MSF Ethics Review Board > Publications
BMC Medical Ethics. 2015 February 26; Volume 16; 10.; DOI:10.1186/s12910-015-0002-3
Schopper D, Dawson A, Upshur R, Ahmad ASI, Jesani A, et al.
BMC Medical Ethics. 2015 February 26; Volume 16; 10.; DOI:10.1186/s12910-015-0002-3
BACKGROUND
Médecins Sans Frontières (MSF) is one of the world’s leading humanitarian medical organizations. The increased emphasis in MSF on research led to the creation of an ethics review board (ERB) in 2001. The ERB has
encouraged innovation in the review of proposals and the interaction between the ERB and the organization. This has led to some of the advances in ethics governance described in this paper.
DISCUSSION
We first update our previous work from 2009 describing ERB performance and then highlight five innovative practices:
• A new framework to guide ethics review
• The introduction of a policy exempting a posteriori analysis of routinely collected data
• The preapproval of “emergency” protocols
• General ethical approval of “routine surveys”
• Evaluating the impact of approved studies
The new framework encourages a conversation about ethical issues, rather than imposing quasi-legalistic rules, is more engaged with the specific MSF research context and gives greater prominence to certain values and
principles. Some of the innovations implemented by the ERB, such as review exemption or approval of generic protocols, may run counter to many standard operating procedures. We argue that much standard practice in research ethics review ought to be open to challenge and revision. Continued interaction between MSF researchers and independent ERB members has allowed for progressive innovations based on a trustful and respectful partnership between the ERB and the researchers. In the future, three areas merit particular attention. First, the impact of the new framework should be assessed. Second, the impact of research needs to be defined more precisely as a first step towards being meaningfully assessed, including changes of impact over time. Finally, the dialogue between the MSF ERB and the ethics committees in the study countries should be enhanced.
SUMMARY
We hope that the innovations in research ethics governance described may be relevant for other organisations carrying out research in fragile contexts and for ethics committees reviewing such research.
Médecins Sans Frontières (MSF) is one of the world’s leading humanitarian medical organizations. The increased emphasis in MSF on research led to the creation of an ethics review board (ERB) in 2001. The ERB has
encouraged innovation in the review of proposals and the interaction between the ERB and the organization. This has led to some of the advances in ethics governance described in this paper.
DISCUSSION
We first update our previous work from 2009 describing ERB performance and then highlight five innovative practices:
• A new framework to guide ethics review
• The introduction of a policy exempting a posteriori analysis of routinely collected data
• The preapproval of “emergency” protocols
• General ethical approval of “routine surveys”
• Evaluating the impact of approved studies
The new framework encourages a conversation about ethical issues, rather than imposing quasi-legalistic rules, is more engaged with the specific MSF research context and gives greater prominence to certain values and
principles. Some of the innovations implemented by the ERB, such as review exemption or approval of generic protocols, may run counter to many standard operating procedures. We argue that much standard practice in research ethics review ought to be open to challenge and revision. Continued interaction between MSF researchers and independent ERB members has allowed for progressive innovations based on a trustful and respectful partnership between the ERB and the researchers. In the future, three areas merit particular attention. First, the impact of the new framework should be assessed. Second, the impact of research needs to be defined more precisely as a first step towards being meaningfully assessed, including changes of impact over time. Finally, the dialogue between the MSF ERB and the ethics committees in the study countries should be enhanced.
SUMMARY
We hope that the innovations in research ethics governance described may be relevant for other organisations carrying out research in fragile contexts and for ethics committees reviewing such research.
Conference Material > Slide Presentation
Wardley T, West KP, Tesfay B, Robinson N, Parry L, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/EQ5OG2MuMi
Journal Article > ResearchFull Text
Trials. 2021 December 4; Volume 22; 881 .; DOI:10.1186/s13063-021-05850-0
Wharton-Smith A, Horter SCB, Douch E, Gray NSB, James N, et al.
Trials. 2021 December 4; Volume 22; 881 .; DOI:10.1186/s13063-021-05850-0
BACKGROUND
Addressing the global burden of multidrug-resistant tuberculosis (MDR-TB) requires identification of shorter, less toxic treatment regimens. Médecins Sans Frontières (MSF) is currently conducting a phase II/III randomised controlled clinical trial, to find more effective, shorter and tolerable treatments for people with MDR-TB. Recruitment to the trial in Uzbekistan has been slower than expected; we aimed to study patient and health worker experiences of the trial, examining potential factors perceived to impede and facilitate trial recruitment, as well as general perceptions of clinical research in this context.
METHODS
We conducted a qualitative study using maximum variation, purposive sampling of participants. We carried out in-depth interviews (IDIs) and focus group discussions (FGDs) guided by semi-structured topic guides. In December 2019 and January 2020, 26 interviews were conducted with patients, Ministry of Health (MoH) and MSF staff and trial health workers, to explore challenges and barriers to patient recruitment as well as perceptions of the trial and research in general. Preliminary findings from the interviews informed three subsequent focus group discussions held with patients, nurses and counsellors. Focus groups adopted a person-centred design, brainstorming potential solutions to problems and barriers. Interviews and FGDs were audio recorded, translated and transcribed verbatim. Thematic analysis, drawing on constant comparison, was used to analyse the data.
RESULTS
Health system contexts may compete with new approaches especially when legislative health regulations or policy around treatment is ingrained in staff beliefs, perceptions and practice, which can undermine clinical trial recruitment. Trust plays a significant role in how patients engage with the trial. Decision-making processes are dynamic and associated with relationship to diagnosis, assimilation of information, previous knowledge or experience and influence of peers and close relations.
CONCLUSIONS
This qualitative analysis highlights ways in which insights developed together with patients and healthcare workers might inform approaches towards improved recruitment into trials, with the overall objective of delivering evidence for better treatments.
Addressing the global burden of multidrug-resistant tuberculosis (MDR-TB) requires identification of shorter, less toxic treatment regimens. Médecins Sans Frontières (MSF) is currently conducting a phase II/III randomised controlled clinical trial, to find more effective, shorter and tolerable treatments for people with MDR-TB. Recruitment to the trial in Uzbekistan has been slower than expected; we aimed to study patient and health worker experiences of the trial, examining potential factors perceived to impede and facilitate trial recruitment, as well as general perceptions of clinical research in this context.
METHODS
We conducted a qualitative study using maximum variation, purposive sampling of participants. We carried out in-depth interviews (IDIs) and focus group discussions (FGDs) guided by semi-structured topic guides. In December 2019 and January 2020, 26 interviews were conducted with patients, Ministry of Health (MoH) and MSF staff and trial health workers, to explore challenges and barriers to patient recruitment as well as perceptions of the trial and research in general. Preliminary findings from the interviews informed three subsequent focus group discussions held with patients, nurses and counsellors. Focus groups adopted a person-centred design, brainstorming potential solutions to problems and barriers. Interviews and FGDs were audio recorded, translated and transcribed verbatim. Thematic analysis, drawing on constant comparison, was used to analyse the data.
RESULTS
Health system contexts may compete with new approaches especially when legislative health regulations or policy around treatment is ingrained in staff beliefs, perceptions and practice, which can undermine clinical trial recruitment. Trust plays a significant role in how patients engage with the trial. Decision-making processes are dynamic and associated with relationship to diagnosis, assimilation of information, previous knowledge or experience and influence of peers and close relations.
CONCLUSIONS
This qualitative analysis highlights ways in which insights developed together with patients and healthcare workers might inform approaches towards improved recruitment into trials, with the overall objective of delivering evidence for better treatments.
MSF Ethics Review Board > Publications
PLOS Med. 2009 July 28; Volume 6 (Issue 7); e1000115.; DOI:10.1371/journal.pmed.1000115
Schopper D, Upshur R, Matthys F, Singh JA, Bandewar SS, et al.
PLOS Med. 2009 July 28; Volume 6 (Issue 7); e1000115.; DOI:10.1371/journal.pmed.1000115
Journal Article > ResearchFull Text
BMC Infect Dis. 2020 September 16; Volume 20 (Issue 1); DOI:10.1186/s12879-020-05407-7
Horter SCB, Stringer B, Gray NSB, Parpieva N, Safaev K, et al.
BMC Infect Dis. 2020 September 16; Volume 20 (Issue 1); DOI:10.1186/s12879-020-05407-7
Introduction: Person-centred care, an internationally recognised priority, describes the involvement of people in their care and treatment decisions, and the consideration of their needs and priorities within service delivery. Clarity is required regarding how it may be implemented in practice within different contexts. The standard multi-drug resistant tuberculosis (MDR-TB) treatment regimen is lengthy, toxic and insufficiently effective. 2019 World Health Organisation guidelines include a shorter (9-11-month) regimen and recommend that people with MDR-TB be involved in the choice of treatment option. We examine the perspectives and experiences of people with MDR-TB and health-care workers (HCW) regarding person-centred care in an MDR-TB programme in Karakalpakstan, Uzbekistan, run by Médecins Sans Frontières and the Ministry of Health.
Methods: A qualitative study comprising 48 interviews with 24 people with MDR-TB and 20 HCW was conducted in June-July 2019. Participants were recruited purposively to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically using coding to identify emerging patterns, concepts, and categories relating to person-centred care, with Nvivo12.
Results: People with MDR-TB were unfamiliar with shared decision-making and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring the choice of appropriate treatment course to them. HCW had concerns about involving people in treatment choices, preferring that doctors made decisions. People with MDR-TB wanted to be involved in discussions about their treatment, and have their preference sought, and were comfortable choosing whether treatment was ambulatory or hospital-based. Participants felt it important that people with MDR-TB had knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership for treatment. Involving people in their care was said to motivate sustained treatment-taking, and it appeared important to have evidence of treatment need and effect.
Conclusions: There is a preference for doctors choosing the treatment regimen, linked to shared decision-making unfamiliarity and practitioner-patient knowledge imbalance. Involving people in their care, through discussions, information, and preference-seeking could foster ownership and self-responsibility, supporting sustained engagement with treatment.
Methods: A qualitative study comprising 48 interviews with 24 people with MDR-TB and 20 HCW was conducted in June-July 2019. Participants were recruited purposively to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically using coding to identify emerging patterns, concepts, and categories relating to person-centred care, with Nvivo12.
Results: People with MDR-TB were unfamiliar with shared decision-making and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring the choice of appropriate treatment course to them. HCW had concerns about involving people in treatment choices, preferring that doctors made decisions. People with MDR-TB wanted to be involved in discussions about their treatment, and have their preference sought, and were comfortable choosing whether treatment was ambulatory or hospital-based. Participants felt it important that people with MDR-TB had knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership for treatment. Involving people in their care was said to motivate sustained treatment-taking, and it appeared important to have evidence of treatment need and effect.
Conclusions: There is a preference for doctors choosing the treatment regimen, linked to shared decision-making unfamiliarity and practitioner-patient knowledge imbalance. Involving people in their care, through discussions, information, and preference-seeking could foster ownership and self-responsibility, supporting sustained engagement with treatment.
Journal Article > ResearchAbstract Only
Trop Med Int Health. 2021 January 6; Volume 26 (Issue 4); 421-427.; DOI:10.1111/tmi.13543
Gil H, Margaryan H, Azamat I, Ziba B, Bayram H, et al.
Trop Med Int Health. 2021 January 6; Volume 26 (Issue 4); 421-427.; DOI:10.1111/tmi.13543
OBJECTIVES
In this retrospective study, we evaluated the diagnostic accuracy of molecular tests (MT) for the detection of DR‐TB, compared to the gold standard liquid‐based Drug Susceptibility Testing (DST) in Karakalpakstan.
METHODS
A total of 6,670 specimens received in the Republican TB No 1 Hospital Laboratory of Karakalpakstan between January and July 2017 from new and retreatment patients were analyzed. Samples were tested using Xpert MTB/RIF and line probe assays (LPA) for the detection of mutations associated with resistance. The sensitivity and specificity of MTs were calculated relative to results based on DST.
RESULTS
The accuracy of MT for detection of rifampicin resistance was high, with sensitivity and specificity over 98%. However, we observed reduced sensitivity of LPA for detection of resistance; 86% for isoniazid (95%CI 82‐90%), 86% for fluoroquinolones (95%CI 68‐96%), 70% for capreomycin (95%CI 46‐88%) and 23% for kanamycin (95%CI 13‐35%).
CONCLUSIONS
We show that MTs are a useful tool for rapid and safe diagnosis of DR‐TB, however, clinicians should be aware of their limitations. Although detection of rifampicin resistance was highly accurate, our data suggests that resistance mutations circulating in the Republic of Karakalpakstan for other drugs were not detected by the methods used here. This merits further investigation.
In this retrospective study, we evaluated the diagnostic accuracy of molecular tests (MT) for the detection of DR‐TB, compared to the gold standard liquid‐based Drug Susceptibility Testing (DST) in Karakalpakstan.
METHODS
A total of 6,670 specimens received in the Republican TB No 1 Hospital Laboratory of Karakalpakstan between January and July 2017 from new and retreatment patients were analyzed. Samples were tested using Xpert MTB/RIF and line probe assays (LPA) for the detection of mutations associated with resistance. The sensitivity and specificity of MTs were calculated relative to results based on DST.
RESULTS
The accuracy of MT for detection of rifampicin resistance was high, with sensitivity and specificity over 98%. However, we observed reduced sensitivity of LPA for detection of resistance; 86% for isoniazid (95%CI 82‐90%), 86% for fluoroquinolones (95%CI 68‐96%), 70% for capreomycin (95%CI 46‐88%) and 23% for kanamycin (95%CI 13‐35%).
CONCLUSIONS
We show that MTs are a useful tool for rapid and safe diagnosis of DR‐TB, however, clinicians should be aware of their limitations. Although detection of rifampicin resistance was highly accurate, our data suggests that resistance mutations circulating in the Republic of Karakalpakstan for other drugs were not detected by the methods used here. This merits further investigation.
MSF Ethics Review Board > Publications
Public Health Ethics. 2016 November 1; Volume 10 (Issue 1); 49-61.; DOI:10.1093/phe/phw039
Schopper D, Ravinetto R, Schwartz L, Kamaara E, Sheel S, et al.
Public Health Ethics. 2016 November 1; Volume 10 (Issue 1); 49-61.; DOI:10.1093/phe/phw039
The Médecins Sans Frontières (MSF) ethics review board (ERB) has been solicited in an unprecedented way to provide advice and review research protocols in an 'emergency' mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at (very) early development stages. This article examines the MSF ERB's experience addressing issues related to both the process of review and substantive ethical issues in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees (ECs), we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the 'optimal' ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process.
Conference Material > Abstract
Horter SCB, Stringer B, Gray NSB, Parpieva N, Tigay Z, et al.
MSF Scientific Days International 2020: Research. 2020 May 20
INTRODUCTION
Person-centred care (PCC) is an internationally recognised priority, and a key underlying principle within MSF projects. PCC ensures that people are involved in their care and treatment decisions, and considers individuals' needs and priorities within service delivery. Clarity is required regarding how this may be implemented within different contexts. Multidrug-resistant tuberculosis (MDR-TB) treatment is lengthy, toxic and insufficiently effective, with recent developments changing the treatment landscape. WHO’s 2019 treatment guidelines include a shorter, 9-11 month-long treatment regimen, and recommends that people with MDR-TB should be involved in the decision around treatment option. We examine what PCC can look like in practice, through the perspectives and experiences of people with MDR-TB and health care workers (HCW) in Karakalpakstan, Uzbekistan.
METHODS
We carried out a qualitative study, comprising 48 interviews with people with MDR-TB (n=24; including repeat interviews with three participants) and healthcare workers (n=20), in Karakalpakstan in June-July 2019. In this setting, MSF and the Ministry of Health collaboratively have provided TB care since 1998. Participants were recruited purposively, to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically, using coding to identify emerging patterns, concepts and categories relating to person-centred care, with Nvivo12 (QSR International, Melbourne, Australia).
ETHICS
This study was approved by the ethics committees of Uzbekistan and the MSF Ethics Review Board.
RESULTS
People with MDR-TB were unfamiliar with shared decision-making, and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring to them to choose the appropriate treatment. HCW distrusted the effectiveness and appropriateness of the shorter treatment regimen, which may influence who is offered this option. Additionally, HCW had concerns about involving people in treatment choices, preferring that the doctor decide. However, people with MDR-TB wanted to be involved in discussions about their treatment, to have their preference sought, and were comfortable choosing the treatment location, whether ambulatory or hospital-based. Participants felt it important that people with MDR-TB have increased knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership of treatment. Involving people in their care was said to motivate sustained treatment-taking, which some felt directly observed treatment (DOT) delivery could undermine.
CONCLUSIONS
There was a preference for doctors choosing the treatment regimen, linked to unfamiliarity with shared decision-making and an imbalance between the perceived knowledge base of practitioners and patients. Involving people in their care, through discussions, information, and preference seeking could foster better ownership and self-responsibility, supporting sustained engagement with treatment, which DOT may contradict. These findings are important with MSF operations working to achieve PCC in practice, highlighting the need for approaches that are context specific and adapted to individuals’ preferences. Programmes should consider more person-centred approaches to treatment delivery, such as community or family DOT.
CONFLICTS OF INTEREST
None declared
Person-centred care (PCC) is an internationally recognised priority, and a key underlying principle within MSF projects. PCC ensures that people are involved in their care and treatment decisions, and considers individuals' needs and priorities within service delivery. Clarity is required regarding how this may be implemented within different contexts. Multidrug-resistant tuberculosis (MDR-TB) treatment is lengthy, toxic and insufficiently effective, with recent developments changing the treatment landscape. WHO’s 2019 treatment guidelines include a shorter, 9-11 month-long treatment regimen, and recommends that people with MDR-TB should be involved in the decision around treatment option. We examine what PCC can look like in practice, through the perspectives and experiences of people with MDR-TB and health care workers (HCW) in Karakalpakstan, Uzbekistan.
METHODS
We carried out a qualitative study, comprising 48 interviews with people with MDR-TB (n=24; including repeat interviews with three participants) and healthcare workers (n=20), in Karakalpakstan in June-July 2019. In this setting, MSF and the Ministry of Health collaboratively have provided TB care since 1998. Participants were recruited purposively, to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically, using coding to identify emerging patterns, concepts and categories relating to person-centred care, with Nvivo12 (QSR International, Melbourne, Australia).
ETHICS
This study was approved by the ethics committees of Uzbekistan and the MSF Ethics Review Board.
RESULTS
People with MDR-TB were unfamiliar with shared decision-making, and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring to them to choose the appropriate treatment. HCW distrusted the effectiveness and appropriateness of the shorter treatment regimen, which may influence who is offered this option. Additionally, HCW had concerns about involving people in treatment choices, preferring that the doctor decide. However, people with MDR-TB wanted to be involved in discussions about their treatment, to have their preference sought, and were comfortable choosing the treatment location, whether ambulatory or hospital-based. Participants felt it important that people with MDR-TB have increased knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership of treatment. Involving people in their care was said to motivate sustained treatment-taking, which some felt directly observed treatment (DOT) delivery could undermine.
CONCLUSIONS
There was a preference for doctors choosing the treatment regimen, linked to unfamiliarity with shared decision-making and an imbalance between the perceived knowledge base of practitioners and patients. Involving people in their care, through discussions, information, and preference seeking could foster better ownership and self-responsibility, supporting sustained engagement with treatment, which DOT may contradict. These findings are important with MSF operations working to achieve PCC in practice, highlighting the need for approaches that are context specific and adapted to individuals’ preferences. Programmes should consider more person-centred approaches to treatment delivery, such as community or family DOT.
CONFLICTS OF INTEREST
None declared
Conference Material > Abstract
Wardley T, West KP, Tesfay B, Robinson N, Parry L, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/a4TlzIISm
INTRODUCTION
Climate and environmental conditions are critical factors in malaria transmission. Médecins Sans Frontières (MSF) teams in South Sudan have seen changes in the timing and intensity of malaria seasonal peaks over the past decade. The Malaria Anticipation Project (MAP) aims to develop predictive early warning systems to better predict and act upon any expected rise in malaria cases, through routine surveillance.
METHODS
Predictive models were developed using environmental data collected from climate and space agencies and weekly outpatient department (OPD) malaria case count in Lankien hospital (Jonglei State, South Sudan) as the epidemiological input and output. An ensemble modelling approach was developed using linear regression and extreme gradient boosting (XGBoost) models in a recursive modelling framework. The models were developed using data from 2012–2020, verified with data from 2020–2022, and then monitored in real time in the 2022/23 season. To assess model performance, observed OPD malaria cases were compared with the monthly average cases and classified into categories to assess how often the model prediction was in the same category as the observed number of cases. We
also conducted a qualitative survey to explore community understanding of malaria and its relationship to climate.
RESULTS
During model development, the predictive performance was very high at 2 weeks’ lead time (75% classification accuracy). Model performance remained satisfactory at up to 8 weeks’ lead time (70% classification accuracy), while beyond this, it became increasingly susceptible to large prediction errors. In the 2020/21 and 2021/22 malaria seasons, the predictive performance at 2 weeks’ lead time was good, but it overpredicted for both seasons at 4–8 weeks. The 2022–23 season saw the lowest number of malaria cases of any year in the data used to train the model. The models predicted that the number of cases would be below the long-term average for Lankien hospital, but overpredicted the burden. Across all models, the shorter the lead time of the models, the greater their predictive performance.
CONCLUSION
This modelling approach has the potential to inform anticipatory action within an operationally useful timeframe. Given the models are trained on historical data and cannot include all factors affecting malaria transmission, if relationships between malaria and other conditions change over time, this will impact model performance, demonstrating the limits of forecasting approaches. The next stage of the MAP project will focus on replicability in other settings and pilot implementation to understand operational feasibility and improve performance.
Climate and environmental conditions are critical factors in malaria transmission. Médecins Sans Frontières (MSF) teams in South Sudan have seen changes in the timing and intensity of malaria seasonal peaks over the past decade. The Malaria Anticipation Project (MAP) aims to develop predictive early warning systems to better predict and act upon any expected rise in malaria cases, through routine surveillance.
METHODS
Predictive models were developed using environmental data collected from climate and space agencies and weekly outpatient department (OPD) malaria case count in Lankien hospital (Jonglei State, South Sudan) as the epidemiological input and output. An ensemble modelling approach was developed using linear regression and extreme gradient boosting (XGBoost) models in a recursive modelling framework. The models were developed using data from 2012–2020, verified with data from 2020–2022, and then monitored in real time in the 2022/23 season. To assess model performance, observed OPD malaria cases were compared with the monthly average cases and classified into categories to assess how often the model prediction was in the same category as the observed number of cases. We
also conducted a qualitative survey to explore community understanding of malaria and its relationship to climate.
RESULTS
During model development, the predictive performance was very high at 2 weeks’ lead time (75% classification accuracy). Model performance remained satisfactory at up to 8 weeks’ lead time (70% classification accuracy), while beyond this, it became increasingly susceptible to large prediction errors. In the 2020/21 and 2021/22 malaria seasons, the predictive performance at 2 weeks’ lead time was good, but it overpredicted for both seasons at 4–8 weeks. The 2022–23 season saw the lowest number of malaria cases of any year in the data used to train the model. The models predicted that the number of cases would be below the long-term average for Lankien hospital, but overpredicted the burden. Across all models, the shorter the lead time of the models, the greater their predictive performance.
CONCLUSION
This modelling approach has the potential to inform anticipatory action within an operationally useful timeframe. Given the models are trained on historical data and cannot include all factors affecting malaria transmission, if relationships between malaria and other conditions change over time, this will impact model performance, demonstrating the limits of forecasting approaches. The next stage of the MAP project will focus on replicability in other settings and pilot implementation to understand operational feasibility and improve performance.
Protocol > Research Study
Carrión Martín AI, Bil K, Salumu P, Baabo D, Singh JA, et al.
2014 September 18
The area of Walikale in North Kivu, Democratic Republic of Congo, is intensely affected by conflict and population displacement. Médecins-Sans-Frontières (MSF) returned to provide primary healthcare in July 2012. To better understand the impact of the ongoing conflict and displacement on the population, a retrospective mortality survey was conducted in April 2013. A two-stage randomized cluster survey using 31 clusters of 21 households was conducted. Heads of households provided information on their household make-up, ownership of non-food items (NFIs), access to healthcare and information on deaths and occurrence of self-reported disease in the household during the recall period. The recall period was of 325 days (July 2012–April 2013). In total, 173 deaths were reported during the recall period. The crude mortality rate (CMR) was of 1.4/10,000 persons/day (CI95%: 1.2–1.7) and the under-five- mortality rate (U5MR) of 1.9/10,000 persons per day (CI95%: 1.3–2.5). The most frequently reported cause of death was fever/malaria 34.1% (CI95%: 25.4–42.9). Thirteen deaths were due to intentional violence. Over 70% of all households had been displaced at some time during the recall period. Out of households with someone sick in the last two weeks, 63.8% sought health care; the main reason not to seek health care was the lack of money (n = 134, 63.8%, CI95%: 52.2–75.4). Non Food Items (NFI) ownership was low: 69.0% (CI95%: 53.1–79.7) at least one 10 liter jerry can, 30.1% (CI95%: 24.3–36.5) of households with visible soap available and 1.6 bednets per household. The results from this survey in Walikale clearly illustrate the impact that ongoing conflict and displacement are having on the population in this part of DRC. The gravity of their health status was highlighted by a CMR that was well above the emergency threshold of 1 person/10,000/day and an U5MR that approaches the 2 children/10,000/day threshold for the recall period.