For asylum seekers in European Union transit or destination countries, navigating life in reception centres can represent a significant burden. The purpose of this study was to explore post-migration stressors during residency in reception centres, and to formulate recommendations for adequate service provision in Belgium.
DESIGN/METHODOLOGY/APPROACH
Research was conducted in two reception centres in Belgium. A total of 41 in-depth interviews were carried out with asylum seeker residents (n = 29) and staff (n = 12). Purposive recruitment was used for asylum seekers (for variation in length of centre residency and family status) and staff (variation in job profiles). Interviews were conducted in English, French or with a translator in Arabic or Dari. Interviews were audio-recorded, transcribed verbatim and manually coded using thematic analysis.
FINDINGS
Asylum seekers face significant constraints with regard to their living conditions, including total absence of privacy, overcrowding and unhygienic conditions. These act as continuous and prolonged exposure to daily stressors. Several barriers to accessing activities or integration opportunities prevent meaningful occupation, contribute towards eroded autonomy and isolation of asylum seeker residents. Inadequate capacity and resources for the provision of psychosocial support in reception centres leads to a sense of abandonment and worthlessness.
ORIGINALITY/VALUE
Analysis indicates that structural and practical challenges to adequately support asylum seekers are rooted in policy failures necessary for appropriate resourcing and prioritization of preventative measures. Such deliberate decisions contribute towards state deterrence strategies, eroding both individual well-being and manufacturing a crisis in the systems of support for asylum seekers.
Conference Material > Poster
Trentesaux M, Pellecchia U, Naim C, Baxerres C
MSF Scientific Day International 2023. 2023 June 7
Journal Article > ResearchFull Text
Front Public Health. 2023 June 2; Volume 11; 1077068.; DOI:10.3389/fpubh.2023.1077068
Amat Camacho N, Chara A, Briskin E, Pellecchia U, Kyi HA, et al.
Front Public Health. 2023 June 2; Volume 11; 1077068.; DOI:10.3389/fpubh.2023.1077068
BACKGROUND
Breastfeeding (BF) should be protected, promoted, and supported for all infants in humanitarian settings. The re-establishment of exclusive BF is also a central part of the management of acutely malnourished infants under 6 months (<6 m). Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) perceptions of BF practice, promotion, and support among CGs with infants <6 m in this setting.
METHODS
We conducted a qualitative study using in-depth interviews and focus group discussions combined with non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programs or who attended health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data were collected involving a local translator and analyzed using reflexive thematic analysis directly from audio recordings.
RESULTS
Participants described how feeding practices are shaped by family, community, and traditional beliefs. The perception of breastmilk insufficiency was common and led to early supplementary feeding with inexpensive but unsuitable products. Participants often linked insufficient breastmilk production with poor maternal nutrition and stress, in a context shaped by conflict and food insecurity. BF promotion was generally well received but could be improved if tailored to address specific barriers to exclusive BF. Interviewed CGs positively valued BF support received as part of the comprehensive treatment for infant malnutrition. One of the main challenges identified was the length of stay at the facility. Some participants perceived that improvements in BF were at risk of being lost after discharge if CGs lacked an enabling environment for BF.
CONCLUSION
This study corroborates the strong influence of household and contextual factors on the practice, promotion, and support of BF. Despite identified challenges, the provision of BF support contributes to improvements in BF practice and was positively perceived by CGs in the studied setting. Greater attention should be directed toward providing support and follow-up for infants <6 m and their CGs in the community.
Breastfeeding (BF) should be protected, promoted, and supported for all infants in humanitarian settings. The re-establishment of exclusive BF is also a central part of the management of acutely malnourished infants under 6 months (<6 m). Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) perceptions of BF practice, promotion, and support among CGs with infants <6 m in this setting.
METHODS
We conducted a qualitative study using in-depth interviews and focus group discussions combined with non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programs or who attended health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data were collected involving a local translator and analyzed using reflexive thematic analysis directly from audio recordings.
RESULTS
Participants described how feeding practices are shaped by family, community, and traditional beliefs. The perception of breastmilk insufficiency was common and led to early supplementary feeding with inexpensive but unsuitable products. Participants often linked insufficient breastmilk production with poor maternal nutrition and stress, in a context shaped by conflict and food insecurity. BF promotion was generally well received but could be improved if tailored to address specific barriers to exclusive BF. Interviewed CGs positively valued BF support received as part of the comprehensive treatment for infant malnutrition. One of the main challenges identified was the length of stay at the facility. Some participants perceived that improvements in BF were at risk of being lost after discharge if CGs lacked an enabling environment for BF.
CONCLUSION
This study corroborates the strong influence of household and contextual factors on the practice, promotion, and support of BF. Despite identified challenges, the provision of BF support contributes to improvements in BF practice and was positively perceived by CGs in the studied setting. Greater attention should be directed toward providing support and follow-up for infants <6 m and their CGs in the community.
Conference Material > Abstract
Camacho A, Chara A, Htet Aung K, Hussein F, Nzala JC, et al.
MSF Paediatric Days 2022. 2022 November 26; DOI:10.57740/2s5d-th30
BACKGROUND AND AIMS
International guidelines on infant feeding in emergencies advise protecting, promoting, and supporting breastfeeding (BF) for all infants in these settings. The re-establishment of exclusive BF (EBF) is also a central part of the management of acutely malnourished infants under six months old. More evidence on the feasibility, acceptance, and impact of BF promotion and support during emergencies is needed. Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) experiences and perceptions of BF practice, promotion, and support.
METHODS
We conducted a qualitative study using in-depth interviews, focus group discussions and non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programmes or reached during health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data was collected involving a local translator and analysed using reflexive thematic analysis directly from audio recordings. [Download full PDF for more information on participants.]
RESULTS
Data shows how BF practices are strongly influenced by family and community. BF is common, although EBF for the first six months remains suboptimal. Frequent perception of breastmilk insufficiency, leading to early supplementary feeding, is associated with poor maternal nutrition, stress, and inadequate BF practice, in a context shaped by displacement and food insecurity. Yet, EBF seems to increase over time, due to growing access to BF promotion. The provision of comprehensive in-patient care generally leads to acceptance and positive outcomes of BF support. The achievement of EBF may be reversed after discharge if CGs lack an enabling environment for BF.
CONCLUSIONS
When designing promotion and support strategies, BF should be understood as an embodied experience shaped by socio-cultural and contextual factors. More emphasis should be placed on the follow-up and management of nutritionally at-risk mothers and infants in the community.
International guidelines on infant feeding in emergencies advise protecting, promoting, and supporting breastfeeding (BF) for all infants in these settings. The re-establishment of exclusive BF (EBF) is also a central part of the management of acutely malnourished infants under six months old. More evidence on the feasibility, acceptance, and impact of BF promotion and support during emergencies is needed. Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) experiences and perceptions of BF practice, promotion, and support.
METHODS
We conducted a qualitative study using in-depth interviews, focus group discussions and non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programmes or reached during health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data was collected involving a local translator and analysed using reflexive thematic analysis directly from audio recordings. [Download full PDF for more information on participants.]
RESULTS
Data shows how BF practices are strongly influenced by family and community. BF is common, although EBF for the first six months remains suboptimal. Frequent perception of breastmilk insufficiency, leading to early supplementary feeding, is associated with poor maternal nutrition, stress, and inadequate BF practice, in a context shaped by displacement and food insecurity. Yet, EBF seems to increase over time, due to growing access to BF promotion. The provision of comprehensive in-patient care generally leads to acceptance and positive outcomes of BF support. The achievement of EBF may be reversed after discharge if CGs lack an enabling environment for BF.
CONCLUSIONS
When designing promotion and support strategies, BF should be understood as an embodied experience shaped by socio-cultural and contextual factors. More emphasis should be placed on the follow-up and management of nutritionally at-risk mothers and infants in the community.
Journal Article > ResearchFull Text
J Int AIDS Soc. 2017 March 28; Volume 20 (Issue 1); 21374.; DOI:10.7448/IAS.20.1.21374
Pellecchia U, Baert S, Nundwe S, Bwanali A, Zamadenga B, et al.
J Int AIDS Soc. 2017 March 28; Volume 20 (Issue 1); 21374.; DOI:10.7448/IAS.20.1.21374
INTRODUCTION
In 2012 Community ART Groups (CAGs), a community-based model of antiretroviral therapy (ART) delivery were piloted in Thyolo District, Malawi as a way to overcome patient barriers to accessing treatment, and to decrease healthcare workers' workload. CAGs are self-formed groups of patients on ART taking turns to collect ART refills for all group members from the health facility. We conducted a qualitative study to assess the benefits and challenges of CAGs from patients' and healthcare workers' (HCWs) perspectives.
METHODS
Data were collected by means of 15 focus group discussions, 15 individual in-depth interviews, and participant observation in 2 health centres. The 94 study participants included CAG members, ART patients eligible for CAGs who remained in conventional care, former CAG members who returned to conventional care and HCWs responsible for providing HIV care. Patient participants were purposively selected from ART registers, taking into account age and gender. Narratives were audio-recorded, transcribed, and translated from Chichewa to English. Data were analyzed through a thematic analysis.
RESULTS
Patients and HCWs spoke favourably about the practical benefits of CAGs. Patient benefits included a reduced frequency of clinic visits, resulting in reduced transportation costs and time savings. HCW benefits included a reduced workload. Additionally peer support was perceived as an added value of the groups allowing not only sharing of the logistical constraints of drugs refills, but also enhanced emotional support. Identified barriers to joining a CAG included a lack of information on CAGs, unwillingness to disclose one's HIV status, change of residence and conflicts among CAG members. Participants reported that HIV-related stigma persists and CAGs were seen as an effective strategy to reduce exposure to discriminatory labelling by community members.
CONCLUSION
In this setting, patients and HCWs perceived CAGs to be an acceptable model of ART delivery. Despite addressing important practical barriers to accessing ART, and providing peer support, CAGs were not well known by patients and had a limited impact on reducing HIV-related stigma. The CAG model of ART delivery should be considered in similar settings. Further measures need to be devised and implemented to address HIV-related stigma.
In 2012 Community ART Groups (CAGs), a community-based model of antiretroviral therapy (ART) delivery were piloted in Thyolo District, Malawi as a way to overcome patient barriers to accessing treatment, and to decrease healthcare workers' workload. CAGs are self-formed groups of patients on ART taking turns to collect ART refills for all group members from the health facility. We conducted a qualitative study to assess the benefits and challenges of CAGs from patients' and healthcare workers' (HCWs) perspectives.
METHODS
Data were collected by means of 15 focus group discussions, 15 individual in-depth interviews, and participant observation in 2 health centres. The 94 study participants included CAG members, ART patients eligible for CAGs who remained in conventional care, former CAG members who returned to conventional care and HCWs responsible for providing HIV care. Patient participants were purposively selected from ART registers, taking into account age and gender. Narratives were audio-recorded, transcribed, and translated from Chichewa to English. Data were analyzed through a thematic analysis.
RESULTS
Patients and HCWs spoke favourably about the practical benefits of CAGs. Patient benefits included a reduced frequency of clinic visits, resulting in reduced transportation costs and time savings. HCW benefits included a reduced workload. Additionally peer support was perceived as an added value of the groups allowing not only sharing of the logistical constraints of drugs refills, but also enhanced emotional support. Identified barriers to joining a CAG included a lack of information on CAGs, unwillingness to disclose one's HIV status, change of residence and conflicts among CAG members. Participants reported that HIV-related stigma persists and CAGs were seen as an effective strategy to reduce exposure to discriminatory labelling by community members.
CONCLUSION
In this setting, patients and HCWs perceived CAGs to be an acceptable model of ART delivery. Despite addressing important practical barriers to accessing ART, and providing peer support, CAGs were not well known by patients and had a limited impact on reducing HIV-related stigma. The CAG model of ART delivery should be considered in similar settings. Further measures need to be devised and implemented to address HIV-related stigma.